N1T10N»L LlBRARV OF MEDICINE / • ^ + NLM 0006*1643 4 'j0pt6f-a£/ /Vl<- ( t?-M?.f?/f/W/-r'M-/i)- oV -?-a--j-/e- J (rtr/r-t w j<V\ ^r^ r .^"H*, WAR DEPARTMENT, Surgeon General's Office, Washington, 1). C, January 2, 1883. Brigadier General Charles H. Crane, Surgeon General, U. 8. Army. Sir: With the present volume, which I have the honor to submit to you, the surgical series of the Medical and Surgical History of the War of the Rebellion is complete. The treatment of regional injuries of gunshot origin is continued, and those of the Lower Extremities are taken up and thoroughly discussed in Chapter X. Miscellaneous Injuries not strictly gunshot in character, but incident to the military status, form the sub- ject of Chapter XI. Chapter XII, on Wounds and Complications, includes facts of general interest and of statistical value relative to wounds; to the nature, peculiarities, and effects of missiles and projectiles; to conditions affecting the course and results of wounds, with especial reference to the graver complications of secondary haemorrhage, erysipelas, pyaemia, gangrene, and tetanus; and, finally, a condensed summary of operations and treatment. Anaesthetics, with reference to their use in the Army, are treated of in Chapter XIII. A brief historical sketch of the Medical Staff, and a description of the Materia Chirurgica will be found in Chapter XIV. The methods of field, railway, and water transportation of the wounded are detailed in the concluding Chapter (XV). It was attempted, from the inception of the work, to give, in the beginning of each chapter, the number of cases to be treated therein. But, as the work progressed, new cases had to be added, duplicates had to be eliminated, or additional information changed the nature of a case, so as to transfer it to a group different from the one to which it had been originally assigned. Thus the total number of cases given in the beginning of a chapter was frequently found to be incorrect at its close, and as the preceding pages had been stereotyped, it was not practicable to make the necessary corrections. The percentages and general deductions, however, were not materially affected by these discrepancies, which have been corrected in the summary of cases given in Chapter XII, in this volume. In undertaking the completion of this work, interrupted by the untimely death of its distinguished author, it may be proper to say that no change in, or deviation from, the ill PREFATORY. o:urin.-.l plan has been attempted; that, so far as known, his wishes and intentions with rcur.rd lo the arrangement and development of the History have been scrupulously regarded. The work was entered upon, not without serious misgivings as to the wisdom of the choice <>f successor, and with a full appreciation of the delicate nature of the task and the difficulties involved in its satisfactory solution; its prosecution has been a source of pleasure, while the labor has been materially lessened by the valuable assistance afforded by Mr. 0. .1. Myers, who has been associated with the work as colaborer since its inception, and to whose faithful and assiduous care the reliability and accuracy of the History is largely due. The completed volume now awaits your approval and the judgment of the profession. It is hoped that its short-comings may not seriously impair or detract from the beauty and harmony of the masterpiece, which must remain a living monument to the intelligent industry, perseverance, and professional learning of the late Surgeon George A. Otis. I am, sir, Very respectfully, Your obedient servant, D. L. HUNTINGTON, Surgeon, U. S. Army, IV TABLE OF CONTENTS PART III OF VOLUME II OF TIIK MEDICAL AND SURGICAL HISTORY OF THE REBELLION, BEING THE THIRD STIROIC^L VOLUME. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES. Page. INTRODUCTION............................................... 1 Table I. Collated returns, indicating the relative fre- quency of shot wounds of the lower extremity in aggregates of wounded men who came under treatment 2 Table II. Partial numerical statement of shot wounds of the lower extremities in the field or primary hospitals in various campaigns during the last year of the war, 1864-'65.......................................... 3 SECTION I. Flesh Wounds of the Lower Extremities .. 5 Punctured and Incised wounds................ 5 Bayonet wounds................................ 5 Abstracts of four cases.......................... 6 Sabre wounds................................... 7 Other Punctured and Incised wounds............... 7 Ligations..................................... 7 Abstracts of three cases .................. 7 A mputations................................. 8 Abstracts of four cases................... 8 Shot Flesh wounds............................... 8 Flesh wounds of the Lower Limbs with injury of the Nerves......................................... 9 Abstracts of seven cases.................... 10 Flesh wounds of the Lower Limbs with injury of the Larger Iilood-\ essels............................ 13 Wounds of Blood-vessels treated without operation 13 Abstracts of six cases......................... 13 Wounds of Blood-vessels treated by ligation ........ 16 Abstract of one case.......................... lb' Wouuds of Blood-vessels treated by amputation.... 17 Abstracts of two cases........................ 17 Plate XXVIII. Gangrene following a shot lacera- tion of the Femoral Artery, facing................ 18 Wounds of Blood-vessels treated by ligation and subsequent amputation......................... 18 Abstract of one case......................... 18 Klesh wounds of the Lower Limbs unattended by Primary injury of the Large Nerves and Blood- vessels ......................................... lg Shot Lacerations.................................. 19 Abstracts of five cases............... ........ 19 Lodgement of Missiles............... ............ 21 Abstracts of six cases........................ 21 Peri-articular wounds. Hip, Knee, and Ankle....... 24 Abstracts of twenty-nine cases................. 25 Plate LVI. Dry Traumatic Arthritis of the Right Hip, facing..................................... 27 Page. 1. Shot Flksh Wounds—[Continued. Complications of Shot Flesh wounds of the Lower Extremities............................. 32 Pysemia........................................ 32 Abstracts of three cases...................... 32 Hospital Gangrene................................ 33 Abstracts of three cases....................... 33 Tetanus......................................... 35 Abstracts of three cases....................... 36 Erysipelas....................................... 37 Abstracts of two cases........................ 37 Hemorrhage..................................... 37 Abstracts of two cases..................... 38 Ligations of Blood-vessels of the Lower Limbs after Flesh wounds.......................... 38 Ligations of the Common Iliac Artery.......... 39 Abstract of one case....................... 39 Ligations of the External Iliac Artery.......... 39 Abstracts of eleven cases.................. 39 Ligations of the Femoral Artery............... 43 Abstracts of seven cases .................. 43 TABLE III. Summary of one hundred and twenty-seven cases of ligations of the Femoral Artery........................ 47 Ligations of the Profunda Artery.............. 49 Abstracts of six cases..................... 49 Ligations of large branches of the Profunda Artery..................................... 50 Abstracts of three cases .................. 50 Ligations of the Popliteal Artery.............. 50 Table IV. Summary of seventeen cases of ligations of the Popliteal Artery.......... 50 A bstract of one case.................. 51 Ligations of the Posterior Tibial Artery........ 51 TABLE V. Summary of seventeen cases of ligations of the Posterior Tibial Artery___ 51 Ligations of the Anterior Tibial Artery........ 51 Abstracts of ten cases .................... 51 Ligations of the Anterior and Posterior Tibial Arteries............................ ....... 52 Abstracts of two cases..................... 52 Ligations of Veins........................... 52 Abstract of one case..................... 52 Amputations in the Lower Limbs after Shot Flesh wounds.................................. 53 Amputations in the Thigh......................... 53 Abstracts ot two cases........................ 53 V TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES- -Coxnxi'Ki). Page. SECTION I—Flesh Woim.s, ETC.—[Continued. Plate XXVII. Effects of Hospital Grangrene, facing ......................................... 53 Table VI. Summary of one hundred and thirty- one amputations in the Thigh................. 54 Amputations at the Knee.......................... 56 TABLE VII. Summary of six cases of amputa- tions at the Knee.......................... 5(i Amputations in the Leg......................... 57 Abstracts of two cases ................... 57 Table VIII. Summary of sixty-three amputa- tions in the Leg............................ 57 Amputations of the Toes.......................... 59 Abstract of one case........................... 59 Tenotomy...................................... 59 Abstracts of three oases........................... 59 SECTION II. Wounds and Injuries of the Hip Joint..... 61 Shot fraccures at the Hip Joint ............... til Table IX. Tabular statement of three huudred and eighty-six shot fractures of the Hip Joint......... 65 Shot fractures at the Hip treated by conservation . .. 66 Recoveries ................................... t>7 Abstracts of twenty-one cases.............. <>7 Pi. \ in LV11. Gunshot fracture of the Right Ace- tabulum and the Head of the Femur, facing... tin PLATE XXXIII. Consolidated gunshot fracture of the Femur, facing........................ 74 Fatal cases................................... 77 Abstracts of fifty-two cases..........".. '7 Excision at the Hip Joint after shot injury.......... 89 TABLE X. Numerical statement of sixty-six eases of excision at the Hip Joint for shot injury.. . 89 Primary excisions at the Hip Joint............. 92 Abstracts of thirty-three cases............. 92 TABLE XI. Nummary of thirty-three eases. 99 Intermediary excisions at the Hip Joint......... 1(11 Abstracts of twenty-two cases............. 101 Table XII. Summary of twenty-two cases 111 Secondary excisions at the Hip Joint ..... 113 Abstracts of eleven cases ................. 113 TABLE XIII. Summary of eieven cases ... 119 Excisions at the Hip Joint for shot injury in the United States service since the war........... 120 Abstracts of six cases..................... 120 Amputations at the Hip Joint...................... 127 TABLE XIV. Numerical statement of sixty-six cases of amputation at the Hip Joint.......... 127 Primary amputations at the Hip Joint.......... 131 Abstracts of twenty-five cases............. 131 TABLE XV. Summary of twenty-five cases. 138 Intermediary amputations at the Hip Joint...... 139 Abstracts of twenty-three cases............ 139 Table XVI. Summary of twenty-three cases................................... 144 Secondary amputations at the Hip Joint........ 145 Abstracts of nine cases.................... 145 Table XVII. Summary of nine cases..... 151 Re amputations at the Hip Joint............... ! 52 Abstracts of nine cases.................... 152 TABLE XVIII. Summary of nine cases--- 159 SECTION III. Injuries in the Shaft of the Femur........ 169 Slmt contusions of the Shaft of the Femur .. 169 Table XIX. Numerical statement of one hundred and sixty-two cases of shot contusions of the Shaft of the Femur .................................. 170 Abstracts of four cases............................ 170 Ligations after shot contusions of the Femur........ 172 Abstracts of eight cases...................... 172 Amputations consequent on shot contusions of the Femur......................................... 172 Abstracts of nine eases....................... 173 shot fractures of the Shaft of the Femur..... 174 Table XX. Numerical statement of sixty-five hun- dred and seventy six shot fractures of the Shaft of the Femur.........................■............ I75 Page. SECTION III.—Injuries of Femub—[Coutinued. Partial shot fractures of the Shaft of the Femur--- 175 Abstracts of two cases........................ 176 Shot fractures of the Shalt of the Femur trented by conservation.................................... 176 Shot fractures of the upper third of the Shaft of the Femur.................................. 177 Recoveries (abstracts of thirteen cases) .... 178 PLATE LIX. Consolidated gunshot fractures of the Femur, facing..............................•*- ■ • 178 PLATE LVIII. Consolidated gunshot fractures of the Femur, facing.................................. 180 Plate LV. Two views of a united shot fracture of the Right Femur over eleven years after injury, facing 182 Fatal cases (abstracts of seven cases)....... 184 PLATE XXV. Secondary inflammation of the Knee Joint, facing.................................... 184 Shot fractures of the middle third if the Femur treated by conservation.............. ...... 187 Recoveries (abstracts of eleven cases)...... 187 Plate LX. Consolidated gunshot fractures of the Femur, facing........................... 188 Plate LXI. Consolidated gunshot fractures of the Femur, facing........................... 190 Fatal cases (abstracts of five cases)........ I9L Plate LXII. Consolidated gunshot fractures of the Femur, facing........................... 192 Plate XXIV. Osteomyelitis in a fractured Fe- mur, facing................................. 194 Shot fractures of the lower third of the Femur treated by conservation...................... 194 Recoveries (abstracts of eight cases)....... 194 PLATE LXIII. Consolidated gunshot fractures of the Femur, facing........................ 190 Fatal eases (abstracts of three eases)....... 197 Plate LX1V. Consolidated gunshot fractures of the Femur, facing....................... 198 Shot fractures of the Femur, without indication of the seat of injury, treated by conservation I'Jb Psetiilarthrosis after shot fractures of the Fe- mur........................................... I! 8 Abstracts of two cases.............. 198 Fxcisions in the continuity of the lemur for shot injury ...................... ........... 199 Table XXI. Numerical statement of one huudred and seventy-five excisions in the Shaft 4if the fe- mur for shot injury........................... 2C0 Primary excisions in the Shaft of the Femur........ 2U0 Recoveries (abstract* of four cases)............ 200 TABLE XXII. Summary of twenty cases of re- covery ..................................... 203 PLATE XXX. Obstructed femoral vein, facing.. 204 Fatal cases (abstracts of five cases)............ '^D4 TABLE XX11I. Summary of sixty-five fatal eases 2(!6 Undetermined cases........................... 207 TABLE XXIV. Summary of six eases with un- known results............................ 207 Intermediary excisiims in the Shaft of the l-Viniir . . 207 Recoveries (abstracts 4>f two cases)............. 207 TABLE XXV. Summary of nine cases of re- covery ..................................... 208 Fat:.! < ases (abstracts of three cases)....... 209 Table XXVI. Summary 4)f thirty-nine fatal cases...................................... 210 Secondary excisi4>ns in the Shaft of the Femur..... 210 Recoveries (abstracts of two cases) .. ......... 210 Fatal cases (abstract of one case).............. 211 Table XXVII. Summary of nineteen cases .. 212 Kxcisions in the Shaft of the Femur at an unknown period........................................... 212 TABLE XXVIII. Summary of seventeen eases 212 Amputations in the shaft of the lemur........ 213 Table XXIX. Numerical statement of sixty-two hundred and twetity'nine amputations of the Thigh for shot injury.................................. 213 VI TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES—Continued. 226 242 Page. SECTION III.—INJUKIES OF FEMUR— [Continued. Primary amputations in the Shaft of the Femur .... 214 Primary amputations in the upper third of the Femur..................................... 214 Successful cases (abstracts of four cases). ... 215 Fatal cases (abstracts of three cases)....... 216 Table XXX. Summary of five hundred and thirty-three cases....................... 217 Primary amputations in the middle third of the Femur...................... ............ 22:) Successful cases (abstracts of five cases).... 223 PLATE LX1X. Tubular sequestra from am- putations of the Femur, facing........... 221 Fatal cases (abstracts 4if five cases)........ 225 PLATE XXXII. Diseased stump of Femur, fnciujr..... ........................ TABLE XXXI. Summary of eleven hun- dred and fifty-sev4Ui cases............ PLATE XXXI. Caugrenc of tho Medulla .. Primary amputations in the lower third of the Femur..................................... Successful 4 ascs (abstracts of seven cases).. PLATE I.XX. Involucra of the Femur, facing.................................. Fatal cases (abstracts of two cases)........ 244 TABLE XXXII. Summary of nineteen hun- dred and fourteen cases.................. 245 Primary amputations in the Femur without in- dication of the seat of incision............... 268 TABLE XXXIII. Summary of three hun- dred and f4>rty-five cases................. 268 Intermediary amputations in the Shaft of the Femur. 272 Intermediary amputations in the upper third of the Femur................................. 272 Successful cases (abstracts of four cases)...... 272 Fatal cases (abstract of one case).............. 274 TABLE XXXIV. Summary of one hundred and forty-seven cases............................ 275 Intermediary amputations in the middle third of the Femur......................................... 217 Successful cases (abstracts of four cases)....... 277 PLATE XXVI. Osteomyelitis of Femur, facing. 278 Fatal cases (abstracts of two cases)............ 27!) TABLE XXXV. Summary of four hundred and seventy-one cases........................... 280 Pl UK XLII. Round musket ball in the medul- lary cavity of the Femur, facing............. 280 Intermediary amputations in the lower third of the Femur......................................... 287 Successful cases (abstracts of five cases)....... 287 Fatal cases (abstracts of five cases)............ 289 Plate XLIII. Results of Osteomyelitis, facing . 290 PLATE XXI. Gangrene of a Thigh Stump, facing...................................... TABLE XXXVI. Summary of six hundred and seventy-six cases............................ Plate XX. Femoral artery and Femoral vein after amputation, facing..................... 294 Intermediary amputations in the Femur without in- dication of the seat of incision................... TABLE XXXVII. Summary of twenty-six cases. Secondary amputations in the Shaft of the Femur... Secondary amputations in the upper third of the Fe- mur............................................ Successful cases (abstracts of four cases)....... 304 Fatal cases (abstracts of three cases)........... 306 Plate LX VI. Shot fracture of the middle third of the Femur, facing........................ 306 Table XXXVIII. Summary of fifty-five cases. 308 Secondary amputations in the middle third of the Fe- mur............................................ 3CS Successful cases (abstracts of five cases)....... 309 Fatal cases (abstracts of three cases)........... 311 Plate XXIII. ' Separation of Periosteum in Os- teomyelitis, facing.......................... 312 292 293 303 304 304 304 Page. SLVTION III.—INJUKIES OF FI..MUU— [Continued. Table X X XIX. Summary of one hundred and sixty eight cases............................ Plate XLIX. Medullary abscesses of the Fe- mur, facing................................. Secondary amputations in the lower third of the Femur Successful cases (abstracts of four cases)....... Plate LXXII. Involucra of bones 4>f the Leg, facing..................................... Fatal eases (abstracts of two cases)............ Table XL. Summary of two hundredandseven Secondary amputations 4>f Thigh, point of ablation not specified.................................... Abstract of one fatal ease..................... Table XLI. Summary of twelve cases....... Amputations in the 4ontiiinity of the Femur of uncertain date .. ............................ Amputations in the upper third of the Femur of uncertain date.................................. TABLE XLII. Summary 4>f thirty-three cases.. Amputations in the middle third of the Femur of uncertain date.................................. Table XLIlf. Summary of seventy cases .... Amputations in the lower third 4>f the Femur of un- certain date................................... TABLE XLIV. Summary of 4ine hundred and four cases.................................. Amputations in the Femur of uncertain date, and seat of operation................................ TABLE XLV. Summary of three hundred and eleven cases................................ Recapitulation ................................... TABLE XLVI. Tabular statement indicating the seats of injury in six thousand two hundred and twenty-nine amputations in the Thigh............ TABLE XLVII. Results of amputations of the Thigh on the occasions named and from the authorities quoted......................................... Concluding observations on shot injuries of the Femur ...................................... TABLE XLVIII. Results of shot fractures of the Fe- mur treated by conservation on-the occasions named and from the authorities quoted.................. Table XLIX. Summary of twenty-one ligations of the Femoral artery in cases of shot fractures of the Femur treated by conservation................... Table L. Numerical statement of Union and Confederate soldiers treated by conservation after shot fracture of the Femur.............. Excisions in the Shaft of the Femur................ Amputations in the Thigh......................... PLATE LXXIII. Thigh stumps, facing............ Table LI. Statement of the ages of six thousand two hundred and nine patients who submitted to amputation of the Thigh for shot injury.......... SECTION IV. Wounds and Injuries of the Knee Joint .. Punctured and incised wounds................. Punctured wounds (abstracts of ten cases).......... I ncised wounds................................... Incised wounds treated without operative inter- ference ..................................... Abstracts of ten cases..................... Amputations in the Thigh after incised wounds.. Abstracts of six cases..................... Shot injuries of the Knee Joint................. Shot contusions of the Knee Joint................. Treated by conservation...................... Recoveries (abstracts of ten cases)......... Fatal cases (abstracts of six cases)......... Treated by amputation....................... Shot fractures of the Knee Joint.................... TABLE LII. Numerical statement of thirty-three hundred and fifty-five cases of shot fractures of tho bones of the Knee Joint............... 314 316 316 317 318 323 323 323 324 324 324 325 326 326 327 327 331 334 335 355 355 355 356 358 359 359 360 361 361 361 362 362 363 363 364 364 365 367 367 VII TARLK OF CONTENTS. CHAPTER X. WOUND3 AND INJURIES Or THE LOWER EXTREMITIES—Coxti.m f.d. K JoiXT— [Coutinued. i)f the Knee Joint treated by eou- Page. SECTION IV.-Ix.tURIKS OF Kx sh4>t fracture servation................................... 3ii8 Recoveries (abstracts 4>f twenty -three eases). 369 Plate 1.XVIII. Results 4>f sbf>t injuries <.f the Knee Joint, facing................... 370 Plate LXV1I. P.all h>dged in outer C4)n- dyle 4,f Left Femur 4>ver 15 years, facing. .. 372 Fatal cases abstracts < f fifteen cases)...... 380 Kxcisions at.the Knee Joint for shot injury .. :!!-4 TABLE LIII. Classified statement of fifty- seven eases 4if excisions at the Knee Joint for shot fracture........................ 385 Primary excisions at the Knee Joint........ ::80 Abstracts 4>f thirty-two cases.......... 386 PLATE LXV. Successful excisions of the Knee Joint after shot injury, facing...... 386 Intermediary excisions at the Knee Joint.... 391 Abstracts of thirteen eases............ 391 Secondary excisions at the Knee Joint...... 394 Abstracts of seven cases............... 394 Excisions at the Knee Joint cf uncertain date 397 Abstracts 4>f five cases............... 3S^7 Amputation at the Knee -Joint................. 397 Table LI V. Summary of one hundred and eighty-nine amputations at the Knee J4>int for shot fracture........................ 398 Primary amputati4>ns at the Knee Joint .... 398 Abstracts of five cases................ 399 TABLE LY. Summary of one hundred and eight cases..................... 401 Intermediary amputations at the Knee Joint 404 Abstracts of five cases................ 404 TABLE LVI. Summary of fifty-one eases.............................. 405 Secondary amputations at the Knee Joint... 407 Abstracts of four cases................ 407 Table LVII. Summary of twenty-six eases............................... 409 Amputations at the Knee Joint of uncertain date................................... 410 Table LVIII. Summary of four cases 410 Concluding ohscrvations on shot injuries of the Knee Joint.......................... 411 TABLE LIX. Shot wounds of the Knee Joint treated by conservation 4>n the occasions named and from the authorities quoted.............. 417 Excisions at the Kuee J4iint.................... 419 Table LX. Excisions at the Knee Joint for shot injury on the occasions named and from the authorities quoted.............. 422 Amputations at the Knee Joint................ 423 SECTION V. Wounds and Operations in the Leg........ 427 Sliot contusions of the hones of the Leg...... 427 Treated by conservation........................... 427 Recoveries (abstracts of six cases).............. 427 PLATE LXXI. Tubular sequestra and pieces of necn>sed bone from tibia, facing.............. 428 Deaths (abstracts of three cases)............... 430 Followed by amputation.......................... 430 Abstracts of eight cases....................... 431 Shot fractures of the hones of the Leg....... 432 Table LXI. Descriptive numerical statement 4>f the nature and treatment of eight thousand nine hundred and eighty-eight shot fractures of the bones 4.f the Leg.............................. 432 Shot fractures of the bones of the Leg treated by con- servation ...................................... 432 Shot fractures of the Tibia treated by conservati4>n 433 Recoveries (abstracts of nine cases)........ 433 PLATE LXXIV. Upper portion of right Tibia sawn longitudinally, facing........ 434 Deaths (abstracts 4>f three cases)........... 436 Shot fractures of the Fibula treated by con- servation ................................... 437 Page. SECTION V.—WOUXDS OF LEG—[Continued. Kee4)veries (abstracts of two cases)......... 437 Deaths (abstract 4>f one case).............. 437 Shot fractures of both b4>nes treated by con- servation ................................... 438 l!eeoY4wies (abstracts of eight cases)....... 438 Deaths (abstracts of three cases)........... 441 Excisions in the continuity of the hones of the Leg for shot injury.............................. 444 Table LXII. Numerical statement of three hundred and eighty-seven excisions in the bones of the Leg for shot fracture............ 445 Primary excisions in the bones of the Leg...... 445 Abstracts of nine cases...................... 445 Table LXI1I. Summary of two huudred and fifteen cases........................ 449 Intermediary excisions in the bones of the Leg.. 453 Abstracts of six cases....................... 453 TABLE LX1V. Summary of eighty-seven cases................................... 455 Secondary excisions in the bones of the Leg.... 456 Abstracts of four cases...................... 456 TABLE LXV. Summary of fifty cases___ 458 Excisi4>ns in the bones of the Leg of uncertain date...................................... 459 Table LXVI. Summary of thirty-five cases 460 Amputations in the continuity of the Leg for shot fracture ................................... 460 TABLE LXVII. Numerical statement of fifty- four hundred and fifty-two amputations of the Leg for shot injury.......................... 461 Primary amputations in the continuity of the Leg for shot injury.............................. 461 Primary amputations in the upper third of the Leg................................ 461 Abstracts of ten cases................. 461 TABLE LXVIII. Summary of one thou- sand and twenty-nine cases.......... 466 Primary amputations in the middle third of the Leg................................ 478 Abstracts of eight cases............... 478 PLATE LXXVI. Laceration of right Leg by solid shot, facing............ 478 TABLE LXIX. Summary of eight hun- dred and ninety-two cases........... 480 Primary amputations in the lower third of the Leg................................ 491 Abstracts of eight eases............... 491 TABLE LXX. Summary 4)f nine hun- dred cases ......................... 494 Primary amputations in the Leg—seat of operation not indicated.................. 505 Successful cases (abstracts of four cases) 505 Fatal cases (abstracts of two cases) .... 506 Table LXXI. Summary of five hun- dred and seventy-one eases ......... 506 Intermediary amputat'mns in the continuity of the Leg for shot injury.......................... 512 Intermediary amputations in the upper third of the L4g............................. 513 Successful cases (abstracts of six cases). 513 Fatal cases (abstracts of three cases)... 514 Table LXX1I. Summary of two hun- dred and ninety-six cases............ 515 Intermediary amputations in the middle third of the Leg.............................. 519 Successful cases (abstracts of five cases) 520 Fatal cases (abstracts 4>f three cases) .. 521 TABLE LXXIII. Summary of three hundred and sixty-eight cases........ 522 Intermediary amputations in the lower third of the Leg............................. 509 Successful cases (abstracts of six cases) 528 Fatal cases (abstracts of four cases)___ 529 TABLE LXXIV. Summary of three hundred and thirty-five eases........ 531 VIII TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES—Continued. SECTION V.—WOUNDS OF Leg—[Continued. Intermediary amputations in the Leg—point of operation not specified....................... 536 Abstracts of two examples................ 536 TABLE LXXV. Summary of forty-seven cases................................... 536 Secondary amputations in the continuity of the Leg for shot injury.................................. 537 Secondary amputations in tho upper third of the Leg.:...................................... 537 Examples of recovery (abstracts of five cases) 537 Fatal cases (abstraots of four cases)........ 539 Table LXXVI. Summary of one hundred and thirty-three cases................... 541 Secondary amputations in the middle third of the Leg.................................... 544 Recoveries (abstracts of five cases)......... 544 Fatal cases (abstraots of three cases)....... 546 TABLE LXXVII. Summary of one hundred and seventy-four cases.................. 547 Secondary amputations in the lower third of the Leg........................................ 550 Recoveries (abstracts of three cases)........ 550 Fatal cases (abstracts of three cases)....... 551 Table LXXVIII. Summary of one hun- dred and twenty-one cases............... 552 Secondary amputations in the Leg—third not indicated................................... 554 Recoveries (abstract of one case)........... 554 Fatal cases (abstract of one case).......... 554 Table LXXIX. Summary of sixteen cases 555 Amputations in the continuity of the Leg of uncer- tain date....................................... 555 Amputations in the upper third of the Leg of uncertain date.............................. 555 Table LXXX. Summary of fifty-one cases 555 Amputations in the middle third of the Leg of uncertain date.............................. 556 Table LXXXI. Summary of forty-seven cases................................... 556 Amputations in the lower third of the Leg of uncertain date.............................. 557 TABLE LXXXII. Summary of fifty-one cases................................... 557 Amputations in the Leg of uncertain date and seat of operation............................ 558 TABLE LXXXIIL Summary of four hun- dred and twenty-one cases............... 558 Recapitulation.................................... 563 Concluding observations on shot fractures of the Bones of the Leg........................ Table LXXXTV. Results of shot fractures of the bones of the Leg treated by conservation on the occasions named and from the authorities quoted.. Excisions in the continuity of the bones of the Leg.. TABLE LXXXV. Results of shot fractures of the bones of the Leg treated by excision on the occasions named and from the authorities quoted 570 Amputations in the Leg........................... 572 Table LXXXVI. Summary of seven thousand six hundred and thirty-seven amputations in the Leg for shot injuries on the occasions named and from the authorities quoted.................. 573 SECTION VI. Wounds and Operations at the Ankle Joint 577 Shot contusions of the Ankle Joint............ 577 Shot contusions of the bones of the Ankle Joint treated by conservation.......................... 577 Abstracts of seven cases...................... 577 Shot fractures of the Bones of the Ankle Joint............................................. 578 Table LXXXVII. Summary of one thousand seven hundred and eleven shot fractures of the Tibio- tarsal Articulation.............................. 578 Shot fractures of the bones of the Ankle Joint treated by conservation................................. 579 Abstracts of twenty cases..................... 579 2* 563 564 569 Page. SECTION VI.—Wounds of Ankle Joint—[Continued. Excisions at the Ankle Joint for shot injury... 585 TABLE LXXXVIII. Numerical statement of thirty-three excisions at the Ankle Joint for shot injury................................. 585 Primary excisions at the Ankle Joint........... 586 Abstracts of eleven cases.................. 586 Intermediary excisions at the Ankle Joint...... 588 Abstracts of eight cases................... 588 Secondary excisions at the Ankle Joint........ 591 Abstracts of nine cases.................... 591 Excisions at the Ankle Joint—time between the injury and operation unknown................ 594 Abstracts of five cases.................... 594 Amputations at the Ankle Joint............... 595 Table LXXXIX. Numerical table of one hun- dred and sixty-one amputations at the Ankle Joint for shot injury......................... 595 Primary amputations at the Ankle Joint........ 595 Plate LXXV. Amputations at the Ankle Joint, facing.......................................... 596 Successful cases (abstracts of eight cases) . 596 Fatal cases (abstracts of four cases)........ 598 TABLE XC. Summary of one hundred and three cases............................. 599 Intermediary amputations at the Ankle Joint___ 603 Successful cases (abstracts of five cases)... 603 Fatal cases (abstracts of two cases)........ 604 Table XCI. Summary of thirty-nine cases 605 Secondary amputations at the Ankle Joint...... 606 Abstracts of two cases.................... 606 TABLE XCII. Summary of thirteen cases. 607 Amputations at the Ankle Joint of uncertain date 608 TABLE XCLTT. Summary of six cases..... 608 Concluding observations on shot injuries of the Ankle Joint................................ 608 Excisions at the Ankle Joint for shot injury..... .610 TABLE XCIV. Results of excisions at the Ankle Joint on the occasions named and from the authorities quoted................ 610 Amputations at the Ankle Joint................ 612 TABLE XCTV. Results of amputations at the Ankle Joint on the occasions named and from the authorities quoted.......... 614 SECTION VII. Wounds and Operations in the Foot..... 617 Bayonet wounds of the Bones of the Foot... 617 Shot wounds of the Bones of the Foot........ 617 Shot contusions of the bones of the Foot........... 617 Abstracts of two cases......................... 617 Shot fractures of the bones of the Foot............. 618 Table XCV. Summary of five thousand eight hundred and thirty-two shot fractures of the bones of the Foot........................... 618 Shot fractures of the bones of the Foot treated by conservation............................. 618 Abstracts of sixteen cases................. 619 Kxcisions in the Bones of the Foot.............. 622 TABLE XCVI. Numerical statement of ninety-seven cases of excisions in the bones of the Foot............................. 622 Primary excisions in the bones of the Foot.. 623 Abstracts of seven cases............... 623 Intermediary excisions in the bones of the Foot................................... 624 Abstracts of four cases................ 624 Secondary excisions in the bones of the Foot 625 Abstracts of two cases................ 625 TABLE XCVII. Summary of ninety-seven cases of excisions in the bones of the Foot 626 Amputations in the Foot......................... 627 Table XCVIII. Numerical statement of one thousand five hundred and eighteen cases of amputations in the Foot......... 628 Primary amputations in the Foot........... 628 Abstracts of ten cases................. 628 IX TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES—Continued Page. SECTION VII.—WOUND8 OF Foot—[Continued. Table XCIX. Summary (>f one hundred and sixty-one cases .................... 630 Intermediary amputati4>us in the Fo4>t...... 633 Abstracts of three cases............... 633 TABLE C. Summary 4>f fifty-two cases. 633 Secondary amputations in the Foot........ 634 Abstracts of two cases................ 634 Page. SECTION VII.—Wounds OF FOOT—[Continued. TABLE CI. Summary of eighteen cases 635 Amputations in the Foot of uncertain date.. 035 Abstract of one case.................. 636 Table CII. Summary of sixty cases 636 Concluding observations........................ 637 Excisions in the bones of the Foot................. 637 Amputations in the Foot.......................... 639 CHAPTER XI. MISCELLANEOUS INJURIES. SECTION I. TABLE CIIL Summary of one hundred and seventy- one th4>usand five hundred and 6ixty-five miscel- laneous injuries................................. TABLE CIV. Summary of one thousand three hun- dred and thirty-six deaths from various causes .... Burns and scalds...................................... Abstracts of four cases........................... Contusions and sprains................................ Abstracts of six cases............................. Concussion and compressi4>n of the Drain............... Dislocations.......................................... Abstracts of fourteen cases........................ Simple and compound fractures ..................... Abstracts of fifteen cases.......................... Punctured, incised, and lacerated wounds.............. Abstracts 4>f nine cases............................ Other accidents and injuries ......................... Abstra^s of six cases............................ SECTION II. Operations for Miscellaneous Injuries___ Kxcisions.......................................... Table CV. Numerical statement of forty-five cases of excisions following miseellaueous injuries or diseases ....................................... Abstracts of two cases........................ Table CVI. Summary of twenty cases....... Amputations...................................... Amputations in the Upper Extremities............. Table CVII. Numerical statement of one hun- dred and ninety-five cases of amputations in the Upper Extremities for disease or f4>r injury not inflicted by weapons of war.............. Page. SECTION II.—Operations fob. Misckl. Injuries—(Continued. Abstracts of three cases....................... 660 Table CVIII. Summary of one hundred and two cases.................................. 661 Amputations in the Lower Extremities............. 664 TABLE CIX. Table of five hundred and eighty- three cases of amputati4>ns in the Lower Ex- tremities for disease or f4>r injury ii4>t inflicted by weapons of war......................... 664 Abstracts of four cases....................... 665 Table CX. Summary of one hundred and forty- nine amputations in the Thigh for miscel- laneous injuries or diseases.................. 666 Exarticulations at the Knee Joint.............. 670 Abstracts of four cases.................... 670 Amputations in the Leg...................... 670 Abstract of one case...................... 671 Table CXI. Summary of two hundred and fifty-nine cases.......................... 671 Amputations in the Foot...................... 677 TABLE CXII. Summary of fifty-one cases 677 Amputations of the Toes...................... 678 Abstract of one case...................... 678 Ligations.......................................... 679 Abstracts of ten cases............................ 680 Operations on the Eye or its appendages.............. 681 Table CXIII. Summary of seventy-six cases .... 681 Operations on the Mouth and its appendages............ 684 Operations on the Air Passages....................... 684 Operations on the Chest and Abdomen................. 684 Operations on the Genito-Iirinary organs............. 684 CHAPTER XII. WOUNDS AND COMPLICATIONS. Page. TABLE CXIV. Frequency of sabre and bayonet and shot wounds on occasions named and from authorities quoted. 685 Sabre and Bayonet Wounds..................... 686 Table CXV. Summary of nine hundred and twenty- two sabre and bayonet wounds recorded during the American civil war, 1861-'65..................... 686 Shot Wounds...................................... 687 Table CXVI. Tabular statement of the shot wounds of the Head, Face, and Neck recorded during the American civil war............................. 688 TABLE C'XVII. Tabular statement of the shot wounds of the Spine, Chest, Abdomen, Pelvis, and Back re- corded during the American civil war............ 689 TABLE CXVIII. Tabular statement of the shot wounds of the Upper and Lower Extremities recorded during the American civil war.......... 690 TABLE CXIX. Table indicating percentage of fa- tality and relative frequency of shot wounds re- corded during the War of the Rebellion.......... 69] TABLE CXX. Tabular statement of the relative fre- quency of shot wounds of the different regions of the body....................................... 693 Definition of shot injuries.......................... 694 Fire-arms and their projectiles..................... 695 Table CXXI. Table indicating the seat of the injury and nature of the projectile in the cases of shot wounds reported during the w ar....... 696 Explosive balls.......................... 701 Page. Abstracts of sixteen cases................. 702 Effects of large projectiles......................... 704 Abstracts of five cases......................... 704 Effects of missiles and projectiles from small arms.. 708 Abstracts of two cases....................... 709 PLATE LXXV1II. Distorted bullets, facing........... 710 Entrance and exit wounds......................... 711 Plate XXXIX. Early appearance of entrance and exit wounds, facing...................................... 712 Effects of projectiles on muscular tissue and tendons. 712 Effects of missiles and projectiles on bony structure. 713 Abstracts of eleven cases...................... 714 Plate XL. Early appearances of entrance and exit wounds, facing.................................... 714 Table CXXII. Numerical statement of shot contu- sions of the bones of the Head, Trunk, and Y.x tremities..................................... 716 Simple fractures (abstract of one case).............. 718 Partial fractures (abstract of one case).............. 719 Penetrations of bone (abstract of one case)......... 719 Perforations of bone (abstracts of three cases)....... 721 Complete fractures (abstracts of two cases)......... 722 Effects of missiles and projectiles on nerves......... 725 Abstracts of thirty cases...................... 726 PLATE XXXVIII. Facial Paralysis consequent on shot injury, facing....................................... 741 Effects of missiles and projectiles on Blood-vessels... 750 Abstracts of eleven cases...................... 750 X TABLE OF CONTENTS. CHAPTER XII. WOUNDS AND COMPLICATIONS—Continued. Page. TABLE CXXU1. Summary nf oue hundred and eighteen oases of 04>mplete divisi4>n of the larger Mood-vessels, indicating the number of cn84>s in which primary bleeding ocourred................ 752 lodgement of missiles and pwjoctiles... .......... 757 Primary symptoms (Muiunon to gunshot wounds . 759 Shock (one case).............................. 759 Pain (abstract of one case)..................... 760 Primary haeumrrhage.......................... 761 Haemorrhages and Ligations................... 762 Arteries...................................... 763 Table CXX1V. Summary 4>f tW4> thousand two hun- dred and thirty-five cases of arterial haemorrhages 4if the Head, Neck, Chest, Trunk, and Upper and Lower Extremities in which the bleeding vessels were indicated by name......................... 763 TABLE CXXV. Tabular statement of one thousand one hundred and fifty-five ligations f4>r shot injuries. 765 Ligations of the Common Carotid artery....... 766 Abstracts of two 4jases.................... 766 TABLE CXXVI. Condensed summary of eighty-two cases of ligations of the Com- mon Carotid for shot injuries............. 767 Ligati4>ns of the Internal Carotid artery........ 770 Ligati4ins of the External Carotid artery....... 770 Table CXXVII. Condensed summary of seven cases of ligations of the External Car4>tid artery for shot injuries...... 770 Ligations of mim>r branches 4»f the External Ca- wtid artery (abstracts of eight cases)......... 770 Ligations of the Temporal artery.............. 771 Table CXXVIII. Condensed summary of eighteen cases of ligations of the Temporal artery for shot injuries................... 771 Ligations of the Facial artery (one example)___ 772 Table CXXIX. Condensed summary of eight ligations of the Facial artery for slwt injuries............................... 772 Ligations of the Subclavian artery (/me abstract) 772 Table CXXX. Condensed summary of fifty- one cases of ligations of the Subclavian artery for shot injuries................... 773 Ligations of branches of the Subclavian artery.. 774 Abstracts of twelve cases.................. 774 Ligations of the Axillary artery............... 775 TABLE CXXXI. Condensed summary of forty-nine cases 4jf ligations »>F the Axillary artery for shot injuries................... 775 Ligations of branches of the Axillary artery. ... 776 Abstracts of four cases................... 776 Ligations of the Circumflex artery............. Table CXXXII. Condensed summary of eighteen ligations 4>f the Circumflex artery for shot injury........................ 777 Ligati4>ns of the Brachial artery................ 777 Table CXXXIII. Summary of one hun- dred and seventy c:isr.« of ligations of the Brachial artery......................... 777 Ligati4>ns of branches 4>f the Brachial artery. ... 782 Abstracts of eleven cases.................. 782 Ligations of the Radial artery................. 782 TABLE CXXXIV. Condensed summary of fifty-nine ligations 4>f the Radial artery for shot in jury.............................. 783 Ligations of the Ulnar artery.................. 784 TABLE CXXXV. Condensed summary of twenty-two ligations of the Ulnar artery for shot injuries......................... 784 Ligations of the Interosseous artery of F4>rearm. 785 Abstracts of nine cases.................... 785 Ligations of arteries of the Hand.............. 785 Table CXXXVI. Condensed summary of twelve cases of ligations of arteries of the Hand.................................. 786 Ligations of the Common Iliao artery.......... 786 Page. TABLE CXXXVll. .Summary of five unsuc- cessful cases of ligations of the Common Iliac artery............................ 786 Ligations of the Internal Iliac artery........... 786 Table CXXXVIU. Condensed summary of three ligations of the Internal Iliac artery 787 Ligations of the Gluteal artery................ 787 Table CXXXIX. Summary of six ligations of the Gluteal artery.................... 787 Ligations of the Sciatic artery................. 787 Abstracts of two cases..................... 787 Ligations of the External lliao artery.......... 787 Table CXL. Summary of twenty-six liga- tions of the External Iliac artery......... 788 Ligati4>ns of the Spermatic artery (one abstract) 788 Ligations of the Femoral artery................ 788 Table CXLI. Summary of three hundred and seventy-four ligations of the Femoral artery.................................. 789 Ligation of the External Pudic artery.......... 798 Ligation of the Profunda Femoris.............. 798 Abstract of one case....................... 798 TABLE CXLII. Summary of twenty-two cases of ligations of the Profunda Fenmris. 798 Ligations of the Perforating arteries........... 799 Abstracts of six instances.................. 799 TABLE CXLIII. Summary of twenty- four ligations of muscular and other small branches of the Femoral artery.......... 799 Ligations of the Popliteal artery..... ......... 800 TABLE CXLIV. Summary of thirty-six li- gations of the Popliteal artery........... 800 Ligations of the Articular branches of the Popliteal artery......................... 801 Abstracts of three cases............... 801 Ligations of the Anterior Tibial artery......... 801 TABLE CXLV. Summary of forty-seven li- gations of the Anterior Tibial artery..... 802 Ligations of branches of the Anterior Tibial ar- tery........................................ 803 Abstracts of three cases................... 803 Ligations of the Posterior Tibial artery......... 803 Table CXLVI. Summary of forty-eight li- gations of the Posterior Tibial artery..... 803 Ligations of Plantar arteries................... 805 Abstracts of three cases................... 805 Ligations of the Peroneal artery............... 805 Abstracts of four cases.................... 805 Remarks on haemorrhages and ligations............. 805 Abstracts of five cases......................... 806 TABLE CXLVU. Table indicating the days on whioh the first haemorrhage occurred......... 805 Traumatio aneurism (abstract of one case).......... 808 TABLE CXLVUI. Summary of seventy-four cases of Traumatic aneurism................ 808 PLATE LXXVII. Traumatic aneurism................ . 808 Causes of haemorrhage (abstracts of three cases)___ 809 Treatment (abstract of four cases)................. 810 TABLE CXLIX. Summary of two thousand two hundred and thirty-five cases of haemorrhage, indicating mode of treatment................ 810 Ligations (abstracts of three cases)............. 813 Table CL. Table indicating the various Modes of Ligations and their fatality..... 814 Veins (abstracts of three cases)..................... 816 Table CLI. Summary of one hundred and six cases of hamorrhage from veins.............. 816 PLATE LXXIX. Fig. 1. The left Femoral vein after death from pyaemia. Fig. 2. Gangrene of Foot after shot wound of Leg. upper third, facing............... 818 Tetanus (abstracts of ten cases)...................... 818 Table CLII. Summary of five hundred and five eases of tetanus, indicatingseatof injury and result. 819 TABLE CLI1I. Statement indicating the day after injury or amputation on which tetanus appeared... 819 XI TABLE OF CONTENTS. CHAPTER XII. WOUNDS AND COMPLICATIONS—Continued. Table CLIV. Numerical statement of results of three hundred and fifty-eight cases of tetanus in which the duration of the disease was reported ... Gangrene (abstracts of nine cases)................... Table CLV. Summary of two thousand six hun- dred and fort3'-two cases of gangrene, indicating the result and frequency......................... Table CLVI. Indicating the years in which the gangrene occurred.............................. Table CLVII. Summary of cases of hospital gan- grene, giving treatment and results............... Table CLVIII. Summary of nine cases of hospital gangrene, showing date and grade of disease...... PLATE XXIX. Dry gangrene of the Feet, facing ... Dry gangrene (abstracts of seven cases)............ Traumatic Erysipelas (abstracts of eight cases)___ Table CL1X. Numerical statement of one thousand and ninety-seven cases of traumatic erysipelas___ Table CLX. Numerical statement of one thousand and ninety-seven cases of traumatic erysipelas, in- dicating causes of death........................ Pyaemia (abstracts of seven cases).................. Table CLXI. Summary of cases of pyaemia, indi- cating location of injury and result............... Table CLXII. Indicating day of appearance of pyaemia after injury and after operation.......... Condensed summary of forty-eight post-mortem ex- aminations in cases of pyaemia.................. Concluding observations on Shot wounds___ Climatic, hygienic, and moral influences............ Multiple wounds (abstracts of two cases)............ Conservation, Excision, Amputation........... TABLE CLXIII. Tabular statement of eighty-seven thousand seven hundred and ninety-three cases of shot injuries of the Upper Extremities, indicating seat of injury, mode of treatment, and final results. 870 Page. TABLE CLXIV. Tabular statement of eighty-six thousand four hundred and thirteen cases of shot injuries of the Lower Extremities, indicating seat of injury, mode of treatment, and final results ... 870 TABLE CLXV. Summary of sixty thousand two hun- dred and sixty-six shot fractures of the Extremities, showing treatment and results................... 873 Excisions........................................ 874 TABLE CLXVI. Numerical statement of four thou- sand six hundred and fifty-six excisions in the Ex- tremities ....................................... 875 Table CLXVII. Tabular statement of excis- ions, indicating the months in which the opera- tions were performed........................ 876 Amputations..................................... 877 Table CLXVIII. Tabular statement of twenty- nine thousand nine hundred and eighty amputa- tions, indicating seat of operation and results.. 877 Table CLXIX. Table indicating the rate of mortality after amputations and excisions in the Extremities................................ 878 TABLE CLXX. Summary of twenty-three thou- sand seven hundred and sixty-two amputations, indicating the period of the operation......... 879 Table CLXXI. Summary of eighteen thousand seven hundred and eighteen cases of amputa- tions in the Extremities, indicating the side upon which the operation was performed..... 880 Table CLXXII. Numerical statement of one hundred and seventy-two cases of double am- putations for shot injuries.................... 881 Table CLXXIII. Condensed summary of one hundred and seventy-two double amputations after shot injury............................ 881 CHAPTER XIII. AN/ESTHETICS. Prolegomena.......................................... 887 Deaths from chloroform................................. 890 Abstracts of thirty-seven cases....................... 890 Deaths from chloroform and ether........................ 894 Abstracts of two cases.............................. 894 Deaths from ether...................................... 894 Abstracts of four cases.............................. 894 Page, Table CLXXIV. Statement of five hundred and ninety- seven cases of the employment of anaesthetics, showing quantities used, time to induce anaesthesia, and period during which it was maintained........................ 896 TABLE CLXXV. Statement showing the frequency of vomiting, excitement, and prostration in five hundred and ninety-seven cases of anaesthesia................... 897 CHAPTER XIV. THE MEDICAL STAFF AND MATERIA CHIRURGICA. Page. Prolegomena........................................... 899 An Act to Reorganize and Increase the Efficiency of the Medical Department of the Army...................... 900 Duties of the Medical Director of a Corps...... .......... 903 Duties of the Medical Inspector of a Corps............... 906 Duties of the Surgeon-in-Chief of a Division............. 906 Duties of a Surgeon-in-Chief of a Brigade............... 907 Duties of the Surgeon in Charge of a Division Hospital ... 90^ Duties of the Medical Recorder of a Division Hospital..... 909 Duties of the Attending Surgeon of a Division Hospital--- 909 Page. Duties of the Operating Surgeon........................ 909 Duties of the Regimental Surgeon....................... 910 Duties of the Assistant Regimental Surgeon............. 912 Duties of the Commissary of Subsistence of a Division Hospital............................................. 912 Duties of the Chief Ambulance Officer of a Corps........ 913 Duties of the Chief Ambulance Officer of a Division....... 913 Duties of the Chief Ambulance Officer of a Brigade....... 914 Materia Chirurgica.......................................... 914 CHAPTER XV. TRANSPORTATION OF THE WOUNDED. Page. Hand Litters.............................................. 923 Wheel Litters.............................................. 926 Mule Litters..............................................< • 926 Cacolets................................................... 927 Ambulance Corps........................................... 931 Ambulance Wagons........................................ 944 Railway Transportation..................................... 957 Water Transportation....................................... 971 Steamer City of Memphis............................. 974 TABLE. Tabular statement of trips of Steamer City of Memphis............................................. 975 Page. Steamer Louisiana and K. C Wood ................ 975 TABLE. Tabular statement of trips of Steamer Louisiana 976 Table. Statement of trips of Steamer R. C. Wood...... 976 Steamer D. A. January................................ 977 Table. Statement of trips of Steamer D. A. January___ 979 Steamer Empress...................................... 931 Steamer J. K. Barnes.................................. 982 INDICES. List of Plates..................................................... t List of Operators and Reporters.................................... jjj Subject-Matter Index..............................................XVII XII THE MEDICAL AND SURGICAL HISTORY • OF THE WAR OF THE REBELLION (1861-65). PART III, VOLUME II. BEING THE THIRD SURGICAL, VOLUME. ON SPECIAL WOUNDS AND INJURIES—CONTINUED. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES. In attempting to furnish a description, as adequate as practicable, of the various classes of injuries inflicted by war-weapons that were reported during the late war in this country, I have reviewed and analyzed at great length, in two preceding volumes, histories of cases of wounds of the head, neck, trunk, and upper extremities. It remains, to complete this branch of the subject, to discuss, in like manner, Wounds of the Lower Extremities, a very important group, comprising not only a larger number of those cases that come under the treatment of the military surgeon than any other group, but a greater proportion of cases demanding operative interference than is observed in other regions, and presenting to the field surgeon, especially in connection with lesions of the hip and thigh, some of the most difficult practical problems he has to encounter. Of the 253,142 cases of wounds returned during the War that have been examined and classified and entered on the permanent registers of the Surgeon-General's Office, 89,528 are cases of Wounds of the Lower Extremities. Of these, 59,376 are entered as Flep.i Wounds, of which 674 were punctured or incised wounds, and the rest shot wounds. The remaining 30,152 cases were all returned as shot fractures, and were distributed as Sl-kg. Ill—i 1 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. follows: Shot Fractures of the Femur, including fractures penetrating the hip joint, 7,776; Fractures involving the Knee Joint, 3,557; Fractures of the Shafts of the Tibia or Fibula, or of both, 10,026; Fractures implicating the Tarsus, Metatarsus, and Phalanges, 8,793. It must be borne in mind that this total of 89.528 cases of wounds of the lower extrem- ities represents only those cases that have been accurately determined and entered on the registers, and by no means all the cases belonging to this group that were reported during the War, and hence as the work progresses the figures will need to be modified. Besides the 2-)3,112 registered cases, quite a number, reported with insufficient details for class- ification, have been noted for investigation; and, by searching the Pensioa Records, and through Union and Confederate reports which continue to be sent in, even at this late date, and by special reports from surgeons who kept note-books, and who, since the publication of the First Surgical Volume, have been led to transmit particulars of their cases, it will be possible, as each successive subject is taken up for analysis, to sensibly augment the aggregates of each group. This was observed in the discussion of the Wounds of the Upper Extremities. In Table XII, on page 454 of the Second Surgical Volume, but 84,718 cases of such wounds are recorded as registered, but in examining Chapter IX it will be found, as mentioned in the Memorandum at page III of that Volume, that 88,741 eases are actually specified, the particulars of 4,023 additional cases having been obtained through information derived from various sources. Such additions may be expected in this Volume also; but they will not invalidate the approximate correctness of the figures above given, so far as relates to the relative frequency of wounds of the lower extremities. For such a purpose, the numbers 89,528 : 253,142 are ample., and the ratio is perhaps quite as reliable as it could be made by larger aggregates. The relative frequency of wounds of the lower extremities received in battle, com- pared with the total number that came under treatment, appears from the above returns to.be represented by a ratio of 35.3 per cent., or a little over one-third. There is good reason to believe that this is a very near approximation to the precise facts. Note, for example, its correspondence with returns from other campaigns: Table I. Collated Returns, indicating the Relative Frequency of Shot Wounds of the Lower Extremity in Aggregates of Wounded Men who came under Treatment. AVars, Campaigns, and Other Occasions. July, 1830, days in Paris and Lyons (Serrier'S table1)........................ Crimean War (MATTHEW'S return')......................................... Crimean War (Chenu's return3)............................................. Italian War of 1859 (CHENU'S return4)....................................... Italian War of 1859 (DEMMES estimates5).................................... Danish War of 1864 (Heine6)............................................... Franco-German War (Consolidated returns7)................................. Totals........................................................... 1 Sf.uuiek (L.), Traite des plaies d'armes a feu, Paris, 1844, p. 30. The insurgents fighting behind barricades, the proportion of injuries of tho lower extremities is less than usual. * MATTHEW (T. P.), Med. and Surg. Hist, of the Brit. Army in the years 1854-55-56, London, 1858, Vol. II, p. 355. 3CHENU (J. C), Rapport, etc., de Campagne d'Orient en 1854-55-56, Paris, 1805, p. 627. 4Chenu (J. C), Statistique Med. Chir. de la Campagne d'ltalieen 1859«MSti(). Vol. II, p. 850. »Demme (H.), Studien, Wiirzburg, 1861, B.I, p. 20. 6 Heine (C.), Die Schussverletzungen der Unteren Extrem- itdten Berlin, 18C6. I much regret that, in regard to the statistics of the Danish War of 1864, I cannot refer to the conclusions of the lamented Gen- eralarzt F. LCEFFLEE, from whose excellent General-Berir.ht iiber den Gesundluitsdienst im Feldzuge gcgen Danemark 1864, Berlin, 1867, the statistics Aggregate Wounded. Wounds of Lower Ex-tremity. Ratio. 784 7,660 34,306 19, 672 17, 095 1,907 24,788 185 2, 396 11,873 7,704 5, 248 553 7,560 23.5 31.2 34.6 39.1 30.6 28.9 30.5 106,212 35,519 33.4 INTRODUCTION.] WOUNDS OF THE LOWER EXTREMITIES. 3 It will be observed, by comparing the tabular statement on page 434 of the Surgical Volume of Part II, that the relative frequency of shot wounds of the lower extremities does not exceed that of wounds of the upper limbs to the extent that might be anticipated from the greater size of the lower limbs. This is doubtless due to the fact that, in all fio-htiiig in entrenched positions, the lower part of the person is partially screened from injury. In the last year of the War, the field casualties of the Union armies were reported with much completeness and accuracy, as has been already noticed {supra, Part I, Vol. II, p. 600, Part II, Vol. II, pp. 6, 917), and over a hundred thousand cases of wounds were recorded with careful discrimination of their nature and position. In the engagements during this period, the combatants had learned to cover their positions with hastily improvised earthworks; and this may partly account for the smaller ratio of wounds in the lower limbs presented in these returns. Notice, for example, in the following tabular statement, the very small proportion of wounds of the lower limbs in the siege operations before Mobile. Another probable cause why the proportion of wounds of limbs was smaller in the field than in the general hospital returns, is that a large number of rapidly mortal wounds of the head and trunk appear on the field casualty lists, representing patients who never reached the base hospitals. Table II. Partial Numerical Statement.of Shot Wounds of the Lower Extremities in the Field or Primary Hospitals in various Campaigns during the last year of the War, 1864-65. CAMPAIGNS. FLESH WOUNDS. FRACTURES. FOOT. MISSILE. a w a 'A O ►J < H O H o m m a a < 55 H p ft Names and Dates. THIGH. Leg. Thigh. LEG. qj a i 1 i Large projec-sho't, shell, and bomb frag-ments, grape. Small projec-tiles, musket, carbine, rifle, pistol balls, anil small mis. siles from shrapnel and 4,037 5 » Q 10 a O 3, 84:3 J3 Q 6 0) O 812 a C 104 8 o 938 Q 21 Army of Potomac, from May 4 to August 31, 1864.. 2, 269 978 10, 828 38,944 30.5 Campaign to Atlanta, from May 4 to Sept. 8, 1804 .. 3,312 16 2,058 6 573 73 581 31 1,044 543 5, 720 23,308 32.4 Gen.G H.Thomas's Army, from Oct. 25 to Dec.31,'64. 376 450 81 106 1 93 74 1,025 3,610 30.6 Gen.W. T. Sherman's Army through Carolinas in '65. 225 3 148 46 3 47 62 i 16 498 1,533 34.4 From Fort Fisher to Goldsborough, N. C., 1865 ... 116 12-1 1 32 2 32 1 35 43 178 1,075 31.5 Siege of Mol.ilc, from March 26 to April 19, 1865 ... 100 84 40 8 32 48 57 137 2,111 14.4 Army of James, from May 4, 1864, to April 9, 1805. 1,091 6 1, 850 390 27 436 11 718 504 3, 899 16,120 27.8 Shenandoah Valley, from May 4 to August 20. 1861 253 2 265 29 4 23 1 16 32 554 2,196 26.7 Shenandoah Valley, from Aug. 21 to Dec. 30, 1864.. 829 1 949 273 18 320 5 403 220 2,540 7,542 26.6 Army of Potomac, from Sept. 1,1864, to Ap'19, 1865 1,017 1 1,126 209 32 27-' 10 555 176 2, 581 10,407 31.1 1 11,356 3S 10, 903 13 1 2, 545 271 2, 787 81 5,243 2 2, 649 27, 900 106,846 30.7 of wounds of the upper extremity in this campaign were cited in the Second Surgical Volume (Chap. IX, p. 434). This eminent surgeon died in 1874; and I have been unable to procure the second volume of his most painstaking and accurate treatise: or to learn that it has been published. Fortunately, Dr. Heixe'S statistics cover the ground, if not as thoroughly, at least with commendable precision. » These 24,788 cases are collected from the following authors: McCoitMAC (W.) (Notes and Recollections of an Ambulance Surgeon, London, 1871, p. 129; total number of cases, 610, lower extremities, 257); BILLROTH and CzERNY (Chirurgische Iiriefe, Berlin, 1872, p. 180;—277—135); RUPPRECHT (Militdrarztliche Erfahrungen, 1871, S. 10;—361—128); MUHLBAUEU (Erfahrungen aus dem Feldzuge, etc., in Bayerisches artzliches Intelligenzblatt, 1871, S. 374;—1899—849); STEINBERG (Die Kriegsl^z- arethe und Baracken von Berlin, Berlin, 1871, S. 146;—8531—974); GOLTDAMMER (Bcricht uber die Thdtigkeit des Reserve-Lazarethes des Berliner Hulfsvereins, in Berliner Klin. Wochenschr., 1871;—639—67); Hf.YFELDER (O.) (Bericht iiber meine Wirksamkcit am Rhein, in Petersburg Med. Zeitschrift, 1871;—226—81); SOCIN (A.) (Kriegschirnrgische Erfahrungen, Leipzig, 1872, p. 8;—643—328); MUXDY and MOSETIG (Service Med. chir. de Vambulunce du Corps Ugislatif, in Gaz. des Hop., 1871, No. 149;—136—58); BECK (B.) (Chir. der Schussv;,1872, S. 160;—4344—1787); FISCHER (H.) (Kriegschir. Erfahrungen, Erlangen, 1872, S. 28;—875—356): KlRCHNER (C.) (jErtzlicher Bericht u. s. w. im Palast zu Versailles, Erlanger), 1872 ;— 2099—751); GRAF (E.) (Die Konigl. Resereelazarrlhr zu Dusseldorf. 1872;—298—101); SCHULLER (Kriegs. chir. Skizzen, Hannover, 1871;—491—166); Gltoa (F.) (Notice sur I'hSpital civil, etc., de Strasbourg, in Gaz. Med. de Strasbourg, 1«7J, No. 17;—140—55); BertiiOLD (Deutsche Mil.-drzt Zeitschrift, 1872, B. I, S. 429;—1804—723); and MossaKOWSky (P.) (Deutsche Zeitschrift fur Chir., 1872, B. I, S. 323;—1415—744). 4 INJURIES OF THE LOWEE EXTREMITIES. [CHAP. X. Examining carefully several series of a thousand each of the 89,528 registered cases of wounds of the lower extremities,1 including only those in which the seat of injury was noted with precision, a predominance of wounds of the left .lower extremity is found in the following proportion: Both limbs, 3.4 per cent.; left limb, 53.1; right limb, 43.5.2 A word may be added regarding the recorded instances of evulsion of one or other of the lower limbs by solid shot, fragments of shell, torpedoes, or other large projectiles. Of 164 such instances 93 recovered, 62 or 40 per cent, were fatal, while in 9 instances the results were not ascertained. In 129 of the 164 cases it is noticed that ablations, many of them doubtless resembling merely the paring and regularization of the soft tissues with removal of splinters or sharp projections of bone, rather than legitimate amputations, were performed. Two of these, however, were successful formal disarticulations at the ankle joint, 2 successful amputations at the knee joint, 1 a fatal exarticulation at the hip. Seventy-six, with 56 recoveries, 14 deaths, and 6 unknown terminations, were opera- tions in the continuity of the leg; forty cases, 26 successful, 13 fatal, 1 doubtful, were amputations in the thigh. In 4 cases, both legs were removed in the continuity with 2 recoveries, 1 fatal and 1 unknown result. In 1 fatal case the left thigh and right leg were simultaneously removed; in 1 case of recovery amputation was performed in the right thigh and through the left knee joint; in 1 fatal case simultaneous amputation of both thighs in the continuity was practised; and in one instance disarticulation of the left hip and ablation of the right leg was performed, the case terminating fatally. In 35 of the aggregate of 164 cases there is no record of operative interference. Of these, 1 was a fatal instance of evulsion of both limbs in the continuity of the thigh; in 6 fatal cases both limbs were torn off in the leg; in 4 fatal cases the right or left limb was torn off in the thigh, and in 24 the mutilation took place in the continuity of the leg with 4 recoveries, 19 deaths, and 1 with unknown result. An additional proof that of the shot wounds received in action those inflicted upon the lower extremities ordinarily constitute about one-third of the aggregate, is found in the carefully prepared statistical researches of Councillor G. Fischer.3 1 The lamented Lceffler, one of the soundest of modern Prussian military surgeons, sets forth (General-Bericht uber den Gesundheitsdienst im Feldzuge gegen Danemark, 1864, Berlin, 1867, p. 48) that of 2,388 Prussians killed and wounded in the Danish War of 1864, about 31 per cent, were struck in the lower extremities, and remarks (S. 49): "The comparatively small proportion of wounds of the lower extremities may appear strange. One is accustomed to regard the preponderance of such injuries as considerable. The protections above referred to (trenches, and, in Schleswig, brush- hedges \Knicks]) would undoubtedly partially protect the lower limbs. But statistics that omit the killed are defective; they give to the shot wounds oi the extremities an undue preponderance, because their immediate fatality is much more limited than is observed in wounds of the head and trunk." Professor H. FlSCHEK (Lehrbuch der Allgemeinen Kriegschir., Erlangen, 1868, S. 25) observes : " In later wars, in which the fighting was mainly in the open field, the remarkable fact has almost uniformly appeared, that among shot injuries those of the lower extremities far exceed those of the upper limbs. Dr. MACLEOD'S statistics refer 68 per cent, of wounds in action to wounds of the lower extremities. [This is an oversight. Dr. MACLEOD (Notes on the Surgery of the War in the Crimea, 1858, p. 414) gives the proportion of wounds of the lower extremities among the men as 31.7; among officers 35.2. Professor FISCHER seems to have added these ratios together.] DJOERUP reports the proportion of wounds of the lower limbs in the Danish army, in the war of 1848-50 as 40.5 per cent. In Paris in 1848, and in Italy in 1859, the wounds of the lower extremities constituted a third, and those of the upper limbs nearly another third. When it is considered that the remaining third was made up of cases of injuries of the head, chest, abdomen, and pelvis, it is apparent how enormously large is the number in modem wars that have to be transported with the utmost care and skill. Hence, perhaps, the most difficult problem for the modern military surgeon is the management of the ambulance trains. LCEFFLER, it is true, has said that the preponderance of wounds of the lower limbs in modern wars is seeming rather than real, and is conditioned on the less proportion of immediate fatality in wounds of the limbs This assumption, though assuredly founded on facts, might explain the conspicuous fact that the shot injuries of the limbs predominate greatly over those of the bead and trunk; but does not explain the extraordinary disproportion between the shot injuries of the upper and lower limbs." 1 may remark that the statistics I have examined do not show any greater disparity in the frequency of wounds in the upper and lower limbs than is warranted by the relative size and position of the extremities. * HEINE (C ) (Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 30) remarks that in the Schleswig-Holstein War, 1860,27 of the 562 cases of injuries of the lower extremities both limbs were injured, or a percentage of 4.8, and Fischer (G.) (Statistik der in dem Kriege 1870-'71, <£c, vorqekommenen Verwundungen und Todtungen, Berlin, 1876) tabulates 780 cases of injuries of both limbs in a total of 20,160 cases of injuries of the lower extremities, or 3.8 per cent. 3 The Statistik der in dem Kriege 1870-1871 im Preussischen Heere, vorgekommenen Verwundungen und Todtungen von G. FISCHER comes to hand as these pages are going to press. Tabelle C (loc. cit., p. 59) contains a recapitulation of the seat of injury in 64,897 cases (7,735 killed and 57,162 ded) In 18 905 instances, or 29.14 per cent., the upper extremity was injured, and in 20,160, or 31. 06 per cent., the lower extremity was involved, ThTlatter percentage varies but little from that given on page 2 (ante 30.5), which was consolidated from a number of publications by various authors. that have appeared since the late Franco-Prussian War. SKCT. I.] FLESH WOUNDS. D Section I. FLESH WOUNDS OF THE LOWER EXTREMITIES. The reader is respectfully referred to the introductory observations to the first section of the Ninth Chapter, in Part II, Volume II, page 435, for many remarks on the Flesh Wounds of the Upper Extremities, which are equally applicable to the cases of the cate- • gory now to be considered. The gravity of flesh wounds in the lower extremities greatly exceeds, however, that of analogous injuries in the upper limbs. The dangers arising from lesions of the great blood-vessels and nerves of the lower extremities, from peri-articular wounds, and especially from deep seton wounds and lacerations of the massive muscles of the thigh, are great. Many, perforations of the thigh that are lightly regarded at the outset, present ultimately formidable complications. Dr. H. Fischer remarked,1 in the late Franco-German War, that "many a wounded man sent to the rear with the diagnosis 'slight shot wound of the thigh,' succumbed to burrowing of pus, detected too late and treated with too little vigor. We had five such cases, and succeeded in all in controlling this terrible complication by early and deep incisions, absolute rest, and disinfecting band- ages. When the first stage is neglected, the surgeon loses the mastery, pyaemia delighting to develop in deep phlegmonous cavities." It was impossible, with the clerical force available, to make more than a superficial examination of the individual cases of the immense series of nearly sixty-thousand flesh wounds of the lower extremities.2 All that has been attempted has been to sift out dupli- cated cases and those that ultimately proved to be complicated by contusioa of bone or by fracture, and to scrutinize the series sufficiently to select instances illustrating the different varieties of injuries of this group, to determine the average distribution of the wounds in the several regions of the limb, and to ascertain approximatively the mortality. Of the series of flesh wounds of the lower extremities, six hundred and seventy-four were punctured or incised, and fifty-eight thousand seven hundred and two were shot wounds. PUNCTURED AND INCISED WOUNDS-—There were reported six hundred and seventy-four cases of punctured or incised wounds of the lower extremities, including a hundred and seventy-six bayonet wounds, twenty-two sabre wounds, and four hundred and seventy-six wounds from daggers, knives, axes, or other pointed or cutting weapons. Bayonet Wounds.—The series of bayonet wounds included sixty-two stabs in the thigh, with two deaths; seventy-seven penetrations of the leg, with two deaths; and thirty- 1 FISCHER (H.), Kriegschirurg. Erfahrungen, Vor Metz, Erlangen, 1872, S. 164. Dr. Fischer, professor of surgery at Breslau, was a volunteer surgeon in the Prussian army during the campaign from Saarbriicken to Metz, August 10 to October 27, 1870. 2Of the 89,528 registered cases of wounds of the lower extremities, 30,152, or 33.6 per cent., were returned as fractures, so that, as in the upper limbs, the wounds of the soft parts alone constitute very nearly two-thirds of the aggregate—59,376 in 89,528 cases. ° INJURIES OK THE LOWER EXTREMITIES. # [CHAP. X. seven wounds of the soft parts of the foot, with one death,—the series of a hundred and seventy-six cases thus presenting a mortality of 2.8 per cent. Several of the cases present particulars of interest: Case 1.—Private P. Dietrich, Co. E, 151st New York, aged 34 years, was wounded at Spottsylvauia, May 12. 1364, and admitted to the field hospital of the 3d division, Sixth Corps. Surgeon R. Barr, 67th Pennsylvania, recorded : "A bayonet thrust through the right leg." The patient was transferred to Douglas Hospital, Washington, subsequently to Summit House, and lastly to the Satterlee Hospital, Philadelphia, whence he was discharged April 27, 1865, because of "lameness of the right leg, caused by chronic eczema," following a bayonet injury. Examiner H. N. Loomis, of Bufl'alo, New York, May 8, 1855, certified: "'A bayonet was thrust through the right leg between the tibia and fibula, about six inches below the knee. The wound healed; but is followed by chronic eczema, extending from the knee to the ankle, much inflamed, with some ulceration, and producing so much lameness as to unfit him for any kind of labor." In August, 1868, the pension examiner states that the eczematous eruption occupies about half the space between the knee and the ankle, and that the limb is still inflamed, ulcerated, and swollen. This pensioner was paid to March A, 1870, since when he has not been heard from. Iii two cases the femoral artery was reported severed by a bayonet. One of these is related by Surgeon J. A. Lidell,1 U. S. V.: A soldier of the 106th Pennsylvania received a thrust in the upper inner part of the thigh from a sabre-bayonet, in a picket skirmish near Fair Oaks, in June, 1862, and perished from haemorrhage before assistance could reach him. The result of the second case suggests the probability that a minor branch, rather than the main femoral trunk,-was injured by the weapon: Case 2.—Corporal E. Hacket, Co. A, 1st Pennsylvania Chasseurs, was accidentally wounded near Camp Whipple, Philadelphia, in August, 1863. Acting Assistant Surgeon L. D. Radzinsky reported: "While at bayonet exercise he received a punctured wound of the right femoral artery, below Poupart's ligament. The wound was received a short distance from the camp. When brought to the hospital tent the man was considerably exhausted from loss of blood. Judging from the clots found in his clothes he must have lost at least twelve ounces. The haemorrhage was immediately controlled by manual pressure upon the external iliac artery, a compress and spica bandage applied, and pressure continued with a tourniquet for three days, at which time the tourniquet was removed, a new dressing applied, and pressure continued with the spica bandage. He was returned to duty five days afterwards, and has not had any untoward symptoms since." Hacket is not a pensioner. Surgeon T. H. Squire, 89th New York, reports a case in which the synovial cavity of the knee was penetrated by a bayonet without bad results, remarking that Dr. James Allen, of Marathon, New York, examined the recent wound and concurred in the diagnosis: Case 3.—"Private C. A. Ball, Co. K, 89th New York, aged 16 years, in the spring of 1862, at Roanoke Island, while jumping for exercise, accidentally sprang against the point of a bayonet. At a moment when the joint was partially flexed, the point of the bayonet penetrated the cavity of the knee joint, the wound being immediately above the centre of the patella. The patient was immediately received ,into the regimental hospital, and Assistant Surgeon W. A. Smith, 89th New York, enjoined perfect rest in bed and low diet, with cold applications to the joint. The wound was from the first regarded as a dangerous one. Some days after the accident occurred, Dr. Squire saw the case with Dr. Smith. There was then synovial swelling of the joint, and other conclusive evidences that the joint had been penetrated. The boy was kept in hospital till the recovery was complete, when he again entered the ranks for duty. The recovery was complete, and no bad effects followed. The wound was not very extensive. The point of the bayonet may have gone through the synovial membrane half an inch or so, and in such a glancing direction as not to injure the cartilage or bone. Dr. Squire did not know exactly how long the boy was kept in hospital, but thought about four weeks." The field registers show that this Private Ball received a gunshot wound of the right side of the thorax at the battle of Chapin's Farm, September 29, 1864, which fact is corroborated by the examining surgeons. For this injury he is a pensioner, but the Pension Records make no mention of a bayonet injury of the knee. Of the five fatal cases in this subdivision of bayonet wounds in the lower limbs, three succumbed from gangrene, one from pyaemia, and one from primary haemorrhage. The following is one of the cases complicated by gangrene: Case 4.—Private S. Dick, Co. E, 79th Indiana, was wounded at Chickamauga, September 19, 1863, and sent to hospital No. 13, Nashville, October 1st. Assistant Surgeon J. K. Bauduy, U. S. V., reported: "He was admitted with a flesh wound of the calf of the left leg, caused by a bayonet. The wound was superficial and slight, and did well for several days; treated with cold-water dressings. On October 20th, hospital gangrene manifested itself; the disease was then prevailing endemically in the hospital. This patient was immediately transferred to the gangrene ward, and applications of pure bromine were made. Tincture of iron and fluid extract of cinchona were freely administered. Milk-punch and beef-tea were also given at stated intervals. His bowels, which were inclined to be costive, were kept open with enemeta of salt, molasses, and tepid water. The disease steadily progressed, and large sinuses formed in all directions in the intermuscular spaces. One immense sinus ran 'LIDELL (J. A.), Bayonet Wounds, with cases, in Am. Med. Times, 1866, Vol. VII, p. 153. SECT. I.} PUNCTURED AND INCISED WOUNDS. 7 alon" the course of the tendo-achilles. The sinuses were freely opened and injected with chlorinated soda solution, and bromine was thoroughly applied, taking great care to get it well into the intermuscular spaces. Disinfecting poultices were used in the removal of the sloughs. November 1th, the gangrene at this date was entirely arrested, but symptoms of pyemia arose. The pulse became frequent and weak, ranging between 140 to 150. Rigors; skin cold and clammy; breathing oppressed and labored. Patient complained of pain in chest. The conjunctiva assumed an icteroid hue, and the whole surface of the body became tinged with a pale yellow appearance. The knee and ankle joints commenced to swell and cause great pain. The followhi"- treatment was then resorted to: Carbonate of ammonia in large and frequent doses; stimulants every half hour; iron and cinchona continued; tincture of iodine and blisters to swollen joints; surface of body washed with whiskey and water. Patient continued to sink, and died on the afternoon of November 7, 1863. Post-mortem: Lungs healthy; no metas- tatic foci could be found in either of them or in the liver; but microscopical examination of the latter revealed a fatty infiltra- tion. The liver was also greatly hypertrophied. The heart, spleen, pancreas, bowels, and kidneys were all healthy. There was an accumulation of pus in the left knee joint." Sabre Wounds.—None of the twenty-two reported sabre-cuts of the lower limbs1 were of a sufficiently grave character to prove fatal. Seventeen of the patients returned to duty, and five were discharged for slight disabilities. Six cases were flesh wounds of the thigh, ten of the leg, and six of the foot. One of the patients, Corporal Rice, 1st Vermont Cavalry, whose case is recorded on page 22 of the First Surgical Volume, suffered also from a sword-cut of the frontal; but he, with the rest, recovered without serious trouble. Other Punctured and Incised Wounds —Besides wounds caused by legitimate weapons of war, a considerable number were reported as inflicted by daggers, dirks, or bowie-knives, arrows, picks, and other pointed implements, and by knives, scythe-blades, hatchets, axes, and other cutting instruments. There were seventy-two of these serious punctured wounds of the lower limbs, and four hundred and four cases of severe incised wounds. There were eight deaths in this series of four hundred and seventy-six cases, a mortality-rate of 1.6 per cent., and disability leading to discharge from service resulted in a hundred and two of the cases. Twenty-eight cases were wounds of the thigh, a hundred and seventeen wounds of the leg, three hundred and thirty-one wounds of the foot. Ligations.—In four instances, at least, of this series, ligations of arteries were practised on account of haemorrhao-e or aneurism. One of these, an instance of aneurismal varix from puncture of the femoral artery and vein, by a pocket-knife, has been narrated, with a figure of the specimen, at page 336 of the Surgical Volume of Part II.2 The three other cases were ligations of the tibial arteries: Cases 5, 6, 7.—Assistant Surgeon J. C. G. Happersett, U. S. A., reports that Private T. J. Moore, Co. B, 82d Ohio, aged 29 years, received, July 14, 1865, a punctured wound near the right ankle. The haemorrhage was so uncontrollable that, on July 22d, Assistant Surgeon H. M. Lilly, U. S. V., ligated the posterior tibial artery, placing a single proximal ligature. July 24th, unhealthy gangrene attacked parts, and bromine dressings were applied. The patient recovered, and was transferred to Jeffersonville October 19th, and to Post Hospital, Louisville, December 16, 1865.—6. Surgeon C. A. Cowgill reports that Lieutenant T. Linder, Co. E, 158th New York, aged 30 years, received, May 11, 1864, a punctured wound by a sharp knife on the inner side of the right leg at the juncture of the lower and middle thirds, dividing the posterior tibial artery through one half its diameter and causing a diffused traumatic aneurism. He was admitted into the Foster Hospital, New Berne, May 20th; the cellular tissue and intermuscular spaces were filled with coagula, which had temporarily arrested haemorrhage. There was great tension and considerable sloughing of the soft parts. May 22d, Surgeon C. A. Cowgill, U. S. V.,-made an incision five inches long over the wound, through the integuments down to the posterior tibial artery, and, ligating it above and below the wound, the coagula were removed and the wound closed by adhesive straps. A good recovery ensued, and the officer returned to duty June 29, 1864.—7. Surgeon G. A. Otis, 27th Massachusetts, reports that Private C. D----, Co. B, 27th Massachusetts, in December, 1863, at Newport News, Virginia, received a severe wound in the left leg from an axe, about three inches above the annular ligament. The tendons of the tibialis anticus, the common and proper extensors, and the anterior 'In old times, and in the combats of the trained European Cavalry, sabre cuts of the lower limbs were not uncommon. RaVATON (Chirurgie d'armee, 1768, Chap. IX, p. 518) gives many examples, in which not only the soft parts but the bones were hacked by sword-cuts. M LEOOUEST also (Chirurgie d'armee, 2eme ed., 1872, p. 461) details several such examples, and refers to illustrations in the Museum of HUTIN at the Hotel des Invalides. Abstracts of interesting incised wounds of the lower limbs may be found also in LE DltAN (Observat. de Chir., 1731, T. II, p. 332) and in La MOTTE (Traile complete de Chirurgie, 1771,'T. Ill, p. 143 et seq.). 2 First the femoral, then the external iliac, and finally and fatally the common iliac were ligated by Dr. J. B. CUTTElt. The operator has published abstracts of these ligations in the Am. Jour. Med. Sci., 1864, Vol. XLVIII, p. 36, Ibid., 1865, Vol. L, p. 391. The pathological specimen, showing the communication between the artery and vein and tho huge sacculation of the latter, is numbered 3507 in Sect. I of the Army Medical Museum. ° INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. tibial artery veins and nerve were divided, and the periosteum. The wound gaped widely, and the artery gave freely per saUv.m. The vessel was completely severed. Ligatures were at once placed by Dr. Otis about the upper and lower orifices of the artery, and the wound was united by sutures. Recovery was rapid and uncomplicated, and the soldier returned to duty. Amputations.—In four instances, after deep incised wounds by axes, complications arose, and recourse was had to amputation. Two were thigh amputations: Cases 8, 9.—Private Christian Webber, 8th Co., New York Independent Volunteers, received, September 24, 1863, a severe wound from an axe, severing the quadriceps of the left thigh two inches above the patella. He was sent to Fairfax Seminary Hospital, September 26th, and deep-seated suppuration having appeared, burrowed, and finally penetrated the knee joint, Surgeon D. P. Smith thereupon decided to amputate the limb. The operation was practised, October 4th, at the junction of the lower and middle thirds of the femur. The patient was transferred, convalescent, to York, Pennsylvania, October 30th, and subsequently discharged. The portion of the femur amputated has been catalogued in the Army Medical Museum,1 but exhibits nothing abnormal.—9. Private T. H. Breckridge, Co. C, 6th New York Artillery, received a wound by an axe in March, 1864, and was sent to Armory Square Hospital. Surgeon D. W. Bliss, U. S. V., reported that the wound involved the right tarsus and metatarsus, and presently became erysipelatous, and that gangrene then supervened. On this account, on May 27th, Dr. Bliss amputated the limb, at the junction of the middle and lower thirds of the femur, by antero-posterior flaps formed by transfixion. Recovery was satisfactory. On December 28, 1864, he was supplied with an artificial limb at Ladies' Home, New York, by Dr. E. D. Hudson, at Government expense. The stump was then soundly healed, and "creditable" in shape. This soldier was discharged July 12, 1865, and pensioned. His pension was paid March 4, 1876. In two instances the leg was amputated for incised wounds of the ankle or foot: Cases 10, 11.—Private M. Dunham, Co. D, Engineer Battalion, aged 23 years, received a severe incised Avound of the left ankle January 24, 1864. He was sent to hospital at Alexandria. Surgeon E. Bentley, U. S. V., reports that long-con- tinued suppuration had ended in necrosis of the tibia-tarsal articulation, the patient being of a strumous habit. Dr. Bentley practised a circular amputation in the lower third of the leg May 5, 1864. Pyaemia supervened, and death ensued June 18, 1864.—11. Private A. Stacy, Co. H, 12th Kansas, received a severe wound of the left leg by an axe on March 17, 1864. He was sent to hospital at Fort Leavenworth. In September, 1864, the limb was amputated by short anterior and long posterior flaps by Dr. Clark. The patient recovered with a good stump, and was fitted with an artificial limb by B. Frank Palmer, at • New York, June "23, 1866. He is a pensioner, and was paid March 4, 1876. The foregoing instances comprise nearly all the seriously complicated cases reported of punctured and incised wounds of the lower extremities. There was a case (Private Wherry, 115th New York) where half the small blade of a pocket-knife broke off against the femur after perforating the quadriceps two inches above the knee joint; attempts at extraction of the foreign body failed; the patient recovered with partial false anchylosis at the knee. Except those noted, the examples of sloughing or consecutive bleeding were trivial, and no case of tetanus was observed. SHOT FLESH WOUNDS.—In the vast series of fifty-eight thousand seven hundred and two cases of shot wounds of the soft parts of the lower limbs placed on the registers, it is difficult in many cases to determine, from the hasty field notes or brief hospital entries, the exact positions and extent of the wounds. As nearly as can be approximated, how- ever, it would appear that about twenty-six thousand of these wounds were in the thigh, about twenty-one thousand in the leg, and about ten thousand in the foot, a certain number of reports presenting no indication of the precise seat of injury. These wounds were of every grade of severity, from trivial skin-scratches to huge lacerations by large projectiles; long furroughed wounds with tortuous tracks, deep seton perforations, superficial or deep penetrations with lodgement of the missile, filling up the gamut. In reviewing the great series, two small groups especially claim attention—the wounds attended by lesion of the principal nerves, and those with injury of the main blood-vessels. We shall consider these first, and then typical examples of shot injuries of the soft parts, selecting for illustration those cases remarkable for extent of lacerations, those in which foreign bodies were lodged in the limb, those ultimately complicated by extension of inflammation to the joints, or by disease of the arteries, or by gangrene, tetanus, and other complications. »See No. 2004, Section I, p. 304, of Catalogue of the Surgical Section of the Army Medical Museum, Washington, 1866. sricr. i.l SHOT FLESH WOUNDS. 9 Flesh Wounds of the Lower Limbs, with Injury of the larger Nerves.—Instances in which wounds of the larger nerves were sufficiently distinct and uncomplicated to be returned under this head were comparatively few; they were less frequent, indeed, than in the upper limbs.1 The relations of the large nerve trunks of the lower extremities to the blood-vessels, bones, and joints are such that they are more liable to share in the injuries of these parts than in wounds mainly involving the muscular tissues. Moreover, it is probable that in many flesh wounds, nervous branches of magnitude were implicated with- out manifestation of any very serious results, and that such cases were not returned as injuries of nerves.2 Presenting less urgency in relation to immediate treatment than lesions of the arteries and bones, these accidents nevertheless were frequently very grave, entail- ing a vast amount of protracted misery, and sometimes fatal consequences. Of fifty-nine cases referred to this category, thirty-one were reported as wounds of the sciatic, two of ttie crural, five of the long saphenous, one of the middle cutaneous, nine of the popliteal, five of the anterior tibial, three of the posterior tibial, and three of unspecified large nerve trunks. Eleven cases proved fatal, of which six succumbed from tetanus. Amputation was resorted'to in four cases, briefly noted in succeeding tables. Two amputations in the thigh were successful; one through the knee joint, and one in the leg proved fatal. Of thirty-one cases of wounds of the sciatic nerve, twenty-five recovered, including one in which amputation in the thigh was practised, and six were fatal. Four died of tetanus.3 One succumbed, long after the injury, from secondary traumatic coxitis.4 Erysipelatous inflammation with sloughing, extending to the hip joint, and resulting in ulceration of the cartilages and caries of the head of the femur and acetabulum. The fourth fatal case5 was an example of exhaustion from protracted suffering. Of the 1 As indicated in Part II, Vol, II, p. 461, there were 96 cases distinguished as nerve lesions of the upper extremities, contrasted with 59 instances in the lower extremities. Professor A. SOCIN (Kriegschir. Erf., Leipzig, 1872, p. 64) remarks a similar disproportion in the Franco43erman War. Relating 16 cases of shot injuries of the nerves, he observes that: " more than five-eighths of these concerned the upper extremities." *In their treatise on Gunshot Wounds and other Injuries of Nerves. By S. WEIR MITCHELL, M. D., GEORGE R. MOREHOUSE, M. D., and William W. Keen, M. D., Philadelphia, 1864, the authors detail (pp. 92, 93) two cases of shot injury of the sciatic nerve: Private IC. Grim, Co. B, 121st Pennsylvania, who received at Fredericksburg, December 13, 186.2, a shot perforation of the left thigh, the ball entering externally four inches above the upper border of the patella, and emerging on the inside of the thigh, two inches lower down, slightly injuring the sciatic nerve. He had, July, 1863, severe burning on the dorsum of the left foot, and eczema, with ulceration about the nails, complete paralysis of the flexors of the foct and partial paralysis of the flexor communis and calf muscles. The other patient entered the hospital about the same time, a ball wound passing close to the sciatic. He had complete loss of power in the flexors of the foot, defective sensation on the outside of the leg and foot, and eczema with burning pain. Both patients were treated with electricity, with gradual gain of motion and relief of pain, and were regarded as fair types cf partial wound or commotion of a nerve. At page 128, of the same work, the case of Private J. S. L. Scott, Co. F, liilst New York, aged 31 years, is related: He had a shot wound of the calf of the right leg. at Cbancellorsville, May 3, 1863. The ball passed between the fibula and tibia about mid-leg. Total loss of motion below knee, slightly tactile insensibility, foot extended and powerless. September, 1863, rapid improvement followed alternated cold and hot douches, with faradization, and a splint to correct the malposition ol the foot. Discharged, improved, February 12, 1864. The reports of Pension Examiners Mann and Lanning, of Manchester, Ohio, where this pensioner now resides, recapitulate the foregoing facts, and describe the paralysis as in all probability perma- nent. The latest report by Dr. Lanning, February 4, 1874, states that "paralysis of the foot and toes is nearly complete," and recommends that the pensioner be excused from further biennial examinations, as his disability is considered irremediable. This recommendation was opposed, and the pen- sioner's condition was unchanged when he was last paid, March 4, 1876. In Circular 6, S. G. O., 1864: On Riflex Paralysis resulting from shot wounds, the same authors narrate two examples of reflex paralysis of the upper extremity induced by shot flesh wounds implicating the nerves of the lower limbs : Private W. W. Armlin, Co. D, 134th New York, aged 23 years, was shot at Gettysburg, July 1, 1863, the ball entering anteriorly about midway on the inner part of the right thigh and emerging outside and below the tuberosity of the ischium, just above the fold of the nates. The sciatic nerve was probably injured. There was partial paralysis of the right leg, and reflex paralysis of the right arm. The latter speedily recovered.—Private D. Kent, Co. B, 145th Pennsylvania, aged 24 years, was struck, at Gettysburg, July 2, 1863, over the upper third of the right rectus femoris, by a musket ball, which passed through the thigh, emerging at the inner side a little below the fold of the nates. There was loss of motion and sensation in the thigh and leg, and reflex motor paralysis in the right arm. The patient was discharged January 20, 1864, for tuberculosis. The paralysis had amended under the use of hot and cold douches, active motor, and faradization. In his work, entitled Gunshot Wounds of the Nerves and tlteir Consequences, Philadelphia, 1872, Dr. S. Weir Mitchell cites the case of Sergeant C. Beatty, 26th Pennsylvania, shot through the calf, at Chancellorsville, May 3, 1863, who suffered intensely from causalgia. The foot, a few days after injury, was prickling and burning intensely. After a fortnight the prickling ceased; but the burning persisted. He recovered in about five months, without treatment. In this valuable work, abounding in illustrations of the effects of shot lesions of the nerves of the trunk and upper limbs, I find no other example of shot wound of the nerves of the lower extremities. 3Privates Albro, 27th Michigan; Fry, 3d New Jersey; Riley, 10th New York; and Smith, 46th New York. 4 Case of Private T. J. Dame, Co. E, 18th Mississippi, wounded at Antietam, September 17,1862. Died June 19, 1863. See Spec. 3849, A. M. M., Cat. Surg. Sect., 1866, p. 243. 6 Case of Private E. M. McGregor, Co. C, 76f.h New York, shot through the left sciatic nerve September 6, 1863. The missile lodged and could not be detected during life. He had motor paralysis of the leg muscles, and intense pain in the upper part of the track of the perineal and anterior tibia, and used hypodermic injections of morphia. He died February 1, 18G3. Surg. Ill—a 10 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. twenty-five survivors, one fully recovered and returned to dutv, three entered the Veteran Reserve Corps, and twenty-one were discharged. With few exceptions, they suffered from neuralgia or from partial motor paralysis. One (Private Armlin, 134th New York) had reflex paralysis of the arm on the side corresponding with the injury to the sciatic nerve.1 Notes of two of the cases of persistent neuralgia are appended: Case 12.—Private W. T. Burk, Co. F, 151st New York, aged 24 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick the following day. Acting Assistant Surgeon E. R. Ould reported: " Gunshot flesh wound of both thighs, perforating upper third and injuring the sciatic nerve of the right thigh. The patient is of a nervous and irritable temperament. Simple dressings were applied, and opiates given at night; wound healing. July 20th, great pain complained of in the course of the sciatic nerve and increasing in the region of the foot and ankle; pulse accelerated, 100 per minute; pain increasing; general appearance moderately good; appetite poor. Applied pounded ice to foot and gave two drachms of solution of morphia four times a day. August 1st, the ice moderated the amount of pain; treatment continued. Patient slept half the night. August 12th, patient much improved; ice discontinued; prescribed morphia, iron, and quinine four times a day. September 1st, pain more severe; the wounds have entirely healed; treatment continued. September 20th, walking about with crutches, but very lame; stimulating and anodyne liniment used night and morning. September 25th, patient finds great relief by keeping his hands wet with water; bowels regular; pulse natural. October 1st, but slight improvement; continued the quinine and iron mixture, also one drachm of fluid extract of cimicifuga. October 30th, still walks lame, the leg being very painful on motion. October 31st, furloughed this day; patient has but little prospect of a speedy recovery." He subsequently returned to the hospital, and was mustered out of service May 31, 1865, and pensioned. Examiner J. H. Helmer, of Lockport, New York, February 9, 1863, certified: "Ball entered right thigh, upper third, passed through in front of the bone, and through the left thigh back of the bone, destroying the femoral nerve. Left leg two inches smaller than the right; muscles flabby; no voluntary motion of the left foot. He can walk, but walks like a paralytic." At a subsequent examination it was additionally reported that " the temperature of the left leg and foot is reduced," etc. The pensioner was paid June 4, 1876. Casf. 13.—Private C. J. Keegan, Co H, 80th New York, aged 40 years, was wounded at Gettysburg, July 1, 1863, and entered the York Hospital on July 19th. Acting Assistant Surgeon G. Byers reported: "Gunshot flesh wound of right thigh; ball entered the middle third below the edge of the sartorius muscle, passing upward and outward, made its exit two inches below and behind the trochanter, injuring the great sciatic nerve in its course. The wound closed kindly; the leg and foot, however, continued oedematous, and the man has suffered very greatly with pains of a darting character. He has at no time been able to use the limb since the receipt of the injury. Liniment of aconite was applied to the leg, and opiates were given internally. May 23,1864, the pain has much diminished in intensity within the last two months." The patient was discharged from service June 28, 1864, and pensioned. Examiner H. B. Day, of Utica, New York, certified, February 16, 1865: * * "The great ischiatic nerve must have been injured, as he has constant pain, numbness, and partial paralysis of the parts supplied by this nerve and its branches, rendering him unable to stand for any length of time," etc. Examiner I. Spencer, of De Ruyter, certified, October 19, 1865: "Permanent lameness of the thigh. The foot is also deformed by an unnatural action of the muscles contracting the toes obliquely, and there is an unnatural fixedness of the arch of the foot," etc. Subsequent examiners reported substantially the same, and all concur in their belief as to the nerve injury. This pensioner was paid June 4, 1876. The two patients wounded in the anterior crural nerve, were discharged without relief of the persistent pain that followed their injuries. Surgeon I. I. Hayes, U. S. V., has furnished a detailed report of one of the cases: Case 14.—Private W. H. Cookson, Co. E, 42d New York, aged 23 years, was wounded at Antietam, September 17, 1862, and entered the Satterlee Hospital, Philadelphia, nine days afterwards. Four months after his admission Surgeon I. I. Hayes, U. S. V., reported: "He was wounded by a mini6 ball entering on the outer side of the right thigh, about midway between the anterior superior spinous process of the ilium and the trochanter major, and, passing obliquely upward, made its exit near the middle of Poupart's ligament, wounding, I infer, the anterior crural nerve, from the intense pain he has suffered in the course of that n«rve. The wound has long since healed. The suffering experienced over the front and side of the thigh, parts supplied by the anterior crural nerve, is instructive as showing the effect of an injury in the course of a nerve manifesting itself in the extremities of that nerve. The pain has not abated by the use of the most powerful anodynes, and sleep is only procured through the influence of sulphate of morphia. A question, which is still 'subjudice,' arises: Shall we excise that portion of the nerve which is wounded, hoping thereby to relieve his almost intolerable suffering?" The patient was discharged from service February 28, 1863, and pensioned. Drs. T. S. Johnston and R. H. Hope, of Rock Hill, S. C, in certifying to the results of the wound, May 9, 1874, stated that "from this cause he is now suffering with neuralgia and partial paralysis of the extensor muscles of the thigh." The pensioner was paid June 4, 1876. Of the five cases of wounds of the long saphenous, one resulted in complete recovery, 1 J. MASON Warren, in an interesting article on Neuralgic Affections following Injuries of Nerves, in Am. Jour. Med. Sci., N. S., 1864, Vol. XLVII, p. 316 (which is reproduced in his excellent Surgical Observations, Boston, 1867, p. 465), details the case of a soldier with wound of the sciatic nerve who was probably Private D. Callahan, < \>. E, 19th Massachusetts, aged 2J years, whose history on the registers of this Office closely corresponds to the graphi" description given by Dr. Warren, to which the reader is referred. His Pension Report for 187C may be added : There was atrophy of the injured thi«-li and le<", with diminished temperature and grea'ly diminished motor power iu the muscles of the leg and foot. SECT. 1.1 SHOT FLESH WOUNDS IMPLICATING NERVES. 11 four in more or less paralysis and atrophy.1 The case of wound of the middle cutaneous nerve was attended with severe neuralgia, which yielded to blistering and other remedies, and the patient returned to duty. The series of nine cases of wounds of the popliteal nerve comprises a fatal case of tetanus.2 The other patients recovered, and three entered the Veteran Reserves, while five were discharged, one after recovery from amputation in the thigh, and one with excruciating neuralgia. The category of five cases of wounds of the anterior tibial included one death from tetanus.3 The four survivors had partial paralysis of the extensor muscles. An instance is detailed: Case 15.—Private D. S. Pierce, Co. B, 1st Michigan, aged 22 years, was wounded at Bull Run, August 30, 1862, and admitted to Ryland Chapel Hospital, Washington, three days afterwards. Surgeon J. A. Lidell, U. S. V., reported: "The patient was admitted to Stanton Hospital from Ryland Chapel, December 5th, with wound in the right leg. The bullet entered the outer part of the front of the middle; third of said leg, about midway between the tibia and fibula. The bullet did not go through the limb. It, however, went in so deep that it could not be reached by exploration. The wound has been healed since the middle of October. The missile has gravitated through between the tibia and fibula, and can now be felt deeply seated in the muscles of the calf. It gives him no trouble. The anterior tibial nerve was divided by the bullet, in consequence of which the muscles of the front of the leg are paralyzed. The end of the foot points downward from activity of those on the back of the leg, and the case resembles talipes equinus. The patient walks haltingly, but without a cane, by the aid of a high-heeled shoe. He has suffered but little pain since the wound healed, and considers himself to be slowly improving. He was discharged December 16, 1862." Examiner D. Hudson, of Lansing, Michigan, reported, May 8,1863: "Ball passed through both peroneal muscles, dividing the tibial nerve * * and lodging deep in the soleus muscle. Ankle joint became stiff at an obtuse angle, requiring a heel more than an inch higher on the right shoe than on the left one. Neuralgic pain in foot and ankle daily and hourly." Drs. J. B. Hull and I. H. Bartholomew, of the Lansing Examining Board, certified, December 7, 1870: "The ball passed down, and now lies under the skin above the inner malleolus. He cannot stand on his leg but a short time, and is getting worse," etc. They also stated that they excised the ball, and reported, September, 1872: " The nerve is diseased, and he suffers great pain through the whole leg; is emaciated and feeble, and growing worse." This pensioner died of "consumption," November 22, 1872, superinduced, in the opinion of the attending physicians, by "the continually depressing effects of the pain and tenderness of his limb." The three cases of wounds of the posterior tibial nerve were fatal. Two involved unsuccessful amputations, one at the knee joint and one in the leg, and the third was fatal from gangrene.4 The two amputations were practised after tetanus had supervened:5 Case 16.—Corporal B. Prather, Co. D, 103d Ohio, aged 18 years, was wounded at the battle of Nashville, December 15,1864, and was admitted to the Cumberland Hospital on the following day. Surgeon B. Clark, TJ. S. V., reported: "Gun- shot wound of right foot, ball entering immediately under the metatarsal bone of the great toe and burying itself in the plantar fascia. The soft parts were remarkably sensitive in the vicinity of the wound, showing a great degree of muscular and nervous irritability. The foot was not swollen, the bones were not fractured, nor the tissues severely lacerated. December 26th, the ball was removed by Acting Assistant Surgeon S. G. Ayres; second operation, exsection of a half inch of the posterior tibial nerve, behind the inner malleolus, by Assistant Surgeon W. B. Trull, U. S. V.; third operation, amputation of the toe, with removal of the first metatarsal bone, by Acting Assistant Surgeon L. E. Tracy. The patient complained, on December 26th, saying that a feeling of stiffness had been coming on for three days, especially in the shoulders, neck, and jaws. The latter gradually closed until it was impossible to introduce food into his mouth. There was a tetanic spasm of the muscles of deglutition, so that the patient was dying from inability to swallow. Chloroform alone seemed to afford temporary relief from his intense sufferings. Relaxation of the jaws was effected by division of the nerve, but the spasms of the muscles immediately returned. At midnight of the 27th, amputation at the lower third of the leg was performed by Acting Assistant Surgeon S. G. Ayres, but without effect. Large opiate injections were afterward given, and the patient obtained sleep. A copious warm perspiration breaking out upon the face and the improved pulse were considered favorable symptoms. Died December 28, 1864." The three cases of shot wounds of unspecified nerves were probably examples of 1 Cases of Lieutenant A. Rodman, 2d Wisconsin, wounded in 1862, and who recovered. Also of Private W. Lette, Co. I', 29th New York, wounded at Bull Run, August 29, 1862; Corporal A. McNeal, Co. A, 121st New York, wounded October 19, 1862; Sergeant C E. Clark, Co. H, 32d Virginia, wounded at Spottsylvania, May 12, 18fi4 ; and Private P. J. Vimont, Co. C, 7th Kentucky Cavalry, who were discharged for disability. 2Case of Private J. G. Grissetta, Co. D, 2d Alabama; wounded at Fort Blakely, April 9, 1864; died April 21st. It is stated that the popliteal iierve was "dark and disorganized." 'Private James Rollins, Co. H, 28th North Carolina, aged 30 years ; wounded at (Gettysburg, July 3,1863; tetanus July 20th ; death, July 22, 1863. 4 Case of Private G. Richmoud, Co. D, 111th New York, wounded at Bristow Station, October 14, 1863, in the upper third of the left calf by a carbine ball. He was sent to the Third Division Hospital at Alexandria. The wound was dilated by an incisiou. Gangrene appeared and spread very rapidly, and death took place October 23, 1863. 6 Case 16, and the case of Private J. Leonard, Co. G, 5th Ohio, aged 22 years, wounded at Gettysburg, July 3,1863; tetanic symptoms July 14th. amputation at knee joint July 16th, and death three hours after. 12 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. injuries of the sciatic in one instance, of the anterior and posterior tibials in the others. Abstracts of two of the cases are subjoined; the third case has been published, and has been noticed in the foot-note on page 9 (case of Private J. S. L. Scott, 121st New York). Case 17.—Sergeant J. W. Crane, Co. A, 79th New York, aged 27 years, was wounded at Bull Run, August 30, 1862, and admitted to Judiciary Square Hospital, Washington, one week afterward. On May 9,1863, he was transferred to DeCamp Hospital, David's Island, whence Acting Assistant Surgeon J. W. Dickie reported: "A ball passed through right thigh at about the junction of the upper and middle thirds. The wound closed about the first of March, and a small abscess formed, about that time, a little below the wound. When the abscess healed a pain commenced in the left hip joint, extending to the foot. This pain was constant. No pain was felt in the right leg except when pressure was made on the wound. The pain was most severe in the hip and calf of the leg. It would at times ascend and affect the respiratory muscles, causing great distress and difficulty in breathing. Appetite poor when admitted, yet the patient is quite fleshy. Had taken considerable quantity of morphia, so much as to be free from pain. May 13th, had recurrence of pain and dyspnoea, and spasm of upper extremities. Gave chloro- form, twenty drops, and repeated the dose in fifteen minutes. May 17th, had another spasm; same treatment. Has slighter attacks more frequently, which are relieved by exposure to cold. May 19th, had another spasm; two grains of sulphate of morphia given; pain checked. May 24th, another spasm; gave chloroform one drachm, and sulphate of morphia one grain; pain relieved. On the next day cauterization was performed along the course of the great ischiatic and peroneal nerves. May 28th, gave nine grains of sulphate of quinine and a half grain of sulphate of morphia, and repeated every evening. May 29th, had a recurrence, but not much spasm. June l"~th, the cauterized surface is healed; patient improving and has but little pain. June 22d, walked out, supporting himself by means of canes." The patient was subsequently transferred to McDougall Hospital, where he was recorded as having been "returned to duty December 28, 1863." The records, however, do not show that he resumed active duty in the field. He was mustered out October 6, 1864, and pensioned. The Hartford Examining Board certified, May 3, 1871: * * "The muscles and skin are bound down to the bone and are much impaired in action. Partial paralysis of both limbs, owing to the injury to the nerves." The same Board reported, September 15, 1873, that "owing to the injury to some nerve he suffers excruciating pain on slight exercise or change of temperature," and, at a subsequent examination, they stated that " pain extends to the spine and down the other leg, and the limb at such times is drawn up spasmodically;" also that "he is confined to bed from one to three months every year," etc. The pensioner was paid June 4, 1876. Case 18.—Private J. W. Young, Co. E, 137th New York, aged 27 years, was wounded at Gettysburg, July 2, 1863, and admitted to Harewood Hospital, Washington, three weeks afterward. Acting Assistant Surgeon T. H. Elliott reported: "Gunshot wound of right leg. Ball entered through upper portion of gastrocnemius muscle and emerged near the head of the fibula. The foot, immediately after the injury, dropped to full extension; all of the muscles of the leg paralyzed from division of nerves; flexors of thigh contracted, causing the heel to be raised from the floor three inches in the erect posture. Patient is unable to bear any weight on the limb. August 6th, wound unhealed; paralysis of extensor muscles complete. Patient discharged from service August 16, 1863." Examiner J. G. Orton, of Binghamton, New York, September 15, 1866, certified: "The power of flexion of the foot upon the leg is impossible in consequence of injury to flexor muscles; walking is performed with much difficulty and not without assistance." On February 29, 1876, he reported: * * "The power of flexion of the foot is entirely gone. It is at present almost worthless, the foot being swollen, and drags when he walks; he cannot walk without assistance." The pensioner was paid March 4, 1876. In addition to the cases of reflex paralysis cited from Dr. Keen in foot-note 2 on page 9, a report of an instance of this rare affection is given below.1 Special reports of operations on this subject are infrequent.2 1 Private C Sullivan, Co. K, 69th New York, aged 3G, was wounded at Spottsylvania, May 10, 1864. From a field hospital of the Second Corps he passed to Douglas Hospital at Washington, and thence to South Street at Philadelphia, from all of which places "a shell wound of the left leg" was reported. Assistant Surgeon S. A. STORROW, U. S. A., in charge of the Filbert Street Hospital, described the injury as ''a shot wound of the gastro- cnemius muscle, involving the posterior tibial nerve." Acting Assistant Surgeon L. Tosier reported the patient's admission to the Ladies' Home Hospital, New York City, November 7th, and the following history: "A shell wound of the posterior portion of the leg, severing the lower portion of the gastro- cnemius muscle. The wound has healed with considerable contraction of the parts, flexing the foot strongly and leaving the ankle joint exceedingly tender and painful—almost immovable. On the morning of July 11th the patient awoke with almost complete paralysis of each forearm and hand, in which condition they yet remain." The patient was discharged December 9, 1864, and pensioned. Examiner E. Bradley, of New York, on February 10, 1866, certified to atrophy of the wounded limb and an open ulcer occupying the lower and posterior surface; also to partial paralysis of the right hand. The New York Examining Board reported, September 11, 1872: "A shell wound, etc., leaving a tender cicatrix which is constantly breaking open. Locomotion is interfered with. The limb is very tender, and it is painful for him to walk. He cannot move his right hand on account of total paralysis of it, nor close the fingers. He states that both hands became paralyzed after he was wounded, and that he recovered the use of the left hand, but the other hand remained useless. We cannot discover any connection between the wound of the leg and the paralysis of the hand." Dr. A. B. MOTT.'of New York Cit}', who was surgeon in charge of Ladies' Home Hospital at the time of the pensioner's discharge from service, certified, February 22, 1873: ' At the time of his admission to the hospital the patient had lost the use of both arms, but he recovered the use of the left arm. As far as my memory serves me, it was my opinion at that time that the paralysis was due to shock at the time of receiving the wound '" The pensioner was paid June 4, 1877. 2 On wounds of the nerves of the lower extremities the reader can consult, in addition to the works already cited, and the researches of ClUJIK- SHAXK. FOXTAXA, J. F. MECKEL, R.ETZIUS, TlEDEMAXX, and other experimenters in surgical physiology on the results of division of the nerves, the following authors: Descot, Diss, sur les affections locales des nerfs, Paris, 1822, No. 233; Swan (J.), A Treatise on Diseases and Injuries of the Nerves, 2d ed., London, 1834 ; HAMILTOX (J.), On some effects resulting from Wounds of Nerves, in Dublin Jour, of Med. Sci., 1834, Vol. XIII, p. 38; Waller, Nouv. meth. anat. pour I'investigation du systime nerveux, Bonn, 1852; PHILLIPEAUX and VULPIAN, Recherclies sur la regeneration des nerfs, in Mem. de la Societe de Biologie, 18.39; Dlchexxe, De electrisation localisie,elc., 2d ed., 1860; Loxoe, Recherches sur les nivralgies, consicutives aux lesions des nerfs Paris. 1860, No. 199; TlLLAUX (P.), Des Affections Chirurgicales des Nerfs, Paris, 1866; PaULET, Les Suites immediates et eloignees des lesions lraun\atiques des nerfs, in'Gaz. Hebdom. de Paris, 1868, T. V, p. 283; FOLLE? (E.), Traitiilim. depath. ext., Paris, 1867, T. II. p. 233. SECT. I.] SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. 13 Flesh Wounds of the Lower Limbs with Injury of the larger Blood-vessels.—As indicated in my preliminary surgical report in Circular 6, 8. Gr. 0., 1865, p. 38, shot wounds of the larger arteries of the lower extremity, the femoral, profunda, peroneal, and tibials, uncomplicated by fracture of the adjacent bones, or by extended disorganization or complete removal of the limb by the impact of large projectiles, that come under the treat- ment of the military surgeon, are comparatively infrequent. It is difficult to convince surgeons who have had little field practice of the rarity of this form of accident.1 It is strikingly illustrated by the fact that, in the series of fifty-eight thousand seven hundred and two cases of shot flesh wounds of the lower extremities we are now discussing, only a hundred and fifty-six instances of this particular lesion, or 2.6 per thousand, were reported. Of one hundred and fifty-six cases, thirty-three were treated without operative inter- ference, eighty-seven by ligation, twenty-three by amputation, and eight by ligation followed by amputation. These four groups will be separately considered. Wounds of Blood-vessels treated without Operation--—This group comprises eighteen cases of wounds of the femoral artery, in two of which the femoral vein was likewise implicated. Of these fifteen terminated fatally. There were three fatal cases in which the femoral vein alone was involved. There were four cases of wounds of the popliteal, with two recoveries. Of two cases of wounds of the posterior tibial, one complicated by wound of the peroneal was fatal. Of two cases of wounds of the peroneal one was fatal, and the result in the other case cannot be ascertained. Two cases of wounds of the ,nternal saphenous vein resulted favorably, as did a case of wound of the dorsalis pollicis. A. case of wound of an unspecified artery of the lower extremity had a fatal result. Twenty-three of the thirty-three cases terminated fatally, a mortality of 71.8 per cent. A few examples of these injuries will be detailed, commencing with a case of occlusion of the femoral artery from contusion, and two instances of direct lesion of that vessel:2 Case 19.—Private S. T. Newell, Co. B, 1st U. S. Artillery, aged 21 years, was wounded at Gettysburg, July 2, 1863, and entered the Satterlee Hospital, Philadelphia, July 11th. Acting Assistant Surgeon W. C. Dixon reported: "The missile, a piece of shell, struck the inner side of the left thigh, middle third, producing a severe flesh wound. Simple dressings were applied. On the 19th the wound assumed a gangrenous appearance ; a mixture of equal parts of creasote, alcohol, and water was applied. Under that treatment it remained about the same until July 2Sth, when the sloughing commenced to spread l/ipidly and nitric acid was applied. On the 29th the femoral artery was exposed at the upper and lower edges of the wound, with a large amount of sloughing tissue occupying the intermediate space. Two days later the slough was removed from around the artery, which was found to have been converted into a fibrous cord bearing no resemblance to an artery. It was watched closely to guard against haemorrhage. At 2 o'clock P. M. on August 1st the artery separated, and the proximate and distal extremities of the vessel were found to be perfectly occluded. The wound healed rapidly, and in September the patient was transferred to Fort Hamilton." He was discharged, at Fort Independence, December 7, 1863, and pensioned. Examiner J. H. Crombie, of Deny, N. H., certified, May 6, 1874: * * "Was struck by a piece of shell, * * making a wound six inches in length and three in width, penetrating nearly to the bone. The limb is weakened very much. The muscular power is considerably limited. He is unable to walk or labor on the limb for any length of time by reason of weakness." The pensioner was paid June 4, 1876. 1 Heine (C.) (Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 127) remarks that; "The rarity with which shot injuries compli- cated by serious arterial hemorrhages present themselves to surgeons at the stations for first dressings (erste Verbandplatz) is an experience that repeats itself in every campaign. Hence operative interference on account of wounded blood-vessels is seldom necessary at this stage. From the last war [the Danish war of 1864J I cannot recall a single case in which ligation or amputation was performed for primary bleeding at the field ambulance stations." 'the first chapter of GUTHRIE'S Commentaries on the Surgery of the Peninsular War, that excellent vade-mecum of the military surgeon, and the chap- ter on gunshot wounds of the extremities by MATTHEW, the historian of the surgery of the British army in the Crimea, have already established the doctrine above enunciated. The misconceptions which such an authority as VALENTINE MOTT adopted in his paper Ore Hsemorrliage from. Wounds,— a paper contributed to the publications of the SANITARY COMMISSION,—can only be explained by his comparatively slight acquaintance with the effects of shot injuries. 2 Of the remaining fifteen cases of shot wounds of the femoral artery treated on the expectant plan, one resulted successfully—case of Wammack, 5th North Carolina—and fourteen fatally, viz: Dinguid, Griffin's Battery; Ledbetter, 9th Alabama; Sylvester, 9th New Hampshire; Riming, 81st Penn- sylvania; Corris, 17th Illinois; Collins, Ordnance Corps; Blaisdell, 17th Massachusetts; Lawrence, 9th New York Cavalry; Masser, 143d Pennsyl- vania; Craft, 144th New York; Stephen, 147th New York; Geary, 4th Georgia; Bailey, 8th Illinois Cavalry, and Clarendon, 26th Massachusetts. In the last two cases the femoral vein was also implicated. It is impracticable to give the details of these cases, but the names are mentioned in order that students of this special subject may be enabled to refer to them in the MS. records of the Surgeon General's Office. 14 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Of the cases of wounds of the femoral artery treated without operation, a case of recovery and a fatal case will be detailed: Case 20.—Lieutenant L. Hallman, Co. D, 51st Pennsylvania, aged 24 years, was wounded at South Mills, April 19, 1S02, and admitted to Hygeia Hospital, Fort Monroe, five days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: " Gunshot wound of femoral artery, a bullet traversing the middle of the left thigh, entering anteriorly, and escaping on the posterior aspect just opposite. Pulsation could indistinctly be felt in the'pedal and posterior tibial arteries. About one week after admission a smart arterial haemorrhage came from the anterior wound. Compression by a bandage and cold wet applica- tions were made, and the haemorrhage was controlled, but returned the next day. We proceeded to his room to tie the femoral; on consultation, however, it was decided to wait, and, if it should bleed again, to operate. He continued doing well. Treat- ment: Absolute rest and cold wet applications, ice in small portions being allowed to melt on the bandage which surrounded the thigh. May 20th, abscess of the skin appeared, and discoloration of the great toe, which eventually sloughed to the first pha- lanx; temperature of the foot all the while good. He was sent to Philadelphia, in June, quite well." Lieutenant Hallman was transferred to the Veteran Reserve Corps on March 14, 1864, and ultimately mustered out of service June 30, 1866, and pensioned. Examiner W. Carson, of Norristown, Pennsylvania, March 3, 1867, certified: "Ball passed through left thigh, * * wounding the sciatic nerve; has lost first joint of great toe, with immobility of all the toes. Atrophy of limb equal to one inch in circumference; foot cold." Examiner H. E. Goodman, of Philadelphia, certified, September 18, 1869: * * "Limb much weakened and painful all the time." The pensioner died, of consumption, November 24, 1871. Case 21.—Sergeant H. Booth, Co. E, 7th Indiana Cavalry, aged 24 years, was admitted to the Gayoso Hospital, Memphis. April 18, 1864, having been wounded on the previous day by the accidental discharge of a revolver held in the hands of one of his comrades. Surgeon F. N. Burke, U. S. V., made the following report: ''The ball entered the left thigh directly over the course of the femoral vessels, two inches below Poupart's ligament, and escaped at the crease of the nate and median line of the left thigh. There was copious haemorrhage at the time the wound was received, but it was arrested by application of the tourniquet. As a precautionary measure it was left on at the time of admission, but not tightened. The wound became unhealthy and had a gangrenous smell on the fourth day. Charcoal cataplasms were then applied, and Laharraque's solution used to the wound. On the sixth day haemorrhage again occurred, amounting to about six ounces, but pressure again arrested it. For the twenty-four hours preceding this the whole limb had become swollen and cedematous, especially the upper portion of the thigh. The patient had become very much prostrated and his pulse quite weak. He was naturally of a weak constitu- tion. It was thought that to tie the artery there would result in gangrane of the limb, as its vitality was evidently quite low, and, the wound being unhealthy, secondary haemorrhage from the sloughing of the vessel would be imminent. Amputation was then thought of, but it was obvious that the patient was too much prostrated to hope for a successful result. Oozing of blood occurred a couple of times during the ensuing few days, but the formation of a small clot was sufficient to arrest it. He died on April 28, 1864. The post-mortem examination discovered the femoral artery to have been perforated so as to admit the passage of a duckshot through the wound about half an inch below the origin of the profunda. The femoral vein was found to have sloughed for a distance of about one and a half inches, gangrene having extended along the fascia and cellular planes from one to one and a half inches at different parts along the course of the wound. The ball had passed between the femoral vessels and the femur." Of the four casss of injury of the popliteal artery, a fatal instance and one that eventually resulted in fatal aneurism are selected for illustration:1 Case 22.—Private J. C. Mapes, Co. K, 103d Pennsylvania, aged 22 years, was wounded in the left leg at Kinston, December 14, 18ii, and entered the Stanley Hospital, New Berne, six days afterwards. Acting Assistant Surgeon J. B. Upham reported: "A mini6 ball entered three inches above the knee joint, on the inside, over the track of the femoral artery, and passing downward and backward emerged in the popliteal space near the insertion of the biceps, lacerating, in its course, the popliteal artery. His condition at the time of his admission was one of great mental and bodily depression. He was treated by stimulants, warm applications, and generous diet. Three days afterwards, secondary haemorrhage coming on, attempt was made to ligate the femoral artery by dilating the wound, which failed. Amputation was not resorted to on account of the con- dition of the patient. Gangrene below the point of the injury came on rapidly, and the patient died December 29, 1862, fifteen days after the reception of the wound. The post-mortem examination revealed the injury of the artery already alluded to, which extended for a considerable distance, the track of the ball being almost in a direct line with the course of the vessel itself." The other case referred to is a remarkable example of aneurism developed after fourteen years, as the remote result probably of a shot contusion of the popliteal artery: Case 23.—Private W. Young, Co. K, 4th New York, aged 19 years, was wounded at Fredericksburg, December 13, 1862, and admitted to Campbell Hospital, Washington, four days afterwards. Surgeon J. H. Baxter, U. S. V., recorded: '• Gunshot wound of leg; patient transferred to Baltimore January 8, 1863 " Surgeon L. Quick, U. S. V., reported that the patient was discharged from McKim's Mansion Hospital, March 18, 1883, for "gunshot wound of left leg, ball entering near the head of the tibia and emerging through the internal belly of the gastrocnemius muscle, producing lameness." The Boston Examinino- Board certified, October 27, 1865: "Has had wound of leg below knee, * * ball emerging one inch below and behind the internal condyle of the femur, evidently passing across the internal saphenous vein. Cicatrices not adherent, but there is some loss of substance of muscle, and the veins of the leg are varicose, probably in consequence of the wound. Mo- tions of joint good. He says he has pain in leg on walking or standing, and much pain in popliteal space while sitting." On August 25. 1'37G,*lhis pensioner came under the care of Dr. J. Collins Warren, at the Massachusetts General Hospital, who ' The other two cases of 6hot wounds of the popliteal artery are those of Pogue, 110th Ohio, who recovered and was discharged, and of Thompson, 120th New York, who died sixteen days after the reception of the injury. SECT. I.J SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. 15 reported the further progress of the case to the Boston Society for Medical Improvement, in the Boston Medical and Surgical Journal, Vol. XCV, No. 18, as follows: "Was wounded fourteen years ago, at the battle of Fredericksburg, by a musket ball, which entered the calf of the left leg a little to the inside, and came out opposite the inner aspect of the knee joint. There was no unusual amount of haemorrhage at the time, and the wound healed well, but on recovery a small bunch remained in the popliteal space, growing larger at times, and again almost wholly disappearing. One year ago it grew larger than before and began to pulsate. It soon filled the hollow of the knee, and during the last two months has spread rapidly on the inside of the thigh. The skin over the popliteal space is made tense by an ill-defined pulsating mass, which spreads along the course of the femoral artery to within eleven inches of the anterior superior spinous process of the ilium. The left knee is nineteen inches in circumference, while the right knee measures but thirteen and one-fourth inches. The patient suffers severely from pain in the calf and foot, which is relieved only by frequent subcutaneous injections of morphine. A pound cannon-ball applied to the femoral diminishes but does not arrest pulsation in the vessel. Heavy pressure with the hand arrests pulsation entirely. August 30th: The patient was etherized and pulsation in the femoral was arrested by two hospital tourniquets applied, near the apex of Scarpa's triangle, alternately every fifteen minutes for twelve hours. During this period the patient was kept profoundly etherized, about a pound and a half of ether having been consumed for that purpose, with the exception of a few minutes during the afternoon, when some beef-tea and brandy were administered. The pulse during this time gradually rose from the normal rate to about 120, but subsided somewhat after nourishment had been taken. On removing the tourniquets pulsation had ceased, although on auscultation a slight murmur was heard beneath the tumor. At midnight there was no return of the pulsation, but the next morning a slight pulsation was observed, which gradually increased to its prtvious force. September 10th: Pressure was applied as before by tourniquet without ether, the patient preferring to bear the pain, and was continued for twenty hours, but had no effect upon the pulsations, which reappeared after it was removed. September 19th : The patient was etherized, the sac laid open, the clots, which were numerous, everted, and the artery tied at each end. It was found that the sac extended to the point of bifurcation of the popliteal artery. Two ligatures were therefore necessary at this point. The patient rallied well from the operation, and for the first week the wound healed rapidly. An attack of erysipelas arrested the healing process and reduced the patient greatly. On October 3d, haemorrhage occurred from the upper end of the wound during the afternoon, and although digital pressure was immediately resorted to by an attendant, and in a few minutes the tourniquet was applied, the patient sank, and died the same evening. Dr. Fitz showed the specimen, which consisted of the aorta from its origin, the left femoral, and a portion of the aneurism in continuity. The fatal haemorrhage had resulted from the sloughing of the walls of the artery at the upper end of the aneurismal sac, where the ligature had been applied. There was no alteration of the inner surface of the femoral artery, but the fibrous tissue was indurated around it, corresponding with the region where compression had been applied. The entire inner coat of the thoracic aorta was thickened, wrinkled, elevated in patches of an opaque grayish-white color, and the canal was dilated, especially that of the arch. Just above the cceliac axis theM' alterations ceased abruptly, the interior of the abdominal aorta being smooth and yellow, its walls evidently in a normal condition. The specimen was particularly interesting from the absence of changes at the point of compression and the presence of chronic inflammatory conditions of the thoracic aorta, such as are associated with the formation of aneurisms in a young man in whom a popliteal anuerism had arisen directly or indirectly from a traumatic cause." Of five cases in which large veins were wounded, three in which the Jemoral vein was separately injured proved fatal, and two, in which the internal or long saphenous was believed to be lacerated, recovered. One of these is detailed:1 Case 24.—Lieutenant L. D. Martin, Co. A, 29th Illinois, aged 32 years, was wounded through the left thigh at the siege of Fort Donelson, February 15, 1862. Dr. Madden, of Nashville, noted the following history of the case, which was forwarded by Surgeon E. Swift, U. S. A., Medical Director: "A rifle ball entered the limb at a point directly over the saphenous opening and glanced around upon the fascia lata to the outer aspect of the thigh, where it emerged one inch below the trochanter major. There was a copious flow of blood from the wounded veins at the time of the injury, but this was readily checked with lint. The patient was conveyed to the Academy Hospital at Nashville. On the eighth day there was a recur- rence of venous haemorrhage from the inguinal wound. This was again arrested by pressure, and the patient continued to improve till the evening of the 5th of March, when the bleeding was suddenly renewed to such a degree that the coats of the femoral artery were supposed to have yielded, burgeon E. Swift, Medical Director in this city, having been consulted, he directed that the artery should not be ligated but judiciously compressed, and it was decided to postpone till the next morning any attempt to place a ligature upon the vessel. Pressure with the fingers upon the artery at the point of its emergence from beneath Poupart's ligament was maintained during the whole night by relays of assistants. Next morning, on intermission of the pressure, there was no haemorrhage, nor was there any pulsation distinguished below the wound. A compress was placed over the artery, and a bandage applied from the toes to the groin. This was removed at the expiration of twelve hours, and the limb was wrapped in flannels. Pulsation below the groin was not perceptible for several days. The limb, however, retained its temperature and its vitality, and the circulation gradually became re-established. There was no recurrence of haemorrhage. The patient recovered his strength rapidly, and returned to his home April 5, 1862, at which time he was able to walk with the assistance of a cane." Lieutenant Martin resigned the service September 17, 1862, and was pensioned. Examiner J. W. Redden, of Shawneetown, Illinois, March 1, 1864, certified: "The ball entered the front of the left thigh near the femoral artery, which seems to have been wounded; there is general derangement of the nerves affecting the joints, and muscular activity and strength of the limb." Examiner H. W. McCoy, of Golconda, Illinois, September 16, 1873, reported the pensioner as having received a "flesh wound of the left shoulder" in addition to the above injury, but no mention is made of this in any previous reports. The pensioner was paid June 4, 1876 1 The three cases of injury of the femoral vein are: Scullen, 25th Ohio, who died of pysmia on the Kith day ; Uainbridge, > : n New York, fatal on the 23d day (f:.r autopsy see Lincoln Hospital Oiso Book No. 17); and Schumaker, 2d New York Cavalry, who died on the eighth day after the reception of the injury. The «,ther t-u*c . f injury of tho internal saphenous vein is that of Johnson, "th Connecticut, who recovered aud was discharged. iU INJURIES OF THE LOWER EXTREMITIES. rcHAP. x. The result of this series of thirty-three shot wounds of the larger arteries and veins of the lower limb sufficiently prove that compression, styptics, or a let-alone practice cannot be safely adopted in such grave accidents. The histories of three fatal cases of wound of the femoral vein corroborates the argument of Surgeon S. W. Gross, U. S. V., in favor of the ligation of wounded venous trunks.1 Surgeon J. A. Lidell, U. S. V., in his excellent memoir on traumatic haemorrhage," has cited two or three other instances of shot lesions of the great vessels of the thigh, reported by Surgeon W. Clendenin, U. S. V., of which I am unable to find any mention in the official returns. The comparative rarity of profuse primary bleeding from shot wounds of the large blood-vessels of the extremities can hardly be seriously contested.3 Wounds of Blood-vessels treated by Ligation.—Eighty-seven cases were reported of shot flesh wounds of the lower extremities with lesions of the larger blood-vessels, treated by primary or intermediary ligation of arteries. Only twenty-six of these resulted favorably, leaving the formidable mortality-rate of 70.1 per cent. Six cases in which the external iliac artery was tied for wound of the femoral or profunda, or of these vessels and their accompanying veins, were fatal. Of sixty-two ligations of the femoral but seventeen, or 27.4 per cent., were successful. One of two ligations of the profunda was successful. In seven ligations of the popliteal, two patients survived. There were two ligations of the anterior tibial with one recovery,—five of the posterior tibial with four recoveries,—two of both tibials with one recovery,—and one fatal case of ligation of the peroneal artery. All of these cases will be hereafter enumerated in brief abstracts or in tabular form; but, as there are many other cases of deligation of the same vessels in shot flesh wounds without primary arterial lesion, it will be most convenient to classify the analogous cases further on, and there will be presented here only a single abstract of a remarkable recovery after ligation of the femoral artery for shot injury:3 Case 25.—Assistant Surgeon R. S. Vickery, 2d Michigan, aged 33 years, was wounded at Petersburg, July 30, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon P. A. O'Connell, U. S. V., reported: "Gunshot wound of upper third of left thigh by mini6 ball; ligation of femoral artery performed by Surgeon W. B. Fox, 8th Michigan." From the field hospital the patient was moved to City Point, and subsequently to New York. Assistant Surgeon J. E. Semple, U. S. V.. reported his admission to the Officers' Hospital, Bedloe's Island, August 25th, with "flesh wound involving direct injury to the large artery of the thigh." In January following, the invalid was transferred to Armory Square Hospital, Wash- ington, where he was discharged from service March 11, 1865. Examiner J. Nichols, of Washington, certified, March 24, 1865 : " Gunshot wound of left thigh, inner aspect, upper third, ball severing femoral artery. Limb much atrophied and shrunk away almost to the bone; leg partially flexed upon the thigh ; inability to extend it. Great danger of secondary haemorrhage from the artery, which requires a long time for restoration. Limb perfectly useless; prognosis doubtful—may yet have to be amputated." Dr. Vickery was a pensioner until May 14, 1867, when he was appointed Assistant Surgeon in the regular army. 1OEOSS (S. W.), Remarks upon the General Applicability of Ligation as a Venous Hemostatic Agent, in Am. Jour. Med. Sci., 1867, Vol. LIII, pp. 17, 305. ' In his paper on the Wounds of Blood-vessels, Traumatic Hemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in the Surgical Memoirs of the Sanitary Commission, 1870, Vol. I, p. 51, etc., Dr. JOHN A. LIDELL published several abstracts, contributed by Surgeon W. CLENDENIN, U. S.V., purporting to be descriptions of examples of " complete division of arteries by gunshot projectiles."' Although these abstracts aptly illustrate the subject in band, it has been found impracticable to verify the cases on the regimental and hospital returns ; but in the confusion of the battle-field it is probable that not a few important surgical accidents failed to get recorded In the case of James Brown, 3d Tennessee Mounted Infantry (loc. cit., p. 51), it appears that this regiment was never in action, and the patient's name is not on the hospital registers, nor does it appear on the death records. In the case of James O'Neal (loc. cit., p. 55), it is left to conjecture whether the man belonged to the 10th Tennessee Mounted Infantry or to Wheeler's Cavalry. No reference to such a case is found on the files of the War Department. In the case of Sergeant French, 4th U. S. Cavalry (loc. cit., p. 56), neither the date of the injury nor the engagement in which i* was received are given, and on inquiry of the Adjutant General it has been ascertained that "there is no record of the enlistment of any soldier by the name of French in the 4th U. S. Cavalry, from 1856 to 1865, inclusive." 3 BILLROTH (TH.) (Chirurgische Briefe, etc., Berlin. 1872, p. 113) remarks: " Of the immediate results of injuries of the larger blood-vessels, of profuse hemorrhages on the field of battle, 1 have as little to relate as other surgeons that have served in the field. None of the colleagues with whom I conversed had obsened such bleedings. Nowhere did I find a case of primary ligation of a large blood-vessel. It has been asserted that injuries of this kind prove fatal so rapidly on the battle-field that any assistance comes too late. There is no valid proof of this assertion. * * Observations are accumulating that arteries, even of the size of the aorta, when perforated by some modern shot projectiles, do not invariably bleed. In Carlsruhe, I have learned of a case a priori incredible, but attended by a careful autopsy, in which a shot through the aorta caused no bleeding until several days after the injury; the patient was therefore transported from Worth to Carlsruhe with a hole in his aorta without any bleeding. I have, myself, seen three cases of shot wounds of the external iliac and femoral artery in which no bleeding occurred." l'roiessor BILLROTH then details the cases. SECT. I 1 SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. 17 Dr. F. H. Hamilton states (Appendix to Treatise on Military Surgery and Hygiene, 1865, p. 640) that in this case "the bleedino- was arrested temporarily by a tourniquet, and three hours afterwards Surgeon Fox, of tho 8th Michigan, enlarged the wound and tied the femoral both above and below the scat of injury." No military surgeon now disputes the propriety of tying both ends of a bleeding artery at the wounded point,1 and it is probable that if the judicious practice of Surgeon Fox had been more generally followed, and the precepts of Guthrie better appreciated, the deplorable fatality of this series of cases might have been largely averted. Wounds of Blood-vessels treated by Amputation.—There were twenty-eight cases in which amputation was practised on account of uncontrollable bleeding from shot wounds of the larger blood-vessels of the lower extremity, and eight cases mentioned in the next subsection, in which recourse was had to amputation after proximal ligation of main arterial trunks had proved ineffectual. The series of twenty-eight cases includes twenty- six thi■■' :ous aiiJ war v.oloi •'.' Ca« ».--> ! ftapp •i.anr >> 1. (• l.-ii.!.! ,-r::d.i. ■ .- -. ..W1::;' "■, w. o • • , •,: .1 .■ii«-!.r: . he v i* !-•■;■ l "'... /!■ '■':•.. •'ber»' ;:»■ - ,•' 'r" v. :■«*., ••»«.•!•.'• '. ' ^V. . ..' -^ .;,,,.,,..„:,■, .... •; .-(: .-*|: :.:• I ••-.!..•!' oxygen . ■ _'■. \. ■■■ •; extract,"' ■ i .-" ' ■ ' • • aphi'y :•' ; . ..■ -jon J. It. i • : •• ft .:>i, i/ttr -1 ■•■ ■'#!. ■• r " ■■" ; ■••'• .***-.. 1 -.11 •■■•■ ■ ,. .1; m p. -v ■.-■■li'.liiy ■•■ • .V,. t.-:- ■•■ : u- ib. . '.Kg was -lV:v' .' 'I'll •■' ■•,. ■ •■' • :' ia with a lobei 1!: 1, ti>'. ... ... .n.mers^i iloth •""J » «■'■• ; • . i'te cotton !.-l!v «.• >>'.• *■■ vvi ne began '»>. •.,■.■ ■,. .... was mivde, ■ V ;>. ■•..'. v'.i.." was ..... .. been ting ail i. v :.ie ■•!• U.vi'.Ml ,;...i :)n pati'"t K vy.-t prepi. ...... Ti.,i pnpli -Itt ■ •,,.■ t - ..rgwon J. .:-ii (.!■■«••. *). , _ . ' dim .....Of the 1 ■' 1 ■ r the ftiiiuro «:- '^ ■ ligation of i.li>' ,; .■ :'..c,)Vere<. ' v.en:: .■ • ihe bi- • ■ ■ r >■. : «dy,Ii ■ ' ., ■ ■ '• "'i.i-.'iih ;'■ '.■<-■ • »'.. p^.bcd •' vy „>:'. y, the ve • '.faa ;■.... US of tl'«- '■■ .inU .'..-. ■.... ->'-. ■... w. '. ! wan wii.' mi.m •■■'1..3S '*V«..'.'.n-\« N>r ^ 0t B^ood V'*~ t.-vo ';?oing su1 . -;. . a the pi-.i.'.'; i p. i&tte- :iry ]t.ij . / c '• t\ Large J Or LdV' cfe \V:- virt ir;\ .r other r;mit.»es jeuetict- Med.M Sur-' Hwt.oi' tlie War of the Rebellion, I'orl III Vol. II op p.-iyc- |; *--m& ■ ^^KDKjwSiSi * ■'■■■ i'"■'* * T.Sin.-lair * .-.in > hj..,.ii.ililh PLATE XXVIII .GANGRENE FOLLOWING A SHOT LACERATION OF THE FEMORAL ARTERY. I'usc of S«>r'_:e;.iiit (1 .W. (liirtliifi-. SECT. I.] SHOT LACERATIONS OF THE SOFT PARTS. 19 ting or perforating wounds by small missiles. These are included in this third subsection of shot flesh wounds of the lower extremities, a group of fifty-eight thousand four hundred and eighty-seven reported cases, which (as stated on page 8) it is difficult to classify. Some instances remarkable for the extent of laceration of the soft parts will be cited, some of lodgement of foreign bodies, and some distinguished by the complications of pyaemia, tetanus, gangrene, erysipelas, haemorrhage, secondary involvement of joints, etc., will be adverted to. In a hundred cases, ligation of the larger arterial trunks was resorted to, and in a hundred and sixty-one recourse was had to amputation. It will be recollected that in the two preceding subsections ninety-five examples of ligations and forty of amputations have been alluded to, as connected with primary injury of the nerves or vessels. All of these cases of ligations and amputations will be cited in consolidated tabulations at the close of this section. Some cases of shot wounds of the lower limbs, in which no operative interference was undertaken, will now be detailed. Shot Lacerations.—After extensive destruction of the fleshy parts of the thigh and leg, reparation was usually slow and imperfect, sometimes as much so as in the remarkable case of laceration of the buttocks, narrated at page 430 of the Second Surgical Volume. Practitioners accustomed to regard mere flesh wounds as of little moment were not always happy in their prognoses of shot injuries of the soft parts in the lower limbs.1 Case 29.—Sergeant J. W. White, Co. F, 14th New Jersey, aged 24 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick on the following day. Acting Assistant Surgeon J. H. Bartholf reported: " The patient was wounded by a cannon ball, or, as he says, by an unexploded shell, which tore through the back of his left thigh and killed a man close by him. It produced a very extensive lacerated wound, extending on the back of his thigh from near his knee to the fold of his buttock—a huge flap hanging downward and a shorter one attached at the upper end of the wound. He was admitted here the next day, without then suffering from any shock. Free suppuration followed, but not any sloughing, and simple measures only were required, viz: poultices, dilute solution of permanganate of potash, balsam of peru, water dress- ings, oakum, simple cerate. It granulated, contracted, and healed till, on November 25th, the raw surface was only four inches square. No loss of motion at the knee joint, strange to say, resulted from this extensive involvement of the muscles. Decem- ber 22d, he is transferred to hospital at Beverly this day. The wound is very nearly healed, and the patient in good health." Subsequently the man was transferred to the Whitehall Hospital, whence he was discharged June 17, 1865, and pensioned. The Trenton Examining Board certified, September 4, 1873: "The muscles of the posterior portion of the left thigh were very badly lacerated by a fragment of a shell; all the flexor muscles were torn through and a most persistent and gangrenous sore followed the wound, and the cicatrix is very large and tender, the leg weakened, so that he cannot walk far or stand long on it." The pensioner was paid June 4, 1876. Even in young and healthy subjects the progress of repair was slow after large solutions of continuity: Case 30.—Corporal A. W. McCausland, Co. B, 16th Maine, aged 18 years, was wounded at Gettysburg, July 2, 1863, and admitted to the field hospital of the First Corps. On August 24th he was transferred to Camp Letterman, where he came under the care of Assistant Surgeon W. F. Richardson, C. S. A., who recorded: "A shell struck the outer side of the left thigh, inflicting a terrible flesh wound eight inches long by four in width, with ragged edges. When admitted the patient was in good health, the wound looking well and filling up with healthy granulations. Up to date the treatment has been cold- water dressings. Stimulants are given and simple cerate dressings now used. The patient improved rapidly, and the wound closed." In October the man was transferred to Satterlee Hospital, Philadelphia, and on January 10, 1864, he was discharged from service by reason of "lameness of left leg resulting from the wound." Examiner T. Hildreth certified, September 4,1873: " Was wounded by a shell in the posterior part of the thigh, carrying away a very large part of the muscles and integument, resulting in a tender cicatrix. He now suffers from numbness of the limb." The pensioner was paid June 4, 1876. Sometimes small projectiles produced extended lacerations by driving into the soft parts coins,2 knives, or other hard objects carried in the pockets of the soldiers: Case 31.—Private J. C. Haggerty, Co. I, 124th New York, aged 21 years, was wounded at Chancellorsville, May 3, 1863. Surgeon J. S. Jamison, 88th New York, noted a "shot wound of the right thigh." The patient passed from a Third 1 Dr. C. HEINE (Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 65) thinks that large shot lacerations of the fleshy parts of the lower extremities are peculiarly liable to be followed by tetanus; but I find in the records under discussion little to corroborate this view. I will revert to the subject in treating of Tetanus. 2 Socin (A.) (Kriegschir. Erf, Leipzig, 1872, p. 16) gives a drawing of a flattened Langblei (the missile of the needle-gun), together with three bent French copper sous pieces and two vest buttons, all of which wei j extracted from the thigh of a French soldier at the Swiss ambulance at Lure. The ball and the large copper coins were detected and removed soon after the reception cf the injury, but the buttons were not extracted until three months afterwards. 20 INJURIES OF THE LOWER EXTREMITIES. chap. x. Corps hospital to Fairfax Seminary, and thence to Satterlee Hospital, when Acting Assistant Surgeon I. Roberts reported the cn*e as interesting, imismuch as the hall struck a silver coin in the right pocket of the man's trousers and was thus deflected from the track of the femoral vessels; but passed through the soft parts, driving fragments of the pocket-book into the tissues, and escaping at the gluteal fold. The wound progressed favorably for a time, but, about July 20th, deep abscesses formed, and there was some sloughing at the aperture of entrance and exit. The abscesses were incised, and several fragments of the pocket-book came away with the pus. There was so much constitutional irritation that quinia and stimulants were freely exhibited. The wound healed about the middle of December, and the man was transferred to the Veteran Reserves. He was quite lame, and the right foot was much everted. He was discharged October 7,18,i I, and pensioned. Examiner J. Nichols, of Washington, certified: "Ball entered anterior aspect of upper third of right thigh, passing directly through, and inflicting a frightful flesh-wound. Bone uninjured; cicatrix very deep and adherent to all the soft parts below, nearly to the bone, render- ing free motion of the limb impossible, and, if much used, very painful." Examiner J. Gordon, of Newburgh, New York, reported, February 28, 187(>: * * "There remains a large umbilicated cavity, with adhesions of skin, fascia, and muscles. He suffers more particularly from distress in the leg, extending in part to the foot, accompanied, before atmospheric changes, with shooting, darting pains, * * so severe at times as to unfit him for manual labor." This pensioner was paid June 1. 187(1. Extensive lacerations of the calf were very slow in healing, and usually resulted in adherent cicatrices with atrophy of the remaining muscular tissues, greatly disabling the functions of the leg and foot: Case 32.—Sergeant F. A. Ingerson, Co. K, 27th Massachusetts, was wounded at New Berne, March 14, 1862. Surgeon G. A. Otis, 27th Massachusetts, reported that "a large fragment of shell striking the calf of the left leg carried away the greater portion of the bellies of the gastrocnemius and soleus muscles. There was inconsiderable bleeding. The laceration was so very extensive that it was difficult to coaptate or adjust the wound, and much of it had to be dressed open." The patient was sent to Academy Green Hospital. After the separation of sloughs, there remained a huge granulating sur- face. On April 19th, the patient was sent to a northern hospital, and discharged December 19, 1832. Examiner A. Lambert, of Springfield, reported, March 11, 1863, the wound "unhealed and discharging constantly." The Boston Examining Board stated, March 23, 1870: "A fragment of shell engaged the left calf. During the suppurating process that ensued a considerable portion of the belly of the calf was lost. The wound has not entirely closed, and the injured leg is notably larger than the other." In October, 1875, Examiner A. W. Nelson, of New London, reported: "There is a large cicatrix of left calf, with loss of most of the substance of the gastrocnemius ; * * patient unable to walk a long distance." In a similar case, amputation was contemplated; but the patient ultimately made a satisfactory recovery without operative interference: Case 33.—Private P. C. Whidden, Co. B, 13th Massachusetts, aged 22 years, was wounded at Antietam, September 17, 1862, and entered the Mason Hospital, Boston, January 22, 1863. Acting Assistant Surgeon W. E. Townsend noted: "Shot wound of left leg. Patient returned to duty November 1, 1863." The following detailed account of his injury and its result was forwarded by the man in July, 1866, through Dr. H. I. Bowditch, of Boston: "Was struck by apiece of shell on the posterior aspect of the left leg, causing extensive laceration and loss of the soft tissues, without injury to the bone. The wound extended from just above the ankle joint about eight inches up the back of the leg, from which, within these bounds, the soft parts, integuments, tendons, muscles, both arteries, and the posterior tibial nerve were entirely carried away, exposing the bones through nearly the whole length of the wound. On the front of the leg, corresponding to the middle of the wound, but about an inch of sound skin was left. A rounded flap, about an inch and a half long, containing the lower portion of the tendo- achilles, was torn up and laid back over the heel. The upper part of the wound was ragged and contused, and the middle portion cleanly cut away. There was but little haemorrhage. He walked with great difficulty to the rear, and was then carried to a house a short distance from the field, where a consultation as to the propriety of amputation was held, six surgeons being present. Four decided that amputation was necessary to preserve life; one assented to this under existing circumstances, but thought that under more favorable conditions there was a possibility of recovery without the operation; the other that amputa- tion was uncalled for. The patient decided to retain the limb. The wound was dressed with lint and was not disturbed for five davs. On the fifth day, he was carried in an ambulance a distance of twelve miles to the hospital in Hagerstown. Upon examination the wound was suppurating profusely and full of maggots, and it was dressed with yeast poultice and powdered charcoal. It was then determined to amputate, but the operation was postponed for three days, and nourishing diet and stim- ulants were ordered. On the fourth day an examination preliminary to the operation was made, when healthy granulations appeared along the edges of the bones, and the operation was abandoned. The patient was then carried to a private house, where he received proper nourishment and good nursing, and at the end of a month, no bleeding having at any time occurred, weut to his home in Boston Granulations had been going on rapidly; the wound had been filling up without a sign of inflam- mation, and a pellicle was spreading out from the sound skin all around the borders of the wound. After the journey the parts became irritated and inflamed, and the process of cicatrization went on much more slowly. By the first of March following the parts were perfectlv healed, and the patient walked about with the aid of a cane. But the pellicle covering the surface being excessivelv thin was easilv abraded, and the newly formed tissues possessing but little vitality, it healed slowly, new portions beino* rubbed off before the old were renewed, so that at no time since the wound was first closed has it been entirely free from slight superficial ulceration. At the present time the gap is partially filled up with cicatricial tissue, which has undergone con- traction making the wound appear much smaller than it originally was. It is covered with a thin layer of epithelium which constantly desquamates. The flap torn up and laid over the heel, as referred to above, instead of presenting the narrow outline of the tendo-achilles, has, in healing, become a thick flabby mass beneath the cicatrix, and after long walking becomes cedema- tous. The length of the cicatrix from top to bottom, on each side of the flap, is seven inches in the median line; from the top SECT. I.] LODGEMENT OF MISSILES IN SOFT PARTS. 21 of the cicatrix to the edge of the flap five inches; across the widest part at top and bottom, three and a half inches; in the middle, the narrowest part, three inches. Four inches and a half above the malleoli the leg measures in circumference six and a half inches; the sound leg at the corresponding part, nine inches. The integument on the front of the leg, at its narrowest part, is three and a half inches in breadth. The muscles of the calf contract but exert no influence over the foot, the tendons being absent, and extension cannot be performed, but the foot drops with its own weight. Owing to contraction of the cicatrix the foot can be flexed to but little less than a right angle with the leg. Sensation, which was lost in the external border of the foot and heel, has gradually returned. There is slight obstruction to the circulation from the slow return of venous blood. The patient walks with ease, unaided by a cane, and without the slightest perceptible limp." The report of the Adjutant General of Massachusetts shows that Private Whidden was discharged from service, by order of the War Department, December 11, 1863. He is not a pensioner. In extensive lacerations of the soft tissues of the thigh and leg by shell fragments, or other large projectiles, it was often difficult to make out the exact extent of the injuries inflicted, and the field returns of the surgeons who examined the primary wounds, and the later reports of the hospital surgeons and pension examiners were often, of necessity, wanting in precision regarding such lesions.1 Lodgement of Missiles.—A few cases of lodgement of projectiles or of foreign bodies driven by them into the soft parts of the lower limbs will be cited:2 Case 34.—Private W. H. King, Co. E, 17th Maine, aged 24 years, was wounded at Bartlett's Mill, November 27, 1863, and admitted to Prince Street Hospital, Alexandria, one week afterwards. Acting Assistant Surgeon J. Cass contributed the specimen (Fig. 4), with the following history: "He was wounded by a musket ball which struck two pocket knives, breaking them and driving the fragments with the ball into the anterior side of the middle third of the left thigh. A hundred fragments of the knives and four of the ball wore removed on the field. Lime-water dressings applied to the wound, and fifteen drops of tincture of iron given before meals. On December 13th, he suffered considerable pain in the wound, and on the following day an incision was made two and a half inches from the wound, and a jagged piece of ball an inch long and three-fourths of an inch wide was extracted. 16th, complained of strangury and some pain in the limb. A teaspoonful of spirits of nitre given three times a day. 17th, was restless during the night; sweats profusely, and had a chill this morning. Gave morphia and whiskey, also half an ounce of castor-oil. Has had no stool for forty-eight hours; pulse llo and feeble; tongue coated; very thirsty; some soreness in inguiual glands. Prescribed extract of ginger and turpentine ten drops each, to be repeated in six hours if it does not operate, and gave tonics and stimulants. 18th, pulse 100, tongue moist and coated. Sweats all the time, and vomited in the night. Bowels moved freely and urinates more freely; appetite better. There is a greater discharge of pus from the Avound. 19th, pulse 115 and feeble; vomited considerable during the day. Ordered two quinine pills to be taken before meals, and an anodyne injection at bedtime. SOth, about the same; had a chill yesterday; granulations are pale and flabby. 21st, pulse 140 and very feeble; great prostration; had a chill this morning and is delirious. Takes stimulants every hour. 22d, rested well, but is more prostrated and shows tendency to coma. Died at 4.30 P. M. Autopsy eighteen hours after death: On cutting through the muscles of the thigh, an inch and a half from the surface and an inch from the main channel of the wound, a sliver of horn from a knife- handle was found, half an inch long and one-sixteenth of an inch wide; also a brass rivet one-sixteenth of an inch in diameter and one-fourth of an inch long. In another place two pieces of horn from the other knife-handle, one three-eighths of an inch long and one-fourth wide, and the other one-eighth pIG. 4._Fragments of ball each way, were found; also a piece of a blade one-fourth of an inch Ions and one-eighth wide; and ?nd P°.<*et knife extracted • j., i-i .,, n ■ i , i •.., i ■• from thigh. Spec. 3236. two pieces ot brass, one being three-eighths of an inch long and one-sixteenth wide at one end and tapering to a sharp point at the other, and the other piece measuring one-eighth of an inch each way. Opposite the external wound the periosteum was found in places thickened, inflamed, jagged, discolored, slightly ossified, and separated from the bone for the space of two and a quarter inches longitudinally, and one inch transversely, with some pus beneath it." Dr. Cass 1CHENU (J. C.) (Apergu hist. stat. et clin., etc., pendant la guerre de 1870-71, T. I, p. 283) observes: "L'iclat de bombe ou dobus cause le plus souvent de larges plaies avec pert!, de substance. Nous connaissons quatre faits dans lesquels la partie antero-interne des teguments de la cuisse fut enlevee d'un seul coup sans Mssion de l'artere f6morale; on voyait les battements du vaisseau an fond de la plaie." The same surgical annalist cites a case, in which disarticulation at the hip joint was performed in extremis by M. MAURICE RAYNAUD on a soldier of the National Guard, aged 19, with a terrible flesh wound of the thigh. 2 Among interesting published cases of lodgement of shot projectiles in the thigh is that of Major It. H. Stephenson, 24th Massachusetts, described by the late J. MASON Warren (Surgical Observations, with Cases and Operations, 1867, p. 546): A musket ball, entering tho front of the left thigh, about two inches below Poupart's ligament, was concealed somewhere beneath the rectus, and eluded the researches of a number of experienced surgeons. WARREN, after ineffectually searching for the ball a month after the injury, advised that the patient should use the limb with a view that muscular action would bring the ball from its hiding place. This prevision was justified, and a fortnight afterwards the position of the ball was recognized, and WARREN cut down and extracted it, and the officer speedily rejoined his regiment. The same writer has related (Boston Med. and Surg. Jour., 1862, Vol. LXVI, p. 473) the case of Lieutenant C---, 2d Massachusetts, wounded in the retreat from Winchester, a musket ball making a long track in the gastrocnemius, and carrying before it, like a glove-finger, a patch of trousers and flannel underclothing, making a huge plug, which could only be removed the following day by free incisions. Dr. M. GOLDSMITH, of Rutland, Vermont, formerly Surgeon U. S. V., has described (The Search for Balls in old Gunshot Wounds, in New York Med. Jour., 1868, Vol. VI, p. 426) the case of a color-bearer of a Vermont regiment, in which a ball deeply buried in the thigh was reached by dilating the sinus leading to it by spoDge-tents. 22 INJURIES OF THE LOWER EXTREMITIES. fCIIAP. x. also contributed five inches of the shaft of the femur of the injured thigh, which constitutes specimen 1985 of the Surgical Section of the Army Medical Museum. It is sawn longitudinally, and shows the shaft to be denser than usual and apparently Bomewhat hypertrophied. (See Cat. Surg. Sect., 1336, pp. 253, 617.) There were several cases in which large missiles buried in the fleshy parts escaped recognition; but none have been observed in which such concealed foreign bodies equalled in magnitude the projectiles that have been cited in some works on military surgery as embedded in the great muscles of the lower limb:1 Case 35.—Lieutenant L. Soistman, Co. H, 98th Pennsylvania, aged 23 years, was wounded at Salem Heights, May 3, 1863. Three days afterwards he entered the Campbell Hospital, Washington, where he obtained a leave of absence on May 19th. On July 8th, he was admitted to the Officers' Hospital, Philadelphia, where Acting Assistant Surgeon W. Cammac recorded the following history: "A piece of shell entered the right thigh at the most depending inner part of the middle of the upper third, went under the deep fascia, and upward under the femoral artery and buried itself. The missile appears not to have been noticed at first, as the wound was sewed up.* After going to his home in Philadelphia he was attended by a private physician, but the missile remained still undiscovered. On July 8th. Acting Assistant Surgeon W. Hunt was called in, who was struck by the peculiar feel, and on introducing a probe immediately found the foreign body, and ordered the patient to the hospital to have it removed. On July 9th, Dr. Hunt enlarged the wound, and, after considerable trouble from the proximity of the large vessels, removed, with the assistance of the forceps, a piece of shell weighing nine ounces, which had lodged in the thigh sixty- six days. Its presence had given rise to no great disorganization, but he complained, he says, of a weight in the part during the whole time. After recovery from the effects of the ether, a half grain of sulphate of morphia was given. Cerate dressings and light pressure were applied, and the wound drawn together with adhesive straps. The patient's general health was excellent. He did remarkably well and felt greatly relieved by the operation. On July 13th, cataplasms were ordered, the wound looking well and suppurating moderately, and the patient having better appetite than any time since wounded. On September 5th he was attacked with intermittent fever, which was checked after several days by quinine. By October 1st the wound had nearly healed, but the leg was still weak from extensive disorganization of the great muscles of the thigh. On November 9. 1S>:>, he was returned to duty." This officer was again wounded, at the battle of the Wilderness, May 5, 1864, in the right side, for which injury he was treated in hospitals at Philadelphia and Annapolis. On August 2, 1834, he was again returned to duty, and on October 13, 1834, he was mustered out of service. The Philadelphia Examining Board certified, October 19, 1870: * * "A deep flesh wound, which, in healing, caused a cicatrix about five inches long and four inches wide* with loss of portion of muscular tissue, causing partial loss of power in the limb upon making much exertion," etc. The pen- sioner was paid March 4, 1876. Sometimes musket balls buried themselves in the muscular parts of the lower limbs after ricochetting from stony or metallic surfaces: Case 36.—Private A. Wegner, Co. A, 16th Michigan, aged 25 years, was wounded at Gaines's Mill, June 27, 1862. Surgeon P. B. Goddard, U. S. V., contributed the specimen (FlG. 5), and reported: "He was wounded in the right hip by a shell and hall, taken prisoner June 30th, and carried to Richmond; paroled July 25th, and arrived at Sixth and Master Streets Hospital, Philadelphia, July 30th. This ball ricochetted from a stone or some hard substance, entered the front of the thigh near the femoral artery, and was cut out at the gluteus maxim us muscle four inches higher up than the orifice of entrance. It did not touch the bone, but carried in with it a long strip of trousers." The patient was discharged January 26, 1883, and pensioned. In the certificate of disability Surgeon Goddard stated that "the ball wounded the sciatic nerve." Examiner R. G. Jennings, of Little Rock, certified, September 5, 1873 : * * " One ball entered the right hip near the joint, glanced, and was cut out from the gluteal muscles. The wound occasionally discharges pus. Suffers from frequent pain in the joint. The leg remains weak and of comparatively little service to him, as he is unable to walk Fio.5.—Distorted or stand long upon it." In January, 1876, the same examiner reported: "Has periodical discharges of pus moved from the and spiculae of bone. The sensation of the right leg is much impaired and the motion impeded by partial thigh. Spec. 4472. paralysis,"' etc. The pensioner was paid June 4, 1876. * « Hi:xxt:x (Principles of Mil. Surgery, 3d ed., 1829, p. 79) has recorded several examples of the lodgement of large projectiles in the thigh. He remarks that: '' Masses of very extraordinary and almost incredible sizes are found. . . I have frequently seen them," he says, " of one and sometimes two pounds weight." He then cites the case of Lieutenant F----, 12th Regiment, wounded at Seringapatam. A cannon shot rolled over the banquet behind which this officer was lying down, and buried itself in the muscles of the hip. The bearers who conveyed him on a dooley to the tent of the chief medical officer, Dr. Alexander ANDERSON, complained of the difficulty of carrying him from the trenches, owing to the litter "having been unusually heavy on one side." The officer was moribund on his arrival; but, after his death, Dr. ANDERSON cut out what he told Dr. Hexxen was "unequivocally a thirty-two pound shot." GUTHRIE (Treatise on Gunshot Wounds, 1871, p. 72) relates the case of a soldier at Badajos, with a large piece of shell 1-xlged in the thigh and buttock. IIexxen says (loc. cit., p. 79) that the projectile weighed eight pounds. It was removed, and the man recovered. LaRREV [Mem. de. Chir. Mil., IS 12, T. HI, p. 58-') describes a case in which he removed a ball weighing five pounds from the thigh of a soldier. It had caused him little inconvenience, except a feeling of weight in the limb. PAILLAKD (Rilation chir. du siege d'anvers) mentions that Bti.IX told bim of a case in which a nine-pound shot was embedded in the muscles of the thigh. -Dr. Gr. M. B. MACLEOD (.Vote* on the Surgery of the War in the Crimea, Stb ed., p. 106; states that he "saw a case at Scutari, in which a piece of shell weighing nearly three pounds was extracted from the hip of a man wounded at the Alma, which had been overlooked for two months, and to which but a small opening led." He further relates that Bal'DE.xs describes the case of a French s. .ldier in the Crimea, in which a shell fragment weighing 2 kilog. 150 grammes, or about five and three-quarters pounds avoirdup i*. buried itself in the thigh so as to be invisible. I have not found this case in the Guerre de Crimie of Baudkx.s. or in his letters of that date to the Gazette MedicaU. A surgeon of a Maine regiment told me of a twelve-pound solid shot, that he had extracted from the muscles of the thi^h of a volunteer soldier at Portland, whioh he should send to the Museum; but the missile never arrived, nor oould the injury referred to be identified on the snrgical rpooris. SECT. I.] LODGEMENT OF MISSILES IN SOFT PARTS. 23 The small iron balls from spherical case-shot, having only a slight velocity at a little distance from the point of explosion, often lodged: Case 37.—Private E. E. Middleton, Co. C, 12th New Jersey, aged 24 years, was wounded at Gettysburg, July 3, 1863, and admitted to Newton University Hospital, Baltimore, several days afterwards. Surgeon C. W. Jones, U. S. V., reported: " The patient was in good condition when admitted. A ball entered near the posterior border of the tibialis anticus, a little above the middle third of the left leg, and, passing downward and backward, was removed July 13th, from the posterior portion of the leg by a counter-opening about four inches below the point of entrance. The missile on being removed proved to be a round ball from a spherical case shot. The wound has healed well and rapidly, but the contraction of the muscles makes the man look as if he had talipes equinus. However, the contraction is growing less by passive motion, and there is reason to hope that he will soon have perfect use of the limb. Simple dressings were used all the time." The missile was contributed to the Museum by Surgeon Jones, and is represented in the cut (FlG. 6). On February 2, 1864, the patient was transferred to Patterson Park Hospital, and one week afterwards he was returned to his command for duty. On June 4, 1865, he was mustered out of service. In his application for pension he alleged that " the wound healed, but broke out afresh in the spring of 1865, FlG- 6.— iron ° CQSG-SuOt Gxtrsct* and discharged pieces of bone." Examiner B. H. Stratton, of Masonville, N. J., September 4, 1873, reported ed from the thigh. the leg as being in an ulcerated condition from necrosis of bone. Examiner F. Ashurst, of Mount Holly, SpeCm 3199- certified, September 18, 1875: * * "The cicatrices are healed, and the pensioner enjoys very good health." This pensioner was paid June 4, 1876. In the next case, a musket ball had remained, innocuously, for more than two years, encysted near the outer hamstring tendons, and was not removed until the patient under- went amputation in the thigh on account of a complicated fracture of the leg. The cyst is of dense connective tissue.1 Case 38.—Sergeant H. M. Lambert, Co. D, 12*th Illinois Cavalry, aged 29 years, sustained a contusion of the right leg by the falling of his horse during a charge on the enemy near Germanna Ford, October 10,1863. Three days after the accident he was admitted to Emory Hospital, Washington, whence Surgeon N. R. Moseley, U. S. V., contributed the specimen (FlG. 7), with the following report: "Slightly comminuted fracture of both bones of right leg at middle third, followed by copious discharge of sanious pus. The patient having become weak and debilitated, tonics and stimulants were resorted to with the desired effect. On October 25th, double-flap amputation at the upper third of the leg was performed by Acting Assistant Surgeon W. H. Ensign. Simple dressings and adhesive straps were used. The patient did well, and the stump had almost entirely healed, when, on November 8th, haemorrhage supervened. Graduated compresses were resorted to without avail, and on November 10th the limb was reamputated at the lower third of the thigh by the double-flap method. The stump was again well-nigh healed, when, on November 26th, haemorrhage again set in, and Dr. Mott's tourniquet was applied with perfect success. On December 10th the tourniquet was removed, and no return of the haemorrhage followed. By January 18, 1864, the patient was up and about the ward, and doing well. The specimen, a conical ball enclosed in a sac, was removed from the amputated leg at the second operation. The patient had received this ball in a skirmish with the Cysted in"connect- enemy in Kentucky, in October, 1861, and the missile had remained in the popliteal space beneath the outer >ve tissue. Sp. 1879. hamstring tendons, without inconvenience, for two years and one month." The amputated tibia and fibula, showing no attempt at union, were contributed by the operator (See Cat. Surg. Sect, 1866, p. 511), and constitute specimen 1744 of the Surgical Section of the Army Medical Museum. The patient was subsequently transferred to Judiciary Square Hospital, and discharged from service July 30, 1864. He is a pensioner, and was paid June 4, 1876. There were cases in which missiles gravitated for considerable distances from the point at which they at first lodged: Case 39.—Private A. J. Dougherty, Co. 1,13th Indiana, aged 19 years, was wounded in the thighs at Turkey Bone Bridge, November 2, 1861. After being treated for a time at the regimental hospital he was returned to his company for duty, and subsequently he received a furlough to visit his home in Philadelphia. Acting Assistant Surgeon H. M. Bellows reported the following history: "He was admitted to Broad and Cherry Streets Hospital, April 13, 1883, at which time a foreign body was discovered beneath the skin on the front of the right thigh, five inches above the patella, which gave rise to considerable pain whenever the patient walked. On the next day it was removed by Surgeon J. Neill, U. S. V., and prove'd to be the half of a round leaden ball. He stated that the missile entered the left thigh just below and in front of the trochanter, where the only visible scar was found. After the injury he had some pain and tenderness on pressure over the lower part of the abdomen, with difficult micturition for a few days. On examination the presumption was that the fragment must have crossed from left to right, either in front or just above the pubes, and thence gradually downward into the thigh. The wound healed by granula- tions and by the 5th of May had completely cicatrized." The missile was contributed to the Museum by the operator, and constitutes specimen 1776 of the Surgical Section. The patient was subsequently transferred to Indiana, and mustered out at the expiration of his term of service, June 19, 1864. He afterward again enlisted, and was finally discharged June 21,1865, 1 At the points a a the ball is uncovered by the cyst; but the cellular envelope was probably nicked by the scalpel in cutting out the ball. This is one of the few good examples the Museum possesses of the "Kyste difinitif" surrounding balls as denned by Baudens (La Guerre de Crimee, 2eme §d., 1858, p. 119). This "Kyste primitif," which he claimed to have "peremptorily demonstrated" to always invest balls embedded in the muscular tissues, even when extracted immediately after the infliction of injury, has not been observed by others (See MACLEOD, Notes, etc., op. cit., p. 109), and doubtless means nothing more than that missiles sometimes get an investment from the intramuscular areolar tissue. 24 INJURIES OF THE LOWER EXTKEM1TIF.S. [CHAP. X. and pensioned. Examiner E. A. Smith, of Philadelphia, August 2-% 1st'>.">, certified: * * "Pain in right testicle, and left leg feels perfectly dead at times; walks with difficulty." The Philadelphia Examining Board reported, February, 18, 1874: "Complains of pain in both limbs. Alleges that he has difficulty in passing water al times from irritable condition oi bladder, and pain in the whole course of the ball. Cicatrices are without adhesions to the bone, and there is no atrophy of the limb. Slight stiffness about the left hip joint." This pensioner was paid June 4. 1876. As in Chapter XI the peculiarities of shot wounds in general will be discussed, it would be superfluous here to dwell longer on the particular instances of missiles lodged in the fleshy parts of the lower limbs.1 While not wishing to be rudely incredulous in regard to the almost marvellous accounts that some authors have given of large projectiles embedded in the soft parts of the thigh and leg, I may say that analogous authenticated examples are not to be found in the experience of the American Wrar, and that in most of the remarkable heretofore recorded cases there is reason to believe that they were probably associated with fractures. Peri-articular Wounds.—After the shot wounds of the soft parts of the lower extremity implicating the larger vessels and nerves, or producing great lacerations, or complicated by the lodgement of foreign bodies, cases are to be considered in which mis- siles, without immediately injuring the osseous articular surfaces, so injure the surrounding ligaments and other soft parts, in some instances even the synovial membrane, as to light up immediate or consecutive inflammation in the "capsular cavity, or to induce, through the formation of cicatricial bridles or by other deformities, a diminution or even abolition of the movements of the joint. These injuries have been discriminated by M. Legouest under the title of Peri-articular Wounds? He apparently includes in this group only cases in which the capsular cavity is not primarily opened; but I prefer to adhere to the definition proposed in my monograph on Excision of the Head of the Femur? and have not felt at liberty to exclude from this category the rare instances in which evidence indicates the probability of a primary lesion of the synovial membrane without direct implication of the bones of the articulation, and I observe that Drs. Beck and Fischer adopt a similar view-4 After a careful analysis of the reports of cases liable to belong to this group, four hundred and thirty-seven have been classified as instances of peri-articular shot wounds of 1 The Army Medical Museum is rich in specimens of projectiles extracted from the soft parts of the lower limbs. Besides those described in the text, there are twenty examples of small missiles extracted from the soft parts of the thigh. These specimens are numbered 176, 1C95, 1368, 2559, 2054. 2971. 4400, 4476, 4480, 4501, 4502, 4507, 4520, 4521, 4552, 4553, 4501, 4574, 4624, 4693. Brief notes of the particulars regarding these cusps may be found in the Catalogue of the Surgical Section of 1866, from pages 593 to 597. Two of the most remarkable are illustrated in the annexed wocd-cuts. That represented in Figuke 8 was extracted by Assistant Surgeon J. T. Calhoun, U. S. A., from the thigh of a private cf the ISCth New York, at the battle of the Wilderness, May 7, 18C4, and was regarded as an explosive ball. Specimen 4553 (1'IG. 9) was remarkable for having entered the left thigh below and in front of the great trochanter, and having passed subcutaneously around the pubic region and lodged in the right" high five inches above the patella. The case is that of Private A. (}. D----, 13th Indiana, wounded at Gauley River, November 2,1862; the ball was extracted by Surgeon JOHN NEILL, U. S. V.. April 14, 18C3. There are seven specimens of missiles extracted from the fleshy parts of the leg in the Museum, viz: Numbers 1586, 2326, 3199, 4-1S2, 4500,4514, 4695, and two specimens extracted from the soft parts of the foot, viz: 1580 and 4523. All of these specimens are described, with notes of the cases to which they belong, in the 27th Chapter of the Surgical Catalogue already referred to. These specimens are neatly mounted on brass rods. Dr. A. SCHINZIN'CEH (Das Reservtlazareth Schwetzingen im Kriege 1870-71, Freiburg, i. B., 1873, p. 37) relates that he has a small collection of FIG. 8. — Distorted extracted bullets remarkable for their deformation, and that those extracted from German soldiers have rolln(i' {,au~ extracted ball cxtr.utr.l from ^^ mounted ;n s;iver, and on. the setting the name of the wounded man and the date of the battle from thigh. Spec.4553. engraved, at the thoughtful suggestion of the princess of that province. *LEGOrr.?T (L.) (Traite de Chirurgie d'Armee, 2eme ed., Paris, 1872. p. 442). Some citations from his remarks on this subject may be found in tb.' Surgical Volume of Part II of this work, footnote 1, p. 503. His further observation on this point is worthy of consideration, that " when shot wounds and notablv even slight contused wounds are situated on the side of extension of joints, where they are exposed to continual attritions and tractions, they readilv inflame and sometimes give rise to circumscribed abscesses or diffused phlegmons of more or less gravity. ' 5 Otis (G. A.). A Report on Excisions of the Head of the Femur for Gunshot Injury. Circular Xo. 2, War Department, Surgeon General's Office, Washington, D. C, 18 i9. pp. 63, 90, 92. 4BECK (B.) (Oiirurgie der Schussrerletzungen. 1872, p. 609) details 25 cases, in which the soft parts of the knee joint were either primarily or secondarily involved. Four, or 16.0 per cent., terminated fatally. He also gives 7 cases of flesh wounds of the ankle joint; no deaths. Fischeu (H.) (Kriegschir. Erfahr., Ister Theil, Vor Metz, Erlangen, 1872, p. 102) gives an account of 7 cases in which the knee joint was injured without lesion of tho bony structure. Two, or 28.5 per cent., had a fatal termination. SECT. 1.1 PERI-ARTICULAR WOUNDS. 25 the lower limb, of which forty-nine are referred to the hip joint, three hundred and fifty- one to the knee joint, and thirty-seven to the ankle joint. Each of these subdivisions will be concisely discussed. In peri-articular shot wounds of the Hip Joint, the difficulties of diagnosis are almost insurmountable in the present state of our knowledge. In the cases of recovery, the exact extent of the lesions can only be surmised, and in the fatal cases necroscopic examination will scarcely determine with absolute precision whether the articular capsule was primarily or secondarily opened. Memoranda of forty-nine cases of shot wounds, which the reporters believed to have led to the opening of the coxo-femoral articulation without direct injury of the bones, are found on the registers. Thirty-five instances are adduced in which it was supposed that there was primary lesion of the joint capsule; twenty-one of them are reported as recoveries. Abstracts of seven of these have been already published.1 Of the remaining fourteen recoveries, such scanty information as can be found in the reports is condensed in the appended abstracts: Cases 40-48.—Lieutenant D. H. Miller, Co. H, 75th Ohio, aged 28 years, was wounded and captured at Gettysburg, July 1, 1883. After remaining a prisoner for a few days, he was admitted to the Eleventh Corps Hospital. Several weeks later he proceeded to his home in Logan, Ohio, where he was attended by Drs. G. W. Pullen and J. Sharp, who reported his case as follows: "The ball entered the posterier and inferior part of the glutei muscles of the left hip, passed over the neck of the femur, and came out on the inner side of the trochanter major. February 15, 1864, the wound has closed, but the motions of the hip joint are diminished to a great extent, and the leg is so weakened that he is unable to walk without the use of crutches." The patient was discharged from service January 22, 1864, Surgeon A. M. Speer, U. S. V., certifying- to "shot wound of hip joint without fracture." Examiner T. 0. Edwards, of Lancaster, Ohio, in February, 1871, stated that "the wound had opened and discharged a portion of his blouse," etc. Examiner W. C. Hyde certified, September 10, 1873: "There is flattening of muscles of the hip, the cavity of the joint injured by the missile, and the joint partially anchylosed." The pensioner was paid March 4, 1877.—Corporal L. Bertram, Co. A, 6th Louisiana, entered a Confederate hospital at Richmond with "shot wound of right hip, involving the joint," received May 4, 1863, and was furloughed April 15, 1884.—T. J. Brandon, a member of Co. F, 14th Alabama, was treated in the Confederate hospital at Farmville for "shot wound in the buttock with injury to hip joint," and was furloughed October 22, 1832.—Private IT. Kimberlin, Co. G, 48th Virginia, received a gunshot injury of the right hip joint, producing lameness, and was furloughed from the Confederate hospital at Farmville.—Private C. C. McMurray, Co. H, 15th North Carolina, was admitted to hospital No. 24, Richmond, with "shot wound of hip joint," and was discharged Septem- ber 13, 1832.—Private G. TV. Williams, Co. F, 3d North Carolina, appears on a Confederate hospital case-book as having received a "shot wound of the hip joint, May 3, 1833, the ball being extracted near the knee." Furloughed.—Private J. Hilk, Co. B, 112th Pennsylvania, was wounded in June, 1882. Surgeon E. Grisvvold, of the regiment, reported, "an injury to hip joint by a pistol ball.'' The man was discharged from service October 16, 1832. He is not a pensioner.—Private I. J. Brown, Co. A, 18th Infantry, was wounded at Stone River, December 31, 1832. He was treated at various hospitals, and lastly at Camp Thomas, Ohio. Acting Assistant Surgeon C. R. Reed reported that he was discharged March 17, 1834, by reason of "shot wound of left hip joint." He is not a pensioner.—Private M Ahem, Co. E, 183d Pennsylvania, aged 24 years, was wounded at Spottsylvania, May 14, 1834. Surgeon L. A. Edwards, U. S. A., reported his admission to Lovell Hospital with "shot wound of right hip joint." The man was mustered out July 13, 1835, and is not a pensioner. Spontaneous luxation after traumatic coxitis from shot injury of the hip joint with- out fracture, was reported in three instances: Cases 49-51.—Sergeant I. Murdick, Co. I, 134th Pennsylvania, aged 23 years, wounded at Fredericksburg, December 13, 1862. He was admitted to Stone Hospital, Washington, December 20th, with " gunshot wound of left thigh." Assistant Surgeon C. A. McCall, U. S. A., reported that the man was discharged from Mount Pleasant Hospital, April 16,1863, because of "gunshot wound over left trochanter, passing in the direction of the hip joint; ball undiscovered and interfering with the free use of the joint." Examiner G. McCook, of Pittsburg, June 22,1834, certified : * * "Inflammation and suppuration have ensued and have progressed until the round and capsular ligaments of the left hip joint have been destroyed and the femur drawn at least two inches above the acetabulum. The left leg is thrown across the right at least two inches or more above the right knee, resembling the position of a dislocated femur. The heel is elevated, and it is with extreme difficulty that he can walk with the aid of crutches. The toes of the left foot rest on the dorsum of the right." On November 22, 1837, the pensioner was furnished 'OTls(GEOltGEA.) (A Report on Excisions of the Head of the Femur for Gunshot Injury. Circular So.2, War Department, S.G. O., Washington, 1869, pp. 90-92): Case 166, Corporal H. C. Boyd, 39th 111.; Case 169, Lieut. C. Duncan, 18th Ind.; Case 176, Pt. G. W. Minnick, 7th Md.; Cask 177, Pt W. M. Moore, 3d Ohio; CASE 178, Pt. W. N. Morgan, 9th Penn'a Reserves; Case 185, Pt. Jacob Widmann, 97th New York; Case 186, Pt. Henry Witzleben, 28th Ohio. In all seven cases the evidence of direct lesion of the articulation was inconclusive, and tho opinions of the several surgical attendants were conflicting in each instance. Two cases (Witzleben, Morgan) terminated in false anchylosis. In the latter the adhesions were forcibly and successfully broken up by Professor S. D. GROSS. In one case (Widmann), after suppuration of the joint, the head of the femur was apparently luxated. Professor B. von LANGENBECK holds (Ueber die Schussverletzungen des HUftgelenks, in Archiv fur Klin. Chir., B. XVI, p. 286) that, "the most usual result (constanteste Ausgang) of healing shot injuries of the hip joint is in anchylosis." Surg. Ill—4 26 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X with an apparatus for dislocated hip joint, by Dr. E. D. Hudson, of New York City. Examiner J. K. Rcinholdt, February 7, 1871, certified : " The downward momentum caused the ball to imbed itself securely in the hip joint. * * Parts swollen and tender; wound discharging; more or less injury to great sciatic nerve; limb deficient in temperature; more or less constant pain; confined to bed months at a time," etc. This pensioner died May 7, 1374, of convulsions superinduced by the results of his wound, his attending physician and others stating that the serious attacks of inflammation, resulting in the formation of abscesses, proved a severe tax upon his vitality and prepared the way for his sudden demise.—Private R. Emerick, Co. D, 82d Pennsylvania, aged 28 years, was wounded at Cold Harbor, June 1, 1864, and admitted to hospital at Alexandria, and subse- quently to Pittsburg. Surgeon J. Bryan, U. S. V., reported that he was transferred to the Veteran Reserve Corps, October 8, 1864, by reason of "a grapeshot wound, dislocating the right femur." Not a pensioner.—Lieutenant F. Heck, Co. I, 74th Penn- sylvania, aged 37 years, was wounded in the right thigh at Rappahannock Ford, August 22, 1862, and was discharged from service October 9, J.863. In 1874, the Examining Surgeons report: "Firm anchylosis, with head of femur thrown out of socket; knee and ankle joints entirely stiff; foot in an extended position, and limb shortened two inches." Two cases are reported as injuries of the hip joint by large projectiles: Cases 52-53.—Private J. Teeters, Co. A, 84th Pennsylvania, aged 34 years, was wounded at Bull Run, August 30,1862, and discharged from service March 29, 1863. Assistant Surgeon J. D. McClure, of the regiment, certifying to "an injury in the right hip joint by a piece of shell, producing paralysis of the whole leg." This man was a pensioner, but has not been heard from since September 4, 1364.—Private W. S. Gardiner, Co. A, 14th South Carolina; injury to hip joint from bomb; furloughed. The entire subject of traumatic lesions of the hip joint is of such importance that it is deemed proper to adduce or to refer to the previous publication of all the information that can be found on the registers, with the warning that, in many instances, the facts are derived from reports suggestive of superficial examination, and sometimes of diagnoses that must be regarded as little more than conjectures.1 Of the fourteen Fatal Cases in the series of thirty-five shot injuries believed to have been attended with primary lesion of the hip joint without fracture, the details of all are published in Circular 2, S. G. 0., 1869, already cited.2 In the reports of many of these cases it is stated that the character of the lesions was verified by necroscopic examination, and in others it may be inferred that autopsies were made, so that the series is, as a whole, more reliable than the preceding.3 Of the series of forty-nine cases of reported peri-articular shot wounds of the hip joint, fourteen may be classified as examples of secondary traumatic coxitis.4 Seven were 1 Vox Langexbeck (B.) (Uber die Shussverletzungen des HUftgelenks, in Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 280) remarks: "It may be taken for granted that a gunshot injury of the hip joint may heal under favorable circumstances without traumatic coxitis beginning. Coxitis may certainly be avoided in simple capsule wounds, which are kept perfectly quiet from the commencement, as well as in gunshot injury of the knee joint, as I have seen the recovery of several cases without any inflammation arising. As, however, in most cases (Pott's) side splint was recommended by the surgeon or adopted by the patient, and as during the last war not a few of the men were subjected to distant transport, and, injury of the hip joint not having been discovered, were allowed to go about, it was difficult in such cases to avoid inflammation. It appears to me that we must admit that in all those cases in which coxitis suddenly appears a considerable time after the injury, recovery is certain under favorable external circumstances without any further trouble occurring." [The translation is the version of JAMES F. WEST, F. R. C S.] 2 Circular No. 2, S. G. O., 1869, op. cit., pp. 90, 91, 92. The names of the patients, the duration of life after injury, and the names of the reporters are noted: Case 165, W. Blair, survived injury 23 days; extent of injury demonstrated by autopsy; McKEE, reporter.—CASE 167, A. D. Bradshaw, survived 13 days; verified by autopsy; Burne, reporter.—Case 168, P. Cornell, survived 3 days; WOLFE, reporter.—Case 170, J. W. Falconer, survived 15 days; autopsy; MOKOXG, reporter.—Case 171, S. Finnegan, survived 1 day; COLE, reporter.—Case 172, G. Green, survived 14 day's; Gkaiiam, reporter.—Cask 173, F. M. Hate, survived 102 days; Hatcuitt, reporter.—Case 174, J. E. Leedy, survived 7 days; Leavttt, reporter.— Case 175, J. McMahon, survived 19 days; Bliss, reporter.—Case 179, B. F. Pittman, survived 73 days; Janes, reporter.—Case 180, W. R. Reeves, survived 16 days; autopsy; Harrington, reporter.—Case 181, T. Smith, survived 28 days; autopsy; Vanderkieft, reporter.—Case 182, R. Taylor, survived 4 days; autopsy; Seabrook, reporter.—Case 183, B. K. Wagoner, survived 265 days; Hatchitt, reporter.—Case 184, of J. Wells, was also reported in Circular 2 as belonging to this group; but the carbine ball inflicting the injury, much deformed, with large bone fragments embedded in it (Specimen 2994, Cat. Surg. Sect, 1866, p. 60S), has since been discovered, and the case has been transferred to the category of shot fractures of the neck of the femur. In three cases, in which the patients died within a few daj-s after the infliction of the injury, it is probable that there were grave concom- itant lesions. In those in which they survived two months, three months, and eight months, respectively, there were no autopsies held, and the lesions were not accurately determined. In the eight remaining cases, the patients lived from one to four weeks; the mean was 16 days. 'BILLROTH (TH.) (Chir. Briefe, u. s. w., Berlin, 1872, p. 238) observes: "I am of opinion, that neither the direct injury of the joint capsule and bone, nor the secondary necrosis, can always be early diagnosticated. In cases resulting favorably, the diagnosis can generally only be made ex post, from the total anchylosis of the hip joint, and in many cases only after the discharging of some necrosed bone. . . Nevertheless I had not imagined the diagnosis to be so difficult; I had thought that there must be, under all circumstances, symptoms of acute coxitis; but I was mistaken therein. . . But gradually we arrive at a correct diagnosis in the majority of these cases from the slow progress after the injury, the copious suppuration, rapid debilitation, and speedy decubitus." 4 Circular No. 2, S. G. O., 1FG9, op. cit., pp. 93, 94. The cases of five of the seven patients who partially recovered have been enumerated in the Circular above cited: Case 190, of Capt. H. C Mason, 20th Massachusetts, is more extensively reported by J. Mason Warren in his excellent Surgical Observations with Cases and Operations, Boston, 1867, p. 565. A fortnight after the accident, acute inflammation of the hip joint came on, and Warren cut down and removed the ball from directly over the capsule of the joint. He ultimately recovered with stiff joint. The next case, No. 191, A. McGce, will be noticed on the next page. In Case 193, Private S. Schafer, 81st Ohio, was struck in the left hip at Resaca, May 14, 1864, and recovered with a »tiff joint, according to Surgeon W. Theei.keld, U. S. V., and others. Case 196, Private W. A. Shingledecker, 101st Pennsylvania, Gettysburg, July Q. X r- I G X X - >- - ■ii ii: :ii, ' '. ret':;-/'.:-.-! :>. 'T<-ih.. -,v ,'• .VIcGuire, >i» I, •v, - -.:j- ,< LTM. .• :-l Oo ■- i»r. ,.' !lioi-,|.i:, ' a 1 of U.. •vcr pai.'t u.' Army V .■ ■ !: : r*P(.';,. . d':;i • ners (r. M< : hk 'a Ex;.i)in'-.i <' W. Or .:uvir.: ;. i 'i-:\e i-iform:.!:. n •>!' 'l.;lt • , m . 1 \'o. I ■'.,-. .L . .-■ Ml ,,: • ■ n.i I upri < •« !!•''•. of 1- [•-■spitul iv: ■.; . t'ive yv- >' '7UXTF.1I ■:■ v '■'•' <"*-»lE! £g* .».. ?m '. '..'-.'*/'A'*' .' «• ■ -'4 :*•• :■:;*.' ,.'V. .. ■!'..'•• ■• ■'•%<,''".. v."■ ';'■'* •V;%-'*f ' ;■:• .V';'''■■* "■■'•= !* *■:*. v'V 1 i :.,• .-'•4, .-. ■■■■ i. ».• >■ :m..'' ..,. ■*.;?■.»■ •» . •:: >■., 1*: p '... •' .v' '."!■ ••'•i?!1 i< ft ;/;/%: !.. •^.••:f ■' ■■' ^^v/iifr. .% >'TC fj>.- *; **.■ *in:t\.: . :'«k .:':^: ■<*• X V' »* "T '".V^Curtl! -5-T i .**:&.■ <>'' .-!,•■ • •!■• •;;■,;. •%:'■ .*' ,;■ ^:;S^;# ,-v >' >' • *■% .fc ^•^ ■' *•!' .•£&*>■:■ ■"" '" '#:• ; .*'"'' *i*:'..* *J&i \. jC****:, •:iy «l -^, 1^ ■..•Sf.'i-'Vj '* ''** 'V ■'■. ■'•'■% SECT. 1.1 PERT-ARTICULAR WOUNDS. 27 fatal, and seven resulted in recovery. Abstracts of five of the latter have been published in Circular 2, and two others are here noted: Cases 54-55.—Sergeant J. A. Heady, Co. B, 15th Kentucky, aged 22 years, was wounded at Chickamauga, September 20, 1863, and was discharged from Camp Chase July 18, 1864. Surgeon J. T. Carpenter, U. S. V., certified to "shot wound of left hip, the ball entering three inches above and posterior to the trochanter major and remaining; function of hip joint inter- fered with, and marching impossible." This man is an applicant for pension. The Louisville Examining Board reported, in 187&, that the missile was still unextracted.—Private E. D. Bates, Co. B, 24th New York Cavalry, aged 21 years, was wounded in the left hip at Petersburg, June 17, 1864, and was treated at various hospitals. Surgeon R. B. Bontecou, U. S. V., reported his discharge from Harewood Hospital, Washington, May 5, 1H;>,">, by reason of "shot wound resulting in necrosis of head of left femur." The various Examining Surgeons certify to more or less injury of the bone, also that the missile remains in the limb. Of the seven examples of secondary coxitis from shot wounds which recovered, the most interesting is the one numbered 191 of Circular 2, in which the nature of the injuries was observed more than seven years after reparation had taken place. Case 56.—Albert McGee, a negro refugee, aged about 30 years, is reported to have been struck at the first battle of Bull Run, July 21, 1861, by a musket ball, which probably entered the Tight hip at the level of the trochanter major, and, passing downward and forward, made its exit from the inner surface of the thigh just below the perineum. He made a complete recovery with the right lower limb shortened two and a half inches. About seven years subsequently McGee entered the Howard Grove Hospital, at Rich- mond. Assistant Surgeon J. H. Janeway, U. S. A., then stationed at Richmond, learned from Dr. D. R. Brower that the man came to Howard Grove Hos- pital in the latter part of October from the settlement of refugees at Hampton, Virginia, and was then suffering with Bright's disease. Professor Hunter McGuire, of Richmond, and Dr. J. N. Upshur, at the time resident physician at the Howard Grove Hos- pital, have kindly contributed their recollection of the case.1 An autopsy was made by Dr. J. N. Upshur, and the surgeons who examined the injury of the hip were of the opinion that the head of the femur had been grooved by the ball at its lower part. The pathological specimen3 was sent to the Army Medical Museum, and there a vertical section of the epiphyses and upper portion of the femur was made, and it clearly appeared that there had never been a fracture of the head, and that the groove, supposed to have been made by the ball, was a depression resulting from a former abscess. The appearances closely resembled those sometimes observed in cases of chronic rheumatic arthritis. They are represented in the wood-cut above (FlG. 10), and yet more satisfactorily in the heliotype opposite (Plate LVI). 2, 1863, after a gunshot wound disordering the functions of the right hip joint, recovered with a stiff joint, according to the testimony of Examiner of Pensioners G. McCOOK—CASE 197, Private T. Swartwood, 25th Ohio, was wounded May 8, 1862, by a musket ball which injured the right hip joint. Pension Examiner C. HUPP testified that the limb was shortened two inches and all movements of the articulation caused severe pain. 'Dr. HUNTER McGUlOE writes, Richmond, Va., October 17, 187'/ : "I have received your letter of the 12th inst., and am sorry to be able to give you so little information about the case you speak of (CASE 191 of your report on excisions at the hip joint). I think I gave you at different times two specimens of shot wounds of the bead of the femur. One of these cases you saw in the College Hospital here, before I operated. [Reference is made to Specimen No. 6217, Surg. Sect., A. M. M., an excised head and upper extremity of the right femur with osteomyelitis.] The other is the specimen Dr. UPSHUR speaks of, the one you here refer to. My recollection of this case is not very distinct, but I am quite certain that I looked upon it at the time as a case of peri-articular gunshot wound of the hip, and that the changes about the head and neck of the femur were due to the resulting coxitis. . . Dr. D. R. Brower was in charge of the Howard Grove Hospital when this specimen was obtained. He was, afterwards, superintendent of the Insane Asylum at Williamsburg, Virginia, and I think is now in Chicago and holds some office there under the government. He may be able to give you further information about the case, but I do not think it probable that he will remember anything about it." Dr. J. N. UPSHlin in a letter to Dr. HUNTER MCGUIRE, dated Richmond, October 16. 1877, remarks: " In compliance with your request, I would state in regard to the history of the negro man con- cerning whom you have received a letter from the surgeon in charge of the Medical Muser.m at Washington. He came to Howard Grove Hospital, then a hospital for freedinen—suffering with Bright's disease of the kidneys. Having noticed considerable shortening of tho right leg, with inversion of the foot, I enquired if he had had fracture of the thigh; he replied that he had been in the army, and was shot by a Confederate sharpshooter stationed in an apple tree, the ball passing just below and through the hip joint. The wound had healed perfectly, and he possessed some motion in the joint. There was no reason for surgical interference at that time. After his death, which occurred a few weeks subsequently, I made a post-mortem exam- ination, removing the head of the femur, which I found had been fractured within the capsule, and recovered with perfect bony union. As well as I remember, the bone bore plainly on its surface the track of the ball. The specimen was removed and given to you, and sent by you to the Medical Museum. I could not obtain from the man, who was an ignorant negro, a clinical history of the case " 2 This specimen closely resembles one figured by M. Lebeut (Traiti d'Anatomic, pathologique gin. et spec, Folio, 1861, T. II, p. 603, et Atlas, T. II, PI. CLXXXI (Figs. 1-3), in his magnificent iconographic work. This is a specimen presented by M. VERNEUIl.as "a beautiful typical specimen of dry arthritis (artbrite seche) of the upper part of the femur. The upper ledge of the head of the bone is crushed down in the shape of a mushroom. At the anterior part of the neck a considerable projection is seen, a true exostosis of irregular surface, perfectly isolated by a line of demarcation from the rest of the Done. This tissue was at that point very red and vascular. On the surface of the head of the femur is found a multitude of rounded cartil- aginous vegetations, some of which, narrow at their base, might have ultimately detached themselves and fallen as foreign bodies into the articular cavity. In spots the diarthrodial cartilage is ossified abnormally. On the specimen a condensation or kind of concentric hypertrophy of the head of the femur is observed in the section, while the lower part of the head of the bone presents, on the contrary, an atrophic rarefaction of its tissue. There is, therefore, an unequally distributed rrocess of osteo-cartilaginous new formation, of atrophic absorption, and of ossification of the normal cartilage." Loc. Fig. 10.—Chronic traumatic arthritis of the right hip joint following a shot injury, with secondary suppurative transformations which ultimately eventuated in recovery. Spec. 5518. 23 INJURIES OF THE LOWER EXTRKMITIES. [CHAP. x. Abstracts of six of the seven fatal cases of secondary arthritis from peri-articular shot wounds of the hip are published1 in the oft-cited Circular 2. The following is tho seventh: Case :>7.—Private C. M. Blachwelder, Co. A, 52d North Carolina, was wounded at Gettysburg, July 2, 18(k5, and admitted to hospital at Chester about three weeks afterwards. Surgeon E. Swift, U. S. A., reported: '" Gunshot wound, followed by a dissecting abscess involving tho head of the femur and its ligaments. The patient died of pyaemia, September 21, 1863. 1 he post-mortem showed inflammation of the arachnoid membrane with serous effusion, also effusion of serum in the other serous membranes, and twelve ounces of pus in the left pleura." Of peri-articular shot wounds of the Knee Joint, three hundred and fifty-one cases were reported. It would appear that of two hundred and fifty-five of these cases, accord- ing to the evidence available, the articular capsule of the knee joint was directly involved without fracture, and that in ninety-six cases the projectiles did not injure the joint, which was opened by secondary traumatic arthritis.2 Of the aggregate of the three hundred and fifty-one cases, ninety-eight or 27.9 per cent, had a fatal termination. Three hundred and thirteen cases were treated without operative interference and thirty-eight were followed by amputation. The latter will be enumerated in the tabular statements of amputations following shot flesh wounds of the lower extremities. Of the three hundred and thirteen cases treated without operative interference, two hundred and forty-four recovered and sixty-nine or 22 per cent, proved fatal. In the following two cases of recovery the joint appeared to be directly injured. The patients recovered with considerable use of the limbs: Case 58.—Private A. Parker, Co. K, 5th Maine, aged 18 years, was reported by Surgeon C. S. Tripler, U. S. A., as having received a "bullet wound of the left knee" at the battle of West Point, May 7, 1862. Surgeon A. B. Mott, U. S. V., in charge of the Ladies' Home Hospital, New York City, recorded the following description and result of the injury: "A musket ball entered the left knee joint at the junction of the tibia and fibula, passed through the joint, and emerged at the inner edge of the internal hamstring. Bleeding occurred freely for about forty-five minutes and then ceased spontaneously. The pain after the wound was very severe. On the day following a consultation of surgeons was held, when it was thought amputation would he necessary; but the operation was postponed. Two days after he went to Fort Monroe, where he remained until May 25th, when he came to this hospital. While at Fort Monroe he suffered considerable pain for six days after the receipt of the injury, and cold-water dressings constituted the entire treatment, with perfect quiet of the limb. When admitted here the leg and foot were badly swollen; discharge slight and watery; orifice of exit closed. The external wound was attacked with gangrene, and a deep slough came away. Charcoal poultices were used, and creasote, and the wound stuffed with pulverized cinchona. After the slough came away there was some synovitis, and tincture of iodine was applied for several weeks. The general treatment was tonic and sustaining; porter and ale were taken occasionally hut not regularly. September 5th, wound has healed with a good cicatrix. There is stiffness in the knee which is gradually improving. Treatment: cold douche, passive motion and careful use of the limb. Patient has used crutches and afterwards a cane, but now uses neither. December 30th, the knee can be flexed to hut little more than a right angle and is very straight. Patient walks without a limp, and there is very little weak- ness in the limb. He has been on guard duty for more than two months." This man was assigned to the Veteran Reserve Corps November 27, lS,j;>. He is not a pensioner. cit., p. 603. In many respects this specimen closely resembles that of McGee, which is represented in FIGURE 10, and in the heliotype print, Plate LVI, Med. and Surg. Hist, of the War of tlie Rebellion, Part III, Vol. II, op. page 27. In the specimen in the Army Medical Museum there is more extensive ossification of the cartilage at the rim of the acetabulum, and the neighboring osseous surfaces are more densely studded with osteophytes. The atrophic rarefaction and absorption are more pronounced at the inferior portion of the head, giving rise to the appearance which was mistaken for a groove made by a ball. On such lesions consult further Carl ROKITANSKY, Lehrbuch der Pathologisclicn Anatomic, Dritte Umgearbeitete Auflage, Wien, 1856, B. II, S. 205. 1 Circular N'o. 2. S. O. O., 18G9, op. cit., pp. 92. 94. The six published cases are: Case 187. Pt. J. Delaney, 51st New York, wounded at Antietam, Sept. 17, 1862; matter burrowed about the left hip joint, and the thin part of the acetabulum was perforated. Dr. William M. Norsox reported his case and death, Dec. 24, 18J2.—Case 198. Pt. G. J. Dunn, 18th Mississippi, was struck at Antietam, Sept. 17, 1862. Secondary involvement of the head of the left femur, from which he died June 19,1863. A wood-cut of the specimen is reproduced in the Circular.—CASE 189. Pt. A. Hall, 1st Cavalry, was wounded in Louisiana, Sept. 27, 1865, the ball penetrating ultimately into the hip joint of the left side. Death, January 12, I860, Asst. Surgeon A. HARTSUFF. U. S. A., having reported the case.—Case 194. Serg't C. M. Scovil, 14th Connecticut, wounded May 12, 1864, received a musket contusion of the left hip joint. He died July 14, 1864, as reported by Surgeon T. R. Spexcer, U. S. V.—Case 195. Lieut. J. G. Seldon, 2d Cavalry, received July 3, 18f>'3, at Gettysburg, a wound of the left thigh in the vicinity of the hip. The hip joint became involved secondarily. He died Sept. 17, 1863. Asst. Sui-fcon R. F. Weir reported the case.—Case 198. Serg't C. B. Wheeler, 81st Indiana, received a shot wound of the left hip joint, near Atlanta, August S. ISjI. The injury soon affected the articulation, and Surgeon M. S. Shekmax, 9th Indiana, reports that he had profuse suppuration, and died October 7, 1864. * HKIXE (C' (Die Schussverletzungen der unteren Extremitaten, Berlin, 1866, p. 58) observes: " Shot wounds of the soft parts, in which, secondarily, suppuration of the joint resulted from the breaking down of the tissues surrounding the shot channel, especially at the knee joint, were not very rare, while at the hip joint we only observed a solitary but very remarkable case of this kind." KlRCHXER (C.) (Aerztlicher Bericht uber das Koniglich Prev?ische Feld-Lazareth im Palast zu Versailles, Erlangen, 1872, p. 86) tabulates 27 injuries of the soft parts of the knee joint; but does not give the results. ARNOLD (J.) (Anatomische Beitrage zu der Lehre von den Schusswunden, Heidelberg, 1873, pp. 123, 124) gives details of 2 cases of shot wounds of the knee joint, in which, at the autopsies, the bones of the joint were found uninjured. SECT. I.] PERI-ARTICULAR WOUNDS. 29 Case 59.—Private G. Deacon, Co. G, 14th Virginia Cavalry, aged 25 years, was wounded at Boonesboro', July 8, 1863, and admitted to the Cavalry Corps Hospital. Surgeon S. B. W. Mitchell, 8th Pennsylvania Cavalry, noted a "flesh wound at the knee joint." One week after the reception of the injury the wounded man was transferred to hospital at Frederick, whence Acting Assistant Surgeon W. S. Adams reported the following history: "He was wounded by a spent ball, which entered on the outer lateral surface of the right knee, passing inward and forward, striking the patella and lodging. The patient worked the ball out with his finger on the field. By examination I find no evidence of the ball having entered the cavity; the joint can be moved without pain, and there is no evidence of effusion. Simple dressings were ordered to the wound. On July 25th the external opening had closed and an abscess was forming at the point of lodgement of the ball. Enlarged the external opening so as to communicate with the abscess, when about a half ounce of pus escaped, but no synovial fluid, although there was evidence of the joint being involved, but perhaps not communicating with the opening. On the following day the swelling of the joint was more extensive and fluctuation well marked. Tincture of iodine was then ordered to be applied to the joint twice a day, and the limb was placed in Smith's anterior splint. On August 10th the wound had nearly healed, effusion within the joint had almost entirely subsided, and the patient was comfortable. By August 20th the wound was entirely healed; .appearance of joint natural. Considerable anchylosis existed, partly owing perhaps to deposit and partly to long continuance in one position. About a week later the splint was removed, and afterwards passive motion was resorted to without producing much pain or tenderness. On September 5th the patient was transferred to Baltimore, having considerable and daily increasing motion of the knee." He was paroled from West's Buildings Hospital on September 25, 1863. Then follow three fatal cases of direct shot injury involving the cavity of the knee without lesion of the osseous surfaces: Case 60.—Private J. Wagoner, Co. F, 116th Pennsylvania, aged 23 years, was wounded at Petersburg, June 22, 1864, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon D. H. Houston, 2d Delaware, recorded: "Flesh wound of left thigh by a minie" ball." Surgeon G. L. Pancoast, U. S. V., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 333, Spec. 3260) with the following notes of the case: "The patient entered Finley Hospital, Washington, July 1st, with shot wound through left knee joint. The bone was not injured. He died July 17,1864. Two days before death signs of pneumonia presented themselves. An autopsy was made by Acting Assistant Surgeon G. H. Hopkins, who found extensive inflammation extending all around the joint and its neighboring parts. The femur and tibia were denuded of cartilage around the edges. In the cavity of the thorax there was considerable pleuritic adhesion, with effusion of thick pus, the lungs themselves being very much congested and hepatized—in fact, the lungs were diseased throughout their entire extent. There was also effusion both in the pleura and pericardium." The specimen consists of the bones of the injured knee joint. Case 61.—Private E. Dolan, Co. D, 5th U. S. Cavalry, aged 21 years, was wounded at Gaines's Hill, June 27, 1862. Acting Assistant Surgeon R P. Thomas contributed the pathological specimen (Cat. Surg. Sect., 183o, p. 333, Spec. 227), with the following description: "The patient was wounded by a bullet, which entered on the outside of the left knee joint opposite its lower portion, and made its exit at the inside of the popliteal region, nearly on a horizontal line with the wound of entrance. He was admitted to the Episcopal Hospital, Philadelphia, July 30th, and died on September 30, 1862. During this period he was in a very low condition, the wounds and abscesses in the neighborhood of the joint discharging profusely the greater part of the time; he also suffered from diarrhoea. An autopsy, performed a few hours after death by Acting Assistant Surgeon R. P. Thomas, showed "loss of cartilage, and ulceration of the heads of the femur, tibia, and fibula, with extension of the disease on the posterior aspect of the femur and between the heads of the tibia and fibula. There was also ulceration of the posterior face of the patella and abscesses in the soft parts." The specimen (FlG. 11) consists of the bones of the knee. The age of the patient is perhaps overstated. The epiphyses, both in the tibia and fibula, were not united, and the real age was, probably, under 20; possibly did fig. 11.—Bones of not exceed 19 years of age. left knee. ,Sp.227. Case 62.—Private U. Conn, Co. M, 12th Pennsylvania Cavalry, aged 28 years, was wounded during a cavalry skirmish at Frederick, July 10, 1834, and was admitted to hospital the same day. Acting Assistant Surgeon J. H. Bartholf reported: "He was wounded in the right knee joint by a pistol ball. The missile entered at the lower inner edge of the patella, and I removed it from the joint, having put in my finger between the femur and tibia after enlarging the wound to feel the ball. There was no fracture of any bone. On consultation, it was determined to try to save the j mb. The joint was freely opened and local antiphlogistic treatment was employed. Great pain and swelling, for a few days only, ensued, with but slight irritative fever at any time, and the pulse for weeks ranged from 85 to 95. Sometimes for a fortnight at a time ho had a really good appetite; this notwithstanding that extra capsular abscesses appeared early and continued throughout to discharge much; at other times he was in a precarious condition. He was placed on a water-bed, being thin in flesh on admission and soon troubled with bed-sores. About a month before his death there was some cough. He sank very gently, and died October 14, 1864. The post-mortem examination revealed the recovery from the joint wound by obliteration of its cavity and bony anchylosis, which was not so firm, however, but that accidental violence partly broke it. The crucial ligaments were still undestroyed. There was one vast abscess from the knee to the groin encircling the femur, and another four inches long from the knee downward—neither of them com- municating with the joint. He had gray hepatization (pneumonic) of two-thirds of the middle lobe of the right lung, all the rest of the lungs being healthy. The heart was very small and its weight six ounces. All the other organs were healthy." In the three following cases the projectile did not open or enter the knee joint, and the involvement of the articulation was secondary in its nature: Case 63.—Private E. Williams, Co. E, 5th Michigan Cavalry, aged 26 years, was wounded during the engagement at Shepherdstown, August 26, 1864. Acting Staff Surgeon N. F. Graham reported his admission on the day of the injury to 30 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the field hospital at Sandy Hook with "shot wound of right thigh," and his transfer to Frederick two days afterwards. Acting Assistant Surgeon J. C. Shinier, from the latter hospital, made the following report of the case: " He was wounded by a fragment of a shell, which lodged in the external muscles of the lower third of the thigh in close proximity to the bone. It was extracted on the field through the opening. Upon admission the patient's general condition was good. He experienced no pain whatever from the injury. Suppuration was going on finely and everything indicated a speedy recovery. The wound was thoroughly examined with the finger and a sinus found leading in the direction of the knee, but not into the joint. Sep- tember 15th, patient complains of slight pain and tenderness in knee. The discharge has nearly subsided and the wound is healing. I enlarged the opening so as to allow free vent for the pus. Tincture of iodine is directed to be applied every other day. September 25th, for the last few days there has been some general derangement of the whole system; appetite somewhat impaired; pulse excited; bowels irregular. The knee is still painful, especially upon pressure, and the discharge is the same in quantity. Ordered fifteen drops of tincture of iron three times a day, with a half pint of milk-punch, a poultice of flaxseed meal to be applied around the joint, and the limb to be kept at rest. September 30th, no change in the general condition. The discharge of pus has ceased, but a thin oily looking material, resembling synovia, constantly exudes from the small opening that remains at the entrance of the wound. October 10th, patient has been doing well until to-day; is very restless; pulse accelerated to 128; appetite very moderate; complains of excruciating pain in the knee. The wound has healed externally. Tonics, stimu- lants, and generous diet are continued; one pill of opium is given four times a day, and blisters are applied over the joint. October 20th, patient has received considerable relief from the blisters. The blistered surface having healed on October 25th, I directed them to be reapplied and the surface to be kept excoriated by an ointment of Goulard's cerate and powdered cantharides. The other treatment was continued. 28th, pulse 113; suffers but little pain in knee, and feels quite encouraged. An opium pill is given at bedtime. 30th, pulse 110; appetite improving; bowels regular; tongue clean; knee of its original size and no pain on pressure. November 10th, general health rapidly improving; the ointment is discontinued. November 18th, walks about the ward with a splint adjusted to favor the knee and keep it at rest; general health excellent. On Decem- ber 1st the tonics and stimulants were discontinued and the splint removed from the limb; the knee is anchylosed, and no passive motion is made for fear of exciting inflammation. On December 21st the patient received a fall, the entire weight of the body resting for the time on the injured limb. He was directed to be confined to bed, the limb to be kept at rest, and iodine to be applied over the knee; parts painful. December 24th, doing well; no constitutional disturbance. December 29th, pain and swelling subsided; patient on crutches again. January 10, 1865, patient transferred to Michigan." Assistant Surgeon D. O. Farrand, U. S. A., reported that the man was discharged from Harper Hospital, Detroit, May 26, 1865, by reason of " anchylosis of the knee joint, produced by the wound." Williams is a pensioner, and has been reported by various examiners as suffering from "complete anchylosis of the right knee joint." He was paid June 4, 1876. Case 64.—Private T. G. Scott, Co. B, 54th North Carolina, aged 45 years, was wounded at Harper's Farm, April 6,1865, and admitted to the field hospital of the 3d division, Second Corps. Surgeon O. Everts, 20th Indiana, noted, "shot flesh wound of left knee." From the field hospital the wounded man was transferred to City Point, and thence, on April 22d, to the West's Buildings Hospital, Baltimore. Acting Assistant Surgeon A. Kess- ler contributed the specimen, represented in the annexed Avood-cut (FlG. 12), with the following descrip- tion : "A mini6 ball passed through the left leg just below the knee joint, implicating the joint but not laying it open. The leg became much swollen and discolored, and from the openings flowed a quantity of what appeared to he arterial blood. Soon after the patient's admission there appeared severe constitutional symptoms: rigors followed by high and continued fever, delirium, extreme nervousness, much prostration, constant vomiting, and sleeplessness. Amputation, which, at an earlier period, might have saved his life, was then pronounced impracticable, and the patient died with symptoms of pyaemia, May 4, 1865. A post-mortem examination of the limb revealed the fact that the tissues above and below the joint, the muscles, fascia, etc., were a gangrenous mass, and that the greater portion of the joint itself was divested Fig. 12.—Caries of left °f *ts periosteum and rapidly assuming the character of caries. Otherwise the joint was found to be intact, knee joint. Spec. 4205. exhibiting no fracture." Case 65.—Private W. P. Werden, Co. K, 34th Massachusetts, aged 20 years, was wounded at New Market, May 15, 1864. Surgeon J. V. Z. Blaney, U. S. V., reported his injury as "a shot wound of the knee." Acting Assistant Surgeon J. H. Bartholf contributed the following history from the General Hospital at Frederick: " The patient was ad- mitted here May 25th, from the post hospital at Martinsburg, with a flesh wound oi the left leg near the knee, caused by a mini6 ball. The missile entered a half inch below the patella, between it and the tuberosity of the tibia, directly over the quadriceps extensor tendon, and lodged superficially just under the skin, whence it was extracted the same day. He was removed in an ambulance sixty miles to Martinsburg. The joint soon became inflamed and swollen, and remained so until his admission here. Water dressings had been applied. I found the joint inflamed and very much distended, probably with synovia or'a collection of pus, over the tendon of the quadriceps. A counter-opening was made at the lowest part of-this, and evaporating lotions applied, on the 29th of May. On the 1st of June the patient was somewhat better. June 4th, ice applied to the knee. June lltii, patient has made very rapid and great improvement, so that the synovitis is nearly gone and the abscess is almost healed; but there is communication with the knee joint from the abscess, a minute orifice having been made by ulceration apparently, through which healthy-looking synovia has been flowing in small quantities for a couple of days. There is no constitutional trouble. June 12th, no more synovia comes out. June 17th, patient is permitted to get out of bed and walk a little. July 4th, has gone on very favorably to this time, walking with a cane. Is now transferred to Baltimore." After this date the patient was treated in hospital at Annapolis until September 13, 1864, when he was returned to duty. The Adjutant General of Massachusetts reports that the man was mustered out June 30, 1865. He is not a pensioner. Of thirty-eight recorded instances of lesions of the knee joint without injury to the SECT. i.J PERI-ARTICULAR WOUNDS. 31 articular surfaces, followed by amputation, twenty-nine or 76.3 per cent, were fatal. Two of the cases will be detailed, and all will be enumerated in the tables of amputation at the end of this section: Case 66.—Lieutenant J. A. Boies, Co. H, 13th Infantry, aged 22 years, was wounded in the assault on Vicksburg, May 22, 1863. He was admitted on a hospital transport and conveyed to Memphis, whence he was admitted to the Marine Hospital at Chicago on June 8th. Acting Assistant Surgeon R. N. Isham reported: "He was struck upon the outer side of the left knee by a cannon shot from a distance of about two miles. The ball probably only glanced over the surface, for there was the merest trifling appearance of a redness, but no wound or bruise upon the surface. Amputation at the upper third of the thigh was performed on June 18th, and death resulted June 28, 1863, from pyaemia. A frequent pulse, brown tongue, anxious expression of the face, and diarrhoea indicated the existence of the poison on admission. The strongest symptom, that of profuse discharges from the bowels, almost involuntary, and of a color, smell, and consistency of the discharge from the stump, together with the sickening sweetish odor of the perspiration and chills, indicated the invasion of the disease in a marked manner on the night of the 18th. The treatment was by iron, quinine, and stimulants. Scrupulous attention was given to the stump, removing all soiled dressings three times a day and injecting the wound with a solution of bromine and occasionally with tincture of myrrh and balsam peril. This partially succeeded in correcting its unhealthy appearance and producing the secretion, for a short time, of good-looking pus. There never was any attempt at healing in the wound, the edges of which looked like 'cut edges of pork.' The discharge from the wound was of a dark-colored thin offensive character. There was no sloughing or gangrene. The system seemed to make great efforts to eliminate the poison, as evidenced by the profuse per- spiration and diarrhoea. The blood seemed to part with its serum easily. No clot was formed in the stump, and late in the progress of the disease the discharge consisted of altered blood. The pulse during the case was from 130 to 150. No post- mortem was allowed by his friends, but the sudden invasion of pain in the joints, a swelling of the knee and fluctuation, satisfied me that pus had formed in the synovial cavity." Case 67.—Sergeant G. A. Dyer, Co. G, 6th Maine, aged 21 years, was wounded at Rappahannock Station, November 7, 1863, and was admitted to Armory Square Hospital, Washington, two days afterwards. Surgeon D. W. Bliss, U. S. V., reported: "A mini6 ball entered four inches below and in line with the trochanter major of the right thigh, took a down- ward and inward course, and could not be found on admission to the hospital. On November 29th, the missile was extracted from the popliteal space; suppuration continued free and of good char- acter. Two weeks subsequent to the extraction of the ball a bit of woolen cloth came from the lower wound. December 10th, patient was allowed to get up and move about, using crutches. December 25th, knee joint became painful and continued to swell from this date. Under iodine the swelling subsided to a considerable extent, but the pain continued; suppuration still free and at times thin and poor iu character. On February 1, 1864, synovial fluid was observed from the upper point in the discharge; pain in knee joint still considerable at night, and leg enlarged. On February 19th, the thigh was amputated above the condyles by flap operation; four arteries tied; loss of blood small; patient in fair condition constitutionally. On opening the knee joint after the operation, erosion of the cartilages was discovered, and an abscess below the knee joint communicating with it. February 22d, patient doing well." The specimen represented in the adjacent cut (FlG. 13) was contributed by Surgeon Bliss, and consists of the bones of the knee of the amputated limb, showing a slight deposit of callus on the posterior aspect of the shaft, apparently due to the irritation set up by contact with the ball in position. The patient was discharged from service April 18, 1864, and pensioned, and subsequently furnished with an artificial limb. In his application for commutation, dated 1870, he described the stump as being in a sound condition. The pensioner was paid June 4, 1876. In the cut only a portion of the specimen, which consists of the four bones entering into the femu'r studdeT'wtui^stlo- articulation, is represented. The amputation was done at the middle of the femur, and not through phytes after shot contusion. the lower third as represented in the cut. Of peri-articular shot wounds of the Ankle Joint, thirty-seven cases are indicated on the records;1 but the evidence in regard to the precise nature of the injury may be termed unsatisfactory. In fifteen cases, of which one proved fatal, no operative interference was deemed necessary. In the remaining twenty-two cases the limb was amputated at the leg, with fatal results in twelve instances. One case may here be detailed; all the cases of amputations of leg for peri-articular shot wounds of the ankle joint will be enumerated in the tables of amputations following shot flesh wounds of the lower extremities: Case 68.—Corporal E. D. Goodell, Co. D, 25th Massachusetts, aged 21 years, was wounded at Cold Harbor, June 3, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his admission to the Eighteenth Corps field hospital with "shot wound of right ankle." Surgeon R. B. Bontecou, U. S. V., reported the result of the injury a» follows: "The patient entered the Harewood Hospital, Washington, June 10th, with shot wound of right foot near os calcis, the ball severing the 1 The records of shot flesh wounds of the ankle joint without injury to the bones are very meagre. Kiechneb (C.) (Aerztlicher Bericht uber das Koniglich Preussische Feld-Lazareth im Palast zu Versailles, Erlangen, 1872, S. 86) tabulates 8 cases of flesh wounds of the tibio-tarsal articulation but gives no results. Heixe (C.) (Die Schussverletzungen der unteren Extremitdten, Berlin, 1865, S. 5) thinks it very remarkable that not a single case of secondary arthritis following "shot wound of the ankle jjint without lesion to the boue " was observed. 32 INJURIES OF THE LOWER EXTREMITIES. [CHAT. X. tendo-achilles. On admission, he was very weak. The parts were swollen and suppurating freely, and became subsequently gangrenous, the tarsal and metatarsal bones denuded. An operation was deemed necessary, and performed on July 22d by Acting Assistant Surgeon B. F. Butcher, who amputated the leg at the lower third by the circular method. Sulphuric ether was used. The patient improved after the operation, and was furloughed August 17th, the stump looking well." The bones ot the amputated ankle were contributed to the Museum by the operator, and constitute specimen 3332 of the Surgical Section. In December following the man was admitted to Dale Hospital, Worcester, whence Surgeon C. H. Chamberlain, U. S. V., reported that the stump assumed a large suppurating surface with several sinuses leading to diseased bone, and that on February 20, 18 >j, he removed a sequestrum eight inches in length by a longitudinal incision. After this the patient wns reported as having made excellent progress, and the stump as being nearly healed on March 31st. He was ultimately discharged from the Soldiers' Rest, at Boston, October 31, 1805, and pensioned. The pensioner was paid March 4, 1877. Peri-articular shot wounds of the joints should be treated at the outset by complete immobilization of the articulation, by wire-cloth splints, or plaster bandages, the wound being covered with simple dressings of thick compresses saturated with cold lotions. The complications are to be combatted as they arise. Complications of Shot Flesh Wounds of the Lower Extremities.—In the great series of 58,702 shot fiesh wounds of the lower limbs, besides the* groups characterized by lesions to the principal blood-vessels and nerves, by extensive lacerations, by lodgement of foreign bodies or extension of inflammation to the joints, there were many examples of compli- cations of Pyaemia, Gangrene, Tetanus, Erysipelas, and Haemorrhage. A certain number of cases have been classified in each of these categories. The reader, however, must guard against the belief that this class of cases is complete, for, as explained heretofore, there was neither time nor clerical assistance for an exhaustive search. The cases, however, have been impartially selected, and the results probably present a fair average. Pyaemia.—Three hundred and twenty-eight cases, of which three hundred and twenty, or 97.5 per cent., resulted fatally, were found recorded. One of the eight cases of recovery will be detailed: Case 69.—Private S. S. Chase, Co. L, 1st Maine Cavalry, aged 43 years, was wounded at Stony Creek, October 27, 1864, and admitted to the field hospital of the 2d division, Cavalry Corps, where Surgeon F. LeMoyne, 16th Pennsylvania Cavalry, noted: " Shot flesh wound of both legs." The patient was moved to City Point on the following day, and on November 14th he was transferred to Washington. Surgeon D. W. Bliss, U. S. V., made the following report: "He was admitted to Armory Square Hospital with wounds of the right thigh and left leg. The first ball entered the thigh posteriorly, about the junction of the middle and upper thirds, passing inward and a little downward, and emerging on the inner side of the thigh; the second ball entered the left leg on the posterior aspect, about the middle, and passed directly forward, emerging on the inner side, one and a half or two inches from point of entrance. The patient had an unhealthy appearance and was considerably emaciated when admitted, the wounds discharging a very thin and offensive matter, not very profusely. On November 26th, pyasmia became developed; patient had several violent chills, which were repeated on the following days, when his wounds became dark colored and dry and ceased to discharge, and he grew delirious. From this period quinine, iron, and chlorate of potassa were prescribed, with stimulants and the most nourishing diet, together with applications of crcasote, tannin, and solu- tion of chlorate of patassa to the wounds, under which treatment he gradually improved. At present (December 31st) his wounds are about healed and he is able to leave his bed, being greatly improved in every respect, and convalescent." The man was discharged from service March 24, 1865, because of "permanent contraction of the gastrocnemius muscle of the left leg, resulting from the wound." Examiner J. O. Perry, of Portland, Maine, certified, April 30, 1868, that "both wounds are very tender;" and that "the wound in the leg so far involved the nerves that the leg below it and the foot are quite numb." The Portland Examining Board reported, in 1873 and 1875, that they find deep, and, on the left leg, adherent scars, with considerable loss of tissues in both wounds. The pensioner was paid June 4, 1676. In the greater proportion of the fatal cases, although the ratio of mortality was so large, necroscopic appearances were not recorded: CASE 70.—Sergeant M. Armstrong, Co. M, 6th Cavalry, was wounded at Williamsburg, May 4, 1862, and admitted to the Hygeia Hospital, Fort Monroe, five days afterwards, when Surgeon R. B. Bontecou, U. S. V.. noted a "shot wound of left thigh." Acting Assistant Surgeon S. J. Radcliffe contributed the following history, from Hospital No. 1, Annapolis : "The ball entered the external aspect and posterior of the upper third of the thigh, passing inward and downward, and emerged about the centre of the middle third. The patient was in hospital at Fort Monroe about ten weeks, when he rejoined his regiment. He went through most of the great battles and skirmishes until Gettysburg, in July, 1863, when he was taken prisoner at Fairfield, Peun., and went to Richmond via Staunton, arriving there on July 20th. He was paroled and left the enemy's lines on the 23d, arrived at Annapolis on the 24th and at Camp Parole on August 2d, and entered this hospital September 20th. He states that the leg has not been painful except in cloudy weather, and has not swelled, and that his health SECT. I.] COMPLICATED SHOT FLESH WOUNDS. 33 has been good. Prescribed pills consisting of quinine one and a half grains, and blue mass and capsicum one half grain each, to be given every four hours. September 25th: Had a chill yesterday; tongue coated; skin dry; pulse quick; conjunctiva yellow; countenance dejected and of painful expression; great lancinating pain in leg; nervousness; bowels irregular. Stopped the pills and gave quinine in solution, five grains every six hours. September 27th : Has lost flesh during last week. Has had continued fever, and the leg has been swelling for two or three days and is very painful, the least motion being painful; abscess formin"- between the.former orifices of the wound on the posterior aspect; general condition unfavorable. A large flaxseed pou]tice was applied to envelope the whole thigh, and the quinine was continued. Patient objects to taking stimulants, nnd takes but little. October 1st, A. M.: The thigh, from the groin to the knee, has continued to enlarge to this date, with sharp throbbing pain, sleeplessness, depressed nervous condition, deafness, fever of a low type, diarrhoea and loss of appetite; patient quite hectic, pulse quick, and cheeks flushed; abscess pointing at the eschar or orifice of wound of exit. Made an in- cision from one to five inches long, and a full stream of dark, thin, offensive matter followed, amounting to nearly two pints; bathed with warm water and vinegar, and continued the stimulants, beef-tea and quinine, with an occasional dose of compound mixture of catechu. 5 P.M.: Patient feels better; pulse quick and feeble; .skin in good condition; tongue cleaner; bowels better. Ordered spirits of mindereri, one half ounce, to be given alternately with the other medicine. October 3d: Abscess still discharging very dark, thin, and fetid matter; patient very prostrate; emaciation very rapid and distinct. Gave stimu- lants freely and often. October 3, A. M.: Patient very feeble, pale and thirsty; pulse quick and sharp; bowels worse ; delirium most of the night, and nausea; abscess still discharging; leg very much swollen and highly sensitive; sloughing about the wound. Applied charcoal and yeast poultices, and gave tincture of chloride of iron, twenty-five drops, with quinine every four hours. 3 P. M.: Pupils contracted; stupor; pulse 120, feeble, sharp, and quick; very sensitive to touch; bowels more invol- untary; leg largely infiltrated, red and swollen, and pits at the knee; very little discharge of bloody serum; patient sinking. Died at 5.30 A. M. on October 4, 1863." An example of the series of fatal cases in which autopsies were made is subjoined. This series constitutes seventy-three of the three hundred and twenty cases. Case 71.—Sergeant D. A. Lent, Co. A, 6th New York Heavy Artillery, aged 24 years, was wounded at Cedar Creek, October 19, 1864. Surgeon W. A. Barry, 98th Pennsylvania, noted his admission to the Sheridan Field Hospital with "shot flesh wound of right leg." Several days after being wounded the man was transferred to the Camden Street Hospital, Baltimore, and subsequently to Eulison, Annapolis Junction, whence Acting Assistant Surgeon A. Marion reported the following history: "The patient was admitted to this hospital January 4, 1865, with a wound of the right leg, middle third, a minie ball entering on the anterior aspect one inch outside of the tibia, lodging between the tibialis anticus, tibialis posticus, and the anterior tibial artery. When admitted the wound was completely healed up, but the leg was much swollen and no ball could be detected. During the first week after his admission the patient had his leg rolled up with a bandage, and the swelling completely disap- peared. He became able to walk about until January 18th, when he again complained, and on examination I found the leg again much swollen, with a dark spot located where the wound first healed up. After this flaxseed poultices were constantly applied until February 2d, when, on opening the wound, the ball was carefully removed from its place of lodgement. On the two days following the operation the patient had a severe fever and chills, with extreme pain and great depression. I ordered eight grains of calomel with ten grains of rhubarb to be taken at once, followed by a saline aperient. On the morning after the 4th, I ordered strong beef-tea, with brandy, to be taken freely. This treatment was continued until February 7th, with some saline draughts, according to the condition of the bowels. On the morning of the 8th, I found the patient greatly depressed and complaining of extreme pain in the joints, and on examining the wrists and the left shoulder joint T discovered them to be very much swollen, with a peculiar boggy feel to the touch. All these symptoms were attended with rigors, drowsiness, yellowness of the skin, and offensive perspiration, sometimes accompanied with delirium. Poultices were applied over the joints, with warm fomentations, and opium was given to relieve the pains every night. The treatment was continued, but no amelioration whatever of the symptoms took place, the patient gradually sinking until the morning of February 15, 18G5, when he died. At the post-mortem, an abscess was found in the upper lobe of the right lung, about two and a half inches long and two inches in width and depth, filled with thick pus. Both lungs were much congested. The right ventricle of the heart was filled with a semi-organized clot. Kidneys about six inches long and four inches wide; small abscesses were found in the cortical portion of each one. Pus was also found in the urethra. Liver, spleen, pancreas, stomach, and intestines normal. About one teaspoouful of thick fetid pus was found in the right knee joint, and about half as much in the right wrist joint. There was no pus in the ankle joints." It is to be regretted that autopsies were not more generally practised in cases of this group, and that in the exceptional cases the necroscopical records were so imperfect. Hospital Gangrene.—The shot flesh wounds of the lower extremity that were distinguished by the supervention of hospital gangrene1 numbered two hundred and eighty-three, with one hundred and fifty-eight deaths, or 55.8 per cent. Details of three cases of recovery are appended: Case 72.—Private W. J. Briggs, Co. A, 102d Pennsylvania, aged 27 years, was wounded at Chancellorsville, May 3, 1863. Assistant Surgeon J. C. McKee, U. S. A., in charge of the General Hospital at Pittsburgh, reported the following lIn Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, by Joseph Jones, M. D., published in the Surgical Memoirs of the War of the Rebellion collected and. published by tlie V. S. Sanitary Commission, the author details many illustrations of gangrenous wounds resulting from shot wounds of the lower extremities. Instances may be found in the San. Comm. Memoir, Surg. Vol. II, pp. 234, 250, 310, 311, 315, 318, 329, 331, 334, 337, 347, 375, 380, 388, 394, 399, 406, 411, 437. Surg. Ill—5 34 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. history: " The ball passed between the tibia and fibula, about the middle of the leg, escaping through the calf opposite the point of entrance. The patient was four days at Falmouth Hospital, seven days at Douglas, Washington, and was then removed to Satterlee, Philadelphia. Seventeen days after his admission to the latter he was furloughed and came to Pittsburgh. The wound had healed at its entrance and was still discharging at its exit, but was considered fit to travel with. He had several slight chills before leaving Philadelphia, and one of a more severe character after his arrival home, followed by haemor- rhage from the posterior wound, which was arrested. The next day he came to the hospital. The wound presented the unmistakable evidence of gangrene. He was isolated, and nitric acid was freely applied to all parts. The disease was found very extensive, involving the greater part of the calf of the leg. Poultices of charcoal and pyroligneous acid, etc., were applied. The constitutional remedies were quinia, muriated tincture of iron, stimulants, beef-tea, etc. The disease was checked, and the patient is (July 31st) recovering rapidly. The interest in this case is the distance the man carried the contagion, the great rapidity and destructiveness of its attack, apparently uninfluenced by the comforts of a good home and the best of food and nursing." The patient remained in the hospital until September 3, 1864, when he was mustered out, his term of service having expired. The Pittsburgh Examining Board certified, in 1873 and 1875, that there was wasting of the gastrocnemius muscle from gangrene, and that the resulting adhesions have impaired the action of that muscle and cause pain in the ankle. The pensioner was paid June 4, 1876. Case 73.—Private A. W. Bretz, Co. D, 49th Ohio, aged 23 years, was wounded in the right thigh, at Murfreesboro', December 31, 1862. Surgeon J. R. McClurg, U. S. V., in charge of the General Hospital at Cleveland, contributed the follow- ing history: "The ball entered upon the outer and posterior aspect of the limb, passed through the biceps, semi-membra- nosus and semi-tendinosus muscles, and out upon the inner side of the thigh. The patient was in Hospital No. 21, Nashville, about ten days, after which he was sent to the West-End Hospital, Cincinnati, where he remained over three months. He says his limb was at one time almost healed, but it soon manifested symptoms for the worse, and afterward discharged consid- erably for several days. He was forwarded to and arrived at this hospital upon the evening of the 29th of April, and on the 30th his wound was examined and dressed. At this time we found a ragged, foul ulcer upon the back part of the limb, where the hall entered, about one and a half inches in diameter, surrounded by an erysipelatous—or a halo of dusky red—inflamma- tion, hard and painful to the touch. The patient was feverish, restless, unable to sleep; had poor appetite, and appeared much prostrated. He complained of severe shooting pain in the limb and of the disagreeable odor of the wound. We dressed the wound with the creasote ointment and prescribed a tonic treatment. Some three days afterwards the whole integument and cellular tissue, previously inflamed and diseased, became one putrid mass and dropped out, leaving a large cavity, large enough to admit the whole hand. The haemorrhage at this time was considerable, and was arrested at the time by applying the pure creasote to the whole bleeding cavity, together with compresses, adhesive strips, and a roller from the foot to the groin. The haemorrhage was by this process arrested, and for two or three days afterwards my assistant surgeons reported the case favor- ably. But I was again called upon to visit the patient, who was reported to be siuking very fast, and that the wound was bleeding very much. I found to my surprise the whole bandage and bed saturated with blood, and the patient truly in a dangerous condition. Upon removing the bandages and compresses a large mass of coagulated blood and dead tissue dropped out, having the most intolerable stench imaginable. The haemorrhage was still very great, and I was almost at a loss to know how to stop it. The whole back part of the thigh appeared to be one bleeding cavity. I introduced my hand into the wound and found I could pass my fingers almost up to the tuber ischii. At the bottom of the cavity, entirely exposed to view, were the belly of the biceps, the semi-membranosus and semi-tendinosus muscles. We used cold water, which succeeded in a measure to stop the haemorrhage temporarily. Immediately afterward, or as soon as the patient had recovered from the shock produced by the loss of blood, I put him under the influence of equal parts of sulphuric ether and chloroform; then commencing imme- diately below the tuber ischii and cutting through the parts down to the muscles, I brought the knife down and out at the upper part of the cavity, turning the flaps outward and exposing the whole cavity; with a pledget of lint tied to a probang I cauterized every part of this cavity—the flaps and even the muscles—with pure nitric acid until they became perfectly charred and all haemorrhage entirely ceased. The flaps were now brought together and fixed with wide adhesive strips around the thigh. A compress saturated with a lotion of nitric acid was applied, and over this a roller from foot to groin. The patient was ordered sulphate of quinine one grain, and tincture of chloride of iron fifteen drops, every two hours; also, eggnog, hrandy-punch, and essence of beef. From this moment he began to improve rapidly and complained of no more severe stinging pain in the limb. Not the least haemorrhage ensued afterward, and that most offensive fetid discharge subsided at once. We dressed the sore twice per day afterward, still using a weak lotion of nitric acid. It has progressed and is still (June 1st) progressing most favorably." The patient was assigned to the Veteran Reserve Corps December 11, 1863. There is no record of his ever having applied for pension. In addition to the history of the case, Surgeon McClurg submits the following remarks in relation to the treatment of gangrene: "There is not a doubt in my mind but that the nitric acid is one of the most, if not the most, efficient remedy in use for sloughing phagedena and hospital gangrene. I am aware that of late bromine1 and its compounds are exciting considerable interest in the medical profession as curative agents in hospital gangrene, but I must acknowledge that my expe- rience with these agents will not allow me to call them specific, and I certainly regard them as secondary remedies to nitric acid. The acid is an old and common remedy, and I believe the reason it has not oftener proved its superiority over all other remedies in hospital gangrene has been on account of the cautious manner in which it has been used. This is a serious disease, and the remedy should be freely applied. In the above case, I placed one ounce of acid in a tumbler, dipped my pledget of lint in again and again until the whole diseased part was effectually cauterized. All danger was at once over, and the disease that moment arrested." 1 Among published papers on the local application of bromine in hospital gangrene may be mentioned Bromine in Hospital Gangrene, by R. L. staxfouu, M. D., Surgeon U. S. V., in Am. Med. Times, 18C3, VoL VII, p:24, and Remarks on Hospital Gangrene, by Surgeon G. R. Weeks, U. S. v., in Am. Med. Times, 1863, Vol. VII, p. 46. Goldsmith (M.), A Report on Hospital Gangrene, etc., Louisville, 1863. Thomson (Wm.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C, in Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 378. SECT. I.) COMPLICATED SHOT FLESH WOUNDS. 35 Case 74.—Private H. Barr, Co. I, 21st Iowa, aged 43 years, was wounded at the Black River Bridge, May 17, 1863, and was transferred from a field hospital to Memphis, two weeks after the injury. Acting Assistant Surgeon W. M. Dorran contributed the following history: "He received a flesh wound of the right leg, the ball entering about two inches below the head of the fibula, external aspect, passing inward and downward behind the bones of the leg, and escaping three inches below the head of the tibia, internal aspect. On June 4th, he was admitted into the Jackson Hospital, in this city. The wounds were then small, the external one nearly healed; both wounds were suppurating, and the pus was 'darkish/ the patient stated. Either pus burrowed or a diffuse abscess formed six inches below the internal wound on the calf of the leg, pointed and broke there, discharging a considerable quantity of pus. The tissues all around this new sore began to slough, and a destructive process extended down to within two inches of the ankle, up to the internal wound, forward to the spine of the tibia, and backward to the median line of the muscles of the calf. A consultation was held over the case, and it was decided to ampu- tate, the patient states; but the superintendant of the hospitals happened to be present and overruled the decision, and had the patient transferred to the gangrene section of this, the Union Hospital, on June 30th. On admission, a large portion of black dead tissue surrounded the breach of the surface, which, when cut away by the scissors, made the ulcer to be about eight inches long and four inches in width at the middle of the leg. The tibia was denuded of periosteum to the extent of four inches in its middle third. The internal saphenous vein was a black cord for about six inches. The gastrocnemius and soleus muscles had sloughed to the median line, and the fascia between these two muscles, and also under the soleus, had sloughed away much farther in extent than the muscles. After it was cleaned as well as possible by cutting and washing, fuming nitric acid was applied, or almost poured on the dead and dying tissues still remaining, and with a piece of wood it was worked into their structure, and the semifluid slush or mud was cleaned away, as it formed, by the application of the acid. Then the whole leg was enveloped with a poultice of charcoal and linseed-meal, covered by an oilcloth, and bandaged from the toes to the knee. After the, cauterization, when the patient was under the influence of some stimulants and morphia given to him during the operation, he expressed himself as feeling better than he had for two weeks past, and the leg easier. July 1st, Sloughing by acid not ready to be removed yet; acid again applied where gangrenous ulceration still proceeded, also the poultice and tight bandage. July 4th, The patient rests well at night, and his appetite is rather improved. He is cheerful and hopeful, and of the opinion now that there is a chance of his leg being saved, whereas before he had made up his mind that it was to be lost. The slough by the acid was removed to-day, and the sore is fresher in appearance anteriorly, but posteriorly the fascia is still sloughing. The strong acid was again applied in this region, causing the formation of a mass to be cleaned away to the amount of two or three ounces. Lint saturated with a solution of bromine and bromide of potassium is now introduced into every crevice and sinus and over every sloughing part, and over this a poultice and bandage. Stimulants are given four times a day, also tonics of quinine and tincture of chloride of iron. July 8th, By assiduous attention to treatment, after the manner already described, the sore has been brought to present a fresh and rather healthy base, and some granulations are springing up on the anterior part. Nitric acid has still to be applied under the muscles of the calf, and at the lowest margin of the ulcer some dead tissue remains. July 12th, The ulcer is quite clean and has quite a healthy appearance; granulations are springing up very beautifully, except at the lower margin. The patient's general condition has improved. Resin cerate is used to dress the parts where granulations are springing up, but solution of bromine or Labarraque's solution where any unhealthy appear- ance presents itself. July 16th, The sore appears quite healthy and granulating all over. The muscles that were separated from each other by destruction of tissue between them are beginning to grow together. The tibia, which was bare for some distance, is again being covered by granulations. The edges of the ulcer are becoming depressed and rather inverted instead of being indurated and everted. The internal saphena vein has been destroyed for eight inches of its length and cut away. There was no haemorrhage at any time. September 1st, Ulcer very much reduced in size. Nitrate of silver is used at times to depress exuberant granulations. October 1st, Wound almost completely healed, and patient able to walk about." He was discharged April 6, 1864, and pensioned. Examiner R. S. Lewis, of Dubuque, Iowa, certified, June 16, 1864: "The right leg has been pierced by a ball about three inches below the knee, * * * followed by gangrene ; is still discharging, leaving the limb useless." This pensioner was last paid September 4, 1868, since when he has not been heard from. The pathology and treatment of gangrene of the lower extremities will be considered in the chapter on the general subject. In the lower limbs traumatic gangrene is usually of the humid variety and commonly progresses with great rapidity. Tetanus.—Among cases of shot wounds of the lower extremities not attended by lesions of the bones, joints, great vessels or nerves,1 there were one hundred and seventeen 1 Surgeon J. Julian CHISOLM, C. S. A., in his Manual of Military Surgery for the use of Surgeons in the Confederate States Army (Columbia, S. C, 3d ed, 1864, p. 257), observes that the results described by LAUREY in his campaigns in Egypt and Germany (Mimoires de Chir. Mil. et Cam- pagnes, Paris, 1812, T. Ill, p. 286), in the frequent appearance of tetanus in wounded soldiers upon exposure on battle-fields to cold and damp night air, never followed the leaving of wounded soldiers upon the battle-fields of the Confederacy. Dr. EDWARD WAKREN, Surgeon General of the State of North Carolina, declares (An Epitome of Practical Surgery for Field and Hospital, Richmond, 1863, p. 132) that " the experience of all surgeous establishes the fact that changes of temperature are.prolific sources of this disease;" and Professor SAMUEL D. GROSS (A System of Surgery, etc., 5th ed., 1872, Vol. I, Chap. X, p. 238) remarks that gunshot wounds are peculiarly liable to be followed by tetanus only when the sufferers are neglected, or permitted to lie upon damp, cold ground, or in currents of coid air, after an engagement. Dr. CHISOLM says (I. c, p. 258) that "a trifling puncture or scratch is, at times, sufficient to cause an attack; and it has been noticed by military surgeons that the scraping of the skin by a ball, with bruising of the nerves, is more liable to this complication than the more severe wounds." " Wounds in certain situations," Dr. CHISOLM adds, "are thought to favor its appearance, vizi injury to the hands, feet, joints, etc." . . "Its common period for appearing is between the fifth and fifteenth days." Professor JOS. JONES, Surgeon P. A. C. S., in an article on Traumatic Tetanus, in Confed. States Med. and Surg. Jour., 1864, p. 1, dwells upon the good effects of chloroform mixture, administered by the stomaoh, in shot flesh wounds. The compilers of A Manual cf Military Surgery prepared for the use of the Confederate States Army, Richmond, 1863 [Surgeons A. Talley, W. F. Campuell, St. George Peachey, A. E. Peticolis, and J. Dunn are reported to have constituted the commission that prepared this workj, in the chapter on Tetanus, on page 9, refer to the effect of draughts of cold air in determining violent exacerbations of muscular rigidity. 36 INJURIES OF THE LOWER EXTREMITIES. iCHAP. X cases of tetanus noticed, with one hundred and six deaths, or 90.5 per cent. An example of one of the eleven instances of recovery is appended: Case 7.">.—Private G. C. Niehol, Co. C, 22d Iowa, aged 20 years, was wounded at Vicksburg, May 22. 186:1. Surgeon T. F. Azpell, U. 8. V., noted his admission to the Steamer R. C. WTood, from a field hospital, June 4th, with "shot wound of right thigh." Assistant Surgeon J. M. Study, U. S. V., reported the following history from Union Hospital, Memphis, where the patient was admitted June 8th: "The injury for which this man was admitted was an ordinary ilesh wound, the ball passing transversely from without inward, through the posterior aspect of the right thigh. At the time of his admission the wound showed no indication of having made any progress toward reparation, but preseuted an extremely irritable margin. Warm-water dressing was applied, and on the following day there were marked symptoms of tetanus, chiefly confined to the jaws, which, however, soon became more general, and in addition to the trismus there was that frightful condition of the body intermediate between opisthotonos and pleurothotonos. Sufficient quantity of chloroform was administered by inhalation, to produce complete anaesthesia, twice regularly in twenty-four hours. Sulphate of morphia, in half-grain doses, was given each evening at bed-time, and brandy ad libitum. June 11th, no notable change in the case; patient is stupid, and there is an absence of muscular rigidity as long as the combined effects of the chloroform and morphia continue. June 14th, patient much in the same condition as when last noted, except inn- an extensive tumefaction of the left limb, which tumefaction, so far as the most careful scrutiny would show, is entirely idiopathic in its nature. A roller was applied to this limb from the toes to the groin; otherwise the treatment of the case is the same. June 18th, tetanic symptoms subsiding somewhat; the wound has changed in appearance but little since first noted; tumefaction in left leg still present. Chloroform is given less freely than before; morphia continued the same, also the brandy. June 21st, patient is now able to separate the jaws to the width of half an inch; his general condition is improving rapidly; appetite is ravenous; the bowels are regular; swelling in left leg disappeared; wound beginning to suppurate. Morphia, in one-third doses, is given at bed-time; brandy, one ounce every two hours. June 28th, the wound has been suppurating freely, a large amount of the adjacent, tissues having sloughed away. The warm-water dress- ing, which has been continued until now, is stopped, and scraped lint moistened with glycerine is applied. Patient takes one pint of ale daily. July 15th, the wound is quite healed, and the patient walks with the aid of a cane. On August 19th, he was furloughed." The registers of the Union Hospital show that this man returned from furlough, and was sent to his regiment for duty September 30, 1863. Two examples of fatal cases are subjoined. It has been impracticable to discover any details of autopsies throwing any light on the subject.1 Apparently Uiere were no instances recorded in this group in which microscopical examinations of sections of the spinal cord were undertaken: Case 76.—Private P. Brown, Co. A, 169th New York, aged 36 years, was wounded at Cold Harbor, June 3, 1834, and admitted to Harewood Hospital, Washington, five days afterwards. Surgeon R. B. Boutecou, U. S. V., reported : "Shot flesh wound of left leg. Patient furloughed July 29th." Assistant Surgeon M. F. Coggswell, U. S. V., in charge of the Albany Hospital, reported the following result of the case: "The patient was admitted August 1st, having a large ulcer, measuring six by five and a half inches, on the calf of the leg, the result of a gunshot wound. His general health was very poor, and he was anaemic and debilitated. Gangrene had appeared previous to his admission to this hospital, and the ulcer was indolent, foul, and unhealthy. Nitrate of silver was applied and solution of chlorinate of soda, also poultices of flaxseed-meal mingled with pulverized charcoal. This treatment was followed in twenty-four hours by a healthy discharge of pus and a general improve- ment of the ulcer. Beef-tea, milk-punch, and extra diet were ordered. On the 2d of August his tongue was red and dry, his appetite failed, and he manifested great uneasiness and appeared to labor under an impression of impending evil. That nirht (August 2d) the weather, which had been very hot and dry for several days, suddenly became damp and chilly, and on the morning of August 3d, at 4 o'clock, symptoms of trismus appeared, and were followed in two hours by a general spasm of all the voluntary muscles. The risus sardonicus was marked, and the patient was in great distress; deglutition was impossible. Beef-essence and milk-punch were administered by enemata, and half a grain of sulphate of morphia was injected hypodermic- ally over the epigastrium. The latter acted so speedily and powerfully that in two hours all the muscles were relaxed. The patient's strength, however, was completely exhausted, and at 8 o'clock P. M. he expired, there being no recurrence of the tetanic symptoms. No general post-mortem was made; a local examination did not reveal anything. The trunk of the posterior tibial nerve was intact, but its muscular and cutaneous branches were involved." Case 77.—Sergeant W. Walters, Co. B, 87th Pennsylvania, aged 29 years, was wounded at the Wilderness,'May 8, 1864. Surgeon N. R. Moseley, U. S. V., reported his admission to Emory Hospital, Washington, May 16th, with "shot wound of foot." Surgeon J. H. Taylor, U. S. V., reported the following result of the injury: "The patient was admitted to Summit House Hospital, Philadelphia, May 20th, having been wounded by a ball striking the plantar surface of the left foot at the first interosseous space, one and a half inches from the metatarso-phalangeal joints, going directly through on the dorsum and producing a flesh wound. Cold-water dressings were applied. The patient is of strumous diathesis, having scars on the side of his neck, the remains of scrofulous abscesses. May 30th, at 8 a. m., he was in excellent health; at 12 >t. he com- plained of stiffness and pains in the jaws and neck; great pain, referred to articulation of left inferior maxilla with temporal bone, together with constant fixed pains at the epigastrium, shooting around to the spine; jaws seemingly tied, as the patient expressed; mouth gradually closing; twitching of facial muscles; some difficulty of respiration, but none of deglutition. 1 CHISOLM (J. Jvi.IAN), M. D., (in his Manual of Military Surgery, 3d ed., Columbia, 1864, p. 259) states: "That fruitful source of information, pathology, gives us no instruction in this disease. An autopsy reveals to the eye nothing commensurate with the intensity of the symptoms. A slight congestion of the spinal cord and medulla oblongata is all that can be discerned." SECT. I.J COMPLICATED SHOT FLESH WOUNDS. 37 Treatment: Bowels unloaded by injections; brandy and quinine given in large quantities, milk-punch and beef-tea by mouth and rectum. Liquor of morphia, one half ounce, was given every two hours for eight or ten hours, but with no effect. Injected one grain of sulphate of morphia, dissolved in one drachm of water, hypodermically just over the temporal region; but even this failed to produce any narcotic effect. Counter-irritation was used at the spine with chloroform and covered with oiled silk, but so severe was the burning pain that it soon had to be discontinued. On May 31st, the patient was attacked with severe cramps in the abdomen, the muscles here becoming hard and tense, the muscles of the back rigid and prominent; great pain, referred to chest in inspiration; pupils contracted. There was profuse perspiration over the entire body from the commence- ment of the disease; pulse natural. A solution of sulphate of atropia, one grain to an ounce of water, was now injected, in quantities of one drachm, a little to the left of the median line of the neck at first, and subsequently on each-side of the spine, below the scapula, at intervals of one half, one, and two hours, in all seven or eight times. The pupils were now dilated, but there was not the slightest relaxation of muscular spasm; perspiration still profuse. An effort to rouse him from this state with cold douche had but little effect. The spasms continued to increase in frequency and violence until 3 A. M. on June 1, 1864, when he died." Extraction of foreign bodies, removal of all causes of irritation to the wound, avoid- ing cold and currents of air, were the prophylactic measures advised. Anaesthetics and narcotics were generally employed, but in grave and confirmed cases the therapeutical results were most discouraging. Erysipelas.—In forty-five cases, of which thirty-four proved fatal, extended erysipe- latous inflammation was the most characteristic feature. An example of recovery from this complication is detailed: • Case 78.—Private W. Bowling, Co. B, 1st Maryland Cavalry, aged 22 years, was wounded at Gettysburg, July 4, 1863, and entered the Frederick Hospital two days afterwards. Acting Assistant Surgeon W. S. Adams reported: " The patient was wounded by a mini6 ball which entered two inches above the right patella, passing downward, striking that bone and glancing, and came out at its lower border, without causing fracture or involving the joint. The patient's general health was good. Cold- water dressings were ordered, and rest. July 20th, evidence of erysipelas appeared this morning; bowels constipated; pulse quick. Ordered lead and opium wash to the knee joint, and gave three compound rhubarb pills. 21st, bowels open freely; pulse less frequent; tongue furred, with red edges and tip; skin dry; loss of appetite; erysipelas extending above and below the wound. Applied tincture of iodine around the limb beyond the disease. 23d, erysipelas extending rapidly; considerable gastric irritation; pulse quick but feeble. Ordered one pint of milk-punch a day, and three grains of quinine three times a day. 24th, erysipelas still extending and now occupying the entire right leg and thigh, and the pelvic region down'the left thigh as far as the knee; right limb very oedematous and assuming a decided phlegmonous character. Evaporating lotions of ether were ordered to the worst points, and the other treatment continued. 30th, erysipelas still extending up the body and now occupies the entire left limb. It has subsided in its original seat, and desquamation has taken place. Numerous longitudinal incisions, extending from the instep to the toes of the left foot, were made to relieve the tension. Stimulants were increased to one pint of whiskey per day, and beef-tea and generous diet pushed as far as possible. August 2d, general condition much better, but erysipelas still continues on the feet and ankles, and there is some sloughing of the integuments over the metatarsus of the left foot owing to the incisions not having been made in due time. August 6th, condition still improving; erysipelas has nearly disappeared. 9th, decidedly convalescent; ulcer of left foot granulating finely; appetite good. 30th, ulcer entirely healed; wound of knee nearly so. October 13th, wounds entirely healed, and patient this day transferred to Baltimore." Surgeon T. H. Bache, U. S. V., reported that the patient was paroled from West's Buildings Hospital November 12, 1863. The graver cases of erysipelas complicating flesh wounds were pernicious and contagious: Case 79.—Private L. Brittin, Co. M, 1st Pennsylvania Cavalry, aged 3"> years, was wounded at Hanoverton, May 28, 1864, and admitted to the field hospital of the 3d division, Fifth Corps, where Surgeon L. W. Read, U. S. V., noted "a shot wound of leg." From the field hospital the patient passed to Washington and thence to Philadelphia, entering the Summit House June 28th, and subsequently the Satterlee Hospital. Surgeon I. I. Hayes, U. S. V., recorded the following history: " The injury was caused by a minie' ball passing transversely and producing a slight flesh wound of the upper third of the right leg. The wound healed, when it was attacked by gangrene, and after again becoming healthy the whole limb was seized with erysip- elas. On March 24, 1865, the whole external lateral surface of the knee presented two sloughing wounds, one on a line with the head of the tibia, the other just above the tendon of the muscle. The whole limb was swollen, red, and painful. General condition poor, with headache, fever, dry tongue, and dry hot skin. On March 26th, a large collection of pus, amounting to about six ounces, was evacuated immediately below the patella. The patient's bed was moved, the old splint removed and a Smith's anterior applied. On rinsing the limb a sloughing wound involving nearly the whole popliteal space was found. On the following day the patient was slightly more comfortable, but there was not much change in his general condition. On March 31st, there was no change in the appearance of the wound, but the patient's strength was evidently becoming exhausted. There were symptoms of pyaemia, and he was delirious during the afternoon, but better toward evening. His pulse was 120 and very small; countenance sunken, with hectic spots on the cheeks. He complained of no pain, but was evidently partially unconscious. He died April 6, 1865." Haemorrhage.—In addition to the group of cases of shot flesh wounds of the lower limbs with primary lesion of the large blood-vessels, as discussed on pp. 13, 18, ante, one 38 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. hundred and fifty cases have been noted—and this is probably an imperfect summary— ol consecutive bleeding from the large vessels, among which were sixty-four examples of recovery, eighty deaths, and six cases with unknown results, a mortality rate of 55.5. Consecutive bleeding was from vessels varying in magnitude.1 Tabulations have been made showing the time from the reception of the injury to the onset of the bleeding, the amount of blood lost, and the treatment, but there is not space to reproduce this analysis. Two illustrative cases are appended: Case 80.—Private J. C. Corliss, Co. G, 17th Illinois, aged 21 years, was wounded before Vicksburg, May 19, 1863, and entered the Jackson Hospital at Memphis eight days afterwards. Acting Assistant Surgeon H. D. Garrison recorded the follow- ing description of the injury and its result:. "A conical ball entered the left thigh anteriorly, about five inches below Poupart's ligament, passing upward and slightly inward in its course. The wound was examined at the time by a surgeon, who was unable to extract the ball. When admitted to this hospital the man was in good health, and his wound gave him but very little pain. Water dressings were applied and all went well until about noon on the 28th, when, from some slight motion, copious haemorrhage commenced suddenly. The femoral artery was almost instantly compressed over the pubic arch, but not until much blood was lost. A consultation being called, it was believed that the profunda femoris was probably severed, and that a tourni- quet with a small roller for a pad placed over the track of the ball would probably be sufficient to prevent the recurrence of haemorrhage until nature had time to permanently close the vessel. This plan was accordingly adopted and proved successful for twenty-four hours, when—while Surgeon E. M. Powers, 7th Missouri, in charge of the hospital, was looking at the appliance and congratulating the patient on his safety—the haemorrhage again set in with all its former force. On consultation it was then agreed to inject the wound with solution of persulphate of iron, wtiich was accordingly done, and the tourniquet was re-applied. No further haemorrhage occurred afterwards, but in spite of stimulants freely administered the patient expired fourteen hours after the last attack. The post-mortem examination revealed the fact that the femoral artery was opened about an inch below the origin of the profunda. The opening was about the size of a small pea and seemed to have been caused by the sloughing of the coats. In this case the pulsation of the tibial and popliteal arteries demonstrated that the flow of blood through the femoral was uninterrupted and led to the adoption of an erroneous diagnosis." Surgeon Powers in his report stated that the loss of blood in this case amounted to four and a half pints, also that the bullet was extracted from its place of lodgement after the patient's admission to Jackson Hospital. Case 81.—Private A. Kunkle, Co. B, 62d Pennsylvania, aged 18 years, was wounded at Gettysburg, July 2, 1863, and remained at a field hospital for two weeks, when he was transferred to Baltimore. Acting Assistant Surgeon J. Dickson made the following report from Jarvis Hospital: "He was wounded through the right thigh, the missile entering near the tuberosity of the ischium, and, passing about fourteen inches through the deep muscles, emerged outside of the femur four inches from the knee. He stated that he bled very freely on the field, and after being taken to a neighboring house there was a recur- rence, lasting all night. No further haemorrhage occurred until the patient was brought to this hospital. At that time he was very anaemic and feeble. Generous diet and iron were ordered. On July 17th, an alarming haemorrhage occurred from both wounds, which was arrested by compression and the local application of persulphate of iron. Two days afterwards there was another haemorrhage as profuse as before, and the same treatment was resorted to with the same result. On July 28th, there was a recurrence nearly as profuse as the last. Amputation and ligation of the femoral artery was thought of; but it was concluded he would die after either, and compression upon the femoral and along the course of the wound was resorted to. On July 30th, the patient was rallying. On August 6th, another slight haemorrhage came on, followed by a discharge of sanious pus, the contents of an aneurismal sac. By August 29th the wounds had almost healed and the patient quite built up and walking on crutches, his leg being considerably contracted but straightening gradually." In October following the patient was trans- ferred to the Satterlee Hospital, Philadelphia, and subsequently to Pittsburg, whence he was returned to his regiment for duty February 12, 1864. The Adjutant General of Pennsylvania reports that the man was mustered out with his command July 13, 1864. He is not a pensioner. Ligations of Blood-vessels of the Lower Limbs after Mesh Wounds.—At page 16 it will be recollected that attention was called to a considerable number of cases of direct injury of blood-vessels treated by primary or consecutive ligation, and that it was promised that further on such examples would be enumerated, together with cases of deligation of the same vessels for flesh wounds without primary arterial lesion. The series which will be here presented numbers one hundred and ninety-five instances,—one hundred and ninety-four ligations of arteries and one of the saphenous vein. It will be noticed, how- ever, that among the hundred and ninety-four cases of arterial ligations there were six instances in which the femoral vein was simultaneously tied with the artery it accompanied. 1 An analysis of the series shows 1 fatal case of bleeding from the external iliac; there were 23 coses of haemorrhage from the femoral, with 18 fatal results, 3 recoveries, and 2 unknown. The haemorrhages from the profunda, circumflex, and other branches were 19 with 5 deaths. There were 13 cases of secondary bleeding from the popliteal with 8 deaths; 6, of bleeding from the anterior tibial with 1 death, and 15 of the posterior tibial with 9 deaths. It is hardly necessary to follow out the statistics of the smaller vessels. There were 13 coses of profuse venous haemorrhage of which 10 were fatal This includes 4 cases of bleeding from the femoral veins, all of which were fatal. SECT. I.] LIGATIONS AFTER SHOT FLESH WOUNDS. 39 A fatal instance of deligation of the commonfdiac artery is first detailed, constituting one of the six instances in which this operation was practised during the American civil war. This operation now (1877) foots up sixty-one cases with forty-eight deaths: Case 82.—Private J. Boner, Co. I, 48th Pennsylvania, aged 19 years, was wounded at Tolopotomy Creek, May 31, 1864, and admitted to the field hospital of the 2d division, Ninth Corps. Surgeon J. Harris, 7th Rhode Island, noted, "shot flesh wound of both thighs by a minie ball." Four days after being wounded the man entered Judiciary Square Hospital, Washington. Assistant Surgeon A. Ingram, U. S. A., corroborated the abpve description of the injury, and reported the result as follows: "Disorganization of tissue from a deep flesh wound; haemorrhage took place on June 10th, from the small vessels, and was controlled by pressure, but recurred on June 15th, when the femoral artery was taken up at Scarpa's triangle. This vessel was again ligated, on June 18th, at Poupart's ligament; haemorrhage again occurred on the morning of June 22d, when the common iliac was ligated. The patient died during the day." The report does not show which of the two limbs was operated on, and diligent search has revealed no additional record of the particulars of the case. The reader may compare, on page 333 et seq. of Volume II of Part II, the details and comments on four other examples of ligation of the common iliac artery practised during the War, two for shot wounds of the pelvis and two on account of aneurisms arising from punctured wounds. Yet another instance of unsuccessful ligation of the common iliac artery for consecutive haemorrhage after a shot wound of the pelvis has been recorded by Medical Inspector F. H. Hamilton, U. 8. A. The particulars, so far as they can be ascertained, are stated in the foot-note.1 Ligations of the External Iliac Artery.—In four of these examples ligatures were placed at first on this trunk, but in the seven remaining cases after the femoral had been tied. Case 83.—Private G. W. Husk, Co. F, 1st Maryland Cavalry, aged 47 years, was wounded at Deep Bottom, August 16, 1864. Assistant Surgeon C. Wagner, U. S. A., reported,2 from the hospital at Beverly, New Jersey: "Admitted from City Point with a gunshot flesh wound of the upper third of the right thigh. Bleeding occurred from the femoral artery on Novem- ber 10th, fifteen ounces of blood being lost. The patient was feverish, pulse 130, appetite wanting. Acting Assistant Surgeon J. C. Morton administered chloroform and ligated the external iliac artery. The patient died November 17,1864, from recurrent haemorrhage." Case 84.—Private J. R. Gatewood, Co. F, 21st Georgia, aged 32 years, wounded at Manassas, August 28,1862, Surgeon J. Chambliss, P. A. C. S., reported :3 "Small ball entered just behind the left trochanter, passed out below the perineum, entered the right thigh opposite, and emerged at the external aspect at middle of upper third of the thigh ; bleeding was profuse for several minutes. Aneurism of the femoral artery; digital compression repeatedly used without avail. January 31, 1864, liga- tion of the external iliac artery, pretty much after Cooper's method, by Surgeon Jackson Chambliss, P. A. C. S. February 3d, erysipelatous inflammation subsided. February 15th, the wound presented a healthy granulated appearance and discharged healthy pus. He continued to improve until February 17, 1864, when violent arterial haemorrhage occurred, from which he died in a few minutes." 1 Professor Frank Hastings Hamilton, A. M., M. D., LL. D., in The Principles and Practice of Surgery, New York, 1872, in treating of liga tions of the common iliac, states, at page 232, that: "On the 15th of May, 1864, after the battle of the Wilderness, 1 tied the same vessel in the presence of Dr. WALSEB and my student Mr. HOTN. The patient, John E. Preston, of the 19th Pennsylvania Vols., had been wounded by a rifle-ball which had traversed the pelvis, and the operation was made to arrest a haemorrhage which had already nearly proved fatal. He died on the following day, but without a recurrence of the bleeding.'' In editing the surgical report in Circular No. 6, S. G. O., 18C5, p. 78, I cited from the records but three cases of ligation of the common iliac practised during the American civil war,—the operation on the left common trunk by Surgeon J. COOPER McKEE, U. S. A., for haemorrhage after shot wound of the pelvis (which afforded the specimen 3464, Sect. I, A. M. M.), and the operations by Acting Assistant Surgeon E. N. ISHAM of Chicago, and J. B. CUTTER of Newark, for aneurisms consequent on stabs. In the seventh chapter of Volume II, of Part H, of the Medical and Surgical History of the War, pp. 233-6, these three cases of ligation of the common iliac artery were detailed, and a fourth operation of ligation of this trunk for haemorrhage following shot injury, in the case of Colonel J. II. Scott. 19th Illinois, was quoted from the report of the operator, Professor D. Bradjard, in the Chicago Medical Journal, 1864, Vol. XXI, p. 97, and reprinted in the Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 565. The operation of ligation of the common iliac for haemorrhage after shot flesh wound of the lower extremity reported above (CASE 82) by Assistant Surgeon A. INGEAM, . U. S. A., is the fifth, and the case adduced by Professor F. H. HAMILTON is the sixth, example of the war-series of this important procedure. From Professor Hamilton's printed report of the case of Preston I was unable to trace the injury upon the records, as there is no mention made of it either in the 19th or 119th Pennsylvania Volunteers; but after repeated diligent search the original manuscript entry of the case was found on the field register of the 3d division of the Sixth Army Corps hospital, at the Baptist Church, Fredericksburg, Virginia. It is there stated that Corporal John E. Preston, of Co. G, 119th Pennsylvania, was wounded at the battle of the Wilderness, receiving a " gunshot injury of the anterior superior spinous process of the left ilium." The precise date and extent of the injury is not noticed, nor the disposition made of the patient; but, in a list of deaths in the 3d division hospital, Sixth Corps, at the Baptist Church, Fredericksburg, the death of Corporal John E. Preston, on May 14, 1864, is recorded. In another part of the register, signed by Dr. J. W. Walser, is a list of operations performed at Baptist Church Hospital after the battle of the Wilderness, by Drs. Ham- ilton and Buck, which comprises: " One ligation of the common iliac,—death in twenty-four hours." The data are very imperfect, hut the probabilities are, from the documentaiy evidence accessible, that Corporal Preston, 119th Pennsylvania, was struck, on May 7th, at the Wilderness, by a musket ball which fractured the anterior superior spinous process of the left ilium, and that he was sent to Fredericksburg by the hospital trains that reached that town on Hay 11th. Further, that uncontrollable haemorrhage arose, and that Medical Inspector F. H. Hamilton, U. S. A., ligated the left common iliac artery on May 13th, and that the fatal termination of the case took place twenty-four hours afterwards, May 14, 1864. 2 See Report on Interesting Surgical Operations performed at the Hospital at Beverly, N. J., by Assistant Surgeon C. Wagner, U. S. A., 1864, p. 13. 3 CHAMBLISS (J.), Case of Traumatic Femoral Aneurism—Treated by Digital Compression—Ligation afterwards of the External Iliac Artery, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 97. 40 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Case 85.—Private J. R. Spaulding,1 Co. F, 112th New York, aged 23 years, was wounded at Fort Fisher, January 15, 1865. Assistant Surgeon S. H. Orton, U. S. A., reported, from McDougall Hospital, New York Harbor: "A mini6 ball entered the upper and inner aspect of the left thigh, and, passing a little downward and outward, emerged near the knee, apparently avoiding the bone and all important vessels. Simple dressings were applied for about three weeks, when the wound began to look unhealthy and had a tendency to slough. Solution of the permanganate of potash was freely used and tonics given. On March 23d, haemorrhage occurred from the posterior wound and was arrested by sulphate of iron and pressure. On March 31st, bleeding commenced from the anterior wound. Dr. Orton applied a ligature to the external iliac artery. On April 21st, the haemorrhage recurred from the anterior wound, probably through the collateral circulation, which in the meantime had become established. The bleeding was successfully restrained by the application of the horse-shoe tourniquet, which was kept con- stantly retained for the space of two weeks, when it was omitted without any subsequent recurrence of the haemorrhage. At this time the patient was greatly afflicted with bed-sores, which were a source of great annoyance and sufficient to exhaust his strength. The wounds, however, were healing kindly. On May 31st, the patient was attacked with dysentery, which, in his enfeebled condition, resisted all efforts at once. The patient continued to sink under this complication, and died June 15, 1865, five months after the receipt of the original injury and about two and a half months after the operation of ligating the artery. At the time of his death the wounds were nearly healed." The fourth case of this group is that of Private J. Longford, printed in full in the American Medical Times, 1863, Volume VI, page 256. A somewhat extended abstract of this interesting case is here appended: Case 86.—Private J. II. Langford, Co. F, 10th Georgia, was wounded at Antietam, September 17, 1862. Assistant Surgeon R. F. Weir, U. S. A., reported from the hospital No. 1, Frederick, that the patient entered that hospital October 27th. He had been struck by a musket ball which entered half an inch below Poupart's ligament, helow the right groin, just over the vessels, and made its exit on a line with the right tuber ischii, about two inches and a half behind it. Profuse immediate haemorrhage of arterial color produced syncope, and there was recurrent bleeding when the fainting was over. The patient was confined to his bed only about a week, and, by September 27th, both orifices had cicatrized. When he left his bed the thigh was flexed on the pelvis, extension causing pain. On October 27th, an examination revealed an aneurismal pyriform tumor in the right groin, its apex directed toward the scrotum and the greatest transverse diameter corresponding with Poupart's ligament. At the base its diameter extended to the vessels about four and a half inches; at the apex, internal to the vessels, and about three inches external to the vessels. Starting from Poupart's ligament, the tumor extended in its outer portion three fingers' breadth toward the anterior superior spine, and in the iliac fascia it extended a similar distance. Near the cicatrix of the wound of entrance the aneurismal thrill was very distinct. The patient said he perceived this thrill since he had been able to go about. The prominence of the tumor was moderate. The limb was flexed on the pelvis at an angle of about 4,")°. Neuralgic pains affected the anterior surface of the thigh and bitterly increased in its intensity. Pressure on the aorta or external iliac completely arrested pulsation. The pulsation of the posterior tibeal at the ankle was feeble. The patient was of fine physique, and reported himself as in excellent health prior to injury. By November 5th the tumor had rapidly aug- mented in bulk, and, after consultation, it was determined to operate by Syme's method on the following day. The measures proposed contemplated compression on the right common iliac, an incision through the cicatrix of the wound of entrance sufficient to introduce the left index, and feel and plug the original opening into the artery, then to freely lay open the sac and ligate the vessel above and below the point of injury. November 6th, at noon, patient was placed under ether. A straight incision two inches long, starting from just within the middle of Poupart's ligament and running obliquely downward along the thigh, was made. The upper end of this opening was prolonged by a curved incision one and a half inches long, running upward and outward as far as the ligature of the external iliac artery. This incision was deepened through the superficial fascia, and the knife being then laid aside, the dissection was carried on by means of the handle of the scalpel and the finger nails. The lymphatic of the saphenous opening was thus brought into view, immensely enlarged, congested, and pushed upward. The aueurismal tumor was found to have partially forced its way through this opening, overlapping its upper edge like a femoral hernia. Commencing at the inner margin of this opening the dissection was carried on without much difficulty to Poupart's ligament, which was found very tense, and the arterv could be felt beating just beyond. The upper end of the incision was then prolonged one inch toward the umbil- icus, and after dividing the tendons of the external oblique on a director, the ligament was divided directly over the artery by blunt-pointed scissors. The sheath of the artery was soon brought plainly into view and its covering pushed up to one-half inch bevond the epigastric and circumflex arteries, at which point a ligature was placed around from within outward by means of a Mott's aneurismal needle. The effect of ligation was to arrest pulsation in the tumor. The curved wound was closed by means of silver interrupted sutures. One small artery, the superficial epigastric, required ligation. Not more than one ounce of blood was lost during the operation. The limb was enveloped in cotton batting. An anodyne was given after recovery from the ansesthetic, and repeated at midnight. At 4 o'clock P. M. the patient was quiet; pulse 120, temperature of sound limb-93, of limb operated upon 95 in popliteal space. November 7th. patient passed a quiet night, though sleeping but little, and states that the neuralgic pains have ceased. In a paper on Hospital Gangrene, by Acting Assistant Surgeon A. North, punted in the FlG. 14.—Ligation of right ex ternal iliac forshot injury. Sp. 3986 1 The case is briefly noted by Surgeon J. A. LlDELL, U. S. V., Gunshot Wound of Thigh, etc., iu Surgical Memoirs of the War of the Rebellion. coll. and pub. by the V. S. San. Comm., 1870. Surgical Vol. I, p. 231. PECT. u LIGATIONS AFTER SHOT FLESH WOUNDS. 41 American Medical Times, 1863, Volume VI, p. 257, the sequel of the history is given: "The operation was successful, and in two weeks the wound was nearly healed, when it took on an unhealthy action, and patient then complained of a burning pain in it. Anticipating what was coming, he was immediately moved to a stone building where there had previously been no gan- grene; and here, November 21st, he came undermycare. He remained here for four days before the disease became sufficiently developed to justify his removal to the gangrene tent. November 25th, patient is very desponding, and is growing weaker clay by day; has considerable headache; pulse 120 and almost imperceptible; tongue furred, brown, tip and edges red and dry. The ulcer, which is three inches in width, extends from the pubes up nearly to the anterior spine of the ilium; has an unhealthy and sloughy appearance. Patient complains of a slight burning pain in wound, the edges of which are everted, jagged, and undermined for about two inches; the integument is indurated and tumefied, and extremely sensitive to the touch or the least movement of the limb; characteristic odor not well marked. The sinuses extending under the integument were freely laid open and the surface of the ulcer scraped with a spatula, to which the acid was first applied with a mop, and then worked in with a stick so as to get it down to the comparatively healthy tissue, and was also applied in a similar manner to the tissue surround- ing the ulcer, to destroy, in this way, both the cuticle and cutis vera and thus to limit the extension of the disease. Superficially antiseptic poultices were applied, and opiates given to relieve pain; takes half an ounce of brandy and beef-tea every half hour. November .26th, although the pain following the application of the acid was so severe as to cause slight convulsions for a time, patient is feeling better to-day; pulse 108 and gaining in strength. Fearing that the progress of the disease has not been entirely arrested, the acid was again thoroughly applied. Takes stimulants and tonics, with fifteen grains of tartrate of iron and potass three times a day. November 28th, the black, charred slough has separated, revealing a healthy, granulating surface beneath. The extreme sensitiveness to the touch, together with the induration and swelling of the surrounding parts, has almost entirely disappeared; applied oakum saturated with acid wash to the ulcer. December 5th, patient represents himself as feeling much better; mind hopeful and cheerful; appetite good; ulcer is cicatrizing rapidly; continue stimulants and tonics. December loth, all unfavorable symptoms have disappeared and patient is regarded as convalescent. For two months after this date patient was up and about the ward, when secondary haemorrhage, following sloughing of the sac, supervened, and in four days resulted fatally," March 15, 1863. Assistant Surgeon R. F. Weir's notes state that a sudden change occurred . ou February 25th, when, in the evening, the patient had high fever; pulse 140 and almost imperceptible. On February '27th, considerable pain over the right tuber ischii and knee joint. A consultation failed to discover the cause of this change for the worse. On March 2d, an opening formed at the upper portion of the cicatrix and discharged twelve ounces of ill- conditioned pus. The opening was enlarged and examined digitally and with a probe; the cavity was syringed out. March 9th, the patient's condition had improved since the opening of the sac. March 13th, about the same, discharge increasing in quantity. It was decided to make a counter opening at the lower extremity of the sac, on the inside of the thigh, and seven ounces of fetid pus escaped, which was soon succeeded by a jet of arterial blood. The sac was laid freely open and a compress of sheet-lead was held over the sac by an assistant provided with relays of assistants. About seven ounces of blood was lost during the operation. On March 14th, at 9 o'clock A. M., pressure was removed and bleeding occurred, five ounces being lost. Pressure was again applied. On March 15th, the patient was much brighter, and it was decided to keep up pressure until bleeding recurred, and then to enlarge the lower opening, search for the bleeding point, and, if it could not be found, to freely lay open the sac. At 7 o'clock P. M., seven ounces of blood were lost. Chloroform was given and the opening enlarged; clots were turned out, the entire cavity was exposed, and nothing more than a general oozing could be found. The cavity was thoroughly cleansed, and the slight oozing of blood was stopped by cold water. The patient sank soon afterwards, from the antecedent haemorrhages and the shock of operation. An autopsy was made four hours after death : "Body much emaciated; rigor mortis well marked; right thigh flexed on pelvis and everted. The incision, made for the purpose of opening the suppu- rating cavity to arrest the haemorrhage which occasioned death, was seven inches long, commencing about one and a half inches to the inner side and on a level with the anterior superior spinous process, and terminating on the inner side of the thigh. The thickness of the tissue divided, part of which was cicatricial, was about three and a quarter inches, in which ran the femoral vessels. These were found to have been divided by this incision hut did not otherwise directly communicate with the aneur- ismal cavity. This cavity occupied the iliac fossa of the right side and was situated between the fibres of the iliac muscles, and had crowded the caput coli toward the median line. It extended from a level with the fourth lumbar vertebra to four and a half inches below Poupart's ligament. The sac or abscess in the thigh was about foflr inches in diameter and of a size nearly to contain a foetal head. It had dissected up the tissues with the exception of the tendons, psoas, and iliacus from lesser trochanter, and anterior and inner surfaces of the femur. Below this point, at the bottom of the cavity, a track extended to the inside of the lesser trochanter and approached to within an inch of the surface of the tuberosity of the ischium. Another track extended in front of the pubes toward the root of the pubis. This extensive cavity contained about four ounces of coagulum mixed with blood, which gave to the smooth wall a sloughy appearance. At the inferior, beneath the femoral artery, a small quantity of fresh coagulum was found in the cellular tissue, suggesting the idea that the haemorrhage had proceeded from this point, but the vessels causing it could not be found. An attempt had been made to inject the artery, but had failed for the want of proper instruments. On dissection of the abdominal walls the peritoneal cavity and its contents were found in a healthy condition. The external iliac artery of the right side, from its origin to the point of ligation, had diminished to a small cord about one-eighth of an inch in diameter, firm to the touch, and of a dark color from its containing clot. The principal branch of the external iliac, the epigastric, and circumflex were found larger than the corresponding arteries of the left side. The sacral artery was also enlarged. The chain of lymphatic ganglia along the inside of the iliac artery was much enlarged and indurated, and the tissue in the region of Poupart's ligament had been much altered and firmly matted together by inflamma- tory action. The femoral artery, as it passed under the ligament, was nearly three-fourths of an inch nearer the pubis than usual. The femoral vein was in a normal condition. The artery below the point of ligature to the point of division, in the operation immediately preceding death, was about three and one-fourth inches in length. This portion was laid open, together with the upper portion of the femoral artery, in order to ascertain, if possible, the locality of the original injury. About one and a half inches below the origin of the epigastric and its inner margin there was a faint permanent discoloration, which also Surg. Ill—6 42 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. presented a slight linear appearance; elsewhere the artery presented no peculiar appearance." The specimen is represented in the wood-cut (Fig. 14), drawn from the preparation 3986, Section I, A. M. M., and presented by Dr. Weir to the Museum. In the other seven cases of ligation of the external iliac the femoral artery had previously been ligated. Successful results were finally attained in two instances: Casks 87-93.—Private J. S. Degolia, Co. A, 76th Pennsylvania, aged 32 years, wounded at Drury's Bluff, May 16, 1864. Surgeon A. Heger, U. S. A., described the injury and its result as follows: "The patient was admitted to the Point Lookout Hospital May 19th, having been wounded by a musket ball entering the right hip at the external and posterior aspect, passing across, over the pubes, to the left thigh, and downward toward the knee, wounding the great vessels of the left side, and making its exit one inch above the knee, on the external surface. On May 24th, the femoral artery was ligated above the wound two inches below Poupart's ligament. The patient was much prostrated from the severity of the wound and loss of blood. Stimulants were used, and warm applications to the limb. Repeated haemorrhage required the ligation of the external iliac on May 29th. The patient died, of gangrene, June 1, 1864. The first operation was performed by Surgeon A. Heger, U. S. A., and the second by Surgeon J. H. Thompson, U. S. V."—Private W. S. Marshall, Co. E, 11th Pennsylvania Reserves, aged 26, wounded at Gaines' Hill, June 27, 1862. Assistant Surgeon C. Wagner, U. S. A., reported that the patient was admitted into Hammond Hospital with a "gunshot wound of the right thigh and false aneurism of the femoral artery. The aneurism measured six and a quarter inches in its longest diameter. Dr. Wagner ligated the femoral near Poupart's ligament. On September 6th, haemorrhage to the extent of forty ounces occurred from the femoral artery. Dr. Wagner then tied the external iliac. The bleeding did not recur. The patient died September 16, 1862, from exhaustion."—Private H. Locke, Co. H, 6th Vermont, aged 23 years, wounded at the Wilderness, May 5, 1864. Surgeon Henry Janes, U. S. V., reported, from Sloan Hospital, Montpelier: "Gunshot wound, right thigh; ligation of femoral and iliac arteries for secondary haemorrhage. Trans- ferred to Veteran Reserve Corps December 5, 1864."—Sergeant-Major L. C. Sears, 5th New Hampshire, aged 22 years, wounded at Fredericksburg, December 13, 1862. Surgeon T. Antisell, U. S. V., reported from Harewood Hospital, Wash- ington : "A conical ball entered the right thigh two inches below Poupart's ligament. On the morning of December 19th there was a slight haemorrhage from the wound. Search was made for the ball without result. A counter opening was made and a seton inserted. He remained very comfortable until the 22d instant, when a severe haemorrhage occurred, which necessitated the tying of the femoral in the ward, by Dr. Antisell. On Sunday, January 4, 1863, there occurred a haemorrhage which was arrested by means of styptics and compression. Another haemorrhage followed on the evening of January 7th, which could not be controlled by styptics. Search was made for the bleeding vessel without result. The patient lost much blood. On the following morning, January 8th, the patient was again brought into the operating room and the wound was carefully explored, but the bleeding vessel was not found. The operation of tying the external iliac artery was then performed by Dr. Antisell, in the hope of arresting the haemorrhage permanently. The operation was no sooner completed than there was a welling up of blood from the point from which the previous haemorrhage had proceeded. Styptics and compression were applied, and the patient was returned to the barrack. Stimulants and beef-tea were freely given, and warmth was applied to the extremities to restore reaction. He revived toward evening, and remained sensible and quite comfortable until the evening of the 10th instant. He died January 11, 1863, from exhaustion."—Lieutenant J. A. McQuillan, Co. I, 38th Ohio, aged 25 years, wounded near Atlanta, July 29, 1864. Surgeon J. H. Phillips, U. S. V., reported, from Hospital No. 1, Chattanooga: "Gunshot wound of right thigh. Haemorrhage occurred on September 20th, thirty ounces of blood being lost. The femoral artery was ligated Sep- tember 20th, in the wound, which was gangrenous. On the 26th, the haemorrhage again returned, and it being found impossible to ligate it again in the wound, the external iliac was ligated just above Poupart's ligament, after which the haemorrhage did not recur, but the gangrene continued, and the patient sank, and died October 2, 1864."—Private R. B. Corn- well, Co. A, 23d Ohio, aged 23 years, wounded at South Mountain, September 14, 1862. Assistant Surgeon W. E. Waters, U. S. A., reported from Caspari Hospital that the patient died November 3, 1862, of peritonitis. Acting Assistant Surgeon L. Heard reported:1 "The shot had entered some four inches below Poupart's ligament, over the track of the femoral artery. An examination gave evideuce that the femoral artery had been wounded and that a traumatic aneurism was forming. Water dressing was applied till the 29th, when compression by means of a horse-shoe tourniquet was made, and continued until Octo- ber 4th. On October 10th, Drs. J. F. May and Shippen, assisted by Drs. Hall and Seeley, ligated the femoral artery. Ligatures were placed on the cardiac and distal sides, and the vessel was divided between the two ligatures. On the sixth or seventh day bleeding occurred, which was soon arrested and a tourniquent placed upon the limb. In about a fortnight after the oper- ation the proximal ligature came away of itself, with knot and loop at the end. On October 30th, profuse secondary haemor- rhage took place, which greatly reduced the strength of the patient. Dr. May ligated the external iliac artery. The patient gradually sank, and died November 3, 1862."—Sergeant J. K. Zeiders, Co. I, 53d Pennsylvania, aged 19 years, wounded near Gettysburg, July 3, 1863. Actiug Assistant Surgeon W. V. Keating reported, from Broad Street Hospital, Philadelphia: '' Gunshot flesh wound of the right thigh by a conical ball. The wound sloughed, and secondary haemorrhage occurred from the femoral artery on July 28th. The haemorrhage recurring on August 4th, Acting Assistant Surgeon A. Hewson ligated the femoral artery just above Scarpa's triangle, and on August 11th again ligated the vessel higher up. The thigh became some- what oedematous; by October 28th the wounds of the previous ligations had nearly healed externally. A sinus extended into the tissues below, which were found to be in a softened broken-down condition; ligature separated. On October 8th, Dr. Hewson administered ether and ligated the external iliac artery through a curved incision about three inches long; about six ounces of blood lost, October 25th, slight haemorrhage from point of ligature, and another in the afternoon, amounting in all to about six ounces: controlled by styptics to wound and oil of turpentine and veratrum viride internally. Pulse 130 and weak." The patient was discharged from service May 14, 1864. 1 Heard (L.), Wound of the Femoral Artery—Ligation of both Cardiac and Distal Sides of Severed Vessel—Secondary Hsemorrhage—Ligature of External Iliac—Peritonitis—Death,■ in Am. Med. Times, 1862, Vol. V, p. 337; and Boston Med. and Surg. Jour., 1862, Vol. LXVII, p. 369. SPOT. I. LIGATIONS AFTER SHOT WOUNDS. 43 Professor John Ashhurst, jr., has lately remarked1 that a study of the statistics of the operations of tying some of the larger arteries impresses the fact that "as cases have accumulated, the percentage of mortality has greatly increased."2 This comment, however, is less applicable to the series of ligations of the external iliac artery.3 In studying the statistics the operations for disease and for traumatic cause must be discriminated. The war cases have a fatality more than twice as great as those in civil practice.4 Ligation of the Femoral Artery.'—In a previous portion of this section, commencing at page 16, reference is made to sixty-two ligations of the femoral artery for direct shot injury of the vessel, with the large mortality of 72.6 per cent. An interesting example of a well-managed successful case is adduced, and the great importance of ligating the distal as well as proximal extremities of the vessel is urgently enjoined. In addition to these sixty-two cases there were sixty-five instances in which the femoral artery was tied for consecutive bleeding unattended by primary injury to the vessel. The hundred and twenty-seven examples are enumerated in the summary entitled Table III. This series presents the same grave mortality as when the cases of direct lesion of the vessels were separately considered. References to publications of detailed cases are given; a few abstracts will be presented of cases which furnished pathological material for the Museum: Case 94.—Private B. Ayres, Co. A, 5th Iowa, aged 40 years, was wounded at Vicksburg, May 19, 1863, transferred by hospital steamer to Memphis, and admitted into Gayoso Hospital on the 27th. On the Medical Descriptive List appear the following notes by Acting Assistant Surgeon A. W. Nelson : "A minie ball entered the left thigh through the centre of Scarpa's triangle, passing to the inside of the vein and out at the lower part of the left nates. At the time of admission the wound was in a very dirty and sloughing condition and the skin had a dark tinge. There was considerable diarrhoea, with free perspiration; he was dozing a good deal of the time without any opiate; pulse 100. Water dressings were applied, and he was ordered to lie on the abdomen occasionally to allow the discharge to escape. Ale was given daily. He had a severe rigor on the evening of the 30th, and on the 31st, at 7 o'clock P. M., had haemorrhage from the anterior wound, which was checked by a compress. Fifteen grains of quinine were divided into four powders, one ppwder to be given every four hours. At 2 o'clock P. M. on June 1st the wound was opened to the sheath of the femoral vessels and a darning needle removed from the sheath; there was no haemorrhage, and all compression was removed. The wound was thoroughly cleansed, and the patient removed to bed. About 8 o'clock P. ai. blood, in large quantities, burst forth in a jet, apparently from below; it was quite dark, but the exact shade was not observed. The femoral artery was immediately ligated, but with difficulty owing to the thickened and diseased condition of the parts. There was no haemorrhage after ligation, but patient did not rally under the use of stimulants, and he died at 11 o'clock P. M. Chloric ether was used during the operation. The autopsy disclosed great sloughing in the course of the wound. There was a slough of the femoral fig. 15.—Femoral artery and vein of the size of a three-cent piece. The vein was pierced by the large needle alluded to above, ve'"- Ligation of artery. Specs. two small holes existing opposite each other; the artery was healthy. It was observed that well marked symptoms of pyaemia existed several days before his death; however, the autopsy was not carried far enough to verify this diagnosis." The specimens (FlG. 15) consist of wet preparations of the left femoral artery ligated below the origin of the profunda, and of the femoral vein, showing the point of perforation by the needle, which were contributed by Dr. Nelson. 1 Transactions of the International Medical Congress of Philadelphia, 1877, p. 572. 2 Thus Professor Astihurst observes that when Dr. G. W. Norkis published his classical paper in 1847 (Am. Jour. Med. Sci., Vol. XIII, p. 24), he had collected sixteen cases of ligation of the common iliac artery with eight recoveries and eight deaths, a mortality of fifty per cent., while there are now recorded sixty-one cases with only thirteen recoveries and forty-eight deaths, a mortality of seventy-nine per cent. 3 Thus HODGSON (Treatise on Diseases of Arteries, etc., 1815, p. 41G) enumerated twenty-one instances of ligations of the external iliac following the first operation by Auernethy, in 1796, and fifteen of the twenty-two patients completely recovered, or 68.2 per cent. In 1875, Dr. Rabe collected (Deutsche Zeitschrift fur Chir., Leipzig, 1875, B. V, p. 213) two hundred and seven cases of ligations of the external iliac, of which one hundred and thirty-five recovered, or 65.2 per cent., advancing the death rate but 3 per cent., though the number of cases is decupled. 4 Among American Surgeons two principal methods of ligating the external iliac artery are taught and practised. ABERNETHY, who first ligated this vessel on the living subject in l'9fi (TJie Medical and Physical Journal, London, 1802, Vol. VII, p. 97, and The Surgical and Physiological works of JOHN ABERNETHY, London, 1830, Vol. I, p. 292), made a perpendicular incision ''about three inches in length, through the integuments of the abdomen in the direction of the artery, and thus laid bare the aponeurosis of the external oblique muscle, which was next divided from Poupart's liga- ment, in the direction of the external wound, for the extent of nearly two inches. The margins of the internal oblique and transversalis being thus exposed, the finger was introduced beneath them for the protection of the peritonaeum, and they were divided. Next, the peritonaeum and its contents were pushed upward and inward, and the external iliac artery taken hold of with the finger and thumb. It now only remained to pass a ligature round the artery and tie it; but this required caution on account of the contiguity of the vein." In his second case, ABERNETHY made his incision in a line a little external to the artery to avoid the epigastric. Both of these operations failed, but ABERNETHY'6 third and fourth attempts were completely suc- cessful. Sir Astley Cooper's operation is generally preferred as endangering the peritoneum less, and less weakening the abdominal parietes so as to give a tendency to hernia. Sir A. COOPER saved four of his six patients. His method of operating is described in HODGSON (op. cit, p. 42), by HARRISON ■l\ INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 16.— Ligation of femoral. Spec. 1024. FIG. 17.-Left femoral artery tied four and a half incites be- lowtheprofun- da. .Spec. 3972. (asi; 95.—Private S. Brown, Co. G, 134th New York, aged 16 years, was accidentally wounded on August 30, 1862, and entered the Mansion House Hospital, Alexandria, six days afterwards. Assistant Surgeon W. A. Conover, U. S. V., contributed the following report of the injury: "The ball entered the left leg at the posterior middle third, penetrated the tibialis posticus muscle, and was extracted at the same opening. At first there was free discharge of laudable pus, but suppuration increased rapidly, and by September 26th infiltration of the tissues had nearly reached the popliteal space. Under a supporting treatment the patient seemed to gain rapidly until November 14th, when, during his sleep, a profuse haemorrhage occurred from the sloughing of the posterior tibial artery and a great quantity of blood was lost before it was discovered. His condition not admitting an operation, the wound was plugged with styptics and a handage was applied from the toes to the hip. This treat- ment controlled the haemorrhage for eight days, stimulants being given freely in the mean time in order to prepare the system for an operation, if necessary. On November 28th another attack of bleeding was promptly controlled by the attendant, and, upon consultation, ligation of the femoral artery at the lower third was agreed upon as giving the patient a chance for his life. The operation was performed with some difficulty, owing to the'abnormal structure of a branch artery which had to be carefully avoided. The patient bore the operation very well considering his condition, and, on the following day, his extremities were perfectly warm and remained so, showing that circulation had been re-established. The discharge, however, continued excessive, and although stimulants and tonics were used very freely, the patient sank steadily, and died of pyaemia on December 7, 1862. The autopsy 'confirmed the extensive disorganization from infiltration of pus, the artery being in an unhealthy condition up to within an inch of the ligature. The tying of the artery was a success, the clot having been perfectly formed and the circulation re-established by the profunda, which was sufficiently enlarged for the purpose." The ligated artery was contributed by Dr. Conover, a wet preparation of which is shown in the cut (Fig. 16). Case 95.—Private W. Colgan, Co. C, 2d Massachusetts Cavalry, aged 21 years, was wounded at Berry- ville, September 14, 1864. On the following day he was admitted to hospital at Sandy Hook, and three days afterwards he was transferred to Frederick. Assistant Surgeon R. F. Weir, U. S. A., reported: The wound was caused by a conoidal ball, which entered on the outer border of the popliteal space of the left limb, took a diagonal course up behind the femur, and emerged on the inner aspect at the lower portion of the upper third. The patient was very anaemic when admitted, and stated that he lost a considerable amount of blood on the field. Stimulants and generous diet were ordered. On September 24th there was an attack of haemorrhage to the amount of twelve ounces, which was checked by compression. On the following day another haemorrhage occurred, when the • femoral artery was ligated four and a half inches below the profunda by Acting Assistant Surgeon J. C. Shimer. On the morn- ing of September 28th there was slight oozing of arterial blood, when the openings were enlarged and the source'of bleeding searched for ineffectually. Recourse was had to digital compression. Death ensued at 10 o'clock, September 28, 1864. At the post-mortem (see the adjoining wood-cut, FlG. 17) the femoral and profunda arteries were found to be intact. (See the Catalogue of the Surgical Section of the Army Medical Museum, 18(J'o, p. 4ij3.) » Case 97.—Private I. Curler, Co. G, 5th Michigan, was wounded at Fair Oaks, May 31, 1862, and admitted to Hygeia Hospital, Fort Monroe, four days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: "Gunshot wound of femoral artery, the ball entering the anterior and middle portion of the right thigh and passing out opposite posteriorly, going close to the inside of the femur. The temparature of the limb was good, although the artery at the ankle heat feebly. Haemorrhage from both wounds occurred on June 10th, and returned in a few hours. An unsuccessful attempt to find the artery below the wound was made, and I tied the femoral, as I supposed, above the profunda; but pulsation being so strong in the artery exposed below the ligature, further search was made and the profunda was found unusually high up. This was also tied, and no haemorrhage returned. The foot, before the operation warm, now became cold; hut by the aid of external heat its temperature returned on the following day. The patient was a fine healthy looking young fellow. He was transferred to New York by steamer on June 12th." Surgeon S. W. Gross, U. S. V., contributed the specimen shown in the annexed cut (FlG. 18) and reported the result of the case as follows : "The patient was admitted to DeCamp Hospital, David's Island, New York, June 15th, and was placed under the charge of Acting Assistant Surgeon W. K. Cleveland. At the time of his admis- sion the ligature had come away but the wound had not united. On June 17th, profuse haemorrhage occurred from the profunda femoris, around which a ligature was cast. The patient, however, had lost so much blood that he succumbed two hours after the operation." The specimen (FlG. 18) consists of a small section of the femoral and profunda arteries, and shows the femoral blocked up with a clot at the seat of the ligature, also the ligature around the profunda, where another clot was formed. Case 98.—Private D. Rapp, Co. K, 7th Indiana, aged 20 years, was wounded at Robinson's Creek, November 30, 1863. He was admitted to the field hospital of the 1st division, First Corps, where Surgeon G. W. Metcalf, 76th New York, noted: "Gunshot wound of left thigh." On December 6th, the wounded man was transferred to Douglas Hospital, Washington. Three davs afterwards he was operated on by Assistant Surgeon W. Thomson, U. S. A., who furnished the following detailed (Surg. Anat. of the Arteries, 4th ed., 1839, p. 351), and most of the text-books. Dr. Stephen Smith has published a good account of thirty-two deliga- tions of the primitive iliac artery (Am. Jour Med. Sci., 1860, Vol. XL, p. 17). I have mentioned many of the more recent cases in a foot-note to Part II, Vol. II, p. 333, of the Med. and Surg. Hist, of the War. But by far the most comprehensive analytical summary furnished is given by Dr. L. Rabe [Zur t'nterbindung der grossen Gefdssstdmme in der Conttnuitat by Erkran-Kungen und Verletzungen der unteren Extremitdten, in Deutsche Zeitschrift fur Chir.. Leipzig, 1875. B. V, p. 213), who tabulates 207 cases of ligations of the external iliac, of which 72, or 34.7 per cent., proved fatal. Of these 207 cases the author distinguishes 34 with 22 deaths (64.7 %) as war cases, and 173 with 50 deaths (28.9) as cases from civil practice. In four of the cases from civil life the common iliac was afterwards ligated (twice successfully), and in one of the cases from war practice the same vessel was tied with temporary success. This was Dr. BltAIXARD'S case, published in the Chicago Med. Jour., 1864, Vol. XXI, p. 97, which Dr. RABE quotes from Professor Gt)BLT'8 Jahresbericht for 1864. Fig. 18.—Sec- tion of right fem- oral and profun- da. Ligature on the former has cut its way out. Spec. 1004." SECT. I.J LIGATIONS AFTER SHOT FLESH WOUNDS. 45 report of the case: He was a well developed and very muscular man and had been apparently in good health. At the moment of injury he was retreating, and was struck by a bullet on the posterior aspect of the left thigh a short distance below the gluteal fold, which passed through the limb to the inside of the bone, divided both femoral artery and vein, and made its exit three and a half inches below Poupart's ligament, at the point of election in ligating the femoral in Scarpa's space. There was ^rofuse haemorrhage at the time of injury, and an immediate want of sensibility in the leg and foot. When examined on the 7th of December, the whole limb was found warm and the collateral circulation had been established; but there was no pulsa- tion in either of the tibial arteries. At the superior margin of the wound of exit there was a small tense swelling, which pulsated synchronously with the systole of the heart. An aneurismal thrill, resembling the loud purring of a cat, was distinctly felt, extending along the course of the vessels into the pelvis, but not communicating laterally. The little finger was intro- duced into the wound at the time of the operation, and the pulsation and thrill were found to be closely localized and confined to the divided ends of the femoral vessels. There was no extensive effusion of blood into the tissues of the thigh, and hence this was not in the strict surgical sense of the word a traumatic aneurism. It was concluded that the sac was composed only of the sheath, which had been united by inflammation after the division and retraction of its vessels, and had then been some- what distended after the heart had regained its force. It was also suggested by Surgeon Lidell, who kindly saw the case with me, that there was a free communication between the divided artery and vein in this sac which permitted the arterial blood to return freely by the vein, as evinced by the pulsation communicating with such force backward toward the heart in the line of the vessels. It was unmistakable that there existed a wound of tho femoral artery sufficient to cause its obliteration, that an aneurism was being developed at the divided proximal extremity, and that the proper surgical procedure would be to secure the ends of the vessel at the point of the injury. It was determined to emulate the example of Mr. Syme, to lay open boldly the sac by a free incision and search for and secure the bleeding orifices. It was hoped that the profunda had escaped injury, and every precaution was to be used to secure the femoral below its origin. A small haemorrhage on December 9th rendered immediate interference necessary, and the following operation was then done with the assistance of Surgeon Lidell and the medical officers of the hospital. After the patient had been fully etherized and the femoral artery thoroughly compressed on the pubes by the thumb of a reliable assistant, as evinced by the loss of pulsation in the tumor, an incision four inches in length was made through the skin and fascia?, immediately over the tumor and including the gunshot wound, in a line parallel with the sartorius. A second incision was now made into the tumor, which was dilated instantly by the finger to the size of the first. Distal haemorrhage was anticipated, and it caused but little surprise when a most profuse dark colored torrent poured out from the incision. The lower angle of the incision was rapidly searched in vain for the source of the haemorrhage, and it was feared that it might come from the dark softened depth of the track of the ball. No pressure on the artery had the least controlling effect upon it. The removal of the sponge was followed instantly by a boiling dark torrent of venous blood,-which so quickly filled the cavity as to prevent any examination. So profuse and uncontrollable was the flow that visions of ligating the external iliac were vividly presented to the mind. When the flow was found to arise from the superior angle of the incision numerous and ineffectual efforts were made to secure the vessel, but the parts were so hardened by local inflammation that the forceps glided over them as it would over a cartilaginous surface. This point, from whence the dark blood seemed to flow, was finally compressed by the point of the left index finger, and by means of the nail of the small finger of the right hand a vessel was isolated, a ligature passed around it with an aneurism needle, and this haemorrhage, most embarrassing because uncontrolled by pressure, was finally suppressed. The first ligature was applied at the superior angle of the ..FlG" f femoral incision to the proximal extremity of the divided femoral vein, from which this unexpected and most annoying artery and vein. haemorrhage escaped by regurgitation from the saphena. The blood found its way into the limb by means of arteries arising from the iliac above the point compressed, was finding its way back by the saphena, enlarged to compensate for the occlusion of the femoral, was poured into the femoral a short distance above its divided proximal extremity, and then regur- gitated through the stump of the femoral into the superior angle of the incision. The proximal end of the femoral artery, from which a crimson tide escaped on relieving the pressure slightly, was now easily found, and this was ligated. The wound was now thoroughly cleansed of all clots of blood. The femoral artery and vein, denuded of their sheath for a distance of two inches, were clearly seen at the bottom of the wound, their divided extremities having become adherent to the neighboring tissues during the inflammatory action of the previous ten days. As a precautionary measure a ligature was cast around the femoral artery at the lower angle of the wound, and some little difficulty was experienced in discriminating between the artery and vein, owing to the fact that from ten days' disuse the vein in becoming an impervious cord had become similar in size, color, and consistency to the artery. A small orifice was observed in the vein near its distal extremity, and from this occurred a free black flow on moving the limb. This was also included in a ligature. The wound was now closed by one or two sutures and the patient placed in his bed. A brief recapitulation may give clearness to the above account. The first vessel tied was, therefore, the proximal extremity of the femoral vein near the entrance of the saphena; the second, the femoral artery a short distance below the origin of the profunda, both at the superior angle of the incision; the third, the femoral artery at the lower angle of the incision and two inches from its distal extremity; the fourth, the femoral vein near its distal extremity at the centre of the incision, and to control a flow from an incision through its coats,.which may have been made accidentally. The profunda had not been seen, and it was hoped that it would suffice to keep up the circulation. No important arterial channels had been interfered with by the operation, and a successful issue might be expected. The man was stimulated, took morphia, and his leg was covered closely in bed with blankets to preserve the animal warmth. This man had lost blood freely at the time of the injury; he had been subjected to a very long and fatiguing transport in ambulances and cars before reaching the hospital, and for seven days his food had not been as good or sufficient as might have been desired for one about to undergo such an operation. He was pallid and haggard looking, and iron, nutrients, and stimulants were freely ordered. There was great pain and restless- ness during the ensuing night, and large quantities of morphia were required to procure sleep. December 10th, no interference with the circulation; leg and foot both warm. The whole limb is swollen, and bloody serum escapes freely at the point of 46 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. the injury. December Kth, the restlessness has been the most marked symptom, caused seemingly by constant and severe but indescribable pain in the limb. The pulse is 120, the countenance pale and haggard, the tongue dry and coated, and the general symptoms indicate great nervous prostration. Large quantities of morphia have been found requisite. The whole limb and foot are much swollen and oedematous. On the evening unmistakable signs of sphacelus appeared, the foot became cold, and a hue of purple discoloration was observed as high up as the ankle. The neuralgic pain and restlessness still con tinued. On December 13th, all the symptoms were worse. The discoloration, the dark purple hue of gangrene, extended rapidly upward, particularly on the inside of the limb. The whole thigh became crepitant, the pulse more rapid and feeble. He became more and more depressed, and finally died at 12 o'clock at night. These final scenes all surgeons can imagine. The post-mortem revealed nothing interesting in the great cavities. The whole thigh and leg were found gangrenous as far as the point of the injury. The vessels were dissected, spread upon a board, and a most faithful picture was made of them by the artist under Dr. Brinton's direction. Only the proximal extremities of the vessels were found in the softened gangrenous mass; but they threw light upon the history of the case. The artery was divided below the origin of the profunda, which was uninjured, but not enlarged, as one would expect if the whole force of the circulation had been directed toward it. by the oblit- eration of the main artery. In ten days the profunda should here have been as large as the femoral, if all the blood brought to the divided femoral had been seeking a passage through its calibre. Its undilated condition gives color to the idea that most of the blood brought to the divided femoral extremity found its way quickly back by the divided femoral vein; that the pressure was thus relieved, and that the profunda received only its usual supply of blood. That the limb was nourished by a collateral circulation, arising above the brim of the pelvis, is clear from the fact that no pressure on the external iliac would restrain the flow of blood from the saphena through the femoral vein. The saphena vein is normal, and its relation with the femoral indicates how easily the regurgitating haemorrhage was caused, as no valves are there to prevent it. For several days—from the 9th to the 12th—there were no signs of an interference with the circulation, but at that time gangrene appeared and spread with great rapidity. This may have been due to the recent phlebitis of the profunda vein, which is now filled with a pink firm coagulum. The irritation caused by the operation, or due to the passage of the hall, may have induced the inflammation of this vein, now so vital to the support of the circulation. This seems to have been a wound of an artery, resulting in an aneurism the sac of which was composed of the re-united sheaths and enlarged probably by some dissection upward, in which a free passage of blood took place from the artery to the vein. No question as to the propriety of the operation now exists in my mind, since, as the sequel shows, no digital com- pression over the femoral would have sufficed to prevent or control a secondary haemorrhage." The two speci- mens were contributed by the operator, Dr. William Thomson (see FlG. 19). The case is cited by Dr. Lidell.1 Case 99.—Lieutenant R. W. Smith, Co. I, 5th Pennsylvania Reserve Corps, was wounded at the battle of Bull Run, Virginia, August 30, 1862, in the right thigh. He was conveyed to Alexandria in a rough wagon, and thence brought to Washington, and admitted to Douglas Hospital, September 5, 1882, with a circumscribed false aneurism of the femoral artery. The vessel was ligated in the continuity on September 7th. Secondary haemorrhage followed, and the patient died September 8, 1862. At the autopsy it was ascertained that the haemorrhage had been temporarily restrained by the direction of the wound and coagula in the large aneurismal sac. Recurrent haemorrhage had led to the fatal result. The preparation is well represented in the accompanying wood-cut (Fig. 20) reduced to one-half. Case 100.—Private J. Hiihner, Co. K, 5th Michigan, aged 29 years, was wounded at Fair Oaks, May successfufprox- 31, 1862, and conveyed to New York City one week afterwards. Dr. F. T. Foster, of the New York (Civil) iinal ligation of Hospital, reported the following history: "He was admitted on June 8th, having been wounded by a musket ral artery for ball, which entered the posterior fleshy part of the right thigh and had not been removea. The case presented traumatic aneu- notnjng peculiar, and under simple treatment progressed well until June 27th, when there occurred from the wound a copious arterial haemorrhage, controlled with difficulty by the application of lint and pressure. On the same day he was etherized and the wound opened; but the source of the haemorrhage was not discovered. The wound was again stuffed with lint and the limb bandaged, after which Dr. T. M. Markoe tied the femoral artery a short distance below the origin of the profunda. The ligature came away on the 8th of July, and the incision and the original wound soon beo-an to close by granulation. On the 29th the ball could be felt encysted beneath the integument on the anterior aspect of the thigh, but he declined to have it removed. On September 3d he was discharged from the hospital with the wound entirely healed and the limb in good condition." The man was discharged from service, at Fort Hamilton, New York Harbor, October 1, 1862, and pensioned. Examiner H. F. Montgomery, of Rochester, New York, certified, February 2, 1863: "A hall entered the right thigh in middle third, over the femoral artery, and was not abstracted. There is a long cicatrix in this region, and another behind, on the inside of the bone. His foot is benumbed, and, on exercise, swells and is painful. He is apparently in good health. He has a buckshot in the right leg below the knee." Examiner J. J. Lutze, of East Saginaw, Michigan, reported, March 4, 1874: * * "Large tender cicatrices on outer and inner posterior thigh, points of entrance and incision. Adductor brevis and longus muscles impaired and injured." This pensioner's rate of compensation was reduced from five-eighths to one-fourth on March 4, 1873, since which date he has not drawn any pension. Besides the cases of ligation of the femoral artery above detailed, numerous other cases have been narrated at length in journals or elsewhere, to which references are given further on. In Table III, the entire series of thirty-six recoveries and ninety-one fatal cases are noted alphabetically, and the principal facts regarding them are soncisely recorded. 1 Lidell (J. A.), On the Wounds of Blood- Vessels, Traumatic Hemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in Surgical Memoirs of the War of the Rebellion, collected and published by the United States Sanitary Commission, 1870, Vol. I (Surgical), p. 143. SECT. I.] LIGATIONS AFTER SHOT FLESH WOUNDS. 47 Table III. Summary of One hundred and Twenty-seven Cases of Ligation of the Femoral Artery for Haemorrhage from Shot Injuries unattended by Fractures. Name, Military Description, and Age Ambrose, T. L., Chap- lain, 12th New Hamp- shire, ago 35. Archibald, T., Pt., G, 24th Mass., age 18. Atwood, L. D., Pt.. B, 32d Mass.. age 31. ■Ayres. B., Pt., A, 5th Iowa, age 40. Bailey, J., Pt., I, 55th Penn., age 26. Banfill, T., Serg't, C, 19th Indiana, age 20. Barkeloo, J., Pt., M, 2d Ohio Cav., age 28. Bedingfield, J. T, Capt., G, 60thGeorgia,age25. Bell, J. C, Pt., E. 34th Iowa, age 23. Bills, C, Pt., K, 17th New York, age 20. Blake, G., Pt., I, 3d West Virginia. Brown, 8.. Pt., G, 134th New York, age 16. Brown, W., Serg't, 1st Maryland Artillery. tCheck, J/., Pt., I, 61st North Carolina. Clark, W. £., Pt,, H, 25th North Carolina, age 20. Claypole, S., Pt., D, 62d Penn., age 27. Clelland.W., Pt., A, 8th New York Heavy Art., age 18. Clover, B., Civilian, age 16. Clymer, J., Pt., B, 104th Pennsylvania. 3Coble, J. A., Pt.,F,45tb North Carolina, age 20. Colgan, W., Pt., C, 2d Mass. Cavalry, age 21. Connell. M., Pt., K, 2d New York Heavy Art., age 34. Coultes, W. H., Lieut., C, 61st New York. Coy, J. H., Serg't, K, 6th Maine, age 28. July 25, Aug. 15, ie64. April 2, 12, '65. Sept. 30, Oct. 31, 1864. May 22, June 1, 1863. June 18, Jul. 9,'64 May 12, June 12, 1864. July 19, 1863. Mar. 25, April 15, 1865.'" April 6, 17, '65. Aug. 30, Sept, 26, 1862. Aug. 26, Sept. 9, 1863. Aug. 30, Nov. 28, 1862. Dec. 10, —, '63. July 30, Aug. 3, 1864. April 1, 10, '65. May 30, June 8, 1864. June 1, July 24, 1863. Aug. 23, Sept. 1, 1864. May 31, June 16, 1862. Nov. 27, '63, Jan. 23, '64. Sept. 14, 25. '64. April 7, June 15, 1865. June 1, 18, '62. Nov. 7, 24, '63. Injury, Operator, and Result. Right thigh; haem.; femorallig.; haem. from branch of profunda— large branch tied. Died Aug. 20, 1864. Right femoral artery wounded and ligated; one end tied. Died April 26, 1805, pyaemia. Left thigh, middle third; ligation of femoral, both ends tied. Died November 9, 1864. Left thigh; haem.; wound opened and a darning needle removed from sheath of vein; artery lig- ated. Died June 1,'63, pyaemia. Specs. 2020, 2085, A.M. M. Left thigh; ligation of femoral. Died July 10, 1864. Left thigh; femoral ligated, by Surg. T. R. Crosby, U- S. V. Died June 12, 1864, pyaemia. Right popliteal artery severed; primary lig. of femoral artery; amp. thigh. Disch'dMar. 17,'65. Both thighs; left femoral ligated, by A. A. Surg. N. A. Robbins. Died April 25,1865, exhaustion. Left leg, cutting post. tib. artery; fem. lig., by Surg. A. McMahon, U.S.V.; amp.thighforreeurrent haem. Died Ap. 23, '65, exhaus'n. Wound of thigh, involv. profunda artery; both ends femoral tied; sloughing. Died Oct. 4, 1862. Shot wound of left femoralartery; vessel tied, by Surgeon W. D. Stewart, U. S. V. Furloughed Nov. 12, 1863. Wounds healed. Left leg; fem. lig- in lower third, by Asst. Surg. W. A. Connor, U. S. V. Died Dec. 7, 1862, pyaemia. Spec. 1024, A. M. M. Left thigh ; femoral ligated. Re- covered. Femoral artery severed; femoral artery ligated, by Surg. D. F. Wright, P. A. C. S. Recovered. Shot wound lowerthird rightfem- oral artery; artery tied, by A. A. Surg. J. Morris. Died April 19, 1865, gangrene. Right leg; femoral lig., by Asst. Surg.W.F. Norris, U.S.A. Died Aug. 4, '64, asthenia and pleuro- pneumonia. Left thigh ; one end of femoral tied. Died July 24, '64, typhoid fever. Left fem. artery injured; aneur- ism; femoral tied. Recovered. Left popliteal space ; femoral lig., by A. A. Surg. M. K. Cleveland. Died June 16, 1862. Left thigh; diffused trau. fem'l aneurism; fem. lig. above and below; femoral vein also tied. Recovered. Left thigh ; fem. lig. in continuity, by A. A. Surg. J. C. Shrimer. Died Sept. 28, '64, loss of blood andexhaust. Spec.3972,A.M.M. Right thigh ; one end of fem. tied, by A. Surg. O. P. Sweet, U.S.V. Died June 16, 1865, exhaustion. Middleofthigh; both ends femoral tied, by A. A. Surg. \V. Hunt. Died June 23, 1862, shock. Left thigh; femoral lig., by A. A. Surg. J.C.W. Kennon ; haem. re- curred ; religated, byA.A.Surg. T. O. Bannister, Dec. 1; again on Dec. 23, by Surg. D.W. Bliss. U. S. V. Died Dec. 23, 1863. Name, Military Description, and Age Crowder, D. J., Pt., Stamford's But'ry, age 23. Cummings, J. M., Pt., D, 49th Indiana. Cummins, H., Pt., A, 7th West Virginia, age 21. Curler, I., P., G, 6th Michigan. Darling, S. G., Pt., D, 32d Maine, age 19. Delamater, M., Corp'l, G, 7th Michigan Cav- alry, age 20. Dier.W., Corp'l, A, 129th Pennsylvania, age 23. Doyle, L., Pt., K, 8th Maine, age 34. Dunn, G. R., Serg't, E, 25th S. Carolina,age 20. Edwards, J. W., Pt., B, 28th Illinois, age 18. Edwards, R., Pt., G, 98th Illinois. Elliott, E., Pt.,H, 118th Pennsylvania, age 21. Freeman, C. A., Serg't, B, 37th Mass., age 22. Gardner, R. T., Pt., A, 1st Md. Battal'n,agel9. Gilley, M., Pt., 1, 9th N. York State Militia, age 37. Goodwin, A., Pt., B, 2d New Hampshire. Graham, J. A., Serg't, H, 116th Penn., age 21. Gray, J.,Pt., D, 2d Penn- sylvania Heavy Art'y, age 17. 4Gross, C, Pt., K, 6th Pennsylvania Cavalry, age 26. 6Hagan. J., P., G, 76th Pennsylvania. Hamilton, E., Capt., G, 15th New Jersey, age 19. Harbaugh, H., Serg't, K, 7th Wisconsin, age 22. Harrington, W. J., Pt,, C, 16th Wisconsin. Harris, J. M., Corp'l, C 14th Iowa, age 20. Harrison, E., Serg't, B, 10th New York. Hickey, T., Pt., G, 73d Pennsylvania, age 53. Horn, S., Pt., H, 53d North Carolina, age 21. Dec. 16, '64, Jan. 9, '65. Dec. 28, 1862. May 8, 25, '64. May 31, June 10, 17, '62. May 12, 1864, On field. Mav 28, July 10, 1864. Dec. 13, '62, Feb. 22, '63. May 20, June 1, 1864. May 16, 29,"'64. Mar. 26, April 20, 1865. June 25, Jul. 6,'63. June 3, 13, '64. April 6, 15, '65.' July 2, 23, '63. Mav 5, —,''64. July 2, 20, '63. June 1,. 10, '64. June 18, 30, '64. May 30, 31, "64. July 17, 23,"'64. Mav 6, 15,''64. July 2, Sept. 13, 1863. July 5, 16, "64. July 15, 27, '64. May —, 1864. Aug. 30, Se.27,'62. Mar. 25, July 9, 1865. Injury, operator, and Result. Right thigh; ligation of femoral, by A. A. Surg. D. D. Talbot. Died Feb. 3. 1865, gangrene. Shot wound right femoral artery; vessel ligated. Died Jan. 29, '63. Right thigh; femoral tied above profunda. Died May 29,1864. Right thigh; fem. and profunda lig.; haem. recurred; profunda relig. Died June 17,1862. Spec. 1004, A. M. M Fem. artery severed; vessel lig.; May 26th, thigh amp., by Surg. It. B. Boutecou, U. S. V. Died May 26, 1864, haemorrhage. Right thigh; lig. of femoral, by A. Surg. H. M. Sprague, U.S.A. July 12th, thigh amputated. Died Aug. 7, 1864, pyaemia. Left popliteal 6pace; femoral lig. Died Mar. 4, 1863, pyaemia. Right thigh; femoral and several branches ligated above and be- low wound, by Surg. A. Heger, U. S. A. June 6th, thigh amp. Died June 6, 1864, exhaustion. Right thigh; femoral ligated. Recovery. Right leg; femoral ligated, by A. A. Surg. H. B. Cole. Recovery. Both thighs; femoral ligated. Died July 11, 1863. Right thigh; femoral ligated, by Asst. Surg. H. Allen, U. S. A. Died June 21, 1864, gangrene. Left thigh ; femoral art'y ligated, by Surg. B. A., Vande'rkieft, U. S.V. Died April 18, '65, anaemia. Both thighs; left femoral ligated. Doing well November 30, 1863. Right thigh, involving femoral artery; femoral ligated. Died May 27, 1864, of pyaemia. Left thigh ; femoral ligated above and below. Died Aug. 8, 1863. Rightthigh; haem.; profunda lig.; haem. recurred: iem. lig. Died June 13, 1864. Left thigh; femoral tied in con- tinuity, by Surg. N. R. Mosely, U. S. V. Died July 12, 1664. Left femoral artery divided; liga- tures placed above and below. Died June 8, 1864, exhaustion. Right thigh ; fem. tiedat proximal extrem. and accompanying vein at prox. and distal ends; gang. Died July 27, 1864. Right femoral vein and branch of profunda divided; femoral tied, by Surg.H.W.Ducachet, U.S.V. Died May 16,1864 ; exhaustion. Left thigh; femoral ligated. Dis charged July 21, 1864, atrophy of thigh and leg. Left thigh ; both ends of femoral tied, by Surg. G. F. French, U. S. V. * Died July 20, 1864. Right fem. art. injured ; aneurism ; art. ligated above and below sac, by Surg. J. G. Keenon, U. S.V.; amp. leg, by A. A. Surg. R.W. Coale. Died Aug. 3,'64, pyaemia. Right thigh; ligation of femoral, by Surg. M. Rizer, 72d Penn. Died May 22, 1864. Rightthigh; common femoral tied in continuity. Died Sept, 27, '62. Left thigh; femoral ligated, by A. A. Surg. J. Morris. Died July 14, 1865, haemorrhage. 1 Lidell (J. A.), On Wounds of Veins, in Surg. Mem. of the War of the Rebellion, coll. and pub. by U. S. San. Comm.. 1870. Vol. I, p. 141. 'Dudley (J. G.), Case of Diffused Traumatic Aneurism, in Confederate States Medical and Surgical Journal, 1865, Vol. I, p. 35. 3 WRIGHT (D. P.), The Effects of the Hunterian Method of Ligation, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 177, and Richmond Med. Jour., 1866, Vol. I, p. 309. Lidell (J. A.), op. cit., p. 262. 2 Ibid., p. 233. 3Blackman (G. C), On the Treatment of Inflammation of the Limbs by the Compression, or Ligature, of their Main Arterial Trunk, in Cincinnati Lancet and Observer, 1858. Vol. XI, p. 77, and Richmond Med. Jour., 1866, Vol. I, p. 307. * Lidell (J. A.), On the Wounds of Blood-vessels, etc., in Surgical Memoirs of the War of the Rebellion, collected and published by the XT. S. San- itary Commission, 1870, Vol. I, p. 143. s Batwell (E.), Surgeon, 14th Michigan, in Med. and Surg. Reporter, 1865, Vol. XIII, p. 50. Probably the case of M. Shaw, Pt., I, 17th New York, age 19. Died Nov. 16, 1864. SECT. I.] LIGATIONS AFTER SHOT FLESH WOUNDS 49 Name, Military Description, and Age. Smith, W. F., Major, 1st Dtlawaro. Soeluvell. C. L., Pt., K, 12th X. Jersey, age 22. 'Spivey, D., Pt., (J, 5th N. Carolina, age 4(i. Story, F., Pt., E, 38th Ohio, age 22. Sweeney, J. L., Serg't, D, 12th Mass., age 25. Thorn, H.C.Pt., 1,14th West Virginia, age 19. Tompkins,—, substitute, age 21. Vearing, W., Pt., G, 12th Missouri, age 30. »Vickery, R. S., Asst. Surgeon, 2d Michigan. Wakeham, J. E., Corp'l, E, 18th Virginia, age 27. Mav 6, 6, '*64. ---, July 8, '63. " July 23, Sep. 9, 64 May 15, 30, '64. July 20, Aug. 7, 1864. July 28, 29, '63. Sept. 17, 22, '62. May 22, June 22, 1863. July 30, 30, '64. Mar. 31, April 10, 1865. Injury-, Operator, and Result. Right thigh; fem. lig. above and below.veinalsotied; amp. thigh, Surg. A. N. Dougherty, U.S.V. Died Nov. 6,1864. Right thigh; femoral secured. Disch'd June 30, '65; pensioned. Left thigh, also right leg; aneur- ismal tumorof leftfem. art,; fem. tied, by Surg. E. B. Haywood, C. S. A. Recovered Jan. 10, *64. Right thigh ; gangreno; both ends of fem. tied. Died Sept. 10, '64. Right fem. artery injured and lig. Disch'd from hospital Oct. 15, 1864; pensioned. Right thigh; fem. ligated; haem. recurred from profunda; thigh amp., by Surg. J. B. Lewis. U. S. V. Died Aug. 12, 1864. Right leg and left arm ; femoral ligated; gang. Aug.3d, trismus. Died Aug. 4, 1863, tetanus. Wound of fem. art.; proximal end tied in wound. Died Sept. 22, '62. Right thigh ; small aneurism of femoral artery; femoral tied. Returned to duty Dec. 16, 1863. Left thigh; femoral tied, by Surg. W. B. Fox, 8th Mich. Disch'd Mar. 14, '65; pens'd. Appointed Asst. Surg. U.S.A., May 14, 67. Left fem. artery involved; lig. of artery above profunda, by A. A. Surg. J. Morris. Haem. recur'd; relig. just below Poupart's lig. Died April 28, '65, exhaustion. Name, Military Description, and Aoe. Wilder, E., Corp'l, A, 100th N. York, age 19. Williams, C, Pt., F, 5th Colored Troops, age 23, Williams, G., Pt., E, 9th N. York, Heavy Art., ago 31. Willis, jr., A., Pt.,I,7th Rhode Island, age 25. 3 Wilson, J., Pt., 27th N. York Battery, age 26. Winchell, C. D., Pt., K, 38th Wisconsin, age 19. Winchester, D. W., Pt., I, 1st Mass. H'vy Ar'y, age 21. Witham, A., Pt., A, 1st Maine Heavy Art'y, age 20. Wood, W. R., Pt., H, 81st Indiana. Worley, S., Pt,, A, 139th Pennsylvania, age 20. Aug. 16, Sept. 21, 1864. Sept. 29, Oct. 15, 1864. July 9, Aug. 3, 1864. Dec, 13, 25, '62. May 26, July 16, 1863. April 2, 12, '65. May 19, 28, '64. May 19, June 29, 1864. Dec. 31, '62, Jan. 17, '63. May 5, 20, '64. Injury, Operator, and Result. Left leg; haem. from post, tibial artery ; fem. tied in continuity, by A. A. Surg. J. C. Morton. Deserted March 23, 1865. Laceration left thigh; both ends of fem. tied in wound, by A. A. Surg. O. Warner; haemorrhage recurred. Died October 21,1864, phlebitis. Left thigh; art'y tied below origin of profunda, by A. A. Surg. J.C. Shimer. Died August 4, 1864, exhaustion. Right femoral artery injured and ligated. Died Dec. 28, 1862, from previous bleeding. Left thigh; ball passed close to femoral vessels; large aneurism of fem. artery; fem. tied above and below, by A. A. Surg. G. B. Hammond. Duty July 31,1863. Left thigh; fem. lig. in continuity, by Surg. J. C. McKee, U. S.A. Disch'd July 3, 1865; pensioned. Left thigh ; sloughing; femoral tied in continuity, by Surg. T.R. Crosby, U. S. V. Duty Febru ary 10, 1865. Left thigh; fem. ligated, by A.A. Surg. J. Newcombe. Died July 2, 1804, loss of blood. Right thigh ; femoral tied. Duty June 22, 1863; pensioned. Right thigh ; fem. ligated. Died June 2, 1864. Of this series of one hundred and twenty-seven cases with ninety-one deaths, the mortality rate of 71.7 per cent, of the aggregate scarcely varies from that of the smaller series of ligations for direct shot injury of the femoral adverted to on page 16. Ligations of the Profunda Artery.—Six instances were reported of ligation of the profunda in addition to the cases in which that vessel was tied in connection with ligations of the femoral. Brief abstracts of the two successful and four fatal cases are subjoined: Cases 101-106.—Sergeant B. W. Bedingfield, Co. G, 60th Georgia, age 18 years, wounded at Monocacy, July 9, 1864; admitted into hospital at Frederick; conoidal ball passed through upper third of left thigh and lodged near the inner side of right femur, wounding the right profunda artery; traumatic aneurism, sac five inches in length, containing at least a pint of clotted blood. August 15th, Acting Assistant Surgeon J. H. Bartholf laid open the aneurismal sac. Bleeding came from the profunda artery; a ligature was applied above and below the wound of the artery by an incision four inches along the sartorius muscle; the patient was in good condition though irritable and depressed; brandy was given every hour during the day after the operation; haemorrhage did not recur. August 25th, ligature came away; the wound healed, and the patient was trans- ferred to Point Lookout, October 25th, for exchange.—Private J. H. Beun, Co. E, 45th Pennsylvania, aged 18 years, wounded at the Wilderness, May 6, 1864. Admitted into Campbell Hospital, Washington; shot wound of thigh. May 28th, bleeding to amount of forty-eight ounces from profunda artery; profunda ligated at one end in wound; haemorrhage recurred June 14th, and death on the same day.—Lieutenant J. T. Lowe, Co. D, 12th New Jersey, wounded at Bristoe Station, October 14, 1863; admitted into Third Division Hospital, Alexandria; gunshot wound of left thigh by conoidal ball; haemorrhage to extent of twenty-four ounces from profunda artery; both ends of profunda femoris tied in the wound. Patient died October 30, 1863.— Corporal T. Machelent, Co. B, 140th New York, aged 27 years, wounded at the Wilderness, May 8,1864; admitted into Mower Hospital, Philadelphia; missile entered middle of posterior surface of upper third of right thigh, passed in a direct line and emerged from inner surface; slight wound. July 4th, haemorrhage to the extent of thirty ounces from the profunda artery; the proximal end of the artery was ligated in the wound. Patient was discharged May 31, 1865.—Private M. Murphy, Co. G, 5th Kentucky; wounded at Mission Ridge, November 25, 1863; admitted into hospital No. 4, Chattanooga; contused shell wound of left thigh. On January 1, 1864, gangrene appeared, which was checked, but reappeared on the 17th and 20th, and spread. On January 26th, the profunda gave way and was ligated by Surgeon A. H. Stephens, 6th Ohio. The patient died January 27, 1864.—Corporal T. Patterson, Co. D, 5th Michigan, aged 32 years, wounded at the Wilderness, May 5, 1864; admitted into the hospital at Chester, Pennsylvania; shot flesh wound of upper third of both thighs. On July 13th, bleeding occurred from a branch of the left profunda; one end of the artery was tied in the wound; haemorrhage recurred on July 16th, and death ensued July 20, 1864, from pyaemia. 1 Haywood (E. B.), Aneurism of Femoral Artery cured by Ligature, in Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 36. * Hamilton (F. H.), A Treatise on Military Surgery and Hygiene, 1865, p. 639. 'Lidbll (J. A.), On Gunshot Wounds of Arteries, Traumatic Hamorrhage and Traumatic Aneurism, in Am. Jour. Med. Set., 1864, Vol. XLVII, p. 110, and San. Comm. Mem., Vol. I, p. 119. SURG. Ill—7 50 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. There were also a few examples of ligations of large branches of the profunda involv- ing very difficult and troublesome dissections; instances in which the external circumflex, posterior perforating, and anastomotica arteries were tied are here briefly noted. In several cases it was impracticable to determine what particular branch was severed: Case 107.—Private S. Michaels, Co. E, 9th Maine, aged 35 years, wounded at Petersburg, June 2>, 1864. Surgeon J. J. Craven, U. S. V., reported his admission into the 2d division hospital of the Tenth Corp.s with a "gunshot wound of both thighs." Assistant Surgeon E. McClellan, U. S. A., reported from Hampton Hospital, Fort Monroe: "On July 30th, bleeding occurred from the descending branch of the external circumflex artery: six ounces of blood were lost. Assistant Surgeon E. Curtis, U. S. A., applied ligatures at both ends of the Weeding vessel in the wound—the injury was about the middle of the thigh. On August 4th, a haemorrhage occurred from the femoral artery of the left thigh of about one pint; it was arrested by pressure, hut the patient died from exhaustion a short time after.'' Cask 108.—Private Theodore B. Benedict, Co. D, 7th Connecticut, age 32 years, wounded at Drury's Bluff, May 10, 1864. Assistant Surgeon E. McClellan reported from Hampton Hospital, Fort Monroe: "Gunshot wound of right thigh, flesh. On June 9th, haemorrhage to the extent of eight ounces occurred from one of the posterior perforating arteries. The bleeding vessel was ligated in the wound at one end. The haemorrhage did not recur." On July 25th, the patient was sent north. He was subsequently treated in McDougall Hospital, New York, and Knight Hospital, New Haven. Surgeon P. A. Jewitt, II. S.V., reported from the latter hospital that the patient died May 3, 1865, of pneumonia. Case 109.—Corporal Thomas Haglemeyer, Co. D, 41st Ohio, aged 49 years, was wounded at Nashville, December 16, 1884. Surgeon C. N. Hoagland, 71st Ohio, reported from the 3d division, Fourth Corps: "Gunshot wound of hip; simple dressings." Surgeon J. E. Herhst, U. S. V., reported that the patient was admitted into hospital No. 2, Nashville, December 22, 1864, with a "gunshot wound of the upper third of the right thigh. Wound gangrenous from Scarpa's triangle to the popliteal space. December 29th, separation of the slough caused haemorrhage from the superior perforating and anastomotica arteries—oozing surface. The patient was much exhausted from repeated haemorrhage—blood defibrinated. Acting Assistant Surgeon S. Blackwood applied proximal ligatures to the bleeding arteries in the wound and lint to the oozing surface. Simple dressings were applied, and iron and ale ordered. The patient died January 15, 1864." Ligations of the Popliteal Artery.—Of seventeen cases of ligation of the popliteal for shot flesh wounds of the leg, thirteen were fatal, or 76.5 per cent. Five patients succumbed after amputation of the thigh following ligation of the popliteal. The series is enumerated in Table IV, and a case is detailed: Table IV. Summary of Seventeen Cases of Ligation of the Popliteal Artery for Hcemorrhage from Shot Injuries unattended by Fractures. No. Name, Military Description, and Age. Dates. Injury, Operator, and Result. No. Name, Military Description, and Age. Dates. Injury, Operator, and Result. 1 o 3 4 5 6 7 8 9 Dittus, W., Pt., H, 42d Illinois, age 27. Elliot, J. E., Corp'l, E, 2d Pennsylvania Cav-alry, age 24. Fletcher, J. M., Corp'l, C, 39th Massachusetts, age 28. Gray, Yv\, Pt., E, 18th Infantry, age 20. Kausche, Gr.,Pt..D. 20th New York, age 35. Kraher. J. P., Pt., D, 6th New York Heavy Artillery, age 35. Leonard, J., Pt., L, 7th New York Heavy Ar-tillery, age 21. Lynch, J.. Corp'l, K, "lluth X. York, age 34. Selden, B., Pt., 11, 9th Virginia Cav., age 23. May 14, June 6, 1864. April 1, 29, '63. June 18, Aug. 14, 1864. Dec. 31, '62, Jan. 12, '63. Sept. 17, 17, '62. June 1, July 24, 1864. Mav 30, July 3, 1864. May 10, 17, '64. July 8, 27, '63. Right popliteal region; sloughing; both ends of popliteal art'ry tied in wound, by Ass't Surg. B. E. Fryer, U. S. A. Disch'd Aug. 16, 1865; pensioned. In'r side left leg; poplit'l art. lig., lower portion; haem. recurred; thigh amp. May 5th. Died from shock two hours after operation. Flesh wound up. third right leg; sloughing; both ends artery tied in wound, by A. A. Surg. J. M. McGrath. Died Aug. 24, 1864, typhoid fever. Near popliteal region ; both ends artery tied in wound. Died Jan. 22, 1863, gangrene. Laceration of right poplit'l space; up. end art. tied in wound; haem. recurred. Discli'd Aug. 13, '63. Left thigh near knee; gang.; one end of artery tied in wound. Disch'd Mar. 15, '65; pensioned. Left leg; art. tiedbeh. knee; hasm. recur'd; thigh amp. iust above knee July 8. Died July 23,'64. Left popliteal region : lig. poplit'l, by Ass't Surg. C. A. McCall, U. S. A. Died May 23,'64. pyasmia. Left post. tib. art. wounded ; pop-liteal tied, by A. A. Surg. W.S. Adams. Died Aug. 2,'C3, pyaem. 10 11 12 13 14 15 1C 17 Smith, A. M., Serg't, F, 20th Maine. Smith, F.,, Pt., B, 1st Mass. Heavy Artillery. Smith, P. D.,Pt., C,8th Iowa Cavalry, age 20. Taber, J. A., Serg't, E, 5th Michigan, age 23. Vann, D., Pt., B. 8th New York Artillery, age 18. WTalker, M., col'd serv-ant, K, 58th Penn.. age 13. lWi<:k.J.C.,Pt.,C. 155th Pennsylvania, age 22. Wild, C. B.. Corp'l, E, 114th New York. May 15, 15, '64. May 23, June 29, 1864. Mar. 19, May 6, 1864. Mar. 31, April 12, 1865. June 3, 16, '64. June 3, 26., '64. Mar. 25, Mav 23, 1865. Sept. 19, Oct. 1, 1864. Wound of popliteal artery; art'y tied. Died May 22, 1864. Rt. and l'ftthighs; hasm.from post. tib.: rt. post. tib. lig. in continu-ity; hasm. recurred; poplit'l lig. Died June 29, 1864. Right ankle ; gang.; haem. from post. tib. art'y; poplit'l art'y lig. in continuity, by A. A. Surg. D. McLean. Discli'd Mar. 21,1865. Right leg; poplit'l art'y lig. in contin'ty, by Surg. J. C. McKee, U.S.A. Died April, 18.'65, haem. Left poplit'l art y injured; art'y lig., by Surg. it. B. Bontecou, U. S. V.; haem. recurred; new lig. applied June 20; same day amp. thigh. Died June 22,1864, gangrene. Right poplit'l art'y injured; vessel tied above bleeding point, by Surg. R. B. Bontecou. U. S. V. Died July 3,'64, diarrhoea. [See Case 107.] Both thighs; left poplit'lart'y tied above and below, by Ass't Surg. A. Delany, U. S. V.; June 14, amp. thigh. Died June 20, '65. Rightthigh thro' poplit'l space; lig. of poplit'l; haem. recurred; Oct. 12. amp. thigh. Died Oct. 13, 1864, of exhaustion. 1 This is probably the case referred to by Prof. A. C POST, in the Addendum to Section I of the Surg. Mem. of the War of the Rebellion, pub. by the U. S. San. Comm., 1870, Vol. I, p. 262. sect. I.] LIGATIONS AFTER SHOT FLESH WOUNDS. 51 Case 110.—M. Walker, a colored servant of the 58th Pennsylvania Volunteers, aged 13 years, was wounded at Cold Harbor, June ?>, 1864, by a minid ball, which entered on the inner side of the lower third of the right thigh, passed through the popliteal space, injuring the popliteal artery, and making its exit latterly. Twelve days after the reception of the injury he was admitted 1o Harewood Hospital, Washington. Haemorrhage to the amount of from three to five ounces took place on June 25th, and was controlled by pressure. On the following day haemorrhage recurred, and the popliteal artery was ligated by Surgeon li. B. Bontecou, U. !S. V., by enlarging the wound of entrance, the patient being under the influence of sulphuric ether. The leg was placed in Smith's anterior splint with a fenestra opposite the wound to facilitate dressing, and a supporting treatment was ordered. The patient exhibited typhoid symptoms with very profuse diarrhoea until death, which occurred July 3, 1884. An autopsy showed that the coats of the artery had been injured by the ball, causing sloughing and the subsequent haemorrhage. The history was reported by the operator. Ligations of the Posterior Tibial Artery separately.—In a series of seventeen liga- tions of the posterior tibial artery for shot wounds of the soft parts of the leg and foot, thirteen recovered, or 76.5 per cent. Three patients submitted to consecutive amputation, of whom one died. The cases are enumerated in Table V: Table V. Summary of Seventeen Cases of Ligation of the Posterior Tibial Artery for Haemorrhage from Shot Injuries unattended by Fractures. NO. Name, military Description, and Age. Dates. Injury, Operator, and Result. NO. name, military Description, and Age. Dates. Injury, Operator, and Result. 1 o 3 4 5 6 7 8 Ball, J. D., Corp'l, A, 125th New York, age 24. Brown, W. H., Bugler, 5th New Jersey Batte-ry, age 25. Bvcker, J. F., Pt., B, 1st Confederate, age 21. Dow, J. A. Pt.,E, 136th New York, age 20. Emery. R.. Pt., D, 5th Vermont, age 33. Klannagan, H. A., Ser-geant, H, 16th Penn. Cav., age 25. Gilmore, M., Pt., B, 96th Illinois, age 22. Hagey, J. D.. Pt., I, 138th Pennsylvania, age 24. May 12, 28t'64. May 24, June 10, 1864. April 6, 16, '62. June 20, 20, '64. May 5, Aug. 4, 1864. April 7, May 14, 1865. Aug. 3, 3, p64. April 2, May 8, 1865. Right post. tib. artery wounded; artery tied in wound, by Ass't Surg. A. Ingram, U. S. A. Dis-charged Dec. 29, '64 ; pens'd. Left leg; posterior tibial art. tied. Died July 7, 1064, pyaemia. Right leg; posterior tibial artery tied. Becovered. Right posterior tibial art. severed; vessel tied, by Surgeon I. N. Himes, 73d Ohio. Disch'd June 13, 1865; pensioned. Left leg; gang.; ends of art'y tied in wound, bv A. A. Surg. J. B. Crandall. D"isch'd Dec. 16, '64; pens'd; Aug. 28, '65, amp, leg. Left posterior tib. art'y wounded; vessel tied at its middle third. Died June 15, 1865, erysipelas. Left leg, involving posterior tib. artery ; vessel tied, by Surgeon S. H. Kersey, 36th Indiana. Disch'd Jan. 10, 1865; pens'd. Left posterior tibial art. opened; one end of artery tied in wound, by A. A. Surg. H. M. Bellows; sloughing; May 19, amp. leg, by. A. A. Surg. H. A. Drane. Dis-charged July 26, 1865; pens'd. 9 10 11 12 13 14 15 16 17 Ingalls, H. B., Pt., L, 1st Maine Cavalry, age 25. Maran, M., Pt., A, 2d New Jersey Cavalry, age 20. Oaklev, C. N., Pt., A, 85th New York, age 32. Rigbey, T., Pt., C, 9th N. Hampshire, age 23. 1 Ritter, D. T., Corp'l, F, 208th Pennsylvania, age 19. Sherdan, J., Pt., D, 68th Pennsylvania, age 31. Thompson, S., Pt., E, 4th N. Jersey, age 23. Trowbridge, D. A,, Cor-poral, L, 5th Illinois Cavalry. Wright, E., Pt., F, 119th Pennsylvania, age 18. Mar. 31, April 9, 1865. Feb. 11, 27, '64. March 8, 8, 1865. June 20, J'y3, '64. Mar. 25, April 7, 1865. July 3, 25, ,63. Sept. 22, Oct. 19, 1864. July 8, Sept. 23, 1863. May 5, 23, '64. Right leg; post. tib. artery lig., by Surg. E. Griswold, U. S. V. Disch'd Aug. 12,1865; pens'd. Right leg; gang.; posterior tibial art. ligated on ulcerated surface, by A. A. Surgeon S. S. Jessop. Disch'd Oct. 21, 1805; pens'd. Left leg; lig. post. tib. and pero-neal arteries. Died Mar. 23, '65. Left leg; post. tib. arterv tied at wound. Furl'd Aug. 11, 1864. Left post. tib. art. wounded; both ends of vessel ligated, by Surg. G. L. Pancoast, U. S. V. Dis-charged June 27, 1865; pens'd. Right leg; posterior tibial artery tied at both ends. Discharged Feb. 6. 1865; pensioned. Right leg; both ends of posterior tibial artery ligated in wound', bv A. A.'Surg. J. W. Kerr. Duty March 30, 1865. Right leg; artery ligated in wound. Disch'd Nov. 17, 1863. Ball cutting right post, tibial art.; gang.; art. tied in wound, by Surg. E.Bentley, U. S. V.; May 25, haem. recur'd; leg amp. Died May 28, '64, asthenia and pysem. Legations of the Anterior Tibial Artery.—Of ten cases of ligation in which the anterior tibial was separately tied, seven were successful, one after consecutive amputation. The cases are here briefly noted: Cases 111-120.—Captain C. C. Brewster, Co. D, 10th Connecticut, aged 45 years; wounded at Bermuda Hundred, May 16,1864; shot flesh wound of left leg. Admitted into Chesapeake Hospital, Fort Monroe, May 21st. Bleeding from the anterior tibial artery to the amount of eight ounces occurred. The vessel was ligated in the wound at the cardial end. Hajmorrhage did not recur. Discharged September 19, 1864, and pensioned. Examiner G. C. Jarvis, of Hartford, reported, August 24, 1869: "The wound is now an open, deep ulcer; occasionally pieces of bone come out from some part of the sore." Pensioner died June 17, 1873, of phthisis pulmonalis.—Private W. Brommel, Co. E, loth New York Artillery, aged 30 years; wounded at Boydton Plank Eoad, March 31, 1865; shot wound of left leg, lower third. Admitted into Columbian Hospital, Washington. Haemorrhage from anterior tibial artery; vessel ligated by Acting Assistant Surgeon S. W. Briggs. Died May 2, 1865, from exhaustion from loss of blood.—Corporal T. Condon, Co. C, 2d New York Artillery, aged 21 years; wounded at Deep Bottom, August 16, 1864 ; shot flesh wound of the middle third of the right leg; the ball entered the posterior portion of the leg and made its exit at a corresponding point anteriorly. Admitted into Satterlee Hospital, Philadelphia. Haemorrhage. August 26th, Ligation of anterior tibial artery above and below bleeding orifice by Acting Assistant Surgeon W. F. Atlee. Collateral circulation re-established in twenty-four hours. Discharged July 26, 1865, and pensioned. The New York Examining Board reported, March 4, 1876: "There is a cicatrix three and a half inches in length on anterior surface of right leg; the ball emerged through 1 The case numbered 13 in Table V is detailed by Professor A. C. Post in the Surg. Memoirs of the U. S. San. Comm., Surgical Vol. I, p. 262. 52 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. the calf. Both cicatrices are adherent and interfere with locomotion and the strength of the limb.'—Sergeant M. C. Glass, Co. F, 16th Michigan, aged 24 years; wounded at Hatcher's Run, February 7, 1865; shot wound of right anterior tibial artery. Admitted into Jarvis Hospital, Baltimore. Ulceration and haemorrhage; six ounces of blood lost. Ligation of anterior tibial artery in continuity, February 20, 1865. Died February 28,1865, of hemorrhage.— Private J. L. Renshaw, Co. H, 191st Pennsyl- vania, aged 28; wounded at Petersburg, June 24, 1864; shot flesh wound of left leg by a conoidal ball; sloughing and haemorrhage from anterior tibial artery to extent of eight ounces. Ligation of artery above and beloAv wound. The patient recovered, and was discharged May 18, 1865.—Private S. Riley, Co. H, 92d New York, aged 24; wounded at Cold Harbor, Ji me 1, 1864; conoidal ball passed through the integument of the left leg one inch below the knee. June 25th, sloughing and erye:p- elas. July 8th, recurrent haemorrhage to the extent of six ounces from the anterior tibial artery. The artery was tied in the wound. The patient was discharged February 9, 1865, and pensioned. Examiner H. O. Hitchcock, of Kalamazoo, reported, June 8, 1867: " Ball passed below the patella and under the ligament. The wound was followed by gangrene and large sloughing, and now there is an extensive cicatrix, causing lameness and great weakness of the knee." Examiner J. A. Brow •, of Detroit, reported, September 28, 1869 : "Gunshot wound of left knee, the ball striking the inner condyle of the tibia and the patella, causing weakness and impaired motion of the knee, mostly from contraction of the cicatrix." Examiner D. F. Wooley, of Big Rapids, reported, April 1, 1875: " Ball entered at upper and inner third of the tibia, passing directly in front and under the patella and out, severing the attachment of the lower end of the patella and fracturing the upper end of the tibia; resulting in loss of part of upper portion of the tibia and weakening of knee joint to a serious extent, with slight adhesions of the muscles; on the whole seriously impeding locomotion and requiring care to maintain a standing position upon it." The pensioner was paid March 4, 1876.—Corporal I. Sampson, Co. F, 1st Massachusetts Cavalry, aged 35, was wounded during Sheridan's raid, May 11, 1864; shot wound of right leg, middle third, outside. Admitted into Hammond Hospital, Point Lookout. Gangrenous sloughing set in, destroying the coats of the anterior tibial artery. June 28th, haemorrhage to the extent of four ounces from the anterior tibial artery. Both ends of artery tied in the wound by Acting Assistant Surgeon T. Liebold. The bleeding did not recur. The patient recovered, and was mustered out October 16, 1864. Examiner W. H. Page, of Boston, reported, April 11,1865: " Ball struck about the middle of the left leg, fracturing and splintering the tibia, a large part of which, at seat of injury, has been removed, and there is a deep cicatrix three inches by one and a half. The whole leg is much swollen and oedematous, and there is probably more dead bone to be removed." The Boston Examining Board reported, Decem- ber 2, 1874 : "Ball entered middle third of leg anteriorly and passed directly through. The tibia was shattered, and necrosis has resulted therefrom. The leg is weak and the wound is still open, an ulcer at the time of examination existing the size of a five-cent piece, surrounded by an areola four inches in diameter and somewhat eczematous. His leg is painful and weak upon long standing, and this interferes with the performance of manual labor." In September, 1875, the Board reported: "Large adherent cicatrix, inflamed and very tender; anchylosis of ankle." Pensioner paid June 4, 1876.—Private W. Sauls- bury, Co. K, 39th U. S. C. T., aged 36; wounded at Petersburg, July 30, 1864; flesh wound of lower third of right leg. He was admitted into Summit House Hospital, Philadelphia. Secondary haemorrhage ; ligation of anterior tibial artery January 19, 1865. Amputation of right leg at lower third by double-flap method. Transferred to hospital at Beverly, and discharged May 26, 1865. He died July 16, 1871.—Private J. Skiffington, Co. I, 2d New York Heavy Artillery, aged 28; wounded at Petersburg, June 16, 1864; flesh wound of lower third, right leg. Admitted into Satterlee Hospital, Philadelphia; wound sloughing. Acting Assistant Surgeon W. F. Atlee ligated both ends of the anterior tibial artery in the wound, on account of haemorrhage, July 28, 1864. The patient died August 29, 1864, of pyaemia.—Private L. Weaver, Co. G, 4th Virginia, aged 23; wounded at Gettysburg, July 3, 1863. Admitted into Twelfth Corps Hospital. Shot flesh wound of both legs and face. July 13th, bleeding of eight ounces from the anterior tibial artery, which recurred on the 14th, sixteen ounces of blood being lost. The anterior tibial artery was tied above and below the point of division. The patient was paroled November 12, 1863. Ligations of the Anterior and Posterior Tibial Arteries.—There were two instances in which the posterior and anterior tibial arteries were conjointly tied for shot flesh wounds: Cases 121-122.—Private J. Hoar, Co. G, 144th New York, aged 22 years, wounded at White Plains, July 24, 1863. Shot wound of right foot; admitted into Douglas Hospital, Washington; haemorrhage to the extent of six ounces occurred from the metatarsal artery on August 1st. Assistant Surgeon W. Thomson, U. S. A., ligated the anterior tibial artery in the continuity at the instep and the posterior tibial behind the malleolus. The wounds healed well, and the patient was returned to duty from Central Park Hospital, New York, April 11, 1864. He is not a pensioner.—Private J. Kercher, Co. D, 7th Michigan Cavalry, wounded at Gettysburg, July 2,1863. Shot wound of right leg and of anterior and posterior tibial arteries; admitted into McDougall Hospital, New York Harbor. July 29th, ligation of anterior and posterior tibial arteries. August 10th haemorrhage, amounting to thirty-two ounces of blood. Died August 10, 1863. Ligation of Veins.—Six cases in which the femoral vein was tied simultaneously with the artery are noted on page 38. Specimens from two of the cases are shown in Figures 15 and 19. A case of ligation of the saphenous vein is detailed: Case 123.—Private A. Kendig, Co. B, 97th Pennsylvania, aged 31 years, wounded at Bermuda Hundred, May 18, 1864. Assistant Surgeon E. McClellan, U. S.. A., reported from Hampton Hospital, Fort Monroe: "Gunshot wound of left thigh, inner surface, upper third; the ball entered near the apex of Scarpa's space, passed through the adductor longus muscle, and made its exit over the upper third. Gracilis muscle wounded; phagedaena. On May 24th, haemorrhage to the extent of six ounces occurred from the saphenous vein. Both extremities of the vein were ligated in the wound. The haemorrhage did not recur, but the patient sank and died of exhaustion June 4, 1864." Amputations following shot flesh wounds will next be considered. LJ Z u rr o z < CD o I (A r- o U U. u. u .1 \f>l(fafru .'•.■ ,,,- - r,M,, ,■ Vi 'i Hf x CD Z < o r .rf'iCfl SECT. I.] AMPUTATIONS AFTER SHOT FLESH WOUNDS. 53 Amputations in the Lower Limbs after Shot Flesh Wounds.—Two hundred and one cases were reported of amputations in the lower extremity for shot wounds involving only the soft parts, comprising one hundred and thirty-one amputations in the thigh, six disarticulations at the knee, sixty-three amputations at the leg, and one of the toes. Amputations in the Thigh.—In the hundred and thirty-one cases of this series, ninety- four or 71.7 per cent, were fatal. The cases are enumerated in Table VI. Ten of the operations were primary, with only two recoveries. Fifty-seven intermediary operations, with forty-eight deaths, gave a mortality rate of 84.2 per cent.; sixty-four secondary operations, with thirty-eight deaths, had a death-rate of 59.4 per cent. The amputations were necessitated for the most part by complications of consecutive haemorrhage, gangrene, or secondary disease of the bone or joints, and in some instances were resorted to after ligations, removals of sequestra, or other interference had been unavailingly employed: Case 124.—Private H. Root, Co. B, 104th New York, aged 26 years, was wounded at Petersburg, June 22, 1864, and admitted to the field hospital of the 3d division, Fifth Corps. Surgeon L. W. Read, U. S. V., noted, "buckshot flesh wound of right leg, slight." On June 30th, the patient entered the Harewood Hospital, Washington, whence Surgeon R. B. Bontecou, U. S. V., contributed the specimen (Fig. 21), with the following brief history: "Gunshot wound of right leg, middle third, injuring soft parts. On admission the constitutional state of the patient was very poor; condition of injured parts tolerably good, but wound very painful. The parts subsequently became gangrenous, with rapid sloughing of soft parts; about one half of the lower third, and three-fourths of the upper third, and all of the middle third of the tibia exposed and denuded of periosteum. The tibia became necrosed throughout its whole extent, and at this time the patient became jaundiced. On October 29th, about ten inches of necrosed bone was extracted by Acting Assistant Surgeon D. I. Evans. The general condition of the patient improved soon afterwards, under a supporting treatment throughout, and was doing tolerably well, parts improving, when transferred to hospital at Elmira, January 4, 1865." Two weeks after his transfer the patient obtained a furlough and proceeded to his home in Tioga County, New York, where his limb was subsequently amputated at the middle third of the thigh. Dr. S. Knapp, his attending physician, certified that "he found him suffering from a badly cared for and neglected wound," etc., and that " on February 28, 1865, it became necessary to ampu- tate the leg," which operation he performed, being assisted by Dr. E. Daniels. About two months afterwards the patient returned to the hospital, and on July 21, 1865, he was discharged from service and pensioned. He died July 25, 1870, of consumption, resulting from the wound and its effects, more than five years after the ampu- tation. The parts removed by the amputation at mid-thigh by Dr. Knapp were not transmitted to the Museum; but the large sequestrum comprising the greater part of the diaphysis of the tibia is represented in the wood-cut pig. 21.—Se- (Fig. 21), and, as mounted, is nine inches in length (see Catalogue of the Surgical Section of the Army Medical rieift"tibia Muesum, Washington, 1866, p. 405). Spec. 3601. In a grave case of hospital gangrene following a shot wound at the ankle, the lamented artist, Hospital Steward E. Stauch, made a colored drawing of the appearances after the sloughing surfaces had cleaned off under the applications of fermented cataplasms. The drawing is copied in the chromolithograph opposite, Plate XXVII. Case 125.—Corporal C. H. Dudley, 11th Indiana Battery, received at Chicamauga, September 20, 1863, a wound of the right foot, a conoidal ball entering the under portion just below ankle joint. He was taken prisoner, conveyed to Richmond, and on October 29, 1863, was admitted to Division No. 1 hospital, Annapolis, from the steamer New York. The wound had sloughed extensively. On October 30th and 31st there was haemorrhages from the dorsalis pedal artery, which was promptly arrested by the use of styptics. Soon after admission a phagedenic ulcer made its appearance on the posterior face of the right leg, immediately below knee joint, and an examination, made November 19, 1863, revealed a deeply excavated sloughing wound. Yeast poultices were applied to the sloughing tissues, and when the gangrenous masses had cleaned off a colored drawing was made of the parts by Hospital Steward E. Stauch. November 23d, haemorrhage amounting to eight ounces occurred from this wound, and was restrained by finger compression on the femoral artery; tourniquet was loosely applied on limb, and stimulating draughts given. On November 24th, Assistant Surgeon W. S. Ely, U. S. V., who had charge of the case, reports that the "wound from which the haemorrhage proceeded was thoroughly examined and the diseased tissues found more extensive than had been supposed; the finger could be passed beneath superficial border of ulcer to a considerable extent, and the popliteal artery was found to be divided by the extent of the ulcerative process, and the ligamentous structures of the knee joint were found extensively destroyed. Amputation was determined on as the only rational treatment. It was imme- diately performed, after the circular method, directly above the knee joint, by Surgeon T. A. McParlin, U. S. A., assisted by Surgeon B. A. Vanderkieft, U. S. V. Patient bore the operation well, and the tissues at seat of amputation appeared healthy. No sutures were used to approximate the flaps, wet straps being the only retentive treatment employed." The case progressed favorably until December 2d. Acting Assistant Surgeon C. Hayes kept the further record of the case. On December 8, 1863, haemorrhage, amounting to eight ounces, occurred from the stump. He failed rapidly after this, and died December 11, 1863. Surgical Series of Drawings, Nos. 59, 60, S. G. O., Plate XXVII. 54 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Table VI. Numerical Statement of One Hundred and Thirty-one Amputations in the Thigh for Shot Injury unattended by Fracture. Ko. Name, Military Description, and Age. Atwood, H.,Pt.,K, 14th New Hampshire. Baker, J., Pt., A, 11th Connecticut, age 32. Barkeloo, J., Pt., M. 2d Ohio Cavalry, age 28. Barnum, C. F., Pt., E, 187th Penn., age 30. Barry, E., Pt., A, S2d I'enn., age 24. Blaker, J. P.,Pt., E, 15th Infantry, age 18. Brastcd.A.A., Serg't, H, 90th New York, age 22. Bell. J. C, Pt., E, 34th Iowa, age 23. Belt, W. II. II., Pt., A. 10th Ohio Cavalry, age 21, *' B Bishop, J., Pt., M, 22d New York Cavalry, acre 20. Black. J. M., Corp'l, D, 35th Ohio, age 21. Blaisdell, H., Pt., II, 58th Pennsylvania. Boies, J. A.. Lieut., II, 13th Infantry, age 22. Brockman, II., Pt., I, Gth Kentucky. lBurke, W.. Pt., B, 24th Alabama. Burroughs, II. C, C, 7th C. S. Cavalry. Butler, H., Pt., H. 1st New York Artillery, age 21. Cameron, J., Serg't, K, 31st Maine, age 27. ' ■:*,-)■;]', Ii. A., Pt.. F, 3d Alabama, age 19. Dates. 20 Ca«e. E. F., Pt.. G, 13th Michigan. 21 Chapman, C. II.. Serg't, E. 13th New Hamp- shire, age 26. 22 | Chapman. J. S.. Pt., E. I 4ill Maine, age 33. 23 Cbawg... M. W., Pt.. H, 40th New York, age 21. Sept. 19, 23, '64. June 15, 26, 'G4. July 19. 26," '03. June 18. Sept. 7, 1864. June 3, Aug. 11, 1804. Aug. 7, Sept. 10, 1804. June 1, Nov. 7, 1864. April 6. 18, '65. Feb. 10, April 24, 18G3. Aug. 25, Sept. 6, 1864. July 20, Aug. 15, 1864. April 20, June 28, 1803. May 22, June 18, 1863. April 0. June 20. 1800. Sept. 19, 23, '63. April 1, May 15, 1865. June 1, Aug. 5, 1864. June 20, '64, July 5, '66. July 3, Nov. 29, 1863. Sept, 19, 26, '03. Sept, 30, '64. Apr. 7, '65. June 18, July 5, 1864. Mav 13, 17," '64. L\JLRY, OrERATOR, AND Result. Right fem. art. injured; circulat'n destroyed; gang.; circ. amp. at low. third thigh, by A. Surg.W. Fritz, 12th Mo. Died Sept. 30,'04. Sheath of right fem. art. wounded; haem. from branch of profunda; flap amp. thigh, bv A. A. Surg. J. S. Hill. Died June 21), 1804. Right popliteal artery severed; fem. art. ligated; flap amp. thigh at up. third. Discli'd Mar. 17,'05. Left leg; amp.bel. tuberc. of tibia; haem.; amp. thigh, circ, lo.third, bv A. A. Surg. J. Morris. Died Oct. 13, '64. Spec.3132,A.M. M. Left leg; flap amp. at inid. third, by Dr. J. Shields. Discharged Sept. 2, 1865. Left leg ; gang.; ant. post., lower third thigh, by A. A. Surg. It. W. Forrest. Died Sept.18,1804, exhaustion. Right knee joint; gang.; joint opened; circ, low. third thigh, by A. A. Surg. A. J. Smith. Died Nov. 30, 1804, exhaustion. Left posterior tibial artery cut by ball; gang.; haem.; lig. of fem. artery; amp. at low. third thigh, by A. A. Surg. L. M. Cowan. Died April 23, '05, exhaustion. Shot perforation left thigh ; ery- sipelas; flap amp. at mid. third, bv Surg. J. It. McClurg, U.S.V. D*isch'd Sept. 2, 1803. Right leg, destroying post, tibial artery, vein, and nerve: ha?m.; thigh amp. at low. third, by A. A. Surg. W. J. McIIenc'u. Died Sept. 15, 1804, pyaemia. Right lea;: gang.: flap amp. thigh, low. third, by A. A. Surg. J. E. Crowe. Died Aug. 18,'04, exh'n. Right leg near knee; no fracture; thigh amp. at middle third, by Surg. J. F. Gallo-pe. 17th Mass. Died July 10, 1803. Left knee,by spent shot; pyaemia; amp. of thigh at tipper third. Died June 28, 1803. Right femoral artery cut: double flap amp. thigh. Disch'd Aug. 9, 1803. ----thigh; gangrene: thigh amp. Died Sept 23. 1863. Poplit 1 space, r'tleg; gang.; circ. amp. thigh, by Surg. W. Hayes, U.S.V. Died"May 17, '05, gang. Left leg just below poplit'l space; gang; amp. thigh, bv A. A.Surg. W. C. Way. DicdAug. 0. '04. Right thigh ; ch. arthritis: double flap, thigh, by Ass't Surg. H. E. Brown, U. S. A. Recovery. Right leg; doub. flap amp. thigh, by A. A. Surg. J. E. Steele; haemorrhage: fem. art' ry ligated. Died Feb. 17, 1864, pyaemia. Left fem. artery severed; gang.; Sept. 24. amp. leg four inches below knee; 20th. thigh amp. at upper third. Died Sept. 27, '63. Right thigh: gang., destroying profunda art'y; haem.; circ amp. up. third, by Surg.R. LP. Good- win. Died live hours after open. Left knee; amp. post. flap, thigh. by Surg. E. Bentley, U. S. V. Died July 6, 1864, exhaustion. Right leg; gang.; haem.; amp. at low. third, by Asst. Surg. C. A. McCall, U. S. A. Died May 19, 1864, pyaemia. 38 Name, Military Description, and Age Cheseltine, W. C, Pt., C, 1st Maryland Cav- alry, age 22. Christ, J., Corp'l, M., 198th Penn., age 27. Cook, L., Serg't, C, 26th Ohio, age 25. Cooper, T., Pt., C, 4th Penn. Reserves, age 18. Curtis, J. A., Pt., D, 101st Ohio, age 25. Curtis, G., Pt., A, 1st Colored Troops, age 23. Danielson, H. A., Pt., G, 7th Minnesota, age 23. Darling, 8. G., Pt., D, 32d Maine, age 19. Decker, E., Pt., H, 81st Ohio. Deinlein, D., Pt,, C. 5th Ohio, age 43. Delamater, M., Corp'l, G. 7th Mich. Cavalry, age 20. Deniker, D. H„ Pt., E, 2d Maryland, age 20. Dodge, W. M., Serg't, F, 137th New York, age 45. Doyle, L., Pt., K, 8th Maine, age 34. Drilling, H., Pt,,C, 124th New York, age 30. Dudley, C. H., Corp'l, 11th Indiana Battery. 2Dutcher, J.H., Pt., M, 2d New York Heavy Artillery. Dyer, G. A., Serg't, G, 6th Maine, age 21. Edwards. C. S., Pt., G, 57th Indiana. Elliot, J., Corp'l, E, 2d Pennsylvania Cavalry, age 24. Farder, J., Pt.. 1st N. Carolina Cavalry, age 25. Feary, G. M., Pt., B, 108th New York. May 27, June 4, 1864. Mar. 25, April 7, 1805. June 18, Aug. 10, 1864. June 22, '64, May 3, '76. June 27, Aug. 7, 1864. Oct 27, Nov. 19, 1864. Dec. 16, '64, Feb. 11, '65. May 12, 26, '64. July 22, 1864. May 25, July 10, 1864. May 28, Julv 12, 1864. Sept. 26, 28, '64. July 2, 10, '63. May 20, June 6, 1864. Oct. 26, Ncfv. 1, 1864. Sept, 20, Nov. 24, 1863. May 31, June 5, 1864. Nov. 7, '63, Feb. 19, '64. Dec. 31, '62, May 26, '63. April 2, May 5, 1863. June 20, Sept. 1, 1864. Julv 2, 14, r63. Injury, Operator, and Result. Right thigh, severing fem. vein; gang.; circ. amp. thigh, by Asst. Surg. W. F. Norris, U. S. A. Died June 9, 1804, exhaustion. Rightthigh ; circ amp. thigh, by A.A. Surg. J. II. (iillman. Died April 25, 1865. pyaemia. Right thigh. Aug. 9, haem.; amp. post, flap, mid. third, by A. A. Surg. E. H. Sands. Died Aug. 11, 1804. Left thigh and leg ; contraction of muscles; Dec. 31, hamstring ten- dons divided. Disch'd June 23, '65; leg deform'd and paralyz'd; amp. above knee, by Surg. O. Pemberton, F. R. C. S., of Birm- ingham, England. Rightthigh; gang.; flaps of skin, cir. of muscles, by Surg. S. E. Fuller, U.S.V. Died Aug. 15, 1864, pyaemia. Shell contusion of right thigh and leg; gang.; amp. thigh, by Asst. Surg. J. H. Frnntz, V. S. A. Died Jan. 13, 1865, pyaemia. Left thigh; gang.: amp. thigh, by A. A. Surg. S. W. Thompson. bisch'd August 16, 1865. Right fem. artery severed; artery tied on field; gang.; thigh amp. by Surg. R. B. Bontecou.U.S.V. Died May 26, '04, haemorrhage. ---fem. art. wounded; primary amputation of thigh. Died Aug. 3,1864. Right popliteal space, producing aneurism ; amp. thigh, by A. A. Surg. O. D. Norton. Died Aug. 1,1864, in low typhoid condition. Right thigh; gang.; haem.: July 10, femoral ligated ; amp. thigh, by Asst. Surg. II. M. Sprague, U.S.A. Died Aug 7, '64, py'mia. Right leg; thigh amp. at lower third, by A. A. Surgeon M. M. Townsend. Died Sept. 29, '64. Right leg; gang.; haem.; amp. thigh, by Surg. H. E. Goodman, 28th Penn. Died July 13, '63. Right thigh perforated; June 1, haem; fem. ligated; recurred; amp. thigh, by Asst. Surg. W. H.Gardner, U.S. A. Died June 6, 1864, exhaustion. Rightfem. vein andart'ry wound- ed; haem.; amp. thigh, by Surg. D. W. Bliss, U.S.V. Died Nov. 21, 1864, pyaemia. Right foot; gang., involving pop- liteal artery; haem.; amp. thigh, by Surg. T. A. McParlin.U.S.A. Died Dec. 11,'63, haem., debility. Left popliteal artery divided near end; gang.; thigh amp.,by Surg. J. A. Lidell, U. S.V. Died June 8, '64, exhaustion. Right thigh; amp. thigh,by Surg. D. W. Bliss, U. S. V. DischM April 19, '64. Spec. 2047, A.M.M. Left leg; amp. thigh, by A. A. Surgeon J. B. Burns. Discli'd Aug. 23, 1863. Left leg; haem.: April 29, popliteal artery ligated; haem. recurred; amp. thigh. Died May 5, 1863. from shock, 2 hours after amp. Right thigh and left leg; amp. left thigh, by Surg. H. L. W. Bur- ritt, U. S. V. Died Sept. 2, '64. Right thigh, severing fem. attery; haem.; gangrene; amp. of thigh. Died July 24, 1863. 1 FERRY (C>, Rrport of Wounded treated in Field Hospital of Hindman's Division, etc., in Confederate States Med. and Surg. Jour., 1864, Vol. p. 77. ' LIDELL (J. A.), Wounds of the Arteries, in Surg. Mem. of the War of the Rebellion, by the U. S. Sanitary Commission, 1870, Vol. I, p. 59. SECT. I.] AMPUTATIONS OF THE THIGH AFTER SHOT FLESH WOUNDS. 55 46 Name, Military Description, and Age. Fenton, C, Serg't, E, 1st Penn., age 25. Foss, A. J„ Pt., F, 13th N. Hampshire, age 21. Foust, J., Pt., —, North Carolina Artillery, age 37. Gardner. G. W.. Serg't, H, 12th Illinois Cav- alry, age 29. Goldsborough, II. J., Pt., B, 3lst Illinois. Gooding, H. P., Pt., H, 10th Michigan Cav'ry. Hasev,W. H. H., Serg't, E 20th Maine, age 23. Haskell, A. M., Corp'l, K, 12th Maine, age 23. Haynes, A., Major, 29th Virginia. 'Hembery, A. J., —, K, 4th Alabama. Hickey, J., Pt., C, 22d Massachusetts, age 19. Hogstead, F., Corp'l, A, 187th New York, age 24. Hopper, B., Pt,. F, 64th New York, age 28. Hubbach, H.. Corp'l, F, 68th New York, age 42. Hyatt, J. B., Pt., E, 7th Indiana Cavalry, age 18. Jenkins, W. H., Pt., C, 39th Illinois. Johnson, P., Pt., E, 2d Penn., age 27. Johnson, W., Pt.,G, 31st Alabama, age 22. Jones, J. T., Pt., H, 8th Wisconsin, age 21. Keep, M., Pt., E, 36th Massachusetts, age 83. Keller, B., Pt., E, 1st Mich. Cavalry, age 36. Kenyon. B. G.. Corp'l, II, 11th New Hamp. Kintnnr, S. L., Corp'l, A. 24th Iowa. 2Kogel, C, Pt., D, 15th New York H'vy Arty, age 39. Lane, D., Pt., K, 14th Ohio, age 34. Larkin, T., Pt., K, 4th Mass., age 18. May 6, 22, f64. April 27, M'y8,'03. Mar. 27, June 17, 1865. Oct. 11, 29, '03.. June 26, Deo. 16, 1863. Jan. 30, Feb. 27, 1865. Julv 1, 30, "'64. Oct. 19, Nov. 15, 1864. May —, 27. '64. Sept. 19, Oct. 1, 1863. July 2, Aug. 5, 1863. Feb. 7, 26, '65. May 12, June 16. 1864. Aug. 30, '62, Oct. 6, '65. July! Oct. 13, 1864. Mav 5, 1869. June 27, Oct. 19, 1864. June 15, J'yl,'04. Dec. 16, '64, Feb. 26, '65. May 19, June 4, 1864. May 11, Julv 2, 1864. Je.16,'64, Jan.3,'67. July 12, —, '63. May 30, June 6, 1864. June 14, Aug. 7, 1864. June 23, '63, June 15, '64. Injury, Operator, and Result. Left thigh, wound'g profunda art.; frequent haems.; mnp. thigh, by Surg. R. B. Bontecou, U. S. V. Died Slay 22, '64, exhaustion. Right leg; gang.; amp. thigh. Died May 8, 1863. Left knee, not involv'g joint; ex- tensive suppurat'n in vol v'g joint; amp. thigh, by A.A.Surg. J.Gil- man ; mem.; urtery lig.; July 10, pysemia. Died J'y 25, '6.5, exh'n. Right fem. artery injured; gang.; amp. thigh, by A. A. Surg. W. H. Ensign. Died Dec. 5, 1863, debility. Spec. 1760, A. M. M. Left knee; ulceration of articular surface of bone ; amp. thigh, by A. A. Surg. ,1. D. Davis. Died April 15, IH64. Left knee; extensive suppurat'n, joint disorg'zed ; flap, low. third, by A. A. Surg. T. W. Branch. Died March 4. 1865; pyaemia. Right leg; gang, and haein.; amp. thigh, by A. A. Surg. II. B. Ma- ben. Died Sept. 28, '64, exh'n. Right knee; amp. post, flap, junc. lower third, by A. A. Surg. W. Kempster. Nov. 21, haem.; lig. fem.; haem. 27th and 30th. Died Dec. 1, 1864, exhaustion. Right fem. art. injured: single flap amp. of thigh. Died May 30,'64. Lower portion popliteal space; haem. from poplit'l art,; amp. just above knee. Died end third day. Right leg.follow'dby trau. aneur. of ant. and post, tibial arteries; haem.; gang.; amp. thigh, by Surg, aw! Jones, U.S.V. Died Aug. 16,'63. Spec. 1698, A. M. M. Left leg; amp. thigh, by A. A. Surgeon R. Westerling. Died March 8, 1865. Left knee; destructive inflamma- tion in joint; amp. thigh, bv A. A. Surg. J. E. Dexter. Died June 21, 1864, pyaemia. Left thigh. Disch'd Nov. 20, '63. Contract'n of flex, of thigh, and atrophy: flap amp. thigh seven inches from body, by Dr. L. Bauer, of Brooklyn. Recovered. Leftpoplitenlart.ini.; gang.; amp. thigh, by Surg. J. G. Keenon, U.S. V.: gang, of stump and left long. DiedA'ig. 11.'64, pyaemia. Right thigh. Disch'd. May 18,'65, three large exostoses rem., bone scraped; Oct. 24, rem. large se- questrum; AIay5,'08, thigh amp. at base of trochanter, bv Surg. C. M. Clark, late 33th ill. Re- covered, Oct. 2, 1869. Right knee; sloughing; amp. thigh, bv A. A. Surg. W. P. Moon. Died Oct. 21, 1864. _ Left gastrocnemius ; amp. thigh. Died July 12, 1864, pyaemia. Left leg; gang.; amp. thigh. byA. A. Surg. C. F. Barnard. Trans- fer'd Sept. 20. '65, for musterout. Left popliteal space; knee joint ope'd by suppurat'n; amp. thigh, by Surg. D. P. Smith, II. S. V. Died Jane 0, 1864, pyaemia. Right thigh ; circ. amp. of thigh, bv Surgeon A. Heger. U. S. A. Died July 3, 1864, exhaustion. Left leg: amp. thigh, by Prof. A. H. Crosby. Disch'd Sept. 27. '6".. R't thigh : ainp , ';urg. J. L. Dick- ey, 47th Ind. Died July 16, '63. Right leg; gangrene: amp. thigh, by A. A. Surg. C. H. Osborne. Died June 16, 1864, pyaemia. Left knee; sloughing: amp. thigh, by Asst. Surgeon B. E. Fryer. Died Aug. 16, 1864, pyaemia. Left thigh and wrist. Disc'd Aug. 20, '63. Atrophyand exc. pain ; amp. at up. third thigh, by Dr. C. H. Stedman, Boston. Reo'd. Name, Military Description, and Age. Lauch, H., Pt., Brax- ton's Artillery, age 34. Lee, W. II., Corp'l, F, 32d Colored Troops, Leonard, J., Pt., L, 7th New York H'vy Art'y, age 21. Lloyd, R., Pt., B, 1st Kentucky. Lyon, II. J., Serg't, H, 40th Illinois, age 24. McCarthy,'D., Pt., C, 2d Mass., age 22. McClure,R.,Pt., L, 15th Kansas, age 18. McMahon, E., Lieut., D, 80th New York, age 21. Maher, L., Pt., C, 69th New York. Martin, J. H., Pt., E, 100th Pennsylvania. Martin, M., Pt,, H, 1st Artillery, age 24. 3McCreary, S.C.,Pt.,F, 100th Pennsylvania. Mather, H. G., Pt., H, 90th Penn., age 20. Mathers, W. D., Pt., I, 6th Vermont, age 28. Meyer, M., Pt., L, 15th New York Artillery, age 44. Miller, P., Pt., A, 64th Ohio, age 40. Moore, T., Pt., E, 51st Virginia, age 19. Moss, B. F., Corp'l, B, 101st Illinois, age 43. Nichols, M. S., Pt., G, 91st Ohio, age 23. Nobler, B„ Pt., F, 85th Illinois, age 21. 4 Nottingham, G.M.,Pt., I, 56th Ohio. 6 Page, A. C, Capt., D, 21st Virginia. Percel, J., Pt., —, 148th Pennsylvania. Pittee, R., Corp'l, F, 50th New York. Ports, I. A., Pt,, D, 27th Ohio. Price, G., Pt., C, 2d Delaware. Rayser.J.J., Pt,. B, 14th Penn. Cav., age 40. Dates. Sept. 19, 28, '64. Feb. 10. Mar. 14, 1865. May 30, July 8, 1864. Deo. 31, '62, Ap'l 4. '63. July 21, 28, '64. Aug. 9, Sept. 15, 1862. Jan. 21, 24,'64. Aug. 30, '62, Feb. 7,'63,Jul —, 1864. Sept. 17, Nov. 24, 1862. Mav 12, 12,"'64. June 24, Aug. 14, 1864. Sept. 1, 14. '62. June 17, July 20, 1864. Oct. 19, Nov. 13, 1864. Aug. 18, Oct. 6. 1864. Dec. 16, Jan. 22, 1865. Sept. 19, Nov. 14, 1864. July 25, Nov. 11, 1864. Sept. 19, Nov. 14, 1864. June 30. Aug. 4, 1864. Mav 1, 20, ''63. Sept, 16, 16, '62. Mav 3, 21,''63. Dec. 11, 11, '62. Oct. 3, 12, '62. Julv 2, 2 1863. Oct. 19, Nov. 8, 1864. Injury, Operator, and Result. Left thigh, severing fem. art. and vein; haem; amp. thigh, by Surg. G. M. Burditt, P. A. C. S. Died Sept. 28, shock oper'n and gang, Right thigh; exten. suppu n, knee joint inv.; circ, lower third, by Surg. A. H. Thurston, U. S. V. • Died March 14, 1865, irritative fever, shock. Left leg; July 3, haem.; ligation of posterior tibial artcrv; amp. thigh. Died July ^3, 1«64. Left thigh; amp. thigh at lower third. Disch'd Aug. 26, 1863. Left popliteal space; gang.; amp. of thigh, by Surg. E. J. Buck, 18th Wis. Disch'd April 26, '65. Right popliteal space; amp. right thigh, by A. A. Surg. T. B. Townsend. Disch'd June 17,'64. Right leg, severing ant. tibial art, and nerve ; mortification ; amp. thigh, by Surg.A.C. Van Duzen, U. S. V. Disch'd Nov. 14. 64. Left knee ; circ, lower third, by Asst, Surg. E. J. Marsh, U.S.A. Re-amp., by Prof. W. Parker. Recovery. Spec. 1054. Right knee; amp. post flap, up. third, by Surg. H. S. Ilewit, U. S. V.; necrosis. Disch'd April 12,1864. Spec. 754. Left leg, injuring saphenous vein ; gangrene : amp. thigh at lower third. Died May 18, '64. Left knee: circ, mid. third, by Surg. E. Bentley, U. S. V. To duty Dec. 9, 18o'. Right leg.perforat'gant. tib.art'y; amp. thigh. Disch'd Dec. 4, '62. Left leg; gang.; amp. thigh, by A. A. Surg. G. Badger. Died July 20, 1864. Left leg; gang, and haem.; amp. thigh, by A.A. Surg. F. F. Mur- dock. Died Dec. 16,'64. pyaemia. Left leg: ganc; amp. thigh, by A. A. Surg. J. P. Arthur. Died Oct. 7, '64. Spec. 3780, A. M. M. Left leg; gang.; thigh amp., by Surg. R. H. Gilbert. U. S. V. Died Feb. 9. '65, pyaemia. Right knee; abscess: circ, lower third, by Surg. B. M. Cromwell, C. S. A. Died Nov. 14, 1864. Left leg: gang.: amp. leg, by A. Surg.W.B.Trull,U.S.V Nov.9, diffused aneur. in poplit'l region; haems.: amp. thigh, by Dr.Trull; haems. from and ligation <,f fem. artery. Disch'd June 25,'65. Left leg; knee joint opened by ulceration: amp. thigh, by Asst. Surg. N. F. Graham. U. S. V. Died Dec. 7, '04. pyaemia. Right leg; sloughing and haem.; amp. thigh at lower third, by A. A. Surg. S. C. Ayres. Died Aug. 14. '64, anaemia. Left popliteal region secondarily involv'g popliteal artery: haem.; amp. thigh, bv A. A. Surg. L. Dyer. Died May 29, '63. Post. tib. art. cut by ball: incip. mort.: amp. thigh, by R. T.Cole- man, chief surg. Gen. Stonewall Jackson's Corps. Recovered. Thigh : aneurism : amp. up. third, bv Surg. C. S. Wood; 66th New York. Died May 21, 1863. Popliteal space, destroying popli- teal vessels and nerves; haem.; amp. thigh. Died Dec. 12, 62. Perfor. right poplit'l space: gang.; amp. thigh. Disch'd April 7, '63. Left foot and leg ; gang.: primary amp. thigh, bv Surg. C. S.Wood, 66th N. Y. Died July —, '63. Right knee; joint opened by in- flam.: amp. post, flap, mid. third, by A. A. Surg. A. W. Emory. Died Nov. 8, 1864. 1 Eve (P. F.), Cases of Secondary Hemorrhage, etc., in Surg. Mem. of the -War of the Rebellion, U. S. San. Comm., 1870, Vol. I (Surgical) p. 210. 2LlDELL (J. A.), op. cit., p. 61. 3Ibid., p. 57. 4 BRYAN (J). Amputation of Left Thigh, upper third, in Am. Med. Times, Vol. VII, p. 5. Coleman (R. T.), Items of Army Experience, in Virginia Clinical Record, 1872, Vol. II, p. 141. 50 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No J Name, Military Description, and Age. Dates. Rennick, L., Pt., I, 26th Missouri. Rickard, J. IL, Pt., D, 1st Alabama Cavalry. Robericht, C., Pt., B, 48thNewYork,age44. Rolf, L. F., Pt., M, 1st Maine Artillery. Roork, E. P., Pt., F, 3d Pennsylvania Cavalry, age 22. Root, H.V., Pt., B, 104th New York, age 26. Rowe, G., Pt., B, 01 st Georgia, age 32. Roysler, J. M., Pt., C, 47th North Carolina, age 29. 'Schatt, IL, Corp'l, II, 64th New York, age 30. Shugert. J.L., Corp'l,B, 49th Penn., age 20. Shupe, J., Pt., E, 49th Ohio. Simpson, P., Pt , F, 36th Colored Troops, age 23. Slanker, J., Pt., C, 162d Ohio N. G. Sloss, A., Pt„ A, 5th Penn., age 35. Smith, J. A., Pt.,C, 4th Maryland, age 18. Smith, W. F., Major, 1st Delaware. Spalding, J. E., Pt., C, 35th New York, age 30. Sept. 19, Dec. 30, 1862. Jan. 27, Feb. 28, 1864. Julv 18, '63, "Mar. 15, 05. June 18, (J4. June 30, '00. Nov. 27, Dec. 6, 1863. June 22. '64, Feb. 29, 65. July 9, Aug. 5, 1864. July 1, 26, '63. Mar. 25, April 2, 1865. April!, May 20, 1865. Dec. 15, 15, '64. Sept. 20, 1804. June 19, July 2. 1804. Dec. 10, '64, Juno 10, '65. May 14, June 9, I SOL Oct. 27, 27, '64. Aug. 30, Sept, 12, 1862. Injury, Operator, and Result. Right thigh ; profuse suppurat'n : amp. thigh. Died Dec. 31, '62. pyaemia. Right thigh; ulceration popliteal art.; haem.; thigh amp., by Surg. J. G. Keenon,U.*.V. DiedFeb. 29, '64, exhaustion from haem. Extens. lace, right leg. Disch'd Aug. 22,'64; flap amp. thigh, by Dr. L. Bauer, cf Brooklyn. Died Aug. 23, 1871. Left leg: necrosis ; thigh at mid. third, by Dr. J. C. Manson. Recovery. Right popliteal nerve and artery severed; thigh amp., bv Surg. E. Bentley, U. S. V. Disch'd June 18, 1864. Right leg; gang.; necrosis; Oct. 29, remov. of 10 inches necrosed tibia; thigh amp. Disch'd July 21, '65. Spec. 3601, A. M. M. Right knee : gangrene, involving joint; thigh amp., by A.A. Surg. J. H. Coover. Died Aug. 7, '64. Spec. 3809, A. M. M. Left thigh ; amp. thigh, by A. A. Surg. G. M. Panllin. Died July 29, 1803. Spec. 3961, A. M. M. Left thigh, dividing popliteal art.; amp. thigh, by A. A. Surg. II. Craft. Disch'd Sept. 26, 1865. Specs. 171, 2283. A. M. M. Right knee: second, disease joint; amp. thigh at low. third, by A. A. Surg.W.B.Chambers; haem.; May 24, lig. femoral. Died May 25, '65, exh'n from haemorrhage. Left leg. amp. thigh. Died Jan. 1. 1865, gangrene. Left thigh; amp. thigh. Died Oct, 22, '64, exhaustion. Left thigh, injuring poplit'l art'y; gang.; amp. thigh.bv A.A.Surg. W. H. Drury. Died July 2, '64, 12 hours afteroper'n, from shock. Left knee; destruc. oftissue; amp. junct. low. thirds, by Asst. Surg. J. H. Frantz. Dis.' Nov. 22, '65. Right knee; second, involv. joint; amp. of thigh, by A.Surg. A. In- gram,U.S. A. Disc'd Mar. 23,'65. R lit thigh; lig. fem. art. and vein; amp.th.,l>v Surg. A.N.Dougher- ty, U. S. V. Died Nov. 6, 1864. Left popliteal artery severed; amp'n thigh. Died same day, from haemorrhage. Name, military Description, and Age Spencer, C, Capt,, I, 1st Michigan. Stark, O. H., Serg't, H, 13th New Hampshire, age 36. Suits, S. A*Pt., B, 1st Missouri, age 25. ■ Taylor, James, Pt., K, 7th New York Heavy Artillery, age 22. Thorn, IL C, Pt., 1,14th West Virginia, age 19. Townsend, E., Pt., F, 5th New Hampshire, age 35. Trees, J., Corporal, D, 188th Penn., age 21. Vann, D., Pt., B, 8th N. York Artillery, age 18. Waller, J. R., Corp'l, A, 19th Infantry, age 17. Watson, J. H., Pt., B, 10th N. Jersey, age 36. White, J. L., Guerilla, age 38. Wick, J. C, Pt.,C, 155th Penn., age 22. Wild, C. B.. Corp'l, E, 114th New York. Wing, J. W.,Pt.,H,27th Mass., age 45. Wolf, J., Corp'l, D, 4th New York Cavalry. Wright, D., Pt., A, 57th New York, age 23. July 2, Dec. 28, 1863. Sept. 29, '64, Jan. 3, '65. Nov. 30, '64, Feb. 7, '65. June 16, '64. Jan. 17, '65. July 20, Aug. 7, 1864. June 2, 21, '64. June 2, 28, '64. June 3, 20, '64. July 30, Oct. 25, 1864. June 4, 24, '64. May —, 1863, Primary. Mar. 25, June 14, 1865. Sept. 19, Oct. 12, 1864. Mar. 14, April 7, 1862. Oct. 12, Nov. 26, 1863. Sept. 17, Dec. 2, 1862. Injury, Operator, and Result. Right thigh, injur'g sciatic nerve; amp. thigh, by A. A. Surg.D.O. Farrand. Disch'd May 16, '64. Right leg; sloughing; Dec. 25, amp. leg; reamp. in thigh, by A. A. Surg. H. H.James; haem.; art'ylig. Died Jan. 13,'65,pyaem. Rightthigh ; gang.; popliteal art. sloughed; amp. thigh, by Surg. B. B. Breed, U. S. V. Died Feb. 16, 1865, exhaustion. Left leg; thigh amp., bv A. A. Surg. E. J. Farwell. Disch'd July 6, 1865. Right thigh; Aug. 7, haem.; lig. fem.; amp. thigh, by Surg. J. B. Lewis, U.S.V. Died Aug. 12,'64. Left knee; joint ope. byulcerat'n; amp. post, flap, upper third, by Surg. E. Bentley,U.S.V.; haem.; lig'n. Died July 1,'64, asthenia. Right knee. June 20, haem.; pop- liteal flaps, mid. third. Disch'd Dec. 8, 1864. Left thigh, injuring popliteal art,; haem.; June 16, popliteal lig.; haem. recurred; amp. thigh, by A. A. Surg. E. Vogel. Died June 22, '64, gangrene. Right knee; gang.; thigh amp., by A. A. Surgeon M. L. Herr. Died Nov. 5, '64, pyaemia. Left knee; joint ope. by suppu'n; muscular flaps, mid. third, by Surg. E. Bentley, U.S.V. Died June 28, 1864, exhaustion. Both legs perforated; left post, tibial art. and nerve completely sev'd; gang.: amp. thi. Recov'd. Both thighs; May 23, haem from left popliteal; lig'n; amp. thigh, by A. Surg. A. Delaney, V.S'.V. Died June 20. '65, exhaustion. Right popliteal space; Oct. 1, haem. from popliteal artery: lig.; amp. thigh, bv Asst, Surg. B. A. Fordyce, 160th N. York. Died Oct. 13, 1864, exhaustion. Right leg; gangrene; amp. thigh, by Surg. G. A. Otis, 27th Mass. Died Aprill7,1862, exhaustion. Left thigh; gang.: amp. thigh, by A. A. Surgeon J. F. Thompson. Disch'd Oct. 11, 1864. Rightthigh; gang.; amp. thigh, by A. A. Surg. A. V. Cherbon nier. Died Dec. 20, '62, gang. .Spec. 888, A. M. M. Amputations at the Knee.—But one of the six disarticulations at the knee for com- plications involving shot flesh wounds of the leg had a favorable result. Three of the operations were intermediary, three secondary: Table VII. Numerical Statement of Six Disarticulations at the Knee Joint for Complicated Shot Injuries unattended by Fracture. No. 1 o 3 Najie, Military Description, and Age. Dates. Injury, Operator, and Result. NO. Name, Military Description, and Age. Dates. Injury, Operator, and Result. Cole, D. D., Corp'l, A, 2d New York Cavalrv, age 23. Dempsey, M.Pt.,1,17th Vermont, age 18. Grimes, F. A., Pt.. C, 4th Vermont, age 22. April 7, Aug. 1, 1865. Oct. 5, Deo. 27, 1864. April 16, 22, '62. Leftleg; gang.; amp. at the knee joint, patella retained, by Ass't Surg. G. M. McGill, U. S. A. Disch'd Nov. 22, 1865. Left leg; obliteration of fem. art., sloughing, and recurrent haem.; amp. at knee joiut. by Ass't Sur-geon W. A. Harvey, U. S. V. Died March 26, 1865. Right leg, injuring popliteal art.; haem.: amp. at knee joint, by Surg. R. B. Bontecou. U. S. V.; gang. Died April 28, 1862. 4 5 6 Huntington, I., Pt., B, 92d New York, age 29. Leonard, J., Pt., G. 5th Ohio, age 22. Taggart, S. D., Serg't, G, 150th Pennsylvania, age 25. June 3. Aug. 2, 1864. July 3, 16, ''63. Feb. 6, 20, '65. Leftleg; slough'g; recur't haem.: amp. at knee joint, by Surg. R. B. Bontecou. U. S. V. Died Aug. 8. 1864, exhaustion. Card Phot., Vol. Ill, p. 23. Right leg, injur'g post. tib. nerve ; tetanus; amp. at knee joint, by Ass't Surg. H. C. May, 145th N. Y. Died July 16, '03. tetanus. Leftleg; gang.: recurrent haem.; amp. at knee joint,byAss't Surg. J. Vansant, U. S. A. Died Feb-ruary 20, 1865. •Lidell (J. A.), op.cit., p. 47. SECT. I.] AMPUTATIONS IN THE LEG FOR SHOT FLESH WOUNDS. 57 Amputations in the Leg.—Of sixty-three operations in this category thirty-three proved fatal, or 52.3 per cent. Two primary cases were successful; of twenty-four inter- mediary operations, seventeen, or 70.8 per cent., proved fatal; of thirty-seven secondary amputations, sixteen, or 43.2 per cent., proved fatal. The Museum possesses pathological specimens from some of the cases. Two of the cases are detailed, and all are enumerated in Table VIII: Case 12G.—The late Dr. Bodisco Williams, of Georgetown, D. C, who served in the Confederate Army, presented Acting Assistant Surgeon F. Schafhirt, of the Army Medical Museum, with the specimen figured below, with the accompanying history: " Rev. J. L------, a young priest from New Orleans, acting voluntarily as field chaplain, tried to persuade a company of Irish railway laborers to take up arms to fight against the Yankees in front of Fredericksburg, December 12, 18G2; but during his speech a large shell exploded close in front of the group and killed three and wounded eight, including the priest, who received a small skin wound over the inner surface of the left tibia, about five inches above the tarsal articulation. Rev. L------did not take much notice of the wound until the leg was in full inflammation up to the knee. He had returned to Lynchburg, where he applied bread and milk poultices for several weeks, but afterwards he sent for a physician, who exerted all his knowledge to save the leg. But nothing would avail, and caries of the bone having supervened, gangrene at last reminded the attendant of amputation, which was performed by Dr. Pearson, of Virginia, who took the leg off one inch below the tuberosity of the tibia, August 25, 1863. But even this remedy did not improve the physical health of the patient; and his soul left Lynchburg, September 2, 1863, for that great and blissful haven, it may be hoped, which he had promised to those Irishmen in front of Fredericksburg." The • r ' r ^ Pig 22__Six specimen represented in the adjacent wood-cut (FlG. 22) presents great erosion, as though from caustic jllches of' shaft applications made to arrest the progress of gangrene, and there are neighboring evidences of extensive periosteal of *he left ,,lbiai V r o e o ' o o r carious and ero- thickening with osseous exudations and deposits. See Cat. Surg. Sect., Army Medical Museum, 1866, p. 394. ded. Spec. 858. Case 127.—Private G. Brown, Co. C, 97th Pennsylvania, aged 18 years, was wounded at Petersburg, June 17, 1864, and was admitted to hospital at Fort Monroe two days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported: " Gunshot wound of right foot, flesh." From Fort Monroe the wounded man was transferred to Knight Hospital, New Haven, where amputation was performed but not recorded. Subsequently the patient was transferred to McDougall Hospital, and lastly, on January 19, 1865, to Central Park, New York City, whence Surgeon B. A. Clements, U. S. A., reported: "Gunshot wound of right foot; a minie ball passed through the metatarsus, entering on the dorsum of the foot. Mortification supervened and the condition* of the injured parts became very bad; constitutional condition of patient feeble; loss of appetite; unable to sleep from pain in wound. On July 11th, amputation (apparently circular) of the leg just above the ankle joint was performed at the Knight Hospital, New Haven, by Acting Assistant Surgeon C. Lindsley. Two ligatures were applied, and ether was used as the anaesthetic. Healing progressed well for three weeks, when the stump sloughed, which was arrested in four or five days." The specimen represented in the annexed wood-cut (Fig. 23) was contributed by Acting Assistant Surgeon S. Teats, who performed re-amputation on April 10, 1865, on account of " a sloughing ulcer and a cold and blue condition of the stump." The stump healed at the end of five weeks after the last operation, and the patient was supplied with an artificial leg about two months afterwards. He was discharged from service August 17, 1865, and pensioned. In his application for commutation, dated 1875, the pensioner described the stump as being in good condition. He was paid his pension June 4, 1876. Fig. 23.—Two and a half inches of stump of right leg. Spec. 4329. Table VIII. Summary of Sixty-three Cases of Amputations of the Leg for Complicated Shot Injuries unattended by Fracture. Name, Military Description-, and Age. Addington, J.,Serg't, A, 84th Indiana, age 25. June 20, July 23, 1864. Ainsworth,W.H.,Serg't, May 6, K, 43d New York, age June 2J 22. " 1804 Alexander. E. J., Corp'l, B, 110th New York. Barnum. C. F., Pt., E, 187th Penn., age 30. Barron, C., Pt., D, 14th Connecticut, age 45. June 14, —, '63. June 18, Aug. 27, 1864. May 12, Sept. 10, 1864. Injury, Operator, and Result. Right ankle ; gangrene; amputa- tion leg. bv Surg It. M. S. Jack- son, U. S.V. Died Sept. 2, 1864, pyaemia. Right leg; amp. leg, bv Surg. W. D. Stewart. U. S.V. 'Disch d Nov. 3, 1865. Right leg; amp. of leg. Died July 2, 1863. Left leg: amp. leg, by A.A.Surg. J. P. Arthur; haem.; Sept. 7, amp. thigh. Died Oct. 13,1864. vS/wc.3132, A. M. M. Left foot; gang.; amp. leg. by A. A. Surgeon S. Smith. Disch d June 18. 1865. Name, Military Description, and Age. 6 i Ilatherie, N. T.. Corp'l, A, 15th Mass., age 34. Decker. II.. Pt., F, 50th Penn., age 28. IScll. J., Corp'l. G, OSth Penn., age 40. !) Hieklcy, II., Serg't, E, 10th New Jersey, age Bloomer, A. S., Pt., G, 55th Ohio, age 20. June 6, 24, '04. May 9, Aug. 10, 1864. Dec. 13, '62, Mar. Ii), '63. May 14, Aug. 13. 1864. May 15, July 21, 1864. Injury, Operator, and Result. Left leg; gang.; amp. leg, by A. A. Surgeon M. F. Price; haem. Died June 30, '64, asthenia from wound, and diarrhoea. Right leg; sloughing ; amp. leg, by A. A. Surgeon G. E. Galen. Disch'd May 22, 1865. Left leg ; sloughing; haem.; amp. leg, by A. A. Surg. F. H. Get- chell. Disch'd Dec. 14, 1863. Left; slough ; amp. leg, by A. A. Surg. G. W.Webb; haem. Died Aug. 23/64. Spec. 3665, A.M. M. Right foot; gang.; amp. leg, by Ass't Surg. J. A. Freeman, U. S. V. Disch'd Feb. 10, 1865. Surg. Ill—8 5S INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Di:sriuPTio\, and Age. Brown, C, Pt., C, 97th Penn., age 18. Burke, M., Serg't, C, 155th N. York, age 51. Burley. M. D., Pt.. G, 45lh Penn., age 17. ISe.nis. T.. Pt..D, 8th N. Yt.rk II. Art ry. age 34. Case. E. 1\. Pt*. G, 13th Michigan. Cousins. J. A., Corp'l, I. 1st Maine H'vy Art., ago ^'4. Cross, G. P., Pt.. F, 1st Mass. Heavy Artillery, age 19. Dixon, J. II ,V\.,V, 24th N. Carolina, age 24. Downey, J., Pt., F, 29th Penn., age 30. Emery, R., Pt., I). 5th Vermont, age 33. Gilbert, G. IF, Lieut., B, 122d New York. Gooch, A. B., Pt., F, 12th Ohio, age 21. Goodell. E D., Corp'l, D, 25th Massachusetts, age 21. Goodrich. J., Pt., G, 148th N. York, age 40. Green, J. A., Serg't, E, 2d Connecticut Art'ry, age 25. Gutting, A., Pt., D, 11th Mich. Cavalry, age 26. Hagey, J. D., Pt., I. 138th Penn., age 24. Harris, J. M., Corp'l, C, 14th Iowa, age 20. Hays, A., Corp'l, F, 3d Delaware, age 29. James, A, Pt. 1,2d Ten- nessee Cavalry, age20. Kane, H., Pt., A, 24th Iowa, age 25. •Knoble. H.,Pt.,D,149th New York, age 27. Kuentzler, J., Pt., H, 56th Penn., age 24. Leasure, J., Pt., F. 62d Penn., age 23. L---- J- (field). Dates. June 17, Julv 11, '64,"Ap'l 16, '65. June 3, Aug. 26, 1864. May 6. Sept. 13, 1864. June 17, 17, '64. Sept. 19, 24, 63. Chaplain McCurley. H., Pt., D, 1st Maine, age 18. Maguire, E., Pt.. I. 8th Conn., age 26. June 3, July 22, 1864. May 9, June 5, 1864. Juno 7, 28, '64. Oct. 2, Nov. 9, 1804. April 2, May 19, 1865. July 15, 27, '64 Injury, Operator, and Result. Right foot; gang ; amp. just above ankle, by A. A Surg. Lindsley; sloughing: reamp. leg. Disch'd Aug. 18,'6.'). -Vc. 4329, A.M.M. Right leg; sloughing; amp. leg, by A. A. Surgeon M. Lampen. Died Aug. 27. 1804. pyaemia. Right log: amp. log, by A. A. Surg. P.. Wilson, gang.; haem. Disch'd Jan. 22, iso.">. Right leg; amp. leg. Discharged June 20. 1865. Leftthigh.sevc'gfem. art.; gang.: amp below knee; gang, extend- ing; Sept. 26. amp. at up. third thigh. Died Sept. '_7, '63, gang. Left foot; sloughing and erysipe- loid ; flap amp. at up. third, by Dr. McConuor. Discli'd July 10. 1805. Right leg ; gang.; haem.; amp. log, by Surg. E. Bentley, U. S. V.: two ounces of blood injected into veins. Disch'd Juno 9, '65. Right leg; gang.; amp. leg. by A. A. Surg. J. P. Arthur. Died May 4, 1865. exhaustion. Left leg; caries; amp. leg, by Ass't Surg. II. T. Leglcr.U.S.V. Disch'd Sept 1, 1864. Left leg; gang.; haem.; Aug. 4, 1854, post, tibial lig'n. Discli'd Dec. 10, '64; leg amp. Both feet contused by spent ball; gang, left foot: amp. left log. by Surg. H. W. Ducaohet, U.'S.Y. Disch'd May 23, 1864. Left ankle; caries inv. ank. joint: flap amp. mid. third, by Surg. N. Gay, U. S. V. Disch'd Feb. 13. 1865. Right foot; gangrene; amp. leg, bv A. A. Surg. B. V. Butcher. Disch'd Oct. 31, '65. Spec. 3332, A. M. M. Both ankles; gang.; amp. right leg. by Ass't Surg.H.C. Roberts, U. S.V. Died June5, '64. exh'n. Left foot; circ. amp. up. third leg, by A. A. Surf. P. Wilson. Died July 7. 1804. pyaemia. Right leg : amp. leg. by Surg. J. B. Murphy. C. S. A. Disch'd Sept. 14, 1865. Left leg; artery opened; haem. from post, tibial artery: art. tied; amp. leg, by A. A. Surg. H. A. Drane. Disch'd July 26, '65. Rightthigh; aneurism; sphacelus: an'mal sac probed; exces.husm ; fem. tied; amp. leg, by A. A. Surg. R. W. Coale. Died Aug. 3, 1864, pyaemia. Right foot; slough'g ulcer: amp. leg, by A. A. Surgeon W. W. Stiarpley. Discli'd May 18,'65. Spec. 3668. A. M. M. Left ankle; ball removed: gang.; circ. amp. lower third leg, by Ass't Surg.W. B. Trull, U. S.V. Died May 16, 1865. Left leg; gangrene; amp. leg. by A. A. Surg. J.W. H. Baker. Dis charged May 29, 1865. Both thighs, ball impinging on sheath of left fem. artery; gang.; amp. left thigh. Died Jan. 14, '64, pyaemia. Spec. 2114, A.M.M. Right leg : sloughing: amp. leg, by A. A. Surg. E. K. Tell. Died Aug. 6, 1864, pyaemia. Left leg; haem.; amp. leg, by A. A. Surg, John Priestley. Died June 15. '64, baem. and pyaemia. Leftleg; gang.: amp. leg. by Dr. Pearson. Died Sept. 2, *1863. Spec. 858. A. M. M. Right ankle; gang.; circ. amp. mid. third, by A. A. Surg. G. E. Brickett. Died Aug. 28, 1864, pyaemia. Right leg: gang.; ulceration of ante, tibial art.; amp. leg, by A. A. Surg. W. B. Casey. Disch'd Nov. 28, 1865. 53 Name, military Description, and Age Mangan, J., Pt., F, 82d Ohio, age £8. Mendcnhall, J., Pt., B, 97th Penn., age 30. Moser, C, Pt., K, 5th Michigan, age 43. Moss, B. F.. Corp'l, B, 101st Illinois, age 43. Mott, J.. Pt., E, 105th Illinois, age 37. Paden, W., Corp'l. G, 10th Penn. Reserves, age 22. Parmenter, J. D., Pt., G, 07th Penn., age 16. Prat her. B., Corp'l, D, 103d Ohio, age 18. Reed, J., Corp'l, F, 101st New York. Ross, A. G., Corp'l, I, 13th Mississippi,age21. Saulsbury, W., Pt., K, 3i)th Colored Troops, age 36. Smith, W., Pt.. D, 17th Infantry, age 22. Stark, O. H., Serg't, H, 13th New Hampshire, age 36. Stebbins, E., Serg't, L, 3d New York Cavalry, age 26. Stnltz, G., Serg't, K, 5th New Jersey, age 26. Sullivan, D., Pt., F, 1st Penn. Rifles, age 23. Tawnc}', A.,Pt., D, 74th Indiana, age 38. Tewksbury. D., Pt., F, 73d Ohio, age 22. Thompson, J. A.,Corp'l, K, 10th Indiana, age 27. S Thornton, R. M., Serg't, K, 4th Rhode Island,' age 26. Tillotson, C. A., Pt., E, 39th Iowa, age 32. Tryan, N., Pt., E, 4th Ohio, age 26. Wares, D., Corp'l, 22d Massachusetts, age 31. Williams, G., Pt., H, 29th Colored Troops, age 37. Wolf, C., Corp'l, D, 5th Minnesota, age 31. Wright, E.,Pt.,F, 119th Penn., age 18. Injury, Operator, and Result. July 20, 22, '64. May 20. July 22. 1804. June 18, July 19, 1864. July 25, Aug. 24, 1864. June 26, July 26, 1864. May 23, June —, 1864. April 6, June 21, 1865. Dec. 15, 27, '64. June, '62. Interme- diary. Oct. 19, Nov. 8, 1864. July 30, 1864, Jan. 19, 1865. May 12, July 8, 1864. Sept. 29, Dec. 25, 1864. Sept. 6, Oct. 12, 1862. June 16, '64, Jan. 9, '65. Dec. 13, 29, '62. Sept. 19, Nov. 29, 1863. July 2, '63, Ap'l 8, '64. Aug. 3, Sept, 3, 1864. July 30, Sept. 28, 1864. Oct. 5, Dec. 25, 1864. May 5, July 3, 1864. May 5, 20, '64. Sept. 27, Oct. 22, 1864. Dec. 16, '64, Jan. 5, '65. Mav 5, 25, ''64. Left leg; amp. leg, by Surg. H. K. Spooner, 61st Ohio; haem.; lig. of anterior tibial artery Aug. 15, '64. Disch'd May 23, '65. Right leg; sloughing; amp. leg, by A. A. Surgeon A. D. Hall. Died July 29, 1864, pyaemia. Left ankle and thigh ; gang.; amp. leg, by A.A. Surg. F.D Weisse. Died July 26, 1864, pyaemia. Left leg; gang.; amp. leg, by A. Surg. W. B. Trull. U. S.V.; dif- fused aneurism ; haem.; Nov. 11, amp. thigh ; haem.; Dec. 15, lig. fem. Disch'd June 25. 1865. Left leg; slough, ant. tibial; haem.; amp. leg, by Ass't Surg. B. E. Fryer. U. S. A.; July 27, trans- fusion. Died Aug. 5, '64, baem. Rightthigh; May 29, 31, haem.; June 1, femoral tied; amp. leg, by Surg. G. L. Pancoast, U.S. V. Died June 26, 1864, gangrene. Left foot; gangrene and necrosis; amp. leg, by Surg. R. B. Bonte- cou, U.S.V. Disch'd Nov. 23,'65. Right foot; exe'n half in. post. tib. nerve; Dec. 26, amp. great toe; amp. leg, by A. A. Surg. S. G. Ayres. Died Dec. 29,'64, tetanus. Shot flesh w'nd of ank. joint; circ. amp. at junct. of low. third leg, by Ass't Surg. P. S. Connor, U. S. A. Died July 29, 1862. Right fem. art. injured; also w'd of left thigh; gang.; lig. of fem.; amp. right leg three ins. above ankle. Retired March 14, 1865. Right leg; sloughing; haem.ant. tibial art.; art. lig. in w'nd; haem. recur'd; art. relig.; amp. leg, by A.A.Surg. O. Shiftier. Disch'd May 26, '65. Died July 16, 71. Right ankle joint; suppurative in- flam'n, caries; amp. le£f, by A. Surg A. Ingram, U. S.A. Died July 20,'64. Spec. 2865, A.M.M. Right; slough.; amp. leg, by A. A. Surg.II.II James; sloug'g; Jan. 3, 1865, amp. thigh; haem.; lig. Died Jan. 13, '65, pyaemia. Leftleg; haem.; amp. leg. Dis- charged June 15, 1863. Left leg; gang, and necrosis: amp. leg, by Surg. E. Bentley.U.S.V. Left hospital April 18, 1865. Left foot; extensive inflammat'n ; amp. leg, by A. A. Surg. C. H. Bowen. Discharged. Leftleg; haem.; amp.leg.by Surg. G. Grant. U. S. V.; gang. Died Dec. 6, 1863, gangrene. Left leg.; gang.; amp. leg, by Surg. A. M. Speer, U.S.V. Died May 8, 1864, pyaemia. Left leg ; ga'ng.; amp leg. by A. A. Snrg. A. L. Rice; haem. from popliteal artery; artery tied. Died Oct. 4, 1864. Lett leg; haem.; amp. leg. by A. Surgeon S. A. Orton, U. S. A. Disch'd January 28, 1865. Right ankle ; slough'g and haem.; ant. post flap amp. at mid. third, by Ass't Surg. B. E. Fryer, U. S. A. Died Jan. 6, '65, pyaemia. Left foot; gang.; amp. leg, by A. A. Surg. A. McLetchie. Died Aug. 10, 1864. asthenia. Right leg; amp. leg. by Surg. D. W. Bliss, U. S. V. Discharged October 25, 1864. Left leg ; haem.; amp. leg, by A. A. Surgeon J. H. Buchanan. Died Oct. 25, '64, exhaustion. Left leg, also wound of right leg ; amp. left leg, by A. A. Surg. L. E. Tracy. Died Jan. 19, 1865, gangrene. Right leg, cutting post, tibial art.; gang.; haem.; May 22, lig.; haem. recur'd; amp. leg, by Surg. E. Bentley, U. 8. V. Died May 28, 1864, asthenia and pyaemia. 1 LIDELL (J. A.), Wounds of the Arteries, in Surg. Mem. of the War of the Rebellion, coll. andpub. by the U. S. San. Comm., 1870, Vol. I, pp. 27, 551. SECT. I.] DEFORMITIES AFTER SHOT FLESH WOUNDS. 59 Amputations of the Toes.—There was a single example of amputation of the great and second toes for gangrene following ligation of the femoral artery for a shot wound of the thigh. (Case 55 of Table III, p. 48.) Case 128.—Private J. L. Hunt, Co. G, f>7th New York, aged 42 years, was wounded at the Wilderness, May 5, 18C4. Assistant Surgeon J. C. McKee, U. S. A., reported his admission to Lincoln Hospital, Washington, May 26th, with "gunshot wound of left thi°"h." Two weeks afterwards tho patient was transferred to Camden Street Hospital, Baltimore, and on October 23d he entered Mower Hospital, Philadelphia, where Acting Assistant Surgeon F. W. Saunders recorded the following: "A minie ball entered the thigh at the inner side, upper third, and, passing backward and outward behind the femur emerged just below the tuberosity of the ischium. Deficient circulation from ligature or otherwise of the great trunks occasioned mortification in the foot, rendering necessary the amputation, previous to admission, on September 5th, of the first and second toes at the second joints." The patient was subsequently transferred to McDougall Hospital, New York Harbor, whence he was discharged June 5, 1865, Assistant Surgeon S. H. Orton, U. S. A., certifying, "the wound has been gangrenous; extensive cicatrix remaining, causing great contraction of muscles; little use of leg." On June 1, 1866, the pensioner was supplied with a supporting and extensor apparatus by Dr. E. D. Hudson, of New York, who in his statement reports the ligation as havino- been performed on "July 9." The New York City Examining Board certified, December 8. 1875: "There is a cicatrix five inches by four on inner side of left thigh, middle third, which is adherent and radiated. The femoral artery has been cut and tied. There is great loss of muscular substance. The great and second toes have sloughed away; foot poorly nourished. Has to wear an artificial appliance to enable him to walk. There is considerable atrophy of muscles of the limb. The disability is equal to the loss of the limb." The pensioner was paid March 4, 1876. Tenotomy.—There were five examples of tenotomy for the relief of deformities result- iflg from shot wounds of the lower extremities. The case of Sergeant Louis Morell (Case 243, Med, and Surg. Hist, of the War, Part II, Vol. II, Chap. VI, p. 80, and Plate V, Fig. I) has been detailed. In the case of Private H. B. Franklin, Co. E, 52d Indiana, aged 21, Surgeon A. Hammer, U. S. V., divided the tendo Achillis at the Marine Hospital, St. Louis, November 5, 1864, and relieved talipes of several months' standing. He was returned to duty January 24, 1865. Case 129.—Private J. H. Armidon, Co. I, 49th New York, aged 19 years, was admitted to Satterlee Hospital, Phil- adelphia, June 21, 1863. Acting Assistant Surgeon M. J. Perry reported: " The patient was received from hospital at Washington, suffering from diarrhoea. He had previously received a gunshot wound of the leg at the battle of Antietam. Leg bent almost on to thigh.- The hamstring tendons were cut by Acting Assistant Surgeon T. G. Morton, formerly in charge of the ward. October 30th, leg much straighter; is obliged to walk with crutches. November 20th, is able to walk about with a cane; leg still a little bent. December 13th, wound nearly healed; general health good. January 1, 1834, patient returned to duty, cured." Several weeks afterwards the man entered Augur Hospital, whence he was discharged for disability, February 10, 1864, Surgeon S. B. Hunt, U. S. V., certifying to " Shell wound of popliteal space of right leg, received at Chancellorsville, May 3, 1863, causing permanent lameness; still discharging." The Washington hospital records show that Armidon was "admitted to Lincoln Hospital on February 27, 1833, with intermittent fever," and that he "deserted June 20, 1863," but no note was made of the wound. He is not a pensioner. Case 130.—Private T. Caswell, Co. C, Cth New Hampshire, aged 30 years, was wounded in the right leg, at Bull Run, August 29, 1862. He was admitted to the Georgetown College Hospital, subsequently transferred to Satterlee, Philadel- phia, and lastly to Lovell, Portsmouth Grove. Assistant Surgeon W. F. Cormick, U. S. A., in charge of the latter, reported: "Wound healed with severe contraction of the tendo-achilles, resulting from extensive and repeated sloughing. On October 5, l-i63, tenotomy was performed, by dividing the tendo-achilles, by Acting Assistant Surgeon J. W. Cushing. The wound caused by the operation healed by November 23th, and the splints, etc., were removed, the foot and ankle resuming their former positions and functions. On December 15th the patient was able to walk without crutch or cane. He was discharged from service December 30, 1833." Examiner W. (i. Perry, of Exeter, N. II.. February 17, 1884, certified: "Ball entered the out- side about midway between the knee and ankle joints, passing directly across the leg. * * There is contraction of the tendo- achilles, which has been partially relieved by division, but he cannot bring his heel entirely down. Standing causes pain." In October, 1859, he reported that contraction in the use of the leg had produced irritation of the eschar, resulting in ulceration. Examiner E. B. Hammond stated, September 11, 1875: "The foot is reduced in size, the leg is weak, etc." The pensioner was paid June 4, 1876. The fifth case in which tenotomy was practised has been already noted as 27 of Table VI, on page 54, amputation being resorted to twelve years after the reception of the injury on account of the uselessness of the limb. Case 131.—Private T. Cooper, Co. C, 4th Pennsylvania Reserves, aged 18 years, was wounded near White Sulphur Springs, June 22, 1864. He was admitted to the Post Hospital at Beverly, and, on August 8th, transferred to the Grafton Hospital. Surgeon S. N. Sherman reported: " Gunshot wound of left thigh; ball entered two inches above knee, on outer side, exit near tuberosity of the ischium; also flesh wound of middle of leg. December 31st, leg flexed at nearly right angle to the thigh, caused principally by contraction of the semimembranosus and senuteuduiosus; motion of knee joint perfect; consid- 60 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. erable talipes varus, though without anchylosis. Subcutaneous division of the hamstring tendons performed by Surgeon S. N. Sherman, U. S. V.; chloroform used. Patient reacted promptly, being in good health, though of rather delicate constitution. After division of the tendons the leg was forcibly extended and secured to a straight splint, extending from nates to heel. Twenty-four hours after operation patient rested quite easy and entirely free from pain." The patient was furloughed on April 11, 1865, and admitted to the Emory Hospital, Washington, several weeks afterwards. On June 23, 186."). he was discharged by reason of "paralysis and deformity of the left leg caused by the wound," and pensioned. The man subsequently removed to Birmingham, England, where, in December, 1870, he was seen by Mr. J. B. Gould, the U. S. Consul, who described his condition as follows: " His left leg and foot are withered, the foot icy cold and curled up like a bird's claw, and the leg with- ered and dead to the hip joint," etc. About this time the pensioner was also examined by Surgeon Jos. Morris, M. R. C. S., who certified : "I find him suffering from the effects of a gunshot wound of the left thigh. The sciatic nerve has been injured, and the entire limb rendered permanently and entirely useless. He suffers great pain in the injured limb," etc. This certificate was corroborated by Surgeon Jordan, F. R. C. S., and Professor of Surgery at Queen's College, at a subsequent examination on March 4, 1871. Surgeon Oliver Pemberton, F. R. C. S., in charge of the General Hospital at Birmingham, certified, on June G, 1876: "On the third day of May, 1876, I amputated the left leg of Thomas Cooper above the knee, the said limb having become useless on account of a gunshot wound," etc. The pensioner was paid June 4, 1876. A case of shot injury of the foot in a distinguished general officer may conclude the illustrations selected for this section: Case 132.—Major-General J. Hooker, U. S. V., was wounded at the battle of Antietam, September 17,1862. The injury was reported by Assistant Surgeon B. Howard, U. S. A., as follows: " He was wounded in the right foot by a minie" ball while leading his command, being on horseback at the time, and standing in the stirrups with his weight thrown on his right foot, which was turned outward. The ball struck the inner side of the foot inferiorly to the middle of the scaphoid bone, passing between the first and second layers of the plantar muscles, almost transversely across the plantar portion of the foot, and emerg- ing inferiorly to the anterior border of the cuboid bone. The bones of the foot were uninjured. On the morning of September 18th, I was sent by the Medical Director of the Army of the Potomac to attend General Hooker, * * then lying in a farm- house near the battle-field. Warm-water dressings had been applied previous to my visit. There was no constitutional disturbance, but the foot was hot and inflamed. By means of a syringe I thoroughly washed out the wound with warm water, and finding it most agreeable to the patient, substituted cold- for warm-water dressings. The next day I found the patient very comfortable; the appearance of the foot had greatly improved and the inflammatory symptoms had disappeared. I then ordered a lotion of plumbi instead of cold-water dressings as being more likely to allay any irritation that might arise in the parts. Before the General left that evening, for Washington, I advised him to resume the use of tepid water as soon as all tendency to active inflammation should cease. On October 25th, I heard that tetanic symptoms had manifested themselves, but received a letter from the General a few days afterwards stating to the contrary. On November 25th the General, who had returned to duty in the field, requested me to look at his wound, which still troubled him somewhat. I found the newly formed cicatrices somewhat tumefied; they were painful on pressure, and the General was still unable to mount his horse unaided, though he persisted in being on active duty. On November 30th, I found there had been a steady improvement, and, although the step had not its former elasticity, the wound had left no serious inconvenience behind." General Hooker remained in active service until the close of the war, and was ultimately retired October 15, 1868. Wounds of the soft parts of the lower extremities, though constituting the largest group of injuries received in action, have seldom been much commented on by authors.1 1 In addition to the bibliographical references cited in previous pages of this section the following may be consulted with interest: Pare (A.) (QZuvres completes, ed. Malgaigne, Paris, 1840, T. II, Chap. XXXVII, p. 110) remarks: "Les plaies faites au dedans des Cuisses sont souvent cause de mort subite, quand elles penetrent en la grosse veine Saphene, ou grosse artere, et aux nerfs qui les accompagnent: ce que j'ay veu souvent advenir" and "Mais quand elles penetrent. profond6ment, souvent advient grands accidens, comme inflammation, aposteme, et pourriture aux membranes qui couvrent les muscles, qui causent que l'ulcere jette une tres-grande quantite de matiere, de fa^on que le malade meurt en atrophie, et tout desseicheV' . . . Ravaton (Chir. d'armee, ou Traite des plaies d'armes a feu, Paris, 1768, p. 321 et seq.) dwells on the importance of flesh wounds of the lower extrem- ities and cites many and exceedingly interesting examples of extensive lacerations, lodgement of missiles and other foreign substances. He details six cases of shot flesh wounds of the thigh (06s. 81, 83, 84, 85, 86, 87), an instance (Obs. 90) of shot wound of the knee, the missile opening the joint without lesion (sans toucher) of bone, and four cases of shot flesh wounds in the leg (06s. 91, 93, 94, 95), one of which (06s. 94) was followed by amputation of the leg. . . . Le Dran (H. P.) (06s. de Chir., Paris, 1731, T. I, p. 347) records a case of shot flesh wound of the thigh followed by repeated haemorrhages. WILLIAMSON (G.) (Military Surgery, London, 1863, p. 133), in a subsection on Simple Flesh Contusions and Wounds of the Lower Extremities, records 130 cases of this kind from the mutiny in India, 1857-58; 117 were slight, 13 severe. Of the 130 cases, 90 were returned to duty, 15 to modified duty, and 25 were invalided. . . . THOMPSON (JOHN) (Report of Obs., etc., after the Battle of Waterloo, Edinburg, 1816, p. 125) refers to several cases of extensive lacerations of the soft parts by large missiles. . . . Neale (John) (Chirurgical Institute, London, 1805, p. 247 et seq.). . . . GORDON (C. A.) (Lessons on Hygiene and Surgery, London, 1873, pp. 152,153) cites several examples of flesh wounds of the thigh, and on page 157 gives three cases of recovery after periarticular wounds of the knee joint. . . . Klebs (E.) (Beitrage zur Path. Anatomie der Schusswunden, Leipzig, 1872, pp. 42, 58) cites six obductions in cases of shot flesh wounds of the lower extremities—3 of the thigh and 3 of the leg. . . . Chenu (J. C.) (Apercu hist. stat. et clin. pendant la guerre de 1870-71, Paris, 1874, T. T, p. 278) very briefly adverts to two cases of flesh wounds of the thigh, one of the leg and a penetrating flesh wound of the knee joint, followed by traumatic arthritis. . . . Fischeu (H.) (Kriegschir. Erf, 1872, p. 164) says: " The wounds of the soft parts of the leg, as a rule, progressed very favorably. . . Much worse proved the wounds of the soft parts of the foot. Nearly always circumscribed or diffuse phlegmonous abscesses developed necessitating repeated incisions. . . . MacCormac (W.) (Notes and Recollections of an Ambulance Surgeon, London, 1871, p. 129) tabnlates 63 cases of wounds of the soft parts of the thigh without fracture, with 6 deaths, and 36 cases of wounds of the soft parts of the leg, with 1 death. Luckk (ALBERT) (Kriegschir. Fragen und Bemerlc, Bern, 1871, pp. 6-9) details six cases of shot flesh wounds of the lower extremities compli- cated by secondarj' bleeding, among them three cases of ligation of the crural artery, and remarks: "In recent injuries we yet ligate now and then successfully the crural artery, but we will more and more come to the conclusion rather to tie the external iliao than the crural artery." . . . SchDller (M.) Kriegschir. Skizzen, Hannover, 1871, p. 18) tabulates 136 cases of shot flesh wounds of the lower extremities. All recovered. . . . Schinzinger (A.) (Das Reserve-lMzareth Schwetzingen, Freiburg i. Br., 1873 p. 68) notes the gravity of shot wounds of the soft parts of the thigh after the battle of. Weissenburg. sect, n.l WOUNDS AND INJURIES OF THE HIP JOINT. 61 Section II. WOUNDS AND INJURIES OF THE HIP JOINT. In the important class of injuries of the joints, those of the hip joint are preeminently hazardous to life, obscure in diagnosis, and difficult in treatment. In the Surgical History of the War of the Rebellion, a comprehensive arrd systematic classification of this group of wounds and injuries should include the contusions and sprains and dislocations and simple fractures at the articulation, shot wounds involving the tendinous and ligamentous structures about the joint, or laying open the capsule, and shot fractures implicating the acetabulum or head, neck, and trochanters of the femur, examples of secondary coxitis from extension of inflammation, or septic infection from injuries of the upper part of the shaft, and lastly, cases in which operative interference at the hip is imperative from the extension of lesions of the upper part of the shaft to the articulation. Yet, in this Section, it is proposed to treat mainly of shot fractures involving the hip joint,1 and of operations at the hip following shot injuries, except in a single instance.2 There appear on the records notes of about thirty-five examples of luxations at the hip, fifteen simple fractures believed to implicate the hip joint, and forty-four cases returned as contusions or sprains at the hip; but these cases will be referred to in subsequent chapters of this volume, as more in accordance with the classification heretofore adopted. Examples of coxitis from periartic- ular wounds, in which the primary lesions were believed to be confined to the membranous or ligamentous or other adjacent soft tissues, were discussed in the last Section, and of instances of secondary coxitis from extension of lesions of the shaft we shall find many in the following Section on shot fractures of the shaft of the femur. In the preceding Section (pp. 26, 28) all pains has been taken to collect the obser- vations that were recorded of periarticular shot wounds at the hip, and details are referred to of all the facts that could be collected of forty-nine cases that were reported. Professor H. H. Smith3 and other systematic authors believe that shot wounds of the hip joint, unattended by injury of the bone, are very rare; but there seems to be a growing convic- tion among military surgeons that, owing to the extreme difficulties of diagnosis, many such cases may escape observation, or be misinterpreted until late in their progress. The early recognition of the precise extent of wounds of the hip joint is of the utmost practical ■JOHN Hennen, in his classical treatise, remarks: "The injuries occasioned by balls lodging near or about the joint of the hip are among the most serious of military surgery. The lever, the profuse discliarges, the tedious exfoliations, all tend to sink the patient, and are but too often fatal. In some of these cases the course of the ball is so obscure, and its place of lodgement so uncertain, that it can only be detected after death. I have seen balls lodged in almost every part of the trochanters, neck, and head of the bone, and yet the most accurate examination during life did not lead to a discovery of their situation."—Principles of Military Surgery, 2d ed., Edinburgh, 1S20, p. 155. 2 Among the coxo-femoral disarticulations one example will be cited where the operation was a re-amputation following an amputation in the continuity of the thigh for a bayonet stab in the knee joint, the only case to he adverted to not connected with shot wounds. 3 Professor H. H. SMITH (Princ. and Pract. of Surgery, 1863, Vol. I, p. 526) remarks that "wounds of the hip joint, uncomplicated by injuries of the bone, are seldom seen. The joint lies quite deep, and is protected by the shelving outward of the ilium and by the prominence of the great trochanter, An injury reaching it is almost necessarily associated with some fracture of the bones." 62 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. importance, and demands a careful and prompt examination to determine whether conserv- ative measures are admissible or if operative interference is advisable. Yet here the greatest obstacles present themselves. It must still be admitted, and cannot be too much impressed on the minds of surgeons, that far greater attention and care and trouble are requisite in these than in the injuries of other joints. Until comparatively recent years shot injuries of the hip were regarded as almost inevitably hopeless, and military surgeons enquired into them but little;1 but now it is agreed that recoveries may be obtained in this group of cases, either under conservative measures or by operative interference, and the 1 In the section on the surgical literature of shot wounds cf the hip joint with which Professor B. von Langeneeck prefaces his essay Ueber die Schussverletzungen des HUftgelenks, read before the second session cf the German Surgical Congress, April 19,1673, and printed in the Archiv, B. XVI, S. 264, the learned professor observes that in ancient military surgical literature we find wounds of this joint seldom mentioned. This is emphatically true. Not only in SCHENCKIUS, of Graeffenburg, who laboriously summarized the labors of his predecessors in chronicling rare cases, in PLATER, in FABRICIUS HILDANU8, in the monumental BONETUS, and in other collectors of curious pathological observations, one searches in vain for instances of wounds of the hip; but we scan the writings of the early teachers who treated specially of shot injuries with as little success. MAGGIUS, FERRIUS, ROTA, and the excellent BOTALLUS, VIGO, FELIX WURTZ, HlERONYMUS of Braunsweig, GERSDOKF, and even the so-called father of modern army surgery, AMDROISE Pare, are silent on this subject. At last, toward the end of the seventeenth century, we find a detailed example of recovery from a shot wound of the hip. MATTHIAS GOTTFKIF.I) PURMANN (Funffttig Sonder- und Wunderbahre Schusswunden Curen, Frankfurt, 1721, Obs. XLIII, p. 324) relates the case of Pt. S. Kirsky, of the regiment Gotz, wounded at the siege of Stettin, 1677, in the right hip by a falconet ball, injuring ilium and upper portion of femur. Recovery in twenty weeks, with complete anchylosis of hip. In the writings of English surgeons of the time, in GALE, WISE- MAN, BROWN, and RANBY; among the Germans who were then eminent for treating of shot wounds, Heister, THEDEN. and Sc'HMUCKER; and of French authors who refer particularly to 6hot wounds of the joints, like LeDuan, GARENUEOT, and FAUDACQ, we look in vain for instances of shot injuries implicating the hip. MORAXD and Ravaton, it is true, in the middle of the eight- eenth century, advocated coxo-femoral amputation for shot fractures high up in the femur, but do not allude to any fractures at or above the trochanters. BlLGUER, who cites (Chirurgische Wahrnehmungen, Berlin, 1763, p. 398 et seq.) 117 cases of shot injuries of tho lower extremities during the years 1756-02, among them cases of wounds of knee and ankle joints, gives not a single instance of a shot injury of the hip joint. JEAN Mehee (Traite des plaies d'armes d, feu, Paris, An. VIII—1800), who systematically divides the wounds of the joints into three classes, those of the lower joints (ankle and wrist), middle joints (knee and elbow), and upper joints (hip and shoulder), and who cites numerous examples, only gives examples of wounds of the shoulder joint in the last-named class, and entirely omits wounds of the hip joint. The next definite instance of shot injury cf the hip joint found in surgical annals is remark- able on several accounts. The case is recorded by Dr. JAMES JOHNSTONE, of Worcester, in the London Medical Journal, 1786, Vol. VIII, pp. 135-140. Dr. JOHNSTONE took pains to have prepared a drawing the size of nature, representing the exfoliated fragment of the head of the femur, which is accurately copied in the annexed wood-cut, Figure 24. The case was attended by Mr. Joseph Bran- dish, a " deserving surgeon and apothecary, at Alcester," and has been sometimes cited as an early example of excision at the hip for shot injury. Mr. BRANDISH treated a lad aged 12, who had accidentally shot himself December 23, 1783. The contents of the gun "passed into the upper part of the thigh, adjoining to the middle of the groin, and came out about the middle of the glutaeus maximus." Several successive abscesses were formed, and several exfoliations came away; one, in particular, which appeared to be a considerable portion of the head of the thigh bone with a shot sticking in it. Much as Baron LARREY has to say of oper- ations at the hip joint, he only once describes, a case of shot fracture involving the hip. It appears in the Clinique Chirurgicale (1836, T. V, p. 242): A young officer of the 9th deini-brigade of Infantry of the army of Egypt, at the siege of tl e head oT^e'femur^^o'iiter Alexandria, was wounded at the outer and upper part of the left thigh, the ball surface of exfoliation; 2, same embedding itself in the neck of the femur. The officer recovered with anchylosis bone, showing cancellous surface 0f tne mp- The presence of the missile was not recognized until after the death FlG- 25.—Musket ball lodged in with (A) lead shot sticking in it. ... ... . ., ,, ~ iV. . . ,„, . the neck of the left femur. [After [After JOHNSTONE, op. cit] of the l,atient' at B™xelles, twenty years after the injury. The specimen was legou^ l presented to Baron LARREY by Dr. SEUTIN, and ultimately was deposited in the Museum at Val-de-grace. Professor LEGOUEST had a drawing made of it, which is copied in the adjacent wood-cut (Fig. 25). The chief British surgical authorities in the great Napoleonic wars, Hennen, Guthrie, and Ballingall, cite no cases of shot wounds of the hip. Hennex, in his classical Observations, dwells (3d ed., 1829, p. 158) on the extreme difficulties of detecting the course of balls lodged in this region. "I have seen," he remarks, "balls lodged in almost every part of the trochanters, neck and head of the bone, and yet the most accurate examination during life did not lead to a discovery of their situation." Dr. John Thomson (in his Report of Observations made in the British Military Hospitals in Belgium after the Battle of Waterloo, 1816, p. 123) refers to a case of wound of the hip joint, in which the ball lodged; paralysis was produced, and great swelling of the foot and leg supervened; and to another case, in which the head and neck of the thigh bone together with the acetabulum were, at the autopsy, found in a diseased state: and to one or two other cases which seem to have progressed favorably but were not followed up to the final issue; and to other instances where the ball, without penetrating the capsule of the joint had injured the parts around it, inducing abscesses in the joint and ulceration of the articular cartilages, with softening and absorption of the head and neck of the femur. Writers on more recent wars have cited but few cases and very few of recovery. Muxieue (P.) (V Hotel-Dieude Paris en Juilletct Aout, 1830, Paris, 1830, p. 16) gives the case of M. Firer, aged 23, shot fracture of head of femur. Death August 30, 1830. Jodert (A.J.) (Plaies d'armes a feu, Paris, 1833, p. 247) cites two cases of recovery after shot wounds of the hip joint received in the Paris Revolution of 1830. BAUDKXS (M. L.) (Clinique des Plaies, etc., Paris, 1836, p. 445) relates a fatal case, in which the ball had perforated the head of the femur, in Algiers, November 15, 1835, and adds: "Had I remained at the Algiers Hospital I should have practised disarticulation or resection." ALCOCK (J.) (06*. on Injuries of the Joints, in Med.-Chir. Transact., 1840, Vol. XXIII, p. 261) tabulates four cases of shot wounds of the hip; *but in two only the joint was primarily involved; both were fatal. MACLEOr (G. H. B.) (Notes on the Surgery of the War in the Crimea, London, 1858, p. 309) relates the case of A. McPhail, aged 33, wounded at Dubba, March 24, 1843, by a matchlock ball, which entered anteriorly above the great trochanter of the ri«-ht limb. The wound in the skin cicatrized; but the patient died of tetanus, May 9, 1843. The ball was found embedded in the head of the femur, having fractured the brim of the acetabulum. The specimen is preserved in the Fort Pitt Museum, and numbered 2604. Hyrtl (J.) (Handbuch der topog. Anatomic, Wien, 1865, p. 534) relates the case of a member of the national guard, wounded in 1848; the neck of the femur was fractured; the <£W SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 63 credit of surgery, and still more the interests of humanity, imperatively require that the most favorable periods and conditions of treatment should be diligently sought. Drs. H. H. Smith,1 H. Fischer,2 E. Klebs,3 B. Langenbeck, and other modern writers on military surgery, have dwelt on the inaccessibility of the parts to exploration through the long narrow shot tracks produced by missiles of comparatively small calibre, on the frequent absence of shortening or displacement, or escape of synovia, or indeed with scarcely any serious disturbance of the functions of the joint, until the inflammatory and infiltration patient recovered. Stromeyer (L.) (Maximen, u. s. w., Hannover, 1855, p. 756) tabulates five cases of shot fractures of the neck of the femur from the Danish War, 1848-1800; all were fatal. Two of these five cases are detailed by Dr. II. Schwartz (Beitrage zur Lehre von den Schuss- wunden, Schleswig, 18o4, p. 143). J. J. COLE (Military Surgery, etc., London, 1852, p. 13C) cites a case of fracture of the neck of the femur during the war in India, 1848-49, but the result is not recorded. BERTHERANI) (A.) (Campagnes de Kabylie, Paris, 1862, p. 301) relates the case of Mohammed ben Achmed, shot in the right hip joint at Ieheriden, June £5, 1857; death, August 31st. MATTHEW (T. P.) (Med. and Surg. Uist. of Brit. Army, London, 1858, Vol. II, p. 351) refers to three cases of wounds of the hip joint in the Crimean War, which proved fatal in a few hours. CHENtJ (J. C) (Rapport au Conseil de Santi des Armies de Campagne d'Orient, Paris, 1865, p. 372) tabulates 30 cases of shot wound of the hip joint, of which two recovered. The same author (in Rapport, etc., de Campagne d'ltalie, Paris, 18(19. T. II, p. 690) groups 26 cases of shot wounds of the coxo- femoral region, of which 1G recovered, hut it is not even indicated whether the wounds were fractures or simple flesh wounds. Demme (II.) (Mil. Chir. Studien, Wiirzburg, 1861, p. 252) details two cases of recovery after shot fractures of the bones of the hip joint. IlEIXE (C.) (Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 365) records four cases of shot wounds of the hip joint from the Schleswig-Holstein War of 1864 ; all proved fatal. STROMEVER (L.) (Erfahrungen uber Schusswunden im Jahre 1866, Hannover, 1867, p. 8) tabulates four fatal shot fractures of the hip joint treated at Langensalza. LANGENBECK (B. v.) (Vber die Schussverletzungen der Hiiftgelenke, in Arch, fur Klin. Chir., 1874, B. XVI, p. 270) relates the case of Major J. Preuss, wounded in the hip joint at Milnchengratz, June 28, 1866. The patient died September 13, 1867; and another fatal case of a soldier wounded in 1864. In the latter instance, the autopsy showed that the ball had entered the outer point of the left trochanter major and passed through the neck of the femur in its length into the acetabulum. BRUCE (A.) (Observations in the Military Hospitals of Dresden, London, 1866, p. 24) describes the case of a Prussian wounded at Sadowa, July 3, 1866, which terminated fatally. BlEFEL (R.) (Im Reserve-Lazareth, in LANGENBECK's Archiv, B. XI, p. 441-2) treated a case of shot fracture of the hip joint at Landeshut, in 1866, which proved fatal on the 17th day. In the Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 309, B. v. LANGENBECK tabulates 25 cases of recovery and 63 fatal cases after shot wounds of the hip joint, during the Franco-Prussian War, 1870, collected from various sources. Among the cases of recovery he cites the case of R. Rousseau (Case 12, p. 313), observed by Dr. SCHINZINGER, although the latter (Das Reservelazareth Schwetzingen, Freiburg, i. Br. 1873, p, 56) distinctly states "hip joint intact" (Huftgelenk intact); also the case of Schaefer (CASE 19, p. 315), observed by SOCIN (Kriegschir. Erf., Leipzig, 1872, p. 135), who remarks that the patient died, on the 188th day, of exhaustion. Of the ten cases treated by himself, Professor LANGENBECK had the satisfaction of recording eight recoveries. Stabsarzt DEIXIXGER, of the Railway Battalion (Beitrage zur den Schussfracturen des HUftgelenks unter besonderer Beriicksichtigung der Erfahrungen aus dem Feldzuge 1870-71, und Benutzung der Aden des Kiiniglichen Kriegsministeriums, in Deutsche Militairarztliche Zeitschrift, 1674, B. Ill, p. 314), in his statistics describes 66 cases of shot wounds of the hip joint, of which 13 recovered. All but 15 of these cases are contained in von LANGENBECK'S enumeration. Of the 15 cases not contained therein (CASES 5, 6. 7, 8, 31, 32, 33, 37 [Recoveryl, 38 [Recovery], 49, 50, 51, 54 [Recovery], 56, 58), 12 were fatal while only 3 recovered. Besides the cases collected by Professor von LANGENBECK and Dr. DEINTNGER I have found the following from the Franco-Prussian War of 1870-71, not contained in the tables of either. Assistant Surgeon EvERS, Saxon train battalion No. 12 (Gelenkwunden und ihr Ausgang, in Deutsche mil-arztl. Zeitcshrift, 1874, B. Ill, p. 381), gives the case of Frode, wounded August 29, 1870; ball penetrated the right hip joint; patient recovered but is totally disabled. LOSSEN (H.) (Kriegschir. Erf. etc., in Deutsche Zeitschrift fur Chir., 1873, B. II, p. 64), case of Th. Margaillon, 22d French Infantry, shot wound of neck and trochanter of left femur, August 18, 1870; died September 4, 1870. MAYER (L.) (Kriegschir. Mitth., etc., in Deutsche Zeitschrift fur Chir., 1873, B. Ill, p. 47), case of Sommerfeld, 3d Prussian Jaegers, shot fracture of head and neck of femur; fatal. The cases referred to in this note give a total of 173 cases with 38 recoveries, 134 deaths (a fatality of 77.9 per cent.), and one result unknown. 1 SMITH (H. H.) (The Principles and Practice of Surgery. 1863, Vol. I, p. 526) says: " The diagnosis is difficult, as the joint lies so very deep as to be almost beyond the reach of the finger. There may be neither shortening of the limb nor eversion, and at first the patient may be able to move the limb without very much pain." 2ProfessorH. FISCHER, of Breslau, in his Kriegschirurgische Erfahrungen Vor Metz (Erlangen, 1872. p. 201), remarks on the difficulties encoun- tered in diagnosticating wounds of the hip joint: " The deep position of the bip joint, strongly protected by thick layers of muscles ; the generally long wound-canal, the termination of which is so difficult to determine; the absence of all severe disturbance of the functions of the joint, and the very trivial subjective complaints of the patient, render it often impossible to determine precisely the lesion soon after the injury. All authorities, from Larrey and GUTHRIE to contemporary surgeons, agree in this. LEGOUEST relates (Chirurgie d'Armie, 2» s (Military Surgery, in Am. Jour. Med. Sci., 1867, Vol. LIV, p. 447) that "those surgeons who pointedly condemn all efforts to save the limb after gunshot fracture of the surgical or anatomical neck of the thigh bone, exercise, in our judgment, but little discrimination, wheu they declare, as does the surgical historian of the late American War, that 'experience has demonstrated the uniform fatality of gunshot fractures of the head or neck of the femur when abandoned to the resources of nature,''' and that "no statement can be farther from the truth." The compiler of the surgical report in Circular No. 6, S. G. O.. 1865, might have said "almost uniform fatality," but his statement, if lacking qualifica- tion, was assuredly not widely apart from the truth. 2DEMME (H.), Spec. Chir. der Schusswunden, Wiirzburg, ]S64, S. 348. Piuogoff (\), Grundzuge der Allg. Kriegschir., Leipzig, 1864, p. 814. GROSS (S. IV.). Military Surgery, in Am. Jour. Med. Sci., 1867, Vol. LIV, p. 447. SPILLMANN, Etude Anal, et Crit. d'un Rapport sur la Resiction de la Tetedu Femur, Paris, 1870, Extrait du Rcc. de Mem. de Med. de Chir. et de Pharm. Mil., 3m« se>., T. XXVIII, 1870, p. 48. LANGENBECK (B. VON), Ueber die Schussverletzungen des HUftgelenks, in his Archives fur Klin. Chir., Berlin, 1874, B. XVI. p. 263, and translated as Surgical Obs. on Gun-shot Wounds of the Hip-Joint, by James F. West, F. R. C. S., iu Birmingham Med. Review, Vol. V, 1876, pp. 29, 88, 167. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 67 N. Pirogoff, Dr. S. W. Gross, Dr. E. Spillmann, and Professor B. von Langenbeck, have taught latterly that the expectant plan of treatment of shot injuries of the hip joint is inadequately appreciated by surgeons, and have collected instances more or less apposite to prove that the commonly received opinion that such injuries are uniformly fatal when abandoned to the resources of nature is altogether fallacious.1 It cannot be legitimately contested that, in very rare instances, of shot wounds involving the hip joint, life may be preserved without operative interference. A remark- able case, that has seldom been cited, was reported by Surgeon J. B. Porter, of the recovery, under expectant treatment, of a soldier wounded at Vera Cruz, August 3, 1847, by a mus- ket ball that shattered the neck of the right femur.2 The case observed by Brandish, in 1783, where a lad of twelve survived the exfoliation of a large fragment of the head of the femur with a lead shot sticking in it, demonstrated that such injuries are not inevitably fatal. Though the instances of recovery under expectant measures from shot injuries at the hip quoted by Dr. S. W. Gross from D. J. Larrey and M. Legouest were cases of extracapsular fractures at the trochanters, yet the case of recovery given by Hyrtl, and that observed by M. Legouest in the French soldier at Solferino, and that recorded by M. Boinet, of the soldier wounded in 1830, at Nantes,'were indisputably illustrations of the successful terminations of shot injuries at the hip treated on the expectant plan. Of the twenty-five examples tabulated by Professor Langenbeck of shot injuries of the hip joint recovering under conservative treatment in the Franco-German War of 1870-71, it is incontestable that at least twenty-one appear to be indubitable examples of recovery after intracapsular shot fractures of the hip, implicating either the neck or head of the femur or the acetabulum, while four of the series are open to objection.3 In the large series of three hundred and four cases of shot injuries reported from the American civil war of 1861-65, a number of recoveries under expectant treatment are alleged. Recoveries after Shot Fractures at the Hip under Conservative Treatment.—Of fifty- five tabulated examples of recovery, one is referred to the series of eleven cases in which the osseous lesion was confined to the acetabulum: Case 133.—Private J. L. Harvey, Co. F, 12th South Carolina, appears on a Confederate certificate of disability as having been retired from service, February 18, 1865, by reason of " gunshot wound of right hip, partially destroying the acetabulum and luxating the head of the femur; lameness consequent upon the luxation resulted." There is no evidence that the diagnosis proposed in this case by the Retiring Board had been entertained at the time the injury was received. 1H. Demme's 2 cases of alleged recovery from shot fracture involving the hip joint are those of C. Borelli and Franz Veter, wounded at Magenta, June 4, 1859 (Demme, Mil.-Cliir. Studien, Wiirzburg, 1861, pp. 252, 253). N. PlROGOFF'S 20 cases " observed in full process of healing," but not identi- fied by names, dates, or ulterior histories, are alluded to in Pirogoff's Grundzuge der Allgemeinen Kriegschirurgie, Leipzig, 1864, p. 814. Dr. S. W. GROSS quotes the 22 cases of Demme and Pirogoff, 1 case mentioned by the elder Larrey (Clin. Chir., 1836, T. V, p. 242. See Fig. 25 in foot-note to p. 62, ante), 1 case of Hyrtl, in 1848 (Handb. der topog. Anat., Wien, 1865, p. 534), 3 cases witnessed by Legouest and described by him as shot fractures of the trochanters (Rec. de Mem. de Med., de Chir., et de Pliar. Mil., 1855, 2°"' s6r., T. XV, p. 240), 1 case (Vanderheck) related by Professor F. H. Hamilton (Treat, on Mil. Surg., 1865, p. 397), 2 cases (Bugh and McCabe) reported by Dr. B. B. Miles, and 1 case that occurred"to Brandish in 1783 (see Fig. 24 and reference in foot-note to p. 62, ante), and claims that this resumed of 31 cases conclusively shows that attempts to save limbs after shot fractures of the hip are far from hopeless. Professor E. Spillmann adds no facts, but urges that such positive testimony as adduced by Demme, Pirogoff, and H. Laurey (Bui. de VAcad. de Med., T. XXVII, 1861, p. 138) in favor of conservation should not be lightly rejected. Professor B. VON Langenbeck, finding in ancient and recent military surgical literature few examples of recovery, under conservative treatment, in shot fractures at the hip, presents tables of 25 cases of recovery after shot wounds at the hip joint in the Franco-German War of 1870-71, and of 63 fatal cases under like treatment. 2Porter (J. B.), Medical and Surgical Notes of Campaigns in the War with Mexico, in Am. Jour. Med. Sci., 1852, Vol. XXIII, p. 34. 'Langenbeck (B. VON), Ueber die Schussverletzungen des HUftgelenks, in Archiv fur Klin. Ghir., 1874, B. XVI, pp. 309-316. In Dr. ScHDJZDt- oe«'8 case, No. 12 of the Table, of R. Rousseau, Dr. S. states positively in his report "Das Reserve-Lazareth Schwetzingen, Freiburg i. B, 1873, p. 56," "recites Httftgelenk intact." In Professor H. Fischer's case of Renz, numbered 18, the author in his work "Kriegschirurgische Erfahrungen, Vor Metz, Erlangen, 1872, p. 173, pronounces the injury extracapsular. In Professor Soctn's case of Sebaeffer, numbered 19, the patient died of exhaustion on the 188th day, as noted by Professor SOCTN in his Kriegschir. Erfahrungen, Leipzig, 1872, p. 135. The case ascribed to Dr. W. MACCORMAC (Notes and Recollections, eto., London, 1871, p. 118) is invalid, amounting only to the numerical statement that of three patients with hip joint shot wounds at Sedan, two died. 68 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Of the thirty-three shot injuries in Table IX involving the "acetabulum and head of femur" and treated without operative interference, one terminated in recovery. Accounts of - this remarkable case have been heretofore published by Dr. J. F. Miner, and by the editor of this volume in the Surgical Series of Photographs of the Army Medical Museum, Vol. IV, No. 6, 1866, in Circular No. 7, S. G. 0., 1867, p. 74, and in Circular No. 2, S. Gh 0., 1869, p. 105. Additional information, gathered from the records of the Pension Office since the date of the latter publication, has been added to the history, and the appearance of the patient's limb four years after the date of the injury is represented in Plate LVII. This well known case has been very generally cited by writers on military surgery as an incontestable example of recovery without operative interference after shot fracture of the articular surfaces at the hip:1 Case 134.—Lieutenant Colonel James C. .Strong, 38th New York, was wounded at the battle of Williamsburg, May 5, 1862, by a conoidal musket ball, which entered the right thigh in front, a little below the groin, and made its exit through the buttock, over the lower right-hand border of the sacrum. Surgeon A. J. Berry, 38th New York, examined the wound, and found that the ball had deeply grooved the head of the femur and had fractured the upper rim of the acetabulum. A detached fragment of the rim nearly an inch and a half in length, a part of it covered with articular cartilage, together with portions of clothing, were extracted from the wound. On the 8th of May the patient was transferred, by a steamer from Queen's Creek Landing, to the Hygeia Hospital at Fort Monroe. Here he remained until the 13th, when he undertook a painful journey of five days, on a litter, and reached his home in Buffalo. The injured limb was semiflexed and rotated inward, the head of the femur being dislocated upon the dorsum of the ilium. Any attempt to place the limb in position produced such acute suffering that the effort was abandoned. For ten weeks there was profuse suppuration, with burrowing of pus in the thigh and intense pain, with chills, profuse perspiration, and great prostration, after which a very gradual amendment took place. On December 12, 1862, the patient was removed to Philadelphia, and entered the Officers' Hospital, at Camac's Woods, where he was able to bear treatment by Buck's method of extension by weights. Here a number of spicule of bone were extracted or washed from the wound. On January 6, 1863, the patient was discharged from hospital. On June 1st the wounds were nearly closed, and he rejoined his regiment on crutches, and was mustered out with the regiment on June 22, 1863. On September 29th he was appointed Colonel in the Veteran Reserve Corps. He was subsequently brevetted Brigadier General. In July, 1866, he visited the Army Medical Museum, when his photograph was taken. This is represented in the lithograph opposite, Plate LVII. General Strong was in good health. His limb was shortened nearly five inches, but by the flexibility acquired by the lumbar vertebra, the inclination of the pelvis and extension of the toes, he was enabled to walk with surprising ease with or without a cane. The head of the femur was firmly anchylosed on the dorsum of the ilium. The cicatrices appeared sound. Early in 1869 General Strong was in Washington, at Willard's Hotel, and sprained his ankle in falling in a dark corridor. The compiler was summoned to see him, and found that he had but little trouble with his anchylosed hip joint, and that his general health was excellent seven years after the reception of so grave an injury. The various reports of the Pensiou Exam- iners reiterate substantially the same account of the injuries until the report of January, 1875, of the Buffalo Board. Drs. H. R. Hopkins and M. B. Folwell state that "the ball destroyed a large portion of acetabulum and allowed dislocation of head oi femur upon dorsum of ilium, where it now remains permanently and firmly fixed. Limb shortened about five inches. Thigh six inches smaller than fellow. The pensioner claims partial hemiplegia of right side during the past two years, which, in the lower extremity, has apparently been on the increase, but is rather to be ascribed to the progressive atrophy of the muscles of the limb. Since the attack of hemiplegia he has not been able to dress himself." On June 6, 1877, Examiners H. R. Hopkins and M. B. Folwell add: " Ball entered four inches below the origin of the sartorius and came out at right margin of lower edge of sacrum; there is loss of a portion of the acetabulum and dislocation of femur on dorsum of ilium, with shortening of five inches • the thigh is six inches smaller than its fellow; patient claims incomplete hemiplegia of right side, which is increasing in lower extremity; is unable to dress without the aid of another person to put on his sock. He further states that upon receipt of a 1 MINER (J. F.), Gunshot Wound, with removal of rim of acetabulum and dislocation of femur, in Buffalo Med. and Surg. Jour., May, 1866, Vol. V, p. 380. Dr. MINER, who attended Colonel Strong after his painful transit from Williamsburg to Fort Monroe, and thence, starting May 13th, to New York by water, and thence by rail to Buffalo, a distance in the aggregate of 842 miles, first published an account of the case, remarking that " perhaps the whole surgical history of the rebellion will not furnish a parallel." The regimental surgeon, Dr. BERRY, died soon after the battle of Williamsburg, and the records of Hygeia Hospital and Camac's Woods afford only the scanty data recorded in the text. The photograph from which the lithograph was copied was taken at the Army Medical Museum in July, 1866, and numbered 156 of the Surgical Series of Photographs, Vol. IV, No. 6, and a history was compiled by Assistant Surgeon G. A. OTIS, U. S. A., from the hospital records above noted and from General Strong's oral statement, and this was reproduced in Circular No. 7, S. G. 0., 1867, p. 74, and in Circular No. 2, S. G. O., 1869, p. 105, with notes of the subsequent progress of the case by the same editor. Professor E. SPILLMAN, of the military medical school of Val-de-Grace, has translated the case in full in his important £tudeanalit- ique et critique sur la resection de la tete du femur, Paris, 1870, as an incontestable example of recovery from an intracapsular shot lesion obtained " not by expectation, but by conservative surgery, a most important distinction." The history of the case has been cited by a number of European writers, most of whom have quoted, not the reports of Drs..MlNEE or Otis, but a careless summary in the Jahresbericht, in which the report of the case is ascribed to the late Dr. A. H. HOFF. At page 70 of Circular 7 is an extended citation from Dr. HOFF'S views of the treatment of shot injuries at the hip, and the reviewer has inadvertently ascribed to Dr. HOFF not only the succeeding illustrative cases of recovery without operation after shot injuries at the hip joint, but also the entire compilation of Circular 7. Professor B. v. Langenbeck in his memorable discourse Ueber die Schussverletzungen des HUftgelenks, in three places (in Archiv fur Klin. Chir., B. XVI, S. 265 and 285) has been misled by this erroneous reference. Even his translator, Dr. JAMES F. WEST, in his English version of Surgical Observations of Gunshot Wounds of the Hip Joint, in the Birmingham Medical Review, 1876, VoL V, p. 31 and p. 89, and issued separately in pamphlet form, fails to correct this error, although he has acknowledged his indebtedness to the Surgeon General s Office for copies of the Circulars on the hip joint, and professes to append an abstract of Circular 7. *:i ''"i'".^.^!^"' vl-:''. '' ' * V '•J' ' 1 *' ""V- lafctfi .'iT * ■7 1] *V,1 cm - RAC1 un< ircvlar iNr<">. - .■!!-.! ih. ' ■r .^- ^i' the .tie of William- 'i'-. May 5. -,,d nm<'io i's v- :hr.;;it'h the ..; ,-,. ; n '■■•• 1 tl' v.' 'fid, aTc'fbun'i I .n'.i-ta ■■>';. . '- •'■ •laclu-d Mel.and Suro. Hist of the Wm of the Rebellion.Pari III , Vol.II,<'hap X Ward phot .' Bien lith PLATE LVII. GUNSHOT FRACTURE OF THE RIGHT ACETABULUM AND THE HEAD OF THE FEMUR i>i.uici .l.un.-s r.Sim :W* N,.w York SECT, n.l SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 69 wrench or twist of foot, he has sudden pain running up the limb and spine to the head, causing convulsive action, lasting from one to four hours, followed by confinement to the house for two or three days. These attacks occur only as the result of violence to the ankle or foot." The Examiners state that they are unable to conneot the disability claimed with the original injury, and are of the opinion that the present degree of his disability does not require the constant attendance of another person or entitle him to an increase. The pensioner's brother and wife certify that since he was wounded he has always required and does now (April 28, 1877) require the attendance upon him of another person, and that the attacks of nervous prostration, occurring at times as often as once a week, and sometimes taking on the character of a violent mania, are such as to make it unsafe for him to go about alone. The pensioner was paid to September 4,1878, having survived his terrible injury over sixteen years. In eleven cases of recovery the reports state that the "head of the femur" was involved. The testimony in regard to the opening of the articulation in these cases is very inadequate; one will serve as an example •} Case 135.—Private Jacob Wright, Co. E, 96th Pennsylvania, aged 17 years, was wounded at Spottsylvania, May 8,1864, by a conoidal musket ball, which fractured the head of the right femur. He was captured and remained in the hands of the enemy until August 14th, when he was paroled and conveyed by steamer to Annapolis, Maryland, and admitted into hospital No. 1. The diagnosis here was wound of the left thigh. On September 21st he was transferred to Camp Parole, and thence, on February 17, 1865, to Rulison Hospital, at Annapolis Junction. A fracture of the head of the right femur was diagnosticated. On April 13th he was transferred to the Satterlee Hospital, at Philadelphia. A gunshot wound in the upper third of the left thigh was recorded. July 16th, he was sent to the McClellan Hospital. A gunshot fracture of the upper third of the left femur was reported. Necrosis of the femur existed. He was discharged from service on September 9, 1865. His disability was rated at one-third. The case is reported by Assistant Surgeon John Bell, U. S. A. Pension Examiner G. M. Masser, of Scranton, Pa., reported, November 1, 1866: " Gunshot wound of left thigh; fracture of the os femoris near trochanter, with dislocation down- ward, causing a lengthening of the leg three inches more than the right leg; is very lame and wound still discharging. Is unable to perform manual labor." The Scranton Board reported, September 4,1877 : "Ball entered left thigh through trochanter major, passed through gluteal muscles and coccyx; loss of a portion of trochanter, great loss of soft parts, and adhesion of muscles. The whole limb is covered with a network of large varicose veins. Disability equivalent to loss of limb." The following is a case in which the head and neck of the femur was reported to have been injured; it was successfully treated without operative interference; but the evidence is entirely insufficient to prove an intracapsular fracture: Case 136.—Sergeant James M. Adams, Co. D, 13th Georgia, aged 37 years, was struck, in the action at Monocacy, July 9, 1864, by a round musket ball, which slightly injured the head and neck of the left femur. He was conveyed the following day to the General Hospital at Frederick City. A gunshot wound of the left thigh and hip, involving the joint, was diagnosti- cated. Simple dressings were applied, and tonics and stimulants were given. Extensive abscesses formed in the anterior and posterior parts of the thigh. On September 20th the patient was conveyed to West's Buildings Hospital in Baltimore, and was transferred thence, on October 27,1864, to Point Lookout, Maryland, for exchange. Surgeon A. Chapel, U. S. V., reports the case. 'The remaining ten cases were: 1. Pt. J. Hughes, G, 1st Alabama Cavalry, Hartsville, Tenn., April 11, 1863, shot fracture head of femur; recov- ered and applied in person to a Confederate relief association for a suitable apparatus. Mr. Hughes resided in Crawford County, Arkansas. The case is recorded in the register of a Confederate Relief Association (Circular No. 2, S. G. O., Washington, 1869, p. 74).—2. Pt. G. A. Crymes, B, 22d Virginia Battery, Chancellorsville, May 2, 1863; shell fracture right femur, involving head of bone; Nov. 11th, shortening and partial anchylosis; furloughed for sixty days (Circ. 2, p. 98).—3. Serg't F. M. Hunter, Co. E, 24th Tennessee, age 24, Resaca, May 15, 1864; appeared January 27, 1865, before Con- federate examining board, who reported: "Wound by musket ball entering the superior articulation of right thigh, (teusing partial paralysis; disability permanent. Soldier is unable to serve the government in any capacity;" retired from service (Circ. 2, p. 99).—4. Colonel L. S. Slaughter, 56th Virginia, June 27, 1862; gunshot wound of thigh with a fracture of the femur, which was believed to involve the hip joint; he appeared before a medical examin- ing board, of which Surgeons CKENSHAW, Read, and Peebles were members, and was retired from service on account of "gunshot wound upper third of thigh, fracturing head of hone;. deformity, shortening, and permanent loss of usefulness of limb" (Circ. 2, p. 99).—5. Pt. I. S- Smith, H, 2d North Carolina, age 22, Chancellorsville, May 3, 1863. Confederate Surgeons W. A. HOLT and F. W. HENDERSON certified to shot wound of right hip joint, fracturing head of femur, resulting in necrosis of femur. A Confederate board of examiners certified that he was permanently disabled on account of two gunshot wounds: one a wound of the left wrist, resulting in anchylosis of the joint and partial loss of use of the hand ; the other wound through right hip, fracturing femur; wound still open and discharging; locomotion difficult and painful; retired from service (Circ. 2, p. 99).—6. Pt. R. Finkle, H, 15th Illinois, age 31, Shiloh, April 6, 1862; discharged at Marine Hospital, Chicago, August 9, 1862, on certificate of disability, by Acting Assistant Surgeon R. N. I6HAM, for "wound of right nates with injury of femur." Examiner W. W. BURNS certified, September 14, 1863: "Bullet entered hip on posterior side, passed obliquely throngh to the front, and fractured the head of the femur."—7. Pt. J. Kivel, B, 12th Wisconsin, age 21, Atlanta, July 5, 1864. At hospital No. 2, Chattanooga, and at Cumberland Hospital, Nashville, the injury was reported as a " conoidal ball wound of the left hip;" at Jefferson- ville Hospital as a "shot fracture of the left ilium, anterior spinous process." He was discharged at Swift Hospital, Prairie-du-Chien, May 22, 1865, for "shot wound of left hip, fracturing head of femur." Examiner C. COWLE6, of Baraboo, reported, September 29, 1867: "Ball entered left groin and passed obliquely backward and downward close to the head of the femur."—8. Pt. W. Swank, C, 78th Ohio, age 26, Atlanta, July 22, 1864. Surgeon J. BENSON, 14th Wisconsin, from the field hospital, reported: "Gunshot wound of pubes and scrotum." Ass't Surgeon G. SAAL, V. S. V., reported, from Seminary Hospital, Columbus : "Gunshot wound of left groin, ball lodging." He was discharged at Marine Hospital, Cincinnati, November 16, 1865, for "inguinal hernia of right side and partial anchylosis of left hip joint from gunshot wound, ball entering groin and lodging near bead of femur." Exam- iner T. A. REAMY certified that the ball entered from the right side, midway of Poupart's ligament, passed into the left groin and lodged in the head of the femur, shattering it. The Columbus examining board certified that the ball impinged upon the horizontal ramus of the pubis, remained lodged for seven years, and was finally removed just below the tuberosity of the ischium.—9. Pt. O. Wilson, C, 13th Iowa, age 24, Atlanta, July 21, 1864 ; a "shot, wound of left thigh" was recorded at the field hospital. At the hospital at Keokuk, Surgeon M. K. Taylor reported: " Penetrating wound of left hip, fracture of trochanter major; ball entered posteriorly to hip joint and lodged beneath the integuments of the left groin. Ball removed by an incision two inches long over the point of lodgement." Mustered out May 15, 1865. Examiner S. O. WHALEY, of Osceola, certified, in September, 1873: " Shot wound of left hip by canister shot entering about 1J inches behind trochanter major and passing to groin, same side, where it was taken out, in its passage destroying the head of the femur and part of the acetabulum."—10. Pt. C. Wilson, A, 20th Georgia, Chickamauga, September, 20,1863; in an applica- tion for retirement from the Confederate army it is stated that he was furloughed from the Confederate hospital at Fort Valley, Georgia, March 29, 1865, for " gunshot wound of right hip, fracturing head of femur, resulting in anchylosis of the joint and deformity of the limb." 'u INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Twenty-six recoveries after shot fractures of the "neck of the femur" were reported. Several of these patients have since died, and it is to be regretted that it was imprac- ticable to obtain records of the autopsies, if such were made. Twelve of the cases are here detailed.1 Case 137.—Captain William A. Bugh, Co. G, 5th Wisconsin, aged 35 years, was wounded at the engagement at Wil- liamsburg, Virginia, on May 5, 1862, and after lying a few hours on the field he was removed to a temporary hospital, and thence to a hospital transport in the York River and sent to Baltimore, where he was received at the Camden street U. S. A. General 1 Brief accounts of the remaining fourteen cases are here adduced: 1. Pt. J. W. Galyean, E, 10th Indiana, age 28, Atlanta, August 6, 1864; severe injury near left hip by conoidal ball, thought, however, to have only involved the soft tissues; treated in various hospitals, and discharged May 24, 1865- Examiner C. Hays, of Warsaw, Indiana, probably relying on the patient's statements, reported, in June, 1865, that "the neck of the femur had been shattered by the missile; that spiculae were found at dressing of the wound, and others for several months were eliminated in the discharges." None of the various surgeons who treated the injury reported any elimination of bone fragments or other indication of partial or complete fracture (Circ. No. 2, S. G. O.). Galyean was drowned near Keokuk, June 5, 1871.—2. Pt. J. Doody, C, 6th New Hampshire, aged 23; Bull Run, August 29, 1862 ; discharged from service at Mower Hospital, Philadelphia, March 16, 1863, for shot wound through hip, just below the joint, breaking the bone. Examiner W. S. Perky, of Exeter, N. H., reported, August 13, 1863: " Bone fractured and not united; the leg is shortened; the fracture was so near the head of the bone that union could not be obtained;" in April, 1867, Dr. PERRY reported: " The bone is thrown back onto the dorsum of the ilium ; leg shortened two inches." Doody is reported to have died July 9, 1873 (Circ. No. 2, p. 95).—3. Pt. W. V. Trail, C, 57th Virginia, aged 27; wounded at Gettysburg, July 3,1863, was retired from service in February, 1864, on account of a " fracture of the left thigh bone near the socket," permanently disabling him.—4. Pt. S. T. Hook, B, 79th Indiana; Stone River, December 31, 1862; conoidal ball, stated by Surgeon F. Seymour, U. S. V., to have perforated neck of right femur; case diagnosticated as a gunshot flesh wound of right thigh at Louisville and New Albany hospitals. Discharged May 7, 1863, and pensioned. The Indianapolis Examining Board reported, in October, 1873: " Ball entered two inches below Poupart's ligament, anterior aspect right thigh, passed posteriorly and outward, and made its exit on outer aspect of right nates, fracturing femur in upper third, leaving it shortened one and a half inches."— 5. Pt. W. Miles, A, 60th Illinois, aged 18; Bentonville, March 19,1865; conoidal ball struck righthip; stated to have involved neck of femur. Discharged June 26, 1865; pensioned. Examiner G. W. SCHUCHARD, of Jonesboro', reported, July 29, 1867: "Ball entered the right hip, striking the ilium at the posterior crest of the acetabulum, and has never been extracted." Examiner W. C. Lence reported, in September, 1875: "Ball entered hip about two inches below the posterior superior spine of ilium, passed inward, and remains lodged in external iliac fossa; there were no bones fractured."—6. The details of the case of Pt. T. Winans, B, 28th Illinois, wounded at Sbiloh, April 6, 1862, in which the neck of the left femur was said to have been frac- tured, will be found at page 283, Second Surgical Volume, Case 816.—7. Pt. J. W. Britton, C, 16th West Virginia, aged 23; Lynchburg, June 18, 1864. Surgeon B. A. Vakdkukieft, U. S. V., noted a "shot fracture of the right thigh;" Surgeon S.N.SHERMAN, U. S. V., a " fracture of the neck of the right femur." He was examined July 15, 1865, and discharged on account of "shot fracture of right femur, upper third." Examiner M. D. BENEDICT, of Washington, reported, August 8, 1865: "Ball passed through upper portion of thigh, fracturing neck of femur." Examiner T. Kennedy, of Grafton, reported, September 4, 1873: "Fracture three inches below hip joint; imperfect union; overlapping of upper portion of bone."—8. Pt. A. G. Cotton, Co. H, 6th Indiana, aged 20 years, was wounded at Stone's River, December 31, 1862, and admitted to hospital No. 6, Nashville, January 5th. Surgeon C. Schuslek, 6th Indiana, recorded: " Gunshot wound of left hip, dangerous." One week afterwards the patient was transferred to hospital No. 7, at Louis- ville. Acting Assistant Surgeon W. W. GOLDSMITH reported that the man was discharged from service March 19, 1863, by reason of "gunshot wound of ischium, ball ranging forward and lodging under the sartorius muscle." Examiner J. G. HENDRICKS, of Madison, Indiana, certified, January 14, 1864: "Ball entered the posterior part of the head of the left femur, passing forward and outward, dislocating the head of the femur, and lodging in the trochanter major, whence it was extracted on March 7, 1863. The limb is shortened some three and a half inches and partial anchylosis of the hip joint is produced." Examiner W. W. POTTER, of Washington, D. C, reported, March 28, 1871: "A ball entered centre of left gluteal region, passed forward, transfixing the hip, and made its exit on the anterior aspect of the thigh on a line drawn horizontally with the pubis. The neck of the femur was fract- ured. Union has taken place with two and a half inches shortening. The thigh measures three and a half inches less than its fellow, and in progressive locomotion the weight of the body falls on the ball of the foot." Examiner J. C. BURT, of Vernon, Indiana, reported, September 13, 1873: "A musket ball entered the left hip posteriorly, nearly over the great trochanter, and, passing obliquely inward and downward, caused an oblique fracture of the femur through the trochanters. There is overlapping and shortening of the femur about one inch. Owing to contraction of the hamstring muscles the leg is shortened three inches. Walks with a great halt, and motion of the leg is limited and difficult to perform." Substantially the same was reported in 1875. The pensioner was paid March 4, 1876.—9. Pt. F. Kimball, E, 1st Vermont Cavalry; aged 37 ; Stony Creek, June 27, 1864. He was discharged February 22, 1865, by reason of "two inches shortening of left lower extremity, occasioned by fracture of the femur at the surgical neck, etc." Exam- iner H. M. Chase, of Lawrence, believes that the ball fractured the femur at or near the neck. The pensioner was paid December 4,1875.—10. Pt. R. P. McCutchen, A, 42d Indiana, aged 23; Chickamauga, September 20, 1863. Assistant Surgeon R. BARTHOLOW reported, from the field hospital at Chatta- nooga : '' Gunshot fracture of left femur." The man was discharged for gunshot wound of left thigh, fracturing femur at neck. Examiner T. C. Van Nay, of Evansville, certified to a compound comminuted fracture of neck of femur. Pensioner paid December 4, 1875.—11. Pt. W. B. Reynolds, H, 46th Alabama; Champion Hills, May 16, 1863. Surgeon H. Z. Gill reported: " Gunshot fracture of neck of left femur. Sixty days after the injury the limb was shortened three or four inches, very crooked, and, in my opinion, there was no prospect of a useful limb."—12. Lieutenant C. P. Stoneroad, G, 51st Pennsylvania, aged 24 years, was wounded at the Weldon Railroad, August 19, 1864, by a conoidal ball. He was treated at the field hospital of the 3d division. Ninth Corps, and on August 25th was admitted into the Third Division Hospital, Alexandria. Surgeon E. BENTLEY, U. S. V., reported: "Ball entered the posterior and lateral aspect of the right thigh about one inch below the trochanter major, striking and slightly fracturing the femur. The wound was much swollen. Cold-water dressings were applied and an anaesthetic given, while dressing the wound, to alleviate the severe pain. Septem- ber 10th, the wound had almost entirely closed and the swelling had nearly gone; the pain was still very great and prevented any attempt to move the hip joint. October 4th, the wound had closed entirely and he began to go about on crutches. November 3d, he left the hospital on a leave of absence; he had very little use of his leg; there was considerable shortening of the limb, the toe turning inward; he could bear but little weight upon it, and was compelled to use crutches." On December 18,1864, Stoneroad entered the Officers' Hospital, Annapolis. Surgeon B. A. Vanderkieft, U. S. V., reports: '• Ball entered at the upper margin of the acetabulum, dislocated the hip joint, fractured the neck of the femur, and lodged beneath the floor of Scarpa's triangle." He was discharged December 30, 1864. Examiner E. GREEN, of Bellefonte, June 16, 1865, reports that he cannot decide "whether the mis- sile fractured the neck of the femur or caused partial dislocation; * * * the foot turns out and the limb is shortened about an inch and a half. He only complains of pain on taking severe exercise and in wet weather." Examiner G. F. Harris reports, September 4, 1873: "Ball still lodged, dis- location of joint, shortening two and a quarter inches." Examiner T. R. HAYES, September 8, 1875, makes a similar report, and states that "he is quite lame." Disability total. Last paid June, 1877.—13. Pt. D. Strickler, H, 25th Virginia, aged i9; Gettysburg, July 2,1863. Surgeon H. JANES. U. S. V., noted: "A mini6 ball entered the right thigh externally, fractured the neck of the femur, and lodged; October 26th, bone has united." Surgeon A. Chapel, U. S. V. reported a "gunshot fracture of right femur, "and Surgeon A. Heger, U. S. A., a "gunshot fracture of upper third of right femur." He was transferred for exchange April 27, 1864.—14. Pt. J. Weber, I, 68th Pennsylvania, aged 23; Gettysburg, July 2, 1863. Surgeon S. W. GROSS reported a "gunshot fracture of neck of left femur," and Ass't Surgeon D. BACHE, TJ. S. A., a "gUDshot wound of left groin and fracture of femur." He was discharged July 1, 1865. The Philadelphia Examining Board reported, in October, 1871: "Ball entered left groin near anterior superior spinous process of left ilium, passed through hip joint and out three inches behind left trochanter," and in November, 1873, that "the ball fractured the surgical neck of the femur." SECT, n.] SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 71 Hospital on May 10, 1862. A conoidal musket ball had entered the right groin, passed slightly downward, traversed the line of union between thigh and trunk, fractured the neck of the femur in its transit, and emerged posteriorly at the fold of the but- tock. On flexing or rotating the thigh crepitus was plainly distinguished. His limb was suspended by Smith's anterior splint, and this treatment was continued for two months. The case progressed without a single untoward symptom, and in the middle of July, 1862, consolidation of the fracture was sufficiently firm to permit the patient's removal to the house of a friend. The limb was shortened one and a half inches. In October Captain Bugh was able to move about on crutches, and the wounds were entirely healed. About this time he took a journey to Washington, and was promoted to a lieutenant colonelcy in the 32d Wis- consin and placed on recruiting service. He served until April 25, 1863. His recovery was so rapid and uninterrupted that he reluctantly assented to the opinion of his surgeon, Dr. Edmund G. Waters, that he would be incapable of active duty in the field. A letter was received from Lieutenant Colonel Bugh, dated June 12, 1867, more than five years subsequent to his injury, in which he stated that he had partial anchylosis of the hip joint and was unable to perform any labor in a stooping posture. Otherwise his condition was satisfactory, though he was more readily fatigued and debilitated than before he was wounded. He suffered no inconvenience from the slight shortening of the femur. His death occurred eight years afterwards, on August 19, 1875, of phthisis pulmonalis. Examining Surgeon N. M. Dodson, of Berlin, Wisconsin, informed this office on December 13, 1878, that " no post-mortem was had in the case of Captain Bugh. The wound healed in 1866, and the limb remained sound afterwards. Bugh filled the position of postmaster, was much upon his feet, and residing for some years three-quarters of a mile from the post office, he walked to and fro three times a day with very little inconvenience, using only a cane. The joint was firmly anchylosed. He suffered from pain of a neuralgic character in the whole limb, and at night frequently with cramps in leg and foot." Case 138.—Private J. T. Elliott, Co. H, 22d Georgia, of Sorrell's Brigade, aged 24 years, received, at the engagement at Deep Bottom, Virginia, August 16, 1864, a gunshot fracture of the neck of the left femur. He was conveyed to Richmond and admitted to the Jackson Hospital. He recovered with three inches shortening of the limb, and being permanently disabled and totally disqualified for any military duty, he was retired from the Confederate States service on February 17, 1865. The case is reported by Surgeons A. J. Semmes, Thomas F. Maury, and W. D. Hoyt, members of the medical examining board of the Jackson Confederate Hospital, at Richmond, Virginia, in February, 1865. Case 139.—Private Charles Miller, Co. A, 9th Illinois, aged 26 years, was wounded at the battle of Shiloh, Tennessee, April 6, 1862, apparently by a small rifle ball entering at a point midway between the left trochanter major and the tuberosity of the ischium and fracturing the neck of the left femur. He was conveyed to the general hospital at Savannah, and a month afterward was transferred by steamer to Quincy, Illinois, and admitted to hospital on May 7th. An unsuccessful search for the missile was made, and Buck's apparatus was applied. The bone united and the wound healed. He was discharged from service on October 14, 1862, having limited motion at the hip joint. The case is reported by Surgeon R. Niccolls, U. S. V. On April 7, 1864, Dr. John C. Hupp, Pension Examining Surgeon at Wheeling, West Virginia, stated that the limb was shortened by about two inches, a partial luxation of the head of the femur upward apparently having been produced. Any movement of the thigh created severe pain. The cicatrices were firm and there were no fistulous orifices. In December, 1870, Examining Surgeon C. Griswold, of Fulton, Illinois, reported: " The ball entered posteriorly through the glutei muscles, and fracturing the femur near the socket, resulted in partially stiffened joints both at hip and knee of left leg. The hip joint will admit of only a little forward motion and rotation outward. The knee joint allows only partial flexion, and cannot be crossed over the right leg in a sitting posture. The leg is shortened about one-quarter of an inch. He cannot walk without limping." In August, 1873, Examiner P. J. Farns worth, of Clinton, Iowa, stated : " The bullet remained in for four years, and was found under the superficial fasciae three inches below the wound. Motion of hip joint impaired. Contraction of abductor muscles, causing stiffening and retraction of knee joint. Constant neuralgic pain of thigh and leg, and considerable atrophy of muscles. Thigh two inches less in circum- ference than right at upper third. The original disability has increased." On May 1, 1878, the Davenport, Iowa, Examining Board reported: "There is shortening of the thigh to the extent of three-quarters of an inch, whence it is inferred that fracture of the upper portion of the acetabulum, or neck of femur, occurred; there is partial anchylosis of the knee joint. The patient walks with a cane with considerable impairment of motion." Case 140.—Private T. L. Lomax, Co. K, 30th Virginia, wounded at Antietam, September 17, 1862, and admitted to hospital No. 5, Frederick, on October 20th. Dr. A. V. Cherbonnier communicated, in June, 1869, that "it was supposed, when Lomax was admitted to hospital, he was merely suffering with a fracture of the thigh, high up, with no accurate knowledge of the extent. He was removed to a private residence, and after removal his limb was explored and a full knowledge and extent of the injury was ascertained. The injury was found to be serious, involving the upper portion, the trochanter, and, if I remember correctly, the neck. In the presence and with the assistance of Surgeon H. S. Hewit, U. S. V., and Assistant Surgeon J. H. Bill, U. S. A., I removed all the fragments of bone, and with the gouging forceps removed a considerable portion of dead and rough bone. The operation was repeated a couple of weeks after. The whole of the trochanter major was removed, going deep into the shaft, and leaving, if I remember correctly, but a shell of bone. When I left Frederick I had the satisfaction of seeing young Lomax on crutches. I cannot, with no notes, do justice to what I consider a most interesting case," etc. Surgeon Hewit, in a note dated July 26, 1869, stated: "It was a case of comminution of the kip. Three secondary operations by gouging were performed by myself, in which nearly all the head, neck, and trochanteric portion of the femur were removed. He subsequently made a good recovery." Dr. G. Johnson, of Frederick, subsequently, on October 21, 1869, furnished the following details of the case: " Mr. Lomax was wounded in the left hip. The ball struck the femur, shattering it by his account, but producing no solution of the continuity. He remained in the temporary hospital near the battle-field for weeks, was then brought to Frederick, and on October 31st was transferred to a private residence and came under my charge. His strength at this time was gradually succumbing to profuse suppuration and pain, and although he rallied somewhat at first by the change of circumstances and improved hygiene, it soon became apparent that surgical interference was demanded to arrest the downward tendency. Until this time his only treatment had been the abstraction of detached pieces of bone, detergent washes to the wound, and anodynes and tonics. Carious bone in considerable extent being evident to the probe, it was determined to attempt its removal, and on 72 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. November 15th Drs. Hewit and Charbonnier operated for that purpose, under chloroform. A large quantity of diseased bone was removed from the outer part of the upper third of the femur. There was but trifling haemorrhage, but much depression and irritability of stomach succeeded the operation, yielding, however, in a few days, to stimulants and effervescing draughts. For a fortnight the patient steadily improved under nourishing diet and tonics. He then again began to deteriorate under increasing suppuration, and on December 15th it was determined to again operate for the removal of diseased bone. This was accordingly done on that day by Dr. Hewit, the patient being under chloroform. The great trochanter and about two-thirds in circumference of the shaft of the femur were removed for several inches. The depression consequent was not so great as before, but on December 17th congestion of the right lung occurred, with expectoration of a quantity of typhoid pneumonic sputa. I painted the chest thoroughly with iodine tincture, and gave hydrochlorate of ammonia, with milk punch and animal soup. No consolidation of the lung occurred, and after a few days his chest gave no further trouble. I will not weary you with a detailed account of his symptoms and treatment during the four months ensuing. There was at no time any inflammation of the hip joint. Erysip- elas twice gave much trouble, as also the usual disposition in such cases to form purulent sinuses. On January 23, 1863, I noted hard and excessive swelling of the limb, with grave constitutional disturbance attributed to lymphatic inflammation, and after this subsided much oedematous infiltration. Pieces of carious bone became from time to time detached, and were removed as soon as detected; the feeble circulation was supported by careful bandaging; the wound was kept thoroughly clean and his hygiene perfect. He took exercise in the open air in carriage and on crutches as soon as strength permitted, and in May was quite convalescent. June 8th, he left Frederick for exchange, still on crutches and wound discharging slightly, but looking healthy—almost robust. A year after, he wrote that he was perfectly well and walked comfortably with a cane. In mentally reviewing this case some points of interest occur to me: As to the cause of so extensive a caries—this was a true bone ulcer. The several operations did not consist of merely removing sequestra or detached portions of dead bone, but in paring and pinching off the diseased bone from that which was still sound. The ulceration was progressive. The second operation was more extensive than the first and at a month's interval. These facts are consistent with the theory (suggested, I think, by Dr. Hewit) that the caries depended upon osteitis, and this probably caused by the peculiar velocity with which the minie" ball strikes. The amount of callus effused after the final operation was immense, fully equalling the new bone of a prolonged case of necrosis, and soon allaying the fear at first felt of fracture of the continuity of the bone through muscular action or otherwise. As regards the statistical value of the case it ended well; but after an illness in which his life was in extreme jeopardy several times, and under circumstances rarely attainable in private practice, and I should think impossible in military life. The patient had full advantage of every circumstance that affection could prompt and pecuniary means procure. He was in the prime of life and entirely free from constitutional taint. He was free from depressing influences of every kind, while in his medical and surgical treatment I had the counsel and assistance of scientific and thoroughly experienced men. Among them, both he and I are under lasting obligations to Dr. Hewit, to whose operative skill, no less than to his humanity in permitting his removal from hospital, is due whatever credit may pertain to the issue of the case." The bone removed at the two operations referred to consists of a number of fragments, and was subsequently contributed to the Museum by Dr. Johnson, and constitutes Spec. 5652 of the Surgical Section,. Case 141.—Private M. M. Phillips, Co. F, 42d Mississippi, aged 23 years, was wounded at the battle of Gettysburg, Pennsylvania, July 3, 1863, by a musket ball, which entered the posterior and outer aspect of the left buttock, fractured the neck of the femur, and emerged in the left groin. He was captured and removed to the hospital for Confederates, and was treated by the expectant plan. On July 22d he was transferred by rail to the De Camp Hospital, in New York Harbor. The wounds of entrance and exit had healed. He was able to walk by the aid of a crutch or cane and suffered no pain. The limb was shortened one and three-quarter inches. By flexing and rotating the limb true osseous crepitus was obtained. There was no inversion or eversion. The patient, much against his will, was placed upon a fracture-bed, Avhere extension was produced for six weeks by a twelve-pound weight acting over a pulley. He was then permitted to rise and directed to use passive motion and friction. On September 20,1863, he was paroled, being able to walk without assistance of any kind. The limb was short- ened one and a quarter inches. The case is reported by Acting Assistant Surgeon George Edwards. In the next case, as in the case of Private Charles Miller (Case 139, page 71), partial anchylosis of the knee joint had supervened many years after the injury: Case 142.—Private James Vanderbeck, Co. F, 145th New York, aged 21 years, was wounded at the battle of Chancellors- ville, May 3,1863. by a conoidal musket ball, which entered the left thigh above and behind the trochanter major, passed forward and inward, fractured the neck of the femur, and made its exit at the groin. He was made a prisoner and remained in the hands of the enemy eleven days. He was then exchanged and conveyed to the Twelfth Corps Hospital, at Aquia Creek. The injured limb was simply placed in a comfortable position without any attempt at extension. On June 14th the patient was removed on a hospital transport to Alexandria and placed in the First Division Hospital. He was in good condition. The suppuration was comparatively slight, and no bone splinters were found loose and none had come away. Three days subsequently he was trans- ferred to Philadelphia, and thence, on October 12th, to New York, where he was admitted to the Ladies' Home Hospital. The wounds were closed at this date. The patient was discharged from the hospital and from the service of the United States on November 19, 1863. On that date he walked with crutches. His limb was shortened two inches, with eversion. He was allowed a pension. On August 2, 1866, Dr. E. Bradley, Examining Surgeon of the Pension Bureau, reported that Vanderbeck's general health was good, but that there was much lameness. The fracture was firmly consolidated. Commissioner C. C. Cox reports that Vanderbeck received his pension at the agency in New York City on March 4, 1868, and that his disability was then rated by the examining surgeon as total. On September 9, 1873, Examining Surgeon T. F. Smith, of New York City, states: "Ball entered left nates and emerged beneath left popliteal ligament, fracturing the femur; there is union with deformity and three inches shortening" On September 7,1875, the New York Examining Board, Surgeons T. F. Smith, J. F. Ferguson, and M. K. Hogan, report "that the knee is anchylosed and the patient is obliged to wear a sole on his shoe three inches thick, and to walk with a cane; the leg is useless for purposes of labor." SECT. II.] SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 73 Cask 143.—Private T. C. Garvin, Co. H, 94th New York, aged 43 years, was wounded at Hatcher's Run, February 7, 1865, and admitted to the field hospital of the 3d division, Fifth (,'orps. Surgeon D. C. Chamberlain, 94th New York, noted: "Gunshot wound of genitals." Four days after the reception of the injury the man was admitted to the Newton University Hospital, Baltimore, whence Surgeon R. W. Pease, U. S. V., reported: " Gunshot wound of penis and right testicle, ball emerging from right gluteal region, fracturing the femur." In a case book it is recorded that Buck's apparatus and counter-extension were used, also that there was free suppuration from the wound, and that evidence of union of the bone set in about March 10th. Assistant Surgeon D. C. Peters, U. S. A., reported that the patient was admitted to Jarvis Hospital May 23d, and described the injury as follows: " Gunshot wound of penis, right testicle, and fracture of femur involving the neck. Urine escapes through the lower opening of the penis. He had some union of limb, with about three inches shortening." The patient was discharged from service June 11, 1865, and pensioned. Examiner G. W. Cook, of Syracuse, New York, certified, April 25, 1866: "Bullet struck the glans penis, passing downward and backward through the urethra, producing hypospadia, through which the urine is voided, thence into the right testicle, which is destroyed, thence into the right thigh, fracturing the same." The pensioner died January 3, 1869. Dr. A. Welch, his attending physician, certified that "to the time of his death Garvin was laboring under severe pain and difficulty from a wound which he received in the hip of the right side, passing through the joint and through the testicle, destroying the hip joint, and producing shortening of the limb, and an open wound from which pus and portions of the joint, consisting of splinters of bone, were discharged to the time of his death." Case 144.—Corporal Daniel Bachler, Co. G, 82d Illinois, aged 23 years, was wounded in the battle of Chancellorsville, Virginia, May 2.1863, by a round ball, which, entering just above the right trochanter major, fractured the neck of the femur, and emerged beneath Poupart's ligament about two inches from the symphysis pubis. He stated that he lay thirteen days on the plank road unattended. He was admitted May 15th to the field hospital of the 3d division, Eleventh Corps, and was transferred thence, by steamer, to Alexandria, and admitted May 25th into the First Division Hospital. The patient had been informed that the wound involved the soft parts only; cold-water dressings had been applied. The limb was shortened about three inches. A fracture through the necE was discovered. Partial union had taken place. There was little suppuration and the pus was healthy; the parts were but little swollen. Smith's anterior splint was applied and moderate extension made by weight and pulley. He was furloughed on July 14th for sixty days, and went to Chicago, Illinois. On September 10th Bachler was received into the City General Hospital in Chicago. A gunshot wound of the right hip joint was recorded. He was transferred to the 2d bat- talion of the Veteran Reserve Corps on August 7, 1864. The case is reported by Surgeon Norman S. Barnes, U. S. V. The patient was discharged on July 15, 1865. The Chicago Examining Board, Drs. Wm. C. Lyman, E. D. F. Roler, and F. A. Emmons, report on September 10,1873: " The pensioner was shot through the hip close to the joint; there was loss of some small pieces of bone, and half an inch shortening of the limb." On April 3, 1878, the Board state: "There is partial loss of flexion and of power of leg, with neuralgic pains; the neuralgia is increasing." Case 145.—Private James McCabe, Co. A, 12th Massachusetts, was wounded on September 17, 1862, at the battle of Antietam, by a musket ball, which entered just below the right groin and made its exit at the buttock, fracturing the neck of the femur in its passage. He was conveyed to hospital No. 5, at Frederick, Maryland, and was treated with the limb in an extended position. On November 9th he was transferred to Frederick Hospital No. 1. In December a large metastatic abscess formed about the right shoulder, which was laid open by Assistant Surgeon R. F. Weir, U. S. A., a large quantity of pus escaping. After the healing of the abscess there was much weakness of the muscles of the acromial and humeral region, and the patient could not raise his hand above his chin. On June 16th he was sent in good condition to the Jarvis Hospital at Baltimore, and thence to Point Lookout Hospital, where he remained until July 25, 1864, when, the wound being healed, he was discharged. He was mustered out of service August 5, 1864. On June 10, 1867, he was examined at the office of Surgeon General Dale, of Massa- chusetts. The fracture was firmly consolidated. There was but a slight limp in walking. His general health was excellent. He received a pension and was employed in the Soldiers' Messenger Corps. He experienced no pain, except on change of weather or when his walk was extended beyond two miles. He considered his injury but a slight disability in his business, since he had free passes on all the lines of horse cars in Boston. Case 146.—Sergeant Edward G. Gilliam, Co. C, 11th Virginia, aged 24 years, was wounded in the engagement at Drury's Bluff, Virginia, May 16, 1864, by a rifle ball, which, entering the upper portion of the right thigh in front, fractured the neck of the femur, and lodged. He was conveyed the same day to Richmond and admitted into Chimborazo Hospital. There was ever- sion of the limb, but no shortening. On placing the finger upon the seat of fracture and rotating the thigh it was observed that the trochanter major moved with the shaft. There appeared to be but little comminution, and there was no escape of synovial fluid. The parts were but little tumefied. The limb was comfortably adjusted on pillows. The patient complained of severe pain in the thigh, especially along its inner aspect, and had frequent twitchings of the muscles. The pulse was 80, the tongue clean, the appetite poor. Half an ounce of whiskey was dfn< ted every fourth hour, and a nourishing diet, with one-third of a grain of morphine given at bedtime. During the latter part of May there was severe local pain, with rapid emaciation, and a bed-sore formed over the sacrum. On June 15th the limb was swung in a Smith's anterior splint. The patient's appetite soon began to improve, the pulse about 96. On June 27th he yet suffered severe pain in the hip and along the inner part of the thigh. On July 1st synovial fluid in large amount issued from the wound, after which the pain subsided. His appetite continued to improve, and he now slept well at night. One or two small spiculae of bone were eliminated in the discharges. On July 10th he was stronger and had no pain; the bed-sore was healing; the discharge from the wound was small in quantity, and the oedema was disappearing. For several days, about July 20th, he suffered pain at the knee, and the splint was removed. On July 30th the bed-sore was healed and his health was greatly improved; but any movement of the hip joint continued to create severe pain. By August 10th he had become stout and'fleshy and could suffer the limb to be moved, and August 22d it could be moved freely without producing pain. At this date a small spicula of bone was removed. There was only a slight discharge from the wound. On September 5th he was able to raise the limb a short distance from the bed, and September 14th he sat up in a chair. There was limited motion of the hip joint. He was furloughed for sixty days on September 20,1864. The case is reported.by Surgeon E. M. Seabrook, C. S. A. Surg. Ill—10 74 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Case 147.—Surgeon B. W. Avent reports that an officer received a gunshot fracture of the neck of the femur; two fingers at entrance and exit fully explored the wound; date of injury unknown. The wound was dilated at entrance and spiculse was removed with saw and forceps. He lingered for months, but finally recovered with a limb four inches short, but able to walk with the assistance of a cane. Case 148.—Private R. Yerger, Co. I, 11th Pennsylvania, aged 31 years, was wounded at Antietam, September 17, 1862, and entered the Broad and Cherry Streets Hospital, Philadelphia, on December 12th. Surgeon J. Neill, U. S. V., reported: " He was admitted to this hospital with an undetected fracture of the neck of the right femur. A minie ball entered on the front of the thigh on a vertical line with the anterior superior spinous process of the ilium and four inches below it, and, passing obliquely upward and backward, was cut out on a line with and about two inches below the posterior superior spinous process by the surgeon of the regiment on the field. At the time of his admission the wound had entirely healed, but the patient was unable to bear weight on the limb without pain. The tissues over and above the trochanter were flattened, and the fold in the buttock was absent. Rotation was imperfect, and when an attempt was made to bear weight on the limb distinct crepitus could be felt in the neck of the bone, and he complained of pain at that point. Measurement from the xiphoid cartilage revealed two and a half inches shortening of the injured side, and from the anterior superior spinous process of the ilium it was three-fourths of an inch. The fracture appeared to be impacted, and the whole of the right innominate bone was considerably elevated above its normal position. The posterior superior spinous process of that side was also more prominent than that on the other side, giving the idea that the sacro-iliac symphysis had been injured and in that way accounting for the marked amount of shortening by measurement from the xiphoid cartilage. He stated that when shot he fell, the right hip striking the ground, and any attempt to move the limb gave rise to severe pain in the hip joint; also that the surgeon told him it was only a flesh wound and would soon be well. He remained in a field hospital for nine days, when he was removed to Chambersburg and treated for nine weeks, during which time he was allowed to get up to go to stool. The wound healed about two weeks before admission to this hospital. No fragments of bone were removed; crepitis is not so distinct, and his general condition is good. The amount of shortening from the anterior superior spinous process has increased from three-fourths to a full inch since admission." The patient was dis- charged frorq service April 27, 1863, and pensioned. Examiner J. J. McCormick, of Irwin Station, Pennsylvania, certified, September 5, 1873: "Ball entered right thigh in front of trochanter major and came out one inch from lower end of sacrum, fracturing the neck of the femur. The limb is two and one-half inches shorter than the other; strength so much impaired that he cannot walk without a cane. Muscles of limb are atrophied." In an examination for increase of pension, in April, 1880, Examiner McCormick reports: "There is great impairment of the strength and usefulness of the limb. The pensioner cannot work at all, nor can he set on a chair except a little on the left hip. The injury is nearly equivalent to the loss of the limb." In five instances of recovery after alleged shot fracture of the hip joint the "neck and trochanters" or "the neck and shaft" of the femur were reported to have been frac- tured. Three of the cases1 are here given in detail: Case 149.—C. F. Beyland, Q. M. D., aged 26 years, was wounded December 8, 1861, by a conoidal musket ball, which fractured the great trochanter and neck of the right femur. Excision was proposed and refused. The fracture was treated by Hagedorn's apparatus. After protracted and profuse suppuration the patient recovered with a limb shortened two inches. In July, 1863, he had dispensed with crutches and walked quite well. Assistant Surgeon C." K. Winue, U. S. A., reported the case. Case 150.—Corporal Luke English, Co. E, 2d Wisconsin, aged 21 years, was wounded at the battle of Gettysburg, Penn- syl vania, July 1,1863, by a conoidal musket ball, which entered at a point between the left trochanter major and the tuberosity of the ischium, emerging near the anus, penetrated the right thigh and fractured its trochanters, and lodged. He was admitted the next day into the Seminary Hospital at Gettysburg. Search for the missile was unsuccessful. Two fragments of bone were extracted. Cold-water dressings were applied. On July 17th he was transferred by railroad to York Hospital. Early in August the average discharge of pus was about four ounces. The wound of entrance had nearly closed. On November 4th he could walk a little, the wound, however, discharged considerably. He was discharged from the service of the United States on June 23, 1864. Surgeon Henry Palmer, U. S. V., reports the case. His attorney, John Hancock, of Oshkosh, Wisconsin, reports that English died in 1867. Case 151.—Private Philip Sweeney, Co. C, 3d New York, was wounded in the affair at Big Bethel, June 10, 1861, by a conoidal musket ball, which shattered the trochanters of the right femur. He was admitted to Hygeia Hospital, Fort Mor. <.e, on June 13th, and was treated by Surgeon R. B. Bontecou, U. S. V., by moderate extension and dilatation of the wound by sponge tents in order to facilitate the extraction of primary sequestra, of which many were removed. Suppuration and exfolia- tion persisted until March, 1862. In April there were two severe attacks of erysipelas, involving the entire limb, which greatly reduced the patient, but he quickly rallied, and in May was able to run a race on crutches with his wounded companions. He was transferred to Albany in June, 1862; but his name does not appear upon the hospital reports until March, 1863, when he was admitted to the Ladies' Home, in New York City, where a number of necrosed fragments were removed. On May 25,1863, >The remaining two cases were: 1. Serg't P. Casserleigh, A, 38th Illinois; Chickamauga, Sept. 19, 1863; conoidal ball entered behind the right great trochanter, passed inward and forward, fractured the apophysis, and, it was believed, injured the anterior crural nerve. It was considered possible, though not probable, that the joint was injured. He was discharged July 11, 1863. Examiner T. S. HEXING, of Springfield, reported, in May, 1865, that a ball entered the right hip a little posterior to the great trochanter, passed into the hip and remained concealed in the tissues; limb one and a half inches shortened; motion aud power of joint destroyed; and in November, 1866, that " the ball fractured the head and neck of the femur." The Springfield Examining Board reported, in August, 1874: " The limb is anchylosed in a semiflexed position and shortened four inches (Circ. 2, p. 94, CASE 201).—2. Pt. T. Purcell, F, 96th Pennsylvania, aged 22; Chancellorsville, May 3, 1863; a conoidal ball was stated to have produced a fracture of left femur in upper third, extending into hip joint. From a field hospital of the Sixth Corps he was transferred to Armory Square Hospital, Washington, and subsequently to Cuyler Hospital, Germantown, Pennsylvania. No mention was made at either of the latter hospitals of the involvement of the hip joint. At Mowei Hospital, Philadelphia, the injury was noted as a "gunshot wound of tipper third of left thigh with loss of four inches of bone." He was discharged July 8 1865. Examiner J. T. Carpenter, of Pottsville, reported, in September, 1873: "Entrance of wound about four inches below anterior superior spinous process of ilium, upper third of femur shattered; five inches shortening; no power; wasting of limb." (Circ. 2, p. 95, Case 211.) * TNIURTFS O"' TUK LOWER > V v. -nt rt i ■!<- h .'.. .•fticT reiviv* ■ » .■■:■••. :'■■.<; v-".i' '•• ■ ■ ' '""v 'n'V- . ,• tt. Yer^.-w. '.■ ■ .r.i Cnerry Stre '.$ hospital with ■;' li-i^ with ■}>■ ■ i"-w:;.'d, v, as .'li! ■Vll.n. ' t '.II tl' *: . i'.- !"rr '■> w;M>-.> i -•-,■.; ::;>it !'.•■■.•' ■ oiiiii-.v'-. lies.,; ■: ■' ■ ■.; ■ ■ ■'■■■ 'ii« ;;-'' ■ v ;v-..n .n the j-i;..!..;:.:. ■ i- ' W.-on W '! '-• ,, , ;, ■■■.. i.j hospital lor i.;:l. 'la\-, . • ^'.-inoved r--i :- ■■■ -,- •• ii'tft up to go to Slo-'l. . :: ■■■■1 aboiu »'• . ,- i-....,.- i-,.-; -ropitie ie mi.' >;' "■ ' ,r^ '.'"'^'s ■ >, <■• .i|i.. ior ' ;•■'■ ■ ■ ■•<•>■•= has lio.1 ••;• •■• : ,;,! i, ■•■ n-ice April u '?-• '•■• '■ s"T; " ■- -■..:•■! ' <;:].: "Ball < ijf-■•>•. '•■.• . '')'■./'" • ••. ■•■ :■<•< Kur tlu- femur Ti. ■>> '■ ': '• • ..•-,, .v'thout ;i cauc. Mu* - ■■' ' • v McCormick reports- ''liuii i' mT cuu h« set mi a « (■ ti. -\ ■ • ■" '• ,M |j\-t i:i-r:iiif.'C.'r •••"■ "'i^ _■'"''' ; irochan! rV or .. ■-'-- iemur ■>%•■'■ ■d. Thro: o( <\* •■- iC.'-.il: C.xSE 14'J.—t; F. Bev!,; .. -; •: •'•-* v,i..?-.i,.lrd December- •■• . ;;-. ' tin- ^n .; t ■<•■. tiant'-r .>.:<-• • • • Lxciftion ■.\^s r.ropo'--fd ><>.- r i. .! .• ." ;i! ii'.mi. .: . After p. ■.■•.■ • 1'J nation the patkiv r :■•>■'.;■ '.-. -. Ui , : °. "(.,, i ii d =pen3ed wi'.' ^ '.''if- veil. AhsU'.uuI ^i.-t-' - C K. W ,- i ■■ ''crpc-alLuk. !.■ ' ;a Wi* >.-'•:;. aged 2J yea'--. ■ .s wounded n . .. j-^.i.vja,;.,.:,1-: t.-i.Lca *:'•?' t•'n point bctv e.!: the ief> tr'-ch. , ■'. , , ti f}:.. .<■■ .- '.•'••< t:« right '),.:i'- .-c.H frarrurwl its ireehanterf- v .■■, , .:'!-...i,,:.i: ■■:•. ••.-jr. Seaic,' '. ■!• . miftBile w;.-* unsuv.i-'''^t'.; . • •. i .^.vi ■•>■ w;. '--"m J..;*' ''■'. <■ "■is.-i i fans.ier!vd by a._r :, '-,-i.a:'i:- "«f i:,- v.:.. '." '"• - ' ■ •■ ,d ■ . ... ,! (-• vo'liid. ho**'.-('e'. ■ - •■ '.■"*■ ■• :..^.'.ii:-':. nili1'. ■■-,. •;>;. Henry P.v!rn»>- ' i 'j.^i ;i:- ;-.t*.< •/:■<•■ ' •' -i .,:«.. ■■■. 1667. - ' ..n. ;..- Piiiiip fcjweeiie.. >'■■ U, M iV'-h >:■•:. ■"■"'■ - •■■nid.-d in tK, ^ .,,1 »-, j.i.-.i .-'i .-ti'v-d tbi. tn,.fii:ivr.tr8 of ih' >'<.-'•' t ■m,'i He v.as ..rir'f-f. ■ ••■ ,. .r„i w:.. •. '. ?'-. V.. i.v ui'derat^ v\ ■■- . .ii-iter^oi .u':U : ie i :: i't:u of fcirr.;. ■ ■;•.• ;:."'»ffte, of Wr.i'li '.iir'i' • .-.! un>::. Mar.v,:. '-' !■. 'M.i-il then-v. .■■•;.' ■ > ■ ■■ ..tracks <•;' !•,;;■■:.■. •>;)-'■<=••:!. bir l.'.: • . ■ i-rJued, and ii "-i: ■ ..■'■■•■' run .- "..< .c • j :,. Ml. : . ... Itri'J. but his ; . ■■ •' ;•,.•.>•*;>■• <■.■■■ v... v.-. . ' .i.'U'ir. :■ V, \v York ( i ' ■ >'■ ■■ i i'i ■■"• • ■..•: • aud l..rw...o :■■■ ■ r... .i.iat wa.s ii,, . ■■■ re .1 '... i a little ]«*■■> . ... aij.i p- \M-rof join .t'-.-" -:■ . ..-, .Vugiiff, 1S74 •,,r..( -.•■?, C'.h.i-. ''. r •, lie!-': V-, Med.& Surg. Hist, of the War of the Rebellion, Part III Vol.11. PLATE XXXIII. CONSOLIDATED GUNSHOT FRACTURE OF THE FEMUR Case of Private Philip Sweeny, 3rfi XewYurk Volunteers. Sect. II ] SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 75 he was discharged, being able to walk without a crutch and the limb being but slightly shortened. He soon afterwards engaged himself as a laborer at an iron foundry in Troy, New York, where he has since worked without intermission. On July 20,1866, he was examined by Brevet-Colonel R. B. Bontecou, who found him in perfect health, the injured limb a trifle shortened, and the knee rather stiff, owing to the destruction of connective tissue about the extensor muscles of the thigh during the suppura- tion following the erysipelatous attacks, and, doubtless, the formation of adhesions. The knee joint was in good condition and had sufficient motion to allow a firm, good gait. In a letter dated November 23, 1868, Dr. Bontecou states that Sweeney is at work at Troy in a spike factory, and was able to sit at and run a machine. His knee was stiff from agglutination of the sheath of the extensor muscles of the thigh, otherwise the limb was useful. The Albany Examining Board, Drs. W. Craig, R. B. Bon- tecou, and C. H. Porter, record, in September, 1873: "Gunshot wound through the trochanters, fracturing the femur at the neck, leaving adhesions of all the muscles of the thigh from deep-seated sloughing, the result of erysipelas, making knee joint stiff in the extended posture." In September, 1^75, Examining Surgeon R. B. Bontecou certified that "adhesions have rendered the knee immovable and the limb comparatively useless." The parts injured were not particularly specified in ten instances of recovery after alleged shot fracture of the hip joint. Two are here detailed, and eight are briefly recorded in the foot-note.1 Case 152.—"Private William C. Watson, Co. A, 4th Michigan, was struck in the left hip, at the battle of Malvern Hill, Virginia, July 1, 1862, by a conoidal musket ball. A fracture through the trochanteric region, with fissures probably extending to the joint, was reported. He was conveyed to Philadelphia and admitted into the Episcopal Hospital July 30th, transferred to Master Street Hospital on March 18th, and to South Street Hospital May 11th. The patient stated that for weeks his life was despaired of in consequence of the excessive suppuration which took place. Abscesses formed in the upper third of the thigh. Spiculse of bone escaped at intervals for months from the wound and through the incisions made for the evacuation of the abscesses. On January 1, 1861, suppuration had nearly ceased. The limb was shortened several inches and there was much deformity. On March 24th he was admitted into Christian Street Hospital, where he was discharged from service May 5,1864. He received a pension in September, 1868, and his disability was rated as total and permanent." Surgeon Paul B. Goddard, U. S. V., reports the case. Case 153.—Private Samuel Hensel, Co. H, 114th Pennsylvania, aged 31 years, was wounded at the battle of Chancellors- ville, Virginia, May 3, 1863, by a musket ball, which entered the central portion of the left buttock. The soldier was conveyed by steamer to Washington, where, on May 8th, he was received into Armory Square Hospital. The wound was probed daily in search of the missile, which, at the end of two weeks, presented itself at the point of entrance and was extracted by the patient. He states Aat it was a round ball, but was flattened on one side, and had, in this surface, a clean cut filled with osseous matter. The treatment consisted of rest, position, aud the application of cold-water dressings. On June 16th the patient was transferred to McKim's Mausion Hospital, in Baltimore. About the middle of July the nurse, while dressing the wound, discovered in it a foreign substance, which, upon removal, proved to be a portion of the haversack. The patient was soon afterwards transferred to Mower Hospital, Philadelphia. Early in September a spicula of bone, nearly two inches in length by oue in width in its 1 Cases of: Corp'l J. J. Atkenson, B, 1 st Tennessee; wounded at Murfreesboro'; he was examined at Lauderdale, Mississippi, by Surgeons J. T. KENNEDY, D. W". WHIMPER, and H. YANDELL, P. A. C. S., who certified that he was suffering from a shot wound of left hip, fracturing bone, and wound of left hand, loss of use of two fingers; shortening and deformity of leg; retired to Confederate Invalid Corps (Circ. 2, p. 98, CASE 228).—2. Sergeant Albert G. Beebe, A, 85th Illinois, received, in the engagement near Perryville, Kentucky, October 8,1862, a gunshot wound of the right hip, which was believed to involve a fracture of the joint. He was conveyed to hospital No. 7, in Perryville. He was discharged from service on February 15,1863. His disability was rated as total. He is a pensioner. Examiner P. L. DlFFENBECHER, of Havana, Illinois, reported, May 29,1876: "Wound of right leg; ball entered on the anterior aspect about three and a half inches below the groin, passed posteriorly and wounded trochanter major, superior aspect. Exit just posterior to the thigh joint; bones and muscles destroyed; also large cicatrix at point of ingress. Hip joint and leg affected by rheumatism aggra- vated by fatigue and exposure." The case is reported by Assistant Surgeon H. S. WOLFE, 81st Indiana.—3. Pt. D. J. C. Campbell, E, 3d Virginia, aged 36; Payne's Farm, November 27, 1863; shot wound left hip, hall entering near the trochanter major and lodging in the hone in the vicinity of the hip joint; retired from service, unfitted for any duty (Circ. 2, p. 98, Case 229).—4. Corp'l H. Koch, F, 7th Missouri, aged 26; Chickamauga, September 20, 1863; conoidal baH splintered left femur above the shaft; discharged May 16, 1864. The St. Louis Examining Board reported, June 3, 1874: "Ball struck left thigh near trochanter major, shattering the bone" (Circ. 2, p. 100, CASE 245).—5. Pt. A. C. Woodall, G, 55th Pennsylvania, aged 17; Diary's Bluff, May 16,1864; fracture left hip, involving the articulation ; mustered out June 8,1865, and pensioned (Circ. 2, p. 101, CASE 254).—6. Corp'l T. Gal- lagher, F, 165th New York, aged 30; Port Hudson, May 27, 1863; canister ball entered two and a half inches below great trochanter, passed backward and upward, and lodged three inches from place of entrance; projectile and several fragments of bone removed; discharged December 19, 1863, and pen- sioned. The New York Examining Board reported in October, 1872: "Ball struck outer aspect upper third left hip, fracturing or splintering the femur, and leaving two well-marked cicatrices; interferes with locomotion" (Circ. 2, p. 103, CASE 261).—7. Pt. R. F. Carter, B, 20th North Carolina, aged 21 years, was wounded at Gettysburg, July 1,1863. His injury is entered on the register of the Gettysburg field hospital as a "gunshot wound of thigh and hip, with compound comminuted fracture of hip joint." On September 4th the patient was admitted to Camp Letterman, where Surgeon H. JANES, U. S. V., recorded: " A minifi ball entered outer side of upper third of left thigh, lodging in the left groin and fracturing the femur in its course. When admitted the general health of the patient was good; leg a little swollen. On September 12th a small piece of hone was removed. October 10th, wound discharging freely, and fracture united with firm callus thrown out. November 8th, improving slowly. Patient can hear about one-tenth of the weight of his body on the limb. November 10th, transferred convalescent." Surgeon A. ClIAl'EL, U. S. V., reported that the man was admitted to West's Build- ings Hospital, Baltimore, with "gunshot wound of left hip," and that he was paroled November 12, 1863.—8. Pt. H. Marlatt, G, 12th Illinois Cavalry, aged 19 years, was wounded at Upperville, June 21, 1863. He was admitted to a Cavalry field hospital, where Surgeon J. B. W. MITCHELL, 8th Penn- sylvania Cavalry, noted: "Wound of left thigh by a pistol ball." Surgeon J. A. LIDELL, U. S. V., recorded his admission to Stanton Hospital, Wash- ington, June 23d, with "wound of thigh," and his "return to duty on November 25,1863." It is believed, however, that the man did not return to active field service, but was discharged from the hospital only to accompany his command when changing station from the Army of the Potomac to the Western armies. He was subsequently admitted to Camp Gamble, whence he was transferred to the Lawson Hospital, St. Louis, on February 15,1864. Surgeon C. T. Alexander, U. S. A., reported: "Gunshot wound of left thigh two inches below Poupart's ligament; ball passing downward, inward, and lodging. Wound healed when admitted. General condition good; uses crutches. Patient discharged from service February 27, 1864." Examiner C. Hay, of Warsaw, Illinois, certified, December 20, 1865: "A pistol ball entered the anterior upper third of the thigh, ranging towards the hip joint. The joint was in all probability injured, as he has not been able to move the limb upward since the casualty. The ball was lodged in or near the hip joint, upon the thigh bone, and still rests there. The bones composing the hip joint arc now carious. The urinary organs are much deranged in their functions." 76 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. central portion, was extracted from the wound. Flaxseed poultices were applied. Subsequently ten other pieces, varying in Bize from one-fourth to one inch in length, were eliminated. The wound soon closed and the patient was able to get about on crutches. On September 24th he was transferred to McClellan Hospital, Philadelphia, where, on May 13, 1^64. he was dis- charged from service "because of a compound fracture of the left thigh, upper third, incapacitating him for duty." Pension Examining Surgeon H. L. Hodge, of Philadelphia, reported, May 26,1864 : "On account of a gunshot fracture, probably of the i>s innominatnm (left), there is a luxation of the head of the femur, which destroys the usefulness of the whole limb." On November 1, 1>66, an apparatus was fitted to the disabled limb by Gemrig, of Philadelphia. Examining Surgeon James Cum- miskey reported, April 6, l*t>7 : "Was wounded by a ball entering the left buttock and lodging for a time in the left groin, frac- turing the head of the femur badly, and resulting in shortening of the limb about three and a half inches and much wasting and feebleness of the limb. He is obliged to wear constantly an iron instrument to support the limb in walking. He suffers much pain at night." In a communication to this office dated Philadelphia, February 13, 1868, Mr. Hensel states that he is unable to walk without the use of the apparatus and a cane, but by the aid of these he can walk from a half to three-quarters of a mile, being obliged, however, to rest for two or three minutes once or twice by the way on account of pain and weakness in the limb. The Philadelphia Examining Board, Drs. H. E. Goodman, T. C. Rich, and James Collins, reported, September 4, 1875: " Has had a ball enter the left buttock, which was extracted from the wound of entrance. Has lost bone from head of femur, and the limb is nearly three and a half inches shortened. He has to wear a support with a high heel and sole shoe. Motion of hip joint limited to one-eighth degree. Spine curved from short limb." Details of twenty-one of the reported cases of recovery after alleged shot fractures of the hip joint have been cited in the preceding pages, and the remaining thirty-four cases have been briefly alluded to in the foot-notes. The hip joint was undoubtedly involved in three of the fifty-five cases, viz: Case 134, of Lieutenant Colonel H. C. Strong, 38th New York Volunteers; Case 140, of Private T. L. Lomax, 30th Virginia; and Case 143, of Private T. C. Garvin, 94th New York Volunteers. The latter died four years after the injury, but the opportunity was not improved of ascertaining unequivocally the precise nature of the injury to the articulation. Twelve cases1 were probably examples of fractures of the trochanteric region or base of the neck of the femur, without the capsule. In thirteen cases the evidence is, to say the least, contradictory as to the seat of injury.2 In five cases the evidence adduced is compatible with the supposition that the fractures were extracapsular.3 In five other cases it is not proven that the articulation was directly injured.4 The case of Private A. C. Woodall {Note 1, page 75) seems to have been a periarticular injury only. In the case of Private J. W. Galyean, 10th Indiana Volunteers [Note 1, page 70), the Pension Examining Surgeon, years after the injury, diagnosticated an injury to the joint. In the case of Private J. Hughes, 1st Alabama Cavalry, the evi- dence consists of an affidavit of an unknown surgeon before an "Association for the relief of maimed soldiers." In thirteen cases5 the evidence is entirely insufficient to prove that the injuries were intracapsular shot fractures of the joint. In the case of Private W. C. Watson (Case 152, page 75), 4th Michigan Volunteers, there remains room for argument, but the weight of evidence is adverse to the supposition that the hip was implicated. Of the fifty-five cases of alleged recoveries after shot fractures of the hip joint treated without operative interference, eighteen were Confederate and thirty-seven Union soldiers. In the cases of the Confederate soldiers no information subsequent to the close of the war could be obtained. Of the thirty-seven Union soldiers four had died previous to 1880, one had not been heard from since 1866, and thirty-two were pensioners. 'Cases of: Pt. Philip Sweeney (Case 151, p. 74. ante); Pt. Charles Miller (Case 139, p. 71); Pt. M. M. Phillips (CASE 141, p. 72); Pt. James Vanderbeck (Case 142, p. 72); Pt- J- Doody (Note 1, p. 70); Corp'l D. Bachler (Case 144, p. 73); Serg't E. G. Gilliam (Case 146, p. 73); Pt. J. Wright (C*SE 135, p. fi9); Corp. L.English (Case 150, p. 74); Serg't A. G. Beebe(iVotel, p. 75); Corp. T. (lallagher (ATo > r > r i FlG 32.—Portion of right m- Case 160.—Private G. S. Turner, Co. I, 19th Maine, aged 18 years, was wounded at Gettys- nominatum, with fracture of burg, July 3, 1863. He remained at the field hospital of the 2d division, Second Corps, until July o^gg,0 ea< 1 um' pec' 14th, when he was transferred to the Jarvis Hospital at Baltimore. Assistant Surgeon D. C. Peters, U. S. A., reported: "Gunshot wound of left hip joint. The anterior wound was about the middle, and above Poupart's ligament; the posterior near the tuberosity of the ischium. Blood oozed almost continuously from the wound in front, and twice alarming haemorrhages occurred. He had a bad and colliquative diarrhoea, and was nearly pulseless when admitted. No reaction came on such as would warrant so formidable an operation as tying the common iliac. Constant pressure by com- presses was made. Death occurred on July 19, 1863. The post-mortem revealed an immense traumatic aneurism and abscess about the hip joint. The femoral artery was lacerated and a mass of decomposed tissue. The musket ball struck the acetabu- lum and the head of the femur, gouging them, and subsequent disorganization denuded them of periosteum. The structures around were in an advanced state of decomposition, and it is a wonder the patient lived so long as he did." Case 161.—Private H. West, Co. A, 3d North Carolina, aged 20 years, was wounded at Antietam, September 17, 1862, and admitted to the hospital at Locust Springs, November 22d, where Surgeon T. H. Squire, 89th New York, recorded: "The patient came to this hospital from Sharpsburg. He was wounded by a musket ball, which entered the right gluteal region midway between the summit of the trochanter and the crest of the ilium and lodged in some unknown part of the body. There is a general fullness, and some hardness and redness in the groin and region of Poupart's ligament, and possibly the ball may be iu that neighborhood. The patient's general health is tolerable." On January 19th he was transferred to the Smoketown Hospital, and, on May 11th, to hospital No. 1, at Frederick. Assistant Surgeon R. F. Weir, U. S. A., reported that he died, July 6, 1863, of " gunshot wound of hip, involving the joint." Acting Assistant Surgeon G. M. Paulin contributed the os innominatum and the head of the femur of this case to the Museum. The specimen shows that a round bullet entered obliquely from the right front, fractured the superior portion of the head of the femur, perforated the acetabulum, and lodged in the body of the ilium without derangement to its own form. One half of the head of the femur has been absorbed; the anterior superior third of the acetabulum is carious and partially detached; near the fundus of the acetabulum ulceration has perforated the bone, and the bullet communicates with the head of the femur by a carious channel. The missile is encircled with a wall of new bone thrown out from the irritation of its presence; there is also considerable deposit of callus on the ilio-pubic region, which caused, during life, a prominence in the region of Poupart's ligament. The dorsum ilii and the posterior surface of the body of the ischium show evidence of periosteal inflammation.—(Cat. Surg. Sect, 1866, p. 242, Spec. 3865.) ■LmELL (J. A.), in Memoirs of U. S. Sanitary Commission, New York, 1870, Surgical Vol. I, p. 551, describes the thrombosis with pyaemia. 80 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In twenty of the two hundred and forty-nine cases with fatal terminations after shot fractures of the hip joint, the acetabulum with the head and neck or trochanters and shaft were injured. Port-mortem examinations are recorded in seventeen instances, and the Army Medical Museum possesses eight specimens belonging to cases of this group. Fifteen ot the cases have been detailed in Circular No. 2;1 five will here be given in full: Case 102.—Private R. Snyder, Co. K, 13th Illinois, was wounded at Ringgold, November 27, 1863, and admitted to the general field hospital at Chattanooga on the following day, where Surgeon J. Perkins, U. S. V., recorded: "Gunshot wound of left hip." Two weeks afterwards the patient was transferred to Nashville, where he was admitted to hospital No. 19. Surgeon W. Foye, U. S. V., described the case as follows: "Admitted December 15th, with gunshot fracture of left femur; the ball, which proved to be a large mini6, entered about ona and a half inches to the left and below the anterior superior spinous process of the ilium and had not emerged. The wound was quite small, and discharging a small quantity of pus of a somewhat serous character; pulse weak, about 90, and feverish. Simple dressings, supporting diet, and tonics were ordered. The following day the discharge was of a fair character and the patient feeling better. As the ball had been searched for twice without success, it was deemed best not to disturb the parts unless rendered necessary. On December 18th the discharge was very profuse, amounting to nearly a quart of sanious and watery matter of very fetid odor. The wound was laid open and probed; the path of the ball was apparently along the inner side of the femur, yet that was not sufficiently large for so profuse a discharge; but no other path or sac was found, though the neck of the femur was ascertained to be much comminuted. He seemed more feverish during the day, and had some dyspncea and cough; pulse 100. Treat- Fig. 33.—Bones of the left hip ment continued. On December 19th the patient was evidently failing; pulse 110, and weak; junction with the neck. Spec. 2174. discharge more profuse and of the same character. On the 20th the symptoms were all aggra- vated. He died on December 21, 1863. The autopsy showed that the ball had entered at the point above described and struck the neck of the femur, completely severing it and partially dividing the head, comminuting the lower part of the acetabulum and passing through the ilium, and lay about an inch within the cavity of the pelvis. It was surrounded by coagula, but had done no injury to the intestines. A smaller track was made along the inner side of the femur. No piece of ball was found in this path. Intestines normal; liver and spleen considerably enlarged and friable. The right lobe of the lungs was inflamed but not hepatized. There were no abscesses in any of these organs. The heart and other organs were in good condition." The bones of the injured hip joint were contributed to the Museum by Surgeon Foye. (Cat. Surg. Sect, 1^6:>, p. 242, Spec. 2174.) The specimen (FlG. 33) shows the borders of the bony wound to be necrosed. Case 163.—Private A. Kibble, Co. C, 81st New York, aged 26 years, was struck in the right hip by a cannon ball during the engagement near Petersburg, May 19, 1864. He was admitted to the General Hospital at Fort Monroe, where he died May 25, 1864. Assistant Surgeon E. McClellan, U. S. A., reported: "Both the os innominatum and the femur were frac- tured and much comminuted, all the bones entering into the formation of the joint being literally crushed by a solid shot." Case 164.—Private C. Cook, Co. F, 18th Illinois, aged 41 years, is reported by Surgeon J. Simons, U. S. A., as having died of "gunshot wound," at the General Hospital at Cairo, December 4, 1861. In a report of surgical cases transmitted in April, 1873, by Dr. J. H. Brinton, late Surgeon U. S. V., the injury is described as follows: "Cook was shot while drunk, by a guard, on December 1st, at 6 o'clock P. M., at a distance of thirty yards. The missile, a Maynard rifle ball, entered in left side on a line with the crest of the ilium, passed outward and downward, and emerged at the posterior part of the left buttock. I saw him shortly after the injury in a state of collapse from the shock, pulse 132, feeble and thready; skin cold, white and waxy; cold sweat on forehead; constant venous dribbling from both openings. December 2d, no discharge from his bowels since being shot; passes his urine; is in a very prostrate condition; has reacted but very little. Stimulants have been freely given. A few spiculse were extracted from near the exit orifice. December 3d, patient failing fast; pulse feeble and not to be counted; urine scanty; pulse imperceptible; skin hot and dry; urine voided involuntarily; bowels have not been moved. Died at 9 o'clock a. M., on December 4th. Post-mortem two hours after death: Tissues around wound of entrance dissected up all around for an inch. Ball had passed obliquely outward and downward, grazing the anterior lip of acetabulum, passing through head of femur, splintering it and the neck, and destroying the posterior lip of the acetabulum. The extravasation of blood had passed down from wound of entrance, along and superficial to tendon of external oblique muscle as far as the external ring, then up the inguinal canal through the internal ring, and was collected in a clot of three or four drachms around the internal ring. Both rings were enlarged; a hernia came down after injury, which was reduced; no wound of the peritoneum. The tissues were loosened around the wound of entrance in a circumference of one and a half inches." In addition to this case Dr. Brinton makes the following remarks: "This loosening of tissues around the entrance wound of a conoidal ball I have since observed in hundreds of cases. It is undoubtedly peculiar. Usually the point of a finger passed through the wound can be hooked under the skin and swept around without encountering resistance sufficient to impede its motion. The earlier the wound is examined the more perfectly will this phenomenon be observed, as clots, etc., afterwards block up the disintegrated zone." » Circular Xo. 0,1869: Case 80, p. 77, Pt. Wm. O. M---, C, 24th Iowa, Spec. 3792. Case 124, p. 85, Pt. F. Baker, 1,3d Vermont. Case 129, p. 85, Pt. D. Combe, K, 209th Penn. Case 130, p. 66, Pt. Ch. Cushion, 179th New York. Case 132, p. 86, Pt. S. N. E---, G, 40th Indiana, Spec. 3390. Case 137^ p. 86, Corp'l J. T. Glancy, F, 2d Rhode Island. Case 139, p. 86, Pt. D. M. Johnson, 1,13th Alabama. Case 140, p. 86, Pt. George L---, D, 5th Louisiana, Spec. 3946. Case 142, p. 87, Pt L. L. Lowe, E, 101st Ohio. Case 143, p. 87, Pt. Peter M---, A, 28th Mass., Spec. 4227. CA6E 145, p. 87, Serg't Charles G. P---, G, 13th Penn., Spec. 3632. CASE 151, p. 88, Pt. G. F. Tilton, E, 1st Mass. Cav. CA6E 153, p. 89, Serg't William Whitney, K, 147th New York. Case 158, p. 89, Pt A. Wormack, G, 48th North Carolina. Case 159, p. 89, Corp'l M. F. Yoder, G, 51st Ohio. SECT, n.l WOUNDS AND INJURIES OF THE HIP JOINT. 81 Fig. 34.—Bones of the left hip joint. Spec. 1659. Case 165.—Private M. C. Lcsncur, Co. C, 3d Georgia, was wounded at Liberty Gap, June 25, 1863, and admitted to hospital at Murfreesboro' two days afterwards. Assistant Surgeon W. P. McCullogh, 78th Pennsylvania, recorded: "Gunshot wound of right thigh, ball entering trochanter and passing inward and backward. The missile was traced through the trochanter but could not be found." The treatment is noted as having consisted of water dressings, morphia, stimulants, and tonics, and, in the latter stage, astringents were given to control the diarrhoea. On July 8th, the wound was suppurating freely and the leg was bandaged. On August 1st, an incision was made and some spiculac of bone removed, a discharge of pus to the amount of eight ounces taking place. On August 9th the patient was slowly sinking, and, on the 16th, he was failing rapidly. Ho died August 19, 1863. An autopsy was held eight hours after death, and is recorded as follows: "The ball entered the trochanter major, passing through it and entering the capsule of the joint, carrying away a portion of the head of the femur and ligament um teres, and posterior portion of acetabulum, and was found lodging in the lower attachment of the latissimus dorsi. A large abscess was found in the locality of the iliacus interims and psoas muscle, the cartilage and bone of the joint much absorbed, and the cancellated structure infiltrated with sanious pus." Case 166.—Private M. J. H. Perkins, Co. K, 6th Maine, aged 21 years, was wounded at Chancellorsville, May 3, 1833. He was admitted to Judiciary Square Hospital, Washington, May 7th, and transferred to McDougall Hospital, Fort Schuyler, New York Harbor, one month after- wards. Assistant Surgeon R. Bartholow, U. S. A., contributed the specimen (Cat. Surg. Sect, 1886, p. 235, fyiv. 1659), represented in the adjacent wood-cut (FlG. 34), with the following descrip- tion : "A minie" ball entered the left hip, striking the neck of the femur within the capsule, passing through the obturator foramen and between the rectum and urethra without injuring either, and escaped behind the ramus of the right ischium. Inflammation of the prostate gland, and priapism set in. The patient died June 13, 1863." The specimen consists of the bones of the hip joint, the articular surfaces being entirely eroded. Of the two hundred and forty-nine fatal cases of shot fractures of the hip joint, twenty-three were limited to the head of the femur alone. In ten instances autopsies were performed, and six specimens are preserved in the Army Medical Museum. Two are represented in the adjoining wood-cuts. Specimen 1968 (Fig. 35) was obtained from Corporal J. E. G----, Co. I, 2d South Carolina, aged 22 years, wounded at Gettysburg, July 2, 1863. The head of the femur was slightly fractured; the acetabulum became cari- ous, and the patient died from exhaustion on Oct. 12, 1863, one hundred and two days after the injury (Circular 2, Specimen 2198 (Fig. 36) shows the bone of the left hip joint. The head of the femur is carious and the articular surface has been roughened by ulceration. The history of the case from which the specimen was obtained is given in detail in Circular No. 2, page 82, Case 104. Besides the specimen cases here referred to, fifteen have been detailed in Circular No. 2.2 The histories of the remaining six cases will here be recorded: Case 167.—Private I. Conduri, Co. D, 1st Michigan Cavalry, aged 22 years, was shot in the right thigh while on scout near Culpeper, April 24, 1864. He was admitted to the Third Division Hospital, Alexandria, whence Surgeon E. Bentley, 1 MOSES (J.), Surgical Notes, etc., in Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 337. 2 Circular No. 2,1869: Case 9, p. 66, Pt. C. Benjamin, 118th Pennsylvania. CASE 14, p. 67, Pt. F. Bowman, F, 1st U. S. Sharpshooters. Case 25, p. 69, Pt. J. A. Deyo, B, 20th Indiana. Case 53, p. 73, Pt. J. Harrigan, K, 36th Mass. Case 57, p. 73, Pt Root N. II---, D, 1st New Jersey Cav., Spec. 3636. Case 70, p. 76, Pt J. Lawler, B, 12th New York Cav. Case 74, p. 76, Pt Chas. II. M---, G, 3d Maryland, Spec. 3923. Case 85, p. 78, Pt. John M---, L 61st New York, Spec. 1602. Case 101, p. 82, Pt H. Sault, 1,5th New York. Case 1C8, p. 83, Pt. J. Spangler, A, 38th Ohio. Case 111, p. 83, Sergeant H. Stulter, D, 53d Pennsylvania. Case 113, p. 83, Pt. Peter L. Swank, 1,38th Ohio. Case 115, p. 83, Serg't V. Tidball, H, 122d Ohio. Case 246, p. 100, Pt. F. Kreegor, B, 18th Georgia. Case 251, p. 101, Pt S. Sellers, 1,168th Ohio. Surg. Ill—11 Fig. 35.—Bones of the right hip joint. Head of femur nearly absorbed. Spec. r)Q,CTQ (\ CASE 42) FIG. 36.—Bones of tho left hip joint with carious head of femur. Spec. 2198. 82 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. U. S. V., reported: " The treatment consisted of water dressings, tonics, stimulants, and extra diet. The patient died Juue It, 1864. The post-mortem showed that the ball entered the thigh at its middle third, on its anterior aspect, passed upward and entirely through the articulation of the hip joint, and lodged in the body of the sacrum." Case 108 —Sergeant M. D. Ensor, Co. C, 20th North Carolina, aged 26 years, was wounded and captured at Winchester, September 19, lHiil. On the following day he was admitted to the Prisoner's Hospital, where Assistant Surgeon II. B. Noble, 2d Ohio Cavalry, recorded: 'Gunshot compound comminuted fracture of upper third of right femur; Desault's long splints applied and simple dressings." Surgeon A. Chapel, U. S. V., reported the man's admission to West's Buildings Hospital, Baltimore, January 19, 1865, from Winchester, with "gunshot wound, the ball entering near the trochanter of the Viigh bone, producing fracture." On May 9th the prisoner was transferred to Fort McHenry. Surgeon W. Hays, U. S. V., in charge of the Post Hospital at the latter place-, reported that the man " died from exhaustion, resulting from excessive suppuration caused by gunshot fracture of head of femur, June 3, 1865." Case 169.—Private A. Fann, Co. C, 18th Tennessee, was wounded at Stone's River, December 31, 1862, and admitted to hospital No. 4, Nashville, January 27 th. Acting Assistant Surgeon F. L. Tower reported: "Gunshot fracture of head of left femur and wound of abdomen. Death on January 31, 1863." Case 170.—Private S. Irwin, Co. C, 10th Massachusetts, aged 25 years, was wounded at the Po River, May 12, 1864. Surgeon S. F. Chapin, 139th Pennsylvania, noted his admission to the field hospital of the 2d division, Sixth Corps, with "gunshot wound of left thigh." On May 24th the wounded man was admitted to Prince Street Hospital, Alexandria, whence Acting Assistant Surgeon J. Cass con- tributed the specimen (Cat. Surg. Sect., 1866, p. 234, Spec. 2374) and the following report: "The patient suffered considerable pain, had chills, was very uneasy and anxious, had no appetite, hic- cough, and great prostration, and died May 28, 1864. At the autopsy the left groin was found coiiMderably discolored, and, on examination, it was discovered that the wound commenced just below the middle of Poupart's ligament, extending downward and inward, and terminating at the ischium, which was fractured. The ball was found near that bone, between it and the head of the femur, which was also fractured. The ligaments of the hip joint, the soft parts in the groin, and the upper part of the thigh were gangrenous." The specimen (Fig. 37) consists of a portion of the Fig. 37.—Portion of left ischi- , A . \. , ., t •„ * ,, , ™ • t- ,e t , 4, , , e <, um and upper part of femur. le" ischium and the upper extremity of the femur. Ihere is a partial fracture of the head of the Spec. 2374. femur at its articular border and of the ischium by a battered round ball, which is attached. Case 171.—Lieutenant J. Snyder, Co. K, 83d Ohio, aged 33 years, was wounded at Fort Blakely, April 9, 1865, and admitted to the St. Louis Hospital, New Orleans, five days afterwards. Surgeon A. McMahon, U. S. V., reported: "Gunshot wound of right thigh and nates, fracturing the ischium and the femur at its neck. Death resulted from peritonitis following inflammation of the pelvic fascia." Case 172.—Private A. Underbill, Co. C, 10th New York, was wounded at the Wilderness, May 6, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported: "Gunshot fracture of head of femur." The wounded man was conveyed to Fredericksburg, where he died May 15, 1864. In seventeen of the fatal cases after shot fracture of the hip joint treated by conserva- tion the head and neck, or head, neck, and trochanters of the femur were injured. Full details of fifteen of the cases, with illustrations of eight specimens, have been given in Circular 2.1 Meager details of two cases will here be added: Case 173.—Private H. Peters, Co. D, 18th U. S. Infantry, was wounded at Chickamauga, September 19, 1863. He was admitted to hospital at Chattanooga ten days after the injury. Surgeon J. S. Woods, 99th Ohio, reported: "Fracture of head and neck of right femur. Patient in bad condition; several pieces of bone were removed." The man died October 11, 1863. On the list of casualties at the battle of Chickamauga, furnished by Surgeon G. Perin, U. S. A., Medical Director of the Army of the Cumberland, the injury in this case is reported as a "wound of privates and right side." Case 174.—Private F. Benda, Co. F, 26th Wisconsin, aged 19 years, was wounded at Gettysburg, July 1, 1863, and admitted to the field hospital of the 2d division, Eleventh Corps, where Surgeon W. H. Thorn, U. S. V., recorded: "Gunshot wound of left hip; ball extracted." On August 6th the patient entered Camp Letterman Hospital, where Surgeon H. Janes, U. S. V., recorded: "The patient suffers from a compound comminuted fracture of femur. The ball entered from the outside of the hip, crushing the bone from the trochanter major upward, then passing obliquely upward entered the pelvis near the sacrum. No history of this case could be procured previous to his admission to this hospital. August 12th, the patient suffers from diarrhoea and hectic fever and is sinking rapidly. He died from exhaustion, August 20, 1863. Treatment: Exhibition of tonics, stimulants, and anodynes." > Circular 2, 1869: Case 6, p. 66, Pt. J. Barnes, B, 52d Indiana. Case 8, p. 56, Pt. Anthony B---, C, 12th Illinois, Spec. 466. Case 10, p. 66, Pt. Charles R. B---, E, 16th Maine, Spec. 598. Case 17, p. 67, Pt. W. C---, 159th New Y#k, Spec. 1291. Case 21, p. 68, Pt. D. Curran, A, 5th Kentucky. Case 45, p. 72, Major John J. G---, G, 47th Pennsylvania, Spec. 3789. Case 52, p. 73, Corporal Benjamin H---, C, 9th West Virginia, Spec. 4267. Case 76, p. 77, Corporal Donald McD---, E, 12th New York Cav., Spec. 2170. Case 89, p. 79, Serg't S. W. N---, E, 15th New Jersey', Spec. 1253. CASE 91, p. 80, Captain Samuel Oakley, 77th New York. Case 102, p. 82, Pt. C. Saunders, C, 0th Louisiana Cavalry. Case 106, p. 82, Pt. G. H. S---, H, 2d North Carolina, Spec. 1967. Case 118, p. 84, Pt. R. A. Walker, E, 2d New Hampshire. Cabe 275, p. 113, Pt. A. Swanson, H, 3d Michigan. In the case reported by Dr. J. Dickson Bkuns (Circ. 2, S. G. O., 1869, p. 57), a first attempt to remedy the injury by an operation was suspended, as the haemorrhage was very great. Some ten days or two weeks after, an excision of the head of the femur was attempted, as an examination had shown that the neck was extensively split. After the primary incisions had been made, and several fragments of the neck had been removed, the operation was discontinued, as it became apparent that death was inevitable. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 83 Fig. 38.—Shot fracture of neck of left femur. Spec. 3951. FIG. 39.—Shot fracture of neok of right femur. Spec. 1661. Seventy instances are recorded, among the two hundred and forty-nine fatal cases of shot fractures of the hip joint treated by conservation, in which the neck of the femur was stated to have been fractured. Fifty-six of the cases have been recorded in Circular 2;1 fourteen will be recorded here. Autopsies were made in twenty-one of the cases, and eleven specimens are preserved in the Army Medical Museum. A specimen belonging to this group, represented in the adjoining wood-cut (Fig. 38), was received without history. It consists of the upper fourth of the femur, with a fragment of a round ball embedded in the neck within the capsule. There is no evidence of chronic articular disease. The specimen is a fair illustration of injury to bone by round balls at low velocities. A similar specimen is rep- resented in Fig. 39, showing a round ball embedded in the neck of the femur near the trochanter major, fracturing the neck within the capsule. The history of this case has been detailed in Circular No. 2, p. 81, Case 98. Case 175.—Private J. Boaz, Co. A, 1st Confederate States Cavalry, was wounded at Stone's River, December 31, 1862. He was admitted into No. 19 Hospital, Nashville, January 20, 1863. Surgeon J. Shrady, 2d East Tennessee, noted: "Gun- shot compound fracture of the neck of the right femur." He died February 4, 1863. Case 176.—Private J. W. Connor, Co. D, 81st Pennsylvania, was wounded at Fredericks- burg, December 13,1862. Surgeon J. E. McDonald, 79th New York, recorded his entrance into the field hospital of the 1st division, Ninth Corps, with "Gunshot wound of left thigh." Surgeon J. A. Lidell, U. S. V., contributed the specimen represented in the adjoining wood-cut (FlG. 40) (Cat. Surg. Sect, 1866, p. 243, Spec. 622), and reported the following history: "Admitted to Stanton Hospital, Washington, December 26th, with gunshot fracture of left thigh in upper third; ball not extracted. The injured limb was a good deal swelled; pus flowing from the wound. Exploration did not discover the ball; thigh found fractured high up; amount of displacement small. The case did pretty well till December 31st, when symptoms of pyaemia showed themselves. He grew rapidly worse, and died January 2, 1863. The necropsy showed inflammation of the femoral vein, pus in the femoral and iliac veins, a comminuted fracture in the neighborhood of the trochanters, and the ball firmly impacted in the ischium." The specimen consists of the bones of the hip joint with a portion of the ligaments, the head of the femur being FIG 40 _Bones of tne ieft hip dislocated. The track of the ball is necrosed, but a small quantity of callus has been thrown joint with dislocation of head of out on the anterior surface of the femur. emur. p Case 177.—Private A. E. Davis, Co. E, 1st Maine Cavalry, aged 22 years, was wounded during the Richmond raid, March 2, 1864,.and admitted to the General Hospital at Fort Monroe five days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported: "Gunshot wound of right hip. The patient was admitted in good condition; wound healthy. Pyaemia was developed on March 12th, and death occurred within twenty-four hours. The autopsy discovered that the ball had pierced the neck of the femur. There were symptoms of inflammation of the femoral vein; six ounces of dark bloody fluid in left 1 Circular 2, S. G. O., 1869: CASE 1, p. 65, Pt. A. Baker, 5th Maine Battery. Case 3, p. 65, Pt J. Balines, C, 26th Wisconsin. CASE 4, p. 66, Pt. W. Bancho, H, 3d New Hampshire. Case 5, Corp'l M. Barden, K, 10th Mass. Case 12, p. 67, Serg't G. Bond, A, 137th Blinois. Case 18, p. 68, Pt. P. C---, G, 24th Alabama (see also Confed. States Med. Jour., Vol. I, p. 76). CASE 19, p. 68, Pt J. Connelly, C, 1st Louisiana (Colored) Cavalry. CASE 23, p. 68, Pt. H. Damback, 1,17th Ohio. Case 26, p. 69, Pt. J. Dice, 43d Missouri. Case 27, p. 69, Pt. C. G. Dodson, C, 13th West Virginia. Case 29, p. 69, Pt. E. H. Dunkleberg, F, 11th Infantry. Case 30, p. 69, Pt. St. H. Eisenhower, F, 103d Ohio. Case 33, p. 70, Pt. D. Elmer, M, 14th New York H. A. Case 35, p. 70, Pt. A. E. Fields, B, 6th Maine, Spec. 2932. Case 36, p. 70, Pt. S. Fleig, E, 45th New York. Case 38, p. 70, Pt. J. Foreman, E, 5th Alabama. Case 41, p. 71, Pt S. F---, E, 111th New York, Spec. 1462. Case 44, p. 71, Pt. J. G---, B, New Hampshire H. A., Spec. 3540. Case 47, p. 72, Pt B. F. Green, E, 125th New York. Case 48, p. 72, Pt T. Green, L, 12th Tennessee Cav. Case 50, p. 72, Pt. D. Haley, B, 57th Mass. Case 54, p. 73, Pt. L. P. Harvey, B, 11th New Hampshire. CASE 58, p. 74, Pt W. Huger, D, 7th Virginia. CASE 62, p. 74, Pt P. C Johnson, H, 15th Ohio. CASE 65, p. 74, Pt. D. A. Kimble, G, 3d Minnesota. Case 72, p. 76, Corp'l J. G. Mallory, C, 31st Indiana. Case 75, p. 76, Pt. J. Matthews, A, 11th Louisiana (Colored). CASE 77, p. 77, E. McGee, Secret Service. Case 78, p. 77, Lieut T. H. McKinley, B, 29th U. S. C. T. Case 81, p. 77, Pt. J. W. Moore, H, 6th Penn. Cav. Case 82, p. 78, Pt. J-M---»P. 63d New York, Spec. 782. Case 83, p. 78, Pt. J. R. Morrill, D, 184th Penn. Case 84, p. 78, Pt. P. M---, B, 1st Virginia, Spec. 33. Case 86, p. 79, Pt J. B. Mullen, G, 13th Indiana. Case 95, p. 81, Pt J. L. Riley, 1,21st Mississippi. Case 98, p. 81, Pt. L. R---, F, 48th New York, Spec. 1661. Case 100, p. 81, Serg't F. Sallyards, A, 70th Ohio. Cask 107, p. 82, Corp'l H. F. Smith, B, 1st Wisconsin. Case 109, p. 83, Corp'l J. A. Staunton, H, 1st Florida. Case 110, p. 83, Pt. J. Stewart, B, 26th Ohio. Case 112, p. 83, Pt J. S---, B, 43d Ohio, Spec. 465. Case 117, p. 84, Pt. J. Wagoner, F, 81st Illinois. Case 119, p. 84, Pt I. W. Winans, C, 3d Wisconsin. CASE 120, p. 84, Corp'l G. W. Wright, Blount's Virginia Battery. CASE 121, p. 84, Pt IF. P. Yeargin, E, 22d Georgia. Case 212, p. 96, Pt S. Randall, G, 118th New York. Case 236, p. 99, Serg't S. R. Arrison, A, 118th Illinois. Case 240, p. 100, Pt. J. T. Cone, 7th Virginia (see Am. Med. Times, 1864, Vol. VIH, p. 13). Case 241, p. 100, Pt. W. A. Dibble, C, 106th Penn. Case 249, Pt. B. Page, I, 51st North Carolina. Case 255, p. 102, Corp'l G. W. W---, Virginia Battery. Case 259, p. 102, Pt. H. T. Elam, A, 11th Virginia, Spec. 9. Case 268, p. 104, Pt E. Longj'ear, D, 72d Penn. Case 269, p. 104, Pt L. N. P. Rodeubough, D, 55th Illinois. Case 271, p. 105, Pt, L. Schmidt, H, 8th Kansas. CASE 276, p. 114, Serg't E. Scott, A, 1st New Jersey Cavalry, Spec. 3520. 84 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. thorax, with an oily fluid floating on it; two ounces of light colored bloody fluid in pericardium; an oily substance collected on the blood from all parts of the body. Liver engorged and soft. No formation of pus discovered." Case 178.—Private G. W. Fierstine, Co. K, 93d Pennsylvania, was wounded at Fair Oaks, June 1, 1862, and admitted to the Fifth and Buttonwood Streets Hospital, Philadelphia, six days afterwards. Acting Assistant Surgeon A. C. Bournonville reported: "Fracture of neck of femur, tuberosity of ischium shot off and pelvic bones shattered; no wound of bladder or rectum. Prognosis fatal. Patient was most comfortable by having the limb elevated and supported by pillows. He died June 12, 1862." Case 179.—Private J. M. Hayse, Co. K, 14th Kansas Cavalry, was accidentally wounded May 19, 1864, and admitted to hospital at Fort Smith. Surgeon C. E. Swasey, U. S. V., reported: "Gunshot wound of left thigh into abdomen, with fracture of neck of femur. Death resulted, from perforation of the bowels, on May 20, 1864." Case 180.—Private F M. Hayes, Co. A, 211th Pennsylvania, aged 21 years, was wounded at Fort Steadman, March 25, 1865. He was admitted to the field hospital of the 3d division, Ninth Corps, where Surgeon M. F. Bowes, 211th Pennsyl- vania, recorded: "Wound of right hip by conoidal ball." Two days afterwards the man was moved to the Depot Hospital at City Point, and ten days later he was conveyed on a hospital steamer to Alexandria, where he entered the Third Division Hospital. Surgeon E. Bentley, U. S. V., reported: "Gunshot fracture of right hip. Light cold-water dressings and a bandage were applied over the thigh to facilitate the discharge of pus from the wound. The limb was retained in position by means of an inclined plane, with slight extension and counter-extension. Alcoholic stimulants and nourishing diet were freely admin- istered. He died April 14, 1865. Autopsy thirteen hours after death : Tissues of thigh very much disorganized by the extent of suppuration, involving the entire limb. The femur was fractured at the neck. The ball had passed under the pubis and was found in the pelvis, external to the peritoneum." Case 181.—Private C. Hambrecht, Co. E, 4th New Jersey, was wounded at South Mountain, September 14, 1862, and admitted to the field hospital at Burkettsville. Assistant Surgeon H. A. DuBois, U. S. A., reported: "Gunshot wound through os pubis and neck of femur. Secondary haemorrhage occurred on October 18th. A ligature was applied to the external iliac and the femoral arteries. But little blood was lost, the surgeon being in the ward at the time the haemorrhage commenced. The operation was difficult, it being necessary in order to stop the haemorrhage to compress the artery on each side and close to the wound, which was directly below Poupart's ligament. The patient rallied after the operation and was able to read a letter, but died six hours after." Case 182.—Private W. J. Little, Co. I, 57th Pennsylvania, aged 22 years, was wounded at the Wilderness, May 5, 1864, and admitted to the field hospital of the 3d division, Second Corps. Surgeon 0. Evarts, 20th Indiana, noted: " Gunshot wound of left hip." Surgeon D. W. Bliss, U. S. V., forwarded the specimen (Cat. Surg. Sect, 1866, p. 241, Spec. 2398) aud reported: "The patient entered Armory Square Hospital, Washington, May 28th. He was wounded by a conoidal ball, which entered the right gluteal region on a line with the coccyx, two inches above the anus, passing under the fascia in a direct line and through the ramus of the ischium, comminuting the left femur at its neck, and making its exit over the great trochanter. Powerful stimulants were given but with no effect. The patient died from the effects of the injury, May 30, 1864." The specimen shown in the wood-cut (FlG. 41) fig. 41.—Bones of left hip joint, consists of the bones of the left hip joint, and shows the head of the femur, with the exception Neck of femur shattered. Spec. 2398. 0f a slight fissure on its articular surface, to be uninjured. Case 183.—Private J. McAlpine, Co. C, 7th Illinois, was wounded at Allatoona, October, 5, 1864. Surgeon J. R. Zearing, 57th Illinois, reported his admission to the field hospital of the 4th division, Fifteenth Corps, with "gunshot fracture of neck of femur," and his death on October 8, 1864. Case 184.—Musician F. McNeil, Co. B, 17th Illinois, was wounded at Shiloh, April 6, 1862, and admitted to hospital at Quincy twelve days afterwards. Surgeon R. Niccolls, U. S. V., reported: " Compound comminuted fracture of right femur at the neck and transverse fracture of left femur at the middle third. Dr. Buck's weight and pulley were employed. Death took place on April 27, 1862. At the post-mortem a minie" ball, split longitudinally, was removed from the neck of the femur." Case 185.—Private U. T. Palmer, Co. I, 1st Maine, aged 33 years, was wounded at Cedar Creek, October 19, 1864, and admitted to the field hospital of the 2d division, Sixth Corps. Surgeon S. F. Chapin, 139th Pennsylvania, noted: "Gunshot fracture of left thigh." On October 27th the wounded man was admitted to Camden Street Hospital, Baltimore, whence Surgeon Z. E. Bliss, U. S. V., reported as follows: "Gunshot wound of left gluteal region, with fracture of neck of femur. Smith's anterior splints were applied, and quinine and carbonate of ammonia, etc., were resorted to, but unsuccessfully. The patient died of pyaemia, November 3, 1864. At the post-mortem pus was found in the synovial cavities near the hip joint." Case 186.—Sergeant W. Peabody, Co. C, 10th Vermont, aged 22 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick the following day. Assistant Surgeon R. F. Weir, U. S. A., reported: "Gunshot fracture of neck of left femur and flesh wound of thigh and scrotum. Ball removed July 11th. Tonics, opiates, and stimulants administered; Buck's extension apparatus applied. Death, from exhaustion, July 23, 1864." Case 167.—Private J. R. Smith, Co. H, 12th South Carolina, appears on a report from the Confederate Hospital at Charlottesville as having died June 1, 1864, of "gunshot wound of left thigh; missile found in neck of femur." Case 18S.— Captain B. Ward, Co. B, 33d Alabama, was wounded at Perryville, October 8, 1862. On a report of "Sick and Wounded Confederates left behind after the battle," signed by Surgeon C. Longenbecker, 13th Louisiana Regiment, C. S. A., his injury is described as a "gunshot fracture of left thigh through neck of femur into the joint and os ischii, ball in pelvis," and his death is stated to have occurred on October 27, 1862. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 85 Fig. 42.-Comminuted frac- ture of upper third of left fe- mur, with fissure extending into the neck. Spec. 4930. FIG. 43.—Upper portion of left femur, with fragments of bone removed after shot fracture of the neck. Specs. 3143 and 67. Of the two hundred and forty-nine fatal shot wounds of the hip joint treated by conser- vation fifty were instances of shot injuries of the neck and trochanters, or neck, trochanters and shaft of femur. Autopsies were performed in thirty-two instances, and twenty-five specimens are deposited in the Army Medical Museum. All of the cases have been reported in Circular No. 2,1 and only a few of those in which interesting specimens are preserved will be here briefly noticed. Case 189.—Private C. H. Elliott, Co. D, 61st Pennsylvania, was wounded at the battle of Fair Oaks, May 31, 1862, by several musket balls. One entered near the right acromion process and emerged at the insertion of the deltoid muscle; another at the gluteal fold; a third passed through the upper part of the thigh; a finger was also shot away. He was conveyed to Portsmouth, and on June 5th was admitted into the Balfour General Hospital. A fracture of the head of the humerus was recognized, and, on June 14th, Assistant Surgeon Sheldon, U. S. A., excised the head and about three inches of the shaft (see Second Surgical Volume, p. 586, Case 23). Abscesses formed in the left thigh. Pyaemia super- vened, and the patient died on June 17, 1862. At the autopsy the upper third of the femur was found to be shattered. There was a collection of pus near the wound in the hip. Assistant Surgeon H. L. Sheldon, U. S. A., reports the case. The specimen, 4930, repre- sented in FlG. 42, was contributed by Assistant Surgeon W. Thom- son, U. S. A.—(Circular No. 2, p. 69, Case 31.) Case 190.—Private Philo Wilbur, Co. 1,185th New York, aged 19 years, was wounded in action at the Southside Railroad, Virginia, March 25, 1865. A conoidal ball entered over the left trochanter major, produced a comminuted fracture of the process, and emerged at the lower and inner border of the left buttock. He was taken to City Point aud Washington and admitted, on April 2d, into the Mount Pleasant Hospital. On April 7th there was febrile action and anorexia. On April 9th, Assistant Surgeon H. Allen, U. S. A., removed several detached fragments of bone. Irritative fever and anorexia continued. On April 14th he had a rigor; pyaemia appeared, with vomiting and diarrhoea. On April 18th secondary haemorrhage of from six to eight ounces occurred from branches of the external circumflex, and was arrested by compression of the femoral. He died April 20, 1865. The history, with the specimens 3143 and 67 (FlG. 43), were contributed by Assistant Surgeon H. Allen, U. S. A.—(Circular No. 2, p. 106, Case 274.) Case 191.—"Alfred G. R----, Adjutant 134th Pennsylvania, aged 24 years, was wounded in the upper part of the left femur by a round ball, which partially fractured the trochanter major, at the battle of Fredericksburg, December 13,1862. The wound received no attention for some days, and was then dressed with side splints firmly bound by a roller, a plug of lint being tightly inserted in the wound. On the 20th of December he was admitted to E Street Infirmary, Washington. He stated that for some days he had experienced occasional twitchings in the limb, and had taken large doses of opium. The wound was a little behind the trochanter major. Upon removing the plug of lint about half a pint of blood and pus was discharged. There was no crepitus upon rotation, nor shortening. Owing to his weakened condition, no extended search was made for the missile. Simple dressings were applied, and half grain doses of sulphate of morphia were given. For the two succeeding days he seemed to improve. The twitchings of the limb occurred every few minutes, with occasional intermissions of a few hours. On the 23d the spasms became more violent and frequent, and it was deemed advisable to extract the missile. He was etherized, and the wound was enlarged two inches downward and backward. A gum catheter was made to follow the course of the missile behind and beneath the neck of the femur to the body of the pubis, where the ball was found in the scrotum near the spermatic cord. A flattened round musket ball was extracted through an incision at the base of the scrotum. A portion of it had 1 Circular No. 2, 1869: Case 15, p. 67, Pt. T. B----, 14th North Carolina, Spec. 548. CASE 20, p. 68, Pt. J. C----, 1,10th New Jersey, Spec. 3806. Case 22, p. 68, Pt. J. C---, C, 5th New York Cav., Spec. 3189. Case 24, p. 68, Pt. M. D----, H, 14th New York H. A., ,Sfpec..3261. Case 28, p. 69, Pt. A. D----, B, 43d New York, Spec. 3797. Case 31, p. 69, Pt C. H. E---, D, 61st Penn., Spec. 4930. Case 34, p. 70, Pt. J. F----, H, 1st Mass. Cav., Spec. 2704. Case 46, p. 72, Pt. F. G---, 1st Louisiana, Spec.. 1300. Cask 49, p. 72, Pt. G. H----, D, 26th Michigan, Spec. 2839. Case 51, p. 72, Serg't W. D. H----, A, 6th Iowa, Spec. 3488. Case 55, p. 73, Pt. W. Herold, B, 6th Alabama. Case 56, p. 73, Musician J. B. H----, A, 41st Ohio, Spec. 2178. Case 61, p. 74, Pt. H. J---, F, 14th N. York, Spec. 2309. Case 64, p. 74, Pt. M. K---, D, 65th N. York, Spec. 3419. Case 66, p. 74, Pt. A. J. K---, E, 8th Florida, Spec. 1932. Case 67, p. 75, Pt. L. P. L---, K, 91st Penn., Spec. 1343. Case 68, p. 75, Pt. J. Laner, F, 39th N. Jersey. Case 69, p. 75, Capt J. M. L---, I, 20th Indiana, Spec. 565. Case 71, p. 76, J. McCarthy, E, 76th New York. Case 73, p. 76, Capt. H. D. M---, K, 79th Illinois, Spec. 1747 (Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 337). CASE 88, p. 79, Pt. T. M---, C, 14th Maine, Spec. 1728. Case 90, p. 79, Serg't W. Norton, I, 5th Wisconsin (U. S. Sanitary Commission Memoirs, Vol. I, p. 526). CASE 92, p. 80, Pt. W. O---, K, 2d U. S. Cav., Spec. 2528. CASE 94, p. 80, Adj't A. G. R---, 134th Penn., Spec. 545. CASE 96, p. 81, Pt. J. R----, C, 69th New York, Spec. 86. Case 99, p. 81, Pt T. R---'-, K, 210th Penn., Spec. 4168. Case 103, p. 82, Capt. E. F. S----, K, 1st New York Cav., Spec. 4213. Case 114, p. 83, Corp'l J. M. Thompson, B, 29th Mass. Case 122, p. 84, Serg't D. Y----, H, 106th New York, Spec. 3931. Case 199, p. 94, Serg't J. B. Bridwell, B, 87th Illinois Mounted Infantry. CASE 200, p. 94, Pt. W. Campbell, A, 23d Missouri. CASE 203, p. 95, Serg't W. G. Davis, H, 19th Ohio. Case 205, p. 95, Pt. C. Falk, E, 26th New York. CASE 206, p. 95, Pt. W. T. Fostner, F, 28th Virginia. Case 207, p. 95, Pt. H. B. Gardner, F, 38th Illinois. CASE 208, Pt. M. Haehl, A, 32d Indiana. CASE 209, p. 95, Capt. J. D. Irwin, C, 124th Ohio. CASE 213, p. 96, Pt. J. Scbeets, 1,111th Ohio. CASE 214, p. 96, Pt. D. Schamill, H, 50th Penn. Case 215, p. 96, Corp'l G. Williams, D, 11th Missouri. CASE 242, p. 100, Corp'l M. J. Fitzharris, E, 42d N. York. CASE 258, Pt. F. Beck, F, 115th Penn. Case 263, p. 103, Pt. T. Hayward, F, 5th Penn., Spec. 592. CASE 265, p. 104, Corp'l W. Hermka, D, 1st Maryland Cav. Case 266, p. 104, Pt. J. Ltehart, C, 16th Mississippi. CASE 270, p. 104, Capt, H. A. Sand, 103d New York. CASE 273, p. 105, J. T. Tindell, K, 18th Mississippi Cav. (Confed. States Med. and Surg. Jour., January, 1865). CASE 274, p. 106, Pt P. Wilbur, 1,185th New York, Spec. 3143. Second Surgical Volume: Case 859, p. 295, Serg't W. Spendlove, E, 1st New York Cav., and CASE 935, p. 324, Serg't C. Moulton, D, 2d Maryland. 86 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Fig. 44. — Fracture of trochanter and neck of the left femur by a round musket ball. A fragment of lead is im- pacted in the neck. Spec. 545. FIG. 45.—Fissure of right femur, caused by a conoidal ball lodging in the neck. Spec. 3931. been chipped off. The patient rested well that night, but on the following day the spasms were increased in intensity, commencing in the injured limb and extending over the body. Cloths saturated with chloroform and olive oil were applied to the limb, and an antispasmodic and anodyne mixture was prescribed. He rested quietly until the following morning, when clonic spasms returned and persistently increased. The patient's countenance became pinched, wan, and haggard, and expressive of fright. There was no pain nor trismus, and he partook freely of nouishment. At times there was complete opisthotonos. On December 25th he took four dozen pills of assafcetida of four grains each, and one half ounce of fluid extract of Cannabis Indica in divided doses, without any benefit. Sulphate of morphia in doses of one grain was then prescribed, to be administered every two hours, and a poultice of powdered opium and cinchona applied to the wound, but, as before, without apparent benefit. The mind, up to this time, continued clear and undisturbed, his pulse moderately full and strong, ranging at about 100. He now became drowsy, and at times lay in a semi-comatose condition. His pulse ran up to 150. Respiration was free, but at times hurried, from 25 to 28 per minute. The skin became bathed in sweat, which exhaled a peculiar pungent odor. The bowels were regular; the urine was scantily secreted and high colored, though voided without difficulty. The discharge from the wound was thin, bloody, and offensive. On December 27th opisthotonos recurred, and was temporarily relieved by the application of chloroform to the entire extent of the spine. Subsequently, violent epileptiform convulsions set in, and death resulted from exhaustion, on December 28, 1862." The pathological specimen is figured in the wood-cut (Fig. 44), and shows a fracture of the great trochanter of the left femur and a piece of a leaden ball embedded in the neck. The specimen and history were con- tributed by Surgeon C. L. Allen, U. S. V.—(Circular 2, S. G. O., 1869, p.80, Case 94.) Case 192.—"Sergeant David Y----, Co. H, 106th New York, aged 29 years, was wounded at the battle of Monocacy Junction, July 9,1864, by a conoidal musket ball, which entered two inches posterior to and one inch above the right trochanter major, passed forward and inward, and lodged in the neck of the femur at its middle portion. He was admitted to General Hospital at Frederick, Maryland, on the same day, and the wound did well until the 12th of July, when it assumed an unhealthy appearance. A careful examination was made with the finger and by the probe, and the integu- ments and fascia were divided, giving free exit to sanious and fetid pus. Large quan- tities of stimulants and beef tea were given. On July 19th symptoms of pyaemia made their appearance, such as rigors followed by profuse perspiration and acceleration of the pulse and respiration, dryness of the tongue, and anorexia. Another examination of the wound was made, and the ball was found embedded in the femur, but, owing to the patient's condition, its removal was deemed inadvisable. On July 20th another rigor occurred, and gradual aggravation of all the symptoms followed. He died at 3 o'clock P. m., July 22, 1864." The pathological specimen and history (FlG. 45) were contributed to the Army Medical Museum by Assistant Surgeon R. F. Weir, U. S. A.—(Circular 2, p. 84, Case 122.) Case 193.—"Captain James M. L----, Co. I, 20th Indiana, was twice wounded in an engagement in front of Richmond, on June 27, 1862. The first wound was through the lumbar muscles, and, while lying on the field, he was again struck by a conoidal musket ball, which entered on the outer side of the left thigh a little below the great trochanter, and, passing upward and inward, lodged. He was conveyed to Washington, and on June 29th was admitted to the Columbia College Hospital. A finger could be readily passed into the perforation of the femur, but the ball could not be reached. There was no shortening or eversion of the limb, interfering with the motion of the joint. Three formal attempts to ascertain the position of the ball and accomplish its removal were unsuccessfully made. The patient died from exhaustion, August 19, 1862." The speci- men is represented in the adjoining wood-cut (FlG. 46). It shows the upper portion of the left femur perforated between the trochanters on the posterior surface. The track of the ball is carious. The great trochanter has been split off, but is reunited by callus. The space between the trochanters is bridged over by a displaced fragment of bone, attached in its new position by slight osseous deposits. The missile was found resting against the capsular ligament. Assistant Surgeon W. M. Notson, U. S. A., who attended and reported the case, is confident that the ball was external to the joint; but as the grooving of the neck extends upward nearly to the articular surface of the femur, it is hardly possible that the joint escaped.—(Circular 2, p. 75, Case 69.) In twenty-seven of the two hundred and forty-nine shot fractures of the hip joint with fatal terminations the parts of the joint involved were not indicated. The details in the cases are very meagre, and no autopsies were made. Fifteen have been recorded in Circular No. 2 j1 such information as was obtainable of the remaining twelve will here be given: Case 194.—Private J. Cilley, Co. E, 19th Maine, aged 22 years, was wounded at Petersburg, June 22,1864, by a conoidal ball. He was taken to the field hospital of the 2d division, Second Corps, where Surgeon J. F. Dyer, 19th Massachusetts, noted : " Shot fracture of the left hip joint." On July 1, 1864, he was admitted into the Carver Hospital, Washington, and he died August 30, 1864. Surgeon O. A. Judsou, U. S. V., reports cause of death: "Exhaustion following shot fracture left ilium." FIG. 46.—Perforation of the neck of left femur byaconoidal musket ball. .Spec. 565. 1 Circular 2,1869: CASE 2, p. 65, Corp'l J. A. Baker, C, 49th New York. Case 7, p. 66, Pt. C S. Bates, G, 27th Michigan. Case 13, p. 67, Corp'l W. Bowen, K, 56th Penn. CASE 37, p. 70, Pt J. Forbes, C, 31st Mass. CASE 39, p. 70, Pt S. Fowler, 4th Michigan Battery. CASE 60, p. 74, Pt. W. Jackson, B, lOCth New York. CASE 63, p. 74, Pt. H. Jones, 1,151st Penn. CASE 87, p. 79, Lieut. M. Mullen, G, 69th Penn. CASE 97, p. 81, Corp'l J. Robinson, I, 3d Marjland Cavalry. Case 105, p. 82, Capt R. Shaw, K, 56th Penn. Case 184, p. 92, Pt J. Wells, C, 1st Mass. II. A. Case 202, p. 95, Pt J. E. Clark, E, 23d Pennsylvania. Case 210, p. 95, Pt A. Latten, Morgan's Command (see Confed. States Med. and Surg. Journal, 1865, p. 9). Case 250, p. 101, Pt E. Powell, A, 3d U. S. C. T. Case 252, p. 101, Pt. J. Shafer, A, 7th Maryland. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 87 Case 195.—Private J. Farrell, Co. 1>, 14th U. S Infantry, aged 35 years, was wounded at Spottsylvania, May 12,1864, and admitted to the field hospital of the 2d division, Fifth Corps. Surgeon W. R. DeWitt, jr., recorded: "Gunshot wound of left thigh; severe." On May 18th the wounded man was received into Douglas Hospital, Washington. Assistant Surgeon W. Thomson, U. S. A., reported: "Gunshot wound of left hip; fracture of pelvis and femur. Haemorrhage to the amount of two ounces occurred from a muscular branch on May 28th, and ceased spontaneously. The patient died of asthenia May 28, 1864. Case 196.—Colonel C. Knoderer, 167th Pennsylvania, was wounded at Suffolk, January 30, 1863. Surgeon D. M. Marshall, of the regiment, reported: "Wound of left hip produced by a piece of shell, completely shattering the hip joint and causing immediate prostration. Stimulants were given internally, and cold applications, combined with styptics, were used. Death occurred on February 15, 1863." Case 197.—Corporal E. W. Mulford, Co , E, 74th Illinois, was wounded at Chattanooga, November 25, 1863, by a conoidal ball, which fractured the right hip. He died December 10, 1863, in the 2d division, Fourth Corps, field hospital. Surgeon F. W. Lyth, 36th Illinois, records the case. Case 198.—Private M. Murphy, Co. D, 8th New York Heavy Artillery, was wounded at Cold Harbor, June 3, 1864, by a conoidal ball. He was taken to the field hospital of the 2d division, Second Corps, where Surgeon J. F. Dyer, 19th Massachusetts, records: "Shot fracture of the right hip joint and wound of both shoulders." He died June 6, 1864. The cause of death is given on the burial records as "shot wound of bowels." Case 199.—Private A. Olds, Co. F, 8th New York Heavy Artillery, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported : "Gunshot fracture of left hip joint. Died June 5, 1864." Case 200.—Private C. Pease, Co. C, 4th Michigan, was wounded in the left hip at Gettysburg, July 2, 1863. He was treated at a Fifth Corps field hospital until July 24th, when he was admitted to Camp Letterman. Surgeon H. Janes, U. S. V., reported that the man "died August 7, 1863, of gunshot fracture of left hip joint." Case 201.—Private H. Stratton, Co. B, 99th Pennsylvania, was wounded at Gettysburg, July 2, 1863, by a conoidal ball. He was taken to the field hospital of the 1st division, Third Corps, where Surgeon G. W. Lyman noted: "Gunshot compound comminuted fracture of the right thigh implicating the hip joint." He died July 4, 1863. Case 202.—Private J. J. Stumple, Co. A, 7th West Virginia, was wounded at Cold Harbor, June 3, 1864, by a conoidal ball. He was taken to the field hospital of the 2d division, Second Corps, where Surgeon J. F. Dyer, 19th Massachusetts, noted: "Shot fracture of the right hip." He was admitted into the Second Division Hospital, Alexandria, June 7th, where Surgeon T. R. Spencer, U. S. V., records "shot wound, right thigh." He died June 25, 1864. Case 203.—Private T. O. Tucker, Co. D, 61st Pennsylvania, aged 39 years, was wounded at Spottsylvania, May 15, 1864, by a shell. He was taken to the field hospital of the 2d division, Sixth-Corps, where Surgeon S. J. Allen, 4th Vermont, noted: "Wound of the right groin." On May 26, 1864, he was admitted into the Second Division Hospital at Alexandria. He died the following day. Surgeon T. R. Spencer, U. S. V., reported the cause of death "shot wound of the right hip joint." Case 204.—Private J. Volkommer, Co. C, 46th New York, aged 19 years, was wounded at Petersburg, July 30, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon P. A. O'Connell, U. S. V., reported: "Gunshot wound of left hip; ball entered one and a half inches from the trochanter major, wounding the capsular joint." Three days after the reception of the injury the wounded man was transferred to the Depot Hospital at City Point, whence he was sent to De Camp Hospital, David's Island, New York Harbor, August 7th. Assistant Surgeon W. Webster, U. S. A., in charge of the latter, reported that the patient died November 19, 1864, of "gunshot wound of left hip, with fracture of femur." Case 205.—Private S. Waisner, Co. E, 28th North Carolina, was wounded and captured at Gettysburg, July 3, 1863, and entered Camp Letterman on July 23d. Surgeon H. Janes, U. S. V., reported: "Gunshot fracture of right hip joint. Death on August 18, 1863." Of the series of two hundred and forty-nine cases of shot fractures of the hip joint unsuccessfully treated by conservation, fifty-two have been detailed in the preceding pages and one hundred and ninety-seven cases have been briefly noted, the details of the cases having been cited in Circular No. 2. In one hundred and eighty-four cases the injuries were caused by small, and in fifteen cases by large projectiles, while in fifty instances the nature of the missile was not indi- cated. Fragments of bone were removed in twenty-one of the two hundred and forty- nine fatal cases of shot fracture of the hip joint treated by conservation. Pyaemia was indicated in thirty-eight instances, gangrene in thirteen, tetanus in one case, erysipelas in one case, peritonitis in five cases, and secondary haemorrhage in fourteen cases. In one instance (Case of John McCarthy, Co. E, 76th New York, Circular No. 2, p. 76, Case 71, and foot-note 1, p. 85) the femoral artery was tied, and in two instances (Cases of: Cor- poral J. F. Smith, Co. B, 1st Wisconsin, Circular No. 2, p. 82, and 107, of Private C. Hambrecht, Co. E, 4th New Jersey, Case 181, p. 84, ante) the external iliac artery was 88 SHOT INJURIES OF THE LOWER EXTREMITIES. | CHAP. X. ligated. In four instances the missile penetrated the abdomen; in nine cases the pelvic cavity was pierced, but apparently without injury to the viscera. In fifteen cases a shot fracture of either the ilium, ischium, or os pubis was reported; in two instances the blad- der was involved,1 and in twenty-two cases the injury to the hip joint was complicated by various other injuries of less gravity. Eleven patients died on the day of the reception of the injury; fifty-three survived the injury from one to ten days; seventy, from eleven to twenty days; thirty-two, from twenty-one to thirty days; twenty-one, from thirty-one to forty-days; the remaining sixty-two patients lived from forty-one to two hundred and sixty-three days, and one patient lingered for nearly two years and a half.2 In eighty- three instances it was reported that the missile had lodged, in nineteen of which it was stated to have been extracted. In seventy-eight of the two hundred and forty-nine fatal cases of shot fracture of the hip joint treated by conservation, the specimens indicating the bony lesion at the hip are preserved in the Army Medical Museum. Illustrations of forty of these seventy-eight specimens were given-in Circular No. 2, pp. 66-114, and twenty-one have been repre- sented by wood-cuts in the preceding pages. In tabular statement IX, on page 65, ante, the total number of alleged shot fractures at the hip joint treated by the conservative expectant mode was given as three hundred and four, of which fifty-five were reported to have recovered; but, from an analysis of the cases, it becomes clearly evident that it would be impossible to arrive at just conclusions regarding the mortality of injuries of this nature from the total number of cases tabulated. It has already been stated on pp. 76, 77, ante, that in fourteen of the fifty-five cases of recovery after alleged shot fractures at the hip joint the evidence is contradictory, or adverse to the supposition that the hip was implicated; that in nineteen instances the evidence is vague and insufficient, and that in two cases the testimony consists solely of the statements of examining surgeons based upon examinations made long after the injury had healed. Deducting these thirty-five cases, there remain two hundred and sixty-nine cases with twenty recoveries, giving a mortality of 92.5 per cent. But it was further stated on pages 76 and 77, ante, that in twelve instances the evidence is compatible with the sup- position that the fractures were probably in the trochanteric region, and that in five instances the fractures were extracapsular. Eliminating these seventeen cases, there remain only two hundred and fifty-two cases with three recoveries, or a mortality rate of 98.8 per cent. Of the three patients that recovered after undoubted intracapsular shot fracture of the hip joint, one, Private T. C. Garvin, Co. H, 94th New York (Case 143, ante), died nearly four years after the reception of the injury, from which pus and portions of the joint, consisting of splinters of bone, were discharged to the time of his death. In the case of T. L. Lomax (Case 140, ante), in which it remains a disputed point whether it should be regarded as an example of treatment by excision or by conservation, it was impracticable to ascertain whether the patient is still living. The third patient, Colonel J. C. Strong (Case 134, ante), was in tolerably good health in December, 1878. From the evidence recorded on the registers of this Office in the alleged examples of recovery after shot fractures of the hip joint treated by temporization, I must continue to share the unfavorable impression of the results in this class of injuries of Guthrie, and 1 The details of these cases have been published with Injuries of the Parts Contained in the Pelvis, Section II, Chapter VII, Second Surgical Volume, viz: Sergeant T. A-----, Co. C, 119th New York, Casb 922, p. 318; see also Xote 2, p. 77, ante; and Sergeant W. Spendlove, Co. E, 1st New York Cavalry, Cask 859, p. 295, and Note 1, p. 85, ante. *Case of Private Louis Schmidt, 8th Kansas, wounded at Chickamauga, Sept. 19, 1863, died Jan. 3, 1866. Circular No. 2, 1869, CASE 271, p. 105. SI'.CT. II.] EXCISION AT THE HIP FOR SHOT INJURY. 89 many of the older as well as more modern writers on military surgery, and can only reiterate the conclusion that I have already expressed in Circular No. 6, at page 61, and in Circular No. 2, at page 117, that shot injuries of the hip joint, when abandoned to the resources of nature, prove almost uniformly fatal.1 With regard to the twenty-five cases of recovery after shot injuries of the hip joint under conservative treatment in the Franco-German War, 1870-71, tabulated by Professor von Langenbeck, and alluded to on page 67, ante, it may be hoped, in the interest of sur- gical science, that the future histories of these patients will be noted, and that when death ensues it may be found practicable to have the extent of the injury to the hip joint pre- cisely ascertained by post-mortem examination. The difficulties of such a task are apparent and have hitherto proved insurmountable. In five of the fifty-five cases of recovery after alleged shot fracture at the hip joint cited from the American civil war, the patients have since died; but so far the opportunity to verify the diagnosis by an autopsy has not been improved. EXCISION AT THE HIP AFTER SHOT INJURY.—A large addition to our statistical information on this subject was afforded by the experience of the American civil war as indicated by the accompanying tabular statement: Table X. Xanierical Statement of Sixty-six Cases of Excision at the Hip Joint for Shot Injury. Operations. Cases. Pek Cent. of MOUTALmV Recovery. Fatal. Total. 1 2 3 32 20 8 33 22 11 96.9 90.9 72.7 6 60 66 90.9 "Twelve cases of excision of the head of the femur for gunshot injury are all that are recorded in print, prior to 1861," is correctly asserted at page 17 of the report from this Office2 published in 1869; but it is now known3 that in the Italian Campaign of 1859 Dr. J. Neudorfer excised at the hip for shot injury four times, at least, which gives a total 1 In note 1, of page 62, ante, it was attempted to give, in chronological order, the earliest references to cases of shot wounds of the hip in military surgical literature, and the first case adverted to was that of Private S. Kirsky, in 1677, related by PUKMANN (M. G.) (Funfftzig Sonder-und Wundcr- bahre Schusswunden Curen, Frankfurt, 1721, Obs. XLIII, p. 324). After page 62 had gone to press, the following case, cited by Dr. JOSEPH SCHMIDT (Speculum Chirurgicum oder Spiegel der Artzney, Augspurg, 1656, p. 144), which antedates the case of Puumaxn by 33 years, came to the editor's notice : ''In the month of May, 1634, while the here-stationed Swedish regiment was being mustered in the castle-yard, a sergeant, whose quarters were with Mr. Peter Rehlinger, was accidentally shot through the hip. He was conveyed in a trough to his quarters. I was called upon to see the case, but found that there was great difficulty in the way of bandaging and that the thigh was greatly swollen, the wound of entrance being as large as a hen-egg. On probing the wound I readily discovered the bare bone, with every indication that the shaft must have been split. Great haemorrhage had also taken place; his system was in a bad condition, unfavorable for a cure. The symptoms hourly grew more aggravated and became so severe as to terminate his life on the sixth day. After his death, I endeavored to obtain the consent of the officers to let him he opened, which was readily granted. When I did open him I discovered that the upper part of the femur, the head which enters the hip bone, was comminuted, as if it had been done with a hammer upon an anvil. There was also a long fissure in the shaft running down towards the knee; the great trunk of the artery was torn, and the condition of the soft parts, inwardly near the bone, was so offensive that I can hardly describe it. It was no wonder that he lost his life from so severe an injury. Should he have recovered he would have done so with a bad walk." An instance from the Turco-Russian War of 1877, is related by Kade (E.) (Das tempordre Kriegslazareth der Anstalten der Kaiserin Maria im Kloslcr Mariahimmelfahrt by Sistowa, in St. Petersburger Medicinische Wochenschrift, 1877, No. 45, p. 383): A soldier, on August 31, 1877, received a shot wound of the right coxo-femoral joint without separation of continuity of bone. The ball lodged with its point in the neck of the femur. On September 12th, the wound was enlarged and the missile extracted. The patient died September 17th, of septicaemia following suppuration of the joint. 2 Otis (G. A.), A Report on Excisions of the Head of the Femur for Gunshot Injuries. Circular No. 2, War Department, Surgeon General's Office, January 6, 1869, 4to, pp. 141. 3LONGMORE (T.), Gunshot Wounds, in T. Holmes's System of Surgery, 2d ed., London, 1870, Vol. II, p. 230. Surg. Ill—12 (M) INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. ot sixteen examples of this operation in military surgery prior to our war. Of these, a primary excision by Mr. T. C. O'Leary, in the Crimea, in 1855, was successful. The patient died ten years afterwards of phthisis. A secondary excision, by Dr. Neudorfer, in 1859, was followed by amputation at the hip, which the patient happily survived. In the foot-note1 instances of excision at the hip for shot injury are enumerated, in addition to those practised in the United States service. At the date of the publication of Circular No. 2, S. G. 0., January, 1869, the records of this Office contained sixty-three, as was then believed, authenticated cases of excision of the head, or of the head and neck, or head and neck and portion of the shaft of the '1. OPPENHEIM (F. W.) (Die Extirpation des Schenkelkopfes aus der Gelenkhohle, in Zeitschrift fiir die gesammte Medicin, Hamburg, 1836, B. I, S. 137); a Russian chasseur wounded May 5, 1829, at the battle of Eski-Arna-TJtlar; fracture of neck of left femur and rim of acetabulum. Primary excision May 5, 1829; death from plague May 23, 1829.—2. Seutin (Resection de la partie supirieure du femur, in Bulletin General de Ther- apeutique, Paris, 1833, T. IV, p. 371); Private Lisieux, 25th Infantry; fracture of neck, trochanters, and upper fourth of right femur. Primary excision December 8, 1832; death on the fourth day, from gangrene.—3. C. TEXTOK (Karl TEXTOR, Der Zweite Fall von Aussdgung des Schenkelkopfes mit volkommenem Erfolg, Wiirzburg, 1858, S. 15, No. 12); Kaspar Artes, aged 44 ; caries of head of right femur consequent upon gunshot fracture. Secondary operation on November 8, 1847; death on November 18, 1847.—4. Dr. H. SCHWARTZ (Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, p. 142); 0---, Danish soldier; shot fracture of trochanters of left femur. Intermediary excision May 13, 1849; death, May 20, 18-;9.—5. Dr. O. Ross (Deutsche Klinik, 1850, B. II, p. 451)f; Karl Engelking, aged 23, received, at Fredericia, May 8, 1848, a shot fracture of the left trochanter. Secondary excision, June 10, 1850; death, June 13, 1850.—6. Professor Baum (LOHMEYEU, Die Schusswunden, 1859, p. 199); a subaltern officer; 6hot comminu- tion of neck of femur. Primary excision in 1854 ; death in twenty-two hours.—7. G. E. BLENKIXS (G. H. B. MACLEOD, Notes on the Surgery, etc., London, 1858. p. 341, and G. J. Guthrie, Commentaries, London, 1855, p. 621); Private C. Monsterey. 3d Batt. Grenadier Guards; shell fracture of neck and trochanters of right femur. Primary excision in June, 1855; death in five weeks.—8. G. H. B. MACLEOD (Notes on the Surgery of the War in the Crimea, 1858, p. 338); Private Couch, of the Rifle Brigade; fracture of the neck of left femur, June 18, 1855. Intermediary excision July 5; death from cholera July 10, 1855.—9. Surgeon J. CRERAR (G. J. GUTHRIE, Commentaries, Cth ed., London, 1855, p. 622); Private W. Smith, 1st Royals; grenade fracture of trochanter and neck of left femur. Primary excision August 6, 1855; died August 21, 1855.—10. T. C. O'LEARY (T. V. MATTHEW, Mniical and Surgical History, etc., during the War against Russia, 18.14-'55-'56, London, 1858, Vol. II, p. 378); Private T. McKevena, 68th Regiment; shell fracture of trochanter and neck of left lemur. Primary excision August 20, 1855; recovery.—11. Dr. George Hyde (Matthew, I. c, Vol. II, p. T,H); Corporal B. Sheehan, 41st Regiment; grapeshot comminution of trochanter and neck of femur. Primary excision September 8, 1855; death September 14,1855.—12. Dr. COOMBE (MACLEOD, loc. cit., p. 344); British artillery soldier; shot fracture of neck of femur. Intermediary excision in 1855; death in a fortnight.—13-19. J. Nr.UDORFER (Das Endresultat der Gelenkresectionen, in Wiener Med. Presse, 1871, B. AIT, p. 407) remarks: "I have performed the hip joint resection for shot wounds seven times; six died from the eighth to the eleventh day, and the seventh I exarticulated at the hip after a few days on account of purulent infiltration of the excised joint. The patient recovered after the exarticulation, and lives here in Vienna." J. Schranz, 7th Jaeger Bat., wounded at Palestro, May 30, 1859. Excision at left hip joint November 27th. Purulent infiltration followed, and, on December 1, 1859, amputation at the hip joint was performed by Professor NEUDORFER. The patient recovered, and lived in Vienna in 1868. During the Schleswig- Holstein War, 1864, Dr. NEUDORFER twice excised the hip joint, on Austrian soldiers, for shot fracture of the upper extremity of the femur. Inter- mediary operations. Both cases proved fatal (C. HEINE, Die Schussverletzungen, etc., 1866, p. 369). Of the remaining four operations by NEUDORFER I have been unable to find any details.—20. A successful secondarj' excision of the hip joint for shot wound received in the Austro-Prnssian War, 1866, was performed by Dr. Wagner in Konigsberg. NEUDORFER (Handbuch der Kriegschir., Leipzig, 1872, Zweite Halfte, Abth. 2, p. 1458) states that he saw the patient in November, 1866, at Gorlitz, when his recovery was yet doubtful, but that in 1872 the patient was living at Graz, entirely recovered. He could walk without a cane, and could ascend and descend stairs.—21-23. B. von Langenbeck (Uber die Schussfracturen der Gelevke, 18X8. p. 16); Kucharsky, aged 18, fracture of left trochanter, March 22, 1863. Secondary excision July, 1863; death in fourteen days. Austrian soldier, wounded July 3, 1866; shot fracture of the neck of the right femur. Intermediary resection August 5, 1866; death August 12, 1866. Emil Bauer, ICth Saxon Infantry, wounded June 29, 1866; shot fracture of the neck of right femur. Secondary excision August 20th; death in September, 1866.—24. Dr. SCHOXBORN (B. v. Laxgfxbeck, loc. cit., p. 16); Maxim Glutschak, aged 24; wounded July 3, 1866, fracture of head of the right femur. Secondary resection August 22, 1806; recovery.—25. B. Beck (Kriegschir. Erf, 1867, p. 351); A. F. S---, Wurtemberg drummer, wounded July 24, I860; shot fracture of neck of femur and trochanter major. Intermediary resection August 5th; died August 7, 1866.—26. L. Stromeyer (Erfahrungen uber Schusswunden, 1867, S. 52); a debilitated subject; intracapsular shot fracture of the neck of the femur. Intermediary resection in 1866; death in two days.—Stabsarzt Dr. Deixen'GER, of the Railway Battalion (Beitrage zu den Schussfracturen des HUftgelenks unter besondere.r Beriicksichtigung der Erfahrungen aus dem Feldzuge 1870-71, und Benutzung der Acten des Koniglichen Kriegsministeriums, in Deutsche Mil.-arztl. Zeitschrift, 1874, Jahrgang III, pp. 237-335), gives a tabular statement of forty-five cases of resection of the head of the femur for shot injury, from the Franco-Prussian War, 1870-71. The cases are: 1 primary case fatal, 26 intermediary cases (all fatal), and 17 secondary (with 5 recoveries and 12 deaths), and I case in which the time of operation was not recorded. Brief details are given : 27. A. Stephan, 3d Pioneer Bat.; shot fracture of neck, and trochanter major of left femur, September 20, 1870; excision same day, by Dr. B. BECK; died September 29, 1870.—28. Piurko, 22d Infantry; shot fracture of trochanter and neck of right femur, September 23, 1870; excision October 25, 1870, by Szmula ; recovered, with useless limb.—29. A soldier wounded at Orleans; comminution of head of femur; intermediar)' excision, by Dr. METZLER; died 4 days after operation.—30. J. B. Muller, 85th French Line; shot fracture of head of right femur and rim of acetabulum at Beaune la Rolande, November 28, 1870; excision, by Dr. ROppel, December 2d; died December 7, 1870.—31. Corporal Heinartz, 75th Prussian, wounded at Orleans, December 9, 1870; ball fractured acetabulum and opened joint- excision, December 14th, by Dr. Langenbeck ; died of septicaemia, December 20, 1870.—32. A. Eichner, 2d Prussian Lancers; shot fracture of head of right femur, Orleans, December 4,1870; excision, by Dr. LAXGENBECK, December 12th; died December 18, 1870.—33. J. Schone, wounded at Weissen- berg, August 4, 1870, splintering trochanter and head of femur; excision, by Dr. CzERNT, August 13th; died August 16, 1870.—34. M. Echterbruch Corporal, 78th Infantry; shot fracture of left femur below the greater trochanter, August 16, 1870; excision, by Dr. MWLLER, August 26th; died Sept. 7 1870.—35. J. Pakowsky. 14th Inf., wounded December 3, 1870, in left hip joint; excision, December 14th, by Dr. Newiials ; died December 20, 1870.— 31. J. Unterberg, Oldenberg Infantry No. 91; shot fracture of left trochanter, August 16, 1870; excision, August 27th, by Dr. A. Ewald ; died Sept. 9 ]i;0.—37. J. Wiedener, 52d Infantry, shot wound in right hip joint, August 16, 1870; excision, by Dr. TREXDELENBERG, August 28th; died September 2, 1870.—38. F. Kopzinsky, 5th Artillery, shot fracture of left hip joint, Sept. 19, 1870; excision, October 2d, by Dr. Wegxer ; died October 28, 1870.— 39. J. Busse. 24th Infantry, shot fracture of the left femur, August 16, 1870; excision of hip joint, August 29th, by Dr. MARCUSE; died Sept. 7, 1870.— 40. F. Patzwald, 9th Infantry, shot wound of left hip joint, December 2, 1870; excision, by Dr. BRASCH, December 16th; died December 21, 1870.__41. V. Vaillant, 42d French Line, shot fracture head of left femur, September 30, 1870; excision, October 14th, by Dr. GUAXDIE8; died October 17, 1870.— 42. A. Dettki. 41st Infantry, shot comminution of neck of left femur, August 31, 1870; excision, by Dr. SACHS, Sept. 15th; died October 11, 1870.—43. P. Congacz, French Guards N<> 3, shot fracture of head of left femur, August 18, 1870; excised, by Dr. Langenbeck, September 1st; died Sept. 2, 1870.— 44. C. C. Petit. French Infantry No. 67, comminution of left hip joint, August 16, 1870; excision, by Dr. Langenbeck, September 1st; died September SECT. II.] EXCISION AT THE HIP FOR SHOT INJURY. 91 femur, for shot injury. It has since been ascertained that in one of these cases the head of the femur was not removed;1 but records of four additional cases2 have since been obtained and added to the list of this operation, making a total of sixty-six cases of excision at the hip joint done for shot injuries received during the American civil war. As indicated in Table IX, at page 65, ante, fifty-five of these operations were performed for shot injuries of the hip joint, while in eleven instances the excision was practised for fracture of the shaft of the femur that did not primarily implicate the hip. 4, 1870.—45. C. Pacot, 50th French Infantry, shot fracture of neck of right femur, Weissenburg, August 4,1870; excision, by Dr. Billroth, Aug. 20th; died August 20, 1870.—46. W. Liesegang, 24th Infantry, shot fracture of neck of left femur, Vionville, August 16, 1870; excision, September 2d, by Dr. GAEHDE; died September 3, 1870.—47. E. W. Hoffman, of the Prussian Guards, shot fracture of hip joint, St. Privat, August 18, 1870; excision, by Dr. LOCKE, September 5th; died September 13, 1870.—48. A. Weinert, Corporal, 10th Dragoons, wounded in trochanter major, August 14, 1870; excision, by Dr. FISCHER, September 1st; died September 13, 1870.—49. B. Payant, 32d French Infantry, shot fracture of upper third of right femur, August 16, 1870; excision, September 4th, by Dr. NEUHAUS; died September 8, 1870.—50. A. Piasecki, 5th Infantry, comminution of neck of left femur, September 9, 1870; excision, by Dr. Wagner, September 29th; died October 11, 1870.—51. P. Perrot, 13th French Infantry, comminution of right femur into joint, Gravelotte, August 8, 1870; excision, by Dr. BUSCH, September 12th; died September 23, 1870.—52. J. Pitzer, 83d Infantry, comminution of trochanter major and neck of left femur, Worth, August 6, 1870; excision, by Dr. PAGENSTECHER, September 1st; died September 10, 1870.—53. Sergeant-major B----, 3d French Infantry, shot fracture of trochanter and neck of right femur, Worth, August 6, 1870; excision, by Dr. BECK, at the end of August; died in the latter part of September.—54. C. Schmock, of the Guard Sharpshooters, shot wound in left hip joint, St. Privat, August 18,1870; excised, by Dr. BENSBERG, September 14tb ; died September 19, 1870.—55. F----, 61st Infantry, comminution of neck of left femur, January 21, 1871; excision, by Dr. VOLKMANX, February 20th; died February 22, 1871.—56. J. Blanchet, French Garde Mobilier, shot fracture of head of left femur, November 28, 1870; excision, by Dr. HEINEMANN, December 29th ; died January 12, 1871.—57. E. Paschke, 58th Infantry, comminution of neck and trochanter of right • femur, October 2, 1870; excision, by Dr. BORETIUS, November 6th ; died November 16, 1870.—58. A. Schoblock, 7th Wtlrtemberg Infantry, shot frac- ture of femur high up, Champigny, December 2, 1870; excision, by Dr. 1IUETER, January 6, 1871; died January 13,1871.—59. Bartsch, 2d Guards, shot fracture below trochanter, with fissuriug of neck of left femur, August 4, 1870; excision, September 13th, by Dr. SCHILLBACH; died in a few hours.— 60. D. Blennemann, 7th Infantry, shot wound of hip joint, Gravelotte, August 18, 1870 ; excision, about 6ix weeks later, by Dr. WlXDSCHElDT; recover}-, with good use of limb and one and a half inch shortening.—61. E. Geier, 9th Infantry, shot through left hip joint, Worth, August 6, 1870; excision, by Dr. BILLROTH, September 28th; died October 27, 1870.—62. Scliaal, 10th French Infantry, shot wound in right hip, August 16, 1870; excision, by Dr. JOSEPHSON, October 24th; death October 25, 1870.—63. F. John, 8th Infantry, shot wound of right hip, fracture of acetabulum, Saarbriicken, August 6, 1870; excision, by Dr. HUPEDEN, November 4, 1870; recovery, with moderately free use of limb and one inch shortening.—64. B----, 2d Zouaves, shot fracture of upper third of femur, Worth, August 6,1870; excision six months after injury, by Dr. WELKER; recovery.—65. French soldier, shot fracture of hip joint September 30, 1870; secondary excision ; recovery, with comparatively good use of limb.—66. J. Pieper, 21st Infantry, shot wound of left hip; secondary excision of head of femur, February 19, 1871, by Dr. JACOBY; died Feb. 23,1871.—67. G. Rossmanieck, 4th Infantry, shot in left hip in August, 1870; secondary excision of hip joint; died Sept. 7, 1870.—68. P----, 17th Infantry, shot wound of right hip joint; secondary excision of joint; died.—09. Unknown soldier; secondary excision, by Dr. BATTLEHNER; fatal.—70. Unknown soldier; shot fracture of neck of femur; secondary excision, three months after injury, by Dr. HEPPNEE; death in two weeks.—71. Unknown soldier, shot fracture of neck and trochanter; resection three and a half months after injury; died a week afterwards. In a tabular statement of cases of resection of the hip joint performed during the same period, and collected by Professor B. v. LANGENBECK (Uber die Schussverletzungen des HUftgelenks, in Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 263), I find 7 cases (2 intermediary fatal cases, CASES Nos. 2, 5, pp. 329, 330,)—1 secondary fatal (CASE No. 14, p. 334)—and 4 fatal cases, period of operation not stated (Cases 12, 20, 21, and 27, pp. 333, 335, 336), not contained in Dr. DEININGER's tables. They are: 72. Lieut. Roma, 9th French Infantry, shot frac- ture of left hip joint, August 18, 1870; excision, by Dr. Langenbeck, August 31st; died September 4, 1870.—73. Petit, 67th French Infantry, shot fracture of right hip joint, Mars la Tour, August 16, 1870; excision, August 30th, by Dr. LANGENBECK; died December 10,1870.—74. Unknown soldier, shot fracture of hip joint; excision, by Dr. BILLROTH; died 24 hours after operation.—75. Unknown soldier, shot fracture of pelvis; secondary involve- ment of hip joint; secondarj' excision of head and neck, by Dr. KUSTER; death eight days after the operation.—76, 77. Unknown soldiers; excisions, by Dr. VOLKMANN; fatal.—78. Unknown soldier; excision of head of femur, by Dr. GRAF; fatal.—79. Another intermediary case of excision of head of femur for shot injury during the late Franco-Prussian War, 1870-71, not reported by either Dr. DEININGER or Professor B. v. LANGENBECK, is reported by Dr. GEORGE FISCHER (Dorf Floing und ScJiloss Versailles, in Deutsche Zeitschrift fur Chirurgie, Leipzig, 1872, B. I, S. 227); unknown, fracture of head ff left femur. September 30, 1870; wound of exit and entrance on a level with the trochanter major. October 20th, resection; October 28th, death from pyaemia. An operation ascribed to Dr. LUTTER, in Lancet, 1870, Vol. II, p. 452, is identical with the case described by Dr. H. FISCHER (Kriegschir. Erf. vor Metz, Erlangen, 1872, p. 200), and included in cases collected by Drs. DEININGER and v. LANGENBECK (No. 48, ante).—80-97. CHENU (J. C.) (Aperfu hist. stat. et din., etc., pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493) tabulates eighteen cases of excisions of the hip joint for shot frac- tures, in the Franco-Prussian War, 1870-71, with three recoveries. The same author (loc. cit, T. II, pp. 1-150) records, by name, the cases of recovery after amputations, disarticulations, and excisions ; but, after a careful search, I have been able to find only one of the (3) successful cases of excisions at the hip joint among them. The case is detailed on p. 85: " Lande (P. F.), born June 6, 1849, at Valognes (Manche), 109th line. Fracture of head of femur for shot wound. Resection of head of femur." The case is duplicated and again appears, on p. 86, as Laude, giving same details in every respect. I find no record of the two other cases. There is nothing to indicate whether the cases are primary, intermediary, or secondary operations. The cases reported by Dr. DUBREIL (Gaz. mid. de Paris, 1871, T. XVI, p. 314) and Dr. ARNAUD (GRELLOIS, Hist. mid. de blocus de Metz, 1872, pp. 351-353) are undoubtedly included in CHENU's (loc. cit., p. 493) statistics.—98. ROBERTSON (J. B.) (Resection at the Hip joint—Removal of the Head with Four Inches of tlie Femm—Tetanus—Cure by Physostigma, in Pacific Med. and Surg. Jour., 1878, Vol. XX, p. 500), excised, on April 8, 1876, the head and four inches of the shaft of the femur in the case of George Miller, aged 45, who had suffered for over a year from a sinus, evidently resulting from a rifle shot received two years previously. The wound healed by first intention. Tetanus, which supervened about three weeks after the operation, was successfully treated with physostigma. In February, 1878, Miller was "well and able to ride on horseback and herd cattle in the mountains."—99. Dr. RUDDUCK (MAUNOUUI, Rapport sur le mouvement de I'ambulance No. 5 du Croissant Rouge & Orchanie, du 17 Octobre au 8 Novembre 1877, in Le Pmgres Medical, 1878, No. 1, p. 6) excised, on October 21, 1876, the head of the left femur in the case of Mehemet-Osman, for shot wound received in the Turco-Russian War; secondary operation ; pneumonia; death. Summing up the cases of resection of the hip joint referred to in this note we have a total of 99 cases with 86 deaths, a fatality of e6.8 per cent. Of these 99 cases 8 were primary operations with 7 deaths (87.5 per cent.); 37 were intermediary, all fatal; 27 were secondary with 18 deaths (66.6 per cent.); and in 27 instances with 24 deaths the time of operation was not specified. 1 The case of Lieutenant Dwight Beebe, 3d New York, cited in Circular 2, at page 32. Information received since the publication of the case fjfr, proves it to be an example of removal of three and a half inches of the upper portion of the femur just without the capsule. The case will be detailed with excisions in the continuity of the femur in the third section of this chapter. 2Casks of: I. Private J. W. Epton, Co. I, 5th South Carolina, referred to in Circular 2, at p. 120, but not included in the tabular statements on pp. 59 and 137; 2. Private C. Raines, Co. E, 25th North Carolina; 3. Private G. W. Tilliston, 1st Ohio Light Artillery; and 4. Private T. W. Pease, Co. H, 19th Indiana. 92 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Primary Excisions.—Of thirty-three well authenticated primary excisions at the hip practised during the War, twenty were performed upon Union and thirteen upon Confed- erate soldiers. The only successful result was in the case of Private Cannon, a young soldier of a Georgia regiment, on whom Dr. J. J. Dement, of Huntsville, Alabama, operated. The particulars of the case were communicated by Dr. Claude H. Mastin, of Mobile, formerly Inspector of Hospitals in the Confederate service, and by Dr. J. B. Duggan, of Toombsborough: Case 206.—Private Cannon, Co. A, 49th Georgia, aged 24 years, was wounded at the battle of the Wilderness, May 5, 1864, by a conoidal musket ball, which struck an inch below the left trochanter major, extensively comminuting the femur and lodging in the adductor muscles. The Confederate line being forced back, the wounded man lay on the ground all night until the early morning, when the Confederates recovered their wounded. In Cannon's case, the consultation at the field infirmary by Surgeons J. J. Dement, Holt, J. J. Wynne, and F. P. Henderson, it was determined to enlarge the wound and remove the detached fragments of bone. Accordingly, the patient having been chloroformed, Surgeon Dement made an incision two inches upward from the entrance wound, and extending from the wound downward four inches. On ascertaining the condition of the parts, it was decided to exarticulate the head of the femur. This was readily accomplished, and then the neck and upper extremity of the shaft were removed. The fragments of the upper extremity of the femur, when put together, measured four and a half inches. The haemorrhage during the operation was trivial. All the medical gentlemen present remarked upon the slight degree of shock induced by the operation. The limb and body were confined by roller bandage to a straight splint extending from the axilla to the foot. A full dose of sulphate of morphia was then administered. In a few hours the patient was placed in an ambulance wagon and conveyed to Orange Court House, twenty-five miles distant, and thence by rail to Staunton, about seventy miles farther, where the after treatment was conducted at the general hospital. Little can be learned of the after treat- ment, save that the patient was supplied with rich diet, a liberal allowance of wine, and that no untoward complication occurred except the formation of abscesses attendant on an exfoliation of a ring of bone from the upper end of the shaft. When this was eliminated, the wound rapidly healed. At the end of nine months the cicatrix was firm. The limb was shortened three inches, and was useless for purposes of locomotion. The patient was in fine health, and moved about on crutches. He went to his home, in Toombsborough, Georgia, in February, 1835, and earned a livelihood by his trade of shoemaking. He enjoyed good health until November 12, 1865, when he had an attack of diphtheria which terminated fatally on November 23, 1865. The thirty-two unsuccessful primary excisions at the hip may be arranged in three categories. The first comprises thirteen instances where the circumstances were favorable, the patients of mature and robust organization, the lesions of bone limited to the upper extremity of the femur, the important vessels and nerves intact; the injuries to the soft parts were not excessive; there were no complications of wounds in other regions, and the patients were not subjected to hazardous removals; yet all thirteen succumbed within two or three days, or in one case as late as the fourth day, from the conjoined shock of the injury and the operation. Case 207.—Captain Frederick M. Barber, Co. H, 16th Connecticut, aged 32 years, was wounded at Antietam, Septem- ber 17, 1862, by a musket ball, which entered behind the right trochanter major and shattered the trochanters and neck of femur. He was conveyed to the field hospital of the 3d division of the Ninth Corps. His general health was good, and there was but little shock. There was no swelling of the soft parts; the fracture was accessible to exploration, and appeared limited to the epiphysis. The case was one in which excision seemed peculiarly applicable, and, after a consultation of several surgeons of the division, that operation was decided upon. On the morning of September 18th, the patient being anaesthetised by chlo- roform, Surgeon Melancthon Storrs, 8th Connecticut, made a straight incision four inches long, passing through the wound of entrance. The comminuted fragments of the neck and trochanter were extracted, the round ligament divided, the head of the femur removed, and the fractured upper extremity of the shaft was sawn off by the chain saw. The edges of the wound were then approximated by adhesive straps, and simple dressings were applied. Little blood was lost, and the patient rallied promptly from the operation, and appeared quite comfortable during the day. Surgical fever soon set in, however; the patient sank rapidly under the constitutional irritation, and died on September 20, 1862. Case 208.—Sergeant Edwin T. Brown, Co. C, 21st Massachusetts, aged about 30 years, was wounded in front of Peters- burg, on July 23, 1864, by a ragged fragment of a mortar bomb, which struck the left thigh over the trochanter major and comminuted the upper extremity of the femur. The wounded man was immediately conveyed to the hospital of the 1st division of the Ninth Corps. Surgeon Whitman V. White, 57th Massachusetts, and Surgeon James Oliver, 21st Massachusetts, saw the patient a short time after his admission to the hospital. He was a strong, healthy man, five feet ten inches in height, weighing about one hundred and sixty pounds, with a constitution of iron, and was in perfect health when injured. The soft parts about the seat of injury were lacerated and torn, and the upper extremity of the femur, to an extent of five inches, was crushed to fragments. No important arteries or nerves were wounded. Excision of the fractured bone was decided upon. On the afternoon of the day on which the injury was received chloroform was administered, and Dr. White made a longitudinal incision and removed the shattered fragments. The ligamentum teres was divided and the head of the bone turned out. The broken extremity of the shaft of the femur was evened off with a chain saw. The patient reacted promptly from the shock of SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 93 the operation. The limb was placed in proper position, and stimulants were freely used. Dr. Oliver states that he saw the man several times on the following day, who was in excellent spirits, and talked and laughed, and did not complain of any pain. On the 26th his appetite failed and he began to sink. He died July 27, 1864. Cash 209.—Private Charles Beard, 12th Mississippi, was wounded and made a prisoner in the engagement on the Weldon Railroad, August 23, 13G4. With nearly two hundred other wounded Confederates he was received at the field hospital of the 1st division of the Fifth Corps at Reams's Station, where it was found that a conoidal musket ball had entered the front of the right thigh a little to the outside of the course of the great vessels, and had comminuted the neck of the femur and fractured the head, and lodged in the acetabulum, of which the lower portion of the rim was broken off. A few hours after the reception of the wound the patient was placed under the influence of chloroform, and, after a thorough examination, it was deemed expedient to excise the upper extremity of tlie femur. The operation was performed by Surgeon A. A. White, 8th Maryland. An incision, commencing a little below the anterior superior spine of the ilium, was carried downwards below and behind the prominence of the trochanter major. From the lower extremity of the first, another incision, Dr. McGill states, was carried backwards. The muscular attachments were then dissected aside, and the chain saw was passed around the bone, which was divided just above the lesser trochanter. The head of the femur was then readily exarticulated, and the ball and splintered fragments were removed. The wound was then approx- imated by sutures and adhesive strips, and the limb was suspended by Smith's anterior splint. The of head of right femur. patient reacted favorably; but very soon after the operation there was a marked rigor, and on the follow- p ing day there was extreme irritability of stomach and retention of urine. The case terminated fatally on August 25,1864, two days after the reception of the injury. At the autopsy, it was found that the fracture of the acetabulum did not communicate with the interior of the pelvis; but the articular surface was intensely injected; its cavity was filled with offensive sanious pus. The sawn extremity of the femur was black. One report states that the patient's appearance was of one who had undergone great privations and was not in a favorable condition to undergo any severe operation. The excised portions of bone, repre- sented in the accompanying wood-cut (Fig. 47), were sent to the Army Medical Museum without a memorandum; but were ultimately identified, and numbered 1410 in the Surgical Section. Case 210.—Private Bartholomew Dempsey, Battery I, 4th Artillery, was wounded February 25, 1864, at Buzzard's Roost, Georgia, by a piece of shell, which passed through the upper portion of the right thigh, crushing the trochanter and neck of the femur, and producing fissures which extended to the head of the bone. The wounded man was taken to a private house in the neighborhood, at a place called "Big Spring," or in another report "Burke's Spring," a place ten miles northwest of Dalton, where, shortly after the reception of the injury, it was decided, on the recommendation of Surgeon S. G. Menzies, 1st Kentucky, that excision should be performed. Chloroform having been administered, Surgeon Nathan W. Abbott, 86th Illinois, made an incision five inches in length, commencing two inches above the trochanter major. After dissecting aside the muscular attachments and removing many fragments of the neck and trochanteric portions of the femur, the shaft of the bone was smoothly divided by the chain saw at a point an inch or a little more below the lesser trochanter. Then, with a straight bistoury, the capsular and round ligaments were divided, and the fractured head of the femur was exarticulated. The wound was then approximated by sutures and adhesive strips. The patient rallied satisfactorily from the shock of the injury and operation, and his condition was encouraging on the following morning, when the Union forces retired, sending all the wounded who could be moved to the hospitals at Chattanooga. Private Dempsey alone was left at Big Spring. On the evening of February 26th Surgeon Menzies sent Assistant Surgeon P. F. Ravenot, 7Cth Illinois, with a cavalry escort from General Cruft's camp, to Big Spring, a distance of five miles, to learn of Private Dempsey's condition, and, if possible, to bring him off. The escort was dispersed and Dr. Ravenot was captured. The fate of Dempsey could not be definitely ascertained. He is dropped from the rolls of his company as " missing in action at Buzzard Roost Gap." Dr. Abbott afterwards heard, indirectly, that Dempsey survived the operation four or five weeks; but was not satisfied that this information was reliable. That the case had a fatal termination there can be no doubt. The excised portions of bone were preserved by Dr. Barnes, of Centralia, Illinois, who was present at the operation. A statement has been received from Brevet-Major E. B. Atwood, 16th Infantry, that he had learned from parties who attended Private Dempsey after he was wounded that he died on February 28, 1864, at the house of a Mr. Rogers, ten miles northwest of Dalton, Georgia. Case 211.—Private T. J. Hobson, Co. H, 32d Tennessee, aged 23 years, was wounded at Kenesaw Mountain, June Z4, 1864, by a conoidal musket ball, which struck the femur and comminuted the neck and trochanters. The fracture extended within the capsular ligament. The shock was very great. The patient was seen by Surgeon J. F. Grant, P. A. C. S., who found that amputation was not practicable except at the hip joint, and deemed it expedient to undertake the operation of excision, as giving, in his judgment, the best chance for recovery. The army was then retreating, and if the patient was removed to the rear it was doubtful if surgical relief could be had. Accordingly, about twelve hours after the reception of the injury, the patient being placed under the influence of chloroform, Dr. Grant proceeded to operate, by making a linear incision ten inches long on the outside of the thigh over the trochanters. The articulation was exposed, the capsular ligament divided, and the head of the bone enucleated. The shattered fragments were then removed, and the shaft of the femur was divided by a straight saw just below the trochanter. The loss of blood was slight. Immediately after the completion of the opeiation the patient was placed upon a box-car and transported forty miles over a very rough road to the rear. Reaction was never complete, though the patient lingered three days, and died on June 27, 1864. Case 212.—Lieutenant John A. McGuire, Co. I, 148th Pennsylvania, was wounded on May 12, 1864, at Spottsylvania, by a musket ball, which smashed the trochanters and neck of the right femur. He was carried to the hospital of the 3d division of the Ninth Corps, where, after an exploration of the wound under chloroform and a consultation of the senior surgeons of the division, it was determined to excise the injured bone. The head, neck, and trochanters were accordingly removed through a longitudinal incision by Surgeon George W. Snow, 35th Massachusetts. The patient died on May 15, 1864. 94 INJURIES OF THE LOWER EXTRKMITIES. [CHAP. X. Case 213.—Private CTEourke, 18th Mississippi, aged 24 years, healthy and of fine constitution, was wounded at the Wilderness, May 6, 1864, by a musket ball, which entered the right thigh a little behind the trochanter, shattered the neck of the femur, and lodged. There was little injury to the soft parts, and the important vessels and nerves were unharmed. He was taken to a field hospital, and his injury was examined under chloroform, by Surgeon J. T. Gilmore, Chief Surgeon, 1st division, Longstreet's Corps. The limb was everted and shortened, the fracture appeared to be confined to the epiphysis, and there was no bleeding. Believing that removal of the injured bone offered the best chance of preserving life, Surgeon Gilmore proceeded to excise the head and neck of the femur. A curvilinear incision four or five inches long, with its convexity back- ward, was carried downward from a point a little above and behind the trochanter, and was made to pass through the entrance wound. The muscles inserted in the trochanter were then divided, the head was readily disarticulated, and the femur was then smoothly divided through the trochanters by a chain saw. The operation was accomplished with the loss of but little blood. Yet the patient did not react, but gradually sank, and died May 9, 1864. Case 214.—Private Thomas G. Pease, Co. B, 117th New York, was wounded October 28, 1864, near Fair Oaks Station. The trochanters and neck of the right femur were shattered by a musket ball, which lodged against the head in the cotyloid cavity. The soft parts were not injured badly, and it was determined by surgeons on duty at the field hospital of the Tenth Corps that excision of the upper extremity of the femur was expedient. The operation was performed, a few hours after the reception of the injury, by Surgeon N. Y. Leet, 76th Pennsylvania. The patient died on October 29, 1864. Case 215.—Sergeant James M. Tolman, Co. H, 18th Wisconsin, aged 30 years, was wounded May 14, 1863, near Jack- son, Mississippi, by a conoidal musket ball, which comminuted the head and neck of the left femur, lodging, and producing fissures which extended about two inches below the lesser trochanter. The important nerves and vessels of the region and the walls of the pelvis had escaped injury. The patient was a somewhat cachectic subject, debilitated by malarial disorders. It was deemed that the gravity of the injuries of the upper extremity of the femur rendered operative interference imperative. About twenty-four hours after the reception of the injury, the patient was placed under the influence of chloroform, and Surgeon Henry S. Hewit, U. S. V., exarticulated the head of the femur. The incision commenced a little above and anterior to the trochanter major and extended downward in a curved direction with the convexity backward, and passed through the wound of entrance. The splintered fragments of-the head and neck and the ball were removed, and then the fissured upper extremity of the shaft was sawn two and a half inches below the lesser trochanter. The operation was well borne, and the patient was removed the same day to a hospital in the city of Jackson, where he was supplied with every comfort and provided with the most careful attendance. He did apparently well until the third day, when he began to sink, the wound from this time forward exhaling a faint cadaveric odor. He died four days after the operation, May 19, 1863. Case 216.—An unknown private soldier of the Fifth Corps, Army of the Potomac, was wounded in the engagement at Laurel Hill, near Spottsylvania Court House, on May 10, 1864, by a musket ball, which fractured the trochanteric portion of the left femur. He was conveyed to the field hospital of the Fifth Corps, at Cassin's, on the Block House road. He was placed under the influence of chloroform, and the head, neck, and trochanters of the left femur were excised. Assistant Surgeon J. S. Billings, U. S. A., saw him on the following morning, when he appeared to be in a comfortable condition. Dr. Billings recollects that he was a young and healthy looking man. The attendants mentioned the character of the operation and the name of the operator, but Dr. Billings cannot recall these particulars. On revisiting the hospital three days subsequently, Dr. Billings learned that the patient had died on that morning, May 13, 1864. Case 217.—An unknown soldier of the Eighteenth Corps was wounded, in the assault on the enemy's intrenched lines at Cold Harbor, June 3,1864, by a fragment of shell, which completely comminuted the trochanter and neck of the right femur. Shortly after the reception of the injury he was conveyed to the field hospital of the Eighteenth Corps, and immediately anaes- thetized and examined. Excision of the head, neck, and trochanters of the right femur was then practised. Assistant Surgeon Billings, U. S. A., saAV the patient soon after the operation, and observed that he had rallied encouragingly, and was in a com- paratively comfortable condition. On June 7th the wounded of the Eighteenth Corps were placed in wagons and sent to the rear. Dr. Billings visited the hospital with a view of preventing the removal of this patient, but was informed by the director of transportation that the man had died the previous night, June 6, 1834. Case 218.—A Confederate private soldier was wounded at the battle of Fredericksburg, December 13, 1862, by a frag- ment of shell, which struck the trochanter of the right femur aud fractured it and the neck of the bone, and lacerated the soft parts, but without injuring any of the important vessels or nerves. He was conveyed to a field infirmary, where, a few hours after the reception of the wound, he was placed under the influence of chloroform, and Surgeon Hunter McGuire, Medical Director of Jackson's Corps, having ascertained the extent of the injury, decided that although the lesions of the soft parts rendered the case an unpromising one, yet excision was the only resource that offered any hope, and proceeded to excise the head, neck, and trochanters, dividing the shaft just below the trochanter minor with a chain saw. The wound was left open; the limb placed in a comfortable position by means of pillows, without splints, and the patient was treated at the temporary hospital at which the operation was performed. Notwithstanding the most careful attention to the after-treatment, he succumbed two or three days after the operation. Case 219.—A Confederate soldier of Kershaw's South Carolina Brigade was wounded at the battle of Chancellorsville, May 3, 1863, by a musket ball which shattered the neck of the femur. It having been decided, after an examination of the wound under chloroform, that the case was a favorable one for the operation of excision, the important nerves and vessels being intact, and the injury limited mainly to the neck of the bone, the operation was performed by Surgeon James, 16th South Carolina, ou the day after the reception of the wound. The patient died May 6, 1863. In a second category are placed nine cases of primary excision at the hip which resemble each other in that in each the operations were fairly indicated and offered favor- SECT. II. J EXCISION AT THE HIP AFTER SHOT INJURY. 95 able prospects of success. The patients, for the most part, were robust soldiers, and the lesions were limited to shot fracture of the upper extremity of the femur. All made a struggle for existence, several lived three or four weeks and one for sixty days, and the fatal results were due, in several instances, to the imperative military exigencies that necessitated the removal and inopportune and disastrous transportation of the patients. Case 220.—Private Robert Cole, Co. B, 29th Connecticut (colored troops), was wounded near Fair Oaks, October 27, 1864, by a musket ball, which shattered the upper extremity of the right femur without injury to any important vessels or nerves. He was conveyed to the hospital of the Tenth Corps, where the wound was explored, and it was decided to excise the head, neck, and trochanters of the femur. The operation was performed by Surgeon C. M. Clark, 39th Illinois, a few hours after the reception of the injury, by a longitudinal incision over the trochanter major, and division of the superior portion of the shaft by a chain saw. Dressings to secure the immobility of the limb were applied, and the patient was removed to the base hospital of the Army of the James, at Point of Rocks, where he was received on October 28th, and died on October 29, 1864. Case 221.—Private John Coon, Co. C, 60th Indiana, aged 20 years, a robust man, was wounded at Arkansas Post, Jan- uary 11, 1863, by a conoidal musket ball, which entered the right buttock and passed forward and outward, striking the femur on the inter-trochauteric line and comminuting the neck and upper part of the shaft of the bone. A few hours after the recep- tion of the injury the patient was conveyed to a hospital steamer, and a consultation was held, at which it was determined to excise the injured portions of bone. The loss of blood which had taken place and the patient's exposure to inclement weather were regarded as very unfavorable circumstances, but it was considered that on the whole an excision was the best thing to be done. An ounce of brandy and other restoratives were administered, and half an hour subsequently the wounded man was placed under the influence of chloroform, and Surgeon Milton T. Carey, 48th Ohio, made a semi-circular incision, beginning two inches above the prominence of the great trochanter downward in the direction of the shaft of the femur. The muscular attachments were then divided, and the capsular ligament freely incised. Some difficulty was then experienced in dividing the ligamentum teres; but this was finally accomplished, and the head of the femur removed. The extent of splintering having been determined, the shaft was sawn below the trochanter minor by means of a chain saw. The edges of the wound were then brought together, and a retentive apparatus was applied. After the operation the patient seemed much prostrated, but he rallied after a few hours, and was conveyed on the hospital transport D. A. January to Memphis, Tennessee, and placed in the military general hospital at that place, where he died ten days subsequently, January 21, 1863. Case 222. —Private J. W. Epton, Co. I, 5th South Carolina, was wounded at Deep Bottom, August 16, 1864, and was conveyed to the third division of the Jackson Hospital at Richmond. Surgeon J. G. Cabell, in charge, entered on the hospital register, page 214: "A minie" ball penetrated the right hip joint, on account of which a primary resection of the head and neck of the femur was practised. The patient sank, and died September 2,1864." Case 223.—Private Timothy Greely, Co. C, 74th New York, aged 20 years, was wounded October 5, 1861, by a round musket ball, which entered near the fold of the left natis, struck the left femur at the digital fossa, splintered the neck into the articulation, and made its exit outside the vessels anteriorly. He was conveyed to the E street Infirmary, Washington, on the same day. A stream of blood and another of clear and pellucid synovia issued from the wound of exit. There was but little constitutional irritation, the pulse was but slightly depressed, and the patient congratulated himself ou having escaped with what he regarded as a slight injury. On the morning of October 6tlr Assistant Surgeon John W. S. Gouley, U. S. A., assisted by Surgeon C. H. Laub, U. S. A., Assistant Surgeon C. B. White, U. S. A., Surgeon T. Sim, and Assistant Surgeon H. E. Brown, proceeded to operate. Insensibility having been induced by chloroform, Dr. Gouley made an incision seven inches long, commencing above and behind the trochanter major and continued downward in the axis of the limb. The neck of the bone was found to be badly shattered, but the fracture did not extend to the shaft. A section through the great trochanter and base of the neck was made with the chain saw. The head of the bone was then disarticulated and removed, and the fragments of the neck were extracted. There was very little loss of blood. The wound having been approximated and dressed simply, the patient was put to bed, and the limb was kept in position by pads and cushions. Surgical fever set in soon after the operation; pyaemia was developed, and the patient gradually sank, and died on October 12, 1861. His friends would not permit an autopsy. The pathological specimen and Dr. Gouley's notes of the case were destroyed in the conflagration which shortly afterwards consumed the Infirmary. Case 224.—Sergeant Samuel Grimshaw, Co. H, 6th New York Cavalry, aged 31 years, was wounded at Cedar "Creek, October 19, 1864, by a fragment of shell, which, after lacerating the scrotum, entered at the upper inner part of the left thigh near the femoral artery, making a wound one and a half inches in length, and passing upward and backward, shattered the head and neck of the femur and produced fissures extending four and a half inches in the shaft, and lodged in the acetabulum. The shock to the nervous system was great. The patient was desponding, and he complained of severe pain. He was con- veyed to a field hospital, and two hours after the reception of the injury he was placed under chloroform, and Surgeon A. P. Clark, 6th New York Cavalry, made a straight incision seven inches in length over the trochanter major, and excised the head and four and a half inches of the shaft of the femur. The wound was then dressed, and the limb was supported by pasteboard splints. On the following day no bad symptoms were observed. Beef essence and stimulants were freely given, and afterwards sulphate of morphia was administered. He was removed to the Sheridan Field Hospital at Winchester on October 20th, and there died on November 5, 1864. Case 225.—Private B. C. Johnston, Co. B, 56th North Carolina, Ransom's Brigade, was wounded on the night of the 17th of June, 1864, in front of Petersburg, by a conoidal ball probably, in the right thigh. The ball entered on the inner aspect of the limb and passed obliquely upward t»nd outward, producing a comminuted fracture of the neck of the femur and driving the fragments of bone into the surrounding tissues. The shaft of the bone was not shattered, and, as the man was very much 96 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. worn and exhausted, as most of the Confederate troops were at that time, it was considered advisable to perform resection of the head and neck of the femur, as offering a better chance of recovery than amputation. The operation was performed on June 18th, twelve hours after the reception of the wound, and the bone was sawn through the trochanters. He bore the opera- tion well, and, although weak, was hopeful. He was sent to the Fair Grounds Hospital, from which he was removed in a few days, placed in a tent, and attended by Surgeon Ladd, 56th North Carolina, and Dr. C. J. O'Hagan. He survived the operation two months, and succumbed at last to suppuration, caused by the want of proper food and stimulants, and the general prevalence of pyaemic infection, which at that period intervened in nearly all the surgical cases in the neighborhood of that hospital. To this account Dr. J. D. Jackson adds: "I recollect very distinctly of being present at the operation of Dr. Ladd, being then of the same division with him, but not of the same brigade. It was on the 18th or 19th of June, 1864, that it was done, the place being an unfinished brick church in the centre of Petersburg, which we were then occupying as an hospital. There were also present some four or five other surgeons, among whom I recollect Surgeon C. J. O'Hagan, Dr. Wilson, of Virginia, then the senior Surgeon of Ransom's Brigade, Dr. Luckie, of the same brigade, and, if I mistake not, Dr. R. L. Brodie, then Medical Director of General Beauregard's army, was among the number. The man operated upon was of Dr. Ladd's own regiment; his age, and any other personal peculiarities, I have forgotten, though I think he was young and comparatively robust. The wound had apparently been done by a musket ball, and the range of the wound was, I think, from the inner and upper aspect of the thigh, and nearly transversely through, ranging slightly upward, the aperture of exit being over the trochanter major. K I recollect aright, the trochanter was torn off and most of the neck of the femur shattered to fragments, the shaft of the femur being entirely separated from the head. Chloroform was given, and Dr. Ladd operated by making a slightly curvilinear incision over the acetabulum and trochanter—the aperature of the wound being in its line—cut down upon the head of the femur, exartic- ulated and removed it, and cut off a sharp fragment of the remaining end of the femur. The difficulty of performing the opera- tion seemed to be small. The haemorrhage was trifling. I do not recollect that I saw the patient again, he being sent ofl'to the General Hospital at what was then known as the "Fair Grounds Hospital," situated in the suburbs of Petersburg. But I further remember distinctly of hearing Dr. Ladd, Dr. O'Hagan, and probably others of Ransom's Brigade speaking of his death, which was on the sixtieth day after the operation, and which all agreed at the time in ascribing to want of good food in proper quantity. Owing to the scarcity of our supplies, and the immense number of wounded men then crowding the city in consequence of the battles fought in front of Petersburg on the 17th, 18th, and 19th of June, food really proper for wounded men was not obtained, and anything like delicacies were out of the question." Case 226.—Private Edward A. McDonald, Co. F, 149th Pennsylvania, aged 31 years, a robust, athletic man, was wounded on August 20, 1864, on the Weldon Railroad. A conoidal musket ball entered the upper anterior part of the right thigh and lodged in the head of the femur, after splintering its neck. He was carried to the hospital of the 1st division of the Fifth Corps, and placed under the influence of chloroform a few hours after the reception of the injury, and Surgeon F. C. Reamer, 143d Pennsylvania, assisted by Surgeon Thomas, 119th Pennsylvania, and others, proceeded with the operation. A V-shaped incision, arranged to traverse the entrance wound, exposed the muscular attachments of the neck and trochanter. These being divided, with the capsular and round ligaments, the head of the femur was exarticulated. Fragments of the neck were extracted, and then the femur was sawn through the trochanteric ridge by the chain saw. The wound was then partly closed by sutures and adhesive plasters, a pledget of lint being inserted at; the lower end, and the limb was bandaged and suspended by a Smith's anterior splint. Little loss of blood had been incurred, and the patient reacted and his condition appeared hopeful. Two days afterwards it was deemed necessary to remove the severely wounded from the advanced position of the Fifth Corps, and McDonald was sent in an ambulance wagon several miles, over a rough road, to the railroad to the hospital at City Point. There he remained three days, and was placed on a hospital transport and sent to Philadelphia, entering Broad and Cherry Streets Hospital August 27th. The injured limb was extended by means of a weight and pulley, concentrated nourishment and stimulants were administered, with quinia and opium. August 31st, symptoms of pyaemia were noted and the complication made rapid progress. Death took place September 4, 1864. At the autopsy large metastatic foci were observed in both lungs. Case 227.—Private Charles Morrison, Co. C, 185th New York, was wounded on the Quaker Road, south of Petersburg, on March 29, 1865. A conoidal musket ball struck the outside of the left thigh, fractured the trochanter, and separated the neck from the shaft. In less than two hours after the reception of the injury he was placed on the operating table at the field hospital of the 1st division of the Fifth Corps, and his wound was examined while he was under the influence of chloroform. He was a robust man, in the best health. In the judgment of the operating staff, the case was a very favorable one for the operation of excision. Surgeon William Fuller, 1st Michigan, was requested to perform the operation, and proceeded with it without delay. He entered his knife an inch above the great trochanter and made an incision three and a half inches in length, divided the muscular attachments, and readily exarticulated the head of the femur. A fissure was found to extend downwards half an inch below the trochanter minor. The shaft was divided by a chain saw at this point. The ball could not be found, but, from the direction of its track, it was the opinion of the operator and his colleagues that it had entered the pelvis through the obturator foramen. There was scarcely any haemorrhage during the operation, no artery requiring ligation or torsion. A tent was introduced into the wound, which was then approximated by two sutures and covered by a compress dipped in cold water. A full dose of morphia was then administered, and the patient was made as comfortable as possible in a bed in a hospital tent. In the middle of the night Surgeon Fuller returned to the hospital to visit his patient, but found that he had been removed to City Point, in compliance with orders from a superior authority. Dr. Fuller was subsequently informed by Surgeon Joseph Thomas, 118th Pennsylvania, that the man died on the way to the base hospital, about twelve hours after the operation. There was 6ome haemorrhage a few hours after the operation, but it was not considerable. The report of the patient's death was premature. The records of the City Point Hospital show that he was received there, and survived until April 26, 1865. Case 228.—A Confederate private soldier of Ewell's Corps was wounded at the battle of the Wilderness, May 5, 1864, by a conoidal musket ball, which broke the neck of the left femur into several fragments and lodged in the bone at the junction SECT. II.J EXCISION AT THE HIP AFTER SHOT INJURY. 97 of the head and neck. A few hours after receiving his wound he was placed under the influence of chloroform at a field hospital, and was examined by Surgeon Hunter McGuire, the Medical Director of the Corps, who decided that the case was well adapted for tlie operation of excision of the head of the femur, and proceeded to remove, through a longitudinal incision, the head and shattered fragments of the neck, and to smooth off with a saw the jagged upper extremity of the shaft. The operation was accomplished with but trifling haemorrhage. It is Dr. McGuire's impression, but, owing to the loss of his notes he cannot state positively, that in the subsequent rapid movements of the army it was necessary to send the patient to the rear, and besides the disadvantages of removal, he failed to receive such nourishment and careful treatment as his case demanded. He died of pyaemia, May 22, 1864. As in the majority of the primary field excisions the shattered epiphysis removed was not preserved. Ten fatal cases of primary excision at the hip are placed in a third category. These ten might almost be set aside in estimating the value of the operation, inasmuch as the interference would hardly have been undertaken, had the extent of the lesion been fully ascertained. Four of the cases were complicated by penetration of the pelvic cavity, inducing hopeless peritonitis; four were prostrated from excessive loss of blood; in two instances extensive longitudinal splintering of the shaft of the femur forbade the anticipa- tion of a favorable result. Case 229.—Private J. T. Goode, Co. K, 6th Virginia, aged 21 years, was wounded before Petersburg, July 31, 1864, by a conoidal musket ball, which fractured the upper extremity of the left femur. A few hours after the reception of the injury he was anaesthetized by a mixture of chloroform and ether, and the wound being explored excision was decided upon. Surgeon G. S. West, C. S. A., proceeded to perform the operation, assisted by Dr. W. L. Baylor and others. Upon making a linear incision in the axis of the limb and exposing the fracture, it was found that it extended longitudinally much lower on the shaft than was anticipated. Dr. Baylor reports that one of the surgeons present thinks that fully one-third of the femur was excised. The patient never fairly rallied from the shock of the operation, but he lingered until August 2,1864, when he died. Dr. Baylor adds that the circumstances were very unfavorable, the patient being fully nourished and nosocomial gangrene at the time pervading the surgical wards. Case 230.—Private John McCulloih, aged 35 years, a recruit at the depot for volunteers at Camp Dennison, Ohio, was wounded on August 30, 1861, by the accidental discharge of a musket. The ball, taking effect at the distance of a few yards only, severely shattered the upper part of tL« femur and lacerated the soft parts extensively. The patient was conveyed to St. John's Hospital, in Cincinnati, and on arrivu_«^ was greatly depressed by loss of blood. Professor George C. Blackman deter- mined that removal of the shattered bone oflfrred the best resource for the preservation of life, and, the patient having been rendered insensible by chloroform, excision of the head, neck, and trochanters was practised without delay, through a vertical incision on the exterior of the thigh. The patient died August 30, 1861, four hours after the completion of the operation. This was the first excision at the hip for shot injury in this country. Case 231.—Private G. W. Mayo, Co. B, 25th Battalion Virginia Reserves, was wounded at the affair between Yellow Tavern and the outer defences of Richmond, Virginia, May 12, 1864, by a conoidal musket ball, at short range, which entered the right buttock and passed forward and outward through the thigh, striking the femur between the trochanters, and producing very extensive splintering of the neck and shaft. He was admitted to the Receiving and Wayside Hospital, at Richmond, early the next day, and his wound being examined under chloroform, Surgeon Charles Bell Gibson, C. S. A., determined to proceed at once with the operation of excision of the head and upper extremity of the femur. The injured bone being exposed by a long straight incision, the muscular and ligamentous attachments were divided, and the head of the femur was disarticulated. Numerous detached fragments were then removed, and the shaft of the femur was sawn at a point five or six inches below the trochanter minor. The operation was rapidly accomplished, but the shock, added to the depression already existing from the injury, was such that the patient did not react. He FiG.48.-Shot corn- died at 9 o'clock a. M. on May 15, 1864, about forty-five hours after the operation. The pathological speci- ^"trochantera of men was preserved, and has lately been contributed to the Army Medical Museum by Dr. W. F. Richardson, left femur. Spec. It is represented in the annexed wood-cut (FlG. 48). Case 232.—At the assault on Knoxville, Tennessee, on November 16, 1863, a soldier of a Michigan cavalry regiment was wounded and made a prisoner. He was a man about eighteen years of age, five feet eight inches in height, with light hair and blue eyes, and was in robust health when he received the injury. A mini6 ball entering about the centre of the nates, passed forward, shattering the head and upper part of the neck of the femur, but did not injure the acetabulum. No haemor- rhage of importance followed the wound. It was considered that the case demanded excision of the head of the femur, and the operation was performed on the day of the reception of the injury by Surgeon J. S. D. Cullen, P. A. C. S. "The operator made his incision posteriorly, directly through the thickest part of the gluteal muscles, on a line parallel with the os femoris, instead of laterally. In making his incision, which, at the least calculation, was ten inches in length, he cut the gluteal artery near its point of exit from the pelvis." The artery was ligated finally, though not until there had been much loss of blood. The head and neck of the femur were then excised. " When the siege was abandoned," another report states, " General Long- street retired to Russellville, and this patient was left behind. I am positive that he could not have recovered, for the suppura- tion that followed the operation was immense, and he was suffering from hectic fever when I last saw hirn, some six days after the operation." There can be but little doubt that the patient referred to in this account was Private Isaac Melcar, Co. A, 8th Michigan Cavalry, aged 18 years, who was found abandoned on the retirement of the Confederate army from KnoxVille, and Surg. IH—13 98 INJURIES OF THE LOWER EXTREMITIES. [chap, if was taken to hospital No. 2, in that city, and entered as a case of "gunshot fracture of left hip." No other Michigan cavalry soldier is reported at the period referred to with this or any similar wound. This man died on December 2, 1863. The register of the Knoxville Hospital gives no particulars of the case. Case 233.—Private J. J. PhiUips, Co. G, 61st Virginia, was wounded on the second day of the battle of the Wilderness, May 6, 1864, by a conoidal musket ball, which entered at the posterior upper portion of the left thigh, fractured the femur, and lodged. He was immediately conveyed to Richmond by rail, and was admitted to the Receiving and Wayside Hospital on May 7th. The wound was at once thoroughly explored under chloroform, and excision of the shattered bone was decided on. Surgeon Charles Bell Gibson, C. S. A., performed the operation. A long vertical incision over the trochanter major exposed the injured bone. It was found that the ball had produced extensive longitudinal splintering and had itself split, a small fragment lodging in the medullary canal, while a larger portion had buried itself in the gluteal muscles about two inches from the point of impact upon the bone. The muscles inserted into the trochanter having been divided, the head of the femur was exarticulated, and the upper extremity of the shaft was smoothed off with a saw. The operation was accomplished without much haemorrhage, and the patient rallied promptly from the shock. He had an anodyne, and passed a good night, and, on the following day, May 8th, he appeared to be doing well. On the 9th, however, there was much constitutional irritation, and on the morning of the 10th it was apparent that the man was sink- Fig. 49.—Fissuringof ing. He died at 4 o'clock a. M., May 11, 1864. The pathological preparation was contributed by Dr. right kmur^Spec05499° Richardson to the Army Medical Museum, and is a fine illustration of the characteristic longitudinal Assuring produced in the femur by conoidal balls. It is represented in the adjoining wood-cut (FlG. 49). In a letter dated Chicago, September 18, 1869, Dr. 0. M. Clark, late Surgeon 39th Illinois Volunteers, reports the following case of excision at the hip: Case 234.—"Private C. Raines, Co. E, 25th North Carolina, was wounded June 2, 1864, by a conoidal ball, which entered the right thigh at the upper and outer third, near the great trochanter, passing obliquely downward and inward, and making its exit near the junction of the middle with the upper third of the femur. This man was not seen until eight hours after the wound was received, being among the last to be brought from the field. When he reached the operating table he was almost exsanguinated and pulseless, having lost a large amount of blood. After free administration of milk punch and beef tea, with comfortable rest for two hours' time, he was placed on the operating table at 7 o'clock P. M., and the following operation performed: Chloroform was given (which added greatly to the stimulation of the system—pulse 80 and full), and a longitudinal incision made from the great trochanter down to the extent of six inches. The femur was found to be extensively comminuted, and some sixteen fragments were removed, leaving the periosteum behind. There was diffused ecchymosis with clots through- out the extent of the fracture. The lower fragment was turned out and smoothly sawn off, and then attention paid to the upper portion, which was found comminuted within the capsule to such a degree as warranted the removal of the head of the bone, which was done by extending the incision upward one inch, opening the capsular ligament, turning head of bone out and dividing the ligamentum teres. The parts were then thoroughly cleansed and brought together with eight interrupted sutures. Applied strip of lint to the wound, wet with solution of tannic acid and collodion, then bandaged with spica turns about hip and splint, etc. He rallied well from the operation and passed a comfortable night at the hospital. In the morning he was taken, per hospital transport, to the Chesapeake Hospital, and I have no knowledge of the case since that time, but presume the records of that hospital will furnish the result. The bone removed below the trochanter major measured three and a half inches." This case has been identified as that of " C. C. Kaines, a rebel prisoner," aged 23 years, who was reported by Assistant Surgeon E. McClellan, U. S. A., as having been admitted to hospital at Fort Monroe, June 4, 1864, with "shell wpund of right side and abdomen," and as having died the same day.of "exhaustion." Case 235.—Captain Thomas R. Robeson, 2d Massachusetts, aged 24 years, an athletic man, was wounded July 3, 1863, at Gettysburg, his regiment having become warmly engaged under a musketry fire at short range. A rifled musket ball struck him over the right trochanter major, shattering the neck and head of the femur, and, as was subsequently ascertained, fractured the pelvis and penetrated its cavity. He was carried a short distance to the rear, where the stretcher-bearers became exhausted and laid him down. Sergeant Francis O'Doherty, of his regiment, coming shortly afterwards wounded to the rear, impressed some stragglers and had the wounded man conveyed to a field station of medical officers of the Twelfth Corps. In the after- noon he was brought into the Twelfth Corps hospital, and was examined by Surgeon John McNulty, U. S. V. The sufferings of the patient were intense, and he urgently demanded some operative interference for his relief. Although the prospect was very discouraging, it was decided to comply with his request. An exploration of the wound indicated that there was some injurv of the pelvic wall. The patient was placed under the influence of chloroform very soon after his admission to the hospital, and a few hours subsequent to the reception of the injury Dr. McNulty made an incision over the trochanter major six inches long, passing through the wound of entranee and continued downward in the axis of the limb, turned out the shattered superior extremity of the femur and sawed the bone just below the trochanters. The fragments of the head and neck were then removed. There was more bleeding in this than in Dr. McNulty's other operations of excision of the head of the femur, yet the haemor- rhage could not be called profuse. The patient survived the operation fourteen hours. During this interval he appeared to be unconscious. Case 236.—It has not been possible to learn the name and military description of the subject of this operation. He was a private soldier of the First Corps, and a Frenchman, for the operator recalls the broken English in which he begged for the operation, and expressed his relief and thanks after it was performed. He had a terrible comminution of the upper extremity of the left femur, inflicted by a fragment of shell at the battle of Antietam, September 17,1862. Surgeon John McNulty, U. S. V., excised the head and neck of the femur, five hours after the reception of the injury, through a vertical incision six inches long, SECT. II. | EXCISION AT THE HIP AFTER SHOT INJURY. 99 under chloroform. As in two other operations performed by Dr. McNulty, it was found that the lesions extended into the pelvis. Consequently there could be little or no hope of a successful result. This patient survived the operation only ten hours. Case 237.—Private-----------, of the First Corps, was wounded at the second battle of Bull Run, August 30, 1862, by a conoidal musket ball, which entered the left hip below and in front of the trochanters, and fractured the femur at the junc- tion of the head und neck. He was conveyed to the hospital of General King's division of the First Corps in the brick house which had been occupied as the rebel headquarters at the first battle of Bull Run. The prostration from shock was great, yet it was thought that exarticulation of the femur was the only resource, and that excision would be less hazardous than amputa- tion. Accordingly, fifteen hours after the reception of the injury, Surgeon John McNulty, U. S. V., proceeded to excise the head and neck of the left femur through a vertical incision on the exterior of the limb about six inches in length, the patient being under chloroform. On dividing the round ligament to enucleate the head of the bone, it was discovered that the ball had pene- trated the pelvic cavity through the lower portion of the acetabulum. The femur was sawn through at the junction of the shaft and neck by a narrow-bladed saw. After tho removal of the shattered fragments of bone, the patient suffered much less pain. There were no symptoms of peritonoeal inflammation at tho date of the operation, but they were subsequently developed. The patient died August 31, 1862. Case 238.—Private-----------, was wounded on August 28, 1802, in the engagement between General Rufus King's division of the First Corps and the advance of General Jackson's column on the Washington turnpike, near Gainesville. A conoidal musket ball had splintered the neck and trochanters of the left femur, and was supposed to have lodged about the acetabulum, though the operator discovered in the sequel that it had penetrated into the cavity of the pelvis. The symptoms of shock were very grave and the prognosis very unfavorable; but the chief medical officer of the division, Surgeon Peter Pineo, U. S. V., determined to remove the upper extremity of the femur. The upper fourth of the femur was excised a few hours after the reception of the injury. The excision was done under chloroform, with little apparent loss of blood, through a vertical incision on the outside of the limb. The femur was sawn about two inches below the lesser trochanter. It was now discovered that the ball had passed through the innominatum, and that internal haemorrhage was going on. During the night of August 28th General King's division was driven back to Manassas, and this patient with other wounded fell into the hands of the enemy. It is probable that he survived but a very short time. Dr. Pineo secured the specimen, and it is preserved in the Surgical Section of the Army Medical Museum as No. 71. It is figured at page 233 of the Catalogue of the Surgical Section, and another view is given in the accompanying wood-cut (Fig. 50). The trochanter major is separated into five fragments, and a long oblique fissure produces a complete solution of continuity in the shaft of the femur.—(Circ. 6, S. G. O., 1865, p. 62, Case 5, and Circ. 2, S. G. O., 1869, pp. 21, 132.) The successful primary excision at the hip and thirty-two unsuccessful operations will now be concisely tabulated in alphabetical order for convenience of comparison and reference: Table XL Summary of Thirty-three Cases of Primary Excision at the Hip after Shot Injury. Fig. 50.—Perforation of trochanter and Assur- ing of the shaft of left femur. Spec. 71. Name, Age, and Military description. Date OF INJURY. Nature of Injury. Date of Opera- tion. Operation and Operator. Result and Remabks. Cannon, —, Pt., A, 49th Georgia, age 24. Barber, F. M., Capt.,H, 16th Connecticut, age 32. Beard, C, Pt., 12th Missis- sippi. Brown, E. T., Sergeant, C, 21st Massachusetts, age 30. Cole, E., Pt., B, 29th Con- necticut. Coon, J., Pt., C, 60th Indiana, age 20. 1 Dempsey, B., Pt., Battery I, 4th Artillery. Epton, J. W., Pt., I, 5th S. Carolina. Goode, J. T., Pt., K, 6th Virginia, age 21. May 5, 1864. Sept. 17, 1862. Aug. 23, 1864. July 23, 1864. Oct. 27, 1864. Jan. 11, 1863. Feb. 25, 1864. Aug. 16, 1864. July 31, 1864. Conoidal ball comminuted left femur one inch below trochan- ter major and lodged. Shot shattering trochanters and neck of right femur. Conoidal ball fractured head and neck of right femur and lodged in acetabulum. Fragment of bomb fractured upper extremity of left femur, five inches. Musket ball shattering upper extremity of right femur. Conoidal ball comminut'g neck and upper part of shaft of right femur. Fragment of shell crushing trochanters and neck of right femur. Conoidal musket ball wound of right hip. Conoidal ball fracture upper extremity of left femur. May 6, 1864. Sept. 18, 1862. Aug. 23, 18G4. July 23, 1864. Oct. 27, 1864. Jan. 11, 1863. Feb. 25, 1864. Prim'ry July 31 1864. Head, neck, and upper extrem- ity of shaft, through incision in wound six inches long, by Surg. J. J. Dement, P.A.C.S. Head, neck, trochanters, and tract, upper extremity, thro' straight incision four ins. long, by Surg. M. Storrs, 8th Conn. Head and femur, just above lesser troch., thro' angular in- cision, by Surg. A. A. White, 8th Maryland. Head and broken extremity of shaft, thro' longitudinal in- cision, by Surg. W.V.White, 57th Massachusetts. Head, neck, trochanters, and portion of shaft by longitudinal incision over troch. major, by Surg. C. M. Clark, 39th 111. Head and shaft below troch. minor, through semi-circular incis'n, by Surg. M. T. Carey, 48th Ohio. Head, neck, and shaft an inch below trochanter minor, thro' longitudinal incis. five ins., by Surg. N. W. Abbott, 80th 111. Head and neck of right femur. Head,neck,andnearly one-third of shaft, thro' linear incision, by Surg. G. S. West, C. S.A., and others. Recovered, February. 1865, short- ening three inches; limb useless for locomotion. Died Novem- ber 23,1865, diphtheria. Circ. No. 2, pp. 26, 133. Surgical fever. Died September 20, 1862. Circ. 2, pp. 22, 133. Died Aug. 25, 1864. Spec. 1410, A. M. M. Ctrc. 2, pp. 31, 134, and Circ. 6, p. 70. Died July 27,1864. Circ. 2, pp. 30, 134. Died October 29, 1864. Circ. 2, pp. 33,134. Died January 21,1863. Circ. 2, pp. 23, 133. Died February 28,1864. Ctrc. 2, pp. 25, 133. Died September 2, 1864. Circ. 2, p. 120. Died August 2,1864, from shock of operation. Circ. 2, pp. 30,134. 'Abbott (N. W.), Cases of Resection, in Chicago Medical Examiner, 1864, Vol. V, p. 612. 100 INJURIES OF THE LOWER EXTREMITIES. [chap, x NO 12 Name, Age, and Military Description. 1 Greely, T., Pt., C, 74th New York, age 20. Grinishaw, S., Sergeant, H, 6th N. Y. Cavalry, age 31. "Hobson, T.J., Pt., H, 32d Tennessee, age 23. Johnston, B. C, Pt., B, 56th North Carolina, age 26. McCnlloch, J.. Recruit, age 35. ^ McDonald, E. A., Pt., F, 149th Pennsylvania, age 31. McGuire, J. A., Lieut., I, 148th Pennsylvania. Mayo, G. W., Pt., B, 25th Virginia Reserves. Melcar, I., Pt., A, 8th Mich- igan Cavalry, age 18. Morrison, C, Pt., C, 185th New York, age 21. O'Rourke, —, Pt., 18th Mis- sissippi, age 24. Pease, T. G., Pt., B, 117th New York. Phillips, J. J., Pt., G, 61st Virginia. Raines, C, Pt., E, 25th N. Carolina, age 23. Robeson, T. R., Capt., 2d Massachusetts, age 24. Talman, J. M., Sergeant, H, 18th Wisconsin, age 30. Unknown, Pt., 1st Army Corps (a Frenchman). Unknown, Pt., First Army Corps. Unknown, Pt., General R. King's division, First Army Corps. Unknown, Pt., Fifth Anny Corps. Unknown, Pt., Eighteenth Army Corps. Unknown, Pt., C. S. A...... Unknown, Pt., Ewell's Corps. Unknown, Pt., S. C. Brigade. Kershaw's Date of Injury. Oct. 5, 1861. Oct. 19, 1864. June 24, 1864 June 17. 1864. Aug. 30, 1861, Aug. 20, 1864. May 12, 1864, May 12, 1864 Nov. 16, 1863. Mar. 29, 1865. May 6, 1864. Oct. 28, 1864. May 6, 1864. June 2, 1864. July 3, 1863. May 14 1863. Sept. 17, 1862. Aug. 30 1862. Aug. 28, 1863. May 10, 1864. June 3, 1864. Dec. 13, 1862. May 5, 1864. May 3, 1863. Nature of Injury. Round ball splintering neck of left femur into articulation. Fragm'nt of shell shat'ing head and neck of left femur, fissures extending four and a half ins. in shaft, lodged in acetabul'm. Conoidal ball fract. neck and trochanters of femur, extend- into capsular ligament. Conoidal ball severing head and portion trochanter major, right femur. Shot shattering upper part of femur. Conoidal ball splintered neck and lodged in head of right femur. Musket ball smashed trochant- ers and neck of right femur. Conoidal ball fractured neck and shaft of right femur. Conoidal ball shattered head and upper part neck of left femur. Conoidal ball separated neck from shaft of left femur and fract. trochanter major, and probably lodged in pelvis. Musket ball shattered neck of right femur and lodged. Musket ball shattered trochant- ers and neck of right femur and lodged in cotyloid cavity. Conoidal ball, extensive longi- tudinal splintering of shaft of right femur. Conoidal ball, extensive com- minution of shaft and upper portion of right femur within the capsule. Conoidal ball shattered head and neck of right femur, frac- tured the pelvis, and pene- trated its cavity. Conoidal ball comminuted head and neck of left femur, and lodged in neck; fissures ex- tending down shaft. Fragment of shell comminut'g upper extremity of left femur, lesions extending into pelvis. Conoidal ball fractured the left femur at junction of head and neck, pen. pelvic cavity. Conoidal ball splintering neck and trochanters of left femur, and pen. pelvic cavity. Musket ball fracturing trochan- teric portion of left femur. Fragment of shell comminuted trochanter major and neck of right femur. Fragment of shell fractured trochanter major and neck of right femur. Conoidal ball fractured neck of left femur, lodging. Musket ball shattered neok of femur. Date OF Opera- tion. Oct 6, 1861. Oct. 19, 1864. June 24 1864. June 17, 1864. Aug. 30, 1861. Aug. 20, 1864. Mav 12, 1864. May 13, 1864. Nov. 16, 1863. Mar. 29, 1865. May 6, 1864. Oct. 28, 1864. May 7, 1864. June 2, 1864. July 3, 1863. May 15, 1863. Sept. 17, 1862. Aug. 30, 1862. Aug. 28, 1862. May 10, 1864. June 3, 1864. Dec. 13, 1862. Mav 5, 1864. May 4, 1863. Operation and Operator. Head and fragments of neck, through incision seven inches long.sect. thro' troch. maj. and base of neck, by Ass't Surg. J. W. S. Gouley, U. S. A., and others. Head and four and a half ins. of shaft, through straight in- cision seven inches long, by Surg. A. P. Clark, 6th New York Cavalry. Head and shaft just below tro- chanters, through linear in- cision ten inches long, by Surg. J. F. Grant, P. A. C. S. Head and fragments, through curvilinear incision five ins. long, roughened projection of shaft cut off, by Surg. C. H. Ladd, 56th N. C. Head, neck, and trochanters, through vertical incision, by Prof. G. C. Blackman. Head, fragments of neck, and shaft, thro' trochanteric ridge, V-incision, by Surg. F. C. Reamer, 143d Penn. Head, neck, and trochanters, thro' longitudinal incision, by Surg. G. W. Snow, 35th Mass. Head and shaft, five inches be- low troch. minor, through straight incision, by Surg. C. B. Gibson, P. A. C. S. Head and neck, thro' incision ten inches long, by Surg. J. S. D. Cullen, C. S. A. Head and shaft, half inch be- low trochanter minor, thro1 longitudinal incis'n, by Surg. W. Fuller, 1st Mich. Head, neck, and shaft, through trochanters, curvilinear incis. four inches long, by Surg. J. T. Gilmore, C. S. A. Upper extremity of femur, by Surg. N. Y. Leet, 76th Penn. Head and up. extremity, thro' long vertical incis'n, by Surg. C. B. Gibson, C. S. A. Head, neck, trochanter major, and three and a half ins. of shaft, thro' longitudinal incis- ion six inches long, by Surg. O.M.Clark, 39th 111. Head, neck, and shaft just be- low trochanters, thro incis'n six inches long, by Surg. J. McNulty, U. S. V. Head, neck, and shaft, two and a half inches below lesser trochanter, curved incision, by Surgeon H. S. Hewit, U. S.V. Head and neck, thro' vertical incision six inches long, by Surg. J. McNulty, U. S. V. Head and shaft, at junct'n with neck, vertical incision six ins. long, by Surg. J. McNulty, U. 8. V. Head and shaft, about two ins. below trochanter minor, vert- ical incision, by Surgeon P. Pineo, U. S. V. Head, neck, and trochanters... Head, neck, and trochanters... Head, neck, and trochanters, by Surg. H. McGuire, P. A. C. S. Head and shat'd fragments of neck and shaft, longitudinal incis'n, bv Surg. H. McGuire, P. A. C. S. Head and neck, by Surgeon James, 16th South Carolina. Result and Remarks. Surgical fever, pyaemia. Died Oct. 12,1861. Circ. 6, p. 62, and Circ. 2, pp. 21, 132. Died November 5,1864. Circ. 2, pp. 32, 134. Reaction never complete. Died June 27, 1864. Circ. 2, pp. 30, 134. Died August 16, 1864, from ex- haustion, probably the result of caries and ill-judged diet. Circ. 2,pp. 29,134. EVE (I.ft, p. 263). Died August 30,1861, four hours after operation. Circ. 2, pp. 20, 132. Died September 4, 1864, of pyae- mia. Circ. 6, p. 70, and Circ. 2, pp. 30, 134. Died May 15, 1864. Circ. 2, pp. 28, 134. Died May 15, 1864, from shock. Spec. 5498, A. M. M. Circ. 2, pp. 28. 134. Died December 2,1863. Circ. 2, pp. 25, 133. EVE (I. c, p. 257). Haemorrhage. Died April 26, 1865, irritation and profuse sup- puration. Circ. 2, pp. 33, 134. Did not react. Died May 9,1864. Circ. 2, pp. 27, 133, and Eve (1. c, p. 257). Died Oct. 29, 1864. Circ. 2, pp. 32, 134. Died May 11.1864. Spec. 5499, A. M. M. Ctrc. 2, pp. 27,133. Died June 4, 1864, exhaustion. Did not rally. Died July 3,1863. Ctrc. 2, pp. 25, 133. Died May 19, 1863. Circ. 6, p. 66, and Circ. 2, pp. 24, 133. Survived the operation ten hours. Circ. 2, pp. 22, 133. Died August 31,1862, from shock of injury and operation. Circ. 2, pp. 22, 132. Patient fell into the hands of the enemy, probably survived but ashorttime. Spec.71, A.M. M. Phot. Ser., Vol. 1, p. 13, S. G. O. Circ. 6, p. 62; Ctrc. 2, pp. 21,132. Died May 13, 1864. Circ. 2, pp. 28, 133. Died June 6, 1864. Ctrc. 2, pp. 29, 134. Died two or three days after operation, from shock. Ctrc. 2, pp. 23, 133. Died May 22,1864, pysemia. Circ. 2. pp. 26, 133. Died May 6, 1863. Ctrc. 2, pp. 24,133, and Eve (I. c, p. 257). 'CALHOUN (J. T.), Army Correspondence, in Med. and Surg. Reporter, 1862, VoL VIII, p. 76. 2 Eve (P. F), Contribution to the History of the Hip Joint Operations, etc., hi Trans, of Am. Med. Ass., 1867, Vol. XVIII, p. 261. SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 101 Of the thirty-three primary excisions at the hip seventeen were on the right side, thirteen on the left, and in three cases the side of the injury was not indicated. In twenty-two instances the straight, vertical longitudinal or linear incision, as variously termed by the different operators, was employed; in four instances the curvilinear; in one the V-shaped, and, in six cases the mode of incision was not indicated. In five instances the missile, either whole or in part, was excised with the injured bone. Intermediary Excisions.—Of twenty-two excisions classified as intermediary, two resulted successfully, a mortality rate of 90.9. Sixteen of the operations were practised on Union and six on Confederate soldiers. The shortest interval between the dates of reception of injury and operation was two days, the longest twenty-eight, the average interval being about thirteen days." Details of the two successful intermediary excisions will be first noticed: Case 239.—Lieutenant James M. Jarrett, Co. C, 15th North Carolina, a spare man, 28 years of age, of medium size, of fair complexion, of temperate habits, and good general health, was wounded at the affair at Bristow Station, Virginia, October 14,1863, by a conoidal musket ball, which entered in front and a little to the outside of the median line of the left thigh, two inches below Poupart's ligament, shattered the femur, and made its exit posteriorly at the outer part of the limb, the wound of exit being on a rather higher level than that of entrance. The fracture was dressed with a straight splint, and the wounded officer was placed in an ambulance wagon and transported over rough roads to Richmond, a distance of one hundred and sixty miles. On October 20th, he was admitted to hospital No. 4, at Richmond, in an exhausted state, and was placed in charge of Surgeon James B. Read, P. A. C. S. He complained of extreme pain upon any movement of the limb, and was unwilling to submit to an examination of the injury unless insensibility was induced. Chloroform having been administered, the splints and soiled bandages were removed, and the limb was placed in Sn easy position on pillows. Water dressings were applied to the wounds, and an opiate was administered. For the next three weeks, the progress of the case was very unfavorable. The wound of exit discharged copiously unwhole- some thin pus, mixed with blood and bubbles of fetid gas and small bits of dead bone. The pulse was quick and small, the tongue red and dry. There was a tendency to diarrhoea, and night sweats frequently recurred. On November 9th, as the patient was steadily growing worse, a consultation was -asked for, and Surgeons C. B. Gibson and M. Michel saw the case with Dr. Read. It was decided that the circumstances called for operative interference, and that an excision of the head of the femur offered the best prospect of recovery. On November 9th the patient was anaesthetized, and then placed on his right side on the operating table. A straight incision was commenced two inches below the posterior or exit wound, and was carried through this to the great trochanter, and thence upward for two inches further, thus making a wound about seven inches in length. This incision being carried down to the bone, the upper end of the shaft of the femur was examined and was found to be jagged and pointed, thin layers of bone about three inches long being broken off from its anterior aspect. The lower fragment was projected through the incision by adducting the limb and pushing the knee upward, and it was sawn about two inches below its upper sharp extremity. The trochanteric portion of the femur was then sought for, and was found drawn upward by the psoas and iliacus internus. Its extremity was seized by the lion forceps and drawn downward, and the attachments of these muscles to the lesser trochanter were divided. To luxate the head of the femur so as to admit of the division of the round ligament was a work of great difficulty. It was finally accomplished, partially by twisting the neck of the bone, and the head was exarticulated. The appearance of the principal portion of this excised bone is shown in the annexed wood-cut (Fig. 51). Several large detached fragments and splinters were then extracted, and other closely attached bits of bone were enucleated by the finger-nail. The wound was cleansed and then closed by sutures and adhesive strips. Dry dressings were applied, and the thigh was fixed by a large straight splint. The patient was ordered two grains of opium and a drachm and a quarter of brandy every two hours. At bed-time the patient was quite comfortable, and could shift his position slightly without pain; his pulse was 120. On the following day, anodynes were given at greater inter- vals. On November 11th, they were omitted, except at bed-time, and nutritious diet was ordered. The next day the sutures were removed; the wound began to discharge laudable pus in small quantity. The case progressed without any untoward complication. On December 9th the wound was healed, except at two points, connected by sinuses leading to the cotyloid cavity and the upper end of the shaft. The patient had gained flesh and strength; his pulse was full and strong at 76; his FIG. 51. —Shattered upper portion of the left femur. [From a wood- cut after Read. 1 FIG. 52.—Appearance of limb seven months after operation. [From a photograph.] 102 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X appetite and digestion were natural; he slept well, was cheerful, and did not complain of pain. The limb was shortened five inches. The daily discharge of pus was less than half an ounce. Two weeks subsequently the wound was entirely united; the cicatrix was firm; the patient could move about his bed without inconvenience; there was no pain on pressure about the muscles of the injured part. The patient was now removed to his home in North Carolina, and was soon able to move about on crutches. In September, 1864, ten months after the operation, he reported that he was able to bear considerable weight on the limb, and that he had discarded his crutches and walked about in a high-heeled boot with the aid of a cane. The appearance of the patient, seven months after the operation, is exhibited in the wood-cut on the preceding page (FlG. 52), copied from a photo- graph presented to the compiler by Assistant Surgeon Latimer, C. S. A. Case 240.—Private Hugh Wright, Co. G, 87th New York, aged 28 years, a robust, healthy man, was wounded on May 5, 1864, at the battle of the Wilderness, by a conoidal musket ball, which entered the right thigh an inch within the track of the femoral vessels and two inches below Poupart's ligament, passed backward and outward, shattering the neck and trochanters of the femur, and, having been greatly flattened and distorted by the impact, it lodged amid the fragments of bone. The precise direction of the fracture is indicated in the accompanying wood-cut (FlG. 54).1 He stated that after being wounded, he was carried to the rear by a number of his companions, and, in the evening, was taken to the field hospital of the 2d division of the Second Corps. Here he remained for three days. He was then sent in an ambulance wagon to Fredericks- burg, and placed in a temporary hospital. He stated that his wound was repeatedly examined by different surgeons, but that no treatment was instituted beyond the applica- tion of a compress dipped in cold water to the wound. He was transferred, after a fort- night, on a hospital steamer, to Washington, and on May 25th he was admitted to Stanton Hospital, then under the charge of Surgeon B. B. Wilson, U. S. V. He Avas placed in Ward 6, under the care of Acting Assistant Surgeon J. B. Garland, who communicated a special report of the case. The injured limb was swollen, everted, and shortened. Pus had accumulated in the tissues about the hip. Notwithstanding the gravity of the injury, the patient's constitutional condition is said to have been hopeful. On exploring the wound with the finger, the patient being under the influence of chloroform, detached fragments of bone could be felt. On consultation with Acting Assistant Surgeon George A. Mursick,2 an operation was decided upon, for the purpose of removing these loose fragments, and the missile, if it could be found. On May 27th, the patient was rendered insensible by sulphuric ether, and Dr. Mursick, assisted by Dr. Garland and others, made a straight incision, commencing above and behind the trochanter major and carried downward in the axis of the thigh. It was not in contemplation, at the beginning of the operation, Dr. Garland states, to exarticulate the head of the femur; but when the muscular attachments were divided, and the full extent of the frac- ture was revealed, and the joint was found distended with pus, it was at once determined to make a formal excision. The fragments of the neck were extracted piecemeal. The ball was found lying behind the neck, and was extracted. The capsular ligament being freely incised, a bistoury was inserted into the cotyloid cavity and the round ligament was severed, and the head of the femur was removed without difficulty. The jagged upper extremity of the shaft of the femur was then turned out of the wound by carrying the limb over the opposite knee, and was smoothed off by a chain saw. There was but trifling haemorrhage, and no ligatures were required. The wound was carefully cleansed, dressed with drv lint, and left to heal by granulation. To keep the limb in position, long sand bags were laid on either side of it, and moderate extension was made by means of a weight attached to the leg and suspended from the foot of the bed. At night he took a grain of sulphate of morphia in a draught. The operation seemed to depress him very much, and reaction was slow. He passed a restless night, manifesting much nervous excitement. In the morning his pulse was feeble and frequent; his tongue dry and furred. He was ordered an ounce of brandy every three hours, a grain of opium every four hours, and as much beef tea and concentrated nourishment as he could take. On May 29th his general condition had much improved; the pulse was less frequent and stronger. There was free suppuration. The wound was dressed with a weak solution of permanganate of potassa. On June 1st he continued to improve, the wound looked well, and the character of the suppuration was good. The amount of brandy was reduced to four ounces daily. On August 1st he was still doing well. The wound was filled up with granulations from the bottom, with the exception of a sinus leading to the bone. It continued to suppurate quite freely, and some small pieces of dead bone had come away with the discharges. He had gained in flesh, and his health and spirits were good. On August 22d, he attempted, for the first time, to sit up in bed, but, owing to the rigidity of the parts and the ao-o-lutination of the muscles, the pain caused by the sitting posture was so severe that he was compelled to lie down again. Cold evaporating lotions were applied to the thigh. On August 23d the upper part of the thigh swelled and was painful, and the discharge was increased in quantity. On August 27th the swelling of the thigh had increased, the discharge from the wound was verv free, thin, and flaky, and the surrounding surface was glazed and doughy to the touch. The wound of entrance had re-opened and discharged thin pus. An abscess formed on the inner side of the thigh, and about four ounces of thin flaky FIG. 53.—Appearance of limb two years and five months after operation. [From a photograph.] FIG. 54.—Shot commi- nution of neck and tro- chanters of right femur. Spec. 3375. 1 An anterior view of this specimen is printed in the surgical report in Circular No. 6, S. G. O., 1865, p. 74, and in the Catalogue of the Surgica Section of the Army Med. Museum, 1866, p. 246. 2MURSICK (G. A.), A successful Case of Excision of the Head of the Femur for Gunshot Fracture, in New York Med. Jour., 1865, Vol. I, p. 424. See also Circular No. 6, S. G. O., 1865, p. 68, Circular No. 2, S. G. O., 1869, pp. 41, 135, Plwtographic Series, A. M. M., Vol. IV, p. 38. SECT. II.] EXCISION AT THE HIP FOR SHOT INJURY. 103 pus was discharged. The patient was restless. He was ordered twenty drops of the tincture of the sesquichloride of iron every six hours, with stimulants and nutritious diet. On September 1st the swelling and inflammation of the thigh continued. He complained of nausea and want of appetite. An abscess formed on the outer side of the thigh. On September 5th the abscess was incised, and a large quantity of thin, flaky, and offensive pus was evacuated. He had an irritable stomach, and Hoffman's anodyne was administered. On September 6th the edges of the incision in the abscess were beginning to slough, and nitric acid was freely applied. On September 9th he had diarrhoea; ten grains of subnitrate of bismuth and a grain of opium were given every six hours. On September 13th the diarrhoea had nearly ceased. The patient's general condition had improved, and the wound looked well, though the suppuration was still copious, and had improved in quality. On September 25th a large ring-shaped exfoliation from the upper end of the femur was removed through the wound of operation. On September 26th another exfoliation was removed. On October 6th, 1864, Private Wright was discharged from the military service on account of the expiration of his enlistment. On October 7th the swelling of the thigh had subsided; the discharge from the wounds had much diminished in quantity, and presented the appearance of laudable pus; the diarrhoea had ceased, and his general condition was much improved, he being able to sit up in bed. On October 30th, a sinus communicating with necrosed bone opened on the outside of the thigh. In the latter part of December, another abscess formed on the outer side of the thigh. When this was opened the swelling and inflammation subsided. He continued to do well until February 6, 1865, when another abscess formed in the lower third of the thigh, on the outer side. This was incised and the pus evacuated. Several pieces of dead bone came away with the discharges from the wound of operation. About the middle of March, 1865, he was able to get out of bed, and to walk about the ward on crutches. Soon after, in getting out of bed, "he let his leg fall and hurt it." This accideut was followed by inflammation and swelling of the thigh, and an abscess in .the lower third of it, on the inner side. This was incised, and a small quantity of pus was evacuated. He was now attacked with erysipelas, which extended from the knee to the hip. This was combated with tonics and stimulants, such as iron and quinine, and rapidly disappeared. From this time he did well, taking daily exercise about the hospital on crutches. On April 17th, he was transferred to the Ward Hospital, at Newark, New Jersey. His general health was tolerably good. He could not bear much weight on his limb, and inflamma- tion and abscesses followed any unusual exertion. He remained at this hospital until May 6, 1865, when it was reported that he "eloped." As a discharged soldier, he was no longer under military authority, and was at liberty to go. For many months, though diligent inquiries were made, he could not be traced; but, in July, 1866, Surgeon General L. W. Oakley, of New Jersey, transmitted a letter from Dr. W. Pierson, of Orange, New Jersey, which stated that Wright had entered the almshouse at that place in June, 1865, and had remained there until the following spring, under Dr. Pierson's professional care. At first, the mutilated limb had been enormously swollen from oedema, and there was an ichorous discharge from a sinus near the hip joint. With careful bandaging, the oedema gradually disappeared. In the spring of 1866, Wright left the almshouse, and engaged himself as a laborer on a farm. He wore, Dr. Pierson reported, a cork-soled shoe of his own manufacture. The limb was shortened precisely five inches. The circumference of the injured thigh at the highest part was one inch less than that of its fellow. He walked well without crutch or cane, bearing his full weight on the mutilated limb. There was quite free motion at the hip, but little at the knee. There were no open fistules, and no tenderness about any of the cicatrices. Dr. Stephen Wickes, of Orange, reported, in the summer of 1866, that Wright was in good health, though somewhat intemperate; that he worked daily at light tasks, and was even able to mow grass. He commonly walked with a cane. According to the measurement of Dr. Wickes, the limb was shortened four and three-quarter inches. About this period, Dr. Mursick, the operator in the case, discovered his former patient, and examined him. He found the resected end of the femur firmly attached to the pelvis by ligamentous tissue an inch and a half long. The agglutination of the muscular sheaths had nearly disappeared. The limb was quite under control. The man could flex and extend it slightly, and adduct to a limited extent; the power of rotating and abducting was lost. Motion at the knee was quite restricted, on account of the thickening and consolidation of the surrounding tissues resulting from inflammation. He stated that latterly the improvement in his limb had been very decided; that when he first commenced to walk, the limb felt like a weight attached to the body; this sensation had entirely disappeared. January 15, 1867, Hugh Wright was found duly established at his residence in North Orange, Essex, New Jersey, receiving a pension dating from October, 1864, the date of his injury. The Pension Examiner, Dr. A. W. Woodhull, of Newark, reported "that at that date there was about six inches shortening, with no power of flexion or extension at the hip and the power of rotation to a very limited degree. All motion of the injured limb for progression was imparted by lateral swing of the body itself. I may add that the knee joint of the injured limb is stiffened." On October 19, 1867, Dr. Mursick again examined Wright, and took him to New York, and had his photograph taken. The negative is preserved at the Army Medical Museum, and is No. 188 of the Surgical Series of Photographs, a reduced copy of the lower limbs as shown, in the photograph, is presented in the wood-cut (Fig. 53). At this period, Wright reported that his limb had given him no trouble since the sinuses healed, in May, 1865, and that it sufficed for all purposes of locomotion. He stood on it very firmly, and could move it in any direction with an easy, swinging motion. He had been engaged for a year and a half as a farm hand, and was employed at that time as a wood-chopper. He had for a short time earned larger wages as a hod bearer, and had climbed high ladders with a heavy hod of bricks on his shoulders; but he found this avocation too fatiguing. His general health and physical condition were good. The knee joint continued quite stiff. It could be flexed to about quarter, perhaps, of the normal extent. When he walked, the rounded upper extremity of the femur played up and down on the dorsum of the> ilium over a space of an inch and a half. In November, 1868, Dr. Mursick again examined Wright, and reported on his condition. The utility of his limb had augmented during the twelve months that had elapsed since the last examination. The attachment of the femur to the pelvis was strong; the cicatrices were firm and healthy. All the movements of the thigh were performed with almost as much facility as in the normal state; rotation, even, as well as flexion, extension, adduction, and abduction. His general health was good. On August 3, 1872, Wright's pension was increased to $18 per month on account of increasing disability and because additional legislation permitted larger payment to the more gravely mutilated. In September, 1873, Pension Examiner A. W. Woodhull reported the local disability unchanged, and, on October 26, 1874, the sudden death of the pensioner, Hugh Wright, from supposed cardiac disease was reported. Unfortunately no autopsy was made and the valuable opportunity of examining the relations of tht resected joint was unimproved. 104 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. In the twenty unsuccessful intermediary excisions the average duration of life after operation was twelve and a half days. One patient (Case 248) survived seventy-five days, and apparently succumbed to climatic influences rather than to the effects of the injury and operation; another (Case 251) died at the end of three weeks with colliquative diarrhoea and malarial complications. Four cases where the lesions seemed to indicate the operation, made little or no recuperative effort, and form the first category. The first was a solitary instance of fracture by a shell fragment: Case 241.—Private Cornelius Callaghan, Co. G, 2d Delaware, was wounded in the left hip by a fragment of shell, at the battle of Antietam, September 17, 1862. On September 19th, he was admitted to hospital No. 3, at Frederick, Maryland. He was placed under the influence of chloroform, and an examination of the wound was made by Assistant Surgeons Bill and Colton, U. S. A. The wound being enlarged sufficiently to admit of free exploration, the trochanteric region of the femur was found to be badly comminuted, the great trochanter entirely detached and drawn backward by the action of the gluteus, while fissures extended up the neck within the capsular ligament. "No fissures extended below the trochanter minor. The patient's general condition was good, and all the circumstances being favorable to such an attempt, it was determined, in a consultation of the medical staff, and with the approval of Medical Inspector Coolidge and Surgeon Milhau, U. S. A., that the injured portions of bone should be excised. On September 29th, Assistant Surgeon J. H. Bill made an incision from the wound three inches downward in the course of the shaft, and another three inches long curving upward and inward from the wound to a point a little below the anterior superior spinous process of the ilium. The muscular attachments being dissected aside, a chain saw was passed around the shaft of the femur and made to divide it just below the trochanter minor. The head of the bone was then disarticu- lated. The edges of the wound were united by six sutures, and adhesive plasters and water dressings were applied. The limb was kept in position by pillows, without the use of splints. A full dose of morphia was given, and light but nourishing food was directed. On the following day the patient was quite com- FiG.55.-Neckandtro- fortabIe. His pulse, which was 100 before the operation, now beat 120. He was ordered a diet of beef chanters of right iemur r > r > shattered by a fragment tea, eggs, and oysters, with a small amount of wine. At midnight he was sleeping quietly. On October Spec 840 Sec I "ajlm! ^st ^e was st^ cheerful. His pulse was very compressible at 120, and he was sweating profusely. The thigh was swollen and painful. A draught of aromatic sulphuric acid with a little quinia was added to his prescriptions, and the allowance of wine was increased. The prognosis was now very unfavorable. On October 2d the sweating was checked, but diarrhoea had supervened. The pulse was still softer and more frequent, and suppuration had commenced. At midnight the patient was attacked with vomiting and hiccough. On October 3d the vomiting persisted, and the sweating was renewed. This state continued through the day and night, the patient sinking gradually. He died at 3 o'clock p. M. of October 4, 1832. The pathological preparation is deposited in the Army Medical Museum, and is numbered 840 of the Surgical Section. An anterior view of it is presented at page 247 of the Catalogue of the Surgical Section, and a posterior view in the accompanying wood-cut (FlG. 55). Case 242.—Private D. M. Noe, Co. C, 46th Ohio, aged 22 years, was wounded at the battle of Shiloh, Tennessee, April 6, 1832, 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. V. On April 16,1862, 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 amputa- ting saw. The patient reacted well after the operation, and for five days the symptoms progressed favorably. Pyaemia was subsequently developed, and death ensued on April 24, 1862, eight days after the operation. Case 243.—Private Marsella Smith, Co. F, 38th Virginia, a robust middle-aged man, was wounded near Spottsylvania, early in the morning of May 10, 1864, by a conoidal musket ball, which entered at the upper posterior part of the left thigh, passed through the perinseum without injuring the urethra, and through the soft parts of the right hip. He was sent to Rich- mond by rail, and was admitted to hospital No. 9, otherwise known as the Receiving and Wayside Hospital, on the following morning. On May 12th he was placed under chloroform and the wound was thoroughly explored. The limb was everted and shortened and swollen; there was crepitus on rotation. The fracture appeared to be limited to the great trochanter and neck. It was supposed that the urethra was divided; but this was afterwards proved not to be the case. Surgeon Charles Bell Gibson, C. S. A., decided to excise the injured bone, and the operation was performed forty-eight hours after the reception of the injury, the head, neck, and two inches of the shaft being removed. It is stated that the effects of the chloroform were unfavorable. On the following day "patient commenced sinking at an early hour, and continued growing Fig. 56.—Oblique more and more feeble until 3 o'clock P M., when death ended his sufferings," May 13, 1864. The excised gunshotfractureofthe p0rtion of the femur was preserved by Dr. Richardson, and has been presented by him to the Army Medical upper portion of shaft l * J ' r J J of left femur. Spec. Museum. It is represented in the accompanying drawing (FlG. 50), and shows that the injury to the bone 5500, Sect. I, A.M.M. wag a]t0gether external to the hip joint. Case 244.—A soldier of General Buell's army was wounded in a picket skirmish, about seven miles from Nashville, in March, 1832, by a conoidal musket ball, which shattered the neck and trochanters of the femur. He was immediately conveyed to Nashville, and placed in the College Hospital, under the care of Surgeon A. H. Thurston, U. S. V. Surgeon M. Goldsmith, U. S. V., saw him in 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 accom- SECT. IX] EXCISION AT THE HfP AFTER SHOT INJURY. 105 plished with but little haemorrhage, and although the patient was much prostrated by the shock of the injury and of the opera- tion, he reacted and was in a comfortable condition for several days. But surgical fever and suppuration 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, 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.1 Corporal Smith died on March 15, 1832. The operation was probably done on March 10th.2 . In the second category of intermediary excisions are grouped eight cases well adapted from the local lesions for the operation in which all the patients made a struggle for recovery, and two survived respectively five and eleven weeks: Case 245.—Private T. C. Christopher, Co. D, 18th South Carolina, aged 21 years, a robust man, was wounded at Williamsburg, Virginia, May 5, 1832, by a conoidal musket ball, which entered about two inches below and behind the left trochanter major, and passed forward, upward, and inward. He was stooping at the time he received the injury. He was made prisoner, and sent to York River, and thence on a hospital steamer to Washington, and placed in Cliffburne Hospital, May 17th. His pulse was 100, and he complained of severe pain in the hip and knee. The tissues about the hip were much swollen; the limb was everted, and shortened one and a half inches. The opening made by the bullet was very small, and discharged a thin sanious pus. There was no orifice of exit. The patient was etherized, and careful exploration of the wound revealed a fracture of the inner portion of the neck and probably of the head of the femur. It was decided that excision should be performed, and the patient was placed upon a soothing and supporting regimen preparatory to the operation. May 20th, Assistant Surgeon J. S. Billings, U. S. A., made a curvilinear incision, four inches in length, one inch behind the great trochanter, that revealed the condition of the parts. Fragments of the inner extremity of the neck were removed piecemeal. The head was then removed from tho cotyloid cavity, except a small fragment which was extracted from an intermuscular space. The ball was now discovered lying in the obturator externus muscle, and extracted. Little blood was lost, and reaction took place. Water dressing was applied, and a grain of sulphate of morphia administered. Eversion of the foot was corrected by fastening the limb by straps of adhesive plaster to an upright piece of wood screwed to the foot of the bedstead, and, the latter being raised, adequate extension and counter-extension were secured. On May 21st, the patient reported a comfortable night, but now had a very irritable stomach, with frequent vomiting. His Bkin was cool and clammy; his pulse small and feeble at 115. He was ordered aromatic spirits of ammonia in small doses, brandy, egg-nog, and beef essence, with sinapisms to the epigastrium. On May 23d, the irritability of the stomach had subsided. The PlG. 57._TraDSVerse shot fracture of the patient was weaker; stimulants and concentrated nourishment were given. On May anatomical neck of the left femur, with caries. 24th, the patient rapidly grew weaker. Capillary haemorrhage took place from the surfaces of the incision, but was readily checked by the application of a solution of persulphate of iron. Enemata of beef essence and brandy were administered, and these articles also by the mouth. The patient sank rapidly, and died May 24th, five days after the operation. At the autopsy, twelve hours after death, the soft parts about the seat of injury were found dark in color and softened. The acetabulum was eroded. A clot of blood of three ounces was found between the peritoneum and iliacus externus muscle. The innominatum and superior portion of the femur were removed, and, together with the excised fragments, forwarded to the Army Medical Museum, and numbered 19 of the Surgical Section, having been mounted among its earliest specimens, and it is represented in the wood-cut (FlG. 57).—-(Circ. 6, S. G. O., 1865, p. 62, and Circ. 2,*. G. O., 1869, pp. 35, 135.) Case 243.—Private T. E. Foulke, Co. D, 2d Alabama, aged 17 years, was wounded and captured at Fort Blakely, Alabama, April 9, 1835. A conoidal musket ball entered posteriorly at the middle third of the left thigh, fractured the upper third of the femur, including the trochanters and neck, and was removed from above the anterior superior spinous process of the left ilium. The patient was then transferred to New Orleans, and, on April 15th, he was admitted to the St. Louis Hospital. On admission he was very much exhausted by profuse suppuration, the soft parts about the hip-joint being filled with unhealthy pus. On April 27th Surgeon A. McMahon, U. S. V., excised the head, neck, trochanters, and two inches of the shaft of the left femur, the patient being under the influence of chloroform. He was placed on nourishing diet, with two bottles of porter daily, eggs, beef tea, and everything he desired. On May 25th he was transferred to the Marine Hospital at New Orleans. He was then doing well; but he gradually failed, and died June 5, 1835, of exhaustion, thirty-nine days after the operation. Case 247.—Private Charles E. Marston, Co. F, 1st Massachusetts, aged 19 years, a pale and delicate boy, was wounded at the second battle of Bull Run, August 30, 1832. He was admitted to the College Hospital, Georgetown, D. C, on Septem- ber 6th, having laid on the battle-field several days, and then moved in an ambulance wagon thirty miles over very rough roads. An examination revealed a large bullet wound an inch anterior to and on a line with the right trochanter major, with great comminution of the head and neck of the femur. The limb was shortened, and the foot was everted. The circumference of the ' The ahove 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. 2 The report of the Adjutant General of Wisconsin for 1865, p. 33, states that on March 8, 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—"tho first Union soldier killed in Tennessee"—while Corporal H. F. Smith and one other were wounded, and were sent to Nashville. Surg. Ill—14 106 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 58.—Shot commi- nution of head and neck of right femur. Spec. 328. limb exceeded that of its fellow by half. Tho pulse was 112, and of moderate volume. The tongue was rather dry. The patient suffered little pain. The general condition was not promising, and yet not very bad. Excision of the fractured bone wa3 decided upon, and, on the 27th of September, Assistant Surgeon B. A. Clements, U. S. A., assisted by Assistant Surgeon Charles H. Alden, U. S. A., and the surgical staff of the hospital, proceeded to perform the operation. Chloroform was administered, and a slightly curved incision five inches in length was made on the outside of the thigh, the shot hole in the middle of the incision, and the trochanters and neck were thus exposed. The neck was crushed into about forty fragments, which were extracted. The head was also much broken, and the round ligament was absorbed or destroyed, so that exarticula- tion was easy. The roughened portion of the neck, at its attachment with the trochanter, was sawn off with a small chain saw. The missile, a conoidal musket ball, was found on the inner side of the thigh at the bottom of a large cavity, and was removed with difficulty. After thoroughly syringing the wound and removing the pow- dered bone, the wound was closed by silver sutures, except at the bullet hole, and sand bags were placed to keep the limb in position. Slight extension was made by a weight to the foot. The patient expressed himself as relieved by the operation, and he slept well that night. On the following day his pulse had risen to 128, and the discharge from the wound was very copious, thin, and brown. On September 29th, his pulse was still quick and feeble, and his tongue dry, and, though he took nourishment well, and was free from distress, he gradually sank. He died on September 30, 1882, at half past 8 o'clock A. m., three days after the operation. At the autopsy, on October 1st, made by Acting Assistant Surgeon G. K. Smith, the wound made by the operation was found to be filled with very offensive pus. The upper end of the shaft of the femur was found to be diseased on its posterior surface near the trochanter minor, and the periosteum was loosened from the bone for some distance above and below this point. The fracture of the ischium, which was noticed at the operation, extended obliquely upward and backward from the lower border of the acetabulum, terminating in the sciatic notch, about an inch and a quarter above the spine of the ischium. The lower half of the acetabulum had been broken into several fragments, which were held in positiou by the cotyloid ligament. The excised portions of the femur were forwarded to the Army Medical Museum, and are numbered 328 in the Surgical Section. They are represented in the adjoining wood-cut (Fig. 58). Case 248.—Private John Miller, Co. E, 162d New York, aged about 38 years, a robust, phlegmatic German, in good health, was wounded on June 14, 1833, in the assault on Port Hudson, Louisiana, by a conoidal musket ball, which passed through the upper portion of the thigh, breaking the neck of the left femur transversely, and splitting it longitudinally, but without great comminution. The pelvis was uninjured, and there was no serious damage to the soft tissues. The patient was conveyed to New Orleans on a hospital transport, and was placed in the St. Louis Hospital, on June 16th. It was determined that excision of the injured bone was advisable, and the officer in charge of the hospital, Surgeon F. Bacon, U. S. V., being confined to his bed by illness, the operation was performed on July 8th, by Assistant Surgeon George W. Avery, 9th Connecticut. The head, neck, and great trochanter were removed in the usual way, through a single straight incision of moderate extent over the trochanter and in a line with the axis of the femur. There was an immaterial loss of blood. The state of the tissues involved and the constitutional condition of the patient were as good as might be. Dr. Bacon remarked that the operation was well and rapidly performed. The patient rallied from it promptly, and afterwards received the most assiduous care. His progress was very favorable until the early part of September. The wound had nearly healed, and Surgeon Bacon and his assistants were very hopeful of the patient's recovery. But in September the weather became most oppressively hot, and the patient steadily declined. The wound assumed a bad appearance, discharging copiously, and despite sustaining measures, the patient sank and died from exhaustion on September 21, 1882, seventy-five days after the operation. Dr. Bacon examined the fragments of bone removed, and found the periosteum adherent throughout the larger pieces. Case 249.—Private Henry Phillips, Co. I, 146th New York, a robust man, aged 34 years, was wounded at the South Side Railroad, near Petersburg, on April 1, 1835, by a conoidal musket ball, which entered the left thigh and lodged against the anterior surface of the neck of the femur. The patient was conveyed to the field hospital of the 2d division of the Fifth Corps, and thence by ambulance and rail to City Point, where he arrived on April 4th, and was transferred by steamer to Washington, and, on April 6th, was admitted into Douglas Hospital. He was much exhausted and had considerable fever, though in frequency the pulse and respiration were nearly normal. The wound was painful, and the beginning of its grave constitutional aspect was becoming man- ifest. There was no shortening or deformity of the limb. At a preliminary exploration the ball was found impacted near the anatomical neck, and was extracted. The limited nature of the fracture was also ascertained, and excision was decided on. On April 8th the patient was placed under the influence of ether, and Assistant Surgeon William F. Norris, U. S. A., excised the head, neck, and trochanter major through a curved incision six or seven inches in length with its convexity forward. About twelve or sixteen ounces of blood were lost during the operation. One small artery required a ligature. The ball had crushed in the laminated structure of the anterior face of the neck, and from this cup-shaped cavity a small fissure ran up the articular surface and a deep fissure nearly around the neck; but the separation between the head and neck was incomplete. During the opera- tion this fracture was converted into a complete one in rotating the bone to facilitate the exarticulation. The operation concluded, tlie limb was supported by pillows, and the patient was ordered beef tea and milk punch every three hours, and a full dose of opium at midnight. He had another dose of laudanum at four o'clock the next morning. On the. 9th, 10th, and 11th, there was little pain, and anodynes were not required, but concentrated nourishment and stimulants were assiduously administered. It was thought the nurse exceeded his instructions in the amount of whiskey given, for on April 12th, the patient had hiccough and nausea, and his breath was redolent of alcoholic fumes. He was now transferred to the immediate charge of Acting Assistant Surgeon C. Carvallo. A laxative enema was administered, and, when the bowels were unloaded, a sinapism at the epigastrium, and small doses of creasote allayed the irritability of stomach. On April 13th the stomach was quiet, pulse 120, rather weak, Fig. 59.—Fracture of head and neck of left femur by a conoidal musket ball. Spec. 3235, Sect. I, A. M. M. J SECT. II.l EXCISION AT THE HIP AFTER SHOT INJURY. 107 and there was profuse perspiration. The patient was ordered a cupful of beef tea every two hours, one of milk punch every four hours, milk toast and soft boiled eggs at breakfast and dinner. No change the next day. On the 14th the wound looked well. Some shreds of disorganized connective tissue were removed by the dressing forceps. There was some pain and difficulty in micturition. Small doses of tincture of the sesquichloride of iron were directed thrice daily, and chicken broth was added to his dietary. No entry of importance appears on the 16th. On the 17th the pulse was 120, respiration 32. Slight pain on right side, and signs of pleurisy on auscultation. There was an erythematous blush about the wound, and, in the evening, there was diarrhoea, which was checked by pills of opium and nitrate of silver. On the 18th the pleurisy was worse, the breathing more rapid, and there was retention of urine, so that it was necessary after this to use a catheter. April 19th the countenance was sunken, and the wound was flabby. There was a sore on the sacrum. The patient was moved to a Crosby Invalid Bed. He had a draught containing ammonia and sugar, and a blister on his side. April 20th the nurse reported a chill during the night. The breathing was labored. There were sordes on the teeth. At the next morning visit the patient was very low. He died before noon, April 21, 1865, eleven days after the operation. The autopsy revealed dry pleurisy on either side; lungs healthy, somewhat congested posteriorly; heart and liver not abnormal. A large sub-peritoneal abscess in the course of psoas and internal iliac muscles, which appeared to originate in the obturator foreamen and ascend along the left iliac fossa, denuding the bone of its periosteum. No evidences of pyaemia were found, though it was strongly suspected after the occurrence of the chill on April 20th. The pathological specimen, contributed by the operator to the Army Medical Museum, is represented at page 246 of the Catalogue of the Surgical Section of 1836, and by the wood-cut (FlG. 59). Case 250.—Captain John Phelan, Co. A, 73d New York, aged 22 years, received a compound comminuted fracture of the neck and upper extremity of the left femur at the battle of Spottsylvania Court House, on May 14, 1864. On May 16th, he was admitted to Mount Pleasant Hospital, Washington. The rapid and incessant influx of wounded was such that the attention of the overworked hospital staff was not especially drawn to his case for some time after his admission, and the delay in minutely examining the case was extended by the uncomplaining fortitude of the sufferer, who expressed his wish that the more serious cases should first be attended to, and declared that his own sufferings were comparatively slight. When, however, Acting Assistant Surgeon Mulford, the ward surgeon, proceeded, on June 3d, to adapt apparatus to what he supposed to be an ordinary gunshot fracture of the upper third of the thigh, he was led to apprehend that the injury extended to the coxo-femoral articulation, and requested the opinion of the surgeon in charge of the hospital, Assistant Surgeon C. A. McCall, U. S. A., as to the diagnosis and treatment. Dr. McCall immediately visited the patient, and found him to be a large, muscular, finely formed man, whose previous health had been excellent. When lying quietly in bed, he suffered but little. His appetite was good; and his strength, so far, had diminished but little. Altogether, his general condition was extraordinarily good, in view of the gravity of the injury he had sustained. The ball had entered in front, just over the point at which the profunda is given off from the left femoral artery. The aperture of entrance was small and characteristic as an entrance wound of a conoidal musket ball. The missile had passed toward the great trochanter and shattered it. Further, its course could not be ascertained at the time. Any movement of the limb caused extreme pain. Though the femur was much comminuted, Dr. McCall was not positive that the hip joint was implicated, and, with a view to a full exploration of the injury, he directed Dr. Mulford to make a longitudinal incision three inches in length over the trochanter, to explore the parts thoroughly, and to ascertain by digital examination the condition of the articulation. If it was uninjured, Dr. Mulford was instructed to extract detached fragments of bone and foreign matters, to close the upper part of the wound, and to avail of the lower portion for drainage. In the afternoon the patient was ether- ized, and the exploratory incision was made, and it was found that the fracture extended to the head of the femur. It was then decided to excise the head. The patient was again rendered insensible by the inhalation of sulphuric ether, and Dr. McCall extended Dr. Mulford's incision upward an inch or more, and then made an oblique incision across its upper extremity, as represented in the accom- panying figure (Fig. 61). The two flaps thus marked out were reflected, and the joint was read- ily exposed, the round ligament divided, and the head of the femur exarticulated. The acetabulum was carefully examined and found to be uninjured. Seven large and numerous small fragments of the neck and trochanter major were then removed, a task requiring much time and patience, many fragments being driven into the gluteal muscles, or deeply retracted by the muscles attached to the great trochanter. The fractured upper extremity of the femur was then brought out at the wound, by adducting and pushing upward the knee of the injured limb, and all diseased tissue was removed. The periosteum was in a healthy condition quite up to the end of the bone. The wound was now thoroughly washed out, and approximated by three stitches, and by adhesive strips. A grain of sulphate of morphia was administered, and the patient was put to bed. The operation lasted three-quarters of an hour. Dr. McCall thinks that the ball was removed during the operation; but is not positive on this point. The hospital report, which is quoted at page 69 of Circular No. 6, S. G. O., 1865, states that the patient's pulse was quick and irritable at the time of the operation, that he had a furred tongue and diarrhoea, and was reduced by suppuration. But Dr. McCall (letter of February 11, 1868) thinks that this report exaggerates the gravity of the constitutional symptoms, and is quite sure that the general condition was favorable. The patient rallied well from the operation. For two days the wound was dressed with lint. Suppuration then commencing, the limb was placed in Fergusson's apparatus for excision of the head of the femur, the counter-extension straps being left off. The wound was freely syringed with cold water containing a little permanganate of potassa. A nourishing diet was ordered, with tonics Fig. 60.—Excised head and fragments of neck of left fem ur. Spec. 2618. Fig. 61.—Direction of the incisions in case of excision of the head of the femur. [From a drawing by Dr. McCall.] 108 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. and stimulants. For a week or ten days subsequently, the case progressed favorably. Suppuration was moderate in amount, and of a healthy character. About the middle of June, the weather became intensely hot. The atmosphere of the wards, in which nearly every bed was occupied by a patient with suppurating wounds, became intensely oppressive. About this time, the patient began to grow worse. The cheerful resolution and hopefulness he had hitherto evinced, gave way. Diarrhoea supervened, and he lost strength rapidly. The fatal event was thought to have been delayed by the plan which was pursued of daily removing the patient in his bed at nine in the morning to a spot beneath the shade trees near the hospital, where he had pure air and escaped the distressing scenes of the ward; he remained each day until five in the afternoon. He died on June 21, 1884. The portion of bone excised was forwarded at the time of the operation to the Army Medical Museum. The preparation is No. 2618 of the Surgical Series. It is represented in the adjacent wood-cut (Fig. 60). Case 251.—A private soldier of General Pope's Army of Virginia, was admitted on September 2, 1862, to the Cliffburne Hospital at Washington, D. C, with a gunshot fracture of the neck of the left femur, received at the second Bull Run battle, on August 29,18G2. A conoidal musket ball had entered the left hip directly over the trochanter major and embedded itself in the neck of the femur. The trochanter major and the neck of the femur were split and comminuted, but the head was uninjured. The patient had suffered greatly from the journey from the battle-field to the hospital, and was prostrated by diarrhoea and malarial complications. The tissues about the hip joint were but slightly swollen, and the wound discharged healthy pus. It was decided that excision was the most hopeful resource, and on September 4,1882, Assistant Surgeon John S. Billings,U. S. A., proceeded to operate. Chloroform was administered, and a straight incision was made over the trochanter major, and the head and fragments of the neck were removed. The shaft of the femur was then divided by a chain saw at the level of the trochanter minor. The patient reacted well from the operation. He was placed on a fracture bed, and extension by means of a weight was made on the injured limb. The diarrhoea increased in severity despite all treatment, and the patient succumbed, exhausted, on September 24, 1862, twenty days after the operation. Case 252.—"Private Michael Welsh, Co. H, 10th Kentucky, aged 40 years, was struck by a conoidal ball in the region of the left great trochanter, at the battle of Chickamauga, September 20, 1863, and at once conveyed to a field hospital, which soon after fell into the hands of the enemy. Ten days subsequently, he was brought to Chattanooga; and during the period of his captivity the only nourishment that he received was a small portion of corn-meal gruel daily. Having lost his blankets, he also suffered much from cold, and had contracted a rather severe bronchial inflammation. On the 1st of October, he was admitted into the general field hospital of the Fourteenth Corps, when a conoidal musket ball was removed from among a mass of small fragments of the neck of the femur, the ball having entered just anteriorly to the great trochanter. Two days subsequently, Surgeon F. H. Gross, U. S. V., carried a curvilinear incision, with its con- vexity presenting forwai d, and including the opening made by the ball, from above downward, and excised the head of the femur along with the attached greater portion of the lower surface of the neck of the bone. Many fracture of neck fragments were removed with the forceps; but as the trochanters were not involved in the injury, the remaining ^ 544|mur" sharp portions of the neck were trimmed off close to the intertrochanteric lines, which completed the procedure. No ligatures were required. The man bore the operation well, and the limb was placed in a comfortable position. From the date of the operation up to October 20th, the man did very well, in spite of his enfeebled condition and bronchial trouble, when the discharge from the wound became sanious. On the same night he had a chill and was delirious, and the pulse was very feeble and frequent. On the 25th of October his condition is thus described: Pulse 125 and very feeble; tongue dry and red; had a natural alvine evacuation. At 9 o'clock A. M. haemorrhage recurred from the wound, which was arrested by injecting a solution of sulphate of iron. Stimulants freely administered, but the man grew more and more feeble, and expireti at 2 o'clock P. M. No post-mortem examination was held, but death was evidently due to pyaemia. The specimen shows that about one-fifth of the head at its upper aspect has been shot away, together with the entire upper surface of the neck, about one-half of the anterior and posterior surfaces and the lower border of the neck remaining." The pathological specimen, illus- trated by the accompanying wood-cut (Fig. 62), was forwarded to the Army Medical Museum, June 3, 1868, by the operator. The third category of intermediary excisions includes eight cases in which the con- ditions revealed on exploration offered little prospect of success. All of the patients were subjected to rough transportation. The first case was complicated with shot perforation of the elbow, the second was a man of sixty in poor health, the third a lad, rudely exposed in a wagon without springs; two others had wounds penetrating the pelvic cavity, and, in one of these cases, a splinter of the left innominate bone opened the internal iliac vein, and led to uncontrollable haemorrhage, while, in the other, hyperacute peritonitis supervened. Case 253.—Private G. W. Brantley, Co. C, 2d Alabama, aged 18 years, was wounded and taken prisoner at Fort Blakely, Alabama, April 9, 1865. A conoidal musket ball had passed through the left groin, fractured the neck of the femur, and emerged posteriorly at the apex of the left buttock. He also received a gunshot fracture of the external condyle of the right humerus. He was conveyed to New Orleans, and, on April 15th, he was admitted to the St. Louis Hospital. The thigh, groin, and surrounding parts were infiltrated with unhealthy pus, and the patient was very much exhausted. On April 28th, the patient was anaesthetized by chloroform, and Surgeon A. McMahon, U. S. V., proceeded to excise the head, neck, and trochanters of the left femur. No arteries required ligation. The patient did not rally very well. Stimulants were freely administered; but the patient sank, and died on May 2, 1865, of capillary haemorrhage. The condition of the patient did not admit of any operation on the elbow joint. Case 254.—Private Peter Boyle, Co. D, 59th Massachusetts, aged 60 years, was wounded at Petersburg, July 30, 1864. A conoidal musket ball entered the left hip and passed antero-posteriorly through the soft parts and surgical neck of the femur, SECT. II. | EXCISION AT THE HIP AFTER SHOT INJURY. 109 Fig. 63.—Shot per foration of neck of left femur. Spec. 3593. and fractured the trochanter major. His entry at the baso hospital at. City Point and transfer to Washington are recorded on August 1st. He was conveyed to Washington on an hospital steamer, and on August 3d was admitted to Douglas Hospital. His constitutional condition, on admission, was poor. The wound, however, had an healthy aspect, and a thorough exploration showed that the injury to the soft tissues involved no important part, and that the fracture at the junction of the neck and trochanter major was not accompanied by much longitudinal splintering in either direction. Assistant Surgeon William Thomson, U. S. A., decided that an excision of the injured bone was expedient, and that the operation should be done as soon as the patient had rallied from the fatigue and irritability induced by his long journey. On August 5th, ether having been administered, Assistant Surgeon Thomson proceeded to excise the head, neck, and trochanters of the left femur, through a straight incision of sufficient length made over the trochanter major. The rotator muscles and the tendons of the psoas and iliacus being divided, the round ligament was readily cut and the head exarticulated. The section of the shaft was made by a chain saw at the level of the trochanter minor. The operation was rapidly accomplished, and there was no haemorrhage of moment. The wound was dressed with an antiseptic solution of one drop of creasote to each ounce of water on charpie, and the limb was supported by a sand bag on either side. The patient reacted well after the operation; but at night there was profuse sweating and some nausea. On the following morning he ate a good breakfast. Ho still had a cool, sweating skin, and his pulse was at 128. He gradually sank, and died from exhaustion on August 7, 1834. The pathological preparation, presented by Dr. Thomson to the Army Medical Museum, is figured by the accompanying wood-cut (FlG. 63). Case 255.—Private Charles C. Cleaver, Co. C, 2d Infantry, aged 18 years, was wounded at the battle of Spottsylvania, on May 12,1864, by a conoidal musket ball, which fractured the neck and trochanters of the right femur. He was transferred to Fredericksburg and thence to Belle Plain in a wagon, and thence ou a steam hospital transport to Washington. On May 18th he arrived at Washington, and was admitted to Judiciary Square Hospital. The soft parts of the upper and outer part of the thigh were extensively lacerated, and pus of an ill-conditioned character was burrowing in every direction around the wound. The patient's condition was unfavorable; but it was decided that excision of the fractured portion of the femur afforded the only prospect of relief. Accordingly, on the 19th, Assistant Surgeon Alexander Ingram, U. S. A., proceeded to make a curved incision six inches in length, through which, the head, neck, and four and a quarter inches of the shaft of the femur were removed. Carpie soaked with permanganate of potash was applied to the wound, and tonics and stimulants were freely given. Pyaemia supervened, and the patient died on May 23, 1864, four days after the operation. The pathological specimen, figured in the accompanying wood-cut (FlG. 64), is in the Surgical Section of the Army Medical Museum. Case 256.—Private Alexander Ewing, Co. A, 140th Pennsylvania, aged 30 years, was wounded at the battle of Spottsylvania, on May 12, 1864, by a conoidal musket ball, which comminuted the upper part of the left femur. He was taken to the hospital of the 1st division of the Second Corps, and on the follow- ing day was sent to the rear in a wagon. Arriving at Belle Plain after a three-days' journey over rough roads, he was conveyed on an hospital steamer to Washington, and, on May 18th, he was admitted to Judiciary Square Hospital. There was considerable inflammation and swelling of the soft parts, and the patient was in poor health. On the following day he was anaesthetized, and Acting Assistant Surgeon J. F. Thompson made an incision five inches in length over the great trochanter, including in it the wound of entrance. The muscular attachments being divided, it was found that the neck was splintered, that fissures extended within the capsule, that the great trochanter was separated from the shaft, and the upper part of the shaft much comminuted. The head and fragments of the neck and trochanters were removed, and the shaft was sawn just below the trochanter minor. Ice was applied to the wound, and stimulants were freely administered. The wound assumed an unhealthy action, and the patient gradually sank and died from exhaustion on May 24, 1864, five days after the operation. The pathological specimen was not received at the Army Medical Museum. Case 257.—Corporal Henry C. Sennett, Co. F, 122cl New York, aged 27 years, was wounded in front of Petersburg, March 27, 1835, by a conoidal musket ball, which entered midway between the anterior superior spinous process of the ilium and the trochanter major, and lodged in the head of the left femur. The patient was removed to Washington, and, on April 2d, was admitted to Mount Pleasant Hospital. He was feverish and fretful, and his tongue was furred; but the wound had a healthy aspect, and there was but little swelling or deformity of the limb. But explo- ration with the finger proved that the ball had penetrated the hip joint. On April 4th the patient being anaesthetized by an equal mixture of chloroform and ether, Assistant Surgeon H. Allen, U. S. A., made a T-shaped incision, four inches by six inches, over the trochanter major, and excised the head and neck of the femur. The head was fractured into three pieces, and the ball was embedded in it. Violent hiccough came on immediately after the operation and continued through the night, but was finally arrested by the persistent use of antispasmodics. On April 5th and 6th there was great tympanitis, the bowels being obstinately constipated. An enema of castor oil was administered without effect, and in two hours another of molasses and water and salt, which induced a slight evacuation. Singultus again recurred. On April 7th the bowels moved freely. A chill occurred, lasting half an hour. There was great abdominal tenderness on pressure, and other well marked symptoms of peritonitis. On the 8th fig. 65.—Upper extrem- the hiccough continued; the abdomen became greatly distended; the countenance became pinched and ity of the left femur, from i. .n i i . ,. , . , . , , , - , , , , which the head, with a gnastly, and the patient died at ten at night. At the autopsy, made twelve hours after death, the lungs conoidal ball in it, has were found healthy; the liver greatly hypertrophied; the lower fifth of the ilium inflamed and injected. been excised.—Spec. 153. The tissues surrounding the hip joint were in a sloughing condition, and were infiltrated with fetid pus, which had burrowed several inches under the gluteal muscles and two inches below the trochanter minor. The acetabulum was denuded and slightly FlG. 64.—Shot frac- ture of the neck and trochanter of right fe- mur. Spec. 2819. no INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. fractured at its upper and posterior border. Two inches of the upper extremity of the shaft of the femur was denuded of peri- osteum. The specimen was presented by Dr. Allen to the Army Medical Museum, and is represented in the adjoining wood- cut (Fig. 65). The innominate bone was not removed; but the upper fourth of the femur was sawn off after death, and mounted with the excised head to show how completely the injury to the femur was limited to the epiphysis. Had it not been for the fracture of the pelvis, it would have been difficult to have found a case better adapted for the operation of primary excision. Case 258.—Private F. Machlin,1 11th Pennsylvania, a robust man, was wounded at the second battle of Bull Run, August 30, 1862. He laid on the field several days, and was then transported thirty miles in a wagon to the Warehouse Hos- pital, Georgetown, D. C, where he was received on September 8th. A musket ball had entered the right buttock and emerged an inch and a half below and within the anterior superior spinous process of the ilium. The limb was shortened, and the foot was everted; any movement gave excessive pain. A thorough examination was made under the influence of chloroform, and showed that the neck of the bone was comminuted and the shaft uninjured. The case was considered to be a particularly favorable one for the operation of excision of the broken fragments, and the general condition of the patient was such as to offer some hopes of its success, and it was determined to do the operation on the following day. But the surgeon in charge of the hospital was confined to his bed by illness, and was unable to see the patient for five days. On September 13th the general condition of the latter was less favorable. His pulse was 130, quick and weak, and his tongue was dry. He was placed under very careful nursing, and beef essence, brandy, eggs, and milk, and other concentrated nourishment and stimulants were administered ad libitum. By September 20th this treatment had produced slight improvement, and though he was still in a very unfavorable condition for an operation, it was determined, on consultation, that an excision might afford the patient relief from the constant pain he suffered, and that it could not greatly depress him. At noon on September 20th, accordingly Assistant Surgeon B. A. Clements, U. S. A., assisted by Dr. George K. Smith, of Brooklyn, and the surgical staff of the hospital, performed the operation. An incision five inches in length was made from a point two inches behind and an inch below the anterior superior process of the ilium, downward over the prominence of the trochanter major. The incision exposed the parts freely, and the muscular insertions being divided, and several small loose fragments of bone removed, the irregular broken extremity of the shaft, at its junction with the neck and the tip of the great trochanter, were excised by a chain saw. The remnant of the capsular ligament and the round ligament were now cut, the joint being opened from below and in front with a probe-pointed bistoury. A blade of a long bullet forceps was then introduced as a lever and the head was disarticulated by gently prying it out of the cotyloid cavity. These steps in the operation were facilitated by rotating the trochanter outward, and by lifting the extensor muscles by a metallic retractor. A small vessel was tied at the upper end and another at the lower end of the wound. The wound was well washed out by means of a syringe and a few stitches were applied, the middle portion of the wound being left open. The limb was suspended in a Smith's anterior wire splint. The patient appeared to rally from the operation satisfactorily. At 9 o'clock P. M. he was free from pain; his pulse was 136, and the skin was cool and natural. He had slept tranquilly. On the following day, September 21st, his pulse was 120 and very feeble. The discharge from the wound was dark and thin, and copious. His countenance was placid, the pinched, distressed expression it had worn having disappeared. But in the afternoon he sank rapidly, and died in the evening, thirty-six hours after the operation, September 21, 1862. The specimen is No. 329 of the Surgical Section of the Army Medical Museum, and is represented in the accompanying wood-cut (FlG. 66).—(Circular 6, S. G. O., 1865, p. 64; Circular 2, S. G. O., 1869, pp. 37, 135.) Case 259.—Lieutenant D. N. Patterson, 46th Virginia, aged 31 years, was wounded at an engagement on the Boydton Plank Road near Petersburg, March 29, 1865, and was captured and sent to City Point, and immediately conveyed on an hospital transport to Washington, and placed in Armory Square Hospital on April 2d. On examination, it was found that a conoidal ball had entered the left thigh behind the trochanter major, and had passed inward and forward, fracturing the trochan- ter neck and head of the femur, and the anterior border of the acetabulum. On the day after the patient's admission, five days subsequent to the reception of the injury, Surgeon D. W. Bliss, U. S. V., in charge of the hospital, decided that the case was one in which excision of the upper extrem- ity of the femur was applicable. The wounded man was anxious that an operation should be performed, and his general condition was very satisfactory. On April 3d he was placed under the influence of chloroform, and Surgeon Bliss exposed the fractured bone by a curvilinear incision with its convexity forward. The shattered fragments of the neck were extracted, the rent in the capsular ligament was enlarged and the round ligament was divided, and the head of the femur was exarticulated. It was found that the ball had not only comminuted the head, neck, and great trochanter, but that fissures extended down the shaft of the femur. The bone was divided by the chain saw two inches below the trochanter minor. The deep wound was now washed out, and small fragments of bone were removed, and search was made for the ball. It was finally detected by means of a N61aton probe deeply buried in the obturator muscle near the posterior margin of the obturator foramen. The operation was accomplished with little loss of blood, and the patient reacted satisfactorily. The wound was lightly dressed, sufficient outlet for discharges being left, and the limb was extended and supported by pillows. Careful nursing was provided, and such stimulants and concentrated nourishment as seemed best adapted to the patient's condition. For three days he progressed very satisfactorily. Notwithstanding the extensive lesions of the pelvis, which were not detected until after death, there was no indication of peritonitis or disturbance of the urinary organs. On April 7th, however, profuse haemorrhage Fig. 67.—Extensive fractures of the shaft, tro- chanters, head, and neck of the left femur, and of the os innominatum. Spec. 4048. •Bates (S. P.) (History of Pennsylvania Volunteers, 1861-5, Harrisburg, 1869, Vol. I, p. 30) records the name of this patient as Philip Mechling, Co. 1,11th Pennsylvania Volunteers. SECT. 11. | EXCISION AT THE HIP AFTER SHOT INJURY. Ill took place, which could not be controlled, and the patient died on the morning of that day. At the autopsy it was found that the bleeding had proceeded from the internal iliac vein, gradually worn away by a sharp bit of bone forced inward by the ball. The pathological specimen, represented in the adjoining wood-cut (Fig. 67), is also figured at page 246 of the Catalogue of the Surgical Section of the Army Medical Museum, where another view is given. Case 260.—"I have the honor to report," writes Dr. Hooton, "that I did not take charge of hospital 21 until March 10, 183:>, and did not treat the case referred to. I was somewhat conversant with its history, however, and will give it to you as I received it from Surgeon Sennet, 94th Ohio, whom I relieved. The wound was received at the battle of Stone River or Murfreesboro', the last of December, 1802, or January 1, 1863. Resection of the upper part of the shaft, including the shattered trochanters, was performed on the field. Thjj head of the bone was left in the cotyloid cavity. A few days subsequently the patient was sent by rail to Nashville, a distance of twenty miles. Notwithstanding the fatigue of the long journey, his general condition was very satisfactory, and the wound looked well. Part of the incision healed; but there was a profuse discharge from the lower part, and gradually this discharge became thin and ichorous. About January 21st it was determined to reopen the wound. It was found that the head of the bone was carious throughout its whole extent. It was therefore removed. After this operation, which was accomplished without haemorrhage or other untoward circumstance, the limb swelled very much, irritative fever set in, and the patient died exhausted in a few days." [The records of the hospital identify this patient as Sergeant Dallas W. Hade, Co. H, 101st Ohio, wounded at Stone River, December 31, 1862; died January 31, 1863.] Of the twenty-two intermediary excisions at the hip, four were on the right side, sixteen on the left; in two cases the side of the injury was not reported. A straight longitudinal incision was made in nine instances, a curvilinear in seven, a crucial in one, a T-shaped in one, and in four operations the mode of incision was not stated. In five instances-the missile was removed at the time of the operation. Twenty excisions were performed by Union surgeons and two by Confederate surgeons. Pathological specimens illustrating thirteen of the excisions are preserved in the Army Medical Museum, with photographs of the two survivors of intermediary excisions at the hip. Table XII. Summary of Twenty-two Cases of Intermediary Excision at the Hip Joint for Shot Injury. Name, Age, and Military Description. Date of Injury Nature of Injury. Date of Opera- tion. Operation and Operator. Result and Remarks. lJarret, J. M., Lieut., C, 15th North Carolina, age 28. 2 Wright, H., Pt., G, 8th N. Jersey, age 28. Boyle, P., Pt., D, 59th Mas sachusetts, age GO. Brantley, G. W., Pt., C, 2d Alabama, age 18. Callaghan, C, Pt., G, 2d Delaware. Christopher, T..C, Pt., D, 18th South Carolina, age Cleaver, C. C. Pt., C, 2d Infantry, age 18. Oct. 14, 1863. May 5, 1864. July 30, 1864. April 9, 1865. Sept. 17, 1862. May 5, 1862. May 12, 1864. Left^femur shattered at upper third by a conoidal ball. Coneidal ball shattered the neck and trochanters of right femur and lodged,greatly flat- tened and distorted, amid the fragments of bones. Conoidal ball perforated surgi- cal neck of the left femur and fractured trochanter major. Conoidal ball fractured neck of left femur; also fract. of extl. condyle hum. Comminut'n of left trochanteric region, fissures extending up neck of femur, by a fragment of shell. Conoidal ball fractured head and neck of left femur and lodged in obturator externus muscle. Neck and trochanters of right femur fractured by a conoidal ball. Nov. 9, 1863. May 27, 1864. Aug. 5, 1864. April 28, 1865. Sept. 29, 1862. May 20, 1862. May 19. 1864. Excis'n of head, neck, trochant- ers, and a port'n of shaft of left femur; several large detached fragments and spiculse rem'd, by Surgeon J. B. Bead, P. A. C. S.; chloroform; straight incision seven inches long. Head, neck, and both trochant- ers of right femur removed thro' straight incision; missile extracted; jagged upper ex- tremity of shaft turned out and smoothed off, by Ass't Surg. G. A. Mursick, U. S.V. Head, neck, and shaft of left femur at level of troch. minor, excised through straight in- cision, by Ass t Surgeon W. Thomson, U. S. A.; ether. Head, neck, and trochanters of femur excised, by Surg. A. M. McMahon, U. S. V. Head, neck, and portion of shaft of left femur excised, by Ass't Surgeon J. II. Bill, U. S. A.; curved incision; shaft divided just below trochanter minor. Shattered fragments of head and neck of left femur remo'd through a curvilinear incision four inches long, by Assistant Surg. J. S. Billings, U. S. A. Head, neck, and four and a quarter inches of shaft of right femur removed thro' a curved incision, by Ass't Surgeon A. Ingram, U. S. A. September, 1864. Recovered. Disch'd October 6,1864, and pen sioned. Spec. 3375, A. M. M. Sept. 4, 1873, " Six and a half inches shortening." Pensioner died October 26, 1874, of heart disease. Died August 7, 1864, from ex- haustion. Spec. 3593, A. M. M. Circ. (i, S. G. O., 1865, p. 70. Circ. 2, S. G. O., 1869, pp. 45, 136. Died May 2, 1865, of capillary haemorrhage. Circ. 6. S.G.O., 1865, p. 74. Circ. 2, S. G. O., 1S69, pp. 47, 136. Died October 4,1862. Spec. 840, A. M. M. Circ. 6, S. G. O..1805, p. 64. Circ. 2, S. G. O., 1869, pp. 37, 135. Died May 24, 1862. Spec. 19, A. M. M. Circ. 6, S. G. O., 1865, p. 62. Ctrc. 2, S. G. O., 1869, pp 35, 135. Died May 23, 1864, of pyssmia. Spec. 2819, A. M. M. Circ. 0, S. G. O., 1865, p. 66. Circ. 2, S. G. O., 1869, pp. 43, 135. I_______ 1 Read (J. B.), Resections of the Hip Joint, in Confederate States Medical and Surgical Jour., 1864, Vol. I, p. 5. Phot. Ser., A. M. M., Vol. I, p. 41. Circular No. 6, S. G. O., 1865, p. 66. Circular No. 2, S. G. O., 1869, pp. 39, 135. Eve (P. F.), A Contribution to the History of the Hip Joint Opera- tions, etc., in Trans, of the Am. Med. Association, 1867, Vol. XVIII, p. 256. *MUU8ICK (G. A.), A Successful Case of Excision of the Head of the Femur for Gunshot Fracture, in New York Med. Jour., 1865, Vol. I, p. 424. Circular No. 6, 8. G. O., 1865, p. 68. Circular No. 2, S. G. O., 1869, pp. 41, 135. Surgical Photograph Series, A. M. M., Vol. IV, p. 38. 112 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. 10 13 15 17 18 19 20 22 Name, Age, and Military Description. Ewing, A., Pt., A, 140th Pennsylvania, age 30. Foulke, T. E.. Pt., D, 2d Alabama, age 17. Hade, D. W., Serpent, H, 101st Ohio. Mansion, C. E., Pt., F, 1st Massachusetts, age 19. Machlin, F., Pt., I, 11th Pennsylvania. Miller, J., Pt., E, 162d N. York, age 38. Noe, D. M., Pt., C, 46th Ohio, age 22. Patterson, D. N., Lieut., 46th Virginia, age 31. Phelan, J., Capt., A, 73d New York, age 22. Phillips, H., Pt., I, 146th New York, age 34. Sennett, H. C, Corp'l, F, 122d New York, age 27. Date of Injury Mav 12, 18(>4. April 9, 1865. Dec. 31, 1862. Aug. 30. 1862. Nature of Injury. Date of Opera- tion Smith, M., Pt., F, Virginia. 38th Unknown soldier of General Buell's Armv- [Probably Corporal II. F. Smith, 12th Wisconsin. | Unknown soldier, private of Gen'l Pope's Army. 'Welsh, M., Pt., H, 10th Kentucky, age 40. Aug. 30, 1862. June 14 1863. April 6, 1862. Mar. 29, 1865. May 14 1864. April 1 1865. Mar. 27 1865. May 10, 1864. Mar. —, 1862. Aug. 29 1862. Sept. 20, 1863. Conoidal ball splintered neck separated the great trochanter from shaft, and comminuted upper part of the left femur. The fissure extended within the capsule. Neck, trochanters, and upper third of left femur fractured by a conoidal ball, which lodged above the ant. sup. spinous process of the left ilium. Missile removed. Shot fracture of the trochanters of----femur; resection of the upper part of the shaft and the shattered trochanters on the field; head of bone left in cotyloid cavity. Neck of right femur crushed, and the head of the bone com- minuted by a conoidal ball, which lodged in the inner side of the thigh. Comminution of neck of right femur by a musket ball; fis- sure extending into the head of the bone. Conoidal ball perforated upper portion of left thigh, breaking the neck of femurtransversely and splitting it longitudinally, but without great comminutn. Neck of left femur shattered by a conoidal ball. Conoidal ball fractured the tro- chanter major, neck, and head of the left lemur, and anterior border of the acetabulum; fissures extended down shaft. Missile lodged. Left trochanter major shattered and neck of femur fractured to the head by a conoidal ball, which lodged; man3' fragm'ts driven into gluteal muscle. Conoidal ball crushed in the laminated structure of the an- terior surface of neck of left femur, where it lodged. Mis- sile extracted. Left acetabulum fract'd slight- ly at its up. and post, border by a conoidal ball, which also fractured the head of the bone and lodged in the same. Conoidal ball fractured the upper portion of the shaft of left femur, passed through the perinaeum without injuring the urethra, and through the soft parts of the right hip. Neck and trochanters of---- femur shattered by a conoidal ball. Conoidal ball split and commi- nuted the left trochanter ma- jor and neck of the femur and lodged in the latter. Conoidal ball fractured the neck and head of left femur and lodged. Oct. 1st, ball removed. May 19 1864. April 27. 1865. Jan. 21, 1863. Sept. 27, 1862. Sept. 20 1862. July 8, 1863. April 16. 1862. April 3, 1865. June 3, 1864. April 8, 1865. April 4, 1865. May 12, 1864. Two days after in- jury. Sept. 4, 1862. Oct. 3, 1863. Operation and Operator. trochanters, and two inches of the shaft of femur, by Surg. A. M. McMahon, U. S. V. Result and Remarks. Removal of the head and frag- Died May 24, 1864, from exhaus- ments of the neck and tro- tion. <7t'rc. 6, S. G. O., 1865, p. chanters through an incision 68. Circ. 2, S. G. O., 1869, pp. five inches long, by A. A. 43, 135. Surgeon J. F. Thompson. Excision of the head, neck, Died June 5, 1865, from exhaus- tion. Circ. 6, S. G. O., 1865, p. 74. Ctrc. 2, S. G. O., 1869, pp. 47, 136. On reopening the wound the head of the femur was found carious throughout its entire extent; it was therefore re- moved, by Surg. E. Sennet, 94th Ohio. Fragments of neck removed, head of bone exarticulated, the roughened portion of the neck at its attachment with the trochanter sawn off with a small chain saw. and the mis- sile removed with difficulty at the bottom of a large cavity; slightly curved incision, by Ass't Surgs. B. A. Clements and C. H. Alden, U. S. A. Loose fragm'ts removed, irreg- ular broken extremity of shaft excised, and head of bone dis- articulated ; incis'n five inches long; Ass't Surg. B. A. Clem- ents, U. S. A.,'assisted by Dr. G. K. Smith, of Brooklyn. Ass't Surg. G. W. Avery, 9th Conn.,excised the head, neck, and great trochanter through a single straight incision. Excision of the head, neck, and trochanters, and three inches of the shaft of femur; incision four inches long, by Surg. G. C. Blackman, U. S. V. Shattered fragm'ts of the neck extracted, head of femur ex- articulated, and shaft divided two inches below the trochan- ter minor, through curvilinear incision; missile removed, by Surg. D. W. Blfts, U. S. V. Head of femur exarticulated and the fragments of the neck and trochanter major remov'd, thro' crural incision, by Ass't Surg. C. A. McCall, U. S. A. Head, neck, and trochanter major removed through a curved incision six or seven inches long, by Ass't Surg. W. F. Norris, U. S. A. Head and neck excised thro' a T-shaped incision, by Ass't Surgeon H. Allen, U. S. A. Head, neck, and two inches of the shaft of femur excised, by Surg. C. B. Gibson, C. S. A. Head and splintered upper ex- tremity of femur remov'd thro' a long straight incision, by Surg. A. H. Thurston.U. S.V. Head and fragments of neck of the femur removed: the shaft of femur was then divided at the level of trochanter minor, straight incision, by Assistant Surg. J. S. Billings, U. S. A. Head of femur excised, together with the attached greater por- tion of the lower surface of the neck of the bone,fragments removed and remaining sharp portions of neck trimmed off; Surg. F. H. Gross, U. S. V. Died January 31, 1863. from ex- haustion. Circ.2, S. G. O., 1869, pp. 38, 135. Died Sept. 30, 1862. Spec. 328, A. M. M. Circ. 6, S. G. O., 1865, p. 64. Circ. 2, S. G. O., 1869, pp. 36, 135. Died Sept. 21, 1862. Spec. 329, A.M.M. Circ. 6, S. G. O., 1865, p. 64. Circ. 2, S. G. O., 1869, pp. 37, 135. Died Sept. 21,1863, from exhaus- tion. Circ. 2, S. G. O., 1869, pp. 38, 135. Died April 24, 1862, of pyaemia. Circ. 2, S. G. O., 1869, pp. 34, 135. Died April 7, 1865, from haemor- rhage. Spec. 4048, A. M. M. Circ. 6, S. G. O., 1865, p. 72. Circ. 2, S. G. O., 1869, pp. 45, 136. Died June 21,1864,from diarrhoea. Spec. 2618, A. M. M. Circ. 6, S. G. O., 1865, p. 68. Circ. 2, S. G. O., 1869, pp. 44; 136. Died April 21, 1865. Autopsy: Pleurisy on either side; large subperiosteal abscesses. Spec. 3235, A. M. M. Ctrc. 6, S. G. O., 1865, p. 72. Ctrc. 2, S. G. O., 1869, pp. 47, 136. Died April 8, 1865, from peri- tonitis. Spec. 153, A. M. M. Ctrc. 6, S. G. O., 1865, p. 72. Ctrc. 2, S. G. O., 1869, pp. 46, 136. Died May 13,1864. Spec. 5500, A. M. M. Ctrc. 2, S. G. O., 1869, pp. 43, 135. Died one week after ope rat'n,from surgical fever and suppuration. Ctrc. 6.S.G.O., 1865, p.62. Ctrc. 2, S. G. O., 1869, pp. 34, 135. Died Sept. 24,1862, from exhaus- tion. Circ. 6, S. G. O., 1865, p. 64. Circ. 2, S. G. O., 1869, pp. 36, 135. Died October 25, 1863. Spec. 5442, A. M. M. 1 GROSS (S. W.), Head of the Thigh Bone removed by Excision on account of Gunshot Injury, in Am. Jour. Med. Sci., 1868, Vol. LV, p. 410. Ons (G. A.), Observations on some Recent Contributions to the Statistics of Excisions and Amputations at the Hip for Injury, in Am. Jour. Med. Sci., 1868, Vol. LVI, p. 130. Circular No. 2, S. G. O., 1869, pp. 39, 135. SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 113 Secondary Excisions.—There were reported eleven secondary excisions at the hip practised on nine Union and two Confederate soldiers, resulting in three recoveries and eight deaths, a mortality rate of 72.7 per cent.1 The shortest interval between the recep- tion of the injury and the operation was thirty-one days, and the longest eight years and four months. Two of the survivors of secondary excision at the hip are still pensioners in comparatively good health, at a period remote from the date of operation. Case 231.—Private Joseph Brown, Co. I, 3d Michigan, aged 38 years, was wounded at the second battle of Bull Run, August "29, 1832, by a musket ball, which passed through the left thigh, fracturing the femur just below the trochanter minor. He laid on the battle field three days, and was then removed to Centreville. On September 11, 18G2, he was admitted to Fairfax Seminary Hospital, near Alexandria. Tlie limb was kept in position by appropriate apparatus;, but suppuration was profuse, and, on two occasions, fragments of bone were removed from the wound. Early in March, 1833, there was great swelling of the thigh, the discharge became scanty and fetid, and pus burrowed amid the muscles. On March itlst, an explo- ratory incision was made from three inches above to five inches below the prominence of the great trochanter. The neck and upper extremity of the shaft of the femur were found to be extensively diseased, and excision was decided on. Surgeon D. P. Smith, U. S. V., performed the operation. Difficulty was experienced in separating the mus- cular attachments from the trochanters, on account of the foliaceous masses of callus that had been thrown out. When this dissection was accomplished, many necrosed fragments were extracted, and the periosteum and new bone were separated by the handle of the scalpel and preserved as far as practicable. The shaft of the femur was then divided by powerful cutting bone forceps, about six inches below the tip of the great trochanter. A screw was driven into the mass of callus, below the trochanters, to be used as a lever in disarticulating the head, but it would not hold, and the bone was seized with large forceps and rotated, so as to facilitate the division of the capsular and round ligaments. The head, neck, and trochanters, and the masses of callus adhering to the trochanters, were then removed. The operation was accom- plished with but very trifling haemorrhage, yet great prostration followed, and the patient rallied slowly. As the anaesthesia passed ofF, he had much nausea and vomiting. As soon as this subsided, he was given a very full allowance of concentrated nourishment, such as strong beef-tea, eggs, milk, etc, with half an ounce of brandy every two hours. The wound was par- tially closed; the limb was supported on pillows until the third day, when it was dressed in a Smith's anterior splint. About forty-eight hours after the operation, an erysipelatous blush pervaded the limb, and the constitutional symptoms assumed a typhoid character. A female catheter was passed through the middle of the wound and another at its lower extremity, through which much offensive decomposed serum and grumous blood escaped. The wound was thoroughly washed out through the catheters with warm water impreg- nated with chlorinated soda. On the fifth day there was a rigor, and haemorrhage to the extent of six ounces. As the anterior splint did not permit convenient access to the limb, it was removed, and the leg and thigh were suspended in a canvas hammock, the leg being horizontal —Head, neck, and Trochanters of left an(^ tne thigh in an almost vertical position. A piece of soft toweling femur, with foliaceous extending from the perinaeum to the popliteal space, and, connected by Fig. 69.—Appearance of limb three years after the operation. [From a photograph.] cords with an upright post at the head of the bed, supported the muscles on the sides and under surface of the thigh. The wound freely discharged synovia, bloody serum, and thin pus, until the seventh day, when healthy suppuration was fairly established. During April, 1863, the patient's progress was satisfactory. He was supplied with very nutritious diet, with porter, and cod-liver oil. He took for a time as much as a half a pint of oil daily. During May, the case continued to progress favorably. It was necessary to keep a tube in the wound until June 1st. Pre- viously, whenever it was removed pus would accumulate and burrow. A mesh of suture wire was finally substituted for the tube. This was retained until June 20th, when the patient began to get about on crutches. In the latter part of July the wounds closed. In August, Brown was reported as "well," and on August 23, 1863, he was discharged from the hospital and from the military service of the United States. On March 21,1834, he wrote from his home in Coopersville, Michigan, that his health was good; that he could get about and attend to home business; could saw and split a little wood for fuel, though his knee was stiff and his leg painful. On the whole, there had been steady improvement. In September, 1833, he again wrote, and stated that his general health was good; that he had some control over the movements of the thigh, being able, when standing on the right foot, to swing the left backward and forward, and to adduct the thigh enough to carry the injured limb across the other. He could bear some weight on the limb, and use but one crutch, with a stirrup for the foot. There had been no fistulous orifices since March 1834, and there was no soreness about the cicatrices. In November, 1835, in accordance with a request from the Surgeon General's Office, Mr. Brown had a photograph (FlG. 69) taken to represent the amount of deformity in his limb. This picture is numbered 110 in the Photograph Series of the Army Medical Museum. It is carefully copied in the accompanying wood-cut. The excised bone is preserved at the Museum, and is numbered 1192, Section I. It is represented in the adjacent wood-cut (FlG. 68). On February 12, 1868, he wrote to the compiler of this report: "I take pleasure in informing you that my 'Besides the nine cases recorded in the Report on Excisions of the Head of the Femur for Gunshot Injury, S. G. O., 1869, a successful example has been reported by Dr. E. Stekling, of Cleveland, Ohio, and another successful operation was performed in 1871, by Dr. J. K. Bigelow of Indianapolis. Surg. Ill—15 in INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. limb is in as good condition as when I fast wrote you; but think there is no improvement, except that it is not as tender. There have been no abscesses, nor any pain in the limb, excepting slight pains about the knee, just before storms About two years ago, I slipped and fell upon the ice, injuring the limb severely about the knee, and was thereby confined to the house for about three weeks. In March last I had a severe attack of ague. The limb swelled quite badly at this time, and was much inflamed for about ten days. I applied cold water and a bandage to reduce the swelling. I had to keep it bandaged about two weeks after the inflammation was removed. Since that time the limb has given me no more trouble than usual. Since I was discharged J cannot see that there is any lengthening of the limb. I have to use a crutch and cane all the time when moving about, and I think I shall always have to do this. The injured limb has wasted away somewhat since T last wrote. The circumference of the well limb at the upper extremity is 22 inches, and the injured limb measures at the same place 19^ inches. The knee of the well limb measures around the centre of the knee-pan 15£ inches; the injured limb measures at the same place 17 inches. The above measurements were made in the evening; I think that in the morning the measurements of the injured limb would be less. The knee still remains quite stiff, and gives me about all the pain there is anywhere in the limb. I have been troubled during cold weather by coldness of the outer side of the leg, and I have to warm it by the fire before going to bed nearly every night when I have been out." On November 19, 1863, another letter was received from Mr. Brown, from which the following extract is made: "I take pleasure in informing you that my limb is in as good condition as it has been at any time since it was entirely healed, and, if anything, in better condition. It does not pain me about the knee as much as it did one year ago. It does not have any spell of swelling at the knee as it did for the first two years after my discharge, and there is less soreness about the limb than there was even one year ago. I can get around without hurting it as much as formerly. I can bear some weight upon it. I have walked across a room without the aid of crutch or cane, by stepping very quick with the well limb; but it is more like hopping than walking. There have been no abscesses in the limb. I think that it is gradually improving, and hope that I may yet see the day that I can go without a crutch. My general health is good. I have not been sick a day for a year and a half, and then only a few days with ague. My weight now is 1G7-J- pounds. Before I entered the army my weight was never quite up to those figures, but within a few pounds of it. I have been postmaster at this office over a year, and have attended to all the business of the office almost entirely without assistance, and it gives me pretty good exercise." On Septem- ber 6, 1875, the elate of his last examination for pension, the Grand Rapids Examining Board stated: "There is now a false joint with shortening of the limb." Since then this pensioner has been exempted from further surgical examinations. He was paid September 4, 1877, remaining in comparatively good health more than fourteen years after the operation. The next successful secondary excision at the hip after shot injury was not identified at the Surgeon General's Office until after the publication of Circular 2, in 1869. CASE 262.—G. W. Tilliston, Co. D, 1st Ohio Artillery, aged 44 years, was wounded at Laurel Hill, July 7, 1861, by a rifle ball, which entered the right groin, passing backward through the neck of the femur and lodging in the large muscles of the buttock. Two weeks after the reception of the injury he was mustered out by reason of expiration of service, and subse- quently he was admitted on the Pension Rolls. Dr. E. Sterling, of Cleveland, Avho was the regimental surgeon and treated the wounded man in the field, subsequently certified to the nature of the injury and reported the following: "Extraction of the ball was impossible. The wound was dressed, and within a few days the patient was removed to his home in Cleveland. On or about the 20th of September following it became necessary to remove that portion of the bone traversed by the ball, and I performed the operation of excision at the hip joint." Examiner J. Laisy, of Cleveland, on July 17, 1867, certified to resection of the head and part of the neck of the femur, and stated: "A fistulous opening has formed six inches below the anterior superior spinous process of the.ilium, which is keeping up a constant and profuse discharge of purulent matter. The right leg, in consequence of the operation, is short- ened about three inches. He is unable to bear any weight on the injured limb, and obliged to walk on crutches." tered head of right Two years later, in August, 1869, the excised head of the femur, represented in the wood-cut (FlG. 70), was peo.oo . transmjtte(j j0 the Museum by the operator, who deplored the loss of the other portion of the resected bone, and described the case as being attended with "perfect recovery and a good limb, the pensioner being able to go up and down stairs with ease."' Dr. N. M. Jones, attending physician of the pensioner, certified that he died September 6, 1871, and added that a post-mortem examination, held by himself, revealed "extensive necrosis of the upper third of the femur * * * aQd of the ilium, having entirely destroyed the acetabulum and penetrated the pelvis." He also stated that he found an enormous abscess covering the entire right ilium and sacrum. The third successful secondary excision at the hip was practised, in 1871, for ostitis and coxitis, eight years and four months subsequent to the reception of the shot injury. Case 263.—Private T. W. Pease, Co. H, 19th Indiana, aged 26 years, was wounded at Gettysburg, July 1, 1863, by a conical musket ball, which entered the anterior aspect of the right thigh three inches below Poupart's ligament, passed back- ward and outward, and lodged just behind the trochanter major, having fractured the upper third of the femur and passed through the trochanter. The wounded man remained for several months at a Corps hospital at Gettysburg, where merely a "shot wound of right thigh'' was noted, but no progress of the case recorded. According to his statement, the missile was extracted by incision three days after the injury, and on July 9th, while under the influence of ether, nearly three inches of bone was removed in fragments. Extension and counter-extension were applied, but the latter caused so much pain that it was discon- 1 Professor H. CULBERTSOX, M. D. (Excision of the Larger Joints of the Extremities, Prize Essay, Trans. Am. Med. Assoc., Vol. XXVII, Supple- ment, 1876, pp. 5 and 50), reports this operation as practised "August 20, 1861," which would make it the first excision at the hip after shot injury performed ia the United States, the primary excision practised by Professor BLACKMAN, on Private J. McCulloch (Case 230, p. 97, ante) having been done August 30,1861. Dr. E. Steeling in his letter transmitting the specimen (5590) also asserts that his excision of the head of the femur in Tilliston's case was the first during the war. Pension Examiner Laisy also states that the patient was wounded July 7, 1861, and that resection was performed six weeks afterwards: but. in his official report to the Pension Office, Dr. Sterling states that the operation was performed " on or about the 20th of September." SECT, ii.] EXCISION AT THE HIP AFTER SHOT INJURY. 115 tinued at the end of twenty-four hours. Smith's anterior splints were applied on July 20th, and cold-water dressings were used. The patient also stated that the limb was swollen and painful, the discharge of pus profuse, and his general health bad. For the first two weeks he suffered from constipation, after which, having taken a laxative, diarrhoea set in and troubled him, with short intermissions, for about three months. The records of Camp Letterman Hospital show that the patient was admitted there ou September 5th, also that Acting Assistant Surgeon E. A. Koerper took charge of the case on October 8th, who opened a large abscess on the inner side of the thigh on November 3d, and removed the splints several days afterwards, the fracture having become united and the patient's health improved. The subsequent progress of tho case was recorded by Acting Assistant Surgeon H. L. Smyscr, at the York Hospital, where the patient was transferred on November 14th. The wound of entrance and exit at that time had closed, but there was still discharge from an opening on the middle and external part of the thigh, and the limb was swollen and curved outward, with three inches shortening. After this a steady improvement followed until January 12, 1SLJ4, when the patient was seized with a chill, followed by fever, and a deep seated abscess began to form on the anterior part of the thigh, which was opened four days afterwards. Abscesses continued to form at intervals and suppuration was more or less constant, causing the cicatrices of the wound to be reopened. On February 29th, symptoms of tetanus appeared, being exhibited by stiffness of the muscles of the neck and inability of the patient to open his mouth more than half an inch. This attack was subdued, by the administration of pills of camphor and opium, after several days' duration, and during the succeed- ing night and morning it was followed by an almost constant hiccough, after which another attack of diarrhoea came on. In April following the wound had again healed, and the patient had so far amended as not to require any more medicine. On July 3d, he was able to walk about on crutches for the first time. His term of service having expired, he was mustered out August 8, 1854, and pensioned. Examiner G. W. Clippinger, of Indianapolis, certified, October 17, 1833: * * * "Almost total anchylosis of knee joint, with foot turned inward at the toes; extensive | necrosis of entire shaft of bone, with discharge at three points. * * * Discharge offensive and exhaustive. Is feeble and emaciated, has frequent night sweats, and requires constant aid and attendance." Dr. A. L. Lowell, of the Pension Office, who made a special examination of the pen- sioner on July 20, 1858, reported the following: * * * "The wound is still discharging from its anterior opening and the process of exfoliation is still progressive. The coxofemoral articulation is firmly fixed and immovable. * * * The subject travels with the assistance of crutches. His general health is good." Dr. J. K. Bigelow, attending physician of the pensioner and late Surgeon of the 8th Indiana, reported that he, being aided by Surgeon J. S. Bobbs, "on September 2, 1868, removed ten and a half inches of the necrosed shaft of the femur, said necrosed bone having kept up a constant and exhaustive discharge from three or four large sinuses at various places along the inner and posterior part of the thigh," etc. The Indianapolis Examining Board certified, February 8, 1870: "The pensioner is very obnoxious to erysipelas, which frequently causes large inguinal and popliteal abscesses," etc. Two years afterwards the same Board reported that "the operation for removal of necrosed bone two years ago, apparently resulted in good recovery. * * One year after said operation erysipelas of the limb, with ulceration, etc., again ensued, and on October 20, 1871, he was again attacked with large abscesses, and several sinuses made their appearance. Upon careful examination it was found that the new bone was necrosed and necessitated coxo-femoral exsection, which was performed on the 8th of November, 1871. There is ten inches shortening. He requires the con- stant attention of a nurse," etc. In a report recapitulating the history of this case, transmitted by Dr. Bigelow, in September, 1877, he describes the operation of exsection as follows: "While under the influence of chloroform, an incision was made from the middle of the dorsum of the right ilium down the outer aspect of the thigh to within two inches of the knee joint. The femur was exposed and divided five inches below the trochanter with Hey's saw, and on account of the extensive perfora- tions of the muscles surrounding the bone by osteophytes (Fig. 71) the epiphysis was with difficulty and considerable haemorrhage, enucleated and unjointed from the acetabulum. It was found to consist of a very large dead involucrum, filled in all its aspects with sharp projecting spicules. A portion of the leaden ball was found embedded in the cancellous structure near the trochanter. The wound healed kindly, and was entirely closed in twenty-eight days. In three months a cartilaginous union had taken place, and now—in September, 1877—with the assistance of a ' six-inch lift' on the right boot the man can walk quite well with a cane, having nearly a perfect arthrodial joint at the hip, and being able to attend to the ordinary duties of a Deputy United States Marshal." In 1873, in visiting the Surgeon General's Office, Dr. J. K. Bigelow contributed a photograph of the excised epiphysis, which is copied in the wood-cut (Fig. 71). In 1877, Dr. Bigelow contributed to the Museum another photograph representing the cicatrix and appearance of the injured limb, which is copied in the right hand wood-cut (Fig. 72). This pensioner was paid September 4, 1877. The number of patients who servive shot injuries involving the hip joint until the secondary period without operative interference is small; but such cases may be regarded in reference to their ability to sustain excisions as becoming analogous to the subjects of excisions at the hip for pathological causes. Now we learn from the experience of civil practitioners that excisions at the hip for disease have a mortality rate in children aver- aging perhaps below 45 per cent.', yet in adults of the military age rising to an average Fig. 71.—Shot fracture of tro- chanter major of right femur. (From a photograph furnished by Dr. Bigelow.] FIG. 72.—Appear.inoe of the limb six years after the opera- tion. [From a photograph.] 116 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. of over 60 per cent. It is found on examination, that, as might be anticipated, the second- ary excisions at the hip for traumatic cause attain a mortality rate approximating that of excisions for disease in adults of about the same age. The three survivors of secondary excisions at the hip after shot injury were robust mature men of 26, 34, and 44 years of age. In the eight unsuccessful cases the ages varied from 18 to 43 years. In seven of the eight unsuccessful operations the patients succumbed in from one to eight days from the dates of operation, a mean of a little over four days, while the eighth lived over a hundred days after the operation, and succumbed apparently to unfavorable climatic influ- ences-and only in part to traumatic causes. Case 264.—Private Hugh Frain, Co. G, 31st Massachusetts, aged 22 years, was wounded February 1, 1865, by a conoidal musket ball, which entered the anterior surface of the middle third of the left thigh, ranging upward, and making its exit above the left gluteus, fracturing the neck of the femur in its course. He was on horseback, his regiment serving at the time as mounted infantry. He was treated in the regimental hospital for several days, and then, on February 13th, he was admitted to the St. Louis Hospital, at New Orleans. When admitted, he stated that the surgeon of his regiment had given him chloroform, and examined the wound, and that the bone was not touched. He had walked upon the limb, and there was then no evidence of fracture. His general health became poor. He had night sweats. His tongue was clean and moist, and his appetite was good. The whole thigh gradually became dissected with pus of an unhealthy character. Abscesses discharged through fistulous openings in the groin. The limb was inverted and shortened, and was drawn over to the right. It was decided that an excision of the head of the femur was expedient. On March 24th, Surgeon A. McMahon, U. S. V., proceeded to perform the operation. An incision four inches in length was made over the great trochanter, the soft parts were dissected up, and the femur was divided by the chain saw just below the trochanter minor. The ligamentum teres was softened, and the head of the femur was removed without difficulty. The wound was filled with lint, and the patient was ordered porter, chicken broth, eggs, stimulants, and everything necessary to sustain the drain upon his system. He felt easier for a few days after the operation, but he gradually sank, becoming very much emaciated, and died March 30, 1865, six days after the operation. The ball had injured the neck of the femur, and the subsequent caries had caused the destruction of the head and the disorganisation of the surrounding tissues. Case 235.—Private Edward Hunt, Co. D, 71st Pennsylvania, aged 24 years, was wounded at the battle of Antietam, September 17, 1862, by a conoidal musket ball, which entered about two and a half inches above the trochanter major, and grazing the neck of the right femur, passed out at tho nates. Shortening and eversion were not present, and it was thought that there was not a complete fracture. After the battle, he was removed to a barn near the battle-field, where he was treated with cold-water dressings for eleven days. He was then removed to the City Hotel at Frederick, Maryland, and the cold applications were continued up to November 19th. During this period the wound was discharging healthy pus profusely. As pus was burrowing in the muscles, a seton was run through the wound and six inches down the thigh. On November 19th, he was removed to Jail Street Hospital, and about the last of December he was transferred to the U. S. Hotel Hospital, and thence, on January 20, 1833, to hospital No. 5, at Frederick, Maryland. On January 31st, an abscess formed on the anterior internal aspect of the thigh, which was opened, and discharged nearly a quart of laudable pus in twenty-four hours. On February 2d, the opening on the posterior aspect of the thigh was enlarged and the wound syringed out with warm water. Erysipelas attacked the wound, but it was not of an intense character, and by February 10th, it had subsided, and the patient was in good condition comparatively. On February 23d, he had become more emaciated and had night sweats, but his strength continued good. On exploring for the ball with the finger, in the opening on the inner side of the thigh, a round, smooth surface was felt, which was thought at first fig. 73.—Caries of the ace- to be a piece of a conoidal ball, but was ascertained to be the head of the femur just outside of the ofbthe "righTfemurffoUowkig acetabulum. Excision of the hip joint was now decided upon, and Assistant Surgeon Henry A. an excision for shot fracture. Dubois, U. S. A., operated, the patient being under chloroform, by enlarging the openin°- on the inner side of the thigh, cutting the capsular ligament, and removing the head of the femur. The neck was divided by the lion-jawed cutting forceps. A small quantity of pus was found behind the head of the bone. But very little blood was lost during the operation, and the patient rallied partially, but he never fully recovered from the shock, and died February 25, 1863, two days after the operation. At the autopsy the neck of the femur was found rounded off, and formed a false centre of motion on the inner side of the acetabulum. The rounded extremity of the neck and the acetabulum were carious. The cut (FlG. 73) imperfectly represents the specimen, which was sent to the Army Medical Museum. Case 266.—Ensign W. J. Henry, 21st Mississippi, aged 22 years, was wounded near Petersburg, on June 21, 1864, by a conoidal musket ball, which entered the upper third of the left thigh anteriorly and made its exit at the opposite side of the limb, having badly comminuted the femur, without injuring the principal vessels or nerves. The wounded man was conveyed to Richmond, and was admitted to hospital No. 4, on June 28th. The injured limb was suspended by Smith's anterior splint, the wound was dressed with water dressings, a nourishing diet was ordered, with an opiate at bed-time. Under this treatment the case progressed satisfactorily until August 2d, when the copious suppuration and wasting of the patient excited so much anxiety that a consultation was held, at which Surgeons C. B. Gibson, M. Michel, and J. B. Read assisted. After a careful exploration of the injury under chloroform, it was decided that an excision of the upper extremity of the femur was expedient, and the operation was at once performed by Surgeon J, B. Read, P. A. C. S.' An incision seven inches in length was made, SECT. II.J EXCISION AT THE HIP AFTER SHOT INJURY. 117 commencing above the trochanter and carried downward in the axis of the thigh. The joint was opened and the head of the bone exarticulated. The shaft was sawn below the trochanter minor, about six inches of the bone being removed. The wound being thoroughly cleansed, was approximated and kept in position by sutures and adhesive strips. A long straight splint was then applied on the outside of the limb. An ounce of brandy and thirty drops of tincture of opium was ordered to be admin- istered every hour until reaction should be fully established. August 3d, the patient had reacted and had passed a comfortable night. The pulse was at 136; there was no pain, except in the left knee, which was swollen, but without increased heat or redness. The appetite was poor but improving. A nourishing diet was directed, and half an ounce of brandy every two hours with a grain of opium every three hours. 4th, the patient had rested well, had a good appetite, the tongue was clean, the skin moist, the bowels had been moved naturally, the pulse was at 12'), the countenance was cheerful. The treatment was continued with the addition of porter thrice daily. 5th, the pulse was stronger at 120, the countenance was cheerful ; the treatment was continued. 6th, the patient was reported to have passed a bad night. He complained of acute pain in his left knee and in the right side of his chest. The pulse was 135 and weak. Incipient pneumonia was detected in the right lung. He had vomited the porter, and it was discontinued; the brandy and opium were continued as before. The wound was suppurating profusely. The sutures were clipped, and the wound was kept together by adhesive strips. The bowels were constipated. An enema of warm soap and water was administered, which procured a normal dejection in a few hours. Sinapisms were applied to the chest. 7th, he had rested tolerably well, but breathed badly. He was sweating profusely, and complained of much pain in the chest. The pulse was at 140, and was very weak. He was ordered an ounce of brandy every hour and a grain of opium every four hours. 8th, he was reported as having passed a very restless night. He was too weak to expectorate; the pulse was very feeble at 148. He was evidently sinking. He died at 3 o'clock P. M., August 8, 1834, six days after the operation, and forty- nine days from the reception of the injury. The report gives no account of the post-mortem appearances. Case 267.—Private John W. Nelling, Co. K, 1st Massachusetts, aged 23 years, was wounded on June 30, 1862, at the engagement at White Oak Swamp, by a musket ball, which entered his right groin, passed horizontally backward, comminuted the neck of the femur, and emerged posteriorly. He was abandoned with other wounded in the retreat of General McClellau's army. Being made a prisoner, he was confined in Richmond for three weeks, and was then released and sent by water to Baltimore, where he was admitted to the National Hospital, on July 25th, in a very depressed condition. There was copious suppuration, and through the large orifices of entrance and exit it was easy to explore the extent of the injury to the bone, and to determine that the comminution was limited to the epiphysis. It was deemed advisable to excise the shattered extremity of the bone as soon as the patient could acquire, by a tonic treatment, strength to undergo such an operation. In a few weeks his general condition was much improved, though he was still anaemic and feeble. On August 21st, Assistant Surgeon Roberts Bartholow, U. S. A., in charge of the hospital, proceeded to perform the operation. The patient being placed under chloroform, Dr. Bartholow made a vertical incision, commencing a little above and behind the great trochanter, continued downward into the axis of the limb four inches, and carried it down to the bone. The head of the femur was found to be entirely separated from the neck, and was retained in the acetabulum only by the round ligament. This was divided, and the head was removed. Several necrosed fragments were then extracted, and the jagged extremity of the neck was smoothed by an osteo- tome. But little blood was lost in the operation, and the patient rallied promptly from the effects of the anaesthetic. After he was put to bed, the limb was suspended by Smith's anterior splint, and the patient's condition was rendered comparatively comfortable. The case progressed favorably and without an untoward symptom till the afternoon of August 25th, when a sudden and very e i_ 1? j i i_i j * i ■,„... ., ,,, Fig. 74.—Head and fragments of the neck of right protuse gush ot dark blood from the wound of incision and the entrance bullet femur, excised for gunshot fracture. Spec. 400, Sect. wound took place, and the patient expired before the haemorrhage could be con- *' A- M- M- i trolled. At the post-mortem examination, the soft parts in the vicinity of the wound were found to be in a softened and semi- gangrenous condition. The end of the excised neck was denuded of periosteum and was necrosed. The external iliac and femoral arteries were traced some distance above and below Poupart's ligament, and were found to be in a normal condition. The femoral vein was softened, and near the track of the ball appeared to be broken down so as not to be distinguished from the surrounding tissues. A quantity of dark fluid blood was found under the integuments. The excised head and neck were deposited in the Army Medical Museum by the operator, and are represented in the cut (FlG. 74). Case 268.—Private Joseph Roth, Co. B, 188th New York, aged 25 years, a large robust man, was wounded in the engagement at Hatcher's Run, near Petersburg, on February 6, 1865, by a round musket ball, which entered a little below Poupart's ligament, an inch external to the course of the vessels, and lodged in the neighborhood of the hip joint. He was received at the field hospital of the 1st division of the Fifth Corps, and thence conveyed to the base hospital at City Point, and, as there was no pain or deformity, the case was regarded and treated as a flesh wound, and a week subsequently the patient was sent in the hospital transport steamer State of Maine to the General Hospital at Point Lookout. After a short time, Roth began to complain of great pain in the knee and leg of the wounded limb, which aroused suspicion that the hip joint was impli- cated. The symptoms becoming aggravated, and pointing clearly to some injury of the joint, Surgeon John Vansant, U. S. A., in charge of the hospital, determined to make an exploratory incision, and to ascertain the true condition of things. The patient being anaesthetized by a mixture of chloroform and ether on March 9th, an incision was made, commencing at the wound of entrance, and continued downward three inches or more. The ball was now found impacted in the head of the femur, the anterior part of which was shattered, while the posterior two-thirds of the head was intact. The muscular attachments being divided, and the capsular ligament freely opened, the round ligament was severed, and the head was exarticulated. A chain saw was then passed around the neck, which was divided near to the head, and the latter, with the ball inserted in it, was removed. Some sharp projecting portions of the neck were smoothed off with bone forceps. There was very little haemorrhage. The wound was drawn together and treated by water dressings, and the limb was kept in suitable position by pads and pillows. The patient seemed to do well for several weeks, but gradually became feeble and emaciated, losing all appetite. There was 118 INJURIES OF THE LOWER EXTREMITIES. fCHAP. x but a slight discharge. In May, the patient became quite yellow, and apparently suffered from malarial complications. In spite of a careful tonic and sustaining regimen, and the bracing, wholesome salt air of Point Lookout, he gradually declined, and died June 17, 1855. The pathological specimen was not forwarded to the Museum, and no account of an autopsy was rendered, an annoying omission, since it would have been interesting to have learned what reparative action had taken place during the three months after the operation which this patient survived. Case 269.—Private Alfred Toncy, Co. A, 16th North Carolina, aged 43 years, a farmer by profession, was Avounded June 30,1863, and admitted to hospital No. 4. Richmond, on the same day. A conoidal musket ball had entered the left buttock and lodged. No particular attention was called to this case for some time. The patient seemed to be doing well. On August 11th, however, he complained of great pain in the knee and ankle; the slightest touch caused great anguish. The foot was oedematous. Chloroform was administered, and digital examination of the wound was made. The finger could pass but half an inch into the wound until the limb was carried forward; it then could be passed into the cotyloid cavity, and the ball was found in the acetabulum. Tlie round ligament was severed and the head of the femur was ascertained to be slightly fractured and deprived of its cartilage. Excision of the head of the femur was decided upon, and on August 12th, Surgeon James B. Read, P. A. C. S., proceeded to operate. The patient was laid on his face, and his buttocks were brought to the edge of the table. A straight incision was commenced two inches below the anterior superior crest of the ilium and carried downward to one inch below the trochanter major. The muscles were then separated, and the joint exposed. The head was then dislocated by forcibly bringing the leg under the table. The soft parts were protected by a spatula and the head was sawn off. The ball was removed from the cotyloid cavity, which was found to be broken across and the cartilage loosened. The wound was then closed by sutures and the patient was removed to his bed. He suffered no pain, and in twenty-four hours the swelling had subsided. His general condition was very feeble, and he was freely stimulated during the after-treatment. He died August 19, 1833, eight days after the operation, exhausted by hectic fever. There is no account of any abdominal disturbance or pyaemic symptoms resulting from the fracture of the acetabulum. Case 270.—Private Henry Woodworth, Co. A, 4th Vermont, aged 18 years, was wounded at the battle of Spottsylvania Court House, on May 11, 1864, by a conoidal musket ball, which entered the left thigh, just below the trochanter major, passed inward and forward, grooving the femur anteriorly at the level of the lesser trochanter, and lodging under the sartorius muscle. The patient was conveyed to the field hospital of the 2d division of the Sixth Corps, where the ball was removed through an incision at the edge of the sartorius. A week subsequently, he was placed on one of the trains for the Rappahannock, and was transferred from Fredericksburg to Washington, where, on May 25th, he was admitted to Harewood Hospital. His condition on admission was very unpromising; his pulse was quick and feeble; he was anaemic, and without appetite. He was placed upon a tonic regimen, but he did not improve. The wound discharged profusely; there was much pain in the joint, pain aggravated by the slightest movement, and pus had burrowed in every direction about the articulation. Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, decided that an excision of the head of the femur offered the only possible chance of saving life, and, on July 1st, the patient having been anaesthetized by sulphuric ether, Dr. Bontecou proceeded to peiform the operation. A curved incision, with its concavity forward, embracing the trochanter, readily exposed the joint. The muscular attachments were divided, and the head was easily disarticulated, the joint being disorganized and the round ligament destroyed. The continuity of the bone being uninterrupted, the upper extremity was readily turned out and sawn just below the point of impact of the ball. On examination of the portion of bone removed, it was found that much of the head had been absorbed, and that the remainder was carious. The specimen is represented in the accompanying wood-cut (FlG. 75). The neck and trochanters are covered with traces of the effects of periostitis. The cotyloid cavity was ulcerated. The wound was drawn together by adhesive strips, and the limb was dressed in a fracture apparatus with moderate extension. Every means of supporting the patient's strength was adopted, but he did not rally from the operation, and, sinking gradually/ expired on July 2, 1864. Case 271.—Private John Zaborowski, Co. H, 7th Connecticut, aged 33 years, was wounded at the engagement at Deep Bottom, Virginia, August 16, 1864, by a conoidal musket ball, which entered just below the right trochanter major, and passing upward and inward, fractured the neck and slightly injured the head of the femur. The patient was conveyed to the field hospital of the Tenth Corps, where his wound was dressed, and he was then sent to City Point and transferred to the hospital transport steamer De Molay, and conveyed to the U. S. Hospital, at Beverly, New Jersey, where he was admitted on August 22d. His condition at this period is not described, and it is not stated whether the ball had been extracted. From the subsequent history, it would appear that there was profuse suppuration about the joint, since a free transverse incision was practised to give free escape to the discharge. On September 27th it was determined to excise the head of the femur. The patient had greatly lost in flesh and strength since his admission, and seemed to be rapidly failing from the exhaustive suppuration; extensive slough- ing of the soft parts had supervened, and, upon the whole, the case was unfavorable and unpromising. Chloroform having been administered, and the patient being placed on his sound side, Assistant Surgeon C. Wagner, U". S. A., made an incision four and a half inches in length, extending from just below the anterior superior spinous process of the ilium toward the tuberosity of the ischium, crossing the trans- verse incision previously made over the trochanter major to permit free exit of pus. The thigh was flexed and rotated inward, the tendons of the muscles were divided, and a chain saw was passed under and between the head of the femur and the trochanter major, and the bone was sawn through the neck, the soft parts being protected by spatulas. About one inch of the trochanter major was found to be necrosed, and was removed by a small saw. No blood was lost during the operation. The patient sank rapidly, and died September 28, 1834, of exhaus- tion. A post-mortem examination revealed nothing of note, except slight caries of the acetabulum. The carious head of the femur was sent to the Army Medical Museum, and is represented in the adjacent wood-cut (FlG. 76). The fragments of the neck and the necrosed trochanter major were lost. Fig. 75.-Excised up- per extremity of left femur with a conoidal ball. Spec. 3049. J FIG. 76. —Head of right femur excised for caries fol- lowing a gunshot fracture. Spec. S716, Sect. I, A.M. M. a SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 119 Of the eleven secondary excisions at the hip five were on the right and six on the left side. The pathological specimens were preserved in six instances. Table XIII. Summary of Eleven Cases of Secondary Excision of the Head of the Femur for Shot Injury. K Name, Age, and Military Description. 1 Brown, J., Pt., I, 3d Mich- igan, age 38. Tilliston, G. W., Pt., D, 1st Ohio Light Artillery, age 44. Pease, T. W.. Pt., H, 19th Indiana, age 26. Frain, H., Pt., G, 31st Mas- sachusetts, age 28. Henry, W. J., Ensign, 21st Mississippi, age 22. Hunt, E., Pt., D, 71st Penn- sylvania, age 24. Nelling, J. W., Pt., K, 1st Massachusetts, age 25. Roth, J., Pt., B, 188th N. York, age 25. 2 Toney, A., Pt., A, 16fh" N. Carolina, age 43. Woodworth, H., Pt., A, 4th Vermont, age 18. 'Zaborowski, J., Pt., H,7th Connecticut, age 33. Aug. 2!) 1H62. July 7, 1861. July 1, 1863. Feb. 1, 1865. June 21 1864. Sept. 17, 1862. June 30, 1862. Feb. 6, 1865. June 30, 1863. May 11 1864. Aug. 16 1864. Nati'uk op I:;ji!iiv. Musket ball perforated the left thigh, fracturing femur just below the trochanter minor. Rifle ball enter'd the right groin, passed backward, fractured the head and neck of lemur, and lodged in large muscles of buttock. Date of Opera tion. Mar. 21 1803. Sept. £0, 1861. Conoidal ball fractured upper Nov. 8, third of right femur, passed 1871. thro' trochanter and lodged behind trochanter major, fol- lowed by chronic ostitis and coxitis. Left thigh perforated by a co- noidal ball; the neck of the femur was fractured. Comminuted shot fracture of upper third of left femer by a conoidal musket ball. Conoidal ball grazed the neck of the right femur and passed out at the nates. Musket ball comminuted neck of right femur; head of bone entirely separated. Anterior part of head of left femur shattered by a round ball, which lodged in same. Head of the left femur slightly fractured by a conoidal bail that lodged in acetabulum. A conoidal ball grooved the left femur anteriorly at the level of the lesser trochanter and lodged under the sartorius muscle and was removed. Conoidal ball fractured the neck and slightly injured the head of the right femur. Mar. 24 1865. Aug. 2 1864. Feb. 23 1863. Aug. 21 1862. Mar. 9, 1865. Aug. Ii 1863. July 1, 1864. Sept. 2' 1864. Oitisatiox and Operator. Necrosed fragments extracted; shaft of femur divided six ins. below tipoftroch. minor. The head, nock, and trochanters, and the masses of callus ad- hering to tho trochanters were then removed, straight incis. eight ins. long, by Surgeon D. 1\ Smith, U. S. V. Head and neck of femur ex- cised, by Dr. E. Sterling. Femur divided five ins. below the trochanter and unjointcd from acetabulum, by Dr. J. K. Bigelow, late Surgeon 8lh Indiana. The femur was divided by tho chain saw just below the tro- chanter minor; the head of the femur was removed with- out difficulty; Surg. A. M. McMahon, U- S. V. Incision four ins. long. Head of femur exarticulated, shaft sawn below trochanter minor, six inches of bone re- moved, by Surg. J. 15. Read, C. S.A. Incis. seven ins. long. Opening on inner side of thigh enlarged, neck of the femur divided with lion-jawed for- ceps and head of bone re- moved, bv Ass't Surg. H. A. DuBois, U. S. A. Head of bone removed, several fragments extracted, and the jagged extremity of the neck smoothed by an osteotome, by Ass't Surg. R. Bartholow, U. S. A., thro' vertical incis The neck of the femur was divided near the head of the bone by a ch ain saw; the head of the bone with the ball in- serted was then removed, straight incision, by Assistant Surg. ,T. Vansant.U. S. A. Head cf femur sawn off and the ball removed from tho cotyloid cavity, by Surg. J. B. Read, P. A. C. S.; straight incision. Head of femur disarticulated and upper extremity of bone rca dily turned out and sawn just below the point of impact of the ball, by Surg. R. B. Bantecou, U. S. V.; curved incision. Chain saw passed under and between the head of femur and trochanter major and the bon o sawn through the neck; an inch of trochanter major, found to be necrosed, removed by small saw, by Ass't Surg. C. Wagner, U- S. A.; crucial incision. Result and Remarks. Disch'd Aug: 23, 1863, and pen- sioned. Appointed postmaster in 1867, at (Joopersville, Mich. Able to attend almost entirely without assistance to the busi- ness of the office. Paid pen- sion March 4, 1876. Spec. 1192, A.M.M. Phot.Ser. 110,A.M.M. (Disch'd July 21, 1861.) July, 1867, fistulous opening discharg- ing purulent matter. Three ins. shortening. Pcns'ner died Sept. 6, 1871, of asthenia. Autopsy. Spec. 5590, A. M. M. I'ortions of femur had been pre- viously removed. Patient had been disch'd Aug. 8, 1864. In Sept., 1877, the pensioner had "nearly a perfect arthrodial joint at hip. and was able to attend to the ordinary duties of a deputy marshal.' Died March 30, 1865. Circ. 6, S. G. <)., 1865, p. 72. Circ. 2, S. G. O., 18C9, pp. 54, 137. Died August 8,1864. Circ. 2, S. G. O., 1869, pp. 52, 137. Died Feb. 25, 1863. Spec. 3907, A.M.M. Circ. 6, S. G. O., 1865, p. 66. Circ. a, 1869, S. G. O., pp. 49, 137. Died August 25, 1862, of haemor- rhage. Spec. 400, A. M. M. Circ. 6, S. G. O., 1865, p. 62. Circ. 2, S. G. O., 1869, pp. 48, 137. Died June 17, 1865. Circ. 6, S. G. O., 1865, p. 74. Circ. 2, S. G. O., 1869, pp. 53, 137. Died August 19, 1863, from ex- haustion, of hectic fever. Died July 2, 1864. Spec. 3049, A.M.M. Circ. 6, S.G.O.,1865, p. 70. Circ. 2, S. G. O., 1869, pp. 52,137. Died September 28, 1864, from exhaustion. Spec. 3716, A. M.M. > Smith (D. P.), Gunshot Wounds of the Great Trochanter, in Am. Med. Times, 1863, Vol. VII, p. 12. Circular No. 6, S. G. O., 1865, p. 66. Circular No. 2, S. G. O., 1869, pp. 50, 137. 'Read (J. B.), Resections of the Hip Joint, in Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 6. EVE (P. F.), A Contribution to the History of the Hip Joint Operations performed during the late Civil War, in Transactions of the American Medical Association, Vol. XVllI, p. 256. Circular No. 2, S. G. O., 1869, pp. 51, 137. 3 WAGNER (C), Report of Interesting Surgical Operations performed at the U. S. Gen. Hosp., Beverly, X. J., 1GG4, pp. 14, 15. Circular No. 6, S. G. O., 18C5, p. 70. Circular No. 2, S. G. O., 1869, pp. 53, 137. 120 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Since the termination of the civil war the operation of excision at the hip for shot injury haa been practised five times in the service of the United States Army and once in the service of the United States Navy, and,this aggregate of six excisions1 gives the 1 Four of the operations are described at length in A Report of Surgical Cases treated in the Army of the United States from 1865 to 1871, Circular No. 3, War Department, Surgeon General's Office, Washington, 1871, pp. 228-234, and the facts regarding them will be here briefly recorded, two of the cases are hitherto unpublished, and will be narrated more in detail. Two of the excisions were primary, one intermediary, and three secondary opera- tions. The first case was that of Private Hubert Erne, Co. D, 4th Infantry, aged 48 years, wounded December 2, 1869, while acting as one of a corpo- ral's guard of the mail wagon from Fort Laramie to Fort Fetterman, in an attack by a band of Indians. He was struck in the left buttock by a round carbine ball (cal. 45, weight 225 grains), and fell to the ground. His comrades placed him in a wagon and drove rapidly to Laramie, over a very rough road; he was struck at two in the afternoon and was placed in bed in the hospital at half-past seven, much exhausted, having driven thirty-two miles in five and a half hours. He had lost blood copiously. His extremities were cold, pulse almost imperceptible, and his countenance was pallid and covered with clammy sweat. The left lower limb showed shortening with eversion, the thigh arched with an anterior convexity. The entrance wound was nn inch and a half behind the trochanter major on a slightly higher plane ; the exit aperture was near the centre of the groin just below Poupart's ligament, direQtly over the axis of the femoral drtery. The diagnosis of Assistant Surgeon F. MeachaM, post surgeon, was that there was fracture of the shaft, neck, and trochanters of the left femur. As he had not rallied from the shock, it was thought best to defer surgical interference until morning, and the limb was placed in a comfortable position, and the patient allowed half an ounce of brandy every half hour, while external applications of heat were made by hot blankets, heated sad-irons, and bottles of hot water. At midnight the patient had fairly reacted; but complained of great pain in the middle of the injured thigh. He was ordered a fourth of a grain of morphia to be repeated in two hours if needed. At 7.30 A. M., December 3d, the patient was comfortable ; pulse at 90. No appetite and little sleep during the night. Temperature in axilla 9y° F. Cold-water dressings to wound were applied, milk punch given freely, and an eighth of a grain of sulphate of morphia every two hours. At 1 P. M. Dr. MEACHAM, assisted by Assistant Surgeon J. B. Giuard, U. S. A., placed the patient under chloroform and thoroughly explored the injury, after enlarging the entrance wound to admit the finger to ascertain the extent of shattering of the neck, trochanters, and shaft. No important vessels or nerves were involved. The patient was an old soldier; he had been a hard drinker; during the civil war had been more than once wounded, having on one occasion suffered a shot fracture < f the lower jaw. After careful consideration of the local and constitutional conditions it was determined that excision of the upper extremity of the femur would afford the patient the best chance of life. Dr. MEACHAM made a curvilinear incision seven inches in length, beginning an inch and a half above the trochanter major, traversing the entrance wound and extending downward in the axis of the shaft. Exposing the bone by rapid division of the muscular attachments, the fragments of the shaft were first removed and the pointed upper extremity of the shaft was then divided by the chain saw; then, with some difficulty, the head of the bone was exarticulated, and the operation completed. The exploratory incisions, consultation, and final excision occupied nearly an hour. Little blood was lost, and the patient promptly rallied, with little sign of shock. The upper part of the incision was united by sutures and adhesive strips. The man was put to bed with the injured limb extended, and a weight of four pounds attached by Buck's method. The wound had cold- water dressings, and the patient had an ounce of brandy every hour when awake, and a quarter of a grain of sulphate of morphia every two hours. December 4th, the patient had passed a good night, and had a full pulse at BO. During the day he had nutritious diet, a half ounce of brandy hourly if awake, and two grains of quinia and an eighth of a grain of sulphate of morphia every four hours. Excised fragments of bone were cleaned and sent to the Army Medical Museum and preserved as Specimen 5658, of the Surgical Section, which are represented one-fourth the size of nature (FIG. 78). On December 5th, in the early morning, there was little change in the constitutional symptoms. The patient had slept four hours during the night. He was troubled with hiccough. He had partaken freely of freshly prepared essence of beef. At the surgeon's morning visit, at half past seven, twenty-grain doses of bromide of potassium were substi- tuted for the morphia, and the other treatment and diet were continued, with the addition of canned oyster soup. At the evening visit, at nine, the hiccough had nearly ceased, the wound had begun to suppurate, the pulse was 100, the tongue was moist, and the thirst diminished. The dose of bromide of potassium was reduced one-half; the other treatment was con- tinued. On the morning of December 6th he was found to have passed a restless night, annoyed by hiccough when awake. He complained of the extension, and the weight attached to his foot was diminished one-half. Whiskey was substituted for the left hip. [From a photograph.] brandy which he disliked, and a tincture of sesquichloride of Spec "5658" A. M.M." iron was given in twenty-drop doses, with two grains of sul- phate of quinia every four hours. One-fourth of a grain of sulphate of morphia was ordered to be given when the pain demanded it. The patient was removed to a water-bed. On December 7th the patient was more comfortable and had slept well. He was annoyed by flatulence, the bowels not having moved since the reception of the injury. He was ordered a tablespoonful of castor oil and twenty drops of turpentine, and an enema of soap and water. The suppuration from the wound was quite copious. On the following day it was practicable to omit the anodyne, and the patient had a free evacuatiou of the bowels, with great relief. The patient was allowed a small piece of beef-steak for his breakfast, and chicken for dinner. The discharge from the wound was profuse, and the integument over the hips and nates was somewhat abraded from heat and moisture. The weight attached to the foot was removed altogether. The patient was transferred from the water-bed to a mattress, in the middle of which was a movable portion corresponding with the pelvic region. This arrangement greatl}- facilitated the application of dressings and the use of a bed-pan. The patient was ordered three ounces of beef essence thrice daily and as much milk as he should relish. On the 9th, he was found to have slept well without taking an anodyne. The suppuration was profuse. The pulse was at 1C0. The appetite was abundant. Hiccough was again quite troublesome. The bowels had not been moved since the 7th, and an enema of castile soap and warm water was ordered to be given daily, unless there should be an alvine evacuation before nine in the morning. During the next fortnight there were no symptoms of especial interest. The wound continued to suppurate, but less copiously, and was rapidly filling up with granulations. On December 2Cd the patient passed a very restless night. The surface was hot, and the pulse at 100; the appetite was gone; the abdomen was tympanitic. On December 23d, he had several dejections, and had slept soundly during the previous night, and was in every respect much better. On January 1, 1870, his bowels were again obstinately constipated. Cicatrization of the wound was rapidly going on. Citrate of iron and quinine was substituted for the sesquichloride of iron. Laxative enemata were required daily, and whiskey was still given. The obstinate hiccough ceased about the middle of January, at which date the pulse had fallen to an average of 90, and the wound had far advanced toward healing. For the next six weeks there was very little change in the daily record. The patient's convalescence progressed favorably, and by February 28th the wound was open at two points only. Constipation was still a troublesome complication; the patient being annoyed by injections he was ordered to take a three-grain compound cathartic pill nightly. By the end of March the patient was able to sit up. There were still two fistulous sinuses leading FIG. 77.—Cicatrix in Meaeham's case of successful excision of the FIG. 78.—Anterior and posterior views of head and trochanters of left femur excised for shot perforation. SECT. II. | EXCISION AT THE HIP FOR SHOT INJURY. 121 gratifying result of four recoveries. Adding to the sixty-six cases of excision at the hip for shot injury performed during the War of the Rebellion the ninety-nine cases referred to in Note 1 on page 90 ante, and the six cases detailed in Note 1 commencing on page toward the cotyloid cavity. About an ounce of pus was discharged daily. The limb was about five inches shorter than the other. On April 10th the patient got on crutches, but could not walk far without fatigue. For the next twenty days he seemed disinclined to exert himself but was taken out every day in a wheeled litter. One of the sinuses had closed. By July 8th the patient had gained in flesh and strength, and the purulent discharge had diminished ton few drops daily. The limb was swollen considerably and there was an erysipelatous blush extending below the knee. At this date Br. MEACHAM was ordered to Omaha, and the patient passed into the hands of Acting Assistant Surgeon L. S. TESSON, who, on July 29th, wrote to Dr. MEACHAM that quite a large abscess formed in the muscles of the thigh. On August 9th, Dr. TESSON again wrote that it had been necessary twice to make incisions to evacuate abscesses in the thigh. Again, on March 9, 1871, Acting Assistant Surgeon A. J. Hogg writes that the man is entirely well, the cicatrix being perfectly sound; but the man persisted in lying in bed. On April 1, 1871, Dr. MEACHAM reports that ho had succeeded in getting his patient again under his personal observation, previous to which he had borne transportation in an ambulance for ninety miles, and appeared in better spirits at the end of the journey than when he set out. Tho wound had entirely healed, leaving a firm and sound cicatrix three inches in length. The patient was able to walk comfortably on crutches and had slight control over the limb, which admitted of a to-and-fro motion, with rotation inward. The upper end of the femur rested on the dorsum of the ilium, about one inch above the acetabulum, and was movable in that position. There was six and a half inches shortening. The patient was somewhat hypochondriacal, being greatly troubled with indigestion and irregular bowels. A photograph of the patient, taken at Omaha, March 30, 1871, is copied in the wood-cut (FIG. 77). Private Hubert Erne was discharged from service May 18, 1671, and by an order dated A. G. O., June 9, 1871, was sent to the Soldier's Home, near Washington. In answer to an enquiry from this Office, Surgeon C H. LAUD reported : "Hubert Erne, late of the 4th Infantry, was received in hospital at Soldier's Home on July 16, 1871, in a very emaciated and feeble condition, the result of chronio diarrhoea. Having during his residence here exhibited symptoms of partial insanity, and having no facilities fur the proper care of such cases, he was transferred to the Government Insane Asylum, near Washington, August 20, 1871, at which place it is reported that he died a short time after his admission." Then Dr. C H. NICHOLS, Superintendent of the Government Hospital for the Insane, reported that the patient " was admitted August 19, 1871, to be treated for acute insanity, and that he died Nov. 7, 1871, from exhaustion, of acute mania. No autopsy was made in the case." Another primary excision at the hip for shot fracture of the upper extremity of the femur was practised at Fort Concho, Texas, in 1874, by Assistant Surgeon W. F. BUCHANAN, U. S. A. The fracture was attended with very extensive longitudinal splintering, and it would appear that such conditions involve incisions of such perilous magnitude as to afford the slightest prospects of success even under the most favorable attendant circum- stances. The abstract of this case has not, at this date, (June 1, 1878), been published in print.—Sergeant T. Duncan, Co. K, 25th Infantry (Colored), aged £7, was shot in the left hip while a prisoner and attempting to escape from his guard at Fort Concho, Texas, on the morning of November 24, 1874. On receiving the injury, which was produced by a conical rifle ball at a distance of about sixty yards, he fell to the ground, when he was placed on a wheeled litter and was conveyed to the Post Hospital. At 9.20 A. M. an ounce of brandy with half a grain of morphia was administered. Au examination externally exhibited a wound of entrance in the gluteal region, on a line with the lower border of the great trochanter, and about mid- way between the trochanter and the tuberosity of the ischium; the wound of exit existed in the anterior part of the thigh, same side, about an inch and a half below Poupart's ligament and one inch external to the femoral vessels. The mobility, crepitus, probing, etc., proved that the upper part of the shaft of the femur had been shattered; a compound comminuted fracture, doubtless extending within the capsule. Venous haemorrhage was taking place from the wound in the gluteal region, and great pain was felt in touching the great trochanter and in the knee. There was also great nervousness, and quick and feeble pulse. He was placed on his right side, the injured leg supported, the body bolstered, and the haemorrhage controlled by pledgets of lint saturated with a solution of persulphate of iron. Cold-water dressing was applied, a tin warmer filled with hot water applied to the feet, and a quarter of a grain of sulphate of morphia together with an ounce of brandy was given every two or three hours. On the following day, at 11.30 A. M., the patient was quite nervous, suffering great pain, and only relieved bj' the full effects of the anodyne, having slept little during the night and eaten nothing but a little beef essence; pulse 120 and small; tem- perature normal. It was decided that resection offered him the only chance to survive. He was therefore placed on the operating table and brought under the influence of the anaesthetic, consist- ing of one part of chloroform, and two of ether, when a longitudinal incision about eight inches in length was made, commencing just above the trochanter und extending in the axis of the head and neck of the bone, and the soft parts were dissected away. The upper end of the shaft being found much shattered and the fracture extending within the neck, the head of the bone was exarticulated and the fractured extremity removed with the chain saw. About five inches of the shaft, with the head and neck, were exsected. No arteries were cut, and but one small vein was ligated. All the fragments of bone, about forty, were removed, the parts washed out and a weak solution of per- manganate of potassa applied, the sides of the wound being united with interrupted sutures sup- ported by adhesive straps. The patient was then placed in bed, position maintained by sand bags, and cold-water dressings instituted. As soon as he had recovered consciousness, brandy and morphia were given and repeated frequently. Warmth was applied to the feet. The patient was of great muscular development, and the incision required to be lengthened an inch or so to allow of necessary retraction. His pulse was about the same as before the operation, rather full. Although relieved of the pain he had suffered previous to the operation, he continued restless, constantly trying to change his position, groaning, etc., and died on the morning of November 26th, about fourteen hours after the operation." The excised portion of the fractured femur, represented in the wood-cuts (FIGS. 79, 80), with the history, was contributed to the Museum by the operator, Assistant Surgeon W. F. BUCHANAN, U. S. A. Of the excisions at the hip after shot injury, practised since the close of the civil war in the United States Army, one was an intermediary operation performed by Surgeon Glover Perin, U. S. A., at Newport Barracks, Kentucky, in August, 1867: Case.—Private Francis Ahearn, aged 30 years, U. S. General Service, was wounded at Newport Barracks, Louisville, on July 31, 1867. He was a prisoner in the guard-house, and was shot by a sentinel while attempting to escape. The ball entered behind and below the prominence of the right trochanter major and passed inward and upward, emerging on the anterior part of the thigh, two inches below Poupart's ligament, a little to the outside of the course of the femoral artery, having shattered the upper part of the femur, the fissures extending within the joint. The wounded man was immediately taken to the Post Hospital, and was examined by Colonel PERIN, the surgeon in charge. The patient had been an habitual drunkard for years and had mania a potu when shot. The shock of the injury was so great that an operation was not considered advisable. It was determined to adopt a supporting treatment, and to endeavor to build up the general health, with a view of operating at the first favorable moment when a good result could be reasonably anticipated. On August 26, 1867, the patient was in a better condition than at any time subsequent to the reception of the injury. The pulse was at 90; there had been troublesome diarrhoea, but it was some- what abated; the injured limb was much wasted, except at the upper part of the thigh, where it was greatly swollen; the discharge from the wound was very copious, and there was extreme pain on the slightest movement. There were abscesses about the joint communicating with its cavity. Excision having been decided upon, Surgeon PEEIN, assisted by Assistant Surgeon T. E. Wilcox, U. S. A., proceeded with the operation. The patient being rendered insensible by a mixture of chloroform and ether, the entrance wound was enlarged by a straight incision downward and three Surg. Ill—16 Flo. 79. —Shattered upper extremity of the left femur. Spec. 6513. Fig. 80.—Posterior view of the same specimen. 1 oo 1 ^J_l INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Fig. 82.—Posterior view of the same specimen. 120, we have a total of one hundred and seventy-one instances of excision at the hip for shot injury, of which one hundred and forty-eight, or 86.5 per cent, proved fatal. Forty- three of the operations were primary, with forty deaths, or 93 per cent.; sixty were inter- inches in length. The head of the bone was disarticulated, and the shaft was sawn several inches below the lesser trochanter. The wound was then cleansed and approximated. Scarcely any haemorrhage took place, no ligatures being required. On recovering from the anaesthetic, the patient com- plained of great pain and nausea. Brandy was administered, and half a grain of sulphate of morphia; but there was such irritability of stomach that everything was rejected. A quarter of a grain of sulphate of morphia was then administered hypodermically, and this relieved the pain. But there was no decided reaction, and, sinking gradually, the patient died from the shock of the operation twenty hours after its completion. No autops}- was made. The shattered excised bones were sent to the Army Medical Museum, and are represented in the adjoining wood-cuts (FIGS. 81, 82). Many of the fragments were carious. Of the six cases of excision at the hip joint practised on account of shot injury in the United States since the civil war, three were successful secondary operations. Two occurred in the United States Army and one in the United States Navy. The first of the operations was performed by Assistant Surgeon J. R. Gibson, in August, 1868. The patient recovered with a very satisfactory control of the functions of the articulation and limb. A detailed report of the case was published in Circular No. 2, S. G. O., 1869, pp. 117-120, and in Circular No. 3. S. G. O., 1871, p. 228, an account of the pensioner's progress was given, with a lithograph plate showing the appearance of the injured limb three years subsequent to the operation. The following is the condensed abstract of the case as published in Circular No. 3: " Private Charles F. Read, Co. I, 37th Infantry, while in a stooping posture, and distant about one hundred feet, was shot by a sentinel at Missouri Bottom, New Mexico, on June C, 18C8. The ball struck about the middle of the posterior aspect of the left thigh, causing an injury to the bone, the nature of which is shown in the accompanying wood-cut (FIG. 84), illustrating the specimen contributed to the Army Medical Museum by the operator, Assistant Surgeon J. Fig. 81.—Shattered upper r. Gibson, U. S. A. The case being fully detailed in Circular No. 2, S. G. O., 1869, page extremity of right femur, ,,_,. t> j > . > r b excised for caries following * ' reference will only be made to the more salient points, and to information received since shot fracture. Spec. 5489. the publication of that report. After weeks of temporization, during which the patient, a young man in the prime of life, had become much exhausted from numerous and futile searches after the missile, from bedsores, profuse suppuration, an irritable diarrhoea, and pain so intense as to require the administration of an anaesthetic previous to dressing the wound, the choice lay between a lingering death or excision of the head of the femur, or the more fearful and precarious alternative of amputation at the joint. On August 14th the patient expressed willingness to submit to any operation that would afford relief, when he was anaesthetized for the purpose of again freely examining the parts, and performing such operation as should be considered necessary. Upon explorations of the wound with the probe and finger, the ball was discovered in the head of the femur, a T-shaped incision was made over the joint, the head of the bone was turned out of the acetabulum, and was sawn through the neck, just within the greater trochanter. The incisions were closed with metallic sutures, and the limb was temporarily placed between splints, with a pillow under the knee. A Smith's anterior splint not being on hand, nor the material procurable for making one, a long external splint, made in two parts, and connected by iron braces, was devised and put in course of construction. The after treatment consisted in carbolized dressings to the wound, the administra- tion of antiperiodics to control a fever of a remittent tj-pe (at one time supposed to be the precursor of erysipelas or pyaemia), and a plain nutritious diet. Notwithstanding frequent displacement of the limb from occasional attacks of diarrhoea, and the absence of a proper apparatus to secure immobility, the performance of this formidable opera- tion seemed to have imparted a new tenure of life. By November 20th the patient was able to walk about the hospital, and the further progress of the case was as rapid as it was favorable. On May 16, 1869, this soldier was discharged the service and pensioned for total and permanent disability, the injured member being shortened one inch and three-quarters. He came across the plains by the next train, and, in September, 1869, reported at the Surgeon General's Office, where a photograph was taken. At that time the patient's general health was excellent; the cicatrix was perfectly firm and sound, and the strength of the ligamentous attachments and the amount of control over the movements of the limb were very remarkable. He could bear much weight on the limb. He was supplied with a prothetic apparatus and advised not to use it straightway, but to continue exercising the limb continuously for some months, thereby increasing the strength of the muscles and ligamentous attachments, and the freedom of the newly-formed joint. The next week Bead went to New York, where the pro- posed apparatus was ingeniously applied by Dr. E. D. HUDSON. In the summer of 1870, it was reported that this man could walk very comfortably with a cane either with or without appa- ratus. The appearance of the patient is shown in the accompanying wood-cut (FIG. 83.) In June 1871, three-years after the operation, the man was in very good health, and could walk almost as well as ever." He was last paid on September 4, 1877. The next secondary operation was performed by Surgeon W. E. Tatlor, U. S. Navy. A report of the case was published in Circular No. 3, S. G. O., 1871, p. 232: Charles B. Scott, a seaman of the U. S. Navy, aged 34, of fair general health, was wounded in an attack on a piratical vessel in Tecapan Itiver, west coast of Mexico, June 17, 1870, by a rifle ball, fired at a distance of about eighty yards. He was conve3Ted a distance of seventy miles to the U. S. ship Mohican, on board of which he was treated for several days, and finally transferred on July 12th to the Naval Hospital, Mare Island, California. The wound of entrance was small, and situated a little below and about two inches posterior to the top of the left great trochanter. He rested entirely on the right side, with the Injured limb partially flexed and resting on the sound one, the whole limb being inverted and shortened about one inch. Cold-water dressings had been applied to the wound and anodynes administered when required. His general condition was decidedly below par. The least movement in the injured joint caused severe pain ; he did not sleep well, and his appetite was poor. Full diet, with milk and an anodyne at night, were ordered. On July 14th an examination of the wound was made. No anaesthetic was used, and the result was unsatisfactory. However, appearances led to the belief that the neck and probably the head of the femur were fractured; the ball could not be felt. The joint was not swollen bat was very sensitive, and there was a scanty sanious and fetid discharge from the wound. On July 25th the patient was chloroformed, and Surgeon W. E. Taylor, U. S. Navy, made a single straight incision, seven or eight inches long, and found the neck and head extensively comminuted; he then sawed off the bone just below the trochanter minor, and removed the fragments, some twelve or fourteen in number, as also the ball, which seemed to have struck the neck obliquely, breaking it into three pieces, and then passed into the head, shattering it into nearly a dozen pieces. Very little blood was lost, two small arteries only requiring to be secured. After syringing the wound with a weak solution of permanganate of potash, it was partially approximated by four sutures, and the limb was placed in an ordinary fracture box, and dressed with oakum. The operation was well borne, and reaction prompt. Stimulants, with nutritious diet, were ordered, and rigid cleanliness was enforced. On the 27th the patient began to suffer from decubitus. On the evening of the 29th he became delirious; pulse 130 FlG. 83.—Appearance of the limb fifteen months after the operation. FiG.84.-Excised head of left femur with impacted musket ball. Sp. 5576. SECT. IL] EXCISION AT THE HIP FOR SHOT INJURY. 123 FlG. 85.—Anterior and posterior views of the upper extremity of the left femur. Spec. 5884. Fig. 86.—Appearance of limb seven months after operation. mediary, with fifty-eight deaths, or 96.6 per cent.; forty-one, with twenty-six deaths, or 63.4 per cent., were secondary; and, in twenty-seven instances, with twenty-four deaths, and irritable. Hydrate of chloral being substituted for morphia, lie went to sleep in a few minutes, and next morning awoke refreshed and feeling better than at any time since the accident. The pulse fell to 100. On the 31st, the sutures were removed. The good effect of the chloral was very marked, but, by August 6th, it seemed to have lost some of its effect; whereupon morphia was combined with the usual dose, and he slept well. The discharge from the wound was small in quantity and laudable. On August 8th, some exten- sion of the limb was made, but was badly borne. By the 14th, the patient was doing well in every respect. On the 21st, all dressings being removed from tho limb, it was thoroughly bated and rubbed, after which it was replaced in the fracture box, when extension and counter-extension wcro made by means of the ordinary perineal band and screw. This was discontinued on the 26th, owing to enlargement of tho inguinal glands and the general malaise and discom- fort experienced by the patient. On tho 30th, the use of anodynes was discontinued, as he could sleep without them. September 1st, found the patient improving, the discharge from tho wound being moderate, with an entire absence of inguinal trouble, bedsores, and excoriations. Slight passive motion was commenced in the limb, and it was allowed to rest lightly on a pillow for several hours. On the 7th, he was able, for the first time, with assistance, to leave his bed. After this he continued to sit up several hours daily, and, gaining in flesh, was able, by the 18th, to walk on crutches. He continued to take daily a moderate amount of outdoor exorcise, the limb meanwhile being supported and steadied by means of a wire splint, and his general condition became excellent. On December 27th, he went by steamer to San Francisco, a distance of fifty miles, and returned in the evening, having borne tho journey well. On January 20, 1871, a prothetic apparatus was adjusted to the limb, which, at the beginning, proved highly useful. On February 1st, the patient was transferred to the new Naval Hospital. At this time his general health was excellent. The left buttock was somewhat flattened, and there was a small opening about the centre of the line of incision, which discharged a small quantity of pus; the limb was about three and a half inches shorter than its fellow, the knee being quite stiff and foot everted (Fig. 86). The patient had gained about thirty pounds since the operation of excision, and there was a probability of his being able to walk quite well without the aid of crutches. Scott was discharged April 18,1871, at Mare Island, California, and pensioned. Drs. R. V. WALSH and J. S. GUNNING, of Enniskillen, Ireland, certified, Sep- tember 4, 1875: "There is a fistulary opening connected with the bone. The leg is greatly wasted, being one-third the size of the sound leg." Dr. John St. Clair Gunning certified, October, 17, 1877: "Charles B. Sintt, who died at Oniagh, Tyrone County, Belaud, on the 1st day of July, 1877, was under my professional care, and his death was caused by chronic cystitis, the result of a very extensive and severe injury to his hip joint." The specimen 5884 is preserved in the Museum and shown in the accompanying wood-cut (FIG. 85). The third of the secondary operations of excision at the hip joint for shot injury was practised at Fort Fetterman, Wyoming Territory, in September, 1877, by Assistant Surgeon JOHN V. It. HOFF, U. S. A., who has furnished a detailed report of the case, from which a condensed abstract is made: Sergeant William J. Linn, Co. M, 4th Cavalry, aged 22 years, was wounded in a fight with Cheyenne Indians during the Powder River Expedition, November 25, 1876. The bullet (probably conoidal, calibre .50 inch, weighing 412 grains) entered the right groin three inches below and slightly internal to the anterior superior spinous process of ilium and two and three-fourth inches external to the symphysis pubis, passed obliquely backward through the hip joint, fractured the neck of the femur, notched the posterior segment of the rim of the acetabulum, and emerged at a point about one inch posterior and exterior to the notch in the acetabulum. The wound was received while the soldier was resting on his right knee and left foot in the act of discharging his carbine. The patient was immediately earned to the rear and a plaster of Paris badge applied. He was moved on a travois over an almost impassable country, during weather so cold that mercury froze, and reached Supply Camp on the third day. Here the plaster bandage was reapplied and the patient was placed in an ambulance and carried to Cantonment Reno, reaching the latter place after a five days' jour- ney over a country where roads are unknown, in weather of the utmost severity, and under circumstances of hardship which skillful care and unremitting attention could hut little alleviate. A week after his arrival at Reno, the plaster bandage was removed, the limb was elevated, and the wounds of entrance and exit, which were discharging pus freely, were treated with simple dressings. The wound of entrance closed in four weeks, and, though the wound of exit was still discharging, an immense abscess formed in and about the joint, which pointed in anterior cicatrix, finally opened spontaneously, and remained so for several months. A light extending weight was used for a short time, no medicine given except morphia occasionally for pain and physic for constipation. On March 24, 1877, the patient was transferred to the post hospital at Fort Fetterman. The journey was accomplished in five days on a stretcher slung in an army wagon. When admitted he was very emaciated, pale and pain-worn, and weighed about 100 pounds, having lost 80 pounds since the recep- tion of the injury. Two suppurating sinuses led into the articulation and there was fibrous anchylosis of both hip and knee joints. The patient had not moved from a recumbent ._=rT position since he received the injury, and could not even be raised upon a bed-pan without TeS= great pain. Tonics and a generous diet were ordered, the wounds were dressed with carbolic ijU acid solution. The bowels were freely opened and kept regular. When the patient had fairly ^ recovered from the exhausting effects of the journey a side splint was applied which enabled him to be moved without pain. Notwithstanding the most careful attention the patient Fig. 87.—Appearance of gradually failed, and grew so feeble and complained so much of pain that it seemed but a limb ten months after oper- question of weeks between an operation or death. On September 28th, Assistant Surgeon ation. Side view. j y R H0FF! v g A-) excjsed the hip joint after Sedii.LOTTS method. A circular incision was made to include the great trochanter and opening into the joint, the capsular ligament was severed, the head of the femur was thrown out and removed by the chain saw at a point just below great trochanter. The head of the femur (proper), which had been severed by the bullet at its neck, was found lying loosely in the acetabulum partially absorbed, and was easily removed by forceps. Ether was used; insensibility induced in seventeen minutes and maintained one hour and ten minutes; reaction was rapid and satisfactory. Antiseptic dressings were used. A double splint to fit both legs, made of light iron, reaching to the waist and there secured by a belt, was applied. This proved most useful in enabling the patient to be moved with comparative ease, and, at the same time, keeping the wounded parts measurably immovable. Extension was applied by means of tin plates Anterior view of 1-1 INJURIES OF THE LOWER EXTREMITIES. x [CHAP. x. or 88.8 per cent., the period of the operation was not stated. Grouping the one hundred and seventy-one cases of excision at the hip, according to the time or the occasions on which the injuries were received, we find that of sixteen operations performed before the American war, 1860-65, one proved successful, and that in a second the patient survived after con- secutive amputation; that four fatal operations were performed during the insurrection in Poland, 1863, and the campaign in Schleswig-Holstein, 1864; that six excisions at the hip with two successes were performed during the Austro-Prussian War of 1866; that of seventy-one operations done in the Franco-Prussian War of 1870-71, eight were success- ful; that once, at least, excision at the hip was unsuccessfully performed during tlie Russo- Turkish War, 1876-77, and that in one instance the hip joint was successfully excised for shot injury in 1876, in California; that of the sixty-six cases of excisions at the hip per- formed for shot injury received during the American civil war, six proved successful; and that finally, of the six cases performed in the service of the United States since the close of the American war in 1865 to the present time (1879), four were attended with success. Of the six survivors of excision at the hip performed on patients wounded during the American civil war, two only were living in the early part of 1879: Brown, of Grand Rapids, Michigan (Case 261, ante), and Pease, of Indianapolis, Indiana, (Case 263, ante); both were examples of recovery from secondary excision. Brown can bear his weight upon the injured limb, can walk across a room without the aid of crutches or cane, but ordinarily uses a support. Pease, with the assistance of a "six-inch lift," can walk quite well with a cane. Tilliston, the third survivor of secondary excision, lived until Septem- ber 6, 1871, ten years after the operation. He was unable to bear any'weight on his limb, and was obliged to wear crutches. He succumbed to most extensive necrosis of the pelvic bones and femur, with huge recurring abscesses. In the case of Cannon, the sur- vivor of primary excision (Case 206, ante), the limb was useless for purposes of locomo- tion. He died of diphtheria in 1865, eighteen months after the injury and operation. Of the two survivors of intermediary excision, Lieutenant J. M. Jarrett (Case 239, ante) went to his home in North Carolina, and was reported as doing well in September, 1864, ten months after the operation; walking about with a high-heeled boot and the aid of a cane. Persevering attempts to obtain further information regarding the ulterior history of three inches wide by twelve inches long, secured to the leg by adhesive straps and connected through eyes, at their extremities, by elastic tubing, to a twenty-one pound weight, playing over a pulley. The tubing passed through a piece of board twelve inches long, secured below the foot piece, thereby preventing pressure on the malleoli. This arrangement answered the purposes of extension admirably, while counter-extension was effected by elevating the foot of the bed. The patient's convalescence was very tedious. He suffered from bed-sores and almost continuous pain, requiring the constant administration of opiates and anodynes; but gradually improved, and, on December 0th, Dr. HOFF notes: " From this date there was scarcely an untoward symptom. Convalescence progressed slowly but surely; stiffness of the muscles disappeared entirely about the 15th instaut. Tympanitis lasted three days. Spasm persisted, but with greatly reduced violence, nearly two weeks after the extension-weight was removed, December 27th. Thepatienthaddailyexercise, FlG. 88a.—Excised uppcrex- an(i) ,„, January 111, 1878, took his first walk in the open air. The discharge grew less in pIQ gg^__Posterior view of tremity of right femur; anterior amouutj and on jalmary 15th, the dressings were entirely removed. February 17th, the the same. ' partial anchylosis of the right knee joint not having been fully overcome by passive motion and mechanical appliance, ether was administered and the adhesions thoroughly broken up. There was partial bony anchylosis, the patella at portion of superior external border was firmly joined to femur, and in the breaking down suffered fracture. The limb was placed in a straight splint, and on the third day passive motion was instituted. March 18, 1878, the patient was ordered to join his regiment. The false joint at the hip had all the motions of its predecessor in a somewhat limited degree, and, though capable of sustaining the patient's weight while walking, was not yet equal to any great exer- tion, but daily gained in strength. In other respects the patient's health was in admirable condition. Apparent shortening of the limb one inch. The resected upper extremity of the femur was contributed to the Army Medical Museum by the operator, and is numbered 0787 of the Surgical Section. It is shown iu the wood-cuts (FIGS. 88a, 8Sb). In a letter to Dr. HOFF, dated Fort Clark, Texas, April 3C, 1878, Sergeant Linn writes: " Dear Sir: I write to you according to promise to let you know how 1 am getting along. I am feeling just as well as ever I did. My leg is improving in size and strength, but the hip joint is just about the same as when I left you. I weigh one hundred and fifty pounds now and am still improving." On July 10, 1878, Surgeon Johx MOOKE, U. S. A., Medical Director Department of Texas, forwarded to the Surgeon General two photographs showing the appearance of the limb ten months after the operation. They are copied in the wood-cuts (Figs. 87, 88) on the preceding page. In a letter from Fort Clark, Texas, October, 1 L-7.-3, Linn states that he "don't use a crutch at all, and only uses a cane when he goes to walk a long distance." SECT, n.] EXCISION AT THE HIP FOR SHOT INJURY. 125 this officer were unavailing. The second survivor of the intermediary operation, Hugh Wright (Case 240, ante), excised May 27, 1864, walked well without crutch or cane, bearing his full weight on the mutilated limb. He lived until October 26, 1874; his death was ascribed to cardiac trouble. Of the six patients submitted to excision at the hip in the United States Army and Navy since 1865, four recovered. Assistant Surgeon F. Meacham's primary case of Erne, 4th Infantry, aged 48 (Note 1, p. 120, ante), operated on December 3, 1869. lived until November, 1871. The patient walked comfortably on crutches and had slight control of his limb. Recovering thoroughly from the coxo-femoral lesions, he became a great sufferer from chronic diarrhoea, and, at last, was attacked with acute mania. The other three cases were examples of successful secondary excision. In the case of Charles F. Read, 37th Infantry (Note to p. 122, ante), wounded June 6, 1868, and successfully excised by Assist- ant Surgeon J. R. Gibson, August 14, 1868, the result was exceptionally gratifying. In a letter from his home at Thornton's Ferry, New Hampshire, dated July 1, 1878, nearly ten years after the operation, Read was able to write that he thought he had a very good leg under the circumstances, and used no artificial appliance. His crutches he had laid aside since 1871, relying altogether on his cane, with which he "could get along very handily." He adfls a minute account of the condition of the injured limb, showing indis- putably an extraordinary restoration of the functions of the articulation. "I can use it so well," says Read, "that some think me falsifying when I tell them that the head of the bone is lost." In the secondary case of the seaman, Charles B. Scott, wounded June 17, 1870, on whom Surgeon W. E. Taylor, U. S. N., successfully excised the head of the femur, July 25, 1870, there was temporary relief. The patient regained comparative health and flesh, and partial use of the limb, exchanging his crutches for a cane; but necrosis invaded the articulation, and the patient succumbed July 1, 1877, while on a visit to his friends in Tyrone County, Ireland. In the case of Sergeant W. J. Linn, 4th Cavalry, wounded November 25,1876, who underwent excision at the right hip by Assistant Surgeon J. V. R. Hoff, U. S. A., September 28, 1877; a year after the operation the patient's health was in admirable condition, and there was every prospect that the mutilated limb would regain as great a measure of utility as can be hoped for, under such circumstances. In October, 1878, he had discarded the crutch, and only used a cane when he walked long distances. Of the sixty-six excisions at the hip performed during the American civil war, forty- five were practised on Union and twenty-one on Confederate soldiers. Of the forty-five Union soldiers, four recovered, a mortality rate of 91.1 per cent.; of the twenty-one Confederates, two recovered, a fatality of 90.5 per cent. The side on which the excision was practised was recorded in sixty-one of the sixty- six cases, twenty-six being on the right and thirty-five on the left side. Three of the former, or 88.4 per cent., and also three of the latter, or 91.4 per cent., proved fatal. Six operations, viz: one primary, four intermediary, and one secondary, performed on patients under the age of 20 years, terminated fatally; twenty excisions, viz: nine primary, six intermediary, and five secondary, on patients, between 20 and 29 years, inclusive, presented three recoveries, one after a primary, and two after intermediary operations; of thirteen operations on men between 30 and 39, six were primary, four intermediary, and three, with two recoveries, were secondary; four excisions were per- formed on patients over 40 years, two being fatal intermediary, and two, with one recovery, 126 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. secondary operations. In twenty-three of the sixty-six excisions the ages of the patients were not ascertained. According to the statistical arrangement of the cases of excision at the hip for shot wounds in the American civil war, as given in Table X, p. 89, ante, the mortality of the primary operations was 96.9 per cent., that of the intermediary 90.9 per cent., while the fatality of the secondary operations was only 72.7 per cent. The results of the six excisions at the hip in the American Army and Navy since the civil war gave a mortality of 50.0 per cent, for the primary operations, of 100.0 per cent, for the intermediary, while the three secondary operations were all successful. Of the ninety-nine other cases of excision at the hip after shot injury, cited in Note 1, page 90, ante, of primary cases, 87.5 per cent, proved fatal; of the intermediary all perished, while, of the secondary, only 66.6 per cent, had a fatal termination. Aggregating all cases of excision at the hip for shot injury in which the results have been ascertained, we have a mortality rate of 93.0 per cent, for the primary, of 96.6 per cent, for the intermediary, and of 63.4 per cent, for the secondary operations. This result confirms what we have already stated on page 610 of the Second Surgical Volume, that the "excisions and amputations practised during the intermediary or inflammatory stage are by far the most dangerous, and should never be performed except as compulsory operations." The ratio of mortality in, the secondary or ulterior operations is considerably less than that in the primary operations. But this fact should not lead to the conclusion that the primary operation is to be avoided. The dis- astrous results attending cases of indubitable shot fracture at the hip treated by tempor- ization, as pointed out on page 88, ante, must induce the surgeon to desist from such an experiment, and to excise primarily rather1 than submit the patient to the danger of the inflammatory period.2 In nine3 of the sixty-six cases of excision of the head of the femur performed for shot injuries received during the American "civil war, the acetabulum was involved, and, although these nine cases terminated fatally, the-successful operations of Assistant Surgeon J. V. R. HofT, U. S. A., in the case of Linn (Note on page 123, ante), and of Drs. Schon- 1 Dr. JOHN Ashhukst, jr. (Princ. and Pract. of Surgery, 1871, p. 165), declares that: "Gunshot injuries of the hip joint are universally regarded as among the gravest injuries met with in military practice," and, after reviewing the statistical and other evidence on the comparative advantages of expectant treatment, excision, and amputation, asserts that: "From these facts the conclusion is fairly drawn, that in any case of gunshot injury of the hip joint, primary excision should be preferred to any other mode of treatment, and this simply to increase the chance of life, without reference to the utility of the preserved limb. Of course there may be such extensive destruction of parts as to put excision out of the question, and in such cases the surgeon must still have recourse to what Henxf.n calls the ' tremendous alternative' of hip joint amputation, an operation which may also be required secondarily, after an unsuccessful attempt to save the limb." Dr. WILLIAM THOMSON, formerly Brevet Major and Assistant Surgeon, U. S. A., who, as Acting Med- ical Inspector of the Army of the Potomac and Surgeon-in-charge of Douglas Hospital, Washington, had excellent opportunities to investigate the subject of shot fractures at the hip joint, wrote to the compiler in 1868: * * " From a study of these cases, and others similar in character, it would appear that the fatal terminations, under expectant treatment, are due to the following causes: the joint becomes inflamed primarily or secondarily; the capsule becomes distended by the products of inflammation, gives way, and the contents escape into the neighboring parts, and give rise to those extensive dissecting abscesses which are found at the autopsies, and which account so entirely for the fatal results. If these views should be accepted, a full and free incision into the joint, at an early period, would be the proper surgical procedure, and this is accomplished by its excision. The removal of the head of the bone severs, to that extent, the connection between the body and the lower extremity, prevents that constant disturbance at the joint that follows every motion of the body, and thus places the seat of injury at comparative rest. The division of the bone through its cancellated structure may increase the risk of osteomyelitis with its purulent infection, and experience may yet demonstrate that a full and free incision alone, in the primary stage, may be the best resource of surgery."—(Circular No. 2, S. G. O., 1869, p. 114.) 'LOSSEN (I.) (Kriegschir. Erf. aus Mannheim, Heidelberg und Carlsruhe, in Deutsche Zeitschr. fiir Chir., 1873, B. II, p. 64) cites a fatal case of shot fracture of the neck of the femur and great trochanter, and remarks : "A primary resection of the joint, with removal or gouging of the trochanter major, might in this case have offered a chance for recovery. But it was probably difficult to ascertain immediately after the injury how far the joint was involved. A secondary excision, from the general appearances (post-mortem) cited, gave very little prospect of success." Fischee (H.) (Kriegschirur- gische Erfahrungen, Erlangen, 1872, p. 201) remarks of shot fractures of the hip joint: " All well-timed operative interference miscarries on account of the difficulty of the diagnosis. . . I lament this difficulty and impossibility of exact diagnosis, because I believe that the best mode of treatment of shot fractures of the hip joint is the primary resection of the joint, however difficult the execution of the operation might be." 3Case 209, p. 93, Private Charles Beard, 12th Miss.; Case 224, p. 95, Sergeant S. Grimshaw; Cas-e 235, p. 98, Captain T. R. Robeson; Cask 236, p. 98, Unknown private of the First Army Corps; Case 237, p. 99, Unknown; Case 247, p. 105, Private C. E. Marston, 1st Massachusetts; CASS 257, p. 109, Corporal H. C. Sennett, 122d New York: CASE 259, p. 110, Lieutenant D. N. Patterson, 46th Virginia; CASE 269, p. 118, Private A. Toney, 16th North Carolina. SECT. II. I AMPUTATIONS AT THE HIP JOINT. 127 born1 and Hupeden,2 prove conclusively that an injury of the margin of the acetabulum does not preclude the operation of excision at the hip. When we consider the evidence adduced in the foregoing pages, and especially the fact that of one hundred and seventy-one patients on whom excision at the hip for shot injury is known to have been performed to the present date, twenty-three survived the operation, although in one instance the excision was followed by amputation at the hip (Neudorfer's case of Schranz, Note 1, on page 90, ante), and that the remaining twenty- two survivors had more or less use of the injured limbs, it must be admitted that the results of this operation, so far, have been encouraging, in an almost hopeless class of cases. AMPUTATIONS AT THE HIP JOINT.-In 1867, in a monograph on amputa- tions at the hip joint,3 it was stated that "fifty-three authenticated instances of amputations at the hip joint, performed on account of injuries inflicted by weapons or of lesions con- secutive thereto," had occurred during the American civil war. Since that time, data of thirteen additional cases of this operation have been (J>t;iiin■■■!. making, at the present time, a total of sixty-six cases of coxo-femoral amputations to be considered here: Table XIV. Numerical Statement of Sixty-Six Cases of Amputation at the Hip Joint. AMPUTATIONS. Primary....... Intermediary.. Secondary___ Reamputations Aggregate Total Cases. Ratio of Mortality. 88.0 100.0 77.7 33.3 83.3 I have continued to divide these sixty-six operations into primary, intermediary, secondary, and reamputations, according to the plan adopted in the monograph of 1867, and the relative percentage of fatality of the secondary operations and of reamputations confirm me in the opinion expressed at that time, that the reamputations "should be sep- arated into a distinct class, because they are quite numerous and widely differ in the risk attendant upon them from other secondary operations." Of nine cases of reamputations at the hip three only, or 33.3 per cent., were fatal; of nine secondary operations six, or 77.7 per cent.,- terminated in death. The subjects of the twenty-three intermediary exarticulations at the hip all perished, and of twenty-five primary amputations probably three were successful. As indicated in Table IX, page 65, ante, in twenty-seven of the sixty-six exarticu- lations the injury directly involved the hip joint. In thirty-two instances, the operations followed shot fractures which did not extend beyond the diaphysis of the femur. In two of this series and in seven examples in which the primary lesion implicated the knee joint, amputations in the continuity of the thigh had preceded the exarticulations at the hip. 1 See LANGEMSECK (B. von), Ueber die Schussfracturen der Gelenke und ihre Behandlung, Berlin, 1868, p. 16, and Case 21 of Note 1, on page 90, ante. *See DEININGER, Beitrage zu den Schussfracturen des HUftgelenks unter besonderer Beriicksichtigung der Erfahrungen aus dem Feldzuge 1870-71 und Benutzung der Aden des Koniglichen Kriegsministeriums, in Deutsche Militairdrztliche Zeitschrift, 1874, B, III, p. 300, CASE Ko. 37; and CASE No. 63, in Note on page 91, ante. 3Otis (G. A.), A Report o:t Amputations at the Hip Joint in Military Surgery, Circular No. 7, War Department, Surgeon General's Office, July 1,1867, Washington, p. 20. 1-8 INJURIES of THE LOWER EXTREMITIES. [CHAP. X. In the subjoined foot-note1 an endeavor is made to compile a correct record, in chrono- logical order, of the published authentic examples of amputation at the hip joint in military ■LARREY (D. J.) (Mem. de Cltir. mil. et Camp., Paris, 1812, T. II, p. 180), A soldier of the French army of the Rhine, in 1793. Primary operation; died within a week.—2. WEXDELSTAUT (Reminiscenzen, in HUFELAND's Neues Journal der Practischen Arzneykunde, Berlin, 1811, B. XXVI, Stuck II, p. 110) relates: "I have seen and examined an Englishman, who served as a sailor in the British Navy, and who had lost at the bloody battle of Aboukir, August 1, 1798, the thigh from a cannon ball, and who had undergone the amputation of the probably splintered stump out of the acetabulum, and who survived the operation many years."—3. Larret (D. J.) (Rel. chir. de VArmie. d'Orient, Paris, 1803, p. 329), Bonhomme, officer of the 16th Demi-Brigade, Army of Egypt, 1799. Primary exarticulation at right hip; died of the plague on the eighth day.—4. LARREY (D. J.) (Rel. chir. de VArmie d'Orient, 1803, p. 332), Drummer of 2d Light Demi-Brigade, Army of Egypt, in 1799, aged 20. Primary amputation at right hip; died in a few days.—5. L vnitEY (D. J.) (Mem. de Chir., etc., 1812, T. in, p. 350), A French soldier at Wagram, July 6, 1809. Primary operation; died in three hours.—6. LARREY (D. J.) (Mim. de Chir., etc., T. Ill, p. 351), A French soldier at Wagram, July 6, 1809. Primary operation; died within twenty-four hours.—7. Biiowxkigo (Guthrie's Commentaries, 6th ed., 1855, p. 62), A soldier at Elvas, 1811. Secondary operation ; died in eight days.—8. LARREY (D. J.) (Mem. de Chir., etc., 1817, T. IV, p. 26), A Russian soldier, in 1812. Primary amputation at left hip; died on the twenty-ninth day from dysen- tery.—9. LARREY (D. J.) (Mem. de Chir., etc., 1817, T. IV, p. 50), Lieutenant cf Dragoons, Borodino, September 7, 1812. Primary; alive and well at Orcha three months after.—10. Browxrigg (AVERILL (C.) (A Short Treatise on Operative Surgei-y, London, 1825, p. 217), Private 13th British Light Dragoons, December 29,1811. Secondary operation December 12,1812; recovery.—11. BROWXRIGG (Averill, loc. cit), Particulars not recorded; fatal.— 12. GUTHRIE (G. J.) (Treatise on Gunshot Wounds, 1827, p. 332), Private Mason, 23d British Infantry, in 1812. Secondary re-amputation ; death in seven hours.—13. Cooi'Eit (Samuel) (Diet. Pract. Surg., 8th London ed., 1861, Vol. I, p. 11C), A British soldier at Oudenbosch, in Holland, in 1814. Inter- mediary operation; died in a few minutes.—14. COLE (G. J. Guthrie, loc. cit., p. 351), A soldier at Bergen-op-Zoom, 1814. Secondary operation; died in twenty hours.—15. Emery (Guthrxj, loc. cit., p. 334), Sebastian de l'Amour, Corp. Chass. Britt., Spain, August, 1813. Secondary operatid'h July 21, 1814; death in thirty days.—16. GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, London, 1827, p. 342), Duguet, 45th French Regiment, aged 25, Waterloo, June 18, 1815. Intermediary operation July 7th: recovered. Duguet died in 1840 (GUYOX, Stat, des amputations pratiquies a VArmie d'Afrique, etc., pendant les annies 1837, 1838, e< 1839, in Gaz. Kid. de Paris, 1841, T. IX, p. 106).—17. Mr. BLICKE (J. THOMSON, Obs. after the Battle of Waterloo, Edinb, 1816, p. 270), A British soldier, Waterloo, 1815. Secondary operation; died in eight days.—18. B. BRODIE (G.J. GUTHRIE, On Gunshot Wounds of the Extremities, London, 1815, p. 116) operated, in 1814, unsuccessfully in a case of accidental shot wound.—19. QUARRIER (D.) (Med. Chir. Trans., 1820, Vol. VIII, p. 3), Seaman T. Sullivan, Algiers, 1816. Primary operation; death in fifteen minutes.—20. KlUMER (Exarticulation des Oberschenkels aus dem Huftgelenke, in Journal der Chirurgie, von C. F. von Graefe und Ph. v. Walther, Berlin, 1828, B. XII, p. 121), J. S. C---, aged 38, Waterloo, 1815. Exarticulated in 1822; died on the tenth day.—21. Er. Sper (ROUX (J.), Disarticulation de la cuisse d'apres des observations rec. a Saint Mandrier, Paris, 1860, p. 4), A galley prisoner at Toulon, in 1825; fatal.—22. Dieffexuach (J. F.) (Mag. fur die gesammte Heilkunde, B. XXIV, II, S. 335), A Baron, aged 22. Secondary operation in 1826; died in ten hours.—23. Dr. BRYCE (Glasgow Med. Jour., 1831, p. 262), Soldier, aged 23, at the siege of Athens, May, 1827. Recovery in six weeks.—24. ROUX (P. J.) (Gaz. des Hop., 1830, p. 392), A Swiss subaltern, in 1830. Primary operation; died the same day.—25. CLOT BEY (Gaz. des Hop., 1830, T. IV, p. 96), Ali Homer, an Arab, aged 26. Secondary operation in 1830; died November 17, 1830.—26. SEDILLOT (C.) (Ann. de la Chir. Franc, et Et., 1841, T. II, p. £7!'). A Russian prisoner; Poland, 1831. Primary; died soon after the operation.—27. The elder DEMME (VERDAT, Thise inaug., Berne; 1846, and A. LiJNING, fiber die Blutung bei der Exarticulation des Ober- schenkels, ZUrich, 1877, p. 69), Polish solder, in 1831. Intermediary operation ; death in thirteen days.—28. Surgeon ARNOLD (A.L1JNING, loc. cit, p. 09, and VERDAT, These inaug., Berne, 1846), Russian soldier in Polish War, 1831. Ligation of common iliac by Dr. DEMME. Intermediary exarticulation at hip; death on the third day.—29. Dr. FRANCKE (A. LtixiXG, loc. cit., p. 69, and Fraxcke, Diss., Leipzig, 1835), Russian soldier, A. Pasgezuk, aged 22, Warsaw, Sept. 7, 1831. Operation Sept. 22,1831; death in two days.—30. The elder DEMME (A. LUNING, loc. cit, p. 68, and VERDAT, These inaug., Berne, 1846), Polish soldier, in 1831. Intermediary operation; death from gangrene on fifth day.—31. LETULLE (H. LARREY, Hist. chir. du siege de la Cit. d'Anvers, 1803, p. 307), A French cannonier of the 11th regiment of Artillery. Siege of Antwerp, 1832. Primary operation December 13th; died Decem- ber 22, 1832.—32, 33. During the campaign in Syria, in 1832, two exarticulations at the hip were performed, one by von Welz, the other by CHERUBINI. Both were fatal (M. JAEGER in Dr. W. Walther's Handwbrterbuch der Gesammten Chirurgie, Leipzig, 1836, B. I, p. 409).—34, 35. Al.COCK (R.) (Notes on the Med. Hist, and Stat, of the British Legion in Spain, London, 1838, p. 78) relates that he was informed by Dr. Belmunt that an accom- plished Spanish surgeon had twice amputated at the hip joint during the Peninsular War of 1835—once with success.—36. HUTIN (F.) (Rec. de Mem. de Med. de Chir., etc., 1™ sene, T. XLIV, p. 219), M---, a soldier of the 1st Light Battalion, Constantine, 1836. Primary amputation ; Manec's method; died December 13, 1836 —37. HUTIN (F.) (Rec. de Mem. de Med. de Cliir., etc., T. XLIV, p. 220), L---, 2d Regiment of Engineers, Constantine, 1836. Primary operation; died December 4, 1836.—38. BAUDEXS (L.) (Clin, des plaies d'armes & feu, Paris, 1836, p. 517), C---, a soldier in the Battalion d"Afrique, 24 yeai-s old, Algiers, 1836. Intermediary operation; recovered, and was an inmate of the Hotel des Invalides in 1840 (SEDILLOT, Amp. coxo- femorale, in Rec. de Mim. de Med., 1840, T. 49, p. 276).—39-41. From the tabular statement of Dr. GUYON (Statistique des amputations pratiquies d. Varmie d'Afrique, etc., pendant les annees, 1837, 1838, et 1839, in Gaz. Med., 1841, T. IX, p. 105) it appears that no exarticulations at the hip were per- formed during these years; but Dr. GUYOX states (loc. cit, p. 106) that three unsuccessful amputations at the hip were performed in 1841.—42. BAUDENS (L.) (Rec. de Mem. de Mid. de Chir., etc., 1853, 2nie ser., T. X, p. 130), X---, a soldier of the 18th Light Infantry, Paris, 1848. Primary operation; death on the second day.—43. VIDAL (AUG.) (Traite de Path. ext. et de Mid. op., 5me 6d., Paris, 1861, T. V, p. 731), A French student of medicine, insurrection in Paris in 1848. Secondary exarticulation; fatal.—44-46. During the same revolution RlCHET (M. E. HERVIEUX, Compte rendu des blessis regus d ('ambulance des Tuileries.'m Gaz. Med. de Paris, 1848, p. 712) performed a primary operation which proved fatal; and P. GUEHSANT and ROBERT (L. LEGOUEST, Traiti de Chir. d'Armie, 1863, p. 700) had each an unsuccessful intermediary operation.—47. RESTELLI (F. BAROFFIO, Delle Ferite d'arma da fuoco, Torino, 1862, p. 284) performed a successful exarticulation in 1848, after the insurrection in Lombardy.—48. Trezzi (GRITTI ROCCO, Delle Fratture del Femore par arma da fuoco, Milano, 1866, p. 80) operated unsuccessfully on an insurgent at Milan in March, 1848.—49. C. TEXTOR (G. B. GUENTHER, Die Blutigen Operationen, Leipzig, 1859, Abschmitt VIII, p. 180), Exarticulation for shot fracture of the neck of the femur in a patient aged 32, in 1848; death from pyaemia.—50. TEXTOR, the younger (GUXTHER, loc. cit, p. 180), performed an intermediary operation in 1848; death on the fourth day.—51. ROUX (P. J.) (Des plaies d'armes a feu, Communications failes, etc., par BAUt'EXS, ROUX, etc., Paris, 1849, p. 38, and Gaz. des Hop., 1818. p. 513) had, in June, 18-iS, a secondary fatal operation.—52. LlXHART (W.) (A. LUXIXG, toe. cit, p. 75, and ESCHE, Diss, inaug., Wiirzburg, 18t;3, p. 11), in 1848, in a case of shot comminution of the trochanter, ligated the femoral, and afterwards exarticulated at the hip. The patient died shortly after the operation.—53-59. During the Schlefwiff-Holstein War, 1848-50, seven exarticulations at the hip were made. Prof. B. von Langenbeck (Uber die Schussfracturen der Gelenke, Berlin, 18G8, p. 19) performed four of the seven operations: J. Seibold. drummer in Tann's corps, aged 18, wounded at Hoptrup, June 7, 1848; operation June 8th; patient hale and hearty in 1856. Anders Nielson, 2d Danish Jaegers, aged 26, Schleswig, April 23, 1848; operation April 24th; death May 21st. Niels Andersen, 4th Danish Infantry, Schleswig, April 23, 1848; operation May 14th; death May 20, 1848. Danish soldier, wounded at Bau, April 9, 1848;' operation June 20th ; death June 21, 1848. The other three operations of this campaign proved fatal; no further data are noted (L. Stromeyer, Maximem, 1861, p. 53-.').—60. Lente (F. D.) (Transactions Am. Med. Association, 1848, Vol. IV, p. 316), J. Dalzell, aged 23. Astor Place Riots, New York, 1849. Primary operation; died May 12, 1849.—61-63. In the War in the Punjaub, 1848-49, three primary operations were performed. Dr. McRae (Indian Annals of Med. Sci., 1857, p. 663) states that the patients died—one in six, one in twelve, and one in thirty-six hours, from shock.—64. BECK (B.) (Die Schusswunden, Heidelberg, 1850, p. 315), Soldier of the 2d Baden Infantry, wounded June 20, 1849, in battle, at the Murg. Secondary operation: death six days after operation.—65. Fayreu (J.) (Clinical Surgery in India, London, 1866, p. 630), Moung Schwe-Mo, a Burman, aged 30. Rangoon, Bengal, February 15, 1853. Primary amputation at left hip February 16th ; deatb March 17, 1853.—66. Dr. Beatson (Ranktng's Abstract, 1855, No. 21, p. 182), Thomas Lisbey, aged 61. Conductor in the Ordnance Department, Dounabew, March 19, 1853. Exarticulation of left hip March 25th; died March 25, 1853.—67-110. Of the forty-four exarticulations at the hip performed during the SECT. II.J AMPUTATIONS AT THE HTP JOINT. 129 surgery apart from the sixty-six cases that pertain to the American civil war. This cate- gory comprises one hundred and eighty-four cases, of which the results are ascertained in Crimean War, two were done in the Sardinian army, eight by Professor N. Pirogoff (Grundzilge der Allgtmeinen Kriegsch., Leipzig, 18C4, p. 1137), in tho Russian army, fourteen in the British army (Matthew, loc. cit, p. 374), and twenty in the French army (J. C Chexu, Rapport med. chir. de Camp. d'Orient, 1865, p. 658). Porta states that the two cases in the Piedmontese army were fatal. Of Pirogoff's eight cases two survived five days and the others perished within two or three days. The operations in the English army wero all primary and resulted fatally. The results of tlie operations in the French army were equally unfortunate; all tho patients diod. Of twenty-two of the forty-four cases it is only recorded that they had a fatal termination. The particulars of tho other twenty-two will here be cited: ALEXANDER (T.) (GUTHRIE'S Comment, 6th ed., p. 620) disarticulated at the hip, in the case of Peter Cleary, 23d Fusileers, for gunshot fracture of femur, Alma, Sept. 20, 1854. Operation Sept. 21st; patient died on the passage to Scutari. ALEXANDER (T.) (G. J. GUTHRIE, Commentaries, 6th ed., 1855, p. 620), A Russian prisoner, Alma, Sept. 20, 1854. Primary operation Sept. 22d, died Oct. 22, 1854. ALEXANDER (T.) (G. J. GUTHRIE, loc. cit, p. 620), Peter Sullivan, 33d British Infantry, Alma, Sept. 20, 1854. Primary opera- tion Sept. 21st; died Oct. 11, 1854. MCKENZIE (R.) (MacLeod, Notes on Surgery in the Crimea, London, 1858, p. 369), Soldier, Alma, Sept. 20, 1854. Primary operation; died. Assistant Surgeon Wyatt (T. P. MATTHEW, Med. and Surg. Hist, of the British Army in the Crimea, London, 1858, Vol. I, p. Ill), An officerof the Coldstream Guards, Inkermaun, Nov. 5,1854. Primary operation; died immediately after the operation. MOUNIER (in CllENU's Rapp. mid. chir. sur. la Camp. d'Orient, 18C5, p. 660), Garassimoff, a Russian prisoner, Alma, Sept. 20, 1854. Intermediate operation Sept. 27th; died Sept. 29, 1854, two days after the operation. LEGOUEST (L.) (Mim. de la Soc. de Chir., 1863, T. V, p. 157), Ignatius Wolokenski, 5th Russian Infantry, aged 30, Alma, Sept. 20, 1854. intermediary amputation at left hip October 3d; died Feb. 9, 1855. MOUNIER (Chexu, loc. cit, p. 660), Chiffttzoff, a Russian prisoner, Inkermaun, Nov. 5, 1854. Intermediary operation November 5th; died December 2, 1854, one week after the operation. PAULET (CHEXU, loc. cit, p. 661), Soldier. Primary operation in 1855; died one hour after the operation. LUSTREMAN (CHENU, loc. cit, p. 661), Soldier. Primary operation in 1855; died five hours after the operation. THOMAS (CHENU, loc. cit, p. 661), Soldier, gunshot fracture of the femur, 1855. Primary operation; died five hours after the operation. THOMAS (CHENU, loc. cit, p. 661), Soldier, 1855. Primary operation ; died eleven hours after operation. PERRIN (CHEXU, loc. cit, p. 660), A private of the 32d French Infantry. Fracture of left femur July 5, 1855. Primary operation a few hours after injury; died in one or two da3'S. Franklyn (T. P. MATTHEW, loc. cit, Vol. I, p. 377), A private of the 77th British Infantry, Sevastopol, August, 1855. Primary operation; died twenty-two hours after the operation, from exhaustion. DUNLOP (T. P. MATTHEW, loc. cit, Vol. I, p. 403), A soldier of the 88th Regiment Connaught Rangers. Primary operation; died soon after the operation, in November, 1855. Surgeon-Major TROUSDELL (R. DRUITT, Surgeon's Vade Mecum, 1865, 9th ed., p. 160), A private of the 50th British Regiment, Sevastopol, 1855. Primary operation; died the day after the operation. MOUNIER (CHEXU, loc. cit, p. 660), Pietrow, a Russian prisoner, Inkermann, Nov. 5, 1855. Secondary operation Dec. ISth; died Dec. 29, 1854. LAHIVTERE (CHEXU, loc. cit, p. 660), Kerigla, a Russian prisoner, Traktir Bridge, Aug. 16, 1855. Intermediary operation Aug. 23d; died August 23, 1865, during the operation. Mauger (CHENU, toe. cit, p. 661), A Russian prisoner, Traktir Bridge, Aug. 16, 1865. Intermediary operation; died soon after the operation. Salleron (Mem. de Mid., de Chir. et de Phar. Mil., 2">« ser., T. XXL P- 317), A soldier, Sevastopol, 1855. Intermediary operation (?); died twenty hours after the operation. Salleron (Mem. de Mid., de Chir. et de Phar. Mil, 2D1« s6r., T. XXI, p. 317), A soldier, Sevasto- pol, 1855. Intermediary operation (?); died sixty hours after the operation. Chief Surgeon MABBOIK, of the French Navy (J. ROUX, Disarticulation de la cuisse, Paris, 1860, p. 4), disarticulated, in the case of a soldier of the Crimean army, for fracture of the greater trochanter. The patient died shortly after the operation.—111-112. Professor J. F. HEYFELDER, chief surgeon of the Russian army in Finland, in 1855 (Die Verwundungen und Operationen in Folge des Bombardements von Sveaborg vom 9-11 Aug., in Deutsche Klinik, 1855, B. 7, pp. 530-532) exarticulated twice at the hip. A Finnish soldier, wounded at Sveaborg, August, 1855; primary amputation at left hip; died in two hours. Stanislaus Maletzki, 8th Finnish Bat., shot fracture of neck of left femur, Sveaborg, Aug. 9-11, 1855; primary operation; patient died in less than an hour.—113-115. BERTHERAND (Camp, de Kabylie, Paris, 1862, pp. 145, 238, and 280) gives three examples of disarticulation at the hip: A----, 60th Line, wounded June 20, 1854; fracture of neck of femur, disartic- ulation, by Dr. GlLGENCRANTZ, July 14, 1854 ; death on the same day, before recovering from the effects of the chloroform. C----, 90th Line, shot frac- ture of neck of femur, Algiers, May 24, 1857; secondary disarticulation; died on the day of the operation. W----, 2d Ligion etrangere, shot fracture of neck of right femur; disarticulation by Dr. TABOURET; fatal.—116. BERTHERAND (A.) (Camp, d'ltalie, de 1859, Paris, 1860, p. 37), An Austrian soldier, a prisoner after the battle of Palestro, June 4, 1859. Intermediary operation ; died three hours after the operation.—117. ARLAUD (J. C. CHENU, Camp. d'ltalie en 1859 et 1860, T. II, p. 697), Louis Legallo, Fusileer, 84th French Regiment, age 25, Montebello, May 20, 1859. Secondary exarticulation at right hip; recovered.—118. ISNAED (J. C. CHENU, loc. cit., p. 694), Captain Deshayes, 73d Regiment, Solferino, June 24, 1859. Secondary exarticula- tion at left hip; recovery.—119. ROUX (JULES) (CHENU, Camp, d'ltalie, en 1859 et 1860, T. II, p. 697), Lieutenant Joseph Vitarel, 65th French Infantry, aged 24, Magenta, June 4, 1859. Secondary amputation at left hip; recovered.—120. NEUDORFER (J.) (Handbuch der Kriegschir., 1872, B. II, Abth. II, S. 1468), Johann Schranz, 7th Jaeger. Neck of femur, Palestro, May 30, 1859. November 27th, excision at left hip joint. December 1st, amputation at hip joint. NEUDORFER saw the patient in 1868.—121. NEUDORFER (J.) (loc. cit, p. 1467), Jurko Katsch, of Inf. regiment E. H. Stephan, Solferino, June 24, 1859. Right trochanter. Operation, August 8th, seventy-six days after the injury; died August 25, 1859.—122. NEUDORFER (J.) (loc. cit, p. 1468), Walland Waskaneder, Co. 13, of Baron Rosshach's Regiment, Solferino, June 24, 1859. Fracture of upper third of femur. Disarticulation Dec. 31st (one hundred and ninety days after injury); died four months later.—123. SCOTTI (G. B.) (GRITTI ROCCO, Frat. del fem. per arma da fuoco, Milano, 1866, p. 80), An Italian soldier. Gunshot fracture of femur, Solferino, June 24, 1859. Intermediary exarticulation in July, at Ospitale San Francesco, Brescia; died.—124. Tassani (Gritti ROCCO, loc. cit, p. 80), An Italian soldier. Shot fracture of femur, Solferino, June 24, 1859. Intermediary ampu- tation at hip at Ospitale Maggiore, Milan, July, 1859; died.—125. GHERINI (GRITTI ROCCO, loc. cit, p. 80), An Italian soldier. Gunshot fracture of the femur, Solferino, June 24, 1859. Disarticulation about July 26th, at Ospitale San Filippo, Brescia; died.—126. JOHNSON (T. D.) (Amputation at the Hip Joint, Recovery, in Pacific Med. and Surg. Jour., N. S., Vol. II, 18C8-69, p. 305), A man of San Juan, Monterey Co., received a shot from a Colt's revol- ver, in July, 1862; ball shattered the entire shaft of femur. Dr. JOHNSON exarticulated two days after the injury. The patient recovered, and was still living, in 1868, at the New Almaden mine, in Santa Clara County.—127. VlLLAGRAN (J. M. B. de) (Observacion de una herida de arma defuego situada en el muslo izquierdo complicada con fractura comminutiva del femur: desarticulacion coxo-femoral a los 180 dias, y muerte del enfermo a los 259, in Gaceta Medica de Mixico, 1865, Vol. I, p. 164), Roman Medina, age 26, shot Nov. 2,1863, in the left thigh, and admitted to hospital at San Pablo, Nov. 8, 1863. Disarticulated May 11, 1864; death July 29, 1864.—128-129. Langenbeck (B. von) (Schussfracturen der Gelenke, Berlin, 1868, p. 20), Danish soldier, wounded at Alsen, June 29, 1864; disarticulation July 1st; died July 8, 1864, of septicaemia; and Danish soldier, wounded at Alsen, June 29, 1864; disarticulated at right hip June 30th; death July 5, 1864.—130-131. Langenbeck (B. von) (Die Schussfracturen der Gelenke, Berlin, 1868, p. 21), Austrian soldier, wounded at Koenigsgratz, July 3, 1866; exarticulated at left hip July 10th; death July 14, 1866, of septicemia. Austrian soldier, wounded at Koenigsgratz, July 3, 1866; amputation at right hip July 17th; death July 24,1866.—132. Linhart (W.) (Beck, B., Kriegschir. Erf, 1867, p. 340) performed secondary disarticulation at the hip in 1866, at Wiirzburg, for comminution of upper part of femur. Patient died a few hours after the operation.—133. Fischee (K.) (Militairdrztliche, Skizzen, Arau, 1867, p. 78) mentions a case in which disarticulation at the hip was performed unsuc- cessfully for haemorrhage, in the Austro-Prussian campaign of 1866.—134. HEYFELDER (J.) (Gaz. mid. de Paris, 1867, p. 541) states that an unsuccessful disarticulation at the hip was performed at the hospital at Nedelischt, in charge of Dr. Wilde, after the battle of Koenigsgratz, July 3, 1866.—135. MANNEL (OTTO) (Kriegschirurgische Beobachtungen im Cadetenhaus Kriegslazareth zu Dresden, in Allgemeine Wiener Med. Zeitung, 1867, Jahrg, XII, p. 403), Musquetier B----, 1st ThUringian Infantry, No. 31, wounded July 3, 1866, near Hradeck, in the left femur. Exarticulation October 4, 1866, by Stabsarzt Dr. K0ILXE; died October 8, 1866.—136. Dr. J. HEYFELDER (Gaz. Mid. de Paris, 1867, p. 540) reports that a second amputation at the hip was performed at the hospital at Hradeck, in 1866, which proved fatal in about forty-eight hours.—137. Fayrer (J.) (Gunshot Wound; Amputation at the Hip Joint, in Edinburgh Med. Journal, 1868, Vol. XHI, II, p. 793), Lieutenant H----, shot accidentally, on the Island of Ceylon, Sept. 12, 1867, over the left tuber ischii, ball lodged; fracture of neck of femur not detected. Exarticulation at left hip Sept. 25th; died three hours after the operation.— 138. Ashhurst (JOHN.jr.) (Case of Amputation at the Hip Joint for Gunshot Fracture ofthe Head and Neck ofthe Femur, in Am. Jour. Med. Sci., 1869, SUBG. Ill—17 130 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. one hundred and eighty-three, presenting sixteen recoveries. We thus arrive at an aggre- gate of two hundred and fifty cases of exarticulation at the hip as the present status of this grave mutilation in military surgery, with twenty-seven recoveries, two hundred and twenty-two deaths, and one example with unknown result, or a mortality rate of 89.1 per cent. We will next notice the details of the sixty-six cases of hip joint amputations of the American civil war as classified in Table XIV. Vol. LVII, p. 94), E. B---, Irish woman, aged 22, shot in the right hip, in Aug., 1867, at Tacony, Pennsylvania. Exarticulation on Jan. 14,1868; death in three hours.—139. CAROTHERS (A. E.) (Amputation at the Hip Joint, in Am. Jour. Med. Sci., 1873, Vol. LXV, p. 92), Juan Blanco, aged 14; Saltillo, Mexico,. Dec. 5, 1871. Intermediary operation Dec. 15th; recovery.—At least forty-four exarticulations at the hip were performed during the Franco- Prussian War, 1870-71.—140. Dr. RUFFEL (DEININGER, Beitrage zu den Schussfracturen des HUftgelenks, etc., in Deut Mil.-drztl. Zeitschr, 1874, B. Ill, p. 304), Cbr. Lucia, 3d Brandenburg Field Art., shell laceration, received at Artenay, Dec. 3,1870. Exarticulation at right hip Dec. 4th; died shortly after the operation, Dec. 4,1870.—141-143. Generalarzt Dr.BuBCH (Zweiter Congress der Deutsch.Gesellschaft fur Chir,,'va Berlin Klin. Wochenschrift, 1873, B. X, p. 273, and DEININGER, loc. cit, p. 306) performed three exarticulations at the hip: Aug. Hensel, 2d Pomm. Grenadier Reg't; fracture of right femur, Metz, Oct. 14, 1870; operation Oct. 15th; death immediately after operation. No particulars of the other two unsuccessful cases are recorded.—144-147. Mac- Cormac (W.) (Notesand Recollections of an Ambulance Surgeon, etc., London, 1871, pp. 78, 79), Guerieri, 4th Marines, wounded at Sedan, Sept. 1,1870. Left tibia and upper part of left femur smashed. Admitted to Asfeld hospital Sept. 10th; operation Sept. 18th; death shortly after the operation. Liprende, wound of back part of left thigh by explosion of shell. Admitted to Asfeld hospital Sept. 10th ; operation Sept. 15th; death in six days. Dr. M ACCORMAC (toe. cii.,p. 80) states that Mr. BLEwnT disarticulated the hip at Balan, "but with no better result than our two cases," and, on page 123, enumerates among the operations at the field hospital at Floing, under Generalstabsarzt STROMEYER, another hip joint exarticulation with unknown result. Dr. DEININGER also refers to two exarticulations by Dr. Frank, and cites MACCORMAC as authority. The latter (loc. cit., p. 46), however, only states that "he (Dr. FRANK) afterwards told me there were two cases where operations should have been performed at the hip joint, but this had to be left undone for want of assistance." 148. Ober-Stabs-arzt Neuber (Detninger, loc. cit, p. 308) exarticulated in the case of August Schmidt, 70th French Line; shot fracture of femur, Aug. 18, 1870; died Sept. 7, 1870.—149. Ober-Stabs-arzt Dr. Lipfel (DEININGER, toe. cit, p. 308), at the 8th field hospital of the Tenth Army Corps, at Pont a Mousson, exarticulated for gangrene in the case of Louis Lecoque, shot in the soft parts of the leg; death four hours after the operation.—150. Dr. Koch (Delninger, toe. cit, p. 308), at the hospital at Maizery, Private Andreas Wilczynski, 44th Infantry, shot fracture of the right femur immediately below the trochanter, August 31, 1870. Exarticulation October 23,1870; died of dysentery October 31,1870.—151. Dr. Sachs (Deintnger, toe. cit, p. 306), at the 9th field hospital of the First Army Corps, at Les Etanges, case of J. Nikelski, private, 12th Co., 43d Infantry; shot fracture of right femur; ball lodged. Metz, Aug. 14,1870. Exarticulation Sept. 20,1870; death, from pyaemia, Sept. 25,1870.—152. Dr. Branish, at the hospital at Neudorf (Deixixger, toe. cit, p. 306), disarticulated in the case of Private H. Malton, 66th French line, shot in the left femur August 6, 1870. Operation Sept. 7th; death on day of operation.—153. Generalarzt Dr. Wagner (DErNTNGER, toe. cit, p. 306), at the 8th field hospital, First Army Corps, at Gras, Private M. Buddrus, Co. 2, East Prus. Gren., No. 1; shot fracture of right femur near trochanter major, with extensive injury of the soft parts, received at Metz Sept. 1, 1870. Exarticulation Sept. 17th; died upon the operating table.—154. Assistant Surgeon TRENDELEXBERG (DEININGER, loc. cit., p. 306), of the 8th field hospital, Third Army Corps, at Vionville, case of Adolph Marschall, private, 52d Infantry. Shot fracture of left knee joint August 16, 1870; extensive suppuration. Exarticulation August 28, 1870; death on the same day.—155. Dr. Metzler (Deininger, toe. cit, p. 306), at the Hessian field hospital No. 1, Anoux la Grange, exarticulated at the hip in the case of L. Nouveau, 73d French line, wounded August 18, 1870. Operation Aug. 19th ; death two hours after operation.—156. Dr. Raynaud (Gillette, Remarques sur lesblessures par armes dfeu observees pendant la siige de Metz (1870), et celui de Paris (1871), in Arch. gen. de Mid., 1872, T. XX, p. 571, and Ch. PrLLET, De la suppression de la compression digitateprlliminaire, etc., Paris, 1873, p. 64) exarticulated at the left hip in a young garde nationale, aged 19; death in a few hours.—157. Dr. Wiesemes (B. Beck, Chir. der Schussverlet- zungen, Freiburg, 1872, p. 855), W---, 67th Infantry, wounded before Paris, December 21,1870, by a shell, fracturing femur to neck. Primary operation; death in twenty-four hours.—158. HUETER (Berlin, Klin. Wochenschrift, 1873, p. 250) operated on a French soldier for extensive fracture of femur. The patient died suddenly on the following day from venous haemorrhage.—159, 160. BCEHME (Verhandl. der mil.-drztl. Gesellschaft zu Orleans 1870-71, in Deut. Mil.-arztl. Zeitschrift, 1872, B, I, p. 66), Fracture of femur just below trochanter, arterial bleeding; ligation of femoral; secondary haemorrhage; exarticulation; died during the operation. Another case proved fatal in a few days.—161. Ott (Kriegschir. Mittheil. aus dem Reserve Laz. Ludwigsburg, 1871, p. 52), Harles, a French soldier, wounded at Vionville, Aug. 16. 1870, in right femur close to trochanter. Exarticulation Sept. 24,1870; death a few hours after the operation.—162. SrMON (G.) (Verhandl. des Zweiten Congress der Deut. Gesellshaft fur Chir., in Berl. Klin. Wochenschr., 1873, B. X, p. 261), French officer; fracture of femur—osteomyelitis. Secondary exarticulation; fatal in three days.—163-167. Rupprecht (L.) (Mil. drztl. Erf, etc., im Jahre 1870-71, Wiirzburg, 1871, p. 75) states that four unsuccessful exarticulations at the hip—three primary, one intermediary—were performed at the Bavarian field hospital No. 8, during September and October, 1870, and that a later operation at Verrifires also resulted fatally.—168. Mundy (Rapport sur Vambulance de Vancien corps legislat. du 19 Sept., 1870, au 31 Janv., 1871) exarticulated on December 2,1870, in the case of Deschamp, 2d Zouaves, for shot fracture of the right femur with injury of the large veins and of the hip joint; fatal.—169. Dr. J. ARNOLD (Anat. Beitrage zu den Schusswunden, Heidelberg, 1873, p. 97) gives the case of H. Moulin, wounded at Worth, August 6, 1870; shot wound of right femur, with fissure; osteo- myelitis and necrosis extending to neck of femur. Exarticulation at the hip; death Sept. 22,1870.—170. Dr. Jcsssel (Sedillot, Du traitement des fractures des membres, etc., in Archives gin. de mid., 1871, VI" serie, T. 17, p. 421) performed a secondary fatal exarticulation at the hip.—171-183. Cim' f (J. C.) (Apergu hist. stat. et clin., etc.,pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493) tabulates twenty-three exarticulations at the hip performed on French soldiers. Some details of ten of these cases have just been noticed; of the remaining thirteen cases it is only recorded that all the patients perished.—184. Mortox (T. G.) (The Cincinnati Lancet and Clinic, Cincinnati, Jan. 4, 1879, N. S., Vol. II, p. 9), Dominico Ludovess, aged 24, wounded at Sedan, September 1, 1870; amputation of thigh; admitted to Pennsylvania Hospital Nov. 24,1878; reamputation at hip December 14,1878. In a letter dated February 19, 1879, Dr. Morton reports that the "patient is up and about, and would be discharged, but he has no home to go to." Of the 184 eases of exarticulation at the hip here cited, one (Stromeyer's case, reported by MACCORMAC) must be set aside, since its result was unknown. Of the remaining 183 cases, 16 recovered and 167 proved fatal, a mortality of 91.2 per cent. Of the 53 primary operations, 50, or 94.3 per cent., were fatal. The three recoveries were: Larrey's sub-lieutenant of dragoons, wounded September 7, 1812, and seen at Orcha three months afterwards; Langenbeck's operation on J. Siebold, June 8,1848; T. D. Johnson's operation on the California miner, July, 1862. Of the 32 intermediary cases, 29, or 90.6 per cent., were fatal. The three successful instances were: G. J. Guthrie's Waterloo case of Duguet, in 1815; L. Baudens's Algerian case in 1836; and Carother's case of the Mexican lad, in December, 1871. Of the 31 secondary operations, 26, or 83.8 per cent., had a fatal termination. The five success- ful cases were: Brownrigg's British dragoon, wounded at Merida, December, 1811, and amputated in 1812, who was living, long afterwards, at Spalding, in Lincolnshire, England; Arlaud's case of the fusileer, in the Italian War of 1859; Isxard's case of the officer wounded at Solferino; Dr. Jules ROUX's case of the Magenta soldier, in 1859; and NeudOrfer's case of the soldier wounded at Palestro, May 30, 1859, who underwent secondary excision and amputation in December following. Of two re-amputations at the hip (Cases 12 and 184), T. G. Morton's operation, in 1878, on a French soldier wounded in 1870. had a successful issue. Of the 66 exarticulations in which the period of operation was unknown, 4 recovered, giving a mortality of 93.8 per cent. The operators in the four successful cases were: The unknown operator, who, in 1798, operated on the English sailor who was examined by Dr. WEXDELSTADT; Dr. Charles Bryce, in the case of the British soldier wounded at Athens, in 1827; the Spanish surgeon reported by Dr. BELMUXT to Mr. ALCOCK, who successfully disarticulated in 1835; and Restelli, in the Italian revolution in 1848. Of the 16 successful operations, 5 were performed by French surgeons, 4 probably by English, 3 by American, 2 by German, 1 by an Italian, and 1 by a Spanish surgeon. SECT. IL] PRIMARY AMPUTATIONS AT THE HIP JOINT. 131 Primary Operations.—-Of twenty-five well authenticated primary amputations at the hip joint practised during the American civil war, one was completely successful. The pensioner, Kelly, whose left lower limb Surgeon Edward Shippen disarticulated more than fifteen years ago, still survives in comfortable health. A brief review of the case will be given, with references to a few of the numerous accounts of it that have been published:1 Case 2?2.-Piivate James E. Roily, Co. B, 56th Pennsylvania, aged 28 years, was wounded, about 9 o'clock of the morning of April 29, 18(13, in a skirmish of the 1st division, First Corps, on the Rappahannock, nearly opposite the "Pratte House," below Fredericksburg. A conoidal musket ball, fired from a distance of about three hundred yards, shattered his left femur. A consultation of the senior surgeons of brigades decided that exarticulation of the femur was expedient, and the operation was performed, at four in the afternoon, at the "Fitzhugh House," by Surgeon Edward Shippen, U. S. V., surgeon-in-chief of the 1st division. The single Hap method was adopted, and the amputation was accomplished with slight loss of blood. The patient was at first placed in a hospital tent, and was transferred, May 22d, to the Corps Hospital, progressing favorably. By May 28th, all the liga- tures had been removed. On June 15, 1863, the patient was captured by the enemy, and was removed to the Libby Prison, in Richmond. Up to this date there had been no bad symp- toms. On July 14th, Kelly was exchanged, and was sent to the Annapolis U. S. A. General Hospital. On his admission he was much exhausted by profuse diarrhoea. The internal portion of the wound had united, but the external portion was gangrenous. Applications of bromine were made to the sloughing surface without amelioration. A chlorinated soda lotion was substituted, and in the latter part of July there was a healthy granulating surface. On December 23, 1863, the wound had entirely healed, and Kelly visited Washing- ton, and obtained an honorable discharge from service, and a pension. Kelly then went to his home, near Black Lick P. O., Indiana County, Pennsylvania. A letter, dated January 12, 1865, was received from him at this Office, and represented him as in excellent health and spirits at that time. In the spring of 1863, Kelly went to New York and had an artificial limb adapted by Dr. E. D. Hudson. At that time a photo- graph was taken representing the appearance of the cicatrix and of the prothetic appliance. A reduced copy of this pic- ture is presented in the accompanying wood-cut (FlG. 89). Front and posterior views of the upper half of the shattered exarticulated femur are introduced among the accessories in the picture. In a pamphlet on Mechanical Surgery, New York, 1878, page 31, Dr. E. D. Hudson prints an excellent wood-cut displaying the appearance of the cicatrix and the artificial stump. By this simple and excellent expedient of a padded gutta-percha artificial stump secured to the pelvis by a broad chamois-lined canvas band, Dr. Hudson succeeded in applying satisfactorily and comfortably the ordinary artificial limb for thigh amputations, not only in Kelly's case but in the case of Pt. George W. Lemon, Co. C, 6th Maryland. The specimen of the fractured exarticulated femur is preserved at the Army Medical Museum, as No. 1148 of the Surgical Section. Kelly's disability was rated, March 4, 1874, as total. His pension of $24.00 monthly, was paid in March, 1878, and he was then in tolerably good health, nearly fifteen years after his terrible mutilation. He remains an irrefragable demonstration of a successfu] primary amputation at the hip after shot injury. There was nothing additional recorded at the Pension Office at the above date. Although in the next two instances of primary amputation at the hip it was found impracticable to trace the ulterior histories of the patients, it is known that Surgeon W. M. Compton's patient,-Robinson, aged 35, was alive and well six months after the exarticula- tion, and that Private Williamson, the subject of Dr. J. T. Gilmore's operation, reached his home in Mississippi, after two months, with his stump fairly cicatrized. 'Hamilton (F. H.), A Treatise on Mil. Surg., 1865, p. 482. Sorrel (P.), Gunshot Wounds—Army of Northern Virginia, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 153. Butcher (R. G.), On amputations at the hip joint, in Dublin Quar. Jour, of Med. Sci., 1866, No. LXXXIV, p. 301. Legouest (M. L.), Le Service de Santi des Armies Amiricaines, etc., in Annates D'Hygiene Publique, 1866, Deuxieme s§rie, T. XXVI, p. 270. Circular No. 6, S. G. O., 1865, p. 48. Circular No. 7, S. G. O., 1867, pp. 26, 58. LtJNlNG (A.), Ueber die Blutung bei der Exarticulation des Ober- schenkcls, Zurich, 1877, p. 93. HUDSON (E. D.), Mechanical Surgery: Prothetic Appliances and Apparatus. New York, 1878, p. 31. PIG. 89.—Appearance of stump five years after tlie operation. photograph.] [Prom a 132 INJURIES OF THE LOWER EXTREMITIES. [CHAr. x. Case 273.—Private Robinson, of a Louisiana Regiment, aged 35 years, was wounded at Battery Pemberton, at the con- fluence of the Tallahatchie and Yalabusha Rivers, on March 13, 1863, by a fragment of a twenty-four pounder shell, fired from one of the United States gunboats attacking the work. Surgeon William M. Compton, 2d Texas, was standing near the wounded man when he fell, and ran to his assistance. Hastily exposing the wound, Dr. Compton found that the immense projectile, consisting of nearly half pf an elongated shell, had buried itself in the upper part of the left thigh, smashing the trochanters and neck of the femur and wounding the femoral artery. An assistant compressed the artery at the crural arch, while the necessary preparations for an amputation were made on the spot. Chloroform was administered, and then Dr. Comp- ton made an irregular circular incision through the integuments just above the margin of the huge lacerated wound, dissected up and retracted the skin, trimmed away the lacerated muscles and divided those that were intact, and exarticulated the head of the femur, making, as Dr. Compton described it, an awkward circular amputation. The arteries were now rapidly secured and the wound dressed. Strange to say, the patient reacted with scarcely a symptom of shock. When the influence of the anaesthetic passed away, he was cheerful and even jocular. He was moved to a field hospital, and was treated under Dr. Compton's immediate supervision until March 17th. The febrile reaction was very slight; the appetite never failed; the wound had as healthy an appearance as could be desired. On the fifth day, the patient was sent on a steamer to the large general hospital at Yazoo City. The surgeon in charge of that hospital, Dr. J. M. Greene, writes that the case presented a most extraordinary example of union by the first intention throughout almost the entire extent of the vast wound. The patient left the hospital on April 20, 1863, in fine health and excellent spirits. Dr. Greene received direct intelligence from him near the close of the ensuing September, more than six months subsequent to the operation, and he then reported himself in good condition.' Case 274.—Private Williamson, 13th Mississippi, was wounded at an advanced picket station near Seven Pines, on June 4, 1862. A conoidal musket ball entered the posterior part of the right thigh about two inches below the trochanter major, and, passing forward and downward, made its exit at the middle third of the thigh in front, having badly shattered the femur in its course. The wounded man was carried to the field hospital in charge of Surgeon J. T. Gilmore, C. S. A., in a church building on the road to Richmond, and there placed under the influence of chloroform about two hours after the reception of the injury. After an exploration of the wound, it was decided that amputation should be performed. Dr. Gilmore began the operation with the belief that the comminution of the femur was mainly below the entrance wound, and that by making a long anterior flap the bone might be sawn at least through the trochanters; but when the anterior flap was reflected and the fracture exposed, it was found that fissures extended upward into the neck quite within the capsular ligament, and that disarticulation must be resorted to. A ligature was first placed upon the femoral artery, and the incisions were then extended upward, the joint opened, the round ligament divided, and a short posterior flap formed by cutting downward and outward. Assistants compressed the bleeding orifices of the arteries, which were then rapidly picked up and tied. The amount of blood lost was small. The wound was dressed, and the patient was comfortably in bed within three hours after the reception of the injury. He was put upon a very nutritious regimen, a messenger being sent daily to Richmond for eggs, milk, and other delicacies which could not be procured in camp. Dr. Gilmore attended him for two weeks, during which suppuration was not excessive, and the healing of the wound progressed favorably. He was then placed under the charge of Acting Assistant Surgeon Spinks. Early in July, he was carried to Richmond upon a hand-litter to a private house, at which he received every attention. In the middle of July, six weeks subsequent to the amputation, the wound had entirely healed, and he was allowed to start for his home in Mississippi. Dr. Gilmore learned that he arrived there in safety; but no intelligence was subsequently received from him. Of twenty-two primary coxo-femoral amputations that resulted fatally soon after operation, the following series of thirteen cases is composed of instances in which the wounds were inflicted by cannon shot, shell fragments, or other large projectiles: Case 275.—Private Jacob Barger, Co. B, 26th Pennsylvania, aged 22 years, of robust constitution and sanguine temper- ament, was wounded on the morning of May 18,1864, in the attack of Birney's division of the Second Corps upon the intrench- ments before Spottsylvania Court House. He was struck by a fragment of shell, which shattered the femur from a little above the trochanter minor for nine inches downward, and tore and mangled the soft parts on the anterior and lateral aspects of the 1 "Mississippi State Lunatic Asylum. Jackson, Mississippi, January 1, 1878. MY Dear DOCTOR: I herewith enclose a letter from Dr. Greene, of Aberdeen, Mississippi, the surgeon who treated the case of amputation at the hip joint in the Yazoo City hospital. To explain to you what may appear to be my want of attention in keeping the track of so interesting a case, I will remind you that the operation was performed in the field. The patient was at once conveyed to a steamboat, and as soon as it was full of sick and wounded (a few days) the boat was sent to Yazoo City. Soon after the date of the operation, I was ordered to Vicksburg, where I remained until after the surrender of that city, and for a long time was shut up by the siege from all communication with the outside world. The fall of Vicksburg, in July, was succeeded by the rapid evacuation of Yazoo City, and it was nearly a year before I met Dr. Greene, in Alabama, who informed me of the recovery of my patient. I had not heard of him after the departure of the steam- boat from Fort Pemberton, and did not know that he had fallen into the hands of Dr. GREENE until the doctor informed me himself. I lost my note-book and other papers at Vicksburg and have never had any means of tracing the patient. I will say, however, for Dr. J. M. GREENE, that he stands at the head of hi* profession in Mississippi, and is in every respect a highly esteemed christian gentleman, and his word in any statement of fact where he is known is received as solid truth. Very respectfuUy, your obedient servant, (signed) Wm. M. COMPTON." "Aberdeen, Mississippi, December 29, 1877. DEAR DOCTOR: At the request of Dr. WM. M. COMPTON, of Jackson, Mississippi, I again write to you in regard to the hip joint amputation which he perforraeo: at Fort Pemberton, in 1863. I greatly regret my inability to furnish any facts in addition to those contained in a letter which I wrote to you in 1867. I oelieve I therein told you that the subject of the amputation was received by me in hospital at Yazoo City, Mississippi, in a few days after the operation. So skilfully were the flaps made and so perfect was the coaptation throughout the vast extent of cut surface, that the fibrinous agglutination followed at once, and resulted in union by first intention in all parts except the tracks of ligatures and sutures. I am positive in my recollection that within eix weeks from the time of the operation the patient was dismissed from the hospital with the stump healed. Information of him reached me some months—I believe about five—afterwards, which I then regarded as entirely authentic It was probably iu the form of an application for ' Certificate of Disability' upon which to be 'retired' or 'discharged' from service. At any rate, I am certain that it thoroughly satisfied me of the life and well-doing of the patient. It is to be deplored that in a matter of so much interest to the profession, complete documentary evidence cannot be obtained; but yet I feel assured, from my point of view, that the cause of surgical history can sustain no detriment from placing Dr. COMPTON'S case in the same catalogue as that of Dr. Shippen. Very sincerely, your obedient servant, (signed) J. M. GREENE." SECT. II.] PRIMARY AMPUTATION AT THE HIP JOINT. 133 thigh, leaving uninjured a V-shaped portion of integument and subjacent tissue on the antero-internal femoral region, seven inches wide at the base and ten inches in vertical length. He was carried to a field hospital of the Second Corps and examined about two hours after the injury. There was no apparent shock, and there had been very little haemorrhage. The pulse was full and calm, and the surface of the body 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 the 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. Anrputation having been decided upon, chloroform was administered by Surgeon John Wiley, 6th New Jersey, a medical officer of great experience and caution in this duty. Only two drachms of the anaes- thetic 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. A., and others present on the occasion, have described the admirable dexterity and skill manifested in the operative procedure. The disarticulation was completed in less than forty seconds. Surgeon C. K. Irwine, 72d New York, compressed the crural artery at the groin; Surgeon F. Prentice, 73d New York, grasped the flap and secured the cut end of the femoral; Surgeon James Ashe, 70th New York, had charge of the limb; Surgeon Everts, 20th Indiana, Surgeon E. A. Whiston, 1st Massa- chusetts, and Assistant Surgeon J. T. Calhoun, U. S. A., also aided in the operation. The flap, the form and location of which were determined by the wound, was made by cutting from without inward. Imme- diately 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 failing. The arteries were now rapidly secured. The loss of blood was estimated not to exceed a single ounce. But the patient was insensible, the respiration labored, the pulse very slow and feeble. The usual restoratives were employed without effect. The patient did not rally; he lingered for about two hours, and died a little after noon, May 18, 1864. In consequence of an advance of Rhodes's Division of Ewell's Corps the field hospital was hastily broken up. Surgeon Jewett was under the impression that the specimen was lost. This, however, was not the case. Some one fastened a label with the names of the patient and operator to the mangled limb, and it was forwarded, with other pathological specimens, from Spottsylvania to the Army Medical Museum, where it arrived safely, and furnished the preparation represented in the adjoining wood-cut (FlG. 90).' Case 276.—On March 9, 1862, in the engagement between the U. S. frigate Congress and the rebel iron-clad Merrimac, Private J. Bushmil, 99th New York, or Union Coast Guard, detailed as a seaman on the Congress, was wounded by a piece of shell, which tore away the muscles on the outer side of the left thigh so as to expose the bone, and comminuted the neck and trochanters of the femur. He was immediately conveyed to the military post hospital at Newport News, Virginia, which was distant but a few hundred yards from the anchorage of the Congress, and restoratives and stimulants were administered. Eight hours after the injury, reaction having taken place to a considerable degree, the patient was placed under the influence of chlo- roform by Surgeon R. K. Browne, U. S. V., and Surgeon Leroy McLean, 2d New York, amputated at the hip joint by the lateral double-flap method of Larrey. His principal assistants were Dr. Everts, Dr. R. K. Browne, and Surgeon J. Curtis, U. S. V. The operation was rapidly accomplished, with the loss of but little blood. Six arteries required ligature. The patient did not rally from the shock of the operation, and died in less than two hours after its completion.8 The details of the next primary amputation at the hip (Case 277), communicated by Dr. F. J. Bancroft, of Denver, Colorado, have not been heretofore published :3 Case 277.—"Captain Ralph Carlton, Co. I, 3d New Hampshire, received a severe wound in the left hip and thigh from a cannon ball or a fragment of a shell at the battle of Secessionville, on James's Island, June 16, 1862. The trochanters were fractured and the femur was shattered and laid bare for several inches below. The gluteus maximus muscle was severed from its insertion, and the biceps and semi-membranosus were torn asunder. Amputation at the hip joint was performed about two hours after the reception of the injury by some surgeon whose name I have forgotten, assisted by myself. The anterior flap was made by transfixion and carried well down the limb. The posterior one was short and made by paring the torn ends of muscles and the skin. The patient did not rally, and died about two hours thereafter, although he possessed, apparently, a strong will and a good constitution, and was suffering but moderately from shock at the time of the operation. When told of the dangers Fig. 90.—Commi- nution of femur by a shell. Spec. 3080. 1 The abstract of this case is compiled from a full report by Surgeon C C. Jewett, 16th Massachusetts, of Holliston, and from communications by Assistant Surgeon J. C. C ALHOUX, Surgeon H. F. Lystek, U. S. V., Assistant Surgeon J. D. Stewart, 74th New York, Major Samuel Breck, A. A. G, See Catalogue of Surg. Sect of A. M. M. of 1866, p. 234, Spec. 3080 of Sect. I. See Circular 7, S. G. O., 1867, pp. 30 and 59, and Luntng (A.), Uber die Blutung bei der Exarticulation des Oberschenkels, Zurich, 1877, Case 324, p. 96. 2 The imperfect abstract of Case 276 is compiled from letters from Surgeon G. C. Harlan, 11th Pennsylvania Cavalry, Surgeon R. B. Bontecou, U. S. V., Dr. Rufus King Browne, and Dr. Leroy McLean, 2d New York. See Circular 7, S. G. O., 1867, pp. 24 and 57, and LUNDtG (A.), Vber die Blutung bei der Exarticulation des Oberschenkels, Zflrich, 1877, p. 90, Case 281. 3 The particulars of this case were first communicated to the Surgeon General's Office by Dr. F. J. Bancroft, of Denver, Colorado, formerly Surgeon of the 3d Pennsylvania Artillery, November 26,1875. Captain Carlton's regimental surgeon, Dr. A. A. MOULTON, 3d New Hampshire, wrote to the Surgeon General's Office from Tilton, New Hampshire, December 9,1875, that he "did not see Captain Carlton, but heard that his limb was amputated at or near the hip joint." A search at the Pension Office corroborates the dates of the injury as reported by Dr. Bancroft. On June 16th, the 3d New Hampshire was in a brigade comprising the 97th Pennsylvania, 7th Connecticut, and 3d Rhode Island Artillery. Enquiries regarding the case were addressed to Surgeon J. R. Everhart, 97th Pennsylvania, to Assistant Surgeon H. P. PORTER, 7th Connecticut, and Surgeon H. G. Sttckney, 3d Rhode Island Artillery, medical officers of the brigade of General 1.1. Stephens, and also to Surgeon E. L. Dibble, 6th Connecticut, and Surgeon P. A. O'CONNELL, 28th Massachusetts, New England medical officers who were present at the engagement on James Island, on June 16, 1862; but no farther information could be elicited from any surgeon present at this operation in addition to the details recorded by Dr. F. J. Bancroft, formerly surgeon 3d Pennsylvania Artillery. 134 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. attending and following the amputation, I well remember how earnestly and energetically he said: 'I desire it. I must live. I will live. I have a wife and five children to provide for.' Yet in two short hours all earthly ties were severed." Surgeon A. A. Moulton, 3d New Hampshire, reported that Captain Carlton died on June 16,1862, of "gunshot wound," and in the military history of the regiment, published by the Adjutant General of the State in 1866, he is mentioned as "a gallant and promising officer," who during said engagement " was hit in both legs by a solid shot, and died the same day." Case 273.—Private Cooper, of an Alabama Regiment, aged 20 years, was wounded at the siege of Vicksburg, on May 22, l^r>3. by a fragment of shell, which inflicted a terrible laceration of the upper exterior part of the right thigh, comminuted the upper third of the femur, and fractured the tuberosity of the ischium. There was profuse haemorrhage. Surgeon W. M. Compton, 2d Texas, decided to operate, because the wounded man most earnestly begged that an attempt should be made by amputation to save his life. A few hours after the reception of the injury he was placed under chloroform, and amputation at the right hip joint was rapidly performed by making a large anterior flap and dividing the soft parts posteriorly by a circular sweep of the knife. The stump was dressed and the patient actively stimulated, but he never rallied from the shock of the operation, and died in less than an hour after its accomplishment.1 Case 279.—Private Isaac C. Fulton, Co. I, 4th New York Heavy Artillery, was wounded, on October 1, 1864, in the trenches before Petersburg, by a fragment of shell, which shattered the upper extremity of his left femur and lacerated the soft tissues on the outside of the thigh, without, however, implicating any important vessels or nerves. He was immediately carried to the Second Corps field hospital, under the charge of Surgeon F. F. Burmeister, 69th Pennsylvania, and a consultation was held, at which it was determined that an amputation at the hip joint was the only resource that could possibly preserve life. The wounded man was, therefore, immediately placed under the influence of chloroform, and Surgeon J. W. Wishart, 140th Pennsylvania, did the operation. The ordinary method by antero-posterior flaps formed by transfixion was employed. The operation was rapidly performed and but a trifling quantity of blood was lost. The patient survived the shock of the injury and operation but a few hours, and died at City Point, October 1, 1864. Case 280.—Private Richard Gordon, Co. H, 7th Rhode Island, a stout and apparently healthy man, aged 28 years, was wounded May 18, 1864, in one of the assaults on the lines at Spottsylvania, and was carried on a stretcher, two or three miles to the rear, to a field hospital of the Ninth 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 slight primary haemorrhage. 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, 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, 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 theu 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 on 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 anaesthetic. He was placed in a shelter tent and'took a dose of opium. He died ten hours after the operation, no reaction having taken place.2 Case 281.—Brevet Lieutenant-Colonel J. H. Janeway, Assistant Surgeon, U. S. A., learned that Dr. Hunter McGuire, Surgeon-in-chief of Ewell's Division, performed a primary amputation at the hip after the engagement at Ball's Bluff, October 21, 1861, upon a Union prisoner of war, with a frightful injury of the upper part of the femur, caused by a large projectile, and that the patient succumbed to the combined shock of the injury and operation soon after the completion of the latter. Case 282.—A lieutenant in an Arkansas Regiment in Cabell's Brigade, aged 28 years, was wounded at the attack on Corinth, Mississippi, October 3, 1862. A solid cannon ball struck the right hip and made a formidable wound, tearing up the soft parts of the buttock and shattering the upper extremity of the femur. The trochanters and about five inches of the shaft of the femur were comminuted; the head of the femur was exposed and was split across. It was decided that amputation at the hip presented the only possible surgical resource, and the operation was undertaken, two hours after the injury, by Surgeon W. M. Compton, 2d Texas. The operation consisted in paring into shape the lacerated soft parts at the posterior part of the thigh, completing the disarticulation already partly effected by the projectile, and forming a large and long antero-internal flap. The patient was under the influence of chloroform. There was but little haemorrhage. The flap covered the immense wound and was adjusted with tolerable accuracy to meet the incision at the gluteal region. The combined shock of the injury and operation was very great, and the patient reacted slowly and with difficulty. But he rallied finally, and progressed very favorably for . several days. The inflammation was not intense, appetite returned, and strong hopes of the patient's recovery were entertained. But, on the seventh day, erysipelas invaded the stump and extended rapidly, in spite of the use of tincture of iron and such other treatment as it was thought proper to institute. The case terminated fatally on October 12, 1862.3 Case 233.—A private in General A. S. Johnston's army was wounded on the morning of Sunday, April 7, 1862, at the battle of Shiloh, by a fragment of shell, which shattered the upper extremity of the left femur. The comminution extended to the neck and head of the bone, and the soft parts at the upper third of the thigh were torn into shreds. Notwithstanding the 1 Eve (P. F.), A Contribution to the History of Hip Joint Operations performed during the late civil war, in Transactions of the Am. Med. Ass'n, 1867, Vol. XVILT, pp. 255, 263. Circular No. 7, S. G. O., 1867, pp. 27, 58. ^Hamilton (F. H.), A Treatise on Mil. Surgery, 1865, pp. 485, 627. Circular No. 6, S. G. O., 1865, p. 50. Circ. No. 7, S. G. O. 1867, pp. 30, 59. !EVE (P. F.), A Contribution to the History of the Hip Joint Operations performed, etc., in Transactions of the Am. Med. Ass'n, 1867, Vol. XVIII pp. 255, 262. Circular No. 7, S. G. O.. 1867. pp. 25, 58. SECT. II. | PRIMARY AMPUTATIONS AT THE HIP JOINT. 135 terrible nature of the injury the patient reacted, and it was tliought, in the evening, that his condition justified amputation. At seven in the evening disarticulation at the hip joint was performed by Dr. D. W. Yandell, Medical Director. The operation was well borne; but about three hours after its completion symptoms of exhaustion were manifested, and the case terminated fatally seven hours after the operation, at two o'clock of the morning of April 8, 1862.' Case 284.—A private of the 3d Missouri Regiment was wounded at the siege of Vicksburg, in June, 1863, by a large fragment of shell. The projectile produced a frightful laceration of the tissues on the inner and posterior parts of the right thigh, completely divided the 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 was conveyed to the City Hospital and was plied with cordials. The sufferer had but recently recovered from an attack of illness; the primary haemorrhage 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 forlorn 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 he done without anaesthetics. 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 extend- ing nearly to Poupart's ligament, in which the ligated femoral artery was hanging. Dr. Lay commenced the operation, in the presence of Surgeons Britts, McDowell, Nidelet, and others, 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 inward; the head of the femur was then disarticulated. Eight ligatures were required. The flap fitted well. The operation, which occupied about twenty minutes, was wall 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 opera- tion some fourteen or sixteen hours.2 Case 285.—A private of the 27th Tennessee Regiment was wounded at Jonesboro', Georgia, August 31, 1864, by a cannon shot, which frightfully lacerated the soft parts on the upper and outer part of the thigh and shattered the femur, the splintering extending quite to the neck of the bone. Six hours after the injury, Surgeon J. R. Buist, 1st Tennessee, of Cheat- ham's Division, removed the limb at the hip joint by the antero-posterior flap method by transfixion. The patient was rendered insensible by chloroform. He rallied promptly from the anaesthetic and from the shock of the operation. Cold-water dressings were applied to the stump, and stimulants and concentrated nourishment were administered. After about eight hours the patient began to sink, and he died thirty-six hours after the operation, September 2, 1864.3 In a letter, dated Nashville, Tennessee, March 25, 1867, Dr. Buist states: "I am sorry to say that the exsected head of the femur was not preserved, nor a photographic drawing taken." Case 286.—Private William Waters, Co. K, 123d New York, was wounded at Resaca, Georgia, on May 15, 1864, by a large fragment of shell, which completely carried away his left thigh and fractured both the tibia and fibula of the right leg. He was carried to a field hospital of the Twentieth Corps, and as soon as he had partially rallied from the shock of his frightful injuries chloroform was administered, and Surgeon J. W. Brock, 66th Ohio, amputated at the left hip joint: and then removed the right leg at the place of election. The patient survived the double operation but a short period. The exact length of time is not stated; but he died in the afternoon of the day on which he was wounded, May 15, 1864.4 Case 287.—Private Elisha Wayland, Co. E, 34th Iowa, had his right thigh almost completely torn off at the hip joint, at the siege of Vicksburg, July 3, 1863, by an unexploded shrapnel shell. He was hurriedly conveyed to a field hospital, but bled very profusely during the short transit, and is represented as almost exsanguineous upon reaching the hospital. His regi- mental surgeon, Charles W. Davis, 34th Iowa, having mastered the haemorrhage, had the patient placed under chloroform, ligated the femoral artery, divided the lacerated soft parts which still connected the mutilated limb with the trunk, and then formed a single large anterior flap, and exarticulated the femur. The patient survived the operation two hours, and died July 3, 1863.6 In five of the foregoing examples (Cases 273, 280, 284, 286, 287) and in Case 289, to be cited presently, primary disarticulation at the hip appeared to be of absolute urgency, since the graver injuries of the femur were, in each case, conjoined with lesions of the femoral artery. 1 The particulars of this case were communicated to the Surgeon General by Professor P. F. Eve in a letter dated Nashville, March 5, 1867. See also Eve (P. F.), loc. cit, p. 253, and Circular No. 7, S. G. O., 1867, pp. 24 and 57 ; LUNING (A.), op. cit, p. 90. 2 The abstract of this case was compiled from data furnished by the operator, Dr. BENJAMIN D. Lay, in charge of the City Hospital, at Vicksburg, daring the siege, in a letter to the editor, dated Paducah, July 26, 1867. Dr. Lay, who reluctantly undertook the operation, closes his account with the following remark: "I saw nothing in it to diminish the horror with which I approach such cases, of which I have had the misfortune to have three. I have been present at three others. All were fatal." See Circular No. 7, S. G. O., 1867, pp. 27, 58; Eve (P. F.), loc. cit, pp. 253, 258; I.Oning (A.), op. cit, p. 94. 3 The facts in this case were furnished by Professor PAUL F. EVE, from a carefully written account by the operator, Surgeon J. It. BUIST, 1st Ten- nessee. See Circular No. 7, S. G. 0.,1867, pp. 31, 59; EVE (P. F.), loc. cit, pp. 253, 258; LUNING (A.), op. cit., 97. 4The abstract of this case was made from field returns signed by Surgeon G. E. Cooper, tj. S. A., Medical Director, Surgeon A. L. Cox, U. S.V., and Surgeon A. BALL, 5th Ohio See Circular No. 6, S. G. O., 1865, p. 50; Circular No. 7, S. G. O., 1867, pp. 29, 58; LtJNING (A.), op. cit, p. 96. 6 This abstract was compiled from notes of the case on the Monthly Report of Sick and Wounded of the 34th Iowa, for July, 1863. In a letter to the editor, dated Indianola, Iowa, June 1, 1869, the operator, Dr. C W. Davis, writes: "In reply to yours of May 1st, I will say, after examining my Army surgical notes, I notice the case of E. M. Wayland, Co. E, 34th Iowa Volunteers. Disarticulation of hip joint, on the right side. The femur was fractured at upper third; also laceration of the tissues, muscles, and vessels of the posterior part of the leg as far up as the insertion of the gluteus maximus. I performed the amputation by the single anterior flap operation, ligating the artery before disarticulating the head of the femur. The operation was neat and made a perfect stump, but the patient lived only forty-seven hours." See Circular No, 2, S. G. O., 1869, p. 108. 136 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. FIG. 91.—Shot fracture through the trochanters of the left femur. [From a drawing by Surgeon H. Z. GILL, U. S. V.J The following nine fatal cases of primary amputations at the hip were for wounds inflicted by small projectiles. In one instance (Case 294), the patient survived the opera- tion at least eleven days; in another (Case 293), the patient had rallied so far that it was considered safe to move him, but he succumbed on the road, forty-eight hours after the operation. The remaining seven patients died within a few hours. Case 288.—Private James A. Ailing, Co. D, 3d Wisconsin, was wounded on March. 16, 1865, at the battle of Averysboro', North Carolina, by a conoidal musket ball, which entered the upper part of the left thigh iu front, and produced a comminuted fracture of the femur through the trochanters, with longitudinal splintering extending a short distance down the shaft and upward within the capsular liga- ment. The wounded man was conveyed to a field hospital of the Twentieth Corps. Chloroform was administered and the wound was thoroughly explored, and it was determined to amputate at the hip joint, because it was imperative to move the wounded on the following day over rough roads, and either an excision of the head of the femur, or an attempt at conservation of the limb, offered, under the circumstances, less chance of a favorable result than the removal of the limb. Five hours after the reception of the injury, Surgeon H. Z. Gill, U. S. V., amputated by double flap. The patient reacted well after the operation, but the amendment was of brief duration. He died seven hours after the com- pletion of the amputation, March 17, 1865. A drawing of the shattered extremity of the femur, contrib- uted by the operator, is presented in the adjacent wood-cut (Fig. 91).' Case 289.—Corporal Wad Brookins, Co. C, 49th U. S. Colored Troops,2 was accidentally shot, in the regimental camp, near Transylvania Landing, Louisiana, on September 3, 1863. He was struck in the upper third of the left thigh, at close range, by a musket ball, which divided the femoral artery and badly comminuted the thigh bone. Assistance was immediately rendered, and the copious hemorrhage was controlled by compression. Prompt preparations having been made, the thigh was amputated at the hip by Surgeon Sylvester Lanning, 49th U. S. C. T. The patient died from the haemorrhage and shock, four hours after the completion of the operation, September 3, 1863. Case 290.—Private J. M. Brown, Co. H, 63d Indiana, was wounded on June 16,1864, in the attack of the Twenty-third Corps upon the earthworks at Lost Mountain, near Marietta, Georgia. A conoidal musket ball struck his right thigb and shat- tered the upper extremity of the femur, fissures extending through the trochanter major. He was conveyed to the field hospital of the Twenty-third Corps, and on June 17th, about fourteen hours after the reception of the injury, he was placed under the influence of chloroform, and after a careful examination of the injury, it was decided to amputate at the hip joint. The oper ation was performed by Surgeon Edward Shippen, U. S. V. The operative method was similar to that adopted by Dr. Shippen in his successful operation (Case 272). Comparatively little blood was lost, but the patient succumbed to the shock of the operation and died upon the operating table very soon after the completion of the disarticulation.3 Case 291.—Seaman George Cook, aged 21 years, an Englishman, was wounded on February 1, 1884, in an engagement of a gunboat with a battery supported by sharpshooters, at Smithfield, Virginia. A rifle ball grazed his right thigh, passed througb both testicles and entered thn left thigh, fractured the femur, and passed out at the posterior and outer portion of the limb. The wounded man was taken to the Naval Hospital, at Portsmouth, Virginia, not many miles distant, and Surgeons Solomon Sharp, A. C. Gorgas, John Paul Quiiin, and Assistant Surgeon G. S. Franklin, U. S. N., held a consultation, at which it was decided that the femur was extensively shattered, and that an amputation at the hip joint presented the only chance of saving the patient's life. On the morning of February 2d, the patient was placed under the influence of chloroform, the femoral artery was compressed at the groin, and Suro-eou Gorgas, assisted by his colleagues, proceeded to remove the limb. The operation was performed by transfixing and forming an anterior flap, disarticulating, and then making a posterior flap by cutting from within outward. Very little blood was lost; yet the patient never reacted, but succumbed about two hours after the completion of the operation. The shattered femur was forwarded by Suro-eon Gorgas to the Army Medical Museum. It is represented in the adjacent wood-cut (FlG. 92). It is a very strong and compact bone. The ball has separated five large fragments, and has produced fissures extending from above the level of the trochanter minor a little over four inches down the shaft.'' Case 292.—" Private John W. Dadds, Co. B, 4th Maryland, was wounded on the morniug of May 12, 1864, at the battle of Spottsylvania, by two musket balls, one of which shattered his left tibia and fibula, while the other passed through the left 1 The notes in this case were furnished by the operator, Surgeon H. Z. Gill, U. S. V. See Circular No. 7, S. G. O., 1867, pp. 31, 59; LOnlxg (A), Ober die Blutung bei der Exarticulation des Oberschenkels, etc., Zurich, 1877, S. 102. 2The regiment was styled at the period "11th Louisiana Regiment of African Descent." Its designation was changed, March 11, 1864 to "49th United States Colored Troops." The case was reported on the Monthly Report of Sick and Wounded of the 11th Louisiana Regiment of African Descent, signed by the operator, Surgeon Sylvester Lanning. See Circular No. 2, S. G. O., 1869, p. 108; LOntng (A.), op. cit, p. 93. 3 A Report of Surgical Operations during the Atlanta Campaign in 1864, collected by Surgeon A. M. Wilder, U. S. V., furnished the data in this case. This is one of the two fatal cases referred to by Dr. Edward Shippen, the operator, in connection with an account of his successful amputation at the hip (Case 272, ante.), published in Professor Frank H. Hamilton's Treatise on Military Surgery, New York, 1865, p. 485. A special report from Dr. SHIPPEN, dated January 13, 1866, contains no further particulars. See Circular No. 6, S. G. O., 1865, p. 50; Circular No. 7, S. G. O., 1867, pp. 31, 59; LUxrsG (A.), op. cit., p. 97. 4 An account of this case was forwarded to the Surgeon General's Office by the operator, Surgeon Albert C. GORGAS, U. S. N., together with the pathological preparation. See Circular No. 6, S. G. O., 1865, p. 50; Circular No. 7, S. G. O., 1867, pp. 28, 58; Catalogue of the Surg. Sect, of the Army Medical Museum, 18G6, p. 233; Luntng (A.), op. cit., p. 96. Fig. 92.—Comminution of femur by a rifle ball. Spec. 2273. SECT. n.j PRIMARY AMPUTATIONS AT THE HIP JOINT. 137 thigh, comminuting the femur at the trochanters. He was carried to the field hospital of the 2d division of the Fifth Corps, where a consultation was held by the senior surgeons present. After a careful exploration, under chloroform, it was determined that the thigh wound involved the hip joint. It was decided that an excision of the head of the femur, or a resort to expectant treatment, were alike forbidden by the grave compound fracture of both bones of the leg, which complicated the thigh fracture, and that there was no alternative but coxo-femoral amputation. Accordingly, stimulants were administered, and every means were employed to bring about reaction, and, three hours after the reception of the injury, Surgeon Enos G. Chase, 104th New York, proceeded to remove the limb. He performed the double-flap operation, sometimes described as B6clard's, transfixing the thigh and forming a large flap in front, disarticulating and then cutting from within outward to make a posterior flap. The vessels were then rapidly secured. The patient survived the operation twelve hours."1 Case 293.—Private James Martin, Co. I, 146th New York, aged 20 years, was wounded on July 13, 1863, in one of the reconnoissances of General Lee's position near Williamsport. He was carried to the rear and placed in 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 assisted. It was found that a conoidal musket ball had passed through the upper part of the left thigh from before backward, and had struck the 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 administered, he removed the limb by a double-flap operation. He describes the operation 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, and by the external obliquity of the plane of incision drainage of pus was facilitated more than by the ordinary horizontal antero-posterior flaps." It appears that the disarticulation was rapidly accomplished, and that very little blood was lost. The shock Fig. 93.-Comminuted was great, but the patient is reported to have rallied so far that it was considered safe to move him. On sp°ec. 1379. ° emur' July 16, 1883, he died on the road to Sharpsburg, about forty-eight hours subsequent to the operation. An examination of the specimen from this case, which was forwarded by Assistant Surgeon Howard to the Army Medical Museum, and is represented in the wood-cut (FlG. 93), justified the opinion formed before the operation, that an excision of the head of the femur was impracticable; for besides the comminution about the lesser trochanter and the fissures towards the neck, fissures ran down the shaft of the bone for a long distance.2 Case 294.—A private soldier of Major Douglass's Cavalry was accidentally wounded by a comrade near Lavergne, Tennessee, on October 19, 1862. The injury was inflicted by a round ball, with buckshot, fired from a fowling-piece, the muzzle being within a few inches of the person of the man who was wounded. The charge passed directly through the thigh just below the trochanters, comminuted the femur, and extensively lacerated the soft parts. The operation was performed eight hours after the reception of the injury. Chloroform was administered until anaesthesia was complete. Then an assistant controlled the femoral at the groin, and the operator, Dr. J. F. Grant, P. A. C. S., entered the point of a knife twelve inches long an inch below the anterior superior spinous process of the ilium and transfixed, accordiug to Lisfranc's method, on the outer side of the femur, bringing the point out near the tuberosity of the ischium, and cutting an external and posterior flap five inches long. The gluteal and sciatic arteries were then tied; then an antero-internal flap was cut and the head of the bone was disarticulated. He was taken to the neighboring house of a widowed lady on the Murfreesboro' pike, between Lavergne and Nashville. Here he was seen by Dr. Grant on October 22d, and seemed in every respect to be doing well. On this day that locality was occupied by United States troops and Dr. Grant did not see his patient again. He received a message from him on October 30th, but no subsequent information. It is altogether probable, therefore, that the patient died.3 Case 295.—A private of the 18th Mississippi Regiment, of Barksdale's Brigade, a robust man, under thirty years of age, received a shot fracture of the upper extremity of the left femur, at Malvern Hill, July 1, 1862. The injury was probably caused by a conoidal musket ball, and there was great splintering of bone, extending to the neck. Early on the morning of July 2d the patient inhaled chloroform, and amputation at the hip joint was performed by Surgeon J. T. Gilmore, P. A. C. S., by forming anterior and posterior flaps by transfixion. There was no reaction, and the patient died from the shock of the operation an hour or two after its completion.4 Case 298.—A private of the 21st Mississippi Regiment, a young healthy man, was wounded at Malvern Hill, July 1, 1862, by a conoidal musket ball, which fractured the left femur through the trochanters and neck. Twelve hours after the reception of the injury he underwent amputation at the hip joint. The operation was performed under chloroform, by Surgeon J. T. Gilmore, by the antero-posterior flap method, the flaps being formed by transfixion. The patient only partially reacted after the operation, and, though he lingered until the morning of July 4th, he died apparently from the shock of the operation.6 1 At the date of the publication of Circular No. 7, in 1867, various reports regarding this case led to the belief that the head of the femur had been excised. A report of the case, by Surgeon ENOS G. CHASK, 104th New York, the operator, was finally discovered in time for publication in Circular No. 2, 1869, at page 107; LUNING (A.), op. cit, p. 96. , 2 Assistant Surgeon Benjamin Howaud, U. S. A., the operator, and Surgeon T. M. Flandrau, 146th New York, communicated the facts in this case. See Circ. No. 6, S. G. O., 1865, p. 50; Circ. No. 7, S. G. O., 1867, pp. 28, 58; Cat. Surg. Sect. A. M. M., 1866, p. 233; LUNING (A.), op. cit, p. 94. 3 The abstract of this case was compiled from data furnished by Professor Paul F. Eve. See Circular No. 7, S. G. O., 1867, pp. 25, 28; Eve (P. F.), loc. cit, pp. 254, 260; LUNING (A.), loc. cit, p. 91. 4Eve (P. F.), loc. cit, pp. 254, 259 j Circular No. 7, S. G. O., 1865, pp. 25, 57; LUNING (A.), op. cit, p. 91. sSohrel (F.), Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 155; Eve (P. F.), loc. cit, p. 254; Circular No. 7, S. G. O., 1867, pp. 25, 58; LUxing (A.), op. cit, p. 91. SUKG. Ill—18. 188 IXJURIKS OF THE LOWER EXTRFMITIES. [CHAP. X Table XV. Summary of Iwcnty-five Cases of Primary Amputation at the Hip Joint. No Name, Age, and Military Description. 23 Kelly, J. E., Pt., B, 56th Pennsylvania, age 28. Robinson, Pt., Louisiana reg- iment, age 35. Williamson, Pt., 13th Mis- sissippi, age 20. Ailing, J. A., Pt., D, 3d Wisconsin. Barger, J., Pt., B, 26th Pennsylvania, age 22. Brookins, W., Corp'l, C, 49th Colored Troops. Brown, J. M., Pt., H, 63d Indiana. Bushmil, J., Pt., 99th New York (detailed as a seaman on U. S. frigate Congress). Carlton, R., Captain, 1, 3d New Hampshire. Cook, G., seaman, age 21 .. Cooper, ---, Pt., Alabama regiment, age 20. Dadds, J. W., Pt., B, 4th Maryland. Fulton, I. C, Pt., 1, 4th New York Heavy Artillery. Gordon, R., Pt., H, 7th Rhode Island, age 28. Martin, J., Pt., 1,146th New York, age 20. Unknown, Union soldier, taken prisoner. Unknown, Lieut.. Arkansas regiment, age 28. Unknown, Pt., Maj. Doug- lass's Cavalry. Unknown, Pt., Gen. A. S. Johnston's army. Unknown, Pt., 18th Miss., Barksdale's brigade, age under 30. Unknown, Pt., 21 st Miss___ Unknown. Pt.. 3d Missouri. Unknown, Pt.. 27th Tenn... Waters. W., Pt., K, 123d New York. Wayland, E., Pt., E, 34th Iowa. Date of Injury April 29, 1863. Mar. 13, 1863. June 4, 1862. Mar. 16, 1865. May 18, 1864. Sept. 3, 1863. June 16, 1864. Mar. 9, 1862. June 16, 1862. Feb. 1, 1864. May 22, 1863. May 12, 1864. Oct. 1, 1864. May 18, 1864. Julv 13, 1863. Oct. 21, 1861. Oct. 3, 1862. Oct. 19. 1862 April 7, 1862. July 1, 1862. July 1, 1862. June — 1863. Aug. 31, 1864 May 15 1864. July 3, 1863. Nature of Injury. Conoidal ball fractured upper extremity of left femur. Frag.of 24-poundershell crush- ing trochanters and neck of left femur and wounding fem- oral artery. Conoidal ball fract. right femur, fissures extending into neck quite within capsular ligam't. Conoidal ball fract'd left femur thro' troch's, with longitud'l splinter'g extend'gdown shaft and upw'd within capsul. lig. Fragment of shell shattering right femur from just above tro. minor nine ins.downward. Musket ball comminut'g upper third left thigh and dividing femoral artery. Conoidal ball shattered upper extremity right femur,fissures extending through trochanter major. Piece of shell comminuted neck and trochanters of left femur. Large missile fractured tro- chanters and shattered left fe- mur for several inches below. Rifle ball fractured left femur, wounded both testes and right thigh. Fragment of shell comminuted upper third right femur, frac- turing tuberosity of ischium. Musket ball comminuting left femur at trochanters, involv. hip joint (also fract. left leg). Fragment of shell shattered up- per extremity of left femur. Fragment of shell completely shattered left femur. Conoidal ball comminu'd frac- ture of left femur a little below trochanter major. Large missile fractured upper part of femur. Cannon ball wound of right hip, five inches of the shaft of femur comminuted, head split and exposed. Round ball and buck com- minuted femur just below trochanters. Frag, shell shatt'd up. extrem- ity left femur, com. extended to head and neck of bone. Conoidal ball fractured upper extremity of left femur, splint- ering extending to neck. Conoidal ball fract'd left femur through trochanters and neck. Large frag, of shell comminu- ting right femur extent of eight inches; femoral artery divided. Cannon shot shat'd right femur, splintering extending to neck. Date of Opera tion. April 29 1863. Mar. 13 1863. June 4, 1862. Mar. 16, 1865. May 18. 1864. Sept. 3, 1863. June 17. 1864. ' Mar. 9, 1862. June 16 1862. Feb 2, May 22, 1863. May 12. 1864. Oct. 1, 1864. May 18, 1864. July 14, 1863. Oct. 21, 1861. Oct. 3, 1862. Oct. 19, 1862. April 7, 1862. July 2, 1862. July 1, 1862. Day of injury. Aug. 31, 1864. Large fragment of 6hell carried j May 15, away left thigh, fracturing 1864. right leg. Unexploded shrapnel shell al- I July 3, most completely tearing off 1863. right thigh at hip joint. Operation and Operator. Single anterior flap, by Surg. E. Shippen, U. S. V. Antero-internal flap amputat'n, by Surg. W. M. Compton, 2d Texas. Long anterior and short poste- rior flaps, by Surg. J. T. Gil- more, C. S. A. Double flap, by Surg. H. Gill, U. S. V. Single antero-internal flap, by Surg. C. C. Jewett, 16th Mass. Amputation, by Surg. S. Lan- ing, 49th Colored Troops. Single anterior flap, by Surg E. Shippen, U. S. V. Lateral double flap, method of Baron Larrey, the elder, by Surg. L. McLean, 2d N. Y. Anterior posterior flap, by a New England surgeon, assist- ed by Ass't Surg. F. j. Ban croft, 76th Penn. Anterior posterior flap,bv Surg A. C. Gorgas, U. S. N. Large anterior flap, by Surg. W. M. Compton, 2d Texas. Double flap, Beclard's method, by Surg. E. G. Chase, 104th New York. Anterior post, flaps, by Surg. J. W. Wishart, 140th Penn. Method of Guthrie, by Dr. J. M. Carnochan ; femoral tied before amputation. Double flap, by Ass't Surgeon B. Howard, U. S. A. Amputation, by Surgeon H. McGuire, C. S. A. Soft parts of post, part of thigh pared into shape, large and long antero-internal flap, by Surg W.M.Compton, 2d Tex. External posterior flap, antero- internal flap, by Surg. J. F. Grant, P. A. C. S. Amputation, by Surg. D. W. Yandell, C. S. A. Anterior and posterior flaps, by Surg. J. T. Gilmore, C. S. A. Anterior posterior flap, by Sur- geon J. T. Gilmore, C."S. A. Semi-lunar flap from outer and anterior part, bv Surg. B. D. Lay, P. A. C. S. Antero-posterior flaps, by Surg. J. R. Buist, 1st Tennessee. Amputation of the left hip and right leg, bv Surgeon J. W. Brock, 66th"Ohio. Single large anterior flap, by Surgeon C. W. Davis, 34th Iowa. Result and Remarks. Gangrene, diarrhoea. Disch'd December 23,1863. Spec. 1148. Healed by first intent'n; left hos- pital April 20, '63, in fine health. Eve (P.F.), loccit.pp.254,262. Circ. 7, S. G.O., 1867, pp. 26,58. Six weeks after operation wound healed and patient allowed to leave hospital. Eve (P. F.), loc. cit, pp. 254, 259. Circ. 7, S. G. O., 1867, pp. 24, 57. Died, March 17,1865, seven hours after operation. Circ. 7, S. G. O., 1867, pp. 31, 59. Died, May 18, 1864, two hours afteroperation. . 2, at Evansville. He had been wounded on April 7th, probably by a conoidal musket ball. The projectile had entered the front of the left thigh, about an inch below the level of the trochanter major, and ranging a little upward had emerged from the gluteal region opposite. The upper portion of the femur was crushed and the injury to the soft parts was most extensive. A consultation was held on April 21st, and the opinion that amputation at the hip afforded the only possible chance of preserving life was unanimous. Dr. DeBruler operated, assisted by Dr. T. N. Myers and others. The loss of blood was very trifling. After the completion of the operation, the pulse, which had been carefully watched, was observed to fail rapidly. Unavailing attempts were made to give brandy and other restoratives. In a few moments the man was dead. There was no reason to believe that the use of chloroform had any connection with the fatal result, which was apparently due solely to the shock of the operation. Such was the opinion of the eminent professor of surgery of Jefferson College, Dr. S. D. Gross, who happened to visit the hospital half an hour after the operation. Professor Gross expressed his approbation of the course that had been adopted, since, although it had resulted unfortunately, it afforded the only hope of saving the patient's life.1 Case 311.—Private George M. Spencer, Co. B, 2d New York Mounted Rifles, aged 17 years, was wounded on March 31, 1865, at Dinwiddie Court House, Virginia, by a conoidal musket ball, which entered the right gluteal region, and striking the great trochanter, produced a fracture through the trochanters, with very remarkable longitudinal splintering, extending nine inches down the shaft (FlG. 96). The projectile then lodged. The wounded man was sent to City Point, and thence by steamer to Washington, and entered Judiciary Square Hospital on April 4th. There was already a good deal of inflammatory swelling and sup- puration, but the constitutional condition was encouraging. Upon examination of the wound, it was thought that the fracture did not extend below the trochanter and that the joint was probably involved, and it was determined to excise the head of the femur. The patient having stated that he was anxious to avail of the benefit of any operation that was deemed necessary, he was placed under the influence of chloroform on April 12th, and Surgeon Elisha Griswold, U. S. V., proceeded to disarticulate the head of the femur through a long vertical incision on the outside of the thigh, and to remove the head with an obliquely fractured fragment of the shaft attached to it. The splintering of the shaft was now discovered, and after a hasty consultation with the surgical staff it was decided that amputation at the hip joint was the only procedure which afforded the patient any prospect of recovery. This operation was rapidly executed by Surgeon Griswold, aided by Acting Assistant Surgeons Hill, McCalla, Colton, and Ahern, by the double-flap method. There was but little haemor- rhage; but the shock of the operation was too great. The usual means to promote reaction were diligently employed, but the patient never rallied, and survived the operation less than an hour.2 Cask 312.—A private of Co. C, 54th Massachusetts, a colored man, was wounded and made a prisoner in the assault on Morris Island on July 11, 1863. A fragment of a shell from Fort "Wagner struck the upper and outer part of his right thigh, and fractured the neck and head of the femur and the rim of the acetabulum, and extensively lacerated the soft parts in its exit through the posterior part of the thigh. The patient was conveyed to Charleston on the afternoon of July 12th, and was placed in a hospital hastily prepared for the reception of wounded colored prisoners. The contract surgeon in charge of the hospital reports that the patient's condition, in view of the terrible wound he had suffered, was remarkably good, and that the symptoms of shock were unusually slight. On July 13th, the third day after the reception of the injury, Surgeon R. A. Kinloch, P. A. C. S., saw the case, and amputated at the hip joint by Manec's method. The knife being entered midway between the anterior superior spinous process of the ilium and the great trochanter, and carried downward and inward until its point emerged just in front of the ischium, was made to form a large antero-internal flap; the soft parts on the outer and posterior part of the thigh were then divided by a semicircular incision from without inward, and the head of the femur was then disarticulated. The patient bore the operation well, but a few hours subse- quently there was extreme depression, and the case terminated fatally on the following morning, July 14th, twenty hours after the operation.3 Case 313.—A private soldier of an Ohio regiment, aged 35 years, was wounded at the battle of Shiloh, April 6, 1862, by a fragment of shell, which extensively comminuted the shaft, trochanters, and neck of the right femur, as illustrated in the accompanying wood-cut (Fig. 97). The patient was left on the battle-field during the tempestuous night of April 6th, and until late on the following day. He was then removed to a temporary hospital, and thence to the steamer Lancaster, to be transported to Cincin- nati. On April 16th, it was decided to remove the limb, and the patient being rendered insensible by chloroform, amputation at the hip joint was performed by Surgeon G. C Blackman, U. S. V., by the On April 18th, the patient was transferred to St. John's Hospital, Cincinnati, and Dr. C. D. Palmer FlG. 96.—Longi- tudinal Assuring of right femur. Spec. 4237. Flo. 97.—Comminuted shot fracture of femur. From a drawing furnish- ed by Dr. BLACKMAN. autero-posterior flap. reported that the flaps began to slough. Death ensued on April 22, 1862.4 1 Dr. J. P. DeBuuler, of Evansville, Indiana, communicated the particulars of this case. See Circular No. 7, S. G. O., 1867, pp. 34 and 61, and LUXLNG (A.), Uber die Blutung bei der Exarticulation des Oberschenkels, Zurich, 1877, S. 91, F. 290. 2 This case was first published in Circular No. 6,1865, p. 50, Case 21, from the Judiciary Square Hospital Surgical Report for the second quarter of 186.". See Catalogue of the Surgical Section of the Army Medical Museum, 4to, 1866, p. 248, and Circular No. 7, S. G. O., 1867, pp. 39 and 62, with reference to the report of a board of inquiry in the case, convened April 13, 1865, consisting of Surgeon O. A. JUDSON, U. S. V., Assistant Surgeon W. Thomson, U. S. A., and Assistant Surgeon W. F. Noekis, U. S. A. See also Luntng (A.) (loc. cit, Zurich, 1877, p. 102, CASE 366). sThe particulars of this case were communicated to the Surgeon General's Office by Professor R. A. KiXLOCK, of Charleston. See Eve (P. F.) (loc. cit. Vol. XVIII, p. 255, Case 17, and Circular No. 7, S. G. O., 1867, pp. 36 and 62, and Luntng (A.), op. cit, Zurich, 1877, p. 94, Case 307. 4 Blackman (G. C), Amputation at the Hip joint, in Cincinnati Jour, of Medicine, 1866, Vol. I, p. 101. Circular No. 6, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1807, pp. 34, 61. Luntng (A.), Vber die Blutung bei der Exarticulation des Oberschenkels, Zurich, 1877, p. 91, Cask 289. SECT. II. J INTERMEDIARY AMPUTATIONS AT THE HIP JOINT. 143 Case 314.—A private soldier of the U. S. Army was wounded at the first battle of Bull Run, July 21,1861, by a musket ball, which fractured the lower third of light femur. He fell into the hands of the enemy, and, on the following day, was con- veyed in au army wagon to Manassas Junction, and thence by rail to Richmond, where he was admitted to the Alms House Hospital. One week after the reception of the injury there was extensive purulent infiltration in the muscles of the thigh and incipient gangrene of the leg. Under these circumstances Drs. St. George Peachy and Charles Bell Gibson decided to amputate at the hip joint. On July 29th the operation was performed by Dr. Peachy, in the presence of Drs. Gibson, A. E. Peticolas, Richardson, and others. A preliminary ligature was placed upon the femoral artery at the beginning of the operation, which was probably done according to Larrey's method. The patient is believed to have survived the operation two or three days.1 Case 315.—A private of General Bnigg's army, whose name and military description are not recorded, a large man, six feet high, of fair complexion, about 26 years of age, was wounded on December 28, 1882, in a skirmisR prior to the battle of Murfreesboro'. A conoidal musket ball produced a fracture of the trochanter major and neck of the femur, with fissures extending within the capsular ligament. The wounded man was placed in a field hospital, and his injured limb was supported iu a proper position; but the local inflammation and constitutional disturbance that ensued were intense, and, on January 5,1863, it was determined to amputate at the hip joint. The patient being placed under chloroform, the operation was performed by the antero-posterior flap method by Assistant Surgeon A. C. Crymes, 39th Alabama. On being removed to his bed the patient manifested extreme prostration, and stimulants were freely administered. After a few hours he was able to take nutriment in a concentrated form, and a supporting and stimulating treatment was perseveringly pursued. In a very few hours after the oper- ation, however, the stump evinced a tendency to unhealthy action, and the patient sank into an adynamic condition, and died on the morning of January 8th, three days after the operation.2 Case 316.—A private of Colonel Dockeray's Arkansas Regiment of Cabell's Brigade was wounded at the battle of Corinth, Mississippi, October 3, 1862, by a conoidal musket ball, which shattered the neck of the right femur. He was conveyed to a hospital at Iuka, where, on November 3d, his thigh was amputated at the hip joint by his regimental surgeon, Dr. R. A. Felton. The patient died upon the table before the dressing of the stump was completed. The operation was done under chloroform, and it was the general impression of the surgeons present that the anaesthetic was administered too freely.3 Case 317.—Besides the instance of primary coxo-femoral amputation for shot injury by Dr. B. D. Lay, P. A. C. S., detailed as Case 284, p. 135, ante, were two intermediary amputations at the hip joint for comminution of the upper portion of the femur by conoidal musket balls, performed by the same surgeon. One of them, here to be noted, was that of a Confed- erate private soldier, who suffered a shot fracture of the femur, in Mississippi, early in 1863, prior to the siege of Vicksburg. Comminution of the femur extended high up through the trochanteric region, and amputation at the hip was practised two days after the injury. The patient sank under the shock of the injury and operation a few hours after the latter,3 although the oper- ation was completed rapidly and with slight loss of blood. Dr. Lay observed that "nothing in this case served to diminish the terror with which I approach such cases."4 Case 318.—A private Confederate soldier, whose name and military description are not identified, received a shot com- minution of the femur in one of the engagements in Mississippi, in the early part of 1863, prior to the siege of Vicksburg. A day or two after the injury, amputation at the hip was performed by Dr. B. D. Lay, P. A. C. S. Although the amputation was rapidly accomplished, with little loss of blood, the patient sank and died a few hours after the operation. The detailed memo- randa of this and the preceding case were unfortunately lost.8 Case 319.—Private J. H. Wolf, Co. D, 4th Virginia, had his femur fractured at the battle of Bull Run, July 21, 1861, by a musket ball, which traversed the upper part of the thigh in an antero-posterior direction, and striking the femur four inches below the trochanters, shattered it quite up to the neck. The patient was removed to Charlottesville, and was received in the general hospital at that place on July 24th. The fracture was treated by Smith's anterior suspensory splint, and this mode of dressing proved very serviceable for a time. The inflammatory phenomena did not abate, however, and after four weeks it was decided that removal of the limb at the coxo-femoral articulation alone afforded a hope of preserving the patient's life. On August 21st the operation was performed by Brigadier General Edward Warren, Surgeon General of North Carolina, and was rapidly executed by the double flap method, with inconsiderable haemorrhage. On the following day there was slight hemor- rhage. Death from exhaustion ensued on August 23, 1861, thirty hours after the operation. The constitutional condition of the patient was unfavorable, and he was suffering from colliquative diarrhoea.6 1 The particulars of this case were supplied by Professor T. G. Richardsox, of New Orleans, who was present at the operation. See also Circular No. 7, S. G. O., 1867, CASE XX, pp. 33, 61, and LUNING (A.), Uber die Blutung, u. s. w., Zurich, 1877, p. 89, CASE 270. 2Details of this case were communicated to the Surgeon General's Office by the operator, Assistant Surgeon^A. C. CRYMES, 39th Alabama, anil by Professor R. A. Kixloch, of Charleston, South Carolina. The case has been published in Professor P. F. Eve's contribution (op. cit, Trans. Am. Med. Assoc., 1867, Vol. XVIII, p. 255, Case 20). See also Circ. 7, S. G. O., 1867, pp. 35, 62, and LUNING (A.), loc. cit, Zurich, 1877, p. 92, Case 293). 3This case was first published by Professor P. F. Eve (Transact. Am. Med. Assoc, 1867, Vol. XVni, pp. 253, 261). Further particulars of the case were communicated by Surgeon James D. WALLACE, 1st Missouri. The operator, Surgeon R. A. FELTON, died in 1863. See Circular No. 7, S.G. O., 1867, pp. 35, 62. See also Dr. AUGUST LUNING (op. cit, Zurich, 1877, S. 92, CASE 291). 4 Dr. B. D. Lay, of Paducah, Kentucky, in a letter of July 26, 1867, to the Surgeon General's Office, refers to this case, and Dr. L. D. NIDELET, of Mobile, Alabama, in letters of April 21 and May 4, 1867, mentions having assisted at the operation. 6In a letter to the Surgeon General's Office, dated Paducah, Kentucky, July*25, 1867, Dr. B. D. Lay regrets his inability to furnish more details inspecting this and the preceding case of intermediary amputation at the hip joint, and states that he had kept copious notes of all of his cases of ampu- tations practised during the war, and that these notes, with records and instruments of the Vicksburg hospitals and its branches, were given in charge to Surgeon J. II. BOUCHER, of Major-General J. B. McPHEKSON's corps; and, if the registers were preserved, they would give the desired information. It was ascertained that Dr. J. H. BOUCHER, formerly Surgeon 13th Iowa, afterwards Surgeon U. S. V., and Medical Director of the Seventeenth Corps, resided in Iowa City after the war, and died in April, 1874. His son, Dr. F. H. BOUCHER, of Clarksville, Iowa, July 15, 1878, made a careful examina tion in his father's library for papers and notes pertaining to the surgery of the war without finding any trace of the memoranda referred to by Dr. B. D. Lay. "Eve (P. F.), loc. cit, p. 254. Circular No. 7, S. G. O., 1867, pp. 33, 61. FAUNTLEROY (A. M.), Hip Joint Amputations, in Richmond Med. Jour., 1866, Vol. I, p. 11. LOntng (A.;, Uber die Blutung bei der Exarticulation des Oberschenkels, Ziirich, 1877, p. 89, Cask 271. 144 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Of the twenty-three intermediary amputations at the hip joint, ten were on the right side, six on the left; in seven cases the side of injury was not stated. The Museum possesses pathological specimens from three of the twenty-three cases. Table XVI. Summary of Twenty-three Cases of Intermediary Amputation at the Hip Joint. Name, Age, and Military Description. Date of Injury Nature of Injury. Date of Opera- tion. Operation and Operator. Result and Remarks. Carden, J., Pt., Gen. Rosen- crans's army. Carroll, L., Sergeant, H, 1st Delaware, age 23. Chamberlain, J., Pt., U. S. Army. Eckley, L., Pt., A, 67th Ohio, age 33. Gaines, S., Pt., M, 2d Mich- igan Cavalry. G-----, F., Pt., Texas regiment. Hale, H. H., Pt., G, 14th Illinois, age 21. Hamilton, C, Pt., H, 3d Colored Troops. Jackson, —, Pt., Col. Tap- pan's brigade, age 21. Johnson, P., Pt., C, 2d Del- aware. Lackey, C, Pt., E, 7th Wis- consin, age 30. Martin, —, Pt., 26th Arkan- sas, age 25. Minott, J., Pt., A, 4th Ver- mont, age 20. Pausbeck, P., Pt., K, 43d Illinois. Spencer, G. M., Pt., B, 2d New York Mounted Rifles, age 17. Unknown, Pt., C, 54th Mas- sachusetts. Unknown, Pt., Ohio regi- ment, age 35. Unknown, Pt., U. S. Army. Unknown, Pt., Gen. Bragg's army, age 26. Unknown, Pt., Col. Dock- eray's Arkansas regiment. Unknoum, Confederate sol- dier. Unknown, Confederate sol- dier. Wolf, J. H., Pt., D, 4th Virginia. Sept. 20, 1863. Oct. 22, 1864. Sept. 20 1863. May 20 1864. Jan. 31 1864. July 2, 1863. April 6, 1862. June 14 1863. Nov. 7, 1861. Dec. 14, 1862. May 12, 1864. Dec. 7, 1862. June 23, 1864. April 7. 1862. Mar. 31, 1865. July 11 1863. April 6, 1862. July 21, 1861. Dec. 28, 1862. Oct 3, 1862. 1863. 1863. July 21, 1861, Fragment of shell comminuted femur, ex. lac. of soft parts. Conoidal ball, r't femur splint- ered, extending ten ins.; ball ext.; sharp upper extremity of femur sawn off; Nov. 2, haem., lig. small artery. Conoidal ball, great com. upper extremity of femur, fissures extending to neck. Conoidal ball shattering upper extremity of left femur and wounded sciatic nerve. Conoidal ball shattered head and neck of right femur. Grapeshot shattering left femur at trochanter major up into the neck. Frag, of shell shattered upper portion of the left femur, soft parts ex. lacerated. Musket ball fract. upper part of left femur—great swelling, inflammation, and pain—co- pious haem., digital pressure. Shot comminuted fracture of upper extremity of femur. Conoidal ball perforating right great trochanter; gangrene entire limb. Conoidal ball frac. right femur, thro' trochanters, nearly half length of shaft; surgical fev. Cannon shot shattering the left thigh. Conoidal ball fract. upper por- tion shaft right femur; gan- grene, mortification. Conoidal ball crushing upper portion left femur, extensive injury of soft parts. Conoidal ball fract. thro' right trochan's, splintering extend- ing nine ins.; lodged. Fragment of shell fract. neck and head of right femur and rim of acetabulum. Frag, of shell comminuted shaft, trochanters, and neck of right femur. Musket ball fract. lower third right femur; ex. pur. infiltra- tion ; incipient gang, of leg. Conoidal ball fract. troch. maj. and neck of femur, fissures extending into capsular lig. Conoidal ball shattering neck of right femur. Shot fracture of the femur... Shot fracture of the femur... Musket ball shaft'g femur from four ins. below troch's quite up to neck; colliquative diarr. Sept. 21, 1863. Nov. 11 1864. Sept. 21, 1863. May 24, 1864. Feb. 3, 1864. July 4, 1863. April 12, 1862. June 25, 1863. Nov. 15, 1861. Dec. 27, 1862. May 21, 1864. Dec. 8, 1862. June 25, 1864. April 21, 1862. April 12, 1865. July 13, 1863. April 16, 1862. July 29, 1861. Jan. 5, 1863. Nov. 3, 1862. 1863. 1863. Aug. 21, 1861. Amputation, by Surg. R. P. Bateman, P. A. C. S. External flap made by cutting from without inward, internal flap by cutting from within outward, by Surg. E. Bent- ley, U. S. V. Amputation, by Surg. R. P. Bateman, P. A. C. S. Antero-posterior flap, by Ass't Surg. H. C. Roberts, U. S. V., and others. Large antero-internal - flap, by Surg. E. Shippen, U. S. V. Antero-posterior flap, by Surg. B. Rohrer, 10th Penn. Res., and others. Long anterior flap, by Surg. D. P. Smith, U. S. V., and others. Antero-posterior flap, by Surg. E. P. Gray, 3d Col'd Troops, and others. Antero-posterior flap, by Surg. R. Potts, P. A. C. S. Amputation, by Surgeon P. Pineo, U. S. V. Antero-posterior flap, by Ass't Surg. A. Ingram, U. S. A. Large anterior flap, by Surg. W. B. Welch, of Col. Gun- ther's Arkansas regiment. Short anterior, long posterior flap, by Surg. D.M. Goodwin, 3d Vermont. External and internal flap, after Lisfranc's method, by A. A. Surg. J. P. De Bruler. Incision for excision, double flap amp., by Surg. E. Gris- wold, U. S. V., and others. Manec's method, large antero- internal flap, by Surg. R. A. Kinloch, P. A. C. S. Antero-posterior flap, by Surg. G. C. Blackman, U. S. V. Probably by Larrey's method, by Surg. St. G. Peachy, P. A. C. S. Antero-posterior flap, by Ass't Surgeon A. C. Crymes, 39th Alabama. Amputation, by Surg. R. A. Felton, of Col. Dockeray's regiment. Amputation, by Surg. B. D. Lay, P. A. C. S. Amputation, by Surg. B. D. Lay, P. A. C. S. Double flap, by Surg. E. War- ren, C. S. A. Died September 27, 1863. Progress favorable forthree days; Nov. 17th, pyaemie symptoms. Died Nov. 19, 1864, pyaemia. Autopsy. Spec. 1020. Circ. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 38, 62. Died thirty-six hours after oper'n. EVE (P. F.), loc. cit, p. 255. Circ. 7, S. G. 0..1867, pp. 36,62. Reacted fairly. Died, May 28, 1864, from exhaustion. Circ. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 37, 62. Never rallied. Died one hour after operation, from shock. Died thirty-six hours after oper- ation. Reaction fair; April 14th, gan- grene. Died April 20, 1862. Sank gradually, and died, June 29,1863, from exhaustion. Circ. 2, S. G. O., 1869, p. 109. Succumbed to shock of opera- tion. Eve (P. F.), loc. cit, pp. 255,264. Circ. 7, S. G. O., 1867, pp. 33. 61. Died a few hours after operation. Spec. 710. Circ. 6, S. G.O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 35, 62. But partial reacti'n. Died twenty- four hours after operation. Circ. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 37, 62. Rallied somewhat. Died, Dec. 12, 1862, from exhaustion. Rallied, but soon began to fail; died two hours after operation. Circ. 7, S. G. O., 1867, pp. 38,62. Died, a few moments after oper- ation, from shock. Circ. 7, S. G. O., 1867, pp. 34, 61. Died in less than an hour. Spec. 4237. Circ. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 39, 62. Died twenty-four hours after op- eration. Eve (P. F.), loc. cit, p. 255. Ctrc. 7, S. G. O., 1867, pp. 36, 62. Rallied satisfactorily; April 18th, flaps sloughed badly; pyaemie symptoms. Died April 22,1862. Survived oper'n two or three days. EVE (P. F.), loc. cit, p. 253. Circ. 7, S. G.O., 1867, pp. 33,61. In a few hours stump evinced a tendency to unhealthy action, and patient sank into adynamic condition; died Jan. 8, 1863. EVE (P.F.),loc. cic.,p. 255. Ctrc. 7, S. G. O., 1867, pp. 35, 62. Died before dressing of stump was completed. EVE (P. F.), loc. cit, pp. 253, 261. Circ. 7, S. G. O., 1867, pp. 35, 62. Died. Circ. 2, S. G. O., 1869, p. 108. Luntng (A.), Exart. des Oberschenk., Zurich, 1877, S. 99, Case 340. Died. Circ. 2, S. G. O., 1869, p. 108. Luntng, op. cit., S. 99, Case 341. Died Aug. 23,1861, from exhaus- tion. SECT. II.] SECONDARY AMPUTATIONS AT THE HIP JOINT. 145 Secondary Amputations.—Of nine instances of secondary amputations at the hip joint, eight were practised on Union soldiers and one on a Confederate soldier, resulting in two recoveries and seven deaths, a mortality rate of 77.7 per cent. The shortest interval between the reception of the injury and the operation was forty-three days; the longest, two years nine months and twenty-one days. Six of the operations were performed on the right side and three on the left. Of the two survivors of secondary amputation at the hip, one is a pensioner in comfortable health at a period nearly fifteen years after the operation. Case 320 —Private George W. Lemon, Co. C, Cth Maryland, aged 30 years, had his left femur fractured, at the junction of the middle and upper thirds, by a conoidal musket ball, at the battle of the Wilderness, May 5, 1864. He was left in a shelter tent on the field and fell into the hands of the enemy. On May 13th he was recaptured, and was sent to Fredericksburg, and thence to Alexandria, where he was received at the Third Division Hospital on June 14th. When admitted he had diarrhoea and was greatly emaciated. There was a bed-sore, four inches in diameter, over the sacrum, and smaller sores over the prominences on the spine and scapulae. The lower end of the upper fragment of the femur protruded from the wound, from which there was a profuse offensive ash-colored discharge. To check the diarrhoea, to administer suitable nourishment, and to take pressure from the bed-sores by supporting the body on air cushions, were the first matters attended to. Then moderate extension was applied to the injured limb, and a tolerably good position was maintained by means of pillows and cushions. In three weeks the bed-sores were healed, and there was a slight improvement in the general constitu- tional condition. Extension of the limb causing pain, it was discontinued. For the next ten or twelve months the patient clung to life by the slenderest thread. Detached fragments of bone frequently gave rise to inflammatory swelling, abscesses in the thigh, and profuse suppuration. Yet the appetite and digestion continued to be good, and the great drain upou the system was supported unusually well. In May, 1865, it was found that the fracture was quite firmly consolidated. The patient now occasionally sat up in a chair, but every attempt of the sort was followed by acute inflammation of the thigh, with increased suppura- tion. It was now decided that the patient must ultimately sink under the profuse suppuration, and that an operation should be performed as soon as it was opportune, and that every effort should be made to put the patient in a condition to support this shock. On October 12, 1865, Surgeon Edwin Bentley, U. S. V., proceeded to amputate at the hip joint. Chloroform was administered; the external iliac artery was compressed at the pubis; anterior and posterior semilunar flaps were formed by transfixion, and the femur was disarticulated. The haemorrhage was inconsiderable, and the patient reacted soon and satisfactorily. From the day of the operation he steadily improved, with scarcely On November 15th, Dr. Bentley reported that the ligatures had all come away, and that the wound In December the stump was healed, and the patient began to get about on crutches. The fracture of the exarticulated femur was found to be imperfectly but quite firmly united, with great antero-posterior angular deformity and shortening. The bone was sent to the Army Medical Museum, where it is preserved as Specimen 4386. A posterior view of it is given by the annexed left hand wood-cut (FlG. 98). On January 31, I860, a photograph of the man was taken, from which the right hand wood-cut (FlG. 99) is copied. Lemon was then transferred to the Harewood Hospital, at Washington. He was then quite well, and able to go where he chose on crutches. The cicatrix was firm and healthy. On February 3, 1866, he was discharged from the hospital, and from the service of the United States, at his own request. He went to his home at Bird Hill, Carroll county, Maryland, and resumed his trade of shoemaking. He was granted a pension of fifteen dollars a month. On April 28, 1867, a letter was received from him in which he stated that his health was excellent; that he weighed ninety-nine and a half pounds, an increase of twelve and a half pounds from the date at which he left the hospital; and that he had been able to walk'to the village of Westminster, a distance of seven miles, without fatigue. In a letter dated Westminster, Maryland, July 31, 1870, he states "that the artificial limb is not now or ever has been of the least service to me. * * I have tried to wear it; but it only serves to irritate the stump, and makes it so raw and sore that I cannot bear it to touch anything for days afterwards." The pensioner was paid June 4, 1878.1 1 This secondary amputation at the hip is noted on page 52 of Circular No. 6, S. G. O., 1865, in a foot-note. In the Catalogue of the Surgical Section of the Army Medical Museum, of 1866, p. 248, there is a brief memorandum of the facts of the case, with a wood-cut of the fractured femur, contributed to the Museum by the operator, Surgeon Edwin Bentley, U. S. V. A detailed account of the case, compiled from the reports of the Third Division Hospital, Alexandria, and Harewood Hospital, Washington, is printed in Circular No. 7, S. G. O., 1867, p. 42, SORG. Ill—19 FlG. 98. — Consolidated gunshot fracture of the left femur. Spec. 4386. an untoward symptom. was granulating kindly. Fig. 99.—Appearance of cicatrix after secondary coxo-femoral amputation. [From a photograph.] 146 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The subject of the second successful secondary amputation at the hip,was in good health four and a half years subsequent to the operation, but has not replied to letters of inquiry of a later date. Case 321.—Private Woodford W. Longmoor, a rebel soldier, aged 25 years, a robust, healthy man, was wounded at a skirmish at Cynthiana, Kentucky, on June 11, 1864. A ball from a Belgian rifle, at short range, passed through his right thigh, shattering the shaft of the femur. There was profuse haemorrhage and the shock was alarming. He remained almost insensible for three or four days, and for a fortnight there was extreme prostration. He was placed in a rebel field hospital, and the injured limb was put in a fracture box, with which was connected a crutch piece extending to the axilla. On the evening of the recep- tion of the wound numerous detached bony splinters, a handful almost, were extracted. For six weeks extension and counter- extension were maintained, hut so much suffering arose from this treatment that it was discontinued, and the limb was simply supported in a comfortable position. The patient was confined to his bed for eight and a half months. In the middle of March, 1865, he was removed to Florence, Kentucky, seven miles from Cincinnati, and Dr. George C. Blackman, professor of surgery in the Medical College of Ohio, was consulted in the case. There was a profuse discharge of offensive pus, and the patient's strength seemed to he failing under the protracted irritation and spoliation. There had been frequent recurrences of abscesses in the thigh, attended with excessive pain and swelling, and followed by the elimination of fragments of necrosed bone. Ever since the recep- tion of his injury the patient had taken morphia very freely. Evidently there were still loose sequestra and diseased bone with which sinuses communicated, and Dr. Blackman proposed to remove these sources of irritation. On April 23d the patieut con- sented to an operation, and a number of necrosed fragments were extracted, with much relief to the local irritation and benefit to the general health. During the autumn, however, evidences of exten- sive destructive inflammation of the shaft of the femur became unmistakable, and in December a second operation for the removal of fragments was performed without advantage. The discharge became more offensive and sanious, and the strength of the patient rapidly gave way. In January, 1866, his condition became almost hopeless, and the removal of the diseased limb was determined on. The operation was performed on January 18th. Ether was admin- istered, and the lower extremities were kept elevated for a few minutes before the incisions were made. Then the right femoral was compressed at the groin, and the disarticulation was rapidly effected by Lacauchie's method.1 A circular cut through the skin was made at the junction of the upper third of the thigh; then the integuments were retracted and the muscles were divided circularly down to the bone. A vertical incision was now made on the outer side of the limb, commencing a little above the trochanter and joining the first incision. The head of the bone was then exarticulated. There was but little haemorrhage, and the patient rallied from the operation remarkably well. The follow- ing day he suffered greatly from nausea, which he ascribed to the use of the ether. This distressing complication soon subsided, however, and thenceforward there was no unpleasant symptom, and the patient progressed rapidly toward recovery (Fig. 100). In February, 1867, Longmoor reported himself to Dr. Blackman as in excellent health, and as having recently married. In the latter part of June, 1867, seventeen months after the operation, Dr. Blackman again saw him, and found that his general health was good, and that his stump was sound, though subject to occasional attacks of neuralgia of extreme severity. He was accustomed, in these attacks, to alleviate his suffering by taking large doses of morphia. An examination of the limb after its removal showed that the entire shaft of the femur had been affected by osteomyelitis. The specimen, with its delicately encased sequestra and fragile deposits of new bone, was destroyed by an unskilful preparer. On July 21, 1870, a letter of inquiry was addressed by the reporter to Mr. Longmoor, then at Cynthiana, Kentucky, which elicited the following response: "In answer to your inquiry, 'have you suffered much from neuralgic pains/ I answer there existed, for a long time, contractions of the muscles, in the centre of the stump, attended with considerable pain and tenderness; the interval between those contractions of the muscles and the pain is much lengthened. I now suffer comparatively little, and my general health is much improved."2 In the seven fatal cases of secondary amputations at the hip joint the injuries were inflicted by small projectiles. One patient survived the operation nearly four months; one, twenty-three days; one, eleven days; one, three days; and three, one day or less. 'M. A. E. LACAUCHIE, chirurgien principal, and chief medical officer of the French army of occupation in Rome, gives a description, with illus- trations, of his procedure for amputating at the hip joint, in the Gazette Medicate de Paris, Nos. 19, 20, 25, and 26,1850. 2 The particulars of this case of secondary amputation at the hip joint were contributed to the Surgeon General's Office by the operator, Professor GEORGE C. BI.ACKMAN, of the Medical College of Ohio, in a letter dated February 26, 1867. The operation had been briefly noted in the Cincinnati Jour, of Med., 1866, Vol. I, p. 101, and was more fully detailed in the Report on Amputations at the Hip Joint, Circular No. 7, S. G. O., 1867, p. 43, with a ohromolithograpbic sketch of the patient five months after recovery, from a drawing transmitted by Dr. BLACKMAN. FlG. 100.—Cicatrix five months after secondary amputation at the hip [From a drawing by Prof. Blackman.] SECT. II.] SECONDARY AMPUTATIONS AT THE HIP JOINT. 147 Fig. 101.—Gunshot frac- ture of the femur. Spec. 2288. D „ n « 7 1? G ?Tt *"' °°- °' UOth V™^™™> aged 24 years, was wounded on July 27 1864 at Deep Bo torn on the left bank of James Rn-er. A conoidal musket ball entered at the upper posterior part of the right thth comminuted the oniur rom the trochanters downward for several inches and lodged. The wounded man was ZZneito ^ a.h n,ton on a hosp.tal steamer, and was received at Lincoln Hospital on July 30th. The injured limb was shortened two run a hal inches; the soft parts were badly lacerated. On Awgu.st 7th the position of the ball at the anterior part of tlth Ih wa detected An incision was made and the ball and several detached fragments of bone were removed. On dnh™ wound looked badly, and there was slight sloughing. For the next few weeks the patient lost ground _ steadily. There was profuse suppuration, with great constitutional irritation. There appeared to be no attempt at union at the seat of the fracture. The patient had become much emaciated, and his powers of resistance were failing daily. After due consultation it was determined to amputate at the hip joint On September 15th the operation was performed by Assistant Surgeon J. C. McKee, U. S A The patient was rendered insensible by sulphuric ether. The method by antero-posterior flaps formed by transfixion was adopted. The amputation was rapidly completed and very little blood was lost. The patient did not rally, but died one hour after the operation, September 15, 1864. At the autopsy, the lungs were found to be attached to the thoracic walls by firm fibrinous adhesions. Iu the upper lobe of the right lung there were two small isolated abscesses. Otherwise the lungs were normal. The right weighed 13 and the left 11 ounces. The abdominal viscera were normal, save that the liver and kidneys were unusually small the former weighing 44* and the latter 9* ounces. At the seat of the fracture of the femur (*IG. 101) there was no attempt at repair; the fragments were carious: a large one, consisting of nearly half of the cylinder of the shaft, was four inches long and was quite detached. Fissures pene trated the trochanters and extended posteriorly half-way up the neck of the bone. ♦i, k .SASr ;f 3--SerSeaut Hiram H- Davis, Co. B, 156th New York, aged 26 years, was wounded at the battle of Opequan, Virginia, on September 19,1864, by a conoidal musket ball, which passed through the fleshy part of the left thigh, and, entering the other thigh, fractured the upper third of the right femur He was sent by his regimental surgeon, Dr. G. C. Smith, to the Sheridan Field Hospital near Winchester, where the fracture was adjusted upon a double inclined plane. Thence he was transferred, on March 6 1865 llZZf^Zli rT^f' MarJ,and' ^^ "^ thG ^ W°Und iD thG kft *^ ^ ^at dXmt and SSfrTwaf rl f 7 ' TP1°US SUPPurati011 from fi^l0"s *™ communicating with necrosed bone. Ou April 2oth he was transferred, in a somewhat improved condition, to the Cuyler General Hospital at Germantown, Pennsylvania, where no special alteration in his symptoms or treatment is noted. On May 10th he was moved from Cuyler to Mower Hospital, and thence, on October 18th, to the Post Hospital at Phdadelphia. The register of the Post Hospital states that the fracture of the femur was consolidated at the date of his admission, and that he was discharged from service on November 8, 1865. In the spring of 1866 Davis was received at the Episcopal (civil) Hospital iu Philadelphia. The appear- ance of the injured limb at the date of his admission is indicated in the accompanying wood-cut (Fig. 103). The right lower extremity was shortened six and a half inches; there was false anchylosis of the knee and ankle joints on this side; extensive cicatrices on the thigh indicated the location of former sloughing; there were five fistulous canals communicating with diseased bone; apparently the entire upper portion of the femur was necrosed. On May 5, 1866, Dr. Wil- liam S. Forbes, surgeon to the hospital, amputated the limb at the hip joint. Ether was employed as an anaesthetic, but it did not act satisfactorily. The vessels were controlled by the abdominal aortic compressor. An anterior flap was made by cutting from without inward, the integument being dissected up to form the longer portion of the flap. Then the femoral artery was tied; and then the bone was disarticulated and the posterior flap was completed. The haemorrhage was estimated at less than eight ounces. The patient rallied bravely from the shock of the operation. Forty-eight hours after the operation the pulse fell, and for about five hours there was great depression. This was fol- lowed by a febrile reaction, accompanied by an erysip- f elatous blush, which, commencing at the outer angle IraZMtTtS7 "n °1VGd US ?ntiTXtent- After this the P"fc»t «nk rapidly, and expired sixty-four hours after the of callus wh^h f a i efm™S the »J»"d femur (Fig. 102) it was found to be imperfectly united by fragile masses ot callus, which enclosed large fragments of dead or diseased bone.' 1 Morton (T. G.), On Amp. Hip Joint, with the Hist of the Cases, in Am. Jour. Med. Sci., 1866, Vol. LII, p. 36; Circ. No. 7, S. G. O., 1867, pp. 46, 64. Fig. 102.—Partial union of gunshot fracture of the femur. [From a photo- graph by RHOADS.J FIG. 103.— Gunshot fracture of the right femur with great shortening and deformity. [From a photograph by 148 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Cask 324.—Corporal Frederick Kelb, Co. G, 7th New York, was wounded at Fredericksburg. Virginia, December 14, l^f>2, by a conoidal musket ball, which fractured the right femur at the junction of the upper and middle thirds. After remaining for a fortnight in the field hospital of the 1st division of the Second Corps he was conveyed to Washington and placed, on December 25th, in the Patent Office Hospital, where the injured limb was placed in a fracture box and the wound was dressed with oakum. The case progressed favorably, and, on April 2, 1863, the patient was transferred to Judiciary Square Hospital, and, on May 9th, was sent to De Camp Hospital, at David's Island, New York. Acting Assistant Surgeon John C. DuBois reported: "The ball entered about one inch below the fold of the right natis, and, passing outward, shattered the femur at its middle, and lodged in the anterior part of the thigh. The ball was extracted two days afterwards. On January 1, 1863, six pieces of bone were removed. The limb was placed on a double inclined plane and cold water applied. Six weeks after, the long straight external and short internal splints of pasteboard were applied. This was removed in a few weeks and merely the short internal pasteboard splint retained. On April 2d and 8th, pieces of bone came away. The splint was then removed, and the limb suffered to lie on a hair mattress. May 6th, several pieces of bone removed. May 12th, firm union has taken place, with great deformity. External angular curvature, with about 4f inches shortening, as near as can be measured. His whole limb is everted, and he is unable to raise it. His general condition is much reduced. As union is firm no treatment can be adopted to relieve the deformity. July 10th, a few more pieces of bone have been removed. The probe reveals rough bone, not loose. Internal wound closed; sinus injected with dilute tincture of iodine. General health pretty good." On July 10th he was removed to McDougall Hospital, at Fort Schuyler; and on January 19, 1864, he was readmitted to De Camp Hospital. On June 8, 1834, he was discharged from the service of the United States. There was evidence of disease of the femur. On June 7, 1865, Kelb was admitted to St. Luke's Hospital, in New York City. There had been a series of recur- ring abscesses in the thigh, and it was believed that nearly the entire femur was necrosed. It was determined to amputate at the hip joint, and, on June 7th, the patient being anesthetized by sulphuric ether and the aorta being compressed by Signoroni's clamp tourniquet, the amputation was performed by the attending surgeon, Dr. R. F. Weir, by the method recommended by Dr. Van Buren, an anterior flap being formed by transfixion and a posterior one by section from without inward. The haemorrhage was slight and the shock was moderate. The case at first progressed very favorably. Three weeks after the operation the healing of the stump was far advanced and the patient was able to leave his bed. After this he began to lose ground very gradually. He died on October 4, 1865, nearly four months after the operation. At the autopsy, the pelvis of the right kidney was found to be blocked up with numerous calculi; there was an abscess in the left kidney, and there was tuberculosis of both lungs at an advanced stage. The stump was still open and the horizontal portion of the os pubis was necrosed. A section of the exarticulated femur presented the characteristic lesions of chronic osteomyelitis.1 Case 325.—Private James McGeehen, Co. K, 107th Pennsylvania, aged 48 years, was wounded at the battle of Gettys- burg, on July 1, 1863, by a conoidal musket ball, which entered at the inner aspect of the middle of the right thigh and traversed the entire thickness of the limb, badly comminuting the shaft of the femur in its progress. He lay upon the field for about five hours and lost a good deal of blood, although none of the larger vessels appeared to have been wounded. He was then conveyed to a temporary field hospital, and his wounds were dressed. On July 6th he was removed to tbe Seminary Hospital at Gettysburg, where he remained until September 4th, at which date there was profuse suppuration and some slough- ing at the wound of entrance, and it was deemed expedient to put the patient under canvas in the Camp Letterman Hospital. On October 11th he was moved to the Town Hall Hospital at Chambersburg. Here he was able to move about on crutches, but the injured limb was greatly enlarged and deformed, and numerous fistulous openings successively formed, through which pus was freely discharged and bits of necrosed bone were occasionally eliminated. On April 23, 1864, by order of the Medical Director at Harrisburg, he was discharged from the military service of the United States ou account of "permanent lameness resulting from gunshot fracture of the right femur." Nearly two years subsequently, April 9, 1866, McGeehen entered the Pennsylvania Hospital at Philadelphia. His general condition was satisfactory; his spirits were excellent; a careful examina- tion failed to detect organic disease of any viscus. His injured thigh remained greatly deformed and enlarged; the original wounds had long since closed, but there were numerous fistulous sinuses, discharging on an average a gill of pus daily, and, at intervals, scales or nodules of necrosed bone; three tracks seemed to ascend to within an inch and a half of the trochanter major. It was thought probable that above this point the femur was healthy. After a careful consultation, it was determined to remove the limb at the hip joint. The patient was placed upon tonic treatment, with nourishing diet; his bowels were also carefully regulated. He complained of nothing except his cough, arising from a slight bronchitis, which, however, gave him very little trouble. On April 21, 1866, Dr. D. H. Agnew, Surgeon to the Pennsylvania Hospital, removed the limb. The abdominal tourniquet was employed, and by this means the circulation of the abdominal aorta was completely controlled. The method of operating was by antero-posterior skin flaps, with circular division of the muscles. The femoral artery was ligated after the anterior flap was dissected up. The femoral vein was not included in the ligature. Twenty-one of the smaller arteries required deligation. The disarticulation was accomplished in a minute and a half. Pressure was maintained by the abdominal tourniquet for twenty-seven minutes while the minor vessels were secured. The haemorrhage during the entire operation did not exceed three ounces, scarcely more than an ounce and a half of which was arterial blood. Ether alone was employed in inducing anaesthesia, and about three ounces sufficed, as he inhaled it without effort and soon came under its influence. The stump was packed with lint. The leg, when drained entirely of blood, weighed twenty-two pounds, the entire weight of the body at that time being about one hundred and forty-five pounds. Immediately after his removal to the ward an enema of half a drachm of tincture of opium was administered, and this was repeated at eight in the evening, when the stump was closed by lead sutures and dressed with cerate. On the following day the patient had entirely reacted from the slight amount of shock following the operation. Pulse, which, under agitation from the approaching operation, had been averaging from 100 to 115, had fallen to 98; respiration 20; skin moist and pleasantly warm. No stimulus; moderate diet, and a drachm 1 LIDELL (J. A.), On the Secondary traumatic Lesions of bone, etc., in U. S. San. Com. Mem., 1870, Surgical, Vol. I, p. 438. W. H. Van Buhen, Transactions of New York Academy of Medicine, Vol. I, 1851-57, p. 123, and Contributions to Practical Surgery, Philadelphia, 1865, p. 9, M. A. GUEKIN (Medtcine Operatoire, p. 220) has suggested the same plan. See also Circular 7, S. G. O., 1867, pp. 41, 64. sect, n.j SECONDARY AMPUTATIONS AT THE HIP JOINT. 149 of laudanum by enema. On April 23d he was more comfortable. Had passed a quiet night; had a good appetite. A con- siderable part of the stump had united by first intention, and there was only a little greasy, watery discharge from the inner angle. Dry dressing continued. On April 24th he was doing well. Discharge thin and small, and flaps were rapidly uniting. He was ordered four ounces of whiskey daily, and half an ounce of Basham's mixture. Dry dressing continued. April 25th, no unpleasant symptom save a rather frequent bronchitic cough. The flaps are united at the middle of the stump; the discharge comes from the angles, and it is evidently due to the breaking down of the subcutaneous fat. Laudanum enemata were now given twice daily; warm-water dressings were substituted for the dry applications. April 26th, he ate and slept well, but was troubled by his cough, which was severe, accompanied by tenacious mucous sputa. The opiate enemata were suspended, and from two to four drachms of solution of sulphate of morphine were given every night; during the day, a sedative expectorant mixture every three hours. The stimulus was not increased. April 27th and 28th, steady improvement; cough less troublesome, discharge more purulent and increased in quantity; warm-water dressing still applied. April 29th, discharge purulent and quite abundant, amounting, probably, to three or four ounces daily. April 30th, much the same, excepting that the cough was again more troublesome. The union of the flaps was daily becoming more secure, and the discharge now consisted of laudable pus. Four ligatures came away. May 1st, seemed brighter and better than any day heretofore; ate heartily; stump looked perfectly healthy, discharge moderate; two more ligatures came away. May 2d, condition excellent; the stump was rapidly healing; the skin remained as soft and healthy as on the day of operation. Most of the stitches had been cut away. The pulsation of the external iliac artery, which for several days was very marked, had diminished greatly, and seemed as though propagated through a firm clot. He had been troubled consid- erably with cough for two days. At midnight, in the absence of the watchman, haemorrhage occurred, and on the return of the latter the patient was found dead. Upon removing the dressing it was seen that a secondary haemorrhage had taken place. Most of the blood was retained either in the stump or inside the dressing; the little that had escaped had flowed from the inner angle of the stump back under the body. The haemorrhage was found to have proceeded from the femoral artery. The most powerful restorative measures were employed for a long time, but without producing the slightest effect. Upon dissecting the stump, the union was found to be complete over one-half of the entire surface of the flaps, whilst the deeper portions of the stump were covered with healthy granulations. The femoral vein, which was uot ligated, was entirely occluded; the femoral artery was patulous, its inner coat projecting somewhat beyond the other two; the inner coat of the artery was deeply stained and roughened for at least one and a quarter inches above the extremity; higher up it appeared perfectly healthy; the ligature which had secured the vessel was still attached to a shred of the outer fibrous coat. It had evidently very recently cut its way through, and still retained iu its loop the end of the vessel which had sloughed off. Lying immediately in front of the femoral vessels, embedded in a recent clot, was found the plug which had been driven out of the artery. This was a firm, flesh-colored clot, of the calibre of the vessel, and long enough to reach up to the origin of the deep epigastric, and circumflex iliac arteries. No positive testimony could be obtained that the patient had suffered from one of his violent spells of coughing immediately before the accident, as all in the ward were asleep excepting the watchman; but all the appearances render it highly probable that directly after the ligature of the femoral became detached the violent succussion of the diaphragm incident to a paroxysm of coughing had expelled the clot from that vessel. All the other vessels appeared completely obliterated. Only the thoracic and abdominal cavities were examined. The lungs were large and free from pleuritic adhesions. They were somewhat emphysematous, and showed a large amount of pigment over their surface. The anterior portions were anaemic, but posteriorly there was marked congestion of the lower lobes. The heart was quite flabby and moder- ately dilated. There was no valvular disease or apparent insufficiency, but microscopic examination showed advanced fatty degeneration of the muscular fibres. The liver was also very soft and fatty. Kidneys anaemic and pale. Other viscera healthy. The large vessels and heart contained very little blood. There was a small collection of unhealthy purulent matter in the manubrium of the sternum. The limb, upon dissection, showed very great disease of all the soft parts between the trochanters of the femur and the knee joint. The muscles had undergone fatty degeneration; their sheaths were very much hypertrophied and of almost cartilaginous density. Toward the bone there was a thick layer of tenacious colloid bone carti- lage, apparently resulting from periosteal disease. Through the dense and morbid mass fistulous tracks radiated in every direction, many of them containing small spiculse of bone. The bone itself was diseased from the condyles to within one and a half inches of the lesser trochanter. The shaft had been fractured obliquely, with considerable comminution, and union had taken place by formation of a very large amount of dense bony structure, which projected in spurs and ridges in all directions. The original track of the ball was marked by a deep groove, and one or two small fragments of lead were found embedded in the bone. There was a large anfractuous cavity, bridged over in places by newly formed bone, which still contained several quite large sequestra. There was incipient periosteal disease along the linea aspera up to the trochanters. A section of the bone showed that if osteo-myelitis had existed it had not extended within several inches of the trochanters.1 In the four foregoing fatal secondary amputations, one succumbed to the shock of operation in an hour; another died on the third day with surgical fever and erysipelas; a third in seventeen weeks with phthisis and lithiasis, the stump nearly healed; and a fourth FIG. 104.—Consoli- dated shot fracture of femur, with secondary lesions. [From a pho- tograph by WILLARD. ] ■An account of this case was published by Dr. Thomas G. Morton, in The American Journal of Medical Sciences, 1866, Vol. LII, p. 33 (Com- pound Comminuted Fracture of Right Femur, from Wound by Minii Ball. Amputation at Hip Joint after Thirty-four Months, by Dr. D. H. AGNEW, Death from Secondary Hemorrhage on the Twelfth Day), from notes carefully and admirably drawn up by Dr. William Pepper, the resident surgeon at the Pennsylvania Hospital, under whose immediate care the patient was. See also List of the More Important Specimens added to the Pathological Museum of the Pennsylvania Hospital during the year 1867, by William Pepper, M. D., Curator, in Penn'a Hospital Reports, Vol. I, 1868, p. 399. 150 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. perished on the eleventh day, from giving way of the femoral at the point of ligation. In two of the following cases the patients sank from shock in a little over twenty-four hours. In the third case, secondary haemorrhage was restrained by ligating the external iliac on the eleventh day, but bleeding recurred fatally on the twenty-third day. Case 326.—Antonio Mutieres, a Mexican, aged 30 years, employed by the depot quartermaster at Fort Union, New Mexico, was wounded, in an altercation with another Mexican, on May 10, 1867, by a conoidal pistol ball, which entered two inches below the anterior superior spinous process of the left ilium, and passed downward aud lodged in the neck of the left femur at its junction with the head. He was admitted to the Post Hospital at Fort Union on May 11th, when Assistant Surgeon DuBois, Post Surgeon, enlarged the wound and extracted the ball and wadding with a pair of Tiemann's bullet forceps. After the removal of the ball the finger could be passed half an inch or more into the substance of the cervix, in which the ball had been embedded. The patient suffered but little pain, but he gradually lost flesh and strength from the surgical fever and sup- puration. On June 14th he began to have severe pain, running up the side of the trunk and downward to the knee. This became more continuous and distressing on the succeeding day. Surgeon J. C. McKee, U. S. A., saw the patient in consulta- tion, at this date, and advised that amputation should be performed in preference to an excision. At noon, on June 22d, Assistant Surgeon DuBois operated, assisted by Dr. Short, of Los Vegas, and Dr. Simpson, of Moro. A rude clamp abdominal compressor had been made at the post under the direction of Dr. DuBois, and this instrument, applied a little above and to the left of the umbilicus, effectually controlled the aorta. A long anterior and short posterior flap were made. The disarticu- lation was completed in fifteen seconds. Eighteen arteries were ligated. The soft parts were much diseased, and there was a large amount of venous haemorrhage. The anaesthetic employed was a mixture of equal parts of chloroform and ether. The patient breathed well notwithstanding the compression of the abdomen. The flaps were left open, a cerate cloth being inter- posed. In the evening the patient was free from pain and had slept a little; but he had not reacted satisfactorily, and talked and laughed excitedly. His pulse was at 160 and feeble. It was fuller and less frequent immediately after the operation. Milk punch had been given in small quantities every fifteen minutes. Hypodermic injections of tincture of opium in doses of from ten to thirty drops, repeated every twenty minutes or at longer intervals, were now administered. This remedy appeared to bring the pulse up, and to act as a stimulant and not as a narcotic—a therapeutic result observed by Dr. DuBois in other cases of shock. The patient died June 23, 1867. At the autopsy, the acetabulum was found to be extensively diseased.1 Cask 327.—Private Michael O'Neil,2 Co. E, 58th Massachusetts, aged 19 years, was wounded at the battle of Cold Harbor, June 3, 1884, by a conoidal musket ball, which entered the upper anterior part of the right thigh, and passed backward and slightly upward through the limb, comminuting the upper extremity of the femur. The fissures extended about three inches down the shaft, and through the trochanters half way up the neck. The wounded man was sent in an ambulance to the White House, on the York River, and thence by a hospital steamer to Alex- andria, where he was received at the Third Division Hospital on June 7th. On admission his limb was much swollen, yet there was but little pain, and this was not increased by moving the limb. His general condition was satisfactory, though he reported that he was subject to attacks of inter- mittent fever. His limb was arranged in a straight position, supported by cushions and pillows; evaporating lotions were applied to the Avound, and a nutritious diet was ordered. On June 10th, several fragments of bone were extracted. On June 12th the patient had a chill, and was ordered to take four grains of sulphate of quinia every four hours. The injured limb was now suspended by means of Smith's anterior splint. On June 24th there was another chill. The wound was now sup- purating freely, and the limb was very sensitive when handled. On June 31st there was a slight chill. From this date to August 1st there was little change in the symptoms. It was now decided that there was little hope of consolidation of the fracture. The suppuration was profuse, and it was believed that the patient would inevitably succumb ultimately to the constitutional irritation and the drain upon the system. It was determined, therefore, that amputation should be performed, and the Fig. 105.—Gunshot fracture character of the fracture admitted only of amputation at the hip joiut. On August 10th, the patient of the upper extremity of the was anaesthetised by sulphuric ether, and amputation at the hip joint was performed by the lateral right femur. Spec. 3098. „ , , , n ^-, ■ r. \ TT o -rr ™, , ,. i , , , , flap method by Surgeon Edwin Bentley, U. b. V. I here was but little haemorrhage, and the oper- ation was borne well. The patient had an anodyne, and was freely stimulated. For forty-eight hours after the operation there was some febrile excitement, with complete anorexia. The fever then subsided and the appetite returned. The wound looked well, and the amount of suppuration was trifling. The case progressed very favorably until August 20th, when secondary haemorrhage supervened from ulceration of the femoral near the ligature. About six ounces of blood were lost. A ligature was promptly placed upon the external iliac just above Poupart's ligament. After the operation the patient was very weak and faint, and stimulants were freely administered. On August 22d there was an excess of febrile excitement, but this abated on the following day and the appetite again became moderately good. On August 28th there was nausea and vomiting, which persisted for forty-eight hours. The wound at this time had assumed a very unhealthy appearance, and the patient had become much emaciated. On the night of September 1st there was delirium. The case terminated fatally on the morning of September 3d, twenty-three days after the operation. At the autopsy the viscera was found to be healthy, except that there was an old cicatrix with cretaceous deposit at the apex of the left lung. The lips of the wound were united in nearly their entire extent. There was a large accumulation of pus within the flap, bathing the acetabulum and the gaping mouth of the femoral artery. The wound left by the incision above Poupart's ligament, through which the external iliac was tied, communicated with an abscess between the iliacus externus muscle and the iliac fascia, filled with pus. The ligature on the external iliac was found to be 1 See DUBOIS (H. A.), A Case of Amputation at the Hip Joint for Gunshot Wound of the Head of the Femur, in The Medical Record, 1868, Vol. H, p. 266; Circular Xo. 7, S. G. O., 1867, p. 46; Circular No. 3, S. G. O., 1871, p. 214. * The abstract of this case was compiled from a report by the operator, Surgeon E. Bentley, U. S. V. See Circular No. 7, S. G. O., 1867, p. 39. SECT, n.] SECONDARY AMPUTATIONS AT THE HIP JOINT. 151 placed about half an inch below the origin of the epigastric; the circumflex iliac was given off a little below the epigastric. There was a firm conical plug in the external iliac, ending at the origin of the epigastric. Through this plug ran a canal communicating with the mouth of the circumflexa ilii; this canal was closed by a clot colored by included red corpuscles and of more recent formation than the plugging clot. Ulceration of the external iliac just above the ligature had commenced. The femoral vein was collapsed and contracted; the external iliac vein was distended by a dirty fluid, which, when placed under the microscope, was found to abound in pus globules. Higher up, the contents of the vein consisted of a granular detritus. Tlie branches of the external 'Wlf iliac vein was blocked up by dense coagula. The deep-seated abdominal lymphatic glands were enlarged and deeply injected. An examination of the fractured femur showed that it was shattered, with much loss of sub- stance, just below the trochanters. The fissures ran up with the capsule, and the fractured extremities of the bone were carious and had lost tissue by absorption. Case 328.—Private John Williams, Co. F, 13th Ohio Cavalry, aged 44 years, was wounded at Peebles' Farm, near Petersburg, September 30, 1861, by a conoidal musket ball, which passed through the left thigh and contused or partially fractured the femur. He was conveyed in an ambulance to the field hospital of the first division of the Ninth Corps, and his wounds were dressed, and he was then sent by rail to City Point, and thence to the North in a hospital transport steamer. On October 7th he was received at the General Hospital at Beverly, New Jersey. For over three months the case progressed very favorably under the simplest treatment; but early in February abscesses formed in the thigh, and when they were incised they discharged copiously an offensive pus. About the same time the patient was attacked by an obstinate diarrhoea. On February 17, 1865, an exploratory incision was made, and a careful examination with the finger and the probe indicated that the femur was necrosed as high as the trochanters. It was then considered that amputa- tion at the hip joint presented the only chance for preserving life. The operation was performed by Assistant Surgeon Clinton Wagner, U. S. A. The patient inhaled chloroform; anterior and posterior semilunar flaps were made by transfixion; the femoral artery was tied as soon as divided; disarticulation was then effected, and the operation completed by securing the minor vessels. Very little blood was lost. The patient reacted satisfactorily, but sank and died, apparently from shock, twenty-nine hours after the operation. An autopsy revealed a healthy condition of the viscera and no lesion worthy of special mention. The femur displayed an interesting example of necrosis of the entire diaphysis. It is numbered Specimen 84 in the collection of the Army Medical Museum, and is represented in the adjacent wood-cut, FlG. 106. FIG. I06.-Xecrosis of the femur follow- ing gunshot injury. Spec. 84. Table XVII. Summary of Nine Cases of Secondary Amputation at the Hip Joint. Name, Age, and Military Description. Lemon, G. W., Pt., C, 6th Maryland, age 30. Longmoor, W. W., Pt., age 25. Bowman, D. H., Pt., C, 110th Pennsylvania, age 24. Davis, H. H., Sergeant, B, 150'th New York, age 26. Kelb, F., Corporal, G, 7th New York. McGeehen, J., Pt., K, 107th Pennsylvania, age 48. Mutieres, A., Mexican, team- ster in Quartermaster's De- partment, age 33. O'Xeil, M., Pt., E, 58th Mas- sachusetts, age 19. Williams, J., Pt., F, 13th Ohio Cavalry, age 44. May 5, 1864. June 11. 1864. July 27, 1864. Sept. 19, 1864. ' Dec. 14, 1862. July 1, 1863. Mav II 1867. June 3, 1864. Sept. 30, 1864. Nature of Injury. Conoidal ball fract. left femur, junct. upper thirds; bedsores; abscesses. May, 1865, pro- fuse suppuration, bone firmly consolidated. Conoidal ball shattering shaft right femur; abscesses; nee. bone rem'd; protracted irrita- tion and exhaustive suppu- ration. Conoidal ball com. right femur from trochanters down several inches. Aug. 17th, ball and fragm'ts bone extracted; pro- fuse suppuration; no union. Conoidal ball fract. upper third rightfemur. Mar., '65,healed with great deformity. '66, dis- eased bone; fistulous canals. Conoidal ball fract. right femur, junct. up. thirds. June8, '04, fracture consolidated. June, 1865, abscesses, necrosis. Conoidal ball badly comminu- ting rightfemur. Oct. 11, '65, able to move on crutches— limbdeformed, bonenecros'd. April, '66, numerous fistulous openings discharging. Revolver ball ent'g left thigh, lodging in neck of femur; ball removed—lost strength daily. Conoidal ball comminuting up. extremity right femur. June 10, fragments extract'd. Aug. 1st, profuse suppuration. Conoidal ball thro' left thigh, partially fract'g or contusing femur. Feb, '65, exam, found femur necrosed to trochanters. Date of Opera- tion. Oct. 12, 1865. Jan. 18, 1860. Sept. 15, 1864. May 5, 1806. June 7, L865. April 21, 1866. June 22, 1867. Aug. 10, 1864. Feb. 17. 1865. Operation and Operator. Anterior and post'r semilunar flap, by Surgeon E. Bentley, U. S.V. Lacanchie's method; circular cut thro' skin, integ. retracted, muscles div. circularly down to bone; vertical incision on outer side, by Prof. G. C. Blackman. Antero-posterior flaps, by Ass't Surgeon J. C. McKee, U.S.A. Anterior posterior flap, by Dr. W. S. Forbes, Civil Hospital, Philadelphia. Anterior flap by transfix'n, pos- terior flap by sect'n from with- out, in, by Dr. R. F. Weir, St. Luke's Hosp., N. York City. Anterior post'r skin flap, circ. division of muscles, by Dr. D. H. Agnew, Pennsylvania Hospital. Long anterior, short posterior flap, by Ass't Surgeon H. A. Dubois, U. S. A. Lateral flap, by Surgeon E. Bentley, U. S. V. Anterior and posterior semi- lunar flaps, by Ass't Surgeon C. Warner, U. S. A. Result and Remarks. Steady imp. Dec, 1865, stump healed. Disch'd Feb. 3, 1866. Specs. 4386, 4167, 5040. Phot. £er. 136, 137. Circ. 6, S. G. O., 1865, p. 52. Circ. 7, S. G. O., 1867, pp. 42, 64. Rapid recovery. 1870, general health good. Blackman(G.C), Amputations at Hip Joint, in Cincinnati Jour, of Med., 1866, Vol. I, p. 101. Circ. 7, 1867, pp. 43, 64. Did not rally. Died one hour af- ter operation. Spec. 2288. Circ. 6, S. G. O., 1865, p. 50. Ctrc. 7, S. G. O., 1867, pp. 41, 64. Rallied well. Died May 8,1866, sixty-four hours after operation. Circ. 7, S.G.O., 1867, pp.46,64. July 1st, able to leave bed; after this failed, and died Oct. 4,1865. Ctrc. 6, S. G. O., 1865, p. 52. Circ. 7, S. G. O., 1867, pp. 41, 64. April 23d, heal'g by first intent'n. 2Cth, bronchial cough trouble- some. May 2d, haem. from fem- oral artery; died. Ctrc. 7,1867, pp. 44, 64. Died June 23,1867. Ctrc. 7,1867, pp. 46, 64. Ctrc. 3, S. G. O., 1871, p. 214. Ulceration of femoral. Aug. 20, haem., lig. of ext. iliac. Died Sept. 3, 1864. Spec. 3098. Ctrc. 6, S. G. O., 1865, p. 50. Ctrc. 7, S. G. O., 1867, pp. 39, 64. , Died, twenty-nine h'rs after, from shock of operation. Spec. 84. Ctrc. 6, S. G. O , 1865, p. 50. Ctrc. 7, S.G.O., 1867, pp. 41, 64. 152 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. Reamputations at the Hip Joint.—The category of exarticulations at the hip for diseased conditions succeeding previous amputations in the continuity of the thigh, per- taining to the surgery of the late civil war, includes nine examples with only three deaths.1 Case 329.—Private W. Cotter, Co. E, 9th New Hampshire, aged 27 years, was wounded at Petersburg, July 30, 1864. Surgeon J. Harris, 7th Rhode Island, recorded his admission to the field hospital of the 2d division, Ninth Corps, and noted: "Fracture of thigh, lower third; amputation of thigh at middle third." From the field hospital the patient was transferred to City Point, and thence to Washington, August 3d. Assistant Surgeon W. F. Norris, U. S. A., contributed the pathological specimen, shown in the wood-cut (FlG. 107),.with the following history by Acting Assistant Surgeon H. Gibbons: "The patient was admitted to Douglas Hospital with primary amputation of right thigh, lower part of middle third. The hm operator had made a long posterior skin flap, which was turued up over the muscles and bone, and attached to • WW tne integunNmt anteriorly by means of several sutures. When first seen the stump was greatly swollen, partly from a retention of pus by the bag-ljke flap. A couple of sutures were removed and the pus evacuated. On August 4th, an incision was made in the dependant portion to admit of free drainage, and poultices were ordered. Appetite and sleep were not greatly disturbed, and there was not as much irritative fever as in most similar cases. Ordered stimulants, tonics, and generous diet. August 13th, swelling much reduced; constitutional irritation less. Ligature of femoral artery separated. The poultices were alternated with flannel dressings till September 1st, when wet cloths were substituted. Flaps mostly united; appetite poor; sleep disturbed; stump painful. Ordered morphia at bed-time. September 13th, patient sits up and walks about with some assistance. Stopped the stimulant. September 28th, stump doing well; swelling gone; dead bone felt with the probe Had an attack of diarrhoea, which lasted but a few days. The irritability of the stomach was a source of continual complaint for two or three months. The various stomachics relieved but temporarily; nevertheless there was marked improvement, especially during November, the patient being about on his crutches daily. November 29th, divided the cicatrix (but a small fistulous opening was still remaining) and removed a sequestrum I V''.'t'fll nearly six inches long. It was attended with some difficulty, yet not as much as was expe- rienced in similar cases. The sequestrum consists of the entire bone at the lower extremity, but tapers to two or three points at the other; the circumference is complete for three inches. In its centre, surrounding the medulla, was found a beautiful transparent flake of new bone. The femur contained, as in like cases, a large amount of new hone. July 16,1865, the cavity left in the stump has never entirely closed, but continues to discharge, and refuses to heal, though various stimulating injections have been resorted to. It is over three inches deep. The patient is in a promising state of health." On November 2d, the patient was transferred to the Harewood Hospital. Surgeon 11. B. Bontecou, U. S. V., reported that he was doing well on December 31st, but that there was still a "fistulous discharge from the stump." At the closing of the Harewood Hospital, on May 1, 1866, the patient was transferred to the Washington Post Hospital, where the specimen represented in the adjacent cut (Fig. 108) was removed. Assistant Surgeon W. Thomson, U. S. A., who performed the operation, reported as follows: "Two sinuses lead to the interior of new bone, which have failed to close since the date of the first operation. On June 6, 1866, resection of four inches of femur from the end of the stump, after previously made incisions into the soft parts, was performed. Ether was used, and the incisions were united by silver sutures. June 30th, wound has healed kindly, two-thirds by first intention, leaving a sinus on the under surface of the stump still discharging. September 30th, although mostly healed the stump is still indurated. Two sinuses, evidently leading to necrosed fragments of femur, are still open and keep up an offensive discharge. Small intercellular abscesses form occasionally. Patient in good condition." He was discharged from service October 15, 1866, and pensioned. In the following year he was reported as having been treated for a time at the Bellevue Hospital, New York City, where Drs. H. B. Sands and F. H. Hamilton are said to have removed several pieces of necrosed bone. On October 5, 1871, the pensioner entered the Providence Hospital !« Fio. 108.—Resected extremity of the right femur from a case of osteomyelitis. Spec. 4954. * 1 Amputation at the hip, after previous amputation in the continuity cf the thigh, was first performed by G. J. Guthrie, in 1812, in the case of Private Mason, 23d Infantry, or Welsh Fusiliers, wounded at Ciudad llodrigo. GUTHRIE, On Gunshot Wounds of the Extremities, London, 1815, 8vo, p. 141. Of the nine cases pertaining to the American civil war, the earliest, May 21, 1864, was practised by Dr. A. B. MOTT, on the stump of a prior amputation for bayonet stab of the knee. On September 21, 1864, Dr. GURDON BUCK and Dr. F. Hassenburg disarticulated at the hip unsuccessfully, after prior amputations for shot fracture. In 1865, Dr. J. H. Packard had the first successful reamputation at the hip after previous amputation in the thigh for shot fracture, and Dr. A. M. Fauntleroy successfully reamputated, under similar conditions, on March 11th. In 1866, the successful reampu- tation at the hip by Dr. T. G. MORTON, and a like operation, with fatal result, by Dr. J. B. WlIITCOMB, were practised. In 1870, and in 1871, Dr. G. A. OTIS and Dr. X. S. LINCOLN performed successful reamputations at the hip, after prior amputations of the thigh, for shot fracture. Professor J. FAYRER (Clin, and Path. Obs. in India, London, 1873, pp. 84, 489), in 1867, unsuccessfully reamputated at the hip after prior thigh amputation for an incised wound of knee. Besides these eleven reamputations at the hip, the records of civil surgery afford at least twenty-one examples, viz: five following amputations for bad fractures of the femur—J. Syme's, in 1848 (TJie Medical Times, London, 1849, Vol. XIX, p. 252); J. ROUX'S, in 1859 (Gaz.hebd., 1860, pp. 292, 297), recoveries; J. F. Heyfelder's, in 1861 (Deutsche Klinik, 1862, S. 275), fatal; J. Fayrer's, in 1864, recovery; and J. Fayrer's, in 1865, fatal (Clin, and Path. Obs. in India, 1873, p. 489). There were eight exarticulations following prior amputations for ostitis or ill-defined lesions, viz: A. COOPER'S, in 1824 (Lond. Lancet, 1824, Vol. II, p. 96); Bradbury's, in 1851 (Bost. Med. and Surg. Jour., 1852, Vol. LXVI p. 349); B. Beck's, in 1854 (Deutsche Klinik, 1856, No. 47); Roser's, in 1857 (Thieme's Diss., Leipzig, 1867, p. 9), successful; and Textor's, in 1851 (Esche's Diss., Wiirz- burg, 1863); Chelius's, in 1853 (Thieme's Diss., Leipzig, 1867, p. 8); Heyfelder's, in 1854 (Thieme's Diss., Leipzig, 1867, p. 8); and Hancock's, in 1860 (Lond. Lancet, 1860, Vol. I, p. 319). Eight exarticulations followed prior amputations for malignant growths, viz: Mayo's, in 18;15 (COSTELLO'S Cyclop., 1841, Vol. I, p. 182); BOISSEAU'S, in 1841 (Metz's Diss., Wiirzburg, 1841, p. 17); W. S. Coxe's, in 1844 (Mem. on Amp. at the Hip Joint, London, 1845); Van Buren'8, in 1850 (Contrib. to Pract, Surg., 1865, p. 10); Gros Clark's, in 1866 (Lond. Lancet, 1867, Vol. I, p. 11), successful; and Chelius's, in 1845 (BEUCH, Die Diagnose der bosartigen Geschwiilste, Mainz, 1847, p. 3); VOLKMANN's, in 1868 (Deutsche Klinik, 1868, p. 338); and J. Lister's, in 1872 (Reyher. in Langenbeck's Archiv, B. XVII, p. 516), fatal cases. SECT, n.] REAMPUTATION AT THE HIP JOINT. 153 at Washington, with the stump still in a diseased condition; and ten days afterwards Dr. N. S. Lincoln exarticulated the remain nig part of the femur, conststmg of the head, neck, and trochanteric portions, which was also contributed to the Museum and ,s represented in the annexed cut (FlG. 109). The femoral vessels were respected, so that the disarticulation might be said to have resemb ed an exc.sion or enucleation rather than a imputation. The patient was able to be about in a short time; and on April 2>, 1872, he visited the Army Medical Museum, and a photograph was made of the stump, which is copied in the adjoining wood-cut (Fig. 110). The pen- sioner subsequently entered the Na- tional Military Asylum at Hampton, Elizabeth City County, Va., where Examiner C. McDermont certified the following: '"The right leg has been amputated at the hip joint. This was the third amputation per- formed on the limb. Since the last operation he has been troubled with abscesses in and about the cicatiix, which have not healed, though a year has almost elapsed since the disarticulation was made. It is my belief that the tissues of the wounded limb have been diseased and never free from ulceration since he was wounded. His general health has been considerably impaired by the constant irritation and drain upon his system." This pensioner died at Queenstown, Ireland, January 21, 1874, while on furlough from the Asylum. FIG. 109.—Exartic- ulated head and tro- chanters of righ t femur after osteomyelitis. Spec. 5946. J FIG. 110.—Cicatrix six months after coxo-iemoral disarm tion. [From a photograph.] i.atiou and reamputa- CASE 330.—Private Julius Fabry, Co. K, 4th Artillery, aged 38 years, was wounded at Deep Bottom, Virginia August 16, 1864. Surgeon B. Gesner, 10th New York, reported: "Severe shot wound of left knee joint; amputation at lower'third of femur. Sent to general hospital at City Point, Virginia, August 17th." He was admitted, on August 20th, into Satterlee Hospital, Phil- adelphia, from City Point. Surgeon I. I. Hayes, U. S. V., reported: "Gunshotwound of left leg by round ball, which embedded itself in knee joint; also conical ball; which w;:s extracted high up on outer side of left thigh. August 17, 1864, circular amputation of lower third of left thigh. Improving slow- ly; simple dressings, tonics, and stimulants." On an unsigned case book of Ward 3, of Sat- terlee Hospital, the progress and treatment of the case are recorded as follows: "Stump looks well; patient somewhat weak but doing well. August 26th, suppurates very freely. August 28th, conical ball extracted from outer side of thigh two inches below great trochan- ter. Patient states that he saw one other ball extracted from the wound. September 1st, doing well; suffers from a bedsore contracted before he came here. States that he lost much blood during the amputation, which accounts for his weak and anaemic condition. Septem- ber 9th, doing well. 21st, improving slowly. Fig. 111.—Left femur, November 8th, transferred to Ward A." The trom a case of reampu- tation for osteomyelitis progress of the case is continued on another S^.AM.'m?0'- Case b00k' also "Signed: "December 2d, wound still discharging copiously. Bone ex- posed about one-eighth of an inch; general health middling, appetite good, bowels regular. Some difficulty with his urinary apparatus; detected pus in urine. January 9, 1885, morphia ceases to have any effect except to constipate. Eemains much the same, better and worse, alternately, every ten or twelve days. February 4th, made an incision on external side of stump some two inches in length, just cutting the fascia, and removed a small piece of woolen. The muscles were not affected by the Surg. Ill—20 Fig. 112.—Cicatrix twelve months after coxo-femoral disarti and reamputation. [From a photograph. 1 151 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. superficial sinus." On May 22, 1^6"), this soldier was sent to regimental headquarters at Fort Washington, whence he was discharged from service January 1, 1855, on surgeon's certificate of disability, signed by Surgeon John H. Bayne, U. S. V. In October, Hi;.">, the patient received an artificial limb but could not use it without discomfort. Fabry was admitted into the Soldiers' Home January 31, 1836. The remnant of the femur was affected by osteomyelitis, and Surgeon C. H. Laub, U. S. A., had frequent occasion to have the stump poulticed and abscesses opened. October 27, 1883, Assistant Surgeon J. S. Billings, U. S. A., made an exploratory and palliative operation, cutting down on the outer aspect of the thick involucrum a little below the trochanter major, trephining over one of the cloacae, and discovering a sequestrum consisting of the shaft of the femur. Fabry was pensioned, and remained at the Soldiers' Home for the next three years, suffering acutely, at times, from suppuration in the stump, and again enjoying intervals of comparative comfort. The general health did not give way materially under the protracted suppuration. The patient was exempt from albuminuria, and the viscera generally were in a normal condition. The nervous system seemed shattered, a result ascribed to the inordinate doses of narcotics which the patient consumed. On May l.">, 1870, Assistant Surgeon George A. Otis, U. S. A., exarticulated at the hip and removed the stump. The single anterior flap procedure was used, only the flap was cut from without inward, because the great masses of foliaceous callus enveloping the upper third of the femur precluded transfixion. The accompanying wood-cut (FlG. Ill) will indicate the extent of these osseous formations. Fabry had a rather rapid convalescence, being about on crutches in twenty-one days, and soon afterwards able to ride about the grounds at the Soldiers' Home. A photograph of the patient, made at the Army Medical Museum a year after the operation, is copied in the wood-cut, Fig 112. On May 15, 1878, eight years after the operation, Fabry has had no trouble with his stump. He has never been willing to attempt the expedient of an artificial limb.1 The next case is exceptional inasmuch as the amputation and reamputation followed a bayonet stab in the knee instead of shot injury. Case 331.—Private Lewis Francis, Co. I, 14th New York Militia, aged 42 years, was wounded July 21, 1861, at the first battle of Bull Run, by a bayonet thrust, which opened the right knee joint. He received not less than fourteen other stabs in different parts of the body, none of them implicating the great cavities. He was taken prisoner, and conveyed to Richmond and placed in hospital. One of his wounds involved the left testis, which was removed on July 24th. On October 28, 1861, his right thigh was amputated at the middle, on account of disease of the knee with abscesses in the thigh. The double-flap method was employed. The stump became inflamed and the femur protruded. An inch of the bone was resected and the flaps were again brought together. In the spring of 1862 the patient was exchanged and sent to Fort Monroe. Thence he was transferred to a Washington hospital, and thence, in March, 1862, to his home in Brooklyn. There was necrosis of the femur, and in May, 1862, its extremity was again resected by a civil surgeon. On October 28, 1833, Francis was admitted to the Ladies' Home Hospital, New York. Necrosis had apparently involved the remain- ing portion of the femur. On May 21, 1864, Surgeon A. B. Mott, U. S. V., laid open the flaps and exarticulated the bone. The patient recovered rapidly and had a sound stump. He was discharged August 12, 1864. On October 1, 1865, a photograph, from which the accompanying wood-cut (FlG. 113) Avas taken, was forwarded by Surgeon A. B. Mott to the Army Medical Museum. Dr. Mott reported that the pathological specimen of the exarticulated femur was stolen from his hospital. For some months after his discharge Francis enjoyed good health ; but then the cicatrix became unhealthy, pus was discharged through several sinuses, and there was bleeding from the slightest irritation. In March, 1837, a messenger was sent to his residence, 54 Hamilton Street, Brooklyn, and found him in Very poor health. He had been unable to leave the house since November, 1866. On April 12,1837, he was visited by Dr. E. D. Hudson, who reported him as then confined to his bed. There was a large ulcer at the upper outer angle of the cicatrix, which communicated with extensive sinuses; there was a fistula-in-ano also. The pus from the different fistulous orifices was thin, oily, and ichorous. There could be little doubt that there was disease of some portion of the innomi- natum. The patient was much emaciated, and had a cough with muco-purulent expectoration. His pulse, however, was not frequent, and he had a good appetite. In May, 1837, it was reported that his general condition had somewhat improved. In March, 1858, Pension Examiner J. C. Burdick, of Brooklyn, reported that this pensioner was " permanently helpless and required the constant aid of a nurse." On May 30, 1874 (Decoration Day), and the day prior, at a preparatory parade of the veterans of his regiment, he was particularly active. The day after this.unusual exercise, May 31, 1874, he died suddenly while at table.2 This statement from the Brooklyn Union, June 1, 1874, is corroborated by the records of the Pension Bureau. 1 OTIS (G. A.), Case of Reamputation at the Hip, in American Jour. Med. Sci., 1*71. Vol. LXI, p. 141. Circular No. 3, S. G. O., 1871, p. 215. In the account of Fabry's case, first published in the American Journal of Medical Sciences, 1871, Vol. LXI, p. 141, it is stated that the left leg was first amputated by Surgeon G. W. JACKSON, 53d Pennsylvania; again through the joint, August 23d, by Acting Assistant Surgeon W. F. ATLEE; and again on August 28th, by Acting Assistant Surgeon J. B. ItOE. These statements were taken from the patient's written statements and from the artificial limb statement of Jewett's Leg Company. The original casualty list of the 2d Artillery Brigade of the Army of the Potomac and the case-book of the City Point Base Hospital of the Second Corps show conclusively that the first amputation was done August 17, 1864, at the lower third of the left thigh, by Surgeon G. L. POTTER, 145th Pennsylvania, and that the subsequent occasions of operative interference were ball extractions or incisions. * Circular No. 6, S. G. O., 1865, p. 49.* Circular No. 7, S. G. O., 1867, pp. 52, 65. HAMILTON (F. H.), Treatise on Military Surgery, 1665, p. 62a Fig 113.—Cicatrix sixteen months after a reampu- tation at the right hip, succeeding amputation for a bayonet stab through the knee. SECT. II.J REAMPUTATION AT THE HIP JOINT. 155 Flo. 114. —Shot perforation of right tibia. Spec. 370H. CASE 332.—Private Eben E. Smith, Co. A. 11th Maine, aged 10 years, was wounded August 16, 1864, at Deep Bottom A musket ball passed through the right leg from within outward, fiacturing the head of the tibia. The wounded man was conveyed to a field hospital of the Tenth Corps, where it was determined that an attempt should be made to preserve the limb. Constant cold applications were made to the wounds. After a few days, the patient was sent to the North on a hospital steamer, and, on August 2>d, he was received at the hospital at Beverly, New Jersey. On admission lie suffered but little pain, though the knee joint was considerably swollen. On September 14th secondary hajmorrhage occurred, and it was deemed advisable to remove the limb. The amputation was performed by Acting Assistant Surgeon J. C. Morton, at the lower third of the thigh, by the circular method, the patient being anaesthetised by chloroform. On examining the seat of the injury, it was found that a fissure ran through the external tuberosity of the tibia and the external articular surface, and that the bone was carious in the vicinity of the fracture. Tlie specimen was forwarded to the Army Medical Museum by Assistant Surgeon C. Wagner, U. S. A., and is represented in the wood-cut (FlG. 114). The case progressed favorably until October 17th, when there was hajmorrhage from the stump to the amount of twelve ounces. The stump was in a sloughing condition, and it was therefore determined to tie the femoral artery in Scarpa's space, which was done by Dr. Morton. The ligature came away on November 1st. The wound remained in an unhealthy condition, with a copious fetid suppu- ration, and the necrosed extremity of the femur protruded from the upper angle of the wound. On November 5th, the soft parts were retracted, and four inches of the shaft of the femur were resected by the chain saw. After this the stump became much swollen, frequent abscesses formed, and it was finally decided that necrosis involved the femur quite up to the trochanters. This conclusion was verified by an exploratory incision made on Janu- ary 19,1865, when it was determined to proceed at once to amputate at the coxo-femoral articulation. The operation was performed by Acting Assistant Surgeon John H. Packard. The patient being already under the influence of chloroform, the fem- oral artery was exposed and tied just below Pou- part's ligament. Anterior and posterior flaps were then formed and disarticulation effected. Some difficulty was experienced in securing an artery supposed to be the comes nervi ischiadici; but the quantity of blood lost in the operation was not con- sidered large. There was extreme depression after the operation, and the patient was kept on the am- putating table for two or three days, lest an attempt at removal should prove fatal. Large quantities of stimulants and concentrated food were adminis- tered, and artificial warmth was applied to the surface of the body. Eight days after the operation haemorrhage to the extent of six ounces occurred, and a ligature was placed upon the external iliac artery by Dr. J. C. Morton. The ligature separated on February 17th. On the 19th there was pro- fuse bleeding from the point of ligation, which was controlled by pressure. Direct compression was maintained for fourteen days. After this the patient rapidly improved, and by the end of March he was quite well. On April 12th, Smith was transferred to the White Hall Hospital, near Bristol, Pennsylvania. On May 27, 1855, Assistant Surgeon W. H. Forward, U. S. A., reported his discharge from service with a sound stump and robust health. After his discharge Smith went to his home at Eastbrook, Maine, and was granted a pension. On February 27, 1867, he wrote to this office that his general health was excellent, but that the cicatrix of his stump was painful. In May, 1867, he was admitted to the eastern branch of the U. S. Military Asylum for disabled volunteer soldiers, at Togus Springs, near Augusta, Maine. On May 12th, the surgeon of the asylum, Dr. B. B. Breed, wrote that he "was apparently in perfect health, and complained only of conges- tion of the stump after standing for some time." In July, 1867, Dr. Breed forwarded photographic prints representing the condition of the cicatrix two and a half years after the amputation at the hip, from one of which the adjoining photograph (FlG. 115), is copied. An attempt was proposed to adapt an artificial limb to the stump. The exarticulated portion of the femur was forwarded to the Army Medical Museum by Assistant Surgeon C. Wagner, U. S. A. It is represented in the adjacent wood-cut ( ^IG. 116), and shows a fragile involucrum and sequestrum about to separate extending quite to the epiphysis. Pension Exam- ining Surgeon P. H. Harding, of Ellsworth, Maine, reports, in 1837, that the pensioner's health has become poor, and that he is unable to do any manual labor. On December 4, 1874, Dr. G. Parcher, of Ellsworth, certifies "that, in consequence of the extensive and tender cicatrix, the pensioner cannot sit to work at any trade or to write, and as he cannot wear an artificial limb, he can perform no labor in an erect position." June 4, 1878, this pensioner alleged no further disability.1 V 'JVAGNEE (C-)' RePort °f interesting Surgical Cases, p. 15. MORTON (T. G.), Amp. Hip Joint in Philadelphia, etc., in Am. Jour. Med. Sci., 1866, ■.n° 'J? J' PacKAM> (J. H.), On Amputation at the Hip Joint, in New York Jour. Med., 1865, Vol. II, p. 161. Circular No. 6, S. G. O.. 1865, pp. <9,50. Circular No. 7, S. G. O., 1867, pp. 49, 65. FIG. 115.—Appearance of cicatrix two and a half years after coxo-femoral exarticulation. [From a photograph.] FIG. 116.—The upper half of right femur, disarticulated five months after amputation in lower third. Spec. 81. 156 INJURIES OF THE LOWER EXTREMITIES. IcnAP. x. CASE 333.—Serjeant E. D. Ulmer, Co. G, loth New Jersey, aged 21 years, was wounded at Cedar Creek, October 19, 1864, by a musket ball, which entered the inner face of the left thigh, fractured the bone, and lodged under the skin on the outer Bide of the limb. The femur was badly comminuted, fissures extending into the knee joint and upward for seven inches (FlG. 117). The ball was extracted at a field hospital of the Sixth Corps, and it was determined to attempt to save the limb. The wounded man was conveyed to Baltimore, to Jarvis Hospital, on October 24th. Intense arthritis supervened, with deep dissecting abscesses in the thigh. On November 14th haemorrhage to the extent of twenty-five ounces took place from both orifices, which were in a sloughing condition. The patient was put under ether, and amputation at the middle of the thigh was performed by Acting Assistant Surgeon Edmund G. Waters. The patient rallied promptly after the operation, and in a few weeks was able to get about on crutches. Yet the stump continued painful, and the extremity of the femur was found to be necrosed. In March, 1865, it was found that a cylindrical sequestrum was loose. This was removed, on March 8th, by Acting Assistant Surgeon B. B. Miles, with forceps (FiG. 118). On May 29, 1865, he was discharged. On the following day he started for Philadelphia, and, unfortunately, on the journey he fell with violence upon the stump. After this there was increased suppuration, with deep-seated pain in the stump. On the 22d of January, 1836, fifteen months after the original injury, while dressing the part as usual, a haemorrhage occurred from one of the fistulous openings at the end of the stump, amounting, according to his statement, to at least a pint. On account of this haemorrhage, he was admitted into the Pennsylvania Hospital. The ^ ^^ history of the case and the appearances of the stump clearly indicated the existence of osteo- cylindrical Fig 117.-Shotcom- liti8 with necrosis 0f the neck, and probably ulceration of the head of the bone. The risk "3f™m minutionoflowerhalf J > . . ... n .. e t, • _i iromiemur. of left femur. Spec, of recurrence of dangerous haemorrhage, and the extensive disease ot the lemur, obviously sP. 107, A. 3734, A. M. M. J demanded operative treatment. On February 17, 1838, in the hospital amphitheater, the patient M-M- * being etherised, an exploratory operation was made by Dr. Thomas G. Morton, the attending surgeon, and amputation was decided upon by him in consultation with Drs. W. Hunt and D. H. Agnew. The abdominal tourniquet, used the first time in this country by Professor Joseph Pancoast, June, 1860, was applied, and antero-posterior integumentary flaps were dissected up; the femoral artery was then tied, the muscles cut circularly, and the head of the bone was disarticulated. The aorta was so completely controlled by the abdominal tourniquet that no arterial jet was observed during the operation. About six- teen ligatures were applied. The flaps were approximated with adhesive plaster, no sutures being deemed necessary. The dressings consisted of lint soaked in pure laudanum. The patient reacted well; under vigorous stimulating treat- ment and the local application of permanganate of potash he rapidly recovered. He left the hospital March 27, 1866, for his home in Philadelphia. The exarticulated portion of the femur presented a characteristic example of necrosis following osteomyelitis. A long loose sequestrum was found en- cased in a new deposit of porous bone, and was not limited to the diaphysis, but extended quite into the neck, and then projected through the ulcerated capsular ligament. The head of the femur was ulcerated. The acetabu- lum was healthy. On May 10,1866, the patient was able to get about on crutches. On the 20th, he left for New Jersey to fill a situation as tele- graph operator. On July 24, 1866, he sent a letter to this office from Milford, New Jersey, announcing that his health was excellent, and a few weeks subsequently he corrob- orated this statement by transmit- ting his photograph (Fig. 119). On October 27, 1866, he was supplied with an artificial limb by Clement, of Philadelphia. Ou June 28, 1867, Mr. Ulmer wrote to this office that he had never had a day's illness since the hip joint amputation was performed, and had never been in better health than then. He was stouter than ever before, weighing one hundred and seventy-five pounds, or twenty-five more than his average weight when he had both lower extremities. His stump was firm and solid and gave him no pain or inconvenience. He considered his artificial limb an excellent one, hut found it inconvenient at his work, which required him to sit all day on a high stool. In a letter addressed to the Surgeon General's Office from the publishing house, 1630 Wellington Street, Philadel- phia, October 15, 1878, Mr. Ulmer reported his health as most excellent, his weight at 173 pounds, or 25 pounds more than before exarticulation. He had an artificial limb from Clement, but had to abandon it.1 Fig. 11H— Cicatrix five months after reamputation at the left hip by Dr. T. G. MORTON". |From a photograph.] Fig. 120.—Exarticulated necrosed upper portion of femur. [From a photograph by WlLLAUD.] 1 Morton (T. G.), loc. cit., Vol. Lll, p. 26. Lidell (J. A.), On Secondary Traumatic Lesion of Bone, etc., in U. S. San. Com. Memoirs, 1870, Surg. Vol. I, p. 440. Circular No. 7, S. G. O., 1867, pp. 51, 65. SECT, n.] REAMPUTATIONS AT THE HIP JOINT. 157 Case 334.—Private B. A. Vick, Co. E, 43d North Carolina, aged 37 years, received a shot wound of the knee joint, at Cedar Creek, October 19,1864, and underwent primary amputation at the lower third of the right thigh. Ou December 19th he was sent to the hospital at Staunton. On January 1, 1865, the stump had almost cicatrized, but there were apertures through which pus issued. On February 15, 1865, an exploration with a silver probe revealed bone denuded of periosteum and roughened. Another aperture l«d to a somewhat superficial fistulous track of six or eight inches. It was determined to open the face of the stump, with a view to the removal of the diseased bone. The operation was performed on March 11, 1865, by the surgeon in charge of the hospital. Dr. A. M. Fauntleroy, assisted by Drs. T. W. Glocker and R. K. Carter. Chloroform was administered. A transverse incision was then made over the face of the stump. At the exposed extremity of the femur was a redundant mass of new bone, which was sawn off. It was then found that the carious shaft of the bone was encircled by a soft porous osseous deposit. About six inches of this formation was stript off by the gouge, yet the limits of morbid action had not been reached. An incision on the outer side of the thigh, between the vastus externus and biceps, was extended upward to a point between the great tro- chanter and the anterior iliac spine, and revealed the fact that the entire femur was diseased. It was now decided to disartic- ulate at the hip joint. The femoral artery was compressed upon the pubic bone and anterior and posterior flaps were formed, the arteries being secured as they were cut. The loss of blood was trifling. The flaps were brought together by silver sutures, and the stump was dressed with dry lint. As soon as consciousness was restored the patient was freely stimulated, and warmth was applied to the surface of the body; the patient rallied in a few hours. At bed-time the pulse beat 120. On the following morn- ing the patient was doing well. Pulse still the same in quick- ness and frequency. On March 13th, his condition was satisfac- tory; his appetite was remarkably good; he ate soft-boiled eggs iV'3 and drank largely of rich milk. Suppuration having commenced, jy. a cold water was directed to be constantly applied to the stump to lessen the secretion of pus. He was ordered twenty drops of the tincture of the sesquichloride of iron thrice daily, and ten grains of Dover's powder at bed time. Suppuration amounted to half a pint during the day. On March 20, 1865, he was still toeraph sent doing well. Suppuration was diminished in quantity and was >,,. n, p.,™ i i i_i r. . j 3 ji • . • ■, . FIG. 122.—Cicatrix sixteen months after reamputation tlerotI laudable- Sutures were removed, and adhesive strips used to at the right hip. [From a photograph.) support the flaps and maintain them in apposition. The patient's bowels had been regular since the operation. His tongue had at no time been furred. The stump was doing well. The discharge had abated to three or four ounces. March 28th, the progress of the patient was highly favorable. March 29th, the patient's condition was comfortable and favorable; his appetite continued good. The stump along the lower surface seemed to have united firmly; on the side, granulations were healthy; the pus discharged was laudable. On April 24th the face of the stump had entirely healed. There was still a granulating sore at the outer angle. On July 18, 1865, the patient started for his home, near Tarborough, in Edgecomb, North Carolina. He was in excellent health, and walked about on crutches with facility. A year subsequently he was in Lynchburg, Virginia. Since that date no intelligence has been received from him, and it is not known whether he still survives.1 Dr. A. M. Fauntleroy, the operator, courteously transmitted to the Surgeon General's Office a photograph of the diseased exarticulated femur, which is copied in the wood-cut (FlG. 121), and the photograph of the patient and of his stump sixteen months after the operation, July, 1866, which is represented in the wood-cut, FlG. 122. Case 335.—Henry Campbell, aged 23 years, received, in March, 1863, at New Orleans, a pistol shot in the left knee. Primary amputation at the junction of the middle and lower thirds of the thigh was performed by Acting Assistant Surgeon Avery. Osteomyelitis supervened and resulted in necrosis. After a few months the patient was removed to his home iu Con- necticut. In October, 1864, eighteen months subsequent to the injury, he was visited by Dr. Bauer, of New York, who laid open the cicatrix, crowded with fistulous openings, and removed a cylindrical sequestrum five inches in length. For a few months after the removal of this sequestrum the health of the patient improved, and hope was entertained of his recovery without further operative interference; but persistent pain and constitutional disturbance then recurred with augmented intensity. The lower part of the stump was riddled with sinuses and the tissues were much indurated. The probe detected dead boue, or morbid bona formation, in every direction. In October, 1886, the medical attendants resolved that an operation should be performed for the radical removal of the diseased bone. It was hoped that it would be only necessary to remove a portion of the shaft of the femur. On October 22d, the patient was placed under the influence of chloroform, and Dr. James B. Whitcomb, assisted by Dr. Charles Bliss, of Willimantic, and others, proceeded with the operation. An exploratory incision was made on the outside of the thigh, extending quite up to the trochanter. On exposing the new osseous formation at the end of the stump it was found to be more than twice the normal diameter of the shaft of the femur, rough, porous, and fragile. The immensely thickened periosteum was studded with plates and spines of new bone, and in many cases there were foliaceous masses of callus unconnected with the shaft. Toward the upper extremity of the femur the periosteum appeared less diseased, 1 FAUNTLEltOT (A. M.), Hip Joint Amputations, in Richmond Medical Journal, 1866, Vol. I, p. 7. EVE (P. F.), Contribution to the Hip Joint operations performed, etc., in Trans. Am. Med. Ass'n, 1867, Vol. XVIII, p. 254. Circular Ko. 7, S. G. O., 1867, pp. 50, 65. LOktng (A.), toe. cit, p. 10a Case 368. 158 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. but the bone was found to be softened and disorganized quite up to the great trochanter. It was therefore decided to amputate at the hip joint. Ether was administered. Pressure with the thumb on the femoral artery served to control the haemorrhage. A large antero-internal flap was formed and disarticulation effected. There was very little loss of blood, but the patient was greatly prostrated by the shock of the operation, which, from the beginning of the exploration to the completion of the ampu- tation, lasted fifty minutes. The free administration of ammonia and brandy brought about reaction; but it was temporary, and the case terminated fatally, five hours after the operation, October 22, 1866.1 Case 336.—Private Lewis Larry, Co. A, 1st New Orleans Regiment, aged 23 years, was shot through the left knee by a sentry, July 18, 1864, while attempting to avoid arrest. He was carried to the University Hospital. It was found that the condyles of the femur were badly comminuted. Synovial fluid was dribbling from the wound, with little haemorrhage. Amputation at mid-thigh was promptly performed, under chloroform, by double flaps. The patient did well for about three weeks, when he was attacked with persistent diarrhoea. Erysipelas now attacked the stump. Sloughing phagedaena of the flaps ensued, and purulent sinuses extended upward along the femur, the necrosed extremity of which protruded from the stump. Amputation at the hip joint was performed by Acting Assistant Surgeon F. Hassenburg, on September 21, 1864. The patient was under the influence of chloroform. The artery was controlled at the groin, an anterior flap was formed by transfixion, the capsule divided and disarticulation effected, and a posterior flap cut from within outward. The haemorrhage was inconsiderable, and the patient promptly rallied from the shock of the operation. For a few days his nppetite and general health improved; then the wound assumed an unhealthy aspect, and finally sloughed. Symptoms of pyaemie infection set in, and death ensued on September 30, 1864. On dissecting the removed portion of the thigh it was found riddled with abscesses. The periosteum was enormously thickened and contained flaky ossific deposits. The shaft of the femur was necrosed up to the trochanters, the dead bone being included in a redundant friable involucrum. The preparation was forwarded to the Army Medical Museum by Surgeon Samuel Kneeland, U. S. V.2 Fig. 123.—Diseased Case 337.—Charles H. Hawkins, a second lieutenant in Co. C, 4th New York Cavalry, aged 23 acase of^oxo-femoral years> was wounded in a reconnoissance near Strasburg, Virginia, on the night of June 1, 1882. A conoidal disarticulation. Spec, ball, from a Colt's cavalry pistol, entered the posterior surface of the right thigh, and, passing downward 4 and forward, fractured the femur at the lower part of the middle third, and lodged under the skin about five inches above the knee. The wounded man lay out all night in the rain, and in the sun next day until three in the afternoon, when he was brought into camp and had the ball removed by his regimental surgeon. He was then conveyed in an ambulance to a hospital in Strasburg, where his limb was dressed with a straight splint, moderate extension and counter-extension being maintained. After ten days he was carried on a stretcher to a private house, where he remained seventeen days. Two frag- ments of bone were extracted during this period. He was next transferred to a tent hospital, five miles distant, near Middletown, and after a sojourn of nine days was again transferred to a hospital at Winchester. The splints were removed and the limb was bandaged. On July 19th he was conveyed to Baltimore, and admitted to the Camden Street Hospital on July 20th. His con- dition was very unpromising; there was much irritative fever, a copious suppuration, and partial union of the fracture, with three inches shortening and much angular deformity. No apparatus was applied; but the limb was maintained in an easy position by pillows, and attention was mainly directed to improving the condition by wholesome diet. Two months subse- quently the patient had gained ground, and an operation to remove the diseased bone and to break up the faulty union of the fragments was determined on. On October 1st, the posterior orifice was enlarged, a number of denuded fragments of bone were removed by forceps, and the deformed callus was chiseled and gouged away. Temporary improvement ensued. The limb was put in a proper position and the wound was daily syringed out by iodine injections. After a time, however, it became manifest that the broken extremities of the femur were still diseased. On April 5, 1863, the patient was transferred to the Ladies' Home Hospital, New York City, where he was received on April 8th, greatly reduced in strength. The wounds discharged profusely, and he complained of much pain. On April 29th, Surgeon A. B. Mott, U. S. V., amputated the. limb at mid-thigh. Evidence that the femur was diseased above the point at which it was sawn soon became apparent, and, after a protracted effort to induce healthy action, the flaps were freely laid open and the femur was resected, four inches of the shaft being removed. After this the patient was put upon a full diet, with an allowance of brandy and of porter daily. The stump still failed to assume a healthy action, but became much enlarged, undergoing apparently a fatty degeneration. On April 4, 1864, Lieutenant Hawkins was mustered out of the military service, and was transferred to St. Luke's civil hospital, and came under the care of Dr. Gurdon Buck. The patient was anaemic, his appetite capricious; he was compelled to keep his bed continually on accouut of the pain he suffered when the stump was in a dependent position. For over five months every means were used to bring the patient up to a condition in which an operation for the removal of the diseased femur stump might be safely undertaken. On September 21st, he was placed under the influence of sulphuric ether, and Dr. Buck proceeded to disarticulate. It was found necessary to bisect the stump, uncovering the neck of the hone on the inner as well as the outer aspect, by an incision which commenced above the great trochanter and ran around the extremity of the bone to near the tuberosity of the ischium. During the opera- tion the administration of ether was suspended on account of the extreme feebleness of the circulation, aud brantly was freely given, aud warm apphcations were made to the trunk. The loss of blood was not great, but every possible means had to be called into requisition to bring about a partial reaction after the operation, so great was the prostration and so feeble the recuperative powers. After twenty-four hours of great apparent suffering, the patient died in a syncope, September 22, 1864. The portion of the femur removed consisted of the head, neck, and trochanters, with four inches of the shaft. The head and neck were much softened and the shaft was atrophied and fatty.3 » Circular No. 7, S. G. O., 1867, pp. 52, 65. * Circular No. 6, S. G. 0., 1866, p. 50. Circular No. 7, S. G. O.. 1867, pp. 48, 65. 3 Waters (E. G.), Shot Fractures of the thigh, in Am. Med. Times, 1863, Vol. VI, p. 185. HAMILTON (F. H.), Amp. in Shot Fractures of the Femur, in Am. Med. Times, 1864, Vol. VIII, p. 1. Circular No. 6, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1867, pp. 47, 65. SECT. II.] REAMPUTATIONS AT THE HIP JOINT. 159 Table XVIII. Summary of Nine Cases of Reamputation at the Hip Joint. Name, Age, and Military Description. Cotter, W., Pt., E, 9th New Hampshire, age 27. Fabry, J., Pt., Battery K, 4th Artillery, age 38. Francis, L., Pt.. 1,14th New York State Militia, age 42. Smith, E. E., Pt., A, 11th Maine, age 19. Ulmer, E. D., Serg't, G. loth New Jersey, age 21. Vick, R.A., Pt., E, 43(1 N. Carolina, age 37. Campbell, H., Sutler's Cl'k, age 23. Hawkins, C. H., Lieut., C, 4th New York Cavalry, age 23. Larry, 1,., Pt., A, 1st New Orleans, age 23. July 30, 1864. Aug. 16 1864. Julv 21 1861. Aug. 16 1864. Oct. 19, 1864. Oct. 19, 1864. Mar. — 1863. June 1, 1862. July 17, 1864. Nature of Injury. Musket ball fract. lower third rightfemur; prim.amp. thigh, mid. third. Nov. 29, '64, seq. rem.; osteomyelitis. June,'66, exc. four inches end of stump. Subsequent operation rem'd dead bone. Shrapnel shot wound left knee joint; prim. amp. lower third thigh. Aug. 28, ball and pc. of Fuseext.; necro.; abscesses opened. 1866, discharge pro- fuse ; exfol. fistulous open'gs. Oct. -J7th, dead bone removed. 1867 to 1870, abscesses cont'd to form and dead bone to exfo. Bayonet thrust opening right knee joint (14 other bayonet stabs); gangrene; extensive abscess on thigh. Oct. 28th, amp. mid. third thigh. Nov. -, femur protruded; exsected. May, 1862, necrosed end of femur exsected. Musket ball fract. head of right tibia. Sept. 14th, haem.; amp. low. third thigh. Sept. 17th, haem.; lig. fem. Nov. 5th, ne- crosis; four ins. end of femur resected; frequent abscesses. Conoidal ball com'nuted fract. left femur, fissures extending into kneej t and upw'd seven inches; ball ext. Nov. 14th, hsem.; amp. mid. third. Mar., '65, seq. removed. Jan., '66, haem.fromendofstump; osteo- myelitis. Shot wound right knee joint; prim. amp. lower third thigh. Jan. 1, '65, almost cicatrized. Feb. 15th. increased disch'rge of pus. Exploration revealed entire femur diseased. Pistol shot in left knee; prim. amp. junct. low. thirds thigh ; osteomyelitis; necrosis. Oct., 1864, seq. removed; stump riddled with sinuses. Conoidal pistol ball fract. mid. third right femur; ballextr'd. July 20th, bone partially uni- ted. Oct. 1st, fragments and calloused bone removed. Apr. 29, '63, amp. mid. third; exc. four inches of femur. Shot wound left knee comminu- ting condyles of femur; prim. amp. mid. third thigh; erysip. attack'd stump, flaps slough'd, necrosed end bone protruded. Date of Ofhra- TION. Oct. 15, 1871. Mav 15 1870. May 21 1864. Jan. 19, 1865. Feb. 17, 1866. Mar. 11 1865. Oct. 22 1866. Sept. 21 1864. Sept. 21, 1864. Operation and Opkrator. Reamp. thro' extend'g incision of later operation upward suf- ficiently to allow ready exar- ticulution of head, neck, and trochanteric portion of femur, by Dr. N. S. Lincoln, Wash- ington, D. C Long semi-lunar flap; incision from point on tuberosity oi ischium to point midway be- tween ant. sup. spin, process of ilium and troch. major, by Ass'tSurg.G.A.Otis, U.S.A. Antero-posterior flap reampu- tation at hip ioint, by Surg. A. B. Mott, U. S. V. (Bone found extensively diseased close up to head.) Anterior and posterior flap amputation at hip joint, by A. A. Surg. J. H. Packard. (Femur found necrosed up to trochanters.) Anterior and posterior flap amputation at hip joint, by Dr. T. G. Morton, Penn. Hos- pital. (Bone diseased as high as neck.) Anterior and posterior flap amputation, by Surg. A. M. Fauntleroy, C S. A., assisted bv Drs. T. W. Glocker and It. K. Carter. Large anterior internal flap, by Dr. J. B. Whitcomb. (New osseous formation at end of stump was twice the diameter of shaft of femur; bone soft and diseased up to troch.) Tissues of stump indurated and inelastic; stump bisected by an incision commencing above great troch., running around end of bone to near tuberosity of ischium; antero-posterior flap, by Dr. G. Buck. Anterior flap formed by trans- fixion, posterior flap cut from within outward, by A. A. Surg. F. Hassenburg. Result and Remarks. April, 1872, w'd cicatriz'd firmly. 1873, abscesses unhealed ; con- stant irritation. Died Jan.21,'74. Specs. 252, 4954, 5946. Photos. 01, 180, 324. OTI6 (G. A.), in Boston Med. and Surg. Jour., Feb. 7,'78, Vol. XCV1II, p. 166, and Circular 3, S. G. O., Wash- ington, 1871, p. 283. Reaction prompt. May 18th,w'nd united nearly J full extent by first intention. June 5th, about on crutches. July ^Incomplete- ly cicatrized. Specs. 5684, 5685, 5687, 5699, 5702. Photos. 274, 275, 276. Rapid recovery: stump sound. 1867, confined to bed ; copiously discharging ulcer, fistula in ano. 1870. about on crutches, stump apparently healed. Died, May 30, 1874, suddenly. Extreme depression. Jan. 27,'65, ha?m.; lig. external iliac artery. Feb. 19th, hsem.; compression. Disch'd May 27, 1865, sound Btump. Specs. 81, 3709. Photos. 29, 174, 203. Rapid recovery. Left hospital March 27,1866. 1877, continues in good health; stump in healthy condition. Specs. 107, 3734. April 24, 1865, stump entirely healed. Last heard from July, 1866, in excellent health. Died October 22,1866, five hours after operation. Only partial reaction. Died Sep- tember 22, 1864, in a syncope, after twenty-four hours of great apparent suffering. Rallied promptly; wound became unhealthy and sloughed. Died Sept. 30, 1864 ; pyaemia. The shaft of femur was necrosed up to trochanters. Spec. 3738. These nine cases of reamputation at the hip comprise only three deaths, giving the low mortality rate of 33.3 per cent. In three instances the exarticulation had been preceded by amputation in the lower third of the thigh, and, in six cases, the disarticulation was subsequent to amputation in the middle third of the thigh. In two of the cases the prior amputation was done on account of shot fracture of the shaft of the femur, in six for shot fractures involving the knee joint, and, in one, for a bayonet stab of the knee. In six instances extraction of sequestra or resection of the necrosed extremity of the femur had been practised in the interval between the amputation in the continuity and the disarticula- tion. In the three fatal cases the prior amputation had been primary in two instances; secondary in the third case. One patient survived the shock of the operation only a few hours; another died in a syncope after twenty-four hours of great apparent suffering, and 160 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the third succumbed to pyaemia eight days after the exarticulation. Of the six patients who survived the operation, three, J. Fabry (Case 330), E. E. Smith (Case 332), and E. D. Ulmer (Case 333), were living in August, 1879. Of the Confederate soldier, Vick (Case 334), no information has been received since 1866, and it is not known whether he still lives. Two survivors of the operation have since died: Cotter (Case 329), in 1874, two years and three months after the operation; Francis (Case 331), in 1874, over ten years after the exarticulation. The nine cases cited in Table XVIII, and the operations performed by G. J. Guthrie,1 in 1812, and by T. G-. Morton,2 in 1878, are, it seems, the only recorded examples of reamputations at the hip in military surgery. From the records of the surgery of civil life twenty-five cases may be collected, making a total of thirty-six3 exarticulations at the hip after previous amputations in the thigh, with fourteen deaths, a mortality of 38.8 per cent. Of the eleven cases in military surgery, four, or 36.3 per cent., proved fatal, while, of the twenty-five operations in civil practice, ten, or 40.0 per cent., had a fatal termination. Summing up the sixty-six cases of amputation at the hip detailed in the preceding pages, it will be seen that twenty-five were primary, twenty-three intermediary, nine secondary, and nine were reamputations. In each of the twenty-five primary cases the amputation was performed within twenty hours of the infliction* of the injury, the average interval between the reception of the wound and the operation being about four hours. Sixteen died within twelve hours, one survived thirty-six hours, two about forty-eight hours, and one lingered eight days; in two instances the period between the operation and death could not be ascertained; the average period of death being about twenty hours. Of the three survivors after primary amputation at the hip, one was in comfortable health over fifteen years after the operation; the other two patients were heard from two and six months, respectively, after the date of the operation, but the hope expressed in Circular No. 7, at page 23, that the subsequent histories of these men might be traced has not been attained; and there might be some question regarding the justness of citing these cases as well authenticated instances of recovery. In Table XIV, on page 127, ante, these cases have been classed among the recoveries, thus arriving at a fatality of 88.0 per cent. Should they be excluded, the fatality of the primary amputations at the hip during the war of the rebellion would be 95.6 per cent. The femoral vessels were torn in six of the primary amputations, to wit: Compton's case (273) of Robinson; Carnochan's case (280) of Gordon; Lay's case (284) of a private of the 3d Missouri, in which the femoral artery was ligated prior to amputation; Brock's case (286) of Waters, in which the opposite leg was also amputated at the point of election; Davis's case (287) of Wayland, and Lanning's case (289) of Brookins. The twenty-three intermediary exarticulations at the hip had fatal results. The inter- val between the reception of the injury and the date of the operation varied from twenty- four hours to thirty days, the mean length being a little over nine days. Only two survived 1 See Case 12 in Note 1 on page 128, ante. 2 See Case 184 in Note on page 130. 'In note 1 on page 152, ante, reference was made to 32 instances of exarticulation at the hip after previous amputation in the continuity of the thigh. The prior operations had been performed in 9 instances for shot injury, in 2 for punctured and incised wounds, in 5 for bad fractures of the femur, in 8 for ostitis or ill defined lesions, and in 8 for malignant growths. Particulars of 4 additional instances have since been ascertained, viz: three exartic- ulations at the hip after amputations in the thigh for ill defined lesions: E. S. O'Grady, in 1874 (Dublin Journal of Med. Sciences, 1876, Vol. LXI, p. 78)- T. G. MORTON, in 1877 (Cincinnati Lancet and Clinic, 1879, Vol. II, N. S., p. 9, and letter of Dr. T. G. Morton to the editor, dated February 19, 1879); B. BECK, in 1878 (Archiv fur Klin. Chir., Berlin, 1879, B. XXITI, p. 654); and a reamputation at the hip by T. G. Morton, in 1878: Boasso Dominico (not Dominico Ludovess, as indicated in Case 184 in note on p. 130, ante), aged 24; wounded in the right thigh, by a cannon ball, at Sedan, in 1870 • amputation in middle third; reamputation at hip, December 14, 1878. Recovery (Cincinnati Lancet and Clinic, 1879, Vol. II, N. S., p. 9, and Dr. T. G. MOBTON'8 letters to the editor, dated February 19, March 18, and May 28, 1879). Of the 36 reamputations at the hip, 14 had a fetal termination, a mortality of 38.8 per cent. SECT, n.l AMPUTATIONS AT THE HIP JOINT. 161 the amputation eight days; nine died within the first twenty-four hours, four on the second day, one on the third, three on the fourth, two on the sixth, and in two, the date of death could not be ascertained; the average duration of life after the operation in the inter- mediary series was only about thirty-five hours. In four instances gangrene, and, in two, pyaemia, supervened. In one case (Surgeon P. Pineo'e case of Private P. Johnson, Case 306, p. 141, ante) it is stated that the femoral artery was divided by the missile, and in one (Surgeon E. Bentley's case of L. Carroll, Case 298, p. 139, ante) the amputation had been preceded by a primary partial excision in the shaft of the femur. Of the nine secondary amputations at the hip, two resulted successfully. George W. Lemon (Case 320, p. 145, ante) enjoyed good health in 1879, nearly fifteen years after the operation. In the case of the Confederate soldier W. W. Longmoor (Case 321, p. 146, ante), the following additional information was received shortly after the case had been sent to press: Case 321, p. 146 (continued): Mr. Longmoor, who, at the present writing, is clerk of the court at Cynthiana, Kentucky, writes, under date of April 2, 1879: " I have had two abscesses form in my stump, * * the first one was very severe indeed, and kept me confined to my bed for several weeks, and discharged copiously for about one week of that time. The next and last abscess was not near so severe, and did not confine me to my bed for more than about two weeks. The discharge was not near so great, and the pain accompanying the formation not near so severe. I have a constant pain in my stump; an uneasy, restless sort of a pain that never ceases but is always with me—at times much worse than others, and often taking the form of neuralgia, especially before or during damp or falling weather. I suffer a great deal from neuralgia—acute, very acute, lasting generally four or five days; sometimes compelling me to leave my office, at which times I usually resort to heavy doses of quinine. I use morphine every day. I take about one-fourth of a grain three times a day—have been doing this ever since I was wounded. During these times my stump becomes very sore, and hurts me when I walk. I have never been able to wear an artificial limb, in fact have never tried, knowing its utter impossibility, for I could not bear the weight of the limb much less the pressure on the stump." Of the seven fatal cases after secondary amputation at the hip, one patient died from phthisis and lithiasis, one from secondary haemorrhage and phlebitis, one from the giving away of the femoral artery at the point of ligation, one from surgical fever and erysipe- latous inflammation of the stump, and three from the shock of the operation. The shortest interval between the operation and the date of death was one hour, the longest one hun- dred and nineteen days, the average duration of life being a little above twenty-two days. The average interval between the date of injury and the date of operation was about four hundred and twenty-nine days, the shortest interval being forty-three days, the longest two years, nine months and twenty-one days. The sixty-six exarticulations at the hip were practised in forty-five instances with seven recoveries on Union soldiers, in twenty instances with four recoveries on Confederate soldiers, and, in a fatal instance, on a citizen employe*. In twenty-nine instances with six recoveries, the right limb was removed; in twenty-eight with five recoveries, the left; and, in nine, the side was not stated. Chloroform was the anaesthetic administered in thirty- eight of the sixty-six cases, ether in ten, chloroform and ether in three. In one instance (Dr. B. D. Lay's Case 284, p. 135, ante), stimulants and morphia only were given, and in fourteen instances this point is not mentioned. Considering the ages of the patients we find that three operations, performed on patients under twenty, were fatal; that of thirteen operations performed on patients between the ages of twenty and twenty-four inclusive, three were successful; of ten between the ages of twenty-five and twenty-nine inclusive, two had a successful issue; of seven between the ages of thirty and forty, four recovered; and of four above forty, two had a successful termination. In twenty-nine instances the age of the patient was not recorded. Fragments or splinters of bone were removed prior to the exarticulation at the hip Surg. Ill—21 162 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. joint in the cases of W. W. Longmoor (Case 321, p. 146, ante) and of M. O'Neil (Case 327, p. 150, ante). The ball and detached fragments of bone were extracted in Bowman's case (Case 322, p. 147, ante), and the ball, with some wadding, in the case of Antonio Mutieres (Case 326, p. 150, ante). Of the different modes of amputating at the hip joint, the operation by the antero- posterior flap method was most commonly selected. It was used in twenty-nine of the sixty-six cases of exarticulation at the hip described in the preceding pages, and in five of the eleven cases of recovery, viz: in Dr. E. Bentley's case of Lemon (p. 145, ante); in Dr. A. B. Mott's case of Francis (p. 154, ante); in Dr. J. H. Packard's case of E. E. Smith (p. 155, ante); in Dr. T. G. Morton's case .of Ulmer (p. 156, ante); and in Dr. A. M. Fauntleroy's case of Vick (p. 157, ante). The single flap method was successfully employed in three instances: by Dr. Shippen in the primary case of Kelly (p. 131, ante), by Dr. J. T. Gilmore in the case of Williamson (p. 132, ante), and by Dr. G. A. Otis in the case of Fabry (p. 153, ante), and unsuccessfully in twelve cases. Drs. William M. Compton and G. C. Blackman adapted, with success, the circular method in the cases of Robinson (Case 273, p. 132, ante) and Longmoor (Case 321, p. 146, ante). Larrey's method of amputa- ting at the hip by two lateral flaps was preferred in eight instances; the oval was employed only once, in Dr. J. M. Carnochan's case of Gordon (Case 280, p. 134, ante). In Dr. N. S. Lincoln's successful operation at the hip, in the case of Cotter (Case 329, p. 152, ante), the disarticulation resembled an excision or enucleation rather than a reamputation. The mode of operation is not indicated in ten instances. Prothetic apparatus, that might in some measure compensate the survivors after hip joint amputation for the loss of the limb, and relieve them of the necessity of continually using crutches, have been devised by Charriere, Foullioy,1 and others. In 1867, Dr. E. D. Hudson devised a lined and padded gutta-percha bonnet conforming to the entire ilio-lumbar parts, and some eight inches in length, firmly strapped to the pelvis by a broad chamois- lined canvas band. To this artificial stump an ordinary apparatus for thigh stumps could be fitted. This simple apparatus, which is fully described by Dr. E. D. Hudson in his pam- phlet: Mechanical Surgery, New York, 1878, p. 29, was tried by Kelly and Lemon; but, although great hopes were entertained that it would answer the purpose for which it was designed, it seems that this, as well as similar appliances, have now been discarded as use- less, even by those survivors who, at the first, were favorably impressed with their utility. Mr. Ulmer, who wrote to this Office in June, 1867, that he considered his "artificial limb an excellent one," in a letter dated October 15, 1878, states that after several attempts to wear the artificial limb he had to abandon it, "as it gave intense pain; the weight of the body pressing the top of the limb too severely against the pelvic bone. Another objection is the absence of motive power in the stump to propel the limb. As this has to be given by a swinging motion of the body, the effort is too fatiguing." James E. Kelly, under date of July 30, 1870, writes: "The leg I got from Dr. Hudson is of no benefit to me whatever, nor ever will be. I tried it sufficiently to know that I cannot wear it." Lemon advises this Office on July 31, 1870, that: "The artificial limb is not now nor ever has been of the least service to me." Longmoor has never tried an artificial limb as he "knew it would be useless." Fabry never attempted to wear one, and there is no record that 1 See Gaujot (G.) et Spillmann (E.), Arsenal de la Chirurgie contemporaine, Paris, 1872, T. II, p. 159. M. Debout (Appareils destints aux amputis qui ont subi la disarticulation de la cuisse, in Bulletin Geniral de Thirapeutique Mid. et Chir., Paris, 1862, T. 62, p. 283) relates that Cauzeret, a soldier of the Light Infentry, on whom BAUDENS successfully performed intermediary amputation at the hip, in Africa, in 1836 (CASE 38, Note 1, p. 128, ante), wore the apparatus of Foullioy for 11 years, from March, 1837, to October, 1848. SECT. II] AMPUTATIONS AT THE HIP JOINT. 163 FlG. 125.—Anteriorview of the same specimen. Cotter, Williamson, Robinson, Vick, or Francis essayed a trial. In the case of 53. E. Smith the cicatrix remained too tender to allow the wearing of an artificial limb. While the preceding pages were in press, a report of an unsuccessful primary ampu- tation1 at the hip by Assistant Surgeon Edward B. Moseley, U. S. A., was received from Fort Kobinson, Nebraska. This, with three additional cases given in the foot-note,2 increases the total number of exarticulations at the hip to two hundred and fifty-four, '"Private Bernard Kelley, Co. E, 3d Cavalry, aged 39, while in tho field in pursuit of Cheyenne Indians, on January 11,1879, was struck by a carbine ball (said to have been an accidental shot from one of his own company), which entered at a point just over the centre of the sacrum, half an inch to the left of the median line, passed downward and outward through the glutoal muscles, and struck the left femur just between the two trochan- ters, fractured it, and escaped from the front of the thigh about two inches above its middle, and an inch to the outside of the median line. He was brought to the post hospital at Fort Robinson the same day, and was found to be suffering from a high degree of shock; he was pale, cold, and weak from haemorrhage, which had occurred at intervals since the receipt of the wound. He was given one grain of morphia, and hot water was placed to his feet, and small quantities of beef essence given at frequent intervals. During the night ho reacted a little from shock, but complained greatly of pain in tho wound and of weakness. The thigh was supported in a comfortable position by pillows, and wet compresses were kept over the wounds. About one p. m., a brisk haemorrhage commenced from tho posterior wound, which, on examination, was found to be of such a serious nature as to require immediate interference to save the man's life. He was immediately placed under the influence of chloroform, and the posterior wound was freely enlarged, with the idea that the haemor- rhage came from the sciatio artery. This was found not to be the ca6e, however, the blood flowing from the deeper portion of the wound, and probably originating from the branches of the profunda femoris. This opening allowing of a free introduction of the finger, the wound was thorough^- explored, and the femur was found to be hopelessly comminuted. The bleeding still continuing, it was decided to amputate the limb at the hip joint, which was done at once by Assistant Surgeon E. B. Moseley, U. S. A., assisted by Acting Assistant Surgeon C. V. Petteys. The femoral artery was compressed against the brim of the pelvis by Dr. Petteys, and the limb was removed by trans- fixion from without, joining the incision made previously to explore for the seat of haemorrhage to that forming the anterior flap, which was rather long, and forming the posterior flap from the muscles on the back of the thigh. About four ounces of blood were lost, as well as could be judged, mostly from a general oozing from the surface of the flaps. The neck of the bone was seized by forceps and the head was removed from the acetabulum with some difficulty, owing to the short leverage obtained. The vessels were tied with silk ligatures and the flaps brought together with silver wire. The patient was then covered with blankets and bottles of warm water placed about him, and, as soon as possible after he reacted from the chloroform, he was given teaspoonful doses of brandy and water. He had taken the anaesthetic well and seemed to come out of it in good condition, recognized those about him, asked i f his leg was off, and complained of pain, etc.; his pulse gradually improved in strength and decreased in rapidity. While in this improving condition, and before he could be stopped by the attendants, he suddenly raised his head and shoulders quite high and looked down at where his leg had been, then instantly fell back; the eyes rolled up, respiration became irregular, and he was dead inside of three minutes. Death occurred about two hours after the completion of the operation." The specimen of the fractured femur was forwarded to the Army Medical Museum, with the foregoing report, by the operator, Assistant Surgeon E. B. Moseley, and is numbered 6914 of the Surgical Section. Two views of the specimen are shown in the wood-cuts (Figs. 124, 125). 2To the examples of amputations at the hip joint for shot injury cited in Note 1 on page 128, ante, should be added the following: 185. A primary operation performed by Assistant Snrgeon J. M. Stelner, U. S. A. Private Hall, Co. K, 14th U. S. Infantry, was struck, at the battle of Chapultepec, September 12, 1847, by a round shot, just below the trochanter major of the left thigh. The femur was fractured and the soft parts lacerated for some inches. The patient survived only until evening. The case is reported by the operator, Dr. J. M. STELNER, in the Medical Examiner and Record of Medical Science, Philadelphia, 1849, N. S., Vol. V, p. 15.—186. Another primary operation to be added to the examples of exarticulation at the hip, in Note 1, p. 128, ante, is cited by M. CHEXU from a report of Dr. De POTOR (Stat. Mid.-Chir. de la Camp, d'ltalie, en 1859 et I860, Paris, 1869, T. II, p. 693). On June 25th, 1859, an Austrian, wounded at Solferino the night before, was brought to the Cavalry Hospital. The neck of the femur and the cotyloid cavity were comminuted. Coxo-femoral exarticulation was performed by Dr. Ehrmann. The patient survived only two hours.—187. A third primary operation to be added was performed by T>t. W. A. East, of San Antonio, Texas. A negro, aged 25, received, in the latter part of 1864, in Lavaca Connty, Texas, a shot wonnd at the outer and upper margin of the trochanter major. The head of the femur was comminuted. About ten hours after the injury Dr. EA6T exarticulated at the hip by Larrey'b method. He recovered, and was last heard from in the winter of 1865-66, through Dr. DOUGLASS (W. A. EAST, Gunshot Wound—Fracture of the Head of the Os Femoris—Amputation at the Hip Joint—Recovery, in Southern Jour. of Medical Science, 1866, Vol. I, p. 232). It will be noticed that I have omitted from the list of examples of amputations at the hip joint for shot injury in Note 1, p. 128, ante, several cases heretofore referred to by writers on this subject as authenticated instances of this exarticulation. I believe, with Dr. A. LOning (Ueber die Blutung bei der Exarticulation des Oberschenkels und deren Yermeidwng, Zurich, 1877, p. 56), that the three cases ascribed to A. Blandin, of which two are reported to have been successful, and the successful case of PERRET, are apochryphal. Mr. Ph. F. Blandin, who cites the successful cases of amputation at the hip in his article Amputation, in Diet de Mid. et de Chir. Prat, Paris, 1829, T. II, p. 280, does not men- tion these cases, and they are, as far as I have been able to ascertain, first mentioned by Velpeau (Nouv. Elim. de Medecine Op'ratoire, Paris, 1832, T. I, p. 514); but the latter author, who, in the second edition of his Nouv. Elim. de Mid. OpCrat, Paris, 1839, T. II, p. 539, attempts to cite the authorities for his statements, omits to state the sources from which the Blandin and Perret cases are derived. Malgaigne, in the discussions of the National Academy of Medicine at Paris, on August 8, 1848 (Bull, de VAcad. Nat. de Med., Paris, 1847-48, T. XIII, p. 1278), refers to "a very remarkable thesis" on amputations by "ALEXANDRE BLANDIN, aide-major " to LARREY. Id his Reflexions sur plusieurs points de Chirurgie, read to the first class of the Imperial Institute on March 6,1815, and an extract of which is published in Jour, de Mid. de Chir. et de Phar. Mil., Paris, 1815, T. I, p. 132, Larrey states that " Mr. MILLENGEN, Surgeon in Chief of the British Armies in Spain, assured him that he had made, with success, according to his method [of M. Larrey], two amputations" at the hip. I have omitted these cases, as it is probable that Mr. J. G. V. Millingen, who was Chief Surgeon of the British Armies in Spain and Portugal, in 1811 and 1812, had reference to the cases of Brownrigg. It would, to say the least, appear strange that British writers on military surgery, who cite Brownrigg's and Guthrdz's cases of amputation at the hip, should have failed to record the cases ascribed to Millingen, who, as late as 1830, was chief surgeon of the British Armies. M. Velpeau (Nouv. ISlim. de Mid. Opirat, Paris, 1839, T. II, p. 540) refers to a successful exarticulation at the hip by Wedemeyer, and LEGOUEST in his paper De la disarticulation coxo-fimorale au point de vue de la chir. d'armee, in Rec. de Mim. de Mid. de Chir. et de Phar. Mil., Paris, 1855, 2°"" ser., T. XV, p. 224, and Traiti de Chirurgie d'Armie, Paris, 1863, pp. 669, 670, ascribes two fatal cases of amputation at the hip to the same operator. VELPEAU gives as his authority the Bulletin de Ferussac, T. II, p. 165 ; Legouest, the same Bulletin, T. VI, p. 161. In the second volume of the Bulletin des Sciences Midicales, Paris, 1824, "publii sous la direction de M. le Baron de Ferussac," on p. 161, Obs. m, reference has been made to a case of amputation at the hip cited from an ftrticle by Dr. Wicdemeyer, Amputa- FIG. 124.—Shot com- minution of npper por- tion of left femur. Spec. 6914. 164 INJURIES OF THE LOWER EXTREMITIES. [Chap. x. with twenty-eight recoveries, two hundred and twenty-five deaths, and one instance in which the result was not ascertained, giving the slightly modified mortality rate of 88.9 per cent., instead of 89.1, as indicated on page 130, ante. Of these two hundred and fifty-four cases there were eighty-two primary,1 with seventy-five deaths, or 91.4 per cent. fatality; fifty-five intermediary, with fifty-two deaths (94.5 per cent.); forty secondary, with thirty-three deaths (82.5 per cent.); eleven reamputations, with four deaths (36.3 per cent.); and sixty-six cases with sixty-one deaths, and one unknown result (93.8 per cent.) in which the time of the operation was not ascertained. According to these statistics it would seem that intermediary operations offer the least chance of recovery, that the results of primary operations are more favorable; that secondary exarticulations give one recovery in twelve cases, and that of the instances of reamputation one in about three proves successful; and I can, therefore, only reiterate what I have already stated on page 78 of Circular No. 7, that the statistics "tend to show that unless the nature of the injury is such that the ope- ration can be delayed until the secondary period, it is better that it should be done at once,"2 although it would appear that the dire results of amputations at the hip,3 performed for shot injury during the Schleswig-Holstein War of 1864, the Austro-Prussian War of 1866, and the Franco-Prussian War of 1870-71, have had a tendency to raise doubts regarding the expediency of especially the primary exarticulation at the hip.4 tion nahe am Huftgelenke, wegen Osteosteatoma, etc., in Mag. fur die gesammte Heilkunde, B. XIII, Berlin, 1823. The article will be found at page 45 of the Magazin, and it is there stated that the amputation was performed in May, 1821, the width of a hand below the hip joint ("eine Handbreit unter dem Huftgelenke"). The patient, a soldier named Kloppner, recovered. I have vainly searched Baron FERUSSAC's Bulletin for the fatal cases cited by M. Legouest. The case of fatal secondary exarticulation at the hip by Dr. JOHN Wright, of Illinois, in the case of Private J. W. Spradling, Co. A, 33d Illinois, detailed by the operator in The Cincinnati Lancet and Observer, Vol. XI, No. 5, p. 257, May, 1868, and reported also in Circular No. 2, War Department, S. G. O., Washington, 1869, p. 109, and mentioned by LUNING, loc. cit, p. 108, No. 397, I have omitted from the secondary coxo-femoral amputations for shot injury. The records of this Office show that the original shell wound in the right side, received at Black River, May 17, 1863, healed, leaving a large cicatrix; that a bedsore formed on the left hip, and that the left femur became diseased and was exarticulated on February 20, 1867. It is apparent that the original wound had only.a remote connection with the disease for which the operation was performed. Dr. WEIGHT after- wards reported to the Pension Office that "soon after the amputation Spradling was taken with diarrhoea and that dropsy followed, which continued off and on until the date of his death, September 28, 1872." 1 Larrey's successful instance of amputation at the hip in the case of the lieutenant of dragoons wounded at Borodino, September 7, 1812, has been cited by M. Legouest (De la disarticulation coxo-fimorale, in Rec. de Mem. de Mid. de Chir. et de Phar. Mil., 1855, 2""' s6r., T. XV, p. 234, and Traiti de Chir. d'Armie, Paris, 1863, p. 699) as an instance of successful intermediary exarticulation at the hip. This was undoubtedly a primary operation, and I have classed it as such. M. Larrey (Mem. de Chir. Mil. et Camp., Paris, 1817, T. IV, p. 51) details the case and remarks of the oper- ation : " Que j'entrepris, quoique sur le champ de bataille, avec d'autant plus de confiance qu'il la demandait instamment." 2 Professor B. v. LANGENBECK, in his article: Ueber die Schussverletzungen des HUftgelenks, in Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 299 (republished in his Chirurgisehe Beobachtungen aus dem Kriege, Berlin, 1874), remarks: "As heretofore, I am still quite convinced that dis- articulation of the thigh ought not to disappear from military surgery, and that if we do not regard all very severe shot fractures of the hip joint and thigh from the beginning as lost, in all these cases primary exarticulation ought to be performed if possible during the first 12-24 hours. In this connec- tion I can only repeat what I have said in 1868, and what I may again emphasize, that the only two primary exarticulations that I performed in the Schleswig War, 1848, recovered, and that one of the patients operated upon is still alive." I cannot omit here to call attention to the translation of Pro- fessor B. v. Langenbeck's article by Dr. James F. West, F. R. C. S. The translation is published in The Birmingham Medical Review, Vol. V, 1876, pp. 29, 88, and 166. At page 100, Professor Langenbeck is made to say: "The results of the American War, with its great numbers, have been suf- ficient for settlement of the question of disarticulation of the thigh. We must regard it as an operation which, at the least, ought to be excluded from military practice, and one that ought at the most to be thought of in the light of reamputation." From this Prof. LANGENBECK would appear to be in favor of excluding exarticulation at the hip from the field of military surgery. Nothimg could be more erroneous. What Prof. Langenbeck (Archiv fur Klin. Chir., 1874, B. XVI, pp. 298, 299) really says is: " The results of the American War, with its great numbers, have become decisive as regards the value of hip joint exarticulation. It has been designated as an operation which it would be best to exclude from military practice, and which should at the most be thought of in the light of reamputation," and further on he continues with the remark cited in the beginning of this note. 3 The two exarticulations at the hip for shot injury performed during the Schleswig-Holstein campaign of 1864, and the seven operations performed during the Austro-Prussian War of 1866, proved fatal. Of the forty-four cases of amputation at the hip performed for shot injury received during the Franco-Prussian War, 1870-71, cited in note on page 130, ante, the only successful one, as far as I have been able to ascertain, was the case of reamputa- tion at the right hip performed by Professor T. G. Morton, of Philadelphia, on a soldier named Boasso Dominico (not Dominico Ludovess, as first erroneously communicated in note on page 130, ante), whose thigh had been amputated after the battle of Sedan, September 1,1870. , * Holmes (T.) (A Treatise on Surgery, its Principles and Practice, Philadelphia, 1876, p. 344): " The following are, I believe, the main maxims of practice in gunshot injuries of the extremities. . . II (p. 345). In the lower extremity gunshot fractures involving the hip joint or the upper third of the femur are usually fatal, however treated. Primary amputation is so fatal in these cases that it is almost abandoned. Several cases have recovered nnder strictly conservative treatment; a few cases of successful excision are on record; and secondary amputation has been decidedly more successful than primary. The surgeon must use his own discretion in each case, but all surgeens nowadays have a well founded horror of primary amputation at the hip, believing that the operation is almost necessarily fatal, while the injury is not so." BECK (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 852) remarks: "Exarticulation at the hip . . is only to be performed, as a primary operation, in cases of extensive comminution of the bones with laceration of the soft parts, especially of the large vessels, and where amputation high up is not possible. In injuries which involve the femur in its continuity close to the joint, conservative expectant treatment should be employed, and operative interference should only be had in the further course, as it is known that the secondary operation is more readily tolerated. I have not yet seen in the various campaigns at the places of first dressing a case really adapted to primary exarticulation; either expectation was yet admissible, or resection or high amputation could be performed j or the lesions were of such a nature that there was no prospect of a cure. The wounded of the last category I left to their fate as incurable, ligating only the larger vessels." SECT. II. I AMPUTATIONS AT THE HIP JOINT. 165 Generalarzt B. Beck1 proposes "to let secondary exarticulation at the hip be preceded by resection," and considers this procedure as not unworthy of the consideration of his colleagues. During the Franco-Prussian War, 1870-71, he had selected a patient2 for this mode of treatment, and had excised the hip and intended to remove the limb fourteen days later; but he was compelled to leave the patient, who died about a month after the excision. Professor J. Neudorfer,3 in the case of an Austrian soldier, Johann Schranz, during the Italian War of 1859, resected, on November 27, 1859, the head of the femur for shot injury received at Palestro, May 30, 1859, and, on December 1st, removed the limb at the hip. The patient recovered. This seems to be the only case of this kind on record in military surgery. In civil surgery six instances4 may be cited in which the exarticulation at the hip had been preceded by excision at the hip joint. Five of the six cases had a successful issue, giving the favorable result of a mortality of 16.66 per cent. The evidence set forth in the preceding pages in regard to the three plans of treat- ment of gunshot injuries of the hip joint received during the American civil war shows that of the cases of undoubted intracapsular shot fracture of the hip treated by conserva- tion, 98.8 per cent, had a fatal termination; that in sixty-six cases treated by excision5 1 BECK (B.), Chirurgie der Schussverletzungen, Freiburg, 1872, p. 855. * Beck (B.) (loc. cit, p. 854) remarks: "In another case I had performed resection, and intended to disarticulate 14 days later; but I had to leave the patient, who reacted well, and he died of pyaemia afterwards, because my plan was not followed, to wit: to let, at the proper time, when it became evident that recovery could not be achieved in this manner, the resection be followed by exarticulation." The patient he had selected for this manner of operation was Sergeant Major B----, of the 3d French Infantry (see Beck, loc. cit, p. 894, and note on page 91, ante, Case 53), who had survived a shot fracture of the neck and trochanter of the femur at Worth, August 6, 1870. In the latter part of August the head and neck and more than one-third of the shaft of the femur were excised. But Dr. BECK was sent away before the time for the removal of the limb had arrived. Professor Beck continues: "In another case, which, to .my sorrow, I also had to leave before the proper time for the operation, there was an extreme oblique and longitudinal frac- ture extending into the capsule, with considerable infiltration of the soft parts. When I left Dijon I had ordered that, as soon as the swelling would some- what go down, the limb should be amputated high up, and that subsequently the remaining bone should be extirpated, provided acute septicaemia should not supervene. Several days after my departure the latter complication appeared; energetic interference was not attempted, and only the projecting end of bone fragment was resected. The patient died shortly afterwards." 'Neudorfer (J.), Handbuch der Kriegschir., 1872, B. II, Abth. II, S. 1468, and notes on pp. 90 (CASE 13) and 129 (Case 120), ante. * Heyfelder (J. F.) (Ueber Resectionen und Amputationen, Breslau und Bonn, 1854, p. 155) resected the hip joint on January 11,1848, in a tailor, Carl Eckstein, aged 20, for caries of the joint, and exarticulated the limb on May 20,1851. The patient died in two hours.—2. T. Carr Jackson (Trans- actions of the Path. Society of London, London, 1872, Vol. XXIII, p. 191), for disease of the hip joint, excised, in 1871, the head of the femur in a young man aged 19, and, in 1872, successfully removed the limb.—3. Dr. Teale (Medical Times and Gazette, July 26, 1872, Vol. LT, p. 93) excised, on Decem- ber 28, 1871, the head of the femur for hip disease, in a boy aged 16, and, on July 18,1872, the limb was successfully removed at the hip.—4. In a girl, aged 7, suffering from hip disease, Mr. Hancock performed excision of the head of the femur in the early part of 1871, and, on November 2, 1872, ampu- tation at the hip was performed by Dr. Richard Barwell. The girl recovered (London Lancet, April 5, 1873, Vol. I, p. 105).—5. Dr. Rushton Parker (London Lancet, 1875, Vol. II, p. 699), on a boy, aged 6, with inflammation of the hip joint, excised the head of the femur on July 31, 1874, and amputated at the hip, November 21, 1874. The boy survived.—6. Professor Spence (London Lancet, 1875, Vol. II, p. 549), ThomasH----, aged 20; hip disease; excision at the hip October 29, 1864. Amputation April 13, 1875, by Prof. Spence ; the patient recovered. 'Besides the works referred to on pages 89 to 126, ante, by Abbott, Alcock, Ashhurst, CHENU, Calhoun, Culbertson, Deiningeu, Du- breuil, Eve, H. Fischer, g. Fischer, Guthrie, Grellois, Gross, Heixe, Hodges, Kade, Langenbeck, Lohmeyer, Longmoke, Lossen, Mat- thew, MACLEOD, MUNN, MAUN0URI, MURSICK, NEUDORFER, OTIS, Ol'l'ENHEIM, OPPENHEIMER, PAILLARD, READ, ROBERTSON, SEUTEC, SCHWARTZ, D. P. Smith, Stromeyek, K. TEXTOR, and C Wagner, the following may be consulted on excision at the hip joint: Adams (Z. B.), Excisions of Joints for Traumatic Cause, in Boston Med. and Surg. Jour., 1867, Vol. 76, p. 229; BALLARUE (D. P.), Beitrage zur Statistik der HUftgelenks Resec- tion, Leipzig, 1868. BECK (B.), Zur Statistik der Amputationen und Resectionen, in LANGENBECK's Arch, fur Klin, diir., B. V, pp. 245,256, and Kriegs- chir. Erfahrungen wahrend des Feldzuges, 1866, in Suddeutschland, pp. 266, 351, and Die Schusswunden, Heidelberg, 1850, p. 332. BErard (A.), Risection de Varticulation coxofimorale, in Diet, de Mid. en 30, 1837, T. XV, p. 82. BILLROTH (Th.), Ueber die Resectionen, in Deutsche Klinik, B. V, p. 220. Blandin. (P. F.), Article Resection, in Diet de Mid. et de Chir. prat, Paris, 1835, T. XIV, p. 266. BONlNO (E.), De la risection de la tete du femur, in Annul, de la Chir. Franf et Etrang., Paris, 1844, T. X, p. 385. Bowman (Wm.), Resection of the Hip Joint, in Medical Times and Gazette, London, 1860, Vol. II, p. 210. BltYK (A.), Beitrage zu den Resectionen, in Langenbeck's Archiv fiir Klin. Chir., 1873, B. XV, p. 273. Champion (L.), Traiti de la Risection, etc., These, Paris, 1815. Cheever (D. W.), Two successful cases of Excision of the Head of the Femur, in Boston Med. and Surg. Jour., Vol. LXXV1I, p. 281. C00TE (H.), Remarks on the operation of Resection of the Head of the Femur, in British Medical Journal January 2,1858, p. 2. Diucks (C. J. M.), Diss, inaug. de resectione capitis femoris, Wirceb, 1846. Decaisne, Des moyens d'iviter les amputations et les resections osseuses, Bruxelles, 1855. Eulenbueg (Albert), Beitrage zur Statistik und Wurdigung der Hilftgelenkresection, in Archiv fiir Klin. Chir., 1866, B. VII, p. 701. Focic (C), Bemerkungen und Erfahrungen ueber die Resection im Hiiftgelenk, in Archiv fiir Klin. Chir., Berlin, 1861, B. I, p. 172. Gerdy (J. V.), De la risection des extremitis articulaires des os, Paris, 1839, p. 157. GOOD (R. R.), De la risection de Varticulation coxofim- orale pour carie, Paris, 1869. GOOD (R. R.), Comparative Mortality after resection of the hip joint in France and in England, in Med. limes and Gaz., London, 1869, Vol. I, p. 355. GOSSELIN, Bisection de la hanche, in Bull, de VAcad. de Med., Oct. 15,1861. GURLT, Resection im Hiiftgelenk, in Lan- genbeck's ^rc7it», 1867, B. VIII, p. 903. HANCOCK (II.), On Excision of the Hip Joint, Lancet, 1857, Vol. II, p. 84. Heyfelder (J. F.), Ueber Resectionen und Amputationen, Breslau, 1854, p. 154. Heyfelder (O.), Lehrbuch der Resectionen, Wien, 1863. HUETER (C), Die Resectionen, in Langenbeck's Archiv, B. VIII, p. 94. Jacobsen (L.), Om Resektion of Hofteleddet i Tilfalde af caries og suppuration, Kbhvn, 1874. JAEGER (M.), Operatio resectionis conspectu chronologico adumbrata, Erlangen, 1832. JAEGER, Article Decapitatio, in J. N. Rust's Handbuch der Chirurgie, 1831, B. V, p. 626. Kinloch (R. A.), A case of Excision of the Hip Joint for morbus coxarius, with Remarks upon the Propriety of such an Operation, and a Summary Account of the recorded Cases up to the present Time, in Charleston Med. Jour, and Rev., 1857, Vol. XII, p. 307. Kretschmar (G.A.), Ueber Huftgelenkresection, Jena, 1867. Larghi (B.),'Bisection de tete et du col du femur, in Gaz. Mid. de Paris, 1857, T. XII, p. 8. Le Fort (Leon), De la risection de la hanche dans les cas de coxalgie et de plaies par armes d feu, in Mim. de VAcad. Imp. de Mid., 1861, T. XXV, p. 445. Leisrink (H.), 166 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the fatality was 90.9 per cent., and that in sixty-six cases treated by exarticulation1 it was 83.3 per cent.; but from these results it should not be concluded that operative interference was always indicated, and that amputation was preferable to excision. On page 121, of Circular No. 2, I have already pointed out that the question as to the most eligible treat- ment of shot injuries of the hip joint is not susceptible of a purely arithmetical solution, and that the variety of the conditions under which the patients are placed, the diversity in the extent of their injuries, and the inevitable imperfection of all surgical records forbid any such rigorous comparison. Not less than nine2 of the sixty-six cases of excision at the hip were complicated with such lesions of the pelvic walls and viscera as made any Zur Statistik der Hiiftgelenk Resection, in Archiv fiir Klin. Chir., Berlin, 1870, B. XII, p. 134. LEPOLD (F.), Ueber die Resection des Huftgelenkes, Inaug. Diss., Wiirzburg, 1834. LOCKE (A.), Beitrage zur Lehre von den Resectionen, in Archiv fiir Klin. Chir., Berlin, 1862, B. Ill, p. 291. LYON (Irving W.), Excision of the Knee and Hip Joints, in Am. Jour. Med. Sci., 1865, N. S., Vol. XLIX, p. 49. MOHN8 (J.), Beitrage zu den Resectionen der Knochen, Jena, 1866. Pagenstecher, Zur Resection des Huftgelenkes, in Langenbeck's Archiv, 1862, B. II, pp. 312-315. Percy et Laurent, Article Resection, in Dictionnaire des Sciences Midicales, Paris, 1820, T. XLVII, p. 553. RrED (F.), Die Resectionen der Knochen, Nuremberg, 1860, p. 385. Roux (P. J.), De la resection ou de retrenchment deportions d'os malades, Paris, 1862, p. 49. Saunders (D. D.), Excision or Resection of the Bones and Joints of the Lower Extremity, in Memphis Med. Monthly, April, 1866, Vol. I, p. 77. Sayre (L. A.), Exsection of the Head of tlie Femur and Removal of the Upper Rim of the Acetabulum for morbus coxarius, with perfect recovery, in New York Jour, of Med., 1855, Vol. XIV, p. 70. SCHEDE (M.), De resectione articula.tionis coxx, Halis Saxonum, 1866. SCHILLBACH (L.), Beitrage zu den Resectionen der Knochen, Jena, 1861. SEDILLOT (C), De la resection coxo-fimorale, in Gaz. Mid. de Paris, 1866, T. XXI, p. 691. SENFTLEBEN (H.), Beobachtungen und Bemerkungen ueber die Indikationen, den Heilungsprocess und die Nachbehandlung der Resectionen grcesserer Gelenke, in Langenbeck's Archiv fiir Klin. Chir., Berlin, 1862, B. Ill, p. 112. SlKBERT (L.), Statistik der Resectionen, etc., Jena, 1868. STARK (W.), Beitrage zu der Statistik und den Endresultaten der Gelenkresectionen, in Bei- trage zur Operativen Chirurgie, von Dr. V. CZERNY, Stuttgart, 1878, p. 183. Stevens (G. F.), On Excisions in Cases of Gunshot Wounds, in Trans. Med. Society of New York, 1866, p. 132. SWINBURNE (J.), Exsection of the Hip Joint, and Conservative Surgery, in Med. and Surg. Reporter, 1861, Vol. VII, p. 198, and Vol. IX, 1863, p. 377. Syme (James), Treatise on the Excision of Diseased Joints, Edinburgh, 1831, p. 125. Szymanowsky (J.), Ueber die Resection des Huftgelenkes, in LANGENBECK'S Archiv, 1865, B. VI, p. 787. TALLICHET, Dissert, de resecto femore ex articulo, Halae, 18C8. TEXTOR (CAJETAN), Ueber die Wiedererzeuguvg der Knochen nach Resectionen, Wiirzburg, 1842. ToSTrvrNT (A. L. M.), Sur lesrisections coxo- fimorales dans les cas de coxalgie, Tlifise, Paris, 1868. Wagner (A.), Ueber den Heilungsprocess nach Resection und Extirpation der Knochen, Berlin, 1853, p. 14. WAGNER, Article Decapitatio ossium, in Encyclopadisches Wbrterbuch der Med. Wissenschaften, von W. H. BUSCH, Berlin, 1833, B. IX, p. 188. Winne (C. K.), Statistical Inquiry as to the Expediency of Excision of the Head of the Femur, in Am. Jour. Med. Sci., 1861, Vol. XLII, p. 26. 1 The literature of amputation at the hip joint is copious. In the foot-notes on pages 127 to 159 I have referred to the various sources of information on this subject by Alcock, Ashhurst, Averill, Baudens, Beck, Bertherand, Chexu, Costello, W. S. Cox, Deininger, Guthrie, J. F. Hey- felder, D. J. Larrey, h. Larrey, Langenbeck, Legouest, MacCormac, Macleod, Matthew, Morton, Neudorfer, Otis, J. Roux, P. J. ROUX, STROMKYER, C. TEXTOR, J. THOMSON, and others. To these may be added: Armand (A.), Histoire midico-chirurgicale de la guerre de Crimie d'apris les travaux des medecins militaires, Paris, 1858, p. 19. Barbet, in Prix de VAcad. roy. de Chir., Paris, 1819, T. IV, p. 45, relates the operation by La CROIX, and defends the exarticulation at the hip. BECK (B.), Zur Auslosung des Femur im Hiiftgelenk, in Archiv fiir Klin. Chir., Berlin, 1879, B. XXIII, p. 654. CARPIO (L. H.), Una observacion de desarticulaciqn coxo-femoral, in Gaceta Midica de Mexico, 1865, T. I, p. 346. DENECHAUD, Observation sur Vextirpation de la cuisse, in Rec. de Mim. de Mid., Paris, 1820, T. VIII, p. 190. DOLIGNON, Amputation de la cuisse dans Varticle, in Jour, de Mid. Chir., Paris, 1786, T. LXVI, p. 69. FLAJANI (GlUSEPPO), Osservazione pratiche sopra Vamputazione digli articoli, etc., Roma, 1791. GOURAUD (V. O.), Demonstrations desprincipales opirations de Chir., Tours, 1815, p. 85. GURLT (E.), Amputationen, Exarticulationen, Resectionen, in Jahresbericht ueber die Leistungen und Forlschrilte in der Gesammten Medicin, Berlin, 1868, B. II, Abth. 2, S. 411. HAWERKAMP (A.), Ein Fall von Exarticulatio femoris. Inaug. Diss., Berlin, 1878. HEDENUS (A. G.), Commentatio chirurgica de femore in cavitate cotyloidea ampu- tando, Lipsiae, 1823. HEXOT, Mem. sur la disarticulation coxo-fimorale, in Mem. de VAcad. Nat. de Mid., Paris, 1852, T. XVI, p. 213. HEYFELDER (O.), Exarticulation des HUftgelenks. Bemerkungen zu NEUDORFEK'S Kriegschirurgie, in Deutsche Klinik, 1873, B. XXV, p. 167. JENTY (C. N.) Methodo de hacer la amputacion del muslo por su articulacion con el hueso innominado, etc., Madrid, 1766. JUBIOT, Observations sur Vamputation dans Varticle coxo-femoral, Montpellier, 1840. KERR (WILLIAM), An account of the Operation of Amputating the Thigh at the Upper Exarticulation, in Medical and Philosophical Commentaries, London, 1779, Vol. VI, p. 337. KERST, Heelkundige Mengelingen, Utrecht, 1836, p. 186. KEEMER (R. S. W. L.), Ueber Exarticulation im Hiiftgelenk, Marburg, 1857. KROENER (C. A.), De exarticulatione femoris et cruris qusedam, Stuttgartiae, 1837. L'ALUETTE (PET.), An femur in cavitate cotylcedea aliquando amputandum, Paris, 1748, in HALLER's Disput. chirurg., Lausannae, 1756, T. V, p. 265. Land (A. L.), Over the exarticulatio ossis femoris, in BOERHAVE, Tijdschrift, Amsterdam, 1841, Jaarg. Ill, p. 265. LlSFRANC (J.), Mimoire sur un nouveau procidi operatoire pour pratiquer Vamputation dans I'articulation coxo-femorale, in Archives Ginirales de Med., 1823, T. II, p. 161. Metz (H.), Ueber die Losing des Oberschenkels aus dem Hiiftgelenke, Wiirzburg, 1841. MOKAND (S. F.), Sur Vamputation de la cuisse dans son articulation avec Vos de la hanche, in his Opuscules de Chir., Paris, 1768, T. I, p. 176. Mulder, Overzigt von de voornamste gevallen, welke in het heelen vroekundig akademisch Ziekenhuis to Groningen, etc., zijn waargenommen, door MULDER, Amsterdam, 1814, p. 144. NEVERMANN, Die Exarticulation des Oberschenkels in geschichtlicher Hinsicht dargestellt, in Journal der Chirurgie und Augenheilkundexon C. F. v. Gkaefe und Ph. Walther, Berlin, 1839, p. 95. Porta (L.), Delia disarticolazionedel Cotile, Milano, 1860. PUTHOD, Sur Vamputation de la cuisse dans son articulation, in MOKAND's Opusc. de Chir., Paris, 1768, T. I, p. 199. RaUSCH (J. J.), Ueber die Amputation grosser Glieder nach Schusswunden, Leipzig, 1807. ROBUCHON (L.), Observations et statis- tiques pour servir & Vhistoire des amputations, Paris, 1872, p. 61. Sabatter (R. B.), De la Medecine Opiratoire, Paris, 1824, T. IV, p. 542. Sauvan, Diss.de extirpatione femoris, Vilnae, 1823. SCHNEIDER (AUGUST), Ueber die Exarticulation des Oberschenkels im Hiiftgelenk, Inaug. Diss., Landau, 1848. SMITH (STEPHEN), Statistics of the Operation of Amputation at the Hip Joint, in New York Jour, of Med., 1852, Vol. IX, p. 184. SOLGER, Ueber die Amputation im Huftgelenke, Wiirzburg, 1854. Stemmermann (W.), Ueber die Exarticulation des Oberschenkels, Jena, 1866. UNCER, An femur aliquando et quo methodo e cavitate cotyloidea sit amputandum? Halae, 1793. Yolckees (C), Beitragezur Statistik der Amputationen und Resectionen, in Archiv fiir Klinische Cliirurgie, Berlin, 1863, B. IV, p. 574. Voelkner (LOUIS), Ueber die Exarticulation des Obersclienkels im Hiiftgelenk, Halle, 1868. VOLHEii, Sur Vamputation de la cuisse dans son articulation, in Morand's Opuscules de Chir., Paris, 1768, T. I, p. 189. Volkmann (Richard), Ueber die Anwendung des Esmarch's schen blutersparenden Verfahrens by Exarticulationen des Huftgelenkes, in Centralblatt fiir Chirurgie, May 2, 1874, No. 5, p. 65. WACHTER (G. H.), Diss, chir.dearticulis extirpandis, etc., Groningae, 1810. WAGNER, Ueber die Exarticulation des Oberschenkels aus dem Huftgelenke, in Magazin fiir die Gesammte Heilkunde, von J. N. Rust, Berlin, 1823, B. XV, p. 261. Winninghoff, De exarticulatione femoris, Gryphiae, 1843. Zanders, Ablbsung der Glieder in den Gelenken, Dtlsseldorf, 1831. 2See Case 209, p. 93, of Pt. C. Beard, 12th Miss.; Case 227, p. 96, of Pt. C. Morrison, 185th N. Y.; Case 235, p. 98, of Capt. T. R. Robeson, 2d Mass.; Case 236, p. 98, of au unknown private soldier of the First Corps; Case 238, p. 99, of an unknown soldier; Case 247, p. 105, of Pt. C. E. Mars- ton, 1st Mass.; Case 257, p. 109, of Corp'l H. C. Sennett, 122d N. V.; Case 259, p. 110, of Lieut. D. N. Patterson, 46th Va.; and Case 269, p. 118, of Pt. A. Toney, 16th N. C SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 167 operative interference useless; among the sixty-six coxo-femoral amputations probably all successful cases have been recorded, while some fatal cases may remain unpublished; and in the three hundred and four cases treated by conservation, the correctness of the diagnosis may be questioned in many instances. The character of the injury must determine the choice of treatment; but the general rules regarding shot wounds of the hip joint1 laid down in Circular 2 are uncontroverted: that "expectant treatment is to be condemned in all cases in which the diagnosis of direct injury to the articulation2 can be clearly established;" that "primary excisions of the head or upper extremity of the femur should be performed in all uncomplicated cases of shot fracture of the head or neck;" that "intermediary excisions are indicated in similar cases where the diagnosis is not made out till late;" that "secondary excisions are demanded by caries of the head of the femur or secondary involvement of the joint;" that amputation should be performed: "1. When the thigh is torn off", or the upper extremity of the femur comminuted with great laceration of the soft parts, in such prox- imity to the trunk that amputation in the continuity is impracticable. 2. When a fracture of the head, neck, or trochanters of the femur is complicated with a wound of the femoral vessels. 3. When a gunshot fracture involving the hip joint is complicated by a severe compound fracture of the limb lower down, or by a wound of the knee joint." 'A number of authors especially on excision or exarticulation at the hip have already been cited, but many additional facts in regard to injuries of the hip joint may be derived from the works of: Ballingall (Sir GEORGE), Outlines of Military Surgery, London, 5th ed., 1855, p. 397. Barwell (Richard), A Treatise on Diseases of the Joints, London, 1865. Bell (Joseph), A Manual of the Operations of Surgery, London, 1866, p. 111. Blenkiks (G. E.), Article Gunshot Wounds, in Cooper's Dictionary of Practical Surgery, London, 8th ed., 1861, Vol. I, p. 838. Brltton (J. H.), Consolidated Statement of Gunshot Wounds, Circular No. 9, S. G. O., Washington, July 1,1863, p. 12. Briot (M.), Histoire de VEtat et des Progres de la Chirurgie Militaire en France pendant les Guerres de la Revolution, Besancon, 1817, p. 177. Chaussdjr, Pricis d'expiriences sur Vamputation des extrtmitls articulaires des os longs, in Mem. de la Soc. Med. d'Emulation, an VIH, T. in, p. 399. ChelIUS (J. M.), System of Surgery, translated from the German by J. F. SOUTH, Philadelphia, 1847, Vol. III. CHISOLM (J. JULIAN), A Manual of Military Surgery for the use of Surgeons in the Confederate States Army, 3d ed., Columbia, S. C, 1864. CORTESE, Guida teorica pratica del medico militare in campana Torino, 1862, Vol. I, p. 209, and Vol. II, p. 308. COULSON (W.), On Disease of the Hip Joint, London, 1867. EMMERT (CARL), Lehrbuch der Chirurgie, Stuttgart, 1867, B. rV. ERICHSEN (JOHN), The Science and Art of Surgery, London, 1872. FERGUSSON (Sir WM.), A System of Practical Surgery, London, 4th ed., 1867; and Clinical Lecture on Hip Disease, in London Lancet, 1849, Vol. I, p. 359. FISCHER (H.), Verletzungen durch Kriegswaffen, in v. PlTHA and Bn.LROTH'8 Handbuch, 1865, B. I, Abth. II, S. 483, 496. Gant (F. J.), The Science and Practice of Surgery, London, 1878. Gherini (A.), Vade Mecum per le Ferite d'Arma da Fuoco, Milano, 1866; aud Relazione chirurgica dell 'Ospedale militare provisorio di S. Filippo, in Annali Universali di Medicina, Milano, 1860, Vol. CLXXIII, p. 450. Holmes (T.), Report on Surgery, in Biennial Retrospect of Medicine and Surgery for 1867, pp. 225, 326; A Trea- tise on Surgery, its Principles and Practice, Philadelphia, 1876. HUETER (C.), Klinik der Gelenk Krankheiten mit Einschluss der Ortopadie, Leipzig, 1870-71, p. 596. KOCH (W.), Notizen uber Schussverletzungen, iu LANGENBECK'S Archio fiir Klin. Chir., 1872, B. XHI, p. 510. MALGAIGNE (J. T.), Manuel de Medecine Operatoire, 6ept. ed., Paris, 1861, p. 250. METZLER, Verhandlungen der Mil. arztl. Gesellschaft zu Orleans, 1870-71, in Mil. Arztl. Zeitschrift, 1872, B. I, p. 63. MILLER (JAMES), A System of Surgery, Edinburgh, 1864. MONTFALCON, Memoire sur VEtat Actuel de Chirurgie, Paris, 1816, p. 103. MOTT (V.), VELPEAU'S New Elements of Operative Surgery, New York, 1847, Vol. II, pp. 779, 845. OCHWADT (A.), Kriegschirurgische Erfahrungen, Berlin, 1865, S. 53. OLLD2R (L.), Traiti expirimental et clinique de la Regeniralion des Os, Paris, 1867, p. 165. OTIS (G. A.), Observa- tions on some Recent Contributions to the Statistics of Excisions and Amputations at the Hip for Injury, in Am. Jour. Med. Sci., 1868, Vol. LVI, p. 128. PAGET and STANLEY, Catalogue of the Pathological Specimens contained in the Museum of the Royal College of Surgeons of England, London, 1847, Vol. II, p. 230. PANCOAST (J.), A Treatise on Operative Surgery, Philadelphia, 1846, 2d ed., p. 129. PASSAVANT (G.), Bemerkungen aus dem Gebiete der Kriegschirurgie, in Berliner Klinisclie Wochenschrift, Berlin, 3871, Jahrg. VIII, p. 115. PAUL (H. J.), Die Conservative Chirurgie der Glieder, Breslau, 1859, S. 38, 193. Pirrie (WDLLIAM), The Principles and Practice of Surgery, London, 1860. PlTHA (F.), Krankheiten der Extremitaten, Erlangen, 1868, S. 203. M. Rochoux, Communications sur les playes d'armes dfeufaites a VAcademic, in Bull, de VAcad. deMid., 1848, T. XIV, p. 127. ROSSI (F.), Elimens de Medecine Operatoire, Turin, 1806, T. II, p. 224. SANTESSON (Charles), Om Hqftleden och Ledbrosken uti anatomiskt, pathologiskt, och chirurgiskt lianseende, jemte en Kritish Ofversigt ofver nagra. bland Inflammationlarens vigtigaste, Stockholm, 1849, and Dublin Journal of Medical Sciences, 1851, Vol. XI, p. 432. SEDILLOT (C), Traiti de Midicine Opiratoire, Paris, 1865, T. I, p. 515, and De Vividement sous periosti des Os, Paris, 1867, p. 165, and Compte Rendu de VAcad. des Sciences, seance du 15 Oct., 1866. Simon (Gustav), Mittheilungtn aus der Chir- urgischen Klinik, Prag, 1868, S. 98. SKEY (F. C), Operative Surgery, Philadelphia, 1851, p. 374. SMITH (G. IC), The Insertion of the Capsular Lig- ament of the Hip Joint and its relation to intra-capsular fractures of the Neck of the Femur, in Med. and Surg. Reporter, Vol. VII, p. 244, et seq. Smith (Stephen), Handbook of Surgical Operations, New York, 3d ed., 1862, p. 221. Solly (S.), Clinical Lectures on Injuries and Diseases of the Joints, delivered at St. Thomas's Hospital, in London Lancet, 1852, Vol. II, pp. 121,144. Syme (James), The Principles of Surgery, edited by Dr. Maclean, Philadelphia, 1866, p. 694. Szymanowski (Julius), Additamenta ad Ossium Resectionem, Dorpati Livonorum, 1856. Textor (Cajetan), Grundziige zur Lehr der Chirurgischen Operalionen, Wiirzburg, 1835. S. 310, 348. Velpeau (A. L. M.), Nouveau Elements de Medecine Opiratoire, Paris, 1833, T. I, p. 582. Vermandois, Sur le traitement de quelques maladies,chirurgicales de Varticulation du femur avec Vos innomini, in Journal de Medicine, Chirurgie, Pharmacie, etc., 1786, T. LXVI, p. 51. Vogel (A. F.), Observationes quasdam chirurgicas defendit, Kiliae, 1771. Warren (Edward), An Epitome of Practical Surgery, Richmond, 1863. White (C.), Cases in Surgery, in Philosophical Transactions, Vol. LIX for the year 1769, London, 1770, p. 45. WILLIAMSON (G.), Military Surgery, London, 1863. Woodhull (A. A.), Catalogue, of the Surgical Section of the U. S. Army Med. Museum, Washington, 1866, p. 234. Zang (C. B.), Darstellung blutiger heilkiinstlerischer Operationen, Wien, 1821, Theil 4, pp. 287, 300. 2Professor H. H. SMITH (Princ. and Pract. of Surgery, 1863, Vol. I, p. 526) pronounces "compound fractures involving the hip joint are exceed- ingly dangerous. If left alone death usually results." . . " Some few cases of recovery have resulted after injuries in this locality, but in them the fracturo may not have entered the joint, and these few exceptions to the general fatal result certainly offers no encouragement for their repetition. LOf- fler (F.), Grundsdtze und Regeln fiir die Behandlung der Schusswunden im Kriege, Berlin, 1859, Erste Abtheilung, p. 66), speaking of shot injuries of the hip joint, remarks: "The conservative treatment of this injury, according to the experience hitherto acquired, gives no prospect of saving life. Even if pyaemia does no* supervene, death ensues sooner or later from exhaustion following endless suppuration." 168 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The preceding portions of this Section were already in print when Professor E. Gurlt's1 excellent and elaborate work on resections of joints was received. On page 1261 he enumerates one hundred and thirty-seven cases of excision2 at the hip, of which the results were ascertained in one hundred and thirty-six instances, with sixteen recoveries, a mor- tality rate of 88.23 per cent.; and on page 1319 he states that, considering the severity of wounds of the hip joint and the great mortality that has hitherto followed them, this result must be regarded as favorable. 'Gurlt (E.), Die Gelenk-Reseclionen nach Schussverletzungen. Ihre Geschichle, Statistik, End-Resultate, Berlin, 1879, pp. 1333. Professor Gurlt cites the following additional cases of excision at the hip for shot injury not hitherto published: Dr. Bryk (Gurlt, loc. cit, p. 63) excised the head of the right femur in the case of Nagy Lajos, age 27, wounded at Buda, May 21, 1849; excision May 24; death June 2, 1849. Dr. Abel (Gurlt, loc. cit, p. 317), Pt. J. Poulsen, 20tb Danish Infantry; DUppel, April 18, 1864; neck of right femur; intermediary excision May 4; death May 4, 1864. Dr. IlAHN (Gurlt, loc. cit, p. 317), P. Rasmussen, 5th Danish Infantry, age 25; Alsen, June 29, 1864, in left trochanters; resection July 4, death July 6, 1864. BURCHARDT (GURLT, loc. cit, p. 483), F. Haberditz, Austrian Infantry, age42; Koeniggratz, July 3, 1866, through left hip; resection August 6; fatal. BUSCH (GURLT, loc. cit, p. 395), N. Breidt, 6th Rhenish Infantry, Koeniggratz, July 3, 1866, right hip; excision July 20; death July 21, 1866. BUSCH (GURLT, loc. cit, p. 483), F. Harlitschek, Austrian Infantry, age 74; Koeniggratz, July 3, 1866; right trochanter major; excision August 9; death August 13, 1866; pyaemia. KLOPSCH (GURLT, loc. cit, p. 484), N. N. Oest, Austrian Infantry, Koeniggratz, July 3, 1866, left hip; excision July 7; death July 9, 1866. C. REYHER (GURLT, loc. cit, p. 1159), W. Jowanowitsch, age 45; Russo-Turkish War, August 24, 1876; excision Sept. 8; death Sept. 12, 1876. On p. 1154 Dr. Gurlt tabulates 2 additional cases of excision at the hip during the Russo-Turkish War, 1876-1878, but gives no details. *The operation of excision at the hip was first proposed in 1769, by CHARLES WHITE, F. R. S., Surgeon to the Manchester Infirmary, at the con- clusion of an account of a successful excision of the head of the humerus performed by him April 14, 1768. The paper is recorded in the Philosophical Transactions tor 1769, Vol. LIX, p. 45, and is republished the foUowing year in CHARLES WHITE'S Cases in Surgery, 1770, p. 76. Prior to this a surgeon had, in 1730, according to J. D. SCHLICHTTNG (Observationis varise medico-chirurgicse, in Philosophical Transactions, London, 1744, Vol. XLU, for the years 1742 and 1743, p. 274), extracted the carious head of the femur in a girl, aged 14, by dilating a fistulous opening over the hip. The girl recovered in six weeks. Similar instances in which the diseased head of the femur was spontaneously eliminated or was extracted were reported by A. F. VOGEL (Observationes quasdam chirurgicas defendit, Kiliae, 1771), in 1771; T. KlRKLAND (Thoughts on Amputations, etc., London, 1780), in 1780; HOFMANN (Vom Schaarbocke, Munster, 1782), in 1782 ; OHLE (Schmidt's Jahrbucher, 1834, B. II, S. 116), in 1815 or 1816; SCHMALZ (cited by HEDENUS (A. G.), Commentatio chirurgica de femore in cavitate cotyloidea amputando, Lipsias, 1823, p. 65), in 1817. In the meantime experiments had been made in excising the joints of animals by VERMANDOIS (Jour, de mid. chir. et pJiar., Janv,-Mar., 1786, T. LXVI, p. 73), in 1785; G. L. KOELER (Experimenta circa regencrationem ossium, Gottingen, 1786, experiments 14, 15,16, pp. 84-98), in 1786; CHAUSSD3R (Magazin Encycloped., 56me annee, T. VI, No. 24), in 1801; F. ROSSI (Elim. de Mid. Opirat, Turin, 1806, T. II, p. 224), in 1806; and G. H. WACHTER (Dissertatio Chirurgica de Articulis Extirpandis, Groningen, 1810, pp. 91-94), in 1810; but the first excision of the head of the femur upon the living human subject was performed by Mr. ANTHONY WHITE, of Westminster Hospital, London, in April, 1821. The date of this operation has been variously stated. O. HEYFELDER (Lehrbuch der Resec- tionen, Wien, 1863, p. 78) gives the date as 1815, and, on page 88, as 1818, and refers to an article by LIONEL J. BEALE, in the London Medical Gazette, 1832, Vol. IX, p. 853; but Mr. BEALE gives no date for the operation. In COOPER'S Dictionary of Practical Surgery, 1872, Vol. II, p. 151, it Is also stated that the operation was performed in 1818, and Mr. FERGUSSON speaks of the operation as done in 1818 in his paper in the Medico-Chirurgical Transactions, 1845, Vol. X, p. 578, and in his System of Practical Surgery, 1870, 5th ed., p. 407. FOCK (C), (Bemerkungen und Erfahrungen uber die Resection im Hiiftgelenk, in Archiv far Klinische Chirurgie, Berlin, 1861, B. I, S. 172) and GOOD (R. R.), (De la resection de Varticulation coxo-femoralepour carie, Paris, 1869) correctly state that the operation was performed in 1821. HODGES (R. M.). (The Excision of Joints, Boston, 1861, p. 91) and CULBERTSON (H.), (Excision of the Larger Joints of the Extremities; Prize Essay, in Transactions of the American Medical Association, 1876, Supplement to Vol. XXVII, p. 40) give 1822, and LEPOLD (F.), (Ueber die Resection des Huftgelenkes, Inaugural Th6sis, Wiirzburg, 1834, p. 15) 1824, as the year of the operation. However, in Mr. FERGUSSON'S Lecture on Hip Disease, at King's College Hospital, reported in the Lancet, April 7,1849, at page 361, is quoted Mr. ANTHONY White's own account of the operation on the boy John West, a twin: " In April, 1821, we met, and the boy being placed on a table, I proceeded," etc., etc., with the operation. This would seem to be conclusive as to the date of the operation. Mr. ANTHONY WHITE'S account states further on in the same page (361) that this boy, five years after the operation, became phthisical, and died of diseased lungs in the Westminster Hospital. The pathological specimen was presented by Mr. A. WHITE to the Museum of the Royal College of Surgeons, and numbered 941, and is described at page 230 of Vol. II, 1847, of the quarto catalogue. The patient was a boy, 14 years old, who had suffered from hip disease following a fall received at the age of nine. The head and neck of the femur were excised. The wound healed quickly and quite a useful joint was obtained. The second excision at the hip was performed in 1828, by Mr. HEWSON, of Dublin. The date of HEWSON's operation is given as 1823 by BONLNO (E.), (De la risection de la tite du femur, in Annates de la Chirurgie Franfaise et Etrangere, 1844, T. X, p. 391); HODGES (R. M.), (loc. cit, p. 91); Sayre (L. A.), (Exsection of the Head of the Femur and Removal of the Upper Rim of the Acetabulum for Morbus Coxarius, with perfect recovery, in the New York Journal of Medicine, 1855, Vol. XIV, p. 81); LE FORT (LEON), (La resection de la hanche, etc., Paris, 1860), and others; but the correct date.of the operation seems to be 1828, as given by LEPOLD (F.), (Ueber die Rejection des Huftgelenkes, Inaugural thesis, Wiirzburg, 1834); OPPENHEIM (F. W.), (Die Extirpation des Schenkelkopfes aus der Gelenkhohle, in Zeitschrift fiir die gesammte Medicin, 1836, B.I, S. 137); FOCK (C), (Bemerkungen und Erfahrungen i'tber die Resection im Hiiftgelenk, in Archiv fiir Klinische Chirurgie, Berlin, 1861, B. I, S. 172); Otis (G. A.) (loc. cit, p. 10); GOOD (R. R.), (De la rizection de Varticulation coxo-fimorale pour carie, Paris, 1869). nARGRAVE (WILLIAM), (A System of Operative Surgery, Dublin, 1831, p. 514) states that the operation was performed "a short time since." The third Fig. 126. —Head, excision of the head of the femur, and the first example of the performance of the operation for shot injury, was done by Dr. neek,andpart of shaft OPPENHEIM of Hamburg, in 1829. Professor LONGMORE, in his article on Gunshot Wounds of the Lower Extremity, in the second RIE"sIUsii<'ressful in- editwn of A System of Surgery, of Mr. T. HOLMES, New York, 1870, Vol. II, p. 230, remarks: " It is a curious fact, in a historical termediary amputa- point of view, that Sir CHARLES BELL proposed excision of the upper fragments in 1818 f 1815 ?] at Brussels, in the case of Francois tion at the hip, in the ^e Gay, who had been wounded nineteen days before at Waterloo, and on whom Mr. GUTHUIE successfully practised amputation gueX° Spec. 2929 in at the niP Joint the next day instead. The reasons for his advice are preserved in some manuscript notes made about the time of Army Med. Museum the occurrence, in a diary presented to the Army Medical School by Lady Bell, his widow. The chief points are the following: at Netley. | After 4 jjy proposai jg to extract the head of the bone, and do no more. Mr. Guthrie's proposal is to amputate the thigh at the hip '■' joint. If the bone be taken out, there is a great cavity and suppuration certainly; but by this means the shock and violence will be saved. I fear the shock of so great an injury, especially as now the wound cannot be cut off (alluding to its extent and sloughing condition), and its injury must be superadded to that of the incisions. The man will readily allow of my proposal, but not of G.'s. However, next day he said he would consent. In the meantime I was forced home by business,' etc. The separated head dud neck of the femur in Guthrie's case is preserved in the Museum of the Artny Medical Department at Netley, and, both from its intrinsic interest and because it almost exactly corresponds with the fragment in the Crimean case in which resection was successfully performed, a drawing of it is appended." A reduced copy of this drawing is reproduced in the wood-cut (FlG. 126). 8E0T.III.J INJURIES OF THE SHAFT OF THE FEMUR. 169 Section III. INJURIES OF THE SHAFT OF THE FEMUR. In this Section will be considered only injuries of the shaft of the femur unattended by primary injury of the hip or knee joints, and inflicted by weapons of war. Simple and compound fractures produced by other causes are reserved for consideration in Chapter XII of this volume. No sword or bayonet injuries of the femur are recorded on the registers of this Office, and it is,, therefore, only necessary to consider the shot injuries of and the operations performed in the continuity of the femur. There are recorded 6,738 shot inju- ries of the femur. Of these, 3,620 were treated by the expectant conservative mode; 11 were followed by excision at the hip; 29 by exarticulation of the hip joint; 1 by excision in the shaft and subsequent disarticulation at the hip; 6 by excision in the shaft and sub- sequent amputation of the thigh; 168 by excision in the shaft; 2 by amputation of the thigh and subsequent exarticulation at the hip,1 and 2,901 by amputation of the thigh. The total number of amputations of the thigh to be recorded in this Section will be 6,238, the discrepancies in numbers being due to the many examples of amputation through the thigh in which the operation was performed for shot lesions of the knee joint or leg. The shot injuries of the femur were accompanied by flesh wounds of the upper or lower extrem- ities, of the back, and of the chest. Some were attended by fracture of the pelvic bones, of the bones of the leg, and of the upper extremities; and, in a few instances, by pene- trating wounds of the chest or abdomen. These instances will be alluded to in the various subdivisions of this Section. At page 666 of the Second Surgical Volume the number of shot injuries of the shaft of the humerus is stated as 8,245, and, on page 697 of the same volume, the number of amputations in the arm recorded is 5,456. Comparing these figures with the injuries and amputations of the thigh, it will be seen that while the shot fractures of the humerus exceed the shot injuries of the shaft of the femur by 1,407, the amputations in the thigh are in excess of the amputations in the humerus by 782. The latter fact is, perhaps, to be attrib- uted to the perilous nature of shot injuries of the knee joint. Of the 6,738 cases of shot injuries of the femur, 162 were shot contusions and 6,576 were shot fractures. SHOT CONTUSIONS OF THE SHAFT OF THE FEMUR.—In treating of shot injuries of the shaft of the humerus in the Second Surgical Volume, at pages 667 and 817, only twenty-two instances of contusion of the humerus could be cited. The examples of shot contusion of the femur are not rare, one hundred and sixty-two instances of this class being found on the registers of this Office: fifty in the upper, thirty in the middle, and forty-two in the lower third; while in forty instances the precise seat of the injury was not stated. Amputation in the thigh became necessary in nine instances, with seven 1 The cases of excisions and exarticulations at the hip for shot injuries of the shaft of the femur have already been considered in the preceding section of this Chapter. For the 11 instances followed by excision at the hip see Cases 206, 208, 216, 220, 229, 233, 239, 243, 261, 263, 266, ante. The 29 cases followed by exarticulation at the hip are: Cases 272, 275, 277, 278, 280, 284, 285, 286, 289, 290, 291, 293, 294, 295, 297, 299, 303, 305, 308, 309, 311, 314, 319, 320, 321, 323, 324, 325, 328, ante. In Case 298 excision in the shaft was followed by amputation at the hip, and in Cases 329 and 337 exarticu- lation at the hip joint had been preceded by amputation of the thigh. SURG. Ill—22 170 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. fatal results, a mortality of 77.7 per cent., while of the remaining one hundred and fifty- three cases treated without operative interference, thirty-five, or 22.8 per cent., proved fatal: Table XIX. Numerical Statement of One Hundred and Sixty-two Cases of Shot Contusion of the Shaft of the Femur. • POINT OF CONTUSION. a a a o a < Treated by CONSERVATION. Treated by Amputation of the Thigh. 0> a O o c ■6 5 •2 3 o a w ft ; °5 1 IL 100. 50. 83.3 Upper Third of Femur................... . 50 30 42 40 49 28 36 40 33 23 32 30 16 5 4 10 32.6 17.8 11.1 25.0 l 2 6 1 1 1 1 5 Middle Third of Femur........... Lower Third of Femur................. Part of Femur not specified................... Total.......................... 162 153 118 35 22.8 9 2 7 77.7 It is probable that in many cases in which the periosteum or the external layer of the femur was only slightly bruised the injury to the bone remained unnoticed, and that the wound, treated as a simple flesh wound, healed without complication; but generally, after a few weeks' suppuration, the surface of the bone became roughened and sometimes slight exfoliation followed: Case 338.— Private H. H. Coombs, Co. D, 6th Maine, aged 22 years, was wounded at Fredericksburg, May 3, 1863, and entered Douglas Hospital, Washington, five days afterwards. Assistant Surgeon W. Thomson, TJ. S. A., reported: "He was struck by a bullet on the outer side of the right thigh. The missile was extracted from below the crest of the ilium on May 14th, the operation demanding a very extensive incision, which was kept freely open to permit the discharge to escape. The femur had been denuded of its periosteum for several inches, the ball evidently having been deflected upward after impinging upon that bone. This man recovered, and was transferred to Lovell Hospital, Portsmouth Grove, July 3d." The patient sub- sequently entered Cony Hospital, Augusta, Maine, whence be was returned to duty October 24, 1864. On June 28, 1865, he was mustered out of service, and subsequently he was admitted on the Pension Roll. The Bangor Examining Board, October 4, 1873, certified to the injury, and adds: "The scar is three inches long, and deep, permitting the finger to pass through the fascia and feel roughened bone. Slight lameness results." Examiner C. Fuller, of Lincoln, Maine, reported, October 20, 1877: " The cicatrix is now so depressed that the little finger can be laid in it, and the bone below is a little hollowed, the parts around being very tender on pressure. A disagreeable pricking sensation is also produced there on percussion at the bottom of the heel." The pensioner was paid December 4, 1878. The extracted missile, a conical ball, was contributed to the Museum by Assistant Surgeon W. Thomson, and constitutes Specimen 4277 of the Surgical Section. In two cases of shot contusions of the middle third, and in ten of the lower third of the femur, anchylosis or stiffening of the knee joint resulted. One example1 will be cited: Case 339.—Private W. A. Currier, Co. B, 22d Massachusetts, aged 33 years, was wounded at Fredericksburg, December 13, 1862, and admitted into Harewood Hospital, Washington, four days afterwards. Surgeon T. Antisell, TJ. S. V., recorded the following history: "A minie" ball entered the outer side of the right thigh at the middle third, striking against the femur. The missile was extracted on December 18th, being found to have moulded itself to the cylindrical form of the shaft of the bone. The patient's general health was good. Simple dressings were applied to the wound. On February 11, 1863, the bone was found to be re-covered with periosteum excepting a very small portion, and the wound was allowed to close. On February 20th it had healed; but, on this day, erysipelas set in, spreading rapidly, and invading the whole leg and the body to the umbilicus. The leg swelled enormously and vesicated over a large portion of its surface, the cellular tissues being distended with serum. Punctures being made, several quarts of serum were discharged. By April 22d the patient had recovered, thouo-h he was still debilitated, and there was yet some enlargement. He was discharged from service May 9,1863, by reason of an oedematous and stiffened condition of the wounded leg." Examiner A. L. Monroe, of Medway, Massachusetts, certified, January 12, 1864: "The knee cannot be flexed perfectly; the leg is swollen, aud the fascia of the thigh seems to have been destroyed by the ery- sipelatous inflammation. The limb will improve, but it will never be perfectly restored." The Boston Examining Board, in 1873. certified to "varicose condition of the veins of the thigh aud leg, phlebitis, etc." Pensioner was paid March 4, 1879. 'Partial or complete anchylosis of the knee joint following shot contusion of the femur were noted also in the cases of: Pt. D. Brown, E, 8th Mary- land. Pt. S. Clark, B, 14th Infantry, anchylosis of knee, necrosis, exfoliation. Pt. H. B. Baker, A, 16th Maine; in this instance there was almost complete anchylosis at the hip and knee. Corporal J. C. Noteman, D, 8th Wisconsin, partial anchylosis and paralysis. Pt. R. B. Pierce, F, 7th Wisconsin. Pt. H. Schocker, B, 12th Ohio Cavalry. Lieutenant A. D. Detweiler, C, 116th Pennsylvania. Pt. J. D. Page, K, 57th Illinois. Pt. E. J. Russell, G, 10th Regiment Veteran Reserves, partial anchylosis of knee joint, and false anchylosis of ankle joint. Pt. F. De Brayinan, E. 53d Pennsylvania. Pt. J. W. Bowlinger, M, 4th Cavalry. sect, nil SHOT CONTUSIONS OP THE SHAFT OF THE FEMUR. 171 FlG. 127.—Shot con- tusion of left femur. Spec. 4341. H Of the grave complications after shot contusions of the shaft of the femur, pysemia was the most frequent; it supervened in eighteen instances, of which sixteen proved fatal. There were thirteen cases in which serious secondary haemorrhage followed. Two of the patients recovered, eleven died. Three cases of recovery from gangrene, and three fatal cases were reported: Case 340.—Private J. White, Co. A, 4th New Jersey, aged 19 years, was wounded before Peters- burg, April 2, 1865, and admitted to the field hospital of the 1st division, Sixth Corps, where Surgeon E. Sharpe, 15th New Jersey, recorded: "Shot wound of left thigh." On the following day he was conveyed to the Depot Hospital at City Point, and one week afterwards he was transferred to Washington. Surgeon R. B. Bontecou, U. S. V., who removed the missile from the patient's limb, made the following report: "He was admitted to Harewood Hospital April 12th with a wound of the upper third of the thigh, the ball enter- ing posteriorly, passing upward and inward, impinging against the femur and denuding it of a small portion of its periosteum, and lodging beneath the vastus externus muscle. On April 17th, the ball was extracted by incision, the patient being under the influence of chloroform. The condition of the injured parts and the constitutional state of the patient at the time' of the operation were poor. He was suffering from diarrhoea and his progress was unfavorable. On April 19th, pyaemie symptoms were developed. The treatment consisted of alteratives, and was supporting throughout. The patient gradually sank, and died April 27, 1865." The upper third of the injured femur was contributed to the Museum by Surgeon Bontecou, and is represented in the adjacent wood-cut (Fig. 127). In the following fatal instance of shot contusion of the shaft of the femur, gangrenous osteomyelitis1 was found at the autopsy: Case 341.—Private J. Kagrice, Co. F, 198th Pennsylvania, aged 30 years, was wounded during the engagement at White Oak Road, March 31,1865. Surgeon W. R. DeWitt, U. S. V., recorded his admission to the field hospital of the 1st division, Fifth Corps, with "shot wound of left thigh," and his transfer to City Point ou the following day. Several days afterwards the wounded man was transferred to Douglas Hospital, Wash- ington, whence Assistant Surgeon W. F. Norris, U. S. A., contributed the specimen (Cat. Surg. Sect., 1866, p. 258, Spec. 4-201), with the following history: "The injury was a severe gunshot contusion of the left femur at its middle third. The patient was in good health and spirits at the time of his admission and doing well. The wound was carefully examined, but the ball could not be traced. On April 23d, a large abscess was opened on the anterior aspect of the thigh near the trochanter. On the 29th, another similar incision was required in order to give free exit to pus. The patient, however, continued pretty well until May 5th, when he had a chill. This recurred on May 7th and 8th, and on the 9th, 12th, 13th, and 14th, he had two chills a day. The thigh became painful, the discharge thin and fetid. On May 16th, the patient became delirious, had another chill, and his tongue became swollen and inflamed. He died on the following day. At the autopsy no pleurisy or effusion was found in either thoracic cavity. The lungs, liver, spleen, kidneys, and brain were carefully examined for pyaemie abscesses, but appeared healthy. On examining the femur it was found that the ball had struck it at its middle third, contused the bone without fracturing, and, being deflected from its course, had lodged in the hollow above the acetabulum. The hip joint was healthy and uninjured. A longitudinal section was made of the femur, which exhibited well marked gangrenous osteomyelitis, the medulla being of a dirty greenish color, dry, pulverulent, and excessively fetid. The interspaces between the cancelli contained a dark greenish liquid, a quantity of which escaped in sawing the bone, and was also extremely offensive. The bone where the missile had struck had become necrosed and nearly separated, and around this partial exfoliation a ring of new bone had formed. A portion of the injured femur is illustrated in the adjacent wood-cut (FlG. 128). Besides the specimens referred to in the preceding two cases the Army Medical Museum possesses nine representations of shot contusions of the shaft of the femur,2 and several missiles flattened by impact with the bone.3 'Dr. J. A. Lidell in his excellent paper on Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. Med. Sci., 1865, Vol. L, p. 17, gives the following as the principal pathological effects of contusions of bone: 1. Ecchymosis of the osseous tissue; 2. Ecehymosis of the medullary tissue; 3. Osteomyelitis of a simple character; 4. Necrotic osteitis; 5. Suppurative osteomyelitis; and 6. Gangrenous osteomyelitis. 2Specimen 291 (Cat Surg. Sect. A. M. M., 1866, p. 259): The upper third of the right femur, necrosed one inch below the trochanter minor; the adjacent bone is honeycombed by suppuration. Spec. 759 (Cat, p. 334), showing exfoliation and some periosteal thickening in the lowest third of the right femur. Spec. 1671 (Cat, p. 259): Section of right femur, showing an exfoliation about to separate, and some necrosed action. Spec. 2675 (Cat, p. 259): Contusion at the inner surface of the middle third of the right femur; the bone is necrosed and greatly roughened by suppuration. Spec. 3106 (Cat., p. 258): Portion of shaft of middle third of left femur contused by a ball, which split and escaped in two pieces; the bone is necrosed where struck by the ball; an abscess was found in the medullary canal corresponding with this spot. Spec. 3873 (Cat, p. 258): A section of the upper third of the left femur contused by shot; there is a slight degree of caries with widespread periosteal disturbance. Spec. 6716: Part of the left femur slightly contused. The specimen is sawn longitudiually, exhibiting diseased action of the bone. Spec. 2437 (Cat., p. 283): The lowest third of the left femur amputated for contusion above the inner condyle, where it is locally carious. Spec. 1985 (Cat, p. 258), see Case 34, p. 21, ante. 8 Specimen 4277 (Cat. Surg. Sect. A.M. M., 1866, p. 609) has been alluded to in Case 340. Spec. 2726 (Cat, p. 598): A spherical ball, with a small concave impression caused by contact with the shaft of the femur, in the case of J. C---, Co. I, 1st Ohio Artillery. Spec. 3009 (Cat., p. 604): A conoidal riflo ball from which a smooth slice has been removed on one side; case of T. McG---, 1st Vermont Cavalry. FlG. 128.—Shot contusion of left femur. .Spec.4201. 172 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Ligations after Shot Contusions of the Femur.—At page 47 were tabulated, it will be remembered, one hundred and twenty-seven cases of ligation of the femoral artery for shot flesh wounds of the thigh, with ninety-one deaths, a mortality rate of 71.7 per cent. To this series of operations must be added seven instances of ligations of the femoral following shot contusions of the femur, the patients perishing in every instance: Cases 342-348.—Private G. Coleman, Co. F, 94th New York, aged 19 years; wounded August 29, 1862; slight injury of upper third of femur. December, 1862, ligation of femoral artery on account of secondary haemorrhage; pyaemia. Died December 3, 1862.—Sergeant G----, 16th Illinois; mini6 ball passed through left thigh about three and a half inches above the knee joint, grazing the femur; admitted into tlie hospital of the 2d division, Fourteenth Corps. Surgeon E. Batwell,' 14th Michigan, reported that on the eleventh day considerable haemorrhage occurred, eight or ten ounces of blood being lost. The tourniquet was loosely applied. The bleeding recurred on the twelfth and thirteenth days, when Dr. Batwell cut down and tied the main vessel in the middle stage of its course. He seemed comfortable for about thirty-six hours; but notwithstanding all the efforts used to keep up the temperature of the leg and to nourish and support his system, he gradually sank into a comatose condition, and died on the eighteenth day after the reception of the injury.—Private A. Kitzing, Co. H, 57th New York, aged 40 years; wounded at Fredericksburg, December 13,1862, a musket ball passing through the left popliteal space. December 20th, violent haemorrhage from inner orifice of wound. Surgeon J. P. Prince,2 36th Massachusetts, immediately placed a ligature on the femoral at the 'angle formed by the sartorius and adductor magnus muscles, which entirely controlled the haemorrhage. The bleeding recurred and continued to increase, notwithstanding the use of styptics and pressure, and, on December 23d, the left thigh was amputated at the upper part of the lower third. Pysemia developed, and the patient died January 12,1863. The specimen of the injured knee was forwarded to the Army Medical Museum by the operator, Dr. Prince, and is numbered 535 of the Surgical Section. The femur has been grazed above the condyle and the popliteal artery cut across by a bullet (Cat. Surg. Sect., A. M. M., 1866, p. 457).—Private J. Roberts, Co. A, 9th West Virginia, aged 31 years; wounded at Winchester, July 20, 1864; shot wound of left thigh, denuding upper third of femur of its periosteum; missile lodged, and was extracted July 27th; haemorrhage set in on July 29th, and Surgeon J. B. Lewis, U. S. V., ligated the femoral artery. Typhoid symptoms supervened, and the patient died August 24, 1864.—Private J. Scott, Co. D, 69th New York, aged 30 years; wounded at Petersburg, July 24, 1864; ball entered upper part of left thigh, striking the femur and denuding it of its periosteum for two inches. August 4th, haemorrhage to the extent of one pint; limb bandaged from distal extremity and wound plugged with lint saturated with per- sulphate of iron. Bleeding recurred on the next day, and Acting Assistant Surgeon H. M. Dean ligated the femoral artery in Scarpa's space, about three inches below Poupart's ligament. The case progressed favorably until August 20th, when he had a slight chill followed by profuse perspiration. He died August 21, 1864, of pyaemia. The pathological specimens in the case, consisting of the femoral artery, the contused portion of the shaft of the femur, and the femoral vein, were forwarded to the Army Medical Museum, and are numbered 3105, 3106, and 3118, respectively, of the Surgical Se< ;ion. They were contributed by the operator, Dr. Dean.—Sergeant S. Van Wie, Co. B, 62d Ohio, aged 25 years, was admitted into the hospital at Beverly, New Jersey, August 21, 1864, with a shot wound of the left thigh, injuring the bone, received at Deep Bottom, August 16, 1864. Parts in sloughing condition. September 28th, secondary haemorrhage to extent of eight ounces. Acting Assistant Surgeon J. C. Morton ligated the femoral artery. Patient died September 29, 1864, from exhaustion.—Private A. Young, Co. F, 1st Mis- souri Cavalry, was wounded at Cape Girardeau, April 26, 1863/ He was admitted into the post hospital at Cape Girardeau, and Surgeon H. A. Martin, U. S. V., reported that a minie' ball entered the lower third of left thigh, struck the femur without frac- turing it, and lodged in the perineum. The ball was removed, in a flattened state, May 8th. Profuse haemorrhage occurred on May 11th. The femoral artery was ligated above and below the seat of iujury on May 17th. The haemorrhage did not recur, but the patient sank, and died May 20, 1863. One fatal instance of ligation of the profunda for secondary haemorrhage following shot contusion of the shaft of the femur is found recorded on the registers of the Office : Case 349.—Corporal James Sturgis, Co. G, 85th Pennsylvania, received at Deep Bottom, Virginia, August 16, 1864, a shot wound of the left thigh, the missile injuring the femur. He was admitted into the hospital at Beverly, New Jersey, August 21st. The parts began to slough; haemorrhage to the amount of sixteen ounces occurred, and, on November 1st, the profunda was ligated in the continuity by Acting Assistant Surgeon J. C. Morton. Haemorrhage recurred from the point of ligation, and death ensued November 6, 1864. Adding to this the six cases of ligation of the profunda for haemorrhage following shot flesh wounds of the thigh, recorded on page 49, ante, we have seven instances of this operation with five deaths, in shot injuries of the thigh without fracture of the femur. Amputations consequent on Shot Contusions of the Shaft of the Femur.—In nine instances of shot contusions of the shaft of the femur amputation of the thigh was per- formed. Four were intermediary, five secondary operations; the former proved fatal; of 1 Batwell (E.), Notes of Army Practice—Ligation of the Femoral Artery for Secondary Hemorrhage, in Med. and Surg. Rep., 1865, Vol. XII, p. 254, and Lidell (J. A.), United States Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 186. *PEL\CE (J. P.) (Surgical Cases—Wound in the Popliteal Space—Secondary Hsemorrhage—Amputation, in Boston Med. and Surg. Jour., 1863, Vol. LXVIII. p. 70) gives a detailed account of the case. SECT. III.] SHOT CONTUSIONS OF THE SHAFT OF THE FEMUR. 173 l'.i mi Fig. 129.—Shot contusion of shaft of left femur. Spec. 863. the latter, two recovered. The seat of contusion was in the upper third in one instance, in the middle in two, and in the lower in six instances; while four amputations, with one recovery, were practised in the upper third; one, fatal in the middle third; and four, with one successful issue, in the lower third. The cases will be briefly detailed: Cases 350-358.—Private H. F. Rugg, Co. H, 2d New York Heavy Artillery; wounded at Cold Harbor, June 3, 1864; a minie" ball passed through the middle third of the right thigh, injuring the bone and causing necrosis. Circular amputation of the thigh at the upper third was successfully performed at Blairsville, Pennsylvania, on January 24, 1866, by Drs. St. Clair and T. M. Laney. The pensioner was paid in 1878.—Lieutenant W. D. Templin, Co. D, 32d Iowa, aged 26 years; wounded at Bayou de Glaze, Louisiana, May 18, 1864; missile entered two inches above knee internally and posteriorly and passed downward and outward, slightly grazing the femur. On July 22d, Surgeon E. Powell, 72d Illinois, amputated the left thigh at the lower third. The patient recovered and was discharged March 30, 1865, with a sound stump.—Private Ii. L. Donald, Co. B, 27th North Carolina, wounded at Antietam, September 17, 1862, through the middle of the left thigh, and admitted to the hospital at Ches- ter, Pennsylvania, October 2d. Necrosis and hectic supervening, and death being imminent, amputation at the junction of the middle and upper thirds of the thigh was performed by Dr. J. Ashhurst, jr.,1 by circular incision, November 6, 1862. The patient, with great difficulty, rallied from the shock of the operation; but subsequently sank suddenly, and died seven hours afterwards. Dr. Ashhurst contributed the specimen o'f the injured femur to the Army Medical Museum. It is numbered 863 of the Surgical Section, and consists of "five inches of the shaft of the left femur, showing local necrosis after contusion by a conoidal ball in the upper third. A moderate deposit of callus has occurred adjacent to the seat of injury. The specimen is an interesting illustration of serious injury without complete fracture." (FlG. 129.) (Cat. Surg. Sect., A. M. M., 1866, p. '288.)—Private B. A. Elmore, Co. B, 6th Michigan Cavalry, aged 18 years, received, near Old Church, Virginia, May 28, 1864, a shot wound of the left knee joint. "A conical ball entered the joint from the front, and passing backward and upward, impinged against the inferior epiphysis of the femur, glanced, and passing upward, lodged high among the muscles of the thigh, deep. Knee and thigh considerably Bwelled. Track of bullet emphysematous, filled with thin, dirty looking, offensive pus. The emphysema and suppuration extended as high up as the junction of the middle and superior thirds of the thigh. June 5th, thigh amputated high up in the upper third by the double flap method. The bullet dropped out while cutting the posterior flap. There was but trifling loss of blood during the operation, and the patient reacted promptly. June 6th, feverish and restless, pulse rapid. June 10th, pyaemia developed. Died June 17, 1864." The operator, Surgeon John A. Lidell, U. S. V., contributed the portion of the femur removed, together with the history of the case, to the Army Medical Museum. The specimen is numbered 2437 of the Surgical Section, and consists of the " lowest third of the left femur. It is contused above the inner condyle, where it is locally carious. The specimen is sawn open longitudinally, exhibiting diseased action to the center of the bone." (Cat. Surg. Sect., A. M. M., 1866, p. 283.)—Captain G. Grecheneck, Co. A, 72d New York, received, at Williamsburg, Virginia, May 4, 1862, a gunshot wound of the right popliteal space. Surgeon R. B. Bontecou reported that a minie ball transfixed the thigh between the hamstrings and condyles of the femur, grooving that bone slightly at the attachments of the gastrocnemius muscles and injuring the artery and nerve. The foot became gangrenous, and amputation in the lower third of the thigh, v, by circular operation, was done. Gangrene attacked the stump on the 15th, and he died May 16, 1862.— 1 Private Lafayette Hogan, Co. G, 14th Tennessee, was admitted into Lincoln Hospital, Washington, Decern- ( ber 23, 1862, with a gunshot wound of the right knee. Amputation at the lower third of the thigh was per- formed on the day of admission. The patient died January 1, 1863, from haemorrhage. Assistant Surgeon G. M. McGill, U. S. A., forwarded the pathological preparation (Specimen 1891, Section I) to the Army Medical Museum. It consists of "a ligamentous preparation of the bones of the right knee, except the patella, amputated in the lowest fourth, apparently for a contusion just above and behind the outer condyle." (Cat. Surg Sect., A. M. M., 1866, p. 338.)—Private J. L. Hudson, Co. 1,59th Illinois, aged 18 years, received, at Nashville, December 15, 1864, a shot wound of the right thigh just above the knee joint, the ball grazing the femur and denuding it of its periosteum. The wound progressed favorably until December 30th, when the structures of the joint became implicated. An abscess made its appearance just below the patella. The patient became much debilitated. On January 25,1865, Acting Assistant Surgeon F. B. Nossinger ampu- tated the right thigh at the middle third by the circular method. Great prostration followed. Irritative fever ensued, and the patient died February 1,1865.—The case of Private A. Kitzing, Co. H, 57th New York; wounded at Fredericksburg, December 13, 1862, whose thigh was amputated on account of recurrent bleed- ing after ligation of the femoral artery, has been alluded to on page 172, ante, Case 344.—Private M. Shay, Co. B, 61st New York, aged 20 years, received, at Antietam, September 17, 1862, a shot wound of the anterior aspect of the right thigh; the femur was bruised; ball lodged. October 20th, ball found lying against the femur, at upper third, and removed. The discharge became profuse and offensive and the patient failed daily. November 15th, flap amputation of right thigh at the upper third by Surgeon H. S. Hewit, U. S. V. The patient died November 24, 1862. Dr. Hewit contributed the specimen shown in the wood-cut (Fig. 130). There is "a large portion of necrosed bone nearly detached, with very little callus." He also forwarded the preparation of the right femoral artery to the Museum. It is numbered 853 of the Surgical Section. 1 Dr. Ashhukst, in a published account of this case (Surgical Cases, Illustrating some Practical Points, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 345), states that: " The wound, which appeared to be simply a flesh wound, did well, and was nearly healed, when, from some then unknown cause the track reopened, and by the probe and little finger dead bone was detected about the middle of the left femur." f^k& FlG. 130.—Necrosis of the right femur. Spec. 1096. 174 INJURIES OF THE LOWER EXTREMITIES. 1CHAP. x The left thigh was amputated in three, the right in six instances; of the latter, two recovered. The modes of operation selected were: The circular amputation five times, the flap operation twice; in two instances the manner of operation was not indicated. Seven amputations were practised on Union, two on Confederate soldiers. Comparing the results of cases of shot contusion in the shaft of the femur with the results of analogous cases in the shaft of the humerus, we find that of one hundred and sixty-two contusions in the femur forty-two, or 25.9 per cent., proved fatal, while of twenty- two patients with contusion of the humerus only four, or 18.1 per cent., succumbed, and that while in not a single instance of contusion of the humerus operative interference was deemed necessary, nine amputations of the thigh were practised for complications following shot contusions of the femur.1 The serious consequences ascribed to injuries of this nature by Dr. Lidell have been alluded to on page 171, ante. Professor L. Stromeyer, Dr. H. Gibbons, Professor A. Lticke, M. Jobert (de Lamballe), Dr. C. Heine, and Dr. J. Arnold2 have noted the complications accompanying shot contusions of the femur; but only a few writers on military surgery have cited instances of such injuries.3 SHOT FRACTURES OF THE SHAFT OF THE FEMUR.—Shot fractures of the shaft of the femur were considered as almost universally fatal by the older writers on military surgery, and amputation of the thigh was regarded by many as the only means of saving the patient's life.4 But the many successful attempts at preservation of the limb in cases of shot fracture of the femur within the last twenty years leave no doubt as to the value of the conservative treatment of such fractures.5 Six thousand five hundred and 1 Schwartz (H.) (Beitrage zur Lehre von den Schusswunden, Schlesswig, 1854, p. 147), in a very interesting chapter, carefully notes the frequently 6erious consequences following shot contusions of the femur, and remarks that: "Notwithstanding the most careful treatment, the attempts at conserva- tion not rarely necessitate consecutive amputation as a last means of saving the life of the patient." A. J. Jobekt (de Lamballe) (Plaies d'armes & feu, Paris, 1833, p. 255) refers to contusions with denudation of the femur, and cites a case in which he amputated the thigh unsuccessfully. 2STROMEYER (L.), Ueber die bei Schusswunden vorkommenden Knochen verletzungen, Freiburg, 1870, p. 3. GIBBONS (H.), Contused Wounds of Bone, in the Pacific Med. and Surg. Jour, and Press, San Francisco, 1866, Vol. VIII, p. 284. LUCKE (A.) (Kriegschirurgische Aphorismen aus dem Zweiten Schleswig Holsteinschen Kriege im Jahre 1864, Berlin, 1865, p. 67) remarks that contusions of the femur by musket balls are very severe injuries, frequently misapprehended, and followed by ostitis, osteomyelitis, and even osteophlebitis, and cites three cases of which one proved fatal. JOBERT (A. J. de LAMBALLE), Contusion des os, in L' Union Medicate, Paris, 1865, T. XXV, pp. 263, 337. HEINE (C), Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 164, etc. ARNOLD (J.) (Anatomische Beitrage zu der Lehre von den Schusswunden, Heidelberg, 1873) describes the path- ological changes following contusions of the femur as observed in his autopsies of six cases of this injury. 3 LARREY (H.) (Hist. Chir. du siege de la Citadelle d'Anvers, Paris, 1833, p. 202, etc.) cites three successful instances of shot contusion of the femur, and adds: " Les resultats consecutifs de cette blessure, constats a l'hopital, ont 6t6 l'adherence de la principale cicatrice, l'atrophie et l'ankylose du genou." CHENU (J. C.) (Rapport, etc., pendant la Campagne d'Orient en 1854, 1855, 1856, Paris, 1865, p. 374) tabulates 146 cases of shot contusion of the femur with 22 deaths, a mortality of 15.0 per cent. MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army, etc., London, 1858, p. 355) tabulates 43 cases of shot contusions and partial fractures of the lower extremities, but it is impossible to eliminate from his tabulations the number of shot contusions of the femur. CHENU (J. C.) (Stat. Med. Chir. de la Camp, d'ltalie en 1859 et 1860, Paris, 1869, p. 715) groups 103 shot contusions of the femur with 13 deaths. SCHINZINGEK (A.) (Das Reserve-Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, 1873, p. 69) observed 10 cases of shot contusion of the femur. One of the cases proved fatal from pyaemia, another succumbed to anaemia following arterial bleeding. SCHULLER (Max.) (Kriegschirurgische Skizzen aus dem Deutsch-Franzbsischen Kriege, 1870-71, Hannover, 1871, p. 66) cites 2 cases of shot contusion of the femur, one in the middle, the other in the lower third; both recovered. BECK (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 677) reports 15 cases of shot con- tusions of the femur in the Bavarian (XII) Corps during the Franco-Prussian War, 1870-71, of which 3, or 20 per cent., proved fatal, and remarks: " That the shot contusions, although entirely innocuous looking in the beginning, are apt, in the progress of the case, to prove dangerous, and to convince the surgeon how careful he must be not to overlook the sneaking initiatory processes of inflammation of the periosteum and the interior of the bone." 4 Ravaton (Chirurgie d'Armie ou Traiti des Plaies d'armes ctfeu, etc., Paris, 1768, p. 323): Les coups de feu qui fracassent l'os de la cuisse dans son entier, sont si facheux que j'ai vu perir tous ceux qui l'ont eu fracture." Schmucker (J. L.) (Vermischte Chir. Schriften, Berlin und Stettin, 1785, p. 42): "If the fracture is in the lower part of the bone, the danger is relatively a great deal less, as the muscles are not very powerful here, and, in such a fracture, amputation should not be at once performed, but all other means should first be tried; and very frequently I have happily cured fractures of this kind; but if the femur is fractured and splintered in the middle or above the middle, I never wait for complications, but perform the operation before they occur, and several times I have cured patients where the operation has been done soon." BAUDENS (L.) (Clinique des plaies d'armes dtfeu, Paris, 1836, p. 460) remarks: "Toute fracture de cet os [femur] par coup de feu exige l'amputation immediate," and, on page 461, adds, that of 25 cases with fracture of the femur treated by expectation, only two recovered with deformed limbs, incapable of fulfilling their functions. MACLEOD (Notes on the Surgery of the War in the Crimea, London, 1858, p. 296) advises primary amputation in fractures of the middle and lower thirds of the femur; but where the fracture is in the upper third of the bone he concludes " that slight as the chance of saving life is in any case, it is still our part to attempt con- solidation in preference to amputation." Larrey (D. J.) (Mem. de Chir. Mil. et Camp., Paris, 1812, T. II, p. 503) refers to a case of simple shot fracture of the femur without notable lesion of the soft parts for which amputation had been performed on the 40th day, and remarks: " Je ne d6sapprouve point cette operation; car mon experience m'a appris que toutes les plaies avec fracture de la cuisse sont tres-facheuses, et exigent toutes en general Vamputa- tion qu'on ne peat pas toujours pratiquer dans les premiers momens, et c'est un des cas oil elle peut etre faite consecutivement." •HEINE (C.) (Die Schussverletzungen der unteren Extremitaten, Berlin, 1866, p. 234) declares: " To-day it must be accepted as an axiom that in all cases of shot fractures of the femur by small projectiles, uncomplicated by injury of the femoral artery or by opening of the knee joint, the conserva- tive treatment should by all means be tried." SECT. Ill] PARTIAL SHOT FRACTURES OF THE SHAFT OF THE FEMUR. 175 seventy-six shot fractures of the diaphysis of the femur were found on the returns, furnish- ing examples of every variety of partial fracture, of comminution of bone, of longitudinal Assuring, of oblique or transverse fracture, and of detachment of large fragments. Of these six thousand five hundred and seventy-six shot fractures of the femur three thousand four hundred and sixty-seven were treated by conservation, and three thousand one hun- dred and nine were followed by excision either in the shaft of the femur or at the hip joint, or by amputation of the thigh or exarticulation at the hip. Table XX. Numerical Statement of Sixty-fire Hundred and Seventy-six Shot Fractures of the Shaft of the Femur unattended by Primary Injury of the Hip or Knee Joint. Fract. in Upper Third. Fkact. in Middle Third. Fract. in Lower Third. Point of Fracture unspecifd2d. TREATMENT. •6 S 1 PS 669 4 2 25 24 ■a 5 572 7 23 47 1 1 66 £■6 •8.5 •si-•is o > o o a> W 500 ■6 s 342 1.1 13 "3* •a 2 > a 8 « ■a 5 £•6 .2 "3 i •6 > o SI a> M 145 •6 5 538 ■8.5 1,254 11 25 73 1 1 92 13 1 2 46.0 63.6 92.0 65.2 100.0 100.0 73.3 855 40.6 620 375 232 13 38.2 738 55 78.7 Amputation at the Hip Joint. Excision in Shaft of Femur. Excision in Shaft of Femur 3 56 1 17 2 38 1 66.6 69.1 1 16 4 1 10 2 100.0 71.4 23 3 16 4 84.2 Excision in Shaft of Femur 3 355 2 1 156 1 676 2 195 1 580 4 66.6 55.5 50.0 2 1,120 1 606 1 496 18 50.0 45.0 Amputation in Thigh...... Amputation in Thigh and 1,325 461 801 63 63.4 724 717 1,759 986 740 33 42.8 2,086 609 1,457 16 49.7 1,274 18 46.1 1,355 122 68.9 It was found impracticable to eliminate from the large number of cases aggregated in Table XX the instances of partial shot fractures of the shaft of the femur, as frequently the diagnosis was too vague to allow a distinction to be made between a complete fracture or a partial fracture. The Army Medical Museum possesses eighteen1 specimens of partial 1 Specimen 126 (Cat. Surg. Sect. Army Med. Museum, 1866, p. 260), the upper part of the left femur, the great trochanter being carried away by a grape shot. Spec. 134 (Cat, page 260), upper half of left femur with a section of the shaft just below the great trochanter gouged out: Pt. A. B---, Co. G, 152d New York, aged 34; wounded June 10, 1864; died, of asthenia, August 29, 1864. Spec. 1594 (Cat, p. 261), the upper portion of the left femur, with the great trochanter badly grooved by a musket ball: Corporal J. M----, E, 39th Massachusetts, aged 19; wounded at Petersburg, April 1, 1865; died, exhausted after pleuropneumonia, August 17, 1865. Spec. 2132 (Cat, p. 259), the upper fourth of the right femur, the great trochanter being partly fractured. Spec 2197 (Cat, p. 258), the right femur chipped and contused on anterior and inner face: Pt. G. S----, Co. E, 88th Illinois, aged 27; wounded at Mission Ridge, November 27, 1863; died, from exhaustion, February 18, 1864. Spec. 2995 (Cat, p. 260), the upper third of the left femur partially fractured at the level of the trochanter minor: Pt. E. P----, Co. A, 38th Mass., aged 19; wounded at Port Hudson, June 14th; died, from exhaustion, July 27, 1863. Spec. 3433 (Cat, p. 259), the upper third of the left femur contused and partially fractured: Pt. \V. V----, Co. F, 12th Penn. Cavalry, aged 20; wounded at Winchester, July 24th; died, of typhoid fever, September 29, 1864. Spec 3956 (Cat, p. 261), the shaft of the left femur sawn longitudinally, showing an oblique partial fracture by a conoidal ball, which chipped the shaft in its outer border: Serg't J. O'B----, Co. F, 42d New York, aged 30; wounded at Antietam, September 17, 1862; died, from pyaemia, February 17,1863. Spec. 140 (Cat, p. 260), the lowest third of the left femur grooved two inches above the condyles: Serg't H. D----, Co. E, 2d N. Y. S. M.; wounded at Bull Run, August 30th; died October 10, 1862. Spec. 916 (Cat, p. 260). the lower half of the left femur, penetrated in the lowest third, with a slight osseous deposit on the neighboring portion of the shaft: Serg't L. B----, Co. A, 7th Wisconsin; wounded at South Mountain, September 14th; died December 29, 1862. Spec 1104 (Cat, p. 259), the lower half of the left femur severely contused in the lowest third, with an oblique fissure around the bone. Spec. 1757 (Cat., p. 261), the lowest third of the right femur obliquely perforated above the external condyle: Pt. M. K----, 4th Ohio Cavalry; wounded July 10th; ligation of popliteal and femoral arteries on account of recurrent haemorrhage; died, from exhaustion, August 14,1863. Spec. 1788 (Cat, p. 260), the lower half of the right femur partially split, with a longitudinal fragment nearly detached: Pt. O. B. N----, Co. K, 3d Michigan Cavalry; wounded near Jackson, July 15th; died October 2, 1863, of pyaemia. Spec. 1924 (Cat, p. 260), the lowest third of the left femur grooved on the outer aspect from before backward: Pt. S. T. G----, Co. E, 17th Kentucky; wounded at Chickamauga, September 19th; died November 5, 1863. Spec. 2370 (Cat, p. 261), the lower half of the right femur chipped by a bullet on the outer side; part of the injury repaired by a deposit of callus: Pt. A. R----, Co. A, 2d Penn. Cavalry; wounded at Mine Run, November 29, 1863; taken prisoner, paroled, and admitted into hospital, Baltimore, April 18, 1864; died, May 22, 1864, of pysemia. Spec. 4271 (Cat, p. 261), the lowest third of the left femur, showing partial fracture of the laminated portion of the shaft just above the condyles, with a longitudinal fissure upward: Corp'l J. E. D----, Co. G, 34th Massachusetts ; wounded at Newmarket. May 15th; died, with typhoid symptoms, June 5, 1864. 176 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X Fig. 131.—Partial shot fracture of right femur. Spec. 3339. shot fractures of the shaft of the femur. Two instances will here be cited, and then the shot fractures of the femur treated by expectation, according to the seat of the injury in the upper, middle, and lower thirds, will be considered. Case 359.—Private O. C. Higgins, Co. D, 31st Maine, aged 24 years, was wounded before Peters- burg, June 23, 1864. Surgeon J. Harris, 7th Ehode Island, reported his admission into the field hospital of the 2d division, Ninth Corps, with a "shot wound of thigh caused by a musket ball." From the field hospital the wounded man passed to the Depot Hospital at City Point, and thence, on July 3d, to the Third Division Hospital at Alexandria. Surgeon E. Bentley, U. S. V., in charge of the latter, reported the fol- lowing description of the injury and its result: "A conical explosive ball entered the external aspect of the middle third of the right thigh anteriorly, and, exploding, scattered fragments of lead through the thigh and partially fractured the femur, not, however, preventing the patient from using his leg at will. Water dressings were applied. When admitted the patient was not in good condition, having been suffering from diarrhoea for some time, for which astringents were given. On July 6th, he was somewhat improved. The cold-water dressings were changed to warm. By July 10th the diarrhceal discharges had ceased, but the wound was very much inflamed. On July 15th, a slight discharge of dark and unhealthy pus set in, and flaxseed poultices were applied. Tonics and stimulants were administered. On July 21st, the patient felt better, and his treatment was continued. Two days later there were dark and unhealthy discharges from the wound, but the patient looked bright and his tongue was cleaning. Death occurred suddenly at 4 A. M., on July 24, 1864, the patient having been given water to drink about an hour previously by the nurse, and no signs of rapid exhaustion being then apparent. The post-mortem examination, made nine hours after death, showed the thigh filled with fragments of the bullet, and a partial fracture of the femur; there was profuse suppuration above and around the bone, and great emaciation. The viscera were found to be perfectly healthy." The upper two-thirds of the injured femur were contributed to the Army Med- ical Museum by Dr. Bentley, and are represented in the wood-cut (Fig. 131). The specimen shows the existence of local necrosis, with trivial osseous deposit near by, and the traces of profuse suppuration following the fragments of lead are seen in the roughening of the shaft. In another instance of partial shot fracture of the shaft of the femur, the ball, at the autopsy, was found lodged in the medullary cavity: Case 360.—Corporal J. Higgins, Co. A, 159th New York, aged 19 years, was wounded at Irish Bend, April 14, 1863. Surgeon T. B. Keed, U. S. V., reported his admission to the field hospital of the 4th division, Nineteenth Corps, with a " shot wound of leg." Assistant Surgeon P. S. Conner, U. S. A., contributed the pathological specimen represented in the annexed wood-cuts (Figs. 132,133), with the following history: "The patient entered University Hospital, New Orleans, April 17, 1863. Upon examination he was found to have a wound just below and external to the head of the left fibula, the track of the ball being upward and inward. The missile had not been extracted nor could it be detected. There being no evidence of fracture, the case was regarded as a simple flesh wound and treated accordingly. On the seventh day after admission haemorrhage supervened, but upon cutting down through the popliteal ^pace no bleeding vessel could be detected, and no further haemorrhage occurred. On passing the finger along the track of the wound the superior margin of a cavity was felt, which appeared to be a portion of the femur partially split off and thrown backward. There being no displacement or other evidence of fracture extend- ing entirely across the shaft, and the man being unable to give any account of his position at the time of receiving the injury, it was concluded that the ball had lodged in the femur. Though much prostrated by the loss of blood the patient was rallied by careful nursing. As a precautionary measure the limb was placed in an anterior splint after a few days, from which time the case progressed quite favorably until May 15th, when rigors came on and the patient failed rapidly. He died on May 18, 1863, thirty-five days after being wounded. At the post-mortem examination no inflammation of the knee joint was discovered, but little pus at the seat of the injury, and no abscesses in the lungs or liver. An inspection of the specimen indicates that the leg must have been strongly flexed on the thigh at tlie time the man was shot." The specimen shows longitudinal fractures on the anterior surface of the bone, with some periosteal thickening, and the ball lodged in the medullary canal. SHOT FRACTURES OF THE SHAFT OF THE FEMUR TREATED BY CONSERVATION.—The shot fractures of the shaft of the femur treated by conserva- tion numbered three thousand four hundred and sixty-seven. The result of the injury could not be ascertained in ninety-four instances. Sixteen hundred and eighty-nine patients recovered, and sixteen hundred and eighty-four, or 49.9 per cent., died. The injury was on the right side in fourteen hundred and thirty-one instances, with a mortality rate of 47.0 per cent.; on the left in sixteen hundred and five, of which 47.1 per cent, died; in four hundred and thirty-one cases the side of the injury was not specified. The seat of fracture FlG. 132. —Lowest third of right femur, with ball in medullary canal. Spec. 1296. FlG. 133.—Anterior view of Spec. 1296. SECT. in. 1 SHOT FRACTURES OF THE UPPER THIRD OF THE FEMUR. 177 was in the upper third in twelve hundred and fifty-four instances; in the middle third, in eight hundred and fifty-five; in the lower third, in six hundred and twenty cases; and in seven hundred and thirty-eight instances the precise seat of fracture was not stated. Shot Fractures of the Upper Third of the Femur treated by Conservation.—Very few instances of recovery after shot fractures in the upper third of the femur treated by expectation seem to have been reported by the older authors on military surgery, and I have been unable to find more than eight examples of recovery after this class of injury prior to the beginning of the present century. In the subjoined foot-note1 an attempt is made to collect the instances of recovery after fractures in the upper third of the femur, to show that in later years these cases have been by no means as rare as has generally been believed, and, indeed, the results obtained in the American Civil War, and, subsequently, 1 The earliest instance of shot fracture of the upper third of the femur that I have been able to trace Is a case reported by Dr. JOSEPH Schmidt. In his Speculum Chirurgicum oder Spiegel der Artzney, Augspurg, 1656, p. 144. J. von Meda, of Captain Newmann's company, received a shot fracture of the upper third of the femur, August 31, 1648, at Memmingen. He recovered and was able to go about on crutches. Pubmann (M. G.) (Funfftzig Sonder-und Wunderbahre Schusswunden Curen, Franckfurt, 1721) reports three cases of recovery after shot fracture of the upper third of the femur, viz: The case of a soldier wounded at Tuxckshausen, in November, 1671 (Obs. I, p. 32); the case of Corp'l C Endte, wounded before Stettin in 1677 (Obs. XVIII, p. 213), and the case of M. Leschke, wounded before Wolgarth in October, 1675 (Obs. XXXIII, p. 250). Belloste (Le Chirurgien d'Hopital, 3d ed., Paris, 1716, p. 206) relates the case of Sergeant LeGrand, who received, in 1686, a shot fracture of the upper portion of the right femur, and, after copious suppurations with exfoliations, recovered. The ball and a fragment of the femur were extracted eighteen months after the injury. Ravaton (Chirurgie d' Armie, Paris, 1768, p. 338) relates that at the battle of Dettingen, July 5,1743, a lieutenant of cavalry received a shot fracture of the right lesser trochanter. On the 55th day five pieces of bone came away, and the wound cicatrized without further accident. MOSCATI (Mim. de VAcad. de Chir., Paris, 1768, T. IV, p. 625) relates the case of a soldier of 35, who, at the battle of Crevelt, June 23, 1758, received a shot fracture just below the trochanters of the right femur. He recovered, and was sent to the Invalides, at Paris, where he died April 13, 1764. Two copperplates well represent the fracture united by large masses of callus. Desault (Jour, de Chirurgie, Paris, 1792, T. Ill, p. 104) reports the case of Louis Waymet, shot in Paris, Feb. 28,1791. The ball passed through both thighs and fractured the left femur in the upper third. The patient recovered and walked well. Fenech (E.) (Obs. recueillies d VArmie d'Espagne sur les plaies d'armes it feu aux extrimitis, Paris, Thesis, 1813, p. 10) cites the case of Lieut. Larque, 70th regiment, wounded near the right great trochanter, at Busaco, Portugal, September 27, 1810, and recovered. Legouest (De la Disarticulation Coxo- fimorale, in Mim. de la Soc. de Chir. de Paris, 1863, T. V, p. 166): M. X----was shot in the left trochanter in 1812. He recovered with four or five inches shortening, and was presented by H. Larrey, in 1854, to the surgical clinic of Val de Grace. Fokget (Bull, de la Soc. de Chir. de Paris pendant 1855-56, p. 230) reports that a captain at Waterloo, in 1815, received a shot fracture of the femur near the trochanter. Pieces of bone continued to come away, and suppuration and fistulae yet existed in 1852. HENNEN (J.) (Principles of Military Surgery, London, 1829, p. 131) states that a French prisoner was brought to Brussels after the battle of Waterloo, June, 1815, whose right femur had been struck by three musket balls, splintering the bone from the middle of the upper third to within two inches of the condyles; enormous suppuration followed, and extensive incisions were made to extract bones and balls, and the patient recovered. Four cases of recovery after shot fractures in the upper thirds of the femur, received in the Paris revolution in 1830, are reported by A. J. Jobert (de Lamballe) (Plaies d'armes & feu, Paris, 1833, pp. 262, 264). Larrey (H.) (Relation chirurg. des ivinemens de Juillet, 1830, Paris, 1831, pp. 1P2, 106) relates two instances of recovery after shot fracture of the upper third of the femur: Cases of M. de Saint C, and H----, 7th regiment. Abnal (Mim. sur quelques peculiaritis des plaies par armes &feu, in Jour. Hebd. de Mid. et de Chir. prat, Paris, 1831, p. 36) reports two cases. A member of the National Guard of Lyon recovered after a shot fracture of the neck of the femur, in 1831 (Gensoul, Note sur les blesses recus a VHdtd-Dieu de Lyon, pendant les troubles de 1831, in Gaz. Med. de Paris, 1833, No. 43, p. 300). L ABREY (H.) (Hist. chir. du siege de la Citad. d'Anvers, Paris, 1833, p. 216) cites four cases of shot fractures of the upper portion of the femur treated successfully during the siege of Antwerp, in 1832. Legouest (loc. cit, p. 167) gives the successful case of Tanguel of the 2d light infantry, wounded in the right trochanter, at Cherchell, in January, 1841. The same author states that SEDILLOT successfully treated a shot fracture of the right trochanter in a lieutenant of artillery, wounded in a duel in 1843. According to Huguteb (Bulletin de la Soc. de Chir. de Paris pendant 1855-56, Paris, 1856, p. 230), Dr. Geedy successfully treated a shot fracture of the trochanter in 1848. (This is probably the case of Guiton, alluded to in Gaz. des H6p., 1848, p. 98.) Baudens (Des plaies d'armes d. feu—Communica- tions faites, etc., Paris, 1849, p. 231) cites a case of shot fracture of the upper third of the femur in 1848; the patient recovered. Amussat (Des Plaies d'armes Hfeu—Communications, etc., Paris, 1849, p. 55, refers to a case of recovery. During the discussion on disarticulation at the hip at the meetings of the Surgical Society of Paris (Bulletin de la Soc. de Chir. de Paris, 1855-56, pp. 230-234), on October 24 and October 31,1855, Gibaldes, ROBEBT, and DENONVILLIER8 gave details of three cases of recovery after shot fractures of the upper third of the femur. Schwartz (H.) (Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, pp. 154 and 167) cites two cases: J. G----, wounded at Altendorf, April 21, 1848, fracture of the great tro- chanter; fragments of bone removed; recovery. C B----, of the Berlin volunteers; fracture of trochanter minor; recovery in four months. Huttn (Recherches sur le result at des fractures de la moitii supirieure de la cuisse, in Rec. de Mim. de MCd. de Chir. et de Phar. Mil., 1854, 2mt s6rie, T. XIV, p. 263) found among the inmates of the Hotel des Invalides at Paris, from 1847 to 1853, seventeen patients who had recovered from shot fractures of the upper third of the femur. Matthew (loc. cit, Vol. II, pp. 361, 362) relates two cases of recovery after shot fracture of the upper third of the femur: An officer of the 17th regiment, wounded September 8,1855, by a rifle ball, which fractured the trochanter major of the left femur. On November 11th, the bone had united, and there was only slight shortening of the limb. J. FitzbaU, 62d regiment, received, September 8, 1855, a shot fracture of the femur at the junction of upper and middle thirds. He recovered, with 1J inches shortening. Longmore (T.) (Holmes's System of Surgery, 2d ed., 1870, Vol. H, p. 225) details the case of Lieut. D. M----, 19th regiment, who received a shot fracture of the left femur on September 9,1855. On February 22d, the union of bone was firm. In 1856, "the stiffness of joints gradually disappeared, and the patient was enabled to return to duty." Among the 282 pen- sioners 3fter injuries of the thigh, recorded by name by M. Chenu in his Rapport, etc., pendant la Campagne d'Orient en 1854, 1855, 1856, Paris, 1865, pp. 375-397, 37 cases of recovery are found after shot fracture of the upper third of the femur. From the same campaign, L. Baudens (La Guerre de Crimee, Paris, 1858, pp. 330,331,336) reports a case of recovery after shot fracture of the upper third of the femur among the French troops, not recorded by Chenu : J. Albaric, 80th line, upper third of right femur, Sept. 8,1855; and two cases of recoveries among the Russian prisoners: Jusef Testanief, left femur, just below the trochanter major, and S. Zarepa, fracture of right femur at the trochanter major. Williamson (G.) (Military Surgery, Lon- don, 1863, pp. 141, 142) records six cases of recovery after shot fracture of the upper third of the femur: Private P. Carty, 64th regiment, wounded at Lncknow in 1857. Private J. Ashworth, 53d regiment, wounded November 1,1857; July 14, 1858, wounds healed. Private J. Hewitt, 52d regiment, wounded July 12, 18ol; wounds healed July 20, 1858; and Private E. Collins, 75th regiment, wounded at Delhi, June 8,1857; September 6,1858, sent to modified duty; and cases of Williams and Curtis, on p. 151. In the Italian War of 1859, H. Demme (Militar-Chir. Studien, WUrzburg, 1864, B. H, p. 365) tabulates 43 cases of shot fractures of the upper third of the femur treated conservatively among the Austrian troops, of which 18 recovered, giving a fatality of 58.1 per cent. Among the French wounded in the same campaign, named by CHENU (Stat, med, chir, de la Campagne d'ltalie en Surg, in—23 178 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. in the Franco-Prussian War, 1870-71, have been highly encouraging.1 From the statistics in Table XX, ante, it will be seen that of twelve hundred and fifty-four cases of shot fracture of the upper third of the femur treated by expectation, six hundred, and sixty-nine recovered, and five hundred and seventy-two proved fatal; while in thirteen instances the result could not be ascertained, giving a mortality of only 46.0 per cent. Recoveries after Shot Fractures of the Upper Third of the Femur freated by Con- servation.—Of the six hundred and sixty-nine cases of this group, two hundred and ninety- eight were on the right, and three hundred and thirty-four on the left side; in thirty-seven instances the side was not specified. Five hundred and fifty-one patients were Union, and one hundred and eighteen were Confederate soldiers. Case 361.—Private W. Rigney, Co. G, 21st New York Cavalry, aged 18 years, was shot near Bladensburg, May 27, 18G5. Surgeon B. B. Wilson, U. S. V., reported his admission to Stanton Hospital, Washington, May 29th, with "shot wound of right nates and right thigh, fracturing the femur, received while running the guard." The method of treatment, however, was not stated. On September 13th the patient was transferred to Harewood Hospital, whence Surgeon R. B. Bontecou, U. S. V., described his condition as follows : " He was admitted convalescing from a fracture of the upper third of the femur, caused by a revolver ball, the injured bone having firmly-united with two inches shortening and very slight deformity. His constitutional condition was good, and he was able to go about on crutches and had good prospects of a useful limb." One month afterwards the man was transferred to De Camp Hospital, David's Island, New York, and on June 26, 1866, he was discharged from service and pensioned. Examiner W. G. Davis, of Lyons, New York, certified, July 1, 1872: "Pistol shot wound of right thigh, the ball entering posteriorly and fracturing the femur just below the trochanter major. There is considerable deformity and two and a half inches shortening. Pieces of bone discharged. Has pain in the limb in damp weather. Cannot rotate the thigh or flex it upon the pelvis, and has pain in it if he works, stands long, or lifts heavy loads." No material changes were 1859 et 1860, Paris, 1869, T. II, p. 715, etc.), 50 cases of recovery are found after shot fracture of the upper third of the femur treated by conservation. ROUX (J.) (Disarticulation de la cuisse, Paris, 1860) cites 9 cases of recovery after shot fracture of the upper third of the femur in the Italian campaign of 1859-60, not contained in Chenu'S list, viz: Barka-ben-Brahim, 3d Turks; G. Barbet, 100th line; B. Girel, 65th line; J. Hyvan, 1st Zouaves; J. Labastoule, 15th line; P. Mignucci, 1st Zouaves; J. Pamary, 85th line; F. Rousselot, 5th Battalion; C Rossignol, 6th line. GHERINI (A.) (Relazione chirurgica delV Ospedale militare provisorio di S. Filippo, in Annali Universali di Medicina, Milano, 1860, pp. 459, 460) tabulates 9 cases. MOUAT (The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports for the year 1865, London, 1867, Vol. VII, pp. 502-3) tabulates 2 cases of recovery. HEINE (C.) (Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 251): J----, shot fracture of upper portion of right femur, April 18, 1864 ; recovered, with 1J inches shortening. From the Austro-Prussian campaign of 1866, B. BECK (Kriegschirurgische Erfahrungen, 1867, p. 294) reports 4 cases ; Stromeyek (L.) (Erfahrungen Uber Schusswunden im Jahre 1866, Hannover, 1867, p. 53) 3 cases; R. BlEFEL (LANGENBECK'S Archiv, 1869, B. XI, p. 445) 1 case; and Maas (Kriegschirurgische Beitrage, Breslau, 1870, p. 40) 3 instances of recovery after shot fracture of the upper third of the femur. Gritti (R.) (Nuovi documenti infavore della cura conservativa, etc., in Annali Universali di Medicina, Milano, 1868, Vol. CCV, p. 518, et. seq.) gives details of 10 successful cases of fracture of the upper third of the femur. From various sources it has been possible to collect 264 instances of recovery after shot fractures of the upper third of the femur, received during the Franco-German War of 1870-71. Of these cases were reported among the German forces: By B. Beck (Chirurgie der Schussverletzungen, Freiburg, 1872, p. 694), 28 cases; by W. KOCH (Notizen uber Schussverletzungen, in LANGENBECK'S Archiv, 1872, B. XIII, p. 474, etc.), 5; by A. SociN (Kriegschir. Erfahr., Leipzig, 1872, p. 134), 6; by G. FISCHER (Dorf Floing und Schloss Versailles, in Deutsche Zeitsch. fiir Chir., Leipzig, 1872, B. I, pp. 185 and 224, etc.), 8; by OTT (Wiirtemburg. Med. Correspondenz-Blatt, 1871, p. 169), 5; by H. FISCHER (Kriegschir. Erfahr., Erlangen, 1872, p. 171, etc.), 4; by CZERNY (Bericht Uber die im College Stanislaus in Weissenburg behandelten verwundeten, in Wiener Medizinische Wochenschrift, 1870, No. 57, p. 1373), 3; by A. SCHINZINGER (Das Reserve-Lazareth Schwetzingen, Freiburg, 1873, pp. 70, 71), 3; by H. LOSSEN (Kriegschir. Erf, in Deutsche Zeitschrift fiir Chir., 1873, B. II, p. 112), 2; by Th. BILLROTH (Chir. Briefe, Berlin, 1872, p. 228), 2; by KUCHLER (Memorabilien, 1871, B. XVI, p. 141), 2; by GRAF (E.) (Die Koniglichen Reserve-Lazarethe zu Dusseldorf wahrend des Krieges 1870-71, Elberfeld, 1872, p. 62), 2; and by C. KlRCHNER (Aerztlicher Bericht Uber das K. P. Feldlazareth im Palast zu Versailles, Erlangen, 1872, p. 56), by GUTEKUNST (Zeitschriftfiir Wunddrzte und Geburtshuife, 1870-71, p. 146), by GOLTDAMMER (Berliner Klinische Wochen- schrift, 1871, B. "VIII, p. 150), by Stall (Bericht aus dem K. Wiirttembergischen 4 Feldhospital, in Deutsche Mil. Zeitschrift, 1874, B. Ill, p. 197), 1 each; a total of 74 cases among the German troops. Of the cases of recovery after shot fracture of the upper third of the femur among the French troops in 1870-71: Sedillot (Fractures des membres par armes de guerre, in Arch. Gin. de Mid., 1871, 6™ s6r., T. XVII, p. 423, etc.) reports 10 cases; A. W. Roaldes (Des fractures compliquees de la cuisse, Paris, 1871, pp. 43, 44, 46), 4; A. Chipault (Fractures par armes d feu, Paris, 1872, pp. 4, 7, 19, et seq.), 3; and WM. MacCormac (Notes and Recollections of an Ambulance Surgeon, London, 1871, pp. 120,129), 4; Christian (J.) (Relation sur les plaies de guerre, in Gaz. Med. de Strassbourg, 1872, p. 283), 4; Feltz et Grollemund (Rel. Clin, sur les Ambulances de Hagenau, in Gaz. Med. de Strassbourg, 1871, No. 11, p. 133), 5; JOESSELL (Ambulance du Petit Quartier d, Haguenau, in Gaz. Med. de Strassbourg, 1871, p. 8), 3; MOYNIER (E.) (Ambulance de la Rue Saint Lazare, in Gaz. des Hop., 1871, Vol. XLIV, p. 445), 1; Panas (F.) (Mim. sur le traitement des blessures, in Gaz. Hebd. de Med. et de Chir., 1872, T. IX, p. 391), 2; Vaslin (L.) (Etude sur les plaies par armes a feu, Paris, 1872, pp. 114, 120, etc.), 3; and among the pensioners - enumerated by M. Chenu (Apercu hist. stat. et din., etc., des armies pendant la guerre de 1870-71, Paris, 1874, p. 153, et seq.), 156 cases are found. Five of these are included in the reports of Sedillot (1), Chipault (2), Roaldes (1), MacCormac (1), ante, leaving 151 additional cases. To these should be added 9 cases of French pensioners reported by Mossakowsky (Stat. Bericht ueber 1514 Franzosische Invaliden, in Deutsche Zeitschrift fiir Chir., 1872, B. I, p. 342, et seq.), not contained in CHEXU; and 4 cases of German invalids, detailed by BERTHOLD (Deutsclie MilitairJirztl. Zeitschrift, 1872, B. I, p. 522). One case is reported by G. Tillng (Bericht ueber die 124 im Serbisch-Turkischen Kriege (1876), etc., behandelten Schussverletzungen, Dorpat, 1677, p. 66). The 489 cases of recovery of shot fractures in the upper third of the femur under conservative treatment, here referred to, must convince the reader that recoveries under such circumstances are not as infrequent as the older writers on military surgery contended. 'Beck (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 694, etc.) details 37 cases of shot fractures of the femur in the upper third, of which 28 recovered and 9 proved fatal, and remarks: "Unfortunately, I have not been able to give an entirely precise account regarding the proportion of the seat of the fractures in the various parts of the femur, and the corresponding mortality, as frequently the seat of the fracture was not clearly designated. But I can say this much, that I had reason to be very well satisfied with the results of the fractures in the upper third, providing the lesion was not too extensive and severe. The fractures in the middle third at the junction with the upper always made the most unfavorable impression upon me, on account of the frequent injuries and lesions of the bloodvessels, which, through frequent and even profuse bleedings, etc., easily lead to fatal results, and which should, therefore, be carefully investigated at the place of first dressing, and, if necessary, at once subjected to the proper operation." V* .: of the Rebellion.!..! • ••' // Con- I ninety- ■ fty-s^ven i'M-l ;t:ld '-.•nshiii'g. M \ S:, with "slot iouth'. '••■"■ttmeij', Jiowjver, : _ itecoi;, U. S. V., ar, caused by ;■ n constitutional > mon;h afterwards *b di sen:. rqyd ' from '. t wuund of right vderuM'* deformity ■''' ■. rota •: tlie ■;t' :i.->- ,'. i'IT •jiMf". ■• ixr .ation. , tlsf 1, i.iri c.-.i.paiga •iyv. ..•;:. 2uu>>«l; J. i...HEi;i>.' i \ ) (Fy'':acne '.ftbuUites <■ c;i.'i - ' JUAT if'atea 2 eas^s ■■' . • >very ■.,.:( fern;r , <■'. ' !86-! ■ -, IV, \htSi. . .■ 'rr.-; -1 :.-■« of til.; "., ' .;■ ' ■ '.(:■'■•>, Vol. CC' ■■• :■.-.,,, .•.,«.bk> 1-: i.. >ile » ! rU' no;-. <•■' ,,»:h( cases t.t, ,* He,I rt«.'.j_ .'*« ubirr f,-.'i ■.- *■ 'tttun{, n. ■■.. '.-J Fi^CHlS • • "rrr'Flcin,, und ...^ / (-..vj-r . ■■•i-Bla.. , 871 ." ; 11 . i IPti';evburg ■■■''.. I- Sr.hwelzingen, ' . .r-.Ji.LROTH (Chir. ■ ■■■■•*• ru Dii'scido'-j . U zu Versailles, iir.isci' tF:ic/ie»- . p :'i.'j, 1 each; -'■•..•)i 'a,,ps in : =•-,; A \V. '/, ■ -laz. Mc> ■ ,':■ MoYNIl'.i; <).., <.i:X, Gaz. Jjebi!. •'<• , amnp;' the pension0:* ; !^,i r;isrs are foun< ■ ■ r.. -.wise*. To tlji";...i .■. ...■':- it. '/j it;-:';rr"c fur i -.-.•• •.■■ ■■•„ .;>..'■. Ztit:-- r*t, '.> i«i).'.<•< ■• .'.. .-: •.■ .'v-rleisunoen, w.atv < ' . i. i. ,; . referred to. must ry aun;r. .. lares oi .' '■:■..- i ; i, ;>it ;i \.l ■ >! -[•jt(:"«-: (.■ :i> ' ' ■ :'■•''• ' i.pori • " ut ■•■ t.,.it of tue tnifiiiro ■ . ■(■•" 'y rif s:;: .■!■' i .i unper ''h'.rd, p'-ifi'.1, _- ' ■■■ ,. ■ ■-. • i ^in most anfuvori!. • •■/■' . '.: i ■■ ■■ .; bi."iiDiXa etc.. • ii-..; .. ■:. -;ibji>'ted ■ L e ■■• in:.' ■:- ■ P?'""1; !.' tliis grov.p, ;.!uit n>' ■ ■■ i.-'elii" Med and SurSJ. Hist of the War of the Rebellion, Part 111 Vol.IU'hap X Ward phot J. Bien lith PLATE LIX-CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fig I. Case of Private W. Rigney 21 ■*• New York Cavalry. F12 2 Case of Corporal T. Crasslev 69 *■ New York I SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 179 reported at subsequent examinations. The pensioner was paid June 4, 1879. Photographs taken at the Harewood Hospital in October, 1865, were contributed by Surgeon Bontecou. (Photo's of Surgical Cases, Vol. 8, No. 4, Card Photo's, Vol. 3, p. 32.) A copy, taken at the Army Medical Museum (Photo. Series, No. Ill), is represented in FlG. 1 of Plate LIX, opp. p. 178. Case 362.—Captain D. Lewis, Co. G, 8th Ohio, aged 26 years, was wounded at the Wilderness, May 6, 1864, by a minie" ball, which entered the external part of the left thigh about the junction of the upper and middle third, fractured the femur, and made its exit at the left buttock two inches from the anus. He was conveyed to Fredericksburg and treated with a double inclined plane for three weeks. On May 26th he was removed to a private dwelling in Washington, where he was attended by Acting Assistant Surgeon G. K. Smith, who applied Buck's method of treatment. There was*but little suppuration or constitutional disturbance, and by July 9th the fracture had so far united as to permit the patient to walk on crutches. On July 13, 1864, Captain Lewis was mustered out by reason of expiration of service, and pensioned. In October following his wound had entirely healed, and soon afterwards he was able to walk on the injured limb. Subsequently he was for some years an employe in the Treasury Department. On August 22, 1865, his photograph was taken at the Army Medical Museum (Photo. Series of Surgical Cases, No. 91, A. M. M.), at which time he was in excellent health, and the injured limb showed no other deformity than one and a half inches shortening. The St. Louis Examining Board, in September, 1874, certified to "occasional lameness and soreness." The pensioner was paid March 4, 1879. His photograph is represented in FlG. 1 of Plate LVIII, opp. p. 180. Case 363.'—Private John Durkin, Co. G, 11th Infantry, aged 30 years, was wounded at Gettysburg, July 2, 1863, by a conoidal ball, which entered the outer side of the upper third of the left thigh, and, passing obliquely inward and downward, produced a comminuted fracture of the femur. On the 3d he was admitted to the Seminary Hospital at Gettysburg, where, on the 8th, Assistant Surgeon W. R. Ramsey, U. S. A., made an incision three inches in length a short distance below and opposite the point of entrance, and extracted the ball. On the 31st he was transferred to the Camp Letterman Hospital, where, so far as recorded, expectant treatment only was used. At this hospital a surgeon, who took charge of the case on August 19th, " found the limb lying in bed, without either splints or bandage; wounds discharging freely; considerable shortening of leg; ordered junk bags, placed Barton's handkerchief to foot, and made extension and counter-extension." On the next day the leg was reported the same length as the right one. On Septem- ber 10th there was very little suppuration, and the bones were uniting; but, on the 30th, the discharge still continued, and the patient was reported " sinking." On November 8th, he was transferred to the Newton University Hospital at Baltimore, where, on December 2d, Acting Assistant Surgeon W. S. Smull made an incision, three inches in length, down to the injured part, and removed a small fragment of bone. On February 19, 1864, the wound was still suppurating freely, and presented indications of the presence of necrosed bone. The limb was shortened four inches. The patient was fur- loughed on June 30, 1864, and at its expiration was admitted to the post hospital at Fort Independence, Boston Harbor, the recruiting depot of the 11th Infantry, where he was discharged the service April 30, 1865, for disability arising from gunshot fracture and "excision of four inches of the upper third of the femur, performed previous to admittance." The wound was still sup- purating, and there was partial anchylosis of knee. Prior to his admission to the latter hospital there is no mention of an excision. The patient became an inmate of Old Soldiers' Home; and on August 3, 1868, he visited the Army Medical Museum and had his photograph (FlG. 134) taken. He states that Pig. 134.—Result of shot fracture in the upper third of Dr. Smull excised four inches of the shaft of femur at Newton University thefemur- [From a photograph.] Hospital in December, 1863; that, at the time of the operation, there was profuse suppuration from the wound and abscesses in the thigh, and that Smith's anterior splint was used. At the date of his visit to the Museum open fistulous sinuses remained. The patient's statement at Fort Independence undoubtedly led to the above diagnosis; and, from the treatment pursued prior to his admission to Newton University Hospital, coupled with the report of the operation made the same month, it is most plausible to believe that the great shortening is not to be attributed to excision. The Boston Examining Board in September, 1873, reported the wound of entrance to be still discharging. The pensioner was paid March 4, 1874, since when he has not been heard from. Case 364.—Private A. F. Dinsmore, Co. E, 3d Michigan, aged 19 years, was wounded at Fair Oaks, May 31, 1862, and admitted to Hygeia Hospital, Fort Monroe, four days afterwards. On June 12th the wounded man was transferred on board of the Hospital Steamer Fulton and conveyed to New York. Surgeon J. Simons, U. S. A., reported that he was admitted to De Camp Hospital, David's Island, June 15th, and discharged from service April 9, 1863, by reason of "shot fracture of left thigh." Several months afterwards the man entered the Veteran Reserve Corps, and after serving in that organization for three years he was mustered out and pensioned. Subsequently the pensioner received employment as clerk in the General Land Office, and in December, 1866, he visited the Army Medical Museum, where his photograph was taken (Photo. Series of » Surgical Cases, No. 157, A. M. M.). At that time he was in good health, though the missile, a musket ball, which fractured the femur at the upper third, was still lodged iu the limb. The bone was firmly united, union having occurred, according to his statement, about seven months after the injury, and his treatment having been by moderate extension and counter-extension. He also stated that numerous detached fragments were removed. Examiner J. B. Bascom certified, September 4, 1873: "Gun- shot fracture of left femur. The ball remains in the hip. A fistulous opening finally healed, but occasionally breaks out again. There is a large indurated cicatrix over the trochanter major and several smaller ones, caused by the opening of abscesses." The pensioner was paid June 4, 1879. A copy of the photograph is shoAvn in Fig. 2 of Plate LVIII, opp. p. 180. 180 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Case 365.—Private H. A. Wiggins, Co. K, 37th Massachusetts, age 24 years, was wounded in the left thigh, at the Wilderness, May 5, 186-1. Three weeks afterwards he was admitted to hospital in Alexandria, whence Surgeon E. Bentley, U. S. V., reported the injury as a "shot fracture of the upper third of the femur, caused by a musket ball." In April, 1865, the patient was transferred to Dale Hospital, Worcester, and subsequently to DeCamp Hospital, David's Island, where he was ultimately discharged September 21, 1865, Assistant Surgeon W. Webster, U. S. A., certifying to "angular union of the frac- tured bone, with five inches shortening; wasting and powerlessness of the limb, and anchylosis of the knee joint. Wound not healed." One month after leaving the service the man was supplied with an apparatus for the injured limb by Dr. E. D. Hudson, of New York City. In a communication, received during July, 1866, and corroborated by a statement by Dr. W. J. Kawin. late Surgeon 2d Vermont, the pensioner related the following in regard to his case: "The ball and eight pieces of bone were removed from my leg on the field, and a second operation was performed at the Fredericksburg hospital, where Surgeon Saw'in extracted four pieces of bone." He also alleged that a third operation was performed while he was an inmate of the Alexandria hospital, and that he had recently removed a fragment of bone himself, making altogether some fifty-five pieces that were removed from the limb. Three fistulous openings were described as existing in the injured thigh. The pensioner further represented himself as having been able for two months to move about with the aid of a cane and without crutches, and added that since he was wounded his weight had become reduced from one hundred and seventy-four pounds to one hundred and twenty-nine, and was steadily decreasing. Examiner E. Barton, of Orange, Massachu- setts, certified, January 2, 1867 : "There is an open ulcer near the hip, from which fragments of bone are frequently discharged; the knee joint is nearly perfectly anchylosed, and from the loss of bone the limb is five aud a half inches shorter than the other. The foot is distorted, and he does not know when it is cold. With the aid of an apparatus he walks very comfortably." No new facts were reported at subsequent examinations. The pensioner was paid March 4, 1879. His card photograph, taken at his home in July, 1866, was contributed (Card Photos., A. M. M., Vol. II, p. 21), an enlarged copy of which, taken at the Army Med- ical Museum (Surg. Phot. Series, No. 152), is represented in the wood-cut (FlG. 135). Case 366.—Private I. Wetzel, Co. I, 184th Penn- sylvania, aged 21 years, was wounded in the left thigh during the siege of Petersburg, October 3, 1864. He was admitted to a field hospital of the Second Corps, and trans- ferred to Armory Square, Washington, five days afterwards. In July, 1835, Acting Assistant Surgeon H. A. Robbins reported the following description of the injury and its re- sult : "A conical ball entered the anterior aspect of the limb one inch below Poupart's ligament, passed backward, frac- turing the femur near the trochanters, and made its exit at the apex of the left nates. The limb was treated in Hod- gen's splint without extension. The hone is now united with three and a quarter inches shortening; the foot is everted and the limb slightly turned outward. Incomplete anchylosis of the knee joint exists, and there is still a discharge of healthy pus amounting to about one ounce daily. The patient is not vet able to use crutches, but from present appearances he soon will be." The patient was discharged from service on August 21, 1865, and pensioned. Various Pension Examiners, at successive dates, certified to "shortening of the limb and partial anchylosis of the knee;" and in March, 1877, Dr. J. Y. Shindell reported as follows: "I find the left knee joint quite stiff, also evidences of occasional abscesses in the muscular portions of the leg. He says that about once a year matter does form, and that he continually wears bandages around the thigh as a support." In September, 1877, the Examiner stated: "The pensioner's general physical condition is not good. He is now confined to his bed, and has been for the last two weeks, on account of his wound, which is again suppurating. * * * But the greatest trouble now seems to be in the hip joint and its neighborhood. On probing the opening a little above the joint the body of the ilium seems to be of a honey-combed nature, diseased, and, no doubt, the cause of these frequent attacks of suppuration which occur every three or four months. * * * His leg trouble will very likely cause death some time." The pensioner was paid March 4, 1879. The wood-cut (Fig. 136) represents a photograph taken at the Army Medical Museum on July 6, 1865. (Surg. Phot Series, No. 67, A. M. M.) In the next case perfect consolidation of the ends of the fractured femur took place in less than five weeks. The patient recovered with a strong, sound limb, and, in 1879, while engaged in active business, has walked six miles without difficulty, limping but little. Case 367.—Lieutenant J. S. Lowery, Co. D, 146th New York, aged 21 years, was wounded at Bethesda Church, June 3, 1864. Surgeon W. R. DeWitt, jr., U. S. V., recorded his admission to a Fifth Corps field hospital, with a "severe wound of the right thigh caused by a minie ball." Surgeon D. W. Bliss, U. S. V., reported that the patient entered Armory Square Hos- FlG. 135.—Result of shot frac- ture of upper third of loft femur. [From a photograph.] Fig. 13".—Result of shot fracture of upper third of left femur. [From a photograph.] i.l ' • i- II iM ol'tlt.- VI. >'■■*■■ <1 ^NSOLIDA^ED ■ ,";uiiK',:.t He :i -. l rec/n" . \.li( ■>■ •cue i . t- 1 :!e kn»c ,• . ■• r}'..-ctly at los* 01 !« nt < .ltd :. ' 'e other. '' i >' • c ' en it is cold ,v 1 '. . ■inf'.rtablv.'' r.^l ,vc w*;c ;e:n; r n . . i.t' the left . ^ :nt without < . .:s,-: 'the i> " ■'.. di-.'. •. •.t iyp.-; ■ ,:on Ei i. 1877, Dr .: muec'iV ■' ' ' ,!-ll!Ill ',«? .l.\r 'H)t qw .■■ ■ j' ■: ■ .f -i honey-coin Lv. ■r-nf or four months. !. :-79. The wood-cut (I SVr,.Mt, No. 67, A. M. M.^ u "U ic irnctuv -rand lii at -.1 femur k ,:>, and, in .■r.i\l.\I \' •'. 9V» ■i\ <>"] "ears1, n Fif'h Corp i • "ion rd :'■ i' , .lun- uund of .ire Ho;- Med.and Sui-i. Ilisl ol'll.o War of the lu-bclliou T;.i t 111 Ynl.ll,Chap.X. . ■■'■ ■ $^XY:7;>.:..-r-\ ■■■. ■ . !' . " \:;-. v'^ ^S^-v'..■'■'•'V Ward phot J Bien lith PLATE LVIII.-CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fiy 1. Case of Captain D. Lewis 8* Ohio. I''iv 1' Case of Private A.K Dins more 3 4 Michigan SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 181 pital, Washington, June 7th, and described his injury as a " shot fracture of the upper third of the femur," but gave no account of any treatment but that of simple dressings. Dr. T. M. Flandrau, late Surgeon 146th New York, who attended Lieutenant Lowery at the field hospital, gives the following details: The patient was wounded by a rifle ball while on picket duty. The missile entered at the middle of the thigh, toward its inner aspect, and was cut out on the field by Assistant Surgeon G. H. Fossard, 146th New York, above the trochanter. The femur was fractured in its upper third. The patient was brought six miles on a stretcher to the field hospital of the 2d division, Fifth Corps, where I determined not to amputate, and supported the limb on folded blankets, so that it was very comfortable, lie was then carried by some men belonging to the Quartermaster's Department fifteen miles further to the White House, and placed on a steamboat and sent to Washington. He was left on his stretcher while on board of the transport and was not removed from it until placed on a bed in Armory Square Hospital, four days after receiving the injury. At the latter place, Acting Assistant Surgeon T. O. Bannister had immediate charge of the case. According to the patient's statement the limb was placed in a box, little extension being used and no counter-extension. Three or four small pieces of bone were discharged within a short time, and another small piece was cut since from under the skin. An abscess was opened on the outer side of the I high, the scar of which is conspicuous in the photograph. When the patient left the hospital he used crutches, the wound having closed in four or five weeks and the bone united firmly. He con- tinued to use his crutches until the following April. The limb is shortened two and five-eighths inches; the thigh cannot be fully flexed on the pelvis, but the limb is strong, sound, and freely movable, with the afore-mentioned exception. When wearing a boot slightly thickened in the sole he limps but little. Lately he has walked six miles without difficulty, and is actively engaged in business." In a previous communication Dr. Flandrau stated that the very expeditious recovery of the patient was, no doubt, to be attributed .in a large measure to his good fortune of having unusually comfortable transportation. Lieutenant Lowery became a pensioner from the date of his discharge from service, January 13, 1865. Various surgeons have examined him at regular intervals, and certified to lameness, etc., as resulting from the injury, up to April, 1872, since when he has been exempted from further examinations, owing to the permanent character of his disabilities. He was paid June 4,1879. A photo- graph of the patient was prepared under the direction of Dr. Flandrau, who contributed it to the Army Medical Museum. It is numbered 265 of the Surgical Photographic Series. In the following instance a rifle ball fractured the upper third of the left femur, and passing through the right thigh chipped off a piece of the upper third of the right femur; a second ball shattered the head of the left fibula; a third ball caused a flesh wound of the leg; and a fourth missile struck over the sacrum: Case 363.—Sergeant W. Shakespeare, Co. K, 2d Michigan, aged 18 years, was wounded in both lower limbs at Jackson, July 11, 1863. He was treated at a field hospital of the Ninth Corps for several weeks, and was then transferred by steamer to Cincinnati, where, on August 12th, he entered Washington Park Hospital. On June 1, 1864, the patient was discharged from service and pensioned. Examiner H. O. Hitchcock, of Kalamazoo, Michigan, in March, 1866, furnished the following description of the case: "Shakespeare was struck by a mini6 ball, which, after passing through the upper third of the left thigh and fracturing the femur, entered the right thigh and either fractured the right femur or perhaps chipped off a piece of bone, making its exit on the outer side of that limb. A minie" ball about the same time shattered the head of the left fibula, and another ball produced a flesh wound of the leg; and while lying on the field he was severely wounded by some missile over the sacrum. From this last injury he suffered long and severely. Before being taken from the field several corps surgeons advised amputation of the left thigh, which operation was opposed by Surgeon E. J. Bonine of the regiment, on the ground that it would not add to the chances of recovery. When the patient reached Cincinnati, union of the fragments had taken place, with about seven inches shortening, the fragments crossing each other at a considerable angle and one of them protruding from the wound. Acting Assistant Surgeon A. D. Norton, on August 14th, broke up the temporary union of the parts of the left femur and extended the limb. Three months later, when the case was examined by several surgeons, the parts were still ununited. At present there is complete union of bone, the right leg being one and one-fourth inches shortened, and the left leg one and three-fourths inches shorter than the right. The left femur is a little straighter than normal; the left leg can be flexed upon the thigh to an angle of about 30°; the foot is contracted, rather stiff, and sometimes painful. He suffers considerably from neuralgia, is not as robust as formerly, and walks with the aid of a cane, his gait being rather slow and halting." Several years afterwards the same Examiner reported that the wound in the left thigh frequently opened and discharged pieces of bone and bits of lead. Drs. E. J. Bonine and H. A. Clelland, late Surgeon and Assistant Surgeon of the 2d Michigan, both testify to the injury of both femurs, as well to the fact of amputation having been advised or ordered to be performed at the field hospital, and that the operation was refused or deferred. The former in his report on October 4, 1874, states: "The present condition of the pensioner, as I find by critical examination, is as follows: 'An open, suppurating, and discharging wound in the superior third of the left thigh,' the bone, having been crushed, lapping in the heal- ing, so as to shorten the leg from two to three inches. Bone denuded; partial anchylosis of knee," etc. Examiner Hitchcock, at subsequent dates, lastly in December, 1877, added that "there is a sinus leading down to diseased bone in the left thigh, which is open and discharging more or less nearly all the time. The left knee is nearly anchylosed and is swollen; the foot is tender and the toes are stiffened in a deformed position," etc. The pensioner was paid June 4, 1879. Pension Examiner O. H. Hitchcock presented to the Army Medical Museum a card photograph of the patient (Vol. I, p. 2, Card Photographs). A copy is represented in the wood-cut (Fig. 137). Fig. 137.—Shot fractures of the upper thirds of both femurs. [From a photograph.] 182 INJURIES OF THE LOWER EXTREMITIES. |CHAP. X. Forty-six of the five hundred and fifty-one Union soldiers who recovered after shot fracture in the upper third of the femur died during the fourteen years that have passed since the close of the American civil war, a fatality of less than 0.6 per cent, a year. In the following two instances the patients survived the injuries eleven and ten and a half years, respectively: Case 369.—Corporal T. Crassley, Co. E, 69th New York, aged 34 years, was wounded at Fort Steadman, March 25, 1865, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon F. M. Hammond, 126th New York, noted: "Shot wound of hip by miui6 ball." Assistant Surgeon C. A. Leale, U. S. V., reported that the wounded man was admitted to Armory Square Hospital, Washington, April 1st, and discharged from service July 25, 1865, by reason of. "shot fracture of upper third of right femur, resulting in one inch shortening." The Albany Examining Board, consisting of Drs. R. B. Bontecou, W. H. Craig, and C. H. Porter, certified, September 11, 1873: "The ball entered near the right trochanter, injuring the bone seriously. Numerous portions of bone were removed. The missile passed deeply through the muscular tissue and escaped near the inner border of the right nates. The limb is greatly weakened, and occasionally ulcers appear near the entrance wound, owing to necrosed bone." The pensioner died at the National Military Asylum at Dayton, Ohio, January 8, 1876. The immediate cause of his death has not been ascertained. A photograph, taken at the Army Medical Museum in July, 1865 (Surg. Phot. Series, No. 76), is copied in Fig 2 of Plate LIX, opp. p. 178. Case 370.—Private M. Murthra, Co. H, 159th New York, aged 18 years, was wounded in the right thigh, at Irish Bend, April 13, 1863, and admitted to the Marine Hospital, New Orleans, four days afterwards. Surgeon J. Bockee, U. S. V., described the injury as a "compound fracture of the femur at or near the trochanter," and reported that the patient was assigned to the Veteran Reserve Corps March 9, 1864. Surgeon G. Sutton, U. S. V., recorded his entrance into Augur Hospital, Alexandria, with " chronic ulcer," and his transfer to Sickels Hospital several days afterwards. On May 31, 1865, the man was discharged from service, Surgeon E. Bentley, U. S. V., certifying to "great deformity resulting from the fracture." Examiner C. Rowland, of Brooklyn, reported, July 28, 1865: * * * * "Many pieces of bone have been extracted from a large abscess still existing. The leg is three inches shorter than the other and quite lame. He is obliged to walk with a crutch," etc. The pensioner subsequently entered the National Military Asylum at Augusta, whence Surgeon J. O. Webster contributed his photograph in August, 1869, with the following recapit- ulation of his case: "The wound was caused by a mini6 ball, which entered the anterior aspect of the thigh in the upper third, emerging posteriorly, nearly opposite, and lodging in the pants. On admission to the hospital the limb was treated by sand bags, and by manual extension once a day. The femur united in bad shape, and another Surgeon coming in charge, it was rebroken and a straight splint applied. He was able to bear his weight on the leg eight months after the injury. The wounds have never healed, and the thigh now discharges in four places. Several splinters of bone have come away. He can walk comfortably with a cane." The Augusta Examining Board certified, August 6, 1873 : * * * " The parts being thickly invested by muscles, masses of new bone have been thrown out around the fragments from the surrounding * inflamed tissues. Owing to the nature of the fracture, it being greatly comminuted, proper apposition could not be maintained. Masses of new bone were deposited as supports and the splinters enveloped with provisional callus, producing an enlargement of the limb at the point of the fracture. We are of the opinion that superficial exfoliation is going on in some part of the bone on account of the nature and quantity of the discharges, the limb having to be dressed several times during the day. The pensioner has, at short intervals, profuse haemorrhage from the posterior opening near the ischium. These bleedings are no doubt produced by sharp spiculse of bone cutting small arteries." The pensioner died December 26, 1873. A copy of FIG. 138.—Result of shot fracture ,. , A , x . ° . . „,.,,, , „ ™ „ . -*t ™„. . , of femur. [From a photograph.] his photograph, taken at the Army Medical Museum (Surg. Phot. Series, No. 236), is represented in the wood-cut (FlG. 138). In the next case the patient died from extensive inflammation and suppuration of the injured limb, caused by a fall, eleven and a half years after the injury: Case 371.—Lieutenant E. L. Postley,1 Co. D, 176th New York, aged 39 years, was wounded at Winchester, September 19, 1864. Surgeon E. S. Hoffman, 90th New York, reported his admission to the field hospital of the 2d division, Nineteenth Corps, with a "severe wound of the thigh, caused by a minie! ball." On September 23d the patient was moved to the Depot Hospital at Winchester, where Surgeon L. P. Wagner, 114th New York, recorded the following description of the injury: "The missile entered the right thigh at the upper third, one and a half inches below Poupart's ligament, passed through the limb outside the femoral vessels, and emerged one and a quarter inches below the trochanter major, fracturing and comminuting the femur. The limb was kept in a splint for ten days, after which some extension was made, and subsequently a sort of a Desault splint was applied for five weeks. No bad symptoms occurred. The wound discharged very freely. Not much bone came out, but some was removed at the time of the injury. By November 27th there was firm union of bone, with two and a half inches shortening and some outward curvature at the seat of the fracture, and the patient was able to throw his leg up." On December 1 The case of Lieutenant Postley is noticed by Assistant Surgeon JOHN HOMANS, jr., in his article: Cases of Gunshot Fractures of the Thigh and Wounds of the Chest, showing the Results of Conservative Surgery in the Former, in Boston Med. and Surg. Journal, 1865, Vol. 72, p. 11. ■■■*. :■-■ -.■■>. ■ ;i ;\\ / ■ •■ ?W .. ... ■ vU>.*#-*'••'■ ■■•vj^.*- ml '^M>i '#>*£ %•*■. "■ 'i'»» .,'"V'. '•'- * ■ , Ward phot PLATE LV _ -*JQ VIEWS OF A UN'TED HOT FRACTUPt 0'- EXTREMITY OF Ti'-E RIGHT FFMUR O/tIR FARS AFTB ' I.'ih ■ of I.ieid«anu»t I. .'. !',,-«; N..,, !, S., «:.59e, Sm-oM-i,: - .IVi'RFVi Tin ion sold'- ;.vs v.-mo r^ ' li■■;;■. i. 'm 0.6 ]vr •'•. 'ah eleven &. !u.r v., Fvti ,. -ail-ua-i, March 25. V! Ha-.-.r.i. hL 1 •:*■="■ r« \*> v York, '. ;! ,i 1':e wO-'iv! ■''■ " <>' v;r:r- •''>. l'"<8">, by veu^' !< ' ••"•T ,■,; Hoard, cc t'-''-: ■ . 'i v.i ar the right ' ■.»•(■;) v through ^l*•' ...;. -i.-aally ulcers- ap! ' ' Diyton, Ohio. J- .. ■">■ V1.-dical Mup- i • e;iu. s. v.. M i-.li>:. -t '. •. •. • ■' Vvi ' . ' •■.. vv;•;.■ ■i ,!lli' '..: h), phoi'^T. ■i ca-.o: i i; " * .1 v -•? c.m?..db\ in the i i : i-r ll> :■ ■■-■.i.:.rp.wl:.r i,.u to the- . ■Ohp^ai ' .' -, :u- r..;-A n> t'mur i ':,".! ':■! ' ::Mt -.r. :.H 8!il: ■:-'i'i; ' t ■ . ,. .-.■• -il d:tys aft*3Tv-:r, >U • ■ ■>i >,. H.-ki.'. v. U l~. V. ct-rtif '.n.: I r » Kovr (i i. ' ''.-ooklyn, io.i-m ^ ■: i, -\ i.r:»v> !■■■■;»> .i lorgi' ub-cev."-' >•"• ■ ;-,.. ,,,:.( II,- :-»r^'iged 1/> •..:.- ■ Ni.!i!:..-v Asylum •/ A':..' ■'*'. ., .-: i A. copy of s r.'prvw--•...; V,< :!,::!, --;-r, Sep!*.' .n- r .:• v "Jd il"r i-;on, Nin«M.-c.f h ..; v v ■ m >ved to tV I 'i:pot -.■ ■ri'.ttlor. ■' theinjiiij : "The • ■'.'•.i!lt' passed through the limb ;.;. .. ii:K.furing ami u,,;j:i)iiiutirig the and s:ili.-C)nei;tiy a 6o r of a Desault >vy freely Not uiuch bone ciune nit, < of bon •, with two nnd a i ilf "aches ;. to rim .■!.;.•*!*:-• ."'' Ov. 'a'ml ->■ Mtd.a ?ur;i. Hist, of the War of the Kebellioit l'urt III,Vol.11. Ward phot I' Sinclair » San lith PLATE LV. _ TWO VIEWS OF A UNITED SHOT FRACTURE OF THE UPPER EXTREMITY OF THE RIGHT FEMUR OVER II YEARS AFTER INJURY Case of" Lieubt'imiit K.L. Post lev, 17(> V,' NewVork. Spec 6596, Surgical Section A.M.M. SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 183 9th he was transferred to Camden Street Hospital, Baltimore, and in the following month he obtained a leave of absence and proceeded to his home. He was ultimately mustered out April 13, 1865, and pensioned. Examiner J. Neil, of New York City, certified, April'24, 1867: "The thigh.is shortened about four inches; the limb is crooked and feeble; he requires the aid of a crutch." The pensioner subsequently entered the National Military Asylum at Hampton, whence Surgeon*W. M. Wright reported him, in 1873, as being in good general health, his Wound as well healed, and the fractured bone united, with five inches shortening, also that stiffness of the knee joint resulted from extensive adhesions of the muscles of the thigh. Two years after- wards spiculse were reported to have been removed from the wound, and, on March <>, 187C, Dr. Wright communicated that the pensioner had died on the previous day, stating that "he was able to walk well without the aid of a crutch or cane," and that " two weeks ago he fell, while intoxicated, upon his disabled thigh, which resulted in extensive inflammation and suppuration, from which he died." The greater part of the injured femur, comprising the two upper thirds, was contributed to the Museum by Dr. Wright, and constitutes Specimen 6590 of the Surgical Section. Illustrations of the bone are shown in Plate LV, opp. p. 182. Case 372.—Corporal E. Worthen, Co. B, 2d Vermont, aged 25 years, was wounded in the right thigh, at the Wilderness, May 5, l^til, and admitted to hospital in Alexandria three weeks afterwards. Surgeon E. Bentley, U. S. V., described the wound as a "shot fracture of the upper third of the femur," but the progress of the case was not recorded. On March 17,1865, the patient was transferred to Sloan Hospital, Montpelier, whence Surgeon H. Janes, U. S. V., contributed the following history: " The wound was caused by a minki ball, which entered the thigh in front, passed directly through and emerged posteriorly, at the lower border of the glutei muscles, comminuting the femur for about three inches. From the field the wounded man was taken to the hospital of the 2d division, Sixth Corps, at Fredericksburg, and thence by boat to Alexandria, where the limb was first adjusted, and kept in position by sand bags without extension. He stated that no other apparatus was ever used. Sub- sequently he had typhoid fever and erysipelas. The first fragment of bone was removed in July. 1864, and since that time about fifty pieces have come away. When admitted to Sloan Hospital the wound was still slightly discharging, but the patient was able to go about on crutches. About three months afterwards the bone had become so firmly united that he could walk a short distance without crutch or cane. When discharged from service, June 23,1865, the patient was in good general health, and able to walk a considerable distance on smooth ground without crutch or cane, the injured limb being shortened two and a half inches and considerably deformed. There was also necrosed bone remaining, and the wound still slightly dis- charging." Examining Surgeon C.L.Allen, of Rutland, Vt., reported, September 24, 1866: "The right limb is now three inches shorter than the left. An opening (the wound of entrance) still exists in front of the trochanter, into which a probe passes about four inches; another opening posteriorly (the wound of exit) allows the probe to pass in about three inches. A third opening exists near the middle of the inside of the thigh, having been made by the Surgeon for the dis- charge of the burrowing pus." The same examiner subse- quently certified that he was called on to visit the pensioner on October 23, 1870, and found him "suffering from pyaemia, resulting from the wound breaking out anew, from the effects of which he died October 25, 1870." A card photograph of the patient, taken at the Sloan Hospital, was contributed by Surgeon Janes (Card Photos., A. M. M., Vol. II, p. 22), an enlarged copy of which, taken at the Army Medical Museum (Surg. Phot. Series, No. 129), is shown in wood-cut (FlG. 139). Case 373.—Private G. Ruoss, Co. G, 7th New York, aged 27 years, was wounded near Petersburg, March 31,1865, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon F. M. Hammond, 126th New York, noted: "Shot fracture of right thigh." On the day following the injury the wounded man was sent to the Depot Hospital at City Point, and several days afterwards he was conveyed to Washington, where he entered Campbell Hospital, and subsequently Stanton Hospital. Surgeon R. B. Bontecou, U. S. V., reported his admission to Harewood Hospital September 12th, and his condition as follows: "The patient was suffer- ing from great deformity of the right limb, the result of a shot wound of the upper third of the thigh, fracturing the femur. When admitted he had so far recovered as to be able to sit up, and bis constitutional state was tolerably good. The fractured parts bad firmly united but with great deformity; the wound of entrance had healed, but there were still some discharges from sinuses in the thigh, and small fragments of necrosed bones were daily removed. The prospects of usefulness of the limb are unfavorable; otherwise the patient is doing tolerably well." At the closing of Harewood Hospital, May 1,1866, the patient was transferred to the Post Hospital at Washington, where he was operated on by Assistant Surgeon W. Thomson, U. S. A., who described the injury and operation as follows: "The wound was caused by a minie" ball, which entered on the anterior and outer aspect of the thigh about three inches below the great trochanter, passed inward and a little downward, comminuting portions of the upper and middle thirds of the femur, and escaped posteriorly near the middle of the gluteal fold. On June 8th, the patient was .etherized and a triangular incision, three by three and a half inches, was made on the upper and outer side of the thigh, and several pieces of bone were removed. On September 30th the wound had almost healed. Three sinuses, evidently FlG. 139,—Eesult of a shot wound of upper third of femur. [From a photograph.] FIG. 140.—Shot fracture of upper third of right femur. [From a photograph.] 184 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. leading to necrosed bone, however, 6till existed, two of whieh were located on the upper and one on the lower surface. The patient's health was not very good, having suffered from several attacks of diarrhoea, and a severe attack of ervsipelas which commenced near the wound and soon spread over the entire surface of the leg and foot. On December 31st the sinuses were still open and discharging, and there was great deformity, with about five inches shortening, and almost complete anchylosis of the knee joint." Assistant Surgeon J. Brooke, U. S. A., who took charge of the patient in November, 1867, reported the termination of the case: "I found the limb in much the same condition as described by Dr. Thomson, except that a collection of pus, which had formed on the inner aspect of the thigh just above the knee, had been opened and a sinus found to connect with the seat of the fracture. This sinus, as well as those already described by Dr. Thomson, remained open, and the patient continued extremely feeble, became greatly emaciated, and suffered much from diarrhoea and frequent attacks of almost total loss of appetite. These symptoms continued until his death, which occurred on June 27, 1868. At the autopsy the liver was found to be enormously enlarged, Aveighing ten pounds and ten ounces, and the right lung contained a small mass of calcareous matter." The injured femur, with the os innominatum and patella attached, and portions of the tibia and fibula were contributed to the Museum by Dr. Brooke, and constitute specimen 5450 of the Surgical Section. The femur is imperfectly united, with great displacement and a deposit of foliaceous callus, and shows that extensive periostitis has taken place, and the patella and upper portions of tibia and fibula also show similar pathological changes. The photograph represented in the wood-cut (Fig. 140) was obtained at the Harewood Hospital, and contributed by Surgeon Bontecou. Other photographs of the patient, taken at the same hospital and at the Army Medical Museum, are represented by No. 40, Vol. 8, of Photo's of Surgical Cases, S. G. 0.; Card Photo's, Vol. 2, p. 21, and Vol. 3, p. 27, and Surgical Photograph Series, Nos. 139, 178, 179, and 292. Fatal Cases of Shot Fractures of the Upper Third of the Femur treated by Conser- vation.—Of the twelve hundred and fifty-four cases of shot fractures of the upper third of the femur tabulated in Table XX, on page 175, ante, five hundred and seventy-two proved fatal. Pour hundred and eighty were Union and ninety-two Confederate soldiers. The side on which the injury was received was noted in four hundred and eighty-one instances, the right side being involved in two hundred and nineteen, the left, in two hundred and sixty-two cases. A few fatal examples will be cited: Case 374.—Private J. Northrup, Co. K, 77th New York, aged 21 years, was wounded before Yorktown, April 29,1862, and entered the Douglas Hospital, Washington, May 15th. Assistant Surgeon W. Webster, U. S. A., forwarded the specimen (Fig. 141), and recorded the following history: "The wound was caused by a conoidal ball, which entered on the outer side of the lower portion of the upper third of the left thigh, and was extracted through the gluteus maximus muscle on a level with and two inches from the anus, same side. The missile produced a compound fracture of the femur at the upper third and shortened the limb to the extent of two inches. On admission, the patient, who was of robust and healthy appearance, had considerable fever and constipation of the bowels. There was extensive swelling of the integuments, and he was suffering acute pain. Vedder's long splint was applied, and extension from the ankle and counter-extension by a perineal band was made. By these means the limb was lengthened one inch and retained in that position. The acute pain rendered any further extension impracticable. The patient was ordered to take one-half ounce of castor oil, and sulphate of morphia at night to relieve the pain. May 18th, the wound has been dressed with poultices of flaxseed meal; the swelling has some- what subsided and there is no fever. The pain continues, and to relieve it and promote sleep a mixture of two drachms of elixir of opium and one ounce of camphor water is given in two doses every evening. June 2d, the discharge has ceased and the external wound is nearly closed. There are some signs of union and of the deposition of abundant provisional callus. June 10th, the splint was removed; the shortening of the limb now amounts to three inches. June 16th, tlie patient was this morning attacked with chills and the initiatory symptoms of fever, a frequent and very weak pulse and red tongue, also great tenderness in the epigastric region, with frequent vomiting. The above symp- toms continued without intermission until terminated in death, at 11 o'clock P. M., on June 18, 1862. The autopsy, ten hours after death, confirmed the previous diagnosis of acute gastro-enteritis. The coats of the stomach were found to be intensely congested, with disorganization of the mucous membrane, which appeared to be greatest about the greater curvature of the stomach. The fracture was found firmly consolidated, with abundant deposition of pro- visional callus." The specimen consists of the upper half of the fractured femur, showing partial union at right angles and the shaft roughened by the action of Fio. I41.-Left femur shat- pus' als" callus somewha* copiously thrown out and entangling the fragments, tered below trochanters. Spec, but the inner surfaces being carious 27. ° Case 375.—Private F. Smith, Co. C, 121st New York, was wounded at Fredericksburg, May 3, 1863. Surgeon E. F. Taylor, 1st New Jersey, noted his admission to the field hospital of the 1st division, Sixth Corps, with "shot wound of thigh," and his transfer to general hospital June 13th. Surgeon A. Heger, U. S. A.,con- tributed the specimen, shown in the adjoining wood-cut (FlG. 142), with the following description of the case: "The patient was wounded by a round ball, causing fracture of the left femur at the upper third. He was admitted to hospital at Point Lookout, June 14th, very much reduced, abscesses and sinuses extending through the whole thigh from the pelvis to the knee. He FIG. 142.—Shot frac- ture of left femur. Callus without union. Spec.1810. i XTREMITIL.. .■If- 1 .«■•■ cr the en' i ■ foitnify • I" w; .» Ii. ■ 'ii'...'- i-l ui.t OP tho h;.vo:'i- ,i i, ,<:.<] :i t.»>vert' al'. >f trv.< ,iii! lv>' On Deci'tnbiT 31st, the si - '•' .-sl.oit i ng, and almost compile an-• i i't"i, ■ ,, •'. r.t in .'November, 1*Vi7, , •■,i,n • < ;i'- ; ' ■ Dr. i'liomsort, except t:ir* n, coiit.tion . l... • k opcm d and a sinus found to i -inject r "! • 'jv.ri'ii, remained open, and tii" pa Unit ; in--' frequent attack.1-- ->f almoM.'.otnl .'' M-f'** At the autopir :'■<• liver was • ! ->pd a small mrc? <:' •.■alcareovr t'.!;ia aud fibula were contributed > ...'perfectly unit.:d, with ^■■v-n ■ ' ,i.id the pat.flla and <• -p- r • ,'•<J fne J" ^hot fractur. ■•: li'iudi-H ■. ■•''•. • r.nser- ■'■ ■ -\ , iiird of ■ ■ - -'.'enty-t w -•• ,"' ')V(.(i . . ■ ■ sol-! :^ T> . • i/i>;y-o.i;<. instances, ft in two hur.ufc.: ind :-\f ivixs won; I'd before V^rk-, .-■ a W. Webster. -T. S. A., f. .. .. vonoiilal ball, which >. .•••■ hrough the gluteu.- .i-ax ■ ■< '■lnpouud fract i in of '.!:'• '•■■■•. r hi v.nt, who wis of robu«! ^wellint: of the inHj_,'iii r !" r.n •■•• r i im acute pan ,. ant' s 'I'baie •- !•.....!"ll:i- . •: iuiii> ?i'>w r-.i .- .iiiiicki'd with i ,o, uk pu'se an-' .i li'.q'i- i.. vol..: i" t til t«l ii.: T .!• .. >-y, ton ho .•:•* . ..:■ teritis. Th ■;:sorL .,i;/.'.*-<...i ■ i. the gr»-..'■■• lared, \\: ■.: i; -f the ,-■,.,,.. .-.1 the ■' .1 ■,.-.. OJi . - o! i I depor- I ■ -1 f tbefrn/ti:,. ■ . ,uu , ..hencd by ; ,. ..«.', ir> of lungli'iL' tl i- 'ragmti. ', .', lOUt *>ii PlO. 142.—Shot fr.. (ureof leftfemi.r fa1.; is withoutunion, .'pv. \t ' . OIK. ,V ,: Vi l!.lb. ' .1 /. > otediiis a ,'j:-ion to-hi ii-i-l h< ■ ,■■ -' "t ': - l*r 7 ■ ■■/■a' bos; iuvi mo loth. Surjj-on A. > • . ! " i., . ith the fci (. .■> ;ii ■ ilcsciiption nf'"c cu.v v.-i- iM^.r third. lie as admit to i .. lo^piiiii koi.t hio'igh the vi.,.ic tliit . from t.. pel v.-. ■ '■.- He 'f '>.'■• ° ?jj '& 1 •1. >:^ ' ^ i> :*.;, **.< ^%: f-.Vp CNSOt.CMt' :.,v,NSHOT FRACTURES OF THE FEMUR lh.'-.ki.-\ im- uf Private .J. Huiiiiitoii . - •■.•wra EXTREMITIES. ,.■>,;.■'. > "i . n-d ont' ''_'" i!>.ee H.•']>.- .- V •- i'T": .;iined t>> c-xtei •. •i■• .it'-y and tho wo',> ! ■ i"'. "i; ■.\:is a.f.rain Iiiiu opi-;: ■ -v. in'!' > ■ ■■ hr,.:!1:c •-.ri..«.. ;•■■ .'H.. ■......_ •.' . { • ->. o-.i! • s [nr ■!• .. i'l'i :i • 'o::.-'.•'•.■• ■ .'• '■ ,.• ... ..):■•' Ii". !,-,ii. , t:s K(u.i-t',,i. (i 1 ■ i;!_•-■ • ■ •■■ movc it alv it. ' 11 ■■'•'qrcc.i. H- \ae -i «-.i,r.i to le .' • • piospoctn' obtain ' ■ . ;.,,•! ii. ■ liad L ii >;o i , ;■ "■ ,rW. a; < <" W<- '1 .tn>, ■ •» ■ three im hi' ■ >-i !'■-■ v ! > u totally dua'-if. : i :ierv ■■ . '> ici<.lM-n' »!■ !-•"■ ; ■'■■< i, ■ .■v-pterubtr 1--T7, !... i-vl tb ...,•...-■ '■ ■ <'.t-iation of ':.«m. * .•.,:*-ud ■ ... M. v < v ,f which, .'uk !• il w■•! i.y Aledii"' .,.,,. : ■'r wus paid M.i.n::. I .'. .-,... ■ .. 1 k. ar: il '-'.! year--. ...- •- n'ir.ded at ■■ ■ ■],'■ ■■>' IVom th ".;! i !■ v,.; , on " !i .-'..'!.li.iary ilospitui, «■■ ■*".- ;..uirv and that the pt.t . On j. i.-.iry l ,, • '■ u. uv-m M . ' New i ■ ■ ■• iti'.ii.-, n "'i-'-.'h, :■■ v • ,'(b's - r.or - -, >...i i ---• ' ■ : .'••iie :■•. n d ',' ■ . ■ •' *'id Xti I' pou- ■.;.- . u . i '.i'.«Tal ■ ... '.;.« life, .• •■■ • '"lV priatiou. • s afferw.;. ' • • -i employed a« a -.■• ; t. stiilV; ■ ; ''. -riW i-'-iisls ou ,..•,; s :in! '.•• I'lica E.v" liailiin^ ,-..'... •■! i" tioatrices, aud ■ ■. ■ i ■•;■«• i:, stil disease . . !..•-..•;. ; moved, some '• '-X. opp.. :=■ - '-presenta- . n,.;.-. ' ... i-jied by Lir. \ lu^diau, and ..LMllMO ...... J. Ha< ; ■ elio' wlui' <> } ioket duty at . ti 24, 1 ■* »L ..... ....:'■ .. V ..:•. Monrw \,h..nce Surq .-.>n x rciioi" i ,..i., . ' '"a". Tho bone, tho.-n ,;. ti:,.''' • > .*•!-..- k- pi up with occash' j-:;; ••..'• • nstantslight ( :.-■ ;> ,e [,- ti't.... . .K was discharged from nt-Avii". iui. i ■ . .'hi . i. of Wilmington, Del- 1-,: IV. ...•.!•■ .i' .''.:*• Y'V-.a . iJ|->puration." A Pev-ion ■■. ;. ''ning; -.<& r . • " ■ :ds has '.•••i-n -4Ui>ti u.iting ■ .■•. (>e;ieione>' ■•r.m ~~ '.'i•-)!..ij^raphs lm' ;h • j-:;ti.>>it :■'■•, Vol. *=■. S... ",-i . .., .('.>, p. 21. and V-..1. 3 -.• i.-!- t-vi- ■) ; " • 7lA, .(r. xfn.- ■. i.-t:!','. IVb-r^burg, A;'., Nc.v Jersey, no, !: ''Shot ■.,... w:.h sent to the Depo' i.'"-',tal at . ., '''' i .(■■ • •! .i,, whei.oo Acting Assist;' : •'• igeon i» , c .i«. it.; bill, wliicli struck the femur a".out six •t t-lmiit ^.onstitutior-.l di-turbance took pi: • and i of tho baV could i <<\ .■> ascertained. 'iV ,.a;L.ii .--:■ i. tin1 injured limb Wii;- l'om.d to be siiort»v ■ one and i.,i..m \v:is stiU iiicon-.i)!) rc ru! i'xtene:i"i )•_-, ■ >'ht: wim ■ -ii'dated, aud *lu pa'ientwae ai'o.' ■ ; '■ to &J . ■■• .ruhhes. Ii : -wig goi, 1 and his injured '.■v. -lioi" ;n'', ' an in,:!..'' ..■•'.- 14 187^ -'The ball i -- :£<'<1 througb ::. -us uw le, , u.inf tii- r ' i. wl.. n* it ^'M rtmainu. u«cle« in tho Mrd.and Sure- Hist, of the War of die liebolhoii, l'arl 111, Vol.ll.Chap X Ward pkot. J. Bien lith PLATE LX-CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fig. 1. Case of lieutenant J.BucMev 140 *• New York. Fie 2 Case of Private J. Hamilton Is' Delaware SECT. III.] SHOT FEACTURES OF THE MIDDLE THIRD OF FEMUR. 189 back of the leg and thigh are contracted, so that walking or even much resting on the limb causes spasms (cramps), etc." The pensioner was paid March 4, 1879. His photograph, taken at the Army Medical Museum on July 25, 1865 (Surg. Phot. Series, No. 72), is represented in FlG. 1 of Plate LXI. Case 386—Private J. Friederick, Co. F, 127th New York, aged 19 years, was wounded in the right thigh at Honey Hill, November 30, 1864. Assistant Surgeon J. F. Huber, U. S. V., reported his admission to hospital at Hilton Head, on the day following the injury, with "compound fracture of femur, treated with splints," and his transfer to Washington, May 7, 1865, but gave no account of the progress of the case. The following notes were furnished * by Acting Assistant Surgeon G. K. Smith, from Armory Square Hospital, and by Assistant Surgeon W. Webster, U. S. A., in charge of DeCamp Hospital, David's Island, New York. The wound was caused by a round ball, which entered the inner side of the thigh at its middle third, passing obliquely outward and forward, fracturing the femur and lodging. An attempt to stand on the limb after receiving the injury caused the thigh to bend to an obtuse angle at the seat of the fracture. The wounded man was placed on a shelter tent and conveyed to a steamboat, about eight miles distant, no examination of the wound having been made and no local support having been applied to the broken bone. During the night following the injury the ball was removed through an incision on the external aspect of the thigh. Cold-water applications were used, and a partial support was given by an arrange- ment of blankets around the parts. On arriving at the Hilton Head Hospital a surgical examination was made under chloroform, but with no operative result, the limb being exceedingly tumefied. Smith's anterior suspensory apparatus was then applied, and the topical applications of cold water were continued. This treatment was kept up until January 7th, when side splints, extending below the foot, were substituted, and the limb was maintained iu a straight position. This apparatus was continued for nearly two months, and during this stage of the treatment the swelling greatly subsided, and about a half dozen pieces of bone were removed by the attending surgeon at various intervals. The largest of these is represented to have been about three inches long, one-half inch wide, and one-eighth inch thick. An abscess also opened, spontaneously, about two inches below Poupart's ligament. In the latter part of March the side splints gave way to a fracture-box, the cold- water dressings being still persevered in. On May 1st all local supports by means of splints were cast aside, bandages and pillows being sufficient from that period in consequence of the advanced stage of bony consolidation. On May 10th, when the patient was admitted to Armory Square Hospital, the fractured femur had firmly united, with seven inches shortening, a marked deformity by an outward curvature of the thigh, and very limited motion of the knee joint. There was still a slight dis- charge, and the extremity of the upper fragment lapping by the lower fragment presented itself on the outer aspect of the limb, close to the external condyle, at which point the skin was ulcerated through, exposing the end of the bone. By June 1st the patient's recovery was so far advanced as to enable him to walk about the ward with the aid of crutches. About the last of June, however, he was compelled to resume his bed in consequence of the appear- ance of an abscess on the outer side of the thigh, which was opened and gave exit to about eight ounces of sanious and offensive pus. Up to this time the purulent discharges from the wound had been moderate in quantity and healthy in character. On July 5th, however, the several openings were attacked by gangrene, which rapidly extended up the thigh and destroyed the skin and superficial and deep fascia nearly the whole length of its external surface. This disease was, at length, arrested by the appli- cation of bromine, and by August 15th the wound had become filled with granulations, and cicatrization was progressive. On August 17th the patient was transferred to Douglas Hospital, where a subsequent exploration of the limb resulted in the removal of six small sequestra from the external wound. Simple dressings were now used, and no further operative interference was required in the case until after the arrival of the patient at DeCamp Hospital, where he was transferred on October 23d. At this date he was strong enough to walk from the steamboat landing to his ward on crutches, and bis general health was excellent. There were three apertures, two on the external and one on the posterior surface of the thigh, from which pus of a healthy appearance found exit in small quantities. An examination of the wound by means of a probe revealed secondary splinters, but not sufficiently approachable to warrant an attempt at their removal. The amount of new osseous deposit was considerable, but unfortunately the sequestra were found so intimately embedded in it as to cause their removal to be attended with great difficulty and even impossibility, and involving the sacrifice of so much new growth as to endanger the limb. On February 25,1866, how- ever, the further removal of necrotic pieces was induced by constitutional symptoms, which manifested themselves and indicated local irritation. Portions of the in volucrum were removed by the trephine and chisel, where necessary for the purpose, and small masses of dead bone were extracted from each of the orifices. One of the pieces, deeply situated, measured about two inches in length. As a seeming consequence of the operation the unfavorable constitutional symptoms entirely disappeared, and the condition of the patient and his wounds became highly satisfactory." In June following he was supplied with an apparatus for the injured limb by E. D. Hudson, of New York City, and four months later he left for his home, having been discharged from service November 25,1865, but re-admitted to the hospital one month afterwards. The Examining Board of Augusta, Maine, certified, in May, 1873, and in December, 1876: " The leg is withered and badly deformed, aud there are discharging ulcers all the time. He can perform no manual labor of any kind, and is confined to his bed a large part of the time. The leg, from knee to foot, is nothing but skin and bone." The pensioner was paid June 4, 1879. The wood-cut (Fig. 151) represents a photograph of the patient, taken August 15, 1865. (Photo's of Surgical Cases, Vol. 9, p. 16, and Surg. Phot. Series, No. 90.) Fig. 151.—Shot fracture of middle third of right femur. [From a photograph. J 190 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Card photographs, taken at a subsequent date at the DeCamp Hospital, were contributed by Assistant Surgeon Webster. (Card Photo's, Vol. 2, p. 22, A. M. M.) Case 387.—Private T. Miller, Co. G, 116th Pennsylvania, aged 18 years, was wounded at the Wilderness, May 5, 1864, and admitted to Armory Square Hospital, Washington, three weeks afterwards. Surgeon D. W. Bliss, U. S. V., described the injury as a "fracture of the upper third of the left femur, caused by a minis' hall," but the progress of the case, further than an attack of pleuro-pneumonia, in March, 1865, was not reported. On August 15, 1865, the patient was transferred to Harewood Hospital, whence Surgeon R. B. Bontecou, U. S. V., reported the following history: "When admitted he was convalescent from a wound of the thigh, the missile entering and fracturing the femur at the junction of the upper and middle thirds, passing through and coming out on the inner side, near the tuberosity of the ischium. According to the patient's statement his constitu- tional condition at the time of the injury was very good, although the wound was very painful. Severe haemorrhage followed the injury, with great tumefaction of the whole limb. The fracture box was used and counter-extension, and the treatment was supporting throughout. The patient had so far recovered as to be able to be about on crutches. The thigh had shortened about two inches and three-fourths; but otherwise the man was in good condition and in a fair way of having a useful limb." Two weeks afterwards he was transferred to Mower Hospital, and subsequently to the Post Hospital at Philadelphia, and in October he was finally sent to Harrisburg to be mustered out, his term of service having expired July 14, 1865. An apparatus for the injured limb was furnished on December 6, 1865, by J. M. Gemrig, of Philadelphia. Dr. J. A. McArthur, Surgeon of the SoldieiV Home, Philadelphia, October 17, 1866, certified to anchylosis of the knee joint as resulting from the injury, and described the wound as still open and requiring treatment. The Philadelphia Examining Board reported "almost complete anchylosis of the knee," in September, 1873, and two years afterwards the same Board stated: "The femur is curved antero- posteriorly—concavity forward. There are several scars on the front of the thigh, where spiculse were removed, aud the muscular structure of the thigh is much wasted. He alleges constant pain in walking." The pensioner was paid June 4,1879. A photograph of the patient, taken at the Harewood Hospital in October, 1865, was contributed by Surgeon Bontecou, and copied at the Army Medical Museum. (Photos, of Surgical Cases, Vol. 8, No. 142, and Surg. Phot. Series, No. 114, A. M. M.) A representation is shown in Fig. 2 of Plate LXI, opp. Case 388.—Private H. Shetter, Co. D, 7th Wisconsin, aged 30 years, was wounded at Gravelly Run, March 31, 1865, and admitted to the field hospital of the 3d division, Fifth Corps, where Surgeon A. S. Coe, 147th New York, recorded: "Frac- ture of middle third of right thigh by a mini6 ball." On the second day after the injury the wounded man was moved to the Depot Hospital at City Point, and several days later he was sent to Washington. Acting Assistant Surgeon G. K. Smith reported the following history: "The patient was admitted to Armory Square Hospital April 5th. The missile had entered the external portion of the thigh, producing fracture and lodging. On April 19th, a small opening ulcerated through the skin on the inner side of the thigh, about two inches below the perinseum, through which the hall was removed by the forceps. Tlie limb was bandaged in its whole length and laid upon a mattress, being supported by sand bags and extended by weight and pulley. On July 5th the patient was able to ride about the ward in an invalid chair, and a few days later he walked on crutches. By July 16th the bone had firmly united, with only one inch shortening, though there was still a slight discharge from the wound. The patient's general health was remarkably good." He was subsequently transferred to Harvey Hospital, Madison, and ultimately discharged from Camp Randall November 15, 1865, Acting Assistant Surgeon A. W. Greenleaf certifying to "shortening and total loss of power and strength of the limb." Examiner A. J. Ward, of Madison, Wisconsin, on September 8, 1873, reported over three inches shortening of the limb and anchylosis of the knee joint; and two years later he stated that the pensioner "will never be any better." The pensioner was paid March 4, 1879. Fig. 2 of Plate LXII, opp. p. 192, is a copy of a photograph of the patient, taken at the Army Medical Museum on July 16, 1885. (Surg. Phot. Series, No. 71, A. M. M.) Case 389.—Private H. E. Gumberts, Co. E, 136th Indiana, aged 18 years, was shot in the left thigh, at Camp Carrington, May 13, 1834. Acting Assistant Surgeon J. M. Kitchen reported his admission to hospital at Indianapolis on the day of the injury, and described the wound as a "fracture of the femur, caused by a musket ball." The patient was discharged by reason of expiration of service September 2, 1834, and subsequently he was placed on the Pension Rolls. In January, 1836, Dr. Kitchen communicated that he received a letter from the man stating that he could " run and jump as well as ever," and repre- senting "the injured limb, with the exception of a little shortening, just as good and useful as the other." Examiner H. M. Harvey, of Evansville, Indiana, certified, August 12, 1871: "The ball entered the thigh about midway between the knee and hip joints, on its outer aspect, passed inward, backward, and slightly downward, fracturing the shaft of the femur in its course, and emerging on the inner side of the limb. There is a large amount of callus around the seat of the fracture, and the limb is shortened about one and one-quarter inches. He complains of pafin in the knee joint, and cannot completely flex the leg upon the thigh." At a subsequent examination the pain in the knee was reported to be increasing. The pensioner was paid June 4, 1879. His photograph was obtained in July, 1866, and contributed by Dr. Kitchen to the Museum, where it was copied. (Surg. Phot. Series, No. 153, A. M. M.) A representation of it appears in FlG. 1 of Plate LXII, opp. p. 192. Of the four hundred and twenty-one Union soldiers discharged the service on account of shot fracture of the middle third of femur, thirty-three have died in the course of four- teen years since the close of the war, and one committed suicide. In the following two instances the patients died nine and twelve years after the reception of the injury: Case 390.—Captain R. T. Shillinglaw, Co. I, 79th New York, aged 32 years, was wounded in the left thigh, both upper extremities, and the right temple, at Bull Run, July 21, 1861. The injury of the thigh was caused by a conoidal ball, which fractured the femur obliquely at the middle third. He was made a prisoner and conveyed to Richmond, where the frac- ture was treated at the Alms House Hospital, by a Desault splint for one week, and by Smith's anterior splint for twelve weeks subsequently. Slight suppuration continued for nearly a year after the injury, with occasional elimination of bits of necrosed Ward pbot PLATE LXi - CONS-: F)y 1 I iihf .< A'iImi.CSS. V.'.; >'••!. ». ''A . I'iiss, I.' ■> V'., d< jiTlb, d t! e r -in-- o!" the ca-.c. furt'i'.T thi.u ai ,!'. wis tra!'..-:<■ r/ed ;•• TTa--e\vo"d i i -U:.i ho vns ' ; '.••*cenf *";■• :> ... , ., A 1..-.I ■■ i. ■..:= ;.:!■•• ._■ .■ iMiieii! * nt-i i ■■.. ■ 1 '. Severe bav 'p. ,i. ■■ ■. ■. ■< •-Mlii'Il, !,.l'l .'"M.IH-.. ■ X.' •■ (. ■,. Tin; ;i: .'' '■ ■ ' -di' i.-"led . '-ii- >"uy i)'' ha-. ,'■•:: i ^<'fu! li'Tib." ' '■ :-y>iti;) n. \ :''.i--f!ii'ii;i an 1 in . Ioly IL l-';."' -w. apparatus > J. A Mc * !■■':'■ Surgeon oi' .■■ nidi);, ii: ■'■:<• injury, and i ' i\'j),ii- t complete i ; i' ■ ■ .- :'t artero- .,'- :.iid the ■!■• *..1879. i ■ S i.'^cjii i T\. Smith ; ir«r,ile had euien.d the .i>.-i tbrmiufb 'ii . *Vn u!i .-vi by ti:>5 t'V '>■[,?. Ti.i- i vxuuided !■/ weight a., '. '.!•.• wa'.k'jii on crut'-.lies. '.' i'-■■■!.. rge rroia tV- )V;,rt -> fi, .-vi'.al, Madioi,n. .,,, i;a, \, ' 'iil-i1' ■■ Ttifviiio' i" iiid st:-i;.: ' •-.... ••;! J-eptomber H, iteir:)-- of ■ • -'..''d that tb • " Tnc j. '■- . i" I'■'-'■ ^ 'i "•!"■ . ... b.. A N -71, A. M. M n.,.r,,_ c. . ...ii. at CainpCarriug'oi ,-p ,j]. J. " -;)oiij on tbe day of tin- j •'fnicf1 . ,i- '*'K< barcred by rea^o-1 v. 18;j1. ■•■ ■ ' li l^-.iuary, 183'', j.>!\ . ,i a ](■- . . - wvi! is tvur." a-i-.l reprc- '! ..-.• Kxvi.ii .r II. M ': -.- '. .'.■■ . I: 'be diet ,".• •' :■■■■■■''. ''.),.:• '." its cour.- ■....,-., ' ■ - . and ue liinb b >'■. [II :!■•■ V.. ; I ■•! ' _ i '■•< the ]l?g IJpUl) ..- .•i'por,i"! ,'" "•> '. '.'---' . v. •:■! .niil dune 4 :'..»'.Hi b-, '>!. ;- ii ■(.<■■ . i ' ■- -ii.jc :t. \-. i- "oiiii'i! :..,,■.>*',.. :•;<.! of Pun- !.:•;.■ ... ,,. ,• ].<2. .iic: J i1!-; ■ .-l :lie ;>'.'r^']i:e on Ji«:ri'[iii- ,ivi v-thrc- i wo wod in tli- ■.'oursf' oommitted :-uicid<; In hk<• ioih ■. • >---ars after the receotl u of t'; .• imu v: \t-vYork. aged TO yeni-s. .> ■ - ■..■,:.■!. ■: '.•■ tb,- ■■'• i \ Jl 1861. The i:.,m-y <■! ''■ . ' ' - • ''• : le wa.i made a ui'^oinir ;.nd ,- -. . -. • !t -.-.pliiit i,.r one \ve«k, ard b. .S1..1 I. - ..; .:_, ■. year atlcr the inj uy , '.vit ; j 'cusi- ■'* ' ill' Mi'il and Surv Hist of the Wat- of the Rebellion .1'art 111 Vol II.Chap X Ward phot .1 Bien hth PLATE LXI- CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Fia 1 Case of Seroeant A.Rvder 121 :*■ "Nw York. Case of Private T. Miller 116 * Penn s vl vania . }■ SECT, in.] SHOT FRACTURES OF MIDDLE THIRD OF FEMUR. 191 FIG. 152.—Shot fracture ..! middlo third of left femur. [From a photograph.] bone. Having been exchanged on December 31,1861, he proceeded to his home in New York City, where he was treated, for a time, by his family physician. Some months afterwards he returned to the field, and served as Acting Aid-de-Camp to General Wilcox until January 20, 1863, when he resigned the service. In August following, Captain Shillinglaw was commissioned in the Veteran Reserve Corps, in which organization he remained until August 2, 1865, when he was finally mustered out and pensioned. After leaving the service he took up his residence in Washington City, and obtained employment in the U. S. Treasury Department. The photograph, represented in the annexed cut (Fig. 152), was obtained in June, 1866, when be visited the Army Medical Museum. At that time the injured limb was shortened nearly three inches, but he could walk briskly and without a limp. He used no cane and experienced little or no inconvenience from his wounds. Examiner J. Phillips certified, February 6, 1869: "Gunshot wound of left thigh, left arm, right hand and arm, and right temple. Compound comminuted fracture of thigh bone. The bone has united crookedly, and is about three inches shorter than its fellow; the muscles are attenuated, and the nerves of the limb so affected that he is constantly suffering. Gunshot wound of left elbow joint; ball lodged near the joint, which is now so weakened as to be unserviceable for labor. Flesh wound of right hand from piece of shell. The right arm was pierced by a piece of shell, scraping the bone. This wound impairs the usefulness of the limb. A ball struck the right parietal bone. He suffers but little from this wound." This pensioner died April 14, 1870, of consumption, superinduced by an attack of pleuro-pneumonia and gunshot wounds. Case 391.—Private J. Moran, Co. K, 25th Ohio, aged 22 years, was wounded at Bull Run, August, 30, 1862, and admitted to hospital at Alexandria four days afterwards. Surgeon E. Bentley, U. S. V., reported: "A ball entered on the anterior side of the left thigh, at the top of the middle third, passed though the linib, fracturing the bone, and emerged on the inner side of the thigh, at the bottom of the middle third. The patient was treated by rest and position, and the bone united with considerable shortening. He was discharged from hospital January 30, 1863." The man subsequently joined the Veteran Reserve Corps, and was ultimately discharged from service March 28, 1865, and pensioned. Examiner S. S. Thorn, of Toledo, Ohio, October 3, 1865, certified to the " shot fracture of the femur, fol- lowed by three and a half inches shortening, anchylosis of knee, and impaired power of limb;" also to " the wound being still open and exfoliating bone." Examiner S. M. Smith, of Columbus, one year later reported the injured femur as affected with necrosis, and Exam- iner T. A. Reamy, of Cincinnati, in September, 1873, describes the "muscles firmly adherent to the bone at the point of the injury, an open sinus communicating with the bone anteriorly, and great angular deformity at the union of the fractured bone." The attending physician of the pensioner certified that he died November 11, 1874, of debility superinduced by necrosis of the injured femur, which was attended by continued exfoliation and suppuration. Fatal Cases of Shot Fractures of the Middle Third of the Femur treated by Con- servation.—Three hundred and forty-two cases of shot fracture of the middle third of the femur treated by conservation had fatal terminations. Eighty-six were Confederate and two hundred and seventy-four Union soldiers: Case 392. —Private J. Shimrock, Co. A, 55th Ohio, aged 20 years, was wounded at Chancellorsville, May 3, 1863. Surgeon G. Suckley, U. S. V., reported that he was left in the hands of the enemy, and described his injury as "a shot fracture of the femur." Twelve days after being wounded the man was paroled and admitted to the Eleventh Corps field hospital at Brook's Station, and one month later be was transferred to the Stanton Hospital at Washington. Surgeon J. A. Lidell, U. S. V., contributed the specimen (FlG. 153) and made the following report of the case: "Examination at the thne of admission showed that theright femur was broken near the junction of the lower with the middle third, and that union had not yet taken place. There was a copious discharge of thin pus from the wound of the soft parts. The fracture had been treated in a simple straight fracture-box, and the limb was still in it when the patient was brought to this hospital. He stated that the bullet had not yet been extracted from the wound. He was pale, thin, and weak, with a frequent pulse. His tongue was smooth, dry, and red, and he complained of diarrhoea, but said this was an old affair, and that he had also had chills and fever some tune back. The prognosis was very unfavorable. The broken limb was placed in Hodgen's splint; pills of camphor and opium were given to control the diarrhoea, and the system was supported with a nourishing diet, using eggs, milk, beef tea, farina, etc., together with milk-punch. June 18th, diarrhoea checked; tongue continues red and smooth; has considerable irritability of the stomach. Tbe pills were suspended, but the supporting treatment continued. 22d, secondary haemorrhage from the wound, to the extent of about three ounces, occurred this morning; there was also slight bleeding yesterday, some branch of the profunda being the probable source. Two drachms of solution of persulphate of iron was injected into the bottom of the wound through a catheter, and the haemorrhage did not again occur. 24th, complained of pain in the thigh, was restless, and had some diarrhoea. Gave one-grain opium pills every four hours until the 26th, when the diarrhoea was again checked. Suppuration continued profuse; tongue smooth and red. July 2d, patient appeared to be slowly failing. Fluctuation having been detected above the internal condyle of the femur, an incision was made and about two ounces of pus evacuated. Two grains of quinine was prescribed three times a day, and six ounces of whiskey daily was substituted in place of the milk-punch, which, the patient thought, did not agree with him. 8th, patient began to exhibit night sweats, with increase of pallor and anaemia; suppuration profuse, unhealthy and fetid; necrosed bone at the bottom of the wound firmly impacted. 18th, had a chill, followed by a hot and sweat- ing stage. Administered ten grains of quinine three times a day: chills did not return for four days. 20th, patient very pale 192 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Fig. 153.—Fracture of right femur at junc- tion of middle and low- er thirds. Spec. 1536. and feeble, with smooth red tongue; in addition to quinine he takes muriated tincture of iron, and porter two pints daily, with nourishing diet. 21st, diarrhoea returned and was checked by pills of opium. 22d and 23d, chills occurring at irregular inter- vals, associated with hot flushes and profuse perspiration. 25th, some unhealthy fetid pus was evacuated from the inner side of the thigh by incision. 27th, had pyaemie rigors and sweats again; is much emaciated and very pale; pulse 120 and feeble; tongue glazed and of bright red color. 29th, continuance of pyaemie rigors and sweats, the perspiration being very profuse; left leg and thigh oedematous and blue colored, the superficial veins looking like dark blue knotted cords; all of which denotes obstruction of the left iliac and femoral veins. The patient continued to sink, and died of exhaustion on July 31, 1863. Post- mortem twenty hours after death: Fracture of right thigh firmly united; necrosed bone closely surrounded by involucrum; muscles of right thigh extensively infiltrated with pus. The missile, a conical and much flattened bullet, was found at the lower and inner side of the thigh. The femoral artery opposite the seat of the injury contained an oval-shaped clot of blood (embolus) which completely occluded it; no other abnormity of the artery was noticed. On examination of the left thigh a metastatic abscess was found in the popliteal space containing about an ounce of pus, and the external iliac and femoral veins were dis- covered to be distended with coagulated blood. The femoral and iliac veins of the injured limb appeared to be normal. The liver was somewhat enlarged, nutmegged and fatty; kidneys beginning to be granular; spleen enlarged, softened, and reddish brown in color; lungs containing some frothy serum, otherwise natural; left ventricle of heart containing some coagulated blood." The specimen consists of the lower half of the injured femur with a battered piece of lead attached, and exhibits a fragment four inches long by one and a half wide, which preserved the vitality of its periosteal surface. The effusions from this fragment connect, as a bridge, the broken shaft; its internal surface is carious. Besides this, other and smaller fragments are entangled in the newly formed bone, some of which are necrosed and some serve as bonds. A wet preparation of portions of the common and external iliac and femoral arteries of the right side, showing an embolus in the latter near the seat of the fracture of the thigh, was also contributed by Surgeon Lidell,1 and constitutes Specimen 3454 of the Surgical Section of the Army Medical Museum. Case 33:?.—Corporal W. Ford, Co. B, 1st Colored Regiment, aged 20 years, received a shot wound at Petersburg, June 15, 1835, and was conveyed to Baltimore twelve days afterwards. Surgeon L. W. Read, U. S. V., reported his admission to McKim's Mansion Hospital with "shot fracture of left thigh." On July 25th, the patient was transferred to Hick's Hospital, whence Assistant Surgeon G. M. McGill, U. S. A., forwarded the specimen, shown in the annexed cut (FlG. 154), with the fol- lowing account of the case: "The patient suffered with a wound of the left thigh. The ball had entered the posterior part of the outer aspect of the middle third, pass- ing inward, forward, and slightly upward, and lodged. It was sought for several times but could never be detected. A large detached piece of necrosed bone was taken out of the opening of entrance during the month of September, 1865. The patient complained of continual pain, aggravated by pressure in both lumbar regions, in which regions there was extended flatness on percussion. He continued very weak, had several attacks of erysipelas, and finally sank, after a severe attack, on February 20, 1866. The injured thigh was greatly swollen, its skin shiny and somewhat tuberculated about the sinuses and slow-healing incisions. The diagnosis of fatty degeneration (interstitial formation and proper) was made for the left thigh and leg aud inferred for the great organs. Ford was a long time dying: For seventy hours or more his death was expected from hour to hour. Before death the surface of his body, in appearance, was waxen. The left leg and foot were gangrenous. There was a tumor (result of periosteal action) of the diaphysis of the left femur. The ball (much flattened) was found beneath the sartorius muscle and vessels in the middle third of the thigh. There was pus in the left knee joint, in the left hip joint, and in the superficial fascia of the left leg. No disease of the vessels was observed." The specimen consists of the left femur, obliquely fractured iu the middle third and partly consolidated by an excessive deposit of new bone on the posterior surface, the adjacent surfaces being carious, with a necrosed fragment remaining at the upper portion. Case 394.—Private C. Hill, Co. K, 7th Michigan, was wounded at Antietam, September 17, 1862. Surgeon G. Chaddock, 7th Michigan, reported his admission fe^ur fractaredi to the Stone House Hospital, near the battle-field, with "shot wound of the thigh." ^idd11043third" Surgeon B. A. Vanderkieft, U. S. V., forwarded the specimen, shown in the wood-cut (Fig. 155), with the following history: " The patient was wounded by a musket ball, which passed through the middle third of the right thigh, fracturing the femur. He came under my care six weeks after the injury, there being no previous history other than his statement that a small piece of hone was extracted a few days after the reception of the wound. On account of the normal appearance and length of the leg, the slight suppuration, the absence of other fragments and of any crepitation whatever, I diagnosed an incomplete compound fracture of the thigh, such as is often the result of an injury by a spherical ball received at short distance. (Patient stated that he distinctly saw the man who shot at him.) His general condition was very satisfactory. The fractured limb presented two fistular openings, one on the inner and the other on the outer side of the thigh at the middle third, and discharging but little pus. There was no shortness whatever, and if there had been a complete 1 Dr. Lidell, in an article on Thrombosis and Embolism, in the American Journal of Medical Sciences, 1872, Vol. LXIV, N. S., p. 343, gives a minute account of this important case. FIG. 154.— Oblique fracture of left femur in middle third. Spec. 255. Fig. 155.—Left £ <*>. fetid .rain; co:U is .iiu- i"i.:ar - ,: i , i-<.o 1' ■ Hurroiii'i' ,d and niv iosi'-3 the y it; no o> • • i.; fi.".in< cat ncr ■•! the '--suit i i' ;in i .. . .-. ■ 'i s el u,t bin-..) W.~ •' ,■ .,f, •;.,- ,..-.. ;.'id ti 'i'-i' "ii ' ;;o shortU" Mi ."»iJ :n Journal >f M'ii< •' - ' n» joint ,ii > n.iddic i'>."- ' > previous iop: 'i'V id. Ou ix>x.nv::' ji of any crt-pitation : !■' iji-rioal ball ■.I i •■-: wjmi very " be thigb ... -xunpleh -' . , MS, %*■■> >. M«',l ami Suiv 11 .st ofUir Wi.i-of theRi-bfllion.Kirllll. Volll.l'hav.X Ward phot J Bien Uth PLATE LXII -CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fifi 1 Case of Private H.K (Vumberts VM\ »* Indiana . Fi»j 1' Case of Private H.Sketter 7 *^ \\ i.s rou sm . SECT in.| SHOT FRACTURES OF MIDDLE THIRD OF FEMUR. 193 division of tlie bone consolidation had already followed. The limb was placed between two sand bags, acting as splints, and a plain dressing was applied. A very nourishing diet was prescribed. By tbe 17th of December the patient was doing very well; the inner fistular opening was closed, while the one on the outside was still of the same dimension, but discharging an ichorous pus mixed with small pieces of bono in the form of sand, such as is often noticed in caries of the long bones. On Jan- uary 9, 1863. notwithstanding the continuation of the discbarge of the aforementioned character, the patient felt well enough to sit up a short time in an arm-chair, but, on returning to his bed, he accidentally fell down, and, owing to the fragility of the injured parts, be fractured the same precisely at tbe corresponding point of tbe passage of the ball. Notwithstanding the most careful attendance no consolidation could be obtained, the whole femur seeming to be in a state of molecular disorganization, and having lost its normal firmness even as in racbites. The discharge of ichorous pus increased daily, and the patient died of exhaustion on March 19, 1833, no signs of pyrcmia having been noticed. Tbe use of phosphate of lime against the existing osteomalacia did not afford the slightest relief. According to the patient's statement, there was no constitutional predisposition." The specimen consists of the injured femur, and shows the formation of an immense sequestrum in the lower half and disease of the lower two-thirds of the shaft. Case ::9,"».— Sergeant T. Bechtold, Co. C, 93d Pennsylvania, aged 34 years, was wounded at Fair Oaks, June 1, 1862, and entered Hygeia Hospital at Fort Monroe nine days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: "He received a shot while in line of battle, the ball entering tbe anterior and middle third of the right thigh, and making its exit nearly opposite on the posterior portion of the limb; and while on the ground he was hit again by a conical ball, which entered the back below the inferior angle of the scapula and was cut out in the axilla. On June 12th, secondary hemorrhage from the wound in the axilla set in, which continued from time to time for four days, when it was finally controlled by pressure and plugging. The thigh was swung up in Smith's anterior splint, and imperfect union took place under unfavorable circumstances, the patient being very much emaciated and suffering from bedsores and diarrhoea. He was sent to his home in August, 18.52, and I learned that he subsequently died from the exhaust- ing suppuration, which, from tbe first, kept up from the thigh wound. Sequestra were removed whenever discovered, and the fascia of the thigh relieved to prevent burrowing." The patient died at Lebanon, Penn- sylvania, on September 24, 1862, whence the specimen represented in the wood-cut (FlG. 156) was con- tributed by Dr. B. F. Scbenk. The specimen embraces a portion of the fractured femur, and shows a remarkable instance of reparative effort. The fragments are thoroughly involved with callus, and a large sequestrum is nearly detached. There is also an accidental post-mortem fracture of the specimen one inch below its superior border. Case 396.—Private Tobias Bever, Co. C, 57th North Carolina, aged 30 years, was wounded and taken prisoner at Rappahannock Station, Virginia, November 7,1863. Surgeon John A. Lidell, U. S. V., reported: "The bullet entered the left limb one and a half inches to the inner side of the inner margin of the patella, passed upward and outward, fractured the femur five or six inches above the knee joint and lodged; its locality could not be ascertained. He was admitted into Stanton Hospital November 9th, his general condition being favorable. Tbe synovial pouches were apparently unopened. The limb was placed in Hodgen's splint and a „F?G-] 56-—Portion moderate amount of extension applied; the wound was kept wet with cold water. Some synovial effusion into tured in middle third. the cavity of the joint occurred on November 21st, but no other untoward symptoms were present. November pec' 30th, doing well, wound healing, but little effusion in the knee joint; general health good; bullet still unextracted. December 1st, the external wound is healed; there is a hard substance, feeling like a portion o*bone, or perhaps the ball, to be felt in the outer and back part of the thigh at a point corresponding with the fracture. December 25th, femur united and quite strong. The ball still remained in tbe limb, and its location was not surely known. On January 1, 1864, the extension was discontinued. He could move the limb very well; the amount of shortening was two inches, which was occasioned by overlapping at the seat of fracture. His general health was excellent, and he was out of bed almost every day, and appeared to be doing well until February 1, 1864, when the wounded thigh had become swollen (not circumscribed) and painful. Ordered to stay in bed for the purpose of resting tlie limb and to apply a lotion of lead and opium. The tumefaction of the thigh partially subsided on February 14th, but the lymphatic glands of the groin had become swollen, painful, and tender. March 2d, the swelling about the track of the bullet has increased and is very painful. Fluctuation is also detected. The cicatrix of the wound is tense and puffy; incised it and evacuated about two ounces of laudable pus. March 3d, the pain has ceased and the swelling has partially subsided. The discharge from the wound is thin, straw colored, and flaky. Directed the tincture of iron to be continued, with tbe addition of six ounces of whiskey daily. On March 20th, the swelling and soreness of the thigh had again increased. The discbarge continued free. There was also diffuse redness of the skin, extending from the wound up the inner side of the thigh. He was pale, anaemic, and felt very weak. Stimulants were directed to be continued, with such articles of diet as he could take. It was now apparent that he would not-recover without amputation of the thigh, but we were compelled to await the subsidence of the diffuse inflammation of the soft parts in order to perform that operation with any hope of success. March 22d, the discharge continues copious. It is thin and there is some blood mixed with it. He is somewhat emaciated and slowly failing in strength. March 24th, copious hasmorrhage from the wound, apparently parenchymatous in character, occurred this morning, and about half a pint of blood was lost before it could be controlled. Injected about two ounces of solution of persulphate of iron through a catheter carried deep into the wound, after which there was no more external hasmorrhage. The loss of blood reduced him very much. He gradually sank, and died on the morning of March 27, 1864. At the autopsy, in dissection, great oedema of the areolar tissue of the thigh was found. There was a large cavity beneath the fascia lata and surrounding the seat of fracture. It extended from the synovial pouches of the knee joint up to the trochanter major. It was lined with a moderate amount of plastic exudation. It contained about a quart of dark colored blood mixed with some pus. At the bottom of it, and toward the inner side of the femur, a mini6 ball was discovered. A piece had been split off from the side of it which could not be found. The medulla of the femur above the fracture was found to be bright red in color and soft in consistence. It presented the appearance described by Virchow as the 'red inflammatory marrow' (osteomyelitis). The fracture was firmly but irregu- SURG. Ill—25 194 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. larly united. Examination of the specimen showed that the bullet passed upward and outward from the orifice of entrance at the inner side of the knee, but without opening the joint cavity, and impinged against the femur about three and a half inches above the extremity of the condyles, fracturing the bone very obliquely with comminution, so obliquely, indeed, that while the line of fracture commences about three and a half inches above the extremity of the condyles, as already stated, it terminates about seven inches above the extremities of the femoral condyles, so that the lower fragment of the broken femur is, in all, abo"ut seven inches long. The fragments of comminution had all united with more or less irregularity of position, hut portions of some of them appeared likely to exfoliate. The two principal fragments had united at something of an angle opening fonvard and a little inward, so that the femur bowed backward and. somewhat outward on that account. The marrow at the place of exam- ination, a few inches above the fracture, was bright red in color, and presented a striking resemblance to newly formed gran- ulations. A few spots appeared to be undergoing the process of conversion into bone." The pathological preparation, Specimen 2167, was contributed to the Army Medical Museum by Dr. Lidell. A colored drawing of the specimen, prepared by Hospital Steward E. Stauch, U. S. A., is copied in the chromo-lithograph (Plate XXIV) opposite. Shot Fractures of the Lower Third of the Femur treated by Conservation.—Six hundred and twenty cases of shot fractures of the lower third of the femur were treated without operative interference. Instances of shot fracture of the lower third of the femur, in which the knee joint was primarily involved, are not included in this series; they will be considered in Section IV of this Chapter, with injuries of the knee joint. Three hun- dred and seventy-five of the six hundred and twenty patients recovered; two hundred and thirty-two died, and in thirteen instances the result remained undetermined, giving a ratio of mortality of 38.2 per cent. Five hundred and two were Union, and one hundred and eighteen were Confederate soldiers, and the proportion of deaths among the former was 38.7, among the latter 36.0 per cent. Successful Cases of Shot Fractures of the Lower Third of the Femur treated by Con- servation.—Three hundred and four of the three hundred and seventy-five survivers of shot fracture of the femur in the lower third were Union soldiers, and an account of the pension record has been obtained in two hundred and thirty-nine instances: Case 397.—Private C. H. Schellenger, Co. C, 9th New York Heavy Artillery, aged 35 years, -was wounded at Petersburg, April 2, 1865, and admitted to the field hospital of the 2d division, Sixth Corps, where Surgeon W. A. Childs, 10th Vermont, recorded: " Shot fracture of right femur; splints applied." Surgeon E. Griswold, U. S. V., reported the patient's entrance into Judiciary Square Hospital April 12th, and the fracture as being located at the "middle third" of the bone. He also stated that the treatment at first con- sisted of -simple dressings, and afterwards splints and sand bags were used, and that "the progress of the case was favorable throughout, the wound being nearly healed about the middle of June, with one and a half inches shortening of the limb." Tbe patient was discharged from service June 22, 1865, and pensioned. Examiner E. Hall, of Auburn, New York, certified, November 25, 1865, to " shot wound through right thigh above the knee, breaking the femur obliquely, the ball coming out on the inside of the leg near the scrotum. Limb shortened and knee quite stiff from thickened cartilage." The Syracuse Examining Board reported, April 5, 1876: * * * "The limb, he alleges, is lame, weak, and subject to spasms upon fatigue." The pensioner was paid June 4, 1879. His photograph, taken at the Army Medical Museum in June, 1865 (Surg. Phot. Series, A. M. M., No. 45), is represented in the wood-cut (Fig. 157). In the following instance the patient recovered with such excellent use of the limb that the Pension Examining Board recommended, in 1876, that the pensioner's name be dropped from the Rolls, as the disability had ceased and the injured limb was as well nourished as the other: Case 398.—Private J. Durst, Co. D, 69th New York, aged 21 years, was wounded at Hatcher's Run, March 25, 1865. On the following day he was admitted to the Depot Hospital of the Second Corps, at City Point, and, on March 30th, he reached Washington, where he entered Armory Square Hospital. Acting Assistant Surgeon G. K. Smith con- tributed the following history : "A mini6 ball entered the anterior aspect of the right thigh at the junction of the middle and lower thirds, passing backward and fracturing the femur, and made its exit opposite the wound of entrance. The injury produced very little constitutional disturbance, and the discharge from the wound did not exceed two drachms in twenty-four hours at any time. Tbe limb was treated in Hodgen's splint, without extension, until April 14th, when it was placed on a mattress with a sand bag FlG. 157.—Result of shot fracture of lower third of right femur. [Prom a photograph.] $/ fc.:-\ ■■"•#'. ■ .. "'.'*'■•■■ ^M' . »** 'v ^. I'-t- ■ ■■'ui.''civ nred Femur. . , r,». l Ii 1 -.,,. ;.!.:!. . 01 *v ,.f eritnince u. : i.-iicr anu .1 i all' mc)n>« ,. indeud, ll»nt ■ sidle the •.wily stated, i* ' -••'>'• ■ r'' i i'i m-.it i- • '- ■ n'Oii i '.;■■■ •: of .-one .- ■ ■•■] n-vl a ; txam- ■■.id gran- . !(, Specimen . ...... ,y Hospital veated by Cc.n •d of tk '■■ • on.—Six . • treat"1 ■■:■: i> ---a ', 1 si-.->' will :!;l-0 llLia- •,,,. ;. :; J red and .- , k.i-u, givint;; a -- ,;-° :.'.i-.l one hundred • :i-.' ,--. :'j^ tho fo'v-er was ■■' . ■:-:. ;:; (.' ■: ' ■ :■'•■.-...—Three .;, v.-e of th'" i«ni! * : vil"^ 1 ■'--•:• ■■•' ■■ -f *V ■'I. y*::V. tbe i-'d d " Shot fr.i tbe patiei •■•catc-d at -'-'■•.' A * . . .! I ■ ' of Lo •••: ■ ■ ■<. Exam..»e - •u:..l throuj/! . ut on thf !•■-. •. thicken •! t ••ension .me, 1 :-l.t. - .•:. wold, I. > ■, and the "'• it the tn-au <:\a wen- u ! nr: tu-ur'.i : ■■• pe • treated by Con- ■;:rv':\ ?r-- of shot ..f ;Lj pension . j{.iavyAvtd:«?ry, aged ■ to the field hoepixal of ";!i Venr.otit recorded: '., r.'p'irtod ■Hi, he'ug ■t first cn- i that "the , ubo.it 1!^i ;i:ili«llt. w.-it» of Auburn, i above tbe :.<.' near the .-:'. 'I'll? Syracuse !• ivleg's, i* k.me, I ,n«4, 187'J. Ilia '■..ut.Sw, A.M. M., ;jvered with such xrtrr.ir.'. • Board <;.i.i;v- " iiopped i the i. ; ir-'d limb ;..,er: Is, (VJth N«v,- y 'die follow •' . ;nt, und, ■■•• It: 1. '•'-■ uk d. 'lb.' right rbexv e-. .8 placed on a tuattress wi.b a Band bag •.-^ip-uit Surg Bufferd Bro? Clu-omohth N Y. Osteomyelitis in. a Fractured Femur. sect, in.] SHOT FRACTURES OF LOWER THIRD OF FEMUR. 195 on each side to keep it in position, and extension was applied by Buck's method. On June 9th the extension was removed and the bone was found to be firmly united, with one and one-fourth inches shortening. The patient was now walking on crutches. The anterior wound bad healed for about a week, but the posterior wound was still discharging very slightly. By June 23d he had good movement of the knee and could bend the leg to a right angle with the direction of the thigh. The discharge from the wound at this time did not amount to over one drachm in a week. No fragments of bone were ever removed, and the limb healed almost as kindly as a simple fracture, showing no deformity except the shortening." The patient was subsequently trans- ferred to DeCamp Hospital, David's Island, New York, aud, on August 19, 1865, he was discharged and pensioned. Examiner W. M. Chamberlain, on August 22, 1866, certified to a " well united fracture of the right femur, with only one inch shortening, and some lameness and debility of the limb." Substantially the same was reported at subsequent examinations until January 19, 187C, when the Now York Board certified to the injured thigh being as well nourished as the other, and to the disability as having ceased, in accordance with which the pensioner was dropped from the Pension Rolls. A photograph of the patient, taken at the Army Medical Museum in June, 1865 (Surg. Phot. Series, No. 46, A. M. M.), is represented in Plate LXIII, opp. p. 196. Case 399.—Private E. P. Allen, Co. D, 12th Infantry, aged 19 years, was wounded at Gettysburg, July 2, 1863, and admitted to the field hospital of the 2d division, Fifth Corps. The injury was caused by a mini6 ball, which lodged in the anterior portion of the lower third of the left thigh, and was removed on the following day by Assistant Surgeon E. DeW. Breuneman, U. S. A. The missile was contributed to the Museum by the oper- ator and is represented in the annexed wood-cut (FlG. 158). It consists of a conoidal ball beaten into nearly a triangular pyramid with very sharp edges. From the field hospital the patient was, on July 23th, transfer- red to the Cotton Factory Hospital at Harrisburg, whence Acting Assistant Surgeon W. S. Woods reported that be was discharged from service December 21, 1863, by reason of "compound fracture of left thigh." Examiner C- Hard, of Ottawa, Illinois, certified, May 1, 1869: "There is a compound comminuted fracture of the lower third of the left femur. The bones have united, with three inches shortening, leaving great and incurable deformity, and there is partial anchylosis of the knee joint, making him permanently lame." In Fig. 158.—Batter- September, lti73, the same Examiner stated that "the heel is drawn up, the foot turned out, and the limb moved from thigh! atrophied from foot to body." The pensioner was paid June 4, 1879. Spec. 3028. Case 400.—Private M. Burns, Co. B, 28th Massachusetts, aged 22 years, was wounded at Hatcher's Run, March 25,1865. Surgeon F. M. Hammond, 126th New York, noted his entrance into the field hospital of the 1st division, Second Corps, with "shot wound of left thigh." The wounded man reached Washington April 3d, and was admitted to the Armory Square Hospital, whence Acting Assistant Surgeon G. K. Smith reported the following history: "The missile, a mini6 ball, entered the anterior portion of the thigh at the junction of the middle and lower thirds, and, passing horizontally backward, fractured the femur and made its exit posteriorly. The constitutional disturbance resulting from the injury was very slight, the discharge of pus from the wound amounting to only about half an ounce in twenty-four hours. The limb was shortened two inches. It was placed on a mattrass, between two sand bags, and extension was applied with a sixteen pound weight. Muriated tincture of iron was ordered; but no stimulants were given. By April 15th, the discharge amounted to only one drachm daily, and the limb was shortened only one and a quarter inches. On May 11th, believing the fragments to be firmly united, I allowed the extension to be removed and the patient to ride on the invalid chair, and, on measuring the limb, I found that it was still shortened three- quarters of an inch. I reapplied the weight; but this contraction could not be overcome by any amount of extension that the patient could bear. He was now kept in bed until June 9th, at which time the fragments had firmly united aud he commenced walking on crutches. No fragments of bone were ever removed from the limb." The patient was transferred to the Readville Hospital July 5th, and subsequently to Dale Hospital, Worcester, where he was discharged and pensioned August 28, 1865, Surgeon C. N. Chamberlain, U. S. V., certifying to "fracture of femur, with moderate deformity and shortening and slight contraction of tbe flexors of the thigh." Tbe pensioner enlisted in the 43d Infantry on August 21, 1867, and was again discharged June 10, 1869. Examiner I. F. Galloupe, of Lynn, Massachusetts, certified, in 1869: "A musket ball passed through the left thigh, fracturing the femur. The wound is healed and the bone appears to be sound. The limb is shortened and he walks slow and with difficulty," etc. In June, 1874, the same Examiner reported: " In walking he does not touch the heel, but rests on the forward part of the foot, thus making locomotion slow and fatiguing. The limb is painful when much used and in cold weather. The femur is enlarged and the foot is swollen." The pensioner was paid June 4, 1879. Fig. 2 of Plate LXHI, opp. p. 196, represents a copy of a photograph of the patient taken at the Army Medical Museum on June 25, 1865 (Surg. Phot. Series, No. 47, A. M. M.). Case 401.—Corporal L. Tenney, Co. F, 82d New York, aged 20 years, received a comminuted fracture of the lower third of the right femur, at Gettysburg, July 2,1863. The following history of the case and its result was obtained from reports of Surgeon Z. E. Bliss, U. S. V., in charge of Camden Street Hospital, Baltimore, and Assistant Surgeon W. Webster, U. S. A., in charge of DeCamp Hospital, David's Island, New York Harbor: "The ball, believed to be cylindro-conoidal, struck the anterior surface of the bone external to the median line, and passed directly backward through the posterior surface of the thigh. Tbe patient stated that the limb bent beneath him, at the point of the fracture, directly the injury was received. Soon afterwards he was borne from tbe field on a blanket, and was deposited temporarily in a neighboring barn. The following day he was removed in an ambulance about the distance of a mile to a temporary hospital. There he first received professional attendance, and was placed under the influence of chloroform preparatory to amputation of the thigh. The examination, however, to which he was submitted, appears to have decided the attending surgeon in favor of endeavors to preserve the limb. A rough fracture- box was accordingly adopted, in which the limb remained subjected to cold-water dressings for six days, when the disclosure to the surgeon of three inches contraction of the femur induced him to substitute a double-inclined plane. The patient alleged that by this new apparatus the limb was restored to its normal length. About three weeks after the reception of the injury the double- inclined plane gave place to Smith's wire splint, whieh was employed during a space of five weeks. In the mean time the patient was transferred to the Corps Hospital at Gettysburg, where he remained until October 21st. The fracture appears to have been 196 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. thought suiHciently consolidated on AuguM 20th to warrant the removal of all mechanical support from the limb on that date. Tenncv stated that the limb was at that time of primitive length, and that he could raise the heel from the bed by tlie unaided muscular power of the leg. The posterior aperture gave constant exit to pus of a healthy character throughout the treatment. Tbe perpendicular direction of the wound, in tbe recumbent posture of the patient, is believed to have had a beneficial influence in this instance, as it lias in several other successful cases whose treatment has come under observation, in protecting the patient from accumulations of pus and securing an otherwise happy result. It will be observed that the fracture of tbe femur suffered by this patient was one of those typically favorable cases described by Stromeyer, where the femur is struck by the bullet on the outer side, remote from the great vessels, and tbe limb traversed in an anteroposterior direction, affording free escape to the secretion of the wound during treatment. About the middle of October the patient was able to move about on crutches, and on tho 20th of that month he was removed from Gettysburg to Baltimore. On January 1, 1834, he walked a distance of three miles without the aid of cane or crutch. One week afterwards an exploration of the wounds discovered small necrosed portions of the shaft, which were removed by Surgeon Bliss, under chloroform, by making an incision two and a half inches in length anteriorly, and another internally three and a half inches long. On April 23th the patient was transferred to DeCamp Hospital, at which time he was able to walk about freely without cane or crutch. The osseous case of new bone which surrounded the fracture was very large, and an operation performed by Acting Assistant Surgeon E. DeWitt, on February 18, 1834, for the further removal of necrosed bone, necessitated the penetration of the involucrum by the trephine to a depth of two inches and a half. Nine spiculse of old bone were removed during the operation, the largest of which was one inch long, a half inch wide, and one-fourth of an inch in thickness. About three weeks afterwards a thin fragment of sequestrum, two inches long and a half inch wide, was removed by the same channel. The patient received his discharge from service October 1, 1834, after which be was employed for nearly two years, in the capacity of a wardmaster, at DeCamp Hospital. At the date of the report, March 5, 18(16,. he was one of the most accomplished and indefatigable skaters at the hospital, and suffered no inconvenience from the injured limb, although the two wounds had not yet permanently cicatrized." Examining Surgeon T. F. Smith, of New York City, September 17, 1873, certified to the injury, and stated: " There are eight adherent cicatrices, with great loss of bone and muscular substance; movements of knee joint limited one-half," etc. The New York City Examining Board, two years later, reported that "the bone united with great thickening," etc.; also that "the cicatrices on the anterior, outer, and posterior surfaces of the limb are attached to the bone and at times take on ulceration." Substantially the same was reported at an examination in .September, 1878. The pensioner was paid June 4, 1879. Cask 402.—Private R. Hanlon, Co. C, 5th Cavalry, aged 21 years, was wounded at Beverly Ford, June 9, 1863. On the following day he was admitted to Lincoln Hospital, Washington, subsequently to Judiciary Square, and lastly to Carlisle Barracks, whence he was discharged May 16, 1864, and pensioned. Acting Assistant Surgeon G. K. Smith contributed the following history: "He was wounded by a minie ball, which entered the external aspect of the left thigh near its middle, com- minuting the greater portion of the middle third of tbe femur, and splitting the lower third longitudinally nearly down to the knee joint. Tbe missile lodged and could not be found. Ether was administered and the wound enlarged, and seventeen fragments of bone, comprising three inches of the continuity of the shaft, were removed. On June 23d, an abscess opened on the inner aspect of the thigh, near the perinseum, through which the ball was extracted. Tbe limb was bandaged in its whole length, placed on a mattrass, and kept in position by a sand bag on either side. Owing to the loss of bone no extension was resorted to until October 1st, at which time tbe patient was able to roll his injured limb on the mattrass, the fragments having united, though the callus had not yet become firm and hard. I then applied a ten pound weight, suspended by a cord and pulley, and succeeded in reducing the shortening one-half inch. This amount of extension was continued until I left Lincoln Hospital, on November 8th, but was removed soon afterwards. On December 16th, while moving about on crutches, the patient fell and refractured the bone. The surgeon in charge then applied a long splint to the posterior aspect of the limb, retaining it in that position and preventing any motion of the knee joint until the fragments had reunited. The wound healed in the begin- ning of March, 1864, but broke open again in the middle of June, and continued to discharge slightly until March, 1865, during which time, however, the man was able to walk about and to serve as a watchman at the Government Repair Shops in Washing- ton. On June 20th, 1865, the limb appeared perfectly sound, and at this period the man could walk all day without feeling tired, though there was fibrous anchylosis of the knee joint." Various pension examiners have certified at different dates to "anchy- losis of the knee and about three inches shortening of the limb." The pensioner was paid June 4,1879. Plate LXIV, Fig. 1, opp. p. 198, represents his photograph, taken at the Army Medical Museum in June, 1865.—(Surg. Phot. Series, ~No. 55, A. M. M.) Case 403.—Private J. O'Conner, Co. F, 16th Michigan, aged 16 years, was wounded at Cold Harbor, June 2, 1864. He reached tbe Fifth Corps Hospital at White House three days after the injury, and was thence conveyed to Washington, where he entered the Armory Square Hospital June 10th. Acting Assistant Surgeon G. K. Smith made the following report of the case: "A minie" ball entered the external aspect of the left thigh three inches above the patella, and, passing obliquely inward and upward, fractured the shaft of the femur through the upper end of the lower third, making its exit posteriorly. The patient was treated by Acting Assistant Surgeon T. O. Banister. Hodgen's splint was used, and no extension was applied other than the tying of the foot to the foot-board with a bandage. During the treatment eight small fragments of bone were removed. On December 27th the patient, though his wound had not entirely healed, was transferred to the Veteran Reserve Corps and placed on guard duty; but being unable to perform it, he was readmitted to the hospital for treatment several weeks afterwards. He came under my care on June 22, 1865, at which time he was in good health, but slightly lame and able to walk without a cane. There was still a slight discharge of sero-purulent fluid from the wound. The limb was shortened one and one-fourth inches, and, at the seat of the fracture, it was a little larger than normal but not otherwise deformed. On July 18, 1865, tbe patient was mustered out of service, with his wound still open." Examiner W. G. Wilkinson, of Farwell, Michigan, May 16, 1876, certified to the wound, and stated: "The fracture has been followed by necrosis of bone, several pieces having been removed during the year 1^7.">. The sciatic nerve was injured, and the veins are in a varicose condition. The wound has continued open." The pensioner was paid June 4, 1879. His photograph, taken at the Army Medical Museum in June, 1865 (Sur/. Phot. Scries, No. 49. A. M. M.), is copied in Plate LXIV, Fig. 2, opp. p. 198. •I lb.- Wrti-e, I.- KrWlliiMi I'litr '■-.J\':. ,mj^ i:-:&- ««*•*** wfc .,sp':>. . „ •;■•.. '■; iv*^'; •. -'^•.*':''f % ^ "■ >■•:&/ ' '•' 'S , '!';. M** ilf' .Hi • **-A\l /: ■■■'■ ■% .1. Bin. lull PLATF x;i( -CONSOLIDATED GUNSHOT FRACTnRES OFTHE FEMUR, Fit- i r.,. livatr N.-v Yuv Kis * I'iiso of Privtif,- M Kurm «JR ,h Massachusetts I I.Ml 1 ! i' \r. x. ■ •" -,.;1 ■ i. -,..... . . :.■'■ an eluuiiea! suppe. t from tbe 1ml. .. ■\ stated 'ia. ' ■ aai ra>t.-tin* boil from Ja.- bed i |.!i >., .■■■■■' • • -,! "■ ;':-eture ci •'"• :■ im.ir ii'4' •• •! .y tide patina e ;..« one of tho»e tvpi. ■ ■;- ...-,..,. a: ■ - 1' .ur i • struck t>.» iiiclniil..... be ■ a(. r fdd. . remote from tie -. ,■■ ai --.■!« ami Ii ; ■ -ion, aifnrd'."!- ■ • seap.i ■. '..< ■'•< :-t'iin m tbe wound duriii; tve.. -,. it. V i...... - ;:. ' ■■ ' "•• *" move abon1 • ■•., ■ ebes, i.-ui -n i: .i iii •„ it i:..)-,-|i Ij'u;,- ■ iiv.-d from (.'»••• \-!i. i-31, he walked a .!.-..t. .re of ibn c .i tlie aid of i !!•■ i> -retch. One \vc.k n!' ,-a:a-aa •. • ■ : •'•'scnvercl ^mall '■.'..■•••-••d ]ioi tb-,i-i -i.' vl.'-.'h \v:e r..-.' a.v. .1 by Surgeon Bliss ci lev i i,:< • ■.-a ' ' ' ana a hak - ' -. ,n!et-'b • ;■;•,.-Hi an'.'t'ie. i.:ti in il.y ll.ret. and :i bu'i'.•..ihc- lon^;. » > '. .-fern-d to OR'am, I i «- ■ i|: I, ii .bah tin,.- lie was i-bli- to walk about frtelv with >ut cane or t av ■ " '"'lie which mim- .id.-.: tho f: ..;■..■■ v^ v.ry h;i-'.-'-. and an operation p.atWa "d by Acting Ar-s.v .,,.. : . l-'etuu'lry 18, \f 1 for tbe in'i'nr -.vi... ' i •' >!,., m-. ! I..cme, noee*.-ii,iii.'d •!;• j ■ n tration of t • a.v ■ • ■: nth of two aula- Mid v half. !.'•. • :■■■.a • M bene were moved darn:: the operaf ■> -ina, a. ball' inch wide, and,;! ■■ . ' ■ ,n iin-li in thicl a -- Abo-it thi.-. v. eekfl r,'-< • 'wo inches lonu and a !..■![' •■.-■■•■ ','rdbytli - e -'lui'.ll' :. ''"be patiuit .-, ■ '• . r 1, H04. u»'> ".- u! I ieh la- -.\ • . ■•■ '■ ■■ r ly two year.. . n>« -'-.ipac-ity o>' a wm da ■■<- f the ri'ptiit, March a, I-- . .• •> - ,ni' - •• na.-tacerniplishwl and indela.pable >-k ■ i ■■■' ■ ' eiiieiice from ibe iiiju.-. ti n,i.. although i'i" two wo' ads had not yet pe rm anen dy <■ .-x,'./. • ■ • '-- ■■■I., "f New York City, • •■•>id»(-r 17, 18r;i ri-rtlhVd to tiie hiiuiy. and Mated: " Then ai.' ■•''_■■ • •>•'.•. ..'" '.">ia-i id Bins 11. --.b-t.-i-.i'.' :. ■ ■• a'-uta of kne- joint limited one-half, ' en- J ■ ' > y.-an, la', r, M't.-ni'.-d -I i "the !>• a .initfl v ith great -liickening,'' etc.; also 'i:.U •,.•■■■■ ••••.- an po?- liur mii fae. s •!' tb.- b.-ii' in attached b> the b ne and at times \.X- mi id.:>.•!■. ; •, " .-■••.& !.n..r:ed .;> :,u e\.uniiia inn i,i S<-pt»iiibei-, l'-?-1 The p-tr-• ■■■■• • '.-.'.is paid June 4. l-*7f>. (:.>.»■: 402.— .-'iivat- ii. i: ■:•.' ■ ••. «., ;..!. Cavalry, ng-A ■ ! Mais. •.-- ■•.:■• lone 9, 1«;:'.. On the i.,'i,.--, I'.iii d; y b- wa< ndniiii.'.i ' '.':...'n Hospital, Wuslui.. ••.. s.i'-.-f.^ii-m. ■ "v >,. 'i lastly t;.-( aili.-i.' Hanai ;^ --\'i • in. *■ hewa- is.-li. rr. \ iP, Li^i-i, and p"nsi': i" . Aot'i.. \.- '- ...i < i. I- - . .; i eontribufd the l-diowia^: b:.--., : '' >de n-.-.-.'..)■,:..:. i. . . -• i,i6 bill. v.' ltb witer, .1 ibe - xteir'.i. • •>.- Jeft t!..-. ; • ■ ''s r.iiddb-, eoni- ndni.tin;; ■',••■ .: ■ ■ -.•• • "]•,,,. ,,f t| ^ p, ..■,•,• ibicl ■>[ :b«; f.ii.n.r, and splitting the j '^••. ''ngiti l>\ ■ ■ ,y di".\:i to i!:e Ivi".'1 j'.'b.'. I' .-.-'de lodje'l an. •■ ;: -lot b> fo'ind Ether was adaiiniMenv ■ ■ wound • in.', -^evente'-n ■ :-.■ i-i'i • ---i i.-.uprising three in.-1, -■ ..f ;h ■ < .a innity of tlie shaft, wero nin--. ' •., J u 11 • ■ '..' ' ' --esn upeni d en ■ •'.' ■>'■ tb«' tliigh, n»i ai- the r.a i -nui •.hi-.m.;; -vhijli the ball was extr;. •'. •'. . -nl> -: in its \. hob; ■. i ■ ■ a ii.aMras-", an ' 1 ■;•' ir. "-,;i.m in. .. -. :. i l>a,' on itlier «ido. <•''. ■ -'^-' ;'eiiM. a was - -. '■ I'brr 1-t, ,'t whi i. tiii-.e i.-.n pa'ii-ni. •-.,..- a1.)- t<-roll his iinurcd !i., . •■• • ■' . ■ .•■< ats having ■ • 'i Ii :li. r-dle- b;vi not y 11 Jx-euiii'- t;r.n a-"'. ',.iV-.l ! , h.-n appJied a fa, p. ■ • l cord aud . ;. - .ei< d in reducing tl-e .diort«'mi g uin'-;i;.li incii lii- aiiionnt of . s. •• .•■ .: ■ ' •■ 11 Lincoln - .- . ■ N .- "iiditi- -'1.. be: wa.-s r- -in.ived soon ifecuards. t b I a ;, i ' , v h'nb.'■.-• a— 'he patient i. : ■ i'.e.ui'id the bone. The nun."-.-!! in ■ bar^,. then applied a. b ■ ■--pjiut to ;i ■>• : ■ , i.iainingi* -.'.- i' m and }»it renting any :ia.'i< ■ •■(' • a ■ '■■:■ >■•• >< at unt'! ■:,. ■ ..-.a"ius ha i >i- ... ■ • . ;| : ■; rbe be"in- :... i.' '.iar-.b. 18(>4. but i.-.jke ui .T; i...--.. ■ .. :. . 'die of dun-, nai ■'-. d: ' ■■■•.[. i^d"), Uin i. -.; . -, li.nvv. >-. the man was-.m -■: ,-.,.:■. •.' .. , -ndtowrve.-i •-« n'-.tit'ii:a it !..e '- ,,j,s in Wa?l inu- :.. 'a.,-' y('»t:;. J -«.'»■ the lin'' aj.p.- - ■! y.;-vt". -ti • I'-d, und at this p. r 't :. ;■ •* \"..""■".* pur-^i" :• -.. n-iiiiui-1 ! • ' ■ at .,; . .- -n "an.-).', io.-:- ! ■• '-:i"> a!" ." > ' .lin-. m.'-. ■■ •■ ■ 1bv!i'.. -. 'lae- a eaerwasp'' •: ■ : ,.vrtf IA 1V, I'iG. 1, opp ;• U'-. repre.s.'i*-^ !:i - p';aii.grap',. ? \. '.a \ y :iV M>- in ■' >lu,*.' .-n ■ ■dune, l;Ji ' .• „• '., \n :A. A. M V. , '.\-K 493.—Priv: te .1. U'Conne t', i IP'' vf',,-1, „Lr,..[ \ , ,, ■-, \v,:.-. • .-, Harbor, June '2, lyf.». ■:..- ea. ta-d tbe Fiftii Corps Hcwpital .-.- ,<. ■ •■ :• ■<. ni." . - ^i :.•,■•■ vved t.. Washington, .■'. ... • '.:.,-spt;. .? ><*'■ •■■-.-..-• . ii- fdln.ving re| art of a. • i" • \ n.ini.. b.lli rl'K'red the ext.T-u.a a ,,i. ,,:,^S' > abaale'v av:,! .' np'^ard. frar-'iii.-d tbo shaft «d't'.. .. .. . ,p ,,,,-... ,■'.,- 'j i,, in. ■-.■:•.: ■ . ': • .;!• d by A.::aig Afc^iKtai.* Sni„.-: : . i ■ ." . ■ .-.•■. .. . ■-'. ,; ; .,il. r than Mi-- -•' .. ■! ;'i( foot t" It:e t'-.t-bna'd v.-iti.- a ha • -..,;. -n- ■ . -i i. ..;.ved On lbt'a ■!..'!• /t. ■■• r;.i.ii i.;. 'b- ■■ a his wound '-... ,-■••■! i •" *.- - -i ■ : .-'laa I. < ■ :p-, and j'!j-eii •[■ d (b. y: In:' • a: ai-.i' .■ to pen'orn, [', u ■ • ■■.. • . :■ ' I Pn b<.hp. • ;'.. a. a. ta -evera! v.a . .-, I'r.vtms. II- ' ider iny ..: a-.- o : -I !••.- ... . ^'.'\ at wbiel. titi.e I.- •- ■ ■ . <■ .', . -;i.;,, b. c ..-:..;• I \ i:.,,. ' and able to ■■• ..1 - ...ih ■■•t.i :•• \.ih ^!i., a.- _ht di.~.! .•.'. of «ero-pnruleiii fliud f- :.. '■an:i"i : ' •• inn:. \:.,- -dK/ri.iied (,!i(, i.ri.-. . 'ii -I . . '. '.-■.'. 'be -.•;,• . t le frj.-t irt. V.aa- '. little largi I i; : ■ a'-aa.! ..•■[•■ nn. lai'l '.vice d< loriaed. On .Jui; l". I"''i..'. '-:< . ■■ a' s.'7-vice. -.«■.11 •.> -.'ind si:!1 op.->. I'.xin'i :. ■■■ V- . i.. Wilkinson, of rarwell, Michigan Ma; i- ■i ''•• • .lei. and stali.-ti . • 'J':. ■ i'raiti.n- ha- • ;■ f(.li..\vnd by ia cvcsis n:' line streral p;"ce.s Laving iw. a. 1-i7."< ': '.■• Iati<: ^rve was injur.- ! i.'id the veia~ are in i , rica :e eondiiii-:. Tha wound lia. • ■.".' I •■.....-am." ■ >\ a ■> p.dd Jum- J, 18?'''. H'd in-ob.graph. taki n at I'l-Annj. Mrdkv.: M-\■■■in in Jum . lfiil.. • ■■'■ • >« f.) A M V.A in copied ::i TT..>Tf I.NiS Vic, 0, opp. p. I9l M.'d ;uul Sui-v Hist of die Wiir of die lu'belboii. Part 111, Vol.U.Chap.X Ward phot .'. Baa, hll, RLATE LXIII- CONSOLIDATED GUNSHOT FRACTURES OFTHE FEMUR. Fig 1. Case of Pi'ivate J. Durst 69 tK New York I'Vj ^ Case of Private M.Burns 28 *b Massachusetts SECT. III.] SHOT FRACTURES OF LOWER THIRD OF FEMUR. 197 The records of the Pension Office show that, of the three hundred and four Union soldiers who recovered after shot fracture of the lower third of the femur under conserva- tive treatment, twenty-five have died since the termination of the War. In the following instance the patient survived the injury fourteen and a half years: CASE 404.—Assistant Surgeon T. S. Stanway, 102d Illinois, aged 33 years, was wounded during a fight with Guerrillas, between Lavergne and Nashville, December 21, 1833, a pistol baTl entering the left thigh about four inches above tbe knee joint, passing downward and out about two inches above the knee, fracturing the femur in two places. The limb was treated with simple dressings and kept upon a double-inclined plane. About two weeks after tbe injury an abscess formed, which was evac- uated through the lower wound. The wound healed rapidly, without loss of bone, and union took place between tbe fractured ends. About two months after tbe reception of tbe wound the patient obtained a leave of absence and went to his home, and on April 29, 1SC4, he returned to his regiment with a good limb of proper length. Soon afterwards he started with his command on the Atlanta campaign. In the course of six weeks, however,—owing to the want of sufficient nutrition,—scurvy set in, and the newly formed callus was gradually absorbed. Although keeping the limb supported by starch bandages, he became almost unable to step upon it, in consequence of which be resigned August 13, 1834. Some months after reaching his home partial union again took place, but tbe limb remained shortened to the extent of three inches. Dr. Stanway became a pensioner, and was examined on April 17, 1885, by Examiner J. A. Young, of Monmouth, Illinois, who described his condition as follows: " There is displacement of the upper portion of tbe femur downward and outward, with consequent shortening of nearly two inches. At present he suffers from pain, particularly during locomotion, owing to the slipping of the tendon of the vastus externus over the projecting end of the femur." The San Francisco Examining Board, in September, 1873, reported "an apparent movement in the bone at the point of tbe fracture," and several years later, " slight, overlapping of the extremities, occasioning deformity, also lameness," etc., was alleged. The pensioner died at Los Angelos, California, prior to May, 1878. Fatal Instances of Shot Fracture of the Lower Third of the Femur treated by Con- servation.—Two hundred and thirty-two such cases are reported: Case 405.—Sergeant Sewell T. Douglas, Co. G, 1st Maine Heavy Artillery, aged 28 years, was wounded at the battle of Spottsylvania, May 19, 1804, and was admitted to Emory Hospital, at Washington, May 22, 1834. A musket ball entering posteriorly, had fractured the lower third of the left femur and lodged in the medullary cavity. The injured limb was placed on a double-inclined plane and moderate extension was used. Internally, stimulants and tonics were employed. In August, 1834, the patient suffered from severe diarrhoea. There was a copious ill-conditioned discharge from the'wound. The patient died September 26,1864, from exhaustion, and, at the autopsy, a deposition of callus was found at the seat of in- jury, enclosing several necrosed splinters and a battered musket-ball. The speci- men (Fig. 159) was contributed to the Army Medical Museum by Acting Assistant Surgeon J. M. Downs. Case 403.—Private E. A. Dickerson, Co. C, 5th New Hampshire, was wounded in the right thigh, at Fair Oaks, June 1, 1862, and was admitted to the Fifth and Buttonwood Streets Hospital, Philadelphia, ten days afterwards. Acting Assistant Surgeon A. C. Bournonville reported the nature of the injury and its result as follows : "A compound comminuted fracture of the femur at the junction of the middle and lower thirds. At date of admission the wound was suppurating freely, with no effort at repair, though tbe patient was doing well. The treatment was by weights and sand bags. Death occurred on September 5, 1862." The specimen represented in the cut (FlG. 160) consists of a portion of the femur, obliquely fractured in the lower third, showing considerable but irregular effusion of callus without union, and the formation of a sequestrum in the upper fragment. It was contributed by Acting Assistant Surgeon W. Hunt. Case 407.—Private O. Hales, Co. F, 61st Georgia, aged 34 years, was wounded at Monocacy, July 9, 1834, and entered the General Hospital, at Frederick, three days afterwards. Acting Assistant Surgeon T. E. Mitchell contributed the pathological specimen (Cat. Surg. Sect., 1836, p. 468, Spec. 3934) and the following history: "The patient was admitted into this hospital with gunshot fracture of tbe left femur, lower third. He came under my care on August 29th, Smith's anterior splints having been applied to the injured limb. He complained very much of pain in his leg, which was swollen and discharging freely from the wound. His appetite was good, but his appearance was quite ansemic. I prescribed tincture of iron and quinine, with milk punch three times a day. On September 10th, I removed the splint and substituted Buck's apparatus with sand bags to the outside of thedeg. Under this treatment his condition remained much the same as when I first saw him. By October 1st, sup- puration was still continuous, and the patient was very much reduced in strength. On November 1st, his appetite was better and bis general condition slightly improved, though as yet there was no union of bones. On November 12th, I made counter- openings into the thigh and found sinuses extending nearly to the hip. On November 19th haemorrhage, amounting to about four pints, took place from the femoral artery, from the effects of which he died. The post-mortem examination proved that non-union of tbe bones was due to a small spicula of loose bone between the broken ends of the femur. The haemorrhage was the result of sloughing of the femoral artery, which, in all probability, was wounded in making the counter-opening." The specimen consists of a wet preparation of portion of the femoral and popliteal arteries, injected with wax, and shows the accidental wound of the vessel, enlarged by ulceration, from which the secondary haemorrhage occurred. Fig. 159.—Partially consolidated gunshot fracture of left femur. Spec. 32G7. FIG. 160. —Oblique fracture of lower th ird of right femur. Spec. 240. 198 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. Shot Fractures of the Femur without Indication of the Seat of Injury treated by Conservation.—Besides the shot fractures in the upper, middle, and lower thirds of the femur treated by conservation, considered in the preceding pages, there were seven hundred and thirty-eight cases in which the precise seat of injury was not indicated. In fifty-five % of these cases the result as to fatality is undetermined. Of the six hundred and eighty-three determined cases, five hundred and thirty-eight died principally in the field hospitals a few days after the reception of the injury, giving the large death rate of 78.7 per cent. The histories of these cases are brief, and give little information beyond the mere fact that the femur had been fractured; it is, therefore, not considered necessary to detail examples of this group. In two hundred and eighty-three cases the right femur was involved; in two hundred and eighty-two, the left; and in one hundred and seventy-three the side was not specified. Six hundred and two of the patients were Union and one hundred and thirty- six were Confederate soldiers. Pseudarthrosis after shot fractures of the femur was not frequent. Sixteen instances are reported among the three thousand four hundred and sixty-seven shot fractures of the femur treated by expectant measures. In seven cases the fracture was in the upper third, in three in the middle third, and in six in the lower third. Two examples1 will be cited: Case 408.—Corporal E. G. Abbott, 4th Indiana Battery, aged 21 years, was wounded at Stone River, December 31, 1862. He remained at a field hospital of the Fourteenth Corps for nine days, when he was conveyed to Murfreesboro'. Two months later he was transferred to hospital at Nashville, and subsequently to Louisville, at all of which places his injury was recorded as a "shot wound of left thigh." On April 14, 1863, the patient was discharged from Camp Chase, Acting Assistant Surgeon J. S. Bailey certifying to "Shot fracture of left femur, resulting in nearly two inches shortening." In January, 1871, Dr. A. L. Lowell, Special Examiner of the Pension Office, who saw the man several years previously, furnished the fol- lowing description of the injury and its result, which he obtained partly from his own observations and partly from a personal communication of Examiner L. T. Ballou, of Newark, Ohio : "A conoidal ball struck the left thigh anteriorly, about four inches below the great trochanter, and, fracturing the femur, passed backward and made its exit about one inch below the gluteal fold. He states that neither splints nor extension were ever applied to the limb. About September 1, 1863, the external wound had healed, but there was still some tenderness about the seat of the fracture, and as he further improved and began to use the limb with less care, he observed that it would rotate. At present he is able to shorten the distance between the knee and trochanter six inches by a sudden swinging and extending motion of the limb, which appears to throw the lower fragment to one side and is followed by voluntary contraction of the muscles. While in this position he is able to support his weight (140 pounds) on the limb, and he can then extend the same again to its former position by a little shaking, or, as he describes it, by a 'wiggle,' the thigh in either attitude being firm and inflexible. He can evert the left foot so as to place its heel to the toes of the right foot, thus placing the outer margin of the left foot in apposition with the inner margin of its fellow. These malpositions are com- pleted without eversion of the trochanter. The lower part of the shaft of the femur appears to slide up on the anterior and internal surface of the upper fragment. The upper and middle thirds of the injured thigh exceed the corresponding portions of its fellow one inch in circumference. This increased size is doubtless due to a large ensheathing callus which surrounds the lower portion of the upper third of the femur, and which is distinctly perceptible by digital compression. Sometimes, though only with great care, the man is able to walk well, his gait showing only a slight irregularity of step. The limb is often pain- 1 The remaining 14 instances of pseudarthrosis in the femur after fracture treated by conservation are: 1. Pt. J. Kissee, 1st Arkansas Cavalry, aged 29; fracture of upper third of right femur; Arkansas River, May 16,1864; discharged March 20, 1865; recovery, with li inches shortening and a false joint.—2. Pt. Joseph Patterson, G, 40th Indiana, aged 20; shell fracture of upper third of left femur; Stone River, Tennessee, December 31,1862; dis- charged April 21,1863; there is 3 inches shortening, and the ligamentous union or false joint renders locomotion uncertain.—3. Pt. Franklin Rosenbery, A, 148th Pennsylvania, aged 36; shot fracture of upper third of right femur; Spottsylvania, May 12, 1864; discharged May 15,1865; 1 inch shortening; there is cartilaginous union—the limb can be rotated on the thigh, and the foot is entirely reversed.—4. Pt. H. Meyers, B, 157th New York, aged 30; shot fracture of upper third of left femur; Gettysburg, July 1, 1863; discharged December 3, 1863; shortening about 2£ inches, with false joint at point of fracture.—5. Lieut. B. Button, B, 76th New York, aged 46; shot fracture of upper third of left femur; Gettysburg, July 1, 1863; discharged November 9, 1863; nearly 3 inches shortening and false joint.—6. Corp'l Franklin Cusick, H, 108th New York, aged 21; shot fracture of upper third of right femur; Wilderness, May 5, 1864; discharged March 31, 1865; shortening of 1J inches, leaving a false joint with eversion of toes.—7. Pt. J. F. Hutchinson, B, 7th Maine, aged 24 ; shot fracture of right femur at middle third; Wilderness, May 5, 1864; discharged July 7, 1865; false joint and 2 inches shortening.— 8. Pt. P. S. Chase, I, 2d Vermont, aged 20; shot fracture left thigh, middle third; Wilderness, May 5, 1864; discharged May 16, 1865; false joint and shortening of the thigh 2 inches.—9. Pt. J. L. Hanna, D, 95th Pennsylvania, aged 42; compound fracture- of left femur at middle; West Point, Virginia, May 10, 1862; discharged August 29,1862; false joint at point of fracture, and 3J inches shortening; muscles atrophied.—10. Pt. L. Paul, C, 12th Wis- consin, aged 24; shot fracture of lower third of femur; Kenesaw Mountain, June 15, 1864; discharged September 1, 1865; false joint and 2 inches shortening; varicose veins covering all the leg and lower thigh.—11. Pt. L. D. Boyd, K, 85th Pennsylvania, aged 24; shot fracture left thigh just above the condyles; Ware Bottom Church, May 20, 1864; discharged November 22, 1864; artificial joint and about 3 inches shortening.—12. Corp'l E. H. Morrison, F, 35th Illinois, aged 20; shot fracture right thigh about 2J inches above knee joint; Chickamauga, September 19, 1863; discharged January 19, 1864; false joint and about 2J inches shortening.—13. Pt. H. P. Mayer, A, 1st West Virginia, aged 22; shot fracture left femur, lower third; New Market, May 15, 1864; discharged October 10, 1864; weak cartilaginous union; can bring the bottom of his foot against his face.—14. Pt B. Whiting, C, 9th New York Heavy Artillery, aged 27; shot fracture right femur about 4 inches above knee; Cold Harbor, June 3, 1864; false joint above knee; limb shortened about three inches. M.'-i ..a B:fflM-4.''. ,✓* ■IV'- *'/ l.v. ~-...+s ■ I ■ ■ :: ffe™ ' - . ■■••';- -^M■;■■•?■% '"■' I 'a '■.*• ■"-^&Si':'- '■■ f> Va PLAT CONSOLIDATED ',: J'iES OF 1'HE FEMIJ >v !•! IhmW, ■■«.■:' I'ri- ,,i, il. '* Ml( . a A'K U •'.'■; ! ."!•.:• ,-'■■' « iThont Indicr«-xi .n of tho .Scnv of > a;y treated b••' '■.'•'-' in i' ■ .'i ■ i . .'.> ■ .!.»■ -. ' !!■! ! ■•■ ■ i, 'tie : T. t1'." •.'.•-" i ages, ti.ei'.' \V(;v • a ;. i ;;xlred ■•.-.. ,'■;"* ',vi? p.:A indicated . < ' .' :iv<- ' •■ !< ■' ^ , 'v.r.dred and v ri\ ■. ■. i . :> 'i1' . ;iie {]..»!;.{ I.OSjji'm- •. 'v ;' "'.7 :^t dent. The .. ■-, lej - in-.-! riero i'act tha the ■ avJ i)eer: •;;•. !''• derail example* of . m sTe ri^ht fe '-:.ii '.u. in vol* ;d; in !,wo ■■ ■ (•■i an - ^ever/v r- ihe f:id< 'vas not - ere Union un< o ■■ ' ■■■■n:^ ana thirfcv- :r.vasr.' !.. \ le'.it. Six'^^n in^tan et- r:J -; ./-.-even shot fraJ.nres ...•!: die ■ ;. re v/as ?n the ipper t!,i;'d ■' sampler-1 vih be cited: v -; ,.:"d at Storo I.'ivi••-, December 31, ••..-■ rneyed to A!'.rrrvt'.sbfjro*. Two ■>f which pinn . his njury was . <: :'■•.?,» Omp Chaw . "a-ting Assistant a' -.. c-' -* -.-./i-ti <;.;.' Iu January, . ,.<•,»..' pr ■> ... :y. i".?rn,.v.e»l the fol- < '•',•; ,>- " :. 'it from v. pf-rV'it.in! :■: 1i . ■ 'b '■ : : i "■ -'ragmor. '... i-nc t-idc 'inii ■■•;■..'■■ iii: wtM^'a: (\'.'i pounds) on 3-b ;!■. .. .•■. il....vi:va ■', by a 'wiggh\' ll ']■■', . • a .; . a : (, M,' !'• .'H >wt;n'[ig dii.' 101V .. ■.,' .J.f aiiai\ f .lit ■ • • ilAo '.; 'ii h" anterior a'lii He thirds'■>''in. inj.r. .. <'••■>.■. ■.■<>; r> ■:-. ' iirr portions of • tloubtleee uuo to ;i ■;... ■'!. a. . surrounds thi- >• •!« tlisti-ctly perceptilib; '■■■ :i .x - • m'tinie^ .tho jra i -bowi'a only a «lUr'ut •!■,•• < • . •,:. ..-• of: en uA..: V'oi in\• ii■■•• treated by ••. ■:«•;. • y, A/kaowa <. *valr. i: ' .vi'.'ii Mr- • -■ ■■.,.' ; ..Kirteninganlti' a.a' (• un\>- Oi >il "I loil : '■•: • ■:•-..■ l.i> «mber 31, 1 i ->', ihe • ■-■, union o: j..sf^ in: t •■ ', i'; i'ruii'rl.n T!' n nl. ■■■ ' ■■: ;"■ .nur: Spottsylvnr:. •.. .1 • -.,."i; 1 i "«h cn,1'::,i,; •.-.I 'Uf f«:rV 1'ntin ; »■ . i ■ -i ;,:cv Va; agrd .'•..' • c'm 1 ■ hi' a ■'. I'vi ":nl> a; f'.',.' ,/iut at ;v..ini <»f ■i !•*«•.' •;•; i . "a! a i.'..l: !;■■■••■;. r,r('il Nviv<>mb a cii-.-. .. : , ._-. i>u j i ;..,.■ .; ,,.„„ ]!, 7th ia •..!■';. • ,irt .-,-'. J ',■■■ . I.i i-ii'n'ng. -- . ■• ' . . ■' .M .; a'; ..-i'. - ■■ at -p.1 i. : , I ■ ...J.liu; Wi-'i" . . ' rgi.i'... -.- ,i.a,i _i'i. ;>t. i,. i'„.. ,; : :u: W.-- i-l -; '. !.8»;.". tilSfl Joilit ;•.. ' .' '..'-h-i . ! : a', t f>notun- ie.t thigh j. a'v • ... ! o n! i.r'ening.—12. C>-r; '■ 1.. i'. '.■.-. a' r IU, li^W, dlwharged .lanu , '" a ■ ii- aft ''.'uiur, lower tli>d; > .-.,.., Ai.-p.—14. Pt. n \\1 < Med and Sure Hist of the Wai- of the rebellion Hart 111 Vol.U.l'hui. X Waid pbot J. Bien Uth PLATE LXIV-CONSOLIDATED GU NSHOT FRACTURES OF THE FEMUR Fi«j 1. Case of Private R.Hanlon f, * U.S.Cavah-v I'i!i. IV (';,S(> (>!' Private .1.01 imiu 18 lK Miclrioaii sect, m.] EXCISIONS IN THE CONTINUITY OF THE FEMUR. 199 ful, and frequently he ia obliged to suspend his occupation as a laborer. During the winter of 1869 he could not walk without pain, and was unable to put on hi8 boot." Subsequent examiners report no changes in the condition of the limb. The pensioner was paid June 4, 1877. Case 409.—Private E. Gilroy, Co. F, 6th Vermont, aged 22 years, was wounded and captured at Savage Station, June 29, 1862. After remaining in the hands of the enemy for one month, he was exchanged and conveyed to Philadelphia. Acting Assistant Surgeon J. Neilhin charge of Broad and Cherry Streets Hospital, reported the following description of the injury: "A musket ball entered the right thigh anteriorly, three inches above the knee joint, passed backward and fractured the femur, and was removed by a surgeon on the field. The wounded man was admitted to this hospital on July 30th, at which time there was considerable swelling and inflammation of the thigh, also slight sloughing of the edges of the wound, which discharged healthy pus. The foot was everted and there was two inches shortening of the limb. The patient's health was good. A stim- ulating poultice was applied to the part and the limb kept in a Dessault apparatus, with side-extension and counter-extension, for six weeks. At the end of this time the wounds had healed, but there was very little, if any, union at the seat of the frac- ture. Two moulded splints of binder's board, with bandage, were then applied to the thigh, and Dessault's apparatus continued." Subsequently, on November 18th, " union of bone, with one inch shortening and fair indication of a good cure," was noted in the case; but at the date of the patient's discharge from service, February 23, 1863, the fracture was reported as remaining ununited. Examiner T. B. Nichols, of Pittsburgh, New York, reported April 15, 1838: "The leg is five inches shorter than its fellow and swings loosely, except when he lets his weight down upon it. In this position it supports him, but in no other is it of any use." In September, 1873, the same examiner described tbe injured limb as being shortened six inches, and stated that the man "can lift his right foot with his hand up against his breast." The pensioner was paid June 4, 1879. Comments on the various complications of shot fractures of the femur treated by con- servation—pysemia, tetanus, gangrene, erysipelas, and hasmorrhage—and on the different modes of treatment, will be reserved for the concluding pages of this section of Chapter X. EXCISIONS IN THE CONTINUITY OF THE FEMUR FOR SHOT INJURY. The results of excisions in the continuity of the femur performed during the American civil war have been discouraging, and justify the disfavor with which this operation is regarded among American1 as well as European2 surgeons. One hundred and seventy-five cases have been reported.3 In eight instances the terminations could not be ascertained. ■Hamilton (P. H.) (A Treatise on Military Surgery and Hygiene, New York, 1865, p. 517) remarks that he has never seen a case of shot fracture of the femnr that would justify excision. " The great depth of the bone and the attachment of the muscles to almost every point of the surface of the bone are, perhaps, the chief circumstances which render these operations so unsuccessful." GROSS (S. W.) (Military Surgery, in Am. Jour. Med. Sci., 1867, Vol. LIV, p. 478): " Resection of the femur in its continuity has proved to be a more fatal procedure than amputation at the hip, and should, there- fore, not be repeated." Ashhurst (John, jr.,) (The Principles and Practice of Surgery, Philadelphia, 1878, p. 167) asserts that "excision in the con. tinuity of the femur is a bad operation and should be definitely rejected from military practice." 'SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, etc., Schleswig, 1854, p. 166): "The resection of the splintered ends of the fracture for the purpose of converting the comminuted fracture into a simple fracture, as well as any resection in the continuity, is to be rejected in the femur." DEMME (H.) (Militdr-Chirurgische Studien, etc., Wiirzburg, 1861, B. II, p. 285): " The facts hitherto known justify the total rejection of resection in the continuity of the femur, even more so than the resection in the shaft of the humerus." NeudQrfer (J.) (Handbuch der Kriegschirurgie, etc., Leipzig, 1872, B. II, Zweite Halfte, p. 1521): "Even as an advocate of resection in the continuity of bone, one cannot defend resection in the continuity of the femur, as, in this bone, the indication for the resection is relatively rarely found, and as the risks attending its execution are very great. It is possible that a resection in the continuity for total caries of the injured bone at the point of fracture may prove successful; but, as yet, no such cases have been observed. It is also probable that, even in the most favorable case of recovery after resection for caries, the resected ends of bone would not unite, and that pseudarthrosis would be the result of the resection." 'Instances of excision in the shaft of the femur for shot fracture are not frequent in military surgery: 1. Boss (G.) (Militairarztliches aus dem ■ Ersten Schleswigsclien Feldzuge im Sommer, 1848, Altona, 1850, p. 54) excised 1J inches of the shaft of the left femur in a Prussian soldier, wounded at Dflppel, June 5, 1848; death from gangrene.—2. SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, p. 167) relates the case of a Danish volunteer, wounded at Holding, April 23, 1849; fracture at junction of upper and middle thirds of the right femur; excision April 26; death April 28, 1849.—3. STROMETER (L.) (Maximen, etc., Hannover, 1855, p. 757) tabulates a third fatal instance of excision in the shaft of the femur from the Schleswig-Holstein War, 1848-50.—4-14. Chenu (J. C.) (Stat. Med. Chir. de la Camp, d'ltalie en 1859 et 1860, Paris, 1869, T. II, p. 763) tabulates 6 cases of excisions in the shaft of the femur, with 5 deaths, and, on page 702, gives an extract from a report of Dr. BlMA, of the Sardinian army, who states that of 5 excisions in the shaft of the femur by the subperiosteal method, performed at the hospital at Vercelli, 4 proved fatal: A. Paschit, Regiment Archduke Leopold, admitted into hospital May 31, 1859; shot comminution of femur; excision June 5, after extraction of missile; sent to Verona, Aug. 4,1859; able to walk with the aid of a cane. E. Rigovich, Regiment Archduke Leopold, admitted into hospital May 31, 1859; shot comminution of lower third of femur; excision June 18; death September 13, 1859. E. Opodopic, Regiment Archduke Leopold, admitted May 31, 1859; comminuted fracture lower third of femur; excision of three centimeters of bone June 22; death July 6, 1859. L. Gerbitz, Austrian, admitted into hospital May 31, 1859; comminuted fracture lower third of femur; excision June 23; death July 23, 1859. M. Goldschmitt, Regiment Wimpfen, admitted May 31; com- minuted fracture middle third of femur; excision June 4 ; death July 17, 1859.—15-16. HEINE (B.) (Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 2'J3) reports that in the Schleswig-Holstein War of 1864, excision in the shaft of the femur was only performed twice by Dr. NeudSrfer ; the result is not indicated.—17. LOTZDECK (Zur Resection des Trochanter major, in Aerztliches Intelligenz Blatt, Mttnchen, 1870, B. XVII, p. 438) cites the case of Sergeant W. S----, 9th Infantry; fracture of left trochanter major, July 4, 1866; excision of trochanter in September; death November 9, 1866.—18-21. BECK (B.) (Chirurgie der Schussverletzungen Freiburg, 1872, p. 912) tabulates 4 cases of excision of the 6haft of the femur in the Austro- Prussian War of 1866; only one patient survived—22-37. ClIENU (J. C.) (Apercu Hist. Stat, et Clin., etc., pendant la guerre de 1870-71, Paris, 1874, p. 493) tabulates 16 cases of excision of the shaft of the femur, with 14 deaths, from the Franco-Prussian War, 1870-71; four cases reported by Feltz and Gbou.emund, and two by Roaldes, seem not to be included in M. Chenu's Statistics.—38-41. Feltz et Grollemund (Relation Chir. sur les Ambu- lances de Haguenau, in Gaz. Med. de Strasbourg, 1871, No. 11, pp. 131-134) relate 4 cases: J. Debat, 47th Line, aged 22, fracture of upper third of left femur, in August, 1870; secondary excision September 26; death October 2, 1870. Beschia Mohammed, 3d Tirailleurs; fracture of middle third of right femnr; excision September 26; death October 2,1870. Thomas Ferray, aged 20, 1st Algerian Tirailleurs; shot fracture of middle third of femur, prior to August 8, 1870; excision August 28; recovery. E. Plichon, 3d Zouaves, aged 22; fracture of middle third of right femur, prior to August 9, 1870; 200 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X Fifty-one cases had a successful, and one hundred and sixteen a fatal issue, giving a mortality of 69.4 per cent. Table XXI. Numerical Statement of One Hundred and Seventy-five Excisions in the Shaft of Femur for Shot Injury. OPERATIONS. Cases. Excision in the Upfeb Third. Excision in the Middle Third. Excision in the Lower Third. Part Excised not Specified. -d a> o> o •d 5 -d "a u o ■d OP s •6 "a » a? ■d a o -^ .2'"3 •d a > o o « ■d T3 a) a ■si -d u > o o •d s ■d "a O) P ■s£» .=■•3 IS •d > O IU M 1 ■a -d a S 3 1 C Zr B% M| 90.9 100.0 00.0 60.0 20 9 15 7 65 39 3 9 6 1 1 76.4 81.2 16.6 56.2 13 30 1 69.7 94.4 10.0 33.3 6 6 4 2 21 14 2 3 1 77.7 70.0 33.3 60.0 2 2 1 4 5 2 100.0 71.4 00.0 66.6 1 9 2 17 1 1 2 2 3 51 116 8 69.4 25 49 1 66.2 18 40 1 68.9 5 11 2 68.7 3 16 4 84.2 Primary Excisions in the Shaft of the Femur.—Ninety-one, or more than one-half of the total number of cases of excision in the shaft of the femur, belong to the primary group. In six instances the result remains undetermined; twenty proved successful, and sixty-five were fatal, giving a mortality rate of 76.4 per cent. Cases of Recovery after Primary Excision in the Shaft of the Femur.—Of the twenty patients who survived this operation, four were Confederate and sixteen were Union soldiers. The point of excision was in the upper third in twelve instances, in the upper and middle thirds in one, in the middle third in five, in the middle and lower thirds in one, and in one instance the point of excision was not indicated. Thirteen of the sixteen Union soldiers were pensioned and were living in 1879. In the following case four inches of the upper and middle thirds of the shaft of the femur were excised:1 Case 410.—Lieutenant W. M. Tirtlot, Co. F, 105th Illinois, aged-24 years, was wounded at Resaca, May 15, 1834, by a shell, which fractured the right femur. He was admitted to the field hospital of the 3d division, Twen- tieth Corps, where excision was performed but not recorded. On June 22d he was transferred to hospital No. 2, Chattanooga, and several days afterwards to the Officers' Hospital at Nashville. Surgeon J. E. Herbst, U. S. V., in charge of the latter, reported: "Shot fracture of femur, middle third. Primary excision of about four inches of the shaft at the middle third was performed on the field by Surgeon A. W. Reagan, 70th Indiana. The limb was treated in straight splints, and simple dressings were applied. Tonics and a generous diet were prescribed." ^£~lQlm__41 The patient went on leave of absence July 21st, and on November 28, 1864, he was mustered out and pensioned. inches of right The excised portion of the femur was contributed by Surgeon G. W. McMillin, 5th Tennessee, and is represented for oblique frac- in the cut (FlG. 161). Examiner A. Steele, of Oberlin, Ohio, certified, March 21, 1887: "Part of the femur is ture. Spec.215H. g01ie and the leg is short in proportion. There is exostosis of the femur, and suppuration is nearly constant; also anchylosis of what is left of the knee joint; unimpaired health/' etc. Examiner A. H. Steele, of Olympia, W. T., certified, October 4, 1873: * * "There is lateral motion of the knee joint, caused by the proximity of the injury destroying the lateral secondary excision October 25; recovery.—42-43. ROALDES (A. ~W.)(Des fractures compliquees de la cuisse par armes de guerre, Paris, 1871, p. 58, etc.) details 2 cases of excision in the shaft of the femur: Ch. Huart, Adjutant 193d Batt. Nat. Guards, aged 32; fracture of right femur at union of upper and middle thirds, May 21, 1871; excision June 2; death January 15, 1871. A. Cavarre, Lieutenant of Marines; shot fracture of upper third of right femnr, May 21, 1871; excision June 10; recovery.—44-46. SOCIN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872. pp. 135, 136) cites 3 cases of excision in the shaft of (he femur: A. Leonhardt, shot fracture of left femur at juncture of middle and upper thirds. Gravelotte, August 18, 1870; excision of 7 centi- meters of lower fragment; recovery. A. Leroy, shot fracture of right femur near trochanter, at Noisseville, August 31, 1870; excision September 24; death September 27, 1870. A. Primault, shot fracture of middle third of right femur, Worth, August 6, 1870; excision October 26; recovery, with 12 centimeters shortening.—47. FISCHER (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Chirurgie, Leipzig, 1872, B. I, p. 187) tabu- lates a fatal instance of secondary excision in the shaft of the femur.—48-50. Beck (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 900) reports 3 cases of excision of shaft of the femur in the 14th Corps during the Franco-Prussian War, 1870-71. One recovered, one died; the result in the third instance is not recorded.—51. TEITTOX (W. P.) (Excision of a Large Portion of the Femur after Gunshot Wound, in The Lancet, London, 1879, Vol. I, p. 117) resected the shaft of the femur on an Arab of the Turkish army, in December, 1877. The patient recovered, with 1J inches shortening of the limb. Of the 51 cases here cited, the results could not be ascertained in 3 instances; 12 patients recovered, and 36 died, a mortality rate of 75.0 per cent. 1 The extent of bone excised in the remaining cases was: One inch in 2 cases; two inches in 1; two and a half inches in 1; three inches in 2; three and a half inches in 2; four inches in 1; four and a half inches in 3; five inches in 1; six and a half inches in 1; trochanter major or a portion thereof in 3; and in 2 cases this point was not defined. SECT. 1I1.J EXCISIONS IN THE CONTINUITY OF THE FEMUR. 201 The limb at this time is more of an impediment 1870, he was furnished with an apparatus for his ligaments. There are also extensive cicatrices which are tender and painful. than an advantage." The pensioner was paid March 4, ls?i>. In Janua injured limb by the firm of Marsh & Corliss, of Cincinnati. Cask 411.—Lieutenant Dwight Beebe,5 Adjutant 3d New York Veteran Vols., was wounded on October 27, 1834, while in command of a skirmish line on the Darbytown Road, near Richmond. He was, on the same day, admitted into the Flying Hospital of the Tenth Corps, near Chapin's Farm. Dr. ('. M. Clark, late Surgeon 39th Illinois, under date of September 17° 18JO, gives the following description of the case : "The wound was made with a conoidal ball, which entered the right tliigh| outer surface, at the junction of middle with upper third, passing upward and inward, and making its exit at the upper and inner angle of Scarpa's triangle, slightly abrading the scrotum in its passage. On examination of the wound I found an extensive comminution of the femur, and removed sixteen (1G) fragments before the operation was decided upon. * * I made a longitudinal incision from the great trochanter down, to the extent of five inches, and took away the upper fragment with a chain saw at its junc- tion with the capsule (the bone above being sound). I then removed all the spicule attaching to the periosteum (which was preserved) and muscle, cleansing the wound thoroughly; then turned out the lower portion and removed it smoothly with the common amputating saw. Dr. N. Y. Leet assisted me in the operation." On October 28th, Lieutenant Beebe was taken to the landing near Deep Bottom, and placed on board a hospital transport and conveyed to Fortress Monroe, and admitted into the Chesapeake Hospital on the evening of November 1st. He was placed upon a fracture bed and received the best attention. There was a profuse discharge and the patient soon became exhausted. The upper extremity of the lower fragment necrosed, and a ring of bone seven-eighths of an inch in length exfoliated. This occurred in the middle of January, 18a."). After the dead bone was eliminated, Lieutenant Beebe rallied. On May 17, 1865, he was able to be moved comfortably, and obtained a leave of absence and went to his home in New York. He returned to the hospital July 9th, and, in September, 1835, again went to the north with his regi- ment to be mustered out at the expiration of its term of service (Circular 2, p. 33). In a letter dated Havana, October 27,18G8. Mr. Beebe says: "I continued to improve until I was able to get around with a cane and supposed I was as well as I would ever be, until August, 1837, when my wound broke out and discharged terribly for about three weeks. The medical men here thought it was brought on by irritation, being on it too much. Now, Avith the exception of the limb being quite weak, it only troubles me in damp weather, when it has a dull heavy ache. It has all healed. The flesh on the outside of the thigh is quite numb. My knee is stiff. My general health is not good, and my physician cautions me to be very careful of myself. The limb measures 3| inches short. Resection, 2i inches; necrosis of the bone, $ inch." Pension Surgeon G. D Baley, of Havana, N. Y., examined Lieutenant Beebe in November, 1867, and reported: "Right leg is three inches shorter and three inches smaller in circumference than the other. There is anchylosis of the knee joint. The patient has repeatedly been confined to his room six weeks at a time. The wound is now discharging, the limb is weak and painful. He is constantly liable to fall in walk- ing." In a letter to the editor, dated April 30, 1869, Dr. Baley describes the portion of the femur shown to him by Lieutenant Beebe's father, the upper division of the bone being "just below the greater trochanter obliquely downward from the outer side of the bone, to the middle of the lesser trochanter on the inner side; the lower division being a transverse cut embracing 1J or 1| inches of the upper section of the bone. I think the head of the bone could not have been removed, as there is now, and was at the time of my first examination, the full development of the greater trochanter and neck of the femur. There is at this time great tenderness and pain both above and below the section of excision, with frequent suppurations. There is also evidence of a loss of portion of bone two or three inches below the lower section of the operation." Pension Surgeon F. J. Bancroft, of Denver, Colorado, reported, in September, 1875: " Ball entered anterior portion of thigh, fracturing upper third, and made its exit near th# anus. Resection of two inches of the upper third of the femur was performed, causing shortening of three inches. The muscles are softer and smaller in this limb." Since that time the pensioner has been exempted from biennial examination, his disability being considered permanent. A copy of the photograph, furnished by the patient (Contributed Photographs, Vol. XII, p. 17), is represented in FlG. 162. He was paid March 4, 1879. 'The case of Lieutenant D. Beebe, Adjutant 3d New York, has been cited on page 32 of Circular 2, War Department, S. G. O., 1869, as an example of excision of the head of the femur. It had been stated by Lieutenant Beebe, in a communication to the editor, dated Havana, N. Y., Novem- ber 2, 1868, shortly before the publication of Circular 2, that " the head of the bone was not taken out." A letter of inquiry was thereupon addressed to Dr. N. Y. LEET, late Surgeon 76th Pennsylvania, who had been officially reported as the operator on the register of the Tenth Corps field hospital, requesting information in the case of Lieutenant Beebe, and, in an answer dated Scranton, Penn., March 9, 1869, Dr. Leet stated that "about four inches of the femur, including the head, was removed," and, in a second communication, dated April 20,1869, Dr. LEET asserted that "the style of the operation wns first a longitudinal incision, cutting directly in the direction the ball took until I opened the capsule, thus exposing the head of the bone; by carry- ing the limb over the opposite thigh and pushing the limb upward I removed the head of the bone by sawing through the trochanter with a chain saw." These positive assertions of Dr. Leet led the editor to accept, in such a matter of anatomical detail, the statement of the surgeon rather than the impres- sion of the patient. However, in September, 1869, after the publication of Circular 2, a letter dated Chicago, September 17, 1869, was received from Dr. CHARLES M. Clark, late Surgeon 39th Illinois. In this communication Dr. Clark gave the account of Lieutenant Beebe's case as detailed in Case 411, above, and added that Dr. N. Y. LEET assisted him in the operation. Immediately upon receipt of this communication, on September 20, 1869, a copy of Dr. Clark's letter was forwarded to Dr. N. Y. LEET, at Scranton, for comment on the issue as to matter of fact between Dr. Clark and himself; but no answer was ever received. In the meantime a letter had been sent by the editor to Dr. G. D. Baley, Pension Examining Surgeon, of Havana, where Mr. Beebe then resided, asking whether, in his opinion, the head of the femur in the case of Lieut. Beebe had been removed. Dr. Baley's answer, dated April 30th, is included in the history (CASE 411), and corresponds with the statements of Dr. Clark in regard to the extent of the operation: A letter from Lieut. Beebe, dated September 25, 1869, corroborated Dr. Clark's statement, and gave a description of the excised portion of the femur, then in the possession of his father. In addition to these facts, a letter was received from Dr. D. K. BUOWER, late Assistant Surgeon U. S. V., dated Chicago, Decern- Surg. Ill—26 PIG. 162.—Result of excision in the upper third of the femur. [Prom a photograph.] 202 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In the next case six and one-half inches of the shaft of the femur, from the great trochanter downwards, were excised. By means of a prothetic apparatus and with the aid of a small cane the patient is enabled to make good use of his limb, although it is shortened six and one-half inches: Case 412.—Private J. W. Joslin, Co. I, 7th New York Heavy Artillery, aged 20 years, received a shot fracture of the right thigh at Cold Harbor, June 3, 1864. He was captured, and while in the hands of the enemy underwent the operation of excision of the femur. After being a prisoner for more than two months he was paroled and conveyed by steamer to hospital at Annapolis, where Surgeon B. A. Vanderkieft, U. S. V., recorded his admission, August 26th, with "shot wound of right femur." On November 28th the patient was transferred to Jarvis Hospital, Baltimore, whence Assistant Surgeon D. C. Peters, U. S. A., reported that "the parts were nearly healed on admission, and entirely so on December 31st, when the patient was furloughed, at which time the limb was shortened six inches and could be swung backward and forward, but could not be exercised in lateral or rotary motion." One month afterwards the man entered Dale Hospital at Worcester, whence Surgeon C. N. Chamberlain, U. S. V., reported his condition as follows: " He is in perfect health; the parts are free from tenderness, and the limb is movable in every direction and perfectly under the control of the muscles. The upper end of the femur is enlarged, apparently by new osseous growth, to almost twice its normal diameter, and it has a good false joint." On August 29th the patient was finally transferred to DeCamp Hospital, David's Island, whence Assistant Surgeon W. Webster, U. S. A., contributed the following history: "The wound was inflicted by a minie" ball, which entered the gluteal region about four inches external to the os coccygis, passed downward, and struck the femur a little below the trochanter major, producing a compound comminuted fracture of the upper half of the shaft of the bone. Excision of six and a half inches of the femur, extending downward from a point immediately below the great trochanter, was performed by a surgeon of the Confederate army. This operation was done fifty-four hours after the injury, by a linear incision seven and a half inches long in the axis of the limb, beginning from a point opposite the superior portion of the trochanter major, and on the same day the patient was transferred thirteen miles in an ambulance to Richmond, where he was placed in hospital No. 21. He stated that he was in a very weak and exhausted condition when he reached Richmond. His limb was then placed in a fracture-box, and whiskey was administered twice daily, his diet consisting of corn and wheat bread and inferior soup. Extensive sloughing of the soft parts of the thigh occurred in the third week. On October 26, 1865, the patient was discharged from service, at which time a careful examination of the injured thigh revealed union of the trochanter major with the upper extremity of the lower fragment of the resected femur. There was also extensive deposit of new bone, and the degree of shortening amounted to six and a half inches. He could bear his entire weight upon the injured limb without producing any apparent yielding of the united bone. The flexion of the thigh was natural, and when it was rotated the trochanter major performed its entire and natural circuit. The thigh and leg were very much atrophied, but the knee joint flexed freely, and the cicatrix, though extensive on account of the sloughing of the parts, was firm and healthy. The gastrocnemius and extensor muscles of the foot were rigidly contracted, and the foot was extended to its utmost capacity." One week before receiving his discharge the patient was furnished by Dr. E. D. Hudson, of New York City, with a prothetic apparatus,1 consisting of a case of raw hides, laced upon the thigh and leg, and terminating in an artificial foot with ginglymoid articulations at the ankle and toes. By means of this appliance he was enabled to walk with ease, requiring only the aid of a light cane. In a communication from the pensionfr in March, 1868, he stated that "the apparatus works very well," considering the condition of the limb, and added that he had not had any abscesses about the hip or any part of the injured leg. Various examining surgeons at successive dates certified to the injury and operation resulting in shortening, etc., and the San Francisco Board added, in 1877: "The. result is good, and ber 24,1877, in which the following occurs: "CASE XXX, of the same Circular, in my opinion, is not correctly reported. I treated Lieut. Beebe from his admission into the Chesapeake Hospital until he was considered well enough to be sent north. This case, in my judgment, was not of the magnitude the report represents it. The fractured portions of the femur were removed, and the ends of the bone smoothed off; the head of the femur was not removed from the cotyloid cavity. In this opinion, I am pleased to say, I am sustained by Surgeon D. G. Rush of this city, who was one of the staff of the Chesapeake Hospital at the time the patient was under my treatment, and who repeatedly saw the case with me. He recollects distinctly to have felt, at the time the man was admitted, the head of the femur in its proper position. Surgeon Clark, of the 39th Illinois regiment, told me, a year or two afterwards, that he performed the operation, and described it just as I have done above." From a careful examination of all the correspondence and records on file in this Office, it is evident that the head of the femur was not removed from the cotyloid cavity, that an excision in the upper third of the shaft of the femur was performed by Dr. C. M. Clark, and not by Dr. N. Y. Leet, and that the account of the injury and of the operation as published on page 32 of Circular 2, on the authority of Dr. N. Y. LEET, is erroneous. On July 17, 1879, another letter was addressed to Dr. N. Y. Leet, asking him whether he would deny the correctness of the account of the case as furnished by Dr. C. M. Clark and the pensioner, Mr. D. Beebe. To this, as well as to a prior letter of similar tenor, no answer has been received at the date of this writing (September 8, 1879). This case has been published as an excision of the hip joint by Dr. H. Culbertson (Excision of the Larger Joints of the Extremities, Philadelphia, 1876, p. 64), and as a resection of the hip joint by Professor E. Gurlt (Die Gelenk-Resectionen nach Schussverletzungen, Berlin, 1879, p. 203), and it is to be regretted that the erroneous version of the operation has misled these reliable authorities on excisions. 1 The apparatus is figured on page 33 of E. D. Hudson's Mechanical Surgery, Prothetic Appliances and Apparatus for Amputations, Resections, Ununited Fractures, Diseases of Joints, Deformities, Curvatures of Spine and Paralysis, New York, 1878. FIG. 163.—Result of primary excision in tbe shaft of the femur. [From a photograph. ] SECT. III.] EXCISIONS IN THE CONTINUITY OF THE FEMUR. 203 the leg, by the use of a mechanical apparatus, is of use to the man." The pensioner was paid March 4, 1879. Photographs of the patient, taken in 1885, and showing his appearance without and with the apparatus, were contributed by Dr. Webster (Contr. Photo's, A. M. M., Vols. 9 and 10, pp. 31, 32, and 33) and copied at the Army Medical Museum (Surg. Phot. Series, Nos. 103 and 107). Tlie former is represented in the wood-cut (Fig. 163). Case 413.—Captain S. V. Shipman, Co. E, 1st Wisconsin Cavalry, aged 38 years, was wounded in the right thigh during the engagement at Whitewater River, April 24, 1863. Two days after the reception of the injury he was admitted to the Post Hospital at Cape Girardeau, whence Surgeon W. McClellarr; 1st Nebraska, reported the wound as "a fracture of the femur, caused by gunshot, for which primary resection of three and a half inches at the upper third was performed, the ends of the bone being clipped off. Patient left the hospital on leave of absence July 17th." Captain Shipman was subsequently promoted to Major, and ultimately mustered out as Brevet Colonel on July 19, 1865. In his application for pension he alleged that the ball was not found nor removed from his thigh until eight months after the reception of the wound. Examiner A. J. Ward, of Madison, Wisconsin, October 23, 1836, certified to the injury and operation resulting in contraction of the leg and stiffness of the knee, and added: "The pensioner lias had an abscess form three different times; the last time it laid him on his back some six weeks. It may recur any time, as there is evidently diseased bone in the femur." Dr. H. A. Martin, late Surgeon, U. S. V., in a letter, dated Boston, April 24, 1839, makes reference to this case as follows: "When I was stationed at Cape Girardeau a most interesting case, that of Captain Shipman, was under my care to a perfect successful issue. He lost nearly four inches of the whole shaft of the femur, including portion of the trochanters, and is now living, with a limb shortened some two and a half inches." This pensioner was paid June 4, 1879. Table XXII. Summary of Twenty Cases of Recovery after Primary Excision of the Shaft of the Femur for Shot Injury. Name, Militaiiy Description, and Age, Injury, Operation, and Result. Name, Military Description, and Age. Injury, Operation, and Result. Beebe, D., Adjutant, 3d New York, age 25. Brewer, J. W., Pt., C, 4th Tenn. Cav., age 40. 1 Button, F.H.,Musician, L 14th Mich., age 18. •B----, S.,7thKentucky Mounted Inf 'y, age —. Callioun. W. F., Serg't, F, 5th Virginia, age 25. Conner, S., Colonel, 19th Maine, age 25. Gebhardt, J.,Pt.,B, 149th New York, age 22. Harris,B.F., Lieut.-Col., fith Maine, age 32. Hartman, L, Pt., E, 24th Mich., age 16. Oct. 27, 27, '64. Aug. 14, 14, '64. July 6, 6, '64. April 6, 6, '62. Mar. 25, 25, '65. May 6, 6, '64. July 2, 3, 1863. Nov. 7, 7, '63. June 1, 1, '64. Right; three and a half ins. from junct. with caps, to level of troc. minor, by Surg. C. M. Clark, 39th HI. Mustered out Sept., 1865. Surg. Phot. 210; pens'd. Right; four and a half ins., inclu- ding great trochanter, by Surg. — Sevenson, 4th Tenn. Cav'y. Released June 16, '65; two and a half ins.shortn'g. Circular 2, 1869, p. 58. Left; four ins. upper third, by Surg. E. Batwell, 14th Mich. Disch'd May 5, 1865; pens'd; ligamentous union; three inches shortening. ----; two and a half inches from upper third, by Surgeon S. F. Clardy, C. S. A. Recovered; ends of bone united well; limb of great use. Right; mid. third, by Surg. G. R. Sullivan, 39th N. J. Erysipelas. Released June 11, 1865. Right; two ins., fragment, middle third, by Surg. J. F. Dyer, 19th Mass.; June, haems.; Sept., bone extracted. Disch'd April 7, '66, as Brig. General; pensioned; anchylosis of knee joint; leg entirely useless. Left; about two ins. up. third, by Surg. J. V. Kendall. 149th N. Y. Discli'd March 1, 1865; pens'd; shortening, ulceration, and de- formity. Cont. Phot. Series, Vol. 4, No. 8. Left; three ins., neck, trochanter, upper third. Discharged July 19, 1864; pensioned ; shortened three inches. Right; three ins., upper third, by Surg. J. H. Beech, 24th Mich.; gang. Disch'd Aug. 23, 1865; pens'd; four ins. shortening. Hayes, W. J., Pt., L, 16th Penn. Cavalry, age 18. Joslyn, J. W., Pt., I, 7th New York Heavy Artillery, age 20. Keyser, M., Pt., E, 9th Kansas Cav., age 40. McLaughlin, G. H.. Lt., H, 2d Infantry, age —. 'Reynolds, J. C, Pt., E, 5tb N. Jersey, age 24. Shanley, J., Pt., A, 76th New York, age 24. "Shelley, J. H., Pt., L, 3d Kentucky Cavalry, age 15. Shipman, S. V., Capt., E, 1st Wisconsin Cav., age 38. Shock, A., Pt., A, 4th Penn. Reserves.age 23. Thibaut,F.W.,Capt.,A, 7th New York, age 28. Tirtlot, W. M., Lieut., F, 105th IU., age 24. June 11, 11, '64. June 3, 5, '64. June 17, 20, '63. July 2, 3, '63. May 5, 8, '62. May 24, 26, '64. June 10, 10, '64. April 24, 24, '63. Mar. 11, 12, '62. Dec. 13, 13, '62. May 15, 15, '64. Right; five ins. middle third, by Surg. F. Le Moyne, 16th Penn. Cav.; necrosis. Disch'd June 20, 1865; pensioned; three inches shortening; fistulous opening. Right; six and a half ins. from great troch. downward, by Conf. surg. Disch'd Oct. 26, 1865; pens'd; seven ins. shortening. Surg. Phot. Ser., Nos. 106,107. Circ. 6, 1865, p. 68. Left; one inch middle third, by A. A. Surg. J. Thome. Also exc. r't radius. Disch'd March 1, 1864; compl. union; two ins. shortening; not pensioned. Left. Duty Oct. 9,1864; retired Dec. 31, 1870. Left; portion of trochanter major. Disch'd Aug. 18, '64; not pens'd. Left; portion of trochanter major. Duty Nov. 15, 1864; pensioned; hip joint stiffened; necrosis. Four and a half ins. middle third, by Surg. S. F. Clardy, C. S. A. Disch'd Dec, 1864 ; union com- plete; four and a half ins. short'g. Right; three and a half ins. npper third and portion of troch. inaj. Promoted Maj. Disch'd July 19, 1865; pensioned; two and a half ins. shortening; anch. knee. Right; four and a half ins., frag- ments, up. third, by Ass't Snrg. J. S. Billings, U. S. A. Disch'd Oct. 10,62; pensioned; five ins. short'g. Med. and Surg. Hist., Pt. II, Vol. II, p. 367. Left; trochanter major, by Surg. C. Gray, 7th N. Y. Also amp. left ring finger. Disch'd May 8, 1863; pensioned. Right; four ins. middle third, by Surg. A. W. Reagan, 70th Ind. Disch'd Nov. 28, 1864; pens'd; limb an impediment. Spec. 2159. The injuries are reported to have been inflicted by shell fragments in two instances, by a fuse plug in one, and by small projectiles in seventeen cases. Sixteen of the twenty operations were performed by Union and four by Confederate surgeons. 'BATWELL (E.), Notes on Exsection, in Med. and Surg. Reporter, 1865, Vol. XII, p. 221. 2TnOMPSON (J. W.), Resection of the Long Bones, in Med. Record, 1868-9, Vol. Ill, Case VI, p. 29. 3Pr.AY (O. M.), Reports of Hospitals, in Am. Med. Times, 1863, Vol. V, Case IX, p. 77. 4Maugiis (G. M. B.), Conservative Treatment of Compound Comminuted Fractures of the Femur, in Confederate States Med. and Surg. Jour., 1865, Vol. II, Case 8, p. 8. Thompson (J. W.), Cases of Resections, etc., in Nashville Med. Jour., 1868, N. S., Vol. I, p. 340. THOMPSON (J. W.), Resec- tion of the Long Bones, in Med. Record, 1868-9, Vol. Ill, Case I, p. 28. 201 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. Fatal Cases of Primary Excision in the Shaft of the Femur.—Of the sixty-five cases of this group, the operation was performed on Union soldiers in fifty-three and on Confed- erate soldiers in twelve instances. The right femur was involved in thirty, the left in twenty-six cases; in nine the side of the injury was not indicated. Case 411.—Private A. A. Shaw, Co. C, 9th Missouri State Militia Cavalry, was accidentally wounded in the left thigh by a conical hall, April 1. 1863. He was admitted to the general hospital at Eolla, and operated on by Surgeon II. Culbertson, U. S. V., who described the case as follows: "A compound comminuted fracture of the femur at the lower third, the bone being broken into small fragments, and small spiculae being thrown over the internal surface of the wound; orifice of exit two and a half inches in diameter, and located on inner side of thigh. The vasti, biceps, semi-membranosis, and tendinosis, rectus, and adductors (below) were lacerated as high as the middle third and down to the knee joint, which was not involved. The large vessels were uninjured. The patient was vomiting, being cold and prostrated; pulse 140. Under these circumstances I determined, on consultation, to stimulate and anaesthetize, then remove all loose portions of bone and resect the ends of the femur as far as they were denuded of periosteum, amputation being precluded by the great prostration. In three hours, the pulse having become somewhat fuller and slower and the general surface warmer, I performed the resection. Under the influence of chloroform the patient's pulse grew stronger, and after the operation he seemed better. He recovered from the effects of the anaesthetic in due time, but never rallied fully from the shock of the injury, and his system gradually failed, though supported by full doses of morphia and brandy. He died eighteen hours after the reception of the injury, being conscious of his approaching end." Case 415.—Private Jonathan Wallace, Co. F, 21st Georgia, aged 38 years, was wounded by a conoidal ball, in the charge on Fort Steadman, March 25, 1835. The missile entered on the external surface of the left thigh at the lower portion of the middle third, passed obliquely upward and inward, fractured the femur through the middle third, and emerged on the internal surface an inch above the wound of entrance. He was taken to the field hospital of the 2d division, Ninth Corps, where Surgeon G. W. Snow, 35th Massachusetts, reports that "resection at the middle third of the femur was performed by Surgeon ('•. R. Sullivan, 39th New Jersey, and anterior splints applied." On April 10th, he was admitted into the Armory Square Hospital, Washington. Acting Assistant Surgeon George K. Smith reports "that the injured limb was shortened one inch; extension was applied (Buck's method) with a weight of eleven pounds, after which there was no shortening. Patient did remarkably well until June 8th, when he was attacked with diarrhoea, which was arrested at the end of three days. On June 23d, the bone appeared to be firmly united with half an inch shortening, and, on July 2d, extension was removed, and the patient rode about the ward in an invalid chair. July 28th, it was discovered that the limb had shortened two and one-fourth inches; exten- sion was reapplied with a weight of sixteen pounds, and, on August 5th, it measured three-fourths of an inch shorter than its fellow. On August 15th, a photograph of the patient was taken [No. 92 of the Surgical Photo- graph Series of the Army Medical Museum, a reduced copy of which is represented in the wood-cut, FlG. 164]. On August 17th, the wound had nearly healed, his condition was remarkably good, and the bone had apparently united." On this date he was transferred to the Douglas Hos- pital, Washington, to the care of Assistant Surgeon W. F. Norris. U. S. A., who reports: "The wound was still open and discharging a small quantity of matter, but there was firm union of the broken femur, and the patient could without assistance raise his leg from the bed. His general health seemed to be improving, and he daily rode about the ward in a wheeled chair, the limb being supported in an extended position. August 26th, several small loose fragments of bone were removed. August 28th, had a severe chill; on the 29th, had an attack of erysipelas in the thigh, and, on the following day, a loose piece of necrosed bone, one and a half inches in length, was removed. On September 2d, erysipelas had spread down to ankle joint, llth, erysipelas had disappeared; another small sequestrum was removed from the posterior wound. 16th, had two chills, diarrhceal passages, and vomiting. 21st, he steadily grew weaker; the wound had almost ceased to discharge. There Avas slight icterus; the countenance was pinched and anxious and the breathing labored. 22d, he had pain in Fig. 164.—Appearance five months chest and abdomen, and was unable to pass his urine. These symptoms after excision in middle third of femur. continued until the evening of the 23d, when death ensued from pyaamia. [from a photograph.] ° ' tJ At the autopsy, fifteen hours after death, the brain appeared healthy; but there was a large amount of serous subarachnoid effusion. Both lungs were adherent and thickly studded with pj'semic patches, most of which were dark colored and hardened, a few only having softened, and containing pus. There was considerable serous effusion in the left pleural sac. The spleen was enlarged but not softened; the other thoracic and abdominal viscera appeared healthy. The fractured femur [which is represented in the adjoiuing wood-cut, FlG. 165] was removed and sawn longitudinally; above the fracture the marrow and interspaces between the cancelli presented a reddish chocolate hue, below, it appeared red- dened and inflamed; it had not, in either locality, any gangrenous odor. The femoral vein [represented in Plate XXX, opposite] was found to contain old and partially disintegrated blood clots, and in some portions also a quantity of healthy look- ing creamy pus; its walls were much thickened. It continued to present the same appearance up to about two inches below its FlG. 165.—Ends of fractured left femur united six months af- ter shot injury. Spec. 1354. PLATE XXX. OiJi'1'.! : ; '■• vfV.;?;: VEIN. ! y 11'; : i-> i i\Vr',a h;x:.!,a,ai i'lK,^ f''.fi';.l,' (}fy.'< /'■■)U|-. ■■: «'i '- ill j- i-'nrary Ex>'.\sion >n • ■> ■ .'.':''.!} '.v;i- peri'on vi ■ ■ '. ran: s. T).n.: ' ''^/T/ii oj.i.ht. Fe>nur.—(>' !.i.. Uni;>n sv>Idiers in fifty-1 Ln. '<• nil; \-'.-■> involved in t.n •■its-'a ■••ied- ^i in ,<.."!■. acciilen ally wound' ! perilled I'fl In "■'•'l'''. ••; air a! the 1." ■ • • a ,r,.n ■■- ,.m| ' •:: >!. y' i,'h '.-as not i i . Uinltir these ..' :■ Ji'-.il reject the en ■< ra-i,i\ • a-' being :-M.,ntla ■.-is, u-oIhb, a.b.-.nl. The CM'll ;.u -es 1 Y Yie n uiur iiIv aaving >!' ch.Yi'lfo 'IT1 '.."'. 111. — Pnv.a ,. \ :-ha . c> <\ ilia Vr,-..- ■-. : : •", : • :.,.,, ■ •■ ■" ■■■■' bail. .\r:nl i. l-i b He a.- ■ ,.: a,!,-' :.::••■. ■•'.'' • ' . >. \ -. '. Y.) I <■*<•; ibeo. a;-, ha! . .. .,' ■ • • a.a <:, s^vlii >veii uninjured, ihr ; ; a ■■• ■ . ' ■ .! ■ .aaa'il, or eaiiSLiltation, to 'iar ; •■ . ■ ;. ■ ... .... ...i • ■> t.ay >,aire denuded of ueriosteui-.. :. ;. •:...:;, ., Y ! - , ■} '•'., j. >■:.'!'-, ■ .•<"■. siiiitwhat fuller and slavver and t.. ;;•; ■•■: • a >• j. ■,»•-. fot a t;d >he i :■ . • . i's anise gie>v atr.mger-, ami A • •• :ah i. •.-i-i a-u Yttef. He vet-' - tY •' ■ ,. :'!...• "!f" is of the anrcsrheiic iu a ■ ■!. !>iit nover i-.il;;-'' l-'nlly ti1 an 'la- a '■■ ■■- :,i|ii; v. antl bin system gradually ';,.ib I ' • . - ."Tied by ftdl doses of i. >• pla'i iji- brand}-, i.i i;i'>-'. .he rec-,. ram of th* injury. '>eti> a ;--.■■ >rgia . .ail 38 ;,a:ar a.c ■. 'iiaa- >ir [ a.-( St<•;*.«h,;;, ,, March i£ • •:• ;.. Thfi 'i.'>:--:'e ent<■: ii on :' : exa.rna) .iiu'taoe of : Yf ,h vt. fi.a h;',v«r poi■■[,•,, ■ ' :'■' '!'■ .'■'.'>■' third, pa-se to the lield hos'(.-ital hi 'Le 2d a . -a ., "r mm C"ia>s. \vhei-e -■a' ''.at ii. W. Sin■■',' ,. :i',tli Mn.asaia!>UHutts, r< pores »!■ ,, ivs.a i.-tf.. ; :. :-ie aaddle third of tl ■:■ femur •■ '•■ ;,■■ a .. i,. . ':■■!■ Sir-geoii • .!' Sallivaia I'-iMi ,N. .<; Jiisey, a.ai ant< . i "■ -.■■ ;:i-i ..ppii.-d." < <• \: ■■:! '''h, lie ,va,- .araiiaaii iai ;■ , A:-. - ,'j. Square ! -.j' 'ah \V -lulling ••■■. Actia A-sisuiit S..::! • .,ca."« K. Jt';]i..''i iap.. "toat the injur a ■;!■ was .a..a-'-"t"u <'iieinch; extensien >• , • :V|>;:I . ■. ^}iuck'? I'laa.n!) •.••• rh n >voiglit il'-l .. : anuud^, ath:i >•'■'. ; !'■.■ :e iin_. P:iiie;ii rliu i-i'irarlval!v well unld J. he was .i'1-: diari :t'!(:, /■:;.,h u-as r.i'e-a'd at tht er; :. af thren !,'.v«. ''*•• -I" -'Id, the b."... Mvieared 1 i- . • ariiter' %viIli \\Ai :m iivdi **hor1< i.hig, -.'.'!, ai [N,- Ai Ai. :! a/'i.,1 . t "■•■ '.riii ■ '''.i.tcal "Museniii a. ^-educi-i'. .■■■ :• '..tt'l :1 a. • .!-,;:!(;. FlO. 1.04]. !»-; AugU^l 1" nairly ''.. ■;;-.■.!, ■ '.■ :. Ua. .a was reinar! 'a; goo-1, ,a till. iiUe he w.j.t m ir.f-IV:■ .A v a •i.-move .": fo'ii-il '..)::; erva-i-v j ^.: ii-- ••••■■ nig nay, :i .<■ ■ ■!' . ..■. ■ ■ a- ,-. .■■Mini'':' di. '" ■, •• ' ■, i : ■ i : •■ :. ciia lltii. .-ryt.iu . ' .■■ ■:, i ■ !.a> 1'ii from tin.....■■■■ ■'■ ■ < ■■ lid •."oii'iit" .:. ..-,,•.. '&' ■ ■- •■ n>e.. Vi di^i.a-.:.. ii,--, a.-i.ed;a,d .lux,-, a- . ,! a. •.:.•; •'. . • nd abuoro.'!!, air! .va."- a-abl i. ■• ! uir-1 ..b. 'a-LI;i|.g- 0f the 'i'U\ ".')|'.-'. .ii -en li M.rs after at it! ■ ■ : "-a.■: , iliaaa,,. Both hu.g- '.■■ i ..:■..• ■:■.'■ i'MV O!!1;,' having 4-"-''1' "■■• *'n ' ■ ' ia- eidargeu but n<;r ."'a; a i- ji- . .ei, •.(■ in th'. adjaii ■ ■■'• i". t-( b>- .'a .ti the canceiit j... , had "of, i' ia , vr iociiiiv. ,ay "gangr, n>>'.:- i."alai Old .,'i p.'.|.-!i;i.!ly "i!Mi l( a-i .tt,ei' > ' ■'•'.■•.-. ;i;i a b :-■..'uncd. It c.-'-rinu".'1' a iib't ■ Augii-;. ji-t ,. \i'gi'Ht'28tli, ba*' u l:i the thisrii, ••,;. !, -a : Ull.' i. Yd' .r.-i i ■: :.n had .■!".-...! .l.-v-ii to ' ■■; : --A; ■■:■ ra'-irinii ■ . 'i::ti-!l!ll'i .!'.!.:a be bad T -iui ': Via. 165—Emls of fm tnred le/'f feimi ■"•' ! l';'«'v *y»ipt' r> iriii:.>d six nvoitlis af- ■:.:■ i-1. I'l'i.n pvt.'i'aa. :':;/Viot injury. Sp.<:. .'■i''.-d healthy; bat •T ' ra ra.y rititihieu with ]iy ijinic pa An-*, inir. : ja) ■. There wns cm .^id.'ruble serous r ;i •,■ ,r c and dbdorninal viscera appeared ii,"' i a ■ 'i'. a.e.! and sa" a Ioiigitudinidly; ..-'.• .•■,"'.,, oe, b"lo\v. ';: ■ p:'.;>:»r.-'.! !■ d- ..... . la'eH.'MT"' in J'i.ati: XXV, . ■ i ■ -•■ ;' a quantity ai iieaita; loo a aboi r ri.-'i iaibeB b«l-.iw iu Mdl.aud Surg.Hist of the Rebellion, 3&K** i '.-' A PLATE XXX. OBSTRUCTED FEIVlORAL VEIN. SECT. III.] EXCISIONS IN THE CONTINUITY OF THE FEMUR. 205 junction with the internal iliac vein; here the clots ceased, and the coats of the vein, although of reddish hue, did not appear much thickened. The pus was carefully examined with the microscope and presented its usual round corpuscles, which under the appli- cation of acetic acid exhibited distinctly their characteristic double and triple nuclei. The femoral artery appeared to be healthy." Case 116.— Private W. J. Beck, Co. D, 2d Pennsylvania Heavy Artillery, aged 18 years, was wounded at Petersburg, June 18, 18li4. Surgeon M. K. Hogan, U. S. V., recorded his admission to the field hospital of the 1st division, Ninth Corps^ with "shot wound of left thigh." Surgeon N. R. Moseley, U. S. V., reported the following: "The patient was admitted to Emory Hospital, Washington, June 24th, with fracture of the middle of the upper third of the left femur, caused by a minie' ball, and resulting in resection, which operation was performed on the field on June 19th. The treatment consisted of cold-water dressings, and stimulants and nutritious diet. Death occurred July 8, 18.i4." The upper third of the injured femur was contributed to the Museum by Acting Assistant Surgeon W. H. Ensign, and is represented in the cut (FlG. 1G7). The specimen shows no bony deposit, and the shaft is stripped of periosteum for some distance below the seat of the injury. Cask 417.—Private J. Fearing, Co. G, 21st Massachusetts, aged 23 years, received a gunshot fracture of the right thigh at Cold Harbor, June 3, 1834. He was admitted to the field hospital of the 1st division, Ninth Corps, where the operation of resection was per- formed but not recorded, and several days afterwards he was conveyed to Washington. Acting Assistant Surgeon P. O. Williams described the injury and its result, as follows: "The patient was admitted to Emory Hospital, June 7th, with compound comminuted frac- ture of the femur at tbe upper third, caused by a minie ball, which entered anterior to the femoral artery, passed backward and outward, and emerged on the opposite side. Two and a half inches of the bone had been excised the day after the injury, through an incision four inches in length. The general treatment consisted of tonics, stimulants, astringents, and generous diet. Pulley extension, sand bags, and bandages were applied to the limb and Fig. 107.—Upper FlG. 166.—Upper por tion cf right femur.show ing excision. Spec.294~. cold-water dressings to the wound. Small spiculse of bone and a small piece of lead about shmvingexclsiim! the size of a pea were removed on June 30th. The patient died August 3, 1834, of exhaus- sPee- y81fi tion resulting from the excessive discharge of the wound and from severe diarrhoea, which had troubled him the last two weeks. The post-mortem revealed necrosis of both excised extremities, extending from one to one and a half inches. There was abundant deposit of osseous matter on tbe upper portion, but upon the lower part only a little was found on the posterior aspect." The upper half of the injured femur was contributed by Surgeon N. R. Moseley, U. S. V., and is shown in the cut (Fig. 166). In the following case severe haemorrhage occurred on the twentieth day after the injury, and amputation in the upper third of the thigh was performed: Case 418.—Corporal J. W. Soule, Co. D, 6th Michigan Cavalry, aged 27 years, was wounded in the right thi<*h at Boonesboro', July 8,1863. Surgeon S. B. W. Mitchell, 8th Pennsylvania Cavalry, recorded his admission to the Cavalry Corps field hospital, and noted that a resection was performed. On July 21st the wounded man was transferred to the Frederick Hospital, whence Acting Assistant Surgeon J. H. Bartholf contributed the specimen (FlG. 168), with the following history: "The wound was caused by a rifle ball, which entered below the nates and fractured the femur at-the lower part of the upper third. A portion of the bone was removed on-the evening following the injury, and sand bags were kept to the sides of the limb until the day before the patient was removed to this hospital, when a long outer splint was applied. On admission the limb was in very good condition and shortened only one and three-quarter inches. On July 23d the long splint had become displaced and was doing harm, when I removed it and substituted Buck's extension (pulley, weight, aud sand bags). On the following day the patient felt comfortable and the wound looked well; the short- ening now amounted to two and three-quarter inches. On the next day the extension was increased by additional weight. A moderate flow of haemorrhage from the wouud took place on July 26th, which could not be controlled by pressure on the common femoral artery, and did not cease until after five minutes' continuance of the pressure. The amount of blood lost was estimated at six ounces. Explora- tion showed the sawn end of the upper fragment to be denuded a finger's breadth; but the upper end of the lower fragment could not be felt nor reached. On the 28th a collection of pus was detected, by examination with the finger, in a cavity at the inner side of the upper fragment, and at 8.30 p. m. of this day another haemorrhage, uncontrollable by pressure on the femoral artery, to the amount of eight ounces took place. Stimulants and opiates were then given to procure sleep and time in order to enable the patient to recover, in part at least, from the effects of the haemorrhage and undergo an operation, for which, with a view of having the further advantage of daylight, the following morning was determined upon. At 4 o'clock a. m. the next day there was another hasmorrhage, estimated "at six ounces, and when the patient had pretty well recovered, amputation was performed by transfixion through the site of the wound, making antero-posterior flaps. The patient did not rally well. He died two hours after the operation. At the post-mortem examination, the thoracic and abdominal organs were found to be healthy. The haemorrhages were discovered to have occurred from a large orifice plainly to be seen in the upper end of the lower portion of the severed sciatic artery, the ball having evidently found the vessel lying in its course and disrupted it. The blood not coming from any branch of the femoral explains the non-control of the flow by pressure thereon, as was believed at the time. The bleeding and stopping was probably due to the closing of the orifice by the end of the bone, and to its shifting, and perhaps to other causes. The two sawn ends of the bone were necrosed for the space of one- quarter inch to an inch, beyond which a good amount of callus was thrown out." FIG. 168.—Upperlialfof right femur. Spec. :!t?54. 206 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Table XXIII. Summary of Sixty-five Fatal Cases after Primary Excision of the Shaft of tlie Femur for Shot Injury. NO Name, Military Description-, and Age Austin, M. G., Pt., D, 21st Virginia, age 24. Ball, C. H., Capt., K, 6th Va. Cav., age 29. Becht, J., Pt., Ii, 7th Maryland, age 38. Beck. W. J., Pt.. D, 2d I'eun. Heavy Art'ry, age 18. Bittle, M., Pt., K, 3Gth Wisconsin. Boss, D. W., Pt., K, 3, find admitted to the field hospital of the 1st division, First Corps. Surgeon G. M. Ramsey, 95th New York, recorded: "Gunshot fracture of right thigh. July Cth, resection." On September 5th, the patient was trans- ferred to Camp Letterman, and subsequently to the General Hospital at York. A photo- graph, represented in the annexed cut (FlG. 170), was received from Surgeon H. Palmer, U. S. V., with the following description of the case: "A conical leaden ball entered the anterior aspect of the right thigh six inches below the middle of Poupart's ligament, thence passing backward and slightly upward, making its exit at the posterior aspect, an inch above the point of entrance, fracturing the femur. Two hours after the reception of the injury he was taken to a field hospital, and, he states, on the 3d of July he was placed under the influence of chloroform and fragments of bone to the extent of two inches of shaft were removed by cutting down upon them at the seat of the fracture. Water dressings were used for the first two weeks, when Smith's anterior splint was applied—the limb suppurating profusely, and the man's vital power being a good deal depressed. There was a constant tendency to sloughing in the posterior wound, rendering the frequent application of caustic necessary. The splint was removed on the 15th of November, partial bony union having taken place, suppuration still continuing and spiculse of bone being discharged from time to time; patient, who was upon tonics and nutritious diet, gradually improving. On the 13th of January the posterior wound assumed a sloughing condition, which spread with rapidity, and was attended with considerable constitutional disturbance. It was checked by the free use of bromine, the patient being at the same time upon iron and quinia. Since that time the patient has continued slowly but steadily to improve. April 14th, the wounds have closed; the man is in excellent health and able to walk about on crutches, amount of shortening being two and a half inches. On June 30, 1864, he was discharged from service, although still using crutches, able to bear considerable weight upon the injured limb." Examiner C. D. Cameron, of LaCrosse, Wisconsin, reported, December 2o, 1865: "Shot wound of right thigh, shattering the bone. Some four inches of the femur were removed. Limb much crooked and greatly atrophied; is five inches shorter than the other. Wound not yet healed." Examiner W. D. Flinn, of Redwood Falls, Minnesota, Fig. 170.— Result of intermediary ex- September 26, 1873, certified to "resection of about three inches of bone," and stated "the cision in the shaft of the femur. IFrom it, •, ■, . i i i i ic „ mi_ a photograph.] wound has been open and running during the last two and a halt years. Ine pensioner was paid June 4, 1879. One of the nine survivors after intermediary excision in the shaft of the femur was a Confederate soldier, and eight were Union soldiers. Of the latter, one died nearly a year after the operation, six are pensioners in 1879, and one has not been heard from since 1870. The point of excision was in the upper third of the femur in one instance; in the middle third in five; in the middle and lower in one; and in the lower third in two cases. Table XXV. Summary of Nine Cases of Recovery after Intermediary Excision of the Shaft of the Femur for Shot Injury. No. Name, Military Description, and Age. Dates. Injury, Operation, and Result. No Name, Military Description, and Age. Dates. Injury, Operation, and Result. 1 o 3 4 5 Anderson, L. C, Pt., A, 7th Kansas Cavalry, age 19. Baker, L. M., Pt., B, 2d Wisconsin, age 29. Hall, S. C Pt,, F, 3d Indiana Cav., age 18. Hazelrigg, W. G., Pt., A, 19th Inf'ry, age 31. Kendall, J. B., Serg't, K, 5th Wisconsin, age 34. Nov. 11. 20, '61. July 1, 6, '63. Nov. 8, 15. '<;:s. April 6, —, '62. May 3, 21, '63. Left; three ins. upper third, by A. A. Snrg. J. Thome; erysip-elas. Disch'd March 1, 1864 ; pens'd; four ins. shortening; an-chylosis knee joint. Right; two inches middle third; two and a half ins. short'g; Oct. 14. partial union. Disch'd June 30,1864 ; pens'd; Sept., '73, w'd has been open two years. Surg. Phot. Series, Vol. 4, 1865. Right; three and a half ins. up. third, by Surg. T. R. Crosby, U. S. V. April 13, 1864, amp. up-per third. Discli'd July 8,1864; pensioned; stump healed. Left; lower third. Discli'd Jan. 14,1863; pens'd; three and a half ins. short'g; pieces of bone dis'd; anch. knee joint. Right; three ins. low third, by A. A. Surg. F. W. Kelly. Firmly united. Disch'd May 3, 1864; pens'd; '67. slight limp; two and a half ins. short'g; false anchy. of knee joint. Surg. Phot. 187. 6 7 8 9 McFarland, R., Pt., K, 22d N.Carolina, age 19. Morrison, H. A., Pt., A, 1st Maine Heavy Art., age 20. Whitesell, J., Pt.,E, 61st Ohio, age 25. Wilson, J. E., Pt., F, 13th N. Jersey, age 37. July 3, 23, '63. Mav 19, 23," '64. Aug. 29, Sept. 8, 1862. May 3, 17, '63. Right; two and a half ins middle third, by A. A. Surg. J. L.Whit-aker. Sept. 23, leg paralyzed and two ins. shorten g. Exch'd April 25, 1864. Right; two and a half ins., and fragm'ts amount'g to three ins. more, middle third, by Surg. N. R. Mosely, TJ. S. V. Mustered out June 6, 1865; pens'd; not heard from since March, 1G70. Spec. 2333. Left: four and a half ins. low. and middle thirds, by Surg. B. B. Breed, U. S.V. Disch'd Jan. 17, 1863 ; pens'd. Died Aug. 1..', 63. Spec. 199. Right; fragments, four ins. mid. third, by Surg. W. H. Twiford, 27th lnd. Disch'd April 8, '64 ; pens'd; four and a half inches short'g; anchy. of knee joint. Spec. 1277. SECT. III.] EXCISIONS IN THE SHAFT OF THE FEMUR. 209 FlG. 171.—Section of right femur fractured in lowest third. Spec. 1522. Fig. 172.—Two sections and an irregular portion of shaft of femur. Spec. 394. The injuries were inflicted by a grape shot in one case, by a slug in one, and by small missiles in seven instances. The length of the excised portion of the femur varied from two to five and one-half inches. Fatal Cases of Intermediary Excision in the Shaft of the Femur.—A few illustra- tions, showing the nature and extent of the intermediary excisions practised, will precede the tabular statement of the thirty-nine fatal cases: Case 421.—Private T. Fitzgerald, Co. C, 38th New York, aged 27 years, was wounded at Chancellorsville, May 2,1863, and treated at a field hospital until June 15th, when he was conveyed to Washington. Assistant Surgeon G. A. Mursick, TJ. S. V., reported : "The patient was admitted to Stanton Hospital with compound fracture of the lower third of tho right femur. Resec- tion of a portion of the bone was performed on May 19th, before admission to this hospital. The wound suppurated profusely, and his condition was unfavorable. Water dressings were used, and Hodgen's splint was applied to the limb. Six ounces of whis- key were administered daily. There was no attempt at union of the bone and no abatement of the discharge. By July 2d the patient had become pale, anaemic, and emaciated, when muriated tincture of iron was prescribed in doses of twenty drops three times a day. The patient was also troubled with anorexia, and on July 5th diarrhoea came on, for which astringents, consisting of opium and tannin, and subsequently tincture of catechu and opium, were administered. Death occurred on July 10,1863." A section of the injured femur was contributed by Surgeon J. A. Lidell, TJ. S. V., and is shown in the wood-cut (Fig. 171). The specimen exhibits considerable deposit of callus, imprisoning the necrosed fragments but not uniting the extremities. Case 422.—Corporal J. White, Co. F, 12th Infantry, aged 16 years, was wounded in the thigh at Gaines's Mills, June 27, 1862. Assistant Surgeon H. S. Schell, U. S. A., reported that the femur was fractured and that the wounded man was captured by the enemy. After remaining a prisoner for three weeks he was exchanged and conveyed to Baltimore. Acting Assistant Surgeon E. G. Waters reported the following history: "The patient was admitted to Camden Street Hospital, July 21st, with the left femur badly shattered at the upper third. No apparatus had been applied. On July 26th, he was placed under the influence of chloroform, and an incision over the seat of injury, six inches in extent and exposing the bone, was made and the broken and unattached fragments removed, after which the ends of the upper and lower extremities were sawn off, leaving a hiatus of some four inches. The wound was then closed by stitches and adhesive strips, and tbe patient was put upon a supporting treat- ment. There was considerable loss of blood during the operation, which was performed by Assistant Surgeon R. Bartholow, TJ. S. A. On August 5th, the limb was placed in the anterior splint. At this time the discharge had improved in appearance and diminished in quantity, and the external wound looked healthy and was closing rapidly; the patient also maintained his strength and cheerfulness, and but for a troublesome bedsore over the sacrum he was almost free from pain. On August 8th, typhoid symptoms came on, the pulse being quick and irritable; the tongue dry, cracked, and covered with brown epithelium; appetite good but thirst insatiable. Wine, quinine, iron, and concentrated nourishment were now administered liberally. The wound was nearly closed and presented a healthy appearance as well as the discharge. On August 14th, colliquative diarrhoea came on, from which the patient sank and died, having survived the operation nineteen days. At the post-mortem examination both extremities of the resected portion of the femur wer, 88th Indiana. Dillon, W., Pt., A, 10th New York, age 23. Eisele, R., Pt., E, 6th New Jersey. Fitzgerald, P., Pt., I. 38th New York, age 27. Friend, J., Pt., H, 7th Missouri, age 27. Goddard, W., ---, B, Caswell's Georgia S. S. Hall, J. W., Pt., I, 92d New York. Hall, S. M., Pt,, E, 7th New York, age 29. Hamlin, J. L., Corp'l, (f, 7th Minnesota, age 24. Harper, C. D., Pt., F, 5th Michigau. Heller, J. P., Pt., F, May 3, 147th Pennsylvania. 19, '63. Sept. 30, Oct. 30, 1864. May 3, 18, '63. May 5, 14, '62. Aug. 6, Sept. 1, 18(i4. May 5, Hi, '62. May 5, 17, '62. Sept. Ii), 28, '63. Feb. 14, Mar. 12, 1864. May 25, June 18, 1864. May 5, 14, '62. Sept. 20, —, '63. June 3, 13, "64. May 5, 17, '62. May 2, 19, '63. July 4, 13, v63. June 24, J'y 1,'63, Deo. 14, 29, '62. June 3, 13, '64. Dec. 16, 23, '64. May 5, 14, '62. Injury, Operation, and Result. Right; great trochanter and one inch of shaft. Died Oct. 25, '65; traumatio erysipelas. Right; two ins., and loose spiculse. June 10, diarrhoea. Died Aug. 10, 1863. Left; mid. third, by Surg. R. B. Bontecou, U. S. V. Died May 25, 1862, of pyaemia. Right; three ins. upper third, by Surg. F. Meaeham, U. S. V. Died Nov. 18, 1864. Right; three ins. upper third, by Suig. R. B. Bontecou, U. S. V. Died May 23, 1862; pysemia. Left; by Surg. R. B. Bontecou, U.S.V. DiedMay20,'62ipy33ra. Right; four ins. low. third; amp. mid. third. Died Oct, 10,1863. Right; mid. third, by Surg. G. S. Kemble, U. S. V. May 1, amp. thigh, upper third. Died May 9, '64. shock. Left; four ins. up. third, by Ass't Surg. G. W. Burke, 46th Penn. Died June 21,1864; pneumonia. Five ins. mid. third, by Surg. R. B. Bontecou, U. S. V. Died May 17, 1862. Right; four inches middle third, by Surg. I. Moses, U.S.V. Died Oct. 5, 1863. Spec. 2145. Right; six ins. up. third, by Surg. A. F. Sheldon, U. S. V. Died June 13, 1864, shock. Left; four ins. middle third, by Surg. R. B. Bontecou, U. S. V. Died May 20, 1862 ; pyaemia. Right; low. third. July 5, diarrh. Died July 10, 1863, suppuration and diarrhoea. Spec. 1522. Right; mid. third, by A. A. Surg. A.Sterling. Died July 17,1863; haemorrhage. Spec. 2091. Middle third; erysipelas. Died August 24, 1863. Left; three and a half ins. up. t'd, by Surg. C. A. Cowgill, U. S. V. Died Jan. 22, 1863. Autopsy. Spec. 1328. Left; five ins. up. third, by Surg. A. F. Sheldon, U. S. V. Died June 17, 1864, exhaustion. Left; two and a half ins. upper third, by A. A. Surg. S. Black- wood. Died Dec. 24, '64; shock of operation. Left; four ins. mid. th'd, by Surg. R. B. Bontecou, U. S. V. Died May 17, 18R2 ; pyaemie haemor. from wounded veins of thigh. Right; three ins. Died May 25, 1863, tetanus. Spec. 1272. No. 38 Name, Military Description, and Age Horrigan, D., Pt., K, 28th Mass., age 32. Huntley, H. S., Pt., I, 37th New York. Lemberger,F.,Pt., 1,33d Iowa, age 23. Martin, F., Serg't, F, 155th Penn., age 22. May, A. S., Pt,, E, 8th Iowa, age 26. McCormick, R., Serg't, C, 2d Missouri, age 24. Parker, T., Pt., I, 5th New Jersey, age 20. Paton, T., Pt., E, 72d New York. Polser, J. P., Pt., B, 15th Iowa. Redwood. W., Pt., A, 5th Michigan. Rose, S. L., Serg't, D, 113th Ohio. Sayre, A., Pt., E, 12th Ohio. Smith, I. M., Serg't, I, 73d Pennsylvania. Stevens, H., Pt., I, 59th Mass., age 16. Taylor, C. H., Pt.. E, 3d Artillery, age 20. White, J.,Corp'l, F, 12th Infantry. Young, W., Serg't, C, 5th Minnesota, age 28. May 5, 30, '64. May 5, 17, '62. July 4, 17, *-63. May 8, June 1, 1864. April 9, May 5, 1864. Sept. 20, Oct. 18, 1863. Interme- diary, 1862. May 5, 15, '62. May 7, 17, '62. Oct, 4, 25, '62. May 5, 16, '62. Sept. 20, Oct, 17, 1863. Dec. 11, 26, '63. May 3, 16, '63. May 6, June 3, 1864. Feb. 20, Mar. 6, 1864. June 27, July 26, 1862. Dec. 16, 23, '64. Injury, Operation, and Result. Left; four ins. up. third, by Surg A. F. Sheldon, U. S. V.' Died Sept, 2, 1864, of wounds. Left; lower third, by Surg. R. Ii. Bontecou, U. S. V. Dii-d May 22, 1862; pyaemia. Right; nineteen fragm. and sharp ends, four ins. in all, lower third. by Surg. I. Moses. U.S.V. Died July 26, 1863, of inflammatory fever. Spec. 2084. Left; middle third, by Surg. A. F. Sheldon, U. S. V.; gangrene. Died June 7, 1864 ; exhalation Right; three ins. up. third. Died May 6, 1864. Left; frag, and ends, three and a half ins., mid. third, by Surg. 1. Moses, U. S. V. Nov. 3, arterial haem. DiedNov. 11,1863, i.f py- aemia. Autopsy. Spec. 2131. Right; low. third, by Surg. B. A. Vanderkieft, 102dN. Y. Died in three weeks; pyaemia. Spec. 11. Right; three ins. mid. third, by Surg. R. B. Bontecou, U. S. V Large bed-sores. Died July 2, 1862; diarrhoea. Left; up. port, protruding femnr, by Surg. R. B. Bontecou.U.S.V. Died May 20, 1862, of pyaemia. Left; upper third. Died Oct. 27, 1862. Left; five ins. mid. third, by Surg. R. B. Bontecou. Died Mav 19, 1862. Right; ends and frag., two and a half ins. in all, middle third, by Surg. I. Moses, U. S. V. Died Oct 20, 1863. Spec. 2130. Left; troch. major. Died Janu- ary 23, 1864; pyaemia. Right; fiveins.up. third, includ'g troc. major, by Surg. R. Tho- maine, 29th New York. Died June 8, '63; anaemia. Spec. 1539. Right; three ins. upper third, by Surg. R. B. Bontecou, U. S. V. Died June 5, '64; exhaustion. Spec. 3034. Right; mid. third, five ins., by Ass't Surgeon W. R. Ramsay, U. S. A., and others. Died April 2, 1864; exhaustion from con- tinued haemorrhage. Left; three ins. up. third, by Ass't Surg. R. Bartholow, U. S. A. Died Aug. 14, 1862. Autopsy ; gangrene. Spec. 394. Left; three and a half ins. upper third, by A. A. Surg. S. Black- wood. Died Dec. 31, 1864. Three of these thirty-nine soldiers belonged to the Confederate and thirty-six to the Union army. The right femur was injured in nineteen, the left in eighteen of the thirty- seven cases in which this point was recorded. Secondary Excisions in the Shaft of the Femur.—Nineteen examples were reported in this category. Fifteen patients recovered, three died, and the result in one instance remains undetermined. Recoveries after Secondary Excision in the Shaft of the Femur.—Two examples of the fifteen cases of this group will be given in detail: Case 424.—Private J. Reid, Co. G, 162d New York, aged 35 years, was wounded in the right thigh, at Springfield Landing, June, 1833. Assistant Surgeon J. Homans, jr., U. S. A., recorded his admission to St. James Hospital, New Orleans, July 3d, and described the injury as follows: "The patient had sustained a compound fracture of the right femur a few days previous to entering the hospital, having been wounded by a bullet, which entered the anterior face of the limb about four and a half inches below Poupart's ligament, aud emerged about four inches below the great trochanter, having passed just outside SECT. III.] EXCISIONS IN THE SHAFT OF THE FEMUR. 211 the femoral artery and shattered the bone in its passage. On admission the thigh was but slightly swollen; the shortening amounted to about an inch and a half. I determined to make an effort to save the limb, for experience had taught me how much conservative surgery can accomplish in gunshot fractures of the thigh. A Smith's anterior splint was applied, but, proving uncomfortable, it was removed and the limb was placed on a double-inclined plane. The orifice of entrance healed, and pus, which began to be discharged quite freely, flowed out through the lower opening. On July 29th the patient's condition was favorable for an operation, aud I determined to remove all the necrosed bone possible, and, if necessary, to resect a portion of the shaft of the femur. The patient was placed under the influence of chloroform, and an incision two and a half inches long was made from either side of the orifice of exit in the direction of the long axis of the limb. Several pieces of necrosed bone were then removed, and the end of each fragment of the fractured femur was turned out and sawn off with a chain saw beyond the point where the bone was bare. The periosteum along the course of linea aspera was carefully preserved and peeled off from the bone, or rather the bone was gently torn away from the periosteum. About three inches of the femur were thus resected. No untoward symptom followed for more than two months, and, in October, the limb could be raised by the heel, union being quite firm. About this time he was attacked with erysipelas, which seemed to be caused by the whitewashing of the ward in which he lay; but the attack was slight and soon passed off. In November he could walk about on crutches and bend his knee slightly. I noticed that union took place first and mainly along the inner side of the bone; and as the periosteum here was preserved entire, there was not so much shortening as would otherwise have resulted, it being only three and a half inches. On December 12, 1863, the patient was discharged from service aud left for New York. How useful a limb he will have cannot yet be determined, but amputation would have killed him." The New York City Examining Board, at different dates, certified to the injury, and to union with deformity, and from four and a half inches to five inches shortening as resulting therefrom, together with complete anchylosis of the knee joint. The pensioner is also reported as wearing an artificial appliance attached to his shoe. The pensioner was paid March 4,1879. Case 4'25.—Private J. F. Williams, Co. H, 26th Pennsylvania, aged 25 years, was wounded in the right shoulder and right thigh, at Gettysburg, July 2, 1863. He entered a field hospital of the Third Corps, and was removed to Camp Letterman one month afterwards. Surgeon H. Janes, TJ. S. V., noted the injury as "a compound fracture of the right femur at the upper third, caused by a ininie' ball," and recorded the following result: "On September 8th, the upper extremity of the lower frag- ment was found to be protruding and to be denuded, and four days later the patient was placed upon the operating table and about two inches of the lower fragment were carefully excised by Acting Assistant Surgeon H. Leaman. The limb was then placed in an anterior splint. Small pieces of bone were discharged from time to time and steady improvement followed. By November 9th, partial union had taken place, and several days afterwards the patient was transferred to York Hospital." Surgeon H. Palmer, U. S. V., in charge of the latter, on February 15, 1864, made the following note of the condition of the limb: "At this time there is complete bony union of the fracture. There is, however, some dead bone at the upper fourth of the thigh, still causing rather free discharge of pus by three openings. The thigh is shortened about four and a half inches, its circumference increased four inches, and the limb bent outward. The patient's general health is excellent and his constitutional condition good." The patient was ultimately transferred to Mower Hospital, Philadelphia, July 25, 1865, and one month later he was discharged and pensioned. Examiner E. A. Smith, of Philadelphia, on August 28, 1865, certified to "total loss of use of right arm and right leg from wound of shoulder and thigh, to fracture of femur and eight inches shortening," and to "one hundred aud twenty-nine pieces of bone having been removed," and added that the pensioner "has a cough and is a sad wreck." The pensioner was paid March 4, 1866, since when he has not been heard from. The excision was practised in the upper third in nine instances, in the middle third in four, and in the lower third in two. In four cases portions of the trochanter major and of the shaft of the femur were excised; in the remaining eleven cases the excised portion of the femur varied in length from two to six inches. Fatal Cases of Secondary Excision in the Shaft of the Femur.—The three operations of this group were practised on Union soldiers. In one instance the right femur, and in two the left femur had been fractured. Case 426.—Private J. McElroy, Co. E, 35th Iowa, aged 38 years, was wounded in the right thigh, at Lake Chicot, June 6, 1864, and underwent the operation of resection of the femur at Gayosa Hospital, Memphis. Surgeon F. N. Burke, U. S. V., who performed the operation, made the following report of the case: "The patient was admitted twelve days after the injury, which was caused by a minie ball striking the anterior surface of the middle third of the thigh, fracturing the femur, and lodging in the limb. The leg was placed in a double-inclined concave splint. The wound healed readily without suppuration, and in two months the patient was able to walk on crutches, the fragments—though not in a straight position—having united partly by cartilage and partly by ligament. His constitutional state was very good, he being fat and healthy. The patient was to have been sent to his home on furlough, but on October 25th, having been allowed to go out on the street, he became intox- icated, and, by a fall, refractured the femur at the place of union. On the following day he was placed under the influence of chloroform, and three inches of bone was excised through an incision five inches in length, an opening one inch long being made on the posterior surface of the thigh for drainage. Bilious diarrhoea set in five days after the operation and continued for two weeks. Death resulted from pysemia, November 23,1864, several violent chills having occurred five or six days before and much prostration during two weeks. Large quantities of stimulants, together with quinine and iron, aud nourishing diet were administered, and solution of chlorinate of soda was applied to the wound. The post-mortem examination revealed a large abscess extending from the wound to the hip joint and containing laudable pus in considerable quantity. There was no sign of any reparative process in the ends of the bone, and no pus was found in the lungs, liver, or spleen." 212 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. Table XXVII. Summary of Nineteen Cases of Secondary Excision in the Shaft of the Femur for Shot Injury. [Recoveries, 1—15; Deaths, 16—18; Result undetermined, 19.] Name, Military description, and age. Allen, J. W., Pt., B, 22d Indiana, age 28. Curtin, D., Pt., G, 47th New York, age 25. Dennell, W. I., Serg't, E, 73d Penn., age 23. Duggan, T., Corp'l, M, 11th Illinois Cavalry, age 19. Frazee, H. W., Pt., L, 2d New York Heavy Artillery, age 29. Grayson, C, Pt., F, 16th Mississippi. Haggerty, D., Pt., L, 1st New Jersey Cav., age 23. Hosay, J., Pt., B, 9th Missouri. Houghton, D. F., Corp'l, E, 16th Maine, age 21. Millhouse, J., Serg't, K, 73d Illinois, age 31. Dates. Oct. 8, Dec. 1, 1862. Feb. 20, Julv 15, 1864. July 20, Aug. 23, 1864. Dec. 18, '62„Aug 23, '63. Apl7,'65 April —, 1866. Sept. 17, Dec. 22, 1862. Oct. 12. 1863, July 4, '63, Mar. 8, '64. Dec. 13, '62, Aug. 6, '63. Sept. 20, Dec. —, 1863. Injury, Operation, and Result. Left; three ins. lower third, by Surg. J. G. Hatchitt, U. S. V. Anaemia. Disch'd Feb. 13,1863; pens'd; six inches shortening. Left; four in. mid. third. Disch'd June 5,1865; pens'd; lig. union only; knee joint anchylosed; shortening over seven inches. T.eft; troch. maj. and two inches necrosed shaft, by A. A. Surg. M. L. Herr. Duty Jan. 10,1865; not pensioned. Right; lower third : gangrene. Disch'd April 7, '65; pensioned. July 5. 1866, amputation, junct. lower and middle thirds. Left; two ins. upper thirds, by Dr. Hutchinson; ends wired. Dis'd Jan. 10,'66, befo. operat'n; pens'd; no union, limb no use. R't; necro.; portion of troch. maj. and shaft, by A. A. Surg. A. V. Cherbonnier. Duty April 27,'63. Left; necrosis troch.; exc. discas'd portion, by A. A. Surg. J. H. Thompson. Must, out Sept. 22, 1864 ; applied for pension Dec, 1864, not heard from since. Left; three ins. mid. third, by A. A. Surg. A. Sterling. Prison, Nov. 4, 1864. Left; caries; six ins. up. third, by Surg. C. Alexander, 16th Maine. Disch'd May 15, 1863, pens'd; shorten'g six ins., stiff, open. Left; two and a half ins. middle third. Disch'd April 30, 1865; pens'd; bone carious.very lame. 13 16 18 Name, Military Description, and Age O'Riley, P., Pt., H, 69th New York. 'Reid, J., Pt., G, 162d New York, age 35. Thomas, "W. C, Pt., F, 55th Ohio, age 17. Watts, S., Serg't, K, 33d Ohio, age 21. Williams, J. F., Pt., H, 26th Penn., age 25. Chase, J.A.,Pt., B, 12th Mass., age 36. 2McElroy, J., Pt., E, 35th Iowa, age 38. 3Unknown, Pt., — New Jersey, age 22. Unknown............... Dates. Sept. 17, Oct. 22, 1862. June 8, July 29, 1863. May 2, Sept. 11, 1863. May 14, 1864. July 2, Sept. 12, 1863. Dec. 13, 1862, Jan. 13, 1863. June 6, Oct. 26, 1864. June 27, Aug. 10, 1862. 1862. Injury, Operation, and Result. Left; carious and necrosed tro- chanter major and shaft. Dis- charged Mar. 10,1863; not pen- sioned. Right; necrosis; three ins. upper third, by Ass't Surg. J. Homans, jr., U.S.A.; Oct., '63, union firm erysip. Disch'd Dec. 12, 1863 pens'd; union with deformity anchylosis knee joint. Right: July 11, rem. seq.; ex. of four ins. up. third. Disch'd June 27, 1864; pens'd; great deform. and short'g. Spec. 1686. Right; two ins low. thirds. Dis'd June 6,'65; pens'd; shortening six ins., leg useless. Right; two inches upper third, by A. A. Surgeon H. Leaman. Nov., '63, partial union. Must. out Aug. 26, '65; pens'd; eight inches shortening. Left; fragm'ts and sharp points, two ins. in all, by A. A. Surg. R. Reyburn. Jan. 18,19, haem- orrhage from external circum- flex artery. Died Jan. 19, 1863. Spec. 1021. Right; bone united; refract, by fall; three ins. mid. third, Surg. F.N. Burke, U. S. V. Died Nov. 23, 1864, pyaBinia. Autopsy. Left; five and a quarter inches mid. third, 28 pieces, by Dr. — Merritt. Died Aug. 10, 1862. ---. Excis'n of frag't, and small portion of shaft partly necrosed. Result unknown. Spec. 396. Excisions in the Shaft of the Femur at an Unknown Period after Shot Injury.— Tbe seventeen cases of this group are enumerated in the following table: Table XXVIII. Seventeen Cases of Excision in the Shaft of the Femur after Shot Injury; time of Operation not known. [Recoveries, 1—7; Deaths, 8—16; Result unknown, 17.] NO. Name, Military Description, and Age. Grauaz, F., Pt., D, 1st Penn. Rifles, age 38. Hiatt, H. H., Pt., B, 19th Indiana, age 19. Holbrook, S., Pt., 1st N. H. Battery, age 22. Murphy, E. A., Serg't, C, 2d New York Mt'd Rifles, age 23. Nelson, J., Pt., H, 51st Ohio, age 21. Dates. Dec. 13, '62,---. Aug. 31, '62,---. Deo. 13, '62,---. Mar. 31, '65,----. Sept. 3, '64,---- Shannon, A. J., Pt., F, ' April 20, 35th N. C, age 33. j '64,----. Woolton, A., Pt., A, 15th ! Aug. 28, Alabama, age 26. j '62,----. Operations, Operators, Result. Left; two ins. mid. third. Dis'd Aug. 20, 1863; subsequently en- listed in V. R. C. Dis'd June 4, '65. and pens'd; union complete. Not heard from since Mar. 4, '68. Right; three ins. Disch'd Oct. 20, '63; pens'd. Atrophy; three ins. short'g; anchy. of knee and hip joints. Died Mar. 21, '71; gen- eral debility and prostration. Right; up. third. Discli'd Dec. 17, '63; pens'd; bone discharging; can do light work. Left; two ins. middle third; ball extracted. Disch'd Oct, 11, '65; pens'd; short'g three and a half ins.; anchy. knee joint; necrosis. Right; two ins. one side of upper third; gang., car., necro. Dis'h July 29, '65; pens'd; bone dis- eased; one and a half ins.short'g; anchy. of knee joint. Left. Retired February 9, 1865; limb entirely useless. Right; lower third. Retired Jan. 4,1865; shortening 2§ inches. NO. Name, Military Description, and Age. Baker, R., Lieut., A, 9th Mississippi, age —. Bartholomew, G., Pt,, E, 8th Missouri, age —. Bowman, W. H., Pt., I, 78th Illinois, age —. Furgerson, N., Pt., G, 6th Indiana, age —. McHarper, P., Pt., H, 12th Miss., age —. ♦Maines, R., Pt., F, 70th New York, age 30. Thompson, J. S., Pt., H, 11th Tenn., age —. Woolf, T., Pt., A, 125th Pennsylvania, age —. Yocum, J. P., Pt., A, 89th Illinois, age —. Debuclc, J, Pt., C, 29th Tennessee, age —. Dates. Nov. 25, '63,----. May 8, '62,---. Nov. 24, '63,---. Nov. 23, '63,---. May 5, '62,---, Nov. 24, '63,---. Sept. 17, '62,---. Nov. 24, '63,---. Je. 1, '64. Operations, Operators, Result. Left; three ins. and small frag- ments middle third; diarrhoea. Died Jan. 2, '64; pyaem. Autop. Right: fractured parts mid. third, by Surg. D. W. Hartshorne, U. S. V. Died May 20, 1862. Left; lower third, ends sawn off; pyaemia. Died Dec. 22, 1863. Right; low. third, ends sawn off. Died Jan. 18, 1864; exhaustion. Autopsy. Left. Died June 6, 1864. Left. Died May 31,1862. Right; middle third, rough ends sawn off. Jan. 14, 1864, haem. from profunda art'y. Died Jan. 19, 1874. Autopsy. Left. Died Jan. 25, 1863. Left; upper third, ends sawn off. Dec. 19, pyaemia. Died Dec. 20, 1863. Autopsy. Right; three ins., including tro- chantermajor. Result unknown. 'HOMAN8 (J., jr.), Resection of Three Inches of the Upper Third of Femur, in Am. Med. Times, 1864, Vol. VIII, p. 65. 2 DORRAN (W. M.), Two Cases of Gunshot Fract. of Upper Third of Femur, Treated Conservatively, in Med. Record, 1866-67, Vol. I. Case II. p. 467- 3MERRITT (—), Compound Comminuted Fracture of Femur—Exsection. in .Im. j/e/7. Times, 1863, Vol. VI, p. 247. *PKAY (O. M.). Reports of Hospitals, in Am. Med. Times, 1862, Vol. V, Case III, p. 76. SECT. III.] AMPUTATIONS IN THE SHAFT OF THE FEMUR. 213 The seventeen cases in which the time between the reception of the injury and the operation could not be ascertained comprise eleven Union and six Confederate soldiers. In eleven instances the length of the excised portion of the femur was not indicated; in three instances two inches, and in three, three inches of bone were removed. Summing up the one hundred and seventy-five cases of excision in the shaft of the femur, it will be seen that the operations were performed in the upper third in seventy-six instances, including nine cases in which the operation extended into the middle third of the femur. Of these seventy-six cases twenty-five recovered, forty-nine proved fatal, and in two the result remained undetermined, a mortality of 66.2 per cent. Of the fifty-nine excisions in the middle third of the femur, the final issue could not be ascertained in one case; eighteen were followed by recovery, and forty by death, a death rate of 68.9 per cent. The seventeen operations in the lower third include five recoveries, eleven deaths, and one undetermined result, a fatality of 68.7 per cent. The twenty-three operations with undefined seat of fracture include sixteen deaths, three recoveries, and four undetermined cases, a mortality of 84.2 per cent. In six of the one hundred and seventy-five cases of excision in the shaft of the femur recourse was had to subsequent amputation of the thigh, and in one, to exarticulation at the hip.1 Further observations on excisions in the shaft of the femur will be reserved for the concluding remarks of this section. AMPUTATIONS IN THE SHAFT OF THE FEMUR.—On page 169, ante, the total number of cases of amputations of the thigh to be considered in this section was stated as 6,238. Of these, 9 were performed for shot contusions of the femur, 2,900 on account of shot fractures of the shaft of the femur, and 3,329 for immediate or remote results of shot fractures of the knee joint, leg, ankle joint, or foot: The nine operations for complications following shot contusions of the shaft of the femur have been detailed at page 173, and there remain to be noticed 6,229 cases as indicated in the following table:2 Table XXIX. Numerical Statement of Sixty-two Hundred and Twenty-nine Amputations of the Thigh for Shot Injury. 'The cases of excision in the shaft of the femur followed by amputation of the thigh are: Private J. Becht, B, 7 th" Maryland, fatal (CASE 3, TABLE XXIII, p. 206); Corporal J. \V. Soule, D, 6th Michigan Cavalry, fatal (CASE 418, p. 205, and CASE 51, Tadle XXIII, p. 206); Private S. C Hall, F, 3d Indiana Cavalry, recovery (Case 3, Table XXV, p. 208); Sergeant J. Burroughs, B, 3d Kentucky, fatal (CASE 7, TABLE XXVI, p. 210); Private C Collar, F, 45tb Illinois, fatal (CASE 8, TABLE XXVI, p. 210L- and Corp'l T. Duggan, M, 11th Illinois Cavalry, recovery (CASE 4, Table XXVII, p. 212). In the case of L. Carroll, H, 1st Delaware (Case 298, p. 139, and CASE 11, in Table XXIII, p. 206), the excision in the shaft of the femur was followed by an unsuccessful exarticulation at the hip. 1 Adding to the 6,229 cases recorded in this Table the 9 cases of amputation in the thigh following shot contusions of the femur, the 2 operations cited at page 8, ante, for complications following deep incised wounds, and the 131 amputations tabulated at page 54, ante, following shot flesh wounds of the lower extremity, we have a total of 6,371 recorded cases of amputation of the thigh performed for injuries inflicted by weapons of war in the American civil war. 214 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. As indicated in the Table, the result as to fatality remained undetermined in only eighty of the six thousand two hundred and twenty-nine cases; twenty-eight hundred and thirty-nine were followed by recovery, and three thousand three hundred and ten by death, a mortality of 53.8 per cent. This exceeds- the fatality in cases of shot fractures of the femur treated by conservation (49.9 per cent., see page 176, ante) by 3.9 per cent., while it is 15.6 per cent, less than the ratio of deaths after excisions in the shaft of the femur [C)\).i per cent., see page 200, ante). It will also be observed that of the amputations in which the time between the injury and the operation could be definitely ascertained, the primary are by far the most numerous. The sixty-two hundred and twenty-nine amputa- tions were performed on sixty-two hundred and nine patients, twenty being double opera- tions. In three cases both thighs were removed at the middle thirds; ten ablations of both thighs were performed in the lower thirds; in one case the point of amputation in the right thigh was not stated, while the left thigh was amputated in the lower third, and in six instances of amputation of both thighs the thirds were not indicated.1 In fourteen of the twenty double thigh amputations both operations were primary; in two, both inter- mediary; in one, the operation in the right thigh was a primary, and in the left thigh an intermediary; in one, the amputation in the right thigh was a primary, and in the left thigh a secondary; and in two instances the periods of the operations were not recorded. In twelve cases the ablation in the thigh was accompanied by an amputation of the opposite limb, viz: in three, by amputations at the knee joint; in eight, by amputations in the leg; and in one, by an amputation at the ankle joint.2 PRIMARY AMPUTATIONS IN THE SHAFT OF THE FEMUR FOR SHOT INJURY.—According to the plan indicated on p. 697 of the Second Surgical Volume, the cases in which the operation was practised within forty-eight hours subsequent to the reception of the injury have been classified as primary amputations. Three thousand nine hundred and forty-nine of the six thousand two hundred and twenty-nine amputations in the shaft of the femur belong to this group. In forty-eight instances the results were not ascertained; nineteen hundred and fifty-eight were successful, and nineteen hundred and forty-three were fatal, a mortality of 49.8 per cent. Primary Amputations in the Upper Third of the Femur.—Five hundred and thirty- three of the thirty-nine hundred and forty-nine primary amputations in the shaft of the ■The three instances in which both thighs were removed in the middle thirds are: Sergeant T. Doud, 2d Michigan, primary operations, fatal; Corporal J. W. Woodworth, H, 11th Michigan, primary operations, fatal; Private S. Bagley, B, 5th New Hampshire, right, primary, left, secondary operation, fatal (Spec. 4232, A. M. M.). The ten instances of ablations of both thighs in the lower thirds are: Corporal M. Dunn, H, 46th Pennsyl- vania, primary operations, recovery (Spec. 3193, A. M. M.); Private E. G. Rush, 21st Georgia, primary operations, recovery (see Surg. Phot. Series, Nos. 132, 133, and Cont'd Photo's, Vol. 3, p. 36, and Spec. 3998, A. M. M.): Private S. Allen, G, 59th Massachusetts, primary operations, fatal: Private It. S. Michael, A, 105th Pennsylvania, primary operations, fatal; Private D. Nicholson, H, 22d Massachusetts, primary operations, fatal (Spec. 2966, A.M. M.)j Sergeant E. C. Rabbit, B, 10th Missouri, primary operations, fatal; Private J. Stewart, D, 77th New York, primary operations, fatal; Lieutenant J. Whelpley, D, 1st Maine, primary operations, fatal; Private D. Wallace, I, 5th Artillery, intermediary operations, fatal (Specs. 1383, 1384, A. M. M.); Pt. J. Moore, E, 46th Pennsylvania, intermediary operations, fatal. In the fatal case of Private W. F. Mills, E, 8th New York Heavy Artillery, the point of the primary amputation in the right thigh was not recorded, the operation in the lower third of the left thigh was an intermediary. The six instapces in which the points of ablation were not stated are: Pt. S. Good well, G, 29th Illinois, primary operations, fatal; Pt. H. Kenner, 4th Virginia, primary operations, fatal; Pt. C. Myer, F, 30th Missouri, primary operations, fatal; Pt. H. Tieman, C, 119th New York, primary operations, fatal; Pt. J. A. Parker, L, Cobb's Legion Cavalry, time of operations not stated, recovery; Pt. 67. Nunenger, A, 58th Virginia, time of operations not stated, fatal. 3The three cases of amputation of the thigh and of exarticulation at the knee of the opposite limb are : Corporal C. N. Lapham, K, 1st Vermont Cavalry, amputation of right thigh in middle third and of left leg at the knee joint, primary operations, recovery (see Surg. Photo's Series, Nos. 154,155); Private J. Barker, I, 58th Massachusetts, amputation of right thigh in lower third and of left leg at knee joint, primary operations, fatal; Private II. Smith, I, 14th New Jersey, amputation of right thigh in lower third and of left leg at the knee joint, primary operations, fatal. The eight cases of amputations in the thigh and ablations of the opposite leg are: Private S. Banks, C, 43d Colored Troops, primary amputations in middle third of right thigh and lower third of left leg, fatal; Private L. Johnson, B, 1st Tennessee, primary amputations of left thigh in lower, and right leg in upper third, fatal; Private L. O. Lamphere, G, 21st Connecticut, Sergeant P. Bradley, C, 16th Michigan, and Private J. It. Lewis, H, 53d Georgia, primary amputa- tions in left thighs in lower thirds and of right legs in lower thirds, fatal; Sergeant J. Foss, C, 59th New York, primary amputations of thigh and leg, thirds unknown ; H. Housley, F, 33d Wisconsin, amputation of right thigh in lower third and of left leg in upper third, intermediary operations, recov- ery; Private H. Brown, K, 22d Colored Troops, primary amputation of right leg in upper third, and secondary amputation of left thigh in lower third, recovery ; Lieut. A. Birmingham, A, 69th New York, primary amputation of right thigh in lower third and of left foot at ankle joint, fatal. SECT, m.] PRIMARY AMPUTATIONS IN THE SHAFT OF THE FEMUR. 215 femur were practised in the upper third of the thigh. The result was determined in all but five cases. Two hundred and sixty patients recovered after the operation, and two hundred and sixty-eight, or 50.7 per cent., died. The right thigh was amputated in two hundred and forty-nine, and the left in two hundred and thirty of the four hundred and seventy-nine instances in which this point was recorded. A few successful and fatal exam- ples will be detailed, and all cases of primary amputation in the upper third of the thigh will be enumerated in Table XXX. Successful Cases of Primary Amputations in the Upper Third of the Thigh.—The two hundred and sixty operations of this category were performed on two hundred Union and on sixty Confederate soldiers. It was impracticable to ascertain the subsequent his- tories of the Confederate soldiers. Of the Union soldiers, one officer was retired and one hundred and ninety-nine men were pensioned, and it appears from the records of the Pen- sion Office that one hundred and ninety-three of the survivors after primary amputation in the upper third of the femur were living in September, 1879. One had died from chronic diarrhoea, two from consumption, the result of the injury and the operation, and in four cases the cause of death was not reported: Case 427.—Lieutenant-Colonel E. Avery, 102d New York, aged 24 years, received a shot fracture of the upper third of the right thigh, at Lookout Mountain, November 24, 1863. He entered the field hospital of the 2d division, Twelfth Corps, where the injured limb was amputated by Surgeon C. H. Lord, 102d New York, who reported as follows : "This case of ampu- tation at the upper third of the thigh is of interest from the fact that the patient had recently returned to duty from hospital, where he had been since receiving a severe wound of the face and neck at Chancellorsville, May 3, 1863. His general health was poor, yet he underwent the operation well, and at the date of this report, December 2d, he is getting along finely. The flap has closed completely for nearly two inches anteriorly, and every indication points to a speedy recovery. Dry dressings have been used entirely." The patient was subsequently transferred to hospital at Bridgeport, and afterwards to Nashville, whence he proceeded to his home on leave of absence. Lastly he entered the Annapolis Hospital, and on June 27, 1864, he was discharged from service. Iu the following year he was re-appointed as an officer of the Veteran Reserve Corps, and on December 31, 1870, he was retired from active service. In a communication from Dr. H. E. Goodman, late surgeon U. S. V., the amputation was described as having been performed "at the great trochanter." During January, 1866, Colonel Avery, who was then serving on duty at the office of the Commissary General of Prisoners, visited the Army Medical Museum, being quite well and in good health, and the stump, though affected with neuralgia, having been healed for more than a year previous. This officer's name appears on the retired list in 1H79. Case 428.—Private T. E. Gay, Co. H, 9th Ohio Cavalry, aged 19 years, was shot in the left thigh while on guard duty, at Cypress Creek, April 22, 1864. The nature of the injury was reported by Surgeon C. M. Finch, of the regiment, as follows: " The wound was the result of an accident, the missile, a carbine ball, entering the knee joint at the external condyle, passing upward and comminuting the femur to the upper third, at which point the limb was amputated. From present indications (eight days after the accident) the man will recover." One month after the reception of the injury the patient was transferred to hospital at Nashville, subsequently to Louisville, and lastly to Camp Dennison. Surgeon C. MeDermont, U. S. V./in charge of the latter hospital, reported that "the patient was admitted June 21st in good general health, but in his transfer he sustained a severe contusion of the stump by a fall. On the following day the stump presented a gangrenous appearance, which was checked by the application of a solution of bromine. Subsequently dressing of basilicon ointment was applied, under which it rapidly improved and threw out healthy granulations." The patient was furnished with an artificial limb, seven months after the recep- tion of the injury, by the firm of Douglas Bly, and on November 17, 1H64, he was discharged from service and pensioned. In his application for commutation, in 1870, the pensioner mentions that Assistant Surgeon John C. Thorpe, 9th Ohio Cavalry, performed the amputation. Examiner J. W. Long, of Bryan, Ohio, May 7, 1H?3, certified to "amputation of left leg four inches below the upper point of the trochanter major; muscles very much atrophied, the bone being covered by nothing but the skin and fascia up to the trochanter. He has no power in the stump, etc." The pensioner was paid September 4, 1879. Case 429.—Private J. H. Judd, Co. C, 86th New York, aged 18 years, was wounded in the right thigh, before Petersburg, September 11, 1864. He was admitted to the field hospital of the 3d division, Second Corps, whence Surgeon J. S. Jameson, 86th New York, described the injury as "a compound fracture of the femur at the middle third, caused by a musket ball," and reported that he "amputated the limb at the upper third." The patient was subsequently transferred to City Point, and three weeks after the date of the operation he was moved to hospital at Alexandria, whence Surgeon E. Bentley, U. S. V., described the amputation as an "antero-posterior flap operation." The patient was ultimately transferred to Judiciary Square Hospital, Washington, and discharged from service January 13, 1865, and pensioned. Previous to leaving the hospital he was supplied with an artificial limb by the Jewett Patent Leg Company, of Washington, D. C. In his application for commutation, dated 1870, the pensioner represented the stump as being in a sound condition, but reported the artificial leg as having been unsatisfactory. Examiner F. R. Wagner, of Addison, N. Y., April 15, 1874, certified to " amputation about two inches below the trochanter minor, leaving the stump so short that an artificial limb cannot be worn." The pensioner was paid June 4,1879. The specimen, No. 410, Army Medical Museum, consists of the middle third of the shaft of the injured femur. It was contributed by the operator. 216 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Cask 130 —Private A. Tarcott, Co. H, 94th New York, aged 18 years, was wounded at Fredericksburg, December 13, 1862, and admitted to the field hospital of the 2d division, First Corps. Surgeon C. J. Nordquist, 83d New York, noted: "Gun- shot wound; right leg amputated above knee." Two weeks after the injury the wounded man was conveyed to Washington, where he entered Trinity Church and subsequently Judiciary Square Hospital. On J une 11, 1883, he was transferred to Central Park Hospital, New York City, whence Acting Assistant Surgeon G. F. Shrady contributed to the Army Medical Museum a cast of the stump (Spec. 1373), taken nine months after the amputation, with the following history: "According to the patient's account the lower portion of his right thigh was almost completely carried away by a grapeshot, and a great deal of hemorrhage fol- lowed the injury. Amputation at the upper third by the long posterior flap was performed, on the day following the injury, by Surgeon G. W. Avery, 94th New York. There was an attack of gangrene of the stump in the latter part of April, and the patient has suffered from necrosis of the femur. When admitted Fig. 175.—Stump of right to this hospital the stump was entirely healed." Two months later the patient was furnished with an Si,mne^ec!hK373*eram" artificial limb by E. D. Hudson, of New York City, and on November 15, 1863, he was discharged from service and pensioned. Examiner C. M. Johnson, of Watertown, New York, certified, May 7, 1873: "Tlie stump is only three inches in length, tender and painful; the extremity of the femur being covered only by integument. He uses an artificial limb occasionally only." The pensioner was paid September 4,1879. Fatal Cases of Primary Amputation in the Upper Third of the Thigh.—There were two hundred and sixty-eight cases of this group. Two hundred and thirty patients were Union and thirty-eight were Confederate soldiers. Gangrene supervened in eight, pysemia in thirty, and tetanus in four instances. In the following case the femur was fractured in its upper third: Case 431.—Private W. H. Croyle, Co. H, 55th Pennsylvania, aged 21 years, was wounded at Petersburg, June 16,1864, and was admitted to hospital at Fort Monroe four days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported: "Gunshot fracture of right femur, upper third. Amputation was performed in the field on the day of the injury, chloroform being used." On August 27th, the patient was transferred to DeCamp Hospital, David's Island, New York Harbor, whence Assistant Surgeon W. Webster, U. S. A., reported that the stump was still unhealed, and that the patient was a sufferer from chronic diarrhoea, from the effects of which he died September 7, 1864. In the next two cases primary amputation in the upper third of the femur was per- formed for fractures in the middle third: Case 432.—Private M. H. Bartlett, Co. D, 4th Vermont, aged 19 years, was wounded at Funkstown, July 10, 1863, and entered the General Hospital at Frederick two days afterwards. Acting Assistant Surgeon C. M. Martin reported the injury and its result as follows : "A mini6 ball entered the outer side of the left thigh about the middle third and passed directly through, breaking the bone. Amputation in the upper third was performed on the field by the circular method. When admitted to this hospital there was partial union of the flaps, and granulation was progressing. Cold-water dressings were used. The patient was in good spirits and seemed to be doing finely until July 29th, when I saw a change for the worse, his pulse being low and quick. I then ordered pills of iron and quinine to be given three times a day, also full diet. Two days afterwards he had a slight chill and appeared rather weaker, the stump not looking healthy and the granulations very pale and flabby. Ten drops of nitric acid diluted in an ounce of water was then ordered to be applied once a day, and the pills were continued, with one ounce of whiskey every three hours. On the next day the patient was gradually sinking, and on August 2d, he had a severe chill in the morning. Death supervened at 9.30 A. M. on August 3, 1863. At the post-mortem examination, three hours after, the lungs, heart, spleen, and kidneys were found to be healthy, but the liver was highly congested. On removing the remaining portion of the femur considerable callus was discovered to have been thrown out, and in dissecting the muscles I found two circumscribed abscesses, each containing about half an ounce of pus." The upper portion of the femur was contributed to the Museum by Dr. Martin, and is numbered 3887 of the Surgical Section. Case 433.—Private F. WTard, Co. G, 45th Colored Infantry, was accidentally shot in the left thigh, near Fort Harrison, February 7, 1865. The nature of the injury and its result were recorded by Dr. N. Folsom, Regimental Surgeon, as follows: "A conical musket ball, fired at a distance of about three hundred yards, entered the outer aspect of the limb about the middle, fractured the femur, and, splitting in two, passed out on the inner aspect lower down. There were two orifices of exit, and two more pieces of the ball were found in the wound. The man was admitted to hospital within six hours after the injury. The loss of blood was estimated at a pint and a half, and the bone was found extensively comminuted, there being twenty-six frag- ments. Amputation by the circular method, at the junction of the upper and middle thirds of the bone, was performed under ether, three ligatures being applied and six sutures. Stimulants were freely exhibited, with beef tea, through the night. The case progressed well until forty-eight hours after the operation, when the patient was suddenly attacked with violent pain in the stump, and, the dressing being removed, adhesion was found to be quite extensive. The sutures were then removed and a finger gently introduced at the middle of the wound for one and a half inches, and relief was afforded by giving one-fourth of a grain of morphia. Wet lint covered with oiled silk was now applied, and the adhesions gradually gave way during the week follow- ing. Granulations appeared over about one-third of the surface, but were pale and inactive. The patient took tincture of chloride of iron, fifteen drops three times a day, and good diet and stimulants. Poultices were applied after the fourth day, but suppuration was at no time profuse. Considerable pain and tenderness of the other leg was also complained of. The pulse gradually rose from 100 to 130, and fell in strength. After the seventh day the patient's tongue became dry and brownish. He died on the twelfth day, February 19, 1865." SECT. III.] PRIMARY AMPUTATION OF THIGH IN UPPER TfilRD. 217 Table XXX. Condensed Summary of Fiir Hundred and Thirty-three Cases of Primary Amputations in the Upper Third of the Femur for Shot Fractures. [Recovery, 1-200; Death, 261-528; Result unknown, 529-533.1 Name, Military Description, and Age. Abey, J., Corporal, B, 67th Penn , ago 20. Allen, \V. ('.., I'apt., F, 20th Iowa, nge l>8. Amos, P. .l/..Pt., D, 45th North Carolina, age 27. Atchinson, J. N., Pt.. P. 2d New Jersey, ugc 28. Atwater, T. J., Pt.. tl. 112th Illinois. Avery, R., Lt.Col., 102d New York. Bahcock, J. P., Pt., D, 16th Ohio, age 24. Barker, D., Serg't, K, 10th Illinois Cavalry. Barnes, S., Pt., B, 12th Illinois. Barrett, G. W., Serg't, I, 7th Ohio. Barton, G., Lieut., D, 81st Pennsylvania. Bassett, W., Pt., A, 111th Pennsylvania. Bauer, A. .Serg't, A. 102d New York, age 21. Bedell, H. E., Lieut., D, 11th Vermont. Beaver, J. A.. Colonel, 146th Pennsylvania. Bell, J., Serg't, D, 150th New York, age 28. Benedrum, C. W., Pt., G, 17th Virginia Cavalry. Benninghoff, P., Corp'l, B, 1st Mich. Artillery, age 28. Bine, J., Pt., I, Stuart Horse Art'y. age 43. Birt, W. T.. Corp'l, D, 47th Illinois. Boden, E. G., Pt., A, 1st Vermont, age 19. Brannagan, W., Pt., H, 70th New York, age 21. Brown, A. P., Serg't, K, 74tb Illinois, age 26. Brown, C. E., Lt. Col., 63d Ohio, age 30. Bruek, T., Capt., F, 8th New York. Bryant, E. A., Musician, C.4thN.Hamp.,age24. Butler. G., Pt., 31st Mis- sissippi, age 20. BulV, II., Pt., K, 7th Indiana, age 24. Campbell, J., Pt.. L, 2d Penn. Art'y, age 24. Capstran, A., Pt., H, 98th New York, age 18. Carroll, J., Pt., H, 25th New York, age 19. Carpenter, I., Pt., H, 102d New York, age 19. Carter, W. W., Pt., I, 2d Tenn. Cav., age 26. Carter. A. L., Pt., A, 56th Virginia. Cashine, J. H., Pt., K, 5th N. Carolina, age 30. Cassell, R., Pt., E, 29th Col'd Troops, age 38. Clarke, H.G., Corp'l, A, 111th N. York, age 22. Cook, D., Pt., F, 118th Ohio, age 21. Cookson, R. B., Pt., B, 14th Maine, age 18. Cowger, G. M., Serg't, E, 17th Iowa. Oct. 19, 20, '64. Mar. 20, 20, '65. July 7, 7, '64. Aug. 27, 27, '62. Nov. 18, 19, '63. Nov. 24, 25, '63. May 14, 14,*'64. April 18, 18, '63. Oct. 3, 5, '62. Aug. 9, ll,s62. Dec. 13, 13, '62. Sept. 17, 17, '62. June 27, 27, '64. Sept. 13, 13, '64. Aug. 25, 26, '64. Mar. 19, 19, '65. July 1, 1, '63. Nov. 22, 22,'64. May 2, 2, '63. May 22, 22, '63. May 5, 5, "64. July 2, 4, '63. June 18, 18, '64. July 22, 23, '04. June 8, 10, '62. July 30, 30, '64. July 20, 20, '04. Nov. 28, 28, '63. Sept. 29, 30, '64. May 13, 13, '64. June 1, 2, '62. Dec. 18, 18, '64. April 2. 2, '65. June 27, 27, '62. April 3, 4, '65. April 2, 2, '65. July 2, 3, '63. Dec. 29, 29, '63. Aug. 5, 5, r62. May 14, 15, '63. Operations, Opeuators, Result. Left; circular; Surg. R. Bnrr, 67th Penn. Disch'd May 8. 1865. Right■; Surg. A. Sabine, 76th Ohio. Mustered out June 6, 1865. Lett. Prison, December 4, 1864. Right; circular; Aug. 31st, haem., lig. femoral. Disch'd June 3, '63. Left; flap; Confederate surgeon, Disch'd Feb. 17, 1864. Right; flap; Surg. C. II. Lord. 102d N. Y. Disch'd June 27, '64. Right; circular. Disch'd Maj' 20, 1865. Left; flap. Disch'd June 29,1863. Right. Disch'd April 6, 1863. Right; circular. Disch'd Oct. 27, 1862. Right; circular. Disch'd April 16, 1863. Left; flap. Disch'd Dec. 1,1862. Left; circ; Surg. A. K. Fifield, 29th Ohio. Disch'd Nov. 22, '64. Spec. 2338. Left; Surg. C. B. Park, 11th Ver- mont. Disch'd Feb. 20, 1865. Right;circ; Surg. J.W.Wishart, 140th Penn. Disch'd Dec. 22,'64. Right; flap; Skey's operation ; Surg. C. M. Campbell, 150th N. York. Disch'd Oct. 13, 1865. Left. Recovered. Right; flap; Surg.A.Sabine, 76th Ohio. Disch'd June 18,1865. Right; Surg. Randolph, C. S. A. Furloughed June 11, 1863. Left; circular; Surg. H. Z. Gill, U. S. V. Disch'd Sept. 23, 1863. Died October, 1863; diarrhoea. Right; circular. Disch'd August 30, 1865. Left; flap. Veteran Res. Corps Dec. 31, 1863. Right; flap; Surgs. W.P. Pierce, 88th 111., and 11. E. Hasse. 24th Wis. Disch'd Oct. 28, 1864. Left: flap; Surg. A. B. Monohan, 03d Ohio. Disch'd July 8,1865. Left: Drs. Allen, Davis, and Her- ald, C. S. A. M. O. Apr. 23, '63. Right; circular. Disch'd Oct. 18, 1864. Right; circular. To Provost Mar- shal Dec. 1, 1864. Right; circ; Surg. G. W. New, 7th lnd. Disch'd April 1.1864. Right; flap. Disch'd July 10, '65. Left; circular. Disch'd October 18, 1864. Right. Disch'd June 23, 1863. Spec. 2400. Right; circular. Disch'd Oct. 5, 1865. Right; circular. To Provost Mar- shal May 6, 1865. Amp. by Surg. Evans, C. S. A. Recovery. Left. Released July 10, 1865. Right; circular. Disch'd July 11, 1865. Right; circ; Surg. O. Munson, 108th N. Y. Disch'd Oct. 15, '63. Right; circ. Disch'd June 23, 1865. Left; flap; Surg. E. Adams, 14th Maine. Disch'd Sept. 26, 1862. Left; circular. Disch'd Nov. 23, 1863. Name, Military Description, and Agi Cozad, II. J., Pt., A, 6th Missouri. Congdon, J., Pt., H, 30th Ohio, age 21. Crawford. G. W., Lieut., V, 6th Michigan Cav. Cribb, D. W. P., Pt., F, 2oth Georgia. diss, S. G.. Pt., A, 7th West Virginia, age 19. Crowley, D.,Pt.,F,25th New York, age 35. Cue, E., Pt., F, 97th New York. Curtis, E. D., Serg't, I, 1st Penn. Res., age 25. Dart, E. S., Pt., G, 8th Michigan. Davis, S. M., Pt., A, 24th Georgia. Dailey, P., Pt., G, 140th New York, age 29. Dana, D. Z., Pt., B, 60th New York, age 35. Dean, H. H., Pt, Pro- vost Guard. Dell, F., Pt, F, 70th New York, age 21.' Delcher, P., Pt., K, 3d N. Y. Cavalry, age 42. Dermock, T., Pt., B, 7th Conn., age 27. Donohue, J. S., Capt., A, 8th Michigan, age 27. Downs. T., Pt., P, 88th New York, age 38. 1 Duncan, M. I., Serg't, *G, 21st Virginia. Dunlap, I. N., Pt, I, 17th Illinois. Dunham, C. R., Pt.. H, 1st Maryland, age 30. Emmitt, J.. Serg't, C, 56th North Carolina. Eveland, J., Ft., E, 7th Illinois. Ferguson, S ,Pt, D, 14th N. Carolina, age 28. Finn, T. Lieut., D, 7th West Virginia, age 21. Fisher, H. J., Pt., K, 102d Illinois, age 24. Fisher, J. A., Serg't, E, 52d Virginia. 'Fischer. F., Lieut., K, 47th Ohio, age 26. Fisher, J., Lieut., K, 17th Indiana, age 24. Fitzgerald, P.,Pt., A, 7th Wisconsin, age 18. Fitzhugh, H., Lieut., Purcell's Battery. Flemming, D., Pt." D, 5th C. S., age 27. Foote, F. W., Lieut., I, 121st N. York, age 22. Foster, R., Corporal, B, 16th Penn., age 24. Fox, J., Pt., K, 1st Cav- alry, age 20. French, S. S., Pt., I, Sth N. Hampshire, age 18. Fry, W., Serg't, IC, 123d Ohio, age 26. Gay, T. E., Pt., H, 9th Ohio Cavalry, age 19. Gilbert, R. T., Serg't, D, 18th Georgia, age 31. Golden, J., Pt., B, 2d U. S. Cavalry. June 2, 2, '61. June 21, 24, '64. July 14, 14, '63. May 12, 13, '64. May 24, 24, '64. Sept. 17, 17, '62. Sept. 17, 18, '63. July 2, 3, '63. June 16, 17, '62. July 1, 1, '64. May 5, 6, "64. June 15, 15, '64. July 18, 20, '63. May 1, 2, '62. May 16, 16," '64. Oct. 8, 8, '63. May 6, 7, '64. Sept. 17, 17, '62. Oct. 26, 27, '63. Feb. 15, 15, '62. June 3, 3, '64. July 30, 30, '64. Oct. 4, 4, '62. Sept. 17, 18, '63. June 3, 3, '64. Mar. 16. 16, '6a. Aug. 9, 10, '62. May 19, 20,' '63. Oct. 28, 28, '64. June 18, 18. *04. Nov. 30, 30, '64. May 10, 11, '64. April 5, 5. '65. Aug. 10, 10, '64. June 17, 17, '64. April 2, 2, '65. April 22, 22, '64. July 2, 2, '63. July 21, 21, '63. Operations, Operators, Result. Right; Surgs. G. S. Walker and W. F. McChesney, 6th Missouri. Disch'd June 10,' 1863. Left; circular: Surg. A. K.Fifield, 29th Ohio. Disch'd July 19, '65. Flap. Discharged Feb. 17, 1864. Left; Surg. Gelks, 26th Georgia. Recovery. Right; flap; Surg. D. W. Maull, 1 st Del. Disch'd May 27,1865. Right. Discharged. Right; flap. Disch'd May 15, '63. Right; flap. Disch'd February 3, 1864. Left. Discharged Oct. 18, 1862. Left; Surg. Mitchell, C. S. A. Recovered. Right; flap; Confederate surgeon. Disch'd June 11, 1805. Right; circ; Surg. 11. I>. Whiton, 60th N. Y. Disch'd Mar. 7. '65. Surgeon Gleeves, C. S. A. Re- covered. Right; Ass't Surg. J. Ash. 70th N. York. Disch'd Oct. 13, '02. Left; flap; Confederate surgeon. Disch'd March 8, 1865 Left; flap : Surg. G.C. Jarvis, 7th Conn. Disch'd Dec. 24, 1863. Left; circ; Surg. W. B. Fox, 8th Mich. Disch'd Sept. 28, 1804. Right; Surg. F. Reynolds, 88th N. Y. Sept. 29th,"haem., fem. tied. Disch'd March 13, 1863. Right: circa Surgs. Coleman and Fleming, C-S. A. Fur. Jan.11,'64. Left; flap ; Surg. C. Goodbrake, 20th 111. Disch'd Mar. 2S, 1862. Right; circ; Surg. A. A. White, 8th Md. Disch'd Mar. 30, 1865. Left; Surg. C. H. Ladd, C. S. A. Recovery. Right. Jan. 15, 1863, loose skin cut off. Discharged. Left; Surg. Tracy. C. S. A. Re- tired March 16, 1*865. Left; circ; Surg. D. W. Maull, 1st Del. Disch'd Dec 19, 1864. Left; flap; Surg. W. Hamilton, 102d 111. Disch'd June 14, 1865. Right; Surg. Waddell, C. S. A. Disch'd Oct. 7, 1862. Right; circular. Disch'd Dee. 15, 1863. Left; Surg. Fountain, 2d Ala. Cav. Disch'd May 15, 1865. Left: circular. Disch'd May 25, 1865. Antero-internal large and small post, flap at neck of fem.; Surgs. G. R.C.Toddand Taney, C.S.A. Recov'd. Died two years later. Right; ant post. flap. To Provost Marshal March 7, 1865. Left; flap: Surg.McGuire,CS.A. Disch'd Sept. 27. 1864. Left; circular. Disch'd August 21, 1865. Right; ant. post, flap: Confed. surgeon. Disch'd July 6, 1865. Spec. 3224. Right; flap. Disch'd July 26,'65. Left; circ; Surg. H. C. Leven- saeler, 8th Me. Recovery. Left; flap; As'tSurg.J.C.Thorpe, 9th Ohio. Disch'd Nov. 18, '64. Right,; circ; Asst. Surg. Ramseur, C. S. A. Exch'd Nov. 12. 1863. Left; Asst. Surg. C. J. Wilson, U. S. A. Disch'd Mar, 16,1864. 1 Davis (W. A.), Case of Tetanus—Recovery, in Confed. States Med. and Surg. Journal, 1864, Vol. I, No. 1, p. 8. 2Bryan (J.), Cases of Amputations from the Armies of the Southwest, in Am. Med. Times, lfc'63, Vol. 7, p. 288. Surg. Ill—28 218 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name. Military Description, and Auk. 81 l Goodman, J. E., Serg't, j D, 147th Penn., age 21. 821 Goodwin, W. H , Pt, B, i 9th Missouri S.M. Cav. B3 ! Grim, F. M., Pt.,F, 140th Pennsylvania, age 18. 81 Grims, W., Pt., 1, 49th Virginia, ago 17. 85 Hall, J. D., Pt., K, 1st Delaware, age 18. 86 Hall, J. AV., Serg't, H, 0th Kentucky, age 24. 87 Hall, A., Serg't, H, 152d New York, age 26. 88 Haines. E., Pt., I, 8th Penn. Reserves, age 23. 89 Hamlink. D. F.. Major, 4th N. Y.H.A.. age22. 90 | rinnht. S. /;., Pt, IC, 1st Mississippi, age 31. 91 Ilankins. D. AV., Corp'l, I E, 14th New Jersey, j ago 24. 92 Harrison, S..Pt,A,149th New York, age 25. 93 Harrington, H., Pt. B, 123d New York, age 26. 94 | Hartford. W. H., Serg't, ; A, 5th N.York, ago 28. 95 | Harvey, E. IL, Pt, A, j 7th Mich. Cav., age 19. OPEliATMNS, OPKUATOItS, Kr.si'l.T. 96 97 98 99 100 101 102 103 104 105 106 ! 107 108' 109 110 HI 112 113 G, 2d 115 116 117 ,118' 119 120 ! i 1211 122 | [Iassler, J. A., Pt, II, 16th Penn.Cav.. age23. Hayes. J. E., Lt Col., 12th Kansas. Hays, li. F., Pt, F, 3d \ irginia. Heflen, W. J., Pt., (', 9th Louisiana. Honry, J., Pt., A, 57th New York. Henry, P., Pt Missouri. Hill, R. S., Capt.. B, 2d Indiana Cavalry. Hill, A. F., Serg't, D, 8th Pennsylvania. Himes, A., Pt., D, 7th New York Heavy Art., age 25. Hogan, F., Sergeant, B, Hugcr's Battery. Holbert, J., Pt.,*E, 20th Indiana, age 43. Holman, II., Pt, A, 25th Mass., age 35. 'Hood J. B., Lt. Gen'l, C. S. A. Howard, N. J., Pt., H, 48th Alabama, age 33. Hoyer, B., Pt., G, 107th Penn., age 18. Huder, A. L., Pt., H, Uth Georgia, age 20. Hughes, G. W., Pt., B, 6th Georgia. Huston, W. G., Pt., K, 8th Indiana. Hutchinson, R. B.. Pt., D, 7th South Carolina. Hyatt, R. F., Pt, C, 3d Arkansas, age 18. Ireland, A., Pt., B, 9th Maine, age 18. Irwin, 1. M., Pt.,G, 45th North Carolina, age 21. Irving, V., Pt., H, 8th Louisiana, age 26. Jackson. J., Ser«f't, A 66th Illinois, ntfe 30 Jarrett, I., Serg't. A, 1st New Jersey Cavalry, age 18. Jessup, J., Lieut, B, 187th Pennsylvania. Jones, D. M., Corp'l, I. 199th Penn., age 25. Nov. 27, 27, '03. Aug. 6, 6, 03. June 18. 19, '64. May 31, Je.1,'64. Oct. 27, 28. '64. Julv 9, 9, '04. Aug. 14, lA '64. Mav 6, (i, "04. Mar. 31, 31, '65. Nov. 30, Dec. 1, 18(14. June 1, 2, '64. May 25, 26," '64. June 19, 20, '64. Juno 2, 3, '64. Mav 28, 28,' "64. Feb. 6, 7, '65. April 30, 30, '64. Sept 17, 17, '62. June 14, 15, '63. May 5, 6, '04. Oct. 8, 8, '62. April 16, 16, '65. Sept 17, 17, '62. June 3, 5, '64. June 1, 1,64. Mar. 25, 25, '65. June 25, 26. '64. Sept. 19, 19, '63. June 3, 4, '64. Sept. 17, 19, '02. July 2, 3, '63. Mar. 20, 20, '64. May 23, 23, '63. Sept. 17, 18, '02. Sept. 17, 19, '62. Oct. 27, 27, '64. Oct. 19, 19, '64. Nov. 27, 27, '63. May 9, 10, '64. Mar. 31, Ap. 1, '65. June 18, 18. '64. April 2, 2, '65. Left; circ.; Surg. H.E. Goodman, 28th Penn. Discli'd Sept. 19,'64. Left; flap. Disch'd February 19, 1863. Left; Surg. J. W. Wishart, 140th Penn. Disch'd May 16, 1865. Right; circ. To prison Oct 1, 1864. Left; flap. Disch'd June 22, '65. Right; circular. Disch'd June 7, 1865. Left; flap; Confederate surgeon. Disch'd June 23, 1865. Right; circ; Surg. C. Bowers, 6th Penn. Res. Discli'd Jan 18, '65. Right: flap. Mustered out Sept. I 20. 1865. Right: ant. post flap; Asst Surg. W. E. Whitehead, U. S. A. Provost Marshal, May 6,1865. Right; double flap; Surg. J. S. Martin. 14th N. Jersey. Disch'd Jan. 23, 1865. Left; circ; Surg. J. "V. Kendall, 149th N. York. Reamputation. Disch'd July 15, 1865. Right; flap; Surg. J. Chapman 133d N. York. Disch'd Oct. 4, [ 1805. Spec. 586. Right; circ; Confed. surgeon. Disch'd Aug. 7, 1805. Right; ant. post, flap; Surg. S. R. Wooster, 1st Michigan Cav. Discli'd Dec. 25, 1864. Right; circ.; Surg. F.H.LeMoyne, Kith Penn. Cav. Dis. Aug. 6,'65. Left. Mustered out June 30, '65. Left; Surg. Mayo, C. S. A. Fur- loughed Oct. 30, 1863. Right; Surg. Love, C. S. A. Re- tired Oct. 22, 1804. Right; circ; Surg.D.Kelsey, 64th N. Y. Disch'd Jan. 18,1865. Right; flap; Surg. C. Spinzig, 2d Missouri. Disch'd Jan. 3,1803. Right. Mustered out July 22, '65. Left; flap. Disch'd June 21, '63. Right: ant past flap: Surgs. Peel and Snelly. ('. S. A. Dis- charged Jan. 29, 1805. Left; circ ; Surg. ('. B. Gibson, C. S. A. Recovery. Left; flap. Disch'd Aug. 2,1865. Left; flap. Disch'd June 20, '65. Professor J. G. Richardson, of New Orleans. Recovery. Circular. Furloughed. Right; flap; Surg. J. F. Hutchin- son, 107th Penn. Disch'd July 13, 1863. Left. Exchanged Sept. 25,1863. Right; Surg. Swann, C. S. A. Recovery. Right; periosteum flap; Surg. J. K. Bigelow. 8th lnd. Disch'd October 8, 1803. Right; Surg. T. H. Squire, 89th N. Y. Nov. 21th, bone removed. femoral opened, lig. Provost Marshal, April 27, 1863. Left; sloughing; gangrene. Dis- charged Nov. 24, 1862. Right; Surg. CM. Clark, 39th111. Disch'd June 12, 1865. Right. To Prov. Marshal April 1, 1865. Right; circular. Exchangedand retired February, 1865. Left; circular. Disch'd June 7, 1865. Left; circular; Surg. W. W. L. Phillips, 1st New Jersey Cav. Disch'd July 5, 1865. Right. Mustered out Aug. 7, '64. Name, Military Description, and Auk. Right: flap ; Surg. J. S. Taylor, 23d 111. Must, out June 24,'65. 123 Jones, O., Pt., C, 27th Mass., age 19. 124 Jones, S."P., Serg't, D, 121st Pennsylvania. 125 Judd, J. H., Pt., C, 86th New York, age 18. 126 Kelly, T. A., Pt, E, 57th Alabama, age 19. 127 Kessler, M., Pt, A, 87th Penn., age 46. 128 Key, J. J., Pt., E, 8th South Carolina, age 23. 129 Kilboum, G. L., Serg't, C, 137th N. Y., age 25. 130 Kilner, T. A., Corp'l, E, 16th Indiana, age 30. 131 Kiser, G., Serg't, G, 95th Ohio. 132 Klein, D., Pt, C, 64th Illinois, age 26. 133 Knapp, L., Pt, B, 111th New York, age 21. 131 Knapp, D. E.,Pt.,K.65th Illinois, age 21. 135 Langston, G. M., Serg't, 1,3d SCarolina.age 37. 133 Lawrence, J., Pt, B, 37th Wisconsin. 137 Lcich. J., Serg't, A, 27th North Carolina. 138 Lewis. W. W., Pt., K, 95th Ohio. 139 Liudslcy, D.,Pt, C, 29th Ohio, age 22. 140 Lock, J., Serg't, I, 2d North Carolina. 141 Loftis, W. J., Pt., K, 5th Tenn., age 22. 142 Lowe, W., Pt., F, 9th Maryland, age 17. 143 Lumphrey, O., Serg't Major, 1st N. Y. Cav. 144 Maass, L., P., F, 1st In- diana Battery. 145 Mahoney, J., Pt., A, 11th New York Cav., age 21. 146 Manning, G.M., Lieut., C, Phillips's Legion. 147 Martin, C. A., Serg't, F, 29th Penn., age 27. 148 Matlock, J. M., Pt, A,1st Arkansas Lattery. 149 J/o Cabe, J. P., Serg't, F, 2d Virg'a Cav., age 26. 150 McClain, J. S., Pt, K, 79th Indiana. 151 McConkcy, S. I., Pt., G, 37th Tennessee. 152 McCord. C. P., Corp'l, K, 23d Iowa. 153 McCurley, J , Pt, B, 1st Pennsylvania Art'}-. 154 McDaniels, S., Pt., D, 75th Ohio. 155 McFarland, R. W., Cor- porate.3d Wis.,age 23. 156 McKee, S. T., Pt., E, 4th Penn. Cav., age 2:). 157 McLaughlin, M., Ft,A, 20th Conn., ago 34. 158 McMahon, D., Capt., D, 80th New York. 159 McNulty. C, Pt. A, 29th Massachusetts. 160 Milling, R. R.. Pt., G, 3d S. Carolina Battery. 161 Moore, J. IL, Corp'l, K, 2d New York Heavy Artillery, age 26. Moore, P., Pt, E, 26th Mass., age 32. 163 Mosher, D. H., Pt., B, 8th Mich., age 24 164 j Murphy, E., Lieut., A, 5th Cavalry, age 20. 165 j Myers, S., Pt., C, 183d I Pennsylvania, age 18. 166 | Nealis, J. P., Serg't, E, i 23d Virginia Cavalry. May 15, ]"">,''04. Dec. 13, 15, '62. Sept, 11, 11, '64. July 20, 22, '64. Oct. 17, 19, '64. July 1, 3, '63. July 2, 3, '63. Aug. 30, 30, '62. Aug. 30, 31, '63. July 22, 22, '64. Mav 18, 18.' '61. July 19, 19. '64. July 2, 3, '63. July 30, 30, '64. Sept. 27, 28, '63. June 10, 11. '64. May 8, 8, '64. Sept. —, —, '62: May 27, 27, '64. Oct. 18, 18, '03. April 0, 6, '65. July 13, 13, '63. June 14, 15, '64. Nov. 29, 29, '63. July 20, 21, '64. Aug. 27, 27, '63. Oct. 11, 11, '63. Dec 31, 31, '62. Sept. 20, 21, '03. Mav 17, 17," '63. Aug. 29, 2J, '62. April 11, 13, '62. May 25, 26," '04. Mar. 31, Ap. 1, '05. Mar. 16, 10, '65. July 1, 3. '03. Sept. 17, 18, '62. Sept 20, 21, '03. Aug. 25, 26, '64. Sept. 19, 19, '64. May 6, 8, '04. Sept, 19, 20, '64. Mav 2, 2, '04. July 3, 5, '63. operations, operators, Result. Left: flap; Surg.W. H. Rice, 81st N. Y. Discli'd July 16, 1865. Right; flap; Confed. surgeon. Disch'd Dec. 3, 1863. Right; ant. post, flap; Surg. J. S. Jamison, 80th N. York. Disch'd Jan. 13, 1805. Spec. 4110. Left; ant. post flap; gang. To prison Aug. 21, 1865. Left; flap. Disch'd July 1,1865. Right. Retired Feb. 7, 1805. Left; Surg. H. B. Whiton, 0:'th N. Y. Disch'd July 19,1(Y4. Left; flap; Asst.Surg.J.D.Gateh, 16th lnd. Disch'd Oct. 24, '62. Right; circ; Surg. H. Z. Gill, 95th Ohio. Disch'd Aug. 20, '03. Left; ant. post,flap; Asst. Surg. H. A. Mix, 64th 111. Hffim.; lig. Disch'd Feb. 6, 1866. Left; flap; Surg. W. S. Cooper, 125th N. Y. Disch'd Oct. 5, '65. Left: circ; Surg. C. S. Frink, U. S.V. Mustered out July 12,'65. Right; flap. Exchanged March 17. 1864. Right; flap. Disch'd April 24, '65. Right; Surg. Walker, C. S. A. Recovered. Right; flap; Confederate surgeon. Discharged. Right; Surg. A. K. Fifield, 29th Ohio. Disch'd Jan. 9,1865. Right. Furloughed April 13, '04. Left; ant. post, flap; Surgeon J. Sympson, 24th Ky. Discli'd May 6, 1865. Right; circ; Surg. R. R. Clarke. 34th Mass. M. O. Feb. 2. '04. Left; Surg. T. S. Gardner, 17th Penn.Cav. Disch'd July 24, '65. Right; flap; Surg. G. P. hex, 33d Illinois. Disch'd Dec. 16, 1863. Left; ant. post, flap; Surg. C. Gray, 11th N. Y. Cav. Disch'd March 30, 1865. ---; Surg. Shine, C. S. A. Fur- loughed Oct, 15, 1864. Right; ant. post. flap. Disch'd July 2, 1865. ----; Surgs. Mitchell and Ford, C. S. A. Recovered. Right; Surg. Shackleford.C.S.A. Retired Feb. 28,1865. Left; flap; Surg. L. Manker, 79th lnd. Disch'd March 6, 1863. ----; Surg. Hall. Recovered. Lett; Surg. W. H. White. 22<1 Iowa. Disch'd Aug. 20,1863. Right Disch'd Oct. 29, 1862. Left; flap; Surg. C. L. Wilson, 75th Ohio. Disch'd June 2, '62. Left; circular. Disch'd May 20, 1865. Left; circular. Discli'd June 14, 1865. Left; circular. Disch'd Oct. 3, 1865. Left; flap. Disch'd June 23, '64. Right; flap; Surg. B. A. Vander- keift.U.S.V. Disch'dMar.23,'63. Right; Surgeon Walker, C. S. A. Recovered. Right; circular; Surgeon J. W. Wishart, 140th Penn. Disch'd March 22, 1865. Left; ant. post, flap; Surg. J. G. Bradt, 20th Mass. Disch'd Oct. 30, '65. Died Dec. 5, 1869. Right; Surg. W. B. Fox, 8th Michigan. Disch'd Jan 24, '05. Left; skin flap; Asst. Surg. J. W. Williams. U. S. A. Retired April 25, 1865. Left; circular; Surg. D. H. Hous- ton. 2d Del. Discli'd June 8,'65. Left. Recovered. 'SMITH (STEPHEN), Analyses of 439 amp. in the contiguity of the lower extremity, in Memoirs of the U. S. San. Com., 1871, Surg. II, p. 64. SECT. III.] PRIMARY AMPUTATION OF THIGH IN UPPER THIRD. 219 Name, Military Description, and Age Nelson, J., Lieut,, K, 18th Penn'a Cavalry, age 42. Nnthmann, A., Pt., D, 39th New York, age 40. O'Brien, E., Pt., A, 63d New York, age 24. O'Counell. T„ Pt, H, 124th N. York, age 24. Olive, J. W. A., Corp'l, H, 3d Arkansas. Park, W. B., Corp'l, E, 2d Michigan, age 20. Payne, I. A.. Pt, K, 1st Colored Troops, age 18. Peach, G. S., Serg't. B, 24th Mass., ago 29. Perkins, L. A., Corp'l, D,15fh Virginia,age 19. Peterson, W., Pt., K, 3d Vermont, age 30. Phillips, W. D., Serg't, I, 10th N. York Heavy Artillerv, age 28. IHnkney," J. IL. Pt., C, 4th CI d Troops, age 33. Pluss, W., Pt, E, 23d Michigan, age 39. Powell, F., Pt. A, 10th Louisiana. Purcell, J., Pt., A, 20th Connecticut, age 23. Pullien, R., Pt., E, 47th North Carolina. Pyle, A. J., Corp'l, F, 51st Indiana, age 25. Quinn, P., Serg't, E, 1st Louisiana Cavalrv. Redmond, M.. Serg't. F, 63d New York. Rennells, A. L:, Corp'l, K, 149th Pennsylvania. Richmond, J. L:. Pt., G, 6th South Carolina. Riley, J. H., Corp'l. K. 78th Illinois, age 21. Rohne. A. W., Pt, K. 123d Ohio. Rogers, E., Pt., C, 103d Pennsylvania. Royal, J.B., It., F, 59th Georgia. Sandford, G. P.. Comis'y Serg't, F, 2d West Vir- ginia Cav., age 24. Schenkelberger, J., Lt, 1,1st New York Art'y. Schleier, M., Pt., B, 3d Iowa, age 29. Schneider. E., Pt, H, 5th Artillery. Schwartz, P.. Pt.,F, 46th New York, age 20. Shea, A., Pt. C, Pur- nell's Legion, age 20. Sheldon, D. D., Serg't, B, 14th Missouri. Shomers, P., Pt., A, 140th N. York, age 41. 1 Simpson, W., Courier, Iowa, age 24. Sluder, A. L., Pt, 11, 11th Georgia, age 20. Small, G. VV., Pt., K, 21st Penn. Cav., age 19. Smith, B. S.. Pt., A, 48th Mississippi, age 49. Smith, .1., Pt, B, 2d Massachusetts, age 29. Smith, S. D., Pt, C, 7th N. Hampshire, age 30. Snyder, W. E., Pt., F, 7th Kentucky. Feb. 26, 26, '63. May 6, 8, '64. May 18, 18, '64. July 2, 4, '63. Mav 6, 6, '64. July 11, 11. '63. Oct. 27, 28, '64. April II, 1.1, '03. Sept. 19, 19. '64. June 3, 3, '64. April 2, 2, '65. Sept. 29, 29. '64. Mav 14, 14," 04. Aug. 29, 30. '62. Mar. 16, 10, '05. July 3, 3, r63. April 30, 1863. April 7, 7, '64. Sept. 17, 18, '62. May 12, 12, '64. June 27, 1864. Sept. 1, 1, '64. June 13, 13, '63. Oct. 3, 3, '62. July 3, 3, '63. April 6, 6, '65. Aug. 29, 29, '62. Aug. 14, 14, '64. Sept 19, 21, '63. July 30, 30, '04. June 18, 18, '64. May 23, 23, '62. June 2, 2, '64. Sept. —. July 2, 3, '63. June 3, 3, '64. June 30, J'yl,'62 Mar. 16, 16, '65. July 18, 20, '03. May 22, 22,' '03. Operations, Operators, Result. Right; ant. post Hap; Surg. J. J. Marks, 18th Penn. Cavalry. Discharged. Left; circ; Surg. G. L. Potter, 145th Penn. Disch'd Doc. 9, '64. Right; circ; Surg. P. K. Hubon. 2Sth Mass. Discli'd April 9,'00. Left; circular. Disch'd .I line 15, 1805. Died Juno 9, 18V2. Right; Surgeon Brown. C. S. A. Recovered: Lett (injuring popliteal artery) ; circ; Surgeon E. .1. Bonine,"2d Mich. Disch'd April 9. 1K04. Left; lateral Hap; Confederate surgeon. Disch'd Julv 12, 1865. Riglit ; circ: Surg. S. A. Green, 24th Muss. Disch'd May 10, 1804. Right; circ; Surg. Buvard.C.S.A. Provost Marshal, April, 1. 1865. Right; double flap: Surg. 1). M. Goodwin, 3dVi. Dis. June0,'6o. Left; ant, post, oval flap; Confed. surgeon. Necr. bone removed. Disch'd Oct. 17, 1865. Right; flap. Disch'd Dec. 20, '65. Left; circ; Surg. D.L.Heath,23d Mich. Disch'd July 18, 1865. Left; Surg. Tanney, C.S.A. Re- tired Oct. 22, 1864. Left: ant. post, skin flap; Surg. J. W. Terry, 20th Conn. M. O. June 13, 1805. Right. Exch'd Oct, 26, 1863. Right. Disch'd Sept. 23, 1863. Died Jan. 11, 1867. Right; circular. Disch'd June 10, 1864. Right; circ; Surg. G. B. Cogs- well, 29th Mass. Disch'd May 20, 1863. Right; flap ; Surg. W. D. Hum phrey, 149th Penn. Disch'd July 18, 1865. Right. Retired from service Sept, 6, 1864. Left; lat, flap ; Surg.W. M. Gray, 60th Ills. Gang. Dis. Feb. 8, 65. Right; flap. Disch'd Oct. 26, '63. Right, Disch'd March 12, 1863. ----; Surg. Harris, C. S. A. Pa- roled Oct. 22, 1863. Right; ant. post flap. Recovery. Mustered out June 30, 1865. Left: circ. inside, flap externally; A. A. Surg. J. B. Greene. Dis- charged Dec. 17, 1862. Right; circular. Disch'd Aug. 15. 1865. Left; flap. Disch'd Feb. 24, '64. Right; double flap; Surg. W. B. Fox. 8th Mich. Dis. Apr. 3, '65. Right; circ; Surg. J. S. O'Don- nell, Purnell Legion. Disch'd Oct 28,1864. Left; circular. Disch'd Nov. 11, 1862. Right; flap; Confed. surgeon. Discli'd Aug. 11, 1865. Left; ant. post, flap; Surg. E. Batwell, 14th Mich. Disch'd. Not a pensioner. Left, Exchanged Sept. 25.1864. Right; circular. Disch'd August 2, 1865. Right; cir. Escaped August 18, 1863. Right; ant, post. flap. Disch'd Sept 12, 1805. Left: circ; Con. surg. Disch'd April 13, 1864. Spec. 1856. Left Disch'd Sept 4, 1863. Name, Military Description, and Age. , J. D., Pt., 1,15th New Jersey, age 21. Springer, J. M., Corp'l, B, 40th Illinois. Stackhouse, P. J., Pt,C, 2d Penn. Res., age 34. Steinberger, W., Pt., A, 23d Indiana. Stiensberger, M., Pt., II, 11th Penn., age 30. Stoddard, A., Pt., G, 4th N. Hampshire, ago 33. Stoughton, W. L., Col, 11th Michigan. Stocks, G. W., Pt, I, 3d Iowa. Strecter, H.R., Pt, A, 85th Illinois, age 28. Strickland, N., Pt, C, 203d Penn., age 20. Stuckey, J. S., Capt, I), 138th Penn., age 30. Sweet, L., Corp'l, C, 88th Indiana, age 33. Taggart, J. N., Pt., G, 1st West Virginia!,. A., age 23. Tanner, J., Pt., C, 38th New York. Tarcott, A., Pt, A, 94th New York, age 18. Taylor, M. C, Pt. G, 4th North Carolina Cav. Terry, J., Pt, B, 73d Ohio, age 23. Thompson, W., Signal Quartermaster, U.S.N. Thresher, A., Pt., I, 66th Illinois. Tucker, R., Pt, K, 19th Arkansas, age 21. 2 Tucker, J., Serg't, G, 4th Tenn Cav., age 40. Uhl, G., Serg't. K, 20th Indiana, age 22. Vangorden, J. S., Pt, C, 14th Infantry. Vaughan, J. F., Lieut, K, 7th Indiana, age 32. Vebber, H. H.,Sergt, D, 10th N. Y. Art., age33. Vechan, C, Pt, D, 12th New Jersey, age 24. Vinzant, J.. Serg't, A, 1st Florida, age 26. Wait, A., Corp'l, D,127th Illinois, age 21. Walker, G., Serg't, K, 40th Virginia. Wallace, S. F., Pt., D, 178th N. York, age 18. Wakefield, S., Pt, K, 95th Illinois. Warren, G. W., Pt., B, 20th Indiana. Waters, P., Pt,, C. 4th Cold Troops, age 45. Watkins. J. D., Serg't I, 52d North Carolina. Watkins, L. D., Pt, E, 55th Penn., age 21. Webb, J. M., Lieut, D, 17th Maine, age 29. Wedcking, J. H., Pt, A, 114th Illinois, age 20. 3 Weeks, J. D., Pt., G, 3dCol'd Troops, age 20. Welch, W., Pt, D, 33d New Jersey, age 19. Welsh, J., Pt., A, 4th Penn. Cav., age 27. Westmoreland, M, Pt, B, Nelson's Battery. Aug. 17, 18, '64. April 6, 8, '62. July 2, 4, '63. May 1, 1, '63. Mar. 31, 31, '65. Sept. 1, 1, '63. July 4. 4, '64. July 12, 12, '63. Aug. 9, 9, '64. Jan. 15, 15, '65. Sept. 19, 20, '04. Mar. 19, 20, '65. Aug. 26, 26, '03. Sept. 1, 1, '62. Dec. 13, 14, '62. June 19, 20, '63. July 3, 4, '63. Nov. 7, 7, '61. June 28, 28, '64. July 22, 22,"'64. May 9, 9, '64. Mar. 25, 25, '65. June 6, 7, '62. June 1, 1, '64. April 2, 4,'65. May 10, 11, '64. Dec 4, 6, '64. July 28, 28, '64. June 26, 27, '62. April 9, 9, '64. Mav 18, 19," '03. June 25, 26, '62. i&ept 29, Tio, '04. Dec. 17, 17, '02. June 18, 20, '64. April 6, 6, '65. July 16, 16, '63. Nov. 14, 14, '63. Mav 8, 9, '64. Aug. 16, 16, '64. July 22, 22, '64. Operations, Operators, Result. Right; circ: Surg. J. W. Miller, O. S. A. Disch'd June 24. '65. Right; flap. Disch'd July 10, 1862. Left; ant post flap. Disch'd May 3, 1864. Left; flap. Recovered ; disch'd. Left; flap. Disch'd June 9,1865. Left: flap; Surg. S. A. Green, 24th Mass. Disch'd June 16,'64. Spec. 4306. Right; Surg. W. N. Elliott, 11th Mich. Disch'd Sept 30, 1864. Left; flap. Discli'd Oct. 1,1863. Right; flap ; Surg. II. R. Payne, 10th Ills. Disch'd Nov. 7, 1865 Right; circ; Surg. J.W.Mitchell, 4th C. T. Mar. 8th, reamp. Right. Surg. C. E. Cady, 138th Penn. Disch'd Feb. 8, '65. Left; flap; Confederate surgeon. Disch'd Oct. 4, 1865. Lett: ant, post, flap; Surg. W. B. Wynne. 14th l'enn. Cavalry. Disch'd June 14, 1864. Left; circular. Disch'd June 3, 1863. Right; long post, flap; Surg. G. W. A verv. 94th N. V. Disch'd Nov.12, 1863. Sprc. 1373. Right. Furloughed Nov. 3, 1863. Left; flap. Disch'd Nov. 29, '64. Right; flap; Surg. J. T.Kitchen, U. S. N. Disch'd July 22, '62. Died Sept. 12, 1872. Left; flap; Surg. E. Guilick, 9th Ills. Disch'd Aug. 1, 1865. Left; flap. Recovery. Right; flap. May 14th, reamp. Furloughed. Left; flap. Disch'd July 6,1865. Left. Disch'd Sept. 4, 1862. Left; Surg. G. W. New, 7th lnd. Disch'd Sept. 20, 1864. Right; circ; Surg. O. S. Cope- land, 10th New York Artillery. Disch'd Oct. 5, 1865. Right: circ; Surg. A. Satter- thwaite, 1 th N. Jersey. Disch'd July 18, 1865. Right; ant. post. flap. Paroled July 15, 1805. Left; flap: Surg.A.C.Messenger. 57th Ohio. Disch'd Mar. 23, 65. Right; Surgeon Spence, C. S. A. Recovered. Left; flap. Disch'd June 25, '65. 1870, stump tender. Left; flap; Surg. J. W. Green, 95th 111. Disch'd Aug. 11, '63. Left; flap; Surg. M. Gunn. 5th Mich. Disch'd Aug. 21, '62. Left. Disch'd April 10, 1805. Left; Surg. Warren, C. S. A. Recovered. Left. Disch'd Dec. 20, '64. Spec. 4325. Left; flap; Surg. N. A. Hersom, 17th Maine. M. out June 4, '65. Right; ant, post, flap; Surg. II. Z. Gill. U. S.V. Disch'd May 20, 1864. Left; oblique flap; Surg. S. W. Gross, U. S. V. Also amp. arm. Dis. July 20. '65, and pensioned. Left; circ".; Confederate surgeon. Disch'd Aug. 20, 1805. Right Disch'd Feb. 9, 1865. ----; Surg. J. Semple, C. S. A. Recovered. 1 Bat-WELL (E.), Successful Amputation at the Hip Joint, in Med. and Surg. Reporter, 1865, Vol. XIII, p. 188. 20'KEEFE (D. C), Surgical Cases of Interest treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Med. and Surg. Jour., 1865, Vol. II, p. 25. 3 GROSS (S. W.), Synchronous Amputation of the Left Thigh at its Upper Third and of the Left Arm, in Am. Med. Times, 1864, Vol. VIII. p. 122. 220 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 248 249 350 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 2S9 290 291 292 293 294 Name, Military Description, and Age. Wiatt, T., Pt., A, 24th Kentucky, age 32. Wiggins, W. W., Corp'l, IC, 5th Wis., age 34. Wilbur, D., Serg't, K, 1st Maine H. A., age 37. Willey, 11., Pt, E, 40th Illinois. Wilkinson,H.T., Lieut, C, 22d Virginia, age 25. Winn, J. J., Quarter- master U. S. S. Oneida, age 33. Wise, G. C., Pt, B, 14th South Carolina, age 20. Wolf, A., Pt., I, 38th Wisconsin. Wormwood, C, Pt., B, 97th New York, age 19. Worthy, C. W., Pt., H, 15th S. Carolina,age21. Yeagle, J.,Pt, C, 111th Penn., age 25. Yerwood, T. L., Pt., H, 19th Georgia. York, D. P., Pt, B, 12th Maine, age 30. Able, P., Pt., A, 49th Virginia. Aikens, R.N. G., Serg't, B, 109th N. Y., age 21. Albert, H. C. Corp'l, A, 1st. Cavalry, age 21. Allison, J. J., Serg't, B, 39th Mass., age 40. Anderson, R,, Lieut., I, 31st Iowa. Anderson, S. P., Pt, D, 118th Pennsylvania. Angle, T., Pt,, D, 100th Colored Troops, age 21. Arms, A. I., Pt, H, 71st New York. Armstrong, J., Pt., B, 14thNew York H. Art. Armstrong, J., Pt, A, 2d Rhode Island. Armstrong, S. H., Pt., A, 13th C. T., age 24. Asherwood, J..Pt, G,7th N. V. H. Art'y, age 30. Aylesworth, E. G., Pt., G, 147th New York. Babcock, W., Lt. Col., 75th New York. Bailey, W., Pt, D, 31st N. Carolina, age 23. Bailey, J., Pt, E, 35th Alabama, age 29. Ball, C. A., Corp'l, D, 14th N. Hamp., age 45. Barr, S., Serg't, B, 3d Iowa Cavalry, age 23. Barnes, R. 67., Sergeant Major, 52d N. Carolina. Bart'lett, M. IL, Pt, D, 4th Vermont, age 19. Barrett, A., Pt., H, 4th Indiana Cavalry. Beatty, C. L., Capt.. A, Palmetto S. S. Bell, J. C., Pt., A, 13th South Carolina. Bennett, L., Pt., D, 141st Pennsylvania. Bennett, J. W., Major, 10th Missouri Cavalry. Berguist, G., Pt., C, 95th New York, age 33. Biltz, G. C, Serg't, E, 108th Ohio. Bishop, M.G., Serg't, E, 5th Connecticut, Bollonbaugh. J., Pt., E, 93d Ohio. Bowers, J. C, Capt., D, 184th Penn.. age 20. Boyce, S., Serg't, K, 30th North Carolina. Boyd. J.. Color Serg't, 2d Delaware.* Bragg. J., Pt,, I, 42d New York. Brandt, C, Pt., A, 1st Minnesota. Dates. June 1, 1, '64. Mav 12, 12," '64. Oct. 27, 29, '64. April 6, 8, '62. Nov. 27, 28, '63. April 22, 22, '62. May 6, 6, '64. April 2, 2, '65. June 4, 4. '64. June 22, 22, '64. May 25, 25,"'64. Aug. 9, 10,^62. Sept. 19, 20, '64. May 30, 31, '64. June 10, 10, '64. July 27, 27, '64. June 19, 19, '64. May 21, 21," '63. Sept. 20, 20, '62. Dec. 16, 17, '64. July 2, 2, '"63. July 18, 18, '64. June 25, 25, '62. Deo. 16, 17, '64. June 16, 16, '64. July 2, 3, '63. Sept. 19, 19, '64. May 16, 16, '64. Nov. 30, De. 1, '64, Sept. 19, 19, '64. Oct. 22, 22, '64. July 3, 3, '63. July 10, 10, '63. Oct. 4, 5, '63. Aug. 14, 14, '64. July 28, 28, '64. July 3, 3, f63. Sept. 27, 27, '64. June 17, 17, '64. Mav 14, 14,' '64. July 20. 20, '64. June 28, 28, '64. June 2, 2, '64. Nov. 8, 8, '63. Julv 2, 2, '03. Sept. 17, 17. '62. July 3, 3, '63. Operations, Operators, Result. Right; flap. Disch'd March 22, 1865. Right; flap; Surg. C. R. Crane, 5th Wis. Mustered out 1864. Right; ant. post, flap; Confed. surgeon. Mustered out 1865. Left; circ. Disch'd Aug. 4,1862. Right; circular. Trans. Dec. 3, 1863. Left; Surg. J.Y. Taylor, U. S. N. Also amp. left arm. Disch'd Nov. 17, 1862. Left. Surg. Huger, C. S. A. Re- tired from service Feb. 11,1865. Left; flap : also amp. finger right hand. Disch.'d Sept. 6, 1865. Right. Disch'd. Spec. 1464. Right; circ. Furloughed August 16, 1864. Left; flap: Surg. G. P. Oliver, llltb Penn. Disch'd Feb. 8,'65. ----; Surg. Beckie. Recovered. Left; circ; Surg. H. Fearn, 175th N. York. Disch'd Dec. 30. '64. Left; ant. post. flap. Died July 1, 1864; pyaemia. Right; Asst Surg. J. S. French. 109th N.York. Irritative fever. Died Sept, 17, '64 ; exhaustion. Right; flap. Died Aug. 19,1864; exhaustion. Right. Died July 30, 1864. Flap; Surg. J. C. Morgan, 29th Missouri. Died May 22, 1863. Right Died Sept 29, 1862. Left; circ.; Surg. J. R. Ludlow, U.S.V. Died Dec 30,'64; exh'n. Also amp. arm. Died July 3, '63. Left; circ; Surg. T. F. Oakes, 56th Mass. Died July 21,1864. Right. Died July 6, 1862. Right. Died January 1, 1865. Left; ant. post. flap. Died June 28, 1864; exhaustion. Right. Died July 10, 1863. Left: ant. post. flap. Died Oct. 5, 1864; pyaemia. Left; flap. Died June 14, 1864. Left; ant. post. flap. Died Jan. 28, 1865; exhaustion. Right; ant. post flap; pyaeniic. Died Oct. 25, 1804. Left; oval flap. Died Nov. 28, 1864; irritative fever. Right. Died July, 1863. Left; circ. Died August 3, '63; exhaustion. Spec. 3887. Left; double flap; Asst Surg. J. E. Link, 21st 111. Died Oct. 7,'63. Died August 15, 1864. Circ; Ast.Surg. W.F.Richardson, C.S.A. DiedJuly30,'64; exh'n. Died July 10, 1863. Left. Died November 15, 1864. Left: ant. post. flap. Died Aug. 4, 1864 ; pyaemia. Right. Died May 24, 1864. Right. Died July 28, 1864. Right. Died July 28, 1864. Right; Surg. J. L. Brinton, 81h Ohio. Died July 18, '64; exh'n. Left; Surg. H. F. Lyster, 5th Mich. Cav. Died Nov. 11, '63. Left. Died. Left. Died October 3, 1862. Right. Died July 21, 1863. NO Name, military Description, and Age. Brennan, P.,Pt.,E, 169th New York, age 23. Briggs, J., Pt,, C, 79th Ohio. Brine, J. M., Pt., F, 27th Michigan. Brooks, M., Serg't, H, 16th North Carolina. Browney, W., Pt,, G, 73d New York. Brown, I., Pt., I, 142d Pennsylvania. Brown, J., Pt, K, 102d New York, age 27. Brown, J. F., Pt., A, 15th South Carolina. Brown, J. W., Pt., F, 152d New York. Brown, M. A., Pt., H, 25th S.Carolina, age 18. Buch, J., Pt., H, 27th Iowa. Burks, J. H., Pt., F, 9th Alabama. Burns, A., Pt., F, 66th New York. Butler, A. K., Corp'l, F, 1st Michigan Cavalry. Caesar, H., Captain, A, 52d New York. Cairns, J. W., Pt., G, 5th Penn. Reserves. Callahan, J., Pt, I, 1st New York Dragoons. Carne, W.W., Serg't, H, 26th Massachusetts. Camp, E. L., Serg't, G, 84th Illinois. Campbell, M., Pt., C, 11th Penn. Reserves. Campbell, J., Pt., K, 6th Vermont. Carpenter, C, Pt., L, 1st New York Artillery. Carson, T. D., Pt., C, 4th Ohio. Chambers, W., Pt., I, 4th New Jersey. Chisler, J., Pt., I, 8th Penn., age 19. Churchill, A.W., Corp'l, G, 7th Mich. Cavalry, age 33. Clapp, S. C. B., Lieut,, H, 125th N. Y., age 22. Clarke. A., Pt., A, 69th Indiana. Coffing, J. C, Lieut., K, 10th Connecticut. Collier, P., Pt., K, 3d Missouri Cavalry. Combs, A. J., Pt, H, 39th Georgia, age 27. Condon, S., Pt., I, 87th New York, age 18. Conlin, W., Pt., H, 140th Pennsylvania. Connor, S. A., Pt., G, 62d Ohio, age 21. Connor, P., Pt, D, 53d Pennsylvania. Constine, L., Pt, C, 143d Pennsylvania. Coquillet, I., Pt., G, 8th 111. Cavalry, age 21. Cowman, J., Pt., C, 81st Ohio. Coxe, L. I., Serg't, D, 25th South Carolina. Crane, J., Pt, K, 100th New York. Crawton, W., Pt., H, 63d New York. Croyle, W. H., Pt, H, 55th Penn., age 21. Danner, S., Pt, I, tilth Illinois. Davill, J., Pt., H, 10th Missouri. Davis, E., Pt, C, 18th Ohio, age 35. Delaney, J., Pt, C, 101st Illinois, age 25. Dates. Jan. 16, 16, '65. May 25, 25, '64. July 30, 30, '64. July 3, 3, '63. July 3, 3, '63. May 5, 5, '64. May 27, 27, '64. June 1, 1, '64. May 18, 18, '64. May 16, 16, '64. June 21, 21, '63. June 24, 24, '64. Sept. 17, 17, '62. Mar. 19, 20, '62. May 1, 1, '63. Mav 9, 9, '64. Aug. 10, 10. '64. Sept. 19, 20, '64. June —, —, '64. July 2, 2, '63. May 15, 15, '64. April 30, 30, '63. May 3, 3, "'63. May 5, 5, '64. May 6, 6, '64. Oct. 19, 19, '64. May 12, 12,'64. Primary, Dec. 14, 14, '62. May 1, 1, '63. Dec. 4, 4, '64. June 25, 27, '62. Julv 3, 3. '"63. Oct, 13, 13, '64 June 1, 1, '62. May 11, 13, '63. Dec. 1, 2, '63. Sept. 3, 3, '64. Sept, 29 29, '64. Sept. 4, 4, '64. Sept. 17, 17, '62. June 16 16, '64. Mav 14, 14," '64. Mav 14, 14,"'63. Dec 15, 16, '64. May 25, 26, '64. Operations, Operators, Result. Right; ant. post, flap; Surg. L. Barney, 6th Col'd Troops. Died Feb. 2, 1865; exhaustion. Right Died June 11, 1864. Right; Surg. W. B. Fox, 8th Michigan. Died July 30, 1864. Right. Died July 18, 1863. Left. Died July 13, 1863. Left, Died May 7, 1864. Right; flap; Surg. C. II. Lord, 102d N. Y. Died Feb. 18. 1865. Left; double flap. Died June 9, 1864. Right; Surg. M. Rizer, 72d Penn. Died May 18, 1864. Flap. Died May 22, 1864. Left; Surg. N. Gay, U. S. V. Died June 22, 1863. Died June 26, 1864. Surg. C. S. Wood, 66th N. York. Died Sept. 25, 1862. Right; circular. Died March 27, 1862; pyaemia. Right; Surg. C. S. Wood, 66th N. York. Died May 10, 1863. Surg. C. Bowers, 6th Penn. Died May 10, 1864. Died August, 1864. Left; flap ; Surg. J. G. Bradt, 26th Mass. Died Nov.30,'64. £p.3796. Left; Surg. J. T. Woods, 99th Ohio. Died June 21, 1864. Left, Died August 1, 1863. Right, Died May 18, 1864. Right; Surg. E. Shippen, U.S.V. Died May 2, 1863. Surg.C. S.Wood, 66thN.Y. Died May 3, 1863. Right. Died May 7, 1864. Left; Surg. C. Bowers, 6th Penn. Reserves. Died May 13, 1864. Right; flap. Died Nov. 8, 1864 ; exhaustion; anemia. Right; Surg. J.W.Wishart, 140th Penn. Died June 5, 1864. Right. Died November 7, 1862. Right; Surg. F. G. Snelling, U. S. V. Died Dec. 25, '62; exh'n. Right. Died May 3, 1863. Flap; A. A. Surg.W. Appley. Died Dec. 5, '64; haemorrhage. Right; July 7th. Died Sept. 2, 1862; pyaemia. Left. Died July 15, 1863. Right. Died Nov. 7, '64; tetanus. Right; June 26th, reamp. Died July 8, 1862; exhaustion. Circ; Surg. W. T. Humphrey, 149th Penn. Died May 18, '63. Right; circ; A. Surg. T.W. Stull, 8th 111. Cav. Died Jan. 17,1864. Spec. 1893. Left ; Surg. J. Pogue, 66th 111. Died Sept. 10, 1864; pyaemia. Left. Died October 23, 1864. Right; Surg.M.S.Kittinger, 100th New York. Died Sept. 5, 1864. Died September 22, 1862. Right. Died Sept. 6, '64 ; chronic diarrhoea. Right: Surg. A. C. Messenger, 57th Ohio. Died June 7,1864. Left. Died May 18, 1863. Left; ant post, flap; A. A. Surg. M. L. Herr. Died Dec. 27, '64; pyaemia. Right; ex. and int. lateral flaps. Died June 20, 1864; pyaemia. SECT. III. PRIMARY AMPUTATION OF THIGH IN UPPER THIRD. 221 Name, Military Description, ano Aoe 341 342 343 344 345 340 i 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 Diefenbaugh, J., Pt., H, 93d Ohio. Dingmnn, A., Pt., F, 27th Michigan. Dixon, J., Pt., F, 32d Alabama. Doiz, J. C, Pt., B, 19th Infantry. Donaldson, S., Pt., C, 139th Pennsylvania. Douglass, A. J., Pt., B, 14th W. Va., age 23. Doyle, T., Corp'l, I, 4th Maine. Dudley, J., Pt„ C, 34th Massachusetts. Dudley, W., Pt, E, 64th New York. Dunham, W. IL, Pt,, F, 114th New York. Dunn, <)., Corp'l, F, 66th New York, age 26. Durnan, L., Corp'l, G, 121st Ohio, age 21. Eddy, J. C, Pt., F, 22d Connecticut. Edward, W., Pt., I, 49th Ohio. Edwards, C, Pt, K, 149th New York. 1 Elder, W. B.,Serg't, B, 91st Penn. Erwin, W. B., Pt., C, 5th Tennessee. Evans. E. S., Pt., I, 87fh Indiana. Evans, H., Serg't, E, 12th Massachusetts. Fortna, H. A., Pt.. D, 16th Illinois, age 20. French, J., Pt., C, 53d Ohio. French, D., Pt., F, 81st Ohio. Gaston, T., Pt., E, 89th Illinois. Geary, C. M., Corp'l, M, 1st Maine Cav., age 23. Gillsen, A., Pt., F, 7th Infantry. Gilbert, W., Pt., D, 23d South Carolina. Girrior, W., Pt., K, Dawson's Artillery. Glover, W., Pt., A, 16th or 25th La., age 21. Good, l\, Pt., B, 11th New Hainp.. age 19. Grt'ce, S. M., Pt, A, 27th South Carolina. Griffin, T., Pt., B, 6th Kansas Cavulrv. Groat, P.. Pt., II, 14th Iowa, age 25. Gusler, W., Pt.. F, 60th Illinois. Guilford, H., Corp'l, F, 16th Maine. Haddike, L., Serg't, I, 66th New York. Hall, J. C, Pt., A, 20th Maine, age 37. Harman, J. IL, Serg't, K, 9th Maine, age 21. Hartland, A., Corp'l, A, 99th New York. Hemphill, D., Pt., E, 72d Penn., age 26. Hensey, J. H., Pt, H, 55th Illinois. Hewitt, L. T., Pt., M, 6th Penn. Cavalry. Hills, W., Pt, D, 2d Michigan. Hoffman, A., Pt, I, 57th Ohio. Holmes, J., Pt., H, 9th Massachusetts. Howard, G. J., Serg't, G, 5th Vermont. Howard. IF., Pt, K, 55th North Carolina. May 8, 8, '64. June 3, 3, '64. May 15, 15, '64. July 22, 22, '64. Juno 7, 7, '64. Aug. 25, 27, '64. Julv 2, 3, '63. Mar. 31, 31, '05. July 2, 2. '63. Oct. 19, 19, '64. Sept, 17, 17, '62. Mar. 19, 20, 65. Dec 13, 13, '62. June 26, 26, '64. May 25, 25. '64. Dec. 14, 14, '62. May 14, 14, '64. June 15, 15. '64. May 5, 5. '64. Mar. 19, 19, '65. June 27, 27, '64. May 16, 16, '64. June 1, 1, '64. April 7, 7, '65. Feb. 21, 22, '62. July —, —, '63. April 2, 2, '65. De.31,'62, Jan. 1,'63, May 12, 12, '64. June 15, 17, '64. July 27, 27, '64. May 18, 18, '64. Sept. 1, 1, '61. Dec 13, 13, '62. Aug. 13, 13, '64. Sept. 30, Oct 1/64. May 18, 18, '64. June —, —, '63. July 2, 4, '63. Aug. 31, 31, '64. May 14, 14, '64. Nov. 24, 24, '63. Jan. 11, 11, '63. May 5, 5, '64. Mar. 25, 25, '65. July 3, 3, '63. Operations, Operators, Result. Right. Died July 2, 1864; gan- grene. Left; Surg.W. B. Fox,8thMich. Died June 3, 1864. Right. Died May 25, 1864. Right. Died August 4, 1864. Right. Died June 9, 1864. Left; do. flap; A.Surg.C.W.Stin- son, 23d 111. Died Aug. 27, '64. Right. Died July 6, 1863. Left; flap; Surg. T. IL Squire, 8ilth New York. Died. Left; haemorrhage. Died July 23, 1863. Right; circ Died Oct. 28, 1864 ; pyaemia. Surg. O. S. Wood, 66th N. York. Died October 25, 1862. Left. Died April 14, 1865. Died December 20, 1862. Left. Died June 26, 1864. Left Died June 2, 1864. Right; circ Died Jan. 8,. 1863; tetanus. Left. Died May 16, 1864. Left. Died June 26, 1864. Right. Died May 6,1864. Left. Died May 4, 1865; exhaus- tion. Right; Surg. A. C. Messenger, 57th Ohio. Died July 1,1864. Left. Died June 8,1864. Died June 3, 1864. Right. Died April 1'5, 1865. Asst. Surg. B. Norris, U. S. A. Died Feb. 22, 1862. Left. Died August 15, 1863. Died April, 1865. Right. Died January 7, 1863. Right. Died June 19, 1864. Right; ant post, flap; Asst. Surg. W. F.Richardson.C.S.A. Died June 18, 1864 ; exhaustion. Right; circ; Surg.C. E. Swezey, U.S.V. Died July 29,'64; shock. Right; flap. Died June 14, '64 ; typho-malarial fever. Left. Died September 3, 1864. Left. Died December 15,1862. Left; Surg. A. Van Devere, 66th N. Y. Died August, 1864. Right. Oct. 11th, diarrhoea. Died Oct. 21, 1864. Left. Died June 6, 1864 ; irrita- tive fever. Left; circ; Surg. J. Wilson, 99th N. Y. Died June 24, 1863. Right; July 20th, gang. Died Aug. 20, 1863; pyaemia. Left; Surg. A.C. Messenger, 57th Ohio. Died Sept. 6, 1864. Left. Died May 22, 1864 ; exhaus- tion. Left; Surg. G. B.Cogswell, 29th Mass. Died Dec 22, 1863. Right; Surg. M. F. Carey, 48th Ohio. Died Jan. 13, 1863. Right. Died May 8,1864. v._ Left Died April 2, 1865. Left. Died July 22, 1863. Name, Military Description, and Age. Hughes, N., Serg't, Mil- ler's Mississippi Cav. Hyde, W. J., Pt, C, 19th Louisiana, age 24. Hydrick, L., Serg't, I, 66th New York. Jackson, J., Corp'l, K, 11th Conn., age 36. 2 James, J. L., Corp'l, C, 18th Indiana. Jennings, J., Pt., 1,14th Conn., age 17 Jessop, N., Corp'l, K, 97th N. York, age 30. Johnson, J. W. C., Pt, B, 187th Penn. Jones, D. C, Pt., H,43d Alabama, age 25. Jones, IL, Pt, F, 36th Cold Troeps, age 33. Jones, J. W., Pt., A, 122d Pennsylvania. Jones. O. H., Serg't, D, 146th New York. Kelty, T., Pt., K, 100th Pennsylvania. Kenison, A., Pt., E, 12th Maine. Kennedy, C, Pt,F, 71st Penn., age 27. Kensler, P., Pt., G, 47th Ohio, age 36. Kerr, S. M., Pt, C. 6th Tenn. Cav., age 20. Kief, J., Pt., B, 66th New York. King, T. H., Corp'l, C, 12th N. C, age 19. Kirkpatrick, E., Pt, A, 18th Ohio, age 31. Knox, S., Pt., C, 28th Pennsylvania. Lackey, J., Pt., C, 21st Mass., age 39. Lake, C, Pt., A, 102d New York. Lamson, W. H., Pt., C, 6th Maine, age 23. Langelle, L., Pt, H, 7th Missouri. Laughner, A., Pt., F, 18th Penn. Cavalry. Leary, T., Pt., I, 5th Infantry. Leech, J., Pt, A, 82d Penn., age 42. Leonard, S. H., Pt, A, 3d Massachusetts. Linerman, H., Pt, G, 37th Ohio, age 33. Long, F. M., Major, 45th Illinois. Long, R., Serg't, H, 24th N. Carolina, age 23. Lothian, J., Capt, C, 24th Mich., age 27. Luderking, It., Corp'l, A, 2d Michigan. Lynch, W. M., Serg't, A, 69th New York. Mace, W. H., Corp'l, D, 32d Maine. Maders, W. C, Pt, G, 83d New York, age 30. Mahan, M., Pt., A, 12th Massachusetts. Marsh, J., 2d Lieut., I, 29th Ohio. Martin, A. B., Capt., H, 6th Maryland. Mason, A. J., Capt, H, 145th Penn., age 30. Mathias. L., Pt, C, 107th New York, age 38. May, J., Corp 1, H, 6th Wisconsin. Mayo, J., Pt,, C, 44th North Carolina. July 22, 24, '64. Dec. 17, 18, '64. Aug. 14, 14, '64. June 18, 18, '64. May 1, 1, '63. Aug. 25, 27, '64. Aug. 18, 19, '64. June 18, 18, '64. Mav 16, 10,''64. June 15, 15. '64. Dec. i::, I :\ '62. June 2, 3, '64. July 30, 30, '64. Sept. 19, i9, '64. May 18, 18, '64. July 28, 29, '64. Dec. 16, 16, '64. Dec 16, 16, '62. Oct. 19, 19, '64. Dec. 16, 16, '64. July 20, 20, '64. May 5, 6, '64. Sept. 17, 17, '62. May 9, 9, '64. June 17, 17, '63. Nov. 12, 12, '64. Feb. 21, 22, '62. Sept. 21, 21. '64. Sept. 19, 19, '64. July 28, 28, '64. July 12, 12, '63. June 16, 16, '64. June 16, 16, '64. Nov. 29, 29, '63. June 3, 3, '64. July 22, 22, '64. May 8, 9, f64. Dec 13, 13, '62. July 1, 1, '63. May 5, 5, '64. Dec. 13, 13, '62. Mar. 16, 16, '65. May 14, 14, '64. Oct. 2, 2, '64. Operations, Operators, Result. Left; gang.; circular. Died July 24,1864. Left; flap; gangrene. Died Nov. 20,1865; typh. fever. Left. Died August 16,1864. Left. Died July 23, 1864; ex- haustion. Right; double flap. Died Mav 27, 1863. Left; nnt. post. doub. flap ; Surg Hunt, C.S.A. Died Sept. 26,'U4. Right; circ Aug. 31st, pyaemia. Died Sept. 5,1864; pyaemia. Died July 1,1864. Flap. Died May 19, 1864. Left; flap. Died August 20, '64 ; haemorrhage. Died December 20, 1862. Left; flap. Died June —, 1864; absorption. Left; flap; Surg. T. F. Oakes, 56th Mass. Died July 31,1804. Right: circ; pvsemic sym. Died October 16,1864. Right; Surg. G. L. Potter, 145th Penn. Died.Iune4,'64; pyaemia. Left; flap; Act. Staff Surg. C. B. Richards, U.S.A. Died July 31, 1864. Right; ant. post. flap. Died Jan. 10, '65; typhoid pneumonia. Left; Surg C. S. Wood, 66th N. York. Died Dec 19, 1862. Circular. Died; tetanus. Left; ant. post, flap; Surg. 15. B. Breed, U- S. V. Died Dee. 17, 1864; exhaustion. Left. Died August 22, 1861. Right; Surg. P. E. Hubon, 28th Massachusetts. Died June 1, 1864; pyaemia. Right. Died September 29, 1862. Right: skin flap; circular. Died June 6, 1804. Circular; pyaemia. Died July 7, 1863. Right; oval flap; Surg. J. W. Smith, 2d Ohio Cavalry. Died Dec. 22, 1864 ; pyaemia Asst. Surg. B. Norris, U. S. A. Died Feb. 22, 1862. Right. Died Oct, 8, '64; shock. Right. Died September 24,1864. Left; circ; Act Staff Surg. C. B. Richards. Died Aug. 4, 1864. Right. Died July 12, 1863. Left; circ Died July 23, 1864. Spec. 1685. Left; lat. flap; Surg. J. W. Wis- hart, 140th Penn. Died July 12, 1864. Right; Surg.G.B.Cogswell,29th Mass. Died Dec. 3, 1863. Right; Surg. J. A. Spencer, 69th New York. Died J une 8,1864. Left. Died July 23, 1864. Right. Died June 3, 1864; py- aemia. Left ; flap. Died Deo. —, 1862. Right. Died July 4, 1863. Left. Died May 5, 1864. Left. Died Jan. 12, '64; pyaemia. Left; flap. Died May 6, 1865. Died May 14, 1864. Right; Surg. A. A. White, 8th Md. Died Oct. 4, 1864. 1 BUTLER (W. H.), Remarks on tetanus, with histories of nine cases, in Am. Med. Times, 1863, Vol. 7, p. 158 2 Bryan (J.), Sixteen cases of Amputation treated in hospital at Grand Gulf, Miss., in Am. Med. Times, 1863, Vol. 7, p. 5. O-).) INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. 431 432 433 434 435 436 437 138 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 457 458 459 460 461 462 463 464 465 466 467 llOS 469 470 471 472 1473 Name, Military Description, and Age. McDonald, P., Pt., K, Mh Kansas, age 30. McDonald, IL, Corp'l, B. 98th Ohio, age 39. Mcl'arland, G., Pt., B, 13th Indiana. McGarry, J. E., Pt, B, 105th Penn., age 21. McMorris, M., Pt., B, 124th N. Y., age 18. Mead, J. P., Pt, I, llth Massachusetts. Miller, W., Corp'l, B, 85th Indiana. Montgomery, J. P., Pt, B, 10th Hilary, age 18. Moore, J. N.,Pt, f; 5th Tennessee, age 40. Morgan, G. C, Serg't, D. 48th Illinois. Mulligan. T. H.. Pt, A, 14th Infantry, age 30. Murray, M., Pt, 1,149th New York. Myers. S. C, Corp'l, F, 70th N. Y., age 24. Nelms, W. F., Pt., B, 5th Texas. Noonan, C, —, F, 18th New York. Nye, G. W., Serg't, H, 3d Maine. O'Hagan, M. P., Serg't, C, 10th N. York Heavy Artillery, age 22. Ormsby, R., Pt., G, 64th New York. Osborn, L., Pt., G, 3d New York Cav.,age 27. Page, J. L., Corp'l, H, 66th N. York, age 33. Partridge, P. S., Pt, D, 26th Mississippi. Parker, W. S., Pt, C, 1st U. S. Sharpshooters. Parker, M., Pt., A, 5th Vermont. Paul.W., —. C, 7th Wis- consin. Parkins, J. W., Pt., F, 6th West Virginia. 456 Per N ■rin, W., Pt., I, 158th cw York, age 26. Pettigrew, A. J., Pt., C, llth Penn. Reserves. Potter, W., Pt., B, 29th Ohio, age 22. Poust, W.. Pt., K, 51st Penn., age 29. Pratt, E. C, Lieut, G, 6th Cl'd Troops, age24. Preston, Y. P., Pt.. C, 42d Alabama. Preston, J. W., Pt., F, 147th Penn., age 29. Prescott, C, Pt., G, 51st Pennsylvania. Purdy, H., Pt., C, 2d Penn. Batterv, age 33. Ranne.r, W., Pt, F, 3d Florida. Rathbone L., Pt., C, 25th N. C , age 20. Reaghton, W , Pt., G, 67th Pennsylvania. Reed, J. M., Serg't, B, 24th Michigan. Revnolds. J., Pt., C, 1st Rhode Island Artil'rv. Rice. A., Pt., G. 111th New York, age 21. Rice, J. C, Brig. Gen'l U.S.V., 5th A. C. Richardson.A. ('..Serg't, A, 59th Mass. Richardson. T., Pt, H, llth West Virginia. Dates. Operations, Operators, Result. Sept. 19, 20, '63. Sept. 1, 1, 04. Dec. 12, 12, "62. June 16, 16, '64. May 5, 5, '64. July 21, 23, '61. June 27, 27, '64. Aug. 21, 21, '64. May 14. 14, '64. July —, —, '63. July 2, 4, '63. July 20, 20, '64. July 2, 3, '63. July 3, 3, '63. Sept 14, 15, '62. Aug. 30, 30, '62. Aug. 12, 12, '65. July 2, 2, '63. May 17. 18, '64. Sept. 17, 17, '62. Juno 3, 5, '64. May 3, 3, '63. Oct. 19, 20, '64. Julv 1, 1, '63. June 5, 5, '63. April 2, 2, '05. Julv 2, 3, '03. May 8, 8, '64. Aug. 19, 19, '64. Sept. 29, 29, "64. May 15. 15, '64. June 18, 19, '64. June 2, 2, '64. July 1, 1, '63. Mar. 19, 19, '65. Dec. 1, 1, '64. Mar. 25, 25, '65. May 12, 12," '64. April 5, 5, '62. June 19, 19, '64. May 10, 10, '64. July 30, 30, '64. Mar. 10, 16, '64. Right; circular. Died October 12,1863; haemorrhage. Right; ant. post. flap. Died Nov. 24, 1864 ; exhaustion. Died December 12, 1862; shock and haemorrhage. Right: ant post, flap; Surg. D. S.Hays, 110th Penn. Died "July 17, 1864. Left. Died May 30, '64; pyaemia. Died July 23, 1861; under opera- tion. Right. Died July 6, 1864. Left; ant. post, flap; Surg. J. W. Anawalt, llth Penn. Died Sept. 10, 1864; pyaemia. Left. Died May 17, 1864. Asst. Surg. R. L. Von Harlingen, 53d Ohio. Died July 18, 1863. Left. Died July 14, '04 ; tetanus. Left; circ.; Surg. C. H. Lord. 102d New York. Died July 21, 1864 ; haemorrhage. Left, Died July 28,1863; haem- orrhage. Right Died July 9, 1863. Amp.; sloughing. Died August 8, 1863. Right. Died September 5, 1862. Left; Surg. E. Bentley, U. S. V. Died August 23, 1865; haemor- rhage. Right. Died July 16, 1863. Right; circ. May 22d, haemor- rhage. Died May 27, 1804. Right; Surg. C. S. Wood, 66th N. Y. Died October 10, 1862. Circ; Surg. Taley. Died June 10, 1864. Right. Died May 3, 1863. Right. Died October 21, 1864. Circ. Died July 6, 1863. Left; Asst. Surg. J. T. Wharton, 6th W.Virginia Cav., and others. Died June 5, 1863. Right: Asst. Surg. C. G. Allen, 34th Mass. Died April 13, '65 ; pyaemia. Right. Died July 13, 1863. Left; circ; Surg. A. K. Fifield. 29th Ohio. Died July 6, 1864 ; diarrhoea. Right; circ Died Sept. 10, '64 ; erysipelas. Right. Died Dec. 15,'64; pyaemia. Died June 8,1864. Right; circ.; Surg. J. W. Brock, 66th Ohio. Died Aug. 29,1864; diarrhoea. Left Died June 4,1864. Right. Died September 11,1863; pyaemia. Right. Died March 25,1865. Left; circ. Died Dec. 2,1864. Right. Died March 25, 1865. Left. Died May 12,1864. Left. Died April 5,1862; shock. Left ; circ.; Surg. J. W. Wishart, 140tb Penn. Died June 29, '64 ; exhaustion. Died .May 10, 1864. Right: flap; Surg. T. F. Oakes, 56th Mass. Died July 30, 1864. Right; circ.; Surg. C. M. Clark, 39th 111. Died March 18, 1804; shock and exh'n. Spec. 5656. Name, Military Description, and Age, Dates. Operations, Operators, Result. Rider, J., Pt., A, 8th Kansas, age 37. Riley, J., Pt., B, llth New Jersey. Riley, ().. "Pt, M, 2d New York. Rinker, G. W., Pt., B, 6th Kansas Cavalry. Rupert, J. F., Corp'l, K, 24th Michigan. Ryan, T., Pt., E, 127th Illinois, age 23. Salmond, E., Pt.,G, 74th Ohio. Sanderson, J. K., Pt., F, 37th Massachusetts. Schmidt, F.,Pt,D,l 18th Pennsylvania. Schrafenberger, P., Pt, A, 9th Ohio. Seaman, H. J., Pt., E, 13th Illinois. Seevers, R. D., Pt,, K, 36th Ohio, age 43. Sharp, D., Pt, A, 7th Penn. Reserves. Shepard, H. B., Pt., F, 95th New York, age 21. Sherman, E., Corporal, Young's Bat'ry, age 43. Sherman, M..Pt,G, 28th Pennsylvania. Shields, T., Pt., H, 99th Pennsvlvania. Shrinei{j. T.,Pt.,G,83d Pennsylvania. Slaine, P. S., Pt,H,10th Connecticut. Smith, J., Serg't, K, 7th Connecticut, age 29. Smith, J. W., Serg't, H, 48th N. C, age 23. Smith, N., Pt., A, 39th Illinois. Smith, T., Pt., 34th Cl'd Troops. Soper, J., Pt., C, 16th Maine. Spencer, G. E., Pt, A, 7th Ohio. Stiene.S. P.,Pt,K, 100th Penn., age 22. Stood, M., Pt, C, 14th Michigan. Strong, L., Serg't, A,9th N. York Cav., age 23. Stuart, S., Pt., F, 31st Colored Troops. Sulfrise, C. A., Pt., 6th Tenn., age 20. Sullivan, D., Pt., B, 63d New York. Summer, G., Corp'l, K, 20th Michigan. Thomas, A., Pt., C, 2d Tennessee C. T. Van Buren, M., Pt, H, 59th Ohio. Waffle, W., Pt, F, 14th New York H'vy Art, age 30. Ward, F., Pt., G, 45th Colored Troops. Walters, J. R., Pt, I. 52d North Carolina. Warren, J. H., Pt, D, 42d Georgia. Watson, G. M., PL, D, 63d Indiaua. Weiler,.L,Corp'l, K,40th New York, age 30. Wheeler, A. R.,Corp'l, I, 9th N. Hamp., age 21. Whipple, R. G., Corp'l, K, 24th Mich., age 41. White, P., Pt., A, 35th Indiana, age 27. White, W.,Pt,I, 3d Wis- consin. Whitehead, F., Pt., I, 97th New York. Whitney, G. P., Pt., H, 6th Vermont. Wicks, A., Pt., G, 14th Indiana. Sept. 19, 20, '63. Mar. 29, 29, '65. Sept. 13, 13,'63. July 27, 28, '64. May 12, 12, '64. June 27, 27, '64. Julv 22, 22,"'64. May 5, 5, '64. Sept. 20, —, '62. Sept. 19, 19, '63. Nov. 27, 27, '63. July 25, 25, '64. Sept 14, 15,'62. Mav 5, 6, '64. July 28, 28, '64. Sept. 17, 17, '62. July 3, 3, '63. May 27, 27, '62. Feb. 8, 8, '62. June 2, 2, '64. April 6, 7, '65. April 2, 2, '65. Dec 9, 9, '64. Dec. 13, 13, '62. Nov. 27, 27, '63. Mav 12, ■ 12," '64. Mar. 19, 21, '65. Sept. 13, 13, '63. July 30, 30/64. Aug. 6, 6, '64. Dec 13, 13, '62. May 12, 12, '64. Feb. 5, 6, '64. June 28, 28, '64. Julv 11, 11,"'64. Feb. 7, 7, '65. July 3, 3, '63. May 15, 15, '64. May 14, 14,"'64. May 24, 24, '64. June 16, 16,'64. Aug. 19, 20, '64. June 10, 10,'64. Mar. 16, 16, '65. Mav 12, 12, '04. May 5, 5, ''04. May 10, 10, '64. Left; circ Died October 22, '63; pyaemia. Left Died April 1, 1865. Right. Died September 13,1863. Right: circ.; Surg. C. E. Swezev, U.S.V. Died Julv 29,'64 ; shock. Died May 13, 1864*. Right; Surg. A. C. Messenger, 57th Ohio. Died Aug. 9, 1864. Left. Died July 30, 1864. Right; Surg. G. T. Stevens, 77th N. Y. Died May 12, '65; gang. Left. Died September, 1862. Right. Died October 13,1863. Left; Surg. S. 0. Plummer, 13th 111. Died Nov. 27, 1803. Right; lat. flap. Djed October 20,1864; exhaustion. Died September 15,1862. Right; circ. Died June 12,1864; pyaemia. Right; flap. Died July 29,1864. Left, Died October 5,1862. Right. Died July 5,1863. Died June 10,1862. Died February 10, 1862. Left. Died August 22,1864 ; ex- haustion. Right. Died May 2, '65; pyaemia. Right; circ; Surg. C. M. Clark, j •39th 111. Died April 4,1865. j Left. Died December 23,1S04. Left. Died December 26, 1862. J Left. Died December 21, 1863. Right; Surg. T. F. Oakes, 50th Mass. Died May 30, 1864. Left Died March 21,1865. Right. Died September 16, '64 ; pyaemia. Right; circ; Surg. F. M. Weld, 27th C. T. Died Aug. —, 1864. Left; Surg. A. M.Wilder, U.S.V. Died Sept. 3,1864. Left. Died January 3,1863. Left. Died May 14,1864. Left; circ: Surg.J.G.F.Holston, U. S. V. Died Feb. 29, 1864. Left. Died July 6, 1864. Right; flap; Surg. T. F. Oakes, 56th Mass. Died Sept. 26,1864; pyaemia. Left ; circ; Surg. N. Falsorn, 45th Cl'd Troops. Died Feb. 19, '65. Left. Died. Died May, 1864. Right; gangrene. Died May 22, 1864. Right. Died .May 31,1864; haem- orrhage. Left Died July 20,1864. Left; flap. Died August 25, '64; haemorrhage. Left; Surg. H. G. Averdick, 35th lnd. Died July 12,1864. Left: Asst. Surg. G. W. Burke, 40th Penn. Died March 17. '65. Died May, 1864. Left; Surg. D.W. Maull, 1st Del- aware. Died. Right; Surg. G.W. McCnne, 14th Lid. Died May 12,1864. SECT. m.J . PRIMARY AMPUTATIONS OF THIGH IN MIDDLE THIRD. " 223 No. Name, Military Description, and Age. Dates. May 24, 25, '64. June 17, 17, '64. Oct. 8, 8, '62. Aug. 5, 5, '64. Julv 3, 3, '63. July 2, 4, '63. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 521 522 523 524 525 526 Wiley, J..Corp'l, K, 40th New York. Willey, H., Pt., E, 40th New York, age 28. Williams, E., Pt,E,80th Illinois. Williams, J. B.. Pt, A, 14th N. Y. H. Arty. Williams, W. H, Serg't, D, 13th Mississippi. Wilson, J., l't., B, 5th Texas, age 32. Right; Surg. H. F. Lyster, 5th Mich. Died May 31, 1864. Left; circ.: Surg. W. C. Shurlock, 61st Penn. Lied July 12,1864 ; pyaemia. Died October 10,1862. Right; flap; Surg. T. V. Oakes, 56th .Mass. 1 )icd Aug. 6,1864. Right. Died. Right; flap. July 15th, hsem., lig. fem. Died July 23,1863. 527 528 529 530 531 532 533 Winsket, A., Pt,G, 123d Indiana. Wright, J. 11., Lieut., D, 5th Virginia. Craig, J. C, Pt., E, 44th Mississippi, age 28. Prayer, T. J., Pt, I, 49th Virginia. Hawkins, G. 11'., Lieut, II, 30th Mississippi. Hnnirsy, W., Citizen, Confederate. Whitney, A'., Pt., A, 44th Georgia. June 16, 16, '64. Mar. 25, 25, '65. July 28, 28, '64. June 2, 2, '64. Aug. 31, —, '64. July -r, —, '63. May 19, —," '64. Right; Surg. A. M. Wilder, U. S. V. Died June 23,1864; shock. Left. Died March 27,1865. Right; ant. post. flap. Left: also wound right; Surg. A. Sabine, 76th Ohio. Surg. C. B. Richards, 30th Ohio. In two hundred and five of the five hundred and thirty-three cases enumerated in the foregoing table the precise seat of fracture in the femur was not indicated. In the remaining three hundred and twenty-eight cases the fracture was in the upper third of the femur in sixty-six, in the middle third in one hundred and seventy, in the lower third in fifty, at the knee joint in thirty-seven, and in the leg in five instances. Primary Amputations in the Middle Third of the Femur.—There were eleven hun- dred and fifty-seven of these operations. The results were ascertained in eleven hundred and forty-nine cases; six hundred and eighty-six were successful, and four hundred and sixty-three proved fatal, a mortality of 40.3 per cent. The operations were on the right side in five hundred and forty-four, and on the left in five hundred and thirty-four instances; in seventy-nine cases the side was not specified. Recoveries after ^Primary Amputation in the Middle Third of the Femur.—The six hundred and eighty-six operations of this group were performed on one hundred and forty- five Confederate and five hundred and forty-one Union soldiers. Of the latter, two have become insane, one was retired, and five hundred and thirty-seven were pensioned; in one instance no application for pension seems to have been made. Case 434.—Private J. Kells, Co. I, 113th Ohio, aged 44 years, was wounded at Jonesboro', September 1, 1864. He was admitted to the field hospital of the 2d division, Fourteenth Corps, whence Surgeon W. C. Daniels, U. S. V., reported: "Shot fracture of right thigh at middle third by a minie" ball; limb amputated." From the field hospital the patient passed to Chattanooga, thence to Cumberland, Nashville, and afterwards to Brown, Louisville, from which hospitals his case was described as an "antero-posterior flap amputation of the thigh at the middle third." He was discharged from service at Camp Dennison March 21,1865, and supplied with a Palmer artificial leg four months afterwards. He became a pensioner, and has been paid as such June 4, 1879. In his application for commutation he represented the sturnp as "healed and sound," and stated that Surgeon T. B. Williams, 121st Ohio, performed the amputation. In the following instance a large sequestrum was removed from the stump of the femur three months after the amputation: Case 435.—Private J. McMahon, Co. I, 6th New York Cavalry, aged 23 years, was wounded in the left leg, at Todd's Tavern, May 7, 1864. He was admitted to a field hospital of the Cavalry Corps, where amputation was performed but not recorded, and five days afterwards he was transferred to Washington. Assistant Surgeon W. Thomson, U. S. A., made the following report of the case: "The wound was caused by a musket ball, which caused a fracture of the femur extending into knee joint, for which amputation was performed at the middle third, by the circular method, within an hour, chloroform being used. He was admitted to Douglas Hospital May 12th, at which time a large slough existed on the anterior flap, which soon separated, exposing the end of the bone. There was no vigorous effort at repair, the granulations being pale and flabby. The patient's general condition was unfavorable; he was much depressed and very pallid, and had a severe diarrhoea. On June 20th, the cellular tissue of the stump again began to slough, and, on the 22d, it was found requisite to apply pure bromine. On the 23d most of the sloughs separated, and, by the next day, the stump was clean and the granulations more florid and healthy: One inch and a half of the end of the femur was in a state of necrosis and protruding. On August llth, a sequestrum, nine inches in length, was removed by extraction, leaving a deep cavity in the stump, which was bounded externally by a large and firm cylinder of new bone. The patient's improvement was then rapid, and, by November 1st, he was considered convalescent. This man had remained for weeks as pnle ps death and so feeble as to be unable to lift his head from his pillow. He seemed daily on the verge of the chill of pysemia, and his c;ise was recognized and pointed out as one of osteomyelitis of the femur, from which—if death did not result—a long exfoliation would be removed." On May 18, 1865, the patient was discharged from 224 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. service, and several weeks after he was furnished with an artificial limb by the firm of A. A. Marks, of New York City. In his application for commutation, dated 1870, the pensioner stated that the amputation was performed by Assistant Surgeon S. C. Sanger, 6th New York Cavalry, also that the stump was in a healthy condition. The pensioner was paid June 4, 1879. The sequestrum (Spec. 4281) was contributed to the Museum by Dr. Thomson, and is shown, reduced in size one-third, in Fig. 4 of Plate LXIX, opposite. Amputation of the right thigh in the middle third and of the left leg at the knee joint was successfully performed in the following instance: Case 436.—Corporal C. N. Lapham, Co. K, 1st Vermont Cavalry, aged 23 years, was wounded during the engagement near Boonsboro', July 8,1333, by a cannon ball, which carried away both legs. He was conveyed to the field hospital at Boons- boro', where both limbs were amputated two days after the receipt of the injury. Four months after the operation the patient was deemed well enough to he allowed to go to his home, where he remained until the following year. On May 31, 1834, he was furnished with artificial limbs by Dr. E. D. Hudson, of New York City, who contributed the photographs represented in the annexed cuts (FiGS. 176, 177) and the following description of the operation: " The right thigh was amputated at the middle third, by the antero-posterior flap method, on account of great com- minution of the leg involving the knee joint; the stump is healed and in a favor- able condition. The left leg was disarticulated at the knee joint. This operation was also performed by antero- posterior flaps, and the stump is healed and in good condi- tion, though the supporting cicatrix at the base is not good. The condyles of the femur, as a base, form the most useful, reliable, and comfortable sup- port, and constitute his chief dependence, and the benefits of disarticulation, when com- pared with amputations of the thigh, are shown to be incal- culable." The patient was dis- charged from Baxter Hospital, at Burlington, Vermont, Aug. 25,1864, and pensioned. Five months later, when a student at the Collegiate Institute in Poughkeepsie, N Y., he wrote to Dr. Hudson that " he could walk with ease on level ground, get up and down stairs readily, and was getting along much better than he anticipated in so short a time." Some time afterwards he obtained an appointment as clerk in the U. S. Treasury Department at Washington, in which occupation he is still employed. His pension was paid September 4, 1879. In his application for commutation he reported that Surgeon L. P. Woods, 5th New York Cavzlry, was the operator who amputated his limbs. In thirteen instances re-amputation of the thigh became necessary, and in fourteen cases the protruding ends of the femur were removed. In the following, four inches of the extremity of the bone were exsected nearly seven months after the amputation. Case 437.—Private J. Wearing, Co. L, 2d Pennsylvania Heavy Artillery, aged 20 years, was wounded at Petersburg, June 17, 1864, and admitted to the field hospital of the 1st division, Ninth Corps, where Surgeon M. K. Hogan, U. S. V., recorded: "Wound of left knee joint; amputation at junction of middle and lower third of thigh." One week after the recep- tion of the injury the man was transferred to Finley Hospital, Washington, and in October following he entered Broad and Cherry Streets Hospital, Philadelphia, whence Acting Assistant Surgeon T. C. Brainerd made the following report: "At the date of admission the femur protruded about one-fourth of an inch, and the stump was healed to within one inch of the bone. The patient being anaemic, iron and quinine were administered. Simple dressings were applied to the stump. By November 15th his general health had improved and the line of separation was forming around the protruding portion of the bone. On Decem- ber 1st, the ulcer upon the stump presented a sloughing tendency, but again cleaned up. On January 6, 183"), about four inches of the extremity of the femur was exsected by cutting down upon it from the outer anterior surface of the stump and sawing through the bone with a chain saw. The bone removed was necrosed and surrounded by a large amount of reparative material. A small artery spouted from the medullary canal of the bone, the hasmorrhage from which was promptly controlled by pressing a piece of soft wax into the canal. Three ligatures were applied and ether was used The operation was performed by Acting Assistant Surgeon H. M. Bellows. The patient reacted promptly. Simple dressings were continued to the stump. Two days Fig. 176.—Amputation of right thigh at middle third and of left leg at knee joint. [From a photograph.] Fig. 177.—Appearance of patient with artificial legs. [Prom a photograph. ] .'4y \l##U-4. »V# ? r 1231. Surgit*«l Section, Army Medical Museum SECT. Ill] PRIMARY AMPUTATIONS OF THIGH IN MIDDLE THIRD. 225 later an attack of erysipelas supervened, extending as far up as the groin, but yielding to treatment, and by January 15th it had entirely disappeared and the general condition had much improved. One month later cicatrization was almost complete, and the patient was walking about with the aid of crutches." In April he was transferred to South Street Hospital, and subsequently to Chester, where he was discharged from service July 26, 1865, and pensioned. Some weeks afterwards the man was supplied with an artificial leg, manufactured by R. Clements. In his application for commutation, dated 1870, he represented the stump as being in a sound and healthy condition. The pensioner was paid June 4, 1879. The sequestrum (Spec. 4196) removed from the stump was contributed to the Museum by the operator, and is represented in FlG. 3 of Plate LXX, opposite p. 242. Thirteen of the pensioners have died since the date of their discharge from the service; one from lung disease, three of debility, and nine of causes not stated: Case 438.—Corporal J. Bidlingmaier, Co. H, 73d New York, aged 46 years, was wounded before Peters- burg, September 11, 1864. Surgeon O. Everts, 20th Indiana, noted his admission to the field hospital of the 3d division, Second Corps, with "shot fracture of thigh, followed by amputation." From the field the wounded man was transferred to the depot hospital at City Point, and thence, on October 8th, to Washington. Assistant Surgeon J. C. McKee, IT. S. A., reported his entrance into Lincoln Hospital, with "antero-posterior flap ampu- tation of the right thigh at the middle third," also that he was furloughed December 9th. The patient subse- quently entered Judiciary Square Hospital, and on May 6, 1865, he was discharged from service, having been previously supplied with an artificial limb by the Jewett Patent Leg Co., of Washington, D. C. He was a pensioner until June 16, 1871, when he died of marasmus, his attending physician certifying that "it was evi- dent that some portion of the splintered bone remained in the stump, as abscesses frequently formed thereon and copious discharges ensued;" also that the disease, as a consequence, first became apparent about the first of April, 1871. The amputated portion of the femur, represented in the wood-cut (FlG. 178), was contributed by Surgeon D. S. Hays, 110th Pennsylvania, who performed the operation. The specimen shows that the shaft FlG-178-—Com- , j. , . ., , , ,, , . , „ r r , . minuted lower half was badly comminuted by a conoidal ball, which flattened, in a mushroom shape, against the anterior surface of right femur. in the lowest third. SPK- 412°- Fatal Cases of Primary Amputation in the Middle Third of the Thigh.—The four hundred and sixty-three operations of this group were performed on four hundred and sixty-one patients; in two instances both thighs having been primarily removed at the middle third. Sixty-seven were Confederate and three hundred and ninety-four were Union soldiers: Case 439.—Private G. Cox, Co. K, 1st North Carolina Cavalry, aged 27 years, was wounded at Brandy Station, June 9, 1863. He was admitted to a field hospital of the Fifth Corps, whence Assistant Surgeon B. Howard, U. S. A., reported the following history: "The patient was a man of usual good health but had the bloated appearance of a habitual drinker. He was shot in the right thigh, and was brought to Kelly's Ford, a distance of about three miles, in an ambulance. On examination I found a wound of entrance on the outer side of the thigh, a little above its middle, but there was no wound of exit. The wound of entrance was very small, as if made by a pistol ball. The femur was badly shattered. The patient complained of having lost a good deal of blood on his way to Kelly's Ford. I immediately proceeded to amputate near the upper third by the circular mode. The patient suffered considerably from shock, but rallied comfortably, and was transported eight miles the next morning in an ambulance, and thence by cars to Alexandria. On examination of the amputated leg the femur was found to be shattered more than six and a half inches, but not comminuted as finely as often hap- pens in fractures by a mini6 rifle ball, this fracture being more vitreous in appearance and furnishing but one small fragment, all the others being large ones. The ball had entered the outer side of the thigh, passed behind and partially around the femur, entering at its inner aspect, and lodging in the medullary canal. The interesting point in the case is the relation of the extensiveness of the fracture to the weight and the dimin- ished velocity of the ball; that the bone should have been so extensively shattered by a pistol ball, which, when subsequently weighed, did not exceed five scruples and six grains, and that the mischief was all done, too, after the ball had been so much deflected from its original course." Surgeon T. R. Spencer, U. S. V., reported the patient's admission to Prince Street Hospital, and the result of the case as follows: " On June 19th and 23d, haemorrhage occurred from the external circumflex artery, for which compression and cold applications were made. The loss of blood amounted to six ounces. The patient looked anaemic, and there was considerable sloughing of the stump. Death followed on June 24, 1863." The amputated portion of the femur was contributed to the Museum by the operator, and is numbered 1233, Surg. Section (Fig. 179). Case 440.—Sergeant John Sproul, Co. C, 40th New York, aged 24 years, received at Kelly's Ford, November 7, 1863, a conoidal musket ball wound, causing a compound fracture of the left femur just above the knee. He was taken to the field hospital of the 1st division, Third Corps, Surgeon J. W. Lyman, U. S. V., in chasge, and amputation of the thigh in the middle third, anterior aud posterior flap method, was performed by Surgeon A. Campbell, 40th New York, on the day of injury. He was conveyed to Washington, and admitted into the Douglas Hospital on November 9th. His attending medical officer, Assistant Surgeon W. F. Norris, U. S. A., reports, Novem- ber 16th: It was found impossible to support the heavy posterior muscular flap; the sutures sloughed out, and there was a great gaping surface discharging profusely, but normal in appearance. The patient was very pallid. The stump was Surg. Ill—29 Fig. 179.—Comminu- tion of middle third of rightfemur. Spec.1233. 226 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. thoroughly supported by adhesive straps, and the best nutrients, with stimulants, were administered. 24th, there was slight tenderness along the femoral artery and slight enlargement of the inguinal glands. There was no vigorous effort at repair in the stump, which remained pale aud flabby, and his general condition became worse daily. December 4th, there were well- marked chills with fever in the evening, pulse 120 and feeble, respiration hurried, sweating, and nausea. These symptoms became hourly worse; his pulse became countless, his respiration sighing and very rapid, his face pinched and anxious; occasional vomits of a green bilous matter; he finally died, on December 7th, at 4 o'clock P. M., of pysemia. Autopsy sixteen hours after death. Assistant Surgeon W. Thomson, U. S. A., records: "The most careful examination failed to find a trace of inflammation or coagulation in the blood-vessels. The soft tissues of the stump were perfectly normal. There were found in the thoracic cavity the usual traces of pyaemia. The lungs anteriorly were pale, posteriorly they were both coated over the lower lobes with recent yellow and soft ill-looking lymph. There was no considerable effusion or adhesions; no traces of a frank pleuritis, but of a local asthenic inflammation were found. Both lungs were congested, hardened, and dark in color posteriorly, and in the left there were several small yellowish-white spaces, apparently abscesses. * * The other organs, except the cerebro-spinal, Avere examined and found normal except the spleen, which was slightly hardened and congested. No trace of embolia was found in the lungs, nor was death caused by the secondary changes there produced. The destruction of pulmonary tissue had not progressed sufficiently. There must have been the absorption, by the veins most probably, from this medullary aud cancellated portion of the femur, of a material soluble in the fluids of the blood, and produced, in the cadaveric changes that took place in the organic matter—dead, but confined in this cancellated bone. This caused the fatal toxicsemia which overpowers the nervous system, and may have also caused those local changes found in the posterior portions of both lungs. It seems strongly probable that it is due to blood poisoning, introduced by the veins, since all cases of "pyaemia exhibit pathological changes in the lungs, where the venous blood becomes distributed to thin delicate structures before being depurated by exposure to the atmosphere. The case was about to be relinquished as incomprehensible, when it was proposed by Dr. Norris to saw the femur from its head to its extremity longitudinally, aud thus expose its medullary canal. A small quantity of apparently healthy pus had been found between the periosteum and the shaft two inches from the sawn end, and there were a few osteophytes clinging to the bone at that point. When, however, the bone had been separated in its long diameter, its medullary canal presented the traces of pathological action. This canal and the cancellated structure extending past the trochanters to a point half way through the head were found filled with a yellowish-green substance, intolerably fetid, and resembling, more than anything else, the debris of hospital gangrene." The bone was sent at once to the Museum and portrayed in colors. No pus was found in this bone, aud, under the microscope, nothing but debris. The connective tissue seemed to have perished en masse. In Plate XXXII, opposite, the diseased stump of the femur is represented, and Plate XXXI, opp. p. 228, exhibits the gangrenous condition of the medullary canal. Case 441.—Private William Crawford, Co. B, 2d Pennsylvania Cavalry, aged 40 years, had his right leg shattered near the knee by a fragment of shell, at the battle of Spottsylvania, May 12, 1864. The soft parts were much torn, and the popliteal artery was divided. Amputation was immediately performed near the middle of the thigh by Surgeon Charles Bower, 6th Pennsylvania Reserves. The patient was sent to Washington, and admitted, on July 16th, to Lincoln Hospital. He was in an exhausted condition and had no appetite. He utterly refused to take bark or stimulants of any description. The tongue and fauces were covered with aphthae. There was diarrhoea, from which, in a chronic form, the patient had long suffered. He died on July 27, 1834. There was extreme emaciation. At the autopsy but slight lesions were found in the viscera, except the great intestine, which was studded with ulcers. The necrosed extremity of the femur slightly protruded from the wound. This was the end of a very large, loose sequestrum, invested by a fragile involucrum. The specimen in the Army Medical Museum, No. 2890, Surgical Section, consists of the stump of the right femur, with a very large sequestrum in process of separation and a partial involucrum formed. The histories of the two cases of primary amputations of both thighs in the middle third are very brief. The patients died on the day following the operations: Case 442.—Sergeant Theodore Doud, Co. C, 2d Michigan, received, at Petersburg, July 30, 1834, a shell wound of both thighs. He was carried to the field hospital of the 3d division, Ninth Corps, where, on the same day, Surgeon W. B. Fox, 8th Michigan, amputated both thighs at the middle third. Death resulted July 31, 1864. The case is recorded by Surgeon P. A. O'Connell, U. S. V. Case 443.—Corporal John W. Woodworth, Co. H, llth Infantry, was wounded at Rappahannock Station, November 7, 1863, a shell fracturing both femurs at the middle third. He was taken to the field hospital of the Fifth Corps, and both thighs were amputated in the middle third. He died the next day, November 8, 1863. The case is reported by Assistant Surgeon E. DeW. Breneman, U. S. A. Pyaemia was observed in seventy-six, gangrene in eighteen, tetanus in seven of the four hundred and sixty-three fatal primary amputations in the middle third of the thigh, and in forty-four instances haemorrhages occurred subsequent to the operations. In three cases the amputation ifi the thigh was accompanied by operations in the upper extremities, and in one instance the opposite limb was amputated in the leg.1 'In the case of Private W. J. Hand, K, 45th Massachusetts (Table XXXI, p. 239, No. 1,018,-and Second Surgical Volume, Table XLIV* p. 034, No. 87), the left arm was removed at the shoulder joint; the left arm was amputated in the lower third in the case of Private H. Jackson, E, 4th Colored Troops (Table XXXI, p. 237, No. 904, and Second Surgical Volume, Table LXXIII. p. 747, No. 40); three inches of the right radius were excised in the case of Sergeant J. Robinson, H, 48th Illinois (Table XXXI, p. 239, No. 1,033, and Second Surgical Volume, Table CXXVII, p. 952, No. 51). The left leg was amputated in the lower third in the case of Private S. Banks, C, 43d Colored Troops (TABLE XXXI, p. 235, No. 706). i.-'lli. u " . -I ill. V«.I II ,: ■ 3* :.+♦■. h A MA . ■'.*:ii, v ' .'•■•, Y ' •■'•-.a; .* r■■:•'' ■■• ■•' •* ; ■ ■. '*'&? • '■■'. •< ■■ '• '■ ■ A'i.$■, ■ ■'"■.. 4=.' • •:',.■■■ %»av" %''.' ',■■■, -ffl is :. • ;: ■•■■ -.-rWy. %. & • fSi- •'-*■**#1&''*W OF "HE !' A'bJ: EXTREMITIES. <•.•»''■>■■ >■ ta. '..'f.t nutrieii - with sriiuiii.-uiw, u;,.- ..'.minis: ■ ►.•'.. 24th. il re was flight ■,_ii- .•! iai^tuient of U • ng liniil gland?. •'!;' re w;» n. vigyoua 11 I at re|Miu iu ;..s ua.l Im ."•'iierai .-. •«.i'i"ii !>v.::un. .•..:•■: Yiily l>«ctmbf vA., 'In '•■ w<-t>> :\A)- i.-. ,M.!se Yd and IVY ' ■ -„„-.,r. ;, Ii - --«. = .--■. ■ ■ .v a, ;r a| naa-at. TU™ -mi iY « - ..,- cuiiU.-h,., his . - ;-n s-ha.; ;... . • • •. . --.- tid plnY ■>«! -t, * ...->!<.,• t.a lit- linaily di.^l. .. .■.■■■••hIim ;ii- :•/. » ■•• n.. .1 ;.y8Bmia. Ai'f-a -ixie-li \ Tii-i ..sua U S. '• ■!-; 1 I, ■• u»>i.-' • "'• • Mllll ral'Yli fai 1;Y ' i l t:"3*CI: i »T" : .,.-...-. I'i.,- *,,:'' •.-• • '!•■ -1 .11. j \.....I'.-ally ir an Y Ti i ■•. t- uui in ■• a mii' puh'. ■■■•• • •. 1V f 1 <«- > .-err both •..;■ •: ■ ■ a ••■ flit , . i r a. ■'. •'i-ina :viliesiii-..-• ■ -> '.' : !." r-.k '■.....■■ i.-n^a I, v' i. II >Vr«f. - mil' -•••-!'• ^ at .-i ara Mat- I*.. Y :■ ■■■■<; AuAvy m, . a-d ■ ' . ....■•>,• Laiaa i;.ri..» ;|. ,, ': , • . nilltliM' .'., ,.■.,•■-..• i:,. : .. a ;•• il lil;a • <. • ' . .. ■ ' ' r . :.ti.iO-.f> ... Ul 1 ;" ■' . ■ •J. irljy |.a.- 1 :x "<:\v t'..... ;.... ■imyi. . .,-.., ,; tla rli'mtirs rt.'soii ■ I •' ii i:.. i in c< ii- *. v p. -s! . : j., dm- • ■■:■ •-' :•'»«. intriK: a lie venoi:- '■■•• '..••nies distrila.t -*- '.v;is ' ivnnijO S'- 1 ~ ..yi> - ' " liuuUy. !''..d ,'*rC ,irt< ~y '■ I •■iiii-;. i -v, i.u ex-tiui.-i ■ ■•i».-iit..i .aid fan- ,]„,,! ,,, .' * ■» A. v i'.v _,r,..,< ,,!..■ ■ .,,- S . • • ■• . . .-, :il'.:. :....! .a \V. Won,I ,- a Y rim;Yv :. .y. .itati' i . - ; " ■A sul It. V.c ,, s .-"i.il ' i.-.l, and '. .. ,;.,-.•:-, ; ; |i>80l'M-'l'- * Tilt' ••' . i.a ,j,|,.*Ml ai. ' 'Yltly I'. Ml' -, -.1 III,,! I... iii.' Kt'i.-nlnl :'■' "•!'• }>'<••! > !•-.• Wn tin- ■ ■■ '!'»• vri-.i-. ul, , in tl •'•"!. and u •d in tin.- :r '1"lt^ ■ I *',L>se 1 .. ' ' '" !i"' : n:i tail «:>. ■•:• •'»*■ ' ■ i ami 1 •ng diaiuf' ■ '-iidin^ [• ■ l«-rably f«'^ ■■ I'm und }" .. ' .-*ue S»'. 'ii i: XX ' I, :iud illr- . I.y Sar:;a-i,., r , • •, . '■■ . to Iiincoli: I' >■; aa :r',<% of any de> ;.- . ,«i ; ' ' ••'" l>atiriil !.' ': ' ,a f. ,• ,, ■'. tb.llld .. ■ ■ f .■- ■ ' '' !'i-«'trii!.<-.l if' • ••a ill tile Aim. '' • K'rM; B4'lieil ->u >.••■!;: -[-r. nous: ..-..d.ireDoild, Co. V ^. .M..a;H:; iv-.- • .. hlly :!0, 18 VI. :—I- l;s,.;tal of th* 3d divisi-n > :i>Y •" ■• • .".nue dn*. ^ai-ge-.i .•'■.:. :u the middle -Ird. Diiutl. r»»-:i«Ue.; .'. : : cuko ••.- - c uded ' Uitpii...... .-.oek - ■M.it:d .-F ! ■ l-'il't! The (ra* i^ ■"<•:••■ |.. Ut .1.. • ■ • •« >.'i midii'c 'ii . " : t.iio th ,. (li.a i.p-.-M. • In tl :•• 'm the iifii- • ••' ■■ mil f jao ,-, • Sur ti&jl VjJi.ii.-- TA1»L>- ".LIV* ■ a.,-,:! . : . ......«. • .('Privat* H. ^.iCksonY I h >' !,.-.> .11. • : .-... .ii ■-. • >f tla- right r.idnm an-ex. ;.: ■„..<'.':-...:■. • . - ■: IY-.«, Y-. U. CXXVII, p. 9o0. -N. f. ■ ! ■.', ,-.<" ;•- :.).:'. iXM,'••-03, No. 70oj. Med.ft Surtf. Hint ol' the War of the Rebellion, l'arl 111. Vol II T.Sim-lair A rfon > h.-...unbll, PLATE XXXII.DISEASED STUMP OF FEMUR. SECT. III.] PEIMAKY AMPUTATION OF THIGH IN MIDDLE THIRD. 227 Table XXXI. Condensed Summary of E'even Hundred and Fifty-seven Cases of Primary Amputations in the Middle Third of the Femur for Shot Fracture. [Recoveries, 1—683; Deaths, 1^7—1,149; Results unknown, 1,150—1,137.] name, Military | Descisiptiox, and Age. Adams, C. 11., Pt., G, 116th N. York, age 37. Adams, J., Pt., 11, 27th Ohio. Alexander, J., Pt.. A, 12!'th Penn., age 23. Alexander, .1 , Pt., D, 22d C. T., age 34. Allaback, E.W.. Pt.,A, 52d Pennsylvania. Allen. F. A*., Pt., I. 8th N. V. Cavalrv. age 29. Allen, G. \\Y Serg't, A, 3d Mass. Cav., age 27. .4Hen. -S., Pt., H,23dN. Carolina, age 25. Allroth, VV., Pt., K, 46th New York, age 30. Altenberger, J., Pt., F, 37th Ohio. Ammerman, It. W., Pt., B, 148th Penn., age 22. Andrews, D., Pt., I, 62d PeDn., age 18. Andrews, W. A., Pt.. E. 3dC. S. Inf., age 27. Arts, J., Capt., K, 2d New York. Aschman, R., Capt., A, 1st Sharpshooters. Austin, YV. F.,Capt.,K, 9th Kentucky. Azdell, J., Pt., C, 104th Ohio, age 29. Bachman, C, Pt., D, 198th Penn.. age 28. Bagley, T. R., Pt., H, 24th South Carolina. Bailey, J. C, Pt., r>, 4th Ohio. BaU, E., Serg't, F, 3d Kentucky, ago 24. Barnert, R., Pt., D, 1st N. Y. Dragoons, age 25. Barnes, J. W., Pt., C, llth Tennessee Cav. Barnes, W., Serg't, I, 13th Mass., age 38. Barnhart, T. P., Pt., F, 3d Wisconsin, age 19. Barraham, J. H., Pt., H, 2d North Carolina. Barrett, S., Pt., K, 6Sth Ohio, age 17. Bartlett, \V. F., Capt., I, 20th Mass., age 21. Bartling, H., Pt., L, 9th Mich. Cavalry, age 22. Barton, M., Pt., E, 72d Indiana. Batch, P., Pt., K, 99th Ohio, age 21. Becht, A., Pt., E, 52d New York. Beck, G. H., Corp'l, I, llth Penn., age 18. Becker, C, Corp'l, B, 12th Missouri. Beckwith, D. G., Pt., K, 23d New York. Beckwith, W. G., Serg't, B, 5th Michigan Cav., age 31. Bell, I., Serg't, B, 81st Penn., age 20. Bellis, R., Serg't, D, 1st Maryland P. H. B. OPERATIONS, Ol'KttATOItS, Result. Sept. 19, 20, '64. Mar. 13, 13, 'li.'. Mav 4, 4, Ax Sept. 20, 21,'64. May 24, 24, "'62. June 3, 3, '64. Oct. 19, 20, 'G4. July 1, 3, '63. July 30, 30, '64. May 19, 19, '63. May 12, 13, '64. May 6, 6,'64. Nov. 30, Dec.1,'64. June 25, 25, '62. Aug. 15, 15, '64. April 7, 8, '62. May 27, 27, '64. Mar. 29, 29, '65. May 14, 14, '63. Dec. 13, 14, '62. Sept. 19, 21, '63. Oct. 14, 15, '64. Jan. 28, 28,'64. Aug. 30, 31, '62. Mar. 16, 16, '65. Aug. 16, 16, '64. Mar. 19, 20, '65. April 25, 25, '62. June 12, 12, '64. May 9, 10, fG3. June 20, 20, '64. June 1, 3, '62. May 5, 0, '64. Mar. 8, 8, '62. Dee. 13, 13, '62. April.8, 8, '65. July 2, 3, '63. July 2, 4, '63. Right; circ. A. S jr., U.S.A. Di Right; flap. Dis. h'd Aug. 2, '6-\ Right. Sure.W.G. Nugent, 126tb Penn. Disch'd Mar. 16,1864. Left; flap. Mar. 15,'65, removed necro'd bone. Dis. Mar. 20, '65. Left; flap. Surg. W. S. Woods, 52d Penu. Disch'd Aug. 1,1862. Left; flap. Subseq. operations. Disch'd July 13,1865. Right; circ. Surg. D. F. Leavitt, 3d Mass. Cav. Dis. May 31, '65. Left; circular. Exchanged Nov. 12,1863. Left; flap. Surg. A. F. Whelan, 1st Mich. S. S. Dis. Sept. 11,'65. Left. Surg. S. P. Bonner, 47th Ohio. Subsequent operation. Disch'd Sept. 8,1863. Right; circ. June 24th, removed three ins. femur. Disch'd May 30,1865. Spec. 2698. Left; ant, post. flap. Discharged July 26,1865. Right; lateral flap. Exchanged March 7,1865. Left. Discharged Nov. 10,1862. Right. Surg. H. F. Lyster, 5th Mich. Disch'd Aug. 19,1864. Right, Dr. VV. W. Goldsmith, Louisville. Disch'd Apr. 19,'62. Left; circ. Surg. F. H. Rodgers, 104th Ohio. Dis. June 13,1865. Left; flap. Discharged June 27, 1865. ------. Recovered. Left; flap. Disch'd April 22, '03. Right; flap. One inch fem. rem'd. Disch'd March 22,1864. Left; ant. post. flap. Surg. A. P. Clark, 6th N. Y. Cav. Disch'd Oct. 30,1865. Left; flap. Surg. T. H. Kearney, 45th Ohio. Disch'd Mar. 28, '65. Left. Disch'd April 23,1863. Right; circular. Disch'd Aug. 22,1865. Right; circular. Retired March 17,1865. Left; flap. Confederate surgeon. Disch'd Oct. 14,1865. Left; circ. Surg. N. Hayward, 20th Mass. Disch'd July, 1866. Left; lat. flap. Surg. A. Nash, 9th Mich. Cav. Disch". May 12,1865. Right Surg. D. B. Rice, 102d 111. Disch'd Sept. 15,1863. Right; ant, post. flap. Surg. J. T. Woods, 99th Ohio. Disch'd Nov. 22,1865. Left. Disch'd Dec. 25,1862. Left; circ. Ass't Surg. W. F. Osborn, llth Penn. Disch'd June 1,1865. Right; circ. Surg. C. Cook, 12th Missouri. Discharged. Left. Surg. J. Ebersole, 19th lnd. Disch'd April 10, 1803. Right; circ. Surg.A.K. St. Clair, 5th Mich. June 26th, nee. bone rem. Dis. Sept. 1, '65. Sp. 4239. Right; flap. Disch'd March 10, 1864. Right; circ. Ass't Surg. J. A. Freeman, 13th N. Jersey. Disc. Jan. 31,1864. NAME, MlLITAUY DESCRIPTION', AND AGE Bentley, A. C, Pt., D, 93d Now York, age 27. Bentley, G., Pt., B, 8th Louisiana. Bentley, W. G., Major, 9th N. Y. Cav., age 28. Berran, 1!., Serg't, K, lG'Jth New York. Best, VV. J., Ord'y Sea- man, U. S. S. Pawnee. Biebel, A., Pt., L, 9th N. York Cav., age 23. Bidlingmayer, J.,Corp'l, H, 73d N. York, age 46. Bishop, F., Pt., H, 65th Indiana, age 21. Bishop, I, Pt, K, 111th Ohio, age 24. Bissell, J. B., Sergeant- Major, 26th Iowa. Bivens, T. E., Pt., C, Bissell's Engin'r Reg't. Blair, J., Serg't, A, 105th Penn., age 26. Blake, W., Pt., K, 18th Mississippi, age 18. Boatwright, R. S., Pt., I, 21st South Carolina. Brake, G., Pt., D, 15th West Virginia, age 41. Brandon, S. S., Pt,, C, 27th S. Carolina.age 19. Brannon, L.,Pt.,D,10th Ohio. Breen, M., Pt., E, 9th Mass., age 40. 'Brett, C, Pt., B, llth Alabama. Brickham, I., Pt., K, 14th Wisconsin, age 46. Briggs, W. D., Pt., A, 147th N. York, age 29. Brobst, J., Serg't, A, 107th Ohio, age 22. Brock, M. V., Pt., C, 48th Mississippi. Brown, C, Pt., F, 8th Indiana, age 23. Brown, D. W., Pt., A, 25th Indiaua. Brown, G. M., Pt., A, 31st Illinois, age 22. Bruce, W. D., Pt., C, 13th Virginia. Bruce, V. VV., Pt., A, 17th Mich., age 20. Bryant, W. W., Pt,, G, 1st Tennessee. Buckles, A. J., Lieut,, E, 20th lnd., age 18. Bullent, A. C, Pt., F, 18th New York. Bullock, VV. S., Pt,, G, 89th New York. Burbank, J. H., Pt., F, 10th Massachusetts. Burchett, J. W., Pt., K, 8th Virginia, age 21. Burk. H. F., Serg't, K, 48th North Carolina. Burkett, F. H., Pt., D, 2d S. Carolina, age 24. ^Burnett, J. B., Pt., 1st S. Carolina, age 31. Burton, J. O., Pt., B, 48th Illinois. May 23, 23, '64. Juno 27, 28, '62. June 21, 21, '64. May 27, 27, '63. June 27, 28, '61. Nov. C.i, 27, '64. Sept, 11, 11,'64. Dee. 13, 14, '63. May 14, 14, '64. Sept, 4, 4, '64. May 28, 28, '62. Oct. 2, 2, '64. July 3, 3, '63. Jyll,'G3. Primary. June 18, 18, '64. June 2, 2, '64. Oct. 8, 10, '62. June 3, 5, '64. June 27, 28, '62. April 3, 3, '65. Sept. 29, 29, '64. April 9, 10, '65. July 2, 3, '63. July 28, 28, '64. Feb. 13, 13, '62. June 15, 15, '64. Aug. 28, 29, '62. Nov. 16, 17, '63. May 31, Je.l, '62. Mar. 25, 25, '65. Sept. 14, 15, '62. Oct. 27, 28, '64. May 3, 3, '63. July 3, 3, '63. Sept. 17, 18, '62. July 2, 4, '63. Sept. 17, 18, '62. Feb. 13, 13, '62. OPEUATIOXK, OPERATORS, RESULT. Left; flap. Disch'd June 30, '64. ------. Recovered. Left; circ. Surg. W. H. Rulisnn, 9th N. Y. Cav. Disc. Oct. 5. V5 Left; circ. Discharged Oct. 26, 1863. Left; Surg. N. Pinkney, U. S. N. Discharged. Left; ant. post. flap. Surg. C. H. Andrus, 176th N. York. Disch'd Oct. 21,1865. Right; ant. post. flap. Surg. D. S. Hays, 110th Penn. Disch'd May 6,1865. Spec. 4120. Right; flap. Disch'd Oct. 21, *64. Left; flap; one and one-half inch boneremo'd. Dis'd Aug. 2i),'65. Right; ant, post. flap. Surg. A. T. Hudson, 26th Iowa. Disch'd Jan. 6,1865. Right; flap. Reg'l Surg. C. S. Sheltou. Disch'd July 29,1865. Left; circ. Surg.D.S.Hays, 110th Penn. Disch'd Jan. 11, 1866. Died Nov. 8,1869. Spec. 4125. Left. Sept. 4th, exfol. removed. Exchanged Nov. 12,1863. Left; circ. July 17th, end of bone removed. Exch'd July 23, 1863. Left; double flap. Ass't Surg. J. J. Johnson, 15th W. Virginia. Disch'd Oct. 19,1864. ------; circular. Furloughed Oct. 18, 1864. Left; flap. Surg. C. S. Museroft, 10th Ohio. Disch'd Feb. 15, '63. Right; double skin flap. Disch'd Oct. 18,1864. ------; circular. Transferred July 15, 1862. R't; ant.post.flap. Surg. E. Pow- ell, 72d 111. Disch'd Oct. 20, '65. Left; circ. Surg. D. McFall, 142d N. Y. Disch'd Sept. 11,1865. Left; ant. post. flap. Surg. J. Knauss, 107th Ohio. Disch'd Sept. 6, 1865. Right, Surgeon Craft, C. S. A. Recovered. Right; flap. Surg. J. K. Bigelow, 8th lnd. Disch'd Nov. 29,1864, Left. Disch'd July 31,1862. Left; circ. Surg. J. S. Reeves, 78th Ohio. Disch'd Feb. 2, '65. Right, Surg.W. Grimes, C. S. A. Recovered. Right; circ. Confed. surgeon. Disch'd April 4,1864. Left. Surgeon Wright, C. S. A. Recovered. Right; flaps. Surg. D. S. Hays, 110th Penn. Disch'd May 16,'65. Left, Disch'd Nov. 19,1*862. Right; circ. Surg. T. H. Squire, 8yth N.Y. Disch'd April 20, '65. July, '65, necro. bone remo'd. Right; flap. Disch'd Feb. 25, 1864. Left, Exchanged Nov. 12,1863. ------. Surg. Lindsay, C. S. A. Right. Surgeon Pierce, C. S. A. Furloughed Dec. 4,1853. Left; circular. Recovered. Right; flap. Disch'd June 17, 1862. 1 SMITH (E. H.), Cases of Fracture of Femur, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 24. *FISHKU (G. J.), Cases of Amp. after the Battle of Antietam, Sept. 17, 1862, in Am. Jour, of Med. Sci., 1863, Vol. XLV, p. 47. 228 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. 98 Name, Military DEbcmrriox, anu Age 103 1C4 105 106 107 108 109 110 111 112 113 114 115 116 117 1118 1119 Butler, A.C.,Pt.,D, llth Maine, age 20. Butler,W. H., Serg't, C, Gth C. Troops, age 24. Buzzell, S. P., Corp'l, B, 38th Wisconsin, nge24. Caddell. G. R., Pt., K, 43d N. Carolina, age20. Camtnett, VV. B., Pt., A, 2(ith Maine. Cannon, J., Pt., D, 7th Maryland, age 24. Cappers, A., Pt., A, 4th Wisconsin. Capper, II. M., Serg't.G, luth ('onnectir.ut. 'Carlisle, M., Lieut., G, 19th South Carolina. Carpenter, 11. II., Pt., D, 13dth N. Y., age 27. Carpenter, J. M., Pt., Carpenter's Bat'y, age 17. CaiT, F., Pt., F, 73d Peun., age 18. Carroll, J., Pt., B, 1st N. Jersey Cavalry. Carroll, S. F., Pt., D, 1st N. Carolina Cav. Carrow, J. T., Corp'l, F, 4th Delaware, age 33. Carson, A., Pt., II, 42d Pennsylvania. Carter, C. C, Pt., II, 9th Kentucky, age 35. Cartner, C, Pt., A, 30th Virginia, age 22. Carver, J., Pt., E, 18th Kentucky. Casey, J.," Pt., C, 100th New York, age 19. Casey, P., Pt., II, 1st Cavalry, age 21. Cnsselberty, G., Serg't, K,5lst I'Vv'':';Y'-^' '■&* S;':V: >!l:j1'';-i->V. ': '.."" . ir.V;:r :PJ& ...... ■;*»::' ?! -Y *V^ :... /;:•• •*;. A^ .-'" &v! / ■*&•■'■•:• ■■ ■r l'-iV:.; .;:> ,,£. !Yl^'* ■. , ■.. •'•; ■'■? ■?.> :, «iiv! ,; V}.J-' "i • >: £■*■•,:.■.&■■ 'tM.'A^A^ ff ' \ •4" '■'■ $'.' -jr-y ,?>: v . Y*' ;'■•'■ ■.:|.J.;^..;>,+.;.J &fc:'$ '$%&'■'■'■?■■■■$. "i-i-'i'."*:' ■ ;-:-:i ":;: ■. :i': v;;>.>: ■■■ v;, ""^-v..f'■«*« FV * fc^::>, ■ ,#: Y;!y:. ;•'yY.:... ■■, Y •■:' ■-..:: .."J*J- 1W Si-- 'y<:WA ,. y y: ."•::•*.■ ■«■; • .■ .•..!;■, :■:■ :'!:v ■^•Jv . ■'■'"': ::.>.|.■•'. :•' *,'."!■. • ilSf :■ t '..;|!' '-":' !:::v'i;.''-'-' • • :i ..■■•'■'■7: .'■',.9''n. ^■. ■'■■■'''*>■£''$■:■' ■ii"'' k. ■■'■ '•• ' ■•;'*•• p' >-v '': •'■•■. V .^/ ^ .A> /a&.'.<(; •fc :-'!; :<:! ' JP^:,. ^ y' ! r. \% ;!;;;,'■'' ■ -*Si :Sl: ■:fVfe ■v.v.y&r;-. ;'• vT.'. 't'^s '•'.a . ■i''!-it'V; ;,/ ''':;:S'a:'. ;i'i.',: % :a^';:'v'!: :^*-v * ':i■•"; 1 •'" '!. i;,'a :'■■ ■■ ,,^t< >: - «. ; | ■'Cy": ':■ .''"ft :''• ,v-' ■ •::'4;''n ... . .••(.... a'-v^t' "■^A^'a-M- ••:.tf ■ • ■'':':,fe^'lV>:,jr' :'y--'-'-y; ; :;.iy^- vM, V'-a? "^ . i. P , .,v .if?'--Aav :■;!' f .•"')it,,te|' JA^GRENE OF THE MEOUiLA. !28 La-WiCR l.XT KMITIES. t, A.C.l't. i*. *j«j : ■ w n v, ■■■■- ■ '. i NYM - i ii VKV It. s. a Kb '1 -. ' lDE8C':ii-■«•■.•■ ■ 1) Ac.K Yv i!f Aiu't S irj . vv. .: 1! 'VAy. .*. '■- '''o ■•■ . J.. '.■'. J i' ' I'..- . !.'•! Haiti.'. ■:: ! ', iV\ Yvu .: . 'i-l. Sent . ,i, :■ ,a J ! ' JtiSU., I.» !' '.. iY (. ' •-|»i. ."1 ..• Rigfi.' f ir • A i*"' •"'.''I, •■' Troops. •., iM '64. .• r. p >!; . ■•'!. lY ' il,-i'.i '1 ... i??i Owner.'A . i ' •■■'.■- \ '-!y IP ' Dii-aii'.i ".a,,- .:•> a a. lUi::vi..i. ■ '" ' '. 64. :.'.-,.- \:. R't'.. .a. .- .-- W. B. 1 >v li, J4. 1 fclti M :1 !>'•. : tl Fob. v >. '(/• , -,t. 19, [Let':. Mia; '.i\ ' ''.<-, '.<. Caro i.ia. ■ '..'3 . f;rv .. .•!>. , v '. ''4. .!■„ i, 1 E\ i. •■ ' ' ,.i i 3, 8...' Ia-' ; ... ■: ■<■>: YAL .. a i^.th M ■ ;;. j.''- '.'(1 Aug. 1.9, lotf). .! 1: . • ■ '. i- ' \.'(;.. !y 8. ! Left 'lap. >uri: P. II llobin-m, "-. G4. ' Til "M. Pi.icii-i .In ■e.r>, !fc";.">. V.-iy 27, R:y.-r .. •*!. n P , M lob. IU. ".'4 :...U.k . '!ar. 14, "i.igiir. flap. Hi* lid July 1, u:.V •I. 02. ' r-.'-t. ID, Right l< *vrec. 't ...v l\ Left. .A.-h'i Surg. H : II ivev ■ I•.*"•. l-;(;r|: N.\'. Dwdl'dJ.m* J.!.'i , -.f"t. i9. Left . i''ia Snrg. W. S. Loveinu! ..','.4. ! H. McCo r«, f. S. A. Kxcli'd i -Y>ril 1, lJl>5. lunr. 27, j ].r:-- rireular. }.'i-,->ia-g^l A ;• :.7, 1,4. IU. i i\ idti5. Right. S:l'.' 1st X. J.i •>: i-llt; I'aj I.) T.-n,'.-a U-lt- :• ,. | I L "' ■eH lap j' '7 | ■;. .i.er A .-■■ :; tli (iai i, lit* ! Jr C'.-li.,cr.W H 121si O'.ii.i. uc Ca/.t/, ;.;.j/.,c Lri.V'i-fVOo ,:«) Cral'lUI. t', v., U.M) ill! ■;■:«. Ooi,. ir ■,- • :iatl.Mi>->i:K:(' tY.wl J,, p. t'enn., ag* 1? ••' . -e. J. ■» »'• Car- ; ', i V \V.^i.-i»;|. ..-( .n-a. ' .. !•' V. a. if ".. 'I.... .1 'lue 27 '-. '64. a i HI t: '. II.' :••!•> :r : \ «3. i'ii ".3.:, DlV^ATIa- < '1 1»,M ; ' 1.- a Va, „..• i.r iM-red. . ! . : 1. l|«t '• :■.-.< i'd 1. •■■ -.t P.:-' •'. ■ :. i t>"' ' ' ... • ■ i 1 'an t1! hX i,.,,- ; 17 >■■'.' April .'. •J, <». Julv :. a, a ;., r.iu,-.i iOs'l'l'.'. h;vi. ■■. Di-t. 27, 27 V,I. ,1 .:. '-, ,l,r-r i -.7. i: : 1 -i I.;,, la. j Riirl.'. •. ■ ; 7ilii)li;. ! Lel'l; la.[ ■rrr. ;t 1. Y.Ca, i . I": I! , r'.,,.•.-, • .\,.r-i-. ( Ghmn. N.-'.-i ■ '.. Iu»v.-«i, K. - a. , W:>.«:. ■■' i r i ■■•■i' .'. /.... V . -'liA< ■- ?!• > .l.i.iKn, Ki .1 ' " • ^ :-.* W '( .. M;tv ,:. Kight: Hap. Si.t;; :j, i4 l'.S V.'alwmin.- D;.-niiM inn; •.- .i Jun.- ii, Lett. ))U.|iaryp». a . J-I. S"all"*-:., t .'". •': it.. ■ l.rs i.; t'. .'.'■ .'■• ;g ' ■ L.:!'a r. • '•; irg. ■««;.■ ' Y. i-l ' •.l.iin. -.- veri t. Juu. 1\ ; al. Si .. Y-.J. :|.. ' )\ '•'■ <.:m: \>... : l. ii'= i . • ».'■•(. ' L' ft: i .r, S irg. ('! i... • .■ !:'• ' -nit •.-. r,..Si,n .i&i.. • !. •.-: O,. ; •>. .|n(1. Jan. Ttb, .".'u.iaa -" ■.;; ' .1 '..^thinid^Yi >; . '. nOTi red. •'! !.•■•*. ""u.-g. Wesi. I!-:liri'b!1-.v« .' I'!, 'to I- 7, 18u"i ! !'.IMh1:.-' I'.u-e*r> .) 140 i /• 141 * Kuvipj...;!... •,.T., Pt. } 11 ••'.: D;.\, U. ><. Pi Muss. (.! I , a i 14J | 1 '•■ oaugli. . '.)lii(Se)r" "J" " i>: «-n!i.'Siie, •> K. aJfittl "";' ; 147 | \,r.Jj,,.<.\, " ' ] Sew 'i rk i4fc Det-% ■; ,lJ<)th Ii i '' 1.49 'Devi,,. yur,,:v 17'h l'i. 'fr! ■ y. i Apt i; <' 7, '&'- " : Mar.': .■'. rii, a, u. Julv.: 4, 'ft; ! 1 Sept. IS- ' ! 19, V. !v.l ! M.i- I «, ',- B. j May i I 1?. 'li< a . ' Mar.:'. U< 4 V-!. ■rg. J. P. i r:\-je, ;n.m • 'u Fel :. i, IrTii -org. ,\. (. °'r«kii>. : DlwhMJa . ■ • ^V Dii, , .; ■„: 1150 j *X>^ 1511 J. ^ept. ■ ... c.:. * 't.. v YbT.. a. ■^ .J. Oe\'.' Mai.ifiur 15i, 1) lk«, /.,»'- I J« -^v. 15: i: Di'L '.'Y ..'., I I' i...,-i .:. Di;.:;, .'.. .». ■ c O..C -. ' ■- '. 1551 D,)^ .a ' i- i ), a- 1. • ."■■.'■ H . i..T,ilton, a S u.-a'.J Jul..- . i»CJ. *n-.r J ' ^• R ,«r, D.^ -1-1 J.::i-t«7, lat? 157 .58 Di.-:, P na Do-.. •: (J,:. I hcu».'. Lsit I. I.I.'(; "'.tl. -Vlar. •. 50, »;■ ., ■' t'tll July '- '•' f urn- •: M Off ,. 'ir't, Mm l-tt R.l',0. "•», St. . B. 'I!»,U IKi. ■ ■ I. ... ■ • ..I •).■ -i.r;. . <>'. •.-■> item of s'-.iU' ! «* i;». Sure. k' !'•/, •rwt.T. Tt.:?'v: •: (lap. .Sir; • . . •M on> j!-'-. ■-. •!• '.:i. ■•:a.ai. Oi)..'.. -1 »,IM a Sept. :m. .•."•• .1 Oct. II 16 * Daiug wi :1 l». {..■•:'. V r. oi. f-l- r( of im».-j.: ;-. .-IT, p. 76 l'..:\*.tti. 'nVubaH'tofChtckama—.'.: in Cenfct. $U. j. .K'U ,1864, Vol. I p. 7o I'M. Stanch, pin.x GANGRENE OF THE MEDULLA. SECT. III. PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 229 So. Name, Military Description, and Age. Downs, T. J., Pt., B, 21st Mississippi. Doyle, J., Pt., B, 1st Wisconsin Cavalry. Drain, W. L., lJt., 1, 5th New York, ago 19. Drach, W. S„ Pt., F, 7th Maryland, age 22. Draughn, j. B., Corp'l, 15,30th Tenn., age 20. Duchenes, J., Pt.,C, 71st New York, age 26. DiilT, L. B., Lieut.-Col., 105th Pennsylvania. Duffany, A. L>., Pt., C, tith Vermont, age 44. Dugnl, L., Sergeant, F, I4.ith N. Y., ngo2ti. Dugan, P., Pt., O, 109th New York, age 25. Duncan, L. S., Serg't, I, 4th Tenn. Cav., age2ii. Dunlup,L.I.,Pt.,F,119th l'enn., age 22. Dunn, J., It., 1, 2d New York H. A., age 30. Duren, L. M., Pt., C, 7th Arkansas, age 21. Eaton, G. L., It., F, 10th Conn., age 28. Eck, II., Serg't, F, 14th Louisiana. Euglebreeht, II., Pt., E, 2d Kentucky. Erenburg, A., Lieut., 1st Kv. Light Artillery. Evans, E. M., Corp'l, D, 28tb Iowa, age 19. Everson, F., Pt., E, 1st Wisconsin, age 40. Ewald, IL, Pt.,F, 43d N. Y. rk.age 18. Fairgrieves, O., Pt., H, 1.1th N. Jersey, age 23. Farmer. M., It., K, 10th N. Hampshire, age 24. Faulkner, I., It., 15, (ith Missouri Cav., age 25. Feerer, 1). A., It., A, 79th Ohio, age 2,'. Fickel, S. W., Pt., B, 78th Ohio, age 17. Fitzgerald, C, Pt., G, lOtith Illinois, age 25. Finn. J., Pt., U, llth Infantry, age 28. Fisher, H.. Pt., E, 14th N. York II. A., age 36. Fisher. L., Corporal, F, 184th Penn., age 18. Fisher, T., Corp'l, B, 4th Colored Troops, age 18. Fordire, J. R., Pt., B, 39th Illinois. Folger, I. H-, Lieut., H, 58th Mass., age 21. Follard, J., Pt., A, 21st Tennessee, age 18. Forney, R., It., H, 48th Penn., age 24. Forrest, J. J., Pt., K, 21st Ohio, age 24. 'Forrester, P., Pt., G, 99th Pennsylvania. Fountain, N.,Pt.,B, 18th Wisconsin, age 17. Fouts, S., Pt., G, 2d Iowa, age 23. Fralick, W. A., Pt. M, lOthN.Y. H.A.,agel9. Frazer, P., Lieut., C, 4th Colored Troops, age 40. May 3, 3, '63. Aug. 3, 3, :62. June 2, 2, '64. May 8, 9, '04. Nov. 30, De. 1, '04. July 2, 3, '03. June 18, 18, '04. April 16, 18, '02. Mav 5, 6, '64. Sept. 29, 29, '64. Aug. 14, 14,'64. April 2, 2, '05. Aug. 14, 15,'64. Oct. 8, 8, '02. April 24, 24, '03. Dec. 13, 13, '62. April 7, 8, '02. Sept. 17, 17,'02. Oct. 19, 20, '04. Aug. 24, 24,'04. Mav 3, 5, '03. June 1, 2. '04. June 3, 3, '04. Aug. 25, 27, '64. May 27, 27. '64. Aug. 26, 20, '64. Jan. 7, 7, '65. Oct. 1, 1, '04. Julv 5, 5, '64. June 3, 3, '04. June 14, 15, '64. Sept. 11, 11, '63. June 3, 3, '64. Nov. 30, De. 1,'64 Sept. 17, 18. 'G4. Sept. 1, 1, '64. Dec. 13, 13, '62. Oct. 5, 5, '64. Feb. 15, 16, '62. April 2, 2, '65. July 30, 30, '64. Operations, Operators, Result. Left; circ. Surg. N. Hayward, 20th Mass. Rem. three ins. fem. Exchanged April 11, 1864. Left; flap. Veteran Res. Corps. Left; flap. Surg. C. S. A. Feb. 16, 1805, sequest. rem. Disch'd June 9, 1865. Spec. 113. Right; double flap. Dr. Dungan, C. S. A. Disch'd July 21, 1805. ------. Transferred to Provo6t Marshal May 4, 1805. Left • flap. Snrg. J. M. Merrow, 2d N. II. Disch'd June 14, 1864. Right. Discharged Oct. 25,1864. Right; flap. Surg. CM. Chand- ler, 6th Vt. Disch'd Julv 1,'02. Left; nnt.post.duub.nap. Confed. surg. Disch'd March 2.*, 1805. L't : circ. Kurg.J.Knowlson,109tli N.V. Dis.Nov.3,'6,"). Nov.2.">.'(i.">, reamp., Surg. Thorn, Troy.N.Y. Left ; circ Provost Marshal Nov. 10, 1864. Left; circ. Sure;. P. Leidy, 119th Penn. Disch'd Juno 17, 1865. Right; circ' Disch'd June 9,'05. Left: circ. Furloughed June 16, 1803. Left; circ. Ass't Surg. J. B. Whit- comb, lfith Conn. Disch'd. Left. Surg. White. Furloughed Jan. 20,1864. Left. Disch'd August 4,1862. Left. Snrg.H.E.Smith,27th Mich. Dis. May 15,'65. Subs. rem.bone. Right; circ. A.Surg.J.M.Cowen, 77th 111. Disch'd June 21, 1865. Bight; circ. Insanity. Washing- ton, Oct. 20,1864. Right; flap. Surg. M. Case, 43d N. Y. Idsch'd Sept. 16, 186,'i. Right; circ. Surg. J. S. Martin, 14th N. J. Disch d June 30, '05. Left; circ. Snrg. H. N. Small, 10th N. II. Disch'd June 14,'65. Right; circ. A. A. Surg. J. F. Musgrove. Disch'd Mar. 10,'05. Left; flap. Disoh'd Pec. 28, '04. Right; circ. Surg. J. S. Reeves, 78th Ohio. Dec. 4th, re-amp. by Surg. G. Grant, U. S. V. Dis- charged July 24, 1805. Left. Ass't Surg. F. J. Foster, 13th 111. Cav. Dis. Aug. 31,'C5. Right. Surg. T. M. Flandran, 140th N. Y. Duty Mar. 17. '65. Right; long. ant. flap. Insanity. Insane asylum Mar 3, 1865. Right, circ. Discharged May 30, 1865. Right: flap. Discharged May 20, 1865. Left; circ. A. A. Surg. W. II. Finn. Disch'd June 20, 1864. Right. Surg. 32d Me. Subseq. operat'n. Disch'd Dec. 17, '64. Dead bone removed. Left; circular. Provost Marshal March 18, 1865. Right; flap. Discharged Jan. 13. 1864. Right; flap. Surg. D. S. Young. 21st Ohio. Disch'd June 21,'65. Left; ant. post. flap. Surg. W. O'Meagher, 69th N. Y. Sub. rem. of bone. Dis. Nov. 20. '63. Right: circ. Surg. E. J. Ruck, 18tb Wis. Disch'd May 18,'05. Left; flap. Discharged. Left: circ. Confederate surgeon. Disch'd Sept. 22, 1865. Right; flap; ham. Disch'd April 22, 1865. Name, Military Description and Age. French, S., Pt., D, 10th Penn. Cav., nge 23. French, W., Corp'l. D, 17th Penn. Cav..age 17. Fristiie, R. II., Captain, 8th Kentucky Cavalry. Fultz, IL, It., K, 23d Kentucky, nge 34. Fuller, J., Pt. G., 3d Missouri, age 28. Gable, J., Pt., B, 155th Pennsylvania, age 19. Gahl,jr.,W.,Ft., K,57th Illinois. Gallagher, T., Serg't, F, 7th Louisiana, nge 30. ! Gardner. IL, Capt., I, 100th Illinois, age 23. Gardner, C. II., Pt., C, Kith Mass., age 34. Garrett, IV.. It., I, 15th Mississippi, age 18. Gathers, L.,Pt.,11,155th l'enn., age 30. Gay, I. D., Serg't. F, 91st Indiana, nge 28. Gear, N. II., It., D, 2d Connecticut. Geissler. J., Pt., B, 49th New York, age 49. Gelsleichter, C, Corp'l, C, 13th Ohio Cavalry, age 32. Gibson. G., Pt., C 63d Pennsvlvania. Giese, E. F., It., D, 82d Illinois, age 20. Gibson, H. B., Pt., D, 2d S. Carolina, age 23 Gildersleeve, A., Lands- man. U. S. Steamer Montgomery. Gill, J. VV., Serg't, A, 0th Maryland, age 27. Godley, L.M.,Serg't, E, 22d Iowa. Gnoch, J. D., Pt., B, 15th Virginia. Good, P., It., B, 33d Indiana, age 19. Gould, T. M.. Serg't, E, 29th Alabama, age 29. Goulding. J. F., Serg't, C, 20th Massachusetts, age 29. 3 Gowans, J., Pt., A, 38th New York. Grant, P., Pt., E, 48th Pennsylvania, nge 17. Grant, IL, It., F, 165th New York, age 21. 'Gray, W. A., It., K, 24th Alabama. Gray, W. II., Pt., F, 33d North Carolina. Green, D., Serg't, G, 4th Delaware, age 26. Green, J. D., It., E, 7th Maryland, age 22. Green, T. G.. Pt., G, 36th New York. Green, W. IL, It., K, 2d S. Carolina, age 32. Griffin, H. M., It., D, 14th Michigan, age 20. Grogan, A., Lieut., G, 6th Conn., age 21. Groover, P. H, Pt., I, 48th Alabama. Gross, J., Corp'l, E, 82d Illinois, age 24. Aug. 16, 16, '64. Aug. 16, 16, '04. July 14, 14, '64. Nov. 25, 26, '63 May 14, 14, '64. June 18, 20, '64. Oct. 4, 4, '62. June 14, 15, '03. Nov. 24, 25, 03. June 18, 18, '62. Julv 18, 19,'"64. Feb. 6, 6, '65. Aug. 6, 7, '04. June 1, . 2, '04. July 12, 12, '64. Julv 30, 30,"'64. June 1, 1, '62. July 1, 1, '63. Julv 3, 4, 1803. Jan. 15, 16, '65. April 2, 2, '65. May 22. 23," '63. May 5, 5, '64. June 22, 23, "64. Julv 20,. 21,"'04. July 2, 3, '63. Dec. 13, 15, '62. June 27, 27, '64. Julv 23, 2."),*'64. Sept. 19, 1!), '63. May 23, 24, '64. June 19, 19, '64. Mav 5, 6,'64. July 1, 2. '62. S~ept.~4, 4, '04. July 6, 6, '04. June 29, 29, '64. Oct. 20, 20, '63. May 25, 26, '64. Operations, Operators, Result. Left; circ; bone removed. Dis- charged July 18, 186.1 Left; lateral llap. Discharged Jan. 17, 1866. -----. Recovered. Left; flap. A. A. Surg. R.Wirth. Discharged June 22, 1864. Right; flap. Surg. A. Sabine, 70th Ohio. Disch'd Mar. 8, '65. Right: ant. post. flap. Surg. A. E. Reed, 155th Penn. Disch'd Aug. 7, 1865. Right; flap. Recovered. Left. Surgeon Davis. Retired February 13, I80.">. Right; flap. Surg. A. W. Ilcisc, 100th 111. Ila-m.; lig. of fem'l nrt'ry. Disch'd Aug. 18, 1804. Left; circ. Confed. surg. Dis. July II, 1803. Spec. 288. Right; flap; slough.; gangrene. Recover}'. Left; flap. Disch'd May 29, '65. Left; eirc. Surg. E. Batwell, 14th Mich. Disch'd June 20.'65. Left: dtuib. flap. Surg.ll.Plumb, 2d Conn. Disch'd June 3, '64. July 7th, re-amputation. Right: ant. post. llap. Surg. G. T. Stevens. 77th N. Y. Disch'd June 23, 1865. Card Phot. Left; double flap. Surg. A. F. Wlielan, 1st Mich. S. S. Sept. 7, bone rem. Disch'd Junei','05. Right. Disch'd July 21, 1862. Left: flap. Surg. W. C. Stein' 58th N. Y. Sub. oper. Disch'd March 14, 1864. Left; circ. Transferred for ex- change Sept. 10. 1863. Left; also amp. r't thumb and in- dex finger. Re-amp. Discli'd July 6, 1807. Left; flap. Surg. E. K. Foreman, 6th Md. Discli'd July 21, 05. Left: flap. Discharged Sept. 4, 18i.3. Left; circ. Surg. Slater, 15th Va. Furloughed May 25. 1864. Left: flap. Disch'd April 14, 186.1. Right; circ; gang.; bone exc. Recovery. Right: flap. Surg. N. Hayward, 20th Mass. Aug.30, spieu. ext. Sept. 23, nee. bone ext. Disch'd Jan. 28, 1864. Left; lat. flap. Ass't Surg. R. A. Everett. 5th Mich. Discharged April 27, 1803. Left; circ. Surg.W.R.D.Black- wood, 48th Pa. Dis. Jan. 13,'65. Left; circ. Discharged Feb. 10, 1805. Right. Discharged Oct. 9,1863. Left. Ass't Surg. J. A. Vigal, 33d N. Carolina. Recovered. Left; ant. post, llap: remo. necr. bone. Disch'd June 23, 1865. Left; (lap. Surg. Struth, C. S.A. Disch'd Aug. 18, 1805. Left; flap; necr. bone removed. Disch'd July 1.1, '63. Spec. 115. Right. Released April 1, 1865. Left; circ. Surg.E.Batwell,14th Mich. Discharged July 18,'65. Left; ant. post. Hap. Snrg. F. L. Dibble, (ith Conn. Discharged Nov. 26, 1864. Right. Surgeon Burton. Recov- ered. Right; circular. Disch'd Feb. 12,1865. 'O'MEAGHER (W.), Casualties at the Battle of Fredericksburg, in Am. Med. Times, 1863, Vol. VI, p. 179. 2 Lidell (J. A.), On the Surgical Treatment of Traumatic Hemorrhage, etc., in Surg. Mem. of the War of the Rebellion, collected and published by the U. S. Sanitary Commission, 1870, Vol. I, p. 325. 30'Mkagher (W.), Casualties, etc., op. cit., p. 179, and Surg. Mem. of the War of the Rebellion, Coll. and pub. by the TJ. S. San. Comm., 1871, VoL LT, p. 20. 4 Terry (C), loc. cit, p. 76. ^30 INJURIES OF THE LOWER EXTREMITIES. NO. 239 240 241 242 243 244 245 246 247 Name, Military Description, and Age. Groves, J. J!.. It.. K, 13th North Carolina. Guy. R.W., It., F, 14th N. York S. M., age 30. Guyer. F., Capt. D, 83d New York, age 30. Hall, A. A., Pt., E, 9th N. York Cav., age 26. Hallowdl, W. G., Pt., A, 27th North Carolina. Hamilton. J. R., Lieut., E, 10th Florida. Hammell, D. F., Serg't, E, 122d N. Y., age 34 Hammers, G., Capt., D, 27th Kentucky, age 34. Hanna, O., Pt., B, 47th Ohio, age 26. Hannah, A., Pt., I, 1st Mich. Art'y, age 18. Hauerwas, L , Pt., C, 18th Connecticut. Harford, T. J., Pt., D, 161st N. York, age 21. Harvey, H.G., Capt,, E, 145th Pennsylvania. Haskins, D., Pt., 1st Virginia Artillery. Held, P., Pt., G, 4Cth New York, age 21. Henne, Ii., Lieut,, IT, lilth Missouri, age 40. Herald, J., Pt., I, 1st Michigan. Hill, J., Pt., B, 7Sth N. York, age 36. Hill. I. M., Pt., I, 14th South Carolina. Hiller, S. J., Pt., E, 3d South Carolina, age 23. Hodges, S., PL, F, 82d Ohio, age 20. Holbrook, C, Pt., H, 109th N. York, age 21. Holloway, J. A., Pt., F, 15th South Carolina. Holloway, F., Corp'l, F, 33th Wisconsin, age20. Holmes, P., Pt.. D, 8th Maine, age 20. ^Holmes, W. F., Pt., G, 4th Tenn. Cav., age 24. Hopwood, A. S., Corp'l, B, 7th Kv. Cav.,age 27. Horton, W. H., Pt., B, 8th Alabama age 19. Houghton. C. IL, Capt,, L, 14th New York H. Artillery, age 23. House, M., Serg't, F, 9th Iowa, age 21. Howard, R. C, Pt., F, 5th Penn. Cav., age 22. Howard. W. H., Pt,, K, 14th New York H. A., age 18. Howe, F.M.,Pt..C, 20th Michigan, age 23. Howlctt, H. M., PL, A, 7th Louisiana. Hoyner, J., PL, A, 153d New York, age 39. Hubbard, W. M., Pt., A, 1st Louisiaua, age 26. Hnck, J., Ft., A, 72d New York, age 34. Hudson, G. H., Pt., L, 5th Virginia, age 38. Huffman, A., Corp'l, C, 2d Ohio. Hughes, P. F., Serg't, C, 125th New York, age 22. Hunt, J., Pt., K, 151st New York. July 1, 2, '63. July 1, 2. '63. Mav 6, 7, r64. Oct, 11, 11, '63. Oct. 14, 15. '63. Sept. 10, 10, '64. Oct. 19, 19, '64. July 21, 21, '64. Mar. 21, 21, '65. Aug. 12, 12, '64. May 15, 16, '64. April 8, 9, '64. June 12, 12, '64. Sept. 29, 29, '64. May 23, 23, '64. Mar. 8, a, '62. Aug. 29, 29, '62. Oct. 10, 1.1, '63. July 3, 4, \J3. Oct. 19, 19, '64. May 25, 26, '64. May 12, 14, '64. June 1, 1, '64. June 1, 1, '64. June 3, 3, '64. May 9, 9, '64. June 28, 28, '63. July 2, 2, *G3. Mar. 25, 25, '65. Feb. 1, 1, '65. Sept. 27, 27, '64. Aug. 19, 20, '64. Aug. 18, 18, '64. May 6, 7, '62. Oct. 19, 20, '64. Julv 2, 2, '63. Aug. 27. 27, '62, Sept. 23, 23, '64. Dec. 31, '62, Jan. 1, '63. May 18, 18, '64. June 1, 2, '64. Operations, Operators, Result. Left. Recovered. Right; ant. post. flap. Surg. G. M.Ramsey, 95thN.Y. Disch'd March 30,1864. Spec. 4368. Right; circ. Confed. surgeon. Mustered out. Right; circ. Surg.B.G. Streeter, 4th N. Y. Cav. Disch'd Aug. 23, 18C4. Spec. 4367. Left. Furloughed Dec. 18,1863. -----. Surgeon Bacon, C. S. A. Recovered. Right; flap. Surg.G.T. Stevens, 77th N. Y. Disch'd May 30,'65. Left; circ. Surg. J. W. Lawton, U. S. V. M. o. March 29,1S65. Right; circ. Surg. J.H. Hutchin- son, 15th Mich. Disch'd June 17,1865. Right; flap. Surg. H. H. Lang- don, 79th Ohio. Disch'd Oct. 3, 1865. Left; circ. Confederate surgeon. Discli'd May 12, 1865. Right; circ. Ass't Surg. W. F. Siglcr, 130th 111. Sub. opera'n. Disch'd March 8, 1865. Right; circ. Surg. G. L. Potter, 145th Penn. Disch. Dec, 19,'64. Left; double flap. Ass't Surg. W. F.Richardson, C. ^S. A. Fur- loughed Nov. 10,1864. Right; ant.post.flaps. Nov. 18th, bone rem. Disch'd Mar. 8,1865. Left, Surg. C. Cook, 12th Mo. Disch'd Jan. 27,1863; re-amps. Right. Surg. J. W. Tunnicliffe, 1st Mich. Disch'd Feb. 20, '63. Left; circ. Surg. G-. B. Coggs- well, 29th Mass. Discharged June 4,1864. Spec. 4377. Left. Snrg. L. V. Hurt, C. S. A. Paroled Sept. 23,1SG3. Right; circ. Surg. Evans, C. S. A. Pro. Marshal April 1,1865. Left; flap; gangrene ; re-amp. June 10th. Disch'd June 5, '65. Left; double flap. Confed. surg. Discli'd Nov. 25,1865. circ. Transferred June 7,1864. Right; doub. flap. Confed. surg. Disch'd May 27,1865. Right; circ. Ass't Surg. W. R. Benson, 8th Maine. Discharged May 3,1865. Left; flap; three-fourths of an inch of bone remo. Recovered. Left; Surg. R. R. TavIor,U.S.V. Discli'd June 8,1804. Right; removal of protruding bone. Exchanged. Right; circ. Snrg. W. Ingalls, 59th Mass. Disch'd Aug. 26, 1865. Spec. 4001. Left; flap. Surg. A. Sabine, 76th Ohio. Disch'd June 6,1865. Right; circ. Confed. surgeon. Discli'd July 18, 1865. Right: circ. Discli'd Nov.25,'65. Died Nov. 27, '68. Spec. 391. Left; circ. Surg. W. B. Fox, 8th Mich. Disch'd July 26,'65. Left. Surgs. Hancock and Trip- lett. Disch'd July 14, 1862. Left: circ. Surg. N. L. Snow, ]53dN. Y. Disch'd Jan. 9,'65. Left. Surgeon White, C. S. A. Exchanged March 3, 1864. Left. Discli'd April 7, '63. Died Sept. 8, 1865. Left; circ. Surg. W. S. Love, C. S. A. Released June 28, '65. Left; flap. Surg. B. F. Miller, 2d Ohio. Disch'd April 9, '63. Left; circ. Surg. W. S. Cooper, 125th N. Y. Nee. bone rem. Disch'd Aug. 29,'65. Spec. 3i76. Right; double flap. Discharged Dec. 26, 1864. No. 280 Name, Military DEscr.iPTiox, and Age. Hunt, M., Serg't, D, 3d Vermont, age 25. Hyndman. J. A., Pt., G, 5th Ohio Cavalry. rburg, F., Pt., E, 2d Missouri. Imhoff, F., Pt., D, 2d N. Jersey, age 32. Inman, W., Pt., D, 4th New Jersey. Inman, P., Pt., A. 95th Illinois, age 20. Irvine, T., Pt., I, 1st Pennsylvania, ago 27. Jackson, A., Pt., E, 75th Ohio, age 18. James, J., PL, H., 19th Maine, age 29. James, S.E.,Pt,,G, 30th Iowa. Jarrcll, A., Corp'l, I, 1st Delaware, age 23. Jarvis, I., PL, K, 10th N. Jersey, age 30. ' Jay, I., Pt., 14th In- diana Battery, age 28. Jean R. M., PL, G, 3d Arkansas. Jennings, J. W.. Serg't, B, Hampton's Legion. Jerger, S.,Capt., K, 27th Indiana, age 40. Jess, T., It., F, 125th Hlinois, age 25. Johnson, C. W., Serg't, C, 3d Indiana Cavalry. Johnson, W.W., Corp'l, E, 143d Penn., age 31. Johnston, J. L., Corp'l, G, 19th Ala., age 20. Johnston, G. S., Pt,, H, 27th North Carolina. Johnston, R., Pt., D, 70th Indiana. Jones, J., seaman, U. S. Navy. Jones, E. E., Corp'l, F, 117th N. York, age 26. Jordan. A., Pt., C, 12th Maine, age 21. Joyce, E., Pt., A, 1st Artillery, age 27. Kara, W.. Pt., G, 118th Ohio, age 24. Karstens, H., Corp'l, K, 16th Iowa. Kearney, J., Serg't, I, 76th New York, age 30. Keeler. D. N., Pt., C, 8th Illinois. Keller, G. W., Pt., I, 19th Indiana. Kells, J., Pt., I, 113th Ohio, age 44. Kelly, J., Pt., G, 2d Artillery, age 21. Kelly, M., Pt., A, 1st Vermont Batterv. Kelsey. E. E., i?t., B, 64th New York. Kennedy, J., Serg't, A, 95th Illinois, age 28. Kennedy, P. R., Pt., C, 27th N. C. age 21. Killen, A., Pt., K, 14th Ohio, age 31. Killian, M., Pt,, I, 79th Penn., age 20. King, A., Pt.. H, 7th Michigan Cavalry. 2Kirby, W. T., Pt, —, 59th Alabama. Kirby, W. II., Pt., A, 7th N. Jersey, age 24. June 3, 3, '64. Feb. 23, 23, !63. Oct. 8, 8, '62. July 3, 4, '03. Maj' 5, 5, '64. June 27, 27, '64. May 31, J'nel,'64. Aug. 19, 19, '63. July 2, 3, '63. Oct, 21. 21, '63. April 7, 8, '65. May 31, 31, '64. June 10, 11, '64. July 8, 8, '64. Jan. 17, 18, '64. May 3, 3, fo. Aug. 5, 5,764. June 21, 21, '63. July 1, 2, %3. Julv 22, 22," '64. May 22, 22, '63. July 20, 20, '64. Jan. 15, 16, '65. Jan. 15, 15, '65. Oct. 19. 19, '64. May 27, 27, '63. July 20; 20, '64. Sept. 19, 19, '62. July 2, 2, '63. Feb. 15, 16, '62. Aug. 28, 29, '62. Sept. 1, 1, '64. May 31, 31, '64. Aug. 16, 16, '63. Dec. 13, 14, '62. Dec. 15, 15, '64. Oct. 14, 15, '63. Sept. 19, 21, '63. July 20, 21, '64. Aug. 24, 25, '64. Sept. 19, 19, '63. July 1, 2, fG'i. Operations, Operators. Result. Left; double flap. Surg. D. M. Goodwin, 3d Vermont. Disch'd May 17, 1865. Left; circ. Surg. D.V. Rnnnels and Ass't Surg. G. Sprague, .1th Ohio Cav. Disch'd June 3, '64. Left; flap. Discli'd Oct. 3, 1863. Left; flap. Discli'd March 15, 1864. Left; flap. Snrg. J. D. Osborne, 4th N. J. Disch'd Nov. 21, '64. Left; flap. Surg. G. W. East- man, 16th Wis. Sub. amputa- tions. Disch'd June 17, 1865. Loft; circ. Confederate surgeon. Disch'd May 12, 1865. Right; circ. (also w'd left knee). Surg. C. L. Wilson, 75th Ohio. Disch'd Jan. 20, 1865. Right; flap. Disch'd Nov. 12, 1864. Right; flap. Surg. A. T. Hud- son, 26th Ia. Disc. Feb. 27,'04. Left; circ. A. Surg. E. P. Roche, 35th Mass. Disch'd Oct. 18,'65. Left; circ. Surg. O. R. Freeman, 10th N. J. Disch'd Dec. 15, '64. Right; ant. post. flap. Confed. surgeon. Disch'd July 8, 1665. Left, Surgeon Brown. Recov- ered. Left. Surgeon Bozeman. Re- covered. Right; circ. Discharged Aug. 19, 1863. Left; flap. Surg. M. W. Hooton, 86th 111. Disch'd Feb. 22, '65. Right. Surg. A. Hard, 8th 111. Cavalry. Disch'd Feb. 11, '64. Right; ant. post. flap. Disch'd Jan. 20, 1864. Right; circ. Sept. 5th, gang., slough. Trans'd Sept, 22, '64. Left. Surgeon Hunt, C. S. A. Recovered. Right. Disch'd June 7,'65. Died March 15, 1869; pyaemia. Left. Discli'd August 4, 1865. Left; circ. Ass't Surgeon F. B. Kimball, 3d New Hampshire. Disch'd Oct. 14, 1865. Left; circ. Discharged June 12, 1865. Left; ant post. flap. Surg. M. Benedict, 75th N. Y. Disch'd March 30, '64. Spec. 2670. Left; ant. post. flap. Surg. C. D. Moore, 13th Ky. Disch d April 14, 1865. Right; flap. Snrg. J. G. F. Hol- ston,U.S.V. Disch'd Ap'l8,'63. Right; circ. Surg. G.W.Metcalf, 76thN.Y. Also amp. r't thumb. Disch'dJuly6,1864. Spec.4366. Right; circ. Disch'd Oct. 11, 1862. Left; flap. Surg. J. McNulty, IJ. S. V. Disch'd Dec. 23, '62. Right: ant, post. flap. Surg. T. B.Williams,121stOhio. Disch'd March 21, 1865. Left; flap. A. A. Surgeon J.H. Thompson. July 31, seq. rem. Disch'd Mar. 10,'65. Spec. 2926. Left; bilateral flap. Discharged Dec. 10, 1863. Left. Disch'd March 13, 1864. Left; circ. Surg. J. W. Green, 95th 111. Disch'd June 8, 1865. Left; circular. Furloug'd Feb- ruary 13, 1864. Left; ant. post. flap. Disch'd July, 17, 1865. Right; lat. flap. Disch'd July 13,1865. Right: flap. Ass't Surg. G. R. Richards, 7th Mich. Cav. Disch. ----. Bone protruded; reampu- tation. Left; flap. Disch'd May 6,1864. 'O'KEEFE (D. C), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Med. and Surg. Jour., 1865, Vol. II, p. 25. *TERRT (C), loc. cit., p. 76. sect, ni.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 231 323 324 325 326 327 32S 3:10 331 332 :133 334 335 336 337 338 339 340 341 342 343 344 345 340 347 348 349 350 351 3.3:2 353 354 355 356 i57 358 359 360 361 362 363 364 Name, Military Description, axd Age. Operations, Operators, Rksult. Kline, R, It., E, 51st Penn , ago 19. Kniirm, <;. IL, Serg't, K, 8th Ark , nge 22. Kottingcr, J. F., PL, B, 16th Infantry, age 26. Konkleman, F.. PL, C. 14i)th Penn., age 19. Kohlman, II., Pt., F, 47th Ohio, age 37. Kountz, J , musician, G, 37th Ohio, nge 20. Kramer. ('.. It., E, 191st l'enn.. age 20. Kranz.C.Vorp'l, B, 15th X. Y. 11. A . age 27. Kreig, P., It, C, 46th New York, age 28. Landolt, W. H , Serg't A, 5th Wis., ago 29. LangshoUl. A.. Pt,, B, 8th Illinois. Lane, J. M.. Serg't. E. 10thPenn. Cuv..agc41. Langan, J., It.. I>. 20 Michigan, age 22. Lanning. A.. Serg't. F, 93d Indiana, age 27. Lapham. C. X.. Corp'l, K, 1st Vermont Cav., age 23. Langston.; B. F., PL, C. 5th Arkansas, age 19. Larkin, A. B., It., D, 30th Iowa, age 24. Lawrence, J. K., Pt.. D, 93d New York, age 33. Laurie, C, PL, F, 2d Vermont. Learey, J., PL. M, 10th N. York Cav.. age 22. Leaeh. E. B., Corp'l, K, 2bth Mass., age 33. L-\ T. J., PL. I, 38th Virginia, age 32. Le\ Z I'., PL, C. 23d Tennessee. Le IHure. R.. Serg't. G, 2d Kansas Cnl'd. Leggett, W. l\, Pt., F, 1st Ala. Cav.. age 2'i. Lelar, W. D.. Corp'l, H, 90th Pennsylvania. Lemmnn, J., Corp'l, D, 33d Illinois. Lennon. W., PL, A, 8th Michigan Cav., age 17. Leonard, O. IL. PL. R, 21st Indiana, age 22. Levitt, J.. Serg't, C, 35th Illinois, age 31. Lewis, M.. It. K, 7th Mich. Cav.. age 18. Liesv, .)■ PL, B, 17th Ohio, age 26. Lilley, S. 0.. It., L, 1st Maine II. A.. age 2J. Lincoln, E . Serg't, I, 12th Illinois. Lindsay, W., Pt., I, 18th North Carolina. Listinan, J., Capt., H, 18,3th New York. Little. J., PL, B, 27th Virginia Lofton, B. F., Pt., D, 32d Tennessee. Logan. W. A., Corp'l, D, 110th 111., age 30. Lott, G. W., Serg't, II, 7th South Carolina. Lovely, C, Pt., F, llth Vermont, age 38. Loveridge, C, Pt., B, 1st U.S. S. S. Lowenstein,M.,Lieut., D, 15thN.Y.H.A.,age21. June 3, :i, '64. Dec. 16, 17, '04. Dee. 31, '62, Jan. 1. '63. Oct. 8, 8. '04. Dec, 13, 14, '64. Nov. 25, 25, '63. Mar. 31, 31, '65. Aug. 18, 19. '04. Aug 21, 21, '64. April 6, ti, '05. Mav 12. 12, '63. Oct. 27, 28, '64. June 18, 18, '64. Dec. 15, 15, '64. Julv 8, 10, '03. Nov. 30, Dc. 1, '64. Oct. 2L, 21, '03. May 12, 13,"'64. June 4, 4, '64. Mar. 31, Ap. 1,'65 Sept. 19, 20, '01. Aug. 25. 26, '64. Sept. 20. 20, '03. July 17, 17. '03. Julv 29, 3J. '03. Dec. 13, 14. '62. Mav 17. 17,'03. Oct. 25. 25, '63. Julv 4. 4, '04. June 18, 19, '04. Julv 3, 4, '63. Mav 14, 15, '64. May 19, 21,' '04. April 0, 7, '62. Mav 2, 3, '63. Feb. 6, 6, '65. Aug. 28, 28, '62. Sept, 20, 21, '63. Sept. 1, 1, '64. July 3, 3, '63. June 1, 1, '64. May 27, 27, '62. Mar. 31, 31, '65. Right; flap; necrosis. Mustered out Jan. 25, 1866. Right; circ. Provost Marshal Juno 24, 1865. Left; flap. Ass't Surgeon J. F. Weeds, U. S. A. Disch'd July 15, 1863. Right; flap. Disch'd July 19, 1864. R't; circ.; also amp. three fingers r't hand. Surg. I. N. Barnes, 116th 111. Disch'd Sept. 20, '65. Left; ant. post. flap. Surg C. P. Brent, 54th Ohio. Discharged April 29, 1864. Lett; oval skin flap; circ. sect. of muse. Disch'd June 16, '65. Left; circ. Disch'd Sept. 12, 1865. Left; amp. left arm. Surg. W. II. Fox, 8th Michigan. Disch'd April 27, 1865. Left; circ. Disch'd July 13, '65. Left; flap. Disch'd Aug. 8, '63. Right; flap. Disch'd July 26, 1865. Right; ant. post. flap. Surg. S. S. French, 20th Mich. Gang. Disch'd Sept, 11, 1865. Left; circ.; gang.; necr. Disch'd Nov. 10, 1805. Right; ant. post. flap. (Left; knecjoint.) Surg. A. Wood, 1st Mass. Cav. Disc'd Aug. 25,'64. Left; bilateral flap. Prov. Mar- shal March 27, 1865. Right; lat. flap. Surgeon G. L. Carhart, 31st Iowa. Disch'd Feb. 4. 1804. Left; circ. Disch'd Juno 16,'65. ----; double flap; gang. Fur- loughed. Left; ant. post. flap. Disch'd July 20, 1865. Right; ant. post. flap. Surg. J. G. Bradt, 2oth Mass. Disch'd Oct. 29, 1864. Right. Surgeon Wilbur, C. S. A. Retired March 13, 1865. Right. Surgeon Plummer. Re- covered. Right; circ. Disch'd Aug. 29, 1864. Left; flap. Surg. A B. Stewart, 1st Ala. Cav. Disc. Julv 5. '64. Right. Disch'd May 4, 1863. Right: flap. Surg. G. P. Rex, 33d III. Gang. Disch'd Nov. 4. 1803. Left; circ. Disch'd May 26, '64. Right; ant. post. flap. Surg. C. J. Walton, 21st Ky. Disch'd June 20, 1865. Left; circ. Surg. S. P. Hawlcy, 35th 111. Disch'd Feb. 24. '05. Right. Disch'd Juno 3, 1864. Right; circ. Disch'd Feb. 18, 180.3. Right; flap. Disch'd April 26, 1865. Left; flap. Surg. II. Wardncr, U. S. V. Disch'd May 29,1862. Right; circ. Surg. Lane. Gang. Furloughed July 28, 1863. Right; oirc, Surg J. Thomas, 118th Penn. Disch'd May 29,'65. Left. Surg. Gibson. Recovered. Lef Surg. Grant, Recovered. Right; flap. Surg. N. G. Sher- man, 9th lnd. Disc'd Feb. 1.'65. Right. Surgeon Pierce, C. S. A. Recovered. Right; double flap; also amp. left arm. Disch'd Feb. 6, 1865. Left; flap; gang. Disch'd Jan. 29, 1863. Right; circ. Surg. A. A.White, 8th Md. Disch'd Oct. 20, 1865. Name, Military Description, and Age. Lucas, W. V., Serg't, I, 8th Indiana. Lusty, R , It., E, 15th Massachusetts, ago 18. Luttmann, J., Pt., K, 203d l'enn., age 34. Lyons, W., It., Wheat's iinttery. Maybe, W., Pt., O, 63d Tennessee, age 51. Madden, T., Corp'l, A, 173d New York. Maguire, D., Serg't, B, 2d Penn., age 24. Mugill, D. B., Capt., A, 117th N. York, age 26. Maher, P., Lieut., F, 63d New York, age 42. Main, F. F., It., F, 100th New York, age 19. Mansfield, C, PL, E, 145th Penn., age 30. Manson, S. B., Pt., F, 32d Maine, age 24. Mapes, W. E., Capt,, H, 124th N. York, age 21. Marine, S. A., PL, G, 13th Iowa, age 21. Marr, A. C, Serg't, E, 14th N. Jersey, age 25. Marsh, A., Serg't, B, 64th N. York, age 32. Harsh, T. J., Pt., I, 2d Missouri, age 19. Martin, D. D., PL, C, 12th Maine, age 45. Martin, J., Corp'l, F, 123d N. York, age 25. Martin, J., Pt., D, 106th New York, age 20. Martin, S., PL, II, 64th Illinois, age 22. Martin, W. J., Corp'l, I, 14th W. Va., age 33. Mason, G., PL, K, 13th Virginia Cav., age 24. McAnany, P., Pt., Bat'y A, 1st Art'ry, age 28. McCann, F., PL, B, 10th New Jersey, age 22. McCarthy, F., Corp'l, G, 1st Wis. Cav., age 27. McClaskey, J. R., Serg't, A, 13th Iowa, age 33. McClintock, J. H.. Pt., A, 87th Penn., age 18. McCord,D..Pt,G, 149th New York, age 24. McDonald, IL, Corp'l. F, 01st C. Troops, age 24. MeKarling, J., Pt., D, 154th N. Y., age 20. MoOary, W., Pt., D, 1st New Jersey, age 29. McGuire, P., Corp'l, E, 20th Mass., age 3>. McGill, L , It., B, 97th Penn., age 10. McGaulley, W., Pt., D, 2d W. Va., age 27. McGindley, B., PL, C, 22d Kentucky. McGonagle, (j., Corp'l, C, 35th Ohio, ago 24. McGrcw, N. IL, Pt., F, 34th Ohio. McKay, R., Pt., F, 28th Mass., age 18. McKinney, J , Serg't, A, 15th Ohio. McMahon, J., Pt., I, Oth New York Cav., age 23. May 1, 1, '63. Julv 2, 2, '63. Jan. 15, 15, '65. July 21, 21, '61. May 16, 16, '64. Mav 27, 29,"'63. June 26, 28, '62. Jan. 15, 15, '65. June 22, 22, '64. July 18, 19, '63. May 12, 13, '64. July 24, 24, '64. Aug. 14, 14, '64. July 21, 21, '64. Sept. 19, 19, '64. May 12, 12, '64. June 18, 19, '64. Sept, 15, 15, '62. June 22, 22, '64. Sept, 19, 19, '64. July 22, 22, '64. July 20, 2l,*'64. Sept. 30, Oct.l.'64. April 12, 12, '63. Aug 17, 18, '64. April 30, 3:), '63. July 6, 7, '64. Oct, 19. 19, '64. July 3, 3. '03. Oct. 16, 17, '61. June 22, 22, '64. Julv 12, 13. '63. July 3, 5, '63. Aug. 16, 16, '64. Aug. 23. 23, '62. May 16, 17,"'63. Oct. 19, 20, '04. Sept. 13, 13, '62. May 18. 18. '64. June 24, 24, '63. May 7, 7, '64. Operations, Operators, Result. Right; flap. Disch'd Aug. 27, 1863. Left. Surg. S. H. Plumb, 82d N. Y. Disch'd Jan. 12, 1804. Right; circ. Discli'd May 7, 'C5. Left. Surg. Love. Recovered. Recovered. Left; circ. Surg. N. W. Leigh- ton, 173d N. Y. Disch'd Sept. 12, 1803. Left; circ. Dr. Swinburne. Dis- charged Mar. 1, '04. Spec. 170. Left. Surg. J. W. Mitchell, 4th C. T. Disch'd June 8, 1805. Left. Discharged June 12, 1805. Not pensioned. Left; circ. Confed.Surg. Slough- ing; necr. Disch'd July 30,'04. Spec. 4298. Right; flap. Disch'd March 24, 18G5. Right; flap. Surg. C. L. Traf- ton, 32d Maine. Disch'd May 6, 1865. Right; flap. Disch'd Dec. 19, '64. Right; flap. Surg. M.W. Thom- as, 13th Iowa. Dis. April 5,'65. Right; flap. Surg. T. A. Hehvig, 87th Penn. Discli'd July 8, '(.5. Right; flap. Snrg. J. W. Wis- hart, 140th Penn. Feb., 1865, necrosed bone pulled away. Disch'd Feb. 24, 1865. Right; ant. post. flap. Provost Marshal Oct. 21, 1804. Right; flap. Discharged 1863. Right; flap. Surg. J. Chapman, 123d N.Y. Disch'd July 19,'65. Left; flap. Surg. T. A. Hehvig. 87th Penn. Disch'd Mar. 31,'fi5. Left: flap. Disch'd Feb. 28, '65. Right; ant. post. flap. Surg. J. H.Manown, 14th W. Va. July 27. '65, necrosed bone removed. Disch'd April 16, 1666. Right; circ. Prison Jan. 27, '65. Right: ant. flap. Discli'd from hospital Jan. 20, 1864. Right; circ. Confed. Surgeon. Disch'd March 17, 1865. Right. Disch'd Aug. 14, 1863. Died Feb. 10, 1864. Left; ant.post.flap. Surg.M.W. Thomas, 13th Iowa. Disch'd Aug. 23, 1865. Left; ant. post. flap. Surg. F. A. Hehvig, 87th Penn. Discharged April 10, 1805. Left; circ. Surg. J. V. Kendall. 149th N. Y. May 26th, rem. of bone. Disch'd March 3, 1865. Spec. 2756. Left; ant. post.flap. Confederate Surg. Disch'd Julv 29, 1865. Left; flap. Discli'd May 31,'65. Left; circ. Surg. Clark. Dis- charged Oct. 5, 1863. Right; circ. Surg. N. Hayward, 20th Mass. Disch'd May 14, '64. Right; circ. Snrg. J. 11. Ever- hart, 97th Penn. Disch'd Jan. 17, 1866. Spec. 2399. R't: doub flap. Surg. R. W. Haz- lett,2d W.Va. Dis. April 27,'63. Right; flap. Surg.B.F.Steven son. 22d Ky. Dis. Sept. 10, '03. Right; circ : femoral religated. Disch'd March 31, 1805. Left: flap. Disch'd June 17, 'G3. Died Oct. 27, 1864; shock. Left; circ. Discli'd April 26, '65. Right; circ. Discli'd March 9, 1864. Left; circ. A. Surg. S. C. Sang- er, 6th N. Y. Cav. Aug. 18th, remo. 8 ins. seq. Disch'd May 18, 1865. Spec. 4281. 232 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. NO. 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 Name, Military Description, and Age. McMann, S., Corp'l, C, 1st Peun. Rifles, age 35. McMillan, J , Serg't, G, 24th Michigan, age 22. McMillan, W. IF.,Corp'l, G, 12th Ala., age 29. McMullan, A., PL, B, 36th New York, age 23. McNair, G., Corp'l, C, 6th N.Y. II. A., age 19. lMcNeal, J., Lieut,, C, 10th Georgia, age 34. McNey, J., PL, B, loth New Jersey. McNulty, P., Pt., 7th Mass. 'Bat'ry, age 24. McOmber, M. J., PL, H, 6th Penn. Res. Corps, age 18. McVean.D.C, CapL.E, 1st Wisconsin. Means, P. B., PL, E, 48th Alabama, age 18. Mellon, J., Pt., G, 55th Illinois. Mellinger, M., PL, B, 55th Penn., age 28. Mercer, J. Q., Capt., E, 147th Penn., age 25. Mess, F., PL, B, llth New Jersey, age 47. Messmer, A.', PL, B, 7th N. York H. A., age 33. Milter, D. C, PL, F, 63d Tennessee. Miller, G., Pt., E, 15th Infantry, age 19. Miller, j. R., Pt., D, 1st Conn. H. Art,, age 32. Miller, J. P., Pt., I, 12th New Jersey, age 24. Miner, R. F., Pt., F, 30th Wisconsin, age 29. Moody, D. M., PL, C, 3d Maine, age 36. Moore, S. E., Serg't, L, 1st S. C. Rifles. Moran, I. /C, Pt.,D, 14th Virginia. Morgan, H. O., Captain, 12th Infantry. Morgau, J., PL, K, 145th New York. Morgan, J. M., Pt., Orr's S. C. Rifles. Morse, J. W.,Pt.,F, 14th N. Hampshire, age 20. Moses, M. J., Corp'l, E, 81st New York, age 28. Mo watt, D.,Pt.,C, 100th New York, age 26. Mulrenen, P., PL, H, 30th Mass., age 43. Murphy, D., PL, A, 17th Mass., age 28. Murphy, E. IF, Serg't Major, 48th Georgia. Murphy, H. A., PL, E, 14th Louisiana. Myers, A. A., PL, B, 51st Indiana, age 31. Myrick, N. W., PL, A, 27th Georgia, age 27. Nelson, E. H., Pt., E, 8th Vermont. Newland, 1.1., Serg't, B, 34th Ohio, age 28. Newton, J. A., Pt., F, 34th North Carolina, age 19. 445 Nicholson, J., It., C, 4th West Virginia, age 25. 446 Nixon, J., PL, F, 18th Ohio. 447 Norris, H., Pt., F, 7th S. Carolina Bat'ry, age 44. Dates. May 11, 11, '64. July 2, 4, '63. July 3, 3, '63. July 1, 2, '02. Oct. 19, 19, '64. Sept. 17, 17, '62. May 1.0, 10, '64. Mar. 27, 27, '65. July 2, 4, '63. Sept, 19, 20, '63. July 3, 3, '63. June 27, 27, '64. June 18, 19, '64. June 16, 16, '64. April 1, 1, '65. Aug. 15, 15, '64. Sept. 20, 21, '63. Aug. 7, 8, v64. May 18, 18, '64. May 6, 7, '64. Aug. 27, 28, '64. July 1, 3, '63. Aug. 28, 28, '62. May 16, 16,''64. May 5, 6, '64. Oct. 12. 12, '63. July 28, 28,"'64. Sept. 19, 21, '64. May 9, 9, '64. Aug. 16, 17, '64. July 13, 14, '63. May 13, 13," '63. Aug. 16, 16, '64. July 2, 2. '63. Dec. 15, 15, '64. Aug. 18, 19, '64. Sept. 4, 5, '62. Sept. 19, 20, '64. July 1, 2, ''63. May 19, 20, '63. Dec. 30, 30, '62. Aug. 21. —. '64. Operations, Operators, Result. Right; flap. Surg. J. J. Comfort, 1st Penn. Rifles. Disch'd Aug. 7, 1865. Spec. 221. Right; circ. Surg J. H. Beach, 24th Mich. Disch'd Nov. 30, '63. Left; flap. Exchanged. Right; circ.: July 17 th, flap amp. up. third. Disch'd July 3,1863. Spec. 1392. Left; flap. Disch'd Oct. 5,1865. Right; circ. Surg.G.G.Crawford, C. S. A. Retired Nov. 11, '63 Right; flap. Disch'd Sept. 2, '65. Right; ant. post. flap. Disch'd June 5, 1865. Right; flap. Surg.C. Bowers,6th Penn. Res. Disch'd May 30, '64. Left. Surg. L. I. Dixon, 1st Wis., Capt., V. R. C. Res. May 9, '64. Left. Exchanged Nov. 12, '63. Right. Ass't Surg. J. J. Smith. Disch'd March 1, 1865. Left. Disch'd April 4, 1865. Right; flap. Surg. H. E. Good- man, U. S. V. Two sub. oper. Disch'd Feb. 2, 1865. Left; bilateral flap. Disch'd July 21. 1865. Right; cir. Surg. J. W. Wishart, 140th Penn. Discli'd Dec. 16,'64. Left. Surg. McDonough. Re- covered. Left; ant. post. flap. V. R. C. June 1, 1865. Left; ant. post. flap. Surg. S.W. Skinner, 1st Conn. H. A. Dis- charged May 6, 186.3. Left; oval flap. Surg. Gaskill, C. S. A. Disch'd April 28, '65. Right; flap. Surg. O. Hoyt, 30th Wis. Exfol. removed. Disch'd April 5, 1865. Left; flap. Confederate Surgeon. Disch'd Nov. 28, 1803. Left. Surg. T. A. Evans, P. A. C. S. Disch'd Oct. 25, 1862. Left. Surg. Doughty. Furl'd June 25, 1864. Left; circ. Surg.L. W. Oakley, 2d N. J. Retired Feb. 17,1868. Left; doub. ant. post. flap. Surg. R. K. Tuthill, 145th N. Y. Dis. Feb. 23, '64. Spec. 4317. Left; double flap. Reg't Surg. Transf'd Sept 16, 1864. Left; ant. post, flap; one inch of femur rem. Dis. June 15, '65. Left; ant. post. flap. Surg. W. H. Rice, 81st N. Y. Disch'd Sept. 14, 1864. Left; flap; spic. remo'd. Disch'd Jan. 18, 1865. Right. Discli'd Dec. 26, 1863. Died Sept. 5, 1868; debility. Left; circ. Surg. J. F. Galloupe, 17th Mass. Disch'd Mar. 5,1864. Right. Surgeon Pope. Recov- ered. Right, Surg. Taney, C. S. A. Gangrene. Exch'd Mar. 3, '64. Left; circ. Disch'd July 6, '65. Right; circ. Surg. T. F. Oakes, 56th Mass. Prison Mar. 23, '65. Left; flap. A. Surg. G. W. Avery, 9th Conn. Disch'd Feb. 20, 1863. Left; ant. post. flap. Surg. W. S. Newton, 91st Ohio. Disch'd April 6, 1865. Left. Surg. A. F. Miller, C.S.A. Necro. bone removed. Exch'd March 4, 1864. Left; flap. Disch'd August 14, 1863. Right; flap. Surg. G. D. Beebe, U. S. V. Disch d April 23, '63. Left. To prison Feb. 10, 18:55. NO. Name, Military Description, and Age. Nugent, T., Lieut,, H, 27th Indiana, age 26. Nurse, H. H., Pt., H, 86th Illinois, age 21. O'Brien. J. D., Capt., A, 24th New York. O'Connor, C, PL, G, 8th Connecticut. Ohlinger, F., Pt., D, 13th West Virginia, age 18. O'Kane, D., Corp'l, A, 29th Penn.. age 22. Oliver, C. E. M., PL, F, 123d Ohio, age 20. Oliver, G. W., Pt., H, 7th Ohio, age 36. O'Neal, R. H., Pt., K, 29th Penn., age 21. Orbeton, J. H., Pt., K, 9th Maine, age 33. Osbom, V. B., Pt., A, 2d Kansas Cav., age 26. Owens, J. M., Lieut., H, 8th Penn. Reserves. Oxley, J.H., PL, K, 86th Indiana. Page, J. C, PL, E, 112th New York, age 25. Palmer, W. H., Lieut., G, 53d Illinois. Parks, G. W., Pt., I, 7th Missouri Cavalry. Paul, J. S., Corp'l, H, 71st Pennsylvania. Parr, J., Pt., D, 100th Penn., age 24. Parry, D. D., Pt., F, 3d Ohio. Parsell, L. D., Corp'l, A, 5th New York, age 30. Patterson, S. N., Corp'l, A, 52d Virginia. Paxon, G. H., Pt. E,4th Penn. Cav., age 22. Peeden, J. M, PL, H, 16th Georgia, age 23. Perkins, H. C, Pt., B, 14th Kentucky. Perkins, G. R., Pt., C, 1st Maine Cav., age 18. Perry. J., PL, C, 74th New York, age 20. Phelps, R. S., PL, B, 1st Georgia Cavalry. Phillips, Z. D., PL, H, 49th Va., age 21. Pickering, A. H., Pt., F, 1st Mass. Art., age 29. Pitchford, R. T, Rich- ard's Miss.Bat'n,age29. Plemons, Z. T, ---, E, 60th Georgia. Pollard, A., Serg't, C, 38th Tennessee. Porter, B. C, PL, A, 9th Virginia, age 31. Porter, J. A., Serg't, B, 76th Penn., age 27. Powell, R. H., Pt., E, 7th Wisconsin, age 33. Powell, J., Pt., K, 143d New York, age 20. Powell, W., PL, K, 66th Ohio. Powers, P., PL, B, 25th Missouri. Price, T., PL, G, 5th Artillery, age 26. Prosser, G., Pt., G, 27th Indiana, age 18. Quance, A., PL, B, 1st Michigan, age 16. Rae, A. M., Pt., H, 2d Miss., age 26. Ralph, W. R., PL, I, 8th New Jersey, age 35. Reed, C, Pt., F, 4th W. Virginia. Rieder, C, Pt., C, 41st Ohio, age 19. Dates. July 3, 3, '63. Mar. 16, 17, '65. Sept. 17, 17, '62. May 7, 7, rG4. June 18, 18, '64. Maj' 15, 15, '64. Mar. 31, 31, '65. June 19, 19, '64. July 3, 3, '63. May 20, 20, '64. Jan. 17, 19, '65. Dec. 13, 15, '62. Jan. 1, 2, '63. Jan. 15, 16, '65. Mar. 21, 21, '65. Aug. 16, 17, '62. Oct. 21, 22, '61. Mar. 25, 25, '65. Oct. 8, 9, '62. Aug. 18, 19, '64. Aug. 28, 29, '62. June 11, 11, '64. Oct. 22, 22, '64. Aug. 6, 6, ^62. Mar. 31, 31, '65. July 2, 3, '63. May 14, 16, '64. May 5, 5, '64. June 16, 17, '64. April 2, 2, '65. Nov. 27, 28, '63. July 20, 20, '64. May 10, 10, '64. Oct. 28, 29, '64. Mar. 31, 31, '65. Mar. 19, 19, '65. Sept. 17, 17, '62. Sept. 12, 13, '61. May 27, 27, '64. July 30, 30, '64. July 15, 15, '64. Aug. 18, 19, '64. July 2, 2, '63. May 19, 20, '63. Nov. 23, 21. '63. Operations, Operators, Result. Left; flap. Surg. W. H. Twiford, 27th, lnd. Disch'd May 25,1864. Left; ant.post.flap. Surg.A.Wil- son, 113th O. Dis. June 25, '65. Right; circ. Surg. J. M. Farley, 84th N.Y. Disch'd Dec. 22,'62. Right; circ. Surg. M. Storrs, 8th Conn. Disch'd Oct. 4, 1864. Left; flap. Disch'd June 10, '65. Right; circ. Surg. J. A. Wolf, 29th Penn. Disch d July 4, '65. Right; circ. Surg. C. H. Levan- saler,8thMe. Disc. Aug.30,'65. Right; circ. Surg. J. W. Brock, 65th Ohio. Gangrene. Disch'd May 12, 1865. Right; circ. Disch'd March 14, 1864. Right; double skin flap. Disch'd Jan. 6, 1865. Right; flap. Surg. J. P. Root, 2d Kan. Cav. Disch. May 8,'65. Right; circ. Surg. T. Jones, 8th Penn. Res. Disch'd April 4, '63. Right; flap. Disch'd Mar. 7,1865. Left; ant. post, flap. A. Surg. F. B. Kimball, 3d N. H. Disch'd June 27, 1865. Right; circ. Surg. F. M. Rose, 43d Ohio. DisclfdJune22,'65. Right; flap. Surg.Raydon, C.S. A. Bone remov. subs. Disch'd Nov. 8, 1862. Right. Surg. A. B.Crosby, U.S. V. Disch'd, 1862. Right; circ. Disch'd July 16, '65. Left; lateral flap. Surg. G. D. Beebe. Discli'd March 21, '63. Right; flap. Confed. Surgeon. Discli'd March 8, 1865. ----. Surgeon Grimes, C. S. A. Recovered. Right; flap. Disch'd July 4, '65. Right; circ. Confed. Surgeon. Prison Feb. 18, 1865. Right: flap. Surg. A. C.Miller, 14th Ky. Disced Dec. 31, '63. Right; circ. Act, Staff Surg. G. W.Colby. Discli'd Aug. 24,'65. Right; flap. A. Surg. J. T. Cal- houn, TJ. S. A. Dis. July 19,'64. Left. Recovered. Right. Surg. Moffat, C. S. A. Retired Feb. 11, 1865. Right; flap. Disch'd Jan. 2, '65. Right. Camp Parole June 17, ' 1865. Left. Surg. J. Dwindle, 106th Penn. Prison April 11, 1864. Spec. 1886. Right; circular. Recovery. Left; circular. Confed. Surgeon. Retired Nov. 4, 1864. Left; circ. Surg. N. Y. Leet, 76th Penn. Disch'd Aug. 12, 1865. Right; flap; sequ. rem'd. Disch'd Nov. 28, '65. Spec. 3015. Left; skin flap. Surg. H. Z. Gill, U. S.V. Disch'd Oct. 21, '65. Left; circ. Disch'd Dec.4,1862. Right; flap. Surg. Buchanan, C. S. A. Discharged. Right; ant. post, flap (wound left knee). Disch'd Sept. 21, 1864. Right; flap. Disch'd May 29, 1865. Left; flap. Subs. oper. Disch'd Jan. 20, 1865. Left. To prison Feb. 10, 1865. Left; flap. Disch'd May 30, '64. Left; circ. Surgs. J. R. Philson, 4th W. Va., and S. P. Bonner, 47th Ohio. Disch'd Sept. 1, '63. Right. Surg. Wood. Disch'd April 25, 1864. 1 Fisiikk {O. J.), loc. cit., p. 47. SECT, m.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 233 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 525 527 528 529 530 532 533 , Name, Military Description, and Age. Reifenyder, R. L., Pt., G, 198th Penn., age 30. Reinhart, J., Serg't, 13th New York Battery. Repperger, J.. Corp'l, C, 15th N. Y. Art., age 38. Reynolds, J., PL, C, 33d Mass., age 18. Reynolds, J., PL, B, 13th New Jersey. Rexfurd, S., Pt., I, 45th Penn., age 20. Rhodes, 0., Pt., llth Ohio Battery. Rice, D., Pt., C, 79th Penn., age 23. Rice, G. W., Pt., I, 4th Vermont, age 17. Rice, J., PL, G, 207th Penn., age 23. Richard, L. P., Serg't, H, 7th N. Y., age 45. Richards, W. T, Pt., I, 12th Ala., age 28. Richmond, J., PL, 7th Mass. Bat'ry, age 24. Rider, G., Pt., H, llth Mass., age 29. Riley, G. W., Pt., D, 66th Illinois. Riley, P., PL, M, 3d R. I. Art., age 29. Roach, P., PL, C, 2d Cavalry, age 23. Roberts, E. G.. PL, C, 1st Georgia, age 21. Roberts, C. W., Adj't, 17th .Maine. Roberts, J., Pt., F, 61st Georgia. Robinson, D., Corp'l, A, 25th Indiana, age 21. Robinson, R., Pt., C, 29th Penn., age 39. Rodgers, E., PL, C, 103d Pennsylvania. Rodgers, E. J., Pt., F, 12th Alabama, age 48. Rogers, A., Pt., B, 1st New York, age 17. Rollins, J. W., PL, H, 31st Indiana, age 19. Roney, H, Serg t, E, 3Cth Ohio, age 30. Rose, H., PL, F, 13th Mich., age 35 Roth, J. H., PL, H, 205th Penn., age 22. Rouse, G. A., Serg't, F, 8th Conn., age 22. Rowe, P., PL, B, 4th Artillery. >Rudd, T, PL, E, 32d Virginia, age 28. Rutherford, J., PL, E, 50th Virginia. Rnnyon, J. M., Pt., H, 59th New York, age 16. Samples, J. B„ PL, E, 19th Georgia. Sandford, VV. H.,PL, H, 19th Mich., age 20. Sauer, G.. Serg't, G, 169th N. Y., age 37. Sausser, P., Corp'l, A, 208th Penn., age 24. Savage. W. B., PL, F, 91st Ohio, age 33. Sawyer, T. J., Pt., E, 7th New Hampshire. Sax, J., PL, D, 3d New York, age 23. Mar. 29, 29, '65. Aug. 29, 29, '62. June 9, 9, '63. May 14, 14, '64. May 3, 5, %'A June 2, 2. '64. Sept. 19, 21, '62. Mar. 19, 20, '65. May 5, 6, '04. Mar. 25, 25, '65. April 2, 2, '65. Mar. 25, 25, '6o. Sept. 14, 14, '64. Oct. 9, 10, '64. May 31, 31, '64. Sept. 11, 11, '63. June 11, 11, '01. Nov. 30, De. 1,'64. July 2, 3, '63. Dec. 13, 15, '62. Mar. 20, 20, '65. Nov. 26, 27, '63. Sept. 3, 3, '62. July 1, 1 '63. July 2, 2, 'tis. Sept. 1, 1, '64. Dec. 13, 13, '64. Mar. 19, 19, '65. April 2, 2, '65. S«pt. 30, 30, '64. July 1, 1, '63. Sept, 17. 18, '62. Jan. 30, 30, '63. Sept. 17, 17, '62. Feb. 20, 20, '64. Mar. 16, 16, '65. June I, 1, '64. Mar. 25. 25, '65. July 20, 21, '64. June 20, 21, '63. May 16, 17, '04. Operations, Operators, Result. Left; flap; gangrene. Disch'd July 20, 1865. Right. Disch'd March 14, 1863. Right. Surg. E. Bentley.U.S.V. Disch'd April, 1804. R't; ant. post. llap. Surg. J. Ben- nett, 19th Mich. Dis. Feb.27,'65. R't; ant. post. flap. Surg.J.J.IJ. Lord, 13th N.J. Dis. Oct.19,'63. Left; flap. Disch'd J uly 12, '65. Left: flap. Surg. L. J. Ham, 48th lnd. Disch'd Mar. 23, 1853. Left; bilat. flaps. Surgeon J. F. Reeve, 21st Wis. Disch'd June 15, 1805. Left; ant. post. flap. Surg. G. T. Stevens, 77th N. Y. Disch'd Feb. 23, 1865. Right; ant. post. flap. Surg.W. G. Hunter, 211thPenn. Disch'd Sept. 23, 1865. Spec. 4008. Left; circ. Disch'd Sept. 3, '65. Right; ant. post. flap. Surg. T. F. Oakes, 50th Mass. Recov'd Nov. 2, 1865. Spec. 4000. Right; ant. post. flap. Disch'd Feb. 25, 1865. Left; ant. post. flap. Surg. H. F. Lyster, 5th Mich. Disch d Sept. 29, '65. Died May 3, 1871. Left; flap Surg. J. Pogue, 06th 111. Disch'd June 5, 1865. Right; flap. Surg. S. VV. Gross, U. S. V. Necr'd bone removed. Disch'd June 24,'63. Spec. 4320. Left; flap. Ass't Surg. J. W. Williams, TJ. S. A. Recov'd. Left; circular. Provost Marshal Feb. 24, 1865. Left; flap. Disch'd Dec. 16,'63. Left. Surg. Sly. Furloughed Oct. 31, 1864. Right; double flap. Surg. A. B. Monahan, 63d Ohio. Disch'd Oct. 17, 1865. Left; circ. Prot. bone rem. Feb. 7, '64. Disch'd July 5, 1864. Right. Disch'd March 14, 1863. Left. Confed. Surgeon. Exch'd Sept. 25, 1863. Left, Disch'd Nov. 14, 1864. Right; circular. Disch'd May 18, 1865. Left; circ. Act. Staff Surg. C. B. Richards. U. S. V. Disch'd July 6, 1865. Left; ant. post. flap. Confed. Surgeon. Disch'd June 30, '65. Left; flap. Disch'd July 6, '65. Left; flap. Disch'd Sept. 13, '65. Left. Disch'd Nov. 9, 1863. Right; circ. Furloughed Nov. 2, 1864. ----. Surg. White. Recovered. Right; circ. Surg. J. P. Colgan, 59th N. Y. Sequestr. extract. Disch'd May 4, '63. Spec. 1041. ----. Recovered. Left; circ. Ass't Surg. G. M. Trowbridge, 19th Mich. Dis charged June 30, 1865. Right; ant. post, flap; gangrene. Disch'd March 20, 1865. Left; ant. post. flap. Surg. W. O. McDonald, TJ. S. V, Disch'd July 10, '65. Spec. 4133. Left; ant post. flap. Surg. J. B. Warwick. 91st Ohio. Disch'd Nov. 7, 1865. Left; circ. Surg. C. M. Clark, 33th 111. Disch'd Oct. 33, '63. Right; ant post. flap. Disch'd Dec. 10, 1864. Name, Military Description, and Age. Schad, C. H., PL, M, 1st New York Art., age 19. Scharf, A., Pt., I, 1st N. Jersey Cav., age 30. Scheifely, J., PL, D, 3d Pennsylvania. Scofield, E. D., PL, F, 40th N. York, age 26. Schroeder, F.,Pt,,B, 7th New York, age 21. Schweighauser, S.. PL, 1st Bat'ry Mc. Art'ry. Scott, E., PL, E, 4th Virginia, age 28. Scott, P. H., PL, A, 13th Virginia, age 25. Secor, J., Serg't, E, 142d New York, age 23. Seiferman, B., Pt., B, 26th Illinois. Selbe, S., PL, D, 18th Virginia. Shaffer, F. II., Pt, F, 2d Infantry, age 38. Shafer, S. J., Pt., E, 66th Ohio. Shanley, M.,Pt,B, 164th New York, age 27. Shari,G.,Pt.,L,2dMich. Cavalry, age 22. Shaw. J. S., Serg't, B, 5th Alabama, age 30. Shaw, W. K., PL, A, 5th Connecticut. Shawgo, G..PL, A, 121st Penn., age 21. Shay, L., PL, K, 21st Michigan, age 20. Shearm, M., Lieut., I, 12th N. C, age 25. Shelley, A., PL, H, 52d New York, age 21. Shelley, J. M., Pt., H, 48th Virginia. Sheppard, G., Seaman, Gunboat Prairie. Sheppard, J. M., Capt, K, 21st Conn., age 23. Sherman, E. M., Serg't, C, llth VL, age 18. Sherrill, M. O., Serg't, A, 12th N. C, age 22. Shiffler, J., Pt., G, 55th Penn., age 19. Shindler, G. F., Pt., E, 107th Penn. Shultz, J. L., Pt., H, 5th Penn , age 27. Simms, TV., Pt., A, 1st Virginia Battery. Singleton, G. W., PL, Palmetto S. S., age 22. Sippey, W., Pt., C, 1st Colored Troops. Sisco, F. A., PL, I, 23d Michigan, age 18. Slater, I., PL, D, 75th Illinois. ^Slaughter, W. B., PL, D, 18th Tenn., age 20. Smith, C. S., PL, K, 119th Penn., age 20. Smith, G., Pt., C, 28th Penn., age 27. Smith, H. G., Serg't, A, 33th Illinois, age 24. Smith, J., Pt., D, 6th Penn. Res., age 29. Smith. J. J., Corp'l, H, 5th Pennsylvania. Smith, S. D., Serg't, D, 29th Penn., age 24. Smith, W., Corp'l, B, 1st Georgia S. S., age 22. Primary. May 1, I, r03. April 8, 8, '64. Dec. 13, 15, '62. Sept. 28, 28, '64. May 5, 5, f62. March 8, 8, '62. Oct. 9, 10, '64. Sept. 19, 19, '64. May 1, 1 '63. May 28, 28, '62 June 27, 29. '62. May 1, 1, m June 9, 11, '62. May 18, 18, '64. Nov. 5, 6, '64. Julyl, 2, '63. 3, '63. May! 4, fe April 1, 1, '65. Dec. 17, 17, '64. April 6, 7, '65. May 12, 12, '64. Aug. 9, 9, ?62. April, '63. Primary. May 16, 16, '64. Sept. 19, 19, '64. May 9, 10, '64. Sept, 29, 29, '64. Sept. 17, 19, '62. Mar. 25, 25, '65. May 8, 10, '62. Oct. 7, 7, '64. Feb. 20, 20, '65. Nov. 25, 26, '64. Oct. 9, 9, '62. Sept. 19, 19, '63. May 10, 11, '64. May 8, 8, "64. Oct. 9, 9, '63. June 18, 18, '64. April 11, 11, '63. July 20, 20, '64. ---, '64, Operations, Operators, Result. Right; circ. Ass't Surg. J. S. Billings, U. S. A. Discharged April 15, .'304. Spec. 2361. Left. Surg. W.W.L Phillips, 1st N. J. Cav. Dis. July 20, 1805. Right. Confed. Surgeon. Dis- charged June 22, 1863. Right; ant. post. flap. Snrg. H. ]•'. Lyster, 5th Mich. Disch'd May 18, 1805. Left; double flap. Disch'd July 8, 1863. Spec. 3708, A. M. M. Right. Disch'd August 28,1862. Left; circ. Surg. Thomas. To Prison Feb. 16, 1865. Right; circ. Surg.W. S. Grimes, C. S. A. To Prison Jan. 5,1865. Right; circ. A. Surg. J. S. Bill- ings, U.S.A. Dis. Sept. 9, 1803. Right. Surg. M. K. Taylor, 26th 111. Disch d Oct. 16, 1862. ----. Recovered. Right; flap. Ass't Surg. B. How- ard, U. S. A. Jan. 2d, reamp.; gang Disch'd Sept. 6, 1864. Died Feb. 1, '73. Left; circ. Surg. Tener, C. S. A. Disch'd Dec. 22, 1862. Left. Disch'd August 29, 1865. Left; ant. post, flap. A. Surg. W. F. Green, 2d Mich. Cavalry. Disch'd Sept. 18, 1865. Right; circ. Nee. bone rem. Sept. 14th. Exch'd Deo. 1, 1863. Right; ant. post. flap. Surg. W. C. Bennett, 5th Conn. Disch'd Nov. 16, 18J3. Spec. 1838. Right; circ. Surg.T.A.Ramsey, 121st Penn. Hasm. April 7th, lig. prof. Disch'd June 17, '65. R't; circ. flap. Surg. J.T. Reeve, 21st Wis. Disch'd June 8, '65. Right; flap. Released June 9, 1865. Right; double flap. Discharged Dec. 26, 1864. Right. Recovered. Left. Discharged. Left; circ. Surg. J. H. Lee, 21st Conn. Disch'd Sept. 14, 1864. Right; double flap. Surg. C. B. Park, llth VL Dis. June 28,'65. Right; circ. Surg. Strong. To Prison Oct. 26, 1804. Right; flap. Disch'd June 1, '65. Right. Surg. J. F. Hutchinson, 107th Penn. Dis. Nov. 25, '62. Right; flap. Disch'd July 25, 1805. Right. Surg. Coleman. Recov- ered. Left, To prison April 13, 1865. Right; flap. Surg. H. C. Merry- weather, 5th C. T. Disctfd July 14, 1865. Right; circ; gangrene. Disch'd June 21, 1865. Left; flap. Surg. G. W. Phillips, 75th 111. Disch'd Dec. 5, '62. ----. Removal of six inches of necrosed bone. Recovered. Left; circ. Confed. Surgeon. Disch'd June 16, 1865. R't; circ. Surg. H. E Goodman, 28th Penn. Discharged June 16, 1865. Right; flap. Surg. C. M. Clark, 39th 111. Disch'd June 22, '64. Left; ant. post. flap. Disch'd June 19, 1865. Left; flap. Surg.J.H.Thompson, 139th N.Y. Disch'd May 30,'63. Left; flap. Surg. J. A.Wolf, 29th Penn. Gangrene. Disch'd July 10, 1865. Left. Retired Deo. 7, 1864. 'FisnER (G J.), loc. cit. SURG. 111—30 20'Keefe (D. C), loc. cit., p. 25. 234 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 Name, Military Description, and Age Smock. J. W., Corp'l, F, 19th lnd., age 23. Sneden, R. C, Pt., I, 1st Michigan. Snyder, J.. Pt., I, 3d Missouri Cavalry. Snyder, W. S.. PL, B, 2bth Pennsylvania. Solon, R.. Bugler, H, 1st Mich. Cav., age 19. Spongier, H. D., PL, A, 54th Virginia, age 33. Spcllman, J., PL, E, 9th Massachusetts. Spencer, W. H., Capt., G, 61st New York. Spittler, W., Corp'l, A, ilOth Penn., age 21. Stahlschmidt, E., Serg't, H, 15th New York H. A., age 32. Starr, G.H., Pt.,E, llth Conn., age 40. Stebbins, B. F.. Corp'l, C, 16th Pa.Cav.,age21. Stelzer, C. Pt, K, 37th Ohio. Stevens, C. D., Pt., H, 126th N. York, age 26. Stevens, J. C, PL, A, 13th N. Jersey, age29. lStevenson, H. C, PL, K, Palmetto S. S. Stewart, T., Pt., 1,110th C. Troops, age 22. Stierten, C, Pt., A, 7th New Y'ork- Stiles, J., Pt., B, 1st N. Jersey Cav., age 19. Stoll, J. E„ PL, K, 1st N. J. Cav , age 26. Stroud, £.. It., H, 8th Alabama, age 27. ^Stuart, A. J., Lieut. Iloskin's Miss. Bat'ry, age 25. Sturgis, W. G., PL, B, 75th New York. Sullivan,A.O.L., Corp'l, G, 4th Virginia. Sullivan, J., PL, F, 22d Col'd Troops, age 21. Sullivan, W., PL, 15th New York Independent Battery, ago 22. Sutter, F., It., E, 12th Penn., age 35. Swan, G. ii., PL, B, 21st Conn., age 18. Swayer, H., PL, B, 93d Penn.. age 20. Sweeney, J., PL, I, 24th Mass., age 22. Sweetser, L. C, Lieut., , B, 39th Illinois, age 26. Switzer, D. M., Pt., A, 16th Iowa, age 33. Tanner, L. IL, Corp'l, B, 3d Michigan, age 23. Talbot, A., PL, A, 14th N. Y". H. A., age 22. Talbott, G. B., Pt., D, 38th Indiana, age 24. Terrell, J. M., Pt., B, 9th Virginia. Tcrhune, N. D. F., Pt., Cr, 27th lnd., age 19. Thacker, B.F., Sg't, K, 61st C. Troops, age 21. Theban, T. A., Serg't, H, 4th N. York Art'y, age 25. Thoma, J., Pt., I, 26th New York. Thoma, P., Pt., D, 10th Missouri. Thomas, J., Pt., A, 14th N. Y. H. A., age 20. Thomas, J., Pt., I, 33d Ohio, age 47. Thomas, W., Serg't, B, 99th Penn., age 24. Dates. June 18, 18, '64. June 22, 22, '62. Jan. 11, 13, '63. Sept. 17, 19, '62. June 12, 12, '04. Dec,'64, Primary June 27, 28, '62. June 30, J'y2,'62. July 27, 27, '64. Mar. 31, 31, '65. May 15, 15, '64. Feb. 6, 6, '65. May 19, 19, '63. May 18, 18, '64. Mar. 16, 16, '65. June 27, 27, '62. May 25, 25, '65. Mar. 8, 8, '62. April 30, 30, '64. Mar. 31, A p. 1, '65 July 2, 3, '63. May 19, 19, '64. June 2, 2, '63. May 5, 5, '64. June 16, 18, '64. June 18, 19, '64. Aug. 29, 30, '62. June 25, 25, '04. May 6, 8, '64. Aug. 14, 14, '64. June 2, 2, '64. April 6, 6, '62. May 12, 13, '63. Mar. 2, 2, '65. July 9, 9, '64. Aug. 16, 16, '64. July 3, 4, fe. Aug. 21, 23, '64. June 18, 18, '64. Dec. 13, 14, '62. Sept. 19, 19, '62. Aug. 7, 7, T64. Mar. 19, 20, '65. May 5, 6, '64. Operations, Operators, Result. Left; lat. flap. Surg. J. Eber- sole, 19th Jnd. Sequest. and frag, remov'd. Dis. Nov. 9,'65. Right; flap. Surg. J. W. Tunne- cliffe, 1st Mich. Discharged. Left: flap. Surg. \V. Dickinson, U. S. V. Disch'd July 19, '63. Right; circ. Disch'd Nov. 29, 1862. Left; flap; gangrene. Disch'd Jan. 7, 1865. ----. Paroled Jan. 16, 1865. Left. Disch'd July 13, 1863. Right; flap. Disch'd December 21, 1862. Left. Surg. D. S. Hayes, 110th Penn. Disch'd Jan. 28, 1865. Left; circular. Disch'd July 20, 1865. Left; ant. post. flap. A. Surg. D. Satterlee, llth Conn. Disch'd June 23, 1865. Left; ant. post. flap. Surg. F. LeMoyne, 16th Penn. Cavalry. Disch'd May 31, 18(15. L't; circ. A.Surg.C.B.Richards, 30th Ohio. Disch'd Aug. 24, '63. Right: flap. Surg. G. L. Potter, 145th Penn. Dis June 12, '65. R't; flap. A. Surg. CV.W. Burke, 40th Penn. Disch'd May 28, '65. ----; circ. Surg. J.Mc Y Gaston, C. S. A. Furl'd Sept. 4, '62. Left; flap. A. Surg. H. Bauer, 97th C. T. Disch'd June 28,'65. Right; circ. A. Surg. B. F. Staehly, 7th N. Y. Recovered. Right; circ. Disch'd July 4, '65. Aug. 10, necrosed bone remo'd. Right, Disch'd July 12, 1865. Right. Provost Marshal Sept. 1, 1863. Left. Recovered. Right; flap. Surg. AV. W. Root, 75th N. Y. Discli'd Sept. 2, '63. Left. Surg. S. R. Sayers, C.S.A. Recovered. Left; ant. post. flap. Disch'd Nov. 22, 1864. Left; flap. Surg. G. W. Metcalf, 76th N. Y. Disch'd Jan. 31,'65. Left. Disch'd August 1, 1863. Right; ant. posterior (oval) flap. Disch'd June 11, 18C5. Right; flap. Disch'd Oct. 25, '64. Right; circ. Disch'd Mav 11, 1865. Left. Surg. C. M. Clark. 39th Illinois. Discli'd Nov. 7, 1865. Right. Dr. A. Judkins. Disch'd July 16, 1862. Right; flap. Disch'd Dec. 29, 1864. Left; ant. post. flap. Discli'd Nov. 27, 1865. Left; circ. Surg. L. Slusser, 69th Ohio. Duty Nov. 17, 1864. Left; circ. Surg. 9th Va. Cav. Trans. Aug. 30, 1864. R't; circ. Surg. W. H. Twiford, 27th lnd. Discli'd May 30, '64. Right; flap. Ass't Surg. J. M. Study, U. S. V. Discharged. Left; circ. Surg. H. C. Tomp- kins, 4th N. Y. H. A. Discli'd Mav 31, 1865. Left; flap. Disch'd Mar. 14, '63. Left; flap. Disch'd April 8, '63. Right; flap. Surg. G. W. Snow, 35th Mass. Disch'd Feb. 27, '65. Left; flap. Disch'd June24,'65. Died Sept. 1, 1866. Left; flap. Disch'd Jan. 17, '65. NO Name, Military Description, and Age. Thomson, H. H., Lieut., K,Palmetto S.S.,age22. Thorpe, R., PL, B, 10th Missouri. Todd, J., PL, M, 6th Alabama, age 35. Treadwell, D., Serg't, F, 33d Mississippi, age 29. Tracy, C. H., Serg't, A, 37th Mass., age 32. Troyden, S. W., Serg't, M, 22d N. Carolina. True, R. M., Pt., B, 2d New Hampshire. Tryon, M. M..PL, I, 14th N. Y. H. A., age 26. Tuck, W. H., PL, E, 38th Mass., age 29. Tunney, P., Pt., E, 24th Mich., age 23. Tupper, F. W., Adj'tlst Alabama Cav., age 25. Turner, W. H., It., G, 26th N. C, age 35. Updyke, C, It., B, 2d N. Y. H. A., age 39. Vanalstine, G. P., Serg't, E, 7thN.Y.Art.,age34. Van Blarcom, L., Capt., C, 15th N. J., age 29. Van Houten, S. C, Pt., E, 4th New York H.A., age 32. Viles, W. S., Pt., D, 74th New York. Wade, D. F., Corp'l, D, 66th Indiana. Wadsworth, C.P.,Corp'l, B, 16th Maine, age 25. Wadsworth, D. G., Pt., C, 198th Penn., age 23. Wagner, C, Corp'l, G, 9th N. Y. Cav., age 20. Walker, G. IF., PL, G, 8th La., age 36. Walker, J. A., Pt., C, 3d Arkansas. Walsh, J., Pt., H, 1st Mich. S. S., age 30. Walter, D. P., Pt., C, 33d N. C. age 19. Warrell, W., PL. H, 60th Illinois, age 17. Waters, J. A., Serg't, C, 15th N. C, age 24. Weakly. R., Lieut., G, 42d Tennessee. Wearing, J., Serg't, A, 2d Penn. H. A., age 20. Weathr.rby.J.M, Pt., I, 13th Miss., age 20. Weber, A., Corp'l, 1,7th Louisiana. Weckwith, E., TL, K, 3d Maryland, age 39. Weeks, N., PL, B, 10th N. Y. Art'y, age 26. Weeman, W. H. IL, Pt., 1st Me. Bat'ry, age 28. Welch, T, PL, B, 9th A labama, age 24. Wells, F., Pt., 1, 99th Penn., age 32. Wenhoner, W., PL, II, lathN. Y. II. A.,nge 22. West, 15. F., PL, A, 59th Ohio. Whaley, E. A., Capt., C, 6th Wisconsin, age 28. Whitcomb, J., Pt., K, llth Maine, age 26. White, W. M., Pt., D, 111th N. Y., age 24. Whitehead, J. M., Pt., II, 15th Alabama. Weir, T. P., Pt., B, 5th Georgia. Dates. Sept. 16, 16, '62. Sept. 19, 19, '62. Julv 1, 2, '63. Dec. 15, 16, '64. April 2, 2, '65. July 1, 2, '63. June 25, 25, '62. June 1, 2, '64. Sept. 19, 20, '64. July 2, 3, '63. Dec. 9, 9, '64. July 1, 2, '63. June 7, 7, '64. June 3, 4, '04. May 8, 9, *64. Aug. 25, 27, '64. July 23, 23,"'63. Aug. 33, 31, '62. June 21, 21, '64. Mar. 29, 29, '65. Mar. 31, Ap.1,'65. May 9, 10, '64. July 2, 2, '63. June 17, 17, '64. May 3, 4, '63. Sept. 1, 2, '64. April 2, 2, '65. Jnne 2, 2, '64. June 17, 19, '64. Dec. 11, 11, '62. June 14, 15, '63. Sept. 17, 19, '63. April 2, 2, '65. Oct. 19, 19, '64. May 3, 3, '63. Oct. 27, 28, '64. Mar. 31, 31, '65. Dec. 31, 31, '62. April 1, 1, '65. May 31, Je. 2, '62. July 2, 3, fGZ. July 25, 25, '62. Sept. 19, 19, '63. Operations, operator.* Result. Left. Exchanged Nov. 21, '62. L't; flap. Surg. J. G. F. Holston, I TJ. S. V. Disch'd April 4, 1863. Right. Surg. Hays, C. S. A. Paroled Sept. 25, 1863. Right; ant, post. flap. A. A. Surgeon S. C. Avers.- Provost Marshal March 27, 1865. Right; flap. Surg. E. M. White. 37th Mass. Recovered. Right, Surg. McAden, C. S. A. Paroled Oct. 22, 1863. Left. Discli'd April 1, 1863. Left; circ; gangrene. Discli'd Oct. 12, 1865. Left; flap. Surg. W. A. Barry, 98th Penn. Discli'd July 26,'65. Right; ant. post, flap. Disch'd Dec. 20, 1863. Right; circ. Surg. F. M. Rose, 43d Ohio. Duty Mar. 22, 1865. Left. Exchanged Nov. 12, '63. Right; circ. Surg. J. C. Howe, 2d N. Y. II. A. Dis. Nov. 7, '65. Right; circ. Surg. G. L. Potter, 145th Penn. Dis. Mar. 4, 1865. Left; flap. Confed. Surgeon. Disch'd Dec. 19, 1864. Right; circ. Surg. Hunt, C.S.A. Rem. of seques. July 13, 1865. Disch'd Oct. 14, '65. Spec. 1429. Left; flap. A. Snrg. J. T. Cal- houn,U.S.A. Dis'd Dec. 31,'63. Right; circ. Surg. D.W.Voyles, 66th lnd. Disch'd Nov. 18, '62. Right; ant. post, flap. Surg. C. Alexander, 16th Me. Discli'd June 9, 1865. R't; ant. post. flap. Surg. T. M. Flandreau, 146th N. Y. Disch'd Feb. 21, 1866. Right; ant. post. flap. Disch'd July 24, 1865. Right; circ. To prison Oct. 5, 1864. ----. Surg. Brown. Recovered. Right; flap. Surg. A. F. Whe- lan, 1st Mich. S. S. Disch'd Oct. 24, 1864. Left; circ. A. Surg. J. A. Vigel, 33d N. C. Gangrene. Recov'd. Left; flap. Surg. "W. M. Gray, 60th 111. Disch'd July 31, '65. Right; ant. post, skin flap. Surg. H. Churchill, 8th N. Y. II. A. Released June 14,1865. ----. Surg. McMillan, C- S. A. Recovered. Left; circ. Jan. 6, 1865, resec. of extr. of femur. Disch'd July 26,1865. Spec. 4196. Right. Furloughed Feb. 17, '63. Left. Surg. Davis. Recovered. Right; circ. Disch'd June 2, '65. Died, lung disease, Jan. 5,1875. Right; flap. Confed. Surgeon. Discli'd Oct. 21, '65. Spec. 574. Left; circ. Surg. C. H. Andrus, 176th N. Y. Disch'd Aug. 2,'65. Left. Disch'd Jan. 20, 1865. Right; circ. Confed. Surgeon. Disch'd Sept. 9, 1865. Left; ant. post. flap. Disch'd July 27, 1865. Right; flap. Disch'd April 5, '63. Right. Mustered out August 4, 1865. Left. Disch'd Sept, 12, 1862. .TunelS, '65, reamp. upper third by Dr. J. Benson. Left; ant. post. flap. Surg. A. Satterthwaite, 12th N. Jersey. Disch'd Nov. 3, '64. Spec. 1417. Left. Surg. Boatwright. Re- covered. Left. Surg. Griggs. Recovered. Ym;;;i (3. II.), loc. c.'t., page24. 20'Kf.f.FE (D. C), loc. cit, p. 30. SECT. HI.) PRIMARY AMPUTATION OF THIQH IN MIDDLE THIRD. 235 No. 664 665 666 670 671 672 673 674 675 676 677 678 679 683 681 684 685 686 Name. Military Description, and age. Operations, Operators, Result. 691 692 693 694 695 696 697 698 699 700 701 702 703 Wight, G. L., TL, K, 24th Mich., age 21. Wilbur, J., Serg't, D, 17th Penn., nge 4'J. Wiley, G. O., It., B, 34th" Mass., age 20. Wilkinson, G. 1)., PL, K, 147th N. Y.. age 35. Wilkinson, S. C, Pt., A, 9th Tennessee, ago 21. Williams, B. P., Serg't, K, 40th Ohio, age 23. Williams, E., Coal Hea- ver, U. S. S. Tristam Shandy, age 33. Williams, It.. PL, H, 6th Cold Troops, ago 22. Williams, R., it., A, 14th Georgia. Wills, II., Lieut., G, 173d New York. Wills, J. M., Pt., I, 21st New Jersey, age 15. Wilson, A., PL, G, 48th Col'd Troops, age 20. Wilson, A. L., Serg't, K, 84th Indiana, age 23. Wilson, E. J., Pt., B, 21st N. Y. Cav., age33. Wilson, H. T., PL, G, 10th West Va., age 40. Wilson, L., Corp'l, E, 17th N. Y.. age 25. Wine, J., Pt., C, 9th In- diaua Cav., age 44. Winkler, J., Pt., D, 77th New York, age 33. Winston. D. S., Pt., F, 117th N. York, age 23. Wion, J. W., PL, F, 3d Wisconsin. Wood, E. R., Pt., B, 18th Connecticut, age 30. Wood. J. E.. PL, C, Nel- son's Battery, age 21. Wright, H. J., Pt., C, 2d Michigan, age 21. Young, J., PL, I, 120th New York, age 18. Abbott, J., Serg't, A, 31st Iowa. Adams, H. L., Pt., E, 18th Penn. Cavalry. Adams, J., PL, I, 12th New Jersey. Aherns, D., Pt., B, 31st Maine, age 20. Aikin, H. H., Capt., D, 23th Colored Troops. Akam, R. J., PL, 1,145th Pennsylvania. Alpen, R., Pt., F, 23th Massachusetts. Ambler, W. H., Pt., G, 2d Vermont, age 21. Amstend, G., Serg't, B, 73d Pennsvlvania. Anderson. S. W., PL, K, 37th Mississippi. Ankany, L., PL, D, 33th Ohio, age 23. Arnold, J., PL, K, 3d Vermont, age 15. Askenette, P.. PL, H, 12th Wisconsin. Ataway, S., Pt., G, 1st S. Carolina, age 16. Atwell,O.M.,lt.,I,26th New York, age 21. Barber, A. J., Lieut., llth Infantry, age 30. Baguley, S., Pt., B, 5th N. Hampshire, age 21. June 22, 2, '04. Aug. 29, 29, '64. Sept. 19, 20, '64. June 18, 18, '04. Nov. 33, De. 1,'64. June 20, 20, '64. Jan. 15, 15, '65. Sept. 28, 28, '64. May 12, 12, '04. June 14, 14, '63. Mav 3, 3, '63. April 1, 3, '65. Dec. 16, 16, '64. Julv 6, 6, '64. Sept. 19, 19, '64. Sept. 1, 2, '64. Dec. 17, 17, '64. Oct. 19, 19, '64. Sept, 29, 29, '64. Aug. 9, 11/62. June 18, 18, '64. Sept. 19, 19, '64. June 17, 18, '64. May 5, 6, '64. Aug. 31, 31, '64. Oct. 19, 19, '64. Mav 12, 12," '64. April 2, 4, '65. Julv 30, Au. 1,'64 Julv 3, 3, ''63. June 1, 1, '64. May 18, 18, '64. May 2, 2, fe. July 20, 23, '64. Oct. 19, 20, '64. June 3, 3, '64. July 21, 21, '64. July 3, 3, '63. Dec. 13, 14, '62. July 2, 4, m April 7, 8, '65. Left; ant. post. flup. Surg. J. II. Beach, 24th Mich. Discli'd July 13, 1805. Left ; flap. Disch'd June 9, '65. Spec. 1514. Right. Disch'd March 8, 1865. Left; double lat. flap. Surg. G. W. New, 7th lnd. Disch'd Sept. 14, 1864. Right; circular. Provost Marshal March 5, 1865. Left; flap. Surg. J. N. Beach, 40th Ohio. Haem.; fem. ligated. Disch'd May 29, 1865. Right. Disch'd June 15, 1865. Left; flap. Discli'd Slay 16, '65. ----'. Surgeon Henderson. Re- covered. Right. Snrg.A.H.VanNorstrand, 4th Wis. Resigned Aug. 17,'63. Left. Disch'd Aug. 20, 1863. • Left; ant. post, skin flap; circ. sect, of muse,. Surg. A. P. Bart- lett, 33d Mo. Dis. July 22, '65. Left; circ. Surg. C. J. Walton, 2lst Ky. Disch'd June 10, '65. Right; circ. Surg. J. Boone, 1st Md. P. II. B. Dis. Dec. 6, '64. Left; lateral flap. Surg. 1st W. Va. Disch'd Jan. 17, 1805. Right; circ. Disch'd June 9, '65. Left; ant. post. flap. A. Surg. J. R. Culbertson, 10th lnd. Cav. Disch'd May 15, 1865. Loft; double flap. Surg. G. T. Stevens, 77th N. York. Disch'd Aug. 11, 1865. Spec. 3513. Right; flap. Confed. Surg. Mar. 10,'65, seq. remov'd. Sept. 26th, reamp, A. Surg. J. H. Armsby, U. S. V. Spec. 3226. Right. Disch'd Dec. 26, 1862. Right. Surg. L. Holbrook, 18th Conn. July 29th, flap reamp.; up. third. Disch'd May 4, '65. Left. Surg.G.W.Simple.C.S.A. Provost Marshal April 1,1865. Right; flap. Surg. S. S. French, 20th Mich. Disch'd Oct. 19, '65. Left; ant. post. flap. Surg. E. L. Welling, llth N. J. Feb. 7, '65, seq. rem. Dis. Sept. 5, '65. Left. Died September 14, 1864. Right; oval; sloughing. Died Nov. 16, 1864; pyaemia. ----; circ. Surg. J. W. Wishart, 140th Penn. Died Dec. 23, '64. Right. Surg. W. O. McDonald, U. S. V. Died April 11, 1865; pyaemia. Spec. 4169. Left; circ. Surg. D. Mackay, 29th C. T. Died August 2, 1864. Died July 24, 1863. Left. Died June 14,1864; haem- orrhage. Right; anterior post. flap. Died June 9, 1864 ; exhaustion. Left. Died May 15, '63; anaemia. Left; circ. Died August 16, '64. Right; circ. Died Nov. 27, '64; pyaemia. Right. Died June 23, 1854. Left. Surg. H. MeKennan, 17th Wis. Died July 23, 1864. Right; slongh'g, bone protrud'g Died Aug. 10, '63; diarrhoea. Left; flap. Jan. 5, 1863, haem Died Jan. 9, 1863. Left. Died July 28, '63; pyaemia. R't; circ. Surg.W. O'Meagher, 69th N. Y. June 3d, amp. left thigh. Died July 10,1865; ex haustion. Spec. 4332. Name, Military Dkscription, and Age. Baker, E. S., Corp'l, G, 1st Maine Cav., nge 26. Ball, C. E., PL, F, 53d Mass., age 20. Banks, S.. It., C, 43d Colored Troops. Barron, J., Pt., C, 6th Illinois Cav., age 42. Beils, W. H., Pt., D, 14th New Jersey. Berry, J. R., Corp'l, E, 41st Illinois. Bentley, E., Lieut., 14th Now York Artillery. Berry, J., Corp'l, F, 10th West Virginia, age 20. Bidwell, I). M., Serg't, 20th Mich., age 21. Bigham, J., PL, H, 17th Indiana. Billings, S., Serg't, C, 19th Maine. Dills, W. J., Pt., G, 32d Tennessee, age 35. Binson, J., Pt., G, 23th North Carolina. Bixler, G. W., Pt., H, 82d Penn., age 33. Blystonc, W., Pt., G, 63d Pennsylvania. Bone, J., It., E, 147th New York. Bouton, J. IL, PL, H, 4th Cl'd Troops, age25. Bowlby, P., PL, H, 27th 111., age 25. Boyle, J. E., Corp'l, E, 81st New York, age 19. Bradley, J., PL, D, 164th New York, age 37. Brannon, T. D., Serg't, F, 115th Illinois. Brestler, J.W.,Corp'l,A, 26th Ohio, age 24. Brewer, W. L., Serg't, K, 51st Georgia. Brittaln, F. M., Pt., I, 66th Ohio, age 21. Brown, A., Pt., D, 60th New York, age 25. Brown. J. IF, Capt., I, 47th N. C, age 36. Brough, J. R., Capt., F, 27th Mississippi. Brown, \V. C, Serg't, G, 51st N. Y., age 21. Brown, W., Pt., A, 14th New Jersey. Bruce, A., Pt., H, 91st Ohio, age 20. Buckingham, M., Color Serg't, C, 104th N. Y. Burneson, W., Pt., D, 147th Penn., age 21. Burns, M., Pt., C, 140th N. Y.. age 20. Burson, J. J., Pt., D, 85th Indiana. Burt, J. T, PL, D, Sy- mon's Ga. Res., age 18. Butler, S., PL, C, 3d New Jersey. Butler, W., PL, H, 98th Illinois. Campbell, H., Camp fol- lower, age 23. Campburn, J., Pt., F, 51st Penn., age 23. 1 Cantrell, F. M., Pt., —, 1st S. Carolina, age 30. Carabine, D. W., Pt., G, Myrick's Miss. Battal- ion, age 21. April 9, 9, '05. June 14, 14, '63. July 30, 30, '64. Mar. 31, Ap. 1, '04 June 1, 1, '64. July 12, 12, '63. June 2. 2, '64. Sept. 19, 20, '64. June 3, 3, '64. June 25, 20, '63. July 1, 1, '63. May 13, 13, '64. May 5, 5, %4. April 6, 7, '65. June 18, 18, '64. June 18, 18, '64. Sept. 29, 23, '64. Nov. 25, 2o, '03. June 2, 2, '64. June 3, 3, '64. May 14, 14, '64. June 27, 27, '64. Julv 1, 1, '63. June 15, 15, '64. June 27, 27, '64. Aug. 25, 25, '64. Aug. 31, 31, '64. May 11, 11, '64. July 9, 11, ''64. July 23, 23, '64. July 1, 1, '63. June 16, 17, '64. July 2, 4, '63. July 23, 20, '64. Dec. 13, 14, '64. June 27, 28, '62. June 23, 21, '64. Mar. —, —, '63. Oct. 27, 27, '64. Sept. 17, 18, '62. Dec. 16, 16, '64. Operations, operators, Result. Left; sloughing; femoral; haem.; ant. post, skin flap; circ. sect, cf muscles ; up. third. Died July 18, 1865. Right; haem.; ligation femoral. Died June 29, 1863. Right; amp. left leg. Surg. D. Mackay, 29th C. T. Died July 31, 1864. Right; lat. flap. A. A. Surg. S. S. Jessup. Died April 2, 1864; exhaustion. Left. Died June 6, 1864. Right. Died November 12, '63. Right, Died June 4, 1864. Left; circ. Oct. 25, pysera. chills. Died Nov. 14, '64 ; typh. fever. Right. Died July 13, 1864. Right; flap. Died July 21, '63; pyaemia. Left, Died July 1, 1863. Right; circ. A. Surg. W. F. Smith, 28th Penn. Gang. Aug. 14tb, lig. fem. Died Sept. 23. '64; acute diarrhoea. Right; circ. Surg. J. W. Wishart, 140th Penn. Died. Left; lateral flap; haemorrhage. Died April 15, 1865. Died June 25. 1864. Died June 18, 1864. Left; flap. Oct. 3d, haemorrhage. Died Oct, 3, 1864 ; shock. Right, Dec.5th,gingrene. Died December 25, 1863 Left. Died June 19, '64 ; pyaemia. Left; circ. Diarrhoea. Died Aug. 20, 1864. ----. Surg. G. H. Bane, 115th 111. Died May 21, 1864. Right. Died July 3, 1864. Right. Died August 10, 1863; exhaustion. Left; ant. post. flap. Surg. W. R. Longshore, 147th Penn. Died Nov. 20, '64; chronic diarrhoea. Left; circ. Surg. H. B. Whiton, 60th N. Y. Died Sept. 21, '64 ; diarrhoea. Right; circ. Died Oct, 5, 1864. Left. Surg. A. C. Messenger, 57th Ohio. Died Sept. 1, 1864. Right; flap. Ass't Surg. A. G. Sprague, 7th R. I. May 21st, ha:m.; lig. Died July 11,1864. Right; circ. A. A. Surg. G. M. Paullin. Died July 12, 1864; exhaustion. Spec. 3857. Left; ant. post, flap. Died Aug. 14, 1864; diarrhoea. Right. Died July 5, 1863. Left; ant. post. flap. Died July 19, 1864; exhaustion. Left. Died August 4, 1863. Left. Died August 20, 1864. Right, Surgeon E. Hutchinson, 137th New York. Died March 2, 1835; pyaemia. Autopsy. Right; circ. Died July 23,1862. Died June 22, 1864. Left. A. A. Surg. G.W.Avery, Osteo-myelitis; seq. removed. Oct. 22,"'66, amputa. hip joint. Died Oct. 22, 1853. Right; bi-lateral flap; diarrhoea. Died Nov. 23, '04 ; exhaustion. Right: flap. Died Sept. 25, '62; pyaemia. Right; circ. A.A. Surg. A.Rolls. Died Dec. 22, '64; irrita. fever. •Fisher (G. J.), Cases of Amputations, in Am. Jour. Med. Sci., 1863, Vol. 45, p. 47. 236 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 Cardeman, W., Pt., A, 203d Penn., age 24. Carpenter, L. B., PL, H, 90th N. York, age 25. Carver, E., Corp'l, H, 7th Wisconsin. Case, C. F., Adj't, 36th Illinois, age 27. Casey, T. J., Lieut., E, 16th Mississippi, age 36. Chamberlain, G.., It., D, 8th Michigan. Chapman, W., Pt., G, 21st Ohio. Chase, A., —, I, 4th N. Hampshire, age 35. Cherry, S., Pt., A, 34th Illinois. Chestnut, J., PL, A, 80th Indiana, age 22. Childs, G. W., PL, D, 56th Mass., age 27. Clark, J., It., II, 7th N. York H. A., age 24. Clapp, E., PL, H, 7th Conn., age 47. Clapper, F., Serg't, I, 2d N. York Vet. Cav. Clough, J., It., B, 109th Illinois. Coffin, F., Pt., B, 19th Maine. Coggins, D. M., Pt., I, 13th South Carolina. Colby, J. S., Corp'l, I, 27th Michigan. Cole, A. E., Pt., G, 142d New York, age 17. Cole, S. R., Pt., K, 9th N. Y. H. A., age 48. Collier, H., PL, I, 12th Penn. Cavalry, age 20. Conklin, C, PL, I., 6th Wisconsin. Connell, J., Pt., F, 146th New York, age 21. Cook, C. C, Lieut., C, 77th Pennsylvania. Cook, F. S., Serg't, I, 53d Virginia. Coon, H., jr., Corp'l, H, 149th New York. Courtnay, J. C, PL, H, 30th Illinois, age 18. Courtney, C, PL, F, 89th New York, age 20. Cox, G., PL, K, 1st N. Carolina, age 27. Cox, J., Pt., C, 9th New York Heavy Artillery. Cox, W. F., Pt., D, 91st Indiana. Coyle, J., PL, D, 15th New York Cavalry. Cramer, D., PL, E, l*49th Penn., age 25. Crawford, VV., Pt., B, 2d Penn. Reserves, age40. Crawford, W. S., Pt., D, 18th Ohio, age 23. Crosby, A., Serg't, C, 19th Maine. Cross, W. H., Pt., G, 61st New York. Crowthers, J., Serg't, E, 81st New York, age 26. Crowley, J., Corp'l, A, 7th New York, age 25. Cruger, P. C, Serg't, A, 6th New York Heavy Artillery, age 20. Crumpton, F. A., Pt., I, 4th Indiana Cavalry. Dates. Operations, Operators, Result. Jan. 15, 15, '65. Oct. 19, 20, '64. May 5, 6, r64. Nov. 30, Dec. 1,'64 Aug. 21, -f'64. May 12, 12, '64. Sept. 1, 1, '64. July 30, 30, '64. Aug. 6, 6, ?64. May 14, 14, '64' May 24, 24, '64. June 16, 17, '64. June 2, 2, '64. April 23, 23, '64. Oct. 20, 20, '62. July 3, 3, '63. ---, May 22, '64. May 19, 19, '64. Jan. 15 15, '65. April 2, 2, '65. Dec. 16, 17, '64. April 29, 30, '63. Mar. 31, 31, '65. June —, —, '64. May 10, 12, '64. Nov. 24, 24, '63. July 22, 22, '64. Sept. 17, 19, '62. June 9, 9, '64. Oct. 19, 19, '64. Aug. 6, 6, ?64. Mar. 31, 31, '65. May 8, 8, '64. May 12, 12, '64. Dec. 15, 16, '64. July 1, 2, '63. July 2, 2, '63. May 16, 18, '64. April 2, 2, '65. Oct 19, 21, '64. Jan. 17, 18, '64. Left: circ. A. Surg. H. C. Mer- riweather. 5th C. T. Died Jan. 29, 1865; pyaemia. Right, Ass't Surg. J.Homans, jr., TJ. S. A. Haem. from wound in arm; lig. Died Nov. 14, 1864. Right: ant. post. flap. Died June 16, 1864; exhaustion. Right; circ. A. A. Surg. J. II. Green. Died Dec. 18,'64: pyaem. Left. Died October 16. 1864. Left. Surgs. A. F. Whelan, 1st Mich. S. S., and W.C. Shurlock, 51st Penn. Died May, 1864. ----; by Surg. G. W. Bea«h, 141st N. York. Died Sept. 11, 1864. Right; circ. Surg .G.P.Greeley, 4th N. H. Died Aug. 23,1864 ; exhaustion. Left. Died August 25,1864. Right. Died July 16, 1864. Right; diarrhoea. Died June 11, 1854; asthenia. Right; circ. Surg. P. E. Hubon, 28th Mass. June 27, haBm.; lig. profunda. Died Oct. 9, '64; ex- haustion. Right. Died June 10, 1864. Right. Died April 23, 1864. Left. Died November 10,1862. Died July 9, 1863. Right. Died May 22, 1864. Right; ant. post. flap. Died June 21, 1864; exhaustion. Right; circ. Surg. J.W. Mitchell, 4th C.T. Died Feb. 4,'65; exh'n. Right. Died April 16, 1865. Right; circ. A. Surg. J. A.Free- man, U. S. V. Died Dec. 27,'64; exh. and pneumonia. Spec.375'J. Right. Surg. J. Ebersole, 10th lnd. Died May 9,'63. Spec. 1120. Left; ant. post. flap. Surg. T. M. Flandrau, 146th N. Y.; gang. Died May 27.'65;phleb.andexh. Left. Died October 6, 1864. ----; ant. post. flap. Surg. C.B. Gibson.C.S.A. Died May 14,'64. Died November 25, 1863. Right. Surg.H. McKennan, 17th Wis. Died Aug. 12, 1864. Left, Died Sept, 26,'62; tetanus. Right; circ. Ass't Surg. B. How- ard. U. S. A. Died June 24, '64. Spec. 1233. Left. Died October, 1864. Right; Surg. C. D., Moore, 13th Ky. Died Sept. 2, 1864. Left. Died May 24,1865. Left. Died June 3, '64; pyaemia. Right. Surg. C. Bower, 6th Penn. Res. Died July 27, '64; chron. diarrhoea. Autopsy. Photo. Ser. 164. Spec. 2890. Left: lat. flap. A. A. Surg. J. E. Link. Died Dec. 29, 1864. Left. Died July 12, 1863. Right. Died July 13, 1863. Right; circ. Died June 8,1864; pyaemia. Right; circ. Surg. J. C. How, 2d N. Y. Artillery. Died May 7, '65; pyse. Autop. Spec. 1487. Left; lat. skin.flap; circ. section muscles. Surg. C. H. Andrus, 176th N. Y. Died Oct. 27, '64; pysemia. Left; circ. Died Jan. 30, 1864. No. 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806? 8073 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 Name, Military Description, and Age. Culliden, D., Pt., I, 83d Pennsylvania. Culver, H., Pt.. E, 2d U. S. S. S., age 30. Cumber, J. G, Pt., I, 38th Ala., age 30. Cummings, I. S., Pt., F, 100th Ohio, age 20. Curry, J. H., Serg't, D, 116th Penn., age 23. Curtin, F., PL, A, 28th Mass., age 26. Curtis, R., Lieut., D, 3d New Jersey. Dafrimont, L., Pt., G, 17th Alabama. Dail, J. H., PL, K, 79th Ohio. Dangler, D. F., Pt,, E, 55th Penn., age 20. Davis, G., Pt., B, 2d Artillery. Davis, W. H., Pt., A, 38th N. C, age 21. Davidson. R. C., Serg't, C, 35th Mass. Dawson, G. S., Capt., F, 2d N. Y. H. A., age 26. Delaney, D., Pt., B, 1st Md. Cav., age 29. Dermerhorn, G. B , S'gt, A, 119th Penn. Devon, J., Pt., F, 26th Pennsylvania. Dillon, N., Corp'l, K, 80th HI., age 21. Dinley, J., Pt., E, 73d Ohio. Dolan, J., Pt., I, 74th Ohio, age 26. Doud, T., Serg't, C, 2d Michigan. Dougal, F. L., Pt,, H, 15th Connecticut. Downey, J., Corp'l, B, 2d Iowa Cav., age 21. Dwyer, W., Pt., E, 27th Mass., age 19. Eaton, G. W., Teamster, H, 17th Mass., age 36. Eckhart, G. W., Corp'l, B, 49th Pennsylvania. Eddy, G., Pt., E, 7th Wisconsin, age 24. Elder, M., Lieut., llth Infantry, age 28. Enos, E., PL, H, 10th Penn. Res., age 28. Evarts, E., Serg't, C, 8thN.Y.H. A., age26. Fakee, N., Pt., C, 6th N. Y. H. A. Farrer, J. W., PL, E, 8th 111. Cav., age 27. Ferguson, C. F., Serg't, I, 1st Mass., age 25. Ferguson, D., Pt., G, 125th Ohio. Ferguson, J., Pt., K, 51st Pennsylvania. Fillingim, A., Pt., E, 37th Miss., age 23. Fisher, D., Pt., K, 102d New York. Fisher, S., Corp'l, C, 90th Penn., age 27. Flamburg, M., Pt., G, 52d New York. Flynn, J. F., Pt., E, 1st Maine Cav., age 26. Ford, W., Pt., B, 7th Louisiana, age 23. Frank, E. H., Lieut., A, 26th Iowa. Franklin, G. W., Pt., K, 50th Georgia. Dates. May 5, 6, '64. June 18, 19, '64. May 15, 15, '64. Aug. 6, 6, '64. May 5, 5, '64. June 3, 3, '64. May 6, 6, '64. July 28, 29, '64. Mar. 19, 19, '65. June 18, 18, '64. Oct, 6, 6, '64. June 23, 23, '64. July 30, 39, '64. June 16, 17, '64. Dec. 2, 4, '64. June 1, 1, '64. July 2, 2, r63. Dec. 15, 15, '64. Oct. 29, 29, '63. SepL 1, 2, ^64. July 30, 30, '64. April 24, 25, '63. April 1, 1, '65. April —, —, '63. May 17, 17, '64. Sept. 19, 19, '64. Aug. 30, 30, '62. July 2, 4, '63. May 10, 10, '64. Oct. 27, 28, '64. May 19, 19, '64. June 9, 9, '63. July 2, 2, '63. June 23, 23, '64. Deo. 13, 13, '62. Dec. 16, 16, '64. July 20, 20, '64. Mav 9, 10, ''64.' Oct. —, —, '64. April 6, 6, '65. July 1, 1, '63. Aug. 12, 12, '64. July -, —,'63. Operations, Operators, Result. Left; ant. post, flap; bed-sores. Died June 16, '64; exhaustion. Left; circ. Dec. 17, reamp. Died Jan. 10, '65; gangrene. Right; circ. Surg. H. E. Good- man, U. S. V. Died July 14, 1864; exhaustion. Right. Surg. A. M. Wilder, TJ. S. V. Died Sept. 5, '64; typhoid fever. Right. Surg. W. O. Meagher, 69th N. Y. Died May 30,1864. Left; circ. Surg. P. E. Hubon, 28th Mass. Diarrhoea; haem. Died July 1, 1864. Died May 19, 1864. Right. Died Aug. 31, 1864. Right. Died March 29, 1865. Right. Died July 20, 1864; ex- haustion. Died October 17, 1864; pyaemia. Right; circ. Surg. J. W. Wis- hart, 140th Penn. Died August 16, 1864. Left; circ. Surg. G. W. Snow, 35th Mass. Died Aug. 19, 1864. Left. Dr. A. Garcelon. Necro. Died Dec. 6, '64. Sp. 1427,2828. Left; ant. post, flap; circ. sect, of muscles. Surg. J. B. Lewis, U. S. V. Died Jan. 5, '65; pyiemia. Autopsy. Left. Died June 9, 1864. Left. Died July 10, 1863. Right; circ. A. Surg. R. J. Hill, 45th 111. Died Dec. 17,'64; haem. Died November 14, 1863. Right; circ; nee. femur; prot. remov'd; gang. Died Nov. 21, 1864; exhaustion. Both. Surg. W. B. Fox, 8th Mich. Died July 31, 1864. Right, Died April25,'63; shock. Right ant. posterior flap. Died April 26, 1865; pyaemia. Left; congestive chill. Died April 27, 1863. R't; circ. A. Surg. J. M. Palmer, 80th N.Y. Died May 18, '64. Right; circ. Surg. P. Leidy, 119th Penn. Died Oct. 6, 1864; peritonitis. Right. Sept. 8, 13, haem.; lig. of femoral. Died Sept, 13, 1862; exhaustion. Left. July 20, pyaemiadev. Died July 25, '63; pyaemia. R't, Surg. B. Rohrer, 10th Penn. Res. Died May 19,'64. Sp.2442. Right. Nov. 14, sym. of pyaemia. Died Nov. 18, 1864. Right; flap. Died Oct, 2, 1864; typhoid pneumonia. Left. Surg. A. Hard, 8th 111. Cav. Died June 18,'63. Auto. Sp. 1224. Left. July 8, haem. Died Sept. 11, 1863. Left. Surg. T. L. Magee, 51st 111. Died June 26, 1864. Right. Died Deo. 14, 1862. Right; circ. Ass't Surg. W. B. Trull, U. S. V. Died Dec. 25, 1864; irritative fever. Right. Died August 30, 1864. Right; circ. Died May 30, 1864 ; pyaemia. ----. Surg. J. E. Pomfret, 7th N. Y. H. A. Died Oct. 17, 1864. Right; circ. Died June 2,1865; exhaustion. Autopsy. Left; slough'g; (also w'nd right thigh.) Died Aug. 23,'63; haem. Right. Surg. A. T. Hudson, 26th Iowa. Died Aug. 14, 1864. Left, Died August 10, 1863. SECT.ni.] PRIMARY AMPUTATION OF THIQH IN MIDDLE THIRD. 237 Name, Military Description, and Age. Free, A., Pt., K, 26th Pennsylvania. Frost, A., PL, A, 187th Penn , ago 19. Funt, J , PL, H, 75th Illinois. Gaddie, S. W., Pt., K, 5th Kentucky. Gallagher, P.. PL, B, l.r)7th Pennsylvania. Gardner, J., PL, D, 15th New York, age 28. Gardner, J., PL, K, 27th Indiana. Guy, J., It., A, 35th Massachusetts, age 36. Geiser, B., PL, G, 32d Indiana. Getehell, G. O., Capt., E, 3d Maine, age 28. Getehell, H. D., PL, C, loth Mass.. age 19. Gersinger, J. H., PL, H, 1st North Carolina. Gibbs, L., PL, G, 5th Mich. Cav., age 33. Gilbert, J. H., Serg't, K, 2d N. Y. Cav., age 34. Gilbert, P., PL, D, 83d Pennsylvania. Gilmore. J.A.,Maj., 48th Penu., age 3J. Gleason, C. A., Corp'l, L. 3d Mass. Cavalry- Godfrey, W. M., Pt., F, 7th Iowa. Goldthwaite, J., Capt,, A, 1st .Maine. Goodsell, G. B., Serg't, D, 103d Ohio. Gordon, P., Pt., E, 7th Missouri. Gotwaltz, A., PL, A, 138th Pennsylvania. Gould, E. S , Corp'l, I, 22d Mass., age 19. Gowers, J. A., Pt., B, 14thN.Y.H.A.,age23. Graves, J., PL, D, 111th Illinois. Gray, T. W., Corp'l, F, 58th Indiana. Green, J., Serg'LD,88th New York. Grissel. J., Pt., B, 8th Kansas, age 21. Grow, L., F., Lieut., K, 25th Wisconsin. Haines, J., Pt., I, 7th Indiana, age 29. Hance, W., Corp'l, D, 137tb N. Y., age 18. 861 Hancock, C, PL, A, 21st Virginia. 862 Hancock,J.,PL, E, 179th New York. 863. Hansard. W., Capt., K, 41st >hio, age 22. 34 Hank, M., Corp'l, C, C:id Indiana. 865 Hardy, E., Pt., F, 36th C. T., age 23. Hartman, E., Pt., A, 59th New York. Hartson. P.. Pt., I, 60th New York, age 25. Hatch. W. B., Col., 4th New Jersey. 1 Hawksworth, T., Maj., 6Sth Pennsylvania. Healcy, T., Pt.,E, 157th New York. Healy, J., PL, E, 64th New York. Ilelston, J., PL, H, 49th Pennsylvania. Hemploman, N., Pt., G, 70th Ohio. May 15, 16, '64. June 18, 20, '64. June 24, 24, '64. May 15, 15, '64. Oct. 3, 3, '64. Oct. 19, 19, '64. July 3, 3, '03. Aug. 18, 19, '64. June 4, 4, '64. May 5, 5, '64. SepL 17, 17, '62. July 3, 4, '63. July 3, 4, '63. April 1, 1, '65. June 18, 18, '64. May 31, 31, '64. Sept. 19, 19, '64. Nov. 7, 9. '61. Mar. 25, 25, '65. May 14, 14, '64. June —, —, '63. Sept. 19, 19, '64. Julv 3, 3, '63. Mav 12, 13,*T4. July 23, 28, '64. Sept. 19, 19, '03. Dec. 13, 13, '62. Dec. 16, 17, '64. July 22, 24,'64. May 11, 11, '64. Oct. 29, 29, '63. Sept. 19, 19, '64. June 18, 18, '64. Dec. 16, 16, '64. May 14, 14, '64. July 30, 30, '64. Oct. 19, 19, '64. June 16, 16, '64. Dec. 13, 13, '62. Dec. 14, 14, '62. July 1, 1, '63. April 7, 8, '65. Sept. 19, 19, '64. July 22, 22, '64. Operations, Operators, Result. Left. Died May, 1864. Right. Died SepL 12, 1864. Right. Surg. C. J. Walton, 21st Ky. Died July 15, 1864. Lett. Died May 21, 1864. Right; circ Died Oct. 4, 1864. Left; slough'g; protruding bone excised. Died Feb. 4, 18(55. Left. Ass't Surg. G. V. Woolen, 27th lnd. Died July 28, 1863. Left ; cir; sloughing. Died Sept, 29, 1864; pyaemia. ----. Died Juno 13, 1864. Right; muscular flap. Surg. T. llildreth, 3d Maine. Died May 30, 1834 ; pyaemia. Autopsy. Left. Died October 14, 1862. Right, Surg. G. P. Oliver, 111th Penn. Died July 28, 1863. Right; slough extending nearly to groin. Died Sept., 18, 1863; diarrhoea. Left; ant. post. flap. Died April 27. 1865; pyasmia. Left. Died June 28, 1864. Right; flap. Died June 9,1864 ; exhaustion. Left; circ Died Oct. 12, 1864; pyaemia. ----. Surg. E. C. Franklin.U.S.V. Died Nov. 19, 1861; tetanus. Right, Died April 17, 1865. Left. Died May 20, 1864. Left. Died June 7, 1863. Left; flap. Died Oct. 11, 1864; exhaustion. Right. Died August 7, 1863. Right; circ; seq. removed. Died Sept. 18, 1864; asthenia. Right. Surg. H. C. Messenger, 56th Ohio. Died Aug. 1, 1864 ; wound. Left. Died Oct. 29, 1863; haem. and pyaemia. Right; slough; rem. protr. bone. Died Feb. 23,1863. Spec. 655. Left; ant. post, flap. A. A. Surg. R. McMilley; shock. Died Dec. 18. 1864; exhaustion. Right. Died July 26, 1864. Right; circ. Surg. J. Ebersole, 19th lnd. Died May 29, 1864. Spec. 2408. Left. Surg. J. V. Kendall, 149th N. Y. Died Oct. 29, 1863. Right; flap. Died Oct. 4, 1864; Right; ant. post. flap. Died Jan. 7, 1865. Left. Died May, 1864. Left; flap. Ass't Surg. Th. Wild. 36th C. T. Died Aug. 29, '64; pyaemia. Left. Surg. S. H. Plumb, 82d N. Y. Died Oct, 19, 1864. Right; flap. Surg. H. B. Whiton, 60th N. Y. Gangrene. Died Aug. 16, '64 ; chronic diarrhoea. Left. Died December, 1862. Left, Died Jan. 6,1863; tetanus. Spec. 112. Left. Died July 15, 1863. Left. Died June 8, 1865. Left; circ. Died Sept. 29, 1864; exhaustion and debility. Left; circ. Surg. R. Morris, 103d 111. Died Aug. 18, 1864. Name, Military Description, and Age. Henderson, J., PL, F, 2d New Hampshire. Hendricks, F E., Major, 4th New York H. A. Hengen, H, Pt., A, 2d Louisiana. Henry, J., Pt., B, 103d Illinois. Henwright, T., PL, E, 117th N. Y., age 28. Herndon, T. B., PL, C, 60th Georgia. Hersha, C, Serg't, F, 25th Iowa, age 21. Hess, A., PL, H, 10th New Jersey. Hess, J., It'., I, 83d N. York, ago 19. Heacock, N., Serg't, E, 119th Pen.. Hickman, L.. PL, 1st Virginia Artillery. Higgins, A. W., PL, E, UlthN. York, age 27. HinchclifT .'!. H., PL, E, 210th Pi ni., age 39. Hitchcocl, IL, Corp'l, G, 39th New York. Hoffman. F., Private, Knapp'.-- Penn. Bat'ry. Hoffman J. IF, PL, B, 57th N. Carolina. Holley, C, PL, H, 2d Michigan. Howard, F. H., Pt., B, 6th Mass. Howard, J. S., Capt., G, 8th Penn. Cavalry. Bowel, J. C., Lt., C, 55th Alabama. Hubbard, J. D., Corp'l, G, 8th Florida, age 32. Hubbell, G. P., Corp'l, C, 24th Michigan. Hudnot, M. B., PL, D, 8th New York H. A. Hugh, E., PL, H, 59th New York, age 22. Hulce, C, Corp'l, H, 2d Michigan. Humel, H. J., PL. G, 155th Penn., age 23. Husted, W , PL, 1, 142d New York, age 18. Hutchinson, W. W., Pt., F, 18th Infantry. HutzeLG. F., PL, E, 5th Wisconsin, age 33. Jackson, E., Adj't. 82d New York. Jackson, H., Pt., E, 4th Colored Troops, age 23. Jackson, W., Sergt, C, 23d Kentucky, age 41. Jeffries, A. S., Pt., I, 17th S. Carolina.age 23. Johnson, F. B , PL, C, 16th Maine, age 23. Johnson, I, Corp'l, K, 1st Ohio Art'ry, age 21. Jones,A., Corp'l, K, 15th Mass., age 21. Jones, W. H., PL, H, 1st Maryland, age 36. Kane, D.,Pt.,H, 1st New Jersey, age 19. Keeling, L. T., PL, D, 17th Kentucky. Keller, II. H., PL, B, 7th Mich. Cav., age 34. Kennard, P., PL, A, 16th Kentucky. Kerner, C, Pt., D, 26th Wisconsin, nge 17. Kessler, J, Serg't, A, 441h Illinois, age 26 Kidd.W., Serg't, C, 14th N. Y. H. A., age 33. Kiddoo, A., Pt., K, 102d Elinois. July 2, 2, r63. Mar. 31, 31, '65. Nov. 3, 3, '63. Nov. 25, 25, '63. Sept. 30, —, '64. Nov. 27, £8, '63. Mar. 19, 20, '65. June 1, 1, '64. May 12, 12, '64. Sept. 19, 19,'64. Sept. 29, 29, '64. June 17, 18, '64. Feb. 6, 6, '65. May 5, 5, 64. July 20, 20, '64. Oct. 19, 19, '64. June 18, 18, '64. Jan. 30, 30, '63. Mar. 31, 31, '65. July 20, 20, '64. Dec. 15, 15, '62. Mav 14, 14,"'64. June 16, 16, '64. June 16, 17, '64. June 18, 18, '64. May 5, 5, r64. Oct. 27, 27, '64. June —, —, '64. April 2, 2, '65. June 1, 1, '64. Sept. 20, 20, '64. May 26, 27,'64. April 7, 7, '65. Dec. 13, 14, '62. July 1, 3, '63. May 10, 10, '64. May 19, 19, '64. June 3, 4, '64. May 27, 27, '64. May 5, 6, '64. May 14, 14,"'64. Mar. 19, 19, '65. Nov. 25, 27, '63. June 16, 17, '64. July 20, 20, '64. Operations, Operators, Result. Right. Died July 8, '63; wound. Right. Surg. P. E. Hubon, 28th Mass. Died April 1, 1865. Right. Died Nov. 14, 1863. ----. Died December 20, 1863. ---. Died Oct. 4, '64; exhaus- tion from suppuration. Left. Surg. J. Dwindle, 106th Penn. Died December 3, 1803. Spec. 1885. Right; circ. Surg. G. I\ French, U. S. V. April 14, hicin.j lig. Died April 15, 1805 Left. Died June 18, 1864. Left; circ.; protrud. bone rcino'd. Died May 24, '04 ; exhaustion. Left. Died Oct. 4,1864 ; exhaus- tion. Right; circ; (also other wounds.) Ass't Surg. W. F. Richardson, C. S. A. Died Oct. 23, 1864. Lef ; lat. flap. Surg. J. W. Wis- hart, 140th Penn. Died July 11, 1864; pyaemia. Left; flap. Died Feb. 17, 1865; exhaustion. Right; circ. Surg. J.W.Wishart, 140th Penn. Died May 0, '64. Right; circ. Snrg. J.V. Kendall, 149th N. Y. Died Aug. 11, '64. Left. Died Oct. 25, '64; tetanus. Right. Surg. S. S. French, 20th Mich. Died June 18, 1864. Right, Died Feb. 1,'63; asthenia. Left. Died April 21, 1865. ----. Died July 30, 1864. Left. Died Jan. 22, '63; pyaemia. Autopsy. ----. Died May 17, 1864. Left, Surg. S. II. Plumb, 82d N. Y. Died June 17, 1864. . Right; circ. Surg. G. L. Potter, 145th Penn. Died June 30, '64. Right, Surg. S. S. French, 20th Mich. Died June 18, 1864. Left. Died June 5, '64; exhaus- tion. Right. Surg. A. M.Clark, U.S.V. Died Nov. 15, '64; pyaemia. Left. Died July 28, 1864. Right; circ. Died May 4, 1865; pyaemia. Left. Surg. S. II. Plumb, 82d New York. Died June 7, '64. Left; (alsoamp.arm.) Died Oct. 11, '64; exhaustion. Left; circ. Died June 8, 1864; exhaustion. Left. Died July 9,1865; exhaus- tion. Right. Dec. 25, lig. fem. Died Dec. 25, '62; exhaustion. Left. Oct. 10, hasm. Died Oct. 19, '63; asthenia. ----. Died June 17,'64 ; pyaemia. Right. Died June 19, 1864 ; py- aemia. Autopsy. Left; circ.; slough'g. Died Sept. 10, 1864. Died June 3, 1864 ; wounds. Right May 20, haem.; 28th, re- curred ; ligation. Died June 25, 1864; pyaemia. ----. Died May 14, 1864. Right, Died April 21, 1865. Left; gang.; sym. of ichoraemia. Died Dec. 31, 1863. j Right; anterior post. flap. Died i Julv 7, 1864. Right. Died November 26, lb64. I 1 O MEAGHER (W.), Casualties at the Battle of Fredericksburg, in American Medical Times, 1863, Vol. VI, p. 179. 23* INJURIES OF THE LOWER EXTREMITIES. Name, mii.iiaky Dlsceiption, and ac;e. 919 [920 921 922 923 924 925 926 927 928 929 930 93) 932 Kilbournc, E. A., Pt , H, 45th Penn., age 19. Kincaid. J. M.. Capt., ('., 5„'d N. Carolina. Kirkpatrick. J., Pt., G, 4th N. Y. H. A., age21. Kline. M., PL, H, 203d Penn., age 20. Knight, T., PL, F, 7th Rhode Island. Knight, W., PL, G, 147th New York. Kraai, T., PL, D, 8th Michigan, age 20. Lackey, M., PL, K, 6th Vermont, age 18. Lamb, IL, Pt., H, 31st Iowa. Lambert, X., It., II, 32d Mass., age 34. Lamphere, C, PL, G, 8th Connecticut. Lampman, A., Pt, B, 5th N.Y.H.Art,,age24. Lanier, P., PL, C, 17th S. Carolina, age 33. Larlrin, W. R., PL, B, 22d New York Cav. 'Larry, L., Pt, A, 1st New ()i loans, age 23. Lawyer, F. T., PL, A, 6th Marylaud. Ledbetter, J. W., Pt., H, 131st Illinois, age 28. Leddy, J., Pt., G, 4th Rhode Island, age 21. Lesher, J. M., PL, G, 12th Indiana. Leonard, J., Serg't, D, 55th Penn., ago 27. Lindsay, W., Pt., A, llth New Jersey. Lintz, H., Pt, K, 10th N. Y. H. Art'y, age 20. LittlefieXd, M. 'C, Pt., B, 43d Georgia. Loetze, II., PL, G, 9th New Jersey, age 56. Long, F., Pt., E, 14th N.Y. II. A., age 20. Long. IL, PL, K, 148th Pennsylvania. lard, U , PL. I, 1st Me. Heavy Artillery. Lovetl,"j. D., Pt." I, 54th Ohio. Low, S., Corp'l, F, 17th Penn. Cav., age 23. Lowery, J., Pt., B, 10th N. Hampshire, age 21. Liiwrey, J., Lieut., C, Kith Kentucky. Ludwig. E., PL, F, 6th Maryland. Lynch, J., Pt., I, 89th Penn., age 40. 952 Mann, D., Pt., D, 39th Ohio, age 29. Martin. F., Pt., II, llth New Jersey. 954 Martin, M.'C. Pt., G, 53d North Carolina. 955 Marshall. E., PL, G, 147th N. Y., age 23. May 18, 18, '64. Julv 3, —, '63. June 18, 18, '64. Jan. 15, 15, '65. Dec. 13, 13, '62. Aug. 18, 18, '64. July 20, 21, '64. Julv 10, 10," '63. Mav 26, 26."'64. Feb. 6, 6, 65. Sept. 29, 29, '64. July 18, —,"'64. July 30, -,'64. Sept. 19, 19, '64. July 17, 17, '64. May 5, 5, r64. Mav 12, 12, "'63. Sept. 30, 30, '64. July 20, 20,"'64. June 18, 18, '64. June 18, 18, '64. April 2, 2, '65. Mav 15, 15," '64. Dec. 14, 14, '62. June 2, 4, '64. July —, —, '63. May —, —, '64. July 22, 23, '64. Aug. 25, 25, '64. Aug. 6, 6, r64. May 14, 14, '64. Oct. 19, 19, '64. July 9, 1LYG4. July 4, 4, '64. Nov. 10. 10, '64. Sept. 19, 19, '64. May 28, 28, '64. Operations, Operators, Result. Right; ant. post. flap. Surg. T. S Christ, 45thPenn. Died June 15, 1864; exhaustion. Left. Died Aug. 21, 1863. Left; circ. flap; gang. Died Sept. 20, 1864. Right; circ. A. Surg.F.B. Kim- ball, 3d N. H. Died Feb. 9, 1865; exhaustion. Autopsy. Right. Died December 15,1862. Left. Surg. A. S. Coe, 147th N. Y. Died Aug. 21, 1864. Left; flap. Surg. W. B. Fox, 8th Mich. Aug. 18, reamp. Died Sept. 1, '64; pyaemia. Autopsy. R't; circ. July 21, haem.: lig. fem. Died Oct. 22, 1863; exhaustion. Spec. 3880. Left; flap. Surg. A. T. Hudson, 26th Iowa. Died June 6, 1864. Right. Died March 4, 1865: py- aemia. Autopsy. Left; circ. Surg. T. H. Squire, 89th N. Y. Died Sept. 30,1864. Right. Died July 26, 1864. Right; circ; sloughing. Died Aug. 17, 1864. Right; oval. Surg. J. W. Smith, 2d Ohio Cav. Died Oct. 30, '64 ; pyaemia. Left; double flaps. A. A. Surg. F. Hassenburg. Erysip. Sept. 21, amp. hip joint. Died Sept, 30, '64 ; pyaDmia.etc. Spec. 37:18. Left. Died May 10, 1864. Right; circ. Surg. A. H. Hoff, U.S.V. Died May 27, 1863; exhaustion. Left. Died Oct. 18, '64; pyaemia. Autopsy. Left; flap. Surg.W. Lomax,12th lnd. Died Oct. 2, 1864. Right. Died Aug. 11, '64; exh'n. Right, Died June 28, 1864. Right. Died April 22, '65; typh. fever. Right. Ass't Surg. H. E. Good- man, U. S. V. Died May 21,'64. Right; circ. Surg.G.A.Otis, 27th Mass. Jan. 17, haem.; lig. fem. Died Jan. 31,'63; hiem. Autop. ----; flap; sloughing. Died June 14, 1864 ; exhaustion. Left. Died July 21, 1863. Left, Surg. J. W. Lyman, 57th Penn. Died May. '64. Spec. 3225. Left. Surg. A.C. Messenger, 57th Ohio. Died Aug. 3, 1864. Right; circ. A. Surg. J. D. Wil- lard, 1st Md. P. H. B. Died Oct. 9, 1864. R't; circ. Surg. H. N. Small, 10th N. H. Died Oct. 4, '64; pyaem. ----. Died May 15, 1864. Right. Died Nov. 23, 1864. Right; lat. skin flaps; circ. sect. mus. A.A.Surg. J.H. Bartholf. Died Feb. 14,'65; soft, of brain. Autopsy. Spec. 1369. Left. May 14,1865, reamputat'n. Died May 20, 1865; pytemia. Left, Surg. O. J. Evans, 40th N. Y. Died Dec. 3,'04. Spec. 4117. Left; circ. Surgs. Duval and Wil- kinson, C. S. A. Died Sept. 26, 1864 ; pass, haemorrhage. Right; ant. post. flap. Surg. A. S. Coe, 147th N. Y^. Died June 18, 1864, pyaemia. Name, Military Description, and Am: Massey, J. W., Pt., A, 14th N. C , age 22. 'May, W. F., Serg't, C, 10th South Carolina. McCollum, J., PL, E, 16th Kentucky. McConaughy, S. B., PL, C, 116th Illinois. MeCullough, J. H., Ser- geant, K, 17th lovwa. McElroy. S., Serg't, 1, 7th R." Island, age 33. sMo,Evoy, J., PL, H, 99th Penn. McGowan, W., Pt.; D, 97th N. Y., ago 25. McGill, It., Pt., A, 12th Maine, age 44. McHlhaney, R., Pt., I, 2Sth Pennsylvania. Melligan, D., Pt., I, 110th New York. Meranville, R.E.,Corp'l, F, 2d New York Cav. Miller, F., Pt., E, 66th New York. Miller, J., PL, II, 134th New York. Miller, A., PL, K, 2d Virginia, age 33. Milliner, W., Pt , Goss's Arkansas Reg't.age 30. Mink, M., Pt., E, 28th Iowa, age 21. lMinslett, J. C, Pt., —, 39th Alabama. Mitchell, F. A., Corp'l, I, 17th Maine. Mitchell, J., Pt., L, 6th N. York Heavy Art'y, age 25. Mohner, J., Pt., F, 15th Missouri, age 24. Montgomery, J., Corp'l, C, 93d Illinois. Moon, J. L., PL, E, 44th North Carolina. 8Moran, J., PL, I, 6th New Y'ork. Morear, J , PL, 1st Mas- sachusetts Battery. Morgan, J. D., Serg't, F, 22d Wisconsin. Morse, A. A., Pt., D, 114th N. York, age 25. Murphy, P., Pt.,B, 111th Penn., age 22. Mushiltz, W., Pt., A, llth Penn. Nash, R. J., Pt., G, 9th Virginia. New, 1\, PL, E, 7th N. York. Newton. J. H., PL, B, 70th Indiana. Nicholas, M. B., Serg't, I, 24th Iowa. Notestine, W. F.. Capt., E, llth Mo., age 22. Nunemacher, I., Pt., C, 8th Penn. Cav., age 40. Oberly, F. A., Pt., D, 10th N. York, age 23. O'Brien. T.,Pt.,G, 69th New York. O'Connell, W., Pt., D, 25th Mass., age 19. O'Dounell, C, PL, A, 2d N. York Art'y, age 19. Dates. Dec. 16, 16, '64. Oct. 5, 5, '64. Oct. 3, 3, '64. Jan. 1, 3, '62. Oct. 19, 19, '64. Mar. 25, 25, '63. Oct, 19, 20, '64. Oct. 28, 30, '63. Mav 6, 6, '64. July —, —," '63. Dec. 13, 15, '62. July 20, 20, '04. Oct 19, 19, '64. Dec. 15, 15, '64. April 6, 6. '65. July 24, 24, '64. Sept. 17, 17, '62. Mar. 10, 11, '65. Mav 19, 19," '64. operations, Operators, RKSt'LT. Left; slough. Aug. 5, bone rein'd. Died Sept. 2,1863; pyaemia. Right. Died Oct, 16,*1863; py- aemia. ----. Died May 14, 1864. Left. Surg. J. B. Potter, 30th Ohio. Died May 20, 1863. Left, Died May 27, 1863. Left. Died October 25, 1864; pyaemia. Right; ant. post, flap. Surg. T. Hildreth, 3d Me. Died Dec. 29, 1862. Left. March 27, haemor. Died March 28, 1865. Left. Surg.A.C. Robertson, 159th N.Y. Died June 6, 1863. Right. Died July 29, 1864; ex- haustion. Left; haemorrhage. Died Aug. 18, 1863. ----. Sept. 5 and 6, haem.; 7, lig. femur; 8, haemorrhage. Died Sept. 12, 1862. Right. Surg. C. S. Wood, 66th N.Y. Died Dec. 20, 1862. ----. Surg. H. B. Whiton, 60th New York. Died June 28, '64. Left; circ. May 8, sloughing; haem. from bowels. Died May 9, 1863. Right; nec. bone remo'd. Died Sept. 7, 1863. Spec. 2088. Left; flap; sloughing; bone re- moved ; haemorrh. Died Dec. 7, 1864: pyaemia. ----. Died Sept. 30, 1863; ex- haustion. Right. Surg. H. F. Lyster, 5lh Mich. Died July 29,'63; exh'n. Right; lat. skin flap; circ. sect. muscles. Surg. C. H. Andrews, 176th N.Y. Died Nov. 3, 1864 ; pyaemia. Autopsy. Left; circ. Surg. T. L. Magee, 51st Ills. Died Dec. 23, 1864; irritative fever. Right. Ass't Surg. J. J. Whitney, 18th Wis. Died June 22, I860. Right, Died Oct. 6, 1864. Right, Surg. P. C. Pease. 6th N. York. Died Jan. 3,'62; never rallied. Right. Died Oct. 21, 1864. Right. Died March 26, 1863. Left; circ. A. Surg. B. A. For- dyce. 160th N. Y. Died Nov. 13, 1864; exhaust'n. Autopsy. L't; circ; (alsofract.cran.) Died April 30,'64. Aut. Spec. 2139. ----. June 16, nec. bone remo'd. Died June 24, '64; exhaustion. Spec. 2720. Right; haemorrhage. Died Aug. 16, 1863. ----. Surg. C. S. Wood, 66th N. Y. Died Dec. 23, 1862. Right. Died Aug. 12, 1864. Left; circ. Died Nov. 27, 1864; pyaemia. Left; circ. A.A.Surg. J.H.Green. Died Feb. 12, 1865; exhaustion. Left; flap; diarr. Died April 29, 1865; pyaemia. Autopsy. Right. Surg. G. S. Palmer, U. S. V. Died July 31,'64; exhaust'n. ----. Sept, 26, bone protruding remo'd; tetan. Died Oct. 3.'62. Left; circ. Died Mar. 17, 1865; exhaustion. Left; circ. Died June 28, 1864 ; pyasmia. ' Circular No. 6, S. G. O., 1865, p. 50, Case 16. Circular No. 7, S. G. O., 1867, pp. 48, 65. 2 Terry (C), Report of Wounded treated in Field Hospital of Hindman's Divis., Army of Tennessee, after the battle of Chickamauga, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 76. *0'MEAf.iiEii (W.), Casualties at the Battle of Fredericksburg, in Am. Med. Times, 1863, Vol. VI, p. 179. *Tekey (C), Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 76. 'Lynch (E), Santa Rosa Isle, Health of the 6th N. T. Vols., in American Medical Times, VoL IV p. 198. SECT, ill.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 239 Name, Military Description, and Aoe 995 ' O'Hnra, J., Pt., C, 12th l'enn. Res., nge 40. 996 Palmcrton, J. l\,Pt.,E, 76th New York. 997 Paris, .1. T., Corp'l, G. 21th Mich., age 23. W8 l'arker. J. /,.", PL, G, 12th Georgia. 999 Parker, S. E., Serg't, G, 147th New York. 1000 Parsons, X. R., t orp'l, 1, 44th N Carolina. 1001 Pearsall, E. IL, PL, F, 2d N. V. II. A., age 17. 02 Peiffer, M.,Corp'l, F, 83d Penn., age 37. 1003 Pendergrast,X.F.,Sgt., E, 55th Alabama. 1004 Perigo, B. T., Corp'l, A, 140th New York. 1005 Peril/, J. R., PL,A, 44th North Carolina, ago 31. 1006 Pierce, T. G., jr., It, D, 16th Jowa, age 24. 1007 I'itts, C. C., PL, K, 1st Alabama. 1008 Plankington, J.. Pt., E, 2d Penn. Art'v, age 24. 09 Pollard, A., PL, C, 4th Colored Troops.age 19. 10 Poole, G. T., Pt., G. 7th Illinois Cav., age 35. 11 Poole, J. C.,Pt.,C, 145th Pennsylvania. 1012 Potter, F. W.. Corp'l. C. 7th Rhode Island. 1013 Prentiss, W. S., Pt., A, 2d Maryland, age 26. 1014 Preston. A. A., Pt., C, 2d N. Y. Mt'd Rifles. 1015 Proctor. R., Serg't, B, 90th N. Y., age 35. 1016 Quarles. T. D., Pt., II, 53d Virginia, age 32. 17 Quinn, J., PL, II, 7th N. York Arty, age 25. 18 2Rand, W. J., It., K, 45th Mass., age 25. 1019 Randolph. W., PL, C, 25th Indiana. 1020 Ranger. E. J., PL, H. 24th Mich., age 26. 1021 Raymond. W. !>., Pt.,D, 53d N. Y., age 28. 1022 Redman, R., Corp'l, I, 23d Michigan. 1C;3 Reed, W. H., It., II, 8th j Vermont, age 31. 1024 Rrnisfer. B. M., PL, D, I .list N. C, age 18. 1025| Reynolds. IF, Pt., 42d I .Mississippi. 1020 Rich. E IL, It., L, 8th N. V. II. A., age 27. 1027 1028 11029 Richardson, A. C, PL. 15, 126th Penn., ago 30. Ricketts, L., PL, A, 123d Indiana, age 26. th Riley, R., Colonel Ohio. 1030 Riley, J., Drummer, C, 145th N. Y., age 17. 1031 Risley, S., PL, II, 44th New York, age 27. 1032' 3 Roach, S., It., C, 99th Pennsylvania. 1033 Robinson, J., Serg't, H, 48th Illinois. Dec. 14, 15, '62. Juno 18, 18, '04. May 10, 10," '04. Oct. 19, 20, '04. Mar. 30, ::o, 'tifi. Oct. 3, a, oi. June 5, 5. '64. Mav 8, 8. 'til. July 20, 20, '04. Mav 3, 3, '63. Oct. 14, 15, '63. July 31, 31,"'64. April 9, 9, '05. June 18, 18, '64. June 15, —, '64. Dec. 16, 17, '64. May 12, 12, '04. May 13, 13,'64. April 2, 2, '65. June 2. 2, '64. Oct. 19, 20, '64. June 19, 19, '04. June 18, 19, '64. Dec. 14, 14, '62. April 0. 6, '62. Feb. 7t 7, '65. May 12, 12, '64. May 14, 14, '64. Oct. 19, 21, '64. June 1, 1, '64. Julyl, 3, '63. Nov. 10, 10,'64. Dec. 13, 13, '62. June 27, 27, '04. May 2, 3, '63. July 3, 5, '63. May 5, 5, '64. Dec. 14, 15, '62. May —, Operations, Operators, Kksii.t. Left; ant. post. flap. Surg. J. Howe, 1st N. Y. Jan. 1, 3, '63, haem. Died Jan. 4,'63; exh'n. Right. Surg. G.W. Mctealf, 76th N. Y. Died June, 1864. Right; circ. Died May 19, 1864 ; exhaustion Lett. Died November 8, 1864. Left. Uied March 31, 18C5. Left. Died October 24, 1864, Loft; circ. Surg. J. W. Wishart, 140th Penn. Died June 30, '04 ; pyaemia. Lett; flap. Died Oct. 28. 1804. Left. Died August 5, 1864. ----. Ass't Surg. 11. Howard, U. S. A. Died .May 3, 1863. ----; flap. Died Oct. 28, 1863. Right; circ.; gang. Died Nov. 6, 1864; exhaustion. Right. Surg.W. D. Murray, 161st N. Y. Died April 9, 1865. Left; flap. Aug. 6. haem. Died Aug. 6, 1864 ; exhaustion. Right; (also w'nd left knee joint;) ant. pest, flap. Died July 21, 1854; exhaustion. Lett ; ant. post. flap. A. A. Surg. T. Morrison; pyaemia. Died Dec. 30, 1864. Left. Surg. P. E. Hubon, 28th Mass. Died May 23, 1864. ----. Surg. L. W. Rliss, 51st N. Y. Died May 18, 1804. Right; pysemia. Died June 23, 1865. Right. Died June 7, 1864. Right; circ. A. Surg. J. Homans, U.S.A. Died Nov. 8,'64; haem. Right; flap ; (alsa fracture left.) Died August 0, 1864. Right. Surg. G. L. Potter, 145th Penn. Died Dec. 18, 04 ; exh'n. Right; (also amputa. left arm at shoul, joint.) tjurg. I. F. Gal- loupe, 17th Mass. Died Jan. 24, 1863; pysemia. ----; slough.; exposed end bone removed. Died April 9, 1862. Left; circ. flap. Died Feb. 24, 1865; pyaemia. Right; circ.; sloughing. Died Juno 21, 1864; pyaemia. ----. Surg. D. L. Heath, 23d Mich. Died July 18, 1854. Right; oval flaps. Oct. 24, haem.; lig. fem.; 29th. haem. Died Nov. 21, '04; peritonitis and pyaemia. Right; circ. Died June 15,1864. ----. Died July 19, 1863. Right. Surg. A. Churchill, 8th N. Y. II. A. Died Dec. 20, '64; pysemia. ----; (lap. Died Jan. 29, 1863; haemorrhage. Right"; circ. Surg. C. W. McMil- lan, 1st E. Tenn. Died Aug. 29, 1864; pysemia. Right. Died May 3, 1863; ex- haustion. Left; flap. Died July 29, 1863; diarrhoea and typhoid fever. Right. Died June 1, 1864; ex- haustion. Right; ant. post. flap. Surg. A. J. Ilcrr, 68th Penn. Died Jan. 13, 1863; pyaemia. Right; flap; (also exc. forearm ) Surg. A. Goslin, 48th 111. Died June 1, 1864. Name, Military Description, and Age. 1034 1035 1036 1037 1038 104 1042 1043 1044 1045 1040 1047 1048 1049 L050 1051 1052 1053 1054 1055 1050 1057 1058 1059 1060 1061 1062 1063 1064 1065 1066 1067 1068 1009 1070 1071 1072 1073 1074 Robinett, J. A., Pt., G, Sith North Carolina. Rogers, L. A., Capt., D, 98th Now York, age 36. Rogers,W. M.,0orp'l,A, 116th Illinois, age 35. Rowc, J. B., Corp'l, I, llth New Hampshire. Roystcr, T, PL, Prices Artillery. Rumirlls, A. J., It., D, 27 th (leorgia. Russell, A.l!., Serg't, E, 2d .Massachusetts. Sanders, L. (.'., It., K, 2d N. Y.H. A., age 21. Ssiyers, J. W., Corp'l, C, 8ih N. Y. Cav., nge 24. Scurry, J., It., 1!, 1st Minn., age 35. Scnddcr, L. C, Pt., I, 33d Indiana. Scarlet, G., PL, D, llth Colored Troops. Scott. A., Corp'l, 1,121st Ohio. Seaborn, A.,PL,G, 97th Pennsylvania. Sergeant, W. H., Pt., G, 24th New York, age 28. Shortsleeve, G., It., E, 15th Mass., age 20. Sheppard, G., Pt., C, 1st Illinois Cavalry. "Shilling, H. W.. PL, A, 19th Alabama. Silliman, W., Col., 20th Colored Troops. Skillman, F., Pt., E, 114th New York. Skinner, J., Pt., F, 146th New \rork, age 34. ^Skipper, A. B., PL, A, ICth South Carolina. Slater, B.. Pt., B, 72d New York, age 22. Smiley. J., PL, B, 10th Penn. Reserves. Smith, D„ PL, G, 6th Penn. Reserves. Smith, F. W., PL, C, 2d S. C. Rifles, age 16. Smith, H. M., PL, G, 82d Penn., age 28. Smith, J. J., PL, F, llth West Virginia, age 26. 6Snowbridge, A., PL, G, 99th Pennsylvania. Solomon. H., PL, B, 12th Missouri. Spear, J., Serg't, E, 6th Maryland, age 32. Spear, J. W., Pt., D, 27th Mass., age 39. Sproul, J.,Serg't,C, 40th New York, age 24. Sprowl, J. R., Pt., B, 58th Indiana. Steele, J., Pt., I, 100th Col'd Troops, age 22. Stines, H., Corp'l, D, 97th New York, age28. Stokes, S., PL, F, 1st Mo. S. M. Cavalry. Stonecyphe. S., PL, G, 131st Pennsylvania. Stowers, M. C, Lieut., IC, 6th Georgia. Strong, W. H., PL, 121st Penn., age 20. Stuckei/, H. G., ------, age 18. Julv 2, 3, '03. June 2, 2, '04. July 22, 22, '04. May 16. 10," '04. Oct. 22, 22, '63. Aug. 19, 19, '64. Oct. 17, 19, '64. June 16, 17, '64. April 29, 30, '65. Aug. 14, 14, '64. June 22, 22, '64. Aug. 24, 25,'64. June 27, 27, '64. July 30, 30, '64. June 17, 18, '64. Slay 12, 12, '64. Sept. —, —,'61. Sept. 19, 19, '63. Dec. 9, 9, '64. Sept, 19, 19, '64. May 12, 12," '64. Sept. 19, 19, '63. July 23, 23, '63. May 10, 10, '64. May 12, 12, '64. May 25, 25, '64. April 6, 6, '65. Oct. 19, 20, '64. Dec. 14, 15, '62. May 14, 14,'64. June 1, 2, '64. May 14, 14, '64. Nov. 7, 7, '63. Sept, 19, 20, '63. Dec. 15, 16, '64. June 17, 18, '64. May 21, 22," '64. Dec. 13, 15,'62. Aug. 20, 20, '64. May 8, 10, "'64. June 15, 15, '64. Operations, Opeuatoiis, Result. Left. Died July 22, 1863. Left. Died July 10, 1864. Left; circ. Act. Staff Surg. C. B. Richards, U. S. A. Died Sept. 20, 1864. Right. Surg. J. S. Rose, llth N. II. Died May 19, 1864; wounds. ----; haemorrhage. Died Oct. 27, 1863. Right; circ. Surg. W. V. White, 57th Mass. Died Aug. 22,1864. Right; oval. Asst. Surg. E. 15. Nims, 1st VL Cav. Died Oct. 19, 1864: tetanus. Left; circ. Surg. J. W. Wishart, 140th Penn. Died July 16, '64. Left. Died May 5,1865; exhaus- tion. Right. Died August 21,1864. Right. Died July 15,1864. Left; circ. Died August 25, '64 ; haemorrhage. Right. Died June 28,1864. Left; ant. post. flap. Surg. D.W. Maull, 1st Del.; aneur.; lig. ex. iliac. Died Oct. 9, '64. Sp. 3282. Right; flap. Surg. S. S. French, 20th Mich. Died June 26,1864. Left. A. Surg.M.Rizer, 72d Penn. Died June 5, '64 ; pyaemia. Right; haem. Oct. 20, reamputa- tion. Died Oct. 20,1801. ----. Died September 28,1863; exhaustion. Right. Died December 17,1864. Right; circ. Surg. L. P. Wagner, 114th N.Y. DiedOct.7,'64: pyae. Right; ant. post. flap. Died May 31, 1864; pyaemia. Autopsy. ----; haemorrhage. Died Nov. 2, 1863. Right. A. Surg. J. T. Calhoun, U. S. A. Died July 31, 1854. Spec. 1513. Left. Surg. B. Rohrer, 10th Penn. Res. Died May 11. 1864. Left. Surg.W. B. Lyons, llth Penn. Res. Died May 12, 1864 ----; circ.; severe diarrh. Died June 26, 1804. Right; lat. flap ; femur prot. one inch. Died May 7. '65: pyaem. Left; circ.; haem ; lig. perforating artery. Died Nov. 9,'64; pyaem Right; flap. Surg. J.W. Lyman. U.S.V. Died Jan. 6,'63;'effect of amputation. Right, Surg. G. L. Carhart, 31st Iowa. Died May 17, 1864. Left; circ. Died July 17, 1864. Left; diarrhoea. Died July 6,'64. Left; double ant. post. flap. Surg. A. Campbell, 40th N. Y. Died Dec. 7,1803; pyaemia. Autopsy. Left. Died Sept, 23, 1863. Left; flap. A. A. Surg. J. S. Giltner. Died Jan. 14, 1805. Left; ant. post. flap. Died July 18, 1864; exhaustion. Autopsy. Right; erysipelas. Died June 1, 1864; tetanus. Right. Surg. C. S. Wood, 66th I N. Y. Died Jan. 2, 1863. Right. Surg. A. A. White, 8th Md. Died Sept. 17, 1804. Left; flap. Surg. J. A. Ramsey, 121st Penn. Died May 24, '64 ; exhaustion. Right. Died July 13, 1864. 1 O'MEAGHER (W.), loc. cit, in American Medical Times, Vol. VI, p. 179. * GALLOUPE (I. F.), Army Medical Intelligence, in Bost. Med. and Surg. Jour., 1863, Vol. 68, p. 205. 30'Meaghek (W.), Casualties at the Battle of Fredericksburg, in Am. Med. Times, 1863, Vol. VI, p. 179. 4 Terry (C), loc. cit., p. 76. » Terry (C), loc. cit., p. 76. 6 O'Meagher (W.), Casualties at the Battle of Fredericksburg, in American Medical Times, 1863, Vol. VI, p. 179. 240 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. i N I Name, Military 'I Description, and Agk. 1075 Stulls, H., Pt., A, 6th Wisconsin, age 22. 1076i Sullivan, P., Pt., F. 42d New York. 1077, Summers, H., Serg't, M, 21st N. C, age 30. 1078 Swarman,J.,Pt.,G, 13th I Connecticut. 1079 Tarbell, C. F,Corp'l, D, 21st Maine, age 19. 10801 Tate, H. A., PL, D, llth I N. Carolina, age 31. 1081 Taylor, J., Serg't, K, 2d Colorado Cav., age 33. 1082! Terrell, L. B., Pt., A, I 23d Michigan. 1083 Terry, J. R., Pt., K, 47th Virginia, age 42. 1084 Thomas, F. G., PL, D, 8th Vermont, age 20. 1085 Thomassen, J. H., Pt.,D, 24th Virginia, age 24. 1086 Thompson, A., Pt., D, 8th Vermont, age 22. 1087 Thompson, W., Pt., A, 3d Maryland. 1088 Thompson, W. H, Pt., K, 15th Tenn., age 29. 1089 1090 1091 1092 1093 1094 1095 10961 10^7 1098 1099 1100 1101 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 Thurston, I., Corp'l, H, 54th Indiana. Titus, L. G., Serg't, E, 51st Pennsylvania. Todd, R. L., Pt., llth North Carolina. Trautwine, J., PL, A, 15thN.Y.H.A.,age37. Tressler, S-. Artificer, K, 2d Penn. II. A., age 28. Trester, W. B., It., K, 52d Indiana, age 31. True, W. S., Pt., D, 29th Maine. Tuft, J. 1)., Serg't, E, 5th Maryland, age 26. Turner, S., PL, B, 106th New York, sige 40. Tuthill, D. L., Serg't, I, 7thN.Y.H. A., age 38. Ulum, J., Pt., H, 102d New York. Van Anken, J.L.,Corp'l, K, 56th Penn. Vanausdale, W. B.. Cor- poral, C, 203d Penn., age 24. Vanderburgh, IL, Corp'l, B, 129th Illinois. Van Pelt, D., Corp'l, G, 8th Iowa, age 22. Vincent, T. R, Pt., H, 7th Iowa. Volner, E., Serg't, 13th New York Battery. Walker, W., PL, B, 81st Indiana. Walker, J. W., Serg't. G, 105th Penn., age 25. Wall, G.. PL, H, 26th New York, age 18. Walsh, E., Lieut, B, 52d New York, age 33. Walton, W. IL, Pt.. B, 3d New Hamp., age 23. Ware, II. S., Pt., H, 38th New York, age 23. Warner, C. F., Pt., G, 2d Connecticut. 1113 Warner, M., Pt., 13th Mississippi. 11141 Warner. M., Pt., H, 70th I Indiana. 1115 Warren. G. W., PL, F, i 100th Indiana. 1116 Washington, D., Pt., A, 29th Conn., age 21. Feb. 6, 6, '65. Sept. 17, 17, '62. Sept. 19, 19, '64. Sept. 19, 19, '64.. May 27, 27, '63. July 3, 3, '63. Oct. 21, 21, '64. May 14, 14, '64. Aug. 20, 20, '64. Oct. 19, 19, '64. May 16, 16, '64. Oct. 19, 21, '64. Sept. 30, 30, '64. Nov. 30, De. 1, '64 Dec. 29, 29, '62. Dec. 13, 13, '62. July 3, 3, fe. Aug. 19, 20, '64. Aug. 18, 18, '64. May 18, 18, '64. Oct. 19, 19, '64. June 19, 19, '64. Sept. 19, 19, '64. May 30, 31, '64. July 20, 20, '64. May 12, 12, '64. Jan. 13, 13, '65. July 20, 20, '64. June 10, 10. '64. Nov. 7, 7, '61. July 20, 20, "64. Aug. 3), 31, '64. May 6, 6, '64. Dec. 13, 14, '62. May 12, 12, '64. June 18, 18. '64. May 5, 5, '62. Sept. 19, 19, '64. July 2. 3, '63. Aug. 12, 12, '64. May 26, 26, '64. Oct. 28, 28, '64. Operations, Operators Result. Left; circ. flap. Died Feb. 19, 1865; pyaemia. Right. Died Sept. 29, 1862. ----; circ. Surg. Sutton, C. S. A. Died Nov. 4, 1864 ; pyemia. Right. Died Sept, 27," 1864. Left. Died May 27, 1863; effect of chloroform. Right. Died August 25, 1863. Right; oval flap. Anaemic. Died December 1, 1864; irritative fever. Left. Died June 25, 1864 ----; flap; gang. Died August 27, 1864. ----. Died October ? ', 1864. Left; circ. Died June 21, 1864 ; pneumonia. Right. Died Oct. 21, 1864; ex- haustion. Lett, A. Surg. J. E. Beattv, 2d Maryland. Died Sept. 30, '64. Right; anterior posterior flap; gangrene. Died Dec. 26, 1864; exhaustion. Right. Died January 22, 1863. Left. Died January 7,1863; py- aemia. Right. Died July 10, 1863. Right. Died September21,1864. Right. Died September 4,1864; pyaemia. Right; flap; sloughing. Died September 23, 1864. Right. Died October 22, 1864; Right. Died July 22, 1864. Left; circ. Died Oct. 15, 1864; peritonitis. Left; circ. Surg. G. L. Potter, 145th Penn.; pyaemia. Died July 9, 1864. Right. Haem. from femoral art. arrested before death, but never reacted. Died July 21, 1864. ----. Died May 12, 1864. Left; flap. Surg. G. C. Jarvis, 7th Conn. Died Feb. 10, 1865; pyaemia and exhaustion. Right; middle third. Died July 26, 1864. Right; flap. Died July 3, 1864. ----. Died November 19, 1861. Left. Died September 15, 1864. Left, A. Surg. S. W. Marshall, 84th Illinois. Died Sept. 10, '64. Left; circ. Died June 4, 1864; pyaemia. Left. Died Jan. 23, 1863; ex- haustion. Autopsy. Spec. 973. Right; circular; typhoid fever; diarrhoea. Died June 13, 1864. Right. Died July 21, 1864; ex- haustion. Right. October 9, removed three inches necrosed bone. Died October 12, 1862; exhaustion. Spec. 1007. Right; flap. Died Sept. 23, '64; exhaustion. Right. Died. ----. Died August 27, 1864. Right, Surg. A. Goslin, 48th 111. Died June 9, 1864. Left. Surg. C.M. Clarke, 39th HI. Died Dec. 11, 1864; irritative fever. No. Name, Military I Datfr Description, and Age.1 Washington. G., Pt., A, 48th Colored Troops. Waters, J., Pt., B, 26th Michigan, age 44. Webb, J., PL, G.. llth West Virginia. Webb, J. D., Corp'l, D, 5th Alabama, age 26. Weddle, S., Serg't, L, 1st Md. P. H. B. Cav., age 35. Wedman, I., Pt., A, 7th New York Artillery. Weeks, A. M., Pt., E, 3d N. Hamp., age 21. Weeks, W. H., Pt., E, 10th Conn., age 36. Wendt, C, PL, E, 153d New York. West, S. P., Corp'l, K, llth N. Hampshire. Wheelock, O. R., Serg't, K, 8th Michigan. White, C. S., Pt., G, 142d Penn., age 25. 'White, J. IF, —, F, 39th Georgia, age 40. Whipple, E., PL, B. 2d Rhode Island, age 32. 2 Wick, F., PL, D, 1st N. Y. Art., age 32. Wildhack,C.W.,PL,H, 1st La., age 27. Wilkinson, A. J., PL, G, 7th Wisconsin, age 20. Willman, IL. Serg't, F, 154th New York. Wilson, J., Lieut, Col., 43d New York. Wilson, C, Pt., K, llth Mass., age 25. Winship, N. W., PL, K, 86th New York. Wipfelder, F., PL, C, 52d New York. - Wolf, D., Pt., A, 23d Indiana. Wood, L., PL, B, 65th Illinois. Woodward, J., Pt., C, 59th Illinois, age 40. Woodward, W., PL, C, 67th New York, age 31. >Woodworth, J. W., Cor- 1 poral.H, llth Infantry. Wottington, B., Corp'l, 13th Colored H. A. Wright, A« Pt., C, 5th N. Y. Cav., age 18. Wynn, J. J., PL, E, 20th Alabama, age 25. Fount, E., Pt., A, 23d Virginia. York, H. C, Pt., A, 4th Vermont, age 44. Colladay, C.W.,Pt.,D, Grey's Reserves. Cousin, N. A., Pt., F, 5th Col'd Troops, aged 24. Hart, W., Serg't, G, 6th New York H vy Art'y. Kirby,J. J7., PL, E,58th Alabama. Laureford, G. H., Pt., I, 8th Georgia. Pierson, J., PL, G,26th North Carolina. Royan, J., Pt., G, 10th Tennessee. Walker, S. T., Pt, F, 12th North Carolina. April 1, 1, '65. May 12, 12, '64. Mar. 31, 31, '65. Oct, 19, 20, '64. July 4, 6, '64. June 16, 16, '64. June 2, 2, '64. Aug. 15, 15, '64. Oct. 19, 20, '64. May 12, 12, "64. Aug. 30, 30, '62. Dec. 13, 13, '62. May 18, 18, '64. Mar. 27, 27, '65. Dec. 13, 13, '62. June 14, 15, '63. June 17, 17, '64. July 1, 2, '63. May 5, 5, '64. Mar. 31, Ap.1,'65. July 2, 2, '63. June 1, 2, '62. June 18, 18, '63. June 15, 15, '64. Dec. 16, 16, '64. Nov. 30, De.l,'63. Nov. 7, 7, '63. May 15, 15, '65. May 5, 5, f64. Dec. 16, 17, '64. Sept. 19, 19, '64. May 5, 5, '64. July 2, -, f63. Sept. 29, —, '64. May 19, —, '64. Sept. 1, 1, '64. Mav 5, -, '64. Mav 5, -, '64. Sept. 1, 1, '64. May 15, —, '64. Operations, Operators, Result. ---. Surg. H. Osborne, 51st C. Troops. Died April 3, 1865. Right; circ. Surg. J.W.Wishart, 140th Penn. Died June 26, '64. Right. Surg. C. M. Clarke, 39th Illinois. Died April 10, 1865. Left; ant. post. flap. Surg. H. McGuire, C. S. A. Necrosed. Died Feb. 26, 1865. Autopsy. Right; double flap. Surg. W. R. Wray. 1st Md. P. H. B. Cav. Died July 6, 1864. ---. Surg. A. M. Dougherty, U. S. V. Died June 23, 1864. Right. Died July 9, 1864. Left, Died Sept. 10, 1864; ex- haustion. Right; oval; sloughing; haem.; fem. secured. Died Nov. 5, '64. Right. Surg. J. S. Ross, llth N. H. Died May 19, 1864. Left. Died Sept. 9, 1862. Left; bone protruded. Died Jan. 19, 1863. Autopsy. Spec. 986. ---; circ. June 12, one and a half ins. sawn off. Died June 29, 1864; irritative fever. Left; gang. Died April 5,1865; pyaemia. Right; circular flap; gangrene. Died March 21, 1863; gangrene. Spec. 1000. Left; circ. Nov. 11, bone rem'd; abscesses. Died Jan. 31, 1864; exhaustion. Left. Surg. J.Ebersole, 19th lnd. Died July 7, 1864. Left, Died July 10, 1863. Right. Surg.J.Ebersole,19th lnd. Died May 6,1864. Spec. 2315. Left; bilateral flaps. Died May 17, 1865; exhaustion. ---. Died July —, 1863. Right. June 9, haemorrh'ge; liga- tion femoral artery. Died June 17, 1862. Right. Died June 28, 1863. Right. Surg. J. F. Kimbly, llth Kentucky. Died J uly 30, 1864. Left; ant. post. flap. Died Jan. 9, 1865; irritative fever. Right; circ. Died Dec. 27,1863; pyaemia. Autopsy. Both. Died November 8, 1863. Left; flap. Asst. Surg. H. G. Keefer, U. S. V., and others. Died Mav 21, 1865. Right. Died Aug. 17, 1864; en- teric fever. Spec. 3084. Left; ant. post. flap. A. A. Surg. D. D. Talbot. Died Dec. 23,'64; exhaustion. Right; circular. Surg. J. W. Lawson, C.S.A. Died Oct. 10, 1864; pyaemia. Left; double flap; gang, extend'g to body; four inches femur ex- posed. Died June 7, 1864. Right. Right. A prisoner, not on Pen- sion List. Right. Surg. A. C. Messenger, 57th Ohio. ---. Surg. J. W. Wishart, 140th Pennsylvania. Right. Surg. J. W. Wishart, 140th Pennsylvania. Left; cire. Surg. J. R. Zearing, 57thIU. Leftinhosp. Sept.5,'64. Left; and wound of right thigh. 1 O'KEEFE (D. C), Surgical Cases of interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confed. States Med. and Surg. Jour., 1865, VoL 2, p. 25. 2 THOMSON (W.), Report of Case* of Hasp. Gangrene treated in Douglas Hospital, Washington, D.C., ia Am. Jour. Med. Sci., 1864, VoL XLVII, p. 382 SECT. Ill] PRIMARY AMPUTATIONS OF THIGH IN LOWER THIRD. 241 Tlie seat of injury in these eleven hundred and fifty-seven primary amputations in the middle third of the thigh is reported to have been in the middle third of the femur in ninety-eight, in the lower third in three hundred and fifty-eight, in the femur without indi- cation of the third in two hundred and ninety, in the knee joint in three hundred and fifty- three, and in the leg in fifty-eight instances. Primary Amputations in the Lower Third of the Femur.—Of nineteen hundred and fourteen primary amputations in the lower third of the femur the result could not be ascer- tained in fourteen instances. Nine hundred and seventy-three operations were successful, and nine hundred and twenty-seven were fatal, a mortality of 48.7 per cent. In one hun- dred and fifty-eight instances the limb implicated was not indicated;.in eight hundred and forty-five the right, and in nine hundred and eleven the left thigh was amputated. Recoveries after Primary Amputations in the Lower Third of the Femur.—The nine hundred and seventy-three operations of this group were performed on nine hundred and seventy-one patients, the discrepancy in numbers being due to the fact that double ampu- tations were performed in two instances. Two hundred and twenty-nine were Confederate, and seven hundred and forty-two were Union soldiers. Of the latter, seven hundred and thirty-four were pensioned, and four retired; the names of the remaining four patients are not borne on the rolls of the Pension Office. Case 444.—Corporal J. A. Crawford, Co. K, 6th Wisconsin, aged 24 years, was wounded through the knee joint, at Gettysburg, July 1, 18;i3. He was admitted to the Seminary Hospital, whence Acting Assistant Surgeon W. M. Welch made the following report: "The limb was amputated at the lower third of the thigh on the day following the injury. The patient came under my care on August 15th, at which time the stump was granulating slowly and there was a free discharge of healthy pus; but the flaps had sloughed, leaving the end of the femur bare. A roller bandage was applied to prevent retraction of the muscles, and warm-water dressings with disinfectants were used, iron and stimulants being given internally. The patient's general health was disturbed, though his appetite was tolerably fair. He improved gradually, and was transferred to Camp Letterman on September 2d." Assistant Surgeon H. C. May, 145th New York, continued the history as follows: "The patient came under my charge ou October 12th, being very feeble and troubled with profuse and obstinate diarrhoea, having no appetite, and suffering from hectic fever and much pain, also an abscess along the course of the lower end of the bone. The stump was conical shaped, with the end of the femur exposed, and the granulations were pale and flabby. Astringents and tonics were administered. On October 30th, the diarrhoea was almost controlled, but great pain and irritation was felt about the stump, and, chloroform having been given, a seques- Fig 180 — trum f°ur an(l a ^a^ inches long, and consisting of a complete section of the lower end of the bone, Tubnlar se- was removed by forcible traction. The surfaces of the bone were found to be very rough and sur- mcrvgJJ'from rounded with a wall of callus. The patient did well after the operation; the abscesses ceased to stump of the discharge, and the cavity in the stump filled with healthy granulations. By November 6th, he had rightfemur. . , , . , ,. , . , , , , , , • , Spec. 1971. regained a good appetite, the diarrhoea was entirely checked, and his general appearance and con- dition were rapidly improving." On the next day the patient was transferred to Newton University Hospital, Baltimor.e, where the following described operation was performed on February 2, 1864, by Surgeon C. W. Jones, U. S. V., in charge: "The end of the femur being necrosed, an incision six inches in length was made on the anterior aspect of the thigh and four inches of bone removed. Thirty-six hours afterwards haemorrhage to the amount of four ounces occurred, when the sutures were removed and a large clot of blood was taken out, after which the bleeding ceased. After this the patient's constitutional condition continued to improve and the flaps approximated. By March 24th, the stump had entirely healed with a good cushion." The patient was discharged from service May 3, 1864, and pensioned. He was paid June 4, 1879. The sequestrum was contributed to the Museum by Acting Assistant Surgeon E. A. Koerper, and is represented in Figure 180, and an involucrum of new bone, removed at the last operation, is shown in FIGURE 181. Case 445.—Private J. Miller, Co. C, 18th Kentucky, aged 38 years, received a gunshot injury of the left lower extrem- ity, at Richmond, August 30, 1832. Acting Assistant Surgeon J. B. Smith furnished the following history: "The wound was in the left knee and thigh, and amputation was performed on the field at the lower third of the femur. The patient was admitted to Washington Park Hospital October 15th. At the time of his admission he presented evidences of severe constitutional suffer- ing, his skin being pale and yellow, accompanied by general emaciation, night sweats, and constant diarrhoea. The stump showed two or three small openings, and there was free discharge of sero-purulent fluid. Exposed bone could be distinctly felt with the probe. Astringent medicine was given until the faecal discharges became natural. Warm-water dressings were used to the stump and the flaps supported with adhesive plaster, the wound being syringed every morning with a weak solution of chloride of soda. By December 1st, the patient was doing well, having good appetite and gaining flesh and strength rapidly, and all the constitutional trouble being removed. The end of the bone gradually became more exposed. On January 13, 1863, the patient being considered in a suitable condition for an operation, and having been placed under the influence of chloroform, Surg. Ill—31 FIG. 181.-Invo- lucrum, 4 inches in length, from stamp of right fe- mur. Spec. 2153. 242 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. Acting Assistant Surgeon O. D. Norton cut down to the bone about four inches above its exposed end, dividing all the tissues, and carrying the knife downward to the opening at the end of the stump. The bone, after being dissected from the tissues, was then separated by a saw about three inches above the projecting extremity, the forceps being used for the removal of the spongy bone above the point of the division. Some trouble was experienced from haemorrhage, necessitating the ligating of two or three small vessels. Water dressings were applied. By February 10th, the wound had healed and the patient was apparently doing well. On February 20th, he had a chill, followed by fever and by pain about the stump, when a small incision was made and about half an ounce of healthy pus discharged. From this time there was a gradually lessening quantity of pus until April 20th, when the wound had healed, and the patient, to all appearances, was well, being able to walk about the ward, and all his constitutional symptoms having disappeared." The patient was discharged April 30,1864, and pensioned. He was paid March 4, 1879. The tubular sequestrum, three inches long and surrounded by a cylindrical involucrum of spongy bone, was contributed by Dr. Smith, and constitutes -Spec. 1094 of the Surgical Section, A. M. M. It is represented in FlG. 2 of Plate LXX, opposite. In the following two instances of amputation in the lower third of the thigh, the officers continued in active service until the close of the war: Case 446.—Major-General D. E. Sickles, U. S. V., while in command of the Third Corps, at Gettysburg, was wounded, on the evening of July 2, 1863, by a twelve-pounder solid shot, which shattered his right leg. He dismounted unassisted, and aid arriving promptly, he was removed to a sheltered ravine a short distance to the rear, where the limb was amputated low down in the thigh by Surgeon T. Sim, U. S. V., Medical Director of the Corps. The patient was then sent farther to the rear, and, on the following day, he was transferred to Washington. The stump healed with great rapidity. Two weeks after the injury the patient was able to ride about in a carriage, and early in September he was well enough to again mount a horse, the stump being completely cicatrized. The bones of the amputated leg (Spec. 1335) were contributed to the Museum by the patient, and the history of the case was obtained from the operator. General Sickles subsequently for several years held command in South Carolina and the Department of the South, but has been retired from active service since April 14, 1869.1 Case 447.—Major-General R. S. Ewell, while commanding a division of General Jackson's Corps of the Confederate Army, was wounded in the left knee during the night of the engagement at Manassas, August 28, 1862. Dr. Hunter McGuire, Surgeon and Medical Director of the Corps, who amputated the wounded limb, published an account of the case as follows :2 " He was kneeling on the ground and looking under some pine busbes to get a better view of the field, when he was hit upon the left patella, nearly in the centre of it, and his leg being flexed, the ball passed downward, striking the head of the tibia and splitting it into several fragments. The bullet finally lodged in the muscles of the calf of the leg. He sent for me at once, but the messenger failed to find me, and I did not know he was hurt until General Jackson sent his aid-de-camp to tell me. He was still laboring under the severe shock of the injury when I found him, although several hours had elapsed. In all gunshot wounds of the knee the shock of injury is severe, but it was especially great in this instance. The General's health, naturally not very good, was unusually bad at this time. He had also lost a great deal of sleep, and the night he was hurt was compelled to drink a large quantity of strong tea to keep awake. * * He was so much exhausted when he was shot that his surgeons thought at one time he would die from the shock of the injury. When he had sufficiently recovered from this, I advised him to submit to amputation; but he consented to it very reluctantly, partly because some surgeon had assured him that his wound was not dangerous, but one from which he would soon recover. I amputated the thigh just above tbe knee, performing the operation as rapidly and with as little loss of blood as I could. About ten days after the amputation, to escape capture, he was carried on a litter by some soldiers near fifty miles. The motion on the litter caused the bone to protrude, and in consequence of this and his bad health the wound sloughed. After much suffering and the loss of an inch of bone, he got well enough to go about, when one day he was so unlucky as to let his crutches slip from under him, and falling upon an icy pavement, he re-opened the wound and knocked off another piece of bone. After some months he was well enough to go back to the field again, where he performed some very active service, but from the shape of his stump, and an ill-contrived wooden leg he wore, he was fre- quently troubled with abrasions of the skin, small abscesses, and so on. He now (1866) uses a suitable artificial limb, and with the assistance of a cane gets along right well, being no longer liable to affections of the stump." As already stated, amputation in the lower thirds of both thighs was twice success- fully performed. One of the survivors died in 1877, over thirteen years after the operation Case 448.—Corporal M. Dunn, Co. H, 46th Pennsylvania, aged 21 years, was wounded at Dallas, May 25, 1864. Surgeon W. C. Bennett, U. S. V., recorded his admission to the field hospital of the 1st division, Twentieth Corps, and noted: " Canister-shot fracture of both legs, followed by excision of the head of the left fibula and amputation of the right thigh. Vessels of left leg destroyed and mortification ensuing, necessitating amputation of left thigh." Three weeks after being wounded the patient was removed to hospital at Chattanooga, where the stumps assumed a gangrenous appearance, which yielded to the application of bromine. One month later the patient was transferred to hospital No. 14, at Nashville, whence he was furloughed and proceeded to his home. He subsequently entered the Post Hospital at Elmira, and lastly, on April 24,1865, he was admitted to Central Park Hospital, New York City. Surgeon J. J. Milhau, U. S. A., iu charge of the latter, reported the following history: "The missile passed through both legs just below the knee joints. The right thigh was amputated by the flap method, just above the knee joint, eighteen hours after the injury, and circular amputation of the left thigh was performed forty hours after the reception of the wound. In August, 1864, the right thigh had to be re-amputated at the middle third, which operation was performed by the circular method, at the patient's home, by Dr. Robison, of Wellsville, New York. The stump of the right thigh closed completely about December 1, 1864, but that of the left never entirely healed, and was still discharging from three 1 Circular No. 6, War Department, Surgeon General's Office, Washington, 1865, p. 38. 'McGlHEE (Hunter), Clinical Remarks on Gunshot Wounds of Joints, etc., in Richmond Medical Journal, 1866, Vol. I, p. 262. Prof. P. F. Eve, in a oommunication published in the U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 64, states that " Lieutenant-General Ewell survives an amputation through the upper third of the thigh." r>P.p.Mv> •-' 1- Ward pKot PuATE LXX___INVOLUCRA OF THF tCMHH t'ift 1 .rase of Pt W Vutnaua, i Pemsylvai, 'V >. -. . I i£. 2.-Can of FY J Mill, u; Kentucky. Rpel141 S,'r£ S.-,*. A.M.M !' T>IY TO «• Y 1 !•'». ■ •l!f.« al» ve i*s exposed end, divilia V"«.' So'i< , Y ''t l-.i'in.'T dtqstHt"'! Yov> Y ,¥.-l o;- -•.-•■ . ' «i.'. -';- -; I -• ..,. a■ . • . ■ •' V. AS a ."U' ,v : ;i. ■ . '■•..,-,. • - vsufl well !>cin -: : ' s a Y--ged April 30, l?'w •■• •■ .-■vllndrii'sl imTo!» i •\ e >l. It is vej.resf-t--: a.VYaU ill the l'Y, .. rii'se of the- war: ; v ■ i.ae in command A t!-.*. T< • :■ ait. which shiitN-rrY '■■-■• ■■:■ .. h- a short dYtu: <■■• • '■ v YY-^tor of \h>. '.'■!■ - .■■..-. Thu v.-v.. ; ..-, .-arly iu S'p*. i .• ,..■:■ ■•.■>*:<[ h-z($;;r • . '■ • tl- a- - - •. .VO1* C'OlY' i' LXX, i-pc • thiirii. \as wcvirii <■ f-.-.isti'i aattiYf' a 111 i ' ■. ' a ']■■'■ ... cf :u u-i ■ - • ••■ niece of bcrv . .ce, but froif e slYo, small A-.-.- i.jfu- veil, beicy . • I'-.iiiar.lOTi n. * ■■■ .{,-. survivors •{■.< ! ■ -wiin, Co. H, 46LS >\.-j-.m« recorded his lulnii*- a > Y ■..'■», followed by tor''.-a:a • ■ '-ificat'o?! HJ«u;r'.a i* Ch.-;'.:Yr-.o<'ga, -v ;. iU;r ,; v Ta''itat •'.;'. ':■,.'■ • i .u'-in.y filtered tla.- / s '■; i .i?;-. Su:geon J. .7. A'.) Y "'eg* Jtiet below the kru« V..--8 after tha injury, r>> • :.i Auprupt. 1864, the right ':, eihod, at tbr patknt'fc b->ui ;t December 1 VJfi4, bi. ' t;e left _i___ : -t't, Surgeon ..-uonii * OnHc, '•', ■Khicgton, i- . • narks ■■;<: '•'■■insn ■£ Woun\-'\fJoinU,etc., *.. .!biniu'ji Co*iMt*<••.'.": J v. »irs-, New Yi ■ar." tbLjrri oi t">etha... '•r.; wl! enovw;h tn go b.r k ia ". an ill-contrived wowb-v. (. now (1866) uk* a su'tai ■•' vMui.s <>f the stuiru." Yds of bell' thighs -.■ ■ver rhire?>'ii years >■! z\'\ 21 years, ,'...- ivoutvl : • *M'italof tb« Y ■'' '.--ion, T ■ ..< rde l^ft, !.bY- "..vi il'.;- a Ymi of left vl.'-e*. ' Thrta v ,-.' a gariiT- ..-..ii app' >. ^ .h,..Liui No. 1 I, ai. NaahviH*. >.f Elruira, ai»d ' •-; -, on Av-ri in charge A ' a*- a •■ »v. t<;m i'iijntfnic'! as . a a.aP af thr ' •■ A . . -Cimputatifd u ; .. ■ >■ ' .-.-. of Wfillsv:;!e >•■ Y «. ■■•■ '-'.tirelv I'.'al 'I, . a . ' J = ..»ir: p. 64, «tat< I of tlv r me a ■ ,■ ■.-, l,i, •a. to td 1 v .-. il . In .-, .. .■■ " -.''." .ealth C !•;■ ' ; ■ i 'ilg \M.>!lia; '.; arming th* i 'jrT, he w;t: <• oiigequenc'. ■scrh tO i;< ■'.'iOCer.;t' ration •25, r^i .rid noted: ,,ht thigb. ; wounded .■l-.i to the . Ymi-Y'.! Med ft Surg. Hist.of the War of the Rebellion, Vol.11. Part IU Op. pa«e Ward phot. T .Sinclair a Soil Uth. PLATE LXX—INVOLUCRA OF THE FEMUR Fig. l._Case of Pt W Vannatta, 4 Pennsylvania Cav. __ Fig. 2_Case of Pt.J.Miller, 18 Kentucky. Spec. 2602 Surg. Sect A.M.M. Spec. 1094 Surg. Sect.A.M.M. Fig S_Case of Pt JWearing. '1 Pennsylvania Art___Fig 4 _ Case of Pt LCGriffin, 8 North Carolina. Spec. 4196 Surg Sent. A.M.M; Spec. 3141 Surg. Sect A.M.M. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 243 openings at the time of the patient's admission. On April 30th, chloroform was administered, and several pieces of necrosed bone were removed with the forceps by Acting Assistant Surgeon S. Teats, who made an incision some three inches in length on the face of the stump. The sequestrum being enclosed by a very thick involucrum, it was found necessary to remove a portion of the end of this with the gnawing forceps before the sequestrum could be extracted." The patient was discharged from service August 17,1835, and pensioned, having been previously supplied with artificial limbs by the firm of A. A. Marks, of New York. The removed necrosed fragments were contributed to the Museum by the operator, and constitute Specimen 3193 of the Surgical Section. The pensioner died October 23, 1877. The cause of his death is alleged to have been the diseased condition of the stump of the left thigh. In the second successful case of primary amputation of both thighs in the lower thirds the patient was a Confederate soldier: Case 449.—Private C. G. Bush, Co. C, 21st Georgia, aged 22 years, was wounded and captured during the assault on Fort Steadman, March 25, 1865. He was conveyed to the Ninth Corps field hos- pital, whence Assistant Surgeon S. Adams, U. S. A., contributed the pathological specimen (Cat. Surg. Sect, 1866, p. 321, Spec. 3998), with the following history: "The injury consisted of a shell wound of the right leg below the knee joint, tear- ing open the joint, passing across and smashing the patella of the left leg. Sur- geon L. W. Bliss, 51st New York, amputated both thighs at the lower third on the day of the injury. By April 1st the patient's general condition was excel- lent, Ms appetite and pulse good, and his tongue clean." The specimen con- sists of the amputated lower extremity of the left femur, with fragments of the patella. From the field hospital the pa- tient was sent to City Point, and thence to Washington, where he was admitted to Armory Square, and subsequently to Lincoln Hospital. Surgeon J. C. McKee, U. S. A., in charge of the lat- ter, contributed the photographs, repre- sented in the annexed wood-cuts (FiGS. 182,183), and described the amputation as a flap operation. The patient was released and discharged from hospital Aug. 2, 1865. Subsequently he entered and was treated for a time at St. Luke's Hospital, New York City, where,'on February 28,1866, he was provided by Dr. E. D. Hudson with artificial limbs, by means of which he was enabled to walk, requiring the assistance of two canes only. Twenty-seven of the seven hundred and forty-two Union soldiers who survived ampu- tation in the middle third of the femur have died during the fourteen years since the close of the war. One case (Case of Dunn) has already been detailed; in the following instance the patient survived the operation over fourteen years and died of phthisis: Case 450.—Private C. Briot, Co. C, 39th New York, aged 26 years, was wounded in the left knee, at Bristoe Station, October 14, 1863. He was conveyed to Alexandria on the follow- ing day, and admitted to the First Division Hospital, whence Acting Assistant Surgeon C. W. Koechling transmitted the pathological specimen (FlG. 185), with the following history: " The wound was caused by a mini6 ball entering the external aspect of the knee, passing through the joint, and lodging. The missile was extracted from the internal aspect of the leg, on the field, by the regimental surgeon, and the limb was amputated at the lower third of the thigh, by the circular method, on October 16th, by Acting Assistant Surgeon N. Barnes. The patient came under my care on October 26th, at which time the bone protruded from the stump over an inch. For this gentle attraction of the integuments was made by adhesive strips and kept up for a Fig. 184?^ Upper week, when, the patient suffering too much pain, it was continued no longer, and a roller was piG 185 _ parts of bones of left appiied from above downward and kept on until the bone was nearly covered. The patient Sequestrum leg; tuberosityoftibia ^r . ,.,,.,, • n • • irom stump split off obliquely.— improved every day, there being but very little discharge, but occasionally very severe pain in ofleftfemur. Spec. 2344. the gtump 0n February 8, 1864, the accompanying sequestrum was removed. On February sPec-3027- 20th, the patient was seized with tetanic pains, which, though relieved by the free administration of opium, recurred every other day for a month. After that period the patient did well, and was able to take exercise on crutches, the stump having healed. On May 9th, the patient left the hospital on furlough." He subsequently passed through different hospitals, and lastly Fig. 182.—Amputation of both thighs at lower thirds. [From a photograph.] FIG. 183.—Artificial limbs applied in ease of double amputation. [From a photograph.] 214 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. entered De Camp, David's Island, New York Harbor. On September 19, 1865, the man was discharged from service and pen- sioned. The upper portion of the bones of the leg of the amputated limb were forwarded to the Museum by the operator, and are represented in FIGURE 184, and a cast of the stump was contributed by Acting Assistant Surgeon G. F. Shrady. (Cat. Surg. Sect., 1866, p. 548, Spec. 1787.) The New York City Examining Board certified, March 11, 1874: "The pensioner is unable to wear an artificial limb in consequence of excessive tenderness of the stump, rendering him unable to stand the pressure upon it. He has tried one several times, but it was so painful that he could not wear it more than a few1 hours." This pensioner died November 12, 1877, of phthisis pulmonalis. Fatal Cases of Primary Amputation in the Lower Third of Femur.—Six of the nine hundred and twenty-seven cases of this group were instances of double amputations; the operations were, therefore, performed on nine hundred and twenty-one patients. Seven hundred and ninety were Union, and one hundred and thirty-one were Confederate soldiers. In the following case both thighs1 were amputated in the lower third on the day of the injury, the patient surviving the operations eighteen days: Case 451.—Private D. Nicholson, Co. H, 22d Massachusetts, aged 23 years, was wounded in both thighs, at Spottsyl- vania, May 10, 1834. He was admitted to the field hospital of the 1st division, Fifth Corps, where Surgeon J. Thomas, 118th Pennsylvania, amputated both limbs. Surgeon R. B. Bontecou, U. S. V., reported the following termination of the case: "The patient entered Harewood Hospital, Washington, May 25th. He had undergone amputation of both thighs at the lower third the same day he received the wound, the operations being performed by the antero-posterior flap method. When admitted he was in a very weak condition, the stumps being unhealthy and showing a tendency to slough. A supporting treatment was administered. Pro- gress, however, continued unfavorable. Death occurred from exhaustion May 28, 1864." The amputated portions of the femurs were contrib- uted to the Museum by the operator, and consti- tute Specimen 2966 of the Surgical Section (FlGS. 186, 187), showing the right femur to be trans- versely perforated, with comminution, two inches above the condyle, by a bullet which passed on, badly grooving the left femur on the anterior face at the same level and producing a severe oblique fracture. Case 452.—Private J. O. Blackburn, Co. E, 138th Pennsylvania, aged 35 years, was wounded at Monocacy Junction, July 9, 1864, and admitted to hospital at Frederick on the following day. Assistant Surgeon R. F. Weir, U. S. A., reported the following history: "The injury was caused by a fragment of a shell, which struck the inner side of the left knee, lacerated the soft parts, and comminuted the joint. On the day after his admission the patient was etherized, and the thigh was removed at. the lower third, by Acting Assistant Surgeon W. S. Adams. The integuments in this case being in bad condition on the inner side, a circular incision was made to extend half around the limb, a long lateral flap on the outer side and a circular incision through the muscles, and the parts united by sutures and adhesive straps. The patient's condition at the time of the operation was very poor. July 13th, patient irritable; pulse 120; appetite rather poor; no effort at union by first intention. 16th, some evidence of sloughing of the flap. Ordered yeast poultices, also tartrate of potassa and iron in doses of twenty grains three times a day, and continued the stimulants and generous diet. 20th, line of demarcation well marked. 22d, slough being detached at several points; clipped it off with scissors down to the bleeding surface and thoroughly applied oakum saturated with a strong solution of permanganate of potassa, covering the whole with oiled silk. 25th, slough came away nicely, leaving a clean healthy surface. August 1st, patient doing tolerably well; granulations somewhat abundant but pale and flabby. Has obstinate diarrhoea, and is taking opiates and astringents in addition to other treatment. 10th, diarrhoea partially checked; appetite very poor; sloughing has recommenced, and permangauate of potassa is reapplied. 15th, sloughing about ceased. There is but little discharge, and the end of the stump is dry and refuses to granulate. Applied yeast poultice and continued the other treatment. 21st, patient quite despondent and evidently failing rapidly; pulse 140 and scarcely perceptible. Increased the stimulants. 28th, sloughing still continues and patient sinking. 31st, had a haemorrhage from femoral artery to amount of eight ounces; controlled by tourniquet. Hasmorrhage occurred again on the following morning and was arrested by the tourni- quet, the patient not being in condition to undergo ligation. He died at 7 o'clock P. M., on September 1, 1864. At the autopsy, eight hours after death, the body was found to be much emaciated and the muscles remarkably loose and flabby. On examin- ing the stump to the head of the bone and removing the femoral artery and vein, the end of the artery was found to be pervious from the breaking down of the clot, and the vein much thickened aud indurated." The amputated extremity of the femur, showing the inner condyle to be superficially fractured (Spec. 3832), and four and a half inches of the stump of the bone, being superficially necrosed (Spec. 3488), together with the femoral artery (Spec. 3980), were contributed to the Army Med. Museum by the operator. 1 The remaining five fatal cases of amputation of both thighs in the lower third of the femur are: Pt. S. Allen, G, 59th Mass. (No. 984, Table XXXH, p. 257); Pt. R. S. Michael, A, 105th Penn. (No. 1551, Table XXXII, p. 263); Serg't E. 0. Rabbit, B, 10th Missouri (No. 1652, Table XXXII, p. 264); Pt. J. Stewart, D, 77th New York (N'o. 1769, Table XXXII, p. 265); and Lieut. J. Whelpley, D, 1st Maine (No. 1862, Table XXXII, p. 267). Fig. 186.- each femur. -Anterior view of lower third of Spec. 2966. FlG. 187.—Posterior view of lower third of each femur. Spec. 2966. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. Table XXXII. 245 Summary of Nineteen Hundred and Fourteen (uses of Primary Amputations in the Lower Third of the Femur for Shot Fracture. Recoveries, 1—973; Deaths, 974—1900; Result unknown, 1901—1914. 37 Name, Military Description, and Age Abbott, O. A., Serg't, A, 14th Conn., age 24. Adnir, R., Serg't, F, 7th Infantry. Adams, E. H., Pt., C, 12th Iowa. Aderhold, E., Pt., E, 6th Penn. Reserves. Agren, A., Pt.. C, 7th Minnesota. Aldensen, J. J.,Serg't,K, 46th Miss., age 32. Aldrich,B.,Pt.,A,155th New York. Alexander, G., Pt., A, 4th Virginia, age 39. AHen. J., Corp'l, I, 22d Illinois, age 23. Allen, J. G., Pt.. A, 77th New York, age 39. Allen, R., Serg't, A,59th Illinois, age 34. Ammerman, G., Corp'l, C, 6th Penn. Reserves, age 26. Anderson, J., Pt., I, 21st Ohio. Anderson, J., Pt., I, 21st Kentucky. Andrews, A. C, Pt., H, 32dMass.. age 21. Angle, H., Pt., F, 5th W isconsin, age 31. Anthony, A., Lieut., E, 3M N. C, age 21. Anthony, H. G., Pt., C, Gtli Vermont, age 24. Anthony, R. H, Pt., D, 1st Tennessee. Armsberg, G.,Pt., L, 62d Penn., age 18. Armstrong, A. T., Pt., H, 31st Maine, age 24. Ash, J., Pt., G, 25th S. Carolina, age 30. Ashby. D. C, Lieut., H, 80th Indiana, age 24. Ashburn, J. C, Corp'l, B, 14thW.Va.,age25. Atkins, C. S., Serg't, D, 6th Kans. Cav., age 22. Atwell, W. P., Lieut., G, 37th Wis., age 19. Auker, H., Serg't, C, 28th Penn., age 24. Ayres, D. C, Pt., 1,102d Penn., age 26. Bacon. G. P., Pt., A, 20th Maine, age 18. Bailey, W. F., Pt., A, 2d U.S. Sharpshooters. Bakeoven, G. A.,Pt., F, 72d Pennsylvania. Baker, H. C, Pt., F, 48th North Carolina. Baker, J. D.. Pt., H, 4th Iowa, age 58. Baker. J. W., Lieut., A, 14th Indiana. Baker, S., Pt., K, 16th N. Y. II. A., age 18. Baldwin, C., Corp'l, H, 58th Peun., age 32. Baldwin, P. B., Serg't, D, 48th Alabama. Oct. 27, :8, '64. Feb. 21, 22, '6Y June 8, 8, '63. Oct. 14, 14,'63 Mar. 27, 27, '65. Nov. 30, De. 1, '64. Julv 9, 11, "'64. Mav 3, 4, ''63. Sept 19, 21, '63. June 21, 21, '64. Dec. 15, 15, '64. May 6, 6, '64. Jan. 2, 2, '63. June 22, 22, '64. Feb. 6, 6, '65. May 5, 5, '64. Mar. 25, 25, '65. Sept. 19, 19, '64. July 1, 2, "63. July 3, 3, '63. Mav 12, 14,"'64. May 16, 16, '64. Deo. 15, 17, '64. Oct. 19, 20, '64. July 27, 27, '64. July 30, 30, '64. May 25, 25, '64. May 5, 5, '64. Mar. 31, 31, '05. Aug. 29, 30, '62. Nov. 27, 28, '63. June 27, 27, '62. Nov. 24, 24, '63. Dec. 13, 13, '62. Oct. 7, 7, '64. June 1, 1, '64. June 17, 17, '64. Operations, Operators, Result. Left; circ. Surg. F. A. Dudley, 14th Conn. Discli'd Juno !>,'05. Right; circ. A. Surg. B. Norris, U.S.A. Disch'd July 13, '62; subsequent operntion. Left; flap. Surg. A. II. Hoff, U. S. V. Disch'd Sept. 22, '61. Left. Disch'd May 2, '64. Died •Ian. 22, 1869. Right; circ. Surg. A. T. Bartlett, 33dMo. Disch d June 14, 1805. Right; anterior post. flap. Surg. MoCormack, U. S. A. Provost Marshal March 7, 1865. Left; ant. post. flap. A. A. Surg. W. S. Adams. Disch'd. Spec. 3938. Right; flap. Recovery with good stump. Right; flap. Surg. T. L. Magee, 51st 111. Disch'd Feb. 27,1864. Left; ant. post. flap. Surg. G. T. Stevens, 77th N. Y. Disch'd Sept. 9. 1864. Right; circ. Disch'd July 1, '65. Left; ant. post. flap. Surg. C. Bowers, 6th Penn. Res. Disch'd May 30, 1865. Left; flap. Disch'd March 13, 1863. Left; flap. Surg. C. J. Walton, 21st Ky. Must, out Jan. 23, '65. Right; flap. June 10, reamp. two and a half ins. A.A.Surg. E. B. Lyon. Disch'd Oct. 20,'65. Left; circ. Disch'd May 30, '64. Lett; circ. A. Surg. E. P. Roche, 35thMass. Released July 10,'65. Left; circ. Surg. E. Phillips, 6th Vt. Disch'd June 26, 1805. Left. Surg. — McGuire, C. S. A. Exch'd March 17, 1864. Left. Dec. 21, exfol. removed. Disch'd Oct. 19, '64. Spec. 2156. Right; double lat. flap. Surg. J. S. Ross, llth N. H. Disch'd Nov. 16, 1864. Left; circ. Furloughed July —, 1864. Right. Vermale's method. Asst. Surg. W. B. Trull, U. S. V. Mustered out May 15, 1865. Left; circ. Disch'd June 5,'65. Right; flap. Surg. C. E. Swasey, U. S. V. Aug. 2, haem.; artery see'd. M.out. 1870, bad stump. Right. Disch'd Nov. 25, 1865 1871, not in good condition. Left. Surg. II. E. Goodman, U. S. V. Mustered out July, 1865. Left; circ. Disch'd Mar. 13, '65. Left; flap. Disch'd July 25, 'o'5. Right; circular. Discharged. Left; flap. Surg. M. Rizer, 72d Penn. Mustered out Aug. 24, 1864. Spec. 1883. Right. Surg. Gibbon, C. S. A. Retired. Left; circ. Surg. M. W. Robbins, 4th Iowa. Disch'd July 27,1864. Left. Disch'd February ], 1863. Right; flap. Oct. 12, bone cut shorter. Disch'd Oct. 3, 18G5. Spec. 2382. Left; ant. post. flap. Surg. H. C. Christy. 58th Pa. Disch'd Feb. 4, 1805. ---. Surg. — Cook, 47th Ala- bama. Recovered. Name, Military Description, and Age Batlentine, H.J., Lieut., U, 42d Tenn., age 29. Bangs, L. G., Adj't. 19th Illinois, nge 27. Bappert, M., Pt., G,47th Ohio, age 18. Barclay, T., Pt., K, 14th Louisiana. Barker, U., Pt., H, 31st Virginia. Barnes, J. E., Serg't, A, 77th New York, age 37. 1 Barrett, M., Corp'l, E, 19th Alabama. Bartle. W., Serg't, H, 80th New York, age 25. Bastian, J., Pt., A, 31st Illinois. Bauer, J., Pt., F, 100th New York. Baughman, C., Pt., B, 1st Mich. Art., age 26. Beall, T., Pt., C, 39th Iowa, age 28. Bean, C. H., Pt.. E, llth Maine, age 19. Beightal, J., Pt., C, 93d Penn., age 39. Beisse, N., Bufrler, A, 1st Michigan Battery. Bell, G.W., Pt., H,39th Ohio, age 26. Bell, J. H, Pt., E, 15th Alabama. Bellew, B., Pt., I, 4th Delaware, age 45. • Bergeoin, P. P., Serg't, H, 3d Mich., age 21. Berry, W. T., Pt., Pur- cell s Battery." Beaverson, D., Pt., H, 187th Penn., age 23. Biclcel, J. P., Corp'l, G, 20th Virginia Cavalry. Billington, S. A., Pt., C, llth Maine, age 26. Billingsley.J.B., Pt. I, 43d Alabama, age 21. Bish, A., Pt., G, 155th Penn., age 25. Bishop, J. H., Serg't. F, 18th Kentucky. Bishop, II., Pt.", A, 88th Penn., age 20. Black. W. R., Serg't, G. 67th Penn., age 22. Blanchard, C.H.,Pt.,F, 34th Mass., age 23. Blanchard, W., Pt., B, 90th N. York, age 22. Blackburn, L. §., Pt., D, 3d Missouri. Bliven, C. J., Pt., K, 4th Rhode Island, age 21. Blossom, W. E., Pt.. G, 184th N. York, age 34. Boardman, T., Pt., A, 22d Massachusetts. Bolton, G. W., Pt., D, 44th Ala., age 39. Boland, J. C, Lieut., E, 60th New York, age 32. Bonnell, W. D., Pt.,G, 152d N. York, age 23. Nov. 29, De. 1,'64 Nov. 24, 24,'63. Aug. 3, 3, ?64. Nov. 27, 28, '63. Oct. 19, 20, '64. June 21, 21, '64. Sept. 19, 19, '63. Nov. 17, 17, '64. June 27, 27, '64. July 22, 22, '63. Nov. 22, 22, '64. Oct. 5, 7, '64. July 21, 21, '64. Mar 25, 25, '65. Oct. 8. 10, '62. July 22. 22, '64. Aug. 16, 16. '64. July 25, 25, '64. Aug. 29, 29, '62. July 1, 1, '62. July 10, 10, '64. Sept. 20, 20, '64. Oct. 27, 27, '64. May 16, 16, '64. Oct. 27, 28, '64. Aug. 30, 30. '62. Dec. 13, 13, '62. April 6, 7, '65. Oct. 19, 19,'64. Oct. 19, 19, '64. Oct. 4, 4. '62. July 30, 30, '64. Dec. 5, 6, '64. June 27, 28, '62. Sept. 20, —, '63. May 9, 9, '64. Aug. 14, 14,'64. Operations, Operators, Result. Left; circ. Prov. Marshal June 5, 1865. Right; circ. Surg. F. H. Gross, U.S.V. Erysipelas. Mustered out July 9, 1864. Left; flap. Surg. S. P. Bonner. 47th Ohio. Aug. 18, oper. May 30, '65, nec. bone rem'd. Disch'd Aug. 9, 1865. ----Surg. — White. Recov- ery. ----; circular. Dr. G. L. Miller. Transferred. Left; ant. post. flap. Surg. G. T. Stevens, 77th N. Y. Disch'd Oct. 26, 1804. ----. Amputation. Transferred to hospital Oct. 3. 1863. Left; circ. Surg. O. I. Owens, 40th N. Y. Disch'd June 6. '65. Spec. 4129. Right; circ. Surg. J. Reeves, 78th Ohio. M. out May 31, '65. Left; ant. flap. Surg. M. S. Kit- tinger, 100th N. York. Disch'd May 3, 1864. Right; ant. post. flap. Surg. A. T. Hudson, 26th Iowa. Disch'd June 3, 1865. Left. Surg. J. R. Zearing, 57th Illinois. Disch'd Julv 8, 1865. Left; flap. Surg. N. F. Blunt, llth Me. Disch'd June 10, '65. Right; flap; erysipelas. Disch'd July 12, 1865. Left; circ. Surg. C. S. Muscroft, 10th Ohio. Disch'd June 7, '63. Right; flap. Surg. J. R. Zearing, 57th 111. Disced June 17, '65. Left; circ. Surg.--------, 15th Ala. Diarr. Trans. Aug. 31,'64. Right; circ. Surg. D. A. Cham- berlain. 94th N. York. Disch'd July 13, 1865. Right; flap; abscesses. V. R. C. June, 1863. Left. Recovery. Left; circ. Disch'd July 11, '65. ----. Snrg. — Sawers, C. S. A. Recovery. Left: flap. Surg. X. Y. Leit,76th Penn. Disch'd June 12, 1865. ----; circ. Surg. Hilliard, C.S.A. Recover}-. Left; circ. Union by first inten- tion. Disch'd .March 17, 1865. Left; flap. A. Surg. J. D. Gatch, 16th Indiana. Discharged. Left; flap: gang. May 1, seq. rem. Disch'd Dec. 17, '63. Spec. 1264. Right; ant. post. flap. A. Surg. T. F. Corson, 67th Penn. Dis- charged July 7, 1865. Right; circ. Confed. Surgeon. Disch'd Jan. 9, 1865. Left; flap. Disch'd July 4,1865. Recovery. Left; circ. A. Surg. R. Millar, 4th R. I. Sub. operat's. Disch'd Jan. 23, 1865. Left; bilat. oval flap. Snrg. N. R. Barnes, 184th N. Y. Disch'd June 15. 1865. Right. Surg. E. Bentley,U. S.V. Two sub. op. Dis'd May 2, '64. Left. To Provost Marshal March 16, 1864. Left; ant. post. flap. Surg. W. B. Fox. 8th Mich. Disch'd Nov. 27, 1864. Left; flap. Confed. Surg. Nec. Disch'd May 9, 1865. 1 TERRY (C), Report of Wounded treated in Field Hospital of Hindman's Division, etc., in Conf. States Med. and Surg. Jour, 1864. Vol. I, p. 76. 246 INJURIES OK THE LOWER EXTREMITIES. [CHAP. X. NO. 95 96 97 . 98 99 100 101 102 : io3 IJ * !:, !i... 107 108 109 110 111 112 Name, Military Description, and Age. Boothman, M.M., Pt.,H, 38th Ohio, age 18. Booser, L. B., Pt., F, 2d S. Carolina, age 25. Boring, W., Corp'l, I, 7th Illinois. Boss, J. M., Pt., A, 3d South Carolina. Bourns, W. H., Pt., G, 1st Mich. S. S., age 21. Bowers, A., Pt., H, 32d Ohio. Bond, E., Pt., I, 69th Indiana. Bonde, J. C, Capt., H, 27th Virginia, age 28. Bowers, J., Pt., I, 69th Pennsylvania. Bradley, J. H., Pt., H, 121st Penn., age 26. Bradford, P., Pt., F, 1st Maine H. A., age 21. Brady, J., Pt., C, 71st Penn., age 21. Branoski, J. N, Pt., G, 6lst Virginia. Breene, D., Pt., F, 97th New York, age 19. Bridges, B. F., Pt., C, 25th Indiana lBriggs, W. H., Serg't Major, 15th Va., age 30. Brink, J.,Pt.,C, 2d Penn. Art'y, age 48. Briody, P., Pt., B, 4th New York H. Art'iy, age 25. Briot, C, Pt., C, 39th X. York, age 26. Bristoff, G., Corp'l, A, 2d New York Mounted Rifles, age 28. Bronson, A. B., Corp'l, K, 38th Wis., age 23. Brookfield, R., Capt., C, 5th N. C, age 19. Brooks, J., Pt., F, 151st New York, age 18. Brotherton, H. /., Pt., I, 49th N. Cage 35. Brower, C. A., Pt., D, 14th N. Jersey, age 18. Brown, C, Pt., I, 1st Artillery, age 21. Brown, E., Pt., K, 89th New York, age 35. Brown, G. W., Pt., L, 10th South Carolina. Brown, J., Pt., G, 17th Vermont, age 17. Brown, J. W., Pt., K, 21st Kentucky, ago 30. Brown, T. C, Pt., D, 24th Virginia. Brown, W. J., Pt., D, 19th Maine, age 18. Brown, W. W., Serg't, A, 22d Virginia, age 36. Browne, T. W., Pt., C, 24th New York. !Bryant, W. R.,Pt.,—, 18th Mississippi. Buchanan. J. S., Pt., K, 13th S. C, age 22. Buck, J , Pt., A, 3d X. Hampshire, age 25. Bugbce, S., Corp'l, E, 14th Conn., age 24. Dates. Sept. 1, 2, '61. July 2, 3, '63. Feb. 15, 15, '62. July 28, 28, '64. Dec. 5, 5, '64. Feb. 14, —, '04. Aug. 30, 31, '62. May 3, 3, '63. Sept. 17, 19, '62. June 1, 2, '64. June 17, 17, '04. May 30, 30, '64. Julv 4, 4, '03. June 18, 19, '64. Oct. 5, 6, '62. Sept, 17, 17, '62. June 10, 10, '04. June 18, 18, '04. Oct. 14, 16, '63. July 17, 17, '64. April 2, 2, '65. May 8, 10, '64. Julv 9, 10, "'64. Mar. 31, 31, '65. June 3, 3, '64. Dec. 13, 13, '02. Oct. 27, 27, '64. July 22, 23, '64. June 17, 17, '64. June 20, 20, '64. June 30, J'lyl,'ii2. Nov. 3, 4, '64. Sept. 19, 19, '64. Aug. 29, 29, '62. Sept. 17, 18, 'c:. Aug. 21. 22, '04. June 4, 4, "64. Oct. 27, 28, '64. Operations, Operators, Result. Right; flap. Surg. G. E. Sloat, 14th Ohio. Disch'd June 5, '65. Left. Recovery. Right. Disch'd July 17,1862. Right; circ; gang. Aug 12, circ. reamp. Prison Jan. 27, 1865. Right; ant. post. flap. Surg.W. C. Shurlock, 51st Penn. Disch'd July 18, 1865. Left; circ. Surg. A. H. Brund- age, 32d Ohio. Not a pensioner. Left; flap. Disch'd April 2, '63. Died April 6, 1868, of amp. and chronic diarrhoea. Right; ant. post. flap. Retired March 11, 1864. Right. Surg. S. N. Sherman, 34th N. Y. Disch'd May 15, 1863. Left; flap. Surg. J. A. Ramsay, 121st Penn. Sept, 27, ant. post. flap amp.. A. A. Surg. T. T. Maury. Disch'd June 23,1865. Right; flap. Disch'd Dec. 15, 1864. Left; flap. Surg. M. Rizer, 72d Penn. Disch'd Nov. 26, 1864. Left. Surg. W. M. Nash, 61st "Virginia. Furl'd Jan. 9, 1864. Right; ant. post. flap. Disch'd May 17, 1865. Right; flap. Disch'd March 30, 1803. Left: circular. Confed. Surgeon. Furloughed Dec. 28, 1864. Left; ant. post. flap. Disch'd Dec. 4, 1865. Left; ant. post. flap. Surg. H. C. Tompkins, 4th N. Y. H. A. Disch'd Jan. 31, 1865. Right; circ. A. A. Surg. N. S. Barnes. Bone rem'd. Disch'd Sept. 20, 1865. Died Nov. 12, '77; phthisis pulm. Specs. 1787, 2344, 3027. Right; double flap. Surg. J. D. Mitchell, 31st Maine. Disch'd April 4. 1865. Left; circ.; (amp. finger.) Surg. W. E. Johnson, 109th X. York. Discli'd June 22, 1865. Left. Nov. 3, rem'd necro. end. Released Slav 30, 1865. Left; circ. A.A.Surg.A.R.Gray. Disch'd Nov. 27, '64. Spec. 4034. Right. Sent to Military Prison May 30, 1865. Left; circ; gangrene. Disch'd June 1, 1865. Left; circ. Discharged Feb. 28, 1863. Right; circ. Surg. T. H. Squire, 89th N.Y. Disch'd Nov. 30,'65. ---. Surg. Hawkins, C. S. A. Recovery. Right; flap. Disch'd May 27, 1865. Left; ant, post. flap. Surg. C. J. Walton, 21st Ky. Discharged March 29, 1865. ----. Surgs. Niblet and Harrison. Disch'd Sept. 24, 1862. Right; ant. post. flap. Surg. J. T. Myers, 59th N. Y. Disch'd August 7, 1865. Right; flap. Surg. Lowe, C. S. A. Transferred Jan. 8, 1865. Left. Discharged Oct. 21, 1862. Left; flap. Recovered. Left; iat. flap. Surg. G.W. Met- calf, 76th N. Y. Prison Dec. 30. 1864. Right; circ. Disch'd May 25,'65. Right; ant. post. flap. Surg. F. A. Dudley, 14th Conn. Haem.; lig. art. "Disch'd Aug. 23, '65. Dec, 1865, reamp. upper third. NO. Name, Military Description, and Age. Bush, W., Pt., C, 99th Penn., age 41. Butler, J. M., Pt., D, 5th Iowa. Callahan, T., Pt., I, 9th Georgia. Campbell, D., Pt., F, 7lst Indiana. Campbell, J. M., Pt., C, 25th Ohio, age 34. Cameron, R., Pt,, A, 62d Ohio. Cardwell, J. E., Pt., C, 123d Indiana, age 32. Carl, J. E., Ft., A, 20th Michigan, age 22. Carl, W., Pt., G, 14th Infantry, age 44. Carlvle, T., —, D, 2d N. Y. H. A., age 49. Carroll, J., Pt., D, 10th Louisiana. Carson, D., Pt., I, 86th New York, age 26. Carter, J. W., Pt., C, 85th Illinois, age 24. Carter, J. M., Pt., A, 26th North Carolina. Cawtliorne, C.F., Pt., E, 15th Texas, age 39. Cavanaugh, J., Lieut., B, 43d N. Y., age 25. Clialkley, G. R., Lieut., B, 14th Va., age 29. Chamberlain, A. H., Pt., K, 8th Mich., age 23. Champlain, W. H., Pt., E, 149th N. Y., age 29. Chapman, S. S., Pt., E, 27th Mass., age 34. Cheeseman, R. C.. Capt., A, 45th Penn., age 25. Cherington, D. W., Bu- gler, H, 2d West Va. Cavalry, age 30. Cheseborough,0. B.,Pt, A, 105th 111., age 21. Choseley, S. E., Serg't, B, 4th Texas, age 30. 3Claridy, J. B., Pt., C, 24th Alabama. Clark, A.D.,Pt.,C,I34th New York, age 20. Clark, D., Serg't, H, 61st Pennsylvania. Clarke, J. L., Pt., H, 57th New York. Clarno, W., Pt., C, 3d Wisconsin, age 22. Clements, G. A. H., Lt., D,lstMd.Cav., age 22. Cline, J. H., Pt., K. 4th New York. Clouts, A., Pt., F, 32d Missouri, age 20. Cobb, R. W., Pt., E, 20th Georgia, age 39. Coder, P. M., Pt., A, 28th Iowa. Coldwell, M. B., Corp'l, D. 1st Ga. Leg., age 24. *Cole, J. W., —, G, 28th North Carolina. Cole, W., Corp'l, H, 6th Mass. Cav., age 23. Coleman, J., Pt,, A, 14th Maine. Collins, A., Pt., E, 36th Col'd Troops, age 51. Collins, C, Pt, D, 3d Delaware, age 23. Collins, J. W., Pt., F, 12th La., age 23. Collins, S. A., Pt., K, 20th Maine. Dates. June 18, 19, "64. May 16, 16, '63. Aug. 30, 30, '62. Aug. 30, 30, '62. July 2, 2, '63. April 9, 9, '65. Aug. 6, 7, '64. June 18, 18, '64. Aug, 18, 18, '64. Aug. 14, 15, '64. May 3, 4, '63. May 10, 11, '64. June 27, 27, '64. July 1, 3, '63. Nov. 30, De.1,'64. May 5, 5, '64. July 3, 4, '63. Aug. 30, 30, '62. May 3, 3, '63. May 14, 14, '64. April 2, 2, '65. Sept. 22, 22, '64. May 15, 15, '64. Oct. 7, 7, '64. Sept. 19, 19, '63. Julv 1, 3, '63. Mar. 27, 27, '65. Sept. 17, 18. *62. June 16, 16, '64. Aug. 16, 16, '64. Dec. 13, 14, '62. Mar. 21, 21, '65. May 29, 30, '64. May 16, 17, '63. Sept. 14, 15, '62. June 27, 28, '62. May 18, 20, *64. Aug. 5, 5, *62. Sept. 29, 29, '64. June 18. 18, '64. July 20, 20, '64. April 1, 2, '65. Operations, Operators, Result. Left; flap. Disch'd Nov. 15, '64. Right; eiiv. A. Sure:. J. O. Skin- ner, lnih I;i.,nml\V.H. Darrow, 5th Iowa. Gang.; noo. Disch'd Oct, 23, '63 ----. May 15, '63, reamp. upper third. Surg. S. E. Habersham, P.A.C.S. Disch'd Oct. 12, '63. Right; flap. Disch'd Dec. 22, 1862. Died Feb. 4, 1864. Left; flap. Disch'd August 26, 1864. Left; flap. Surg. C. M. Clark, 39th 111. Discli'd Sept. 27, '65. Left: circ. Surg. S. K. Crawford, 50th Ohio. Discli'd May 23,'65. Right; ant. post, skin flap; circ. of muscles. Surg. S. S. French, 20th Mich. Discli'd Nov. 10,'64. Left; ant. post. flap. Surg.A.A. White, 8th Md. Gang. Duty February 18, 1865. Left; ant. post. flap. Surg. J. W. Buckman, 5th N. H. Disch'd May 29, 1865. Right. Surg. White, 14th La. Recovery. Left; flap. Disch'd Nov. 2, '64. Right; flap. Disch'd Nov. 7, '64. Left. Surg. Warren. Recovery. Right; ant. post. flap. Provost Marshal April 6, 1865. Left; flap. Surg. G. T. Stevens, 77th N. Y. Disch'd Nov. 4, '64. Right; circ. Surg. — Doughty, C. S. A. Retired Mar. 15, '65. Right; circ. Surg. J. C. Wilson, 8th Mich. Disch'd Nov. 29, '62. Right; flap. Surg. J. V. Kendall, 149th N.Y. Disch'd July 2l,'63. Left. Mustered out Sept. 30, '64. Right; flap. Surg. L. W. Bliss, 51st N. Y. M. out July 17, '65. Right; oval skin flap. Surg. P. Gardner, 1st West Va. Cavalry. Disch'd March 29, 1865. Right; flap. Surg.A.W.Reagan, 70th lnd. Disch'd Feb. 24, '65. Left, -Prison May 4, 1865. Left. Recovery. Right; flap. Dec,'63, seq. rem'd. Disch'd Feb. 18, 1865. Right; flap. Confed. Surgeon. Mustered out June 28, 1865. Right. Surg. H. Tavlor, U.S.V. Disch'd Jan. 13, 1863. Right; circ Surg. J W.Brock, 66th O. Disch'd July 26, '65. Right; circ.; protrusion. Disch'd March 16, 1865. Right; circ. Disch'd Aug. 22,'63. Disch'd June Surg. C. B. Gibson, Disch'd April 17, Left; lateral flap 26,1865. Right; circ. C. S. A. Right; flap 1865. Left; gangrene; nec. p'n of shaft rem'd. Retired Feb. 24,1865. Left; circ. Furloughed July 19, 1862. Right; circ. Furloughed July 10, 1864; healed. Right. Disch'd Sept. 22, 1862. Died Jan. 12, 1864; gastritis. Left. Surg. J. W. Mitchell, 4th C. T. Disch'd June 1, 1865. Left; flap. Mustered out June 6, 1865. Right; circ; gang.; sloughing. Recovery Sept. 22, 1864. Right; flap. Surg. W. II. True, 20th Maine. Disch'd----, 1865. •FI8HEB (G. J.), Fifty-seven Cases of Amp. after battle of Antietam, in Amer. Jour. Med. Sci., 1863, Vol. 45, p. 47. *FISHEU (G. J.), loc. cit, p. 47. 3Terry (C), loc. cit, p. 76. 4 SMITH (E. H.), Report of cases of compound comminuted fracture of femur, Chimborazo Bosp., Third Div., in Confed. States Med. and Surgical Journal, 1864, Vol. 1, p. 24. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 247 Name, Miutary Description, and Age. Comstock, IL, Pt., 12th Wisconsin Battery. Connell, M., Pt., E, 2d Ponn. Art'y. age 30. Conner, J., Pt., A, 47th Virginia, age 28. Connor, J., Pt., G, llth Conn., age 21. Conway, P.,Pt.,K, 139th New York, age 29. Coons, G. W., Pt., H, 82d Ohio. Cooper, J. P., Serg't, G, 7th S. tairolina, age 19, Cooper, ^., in., A, 17th Mississippi, age 34. Cooper, W. R., Pt., E, 21st Miss., age 20. Copeland, D. B., Pt., G, 2d New Hamp., age 25. Corbett, C. A., Pt., B, 8th Wisconsin, age 23. Cortes, L. G., Pt, G, 7th Louisiana, age 21. Costello, T., Corp'l, E, 93d Indiana. Coughlin,M.,Pt.,H,94th New York, age 19. Covington. W. J., Pt., E, 18th X. C, age 26. Cox, R. N., Pt., D, 41st Illinois. Craig, J. B., Pt., E, 15th Texas, age 25. Crawford, J. A., Pt., K, 6th Wisconsin, age 24. Creamer, D., Pt., C, 9th Maryland, age 19. Crew, M., Pt., E, 156th Illinois, age 22. Crnnkite, J. W., Major, 121st X. Y., age 24. Crosby, A. C, Corp'l, I, 5th Ga., age 36. Cross, L. M., Pt., E, 58th Penn., age 23. Cross, S. V., Pt., D, llth Missouri, age 33. Crouse, J. L., Serg't, C, 31st Georgia. Crowell, B., Pt., L 20th Mass., age 24. Crowell, S., Pt., I, 93d Ohio, age 19. Crowley, R., Serg't, C, 23d Illinois, age 27. Crown, G., Pt., H, 2d Vermont, age 19. Cullen, D. C, Serg't, E, 32d Ohio, age 30. Curtin, T., Pt., G, 147th New York, age 29. Curtis, A. A., Capt., I, 136th N. Y., age 22. Cuthbert. T., Serg't, G, 8th New York Heavy Artillery, age 44. Daley, E., Pt., K, 158th New York, age 18. Damarce, M., Corp'l, A, 25th Iowa, age 23. Danforth, H. J., Corp'l, A,8thN.Y.Art.,agel8. Daniels, H., Pt., D, 1st Louisiana, age 23. Dantz, W. W., Pt., F, 30th Wis., age 18. Dare, H. C, Serg't, C, 56th Ohio. Davage, J., Pt., B, 4th Col'd Troops, age 22. Sept. 2, 2, '62. Aug. 3, 4, rIA. July 1, 1, '63. Sept, 13, 13, '62. Sept. 29, 30, '64. Aug. 29, 30, '62. Aug. 21, 21, '64. Oct. 19, 19, '64. Oct. 19, 20, '64. June 4, 5,'64. June 6, 7, '64. July 3, 3,'63. June 10, 12, '64. June 3, 3, '64. June 22, 22,'64. July 12, 13, *63. Aug. 12, 12, '64. July 1, 2, '63. Aug. 23, 23,'63. Mar. 22, 22, '65. April 6, 6, '65. Nov. 29, De.1,'63. Sept. 29, 30, '64. June 6, 6, '64. Oct, 19, 19, '64. May 10, 10, '64. June 23, 24, '64. April 2, 2,'65. Sept. 19, 19, '64. July 22, 23, '64. Jan. 15, 16, '65. July 20, 20, '64. Oct. 27, 28, '64. Sept. 28, 28. '64. Mar. 20, 20, '65. May 18, 19, '64. June 14, 16, '63. Aug. 25, 27, '64. May 1, 3, '63. June 15, 15, '64. Operations, Operators, Result. Left; flap. Disch'd Oct. 16, '63. Left; circ. Surg. G. A. Otis, 27th Mass. Disch'd Mar. 21, 1805. Left. Surg. J. S. Bruce, C. S. A. Retired Nov. 29, 1864. Left, Surg. J. B. Whitcomb, llth Conn. Disch'd Nov. 25, 1865. Left; circ Disch'd July 31, '65. Left; circ. Surg. J. Y. Cantwell, 82d Ohio. Disch'd Oct. 25, '6J. Right; ciro. Surg. T. F. Oakes, 50th Mass. Prison Mar. 1,1805. Right; ciro. Surg. Patterson,C. S. A. Prison May !>, 1805. Right; flap. Retired March 18, 1865. Right; ant. post. flap. Dec. 6, nec. bone rem'd. Disch'd May 31, 1865. Right; ant. post. flap. Surg. J. E. Murta, 8th Wis. Disch'd Nov. 22, 1865. Left. Surg. Davis, C. S. A. Dec. 15, nec. bone ext. Exch'd Mar. 4, 1864. Right; (also forearm.) Confed. surg. M. out August 10,1865. Right. Disch'd January 25,1865. Right; ant post. flap. Surg.G.L. Potter, 145th Penn. Released July 13, 1865. Right; ciro. Disch'd Oct. 9,'63. Left; circ; gangrene. Recovery Sept. 22, 1864. Right; ant. post flap. Surg. H.C. May, 5th N.Y. Oct. 30, seq. rem. Feb. 2,'64, nec.bo.rem. 3d, haem. Dis.May3,'64. S.pecs.1971, 2153. Right; circ. Surg. J. Owens, U. S. V. M. out Feb. 23, '64. Died June 28, 1870. Left; circ. A. A. Surg. L. W. Beckwith. Mustered out. Left. Mustered out June 25. '65. Right; ant. post. flap. 31 arch 26, '04, reamp. middle third. Pro. Marshal Dec. 1, 1864. Left; cirO. Disch'd March 29, 1865. Left; circ. Surg. L. H. Baker, 24th Mo. M. out July 13,1864. ----Prison February 10, 1865. Right; flap. Surg. H. F. Lyster, 5th Michigan. Dis. Mar. 27, '65. Right; circ. Teal's method. A. Surg. J. M. Weaver, 93d Ohio. Disch'd May 16, 1865. Right; bi-lateral flaps. Surg. J. S. Taylor, 23d 111. Disch'd Oct. 26, 1865. Left; circ. A. Surg. J. J. Meigs, llth Vt. Disch'd June 6,1865. Right; flap. Surg. A. II. Brun- dage, 32d Ohio. Erysip. Disch. March 30, 1865. Right; double flap. Surg. F. B. Kimball, 3d N. H. Nec. bone rem'd. Dis.Oct.21,'65. Spec.ZUi. Flap. Surg. B. L. Hovev, 136th N. Y. Disch'd Jan. 14,1805. Left; ant, post. flap. Surg. F. A. Dudley, 14th Conn. Nov. 19, gangrene. 22, haem.;lig. femor'l. Disch'd July 18, 1805. Right. Disch'd June 24, 1865. Right; ant. post, skin flap. Surg. A. T. Hudson, 26th Iowa Dis. July 23, 1865. Right; circ; bone prot May 26, hiem.; lig. fem. Dis.Ang. 11,'65. Right; flap. Disch'd Sept. 4, '64. Spec. 4301. Right: circ. Confed surgeon. Disch'd Jan. 6, 1866. Left. Disch'd July 16, 1863. Right; circ. Surg.J.W.Mitchell. 4th C. T. Necrosed ; six ins. of shaft rem'd Disc'd May 20,'65. Name, Military Description and Age. Davenport, J. M., Cap't, G, 10th Kentuckv. Davis, A. A., Pi., K, 6th Wisconsin, age 32. Davis, D. D., Corp'l, C, 2d Mich., age 20. Davis, G.S.,Pt.,A,185th New York, age 33. Davis, J., Pt, F, 61st Penn., age 40. Davis, M., Pt, E, 15th Iowa, ago 19. Day, A., Pt., H, 31st C. Troops, nge 20. Day, I., Pt, A, 5th C. Troops, age 24. Day, W., Pt., A, 10th Virginia. Dean, D. W., Pt., 1st Ia. Battery, age 17. Dean, J. M., Pt, K, 3d West Va., age 22. Deichley, S., Pt., I, 53d Penn., age 19. DMinger, P.,— I, llth North Carolina. Delraer, P., Pt., F, 17th Wis., age 26. Demond,G.,Pt.,K, 145th Penn., ago 32. Dempsey, T., Corp'l, A, 2d Vermont. Deptitch, W., Pt., E, 3d Massachusetts. Dewitt, G. M., Corp'l, H, 147th N. York, age 26. Dickerson, P. B., Lt., H, 13th C. Troops, age 32. Dickinson, I., Pt.,H, 53d Indiana, age 19. Digby, C. T, Pt, D,19th Georgia. Dignian, E., Pt., B, 5th Confederate, age 25. Dittman, J. H., Lieut.G, 1st Md. Cav., age 21. Donthil, S. J., Pt, B, 2d South Carolina. Dole, R. D., Corp'l, H, 38th Ohio, age 25. Dooley, W., Pt., Wash- ington Art'y, age 29. Doore, C. F., Pt., K, 31st Maine, age 16. Doran, M., Lieut., C, 14th Mich., age 28. Dougherty, J. H. Capt, B,llthVa.Cav.,age25. Douglas, G. VV., Lieut., G, 8th Tennessee. Douglass, J. A., Pt., D, llth Infantry, age 23. Downey. W. 'C, Pt,, II, 43d Ala., age 32. Doyle, J., Pt, F, Phil- lips's Legion. Downing, J.,V\., K, 55th Alabama, age 25. Drane, R., Pt., G, 52d Virginia, age 23. Driver, J.. Pt,, II, 3d Wis., age 18. Drumm, G. W., Pt., I, 82d Ohio. Druse, E. H., Corp'], A, 5th Minnesota, age 20. Duel], C. N., Pt., H, 9th N. Y. H. A., age 35. Dugan, W. C., Serg't, F, 03d Ohio, age 20. Duncan, J. II., Serg't, B, 79th New York. Dnnlap, W., Pt.. I, 9th New York, age 24. Dunn, A., Pt,, A, 53d Ohio, age 21. Sept. 1, 2, '64. Mar. 31, 31, '65. Nov. 24, 24, '63. Mar. 31, April 1, 1865. Aug. 21, 21,'04. July 5, 5, '64. Sept. 15, 15,'64. Sept. 29, Oct. I,'04. Aug. 28, 29, '62. Aug. 31, 31, '64. Sept 22, 22, '64. Mar. 31, 31, '65. May 5, 5, '64. July 28, 21), '64. Dec. 13, 13, '62. Mav 3, 3, 63. Dec. 17, 17, '62. Feb. 6, 6, '65. Dec. 15, 15, '64. July 22, 23, '64. Aug. 9, 10Y62. May 16, 16," '64. Aug. 16, 16, '64. July 1, 1. '62. Sept, 1, 2, '64. Dec. 7, 8, '64. April 2, 3, '65. Mar. 19, 19, '65. Nov. 12, 12, '64. Aug. 6, 6, '64. June 18, 19, '64. May 10, 16, '64. Nov. 29, 29, '63. Nov. 30, De. 1, '64. Dec. 13, 13, '62. May 25, 25, '64. Aug. 29, 30, '02 Dec. 16, 17, '64. Oct 19, 19, '64. May 25, 25, '64. Oct. 10, 10, '63. July 30, 30, '64. Aug. 30, 30, '64. Operations, Operators, Result. Right; flap. Surg.G.E.Sloat,14th Ohio. Mustered out Dec. 6, '64. Right; long ant. flap. Surg. J. C. Hall, 6th Wis. April 4, hiem.; lig. femor'l. Aug. 18, dead bone rem'd. Disch'd Sept. 14,1865. Left; circ. Confed. surg. Mar., '64, nec. June 1, gang. 11, nec. bone rem'd. Disch'd Aug. 3,'64. 1870, stump tender. Right; ant. post. flap. Surg. C. W. Crary, 185th X. Y. Disch'd July 2ff, 1805. Left; flap. Surg. G. T. Stevens, 77th N. Y. Disch'd June 16, '65. Right; lat. flap. Surg.W.H. Gib- bon, 15th Iowa. Sept 10, gang. Disch'd May 26, 1865. Right; circ. Jan. 7,'65, nec. bone rem'd. Disch'd June 10,1865. Left; bi-lat. flap. Confed. surg. Disch'd Aug. 31, 1865. Left. Surgeon Walls. Recovery. Left; flap. A. Surg. D. Haider- man, 40th O. Dis. May 9, '65. Left; flap: bone prot. Dec. 30, rem. of bone. Disc'd May 30,'65. Left; bi-lat, skin flaps. Surg. W. Vasburgh, 111th N.Y. Disch'd August 2, 1865. ----. Surgeon Wilson, C. S. A. Recovery. L't; lat. flap. Surg.H.McKennan, 17th Wis. V. R. C. April I,'65. Left. Disch'd Feb. 26, 1863. Right; flap. Disch'd April 19, 1864. Right; flap. Surg. A.A. Stocker, 3d Mass. Mustered out. Left; flap. Surg.A.S. Coe, 147th N. Y. Disch'd June 22, 1865. Left; circ. Surg.F.W.Lytle, 36th Illinois. Furfd Feb. 7, 1865. Right; circ. Confed. surg. Dis. June 20, '05. Reamp. Sept.,'66. Left. Surg. R. Battey, C. S. A. Recover)'. Left: circ. Surg. L. D. Harlow, U. S. V. Pro. Mar. June 16, '65. Left; flap. Surg. R. A. Dodson, IstMd.Cav. Disch'd Jan. 12,'6S. Left. Surgs. Salmon and Page. Recovery. Right; ant. post. flap. Surg. J. Haller, 38th O. Dis. May 20,'65. Left; ant. post. flap. A. A. Surg. J. R. Owens. Provost Marshal March 1, 1865. Left; circ. Surg. — Hays. Frag. bone rem'd. Dis'd July 18.'65. Left; circ. Surg. E. Batwell, 14th Mich. Disch'd Oct. 17,1805. Left; ant. post. flap. Sloughing. Exchanged Feb. 16,1865. Left. Surg. A. M.Wilder, U.S.V. Mustered out June 30,1865. Right; circ. To Regiment Feb. 18, 1865. ----; circ. Furloughed August 23, 1861 Right. Surg. J. S. Ross, llth N. II. Sent to Confederate lines. Left; ant. post. flap. Provost Marshal March 17, 1865. Right. Doing well. Right; circ. Discli'd June 22, 1865. Left. Surg. J. Y. Cantwell, 82d Ohio. Disch'd Feb. 23, 1863. Left; ant. post flap. Surg. V. B. Kennedy, 5th Minn. Disch'd June 5,1865. Right; flap. Disch'd June 9, '65. Left; flap. Disch'd Jan. 2, '65. Left; ant. post. flap. Surg. J. P. Prince. 30th Mass. Discharged. Right; lat. flap. Nov. 9th, gang.; haem. 22, lig.: erysip. Disch'd May 15. '65. 1870, stump slou'g. Right; cue. Surg. S. P. Bonner, 47th O. Disch'd May 3, 1865. 248 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. Name. Military Description, and Age. 238 239, 240j 241 242 243 244 245 246 248 254 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 Dunn, J. W., Pt., K, 3d Wisconsin. Dunn, M.,Corp'l, H, 46th Penn., age 21. Dver, J., Pt. F, 89th N York, age 20. East, T.J.,Seig't, 1,13th Alabama, age 22. Eastwood, J. S., Pt., H, 48th Illinois, age 19. Edge, W. L., Pt., G, 10th S. Carolina, age 23. Edmonds, J. J., Pt., D, 90th Penn., age 38. Edwards, G., Pt., C, 20th North Carolina, age 19. Edwards,G., Pt., F, 30th C. Troops, age 21. Ehle, J. N., Pt., D, 2d Wisconsin. Ehle, W., Pt., A, 14th New York. Eidson, J. W., Lieut.. G, 7th South Carolina. Elam, R. S., Corp'l, E, 22d Va. Bat'ry, age 32. Elfwing, N. A., Major, 48th N. Y., age 33. Elliott, J. J., Pt., L, 1st Maine Cav., age 20. Ellen, H., Pt, C,3dMo., age 27. Ellis, F., Pt., B, 21st Me. Ellis, R., Pt., C, 81st In- diana, age 21. Ellsner, C, Pt., B, 20th Mass., age 25. Ellwood, .L, Pt., I, 2d Mich., age 28. Embree, H. A., Pt, C, 5th N.Y. H. A., age 23. Emerson, S., Corp'l, C, 8th Maine, age 44. Eschbach,H.,Pt.,I.118th Penn., age 48. Estle,J.L.P.,Pt,H,27th Ohio. Estes, B. F., Pt.,F,10th Kentucky, age 24. Evans, J. B., Pt.,D,24th lnd., age 26. Everly. A. F.,Pt.,A,Wth Virginia. 'Ewell. TJ.S.,Lieut-Gen- eral. 2Fabry, J., Pt, K, 4th Artillery, age 38. Fagan, J. B., Lt.-Col., 15th Ala., age 29. Fagar, W.. Pt., B, 59th New York, age 19. Farley, C. J., Capt., B, 5th X. Y. Cav., age 42. Fasnacht, W. E., Pt., G, 147th Penn., age 20. Fawlks, N. G., Pt., D, 13th Tenn. Cavalry, age 45. Fay, J. S., Pt., F, 13th Massachusetts. Ferguson, D., Lieut., A, 113th Illinois, age 27. Field, A., Corporal, C, 113th Ohio, age 29. Finke, F.,Corp 1, F, 10th Illinois, age 26. Finnegan, T., Pt., F, 72d New York, age 45. Dates. June 9, 9, '63. May 25, 26, 27, 1864. June 4, 5, '64. Aug. 19, 19, '64. July 21, 21, '64. De.31,'62 Jan. 1,'63. June 19, 19, '64. Julv 9, 9, '64. July 30, 30, '64. Sept. 14, 15, '62. July 1, 2, '62. Sept. 20, 20, '63. Julv 2, 2, '63. Feb. 21, 21, '65. Aug. 25, 26, '64. May 28, 28, '64. May 27, 28, '63. June 23, 23, '64. May 5, 6, '64. Mar. 5, 5, '64. July 18, 19," '64. July 24, 26, '64. June 22, 22, '64. Mar. 13, 13, '62. Sept. 1, 3, '64. April 9, 9, '65. Aug. 28. 28, '62. Aug. 30, 30, '62. Aug. 16, 17, '64. July 3, 3, '63. Aug. 14, 15, '64. Sept. 19, 20, '64. May 25, 26, '64. April 12, 13, '64. April 30, 30, '63. Jan. 11, 11, '63. June 22, 22, '64. Mar. 21, 21, '65. July 23, 24, '63. Operations, Operators, Result. Right. Disch'd February 9, '64. Both; circ; (h'd of r't fib. exc. on 25th;) gang. Aug., '64, reamp. right mid. third May, '65, nec. bone rem'd from left. Disch'd Aug. 17, '65. Died Oct. 23, '77. Spec. 3193. Left; circ Disch'd June26, '65. Right; circ. A. Surg. A. E. Ar- nold, C.S.A. Trans. Nov. 29,'64. Left;doub.flap. Surg.W.Lomax, 12th lnd. Disch'd July 2,1865. Left; circ. Furl'd June 16, '63. Left; circ. Snrg. D. A. Chamber- lain, 94th N. Y. Sub. operat'n. Dis. Sept.21,'64. '70,bad stump. Right, Surg. — Bissell, C. S. A. Exch'd Sept. 21, 1864. Retired Jan. 17, 1865. Right; flap. Surg. G. J. Potts, 23d C. T. Feb., 1865, nec. bone rem'd. Disch'd July 26,1865. Left; flap. Disch'd Mar. 5,1863. Right; flap. Discharged. Right. Surg. — Carlisle. Re- covery. Right. Sept. 23, nec. bone rem'd. Provost Marshal Oct. 13, 1853. Right; circ. Surg. A. D. Palmer, 9th Me. M. out Sept. 12,1865. Right; flap. Confed. surgeon. Discli'd June 30, 18 Age. Gill, C, Corp'l, F, 105th Penn., ago 22. Glass, X, Corp'l, G, 48th Mississippi. Gomer, A. /'., Lieut., F, 3d Virginia, ugc 27. Goodex, L., l't!", E, 29th Penn., age 22. Gorman, W. H, Pt.,—, 1st Maryland Battery. Gorman, "T. J., l't, —, 83d Ohio, ago 21. Gould, H. P., Serg't, G, 12th Kentucky, age 24. Gould J-, Pt, H, 2d Col'd Troops, age 40. Graeter, C, Pt, K, 7th Ohio. Graham,M.J.,Lieut., F, 9th New York, age 25. Grant, G., Pt., K, 161st New York, age 18. Greene, C. T-, Capt. and A. A. General, U. S.V., age 22. Green, J., Pt., B, 34th New York, age 24. Green, J.. Pt, B, 6th Penn..Cavalry. Green, P., Pt., F,3dVt, age 33. Greenleaf, R., Seaman, U. S. S. Iroquois. Greenlief, IL, Corp'l, G, 17th Mass., age 25. Greer, J. S., Pt., I, 43d Ohio, age 28. Greer, T. I., Lieut., B, 18th S. C, age 22. Griffin, J., Pt, B, 9th Maine, age 27. Griffin, J. J., Pt., L 50th Georgia, age 27. Grimes, S. &., Corp'l. C, 47th Alabama, age 21. Grim, D. D , Pt, D, 1st Cavalry, age 23. Gronoble, I. I , Pt., I, 148th Penn., age 18. Grouse, B., Pt, B, 13th Conn., age 25. Graver, J. JF.,Pt,E,29th Georgia, age 20. Guenther, H.,Pt ,G,65th Illinois, age 24. Haberkern, J., Pt., L 7th Wisconsin, age 21. Hagemyer, A., Pt, C, 15thN.Y.H.A.,age30. Hair, R. A., Pt, E, 5th S. Carolina, age 32. Halfpenny, J., Pt., H, 90th Penn., age 18. Hall, J.W., Capt., K, 4th N. Y. Cavalry, age 23. Hall, M. Y., Pt., A, 31st Virginia. Hall, W., Pt, H, 4th W. Virginia. Hamilton, J. F., Pt., G, 39th Illinois, age 21. Hammer, L., Pt, C, 47th Ohio. Hampel, A., Corp'l, E, 82d Illinois, age 28. Hampton, T. E., Pt., I, 14th South Carolina. Hamrick,A., Pt., E, 4.1th Tenn., age 25. Hancock, J. W., Pt, H, 1st Kentucky Cavalry. Hancock, W. L., Pt., D, 42d Miss., age 25. Hardendorf, A., Pt., D, 6th N. York Cavalry. Oct. 27, 29, '64. June 27, 27, '64. July 3, 3, '63. May 15, 15,"'64. June la, la, '03. April 8, 10, '01. Aug. 0, 0, v04. July 1, 1, '04. Sept. 17, 17, '02. Sept. 17, 17, '62. April 8, 10, '04. Nov. 27, 27, -63. Sept 17, 19, '62. July 3, 5, '63. May 5, 7, '64. April 22, 22, '62. Dec. 17, 17, '62. May 14, 14, '64. Mar. 29, 29, '65. Oct. 27, 27, '64. July 2, 3, '63. Oct. 7, 8, '64. May 7, 7, %4. May 10, 11, '64. April 14, 14, '63. Nov. 30, De. 1, '64. Nov. 26, 26, '64. Feb. 6, 7, '65. Mar. 31, 31, '65. May 29, 31), '64. Aug. 20, 20, '64. June 11, 12, '64. May 5, 5, "64. May 19, 19, '63. Oct. 13, 13, '61. Mav 22, 22," '63. Mar. 16, 16, '05. July 1, 2, '63. Nov. 30, De. 1,'64, Jan. 17, 18, '65. July 1, 2, '63. Aug. 29, 29, '62. Operations, opkuatoi Result. Right; ciro. Surg. — Smith, C. S. A. Disch'd June 28,1865. Left. Recovery. Left ; ciro. Surg. Mayo, ('. S. A. Provost Marshal Oct*, la, 1803. Left; llap. A. Surg.W. la Smith, 28th l'enn. Abscess : bono prot. Discli'd July 1, into. ----. Surg. Hunter. Recovery. Left; flap. Surg. J. F. ness, 90th Ohio. Disch'd Aug. 30,1804. Right; circ. Surg.W.II. Mullins, 12th Ky. Disch'd July 14, '65. Left; circ: nec. bono discharged. Disch'd July 27, 1805. Left; circ. Disch'd Dec. 18, '62. Right; circ. Surg. (!. H. Hum- phreys, 9th N. Y. M. out May 20, '03. Spec. 1436. 1 .eft; ant. post flap. Surg. J. F. Hess, 96th O. July 21, '05, nec. bone rem. Disch'd Aug. 10,'65. Right; flap. Surgs. J. L. Dunn, 109th Penn.and J. A. Wolfe,29th Penn. M. out Sept. 19,1865. Right; flap; two ins. bone rem'd; slough. Disch'd Mar. 10,1863. Right; circ. A. Surg. R. F Weir, U. S. A. Disch'd Sept. 1,1803. Spec. 3897. Left; ant post flap. Surg. E. Phillips, 6th Vt. Disch'd May 31, 1805. Right. Surg — Vreeland.U.S.N. Discharged. Left; flap. Surg. I. F. Galloupe, 17th Mass. Disch'd May 31,'03. Left; circ. Surg. F. M. Rose, 43d Ohio. Disch'd July 29, '05. 1870, stump discharging. Left; circ. Released June 9,'65. Left; circ. Surg. A. M. Clark. U. S.V. Gang. Disch. Jan. 30,'66. Left; flap; haem. recurrent. Ex- changed Nov. 12,1863. Left. Recovery Feb. 28,1865. Left. Discharged July 22,1864. Left; circ Surg.W.C. Byington, 183d Penn. Disch'd June 8,'65. Right; flap. Disch'd Oct. 10,'63. Left; circ. Provost Marshal Mar. 1, 1865. Right; circ. Surg. — Dunn, 58th N. C. Disch'd July 31, 1865. Right; circ. June 1, reamp. flap, mid. third. Disch'd Nov. 1, '65. Right; flap. Surg. A. A. White, 8th Md. Disch'd Sept. 20,'65. Left; lat. flap. Surg.O.B.Gibson, C. S. A. Recovered. Left; flap. Confed. surg. Disch'd Sept. 8, 1865. Lett; flap. Surg. B. G. Streeter, 4th N. Y. C. M. out July 17,'65. Left Surg. Atkinson, C. S. A. Retired Dec. 14,1864. Right; flap. Surg. E. D. Kittoe, U. S. V. Disch'd Mar. 4,1864. Right; flap. Surg.C. M. Clark, 39th 111. Reamp. upper third. Disch'd June 5,1865. Right; flap. Surg. S. P. Bonner, 47th Ohio. Disch'd Oct. 6,1803. Right; ant. post, flap (Skey's). Disch'd Sept. 7,1865. Right Surg. L.V. Huot, C. S. A. Paroled Sept. 5, 1863. Right; ant. post. flap. Provost Marshal March 21,1865. Left; flap. Surg. H. Brown, 1st Ky. Cav. Disch'd Aug. 1,1865. Right; flaps sloughed. July 24, reamp. middle third. Paroled Sept, 5,1863. Left; circ. Disch'd Jan. 13,1863. Name, Military Description, and Age. Hardee, T. J., Capt, II, 9th Georgia. Harding, J., l't., A, 86th Indiana, ago 28. Harding, It., Pt, I, 13th Col'd Troops, ago 22. Hardy, A. T., Pt,A,8th Maine, age 25. Hare, S. P., Lieut., D, 49th Ohio, age 23. Harley, L).,Corp'l, I, 73d Penn., age 30. Harold, W.O., Serg't, B, 57th Alabama, age 25. Harper, W., Pt, B, llth Virginia. Harris, H.D.,Pt.,D, 7th New Hampshire. Harris, W. C, Pt, A, 3d Alabama. Harrison, W. H., Pt., E, 39th N. Jersey, age 32. Hart, B. F., Pt, C, 55th Virginia, age 21. Harding, E., Pt., K, 93d Penn., age 19. Hartman, J., Pt., A, 37th Wisconsin, age 16. Hartler, J., Pt., E, 50th Penn., age 20. Hastey,N.B.,Y\., E, 20th Georgia. Hatch, M. T., Serg't, B, 3d Vermont, age 25. Haverfield,G.A., Serg't, H, 120th Ohio, age 24. Hayes, J., Serg't, A, 5th North Carolina. Hayes, T, Pt., E, 25th N. Carolina, age 28. Haynes, G., Pt,, B, 26th Hlinois. Headley, A., Pt., C, 2d Rhode Island, age 25. "Heckert,P.,Pt,F,120th Ohio. Hearing, J., Lieut., G, 58th Ohio. Heath, P., Pt., A, 9th N. York Cavalry. Hebing, G.A., Pt., I, 23d Iowa. Heizeman,H.,Pt,D,77th Penn., age 19. Helen,G. F.,Pt,B, 114th Penn., age 18. Hellings, J., Pt., H, 5th Penn. Cav., age 22. Henderson, A., Pt, E, 86th N. York, age 22. Henry, M., Pt., I, 69th Ohio, age 19. Hensel, C. W., Pt., D, 66th Indiana, age 20. Hensley, E., Corp'l, I, 39th Kentucky, age 18. Herrin, T. J.,Vt., F, 10th Georgia, age 21. Herron, E. R., Capt., D, 4th Wisconsin, age 24. Hickey, C. M., Pt., H, 7th Louisiana. Hickey, N., Serg't,C,7th N. Y. H. A., age 23. Hill, J., Corp'l, B, 123d Indiana, age 27. Hill, J. W., Pt., I, 10th Alabama, age 23. JHiller, W. P., Pt., A, 2d N. Y. H. A., age 41. Hines, J. D. E., Pt, H, 4th Alabama. Hinson, T., Pt., G, 39th Indiana. Hinson, W. H, Pt., H, 25th N. C, age 37. Nov. 16, 16, '63. Nov. 25, 20, '03. De 17, 17, '04. May 10, 16,"'04. May 27, 27,"'64. Nov. L.r>, L'a, '03. Nov. 30, De. 1,0-1 Jan. 24, 25, '01. July 18, l'J, '03. Oct. I'.I, 20, '04. April 2, 3, '05. Dec. 13, 13, '02. Sept. 19, 19, '64. June 19, 20, '64. Mav 12, 13," '64. May 6, 6, '64. Oct. 19, 19, '64. Sept 21, 22, '64. Sept. 19, 19, '64. Feb. 14, 14, '65. Aug. 3, 3, F64. May 5, 6, '64. July 10, 10, '63. April 29, 29, '63. June 11, 11, '64. May 17, 17, '63. May 14, 14,'64. Julv 2, 3, '63. April 2, 2, '05. Aug. 14, 14, '04. Nov. 25, 20, '63. Mav 14, 14," '64. Oct. 2, 2, '64. April 6, 6, '65. May 27, 27, '63. July 1, 1, "63. Oct, 12, 12, '64. July 28, 28, '64. Oct. 28, 29, '64. July 27, 27, '04. Mav 6, 6, '64. April 7, 8, '62. Sept. 19, 19, '64. Operations, Operators, Result. Right. Surg —Gilmore, C. S. A. Recovery. Left; flap. Surg. W. T. Burgess, 17th Ky. Disch'd Nov. 12, '64. Left; flap. A. A. Surg. J. S. Gilt- ncr. Disch'd Oct, 12,1865. Left; double flap. Duty Dec. 14, 1804. Right; ciro. A.Surg.W.H.Park, 49th O. Disch'd Oct. 25,1864. Left. Discharged May 30, 1864. Died Sept. 14,1869. Left; ant. posterior flap. Provost Marshal March 1, 1805. ----. Surg. — Tripler, C. S. A. Recovered. Right; flap. Surg.W.W.Brown, 7th N. H. Disch'd Mar. 4,1604. Left; circ. Surg.J.M.G.McGuire, C. S. A. Prov. Mar. April 8,'65. Left; circ. Surg. J. H. Kimball, 31st Me. Disch'd Aug. 18,1865. Left. Surg. —Spence, C. S. A. Retired April 1,1865. Right: double flap. Subs, opera. Disch'd March 23,1666. Lett; flap. Surg. W. B. Fox, 8th Mich. June 27, haem.; lig. fem. Disch'd Aug. 14,1805. Left; circ; gangrene; bone prot. Disch'd Aug. 19,1865. Left. Surgeon — Secan, C. S. A. Recover}-. Right; ant. post flap. Surg. E. Phillips, 6th Vermont. Siough- ing. Disch'd July 25, 1865. Right; gangrenous. Discharged May 22, 1865. Right; circ. Surg. Hicks.C.S.A. Released April 1,1865. Left. Paroled May 11, 1865. Right; circ. Surg. J. H. Hutchi- son, 15th Mich. Disch'd Aug. 28,1804. Feb. 28,1865, flap re- amp. middle third. Left; flap. Sept. 15, necro. bone remo. Disch'd May 4,1865. Left; flap. Disch'd Oct. 7,1863. Left; flap. Disch'd Dec. 23, '63. Left; flap. Duty Sept. 1,1864. Left; circ. Surg. J. C. Ross, 94th 111. Disch'd Aug. 17,1863. Right; flap. Surg. S. 11. Kersey, 30th lnd. Disch'd Mar. 28, '05. Right; flap. Healed by first in- tention. Disch'd April 12, '64. Right; flap. Disch'd July 19, 1865. Left; circ. Disch'd April 26, '65. Left; lat. flap. Surg. L. Slusser, 69th Ohio. Nec. bone removed. Disch'd Feb. 0,1865. Right; flap. Disch'd Jan. 13,'65. Right; circ. Surg. J.G. Hatchitt, U. S. V. Disch'd June 20,1865. Left; flap. Released June 14,'65. Right. Disch'd Nov. 20,1863. Left. Surg. — Davis, C. S. A. Recovery. Left; circ. Surg. J. E. Pomfret, 7th New York Heavy Artillery. Disch'd Aug. 15, 1865. Right; flap. Surg. A. M.Wilder, U. S. V. Disch'd June 24,1805. Right. Disch'd Jan. 15,1805. Left. Teale's op.; ant. post. flap. Surg.J.W.Wishart, 140th Penn. Disch'd April 3,1865. Right. Surg. — Hudson, C. S. A. Recoverj-. Right; flap. Disch'd Sept 25,'63. Right; circ. Surg. Bissell, 28th N. C. Prison Jan. 5,1865. 'Bryan (J.), Cases of Amputations from the Armies of the Southwest, in Am. Med. Times, 1863, Vol. 7, p. * O'Meagher (W.), Surgical Cases from Field Hospitals, in Med. and Surg. Rep., 1865, Vol. XII, p. 253. SURG. Ill—32 B, Case XXXI. 250 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 436 438 439 441 442 443 444 445 447 Name, Military Description, and Agk Hitt, H. L., Pt., F, 3d South Carolina. Hodgins, I. M., Pt., D, 34th N. C, age 30. Hoffman, P., Corp'l, B, 107th Ohio, age 21. Hoge, W. F., Pt., Kirk- patrick's Battery. Hollingshead, A.,Pt, K, 2d West Virginia. Holt, A., Pt., G, 12th N. Carolina, age 20. Hopkins, O., Pt., K, 7th Michigan. Hopkins, W.,Pt.,C,lllth Penn., age 21. Horner, G. W., Pt., G, 17th Ohio, age 22. Horton, W. M., Serg't, B, 81st N. Y., age 34. Howard, H. H., Pt, G, H4th N. Y., nge 23. Howard, T.M. l).,Pt.,L, 1st Me. H. Art, age 20. Howald, C, Corp'l, K, 10th Mich., age 21. Howe, R.P.,Pt.,G,120th New York, age 23. Howland, J., ---, B, 1st Georgia. Hoyle,B.M., Pt, F, 34th North Carolina. Huffman, J., Corp'l, M, 1st Penn. Cav , age 28. Hughes, E., Pt., 1, 55th Penn., age 22. Hume, J.,Lieut.,F,140th New York, age 31. Humphries, H., Pt., I, 45th Alabama, age 31. 'Humphrey, W. H., Lt, G, 4th Vermont, age29. Hunt, C. E., Lieut., C, 59th N. York, age 26. Hunter, B. F., Pt,, K, 19th Georgia, age 23. Hunter,C.,Corp'l,G,25th Indiana, age 21. Hutton, .ff.,Serg't, B,62d Virginia, age 20. Ingraham, F., Pt, E, 1st Maine Cav , age 22. Irby, A. V., Pt., D, 44th Virgiuia. Ivers, J., Pt, K, 10th Iowa. Jackson, J., Pt,, A, 22d Cl'd Troops, age 25. Jacobs, J., Pt., K, 1st Mo. Janney, J., Pt., B, 14th New York. Jarvis, R., It., E, 3d N. Hampshire, age 19. Jenkins, E., Pt., K, 125th Illinois, age 19. Johnson, L. D., Pt., F, 9th Tenn. Cav., age 44. Johnson, S., Pt., D, 23d Massachusetts. Johnston, T., Pt., H, 8th New York, age 24. Jones, D. M.,Lieut-Col., 110th Pennsylvania. Jones, E. XV., Serg't, H, 26th Illinois, age 26. Joss, J. C, Lieut, G, 2d Michigan, age 23. Judge, T.,.Serg't, H, 62d New York, age 32. Kahl, M., Pt, A, 37th O. age 37. Kane, J. J., Lieut, H, 6th Ala., age 24. Kaufman, W. H., Pt., A, 9th Penn. Cav., age 20. Kay lor, A., Corp'l, I, 2d Ohio Cav., age 25. Kean, J., Pt., E, 42d N. York, age 30. July 1, 1, '62. July 1, 1, '63. Julv 2, 2, '63. June 3, 3, '64. June 8, 9, '62. May 2, 2, '63. June 1, 1, '62. July 3, 4, '63. May 14, 14,"'64. June 3, 5, '64. Sept, 19, 19, '64. June 18, 19, '64. Sept. 3, 3, '04. July 30, 30, '64. Sept. 14, 14, '62. June 27, 29, '62. July 28, 28, '64. Sept. 29, 30, '64. Mav 5, 5, '"64. Nov. 29, 29, '64. April 2, 2, '65. Mav 9, 10, ''64. July 7, 7, '64. Aug. 10, 12, '64. Sept, 19, 19, '64. Aug. 23, 23, '64. Sept. 17, 17, '62. May 16, 17, '63. Sept. 29, 30, '64. Sept. 2, 2, '64. July 1, 2, '63. May 13, 15, '64. July 19, 19, '64. Aug. 14, 14, '64. Mar. 14, 14, '62. June 3, 4, '64. July 2, 2, '63. Mar. 22, 22, '65. May 6, 6, '64. Oct. 19, 19, '64. Mar. 21, 22, '65. Julv 2, 2, ''63. Dec. 31, 31, '02. Mar. 31, Ap. 1,'65. Mav 12, 12," '64. Operations, Operators, Result. Right. Surg. — Samniond, C. S. A. Disch'd October 14,1862. Left; flap. Exchanged Nov. 12, 1863. Left; circular. Surg.— Purcell. Disch'd July 30, 1864. ----. Surg. — Capers, C. S. A. Recovery. Left; flap. Surg. R. W. Hazlett, 2d W. Va. Disch'd Aug. 22,'62. Left;circ. Surg. — Hicks.C.S.A. Furl'd Oct. 4, 1864. Right. Surg. A. N. Dougherty, U.S.V. Disch'd March 5, 1863. Lett. Surg. G. P. Oliver, 111th Penn. Discharged. Right; double flap. Vet. Reserve Corps Jan. 14,1865. Left; circ Disch'd Jan. 19,1865. Left; circ; necrosis. Discharged May 20, 1865. Right; flap. Duty Oct. 26,1865. Right; flap. Surg. C. H. Mills, 125th 111. Mustered out, 1865. Right; ant. post. flap. Disch'd Jan. 7,1865. ----; flaps sloughed; bone prot. rem'd; small arts. tied. Recov. Left. Surg. Ross. Retired Feb. 23, 1865. Left; circ. Disch'd May 20, '65. Stump unsound in 1870. Right; flap. Surg. — Mitchell, C.S.A. Nec.; rem. seq. Disch'd Feb. 28,1866. Left. Disch'd Oct. 12,1864. Left; circ. Provost Marshal May 6, 1865. Right; flap. Surg.C.B.Park,jr., llthVt. Pyaemia. Disc'd Aug. 3, 1865. Left; flap. Surg.W. J. Burr, 42d N. Y. Disch'd Sept 30,1864. Right; (also wound of right arm.) Retired January 13,1865. Right; circ. Surg. F. M. Rose, 43d Ohio. Hasm.; gang.; necr. bone ext'd, 1865. Disch'd Dec. 3,'65. '70, stump open. SpA24T. R't; circ. Surg. — Love,C.S.A. Sloughing. Prison Feb. 16,'65. Left; flap. Surg. W. B. Rezner, 0th O. Cav. Discli'd June 24,'65. Right. Furloughed Nov. 21,'64. Left; flap. Disch'd Aug. 14, '63. Right; circ. Disch'd April 10, '65. ----. Surg.A. H.Ramsie.C.S.A. Recovery. Left; circ Disch'd April 12,'64. Left; double flap. Feb.24, reamp. nec. bone. Disch'd Oct. 26,'65. Right; ant. post. flap. Disch'd Sept. 9, 1865. Right; circ Prov. Marshal Nov. 16, 1864. Left; circ. Surg. G. Derby, 23d Mass. Discharged. Right; flap. Surg. M. Rizer, 72d Penn. Disch'd May 31, 1865. Left; circ. Surg. D. S. Hays, 110th Penn. Disch'd Oct, 9,'63. Right; flap. Surg. A. Sabine, 76th Ohio. DisclPd June 18, '65. Left. Surgeon E. J. Bonine, 2d Mich. Disch'd Sept. 26, 1864. Left; ant. post. flap. Discharged April 10, 1865. Left; bilateral flaps. Surg. F. N. Barnes,] 16th 111. Dis.Oct.21,'65. Left. Surg. Whitfield, C. S. A. Provost Marshal March 17, '64. Left. Disch'd Sept. 18, 1863. Right; circ. Mustered out June 6, 1865. Left; flap. Surg. W. J. Burr, 42d N. Y. Disch'd Feb. 16, 1865. 448 Name, Military Description, and Age. Keegan, J., Corp'l, D, 58th Pennsylvania. Keep, D. S., Corp'l, I, 142d Penn., age 25. Keller, C, Pt., B, 43d Illinois, age 19. Keller, S. P., Corp'l, E, 1st Maryland, age 23. Kelley, E.,Corp'l,C,25th Indiana, age 26. Kelley, J., Pt., H, 60th Indiana, age 39. Kelley, J. R., Pt., B,14th Georgia. Kelly, T. J., Pt., D, 49th New York, age 19, Kelly, T., Pt., G, 183d Penn., age 35. Kelly, V. B., Corp'l, B, 108th N. York, age 22. Kelly, W., Pt., I, 100th Indiana, age 26. Kemp, R., Pt., K, 6th N. Y. H. A., age 33. Kennedy, J., Pt., G, 42d New York, age 42. Kennedy, J.,Pt.,B, 110th Pennsylvania, age 20. Kennedy, J.,Pt.,C, 157th Pennsylvania, age 19. Kennison, A , Pt.,A,19th Maine, age 39. Keough, P., Pt., C, 33d New Jersey, age 24. Kimball, W. H., Lieut., D, 47th Ohio, age 21. Kimberly, E. P., Pt,, C, 10th Vermont, age 20. Kincaid, W. H., Capt., I, 93d New York. King, J., Pt., D, 124th Ohio, age 18. King, J. J., Pt., D, 60th Alabama. Kingsbury, A., Pt., I, 117th N. York, age 20. Kircher, H., Capt, E, 12th Missouri. Kirkham, A. W., Pt, A, 115th N. Y., age 32. Kirkman, B., Serg't, K, 10th Louisiana. Kirkwood, B. F., Corp'l, H, 7th Md., age 23. Kishbauch, A., Pt., I, 143d Penn., age 21. Kittlein, J., Pt, D, 8th Maryland, age 21. Klett, J., Pt., F, 5th N. YorkH'vyArt.,age36. Klinegger, F., Pt., I, 41st Ohio, age 32. Klinger, C , Pt., E, 33d Ohio, age 19. Knight, A. J., Corp'l, C. 37th Mass., age 26. Knight, D. E., Pt., B, 17th South Carolina. Knight, E. O., Pt, K, 97th New York, age 18. Knight, F.W., Pt,E, 9th Maine, age 24. Knight, W. A., Pt., H, 4th R. Island, age 25. Krause, J., Pt., B, 7th Wisconsin, age 35. Kresgie, F., Pt, I, 81st Penn., age 24. Kretzler, A., Corp'l, D, 162d New York. Dates. Operations, Operatoeb, Result. Kuble, J. U., Pt., K, 2d Aug. 28 Wisconsin. Sept. 30, 30, '64. May 5, 5, '64. April 6, 8, '62. Aug. 18, 19, '64. Mar. 21, 21, '65. Nov. 3, 3, '63. May 23, 24, '64. May 4, 5, '63. June 3, 3, '64. May 10, 12, '64. Nov. 23, 23, '64. May 30, 31,'64. May 12, 12, '64. Aug. 16, 16, '64. June 19, 19, '64. July 2, 2, *63. May 13, 14, '64. Aug. 4, 4, ?64. Sept. 19, 21, '64. Aug. 16, 16, '64. Dec 16, 16, '64. Aug. 29. 29. '64. Sept, 29, 29, '64. Nov. 27, 27, '63. Feb. 20, 20, '64. May 4, 4, '63. Aug. 18, 19, '64. May 12, 12, '64. May 5, 7, '64. Aug. 25, 27, '64. Dec. 15, 15, '64. Aug. 5, 5, ^64. April 2, 2, '65. Mar. —, —, '65. May 5, 6, '64. July 27, 27,"'64. Sept, 17, 17, '62. Mar. 31, Ap.1'65. Aug. 16', 16, '64. June 14, 14, '63. 30, '62. Left; flap. Duty. Jan. 29, 1866, mustered out. Left; circ. Discharged Sept. 27, 1864. Left: reamp. upper third; necro. bone rem'd. Disch'd Mar. 9,63. Right; ant. post. flap. Surg. A. A. White, 8th Md. Dis. May 14, '65. Right; ant. post. flap. Surg.A.B. Monohan, 63d Ohio. Disch'd July 9, 1865. Right. Disch'd March 10, 1864. Right. Surg. — Henderson, 14th Georgia. Recovery. Left; long ant., short post. flap. Disch'd Aug. 23,'64. '67, reamp. Right; flap. Surg. P. E. Hubon, 28th Mass. Disch'd Mar. 2, '65. Spec. 2934. , Right; flap. Surg. F. M. Wafer, 108th N. Y. Duty Sept, 19,1864. Left; lat. flap. Surg. B. N. Bond. 27th Mo. Disch'd June 9, 1865. Right; flap. Disch'd Sept. 21,'64. Right; circ Surg. S. H. Plumb, 82d N. Y. Seq. rem. Disch'd Oct. 5, 1865. Right; flap. Surg. D. S. Hays, 110th Penn. M. out Jan. 17,'66. Right; flap. A.Surg.N.R.Barnes, 76th N.Y. Disch'd June 30, '65. 1870, not healed. Right; flap. Disch'd Sept. 19, 1863. Left; circ. Surg.N. Gay, U. S. V. Gang. Dec. 2, reamp.,circ,mid. A. Surg. J. T. Calhoun, U. S. A. Disch'd Aug. 20, '65. Right. Surg. S. P. Bonner, 47th Ohio. Disch'd Nov. 1,1864. Left; circ. A.Surg.W.G.Bryant, 122d Ohio. Disch'd June 12, '65. Left; flap. Surg. S. Smith, 93d N. Y. Disch'd Nov. 23, 1864. Right; circ.; gang. Disch'd May 16, '65. 1870, stump unhealthy. Right Surg. — Walls, C. S. A. Recovery. Right; circ. Surg. D. McFalls, 142d N. Y. Disch'd Aug. 15,'65. Left; flap; (also amp. right arm.) Surg. J. Spiegelhalter, 12th Mo. Mustered out Nov. 14,1864. Left; flap. Confederate surgeon. Disch'd May 20, 1865. Right. Surg. — White, C.S.A. Furl'd July 3, 1863. Lett; lat. flap. Surg. R. H. Rob- inson, 7th Md. Disch'd April 10, 1S65. Left; (Teale's rectangular meth.) Slough'g; end of bone removed. Mustered out Dec. 28, 1865. Left; ant, post flap. Confed. surgeon. Disch'd June 2, 1865. Left; circ. A. Surg. T. C. Smith, 116th Ohio. Oct., reamp. Disch. July 7, 1865. Right; circ. Disch'd June 5, '65. Right; flap; gang. Disch'd, 1865. Left; ant. post. flap. Discharged Sept. 4, 1865. Right. Provost Marshal May 10, 1865. Left; circ. Surg. W. B. Cham- bers, 97th N.Y. Dis. July 12, '65. Left; circ. Surg. A. D. Palmer, 9th Me. M. out Oct. 4, 1865. Right; dou. flap. Surg. M. Storrs, 8th Conn. Disch'd Nov. 7,1803. Right; flap. Disch'd July 12, '65. Left; flap. Surg. J.H.Buckman, 5th N. H. Disch'd April 13, '65. Right; ant. rect. flap; (amp. fore- arm.) Surg.W.B.Eager, jr.,162d N. Y. Disch'd August 29, 1863. Died Julv 8,'76; phthisis pulmo. Right. Disch'd October 18, '62. lLn>ELL (J. A.) On Pysemia, in XT. S. San. Com. Mem., 1870, Surg. Vol. 1, Sect. Third, p. 535, Case XII. SECT, iil.l PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 251 489 490 491 492 493 494 495 496 497 498 49>J 500 501 502 504 505 500 507 508 509 510 511 512 513 514 516 517 518 519 520 521 522 523 524 525 Name, Military Description, and Age. Kugan, M., It., K, 145th Penn., age 21. Kurtner, C, Pt, A, 31st Virginia Battery. Kyle, H, l't, D, 6th N. Carolina, age 40. Lake,E.,Pt.,D,8th Penn. Cavalry, age 19. Lamarsna, J. J., Pt, D, 127th Illinois, age 18. Lambert, G., Pt., H, 53d Indiana. Lambson, J. F., Pt., A, 4th Iowa, age 26. Land, J., Pt.,B, 10th Ga. Landis, T. J., Corp'l, D, 2d Arkansas, age 25. Lnusperger, (.'., Pt., F, llth Penn., age 34. Lapoint, V., Pt., A. 81st New York, age 35. Larke, W., Pt., E, 9th Wisconsin. Laton, J. M., Serg't, A, 8th New Hampshire. Lavergne, A., l't. Aus- tin's Battery, age 22. Lawrence. C, Corp'l, E, 90th New York. Lawrence, J. A., Corp'l, A, 77th N. Y., age 21. Lawrence, F. J.. l't., B, 159th N. Y., age 17. Lawrence. W. E.. Lieut., F, 32d N. Carolina. Laxton, J. L.. Serg't, F, 3d North Carolina. Leach, M., Pt.. C, 50th Illinois, age 21. iee. r.,Pt.,K, 45th Ala., age 30. Lennard, J. M., Pt., C, 3d Georgia Cavalry. Lewin, J., Pt., D, 7th Maine, age 34. Leyson, J., Pt., D, 20th Mass., age 19. Lichstein, L., Lieut., F, 98th Penn., age 28. Lilley, M. A., Serg't, H, 46th Ohio, age 26. Lindley, F. W., Pt., K, 103d Ohio, age 25. Lindsley, M.W., Pt, G, 1st N.Y. Drag., age 21. Linthurst, C. W., Corp'l, I, 1st Penn. Reserves. Little. W. A/., Corp'l, I, 8th Louisiana. Long, D. B., Pt., E, 75th Illinois. Loomis, D.. Pt, I, 38th Ohio, age 18. Losie. J. M., Capt., A, 107th N. York, age 34. Lowrey.A., Pt.,G, 104th Ohio. Lozier, T. H., Pt., B, 2d Penn. Cav., age 18. Ludaka, A., Pt., L, 102d Penn., age 26. Luhman, E., Seaman, U. S. Navy, age 28. Lundugan, I'., Serg't, A, 5th C. S. Lupton, J. W., Pt, C, 14th N. Jersey, age 21. Luscomhe, F. E., Pt., E, 17th Wis., age 21. Lynch, J., Serg't, 1,17th Tennessee. Madden, J. S., Capt.,D, 32d Miss., age 34. Aug 16, 16, '64. Sept. 19, 19, '04. Julv 1, 2, '63. Oct. 28, 30, '04. June 19, 19, '64. Oct. 5, 5, '62. May 14, 15, '64. Slay 24, 24, '04. Nov. 30, De.1,'64. Mav 6, 6, '64. June 3, 3, '64. Sept. 30, 30, '62. June 14, 14, '63. Mar. 28, 28, '65. June 10, 10, '63. June 21, 21, '64. Sept. 19, 20,'64. Oct. 14. 14, '63. June 1, 1, '64. Mar. 21, 21, '65. Nov. 29, 30, '64. Sept, 21, 23, '63. June 3, 4, '64. Dec. 13, 13, '62. June 18, 18, '64. Aug. 3, 3, ?64. June 19, 21, '64. April 2, 2, '65. Aug. 30, 30, '62. Feb. 10, 11, '64. Oct. 8, 9, '62. Sept. 1, 2, '64. May 25, 20, '64 Sept 11, 11, '62. June 11, 11, '64. Sept. 19, 19, '64. Mar. 15, 15, '63. Sept. 20, 20, '63. July 9, 10, '64. May 19, 20, '63. Sept 20, 20, '63. Nov. 30, De.1,'64. Operations, Operators, Result. Right; ciro. Surg. G. L. Potter, 145th Penn. M. out Oct. 30, '05. ----. Provost Marshal Dec. 17, 1804. Right; flap. Provost Marshal Oct. 15, 1803. Right; flap. Surg. W. L. Baylor, C." S. A. Disch'd Aug. 29, 1865. Lett; flap. Surg.A.C.Messenger, 57th Ohio. Disoh'd March 18, 1865. Left. Discharged April 7, 1863. Left; flap. Surg. B. N. Bond, 27th Mo. Disch'd Oct. 7, 1865. Right; circular. Recovery. Left; ant. post. flap. Prov. Mar- shal March 7, 1865. Left; circ. Confed. surg. Ulcer- ation. Disch'd March 31, 1805. Right; ant. post, flap; nec. seq. rem'd. Disch'd June 16, 1805. Specs. 2373, 3705. Left; circ Disch'd April 20, '63. Left; circ. Discharged June 17, 1804. Right; circ. Dr. Miller. June 8, dise. bone rem'd. Aug., '65, left hospital. Spec. 482. L't; circ; (amp. forearm.) Surg. E. S. Hoffman, 90th N. Y. Sub. operations. Disoh'd Nov.21,'63. Left; ant. post. flap. Surg. G. T. Stevens, 77th N. Y. M. out. Left; circ. Surg. C. H. Andrus, 176th N. Y. Haem. July, 18G5, seq. rem'd. Disch'd Mar. 3, '66. Left. Surgeon — Butt, C. S. A. Furl'd February 5, 1865. Left. Surg. — Walker, C. S. A. Retired Feb. 1, 1865. Left; ant post, skin flap. Disch'd June 30, 1865. Right; circ Surg. — Ringgold, C. S. A. Pro. Mar. April 2, '65. ----. Surg. — Burton, C. S. A. Recovery. Right. Surg. G. T. Stevens, 77th N.Y. Gang.; fem. prot. Disch'd Oct. 17. '64. Re-amp. flap. mid. third, Oct. 21, 1865. Right. Surg. J. Dwinelle, 106th Penn. Disch'd June 6, 1863. Right. Surg. W. A. Barry, 98th Penn. Duty Nov. 15, 1805. Right; flap. A. Surg. D. Haider- man, 46th Ohio. Erysipelas. Disch'd June 9, 1805. Left; flap. Surg. J. H. Rodgers, 104th Ohio. Haem.; gangrene. Disch'd June 30, 1865. Left; flap. Disch'd Oct. 29, '65. Right. Disch'd Oct, 10,'62. Died May 8, 1670: consumption and general debility from injury. ----. Surg.—Momenier,C.S.A. Recovery- Left. Disch'd Dec. 9, '62. Sub. operation 1870. Right; flap. Surg. C. N. Fowler, 105th Ohio. M. out May 17,'65. Right; flap. Surg. J. Chapman, 123d N. Y. Disch'd Jan. 31,'65. Left; circ. Surg. K. G. Thomas, 104th Ohio. Disch'd Sept.28,'62. Right; circ. Surg. W. M. Weid- man, 2d Penn. Cav'y. Disch'd March 2, 1805. L't; flap ASurg. J. Homans. jr., U. S. A. Disch'd Aug. 21, '65. Left; flap. Disch'd Dec. 14, '63. Died June 12, '69; consumpt'n. Left. Surg. — Vaughn, C. S. A. Recovery. Left: circ. A. Surg. R. F. Weir, U. S. A. Disch'd April 3,1865. Specs. 2306, 3924. Left; circ. Disch'd Mar. 29,'64. Right. Surg. W. H. Gentry, 17th Tenn. Recovery. Left; circular. Provost Marshal March 1, 1865. Name, Military Description, and Age. Maddox, J, Corp'l, K, 5th Louisiana. Magee, J., Pt, G, 2d Rhode Island. Mahcr, J., Pt, F, 4th Infantry, age 27. Maire, C. L., Corp'l, K, 109th Penn., ago 37. Malbry, P. S., Pt, K, 3d Alabama. itallory, D. C, Serg't, F, 4th Virginia. Manning, A. F., Pt, D, 50th New York. Manning, G. W., Pt,, A, t15th Virginia. Mnrlow, J., Pt.. I, 7th •Kentucky. Marsh, D. W., Pt., H, 150th N. York, age 21. Marshall, C, Pt,E,llth Virginia, age 22. Martin, H., Pt,H, 8th N. Jersey, age 23. Mashan, R. W., Pt., K, 149th N. Y., age 22. Masters, N., Pt., D, 8th N. Y. Cavalry, age 26. Mattox, M.F.,Pt,, H,13th Virginia, age 34. Maynard,M.,Pt.,D,36th Mass., age 20. McBride, W. H, Pt., B, 44th Virginia, age 30. McBride, P., Pt., D, 1st New York, age 23. McCaffrey, P., Pt., C, 5th N. Jersey, age 29. McCaleb, B., Pt, D, 1st vTenn. Cav., age 25. McCann, A. J., Serg't, K, 36th Wis , age 23. McCann, D., Pt., D, 40th New York, age 39. McCann, H., Serg't, A, 95th Penn., age 21. McCarthy, B., Pt, K, 170th N. Y., age 28. McCarthy, J., Pt, D, -139th N. Y., age 21. McCarthy, W., Pt., B, 27th Michigan. McCaughey, T. M., Pt., D, 74th 111., age 18. McClellan, W. R.,Serg't, A, 209th Penn., age 27. McCloskey, Pt., U. S. Marines, age 28. McColloch, W. M., Pt., K, 20th Indiana. McConnell, A. F.,Corp'l, K, 121st Ohio, age 24. McConnell, J., Capt, F, 4th Georgia, age 22. McConnell, J. J., Serg't, G, 3d lnd. Cav., age 25. McCord, T.N., Pt, For- est's Cavalry, age 28. McCready, J. A., Serg't, E, 12th Ala., age 29. McCutcheon, G. H, Pt, E. 6th South Carolina. McDonald, D., Serg't, A, 101st New York,age 24. McDonald, J., Pt., D, 4th New Jersey, age 23. McDonald, P., Pt, F, 54th Tenn., age 25. Dates. July 2, 2, '63. May 5, 5, '64. Dec. 14, 14, '02. June 15, 16, '64. May 30, J'nel,'64 Nov. 27, 28, '63. June 3, 3, '63. April 13, 13, '63. May 16, 10, '63. June 29, 29, '64. July 3, 3, '63. Mar. 31, Ap. 1, '65 May 27, 27, '64. June 13, 13, '64. Sept. 19, 19, '64. July 20, 20, '64. Mar. 25, 25, '65. Sept. 1, 1, '62. Sept. 14, 14,'64. Sept. 22, 23, '64. June 17, 17, '64. Nov. 27, 28, '63. April 2, 2, '65. June 16, 17, '64. June 1, 2, '64. Oct 11, 11, '63. May 17, 18, '64. Mar. 25, 25, '65. March 8, 8, '62. June 25, 26, '62. Mar. 16, 16, '65. Mar. 25, 26, '65. Oct 11, 12, '63. Aug. 21, 22, '64. Sept. 20, 20, '64. Sept. 30, Oct 2,'64 July 21, 21, '64. April 2, 2, '65. Sept. 19, 19, '63. Operations, Operators, Result. Left. Surg.—Strickland.C.S.A. Paroled Sept. 5, 1863. Right; flap. Surg. G.W. Carr, 2d R. Island. M. out Oct. 16, 1864. 1870, stump discharging. Right; circ. A. Surg.A.M.Clark, U.S.V. Gang.; erysip.; remo. exfol. Disch'd July 8, 1863. Left; flap. Surg. J. L. Dunn, 10'JthPenn. Disch'd June27,'05. Right; lat. flap. Surg. C. B. Gib- son, C. S A. Transferred June 3, 1864. Right Surg. — Holt, C. S. A. Furloughed Jan. 19, 1864. Right; flap. Disch'd Sept. 30, 1803. Right Surg. — Lewis, C. S. A. Furloughed June 24, 1863. Right. Surg. W. Berry, 7th Ky. Disch'd Sept. 21, 1803. R't; circ. Surg. C. M. Campbell, 150th N. Y. Mar.,'65, 6eq. rem. Disch'd Sept. 11, '65. Spec. 476. Left. Provost Marshal Sept. 25, 1863. Left; circ. Surg. H. F. Lyster, 5th Mich. Disch'd Sept, 8,1865. Left; flap. Surg. J. V. Kendall. 149th N.Y. Disch. June 13,'65. Right; circ. Disch'd March 25, 1865. Left; circ. Prov. Marshal April 1, 1865. Left; circ. Disch'd Feb. 4, '65. Right; circ. Surg.W. G. Hunter, 211th Penn. Provost Marshal July 20, 1865. Spec. 3996. Left; sloughing. Disch'd April 4, 1863. Right; antpostflap. Surg. H.F. Lyster, 5th Mich. Disch d Apr. 17, 1865. Spec. 4112. Right; ant. post, flap; bone prot.; gang. Disch'd Nov. 23,1865. Right; circ Surg. N. Hayward, 20th Mass. Disch'd Sept. 27, '64. Left; ant. post. flap. Discharged Nov. 8,1864. Left: flap. Surg.C.C.McGlaugh- lin, 95th Penn. Disoh'd —, 1865. Left; ciro. Surg. D.W.Maull, 1st Del. May, '65, seq. rem. Disch. Oct. 19, '65. Died April 5, '70. Spec. 1581. Right; circ. Dec. 30, dead bone remo'd. Disch'd May 22, 1865. Left. Disch'd May 29, 1865. Left. Surg. W. P. Pierce, 88th 111. Disch'd Mav 18, '65; never healed. Died Jan. 20, 1867. Left; circ. flap. Surg. W. G. Hunter, 211th Penn. Disch'd July 28, 1865. Spec. 4029. Left. Disch'd Aug. 21,'62. Died January 14, 1863. Left; flap. Confederate surgeon. Disch'd August 8, 1862. Right; double flap. Surg. T. B. Williams, 121st Ohio. Disch'd June 16, 1865. Left; ciro. A. Surg. E. M. Smy- ser, 48th Penn. Released June 14, 1865. Spec. 3993. Right; ant. post flap. Surg. E. W. H. Beck, 3d lnd. Cavalry. Disch'd Sept. 5, 1864. Left; ant. post. flap. A. Surg. J. C. G. Happersett, U. S. A. Retired March 16, 1865. Right; circ. Confed. surgeon. Prison Jan. 5,1865. Left; post.flap; (also w'd of head, arm, and foot.) A. Surg. S. P. Breckinridge,C.S.A. Recovery. Spec. 5515. Right; flap. Surg. G. M. Beaks, 141st N. Y. Dec. 10, gangrene. Disch'd Sept. 20,1865. Left; circ. Surg. H. Plumb, 2d Conn. Heavy Artillery. Disch'd Sept. 11,1865. Left. Surg. — Smith, C. S. A. Transf d June 16, 1865. 2rr2 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. No. Name, Military Description, and Age. McDowcll,C..Pt.,I,117th Now Ycrk, age 21. McElroy, R. D., Pt., A, 4th N. Y. II. A., age33. McFarland, J. H,Capt., G, 1st Missouri. McGaha, W. H, Pt, A, 2d Virginia. McGuire, T.,Pt.,D, 21st Illinois, age 22. Mclntire, H., Pt., C, 12th New Jersey, age 21. McKinney, J. F„ Pt., F, 44th Miss., age 26. McKinstrey, R., Pt., C, 70th New York. McMahon, II. F., Pt, L, 1st Mass. Artillery. McMahon, M.,Pt.,B,15th Infantry, age 19. McMahon, P., Pt., G, 32d Wis., age 27. McMann, J., Pt,, F, 48th Alabama, age 18. McManus, J., Serg't, G, 69th Indiana. McMillan, C, Corp'l, F, 4th West Virginia. McRea, P., Pt., H,153d New York, age 24. Meaker, W., Pt., G, 5th Michigan, age 19. Meetz, T., Corp'l, C, 5th Alabama, age 31. Meidam, S., Pt., E, 5th Wis., age 17. Meinliart, P., Pt., D, 6th Louisiana. Meis, W., Pt., E, 9th N. Jersey, age 30. Mcissner, D. F., Pt., K, 34th N. Jersey, age 19. Merrick, G. W., Major, 187th Penn., age 26! Merrill, C, Pt., K, 4th New Hampshire. Mersheimer, G., Pt., D, 109th Penn.. age 22. Messer, S.L.,Pt.,E, 20th Maine, age 33. Milan, J. K., Lieut., F, 17th Arkansas. Miles, J., Pt, F, 53d lnd., age 22. Miller, C, Pt, E, 43d New York, age 20. Miller, C. A., Pt., G, 20th Wisconsin, age 27. Miller,F. M., Pt,, Nelson Battery. Miller, j., Corp'l, F, 2d Artillery, age 33. Miller, J., Pt., K, 118th Penn., age 30. Miller, J., Corp'l, B, 73d Ohio, age 25. Miller, J., Pt, C, 18th Kentucky, age 38. Millis, H.C., Lieut., B, 45th North Carolina. Mills, S. S., Serg't, B,7th Minnesota, age 39. Minnich, A., Serg't, K, 200th Penn., age 24. Minshew, J., Pt., G, 50th Georgia, age 29. Mitchell. S. J., Corp'l, A, 5fith Virginia, age 32. MofiBtt, S., Lieut-Col., 96th N. Y., age 28. Molegan, L. G., Pt., H, 32d Mass., age 24. 611 Monroe, E., Pt., H, 59th Illinois, age 24. 612 Moore, A. M., Pt., Wash- ington Bat., age 18. 573 574 575 576 577 578 579 580 581 582 583 584 585 580 587 588 589 590 591 592 593 594 595 596 59' 598 599 600 601 602 603 604 605 606 607 608 609 Dates. July 4, 4. '04. June 18, 18, '64. May 16, 17, '63. July 3, 3, '63. June 21, 21,'64. Mar. 28, 29, '65. Dec. 16, 16, '64. June 25, 25, '62. June 16, 17. '64. July 3, 4, '64. Mar. 22, 22, '65. July 2, 3, '63. May 16, 16, '63. May 19, 20, '63. Sept. 19, 19, '64. June 16, 17, '64. Oct. 19, 19, '64. April 2, 2, '65. May 4, 5, '63 May 6, 6, '64. July 10, 12, '04. June 18, 18, '64. Aug. 27, 27, '63. June 16, 16, '64. Mar. 31, 31, '65. June 11, 11. '63. Nov. 24, 24, '64. May 5, 6, '64. April 27, 27, '65. July 18, 18, '64. Aug. 11, 11, '64. Sept. 30, Oct 1,'64. Mar. 19, 19, '65. Aug. 30, 30, '62. Oct. 14, 14, '63. Dec. 16, 17, '64. Mar. 25, 27, '65. July 2, 3, '63. May 29, 30, '64. Oct. 27, 28, '64. Oct. 19, 19, '64. Dec 15, 15, '64. April 2, 2, '65. Operations, Operators, Result. Right; ant. post, flap Surg. H. \V. Carpenter, 117thNcw York. Disch'd Jan. 19,1866. Spec. 390. Left; circ. Surg.H.C.Tompkins, 4th N.Y.H.A. Dis. Nov.21,'64. ----. Surg. — Taylor, C. S. A. Recovery. Right. Surg. — Strath, C. S. A. Exchanged March 3, 1864. Right; flap. A. Surg. J. L. Reat, 21st 111. Disch'd Feb. 27,1805. Left ; ant. post. flap. Surg. S. H. Plumb, 82d N. Y. Disch'd June 6, 1865. Right: ant, post. flap. Provost Marshal March 27, 1865. Right. Surg. T. Sim. U. S. V. Disch'd Sept. 29, 1802. Left; circ. Disch'd Nov. 14, '64. Right; ant. post. flap. Disch'd Aug. 29, 1805. Left; flap. Surg. A. B. Monohan, 63d Ohio. M. out June 20,'65; not healed 1870. Left. Exch'd Sept. 25, '63, and furloughed. Right; flap. Disch'd Nov. 6,'63. Left. Disch'd Sept. 22,1863. Right; circ. Surg. N. L. Snow, 153d N. Y. Disch'd June 14,'65. Left; circ. Surg. II. F. Lyster, 5th Mich. Disch'd Nov. 9, '05. Spec. 3218. Left; ant, post flap. Surg. — Mushett, 5th Ala. Prison Feb. 10, 1865. Left; flap. Disch'd Sept. 1,18(55. Right. Surg. W. A. Robertson, 6th La. Recovery. Right; flap. Disch'd Feb. 12, 1865. Left; flap. Disch'd Nov. 2, 1864. Right; circ. Disch'd Sept. 30, 1864. Right; flap. Snrg. S. A. Green, 24th Mass. Disch'd Nov. 25,'63. Right; flap. Surg. J. L. Dunn, 109th Penn. Disch'd Aug. 2,'65. Left; flap; erysip. Discharged August 17, 1865. Right. Surg. —Mitchell. C.S.A. Furloughed Oct. 9, 1864. Right; circ Disch'd June 26,'65. Left; flap. Discli'd Dec. 24,1864. Left: circ Surg.O. Peabody, 23d Iowa. Gang. Dis. Aug. 5,'65. ----. Surg. — Love, C. S. A. Recovery. Right; flap. A.A.Surg.Maxwell. Fort McHenry July 2, 1865. Left; circ. Mar. 29.'65, bone rem. Disch'd Sept.9,1865. Spec. 4:349. Right; circ. Disch'd August 22, 1865. Left: flap; boneexp.rem. Disch. April 23, 1864. Spec. 1094. Left. Surgeon — Butts, C. S. A. Recovery. Right; circ. Surg.V.P.Kennedy, 5th Minn. Disch'd Mar. 28, '05. Right; ant post. flap. Surg. W. O. McDonald, U. S. V. Disch'd July 19, 1865. Spec. 4134. Left; nec. bone rem'd. Provost Marshal Sept 28,1863. Right; ant. post. flap. Prison Oct. 1, 1864. Left; circ. A. Surg. W. Wood- ward, 39th 111., and Surg. T. H. Squire, 89th N. Y. Must, out. Left; lat. flap. Dis. Sept. 8, '65. Died Oct. 22, '69; anaemia and pain resulting from amputation. Right; circ. M. out May 27, '65. Right. Released June 21,1865. Name, Military Description, and Age. Moore, P., Pt, E, 1st Vt H. Art., age 19. Moore, H. F., Pt,, C, 20th Penn. Cav., age 19. Morton.H., Serg't, D, 23d Wis., age 25. 'Morse, S.L.,Pt.,E,24th Iowa. Moss, E.,Pt.,F,7th Col'd Artillery, age 23. Mothersbangh, S.,Pt,B, 91st Penn., age 35. Muller, G., Pt., A, 40th New York, age 32. Murphy, D., Pt., D, 20th Mass., age 23. Murphy, J. D., Serg't, F, 42d Tenn., age 18. Murphy, P., Corp'l, II, 147th N. Ycrk, age 22. Murray, R. W., Pt., F, 4th Texas. Murray, M., Pt, A, 4th Delaware, age 19. Murray, R, Corp'l, D, 2d N. York M. R., age 18. Myers, C, Pt., 1st Conn., nge 32. Naragon, A. C , Pt., F, 19th Ohio, age 24. Naughton, E., Pt., F, 3d N. Jersey Cav., age 21. Neat, W., Pt., 1,28th 111. Neidhart, J., Lieut, D, 10th Conn., age 24. Newell, A., Pt., F, 14th Ohio, age 17. Newell, T.L.,Pt,F,llth Penn., age 19. Newton, J. M., Serg't, D, 12th Illinois. Nice, W. T., It,, B, 1st Penn. Artillery. Nichols, H.,Pt.,K, 138th Penn., age 20. Nickason, A., Serg't, I, 75th New York, age 35. Nickle, J., Serg't, H, 14Cth Penn., age 24. Nigh, J., Serg't, C, 35th Illinois, age 33. Norman, W. B., Pt., D, 13th Miss , age 25. Norris, J. A., Capt., C, 98th Ohio. Obier, J., Pt., E, 1st Del- aware, age 27. O'Brien, P., Pt., G, 34th Mass., age 27. O'Bryan, P., Pt., F, 7th Maine, age 35. Oliver, J., Pt,, L, 72d Pennsylvania. Oliver, J., Pt., A, 2d Michigan Cavalry. Ordway, A., Pt., L, 1st Maine Cavalry. Osborne, J., Pt., G, 132d Pennsylvania. Oslin, J. 0., Pt., A, 2d Tennessee. Otlew, J. B., Pt., A, 43d N. C, age 26. Ott, C. A., Pt., B, 155th Penn., age 19. Palmer, H. H., Corp'l, B, 2d Ohio Cavalrv. Park, G. A., Pt,'A,81st Ohio, age 29. Park, S. W., Colonel, 2d New York, age 36. Parker, M., Pt., H, 1st Arkansas, age 20. Dates. June 1, 2,'64. April 9, 9, '05. Nov. 3, 4* '03. May 16, 16, '63. Oct, 30, 30, '64. Oct, 27, 27, '64. Julv 2, 4, '63. Dec. 13, 13, '62. Nov. 30, De. 1,'64. May 12, 12, '64. May 6, 6, '64. June 2, 3, '64. Sept. 30, 30, '64. April 5, 6, '65. Sept. 19, 21, '63. Aug. 25, 25, '64. Oct 4, 4, '62. Mar. 30, 30, '65. June 14, 14, '64. May 8, 10, '64. Oct. 3, 5, '62. Dee. 13, 13,'62. June 2, 2, '64. Sept. 19, 19, '64. Dec. 9, 10, '64. Sept. 19, 19, '63. Sept. 3, 4, '64. July 20, 20, '64. Dec. 13, 14, '62. June 18, 18, '64. Sept. 17, —, '62. Sept. 17, 18, '62. Oct. 8, 8, '62. June 22, 23, '64. May 3, 3, '63. Sept. 20, 20, '63. Oct. 19, 19, '64. June 18, 19, '64. July 3, 3, '63. Aug. 25, 25, '64. May 3, 3, '63. May 16, 17, '64. Operations, Operators, Result. Left; double flap. Surg. C. B. Park, 1st Vermont H. A.; necro. Disch'd August 11,1865. 4 Right; circ. Disch'd April 11,'66. Left; flap. Surg. J. S. McGrew, 83d Ohio. Disch'd Mar. 10, '64. Right; double flap; gangrene. Disch'd Sept. 15, 1863. Right; flap. Recovered. Right; ant. post flap. Disch'd July 13, 1865. Right; aotero-rectangular. Dis. Fob. 20,1864. Spec. 1478. Left. Surg. J. Dwinelle, 106th Penn. Disch'd Sept., 1863. Left; circ. A. Surg.A. I.Gustine, 48th Tenn. Pro. Mar. May 6.'65. Left; flap. Surg. A. S. Coe, 147th N.Y. Disch'd Sept. 9,1865. Right. Surg. R. M. Terrill, P. A. C. S. Recovery. Left; flap. Surg.A. S. Coe, 147th N. Y. Disch'd Mav 16,1865. Left; double flap. " Surg. R. T. Paine, jr.. 2d N. Y. M. R. Gang. Disch'd June 15, 1865. Right; circ Surg. E. Bentlev, U. S. V. Disch'd July 10,1865. Left; circ. flap. Confed. surgeon. Disch'd Sept. 25, 1864. Left; ant. post, flap Surg.W.W. Bowlby, 3d N. J. Cav. Disch'd Oct. 26, '65. April 20, '68, flap reamp. mid. third. Spec. 2443. Right; circular. Reamputation. Disch'd April 17, 1863. Right. Surg. C. M. Clark, 39th Illinois. M. out Sept. 2,1865. Left; circ; flap. Surg.G.E.Sloat, 14th Ohio. Disch'd June 21,'65. Left; circ. Disch'd July 21,'65. Left; flap. Disch'd May 13, '65. Right. Disch'd June 3, 1863. Right; circ; bone prot. Sept. 27, reamp.; ant. post, flap, middle third. Disch'd April 19,1865. Left; circ. A. Surg. B. Fordyce, 160th N.Y. Disch'd May 25, '65. Right; ant.postflap. Surg. J.W. Wishart, 140th Penn. Disch'd May 19, 1865. Right; flap. Surg. S. B. Hawley, 35th Illinois. M. out July, 1864. Right;circ. Surg. —Barr.C.S.A. Prison Nov. 19,1864. Right. Surg.T.B.Williams,121st Ohio. Disch'd Oct. 3,1864. Right. Surg.D.W.Maull, 1st Del. Dec. 28, reamp. mid. third. A. A.Surg.H.Stone. Nec May 7, '64, reamp. up. third. A.A.Surg. R. J. Lewis. Disch. Dec. 3, '64. Left; flap; sloughing. Disch'd February 4, 1865. Left. Disch'd June 29,'63. Died July 9, '66; effects of amp. Right. Surg. S. G. Lane, 5th Pa. Res. Disch'd Dec. 1,1862. Left; flap. Surg.C.L.Henderson, 2d Mich. Cav. Dis. Dec. 17, '62. Left; circ. Mustered out. Left; circ. Disch'd Nov. 7,1863. Left. Surgeon — Holt, C. S. A. Recovery. Left. Pro. Marshal April 1,1865. Left; circ Surg. J. A. E. Reed, 155th Penn. Gangrene. Disch'd May 25, 1865. Right; circnlar. Confed. surgeon. Discharged. Left; flap. Surg. W. C. Jacobs, 81st Ohio. Disch'd May 5,1865. Right. Surg.H.McLane,2dN.Y. Mustered out May 26, 186a Left; circ. Surg. C. E. Swasey, U. S. V. Disch'd July 19,1865. 1 BE VAN (J), loc cit., p. 287. sect. m.j PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 253 655 656 657 658 660 661 662 663 664 665 666 667 Name, Military Description, and Age, 671 072 673 674 675 676 677 679 079 683 684 685 690 691 692 693 Parker, M. F.,Pt.E, 19th Michigan, age 25. Parker, \V., Pt, I, 1st Mass. II. Art'y, age 27. Parker, W. F., Pt, F, 10th Iowa, age 21. Parquette, H., Pt, I, 1st N. H. H. Art'y, age 21. Parquetti, J., Pt., B, 1st California Cavalry. Parsons, \V. D., It., B, 2d Vermont, age 18. Patterson, W. H., Lieut., O, 37th Virginia, Payne. L. D., Serg't, D, 44th Virginia, age 22. Peak, R., Pt., E, 66th Illinois, age 19. Perkins, G., Pt., A, 64th New York, age 22. Perkins, H. E., Serg't, C, 7th Vt, age 22. Perrin, W. S., Lieut, C, 1st R.I. Arty, age 24. Peters, J., Pt, K, 203d Penn., age 30. Philo, E. R., Pt., I, 1st Sharpshooters, age 24. Picquet, L. A., Pt., A, 63d Georgia. Pierce. C. L., Lieut., K, 9th N. Y. Cav., age 23. Pierce, T. D., Pt., A, 8th Tenn., age 37. Pine, J. A., Pt., I, 168th Ohio, age 18. Pinson, J. V., Pt., K. 31st Indiana. Plunkett, C, Pt., B. 4th Rhode Island, age 27. Pool, D. E., Pt., D, 53d Illinois. Pope, IF., Pt., K, 10th Alabama. Poulson, XV. S., Corp'l, F, H8th Ohio. 'Powell, J. W., Pt, A, 19th Alabama. Powell,S.,Corp'l, F, 21st Ohio, age 20. Powers, D., Pt., E, 35th Indiana. Price, £'., Pt., B, 35th Virginia Cavalry. Prince, S. W., It.,I, 24th South Carolina, age 17. Printy, T., Pt., G, 20th Indiana, age 33. Prior, W., Pt., H, 72d Pennsylvania. Quinn," J., Pt., G, 21st Penn. Cav., age 22. Quinn, M., Pt., B, 55th New York. Quinn, M., It., A, 14th Louisiana. Rabardy, J., Pt., K, 12th Massachusetts. Ragan, J., Pt., B, 4th Mass. Cav., age 19. Raley, C. S., Pt., G, 60th Georgia. Ramsey, W. R., Serg't, F, 150th Penn. Rausher, H., Pt., D, 25th Iowa, age 24. Raynor, L. H., Pt., F.lst Vermont, age 21. Reason, W., Pt, H, 2d Cavalry, age 22. May 15, 16, '64. June 16, 18, '04. Oct. 21, 21, '64. Sept, 14, 14, '64. July 29, 30, '65. April 2, 2, '05. Aug. 2, 2, v64. Mar. 25, 25, '05. Aug. 4, 4, 764. Mar. 25, 26, '65. Mar. 29, 29. '65. Aug. 25, 26, '64. Jan. 15, 15, '65. Aug. 15, 15, '64. May i.'8. 30,''04. April 1, 1, '65. Nov. 28, 28, '64. June 11, 11, '64. April 6, 6, '62. July 15, 15, '64. July 14, 16, '63. May 3, 4, '63. Oct. 8, 10, '62. Sept. 19, 19, '63. Aug. 11, 11, '64. Jan. 2, 3, '63. Nov. 29, 30, '63. Nov. 30, De.1,'64. June 25, 26, '62. Sept. 17, 18, '62. Oct. 27, 27, '64. June 27. 27, '62. Aug. 28, 28, '62. Sept. 17, 17, '62. Oct. 27, 27, '64. Mar. 5, 5, '65. May 6, 8, '64. Sept. 1, 2, '64. June 4, 4, '64. Sept. 14, 15, '64. Operations, Operators, Result. Left; flap. Surg. J. Bennett, 19th Mich. Disch'd Oct. 16,1864. Right; ciro. Disch'd Feb. 27, '65. Left; ciro. Surg.R. J. Mohr, 10th Iowa. Disch'd Aug. 21, 1865. Right. (Teale's method.) Surg. R.B. Bontecou, U.S.V. Gang.; haem. Dis.Oot. 1,'65. Spec. 3244. Left; circ. A. Surg. H. E. Brown, U.S.A. Disch'd June 25, 1866. Spec. 4383. Right; ciro. Surg. C. B. Park, jr., llth Vt. Disch'd Aug. 11, '05. ----; ant. post flap. A. Surg. Anderson, C. S. A. Prov. Mars. Nov. 1,1864. Left. A. Surg. E. P. Roche, 35th Mass. Released June 14, 1865. Spec. 4015. Left; ant. post. flap. Surg. J. Pogue, 66th 111. Erysip. Feb. 21, 65, reamp. mid. "third; ciro. flap. A. A. Surg. S.W. Thomp- son. Mustered nut July 19, '65. Left; ant. post. flap. Surg. M. II. Raymond, 26th Mich. Exfol. Disch'd Nov. 17, 1865. Left; flap. Surg. C. Winne, 77th Illinois. Discli'd Nov. 25,1805. Right: circ. Disch'd Feb. 4, '65. Lied August 13, 1876. Right; circ. Surg. L. Barnes, 6th Col'd Troops. Bone prot. Disc'd July 18, 1865. Left; ant. post, flap. Discharged March 2, 1865. ----. Surg. — Brown, C. S. A. Recovery. Right; flap. Surgs.R.Curran, 9th N. Y. Cav., and A. P. Clark, 6th N. Y. Cav. M. out Sept. 25, '65. Left; circ. Surg. J. Sparks, 8th Tenn. Disch'd March 18,1865. Right; ant. post. flap. Dr. Mc- Neese. Disch'd Oct. 18, 1864. Left, Disch'd October 7,1862. Left; ant. post. flap. A. Surg. R. Millar, 4th R. I. M. out Oct, 15, 1804. Left; circ. Snrg. Hinkley. Two subs. oper. Disch'd Oct. 10,'03. Left. Surg. — Taylor, C. S. A. Furloughed July 3, 1863. Right; flap. Surg. S. Marks, 10th Wis. Disch'd Feb. 15, 1863. ---. Recovery. Left; flap. Surg. D. S. Young, 21st Ohio. Gang.; necro. bone rem. Disch'd June 5, 1865. Left. Surg. C. J. Walton, 21st Ky. Mustered out Mar. 27,'63. Left. Recovery. L't; lat. flap. Surg. McKinley, C. S.A.Gang. Pro.Mar.May3U,'65. Right; doub. flap. Cenfed. surg. Disch'd July 8, '03. Spec. 367. Right: flap. Surg. B. A.Vander- kieft, U. S. V. Dis. Jan. 11,'63. Left; flap. Disch'd Oct. 17,1865. Left, Disch'd Feb. 13, 1863. Left. Surg. — White, C. S. A. Gang.; abscess, fistula;. Recov. Left. Surg. J. McL. Hayward, 12th Mass. Disch'd Dec. 1, '02, R't. Con.surg. Kebel. Mar. 3,'65. reamp.; circ. A. A. Surg. F. H. Getehell. Disch'd Jul y 27, '65. ----. Provost Marshal May 10, 1865. Left; flap. Confed.surg. Disch'd June 3, 1865. Left; ant. post, skin flap; gang. Nit. acid. Disch'd Sept. 12, '65. R't; lat. flap. Surg. C. B. Park, jr.,lstVt H.A. Gang. Disch'd Feb 21, '65. 1870, stump bad. Right; skin flaps; circ. muscle. A. A. Surg. W. B. McCausland. Duty Apr. 2,'65. Sps. 3914,1574. Name, Military Description, and Age Reagan, W. B. L.,Lieut, 16th Tenn. Bat.nge 25. Rector, C. J., Lieut., C, 185th N. York, age 21. Reed, G. P., Sergeant, I, 104th Ohio, age 32. Reeves, J. J., It., F, 1st Maine II. A., ago 27. Regner, M., It., E, 6tli Wisconsin, ago 25. Reitzel.H J.,Vi.,A,12th North Carolina. Ronner, A., Pt., K, 26th Iowu, age 16. Reynolds, E. B., Pt, 3d Iowa Battery, age 18. Rice, A.V., Colonel, 57th Ohio, nge 27. Rice, A. D.F Pt., B, 38th Wisconsin, age 17. Rice, E., Pt., F, 113th Ohio, age 25. Rice, L., It., K, 16th Michigan, age 22. Rice, W. H, Captain, Rice's Battery. Richards, R., Pt,C, 51st Virginia, age 27. Ricker, J. W., Lieut., I, 48th Massachusetts. Rider, J., Pt, D, 98th Illinois. Rider, J. F., Pt., A, 4th Virginia, age 37. Ried, L. W., Adj., 25th Virginia Cavalry. Riggs, H., Pt., F, 27th Ohio. Rigsbey, N. L., Pt., A, 19th Indiana, age 20. Riley, H., Pt, F, 13th Infantry, age 30. Rind, E., Pt., B, 5th Tennessee. Ritchey, D.,Pt, K, 208th Penn., age 25. Roach, J. F., Lieut., E, 45th N. C, age 20. Roberts, C. Pt., II, 45th Ohio, age 23. Roberts, O. D., Serg't, H, 118th Penn. Roberts, W. W., Corp'l, A, 8th Illinois Cavalry. Robertson, J., It., I, 18th Mississippi. Robinett, M. P.. Pt., E, 65th Ohio, age 20. Robinson, J. /?., Serg't, li, 18th South Carolina. Rodgers, T. J., Pt, E, 47th Ohio, age 20. Rogers. C. H, Corp'l, I, Cobb's Legion Cav. Rogers, G., It., V, 2d Michigan, age 24. Rose, E. E., It., F, 47th Indiana, age 34. Rose, F., Pt, D, 57th N. York, age 20. Rose, H. A., Pt, F, 10th N. Y. Cavalry, age 16. Ross, H., Pt,* A, 16th Iowa. Ross, W. E. W.. Lieut. Col., 31st Col'd Troops. Roth, J., Pt., B, 12th Missouri, age 23. Rourke, J., Pt., I, 1st Louisiana Cav., age 25. Royal, H. S., Serg t, A, 30th N. C, age 26. July 24, 24, '64. Mar. 29, 29, '65. June 11, 11, '64. June 18, 19. '64. Feb. 6, 7, '05. July 20, 20, '64. May 14, 14,' '64. Mar. 7, 8, '62. June 27, 27, '04. April 3, 3, '05. June 22, 23, '64. Sept. 30, 30, '64. Oct. 3, 3, '61. Aug. 17, 18, '64. May 27, 27, '63. Sept. 19, 19, '63. May 3, 5, '63. Oct. 8, 9, '64. Oct. 4, 6, '62. June 20, 20, '64. Dec. 29, 29, '62. June 25, 25, '64. Mar. 25, 25, '65. Sept. 19, 19, '64. June 27, 27, '04. Sept. 30, 30, '64. Oct. 12, 12, '63. May 8, 8, '64. Nov. 29, 30, '64. Mar. 25, 25, '65. July 22, 22, '64. Nov. 27, 27, '63. Julv 11, 11,"'63. Mar. 27, 27, '65. Oct. 14, 15, '63. July 30, 30, '64. May 21, 21, '63. July 30, 30, '64. May 14, 14, '64. Jan. 30, 31, '65. May 3, 3, "63. Operations, Operators, Result. Right. Surg. — Love, P. A.C.S. For exch. Nov. 22, 1864. Left; double flap. Surg. P. L. Sonnick, 187th N. Y. Must, out May 29. 1865. Left; circ. S^irg. J. II. Rodgers, 104th Ohio. Disch'd Oct. 25,'64. Left; flap. Disch'd Dec. 3, 1864. Left; circ. Disch'd Aug. 21, '65. ----. Surg. — Ilinkle, C. S. A. Recovery. Left: flap.' Surg. A. Sabine, 76tli Ohio. Sept., 1864. bone exfol. Jan., 1805, reamp.; double flap, middle third. A. A. Surg. J. M. Adlcr. Disch'd May 26, 1865. Right. Surg. B.J. Newland,22d lnd. Disch'd July 6, 1863. Right; circ. Surg. A. C. Messen- ger, 57th Ohio. Recovery. Pro- moted. Mustered out. Left; circ. Surg W.C. Shurlock, 51st Penn. Disch'd Aug. 12,'05. R't; flap. Surg.A.Wilson. 113th Ohio. Disch'd Mav 3, 1805. Left; flap. Disch'd Mar. 21, 1865. Left, Surg. — Daily, C. S. A. Recovery. Right. Prison Nov. 19, 1864. Right; flap. Surg. Y. G. Hurd, 48th Mass. M. out Sept. 3, '63. Right. Disch'd May 2, 1864. Right; ant. post flap. Furl'd June 14, 1863. Recovered with good stump. ----. Surg. — Fleming, C. S. A. Recovery. Right; circ. Disch'd Apr. 8, '63. Right: circ Surg. J. Ebersole, 19th lnd. DisehFd Nov. 14, '64. R't. Surg. E.O.F. Roller,55th 111. Gang. Feb.,'64. seq.rem. Disch. Nov. 19, '64. Died Oct. 10, '68. Spec. 2676. Left. Surg. — Carder, C. S. A. Recovery. Left; ant. post flap. A. Surg.W. CarrolI.U.S.V. Disch'd June28, 1865. Died May 14,1872; lung disease. Spec. 4132. Right; circ. Surg.— Singlet, C. S. A. Prison Nov. 19, 1864. Right; antpost.flap. Surg. F. H. Kearney, 45th Ohio. Gang.; end ofboneexp. Disch'd Juue27,'65. Left; circ. Disch'd July 18, '65. Left; circ. A. Surg. T. W. Stull, 8th 111. Cav. Disch'd Apr.27,'04. ----. Surg. —Griffin, 18th Miss. Recovery. Right; flap. Confed.surg. Disch. Sept. 6, 1865. Right; circ. Surg.W. L. Baylor, C. S. A. Prov. Mar. Mav 10, 05. Right: flap. Surg. S. P. Bonner, 47th Ohio. Disch'd June 30,'65. Right. Surg. — Taylor. C. S. A. Furloughed Jan. 26, 1864. Left; circ. Disch'd June 6,1864. Left; flap. Surg. J. L. Dicken, 47th lnd. Disch'd July 26, '65. Right; circ.; (amp. arm.) Snrg. W. W. Potter, 57th N. Y. Seq. rem. Dis. Oct.3,'64. Spec. 3104. Left; ant. post, flap. Subs. oper. Disch'd Feb. 7, 1865. Left; flap. Surg. J. Pomerene, 42d Ohio. Disch'd Aug. 28,'63. Left; circ. Surg. J. P. Prince, 36th Mass. M. out Mar. 11, '65. Left; flap. Surg. A. T. Hudson, 26th Iowa. Gang. Discharged April 18, 1865. Left; flap. A.A. Surg. J. Brady. Disch'd Oct. 19, 1865. ----; circ Surg. — Bridges, C. S. A. Furl'd June 23, 1863. 'Terry (C), loc. cit., p.70. 254 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. Name, Military Description, and Age. Runyon, J. A., Lieut, A, 74th Indiana, age 18. ™\ Rush, C. G., Pt., C, 21st ' Georgia, age 22. 739 Rust, C. W., Serg't, C, 8th Kansas, age 22. 740 Ryan, J. A., Lieut., L, 5th Virginia. 741 Ryan, T., PL, G, 90th Illinois, age 28. 742 Saeger, D. L., Pt., A, 19th Ohio, age 24. 743 Sage, W., Pt., E, 42d Ohio. 744 Saila, A., Corp'l, I, 65th Ohio, age 24. 745 Saladal, L., Pt., E, 9th N. Hampshire, age 23. 740 Sanborn, S. F., Pt., E, 21st Wisconsin, age 24. 747 Sanford. J. R., Capt., B, 33d N. Jersey, age 40. 748 Santo, C, Pt., F, 60th New York, age 20. 749 Santry, J., Pt., I, 14th N. Hampshire, age 20. 750 Saunders. B., Serg't, I, 53d Georgia, age 28. 751 Sawyer, J. H., Q. M. Serg't, 36th Mass. 752 ' Sawyer, W. C, Capt., H, 23d Mass. 753 Saxon, W. T, Serg't, E, 51 st Georgia, age 21. 754 Scales, J. R., Pt., H, 43d Alabama, 755 Schriner, L., Pt., K, 81st Penn., age 18. 756 Schwartz, F., Pt., B, 1st Maryland, age 49. 757 Scott, J., Serg't, A, 126th Ohio, age 27. 758 Scram, J., Pt., D, 134th New York, age 31. 759 Sebastian, J. M., Serg't, A, 7th Kentucky. 760 Serey, J., Pt,, K, 17th Conn., age 17. 761 Shacklev,F.H.M.,Corp., B, 32d Maine, age 19. 762 Shaeffield, W. J., Pt., H, 19th Georgia, age 22. 763 Shafer, E., Pt., K, 23d Michigan, age 21. 764 Shaffer, J.,Corp'l.C, 61st New York, age 26. 765 Shaffer, M. V., Pt., G, 105th Penn., age 25. 766 Shaffer, T., Pt, F, 138th Penn., age 26. 767 Shane, J. B., Lieut., D, 16th Kv., age 23. 768 Shannon", W. M., Pt., G, 14th W.Va., age 23. 769 Shattuck, W. W., Pt., C, 7th Michigan. 770 Shelly, J., Pt., D, 46th Penn., age 24. 771 Shelly, W. H.. Pt., LJJth Michigan, age 26. 772 Shepardson, C, Corp'l, G, 114th New York. 773 Sherwood, n., Serg't, C, 4th Michigan. 774 Shields, R., Pt., K, 12th Wis. Bat'ry, age 20. 775 Shoop, S., Pt., F, 200th Penn., age 23. 776 Short.S.A..Serg't.A.73d Illinois, age 26. 778 Shrieve, A. T., Pt.. A, 6th Maryland, nge 22. Shrum, J., Pt.. II." 139th Penn., nge 19, June 14, 14, '64. Mar. 25, 25, '65. Dec. 15, 15, '64. May 3, 3, '63. Nov. 25, 27, '63. Sept, 2, 3, '64. May 1, 1, '63. June 18, 19, '64. July 30, 30, '64. Sept. 1, 2, '64. May 8, 9, *64. July 1, 2, '63. Oct. 19, 21, '64. May —, —,■ '64. May 31, Je. 1, '63. Mar. 14, 14, '62. Slay 3, 3, '63. Sept, 14, 14, '64. Sept. 17, 19, '62. Aug. 21, 22, '64. Oct. 19, 19, '64. Dec. 19, 19, '64. May 16, 16, '63. July 1, 1, '63. June 18, 18, '64. June 18, 18, '64. Mav 15, 15,"'64. April 7, 7, '65. May 6, 8, '64. Sept, 21, 22, '64. Aug. 6, 7, 764. June 18, 18, '64. Mav 31, Je.2,'62. July 20, 21,*'64. May 5, 6, '64. Sept. 19, 19, '64. June 20, 22, '64. Mar. 21, 21, '65. Mar. 25, 27, '65. Julv 20, 21,"'64. June 1. 2, '04. Sept. 19, 19. '64. Operations, Operators, Result. Right; circ. Disch'd Nov. 5, '64. Both ; ant. post. flap. Surg. L.W. Bliss, 51st N. Y. Released Aug. 2, 1865. Spec. 3998. Right; circ. Surg. H. B. Turtle, 89th 111. Disch'd Juno 14,1865. Right: ant. post, flap. Surg. J. W. Walls, P. A. C. S. Retired Feb. 16, 1864. Left; flap* Surg. H. Strong, 90th Illinois. Disch'd March 19, '65. Right; flap. Surg. B. M. Failer, 19th Ohio. Gang. Disch'd Ma}' 16, 1865. Left; flap. Surg. J. Pomerene, 42d Ohio. Disch'd July 23, '63. Left; flap; gangrene. Disch'd Aug. 17, 1865. Left; anterior post, flap. Disch'd March 29, 1866. Right; circular. Surg. S. Marks, 10th Wis. M. out May 25,1865. Right; circ. Surg. J. Reily, 33d N. J. Disch'd Sept. 12, 1864. Left; ant. post, flap; ganq.; nec. seq. rem. Disch'd Sept. 20, '64. Left; circ. Surg.W.W. Root,75th N.Y. Boneprot, Dis. June 0,'65. Right. Surg. J. J. Knott, P. A. C. S. Recovery. Left; double flap. Surg. J. P. Prince, 36th Mass. Disch'd Jan. 19, 1864. Left ; circ. Surg. G. Derby, 23d Mass. Disch'd Nov. 17. 1862. Right. Surg. - Todd, C. S. A. Gang.; bone prot, Retired Dec. 22, 1864. ---. Surg. — Luckie, C. S. A. Recovery. Left. Surg. G. B. Cogswell, 29th Mass. Dis. Dec, 27,'02. V. R.C. Right: ant. post, flap ; gangrene. Blustered out Dec. 24, 1864. Left; lat. flap. Disch'd May 20, 1865. Right; flap. Surg. J. L. Dunn, 109th Penn. Dis. Aug. 18, '65. Right; flap. Surgs J. Pomerene, 42d Ohio, and W. Berry, 7tb Ky. Disch'd Sept. 1, 1863. Left; circ. Confed. surg. Disch'd May 14, 1864. Right; circ; slough'g: bone prot. Mustered out Dec. 12, 1864. Right. Retired March 15, 1865. Right; circ; gangrene. Disch'd June 7, 1865. Left; circ. Discli'd Nov. 6,1865. Right; flap. Surg. W. Watson, 105th Penn. Dis. June 17,'65. Left. Disch'd June 12, 1865. Left. Surg. J. H. Rodgers, 104th Ohio. M. out July 15, 1865. Right; circ. Confed. surg. Exfol. rem. Dis. June 2,'65. Spec. 108. Left; circ Disch'd July 18, '62. Left; ant. post. flap. Disc'd June 10,1865. Left; flap. A.Surg. H.C.Grover, 20th lnd. DischM May 6,1865. Right; flap. A. Surg. J.'Homans, jr., U. S. A. Disch'd June 8, '65. Right; flap. Surg. W. H. Gib- bon, 15th Iowa. Recovery. Right; circ, with lat. flaps. Surg. A. T. Hudson, 26th Iowa. Dis- charged Sept. 1,1865. Right; long ant. short post. flap. Surg. W. O. McDonald, U. S. V. Disch'd July 5, '65. Spec. 4136. Right: flap. Surg. W. P. Peirce, 88th 111. Slough'g; hasm.; lig. Disch'd Jan. 18,1«65. Left; ant. post flap. Surg. C. T. Simpers.OthMd. Dis.May 14,'65. Left; lat flap. Surg.W.A.Barry, 98th Penn. Disch'd Mar. 20,'65. Died Aug. 10, 1870. Name, Military Description, and Age. Sibley, P. H., Pt,E, 18th Mississippi. Sickles, D. E., Major General, U. S. V. Sieben, J., Serg't, D, 4th New York. Sinks, J. F., Q. M. S'g't, 61st Ohio, age 22. Simmons, P., Pt., I, 60th Ohio, age 46. Sisco, M., Pt., D, llth Vermont, age 19. Sivert, C. W., Pt, I, 2d West Virginia. Skellie, E., Corp'l, D, 112th New York. Skidmore, G., Pt., I, 53d Ohio, age 3i). Slack, O. F.,Pt,E, Pur- nell Md. Leg., age 20. Slater, W. H., Capt., G, 15th New Jersey. Slaughter, J. L., 'it., E, 4th C'd Troops, age 18. Smathers, H., Pt., E, 53d Ohio, age 23. Smith, E., Pt, B, 4th Col'd Troops, age 18. Smith, G., Pt., A, 14th Conn., age 19. Smith, H., Pt., A, 149th Penn., age 25. Smith, H. C, Pt.,A, 10th Conn., age 25. Smith, J., Serg't, E, 61st New York, age 23. Smith, J., Pt., D, 6th N. Hampshire, age 27. Smith, J., Corp'l, F, 3d Artillery. Smith, J.A.,Pt,E,115th New York, age 21. Smith, J. G., Pt., B, 61st Alabama, age 42. Smith. J. O., Pt., H, 62d Virginia, age 40. Smith, J. R., Serg't, E, 53d Penn., age 34. Smith, N. B., Pt.,H, 98th Ohio, age IS. Smith, S., Corp'l, K, 22d Col'd Troops, age 22. Smith, S. H, Pt., B, 24th Virginia. Smith, T. N., Pt., B, 43d New York, age 30. Smith, W. E., Capt., E, 4 th Georgia. Smith, W. H, Serg't, C, 17th South Carolina. Smock, G.W.,Corp'l, A, 14th New York S. M., age 18. Sneed, J. R., Serg't, K, 19th S. C, age 23. Snoddy, W., Pt., D, 46th Peun., age 49. Snowble, J. F., Serg't, H, 72d New York, age 31. Snyder, J. O., Lieut., B, 7th Penn. Reserves. Snvder, W. P., Pt., H, 7tbN.Y.H.A.,age22. Solan, T., Pt, K, 10th N. Hamp., age 30. Song. P., Pt., H, 47th N. York, age 24. Soper, I, Pt., B, 4th Wis- consin. Southworth, J. E., S'g't, C, lstU.S.S.S.,age26. Spalding, L. G., Pt., B, 4th Vt., age 29. Dates. May 6, 6, '04. July 2, 2, '03. Sept. 17, 19, '62. June 22, 22, '64. Aug. 18, 18, '64. Oct, 19, 20, '64. Aug. 23, 23, '62. Sept. 29, 29, '64. June 27, 27, '64. June 3, 3, '64. Dec. 13, 13, '62. Sept. 29, 29, '64. June 23, 23, '64. Sept. 29, 29, '64. Oct. 1, 1, '64. June 1, 1, '64. April 2, 2, '65. April 7, 8, '65. June 3, 4, '64. May 2, 2, '63. May 7, 8, '64. Mar. 25, 25, '65. July 6, 6, '63. Mar. 31, Ap. 1. '65 July 20, 2'J, '64. Sept. 29, 29, '64. June 30, J'yl,'62. Oct. 19, 20, '64. June 25, 25, '62. Mar. 25, 25, '65. April 29, 30, '63. July 22, 22, '64. Dec. 9, 11, '64. July 23, 24, "'63. Dec. 13, 13, '62. Nov. 27, 27, '64. July 30, 30, '64. Aug. 16, 18, '64. May 27, 27, '63. Nov. 7, 7, '63. Nov. 7, 7,'63. Operations, Operators, Result. ----. Surg. — Griffin, 18th Miss. Recovery. Right. Surg. T. Sim, U. S. V. Recovery. Spec. 1335. Right, Discharged Feb. 9,1863. Left; circ. Surg. H. K. Spooner, 61st Ohio. Erysip. Discharged March 31, 1865. Left; flap. Disch'd Feb. 7,1865. Right; flap. Disch'd May 27,'65. Right. Surg.R.W.Hazlett,2d W. Va. Disch'd Feb. 2, '63. Died April 7, 1876; consumption. R't; circ. Surg.C.E.Washburn, 112th N. Y. Dis. June 24,1865. Left; ant post. flap. Snrg. A. C. Messenger, 57th Ohio. Disch'd Jan. 3, 1865. Right; flap. Surg. J. O'Donnell, Purnell Legion. Disch'd Oct. 16, 1864. Right. A. Surg. W. E. Mattison, 3d N. J. Disch'd April 22,1865. Left; circ. A.Surg.G.G.Odiorne, 4th Col'd Troops. Gang. Dis. March 27, 1865. Left; flap. A. Staff Surg. C. B. Richards, U.S.A. Disch d June 17, 1865. Right; lat,flap. A.Surg.M.Phil- lips, 22d Col'd Troops. Disch'd July 19, 1865. Right; flap. Surg. F. A. Dudley, 14th Conn. Disch'd June 16,'65. Left; ant.post.skinflap; circ.seet. muscles. Disch'd Dec 8,1864. Left; long ant. flap. Surg. T. H. Squire, 89th N.Y. Disch'd July 31, 1865. R't; circ. Surg. W. B. Hart man, 116th Penn. Dis. July 20,1865. Left; flap. Disch'd Aug. 2,1865. Right; flap. Disch'd Sept. 29,'63. Left; flap. Confed. surg. Disch'd July 20, 1865. Right; circular. Recovery. Right; circ. Exch'd Nov. 12,'63. Right; circ. Surg. P. E. Hubon, 28th Mass. Disch'd July 14,'65. Left; flap. Disch'd Jan. 2,1865. Right; lateral flap. Disch'd June 13,1865. ----. Surg. — Neblitt, C. S. A. Recovery. Right; ant. post. flap. Surg.G.T. Stevens, 77th N.Y. Discharged January 26, 1865. ----. Surg.W.H.Philpost,C.S. A. Recovery. Right; circ. Surg.W. L. Baylor, C.S.A. Released May 10,1865. Right; circ. Surg. R. B. Brown, 31st N. J. Disced June 15, '64. Spec. 1144. Right Surg.—Hawkins, C.S.A. Retired Feb. 24,1865. Right; flap. Surg. IL Z. Gill, U. S. V. Disch'd June 19,1865. Right; circ. Surg. C. K. Irwine, 72d N. Y. Bone exfol. Disch'd July 27, 1864. Left; flap. Surg. C. Bower, 6th Pa. Res. Disch'd April 1, 1863. Right; flap. Surg. J. E. Pomfret, 7th New York Heavy Artillery. Disch'd June 6,1865. Left; circ. Disch'd Oct. 26, 1865. Left; flap. Confed surg. Disch'd Oct 26,'64. 1870, stump always sore. Left; flap. Surg.W.R. Bronnell, 12th Conn. Disch'd J uly 14, '63. Right. Discharged June 28,1864. Left. Disch'd March 28,1864. 1 Derby (G.), Army Med. Intelligence, in Boston Med. and Surg. Jour., 1862, Vol. 66, p. 198. OTIS (G. A.), ibttU, p. 239. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 255 820 821 822 823 824 825 826 829 830 831 832 833 834 835 838 839 840 841 842 843 844 845 846 847 848 849 850 851 852 853 854 855 856 Name, Military Description, and Age. Specht, J., Pt., A, 49th New York, ngo 45. Spinnings, T., It., F, 137th N. York, age 19. 'Spivey, W. W., Pt., K, 27th Alabama. Sprinkle, S. M., Pt., I, 39th Ohio, age 23. Squires, C. W., Pt, B, 16th Connecticut. Staples, R. C, Pt., F, 7th Illinois. Stark, A. E., Serg't. II, 49th Virginia, age 28. Stark, J. T., Serg't, I, 13th Ky., age 25. Starr, A. T.,Pt, F, 106th Penn, age 23. Staton, G.D.,lt.,F,4Bth Alabama, age 28. Steel, B., Serg't, C, 9th Georgia, age 22. Stephens, A. F., Pt., H, 65th Illinois, age l9. Stephens, G., Pt, C, 1st Cavalry, age 35. Stephens, S. B., Pt.'G, 8th Georgia. Stephenson, R., Pt., B, 19th C. Troops, age 19. Stevenson, G, Pt., A, 7th Indiana, age 23. Stickles. J. R., Pt.. M, 2d Mich. Cav., age 18. Sticknev, J. G., Serg't, D, 0th Vt, age 24. Slinson, A., Pt., 1, 38th N. Carolina, age 20. St. Martz, W., Serg't, F, 59th Illinois, age 26. Stone, D., Pt, C, 63d Pennsylvania. Strong.'R. M., Lt.-Col., 19th Wis., age 34. StubbUfield, W. H, Pt., C, 2d S. C, age 19. Sturgis, W. H., Pt., K, 9th Maine, age 25. Sturman, J. A., Pt., A, 3d lnd. Cav., age 19. Suggs, R. R., Pt, M, 8th S. C, age 22. Sutton, J. M., Lieut., E, 148th Penn., age 22. Swartz, J., Pt., K, 3d N. Jersey Cav., age 20. Swayne, W., Col., 43d Ohio, age 30. Sweezey, I. T., Serg't, I, 150th N. York, age 19. Swisher, J., Corp'l, B, 81st Ohio, age 22. Sykes, O., Pt., C, 123d Ohio, age 17. Tatom, R. P., Pt., C, 19th Georgia. Taylor, F. L. Pt.,E, 17th Vermont, age 22. Taylor, J. H, Lieut,, F, 16th South Carolina. Taylor, J., Pt., A, 19th Michigan, age 19. Temple, J. B.,Pt.,A,8th N. York Art'y, age 57. Tennis, S., Pt, F, 24th Missouri, age 28. Mar. 25, 26, '65. Julv 2, 3, '63. Sept. 19, 19, '63. July 30, 30, '04. April 20, 20, '04. Oct. 4, 4, '62. Oct. 19, 20, '64. Mav 28, 28,"'64. June 16, 16, '64. Aug. 16, 17, '64. Aug. 14, 14, '64. Nov. 25. 26, '64. Julv 28, 28," '64. Oct. 7, 7, '64. June 23, 23, '64. June 18, 18, '64. June 11, 11, '64. Aug. 21, 21, '64. April 2, 2, '65. Dec. 15, 16, '64. Aug. 29, 29, '62. Oct. 27, 29, '64. June 1, 3, '64. May 18, 18,"'64. Aug. 3, 4, '62. July 1, 3, '63. May 10, 11, '64. June 1, 1, '64. Feb. 2, 2, '65. Dec. 13, 15, '64. Aug. 7, 7, 764. Sept. 19, 20, '64. Aug. 19, 19, '64. April 2, 2, '65. June 19, 19, '64. June 22, 22, '64. June 22, 22, '64. Dec. 28, 28, '62. Operations, Operators, Result. Left; flap; gangrene; neorosis. Disch'd Sept. 18,'65. Spec. 4174. Right; ciro. A. A. Surg.W. S. Woods. Gang.; necro. Nov. 7, reamp. up. third. Disch'd Sept. 14, 1864. Spec. 4185. ----. Recovery. Left; flap. Surg. J. C. Denise, 27th Ohio. Disch'd Deo. 2, '65; sub. amputations. Left; ciro. Surg. N. Mayer, 16th Conn. Disch'd April 17, 1865. Right; flap. Surg. R. L. Metcalf, 7th 111. Disch'd Nov. 26, 1862. Left; double lat. flap. Surg. J. M. G. McGuire, C. S. A. Ex- changed Feb. 16, 1865. Left; ant. post. flap. Surg. C. D. Moore, 13th Ky. Disch d June 10, 1865. Left; ciro. Surg. H.A.Martin, U. S. V. Disch'd Jan. 17, '65. Right; circ. Disch'd Jan. 15, 1865. Left. Surg. W. S. Cooper, 125th N. Y. Prison Oct. 26> 1864. Left; flap. Surg. J. H. Rodgers, 104th Ohio. Disch'd Junel3,'65. Left; ant, post. flap. A. A. Surg. C. Rogers. Disch'd March 8, 1865. Operation Jan., 1866. Right. Surg. J. S. Jackson, C. S. A. Recover}'. Left: flap. Surg. D.MacKay,29th (J. T. Disch'd April 17. 1865. Right; flap. Surg. G. AV. New, 7th lnd. Gang. Dis. Oct. 5,'64. Left; flap; gang. July 11, flap, middle third. A. Surg. R. Rae, 1st N.Y. Drag. Dis. Mar. 10,'65. Left; ant. post. flap. Surg. E. Phillips, 6th Vt. Exfol.; gang. Disch'd Oct. 12, 1865. Right, Trans'd for release June 21, 1865. Right; ant. post flap. A. Surg. H. P. Jennings, 51st O. Gang. Disch'd June 26, 1865. Left. Discharged Jan. 13, 1863. Left; ant. post. flap. A. Surg. — Gibbs, C. S. A. Discharged April 11, 1865. Left; circ June 15, medulla prot. from bone. Released June 14,'65. Right; flap. Surg. A. D. Palmer, 9th Me. M. out Sept. 27, 1864. Left; circ. flaps. Exfol. Disch'd April 22, 1863. Left. Transferred Sept. 28, '63. Left; circ. Surg. J. W. Wishart, 140th Penn. Dis. Nov. 2,1864. Nov. 13, '64, reamp. up. third. '70, stump not healthy. Sp.2280. Right; ant post. flap. Disch'd April 26, 1865. Right; flap. Surg. F. M. Rose, 43d Ohio. Haem.; lig. small art. Retired. Left; flap. Surg. H. Z. Gill, U. S.V. (Alsoamp.Ieftsec'dfing'r.) Disch'd July 19, 1865. Left; circ. A. Surg. J. C. Simon- son,66th lnd. Discli'd May, 9,'65. Left; circ. Disch'd June 3,1865. Left Surg. — Matthews.C.S.A. Recovery. Left; circ. Snrg. L. W. Bliss, 51st N. Y. Bone prot. Disch'd November 4, 1865. ----. Surg. — Cooper, C. S. A. Recovery. Right; flap. Surg. J. Bennett, 19th Mich. Disch'd Sept. 13,'65. Left; ant post. flap. Surg. M. F. Regan, 164th N. Y. Seq. rem. Disch'd Aug. 25, 1865. Right; haem. Disch'd July 15, 1863. Name, Military Description, and Age. Terry, W., Pt., G, 8th New Jersey, age 19. Thair, J.,Pt, E,22dKy. Thompson, H, Pt., A, 2d Tennessee. Thompson, IL, Pt,G,7th Indiana, age 23. Thompson, M., Serg't, D, 88th Indiana, age 24. Thompson, J. R., Pt., C, 40th Indiana, nge 20. Thompson, J. A.,Serg't, G, 79th N. Y., age 42. Thompson, S. J., Serg't, B,79th lnd., age 22. Thanason, T. B., Pt., E, 17th Miss., age 27. Thornton, R., Pt, 1,29th Conn., age 18. Thurmer, J. W., Capt,, D, 13th Mississippi. Tomlin, J., Pt., A, 21st Tenn., age 19. Tompkins, S. C, Serg't, F, 159th New York. Torrance, R. A., Pt., H, 8th Texas Cavalry. Tower, D.W., Lieut., B, 17th Iowa. Townsend.A., Lieut, G, 18th Infantry, age 20. Tramell, J. F.,Pt, L, 6th Alabama, age 21. Treadway, J. A., Pt., H, 43d N. Carolina. Trexler, W. G., Pt, B, 93d Pennsylvania. Trow.W., Pt, A, 8th N. York Art'y, age 26. Truckey, G. F., Pt,, A, 7th Wis., age 19. Truesdell, J. W.. Pt., L, 54th Penn , age 21. Trvon, J. L., Serg't, H, 9th New York, age 33. Tumblin, S. H, Pt., H, 22d N. Carolina. Turnbull, J. M., Lieut., C, 36th Illinois. Turner, C.H.,Pt,B,38th New York, age 24. Turner, P. L., Pt.,A,23d N. Carolina, age 19. Underwood, C, Serg't, D, 36th Mass., age 27. Underwood, J., Pt., F, 41st Ohio, age 23. Usher, J., Pt., D, 107th New York, age 26. Utter, W., Pt., K, 8th Iowa, age 21. Van Lear. A. G. L., Pt., K, 5th Virginia. 2 Vick, R. A., Pt., E, 43d N. Carolina, age 37. Vickery,D.L.,Pt, 1,40th Indiana, age 23. Walbridge, H.C., Pt., E, 145th Penn., age 18. Wager, M. H., Pt., G, 123d Ohio, age 39. Walker, G. R., Pt, E, 7th West Virginia. Walker, H., PL, K, 6th Vermont. Walker, S., Serg't, F, 155th Penn., age 29. 3 Wallace, D. P., Pt, K, 42d Ohio. Oct 7, 7, '64. Mav 22, 22,*'P3. Sept. 20, 20, '63. May 5, 5, '64. Mar. 19, 19, '65. Nov. 25, 27, '63. May 9, 10, '64. Nov. 25, 26, '63. Sept. 3, 3, '64. Oct 27, 27, '64. Dec. 11, 11, '02. Dec. 8, 8, '64. Mav 2, 3, '63. Dec. 26, 26, '63. May 16. 16, '63! Aug. 7, 7, ?64. July 1, 1, '63. Julv 2, 2, '63. May 31, Jo. 2,'62. June 3, 3, '64. June 17, 18, '64. July 18, 19, '64. June 11, 11, '64. May 2, 4, '63. May 26, 27, '64. Deo. 13, 15, '62. Oct, 11, 12. '63. Sept. 30, Oct. 1,'64, Dec. 15, 16, '64. May 25, 27, '64. July 19, 20, '63. May 3, 3, '63. Oct. 19, 19, '64. Nov. 25, 27, '63. June 16, 17, '64. Mar. 31, 31, '65. July 4, 5, '62. April 16, 18, '62. Mav 3, 3, l63. July 12, 12, '63. Operations, Operators, Result. Left; circ A. Surg. — Johnson, C. S. A. April 14, '65, reamp. mid. third. Disch'd June 28,'65. Left. Surg. B. F. Stevenson, 22d Ky. Disch'd Aug. 1, 1863. ----. Surg. — Bates, C. S. A. Recovery. Right; ant. post. flap. Mustered out Sept 20,1864. L't; dou. flap. Surg.D.S.Young, 21st Ohio. Disch'd Oct. 17, '65. Left; flap. Disch'd Dec. 1,1864. Left; circ. Surg. S. S. French, 20th Mich. Nec. bone removed. Disch'd Aug. 15,'64. Spec. 2968. Left; flap. A. A. Surg. R.Wirth. Gang.; necro. Dec. 4, reamp.; circ. Disch'd Aug. 25, 1864. Left; double flap. Surg. — Pat- terson, C. S. A. For exchange Nov. 22,1864. Left; flap. Snrg. N. Y. Leit, 76th Penn. Disch'd Aug. 16, 1805. Right. Surgs. Hill and Franklin, C. S. A. Retired Oct. 29, 1864. Left; bi-lateral flap. Provost Marshal May 6, 1865. Left; ant. post. flap. Surg. C. Robertson. 159th N. Y. Disch'd Aug. 1, 1863. Left. Surg — Holmes, C. S. A. Recovery. Left; flap. Surg. J. H. Ealy,17th Iowa. Pieces of bone removed. Mustered out May 5, 1805. Left: circ. Surg. L. Slusser, 69th Ohio. Retired Dec, 1804. Left. Provost Marshal Sept. 10, 1803. Left. Paroled Sept. 25, 1863. Left; flap; prot. bone removed. Disch'd July 5, 1862. Left; flap. A.Surg.C.H.Pegg,8th N. Y. H. A. Haem.; nec. bone removed. Disch'd Sept. 20,'65. Right; circ, Surg. C. N. Cham- berlain, U. S. V. Disch'd Oct. 17, 1864. Right; circ. Disch'd Sept. 14, 1864. Right; flap. Surg. B.G. Streeter, 4th N. Y. Cav. Dis. Apr. 28,'65. Left. Recovery. Left; flap. Surg. W. P. Peirce, 88th 111. Resigned Nov. 4,1864. Right. Confed.surg. Gang.; haem. Mar. 1,'63, amp. up. third; haem. Disch'd Sept. 9,1863. ----. Furloughed Feb. 6,1864. Left. Discharged July 12, 1865. 1865. dis. bone removed. Died April 30, 1867. Right; ant. post. flap. Disch'd May 11, 1865. Left; ant. post. flap. Surg. W. C. Bennett.U.S.V. Dis.June 6,'65. Right; semi-circ. integ.flaps; circ. cutmus. Surg.H.Z.Gill.U.S.V. Exfol. Disch'd Oct. 21, 1803. Right; circ. May 15, haem.; lig. femoral. Recovery. Right; necr. Mar. Il, '65, reamp. hip joint. Recovery. Left; circ. Disch'd May 20,1864. Left; flap. Surg. G. L. Potter, 145th Penn. Disch 'd June 8. '65. Right; circ. Surg. T. H. Squire, 89th N. Y. Recovery. Left; flap. A.A.Surg.C.G.Page. Disch'd Oct. 23,1862. Right. Surg. H. Janes, 3d Vt. Disch'd August 22, 1804. Right; ant post. flap. A. Surg. D. D. Swift, 126th Penn. Lieut. V.R. C.March 11, 1864. R't; circ. Surg. J. Pomerene,42d Ohio. Disch'd Oct. 7, 1863. 1 TERRY (C), loc. cit, p. 76. 'Fauntleroy (A. M.), Hip Joint Amp.-Rec, in Richmond Med. Jour., 1866, Vol. I, p. 7. Circular No. 7, S. G. O., 1867, pp. 50, 65, etc. 'BRYAN (J.), loc. cit. Vol. 7, p. 288. 256 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, military Description, and Age. 898 Wallace, R. T., Pt, A, 70th Penn., age 33. 899 Walsh, R. L., Pt., E, Sth Ohio, age 24. 900 Wanzcr, J., Pt., G, 137th New Vork. . 901 Ward, F. B., Corp'l, F, 20th Maine, age 22. 902 Ward, T. W., PL, E, 14th Alabama. 903 Wardell. S., Corp'l, A, 14thN.Y.H.A.,uge23. 904 Watkins, J. R., Pt,, G, 43d N. C, age 37. 905 Watson, G. W., Lieut,, H, 90th Penn., age 35. 906 Watson, M. F., Lieut., I, 5th Artillery. 907 Webb, W. E., Serg't.K, 100th Ohio, age 22. 908 W.-iler, G. S., Pt., G, 65th Illinois, age 29. 909 Wells, D.,Corp'l,E, 121st New York, ago 28. 910 Wells, G., Serg't, K, 7th Louisiana, age 21. 911 Welsh, J., Ft., H, 6th Kentucky, age 26. 912 Welton, F. G., Pt,, B, 4-d Illinois, age 21. 913 Werle, M.,Pt.,K,66thN. York, age 23. 914 Worth, W., l't, E, 7th Now York, age 32. 915 Westbrook, J. W., Lieut, B, 4th Miss., ago 23. 916 Wetler, IL.Lieut., 11,8th Penn. Res., ago 20. !»17 Wliealan, J..lt..D, 123d Ohio, age 23. 918 Whrrle;;, P., Pt., K, 61st N. Carolina, age 23. 919 White. A. J..Pt,H. 155th Pennsylvania, age 19. 920 White, G.C.,Pt.,F. 144th New York, age 40. 921 White, J., Corp'l, E, 6th Tennessee, age 28. 922 White, J. M., Pt, A, 55th Illinois. 923 White, P. P., Pt,A, 20th N. Carolina, age 21. 924 Whitlock, R.,Pt,G,llth Connecticut. 925 Whitner, P. IF, Pt., A, 12th N. Cage 24. 926 Whitney, J. F., Corp'l, C, 14th" Mich., age 21. 927 Whitney, W. E., Pt., I, 21st Mich., age 53. !>28 Whittingham,A.,Serg't, E. 28th Penn. '.K9 Wicks, B., Pt., A, 89th N. Y., age 20. 930 Wiggs, J. £T.,Pt, 1,16th N. Carolina, age 23. 931 Wiginton, J. T., Pt., K, 28th Tennessee, age 18. 932 Wiley. W. A., Colonel, 41st Ohio. 933 Williams, B., Pt, E, 6th Colored Troops. 934 Williams, E. C, Pt., D, 3d Wis., age 23. 935 Williams, E. S., Pt, H, 2d Wis., age 23. 936 Williams. G. J., Corp'l. B, 42d Ohio. 937 Williams, J., Pt., C, 1st Infantry, age 28. i::s Williams,'!'. IL, Corp'l, j E, 13th New Jersey. 939 Williamson, J. J.,Lieut, B, 2d New York Arty, age 30. 94 1 Wilkerson. W.H., Lieut., G, 44th Virginia. 941 ! Wilkins.J.,Crp'l.L,14th | I N. Y. H. A., age 33. Dates. Oct. 22, 24, '62. May 10, 10, '64. Oct. 29, 30, '63. July 2, 3, '63. May 30, 30, '64. June 2, 3, '64. July 12, 12, '64. Slav 5, 7, r64. July 2, 3, '63. Aug. 6, 7, '64. Nov. 29, 29, '64. Oct. 19, 20, '64. Sept. 19, 19, '64. June 23, 23, '64. May 29, . 29, '64. June 16, 16, '64. April 7, 7, '65. Nov. 30, Dec 1,'64 Aug. 28, 28, '62. Dec. 15, 16, '63. Sept 30, 30, '64. June 22, 22, '04. Nov. 30, De.2,'64. May 27, 27, '64. June 27, 27, '64. July 1, 2, '03. Sept. 13, 13, '62. July 1 1, '63. Mar. 16, 16, '65. Dec 13, 13, '64. Sept. 17, 17, '62. Sept. 17, 19, '62. April 7, 7, '65. Sept, 1, 1, '64. Nov. 25, 25, '63. Feb. 11, 11, '65. Mar. 16, 16, '65. July 1, 2, '63. Mavl, 1, '63. Feb. 22, 22, '65. Julv 3, 3, '63. June 3, 3, '64. May 10. 11, '64. Aug. 19, 20, '64. Operations, Operators, Result. Left; ant. post. flap. Surg. R. B Bontecou, U. S.V. Disch'd Jan. 8,1804. Specs. 2031, 3018. Left. Surg. J. L. Brenton, 8th O. Disch'd Oct. 13,1864. R't: ant. flap. Surg. G. P. Oliver, 111th Penn. Disch'd Mar. 1,'64. Right; flap; erysipelas. Disch'd Nov. 28,1864. Right; dou. flap. Surg. — Dixon, C. S. A. Involucrum removed. Disch'd July 17, 1865. Left; circ. Discli'd June 23, '65. Left; lateral flap. Prison Oct. 14, 1864. Right; circ. Disch'd Nov. 14,'65. Right; circ A. Surg. B. Howard, U. S. A. Promoted. Spec. 1382. Left; circ. Surg.GA.Collainore. 100th O. Gang. Dis. Mar. 27,'65. Right: circ. Confederate surg. Disch'd June 5, 1865. Right; circ. Discli'd June 12, 1865. Left; circ. Surg.—Davis,C.S.A. Provost Marshal Feb. 11,1865. Left; circ ; nec. bone removed. Disch'd April 10, 1865. Right: circ. Surg. Z. P. Hanson, 42d 111. Disch'd Mar. 20, 1865. Left; ant. post. flap. Surg. G. L. Potter, 145th Penn. Discharged June 24, 1865. L't; dou.flap. Surg. W.Vasburgh, 111th N.Y. Dis. Aug. 18,1805. Left; circ Pro. Marshal Feb. 6, 1865. Right. Surg. L.W. Read, 1st Pa. Reserves. Disch'd Sept. 29,'62. Left; flap. Surg. O. Ferris, 123d Ohio. Disch'd May 23, 1864. Right. Prison April 14. 1865. Left; flap; erysip.; gang.; bone remov'd. Disch'd Nov. 10,1864. Right; ant. post. flap. A. Surg. C. T. Reber, U. S. V. Discli d Aug. 11,1865. Left Surg. C. W. McMillan, 1st Tenn. Discli'd May 9,1865. Right; circ. A.Surg. J.T. Smith, i5th 111. Disch'd June 6, 1865. Left, Surg. — Bissell, C. S. A. Exchanged. Left Discli'd Dec. 31,'62. Died of apoplexy Dec. 16,1864. Left. Exchanged Nov. 12, 1863. Left; circ Surg.A.Wilson.113th Ohio. Disch'd June 25, 1865. Left: circ. flap. Surg. J. Avery, 21st Mich. Disch'd June 16,'65. Left. Disch'd December 31, '62. Left; flap. Surg. T. H. Squire, 89th N. Y. Disch'd Feb. 23, '63. Left; circ. Released June 14,'65. Left; circ. Surg. — Wilson, 28th Tenn. Pro. Mar. Nov. 16, 1864. Left Disch'd June 7.1864. Maj. V. R. C.April 19,1865. Left; circ. A. Surg. H C. Merry- weather. 5th Colored Troops. Discli'd July 25, 1865. Right; circ. (Skey's operation.) Disch'd Sept. 1, 1865. Right; circ. Disch'd December 1, 1863. Left: flap. Surg. J. Pomerene, 42d Ohio. Disch'd Oct 29,1863. Left; ant. post. flap. Surg. A. J. H. Buzzell, 3d N. H. Disch'd Sept. 22, 1865. Left; double flap. Surg. J. A. Freeman, 13th N. J. Disch'd Nov. 7, '63. Died May 16. '70. Right; circ. Surg. J. W. Wishart, 140th Penn. Nec.bone remov'd. Disch'd Feb. 25. 1865. ----. Surg. — Graves, 44th Va. Recovery. Right; circ. Surg.W. V. White, 57th Mass. Disch'd Maj- 30,'65. Name, Military Description, and Age. Wilkinson, J.W., Pt., A, 187th Penn., age 40. Wilkinson, S. F., Pt, D, 150th N. York, age 40. Wilson, A.,Corp'1, H, 6th New York Cavalry. Wilson, E. E., Pt., H, 110th Penn, age 20. Wilson, G., Pt., I, 95th Ohio. Wilson, H., Pt., I, 45th Missouri, age 19. Wilson, P. P., Lieut, H, 5th Connecticut. Wilson, R., Pt., E, 49th Indiana. Wilson, S., Pt., F, 65th Georgia, age 26. Wilson, VV., Pt., I, 1st Massachusetts. Winder, J., Pt, E, 43d New York, age 39. Wing, A. O., Pt., F, 1st Maine Art'y, age 27. • Winstead, W.D., Pt, H, 16th North Carolina. Woodle, R., Pt., F, 21st South Carolina. Wood. I., Corp'l, G, 94th Ohio, age 22. Woods, W., Pt., G, 32d New York. Woolbough, J.R.,Pt,I, 118th Penn., age 33. Workman, A. J., Pt, I, 29th Virginia, age 20. Wright, A., Pt, I, 68th Colored Troops,age 24. Wright, J. C, Serg't, C, 58th Illinois. Wylie, R., Pt., D, 23d Penn. Militia. Wyse, C. F., Pt., F, 69th New York. Yale, T., Corp'l, H, 23d Wisconsin. Yatton, G. W., Pt., D, 10th N.Y. Heavy Art., age 23. Yeager, B., Pt., A, 9th New Jersey, age 21. Yeiser, J., Pt, F, 10th Iowa. Yemmans, F., Pt, B, Sth Mich. Cavalry, age 32. Young, A. L., Corp'l, F, 46th Peun., age 24. Young, G., Serg'tG, 8th Michigan, age 23. Young, L.,Corp'l, F,81st Ohio, age 22. Zahnizer, M. B., Pt, B, 140th Penn., age 21. Zimmerman, H., Pt, E, llth Indiana, age 18. Abrams,L.,Pt..D, 158th New York, age 30. Aiken, W., Pt., G, 105th Pennsylvania. Albert, G., Pt., A, 27th Michigan, age 30. Alderson, B.,Pt.,E,lllth Illinois. Aldinger, C, Pt., E, 7th New York. Alexander.A. C, Pt., H, 64th Ohio, age 20. Alexander, N. A., Pt.,A, 5th Iowa, age 23. Allen, D., Serg't, G, 4th Maine, age 21. Allen, G., Pt., H, 12th Missouri. Dates. June 19, 20, '64. Mar. 16, 16, '65. Oct 15, 15, '63. July 2, 4, '63. Aug. 30, 31, '62. Oct. 7, 7, '64. June 22, 23, '04. Dec. 29, 29, '62. Nov. 30, De.1,'64. June 25 25, '62. Oct. 19, 20, '64. June 18, 19, '64. July 1, 1, '63. June 16, 10, '64. May 14, 14, '64. May 7, 7, '62. Oct 1, 1, '64. Mav 16, 16," '64. April 9, 10, '65. Oct. 3, 4, '62. July], 2, '63. Sept. 17, 19, '62. Jan. 11, 11, '63. April 2, 2, '65. May 6, 6, '64. Nov. 25. 25, '63. Nov. 25, 25, '64. July 20, 21, '64. June 17, 17, '64. July 22, 22, '64. Mav 12, 12,*'64. Aug. 24, 24, '64. April 2, 2, '65. May 2, 2, '63. July 30, 30, '64. July 22, 22, '64. Dec. 13, 13, '62.' Dec. 13, 13, '64. Sept. 19, 19, '62. May 5, 5, *64. June 5, 5, '63. Operations, Operators, Result. Right; ant. posterior flaps. Surg. W. F. Humphrey, 149th Penn. Discli'd Jan. 19, "1865. Right; circ. Surg. C. M. Camp- bell, 150th N.Y. Disch'd June 17, 1865. Right; circ. Surgs. A. P. Clark, 6th N. Y. Cav., and W. II. Ruli- son, 9th N. Y. Cav. Discharged April 26, 1864. Right; flap. Surg. H. F. Lyster, 5th Mich. Disch'd Aug. 7, '64. Left; circ. Surg. H. Z. Gill, 95th Ohio. Disch'd Nov. 28, 1862. Right; bi-lat.flap. Confed. surg. Disch'd Jan. 31, 1865. Right; (also wound of left leg.) Surg. J. Chapman, 123d N.Y. Discli'd Dec. 22, '64; sub. oper. Right; flap. Disch'd March 16, '63. 1870, stump sore. Left: lat. flap. Provost Marshal March 2, 1865. Left; circ. Disch'd Sept. 29,'62. Left; long ant. flap; sloughing. Disch'd July 10, 1865. Left; circ. Discharged 1865. Right. Surg. — Murphy,C.S.A. Exchanged March 17, 1864. ----. Surg. — Muller, C. S. A. Recovery. Left; flap. Disch'd Dec. 2,1864. Right; (also wound of left leg.) Disch'd Sept 15,1862. Left; flap. Surg.J.Thomas, 118th Penn. Nec. bone rem'd. Disch'd July 25, 1865. Right; circ. Retired February 22, 1865. Left; circ. skin flap; circ. sect muscles. A.Surg. 15. F. Lyford, 68th C. T. Discli'd June 10,'65. Left; flap. Confed. surg. Disch'd April 10, 1863. Right. Surg.—Neil!, Dickenson College. M. out Aug. 4,'63. Left; circ. Disch'd Mar. 30,'63. Right; flap. Surg. J. B. Sparks, 19th Kentucky. Disch'd March 7, 1863. Right; flap. Surg. O. S. Cope- land, 10th N. Y. Art'y. Disch'd Oct. 3,1865. Left; circ; bone rem'd. Disch'd Feb. 25,1865. Spec. 2972. Right; circ. Surg. R. J. Mohr, 10th Iowa. Disch'd Nov. 23,'64. Left. Confed. surg. Gang. Mar. 26, '65, reamp.; circ; mid. third. Dr. S. L. Norris, Saugatuck. Disch'd June 10,1865. Left; flap. Disch'd July 28,'65. Left; circ Surg.W. B. Fox, Sth Mich. Gang. Disch. June 9,'65. Right; flap. Surg. W. C. Jacobs. 81st Ohio. Disch'd Feb. 17,V5 Right; circ; gangrene. Disch'd July 4, 1865. Left; flap. Surff.J.A.Comington, llth lnd. Disch'd Mar. 2(>.'05 R't; flap. Surg.TI.C. Levensaler, 8th Me. Died June 5, '05; irri- tative fever. Right, Died June 9, 1863. Left; circ Surg.W.C. Shurlock, 51st Penn. Died Aug. 27, '64 ; exhaustion. Left. Surg.A.C. Messenger, 57th Ohio. Died Aug. 14,18,64. Right. Surg. C. S. Wood, 66th N. Y. Died Dec. 28, 1 s(i2. Right; (also other wounds;) flap. Surgeon J. n. Hutchison, 15th Mich. Died Dec. 13,1864. Left. Surg. J.G.F. Holston, U.S. V. Died Sept. 29,1862. Left; flap. Died June 6,1864. Right. Surg. J. Spiegelhaltcr, 12th Mo. Died June 25, 1863. SECT. III.J PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 257 984? '.185$ 986 990 991 992 993 994 995 996 997 998 999 1000 1001 1002 1003 1004 1005 1006 100 1008 1009 1010 1011 i012 10R 1014 1015 1016 1017 1018 1019 1020 1021 1022 1023 1024 1025 1026 1027 1028 Name, Military Description, and Age. Allen, E. S., Serg't,D,3d Maine, age 36. Allen, S., Pt, G, 59th Mass., age 19. Almon, W. J., Pt., F, Sth North Carolina. Alpen, R., Pt., F, 20th Massachusetts. Alsop, W., Pt, F, 33d Indiana. Alva, J., Corp'l, F, 13th Ohio Cav., age 21. Anderson, J. B., Pt., H, 81st Indiana, age 33. Anderson, J. S., It., A, 123d Ohio, age 22. Anderson, J. //..Corp'l, H, 59th Georgia. Andrews, J., Pt, D, lltu Vermont. Andrews, J., Capt., D, 66th Illinois. Anglen, T. R., Pt., D, 38th Virginia. Antonio, J., Pt, A, llth Conn., age 31. Argo, J E., —, H, 1st Georgia. Armond, F., Pt., D, 1st Delaware, age 39. Armstrong, F.,Serg't, A, 58th Mass., age 30. Armstrong, J.. Serg't, M, 21st Penn. Cav., age 28. Armstrong, S., Pt, G, 2d Mich., age 45. Armstrong, T. H, Pt,D, 7th S. Carolina Cav. Arnich, M., Pt, K, 200th Pennsylvania. Atwood, R. W., Corp'l, C, 105th Illinois. Austin, H. K. N., Serg't, E,9thN.Y.H.A.,age35. Bailey, H.,Corp'l,B,39th Illinois, age 27. Baines, J. A., Pt. ,G, 55th Illinois, age 25. Baker, C, Pt., 12th Wis- consin Battery. Bamberter, J., Pt., F, 2d Missouri. Banks, E. M.,Pt,H, 16th Maine. Banning, L., Pt., A,122d New York. Barbour, S.V., Pt,E,9th N. Y.H.Art'ry,age28. Barclay, W. IL, Lieut., K,7thN.Y.,age23. Barker, J., Pt., I, 58th Mass., age 42. Bames, C, Pt., D,40th New York, age 21. Barnes, IL, Pt, H, 14th Indiana. Barnes, J. M., Corp'l, A, 12tb Kentucky, age 31. Barnes, S. W., Pt, H, 140th Penn. Barnett, P., Pt., F, 3d Delaware. Barringer, F., Pt., E, 140tb Penn.. age 18. Bartlett, M., Pt., G, 10th Maine. Bass, W. L., Pt., K, 6th Georgia. Battee, P., Sergeant, B, 76th Ohio. Battles, T, Pt,, —, 36th Alabama. Beach, J. T, Adj't, 5th Louisiana. Beard, H., Pt., F, 46th Pennsylvania. Beaty, S., Pt., B, 30th Ohio, age 44. Bebout, B., Corp'l, D, 140th Penn. July 2, 3, '63. June 17, 17, '64. Mav 8, 8, '"04. Mav 30, —,"'64. June 25, 25, '64. Oot. 1, 1, '64. June 20, 20. '64. July 18, —,' '64. Nov. 29, 29, '03. Sept. 19, 19, '04. May 27, 27,"'64. July 3, 3, '63. June 6, 6, '64. Sept. 14, 15, '02. May 18, 18, '64. June 3, 3, '64. June 18, 18, '64. June 18, 18, '64. Aug. 18, 19, '64. Mar. 25, 25, '65. May 27, 27, '64. June 1, 3, '64. May 20, 20, '64. July 22, 23, '64. Oct 5, 5, '64. Sept. 19, 19, '63. Dec. 13, 13, 62. Sept. 19, 19, '64. Oct. 19, 20, '64. June 3, 5, '64. June 17, 17, '64. May 5, 6, '64. Sept. 17, 17, '62. Aug. 6, 6, '64. July 3, 3, '63. June 18, 18, '64. June 16, 18, '04. Sept. 17, 17, '62. May 16, 17, '64. Sept. 1, 1, '64. Nov. 25, 25, '63. May 4, 5. r63. July 20, 20, '64. June 16, 16, '64. July 2, -, '63. Operations, Operators, Result. Left. Died Aug. 7, 1863; haem. Both. Died June 27, 1864. Left; circ; slough.; haem. recur- rent. Died May 24,'04 ; exh'n. Left. Died Juno 14, 1864. Right. Surg. J. Bennett, ICth Mich. Died July 3, 1864. Right Died Nov. 5, 1864; chr. diarrhoea and wounds. Lett. Surg C. J. Walton, 21st Ky. Died July 1, 1864. Right. Died August 11, 1864. Left. Surg. A. M.Wilder.U.S.V. Died December 12, 1803. Right; circ. Died Sept. 28, '64 ; gen'l depress'n of nerv's system. ----; flap. Surg. W. R. March, 2d Iowa. II;cm. DiedJune23, 1864; pyaemia. ----. Died October 8,1863; chr. diarrhoea. Right; ant, post, flap. Died June 14, 1864; exhaustion. ----. Injured end of stump, caus- ing slough. Died Oct 10,1862. Right. Died May 30, 1864; py- emia. Left; flap; haem.; lig.; haem. ree'd. Died July 18,1864; exhaustion. Right; circ. Died July 11/64; pyaemia. Left. Died June 29, 1864. Right; circ Surg. ------, 7th S. C. Cav. Died Oct. 9, 1864. ----. Died March 29, 1805. Right. Surg. J. W. Hastings, 33d Mass. Died June 4, 1804. Left; circ. Died June 30, 1864; pyaemia. Right Died June 11,'04; pyaem. Left; flap. Act. Staff Surg.C.B. Richards, U. S. A. Died July 25, 1864. Left. A. Surg. J. J. Whitney, 18th Wis. Died Oct. 15, 1864. Left. Died October 25, 1863. Left. Died December 16,1862. Left. Died October 12, 1864 ; ex- haustion. Left; ant. post. flap. Surg. G. T. Stevens, 77tb N. Y. Haem. fatal before discovery, Oct. 27,1864. Right; circ. Surg. G. L. Potter, 145th Penn. Oozing of blood; diarr. Died July 6, 64 ; exh'n. Right; (amputa. left knee joint.) Died June 28, 1804. Right; haem. June 17, lig. fem. Died June 19, 1864. Right. Died October 7, 1862. Right; ciro. Surg. C. S. Frink, U.S.V. Died Nov. 14,'64; exh'n. Right. Died August 2, 1863. Left. Surg. C. N. Chamberlain, U. S. V. Died July 1, 1864. Right; lat. flap. Surg. J. W. Wishart, 140th Penn. Died July 15, 1864. Right. Died November 6, 1862. ----; flap. Died July 30, 1864. Left. Died September 4, 1864. Right; flap. Surg.A.Sabine, 76th Ohio. Died Nov. 26, 1863. ----; pneumonia; pyaemia. Died May 28, 1863. Left; (also w'nd of face.) Died October 17, 1804. Left; double flap. A. Surg. C. B. Richards, 30th Ohio. Died June 16, '64; shock and loss of blood. ----. Died August 9, 1863. 1029 1030 1031 1032 1033 1034 1035 1036 1037 1038 1039 1040 1041 1042 1043 1044 1045 1046 1047 1048 1049 1050 1051 1052 1053 1054 1055 1056 1057 1058 1059 1060 1061 1062 1063 1064 1065 1066 1067 1068 1069 1070 1071 Name, Military Description, and Age Bebout,L.,S'gt,D,140th Peun., ajre 32. Bechtell, D. R., Pt, B, 21st Penn., age 23. Bechtolt, F.,Pt, G,54th Ohio. Beck, C, Pt, D, 29th Ohio. Beck, G. W., Pt, C, 21st Illinois. Bcckman, W. W., Serg't, D,27th S. C, age 33. Beckwith, C. J., Pt, C, 26th Connecticut. Beeker, J. J.,Pt,K,89th Ohio. Belcher, F., Pt,, B, 49th Mass., age 20. Bell, II.,1't,I, 36th Col'd Troops. Bell, R. H., Capt, F, 7th N. Y. H. A., age 37. Benedict, A., Serg't, A, 104th Illinois. Bennett, T., Pt,F, 199th Pennsylvania. Benton,*G. M., Lieut, B, 12th Conn. Berry, E. P., Capt., E, 5thN. Jersey, age 24. Betts, J. S., Pt., F, 40th New York, age 22. Bibbs, W. J., Pt, G, 32d Tenn., age 35. Biddle, G. C, Pt., C, 205th Penn., age 25. Biddle, IL, Corporal, C, 148th Pennsylvania. Bigalow, C, Pt., E, 17th Infantry, age 16. Birmingham, A., Lieut, A, 6yth New York. Bishop, L., Sergeant, C, 154th New York. Bitter, L., Pt.. B, 180th Ohio. Blackburn, J., Pt., E, 138th Penn., age 35. Blackwell, E.,Pt,F,13th Colored Troops, age 24. Blanchard, W., Captain, K, 13th Illinois. Blaney, J. W., Pt, E, 7th West Virginia. Blett, D., Lieut., F, 1st Penn. Rifles, age 35. Bodley, E., It., B, 39th Indiana, age 28. Bohrer, T., Serg't, I, 159th New York. Bond, R., Pt., A, 24th Mass., age 28. Bonhaum, A.. Pt., F, 143d Penn., age 43. Bonneberg, J., Pt., E, 12th Missouri. Bonyea,R.,Pt.,F, 118th New York, age 33. Boughton, J. H., Corp'l, E, 2d Conn. H. Art'ry. Boutwell, R. T., Pt., B, 4th Vermont Bowman, H. M., It.. H, 60th lnd., age 21, Boyd, AV. A, Maj., 84th Indiana, age 37. Boyle, M., Pt., D, 1st Delaware. Boyles, T. R., Pt., D, 187th Pennsylvania. Bradford, J. M., rt., B, 10th Michigan. Bradford, W. II., Pt,A, 38th Wisconsin, age 20. Bradley, P., Sergt, C, 16th Michigan. June 3. 3, '64. June 18, 18, '64. July 3, 3, '64. July 28, 28, '64. June —, —, '04. June 16, 16, '64. June 14, 14, '63. June 27, 27, '64. May 27, 27, '63. Sept. 29, 29, '64. May 7, -, f64. May 14, 14, '64. April 9, 9, '05. Oct. 19, 19, '04. July 2, 3, '63. Nov. 26, 26, '63. May 15, 16, '64. April 2, 3, '65. Oct. 27, 27, '64. May 5, -, '64. Dec. 13, 13, '62. July 1, 1, '63. Dec. 7, 7, '64. July 9, 11, '64. Dec. 15, 16, '64. Nov. 27, 27, '63. Dec. 13, 13, '62. May 8, 9, '64. Sept 19, 19, '03. April 13, 13, '63. Aug. 14, 16, '64. June 18, 18,'64. Dec. 29, 29, '02. 'June 3,« 3, '04. Sept. 19, 19, '64. May 12, 12, '64. Nov. 3, 3, '03. May 7, 7, "64. Dec. 13, 13, '02. June 18, 18, '64. Feb. 0, 6, '05. June 17, 17, '64. Aug. 21, 21, '64. Operations, Operators, Result. Left; circ. Surg. J. W. Wishart, 140th Penn. Died Oct 8, '64 ; disease of stomach. Right Died July 16, 1864. Left. A. Surg. C. B. Richards, 30th Ohio. Died Aug. 28, '64. Left; circ. Surg. A. K. Fifield, 29th Ohio. Died Sept. 16, '64. Left. Surg. A. L. Cox, U. S. V. Died June 24, 1804. Right; circular. Died June 25, 1804; pyaemia. Right. Died June 20, 1863. Left Died July 22, 1864. Right. Died June 10,'G3: diph- theria. ----. Died October 15, 1864. Left; haem.; lig. femoral. Died June 24, 1864 ; exhaustion. Left. Died May 20, 1864. Left; circ Surg. G. DeLandre, 158th N. Y. Died May 29, '65. Right. Confed. surg. Died Nov. 4, 1804 ; general depression. Left, July 8, hasm. Died same day. Left; ant. post. flap. Surg. H. F. Lyster, 5th Mich. DiedDec. 17, 1863; pyaemia. Right; circ Ass't Surg. W. F. Smith, 28th Penn. Gang.; lig. femoral on face of stump. Died Sept. 23, '64; acute diarrhoea. Right: ant. post. flap. Surg. W. O. McDonald, U. S. V. Died April 25,'65; pytem. Spec. 4159. Right. Died January 28, 1865. Left; flap; gastric irritability. Died May 30, 1864. Right; (amputa. left ankle joint.) Died December 17, 1802. Left. Died July 31, 1863. Right. Ass't Surg. J. W. Reed, 115th Ohio. Died Dec. 9, 1864. Left; circ. A. A. Surg. W. S. Adams. Haem. recurrent. Died Sept. 1, 1864 : haem. and exh'n. Specs. 3882, 3848, 3980. Right; flap. A. A. Surg. J. S. Giltner. Died Dec. 27, 1864. . Left. Surg. S. C. Plummer, 13th 111. Died Dec. 4, 1863. ---. Died December—, 1862. Right; circ. Surg. J. J. Comfort, 1st Penn. Rifles. Died June 30, 1864; pyaemia. Left; flap. Surg.A.M.McMahon, 64th Ohio. Sept. 28,'63, haem.; lig. fem., fatal six hours after. ----. Died April 14, 1863. Left; circ. A. A. Surg. S. J. Holley. Died Sept. 2/64 ; irri- tative fever. Right. Died Aug. 7, '64 ; exh'n. ----. Died January 14,1863. Left; circ; haem. Died July 8, 1864; pyaemia. Spec. 2930. Right; flap. Died Oct. 20,1864; exhaustion. Left. Died May 12, 1864. Left. Surg. J. S. McGrew, 83d Ohio. Died Feb. 1. 1864. Left. Ass't Surg. H. Kirby, 84th lnd. Died July 11. 1864. Right, Died Dec. 31, 1862 ; py- aemia and tetanus. Right. Died June 19, 1864. Left. Died February 17, 1865. Left; circ Surg. W.B. Fox, 8th Mich. Died June 25, 1804. Left; (also amp. right leg.) Died Sept. 16, 1864. v0.s INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military r>Vir iDescription, and Age.| "ah'- • perations. operators, Result. 1074 1075 1072, Brand. A., Serg't, K, | Mav 16, 1 21st S. C, age 30. 18,"'64. 1073; Brandshaw, H. H. Pt, \ July 3, G, 7th Tennessee. : 3, 03. Brause. A. D., Pt, II, Sept. 19, 49th Penn., age 20. 19, '64. Bremer. E., Pt, A, 39th ; Feb. 6, New York, age 29. ! 8, 64. Brewer. J. S., Corp'l. A, Oct, 19, 20th South Carolina. 19, 64. Brickley, P., Pt., B, 6th Slay 14, Tennessee. 14, 04. Briggs, M. IF, Pt., C, j....... 24th Virginia. Brihin, J., Recruit, age i Aug. 20. 38. 20, 04. I()7t 1077 1078 1079 1080i Rroomeling, T., Pt., C, 106th N. York, age 24. Brown, W. IL H., Lt. Col., 61st Ohio. Brown, H. Z., Pt., F, 1st Mass. H. A., age 29. Brown, J. F., Lieut., F, 147th N. Y.. age 29. Brown, J. W., Pt., K, 3d Michigan. Brown, O. S., Serg't, F, 145th Pennsylvania* Bryant, D., Pt., C, 19th Massachusetts. Bryant, J. C, Pt. B, 18th Georgia, age 29. Buchanan, A, Corp'l, K, 19th Mass.. age 28. Bump, J., Pt., M, Sth N. York A rt y, age 18. Bunting, J. M., Pt, B, 99th Pennsylvania. Burbank, W. IL, Lieut, 58th Massachusetts. Burdy, T., Pt, K, 71st Pennsylvania. 1081 1082 1083 1C84 1085 1086 1087 1 1089 1090 1091 1092 1093 1094 109 1090 1097 1098 1099 1100 1101 1102 1103 1104 1105 110< 1107 1108 1109 1110 1111 1112 1113 Burfell, L.,Pt,D, 118th Ohio. Burghart, C. H., Lieut., K, 4th New York H'vy Artillery, ago 20. Burgin, C. //., Serg't. H, 5th Ala., ago 24. Burlcy, \\Y Pt, K, 73d Ohio, age 40. Burke, V., Pt., B, 1st Mich., age 30. Burmastcr, J., Pt, I), 88th Illinois. Burns, P.. Pt., C, Sth New York. Burns, P., Pt., E, 15th Infantry. Burns, R., Pt, A, 23d Illinois. Burr, T., Pt., K, 112th New York, age 33. Bush, J., Corp'l, F, 90th New York. Bushnell, O.. Pt., A. 101st Illinois. Butcher. J., Serg't, F, 37th Wis., age 4.3. Butler, L., Ft. B, 181st Ohio, age 43. Butler, J. .Y..Pt, O, 1st Georgia, age 41. Byers.J. IL, Pt.,G, 35th Iowa. Bvrne, W.. Corp'l, F, 60th Ohio, age 19. Cahill, J., Ft, K, 170th New York, age 43. Calhoun. C. H., Lieut., F. 5th Va.. age 21. Caiman, E F..Serg't, E, Sth N.Y. H. A. age 29. 'Cameron. 1). II.. l't.. C, 4th Rhode Island. Julv 9, 10, "'64. July 20, —, '64. June 18, 18, '64. May 12, 12,"'64. Julv 3, 3, '03. July 3, 3, '63. Sept. 17, 17, 02. April 0, 7, '65. May 12. 13," "64. June 3. 3, '64.' Nov. 29, 29,'64. June —, —, '64. June 29, 29, '62. Mav 14, 14,"'64. April 2, 2, '65. Oct. 19, 19, '64. Oct, 28, 30, '63. June 17, 19, '64. Sept. 19, 19, '63. Aug. 20, 20, '64. Aug. 10, —, '64. April 2, 2, '65. June 3, 3, '64. June 14, 14, '63. June 4, 4. '64. June 17, 17. '64. Dec. 7, 7, '64. Dec —, —, '64. Mav 14. 14,"'63. Mav 9, 9, '"64. May 24, -,'64. May 3, 4, '63. Aug. 25, 27. '64. Mar. 14, 14, '62. 1114 Campbell, A., Lieut.. H. Nov. 27, 32d Alabama. j 27. '63. Left: flap; slough'g bone exp'd. Died June 1. 1804. Died. Right; circ: pvieinio symptoms. Died Nov. 19.'1864. Left; flap. Surg. A. N. Dough- erty, l'. S. V. Stump diseased. Died June 1, '04. Spec. 2043. ----. Died No-, ember 8, 1864. Kight. Surg. 1). L. Heath, 23d Mich Died July 28. 1804. Left. Died July ±9, 1S02. Kight . ciro. Surg. G. L. Sutton, li.S.V. Gangrene. Died Oct. 8. 1864. Left; circ A.A.Surg.G.M.Paul- lin. Gangrene. Died August 11, 1864; diphtheria. Right. Died September 5, 1864. ----. Died June 20, 1804. Right; flap: erysipelatous. Died July 14.'04; exh'n. Spec. 3573. Right. Died July —, 1863. ----. Died July 29, 1863. Right. Died October 8, 1862. Left; flap. Died April 28,1865; exhaustion. Left; long ant. flap. Surg. J. F. Dyer,19thMass. Died Je. 2,'64. Right; circ. Surg. S. H. Plumb, 82d N. Y. Died July 7, 1864; pyaemia. Left, Surg. N. A. Hursam, 17th Me. Died Dec. 5,'64. Spec. 4119. Right Died June 10, 1864. Right; ulcer, dead bone exp'd. Nov. 29, reamp. six ins. higher. A. A. Surg. R. P. Thomas. Died Dec. 12, 1862; pyaemia. Right. Died July 30, 1864. Left: flap. Surg. G. B. Parker, U. S. V. Died April 17, 1805: result of wound. ----; circ,; bone exposed. Died November 28, 1864; pyaemia. Left; circular; gangrene. Died November 1, 1803. Left; flap. A. A. Surg. W. S. Forbes. Died July 25,'64 ; pyae. Right. Died October 8, 1863. ----. Died August 25, 1864. Right. Died August 17, 1864. Right; flap. Surg. J. S. Taylor, 23d Illinois. Died April 4, '65. Right. Died June 20, 1864. Right. Surg. E. S. Hoffman. 90th N. Y. Died June 24, 1863. Right. Died June 14, 1864. Left; oval flap. Surg.W.B.Fox, 8th Mich. Died June 25,1864. Right; circ. A. Surg. J.W.Reed, 115th Ohio. Died Dec. 9,1864; exhaustion. Left. Died January 5. 1865. Right. Surg. J. B. Rice, 72d Ohio. Died. Left; colliquative diarrh. Died May 22. 1864. Left; phleg. erysip. Died July 3, 1864. Right; ant. post flap. Died May 8, 1863; hemorrhage. R't; circ. A. Surg. T. C. Smith, 116th Ohio. Died Sept. 1, 1864. Right; circ Surg. G. Derby, 23d Mass. April 5, haem.; lig. fem. Died April 6,1862; exhaustion. ----; circ. Surg. J.C. Morgan, 29th Missouri. Died. Name, Military description", and age Campbell, 15..l't. A,81st Ohio. Campbell, S. G., Pt., F, 58th Virginia, age 31. Campher, L., Pt., G,4tb Colored Troops. Capen, S. L..Pt.,B,207th Penn.. age 22. Carey, ()., Pt, E, 86th New York, age 21. Carlin, J., Pt., C, 41st Ohio. Carlton, R. B., Pt.. F, 3d Vermont, age 22. Curnier, D., Corpl, L, 14thN.Y.H.A., ago 19. Carnahan, J. A.,Pt.,K, 10th Michigan. Carney, J.. Ft,, F, 155th New Yoik, age 35. Carpenter, J. M., Pt, C, 33d Indiana. Carroll. J., Pt., A, 20th Massachusetts. Carroll, W., Pt, H,66th Illinois. Carter, C.S.,Pt.,D, 50th Penn., age 22. Casey. T., Serg't-Major, 51st Illinois. Cassidy, M., Pt,C,90th New York. Causey, B. F., Pt, F, 30th Georgia, age 21. Cave, R., Pt., F, 8th Illinois Cav., age 29. Certain. W. R.} Pt., H, 47th North Carolina. Chancellor. II. C, jr., Lieut, B, 150th Penn. Chandler. W. S. J., Pt., A, 1st Maryland. Cheever,W."Pt,A,30th Mass.. age 28. Churchill. W.H., Serg't, H, 2d U. S. S. S. Clark.Ci.IL, Serg't, I. 2d N.Y. H.Art'ry, age 32. Clark, G. F., Pt, A, 149th New York. Clark, J.. Pt., A, 83d Ohio, age 18. Clark. J., Pt., 13th New- York Battery. Clark, J., Pt., —, 38th North Carolina. Clark, J. L., Serg't, G, 5th S. C. Cav., age 27. Clark. S. F., Serg't, D, 1st Massachusetts. Clark, W. D., Pt, A, 3d New Jersey, age 26. Cleaveland,J.F.,Pt,G, 16th Maine, age 25. Clough, J. E., Pt, 15, llth Mass., age 50. Cobaugh, J., Ft, A, 10th Penn. Reserves. Coffee, J., Pt., E, 69th New York. Cogswell, W. H., Lieut., B, 2d Connecticut. Cole. C, Pt, II, 124th Indiana, age 20. Cole, W., Corp'l, G, 5th Michigan. Cone, C. C, Lieut., I, 8th Col'd Tr'ps, age21. Conner, E.. Pt., D, 72d Pennsylvania. Connor." D. C, Pt., O. 90th Ohio, age 21. Converse. D. B., Pt, G, 129th Illinois. Conway. R., Pt, F, 30th Iowa, age 18. Cook, J. B., Lieut, H, 148th Penn., age 24. Cook. W. D., Lieut., F, 21st S. C, age 36. Aug. 25, 25, '64. May 31, Je. I,'rt4. Sept. 29, 29, '64. April 2. 2, '05. May 24, 24,"'64. Nov. 25, 25. '03. May 5, (!, ''04. Aug. 19, 19, '64. Sept. 1, 1, '64. June 3, 3, '64. July 20, 20," 04. Dec. 13, 13, '62. May 28, 28, '64. May 12, —, '64. Sept. 19, 21, '63. June 14, —, '63. Nov. 29, 30, '64. Aug. 1, 3, '63. June 1, 1, '64. July 3, 3, '63. July 3, 4, '63. Oct, 19, 21, '64. Oct, 27, —,'64. June 5, 6, '64. May 15, 15, '64. April 9, 9, '65. July 20, 20, '64. July 3, 3, '63. May 28, 29, '64. Dec. 13, 13, '62. Mav 8, 8, '64. Dec. 13, 14, '62. April 1, 2, '65. May 6, 6, '64. Sept. 17, 17, '62. Sept. 19, 19, '64. Mar. 10, 10, '65. Julv 2, 2, '63. Sept 29, 29, '64. Sept. 17, 17, '62. Dec. 16, 16, '64. June 4, 4, '64. Jan. 11, 11, '63. May 5, 5, '64. Jan. 15, 15, '65. operations, operators, Result. Left. Surg. J. Pogue, 66th 111. Died Oct. 19, 1864. Left; circ. June 20, haem ; 21, lig. Died June 23, '64 ; pyaemia. ----. Died October 27, 1864. Right. Died April 14, 1605. Left; diarrhoea. Died June 2, 1804 ; pysemia. Left. Died December 9, 1803. Right; ant post. flap. Died May 26, 1804 ; pyaemia. Left. Surg." T. F. Oakes. 56th Mass. Died Sept. 13, 1864. Left. Died Oct. 4, 1864 ; chronic diarrhoea. Right; lateral flap. Died June 13, 1864. Left. Died July 21, 1864. Right. Died January 15,1863; pyaemia. ----. Surg. W. F. Cady, 12th 111. Died June 15,'64; pyaemia. Right. May 20, haem.; lig. fem. Died June* 3, 1864. Left Died Oct. 4,1863; pyaemia. Left. A. A. Surg. — Kendall, U. S. N. Died June 22, 1863. Left; lateral flap. Died March 8, 1805; exhaustion. L't; circ. A. A. Surg.C. Carvallo. Died Aug. 20,1863. Spec. 1677. ----. Snrg. C.B.Gibson, C.S.A. Died June 12,1864 ; exhaustion. Left, Died Aug. 5, 1863. Right. Died July 9, 1863. Right; ant. post flap. Died Nov. 24, 1864; pyaemia. Right; circ. Died Nov. 7, 1864 ; wounds. Left; ant, post flap. Surg. G. L. Potter, 145th Penn. Typhoid fever. Died Julv 20. 1804. Right. Surg. C. H. Lord, 102d New York. Died May 23, '64. Right; flap. Died May 4,1865; pyaemia. Left. Died August 22, 1864. ----. Died. Right; dou. skin flap; sloughed. Died June 18, 1864 ; pyaemia. ----; flap. Died December 30, 1862. Right; femur protrud. and exfol. Died Juue 25, '64; pyaemia. Left; flap. Dec. 30, hiem.; fem. ligated. Died Dec. 31, 1802; exhaustion. Left; oval ant. post, flap. Surg. 11. F. Lyster, 5th Mich. Diarr., phlebitis, slough. Died April 23, 1865; exhaustion. Right. Surg. B. Rohrer, 10th Penn. Res. Died May 19, 1864. Right; circ. A. A. Surg. A. V. Cherbonnier. Prot, fem. rem'd; necrosed. Died Jan. 28,1863. Left; circular. Died October 7, 1864; exhaustion. Right; circ. Died April 19, '65. Left; haemorrhage. Died Julv 13, 1863. Left Died October 22, 1804; exhaustion. Right. Died October 10, 1862. Left; flap. A. Surg. R. J. Hill 45th Ohio. Died Jan. 11, 1865. Left. A.Surg.G. M. Trowbridge, 19th Mich. Died Sept. 4,1864. Right. Died February 18, 1863. Right. Died June 1, 1864. Left. Died April 29, 1865. 1 THOMPSON (J. H.), Wounded at the Battle of New Berne, in Am. Med. Times, 1862, Vol. 5, p. 6. sect, in.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 259 Name, Military i description, anh ai 11160; Coons. H., Pt, K, lOCth New York, ago 42. 1101 1102 1163 1164 1105 1166 1167 1108 1169 1170 1171 1172 1173 1174 1175 1176 11 1178 1179 1180 1181 1182 1183 1184 1185 1186 1187 1188 1189 1190 1191 1192 1193 1194 1195 1196 1197 1198 1199 1200 1201 1202 1203 1204 Cooper. I) , l't., D, 5ih New York Artillery. Cope, IF M.. Serg't, I. 33d Mississippi. Copperuall, C. Pt, B, 75th New York. Corkeran. W. J., Pt., V, 56th Virginia. Corn, J.. Pt, K, 88th Pennsylvania. Corpine. F., Pt., 11. llth Penn. Cav., age 64. Cosgrove, J.W., Serg't, A. 50th Mass., age 21. Costello. C Pt, P, 28th Pennsylvania. CovinQtun, .1. -I, Serg't G. 23d South Carolina. Craig. J., Pt., A. 119th Pennsylvania. Cramer! R., Pt., I, 21st Michigan. Cress. 11..Corp'l. K. 95th Penn., age 2a. Crews. M. A., Pt. F, 2d South Carolina, ago 30. Crisler. W. R.Corpl, C, 107th New York. Cronan, T.. Pt., C, 149th New York. Cronin, D.. Pt., F, 59th New York. Crow, T., Pt., B, 86th Indiana. Crulip, W. B., Pt., F, 53d Penn.. age 18. Cummings.G. P., Serg't, K, 1st Mass Art.,age 26. Cunningham, P., Pt,H, 5th Texas. Cunningham, S., Pt., D, 13th Indiana Cavalry, age 29. Cunningham. H. L,Cor- poral. G. 22d Wis. Cupperaull, C. E., Pt., K, 6th Wis , age 29. Curach. C, Pt., D, 10th Ohio. Daggett,C. H.,Corp'l, Ii 1st Me. H. Art., age 18. Dailev, B. IL, Pt., A, 18th" Ohio, age 21. Dallsby, J. O., Pt., I, 22d Indiana. Daly, J.M., Pt, H, 40th Indiana, age 22. Danforth. M., Pt., A, 116th Ohio, age 18. Daniels, B. F.,Corp'l, B, 4th Louisiana. Darrow, J., Corp'l, I, 59th New York. Daum, L., Pt., G, 5th New York. Davis, A., Pt, D, 44th New York, age 23. Davis, H. J.. Lieut., K, 30th Ohio, age 22. Davis. J. P., Pt., C,27th Mass., age 34. Dawley. E., Pt, K, 19th Michigan. Day, C. C, Pt., A, 19th Wisconsin, age 29. Day, S. M., Pt., I, 4th Virginia, age 18. Dean, W., Pt., D, 10th Missouri. Dempsey. C.,Pt.,G,32d Mass., age 38. Derocher, G., Pt., I, 1st Maine, age 23. Detwyler,G.,Pt,D,7fh New Jersey, age 19. Devlin, A., Pt., H, 20th Massachusetts. Dewey, E. E., Pt.. F, 1st Vermont, age 31. Sept. 9, 9, '04. June 5, 5, '64. Julv 20, 211, '04. June 14, 14, '63. Julv 3, 3, '63. Mar. 31, 31, '65. Aug. 19, 20, '64. Sept. 17, 17, Y2. Mar. —, —, '65. Mav 5, 5, '64. Mar. 19, 19, '65. May 6, 7, '64. June 1, 3, '64. Mar. 16, 16, '65. Mav 25. —,* '64. Dec. 13, 13, '62. Sept. 19, 19, '63. June 3, 4, '64. June 18, 18, '64. Jan. 27, 28, '64. Dec. 4, 5, '64. May 16, 16, '64. June 18, 19, '64. Oct. 8, 8, '62. June 19, 19, '64. Dec. 15, 15, '64. June 27, 27, '64. Nov. 25, 27, '63. Sept. 13, 13, '64. July 28, 28, '64. Nov. 10, 10, '64. Aug. 20, 20, '64. May 5, 5, '64. Mav 22, 24," '63. May 14, 14, '04. June 25, 25. '64. May 13, 13," '64. May 3, 4, ;63. Sept 19, 19, '62. May 12, 12, '64. May 12, 12," '64. June 22, 22, '64. June 1, 1, '62. June 1, 1, '64. Operations, Operators, Result. Right. Snrg. M. S. Kittengcr, 100th N. V. Died Jan. 'J.r>, '0.">, enteritis, etc. Right; sloughing. Died July 20, 1864. Left. Died August 5, 1864. Left. Died June 29, 1863. Right. Died April 29, 1865. Right. Died July 9, 1863. Right; flap. Died April 6, 1865; exhaustion. Right; circ Died Sept. 1,1864; exhaustion. Right. Died Sept. 23, 1862. Right Died July 3, 1865. . Left; flap ; slough'g. Died May 20, 1864. Right, Died April 4, 1865. Right; ant, post, flap ; abscesses; diarrhoea. Died J uly 8, 1864. Right ; haein.; lig. femoral. Died Oct. 25. 1804 ; tuberculosis. Right. (Skey's operation.) Surg. J. Chapman, 123d N. Y. Died March 17, 1805. Right. Died June 8, 1864. Left. Died January 18, 1863. Left. Died October 29, 1863. Left; circ Died July 10, 1864 ; pyaemia. Spec. 3165. Right; post, flap; pyaemia. Died Sept. 9, 1864. Right; circ. Surg. C. W. McMil- lan, 1st E. Tenn. Died Feb. 18, 1864; exhaustion. Right: circ. Surg. H.B.John- son. 115th O. Recurrent haem.; lig. fem'l. Died Jan. 26, 1865. Right. Surg. J. Bennett, 19th Mich. Died June 26, lfc?64. Left; ant. post. flap. Died Aug. 13, 1864; gang., exhaustion. Left. Died November 4, 1862. Left; ant. post. mus. flap; gang. Died June 30, 1864; severity of wound, etc. Left; lat flap. A. A. Surg. M. L. Herr. Gang. Died Jan. 8,'65. Right Died June 30,1864. Left; circ.; gangrene. Died Dec. 7, 1863. Left. Died September 20, 1864. Left. Died August 3, 1864. ----. Surg. D. W. Maull, 1st Del Died Nov. 12, 1864. ----Died August 23, 1864. Right. Died June 1, 1864. Right; circ. Ass't Surg. II. M. Sprague, U. S. A. Died June 5, 1863. Spec. 1623. Left; diarrhoea. Died June 19, 1864; exhaustion. Left. Died July 11, 1864. Left; flap; recurrent haem. Died June 16, 1864. Left; circ. Died June 9,1863. Left. Died September 30, 1862. Left; circ Died June 7, 1864; pyaemia. Right; flap; femur prot. Died February 20, 1865. Right; flap. Died August 1, '64. ----; bone prot.; removal of bone. Died June 18, 1862; pyaemia. Right; circ; gang. Died Aug. 7, 1864; pyaemia. 1205 1206 1207 1208 1209 1210 1211 1212 1213 1214 1215 1216 1217 1218 1219 1220 1221 1222 1223 1224 1225 1226 1227 1228 1229 1230 1231 1232 1233 1234 123S 1236 1237 1238' 1239 1240 1241 1242 1243 1244 1245 1246 1247 12 1249 Name, Military Description, and Age Dice, J., Pt, A, 149th New York. Dick, J., Pt, K, 7th N. York. Dickensheet, D., Pt., B, 71st Illinois, age 26. Dickerson, C, Corp'l, C, 48th N. C, age 29. Dietrich, J., Pt., II, llth Pennsylvania. Dingman, A.W.,Pt.,D, 91st N. Y., age 23. Dix, I. I., Pt., D, 4th Virginia. Dodge, H N., Corp'l, G, 10th Massachusetts. Doman, I, Pt., C, 198th Penn., age 16. Dormoy, G., Pt, K, 75th Illinois. Dougherty, J., Pt., D, 9th N. Hampshire. Douglass, E., Pt, K, 9th N. Hampshire. Douglass, D., Pt., E, 9th N. Y. H. Art, age 40. Draper, I. Ta, Pt, E, 3d Delaware, age 37. Dudley, J.A.^t.'E, 58th Virginia. Dudley, A., Pt., C, 15th Infantry. Duenisch, T., Pt., F,37th Ohio. Duncan, W. H., Pt, A, 87th New York. Dunn, A., Pt.,H, 1st Mis- souri Cavalry. Dupple, S., Pt, K, 142d Penn., age 20. Durant, C, Pt., D, 32d Mass.. age 35. Dwire.W. J., Pt,G, 55th Ohio. Dwyre, J., Pt., K, 176th New York. Dykeman,W., Pt., B,5th Michigan, age 45. Eagan, J., Pt,, E, 10th New York. Eaton, J., Pt, G, 16th Maine, age 27. Eaton, L., Pt, 1,17th In- diana, age 18. Eddie, J..Pt,K,3dMich- igan, age 23. Edwards,G.,Pt,H,21st Connecticut, age 20. Egan, J., Pt., G, 2d N.Y. State Militia, age 18. Eiznor, J., rt, F, 120th New York. Elam, S. A., Pt., A, 33d Wisconsin, age 26. Elkin, C. R., Pt, E, 22d Georgia, age 22. Ellingwood, H., Pt., K, 79th Indiana. Ellison,R.,Corp'l,E,86th New York. Emerson, IL, Pt, I, 88th Illinois, age 34. Enbank, J. G., Pt, A, 51st Alabama. Estel, A., Corp'l, F, 10th N. Y. Cav., age 21. Etters, B. J., Pt,, G, 51st Penn., age 18. Faber, J. C, Serg't, G, 210th Penn., age 28. Faehndrich, J., Pt., C, 52d New York. Fales, A., Pt, F, 9th N. Y. II. A., age 20. Fales, J.A.,Corp'l, K, 3d Vermont, age 45. Farrelly,B.,Pt,K, 100th New York, age 37. Faust, P. L., Pt, A, 79th Penn., age 26. May 25, 25, '64. Dec. 13, 13,'62. Dee. 7, 8, 02. April 1. 1, '65. Dec. 13, 13, '62. Mar. 30, 31, '65. May 3, 5, '63. May 5, 5, '64. Mar. 29, 29, '65. June 27, 27, '64. May 12, 12,'64. May 12, 12, '64. June 1, 3, '64. June 17, 19, 'C4. Sept 19, 19, '64. Aug. 7, 7, '64. May 17, 17, '62. June 1, 1, '62. April 4, 4, '64. May 12, 13, '64. Feb. 6, 8, '60. May 15, 15, '64. Sept. 19, 19, '64. May 11, 12, '64. June 17, 17, '64. June 17, 17, '64. June 21, 21,'64. May 5, 5, '64. July 30, 30, '64. Sept. 17, 17, '62. Mar. 25, 25, '65. Mar. 30, 30, '65. May 24, 24,'64. Sept.1, 1, '64. Oct. 16, 16, '64. Nov. 30, De. 1, '64 June 3, 3, '64. June 24, 24, '64. May 9, 9,'64. April 1, 2, '65. Dec. 13, —, '62. July 9, 10, '64. Aug. 21, 21, '64. May 17, 17, '64. Aug. 10, 10, '64. Operations, Operators, Result. Right. Died May 27, 1804. ---. Died December 20, 1862. Right; circ. Snrg. P. Harvey, 19th Iowa. Sloughing; haem. Died Dec. 22, 1S0J; exhaustion. Right. Surg. T. II. Squire, 89th N. V. Lied May ?. '05; exh'n. Right; flap. Died Dec. 13, 1862. Left; ant. post flap. Surg. J. C. Hall, Otli Wis. Died April 17, 1H0."",; exhaustion. Right; ant. post, llap; slough'g. Died May 7, It'OX ----. Surg. G. T. Stevens. 77th N. Y. Died May 22, 1804. Left; circ; erysip. Died April 19. 1805; pyaemia. Right. Surg. T. M. Cook, 101st Ohio. Died June 30, 1864. ----. Surg.W. C. Shurlock, 51st Penn. Died Mav 18, 1864. ---. Surg. J. S.'Ross, llth N. Hampshire. Died May 17, '64. Left; circ; gangrene. Died July 31, 1864 ; pyaemia. Left; flap. July 9, 11, 12, haein. Died July 12, 1864. Left; circ; flap opened, stump ex- posed. Died Oct. 23, '04 ; diarr. Right. Died September 5, 1804. Left; gangrenous. Died May 30, 1862. Right; gangrene. Died June 11, 1862. Left. A. Surg.W. W. Bailey, 1st Mo. Cav. Died April 5, 1864. Right; circ. July 18, 19, haem. Died July 21; haem. Spec. 2885. Right, Died February 12, 1865. Right; (also wound of left thigh and testes.) Removal of testes. Died May 30, 1864. Right. Died Sept, 23, 1864. Left; circ. Snrg. H.F.Lyster,5th Mich. DiedJulyl5,'64 ;pneum. Left. Surg. D.W. Maull, 1st Del. Died July 6, 1864. Left. Died July 8, 1864. Right. Surg. B. N.Bond,27th Mo. Died July 16, 1864; haem. Left; circ. Died June 2, 1864; pyaemia. Right; flap. Surg. N. Y. Leet, 76th Penn. Died Sept. 4, 1864. Right. Surg. S. N. Sherman,34th N. Y. Died Sept. 25,1862. Right, Died April 22, 1865. Left; flap. Surg. L. Dyer, 81st 111. Died June 6,1865; chronic diarrhoea and erysipelas. Right; circ.; missile lodged in left knee. Died June 19,'64; pyaem. Left. Died September 24, 1804. Left. Surg.H.F.Lyster,5thMich. Died Oct. 25, '04. Spec. 4116. Left; circ. A.A.Surg. J.C.Tay- lor. Gang. Died Dec. 13,1864; irritative fever. ----; lat. flaps. Surg.— Black, C.S.A. Died June 5,'64; exh'n. Left; circ. Died July 22,1864 ; pyaemia. Right; circ. Died May 30,1864; exhaustion. Left. Died May 17,1865; pya^m. Left. Supposed to have died. Spec. 1302. Right; circ. A.A.Surg. J. C. Shimer. Gangrene. Died July 13, 1804. Left. Died September 21, 1864. Left. Died July 21, 1864 ; exh'n. Left; haem.; fem. art'y lig'd. Died October 2, 1864. 260 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. Name, Military Description, and Age. Operations, Operators, Result. Name, Military Description, and Age, Dates. Operations, Operators, Result. 1250 I 1251] 1252 1253 1254 1255 I 1256 1257 1258 1259 1260 1261 1262 1263 1264 1265 1266 1267 1268 1269 1270 1271 1272 1273 1274 1275 1276 1277 1278 1279 1280 1281 1282 1283 1284 1285 1285, 12s7 12S8 1289 1290 1291 1292 1293 12 4 Ferguson, W., Corp'l, D, 1st Artillery, age 20. Ferrer, II , Ft, D, 96th Ohio, age 2 ». Fetler, R., l't, C, 9th 111. Cavalry, age 30. Finaughty, M., Serg't, G, 10th Infv, age 30. fisher, N., Pt, F, 22d Col'd Troops, age 23. Fitch, M., Ft., A, 14th New York H'vy Arty. Flax, S., Pt., C, 90th Ohio. Fletcher, G. W.,Corp'l,K, 3d Arizona Cav.,age 32. Flood, P., Pt, H, 28th Massachusetts. Ford, E. T., Pt., C, 121st New S'ork. Forston, W., Pt., F, 53d Indiana. Fortney, IL, Pt., F, 12th West Virginia. Foster, J., Pt., K, 82d Indiana, age 20. Fredcnburgh.W.Pt., D, 111th Penn. Fredericks, D., Pt., G, 58th Penn., age 42. French, G. W., Pt, C, 13th Iowa, age 26. Frost.W. H., Pt., A, 32d Wisconsin. Fullerton, A. B., Pt., A, 1st Vt. H. Art., age 26. Garl, W. O., Pt, G, 36th Iowa. Garland, M. H., Pt., D, 13th New Jersey. Garnish, J., Pt., F, 8th Michigan, age 46. Gay, J. C, Ft., A, 7th Maine, age 37. Gear, W., Ft, E, 14th Illinois. Gentry, W. H, Pt., G, 44th Virginia. George, A. I., Pt., C, 4th l'enn. Cav., age 29. Gerard, C, Pt., K, 35th .Massachusetts. Geringer, J. H., Pt, H, 1st North Carolina, Gerry,W. H., Pt, H, 7th Mass., age 30. Gibbons, P.,Pt, E, 150th Penn., age 29. Gibbs, A., Pt., I, 6th C'd Troops, age 22. Gibney, T., Pt., A, 69th New York. Gibson, J. M., Corp'l, A, 3d Kentucky, age 34. Giddings, J. A., Pt., G, 3d Wisconsin, age 17. Gillespie. B. F., Pt, G, 30th Ohio, age 32. Gillespie, J. D., Serg't, E, 49th Penn., age 21. Gilley, C.H., Pt., K, 60th Georgia. Gillinore, R., Pt, F, 91st New York, age 20. Gilman, W., Corp'l, K, 32d Mass., age 31. Gilt,J.A..Corp'l,G,130th Indiana, age 33. Ginither, J. A., Pt, B, 49th Penn., age 22. Glasgow, A. I., Pt., H, 21st N. C.age 26. Gleason, T. E.,Corp'l, D, 66th Illinois. Glidden, G., Pt., K, 40th Mass., age 22. Goff. C, Pt, G, 22d Va 1 Goode. P.. Corp'l, G, 26th Tennessee, age 22. Oct. 7, 7, '64. Nov. 3, 3, '63. Dec. 17, 17,'64. July 2, 3, '63. Sept. 29, 29, '64. Mar. 25, 25, '65. July 3, 4, '64. May 18, 18,'64. May 12, 12, '64. Sept. 19, 19, '64. Oct. 5, 5, '62. June 5, 5, '64. Aug 7, 7, '64. Sept. 17, 17, '62. Sept. 30, 30, '64. July 20, 21, '64. Feb. 3, 3, '65. Mar. 25, 25, '65. April 4, 4,'64. June 4, 4, '64. June 3, 3, '64. June 1, 1, '64. Oct. 5, 5, '62. Mar. 25, 25, '65. Mar. 29, 29, '65. Aug. 19, 19, '64. July —, —, '63. May 5, 5, '62. Oct 27, 28, '64. Sept 29, 29, '64. Sept. 17, 17, '62. Nov. 25, 27, '63. Mav 3, 3, '63. July 28, 28, '64. April 6, 7, '65. Dec. 13, 13, '62. Mar. 31, 31, '65. July 2, 3, '63. Dec. 16, 16, '64. Mav 10, 12."'04. July 2, 3, '03. July 22, 22,"'64. May 15, 15,'64. Sept. 19, 19, '64. May 15, la,''64. Left. Died December 9, 1864; pyaemia. Left; (also wound of right knee.) Died Nov. 18, 1863. Left: circ. A.A.Surg. R. G. Ludlow. Died March 13, 1865. Right; flap: haem. from femoral. Died July 7, 1863; exhaustion. Right. Died October 30, 1864. Left; circ; (also wounds of left shoulder and thoracic parietes.) Died May 2, 1865. Left. Surg.C. J.Walton, 21st Ky. Died Sept. 4,1864. Left. Died August 30, 1864; gangrene. ---. Surg. P. E. Hubon, 28th Mass. Died May 16, 1864. Right; flap. Died Oct. 8, 1864; exhaustion. ---. Died October 9, 1862. Left. Died June 12,1864. Left. Surg. C. S. Arthur, 75th lnd. Died Feb.17,1865; pneum. Right. Died November —, 1862. Left Died Oct. 27,1864 ; pyaem. Right; lateral flap. Surg. M. W. Thomas, 13th Iowa. Died Nov. 24, 1864; exhaustion. Left. Surg. A. B. Monohan, 63d Ohio. Died Feb. 25,'65; pyaem. Left. Died April 4, '65; pyaemia. Right Surg. S.H.Sawyers, 36th Iowa. Died April 7, 1864. Left. A. Surg. L. W. Kennedy, 123dN.York. DiedJune24,'64. Left; circ. Surg. W. B. Fox, 8th Mich. Died June 30, 1864. Right Surg. G. T. Stevens, 77th N.Y. Gang. Died Dec. 26,'64. ---. Died October 7, 1862. Left. Surg. L.W.Bliss, 51st N.Y. Died April 5, "65. Spec. 4020. Left; flap. Surg.W. G. Keir, 91st Penn. Died Apr. 29,'65; pyaem. Left; circ. Surg.T.F.Oakes, 56th Mass. Died Aug. 30,1864. Left. Died July 28, 1863. Right. Died May 22, 1862; py- aemia. Right: flap. Died Jan. 5, 1865; pyaemia. Left Died March 12, '65; pneu- monia and amputation. Right. Died Dec. 22, 1862. Right. Died Jan. 11, '64 ; pyaem. Right; circ. Died June9,1863; pyaemia. Specs. 1241,1242. Right; circ. Act, Staff Surg. C. B. Riehards.U.S. A. Died Aug. 9, 1864; empyema. Right; circ; haem.; diarrh. Died Blay 12, 1865; exhaustion. Left. Died December 18,1862. Right; ant. post, flaps. Died May 25, 1865; exhaustion. Left. Died July 28,'63; pyaemia. Left; (Vermale's method.) Ass't Surg.W. B.Trull.U. S.V. Died Jan. 2,1865; typhoid fever. Right. Died J une 4, '64; pyaemia. Right. Died October 18, 1863. Left. Surg. W. R. Marsh, 2d Ia. Died Nov. 2,1864 ; wounds. Left. Died June 13,1864; exh'n. ---; circ. Died October i, 1864 ; pyaemia. Right; flap. Died June 27, '64 ; asthenia. 1295 1296 1297 1298 L299 1300 1301 1302 1303 1304 1305 1306 1307 1308 1309 1310 1311 1312 1313 1314 1315 1316 1317 1318 1319 1320 1321 1322 1323 1324 1325 1326 1327 1328 1329 1330 1331 1332 1333 1334 1335 1336 1337 1338 Goodson, A. A., Pt,, K, 22d N. C, age 25. Gordon, J., Pt, C, 1st Michigan Artillery. Gould, J. P., Col., 59th Massachusetts. Grady, F., Pt., D, 8th N. C. Battalion. Graves,E.,Serg't,F,37th Massachusetts. Gray, 10. F., Pt., G, 26th Illinois. Gray, H. M., Serg't, E, 37t"h Hinois, age 30. Green, E. B., Pt., H,55th Ohio. 67reew, H. W., Serg't, D, 31st Miss. Green, J.,Pt, B, 1st R.I. Artillery. Green.T. W., Pt,F,151st New York, age 26. Greenlee, A. F., Pt., F, 140th Pennsylvania. Griffith, J., Pt., K, Sth Connecticut. Griffith, B., Corp'l, G, 18th Ohio. Guillery, A., Pt., A, Miles's Legion. Gwynn, J., Pt., I, 70th Ohio. Hackathorn, J., Pt., F, 126th Ohio, age 2L Hagan.L. tf, Pt, K,23d North Carolina, age 18. Haines, J., Pt., E, 50th Penn., age 19. Haines, J. C,Pt,B, 52d Ohio. Hall, J. W., Pt, G, 4th Michigan, age 24. Ham, J. C, Pt., B, 87th Penn., age 24. Hamrick, A., Corp'l, H, 28th N. C, age 23. Hanes, E., Pt,, K, 7th N. Y. EL A., age 20. Hankins, G. S.. Pt., B, 142d N. York, age 20. Hardy, A., Pt., C, 140th New York, age 33. Hardy.G. E., Pt., 1,13th N. Hampshire, age 31. Harland, D. G., Corp'l, B, 84th Illinois. Harle, B. B'., Serg't, E, 158th N. York, age 24. Harper, J. L., Pt, C, 63d Indiana. Harrington,T.,Serg't, A, 6th Mass. Cav., age 29. Harrington, W., Pt, B, 90th New York. Harris, H. B., Serg't, G, 46th Pennsylvania. Harris, J. L.,Pt, F, 56th Virginia. Harrison, F., Pt., M, 1st Texas Legion. Harry, L., Pt., I, 147th Penn., age 23. Hartman, C, Pt., I, 1st Louisiana. Haskell, C, Pt., F, 2d Mass. Art'y, age 22. Haskill, C, Pt., F, 82d Ohio. Hawk, C, Pt., H, 210th Penn., age 26. Hawks, E., Corp'l, G, 115th Penn., age 37. Hays, G. W., Corp'l, K, 2d Michigan, age 19. Sept. 19, 19, '64. Feb. 3, 3, '65. July 30, 30, '64. Feb. 12, 14, '63. May 5, 5, '64. May 13, 13, '64. Dec. 7, 9, '62. May 15, 15, '64. July 20, 20, '64. July 3, 3, '63. July 9, 11, %4. July 3, 3, '63. Dec. 20, 20, '63. Deo. 31, 31, '62. Aug. 28, 28, '64. May 12, 14,'64. July 1, 2, '63. June 7, 8,'64. July 22, 22, '64. May 13, 13, '64. Oct, 19, 20, '64. May 11, 11, '64. June 8, 8, '64. July 4, 4, '64. June 16, 16, '64. Sept. 30, Oct.1,'64. Dec. 31, 31, '62. Sept. 30, 30, '64. Feb. 18, 18, '65. May 18, 20, '64. June 14, 14, '63. July 20, -,'64. July 3, 3, '63. Dec. 24, 25, '62. Dec. 19, 19, '64. July 13, 13, '63. Mar. 10, 11, '65. July 1, 1, '63. Mar. 31, 31, '65. May 12, 12, '64. June 17, 17, '64. Heistand, B., Pt.E, llth Dec. 15, Missouri, age 17. 16, '64. Henderson, N.W.,Pt.,E, Sept. 19, 123d Ohio, age 16. 20, '64. ---; circ.; haem. Oct. 20, reamp. at mid. Died Oct. 27,'64; pyaem. Right. Surg. A. B. Monohan,63d Ohio. Died Feb. 10, 1865. Left: circ Surg.AV.lngalls, 59th Mass. Died Aug. 22,1864. Left Snrg.C.A.Cowgill, U.S.V. Died Feb. 15,1863. ---. Surg. G. T. Stevens, 77th New York. Died Mav 26,1864. Left; flap. Surg.W. Lomax,12th lnd. Died July 5, 1864. Right; ant. post. flap. A.Surg. M. A. Mosher, 20th Wis. Died Dec. 17,1862; haemorrhage. Right. Died June 20, 1864. Right. Died October 25, 1864. Right. Surg. G. Chaddock, 7th Mich. Died July 16, 1863. R't; circ. A.A.Surg. J.C.Shinier. Died Aug. 4,1864. Spec. 3935. ---. Died A ugust 3,1863. Left. Died December 24, 1863. ---. Died February 6,1863. Left. Died May 23, 1863. Right; circ. Snrg. R. Morris,103d Illinois. Died Oct. 3,1864. Left; ant post flap. Died June 9, 1864; exhaustion. Left. Died September 18,1863, diarrhoea. Right; circ. Surg. S. S. French, 20th Mich. Died June 26,1864; exhaustion. Left. Died July 30, 1864. Left; long ant flap. Died July 6,1864; exhaustion. Left; ant. post. flap. Oct. 28, fem. artery lig. Died Oct. 28,1864; haemorrhage. Left; ant, post. flap. Died June 13, 1864 ; exhaustion. Right; circ Surg. G. L. Potter, 145th Penn. Died July 10, '04; pyaemia. Left; (also w'nd of wrist.) Died July 15, 1864; exhaustion. Right Died July 7, 1864. Right, Died Oct. 15,1864; morti- fication following amputation. ---. Died January 3, 1863. Left. Surg. F.L.Ainsworth.U.S. V. Died Nov. 16, '64 ; irrita. fev. Right. Died Feb. 28,1865. Left; circ. A. Surg.C.H.Andrus, 128th N.Y. Died July 14,1865; chronic diarrhoea. Right. Surg.E. S. Hoffman,90th New York. Died Sept 2, 1863. Right Died July 27, 1864. Left. Died July 16, 1863. ---. Died December 31,1862. Right. Died Dec. 20, 1864. Right. A. Surg. J. T. Myers, 91st New York. Died July 13,'63. Left; circ. Died Mar. 30, 1865; shock of wound and operation. Right. Died July —, 1863. Right; ant post, flap; (also flesh w'nd r't thigh.) Died May 9,'05. Right; flap. Died June 8, 1864. Spec. 4547. Left: circ; (and exe'n right knee joint.) Died July 2, '64; exh'n. Spec. 3046. Left; circ Died Jan. 7,1865. Right; circ; (and excis'n of ulna.) Died Nov. 4,1864; pyaemia. 1 O'Keefe (D. C), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Med. and Surg. Jour., 1805, Vol. II, p. 29. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 261 1339 1340 1341 1342 1343 1344 1345 1346 1347 1348 1349 1350 1351 1352 1353 1354 1355 1356 1357 1358 1359 1300 1361 1362 1363 1364 1365 1366 1367 1368 1369 1370 1371 1372 1373 1374 1375 1376 1377 1378 1379 1380 Name. Military Description, and Age. Hendricks, M.,Corp'l, C, 4th Delaware, age 40. Henry, W., Pt., I, 30th Indiana. Herman, I., Pt, B, 27th Michigan, age 19. Herron.G. S., Pt, F,7th S. Carolina, age 21. Hickman, R., Corp'l, E, 1st Del. Cav., age 23. Hicks, J., Pt., D, 56th N. Carolina, age 20. Hicks, J.W., Pt., A, 37th Indiana. Higgins, J., Pt, I, 6th Louisiana. Higgins, N., Pt, M, 1st Me. H. A., age 44. Highland, W., Pt, E. 41st Ohio. Higlev,A.,Serg't,E,68th Ohio. Hildreth, N., Corp'l, B, 94th N. York, age 21. Hill, D. S.,Lieut.,G,10th Vermont. Hill, E., Pt., C, 114th Illinois. Hill, H. W., Pt., A, 24th New York Cavalry. Hill,W.,Pt, A, 32d Col- ored Troops, age 21. Hillman, J., Pt., C, 31st Massachusetts. Hinkley, A. P., Corp'l, C, IstMe. H.A.,age 19. Hinton, A. B., Serg't, H, 4th C. Troops, age 26. Hipp, A., Pt, F, 15th Missouri. Hockley, E. J.,Serg't,B, 12th Mass., age 23. Holden, G. W., Pt., I, 33d Indiana. Holden, H.,Pt., I, 42d N. Carolina. Holman, J., Pt., F, llth Missouri, age 22. Holmes, D. H.,Pt„D,7th Maine, age 23. Holmes, G. E., Serg't, I, 19th Maine, age 21. Homans,S.C..Pt,E, 91st Pennsylvania. Hoogland, E., Pt., A, 2d N.Y. Mt'd Rifl., age 19. Hoover, J., Pt., K, 55th Ohio. Hopper, W., Serg't, A, 46th Pennsylvania. Horth, M.F.,Pt,D,179th New York. Horton, A., Pt., B, 48th New York, age 19. Horton, I., Pt., G, 150th New York. Houck, W. F., Pt., D, 138th Illinois, age 26. Hough, A.,Serg't,H,15th Indiana, age 31. Houston, J.W.,Serg't,C, 7th 111. Cav., age 23. Howard, F. H.,Lieut,F, 2d N. Y. Arty, age 25. Howe, II. A., Corp'l, I, 95th New York, age 40. Hubbard, W., Serg't, A, 12th Connecticut. Hudson, F., Serg't, B, 132d N. York, age 24. Hudson, H., Pt, D, 7th Mass., age 25. Hudson, T. F.,Pt.,A, 4th Louisiana, age 23. June 17, 19, '64. May 7, 7, '64. May 12, 12,*'04. Aug. 19, 20, '64. Oct. 17, 18, '64. Mar. 25, 25, '65. May 31, 31,'64. Julv 9, 11, "'64. June 21, 22, '64. Nov. 25, 25, '63. July 21, 21, '64. Feb. 7, 8, '65. Sept. 19, 19, '64. May 22, 22, '63. June 18, 18, '64. Dec. 7, 7, '64. June 14, 14, '63. June 18, 18,'64. Sept. 29, 29, '64. June 26, —,'64. Dec. 13, 13, '62. July 20, 20, '64. May 19, 19, '64. Dec. 16, 17, '64. May 12, 12, '64. May 12, 12, '64. Oct. 27, 27, '64. June 17 17, '64. June 19, 19, '64. May 3, 3, '63. July 10, 10, '64. June 3, 3, '64. July —, —, '64. June 21, 21, '64. Nov. 25, 27, '63. Dec. 15, 17, '64. June 1, 1, '64. June 19, 19, '64. Oct. 19, 19, '64. Mar. 7, 9, '65. Mav 5, -, '64. Dec. 16, 17, '64. Operations, Operators, Result. Left; dou. flap. Surg. A. S. Coe, 147th N. Y. Died July 2, 1864. ----. Surg.C. J.Walton,21st Ky. Died June 26, 1804. Right; circ. Died Juno 3,1864. Right; circ. Surg. J. F. Hutchin- son, 107th Penn. Died Sept. 18, 1864; pyaemia. Spec. 4155. Loft; antpost.flap. Confed. surg. Died Peb. 27,'05; typhoid pneu- monia and chronio diarrhoea. Right; flap. Surg. T. F. Oakes, 50th Mass. Died April 15,1865. Spec. 3995. Lett, Died June 13, 1864. ----; circ. Surg. C. H. Todd, C. S. A. Died July 25,1864. Right. Died October 2, 1864. Right. Died December 26,1863. Left, Surg. E. M. Rogers, 12th Wis. Died July 25, 1864. Left. Surg. C. N. Chamberlain, U. S. V. Died Mar. 4, '65; py- semia. Specs. 1504, 1595. Left. Died October 26, 1864. Right Died August 14, 1863; gangrene and chronic diarrhoea. Right; (also flesh w'nd left thigh.) Surg.W.B.Fox,8thMich. Died at Andersonville, Nov. 8,1864. Right. Died December 16,1864 ; pvaemia. Left. Died July 8 1863. Left. Died Aug. 1, '64; pyaemia and osteomyelitis. Spec. 2918. Right. Died October 21, 1864; exhaustion. Left Died July 16, 1864. Right; flap. Died Dec —, 1862. Left. Died August 16, 1864. Left; circ; gangrene. Died July 29,1864. Right; circ. Died Feb. 6. 1865. Left; ant. post. flap. Surg. F. M. Everleth, 7th Me. Died June 2. 1864; exhaustion. Left. Surg. W. J. Burr, 42d N.Y. Died June 15, '64; pyaemia. Left. Died November 6, 1864. Right; circ; (also w'nd left leg.) Died July 5,1864; pyaemia. Right. Died June 22, 1864. Left. Died May 5, 1863. Right; circ. Surg. G. W. Snow, 35th Mass. Died Sept. 6,1864 ; chronic diarrhoea. Right; lat. flap. June 16, fem'l ligated on face of stump. Died June 23, 1864: exhaustion. Right, Died August 10, 1864. Left. Surg.T.M.Cook, 101st Ohio. Died June 23, 1864. Left; circ.; gangrene. Died Jan. 6, 1864. Left; circ. A. A. Surg. J. N. Van Meter. Died Dec. 31, '64; irrita. fever and colliquative diarrhoea. Left; circ. Surg. G. L. Potter, 145th Penn. Died Aug. 17,'04. Spec. 1397. Left. Surg. G. W. Metcalf, 76th New York. Died July 25,1864. Right. Died October 21, 1864. Left; flap. A. Surg. E. F. Hen- dricks, 15th Conn. Died March 23, 1865; haemorrhage. Right. Died May 31, 1864. Right; ant post. flap. A.A. Surg. R. L. McClure. Died Dec. 24, 18ol: exhaustion. 1381 1382 1383 1384 1385 1386 1387 1388 1389 1390 1391 1392 1393 1394 1395 1396 1397 1398 1399 1400 1401 1402 1403 1404 1405 1406 1407 1408 1409 1410 1411 1412 1413 1414 1415 1416 1417 1418 1419 1420 1421 1422 1423 1424 Name, Military Description and Age Huett, L. A., Pt., E, 51st Indiana. lluff.W. F., Pt,G, 119th Penn., age 22. Humphrcys.C. J.,Corp'l, H,81st N. V, ago 25. Humphries, J., Pt., B, 50th Ohio, age 47. Hunker, J. C, Pt, D, 2d N.Y. Mt'd Rid., ago 30. Hunnewell, J., Pt, H, 31st Maine, age 36. Hunter.J., Serg't,B,57th Pennsylvania. Hurley, J., Pt, B, 8th Maryland, age 33. Hutchinson, G., Pt, K, 13th Iowa. Hutchinson.R. D..Pt,G, 89th Indiana, age 21. Hyett, C. P., Capt, 6th Miss., age 25. Ingraham, (?.,Pt,K,15fh Alabama, age 22. Jackson, E. D., Pt., G, llth New York, age 24. Jackson, G. W., Pt, H, 16th Georgia. Jackson, P., Pt., E, 31st Colored Troops. Jackson, W. H., Pt, E, 1st Penn. Rifles. Jackson, W.,Pt.,G, 107th New York. Jacobs, J.,Serg't,G, 90th New York. Jacquith, A. J., Capt., I, 1st Me. H. A., age 32. Johns, J. A., Pt,, G, 5th Florida. Johnson, A. A., Pt., F, 107th New York. Johnson, C. L.,Pt.,B, 1st Tennessee. Johnson, P.C., Corp'l,C, 48th N. Carolina. Johnson, S., Pt.,C, 110th Pennsylvania. Johnston, T, Pt, I, 42d Mississippi. Jones, A. A., —, K, 7th North Carolina. Jones, J. 0., Pt., I, llth Virginia. Jones, M., Pt, K, 16th Maine, age 24. Jones, S. W., Pt, B, 1st Mass. H. A., age 29. Jones, W., Pt., B, 23d Colored Troops. Jones, W. A., Pt., A, 6th Iowa. Justin, J. H., Corp'l, E, 57th Illinois. Justis, E., Pt., A, 90th Ohio, age 29. Kaser, J.,Serg't,B, 107th Penn., age 24. Karr, M., Pt,H, 1st New York Dragoons, age 21. Keating, P., Pt.,F, Phil. Legion. Keaton, J.M.,Pt.,D,19th Indiana, age 24. Keese,W., Corp'l,G,74th New York, age 31. Keilholz.D. P.,Corp'l,K. 65th New York. Kelly, D. 1\, Pt, C, 67th New York, age 25. Kelly, T.,Pt,G, 51st N. York, age 34. Kelly.W. B., Pt.,F, 39th Mass., age 23. Kelly, W. R., Pt., A, 7th Maine, age 43. Kemp, I. M., Pt., L, 2d N.Y. Mt'd Rifl., nge 21. Dec 30, 30, '62. May 5, 6,'64. Juno 3, 3, '64. July 21, 21, '64. July 17, 17, '64. June 25, 25, '64. July 3, 3, '03. May 5, 5, 1i4. July 21, 21,'64. April 9, 9, '65. Aug. 21, 21, '64. July 3, 3, '63. Nov. 25, 26, '64. Sept. 14. 15, '62. Oct. 28, 28, '64. Dec. 13, 13, '62. May 25, 25, '64. June 14, 14, '63. June 16, 18, '64. Sept. 17, 17, '62. May 25, 25, '64. Aug. 6, 6, '64. April 1, 1, '65. May 5, 6, '64. July 3, 3, '63. July 3, 3, '63. Dec. 13, 13, '62. May 19, 19,'64. July 30, 31, '64. Nov. 24, 25, '63. —, '62. June 27, 28,'64. June 21, 21,'64. May 7, 7, '64. Dec. 13, 13, '62. May 12, 12, '64. July 23, 24, '63. May.'64, Primary. June 8, 8, '64. May 12, 12,"'64. Aug. 18, 18, '64. May 12, 12, '64. June 17, —, '04. Operations, Operators, Result. ---. Died February 27, 1863. L't; circ Surg.P.Leidy,119thPa. Died June 6, 1864 ; pyaemia. Right. Surg.J.H. Lee,21st Conn. Died Aug. 17, 1H64 ; diarrhoea. R't. Surg. J. W. Lawton, U.S.V. Gang. Died August 24, 1864. R't; circ A. Surg. E. M. Smyser, 48th Penn. Died Aug. 29,1864; pyaemia. Left; flap. Died July 21, 1864; exhaustion. Left. Died July 22, 1863. Left. Died June 5, 1864. Right. Died July 29,1864. Right; circ. Died April 24, '65; haemorrhage. Left Died Sept 22, 1864. Right. Died August 3, 1863. Right; semi-circ. skin flaps; circ. incis'n muscles. A. A. Surg. J. F. Musgrove. Died Mar. 6,'65; consumption. ----. Died Oct. 17,1862; exh'n. Left; (also wound right thigh.) Surg. E. Jackson, 30th Colored Troops. Died Nov. 20,1864. Left; (also wound of right knee.) Died December 14, 1862. R't; circ A. Surg. L.W. Kenne- dy, 123d N.Y. Died June 4,'64. ----. Surg. W. Y. Provost, 159th N. Y. Died June 23,1863. Right; flap. Died July 11,1864; prostration. Left; haem.; femoral artery lig'd. Died October 5,1862. Right. Surg. P. II. Flood, 107th N.Y. Died June 1,1804. Left; (also amp. right leg.) Died August 21,1861. Right; circ. Surg. C. M. Clark, 39th 111. Died April 3,1865. ----. Died May 11,1864. Left. Died Aug. 14, '64; pyaem. ----; circular. Died. Right. Died July 15,1863. Left; flap. Died Jan. 16, 1863; pyaemia. Left; flap; (also fract of forearm.) Died of haem. from radial artery June 1,1864. Spec. 2262. Right; flap. Died August 19,'64; pvaemia. Right. Surg. R. L. Von Harlin- gen, 70th Ohio. Died Dec. 24, 1863; pneumonia. Left. Died November 2, 1862. Right. Died August 3, 1864. Right. Died August 5, 1864; gangrene and exhaustion. Left; circ. Surg. B. G. Streeter, 4th N.Y.Cav. DiedMay27,'64; pyaemia. ----. Died March 6, '63; slough- ing of stump. Left; haem.; lig. of fem. artery. Died June 12, 1804. Left; haem.; lig. of fem. artery. Died Mav 8, 1804. ----. Died May 10, 1864. Left. Died June 19,1864. Right. Surg. J. S. Ross, 11 th N. Hampshire. Died May 29, '64; pyaemia. ----. Died August 18, 1864. Left; ant. post flap. Died July 9, 1864. Left. Died July 6,1864. 262 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Ac 142: 1420 1427 1405 1423 1430 1431 1432 1433 1434 1435 1436 1437 1438 1439 1440 1442 1443 1444 1445 1440 1447 1448 1441) 1450 1451 1452 1453 1454 1455 1456 1457 1458 1459 1400 1461 1462 1463J 1464 1405 Kennaman, IF, Ft, G. 12th Alabama, age 32. Kent, P. A., It., B, 14th Mississippi. Kerr.T., PL, L, 83d New York, age 20. Kester, F. M.. PL, I, 71st Ohio, age 22. Kiefcr, M. L.. Pt., B,0th l'enn. Res., age 33. Kimball, D. C, Pt, B, 4th Mich., age 21. Kimberly, 1)., Pt,E, 7th Connecticut, age 27. King, P., Pt., E, 97th N. York, age 33. Kinsey, W. S-, Private, Blount's Va. Batteiy. Kinsley, J., Corp'l, K, 58th Penn., age 27. Kirk, E., Pt, A, 98th Ohio. Kirkendall,D.,Pt,B,73d Ohio. Klinkhart, C, Pt,, B, 149th N. York, age 25. Knight, A. B., Pt, B, 86th New York. Knoll, J., Pt, C, 26th Michigan. Kruni, D.,Capt, B,139th Pennsylvania, age 50. Kunkle, D., Pt., E, 57th Penn., age 19. Knnklc, J., Pt, E, 148th Pennsylvania. Ladd, C, Serg't, E, 25th Ohio. Lamb, T., Citizen. Lamphere, L. O., Pt., G, 21st Connecticut. Lane. A. II., Pt,D, 104th Illinois, age 26. Lane, J., Pt., A, 37th Wisconsin, age 25. Lanier, IF. B., Capt., H, 01st North Carolina. Lankow, F., Pt., E, 26th Wisconsin. Laury, J., Pt., B, 56th Pennsylvania. Lawrence, D.W.,Pt,C, 7th Michigan. Lawrence, T. J., Pt., B, Sth N. Hampshire. Lawson, E., Pt., F, 30th Alabama, age 22. Laydon, D., Ft, G, 54th Indiana, Leather, E., Pt., B, 55th Ohio, age 43. Lee, D., Pt,,G,57th Mas sachusetts, age 30. Lee, F. G., Pt., B, 120th Indiana, age 20. Lee, J. IL, Pt., I, 29(h Iowa. Leech, C, Pt. Ohio. Leffler, J., Pt. Ohio, age 21. Legett, A. s., 9th Kentucky. Leghtback.IL.Pt., E, 2d New Jersey, age 21. 'Lence, R., Ft, —, 18th Mississippi, age 35. Leonard, J.H.,Pt.E,9th N. Y. H'vy Artillery. Leonard, j. D., Pt, I, 1st Michigan Artillery. A, 63d D, 82d Pt., D, May 12, 1J.''04. Nov. 25, 25, '63. May 10, 10, '64. Dec. 16, 17, '64. May 8, 10, '04. July 2, 3, '63. June 2, 2, '64. June 18, 19, '64. June 17, 17, '64. Sept, 30, 30, '64. June 27, 27. '64. May 25, 25, '64. June 16, 16, '64. May 11, 11, '64. May 10, 10, '64. Sept. 21, 22. '64. Oct. 2, 2, '64. July 3, 3. '63. July 1, 1. '63 Primary, 1862. June 30, 30, '64. Aug. 7, 7, ?64. June 17, 18, '64. May 15, 15."'64 May 25, 25. '64. Mav 8, 8, '"64. Sept 17, 17, '62. May 27, 27, '63. Dec. 16, 18, '64. Dec. 28. 28, '62. Mar. 16, 10, '6-5. Aug. 19, 20, '64. Mar. 9, 10, '65. July 4, 4, '63. Oct. 3, 4, '62. June 18. 18, '04. Jan. 1, 1, '63. May 5, 6, '"64. Sept. 17, 17. '62. Oct. 19, 20, '64. July 4, 4, '64. Operations, Operators, Result. Left; ant post. flap. Died June 14,1864; exhaustion. Left; circ. Died Dec. 5,1863. Left. Died May 23,1864. Left; lat. flap. A. A. Surg. M. L. Herr. Died Dec. 29, '64; pyaem. Right; flap. Surg.C. Bower,6th Penn. Res. Died June 26,1864; pvaemia. Lei't, Died July 6, 1863; trau- matic tetanus. Left. Died July 5, 1864; irrita- tive fever. Left. Surg. J. W. Anawalt, llth Fa. DiedOct.19,'64. .Spec.4145. Left; circ. Died July 12, 1864; jaundice. Right Died Oct. 17,'64 ; exhaus- tion and diarrhoea. Left Died August 5,1864. Right. Died July 7, 1864. ----: circ. Surg. J. V. Kendall, 149th N. Y. Died July 11,1864; pyaemia. Right; circ. Surg. H. F. Lyster, 5th Mich. Died May 20, 1864; exhaustion. ----. Surg. J. W. Wishart, 140th Penn. Died May 12,1864. Right. Surg. S. F. Chapin, 139th Penn. Oct. 15. one inch of bone rem'd. Died Nov. 25,'64; exh'n. Left Surg. O. Everts, 20th lnd. Nov. 26, ant. postflap.mid.third. A.A.Surg. J. H.Packard. Died Dec. 16,'64; exhaustion. Specs. 3715, 4122. Left. Surg.C. S.Wood,66th N.Y. Died July 24, 1863. Right. Died July 14, 1863. ----; double flap. Surg. E. C. Franklin, U.S.V. Died—,1862. Left; (also amp. of right leg.) Died July 22,1861; tetanus. Right. Sept. 21, circ. re-amp. at middle third. Died Oct 4,1864. Left. Surg.W.B. Fox, 8th Mich. Died July 7,1864. Right; lat flap. Died May 19,'64. Right. Died June 4, 1864. ----. Died May 9,1864. Right, Died September —, '62. Right. Died June 30,1863. Right; ant post. flap. A.A.Surg. R. L. McClure. Died Feb. 9,'65. Left. Died February 24, 1853; pvaemia. Right; circ. Died April 23,1865; fatty degeneration of the heart. Left; circ. Surg. F. F. Oakes, 56th Mass. Died Sept. 27,1864; pyaemia. Right; ant. post. flap. Died Mar. 16,1865; exhaustion. Right. Died July 31,1863. Right. Died October 4, 1862. Right. Died August. 10, 1864; pyaemia. Left. Died January 2, 1863. Right; circ. Died July 23,1864 ; diarrhoea. ----; circ. Confed. surg. Died Sept. 21, 1862; pyaemia. Right. Died October 28, 1864. Left. Died July 8, 1864. 1466 1467 1408 1469 1470 1471 1472 L473 1474 1475 1476 147' 1478 1479 1480 1481 1482 1483 1484 1485 I486 1487 1488 1489 1490 1491 1492 1493 1494 1495 1496 149 1498 1499 1500 1501 1502 1503 1504 1505 1506 1507 Name, Military Description, and Age. Lesley, J., Pt., A, 116th Illinois. Letner,D.,Lieut.,B, 30th Iowa. Lewis, J.,Pt,K, SthVt, age 18. Lewis, J. R., Pt., H, 53d Georgia, age 32. Lewis, J.W.,Pt,D,14Cth Penn., age 18. Lienthardt E.. Serg't,K, 52d New York, age 42. Lilly, A., Pt., A, 85th In- diana. Linaweaver, C., Corp'l, K, 57th Illinois. Lindsay, J., Pt., A, 134th Pennsylvania, Lindsey, S, Pt., A, 73d Ohio, age 22. Link, G., Pt., F, 9thLa., age 27. Listen, W., Pt., D, 21st Illinois. Lock, J. L., Pt., I, 59th Illinois, age 23. Locy, M., Ft., A, 135th Pennsylvania. Long, T., Pt., B, 56th Massachusetts. Longmeyer, J., Pt., Capt. Brown's Co.,(?) age 18. Loss, J. E., Pt, 1,184th Penn., age 28. Loucks, D., Pt., O, 106th New York, age 17. Louison, W., Ft, G, 81st Pennsylvania. Love, T.W.,Pt, D, 74th Illinois. Love, W., Pt, G, 16th Maine, age 19. Lovett, G. G., Lieut., G, 119th Penn., age 22. Lowe, J., Pt., B, 54th Pennsylvania. Lowery, W. J., Pt., D, 64th New York, age 18. Lowthrop, J., —, K, 43d North Carolina, age 23. Lunn, J., Pt, D, 5th N. York H'vy Artillery. Lunt, C. W., Serg't., F, 22d Massachusetts. 2Lurchin, R. W., Pt., F, 6th Maine, age 28. Lyle, W. H., Pt., I, llth Mississippi. Lynch, H. IF.,Pt.,F,13th Georgia. Lynch, J. A., Serg't, B, 24th Michigan. Lyons, J. N., Pt., I, 42d Ohio. Mackey, J., Pt., B, 9th Indiana. Maddock, C. H., Pt.,F, 1st Maine, age 22. Maguire, C. F.. Pt,, F, 14th New York Art'y. Malone, J., Pt,E, 9th N. York State Militia. Mann, E., Pt, C, 52d O., age 22. Mann, J. I., Pt, B, 26th Michigan, age 24. Markham, W. D., Pt., —, 47th N. Carolina. Marshall, G. W„ Pt., D, 64th New York. Marshall, L., Pt, F,27th Mass., age 24. Marshbrun,S. IF., Maj., 53d Georgia. June 27, 27, '64. May 22, 24, '03. Oct. 19, 21, '64. July, '63, Primary. June 7, 7. '64. June 23, 23. "64. May 25, —,' '64. Oct. 12, 12, '64. Dec 13, 13, '62. Mar. 19, 19, '65. Julv 9, 10, '64. Sept, 19, 19,'63. Dec. 15, 16. '64. Dec. 13, 13, '62. My 18.'64, Primary. Oct 13, 15, '63. Oct. 1, 2, '64. Oct. 19, 19, '64. Sept. 17, 17, '62. June, '64, Primary. May 12, 12," '64. May 6, 8, '64. April 2, 2, '65. Mar. 25, 25, '65. July 12, 13, '64. July 17, 17, '64. May 10, 10, '64. May 3, 3, '63. July 3, 3, fe. July 9, 11, '64. May 14, 14, '64. Dee. 29, 29, '62. June, '64, Primary. Oct. 1, 1, '64. June 17, 17, '64. Dec. 13, 13, '62. Mar. 21, 21, '65. June 7, 7, '64. July 3, 3, '63. July, '63, Primary. Mar. 14, 14, '62. Oct, 19, 19, '64. Operations, Operators, Result. Left. Surg. A.C. Messenger, 57th Ohio. Died Sept 20, 1864. Right; circ. Ass't Surg. H. M. Sprague, U. S. A. Gang. Died May 29,1863. Spec. 1621. Right; flap; erysip.; gang. Died Nov. 11,1864 ; exhaustion. Left; (also right leg at point of election.) Surg. J. J. Knott, P. A.C. S. Died July 10,1863. Right: circ. Surg. J.W.Wishart, 140th Penn. Died June 11,1864. Right; double lat flap. Died August 14, 1864. Left. Died July 2, 1864. Right. Died October 16, 1864; haemorrhage. Right. Died January 15, 1863. Right; (alsofract.leftleg.) Died April 30,1865; exhaustion. Left; circ Died July 10, 1864. Left, Died October 8, 1863. Left; ant. post. flap. Died Jan. 31, 1865. Left, Died December 13, 1862. Right. Died May 20, 1864. Right, Died October 21, 1863. Left; ant post flap. Surgeon G. Chaddock, 7th Michigan. Died Nov. 23,1864. Right; circ. Died Nov. 16,1864; typhoid fever. Left. Died. Right, Died July 12, 1864. Right. Died May 26, 1864; py- aemia. Left. Died May 31,'64; pyaemia. Left. Surg. R. R. Clark, 34th Mass. Died May 6, 1865. Right. Surg. M. H. Raymond, 26th Mich. Died June 14, 1865; exhaustion and diarrhoea. Left, Snrg. G. T. Stevens, 77th N.Y. Gang. Died July 13.'64. Right; ant. post. flap. Confed. surg. Died Dec. 13,'64 ; exh'n. Right. Died May 12, 1864. Right; circ Died June 1,1863; pyaemia. ----. Died August 1,1863. ----; circ Surg. C. H. Todd, C. S.A. Died Aug. 12,'04. Sp.3824. ----. Died May 17,1864. Right. Died January 3,1863. Right. Surg. J. N. Beach, 40th Ohio. Died July 4,1864. Left; (also exc. of metacarpus.) Surg. J. S. Jemison, 86th N. Y. DiedOct.27,'64;exh'n. ,^p.4121. Left. Died June 23,1864. ----. Died January 1, 1863. Left, Died May 1,1865; typhoid fever. Right; circular. Died Aug. 19, 1864. ----. Died July 16,1863. ----. Died July 16,1863. Right. Died March 14,1862. Right: (also wound through left knee.) Surg.J.J.Knott.P.A.C.S. Died Nov. 18,1864. 1 Fisher (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., after the battle of Antietam, Sept. 17, 1862, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 47. * Lidell (J. A.), Suppurative Osteomyelitis (acute) following Primary Amputation of the Right Thigh, in Surgical Memoirs of tlie War of the Rebellion, Collected and Published by the U. S. Sanitary Commission, Surgical Volume I, p. 350. Ibid. On Tlirombosis and embolism, in Am. Jour. Med. Sci., 1872. New Scries. Vol. LXIV, p. 353. sect, in.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 263 Name, military description'. and ace. 1508 1509 1510 1511 1512 1513 1514 151 1516 1517 1518 1519 1520 1521 1522 1523 1524 1525 1526 1." 1528 1529 1530 1531 1532 1533 1534 1535 1536 1537 1538 1539 1540 1541 1542 1543 1544 1545 1546 1547 1548 1549 1550 1551 1552 Martin, R.,Corp'l, F, 93d New York. Martin, A. ,l.,Pt, F, 82d Ohio. Mason, D., Pt, K, 32d Wisconsin. Mason, H.W.,Pt.,B,24th Wisconsin, age 21. Massie,J.W., Lt.,G,19th Virginia. Matthews, B., —, H, 16th Georgia. Matthews.W., Corp'l, B, 78th Pennsylvania. May, P.,l't. A, 5th Mich. Mazerva, G., Pt, A, 80th New York. McBride, J. A., Pt., —, 7th C. S. Cav., age 26. McBride, M. ('., Lieut, G, 9th Louisiana. McCandless.W. W., Pt., H, 84th Illinois. McCarthy, D.,Pt..B,39th Indiana. McCarthy, J., Pt, Car- penter's Battery. McCartney, J..Corp'l.H. 149th l'enn., ago 24. McClarence, la, Pt., F, 20th Massachusetts. McComb,.I..Captain. D, 12th N. Jersey, age 2.1 McCom/ton.A../., Pt, F 53th Alabama. McCormick, N., Corp'l, E, 4th Delaware. McCnllough,S.E.,Corp., A, 47th Illinois. McCullouffh, W., Pt., D, llth Pennsylvania. McCurdy,T.",Pt.H. 38th Indiana. McDill, R., Pt., I, 81st Ohio, age 25. McDonald, H,Corp'l, D, 35th Ohio. McDonald, P., Pt., B, 170th New York. JIoDougal, A. L., Col., 123d New York. McFa'bkn, J. L., rt, C, 34th N. C, age Is. McFarland, J. A.,Corp'l, E, 18th Tennessee. McGarvey, M..Corp'l,C. 4th Infantrj-. McGenty, E.,Pt., E, 08th Pennsylvania. Mctlrath, J., It, E, 88th New York, age 30. McGraw, II., Lieut., K, 140th New York. McKenzie, A..Corp'l, 51, 8th N. Y. H. A.,age21. McKnight, L. IF, Pt, C, 2d Tenn. Cav., age 22. McLeod, J., Pt., F, 16th Infantry. McNew, C, Pt., E, 34th Iowa, age 25. 'McXutt, J, Lieut., —, 17th Miss., age 26. Melane, R. B., Pt, L, 1st Tenn. Cavalry. Menich, J., Pt, F, 10th New Jersey. Meniott, E., Pt, D, 6th Mo. S. M. Cav., age 23. 51enzie, J. R., Pt,, I, 9th N. Y. H'vy Artillery. Messmger,W., Pt, A, 3d Vermont. Meyer, J., Pt., K, 2d N. Y. H. A., age 23. \ Michael, R. S., Pt., A, ) 105th Pennsyvania, May 5, ti, '04. July 23, 20,"'04. Mar. 21, 21, '0.r>. Nov. 3ll, Dee.l,'i.4 July 2, 3, '63. Sept. 14, 15, '02. Jan. 2, 4, '03. May 5, 0, '04. May 5, 0, '64. Oct. 27, 27, '04. July 9, 9, 04. Dec. 31, 31, '02. Sept. 19, 19, '03. Sept. 19, 2H, '64. June 18, 18, '64. Julv 3, 3, '63. June 3, 3. '04. July 20, 20.' '04. June 17, 17, '04. Mav 22. 24,"'03. May 5, 5. 04. Aug. 31, 31, '04. Mar. 19, 19, '6!">. June 19, 19, '64. May IS. 18," '04. June 4, 4,'04. June 23, 23. '04. Myl5,'64, Primary. June 2, 2, '64. July 3, 3, '63. June 16, 17, '04. July 1, 1, f63. June 3, 4, '64. Mar. 25, 27, '64. May 27, 27, '04. Jan. 11, 11, '03. Sept. 17, 18, '62. Oct.9,'63, Primary. May (i, 6, '64. May 3, 4, ''65. Oct. 19, 19, '64. June 7, 7, '64. April 7, 8, '65. July 3, 3, '63. Operations, Operators, Result. ---. Died May 7,1864. Right. I >ied September 5,1804. Kight. Surg. A. B. Monohan,03,1 Hhio. Died March 29, 180a. llight; circ. Surg. J. R. Ludlow, I .S.V. KicdDe'c.23,'04 ; pycetn. Lilt. Died. ----. Died Sept. 28, '62 ; exhaus- tion. Right. Surg. C. J. Walton, 21st Ky. Died Jan. 10,1863. ----. Died May 19,1864. Left. Died May 7,1864. ----; circ. Surg. J. T. Kelby, C. S. A. Died Oct. 28,1864. ---; circ. Snrg. C. II. Todd, C. S. A. Died July 22,1864. Right. Died. ----. Died Oct. 8, 1803. ■---; circ. Surg. G. W. Burdett, C.S.A. DiedSept.21,'04; shock. ----; flap. Died Feb. 11, 1865, while on furlough. Left. Surg. N. Hayward, 20th Mass. Died July 20, 1863. Left, Surg.A.Satterthwaite, 12th N. J. Died July 2,1864. Left. Died Juiy 29,1864. ----. Surg. D. S. Hopkins, 4th Delaware. Died June 22,1864. R't: circ. A.Surg.H.M.Sprague. U.S.A. Died J'vl2.'63. Sp.PoVi. Right. Died May 16, 1864. Right. Died Sept. 3, 1864. Left; circ. Surg. W. C. Jacobs, 81stO. DiedMay7,'65; diphth. Left. Died August 2,1864. Right. Surg. M. Rizer,72d Penn. Died Slay 18, 1804. Right A. Surg. L.W. Kennedy, 123d N.Y. Died June 23,'04'. Right; ant. post. flap. Surg. J.H. Buckman, 5th New Hampshire. Died July 22, J804. ----. Died May 27,1864. Left. Died Dec. 3,1864. Left. Died July 23,1863. Left. A.Sur*. J.S. Smith,U.S.A. Died June 29, '64. Spec. 3766. ----. Died July 8,1803. Right; ant. post.flap. Snrg.G.W. McCune, 14th lnd. Died July 11,1804. Right; flap. Surg. H. P. Stearns, U.S.V. Died April 16,1864. Right. Died June 11,1864. Right Died February 17, 1863; wound. ----; flap. Died Sept. 19, 1862; shock and exhaustion. ----. Died October 27,1863. Left. Died May 28,1864. Left; flap. S urg. F. G. Porter, U. S.V. Lig. fem. Died May 29, 1865; exhaustion. Right. Died October —, 1864. Right. Died June 8,1864. Right; circ. Surg. P. E. Hubon, 28th Mass. Died May 25,1865; pyaemia. Right and left Died July 16,'63. No. Name, Military Description, and Age. Dates. ,1553 Miller, B., l't, B, 185th Mar. 25, New York. 25, '05. 1554 Miller, J., Pt, F, 88th May 10, 1 Penn., age 39. 10, '04. 11555 Miller, J., Pt, G, 6th In- May 14, diana. 14, '04. 1556 Miller, J., Pt,,E, 57th N. April 6, Carolina. 0, '05. 1557 Miller, J. E., Pt., II, 33d May 3, Virginia, nge 22. 5, '03. 1558 Miller, S. K., Serg't, K, Sept. 19, 2d Ohio Cav., age 23. 19, '64. 1559 Miller, W. S., l't, K, 8th Aug. 28, Indiana Cavalry. 28, '04. 1560 Mills, A. B., Pt,'i:, 10th July 3, 3. %3. Maine, age 19. 1561 Minoque, J, I't.G, 12th May 12, Infantry, ago 24. 12, '04. 1562 Mitchell, G., l't,, D, 2d June 19, Maryland, nge 42. 19, '04. 1503 Mitchell, J., Citizen em- Oct. 10, ploy6, age 25. 10, '04. 1564 Mitchell, B.J.,Lieut,B, Oct. 19, 1st Maine. 19, "64. 1505 Monroe, M., Pt.,E, 109th June 17, New York, age 28. 17, '64. 1506 Moody, J., Pt, H, 17th April 2, Vermont, age 45. 2, '65. 1567 Moore, .1. T., l't,, G, 45th July 12, North Carolina, age 20. 14, '64. 1568 Moore, L. M., Lieut., —, July 3, 17th Mississippi. 3, '63. 1569 Moore,W. B.,Pt,E, llth Mav 25, N. Hampshire, age 34. 26,"'64. 1570 Moran, H., Pt., K, 155th June 3, New York, age 25. -, '64. 1571 Morey, D. D., Serg't, C, May 20, 9th Maine, age 28. 30, '64. 1572 Morill, D. H., Corp'l, C, May 18, 31st Maine, age 22. 18,"'64. 1573 Morris, J., Pt., F, 39th June 1, Illinois, age 40. 2, '64. 1574 Morris, W. C, Pt., E, 4th May 19, Alabama, age 24. 19, '64. 1575 Morris, W., —, C, 44th July 2, New York, age 30. 3, '63. 1576 Morrison, J. H., Pt., B, Dec. 13, 19th Massachusetts. 13, '62. 1577 Morse, W. E., Pt., B, 2d Dec. 13, New Hampshire. 13, '62. 1578 Morse, R., Pt,, C, 100th Aug. 6, 6, ^64. Ohio, age 20. 1579 Morton, B. T., Pt, H, 2d June 18, Ohio Cav., age 24. 2u, '04. 1580 Morton, D. H., Pt., D, May 23. 149th Penn., age 20. 24, '04. 1581 Morton, J. IF., Pt., E, July 3, 18th Virginia. 3, '63. 1582 Morton, P., Pt., I, 83d May 10, Penn., age 35. 10, '64. 1583 Mullen, W. \V., Pt., D, June 4, 57th Indiana. 4, '04. 1584 Mullen, C, Serg't, M., April 7, 7th Penn. Cavalry. 7, '65. 1585 Murphy. P., Pt, D, 28th June 15, Pennsylvania. 15, '64. 1580 Myers, "R. P., Pt., K, July 3, l'llth New York. 3, '63. 1587 Nash, J. A., Pt.. H, 1st June 21, Mass. 11. A., age 19. 21, '64. 1588 Nason, S. IL, Pt, F, 1st June 18, Maine IL A., age 28. 18, '64. 1589 Nauss, J., Pt,, C, 82d July 20, Ohio, age 24. 20, '64. 1590 Neal, F., Pt, M, 21st Pa. June 18, Cavalry. 18, '64. 1591 Neal, L.,Corp'l, I,2dKy. Dec. 15, Cavalry. 17, '61, 1592 Neilson, G., Corp'l, Tar- Dec. 16, rant's Battery. 16, '64. 1593 Nelson, 0., PL, F, 40th July 20, Mississippi. 20," '64. 1594 Nelson, It., Pt, E, 26th Deo. 13, Pennsylvania. 13, '62. 1595 Wewman, W. Right Died October 12, 1864; remittent fever. Right. Died October 7, 1863. Left; flap. A. Surg. P. Adolphus, U.S.A. DiedJune21,'64; exh'n. Left; circ. Died July 12, 1804; pya.niia. Left ; ant post. flap. A. A. Surg. M. II. llend. Died Oct. 15, '04; double pneumonia. Right Died Nov. 12,'64; second- ary liaanorihage. Lett Died June 27,1805. Right. A. Surg.E. P.Roche,35th Mass. Died A pril 24,1805. Left; circ. A. Surg. J.C. McKee, U. S. A. Died August 9. 1804. Spec. 2856. Left. Died August 2, 1803. Right; circ: (also w'd left thigh.) Surg. J.S.Ross,llth N.H. Died June 24,1864 ; pyaemia. Left, Died June 18,1804. Left. Died July 22,1804 ; opera- tion and chronic diarrhoea. Left. Surg. J. S. Ross, llth N. Hampshire. Died May 20,1804. ] Left. Died July 8,1864. Right; flap. June 1, haem.; lig. femoral. Died June 2,'04; haem. Left. Died July 22, '63; pyaemia. ----. Died December 16,1802. Left. Died December 18,1862. Right; circ. Surg. C. S. Frink, U. S. V. Died Nov. 22,1864. Right; circ. Surg.J.H.Whitford, 30th O. Haem. Died July 2,'64. Right; short ant. and long post. flaps. Surg. W. F. Humphrey, 149th Peun. Died June 6,1804 ; pyaemia. Spec. 2795. ----. Died July 23,1803. Right; circ. Died May 20,1864; haemorrhage. Right. Died June 18,1864. Left. Died May 18, 1865; amp. and pneumonia. ----. Died June 17, 1864. Left, Surg. H. 51. McAbee, 4th O. Died August 31, 1863. Right; ant. post. flap. Died June 30, 1864; exhaustion. Left; ant. post. flap. Surg. H. F. Lyster, Sth Mich. Died July 4, 1864; pyaemia. Right. Died October 19,1864. Right Died June 19,1864. ----. Died December 17, 1861 ; shock. Right; circ. Died Jan. 14,1865. Left. Died July 26,1864. ---; circ. Died Dec. 15,1862. ----; flap. Died Sept. 27,1862. 'Fisher, (G. J.), Amp. after Battle of Antietam, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 47. 'Chalmers (H. S.), Report of Three Cases illustrating the Correlation existing between Erysipelas, Diphtheria (and Hospital Gangrene?), In Confed. Slates Med. and Surg. Jour., 1864, Vol. I, p. 86. 264 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 1596 1597 1599 1600 1601 Name, Military Description, and a<;e. Newton.W., ('apt., E. 2d Ohio Cavalry. Nicholas, I., Corp'l, G. 7th C. Troops, age 21. Nichols, D., Ft., E, 31st Maine. J Nicholson, D.,Pt,H,22d S Mass., age 23. Nickerson, J., l't, D, 3d R. I. Artillery, age 38. 1602 1603 1004 1605 1606 1607 1608 1609 1610 1611 1612 1613 1614 1615 1616 161 1618 1619 1620 1621 162: 1623 1624 1625 1626 1627 1628 1629 1630 1631 1632 1633 1634 1635 1636 1637 1638 1639 1640 Nolton.A.W., Pt.F, 93d New York, age 22. Norton, M., Pt, I, 117th New York. Nnnamaker, W., Pt, A, 77th Pennsylvania. 0'Connor,P.,Pt.,H,147th New York, age 33. Ogden.T.W., Pt,F,94th New York, age 16. Osgood.G. IL, Serg't.,K, 111th Pennsylvania. Otley, J. K., 'Adj't, 32d North Carolina. Owen, E. F., Pt, B, 29th Peun., age 42. Owens.B. E., Ft, C, 30th Virginia. Page, B. M., Pt,, 1,126th Ohio, age 21. Paine, B., Musician, E, 1st Alabama, age 22. Patterson, J., Corp'l, K, 10th Missouri, nge 22. Parker, L. IL, Serg't, D, 12th N. II.,age26. Parnell, E., Pt, A, 111th New York. Parsons, VV., Serg't, K, 124th N. York, age 20. Pasuhall, A. O., Pt, G, 124th Indiana, age 23. Patten, H. L., Maj., 20th Mass., age 28. Paul, J., Serg't, B, 152d New York, age 24. Peck, W. R., Pt, I, 1st Minnesota. Peden,J.,Corp'l,A,140th Pennsylvania. Pelkey," J., Pt., II, 2d Minnesota. Perkins, M., Pt, D, 18th Massachusetts. Perry, II. H., Corp'l, K, 57th Mass., age 20. Peters, E., Pt, C, 29th Conn. (Cold.) Peterson, O. C, Pt., A, 5th Minnesota, age 31. Peterson, P. 15., Adj't, 78th New York. Peterson. O., Pt., G, 39th North Carolina, age 25. Phelps, R. E., CorpM, K, 49th Massachusetts. Phelps, C. B., Pt., H, 38th Virginia. Phipps, J., Pt., A, 187th Pennsylvania, age 19. Phyfe,\'V.F.,Pt, E, 10th New York, age 22. Pickens, P., Serg't, F, 141st Pennsylvania. Pike, S., Serg't, 1, 10th Ohio Cavalry. Plutts.N..Serg't,D,100th Illinois. Polleys, T. A., Serg't.H, 6th Wisconsin, age 25. Pomeroy, W., Pt., B, 1st Maine H. A., age 30. Pool, E. G., Pt, A, 12th Massachusetts. Poppleton, B. H , Pt., B, 7th Iowa, aged 21. Posey, E., Pt., A, 39th Colored Troops. Mar. 31, 31, '65. Oct. 28, 28, '64. Mav 12, 12,"'64. May 10, 10,'64. Nov. 10, 10, 63. May 12, 14," '61. Mav 13, 13,"'64. Aug. 5, 5, s04. May 25, 26, '64. Oct. 19, 19, '64. June 27, 27, '64. Mar. 25, 25, '65. Dec. 17, 17. '64. Mar. '65, Primary Mav 12, 12, '64. Dec. 15, 15, '64. Oct. 18, 18. '63. Julv 2, 3, '63. July 2, 3, '63. Mav 5, 6, '64. Mar. 10; 10, '05. Aug. 16, 17, '64. May 30, 31, '64. July 3, 5, '63. Mav 8, 8, '64. Nov. 25, 25, '63. Dec. 12, 13, '62. Mar. 25, 25, '65. Oct. 27, 27, '64. Dec 16, 16. '64. Sept. 17, 17, '62. Nov. 30, De. 1,'04 Mav 27, 27," '63. May 15, 16," '64. June 25, 25, '64. Sept, 27, 28, '64. July 3, 3. '63. Aug. 28, 28! '64. July 22, 22, '64. June 18, 19, '64. June 18, 18, '64. Sept, 17, 17. '62. July 22, 2,',',64. Oct. 28, 28, '64. Operations, Operators, Ri>llt. Left. Died April 8,1865. Right. Died Nov. 28,1864 ; irrita- tive fever. ---. Surg. P. O'M. Edson, 17th Yt. Died May 2.', 1864. Both thighs; ant.post.flap. Surg. J. Thomas, 118th Penn. Died Mav 28, '64 ; exh'n. Spec. 2966. Right: ant post. flap. Surg.S. W. Gross, U. S. V. Died Nov. 20, 1803; erysipelas. Left; circ". Died June 4, 1864; pyaemia. Right Died May 28, 1864. Right. Surg. J. N. McCandless, 77th Penn. Died Aug. 15,1864. Left: ant. post. flap. Died June 14,1804 ; pyaemia. Right Died October 29,1864. Right. Died July 25,1864. Left. Surg. J. T. Kilby, C. S. A. Died April 25,1865. Right; circ. Died Feb. 5,1865; exhaustion. Right Died May 10,1865. Left; circ. Died May 26,1864. Right: ant post. flap. Died Dec. 24,1804. Left. Died Jan. 20,1864 ; chronic dyspepsia and diarrhoea. ---. Died July 24,1863; haemor- rhage. Right. Surg. H. M. McAbee, 4th Ohio. Died July 13, 1863. Right. Died July 3, 1864. Right; ant post. flap. Died Mar 16,1865; exhaustion. Lett; anterior post. flap. Surg. N. Hayward, 20th Mass. Died Sept 10,1864: pyaemia. Left; flap. Surg. M. Rizer, 72d Penn. Died June 30,'64; pyaem. Right: haem.; ligat'n. Died July 21,1863. ---; circ Surg. J. W. Wishart, 140th Penn. Died Mav 15,1804. ---. Died Nov. 2s, 1803. Left: (also wound of right side and lung.) Died Dec. 20,1862. Right; ant. post. flap. Died April 9,1865; apoplexy. Left. Surg. A. (j. Barlow, 62d Ohio. Died Nov. 17,1864. Left; circ. Surg. V. B. Kennedy, 5th Minn. Died Jan. 13,1865. Left. Died October 13,1862. Left; lat. flap. Died May 18,'65; exhaustion. Right. Died August 9, 1863. Left; circ. Died June 11,1864. Left. Died July 4,1864; exh'n and irritative fever. Left; anterior post. flap. Surg.G. Chaddock, 7th Mich. Died Oct. 18,1864: exhaustion. Left; (also wound of right leg.) Died July 10,1863. Right. Died October 9,1864. Left. Died September 16,1864. Right; posterior flap. Surg. J.H. Beech, 24th Mich. Gang. Died June 30,1864 ; haemorrhage. Right; circ. Died June 27,1864 ; pvaemia. Right. Died October 14,1862. Left. Surg. W. C. Jacobs, 81st Ohio. Died Sept. 7,1864. Right. Surg.M.Tucker,39thCl'd Troops. Died Nov. 9,'64 ; haem. NO 1641 1642 1643 1644 1645 1646 1647 1648 1649 1650 1651 1652 1653 1654 1655 1656 1657 1658 1659 1660 1661 1662 1663 1664 1665 1066 1067 1668 1669 1670 1671 1672 1673 1674 1675 1676 1677 1678 1679 1680 1681 1682 1683 1684 1685 Name, Military Description, and Age. Post, J. K., Pt., B, 112th June 1, New York, age 21. 3,'64. Potter, W. M., Pt.,E,84th May 3 Pennsylvania. 3, '63. Pratt, A., Pt, D, 34th Sept. 19, Massachusetts. 20, '64 Price, J., Pt, C, 78th Sept 28, Penn., age 53. 28, '64 Priest, J.,Corp'l,D,129th July 20, Illinois. 20, '64. Pritchett J. L., Pt, A, April 9, 87th Illinois. 9, '64 Pryor, W., Pt, F, 21st Dec. 12, Mississippi. 12, '62. Pulley, D. VV., Pt., E, Dec. 15, 60th Blinois, age 20. 16, '64 Pune, D. S., Ft., A, 79th July 20 Ohio. 20, '64. Putnam, C, Corp'l, E, Mar. 31, 64th New York, age 27. 31, '65. Quinn, F., Pt, K, 147th July 30, New York, age 40. Au. 1,'64 (Rabbit, E. C, Serg't, B, Nov. 24, J 10th Missouri. 25. '63 'Rainwater.J. G., Pt.,—, Sept. 17, 18th Miss., age 28. 19, '62. Rapp, J., Pt., C, llth June 19, Conn., age 31. 19, '64. 2Rate, J. B., Pt,, —, 45th Sept. 17, Virginia, age 23. 17, '62, Rayburn, S. Y., Serg't, July 3 D, 27th Indiana. 3, '63. Reardon, J., Pt,, D, 52d June 27, Ohio. 27, '64 Ream, C, Pt., I, 26th N. Dec. 13, York, age 60. 14, '62. Recolder.G., Pt., A, 79th June 16, Penn., age 18. 16, '64. Reddick, G. H., Serg't, July 2, F, 20th Indiana. 2, '63. Reece, E., Pt,, I, 36th May 15, Alabama. 15, '64. Reed, J., Pt,C, 15th Va., June 18, age 26. 20, '64. Reed, J., Pt., G, 123d May 15, Ohio. 15, '64. Reedy.C. T., Pt.,G, 40th June 20, Ohio. 20, '64. Reeves, A., Pt., C, 36tb Nov. 23, Ohio. 23, '63. Reeves, W. J., PL, C, May 14, 10th Missouri. 14, '63. Reidman, G., Pt., 1,15th Sept. 17, Massachusetts, age 44. 17, '62. Remele, D., Pt, E, 109th May 6, New York, age 19. -, '64. Renerson,W. Ii., Pt., E, June 16, 1st Maine, age 27. 16, '64. Reynolds, W. T.', Pt., A, April 5, 4th Delaware. 5, '65. Rhea, J. M., Pt., I, 8th June 20, Iowa. 20, '63. Richards, A. J., Pt,, K, May 30, 9th N. H., age 25. 30, '64. Richardson, W. A., Pt, Nov. 25, G, 6th Iowa. 25, '63. Riley, P.,Pt,G, 42d Mas- Aug. 27, sachusetts, age 19. 28, '64. Riling, J., Pt, C, 159th April 13, New York. —, '63. Ripley, C. A., Pt., E, 2d July 4, Iowa. 4, '64. Riple y, L. D.,Pt.,E,10th Sept. 19, West Va., age 29. 19, '64. Ritka, A., Pt, M, 4th Sept. 19, N. Y. Cav., age 32. 19, '64. Robarge, L. J., Corp'l, I, Mar. 1, 5th Cavalry, age 30. 2, '64. Roberts, W. H., Pt, E, Mav 14, 33d Ohio. 14.' '64. Robinson, F., Pt., D, 3d Mar. 5, Cavalry. 5, '64. Robinson, D. W., Pt. F, May 27, 53d Mass., age 43. 27, '63. Robinson, H., Capt., G, May 3, 55th Ohio. 5, '63. Robinson, J., Pt,K,123d Sept. 3, Ohio, age 24. 4, '61. Dates. Operations, Operators, Result. Right; circ. Died June 21,1864; exhaustion. Left. Died May 20,1863. ----. Died September 20, 1864, on operating table. Right; lat. flap. Died Oct. 18,'64; surgical pneumonia. Right. Died August 24,1864. Right; circ. Died April 30,'64. ----. Died December 18,1862. Right; lat. flap. A. A. Surg. L. Sinclair. Erys. Died Feb.4,'65. Left. Died August 4,1864. Left; circ. Died J une 22,1865; pyaemia. Spec. 4238. Right; circ. A. A. Surg. S. J. Holley. Died August 2,1864. Both. Snrg. E.J. Buck,18th Wis. Died Dec. 26,1863. Left; circ; (haem. fr. ant tib. art.; gang.) Died Sept. 22,'62; pyae. Right. Died July 13, 1864. Left ; circ. Confederate surgeon. Died Sept. 30,1862; pyaemia. Left; circ Surg.W. H. Twiford, 27th Indiana. Died Aug. 1,'63. Left. Died July 4, 1864. Right. Died January 6, 1863; pvaemia. Left; circ. Died July 24, 1864; pyaemia. Left. Died July 6,1863. Left. Asst Surg. C. H. Burbeck, 60th N.Y. Died May 17,1804. Left. Confed. surgeon. Nov. 1, fein. lig. Nov. 8, re-amp. at up. third. Surg.G.S.Palmer.U.S.V. Haem. Died Nov. 14,'64 ; exh'n. Right. Died July 10, 1864. Right. Surg. J. N. Beach, 40th Ohio. Died July 19,'64 ; pyaem Right. Died December 18,1863. Left. Died Aug. 3,1863; chronic diarrhoea. Left. Died September 30, 1862. Left; circ Died Aug. 8, 1864; diarrhoea. Left: ant. post. flap. Died Aug. 9,1864. Right; circ. Died A pril 30,1865. Right; circ. Surg. H. Z.' Gill, 95th Ohio. Died July 25,1863. Left; circ. Died June 20, 1864; exhaustion. Right; circ. A. Surg.W. S. Lam- bert. 6th Iowa. Died December 24, 1863; pneumonia. Left. Died October 4, 1864; py- aemia. Left. Died Oct. 6,1863; chronic diarrhoea. ----. A. Surg. A. F. Marsh, 56th 111. Died July 15,1864. Left. Died October 17,1864. Right; circ. Died Feb. 26,1865; typhoid fever. Left; circ. A. Surg. J. W. Wil- liams, U. S- A. Died March 14, 1864; tetanus. Spec. 2151. Left. Died May 23, 1864. Left. A.Surg. B.Dnrham, jr.,72d 111. Died June 22,'64; diarrhoea. Left. Died June 6,1863. Left; circ Died May 11, 1863; exhaustion. Left; flap. A. A. Surg. J. R. Uhler. Died Sept. 10, 1864. •FISHER (G. J.), Report of Fifty-Seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam, Sept. 17,1862, Am. Jour. M>-1. Sa\, 1663, Vol. XLV, p. 47. 2FI8HER (G. J.), op. cit, p. 47. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 265 1686 168' 1688 1689 1690 16!) I 169 1693 1694 1695 1696 1697 1698 1699 1700 1701 1702 1703 L704 1705 1706 1707 1 1709 1710 1711 1712 1713 1714 171 1716 171 1718 1719 1720 1721 1722 1723 1724 1725 1726 17; 171 1729 Name, Military Description, ani> Aoe. Robinson, J. T., Pt., A, 1st Ohio Artillery. Robinson, P. P., Corp'l, A, 57th Penn. Rodgers, J. A.,Pt.,G, 1st Cavalry, age 19. Rodgers, W. B., Pt., D, 88th Penn. Roff, W. H., Lieut., H, 2d N. Y. H. A., age 35. Rogers, C, Pt, E, 104th Ohio, age 19. Uogers, S., PL, F, 1st Maine, age 21. Rolfc, G..Pt,H,2d N.Y. Cavalry, age 36. Rolfs, D. B., Pt, D, 6th N. Y. H. A., age 42. Roper, S., Pt, A, 140th Penn., age 43. Rose, W.H.,Pt.,C, 105th Illinois. Ross, E., Serg't, G, 52d New York. Ross, R E., Corp'l, II, 36th Indiana. Rouark, T. H..Pt.,F, 1st Maryland, age 25. Roussel, E. G., Capt, G, 7-'d Penn. Rowe, A. F., Pt, A, 1st Maine H. A., age 33. Rumbell, J. F.,Corp'l,F, 7th Infantry. Rurasey, J. W., Pt., A, 3d Mi, age 43. Rupert, H., Pt., M, 2d Penn. Cav., age 21. Russell, A. P., Capt., 1st Maine, age 28. Russell, W., Pt., B, 90th Pennsylvania. Ryan, VV. J., Pt., E, 2d N. Y. State Militia. Sargent.O. H. P., Pt, G, 22d Mass., age 30. Schaeffer, T., Pt,C,26th Wisconsin. Schlechter, J., Pt,—,5th Cavalry, age 27. Schmidt, J., Pt, A, 60th Indiana, Schnapp, C, Pt., L 76th New York. Schoner, W., Pt., E, 82d Illinois. Schwartzwaelder,A.,Pt, D, 32d Indiana. Scott, C. L., Pife Major, 30th Indiana. Scott, W., Pt., C, 39th Illinois, age 19. Searcey, D., Pt, E, 19th Kentucky. Seidolph, I., Pt., B, 39th New York, age 19. Sevoy, W., Pt., A, 27th Iowa. Shank, A., Pt., C, 1st Penn. Cavalry, age 23. Shanks, J., Pt., D, 21st Kentuckjr, age 29. Shannon, R.G.,Capt, F, 25th Indiana. Sharp, C. D., Serg't, D, 140th Penn. Sharp, J., Pt., E, 14th N. Y. H. A., age 20. Shattuck, A. B., Capt., E, llth N. Hampshire. Shaw, A. J.,Pt, H, 113th Ohio. lShelton, J. A. J., Lieut., G, 50th Tennessee. Shelvin, W., Colored Pioneer. Shields, P., Pt, D, 6th Wisconsin. Juno 4, 4, '64. Mav 5, 0. '04. Aug. 25, 26, '64. Sept. 17, 17, '02. June 6, -, '64. July 8, 8, '64. June 18, 18, '64. April 1, 1, '65. June 1, 1, '64. June 16, 17, '64. May 27, 27, '64. Dee. 13, 13, '62. Sept. 19, 20, '63. Aug. 3, 3, 64. Sept. 17, 17, '62. June 16, 16, '64. Feb. 21, 22, '62. June 2, 4, '64. June 24, 25, '64. Sept. 20, 22, '64. Dec. 13, 13, '62. Sept. 17, 17, '62. May 1, 1, '62. May 25, 25, '64. J'yl8,'64: Primary. July 10, 11, '6a June 20, 21, '64. May 3, 3, '63. Nov. 25, 25, '63. June 27, 27, '64. Oct. 13, 13, '64. Dec 20, 20, '02. June 16, 16, '64. May 18, 18, '64. Oct. 14, 16, '64. June 20, 20, '64. Mar. 21, 21, '65. July 2, 3, '63. July 39, 30, '64. Dec. 13, 13, '62. June 27, 27, '64. Aug. 30, 30, '64. Aug. 31, 31, '64. April 29, 29, '63. Operations, Operators, Result. Left, Surg. E. B. Glick, 40th lnd. Died June 26, 1864. ----. Died May 6, 1864. Left; flap. A. A. Surg. J. R. Uhler. Died Oct. 2, 1804. Left. Died Oct. 17, 1862. Left. Surg. P. E. Hubon, 28th Mass. Died June 30, 1804. Right. Died July 8, 1804. Left. Died August 6, 1864. Left; circ. Died April 21,1865; Left; circ. Surg. J.W.Wishart, 140th Penn. Haem.; lig. fem'] art Died Aug. 10, '64; exh'n. Right. A.'Surg.G.M.Trowbridge, 19th Mich. Supposed to be dead. ----. Died December l'.i, 1862. Left. Died Sept. 30,1863. Left. Surg A. A.White, 8th Md. Died Oct. 6, '64. Spec. 4855. ----. Died October 11, 1802. Right; (alsoamp. finger.) Hasm. Died July 29,'04 ; gangrene and pvaemia. Spec. 2907. —'-. A. Surg. B. Norris.U. S. A. Died March 25, 1862. Left. Died July 11, 1865; fatty degenerat'n of heart. Spec. 4290. Left; circ. Died July 8, 1864. Left; circular. A. A. Surg.A.A. Younglove. Died Oct. 2,1864. Left. Died Jan. 1,1863; pyaemia. Right. Died October 2, 1862. ----. Died May 30, 1862; py- aemia. Right. Died June 20, 1864. Right; (also fracture of left leg.) Died July 25, 1864. Left. Died July 11, 1863. Left; double flap. Surg. J. H. Beech, 24th Mich. Gang. Died July 24,1864; exhaustion. Right. Died June 5, 1863. Right. Died Dec. 27, 1863. Left. Surg. S. H. Kersey, 36th lnd Died July 28,1864. Right; circ Died Nov. 10, '64. Right. Died Feb. 5,'63; pyaemia. Left; circ. Surg. J. W. Wishart, 140th Penn. Died Sept. 27,'64. Right; (also wound of left heel) Died May 21, 1864. Right; ant post. flap. Snrg. E. Bentley, U. S. V. Died Oct. 24, 1863; haemorrhage. Left. Surg.C. J. Walton,21st Kv. Died July 17,1864. Right. Surg. A. B. Monohan,63d Ohio. Died March 23,1865. Left; (also wound of right thigh.) Died August 10, 1863. Right; circ. Surg. J. Oliver, 21st Mass. Died Sept. 8,'64; pyaem. Right. Died December 17,1862. Left. Died July 19, 1864. ----. Gang. Died Oct. 23, '64; pyaemia. Right. Surg. A. T. Hudson, 26th Iowa. Died Aug. 31,1864. Left. A. Surg. J. T. Duffield, 7th lnd. Bone rem'd ; haem.; lig. of fem. June 9, lig. of exter. iliac Died June 19, '64. Spec. 1143. 1730 1731 1732 1733 1734 1735 1730 1737 1738 1739 1740 1741 1742 1743 1744 1745 1746 1747 1748 1749 1750 1751 1752 1753 1754 1755 1756 175 1758 1759 1760 1761 1762 1763 1764 1765 1766 1767 1768 1769 1770 1771 1772 1773 1774 Name, Military Description, and Aoe Shipper, R., Corp'l, C, 12th Illinois, age 19. Shoemaker, G., Pt., B. 39th New York. Shorey, It., l't., I, 17th Maine, age 45. Showalter, J., Pt.,C, 53d Penn., ago 20. Shuster, G., Serg't, G, 30th Ohio. Sihnnn.W. L.,Corp'l, K, 32d Mass. Simmons, J. K, Pt., D, 210th Penn., age 38. Simmons, D. F.,Pt,G, 38th Mass. Simmons, S. S., Sergt, D, 84th Penn. Simmons, T. N., Corp'l, C, 14th Tenn. Singer, L., Pt., F, 174th New York. Sisey, J., Pt, K, 21st Kentucky. Sloan, M., Pt, H, 47th Indiana. Smith, A. C, Corp'l, C, 20th Connecticut. Smith, E., Pt, C, 18th N. Y. Cavalry, age 38. Smith, IL, Pt," 1,14th N. Jersey, age 24. Smith, H., Pt., A, 88th Pennsylvania. Smith, H. D.,Pt.,H, 18th Infantry. Smith. J. F., Pt, C, 61st New York, age 17. Smith, J. N., Pt., E, 7th Wisconsin, age 17. Smith, J. W., Corp'l, E, 42d Indiana. Smith, T., Serg't, G, 4th N. Y. H. A., age 22. Smith, W., Pt., B, 17th Kentucky. Snodgrass, N.,Pt, F, 3d Tennessee, age 24. Snyder. W. H.,Musician, G, 23d Kentucky. Sockwell, B. F., Pt, D, 25th New Jersey. Sow, J. L., Serg't, B, 124th Ohio. Sparry, J. E., Corp'l, L, 1st Vermont Cavalry. Spaulding, D., Pt, K, 16th Maine, age 29. Sporleder, L., Pt, B, 187th Penn. Sprajrue, T. M., Pt., C, 1st Maine. Springer, S., Pt, A, 37th Wisconsin, age 15. Stanislaus, J., Pt., 1,1st Maine, age 46. Steel, L. Ta, Pt, F, llth Pennsylvania. Steele.G. S.,Pt,D,126th New York, age 23. Sterling, E. E.,Corp'l,E, 143d Penn., age 32. Stetson, J.M., Ft, H,57tb Mass., age 17. Stevens, D. H., Pt, D, 5Cth Penn., age 24. Steward, C. A., Pt, 5th Maine Battery. [Stewart, J., Pt.. D, 77th i New York, age 38. Stiles, J., Pt., A, 2d Del- aware. Stoner, W. K., Pt., A, 53d Ohio. Stooksbury, R., Serg'tF, 6th Tennessee. Stout, S., Pt., I, 143d Pennsylvania. Oct. 5, 5, '64. Julv 2, 3, '63. Nov. 27, 29, '63. June 3, 3, '64. June 27, 27, '04. Julv 3, 3, '63. April 1, 1, '65. April 30, —, '63. Nov. 27, 28, '63. July 3, 3, '03. July 11, 13, '63. June 27, 27, '64. May 5, 5, '64. Mar. 19, 21, '65. May 4, 4, '04. June 7, 7, '64. June 18, 18, '64. May 31, 31, '64. April 8, 9, '65. May 10, 10, '64. June 27, 27, '64. June 18, 18, '64. Sept. 19, 19, '63. May 14, 14, '64. Nov. 25, 25, '63. Dec. 13, 13, '62. May 15, 15, '64. Julv 3, 3, '63. May 10, 10, '64. June 18, 18, '64. Oct. 19, 20, '64. June 18, 19, '64. Mar. 25, 25, '65. May 5, 5, '64. June 22, 23, '64. May 9, 10, "'64. May 13, 13, '64. May 6, 6, v64. May 3, 3, r63. Mar. 25, 25, '65. July 2, -, '63. July 3, 3, '64. May 14, 14, '64. May, '63, Primary Operations, Operators, Result. Right; circ. Surg. P. N. Woods, 39th Iowa. Died Dec. 26,1804. ----. Surg. F. Wolf, 39th New York. Died July 25, 1863. Kight; out. post. flap. Died Dec. la, lso:i: gangrene. Right. Surg. G. L. Potter, 145th Penn. I)iedJune24,'64. Sp 665. Right. Surg. A. C. Messenger, 57th Ohio. Died July 26,1864. Left. Died July 28, 1863. Left; (also wound of right leg.) Surgeon A. A. White, 8th Md. Died April 12, 1805; pyaemia. Left. Died May 10, 1803. Right. Died December 9, 1803. Right. Died July 16, 1863. Left; haem.; fem. ligated. Died July 17, 1803. Left. Surg C. J. Walton, 21st Ky. Died July 6, 1864. Left. Died May 7, 1864. Right. Died March 28, 1865. Right: circ. Surg. C. Powers, 160th N.Y. Died June 19, 1864. Right; flap; (also left leg at knee joint) Died June 17, 1864. Right. Died July 3, 1864. Right. Died June 19, 1864. Right. A. Surg. W. B. Hartinan, 116th Penn. Died May 24, '65; pvaemia. Left. Died July 3, 1864 ; pyaem. Right. Died July 18, 1864. Right; ant. post. flap. Died June 29, 18G4; exhaustion. Left. Died Oct. 11, 1863. Right. Died July 29, 1864. Right. Died December 23,1863. Laft. Died February 5, 1863. Right. Died July 16, 1864. Right. Died July 15, 1863. Left; circ. Died May 20, 1864; exhaustion. Left. Died June 19, 1864. Left; oval skin and circ muscles. Surg. G. T. Stevens, 77th N.Y. Died Oct. 26,'64; toxicohaemia. Left; circ; (also w'd right thigh.) Surg. S. S. French, 20th Mich. Died Sept. 4, '64; ch. diarrhoea. Right; ant. post. flap. Died May 16. 1865; pyaemie intoxication. Right. Died May 19, 1864. Left; circ. Surg. A. Van Devere, 66th N. Y. July 23, haem.; fem. lig. Died July 29,'64 ; exh'n. Right; flap; haem.; lig. small art. Died A ngust 12, '64 ; pyaemia. Right; ant. post. flap. Died May 29, 1864; pyaemia. Right. Died June 19, 1864. ----. Died May 1.1, 1863. Right and left. Died April 17, 1865; pyaemio intoxication. Right. Died July —, 1863. Right. Surg. A. C. Messenger, 57th Ohio. Died Sept. 15, '64. Right. Surg. D. L. Heath, 23d Mich. Died May 26, 1864. Right; double flap. Surg.W. F. Humphrey. 149th Penn. Died July 11, 1863. •JONES (J ), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, in United States Sanitary Commission Memoirs, 1871, Surgical Volume II, p. 403. Surg. HI—34 266 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. Name, Military Description, and Ace. Operations, Operator RESt'l.T. 1775 ' smbblebein, IL, Pt., C, 90th Penn. 1776 Sullivan, M., Corp'l, E, 17th Wisconsin. 1777 Summerville, J. IL, Pt., D,llthPa.Res.,ngel9. 1778 Sumner, F. H., Pt, H, 39th Mass., age 29. 1779 Sutton, S. S.. It., K, 12th New Jersey. 1780 Swain, J.G., Pt., I, 20th Mass., acre 19. I7HL Swoinhart, P.,Pt.,C,47th lVnu., nge23. 1782 Swisher, C, l't, B, 3d Va. Mounted Infantry. 1783 Swycr, W., Pt, C, 143d Penn., age 24. 1784 Tack, G. D., Pt., E, 77th New York. 1785 Tnggart. C. F., Maj., 2d l'enn. Cav., age 32. 1780 1787 1788 1789 1790 1791 1792 1793 1794 1795 1796 1797 1798 1799 1800 1801 1802 Tanner, L. M.,Corp'l, E, 37th Mass., ago 21. Tanner, R. J., Serg't, C, 103d Illinois. Taylor, A., l't., A, 1st Vermont Cavalry. Taylor, D. W., l't, D, 81st Indiana. Taylor, R., Pt, G, 5th New Hampshire. Taylor, W., Pt, E, 188th New York. Terry, VV. B., Pt., B, 6th Connecticut Theurer, P., Pt., D, 82d Ohio, age 32. Thomas, B., Pt., G, 70th Indiana. Thomas, J. L., Pt, B, 2d Maine. Thomason, J'..Pt.,B,49fh North Carolina, age 28. Thompson, G., Pt, A, 71st Penn., age 50. Thompson, T. B., Pt., G, 52d North Carolina. Thompson, R.W.,l't.,G, 53d Ohio, age 23. Thompson, IF.,Pt.,I, 12th Virginia. Thorp, E., Pt., G, 1st Penn. Art'y, age 20. Tickner, VV., Pt., D,90th Pennsylvania. 1803! Tiller, G. M., Lieut., C, I 64th Miss,, age 20. 1801; Tillinger, C, Lieut, K, j 3d Missouri. 1805 Tindall, J., Pt., E, 1st | Delaware, age 38. 1800: Tinker.G..Corp'l, I, 27th | Illinois, age 19. 1807 Tipton, S., Pt., II, 97th i Indiana. 180s Todd, G. W., Major, 91st ! Pennsylvania. 18.'9 Tomilson, A., Pt, I, 39th I Illinois, age 21. 1810 Tomlinson, A., Pt., E, 116th Penn., age 36. 1811 Tompkins.G., Pt,G,84th Illinois. Tourtelotte.C. A.,Serg't, IJ. Isth Conn. Toy, J.. Pt., E, 7th Mis- 181 1813 1814 Trauseht, N.,Pt,F, 14th Maine, age 28. si 5 Tremlett. H. M., Lieut. Co)., 39th Mass. 1810 Trimmer, Adam, Pt., H, , 143d Penn., age 21. May 3, 3, '63. Aug. 20, 20, "64. Dec 15, 15, '62. Feb. 7, 7, '65. June 3, 3, '64. Dec. 13, 13, '62. Oct. 19, 19. '04. Aug. 20, 26, '63. May 10. 10,"'64. May 12, 12, '64. Oct. 22, 23, '63. April 2, 2, '65. July 28, 28, '64. May 5, 5, '64. June 27, 27. '64. July 3. 3, '63. Mar. 31, 31, '65. Oct. 7, 7, '64. May 25, 25, '64. May 15, 15, '64. Mav 27, 27." '62. Julv 14, 14,*'64. June 3, 3, '64. July 2, 3, '63. July 22, 22, '64. May 15, 1 5," '04. Aug. 4, 5. '04. Sept. 17, 17, '62. Dec. 15, 15, '04. Aug. 10, 10, '61. Feb. 8, 8. '64. Nov. 25, 27. '63. June 27, 27, '64. Dec. 13, 13, '62. Aug. 16, 16, '64. June 1, 1, '64. Dec. 31, 31, '62. June 18, 18, '64. June 25, 25, '63. Oct. 19, 19, '64. Mar. 30, 30, '65. June 18, 19, '64. Left; circ Died June 2. 1863; pvaemia. Left. Died September 20, 1864. ---. Feb. 15.'63, reamp. in mid. third. Died Feb. 28,'63; pyaem. Left; ant. post. Hap. Died Feb. 25. 1805; pya'inia. Right. Surg. F. F. Burmeister, 69th Penn.' Died June 7, 1864. Spec. 3304. Left; ant. post, flap.; seq. rem'd. Oct. 8, reamp. mid. third. Died Oct. 16, '63; pvaem. Spec. 1265. Left; circ. Died Nov. 18, 1864; diphtheria. Right. Died in the hands of the enemy. Right;'flap. Died June 18,1864; exhaustion. Left. Died May 18, 1864. Left; circ. Surg.W.M.Weidman, 2d Penn. Cav. Died Oct. 24, '63. Spec. 1765. Right. Died May 18. 1865; py- aemia. Right Died August 21, 1864. ---. Died May 6,1864. Left. Surg. T. M. Cook, 101st O. Died July 3, 1864. ---. Died July 11, 1863. Left. Died April 12,1865. Left. Died Nov. 1,1S64. Right; circ. Surg. G. M. Beaks, 141st N.Y. Died July 14,'64; exhaustion. Right. A.Surg D.L. Jewett.20th Conn. Died June 21,1864. ---. Died June 19.1862. Left; circ. Died July 20, 1864; gangrene. Left; circ. Ssrg. F. F. Burmeis- ter, 69th Penn. Died Aug. 23. 1864 ; ch. diarrhoea. Spec. 3489. Left. Snrg. H. M. McAhee. 4th Ohio. Died Aug. 9,1803. Left. Surg. F. N. Barnes, 116th Illinois. Died Nov 2,1864. Right. Died June 27, 1864. L't; circ A. A.Snrg.W.S.Adams. Haem.; fem. art. tied. Died Aug. 12,'64; haem. Specs. 3929, 3960. Left. Died Nov. 16,1862. Right; circ; (also w'nd left leg.) A.A.Snrg.F.B.Nossinger. Died Jan. 1,1865; tetanus. ----. Died Sept. 5,1861. Left Died Feb. 13,1864. Spec*. 2115, 2087,2041, Left; circ. Died Jan. 25, ] 804. Left. Surg. J. H. Hutchison.15th Mich. Died July 20,1864. ----. Died Dec. 19,1862. Right; circ. Haem. Died Sept. 14, '64; syncope. Right; circ. Surg. P. L\ Hubon, 28th Mass. Died June 18. 1864. Left. Died Jan. 19,1863. Left. Died August 15,1864. Left; circ. Surg. J. S. Reeves, 78th O. Died July 9,"03; pyaem. Right; ant. post, flap; (also w'nd left arm.) Sphacelus; phlebitis. Died Nov. 15, '64 ; pyaemia. Left. Died June 6, 18*65. Left. Died August 14, '64 ; irri- tative fever. 1817 1818 1819 1820 1821 1822 1823 1824 1825 1826 182 182! 1829 1830 1831 1832 1833 1834 1835 1836 183' 1838 1839 1840 1841 1842 1843 1844 1845 1846 184 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 Name, Military Description, and Age. Dates. Operations, operators, Rebult. Trint, J. M., Pt, I, 29th Iowa, age 22. Tudar, S.. Pt, G, 61st Virginia, age 40. Turnball, E., Corp'l, K, 48th N. York, age 19. Turnbaugh, J., Ft, E, 208th Penn., age 21. Turner, T. C, Corp'l, C, 12th Georgia, nge 29 Turney, E., Serg't, D, 27th Indiana. Upton. A., Pt., D, 59th Massachusetts. Unknown, 85th N. York. Unknown, 56th Pennsyl- vania. Usher, S., Lieut.,G,»17th Maine. Vache, H. W., Pt, K 45th Penn., age 20. Van Blarcome,A.H.,Pt. D, 65th N. Y., age 21. Vance, W. H., Pt., G, 33d Ohio. Vandamark, D., Pt., B, 30th Indiana. Van Gordon, J., l't, F, 58th Penn. Van Ingen.G.,Adjutant, 89th N. Y., age 29. Van Vliet, J., Pt, H, 107th New York. Vaughan, J., Pt., F, 6th Kentucky. Viele, M., Pt, I), 111th New York. Violet, J.,Corp'l, A, 13th Peun. Cav., age 22. Wager, J. A., Pt., C, 115th N. Y., age 19. Walby, M., Pt, D, 114th New York. Walker, A. H., Pt., K, 31st Indiana, age 24. Walker, L. M., Pt., A, 39th Mass., age 22. Walker, S., Lieut,, D, 133d Penn. Wallace., W. C, Capt., A, 01st Virginia. 'Ward, D.,Corp'l,H,13th West Va., age 19. Ward,G.W.,Tt,K,l3th North Carolina. Ward, J., Pt, C. 98th N. York, age 21. Ward, J. H., Pt., D, 27th Massachusetts. Warner. J.. Serg't, F, 28th Kentucky. Watson, J. £T.,Pt.,I, 26th North Carolina. Watts, T., Pt., F, 26th Pennsylvania. Wearer, A., Pt., G, 63d Georgia. Webster, B. L., Pt, A, 21st North Carolina. Week, I. Pt, D, 1st New York Artillery. Weir, J. A., Ft., K, 3d Virginia. Welin, P.,Pt.E, 1st Min- nesota. Weller.G. A.,Pt.,C, 54th Pennsylvania. Wells, 'E., Pt., I, 12th Iowa, age 21. Welman, W. F , Pt, I. 1st Minnesota. Weslev, D. F.. Corp'l, K, 128th New York. July 4, 4 "63. Julv 30, 31,"'64. June 3, 3, '64. April 2, 2, '65. July 12, 14, '64. July 3, 3 '63. Jan. 11, 11, '65. My30,'62 Primary. May . N. Y. Died March 31,1865. Michigan, age 20. 10, '64. 62 Boyles, B., Pt, I, 28th July 12, Left. Died July 15, 1863. 108 Finlay, J., Pt., C, 52d Dec. 13, ----. Died December 20,1862. Illinois. —, '63. New York. 13. '62. 63 Broad, L., Pt., C, 5th May 5, ----. Died May 7, 1862. 109 Finley, M. K., Lieut, F, April 8, ----. Died April 21, 1864. Michigan. 5,'62. 162d New York. 8, '64. 64 Brown, B.F.,Pt.,C,22d May 7, ----; (also w'nds leg and neck.) 110 Fish, E. A., Capt., A, Sept. 29, Left. Died October 1, 1864; ex- Massachusetts, age 23. 7, '64. Died May 17, '64; ulceration of 81st New York, age 42. 29, '64. haustion. jugular vein. Autopsy. 111 Fitzpatrick, J., Corp'l, April 8, Left.. Died April —, 1864. 65 Brown, W. M., Pt, G, May 14, Right. Died May 14,1884. F, 173d New York. 8,'64. 12th Illinois. 14. '64. 112 Flomerfield, P., Pt, F, Sept. 17, Left. Died Sept. 18, 1862. 66 Burke, T. A., Lieut., E, June 15, Right. Died Sept. 1, '64; pyaem. 69th New York. 18, '62. 16th Iowa, age 23. 15, '64. 113 Flowers, M.,Pt.,H, 101st Aug. 30, ----. Sept. 19, haBm., 40 oz.; lig. 67 Bushnell, H. S., Corp'l, I, 17th Michigan. May 12, 12, '64. Right. Died May 21, 1864. New York, age 26. 30, '62. femoral. Died Sept 24, 1862; exhaustion. 6S Cantrell, A. D., Pt., D, Dec. 31, Left, Died January 2, 1863. 114 Folk, J. S., Pt., B, 141st July 3, Left; (also wound of right hip.) 18th Infantry. 31, '62. Pennsylvania. 3, '63. Died July 27, 1863. 69 Cartwriglit, H. C, Pt, April 8, Left. Died June 8, 1864. 115 Fosket,0.,Pt,F,34thN. Dec. 13, Left. Died December 31, 1862; B, 130th Illinois. 8, '64. York, age 19. 13, '62. pyaemia. 70 Castar, S., Pt., B, 2d July 2, Right. Died July 30,'63; pyawn. 116 Foss, J., Serg't, C, 59th Sept. 17. Thigh and leg amputated. Died Wisconsin. 3, '63. New York. 17, '62. Sept. 21, 1862. 71 Chapman, B , Corp'l, A, Feb. 14, Right. Died February 19, 1865. 117 Fouts, M. N., Pt., G, 4th Oct. 23, Right Died October 25, 1864. 14th N. Y. H'vy Art. 14, '65. Missouri S. M. C. 23, '64. 72 Chasteen, At, Pt., D, Dec. 15, ----. A. Surg. R J. Hill, 45th O. 118 Freeman, A., Pt, A, May 15, Left; stump alive with maggots; 81st Indiana. 15, '64. Died December 16, 1864. i 155th Penn.. aee 31. 15, '64. . bled to death May 26, 1804. 73 Cherrington. C. H., Pt, Oct. 19, ----. Died October 20, 1864. 119 Gartland, J., Color Bear- Sept. 17, Right. Died September 25,1862. K. 36th Ohio. 19, '64. er, A, 72d Penn. 17, '62. 74 Clark, D. C. Pt., K, June 29, Right. Died July 1, 1864. 120 Gates, J., Pt., F, 8th Sept 17, Left. Died October 14,1862. 188th Penn. 29, '64. Pennsylvania. 17, '62. 75 Clarke, J., Serg't, H, Mar. 13, ----. Died April 7, 1862. 121 Gillen, N., Pt, I, 69th Sept. 17, Left. Died September 27, 1862. 27th Ohio. 13, '62. Pennsylvania. 17, '62. 76 Coleman, D. G., Pt., A. May 3, Right. Died May 26, 1863. 122 Gillespie, R. G., Pt., F, July -, ----. Died July 8, 1863. 30th North Carolina. 3, '63. Phillips' Legion. —, '63. 77 Collins, 11., Lieut., D, May 27, Left. Snrg. A. T. Hudson, 26th 123 Gleasman. C, Pt., H. Sept, 29, Left. Died Oct. 1, 1864 ; haem. 29th Missouri. 27, '64. Iowa. Died June 3, 1864. 117th New York. 29, '64. 78 Collins, R. J., Pt., F, Dec. 13, Left. Died December 30, 1862. 124 Glover, W. E., Pt, D, July —, Left. Died July 24, 1864. 108th New York. 13, '62. 118th New York. —, '64. 79 Connell, P., Corp'l, E, Jan. 2, ----. Died January 3, 1863. 125 Godbold, H. L., Lieut, Aug. 23, Left. Died Sept. 27, '62; pyaem. 35th Indiana. 3, '63. F, 1st Pa. Art, age 23. 23, '62. 80 Conteil, M. K., Pt., A, Oct. 4, ----. Died. 126 Golding, J. J., Corp'l, A, July —, ----. Died July 17, 1863. 13th Missouri. 4, '62. 3d Battalion S. C. —, '63. 81 Cook, C. S., Corp'l, I, April 13, 13, '63. Left. Died May 29, 1803; chr. 127 Goodling, G., Pt, F, 2d Sept. 17, Right. Died October 21,1862. 2oth Connecticut. diarrhoea. Delaware. 17, '62. 82 Cooper, H. M., Pt., H, April 8, ----. Died April 28, 1864. 128? Goodwell, S., Pt., G, Mar. 30, Both. Surgs. W. D. Murray, 16*1 st 29th Wisconsin. 8, '64. 129S 29th Illinois. 30, '65. N. Y., and J. W. Angell, 23d 83 Cramer, A., Pt, F, 31st June 5, Left. Surg.B.N. Bond,27th Mo. Wis. Died March 31,1865. Missouri. 5, '63. June 12, artery sloughed; nec; reamp. Surg. C. G. Strother, 130 Gordon, J. B., Lieut., C, 1st West Virginia. June 18, 18, '64. Left. Died June 19, 1864. 31st Mo. Died June 22, 1863. 131 Gould, J. M.,Pt,G, 81st Aug. 6, Left: circ. Surg.W.H.Rice,81st 84 Cramer. S., Pt, B, 142d Julyl, Left; (also amp. arm.) Died July New York, age 21. 6, '64. N.Y. Died Sept. 3, 1864. Pennsylvania. 1, '63. 9, 1863. 132 Gould, P. H., Pt., II, Oct. 4, Right. Died October 20, 1862. 85 Cronstein, M., Pt., F, 3d July 3, Right. Died July 6, 1863. 8th Wisconsin. 4, '62. Infantry. 3, '63. 133 Gregg, J. II., Capt., I, July 3, ---. Died July 3,1863; shock. 8u Cuff, IF., Pt., D, llth June 7, Right. Died June 10, 1863. I37th New York. 3, '63. Louisiana C. T. -, '63. 134 Grunbine, C, Pt. F, 93d May 5, Right. Died May 5, 1864. 87 Danforth, H., Pt, H, Julv 20, Left; reamp. Died July 31, '64. Pennsylvania. 5, '64. 123d New York. 21,"'64. 135 Guy, A., Pt., G, 51st N. Oct. 1, Right. Died October 19, 1864 88 Davis, J., Pt, F, 40th April 6, ----. Died. Carolina, age 44. 1, '64. pvaemia. Illinois. -, '62. 136 •Gwinn. F., Pt, F, 30th July 28, Left Died September 6, 1864. 89 Davis, M., Pt, E, 2d N. Julv —, ----. Died July 7, 1863. Louisiana. 28, '64. Carolina Batt. —,"'63. 137 Hair, J., Pt, K, 61st June I, Left. Died June 11, 1862. 90 Davis, T.J., Pt, D, 40th April 30, Left. Died June 9, 1864. Pennsylvania. 1, '62. Iowa. —, '64. 138 Hale, W. H., Pt., F, Mav 10, Left. Died May 12,1864. 91 Dawson, W. R , Pt., E, May 14, Left Died May 23, 1864. 152d'New York. 10,' '04. 139th Pennsylvania. 14, '64. 139 Halstead, S. F., Pt., K, Julv 3, Left. Surg. II. M. McAbee, 4th 92 Dean, W. C.,'Serg't, G, June 12, Right. Died June 15, 1864. lllth New York. 3, '63. Ohio. Died August 2, 1863. 40th Kentucky. 12, '64. 140 Hamilton, J. S., Serg't, Oct. 19, ---. Died October 20, 1864. 93 Deckett, J. M., Lieut., H, July -, ----. Died July 7, 1863. A, 5th West Virginia. 19, '64. 2d N. Carolina Battery. —, '63. 141 Harris, S., Pt, H, 90th Dec. 15, Left. Died December 16,1864. 94 Derenger, E., Corp'l, E, Aug. 30, ----; circ. A. Surg. J. A. Arm- Ohio. 15, '64. 73d Pennsylvania. 30, '62. strong, 73d Penn. Died Sept. 22, 1862. 142 Hnslette, F. A., Pt, C, 45th Pennsylvania. Mav 6, R, '64. Right. Died May 17, 1864. 95 Dessart, G., Corp'l, B, June 25, ----. Died July 18, 1862. 143 Hastings, 0.,Pt.,B, 16th July 22, Left. Surg. 11. McKennan, 17th 74th New York, age 21. 25. '62. Wisconsin. 22, '64. Wis. Died July 22,1864. 96 Devas, P., Pt., E. lllth July 2, ----. Surer. H. M. McAbee, 4th 144 Hawley, R., Pt, K, 2d Oct. 27, ---Died October 31,1864. New York. 3, '63. Ohio. Died July 12, 1863. South Carolina. 27, '64. 97 Dooley, J., Corp'l, I, June 14, ----. Died June 30, 1863. 145 Hewlett, G., Pt., H, llth May 5, Left, Died May 10, 1862. 38th Massachusetts. 14, '63. Mass., age 19. 5, '62. 98 Doty, W. F., Pt., E, Aug. 5, 5, T62. ----; (also wound of arm.) Died 146 Hoffadin, J., Pt,, F, 7th Dec. 13, Right. Died January 4, 1863; 21st Indiana. August 6, 1862. New York. 13, '62. pyaemia. 270 INJURIES OF THE LOWER EXTREMITIES. |CHAP. X. NO. 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169) 170j 171 172 173 174 175 176 177( 178 179 180 181 182 183 184 185 186 187 189 j 190 191', 192 193 194 Name. Military Description, and age Operations, Operators, Result. Name, Military Description and Age. Dates. Holmes, G., Pt., D, 6th Now Jersey. Hopson, A., Pt.,"B, 4th Vermont, Hubbell, W. W., Major, 62d New York. Hudson, A., Pt. B, 43d Wisconsin. Hughes. E., Pt, E, 6th Colored Troops. Hughes, G . Serg't, B, 105th Pennsylvania. Hughes, J.. Pt, G, 15th Massachusetts. Hunter. M., Pt, C, 21st Missouri. Irish, A. J., Pt., G, 9th Maine, age 24. James, W., Pt, I, 122d Ohio, age 29. Jasper, A. F., Pt., E, 12th Virginia. Johnson. J., Pt, A, lllth New York. Johnson, J. E., Pt., A, 153d Penn., age 22. Jones, B. M., Pt., H, 5th North Carolina. Jones, R.J., Pt., F, 18th Infantry. 'Joyne, D., —, —, 1st Louisiana. Keevitt, F., Pt, I, 68th Ohio. Kehoe, T., Pt, C, 107th Pennsylvania. Kelley, J., Pt., A, 1st Delaware. Kelso. M. C, Pt., A, 134th Pennsylvania. Kelton, I. J., Capt, 21st Massachusetts. Kennedy, J. B., Capt, D, 1st Michigan. Kenner, H, Ft, —, 4th Virginia. King, J., Pt., A, 7th In- fantry. King, P., Pt., B, 5th Vermont. Kinkle, C, Pt, I, 23d Ohio. Kline, C. A., Pt, E, 26th Ohio. Knight, B. F., Pt,I,9th Iowa. Koff, J., Pt., D, 46th Pennsylvania. Kohl, J., Pt, E, 26th Connecticut. Lalone, A., Pt. B, 27th Michigan. Lanfair, S. P., Pt., A, 37th Mass., age 40. Lawrence, G., Pt.,C, 5th Michigan. Lawrence, J. W., Pt., C, 9th Kentucky. Lewin, J., Pt., H, I42d New York, age 20. Lilly, S. W., Pt, E,6th New Jersey, age 19. Livingston, A., Pt., A, 2d Sharpshooters. Loury, M.F., Pt,A, 6th Kentucky. Lumbard,H.,Pt, D,46th Indiana. Lumpkin, J. W., Pt., H, 1st Texas. Lynch, P., Pt., D, 73d New York. Mahaffey, D. D., Pt., E, 63d Pennsylvania. Maloney, R., Pt, E, 69th New York. Mauley. N. F., Pt., D, 27th Mass., age 39. Mansir, W. H., Pt., B, 37th Mass., age 19. Manyfold, J. H., Pt., K, 97th Illinois. Martial, J., Pt., C, 8th Missouri. May 5, -, '62. Dec. 13, 13, '62. June 7, 7, '64. Nov. 5, 5, '64. Sept. 28, —, '64. July 3, 3, '63. Sept, 17, —, '62. July 14, 14,'64. May 20, 20, '64. May 6, 6, *64. May 15, 15, '64. April 2, 2, '65. July 3, 4, \Z. May —, —, '62. Dec. 31, 31, '62. —, '63.' Julv 22, 22, "'64. Sept. 17, 17, '62. Sept. 17, —, '62. Dec. 13, 13, '62. Sept 1, -, '62. Dec. 13, 13, '62. July —, —, '63. Julv 3, 3, '"63. May 3, -, '63. Sept, 19, 19, '64. Sept. 19, 19, '63. May 22, 22, '63. May 25, 25, '64. May 27, 27, '63. Mav 6, -, '64. Mav 5, 5, '64. July 3, 3, '63. Aug. —, —, '64. June 3, 3, '64. May 5, 5, '62. Sept. 17, 17. '62. July 28, 28, '64. April 8, 8, '64. Oct. 7, 7, '64. Julv 2, -, "63. June 18, 18, '64. Sept. 17, 17, '62. May 16, 16, '64. May 5, 5, '64. July 12, 12, '63. Jan. 11, 11, '63. ---. Died May 10, 1862. Left. Died December 15, 1862. Right. Died June 7, 1864. ---. Died November 5,1864. Left: (also wound right thigh.) Died Oct. 12,1864. Left. Died July 7, 1863. Left. Died September 28, 1862. ---. Died July —, 1864. Right. Died May 22, 1864 ; ex- haustion and shock. Right June 24, pyaemia. Died July 2, 1864; pyaemia. Left. Died July 24, 1864. Right. Died May 15, 1865. Right. July 22, haemorrh. Died July 22, 1863; exhaustion. ---. Erysipelas. Died June 3, 1862; pyaemia and haemorrhage. ---. Died January 10, 1863. ---. Re-amp. Died of varioli. Left. Surg. H. McKennan, 17th Wisconsin. Died. Right Died September 29,1862. ---. Died September 21,1862. Right. Died December 29,1862. ---. Dr. Miller. C. S. A. Died September 24,1862. Left. Died December 15, 1862; wounds. Both. Died July 6, 1863. Right. Died July 15, 1863. Left. Died May 12, 1663. Right; (also wound left thigh.) Died October —, 1864. Right. Died Sept. 20, 1863. Right; flap. Surg. E. J. McGoo- risk, 9th Iowa. DiedJune20,'63. Left. Surg. W. C. Bennett, U. S. V. Died July 25, 1864. Right. Died June 7,1863. Right, Died May 11, 1864. Right. May 25, 26, haem.; lig. Died May 26. 1864; exhaustion. Left. Died July 15, 1863. Right. Died August 26, 1864. Right. Died June 15,'64; haem. Right. Died June 12, 1862. Right. Died Nov. 25, 1862. Left, Died September 3, 1864. ---. Died April 16, 1864. Right. Died October 9, 1864. Left. Died July 13, 1863. ---. Died June 19, 1864. Right. Died September —, 1862. Left. Died June 3, 1864. Right. Died May 22, 1864. Right. Died July 28, 1863. ----Died January 14,1863. 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212) 213$ 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 Martin, J., Pt., I 2d Rhode Island. Maxwell, R., Lieut., H, 1st Penn. Rifles. McCright, C. M., Corp'l, C, 52d Indiana. McFall, H., Pt., H, 76th New York. McMiller,C.,Pt.C,85th Pennsylvania. McNaughton, J. B., Pt., F, 108th New York. Merrill, W. R., Pt, A, 6th New Hampshire. Merritt. II, Pt., I, 33d New York. Mertins, H., Pt, H, 17th Iowa. Miller, H., Pt, B, 147th New York. Mills. W. F., Pt., E, 8th N. Y. H. A., age 42. Mills, W., Pt., A, 130th Indiana. Montague, L., Serg't, G, 12th Ohio Cav., age 19. Moore, S., Pt., G, 51st Pennsylvania. Morrow, E. G., Capt., G, 28th North Carolina. Morton, H., Pt., H, 81st New York, age 21. Moses, J., Pt, K, 80th Indiana. Myer, C, Pt, F, 30th Missouri. Nailor, N. A., Pt., B, 4th Colored Troops. Needick, A., Serg't, B, 89th New York. Neice, T. F., Pt., K, 5th Texas. Newsum, W. O., Lieut., H, 4th Alabama. Nicholas, C, Pt, D, 98th Pennsylvania. O'Connor, M., Pt, F, 16th Infantry. Odom, J. C, Pt, G, 18th Georgia. Orr, J. A., Pt,, G, 41st Illinois. Ostar, P., Pt., I, 7th N. York. Owen,.A., Serg't, G, 1st Confed. Cavalry. Oxley, B. W., Pt., B, 24th Virginia. Palmer, G., Pt., B, 7th Michigan. Peebles, H. T., Capt., C, 32d Iowa. Perry, D., —, —, 7th Michigan, Petrey, J., Corp'l, K, 8th Vermont. Phillips, J., Pt., H, 21st Illinois. Pierce, J., Serg't, E, 43d Ohio. Pierce, F. M., Pt., A, lllth Pennsylvania. Pleasure, O., Pt., F, 12th Wisconsin. Pool, IJ. J., Pt., E, 18th South Carolina. Porter, J. A., Serg't, K, 74th Indiana. Prentice, H., Pt., B, 21st New Jersey. Price, J. TJ., Serg't, A, 14th Indiana. Prouty, L., Pt., D, 105th Ohio. Pugh.W. C,Pt,D,37th Mississippi. Rainer, S., Pt, F, 61st Georgia. Randolph, R., Pt., B, 16th Georgia. May 14, 14, '64. May 8, 8. '64. April 9, 9, '65. Dec. 13, 13, '62. Aug. 16, 16, '64. Dec. 13, 13, '62. Dec. 13, 13, '62. May 3, 3, '63. Nov. 25, 25, '63. July 2, 4, '63. June 16, 16, '64. Mar. 9, 9, '65. Oct. 2, -, '64. Mav 12, 12," '64. July —, —, '63. May 17, 17, '64. Oct. 8, 8, '62. June 4, 4, '63. June —, —, '64. Sept, 17, —, '62. July —, — '63. May —, —, '64. May 3, 3, '63. Sept. 19, —, '63. July —, —, '63. July 12, —, '63. Dec. 13, 13, '62. Aug. —, —, '64. Mav —, —,"'62. Sept. 17, 19, '62. April 9, 9, '64. May —, —, '64. Oct. 19, 19, '64. Dec. 31, 31, '62. Mar. 13, 13, '62. Sept. 17, 17, '62. Sept. 3, 3, '64. Oct. —, —, '62. Sept. 1, 1, '64. May 3, —, '63. Oct, 3, 3, '61. Oct. 8, —, '62. Oct. 8, 8, '62. July -, —, '63. July —, —, '63. Operations, Operators, Result. ---. Died May 15, 1864. Left. Surg. J. J. Comfort, 1 st Pa. Rifles. Died Mav 12, 1864. ----. Died April 10, 1865. ---. Died December 13, 1862. Left; sloughing; haem. Aug.28, re-amp. up. third. A. Surg.C. Wagner, U. S. A. Died Sept. 4, 1864; haemorrhage. Right. Died December 26,1862. ----. Died December 20, 1862. Left. Died May 29, 1863. Right. Surg. E. J. Buck, 18th Wis. Died Nov. 27, 1863. Right Died August 3, 1863. Right; (also int. amp. left thigh.) Surg. S. H. Plumb, 82d N. Y. Died June 23, 1864. Left. Surg. V. H. Gregg, 124th Indiana. Died March 9, 1865. Right. Died December 1,1864. Left Surg. J. S. Ross, llth N. H. Died May 18, 1864. ----. Died July 27,1863. Right; (also wound of cranium.) Died May 26,1864. Right. Died October 14, 1862. Both. Surg. M. W. Robbins, 4th Iowa. Died June 5, 1863. Left. Surg.W.S. Treinaine, 31st Col'd Troops. Died July 8,'64. ----. Died September 27,1862. ---. Died July 10, 1863. Left. Died May 20, 1864. Left Died May 12,1863. Left. Died September 25,1863. ----. Died July 12,1863. ----. Died July 15.1863. Left. Died December 30, 1862. Right. Died August 24,1864. Right. Died May 31, 1862. ----. Died September 25,1862. ----. Died April 25, 1864. Right. Died May 14,1864. ----. Died October 20,1864. ■----. Died January 10,1863. ----. Died March 21, 1862. ----. Died September —, 1862. Right. Surg. E. M. Rogers, 12th Wis. Died Sept. 29,1864. ----. Died October 16,1862. Right Died September 14,1864. Right. Died May 27, 1863. Left Died October 4,1861. ----. Died October 12, 1862. ---. Died October 19, 1862. ----. Died July 30,1863. ----. Died July 6,1863. i FORMEXTO (F.J, jr., Notes and Observations on Army Surgery, 1863, p. 17. sect, it] PRIMARY AMPUTATIONS OF THE THIGH. 271 ,T ! Name, Military , Description, and Age. * Dates. Sept 111, Operations, Operators, No. Name, Military Dates. Operations, Operators, Result. Description, and Age. Result. 241 Ravburn, L. C., Lieut, --- Died September 20, 1864. 289 Trone A , PL, H, 3d * Jan. 7, Left. Died January 18,1864. B", 13th West Virginia. 19. '64. Penn. Cavalry. -, '64. 242 Redman. T. ('., Lieut, July—, Left Died August 2,1863. 290 Tucker, R., Pt., D, 14th Oct. 1, Left; haemorrh. recurred. Died C. 4th Virginia. —,"'63. Tennessee, ago 34. 1, '64 November 4, 1864. 243 Reed, L. P.. Pt. H, 36th May ti, Right Died May 12. 1864. 291 Turants, L., Pt, C, 76th July 3, Left. Died July 22, 1863. Massachusetts. 6, 'lit New York. 5, '63. 244 Reifsnyder, W., Pt., B, Julv —, Right. Died July 30, 1864. 292 Turner, J K., Pt., H, Oct. 8, Right. Died October 11, 1862. 55th Pennsylvania. —,"'64. 33d Alabama. -, '62. 245 Renningcr, A , Pt, F, Dee. 13, ----. Died January 29, 1863. 293 Turway, J., Pt., F, 6th May 6, Left Died June 4. 1864. 131st Pennsylvania. 13, '62. Maryland, age 24. 6, '64. 246 Reynolds, E., Capt., D, Dee. 13, Left Died December 24,1862. 294 Unknown. July 3, 3, r63. Left. Died July 3, 1863. 5i'th New York. 13, '6X. 247 Roberts, H., l't., H, Sth Sept. 19, ----. Surg. J. G. F. Holston, U. 295 Uttlcy, W., Serg't, B, Sept. 17, Right Died September 30,1862. Iowa. 1!>, '62. S. V. Died Sept. 23,1862. 59th N. Y., age 29. 19, '62. 248 Roberts, W. (1., Pt, B, April 9, ----. Died April 14, 1865. 296 Vanalstein, A., Corp'l, A, Dec. 13, ----. Died December 14, 1862. ]2-'d Illinois. ii, '65. 105th New York. 13, '62. 249 Robinson, S. R., Pt, I, Feb. 15, Left. Died March 18,1862. 21)7 Van Outerstorp. J..Corp., June 18, -—. Died June 23, 1864. llth Illinois. —, '62. F, 4th N. Y. H. A. 18, '64. 250 Rowe, J. L., Serg't, E, May 27, ----. Died June 6,1862. 298 Voellinger, J., Lieut, A, Sept. 19, Right. Died October 18, 1863. 2d Maine. —,"'62. 27th Illinois. 19, '63. 251 Ruby, 1. W., Pt., C, 66th June 9, Right. Surg.J. H.Grove.U.S.V. 299 Walker, J., Pt, G, 35th Sept 19, ----. Died October 10, 1863. Indiana. 9, '64. Died June 14,1864. Illinois. 19, '63. 252 Rude.r,N.,Capt., H, 16th Sept. 14, ----. Sept. 26, haem. Died Sept. 300 Walters, D. N., Pt, C, May 15, Right. Died June 3, 1864. Georgia. 15, '62. 27, 1862; exhaustion. 42d Indiana. 15, '64. 253 Ryan, J., Pt, D, 5th Sept, 19, ----. Died September 24,1863. 301 Ward, C. IF., Pt, H, Oct. 7, Right. Died October 9, 1864. Kentucky. —, '63. 6th South Carolina. 7, '64. 254 Scott, L. S., Lieut., B, July 1, 2, r63. Right; (also wound of left thigh.) 302 Ward, R. F., Serg't, B, May 16, ----. Died May 19, 1864. l'.'th Maine. Surg. G. Chaddock, 7th Mich. 39th Iowa. 16, '64. " Died July 13, 1863. 303 Watson, C., —, —, 1st Sept. 17, ---; (also wound of arm.) Died 255 Scott, C. I'., Pt, F. An- July 4, Left. Died July 6, 1863. Texas. —, '62. September —, 1862. thony's Regiment. 4, '63. 304 Watson, H., Pt., B, 4th Sept. 29, Right. Died November 9, 1864. 256 Sears." W. A., Pt., H, June 18, Right. Died June 20, 1864. Colored Troops, age 23. 30, '64. 34th Mass., age 33. 18,'64. 305 Webb, A. H., Serg't, E, July 28, Right. Died August 4, 1864. 257 Sitae, J., Pt, I, 15th July —, ----. Died August 12,1863. 7th Mississippi. 28, '64. Louisiana. —, '63. 306 Weber, W., Pt, B, 73d May 5, ----. Died May 13, 1862. 258 Shellhart,C.,Pt,G,68th Julv 28, Left. Surg. E. M. Rogers, 12th New York. -, '62. Ohio. 28, '64. Wis. Died July 30, 1864. 307 Weir, J., Corp'l, K, 73d Sept. 19, Right. Died October 8,1863. 259 Shurman, J. E., Pt., C. Mav 5, ----. Died May 5,1864. Illinois. 19, '63. lllth New York. 5, '64. 308 Welch, J. W., Pt., B, Sept. 19, Right. Died October 14, 1863. 260 Sink, A. J., Pt.. A, 33d Julv 20, Left. Died July 21,1864. 125th Ohio. 19, '63. Indiana. 20,''64. 309 Wells, G. E., Pt., B, 35th Left. Died December 29, 1862. 2fil Smith, H, Pt., F, 8th June 26, Right. Died July 21, 1862. Georgia. Alabama. —, '62. 310 Westcott, 0.,Pt,C, 121st May 3, Right. Died May 14, 1663. 262 Smith, I., Pt., C, 15th May 27, Left. Died May 27,1863. New York. -, '63. New Hampshire. 27, '63. 311 Weston, J., —, B, 2d June 27, ---. Died July 24, 1862. 263 Smith, J., Pt., C, 44th Dec. 31, ----. Died. Infantry. White, W. A., Pt, C, 37, '62. Indiana. 31, '62. 312 Oct. 4, ----. Died Nov. 19, 1862. 264 Smith, L., Pt., B, 118th Sept, 17, ----. Died September 17, 1862. 43d Ohio. 4, '62. Pennsylvania. 17, '62. 313 Whitman, G.W.,Pt.,K, May 31, ----. Surg. A. N. Dougherty, 265 Sorrells, \V., Pt., H, Nov. 7, ----. Died November 14, 1861. 7th Michigan. 31/62. ir. S. V. Died June 1,1862. 27th Illinois. 7. '61. 314 Williams, F. K., Serg't, June 26, Right. Died July 8, 1862. 2S6 Spencer. S. E., Pt, G, May 8, Left. Surg. J. R. Bailey, 8th Mo. A, 8th Alabama. 26, '62. bth Missouri. 9, '62. Died Mav 24, 1862. 315 Wilson, J., Pt, 21st N. Mar. 27, Left; (also amp. arm.) Surg.C. 207 Spoth, A., Pt., F, 7th Sept. 17, Left. Died February 16,1863. York Battery. 27, '65. Winne,77thlll. DiedMar.27,'65. Michigan. 17, '62. 316 Wilson, J. F." Capt, G, Mar. 25, ----. Surg. J. W. Wishart, 140th 268 Springer, J., Pt., G, 53d July —, Right. Died July 31, 1863. 140th Pennsylvania. 25, '65. Penn. Died April 14, 1865. Illinois. —, '63. 317 Witty, T.T., Pt, E, 29th July 4, 4, f63. Right; haemorrh.; pyaemia. Died 269 Stafford, I., Pt, H, 43d Dec. 13, Right Died December 26,1862; Iowa, nge 28. September 7, 1863. New York. 13, '62. gangrene. 318 Wood, P., Lieut, F, 27th May 9, 9, '64. Left Died May 13, 1864; ex- 270 Stamm.W., Pt., G, 151st July 1, Right. Died August 1, 1863. Mass., age 29. haustion. Pennsylvania. 1, '63. 319 Wooden, J. IF, Sersf't, May 5, Left. Died. 271 Steele, G. H., Serg't, K, Oct. 9, Right Died November 12,1864. D, 27th N. Carolina. 5, '64. 1st New Hamp. Cav. 9, '64. 320 Wooll, G., Pt., A, 26th Dec. 13, Left. Died January 23, 1863. 272 Stephens, E., Pt.,B, 14th July 3, 5, f&i. Left. Died July 6, 1863. New York. 13, '62. Infantry. 321 Wright, R., Pt., E, 93d Nov. 24, Left. Died November 24, 1863. 273 Stevens, R., Pt, A, llth Nov. 27, Right Died December 8,1863. Ohio. 24, '63. New Jersey. 27, '63. 322 Yates, W. H., Pt., B, Sept. 17, ----. Died September 28, 1862. 274 Stine, J., Pt, B, 14th July —, ----. Died July 30, 1863. 5th New Hampshire. 17, '62. Louisiana. —,"'63. 323 Young, E. C, Pt., H, Mav 0, Right. Died May —, 1864. 275 Stowe.J. P.,Pt,G, 15th Sept. 17, Right. Died October 1, 1862. 36th Massachusetts. -, '64. Massachusetts. 17, '62. 324 Zoller, J., Serg't, F, 16th Oct. 7, Left. Died October 23, 1864. 276 Strayhome, T. A., Pt., Dec. 31, ----. Died January 25, 1863. New York H. Art'y. -, '64. E, 21st Minois. 31, '62. 325 Brey, W. H., Lieut, E, July 3, 277 Sullender, H. G., Pt, B, May 2, ----. Died May 13, 1863. 53d Virginia. -, "63. 143d Pennsylvania. -, '63. 326 Case, A., Pt., C, 8th N. June 3, Right. Surg. J. L. Brenton, 8th 278 Summers, J. G., Pt, B, Dec. 13, Left. Died December 29, 1862. York H'vy Art'v- -, '64. Ohio. Not a pensioner. 13th Mississippi. 13, '62. 327 Diggin, D., Pt., A, 12th June 2, Right. 279 Swart, A. W., Corp'l, I, July 3, 3, r63. Right. Died July 25, 1863. Georgia. 3, '64. 20th X. Y. S. M. 328 Elrod, W. B., Pt., G, July —, 280 Swinnford, R. M., Pt., May 22, Right; flap. Surg. M. W. Rob- 16th Georgia. —, '63. B, 25th Iowa. 22, '63. bins, 4th Iowa. Died July 5,'63. 329 Foran, J., Serg't, C, 63d Mav 8, ---. Surg. P. E. Hubon, 28th 281 Taft, E., Pt, E, 42d N. Sept. 17, Right, Died October 7, 1862. New York. 8, '64. Mass. Not a pensioner. York. 17, '62. 330 Gaskin, H, —, 18th N. May 27, 282 Terrell, J., Corp'l, K, June 2, Left. Died June 17, 1864. Carolina. —, '62. 55th Penn., age 22. 2, '64. 331 Glendy, R. J., Lieut., C, July —, 283 Thorn, T. J., Lieut., D, July 3, Right; (also amp. arm.) Died 4th Virginia. —, '63. 16tb N. C, age 30. 4, '63. July 30, 1863; pyaemia. 332 Hagler, C, Pt., F, 7th Dec. 13, Right. 284 Tibbetts, E. G., Pt., H, May 27, Right. Died July 14,1863. North Carolina. —, '62. 12th Maine. 27, '63. 333 Hambrich, J., Pt., A, July —, 2851 286/ Tieman.H., Pt,C, 119th June 21, Both. Surg. G. P. Oliver, lllth 24th Georgia. —, '63. New York. 21, '64. Penn., and J. V. Kendall, 149th 334 Jones, G. W., Pt, A, 43d June 2, Left. N.Y. Died June—, 1864. North Carolina. 3, '64. 287 Tiltou, G. A., Pt., C, May 12, ----. Surg.W. C. Shurlock, 51st 335 Kirkland, W. L., Pt,K, May 28, ---. Surg. — Taylor, C. S. A. llth New Hampshire. 12, '64. Penn. Died May 29,1864. 4th South Carolina. 28,'64. 288 Trimble, A., Corp'l, E, Oct 8, ----. Died October 11, 1862. 336 Kroupe, T., Pt., St. M. April 23, 10th Wisconsin. -, '62. . 23d C. S. A. —,'62. 272 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. Name, Military Operations, Operators, No Name, Military Dates. Operations, Operators, Description, and Age. Result. Description, and Age. RE6ULT. 337 McCauley.T., Pt., G, 2d July 14, Right. Not a pensioner. 342 Orender, L., Pt., I, 2d Julv —, Illinois Lt. Art'y. —, '64. South Carolina. —, '63. 338 McGchce, W. B., Pt, C, July 3, 343 Overton, H. T., PL, A, Nov. 25, Right. 17th Mississippi. -, '63. 17th Alabama. 25, '63. 339 Meadows, H. M'., Pt., A, July 28, Left. 344 Williams, J., Serg't, D, May 31, Left on field. Not a pensioner. 34th Alabama. 28, '64. 2d Ohio Cavalry. —, '64. 340 Morris, J. T.,Pt., B, 34th Aug. 31, Left. Surg. A. C. Messenger, 345 Wina, E., Pt., F, Sth Sept. 29, Left; not doing well. Not a pen- Alabama. 31, '64. 57th Ohio. Colored Troops, age 30. —,'64. sioner. 341 O'Kcefe, P., Serg't, C. 30th Louisiana. July 28, 28, '64. Right. In three hundred and forty-one of the cases enumerated in this table the seat of frac- ture was in the femur; in two, in the knee joint; and in two, in the leg. In four fatal instances both thighs were primarily amputated; and in one, primary amputation of the thigh was performed on the right, and intermediary amputation in the lower third on the left limb.1 In three cases, an arm, and in one, a leg were simultaneously removed.2 INTERMEDIARY AMPUTATIONS IN THE SHAFT OF THE FEMUR FOR SHOT INJURY.—This category comprises thirteen hundred and twenty cases. Four hundred and seventy-nine proved successful and eight hundred and forty-one were fatal. Intermediary Amputations in the Upper Third of the Femur.—There were one hun- dred and forty-seven intermediary amputations in the upper third of the femur, with fifty recoveries and ninety-seven deaths. The right limb was implicated in seventy-seven cases, the left in fifty-four, and in sixteen this point was not recorded. The modes of operation are reported as: circular, forty-six; flap, thirty-nine; not stated, sixty-two. Successful Cases of Intermediary Amputations in the Upper Third of the Femur.— The fifty operations of this group were performed on forty Union and ten Confederate soldiers. Thirty-five of the thirty-eight pensioned Union" soldiers were living in 1879. The injuries were caused by shell in five, by grapeshot in one, by solid shot in one, and by small missiles in forty-three instances. In the following case the patient, an employe* of the Pension Office, was in excellent health in October, 1879: Case 453.—Private Lorenzo E. Dickey, Co. A, 4th Maine, aged 21 years, received a gunshot wound of the right thigh, at Chantilly, September 1,1862. He was taken to a field hospital in the vicinity of the battle ground, where the limb was amputated at the upper third, on the fourth day after the reception of the injury. On September 8th, the patient arrived at Washington and was admitted to Douglas Hospital. A haemorrhage from the femoral artery, to the amount of twenty ounces, occurred on October 16th, and was controlled by pressure. After this the case progressed favorably and the wound healed about January 1, 1863. About two months later the patient was transferred to Lincoln Hospital, and sub- sequently he was sent to St. Elizabeth Hospital, whence he was discharged June 16, 1863, and pensioned. Mr. Dickey was subsequently appointed a clerk at the Pension Office. On January 14, 1873, he visited the Army Medical Museum, being in as good general health as he had been previous to the time of receiving the injury, and suffering no pain from the stump. He stated that his weight then was 192 pounds, while before he was wounded and lost his leg he only weighed 170 pounds. Owing to the shortness of the stump, being only three inches long from the hip joint, he is unable to wear an artificial limb and is obliged to use crutches in walking. A copy of the photograph, taken in 1873, is represented in the wood-cut (Fig. 188). His pension was paid September 4, 1879. Fig. 188.—Appearance of stump eleven years after amputation. [From a photograph.] 1 Cases of Pt. S. Goodwell, G, 29th Illinois (No. 128, p. 269), fatal; Pt. H. Kenner, 4th Virginia (No. 169, p. 270), fatal; Pt. C. Myer, F, 30th Mis- souri (No. 212, p. 270), fatal; Pt. H. Tieinan, C, 119th New York (No. 285, p. 271), fatal. In the case of Pt. W. F. Mills, E, 8th New York H. A. (No. 205, p. 270), primary amputation in the right thigh, and subsequently intermediary amputation in the left thigh was performed. 1 An arm was simultaneously removed in the cases of Pt. S. Cramer, », 142d Pennsylvania (No. 84, p. 269, and Second Surg. Vol., Table LXXV, No. 39, p. 751); Lieut. T. J. Tliorn, D, 16th North Carolina (No. 283, p. €71, and Second Surg. Vol., Table LXXV, No. 153, p. 752); and Pt. J. Wilson, 21st New York Battery (No. 315, p. 271, and Second Surg. Vol., TABLE LXXV, No. 167, p. 752). In the case of Serg't J. Foss, C, 59th New York (No. 116, p. 269), the opposite leg was amputated. SECT. UL] INTERMEDIARY AMPUTATIONS OF THE THIGH. 273 The femur was fractured in its upper third in four of the fifty examples of this group, necessitating amputation close to the trochanters: Case 454.—Captain John C. Hilton, Co. K, 145th Pennsylvania, aged 22 years, was wounded at Gettysburg, July 2, 1863, by a conoidal ball, which fractured the right femur in its upper third. He was carried to the field hospital of the 1st division of the Second Corps, where Surgeon C. S. Wood, 66th New York, reports: "The bone was extensively comminuted. I amputated the thigh about one inch below the trochanter major. The operatiou was not performed until eleven days after the receipt of the injury, yet the patient at this date, August 2d, is rapidly improving." The patient entered Camp Letterman hospital August 5th, where Acting Assistant Surgeon B. F. Butcher notes: "He is doing very well; the treatment consists of stimulants and nourishing diet, with water dressings to the stump. August 20th, still improving, all ligatures were removed, the stump healing rapidly. On the 25th, the stump had entirely healed, and on September 1st, he left the hospital on leave of absence." This officer was discharged December 19, 1863, entered the Veteran Reserve Corps February 5, 1864, was mustered out of service June 30, 1866, and pensioned. His pension was paid June 4, 1879. Case 455.—Private Alvin Hubbard, Battery M, 5th Artillery, aged 20 years, was wounded at Spottsylvania Court House, May 12, 1864, by a solid shot or a large fragment of shell, which struck both knees, fracturing the patella and opening the joint of the right knee, and inflicting a large flesh wound on the inner side of the left knee. He was taken to the field hos- pital of the Artillery Brigade, Sixth Corps, and on the 14th sent to Fredericksburg. On May 24th, he was admitted into the Third Division Hospital, Alexandria, from which Surgeon E. Bentley, U. S. V., reports: "The right leg and knee were badly swollen, painful aud oedematous, and the soft parts ecchymosed; there was an unhealthy discharge from the wound; the left knee was black and swollen, but the joint was not seriously injured. His constitutional condition was much disturbed, pulse quick aud frequent, appetite poor. Oil the '25th, it was decided to amputate, and, after placing the patient under the influence of chloroform, Surgeon Bentley removed the right thigh just below the trochanter by the circular operation; free incisions were made in the integuments of the left knee. He rallied well from the operation, and the after treatment consisted of stimulants, opiates, and nourishing diet. On October 7th, he was transferred to the First Division Hospital, Alexandria; on February 25, 1865, to the hospital at Fairfax Seminary; and finally discharged at the Judiciary Square Hospital, Washington, May 19, 1865." Examining Surgeon E. H. Wood, of Hersey, Michigan, September 5, 1877, reports: " The stump of the amputated limb is sound. The wound on left knee healed, leaving a large scar, and the patella so dislocated upward that this leg can be only semi- flexed." His pension was paid June 4, 1879. In the next case the patient died, nearly nine years after the operation, of tubercular disease of the lungs complicated with necrosis of the stump of several years standing: Case 456.—Private J. Frederick, Co. D, 15th Massachusetts, aged 35 years, was wounded and captured at Bristoe station, October 14, 1863. After remaining a prisoner for a month he was paroled and brought to Annapolis, where he entered the First Division Hospital on November 18th. Assistant Surgeon W. S. Ely, U. S. V., contributed the pathological specimen (FlG. 189), with the following description of the injury: "A fragment of a shell entered the left thigh in its middle third pos- teriorly, and passing directly forward, produced an extensive comminution of the femur and great destruction of muscular tissue. He laid upon the battle field without medical attendance until the afternoon of the following day, when he was conveyed by the enemy to Gordonsville, where he suffered amputation of the injured limb at the junc- tion of the upper and middle third, by the circular method, on October 26th. When admitted here, this soldier gave evidence of having endured a full share of the exposure and neglect to which our captured men, as a general rule, were subjected. His system was found to be excessively reduced: his pulse rapid and feeble; anorexia exist- ing, and an exhausting diarrhoea complained of. At the seat of the operation the parts gave evidence of unhealthy reparation, the wound was open, the skin retracted, and the sawn extremity of the femur protruding beyond the tissues to the extent of one and a half inches. It was thought advisable to leave to nature the removal of the pro- truding bone, and therefore no operative interference was determined upon. The patient's body was thoroughly cleansed, and an equable temperature maintained in his room, the stump washed twice with alcohol, and lint moist- ened with diluted alcohol kept applied. Generous diet was enjoined, and six ounces of spiritus fermenti was given daily. For the diarrhoea a prescription was ordered consisting of one grain of sulphate of morphia, ten grains of quinine, one and a half drachms of diluted sulphuric acid, and one ounce of water, to be given in doses of a tea- piQ lg9 _ spoonful three times a day. By December 1st, the patient was slowly improving, the diarrhoea being no longer Tubular se- troublesome, and his appetite good, though his pulse still continued rapid. The stump under the action of the nearlyo ins. alcohol applied locally, combined with the constitutional measures employed, now presented a granulating surface, removedsix and the granulations were slowly extending towards the extremity of the bone, one inch of which was still exposed, amputation. His treatment was yet continued with the exception of the prescription for the diarrhoea, for which a mixture of Spec- 2232, twenty grains of quinine, one and a half drachms of muriated tincture of iron, and ten drachms of simple syrup was substi- tuted, to be given in teaspoonfuls one hour before meals. On January 6th, the applications of alcohol to the stump were discon- tinued ; the patient still doing well and no marked change having occurred. January 29th, by seizing the protruding extremity of the femur between the fingers it became perceptible that a slight movement of rotation could be made. February 4th, necrosis going on certain but slow; considerable movement now attainable, causing great pain to the patient; muscles of affected limb apparently becoming hypertrophied; general health of patient continuing good. February 26th, protruding bone a little more mobile; discharge increasing in amount and becoming offensive. It was not yet deemed advisable to interfere with the natural process going on, a portion of the fragment not being sufficiently separated and liable to break off if extraction was attempted, thus retarding the subsequent reparative process. On April 1st, interference was deemed proper, the fragment appearing to be very free. Sensibility being too great to operate without the use of anaesthetics, chloroform was administered, the extremity Suhg. HI—35 274 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. Beized with a large forceps by Surgeon B. A. Vanderkieft, U. S. V., and by a combined motion of traction and rotation the sep- arated portion, measuring five inches in length, was removed entire. The patient recovered rapidly from the anaesthetic and felt great relief. He progressed finely and the stump closed rapidly, and the result of waiting upon nature in this case proved very satisfactory, though it would be interesting to know whether a second operation performed at the time of the patient's admission would have prevented necrosis to the depth at which it was found to exist." The patient was discharged from service May 24, 1864, and supplied with an artificial limb by B. F. Palmer, of Philadelphia, five months afterwards. He died March 13, 1872, Dr. J. Hyndman, of Boston, certifying that his death was caused by "tubercular disease of the lungs, complicated with necrosis of the bone of the amputated limb" of several years' standing, etc. Fatal Cases of Intermediary Amputation in the Upper Third of the Thigh.—The ninety-seven operations of this category were performed on eighty-one Union and sixteen Confederate soldiers. A case, in which the amputation had been preceded by primary excision in the upper third of the femur, has been detailed on page 205, ante (Case 418, Corporal J. W. Soule, D, 6th Michigan Cavajry); a second case will here be cited: Case 457.—Private J. Kelly, Co. F, 1st New York Cavalry, aged 21 years, was wounded near Hagerstown, July 7, 1863, and admitted to hospital at Frederick on the following day. Acting Assistant Surgeon J. H. Bartholf contributed the specimen (No. 3875, Surgical Section, A. M. M.), with the following history: "While acting as a scout the man had his left thigh fractured by a cavalry pistol conoidal shot, at a point a little above the junction of the middle and lower thirds. The ball, much battered, was removed from under the skin on the inner side of the limb, three inches above the edge of the condyle. When admitted into hospital, Smith's anterior splints were applied and continued till July 16th, when Buck's extension apparatus was substituted, with sand bags to the side of the limb. Much foetid pus was found to be confined in the limb, which was let out by enlarging the opening. The patient having all the signs of pneumonia of the left lung, an oiled silk jacket was applied around the thorax. July 18th, patient more comfortable with the change of appliance to the limb; six ounces of milk punch given daily, and nourishing diet. 19th, rusty colored sputa continuing, with but little cough; double friction sound over heart; heart's action somewhat turbulent. 21st, pulse 120; brown, moist fur on tongue; feeling of great oppression in chest, but friction sound over heart nearly gone; some diarrhoea; suppuration from limb very free and somewhat offensive. Applied oakum dressings and gave pills of camphor and opium. 22d, pulse smaller; cough increasing; pain and tenderness to pressure of limb now extending up to groin and becoming more acute from pus burrowing up among the muscles; diarrhoea continuing at intervals. Increased the milk punch to one pint per day. 23d, patient very feeble and in a very critical state; thoracic symptoms dimin- ishing. 27th, all chest symptoms gone; thigh in bad condition; pus burrowed among the muscles in front nearly to groin; has two troublesome bedsores. 29th, sleeps tolerably well now; vomited once after tea, but has no chills. 31st, pulse still 120; erysipelatous inflammation about the wound. The best of diet and half a pint of milk punch is given daily. August 5th, the patient's general condition, strength, and appetite has somewhat improved during the last few days. The diarrhoea continues, however, the bedsores are very troublesome, and the fractured bone is a good deal necrosed, and abscesses are extensive in the thigh. 6th, amputation was performed by Assistant Surgeon R. F. Weir, U. S. A., at 4 P. M., as low down as the wound would permit; method: Flaps of skin and circular of muscles. Two and a half inches of the upper fragment of the bone were removed, when, the medullary canal and periosteum being still found dead, one and a half inches more of the shaft were taken off, thus getting a line or two above the necrosis. Four fragments were found, all being more or less attached by periosteum or muscle, but all partially denuded of periosteum and necrosed. One large lower fragment embraced the greater part of the lower third of the femur and was considerably denuded and necrosing, showing scarcely any effort at repair. A sinus on the outer and front aspect of the thigh, found at the amputation to reach nearly up to Poupart's ligament, had a counter opening then made in its upper extremity. Reaction did not take place, in spite of all efforts, until 11 P. M., and not decidedly then, vomiting occurring at intervals and some delirium. Patient was placed on a water-bed at 11 P. M. 7th, pulse 150 and a mere thread; condition very precarious indeed. At 9 A. M., patient rallied somewhat, then fell asleep and slept the greater part of the day. Adminis- tered beef tea and milk punch alternately throughout the day. 8th, pulse 116 and much fuller; flaps sloughy and foetid. Applied the strong nitric acid, and after that injected a mixture of hydrochloric acid, one ounce; laudanum, two ounces; and water, fourteen ounces, between the flaps and into the sinus, after which oakum dressing, wet with the same wash, was applied. All the sutures were removed but one, and extension was applied to flaps, to prevent retraction, by adhesive strips, string, pully, and weight. Patient has considerable diarrhoea, and takes camphor and opium pills; is also ordered ten grains of tartrate of iron and potassa three times a day. 9th, pulse 136; suppuration from stump healthy and not foetid; diarrhoea ceased during night but recurred this morning. Patient has aphthae on the tongue and lips; has some little relish for food. Opium is con- tinued, and tincture "of chloride of iron is substituted for the tartrate of iron and potassa. 10th, pulse 120; diarrhoea a little better; ordered Hope's mixture for it, also ten grains of chlorate of potassa four times a day for stomatitis. Stump not sloughy; good flaps. Patient has some little appetite and is ordered good food, with one pint of milk punch daily, llth, stump in good condition; diarrhoea worse. Gave one grain of opium every two hours and continued other medicine. 12th, stomatitis and diarrhoea ceased. 13th, stomatitis and diarrhoea returned. Patient losing strength and wasting in flesh ; pulse 126; pus from stump healthy. 14th, pulse 128; had nausea last evening and vomiting this morning; no chill; diarrhoea slight; granulations weak and pale. Discontinued the tincture of iron, and prescribed extract of nux vomica, four grains, and pulverized iron, twenty grains, to be made into sixteen pills, and administered one three times a clay. 15th, pulse 130; some nausea; stomatitis very bad; diarrhoea troublesome; bedsores painful. Treatment continued and brandy mixture ordered. 17th, subsultus ten- dinum. 18th, patient died. Sectio cadaveris seventeen hours after death: Body much emaciated. On examining the stump found sinuses up the thigh in various directions, and just behind the trochanter major a circumscribed abscess containing about an ounce of pus ; another similar one near the trochanter minor; hip joint intact; tissues of stump very unhealthy, and wound of stump pale and flabby and presenting scarcely any granulations. On opening the chest found the right lung healthy and SECT. III.l INTERMEDIARY AMPUTATIONS OF THE THIGH. 275 weighing twelve ounces; left lung, upper lobe healthy; lower lobe in a state of red hepitization through nearly its entire extent, and permeable to air here and there; weight one pound and two ounces. Pleura healthy. The heart was contracted and firm, clots in both sides of it, especially in the left; valves healthy; no evidence of endocarditis; recent pericarditis well marked; pericardium throughout adherent by new false membrane becoming organized, susceptible of being torn off by little force; weight of heart ten ounces. Liver moderately contracted, with cirrhosis and a little hobnailed; weight three pounds and two ounces." Table XXXIV. Summary of One Hundred and Forty-seven Cases of Intermediary Amputations in the Upper Third of the Femur for Shot Injury. [Recoveries, 1—50; Deaths, 51—147.j Name, Military Description, and Age. lAnderson, S., Pt., B, 20th Alabama. Beckart, A., Pt., A, 74th New York, age 22. Bray, J. A., Pt., K, 3d Virginia. Briscoe, L. N., Pt., K, 7th South Carolina. Cain, J., Corp'l, I, 104th New York. Calder, J., Lieut., G, 2d Kentucky Cav., age 28. Cunningham, E.H., Sgt, E, 9th Louisiana. Dalton. T.W.,Pt.,G,82d New York, age 18. Darlington, W. B., Maj., 18th Penn.Cav., age 35. Dickey, L.E.,Pt., A, 4th Maine, age 25. Dunlap, J. H., Pt., P, 3d N. Y. Artillery. *Dwyer, L., Pt., F, 14th Louisiana. Eagan, L. W., Pt., —, 22d New York. Frederick, J.,Pt.,D,15th Massachusetts, age 35. Hamlin, W. H., Corp'l, L, 7th Missouri Cav. Hervey, R., Pt., C, 82d Pennsylvania. Hilton, J. C, Capt., K, 145th Penn., age 22. Hobbs.L. H., Pt., H, 27th Georgia, age 33. Hubbard A., Pt., Bat'ry M, 5thU.S.Art.,age20. Hugot, J., Pt., H, 5th N. Jersev, age 30. Iffla, A. G., Pt., C, 83d New York. James, T., Pt, E, 147th New York, age 37. Jennings, T., Pt.,—,24th New York. Kane, J., Serg't, D, 2d Michigan, age 23. Keenan, J., Pt., B, 36th Illinois, age 34. King, E. S., Pt., E, 23d Colored Troops. Kirn, P., Pt., A, 69th In- diana. Kniffens, C, Serg't, D, 30th New York S. M., age 39. Kreger, J., Pt., C, 142d Pennsylvania. Linehan, T., Pt., D, 37th New York, age 19. Manghermar. J. G., Pt., K, 87th Indiana. Masterson, J., Pt., B, 106th Penn. Miller, J. H., Pt., E, 33d Iowa. Neal, W. H., Pt., H, 9th Illinois, age 20. Sept. 19, 22, '63. Aug. 29, Sep.8.'62. June 27, 30, '62. July 21, 29, '61. July 1, 5, '63. Sept. 20, 27, '63. Aug. 9, 14, '62. Dec. 13, 16, '62. May 5, 9, '64. Sept. 1, 5, '62. De.14,'62, Ja.11,'63. June 30, J'y 8, '62, Aug. 30, Sep.3,'62. Oct. 14, 26, '63. Oct. 18, No.18,'61 Julyl, -, '62. July 2, 12, r63. Aug. 27, Se.17,'64 May 12, 25, '64. May 5, 8, '62. Sept. 17, Oct.7, '62. Feb. 6, 10, '65. Aug. 30, Sep.5,'62. May 6, 12, '64. Nov. 30, De. 5,'64. July 30, Au. 12,'64 Aug. 30, Sep.4,'62. Julyl, 7, '63. Dec. 13, 21, '62. May 31. Je.27,'62. Sept. 19, 24, '63. Sept. 17, 21,'62. April 30, M'y3,'64. May 27, 30, '63. Operations, Operators, Result. ----; erysipelas; gangrene. Re- covery. Left; ciro. A. Surg. G. M. Mo- Gill, U. S. A. Dis'd May 22,'63. Left. Surg. A. Y. P. Garnett, P. A. C. S. Recovery. Left. Surg. — Jennings, C. S. A. Recovery. Left; circ. Surg. E. G. Chase, 104th N. Y. Disch'd Nov. 3, 1864. Spec. 3022. Right. Surg. XV. Varian, U. S.V. Disch'd March 1, 1864. Right. Snrg. — Davis, C. S. A. Recovery. Left; ivnt. post, flap; gangrene. V. R. C. June 21, 1863. Right; circ. Confed. surgeon. Disch'd October 30, 1864. Right; haem. from femoral artery. Disch'd April 27, 1863. Right; circ. Surg. C. A. Cowgill, U. S. V. Disch'd April 15,1863. Right; circ. Surg. F. Fonnento, jr , C. S. A. Recovery. Right. Ass't Surg. B. Howard, U. S. A. Left; flap. Confed. snrg. Five ins. nec. seq. removed. Disch'd May 24, 1864. Spec. 2232. Died March 13, 1872; tuberculosis. Left; flap. Surg. N. S. Hamlin, 7th Mo. Cav. Disch'd May 5,'62. Left. Surg. C. Page, U." S. A. Disch'd Oct. 6, 1863. Right. Surg. C. S. Wood, 66th N. Y. Disch'd Dec. 19, 1863. Right; circ. Transferred Sept. 22, 1864. Right; circ. Surg. E. Bentley, U. S. V. Disch'd May 19,1865. Left; circ; hyperostosis. Disch'd July 7, 1863. Spec. 1256. Right. Surg. W. T. Thurston, U. S. V. Disch'd Dec. 12,1862. Left; flap. Disch'd Sept, 6, '65. Right. Ass't Surg. B. Howard, U. S. A. Left, Disch'd March 27, 1865. Right (gang.); ant. post, flap. Dr. Rainey, Franklin,Tenn. Disch'd June 12, 1865. Left; flap. Surg. E. Bentley, U. S. V. Disch'd June 8, 1865. Right; circ. Disch'd Nov. 23,'62. Right; circ. Surg. R. Loughran, 20th N. Y. S. M. Nec. Disch'd August 9,1864. Spec. 4300. Right. Disch'd April 22, 1864. Right; flap. A. A. Surg. G. H. Dare. Haem.; lig. fem. artery. Disch'd Sept. 26, 1862. Died July 15, 1876. Right; flap. Surg. H. J. Herrick, 17th Ohio. Disch'd May 7, '64. Right; circ. Disch'd Jan. 13,'63. Right; flap. Confed. surgeon. Discharged, 1865. Right; circ. Disch'd Feb. 5, '64. Name, Military Description, and Age. Nehemiah, C. 8., Pt., K, 26th Indiana, age 32. Ochs, H. G.,Pt.,H, 54th Penn., age 26. O'Connor, J., Pt,, G, 28th Pennsylvania. Page, G. L., Corp'l, B, 18th Texas. Perkins, G., Pt., G, 2d Kentucky. Peters, J., Pt.,A, 69th N. York, age 28. ♦orter, C,Citizen of Rus- sellville, Ky., age 17. Roberts, T., Guerilla, age 31. Royston, W. H., Pt., C, 2d Iowa, age 24. Schmidt, H., Pt., G, 57th Illinois. Seiter, J., Serg't, I, 7th New York. Spear,W. A.,Pt,,1,112th New York, age 35. Velzy, G.,Corp% K, 94th New York, age 21. Vick, E. R., Pt., I, 30th North Carolina. Whitacre, J. R., Pt., E, 69th Indiana. Woodhouse, J., Pt., I, 20th Wisconsin, age 28. Acker, D., Pt., D, 148th Pennsylvania. Allen, H. H.,Pt.,F,100th Penn., age 35. Allen, L. M., Pt., E, 10th Arkansas. Anderson, W. G., Pt, G, 114th Penn., age 16. Balcom, M. S., Pt., B, 12th Conn. Barr, R.G.,Capt.,B, 49th Penn., age 24. Becht, J., Pt,, B, 7th Maryland, age 38. Belden, H., Pt., H, 171st Ohio, age 18. Blantin, A., Pt,, K, 15th South Carolina, age 37. Brinkley, J. H, Pt., A, 28th N. Carolina. Bryan, E. G., Pt, E, 3d Mass., age 22. Bueson, T., Pt., A, 142d New York. Bushnell, E., Serg't, G, 29th Indiana. Carney, J., Pt., B, 66th New York, age 20. Chase,G. L., Pt., D, 36th Mass., age 25. Clinch, T., Lieut., A, Palmetto S. S. Dec. 7, 31, '62. May 15, 23, '64. Sept, 17, Oct. 9,'62. Sept. 19, 26, '63. Jan. 1, 5, '63. July 21, Aug. 12, 1861. July 11, 21, '64. Feb. 10, Mar.4,'64, Feb. 15, Mar.6,'62. Oct. 4, 28, '62. Sept. 17, 27, '62. Sept. 29, Oct. 2,'64. July 1, 8, '63. July 1, 17/62. Aug. 30, Sep. 6,'62. Dec. 7, 11, '62. May 3, 18, "63. May 12, 28, '64. April 6, My 6,'62. Deo. 13, 1862, Ja. 11,'63. May 17, Je. —,'64. May 10, 24, '64. Mar. 31, Ap.12,'65. June 12, 26, '64. Sept. 14, 26, '62. June —, J'yl2,'62. Oct, 19, 24,'64. Jan. 15, 19, '65. De.31,'62, Ja.28,'63. Sept. 17, 27, '62. May 5, 29, v64. May 31, Je. 5,'62. Operations, Operators, Result. Right, Surg. B. O. Reynolds, 3d Wis. Cav. Disch'd J une 9, '63. Right; circ. Disch'd Jan. 31, '65. Right; flap. Disch'd June 27,'63. Died April 13, 1867. Right. Surg. Bakeman, C. S. A. Retired Feb. 10, 1865. Left; flap. A. Surg. W. T. Men- dennall, 57th lnd. Discharged March 30, 1863. Right. Surg. — Walker, C. S.A. Disch'd Jan. 25, 1862. Died ApriJ 8, 1871. Right (gang.; aneurism); lateral flaps. Dr. J. R. Bailey, of Rus- sellville. Recovery. Left; ant. post. flap. A. A. Surg. P. Gilroy. Prison June 26, '64. Left; flap. Disch'd Nov. 8, '62. Right; flap. Surg. J. R. Zear- ing, 57th Illinois. (Amp. arm.) Disch'd Dec. 18, 1863. Right. Disch'd Dec. 15, 1862. Right; Confed. surgeon. Disch'd June 13, 1865. Left; circ. Surg. R. Loughran, 20th N. Y. S. M. Disch'd July 19, 1864. ----. Surg.— Sacherell, C.S.A. Recovery. Left; circ. A. Surg.D.W.Voyles, 66th lnd. Disch'd Nov. 22. '62. Right; circ. Surg.P.Harvey,19th Iowa. Bone remo'd. Recovery. Right. Died June 3, 1863. Right; circ. Surg. A. F. Sheldon, U.S.V. Died June 4,*64; exh'n. ---- (erysipelas; haem.) Died May 6, 1862. Right; flap. Jan. 13,15,17,haem.; lig. mus. branch. Died Jan. 17, 1863; exhaustion. Right (pyaemia; diarrhoea); circ. A. A. Snrg. W. S. Ward. Died June 23, 1864 ; shock. Right (gang.); circ. A. A. Surg. M. C. Mulford; slough. Died July 27, 1864; diarrhoea. Right (prim. exc. fem.); ant. post, flap. A.A.Surg. J. Tyson. Died April 12, 1865; shock. Right (haem.);circ. Surg. A.M. Speer, U. S. V. Died June 27, 1864; shock. ----(frag's removed); oval flap; slough. Died Oct. 1, '62; pyjem. Left. Surg. — Eads, C. S. A. Died August 4, 1862. Left (mortification). Died Nov. 9, 1864; exhaustion. ----. Surg. J. W. Mitchell, 4th C. T. Died Jan. 19, 1865. Left. Died Jan. 28, '63; shock. ----. Surg. C. S. Wood, 66th N. Y. Died Sept. 30, 1862. Right; ant. post. flap. Surg. A. F. Sheldon, IJ. S.V. Died June 10,1864; exhaustion. ---; flap. Died June 8, 1862; shock. 1 Hinkley (H.), Treatment of Hospital Gangrene, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 132. "Fobmeoto (F.), Notes and Observations on Army Surgery, New Orleans, 1863, p. 20. 276 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No Name, Military Description, and Age, Clayborne, J. B., Pt., H, July 3, 22d N. Carolina, age 23. 19, 63. Dates. ages Clodins, C, Pt., A, 125th Pennsylvania. Conra.l, P., Pt., E, 26th New York, age 43. Conway, A., Pt., G, 34th Ohio. Cowan, J., Pt., H, 155th Peun., age 32. 1 Curtis, G. F., Corp'l, C, 10th N. Jersey, age 22. * Davis, H. C, Pt., 1,46th Indiana. Dawson, B.,Pt,D,100th Penn., age 18. Deal, J., Pt., K, 81st Penn., age 35. De Frend, J., Pt, M, 4th Artillery, age 21. Dibble, H., Pt., F, 198th Penn., age 20. Doane, H. II., Pt., 1,1st Maine II. Art'y, age 23. Dougherty, J. J., Pt., C, 1st Me. H. Art., age 32. Ellsworth, J., Pt., C, 1st Minnesota. Fellows, C. B., Serg't, H, 115th N. Y., age 26. Fenner, T., Pt., G, 142d Pennsylvania. Fisher, II., Serg't, A, 10th N. Jersey, age 21. Frazier, J. H.,Pt., A,56th New York, age 25. Gaw, R. P., Pt., B, 23d Penn., age 52. Hite, H. S., Pt., A, 17th Virginia. Hoffman, C, Pt., A, 1st Cavalry, age 24. Hostetter, A., Corp'l, K, 45th Penn., age 23. Howell, J., Serg't, K, 110th Ohio, age 37. 3Hutchings, J.B.,Pt.,G, 6fh New York H. Art., age 22. Jackson, C, Corp'l, G, 2d Michigau. Johnson, J., Pt., A, 153d New York, age 21. Jones, T, Pt., H, llth Virginia. Jourman, R., Pt., E, 35th Colored Troops. Kelly, J., Pt, F, 1st N. York Cavalry, age 21. Kerr, R. D., Pt., F, 5th N. Carolina Cavalry. Oferatioxs, Operators, Result. May 3, 17, '63. Dec. 13, 25, '62. Sept. 10, 14, '62. June 26, J'yll,'64. May 31, Je. 5,'64. May 1, 10, ''63. May 30, Je.5,'64. May 8, 27, r64. Nov. 30, De.3/64 Mar. 31, Ap.6,*65. May 21, 29, '64. May 18, 22, '64. July 3, -, '63. Sept. 29, Oot.2,'64 Deo. 13, 16, '62. Oct. 19, 22, '64. Deo. 6, 11, '64. June 1, 9, '64. May 5, 8, '62. Aug. 1, 8, '63. May 9, 26, '64. July 9, 12, '64. May 30, Je. 5,'64. June 25, 28, '64. Oct. 19, No. 9, '64. June —, J 'y 10, '62. Feb. 20, 26, '64. July 7, Au. 6/63. May 6, 23, '64. Kisner, G. W., Pt., E, Jnne —, 19th Mississippi. J'yl3,'62. Knox, T. T., Pt., B, 1st \ Oct. 19, Maine, age 40. 22, '64, Right (slough.; haem); circ. A. Surg. B. Stone, U. S. V. Died July 22,'63; exh'n. Spec. 2056. Left. A. Surg. C. H. Lord, 102d N. Y. Spec. 1153. Right, Died January 12, 1863; pyaemia. Right. Died Sept. 16, 1862 j te- t an us. Left; ant. post flap. A. A. Surg. A. W. R.Andrews. Died July 11, 1864; syncope. Spec. 3345. Autopsy. Right; circ. A. Surg. G. A. Mur- sick, U. S. V. Died June 7, '64; exhaustion. Autopsy. Right (hiem.); circ. A. A. Surg. L. Dyer. Died May 18, 1863. Left; circ. A. Surg. W. Thom- son, U. S. A. Died June 7,'64; shock. Spec. 3547. Right; circ. A. A. Surg. J. New- combe. Died June 6, 1864. Right; circ. Surg. S. E. Fuller, U. S. V. Died Dec. 4, 1864; haemorrhage and shock. Right (ball extr.); flap. Surg. N. R. Moseley.U.S.V. Died April 12, '65; nerv. exh'n. Spec. 4067. Right (mortification); ciro. A. A. Surg. J. H. Thompson. Died June 1, 1864; pysemia. A Right. A.A. Surg. W. C. Dixon. Died May 25, 1864. Left. Surg. C. S. Wood, 66th N. Y. Died July 20, 1863. Right; anterior post, double flap. Confed. surgeon. Died Nov. 11, 1864; congestion of lungs. Left; circ. Surg. J. A. Phillips, 9th Penn. Res. Died Jan. 12, 1863; wound. Right; lat. skin flap; circ. muse. Surg. C. H. Andrus, 176th N. Y. Died Nov. 12,'64; exh'n. Autop. Left; ant.post. flap. A. A. Surg. W. Balser. Died Dec. 13,1864; exhaustion. Left. A. Surg. B. Stone, U.S.V. Died June 13, 1864. Spec. 1407. ---; flap. Surg. D. Prince. TJ. S. V. Died May 9, '62; shock. Right (haem.); dou. oval skin flap. A. Surg. W. Thomson, U. S. A. Died Ang. 8, '63; shock. Spec. 1679. Autopsy. Right; ant post flap. Surg.A.F. Sheldon, U. S. V. Died May 28, 1864: exhaustion. Left; amp. mid. third; reamp. up. third while on table. A.A.Surg. W. S. Adams. Died July 12, 1864; shock. Left; circ. Surg. J. A. Lidell, U. S. V. Died June 10, 1864; exhaustion. Autopsy. Left. (June 25, exc. fib.) Surg. A. F. Whelan, 1st Mich. S. S. Died July 2, 1864. Right (haem.); circ. A.A.Surg. J. Neff. Died Nov. 17, '64; pyaemia. Right. Surg. — Ward, C. S. A. Died July 16, 1862. R't; flap. Surg. —Hallyfield, C. S. A. Died June5,'65;consump. Left (ball extr.). A. Surg. R. F. Weir, U.S.A. Erysipelas. Died Aug. 18,'63. Spec. 3895. Autop. ---(haem); ant. post. flap. A. Surg. W. F. Richardson, C. S. A. Died May 23, 1864. Right. Surg. — Ward, C. S. A. Died July 14, 1862. Left (mortification); lat.skin flap; circ. sect. muse. Surg. C. H. Andrus, 176th N. Y. Died Nov. 10, 1864; pyaemia. NO, Name, Military description, and aoe. Labrie, O., Pt., H, 126th Ohio, age 23. Laughery, J., Pt.,C,26th Pennsylvania, age 27. Lochner, J., Pt., I, 13th Illinois. *Lochterhand,E.,Pt., H, 37th Wisconsin, age 34. Lounsbeck, G., Pt, G, 64th New York, age 28. Lutz, J.,Pt.,B., 1st Penn. Reserves. Mackay, M., Pt., D, 26th New York. Macon, J. M., Capt., A, 19th Miss., age 30. Mapes, E. A., Pt.,C,10th N. Y. Cavalry, age 22. Markins, G., Pt., H, 2d W. Virginia M. I. McAllister, D.,Pt.,G, 3d Maryland, age 57. McAtee, G., Pt., E, 12th Virginia, age 19. * McLaughlin,G., Pt, A, 84th New York, age 25. McMullen, M., Pt., G, Virginia Grays. McNiece, S., Pt., C, 19th Indiana. Merritt, C. S., Corp'l, D, 40th Illinois. Murit, B., Pt., H, 17th New York. Murphy, J. M., Pt, E, 27th Georgia, age 22. Musser, J., Capt., A, 46th Illinois. Noonan, F., Pt., F, 18th New York. Nugent, P., Pt., I, 5th Artillery. Parrish, P. B., Serg't, D, 31st N. C, age 22. Patten, J., Pt., 1,3d Wis- consin, age 21. Pierce, T. M., Pt., B, 1st Maine Art'y, age 16. Province, S., Pt., 1,90th Pennsylvania. Radford, V., Pt., K, 71st Penn., age 29. Razette, V., Corp'l, G, 57th Mass., age 33. Robbins, A., Pt., G, 48th Colored Troops. Rowell, A., Pt., F, 94th New York. Rowland, R., Pt., 1st N. York lnd. Bat., age 31. Ryder, S., Pt., F, 1st Mass. H. Art'y, age 39. Smith, —, —, 14th New York S. M. Soule, J. W., Corp'l, D, 6th Michigan Cavalry, age 27. Stanford, G., Pt.,A,12th Georgia, age 30. Dates. July 9, 12, *64. July 2, 7, *63. Nov. 27, 30, '63. June 17, J*y3,'64. May 12, 18. ,6'4. Dec. 13, 20, '62. Aug. 29, Sept. 12, 1862. May 5, 8, '62. June 11, 23, '64. Sept. 24, 29, '63. July 9, 12, v64. July 18, 28,' '64. Aug. 27, Sept. 2, 1862. Feb. 25, —, '63. Aug. 30, Sept. 22, 1862. April 6, -, '62. Aug. 30, —, '62. Sept. 17, Oct. 10, 1862. April —, —, *62. Sept. 17, Oct 1/62. July 2, 5, '63. Sept. 29, Oct. 7/64. May 25, Je.7,'64. May 19, 25, '64. Aug. 31, Se.— ,'62. May 12, 19, '64. May 5, 9, '64. July 4, 7, '64. Aug. 31, Se.—,'62. June 19, 27, '64. Mav 31, Je.5,'64. July 21, 27, '61. July 8, 29, *63. July 9, 13, '64. Operations, Overators, Result. Left; circ. A.A. Surg. J. C. Shi- nier. Haem. from branch of prof. art,; lig. Died July 23, 1864. Autopsy. Left; haem. from femoral artery. Died July 19, If 63; exhaustion. Lef-,. Died November 30, 1863. Left; circ. A. Surg. G. A. Mur- sick, U. S. V. Died July 9/64; pyaemia. Spec. 2738. Autopsy. Right (haBm.); flap. A. A. Surg. H. D. Vosburg Died May 18, 1864 ; exhaustion from haem. Left; haemorrhage; lig. femoral artery. Died Dec. 22, 1862; exhaustion. Left. Surg. O. A. Judson.U.S.V. Died Sept. 17, 1862; hemor- rhage. Spec. 4280. ----. Surg. D. Prince, U. S. V. Died May 8, 1862. Right (slough.); circ. A. A. Surg. J. P. Nagle. Died June30/64. Right. Died September 29,1863. Right; flap; skin circ. muscles. Died July 13, 1864; shock. Right; double flap. A. Surg. J. Willard, 1st Md. P. H. B. Died July 29, 1864. ----; ant. post. flap. A. Surg. C. A. McCall, U. S. A. Died before operation was completed. Right. Dr. P. H. Johnson, Rich- mond. Died eight days after operation. Spec. 3016. Right; circ. A. A. Surg. B. F. Bowles. Died Sept. 25, 1862. Spec. 75. ----; double flap. Surg. E. C. Franklin, U. S. V. Died April 28, 1862. ----. Died September 14,1862. R't; ciro. A. A. Surg. A.North, Died Oct. 21, 1862; exhaustion. Specs. 779, 871. Left. Died April 24, '62; shock. Right. A. Surg. H. A. Dubois, U. S. A. Died Aug. 8, 1863; tuberculous disease. Spec. 3886. Left; circ. A. Surg. B. Howard, U. S. A. Died July 8, 1863. Spec. 1380. Right, A.A.Surg. E. K. Deemy. Died October 9, 1864. Right; circ. A. A. Surg. H. S. Kilbourne. Died July 22,1864; exhaustion. Spec. 3396. Right; circ. Died May 31, '64; asthenia. Spec. 2617. ----. Died September 21,1862. Left; circ. A. A. Surg. J. H. Thompson. Died May 25,1864 ; pyaemia. Right. Died June 1, 1864; py- aemia. Left. Died July 9, 1864. ----. Died September 10,1862. Left; circ. A. A. Surg. W. C. Pryer. Died June 27/64; exh'n. Left. A. Surg.A. Ingram, U.S.A. Died June 12,1864; exhaustion. Spec. 2824. ----. Surg.—Darby, Hampton's Legion. Died July 27, 1861. Right (July 8, exc; baem. from sciatic artery); ant post. flap. Died July 29,1863. Spec. 3854. Autopsy. Left; circular. Died same day; never rallied. » Lidell (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in V. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 383. *Bryax, 'J.), Brief Description of Sixteen Cases of Amputations Treatedin the Mary Ann Hospital, Grand Gulf Miss., in Am. Med. Times.Vol. VU, 1863, page 5, case XJJI. •Lidell (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in XT. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 413. ♦Lidell (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in XT. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 409.' •Coueb (E.), Report of some Cases of Amputations and Resections, from Gunshot Wounds, performed at the Mount Pleasant XT. S. A. General Hospital, by C. A. McCall, M. D., XT. S. A., in Med. and Surg. Reporter, 1862-3, Vol. 9, p. 194. SECT..m.l INTERMEDIARY AMPUTATIONS OF THE THIQH. 277 NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 133 134 135 136 137 138 139 Stiff, D. D., Serg't, A, 2d Michigan Cavalry. Still, C. B., Pt., B, 22d Indiana. Tetard, J., Serg't, F, 6th Infantry. Thomas, W. C, Pt., G, 7th Connecticut. Tompkins, G., Pt., G, 1st New York Bat'y, age 40. Underwood, T., Pt., G, 1st Mich., age 30. Verner, J., Pt., I, 99th New York. June 10, 13, '63. Septl, -, '64. July 1, 4, '63. Oct. 22, No. 9, '62. July 3, 17, r63. June 27, J'y 9/62. Aug. 28, Se.18,'62. Right (ball and bone extracted). Died one hour after. Spec. 659. Autopsy. Left. Died September 13,1864. Left; double skin flap. A. Surg. B. Howard, U.S.A. Died July 13,1863. Hiem. Spec. 1381. Right; ciro. Died Nov. 9, 1862. Right (July 4, amp. leg.; gang.); amp. thigh to get rid of putrid mass; hueni.; lig. fem'l artery. Died July 26, 1863; pyaemia. Right. Surg. W. Faulkner, 83d Penn. Erysipelas; gang. Died August 11, 1862. Left. Died September 21, 1862; pyemia. 140 141 142 143 144 145 146 147 Vose, E., Pt., I, 5th New Hampshire. Warren, C, Serg't, I, 15th Massachusetts. Wheedon, R. A., Corp'l, K,47th N. Cage 24. Whitbeck, W., Pt, E, lllth New York. Williams,W.,Pt.,B,24th Michigan. Winchell, G., Pt., D, 14th New York Art'y, age 18. Woodward, J. T., Pt, D, 26th Mississippi. Worchester, S. W., Pt, B, 9th N. Y. H. Art'y. Deo. 13, 22, '62. Sept. 17, Oct. 2/62. July 3, 7, m July —, —, '63. July 1, 6, '63. May 12, 29, '64. June 3, 23, '64. Sept. 19, 23, '64. Left. Surg. C. S. Wood, 66th N.Y. Died Dec. 23, 1862. Left (gang.); flap. Surg. A. N. Dougherty, U. S. V. Died Oct. 2, 1862; shock. Spec. 379. Left; baem. from muscul. branch. Died July 23, 1863; pyaemia. Right. Surg. C. S. Wood, 66th N. Y. Died July 14, 1863. Left. Died July 20, 1863. Right; circ. Surg. A. Delnney, U. S. V. Died June 2, 1864; congestion of lungs. ---; circ. Surg. C. B. Herndon, C. S. A. Anorexia; bed sores; diarr. Died July 15/64; exh'n. Left; flap. Surg. W. A. Barry, 98th Penn. Died; exhaustion. In one hundred and thirteen of the above cases the femur had been fractured—in eighteen, in the upper; in fifty, in the middle; in fifteen, in the lower third; and in thirty, without indication of the precise location. In twenty-nine instances the seat of fracture was in the knee joint, and in five in the leg. In one case, primary amputation in the upper third of right arm, in three instances excision in the thigh or bones of the leg, and in one, amputation in the upper third of the same leg had preceded the amputation in' the thigh.1 Intermediary Amputations in the Middle Third of the Thigh.—The four hundred and seventy-one intermediary amputations in the middle third of the thigh furnished two hundred and sixty-six deaths, a mortality rate of 56.4, or nearly 10 per cent, less than the intermediary upper third amputations. Seventy-two of the four hundred and seventy-one operations were performed on Confederate soldiers. The right limb was removed in two hundred and nine, and the left in two hundred and thirty-five instances, and in twenty- seven the side was not indicated. The circular and the flap methods were each employed in one hundred and sixty-three cases; in one hundred and forty-five the mode of operation was not stated. Successful Cases of Intermediary Amputations in the Middle Third.—One hundred and sixty-seven of the two hundred and five operations of this group were performed on Union soldiers. All but seven were living in October, 1879. Two had undergone ante- cedent operations; one an excision at the knee joint, and one an amputation in the upper third of the leg.2 Sequestra were removed in twelve,, and fragments or protrusions of bone in thirty-one instances: Case 458.—Sergeant H. Clark, Co. E, 125th New York, aged 22 years, was wounded at the Wilderness, May 6, 1864, and entered tlie Third Division Hospital, Alexandria, eight days afterwards. Surgeon E. Bentley, U. S. V., reported: "The patient was admitted with a shot injury of the left knee joint, caused by a conical ball. His physical state was good, but the condition of the wounded limb was such as to give no hope of recovery without resorting to amputation. The operation was performed by antero-posterior flaps, at the junction of the middle and lower thirds, on May 17th, chloroform being used as the anaesthetic. The patient did not rally well, and fears were entertained of his immediate death. He had chills at intervals for a week or ten days. By June 10th, the stump was doing well and partly closed by first intention, though there was profuse suppuration. The treatment consisted of stimulants, beef tea, iron, and quinine, and cold-water dressings. With the exception of the excessive suppuration the patient did well until June 20th, when he had a severe chill, and stimulants were ordered to ■Private H. Schmidt, G, 57th niinois (TABLE XXXIV, No. 44, p. 275, and Second Surg. Vol., TABLE LXVHI, No. 920, p. 711), amputation right thigh and right arm in upper thirds, recovery; Corp'l J. W. Soule, D, 6th Michigan Cavalry (TABLE XXXIV, No. 131, p. 276, and TABLE XXIII, No. 51, p. 206, ante), primary excision of femur in upper third and amputation of thigh, fatal; Pt. J. Becht, B, 7th Maryland (TABLE XXXIV, No. 57, p. 275, and Table XXIII, No. 3, p. 206, ante), primary excision iu middle third of femur and amputation of thigh, fatal: Corp'l C. Jackson, 2d Michigan (TABLE XXXIV, No. 91, p. 276), excision of upper part of fibula and subsequent amputation of thigh, fatal; Pt. G. Tompkins, G, 1st New York Battery (Table XXXIV, No. 137, p. 277), amputation of upper third of leg followed by amputation in thigh, fatal. 'Private W. M. Constable, H, 1st Cavalry, wounded March 31, 1865; primary excision of knee joint March 31, 1865, amputation of thigh April 5, 1865 (Table XXXV, No. 43, p. 280); Pt. A. J. Cheever, H, 16th Massachusetts, wounded July 2, 1863, amputation of leg July 4th, and amputation of thigh July 18, 1863 (Table XXXV, No. 35, p. 280). 278 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 190.— Sequestrum, 4J ins. long, remov'dnine months after amputation. Spec. 666. FIG. 191.—Cast of stump of left thigh, nineteen months after am- putation. Spec. 294. be used freely, and quinine was given in large doses. The secretion having become watery and offensive, the dressings were changed frequently. No repetition of the chill occurred, and by June 25th the patient's countenance had changed very much for the better, being now clear instead of the yellow hue. The treatment was continued, and the patient steadily improved, his appetite being good and his bowels regular. On July 1st, the stump had closed with the exception of one opening, which was still discharging a large quantity of pus, healthy in color and odor, however. On July 7th, the patient complained of pain just below the great trochanter, caused by tumefaction and great heat of the skin, for which tincture of iodine was applied, fol- lowed by a tight bandage, and morphia was administered. On July 10th, an abscess was opened in the region of the great trochanter and followed by a thin watery discharge. A tent was then introduced, and the whole stump being much swollen, it was painted with tincture of iodine, and a bandage was applied tightly. On July 15th, another abscess was forming on the posterior aspect; the stump, though much reduced in size, was still discharging quite freely. On July 20th, the patient was suffering from a severe diarrhoea, and his diet was restricted, and lead and opium prescribed. By July 30th, the diarrhoea was checked; the abscess on the posterior aspect of the thigh, having formed a track and opened at the end of the stump, evacuated half a pint of healthy pus. The stump still continuing to discharge large amounts of pus, the bandage was kept tightly applied. Diluted creasote was also used locally, and iron and quinine was continued internally. On August 7th, a new abscess was opened just below the great trochanter. On August 13th, the stump still suppurating freely, an injection of solution of chloride of zinc was commenced, the bandage being continued, and the patient freely stimulated by the use of whiskey. After this date several abscesses formed on different parts of the thigh, which were opened and discharged large quantities of pus. By proper bandaging the limb was finally reduced to near its natural size, but one opening remaining at the end of fhe stump and discharging a limited quantity of pus. By the use of stimulants and nourish- ing diet the patient's general health improved so as to enable him to he transferred to hospital at Albany, near his home, on November llth." The description of two sub- sequent operations was contributed by Assistant Surgeon J. H. Armsby, U. S. V., in charge of Ira Harris Hospital: "At the time of the patii'ftt's admission his constitutional condition was bad, being pale, weak, and emaciated. The stump was swollen aud inflamed, and there were several small fistulous ulcers. On February 6,1865, a sequestrum (FlG. 190) was removed through an incision about five inches in length by Acting Assistant Surgeon H. Pearce. After this operation the stump began to heal, and continued to do well up to September 4, 1865, when the patient was discharged from service. On December 9th, following, he applied for admission into the Albany City Hospital. The stump was then healed with the exception of a small fistulous ulcer, which was discharging moderately. There was but little swelling and pain, but, on examination with the probe, naked and carious bone could be discovered. The patient having been placed under the influence of chloroform, two elliptical incisions were made on the extremity of the stump, including the ulcer, and the tissues were removed down to the bone, thus leaving lateral flaps. A chain saw was then introduced and the bone cut through an inch and a half higher up, after which the flaps were brought together and secured by sutures. Cold-water dressings were applied after the operation." A cast of the stump (FlG. 191) was also contributed to the Museum by Dr. Armsby, and constitutes Specimen 294 of the Surgical Section. Fourteen months after the last operation the patient was supplied with an artificial limb by E. D. Hudson, of New York City. Examiner A. P. Cook reported, May 14, 1873: "He is unable to wear an artificial limb. The femur is about three inches shorter than the fleshy stump. The stump is atrophied, the muscles are soft, and there is a deep cica- trization at the end, which is very tender." The pensioner was paid June 4, 1879. Case 459.—Lieutenant-Colonel George R. Maxwell, 1st Michigan Cavalry, aged 22 years, was wounded at Five Forks, Virginia, April 1, 1885. He was taken to the field hospital of the Cavalry Corps and remained there until April 15th, when he was sent to Washington on the hospital steamer Connecticut, and admitted to the Armory Square Hospital on the 16th. Acting Assistant Surgeon C. A. Leale,1 in a special report of the case, furnishes the following particulars: " The left knee joint was opened by a conoidal ball, which had entered opposite the head of the fibula and was extracted at point of entrance. He was very anaemic and in a generally unfavorable condition; extensive suppuration had taken place, the leg had become infiltrated with serum, the knee joint was filled with pus, and the muscles of the thigh had been separated by extensive abscesses extending as high as the apex of Scarpa's triangle. April 17th, no change in his condition; he was placed under the influence of ether, and the thigh amputated by the circular operation, at the middle third, by Surgeon D. W. Bliss, U. S. V.; the stump was dressed with water, and the patient placed in bed. April 18th, although twelve ligatures had been applied, haemorrhage continued to take place (he being apparently of a haemorrhagic diathesis), and altogether about eight ounces of blood was lost. Applied liquor ferri persiilphas by a camel's hair brush to the whole of the surface of the wound, which had been left open and exposed to the air for about fifteen minutes; this, with the styptic, entirely checked all oozing. April 20th, the granulations had become healthy; about two drachms of pus discharged daily. On the 30th the stump had nearly closed. June 23d, a piece of necrosed femur of a conical shape, and about four inches in length, was removed. August 8th, he was mustered out of service; his stump (FlG. 19^) was solid and in good condition." The pensioner was paid June 4, 1879. 1 Leale (C. A), Intermediary Hsemorrhage, Parenchymatous in Character, following Secondary Amputation of Thigh; Recovery, in United Statu Sanitary Commission Memoirs, Surgical Volume I, p. 176. Fir.. 192.—Amputation of left thigh at mid die third. [From a photograph.] >■(•■ A V V L^ti* '■"'<:*.*■{■■ an.l fl', i. . .in- . ail a anL'"a. 0| 'i.in. ■ a ra 1 .. - tv I,t '* . Ami I trfotf \, llr ''■■■' ■• • »!. -(.,:.u : ''Ai Uf ' . . i."'a ■ m av p waa ewollwri -:nini(l'i< i:i)Y. s removed through ;-> < » im ■ a :Y • inir> bi»gan to hi'.-J ^ : ■'• a •:•<>'}; following. k'; '' : •■■ -:i! ail fistulous '■ ■ Y.'UIlCe « »t" ' - ■ ^'■Mii/. i'icludim, ■ -' ' ■ i.'ii t'aps. . .■« aft.l Mjm.ii:;, '•'i ait.-ei: n ai ii...|. In J' \> ■■ 14. l^:i: "' !{,■]> V:.-. • ii...-; a. •a i.iie i- -• •Y >:. .. uiioiilal hi. . i-, ai-.l ! •lax ill, Is A; .' ;-m: 1 Im;.".. '•re iait;i \ • vuva . «.' the 111. Was > ..lllVT "'*''' f .-thtr. ira ' niD.W. lili- ! S.V.; ■' "f ha.! Y- a ., , !i,.(]. •■■■• '.VOia.'l v ;, , ..| i M-izilig. A|>Mi ' !• |> had nearly ola v ' ' August Htti, Ik: wa^ . : I'm- 4, 1879. lircovrr , Ed.Stand, 1'ii.x T Sinclair 8-Sor ihroniutith. PLATE XXVI. OSTEOMYELITIS OF FEMUR C'hsc of Private <' Clmse, 120u.' New-York. N'° B71") Stii-ynal Section SECT. III.] INTERMEDIAEY AMPUTATIONS OF THE THIGH. 279 FIG. 193. —Upper portion of right tibia with eccentric splin- tering. Spec. 3558. Case 460. —Private O. Vezina, Co. B, 9th New Hampshire, aged 24 years, was wounded at Tolopotomy Creek, May 31, 1864, and admitted to the field hospital of the 2d division, Ninth Corps, where Surgeon J. Harris, 7th Rhode Island, noted: "Shot wound of right leg by minie ball." Four days after the reception of the injury the man was transferred to Douglas Hospital, Washington, where the limb was amputated. Assistant Surgeon W. Thomson, U. S. A., who performed the operation, described the case as follows: "The missile entered over the anterior surface of the tibia at about the junction of the lower thirds, passed obliquely upward and inward, fracturing the bone in several pieces and lodging beneath the integuments, whence it was extracted on the field. The fibula was not injured. On admission, the leg was erysipelatous and abscesses were bur- rowing above and below, one of which was opened below the internal malleolus. Poultices were applied, and several sloughs of the integuments came away, leaving the muscles and tendons exposed. Tho patient suffered constitutional irritation from continual pain and was anxious for amputation, which was performed on June llth, by the antero-posterior flap method, at the lower part of the middle third. The stump was dressed with equal parts of tincture of opium and tincture of camphor, and poultices were applied until June 18th, when the sloughs had entirely separated. After this, cold-water dressings were used and the stump progressed finely. By September 1st, it had been healed for some time, with the exception of a fistulous opening lead- ing to uecrosed bone. On October 13th, the patient having for some days suffered from great pain and consequent inability to rest, a sequestrum, six inches long and of a nearly entire circum- FIG 194 _ ference, was, with great difficulty, removed by Acting Assistant Surgeon H. Gibbons. A large Tubular se- formation of new bone was discovered around the cavity thus left in the stump. After the h^long^re- operation the pain ceased, and the patient again became cheerful and his appetite good. On moved from December 23th, the opening had almost entirely closed." The upper portion of the tibia of the four months amputated limb, showing eccentric splintering by the missile, and necrosis adjacent to the seat ^fomSpec of the fracture, was contributed by the operator, and is represented in the wood-cut (FlG. 193). 3599. The sequestrum, shown opposite (FlG. 194), was contributed by Assistant Surgeon W. F. Norris, U. S. A. The patient was discharged from service June 14, 1865, and furnished with an artificial limb one month afterwards by B. F. Palmer, of Phila- delphia. The pensioner was paid June 4, 1878. In the following instance the officer remained in active service until 1870, when he was retired. He died in 1879: Case 461.—Brigadier-General T. W. Sherman, U. S. V., Colonel 3d U. S. Artillery, was wounded, during the assault on Port Hudson, May 27, 1863, by a conoidal musket ball passing through his right leg and causing a fracture of the tibia and fibula at the upper third. When conveyed to New Orleans, three or four days after the injury, the wound, which was extensive and greatly lacerated, was found to have been very tightly sewed up with one continuous suture, the cutting out of which gave exit to a large discharge of decomposing coagula, pus, and bone splinters. His constitutional symptoms had assumed a most aggravated character, and the patient remained in a very discouraging condition for nearly two weeks, when amputation through the middle third of the thigh, though only offering the slightest hope of success, was performed by Professor Warren Stone with favorable result. The injured tibia and fibula (Spec. 3604), many of the missing fragments of which were discharged from day to day before the amputation, were contributed to the Army Medical Museum by Professor F. Bacon, of New Haven, late Surgeon U. S. V. General Sherman was mustered out of the volunteer service April 30, 1866, and retired from active service December 31, 1870. He died at his home in Newport, R. I., March 16, 1879. (See Circular No. 6, War Department, S. G. O., 1865, p. 38.) Fifteen of the patients survived ulterior operations—one a re-amputation at the hip joint,1 ten, re-amputation of the thigh, one an amputation of the opposite arm and leg in consequence of an accident, and three, ligations of the femoral artery. Consecutive bleeding was observed in nine, pysemia in two, and gangrene in fourteen of the cases of this group. Fatal Cases of Intermediary Amputation in the Middle Third of the Thigh.—Two hundred and sixty-six cases belong to this group. Thirty-four of the operations were practised on Confederate, and two hundred and thirty-two on Union soldiers. Pyaemia was noted in forty-two, gangrene in thirty-three, tetanus in four, erysipelas in four, and hasmorrhage in sixty-nine instances. The Museum possesses specimens in eighty-nine of the two hundred and sixty-six cases: Case 462.—Corporal Clark Chase, Co. B, 120th New York, aged 23 years, was wounded at Cold Harbor, Virginia, May 31, 1864. Surgeon O. Evarts, 20th Indiana, reported the admission of the patient into the hospital of the 3d division, Second Corps, with a "shot wound of the left thigh, flesh; simple dressings." He was transferred to Washington, and admitted into Douglas Hospital on June 4th. Assistant Surgeon William Thomson, U. S. A., reported: " Shot fracture of right femur, lower part of middle third. The patient's condition was apparently good, his pulse full and strong. The bone was much comminuted. There was no inflammatory action. June 5th, Assistant Surgeon W. Thomson administered ether, and amputated the left thigh in the upper part of the middle third by the circular method. 8th, pyaemia developed, ushered in by a chill. 10th, chill; conjunc- 1 Sergeant E. D. Ulmer, G, 15th New Jersey. (See CA6E 333, p. 156, and Table XVIII, No. 5, p. 159, ante, and Table XXXV, No. 183, p. 282.) 280 INJURIES OF THE LOWER EXTREMITIES. [chap. x. tiva slightly yellow, llth, hasmorrhage, to the extent of four ounces, from a muscular branch, which ceased spontaneously and did not recur. The discharge from the stump was very dirty and offensive, and breath sweetish. He died June 12, 1864. The autopsy revealed pysemic patches in the lungs, phlebitis of femoral veins, and osteomyelitis of the femur." Dr. Thomson con- tributed the pathological preparation of the femoral artery to the Army Medical Museum, numbered 2509, and the lower two- thirds of the femur, numbered 3548, of the Surgical Section. He also forwarded the upper extremity of the femur (Spec. 6715, Surg. Sect.), removed post-mortem. A longitudinal section of the specimen, showing osteomyelitis, was drawn by Hospital Steward E. Stauch, and is copied in the chromo-lithograph (Plate XXVI) opposite p. 278. Case 463.—Brigadier-General E. Kirby, U. S. V., First Lieutenant, U. S. Artillery, was wounded at Chancellorsville, May 3, 1863. He was admitted to the Artillery Brigade Hospital, Second Corps, whence Surgeon J. H. Merrill, 1st Rhode Island Artillery, reported: " Wound in lower third of left thigh by two bullets from a spherical case shot. Patient sent immedi- ately to Washington." Surgeon B. Norris, U. S. A., under whose care the patient came to Washington, reported the following description and result of the injury: "Two round balls entered the thigh about two inches above the condyles, producing a com- minuted fracture of the lower third of the femur. The case came under my treatment on May 5th, and amputation at the middle third by the circular method was performed on May 10th. The tourniquet was used, and chloroform employed as the anaesthetic. One ball was found embedded in the medullary canal of the femur, and the other in the vastus externus muscle. The operation was followed by increase of fever, which rapidly assumed the typhoid type. This brave young officer survived the operation eighteen days, and died of pyaemia May 28,1863." The amputated portion of the femur was contributed to the Museum by the operator (Cat. Surg. Sect., 1866, p. 290, Spec. 1076), and is represented in Plate XLII, opposite. Table XXXV. Summary of Four Hundred and Seventy-one Cases of Intermediary Amputation in the Middle Third of the Femur for Shot Injury. [Cases of recovery, 1—205; fatal cases, 206—471.] Name, Military Description, and Age. Albert, J., Pt., D, 46th Penn., age 26. Alexander, J. D., Pt., A, 8th Maryland, age 20. Allhouse, L., Pt., H, 6:3d Peun., age 20. Baker, G-, Teamster. Baker, J. T., Pt., B, 72d New York. 1 Barker, C. R., Pt., D, 7th Louisiana, age 23. Barleon, G., Pt., C, 33d Ohio. Bartmess, G. J., Serg"t, G, 3Gth Ohio. Bell, C. E., Serg't, C, 74th New York. Bennett, D., Pt., K, 1st W. Virginia, age 19. Blazier, T. F., Pt., C, 1st Blodgett, E. F., Pt., D, 4th Vermont, age 34. Bodge, G. E., Pt., A, 5th Louisiana, age 25. Boscroe, S., Pt., M, 4th Cavalry, age 21. Boss, E. P., Pt., K, 44th New York. Boucher, G., Pt., A, 76th New York. Bowen, J. H., Corp'l, C, 19th Indiana, age 23. Boyle, M., Pt., F, 5th Ohio. Brassell, W., Pt., M, 72d Penn., age 18. Dates. 20 Brown, J., Pt., H, 100th New York, age 21. 21 Bruce, J., Pt., B, 49th Penn., age 21. BuffingUm, J. D., Pt., A, Huger's Battery. Buffum, T. J., Corp'l, K, 100th New York. Aug. 9, 14, '62. May 8, 12, r64. May 5, 27, '64. Aug.— —, '64. July 1, 5, '6-2. July 21, Aug. 9, 1861. Jan. 3, 10, '63. Sept. 14, 17, '62. Aug. 27, Sept. 4, 1862. Mar. 23, 27, '62. July 7, 15, '63. May 5, 12, '64. Sept. 19, Oct. 10, 1864. Feb. 22, 25, '64. June 27, 30, '62. July 1, 6,'63. Julyl, 18, '63. Aug. 9, 13, '62. Sept. 17, Oct 7,'02. July 27, Au. 1,*64. May 10, 14,'64. Sept. 17, 21, '62. July 18, 23, '6a Operations, Operators, Result. Loft. Surg. D. O. Perry, 10th Me. Necrosed. Disc'd Jan. 4,'64. Right; circ. Confed. surgeon. Disch'd June 20, 1865. Left; circ. A. A. Surg. M. F. Price. Seq. removed. Disch'd May 24, 1865. Spec. 2908. Right; flap. Recovery. Left. Surg.— Russell, C S. A. Disch'd Aug. 22, 1865. Right. Surg. — Ford, C S. A. Necro.; dead bone, seven and a half ins. in length, extracted. Retired Jan. 5, 1865. Left; flap. Disch'd April 27, '63. Left; flap. Disch'd Jan. 5, 1863. Died Aug. 9, 1866; consumpt'n. Right; doub. flap. A. A. Surg. R. Reyburn. Six and a half ins. bone removed. Disch'd Jan. 23, 1863. Spec. 323. Left; flap. Disch'd June 18,'62. Left. Recovery. Right; flap. Disch'd August 22, 1864. Right; ant. post. flap. A. Surg. — Dorsey, 1st Md. Cav. C S. A. Exchanged Feb. 16,1865. Right; circ. Confed. surgeon. Disch'd Julv 15, 1865. Right. Disch'd Feb. 28, 1863. Right; circ. Surg. J. M. Farley, 84th N. Y. Disch'd Feb. 23,'64. Left (gang.); circ. Disch'd Dec. 19,1863. Left; flap. Disch'd Nov. 21,'62. Left; lat. flap. A. A. Surg. J. H. Bartholf. Disch'd Dec. 29. '62. Spec. 771. Died Jan. 20, 1865; consumption. Right; circ. A. A. Surg. W. L. Welles. M. O. Feb. 9, 1865. Right; circ. Confed. surgeon. Seq. rem'd. Prison (sentence G. C M.) July 3, 1865. Right. Surg. — Gray, C. S. A. Furloughed. Right (mortificat'n); ant.post.flap. Disch'd Feb. 14, '64. Spec. 37. Name, Military Description, and Age. Burgess,D. M., Pt., Mas- sier's Battery. Campbell, W., Pt., C, 69th Penn. Campbell, W. P., Capt., D, 1st Arkansas. Campbell, W. B., Pt., C, 1st Me. H. Art., age 20. Carey, J.G.,Pt., D,106th Pennsylvania. Carey, W., Pt., B, 13th Arkansas. Carl, M., Pt., G, 107th Pennsylvania. Case, J. E., Pt.,E,16th Conn., age 22. Castor, T., Pt., I, 5th Mich., age 26. Champens, W., Corp'l, C, 76th Penn., age 20. Chase, P. E., Pt., C, 7th Col'd Troops, age 25. Cheever, A. J., Pt., H, 16th Mass., age 35. Christ, A. L., Corp'l, A, 5th Penn., age 21. Clark, F., Corp'l, F, 4th Michigan, age 21. Clark.H., Serg't,E,125th New York, age 22. Clark, M. D., Pt., D, 6th Ohio Cav., age 18. Clune, J.,Pt., F, 14th In- fantry. Collins, M., Pt., K, 13th Kansas, age 26. Conners, W. B., Pt., C, 28th Illinois. Constable, W. M.,Pt., H, 1st Cavalry, age 26. Cook, J. M, Lieut look, J. M, Lieut., E, May 119th Penn., age 30. 11, 'I Cooper, A., Corp'l, F, 101st New York. Dates. Nov. 3, 7, '63. Sept. 17, 21, '62. De.31,'62 Ja.27,'63. May 9, Je. 1,'64. May 14, 26, '64. April 7, 24, '62. Sept. 17, —, '62. Sept. 17, Oc—,'62. May 6, 11, %4. July 11, 15, '63. Aug. 14, 19, '64. July 2, 18, *63. Jan. 30, Fe.4,'64. July 2, 16, r63. May 6, 17, '64. Mar. 31, Ap. 5, '65. Aug. 30, Se. 5,'62. Dec. 7, 10, '62. Oct. 5, 19, '62. Mar. 31, Ap.5,'65. .3, 1, '63. Aug. 30, Se. 8,'62. Operations, Operators, Result. Right. Surg.—Browne, C.S.A. Recovery. Right; circ. Nec. bone excised. Disch'd July 29. '63. Spec. 3822. Right. Surg. J. Aveuts, C. S. A. Furloughed Oct. 1, 1863. Left; circ. Surg. D. W. Bliss, U. S. V. Disch'd Feb. 16,1865. Right; circ. A. A. Surg. J. H. Thompson. Disch'd May 27,'65. Right. Surg. C. H. Mastin, C. S. A. Recovery. Left; flap. Disch'd Feb. 17, '63. Left; circ. Dr. P. W. Ellsworth, Hartford, Conn. Seq. remov'd. Disch'd Oct. 16, '63. Spec. 2859. Left; circular. Confed. surgeon. Disch'd Jan. 27,1865. Left; flap. Confederate surgeon. Disch'd Aug. 24, 1864. Right; circ. A. A. Surg. H. B. White. Fragments removed. Disch'd May 26, 1865. Left (July 14, am p. leg). Disch 'd January 27,1864. Right; circ. Surg. E. Bentley, U. S.V. Gangrene. Mustered out Dec. 23, 1864. Left; flap. Surgs. Ramsour and Patterson, C.S.A. Carious bone rem'd. Disch'd June 14,1864. Left; ant post. flap. Surg. E. Bentley, U. S.V. Seq. four and a half ins. long rem'd. Disch'd Sept. 4, '65. Specs. 294, 602, 666. Left; circ. Surg. D.W. Bliss, U. S.V. Disch'd July 18,1865. Spec. 4058. Right (haem.); flap. Disch'd Jan. 2, 1863. Left; flap. Surg. A. J. Ritchie, 2d Kansas. Dec. 25, haem.; lig. fem. art. Disch'd May 13,1864. Right; circ. Surg. W. F. West, 28th 111. Disch'd April 4, 1863. Right (Mar. 31, exc. knee j't); circ. A. A. Surg. F. H. Colton. Seq. rem'd. Disch'd Nov. 18,1865. Left. A. A. Surg. H. W. Duca- chet. Disch'd Aug. 19, 1863. Died July 28, 1865; sunstroke. Spec. 1119. Left; flap. Disch'd Dec. 11,'62. 'Jones (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, In XT. S. San. Com. Memoirs, 1871, Surgical Volume II, p. 267. >-hm :tWB t.^V 13i£» « •* ' ■ -A •." ^ ■V- K'f* ft- i V > 1 '■■*>"■ } ; \i- , a Y. A<*A, '¥'$''«>'\* -\ . / -4 -•n*v-'< ■■ -ur-r.cY-;. .T„ >'.>.' toth« A31 , j 'V.I, la ■ . I v *, .c ' Ts. . ' , >.:. :--•!. \i:u ,■ rV. t,'(v4. ' *> ' Middle l,ird : ■s ■ ■ + .1 Oi, ( ■n<;ia .,, II) *. -IT' >• &\ )ia'l ,1 ,)<■ ^mailjvi in the C>j' re: ■„ •».-■ irJU MUbK SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 281 name, Military Description, and Age. 46 Cortelyou, W.,Pt., B, 9th New York. 47 Cronk, E., Pt., F, 21st Missouri. 48 Crosson, B. F., Pt., E, U8th Georgia. 49 Cunningham, J. H., Pt., I, i!d Missouri. 50 Cutsinger, S., Pt.,C, 27th Indiana. 51 Daverio, C, Pt., E, 3d Maryland, age 26. 2 Davis, D. D., Pt.,K, 28th North Carolina, age 21. 53 Denton, E., Serg't, H, 113th N. Y., age 42. 54 Dodge, B. C, Serg't, M, 2d Indiana Cavalry. 55 Donahoe, P., Pt, C,9th Illinois, age If. 56 Donahue, A., Pt., O'Har ris's Battery. 57 Donovan, F., Serg't, I, 90th Illinois, age 46. Dumass, M. A., Pt., C, 44th New York. Dunlap, J., Pt, A, 14th Louisiana, age 29. 60 Dwyer, J. M., Corp'l, B, 20th Indiana. Easterly, A. N., Pt., B, 24th Iowa, age 20. Operations, Operators, Result. Farnum, G. W., Pt, E, llth Vermont, age 20. Farrell, J., Pt, I, 119th New York, age 35. Fellsburg, C, Corp'l, D 119th N.Y., age 23. Fifield, L.B.,Pt.,A,16th Mass., age 24. Fletcher,W.,Pt, H, llth Massachusetts. Flippo, J., Unassigned Recruit, age 25. Flockhart, D. S., Corp'l, D, 119th Penn., age 31. Foreman, J. W., Pt, H, 13th Infantry, age 20. Givens, J. F., Pt.,C, 24th Virginia. Goebel, J., Pt., E, 151st New York, age 39. Gordon, W. ¥., Serg't, A, 15th Texas. Gowan, J.,Corp'l, B, 82d Colored Troops. Graham, F., Pt., A, 2d S. Carolina, age 37. Gray, W., Serg't, G, 1st West Virginia. Gunold, J., Serg't, E. 45th Virginia, age 22. Hagerman, J. T, Pt.. K, 18th Virginia, age 21. Hamilton, J. H., Pt, M, 15thN.Y.H.A.,age21. Harney, F. W., Pt., B, 8th N. Jersey, age 18. Harnnoek,J., Pt., A, 8th A labama. Harting, L., Lieut., B, 7th New York. Hays, J., Pt., A, 1st Texas Cav., age 22. Haywood, J., Pt., D, 8th Colored Troops. Hearler, B., Pt, G, 42d Illinois. April 19, 23, '62. April 6, 15, '62. June 29, J'y5,'64. Oct. 4, 8, '62. Sept. 17, 21, '62. Aug. 9, 12, '62. Julv 3, 8, '63. Sept. 29, Oct. 2,'64. Aug. 22, 31, '62. Jan. 11. Fe. 2,'63 April 6, 18, '62. Nov. 25, De.13,'63 May 27, Je. 17, '62 Mav 5, 30, '62. May 5, 9, '64. April 6, 10, '64. June 1, 13, '64. July 1, 9, %3. July 1, 5, '63. Aug. 30, Sept. 26, 1862. July 21, Au.15,'61 Mar. 26, Ap. 4,'64. Nov. 7, 15, '63. Oct. 9, 13, '63. May 5, 30, *62. June 3, 8, '64. July 22, 27, '64. De.17,'64, Ja. 12,'65. Oct. 19, 23, '64. Mar. 23, Ap. 4,'62. Oct. 19, 23, '64. July 3, 6, '63. Aug. 6, 9, '64. Oct. 27, 30, '64. May 5, 19, *62. July 1, 5, '62. Septl, 10, '63. Feb. 20, Ma. 1,'64 De.31,'62. Jan. 4,'63. Right. Two Confed. surgeons. Bone taken away. Recovery. Left; flap. Surg. E. C. Franklin, U. S. V. Disch'd Aug. 29, '62. Left. Surg. R. A. Lewis, l\ A. C. S. Recovery. Left. Surg. — Palmer, C. S. A. Recovery. Right. Disch'd Jan. 10, 18G3. Left. Sept. 2, re-amp.; gang.; nec. bone rem'd; large vessels secured. Disch'd April 16, '63. Left. Exchanged March 17, '64. Left; short ant., long post, flap; neo Disch'd Oct. 17, 1865. Left; flap. Dr. Haggarty. Dis- charged Feb. —, 1863. Right; circ. Surg. W. Dicken- son, U. S. V. Dis'd July 19, '63. Right. Surg.C. H.Mastin,C.S.A. Recovered. Left; ant. post. flap. Surg. H. Strong, UUth Illinois. Disch'd Feb. 24, 1865. Right; ciro. Disch'd Oct. 16,'62. Left; circ. A.Surg. J. S. Billings, U. S. A. Prison May 1, 1863. Spec. 32. Left; flap. Surg. I. H. Thomp- son, 124th N. Y. Disch'd Sept. 1, 1864. Right (gang.); circ. Surg. W. J. McKim, 15th 111. Disch'd Oct. 5, 1864. Right; flap. Surg. D. W. Bliss, U. S. V. Disch'd Aug. 15,1865. Right; flap. Disch'd March 21, 1864. Left; flap. July 16, re-amp. up. third. A. Surg. W. H. H. Gin- kinger, 27th Penn. Discli'd Dec. 9,' 1864. Right;circ. A.Surg.M.F.Bowes, 12th Penn. Cav. Exfol. Disch'd Sept. lti, 18C3. Left; flap. Surg. — Walker, C. S. A. Disch'd March 28, 1862. Right; circ. A. A. Surg. D. S. Bootb. Returned to his home June 3, 1864. Right; circ. A. Surg. P.C. Davis, U. S. A. Jan. 13/64, protrud'g bone sawn off. Disch'd June 15, 1865. Left; circ. A. A. Surg. C. H. Wade. Nov. 25,'63, three ins. of bone rem'd. Disc'd Sept. 20, '64. Right. Recovery. Left; circ. Disch'd Oct. 7,1864. ----. Surg. T. E. Chaille, C.S.A. Recovery. Left; flap. A. Surg. J. T. Brown, U. S. V. Disch'd June 24, '65. Left ; circ. Furloughed March 16, 1865. Left; ciro. A. Surg. H. Pinkney, 83d N. Y. Disced Oct. 2, '62. Right; flap. Dr. Duball. Released April 1, 1865. Left; flap. Furloughed Nov. 21, 1863. Left; flap; slough. Discharged May 17, 1865. Right; circ. Surg. — Pope, C.S. A. Disch'd June 18, 1865. Right;circ. A.Surg.J.S.Billings, U. S. A. Prison June 27, 1862. Spec. 30. Left; flap. A. A. Surg. J. Swine- burne. M. O. May 8. 1863. Left (extravasation, mortification, and synovitis); circ. Surg. J. Bockee, U. S. V. Discharged Nov. 3, 1864. Spec. 400. Left; circ. Surg. — Holmes, C. S. A. Disch'd Oct. 3, 1865. Right; flap. Disch'd August 9, 1864. Name, Military Description, and Age. Heffner, J., Pt., C, 31st Ohio, age 24. Henderson, N. G. B.,Pt, H, 3d Texas. Hill, J., Pt, I, 3d Wis- consin. Hinsey, A., Pt„ F, 85th Illinois, age 17. Hoffacker, W., Corp'l, II, 3d Maryland, ago 22. Howard, W. H., Corp'l, E, 147th N. Y., age 23. 1 liens, J. S., Pt, I, 61st New York. Ivens, T. S., Confederate conscript. James, J., Pt., I, 2d Iowa Cavalry, age 20. Jordan, J., Pt., H, 1st Maryland, age 19. Keever, J. L., Pt., E, 91st Penn., age 19. Kelly, P., Pt,, E, 37th New York. Kenny, D., Pt,, A, 16th Infantry, age 40. Kerrigan, J., Pt., K, 5th New York, age 20. »Kimm, J., Pt, E, 152d New York, age 21. Kinnie, A., Pt., H, 14th New York. Knott, E., Pt, D, 3d New Jersey. Lanthrup, J. E., Pt., C, 59th Virginia. La Page, J., Pt., 1,147th New York, age 40. Lehr, W., Corp'l, K, 7th Ohio, age 25. Les, J., Pt., D, 6th Con- necticut, age 34. Linn, M., Pt, A, 122d Ohio. Locke, J.C.,Pt.,E, 100th Pennsylvania. Loeb, L., Pt, I, 3d New Jersey. Lofton, E., Pt,, F, 23d N. Carolina, age 22. Lynch, T., Pt, D, 40th New York, age 22. Lyon, A.E.,Pt, E,37th Iowa, age 23. Lyons, R.. Pt, D, 176th New York, age 42. Machamer, D., Pt., G, 96th Penn., age 22. Mackin, J., Pt., H, 24th Massachusetts. Madden, F.,Pt, H, 40th New York, age 18. Malloy, M., Pt, H, 69th New York. Dates. Sept. 19, 24, '63. Oct. 2, 8, '62. Sept. 17, 20, '62. July 19, 25, 'fi4. May 11, 27, '64. June 18, J'y6, '64. Dec. 13, 16, '62. Oct. 23, No.11,'64. Nov. 19, 28, '64. July 6, 12, m May 12, 19, '64. Mav 3, 18, '63. De.31,'62, Jan.3,'63. Aug. 30, Sep.7,'62. May 31, J'ne6,'64. June 27, J'y 1, '62. June 27, 30, '62. Feb. 9, 12, '64. July 2, 6, '63. Mar. 23, 26, '62. Mav 10, J'nel,'64. May 6, 27, '64. Aug. 30, Se.20,'62. June 27, J'y 2, '62. July 2, 5, '63. Sept. 1, 5, '62. Aug. 8, 12/64. Sept. 22, 27, '64. May 10, 14, '64. Dec. 13, —, '62. Julv 2, 7, '63. Sept. 17, 27, '62. Maroney, P., Pt,, G, 63d New York. Marsh. S., Corp'l, B, 1st Mass. Cav., age 27. Martin, P.,Pt.,H, 39th N. York, age 45. Mason, J. H., Corp'l, E, 149th Penn., age 31. Operations, Operators, Result. Sept. 17, 27, '62. Nov. 27, De.10,'63, Feb. 6, 11, '64. July 1, 8, '63. Right; circ. Surg. S. J. Young, 7!ith 111. Disch'd July 5, 1864. Left Recovery. Right; flap. Disch'd Jan. 13, '63. Left; flap. Surg. E. Batwell, 14th Mich. Disch'd June 15,'65. Right; ant. post. flap. Surg. R.B. Bontecou, U. S. V. Furlough'd July 19, '64. Spec. 3003. Left; circ. A. Surg. A. Delaney, U. S. V. Disch'd June 23, '65. Spec. 2805. Right; circ. Surg. C. S.Wood, 6bth N.Y. Nec.;re6ec. of stump; bone and necro. bone removed; osteomyelitis. Dis'd July 7,'63. Left A. A. Surg. F. A. Bu6hey. Prison March 3, 1865. Left; circ. A. Surg. J. A. Free- man, U.S.V. Haemorrhage; lig. Disch'd April 20,'65. Spec. 3753. Right; end of bone rem'd. Duty Nov. 29, 1864. Left; circ. Surg. D. W. Bliss, U. S.V. April 6, '65, seq. rem'd. M. O. Nov. 17, 1865. Left. M.O. June 22,1863. Died June 13, '64; general debility, result of injury. Left; ant. post. flap. Duty Nov. 28, 1864. Right; flap. Surg. J. C. Dorr, U.S.V. Haem.; exfol. Disch'd July 26,1863. Left; double flap. Surg. J. A. Lidell, U. S. V. Disch'd Jan. 16, 1865. Left; flap. Disch'd December 13, 186a. Right; ant. post. flap. Disch'd Sept. 30, 186:2. Left. Recovpry. Right; flap. Disch'd March 4, 1864. Left: flap. A. Surg. C. E. Denig, 7th Ohio. Disch'd July 3,1862. Right; circ. July 15, 1865, seq. rem'd. Disch'd Oct. 28, 1865. Spec. 1557. Left; circ. Surg.C. Page, U.S.A. Disch'd March 4, 1865. Left; circ. Disch'd June 29, '63. Left. Surg. W. H. White, U.S.V. Disch'd Oct. 1, 1862. Left (erysipelas). Exch'd April 27, 1864. Right; circ. July 3, '64, two ins. of femur sawn off and seq. rem'd. Duty Oct. 25. 1864. Right; flap. A.A.Surg. J.Prieto. Haem.; lig. fem. art. Disch'd Aug. 15, 1865. Right (gangrene); ant. post. flap. Disch'd April 2,1866. Left; circ. Surg. G. W. Thorn- hill, P. A. C. S. Sept. 15, '64, seq. rem'd. Disch'd Dec. 5,'64. Right; circ. Surg. F. G. Snell- ing, U. S. V. Discli'd June 25, 1863. Spec. 1620. Left; flap. Jan. 29, 1864, large bulbous mass of bone removed. Disch'd April 23, 1864. Right; ant. post. flap. Surg. M. C. Rowland, 61st N. Y. Oct. 4, haem.; lig. fem. art. Jan. 15,'63, rem'd seq. Disch'd March 4, 1863. Spec. 3957. Left; flap. Feb. 14, 1863, rem'd seq. Disch'd March 6, 1863. Right; circ. Surg. E. Bentley, U. S.V. Pyaemia. Dec. 20, '64, 5 ins. seq. rem'd. Disch'd July 12, 1865. Left; circ. flap. Surg. J. Aiken, 71st Penn. Exf. Disch'd Dec. 5, 1864. Spec. 2039. Right; ciro. flap. Disch'd Jan. 29, 1864. •Lidell (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 385. 'LIDELL (J. A.), On Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. Med. Sci., N. S., 1865, Vol. L, p. 20. Surg. Ill—36 282 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military description, and age 'Maxwell. G. R., Lieut. Col., 1st Mich. Cavalry, aire 22. 122 M. Cambridge, S.,PL, F, !)5th Penn., age 17. 3 McCoy, J., l't., B, 3d New Jersey, age 32. 124 2McCrearv, S. C, Pt, F, 100th'Penn. 125 McDonald, J., Fireman, II. S. Steamer Dragon. 126 Mo.Farland, W. H., Pt., B, Sth Wis., age 19. 127 McGary, E.,Pt, B, 17th Illinois Cav., age 20. Molirath, J., Pt., I, 4th Artillery, age 33. McKenzie, J., Serg't, I, 79th New York. McLaughlin, J., Pt., A, 3d Alabama, age 35. McNairy, T. W., Pt., B, 27th North Carolina. McVey, W., Pt., F, 5th Merrifieid, W., Pt., H, 14th W. Va., age 18. Miller, E., Pt., D, 61st New York, age 27. Miller, J. H., Pt., A, 118th Penn., age 21. Miiller, E., Pt., F, 29th New York, age 31. Mullins, P., Pt, K, 2d Wisconsin, age 20. Munn, D. A., Pt, K, 34th North Carolina. Nicholas, G. J., Corp'l, II, 73d Pennsylvania. Norris, J., Pt., I, 37th Mass., age 36. Oatis, J., Pt., H, 24th New York, age 20. Paddock, J., Corp'l, D, 43d Indiana. Page, C. W., Serg't, D, 3d Wisconsin. Perkins, N. B., Pt., Sth Maine Battery. Pitcher, J., Pt,, K, 94th New York. Pollock, J., Pt., K, 84th Illinois, ago 42. Postles, W. R., Corp'l, A, 1st Del., age 24. Potter, L., Pt., A, 56th Penn., age 26. Power, J. H., Pt, B, 36th Indiana. Preitling, C, Hospital Steward, 39th N.York, age 24. Pyle. J.. Serg't, B, 105th Indiana, age 36. Quote, R., Pt., C, 45th N. Carolina, age 31. Radley, A., Pt., B, 44th New York, age 21. Ray, J., Pt., B, 57th Virginia, age 29. Redding. J. M., Pt., A, 5th Georgia. Reveur, J., Pt., E, 47th New York, age 36. DATE8. April 1, 17, '65. May 3, 23, '63. May 10, 13, '64. Sept. 1, 14, '62. Mar. 9, 12, '62. May 4, 7, '63. Deo. 20, 23, '64. April 16, May 9,'65 July 21, 30, '61. Mav 2, 7, '63. Oct. 14, 24, '63. Sept. 19, 23, '63. Aug. 22, 28, '64. June 3, 8, '64. Dec. 13, 18, '62. Aug. 29, Se.5,'62. Aug. 28, Se.12,'62 June 27, J'yl3,'62. May 3, 18, ^63. Aug. 21, 26, '64. Aug. 30, Sep.9,'62. April 25, Myl5,'64. Sept. 17, 20, '62. May 3, 23, "to. Aug. 30, Sep.6,'62, Sept, 2, 6, '64. Dec. 13, 25, '62. July 1, 4, '63. Sept. 20, 27, '63. May 10, 17, '64. July 14, 24, '63. July -, 6, '63. May 8, 15, ''64. July 3, 6, '63. Sept. 19, Oct. 2,'63, Feb. 20, 25, '64. Operations, Operators, Result. Left; circ. Surg. D. W. Bliss, U. S. V. Haem.; nec. bone re- moved. M. O. Aug. 8, 1865. Left; flap. A.A.Surg. F.Hinkle, Gangrene. Disch'd July 4, '64. Right; flap. Confed. surgeon. Slough'g. Disch'd Sept. 2, '65. Right; flap. Disch'd Dec. 4, '62. Right, Surgs. Macomber and Bragg, U. S. N. Disch'd Jan. 13, 1863. Right. Confed. surgeon. May 14, amp. upper third. Disch'd March 21. 1864. Left; flap. A.A.Surg. R. T. Sill. M. O. Dec. 15,'65. Subsequently lost the other leg and one arm by accident. Died Jan. 15, '69. Left; ant, post flap. Surg. — Board, C.S.A. Nec.bone rem'd. Disch'd Nov. 11,'65. Spec. 1408. Right; flap. Surgs. Peachy and Gibson, C. S. A. Disch'd Oct, 22, 1861. Right; circ. Surgs. Black and Wilkerson, C. S. A. Recovery. Left. Furloughed Jan. 22,1864. Left. Surg. — Roberts, C. S. A. Disch'd Oct. 16, 1863. Left; circ; nec. bone removed. Disch'd July 19, 1865. Right; circ. Disch'd July 21, 1865. Left; ant. post. flap. A. A. Surg. A. E. Carothers. Nec. Disclrd March 21, 1864. Left; circ. Disch'd June 9, '63. Right; circ. A. A. Surg. S. R. Skillern. Nec. bone sawn off. May, 1863, reamp. upper third. Disch'd July 2, '64. Spec. 1227. Right. Surg. — Hoyt, C. S. A. Disch'd Sept, 28, 1862. Left. Oct. 20, 1863, flap re-amp. up. third. Disch'd Feb. 10, '65. Left; ant. post. flap. Surg. Z. E. Bliss, U.S.V. Sloughing; haem. Sept, 24, re-amp.; nec. Disch'd Aug. 7, 1865. % Right; dou. flap. A. A. Surg. C. M. Ford. Disch'd Mar. 24, '65. Right; flap. Surg. — Keller, C. S. A. Disch'd Aug. 23, 1864. Left. Disch'd Feb. 9. 1863. Right. A.Surg.A.Ingram,U.S.A. Disch'd Dec. 7,1863. Spec. 1156. Right; lat. flap; mortification. Sept. 13, re-amp.; exfol. Disch'd Aug. 16, '63. Spec. 1225. Right; ant. post. flap. Sept. 12, haem. Disch'd May 6, 1865. Left; circ. Surg. T. Antisell, U. S. V. Disch'd Dec. 24,1863. Spec. 990. Left; flap. Surg. J. H. Brinton. U.S.V. July26, re-amp. Disc'd June 18, 1865. Spec. 1495. Right; circ. Disch'd Jan. 24, 1864. Right (gangrene); ant. post. flap. Surgeon E. Bentley, U. S. V. Duty Sept. 19, 1864. Left. Ass't Surg. W. B. Witt, 69th lnd. (M. O. July 18, '63.) Left. Provost Marshal Septem- ber 10, 1863. Left; ant, post. flap. Ass't Surg. S. B. Ward, U. S. V. Disced Nov. 8, 1864. Left (gangrene). Exch'd March 7, 1864. Left, Surg. H. M. Lawson, C. S. A. Recovery. Left; flap. Surg.— Harrington, C. S. A. Disch'd May 1, 1865. Name, Military Description, and Age. Rice, T. JET., Pt., I, 31st Tennessee. Rich, H. C, Seaman. U. S. N., age 22. Richards, J. F., Pt., D, 15th Indiana. Rickard, H. C, Pt., M, llth Vermont, age 23. Robbins, O. P., Pt., H, 10th Pennsylvania. Ross, J., Pt., C, 123d Illinois. Rudy, P. H., Lieut., B, 2d Kentucky Battery. Sackett, V. B., Pt, G, 42d Pennsylvania. Sadler, J., Pt, M, 100th Pennsylvania. Schlotterback, J., Pt., I, 75th Ohio. Scott, J., Serg't, D, 34th Ohio, age 27. Scraggs, J. A., Pt, G, llth Virginia Cavalry, age 32. Shepherd, E., Pt., F, 1st Michigan. Sherman, T. W., Brig- adier General, U. S. V. Shubert, P., Pt, G, 15th Massachusetts. Smith, B., Pt., C, 88th Pennsylvania, age 21. Smith, J., Pt, G, 73d New York. Snackenberg, H,Pt., A, Mo. Home Guards. Spielman, S., Pt., D, 24th Iowa, age 28. Stone, C. H., Pt., F, 5th New Hamp., age 21. Sweatt, \V., Pt., K, 6th New Hampshire. Taylor, W., Pt, H, 42d Illinois, age 24. Tomy, E. H., Pt.,C, 27th Indiana. Tonsing, F. H., Pt, B, 107th Ohio, age 21. Trainer, J., Pt., C, 4th New Jersey. Tricketts, E!, Pt.,C, 14th W. Va., age 20. 'Ulmer, E. D., Serg't, G, 15th N. Jersey, age 22. Vezina, O., Pt,, B, 9th New Hamp., age 24. Vogelsang, D.,Pt.,A, 1st Minnesota. Walker, G. W., Pt., D, 12th Pennsylvania. Warren, J. A., Pt., C, 28th Illinois. Waux, J., Pt., E, 1st Louisiana, age 21. Wcatherly, L. H.,Corp'l, F, 10th Ala., age 20. Wheeler, J., Pt., F, 16th Kansas Cav., age 30. Wilckens,H.,Pt.,K, 17th Infantry, age 25. Dates. June 5, J'y 1,'64. Mar. 22, Ap. 8, '62. Sept. 11, 16, '61. Sept, 19, Oc.19,'64. June 27, J'y23,'62, Oct, 7, 18, '63. Sept. 30, Oc.13,'64. Aug. 9, 12, '62. Aug. 29, Se.15,'62. Aug. 30, Se.25,'62. May 10, 20, '64. Mav 9, 15,'64. July 21, Au. 1,'61. May 27, J'e-,'63. Oct. 21, No.—,'61. Mav 8, 26,''64. June 15, 25, '62. June 19, 22, '61. Sept. 19, 22, '64. June 3, 22, '64. Aug. 29, Se. 15,'62 Nov. 30, De. 4,'64, Sept. 17, 20, '62. July 1, 6, '63. June 27, 30, '62. Oct. 19, 22, '64. Oct. 19, No.14,'64 May 31, J'ell,'64 Sept. 17, 20, '68. Aug. 30, Se.21,'62 Oct. 5, 28, '62. July 2, 5, '63. May 12, J'e 3,'64. Oct. 28, Nov. 1, 1864. May 10, J'e8,'64. Operations, Operators, Result. rg. R. C. Bond, hM May 24, '62. Left. Surg. — Dorsey, C. S. A. Recovery. Left. Surg. S. Moody, C. S. A. Piece of bone rem'd. Disch'd Dec. 1, 1862. Right; flap. Sur^ 15th lnd. Disch Left; circ. A. Surg. J. G. Thomp- son, 77th N. Y. Haein. Dischfd June 19, 1865. Right; ant. post. flap. Surg. D. McRner, U. S. V. Disch'd Feb. 27, 1864. Died April 15, 1867. Specs. 1129, 2377. R't; flap. Dr. D. Swain, Shelby- ville, Tenn. Disch'd Feb. 4,'64. ---. Snrg. — Montague, C. S. A. Recovery. Right. Discli'd Nov. 12,1862. Left; circ. flap. Surg. E. Bent- ley, U. S.V. Disch'd June 6,'63. Left; flap. Disch'd Dec. 27, '62. Spec. 83. Right; circ; two ins. bone rem'd. Disch'd May 3, 1865. Left; ant. post, flap. Surg. E. Bentley, U. S. V. Gangrene, Prison March 1, 1865. Right; flap. Confed. surgeon. Discharged. Right. Prof. W. Stone. Retired. Spec. 3604. Died March 16,'79; pneumonia. Right; circ. Surg. T. R. Crosby, U. S. V. Disch'd Feb. 14, '62. Left; ant, post. flap. Surgeon J. Carroll, C. S. A. Necrosed bone rem'd. M. O. Jan. 15,1866. Left; flap. Disch'd Sept, 3,1862. Right; flap. Dr. E. Evans. Mus- tered out 1861. Left; circ; flaps. Disch'd Aug. 23, 1865. Spec. 4220. Left; circ. Surg. C. Page, U. S. A. Gang. Dec. 18, re-amp mid. third. Disch'd June 9, 18C5. Left; circ. A. Surg. B. A. Clem- ents, U. S. A. Disch'd May 19, 1863. Left (gang.); circ. Dr. Raney, Franklin, Tenn. Disch'd June 29, 1865. Right; flap. Disch'd Deo. 19, 1862. Right; flap. Disch'd July 15, 1864. Left. Disch'd Oct. 15,1862. Right; circ. Disch'd Feb. 13, 1865. Left. (Haem., gang.) A.A.Surg. E. G. Waters. March 8, 1865, exfoliation rem'd. Disch'd May 29,1865. Feb. 17, '66, amp. hip j'nt. Recovery. Specs. 107, 3734. Right (erysipelatous inflam.); ant, post. flap. A. Surg. W. Thom- son, U. S. A. Oct. 15,1864, nec. seq. rem'd. Discli'd June 14, 1865. Specs. 3558, 3599. Left; flap. Disch'd Nov. 25,'62. Right. Surg. E. Bentley.U.S.V. Disch'd June 18, 1864. Right; flap. Surg. W. F. West, 28th 111. Disch'd Mar. 20, '63. Right. Surg. P. F.Whitehead, P. A. C. S. Retired Jan. 30, 1865. Right; flap. Retired Dec. 9, '64. Right; flap. Surg. J. P. Erick- son, 16th Kansas Cav. Disch'd April 25, 1865. Left; ant. post. flap. A. A. Surg. S. D. J. Evans. May ], '65, nec. bone rem'd. Disch'd Aug. 26, 1866. Spec. 4347. 1 Lidkll (J. A.), On the Wounds of Blood-vessels, Traumatic Hxmorrhage, Traumatic Aneurism, and Traumatic Gangrene, in XI. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 176. 2 Lidell (J. A.), On the Wounds of Blood-vessels, Traumatic Hxmorrhage, Traumatic Aneurism, and Traumatic Gangrene, in XT. 8. San. Com. Memoirs, 1870, Surgical Volume T, p. 57. 'Lidell (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in XT. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 440. MORTON (T.G.), On Amputation at the Hip Joint, etc., in Am. Jour. Med. Sci., N. S., 1866, Vol. LIT, p. 17. Circular 7, S. G. O., 1867, pp. 51, 65. SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 283 Name, military Description, and Age. Willard, L. C, Pt., A, 64th Illinois, age 20. Williams, L., Serg't, C, 2d Bait. Cav. Mo. S. M. Williams, W. S., Pt., Morgan's Cavalry. Williamson, W. H , Pt., D, 114th N. Y., age 24. Willis, N. P., Pt., U. S. Signal Corps, age 23. Willson, J. P., Pt., K, 123d Illinois. Wilson, G., Serg't, D,7th Louisiana, age 26. Wilson, W., Pt, B, 2d Colored Troops. Wingo, T., 8th Ky. Mt'd Infantry, age 20. Wooden, L. W., Corp'l, K, 3d New York Cav. Woodward, O. S., Col., 83d Penn., age 27. Worthington, A. S., Pt,, D, »8th Ohio, age 21. ' Toung, J. W., Pt., D, 13th Miss., age 22. Zahns, J., Pt, A, 3d Wis- consin. Ackerman, G., Pt., L, 6th N. Y. H'vy Art'y, age 33. Addy, G., Pt., C, 7th Iowa. Allen, E. H., Pt, A, 2d Massachusetts Cav'lry, age 24. Anderson, G.W., Corp'l, B, 73d N. York, age 23. Anderson, W., Pt., F.6th New York H. Artillery, age 24. Atkins,W.H.,Pt, 1,10th Massachusetts, age 20. Atkinson, J. M., Pt.. A, 3d Indiana Cav., age 23. Baily, J. E., Lieut., A, 7th Maine, age 38. Baily, W.,Pt,E, 7th N. York, age 23. Baker, L. D., Pt., G, 4th Iowa. Barnes, L., Pt., I, 34th New York, age 19. 2 Barrett, G. Y., Pt,, F, 5th New Hampshire, age 20. 3Bause, J., Pt., B, 42d Indiana, age 24. Bell, L. H., Lieut., B, 113th Ohio. Benton, H. S., Serg't, C, 7th Mass., age 21. Berkey, C, Pt., A, 10th Penn. Reserves, age 24. Berns, J. F., Pt., F, 5th Ohio, age 19. Biehl, N., Pt., I, 155th Pennsylvania, age 27. Blanchard, A., Serg'tE, 92d New York. Blockle, M., Pt, A, 46th Iowa, age 20. July 28, Aug. 23, 1864. Aug. 16, 19, '62. Oct 19, 23, '64. Feb. 3, 10, '65. Oct. 7, 11, '63. Sept. 17, 28, '62. Nov. 21, De.15,'63. July 19, Au. 4, '63. Oct. 2, 14, '62. Mav 5, 15, "'64. June 27, J'y 16,'64. Sept. 17, 20, '62. Aug. 9, 14/62. May 19, 25, '64. Nov. 7, -, '61. July 12, 31, '64. July 2, 6, '63. June 18, J'y 5,'64. July 1, 6, '62. May 12, J'e 2,'64. July 12, 29, '64. Jane 2, 25, '64. De.29,'62. Ja.20,'63. June 30, J'y21,'62 Dec. 13, 25, '62. De.31,'62 Jan. 8,'63 Sept. 20, 30, '63. May 6, 25, '64. Aug. 30, Se. 18,'62 June 9, 23, '62. June 19, J'y 19,'64 May 31, J'ell,'62 June 30, J'y 6,'64. Operations, Operators, Result. Right (gang.); ciro. flap. Surg. J. C. Denise, 27th Ohio. Disch'd July 6, 1865. Right; flap. Dr. Raylin. Dis- charged. Left. Dr. V. B. Thornton. Re- covery. Spec. 406. Right; circ. A. Surg. J. Homans, jr., U. S. A. Disch'd May 13,'65. Left; circ. Surg. B. N. Bond, 27th Mo. Seq. rem'd. Disch'd Sept. 3, 1865. Right; circ. Disch'd Feb. 2,'64. Left. Retired September 22,'64. Right; flap. A. A. Surg. W. P. Powell. Disch'd June 16,1864. Left; circ. Surg.W.H.Gobrecht, U. S. V. Pro. Mar. Dec. 19, '63. Right. Nov. 1, reamp. Surg. S. A. Green, 24th Mass. Disch'd Feb. 17, 1863. Right. Surg. D.W. Bliss, U. S.V. M. O. Sept. 20. 1864. Spec. 2269. Left (gang.); circ. A. A. Surg. T. H. Hammond. Discharged. Left ; circ. Furloughed Novem- ber 20, 1862. Left; flap. Disch'd Dec. 21,'62. Left; flap. Surg. E. Bentley, U. S.V. Died June 9,'64 ; pyaemia. Spec. 2659. Right. Surg. E. C. Franklin, U. S.V. Died Dec. 12,'61; pneum. Left; circ. A. A. Surg. W. H. Randolph. Died Aug. 16,1864; exhaustion. ----; haemorrhage. Died July 19, 1863. Right; ant. post. flap. Surg. E. Bentley, U. S. V. Died July 17, 1864; exhaustion. Spec. 2831. Right; flap. July 26, bone rem'd; slough.; haem.; lig. fem. art'ry. Died Aug. 12, '62; exhaustion. Right. (Haem.; May 25, lig. fem. art'ry.) A. A. Surg. T. Liebold. Died June 7, 1864; pyaemia. Right; skin flap; circ. sect. mas. Surg. H. W. Ducachet, U. S. V. Died July 31, '64; prostration. Left; ant. post. flap. Surg. R. B. Bontecou, U. S. V. Haem. from fem. art. Died July 6, '64; ex- haustion. Spec. 3037. Left. Died January 25, '63; ex- haustion. Right (July 3, ball ext.); circ. Surg. R. B. Bontecou, U. S. V. Died July 28, '62; deeply jaun- diced. Right. (Dec. 16, osteo-plast. oper. at knee joint A. Surg. J. W. S. Gouley.U. S.A. Slough ; gang.; haem.) Surg. J. P. Prince, 3:>tb Mass. DiedDec.28,'62. Spec.536. ----; lat. flap. Surg. J. Shrady, jr., U. S. V. Diarrhoea. Died January 15, 1863. Left. Surgeon I. Moses, U. S. V. Died October 10, 1863. .Left; dou. flap. Surg.E.Bentley, U. S. V. Died June 17, 1864 ; pyaemia. Spec. 2657. Left (Sep. 11, haem.; 13,14, haem.; lig. fem.; Sept. 17, haem.); circ. Died Sept. 18,1862. Autopsy. Left; ant. post. flap. A. Surg. J. S. Billings.U.S.A. Haem. Died July 2, '62. Autopsy. Spec. 23. Right (June21, exc.tibia; gang.); circ. Surg. E. Bentley, U. S.V. Gang.; ulcer'n of artery. Died July 21, '64; exh'n. Autopsy. Spec. 3337. Right; flap. A. A. Surg. W. K. Cleveland. Died June 13, 1862; exhaustion. Right; lat. flap. Surg. J. G. Kee- non, U. S. V. Died July 17, '64. Name, Military Description, and Age. Bodman, C, Pt., G, llth Infantry, age 24. Bovard, P., Pt., K, 1st Massachusetts. Boyd, J., Pt., C, 19th Ohio. Bradley, J., Pt., F, 48th Pennsylvania, age 21. Brannagan, J., Pt, I, 69th Pennsylvania. Britton, C, Pt., C., 12th Kentucky, age 40. Brizzee, W. J., Pt,, G, 46th Pennsylvania. Brown, T., Pt, K, 5th Col'd Troops, age 21. Bryant. N. B., Pt., K, 19th Miss., age 25. Buckey, J. E., Pt., E, 7th Maryland, age 30. Burditt, W. C, Pt., I, 4th West Virginia. Burke, W., Pt., G, 69th New York. Burroughs, J., Serg't, B, 3d Kentucky* Cadv, T. P. T., Pt., C, 12th Illinois, age 22. Carpenter, H. W., Pt,,K, 3d Michigan, age 33. Carpenter, J. H., Pt., E, 110th Ohio, age 40. Can-, G. W., Serg't, G, 1st Maine H. Artillery, Casey, M., Pt., K, 108th New York. Chamberlain, R., Serg't, I, 16th Conn., age 43. Chandoin, B. P., Pt., A, 4th Texas, age 20. Chase, C, Corporal, B, 120th N. York, age 23. Christy, W. J., Pt, E, 19th Mass., age 23. Coe, W. W., Serg't, H, 23d N. Carolina, ago 23. Cole, C. M., Pt, B, 48th New York. Coleman, C, Pt., G, 1st Penn. Reserves. Collins, J. F., Pt., F, 2d Kentucky. Connors, J., Pt,, H, 7th N.Y. H'vyArt,age37. Conrad, H., Pt, I, 24th Michigan, age 21. Conway, P., Pt., M, 1st New Hampshire Cav. Cooke, A. E., Serg't, G, llth Infantry, age 20. Creighton, M., Serg't, B, 9th Mass., age 20. Culbertson,D. J., Serg't, A, 69th Ohio, age 25. Darcey,W. H.,Pt.,D,6th Maryland, age 23. Davis, H. A., Pt,,D, 12th N. Carolina, age 30. Dav, J. W., Corp'l, H, 91st Ohio. Dean, S., Pt., I, lllth New York. July —, 10, '63. June 25, J'y 2, '62. Jan. 2, -, '63. June 3, 8, '64. June 3, -, '64. Nov. 30. De.30,'64. June 22, —, '64. Sept. 29, Oc.18,'64. May 5, 19, ^62. June 5, 10, '64. May 19, 26, '63. Sept. 17, 24, '62. Sept. 20, —, '63. Oct, 3, No.1,'62. Nov. 27, De.13,'63 June 22, J'y 5, '64, June 18, J'y 3,'64 Sept. 17, 27, '62. Sept. 17, Oc.15,'62 Sept. 17, 24, '62. June 1, 5, '64. Aug. 16, Sep.8,'64. July 2, 15, '63. July 19, Au.1,'63 Sept, 14, 23, '62. Sept. 20, 23, '63. June 16, 26, '64. May 6, 22, '64. Nov. 14, 22, '64. July 2, Au. 1,'63. May 12, 26, '64. June 1, 16, '64. May 31, J'ne9,'64 April 7, 14, '65. July 20, 23, '64. July 3, -, '63. Operations, Operators, Result. Right. Died August 15, 1863. ---(gangrane). Died July 3, 1862. Left. Died January 13, 1863. Right-(mortification; haem.); circ. A. Surg. H. Allen.U.S.A. Died June9°64;shock,etc. Spec.2931. Left; flap. Surg. F. F. Burmeis- ter, 69th Penn. Died June 14, 1864. Spec. 1501. Left (carious); lat. flap. A. A. Surg. J.E.Patterson. Died Jan. 6, 1865. Right, Died July 4,1864. Left; circ. A. A. Surgeon H. B. White. Died Oct. 26, 1864. Left; ant, post. flap. A. Surg. J. S. Billings. U. S. A. Gangrene. Died May 26,'62. Aut. Spec. 31. Left; ant. post. flap. Died June 20, 1864. Left; circ. A. A. Surg. L. Dar- ling, jr. Died May 31, 1863. Spec. 1625. Right. Died September 27,1862. Right. (Sept. 28, excis. femur.) Died October 10,1863. Right. Surg. J. F. Hogden, U. S. V. Died Nov. 8,1862; pyaemia. Spec. 469. Right; circ. Surg. E. Bentley, U. S. V. Died Jan. 11. '64; py- aemia. Autop. Specs. 2011, 2012. Left (exc. fib.); circ. A. A. Surg. J. F. Thompson. Died July 16, '64; pyaemia. Spec. 2759. Right; circ. Surg. A. F. Sheldon, U.S.V. Died July 10, 1864; exhaustion. Spec. 2764. Left, Died Oct. 3,'62. Spec. 380. Right. A. Surg. J. Oliver, 21st Mass. Died October 29, 1862. Spec. 274. Left, Surg. A. X. Dougherty, U. S.V. DiedSept.29,'62. 5p«c'.127. Right; circ. A. Surg. W. Thom- son, U. S. A. Haem. Died July 12, 1864 ; pyaemia. Autopsy. Specs. 3548, 2509, 6715. Right; circ. A. A. Surg. D. Ken- nedy. Died Sept. 22, 1864; ex haustion. Spec. 3643. Right; circ; slough. Died Sept. 19, 1863. Left. Died August 3, 1863. Right. Surg. H. S. Hewit.U.S.V. Died, Sept. 23, '62, on operating table. Right. Surg. A. W. Heise, 100th 111. Died Oct. 5,'63; exh'n. Right; .circ. Died June 26, '64. Left (May 19, excis. fib.; gang.); circ. Surg. 0. A. Judson, U.S.V. Died May 27, 1864; pyaemia. Spec. 3653. Left (gang.); circ A. A. Surg. M. Darrach. Died Dec. 18, '64; pyaemia. Left; flaps sloughed. Died Aug. 6, 18S3. Left; circ. A. A. Surg. T. W. Miller. Died June 9, 1864 ; py- aemia and tetanus. Spec. 2818. Right (nec); circ. A. A. Surg. J. W. Digbev- Died June 18, 1864. Spec. 3399. Left; circ. A. A. Surg. J.Phil- lips. Died June 24, '64; exh'n. Right; lat. flap. A. Staff Surg. W. J. Burr, U. S. A. Died April 24, 1865. Right. Surg. J. B.Warwick, 91st Ohio. Died July 23,'64; exh'n. Left. Surg. O. Munson, 108th N. Y. Died August 9, 1863. •FISHER (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., etc., in Am. Jour. Med. Sci., N. S., 1863, Vol. XLV, p. 47. * PRINCE (J. P.), Surgical Cases, in Boston Med. and Surg. Jour., 1863, Vol. LXVLU, p. 69. 'Shrady, jr. (J.), Cose* in Military Surgery, in American Medical Times, 1863, Vol. VI, p. 113. 284 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. Name, Military Description, and Age. 262 Delaney, J., Pt., G, 67th May 6, 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 1299 New York, age 20. DemasUrs,A., Pt., F, 7th Florida, age 24. Dennison, H., Pt,,E,123d Ohio. * Dick, T., Pt, B, 6th N. Hamp., age 23. Dillon, J., Pt, D, 34th New York, age 19. Dobey, E., Pt., D, 14th North Carolina. Donnelly, J.,Pt,,B,198th Penn., age 22. Douglas, A. J., Pt., M, 1 st Maine H'vy Art'y, age 21. Dovers, C, Pt., D, 148th Pennsylvania. Drake, J. B., Pt, H, 62d Penn., age 22. Durgin, P. G., Pt.,H,6th New Hamp., age 19. Eaton, J. A., Lieut., D, 10th N. Hamp., age 24. Edson, W., Pt., I, Sth N. Carolina, age 22. Elliott, P., Pt., B, 18th Georgia Bat'ry, age 24. Elliott, P. M., Pt.,G,96th Ohio, age 20. Evans, S. B., Corp'l, D, 140th Penn. Evans, W. E.,Pt.,G,37th Georgia, age 28. Fanning, H. C, Pt., D, 8th Conn., age 18. Fitzpatrick, T., Pt,, A, 10th Infantry. Frakes, W., Pt., B, 26th Indiana, age 19. Furlong, P., —, E, 4th New York. Galiger, M., Serg't, G, 73d New York, age 22. Gibbs, C. E., Pt., E, 19th Iowa, age 21. Gilbert, J., Pt.. G, 119th New York, age 38. Gittens, T., Pt, G, 12th Mass., age 48. Glenn, J. R., Pt., E, 32d Alabama. Goddard, W. A., Pt., F, 9th Maine, age 35. Godwin, C, Pt., E, 48th North Carolina, age 33. Going, J. B., Pt., G, 60th Georgia. Gordon, S. I., Serg't, B, 1st Alabama Cavalry. Gray, N, Pt., II, 33d N. Carolina, age 26. Gray.W. A., Pt,,K,13th New Hamp., age 25. Greene, A., Pt., E, 93d Penn., age 34. Grey.C. C , Lieut, I, 4th Maine, age 28. Grovendyke, A., Lieut., F, 124th lnd., age 34. Gump, H., Pt., D, 61st Penn., age 45. Hack, C, Pt., D, 15th Connecticut, age 21. Hale, J. Ii., Pt., C, 31st Iowa. Dates. 27, '64. Dec. 7, 11, '64. June 15, —, '63. May 8, 11, '64. June 1, 13, '62. Sept. 19, Oct.4,'64. Mar. 29, Ap. 7, '65. May 19, 31, '64. May 3, 17, r63. July 1, 27, '62. Aug 30, Se. 19,'64. May 10, 21, '64. May 12, 20, '64. April 6, 16, '65. Nov. 3, 30, '63. June 2, 9, '64. Dec. 16, 20, '64. Sept. 17, Oc.17,'62. May 6, 14, '!64. Dec. 7, 12, '62. Sept. 17, Oct. 1,'62 July 2, 5, '63. Dec. 7, 30, '62. July 2, 6, '63. Dec. 13, 21, '62. Nov. 27, De. 1,'63. May 20, J'ne5,'64. Dec. 13, 17, '62. Sept. 19, 22, '64. Nov. 25, —, '64. May 3, 10, '63. June 1, 13, '64. May 9, 29, '64. Mav 6, 20, ''64. Nov. 30, De.25,'64. May 5, 15, '64. Mar. 8, -, '65. Nov. 24, De. 3, '63. Operations, Operators, Result. Left; ant. post. flap. A. A. Surg. J.A.Bates. Haem.; lig. fem. art. Died July 10, 1864; pyaemia. Right (gang.); circ. Surg. S. D. Turney, U. S.V. Died Dec. 14, 1864; gangrene. Right. Died J une 26,1863. Left; circ.; sloughing. Died June 12, 1864; pyaemia. Left; flap. A. A. Surg. G. W. Edwards. Died July 13, 1662; exhaustion. ----; circ. Surg. J. W. Lawson, C. S. A. Haem. Died October 18,1864; exhaustion. Right; ant. post. flap. Surg. N. R. Moseley.U. S.V. Died April 11, 1865; exhaust'n. Spec. 4069. Right (haem.); lat. flap. A. A. Surg.W. H. Ensign. Died May 31, 1864. Spec. 2388. Left (gang.). Surg. C. S. Wood, 66th N. Y. Died May 19,1863. Spec. 1171. Right; circ. A. A. Surg. W. K. Cleveland. Died August 2, '62; exhaustion. Left, A. A. Surg. W. K. Cleve- land. Died Sept. 20, 1864. Left (sloughing). A. A. Surg. J. Coloosdian. Died May 27, '64. Left; circ. A. A. Surg. J. Phil- lips. Haem.; lig. fem. artery. Died May 25, '64; haemorrhage. Left; ant. post. flap. A. Surg. W. Carroll, U. S. V. Died May 20- 1865; exhaustion. Spec. 4163. Right (ven. haem.; diarr.); circ. A. Surg. P. S. Conner, U. S. A. Died Nov. 30, 1863. Left; circ. Surg. J. W. Wishart, 140th Penn. Died June 13, '64. Right (haem.); lat. flap. A. A. Surg.B.L. McClure. DiedDec. 24, 1864; exhaustion. Right. A. Surg. J. Oliver, 21st Mass. Died October 29, 1862. Spec. 287. Left; ant. post. flap. Died June 3, 1864; exhaustion. ---; circ. Surg. T. W. Florer, 26th lnd. Died Dec. 26, 1862; pyaemia and pneumonia. ---; flap. Died October 1, '62; exhaustion and shock. Left (haem.); lig. prof. art. Died July 8,1863; exhaustion. Left; ant. post flap. A. Surg. J. J. Sanders, 1st Iowa Cav. Died Jan. 22, 1863. Right; flap; haem.; gang. Died August 13, 1863; pyaemia. Left; circ. Surg. E. Bentley, U. S.V. Haem. Died Jan. 1,1863. Autopsy. Spec. 595. ---. Surg. J. C. Morgan, 29th Mo. Gang. Died Dec. 5,1863. Left; flap. A. Surg. A. P. Frick, 103d Penn. Died June 5,1864. Left (gang'ns); circ. Died Jan. 13, 1863. Left; circ. Surg. D. Orsay, C. S. A. Gangrene. Died Oct. 6,'64; exhaustion. Right. Died December 27,1864. Left (gang.); circ. May 14, haem. Died May 15, 1863. Right; ant. post flap. A.Surg. S. B. Ward,U.S.V. Gang. Died June 25, '64. Autop. Spec. 2709. Right; circ. Surg. E. Bentley, U. S. V. Died June 2, 1864; haemorrhage. Spec. 2661. Left; circ. Prof. F. H. Hamilton. Died May 29, 1864; pyaemia. Right; ant. post. flap. A.Surg. W. B. Trull, U. S.V. Died Dec. 27, 1864; exhaustion. Left; circ. Died Jun« 9, 1864; pvaemia. Autopsy. Left. Died April 18, 1865. Left; lat. flap. Surg. J.C.Mor- gan, 29th Mo. Died Dec. 3,'63. Name, Military Description, and Age. Hall, J., Pt., A, 12th Pennsylvania, age 22. Hall, P., Pt., D, 42d Virginia. Hammond, C, Pt., H, llth Massachusetts. Hankins, J., Pt., D, 4th New Jersey. Hargrow, J. H., Pt., D, 12th North Carolina. Harman, B., Pt., A, 50th Penn., age 24. Harris, D., Pt., F, 59th Col'd Troops, age 22. Harris, J., Pt., A, 38th Col'd Troops, age 21. Harris, R. E. H., Pt, F, 57th N. C, age 27. Hartley, W., —, C, 6th Georgia. Hayden,G.,Corp'l, B,lst Md. Battery, age 22. Hayer, G., Pt., K, 6th N. Y. H. Art'y, age 27. Hedder, W., Pt., C, 56th New York. Henery, J. F., Adjutant, 157th N. Y., age 24. Hennely, P., Pt., K, 48th Pennsylvania. Hezeltine, L.,Pt.,D, 86th New York, age 19. Highsmith, D., Pt., D, 24th Georgia. Hill, S. W., Corp'l, H, 36th Wis., age 36. Hollenback, H. W., Pt, A, 46th Illinois. Honan, M., Pt., B, 10th Vermont, age 24. Hoysington, A., Pt., A, 8th Michigan, age 25. Hughes, J.O.,Pt.,A,lst Maine H. Art'y, age 29. twin. F. H., Corp'l, E, 93d Penn., age 22. Janvrin, G. A., Pt., B, 12th N. H., age 20. Jenkins, F., Pt., D, 1st New York. Jenkins, J., Pt, D, 20th Wisconsin, age 22. Johnson, I., Pt., C, 57th Indiana, age 27. Jones, A., Lieut., Texas Regiment. Jones,A.D., Pt, B, 12th New Hamp., age 20. Jones, W. R., Pt., H, 32d Ohio, age 25. Keefe, J. A., Pt., H, 63d New York. Keeley, E., Serg't, A, 15th Infantry, age 21. Kelly,W. D., Pt., 1,13th Ohio. Kielt, J., Serg't, C, 69th New York, age 20. Kirby, E.,Brig.-General, U.S.V. Koerner, J., Corp'l, B, 10thN.Y.H.A.,age28. Kopp, S. S., Pt., E, 10th Penn. Res., age 21. Ladd, G. W., Pt, B, 2d New Hamp., age 21. Dates. May 10, 28, '64. July 3, 8, '63. Aug. 29, 3e. 18,'62, Sept. 19, 23, '64. Sept. 17, Oct. 7,'62, Sept. 30, Oc.14,'64. July 15, 24, '64. Sept. 29, Oc.22,'64. May 4, 30, '63. Sept. 17, Oct. 3,'62. July 3, 8, *63. May 19, Je. 16,'64. June 1, 13, '62. July 2, 20, '63. Aug. 29, Se. 12,'62. May 8, 17, '64. Sept. 19, 23, '64. May 26, J'ne9,'64. April 6, -, '62. April 2, 7, '65. June 26, J'y 4, '64. May 19, 22,' '64. Mar. 25, Ap.l4.'65. June 3, 8, :64. Aug. 31, -, '62. Dec. 7, 22, '62. Nov. 30, De.28,'64 Feb. 15, Mar.7,'62 June 3, 8, '64. June 27, J'yl0,'64. Sept. 17, Oc.10,'62. Aug. 7, 12, '64. Jan. 2, 6, '63. Sept. 17, Oc.10,'62. May 3, 10, '63. April 2, 15, '65. Aug. 28, -ie.20,'62 Aug. 29, Se.19,'62 Operations, Operators, Result. Left; ant post flap. Surg. R. B. Bontecou, U. S. V. Died May 31, 1864 ; exhaustion. ----. Died July 15, 1863. Right; circ. A. Surg. J. C. Mc- Kee, U. S. A. Died Sept. 28, 1862. Spec. 63. Right; modified flap. A. Surg. J.G.Thompson, 77th New York. Slough. Died Oct. 10, 1864; typhoid fever. Right. Surg. H. S.Hewit, U. S.V. Died October 9,1862. Spec. 365. Left; circ. Surg. G. S. Palmer, U.S.V. Died Oct. 17,'64; exh'n. Right; flap. A.A.Surg. J. Prieto. Died July 25, 1864; tetanus. Left: flap. A.A.Surg. A. B. Cha- pin. Died October 24, 1864. Left;ciro. Surg.C.D.Rice.C.S.A. Gang. Died June 7, 1863. Right. A. Surg. R. F.Weir, U.S. A. Pyajmia. Died Oct. 24, '62. Spec. 872. Left (haem.); lig. femoral artery. Died Sept 25, 1863; exhaust'n. Left; circ. A. Surg.W. F. Norris, U.S.A. Haem.; lig. Died June 29, 1864 ; pyaemia. Autopsy. ---(amp. knee j't, June 1); hiem. Died July 3, 1862. Spec. 4933. Right. Died July 24, 1863; py- aemia. Right. Surg.O.A. Judson,U.S.V. Died October 25,1802; pyaemia. Spec. 184. Left; circ. Surg. O. A. Judson, U.S.V. Haem. Died June 9, '64; pyaemia. Left; circ. Died Oct. 20, 1864; exhaustion. Right; circ. A. A. Surg. H. M. Dean. Died June 16,1864; ex- haustion. Spec. 2490. ----. Surg. E. C. Franklin, U.S. V. Died April 27, 1862. Right; ant. post. flap. Surg. E. Bentle3', U. S.V. Died April 10, 1865; exhaustion. Left; circ. A. A. Surg. J. H. Thompson. Died July 29, '64; pyaemia. Spec. 2760. Right; oval flap; circ. of muscles. Surg. N. R. Moseley, U. S. V. Died May 27,1864. Spec. 2308. Left; circ. Surg. D. W. Bliss, U. S. V. Died May 2, '65; py- aemia. Spec. 4077. Right; ant post, flap. Surg. R. B. Bontecou, U. S.V. Haem. Died June 11, '64 ; exh'n. Spec. 3070. ----. Died October 2, 1862. ----; circ. Surg. T. W. Florer, 26th lnd. Died Dec. 26, 1862; haemorrhage. Left; lat. flap. A. A. Surg. H. C. May. Died Jan. 1.1865; exh'n. Spec. 3757. Right; circ. 18th, haem. from fem. Died March 18, 1862; haem. Right; ant, post, flap. Surg. R. B. Bontecou, U. S.V. 9th, haem. Died June 11, 1864; exhaust'n. Spec. 3062. Right; circ. Surg. E. M. Powers, 7th Mo. Died July 13,'64; shock. Right. A. Surg. L. H. Searle, 26th N. Y. Died Oct, 19, 1862; exh'n. Spec. 813. Left; circ. Died Nov. 28, 1864; chronic diarrhoea. ----. Surg. C. J. Walton, 21st Ky. Died Jan. 9,1863. Left j lat. flap. Died Oct. 25,'62; pyaem. Autop. Specs. 790,873. Left, Surg. B. Norris, U. S. A. Died May 28, 1863; pyaemia. Spec. 1076. Right; circ. Surg. E. Griswold, U. S. V. Died April 24, 1865. Right, Surg. C. Page, U. S. A. Died Sept. 22,1862. Spec. 76. Right. A. A. Surg.H.C.Heilner. Died Sept 25,1662. Spec. 118. SECT. III.J INTERMEDIARY AMPUTATIONS OF THE THIGH. 285 338 339 840 341 342 343 344 345 346 347 350 351 352 354 355 356 357 358 359 360 361 363 364 365 366 367 369 370 371 372 373 Name, military Description, and Age, Landman, J., Pt., 6th Georgia. Lane, T., Pt., F, 6th N. Y. H'vy Art'y, age 50. Langford, J.,Pi,, E, 60th Georgia, age 36. Lasley, L. C, Pt., H, 124th lnd., age 19. Lawson, L. B., Pt., F, 128th New York. Lebroke, II. F., Pt., A, 6th Maine, age 24. Lehman, C, Lieut., D, 20th New York S. M. Libbey, J., Pt, G, 69th New York. Long, J., Pt., E, 148th Penn., age 29. Loomis, J., Pt., G, 109th New York, age 31. Loutz, J., Pt, D, 94th New York, age 17. Loveland, J., Pt.,C, 16th Connecticut. Luce, D. A., Pt., C, 17th Vermont, age 42. Luherman, C.,Corp'l, D, 9th Ohio. Lunceford, T. J., Serg't, E, 2d West Virginia Cavalry, age 24. Lynch, C, Pt-, A, 95th New York, age 22. Lyon, S., Pt., C, S4th In- diana, age 23. Mallet, J. H..Pt.,E, 19th Iowa, age 30. Mallott, F., Pt., A, 92d New York, age 21. Marquardt, J., Pt, G, llth Wisconsin, age 22. Marquis, H. M., Corp'l, B, 23d N. Carolina. Marston, G., Pt, H, 4th Vermont, age 29. Martin, H., Pt., H, 26th Ohio. Mask, M., Pt., A, 23d N. Carolina, age 24. Maurer, H.,Corp'l, K,7th Maryland, age 24. Mayer, J., Pt., H, 44th New York. Mayo, G. W., Serg't, A, 43d Alabama. McAvory, W., Pt., G,73d New York, age 20. McCarty, J., Pt, I, 61st Pennsylvania. McCormick, J.E., Pt,E, 26th Indiana, age 22. McCoy, J., Pt., B, 140th Penn., age 17. McKee, T., Pt., I, 123d Ohio. McKenna,P.,Pt,I,67th New York, age 30. McLaughlin, R., Pt,, H, 142d Penn., age 21. McMahon, J., Pt.,A, 61st New York. McMicken, N., Pt, A, 151st Penn., age 24. Sept 17, Oct. 6,'62 May 19, 25, '64. July 1, 18, '63. Mar. 19, Ap. 1,'65. Sept. 19, 26,'64. May 3, 17, '63. Sept. 13, Oct. 4,'62. Sept. 17, Oct. 8.'62. May 10, J'ne4,'64. Mav 12, J'ne'2,'64. April 2, -, *65. Sept. 17, Oct 7,'62. Sept 30, Oc.17,'64. Sept 19, Oct 7,'63. Dec. 21, 1864, Jan. 9,'65. Mar. 31. A.pr.7,'65. Sept. 19, Oct. 6,'63, Dec. 7, 28, '62. Sept. 29, Oc.15,'64. May 22. J'ne8,'63 Sept 17, Oct. 8,'62. Aug. 29, Se.15,'64, Sept. 19, 25, '63. Sept. 14, 20, '62. Mar. 31, Ap. 6,'65, Dec. 13, 24, '62. May 10, 13, '64. July 2, 8, '63. June 1, 7, '62. Dec. 7, 12, *62. May 12, J'ne3,'64. June 15, —, '63. June 1, 16, '62. May 10, 23, '64. Sept. 17, —, '62. Julv 2, An. 1,'63 Operations, Operators, Result. Left (uloer'n of post. tib. artery; haem.); flap. Ass't Surg. R. F. Weir, U. S.A. Died Oct. 14,'62; pneumonia. Specs. 789, 875. Right; ciro. Surg. E. Bentley, U.S.V. Died May 28, 1864; gangrene. Spec. 2658. Left; flap of skin and ciro. of muse Died August 10,1863; pyaBmia. Specs. 3856, 3968, 3987, 3988. Right; oirc A.A. Surg. D. Shep- pard. Died April 4, '65; shock and exhaustion. Left; modified flap. A. Surg. J. G. Thompson, 77th N.Y. Haem.; lig. fem. art. Died Oot. 4,1864; exhaustion. Left. (haem.). Died May 29,1863; exhaustion. Right. Died Oct. 9, 1862; pros- tration. Spec. 141. Left. Dr. Green. Died Dec. 11, lgh'2; exh'n. Autop. Spec. 1099. Right; circ A. A. Surg. F. H. Colton. Died June 4, '64 ; shock. Right; circ. Surg.A. F. Sheldon, U. S. V. Gang.; diarrh. Died June 19,1864; exhaustion. Left. A.A.Surg.J.Tyson. Haem.; slough.; lig. fem. art Died May 26, 1865: exhaustion. Left. Surg. T. H. Squire, 89th N.Y. Died Oct. 16,1862; haem. Spec. 3576. Left; ciro. Surg. J. T. Kilby, P. A. C. S. Died Dec. 9, 1864. Right; circ. Surg. F. Irish, 77th Penn. Died Oct 7, 1863. Left; oval flap; circ. sect, muse. A. Surg. R. F. Weir, U. S. A. Died Jan. 17, 1865; pyaemia. Autopsy. Spec. 3811. Left; lat. flap. Surg. N. R. Mose- ley, U. S.V. Died June 24, '65; exhaustion. Spec. 4071. Right (erysip.; rec't haem.; lig,; gangrene). Died Oct. 8, 1863. Left; ant. post. flap. A. Surg. J. J. Sanders, 1st Iowa Cavalry. Died Dec. 30, '62; haemorrhage. Left. A.A.Surg. B. N. McCleery. Died October 27, 1864. Right. Surg. E. M. Powers, 7th Mo. Died June 16, 1863; phle- bitis and pyaemia. Left. Surg. H. S. Hewit, U. S.V. Died Oct. 18, '62. Spec. 369. Right (mortification); circ A. A. Surg. J. C. Shimer. Died Sept. 15,'64 ; shock. Autop. Spec. 3831. Right. Died Sept 30, 1863. Right. Oct. 6, 8, 9, haem.; lig. fem. ait.; slough. Died Oct. 9,1862; exhaustion. Left; flap. Surg. N. R. Moseley, U.S.V. Died April 9, 1865; nerv. exh'n and haem. Spec. 4070. Left. Died Dec. 29,1862. Spec. 4154. ----; ant. post. flap. Surg. C. B. Gibson, C. S. A. Died May 16, 1864; exhaustion. Left (haem.). Died July 11,'63; exhaustion. Left; flap; pyaemia. Died June 11, 1862. Right; ant. post. flap. A. Surg. E. A. Clark, 37th 111. Died Dec. 24, 1862; haemorrhage. Right; ant. post. flap. Surg.R. B. Bontecou.U. S.V. Haem. Died June 8, '64 ; exh'n. Spec. 3058. ----. Died July 15, 1863. ----. Died June 18,1862; exh'n. Left; antpost.flap. Surg.E.Bent- ley, U. S.V. Gang.; pyae. Died June 7,'64; asthenia. Autopsy. Spec. 2553. Left (haem.). Oct. 2, fem. art. lig. Died Oct. 16,1862. Right (sloughing). Died August 12, 1863. Name, military Description, and Age, McPherson, D., Pt., E, 5th Mich., age 24. McPherson, W. H., Pt., D, 50th Georgia. McVeay, J., Pt,, E, 23d Penn., age 25. Medgley, A. W., Lieut,, H, 10th Massachusetts. Meeker, A., Pt., D, 15th New Jersey. Melhan, W., Lieut,, C, 188th N. Y., age 21. Melman, C, Pt., B, 1st New Jersey, age 17. 1 Mensh, C, Pt., H, 33d New York. Metzer, W., Serg't, E, 1st Louisiana, age 26. Mires, E., Pt., A, 23d Michigan, age 23. Mohre, A., Pt,, K, 104th Pennsylvania. Moore, W., Serg't, I, 33d Missouri, age 44. Morgan, W. E., Corp'l, B, 57tb Illinois. Morris,C.,Corp'l, F, 19th Iowa, age 48. Morrison, W. E. L., Pt., I, 29th Conn., age 21. Morriton, T. P., Pt., E, 1st Miss., age 26. Morse, L. O., Pt, 1,17th Vermont, age 17. Murphy, D., Pt., F, 62d Penn., age 18. Noble, S., Pt., I, 71st Pennsylvania. Nolf, J., Pt, A, 155th Penn., age 23. O'Brien, J., Pt., F, 1st Ohio. Osborne, W. P., Serg't, A, 31st lnd., age 26. Page, J. M., Pt, B, 27th Georgia, age 37. Patterson, T. A., Serg't, A, 43d Alabama. Pearl, S., Pt., F, 97th N. York, age 34. Peasly,J.E.,Com.Serg't, F, 6th N. Y. H. Art'y. age 38. Peters, J., Pt., H, 8th Penn. Reserves. Piersol, C, Pt„ G, 145th Penn., age 19. Pinckney, J. C, Pt., I, 7th Minnesota, age 31. Pitcher, DeW., Pt, K, 2d N. Y. H. A., age 20. Piatt, F., Pt., E, 72d N. York, age 40. Pool, S., Pt., H, 23d N. Jersey. Porter, W., Pt., H, 16th Connecticut. Potter, C. II., Pt., C, 31st Maine, age 16. Raynor, G. W., Pt., G, 12th Alabama, age 18. Reigle, J., Pt., H, 88th Penn., age 23. June 2, 14,'64. Sept. 14, 24, '62. Mav 31, J'ne7,'62. May 5, 10, '04. Oct. 19, 24, '64. Mar. 31, Ap.l7,'G5, Sept, 17, Oc.16,'62. Mav 5, 31, ''62. April 23, 29, '64. Nov. 30, De.19,'64, June 1, 9, '62. July 14, 22, '64. April 6, -, '62. Dec 7, 26, '62. Oct. 27, Nov. 10, 1864. Nov. 30, Dec. 28, 1864. May 9, 27, '64. Dec. 13, 27, '62. Sept, 17, Oct. 9,'62 Mar. 25, Ap. 7, '65 Nov. 25, —, '63. April 6, 13, '62. Aug. 19, 22, '64. May 10, 13, '64. May 6, 23, '64. May 31, June 16, 1864. Sept, 17, 27. '62. June 3, J'y 2,'64 July 19, 23, '64. April 7, 13, '65. Julv 2, 5, '63. Dec. 13, 25, '62. Sept. 17, Oct. 8,'62 May 18, 29, '64. April 6, 17, '65. May 8, 28, '64. Operations, Operators, Result. Right; circ A. A. Surg. P. C. Porter. Died June 20,'64; exh'n and pyaemia. Spec. 2555. Right Surg. — Boyle, C. S. A. Died Oct. 27,'G2. Specs. 834, 874. Right; dou. flap. Surg.R.B.Bon- tecou, U. S. V. Died June 8, '62. Left (gang.). Surg G.T.Stevens, 77th N. Y. Died May 11,1864. Left (gang); oval flap. A.Surg. E. B. Nims, 1st Vt. Cavalry. Died Nov. 6, 1864; exhaustion. Left; circ. Surg. D.W. Bliss, U. S. V. Died April 18,'65; exh'n. Right. A. Surg. W. M. Notson, U. S. A. Died Oct 28, 1862. Spec. 936. ----; dou. flap. Surg. A. B. Mott, U.S.V. Died June 7,'62; gang. Left. A. Surg. G. F. Thompson, 38th Mass. Haem.; lig. fem. art. Died May 15, '64; exhaustion. ----; circ. Surg. J.R.Ludlow, U.S.V. Died Dec. 20,'64; haem. Left. Haem.; lig. fem. art. Died June 19, 1862. Autopsy. Left; lat flap. Surg.J.G.Keenon, U.S.V. Died July 27,'64; exh'n. ----. Surg. E. C. Franklin, U. S. V. Died April 26, 1862. Right; ant, post. flap. Surg. H. S. Churchman, U. S. V. Died Dec. 26, 1862; shock. Left (Oct, 27, exc. knee j't); circ. A.A.Surg. J. Pitkin. Died Nov. 12, 1864; exhaustion. Left; ant. post. flap. A. S urg. J. H. Cruthers, 88th Ohio. Died Jan. 2, 1865; haem. Left (slough'g); circ A.A.Surg. T.W. Carroll. Flaps slough'g; gang. Died May 31, 1864. Right; circ. Surg. O. A. Judson, U. S. V. Jan. 4, '63, haem.; lig. fem. art. Died Jan. 4,'63; exh'n. Spec. 637. Left. A. Surg. W. M. Notson, U. S. A. Died Oct. 28, 1862. Left; circ A.A. Surg. L. J. Dra- per. Haem. Died April 22, '65. Autopsy. Spec. 186. Left, Died December 16, 1863. Right, Haemorrhage. Died April 15, 1862. Right; circ. Surg. T. F. Oakes, 56th Mass. Diarrhoea. Died Sept. 16,'64; exh'n. Autopsy. ----; ant. post. flap. Surg. C. B. Gibson, C. S. A. Died May 16, 1864; exhaustion. Right, A. A. Surg. P. C. Porter. Died May 31, 1864 ; exhaust'n. Left (gang.); circ. A. A. Surg. J. H. Thompson. Died July 18, 1864; exhaustion. Right. Surg. H. S. Hewit.U.S.V. Died October 2, 1862. Left (gang.; diarrhoea). A. Surg. W. F. Norris, U. S. A. Died July 12, 1864 ; pyaemia. Left (gang.); circ. A. A. Surg.W. M. Dowan. Died July 24,1864, while chloroformed. Autopsy. ----; ant. post. flap. A. Staff Surg.W. J. Burr, U. S.A. Died May 4, 1865. Left (haem.). Died July 8,1863; exhaustion. Left. Died December 29, 1862. Left. Surg. T. H. Squire, 89th N. Y. Died Oct. 10,1862. Right; ant. post. flap. A.A.Surg. O. T. Trautman. Haem. Died June 3, 1864 ; exhaustion. Right; ant. post. flap. A. Surg. W. Carroll,U. S. V. Haem.; fem. art. lig. Died May 6, '65; exh'n. Spec. 4164. Right; ant, post flap. Surg. R.B. Bontecou, U. S. V. June 8, 12, haem.; lig. fem. art. 16,24, recur- rent haem.; re-lig. Died June 24, 1864; haemorrhage. 'PURDY (E. M.), Cases of Gunshot Wound, in American Medical Times, 1863, Vol. VL, p. 66. 286 INJURIES OF THE LOWER EXTREMITIES. [CHAP.x. N Name, Military Description, and Age. 418 421 439 Reed, W., Pt., G, 39th New York, age 30. Re.ntz, J. IF.,Lieut, 13th Alabama, age 21. Rice. S.H.,Corp'l,E,50th Penn,, age 29. Ricker, J., Pt, K, 2d N. Hampshire, age 24. Riggs, I.,Pt, I,8thPenn. Reserves. Roberts, W. P., Pt., I, 42d Mississippi. Robertson, G., Pt,A, 63d ■ New York, age 42. Robinson, Mary, wife of Colored soldier. Robinson, W. B., Pt, B, 2d E. Tennessee. Robison, W. R., Pt., D, 29th Alabama, age 23. Rodden, M. L., Serg't, D, 96th New York, age 25. Rolland, J. G., Serg't, F, 7th New York Artil'ry, age 21. Sargent, C. H., Pt, 1,6th N. Hampshire, age 25. Scanlan, P., Pt, G, 63d New York, age 34. Scanlon, J., Pt, A, 3d Maryland. Schadot, J., —, G, 30th Ohio, age 40. Schock, W., Corp'l, K, 46th Pennsylvania. Schuyler,W. N„ A.D. C. and Capt., 155th N. Y., age 24. Secord, J., Pt, B, 43d New York. Sharon, P., Pt, I, i53d New York. Shields, H., Pt, C, 61st Pennsylvania. Shire, j., Pt., B, 5th 111. Cavalry, age 25. Shultz, B., Pt., H, 1st Penn. Artillery, age 21. Singer,W. H.. Pt., C,7th Virginia, age 22. Smith, H.E.,Pt.,E, 80th New York, age 17. Smith, W., Corp'l, I, 1st N.Y. Dragoons, age 28. Spencer, J., Pt., G, 48th Penn., age 19. Sproule, L., Pt., E, 37th Illinois, age 23. Squires, L., Pt., D, 29th Ohio. Stevens, J., Pt., E, 3d Missouri Cavalry. Dates. Feb. 6, 11, '04. Sept. 17, Oct. 7,'62. May 13. 19, '64. May 5, 8, '62. Dec. 13, 29, '62. July 1, 24, '63. Sept. 17, Oc.17,'62. April 12, 21, '64. Nov. 6, -, '63. Mav 15, J'ne'7,'64 May 31, J'el2,'62 May 19, 26, '64. Dec. 13, 1862, Jan.1,'63 Dec. 14, 26, '62. Aug. 9, 15, '62. Sept. 17, Oct 8,'62 Aug. 9, 16, '62. June 3, 16, '64. May 5, 10, '64. Sept. 19, Oc.18,'64. May 31, J'e—,'62. Feb. 11, Mar. 6, 1863. Mav 31, J'ne9,'62, Nov. 27, De.15,'63. Mav 12, 28,"'64. June 11, J'y 6, '64. May 9, 16, ^64. De. 7, '62, Jan.3,'63. Aug. 9, 15, '62. April 4, 12, '64. Operations, Operators, Result. Right. Surg. J.Aiken, 71st Penn. Died March 1, 1864; tetanus. Right; flap. A. Surg. C. P. Rus- sell, U. S. A. Diarrhoea. Died Oct. 11, 1862. Spec. 800. Right; circ. Died June 7, 1864; pyaemia. Right; circ. Surg.R.B.Bontecou, U. S. V. Died Sept, 21,1862. Left. Surg.J.E.Summers.U.S.A. Died Jan. 10,'63; pyae. ^pec.661. Right; circ. A. A. Surg. J. L. Whitaker. Diarr. Died Aug. 5, 1863; exhaust'n. Spec. 2057. Right; flap. A. A. Surg. A. V. Cherbonnier. Died October 21, 1862. Spec. 360. Right; ant. post, flap. Surg. H. Wardner, U. S. V. Died April 26,1864; exh'n. Spec. 3315. Left (haem.). Died Nov. 12, '6* Left; circ. A. A. Surg. R. L. McClure. Died June 22, 1864; exhaustion. Spec. 3372. Left; flap. A. A. Surg. W. K. Cleveland. Died June 17,1862. Right; circ. A. A. Surg. W. C. Mulford. Gang. Died June 2, 1864; pyaemia. Spec. 2381. Right. Died Jau. 7, 1863; shock and suppuration. Right. A. Surg. G. M. McGill, U.S.A. Haem.; lig. fem. art.; haem. rec'd. Died Jan. 14,1863; haem. Autopsy. Left; circ. A. Surg. P.Adolphus. U. S. A. Died Aug. 20, 1862. Spec. 42. Right. Died October 12,1862. Left; ant. post. flap. A. Surg. J. B. Brinton, U. S. A. Haem.; lig. Died Sept, 2, 1862. Spec. 50. Left; circ. A. Surg. W. Thom- son, U. S. A. Died June 20,'64; exhaustion. Spec. 3560. Left (gangrene). Surg. G. T. Ste- vens, 77th N. Y. Died May, 1864; gangrene. Right (nearly moribund from haem. Oct. 12, lig. pop'l art.); lat flap. Ass't Surg. C. H. Allen, 8th Vt. Died Oct. 18, 1864; exhaustion. Right. Died July 3, 1862; py- aemia. Spec. 4940. ----; ant. post. flap. A. Surg. J. B. Ensey, 5th Illinois Cavalry. Died March 6, 1863. ----; flap. Died June 15,1862; pysemia. Left; circ. A. A. Surg. J. Cass. Dec. 22. haem. Died Jan. 6. '64. Specs. 2006, 2007, 2008. Right (re'nt haem.); circ. Surg. D. W.Bliss, U. S.V. Died June 2,1864. Spec. 2371. Left; circ. A.A.Surg.D.H.King. Died July 17, 1864; asthenia. Right; oval flap. Surg. E. Bent- ley, U. S. V. Hasm.;'lig. Died May 31, 1864; exhaustion. Right; lateral flap. Surg. H. S. Churchman, U. S.V. Died Jan. 9, 1863; pyaemia. Left; ant. post, double flap. A. A. Surg. J. B. Bellanger. Died Sept. 5, 1862; exh'n. Spec. 52. Left, Surg. J. E. Lynch, 1st Mo. Cav. Died one hour after. „ Name. Military Description, and Age 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 Stewart, E., Pt., B, 13th W. Virginia, age 25. Stewart, J., Ft, C, 26th Indiana, age 22. Stone, B., Capt., —, llth Massachusetts. Stroup, VV., Seaman. Strunk,W.C.,Pt,,G,56th Mass., age 26. Sturdevant, J. H.,Pt,C, 5th Vermont, age 20. Swink, J., Pt., K, 5th Virginia, age 18. Taylor, T. L., Pt.,C, 82d Ohio. Thompson, A.,Corp'I,A, 98th Penn., age 29. Thornbury, L., Pt., C, 97th Penn, age 20. Tournier, I., Pt., A,147th New York, age 42. Unknown. Vanderhoof, N. P., S'g't, B, 146th N. Y., age 21. Walker, J., Serg't, F, 2d Maryland, age 21. Walker, P., Pt, C, 37 th Wisconsin, age 38. Watts, J. H., Serg't, K, 110th Penn., age 24. Weaver, J., Pt., G, 103d Penn., age 31. Welch, E., Pt-, I, 14th Indiana. Wells, F. M., Lieut, D, 132d Pennsylvania. VVestlake, W.W., Corp'l, A, 17th Conn., age 18. Whitcher, O. B., Corp'l, M, Sth New York H'vy Artillery. Wilber, N., Pt., C, 185th New York, age 31. Wilbur, W. F.,Corp'l, I, 29th Ohio, age 24. Williams, H. P., Pt., G, 53d Penn., age 17. 'Williams, R., Pt., C, 28th Penn. Wilson, W., Pt, I, 2d New York Cavalry. Witman, J., Pt, A, 16th Michigan, age 23. Wolford, J. R.,Serg't, B, 30th Indiana. Wynne, W. G., Pt., F, 66th New York. Wyznski, C, Pt., B, 3d Md, Cavalry, age 26. Yearby, J., Waiter, C, 12th N. Hamp., age 25. Young, G. W., Pt„ F, 114th Pennsylvania. Dates. July 24, 28, '64. Dec. 7, 11, '62. Aug. 30, Sep.4,'62. Feb. 12, —, '62. July 30, Au.12,'64. May 12, 24, '64. May 3, 12, '63. Aug. 31, -,'62. April 2, 25, '65. July 25, Au. 1,'64. May 5, 9, '64 Dec. 7, 11, '62. May 1, 5, '63. June 16, J'y 6, '64. June 3, 20, '64. Mar. 26, Ap. 2, '65. May 31, J'ne4,'62. July 3, -, '63. May 2, 6, '63. July 2, 14, '63. June 1, 13, '64. Mar. 29, Apr.2,'65. May 3, 8, %3. May 5, 20, ''64. Sept. 16, 30, '62. April 9, 16, '64. May 10, 25, '64. Sept 19, Oo.l9,'63, Sept 17, Oc.16,'62, May 18, 29, '64. Aug. 7, 1V64. May 3, 8, '63. Operations, Operators, Result. Left; flap. A. Surg. J. Willard, IstMd.P.H.B. Died Aug. 5,'64. Left (gang.); circ. Surg. T. W. Florer, 26th lnd. Died Dec. 24, 1862; hemorrhage. Right. A.Surg. B. Howard, U. S.A. Died Sept. 10, 1862. ----; double flap. Surg. E. C, Franklin, U. S. V. Died March 5, 1862. Left (slough.); circ. A. A. Surg. E. Seyffarth. Died Aug. 12,'64. Left. A. Surg. M. J. Hyde, 2d Vt. Necrosed. Aug. 20, haem.; re-amp. Died Aug. 21,1864. Right; circ. Died June—, 1863. ----. Died October 9, 1862. Right (erysip.; haem.). Surg. D. W. Bliss, U.S.V. Died May 23, 1865. Spec. 4096. Right; circ. A. A. Surg. W. L. Welles. Died Sept. 13, 1864; irritative fever. Left ; ant. post. flap. Died Aug. 15, 1864. Left. Surg. J. P. Root, 2d Kansas Cavalry. Died Dec. 13,1862. Left (hasm.); circ. Died May 16, 1863. Autopsy. Left (J'y 2, ham. recur'd; gang.); circ. A. A. Surg. J. Winslow. Died July 6, 1864; asthenia. Right; circ. Surg. S. S. French, 20th Mich. Exf. bone extracted. Died Aug. 22,1864. Spec. 3128. Left; circ. Diarrhoea. Died April 22, 1865; exhaustion. Left; flap. Died June, 1862. Right; ant. post. flap. Surg. H. M. McAbee, 4th Ohio. Died July —, 1863. Left. Died June 2, 1863. Spec. 1064. Right. Died July 25,1863; teta- nus. Left; ant post. flap. Surg. E. Bentley, U. S. V. Haem. Died June 18, 1864; haemorrhage. Left; circ. Surg. D.W. Bliss, U. S.V. Died April 18,'65; fract. of cranium. Spec. 4041. Left; circ. May 15, haem., lig. fem. art, recur'd, prof, ligated. Died May 17, 1863. Right; ant, post. flap. Surg. R. B. Bontecou,U.S.V. Died June 14, 1864; pyaemia. Spec. 3059. Right; flap. A. Surg. C. A. Mc- Call, U. S. A. Died October 2, 1862. Spec. 59. Right; circ. Surg. F. Bacon, U. S. V. Died April 28, 1864. Left; ant post. mus. flap. Surg. A. F. Sheldon, U. S. V. Died May 27, 1864; exhaustion. Right, (hasm.). Died Nov. 13,'63. Left; flap. A. Surg. P.Adolphus, U. S.A. Oct. 25, haem.; lig. fem. art. Died Nov. 3, '62. Autopsy. Spec. 746. Left; circ. A. A. Surg. R.W.W. Carroll. Died May 31, 1864; pyaemia. Left: flap. A.A.Surg.H.B.White. Died August 20, 1864; exh'n. ----. A.Surg.B. HowarcLU.S.A. Died May —, 1863. The seat of fracture in the cases enumerated in the foregoing table was in the middle third of the femur in seventeen; in the lower third, in ninety-four; in the femur, without specification of third, in sixty-six; in the knee joint, in two hundred and thirty-four; in the leg, in fifty-six; and in the ankle joint or foot in four instances. 'Coues (E.), Cases of Amputations and Resections, from Gunshot Wounds, performed by Assistant Surg. C. A. McCall, XT. S. A., in Medical and Surg. Reporter, 1862-3, VoL IX, p. 195. SECT, in.l INTERMEDIARY AMPUTATIONS OF THE THIGH. 287 • Intermediary Amputations in the Lower Third of the Thigh.—There were six hundred and seventy-six of these operations. Two hundred and seventeen were successful and four hundred and fifty-nine terminated in death—a mortality of 67.9 per cent.,—exceeding the fatality of the intermediary amputations in the upper third by 1.9 per cent, and the same operations in the middle third by 11.5 per cent. Successful Cases of Intermediary Amputations in the Lower Third of the Thigh.— Of the series of six hundred and seventy-six intermediary amputations in the lower third two hundred and seventeen had favorable results, comprising thirty-one Confederate and one hundred and eighty-six Union soldiers. Of the latter, one hundred and eighty-four were pensioned and one retired, and eight have died since the close of the war in 1865. Of fifty-three of these cases pathological specimens are preserved in the Army Medical Museum. Case 464.—Private W. Vannatta, Co. D, 4th Pennsylvania Cavalry, aged 24 years, was wounded at Upperville, June 21, 1863, and entered Stanton Hospital, Washington, three days afterwards. Surgeon J. A. Lidell, U. S. V., reported: "The patient, a man of sound constitution, had received a wound of the right knee by a carbine ball. The missile entered the limb on its anterior inner face a short distance below the joint, passed backward and upward, and escaped through the popliteal space, apparently without opening the joint. From the course and direction of the wound the upper part of the tibia was supposed to be injured. At the time of admission the patient's condition was good, there being no pain, heat, or swelling about the injured knee. He was directed to refrain from using it by remaining quietly in bed, to have ice applied to the wound constantly so as to lessen the danger of inflammatory action, and to be supported by nutritious diet. Under this treatment his case progressed without an untoward symptom until July 5th. At inspection, on this day, I especially noticed his condition as very promising, the anterior orifice of the wound being nearly healed. But, about the middle of the following night, he was seized with great pain and distress in the injured knee, and full doses of morphia were administered without producing much relief. On the following morning the knee was found to be greatly swollen, hot, and exceedingly tender, the patient complaining of intense gnawing pain in it, and crying out from agony occasioned by it. Although his pupils were markedly contracted from the large quantities of anodynes taken, his countenance was expressive of great distress; pulse frequent, quick, and irritable; skin hot and dry: he was also thirsty, had a coated tongue, and had had a slight chill. Free abstraction of blood from the neighborhood of the knee by cups was ordered, also ten grains of calomel, and anodynes as required. On July 7th, the patient's condition had not materially changed. Seeing that the arthritis was secondary to the wound, and believing that it was associated with fracture and comminution of the upper end of the tibia, amputation appeared to be the proper remedy. The operation was accordingly performed by Assistant Surgeon P. C. Davis, U. S. A., in the lower third of the thigh, by the circular method, about midday— thirty-six hours after the attack. Anaesthesia was produced by sulphuric ether. The patient bore the operation well. On examining the amputated limb the inner part of the head of the tibia was found to be extensively injured by the bullet, a deep groove having been made in the bone, associated with much comminution, and some of the broken fragments connected directly with the joint. The cavity of the knee joint was found to contain about four ounces of dirty-brown colored viscid liquid, in which yellowish shining globules (synovia), looking like oil, floated. The lining membrane of the joint was stained with a dull red hue throughout its whole extent and had entirely lost its polished and shining appearance. The internal semilunar cartilage com- pletely covered the opening in the head of the tibia. On July 10th, the patient was progressing pretty well." On October 2d, he was transferred to Turner's Lane Hospital, Philadelphia, where a second operation was performed by Acting Assistant Surgeon C. B. King, who described it as follows : "When admitted, the femur was protruding about half an inch, and appeared to be dead as far up as could be felt with the probe, a ring of new bone being thrown around it. The discharge was very pro- fuse. On October 5th, the patient having been placed under the influence of ether, an oval incision was made around the end of the bone and through the cicatrix and some unhealthy granulations, when, after dissecting the muscles for a short distance, the vitality of the new bone was found to be small, and lateral incisions were made and the flaps dissected up for about four inches, where the new bone seemed to be more healthy, and was sawn off. About four inches of the remaining dead bone, which I judged as reaching up as far as the great trochanter, was extracted with the forceps. The femoral artery was avoided by making the internal lateral incision below the vessel, and the patient lost but little blood. Three or four small arteries were ligated, and the wound was closed with iron wire and adhesive straps. The patient, being very weak from suppuration and the shock of the operation, was rallied with difficulty. Cold-water dressings were applied and stimulants administered. On the following day the patient was still very weak, had a slight fever and coated tongue, and the stump was very much inflamed and swollen. The sutures were removed and the straps loosened, and milk punch, beef tea, and generous diet were ordered. On October 12th, the inflammation was somewhat reduced, the discharge free but very offensive, and the patient was gaining strength slowly and his appetite improving. The ligatures were now removed. Ou October 18th, the bands were removed, union having taken place in the stump. On November 4th, the wound had closed with an abundance of flap, and the patient was going about on crutches. On November 16th, he was transferred to Haddington Hospital for the purpose of getting an artificial limb." Acting Assistant Surgeon J. R. Levis, in charge of the latter hospital, recorded the following result of the case: "At date of admission a fistulous opening existed in the stump, and on examination by the probe the whole wall of this sinus was found to have an osseous fell leading directly to the end of the femur, where loose spiculse of bone were clearly perceived. A small pledget of sponge tent was applied, and on November, 20th the orifice was well dilated, and, with the dressing forceps, several pieces of bony formation were removed, which crumbled readily under pressure; also a good sized spicula from the sawed surface of the femur. Some inflammation followed this operation, for which lead and opium lotion was applied; perfect quiet 288 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. was enjoined, and anodynes given at bedtime. On November 23d, the inflammation was still continuing and the patient suffer- ing intense pain in the stump, but two days afterwards both were subsiding. On December 1st, another examination was made by the probe and another small piece of bone was extracted. By December 10th, his health had improved, the discharge had much lessened, and the stump was doing well, the patient stating that it felt better than at any previous time. In January, 1864, the patient went to his home on furlough, and in the following month, when he returned, the discharge had almost ceased. On March 1st, the sinus had closed and the stump was apparently sound." The patient was subsequently transferred to Christian Street Hospital, and was discharged from service June 7, 1864, and pensioned. Examiner J. Walker, of Bethany, Missouri, certified, May 2, 1874 : '' I find him unable to wear an artificial limb on account of tenderness and shortness of the stump. He is unable to raise the stump in walking, and wears a wooden peg with a leather socket, buckled around his waist. He is also unable to raise the peg, but moves it by moving the side of his body. The stump chafes so easily that he can wear the socket but a short time, and then has to use a crutch." Tbe pensioner was paid June 4, 1879. The bones comprising the knee of the amputated limb were transmitted to the Museum by Surgeon Lidell, and the involucrum and sequestrum, removed at the second operation, together with a cast of the stump, were contributed by the operator. (Cat. Surg. Sect., 1866, pp. 341, 309, and 555, Specs. 1336, 2602, and 1529.) Specimen 2602 is represented in FlG. 1 of Plate LXX, opposite p. 242. Case 465.—Corporal H. H. Ellis, Co. I, 16th New York, aged 23 years, was wounded in the left knee, at Fredericksburg, May 3,1863. Five days after the injury he was admitted into Douglas Hospital, Washington, whence the following history was received: " On examining the wound it was found that a conical ball had fractured the patella so extensively as to involve the joint. On May 13th, there were symptoms of synovitis, and the thigh was amputated at the lower third, by the circular method, by Acting Assistant Surgeon J. E. Smith. Portions of clothing were removed from the amputated knee, and an examination showed that the patella had been broken into numerous fragments, that a fissure extended through the inner cartilaginous face of the bone, and that synovitis had been developed. The patient was broken down with diarrhoea. The stump was dressed with alcohol, and stimulants, quinine, and nutrients were given as largely as possible. The general condition of the patient was bo unfavorable that no effort at repair was perceptible in the stump for many days. On May 20th, a haemorrhage of several ounces occurred and was controlled by pressure. During the following night the bleeding recurred so freely as to render a liga- tion of the femoral artery necessary, which was performed below the profunda on May 21st. The patient was so prostrated from the loss of blood that he almost died from the effects of the ether. The most careful administration of whiskey, ammonia, valerian, and morphia alone sustained his life during the next forty-eight hours. There was no recurrence of haemorrhage after the ligation, nor did this ligature of the main artery produce the slightest perceptible effect upon the appearance of the stump. The usual changes were resorted to in the various astringents given for the diarrhoea, nitrate of silver, opium, tannin, and sul- phuric acid, all proving at first beneficial and then losing their effect. Lemon juice was given, as the patient's stomach would bear it. with evident benefit as an antiscorbutic. For weeks the patient hung between life and death. His whole thigh was much swollen and very tender on pressure; the incisions were healthy in appearance, the discharge moderate, and the granula- tions very tedious. Under a careful treatment he gradually grew stronger, his diarrhoea ceased, and the stump, though yet greatly swollen, became closed excepting at the inner extremity, where the end of the femur protruded, the flaps from the first having been insufficient. On August 9th, Dr. Smith was ordered to remove the exfoliating end of the bone, which was loose, and, to his surprise, proved to be a very extensive sequestrum ten inches in length. Considerable haemorrhage supervened, but after the operation convalescence was very rapid, and the stump, no shorter than before, soon closed entirely, being firm and in every way satisfactory. A formation of new bone could be plainly felt in it. The patient regained his flesh and strength, and left the hospital October 26, 1863, his term of service having expired May 22d." The history, with the sequestrum, represented in Fig. 1 of Plate LXIX, opposite p. 224, and the bones of the amputated knee, were contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A., in charge of Douglas Hospital. A ligamentous preparation of the latter specimen constitutes No. 1852 of the Surgical Section. The patient was subsequently an inmate of the Post Hospital at Albany, and afterwards entered Central Park Hospital, New York City, to be fitted with an artificial limb by Dr. E. D. Hudson. He left for his home June 6, 1864. His pension was paid June 4, 1879. (See wood-cut 64, p. 63, Circular 6, S. G. O., Washington, Nov. 1, 1865.) Case 466.—Private J. Nash, Co. G, 143d Pennsylvania, aged 21 years, was wounded at North Anna, May 22, 1864. He was admitted to the field hospital of the 4th division, Fifth Corps, where Surgeon C. W. Chamberlain, U. S. V., recorded: "Severe shot wound of right knee joint by musket ball." From the field hospital the wounded man was conveyed to Port Royal, and thence by steamer to Washington. Surgeon D. W. Bliss, U. S. V., reported that " the patient entered Armory Square Hospital May 29th, having undergone circular amputation of wounded limb at the lower third of the thigh the day previous to his admission, while on board of the hospital transport." On July 22d, the patient left for his home on furlough, whence he returned several mouths afterwards, and subsequently he was transferred to Judiciary Square Hospital. Surgeon E. Griswold, U. S.V., in charge of the latter, reported that the presence of necrosed bone in the stump having been indicated by suppuration, a tubular sequestrum, eight and three-fourths inches long, was removed on April 9, 1865, by Acting Assistant Surgeon F. H. Hill. On June 22, 1865, the patient was discharged from service and pensioned, having been previously supplied with an artificial limb by tbe Jewett Patent Leg Company of Washington, D. C. His pension was paid March 4,1879. The sequestrum (Cat. Surg. Sect.. 1366, p. 308, Spec. 144) is shown in Fig. 2 of Plate LXIX, opposite p. 224. Eight of the patients who recovered* after intermediary amputation in the lower third have died since the close of the war. In the following instances the pensioners survived the operation three and nine years respectively: Case 467.—Private J. Glassie, Co. B, 63d New York, aged 22 years, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 1st division, Second Corps. Surgeon W. S. Cooper, 125th New York, noted: "Shot wound of left leg; amputation at lower third by Surgeon P. E. Hubon, 28th Massachusetts." One week after the reception of Ihe injury the man was admitted to Emory Hospital, Washington, where Surgeon N. E. Moseley, U. S. V., recorded that the limb was SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 289 FlG. 195.—Appearance of thigh stump after lateral flap operation. [From a photograph.] re-amputated above the knee on June 20th, also that abscesses formed subsequently, and that the stump of the femur became hypertrophied. On March 10, 186.">. the patient was transferred to Central Park Hospital, New York City, whence Surgeon B. A. Clements, U. S. A., reported the following: '"When admitted, the end of the stump was red and inflamed, and there were three sinuses leading to necrosed bone. On March 19th, chloroform was administered, and a sequestrum about eigbt inches long was removed by Acting Assistant Surgeon S. Teats. Tlie patient did well after the operation. By July loth, the stump had entirely healed, and one month later he was discharged from service." The man subsequently became a pensioner. He died at Brooklyn, New York, November 12, 1867. The removed fragment was contributed to the Museum by the operator, and constitutes Specimen 3100 of the Surgical Section. A representation of it appears in FlG. 3 of Plate LXIX, opposite p. 224. Case 468.—Private Alexander McConkey, Co. 1). 63d Pennsylvania, aged 4H years, was wounded at the Wilderness, May 5,1864, by a conoidal ball, which entered on the inner condyle of the left knee, passed through the joint, and made its exit on the opposite side. He was conveyed to Washington, and admitted into the Hare- wood Hospital on May 14th. Surgeon R. B. Bontecou, U. S. V., furnishes the follow- ing notes of the case : "An examination of the injury was immediately made; the soft parts around the wound were found much inflamed and the joint oedematous. His general condition being good, it was decided to amputate without delay, and the patient being chloroformed, Surgeon Bontecou removed the thigh in the lower third by the lateral flap operation. Tlie stump healed favorably, the ligatures came away on the eighth day, and the patient progressed well on a supporting diet until, July 29th, he had so far recovered as to be about on crutches, when he accidentally fell, injuring the stump, which became inflamed; alcohol and water dressings were applied. On August 4th, an abscess was opened, which discharged about four ounces of pus. 5th, he had a severe attack of diarrhoea, which was checked by proper treatment. 30th, condition very good; a small sinus still exists, owing to some necrosed bone." He was trans- ferred to Pittsburg, April 3, 18(>f>. and admitted into hospital there. The wound had entirely healed, and he was discharged May 19, 1865. He was pensioned, and died May 15, 1873; the cause of death is not satisfactorily given. The pathological speci- men, showing the bones of the left knee, with the articular extremity of the femur shattered (No. 3066, Sect. I, A. M. M., Cat, 1866, p. 338), was contributed by the operator, who also furnished a photograph of the stump, which is copied in the adjoin- ing wood-cut, FlG. 195. Fatal Cases of Intermediary Amputation in the lower Third of the Femur.—This group comprises four hundred and fifty-nine operations performed on four hundred and fifty- seven patients, in two instances intermediary amputations in the lower thirds of both thighs having been performed: Case 469.—Private W. Sailor, Co. E, 119th Pennsylvania, aged 40 years, was wounded in the left leg by a conical bullet, at Rappahannock Station, November 7, 1863. Two days afterwards he was admitted to Stanton Hospital, Washington, whence Surgeon J. A. Lidell, U. S. V., made the following report: "On examination, it was found that the injured leg was much swollen and dark colored on its anterior surface, that there was no pulsation in the anterior tibial artery, and that both the tibia and fibula were extensively comminuted, with much laceration of the soft parts. His pulse was frequent and irritable, and he had a good deal of constitutional disturbance and fever of aii irritative type. On November 14th, the fever had abated, and the general condition much improved; pulse fuller and less irritable; appetite better; wound suppurating; discharge thin, dark colored, and offensive; leg not improved. There being manifestly no hope of saving it, the bones being broken and the soft parts inflamed nearly up to the knee joint, and comminution very extensive, the limb was amputated in the lower third of the thigh. The operation was performed by the circular method by Assistant Surgeon G. A. Mursick, U. 8. V., under sulphuric ether. A dissection of the amputated limb showed that the bones were extensively comminuted.as high up as the head of the fibula. The anterior tibial artery was found to be divided by the bullet a little below where it passes through the interosseous membrane, the ends being separated from each other about one inch and retracted within the sheath, also closely contracted. The cardiac end was plugged up by a firm coagulum about an inch in length. The distal end was also plugged up by a small coagulum. The anterior tibial muscles were pale yellow in color, soft and greasy to the touch (fatty degeneration). The patient bore the operation well. The stump was dressed with lead sutures and adhesive plaster, and a full dose of morphine was administered. He had a good night's rest after the operation, and, on the following day, expressed a desire for food, his pulse being full, frequent, and quick ; bowels confined, for which a dose of rochelle salts was ordered. On November 17th, suppura- tion commenced, but little of the stump being united by adhesion; general condition good. Prescribed moderate stimulation, with whiskey. 18th, edge of posterior flap looked sloughy; ordered diluted Labarraque's solution to the stump, and twenty drops of muriated tincture of iron every six hours internally. 20th, had a chill in the morning, followed by fever and sweat; skin sallow looking; granulations in stump looking well, except on the posterior flap, a small portion of which was sloughing. Ordered five grains of quinine every six hours, twenty drops of muriated tincture of iron every four hours, and one ounce of whiskey every three hours. 21st, had a chill in the afternoon; sallow appearance of skin deepened; pulse irritable; slight sub- sultus; bowels'not moved for two days. Ordered ten grains of aloes and twenty grains of rhubarb to be given at once, and continued other treatment. 22d, had chills again in the afternoon, with slight delirium. Ordered one-twelfth of a grain of cor- rosive sublimate, with three grains of iodide of potassa, every four hours, and continued the whiskey. 23d, patient vomited in the morning, had also a good deal of fever. Applied sinapism to epigastrium. 24th, rigors, etc., in the morning; treatment Surg. Ill—37 290 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. continued. 25th, rigors, fever, and delirium; skin very yellow. 28th, rigors, etc.; urine passed involuntary; bedsores on sacrum. Ordered a water bed. Patient died, exhausted, on December 1, 1863, the seventeenth day after the amputation and the eleventh day after the advent of the purulent infection. Autopsy twelve hours after death: Rigor mortis well marked; skin yellow; some emaciation; stump swollen and oedematous; femoral artery well plugged up in stump; end of femoral vein well sealed up in stump; femoral vein empty and collapsed from the end up to the valve at the first anastomosing branch, a distance of about six inches; the vein in this situation about as large as the artery; the walls of the vein also much thickened, being about as thick as those of the artery; the lining membrane looking velvety, wrinkled, and dirty gray in color; no pus in vein. From the valve above mentioned up to the mouth of the vena profunda, a distance of about two and a half inches, the femoral vein was filled to distension with fetid broken down liquefied blood, its lining membrane dirty gray colored in this situation, and its walls somewhat thicker than natural; no pus revealed in this locality by the microscope. At the mouth of the vena profunda the femoral vein was plugged up with yellowish white fibrine; vena profunda and many of its branches filled and knotted with recent coagulum; femoral vein also filled with recent coagulum above the mouth of the profunda to a distance of about two and a half inches; the lining membrane of the profunda and part of the femoral vein last mentioned stained dark red, and the walls of the vessels somewhat thickened in same locality. A thin dark colored recent coagulum, not filling the calibre of the vein, extended the whole length of the external iliac. The end of the femur in the stump (FlG. 2, Plate XLIII, opposite) was necrosed to the extent of nearly half au inch, and here the periosteum was thickened, varying from a line to one-third of an inch, detached and gangrenous; underlying bone white in color; medullary membrane at end of bone gangrenous and dirty grayish green in color to the depth of about one-third of an inch; medullary membrane elsewhere more vascular than natural, which was well shown by splitting the bone lengthwise with a saw (FlG. 1 of Plate XLIII, opposite). Three or four small superficial abscesses were formed about the right extremity of the spleen; the rest of that organ was contracted and indurated. Five or six small superficial abscesses were discovered in the lungs, the pulmonary tissue surrounding each of them being con- solidated by inflammatory action. The other organs were natural, and the blood did not exhibit any abnormity." The femoral artery (Spec. 1887) and the femoral vein (Spec. 1888), together with three inches of bone from the stump (Spec. 1890), and the section of the spleen containing the metastatic abscesses (Spec. 1889, shown in FlG. 3, Plate XLIII, opposite), were contributed to the Museum by Dr. Lidell. In the following instance a shot injury of the inner condyle of the right femur was followed by severe secondary arthritis, which necessitated amputation. The autopsy revealed suppurative osteo-myelitis: Case 470.—Private J. N. Saxon,1 Co. D, 9th Louisiana, aged 27 years, was wounded in the right knee, at Rappahannock Station, November 7, 1863, and suffered amputation at the Stanton Hospital, Washington. Surgeon J. A. Lidell, U. S. V., who performed the operation, described the case as follows: "A conical bullet entered the knee about three inches above the patella, on a line with its inner margin, passed backward, downward, and a little inward, and escaped at the inner posterior side, about six inches below the joint. The inner condyle of the femur was fractured by the missile passing through it, but without opening the cavity of the joint. The patient stated that his knee was bent at the time of the infliction of the wound. He was admitted two days after the injury and did well, having good spirits, good appetite, and but little pain or swelling of the parts until the night of November 16th, when he had a severe chill, accompanied with great pain in and about the knee, and the injured parts became hot and swollen. On the following morning he exhibited great constitutional disturbances: skin hot; tongue coated white; pulse very rapid, gaseous, and weak. The injured knee was much swollen and exquisitely tender, and he complained of intense pain in it; the anterior orifice of the wound presented a gelatinous appearance, with elevated and everted edges. The patient appeared so feeble that I thought he would not then bear the shock of an amputation, and ordered him to take whiskey freely with anodynes. The next day, November 18th, his general condition appeared unchanged with the exception of his pulse, which was stronger and not gaseous, being 120 by the watch. He had not slept during the night, and complained of great pain in the knee, which was rather more swelled, and the tumefaction was extending up the thigh. The wound presented the same gelatinous appearance as the day before, and the skin over the saphenous veins looked purple colored, but the veins did not exhibit any induration. The thigh was amputated at the lowTer third, by tbe flap method, at 1 p. M., about thirty-six hours subsequent to the accession of the secondary arthritis. The patient was under sulphuric ether and bore the operation well. Examination of the amputated member showed the inner condyle of the femur to be extensively comminuted. There was a layer of yellowish gray colored plastic exudation on the articulating surfaces of the fragments in the joint, and the cavity of the joint contained about three ounces of reddish brown colored liquid, in which shining globules floated resembling oil in appear- ance. The synovial membrane was reddened, especially the pouches of it in relation with the quadriceps extensor cruris. The subcutaneous areolar tissue was infiltrated with a yellowish serum. The bullet was ascertained to have passed behind the joint. On the day following the operation the patient's tongue was coated and his appetite poor; he had also moderate diarrhoea, the evacuations being very offensive. Five grains of blue mass was given at night, and free stimulation with whiskey. On the 20th, the patient was comfortable and the stump looked well. The diarrhoea was unchanged, but during the following several days it gradually abated and the patient progressed well in every respect. 28th, patient cheerful; tongue clean; appetite good; bowels regular; stump but little swollen; granulations healthy; suppuration moderate in quantity and laudable in quality. 30th, patient appeared to be doing well, but complained a good deal of pain in and about the stump. December 1st, patient restless and complaining of increased pain in the stump, especially about the end of the bone; no preternatural swelling, redness or heat in the stump. Prescribed one-fourth of a grain of sulphate of morphia and one drachm of Hoffman's anodyne every four hours. 2d, patient more restless, appearing much agitated and very nervous, having slept but little, and complaining of agonizing pain about end of bone and end of femoral artery. There were exacerbations in the pain and sometimes the whole stump ached, but there was no febrile excitement and nothing untoward in the appearance or feel of the stump; neither was it 1 Lidell (J. A,), in Surgical Memoirs, * * by the United States Sanitary Commission, New York, 1870, Vol. I, p. 358, gives a detailed account of this case, 1.1- .i. \ th' \. a. ].r.tf ..iWli lique inl '■'(,. •' |.:16> revi- •). da.' \si?'h whi' Hbr ' ;:h !'(;ea' >■ > a■>{; ^>v , M ■■■11 ■I. '1/ I id r- •.« - ere f. \ «i i.(«fioi:i ■■ .r. la.matoiy r< ' ;■<-") and tl>f ' e M ie<;n COIlta' ..-in. 1 - :V 1 ■ ' . an was contra* i -;aiTounding eucb ■ xh;bit any ru: from the stump > .'•V. XL III. -pp..-. ilic r. • .ii ion. •a I- rel i ' \V. v W t'i • .-hen be1' ;avity of t; ,.i\s aftf , ,f >(-■■ ,;■ ' l.i. :.. pal t" ' knee, .: ! -.; A. Lideli » ■ ! es abor** ■ •Bterio.' i s ~! gv;,y col'Te' .-ii J>OUt lliree "inx' J Bifn Chroniolilh RESULTS OF OSTEOMYELITIS. SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 291 swelled, red, or hot. 3d, patient had a bad night, and complained much of sickening pain in end of stump and in bowels. About 7 A. M. the ligature separated and a most profuse haemorrhage occurred, the blood pouring out in a stream as large as the calibre of the artery. It was finally stopped by digital compression, but, in the meantime, he had lost more than six pounds of blood, which brought him very low. He was stimulated as freely as possible with whiskey and carbonate of ammonia, but did not rally, and died about 3 P. M. Autopsy twenty-three hours after death : Surface of body very pale and waxy (exsanguinated); rigor mortis strong; superficial lymphatic ganglia lying along the vena saphena magna of amputated thigh all enlarged and exhibiting a faint reddish hue on section; deep ganglia not affected; stump not oedematous and no part sloughy; stump healed throughout except in the track of the ligatures and at the end of the bone. The femoral ligature had come away and the end of the vessel was patulous, uncontracted, and unobstructed. The coats of the artery were infiltrated with blood (recent) at its end and for about half an inch above it. A branch of considerable size was given off from the artery about three-fourths of an inch above its end, which had apparently interfered with the formation of a suitable clot for the permanent plugging up of the vessel; there had been but little effort towards occlusion. No other abnormity existed in the artery. The end of the femoral vein was well sealed up, the vein itself diminished in size up to the nearest valve, a distance of about an inch, and its walls thickened in same locality so as to equal those of the femoral artery; lining membrane not stained with blood; no emboli and no thrombi found anywhere, and no vein presenting any abnormity, the vena profunda uot being overlooked. A remarkable osteophyte was found in relation with the femoral artery and vein at their respective ends iu the stump. It was developed from (connected with) the linea aspera, a little above the end of the femur, and thence passed horizontally inward, separating or fork- ing into distinct plates, toward the ends of which the one laid in front of and was closely adherent to that side of the artery at and near its end; the other laid behind and was adherent to the vein at and near its end. This osteophyte was about seven- eighths of an inch wide where broadest, and about one-fourth of an inch thick. It was of recent formation. The lower part of the femur in the stump was moderately enlarged by deposit (laminated) of new bone beneath the periosteum (hyper-nutrition); this membrane was detached for about one-fourth of an inch above the line of the saw all the way round the bone, which pre- sented a dull white color in that locality. The medullary membrane was noticed to bulge out a good deal at the end of the bone and to present a dark red or reddish brown color. It was also strong and tough (flesh like). On sawing through the lower part of the femur lengthwise and cleaning off the bone dust the medullary membrane was seen to be more vascular than natural; the medullary tissue exhibited about a dozen small milk-colored abscesses on the surface of the section, showing pus under the microscope, and varying in size from that of a split pea to a mustard seed. The osseous tissue outside of the medullary canal was more compact and heavier than natural in the same locality. The periosteum was thickened to the extent of from one to three lines and more vascular than natural, the thickening being greatest where it had been detached from the bone. There was also a small abscess, flattened in shape, and holding about an ounce of cream-like pus, in the quadriceps extensor cruris muscle, and the red muscular tissue in immediate relation with it was changed to a dark brown color, which, however, did not extend to any depth. The spleen was enlarged, and the other organs all exsanguinated but presenting no other abnormity." The bones of the knee of the amputated limb (Spec. 1819), the femoral vein and artery (Spec. 1892), with portion of the osteophyte attached, and a longitudinal half section of the lower end of the stump of the femur (Spec. 1860, shown in Fig. 4 of Plate XLHI, opposite p. 290) four and one-fourth inches long, were contributed to the Museum by the operator. Gangrene of the thigh stump was reported in forty-seven instances, and, in the follow- ing instance, tetanus, which appeared on the tenth day after the amputation, hastened the fatal issue: Case 471.—Captain W. E. Davis, Co. B, 30th North Carolina, aged 25 years, was wounded in the skirmish at Kelly's Ford, Virginia, November 7, 1863. He was conveyed to the hospital of the Third Corps, and, November 10th, was transferred to Washington and admitted into Douglas Hospital. Acting Assistant Surgeon Carlos Carvallo reported that the ball entered the anterior external aspect of the right leg about two and a half inches below the inferior edge of the patella, one and a half inches external to the median line of the leg, and one and a quarter inches below the head of the fibula, where it fractured the bone, and descending downward, inward, and backward, emerged in the posterior internal aspect of the leg, midway between the inferior edge of the patella and the internal malleolus, internal to the bulk of the gastrocnemius muscle. The right foot was cold, of a purple hue, and entirely senseless; the leg, from knee to upper portion of lower third, was swollen and emphysematous, and the middle third was of a yellow and dark green, intermixed with a brown-purple hue. Diagnosis: Gangrene of the foot and leg from gunshot wound of leg, with, most probably, injury and obliteration of the main arteries. Amputation was the sole treat- ment indicated, the foot and lower portion of the leg being completely mortified. Assistant Surgeon W. Thomson amputated the thigh at the lower third by the circular method. The femoral was secured by digital compression and the tourniquet. Very little arterial blood was lost. A grain of morphia was administered in a half ounce of whiskey immediately after the operation, he having readily revived from the ether narcosis, and he stated that he had slept undisturbed during the operation, without dreaming, and was now entirely free of pain. The cut surface of the stump showed the tissues infiltrated and of an unhealthy appearance. Stimulants were administered. The stump was dressed with dry charpie. At night the pulse was 130, tongue moist, skin dry. The stump was boggy and crepitant to pressure, and a dark discoloration was visible on the external aspect extending to the tensor fascia lata. November 12th, towards evening a line of demarcation was visible of a large slough in external side of skin flap, no discharge from stump; tension of the skin caused by three sutures, which were removed, followed by gaping of the flap. About 9 p. M., the pulse became frequent (145), and there was great paleness of the conjunctiva and skin. The extensive sloughing, weak pulse, and anaemic appearance presented a hopeless prognosis. Late in the evening, a strong solution of bromine was directly applied to the surface of the stump by means of charpie. The application was at first paiuless, but, after penetrating the mortified tissues and coming in contact with sensitive parts, it caused such pain that the patient was fortified during the operation by a half ounce of sherry wine in powdered ice and one-half grain morphia. 13th, Dr. Holly touched the line of demarcation (which was very well marked, and extended to the whole circumference of the stump) with pure bromine, by means of a flattened stick, in order to facilitate and hasten the efforts of nature. He also applied Dr. 292 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Thomson's solution of bromine (composed of one drachm of pure bromine, three drachms of bromide of potassium, and three ounces of water), by means of a glass pipette, to all the sinuses beneath the mortified integuments and the sinuses near the arteries: besides this application, after carefully washing the stump with "blue wash" (solution of permanganate of potassa). and protecting the integuments outside with castor oil and the surface of the stump with a thin muslin rag, the vapor of bromine was administered by pouriug an ounce of solution of bromine on charpie; this was applied to the face of the stump and covered with simple cerate spread on sheet lint and inclosed by oil-cloth and a bandage. The application of bromine was repeated at 1 and 7 P. M., and the nourishing food and stimulants continued. An injection of soap and water caused the first passage since the date of the injury and gave great relief. 14th, the effects of the bromine yesterday had hermetically sealed the surface of the stump, covering it with a yellowish gray matter, which was removed as much as possible, a large amount of mortified integ- uments being cut away and three loose ligatures removed. Decubitus of gluteal region, somewhat to right of sacral bone; bedsore the size of the palm of the hand, with a yellow greenish slough, which was partly removed with the assistance of a scissors. India-rubber rings employed, and ointment of cinchona bark. Bromine was freely applied four times during the day. There was an abundant discharge of thin unhealthy pus, and the removal of a great quantity of slough discovered a red gran- ulating surface. 15th, wound dressed with bromine at 9 A. m. and 4 P. M. Doing very well; slough removed in large pieces. 17th, large quantity of sphacelated integuments removed and vapor of bromine applied. The stump was exposed for an hour to a painter's view. 18th, the decubitus is becoming the most painful and prominent feature of his complaint. For the first time he had a free passage without adjuvants; slept on his belly. On the 19th, he was put on a water bed, on which he lay much easier. An extensive slough was removed from the inferior portion of the flap, as also from the decubitus, which discharges healthy pus in large quantity; could see an artery pulsating. Bromine applied to bedsore. Patient felt bright, and eat a hearty dinner. In the evening, he complained of a little pain in his throat resembling tonsilitis. 20th, on examining the patient's throat, it was found that he could only open his jaws enough to show the tip of his tongue. Tetanus diagnosticated. Nutritious diet and stimulants were given as usual. At 4 p. m., a laxative was administered. The decubitus was dressed with pulverized cinchona. The stump, which had a beautiful red granulating surface, with one single ligature, was dressed at night with castor oil. He had had contractions and jerking of the stump once«in the morning, but had not paid any attention to it until 6 P. M.. at which time it became more frequent, recurring nearly every half hour; three ounces of brandy and a half grain of morphia were ordered at 10 and 12 P. M. and 2 and 4 A. m. 21st, trismus well confirmed. Contractions of glottis muscles and fits of suffocation after taking fluids, though administered in small quantities and through a pipette. There was rigidity of the mas- r-eters and sterno-cleido-mastoid muscles, and of the muscles of the back of the neck, which were quite hard. The head inclined backward and to tlie left side; difficulty of articulation. The difficulty of swallowing increased and only fluid nourishment could be taken. He gradually sank, and died November 22, 1863, of asthenia. A post-mortem, examination of the stump was made November '24th. There was a natural clot of blood at the distal end of the femoral artery. The neurilemma of the sciatic nerve appeared thickened, and the fibres of the nerve more gross and coarse than usual. The ends of several nerves were strongly attached to the external surface of the stump. The body and spine were not opened. A drawing, by Hospital Steward E. Stanch, of the gangrenous stump, is copied in the chromo-lithograph, Plate XXI, opposite. Case 472.—Sergeant D. A. Barnett, Co. B, 99th Pennsylvania, aged 22 years, was wounded at Kelly's Ford, November 7, 1863. Surgeon J. W. Lyman, U. S. V., recorded his admission to the field hospital of the 1st division, Third Corps, with ".shot wound of left knee joint." Two days after the reception of the injury the wounded man was transferred to Douglas Hospital, Washington, whence Assistant Surgeon W. Thomson, U. S. A., reported the following history: "The patient was anaemic when admitted, and stated that very free haemorrhage took place the moment he was wounded. He was struck by a bullet, which entered the leg at the lower border of the patella, and was removed through an incision at the median line poste- riorly, four inches above the joint. An examination showed the probable obliteration of the main vessel, since there was no circulation in the foot, which, with the leg half way to the knee, was cold and purple or tallow colored, and in the early stages of traumatic sphacelus. This, added to the direct wound of the knee joint, rendered an operation necessary, which was performed on November 10th. Ether was given, and the limb was removed by Acting Assistant Surgeon P. R. Holly, at the lower third of the thigh, by the circular method, with a straight cut from the wound of exit to the point of the circular incision. The opera- tion was well borne and there was no serious loss of blood. On examining the amputated leg, I found that the ball had com- minuted the patella and passed through the femur, entering at the outer margin of the inner condyle and dividing the popliteal artery. The popliteal space contained a large quantity of coagulated blood, and the ends of the vessel were surrounded by a mass of pink-colored and semi-organized clot, sufficiently firm to prevent haemorrhage. The patient's tongue was very pallid and his whole appearance anaemic. His leg soon became swollen though perfectly white, resembling a case of phlegmasia alba dolens. The skin was smooth and blanched; there was tenderness along the line of the bone and no vigorous effort at repair, the edges of the incision being pale. The discharge consisted of dark colored ill-looking pus, and the whole appearance of the stump was unfavorable; the edges gaped widely apart. On November 20th, a slight slough appeared on the posterior lip of tfie stump, and two days afterwards the patient had a severe chill, followed by profuse perspiration in the night and succeeded" by a light cough. During the night of the 23d there was another severe chill, and the next day respiration was increased in fre- quency and accompanied by pain in the right side. There was no perceptible dullness on percussion, but on auscultation it was found that inspiration was deep and a little labored, while the expiration over both lungs anteriorly was prolonged almost as in phthisis. There was no rale, but the expiratory sound seemed to indicate that the whole, lung had lost some of its elasticity and returned upon itself after dilatation with apparent difficulty. Expectoration was slight, very tough and viscid; the pulse rapid and feeble; the skin relaxed. The pulse became still weaker, and the respiration more hurried until almost sighing; the nervous depression increased. The breath had the sweet sickening smell resembling the odor of fermentation, which denotes pyaemia. Death occurred at ^ a. m. on November 26,1863. The post-mortem examination was made six hours afterwards. On opening the right pleural cavity we found the lung coated with soft greenish colored lymph, and there was an effusion amounting to six ounces of yellow pus and serum, separating into two strata, the upper serum, the lower pus, aud having (under the micro- scope) the usual pus corpuscles floating in a fluid with an abundance of uurecognizable debris. There seemed to be also a thin I- i va* >•■> ••<■■ ••: ;■■ rOmpl.Kai Ya ■• ter I.e.'. •••! \ i '•( ubitu-s, •bright.:..-..: .■•:,! tlie p. -a ■V-.-.-d. N \ •■■■• 1 vYi. -, I \. M -.M-r -n-ia. . ■■■! :li sle a. .: i :e :-■;;- le- at'tY ' ,aa TY> YuY ' ■•> •."'. iwr^, ,.f a' tla- .Ii, , ■ 'a..JO J I Y ■ ■ a ■• -..1 »;•- ji,Y . -.f Ye ,ia ,, a ■ • . i'a- I, -..., Y. !b ■ ;.ud "'.i' ■ iiiishmi'ii; • ai.inal'.on •' itmp w:ifc a..a '~ .r- v., • ■■ of fl.e sea. ,- ,,,,] .. .. ,,,.,-v... v - a .ii.- ■:•■ eop-i. '■» llioiusa enii.rrhag* '..- |.nt"l!.i. •ilO.. ■ l.e l.j'gi.' a: •! nation was in- I. it on m:.-.-. ia- at )'•■:( ,• . ;i- .nilUr - . liaiunora^ |>uix .1 Lilell ('hll)llliililll GANGRENE OF ATHIGH STUMP sect, in.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 293 layer of pus beneath the pleura anteriorly, giving that portion of the lung a yellowish color. The upper lobe was apparently normal; the lower lobe posteriorly was congested, dark in color, and, on division, revealed nodules of tissue of various sizes in all stages of pathological changes from acute congestion to thorough hepatization and yellow softening. Tbe diseased spots were in dimension from the size of half an English walnut to that of a split pea, the large ones having in the center a space white or yellow in color, and probably breaking down rapidly. The outline of these solidified portions, on section, suggested the idea of embolism, since they were somewhat triangular in shape, with the base at the pleural surface and the apex at the deepest portion of the lung, giving the impression that a circumscribed area of lung nourished by a single vessel had been destroyed by its occlusion. Tbere was no recent effusion in the left pleural cavity, but changes in the parenchyma similar to those on the right side were discovered. An examination of the vessels of the stump revealed the existence of inflammation of the artery and veins. Both the femoral artery and vein at the point of their escape from the pelvis were normal. The femoral vein at the entrance of the saphena was filled with a semi-organized clot, which extended through the saphena and femoral to a point two inches from the cut ends of these vessels, where they had been divided on the face of the stump. (Sec; left-hand figure of Plate XX, opposite p. 'J94.) These vessels, as will be seen, are now hard and firm dark-red cords, of course entirely impervious. The artery from the origin of the profunda to a point two inches from its cut termination was also reddened, and its inner coat softened and easily removable. The phlebitis, with its occlusion of the main venous trunks, accounted for the swollen and white condition of the stump, compared above to the condition known as phlegmasia alba dolens. In making this dissection it was observed that the inflammation, apparent in the artery and to some extent circumscribed (since its lower extremity yet contained the clot formed on the application of the ligature and was normal both in color and firmness, as well as that which occluded the veins), had extended through the coats of these vessels from without. No pus was found in the veins, and no evidence of inflammation except the marked redness of the coats and the firm and clotted coagulation of the blood within." Wet preparations of the femoral and profunda arteries (Spec. 2v>4<>), the femoral and saphena veins (Spec. 3991), and the pop- liteal artery and vein {Spec. ±>47). saved from the stump, were contributed to the Museum by Assistant Surgeon Thomson. Drawings of the specimens 3991 and '2"246 were prepared by Hospital Steward Stauch, and are represented, the former on the left and the latter on the right side of Plate XX, opposite p. 294. Case 473.—Corporal L. C. GrijKn. Co. D, 8th North Carolina, was wounded in the left knee by a piece of shell, at Winchester, July 19, 1^64. He was conveyed to hospital at Richmond, where the limb was amputated at the lower third of the femur by Dr. Joseph Jones. The patient died in February, 1865. The specimen, a portion of the stump four and a half inches long, was contributed to the Museum by Acting Assistant Surgeon F. Schafhirt. It constitutes number 3141 of the Surgical Section, and exhibits a prodigious involucrum. The bone is exceedingly hyperostosed, measuring three and a half inches in diameter at the extremity. The extremity and central portions are carious, and a slight sequestrum is contained. A representa- tion of the specimen will be found in Fig. 4 of Plate LXX, opposite p. 242. Table XXXVI. Summary of Six Hundred and Seventy-six Cases of Intermediary Amputations in the Lower Third of the Femur for Shot Fracture. [Recoveries, 1—217; Deaths, 218—676.] Name, Military Description, and Age. Anderson, J., Serg't, I, July 3, 54th New York, age 32. 8, '63. Askey, J., Pt., F, 200th Mar. 25, Pennsylvania, age 18. 28, '65. Austin, O. II., Pt., D, April 29, 106th New York. May 22, 1863. 4 Bassett. W., Pt., E, 4th June 27, New Jersey, age 20. J'y 1, '62 5 Bathurst, J. B., Pt., D, June 4 45th Penn., age 19. 16, '64 Baners, P., Musician, D, April 1, 74th Pennsylvania. 6, '62. Becker, A., Pt., F, 3d May 10, Missouri. 19, '61 Beers, L. R., Corp'l, E, Sept. 29, 188th Penn., age 19. Oc.29,'64 9 Bennett, P. L.Pt., F, 1st Aug. 23, Maine Cavalry, age 24. 30,'64. 10 '. Beverlin, G., Pt., B, llth June 17, i West Virginia. J'y5,'64. 11 Biddle, W. B., Pt., K, Oct, 19, 138th Penn., age 27. 27, '64. 12 j Bloomer, S., Serg't, B, Sept. 17, 1st Minnesota, age 24. 20, '62. Operations, Operators, Result. Left; ant. post, flap; slougfk.i nec. Aug. 2, flap, mid. third. Surg. C.W. Hagen, 54th N.Y. Hasm.; necro. bone removed. Disch'd Aug. 25,1864. Spec. 4358. Right; circ. Surg.W. G. Hunter, 211th Penn. April 11, haem.; lig. fera. art. Disch'd July 28, 1865. Spec. 3997. Left (erysipelas). A. A. Surg. R. W. Hazlett. Haem.; lig. femoral art,; ree'd. Disch'd Aug. 23,'63. Right; flap. Disch'd January 7, 1863. Left; circ. A.A. Surg. J. C. Nel- son. June 28, nec. bone rem'd. Disch'd Nov. 20,'65. Spec. 2584. Left; circ. Surg. J. McL. Hay- ward, 12th Mass. Erysipelas. Disch'd Aug. 23,1862. ' Right; flap. Drs. Fellerer and Comstock, St. Louis. Disch'd. Right (gangrenous slough.); circ. A. Surg. S. H. Orton, U. S. A. Gang. Disch'd Nov. 9, 1865. Spec. 3682. Left; lat. flap. Surg. N. R. Mose- ley, U. S.V. Nec. Discli'd Aug. 12, 1865. Right; circ. Surg. L. R. Stone, U. S. V. M. O. Nov. 11, 1864. Left: circ. A.A.Surg.B.B. Miles. Exfol. rcln'd. Disch'd July 18, 1*65. Specs. 109, 3425. Right. A.Surg.E. G. Pugsley, 1st Minn. Disch'd Dec. 6, '62. Name, Military Description, and Age. Boebel, H., Lieut.-Col., 26th Wisconsin. Bonhomme, E., Pt., E, 73d Col'd Troops, age 27. Bosworth, C. W.,' Pt., I, 1st Maine H'vy Art., age 23. Brown, J. T., Corp'l, C, 10th Illinois, age 21. Buehler, J., Pt,, C, 41st New York. Bulmer, B., Pt,, A, 71st Pennsylvania. Bttrle, J., Corp'l, K, 61st New York, age 52. Burwell, T. J., Pt,, H, 81st Ohio, age 23. Butler, C. H., Pt., H, 2d Conn. H. Art'y, age 20. Carlin, J., Pt., I, 3d Vt., age 20. Carpenter, H., Pt., A, 121st N. York, age 24. Casebolt, T. D., Pt., E, 3d Iowa, age 21. Causdell, J.A.,Corp'l,B, 10th Minnesota, age 27. Claden, M., Pt., I, 108th Ohio, age 31. July 1, 4, '63. April 10, 24, '65. May 19, 24,"'64. June 27, J'y2,'64. May 2, 8, '63. Sept. 17, 20, '62. Aug. 25, Sept. 15, 1864. Mar. 21, Ap.2,'65. Oct. 19, 22. '64. May 5. 9, '64. May 3, 6, '63. April 6, 9, '62. Dec. 15, 19, '64. May 14, 22, '64. Operations, Operators, Result. Right, Disch'd May 28, 1864. Left (April 10, amp.leg.; slough.); circ. Surg. F. E. Piquette, 86th C. T. Disch'd June 17, 1865. Died June 3, 1867 : marasmus. Left; flap. Surg. D. W. Bliss, V. S.V. Nec. Disch'd April 10, 1865. Jan. 9,'68, flap, mid. third. Left (gang.); circ. A. Siirg.C.W. Burke. 46th Penn. Gangrene; end of bone rem'd. Mustered out August 31,1864. Right thigh ; circular operation. Disch'd Nov. 28,1864. Right. Discharged Dec. 12, '62. Right; double flap. Surg. W. O'Meagher, 37th N.Y. Re-amp. upper third. Disch'd May 30, 1865. Died July 16, 1868. Right; circ. Surg. A. F. Marsh, 56th 111. Disch'd Sept. 11, '65. Right; flap. A.Snrg. J. J. Meigs, llth Vt. Disch'd Aug. 17, '65. Left; flap. Surg. E. Phillips, 6th Vt. M.O.March 18, 1865. Left. Confed. surgeon. Disch'd June 15, 1864. Left; flap. Disch'd Oct. 19,'62. Left; flap. A.A.Surg. J. H. Mo- Intire. Slough'g. Disch'd May 29, 1865. Right; circ. A.Surg.J.M.Brown, U. S. A. Disch'd May 11, '65. 294 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. Name, Milttakt Description, and Age Clarey, P., Pt., I, 24th Michigan, age 18. Clark, S. A., Pt,, E, 1st Sharpshooters. Cleggett, T., Pt.,D, 76th Colored Troops, age45. Cliff, H., Serg't, F, 76th New York, age 34. Cocheran, F., Pt,, G, 9th Louisiana, age 19. Cochran, P., Serg't, A, 19th Tennessee, age 25. Cooley, G. W., Corp'l, E, 75th Ohio. Corcoran, P.,Pt.,C, 100th New York. Crawford, A.N., Corp'l, G, 32d Tenn., age 28. Critse, P. L., Serg't, C, 21st Georgia, age 44. Curie, H., Pt., F, 7th Connecticut. Curren, T. S., Pt., E, 7th Ohio. Darling. R. A., Pt., H, 67th New York. Darraugh,J.C.,Lieut.,D, 9th Mich. Cav., age 19. Davis, L., Pt., A, 9th W. Virginia, age 18. Debold.C.A., Pt.,H,21st N. Y. Cavalry, age 21. Deery, P., Pt., C, 170th New York, age 55. De La Barr, G., Pt., C, 13th Mich., age 16. Devine, J., Lieut., F,32d Iowa, age 43. Dilley,J.L., Musician,G, 62d Ohio, age 24. Dillon, G., Pt., F, 40th New York. Dimmick, L. L., Pt, G, 10th Wisconsin. Dunlap, R. K., Pt., 1,4th Virginia. Ellis, A., Pt., F, 114th New York, age 21. Ellis,H.H.,Corp'l, I,16th New York, age 23. Emigh, B. F., Lieut., F, 2d Penn. H'vy Artil'ry, age 24. Emmert, G. S.,Corp'l,H, 37th Illinois, age 23. Everett, D., Pt., L, 15th Kansas Cav., age 18. Falconer, D. G., Lieut., B, 79th N. Y., age 25. Farthing, G. W., Pt., D, 5th Tennessee. Fish, R. M., Pt., I, 24th Michigan, age 22. Fitzmorris,E.,Pt.,K,12th New York, age 24. Fletcher, D. C., Serg't, H, 40th New York. Frum, P., Corp'l, F, 3d West Virginia, age 28. Fuller, P., Serg't, G, 1st Missouri H. G., age 41. GaUana, P., Pt., C. llth Penn. Cav., age 35. July 2, 10, '63. Aug. 30, Se.22,'62. April 2, 24, '65. July 1, 5, '63. July 9, 14, '64. Dec. 16, 29, '64. May 2, 12, '63. July 18, 21, '63. May 16, 19, '64. Aug. 21, 29, '64. Aug. 16, 19, '64. Aug. 26, Sept. 1, 1861. May 31, Je. 3,'62. Oct, 1, 17, '64. Aug. 26, 29, '64. July 24, 28, '64. Aug. 26, Sep.7,'64. Mar. 19, 27, '65. April 8, 12, '64. April 2, 6, '65. Sept. 1, 10, '62. Oct. 8, 24, '62. Mav 3, 7, '63. Oct. 19, No. 7, '64. May 3, 13, '63. June 17, 25, '64. Dec. 7, 14, '62. June 15, 20, '64. Sept. 17, Oct. 9,'62 July 2, 7, %3. Julyl, 6, '63. Aug. 30, Sep.8,'62. Sept. 1, 18, '62. Aug. 29, Se.21,'62. Aug. 5, 19, '61. April 1, 7,'65. Operations, Operators, Result. Left (mortification); circ. Surg. A. J. Ward, 2d Wis. Remrd nec. bone; gang. Disch'd Feb. 26, 1864. Right; flap. Surg. D. W. Bliss, U. S. V. Disch'd Jan. 29, 1863. Right; ant. post, skin flap; circ of muse. Surg. F. E. Piquette, 86th C. T. Haem.; lig. femoral art. Disch'd July 22, 1865. Left; circ. Disch'd Nov. 28, '63. Right; circ. Fort Monroe, Sept, 20, 1864. Left; ant. post. flap. Ass't Surg. J. H. Cruthers, 88th Ohio. Pro- vost Marshal May 6, 1865. Right. May 27, amp. mid. third. Disch'd Jan. 22, 1864. Right; flap. Disch'd Aug. 25, 1864. Died Jan. 28,1868. Left; circ. A. Surg. H. E. Good- man, U. S. V. Provost Marshal October 21, 1864. Right. Surg. — Edwards, C.S.A. Prison Nov. 22, 1864. Left (August 17, amp. leg); circ. Disch'd June 10, 1865. Right, flap. Surgs. Gleaves, Mc- Donald, and Searout, C. S. A. Disch'd July 17, 1862. Right; flap. Surg. D. Prince, U. S. V. Hiem.; lig. fem. artery. Disch'd August 9, 1862. Right; lat. flap. Surg. A. Nash, 9th Mich. Cav. Mustered out, Left; circ. A. A. Snrg. T. J. Du- nott. Sept. 3, haem. Disch'd Oct, 26, '65. Specs. 1423, 1072. Left; circ. A. A. Surg. W. S. Adams. Disch'd Dec. 17,1864. Left; ant. post. flap. Surg. A. Heger, U. S. A. Disch'd Aug. 15, 1865. * Left; double flap. Surg. D. S. Young, 21st Ohio. Disch'd Oct. 21, 1865. Left; flap. Disch'd August 30, 1864. Right; circ. Surg. J.S.Taylor, 23d 111. Disch'd July 15,1865. Left. Disch'd March 14, 1863. Died May 25,1870. Left; circ. A. A. Surg. J. Sloan. Rem'd end of bone. Disch'd April 16, 1863. ----. Surgeons Stroth and Saw- yer, C. S. A. Recovered. Left. A.A.Surg. E. G. Waters. Disch'd May 31, '65. Spec. 3423. Left; circ. A. A. Surg. J. E. Smith. Haem.; lig. fem. artery. Removed exfol. bone. Disch'd from hospital June 6,'64. Specs. 1852, 1853. Left; circ. A. A. Surg. F. H.Col- ton. Sloughing; seq. extracted. Disch'd May 10,'65. Spec. 3598. Right; flap. Surg. P. Harvey, 19th Iowa. Bone rem'd. Disch'd. Right (mortification; 17th, amp. leg; gangrene); ant. post. flap. Disch'd Aug. 19, 1864. Right; ant. post. flap. A. Surg. J. B. Brinton, U. S. A. V. R. C. July 20, 1863. Spec. 453. Left. Recovery. Right; circ. Nov. 4,2J inches end of bone rem'd; erysip. Disch'd April 19,'65. Specs. i589, 2624. Right: circ. Oct. —, seq. rem'd. Mustered out. Spec. 1051. Right; circ. Surg. H. Bryant, U. S. V. Recovery. Left (Aug. 29, amp. leg; gang.); gang. Aug. 6, '63, seq. rem'd. Disch'd July 7, '64. Spec. 1665. Right. Surg. O. B. Payne, 10th Mo. Two subsequent amput'ns. Disch'd Oct. 25, 1865. Left (gang.); circ. A. A. Surg. Z. P. Dennler. M. O. Jan. 17, 1866. Spec. 4045. No. 79 Name, Military Description, and Age. Gardener, J., Corp'l, I, 72d Penn., age 21. Gardner, J., Pt.,—, 73d Ohio. Gayman, S., Pt., B, 69th Indiana. George, E. L., Serg't, G, 73d Col. Troops.age 30. Gibson, G. S., Pt., H, 10th Missouri, age 19. Glassie, J., Pt., B, 63d New York, age 22. Golden, P., Pt., H, 28th Massachusetts, age 38. Green, H., Pt., K, 17th Maine, age 24. Greene, A. H., Serg't, B, 12th New York. Grubbs, H. B., Pt., Car- ter's Battery. Halderman, C, Pt,, H, llth Penn., age 28. Hamilton, J., Pt.,C, 45th Pennsylvania. Hand, C, Pt., B, 15th N. Jersey, age 33. Hannon, M., Pt,, K, 76th New York, age 24. Harris, C. W., Pt., G, llth Miss., age 20. Hart, B. B., Scout, H, 24th New York, age 33. Hawkins, W. W., Serg't, I, 93d N.York, age 20. Hayes, J. W., Corp'l, D, 60th Ohio, age 19. Henning, B. D., Lieut., F,3dPenn. Res.,age29. Henderson, J., Serg't, A, 126th N. York, age 29. Herron, J., Pt., I, 8th Penn. Cav., age 18. Hess, R., Pt., G, 153d Pennsylvania. "' itt.W. E.,Pt.,I,8th isconsin. odgman, O., Pt., K, 1st Wis. Cav., age 19. Hoon, E. L., Pt., H, 102d Pennsylvania, age 23. Hope. G. W., Serg't, A, 6fh New York Cavalry, age 30. Horner, D. J., Pt. C,142d Pennsylvania. Hosmer, O. M., Pt., F, 106th N. Y., age 20. Housley, H., Cook. F, 33d Wis., age 20. Howell, A.,Corp'l, K,lst N. Y. Cavalry, age 21. 'Huber, J., Pt., A, 1st Ky. Battery, age 25. Huffman, F. M., Pt., D, 3d W. Virginia, age 26. Hutchings, S., Lieut., G, 5th Maine, age 22. Johnson, G. H., Pt., F, 8th Colored Troops. Jones, J. P., Pt., K, 52d N. Carolina, age 21. Joy, A., Serg't, C, 24th Michigan. Dates. Sept. 17, 21, '62. Aug. 30, Sep.5,'62 Aug. 30, Sep. 3,'62 April 10, 23, '65. Oct. 12, No.10,'64 June 3, 20, '64. Aug. 30, Sep.9,'62 May 23, Je. 10,'64 June 27, 30, '62. Sept. 14, 18, '62. July 2, 25, '63. Sept, 14, 17, '62. May 12, 16, '64. Sept. 14, 18, '62. July 3, 15, *63. Aug. 28, Se.16,'62. May 5, 16, '64. May 9, 27, '64. May 9, 14, '64. May 10, 30, '64. Mar. 31, Ap.5,'65. July 1, 5, '63. Oct. 3, 8, '62. Sept. 5, 25, '64. Sept. 19, 28, '64. Nov. 24, De. 3,'63, Deci 13, 21, '62. Sept. 19, Oc.16,'64 April 2, 11, '65. April 1, 7, '64. Oct. 8, 12, '62. Aug. 29, Sept. 15, 1862. May 10, 18, '64. Feb. 20, 25, '64. July 1, 14, '63. July 1, 7, *63. Operations, Operators, Result. Left; flap. Surg. M. Rizer, 72d Penn. Gang. Discli'd August 4, 1863. Right. Ass't Surg. B. Howard, U. S. A. Left; flap. A. Surg. W.B.Witt, 69th lnd. Disch'd April 29, '63. Right; circ. Surg.F. E. Piquette, 86th C. T. Disch'd June 17/65. Right (necrosis; gang.); circ. A. A. Surg. J. J. Bell. Disch'd June 10, 1865. Left (June 3, amp. leg; gang.); bilat. flap. Surg. N. R. Moseley, U. S. V. Necrosed bone rem'd. Disch'd Aug. 15,'65. Died Nov. 12, '67. Spec. 3100. Left; dou. flap. A.A.Surg. J. O. French. June 30, 1863, re-amp. mid. third. Disch'd Jan. 5, '64. Spec. 147. Right; flap. Surg. D. W. Bliss, U. S. V. July 4, haem. Disch'd Nov. 21,1864. Spec. 2498. Left. Surg. A. D. Palmer, 9th Maine. Disch'd Feb. 24,1863. Right. Surg. — Roberson,C.S.A. Furloughed Sept. 21, 1864. Right; flap. Surg. H. Palmer, U. S. V. Rem'd bone. Disch'd October 6, 1863. Right. Disch'd Dec. 30, 1862. Right; circ. Disch'd June 17, 1865. Right; circ. Gang.; bone rem'd. Sept. 12, '63, re-amp., circ , mid. third;baem. Disch'd June24,'64. Died June 22, 1870. Spec. 4324. Left: circ. Surg. —Clark, C.S.A. Necrosed bone rem'd. Exch'd Nov. 12, 1863. Right. Surg.A.Wynkoop, U.S.V. Disch'd Nov. 15, 1863. Right (May 6, amp. leg, Teale's method). April, 1865, carious bone rem'd. Disch'd July 12, 1865. Spec. 4497. Rght; circ. A. A. Surg. T.W. Carroll. Disch'd April 17, '65. Right. Surg. N. F. Graham, 12th Ohio. M. O. Sept. 26, 1864. Right: circ. A.A. Surg.F.G.H. Bradford. Disch'd Aug. 1, '65. Right; ant, post. flap. A.A.Surg. F.H.Hill. Disch'd Sept. 30,'65. Spec. 4044. Left; ant. post. flap. Mustered out July 24, 1863. Left. Surg. J. E. Murta, 8th Wis. Disch'd Nov. 24, 1862. Right; flap.' A. A. Surg. C. C. Joslin. Disch'd July 4, 1865. Right: lat, flap. A. A. Surg.W. S. Adams. Tub. seq. removed. Disch'd Mar. 18, '65. Spec. 3860. Right; circ. flap. A. Surg. A. Ingram, U. S. A. Mar. 4, 1864, rem'd nec.end. DutyNov.11,'64. Left. Subsequent operat'n. Dis- charged Feb. 19, 1864. Left. A. A. Surg. E. G. Waters. Disch'd May 30,'65. .Spec. 3424. Right: ant.post. flap; circ. of mus. (amp. left leg). Surg. F. E. Pi- quette, 86th C. T. Recovered. Right; flap, skin; circ. muscles A.A.Surg. A. R. Gray. Slough. Disch'd J une 20, '64. Spec. 3947. Left; circ.; gangrene. Disch'd June 23, 1864. Left; circ. A. A. Surg. H. C. Heilner. Haem. Disch'd Feb. 13, 1863. Spec. 120. Right; double flap. Surg. G. E. Brickett, 21st Maine. M. O. July 27, 1864. Left (gangrene); circ. Surg. — Holmes, C. S. A. Disch'dOct, 3, 1865. Right. Gangrene. Exchanged March 17,1864. Left; circ. Surg. J. H. Beech, 24th Mich. Disch'd Oct. 18,'63. 1 Stanford (R. L.), Bromine in Hospital Gangrene, in American Medical Times, 1863, Vol. VII, p. 24. I '}% i ■ ; ■ 3 ■ . f::; ■ -. ■> -■'.it- -~ cl '*a I' H ,* RY AND f KIVUiRa i ."-, J, V?.,- .a- •-. a, ^ P- . 1-. (i')Ul , a'„ aa ::. 1. , erg't.G, |A(.r. ' '. I ro<'i>5.aif"30. ! '.: . ' .t. < . <*.. >y, 11.; im i,'->..::i,, . ^'..li. -1 \-v ! , i .. ;•>!('•. ;■ ' it,n. tia:v. a. 1. Junr. 3'J. ;Y.I. Diva iip > i , ■- i" H K , ' N. i May hi iKi* 16, '64 if- , am i S„Pt. 14, ■ Rija i I J8; '62. | Y'p ,' itam r>:. : YdJab Y ■•n.-r. T W ■' :RiKf .a- Bi-aUi. ■■<; V,-r. 31, j Right: ant .-\ji 3/65. i KH. Hi' i • .» '..Mux !. dKept. :!'), ■>">. .S'j>ce. t-'A I 1 ■') -a" 1. .//.'ft: ar" a ».. tlap. Mastcrfd! •' ''''':■'. • out Ju:. . -^jjO. YaS. f *r'Y ■■■'■ % I •■••ft. YY: a. Miata, 8th Wis. ! •' ?. ' - !>'>■• '■ -i , Y.J2.' • .'-■ <; ■'■'•' •■ ^ i--f S.-ir. • :'.^-. -' ' c,ilx P. a. . ' *■; .....■ ' ' '■ •■ 'ah I 18"', •;«.«.. 1 i. IV. ! :WJ ,s-Vt. Y a,. A.A^v.S • !'.?;insyiA...... .;i.?-3. ; ^8. 'e..1, : '■:.■ a a- A Mar i, ; a. ( l*?.l ; d C ' ., • ,.lMay:s." ' K. "a v,t po-a t.. Disdi'd :\ I" (1 : C>) M .j. ,;, '.■'. •"fie, in American M<-J, M.alanul Surg.Hist.of (lie KelioUion l fm'i :j AS -: PLATE XX FEMORAL ARTERY AND FEMORAL VEIN AFTER AMPUTATION. sect, in.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 295 Namb, Military Description, and Age. 99 Reefer, C, Pt., E, 16th Mich., age 46. )0 Kemp, S. P., Pt., I, 7th Ohio. Kent, W. E., Pt., C, 6th Ohio Cavalry, age 22. 102 Krider, C. C, Lieut., C, 49th N. Cage 38. )3 Kuhns, J.W.,Pt.,C, llth Pennsylvania. 104 Kuoni, C, Serg't, C, 9th Wisconsin. 105 Larck, J., Pt., A, 5th W. Virginia, age 22. 106 Large, W.G., Pt.,K, 90th Pennsylvania, age 21. )7 Lauer, J. S., Pt., B, Sth New Jersey. 108 Leonard, J., Pt., E, 2d N. Y. S. M., age 30. Lewis, J., Pt., K, 47th Colored Troops, age 20. Little, T., Pt., I, 19th Maine, age 28. Lothrop, J. H., Pt., F, 16th Intantry, age 21. Lowe, H. B., Serg't, F, 5th Wisconsin, age 34. Lynch, J , Pt., C, 47th New York, age 30. Maedel, C, Pt.,C,9th 111. Maron, P., Pt., E, 2d Mass., age 27. Martz, C, Pt., G, 64th New York, age 26. Aug. 30, Sept. 12, 1862. Aug. 9, 14/62. Oct. 1, 15, '64. Mar. 25, 28, '65. Deo. 13, 16, '62. April 30, M'yl0,'t>4 July 24, 27,''64. April 29, May 15, 1863. May 3, 7, '63. July 2, 5, '63. April 3, 18, '65. July 2, 6, '63. Sept, 19, 24, '63. Mav 3, 6, '63. Julv 30, An.*3,'64. Oct. 3, 13, '62. May 3, 9, '63. Mar. 25, 30, '65. Operations, Operators, Result. Matthews, L W., Pt., K, 23d Ohio, age 24. Maurer,A..I.,Pt.,B,53d Ohio. Mayes, -S., Pt., F, 1st Penn. Cavalrv, age 20. McAllister, W. H. H., Serg't, G, 4th Vermont, age 27. McCombs,S.,Pt.,A,28th Illinois, age 18. McConky.A., Pt.,D,63d Pennsylvania, age 48. McCormick, M., Serg't, F, 2d Cavalry, age 36. McCray,A.F.,Pt., E,6th Missouri Cavalry. McGarraghan, H.,Pt.,E, 24th Ohio, age 20. McGinley, E., Corp'l, I, 23d Wisconsin, age 30. McGlone, H. W., Pt., F, 55th Ohio. McGrogan, J.,Pt., H,62d Pennsylvania. McMulUn, H. P., Pt., G, 61st Georgia, age 23. McMulUn, R. J., Pt., I, 4th Georgia, age 20. McWhinnie, J., Serg't, A, 20th Conn., age 24. Mickle, C, Pt., E, 83d Penn., age 19. Miller, C, Pt., B, 8th Illinois. Miller, G.W., Pt., I, 61st Georgia, age 19. Miller, J., Pt., 1st Ky. Battery, age 22. July 24, Au. 4,'64. May 2, Je. 1,'63. Oct. 1, 12, '64. Dec. 13, 23, '62. April 6, -, '62. May 5, 14, -f64. Sept. 19, 26, '64. Aug. 16, 19, '62. De.31,'62. Jan.4,'63 Nov. 3, 13/63. Mav 3, 12, "'63. July 1, 5, fe. July 9, 25, '64. May 3, 23, '63. Mav 3, 26, ''63. July 1, 25, %2. April 6, -, '62. Julyl, 15, '63. Nov. 30, De.7,'64 Left; flap. Surg. J. C Dorr, U. S. V. Disoh'd October 5, 1865, Spec. 4546. Right; double flap. A. Surg. T. G. Mackenzie, U. S. A. Discli'd Oct. 20, 1862. Specs. 51, 4477. Left (pyaem. symptoms); flap. A. Sur^. P. C. Davis, U. S. A. Discli'd May 4, 1865. Left; ciro. Surg. J. H. Kimball, 31st Me. Released June 15/65. Left; ciro. Disch'd Nov. 14,'63. Right; flap. Disch'd March 16, 1865. Left; lateral flap. Disch'd Jan. 10, 1865. Right; flap. Surg. A. W. Whit- ney, 13th Mass. Mustered out Deo. 13,1864. Left; circ. Surg. J. Dwinelle, 106th Penn. Disch'd Mar. 28,'64. Left; circ. Nov. 7, seven inches end of bone rem'd. Sent to In- sane Asylum June 6, '64. Spec. 2152. Right (gang.); ant. post, skin flap; circ. mus. Surg. F. E. Piquette, 86th C. T. Disch'd July 22,'65. Right; lateral flap. Discharged August 1, 1864. Left; circ. Confed. surgeon. Re- amput'n middle third. Disch'd Nov. 18,1864. Left. Ass't Surg. J. S. Ewing, 5th Wis. Disch'd June 21, '64. Right; circ. A. A. Surg. S. J. Holley. Necrosed bone rem'd. Disch'd May 25,1865. Left; flap. Surg. E. G uelick, 9th III. Disch'd Sept. 22, 1863. Right; circ. Disch'd August 21, 1863. Right (mort'n); circ.; nec. Sept. 26, re-amp. mid. third A. Surg. J. H. Armsby, V. S. V. DiscVd Oct. 4, '65. Specs. 2853, 3195. Right. Ass't Surg. L. D. Miller, 1 st N. J. Disch'd Aug. 18,1865. Left; flap. Disch'd July 27,'64. Right; flap. A.Surg. P.C.Davis, U.S.A. Disch'd May 6,1865. Right; circ. A. A. Surg. C. W. Filmore. Bone extracted. Dis. Sept. 19,1864. Spec. 200. Right; double flap. Surg. E. C. Franklin, U. S. V. Discharged April 7,1863. Left; lat. flap. Surg. R. B. Bonte- cou, U.S.V. Disch'd May 19,'65. Died May 15, "73. Spec. 3066. Left; flap. A. A. Surg. J. R. Uhler. Disch'd June 15, 1865. Left; flap. A. Surg. W. H. H. Cundiff, 2dMo.S.M.C. Disch'd. Right; circ. A. A. Surg. J. M. Henderson. Disch'd May 14,'63. Right (Nov. 11, haem.); circular. Ass't Surg. S. McClellan, 13th Conn. Disch'd March 10, '64. Right; circ. Surg. II. S. Potter, 105th 111. Disch'd Aug. 5, '63. Left; flap. Disch'd September 15, 1862. Left; circ. Surg. — Todd, 6th Va. (C. S. A.). Exch'd. Specs. 2692, 3871. ----(May 4, amput'n knee joint.) Surg. — Philpot, C.S.A. Haem.; lig. fem. art. Furl'd Aug. 4,'63. Left; circ. Surg. H. E.Goodman, 28th Penn. Necro. bone rem'd. Disch'd May 4, '64. Spec. 1284. Right, Re-amp. by Dr. Waters, April, '63, seq. rem'd. Disch'd June 27, 1863. ----. Surg. E.C. Franklin.U.S.V. Hasm. Recovery. Right; flap, skin : circ. muscles. A. Surg. R. F. Weir, U. S. A. Necrosis; Paroled Nov. 12, '63. Spec. 3908. Right (gang.; caries); circ. A. A. Surg. S. T. Williams. Disch'd March 11,1865. NO. Name, Military Description, and Age. 136 Millican, G. F., Corp'l, H, 26th Miss., age 35. 137 Minehan, A., Corp'l, F, 27th Mich., age 31. Mitchell, W.,Pt,, A, 122d Ohio, age 21. Moore, J. L., Lieut., K, 10th Penn. Res., age 26. 10 Morton, W. G., Pt,, F, 4th Ohio, age 20. 11 Mulligan, P.,Pt.,A,125th New York, age 44. 142 Musselman, W., Pt., H, 49th Virginia, age 40. 143 Myers, G., Pt., I, 24th N. York, age 19. 144 Nash, J., Pt., G, 143d Penn., age 21. 15 Peabody, A., Pt., G, 43d Missouri. 16 Perrott, G.W., Corp'l.G, 21st New Jersey. 147 Fetters, T. T., Capt,, B, 34th Virginia, age 33. 148 Phillips, W. M., Corp'l, D, 121st N.Y., age 28. Pitts, E. W., Pt., B, 69th New York, age 19. Pixley, P., Pt,, A, 55th Ohio. Place, S. W., Pt,, G, 1st Rhode Island Artil'ry, age 28. Powell, J , Pt., B, 29th Iowa, age 21. Priest, C, Pt,, H, 8th N. Hampshire, age 20. 154 Pullen, W. IL, Serg't, I, 5th Michigan, age 24. 155 Rial, J., Pt., B, 4th Ohio, age 22. Rice, A. D., Pt,, F, 45th Penn., age 23. 157 Roberts, C, Pt,, E, 1st W. Tenn. Cavalry. 158 Roberts, C. W., Pt., B, 12th Mississippi. 159 Robinson, E. P., Pt., H, 122d Penn., age 18. 160 Robinson, J. C, Brig. General U. S. V. 51 Robisho, J., Pt., D, 76th Illinois, age 23. 162 Rose, P. B., Ass't Surg. Sth Michigan, age 30. 163 Russell. Z. B., Serg't, B, 7th Wisconsin. 164 Sansom, S. B., Pt., I, 14th Indiana. 165 Schondan,J.,Pt.,K,95th New York. Schrabaskie, M., Pt., B, 183d Penn., age 46. 167 Scroggs, A., Pt., C, 48th North Carolina, age 19. 168 Sedgewick, P., Pt,, E, 125th N. York, age 23. Aug. 19, 29, '64. Aug. 21, Se. 10,'64 Sept. 19, 23, '64. June 27, J'y24,'62. Nov. 27, Dec. 3, 1863. June 17, J'y 13,'64. Sept. 19, Oc.25,'64. Mar. 31, Ap. 6,'6S. May 22, 28, '64. Feb. 21, March 15, 1865. May 3, 10, '63. April 6, 11, '65. Oct. 19, Nov. 18, 1864. Jan. 30, Feb.2,'63 Mav 2, 7, '63. Oct. 19, Nov. 10, 1864. April 30, May 4, 1864. Oct, 27, Nov. 26, 1862. July 2, 7, M53. June 3, 15, '64. Operations, Operators, Result. Seiders, J. Y., Serg't, K, 151st Penn., age 30. Shackelford, F. W., Pt., E, 15th Ohio. Shea, J. A., Pt,, 1st Me. Battery, age 21. Sept. 17, Oct. 15, 1862. April 28, Myl2,'63. June 4, 7, '64. May 3, 8, '63. May 8, 15, 64. April 9, M'y8,'65 Oct. 27, Nov.6,'64 Sept, 14, 17, '62. May 3, 15, Y63. July 1, 15, ''63. April 1, 8, '65. Sept, 17, 20, '62. July 2, 6, '63. July 1, 8, '63. De.31,'62 Ja.26,'63 Oct. 19, 25, '64. Right; ant, post. flap. Surg. — Clark.C.S.A. Trans. Nov. 2,'65. Right; circ. Surg.O. A. Judson, U. S. V. Haem.; lig. fem. artery. Oct. 19, re-amp. Disch'd May 19, 1865. Spec. 3272. Left, Teale's method. A. Surg. J. G. Thompson, 77th N. Y. Bony tumor, and seq. rem'd. Disch'd Jan. 19, 1865. Left (aneurism); dou. flap. Surg. R. B. Bontecou, U. S.V. Hsem.; lig. fem. art. Res'd Jan. 21,'63. Right; flap. Surg. A. N. Dough- erty, U. S. V. Disch'd July 8, 1864. Spec. 182. Left; circ. Ass't Surg. A. Ingram, U. S. A. Necrosed bone rem'd. Spec. 2866. Left; circ. Surg. —Blair, C.S.A. To Fort McHenry Feb. 10,1865. Left; circ. Dr. J. II. Thompson. Disch'd July 6,'65. Spec. 4063. Right; flap. April 9, 1665, seq. removed. Disch'd June 22,'65. Spec. 144. Left; flap. A. A. Surg. J. F. Bruner. Disch'd June 30,1865. Right; circular. Confed. surgeon. Nec. Dec. 3, re-amp. Dr. Olcott, Jersey City. Recovery. Left; ant. post. flap. Released August 10, 1865. • Right; circ. Surg. R. W. Pease, U. S. V. Haem. Disch'd Jan. 12, 1865. Left. Surg. J. Dwyer, 69th N.Y. Disch'd Jan. 12, 1864. Left; circ. Disch'd December 9, 1864. Left; ant. post. flap. A. A. Surg. B. B. Miles. Exfol'n removed. Disch'd May 7, '65. Spec. 106. Left; circ. Feb. 28, '65, necrosed bone came away. Disch'd May 22, 1865. Spec. 228. Right; circ. Disch'd April 9, 1863. Left; flap. Disch'd September 14, 1864. Right: ant. post. flap. A. Surg. W. Thomson, U. S. A. Hiem. Disch'd July 8, 1865. Specs. 3562, 3570. Left; circ. A. Surg. J. A. Bige- low, 8th Conn. Erysip. Disch'd April 2, 1863. Left; flap. Surg. N. Gay, U.S.V. Discharged. Left. Surg. — Craft, C. S. A. Disch'd Jan. 15,1865. Left. Surg. G. P. Oliver, lllth Penn. Nec. bone rem'd. M. O. Left; circ. Surg.B.Norris.U.S.A. Retired May 6, '69. Spec. 2268. Right (slough'g); doub. lat. flap. A. Surg. A. Hartsuff, U. S. A. Disch'd Aug. 9,1865. Re-amp. Left; circ. Surg. D. W. Bliss, U. S. V. Disch'd Mar. 28,1865. Right; flap. Discharged. Right; sloughing. Rem'd end of bone. Disch'd Feb. 11, 1864. Left; flap. Surg. G. M. Ramsay, 95th N.Y. Bonerem'd. Disch'd Feb. 9, 1864. Right; circ. A. A. Surg. D. L. Haigbt. Seq. rem'd. June 7,'66, nec. bone rem'd; muse. art. lig. Disch'd Oct. 15,'66. Specs. 2452, 1484, 4956. Right, (Deo. 10, end bone rem'd.) Disch'd from hosp'l Feb. 9,'63. Right; circ. Surg.W. S. Cooper, 125th N. York. Bone extracted. Disch'd Sept, —, 1864. Left 'gang.). A. Surg.C.A.Ham- ilton, 76th N. Y. Recovery. Right; flap. Disch'd April 11, 1863. Right; ant. post. flap. A.A.Surg. E. G. Waters. Disch'd April 3, 1865. Spec. 3427. 296 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name. Military Description, and Age. Operations, Operators, Result. ec.2575. Left; ant. post. flap. A. A. Surg. W. Hunt. Died June 16, 1862 ; exhaustion. Right. Surg.G. P. Oliver.lllth Penn. Died May 15, 1863. Left; circ. A.A. Surg. F. S. Bar- barin. Died Sept. 20,'64; pyaem. Spec. 3004. Right. Died Oct. 7,'62; pyaemia. Right (aneurism); circ. A. Surg. W. Thomson, U. S. A. Slough. Died June 4,'64 ; pysemia. Au- topsy. Specs. 3545, 3529,3579. Left; circ. A.Surg. J.S. Billings, U. S. A. Died May 18,1862. Left; ant. post, flap. A. A. Surg. J. J. Cockrell. Died Nov. 12, 1864; haemorrhage. Left. Died October 21, 1863. Right. Died May 18,1863. ----. Surg. T. H. Squire, 89th N.Y. Hiem. Died Oct. 18, '62. ----. Surg. E. C. Franklin, U.S. V. Died May 18, 1862. ----. Surg. D. P. Smith, U. S. V. Died Sept. 21, 1862. Autopsy. Left; ant. post. flap. Surg. R. B. Bontecou, U. S. V. Haein.; lig. fem. art. Died June 4,'64; exh'n. 1 LIDELL (J. A.), On the Major Amputations, for Injuries in both Civil and Mil'ry Practice, in Am. Jour. Med. Sci's, N. S, 1864, Vol. XLVII, p. 367. 2 LIDELL (J. A.), On the Wounds of Blood-vessels, Traumatic Hsemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in XT. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 198. 'Smith (E. H.), Report of Cases of Compound Comminuted Fracture of Femur, etc., in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 24. 4 Bryan (J.), Amputations from the Armies of the Southwest, in Am. Med. limes, 1863, Vol. VII, p. 288. 'Lidell (J. A.), XT. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p 141. •Ducachet H. W.), Cases of Military Surgery, in Am. Med. Times, 1863, Vol. VI, p. 137. 300 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. Name, Military batfs Description, and Age. Knight, B, Pt, E, 110th May 25, | Col'd Troops, age 24. '.J'e 1,'65. I 446 Knight, W. T., Corp'l, Mar. 25, C, 54th N. Carolina. Ap. 7,'65. 447 Langenderser, M, Pt, Mar. 11, A, 189th Ohio, age 18. 14, '65. 448 Laurier, T, Lieut, K, June 1, 71st New York. 8, '62. 449 Lawton, C. M, Pt, H, June 3, 58th Penn, age 30. 8, '64. 450 Leach, W. B, Pt, K, 2d June 1, Conn. H. A, age 37. 16, '64. il Lee. P, Pt, C, 142d May 12, Penn, age 20. 24, '64. >2 Leedy, D, Pt, F, 26th Aug. 8. Illinois. 14, '64. 453 Leslie, W., Pt, B, 16th De.31,|62 Infantry. Jan.4,'63 454 Lindsay, F, Pt, C, llth Dec. 13, Penn, age 22. 29, '62. 455 Linsenberger.W.R, Pt, May 5, B, 139th Penn, age 22. 29, r64. 456 Livingston, L. A., Capt, July 2, F,8th Alabama, age 23. 14, '63. i7 Llewellyn, J. T, Corp'l, Mar. 31, C, 13th Ohio Cavalry, April 11, age 21. 1865. 458 Lobden, S, Pt, I, 2d Oct. 19, Conn. H'vy Artillery, No. 2,'64 age 22. 459 Lohr, E. J, Pt, B, 54th July 18, Penn, age 24. 29, '64. 460 Loid, W. H, PL. B, 2d April 6, New York H'vy Art, 25, '65 age 26. 461 Love, H. T, Pt, C, 41st July 20, Alabama, age 30. 31,'64. 462 Loveland, W. II, Capt, May 5, B, 4th Mich, age 35. 20, '04. >3 Lucdi.-k.W, Pt, C, 37th Nov. 24, Ohio. De.16,'63 464 Lynch. A. D, Pt, B, 2d June 2 New York H'vy Art, 8, '64. age 41. 465 Lyons. C. H, PL, K, Sth May 3. Ohio. -, '63. 466 Madden, C, Pt, 3d S. Sept. 17, Carolina Art'v, age 17. Oct. 2,'62 467 Mallett, C, Serg't, F, Dec. 13, 57th New York. 28, '62. 468 Marion, G. S, Pt, C, May 6. 45th Penn, age 21. 15, "'64, Mark, J, Pt, K, 110th Mar. 25, Ohio, age 42. Ap. 3.'65 0 Markle, II, Pt, C. 148th May 3, Pennsylvania. -. '63, 471 Mars, H, Pt, G. 5th Mar. 31, New York, age 24. A p. 9,'65, 472 Marsh. H. F.. Pt, City June 13, Batt'n, Petersburg. Va. 20, '64. 473 Martin, C, Pt, C, 16th July 2, Michigan, age 19. 5. '63. 4 Marx, J, PL, F, 24th Sept. 20, Illinois. 30. '63. 475 Marys, D, PL, C. 90th May 5, Pennsylvania. 20, '64 476 Mather, Z. IL. Serg't, M, 5th Mich. Cav, age 27. 7 McAnnay, L, Corp'l. L, Mar. 25. 20th l'enn. Cav,age 21. Ap. 1,'65, 478 , McCallum, M, Serg'LD, May 3, 1 ! 140th Penn, age 32. 9, '63. 479 | McCloud, M., Pt, E, 32d Nov. Alabama. De. 3,'03. 480 McCormick, C, PL, A, Julv 2, I 57th Penn., age 22. 5, '63. Operations, Operators, Result. Right: circ. A. A. Surg. R. H. Blandry. Died June 15, 1865; pyaemia. Right; circ. Surg. W. L. Baylor, C. S. A. Died April 18. 1865. Right: oblique anterior post. flap. A.A. Surg. J. J. Cockrell. Bone rem'd. Died April 15, 1865. Right, (Gangrene.) Died in two hours after operation. ----; ant. post. flap. Surg. R. B. Bontecou. U. S.V. Ha?in. Died June 11, '64; shock. Spec. 3057. Left; ant. post. flap. Surg. R. B. Bontecou, U. S. V. Died June 19, 1864; pyaemia. Spec. 3032. Right; ant. post. flap. A. Surg. A. Ingram, U.S.A. Sloughing. Died May 27, 1864. ----; flap. Surg. J. H. Hutchison, 15th Mich. Died Aug. 14,1864. Right (gang.; mortificat'n); gan- grene. Died Jan. 9,1863. Left, Surg. H. Bryant, U. S. V. Died January 4,1863; pyaemia. Spec. 570. Left; ant. post. flap. Surg. R. B. Bontecou, U. S. V. Died June 7, 1804; exhaustion. Spec. 3041. Left. (July 3, amp. leg; erysip.) Haem. Aug. 4, bone excised. Died Sept, 27, '63; exhaustion. Left; circ. A.A.Surg.Z.P.Derm- ler. Died May 6,'65; pyaemia. Spec. 4062. Right: ant. post. flap. A.A.Surg. C. H. Jones. Died Nov. 16,'64; exhaustion. Left, circ. A.A.Surg.J.H.Coover. Died Aug.8, '64; pi.-pneumonia. Right; ciro. Surg. O. A. Jndson, U.S.V. Phagedaen. Died May 6, 1865; exhaustion. Left; circ. Died Aug. 1, 1864. Left; circ. Med. Ins. F. II. Ham- ilton, U. S. A. Haem. Died May 31, '64; exh'n. Spec. 2287. Right. Died January 4, 1864. Left; circ. Surg. J. W. Wishart, 140th Penn. Died July 4,1864 ; pyaemia. Right. Surg. G. P. Oliver, lllth Penn. Died May 13, 1863. Right; circ. A.Surg.A.H. Smith, LI. S.A. Haem.; lig. fem. Died Oct. 8, 1862: exh'n. Autopsy. Specs. 777. 833. Left. Died Jan. 2, 1803. Haem. Spec. 2451. Left; lat. flap. Surg. R. B. Bonte- cou, U. S. V. Died May 19,'64; pyaemia. Spec. 3055. Left; circ. A. Surg. H. Allen, U. S. A. Died April 23, 1865; pyaemia. Autopsy. Spec. 158. ---. Surg. C. S. Wood, 66th X. Y. Died June 7,'63. Spec. 1172. Right; circ. A. Surg.W. F. Nor- ris, U. S. A. Died April 22,'65; pyaemia. Autopsy. Spec. 3237. Right; circ. A.A.Surg. J. Money- penny. Died June 24, 1864. Right. Haem. July 14, re-amp. mid. third; haem. DiedJuly21, 1803; pyaemia. Autopsy. Left. Surg.I. Moses.U.S.V. Died Oct. 6. 1863. Spec. 2127. Right. (Gang.; May 10, amp. knee j't; art.sloughed: haem.) Surg. J. Ebersole, 19th lnd. Died May 20. 1864. Spec. 2340. Left (haem.); flap, skin; circ. mus. Died Aug. 19, 1803; pyaemia. Autopsy. Spec. 3963. Left (humid gang.); circ. A. A. Surg. W. B. McCausland. Died April 15, 1865; pneumonia. Left. A. Surg. W. Thomson, U. S. A. Erysipelas. Died May 17, 1863; pyamia. Spec. 1081. Left; circ. Surg. J. C. Morgan, 29th Mo. Died Dec. —, 1863. Left, Haem. Died July 12,'63; exhaustion. Name, Military | -r,^^ Description, and Age. i "Alto- 488 497) 498) McConnell, D. W, Pt,J April 6, H. 46th Ohio. * -, '62. McDonald, J, Corp'l, B, April 1, 94th New York, age 20. 8, '65. McGee, J, Pt, C, 6th De.29,'62 Missouri. Jan.8,'63, McHarvard, T., Pt, C, July 2, 28th North Carolina. 15, '63. McKittrick, L, Pt, A, Jan. 1 37th Indiana. 10, '63. McLean, P, Pt, E, 86th April 10, Cold Troops, age 23. 29, '6, Mellick, M, Pt, F, llth Aug. 9, Pennsylvania. 15, '62. Merron, J, Pt, D, 12th May 9, Mass., age 31. 16, '64. Metitel, F, Corp'l, F, Nov. 27, 26th Penn, age 20. |De.23,'63, Miller, A, Pt, E, 95th I May 3, Penn, age 18. | 14, '63. Miller, C, Corp'l, K, 5th | April 7, N. Hampshire, age 33. i 23, '65. Operations, Operators, Result. Miller, L, Pt, D, 100th Ohio, age 25. May 15, 18, '64. Miller, L. S, Pt, E, 12th j Aug. 30, Massachusetts. Sept. 18, 1862. Miller, S. C, Pt, K, Sth April 9, Illinois, age 38. iM'y8,'65. Mills, W. F, Pt, E, 8th June 16, N. Y. H. A, age 42. —, '64. Moan, F. H, Corp'l, F, May 3, 6th Maine, age 22. 14, '63. Moore, J, Pt, E, 46th Aug. 9, Pennsylvania. 15, 62. Moorehouse, O. J., Pt, Nov. 24. H, 31st Iowa. 30, '63. More, J, Pt, 1,76th Col- April 9, ored Troops, age 30. 25, '65. Moriarty, C, Pt, K, 8th April 13, New Hampshire. M'yl,'63. Morse, J, PL, B, 2d ! June 16, Penn. Art'y, age 22. j 25, '64. Murray, H. T, Serg't, I, ! Nov. 27, 6th Maryland, age 24. j Dec. 10, ' 1863. Murray, W, Pt, C, 20th I Dec 7, Iowa, age 25. I 20, '62. Myers, E, Pt, A, 154th New York. Myers, H, Pt, E, 93d Penn, age 23. Nance, T. J., Pt, H,30th Texas Cavalry. Nelson, C, Pt, A, 129th Indiana, age 18. Nelson, D, Pt, E, 13th Colored Troops. Nicely, M, Pt, E, 79th Indiana. Nickinson, A., Pt, G, 52d North Carolina. May 3, 16, ^63. May 12. 31, '64. April 4, May 1,'64, Mar. 8, 29, '65. Dec. 15, —, "64. Sept. 19, —, '63. July 3, —, '63. Noye, 0, Pt, C, 63d June 7, Colored Troops. 21, '63. Ocker, T, 'Capt.. A, 6th April 2, Maryland. ' —. '65. O'Hara, H, Pt, I, 19th De.7,'62, Iowa, age 23. Jan. 1,'63 O'Reilly, P., Pt, E,42d j SepL 17, New York, age 20. ;Oct. 1,'62. ---. (April 10, amp. knee joint; slough'g; necrosis.) Surg. E. C. FranUin, U. S. V. Died April 25, 1862. Left; circ. A. A. Surg. H. Gib- bons, jr. Haem. Died April 20, 1865; pyaem. Autop. Spec. 3200. Left. Died February 2, 1863. ---. Died July —, 1863. Left. Died February 13, 1863; pyaemia. Autopsy. Left; circ. skin flaps; circ. sect. muscles. Surg. F. E. Piquette, 86th Col'd Troops. Died May 8, 1865; ac. diarrhoea. Right; ant. post. dou. flap. Surg. J. E. Summers, U. S. A. Haem. from w'd in axilla. Died Aug. 26, 1862. Spec. 41. Left; circ. A. A. Surg. J. O. French. Died May 25, 1864; pyae mia. Autopsy. Spec. 2286. Right ; ant, post, flap. Surg. C. Page, U.S.A. Haem. Died Jan. 19, 1864. Specs. 1433. 2019. Right; circ. Haem.: lig. fem. art. Died June 6, 1863. Autopsy. Spec. 1243. Left. Surg. B. A. Vanderkieft, U.S.V. Died April 29,'65. Spec. 4104. Left: circ.; necrosis. Died April 4, 1865; gangrene. Right; flap. Surg. B.A.Clements, U. S. A. Died October 3, 1862; pyaemia. Spec. 3493. Left; bi-lat. flap. Ass't Surg. A. Hartsuff, U. S. A. Died May 9, 1865. • Left. (Prim. amp. right thigh.) Died June 23, 1864. Right; circ.; haem.; lig.fem.art. Died May 23, '63. Spec. 1255. Both; double flap. Surg. J. E. Summers, U. S. A. Died Aug. 26, 1862. Specs. 46, 47. Right (ball extr'd); circ. Surg. J. C. Morgan, 29th Mo. Died Dec. 18, 1863. Right; circ. Surg F. E. Piquette, 86th Col'd Troops. Died May 1, 1865; exhaust'n and diarrhoea. Left. Died May 3, 1863. Right. (Amp. leg.) A. A. Surg. E. T. Caswell. Haemorrh. Died August 10,1864; pyaemia. Right; circ. Surg. E. Bentley, U. S. V. Died Dec. 19, '63; py- aemia. Autopsy. Left; lat. flap. Snrg. P. Harvey, 19th Iowa. Died Dec. 29,1862; pyaemia. ---. Died May 22, 1863. Left; ant, post, flap. Surg. R. B. Bontecou, U. S.V. Haem. Died June 11, 1864 ; typhoid fever. Right (April 4, amp. leg); circ. Surg. C. E. Swasey, U. S. V.; pyaemia. Died May 8, '64; ex- haustion, etc. Right (abscess); skin flap. Ass't Surgeon E. F. Hendricks, 15th Conn. Died April 13,1865; ex- haustion, etc. Right. Died Dec. 22, 1864. Left thigh. Died October 17, '63. ---. Surg. C.S.Wood, 66th N. York. Gang. (prim. amp. arm). Died July 19, 1863. Right, Died July 14,1603. Left. Died May 3, 1865. Right; lat. flap. Surg.P.Harvey, 19th Iowa. Died Jan. 9, 1863; pyaemia. Left; lat. flap. A.A. Surg.W.W. Keen, jr. Died Oct. 6,'62; exh'n. Spec. 793. SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 301 Name, Military N \ Description, and Age, Osborn, E, Pt, D, 91st New York, age 20. Osborne, S, Pt, M, 2d Conn. H. Art'y, age 44. Osgood, T. J, Pt, A, 39th Illinois, age 20. Paddock, D. G, 11, G, 83d Peun, age 23. Page, A, Pt, B, 161st New York. 'Parker, X., Corp'l, B, 51st Georgia, age 40. Parsons, T. H, Capt, C, 91st Penn, age 29. Payne, D, Pt, H, 2d Conn. H. Art'y, age 25. Payne, G.H,Pt,K,64th New York, age 18. Peck, N. A, Serg't, D, 2d Rhode Island. Perkins. W. J., Pt, A, 7th C. S. Cav, age 24. Perry, A, Pt, C, 6th N. York Cav, age 24. Perry, W, Pt, A, 34th North Carolina. Peters, F, Pt, A, 49th Penn, age 24. Philbrick, R, Pt, D, 117th N. Y, age 25. Phillips, J., Pt.. I, 37th North Carolina. Pippin. A. P., Pt, D. 2d Alabama, age 18. Polhemus, J, Pt, F, 137th New York. Potter. F. B, Pt, D, 12th Mass, age 24. Powers. J, Pt, H, 74th New York. Prescott, C. R, Corp'l, F, 14th New York S. M, age 27. Preston, T, Serg't, E 14th W. Virginia Cav, age 21. Price, A.H,Pt ,H, 188th Penn, age 25. 539 . Pulhemus. J, Pt, E, 1st ' Mich, age 20. Mar. 31, Ap. 6,'65. May 31, Je. 27/64 Aug. 16, Sept. 15, 1864. Putnam, G. R, Pt.', 10th Mass Battery, age 32. Rainier, M. G, Pt, G, 124th Indiana, age 20. Rairdon, W, Pt, I, 40th Indiana, age 36. Ramsey, W., Pt, H, 6th Virginia Cav, age 19. Corp'l, Ransom, F. H D, 34th Ohio. 545 Reeves, G. T, Pt, E, i 29th Iowa. 546 j Reeves, W, Pt, K, llth ! Mass, age 45. 547 j Reinhart, L., Pt, F, 23d N. Carolina, age 39. 548 ■ Revis, W., Pt, D, 8th Tenn. Cavalry, age 21. Id, ill. April 7, 15, '64. May 16, June 2, 181.4. May 3, 11, '63. Oct. 19. Nov. 2, 1804. Oct. 12. 29, '64. Mav 3, 29,'63. June 18, —, *04. Aug. 16, Sept. 3, 1864. June —, J'y 8, '62. June 1, 7, '64. June 15, 24, '64. June —, J'y 3, '62 April 9, 26, '65. May 3, 8, '63. May 6, 27.''lit. Aug. 30, Sep.-,'62 Julv 21, 24,"'61. July 9, 25, '64. May 30, J'ne8,'C4. Dec 13, 26, '62. Aug. 25, Sept. 23, 1864. Mar. 10, 13, '65. June 27, July 9, 1864. April 1, 8, '65. May 16, 27, '02. April 30. M'y3,'64. May 24, 28,''04. Mav 12, 19, '04. Feb. 20, Mar.5,'64, Operations, Operators, Result. Name, Military Dusciiiption, AND Age. Left; semi-circ. Surg.T. R. Cros- by, U.S.V. Died April 18,1865; pyaemia. Right (gang): double flap. A.A. Surg. W. C. llnrle. Died June 30, 1804; pysemia. Right (sloughing); ciro. A. A. Surg. J. C.Martin. Haem.; lig. fem. nrt. Died Sept. 28, 1864; exhaustion. Right; lat. flap. Surg. R. Ii. Bon- tecou, U.S.V. Haem.: lig. teni. art. Died May 24, 04 ; exh'n. Right; circ A'.Surg.S.lI.Orton, U.S.A. Died April 27, 1804. Left, (lhtm.: lig. post. tib. art.; hiem. recurred ; lig. fem. art'y.) Died June 2, 1804; shock. Left; ciro. A. A. Surg. J. O. Stanton. Abscess; exostosis. Died June 20, 1803; pyaemia. Spec. 1324. Left; double flap. Surg. R. W. Pease, U.S. V. Haem.; lig. fem. art. Died Nov. 17, 1864. Left (Oct. 21, haem.; lig. pop. art. Oct.28, haem.; lig.fem.art.); flap. A. A. Surg. J. C. Norton. Died Dec. 4,1864; exhaustion. Left. (Gang.) Died June 2, '63. Spec. 1181. Left. Surg.F. F. Burmeister,69th Penn. Died June 28,'64. Spec. 4512. Left (art. sloughed; haem.); circ. A. A. Surg. B. B. Miles. Died July 8,'65; osteomyelitis. Spec. 2965. Left. (Irrita. fever.) Died July 16, 1862. Left; circ. A. A. Surg. J. Cass. Died June 8, 1864; exhaustion. Left; circ. A. A. Surg. J. Money- penny. Died June27,'64; exh'n. Right. Surg. — Eads, C. S. A. Died July 7, 1862. Left; flap. Surg. A. McMahon, U. S. V. Died May 11, 1865; suppuration and exhaustion. Left; circ. Died May 15, 1863; haemorrhage. Right. Died June 5, 1864. ----. Died Sept. 11,'62; tetanus. ----; circ. Drs. Darby and Con- rad. Exc. end of femur. Died August 8, 1861. Left; circ. A. A. Surgeon T. J. Dunott. Died August 2, 1864. Spec. 3911. Right; circ. Surg. O. A. Judson, U. S. V. Died June 13, 1864; shock. Spec. 2942. Left. (Haem.) Dec. 30, haem.; lig. fem. art. Died Jan. 15, '63; exhaustion. Right (sloughing); ant. post. flap. Surg. G. S. Palmer, U. S. V. Haem. Died Nov. 2, 1804. Left (gang.); flap. Surg. C. A. Cowgill, U. S. V. Died March 22, 1865; shock. Right (gang.); circ. A. Surg. C. C. Byrne, U. S. A. Haem.; lig. Died July 23,'64 ; haemorrhage. Right; circ. A. Surg. W. Thom- son, U.S. A. Sloughing. Died April 18, '65; pyaemia. Autop. Left, (Gangrene.) Died May 30, 1862. Left. Died May 5, 1864. Right, Died May 31,'64; tetanus. Left, Surg. O. A. Judson.U.S.V. Hsem. Died May 30,'64; pyaem. Autopsy. Spec. 2276. Left. (Haem.) Surg. H. L. W. Burritt, U. S. V. Gang. Died March 11, 1864. Spec. 2228. Operations, Operators, Result. Reynolds, H. H, Pt, F, Sept. 4, 1st Mich. Cav, nge 28. 18, '64. 550 Rice, S, Pt, A, 142d New York, nge 27. 1 Richards, E, Pt, H, 8th Maine, nge 20. Hidy, .1, Pt, I, 9th N. V. ll'vv Art'y, age 41. Ripley, F, Pt.', G, 10th Massachusetts. A Bobbins, E. II, Serg't, F, lath Mass, age 29. Robinson, F. B , Pt, H, 7th New Hampshire. Robinson, J.. Pt, D,12th Conn, age 34. 557 Rors, D., Pt, E, 1st S. Carolina, age 22. 558 Rombaugh, I, PL, B, 28th Pennsylvania. 559 Rosenfelt, N, Serg't, D, 26th Peun, age 22. Ross, B. W, Pt, C, 26th New York, age 22. Rowe, J. A, PL, I, 3d Maryland Cavalry. Royal, R. B, Pt, B, 6th Maine, age 25. Ruhling, F.J,Serg't, E, 112th N. Y, age 29. Sackner, J. C, Pt, E 2d Michigan. Sailor, J, Serg't, E, 45th Ohio. Sailor, W, Pt, E, 119th Penn, age 40. Salzman, C, Pt, K, 2d Infantry, age 31. Saltzman.W.C, Bugler, 1st N. Y. lnd. Battery, age 21. Sampson, D. B, Pt, C, 67th New York, age :i4. Saunders, S, Pt, K. 52d New York. 2Saxon. J. N., Pt, D, 9th Louisiana, age 27. 3Schaffer, C, Corp'l, D. 9th Illinois Cavalry. Schaup, H, Pt, K.lOOth New York, age 29. Schlaf, A, Pt, B. 2d Penn. Art'y, age 42. Schneider, F, Pt, E, 20th Wis, age 25. Schweitzer, S, Pt, A, 101st Ohio, age 18. Seber,J.W,Pt,A,76th New York, age 27. Sehman, C, Pt, F, 28th Ohio. Senior, T. H,Pt,C, 10th Maine. Sheridan. N. B, Pt, A, 90th Pennsylvania. Sept. 29, Oc.14,'64, June 3, 9, '64. Oct. 19, 25, '04. May S, II), '04. May 0, June 2, 1864. July 11, An. 1,'63, Oct. 19, Nov. 4, 1864. July 28, Au21,'64 Sept, 17, Ocl3.'62 July 2, 19, '63. Dec. 13, 29, '62. Aug. 16, 28, '64. June 3, -, '64. June 1, 11, '64. May 31, June 24, 1862. Sept. —, 30, '63. Nov. 7, 14, '63. De.27,'65 Jan. 3,'66 Oct. 19, Nov. 16, 1864. May 31, I'e— ,'62 June 16, —, '64. Nov. 7, 18, '63. Aug. 24, 27, '63. May 14, J'e 11,'64 Nov. 30, Dec. 7, 1864. Dec. 7, 11, '62. Julv 7, 21,'64. July 1, 4, '63. May 16, 30, '62. July 2, 18, "'63. Dec. 13, 17, '62. Left. A. A. Surg. J. H. Bartholf. Haem.; lig. popliteal art. Died Sept. 30. 1804; pyaem. Autop. Spec. 3930. Left; circ. A.Surg D.R.Brower, U.S.V. Died Oct. 21,'04 ; pyaem. Left (haem.); ant. post.flap. Surg. R. B.Bontecou.U.S.V. Slough.; haem.: re-amp. mid. third. Died June 13,'64 ; exh'n. Spec. 3004. Left; circ A.A. Surg.W.B. Mor- rison. Died Nov. 11,1804. ----. (Gangrene.) Surg. G. T. Stevens, 77 th N. Y. Died May 13, 1864. Right (haem.; May 30, lig. fein. art.; slough.; haem.); double lat, flap. A. A. Surg. J. Ransom. Died July 15, 1804. Left (haem.); circ. Died Aug. 10, 1863. Spec. 1062. Right; ant. post. flap. A.A.Surg. C.H.Jones. Nov. 11, haein.; fem. art. lig. Died Nov. 23,'64; haem. Spec. 3443. Left; double flap. A. A. Surg.W. L.Hammond. Died Aug. 22,'04. Left, Surg.C. Page,U.S.A. Died Jan. 5, '03; col. diarr. Spec. 1745. Right. Surg.C.W.Jones,U.S.V. Slough.; exc.endofbone; haem.; lig. fem. art. Died Oct, 2, 1863. Spec. 1699. Right. Died Jan. 9, 1863. Spec. 577. Left; circ. A.A.Surg.E.B.Wool- ston. Sloughing. Died Oct. 18, 1804; exhaustion. Left; circ. Died June 23, 1864. Left; lat. flap. Surg. R. B. Bonte- cou, U. S. V. Hiem.; lig. fem. art, Died June 18,1864 ; gang. Spec. 3050. Left; circ. A. A. Surg. F. H. Brown. Died June 24, 1862; shock. Right, Died Oct. 1, 1863. Left; circ. A. Surg. G. A. Mur- sick, U. S. V. Died Dec. 1, '63; pyaemia. Autopsy. Specs. 1887, 1888, 1889, 1890. Left (gang.), ant. post. flap. A. Surg. C. C.Graj.U.S.A. Haem.; lig. fein. art. Died Jan. 13, '66. Autopsy. Left : ant. post. flap. A. A. Surg. E.G. Waters. Died Nov. 22,'64; diphtheria. Spec. 3731. Left, (Pyaemia.) Died June 26, 1862. Left. A.Surg.T.O. Cornish, 15th Mass. Died J'e 25, '64. Spec. 204. Right; flap. Surg. J. A. Lidell, U. S.V. Osteo-myelitis. Died Dec. 3, 1863; haem. Autopsy. Specs. 1819, 1860, 1892. Left; ant. post. flap. A. A. Surg. S. R. Coale. Died Sept. 12,'63; pyaemia. Spec. 2101. Left; circ. A.A.Surg. J. S. Hill, Died June 15, 1864; shock. Right; ant. post. flap. A.A.Surg. C. W. Harper. Dec 15, haem. Died Dec. 16, 1864 ; pySmith, W. L., Pt, I, Sth North Carolina, age24. 15 Snider, D, Pt., G, 4th Maine, age 47. 16 Somers, J, PL, E, 64th New York, age 21. Sponholtz, F, Pt, A,5th New Jersey. Spring, W., Pt., K, 19th Iowa, age 20. 19 Steadman, W., Pt, A, 1st Mass. H'vy Art'ry, age 21. 600 Steele, W, Pt, H, 2d New York H'vy Art'y. 601 Steinhofer, A, Pt, D, 20th Mass, age 24. 602 Stephens, E, Pt, I, 1st Pennsylvania Rifles. 603 Sterling, G., PL, I, 20th Maine, age 29. »4 Stoldt, G, Capt, 58th New York. 605 Stone, G. E, Pt, M, 1st Mass. Art'y, age 29. Story, J.C,PL,D,114th New York. 607 Stover, A. W, Serg't, I, 20th Maine, age 23. Stowell, F. M., PL, D, 70th N. York, age 28. Strader. F. P,Capt, H, 6th Indiana, age 26. 610 Stringer, T. J, Pt, C, 98th Ohio. 611 Stubbs, J. P., Pt, F,13th Georgia. 612 j Stuckey, J. E, Corp'l.B, 42d Pennsylvania. 613 Sullivan, J. W, Pt, C, 6th Maryland, age 18. 614 *Tate, J. G., Pt, —, 53d Georgia, age 20. Sept. 19, 22, '64. July 20, 26, '64. July 9, Aug. 3, 1864. Sept. 17, 24, '62. Sept. 19, 22. '63. Aug. 10, Sep.1,'61. July 26, Au. 1,'64. Sept. 29, Oct.6,'64, Nov. 25, —, '63. Dec. 16, 29, '64. Oct. 25, Nov. 13, 1864. May 9, 18, '64. May 6, 20, '64. April 1, 10, '65. May 3, 7, '63. Dec. 7, 11, '62. May 16, 25, '64. Oct. 17, —, '64. May 18, 27,"'64. June 18, July 15, 1864. Sept. 30, Oct. 15, 1864. July 3, 6, '63. May 19, 29. '64. Sept. 19, 24, '64. June 20, 28, '64. July 2, 31, ^63. Nov. 25, De. 9, '63. Oc—,'62. Sept, 19, 22, '64. Dec. 13, 24, '62. Oct. 19, Nov. 9, 1864. Sept. 17, 29, '62. Operations, Operators, Result. Right. Asst. Surg. J. A. Bigelow, Sth Conn. Haem. Died Oct. 25, 1862. Left (gang.); flap. A. A. Surg. G.W.Edwards. Died June 30, 1862. Autopsy. Right; flap. Surg. W. A. Barry, 9bth Penn. Died Sept. 27, '64; exhaustion. Left; ant. post. flap. Surg. J. B. Lewis, U. S. V. Aug. 3, haem.; lig. fem. art. Died Aug. 14,'64; haemorrhage. Spec. 4270. Right; circ. A. A. Surg. A. R. Gray. Died Aug. 8,'64 ; exh'n. Autopsy. Spec. 3814. Right. Died Sept. 27, 1862. Right. Died October 16, 1863. ----. Died September 15, 1861. Right; flap. A. A. Surg. C. T. Bullen. Died August 23, 1864; exhaustion. Left; circ. A. A. Surg. C. C. Ela. Hiem. Died Oct. 14,'64; haem. Left. Died Dec. 4, 1863. Left (gang.); bi-lateralskin flaps; circ. muse. Surg. J. R. Brust, 1st Tenn. Died May 28, 1865; exhaustion. Left (Nov. 10, pyaemia); ant. post. flap. A. Snrg. W. H. Warner, 3d Wisconsin Cavalry. Died Nov. 13, 1864; pyaemia. Left; ant. post. flap. A. Surg. G. A. Mursick, U. S.V. Died May 31,1864; pyaemia. Autopsy. Right (slough.); circ. Surg. R. B. Bontecou, U. S. V. Died Mav 23, 1864; haemorrhage. Left; ant. post. flap. A. Surg.W. F. Norris, U. S.A. Died May 1, 1865; pyaem. Autop. Spec. 2629. Left, Snrg. G. P. Oliver, lllth Penn. Died May 24, 1863. Left; circ. Surg. G. H. Hubbard. U.S.V. Slough'g. Died Dec. 30, 1862. Right, Surg.D. P. Smith.U.S.V. Died June 8, 1864; pyaemia. Spec. 3296. Left. Died November 9, 1864. Left. Died May 30, 1864; py- aemia. Spec. 822. Left (spic. rem'd); lat. flap. Surg. N. R. Moseley, U. S. V. Died April 11, 1865; debility. Spec. 2874. Left (Oct, 11, amp. leg; gang.); bi-lat. flap. Died Oct. 20,1864; exhaustion. Spec. 3285. Left. Died July 21,-63; tetanus. Right; ant. post.flap. A.Surg.W. Thomson, U. S. A. Died June 18, 1864; pyaemia. Autopsy. Right; circ. Surg. L. P.Wagner, 114th N. Y. Died Oct. 7, 1864 ; pyaemia. Autopsy. Right; circ. A. A. Surg. A.N. Brockway. Died June 30, '64 ; shock. Left; haem.; lig. Died August 3, 1863. Left. A.Surg.C.C.Byrne.U.S.A. Died Dec, 16, 1863; pyaemia. Left. Died November 4, 1862. ----; circ. A. Surg. — D'Orsay, P. A. C. S. Died Oct. 10,1864; pyaemia. Right. Died November 17, 1863. Left; ant. post, flap. A. A. Surg. T. F. Murdock. Died Nov. 22, 1864; exhaustion. Spec. 3414. Left; circ. Died Sept. 30, 1862; pyaemia. 639 640 641 642 ( 643) Name, Military Description, and Age. Taylor, C. IF, Pt, C, 60th Georgia, age 20. Taylor, J, Pt, H, 91st Ohio, age 32. Taylor, J. G, Pt, G, 12th Mass, age 37. Teagles, B. A, Pt, G, 126th N. York, age 20. Thompson, J. M, Pt, H, 12th N. Hamp, age 20. Thompson, W., Pt., H, 69th N. York, age 19. Thompson, W. H, Pt, C, lstU.S.S.S,age20. Thormsley, J., Pt, I, 97th Ohio, age 18. Thorn, S. R, Pt, A, 124th Pennsylvania. Tibbetts, W.B, Serg't, K, 1st Me. Cav, age 28. Tibbs, L, Serg't, Sth Col'd Troops, age 21. Timberlake, T., Corp'l, H, 25th Ohio, age 20. Tracy, A. L, Pt, K, 141st Penn, age 35. Tresonthick, S. H , Capt, E, 18th Penn. Cavalry, age 22. Trimbly, J. E, Pt, D, 68th Indiana. Truex, J. P., Corp'l, F, 14th N. Jersey, age 22. Truitt, H. W, Pt, E, 137th Illinois, age 22. Uhland, F., PL, G, 47th Pennsylvania. Unknown, Pt, 23d Ky. Unks, G, Corp'l, L; 62d Pennsylvania. Valley, J. R., Pt, 1,20th Maine, age 20. Vanderslice.A. H,Corp, E, 27th Penn, age 30. Vermillye, J. C, Pt, K, 124th N. York, age 24. Vest, C, Pt, B, 42d Vir- ginia, age 23. Vincent, R, Corp'l, H, 149th New York. Vittman, G. L, Pt., K, 14th N. Hamp, age 27. Walker, T. S, PL, D, 116th Pennsylvania. Wallace, D, Pt, I, 5th Artillery. Wallace, W., Pt, E, 63d New York, age 34. Walters, C, PL, H, 42d New York, age 21. Wannamaker, D., Pt,F, 5th New York. Ward, J, Pt, I, 170th New York, age 30. Watkins, F. M., Serg't, F, 57th Indiana, age 24. Weatherell, J. H,Capt, C, 10th Mass, age 39. Weaver, A., Pt., C, 2d Tenn., age 35. Weaver, J. E, Pt, A, 3d Indiana Cavalry. Dates. Dec. 13, 26, '62. July 20, Aug. 6, 1864. Dec. 13, —, '62. Feb. 6, 11, '64. June 3, 9, '64. Mar. 25, April 2, 1865. June 3, 16, '64. Nov. 25, De. 9, '63. May 3, 7, NS3. Mar. 31, Ap.13,'65 Sept. 29, Oct. 7, "64. Nov. 30, De. 5, '64. July 2, 5, M53. June 15, 23, *64. Sept. 20, Oct. 1,'63. May 31, June 14, 1864. Aug. 21, 24, '64. Oct. 22, 25, '62. De.31,'62, Jan. 5,'63. May 12, 30, '64. Feb. 7, 23, '65. Julyl, 16, '63. May 12, 20, "64. May 12, 19, "64. May 3, 9, '63. Oct. 19, No. 2, '64. May 3, 15, *63. July 1, 4, *'63. June 3, 19, '64. Sept. 30, Oc.17,'64. Aug. 28, Sep. 9,'62 May 25, 30,**64. May 15, 30, '64. May 5, 19, '64. June 8, 19, '63. July 1, 17, r63. Operations, Operators, Result. Left. (Haem.; gangrene.) Died Dec. 28, 1862. Spec. 638. Left (gang.); ant. post.flap. A.A. Surg. M. M. Townsend. Died August 10,'64. Spec. 4273. ----; circ. Surg. E. Bentley, U. S. V. Dec. 28, haemorrh. Died Dec. 28, 1862. Right. Surg. J. Dwinelle, 106th Penn. Died Feb. 19,1864; py- semia. Spec. 2045. Left; lat. flap. Surg.R.B.Bonte- cou, U.S.V. Died June 15, '64. Right. (Dry gangrene.) Surg. D. W. Bliss. Pyaemia. Died April 15, 1865; exhaustion. Right; flap. Surg.A.F.Sheldon, U.S.V. Died June 16,'64; shock. Right; circ; gang. Died Dec. 13, 1863. Left. Surg. G. P. Oliver, lllth Penn. Died May 8,1863. Left: lat,flap. Surg. E.Griswold, U. S. V. Died April 19, 1865. Right; circ. A. A. Surg. B. T. Crooker. Haem. Died Oct. 19, '64; pyaem. Autop. Spec. 1049. Right; ant. post. flap. A.A.Surg. H. Seaman. Dec. 12, haem. Died Dec. 19,'64; pyaemia. Autopsy. Right, Haem.; lig. fem. artery. Died July 22, '63; exhaustion. Left; circ. Surg. A. P. Frick, 103d Penn. Gang. Died July 26, 1864. Left; circ. Died Oct. 22, 1863. Right. A. A. Surg. J. H. Thomp- son. Haem.; fem. art. secured. Died June 20, 1864; pyaemia. Left; ant. post. flap. A. A. Surg. C. H.Wade. Died Sept. 26,'64; typhoid fever. Left, Died Oct. 30, 1862; haem. Spec. 732. ----. Died January 5, 1863. Left. Gangrene. Died June 5, 1864; pyaemia. Right; circ. A. Surg. J.Vansant, U.S.A. Died Mar. 3,'65; pyaem. Left, (Haem.) Died August 20, 1863; colliquative diarrhoea. Left (haem.); skin flaps; circ. mus. Surgeon T. R. Crosby, U. S. V. Haem.; lig. fem. art. Died May 28, 1864; exhaustion. Left; ant. post. flap. A. Surg. T. McMillin, U. S. A. Died June 10, 1864; pyaemia. Spec. 2820. ---. Surg. G. P. Oliver, lllth Penn. Died May 15,'63; haem. Right; circ. Surg. R. W. Pease, U. S. V. Died Nov. 9, 1864; exhaustion. Left. Surg. A. N. Dongherty,U. S. V. Died May 23, 1863. Both; circ. Died Aug. 2, 1863. Specs. 1383, 1384. Right; circ. A.Surg. S. B.Ward, U. S.V. Died July 14,'64; py- semia. Spec. 2713. Left; circ. Surg. — Whitman. Died October 30, 1864. ----. (Sept. 7, gang.) Sept. 17, haem. Died Sept, 27, 1862. Right;circ. A.A.Surg.R.Ottman. Died July 12, '64. Spec. 2471. Right (four inches tibia rem'd; caries); circ. A. Surg. R. Mc- Neilly, 19th Ohio. Died June 22, 1864; exh'n. Spec. 3368. Right. Surg. H. W. Ducachet, U. S. V. Haem.; lig. fem. art'y. Died June 20, 1864; pyaemia. Left; circ. Surg. J. Shrady, 2d Tenn. Venous haem. Died June 25, 1863. Left. Surg. W. H. Rulison, 9th N. Y. Cavalry. Died Aug. 30, 1863. Spec. 1482. » LIDELL (J. A.), On the Secondary Traumatic Lesions cf Bone, etc., in XT. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 380. LIDELL (J. A.), On Thrombosis and Embolism, in Am. Jour, of the Med. Sciences, N. S., 1872, Vol. LXIV, p. 356. *FISHEB (G. J.), Report of Fifty-seven Cases of Amputations, etc., in Am. Jour, of the Med. Sciences, N. S., 1863, Vol. XLV, p. 47. sect, m.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 303 NO. Name, Military Descripiiox, and Age. Dates. Operations, Operators, Result. No. Name, Military Description, and Age. Dates. Operations, Operators, Result. 652 653 654 655 656 657 658 659 660 661 662 663 664 Weaver, J., Pt, K, 59th Alabama, age 36. Weiser, A, PL, I, 73d Pennsylvania. Weiss, C, Pt, F, 29th New York, age 30. Wells, A. A, Serg't, I, 5th New Hampshire. Wenger, W, Pt, E, 1st Ohio. Werber, G, l't, K, 39th New York, age 31. Whaley, C. H, Pt, G, 14th New York. Whallon, W. M, Pt, C, 129th Penn, age 21. Wheeler, H. S, Serg't, B, 2d Conn. H'vy Art., age 29. Wiesmiller, C, Pt, B, 12th Penn. Reserves, age 22. Wilcox, B. F, Pt, B, 135th Ohio, age 21. Will, J, Pt, A, 10th New York. 'Wilkie, T, Pt, D, llth Conn, age 40. Juno 17, 23, '64. May 3, -, '63. Aug. 28, Se.—,'62. May 3, 8, '63. Nov. 25, —, '63. May 6, 25Y64. Aug. 29 Sept. 2, 1862. Deo. 13, 18, '62. Oct. 19, 26, '64. Dec. 13, 25, '62. July 3, 14, r64. Aug. 30, Sep.5,'62. Sept. 17, Oct.2,'62. ---: post. flap. Died July 2, 1864. Left. Died June 3, '63; pysemia. Spec. 1545. ----. Died September 23,1862. Left. Surg.G. P. Oliver, lllth Penn. Died May 15, 1863. Left. Died December 15, 1863. Left; ciro. Surg. E. Bentley, U. S.V. Died June 7,'64; astheuia. Left. (Gang.) A. A. Surg. J. Nichols. Died Sept. 6, 1862. Spec. 138. Left. (Deo. 14, lig. fem. artery.) Dec. 24, hsem.; lig. fem. artery. Died June 4, 1863; pyaemia. Right; ant. post. flap. A.A.Surg. B. B. Miles. Haem.; lig. Died Nov.ll,'64;ch. diar. Spec. 3434. Left. A. A. Surgeon D. Weisel. Haem.; lig. Died Dec. 27, '62; exhaustion. Spec. 569. Right; ant. post. flap. Surg. J. B. Lewis, U. S. V. Haem. Died Aug. S, 1864. ----. A. Surg.B.Howard,U.S.A. Died Sept. —, 1862. ----; ant. post. flap. A. Surg. C. A. McCall, U. S. A. Died O^t. 23, 1862; pyaemia. Autopsy. 665 666 667 668 669 670 671 672 673 674 675 676 Wilkins, T. E., Corp'l, A, 49th Virginia. Wilson, C. M, Pt, F, 4th New York, age 35. Wilson, G, PL, F, 1st, New Jersey, age 21. Wilson, G. 8, Adjutant, 17th New York, age 24. Wilson^ T. C, Pt, C, 26thT)hio. Wilson, W. C, Pt, G, 105th Penn, age 21. Wilson, W, Sergt, F, 9th Penn. Cav, age 22. Wimer, A, Pt, A, 139th Penn, age 21. Wolf, W, Pt, H, 91st Pennsylvania, age 35. Wollenweber, L, Pt,K, 90th Pennsylvania. Woodward, J. A,Lieut, I, 86th N. Y, age 20. " Wright, J, Pt, D, 7th New York H'vy Art'y, age 19. Oct. 19, 31, '64. May 5, June 2, 3864. June 3, 13, '64. De.13,'62, Ja. 12,'63. Sept. 19, 22.'63. Aug. 16, Se.14,'64. De.29,'63, Ja.19,'64. May 5, 13, 64. June 18, July 5, 1864. Dec. 13, 27, '62. May 3, 11, '63. June 4, 19, '64. ----j circ. (Haem.; lig. ant. tib. and pop. arteries.) Surg. J. M. G. McGuire,C.S.A. Slough'g; gang. Died Nov. 12/64 ; hsem. Left; ant. post. flap. Surg. R. B. Bontecou, U. S. V. Haem.; lig. fem. art. Died June 5, 1864; exhaustion. Spec. 3043. Right. A. A. Surg. W. C. Minor. Diarrhoea. Died June 25, '64. Right. Haem. Jan. 12, lig. fem. art. Haem. recurred 17; 21, lig. fem. artery. Died Feb. 7,1863; pyaema. Right. Died September 22,1863. Left. Died September 16, 1864; pyaemia. Right; circ. Died May 27,1864. Left. Died June 3, 1864. Left; ant. post. flap. Surg. E. Bentley, U. S. V. Died July 9, 1864 ; exh'n. Autop. Spec. 2832. Right. Died January 7, 1863. Right; circ. Died June 1, 1863; pyajmia. Autopsy. Right; ant, post. flap. Surg. R. B. Bontecou, U. S. V. Haem. Died June 29,1864; exhaustion. In two instances intermediary amputations in the lower third of both thighs were unsuccessfully performed. One of these cases is detailed:2 Case 474.—Private D. Wallace, Co. I, 5th Artillery, aged 37 years, was wounded in both legs, at Gettysburg, July 1, 1863, and suffered amputation at the field hospital of the 2d division, Fifth Corps. Assistant Surgeon B. Howard, U. S. A., reported: " The patient was struck by a minie" ball, which passed through one knee joint and shattered the patella of the other. A flesh wound was also received by another shot in the upper third of the left thigh. Both thighs were amputated by the circu- lar method in the lower third, in immediate succession, on the third day after the wound was received. Very little blood was lost at the operation, and no appreciable oozing had occurred by the next day, at which time the patient was in such good spirits as to create frequent merriment among his wounded comrades by his funny witticism. His pulse and appetite had both improved." The patient was subsequently transferred to Camp Letterman, where he was received on August 1st, in a very exhausted con- dition, the stumps not having been dressed for two days; he died on the following day, August 2, 1863. The bones of the knee joints of the amputated limbs were contributed to the Museum by Dr. Howard, and constitute specimens 1383 and 1384 of the Surgical Section. The former consists of a ligamentous preparation of the right knee, from which the patella was shot away; the latter embraces the bones of the left knee, the condyles of the femur being completely shattered. The amputations in the foregoing table were performed, for shot injuries of the lower third of the thigh, in forty-one; of the knee joint, in four hundred and thirteen; of the leg, in two hundred and two; and of the ankle joint or foot, in twenty instances. The Museum possesses specimens in two hundred and three of the six hundred and seventy-six cases of intermediary amputations in the lower third of the thigh. Intermediary Amputation in the Shaft of the Femur without Indication of the Seat of Incision.—In twenty-six only of the thirteen hundred and twenty intermediary opera- tions the seat of operation was not specified. Seven had successful and nineteen fatal terminations; a mortality of 73.0 per cent. ^Eighteen operations were performed on Union and eight on Confederate soldiers. The seat of fracture in the twenty-six cases was in the lower third of the femur in two; in the knee joint, in three; and in the leg, in three cases; in eighteen instances the fracture was recorded to have been in the femur, but the precise point was not indicated. Such meagre details as are reported on the records of this office will be found in the table on the next page. 'Coues (E.), Report of some Cases of Amputations and Resections from Gunshot wounds, performed by Ass't Surgeon C. A. McCall, XT. S. A., in Medical and Surgical Reporter, 1862-3, Vol. IX, p. 195. 2 The other instance of intermediary amputation of both thighs in the lower thirds is that of Private J. Moore, E, 46th Pennsylvania (Tablb XXXVI, p. 300, Nos. 497, 498, ante), wounded Aug. 9, 1862; double flap amputations at lower thirds of both thighs, Aug. 15, 1862; death Aug. 26, 1862. 304 INJURIES OF THE LOWER EXTREMITIES. Table XXXVII. [CHAP. X. Summary of Ticenty-si.v Cases of Intermediary Amputation in the Thigh for Shot Fracture, the Point of Ablation unspecified. [Recoveries, 1—7; Deaths, 8—26.] NO. Name, Military Dates. Operations, Operators, x Name, Military * Description, and Age. Dates. Operations, Operators, Di s< nn-nox, and Age. Result. Result. 1 Grim, P., PL. F, 25tb Aug. 9, Left. Surgs. Bland and Miller, 14 Lohnes,A.,PL, K, 104th July 1, Right. July 22, re-amp. Died Virginia. 29, '62. C. S. A. Recovery. New York, age 27. 9, '63. August 20, 1863. o Read. J. M., Pt., H. 48th Oct, 29, --- Surg. — Westmoreland, 15 McDonald, A. ().,Serg't, Dec. 13, Left. Died January 2,1863; py- Ahibaniii. No. 13. '63. C. S. A. Recovery. l D, 7th Mich., age 25. 28, '62. aemia. 3 Siblry. R W., Pt., A, June 13, Left. Surg. J. N. K. Monmonier, 16 j Peck, M. A., PL. II, 33d April 30, ----. Died June 5, 1864. 6th Louisiana. 17, '62. 8th La. Recovery. Right. Ass't Surg.T?. Howard, Iowa. M'v3,'64. 4 Stevens. —, Pt..—,13th Aug. 30, 17 Rankin, W. H.. Pt., 0. June 27, ----. Died July 21, 1862. Massachusetts. Sep.4.'«2. U.S.A. 95th Pennsylvania. J'y 10,'62. ,r) Tony, W.. PL, —, 76th Aus:. 30, Left. Ass't Surg. B. Howard, 18 ! Rhoads, D. W., —, llth April 7, ----. (Erysipelas; haem.) Died Pennsylvania. SepT3,'62. U. S. A. j Kentucky. My 3.'62. May 3, 1862; haemorrhage. (I V„0t. F. E.. Serg't, F, June 8. Left. Disch'd June 28, 1864. 19 ■ Rodgers. E. F., Serg't, Auc. 30, Right. Ass't Surg. B. Howard, 1st Maryland. 19, '62. C, 1st Michigan. Sept. 6, U. R. A. Died Sept. 16, 1802; 7 Williams, G.H.. Pt., B, Sept. 19. ---. Surg. — Carlisle, C. S. A. 1862. pyaemia. 7th South Carolina. 27, '63. Recovery. 20 Ross, C PL, E, 5th N. Aug. 30, Right; circ. Died (let. 7, 1862: 8 Anderson, A., PL, B, April 6, Left. Died April 28, 1862; haem- i York, age 17. So. 23.'62. pyaemia. 43d Illinois. 22, '62. orrhage. 21 Shields. J. A., PL. K, Slav 31, ----. June 17, pyaemia. Died 9 Dixon, M"., Pt., D, 14th May 12, ---. Died May 21, 1864; py- | 105th Penn., age 19. Je. 10.'62. June 30, 1862. Autopsy. N. Carolina, age 21. 19, '64. aemia. 22 i Sonderman, (.'... Pt., K, April 6, ----. (Erysipelas; haem!) Died 10 Fox, M., PL, B, 1st Aug. 30, Right. Ass't Surg. B. Howard, 17th Illinois. •2~>, 'tii April 25, 1862. Michigan. Sep. 4,'62. U. S. A. Died Sept. 10, 1862. 23 i Thornburg, G., PL, C. April (i. ----. Died May 2,1862; hsemor- 11 Freyer, W., Pt., K, 1st '• Aug. 30, Riarht. Ass't Surg. B. Howard, 70th Ohio. 20, '62. rhage. Michigan. Sep.2,'62. U. S. A. Died Sept. —, 1862. 24 | Waller. D. J., —, E, 23d SepL 14, ----. Sept. 15, amp. leg; 25, 12 Harney, It., Serg't, A. j June 2, Left; circ. A. A. Surg. F. G. H. South Carolina. 25. '62. haem. Died Oct. 13, 1862. 29th Mass., age x8. j 14, '64. Bradford. Died June 26, 1864; exhaustion. 25 Warren, H. ii., Corp'l, D, 18th Mass. Dec. 13. 20. '62 Right. Died December 20,1862. 13 Legler, G., Pt., K, 9th April 30, Right. Died June 3, 1864. 26 Weston, H., PL, K, 15th April 6, Right. Died May 13, 1862. Wisconsin. ;M'yiV<34. Illinois. 25, '62. SECONDARY AMPUTATIONS IN THE SHAFT OF THE FEMUR.—There were four hundred and forty-two cases in which the amputation in the thigh was practised sub- sequent to the thirtieth day after the reception of the injury. Two hundred and thirty-nine recovered and two hundred and three died, a fatality of 45.9 per cent., or 3.9 per cent, less than in the series of primary, and 17.8 per cent, less than in the series of intermediary operations. Secondary Amputations in the Upper Third of the Shaft of the Femur.—Fifty-five operations of this nature were reported, with twenty-five deaths, or a mortality of 45.4 per cent. The operations were performed on forty-five Union and ten Confederate soldiers. In thirty the right limb, and in twenty-one the left limb, was involved, and in four this point was not indicated. Recoveries after /Secondary Amputations in the Upper Third of the Femur.—Thirty of the secondary amputations in the upper third of the femur resulted favorably, six on Confederate and twenty-four on Union soldiers. Twenty-three of the latter were pensioned, and all but one were living in October, 1879. In two cases the lesions were consequent on injuries inflicted by shell, in one by grape shot; in twenty-seven, the injuries were believed to have been caused by small projectiles. Two of the patients had undergone prior operations, one, an amputation of the same leg, and one, an excision of three and a half inches of the upper third of the femur.1 The convalescence was retarded by pysemia in one, by gangrene in two, and by haemorrhage in three instances. In the following case bleeding occurred on the thirteenth day, but was readily controlled by the tourniquet and ice: Case 475.—Captain J. A. Bates, Co. D, 12th New York, was wounded in the right leg at Gaines's Mill, June 27, 1862, and underwent amputation nineteen months afterwards. Surgeon A. B. Mott, U. S. V-., who performed the operation, made the following report of it: "The wound was caused by a shell which splintered the tibia about midway between the knee and the foot without completely fracturing it. The patient entered Ladies' Home Hospital, New York City, December 25, 1863, and 'The amputation of the thigh had been preceded by amputation in the leg in the case of C Basim, PL, H, 8th Pennsylvania Reserves (TABLE XXXVIII, No. 2, p. 308), by excision in the shaft of the femur in the case of PL S. C. Hall, F, 3d Indiana Cavalry (Table XXV, No. 3, p. 208, ante, aud Table XXXVUI, Ko. 9, p. 30s;. SECT. III.] SECONDARY AMPUTATIONS OF THE THIGH. 305 thirty days afterwards the limb was amputated. At the time of the operation the leg had become greatly swollen from enlarge- ment of the bone, the skin was discolored with numerous ulcerations, and there was an immense discharge of matter from the ulcers and from an abscess about the knee joint. The patient was in a very low and emaciated condition, had no appetite, and was unable to sleep without taking anodynes. The amputation was performed at the upper third of the thigh by the circular method, aud was attended with little hsemorrhage, chloroform being used, and followed by prompt reaction. Ligatures were applied to every bleeding vessel. The patient did well from the time the operation was performed. He was ordered to have two pints of porter and six ounces of brandy daily, together with nourishing diet. Some hsemorrhage took place on tlie thirteenth day, which was easily controlled with the tourniquet and ice, but recurred one week afterwards. On June 12, 1864, the patient was discharged from the hospital cured." Captain Bates re-entered the Army as an officer of the 43d Infantry, July 28, 1866, and four years later he was retired from active service. He was furnished with an artificial limb by B. F. Palmer, of Philadelphia, July 14, 1869. In the next case the amputation was not performed until seven years after the date of the reception of the injury: Case 476.—Private Jesse M. Jones,1 Co. K, 21st Indiana, aged 29 years, was wounded at Baton Kouge, August 5, 1862, by a musket ball, which fractured the right femur at the junction of the middle and upper thirds. He was taken to the regimental hospital, remained there one day, and was then sent ou a hospital transport to New Orleans, the limb meanwhile being supported by bandages and pillows. On arrival, August 7th, he was admitted to the St. James Hospital, where a long splint was applied, seventeen days after the reception of the wound. He was discharged April 15, 1863, and pensioned. On No- vember 14, 1866, Examining Surgeon W. J. Hoadley, of Danville, Indiana, reports : "The wound still unhealed, fracture had united by large deposits of bone; limb shortened four and three-fourths inches." In January, 1869, he entered Providence Hospital, Washington; and, on the 23d, Dr. D. W. Bliss, late Surgeon U. S. V., amputated the thigh in the upper* third by the antero-posterior flap method. The patho- logical specimen was presented to the Army Medical Museum by the operator. It is No. 5558 of the Surgical Section (FlG. 196), and shows great deformity, with exfoliations on posterior aspect, and a fragment of lead imbedded in the callus. On March 9, 1869, Jones visited the Museum, when his photograph (A. M. M. Card Photographs, Vol. I, p. 27) was taken, a copy of which is shown in the wood-cut (Fig. 197). His pension was paid December 4,1879. Of four of this series of thirty cases of secondary amputation in the upper third of the femur the specimens are preserved in the Army Medical Museum: Case 477.—Sergeant J. Hammill, Co. D, 8th New Jersey, aged 23 years, was wounded in the right knee, at Chancellorsville, May 3, 1863. From the field he was conveyed to Potomac Creek Hospital, and thence, six weeks afterwards, to Washington, where the injured limb was amputated. Surgeon D. W. Bliss, U. S. V., who performed the operation, reported: "The wound was caused by a minie' ball, which struck the external condyle of the femur and passed directly through, comminuting the condyles and lower part of the femur and opening the joint. The patient was admitted to Armory Square Hospital, June 14th. He was then suffering from profuse suppuration from the joint, and had a large abscess attended with disintegration of the tissues of the calf of the leg, in consequence of which he was in a very reduced condition. There were no symptoms of pysemia, however. As there was no possible chance of life for the patient without an operation, it was decided to amputate, which was done on June 16th, by the circular method, at the junction of the middle and upper thirds. The soft parts were found in a very diseased condition. The patient stood the operation well and progressed favorably. Three months afterwards he was transferred to St. Elizabeth Hospital." The man was ultimately discharged from Ward Hospital, Newark, May 4, 1864, having been previously furnished with an artificial limb by E. D. Hudson, of New York City. He is a pensioner, and was paid June 4, 1878. The amputated part of the femur, together with the bones of the knee, were contributed to the Museum by the operator, and are shown in the cut (Fig. 198). The specimen shows a slight deposit of callus on the border of the fracture, and much disorganization of the articulation by suppuration. As already remarked, ODe of the twenty-three pensioners of this of lower "third" of right fe- •> j i. mur, with slight deposit of group died nearly fifteen years after the operation: oaUus- SpK-1263- Case 478.—Private M. Hartigan, Co. H, 108th New York, aged 18 years, was wounded in the left knee, at Antietam, September 17,1862. He was moved from a field hospital to Frederick twelve days after the injury, and two days later to Ches- ter, where the injured limb was amputated. Acting Assistant Surgeon C. J. Morton, who performed the operation, contributed •An account of the case has been published in Circular No. 3, Surgeon General's Office, Washington, 1871, p. 209. Surg. Ill—39 FIG. 196.—Eight femur fractured at junction of upper and middle thirds. Spec. 5558. FIG. 197.—Appearance of weeks after operation. [From i FIG. 198. —Shot fracture 306 INJURIES OF THE LOWER EXTREMITIES. [CHA1\ X the pathological specimen (Cat. Surg. Sect., 1866, p. 337, Spec. 262), with the following details of the case: "The wound was produced by a ball, which entered near the centre of the popliteal space and emerged at outer side of the knee. The man walked from the battle field to the field hospital. After his admission to Chester Hospital, on October 2d, the wound did well for a few days, when synovitis ensued, and the knee joint became highly inflamed and painful on motion. The patient was also Buffering from diarrhoea, poor appetite, and was much emaciated. About a week afterwards large dissecting abscesses formed above and below the knee, which were freely opened, and compresses were then applied to prevent the upward tendency of the abscesses. On October 29th, the muscles were completely dissected with pus to above the middle of the thigh, and the least movement of the limb would cause the most agonizing pain; the patient's appetite now being completely gone and his emaciation very great. On consultation, it was then decided that, as the only means of preserving life, amputation should be resorted to, which was performed about four and a half inches below the great trochanter. The patient spent a wakeful night after the operation, his pulse being 160; but after several days he began to rest better and regained some appetite, and by November 6th his general condition was much improved, the stump healing nicely and showing every prospect of recovery. By December llth, the stump was nearly healed and the patient had almost recovered. Dissection of the amputated limb showed that the ball had passed through the joint and struck the outer condyle of the femur. The cartilage of the femur and tibia was very much roughened." The specimen consists of a ligamentous preparation of the bones of the injured knee. The patient was discharged from service May 19, 1863, and pensioned. He was subsequently supplied with an artificial limb by the Palmer Arm and Leg Co., by whom the operation was described as having been performed by the flap method. The pensioner died April 1, 1877. Fatal Cases of Secondary Amputations in the Upper Third of the Thigh.—The twenty-five operations of this group were performed on four Confederate and twenty-one Union soldiers. In one instance excision in the middle third of the femur had preceded the secondary amputation.1 Four patients perished from pysemia, two from gangrene, ten from exhaustion, three from shock. In one instance it was believed that chloroform con- tributed to the unfortunate result,2 and in five the cause of death was not recorded. Case 479.—Private John Pool, Co. H, 119th Pennsylvania, aged 23 years, w#s wounded by a conoidal ball, at Rappa- hannock Station, November 7, 1863. He was admitted into the Stanton Hospital, Washington, November 9th. Surgeon John A. Lidell,3 U. S. V., furnished the following history, with the specimen ;No. 2229, Sect I), to the ^.rmy Medical Museum : "The bullet had entered the lateral and external part of the left thigh near the junction of the middle and upper thirds, and passing downward, inward, and somewhat forward, had fractured the femur at its middle. The missile appears to have been split, by contact with the bone, into two pieces, which made their escape through separate openings in the popliteal space. When admitted the knee was much swollen and hot; the patella floated some distance above the femoral condyles. He did not complain ol pain, and his general condition was favorable. The wounded limb was propped up with long sand bags placed on either side of it, and moderate extension was applied by a weight hanging over the foot of the bed and attached to the foot and leg by strips of adhesive plaster. Counter extension was effected by elevating the foot of the bed. He was put upon supporting diet, and simple dressings applied. The inflammation and swelling at the knee gradually subsided, and, on December 1st, had entirely disappeared, the wounds in the popliteal space closed; the wound of entrance, however, was still open and discharging. On the 20th, there was a slight hsemorrhage of arterial blood from the wound of entrance, which was readily checked. On the 28th, the limb was placed in Hodgen's splint to facilitate the outflow of pus. January 8, 1864, the wound in the popliteal space reopened and the wounds, both of entrance and exit, discharged freely. 24th, pulse 110; he was daily becoming more feeble. On exploring the wound through the orifice of exit with N61aton's probe detached fragments were found at the seat of fracture. The patient was etherized, and through an incision about four inches long, made in the back part of the thigh, six detached fragments of considerable size, the largest about two inches long by three-fourths of an inch wide, were extracted. The supe- rior and inferior part of the fractured femur were found to be held in proper position by strong splints of provisional callus, which had been thrown out on the inner and outer sides of the hone. The finger could be readily passed between the broken extremities of the bone, both ends of which were necrosed but not yet detached. On the 25th, the thigh had swelled a good deal and was emphysematous, but, on the 28th, the emphysema had disappeared and the swelling was subsiding; the limb was again placed in Hodgen's splint. On the 31st, he was improving in every respect. On February 14th, he was doing finely; no night sweats; slept well; appetite good; pulse 80; discharge of pus moderate. 24th, two fragments of bone were extracted. March 1st, a diffuse inflammation, accompanied with redness and much swelling, attacked the thigh and spread rapidly through the limb; there was also great constitutional disturbance. After a time this inflammation subsided in a great measure but left him much weakened. About April 1st, another attack of diffuse inflammation brought him still lower. 18th, the whole limb was greatly swollen from the groin to the toes; a small slough on the instep separated; the knee joint was extended with effusion, the patella floating some distance above the femoral condyles. There was a profuse discharge of thin pus from the wound of operation in the back part of the thigh. He was much emaciated, pale, and weak; pulse frequent and feeble; tongue red and inclined to be dry; appetite capricious and poor, and he was subject to frequent attacks of diarrhoea. He was steadily 1 Case of Private C Collar, F, 45th Illinois (TABLE XXVI, No. 8, p. 210, ante, and Table XXXVIII, No. 34, p. 308). *Case of Private J. BradUy, D, 25th North Carolina (Table XXXVHI, No. 32, p. 308), admitted to Chimborazo Hospital, Richmond, June 25, 1862, with a slight wound of patella and integumente covering it, not penetrating joint. July llth, patella partially necrosed; gangrene appeared on inner and outer aspect of knee joint, showing tendency to spread. July 18th, amputation of thigh at junction of middle and upper thirds. Death July 18, 1862, a few minutes after the operation. A remark on the hospital register explains: " The wound was deemed of trifling importance until the llth, when the patella was discovered to be necrosed. The chloroform may have contributed to the unfavorable result, for it caused him to vomit freely, and he was unable to retain any stimulants on his stomach." •LIDELL (J. A.), On Secondary Traumatic Lesions of Bone, viz: Osteo-myelitis, Periostitis, Ostitis, Caries, and Necrosis, in XT. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 414. * 4 ■•■*• ■■•':;'••» .*&■ fa* ■■•■ i« 'N.Y''Y .- OF "I. Y6«j p. 3;<«*. •■<■ :... .cirt of t: ,-',a hospital. After (..•' m j :l., 1,; •.. j. M,r iw . ; I . :* -i- i •»■ *M'iJ*:'S ■ • .-a, :..! ;-i .. -i«rwiJ,i; ii: • ill I.V t:V .'hi I r FoA A twe. y p., • TTi»ioi -j "t-otWiX ''' : T ', !'! ■ -... .^tv. VJ" ^t n'.on Ih {> T' that V{. . Tlf >■■ • war 1 :-tf.i4, ! ■ON.: • ■ Ik*, 'i ifif ■;;;.. *1 Y, •a. a6'>UL '. two inch■■* • r i6.i: . .■fiia.'iy-a -r.a !iad 6."" ,:■•■..-.■ .va- :ni|iro'. ;•■►■ iu e, ■ v ■ !: dis<:ha;u; • '.■• ' •■ •: a'•>"■. After a tiro-; t h.s • ..f ''itf.-i' !■■ iti...irat.iti 2-< '. 1YJ0V t.immii' i !.|\»UJ- • :ia.ll ulou.r'i >in 1 ■ .^t in*: , rer.;i t..( a:-!v,ttd ••..; ay if? Tl -..,-. ;:. i j.,t. - u- nti. ■••• .ciated, |Ktl,?. «i. ! \v i ■■■ '■ ■ ■ • ibject : r • ■•■•■ •*. : ■ .-.h •• ■ ■ r ■• 16-. ,:: ■ •• yi.H «... t • • ruv rf tUi" ' 'f >•*•.: .•.„** m... > I ■'■ : • !. '* ' ■ ■ • f | L \v:w Mcd.i; -MirS. Histof'theM'ar of the-Rebellion. Cut III Veil.Ii r1 ,i V.?£- YIA Mta>u<-h ptnvt PLATE LXVI-SHOT FRACTURE OF THE MIDDLE THIRD OFTHE FEMUR I'rival «• .lnl.n l'nnl.C, II 11 !llh Perm sylvan i n . Spt'cimfn. _'_'_") A.MM. SECT, ni.] SECONDARY AMPUTATIONS OF THE THIGH. 307 fad ng, and, there being no hope of savmg Ins hfe without amputation, he was placed under the influence of sulphuric ether, t™ 7w Y ,m1 v th;,fe7ral arte^' and the ^h ""P-tated in the upper third, by the double flap method, ^ Surgeon J. A. Lulcll, U. fc, V The femur was sawn off about one and a half inches below the trochanter minor. The soft parts of the thigh wore so much diseased as not to admit the performance of the operation at any point below. But little blood was lost during the operation. There was a good deal of shock, but he reacted promptly afterward. In a short time the stump becamesloughy; he gradua ly failed, and died of exhaustion April 26, 1863. On examming the amputated meni, extensive burrowing of pus was found among the muscles of the thigh, and numerous small pieces of the bullet and fragments of bone st.ckmg into the soft part around the seat of fracture. The ends of the broken femur were not in apposition, but separated from each other by the space which had formerly been occupied by the fragments of bone extracted by operation. Pretty firm union had, however, taken place by means of a bridge of new bone which arched over the chasm in front. On splitting the femur open lengthwise with a saw the marrow presented a coppery-red color, and there were abundant deposits of new reddish colored osseous tissue both within the medullary canal, endostosis, and, external to the bone, periostosis, for a considerable distance above the fracture. In the marrow below the fracture there was a large-sized chocolate-colored spot, the result, apparently of an old extravasation of blood. The substance of the marrow was decidedly tougher than normal. There was a considerable deposit of new osseous tissue lying between the periosteum and the bone. The periosteum itself was thicker and redder than natural m that locality, and from it these laminae of new osseous tissue had been developed. Tbe knee joint was swelled out with a straw-colored jelly-like substance; the synovial fringes were reddened, but the articular cartilage presented no abnormity » A drawing of the specimen, No. 2229, by Hospital Stewart E. Stauch, is copied in Plate LXVI, opposite p. 306. In the following instance amputation was performed twenty-two months after the injury. The patient had been discharged and pensioned, but the wound reopened, allowing the end of the lower portion of the femur to protrude through a fistulous passage: Case 480.—Private P. Eiley, Co. A, 10th New York, aged 24 years, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, recorded: " Gunshot fracture of left thigh, upper third." Surgeon J. C. McKee, U. S. A., contributed a photograph, which is shown in the wood-cut (Fig. 199), and reported as follows: "Admitted to Lincoln Hospital, Washington, June llth, with a gunshot fracture of the left femur, the ball entering the anterior surface of the thigh four inches below the anterior superior spinous process of ilium, passing directly backward, producing a compound comminuted fracture of the upper third of the femur, and lodging in the muscular substance of the thigh posteriorly. Extension and counter-extension were used, but re- moved on account of the inflammation of the parts and the severe pain produced. Three weeks after admission free incisions were made for the discharge of pus. The patient slowly recovered, with four and a half inches shortening of the limb." He was mustered out of service August 1,1865, and pensioned. A cast of the injured limb in this case was also contributed by Dr. McKee, and constitutes specimen 4051 of the Surgical Section of the Museum. (See Cat. Surg. Sect., 1866, p. 535.) Examiner . W. H. Thomson, of New York City, certified, January 22,1866: "A ball entered the inner aspect of the left thigh and fractured the femur opposite the great trochanter. The limb is now much distorted and marked with fistulous passages, from one of which, at the anterior upper third of the limb, the end of the lower portion of the femur protrudes. He should not have been discharged from hospital in that condition." Dr. M. M. Marsh, Sjurgeon at the Lincoln Hospital, New York City, certified: "That in the month of April, 1866, Peter Riley came into the hospital for an ' operation on a shattered femur in its upper third, the lower fragment of bone protruding. Amputation was performed, and the patient died of pyaemia May 7, 1866, and in consequence of the injury received in the service as the remote cause." (See Photo. Series, A. M. M., No. 117.) Fig. 199.—Appearance of limb a year after injury. [Prom a photograph.] Consecutive bleeding was observed in three instances, two of which necessitated liga- tion of the femoral artery. One of the cases is detailed:1 Case 481.—Private J. B. Lynn, Co. B, 83d Ohio, aged 19 years, was wounded in the right leg, at Fort Blakely, April 9, 1865, and was admitted to Sedgewick Hospital, Greenville, four days afterwards. Assistant Surgeon A. Hartsuff, U. S. A., who amputated the injured limb, furnished the following report of the operation: "The wound consisted of a longitudinal frac- ture of the upper portion of the tibia, involving the knee joint. The ball passed through the bone downward and emerged opposite the tendon of the gastrocnemius. On May 30th, the limb being infiltrated with serum and there being extensive bur- 1 The other instance of ligation of the femoral artery is that of Private H. Griffith, E, 8th New York Cavalry; wounded at Antietam, September 17, 1862; shot fracture of left knee joint. Amputation at upper third of thigh, November, 1862; ulceration of branch of femoral artery, hsemorrhage; ligation of femoral at Scarpa's triangle, November 19, 1862 ; death November 19, 1862. Specimens 768 and 855, Sect. I, A. M. It. 308 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. rowing of pus from phlegmonous erysipelas, amputation was performed at the upper third of the thigh by the circular method. No sutures were introduced on account of the condition of the parts, thereby favoring the draining of the serum. Though the patient was debilitated and much emaciated, he finally rallied under stimulants and nourishing diet. On June Sth, hsemorrhage occurred, amounting to over twenty ounces, when the femoral artery was immediately cut down upon, exposed in its continuity, and ligated about an inch above the face of the stump. Death occurred two days later, from exhaustion. The ligatures were found to have ulcerated through, the arteries being patulous and showing no attempt at closing." Table XXXVIII. Summary of Fifty-five Cases of Secondary Amputation in the Upper Third of the Femur for Shot Fracture. [Recoveries, 1—30; deaths, 31—55.] No. Name, Military description, and age. Babson.C. L.,Pt.,K, 16th Maine, age 21. Basim, C, Pt., H, 8th Penn. Reserves, age 20. Bates, J. A., Capt., D, 12th New York. Brinker J. H., Pt., E, llth Penn., age 23. Crede, F., Pt., C, 178th New York, age 29. Drew, D., Pt., F, Phil- lips' Legion. Ellett, L., Pt., D, 16th Mississippi, age 20. Glenn, J., Pt., K, 42d Pennsylvania. Hall, S. C, Pt., F, 3d Indiana Cavalry. Hammill, J., Serg't, D, 8th New Jersey. Hartigan,M.,Pt.,H,108th New York, age 18. 2 Henry, D.P.,Pt.,H, llth Missouri, age 29. 13 Hervey, R., Pt., C, 82d Pennsylvania, age 20. 14 Jarvis, H., Pt., K, 55th Massachusetts. 15 Johnson, C, Pt., H, 13th Louisiana. 16 Jones, J. M., Pt., K, 21st Indiana, age 29. Knox, A.G., Pt., D, 18th New York, age 19. Kuhns, W. H., Serg't, C, 102d Pennsylvania. Loggins, W., Pt., E, 6th Texas Cavalry, age 21. 20 Morris, T. H., Pt., D, 6th Iowa, age 21. De.13,'62. Mar. 28, 1863. Sept. 17, Dec. —, 1862. Je. 27,'62, Jan. 24, 1864. De.13,'62. Mar. 21, 1864. April 9, Sept. 1, 1864. Au.31,'62, Ja.31,'63. May 3, J'ne 6,'63. De.20,'61, Fe. 9,'62. Nov.8,'63, April 13, 1864. May 3, June 16, 1863. Sept. 17, Oo.30,'62. Oct. 4, De.26,'62 July 1, Aug. 1, 1862. No.30,'64, M'y8,'67. Oc.20,'63 J'yl4,'64: Au. 5,*62, Jan. 23, 1869. Sept. 14, De.12,'62 May 31, J'y 2,'62. De.21,'62, Feb.-,'63 Ap.6,'62, Ap. 5,'67. Oakes, E., Pt., E, 14th Louisiana. 22 Page, W. A., Pt., F, 21st North Carolina. 23 Perry, H. D., Pt., H, 19th Mass., age 17. 4 Plack, J. H., Corp'l, F, 34th Ohio. 25 Rufus, O, Pt., 1st Col'd Artillery, age 25. 2C Sears, J., Pt., E, 43d N. York, age 26. 7 Shanen, J., Pt., E, 170th New York, age 46. 28 j Sherwood, G. A., Corp'l, G, 14th Indiana. Operations, Operators, Result. May 5, J'y 9, '62 May 25, J'y 19,'62. De.13,'62 May 29, 1866. De. 29,61, Feb.-,'62. Jan. —, M'h 1,'64. July 1, Aug. 19, 1862. May 24, Oct. 1,'64. Sept 17, Oo.25,'62. Left; circ. A. A. Surg. A. Cool- idge. Disch'd Oct 16, 1863. Right. (Sept. 17, amp. leg; gang.) Drs. Jones, Stewart.and Thomp- son, Strattonville, Pa. Disch d Deo. 6, 1862. Right; ciro. Snrg. A. B. Mott, U. S.V. Feb. 6, haem. recurred. Disch'd June 12, 1864. Right (necrosis); flap. A.A.Surg. J. H. Thompson. Discharged March 3, 1865. Left; ant. post. flap. Surg. J. F. Randolph, U. S.A. Discharged Oct. 21, 1865. Left. Surg. — Owens, C. S. A. Recovery. ---; circular. Recovery. Right; ciro. Surg. E. Shippen, U. S. V. Disch'd May 16,1862. Right. (Exo. femur.) Surg. T. R. Crosby, U. S. V. Disch'd July 8, 1864. Right; ciro. Surg. D. W. Bliss, U. S. V. Disch'd May 5, 1864. Spec. 1263. Left (synovitis);flap. A.A.Surg. C. J. Morton. Disch'd May 19, 1863. Spec. 262. Left Discharged April 7, 1863. Left; flap. Surg. C. Page, U. S. A. Aug. 12, lig. femoral artery. March 28,'63, gen. hsem.; gang.; pysBmia. Disch'd Oct. 6,1863. Right (disch'd Nov. 25, '65); flap. Dr. A. R. Carey. Recovery. ---. Surg. — Friend, C.S.A. Recovery. Right (necrosis; exfol.); ant post. flap. Disch'd April 15, 1863. Surgeon D. W. Bliss, U. S. V. Recovery. Spec. 5558. Right; flap. Act Ass't Surg. A. North. Disch'd Jan. 14,1863. Right; flap. Discharged July 6, 1862. Right; circular. To Prison Nov. 9, 1863. Right (discharged April 29, 1863. Suppuration, erysip., etc.); flap. Dr. H. S. Sawyer, Ceuterville, Iowa. 1870, stump healthy. Right thigh. Recovery. Left. Surg.—Brundidge, C.S.A. Recovery. Left. (Portion of ball and spicules removed; necrosis; deformity. Disch'd Sept. —, 1863.) Right. Surg.W. R. S.Clark, 34th Ohio. Disch'd May 24, 1862. Left; flap. Surg. D. O. McCord, 9thLa.C.T. Duty Feb. 10,'66. Left (sloughing); flap. Surg.A. B. Shipman, U. S. V. Disch'd Sept, 14, 1864. Right; lateral flap. Surg. T. R. Crosby, U. S. V. Oct. 6, haem.; lig. fem. art. Disc'b Aug. 15,'65. Left; flap. A. A. Surg. W. M. Hines. Disch'd Deo. 13, 1862. NO. Name, Military Description, and Age, Smith, P., Pt., F, 5th In- fiantry. Walsh, H., Landsman, U. S. S. Mendota, age 18. Bosse, E., Pt., F, 8th New York. Bradley, J., Pt., D, 25th North Carolina. Byram, W., Pt., K, 3d Michigan Cav., age 20. Collar, C, Pt,, F, 45th Illinois, age 20. Cowperfhwaite,C.,Corp., L, lstN.J.Cav.,age22. Cunningham, O. H., Pt,, I, 82d Ohio, age 35. Ellithorpe, P. G., Pt., I, 1st Penn., age 20. Farr, F. B., Serg't, H, 2d New York H'vy Artil- lery, age 22. Goodsell, A., Pt., H, 1st Colorado Cavalry. Griffith, H., Pt., E, 8th New York Cavalry. Hughes, S. D., Pt, D, 14th South Carolina, age 38. Humma, L., Pt., H, 88th Pennsylvania. Icanberry, A., Pt.,K, 6th Kansas Cav., age 18. Ivery, N., Pt., B, 12th Michigan. Kreps, J., Pt., C, 29th Iowa, age 16. Luxford, G., Pt, A, 50th Illinois, age 16. Lynn, J. B., Pt., B, 83d Ohio, age 19. O'Brien, D., Pt., H, 69th New York. 1 Peaslee, A., Pt., I, 22d Mass., age 23. 2 Pool, J., Pt., H, 119th Penn., age 23. Riley, P., Pt., A, 10th New York, age 24. Seville, W. S., Pt., G, 1st Delaware. Slioffeitt, J. H., Pt., E, 13th Alabama, age 20. Sim?, T. R., Pt., F, 12th Tenn. Cav., age 20. Smith, C. A., Pt, C, 51st Illinois, age 41. Feb. 22, M'y4,'62. July 16, Sept. 2, 1864. June 8, J'yl5,*62. J'yl8,'62. May 6, Aug. 7, 1864. Feb. 14, M'yl,'64. Oc.12,'63, Jan.5,'64. May2,'63, May3,'64. July 2, Au.10,'63. April 7, Aug. 2, 1865. No.29,'64, Ja.14,'65. Sept. 17, Nov. —, 1862. J'y 2,'63, Feb. 6, 1864. Au.30,'62, Jan. 20, 1863. Nov. —, De.22,'63. April 7, M'yl5,'62. April 30, July 9, 1864. Oct. 5, Nov. 20, 1864. April 9, May 30, 1865. Sept. 17, Dec. 5, 1862. June 27, Au.14,'62. No. 7, '63, April 18, 1864. J'e 3,'64, Ap. -, '66. Sept, 17, 1862, Jan. 5, 1863. July 3, Nov. 1, 1863. Sept. 22, Nov. 7, 1864. Nov. 30, 1864, Jan. 8,'65. Operations, Operators, Result. Right; flap. A. Surg. B. Norris, U. S. A. Disch'd July 13.1862. Left; ciro. Surg. W. Johnson, U. S. N. Disch'd April 11,1865. Spec. 3213. Left; lat. flap; hectic fev.; diarr. Died Sept 1,'62; pyam. Autop. ---. (Necrosis; gang.) Died few minutes after operation. Right. (July 30, bone rem'd.) Surg.A.Hammer, U.S.V. Died August 10,1864. Right. (March 12, exc.) Surg. W. J. McKim, 15th 111. Died May 9, 1864 ; shock. Left; circ. A. Surg. A. Ingram, U.S.A. Died Jan. 6,'64; shock. Right (ball ext.; erysip.); double flap. Surg. D.W. Bliss, U. S.V. Died June 5, '64. Spec. 2254. Left; slough.; diar.; haem.; tourn. Died Oct. 5,1863; exhaustion. Right (frag's bone and two pieces of ball rem'd ; haem.); ant. post. flap. A. A. Surg. B. B. Miles. Died same day. Specs.1565,2797. Right. Died one hour after oper- ation. Left. Surg. H. S. Hewit, U. S. V. Hsem; Nov. 19, lig. fem. artery. Died Nov. 19,'62. Specs.768, 855. Right; circ. Surg. A. Heger, U. S. A. Died Feb. 16, 1864; py- aemia. Autopsy. Left, (Erysipelas.) Surg. D. P. Smith, U. S. V. Died Jan. 20, 1863. Spec. 1186. Left thigh. Died December 30, 1863. ---. Died three hours after oper- ation; exhaustion. Right (carious); ant. post. flap. A. Surg. E. A. Clark, U. S. V. Died Aug. 8,1864; pyaemia. Right (necrosis); circ. Surg. S. S. Boyd, 84th lnd. Died Nov. 28, 1864; exhaustion. Right (erysip.); circ. A. Surg. A. Hartsuff, U. S. A. Haem.; lig. fem. art. Died June 7, 1865. Right; flap. Surg. H. S,. Hewit, U. S. V. Died Dec. 16, 1862; exh'n. Autop. Specs. 755,1101. Left, Dr. —Halsted. Died Aug. 15, 1862. Left (frag's bone rem'd); double flap. Surg. J. A. Lidell, U.S.V. Sloughing. Died April 26, '64 j exhaustion. Spec. 2229. Left. (Deformity; fistulous pas- sage.) Died May 7, '66; pyaem. Right (deformity); flap, skin; circ. muscles. A. Surg. R. F. Weir, U. S.A. Died Jan. 10, 1863; shock. Spec. 3866. Right (thrombo.; gang.; erysip.); circ. Surg. A. Heger, U. S. A. Died Nov. 2, 1863. Autopsy.. Right; ant. post. flap. A.A.Surg. M. L. Herr. Died November 22, 1864; exhaustion. Right; circ. Surg. J. R. Ludlow, U. S.V. Died Jan. 8,'65; exh'n. •Sturgis (F. D.), Reports of Hospitals, in American Medical Times, 1862, Vol. V, p. 174. *Ln>ELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in XT. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 414. SECT. III.] SECONDARY AMPUTATIONS OF THE THIGH. 309 In three of the fifty-five cases enumerated in the foregoing table the seat of injury was in the upper third; in twelve, in the middle third; in eleven, in the lower third; in seven, in the femur without precise indication; in fifteen, in the knee joint; and in seven cases in the leg. Secondary Amputations in the Middle Third of the Femur.—The one hundred and sixty-eight cases of this group comprise one hundred and two recoveries and sixty-six deaths, a mortality of only 39.2 per cent., or 6.2 per cent, less than the mortality of the secondary upper third amputations. Twenty-seven of the one hundred and sixty-eight operations were practised on Confederate, and one hundred and forty-one on Union soldiers. Of one hundred and sixty-two cases in which this point was indicated, the injuries were on the left in eighty-nine and on the right side in seventy-three instances. Vases of Recovery after Secondary Amputation in the Middle Third of the Femur.— One hundred and two cases belong to this category. The injuries were caused by shell in one, by solid shot in two, by canister shot in one, and by small projectiles in ninety-eight cases. Nine patients were Confederate, and ninety-three Union soldiers; five of the latter have died since the termination of the War, while eighty-eight remained pensioners in January, 1880. Case 482.—Private Andrew Van Vorst, Co. A, 134th New York, age 18 years, was wounded at Gettysburg, July 1, 1863, by a conoidal ball passing through the right knee joint, causing a comminuted fracture. He was admitted into the Camp Letterman Hospital on August 21st. Acting Assistant Surgeon W. M. Welch, under whose care he was placed October 28, 1863, records: " Thigh was amputated at the middle third August 1st; the stump is healing finely and his health is good." He was sent to Balti- more November 8th, where he remained in the Newton University Hospital until April 25, 1864, when he was sent to New York and admitted into the DeCamp Hospital. His stump had entirely healed. On October 16th, he was transferred to Albany and admitted into the Ira Harris Hospital, Fig. 200. — Appearance of stump three months after am- putation. Spec. 417. from whence Assistant Surgeon J. H. Armsby, U. S. V., reported his recovery and discharge from service August 11, 1865, and contributed a plaster cast of the stump (A. M. M., Spec. No. 417, Sect. I, Cat. 1866, p. 554), a drawing of which is given in the wood-cut (Fig. 200). His pension was paid January 4, 1880. Case 483.—Private J. Scheuermann, Co. K, 9th Ohio, aged 28 years, was wounded at Chickamauga, September 19, 1863, and admitted to the field hospital of the 3d division, Fourteenth Corps, where Surgeon J. R. Arter, 31st Ohio, noted: " Shot fracture of right thigh." Several weeks after the reception of the injury the wounded man was transferred to hospital at Chattanooga, subsequently to Bridgeport, and, on December llth, to Murfreesboro', whence Assistant Surgeon G. V. Woolen, 27th Indiana, reported the case as follows: " The ball entered the limb anteriorly, about four inches above the knee joint, passing backward and upward, fracturing the femur at the junction of the middle and lower third, and lodging in the gluteus maximus muscle. The fracture was oblique and lateral, and remained ununited, the limb being shortened about three inches. The ends of the bone were necrosed, and suppuration profuse. About three months after his admission the patient had an attack of erysipelas, which subsided, but left the limb in an oedematous condition. At this time his constitutional condition had become very feeble, his appetite was wanting, and he was unable to sleep from pain in the wound, which was discharging considerable quantities of ichorous pus. It was then deemed proper to remove the limb, and amputation was performed by Assistant Surgeon J. E. Link, 21st Illinois, on March 18, 1864. The operation was done by the circular method at the junction of the upper and middle thirds, but little haemorrhage taking place. The ligatures were applied and chloroform was used. The patient rallied well from the operation, and immediately began to improve in general health. In the course of a month the stump had closed." The patient was subsequently transferred to Washington Park Hospital, Cincinnati, mustered out of service July 14, 1864, and supplied with an artificial limb of Dr. Bly's pattern one year afterwards. He is a pensioner, and was paid September 4, 1879. The amputated femur was con- tributed by Surgeon I. Moses, U. S. V., and is represented in tbe cut (FlG. 201), showing a moderate deposit of callus but no union of the fracture. Case 484.—Private F. Luck, Co. C, 21st Wisconsin, aged 21 years, was wounded in the right knee, at Chaplin Hills, October 8, 1862. He was admitted to hospital No. 7, Perryville, and discharged from service February 15, 1863, Surgeon J. G. Hatchett, U. S. V., certifying to "complete destruction of the use of the knee," as resulting from the injury. On the 2d day of the following December the man entered Harvey Hospital, at Madison, whence Surgeon H. Culbertson, U. S. V., contributed the pathological specimen (No. 2074, Surgical Section, A. M. M.), with the following report: "This soldier received a penetrating wound of the knee joint, and was unfortunately discharged at the breaking up of the Perryville Hospital, when the knee was still running and not in FlG. 201.-Shot frac- ture of middle third of right femur. Spec. 2802. 310 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. progress of cure. The injury was caused by a mini6 ball, which entered posteriorly and to the inside of the tuberosity of tlie external condyle of the femur, passed obliquely forward and slightly inward, fracturing the external condyle and also the upper and outer margin of the patella, and came out opposite that point of the bone. True and false anchylosis resulted, the former between the inner condyle and head of tibia, and necrosis of the inner condyle ensued. At the time of the patient's admission the state of the parts was as follows: The joint was enlarged and the wound open over the external condyle, and some three inches higher up the thigh another opening existed, both of which discharged unhealthy pus. There was also periostitis extend- ing up as high as the lower fourth of the femur, and the soft parts about the joint were swollen and indurated up to the middle third of the thigh. Circulation below the knee was extremely feeble, and the leg, bent upon the thigh at right angle, was extremely emaciated. The patient's constitution showed marked evidence of scrofulous diathesis. At first I determined to treat the case by resection of the joint, but on reflecting, and with the advice of Dr. E. B. Wolcott, Surgeon General of Wisconsin, I decided upon amputation as affording the best and safest means for the removal of the disease. Just before the operation, which was doue on January 3, 1864, the patient fell upon the floor and broke the union between the tibia and inner condyle of femur; yet from the inflammatory exudations thrown out about the joint it was found impossible to straighten the limb, though efforts were made to effect this object while he was under the influence of chloroform. I performed the amputation at the middle third of the thigh, by the circular method, in the presence of Dr. Wolcott, Acting Assistant Surgeons J. J. Brown and J. Favill, and Medical Cadet W. B. Buckley. Nothing unfavorable occurred, and the wound healed by first intention, though the ligature applied to the femoral artery has not yet (February 7th) come away. The stump now certainly demonstrates the superiority of the circular over the flap operation of this member, being one of the most perfect in form I have yet seen. This case illustrates the efforts of nature to diminish the capacity of the joint by anchylosis and the exudation into it of plastic organizable material; also the fact that penetrating gunshot wounds of the knee joint will require amputation, even though nature be given fifteen months in which to effect a cure. On examination of the morbid specimen, it will be seen that the ball passed through the can- cellated structure of the external condyle, entering the cavity of the joint only at two opposite points, thus inflicting upon the Bynovial membrane but a slight wound so far as extent is concerned. Unquestionably great inflammation must have followed the wound, as is proved by the effects observable. But nature could not have been as successful had the external condyle been broken into fragments. It was in fact a penetrating wound of a portion of the joint which inflicted great injury to it, and yet it was singularly and uncommonly local, the wound of the bone appearing as though it might have been made with a circular punch. The fact that the bones entering into the formation of the joint were injured in so limited a manner would seem to be the reason why amputation was not required long since." Dr. Culbertson appends the following remark to this history: "This case is cited not because of the amputation performed, but to illustrate the great efforts of nature in the cure of penetrating gunshot wounds of knee joints, and also her failure in the attempt." Three months after the operation the patient was well enough to proceed to Chicago for the purpose of being fitted with an artificial limb, and on May 28,1864, he left the hospital for his home. The pensioner was paid June 4, 1879. Case 485.—Private E. Green, Co. K, 119th Pennsylvania, aged 35 years, was wounded in the right thigh, at Rappahan- nock Station, November 7, 1863, and was admitted to Armory Square Hospital, Washington, two days afterwards. Surgeon D. W. Bliss, U. S. V., furnished the following description of the injury, and of the operation which he per- formed: "The missile, a conical ball, entered one and a half inches above and to the right of the patella, passing across the limb, fracturing the femur in the lower third, and lodging on the inner and posterior side, nearly opposite the point of entrance. The limb was treated in a skeleton fracture-box, and water dressings were used. On November 18th, the ball was extracted. Haemorrhage occurred on the following day, and again three days afterwards. The discharge of pus became copious about December 1st, and dry gangrene of the toes and dorsum of foot appeared. The upper fragment of the femur protruded one and a half inches, and at every effort to extend the limb so as to retract the protruding bone violent haemorrhage ensued. The patient's system was greatly reduced, and careful attention was paid to retain his digestive powers by a rotation of stimulants and nourishing diet. A slight change in the position of the limb, on December 28th, brought on a haemorrhage to the amount of twenty ounces in three minutes' time—evidently from the femoral artery, which was then controlled by pressure. By January 20, 1864, sloughing of the heel and dorsum of foot had commenced, and the patient's system was still so much debilitated that a decision to operate, which had been retarded as calculated to prove fatal, was now arrived at as a last chance to preserve life. On the following day the thigh was amputated at the middle third by antero-posterior flaps, four arteries being tied and but little blood lost. Ether was used as the anaesthetic. At the operation an abscess was discovered in the anterior flap extending upward for three inches, and the femoral artery was found to be destroyed in the upper part of the popliteal space, evidently by the missile. Above the point of the amputation the vessel was healthy; but no clot was found. The vessels of the leg were much constricted. The lower fragment of the femur was flexed at an angle of thirty degrees with the leg, and, by contraction of the muscles of the FlG: 202.—Shot . . j, . , ' J comminution of the thigh, was pressed farmly against the wounded extremity of the femoral artery, thereby preventing fatal lower third of right haemorrhage. The flaps of the stump presented an unhealthy appearance, being much indurated and infil- femur- sPec- 2033- trated with serum. Tincture of chloride of iron was applied to the entire surface with a view of stimulating the parts and of obtaining its haemostatic effect upon the capillary vessels which failed to contract from cold and exposure to the air. A large tent was placed through the fourchette of the stump so as to prevent the accumulation of pus, the flaps being gently brought together and tepid water dressing applied. The patient improved daily, and was in a fair way of recovery one week after the operation." The amputated portion of the femur was contributed to the Museum by the operator, and is shown in the wood-cut (Fig. 202). The specimen shows the parts about the fracture to be dead and stripped, and its upper half to be covered with an involucrum of foliaceous callus tolerably dense posteriorly, also some periosteal deposit above the condyles. The patient sub- sequently entered Judiciary Square Hospital, and was discharged July 7, 1864. He was furnished with an artificial leg by B. F. Palmer, August 26, 1865, and was paid as a pensioner until September 4, 1867, since when he has not been heard from. sect, in.] SECONDARY AMPUTATIONS OF THE THIGH. 311 FIG. 203.—Appearance of stump two months after amputation. [From a photograph.] In the next case the amputation was performed five years after the reception of the injury, owing to the continual recurrence of abscesses. The patient died eleven years after the operation, of pulmonary disease: Case 486.—Private Charles M. Bowen,' Co. A, 27th Indiana, aged 19 years, was wounded at Antietam, September 17, 1862. He was taken to Frederick and admitted to No. 1 hospital on September 24th. Acting Assistant Surgeon J. C. Shimer records the following: "A conoidal ball had entered the outer aspect of the left thigh about five inches above the knee, fractured the femur, and passed out directly opposite. Buck's apparatus was applied. On Octo- ber 19th, considerable amount of callus had been thrown out, and there was some union; his appetite and general condition were good. October 23d, a deep but circumscribed abscess on the outer side of middle third of thigh was opened and evacuated. 30th, both the wounds of entrance and exit were enlarged to evacuate pus more freely. December 5th, he has improved greatly; passive motion has been employed to overcome stiffness of the knee." On March 18,1863, he was able to walk with the aid of orutches, and the wounds had nearly healed. A slight attack of erysipelas yielded readily to treatment. May 21st, the wound took on a gangrenous condition, for which strong nitric acid was applied. On June 15th, he was transferred to Baltimore. The wounds looked healthy and his general condition was excellent. He entered the Jarvis Hospital on the 16th, and was discharged September 7, 1863. The femur had only partially united; the sciatic nerve was injured; his leg was partially and his foot entirely para- lysed. He received a pension, and was employed as a clerk in the Interior Department. Owing to a recurrence of abscesses he entered the Providence Hospital, Washington, in the autumn of 18C7, and, on Noyember llth, the limb was amputated in the middle third by Dr. D. W. Bliss, late Surgeon U. S. V. The wound healed well, and a photo- graph was taken at the Army Medical Museum on January 9, 1868, at which time the stump was firm and healthy. The specimen was contributed to the Museum by the operator, and is No. 4914, Surgical Section. The fragments are considerably over- lapped, having undergone unusual disturbance, and the amount of callus exceeds what is necessary for complete union. On March 10, 1871, the patient was a clerk in the Pension Office; the stump was healthy but his general health poor. He died March 17, 1878, of phthisis pulmonalis. The amputation in the thigh in the one hundred and two cases of this group had been preceded by other operations in thirteen instances, viz: by amputation at the knee joint in two, by amputation in the leg and subsequent amputation at the knee in one, by ablation in the leg in six, by excision in the sliaft of the femur in one, and by excision in the bones of the leg in three instances.2 Fatal Cases of Secondary Amputation in the Middle Third of the Femur.—The sixty-six operations of this category were practised on forty-eight Union and eighteen Confederate soldiers. Eight autopsies are recorded in this series, and twenty-five path- ological specimens are preserved. Pysemia was observed in ten, gangrene in fourteen, and erysipelas in seven cases. In nine instances copious haemorrhages preceded the amputation, and in eleven haemorrhages occurred after the operation. Case 487.—Private L. Williams, Co. C, 26th Michigan, aged 23 years, was wounded at Spottsylvania, May 12, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, recorded his admission to the field hospital of the 1st division, Second Corps, with "shot wound of left knee, caused by a mini6 ball." Assistant Surgeon J. C. McKee, U. S. A., who contributed the path- ological specimen of the case (Cat. Surg. Sect., 1866, p. 343, Spec. 2538), reported the result of the injury as follows.: "The wounded man entered Lincoln Hospital, Washington, May 30th. He was a man of nervous and irritable temperament. When admitted he suffered from much constitutional derangement, and the tissues in the neighborhood of the injured joint were much enlarged, tender, and painful. Cold-water dressings were used, and tonics and stimulants were administered. On June 13th, the parts above and below the knee joint being infiltrated with pus and discharging copiously through several openings, ampu- 1 Circular No. 3, Surgeon General's Office, Washington, 1871, p. 205, Case DLXXXV. 2 The limb had been removed at the knee in the case of Corp'l F. Hare, B, 6th Wisconsin (Table XXXIX, No. 39, p. 314), and of Pt. L. C. Young, A, 3d Virginia (Tadle XXXIX, No. 100, p. 315). In the case of Pt. A. Bronchard, 5th New Hampshire (Table XXXIX, No. 11, p. 313), the fracture in the foot had been followed by excision of the 3d and 4th metatarsal bones, then by amputation in the lower third of the leg, then by amputation through the knee joint, and finally by amputation in the thigh. The patients who had undergone amputation in the leg were Corp'l II. W. Hughes, I, 133d New York (TABLE XXXIX, No. 43, p. 314); Pt. W. Stifle, A, 29th Ohio (TABLE XXXIX, No. 86, p. 314); Pt. J. Bowen, C, 42d Illinois (TABLE XXXIX, No. 8, p. 313); Pt. B. Nussbaumer, B, 67th Ohio (Table XXXIX, No. 67, p. 314); Corp'l G. Dewey, M, llth Illinois Cavalry (Table XXXIX, No. 24, p. 314); and Lieut. J. H. Bell, D, 61st Ohio (Table XXXIX, No. 5, p. 313). In the case of Corp'l T. Duggan, M, llth Illinois Cavalry (Tadle XXVII, No. 4, p. 212, ante, and Table XXXIX, No. 26, p. 314), an excision in the shaft of tho femur had been performed, and excisions in the bones of the leg in the eases of Pt. S. Montgomery, 1,139th Pennsylvania (Table XXXIX, No. 63, p. 314); Pt. W. Stockdale, D, 48th Indiana (Table XXXIX, No. 87, p. 314); and Pt. C. Murphy, D, 69th New York (Table XXXIX, No. 65, p. 314). 312 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. tation was decided upon, and performed at the middle third of the femur by Acting Assistant Surgeon A. Ansell, as the only chance of saving the patient's life. On examining the injured parts after the operation the missile was found to have passed through the joint, comminuting the patella and knocking away the head of the tibia on its inner side. The subsequent treat- ment consisted of cold-water dressings to the stump and the administration of six ounces of brandy per diem; one grain of sulphate of morphia was given at bedtime after the operation. Iron and quinine were prescribed some days afterwards. The patient did exceedingly well, and the stump healed kindly, the cicatrix forming perfectly with the exception of one small open- ing, which Berved as an outlet for a small abscess about the size of a pigeon's egg. Haemorrhage took place from this part of the stump on July 18th, when the tourniquet was applied to the femoral artery, which had the effect of arresting the flow of blood. A plug of lint saturated with a solution of persulphate of iron was then introduced into the wound and the tourniquet removed. Hiemorrhage occurred again on the morning of the following day, when, on consultation, it was decided to open the stump and ligate the bleeding vessel. This was also done by Dr. Ansell, who tied the femoral as well as two muscular arteries, which had been opened by the incision. The operation was performed at 11.30 A. M., and the patient died at 6 P. m. on the same day, July 19, 1864, not having rallied, and having lost altogether about twenty ounces of blood. The interior of the stump was found to be perfectly healthy, with the exception of the small abscess before mentioned." The specimen consists of the bones of the amputated knee, showing the articular surface to be carious, and a longitudinal incomplete fracture extending between the condyles two and a half inches up the femur, on the shaft of which two trivial points of periosteal thickening appear. The stump of the femur, showing a partially detached sequestrum and handsome but useless foliaceous deposit, together with a wet preparation of the ligated femoral artery, were also contributed to the Museum by Acting Assistant Surgeon H. M. Dean, and constitute specimens 2882 and 2883 of the Surgical Section. Case 488.—Captain E. W. Capps, Co. C, 15th Virginia Cavalry, aged 35 years, was wounded at Brandy Station, Virginia. October 11,1863. He was admitted, on October 21st, into Lincoln Hospital, Washington. Assistant Surgeon H. Allen, U. S. A., reported:1 "A conoidal ball entered the right leg, from without inward, about one and a half inches below the patella, passed through the anterior portion of the leg, fractured the spine of the tibia, and emerged on the inner side of the limb. On admission a bandage was found applied tightly to the affected part. Upon its removal the joint was discovered to be greatly swollen from effusion, and the wounds presented an inflamed appearance. Cold-water dressings were applied. No constitutional Bymptoms were present. After the effusion in the joint had subsided a thorough examination of the wound was made. The head of the tibia was found pierced by the ball. No stellation existed, nor was the joint involved. A seton of tow was thrust through the wound and withdrawn, bringing away several small fragments of bone. On October 21st, a small abscess was opened in the popliteal space. The patient, from this time, did remarkably well, and all thought him to be out of danger. On January 26, 1864, however, when he was walking, with the assistance of crutches, from one ward to another, he stumbled, and, in order to preserve liis balance, bore his weight upon the injured limb. The following day an erysipelatous inflammation set in about the joint, which became enormously swollen. He was restless and uneasy, his skin hot and dry, tongue coated with a thick whitish fur; he had severe pain in the head; pulse 140; anorexia and constipation present. On January 29th, a sense of decided fluctuation was felt in the joint, and it was thought at the time that pyarthrosis of the knee joint was present. He had little or no fever. His pulse averaged 120 beats per minute, soft, compressible. Face very pale, mind clear. The swelling in the course of a week had gone down completely from the limb below and^above the joint; but around the seat of injury and joint a dull purplish red color lingered. By judicious pressure pus could readily be made to exude through the internal wound. Pus had burrowed a very little distance in the parts connected with the popliteal abscess above mentioned. No sinus of any extent existed. It was now evident that the case was one demanding amputation, and, the patient's condition being favorable, the circular operation was performed by Assistant Surgeon J. C. McKee, U. S. A., in charge, on February 8th. The joint, which gave evidence of the presence of pus of long standing, the cartilages being denuded and partially destroyed, was sent to the Army Medical Museum (Specimen 2036 of the Surgical Section). The patient did well until February 12th, when he had a severe chill which lasted forty minutes. This was followed by a profuse diaphoresis. The skin became cold and clammy, the pulse 120 and feeble. On the following day he had another chill, and, on the 15th, two more, one in the morning at six, the other at four o'clock in the afternoon. Another exacerbation occurred on the morning of the 16th. In other respects the con- stitutional symptoms of what was evident to all to be pyaemia were remarkably slight. His tongue remained clean. His appetite continued the same. There was no vomiting, no fever of any consequence followed the chills; his pulse varied from 120 to 140, rapid and weak. His appearance at this time was that of a man who was suffering from a severe hsemorrhage; his anaemic condition was startling; his sclerotica were pearly white, his lips and gums pale, his finger nails blue. He had a slight cough, though no expectoration. His most distressing symptom was the colliquative sweatings, which came on during the night, and which were not apparently connected with the chills. The limb looked well, and there was no unusual amount of pain in it. The flaps were granulating finely. On February 18th the sixth chill took place, and, on the next day, the seventh, followed by vomiting. He now rapidly sank, and died on February 20th, at four o'clock A. M. Autopsy: Rigor mortis marked. Adipose tissue abundant. Limb much swollen and of a tallow color. Upon dissecting out the vessels the tissues of the thigh were found greatly indurated, especially along the course of the Hunterian tract. The interior of the femoral vein was filled with a solid black clot, which was firmly adherent to the walls of the vein. No disintegration noticed. The lower third of the vessel, that which had lain in contact with the suppurating surface of the stump, was stained by a purulent fluid for about two inches from the patulous opening. A curious appearance was observed in one of the small branches of the profunda vein in the upper third of the thigh. It presented the same general aspect seen in the patulous end of the femoral, and was filled with pseudo- pus." A drawing (made by Hospital Steward E. Stauch, and copied in Plate XXIII, opposite) of the upper two-thirds of the femur, removed at the post-mortem, shows the separation of the periosteum in osteomyelitis. Upon a longitudinal section of the femur (Plate XLIX, opposite p. 314) the medulla throughout was found to be of a grayish-yellow color, which was more intense at the region of the trochanter than elsewhere. Numerous small abscesses, more or less elliptical, were arranged lineally 1 A condensed abstract of this case was published by Dr. Allen in the American Journal of Medical Sciences, 1865, Vol. XLIX, p. 39, in connec- tion with his Remarks on the Pathological Anatomy of Osteomyelitis, -with Cases. I ■•;■■•■■ •■'§<■- y. . Y*;Ya;,y, • , ■■•(,!■■ ' .:■ ' •■•.ft-'. r.;.v».« »-f-| ,,.■«■ ..'•/. '• W ',' Y*' ' x: A\ V .ting /.aci--'.i.' • r ■ p'-ration tl.v •■ . :l v 'ibia 01. its !'•/•,■ ♦" g''■ i ■■•■ .' m.. and the pntii'iit *i . *.\ '.- \ OUI)2 a : ,- ' ■ i and hrr.'is . > ■ ■-;' ' .it* J to ihe > ( • . wars, . '».-< 1", ' ■ ■" .»! i ■■ VI.., , U 1 ■« ,. lit * <:.-i * ,, .»..■ I- a ■* Y. > . : i ■■ oi rh »r . >*non !i*.-<.vered .'(.• .■■■ -.— M,rii.,! . va !i,.U ■ i YiYun' !■■ ,.f i\..y na ; :. -. TY . ■ -.1. V-" ,-■•;.■ . • i .- 1Y. a: Liorij' v slight 'li.wed i. a-Jeriri!.' ■■V la: ; ! i i' :.'!' 'ccl.H i el' llir W;irofHn'I.,Vliclli<.ii. I'.irl III Vol II PLATE XXIII SEPARATION OF PERIOSTEUM IN OSTEOMYELITIS. ( use «. . I' ( Y|.l ;iin !•! W I'upps. I.")11.1 Vir:Jllii:i SECT. III.] SECONDARY AMPUTATIONS OF THE THIQH. 313 down the central portion of the medulla. The bone was not thickened or vascular. The periosteum, however, was inflamed, and, at the lower two-thirds of the specimen, was readily stripped from tbe bone, where it presented the appearance of having been pulled away from the femur by the fibres of the muscles inserted upon it. Case 489.—Lieutenant-Colonel G. F. Lamon, 32d New York, was wounded in the left thigh, at Crampton's Pass, Sep- tember 14, 1862. He was conveyed to hospital at Burkittsville, whence Assistant Surgeon H. A. DuBois, U. S. A., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 287, Spec. 792), with the following history: "The injury was caused by a mini6 ball, producing a compound comminuted fracture of the femur in the lower third, which was treated with Smith's anterior splints. The wound suppurated freely, and at the end of the second week all inflammatory symptoms had subsided. There was no pain from the first. On November 3d, I found recorded in the case book: 'A speedy recovery beyond doubt; shortening about an inch.' Several days after this bleeding took place, which was thought to be from the femoral. The artery was then compressed with the finger at Poupart's ligament for about fifty hours. Up to the time of the haemorrhage the patient had an excellent appetite; but he now sank speedily and did not rally for two days, though strongly stimulated and receiving the most nourishing diet. On November 9th, the thigh was removed by the flap method by Surgeon L. W. Oakley, 2d New Jersey, it being decided inexpedient to secure the artery. The patient did not completely recover from the shock. Eight hours after the operation he commenced to sink with great rapidity, and three hours later he died. The specimen illustrates well the nature of a wound in the bone caused by a minie' ball, also the amount of union after two months' rest. On examining the removed limb it was found that the ball had brushed the artery, and that the artery had ulcerated to the extent of about one-third of an inch. During the last month the case was under the care of Surgeon Oakley." The pathological specimen consists of the amputated lower half of the femur, and exhibits shortening, with slight union and some deformity, the fractured extremities being necrosed and spanned at points by new bone. Of the sixty fatal secondary operations in the middle third of the thigh, ten had been preceded by other major operations, viz: one by a primary amputation in the middle third of the opposite thigh, two by exarticulations at the knee joint, and seven by amputations in the leg.1 In one instance the amputation in the thigh was followed by exarticulation at the hip joint.2 Table XXXIX. Summary of One Hundred and Sixty-eight Cases of Secondary Amputation in the Middle Third of the Femur for Shot Fracture. [Recoveries, 1—102; Deaths, 103—168.] Name, Military Description, and Age Abbott, T., Pt., E, 7th Penn. Reserves. Barger, W. M., Pt., H, 34th Rlinois. Barnes, B. C, Pt., C, 146th N. York, age 20. Barnett, W. M., Pt., F, 10th West Va., age 18. Bell, J. H., Lieut., D, 61st Ohio, age 52. Besley, S. B., Corp'l, H, 147th N. York, age 30. Bowen, C. M., Pt., A, 27th Indiana, age 19. Bowen. J., Pt., C, 42d Illinois, age 21. Brader, S., Pt., M, 4th N. Y. Cavalry, age 25. Bristcr, J. J., Pt.,G, 19th Ohio, age 23. Sept. 14, Nov. 14, 1862. April 7, J'e 1,'62. Mav 5, J'ne9,'04. Nov.6,'63. Mav 25, 1865. July 20, 1864, Oct. 27, 1870. May 5, Oct. 3,'64. Sept. 17, 1862, Nov. 11, 18C7. Dec. 30, 1862, June 21, 1863. June 12, Aug. 15, 1864. Se.19,'63. Sept. —, 1864. Operations, Operators, Result. Left (abscesses); flap. Surg. H. S. Hewit, U. S. V. Discharged Jan. 27, 1863. Right; flap. Surg. O. Martin, U.S.V. Disch'd July 22,1862. Left; ant. post. flap. Surg. E. Donnelly, 2d Penn. Reserves. Disch'd Jan. 26, 1865. Right; flap. Dr. J. W. Ramsey, Wilsonburg, W. Va. Mustered out May —, 1865. Left. (July 20, 1864, amp. leg. Disch'd Dec. 15, 1864. Neuralg. aff'n of stump.) Dr. D. A. Hart, Cleveland, Ohio. Recovery. Right (gaDg.; bone dis.); circular. A. A. Surg. C. E. Lee. Disch'd August 17, 1865. Left. (June, '63, nec. bone rem'd. Disoh'd Dec. 7,'63.) Dr. D.W. Bliss. Spec. 4914. Died March 17,'78; phthisis pulmonalis. Right (Dec. 31, 1862, amp. leg; June 17, 1863, haem.); circular. Surg. T. D. Fitch, 42d Illinois. Disch'd April 28, 1864. Left (carious); circ. A. Surg. C. A. McCall, U. S. A. Disch'd July 5, 1866. Spec. 2927. Left. (Disch'd; anch. knee, July 22, '64.) Drs. Smith and Han- nan, Huntington, O. Recovery. Name, Military Description, and Age. Bronchard, A., Pt.. A, Sth New Hampshire, age 31. Brunemer, J. H., Corp'l, H, 7th Wisconsin. Buckley, J., Pt., A, 15th Infantry, age 24. Burgenson, S., Pt., F, 15th Wis., age 22. Burnes, W., Pt., A, 14th Ohio, age 36. Cain, J. H., Pt., I, 17th Illinois. Capp, A., Serg't, B, 2d Maryland, age 24. Carey, C, Pt., F, 5th Infantry. Coleman, O. A., Pt., B, 3d South Carolina. Conlon, J. IL, Pt., B, 5th Wisconsin. Crispin, J. A., Pt., A, 3d New Mexico. Culley, J., Pt., K, 7th Missouri, age 23. Daniels, S.. Pt., K, 1st Iowa. April 7, 1865, Sept. 14J De. 8, '62. Aug. 7, Sept. 12, 1864. De.31,'62, Mar. 17, 1863. Sept. 19, No.24,'63 Oct. 21, No.30,'61. April 2, Oct. 11, 1865. Feb. 21, Ap.15,'62 No.18,'63, JMar.4,'G4. May 5, J'e 20,'62. Feb. 21, Mar.-,'62 May 18, 1863, Ap.10,'64 Aug. 10, Oc—,'61, Operations, Operators, Result. Left. (Disch'd April 12, 1865; 17, exc. met.; May 15, amp, leg; Feb. 18,'66, amp. kn.jt.) Rec'y. Left (gang.); circ. A. A. Surg. Q. W. Carey. Disch'd April 1, 1863. Spec. 917. Right (haem. post, tib.); circ. A. A. Surg. P. L. Rice. To regi- ment Dec. 7, 1864. Right; flap. Disch'd July 13, 1864. Right; flap. Disch'd Sept. 8, 1864. Right; flap. Surg.I.Casselberry, 1st lnd. Cavalry. Discharged. Right (nec); circ. Surg. E. Bent- ley, U. S. V. Disch'd Jan. 15, 1866. Spec. 4387? Left; circ. A. Surg. B. Norris, U. S. A. Discharged. ----. Surg. C. L. Dunkley, C. S. A. Recovery. Left; double flap. A. A. Surg. J. W. Dickie. Disch'd July 8, '63. Right. A. Surg. B. Norris,U.S.A. Disch'd Feb. 28, 1863. Right (caries; erysip.); circ. A. Surg. H. R. Tilton.U.S.A. Disc. July 14, 1864. Spec. 2677. Right; circ. Dr. J. P. Coulter, Marion, Iowa. Discharged. 1 Primary amputation in the middle third of the opposite thigh had been performed in the case of Pt. S. Baguley, B, 5th New Hampshire (TAl)l.E XXXI, No. 703, p. 235, ante, and Table XXXIX, No. 105, p. 315). In the cases of Pt. George T. Skilton, I, 36th Wisconsin, and Pt. J. M. Storey, H, 37th Wisconsin (Table XXXIX, No. 156, p. 316, and No. 157, p. 316), exarticulation at the knee joint had been performed prior to the amputation in the high; and amputation in the leg had preceded thigh amputation in the cases of Corp'l H. G. Brown, B, 37th Wisconsin; Pt. G. Christiana, A, 120th New York; Pt. W. L. Hindman, E, 155th Pennsylvania; Pt. H. Linn, A, 6th Pennsylvania Reserves; Pt. L. Winters, K, 50th Georgia; Pt. J. F. Drain, A, 53d Virginia; and Pt. A. C. Frost, C, 15th Massachusetts (Table XXXIX, Cases Nos. 108, 112, 125, 137, 166, 116, and 122). 2Case of Lieut. C. H. Hawkins, C, 4th New York Calvary (Case 337, p. 158, and No. 8 of Table XVIII, p. 159, ante, and No. 124 of Tabi.b XXXIX, p. 315). Surg. Ill—40 314 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. 25 Name, Military Description, and Aoe. 29 30 Dewey, G., Pt., D, 51st New York. 'Draper, L. G., Lieut., F, 75th N. Y., age 27. Duggan, T., Corp'l, M, llth Illinois Cavalry. Durkee, E. W., Pt., G, 18th Wisconsin. Dwyer, J., Pt., G, 69th New York, age 33. Eastman, W.,Pt.,1,114th New York, age 35. Ekstrand, J. H., Lieut., H, 13th Col'd Troops, ' ago 33. English, J., Pt., D, 23d Ohio. Everett, P., Pt., K, 53d Pennsylvania. Fisk, J., Pt., C, 4th R. Island Bat'ry, age 25. Galway, R., Pt., E, 54th New York, age 36. Gibson, J. W., Corp'l, F, 123d Ohio. Green, E., Pt., K, 119th Penn., age 35. Griffin, W., Pt., A, 69th New York, age 20. Griggs, W. I., Serg't, A, 42d Virginia. Hare, F., Corp'l, B, 6th Wisconsin, age 23. Harvie, W. E., Pt., A,2d Kentucky. Haycock, H. H., Pt., K, 137th New York, age 21. Howard, W. H., Pt., A, 7th Infantry, age 24. Hughes, H.W.,Corp'l, I, 133d New York. Husband, J., Serg't, K, 5th Penn.Art'y, age 21. Jefferson, E., Pt., E, 1st Minnesota, age 19. Jones, J., Pt., K, 13th Tenn. Cav., age 26. Keigan, P., Pt., D, 1st Colorado. Kelly, B., Pt., G, 83d New York. Kelly, ft.. Pt., B, 106th Penn., age 23. King, J. M., Capt., C, 13th Louisiana, age 25. Kreidler, C. W., Pt., A, 15th Infantry. LaMarsh, J., Pt., I, 3d Vermont, age 20. Dates. De.13,'62 Jan. -.'63, Oc.19,'64, M'y 2,'67. De.18,'62, J'y 5,'66. April 6, M'y20,'62 Sept. 17, Oc.20,'62, Oct 19, No.29,'64 Aug. 30, 1864, July 17, 1868. Sept. 17, Oc.23,'62 June 1, Au. 1,'62 J'y 1, '62, Ja.17,'63 April 20, 1865, Sept. 8, 1866. June 15, July 26, 1863. No. 7, '63 Jan. 21, 1864. June 3, Au. 2,'64, Au. 9,'62, J'e 20,'63 May 5, Au. 6,'64 Oct. 4,'63, Jan. 10, 1864. Oc.28,'63, Mar.8,'64, Julv 2, Au. 4,'63, J'e 14,'63, Jan 21, 1864. Mar. 18, Ap22,'65 July 2, Sept. 14, 1863. No.13,'64 M'yl0,'65 Mar. 26, Ap.26,'62 Sept. 17, Oc.20,'62, July 2, Nov. 10, 1863. Jan. 1, Sept. 15, 1863. Apr.7,'62, May 21, 1863. Sept. 19, No. 1, '64, Litzinger, R. A., Corp'l, Feb. 21, G, 2d Cavalrv. J'ne4,'62. Luck, F., Pt.', C, 21st Oct.8,'62, Wisconsin, age 21. Jan. 3,'64. I Lndis, M., Pt., A, 2d Oct. 8,'62, Operations, Operators, Result. Missouri, age 37. Mangan, J., Pt., H, 1st Artillery, age 23. Marshall, J., Pt., 1,69th Ohio, age 20. Fe.11,'63 June 24, Oct. 24 1864. Mar. 19. Sep. 5,'65, Left (Dec. 14, amp. leg; 28, re- amp. leg; slough.); double flap. A. A. Surg.W.V.White. Disc. Oct 23, 1863. Lett. (M. O. Feb. 15,'66, deform- ity of limb.) Dr.M.D.Bennedict, late Surgeon 75th N. Y. Right (disch'd April 7, '65); flap. Surg. E. Andrews, late 1st 111. Light Artillery. Right; circ. Disch'd July 16, 1862. Right. Disch'd April 27, 1863. Died April 9, '70; consumption. Spec. 756. Right; ant. post. flap. Surg. T. Sim, U. S.V. Disch'd April 10, 1865. Spec. 3474. Left. (Nov. 24, '63, shell injury of left tibia. Disch'd Jan. 12, '65. 1868, constant pain in site of first wound; cancerous tumors inv. entireknee joint.) Recov'y. Specs. 5479, 5480. Right; flap. A. Surg. A. Mass, 100th Penn. Disch'd Mar. 6, '63. Left; flap. Surg. P. A. Jewett, U. S. V. Disch'd April 2,1863. Left (haem.); circ. Surg. J. Neill, U. S. V. Disch'd Aug. 6,1863. Right (Dec. 15, '65, frag's nec. bone rem'd; disch'd June22,'66); flap. A. Surg. G. M. McGill, U. S. A. Recovery. Right; circ. A. Surg.W. G. Bry- ant, 122d Ohio. Disch'd Feb. 13, 1864. Right (hsem's; dry gang.); ant. post. flap. Surg. D. W. Bliss, TJ. S. V. Disch'd July 7, 1864. Spec. 2033. Right; flap. Surgeon — Gibbs, C. S. A. Recovery. ----. Surg. — Douglass, C.S.A. Recovery. Left (May 6, amp. kn. j't; gang.); circ. Confed. surgeon. Disch'd May 22, 1865. Left "(symptoms of gang.); flap. Surg. S. J. W. Mintzer, U. S. V. Disch'd March 21, 1864. Right; circ. A. A. Surg. H. C. May. Disch'd June 18, 1864. Spec. 2201. Left. Discharged June 3,1864. Right (amp. leg June 14, '63; dis. Oct. 12, '63); circ. Dr. Olcott, Williamsburg, N.Y. Recovery. Right; circ. Surg. A. Hard, 8th 111. Cav. Disch'd Aug. 5,1865. Left (gang.; erysip.); ant post. flap. A. A. Surg. B. B. Miles. Disch'd Dec. 9, '63. Spec. 1732. Right; circ. A. A. Surg. T. W. Baugh. Disch'd Aug. 22,1865. Right; flap. A.Surg. J. C. Baily, U.S.A. Disch'd Aug. 23,1862. Right; circ. A. A. Surg. W. H. Matlock. Disch'd March 7,' 63. Spec. 4826. Left; ant post. flap. A.A.Surg. F. Hinkle. M. O. Sept. 10, '64. Spec. 1994. Right. (Nec. bone rem'd.) Snrg. A. H. Thurston, U. S.V. Furl'd Nov. 7. 1864. Spec. 1918. Right (disch'd May 16, '63; bone diseased); flap. Dr. G. C. Black- man, late Surg.U.S.V. Recov'y. Left; flap. A. A. Surg. C. W. Stinson. Caries. Disch'd Aug. 4, 1865. Right; circ. A. Surg. B. Norris, U. S. A. Discharged. Right (caries; periostitis; disch'd Feb. 15, 1863); circ. Surg. H. Culbertson, U. S.V. Spec. 2074. Right; circ. Snrg. J.G. Hatchitt, TJ. S. V. Recovery. Left (gang-.; hsem.; nec); circ. Surg. E. Bentley, U.S.V. Reg'l Headquarters Jan. 27,1865. Left; flap. Surg. C. O'Leary, U. S. V. Disch'd Feb. 6,1866. Name, Military Description, and Age Martin, R. C, Lieut., K, 25th Arkansas. McDonald, S. H., Re- leased prisoner, age 22. McDougall, R., Corp'l, G, 2d Mich., age 21. McFarland, D., Corp'l, A, 22d C. T., age 22. McWhinney, F., Pt, A, 123d Illinois, age 21. Montgomery, S., Pt., I, 139th Penn., age 23. Moore, D. A., Corp'l, H, 92d New York, age 27. Murphy, C, Pt., D, 69th New York, age 24. Nickerson, C, Corp'l, K, 1st Maine H'vy Art'y, age 23. Nussbaumer, B., Pt., B, 67th Ohio, age 27. Nutting, J., Pt., F, 19th Maine, age 21. Page, E., Corp'l, H, 17th Kentucky, age 21. Painter, G. W., Serg't, H, 139th Penn., age 24. Porter, E., Ph, G, 2d Vermont, age 37. Powell, J. E., Serg't, A, 6th Kans. Cav., age 28. Rand, K., Corp'l, C, 2d Vermont, age 23. Reed, J., Pt., K, llth Illinois, age 37. Rich, R. E., Pt., B, 19th Massachusetts. Robb, B. F., Pt., K, 26th Pennsylvania, age 25. Robertson.W.B., Pt., H, 27th N. York, age 20. Sauer, C, Pt., I, 88th Hlinois. Scheuerman, J., Pt., K, 9th Ohio, age 28. Scott, J., Pt., K, 18th Massachusetts. Schneider.M.,Pt.,F,26th Wisconsin, age 26. Shaw, J.W.,Pt., I, lllth New York. Sherrer, J. M., Pt., C, 27th S. C, age 38. Steel, J. L., Corp'l, C, 2d Iowa Cavalry, age 26. Stinson, J., Pt., B, 99th Penn., age 18. Stitle, W., Pt., A, 29th Ohio, age 21. Stocdale,W.,Pt, D,48th Indiana, age 28. Sullivan, J., Pt.,H,15th Indiana, age 37. Suter, J., Pt., H, 19th Illinois. Thayer, A., Pt., F, 48th New York, age 18. Todd, M. A., Pt., E, 14th Alabama, age 22. Vanvourst, A. K., Pt.,A, 134th N. Y., age 18. Ward, F., Pt., D, 49th New York. Dates. Sept. 19, Oc.20,'63. De.25,'64, April 1, Je. 1,'64. June 16, Au.2,'64, April 2, M'yll,'65 May 12, July 29, 1864. J'e 1,'64, Jan. 13, 1865. Sept. 17, 1862, Mar. 23, 1863. May 31, Oct. 27, 1864. Ma.22,'62, ----, '63. May 5, Aug. 22, 1864. Sept. 20, 1863, Jan. 24, 1864. May 5, J'e 5,'64. June 1, Au.22,'64, May 10, J'ell,'64. May 5, J'e 23,'64, Feb. 5, Ma.24,'64. Sept. 17, No.10,'62. May 3, Aug. 6, 1863. J'e27,'62, May 14, 1863. Nov. 25, De.30,'63. Se. 19,'63, Mar. 18, 1864. June 18, Au.12,'64. July 1, Aug. 13, 1863. J'y 3, '63, June 1, 1872. May 16, J'el6,'64. Nov. 3, De.29,'63. July 2, Sep.2,'63. May 8,'64, March 15, 1866. May 14, J'y 6, '63. No.25,'63, Jan. 22, 1864. Jan. 2, M'h 4,'63. May 7, Sep.6,'64. Aug. 29, Oc.10,'64. July 1, Au. 1,'63. April 6, Myl2,'62. Operations, Operators, Result. ---. Surgeon — Hall, C. S. A. Recovery. Right. (Gangrene.) Recovery Sept. 22, 1865. Left; flap. Disch'd July 13, '65. Right; circ. A. A. Surg. W. L. Wells. Disch'd Sept. 7,1865. Left; circ. Surg. J. B. Larkin, 17th lnd. Disch'd July 22, '65. Left (May 12, exc. tibia): flap. Surg. E. Bentley, U.S.V. Disch. August 2, 1865. Right (disch'd Nov. 18,'64); bilat. flap. Dr. O. F. Parker, Parish- ville, N. Y. Recovery. Right (March 18, '63, dead bone exc); circ. A.A.Surg.A.North, Disch'd Sept 12, '64. Died Dec 28, '64; pneumonia. Spec. 3867. Right (gangren's);latflap. Surg. N. R. Moseley, U. S.V. Disch'd April 12,1865. Stump dis'd, re- amp. Died April 29,'68; tuber- culosis. Spec. 2898. Left. (April 22. 1862, amp. leg; caries. Disch'd July 28, 1862.) Right; flap. Surg. — Manson, Hartland, Maine. Disch'd Jan. 26,1865. Left (gang.; bone diseased); ant. post flap. A. A. Surg. P. Peter. Erysip. March 25,'64, exc. end fem.; Oct. 20, seq. rem'd. Duty Jan. 21,1865. Spec. 2196. Left; flap. A. A. Surgeon J. L. Stewart. Disch'd April 19, '65. Right; circ. A. A. Surg. S. N. Goss. Disch'd June 12, 1865. Right; circ. Surg. C. E. Swasey, U. S. V. Disced Jan. 23, '65. Left (May 26, haem.; gang.); circ A. Surg. J. C. McKee, U. S. A. Nec. bone rem'd. Disch'd Oct. 28, 1865. Right; circ. Surg. G. S. Kemble, U. S. V. Disch'd June 22, '64. Left; circ A. A. Surg. P. Mid- dleton. Disch'd Jan. 17,1863. Right. (Gangrene.) Surg. D. W. Bliss, U. S.V. Disch'd Dec. 19, 1863. Spec. 1582. Left (erysip.); flap. Surg. J.Neill, U. S. V. Disch'd Jan. 27, 1864. Spec. 1330. Left; flap. Disch'd Jan. 10, '65. Right (erysip.); circ. A. Surg. J. E. Link, 21st m. Disch'd July 14, 1864. Spec. 2802. Left; circ. A. A. Surg. J. C. La- mont. Disch'd Feb. 17, 1865. Right; ant. post. flap. Disch'd Jan. 29,1864. Right (M. O. June 16, 1865; '66, bone came away); ant post. flap. H. K. Spooner, late Surg. 61st Ohio. Recovery. Spec. 6670. Left.; circ. Furloughed October 10, 1864. Left; lat. flap. A.A.Surg.W.P. Sweetland. Disch'd Oct. 1, '64. Left; flap. Surgeon H. Palmer, U.S.V. Erysipelas; abscesses. Mustered out Sept. 8,1864. Right (May 9,'64, amp. leg; disc. Aug. 16, 1865, gangrene); flap. Recovery. Right; flap. Confed. surgeon. Mustered out July 15, 1865. Right: flap. A. Surg. R. Bartho- low.U.S.A. Carious bone rem'd. Disch'd April 26,'65. Spec. 2105. Right; flap. Surg. F. Seymour, U. S.V. Disch'd June 18,1863. Right; flap. Dr. C. Freiot, Troy, New York. Disch'd January 4, 1865. Left; circ. Retired March 30, 1865. Right. Disch'd Aug. 11, 1865. Spec. 417. Left. (Gangrene.) Dr. White. Disch'd October 28,1862. 1HOMANS (J., jr.). Cases of Gunshot Fracture of the Thigh, Restdts of Conservative Surgery, in Boston Med. and Surg. Journal. 1865, Vol. 72, p. 29. if-.' 14, AT.| V , '. > , ciouc 1 ' . : st..:' ... ..r ■ ' D- '. i ,-v. a-i .;•• i apLit ,:ir'-. 1. ib»;v i':irlit. l>i-:b \<"\ Apr : '/. ". .-; '<• 7.>i. " irlii. ant. ycm'- ■ o.V. f«.V. t rst »'j:v.:. ai..--.. •'■ a,-,. entir' 1' , --ho Rght; da,. A. . '. ' lOOtn :'nnti L> *■ '• I r.fft ; tl.i'.> Sui-jr .'"■ '. ?■ \ l">i«cli 'c ». |.i. i • ('■■ cir;. rturjr. .a :' ~. . . i/^h'd An* ' . I* . •• Doc. 15, '65. frsv: i ,,i' "u.'d c*ir<:h'd .'in> -"' 'tii'■ . ,.. VM'.V P. :V| M- -iijl V a M-i'r.o J ,-Sq. : ■X .1. L • I -dJu. •■-.>.:. ti! !;• : >,r.s.\ Vnv. 18, '01 I-arkfi I.ifi-iver >< 63, ■!.-. '..Surg..1. i v, 64. Di. >»>i». Sff •tY.ut.flar :.s.v. : ■"I'iltUJ. .; i- 8 a.vj, IK ,jt. \riryir i Ser<> ?■■■*■ p«<: u,. , Sjn- ::■■ .. Kivfat; tla; 0.8. A k ------. RilT (aft '.Me Ciro. t' •■ Muv '_v •V j.^rt nvii. <•,.. i.rc W. n Bry ] D.wh'l Feb. ' .* jth^st • <">'•' u- I>. ^ . Mis*, ;•. J'.'v I. '-'A "I. P W - K 't- '•■ '■•{-. i ■ i. .-a s. \' •"••I J . A. ■»t. UUP * r., i>t. i llave«N ■"« I. 137;:-, ..■ *' fl. ,„-,-,• a 7lh Ii,1. Ail- eu ,, -'a ■...!<'.• J >. rt! 1, Vj IVo.-.A , V r-?1' . »- :.*^D, 1 .. la Kijiit (••tip. . fk-t is, 'm.. Witn»iniaii..-{ il-rb*; <-;r< i 111 < V . U'jl- ..-.n. P.. ft, D '•',':'4.- >'...• .1 V'Y.i/fi.: ■ IUi ... M.r.26. . r;.-ai > ■ > \!«Vt)2 ! ' - ■a IU i <••»: jr. 1' I'- Viln, A. Ra-flr 1\ W. < ...il- C-ilWTK i.- ; r. n*i>v i. r. . .r«2 •• rk, r-j .- ? Mh,' . ' 11}"'-' l't . ' •:.'h NOT.'^ D«.a,' , ' '; • K. Rf. IV ■' M»r : :b< •■ ■ "* ! J;in :,\»o.-. ■ MY JO) ! • A IB- irtt.;: : >i j\- 3, v, i Tun», 187 I ' .pt <;.., J...i : .<.■ .i. «),•? 25. ij'-pi. '. | i;.-.n • T- \. Apr.7. 62,' Mav 31 V. X I! I»i :1. n.nrst. ., :-;I"C .' "• Lis iuies . at . iitV a 1ft..ii ci •. Slu "s<»n ". i^.Y. Sper ■« rv.J.G.H.-. chit 1 ,- >PT~ •e a . ,Kf ra ■ 1.- .-..•■ IK ■a;- ret i.r* ,-f M K..» .i»i. t>e.3.' » ■ • Marrb i 1?. ..-•. -.?-. - May 1-J'y<', v- St. No.!*. Jh n .'. '•la J i . >1 -, ■ ' '.!■ S.--:p.r-. - t r !;h i Aaff. V .1-. Oc.K', ;, Ji.H :.k'. Di*. .4. • ' . »i-.*c. 4J7. i ,*.-.-' . 't. (<;'• v:li'd Jan • ' Dr.C.Fr 'iisi'i'f1 J.-. t-.4 M PLATE XLIX-MEDULLARY ABSCESSES OFTHE FEMUR l';isc oi'Ciipl A'. W CappM l")',11 \ ii'-iiiu.i * SECT. IU.] SECONDARY AMPUTATIONS OF THE THIGH. 315 Name, military Description, and Age. Wellman.J. G.,Serg't,I, 27th New York, age 25. West, W., Pt, F, 2d Ohio Cavalry. Whiting, C, Pt., C, 17th New York. Whortenberry,J.M.,Pt, B, 15th Kentucky. Winning, J., Pt.,A,125th Ohio, age 27. Wood, W. W., Pt., D, 46th Georgia. Toung, L. C, Pt., A, 3d Virginia. Young, M., Pt., F, 25th New York, age 25. Zweifel, J., Corp'l, F, 6th Wisconsin, age 23. Allman, G. W., Pt., I, 8th Iowa Cavalry. Ambrose, B. J., Corp'1,1, 105th Ohio, age 24. Baguley, S., Pt., B, 5th New Hamp., age 21. Bauer, P., Pt., 3, 9th Illinois. Boling, J., Serg't, B, 28th Tenn., age 27. Brown, H. G., Corp'l, B, 37th Wisconsin, age 21. Bryant E. K., Pt., H, 1st Massachusetts, age 37. 'Capps,E. W.,Capt.C, 15th Virginia Cavalry, age 30. Carr, W. E., Pt., D,27th Mass., age 21. Christiana, G., Pt., A, 120th N. Y., age 36. Cobb, C. P., Pt., F, 1st Michigan, age 20. Curly, J., Pt., K, 69th New York. Debar, J., Pt., T, 88th New York. Drain, J.F.,Pt, A, 53d Virginia, age 26. Eastman, H. J., Pt., F, 1st Vt. Cav., age 23. Edwards, J. W., Pt., G, 44th Alabama, age 26. Ewing, W. E., Pt., C, 2d Wisconsin, age 32. Farley, H., Pt,, H, 61st Pennsylvania, age 27. Flippin, A. M., Corp'l, C, 33d Miss., age 34. Frost, A. C, Pt., C, 15th Massachusetts. Goode, W. F, Pt, H, 2d Mississippi, age 18. July 21, Nov. 5, L861. Jan. 17, Mar. 29, 1862. Aug. 30, Oct. —, 1862. De.31,'62, Au. -,'63 May 14, Oct. 12, 1864. Sept. 20, De.27,'63 May 12, July 27, 1864. May 27, July 28, 1862. J'y 3,'63, April 14, 1864. May 7, —,s64. No.22,'63, Jan. 29, 1864. April 7, June 3, 1865. Feb. 14, Mar. 15, 1862. No.30,'61, Feb. 18, 1865. June 17, July 21, 1864. May 19, J'e 20,'64. Oct 11, 1863, Feb. 8, 1864. June 3, Se.8,'64. July 2, Sept. 2, 1863. Mar. 31, June 3. 1865. Sept. 17, Oc.20,'62. Sept. 17, Oc.21,'62. July 2, Oct 9, 1863. Mar. 2, J'e6,'64. May 8, ■ Jnlv 11, 1864. July 2, Au.13,'63. May 5, J'yl5,'64. July 20, Nov. 14, 1864. July 2, Se.12,'63. Sept. 17, Dec. 22, 1862. Operations, Operators, Result. Right (slough.; necrosis); long int., short ext. flap. Dr. R. Steb- bins, Allegany Co., N.Y. Diso'h Dec. 15,1862. Spec. 1067. Left; flap. A. A. Surg.W. Dick- inson. Disch'd April 24, 1862. Left; ant. post flap. A. Surg.W. E.Waters, U. S.A. Discharged March 25,1863. Left. Surg. F. Seymour, U. S.V. Disch'd Feb. 15, 1864. Left (gang.; rupt. pop. art.); ant post. flap. Surg. H. P. Stearns, U. S.V. Hsem. Dec. 5, re-amp. upper third. Haems. Disch'd May 20, 1665. Right. Surg. — Agnes, C. S. A. Recovery. Right. (May 12, amp. knee joint.) Surg. W. F. Richardson, C.S.A. Gang. Furl'd Sept 17, 1864. Spec. 5514. Right; flap. Dr. J. R. Bronson. Nec; ervsip. Jan. 3, '63, circ, up. third. Disch'd May 26, '63. Right; ciro. A. A. Surg. B. B. Miles. Disch'd Nov. 10, 1864. Spec. 2256. Left. Died August 7, 1864; ex- haustion. Left. (Gang.; diarr.) Feb. 10, gang.; 14, 15, hsem. Died Feb. 18, '64; exh'n. Spec. 2199. Left (April 8, amp. right middle third); ant. post flap. Surg. O. A. Judson, U. S. V. Died July 10, 1865; exh'n. Spec. 4232. Right; double flap. Dr. Briggs, Nashville. Mar. 23, hsem.; lig. fem. art. Died May 5,'62; exh'n. Right (carious); oval skin flap. Surg. B. B. Breed,U.S.V. Died April 26,1865. Right (Junel7,amp.leg; slough.); flap. Surg.N.R.Moseley.U.S.V. July 31, bone rem'd. Died Aug. 3, 1864. Specs. 2897, 2945. Right; circ. A. A. Surg. C. W. Carrier. Died July 3,'64; pyaem. Right (erysip.; pyarthrosis); circ. A. Surg. J. C. McKee, U. S. A. Died Feb. 20, 1864; pyaemia. Autopsy. Spec. 2036. Left; circ. A. A. Surg. J. Morris. Died October 7,1864. Right. (August 10, amp. leg.) A. A. Surg. H. Leaman. Died Sept. 26, 1863; exhaustion. Left; circ. Surg. A. F. Sheldon, U. S. V. Died July 1, 1865; osteomyelitis. Spec. 4215. Lett; flap. Died Oct. 27. 1862. Spec. 4828. Left; flap. A. Surg. P.Adolphus, U.S.A. Nec. bone rem'd. Died Nov. 27, '62. Specs. 446,447. Left. (July 4th, amp. leg, nec. bone rem'd.) Died Nov. 5, '63; exhaustion. Specs. 1963,1975. Left (extracted splinters of bone); slough. Died Sept. 19,'64; exh'n. Left (si. ven.; haem.); ciro. A.A. Surg. T. L. Leavitt. Died Oct. 26, '64; dysentery. Spec. 2837. ----(Gang.; slough.; haemorr.) Died Aug. 13,1863; shock. Left; circ. A. A. Surg. W. W. Volk. Died Sept. 2, 1864. Left (tib. carious); circ. A. A. Surg. D. D. Talbot. Died Dec. 28, 1864; exhaustion. Left. (Prim. amp. leg.) Died Sept, 16, 1863; gangrene. Left; flap, skin; circ. mus. A. Surg. R. F.Weir, U. S.A. Dec. 27, haem.; gang. Died Jan. 15, '63; pyaem. Specs. 3858,3893. NO Name, Military Description, and Age. 2Hawkins, C. H., Lieut., C, 4th New York Cav., age 23. Hindman, W. L., Pt., E, 155th Penn,age20. ^Holland, W., Pt., 1,6th N. Carolina, age 45. Holmes, J., Pt., D, 1st New York, age 26. Hoxey, G., Pt, D, 10th Illinois, age 20. Ingram, W. A., Serg't, B, 20th N. Y. S. M. Jackson, H.A., Lieut.,D, 45th Alabama, age 29. Jell, F., Serg't, I, 95th New York, age 35. Johnson, E. F, Pt., I, 8th Georgia, age 18. Kirke,S.H.,Pt.,K, 200th Pennsylvania, age 19. Lafferty, J. C, Capt., C, 12th Illinois, age 21. Lamon, G. F., Lieut. Col., 32d New York. Lemar, J. C, Pt., B, 97th Illinois, age 21. Linn, H., Pt., A, 6th Pa. Reserves, age 25. Long. J., Pt., B, 47th Indiana. Matthews, T., Pt, D,8th Ohio, age 32. McBain, W., Serg't, E, 23d Illinois, age 31. McCann, R. H., Corp'l, G, 13th Miss., age 19. McCure, A., Pt., F, 3d Alabama, age 19. 4McGowan, P., Pt, A, 61st New York, age 32. Meadows, J. W., Pt., C, 16th Tennessee, age 20. 'Meyer, S.,Pt.,H, 110th Pennsylvania, age 25. Meyres, D. C, Serg't, C, 7th Mississippi Battery, age 24. Patton, S., Pt., G, 31st Georgia, age 42. Pitcher, A.,Pt,G, 122d New York, age 25. Poucher, A., Pt., A, 14th New York. Roe, J., Pt., B, 42d N. York. Roth, J., Pt., K, 2d Wisconsin. Roxbury, C. F., Pt., F, 124th Penn., age 29. J'e8,'62, April 29, 1863. May 23, June 24, 1864. June 1, Aug. 4, 1864. June 30, Aug. 7, 1862. Mar. 21, June 24, 1865. Aug. 30, —, '62. No.29,'64, Jan. 1, 1865. July 3, Au.26,'63 July 3, Au.l2,'G3. April 2, May 22, 1865. Oct 5, Nov.9,'64 Sept. 14, Nov.9,'C2. Jan. 11, My 25,'63. Sept. 17, 1862, Jan. 15, 1863. May 1, J'e 10,'63. May 6, June 10, 1864. Sept. 24,' 1864. May 3, J'e7,'63. Sept. 19, Oct. 31, 1864. May 31, J'yl5,'62. No.30,'64, Jan. 24, 1865. July 2, Nov. 9, 1864. No.30,'64, Jan. 1, 1865. July 9, Aug. 10, 1864. May 6, June 7, 1864. Aug. 29, Oct. 4,'62, Sept. 17, Oct. 27, 1862. Au.30,'62 Operations, Operators, Result. Right, (Oct,,'62, dis. bone rem'd.) Surg. A. B. Mott. U. S.V. Sept., '63, exc. four ins. Amp. bip jt., Sept. 21,'64. Died Sept. 22,'64; syncope from shock. Left (May 23, amp. leg; gang.); circ. A.A.Surg. M.C. Mulford. Died June 24,'64 ; inflammation and suppuration of stump. Left (erysip.; gang.; bone rem'd; haein.); circ. A. A. Surg. T. L. Leavitt, Died August 4, 1864. Spec. 2924. Left. A. A. Surg. S. D. Gross; pyaem. Died August 19, 1862. Autopsy. Spec. 256. Right (sloughing); circ. A. A. Surg. E. P. Fitch. Died June 24, 65, one hour after. ----. Died October 4, 1862. Left; ant. post. flap. A. A. Surg. R. McNeilly. Died Jan. 20,'65; exhaustion. Right; gang.; haem Died Sept, 25, 1863; exhaust'n and diarr. Left. Died Sept. 7, '63; exh'n Spec. 1947. Left (bone carious); ant.post.flap. Surg. E. Bentley, U. S. V. Died May29,'65; prostration. Autop. Left; circ. A.A.Surg. P. L. Rice. Died Nov. 25,'64; exhaustion. Left (ulc. fem.art.; haem.); flap. Surg. L. W. Oakley, 2d N. J. Died Nov. 9, '62. Spec. 792! Left. (Synovitis.) Died June 23, 1863; pyaemia. Left (Dec. 4, amp. leg; gang.; nec); flap. Surg. J. B. Lewis, U.S.V. Ham. Feb. 4,'63, lig, fem. art.; March 5, bone rem'd. Died March 31,1863. Autopsy. Specs. 3818,3983,748. Right, Surg. G. Grant, U.S.V. Died Jan. 15,1864. Spec. 1351. Right; circ. Surg. D. W. Bliss, U. S.V. Died June 12, '64; amp. Spec. 2499. ----. Gang.; haem ; flap. A.A. Surg. A. M. McLetchie. Gang. Died Sept. 25, 1864. Right. Surg. C.Witsell, C. S. A. Died July 2, '63; typ. fever. Right; oval flap. Surg. A. At- kinson, C. S. A. Died Oct. 31, 1864; pneumonia. Left (prof, discharges; erysip.); circ. Dr. W. Parker. Diarrh. and gastric irritability. Died in the course of twenty-four hours Right; bi-lat. skin flap; circ. sect. mus. A. A. Surg. R. McNeilly. Died Jan. 31, '65; exhaustion. Left (nec; bone rem'd); ant post. flap. A. A. Surg. W. P. Moon. Died Nov. 9, 1864. Left; ant. post. flap. A. A. Surg. W. J. R. Holmes. Died Jan. 1, 1865; exhaustion; shock. Left; circ. A. A. Surg. J. H. Coover. Died August 27,1864; exhaustion. Spec. 3836. Left; circ. Surg. D.W. Bliss, U. S. V. Died July 13, '64. Spec. 2449. Left. A. S. J. B. Brinton, U.S.A. Died Oct. 21,1862 ; pyaemia. Left. A. A. Surg. N.Webb. Oct. 29, haem.; 30, ree'rd, lig. femoral art. Died Oct 30,1862; exh'n. Spec. 436. Left. Died Oct 19, 1862. Spec. 4014. Left (erysip.); flap of skin; circ. of mus. A. Snrg. R. F. Weir, U. S. A. Erysip. Died March LI, '63; exh'n. Specs. 3855, 3903. 1 Allen (H.), Remarks on the Pathological Anatomy of Osteomyelitis, with Cases, in American Jour. Med. Sciences, 1865, N. S., Vol. XLIX, p. 39. 2 Waters (E. G.), A Report of Twelve Gunshot Fractures of the Thigh, in Am. Med. Times, 1863, Vol. VI, p. 185. Hamilton (F. H.), Amputa- tions in Gunshot Fractures of the Femur, in Am. Med. Times, 1864, Vol. VIII, p. 1. Circ. 6, S. G. O., 1865, p. 50. Ctrc. 7, S. G. O., 1867, pp. 47, 65. •Leavitt (T. L.), Tenacity of Human Life as seen in Cases of Gunshot Injuries, in Medical and Surgical Reporter, 1865, Vol. XHI, p. 205. 'Kennedy (J. T.), Reports of Hospitals, in American Medical Times, 1862, Vol. V, p. 105. •Moon (W. P.), Case of Gunshot Wound of the Thigh, in American Journal Medical Sciences, N. S., 1868, Vol. LV, p. 62. 316 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. Ryall, W. C, Corp'l, E, 121st Penn. Scott, M.E..Pt.,B, ]7th Indiana, age 25. Shindler, M., Pt., II, 43d New York, age 10. Skilton, G.T.,Pt., 1,36th Wisconsin, age 31. Storey, J. M.,Pt, II,37th Wisconsin, age 30. Stratton, A.,l't.,D,110th Ohio, age 21. Stuart, S. H, Pt., D, 2d Arkansas Cavalry. Sullins, IF., Texan Le- geon, age 20. Dates. De.13,'62 Feb. 4, 1863. April 2, J'e 2,3,'65. May 5, June 19, 1864. June 3, Aug. 30, 1864. J'y 30,'64, April 14, 1865. May 5, June 24, 1864. Sept. 27, ----,'64. De.21,'62, Fe.18,'63. Operations, Operators, Result. Left (necrosis); ciro. A. Surg. A. Hartsuff, U. S.A. Died Feb. 14, 1863; exh'n. Spec 1053. Left (necrosis); circ. Surg. H. Wardner, U. S. V. Died July, 19, 1865; exhaustion. Left (gang.); ant. post flap. Surg. E. Bentley, U. S.V. Slough'g; ham. Died June 27,'64; haem. Right (gang.; lucm.; Aug. 8, amp. knee; gang.; hasm.); circ. A. A. Surg. N. F. Martin. Died Sept 19, 1864; exhaustion. Left. (July 31, amp. knee; htem.; fang.) A. Surg. S. H. Orton.U. .A. Died July 3,'65; gang. Left (nec; pyaem.); ant post. flap. A. A. Surg. J. Priestly. Died June 29,1864; pyaem. Autopsy. Right. Died November 10,1864. Left. Died March 2, 1863; ery- sipelas. NO. Name, Military Description, and Age Tafft, F. H., Pt, K, 3d Rhode Island Artillery. Thomas, J., Pt, K, 30th Indiana, age 26. Travicke, W. H., Pt., A, 8th Alabama, age 46. Warner, S. N., Pt., II, 83d Penn., age 21. Williams, L., l't.C, 26th Michigan, age 23. Winters, L., Pt,, K, 50th Georgia. Woolsey,A.,rt.,H,20th New York. Zody, A. E., Capt., D, 102d Ohio, age 28. Dates. June 16, July 23, 1862. Sept. 19, Dec. 18, 1863. July 2, Au.6,'63. July 1, Au. 3,'63. May 12, June 13, "1864. July 3, Sept. 11, 1863. Aug. 30, Oct. 1,'62. Se.24,'64, Jan. 26, 1865. Operations, Operators, Rebult. Left; circ. A. A. Surg. W. K. Cleveland. Died July 27, *62; exhaustion. Left. (Gang.) Teal's method. Dec. 31, rupture fem. art. Died Dec. 31, '63; haem. Spec. 2172. Left. Sloughing; Aug. 18, hsem.; gang. Died Sept. 4, 1863. Left. Died August 14, 1863; diarrhoea. Left, A. A. Surgeon A. Ansell. Hsem.; lig. fem. art. Died July 19, '64; hasm. Autopsy. Specs. 2882, 2883, 2538. Right (July 3, amp. leg; slough.; haem.); circ. A. Surg. B. Stone, U.S.V. Died Sept. 30, 1863; pyaemia. Left. Hsem.; lig. fem. art. Died Oct. 5, 1862; exhaustion. Left; (erysip.); flap. Surg. R. H. Gilbert, U. S. V. Diarr. Died Feb. 21,1865; pyaemia. The seat of fracture in the foregoing one hundred and sixty-eight cases was in the middle third of the femur in seven; in the lower third in twenty-three; in the femur, pre- cise seat not indicated, in twelve; in the knee joint, in sixty-eight; in the bones of the leg, in forty-eight; and in the ankle joint or foot, in ten cases. Secondary Amputations in the Lower Third of the Femur.—Two hundred and seven operations of this group were reported. One hundred and seven were successful and one hundred proved fatal, a fatality of 48.3 per cent. Successful Cases of Secondary Amputation in the Lower Third of the Femur.—Four- teen of the one hundred and seven successful secondary operations were practised on Union and ninety-three on Confederate soldiers. Eighty-nine of the former were pensioned, but seven have died since the close of the War. The side of operation was not indicated in seven instances; in forty-four the right, and in fifty-six the left side was implicated. Major operations had preceded the amputation in the thigh in thirty-one cases, viz: amputation at the knee joint in four, in the leg in twenty; excision in the bones of the leg in six, and amputation of the opposite leg in one instance.1 In the following instance the amputation was performed by the subperiosteal flap, advocated by Assistant Surgeon George M. McGill, U. S. A. Case 490.—J. H. Allison, a farrier of Co. I, 21st Pennsylvania Cavalry, aged 19 years, was wounded in the left thigh, at Amelia Court House, April 5, 1865. From a field hospital he passed to the Cavalry Corps Hospital at City Point, thence to Annapolis, and afterwards to Baltimore, where he entered Jarvis Hospital, and subsequently, on July 24th, Hicks Hospital. Assistant Surgeon G. M. McGill, U. S. A., in charge of the latter, reported the following history: "The wound was caused by a minie" ball, which entered the inner aspect of the lower third of the thigh and made its exit posteriorly, having passed down- ward, outward, and backward behind the femur, and clipped a piece from the posterior surface of the bone. The femoral artery was cut by the bullet, and profuse primary hajmorrhage occurred on the field, followed by a secondary attack on May 19th, and two recurrences since. Each secondary hemorrhage ceased spontaneously and did not amount to more than a teacupful. About 1 The four cases in which the amputation in the thigh was preceded by exarticulation at the knee are: Pt. J. M. Brooks, A, 17th Pennsylvania Cavalry (Table XL, No. 14, page 320); Pt. H. Desmond, 1, 28th Massachusetts (Table XL, No. 25, p. 320); Pt. C. H. Rist, A, 36th Wisconsin (TABLE XL, No. 82, p. 321); and Pt. H. Sholes, D, 26th New York (Table XL, No. 84, p. 321). Antecedent amputations in the leg had been performed in the following cases, enumerated in Table XL: Pt. D. M. Fletcher, 10th Indiana Battery (No. 36, p. 320); Pt. G. Mclntire, I, 7th Maine (No. 61, p. 320); Pt. J. Morrin, G, 126th New York (No. 69, p. 321); Pt. J. B. Bronson, I, 14th Ohio (No. 13, p. 320); Lieut. M. A. Cobb, A, 23d Alabama (No. 20, p. 320); Pt E. Crawford, F, 105th Ohio (No. 23, p. 320); Pt. H. S. Dickens, H, 126th New York (No. 26, p. 320); Pt. W. F. Dudley, F, 1st Maine Cavalry (No. 28, p. 320); Corp'l D. C. Eaton, H, 5th New Hampshire (No. 31, p. 320); Pt. H. Hadlow, H, 81st New York (No. 42, p. 320); Pt. F. Hoffman, H, 2d Pennsylvania Heavy Artillery (No. 47, p. 320); Pt. I. M. Welsh, B, Sth Maine (No. 101, p. 321); Pt. B. Thompson, C, 28th Pennsylvania (No. 93, p. 321); Pt. W. Bacon, I, 7th Maine (No. 4, p. 320); Corp'l A. Bisbee, B, 7th Maine (No. 9, p. 320); Corp'l J. Duran, C, 17th Maine (No. 29, p. 320); Pt. W. H. Miller, I, 72d Pennsylvania (No. 67, p. 321); Pt. L. N. Kimball, H, 22d Massachusetts (No. 53, p. 320); Pt. J. Kerrin, G, 19th Infantry (No. 52, p. 320); and Pt. H. Pust, K, 104th Hlinois (No. 78, p. 321). Excision in the bones of the leg had been performed in the cases of: Pt. J. A. Angell, D, 1st Wis- consin Cavalry (No. 2, p. 320); Pt. W. H. Bnrdick, B, 82d Pennsylvania (No. 17, p. 320); Corp'l T. Odell, H, 5th Michigan (No. 73, p. 321); Pt. J. Fergus, A. 70th Indiana (No. 34, p. 320); Serg't J. Lowth, M, 4th Wisconsin Cavalry (No. 57, p. 320); and Pt. E. A. Bennett, F, 44th New York (No. 7, p. 320). In the case of Pt. H. Brown (No. 15, p. 320), K, 22d Colored Troops, the opposite leg had been previously removed. Med 8 --.ii ••: Hint iif lln> Wiir ot the Koliflliou. I'.-irt III .Vol .n.Uutp \ it,, ,, Ward phot T Sinclair a foil lith PLATE LXX II —INVOLUCRA OF BONES OF THE LEG. Fig 1. _ Private Olivet* Payne, D. 'i8 IS. Colored Troops Specimen 4740, A. MM. Fig. 'I Private W Miller l.7'2 Pernisylvmiiu Vols. Specimen 4172 A.M. M. nan:. . ,iUtfY •: .i:.q,l v K.n oi >.d. A.. ■ ;., . ' av YtJVi : | .a , . -a :. "■■■ >; ■•;,.>, K-ca^iar. '; .,c !<". in U, etmigbU-'J tlr- "i" i ■ :<■!. '.ivcion \\ •'!_■ i|, i ■ ;■■■■' .•■'•■'. 'itW. .mi • ■..:.■,.• a' h. juti/ .1 ; l'i ■ ■ . i .g -ory n:'nnt lOi'Cled l.itl.- '■ !• v ■ Y, ,• ,•••;. kiudog"i» w< 'ii -,oy . '!.! : a ,|. ,'resdcl ;' ■Yxr itiot; i;t-|>v-:.a • • -.ivy I'.ill laii iKlia 'h. T.'v lti.-t lia. . - . .. / - n Febr-.ary 2-itb. I ;.,., r,., ,»• i- |,\. ..i. , • , ;. ,)f a al ,.,-cW f,»" til'. .••■■' \-::.» itYaia--r,d!.-a- .-a-. ..-,, NY- : Y:U, lrW !•■ ut in a ciii'ir all day, i u- ■ ■>. ■■ Y: , acrfi--'iy n surfiico granulrtion \x- . .e ,a 1'. ^ <•) : • ■■ntYally round?:: " 1>. . ' ■(• Y "I / >:•■ .•iiiifi.'itafi'd hrrY riay . ,y- > ■ ■ \ ;a :'■.■ ri'i^ntiiT.. at ■ < : a ' a a •.■•'■-■ r ,|,c ,,i]!n .••■• .,;■'•.; ill.UU. ia ch.uy their m:, thign . » ^ronp'i "<»pl.o-- ' ' r. * lurnifb*- \,.i. ,.. a Y r- . . • ■ : tb»t "ou hcj •;;, ; f »r (Pig. -JOi 'a . • a ■■ "wr.- v..-;!f* ;• • -, tT:ii'.f:- a a. •UltflV.ir '. '•■■' '':•" - '" P'" ' :■<■•' •■a ii,. the :i>\ve' :v-ider'"J ^e;.u''. ■a : J J t' t:": ■■ " ' th.- A ■ • A •al m ; a"' i 'i-d :..-. . S.lt't a . (■' ,.,] >.r tea u .1. ■•! !)( ■;!,•:•' ■a! Lou' i ■ irDprcv. '.' £ •va» '' a tl. ■ alia ged i're::i ••ofl t.iesuer., u..-Cni!. .5.. '■ P. \T- i '•' .^ ' 7"2tl Pci-iipy. a.nia, '..:•■ ■-.-. , •■•■■p.. .'i &■.pviubee IT. li-«'-'i. .'.-:■• .•■ ■ a:•.;..;;•. j. J V.,- . ,' . • (V.re Ee'«y;!.i >\"as Ui.> -n, • ■ er- " • '■ j': ' aii, !..•(, tit! OT aati(.2 t.aii-;' p«rfo,-.v'a ylllv .I'l.! •'."•.• tr:»i.rf -red te Antiory Square Hivj- jl. am , .<(..■.. ..n Mai-^h tM, 1864. ^-■ti.i-.. A^ -.ir-; a ., j. ..•;•! hi-dt1 'Vrljle, Im!: boia-S ■!' ll'a i ,-■ : !'• i- •. ■:(■*:- a •■£ , i .-.aiipu!.■■•:',. -Il ..lOVr 111 ' ■'••n in :.: •uH . S . !.> ..■ n.fi.a ii ■ sabs.-r.-.i'; t !..;!•.. iwj».»'' :.. Cr>tvt<«. as*;* v: * * ■&*>■;:<■;■■ Kv*' • * 3rfr< *v* ' pY ■-'... ~'>.^'.'' ."!:..' ..,!■ f , *." k<* ■■V. '* *W • •Hi *v- V v* '• f.. <••$ ■Jr •:. .'•.;..■ a * '■ •...,' '' :.■' ' i'''&jfiia: ft 'J '•.■' * ■ -,*■■" ■ ■'! .,■ • ■■* i@:iiHp ^ '. .' ' ' ' Y*' ' 'Y ' •;'■ :$$*' My h- . '■ •> y- . ,-,-::>. ^Y :ft. «- *•: :■ ?X,.' ' U a "/.a^Y •:# . ,Y< -j. . A-\ ;r.v ';'at < ' £•'•■":. ': ,;;:;iiH:':;:-Y,v . Af{ ''* "^.'': \ .■'&■■ a. ' , )*' V-.*.' '■■ '■ 'A''-'':' • '•*■.', >\ ■' Aft A A " ' *;■ ;'■■>..%■:■■■£■ , .,, . T a •;*i' ::'''>...v! :■. ;i* .-.., ■..*■.' 'f :;,;*.'^i'-< * :; ■ • '■'-k-'^V. ■ .'.: >•!. f :••*':■':•' ■ Vy ''■'it. OLbC^A OF BOKF.S or T ,£ if.i "re. .tie VV* .\|i||,m >.iM\lviu>iai Vols. >• •<-ii H7'2 A.MU SECT. III. J SECONDARY AMPUTATIONS OF THE THIGH. 317 April 20th, the wound was attacked with gangrene. The knee joint at first, and at different periods since, became severely inflamed, and was opened eight times, discharging a serous purulent fluid on each occasion. The leg became bent at right an^le with the thigh and firmly anchylosed, and several attempts were made to straighten the limb by means of anterior splints, which, however, gave the patient great pain, and were followed on each occasion by erysipelas. One attack of this disease supervened about December 13th, leaving the limb in a flabby and oedematous condition, and with several indolent ulcers, which obstinately refused to heal and were a source of great anxiety and annoyance to the patient. On February 16, 1866, the limb being found in a sloughing condition and the patient seeming to sink gradually, being very nervous, sallow, and anaemic, and his pulse very weak, quick, and irritable, Acting Assistant Surgeon H. McElderry amputated the leg by my direction. The operation was performed in the lower third of the femur through the diaphysis, by forming an ample anterior flap and a short and somewhat thick posterior one, and raising a very long and wide periosteum flap. The periosteum flap was raised with the greatest ease, and, after the operation was completed, was folded over every part of the cut surface of the bone. Great prostration followed the operation, from which the patient reacted rather Blowly. He was kept under the influence of morphia the first several days. The bandages were removed and the stump dressed for the first time on the third day. Fever and attacks of vomiting appeared on February 19th, but after the next day the patient improved steadily and speedily. The last ligatures came away on February 24th. During the progress of his cure his blood presented the remarkable phenomenon of a change of the white corpuscles into red. At his own request the patient was discharged from service March 20, 1866, at which time he was able to sit in a chair all day, the stump being perfectly well with the exception of a surface granulation in the cicatrix. The end of the bone in this case was beautifully rounded." Dr. McGill' further reported that an examination of the amputated limb fully corroborated tbe previous diagnosis of extensive fatty degeneration, and contributed two specimens of the case, one of which, embracing the amputated femur and upper portion of tibia, is shown in the cut (Fig. 205). The other specimen consists of a lig- amentous preparation of the tarsus and metatarsus and lower portion of the bones of the leg, and shows anchylosis of the ankle joint as well as a trans- verse fracture in the astragalus, believed to have been inflicted after the operation. (Cat. Surg. Sect., 1866, p. 440, Spec. 483.) A cast of the stump, made four weeks after the amputation, was also contributed by the same donor, and constitutes Specimen 403 of the Surgical Section (Fig. 204). The patient, after being discharged, was admitted on the Pension Rolls, and furnished with an artificial limb two years afterwards. The Muscatine, Iowa, Examining Board, on June 4, 1873, reported that "on account of contraction of the anterior muscles of the thigh, pre- venting the limb from being carried backward, he is unable to wear an artificial leg." This pensioner was paid June 4, 1879. Necrosis of the tibia and fibula following amputation in the lower third of the leg, and unhealthy condition of the soft parts of the stump, rendered secondary amputation in the lower third of the thigh unavoidable in the following instance: Case 491.—Private W. H. Miller, Co. I, 72d Pennsylvania, aged 21 years, received a shot fracture of the tarsal and metatarsal bones of the left foot, at Antietam, September 17, 1862. Assistant Surgeon J. J. Woodward, U. S. A., recorded his admission, six days after the injury, to the Patent Office Hospital, Washington, where the injured limb was amputated on September 28th, by Acting Assistant Surgeon P. Middleton, the operation being performed by the circular method at the lower third of the leg. Several months afterwards the patient was transferred to Armory Square Hospital, and subsequently he passed through several hospitals in Philadelphia, entering Christian Street on March 21,1864. Acting Assistant Surgeon R. J. Levis, in charge of the latter, reported that he found the patient's general health feeble, both bones of the stump necrosed in nearly their whole length, and the soft parts in a very unhealthy condition, necessitating a re-amputation at the lower third of the thigh, which he performed by the antero-posterior flap method on April 28, 1864. He also reported that the patient reacted promptly, and that his general health improved greatly after the second amputation, and that the stump healed readily. On September 3,1864, the patient was discharged from service and became a pensioner. He was paid as such March 4,1879. The amputated bones of the foot and the soft tissues, as well as the bones removed at the second operation, were contributed to the Museum by the respective operators (Cat. Surg. Sect., 1866, pp. 440, 503, and 402, Specs. 97, 2748, and 4172). The last of these specimens is represented in Fig. 2 of Plate LXXII, opposite, showing the dead shafts of the tibia and fibula surrounded by a quite complete involucrum, which, in size, approaches hypertrophy. The extremity of the fibula is roughened, but softened as if carious. The tibia approaches roundness, but its extremity is incomplete, exhibiting the end of the sequestrum. FIG. 204. — Appearance of stump of left thigh four weeks after operation. Spec. 403. FIG. 205.—Upper portion of left tibia and fibula and lower portion of femur. Spec. 477. ■The late Dr. G. M. McGill in a letter to the Surgeon General, U. S. A., dated April 12,1866, says: "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 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 iD 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 proximal forms. Thus we have sequestra, thus often osteomyelitis and pysemia. With periosteum over the cut end of a bone, we have a tissue there whose oflice 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." The case of Allison and the preceding extract from Dr. McGnx's letter have been noted in Circular No. 3, S. G. O., War Department, Washington, 1871, p. 280, Cask 4. :>ls INJURIES OF THE LOWER EXTREMITIES. |CHAP. X. Amputation at the knee joint had preceded amputation of the thigh in the next case: Cask 492.—Private Cutler H. Rist, Co. A, 36th Wisconsin, aged 18 years, was wounded at Cold Harbor, June 1, 1864, l>y :i conoidal ball, which entered on the inner and posterior portion of the left leg and caused a fracture of tbe tibia, which extended into the knee joint. He was immediately conveyed to the field hospital of the 2d division, Second Corps, where amputation at the knee joint was performed by Surgeon J. M. Burr, 42d New York. On June llth, he was admitted into Lincoln Hospital, Washington, where Acting Assistant Surgeon C. H. Bowen reported: "Date of operation, June 3d; amputation at knee joint, leaving patella and condyles of femur." Dr. Bowen adds: "Having seen several of these operations performed, they have all died in periods varying from six to twenty days, from pyaemia, tetanus, etc., I totally discard the operation: 1st, from the extensive suppuration from the condyles of the femur and from the patella, from the duration of the suppuration, which will continue until the entire cartilaginous substance from condyles and patella is either cut away or has sloughed off by the work of nature, after which comes the continuous discharge of the synovial fluid from the wound. In the case of Rist, in which the limb was amputated on June 3, 18G4, the synovia still exudes, in December, 1864, in quantities varying from a teaspoonful to a tablespoonful, and, more especially, after the least exertion, such as walking by means of crutches; besides, the cicatrix is of a slough- ing character, tending to gangrene. December 14th, amputation not healed; continuous discharge of synovial fluid, more especially when walking; tendency to slough ; patient otherwise in a healthy condition, and desires a re-amputation, and, in my opinion, the stump will never heal while remaining in its present condition." On December 15,1864, Assistant Surgeon J. C. McKee, U. S. A., amputated the thigh at the lower third; skin flap and circular section of muscles. Simple dressings were applied. The patient recovered rapidly. He was transferred to Harvey Hospital, Madison, Wisconsin, on March 23d, and discharged from service May 20, 1865. His pension was paid March 4, 1879. Dr. McKee contributed a photograph of the patient (Contributed Photographs, Vol, II, p. 25), which is reproduced in the wood-cut (FlG. 206), and the pathological specimen which consists of "the extremity of the left femur and the soft tissues forming the stump Fig. 206.—Appearance of stump after „ . , ,,,..„ ,r, . t j c • t n .• , „ „ -,ns>A amputation in lower third of thigh. after amputation through the knee joint." (Catalogue of Surgical Section, A. M. M., leob, p. 502, Spec. 3514.) Primary amputation of the right leg at the upper third and secondary ablation at the lower third of the left thigh were performed in the next case. The patient survived the operations eight years: Case 493.—Private H. Brown, Co. K, 22d Colored Troops, aged 19 years, was wounded in both legs, at Petersburg, July 30, 1864. He was admitted to the Eighteenth Corps Field Hospital, where Surgeon S. A. Richardson, 13th New Hamp- shire, recorded "amputation of right leg." Surgeon J. H. Taylor, U. S. V., reported the following history: " The patient was admitted to Summit House Hospital, Philadelphia, August 17th, with shell wound of both legs, the right leg having been amputated at the upper third by flap method on the field. The stump of the right leg healed entirely, but the wound of the left tibia, which was injured in the upper third, resulted in necrosis of the bone extending into the knee joint, and was attended by extensive sloughing of the soft parts. The left limb was amputated on March 19, 1865, above the knee joint, by Acting Assistant Surgeon O. Shiftier, the double flap method being employed and chloroform used. The treatment consisted of simple dressings, tonics, and stimulants. The stump healed kindly and the patient progressed well." Several months after the operation he was supplied with artificial limbs by the Palmer Ann and Leg Company. At the closing of Summit House Hospital the patient was transferred to Mower Hospital, and subsequently to the Post Hospital at Philadelphia. On September 11, 1866, he left for his home, cured, having been discharged from service to date from March 20, 1865. His name appeared on the Pension Rolls until July 14, 1872, when he died. The cause of his death has not been ascertained. Fatal Secondary Amputations in the Lower Third of the Thigh.—One hundred secondary operations in the lower third of the femur proved fatal. Twenty-four were practised on Confederate and seventy-six on Union soldiers. In three the injuries had been caused by shell, in two by grapeshot, and in ninety-five by small projectiles. Pysemia was noted in twelve, tetanus in one, and gangrene in twenty-one instances: Case 494.—Private W. H. Powell, Co. I, 3d South Carolina, aged 20 years, was wounded at Antietam, September 17,1862, and entered hospital No. 5, Frederick, November 25th. Surgeon H. S. Hewit, U. S. V., recorded the following history : "The patient had been wounded by a grapeshot in the right leg and through the ankle joint, for which amputation had been performed at the middle third of the leg. The stump was doing badly, having commenced sloughing on the outer side. There was also much swelling. The granulations on the inner side of the stump were very exuberant. Pain in the knee joint indicated carti- _ laginous inflammation. Reamputation was deemed necessary, and was performed by Acting Assistant Surgeon A. V. Cherbon- nier, above the knee, on November 30th. At the operation, the track of an old abscess was discovered, extending some distance up the thigh. Two days afterwards the stump showed some fungous granulations and the dressing was supplemented with a weak solution of nitric acid, with which the sinus was also injected. This treatment was kept up until December 10th, when SECT. III. | SECONDARY AMPUTATIONS OF THE THIGH. 319 the stump had assumed a healthy appearance, but a large quantity of laudable pus was being discharged from the sinus. The injection was then increased and a tight bandage applied, and the dressing of the stump was changed to a solution of tannin. On the 20th, the stump was still doing well, and the sinus seemed to have closed, pus having ceased to come from it. On the '24th, the stump grew painful aud the discharge ceased. Poultices were now applied and tincture of iodine used to the hip. Iodide of potassa was also prescribed in doses of five grains three times a day, and the same quantity of quinine, and one half ounce of cod-liver oil every four hours. On the 26th, the patient's condition had improved. The discharge of pus having become offensive, the stump was washed with a dilution of chlorinate of soda, the poultice discontinued, and wet strips applied." The patient was transferred to hospital No. 6 on December 29th, and to hospital No. 1 six weeks later. Assistant Surgeon R. F. Weir, U. S. A., in charge of the latter, recorded the termination of the casa as follows : "At the time of admission the stump looked healthy and was suppurating, and the patient was in tolerable good health, but had quite a large bedsore above the sacrum, which was healing. He was taking tonics and stimulants, also iron mixture and cod-liver oil, and the stump was dressed with oakum saturated with acid wash. On February 29th, fluctuation was detected in the stump, and an opening was made on the anterior aspect one inch long, through which pus escaped. On March 17th, the patient complained of pain in the stump and more jius was discovered by the probe, necessitating another incision, one and one half inches long, to be made to allow it to escape, after which poultices were applied. Two days afterwards an abscess was discovered on the anterior aspect of the stump and just opposite the point of the previous incision, which on being opened evacuated two ounces of pus. For some days after this the patient was much better and the stump was improving slowly. One month later, however, he was noticed to be failing, and looking very pale and anaemic. Erysipelas was discovered in the stump on April 24th, for which lead and opium lotion was applied. At the same time the patient was suffering from considerable irritability of the stomach, being unable to retain any food or medicine for any length of time. Hydrocyanic acid having been administered for this without any good effect, lime water was given, which appeared to relieve the patient to some extent. On the following day the erysipelas was found to be extending to the opposite side and body, and, on April 28th, it was leaving the stump and was spreading still farther upon the body, the patient's condition being quite feeble, having no appetite, his tongue coated, skin dry, and pulse weak. During the two following days he was in a critical condition and unable to retain anything on his stomach, nourishment being given by the rectum. Hydrocyanic acid and lime water were now used without benefit, and tincture of opium was sub- stituted with apparent relief. On the morning of May 1st, the patient appeared brighter, having rested well and being able to retain his nourishment. The erysipelatous inflammation had left the stump, but had extended across the body and was spread- ing down the other thigh. In addition to his treatment egg-mixture and tincture of iron was now prescribed for the patient. He failed rapidly on the next day, and died on the morning of May 3, 1863. At the post-mortem examination four ounces of purulent serum was discovered in each side of the chest, and the lungs were found to be partly congested, with small calcareous deposits in the upper lobe of the right side. The heart was of normal size, the cavity of the stomach very much congested, the liver having the appearance of fatty degeneration, the gall bladder very much distended, and the kidneys moderately congested. The tissues about the stump were healthy, but on opening the capsular ligament about two ounces of pus was found around the hip joint. The cartilage lining the acetabulum was softened, and in some places entirely gone. On dissecting out the nerves the bulbous expansions of their ends were shown to be well marked. Above the saphenous a wire ligature was found, which seemed to have given rise to little or no irritation. The patient had frequently complained of pain in the stump, but it is impos- sible to say whether it was caused by this ligature or by the abscesses that were forming from time to time. The end of the stump of the femur was found to be surrounded by an involucrum, exposing a small sequestrum running up the shaft." The amputated stumps of the tibia and fibula were forwarded to the Museum by the operator, and the stump of the femur was contributed by Acting Assistant Surgeon A. North.— (Cat. Surg. Sect., 1866, p. 400, Spec. 795, and p. 300, Spec. 3837.) In the following instance Syme's amputation at the ankle joint had been performed on the day of the injury, but continuous sloughing and abscesses followed, and amputation at the upper third of the leg and subsequently at the lower third of the femur were practised: Case 495.—Private F. M. Bland, Co. D, 23d Iowa, received a shot wound in the left foot, during the engagement at the Black River, May 19, 1863. " .Syme's amputation at the ankle was performed the same evening at a field hospital. On June 13th, the patient was admitted into Adams Hospital, at Memphis, at which time nearly the entire flaps had sloughed off the stump and the bones were exposed to view. An abscess had also formed at about the middle of the lower third of the leg, and periostitis of the tibia and fibula existed at the same point. The general condition of the patient was low; he having suffered from diarrhoea for four months. He was put upon iron, quinine, stimulants, and astringents. On June 17th, his general con- dition being somewhat improved and the diarrhoea checked, it was decided to amputate, which was accordingly done at the junction of the upper and middle thirds of the leg by Acting Assistant Surgeon J. Thompson. I saw the patient for the first time on the following day, when, though in a low condition, he seemed to be rallying from the shock of the operation. I admin- istered iron, quinine, stimulants, and beef tea, and had water dressings applied to the stump, under which course the general condition of the patient gradually improved. The stump at first appeared to do well, but before many days began to discharge thin ichorous looking pus. This was the condition of the patient when his ward was transferred to the charge of Acting Assistant Surgeon W. P. Sweetland. On June 26th, the wound gaped open, no adhesions having formed in any part of the stump, and the flaps soon commenced sloughing. It was then decided that the only chance for the patient rested in another operation, and accordingly, on July 2d, the thigh was amputated at the middle of the lower third. The patient seemed to bear up well under the operation, and, as before, seemed at first to be doing well. But soon the stump became gangrenous; an abscess also formed on the patient's shoulder below the clavicle, the edges of which sloughed, laying bare the thyroid axis and destroying its branches. On July 13th, the patient was removed to my ward in a rapidly sinking condition. He died on July 16, 1863." The foregoing history was transmitted by Acting Assistant Surgeon B. J. Bristol, and the bones removed at the second amputa- tion were contributed to the Museum by Surgeon J. G. Keenon, U. S. V. (Cat. Surg. Sect., 1866, p. 441, Spec. 1706.) The specimen shows the extremities to be necrosed, no reparative action having occurred. 320 INJURIES OF THE LOWER EXTREMITIES. |CHAF. X. Table XL. Summary of Two Hundred and Seveyi Cases of Secondary Amputation in the Lower Third of the Femur for Shot Fracture. [Recoveries, 1—107; Deaths, 108—207.1 NO. 15 22 Name, Military Description, and Age. Allison, J., Farrier, I, 21st Pennsylvania Cav- alry, age 19. Ansell, J. A., Pt., D, 1st Wisconsin Cav., age 23. Arendt, J., Pt., E, 5th Kentucky. Bacon, W., Pt., I, 7th Maine, age 21. Bass, J. B., Pt., K, 59th Illinois. Bassett,J.F.,Pt.,I,114th New York, age 22. Bennett, E. A., Pt., F, 44th New York, age 41. Biddle, D., Corp'l, A, 107th Ohio, age 23. Bisbee, A., Corp'l, B, 7th Maine, age 25. Bishoff, D.D.,Pt.,B,14th West Va., age 25. Blakeley, J. W., Pt,, F, llth Massachusetts. Boyd, H., Pt., D, 51st Colored Troops, age 42. Bnmson, J. B.,Pt.,1,14th Ohio, nge 18. Brooks, .7. M..Pt.,A,17th l'enn. Cav., age 28. Brown, H., Pt., K, 22d Colored Troops, age 19. Brown, W.C., Pt., K,93d Ohio, age 23. Burdick, W. H., Pt., B, 82d Penn., age 24. Chase, H.W.,Pt.,H, 96th New York, age 21. Clapp,F.,Pt.,K.2dMass. Cavalry, age 21. Cobb,, M. A., Lieut., A, 23d Alabama, age 39. Comer. C, Serg't, F, 13th Virginia Cavalrv. Costello, P., Pt., E, 88th Illinois, age 26. Crawford,E.,Pt.,F,105th Ohio, age 20. Deny, J. M.,Pt.,B,126th Ohio, age 23. Desmond, H.,Pt., I, 28th Massachusetts, age 29. Dickens, H. S., Pt., H, 12Gth N. Y., age 30. 1 Doerflinger, C. H., Lt., B, 26th Wis., age 20. Dudley, W. 1\, Pt., F, 1st Maine Cav., age 24. Duran, J.,Corp'l, C, 17th Maine, age 23. Eastman, J., Pt., E, 1st Wisconsin. Dates. Ap. 5, '65, Feb. 16, 1866. July 23, Sept. 18, 1864. Jan. 1, Mar.1,'63. J'yl2,'64, ----,'66. M'h7,'62, Jan. 16, 1863. Oct, 19, Nov. 29, 1864. May 22, 1864, Mar.2,'69. Julyl, Au.13,'63. Ap.16,'62, Ap. 8, '63. May9,'64, Mar. 13, 1865. J'y21,'61, No.—,'62. May 25, Je. 25,'65. Aug. 5, ----,'64. June 21, Sept, 10, 1863. July 30, 1864, Mar. 19, 1865. Se.20,'63, April 12, 1864. Ap. 6,'65, Mar. 27, 1866. Sept. 29, De. 1, '64. J'yl3,'63, Mhl8,'64. De.15,'64, Jan. 19, 1865. June 19, Oc.20,'63. No.25,'63, July 18, 1864. Sept. 19, 1863, Aug. 5, 1864. Sept. 21, Oct. 30, 1864. De.13,'62, ----, '63. J'v 2, '63, April 24, 1864. May 2, Je.27,'63. Mar. 1, Jane 14, 1864. M'y6,'64, Mav 18, 1865. Sept. 19, Dec. 25, 1863. Operations, Operators, Result. Left (bfem's; erysip.); ant. post. flap. A. A. Surg. H. McEldery, Disch'd March 20,1866. Specs. 477, 403, 483. Right (gang.; Aug. 1, '64, excis. tibia; haem.); circ. A. A. Surg. J. C. Thorpe. June 16, '65, re- amp. Recovery. Spec. 5549. Left; flap. A. Surg. J.W.Pearce, 51st lnd. Disch'd Nov. 17, '63. Left (amp. leg; nec; disch'd June 16, '65); flap. 1870, good stump. Spec. 2841. Left (disch'd Sept, 20, '62); circ. Dr. S. Cabbot, Mass. Hospital. Necrosed bone removed. Left; ant. post. flap. A.A. Surg. A.W.Emory. Disch'd April 10, 1865. Spec. 3476. Left. (M. O. Oct. 11,'64; Dec..'64, nec. bone rem'd; Jan., '69, exc. up. frag, fibula.) Dr. T. Becket, Albany. Re-amputation. Left; circ.; gang.; exfol. Disch'd June 24,1864. Right (May 12, 1862, amp. leg; disch'd Feb. 10, 1863); circular. Left (nec); circ. A. A. Surg. J. H. Butler. Disch'd May 20,'65. Right (disch'd Sept. 29,'62); flap. Died Jan. 30,1870; phthisis. Left; lat. flap. A.A. Surg. R. H. Blandry. Recovered. Right, (Pr. amp. leg.) Disch'd June 21, 1865. Left (June 21, amp. knee joint; gang.); ant. post. flap. Disch'd July 28, 1865. Left (July 30, amp. right leg); dou. flap. A.A.Surg.O.Shittler. Disch'd March 20, 1865. Died July 14, 1872. Left (erysip.); ant. post. flap. A. Surg.B.E.Fryer.U.S.A. Disc'd Oct. 7,1864. Spec. 117. Bight (exc. tibia; disch'd Oct, 12, ]sr..Y flap. Dr. B. E. Phelps. (airy. Pa. 1870, stump healthy. Lett ; tlap. A. A. Surg. E. Vogel. Ki-fch'.l April 14, 1865. ---; circular. A. A. Surg. J. F. Thompson. Disch'd Sept. 13,'64. Right (Deo. 17, amp. leg; gang.); bi-lat, skin flap; circ. sect. muse. A. A. Surg. W. I. K. Holmes. Provost Marshal June 3,1865. Right. Surg. I. P. Smith, C. S. A. Recovery. Right; circ. Surg. G. Grant, U. S.V. Gang. Disch'd June 17, 1865. Spec. 3006. Right (Oct. 4, '63, amp. leg); circ. A.Surg.G. M. Sternberg,U.S.A. Haein's; lig. prof, art,- Disch'd March 18, 1865. Spec. 3108. Right; nec.; sect, skin flap. A.A. Surg. B. B. Miles. Disch'd June 28, 1865. Spec. 3417. Right (Dec. 21,'62, amp. knee j't); post. flap. Disch'd Dec. 22, '63. Left (July 11, amp. leg); ant. post. flap. A. A. Surg. R. J. Lewis. Disch d April 28, 65. Spec. 2740. Left; circ. Surg. J. A. Lidell, U. S. V. Disch'd Feb. 25,1864. Left (March 2, amp. leg; gang.); circular. A. Surg. W.Webster, U. S.A. Disch'd Aug. 14,1865. Left (gang.; Aug. 28, amp. leg); circ. Surg. G. Derby, U. S. V. Disch'd August 7, 1865. Right (gang.); circ. A. A. Surg. W.E. Whitehead. Disch'd Nov. 29, 1864. Died April 10, 1870. Spec. 2035. NO Name, Military Description, and age. Eaton, D. C, Corp'l, H, 5th New Hamp., age 30. Elliott,T.A.,Corp'\, Shu- maker's Battery. Eustis.J. B.,Pt.,E,149th New York, age 23. Fergus, J., Pt., A, 70th Indiana, age 34. Fisher, A., Pt., C, 7th N. Y. H'vy Art'y, age 26. Fletcher, D. M.,Pt, 10th lnd. Battery, age 25. Fulwiler, L. B., Pt., A, 20th Indiana. Garlick, J., Pt., I, 26th Pennsylvania, age 21. Glavin, D., Pt., E, 87th New York. Graham, R. P.. Pt., H, 7th niinois, age 23. Grant, W., Pt., G, 9th N. York Artillery, age 36. Hadlow, H., Pt., H, 81st New York, age 21. Hagadone.A., Serg't, M, 2d New York Heavy Artillery, age 29. Ham, W., Pt., G, 42d Indiana, age 20. Hanley, M., Pt., A, 18th Connecticut, age 19. Hill, G.N.,Corp'l, A, 5th Colored Troops, age21. Hoffman, F., Pt., H, 2d Penn. Heavy Artillery, age 21. Hogg, W., Pt,, I, 76th New York, age 34. Hubbard, A., Pt., D, 6th New York Cav., age 31. Inman, A. W., Pt., B, 124th Ohio, age 30. Jinnett, J., Pt., D, 67th North Carolina. Kerrin, J., Pt., G, 19th Infantry, age 27. Kimball, L. N., Pt., H, 22dMass., age 19. Kirk, W. IL, Capt., D, 3d N.C.M't'd Infantry. Klammer, A., Pt., E, Sth Minnesota, age 26. Love, J. W., Pt., D, 25th Georgia, age 24. Lowth, J., Serg't, M, 4th Wisconsin Cavalry, age 26. Mason, D., Corp'l, G, 104th Illinois, age 23. McClelland, W. H., Pt., A, 12th Ohio Cavalry. McCue, A., Pt,, G. 21st Massachusetts. Mclntire, G., Pt., I, 7th Maine, age 24. Sept. 17, De.29,'62, Jan. 4, Fe.18,'62. Oc.28,'63, Jan. 21. 1864. ' Mav 14, Aug 15, 18(i4. June 17, Oc.19,'64 Oc.27,'64 Dates. June 25, J'y 26,'62. Mav 3, J'yl'l,'63. June 1, July 2, 1862. Oct. 5, Nov. 9, 1864. Oct. 19, No.26,'64. May 31, Aug.], 1862. Aug. 25, Nov. 21, 1864. Sept. 20, De. 6, '63. June 13, Dec. 23, 1863. Sept. 29, De.29,'64 June 18,. Dec.6,'64 May 5, J'ne7,'C4. July 22, 1864, Jan. 1,'65. May 27, J'y 5, '64. De.29,'63. J'e22,'64: Aug. 13, 1864. ' May 10, 1864, Jan. —, 1867. De.29,'64, Feb.4,'65 De.16,'64, Feb. 10, 1865. De. 7, '64 Au.31,'65 Aug. 24, 1864, June 2, 1865. May 14, July 6, 1864. De 18,'64 Feb.7,'65 Sep.1,'62 Feb. 27, 1864. May 10, Oct. 16, 1864. Operations, Operators, Result. Left. (Sept. 17, amp. leg.) Disc'd March 13, '63. Died Julv 1. '63. ----. Surg. H. McGuire, C. S.A. Recovered. Left (haem.); circ. Surg. W. Va- rian, U. S. V* Disch'd April 3, 1864. Spec. 2097. Died Feb. 18, 1875; consumption. Left (June 24, exc. fib.; gang.; tib. art, sloughed; haem.); circular. Surgeon R. L. Stanford, U. S. V. Discli'd Jan. 20,1865. Left; circ. Surg. J.W. Merriam, U. S. V. Disch'd June 24,1865. Right (Oct, 28, amp. leg); flap. Mustered out July 10, 1865. Left; flap. A. Surg. P. Goddard, U.S.V. Discli'd Aug. 22,1862. Right; flap. Disch'd June 27, 1864. Left (frag, of bone rem'd); double flap. A. Surg. W. Thomson, U. S. A. Disch'd Feb. 28, 1863. Spec. 4931. Right; circ. A. A. Surg. D. C. Bell. Haem.; lig. fem. artery. Disch'd May 22, 1865. Right; ant. post. flap. A.A.Surg. C. H. Jones. Disch'd Feb. 2,'65. Right (prim. amp. leg; July 24, gang.); circ. Aug. 15, re-amp. mid. third. Necrosed. Disch d May 2, 1863. Right (gang.; nec); flap. A. A. Surg. W. H. Ensign. Disch'd July 12, 1865. Spec. 3436. Left; circ. A.Surg.N.Teal, 88th Indiana. Disch'd Sept. 30,1864. Left; circ. A. A. Surg. C. H. Jones. Disch'd June 15, 1864. Died March 2,1866. Spec. 1993. Left; lateral flap. Recovery. Left (July 11, amp. leg); flap. A. A.Surg.J.S.Waggoner. Disch'd August 15, 1865. Spec. 3714. Right; ant. post. flap. Surg. E. Donnelly, 2d Penn. Reserves. Disch'd May 6, 1865. Left (inter, amp. leg; ext.nec); circ. A.Rurg.S.H.Orton,U.S.A. Disch'd Nov. 7,1865. Spec. 278. Left; circular. Disch'd June 15, 1865. ----. Surg. — Turner, C.S.A. Recovery. Right (Aug. 13, amp. leg; gang.); flap. A. Surg. T. A. McGraw, U. S. V. Bone rem'd. Disch'd June 4, 1865. Right. (May 10, '64, amp. leg; haem.; lig. Disch'd Oct. 17,'64.) Dr. W. II. Thorndike, Boston, Mass. Recovery. Right; circular. Resigned May 15, 1865. Right (nec. fragm'ts rem'd); circ. A.A.Surg.H.M. Lilly. Disch'd June 1, 1865. Spec. 4245. Left; oval flap. A. A. Surg. G. E. Sloat. Disch'd Jan. 14,1866. Right (gang.; May 27, '65, exc. fib.; lig. post. tib. art'y); at con- dyles. Surg. H. Culbertson, U. S. V. Disch'd July 17,1865. Right; circ A. Surg.C.W. Law- rence, 22d Mich. Disch'd Jan. 6, 1865. Right; circ. Confed. surgeon. Disch'd Sept. 11, 1865. Left (disch'd June 23/63); circ. Dr. B. S. Shaw, Mass. Hospital. Recovery. R't (May 11, amp. leg); ant, post. flap. A.A. Sure. G. E. Brickett. Haem. Disch'd June 16, 1865. 1 Lidell (J. A.), On theMajor Amputations for Injuries in both Civil and Military Practice, in Am. Jour. Med. Sci., N. S., 1864, Vol. XLVII, p. 368. SECT. III.] SECONDARY AMPUTATIONS OF THE THIGH. 321 Name, Military Description, an'd Age. McLeppy, J., Corp'l, C, 20th Indiana, age 31. MoLin, V., Pt., H, 7th Wisconsin, nge 20. MoMahon,A.,Pt.,G.9th New York S. Militia. McMurray, J. T., Serg't, D,9th Alnbama.age 24. Miller, J. M., Pt., D, 6th Michigan Artillery. Miller, W. H., Pt,, I, 72d Pennsylvania, age 24. Montano, J. R., Surgeon from Mexico. Monin, J., Pt., G, 126th New York, age 21. Newman, E. B., Serg't, F, 48th New York, age 23. Nichols, L., Pt., F, I57th New York, age 18. O'Boyle, M.,Pt.,E, 156th New York, age 17. Odell, T., Corp'l, H, 5th Michigan, age 20. Ferryman, J. L., Pt., D, 20th Georgia. Potter, H. G., Serg't, A, 74th Indiana, age 20. Potts, N. H., Serg't, B, 95th Penn., age 22. Powell, S. H., Corp'l, C, 14th New Jersey, age 24. Post, H., Pt., K, 104th Illinois, age 25. Reid, W. F., Pt., A, 1st N. C. Battery. Rice, R., Pt., I, 1st Mis- souri Cavalry, age 23. Ringold, W. H., Pt., I, 188th New York, age 19. Rist, C. H., Pt., A, 36th Wisconsin, age 19. Shafer, A., Pt., B, 13th Ohio Cavalry, age 18. Sholes, H., Pt., D, 26th New York, age 20. Silsbee, J. H., Pt., C, 8th New Jersey, age 27. Sloppy, P., Pt., E, 148th Pennsylvania, age 20. Smith, M., Pt., G, 16th Virginia. Sollers, J. H., Lient,, B, 73d Pennsylvania. Stout, A. H., Pt., H, 13th Pennsylvania Cavalry, age 25. Street, B., Pt., E, 27th Indiana, age 20. Sullivan, E., Pt., D, 5th Infantry, age 39. Taylor, W., Serg't, B, 106th N. York, age 26. Thompson, B., Pt,, C, 28th Penn., age 33. Tannoy, J., Pt., E, 36th Virginia, age 33. June 28, De. 6,'62. July 3, Aug. 3, 1863. Sept. 17, Oc.22,'62. July 2, Au. 3,'63. May 27, J'yl8,'(i3 Sept. 17, 1862, April 28, 1864. April 6, 1862, Operations, Opkratorb, Result. July 3, Nov. 3, 1863. Feb. 20, 1864, June 18, 1868. July 1, Aug. 14, 1863. Oc.19,'64, Jan. 13, 1865. J'e 18,'64, Jan. 13, 1865. Sept, 19, Oc.30,'63. Se.20,'64, May 13, 1865. May 3, J'ne5,'63. J'lyP,'64, Sept. 15, 1864. De.7,'62, Oct. 24, 18G3. Mav 25, Se. 15,'62. May 26, Oc.27,'63. June 1, Julv 13, 1864. June 1, Dec. 15, 1864. Sept. 30, Nov. 15, 1864. De.13,'62, Feb. —, 1863. May 3, June 18, 1863. May 10, J'y25,'64. Au.30,'62, May4,'64. May 2, July 28, 1863. Sept. 29, Dec. 3, 1864. Aug. 2, Sept. 7, 1864. Feb. 21, M'yl4,'62. Sept. 19, Nov. 25, 1864. Se. 17,'62, April 14, 1863. Aug. 17, Oc.27,'64. Right; ciro. A. A. Surg. J. E. Steel. Disoh'd June 8, 1863. Specs. 1836, 4760. Right; ant. post, flap. Surg. C. W. Jones, U. S. V. (August 6, heem.; lig. fem. artery; disch'd Sept. 6, '64.) Specs. Ki97, 2154. Left. Surg. J. B. Lewis, U. S. V. Disch'd Jan. 9, '63. Spec. 449. Right: circ; end of fem. rem'd. Exchanged March 3, 1864. Left ; flap. A. A .Surg. R. Koeler. Disch'd Sept. 22,1863. Left (Sept. 28,'l>2, amp. leg; nec); ant. post. flap. A.A. Surg. R.J. Levis. Disch'd Sept. 3, 1864. Specs. 97, 2748, 4172. Left. (Ulceration.) Langenbeck's method. Dr. Sutherland, S. C. Recovery. Spec. 90. Left (July 4, nmp. leg; gang.; hsem.); nnt. post. flap. A. Surg. T. C. Brainerd, U. S. A. Seq. and fragments rem'd. Disch'd June 18,1865. Specs. 2604,1416. Left (disch'd June 19, 1865, limb distorted; knee i't anchy.); flap. Dr. S. Shove, Katonah, N. Y. Recoverv. Right; hsem. A. A. Surg. C. H. Jones. Disch'd May 31, 1864. Spec. 1670. Left; ant. post, flap; skin, circ. sect, muscles. A.A. Surg. B. B. Miles. M. O. 1865. Spec. 3728. Left (slough.; excis. tibia); flap. A. A. Surg. G. C. Harlan. Dis- charged May 22, 1865. Left. Surgeon A. M. Spalding, C. S. A. Recovery. Right. (Synovia; nec.) A. A. Surg. J. W. Taylor. Re-amp. mid. third. Disch'd June 20,'G5. Left (haem. recur'nt); circ. Surg. R. S. Kenderdine, U. S. V. Dis- charged August 24, 1864. Right (gang.; nec); ant. post.flap. Surg. T. Sim, U. S. V. Disch'd Jan. 3,1865. Spec. 3468. Left (Dec. 11, amp. leg); conical. A. A. Surg. R. N. Isham. Dis- charged March 4,1864. ----. Surg. — Miller, C. S. A. Recovery. Right (gang.); circ. A. A. Surg. A.L.Allen. Disch'd July 29,'64. Right; flap. A. A. Surg. R. J. Levis. Disch'd Feb. 11, 1865. Spec. 3680. Left, (June 1, amp. knee joint.) Surg. J. C. McKee.U. S.A. Dis. Mav 20, 1865. Spec. 3514. Left;" circ. A. A. Surg. W. H. Coverton. Seq. rem'd. Di6ch'd Aug. 5,1865. Spec. 3723. Right (Dec. 15, amp. knee joint; gang.); ant. post.flap. Surg. D. W. Bliss, U. S.V. Disch'd June 4, 1863. Left; circ. A. A. Surg. W. S. Ward. Aug. 5, re-amp. Disch'd May 6, 1864. ----. Confed. surgeon. Necrosed end femur removed. Recovery. ---. Ass't Surg. M. P. Shelton, C.S.A. Recovery. Right; ant. oval flap. A.A.Surg. T. Liebold. Exfol. Disch'd Oct, 9, '63. Died Mar. 14, '64; fatty degenerat'n. Autop. Spec. 1808. Left (nec): flap. A. A. Surg. J. H. Thompson. Disch'd July 8, 1865. Spec. 3477. Left; ant. post. flap. Ass't Surg. G. W. Burke, 46th Penn. Mus- tered out Feb. 7, 18C5. Left; circ. Ass't Surg. B. Norris, U. S. A. DischVI Aug. 23,1862. Left (nec); ant. post. (lap. A.A. Surg. J. Neff. Disch'd Aug. 6, 1865. Specs. 5, 4856. Right (Oct. 3, amp. leg ; erysip.; gang.); flap of skin; circ. muse. Dis. May 6,'63. Specs. 3883,3965. Left thigh. For exchange April 8, 1865. Name, Military Description, and Age Vogt, M., Pt., I, 15th N. York Artillery, age 23. Wagenknight, W., Pt., G, 118th Penn., age 38. Wager, G. H., Pt., H, 22d New York. Wandel, G., Pt., K, 7th Ohio, age 25. Waters, W. W., Serg't, K, 6th Cavalry, age 23. Weiderecht, M., Pt., D, 6th Ohio. Welsh, I. M., Pt., B, 8th Maine, age 21. Weymouth, H. G. O., Capt., K, 19th Mass. White, H.S., Pt.,V, 54th Virginia. Wilder, F. W., Pt., A, 59th Georgia, age 22. Wood, M. P., Pt., G, 43d Georgia. Wren, R. L., Pt., C, 15th Ohio, age 26. Yearkes, G., Pt,, A, 3d Maryland Cav., age 30. Anthony, C.,Pt,, H, 55th Penn., age 34. Ashford, W. H., Pt., I, 18th Georgia. Baesier, J. P.,Pt.,C,75th Ohio. Ballinger,R.,Pt.,A,113th Ohio, age 29. Barrett, G., Pt., C, 13th Indiana, age 22. Beebe, C, Serg't, B, 3d Wisconsin, age 26. Bertsch, W., Corp'l, G, 58th New York. Binns, E. D., Pt., K, 53d Virginia, age l9. Black, B. P., Pt., A, 6th Kentucky. Bland, F.M.,Pt.,D,23d Iowa. Brady, B., Pt., C, 4th Infantry, age 34. Brooks, J. H., Pt., E, 1st Maryland Cav., age 39. Bulltn, H. W., Lieut., Darden's Bat'y, age 25. Callahan, M., Corp'l, K, 1st New Jersey, age 17. Camp.W. H..Pt.,B, 203d Penn., age 35. Cannivan, C. C, Pt., G, 88th Pennsylvania. Cogby, H. J., Corp'l, B, 139th Penn., age 25. Colby, H. A., Serg't, G, 2dU. S. Sharpshooters, age 23. Crocker, W., Pt., H, 42d Virginia. DeHoff, E., Pt., H, 38th Ohio, age 26. Derr, J. W., Pt., E, 7th Maryland, age 18. Doubleday,W.O.,Corp., H, 14th Vt., age 41. Drake, J. H.. Pt., 1,71st Pennsylvania, age 23. Efner, J. B., Pt., F, 4th Texas Cavalry. May 19, June 28, 1864. Sept. 20, Nov. 23, 1864. Aug. 30, ----,'62 No.27,'63 Mar. 15, 1864. Mar. 30, 1865, Mar. 19, 1866. No.25,'63. Oc.19,'64, M'y20,'G4. April 12, 1865. De.13,'62 Jan. 17, 1863. Jan. 30, Ap. 1,'63. July 2, Oc.24,'63 J'y26, No.8,! Feb.l, Sept. No.22, J'e 25. Oct. No.—, Aug. 29, —, '62. June 27, Aug. 10, 1864. July 21, Au.23,'64. Mav 28, J'y 7,'64. Aug. 29, ----, '62. July 3, Se.30,'63. Sept. 19, Oc.30,'63. May 19, July 2, 1863. May 24, J'e 25, '64. Aug. 16, Sept. 28, 1864. No.30,'64, Jan. 6,'65. June 11, Aug. 3, 1864. Jan. 15, Mar. 5, 1865. Aug. 30, Oc.31,'62. May 3, J'net),'03. June 18, Oct. 20, 1864. Oct, 2, Nov. 4, 1863. Aug. 7, Dec. 5, 1864. Mar. 31, May 15, 1865. July 1, Au.10,'63 June 1, July 10, 1862. June 14, ----,'63 Operations, Operators, Result. Left (gang.; nec); ant. post. flap. Surg. R. B. Bontecou, U. S. V. Disch'd Oct. 21,'65. Spec. 3053. Left (gang.; haem.); circ. A.A. Surg. J. Cass. Discharged July 26, 1865. Right thigh. Discharged March 11, 1863. Left (gang.); circ. A. A. Surg. M. L. Herr. Duty June 28, '64. Spec. 2202. Right (Disch'd July 6, '65); circ. Dr. N. S. Lincoln, Washington, D. C. Recovery. Spec. 4047. Righfr; circ. A. Surg. R. Bartho- low.U.S.A. Disch'd May 17,'65. Right. (Amp. leg; nec; haem.) Surg. G. Derby, U. S. V. Dis- charged August 25, 1865. Left (ball extr'd); circ.; flap. A. A. Surg. D. R. Good. Disch'd April 8, 1863. Spec. 701. Right thigh. Recovery. Right; ant, posterior flap. A. A. Surg. J. E. Steel.U.S.A. Prison April 19, 1864. ----. Surgeon — Burk, C. S. A. Recovery. Left; circ. A. A. Surg. P. Peter. Disch'd July 28, '64. Spec. 2195. Left; ant. post. flap. A. A. Surg. J. N. Snively. Spec. 3721. Right; flap. A. A. Surg. W. L. Welles. Died July 12,'64; exh'n. ----. Profuse suppuration. Surg. — Love, C. S. A. Sloughing. Died Nov. 30, 1864; gangrene. ----; thigh. Died December 12, 1862. Left (gang.); oval flap. A. A. Surg. J. C. Thorpe. Died Aug. 12, '64; gang, and irrit, fever. Left (slough'g); flap. A. Surg. H. M. Sprague, U.S.A. Slough. Died Aug. 31,1864; exhaustion. Right; circ. Surg. S. E. Fuller, U.S.V. DiedJuly7,'64; shock. ----; thigh. Died October 7, 1862. Right; haem. Died October 3, 1863. Spec. 1943. Right; circ. Died October 30, 1863; hcemorrhage. Autopsy. Left. (May 19, Syme's nmp.; slough.; June 17, amp. leg.) A. A.Snrg.W.P.Sweetland. Gang. Died July 16,1863. Spec. 1706. Right; circular. A.A. Surg.A. Ansell. Died Nov. 2, 1864. Left (slough.; haem.; lig. femoral art.); circ. A.A.Surg.J.C. Mor- ton. Died Oct. 17, '64 ; exh'n. Right. (Dec. 31, amp. leg; teta.) Died Jan. 7, 1865; trismus. Left; circ. A.A. Surg.W.C.Mul- ford. Died August 5,'64 ; haem. and asthenia. Spec. 2922. Left; circ. A. Surg. S. H. Orton, U. S. A. Died March 15, 1865; hsemorrhage. ---- (nec; aneurism); ant. post. flap. Died Nov. 14, 1862. Left. (Bone and ball removed.) Surg. J. H.Baxter.U.S.V. Died June 17, '63. S}*cs. 1229, 1230. Left (nec; gang.); nnt. pest. flap. Surg. N. R. Moseley, II. S. V. Died Nev. 1,1864. Spec. 3319. Right (slough.); Teale's method. A. Surg. C.W. P. Brock, C. S.A. Died Nov. 9, 1883; exhaustion. Left (Aug. 7, amp. leg; gang.); lat. flap. Surgeon B. B. Breed, U. S.V. Died January 16,1865. Right (March 31, rem'd patella); circ. A.A. Surg. F. Hall. Died June 23, '65; exh'n. Spec. 41E9. Left. Surg.L.\V.Oakley,2dN.J. Diarr.; dysen. Died A ug. 12, '63. Left. (Knee ulcerated.) Dr. H. Marsh, Albany, N. Y. Died July 14, 1862. Left thigh. Died July 18, 1863. Surg. Ill—41 322 INJURIES OF THE LOWER EXTREMITIES. [CHAF. X. j No | Name, Military Description, and Age. Dates. Eline, J. A., Pt, D, 76th Pennsylvania. Fennimore, H., Pt., E, 101st Indiana. Gates, A. E.,Pt.,C, 18th Connecticut. George, M., Captain, A, Louisiana Zouaves, age 25. Hall, W. IL, Pt., I, 19th Maine, age 18. Hannans, J.. Pt., K, 97th Pennsylvania, age 23. 138 Harriman, R. C, Pt., F, llth Maine, age 39. 162 Harrington, W., Pt., A, 106th N. York, age 20. Hartman, L., Pt,, B, 2d Infantry, age 24. Henderson, E., Pt., B, 16th N. C, age 32. Hines, T. I., Pt., D, 1st Maryland, age 32. Holbrook, E., Corp'l, B, 40th Mass., age 25. Holland, A., Pt., B, (ith New Jersey, age 26. lHouse, J.,Pt., K, 2d Mis- sissippi, age 16. Ingerson, A., Pt,, A,123d Ohio, age 18. Jacobson, F., Pt.,C, llth Connecticut, age 18. Johnson, D. A., Pt., E, 43d New York, age 37. Jones, T., Pt., E, 70th New York, age 26. Kennedy, P., Pt.,C, 59th Georgia, age 46. Kewley, W. C, Pt., G, 68th Ohio, age 46. Kightlinger, J., Pt., F, 145th Penn., age 23. Lane, W., Pt,, I, 1st E. Tennessee, age 20. Langfield, W. E., Pt., K, 7th New Hampshire. Langworthy, S., Pt., B, 117th New York, age 28. Lawrence, T. K., Pt., G, 24th Georgia, age 31. Lininger, S., Pt., H, 74th Indiana, age 32. Lockey,A.,P\.,F, 3d Mis- sissippi, age 29. 2Loomis, I. A., Pt., G, 16th Wisconsin, age 23. Lovell, P., Pt., C, 10th Missouri, age 41. LumUy, F. S., Pt., H, 29th Mississippi, age 26. Lyons, G. W., Pt., I, 43d Ohio. Operations, Operators, Result. May 24, Aug. 12, 1864. May 20, July 10, 1864. Aug. 16, Sept. 16, 1864. May 9, Sept, 11, 1864. July 2, Oct. 19, 1863. De.16,'64, Jan. 24, 1865. July 1, Au.27,'63. June 3 July 12, 1864. May 6, June 15, 1864. Aug. 1, Oc.29,'64. May 15, June 19, 1864. June 18, Aug. 20, 1864. No. 7,'63, July 2, 1864. July 3, Au. 7,'63. July —, Au. -, '63. May 22, J'e 24,'63. Aug. 14, Oct. 1,'64. De.31,'62 Mar.2,'63. May 14, J'y2,'64. May 14, J'y 12,'64 July 3, Au. 6,'63. Sept, 19, No.19,'63, No.30,'64 Fe.24,'65 Apr.6,'62, Jan. 25, 1866. No.25,'63, Feb.2,'64 Nov. 24 De.31,'G3 Oct. 4,'62. Feb.2,'63. Left. August 31, haem. Died August 31, 1863; exhaustion. Left thigh. Died November 2, 1863. Left thigh. Died July 26, 1864. Left; circ Surg. C. H. Lord, 102d N.Y. July 21, ligature torn off; haem.; fatal. Left (slough.); ant. post. flap. A. A. Surg.W. H. Randolph. Died Sept. 5, '64 ; pyaem. Spec. 3025. Right. (Haem.; diarr.; June 11, amputation leg.) A.A. Surg.W. Stillman. Died Sept. 20, 1864; pytemia. Left; circ. A.A.Surg.J.C.Morton. Sept. 23, haemorrhage; lig. fem- oral artery. Died Sept, 26, '64. Spec. 3711. Left, Teale's method. Surg. R. B. Bontecou, U.S.V. Died Sept. 19, '64; exhaustion. Spec. 3328. Right; ant. post. flap. A. Surg. H. E. Brown.U.S.A. Died Oct. 24, '63; exhaustion. Autopsy. Left (gang.): bi-lat, flap. Surg. B. B. Breed, U. S. V. Died April 3, 1865. Right. Died September 17,1863; hectic fever. Left (gang.); circ. Surg. R. B. Bontecou, TJ. S. V. Sloughing. Died July 30, '64; exhaustion. Left; ant. post flap. Surg. E. Bentley, U. S.V. DiedJulv21, 1864. Autopsy. Spec. 3342. Right. (Gang.; erysip.; exfol.; nec.) Stump swollen greatly. Left; ant. post, flap. Surg. J. B. Lewis, U. S. V. Died June 26, 1864; pyaemia. Right (June 18,amp. leg; gang.); circ. A. A. Surg. W. B. Casey. Died August 26, 1864. Right (Nov. 7, exc. tib.); circular. A. A. Surgeon T. B. Townsend. Gangrene. Died Aug. 6,1864. Left (haem.); flap. Surg. C. W. Jones, U. S. V. Died Aug. 18, 1863. Spec. 1695. Left thigh. Died August 23, 1863. Right; extensive burrowing of pus. A. A. Surg. J. Thompson. Died July 11,'63. Spec. 1702. Left (oedematous); circ. Surg.A. F. Sheldon, U. S. V. Died Oct. 8, 1864; exhaustion. Left: lig. torn off; haem.; re-lig. Died March 6, 1863. Right (haem.); flap. A. A. Surg. F. H. Getehell. Died July 5, 1864; exhaustion. Left; flap. A. A. Surgeon F.H. Getehell. Died July 12, 1864; exhaustion. Left thigh. Died Aug. 19, 1863. Right. (Exc. int. condyle.) Died December 7, 1863. Right (gang.; carious); oval flap. A. A. Surg. D. D. Talbot. Died April 27, 1865; pyaemia. Right (sloughing; necro.); ant. post, flap. Dr. F. H. Milligan. Died February 18, 1866. Left (exc. ttbia; Jan. 10,'64, amp. leg; gang.; hsem.); circular. A. Surgeon R. Bartholow, U. S. A. Died Feb. 3, 1864. Spec. 2108. ----; circ. A. Surg. J. H.Wilson, 73d Penn. Died Jan. 5, 1864; shock and gangrene. Left. (Necrosed bone removed.) Died Aug. 14, 1863. Spec. 968. NO. 187 Name, Military Description, and Age. Dates. Maxfield, D. E., Pt., E, Sept. 17, 97thNew York, age20. Oc.22,'62. McCreary, G. L., Pt., F, I Mav 12, 100th Penn., age 19. !J'e 12,'64. McDerbit, W., Pt., D, 173d New York, age 27. McGir, E., Pt,, F, 5th New York. McHenry, A., Pt.,B, llth Mississippi, age 26. Miller, A. J., Pt., D, 5th Kentucky. MiUsap, M., Pt., I, 31st Iowa, age 23. Morgan, J., Pt., E, llth Penn. Reserves. Munn. W., Pt., I, 27th Michigan, age 31. Nevius, T., Pt., F, 63d New York. Ogden, D., Pt., E, 2d Illinois Cav., age 21. Otto, B. G., Serg't, A, 48th Pennsylvania. Oicen, A., Serg't.G, 19th Georgia. Patten, W. F., Pt,, C, 9th Mississippi, age 24. Perry, O., Pt., F, 41st Illinois. 3Pettigrew, J. A., Capt., C, 20th Tennessee. 'Powell, W. H, Pt., I, 3d South Carolina, age 20. Prentice, S. B., Pt.,C, 1st District Columbia Cav. Rader, J., Pt„ F, 59th Dlinois, age 21. Richard, J., Corp'l, E, 9th Wisconsin. Roberts, J. F., Pt., K, 147th New York, age 33. Robinson, A.. Pt., D, 8th Wisconsin, age 30. Rodrigues, A., Corp'l, C, May 15, 101st Illinois, age 23. J'y28,'G4 Aug. 30, ----, '62. Sept. 17, Oc.21,'62. Nov. 30, 1864, Mar. 24, 1865. July 12, -----, '63 J'e 24, '63. Jan.4,'64 Sept. 17, Nov. 30, 1862. June 15, J'y21,'64. Aug. 19, Dec.7,'64. Se.23,'63 May 5, J'ne8,'64 May 8, J'ne-,'64 Operations, Operators, Result. Schultz, C, Pt., K, 5th Minnesota, age 44. Scott, L., Pt., F, 2d New York Mounted Rifles, age 17. Seiberlieh, J., Corp'l, F, 19th Wisconsin, age 23. Sharp, O. D., Pt., H, 1st North Carolina. Shelly, J. J., Pt., B, 2d Tennessee. Staggs, A., Pt., K, 10th Kentucky Cavalry. Stanley, F. E., Serg't, A, 13th Connecticut. Stanton, J., Pt., H, 2d Infantry, age 40. De.l6,'64; Jan. 27, 1865. Sept. 20, Nov. 19, 1864. May 16, June 28, 1864. Sept. 17, No.15,'62 Ja.10,'62 July 3, Au. 5,'63. April 13, ----, '63 July 3, Au. 8,'64 Left; circ. A. A. Surgeon A. V. Cherbonnier. Oct. 23, 25, haem.; lig. femoral artery. Died Oct. 27, 1862; exhaustion. Right; circ. A. A. Surg. F. G. H. Bradford. Died June 25,1864; exhaustion. Right. (Amp. right second and third fingers.) Died July 29,'63. —. Died October 3, 1862. Right. Died August 23, 1863. Right (sloughing); circ. Died November 15, 1863. Right. Died July 6, 1863; py- aemia. Right. A. Surg.W.A.Hammond, U. S. A. Died October 4,1861; exhaustion. Right (May 10, amp. leg; gang.); Teale's method. A. A. Surg. C. F. Trautman. Died Oct. 4, '64 ; exhaustion. Spec. 3330. Left, (Joint eroded.) Surgeon H. S. Hewit, U. S.V. Died Oct* 24, 1862; shock. Spec. 489. Left (slough.; ant. tib. art.; haem.); semi-circ. flap of skin ; circ. inc. thro. mus. Surg. C.Winne,77th Illinois. Died Nov. 6,'64; exh'n. ----. Died October 15,1862. Right; circ. A. Surg. C. Bacon, U. S. A. Died October 28,1862. Spec. 926. Right (Mar. 19, amp. leg^ gang.; haem.); ant. post. flap. A.Surg. J. C. Thorpe, U. S. V. Died April 20,1865; pyaemia. Right. (Prim. amp. leg; gang.) Died September 12, 1863. Right; circ. A. Surg. J. E. Link, 21st 111. Died Jan. 7, 1864; shock. Spec. 2136. Right. (Sept. 18, amputat'nleg.) A. A. Surg. A. V. Cherbonnier. Erysip. Died May 2, '63: exh'n. Autopsy. Specs. 795, 3837, 3962. Left (necrosis); flap. A. Surg. E. Curtis, U. S.A. Died August7, 1864; exhaustion. Left (Aug. 19.exe tib.; caries); circ. A. A. Surg. M. L. Herr. Gang. Died Jan. 4, '65; exh'n. Left. Died September 27,1863. Left; ant. post. flap. Surg. E. Donnelly, 2d Penn. Reserves. Died Aug. 2,1864; chr. diarr. Left; ant. post. flap. A. A. Surg. J. N. Sharpe. Died July 1,'64; exhaustion. ----; circ. A. A. Surg. R. C. C. Jones. Gangrene. Died Aug. 3, 1864; exhaustion. Autopsy. Left (nec. tib.); circ. A.A.Surg. J. G. Harvey. Died Feb. 9, '65; chronic dysentery. Right (Nov. 1, gang.); flap. Surg. E. Bentley, U. S. V. Died Nov. 30, 1864; exhaustion. Right (erysip.); circ. A. Snrg. D. R. Brower, U. S. V. Died July 13, 1864; exhaustion. Left; gangrene. Died Nov. 21, 1862. Right. Dr. G. H. Higgins. Died a few hours after the operation. Spec. 405. Left. Died Sept. 1,1863; pyaem. Autopsy. Left. (Haemorrhage.) Died May 29, 1863. Left. (Chronic diarrhoea.) Died August 11, 1863. ■JONES (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, in United States Sanitary Commission Memoirs, 1871, Surgical Volume II, p. 291. 2Milligax (F. H.), Amputation of the Thigh resulting from Injury received nearly four years prior to tlie operation, in Cincinnati Lancet and Observer, 1869, Vol. XII, p. 590. 'MOSES (L), Surgical Notes of Cases of Gunshot Injuries occurring during the advance of the Army of the Cumberland, Summer of 1863, in American Journal of the Medical Sciences, 1804, N. S., Vol. XLVII, p. 340. 4 FISHER (G. J.), Amputations after tlie Battle of Antietam, in American Journal of the Medical Sciences, 1863, N. S., Vol. XLV, p. 48. SECT. III.J SECONDARY AMPUTATIONS OF THE THIGH. 323 NO. 194 195 196 197 198 199 200 201 Name, military Description, and Age. Dates. Mar. 31, Ap.21,'65. Oct. 13, Nov. 23, 1863. Aug. 30, Oc.10,'62. Aug. 30, Oct. 9,'62. June 1, Sept. 14, 1864. Sept. 19, Oo.25,'64. Oct. 15, Nov. 27, 1864. J'y 1, '63, Sept 9, 1864. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. Teefle, S., Pt., H, 9th Iowa, age 34. Thomas, G. M., Black-smith, I, 3d Penn. Cav. Touhey, J. D.,Corp'l, B, 14th New York. Turner, J. P., Serg't, I, 16th Massachusetts. Twining, P. E., Serg't, F, 36th Wisconsin, age 26. Veasey, J. W., Pt., C, 3d Alabama. Waters, B. G., Pt., H, 19th Maine, age 19. Wenzell,A.,Pt., E, 121st Pennsylvania, age 21. Left; circ A. A. Surg. D. Shep-pard. Died May 1,'65; exh'n. Right; circ. A. Surg. A. Ingram, U.S.A. Died Jan. 28, 1864; pyaemia. Spec. 2821. Left. (Hsemorrhage.) DiedOot. 13, 1862; pysemia. Left. Died October 18, 1862; pyaemia. Left. (June 1, amp. leg.) A. A. Surg. M. Rizer. Slough'g. Died October 16, 1864. Right; oirc Surg.—Weatherby, C.S.A. Died Nov. 14,'64; exh'n. Left (Oct. 15, amp. leg); circular. Surg. E. Bentley, U. S. V. Died April 28, '65. Specs. 3445, 3446, 3447, 3448. Right (fragm'ts neo. bone rem'd); oval skin flap; circ. muscles. A. A. Surg. J. H. Jamar. Died Sept 28, 1864 ; pyaemia. 202 203 204 205 206 207 Wileman, L. G., Pt., C, 32d Mississippi. Wilson, S.,Pt.,I,6th N. Hampshire, age 24. Wingate, B., Capt., D, 5th Infantry. Wormsley, L. W., Pt., K, 8th Florida, age 35. Wright, J. E., Pt,, K, llth Wisconsin, age 23. Wyatt, I, Capt., 10th Missouri Cavalry. Oct. 8, -----, '62. May 10, June 13, 1864. Feb. 21, Ma" 19, 1862. July 2, Dec. 29, 1863. April 9, June 18, 1865. Sept. 27, No.23,'64. ---; circular. Surgeon J. G. Hatchitt, U. S. V. Died Jan. 16, 1863. Right; circ. Surgeon G. L. Pan-coast, tl. S. V. Died June 21, 1864; exhaustion. Spec. 2301. Right (nec); circ. A. Surg. B. Norris, U. S.A. Died June 1, 1862; operation and diseased stomach. Right (July 6, amp. leg; necr.); circ. A. Surg. C. W. P. Brock, P. A. C. S. Died Dec. 30,1863; exhaustion. Left; flap. A. Surg. W. H. For-wood, U. S. A. Died June 26, 1865; pyaemia. Left. Died November 25, 1864. The seat of fracture in the foregoing two hundred and seven cases was in the lower third in seventeen; in the knee joint, in seventy-three; in the leg, in ninety-one; and in the ankle joint or foot in twenty-six instances. Secondary Amputations of the Thigh, Point of Ablation not specified.—Of twelve secondary amputations in which the seat of operation was not indicated, nine were per- formed on Union and three on Confederate soldiers; all resulted fatally. Seven operations were on the right, two on the left side; in three cases this point was not recorded. In two instances total excision of the knee joint and in two other cases amputation in the leg had preceded the ablation of the thigh. One of the latter cases is here detailed:1 Case 496.—Private G. R. Hathaway, Co. A, 125th Illinois, aged 24 years, received a shot fracture of the tarsal bones of the left foot, at Kenesaw Mountain, June 27, 1864. Five days after the reception of the injury he entered the field hospital at Chattanooga, where amputation was performed, but not recorded. Surgeon B. Cloak, U. S. V., reported the termination of the case as follows: "The patient was admitted to Cumberland Hospital, Nashville, July llth, having undergone amputation of the leg below the knee previous to his admission. On August llth, a second amputation was performed above the knee, by the antero-posterior flap method, by Acting Assistant Surgeon J. C. Thorpe. The flaps at the time of the second operation had become indolent and slightly gangrenous and could not be brought to cover the protruding bones; the patient's condition being weak and anaemic and his tongue whitish. Stimulating dressings were applied to the stump of the thigh, which looked clean but failed to close by first intention, though it became covered with healthy granulations. The patient died of irritative fever September 9, 1864." Table XLI. Summary of Twelve Fatal Cases of Secondary Amputations in the Thigh for Shot Fracture of the Femur, the point of Ablation not specified. No. Name, Military Description, and Agf. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 1 2 3 4 5 Dowd, J., Farrier, M, 10th Missouri Cavalry, age 24. Edmondson, W.W., Pt., C, llth Iowa, age 20. Hathaway, G. R., Pt.,A, 125th niinois, age 24. Hawkins, W., Pt.,C, 17th Ohio. Kellum, T. H., Pt., B, 89th Indiana, age 18. April 18, 1863, Right. (April 19, '63, amp. leg, lower third; 1865, gang.) Nov., 1867, necrosis; re-amp. of thigh. Died Nov. 15, 1867. Right. Died September 3, 1864. Left (int. amp. leg; gang.); ant. post. flap. A. A. Surgeon J. C. Thorpe. Died Sept. 9, 1864; irritative fever. Right; circ. Surg. S. E. Fuller, U. S. V. Died March 21, 1864; pyaemia. Right; circ. Surg. E. Powell,72d 111. Died Aug. 3, '64; septaemia. 6 7 8 9 10 Kiefer, M., Pt., C, 31st Pennsylvania, age 33. Tarpen, J., Pt., B, 2d Missouri, age 36. Traube, A., Corp'l, E, 2d Missouri, age 34. 1 Unknown. 3 Unknown. Vaughn, W., Pt., B, 13th South Carolina. Whitbeck, O.. Pt., D, 109th N. York, age 29. June 29, Au. 1,'62. Oct. 8, No. -, '62. Oct.8,'62, Mar. 25, 1864. May —, -----, '64. May —, -----, '64. ---. Diarrhoea. Died August 18, 1862; exhaustion. Right. Died November 14,1862. Left; ant. post. flap. A. A. Snrg. P. Gilroy. Died May 5, 1864. ----. (Total excision knee joint.) Fatal. ----. (Total excision knee joint.) Fatal. Right thigh. Died June 26,1864. Right. (Typ. fev.) Dr. G. Burr, Binghamton. Died July 10,'64. July 22, -----, '64. June 27, Aug. 11, 1864. Se.20,'63, Feh. 28, 1864. May 18, J'y 18,'64. 12 May 6, J'y 9,'64. 1 The other instance is that of Farrier J. Dowd, M, 10th Missouri Cavalry, aged 24 ; wounded at Cherokee, April 18, 1863; shot fracture of right foot; April 19th, amputation of leg at lower third by Surgeon P. N. Wood, 39th Iowa; discharged January 25, 1864. In 1865, gangrene appeared on the 6tump; bromine was applied without effect; amputation of the thigh; necrosis of femur in November, 1867 ; re-amputation and death November 15,1867 'CULBERTSON (H.), Tabular Statement of Excision of Knee Joint, in Transactions of the Am.Jled. Ass'n; Prize Essay, 1876; Supplement to Vol. XXVII, p. 186. MCGUIRE (H.), Clinical Remarks on Gunshot Wounds of Joints, etc., in Richmond Medical Journal, 1866, Vol. I, p. 263. •Culbertson (H.), loc. cit. McGuire (H.), loc. cit. 324 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. AMPUTATIONS IN THE CONTINUITY OF THE FEMUR, OF UNCERTAIN DATE.—In five hundred and eighteen cases of amputations in the thigh for shot injury the intervals between the injuries and operations are unknown, one or the other or some- times both dates having been omitted in the reports. The ablations were practised in the upper third in thirty-three, in the middle third in seventy, in the lower third in one hun- dred and four, and at an unspecified portion of the thigh in three hundred and eleven cases. Although the recorded data are generally meagre, the results have been ascertained in all but thirty-two cases. One hundred and sixty-three had successful, and three hundred and twenty-three fatal terminations, a mortality rate of 66.4 per cent. Amputations in the Upper Third of the Thigh, of Uncertain Date.—There were thirty-three amputations in the upper third of the thigh, in which the length of interval between the injury and operation could not be ascertained. Twenty-eight of the patients were Confederate, and five were Union soldiers; twelve recovered and twenty-one died. Successful Cases of Amputation in the Upper Third of the Thigh, of Uncertain Date. The twelve operations of this group were all performed on Confederate- soldiers—on the right side in four, on the left in three, unspecified in five cases. The nature of the missiles and the methods of operating are not recorded. Fatal Cases of Amputation in the Upper Third of the Thigh, of Uncertain Date.— There were twenty-one operations of this class, five performed on Union and sixteen on Confederate soldiers; eight on the right and nine on the left limb; in four cases the side was not specified. No antecedent operations were recorded. Table XLII. Summary of Thirty-three Cases of Amputation in the Upper Third of the Femur, time of Ablation not specified. Name, Military Description, and Agk. Anderson, J. E., Pt., F, Holcomb's S.C.Legion. Brown, S., Pt., C, 53d South Carolina. Carroll, J., —, 2d South Carolina. Chambers, D. W., Pt., D, 37th North Carolina. Freeman,R., Pt., F, 14th North Carolina. Long, J. D., Pt., I, 1st Texas. 0'Bryant, W. H., Pt,, F, 2d S. Carolina Rifles. Piles, J. M., Pt., I, 12th Mississippi, age 23. Ward, J., Pt., D, 8th Louisiana. White, A. C, Serg't, H, 5th South Carolina. Williamson, G. A., Col., 2d Arkansas. Wimmer, J. W., Pt., K, 48th North Carolina. Anderson, G. B., Pt., F, 41st Alabama. Blankenship, E. P., Pt., E, 57th Virginia. Bowen, J., Pt., B, 7th Virginia. Buford, P. M.. Pt., G, llth Miss., age 20. Burley.H. H.,Pt.,G, 49th Pennsylvania, age 21. June 3, ----, '64, May 2, ----, '63. April 26, ----, '63. Nov. 1, ----,'64. July 6, ----, '64. Aug. 16, ----, '64, De.13,'62. Operations, Operators, Result. July —, ----,'63. July —, ----,'63. July —, ----,'63. May 12, ----, '64. ----. Furloughed May 27,1864. Left. Released July 8, 1865. Right. Provost Marshal May 31, 1865. Right. Furloughed September 12, 1864. Left. Furloughed November 30, 1864. Right. Furloughed September 2, 1863. ----. Discharged February 21, 1863. Right. Retired January 23,1865. ----. Surgeon— Momer, C. S.A. Recovery. Left. Furloughed September 7, 1864. ----. Recovery. ----. Surg. W. D. Lindsay, 48th N. C. Recovery. Left. Died September 21, 1864. ----. Died July 23, 1863. Left. Died August 15, 1863. Left. Died August 15,1863. Right. Extensive bedsore over sacrum. Died June 6, 1864. NO Name, Military Description, and Age. Cleland, D., Pt., D, 1st South Carolina Rifles. Dillings, I., Pt., A, 5th Artillery, age 34. Garreth, W. A., Pt., B, 45th Penn., age 21. Kinsley, P., Pt., C, 31st Virginia. Lofton, J., Pt., G, 8th Louisiana. Mc Whorter, J.B., Pt.,E, 2d S. Carolina Rifles. Neighbours, W., Pt,, K, 3d Georgia. Neil, W., Pt., K, 14th S. Carolina. Peterson, L., Pt., K, 36th Wisconsin, age 37. Segrist, W. D., Pt., I, 5th South Carolina, age 30. Snider,J.A., Pt., D, 12th Virginia Cavalry. Trott, J. H., Serg't, K, 57th North Carolina. Underhill, J., Pt., C, 1st N. Carolina Battery. Whitworth,R.A.,Corp'l, E, 64th Georgia, age40. Wilkinson, W.,Pt., I,22d Col'd Troops, age 38. Wooddle, P. H., Corp'l, F, 19th Virginia Cav., age 25. Dates. Deo. 3, ----,'64. Sept. 30, ----, '64. June 3, ----,'64. May 28, ----, '64 De.17,'62 Aug. 16, ----,'64 June 15, ----,'64 Operations, Operators, Result. Right. Died May 25, 1864. Left. Died January 9, 1865. Left. Died October 22,1864. Right. Died June 7, 1864. ---. Sloughing; haemorrhage. Died July 17,'63; haemorrhage. Right. Died October 7, 1864. Left. Died September 22, 1864. Left. Died June 16, 1864. Right. Died June 11, 1864. Left. Died July 16, 1864; py- aemia. Right, Died June 30, 1864; py- semia. Left. Died December 17,1862. ---. Died March 24, 1865. Right. Died September 7, 1864; exhaustion. Right; ant. posterior flap. Died July 15, 1864. ----. Necr.; ext nurulent infil.; circ. Surg.W.S. Love,P.A.C.S. Died Nov. 8, 1864 ; exhaustion. Amputations in the Middle Third of the Thigh, of Uncertain Date —In this group are recorded seventy cases, of which thirty-four were successful, twenty-nine proved fatal, sect, m.] AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 325 while the result in seven cases could not be ascertained. Fifty-three of the patients were Confederate, and seventeen Union soldiers. The amputations were on the right side in twenty-eight, on the left in thirty-one, not reported in eleven instances. The seat of frac- ture in these cases was in the middle third of the femur in one, in the lower third in six- teen; in the femur, precise seat not recorded in forty-two; in the knee joint in seven, and in the leg in four instances. Table XLIII. Condensed Summary of Seventy Cases of Amputation in the Middle Third of the Femur, of Uncertain Date. [ Recoveries, 1-34; Deaths, 35-63; Results unknown, 64-70.] Name, Military Description, and Age. Baldwin, J., Pt., A, 26th North Carolina. Boykin, P., Pt., C, 19th Louisiana, age 18. Clark, J., Pt., D, 1st Louisiana N. G. Comer, T, Capt,, H, 5th South Carolina. Cribb, J., Pt., C, 49th Georgia, age 32. Croft, J., Pt., L, 50th Georgia. Dell, P., Pt., C, 20th Louisiana. Edmonson, J. C, Pt., K, 13th Georgia. Evans, W. S., Lieut., B, 4th Georgia. Farr, J. R., Pt., 1 18th Tennessee. Fechner, C, Pt., —, 3d Alabama, age 28. Ferguson, J. G., Pt., A, 12th Tennessee, age 24. Foster, P., Pt., I, 57th Virginia, age 21. Gales.F. V., Musician.E, 30th Tenn., age 31. Hearn, B. L., Pt., H, 6th Georgia. Helms, C. A., Pt., B, 43d North Carolina, age 33. Hunt, S. J., Pt., D, 18th Virginia. Ingraham,L.,Pt., D, 42d Mississippi. Johnston, W. S., Pt., I, 20th North Carolina. Kennedy, T. J., Pt., E, 16th Ark. Cav., age 25. Mayne, J. J., Pt.,A, llth Georgia. Passons, W., Pt., F, 5th Kentucky Cav., age 44. 1 Powell, J. K.P.,—,C, 31st Georgia. Praft, J. H, Pt., F, 7th Tennessee, age 41. Satterwhite.D. S., Pt.,G, 7th Georgia. Seott, G. W., Serg't, H, 7th South Carolina. Sharp, W. T., Serg't, G, 22d Georgia. Stegen, J. W., Serg't, D, 56th Virginia. Stout, T. N., Pt., C, 6th Louisiana. Swicegood, J. H., Pt., A, 54th N. C, age 26. Underwood, J., Corp'l, K, 18th Georgia. Watson, J. B., Pt.,Cobb's Georgia Cavalry. Wilkinson, S. R., Pt., I, 14th Alabama. Williamson,A., Seaman, St'r Savannah, age 55. Bagby, A. V, Pt., E, 23d North Carolina. Barker, E., Pt., A, 26th North Carolina, age 21. July 2, ----,'63 Aug. 31, ----, '64 May 27, ----, '63, Aug. 16, —,'64. May 3, ---,'63 Jan. 2, ----, '63 May 12, -----, '64, July 9, -----,'64, Sept. 19, ----,'63. May 2, ----,'63 July 20, ----,'64, July 12, ----,'64 Nov. 30, ----,'64 Sept. 30, ----, '64 July 18, ----,'64, Operations, Operators, Result. July 2, ----, '63. May 3, ----, '63. Sept. 27, ----,'64. June 26, ----, '62. 1865. Oct. 7, ----, "64. July —, ----, '63. Feb. 6, ----, '65. June 27, ----,'62. July 2, ----,'63. June 7, ----,'64. May 3, ----, '63. July —, -----, '63. 1864. July —, -, '63. Left; gangrenous. Paroled Nov. 12, 1863. Right. Retired Dec. 22, 1864. Left thigh. Duty July 31, 1863. Left. Furloughed September 23, 1864. Right. Retired October 31,1864. ----. Furloughed July 3,1863. Left; flap. Discharged July 17, 1865. Right. Furloughed November 8, 1864. Right. Furloughed October 9, 1864. Left. Surg. H. W. Brown, P. A. C. S. Recovery Dec. 20,1864. Right. Retired J anuary 19,1865. Left. Retired January 23,1865. ----. Retired February 6,1865. Left; ant. posterior flap. Provost Marshal March 7, 1865. Right. Furloughed December 6, 1864. Right. Retired January 20,1865. Right. Paroled May%l, 1865. Right. Exchanged Mar. 3,1864. ----. Furloughed October 13, 186a Right. Retired March 18,1865. Left. Exchanged March 3,1864. Right; circ. Prison April 28, 1865. ----; circ. Furloughed August 26, 1862. Right; flap. Released June 28, 1865. Left; flap. Discharged July 17, 1865. Right. Exchanged October 13, 1863. Right. Retired March 11,1865. ----. Recovered. ----. Furloughed September 9, 1863. Left. Retired March 3, 1865. ----. Furloughed September 17, 1863. Left. Exchanged November 12, 1863. Right. Furloughed September 16, 1863. Left. Recovered. Right. Died October 3,1864. Left. Died August 12, 1863. Name, Military Description, and Age Beiden, R., Pt., H, 116th Pennsylvania, age 24. Boswell, J., Pt., B, 63d Georgia, age 31. Butler, W. C, Serg't, F, 2d Florida, age 26. Chinn, F. E., Pt., H, 7th North Carolina. Cobb, J., Pt., G, 9th Vir ginia, age 22. Cobb, L. G., Pt., H, 45th North Carolina. Conway, J., Pt., F, llth Infantry, age 23. Davis, J. D., Corp'l, D, 8tb Virginia. Gohegan, T. 0., Pt., D, 19th Mississippi. Goodman,E.,Pt.,D, 27th Pennsylvania. Hall, J. H, Pt., E, 43d Tennessee. Heath, G. E., Pt., 1,12th Massachusetts. Jones, J. C., Pt., F, 122d New York, age 26. Mallory, I. r.,Pt.,E,45th North Carolina, age 24. Metz, J., Pt,, A, 68th Pennsylvania. Milroy,J. T.,Pt., E,45th North Carolina. Robinson, J., Pt., B,45th North Carolina. Sheperd, W. B., Pt., E, 45th Georgia, age 30. Simons, L., Pt., F, 7th N.Y. H'vy Art., age 27. Spiess, IL, Pt., I, 67th Ohio, age 23. Suggett, T., Pt,, G,24fh Michigan. Sutton, O.D.,Pt.,T>, 45th Georgia. Thomas, fi. L., Pt., F, 45th Penn., age 18. Walrom,J. P.,Lieut.,D, 28th Virginia. White, T. H., Pt,, I, 6th Wisconsin, age 19. Williams,C.,Contrab'nd, Government employe. Wingfield, W. L.,Pt., D, 58th Virginia, age 19. Bennett, W„ Pt., B, 13th South Carolina, age 19. Carmonay, D., Pt., K, 5th Michigan. Coleman, J. L., Pt., B, 9th Virginia Cavalry. Daniels, W., Pt., K, 6th Alabama. Edwards, W. H, Pt., G, 41st Virginia. Fullerton,VV.,Pt.,G,60th Ohio, age 44. Phelix, —, Colored serv- ant, age 25. June 5, ----,'64. June 19, ----, '64. July —, ----, '63. Operations, Operators, Result. 1864. Aug. 28, -----,'64. July —, -----, '63, July —, ----, '63, April —, ----, '65, July—, ----, '63. May 6, ----, '64. July —, ----,'63. July —, ----S '63. July —, ----,'63. July —, ----,'63. Aug. 9,- June 3, ----, '64 May 10, ----, '64. July 1, ----, '63. June 16, ----, '64 July —, ----, '63 Aug. 18, ----, '64 Feb. 22, 1865. Au. 13, — May3,'63, Se. 30,'64, Left. Died June 23, 1864. Right; ciro. Gang.; diarrhoea. Died July 21,1864; exhaustion. Left. Died August 15, 1863. Left. Died September 12,1864. ----; flap; diarr.; slough'g; haem. Died Sept. 22, '64; pyaB. Autop. Right. Died August 16, 1863. Left. Re-amputation upper third. August 11, 1863, bone cut off. Died Aug. 18,1863; exhaustion. Right. Died May 5, 1865. Right. Died August 18, 1863. Right. June 18, haem.; lig. of fem. art. Died August 9, 1863. Left thigh. Died July 2, 1864. Left. Died Sept. 12,1863; diar- rhoea. Left thigh. Died May 30, 1864. Right. Died August 12, 1863. Left. Died August 18,1863. Right. Died August 12, 1863. Left. Died August 14, 1863. Left. Died August 19,----; py- aemia. Left. Diarrhoea. Died July 9, 1864; exhaustion. Left. June 5, erysipelas. Died August 13, 1864 ; exhaustion. ----. Died August 3, 1863. Left thigh. Died May 30,1864. Left thigh. Died July 29,1864. Right thigh. Died July 30,1863. Right, Died September^, 1864; wound. ----; circ. A.Surg. J. E. McGirr, U.S.V. Died Feb. 22, 1865; prostration. Right. Died of pyaemia and pneumonia within ten days. ----; circular. Left thigh ; circular. Not a pen- sioner. Right thigh. Left thigh. Left thigh. ----. Not a pensioner. Left thigh. 1 Smith (E. H.), Report of Cases of Compound Comminuted Fracture of Femur, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 24. 326 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Amputations in the Lower Third of the Thigh, of Uncertain Date.—This group com- prises one hundred and four cases, with thirty-seven recoveries, sixty-one deaths, and six cases in which the final result could not be ascertained. The operations were performed on thirty-two Union and seventy-two Confederate soldiers; thirty-seven amputations being on the right and forty-six on the left side, while in twenty-one this point was not recorded. The seat of the injury was in the lower third of the femur in fifty-two, in the knee joint in twenty seven, in the leg in twenty-four, and in the foot in one instance. In one of the fatal cases the patient had undergone amputation of the arm, and, in a second, hasmorrhage from the femoral artery was followed by ligation of that vessel. Table XLIV. Condensed Summary of One Hundred and Four Cases of Amputations in the Lower Third of the Thigh, of Uncertain Date. [Recoveries, 1-37; Deaths, 38-98; Result unknown, 99-104.] Name, Military Description, and Age. Adams,R.T., Pt., H,21st Virginia, age 19. Allen, W. S., Captain, E, 2d Mississippi. Bovien, B., Pt., G, 1st South Carolina. Burns, G., Pt., D, 50th Virginia. Chamberlain, W.A., Pt., A, 61s.t Georgia. Clarke, S-, Pt., E, 23d North Carolina. Coffee, L., Pt., E, 22d Alabama, age 19. Craft, J. H, Pt., F, 7th Tennessee, age 20. Fields. L., Pt., Latham's Batterv. Foster, ~S., Pt., A, 33d Alabama. Fountain, A. G. C, Pt., E, 6th S. C, age 29. Foust, E. B., Pt., B, 13th Mississippi, age 21. Gonton, A., Pt., F, 25th North Carolina. Hoye,H. H, Serg't, Fall- ing Battery, age 23. King, W. A., Corp'l, L, 1st South Carolina. King, W. H, Pt., F, 2d Mississippi, age 23. KUckley, J. F., Pt., A, 10th Georgia. Laney, S. L., Pt., B, 26th North Carolina. Maddox, M., Corp'l, F, 7th S. Carolina, age 19. Mahoney, D. A., Corp'l, A, 60th Alabama. Maud, J. P., Pt., F, 10th Virginia Cavalry. McVey.W. J.,Pt.,F,3Hh Virginia, age 24. Nowland, J., Serg't, B, 1st Ga., Cobb's Legion. Painter, S. B., Pt., H, 65th X. C, age 19. Parks, J. D., Pt., A, 2d Mississippi. Phillips, E., Serg't, C, 6th Miss., acre 23. Prong, A., Pt., H, 2d Louisiana. Reed, A., Pt., B, 5th S. Carolina. R.i/an,E., Pt..B, 5th Con- federate, age 35. Stone, S. .V., Pt., I, 55th North Carolina. Stroud, E. D., Pt., H, 8th Alabama. Talley, W. O., Pt.,G,23d Virginia, age 22. Thurman, M. P., Pt., K, 6th South Carolina. Dates. June 2, ---,'64. Sept. 17, ---,'62. Sept, 30, ---,'64. July —, ---,'63. June 27, ---,'64. May 3, ---,'63. 1864 M'y31,'62 J'e 2,'64 1865. Nov. 29, 1863. Sept, 30. —,-64: Aug. 16, ---,'64, Sept. 17, ---,'62. Aug. —, ---,'64. July 1, ---,*63. May 22, ---,'64. Mar. 23, 1862. Seiit, 17, ----,'62. April 2, ----,'65. July 21, ----,'61. Nov. 30, ----,'64. May 27, ---,'63. June 25, ---,'64. July —, ---,'63. July 2, ---,'63. May 5, ---,'64. June 12, ---,'64. Operations, Operators, Result. Left. Retired February 10,1865. Left. Surg. A. Y. P. Garnett, P. A. C. S. Recovered. Right. Furloughed December 9, 1864. Right; bi-lateral flaps. Paroled August 24, 1863. Left; flap. Discharged July 17, 1865. Right. Furloughed June 16, '63. Left; flap. Prison July 4, 1865. ----. Retired December 29, '64. Right. Furloughed October 5, 1864. ----; circular. Transferred. Right. Provost Marshal May 31, 1865. Left. Retired March 15,1865. ----. Retired January 19, 1865. Left. Prison April 14, 1865. Right. Furloughed September 2, 1864. Right, Dr. Eads. Transferred March 3, 1863. Right. Furloughed October 21, 1864. Right. Furloughed October 6, 1864. Right. Exchanged March 17, '64. Right. Discharged October9,'65. Left. Surg. — Douglas, C. S. A. Recovered. Right. Retired March 27, 1865. Left thigh. Recovered. Left. Discharged from hospital July 2, 1865. ----. Discharged October 4, '61. Left; ant. posterior flap. Provost Marshal March 7, 1865. Left. Duty August 17, 1863. Left. Furloughed December 16, 1864. Left. Retired December 31, '64. Right. Exchanged November 12, 1863. Right. Furloughed October 1,'63. Left. Retired January 20, 1865. Right. Furloughed October 21, Name, Military Description, and Age. Tunstall, P. A., Serg't, B, 34th Virginia. Whitaker, J., Capt., E, 47th Alabama. Wither spoon, J. C, Lt., D, 1st S. Carolina. Young, J. E., Pt., H, 7th Maine, age 17. Ames, E. T., Pt., I, 1st N.Y. Dragoons, age 26. Ashwood, T. W., Pt., C, 12th Virginia Cavalry. Becker, C, Pt., C, 2d Tennessee, age 25. Blackwood, J., Pt,, H, 49th North Carolina. Boorman, E., Pt., C, 6th New Jersev. Bostwick, D., Pt., C, 2d Michigan. Bradley, T. C, Pt., K, 22d North Carolina. Burgay, H. C, Pt., F, 44th Georgia. Byles^ M., Pt,, F, 55th Norm Carolina. Collins, J. C, Pt., C, 2d N. York M. R., age 29. Connelly, J. A., Pt., G, 100th Pennsylvania. Duffy, S. K., Pt., D,48th New York. Evins, N., Pt., H.Cobb's Georgia Legion. Faircloth, J.,Pt.,A, 59th Georgia. Fowler, W. S., Pt.,B,10th N. Carolina Artillery. Freeland, J. A., Pt., G, 5th New Jersey. Glisson, J., Pt., A, llth Florida. Hamilton, W., Pt., 124th New York, age 44. Harmon, J. E., Pt., G, 79th Pennsylvania. Ingalls,A. S., Major,40th New York. Johnson, D.R.,Pt.,T, 82d New York. Knapp, E., Pt., A, 4th Vermont, age 34. Knox, J. F., Pt., B, 13th North Carolina. Kurach, C, Pt., D, 10th Ohio. Lovell, D.O., Pt., H,25th Massachusetts, age 25. Lovell, W. H., Pt., B, 72d New York. Maloy, P., Pt., D, 5th Cavalry. Martin, C, Pt., I, 38th Illinois. Martin, G. C, Pt., G, 2d Maine. 1864. July 2, ---,'63. Sept. 30, ---,'64. May 14, ---,'64. Mav 7, -----",'64. May 5, ---,'62. Nov. 24, ---,'63. 1864. May 31, ---,'64. Nov. 21, ---,'63. July 18, ---,'63. 1864. Sept. 30, ---,'64. May 5, ---,'62. May 3, ---,*63. Oct. 8, ---,'62. 1862. July —, ---,'63. May 5, ---,'64. May 5, ---,'62. Oct. 8, ---,'62. May 16, ---,'64. Julv 2, ---?63. June 27, ---,'62. 1862. April —, ---,'62. Operations, Operators, Result. Left. Furloughed December 16, 1864. Left; circular. Prison October 22, 1864. Left. Furloughed November 9, 1864. Left. Furloughed June 29,1864. Not a pensioner. Left thigh. Died June 25, 1864. ---. Haemorrhage. Died Oct. 1,1863; pyaemia. Left; circular. Died May 19, 1865. Left, Died September 14,1864. ---. Died May 14, 1862. Right, Died December 10,1863. Right. Died September 1, 1864. Left. Died October 31, 1862. Left. Died September 13, 1864. Left thigh. Died June 6, 1864. Right. Surg. G.B.Cogswell,29th Mass. Died Dec. 6, 1863. Right thigh. Died July 31,1863. ----. Died November 19, 1864. Right. Died January 26, 1865. Left thigh. Died March 29,1865. Left thigh. Died May 20,1862. Right. Died September 16,1864. Right thigh. Died June 16,1863. ----. Died November 2, 1862. Right; double flap. Died Aug. 11,1862. ----. Died July 31, 1863. Right; circ. Died May 28,1864; exhaustion. ----. Died May 16,1862; haem- orrhage. Left. Died November 4, 1862. Right thigh. Died June 17, '64. ----. Died July 26,1863. ----. Died July 9,1862. Left. Died October 8,1862; py- aemia. Left thigh. Died June 10,1862. SECT. III.] AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 327 Name, Military Description, and Age. Operations, Operators, Result. Name, Military Description, and Age. DATE8. Operations, Operators, Result. Maxey, D. M., Serg't, C, 3d Maine. May, G., Pt., T, 55th N. Carolina. May, J., Pt., K, 9th Ala- bama, age 20. McDonald, J. M., Pt,, G, •21st Georgia. McElreen, E.,Pt.,B, 20th Georgia, age 18. McGovern, J.,Pt.,H, 9th Massachusetts. McKenzie, J. R., Pt,, E, 1st Minnesota. McKerroll,J.M., Ensign, C, 1st S. C. Cavalry. Miller,M.S..Pt.,E, 116th Ohio. Mingle, E., Serg't, A, 148th Pennsvlvania. Myers, A. R., *Pt., I, 48th Virginia. Myers, G. R., Pt., E, 6th Virginia Cavalrv. Nettles, W., Pt., (J. llth South Carolina. Peele, J. J., Pt., C, 3d N. C. Artillerv, age 19. Pegram, SA Pt., E, 22d North Carolina. Pellett, S. S., Pt,, D, 4th Louisiana, age 24. Peterson, S., Pt.. I, 56th North Carolina. Pilnev, G. H., Pt,, C, 2d N. Y. H. A., age 25. Poole, J., Pt., G, 13th Mississippi. Julv 2, ----*,'63. J'y30,'62. May 28, ----,'64. J'y30,'62 July 3, ----,'63. June 5, ----,'64. July 3, ----,'63. Mav 6, ---^,'64. 1864. June 3, ----,'64. July 21, ----,'61. Right. Died August 14, 1863. Right. Died September 10,1864. ----. Surg. — Thorn, C S. A. Died Sept. 3, 1862. ----. Haemorrhage. Died July 26, 1863. Left. Died August 14, 1864. ----. Died August 5, 1862; ex- haustion. Left thigh. Died August 7,1863. Right. Died August 22, 1864. Right. Died September 11,1864. Right. Died August 1, 1863. Right. Died May 17, '64 ; morti- fication of stump. Left; slough; haem.; lig. fem. art.; ham. recur'd. Died Oct. 10,'64. Left. Died September 14,1864. Left. Died February 12, 1865; pysemia. Left. Died September 20,1864. ----; circular. Died August 20, 1864. Right. Died January 2, 1865. Left thigh. Died June 12,1864. ----. Died August 28,1861. Powers, E. G., Pt., K, 40th N. C, age 27. Pridmore, F., Serg't, K, 41st Alabama. Reed, F., Pt., A, 53d niinois. Rogers, J. H.,Pt.,A. 21st South Carolina. Seloy,A., Corp'l, K, 15th Louisiana. Smith, W. H. H., Pt., G, 55th Penn., age 22. Smoot, D. J., Lieut., G, 4th North Carolina. Snyder, J., Pt., L, 2d Mich. Cavalry, age 33. Spain.H. P., Pt., D, 21st South Carolina. Templin, W. C, Corp'l, C, 73d Ohio. Thompson,G. T., Pt., F, 56th North Carolina. Walker, H., Pt., F, 27th Massachusetts, age 35. Webb, J., Pt., C, 5th Ar- kansas. Barrett, J. L., Pt., H, 21st Virginia. Fewell,J. W.,Pt., A, 4th Virginia Cavalry. Prather, J., Pt., H, 41st Alabama. Racer, W., Pt., Fry's Battery, Orange Art. Thomas, C, Pt., G, 5th Col'd Troops, age 22. Tibbs, J. A., Pt., F, 50th Alabama. July 12, ----,'63. Sept. 29, ----,'64. 1864. Dec. 25, ----,'63. July —, ----,'63. July 14, ----,'64. Oct. 8, ----,'62. Sept. 29, ----,'64. Left; flap. Died February 12, 1865; pyaemia. Right thigh. Died April 6,1865. Left. (Amputation arm.) Died August 12, 1863. Left. Died September 9,1864. ----. Died June 20, 1863. Right. Died October 23,1864. ----. Died May 20, 1864. Right. Died April 12,1864; con- gestion of the brain. Left thigh. Died June 9,1864. Left thigh. Died August 9,1863. Left thigh. Died April 12, 1865. Right, Died August 3, 1864; exhaustion. Left. Died November 2, 1862. Right thigh. Right thigh. Left thigh. Left thigh. Left thigh. Left thigh. Amputations in the Continuity of the Femur, of Uncertain Date, and without Indica- tion of the Seat of Operation.—In three hundred and eleven cases of amputations of the thigh the interval between the injury and the operation and also the precise seat of the operation were not recorded. The operations were performed on three hundred and nine patients, in two instances both thighs having been amputated; seventy-nine, among them one with an amputation of both thighs, recovered, and two hundred and eleven perished, while the fate of nineteen could not be ascertained, giving a death-rate of 72.7 per cent. for the determined cases. Eighty-nine were Union, and two hundred and twenty were Confederate soldiers. The three hundred and eleven operations were on the right side in eighty-nine instances, on the left in one hundred, and not stated in one hundred and twenty- two. Such meagre details as are entered on the records of this Office will be found in the following table: Table XLV. Condensed Summary of Three Hundred and Eleven Cases of Amputations of the Thigh, of Uncertain Date and Seat. [Recoveries, 1-80; Deaths, 81-292; Result unknown, 293-311.] No. Name, Military Description, and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. l 2 3 4 5 6 7 Barclay, R. G., Lieut., G, 5th Louisiana. Bass, J., Pt., F, 2d South Carolina. Bost, H. M., Pt., F, 1st North Carolina, age 18. Bowie, H. L., Capt., H, 6th Alabama. Boyle, J. R., Lieut., C, 12th South Carolina. Bristow, J. C, Pt., E, 5th Texas. Brown, E. Z., Pt., D, 1st South Carolina. May 3, ---,'63. July —, ---,'63. June 1, ---,'64. May 12, ---,'64. July 1, ---,'63. Right. Furloughed October 26, 1863. ---. Transferred Oct. 1,1863. Right, Retired January 24,1865. Left. On leave July 4, 1864. Right. Furloughed March 12, 1864. ---. Discharged Oct. 16,1862. Right. Furloughed November 17, 1864. 8 9 10 11 12 13 14 Brownfield, T. N., Pt., G, 9th Georgia. Bullard, J. N, Pt,, G, 12th Georgia. Carlisle, V., l't., F, 40fh Alabama. Carter, J. P., Pt., K, 2d Va. Cavalry, age 21. Christian, J. O., Serg't, D, 8th Georgia. Daniels, J.A., Pt., K,9th Georgia. Dunkin, G. W., Pt., D, 33d North Carolina. Oct. 7, ---,'64. Mav 3, ---",'63. Left. Furloughed December 24, 1864. Left. Furloughed June 24,1863. Left thigh. Recovery. Right. Retired February 16,1865. Right. FurloughedDecember27, 1864. Right. Retired December 16, '64. ---. Surg.—Hickerson, C.S.A. Recovery. Sept. 30. ----,'64. Oct. 7, ----,'64. June 30, ---,'62. Sept. 30, ---,'64. 328 INJURIES OF THE LOWER EXTREMITIES. rCHAP. X. NO. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 36 39 40 41 42 43 44 45 46 47 48 491 50J 51 52 53 54 55 56 57 58 59 60 61 62 I Name, Military Description, and Age Dunn, S. M., Lieut., A, Cabell's Art'v Batt'n. Earglc, W. «.,Corp'l, H, 13th South Carolina. Edens, W. M., in., B, 9th Louisiana. Ennis, H, Pt., F, 26th North Carolina, age 38. Evans, C, Pt., I, 47th North Carolina. Fadeley, I. P., Pt., K, 33d Virginia. Fears. E. B., Serg't, E, 3d Georgia. Foster, J. A., Serg't, F, 52d North Carolina. Fowler, E. W., Lieut., C, 18th North Carolina. Frangan, A., Corp'l, C, 2d Missouri. Gammon. G. D., Pt., D, 44th Virginia. Gleadon, G. W., Pt., G, 19th Georgia. Haymons.A., Pt., F, 12th Georgia. Hays, R. W., Pt., G, 17th Georgia. Hederick, H. J., Pt,, E, 25th Virginia. Henderson, D. J., Pt., A, 35th North Carolina. Holmes, M.C., Lieut., H, 4th Texas. Huffman, W., Pt., I, 1st Ky. Cavalry, age 19. Hughes, J., Pt., F,54th North Carolina. Ivie, L. C., Pt., F, 60th Georgia. James, J. W., Lieut., A, 21st Georgia. Jones, O. T., Pt., H, 2d S. C. Rifles, age 21. Lawrence, J. H., Serg't, B, 4th Virginia. Lawrence, K,Pt.,B,19th Louisiana, age 25. Lutz, C. Serg't, Marine Corps, U. S. N., age 29. Mathers, J., Pt., F, 32d North Carolina. McD.'nirl. J. J., Serg't, F, 35th Georgia. Miller, S., Pt., A, 1st Mo. S. M. Cavalry. Mims, R., Pt., H, 6th Georgia. Mook, L. A., Pt,, G, 2d North Carolina Bat'ry. Morgan, E. C, Serg't, E, 2d S. Carolina Rifles. Moss, W., Pt., H, 4th Alabama. Mullen, W., Pt., D, 45th Alabama. Nunnery, J. M., Pt., A, 41st Louisiana. Parker, J. A., Pt., L, Cobb's Ga. Leg. Cav. Patterson, P. B., Pt., Adam's Co. Hampton's S. Carolina Legion. Patterson, W., Pt,, G. 27th North Carolina. Perkins, C, Pt., B, 1st Louisiana. Pierce, T.M.,Pt., B.Brad- ford's Battery, age 22. Reid, A. J., Pt., I, 37th North Carolina. Rhoades, C.A , Serg't, B, 10th Georgia. Roberts. C. M., Lieut., B, 1st N. C Cavalr}-. Robertson G.T.N.,Corp., H, 13th X. Carolina. Robertson, J. A., Serg't, B, 12thGeorgia, age21. Robinson.E. S. Z>.,Pt.,B, 1st South Carolina. Rutledge, R. S., Corp'l, C, 1st South Carolina. Segrist, D. F., Pt., B, 4th Alabama. Dates. June 4, ---,'64. July 3, ---,'63. ---,'65. May 5, ---,'64. Oct. 14, ---,'63. July 21, ---,'61. ---,'64. ---,'64. Oct. 8, ---,'62. May 2, ---,'63. Sept. 17, ---,'62. Sept.--- May 20, ---,'64. Aug. 30, ---,'62. Aug. 15, —,'63. May 4, ---,'63. May 2, ---,'63. Nov. 14, ---,'63. Sept. 30, ---,'64. Nov. 27, ---,'63. De. 9,'64 ---,'63. July 3, ---,'63. July 21, ----,'61. Oct. 8, ----,'62. June 24, ---,'64. ---,'61. Sept. 17, ---,'62. May 3, ---,'63. Aug. 15, ---.'64. Julv 3, ---*'63. Feb. 6, ---,'65. Sept. 30, ----,'64. Operations, Operators, Result. Right On leave August 12,1864. Left. Paroled September 12,1863. Left. Discharged September 26, 1865. Right. Retired February 23,'65. Left thigh. Furloughed. ----. Recovery. Left. Furloughed January 17, 1865. Right. Released June 14,1865. Left. Transferred September 30, 1864. Left. Transferred March 10, '63. ----. Furloughed July 2, 1863. ----. Discharged from hospital March 4, 1863. Right. Discharged from hospital May 28, 1863. ---. Discharged October 13,'62. Right. Discharged August 29, 1862. Left. Furloughed July 26,1864. Right. On leave September 26, 1863. Left. Discharged December 1, 1864. Right, Furloughed June 11, '63. Right. Furloughed June 25, '63. ---. On leave February 11,'64. Right. Retired February 3,1865. Left. Furloughed April 1, 1864. Right. Retired October 19,1864. Right. Surg.-------, C. S. A. Discharged Nov. 17. 1865. Right. Transferred April 9, '65. Left. Furloughed February 9, 1863. ---. Discharged May 13,1862. Right. Transferred August 3, 1863. ---. Transferred July 12,1863. Left. Furloughed March 17, '65. ---. Discharged September 9, 1861. Left. Transferred February 11, 1863. Right. Paroled June 21, 1865. Both. Furloughed Aug. 2,1864. ----. Discharged August 29,'61. ----. Discharged from hospital April 27, 1863. ---. Discharged October 20, '62. Left; circular. Released July 13, 1865. ----. Discharged October 7, '62. Right. Furloughed June 23, '63. Right. Furloughed September 9, 1864. ----. Paroled September 5,1863. Left. Retired March 17,1865. ----. Discharged October 24, 1862. Right. Furloughed November 17, 1864. Right. Discharged June 26,186-. Name, Military Description, and Age. Shippey, J., Pt., C, 5th South Carolina. Singleton, R. L., Serg't, C, 17th Tenn., age 22. Smith, J., Pt., I, 1st Mis- souri L. A., age 22. Smith, J. C., Pt., G, llth South Carolina. Spainhond, P., Pt., D, 53d North Carolina. Spears, A. D., Pt., H, 15th South Carolina. Stevens, J. G., Lieut., E, 4th Georgia. Stone, J. L., Pt., B, 37th Virginia. Stovall, J. E., Pt., B, 21st Georgia. Weeks, W., Pt., C, 34th North Carolina. Welch, J., Pt., D, 3d Ar- Whitly, D.,Pt., H, 27th North Carolina. Whitman, R. F, Pt., A, 44th Alabama. Willis.H. C, Pt., B, 45th North Carolina. Winslow, E. G., Pt,, G, 29th Mississippi. Woodbridge, W. B., Lt. Col., 4th Va. Cavalry. Toungblood, W.S.,Covp., A, 45th Georgia. Zoble, J., Pt,, E, 3d S. Carolina. Abernathy, S. M., Pt., B, 28th North Carolina. Adicks, H., Pt,, I, 27th South Carolina. Allen, C. A., Pt., E, 1st Michigan Cavalry. Allen, R., jr., Lieut., F, 1st Cavalry. Amos, D. J., Serg't, 1, 5th Georgia. Angel, —, Pt., —, 5th Texas. Ashby, W., Pt., F, 8th North Carolina. Atridge, R., Corp'l, A, 6th Wisconsin. Ballentine, J. L., Serg't, A, 6th South Carolina. Barbor, A., Pt., D, 3d Michigan. Barlow, M., —, D, 109th New York, age 41. Baughan, R. E., Pt., D, 21st Virginia. Beaman, C. C, Pt., G, 3d Arkansas. Btllfiower, H, Pt., H, 14th Georgia. Blair, S. F., Pt., B, 38th Virginia. Bonnell, W. W., Pt., I, 26th New Jersey. Bowen, A. P., Lieut., F, 4th Virginia. Brayman, G., Pt., E, 52d Massachusetts, age 18. Bresner, J., Pt., H, 9th New York. Brewer, J. 6'.,Pt., D, 13th Mississippi. Bristor, P., Pt., C, 16th Tennessee. Brown, J., Pt., L, 1st Texas. Bryant, J.S.,Pt., 1,100th Ohio. Bryant, T. D., Capt., A, 27th North Carolina. Burrows, P. A., Pt., I, 57th Massachusetts. Burwenick, A., Pt., A, 1st Kansas. Butler, L. F., Pt., H, 2d Ohio Cav., age 18. Butler, W.B., Pt., I, 50th Georgia. Campbell, G. J., Corp'l, D, 10th Maine. Chadman, J. H., Colored Teamster. Dec. 31, ---,'62. June 18, ---,'61. Oct. 27, ---,'64. July —, ---,'63. July 28. ---,'64. Oct. 12, ---,'63. May 3, ---,'63. May 3, ---,'63. Sept. 19, ---,'63. Oct. 14, ----,'63. Nov. —, ----,'63. ----,'64. July 14, ----,'63. June 28, ----,'62. Dec. 5, ----,'63. ----,'62. Sept. 17, ---,'62. Operations, Operators, Result. Aug. 30, ---,'62. ---.'64. July —, ---,'63. ---,'62. July —, ---,'63. May 3, ---,'63. ---,'63. June 14, ---,'63. Sept, 17, ---,'62. Oct. 8, ---,'62. July —, ---,'63. May 8, ---,'64. May 6, ---,'64. Aug. 10, ---,'61. July 2, ---,'64. July —, ---,'63. Aug. 9, ---,'62. July 3, ---,'63. ---. Discharged October 12, '62. Left. Retired March 18,1865. Right. Discharged November 30, 1861. Right. Furloughed January 21, ---. Exchanged October 22, 1863. Left. Furloughed September 6, 1864. Left. Furloughed November 11, 1863. ----. Furloughed June 11,1863. ---. Discharged October 1, '62. Right. Furloughed July 6,1863. Right. Retired December 31,'64. Right. Transferred September 30, 1864. Left. Discharged November 5, 1862. Left. Furloughed November 12, 1863. Right. Furloughed June 25, '63. Right. On leave August 15, '64. Left. Furloughed February 21, 1863. Left. Furloughed March 14, '65. Right. Died May 27, 1864; py- aemia. Left. Died August 26, 1864. ---. Died October —, 1863; wound. Right. Died July 28, 1862. ----. Died January 1, 1864. ----. Died September 5,1862. ---. Died October 12, 1864. Right. Died November 28, 1862. Right. Died March 28, 1865. ----. Died September 22,1862; diarrhoea. Left, Died May 29, 1864. Left. Died June 4, 1865. ---. Died July 10, 1863. Right. Died December 24, 1862. ---. Died July 15, 1863. Left. Died June 7, 1863. Left. Died December 9, 1863. ---. Died July 15, 1863. Right. Died November 1,1862. Left. Died June 15, 1864; py- semia. ----. Died October 28,1862. —-. Died July 10, 1863. Right, Died June 1, 1864. Right. Died October 30. 1863. Left. Died June 1, 1664; ex- haustion. ----. Died August 24, 1861. Right. Died August 7,1864. Left. Died August 7, 1863. ----. Died September 20,1862. Left. Died August 13, 1863. SECT. HI.) AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 329 Name, Military Description, and Age, 116 158 Chappel, H. J., Lieut., I, 21st South Carolina. Chappie, J. A., Capt., E, 3d Virginia Cavalry. Cheevers, K., Pt., F, 34th Georgia. Church, W., Pt., K, 5th Vermont, age 23. Clark, J. R., Serg't, K, 115th New York. Comer, W. E., Pt., C, 34th North Carolina. Cone, T. J., Lieut., G, 18th Georgia. Conklin,J.W.,Lieut.,K, 152d New York. Connor, J. B., Pt., F, 3d South Carolina. Cook, G. M., Pt., B, 28th New York. Cooper, J., Pt., C, 73d Illinois. Copage, W. F, Pt., A, 8th N. Carolina, age 17. Crews, B., Pt., E, 2d N. Carolina Battery. Crowley, T., Pt., A, 1st Minnesota. Cunningham, P., Pt., E, 5th North Carolina. Dampert, —, Pt., H, 4th Alabama. Darnsoe, C. S., Serg't, D, 14th South Carolina. Dew, J., Pt., B, 44th N. Carolina. Donohoe, F, Pt., B, 15th Louisiana. Dowdy, J., Pt., B, llth Virginia. Duffield, W., Pt., D, 86th Illinois. Dunbar, A.B., Pt., 1,33d Massachusetts. Everett, D., Pt., E, 7th Ohio. Falley, J. S., Corp'l, K, llth Georgia. Fant, L. T, Pt., A, llth Mississippi. Farris, R. E., Corp'l, G, . 10th Maine. Fieldsend, H., Vt., I, Sth Connecticut. Fleming, J., Pt., K, 7th Louisiana. Frank, A., Pt., I, 5th Louisiana. Freeman, B., Pt., —, 5th Texas. Freeman, G., Pt.,H, 26th Michigan, age 22. Funderbunk, F., Pt., E, 8th Georgia. Gamage, T. B., Pt., E, 9th Georgia. Geron.A. D.,Pt.,C,84th New York, age 22. Gilbert, S. P., Pt., D, 28th North Carolina. Gillespie, P., Pt., K, 2d Michigan. Glave, F., Pt., A, 1st Minnesota. Goldsticker, J. A., Pt., A, 4th Texas. Goodin, H., Pt., I, 39th Rlinois, age 47. Goodman, E., Serg't, D, 27th North Carohna. Goodson, J. H., Pt., B, 18th North Carolina. Gow, E. J., Pt., F, 1st South Carolina Cav. Goynes, D., Pt., B, 14th Louisiana. Grady, J. W., Pt., E, 30th North Carolina. Greer, J. N., Pt., C, 9th Georgia. Haines, F., Pt., A, 8th Virginia. Hall, H., Pt., H, 18th North Carolina. Hamlet, B. O., Pt., A, 2d U. S. S. S. Operations, Operators, Result. May 6, ----,'64. ----,'62. Aug. 9, ----,'62. Oct, 8. ----,'62 June 3, ----,'64. July —, ----,'63. July 3, ----,'63. July 6, ----,'63. July - -,'63. ----,'64. June 27, ----,'64. May 15, ----,'64. Sept. 17, ----,'62. ----,'62. Aug. 9, ---,'62. Aug. 9, ---,'62. ---,'64. July 21, ---,'61. Dec. 5, ---,'63. July 21, ----,'61. July 11, ----,'63. July —, ----,'63. July —, ----,'63. ----,'64. July —, ----,'63. Oct. 21, ----,'61. July —, ----,'63. July —, ----,'63. ----. Died July 8, 1864. Left. Died September 24, 1864.. Right. Died March 27,1865. Right. Died August 19, 1862; chronic diarrhoea. Right. Died August 15, 1864. Left, Died April 8, 1865. Left. Died July 7, 1862. Left. Supposed to be dead. ----. Died December 29, 1862. ----. Died August 29, 1862. Right. Died October 30, 1862. Right. Died June 15, 1864. ----. Died July 16, 1863. Right. Died July 27, 1863. Left. Died July 17, 1863. ----. Died September 4, 1862. Right. Died July 23, 1863. Left. Died October 23,1863. ----. Died September 20, 1862. Left. Died May 22, 1864. Right. Died August 8,1864. Left. (Also fracture right femur.) Died June 25, 1864. ----. Died October 9, 1862. Right. Died September 31,1862. Left. Sloughing; pyaemia. Died December 26, 1862. ----Died September 5, 1862. ----. Died August 19, 1862. Left. Died October 12, 1863; pyaemia. ----. Died May 31, 1862. ----. Died September 7, 1862. Left. Died June 17, 1864. ----. Died August 28,1861. ----. Died January 1, 1864. ----. Died August 13, 1861. ----. Died September 13, 1862. Left. Died July —, 1863. ----. Died August 3, 1863. Left. Died July 15, 1863. Left. Died August 10, 1864. Right. Died January 29, 1864 ; anaemia. ----. Died July 14, 1863. ----. Died September 30, 1862. ----. Died January 5, 1863. ----. Died October 25, 1863. ----. Died August 9, 1864. ----. Died November 5, 1861. ----. Died July 22, 1863. Left. Died July 20, 1863. 168 Name, Military Description, and Age. 200 Hamlin, J., Pt., D, 1st Penn. Rifles, age 28. Hancock, T., Pt., I, 5th North Carolina. Hannah, E. B., Pt., G, 45th Georgia. Hardsaw, D.,Pt.,B, 17th Iowa. Harner, W. T., Serg't, E, 98th Ohio, age 39. Hartneady, P., Pt., B, 69th New York, age 26. Hatley, D., Pt., K, 21st North Carolina. Hawes, J. E., Lieut., G, 2d Virginia Battery. Hedrick, 17., Pt., C, 1st N. Carolina Jun. Res. Henderson, J. M., Pt., F, 2d South Carolina. Hera, E. A. W., Pt., D, 7th Tennessee. Hernandez, I.,Pt.,C,39th New York. Hill, L. N., Pt., G, 14th Georgia. Hinds, L. A., Pt., H, 1st South Carolina. Hoffman, A., Pt., C, 30th New York. Holder. G. A., Pt., H, 6th Alabama. Holmes, B., Pt., F, 57th North Carolina. Holt, —, Pt., Page's Bat- tery. Holt, R. S., Pt,, A, Mor- ris's Artillery. Howard, T, Pt., —, 28th North Carolina. Howse, A. J., Pt., C, Cobb's Legion. Irwin, J. C.,Pt.,E, 37th Mississippi. Jackson, F, Pt., G, 27th North Carolina. Jenkins, S., Serg't, B, 6th Louisiana. Johns, —, Corp'l, E, 2d Infantry. Johnson, W., Pt., F, 1st Tennessee. Johnston,A., Pt., D,80th Ohio. Keith, A. B., Corp'l, I, 7th Massachusetts. Kelly, A/., Pt., H, 43d North Carolina. Kendrick, T. L., Pt 10th Maine. King, D. R., Capt 48th Alabama. Lair, A., Serg't, C, 1st Penn. Cavalry. Letellier, J. C., Pt., E, 19th Virginia. Loyd, B. F., Pt., G, 22d Georgia. Mahon, S. B., Pt., D, 7th Penn. Reserves. Mathews, J., Pt., I, 48th Georgia. McBride, B., Pt., B, 42d Mississippi. McClendon,R. L., Pt.,G, 61st Alabama. McCrae, F., Serg't, K, 8th South Carolina. McCullough, IF., Pt., K, 6th S. C. Cavalry. McDaniel, J. W., Pt., B, 2d Mississippi. McDonald, J. T., Pt,, B, llth Georgia. McElhany, J., Pt., C, 42d Pennsylvania. McGuire, M., Pt., G, 4th Infantry. McMillen, A., Pt., A, 12th Infantry. McNaughton.J. B., 108th New York. Merrill,,T. J.,Pt.,F, 19th Georgia. Miles, J. E., Pt., H, 18th Georgia. A, B, Operations, Operators, Result. July —, ----,'63. July —, ----,'63. May 14, ----,'63. Oct. 8, ----,'62. ----,'64. July —, ----,'63. May 6, ----,'64. ----,'64. Sept. 17, ----,'62. July —, ----,'63. July —, ----,'63. ----,'63. July —, ----,'63. Oct. 8, ----,'62. ----,'65. Aug. 10, ----,'61. Oct. 2, ----,'62. Oct. 3, ----,'62. May 3, ----,'63. Aug. 9, ----,'62. Aug. 9, ----,'62. ----,'65. Aug. 31. ----,'62. -,'65. -,'64. -,'61. J'ne6,'62. Sept, 17, ----,'62. Aug. 9, ----,'62. Dec. 13, ----,'62. Right. Died June 28, 1864. ----. Died July 12, 1863. ----. Died July 27, 1863. Left. Died August 15, 1863. ----. Died November 9, 1862. ----. Died June 11, 1864. ----. Died July 24, 1863. Left. Died December 24, 1862. Left. Died March 25, 1865; ery- sipelas and tetanus. Right. Died June 1, 1863. ----. Died September 16,1862. Left. Died June 13,1864. ----. Died January 9, 1863. Right. Died October 15, 1864; pneumonia. Right. Died November 17,1862. Left. Died May 27, 1864; py- aemia. ----. Died July 17, 1863. Left, Died August 4, 1863. Right. Died October 1, 1863. ----. Died July 19, 1863. ----. Died June 16,1863. ----. Died October 21, 1802; pysemia. Right, PysBmia. Died March 21, 1865. Right. Died April 11, 1865. ----. Died August 20,1861. ----. Died Ootober 26, 1862. Right. Died December 13,1862. Left. Died June 2, 1863. Right. Died May 22, 1864. ----. Died August 16,1862. ----. Died November 26,1862. ----. Died September 23,1862. Left. Died April 19, 1865. ----. Died September —, 1862. ----. Died October 20, 1862. ----. Died September 4, 1862. Right. Died June 3, 1864. Right. Died April 11, 1865. ----. Died December 5, 1864. Left. Died November 3, 1864. ----. Died September 9, 1861. Left. Died May 22,1864. ----. Died. Left. Died September 29,1862. ----. Died September 7, 1862. Left. Died December 26,1862. ----. Died September 25,1862. ----. Died September 18,1862. Surg. Ill—42 330 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO 207 208 209 210 211 212 213 214 215 216 217 218 219) 220f 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 Name, Military ^ Description, and Age. Miller, O. O., Pt., B, 145th Penn., age 23. Millirons, A. B., Pt., Jordon's Battery. Minri.-ck, S., Corp'l, B, 10th Wisconsin. Mitchel.A. S.,Pt.,H,7th Ohio Cavalry, age 21. Moss, T., Pt., C, 10th Georgia. Moulton, A., Pt., G, 3d New Hamp., age 24. Mullen, J. H., Pt., G, 37th North Carolina. Myers, G. If., Pt., A, 2d Virginia. Nail, >P.^.,Pt,,F,68th North Carolina. Nelms, W. M.,Pt, D, 5th Texas. Nelson, W., Pt., A, Low- th er's Battalion. Nicholls, W., Pt,, 1,27th Alabama, age 22. Nuntnger, G., Pt., A, 58th Virginia. O'Neil, H., Pt., C, 1st Kansas. Otto, F.,Pt., H, 1st Iowa, age 31. Padgett, T., Pt., I, 1st Artillery. Park, L. H., Rt., G, 21st Connecticut, age 34. Parker, S. M., Pt., A,32d Mississippi. Parrish, J.A.,Pt.,B, 12th Infantry. Parvin, L., Pt., B, 7th Tennessee. Penno, A. B., Pt., B, 1st Rhode Island. Perry, C, Pt., F, 15th Massachusetts, age. 18. Peterson, J. H., Pt., H, 33d Alabama. Pierce, W. F., Pt., G, 27th Mississippi. Piper, L. R., Corp'l, F, 8th Penn. Reserves. Poioell, C., Pt., E, 9th Virginia. Pritchet, J., Pt., G, 50th Indiana. Pritchctt, T. R., Pt., K, 55th Virginia. Quinn, W., Pt., —, 2d Vermont Battery. Radford, G., Corp'l, B, 26th New Jersey. Rawls, J. T., Pt., C, 3d South Carolina Cav. Reaser, U., Pt., B, 151st Pennsylvania. Reed, F., Pt., A, 53dIlli- nois. Reese, J., Pt., E, 8th Georgia. Rhinebast, J., —, 62d N. York, age 32. Roberts, A.J., Pt., 1,48th Alabama. Robins, W. F., Pt., M, 22d North Carolina. Rogers, R., Corp'l, K, 2d N. Y. Artillery, age 21. SanD, J., Pt., A, 7th N. York Heavy Artillery. Saunders, W., Pt., F, 47th Alabama. Sax, —, Capt., K, 37th Mississippi. Sensabaughn, W., Pt., E, 5th Texas. Sheldon, H., Pt., C, 8th Michigan. Simpson, R. H., Major, 17th Virginia. Sink, J, Pt., F, 15th N. Carolina. Smoke, J, Pt., K, llth South Carolina. Spencer, S. G., Pt., D, 76th New York. ---,'64. ---,'63. Oct. 8, ---,'62. April 28, ---,'64. Aug. 13, ---,'64. July —, ---,'63. July 21, ---,'61. Oct. 22, ---,'64. Dec. 7, ---,'64. ---,'62. Aug. 10, ---,'61. Aug. 10, ---,'61. July —, ---,'63. May 16, ---,'64. Oct. 8, ---,'62. Aug. 9, ---,'62. July 21, ---,'61. Sept. 17, ---,'62. Oct, 8, ---,'62. Dec. 13, ---,'62. July —, ---,'63. Sept. 14, ---,'62. June 14, ---,'63. May 3, ---,'63. July 1, ---,'63. July 12, ---,'63. July 21, ---,'61. May 31, ---,'62. ---,'63. May 19, ---,'64. ---,'64. Oct. 8, July —,' ---,'63. May 12, ---,*64. ---,'64. July —, ---,*63. Operations, Operators, Result. Left, Died May 23, 1864. Left. Died August 4, 1863. ---. Died October 14,1862. ---. Died October 14, 1864; chronic diarrhoea. Right. Died June 20, 1863. Left. Died September 26, 1864. —. Died July 13, 1863. ----. Attempted to tie fem'l art.; had to amp. Died Aug. 13, '61. ----. Died January 12, 1863. ----. Died September 7, 1862. ----. Jaundiced. Died Nov. 12, 1864. Left, Died December 19,1864; gangrene. Both. Died August 17,1862. ----. Died August 21, 1861. ----. Died August 25, 1861. ----. Died July 26, 1863. Left. Died June 11, 1864. Left. Died November 3, 1862. ----. Died August 23, 1862. Left. Gangrene. Died Septem- ber 24, 1864. ----. Died September —, 1861. ----. Died eight days after am- putation. Right. Died October 26, 1862. Right. Died February 16, 1863. Right. Died January 1, 1863. ----. Died July 21, 1863. Left, Died November 26, 1862. ----. Also wound of lungs. Died December 9, 1863. Left. Died August 20, 1863. Left. Died May 31, 1863. ----. Died June 9, 1864. ——. Died July 23, 1863. ----thigh and left arm amputat'd. Died August 12, 1863. ----. Died August 18, 1861. ----. Died August 14,1863; py- semia. ----. Died September 11, 1862. ----. Died July 23, 1863. Left. Died June 13,1864. Left. Died June 19,1864. ----. Sloughing. Died October 1, 1864; diarrhoea. ----. Died October 16, 1862; gangrene. Left. Died July 21, 1863. Right. Died May 20, 1864. ----. Died June 15, 1864. Left. Died October 23,1863. Right. Died June 5, 1864. ----. Died. NO. Name, military Description, and Age. Stackhouse, S. W., Pt., G, 104th Penn. Stanley, G., Pt., H, 63d Pennsylvania. Stephens, G. W., Pt., F, 3d Vermont, age 40. Sturtevant, E., Serg't.E, llth New Jersey. Sullivan, D. C, Pt., E, llth Mississippi. Sullivan, W. H., Pt., A, 49th Virginia. Tabor, J., Pt., C, 4th Vir- ginia. Taylor, W. L., Pt., E, 27th North Carolina. Terrell, C, Pt., E, 15th Virginia. Thornton, J. W., Corp'l, B, 40th Alabama. Tolin, E. S., Pt., I, 8th Alabama. Tyler. E., Pt,, E, 4th Rhode Island. Tyrrell, J., Pt., 1,8th N. York H. Art'y, age 46. Van Aman, J., Pt., A, 57th New York, age 20. Vanpell, J. S., Pt., H, 1st North Carolina. Vaughn, G. W., Pt., H, 40th North Carolina. Wade,H., Pt,, C, Cobb's Georgia Legion. Wadkins, C. Serg't, H, 45th North Carolina. Wakefield, L., Pt,, C, 3d Iowa. Walker, J. M., Pt., F, 48th North Carolina. Wallron, W., Corp'l, E, 52d Pennsylvania. Walls, J., Scout. Ward, J. D., Serg't, A, 4th Mississippi. Ward, W. F., Corp'l, D, 57th Massachusetts. Wardlaw, J. S., Serg't, G, 9th Georgia. Weiand, J., Pt., F, 148th Penn., age 30. Welch, J., Pt,, K, 98th Ohio. Whitcher, J. S., Pt., I, 116th New York. White, H. T., Pt., 1,25th North Carolina. Wilkcrson, J., Pt., E, 1st Georgia Cavalry. Williamson, W.W., Pt, H, 57th Alabama. Willis, W. W., Pt,, I, 21st Virginia. Wilson, C, Corp'l, B, 7th Ohio. Wilson, T., Pt., D, 18th Mississippi. Wingo, M. S., Pt,, F, 18th Georgia. Wood, P. S., Lieut., C, 4th Texas. Wood, W. B., Serg't, I, 16th Tennessee. ■Woods, J., Pt., C, 14th Louisiana. Batman, J. W., Pt,, G, 2d South Carolina. Bonnell, G. B., Pt., C, 2d Florida. Campbell, W. G., Pt., D, 45th Alabama. Carnolf, J., Pt,, B, 1st New Jersey Cavalry. Champion, J. A., Pt.," G, 66th Georgia. Collins, B. R., Pt., F, 13th Georgia. Cousins, W. T., Capt., C, 17th Georgia. Earheart, R., Lieut., C, 54th Virginia. Freret, J., Pt., —, Wash- ington Artillery. Dates. June 1, ---,'62. May 5, ---,'64. July —, --V63. ----,'64. ----,'64. Operations, Operators, Result. Sept. 17, ---,'62. Oct. 27, ---,'64. June 1, ---,'62. ---,'64. Mar. 31, 1865. July —, ---,'63. July 12, ---,'63. May 31, ---,'62. July —, ---,'63. May 6, ---,'64. Dec. 5, ---,'63. May 12, —,'64. Oct. 8, ---,'62. May 27, ---,'63. ---,'64. ---,'64. Aug. 9, ---,'62. Aug. 9, —,'62. Oct. 21, ---,'61. ---,'63. Oct, 8, ---,'62. Oct. 7, ---,'64. July —. ---,'63. Oct. 8, ---,'62. June 2, ---,'62. -,'64. July —, ----,'63. ----. Died June 18, 1862. Right. Died. Right. Died June 11, 1864. Left. Died July 13, 1863. ----. Haemorrhage. Died June 26, 1864. Right. Died June 12, 1864. ----. Gangrene. Died July 23, 1863. ----. Died November 21, 1863. ----. Died May 25, 1864; nerv- ous shock. Left. Died March 29,1865. Right, Died February 12,1864; pyaemia. Right, Died October 13, 1862; haemorrhage. Left. Died November 21, 1864. ----. Died June 9,1862. Right, Died August 27, 1864. Right. Died under operation, March 31, 1865. Right. Died June 25, 1863. ----. Died July 23, 1863. Left, Died July 25, 1863. Left. Died November 1, 1863; tetanus. ----. Died July 29, 1862. Right. Died February 4,1865. Left. Gangrene. Died August 19, 1863. Right. (W'nd of left lung.) Died June 5. 1864; pysemia. ----. Died January 7, 1864. Left. Died June 17, 1864. Left. Died November 1, 1862. Left. Died June 5, 1863. Right. Died August 29, 1864. Left. Died August 23, 1864. Left. Died June 17, 1864. ----. Died September 23, 1862. ----. Died August 17,1862. ----. Died October 28, 1861. ----. Died June 1,1863. ----. Died July 22, 1862; py- emia. Left. Died November 14,1862; typhoid fever. ---. Traumatic delirium; sui- cide. Left thigh. Left thigh. Left thigh. ---thigh. Right thigh. Right thigh. Left thigh. Left thigh. Left thigh. ' HITCHCOCK (A.). Army Medical InUlligence, in Boston Medical and Surgical Journal, 1862, Vol. LXVI, p. 361. SECT. III.] AMPUTATIONS IN THE THIGH. 331 No. Name, Military Description, and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, and Ace. Dates. Operations, Operators, Result. 302 3*03 304 305 306 Gcrdin, W. J., Pt., H, 5th Georgia. Hagler, J. G., Pt., D, 20th Alabama. Hendrick, W. D., Pt., D, 55th North Carolina. Humant, J. A., Capt., C, 12th South Carolina. Jones, H. E., A. A. G., Gracie's Brigade. Right thigh. Right thigh. Left thigh. Left thigh. Right thigh. 307 308 309 310 311 Mass, M., Pt., C, 49th North Carolina. Norlow, J. R., Pt., D, 41st Georgia. Odam, J. J., Vt, F, 1st South Carolina. Tucker, D., Pt., F, 9th Arkansas. Williams, J., Vt, C, 1st Texas. Oct. 8, ---,'62. Sept. 30, ---,'64. Right thigh. Right thigh. Left thigh. Left thigh. Right thigh. ----,'64. The seat of fracture was recorded to have been in the lower third of the femur in two; in the femur, precise location not specified, in three hundred and four; in the knee joint in one; and in the leg in four instances. The two patients with amputations of both thighs were Confederate soldiers; one recovered and was furloughed, and has not been heard from since; the other died shortly after the operation. Recapitulation.—Six thousand two hundred and twenty-nine cases of amputation in the shaft of the femur have been enumerated in Tables XXX to XLV, inclusive, and the results ascertained in all but eighty cases. Two thousand eight hundred and thirty-nine had successful and three thousand three hundred and ten fatal terminations, a mortality rate of 53.8 per cent. Had it been practicable to determine the issues in the eighty cases with unknown results the fatality rate would only be slightly modified. Assuming that all these eighty cases had proved fatal the mortality would be 54.4 per cent., an increase of only 0.6 per cent.; or, supposing all the eighty cases terminated successfully the decrease in the rate of mortality would be 0.7 per cent., leaving a fatality of 53.1 per cent., a deviation of only a little over one half of one per cent, from "the percentage of fatality obtained in the determined cases. In five thousand seven hundred and eleven of the six thousand two hundred and twenty-nine amputations in the femur the precise length of time between the injury and the operation was recorded. Three thousand nine hundred and forty-nine, or over two- thirds, were primary operations; one thousand three hundred and twenty intermediary, and four hundred and forty-two, only, secondary operations. In the three thousand nine hundred and forty-nine primary operations the results were not ascertained in forty-eight instances; one thousand nine hundred and fifty-eight were successful, and one thousand nine hundred and forty-three fatal, a mortality rate of 49.8 per cent. One thousand three hundred and twenty intermediary operations were followed by four hundred and seventy- nine recoveries and eight hundred and forty-one deaths, a fatality of 63.7 per cent. Four hundred and forty-two secondary operations comprise two hundred and thirty-nine recov- eries and two hundred and three deaths, a mortality of 45.9 per cent. Of the remaining five hundred and eighteen cases in which the time between the injury and operation could not be ascertained, thirty-two were recorded as without result, one hundred and sixty- three as recoveries, and three hundred and twenty-three as fatal, a death rate of 66.4 per cent. The foregoing results differ somewhat from those obtained in the series of amputa- tions of the arm (Second Surgical Volume, p. 805). In the latter, the primary operations gave a mortality of 18.4 per cent.; the intermediary, of 33.4; and the secondary, of 27.7 per cent.,—the fatality of the secondary operations exceeding that of the primary,—while in the femur the mortality of the primary amputations exceeds that of the secondary. 332 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Considering the series of amputations in the continuity of the thigh according to the seat of the original injury (Table XLVI) it will be seen that the femur had been fractured in twenty-nine hundred,1 or in 46.6 per cent, of the total number of amputations; the Table XLVI. Tabular Statement indicating the Seats of Injury in Six Thousand Two Hundred and Twenty-nine Cases of Amputation of the Thigh after Shot Fractures. POINT AND PERIOD OF OPERATION. &SH JO a « S2 H2 Primary......... Intermediary..... Secondary....... Period Unknown. Primary......... Intermediary..... Secondary....... Period Unknown. Primary......... Intermediary..... Secondary....... Period Unknown. Primary......... Intermediary..... Secondary....... Period Unknown. Aggregates. o 533 147 55 33 1,157 471 168 70 1,914 676 207 104 345 20 12 311 6,229 SEAT OF INJURY. Uppkb Thisd. Middli Third. Loweb Third O ^3 1.1 5S 160 198 2 607 497 20 466 801 56 o>a Vr3 21 19 2,900 Knee Joint. 248 96 42 2 581 121 33 105 138 26 5 552 292 40 19 2 3 4 1 1,173 1,226 2,399 Ankle Joint or foot. knee joint in twenty-three hundred and ninety-nine, or 38.5 per cent.; the bones of the leg in eight hundred and sixty-four, or 13.8 per cent.; and the ankle joint or foot in sixty-six, or 1.1 per cent. Of the twenty-nine hundred amputations for shot fractures of the femur twelve hundred and fifty-seven were successful, fifteen hundred and sixty-three fatal, and eighty results could not be ascertained, a mortality of 55.4 per cent.; of these the amputa- tions following fractures of the upper third had a fatality of 73.6 per cent.; those following fractures of the middle third a mortality of 55.3 per cent.; and those following fractures of the lower third a death rate of 45.0 per cent. The ratio of mortality of the twenty-three hundred and ninety-nine amputations following shot injuries of the knee was 51.1 per cent., eleven hundred and seventy-three patients having recovered, and twelve hundred and twenty-six having died. The mortality of the eight hundred and sixty-four amputations of the thigh for shot injuries of the leg was 56.1 per cent., four hundred and eighty-five of the eight hundred and sixty-four operations having proved fatal. Finally, the sixty-six 1 While the total number of amputations following shot fractures of the femur as cited in this table, viz: 2,900, agrees with the total number of amputations as indicated in Table XX, page 175, ante, the figures in several of the subdivisions have been slightly modified, as, in the progress of the work, the results as well as the seats of fracture in several cases classified in Table XX as " undetermined" or " unspecified" were ascertained. Thus. the number of amputations for fractures of the upper third remains the same, 93 cases with 24 recoveries, 67 deaths, and 2 undetermined results. The amputations for fractures in the middle third are 360, as in Table XX, but the number of recoveries is increased by 2, while the undetermined cases number 2 less. Similarly the total number of amputations for fractures in the lower third is increased by 2, and those for fractures with unspecified seat decreased by 2, the seats of fracture in these cases having been determined since the publication of Table XX. Finally, the results have since been ascertained in 5 cases recorded in Table XX as undetermined with unspecified seat of injury, thus giving, in this group, 466 recoveries and 56 undeter- mined results instead of 461 recoveries and 63 unknown results. sect, in.] AMPUTATIONS IN THE THIGH. 333 operations for shot injuries of the ankle joint or foot were followed by thirty-six deaths, a fatality of 54.6 per cent. Thus it would seem that of the amputations in the thigh per- formed for shot fractures, those for fractures of the lower third of the femur offered the best chance for life. The point of section or ablation in the thigh was in the upper third in seven hundred and sixty-eight, in the middle third in one thousand eight hundred and sixty-six, in the lower third in two thousand nine hundred and one, Fi~d in the femur, point not specified, in six hundred and ninety-four instances. The mortality rate of the first group was 53.8 per cent., of the second, 44.5, of the third, 53.6, and of the last, 80.7 per cent., the death rate being the largest in amputations in the upper third, next in the amputations of the lower third, and lowest in those of the middle third, a result differing from that obtained in the different thirds of the arm, where the operations in the upper third were less fatal than those in" the lower third (Second Surgical Volume, pp. 805, 806), the percentage of fatality after amputation in the upper third being 18.4, in the middle third 16.4, and in the lower third 26.0 per cent. Of the six thousand two hundred and twenty-nine amputations in the continuity of the femur the side was not indicated in seven hundred and nine cases. The right side was involved in two thousand six hundred and ninety-eight, the left in two thousand eight hun- dred and twenty-two. Of the former, one thousand two hundred and ninety-six recovered, one thousand three hundred and seventy-three died, and in twenty-nine cases the results were unknown, a death rate of 51.4; of the latter, one thousand three hundred and seventy- seven recovered, one thousand four hundred and sixteen died, and in twenty-nine cases the results were undetermined, a mortality of 50.7 per cent. This would point to the fact already noticed in the discussion on the amputations of the shoulder joint and arm (Second Surgical Volume, pp. 655, 806), that the left extremity, although most frequently inter- ested, had a less proportionate fatality than the right; but the difference in the mortality rates of the two sides is too insignificant to allow conclusions to be drawn, especially as the number of undetermined cases is sufficiently large to materially modify the result. As already stated on page 214, ante, the six thousand two hundred and twenty-nine operations were performed on six thousand two hundred and nine patients, twenty having submitted to amputations of both thighs.1 Four thousand seven hundred and seventy-one were Union, and one thousand four hundred and thirty-eight were Confederate soldiers. Of the Union soldiers, two thousand and ninety-six recovered and two thousand six hundred and fifty-seven died, while the results in eighteen cases were undetermined, a mortality of 55.9 per cent. Of the Confederates, seven hundred and forty survived, six hundred and thirty- six died, and the fate of sixty-two remained undecided, a fatality of 46.2 per cent. ■Of the twenty cases of amputations of both thighs, three were successful, viz: Corporal M. Dunn, H, 46th Pennsylvania (CASE 448, p. 242, and Nos. 239, 240, TABLE XXXH, p. 248); Private C. G. Rush, C, 21st Georgia (CASE 449, p. 243, and Nos. 737, 738, TABLE XXXII, p. 254); Private J. A. Parker, L, Cobb's Legion Cavalry (Nos. 49, 50, Table XLV, p. 328). The seventeen fatal cases are: l't. S. Baguley, B, 5th New Hampshire (No. 703, Table XXXI, p. 235, and No. 105, Table XXXIX, p. 105); Serg't T. Doud, C, 2d Michigan (Case 442, p. 226, and Nos. 806, 807, Table XXXI, p. 236); Corp'l J. W. Woodworth, H, llth Infantry (CASE 443, p. 226, and Nos. 1143, 1144, TABLE XXXI, p. 240); Pt. S. Allen, G, 59th Massachusetts, Nos. 984, 985, Table XXXH, p. 257); Pt. R. S. Michael, A, 105th Pennsylvania (Nos. 1551, 1552, Table XXXII, p. 263); Pt. D. Nicholson, H, 22d Massachusetts (Nos. 1599, 1600, Table XXXH, p. 264); Serg't E. C. Rabbit, B, 10th Missouri (Nos. 1652,1653, Table XXXII, p. 264); Pt. J. Stewart, D, 77th New York (Nos. 1769, 1770, Table XXXII, p. 265); Lieut. J. Whelpley, D, 1st Maine (Nos. 1862,1863, Table XXXII, p.267); Pt. S. Goodwell, G, 29th Illinois (Nos. 128, 129, TABLE XXXIII, p. 269); Pt. H. Kenner, 4th Virginia (Nos. 169, 170, TABLE XXXIII, p. 270); Pt. C. Meyer, 30th Missouri (Nos. 212, 213, Table XXXIII, p. 270); Pt. W. F. Mills, E, 8th New York H. A. (No. 205, Table XXXIII, p. 270, and No. 495, Table XXXVI, p. 300); Pt. H. Tieman, C, 119th New York (Nos. 285, 286, Table XXXIII, p. 271); Pt. J. Moore, E, 46th Pennsylvania (Nos. 497, 498, Table XXXVI, p. 300); Pt. D. "Wallace, I, 5th Artillery (Nos. 642, 643, Table XXXVI, p. 302); Pt. G. Nunenger, A, 58th Virginia (Nos. 219, 220, Table XLV, p. 330). Of the 20 cases, 2 were primary operations in the middle thirds; 8, primary operations in the lower thirds; 4, primary operations, the seat not recorded; 2, intermediary operations of both thighs in the lower thirds; 2, amputations of both thighs, time and operation not stated; 1, primary amputation of the right and intermediary of the left thigh, and 1, primary amputation of right and secondary operation in left thigh. 334 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. The following tabular statement will enable the reader to compare the results of the amputations in the thigh of the American civil war with those of other wars: Table XLVII. Results of Amputations of the Thigh on the Occasions named and from the Authorities quoted. ACTION, ETC. Amputations. Primary Oper-ations. Intermediary Operations. Sec Ope o ondauy Operations rations, i Unknown D OF VI IC. 00 3 o 9 o « .a a s o is K a P •e > o .1 si! 3 O J8 P .2 y o o o A a . c 3 C 8 5 P Deaths. Result-Unknown. 6 ■c % o 5 Q p 1 1 I 4 1 3 198 4 23 15 35 37 8 5 18 20 218 13 7 2,748 16 806 6 33 166 19 12 798 3,794 7 1 2 2 112 2 9 13 17 12 1 1 8 7 90 7 227 14 195 3 3 87 13 6 243 342 2 1 i Battle of Mollwitz, 1741 (SCHMUCKER2)........ 1 1 o 1 1 77 2 14 2 18 23 7 4 10 12 128 6 7 2,033 2 611 3 29 72 6 6 514 3,452 5 1 Battle of Fontenoy, 1745 (Faure,4 Boucher,5 i i i o Germany, 1756-1763 (Mehee,8 Mursinna9)___ Napoleonic Wars, 1791-1815 (LARREY,'0 HEN-NEN," Guthrie,'* Eudes," CarrS,14 Mi- 1 53 5 2 9 9 49 21 4 54 3 • War of 1812-14 (MANN18) 2 1 1 2 7 Revolution in Paris, 1830 (Arnal,'9 Meniere,70 D. J. Larrey,21 H. Laheey,22 Roux23)...... 4 12 4 2 2 o 2 1 French in Algiers, 1830-1836 (BAUDENS26) Spanish Peninsular War, 1836-37 (Alcock26) .. Campaign of Constantine, 1837 (SEDILLOT27)... Campaign in Mexico, 1847 (PORTER,28 JARVIS29). Revolution in Milan, 1848 (RESTELU30)........ Paris, 1848 (Huguier,31 Amossat.^Baudens,33 JORRRT,** MAT.OATfINK,3* Rnil-X36) 17 18 2 5 11 1 7 1 12 7 1 1 1 7 2 4 4 3 1 3 6 3 3 1 2 90 3 128 Sleswick-Holstein, 1848-1850 (STROMEYER,*7 D J8RUP38)................................. Revolution in Baden, 1849 (Beck39)........... .... 5 1 o 5 7 197 Bombardment of Sv6aborg, 1855 (HEYFELDER40) Crimean War, 1854-57 (MATTHEW,41 CHENU,42 HUBBENET43).............................. || 488 165 1,424 24 .... 38 14 171 412 1 480 488 British in India, 1857-58 (WILLIAMSON,44 GOR-DON46) ..................................... 1 Italy, 1859-60 (CHENU,46 DEMME,47 GHERINI48).. New Zealand War, 1863-65 (MOUAT49)......... 1 7 41 8 1 27 7 6 106 58 16 2 1 19 4 73 3 3 35 4 Danish War, 1864 (HEINE,60 LUCKE,61 OCH- 3 12 1 2 9 2 18 15 2 2 .... 5 . 10 7 Germany, 1866 (Stromeyer,64 Fischer,66 Man-xel,66 Beck,67 Biefel,68 Maas59)............ .... 32 Austro-Italian War, 1866 (Gritti60)........... United States Army, 1865-70 (Otis61).......... 4 149 Franco-German War, 1870-71, Germans (HE1N-ZEL62)...................................... 8 121 359 26 16 342 o 6 3,452 5 7 Franco-German War, 1870-71, FrenchfCHENU63) Russo-Turkish War, 1876 (TILING,64 STEINEE66) Totals............................... 9,017 1,419 7,049 549 406 1,701 14 17 53 .... 259 771 33 737 4,524 502 Of the aggregate of nine thousand and seventeen amputations in the thigh here adduced, five hundred and forty-nine were undetermined, one thousand four hundred and ' DIONIS (P.), Cours d'opCrations de Chirurgie, 6d. par G. De la Faye, Paris, 4">° 6d., 1750, p. 740. 2 SCHMUCKER (J. L.), Vermischte Chirurgische SchrifUn, Berlin und Stettin, 1785, B. I, p. 43. 3HOME (Francis), Medical Facts and Experiments, London, 1759, p. 115. 4Faure, Vamputation etant absolument necessaire, etc., in Prix de VAcad. Royale de Chir., 1819, T. Ill, p. 337 (2 recoveries). s BOUCHER, Obs. sur des playes d'armes a feu com- pliant cs sur tout de fracas des os, in Mim. de VAcad. Roy. de Chir., Paris, 1753, T. II, p. 470 (1 fatal). 6Bagieu, Examen de Plusieurs Parties de la Chirurgie, Paris, 1756, T. L, p. 153 (1 fetal). 7Boucher, in Mem. de VAcad. Roy. de Chir., Paris, 1753, T. n, p. 477. 8Meh£e (Jean), Traiti des plaies d'armes a feu, Paris, An. VUI (1799), p. 215 (1 fetal). 9Mursinna (C. L.), Neue Med. Chir. Beobachtungen, Berlin, 1796, pp. 177, 181 (2 recoveries), "Larrey (D. J.), Clin. Chir., Paris, 1829, T. HI, p. 623 (7 recoveries); and Mem. de Chir. Mil. et Camp., Paris, 1817, T. rV, p. 53 (1 recovery); and Relation Hist, et Chir. de VExpidition de VArmie d'Orient, Paris, 1803, pp. 360, 432-433 (10 recoveries, 1 fetal). " Hennen (John), Principles of Mil- itary Surgery, London, 1829, pp. 276, 278 (2 fetal). "GUTHRIE (G. J.), Gunshot Wounds, London, 1827, pp. 260, 375 (5 recoveries, 8 fetal); and Com- SECT. III.] SHOT INJURIES OF THE FEMUR. 335 nineteen had successful, and seven thousand and forty-nine fatal terminations, a death rate of 83.2 per cent. CONCLUDING OBSERVATIONS ON SHOT INJURIES OFTHE FEMUR. Until the middle of the present century the majority of the writers on military surgery insisted upon immediate amputation as the only means of saving life in comminuted shot fractures of the femur,1 while there were a few only who questioned the necessity of the operation, ancl who declared2 that not only life but also a more or less useful limb might be mentaries, London, 1855, 6th ed., p. 158 (77 recoveries, 62 fatal, 9 results unknown). i3Eudes (P. J.), Sur les avantages de pratiquer Vamputation sur le champ de bataille, etc., Paris, 1815, Th6se, p. 16 (1 recovery). 14Carre (A. C.), De Vamputation considirle comme moyen curatif dans les accidens de debilite, etc., Paris, 1815, Th<5se, No. 9, p. 13 et seq. (2 recoveries, 2 fatal). I5MIREAU (II. L. M.), Sur les inconviniens de Vamputation du moignon de la cuisse devenu conique, Paris, 1815, pp. 15, 16, These (1 recoveiy, 2 fatal). 16 Arnal, Mim. sur quelques peculiarilis des plaies par armes dfeu, in Jour. Hebd. de i/Vd. et de Chir.prat., Paris, 1831, T. Ill, p. 36 (1 recovery). "Klein (D. C), Practische Ansichten der bedeutendsten chirurgischen Opera- tionen, Stuttgart, 1815, p. 35 (7 recoveries). 18Mann (J.), Medical Sketches of the Campaign of 181'~»-13-14, Dedham, 1816, p. 213 et seq. 19Arnal, in Jour. Hebd. de Med. et de Chir. prat., Paris, 1831, T. Ill, p. 36 (2 recoveries). M Meniere (P.), L'Hdtel Dieu de Paris, en Juillet et Aout, 1830, Paris, 1830, p. 323 et seq. (2 recoveries, 9 fatal). 2ILarrey (D. J.), Clin. Chir., Paris, 1832, T. IV, p. 282 (1 fatal). ^LARREY (H.), Relation chirur- gicale des evinements de Juillet, 1830, Paris, 1831, p. Ill (4 recoveries, 1 fetal). 23R0UX (PHIL. J.), Des plaies d'armes d feu; Communications, etc., Paris, 1849, p. 37 (1 recovery, 3 fatal). 24Larrey (H.), Histoire chirurg. du siige de la citadelle d'Anvers, 1833, p. 311 et seq. (13 recoveries, 2 fatal). J6Baudens (L.), Clinique des Plaies dArmes d feu, Paris, 1836, p. 460. MALCOCK (R.), Notes on the Med. Hist, and Stat, of the British Legion in Spain, London, 1838, pp. 92, 95. "SEDILLOT (G.), Campagne de Constantine de 1837, Paris, 1838, p. 266. 28PORTER (J. B.), Med. and Surg. Notes of Camp, etc., in Mexico, 1845-46-47-48, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., pp. 32, 37, and Vol. XXIV, p. 28 (1 recovery, 2 fatal). M Jarvis (N. S.), Surgical Cases at Monterey, in New York Jour, of Medicine, 1847, Vol. VIH, p. 158 (2 fatal). S"Restelli (A.), Note ed Osservazioni cliniche di chirurgia mil., in Annal. Univers. di Medicina, 1849, Vol. CXXX, p. 243. s'-^Dw plaies d'armes dfeu, Paris, 1849, Communications, par Huguier, p. 142 (5 recoveries); Amussat, p. 57 (1 fatal); Baudens, p. 224 (5 fatal); Jobert de Lamballe, p. 155 (1 recovery, 3 fatal); Malgaigne (1 unde- termined); ROUX, p. 39 (1 recovery, 3 fatal). ''Stromeyer (L.l, Maximen, Hannover, 1855, pp. 756, 757 (51 recoveries, 77 fatal). mDj8rup, Bemxr- kninger over de i Krigen 1848-50 foretagne Amputationer, in Hospitals-Meddelelser, 1852, B. V, p. 106 (39 recoveries, 51 fatal). " Beck (B.), Die Schuss- wunden, Heidelberg, 1850, p. 347 (7 recoveries, 6 fetal). ^Heyfelder (J. F.), Die Verwundungen und Operational in Folge des Bombardements von Sviaborg, in Deutsche Klinik, 185o, B. VII, p. 584-5. 41 MATTHEW (T. P.), Med. and Surg. Hist, of the British Army, etc., in the years 1854-55-56, London, 1858, Vol. H, p. 368 (62 recoveries, 119 tatal). 42Chenu (J. C), Rapport, etc., pendant la Campagne d'Orient en 1854-55-56, Paris, 1856, p. 662 (126 recoveries, 1,545 fatal). ^HCbbenet (C. v.), Die Sanitdts-Verhdltnisse der Russischen Verwundeten, etc., in den Jahren 1854-56, Berlin, 1871, p. 182 (89 recoveries, 269 fatal, 488 undetermined). ^Williamson (G.), Military Surgery, London, 1863, p. XXVH (14 recoveries, 1 fatal). "GORDON (C. A.), Experiences of an Army Surgeon in India, London, 1872, p. 26 (1 fetal). ^CHENU (J. C), Stat. Med. Chir. de la Campagne d'ltalie en 1859 et 1860, Paris, 1869, T. II, p. 754 (79 recoveries, 257 fatal). 47Demme (H.), Militdr-Chirurgische Studien, Wiirzburg, 1861, Zweite Abth., p. 264 (110 recoveries, 321 fatal). 48Gherini (A.), Relazione chirurgica dell'Ospedale militare provisorio di S. Filippo, in Ann. Universali di Med., Milano, 1860, Vol. CLXXIII, pp. 459, 460; 39 cases (6 recoveries, 33 fatal). 49 MOUAT, The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports for the Tear 18C5, London, 1867, Vol. VH, p. 513. "Heine (C), Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 275 et seq. (3 fetal, 1 unde- termined). 61L1)cke (A.), Kriegschir. Aphorismen, in Langenbeck's Archiv, 1866, B. VII, p. 25 (1 fatal). S2Ochwadt (A.), Kriegschir. Erfahrun- gen, Berlin, 1865, Appendix (Table of Operations) (3 recoveries, 20 fatal). 63 NEUDORFER (J.), Aus demfelddrztlichen Berichte uber die Verwundeten in Schleswig, in Langenbeck's Archiv, 1865, B. VI, pp. 531, 532 (5 fatal). "STROMEYER (L.), Erfahrungen uber Schusswunden im Jahre 1866, Han- nover, 1867, pp. 16,17 (27 recoveries, 23 fetal). "FISCHER (K.), Militairdrztliche Skizzen aus Siiddeutschland, Aarau, 1867, p. 90 (32 recoveries, 9 fatal, 7 undetermined). "MANNEL (O.), Kriegschir. Beobachtungen, in Allg. Wiener Med. Zeitung, Jahrgang, XII, 1867, No.48, p. 403 (1 fatal). 67BECK (B.), Kriegschir. Erfahrungen wdhrend des Feldzuges 1866, Freiburg i. B, 1867, p. 333 (25 recoveries, 26 fatal). ^BrEFEL (R.), Kriegschir. Aphorismen von 1866, in Langenbeck's Archiv, Berlin, 1869, B. XI, p. 475 (7 fetal). 69Maas (H.), Kriegschirurgische Beitrage, Breslau, 1870, p. 73 (3 recoveries, 6 fetal). 60GRnTl (R.), Nuovi documenti in favore della cura conservativa, etc., in Ann. Universali di Med., Milano, 1868, Vol. CCV, p. 518 etseq. 61 Otis (G. A.), Circular No. 3, War Department, S. G. O., Washington, 1871, p. 205 et seq. (6 recoveries, 6 fetal); 17 amputations following shot wounds are reported in Circular 3, but 5 of these cases are from the American civil war, 1861-65, and are included in the preceding tables of amputations. ** Hein- zel, Ueber die conservirende Behandlung der Kniegelenkschiisse, in Deutsche Militairdrzt. Zeitschrift, 1875, Jahrgang IV, pp. 358-59. ^Chenu (J. C), Apercu hist. Stat, et Clin, sur le service des ambulances et des H6pitaux, etc., Paris, 1874, T. I, p. 493. "THING (G.), Bericht uber 124 w serbisch- tiirkischen Kriege, etc., behandelte Schussverletzungen, Dorpat, 1877, pp. 66-69 (2 fetal). ^Steiner (F.), Aus dem Tagebuche eines deutschen Arztes wahrend der Zeit des Krieges im Oriente 1876, in Wiener Med. Wochenschrift, 1877, p. 657 (2 recoveries, 3 fatal). Of these 9,017 operations 366 were in the upper third of the femur, 503 in the middle third, 436 in the lower third, and in 7,712 the seat of ablation was not specified. The results iu the upper third amputations were 133 recoveries, 232 deaths, and 1 unknown result, a fatality of 63.5 per cent.; in the middle third, 213 recoveries, 290 deaths, or 57.6 per cent, fatality; in the lower third, 211 recoveries and 225 deaths, a mortality of 51.6 per cent.; and in the femur, seat not specified, 862 recoveries and 6,302 deaths, with 548 undetermined results, a fatality of 87.9 per cent. 'Guthrie (G. J.) (Treatise on Gunshot Wounds, London, 1827, p. 373) remarks: "Injuries of the femur from musket balls are the more common wounds that render amputation necessary," and, on p. 375, " Upon a review of the many cases I have seen I do not believe that more than one-sixth recovered so as to have useful limbs; two-thirds of the whole died, either with or without amputation; and the limbs of the remaining sixth were not only nearly useless, but a cause of much uneasiness to them for the remainder of their lives." Larrey (D. J.) (Clinique Chirurgicale, Paris, 1829, T. ID, p. 636): "Lorsque les coups sont regus au centre ou a la partie superieure de la cuisse, de manidre que le projectile la traverse d'avant en arriere, en fracturant le femur, l'amputation devient indispensable." Kerveguen (H. G.) (Des cas d'amputation dans les plaies d'armes d feu, Paris, 1847, p. 33) notices one or two recoveries from pistol shot; but remarks that " these fortunate results must be regarded as exceptions which must not be set up in opposition to the regular rule, viz: that we must amputate whenever the femur is fractured by shot." Schwartz (H.) (Beitrage zur Lehre von den Schusswunden. Gesammelt in den Feldziigen der Jahre 1848, 1849 und 1850, Schleswig, 1854, pp. 155, 168) cites cases of shot fractures of the shaft of the femur of the Schleswig-Holstein War, 1848-1850, and advises primary amputation in all cases of extensive comminuted fractures, whether in the upper, middle, or lower thirds of the femur. Blenkks (G. E.) (in his article Gunshot Wounds, in COOPER'S Diet, of Practical Surgery, London, 1861, Vol. I, p. 817) remarks: " Were I to judge, then, from my own personal observations in the army, and from some other cases which I saw under my colleagues, I should, without hesitation, recommend immediate amputation in all cases of compound fracture of the thigh caused by grapeshot, musket balls, etc." 2Le Dran (H. F.) (Traiti ou reflexions tirCes de la pratique sur les plaies d'armes d feu, Paris, 1737, p. 221) evidently believed that a useful limb might be preserved after comminuted fracture of the femur: " Sans parler des pansemens qui sont 6nonces dans la premiere partie, je dirai seulement, que supposant le famer fracture en eclats, et qu'il y eut lieu d'esperer de conserver la cuisse, on doit aprfis avoir fait ce que l'art present, faire ensortc de fixir le reste des pieces fracturees, de maniere qu'elles ne jouent pas l'une contre l'autre, comme je l'ai dit en parlant des playes au bras." Hutin (Recherches sur le resultat des fractures de la moitie supCrieure de la cuisse, etc., in Rec. de Mem. de Mid. de Chir. et de Phar. Mil, 1854, T. XIV, p. 253), on page 272, believes that the facts cited by him "demontrent que Ton ne doit pas adopter exclusivement le prdcepte de recourir toujours a l'amputation dans les cas dont il s'agit, et qu'il est de ces fractures dont on peut esperer une gu6rison bonne et durable, quoiqu'elle ne laisse qu'un membre difforme." 336 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. preserved to the patient by an expectant conservative mode of treatment. From the fol- lowing statistical summary of fractures of the femur treated by conservation, recorded in other wars, it will be seen that of a total of three thousand four hundred and seventy-four cases only about two hundred and fifty antedated the year 1850. But with improvements Table XLVIII. Results of Shot Fractures of the Femur treated by Conservation on the Occasions named and from the Authorities quoted. CASE6. Upper Third. Middle Third. Lower Third. Seat not Indicated. ACTION, Etc. "3 O >> > o s "5 c — pi s e 01 o o III "a c S.S PS p tA u 41 > a V « Fatal. "Result Unknown. o o 3 c II if o 8 « a 3 O Ambulance d VArmie du Rhin, etc., Paris, 1871, pp. 44, 46, 48 (5 recoveries, 12 fatal). FELTZ et GllOLLEMUND, Rel. Clin, sur les Ambulances de Haguenau, in Gaz. Med. de Strasbourg, 1871, No. 11, p. 133 (11 recoveries, 3 fatal). JOESSELL, Ambulance du Petit-Quar tier a. Hague- nau, in Gaz. Mid. de Strasbourg, 1871, p. 8 (7 recoveries, 6 fatal). MACCORMAC (W.), Notes and Recollections, etc., London, 1871, p. 129 (8 recoveries, 20 fetal). MOYNIKR (EUGENE), Ambulance de la Rue Saint Lazare, in Gaz. des Hdpitaux, 1871, Vol. XLIV, p. 445 (2 recoveries, 1 fatal). PANAS (F.), Mem. sur le traitcment des blessures, etc., in Gaz. hebdomadaire de Mid. et de Chir., 1872, T. IX, p. 391 (2 recoveries, 4 fatal). PONCET (F.), Contribu- SURG. Ill—43 338 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. immediate amputation, and who yet, in 1849,* insisted that "les fractures du corps du femur demandent impe'rieusement l'amputation immediate," acknowledged, in 1858, after his experience in the Crimean War, "cette sentence trop absolue."2 The successful attempts at conservation in shot fractures of the femur recorded from the Danish War of 1864, by Heine, from the Six Weeks' War of 1866, by K. Fischer, Beck, and R. Gritti, and from the Franco-German War of 1870-71, by Beck, H. Fischer, Lossen, Rupprecht, and Socin among the Germans, and Chipault, Feltz, Grollemund, Roaldes, Sedillot and others among the French (Table XLVIII and notes on p. 336), stimulated the propensity towards con- servative opinions in war surgery. B. Beck, who, in 1850, insisted upon immediate ampu- tation,3 "be it in the field or in cities in well conducted hospitals, in all shot fractures of the femur, even if there be only the slightest splintering or displacement of the ends of the femur in oblique fractures," conceded, in 1872, after the Franco-Prussian War,4 that "we have, in the field hospitals, by expectative therapy and by the use of the simplest band- ages, saved a considerable number of shot fractures of the femur." Se'dillot5 declared that "the extreme mortality of amputations of the thigh in war surgery, and the annoyances and accidents to which the apparatus destined to replace the limb are liable, have led us to renounce this operation in all cases in which the most positive necessity does not require it." Socin6 considers it "inexcusable to perform in a case of shot fracture of the femur for splintering of bone alone, the primary amputation as yet advocated by the first authorities of French military surgery. Only when we are assured that the vessels, artery and vein, are shot through, is the operation justifiable." Already in the early part of the War of the Rebellion many American surgeons were tions, etc., in Montpellier Medical, 1872, T. XXVIH, pp. 41-43 (1 recovery, 4 fatal). ROALDES (A. W. DE), Des fractures compliquies de la cuisse, Paris, 1871, p. 43, etc. (11 recoveries, 10 fatal). SEDILLOT, Du traitcment des fractures des membrespar armes de guerre, in Archives Genirales de Med- ecine, 1871. 4mc s6r., T. XVH, p. 423, etc. (25 recoveries). TaCHARD (E.), Reflexions pour servir a Vhistoire de la Chirurgie, in Gaz. des Hopitaux, 1871, p. 238 (1 fatal). VASLIN (L), Gtude sur les plaies par armes d feu, Paris, 1872, pp. 102, 244 (7 recoveries, 3 fetal). CHENU (J. C) (Apercu hist. ttat. et clinique, etc., Paris, 1874, T. II, pp. 153-1038) names 705 pensioners who recovered after shot fractures of the femur; 12 of them have been recorded by the authors just quoted, viz: Chipault (2), Christian (2), MacCormac (1), Feltz et Grollemund (2), Roaldes (3), and Sedillot (2), leaving 693 cases to be added to this series, viz: 151 in upper third, 58 in middle third, 110 in lower third, and 374 in which the location of the injury was not specified. M06SAKOWSKY (P.) (Stat. Bericht ueber 1415 Franzbsische Invaliden, in Deutsche Zeitschrift fiir Chirurgie, 1872, B. I, p. 342) cites 19 cases of pensioners after shot fracture of the femur not reported by CHENU, viz: 9 in the upper third, 9 in the middle third, and 1 in the lower third of the femur. 49TILING (G.), Bericht ueber 124 im Serbisch-Turkischen Kriege im Baracken Lazarethdes Dorpaler Sanitats-Train Zu Swilainatz behandelte Schussverletzungen, Dorpat, 1877, pp. 66-69 (1 recovery, 2 fatal). KADE (E.), Das Tempordre Kriegslazareth des Ressorts der Anstalten der Kaiserin Maria, in St. Petersburger Med. Wochenschrift, 1877, No. 45, p. 384 (4 recoveries, 2 fatal). STEINER (F.), Aus dem Tagebuche tines Deulsclien Arztes wahrend der Zeit des Kriegs im Orient, 1876, in Wiener Med. Wochenscrift, 1877, No. 28, p. 681 (2 recoveries). Of the 3,474 cases of shot fractures of the femur treated by conservation here referred to, 2,132 were successful and 1,242 were fatal, while in 100 instances the result could not be ascertained. But it would obviously be unfair to make a deduction regarding the percentage of mortality from the numbers here adduced. Among the cases of recovery enumerated are 63 pensioners observed by HUTDJ (No. 29, ante) at the Hotel des Invalides at Paris during the years 1847-1853; 29 pensioners recorded among the Danes after the Schleswig-Holstein War, 1864, by HANNOVER (No. 43, ante); 65 pensioners observed by BERTHOLD (No. 47. ante); 693 pensioners tabulated by Chenu (No. 48, ante); and 19 pensioners observed by MOSSAKOWSKY (No. 48, ante). These cases, numbering 869, should be deducted from the total number of recoveries, leaving 1,263 successful to 1,242 fatal cases, a mortality of 49.5 per cent. Of the 869 pen- sioners thus deducted, 181 recovered after shot fractures in the upper third of the femur, 97 in the middle, 133 in the lower third, and 458 in the femur, third not specified. Deducting these from their respective categories in Table XXXVI there remain 489—181=308 recoveries in the upper third to 230 deaths, a mortality of 43.7 per cent.; 296—97=199 recoveries to 148 deaths in the middle third, a death rate of 42.6 per cent.; 307—133=174 recoveries to 125 deaths in the lower third, a fatality of 41.8 per cent., and 1040—458=582 recoveries in the femur, seat unspecified, to 704 deaths, or a mortality of 54.7. 1 Baudens (L.), Des Plaies d'armes dfeu. Communications, etc., Paris, 1849, p. 218. 'BAUDENS (L.) (La Guerre de Crimc'e, Paris, 1858, p. 131): "Avant la guerre de Crim6e, c'Stait un principe g6neralement accepte qu'une fracture du femur deterniinee par un coup de feu neeessite l'amputation. D y a lieu de penser que, grace a mes nouveaux appareils a fractures, on peut en appeler de cette seutence trop absolue;" and, on p. 333, "lis prouvent, contrairement a l'opinion reQue, que les fractures comminutives du femur avec plaie ne sont pas fatalement vouees a l'amputation, si on a le soin d'extraire les esquillcs et les corps Strangers pourfaire d'une plaie compliquee une plaie simple, et si a I'aide d'un appareil a fracture convenable, on parvient & placer le membre dans une immobility complete, sans l'ebranler meme pendant les pansements. et a donner aux humidit£s purulentes un facile ecoulement." 3BECK (B). Die Schusswunden, Heidelberg, 1650, p 283. 4BECK (B.), Chirurgie der Schussverletzungen, Freiburg, 1872, p. 691. 5 SfcniLLOT (Du traitcment des fractures des membres par armes de guerre, in Arch. Gin. de Mid., 1871, 6me serie, T. XVII, p. 422) remarks: ' L extreme mortalite de l'amputation de la cuisse dans la chirurgie de guerre, et les ennuis et les accidents que causent les moyens de prothese destines a reinplacer ee membre, nous ont conduit a renoncer a cette operation dans tous les cas oft la n^cessite la plus 6vidente ne l'iniposait pas. Les ablations partielles ou totales par un boulet, un 6clat d'obus; des fracas osseux trfis-etendus avec division de l'artere, de la veine crurale et du nerf sciatique; la gangrene, les fractures avec large ouverture du genou et fragmentation des condyles du f6imir et du tibia, sont les seules complications qui semblent empecher absolnment la conservation de la cuisse." •SOCIN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 128) believes that the experiences of the late campaigns confirm on the one hand the previous reports of the enormous mortality of primarj- amputations of the femur, and, on the other hand, prove that the conservative treatment is not only enabled to save many useful extremities but gives far better results in regard to mortality. SECT. HI.] SHOT INJURIES OP THE FEMUR. 339 led to similar conclusions. Assistant Surgeon Philip C. Davis, U. S. Army, in a report to the Surgeon General of his services from June 1, 1861, to June 19, 1863. remarked that: "The mortality was very great in cases of amputations for compound comminuted fracture of the femur; better success being met with by using splints and other appliances adapted to the nature of the cases." (See Appendix to Part I of the Med. and Surg. Hist, of the War of the Rebellion, p. 15.) Surgeon A. J. Phelps, U. S. V., in his observations after the battle of Chickamauga, September 19, 1863, stated: "As a rule a gunshot fracture of the femur should not be amputated, but should be treated with the expectation of saving the limb. Such appliances should be used as to secure drainage from the wound and com- fort to the patient, and the case then be left to nature supported by good air and generous diet." Surgeon J. S. Woods, 99th Ohio Volunteers, in a report from the hospital at Chat- tanooga, declared: "Amputation is almost never warrantable; but the prospect of success warrants the effort to save the life with the limb." Surgeon Henry J. Churchman, U. S. V., detailed eleven cases of shot fractures of the femur treated at the hospital at Fayetteville, Arkansas, and arrived at the following conclusions: "The results, so far, of the cases given, force me to believe, Guthrie and others to the contrary, that: 1, Gunshot fractures of the femur, as a rule, do not require amputation to save life; 2, As a rule, none should be ampu- tated save those where, in addition to comminution, there is extensive laceration of soft parts or serious injury done to principal artery or nerve or both." Surgeon A. W. Heise, 100th Illinois, who had observed twelve cases of comminuted fractures of the thigh at the first division, Twenty-first Corps, field hospital, "of which six had recovered, two would probably recover, and four had terminated fatally," concludes that "the results of these few cases, so much at variance with the experience of all military surgeons, will be one more reason to encourage a hope for a favorable result from conservative treatment of these unfortunate cases." Like views were entertained by Surgeon I. Moses, U. S. V., Assistant Surgeons A. H. Hoff and DeWitt C. Peters, U. S. A., Assistant Surgeon A. E. Carothers, U. S. V., Acting Assistant Surgeons B. B. Miles, J. Swinburne, E. G. Waters, and the Confederate Surgeon G. M. B. Maughs.1 That the conservative mode of treating fractures of the femur gave the best results and was most zealously advocated by surgeons in charge of general hospitals remote from the scene of conflict2 is readily understood when it is considered that 1 Moses (I.) (Surgical Notes of Cases of Gunshot Injuries occurring during the Advance of the Army of the Cumberland, in Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 338): With our ambulances, " easy and abundant, and the hospitals amply supplied with everything essential . . we were pre- pared to exert ourselves for the preservation of limbs, and our success has been such as to warrant our efforts." HOFF (A. H.) (Amputations and Resec- tions—Conservative Surgery, in Am. Med. Times, 18C3, Vol. VII, p. 102): "1 am heartily tired of amputations, more especially of the thigh, and, with one or two surgeons, have attempted to save limbs as well as lives by calling in Dame Nature and attempting to assist her, and this, I am happy to say, with a success far beyond expectation." Peters (DeWitt C) (Am. Med. Times, 1864, Vol. VIII, pp. 52, 53) examined 25 cases of recovery after com- pound fractures of the femur received by Confederate soldiers at the battle of Gettysburg, and remarks: " The general condition of all the men was tar above my expectations of finding them, considering they were prisoners of war and liable more or less to nostalgia. . . The treatment they had received was, in my opinion, in conformity with the laws of conservative surgery, yet it seemed to me had a little more care been given to extension or counter-extension, there would have been less shortening and deformity." CAROTHERS (A. E.) (On Compound Comminuted Fracture of the Femur from Minie Balls, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 350, et seq.) concludes: " That the operation of resection is not advisable, but that it offers a more favorable prognosis as a primary than as a secondary operation," and advises moderate and regular extension and counter-extension and the use of the anterior wire splint. Miles (B. B.) (Conservative Treatment of Gunshot Fractures of the Knee-Joint, in Am. Med. Times, 18G4, Vol. VIII, p. 50): "In considering ihe results of gunshot fractures of the femur, the situation of the injury is of vast importance in regard to the chances of recovery, either with or without amputation; as for amputation it has been abandoned, except when large blood-vessels and nerves are implicated." Swinburne (John) (Amputations, when to be performed and when not required in Military Surgery, in Am. Med. Times, 1863, Vol. VI, p. 149): "Excision of the shaft is evidently out of the question, since all die after the operation. The question then arises, shall we amputate? Or shall we treat such cases as ordinary compound fractures? I prefer the latter, and have from the first thought it the most reasonablo treatment." WATERS (E. G.) (A Report of Twelve Gun- shot Fractures of the Thigh, treated conservatively in the U. S. A. General Hospital 'National," in Am. Med. Times, 1863, Vol. VI, p. 170). Maughs (G. M. B.) (Conservative Treatment of Comp. Comm. Fracture of the Femur, witli Cases, in Confederate Slates Med. and Surg. Jour., January, 18C5, Vol. II, p. 10): "No excisions of the femur, no incisions of soft parts for the removal of loose pieces of bone, no formidable display of machinery to keep the limb in place and the patient from sleep. The wounds were carefully examined, and all foreign bodies, including spicula of bone immediately in the track of the ball, removed. . . As a general rule, ordinary fractures above the knee from rifle balls should never cause primary amputation." 2 Surgeon J. T. Hodgen, U. S. V., on October 17, 18C2, reported from the City General Hospital, St. Louis, of shot fractures of the femur, that he "succeeded in saving 37 out of 53 cases admitted," and, in a letter dated April 30,1863, suggests that "amputation for these fractures should seldom be performed." Surgeon John H. Brinton, U. S. V., on May 19,1863, in a report to the Surgeon General U. S. A., on Dr. Hodgen's cradle splint, takes 340 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. cases reaching these hospitals had been generally selected by the surgeons in the field as cases in which there existed some chance of saving the limb. But while many of the American surgeons advocated and practised conservative meas- ures in shot fractures of the thigh, there were those who deprecated the frequent attempts at conservation, and who were of the opinion expressed by Surgeon S. Hart, U. S. V.,1 that "more amputations would have saved more lives." Surgeon T. H. Squire, 89th New York Volunteers, wrote in 1862, after the battle of Antietam: "A badly shattered femur by a ball through the thigh should always be amputated, and the quicker the better." Surgeon G. D. Beebe, U. S. V., in his report of the centre division of the Fourteenth Corps, at the battle of Murfreesboro', remarked: "In the shaft of the femur I believe amputation is the true conservative course." Surgeon G. A. Collamore, 100th Ohio Volunteers, declares: "In fractures affecting the lower two-thirds of the limb, I should amputate so as to remove the fractured portion;" and Surgeon H. S. Hewit,2 U. S. V., Medical Director of the Army of the Ohio, reported, in September, 1864: "Compound comminuted fractures of the thigh were almost invariably amputated primarily when reaction took place." Surgeon F. Sorrel,3 Inspector of Hospitals of the Confederate States Army, also favored primary amputation on the field as "the greater readiness with which the patient can be transported from the field; the greater ease and comfort realized under these circumstances, when the limb has been removed; the lesser time required in hospital for recovery, would all seem to point to its adoption as the wiser policy." Reviewing the cases of injuries and operations in the shaft of the femur recorded during the American civil war, it cannot be denied that the results of the conservative mode of treatment as well as of the amputations have been very gratifying. The three thousand four hundred and sixty-seven cases of the former group gave a mortality of 49.9 per cent., while, of the six thousand two hundred and twenty-nine cases of the latter group, 53.8 per cent, were fatal. Less favorable were the results of excisions in the shaft of the femur, which exhibited a mortality of 69.4 per cent, in the one hundred and seventy- five cases of this operation recorded on the registers of this Office. Of the six thousand two hundred and twenty-nine amputations of the thigh it is true only two thousand nine hundred were performed for shot fractures of the femur, while the remaining three thousand three hundred and twenty-nine were done for shot fractures of the knee joint, leg, or foot, and the objection may be made that it would be unfair to compare the results of six thousand two hundred and twenty-nine amputations in the thigh with the results of shot fractures of the femur treated by either conservation or excision, the injuries in all these cases being in the femur; but the mortality of the two thousand nine hundred amputations in the thigh for fractures of the femur, with one thousand two hundred and fifty-seven issue with the latter suggestion: "I think that neither an examination of gunshot injuries of the thigh made on the battle-field, nor of the study of the pathological specimens in the Army Medical Museum, will sustain this view of Dr. Hodgen. It must, moreover, be remembered that the cases sub- mitted to the treatment of this surgeon are cases which have reached him at advanced periods after the reception of the injuries; that they have been selected by the surgeons at the sceue of conflict as cases in which there existed some chance of saving the limb. They were forwarded to St. Louis for that purpose, and not for amputation. Were the worst cases sent him, I doubt much if his results would be as encouraging." From his experience, based upon the cases treated by him at the Stewart Mansion Hospital, Baltimore, Assistant Surgeon DE WITT C. Peters, U. S. A., reported, in 18<>3: My experience in the treatment of compound fractures of the thigh caused by gunshot wounds and by other kinds of violence has inclined me to favor the most conservative course of action. In cases where the large aud important blood-vessels and nerves have escaped injury, and where there is not any extensive laceration and destruction of the soft parts, when the constitutional symptoms are not alarming, the true indications are, it appears to me, to try and save the limb. Instances where, by chance or accident, the surgeon has not seen the case in time to perform primary amputation, and has left nature to her own powerful efforts, which have been finally crowned with success, are by no means infrequent, and these instructive cases should not, iu my judgment, be overlooked in forming our opinions in deciding whether a limb should be sacrificed or not." 1Appendix to Part I of the Medical and Surgical History of the War of the Rebellion, p. 118. ^Appendix to Part I of the Medical and Surgical History of the War of the Rebellion, p. 311. 5 SORREL (F.), Gunshot Wounds—Army of Northern Virginia [An Extract from a Report on the Sickness and Mortality in the Armies of th* Confederate States, for 1863 , in Confederate States Medical and Surgical Journal. Richmond, 18(54, Vol. I, p. 154. SECT. HI.] SHOT INJURIES OF THE FEMUR. 341 recoveries, one thousand five hundred and sixty-three deaths, and eighty unknown results, or 55.1 per cent., exceeds that of the total number of amputations (53.8) only 1.6 per cent., leaving the relative results nearly the same—the percentage of fatality of the total number of amputations, and that of the amputations for fractures of the femur, exceeding the fatal- ity of the conservatively treated cases 3.9 per cent, and 5.5 per cent, respectively. But it is obvious that in comparative statements of cases treated by conservation and by amputa- tion the majority of intermediary and secondary operations should be considered only an abandonment of the conservative treatment made necessary by subsequent complications. To arrive, therefore, at a correct estimate of the value of conservation, we must contrast the latter with the primary operations; and here it will be noticed that while the conserv- ative cases presented a fatality of 49.9 per cent., the mortality of the primary amputations was 49.8 per cent., the latter offering a slightly better chance for the preservation of life.1 In comminuted fractures of the upper third of the femur surgeons generally consid- ered conservation preferable to amputation. Professor F. H. Hamilton2 gave it as his impression that "in compound gunshot wounds of the upper third of the femur amputation should never be performed." Surgeon Charles O'Leary,3 U. S. V., found, during the Peninsular campaign in 1862, that "amputations at the upper third of the thigh proved fatal within a short time in all cases. The results of this operation were such as to dis- suade us from resorting to it in subsequent battles, except when a limb was in such a con- dition as to make its removal a relief to the patient." Surgeon G. A. Collamore,4 100th Ohio Volunteers, who advised primary amputation in shot fractures of the middle and lower thirds of the femur, declares that "if the fracture occur in the upper third, I should prefer to trust the case to nature, with such aid from position, splints, etc., as could be obtained." Surgeon J. J. Chisolm,5 Confederate States Army, declares that "A compound fracture in the upper third of the thigh should be treated, in every respect, as if in the arm. Unless the leg is so mangled that an amputation is an act of necessity, it should not be thought of." That these views largely prevailed among the surgeons of the War of the Rebellion is apparent from a comparison of the number of cases of shot fractures of the upper third of the femur treated by amputation with those treated by conservation. In fifteen hundred and seventy-seven of the twenty-nine hundred amputations for shot frac- tures of the femur the precise seat of the injury was recorded. Of these fifteen hundred and seventy-seven cases the injury was in the upper third in only ninety-three instances, or 5.8 per cent., while in two thousand seven hundred and twenty-nine of the three thou- 1 Professor Th. Billroth (Chirurgische Briefe aus den Kriegslazarethen in Weissenburg und Mannheim, 1870, Berlin, 1872, p. 239) contends that the intermediary and secondary operations should be grouped with the conservation cases, and this result compared with that of the primary operations: MODE OF TREATMENT. Cases. Recovery. Fatal. Unknown. Mortality. 3,467 67 1,762 1,689 24 718 1,684 42 1,044 94 1 49.9 63.6 59.2 5,296 2,431 2,770 95 53.2 or a fatality of 53.2 per cent, for conservation against 49.8 for primary amputation. 'HAMILTON (F. H), Amputations in Gunshot Fractures of the Femur, in American Medical Times, 1864, Vol. VHI, p. I. 30'LEAUY (CHARLES), Surgeon U. S. V. "Extract from a Narrative of his Services in the Volunteer Medical Staff," in Appendix to Part lofthe Medical and Surgical History of the War of the Rebellion, p. 70. 4 Smith (Stephen), Analysis of Four Hundred and Thirty-nine Recorded Amputations in the Continuity of the Lower Extremity, in United States Sanitary Commission Memoirs, 1871, Vol. II, p. 62. 5Chisolm (J. J.), A Manual of Military Surgery, Columbia, 1864, p. 394. 342 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. sand four hundred and sixty-seven cases treated by conservation, in which the locality of the injury was ascertained, twelve hundred and fifty-four, or 46 per cent., or nearly one-half, were for fractures in the upper third of the femur. The number of amputations for frac- tures in the middle third of the femur was three hundred and sixty, and for fractures in the lower third eleven hundred and twenty-four, while of the cases treated by conserva- tion those for fractures in the middle third numbered eight hundred and fifty-five, and those for fractures in the lower third only six hundred and twenty. Ribes,1 Demme,2 Pirogoff,3 and others4 have called attention to the great fatality fol- lowing shot fractures in the middle third of the femur, and Surgeon E. Andrews,5 1st Illinois Artillery, reports to have had a similar experience. But neither the results of the cases treated in the American civil war (Table XX, p. 175, ante) nor of the cases collected in Table XLVIII, on p. 336, appear to confirm this opinion. In the former the percent- age of fatality is 46 per cent, for fractures in the upper third, 40.6 per cent, for fractures in the middle third, and 38.2 per cent, for fractures in the lower third. In the latter the fatality is 43.4 per cent, for the upper third, 43.1 per cent, for the middle, and 42.3 per cent. for the lower third, thus affirming, in shot fractures of the femur at least, the old axiom that the gravity of injuries of the extremities steadily augments in proportion as the seat of the injury approaches the trunk. When it had been decided in a shot fracture of the femur to attempt preservation of the limb, all loose spiculse and foreign bodies were carefully removed,6 the limb was then brought as near as possible to its normal position, and there held by the use of splints. The extraction of splinters retaining any connection by the periosteum, and also the practice of cutting off the broken ends of the bone, was generally deprecated.7 1 Ribes (F.) (Mimoire sur la fracture du tiers moyen du femur compliquee de plaie, et produite par arme d feu, in Gazette Midicale de Paris, 1831, T. II, No. 12, p. 101) asserts: "Toutes les fractures du femur compliquies de plaie, produites par un corps poussS par la poudre a canon sont des maladies graves; mais celles qui arrivent au tiers moyen de cet os eout extrSmement dangereuses et presque toujours mortelles." 2 DEMME'S (H.) (Militar Chirurgische Studien, Wiirzburg, 1861, p. 262) tabulations show a similar result in the Italian War of 1859 ; the mortality of fractures in the middle third of the femur being 60.87 per cent, to 58.14 of the upper and 43.42 of the lower thirds. 3PlROGOFF (X.) (Grundziige der Allgemeinen Kriegschirurgie, Leipzig, 1864, pp. 783, 784) remarks that in the hospitals in the Caucasus and after the Crimean War he saw 20 cases of recovery after shot fractures of the upper third of the femur, but no cases of recovery after fractures of the middle third, and adds: "Our own efforts—comparatively few in comparison to the number of amputations—to cure shot fractures of the middle third of the femur, miscarried." •FISCHER (H.) (Kriegschirurgische Erfahrungen, Erlangen, 1872, p. 178) analyses twenty cases of fracture of the femur that were treated by him during the Franco-Prussian War, 1870-71: 10, with 6 deaths, or 60 per cent, mortality, were in the upper, 5, all fatal, were in the middle, and 5, all recoveries, were in the lower third ; and reaches the conclusion: " That shot fractures in the middle third are the most dangerous, and are least adapted to conservative treatment. I believe, therefore, that it would be best to amputate primarily in extensive comminuted fractures of the middle third, and to attempt conservative treatment only in shot fractures with little splintering. Stress should be laid upon this rule, as especially to-day, too little primary amputating is done. Primary amputation for shot fracture of the femur is considered almost a crime. . . It is altogether different in shot fractures of the lower third of the femur; here the conservative treatment promises the best results. Between the two stand the results of shot fractures in the upper third. There the amputation or exarticulation is, under all circumstances, a dangerous proceeding, and we may, therefore, allow the conservative treatment a larger field." BECK (B.) (Chir. der Schussverletzungen, 1872, p. 694) remarks: " Fractures of the middle third of the femur near the junc- tion with the upper third always impressed me most unfavorably, on account of the frequently co-existing injuries of the blood-vessels." 6 ANDREWS (E.) (Complete Record of the Surgery of the Battles fought near Vicksburg, December 27, 28, 29, 30, 1862, Chicago, 1863, p. 37): "It would seem that shots through the cancellar tissue, at the superior fifth of the femur, are much less dangerous than those in the compact bone of the shaft below; the reason is, that when a ball bores its way through spongy bone, it produces only a moderate amount of shattering, owing to the yielding character of that tissue; but the impact of a mini6 bullet upon the brittle ivory of the shaft shatters it for several inches, and disperses the fragments with the force of an explosion among all the surrounding tissues, producing immense disorganization. These cases nearly all die within the first five days, no matter what treatment is adopted." 6 The records show that fragments of bone were dislodged in 288 instances at least, of which 170 had successful terminations. 'Surgeon A. W. HEISE, 100th Illinois, who observed twelve cases of comminuted fractures of the thigh at the 1st division, Twenty-first Corps, field hospital, of whom six had recovered with union, two would probably recover, and four had terminated fatally, remarks, in a communication to the Medical Director of the Twenty-first Corps, dated February 4, 1863: " In all these cases the principal vessels had escaped injury. Primary sequestra, or those directly and completely separated by the force of the projectile, were carefully removed by making a liberal incision over the parts. But sequestra retaining connection by periosteal, muscular, or other attachment, I did not interfere with. In only two cases I found that during the process of suppura- tion sequestra were thrown off. In the majority of these comminuted compound fractures I find that the removal of splinters retaining any connection with periosteum is unnecessary and often injurious, as is also, in my opinion, the practice of sawing off the broken ends of the bones projecting from the comminuted parts. I am strengthened in the belief, from observation made here, that by proper treatment, and under favorable circumstances, splinters become impacted in callus, and, in time, unite with the other fragments of the bone, and, in this manner, a cure is completed without operative inter- ference. Whether the splinters which have thus become impacted in callus will lead to mischief, or are subsequently discharged as if they were so many foreign bodies, the future will determine." Surgeon A. J. Phelts, U. S. V., in his observations after the battle of Chickamauga, recommends that "loose spicula only should be removed, and resections of the shaft be eschewed." Surgeon H. S. HEWIT, TJ. S. V., in his Report on the Military Med- SECT. 111.J SHOT INJURIES OF THE FEMUR. 343 The plans adopted for the mechanical support of the fractured thigh bone, for main- taining proper extension, for retaining the fractured ends in accurate apposition, and for facilitating the necessary dressings, during transport as well as in hospitals, were manifold and ingenious, and doubtless contributed to the success achieved in the saving of useful limbs. The extended position, which may be traced back to Hippocrates,1 but for the systematic and rational application of which we are indebted to Desault,2 as well as the icine, Surgery, and General Conduct of the Medical Department of the Army of the Ohio, from May, 1, 1864, to September 8, 1864 (Appendix to Part I, Med. and Surg. Hist, of the War of the Rebellion, p. 311), declares " the principle of removing fragments primarily when detached is obvious and has been recommended to the surgeons of the department." Surgeon W. W. BLAIR, 58th Indiana, in Report of the Medical Staff of the 1st division of tlie Twenty-first Corps, at the Battle of Stone's River (Appendix to Part I, Med. and Surg. Hist, of the War of the Rebellion, p. 2G3), states that "all frag- ments of bone completely separated by the force of the projectile were carefully removed by making an incision if necessary; but fragments retaining connection by the periosteum were not removed, and in only two cases were sequestra thrown off during the process of suppuration." Surgeon Henry J. CHURCHMAN, U. S. V., in charge of the hospital at Fayetteville, Arkansas, insists that " the comminuted fragments, if small and detached, should in all cases be removed at once under chloroform, and the thigh put in splints so as to keep parts in properapposition and invite callus—the amount of exten- sion or counter-extension to be regulated by the amount of comminution or loss of substance. It seems to me that the inflammation and suppuration necessitated by an unreduced compound comminuted fracture detach the periosteum from fragments, and not from fragments alone but from bone gen- erallv, while the system wastes from suppurative exhaustion and pyaemia. Should even a useless limb result from effort to save, amputation could subsequently be performed under far more favorable circumstances than are generally found in the crowded wards of a general hospital." 'Hippocrates, Oeuvres completes par E\ Littre, Paris, 1841, T. Ill, Des Fractures, Par. 19, p. 483. 2Desault (P. J.) (Oeuvres chirurgicales, ed. par Xavier- Bichat, Paris, 1813, T. I, p. 249, and PLATE H) employed a straight outer splint to reach from the hip to some distance beyond the foot; an inner splint extending from the perinaeum and terminating opposite the end of the outer splint; an anterior splint reaching from the abdomen to the knee ; and an extending and counter-extending band, the former secured to the foot and lower extrem- ity of the long splint, the latter to its upper extremity after being passed under the perinaeum. Junkbags and the SCULTKTUS bandage completed the apparatus (see FIG. 207). H.J. BRUNXIXGHAUSEN (Ueber den Bruch des SchenkelbeinhaUes iiberhaupt, und insbesondere eine neue methode, denselben ohne Hinken zu heilen, Wiirzburg, 1789) fastened the broken thigh to the sound one, a principle followed by HAGEDORN (M.) (Abhandlung von dem Bruch des Schenkelbeinlialses, nebst einer neuen Methode, denselben leicht und sicher zu heilen, Leipzig, 1808) in his apparatus, which makes the sound limb the extending power, both feet being secured to the foot-board, and the splint to the sound thigh. The apparatus was extensively used on the continent of Europe as well as in England, and was considered a most simple and effectual apparatus. To obviate the principal objection to DESAULT's splint, that it does not act in the line of the axis of the broken limb, but obliquely, drawing the upper fragment outwards, PHILIP Syng PHYSICK (JOHN SYNG DORSEY, Elements of Surgery, Philadelphia, 1813, Vol. I, p. 163) lengthened the outer splint (see Fig. 208) until it reached nearly to the axilla, and attached to its inner side, at about two inches above its lower end, a block grooved on its inner margin, and broad enough to reach the line of tbe middle of the foot. Counter-extension was thus made more in the line of the body. If the patient experienced any difficulty in bearing pressure upon the top of the foot, Dr. PHYSICK used a buckskin gaiter laced around the ankle, with straps for extension. Dr. HUTCHINSON added a notched block, over which the extending band is stretched, throwing the direction of the extension in the line of the limb. The apparatus of Brunxixghausen as well as of Hagedorn prevented the lateral movements of the pelvis. This defect was partially overcome by WILLIAM GIBSON, of Philadelphia (Reflexions on the Treatment of Fractures of the Thigh, with an Account of a New Apparatus, in the Philadelphia Jour, of the Med. and Phys. Sciences, 1821, Vol. HI, p. 230, etc.), who, in a case of oblique fracture of the femur, had applied-DESAULT'S splint; but, owing to the obesity of the patient, found it impossible to keep up extension and counter- extension sufficient to prevent the overlapping of the fractured ends of the bone, and tried the method of HAGEDORN: " I soon found, how- ever, that simple and ingenious as it was, and calculated to effect Fig. 207.—Desault'8 splint. Fig. 208. -PHYSICK'S modification of Desault's splint. extension and counter-extension to a much greater degree than that of DESAULT, that it was still imperfect, but susceptible of such changes as would make it a most valuable acquisition." Dr. GIBSON constructed two splints five and a half feet in length, reaching from the axilla beyond the feet. Both feet were confined by gaiters to a foot-board, which was firmly supported upon the ends of the long splints through mortises near its edges. But as both feet are imprisoned, the confinement is apt to become irksome to the patient, and it is difficult to prevent bedsores, to give the patient a stool, or to use a urinal. Subsequently, Dr. GIBSON recommended (Philadelphia Journal of Med. and Physical Sci., 1822, Vol. V, p. 372) a triangular frame presenting a single inclined plane, on which both extremities were extended; the feet were confined to a foot-board, and counter-extension was made by the weight of the body. In a similar manner Dr. E. MICHENER (Remarks on the Treatment of Fractures of the Femur, in the American Medical Recorder, 1822, Vol. V, p. 430) raised the limb on a single-inclined plane to receive counter extension by the weight of the body. A further modification of DESAULT's splint was that of LUKE HOWE (Observations on the various methods of treating the fractures of the Os Femoris, with Cases, in which a new apparatus was successfully used, in The New England Journal of Medicine and Surgery, 1824, Third Series, Vol. Ill, p. 234). The extension was made at the foot with weight and pulley; counter-extensiou by a band over the groin and ischium, connected by a strap with the headboard of the bed, and a waist band was buttoned or sewed on the pelvis and fastened to the side pieces of tbe bedstead by bandages or tape. The pulley and weight was also employed by WILLIAM C. Dantell (Metlwd of Treating Fracture of the Thigh Bone, in Am. Jour. Med. Sci., 1829, Vol. IV, p. 330) attached to a handkerchief passed around the ankle. BOYER'S splint (Traiti des Maladies Chirurgicales et des Operations qui leur conviennent, Paris, 1831, T. Ill, p. 305, and PI. IH, opposite p. 640) is composed of a long splint for the external side of the limb, with a foot-board, which was moved up and down by means of a screw for the purpose of making extension ; of an inside splint from the perinaeum to the foot, and of an anterior splint reaching from the groin to the ankle. A padded leather band through the perinaeum and buckled into the upper end of the outer splint made the counter-extension. A modification of BOYER's DESAULT was used by Dr. JOSEPH E. HARTSHORNE, of Philadelphia. The counter-extension was made against the perinaeum at the upper end of the inside splint, and both splints were connected at the lower end by a transverse piece through which a long wooden screw passed having a foot-board attached to it. By this arrangement the outer splint could be detached from the inner one without disturbing either the extending or counter-extending force. The splint is figured, after nature, by H. H. SMITH (The Principles and Practice of Surgery, Philadelphia, 1863. Vol. I, p. 625). Liston's modification of DESAULT (R. LISTON, Practical Surgery, London, 1840, p. 88) consists of a straight splint from the axilla to about six inches below the foot, perforated with two holes at the upper extremity and with two deep notches in the lower end, and an opening to receive the external malleolus. The perineal band is tied to the upper end of the splint; the foot is secured to the processes at the lower end of the splint by a roller passing from one to the other, and then junkbag, 344 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X semiflexed position, which was brought into practice chiefly by Percival Pott, found their advocates, although the former was perhaps better known to American surgeons through its modifications by Physick, Gibson, and others. An apparatus on the plan of the double- splint and thigh are all bound together by continuing the roller up the limb. The apparatus keeps up a moderate extension and counter-extension. The splint employed by W. E. HORNER, of Philadelphia (H. H. SMITH, The Principles and Practice of Surgery, Philadelphia, 1863, Vol. I, p. 627) is similar to Physick'8, but the upper extremity of the inside splint is slightly carved out like a crutch head, and has stretched across it a soft leather strap. On the inside of the upper portion of the splint two leather loops are nailed to serve for the attachment of the counter-extending band. Extension was made by adhesive strips. The mode of making extension by adhesive strips and weight is said to have been first employed by Dr. JOSEPH SWIFT, of Easton, Pennsylvania. It was suggested, in 1843, by Dr. ENNIS, a pupil of Dr. SWIFT, to Dr. E. WALLACE, of Philadelphia, and was by the latter successfully employed in a case of simple fracture of the thigh (WM. HUNT, Extracts from Clinical Lectures, in Pennsylvania Hospital Reports, 1869, Vol. II, p. 273). The same mode was employed by Dr. FREDERICK D. LENTE in 1851, in the New York Hospital (F. D. LENTE, A statistical and critical Account of the Fractures occurring in the New York Hospital, etc., in New York Jour, of Med., 1851, Vol. VII, p. 179). It consisted in the employment of broad strips of adhesive plaster (2J or 3 inches), which were applied to the limb previously shaved, on either side of it, from a little above the knee to below the foot, where it was secured to the ring at the end of the screw. The straps are confined by a single roller bandage. To prevent slipping of the plaster the extension is not applied until some hours after the application of the strips to the limb. In 1853, Dr. JOSIAH CROSBY (New Mode of Extension in Fractures, in Am. Jour. Med. Sci., 1854, Vol. XXVII, p. 76) published a description of his mode of procuring extension by adhesive strips, which he " used, for the first time, in 1849," and which he believed had never been suggested to the profession in a manner to attract the attention of surgeons until it appeared in Professor MUSSEY's Surgical Report to the American Medical Association at their session in 1850 (Transactions of the Am. Med. Associa- tion, 1850, Vol. Ill, p. 382). Dr. D. Gilbert (Cases in Surgery, in Am. Jour Med. Sci., 1851, N. S., Vol. XXI, p. 70) substituted a movable for HUTCHIN- SON'S permanent block, which he attached to the straps of a common tourniquet, close to the sole of the foot, placing the instrument upon the distal side of the block and regulating the extension by the screw of the tourniquet, using adhesive plaster as a counter-extending bandage. Similarly, JOHN Neill (New Means for making Extension and Counter-Extension in Fractures of the Leg and Thigh, Philadelphia, 1855, p. 4) made counter-extension by means of adhesive plaster. The ends of the extending and counter-extending strips were carried through their respective holes at the upper and lower ends of the splint and secured to each other about the middle of the outer splint. By twisting these united bands by a small stick the extension oould be increased and maintained. J. McF. GASTON (Counter-Extension with Adhesive Plaster, in Southern Med. and Surg. Jour., 1859, N. S., Vol. XV, p. 672) adapts adhesive plaster to counter-extension in the manner of Gilbert, but claims superiority in this, that he makes the attachment of the strips over the spinous process of the ilium and the trochanter, thus giving more fixed resistance to the force of extension. Dr. L. A. DUGAS (On the Best Plan of Treating Fractures in Country Practice, in Southern Med. and Surg. Jour., 1854, Vol. X, p. 69) employs 4 wooden splints, a little shorter than the femur, secured around the thigh with many-tailed bandages, a long splint from the side of the thorax to a little below the foot secured by separate ties around the abdomen, pelvis, thigh, leg, and foot, a weight fixed to the ankle and hung over the foot-board, and an arch of crossed hoops to protect the toes from the bed clothes. Dr. H. Lenox HODGE (Counter Extension in Fractures of the Femur, in Am. Jour. Med. Sci., 1860, N. S., Vol. XXXIX, p. 565) devised a modification of PHYSICK, with adhesive strip extension and counter-extension. He dispenses with the perineal band, and prevents the patient from rising or sitting during treatment by a piece of iron attached to the long splint which extends over the patient's shoulder, terminating in a blunt hook. A broad piece of adhesive plaster placed on the front and back of the chest, and secured by strips around the body, is looped over a small block of wood which is attached to the hook at the end of the metal bar, thus making counter-extension. To prevent excoriation or sloughing in parts under pressure, the groin, or the perinaeum and the ankle, Dr. B. E. COTTING (Simple Apparatus for Fractures of the Thigh, in the Boston Med. and Surg. Jour., 1861, Vol. LXV, p. 129, etc.) recommends a band of stout cotton or linen cloth made to fit the pelvis and upper part of the hips closely, and a stocking on the leg, with side straps of strong cotton cloth, which should hang free for a few inches below the foot. By these straps extension is made on the Desault splint, the whole leg being brought down with great steadiness, and without the slightest danger from undue pressure on any particular portion. Dr. J. H. PACK- ARD (On the Employment of India-Rubber in obtaining Continuous Extension in the Treatment of Fractures of the Femur, in Am. Jour. Med. Sci., 1862, Vol. XLIV, p. 90) added to the inner and lower end of Physick'S long outer splint a pulley, through the groove of which he ran an India-rubber cord, Becured to the leg and ankle by adhesive plaster. The rubber cord was drawn until a sufficient degree of tenseness had been obtained, when the end was tacked to the outer side of the long splint. Two or three inches of the India-rubber cord should be free between the adhesive plaster and the pulley in order to make the elastic force operative. A similar apparatus is figured by R. Barwell (A Treatise on Diseases of the Joints, London, 1865, p. 266, etc.). Dr. T. H. BACHE (F. W. SARGENT, On Bandaging and other Operations of Minor Surgery, Philadelphia, 1862, p. 179) cut a long narrow fenes- trum in Physick'S outer splint, extending upwards from near its lower extremity; in this fenestrum slides an iron arm, capable of being firmly fixed by screw clamps at any point, so as virtually to lengthen or shorten the splint in adaptation to limbs of different lengths. An ingenious apparatus is described and figured by Dr. Henry N. HEWIT (Original Adaptation of Received Principles of Treatment in Fracture of the Thigh, in Tlie Medical Record, 1868-69, Vol. Ill, p. 217): "It consists of two light flat lateral bars of steel connected by a cross-bar below the sole of the foot. The exterior bar or splint extends from its angle with the cross-bar, six or eight inches below the foot, to the side of the chest opposite the nipple. Two flat bands of steel well padded secure it to the chest and body. The inner bar reaches nearly to the perinaeum, but does not impinge, and the floor of the splint is of flexible metal, carefully padded by a continuation of the bands, which secure it to the limb and buckle in front. The two lateral bars opposite the thigh are fenes- trated, and nuts are inserted capable of sliding longitudinally, through which play the screws, which can be used for the exact application of detached moulded metallic ' splints of coaptation.'" 1 POTT (Percival) (Chirurgical Works, Dublin, 1778, Vol. II, p. 304) ascribed the cause of the retraction of the bone in fractures of long bones to the tension of the muscles: "In the thigh, the case is still more obvious, as the muscles are more numerous and stronger. The straight posture puts the majority of them into action, by which action that part of the broken bone which is next to the knee is pulled upward, and by passing more or less underneath that part which is next to the hip, makes an inequality or rising in the broken part, and produces a shortness of the limb." He discarded all machinery for extension in use, and relied on the relaxation of the muscles by placing the knee "in a middle state, between perfect flexion and extension," supporting the leg and foot by smooth pillows, and inclining the patient's whole body to the outside of the fractured femur. The same position was recommended by Robert White (The Present Practice of Surgery, London, 1786, p. 147) in fractures toward the middle or lower part of the thigh bone, in "order to moderate the subsequent tension; but as soon as the swelling and tightness of the muscles are subsided, the limb should be carefully and gradually brought down, and the toe, knee, and groin kept in a direct line with each other." A double-inclined plane suspended by ropes and cross- bar from a ring was advised by J. N. SAUTER (Anweisung, die Beinbruclu, der Gliedmassen, vorzuglich der complicirten, und den Schenkelhalsbruch nach einer neuen, leichten, einfachen und wohlfeilen Methode ohne Schienen sicher und bequem zu heilen, Konstanz, 1812). The apparatus is figured by Matthias Mayor (Bandages et Appareils d Pansements ou Nouveau Systeme de Diligation Chirurgicale, Paris, 1838, 3m" 6d., PL. 11, FIG. 72). Sir Astley Cooper (Surgical Essays by Astley Cooper and Benjamin Travers, London, 1819, Part II, p. 49, and Fig. 5 of Plate VIII) placed the patient on his back, brought the thigh over a double-inclined plane composed of three boards, one below to reach from the tuberosity of the ischium to the patient's heel, and the two others above, with a joint in the middle by which the knee may be raised or depressed. Sir Astley COOPER, who had employed this double-inclined plane for near twenty years, ascribed its construction to Mr. WHITE, of Manchester, "who had one made of iron, and hollowed to adapt it to the form of the leg and thigh, but this machine was too heavy and too complicated for use. Mr. James, of Hoddesdon, improved upon Mr. White's idea, by having the instrument made of wood, with movable splints upon the sides." Charles Bell (Observations on Injuries of the Spine and of the Thigh Bone, London, 1824, p. 45) also placed the patient on his back instead of the side as advised by POTT: " It is now about eighteen years since I have been accustomed to show the application of the double-inclined plane to fractures of the thigh bone, that it relaxes the muscles inserted into the inner trochanter, and at the same time relaxes all the muscles on the back part of the thigh by the bending of the knee; in short, that it SECT. III. | SHOT INJURIES OF THE FEMUR. 345 inclined plane of Pott, introduced, in 1854, by Professor N. R. Smith,1 and known as Smith's anterior splint, was largely employed in shot fractures of the femur in the early part of the war, the reports indicating that it was used in at least two hundred and eighty-eight instances. Surgeon J. T. Hodgen, U. S. V., in charge of the City General Hospital, St. Louis, forwarded, humours the natural position of the limb; and that instead of having to restrain and bring down the upper portion, the lower part is raised to correspond with it." The apparatus is figured on p. 346 of Vol. II of C. Bell's System of Surgery, London, 1841, and is copied in the adjoining wood-cut (FlG. 209). A modification of Bell's apparatus by J. Amesbury (Observations on the Nature and Treatment of Fractures of the Upper Third of the Thigh Bone, London, 1828, p. 132) was found objectionable on account of its cost and complicated character. It consists of three parts, exclusive of straight splints and straps: one part for the thigh, one for the leg, and the third for the foot. The thigh plane again consists of two pieces arranged to make the upper part of the plane conformable to that of the thigh. Hinge joints connect the thigh and leg pieces, aud the foot-board is fitted upon the leg plane by means of a screw, allowing it to be moved at a greater or less distance from tbe angle of the two planes. A steel rod connects the two planes underneath, by which the angle of the plane may be altered at pleasure. The apparatus can only be prepared by the manufacturer. The apparatus of MATTHIAS MAYOR (loc. cit, p. 6, and PL. 10, Figs. 66, 67, and 68) consists of two planes made of wire and connected by a hinge, with cords to suspend the limb from the bed or ceiling. In 1828, NATHAN SMITH FlG' 209.-Double-inclined plane of C. Bell. [After BELL.] (Observations on Fractures of the Femur, with an Account of a New Splint, in The Philadelphia Monthly Journal of Medicine and Surgery, 1828, Vol. H, p. 51) perfected an apparatus similar in principle to AMESBURY's but of simple construction and material. It consisted of two thin broad pieces of bass wood, so warped that the concavity of one corresponded to the convexity of the under surface of the thigh, and the other to that of the leg. Both were joined by hinge-like rivets. A strap passing from the upper extremity of tbe thigh-piece to the lower extremity of that of the leg, allowed the limb to be fixed at any angle. His son, Nathan R. Smith (Description of an Apparatus for the Treatment of Fractures of the Thigh and Leg, in The Baltimore Monthly Journal of Medicine and Surgery, 1830, Vol. I, p. 305), substituted for bass wood thick binder's board, which he slightly moistened with wetted sponge and shaped into a semi-cylindrical form with the hand. To meet certain requirements, which N. R. SMITH deemed indispensably necessary in the treat- ment of fractures of the femur (Observations on Fractures of the Thigh and Leg; with a Description of an Apparatus applicable to the treatment of such injuries, in Baltimore Medical and Surgical Journal, 1833, Vol. I, p. 13), he devised, in 1833, a new apparatus, consisting of four pieces, viz: two concave planes, the one adapted to the inferior surface of the thigh, the other to that of the leg. These are united by a hinge corresponding to the knee. The third piece is for the foot, and the fourth is connected with the thigh piece, and extends upward beside the body. To allow the patient to change his position, Dr. Smith suspended the limb by means of a cord attached to some fixed point, as already indicated by SAUTER and MAYOR. In LONSDALE'S apparatus (E. F. LONSDALE, A Practical Treatise on Fractures, London, 1838, p. 295) the thigh and leg planes were joined at a point corresponding to the knee by a hinge. A horizontal plane, joined also by a hinge to the upper part of the thigh plane, was serrated at the foot end, allowing the leg plane to be fixed at any angle. This simple apparatus was very generally used in the Middlesex Hospital, London. JOSIAH C. NOTT (Description of a Mod- ification of the Double Inclined Plane, with an exposition of its advantages over other apparatus for fractures of the lower extremity, in Am. Jour. Med. Sci., 1839, Vol. XXIII, p. 21) describes and figures an apparatus similar to LONSDALE'S, with the addition of a foot-board. Three narrow slits are cut through on each side of the thigh plane, two inches from the edges. Through these are drawn leather straps, long enough to pass around the limb after the pads and splints are applied. By means of buckles at the end of the leather straps the limb is firmly secured to the plane. The apparatus of MclNTYRE, of Newcastle (WM. FERGUSSON, A System of Practical Surgery, London, 1842, p. 282), is better known in its simplified form by R. LlSTON (Practical Surgery, London, 1840, p. 96). It consists of a foot-board of wood, and a thigh and a leg piece of sheet-iron made to fit the limb, and capable of being elongated, by means of screws, to suit any limb, or of being adjusted to any angle. A cross plate of iron is attached to the foot end of the apparatus, which is so arranged that it will always rest flat on the bed, whether the limb he raised or depressed. ■SMITH (N. R.), A New Instrument for the Treatment of Fractures of the Lower Extremities, in the Maryland and Virginia Medical Journal, January, 1860, Vol. XIV, p. 1, and The Anterior Suspensory Apparatus for the Treatment of Fractures of the Lower Extremity, in Am. Jour. Med. Sci., April, 1861, N. S., Vol. XLI, p. 346, and Treatment of Fractures of the Lower Extremity by the Use of the Anterior Suspensory Apparatus, Baltimore, 1867. On page 11, etc., of the latter work, Professor SMITH describes the apparatus as follows: "A single splint constitutes the whole of the rigid, or supporting, part of the apparatus. It may be made of wood or wire (FIG. 210). The first employed by me was of wood. It was three inches broad half an inch thick, and long enough to extend from above the spine of the ilium to the toes. It had an angle corresponding to that of the ankle, another at the knee more obtuse, allowing the leg to be very slightly flexed, and a third corresponding to the hip, still more obtuse, slightly flexing the thigh on the pelvis. Two staples, by which to suspend it, were attached to the upper surface, one a little above the knee and the other about the middle of the leg. ThS splint may be sawed, in one piece, out of thick pine plank, or may be made of three pieces united at the angles by nails or screws. I now employ a splint of tinned wire. The size of the wire should be that of a No. 10 bougie. If lighter than this it is apt to spring too much. It is constructed of one piece of wire bent twice at right angles, at each extremity, in the form of a long parallelogram (Fig. 210), being, however, three inches and a half wide at its upper extremity and two and three-fourths at its lower. It must be long enough to extend from a point a little above the anterior spinous process of the ilium to an inch beyond the toes when the leg, foot, and thigh are extended. Three feet eight inches will be sufficiently long for most adults. A little excess of length, above or below, is unimportant. The side pieces are to be sustained by curved cross-pieces at distances of about five inches, firmly clinched and soldered upon them, and having loops in their centres for the attachment of the hooks. The wire frame is then to be bent by the surgeon to suit the case. The lower angle corresponds to the ankle, and is one of aDout 120°, to secure an easy posture of the foot. The angle at the knee is very obtuse, about 160°. The angle at the hip should be of about the same degree. The angle at the ankle should be about five inches from the extremity; that of the hip seven. The middle bend corresponds to the knee. The angles are easily made by bending the splint over the margin of a strong chair or table. It will often be necessary to vary these angles to suit particular fractures. The wire frame is now to be tightly wrapped with a muslin bandage, and it is ready for application. The suspensory apparatus Surg. Ill—44 Fig. 210.—Smith's anterior splint. 346 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. in October, 1862, to the Surgeon General a description of a cradle splint,1 which had been successfully employed by him in the hospital under his charge. "By this arrangement," he writes, "we have succeeded in saving thirty-seven out of fifty-three cases admitted, or ia simple and easy of application. A small iron pulley is to be screwed into the ceiling, over the bed of the patient, perpendicularly over the middle of the shin, or nearly 60. A cord, about as thick as the wire of the splint, passes over the pulley, and is reeved through a small tent-block, by which, slipping it upward or downward, we elevate or depress the limb. The eccentric pressure prevents the weight of the limb from causing it to slip; if not, rub tbe cord with chalk. This single cord, which depends from the block, has a loop at its end, about two feet or more above the limb. Through this another cord, about five feet long, passes and bangs double from the loop, by its centre. Each end has a hook attached to it of the form represented in the cut (Fig. 211). It is made of much smaller wire. When everything is ready for suspension, these hooks are to be attached to the loops in the cross-bars. The application of the apparatus is extremely simple. The limb (we are now supposing a fracture of the thigh) is to be carefully adjusted and laid on pillows still supported by tbe hands of assist- ants. The splint is now to be laid along the upper surface of the limb, the foot portion an inch remote from the instep, the middle angle nearly corre- sponding to the knee. I formerly placed a long narrow compress under the splint, but it is generally superfluous. One may, however, be placed on the instep, and one under the hip extremity of the splint. I now pass a piece of wet bandage, long enough to embrace the limb and overlap, under the foot and over the splint, so as to embrace both, not tightly. I pass another, also wet, around the ankle, another beneath the knee, a fourth above the knee, and a fifth around the thigh near the hip. Button-hole slits may be made near the end of each sling, and these be buttoned on to the loops in the cross wires of the splint. The limb being still kept extended by the hands of FIG. 211.—Shows suspension apparatus and the member attached to the assistants, the hooks are now to be applied. It is very important to select splint by the slings at four points, preparatory to the application of the .... ..,.., . ... .... „ .. bandage, f After Smith 1 properly their points of attachment so as to adjust well the centre of gravity of the limb. In fractures of the middle of the thigh, I attach the upper hook nearly over the seat of the fracture; the other a little above the middle of the leg. By pulling upon the tent-block the limb is now gently raised from the pillows and hangs suspended in the slings. Observe now whether the upper portion of the splint presses down too much upon the thigh, or springs up too much from it. If the former occurs, then attach the upper hook higher; if the latter, attach the lower one lower. But this may be cor- rected, if slight, by slipping the cord, with tbe hooks attached, through the loop of the single cord so as to correct the bearings, and securing it with a piece of twine just below the loop to keep it thus. The limb being now raised, so that one may pass his hand under every part of it, the application of the roller is made. The surgeon commences with the foot, the splint being held steady. Three or four turns are to be made loosely around the foot, care being taken not to press it upward against the splint, which it must never touch. Then figure-of-8 turns are made around the ankle and foot, and the roller is carried upward along the leg and thigh, reversing, where necessary to make perfect adaptation, and great care being taken not to crowd the limb too firmly against the splint. On reaching the hip with the roller, a few spica turns are to be made obliquely through the groin and around the pelvis, concluding with two direct turns around the pelvis (FIG. 212). I often besmear tho whole under surface of the bandage thus applied with starch. This prevents the slipping of the bandage, and preserves a uniform and accurately adapted surface of support." Fleet Surgeon JAMES C PALMER, U. S. N., applied, in a case of fracture of both thighs (Herbert Smith, Assistant Surgeon, U. S. N., Case of Fracture of Both Thighs, in Am. Jour. Med. Sci., 1865, Vol. L, p. 58), a modification of SMITH'S anterior splint. It consisted of two continuous parallel rods of No. 9 iron wire, passing over the anterior surfaces of both limbs, from the toes upward, arching over the pubes clear of the anterior spinous processes, and bent at the groins at an angle of about 30 degrees. The abdominal arch was well padded. Roller bandages were employed as usual, and the limbs, slung separately, were suspended by a single cord passing over a pulley at the ceiling, and making extension at an angle of about 30 degrees. 'Dr. HODGEN published a description of the cradle splint in the American Medical Times, New York, January to July, 1863, Vol. VI, p. 245: "Having experienced great difficulty in dressing compound fractures of the femur when the wound was on the posterior part of the limb, I at length devised the apparatus to meet this difficulty. The wood-cut (FlG. 213) shows the construction of the cradle, so that I need only give the measurements and mode of application. The foot-board is four inches and a half wide, one inch thick, and fourteen inches high (or long),.supported on a base fifteen inches long and one inch square. The centre support is seven inches high, eight inches on the base, and one inch thick. The uprights of this portion are one inch wide at the top and one inch and a half wide at the base; this piece is placed twenty-one inches from the foot-board. The longitudinal strips are forty-two inches long, one inch and a quarter wide, and half an inch thick; one end of each of the four is fastened by screws to the foot-piece, two at the base, the remaining two above them, leaving spaces of four and a half inches between the lower and upper pieces. The lower strips are fastened to the outside of the centre support at its base, the upper at the inner side of the upright portion, thus forming the frame represented in the cut (FIG. 213). This may be adapted to either limb by binding the ends of the pieces designed for the perinaeum and pubes, the lower one from above and the upper from below, and shortening them so that the foot will come near the foot-board—the upper strip passing in front of the pubes and the lower a short distance from the perinaeum. Strips of cotton or linen cloth, two and a half inches wide, are now placed on the upper longitudinal bars, and pinned, so that they form a double-inclined plane on which the limb may rest. These suspension strips are placed in contact with each other, and, being distinct, any one may be removed and replaced to insure cleanliness, when necessary, without disturbing the limb. The limb is then prei>ared by placing broad strips of adhesive plaster on either side of the leg and securing them in the usual manner by a roller. It is then placed on the suspension Fig. 212.—Represents the member as completely dressed and suspended. [After Smith.] Fig. 213.—Hodgen's cradle splint for fractures of the femur. SECT. III.] SHOT INJURIES OF THE FEMUR. 347 of 66 per cent." Surgeon J. H. Brinton,1 U. S. V., to whom Dr. Hodgen's paper was referred by the Surgeon General for examination and report, recommended that a "certain number of these cradles be issued to tlie surgeons in charge of the Washington hospitals, in order that this mode of treatment be fairly tested. I do not anticipate for it a failure." In the campaign before Kichmond, in 1862, Acting Assistant Surgeon J. Swinburne2 pro- posed a plan for counter-extension available on the field, whereby the stretcher becomes the splint, and the system of extension can be carried into effect immediately after the receipt of the injury. In 1863, Dr. Hodgen3 proposed a second apparatus, "a combination of the strips, and the free ends of the adhesive plasters placed around the foot- board and secured to it. A strong cord is fastened to the middle of the foot- board at a proper height, and passed over a pulley which is to be screwed into the foot-board of the bedstead. A bag containing from five to twenty pounds of sand is attached to the cord, and this weight serves as an extend- ing force. Two or more bricks are placed under each of the legs of the bedstead at the foot, thus elevating it four or six inches and allowing the weight of the body to serve as the counter-extending force. Thus the limb is suspended so that the air circulates freely under and about it." ' Surgeon J. H. BRINTON, U. S. V., to whom the paper of Dr. HOD- GEN was referred by the Surgeon General for examination, reports: "The essential portions of this treatment seems to be that the fractured limb is Fid. 214. - HODGEN'S splint applied. suspended in a cradle formed by strips of bandages attached laterally to a framework. These strips are so arranged as to form a double-inclined plane. Extension is obtained by the attachment to the foot of a sand bag of from five to twenty pounds weight. By raising the foot of the bed from six to eight inches, the weight of the body is made the counter-extending force. Surgeon HODGEN also suggests that the same result may be obtained by the use of SMITH'S anterior splint, widened at its upper end, with an oblique suspension for procuring counter-extension. In other words, this latter modification is almost identical with this apparatus as it is applied in our eastern hospitals in the treatment of compound fractures. The only difference in the application, according to the views of Dr. Hodgen, is the absence of redundant band- ages. The advantages which Surgeon Hodgen claims for his cradle splint is the increased ventilation, the cleanliness, and the ease with which portions of the dressings may be changed; all of these ends are, however, attained by the use of Smith's anterior splint, judiciously applied, and suited to the exigencies of each individual case. From a careful study of very many cases of gunshot fractures of the thigh, both in our western and eastern hospitals, I have come to the conclusion that the treatment by suspension, in some form or other, is preferable to the use of the Desault or other immobile appa- ratus. I believe that the methods of Surgeon Hodgen and Dr. Smith will alike be productive of good results, when properly applied and carefully attended to. The success which has been obtained by Dr. Hodgen I do not attribute so much to the new form of dressing employed as to the care, time, and attention which he personally bestows upon the cases under his charge. . . I would state, that when it is decided to try and save the limb, I should be inclined to regard the treatment suggested by Dr. HODGEN as a valuable one. It possesses, I think, all the advantages of the anterior splint, and, in the hands of a young and inexperienced surgeon, is, perhaps, more manageable. The extension can be more readily graduated, and the limb of the patient is equally open to the inspection of the surgeon. The chief objeotion to its employment is the mobility of the counter-extending point. This fact, which would lessen its value in the treatment of a simple fracture of the thigh, is of little moment in the class of cases resulting from gunshot injuries. In the latter, the life of the patient and the consolidation of the fracture are the chief points at stake; shortening or deformity matter but little. I would, therefore, respectfully suggest that a certain number of these cradles be issued to the surgeons in charge of the Washington hospitals, in order that this mode of treatment may be fairly tested. I do not anticipate for it a failure." 2The plan was explained in a paper read before the New York State Medical Society, in February, 1864 (Transactions of the Medical Society of the State of New York, 1864, p. 159), and a MS. copy thereof was sent to the Surgeon General U. S. A., by Dr. J. V. P. QuaCKKS'bush Surgeon Gen- eral of the State of New York, on April 11,1864 : "As soon after the injury as practicable, to place the patient ou a bed or stretcher, extend the limb as near as possible to its normal r length, without giving too great pain, retain it in that posi- tion by fastening the patient's foot to the foot of the bed or stretcher by means of adhesive plaster, as I am in the habit of doing in ordinary fractures of the thigh (Fig. 215). Of course there should be no bandaging of the leg or thigh. Make the counter-extension by the use of a large perineal belt fastened to the head of the bed or stretcher. In order more fully to make the stretcher a splint, I propose to place two sliding iron rods, 4, 4, the length of which should be from 8 to 12 inches, and placed upon the handles of the 1'1,;' 215-SWISBUKMs'B plan of applying early extension. [After Swinburne.| stretcher, which are to be provided with thumb screws, 3, 3, to keep them iu any desirable position, and allow of their being depressed, elevated or extended, as the case may require. The foot-slrap or cord can be fastened to the sliding iron rod, 4, 4, at the foot of the stretcher, while the perineal belt, 2, can be fastened to the sliding iron rod or arm, 4, 4, at the opposite end. Thus making an apparatus for the treatment of this fracture as complete and perfect as can possibly be produced in private practice; and since the majority of these fractured bones suffer no loss of substance, why should we not then succeed in effecting as good results by this method in army practice as in private practice ?" 'HODGEN (J. T.) (On the Treatment of Gunshot Fractures of the Femur and Tibia, in American Medical Times, 1863, Vol. VII, p. 169, and in 77ie St. Louis Medical and Surgical Journal, January and February, 1864, Vol. I, p. 20): " The body of the splint is made of No. 2 iron wire, which is sufficient to support the limb, all of one piece, bent as seen in the cut (Fig. 216). The dimensions are as follows: Four inches across the bottom of the foot ; twenty-two inches from the foot to the bend at the knee; twenty inches from the bend of tho knee to the upper ends of the wire (corresponding to the pubes and hip when applied). These upper ends are eight or nine inches apart, being separated by a bow of thick wire; another similar bow is placed at the knee, having a span of six inches. These two bows are made so as that they can be put on or taken off without disturbing the dressings, and are put in position after all else is arranged—the one at the hip having a loop at each end to receive the upper end of the splint wires, the other simply hooks, to be looped on at the knee. A roller bandage may be placed around the hips and upper end of the external limb, the splint to keep the latter in place, if required. How applied: A bandage is applied to the foot: an adhesive strap, three inches wide, is applied to each side of the leg, extending four or five inches below the foot, and up to the knee in case of fracture of the femur ; or to the fracture, in case the tibia is the injured part. The roller is then extended smoothly over the adhesive plasters. That limb of the splint designed to pass next the pubes is bent upward, at a point 318 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X principles of Smith's anterior splint, Swinburne's extension, and the strip bandage supports used in the cradle splints," which he had found in some respects more desirable than the cradle splint. Dr. Gurdon Buck's apparatus,1 a modification of Physick's Desault, in which the long splint was dispensed with, and constant and uninterrupted extension was kept up from the bend of the knee in the splint, corresponding to the distance from the bend of the knee to the pubes on the sound side of the body. Strips of bandages three inches wide are now looped over one limb of the splint, continuously from the upper to the lower end, and allowed to belly downward a distance equal to two-thirds of the diameter of that part of the extrem- ity designed to rest upon each one; the other ends of these strips are pinned over the other limb of the splint, thus forming a double-inclined trough in which the extremity is now to be placed on these strips of muslin. The free ends of the adhesive strips are next fastened to the cross-piece at the foot, three inches apart, and the whole suspended from a pulley fixed to the ceiling or a frame; the pulley should be almost over the foot if the ceiling be eight or ten feet high, giving the suspend- ing cords an oblique direction, that in this way we may have sufficient extension. If the patient is disposed to slide toward the foot of the bed, this must be elevated on two bricks under each of the legs at the foot of the bedstead." 'The apparatus used in the New York hospitals since 1859 (G. F. SCHRADT. Report of the Proceedings of the Medical Society, in New York Journal of Medicine, 1859, Vol. VI, 3d series, p. 239) is ex- plained in the Am. Med. Times, 1861, Vol. II, p. 214. The following description is taken from BUCK (GUBDON), (Description of an Improved Extension apparatus for the Treatment of Fractures of the Thigh, in The Medical Record, 1867-68, Vol. II, p. 49): "Articles composing the apparatus: Two bands of adhesive plaster spread on Canton flannel or thick twilled cotton; each band being two inches and a half wide and two feet long. At the end of one of the bands a piece of elastic rubber webbing, two inches wide and ten long, is attached. At one end of the other band a buckle of corresponding width is fastened. A thin block of wood three inches and a half wide transversely and three inches verti- cally. The perineal portion consists of rubber tubing of one inch calibre, having inside of it a tube of muslin stuffed with bran and left an inch longer than the rubber tube at both ends. At each end of the muslin tube a metallic ring is first fastened, and then shoved within the rubber tube, to the end of which it is also fastened. This arrangement prevents the rubber tube from being over-stretched. Two straps fastened to the rings at the ends of the perineal portion serve to lengthen it and allow it to be made fast to the head of the bedstead. A belt that passes around the opposite side of the body, and maintains the bearing of the perineal band in a line with the axis of the body and limb. The perineal portion should be wound with a narrow strip of Canton flannel or other soft material, and this should be changed as often as soiled. Four guttered coaptation splints, covered with flannel, are intended to surround the fracture and be secured in place by three elastic bands, each having a buckle at one end. An upright support- ing a pulley wheel, to be fastened to the floor by three screws, opposite the foot of the bed. Mode of application: The bands of adhesive plaster are first to be applied, one on either side of the limb from a point above the ankle upwards as high as the seat of fracture. The limb is then to be bandaged in the usual manner, beginning at the toes and covering the plasters, but leaving their lower ends free. The band of elastic webbing is next passed around the sole of the foot and fastened to the buckle on the other side of the foot. The block of wood should then be interposed between the loop of webbing and the foot. A cord fastened to the block thus adjusted is passed over the pulley, and has a weight suspended from it. This arrange- ment combines elasticity with the extending force, keeps the bands stretched out smooth, and pre- vents pressure upon the ankles. The amount of weight required must be proportioned to the resist- ance to be overcome and the toleration of the pa- tient. Sometimes five or six pounds only can be borne at the outset, and an increased weight sub- sequently. After a fracture has taken place the sooner the limb is put up and subjected to treat- ment the better. Spasmodic twitchings of the muscles are controlled, and the patient made com- fortable from the outset. To permit the applica- Fig. 216.—J. T. Hodgen's suspension apparatus. Fig. 217.—Gurdon Buck's apparatus. tion of lotions to the seat of injury during the first few days, the bandage should not be carried above the knee, and the ends of the plaster should be rolled up and kept in reserve. At the end of six or eight days the plasters may be extended up on the thigh and the bandage continued over them. The coaptation splints are now to be applied around the thigh and secured by the three elastic bands. To complete the apparatus the perineal band should be adjusted and its ends fastened to the head of the bedstead so as to be in a line with the axis of the body and limb. The limb should be raised on a hair cushion sufficiently to keep the heel from pressure. In the employment of this method of treatment, experience has shown that in a large majority of cases the use of the perineal band may be dispensed with, the weight of the body being sufficient to resist the extending force. This resistance may be further increased by raising the foot of the bedstead five or six inches above the floor. The advantages claimed for this method over others hereto- fore in use are its great simplicity of arrangement, facility of management, and especially the comfort it affords the patient during a long confinement in bed. The efficiency with which uninterrupted extension of the limb can safely be kept up secures, it is believed, better results than have been obtained SECT. HI.] SHOT INJUKIES OF THE FEMUR. 349 by means of a weight and pulley, was frequently employed during the war.1 Dr. Vedder,2 in 1862, recommended a long straight splint, which by a mechanical arrangement may be folded in the middle when not in use, and securely straightened when desired. Extension is made by a rachet pulley, a drawing of which has already been given in Figure 570, on page 812 of the Second Surgical Volume. During the last year of the war a combined splint and fracture bed, constructed by Dr. I. Langer,3 was used with favorable results by by any other method. The sitting posture may be allowed without disturbing the action of the apparatus ; an indulgence for which patients are always very grateful, and one which greotly alleviates the irksomeness of their condition. The materials required for employing this treatment are obtainable under almost any circumstances, the only indispensable article being adhesive plaster. If this is of the ordinary description it is better to use it of double thickness. All the other articles requisite may be improvised. The elastic band may be dispensed with, and a round stick properly placed across the foot of the bedstead may serve instead of a pulley." ■In a report to the Surgeon General, in February, 1863, Surgeon H. J. CHURCHMAN, U. S. V., speaks favorably of BUCK'S pulley: "In regard to mechanical appliances I much prefer BUCK'S pulley with side splints rolled in muslin, which may be so tacked to splints as to permit their being easily thrown down for dressing or inspection. Of course when there is a discharging wound the splint must be so shaped as to leave wound readily accessible. In lieu of the usual counter-extending adhesive strips or the galling perineal band, I propose to substitute, when attainable, the old-fashioned ribbed corset, lacing up in front with side buckles, by which, with strong tapes, the body may be secured to the buuk or bedstead. The tape might be tightened or loosened as deemed necessary. This apparatus would relieve materially the vexation of spirit to both surgeon and patieut necessarily incident to the old plan. I propose this iu connection with Buck's pulley, while the side 6pliuts, arranged as I have stated, give uniform support to the limb iu its whole extent and keep it in proper line. In the absence of the corset, I have heretofore advantageously employed in several instances Buck's pulley, with side splints as described, and elevation of foot of bed, as described in case 5. The corset will relieve a position found more or less uncomfortable to patient. The only objection in theory is the difficulty of defecation when bound down by the side straps. In practice there is no serious difficulty when using the bed-pan. If deemed necessary, however, the men cau readily unbuckle the straps for the time." 2 Vedder (JOSEPH H.), New Apparatus for the Treatment of Fractures of the Long Bones, in American Medical Times, 1862, Vol. IV, p. 254. 3 Under the direction of the Medical Director of the Army of the Potomac, Colonel T. A. MCPARLIN, Dr. Langer's apparatus was tried by Sur- geon W. L. FAXON, 32d Massachusetts, who reports, on March 28, 1865: " I have the honor to report that on the 7th and 8th days of March, 18(i.">, I witnessed the application of Dr. I. LANGEK'S combiued spliut and fracture bed, in two cases of compound fracture of the thigh, one near the trochanter major, the other at the middle third, in consequence of gunshot injuries. Each of the patients were transferred and located comfortably, iu teu miuutes, from the beds on which they were lying to Dr. Langek's beds, with the aid of two assistants. Exteusiou and counter-extension were applied from the beginning. No anaesthetics were given, and the patieuts have evinced no suffering. The changing of the sheets lying under the patients and the evac- uations from the bowels during their confinement were effected without the necessity of lifting the patients from the beds they were first put on. The discharge of the matter from three wounds in the first case—the bullet entering at the edge of the nates on the left side, penetrating the left thigh, and entering the right limb one inch below the tuberosity of the ischium—as well as from the two wounds in the second case, has not at any time made the patients uncomfortable, as the matter and the water used for cleansing ran off freely. The position as well as the axis of the limbs are nearly straight, and the shortening iu neither case exceeds one inch. I consider Dr. Langer's combined splint and fracture bed as I have seen it in opera- tion at this hospital as the best appliance I have used, or seen used in the army. The patient can always be made comfortable; he seldom requires opiates to procure sleep (in neither of the cases above quoted were any bed-sores); tbe patients can always be kept clean, the bed clothing is not at all soiled, one nurse can take care of as many cases as of simple wounds, and the operation of lifting and shifting the patient in dressing of the wound is entirely avoided, an object of great im- portance to all concerned; and I respectfully request that fifty of Dr. Danger's beds be furnished for use of this hospital, if possible." This report received FIG' 818.-Dr. I. Danger's apparatus. the favorable endorsement of the Acting Chief Medical Officer of the Depot Field Hospital at City Point, Surgeon G. B. Parker, TJ. S. V., and was for- warded to the Surgeon General of the Army for favorable consideration by the Medical Director, Colonel T. A. McParun. Dr. Langer's apparatus consists of a triple-inclined plane, on which extensiou and counter-extension of the fractured femur is kept up by the weight of the body and the leg: " It is constructed of iron and covered with duck-cloth; its weight is twenty-six (26) pounds, including the straps to swing the apparatus in an ambulance wagon or anywhere else. It consists of: a. One head piece. 6. Two trunk bars. c. One cross piece, d. Two thigh pieces. «. Two leg pieces. /. Two bows under the knees. The thigh as well as the leg piece, for the injured limb, has pins to support the straps on which the limb rests, a. Head piece connected with the trunk bars, arranged to change its relative position, when vertical, to form a shelter to the head, when horizontal, to make an elongation to the trunk part for the head to rest on, or serving instead of legs, when set down, with a strip of wood at its opening to keep it spread; it is covered with double cloth, which is to be stuffed if chosen. 6. Two trunk bars, connected with the head piece by bolts and thumb-nuts; to the necks of the bolts straps are fastened to swing the apparatus. On each of the bars is a loop for an additional strap, to support the arm, or if the wounded man is exposed to the weather, to attach there a storm hood. Between these bare cloth is stretched for the patient to rest on. A blanket and a sheet doubled up and spread over the cloth before the patient is laid ou it will enhance the comfort. These trunk pieces are connected with the cross piece in a manner as to allow the change of their relative position from a level with the thigh pieces to an angle of 45°. c. Cross bar, with a bend nine inches, opening to receive a bed-pan with a neck on each end, to rest on a fulcrum having a head to secure against slipping. Near the angles of the bend are two holes to receive the screws of d. d. Two thigh pieces, rotating in a loop counected, movable, with-a screw and thumb-nut, with the cross-piece so as to allow either of the two thigh pieces to elevate or lower nearly three-fourths of a circle; also to allow to separate one from the other; but if wanted stationary they are fastened together by a 350 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. surgeons of the Army of the Potomac. In a few instances the single long splint of Dr. Kimball1 was preferred. Assistant Surgeon W. Thomson, U. S. A., substituted the "bran box for Hodgen's splint, which had become uncomfortable and difficult to adjust."2 Surgeon J. T. Woods, 99th Ohio, employed the double-inclined plane in fractures of the femur near the trochanters, and Desault's splint, or some modification thereof, in fractures of the middle third of the femur.3 Surgeon E. McDonnell, U. S. V., advised that in fractures of the upper third of the femur all extension apparatus be dispensed with as liable to produce a hiatus between the fractured ends, leaving, on account of the absence of periosteum and nourishing vessels, no chance for repair, and that the limb be simply placed in an easy position regardless alike of deformity and shortening.4 The danger of producing such a separation of the ends of bone as might delay if not interfere with the union of bone was pointed out by Dr. J. R. Lothrop, at the Buffalo General Hospital,5 and other surgeons. The method of wiring together the fractured ends of long bones proposed by Assistant Surgeon B. Howard,6 already referred to in the Second Surgical Volume, at page 819, found key; four holes on each end, to adjust the length and to connect with the spreading bows under the knee and the leg pieces. On each end of the thigh pieces are slats for the straps to swing the apparatus; when the two thigh pieces are connected by key there is still a place left for defecation, e. Two leg pieces, with four holes on each end, to be adjusted and connected outside of the end of the thigh pieces; the cross bars of each have a hole for a cord to pass through, to fasten a weight to the foot if required; to the cross bar is a strap fastened to swing the apparatus. The inner comer to be connected with a cord. One of the thigh as well as one of the leg pieces has pins to fasten the straps stretched across for receiving the injured limb to rest on. The other is covered with cloth; both of them have a well padded cushion secured at the end near the cross piece, f. Bows under each knee, to connect by a bolt and thumb-nut, inside of the ends of the thigh pieces, to keep the thigh and leg piece from drawing together by the weight of the limb resting on them. To these two bows a strap is attached, which fastens to the floor, preventing side motions or raising the whole apparatus." 1 Sargent (F. W.), On Bandaging and other Operations of Minor Surgery, Philadelphia, 1862, p. 182. Dr. KIMBALL'S splint extends from tho axilla to below the foot, but is so contrived as to be capable of being lengthened at each extremity by sliding bars. The upper sliding bar terminates in the manner of a crutch; to the lower is secured at right angles a transverse bar, which is moved up and down by screw, thus regulating extension at will. The perineal band is used, but may be discontinued with safety by moving the upper crutch-like sliding bar into the axilla. 'Report of Assistant Surgeon Wm. THOMSON, U. S. A., in charge of Douglas Hospital, Washington, for June, 1863 (File A, No. 103): "It is difficult to conceive of a more suitable apparatus for compound gunshot fractures of the thigh than the Bran Box, properly arranged. The limb is sup- ported at every point; the skin is kept cool and dry, and the profuse discharge easily removed at each dressing. Where extension is desired, it can readily be mado by fastening the adhesive strips attached to either side of the leg to the box and then adding a sufficient weight to a cord fastened to the foot-board." 3 In his report from the hospitals at Chattanooga, Surgeon WOODS remarKs: (: The limbs were placed in positions most comfortable to the patient for some time, when, suppuration having at last become much reduced in quantity and the reparative callus was being thrown out, they were (usually under chloroform) placed in some form of splint with moderate extension and counter-extension. My observation led me to conclude that the double-inclined plane is inferior save where the fracture is within a short distance of the trochanter, and the tilting of the upper fragment requires the adaptation of the lower fragment to it by changing the position of the leg from the straight line, and possibly when the fracture is so low down that the condyles are drawn backward and downward. SMITH'S anterior splint failed to meet my expectations in every particular. D? it be applied as Dr. SMITH directs, the parts are hidden from view, sacculation of pus occurs, drainage is imperfect, and filth accumulates in the bandage. If the leg be simply suspended in the wire frame, sufficient quietude of the parts is not maintained, and the extension is neither sufficient nor reliable, and, if the fracture be in the upper third, the motions of the body produce movement in the fractured extremities—just what a splint is designed to prevent. The splint of DESAULT, modified in various ways to suit particular cases, can be so applied as to secure the desired immobility, extension, drainage, exposure, and cleanliness. My impression from observing these cases leads me to conclusions briefly summed up thus. . . The proper dressing of a limb is really of great importance and very much underrated. That 'supporting' diet in the early stages of these injuries is overestimated. That an object of the first importance is to secure an abundance of fresh air, cleanliness, and perfect drainage. A very great error consists in excessive bandaging—a limb is better off without bandaging or splints until reparation has commenced. The covering of gunshot wounds with lint, either picked or patent, is objectionable; the pus drying at the edges glues it fast and is not permitted to drain away. The best splint for fracture at the trochanter major or immediately above the condyles is some form of the double-inclined plane, and, for fractures in the middle of the femur, some modification of the DESAULT splint." 4 Surgeon E. McDoxnell, U. S. V., who had charge of a field hospital after the battle of Antietam, remarks, in a special report, transmitted in Feb- ruary, 1863, of a fatal case of fracture of the upper third of the femur treated by Buck's apparatus: "It appears to me the lessons most practically deducible from the foregoing case are two, viz: 1st, that there was such a destruction of bone that when the limb was extended by Buck's plan a hiatus was produced between the fractured ends, as left by the absence of periosteum and any nutrient vessels no chance for repair—hence I think this or any apparatus separating the fractured bones destructive of our hopes of a good result. This case, with many others in the hospitals of Sharpsburg, gave ample scope for contemplation on the different methods devised by distinguished members of our profession to advance conservative surgery. The result of my observation is that, should I ever have charge of as many wounded men as those in the Sharpsburg hospitals, over which I had control, I should in all cases of badly compound comminuted fractures of the femur in the upper third dispense with all extension apparatus, and simply place the limb in an easy position regardless alike of deformity and shortening (amputation being out of the question). This I am persuaded is the treatment to save most lives." 'LOTHROP (J. R.), A Case of Gunshot Wound of the Femur, in Buffalo Med. and Surg. Jour., 1866, Vol. V, p. 470. 6 In his article (The Application of Sutures to Bone in Recent Gunshot Fractures, in the Medico-Chirurgical Transactions, London, 1865, Vol. XLVIU, p. 252) Dr. Howard defends this expedient: " The shock of the operation involved in this plan of treatment, superadded to that of the original wound, immediately suggests itself, of course, as an objection to its adoption. Over against this, however, we must weigh the immediate dangers pre- viously enumerated from the pressure and constriction of tight dressings attending the use of simple splints. Those from the enclosed fragments and spicuhe during transportation being in continual motion, and afterwards awaiting tedious extrusion by the slow processes of nature, keeping the patient in a condition which renders him continually susceptible to various intercurrent diseases, and, should union be ultimately effected, tbe degree of effort called forth for its accomplishment has left behind such a surplus of provisional callus, and other pathological changes in the parts adjacent, as seriously to diminish the usefulness of the limb for a long period, with a still further danger that after apparent recovery tertiary sequestra, as mentioned by Dui'UY- TRKN, may continue to be extruded for ten, fifteen, or even twenty years thereafter. Iujhe operation described the chief causes of the evils above enumer- ated are removed. Iu advantages consists mainly in this: 1st. Negatively: In the absence of everything which may act as a foreign body and dangerous SECT, m.] SHOT INJURIES OF THE FEMUR. 351 even less favor in shot fractures of the femur than in those of the humerus, and it seems that in one instance only this plan was attempted: Case 497.—Private H. Itigalls, Co. B, 6th Ohio Cavalry, was wounded during the engagement near the Pamunkey River, May 28,1864. He was admitted to the field hospital of the 3d division, Fifth Corps, whence Surgeon L. W. Reed, U. S. V., reported the injury as a "severe shell wound of the left thigh." From the field hospital the patient was moved to White House Landing, where he died from the effects of his injury on June 2, 1864. This case has been identified as one published by Dr. Benjamin Howard, late Assistant Surgeon, U. S. A. (Medico-Chirurgical Transactions, London, 1865, Vol. XLVIII, p. 251), as follows: "On May 29, 18G4,1 was called in consultation on the field to see the patient, who was sixty years of age and of broken down constitution; he had received a severe fracture of the femur from a large fragment of shell, which I found firmly wedged into the bone about three inches above the knee. From this point there proceeded a long oblique fracture, running upwards and outwards, with some comminution of the inner aspect of the bone in the vicinity of the piece of shell. The sharp pointed lower fragment was overriding the upper, causing a shortening of about three inches, reduction of which, with such a wound, could not possibly be maintained with splints alone during transportation. Having made the requisite incision and extracted the impacted piece of shell, I proceeded to remove the looser fragments; then causing steady extension to be kept up while I kept my finger and thumb in the wound, I guided the fractured ends so that the corresponding serrations were accurately refitted to their original position for about two thirds of the circumference of the bone. Having somewhat enlarged the incision, I directed the limb to be so bent upon itself as to slightly reopen the fracture, while I drilled the requisite holes and passed a suture, which firmly secured the interlocked fragments, rendering shortening or shifting impossible. A straight splint was then applied, the wound being left exposed for the repetition of cold-water dressings. After the operation the patient ceased to com- plain of pain and seemed very comfortable. The next morning he was hurried away in an ambulance train, and I saw no more of the case. In consideration of his age, the nature of the wound, and his broken-down constitution, I was not surprised when subsequently I incidentally heard that he died on the road three days afterwards." The amount of shortening1 of the injured limb was indicated in seven hundred and thirty-two2 of the sixteen hundred and eighty-nine cases of recovery after shot fractures of the femur treated by conservation, varying from one-quarter of an inch to eight inches, and averaging 2.31 inches.3 In fifty-two cases the reports indicated shortening, but the precise amounts were not stated. In twelve instances it was recorded that there was no shortening whatever, and in eight hundred and ninety-two this point was not noted. One instance is reported in which the limb was found lengthened :4 source of irritation. 2d. Positively: In securing complete coaptation and perfect rest. This plan of treatment is new only in its application. Substan- tially the same operation, including the use of the wire suture, has for a long time been practised, and still meets with general approval, as a secondary operation for ununited fracture. Other things being equal, why should it be less advisable as a primary one, where, in the absence of all pathological changes, we have a healthy condition of all the parts, with sound bone in apposition and at rest. These considerations led me to hope for a healthy pro- cess of uninterrupted repair, with speedy use of the limb after union. The selection of the cases'(which at most must be quite limited in number, either on the field or in civil practice), the amount of bone which may be with propriety removed, etc., must, of course, be a matter of careful judgment." 1 The exact amounts of shortening in the 732 cases in which this point was ascertained are: J of an inch in 1 instance; J in 1; J in 20; J in 17; 1 in 77; liinl9; li in 1; 1£ in 80; ljinl3; 2 inches in 179; 2|in2; 2Jin5; 2J in 82; 2} in 14; 2Jinl; 3 in 111; 3iiu5; 34 in 23; 3|in3; 4 in 42; 4Jin6; 4| in 1; 5 in 16; 5Jin3; 6 in 5; 6£inl; 7 in 2; 7J in 1; 8 in 1. 2 Assistant Surgeon DEWITT C. PETERS, U. S. A., in a letter to Medical Inspector JOHN M. CUYLER, U. S. A., dated Jarvis TJ. S. A. General Hospital, Baltimore, January 11, 1864, remarks: " Recently I had the opportunity of hurriedly examining twenty-five rebel prisoners who were wounded at Gettysburg, and had, up to a late period, been treated in hospitals near the field. They were lying side by side and had compound gunshot fractures of the femur. My time was limited, as they were under orders to embark for exchange; but I measured their injured limbs and found the greatest amount of shortening to be four inches, and tbe least about one inch. Average near two and a quarter inches. I believe you were instrumental in having these bad cases retained near the battle field, also many others, and the happy results prove your wise forethought. I have long argued that many of these cases were killed by transportation employed too early. The cases I saw fully show how much nature can do; but I cannot say so much about the treatment, for some of them were strangely crooked, bowing every way. I think with proper extension and counter-extension they might have been greatly improved. I thought the mention of them might be interesting, as they were prisoners and depressed in spirits; it further adds to our knowledge of nature's reparative powers when aided." 3 The instances in which the shortening of the limb after recoveries from shot fractures of the femur has been recorded in military surgery are few: STKOMEY'ER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 724) remarks that he has notes regarding the length of the limb in 1.2 of the 15cases of shot fractures of the femur that he observed. In one of these the shortening was 5 inches; in 1, 4 inches; in 4, 3 inches; in 5, 2 inches; and in 1,1 inch, averaging 2$ inches. Chenu (J. C.) (Rapport, etc., pendant la Campagne d'Orient en 1854-55-56, Paris, 1865, p. 375 et seq.) cites 126 cases of recovery after shot fractures of the femur. The amount of shortening is ascertained in 32 cases, varying from 3 to 11 centimetres, and averaging 5.7 centimetres, or about 2£ inches. WILLIAMSON (GEORGE) (Military Surgery, London, 1863, p. 138) reports, from the mutiny in India, in 1857-58, 13 cases, viz: "Limb 3 inches shorter in 3; 2J inches shorter in 1; IJ inch shorter in 4 ; and 1 inch shorter in 5 instances;" an average of 1.7 inch. CHENU (J. C.) (Stat. Mid. Chir. de da Camp, d'ltalie en 1859 et 1860, Paris, 1869, p. 715 et seq.) reports, among 118 cases of recovery, 25 cases with shortening varying from 2 to 15 centi- metres, the average being 7 centimetres, or 2| inches. BECK (B.) (Chirurgie der Schussverletzungen, Freibmg, i. B., 1872, p. 694 et seq.) ascertained the shortening in 23 instances varying from 1 to 4J inches, averaging 2.25 inches. CHENU (J. C.) (Aperepn, Hist. Stat. et. Clin., Paris, 1874, p. 453 el seq.) records 705 invalids after shot fractures of the femur treated by conservation. Shortening is stated to have existed in 426 instances; in 201 cases the amount of shortening is definitely stated, and varies from 3 to 23 centimetres, averaging 7.4 centimetres, or very nearly 3 inches. According to these limited statistics the average shortening in shot fractures of the femur is 2.7 inches. 4 Professor F. H. Hamilton (A Practical Treatise on Fractures and Dislocations, Philadelphia, 1875, p. 516) relates the following case as an example of lengthening of the limb after shot fracture of the femur: "Melchior Brietel, Private, 12th N. Y. V., was wounded in June, 1862, at the battle of White Oak Swamp, Virginia, by the fragment of a shell, which struck the left leg three inches above the condyles. He was taken to Richmond as a prisoner, and about a month later he was exchanged and sent within our lines. January 1, 1864, I found him in the United States General Hospital, at Newark, under the charge of Surgeon Taylor. The wound was still discharging matter occasionally, and several fragments of bone had been removed. Splints were not applied until after his exchange. No extension was ever employed. At the end of four months he began to walk about with crutches. 352 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Case 498.—Lieutenant J. Davis, Co. G, 73d Ohio, aged 35 years, was wounded at New Hope Church, May 25, 1864, and admitted to the field hospital of the 2d division, Twentieth Corps. One week after receiving (he injury the patient was moved to Chattanooga, where the wound is described as an "injury to the trochanter major." He was subsequently sent to the Officers' Hospital at Nashville, whence he proceeded to his home on leave of absence, August 10th. He was mustered out of service May 5, l?-65, and pensioned. Examiner O. J. Phelps, of Piketon, Ohio, certified, July 25, 1865: "The ball entered at the groin, passed through, shattering the trochanter major, and as yet rendering the limb entirely useless. It is still unhealed." Examiner J. Arnold, of Waverly, December 12, 1871, stated: "The hip joint is rendered entirely useless. There are two ulcerating sores that discharge very much all the time, and small pieces of bone are taken out. Has to use crutches to get about." Examiner W. Scarlock found no improvement in the pensioner's condition in September, 1873, and reported, two years later: " One running sore still exists on the outer side, over the great trochanter. There are four tender cicatrices that have recently healed, two on the inner and two on the posterior side, ranging from four to six inches below the original wound. The limb is lengthened some three inches, and its movements are painful and limited. The wound still requires dressing once or twice a day." At a subsequent examination, in 1877, the limb was still found to be in the same condition, lengthened, etc., and the pensioner was reported as wholly unfit for any occupation requiring manual labor. The pensioner was paid Sept. 4, 1879. The side of the injury was recorded in three thousand and thirty-six instances; four- teen hundred and thirty-one were on the right, and sixteen hundred and five on the left side. Of the former, six hundred and sixty-one, or 46.1 per cent., and of the latter seven hundred and forty-three, or 46.2 per cent., were fatal. Here, as well as in the cases of shot injuries of the shoulder joint and arm (Second Surgical Volume, pp. 610, 806), the left extremity seemed to have been most frequently interested; but here, also, the number of cases in which this point could not be ascertained (four hundred and thirty-one) prohibited definite conclusions on this subject. In two hundred and eighty-four cases the fractures of the femur were accompanied by lesions of other portions of the body: fractures of the bones of the head in nine instances, penetrating wounds of the chest in five, penetrating wounds of the abdomen in three, fractures of the pelvic bones in thirteen, fractures of the upper extremities in thirty-three, fractures of the opposite lower extremity in twenty-five, and in one hundred and ninety-six instances the fractures of the femur were accompanied by shot flesh wounds of the upper or lower extremities. Pysemia was noted in one hundred and fifty- one instances with one hundred and forty-seven deaths; tetanus in eighteen with seventeen deaths; gangrene in fifty-three with thirty-two deaths; erysipelas in forty-six with twenty- six deaths; and hasmorrhage in one hundred and thirty-three with one hundred and eighteen deaths. The external iliac artery was unsuccessfully ligated in one instance: Case 499.—Private M. Teel; Co. C, 73d Indiana, was wounded through the upper third of the right thigh, at Stone River, December 31, 1862. Assistant Surgeon F. L. Town, U. S. A., reported that the wounded man was admitted into hospital No. 4, Nashville, six days after receiving the injury, where, by reason of secondary haemorrhage, the external iliac had to be ligated, resulting fatally on January 19, 1863; also that the severity of the original injury was sufficient to produce death. The femoral artery was ligated in twenty-one instances, of which two proved success- ful. Socin1 has remarked that in a shot fracture of the femur "accompanied by an injury of the artery alone, conservation might yet be attempted after an utmost early ligation;" but a most careful examination of all the cases of shot fractures of the femur treated by conservation during the American civil war has failed to disclose a single instance of recov- ery after fracture of the femur accompanied by an unquestionable primary lesion of the femoral artery. In the following instance the femur had been fractured and the femoral artery severed by a minie' ball; the artery was promptly ligated. The patient survived nine months and eleven days, but finally perished from the effects of the injury: On measuring I found this limb lengthened half an inch, and this measurement was confirmed by Surgeon TAYLOR and others. There was no anchylosis at the knee joint.'" Professor HAMILTON must have been mistaken as to the name of the patient. The name of Melchior Brietel is not borne on the rolls of the 12th New York Volunteers'. A private, Melchior Breitel, I, 12th New Jersey Volunteers, wounded at Chancellorsville, Virginia, May 3, 1863, was admitted to the Newark U. S. A. General Hospital with a gunshot wound of the thorax and the left arm, September 9, 186:1. He was discharged March 28, 1864, and has been a pensioner since. The records of the Newark hospital, as well as the soldier's certificate of disability, and the certificates of two pension examining surgeons, agree in the diagnosis: " Gunshot wound of chest and left arm," but no mention is made of a shot fracture of the femur or its treatment, and Professor Hamilton himself, in his Lectures on Gunshot Injuries of the Chest, in American Medical Times, 1864, Vol. VIII, p. 182, cites the case as an example of perforating wound of the lung followed by empyema, without mentioning an injury of the femur. 1SOCDC (A.), Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 128. SECT. III.] SHOT INJUR! KS OF TH K FEMUR. 353 Case HOO.—Private B. M. Dunn, Co. D, 1st Louisiana, was wounded in the right fhigb, at Gettysburg, July 2, 1863, and admitted into Camp Letterman four weeks after the injury. Assistant Surgeon W. F. Kichardson, C. S. A., reported: "He was wounded by a minie" ball, which entered at the inner anterior portion of the thigh about the middle third, and made its exit at the posterior and outer portion, severing the femoral artery and fracturing the femur in its course. The femoral artery was Heated in Scarpa's space on the day of the injury. When admitted in my ward the patient was suffering intolerable pain, occasioned bv moving him four miles in an ambulance over a rough road, without splints, sand-bags, bandages, or any other appliance to the limb, and with the ends of the bones overlapping each other. I administered chloroform and placed the bones in apposition, attaching a twenty-pound weight to the leg. Three days afterwards I reduced the weight to ten pounds, and on August 8th Smith's anterior splints were applied. One ounce of whiskey was given three times a day. The patient improved under the treatment adopted. On August Kith, the splint was readjusted, and again on September 1st, when the wound was found to look well and healthy and to be still discharging laudable pus. After this, tincture of iron in closes of fifteen drops was given in addition to the whiskey, and on September 6th the ligature was removed. On September 8th, the patient complained of sharp shooting pains around the wound, extending downward to the knee; he was placed under chloroform, and an incision one and a half inches long was made behind the exit wound, through which four or five small pieces and one large piece of bone were removed. Considerable hsemorrhage ensuing, persulphate of iron was injected in the wound, after which the leg was again placed in a splint. By September l'2th, the patient was again improving. On October 10th, the wound was still discharging freely, and the thigh was much swollen and very painful. The patient was also suffering from a rather troublesome diarrhoea. On November 10th. when he was transferred to Baltimore, his wound was still suppurating freely, but his general 'health was improving and union of tlie fractured bone was firm, so that he could bear about one-twelfth of his weight on the injured limb." In Baltimore, the patient was admitted to West's Buildings Hospital, and two months later he was transferred to Point Look- out. Surgeon A. Heger. U. S. A., in charge of the latter hospital, reported that the man died, from the effects of the fracture of the femur, April 13, 1864. Table XLIX. Summary of Twenty-one Ligations of the Femoral Artery in Cases of Shot Fractures of the Femur treated by Conservation. Name. Military description". ank a( Date anu Description of Injury. Union Lieutenant. ! Comminuted fracture upper thirdoffemur. Harrisburg. j Miss., Julv 14, 1864 Smith, F. A.. Pt..G, 4th | Conoidal bail fract're of lower Alabama, age 24. I third of left femur. Gettvs- ] burg, July 2. 1863. Wright, M., Pt.. F. 25th | Conoidal ball fractured por Indiana, age 18. Brooks, A. M., Lieut. 26th Virginia. Campbell, J. W., Pt., A, 17th Virginia, age 23. Campbell, 8., Pt., H, 140th Penn., age 30. Cox, T. C.. Pt., G. 88th New York. Coder, D.,Corp'l, F, 16th Pennsylvania Cavalry, age 23. Detweiler, C.,Pt.,A,47th Pennsylvania, age 24. tion of external condyle (if right femur and pussed thro' popliteal space. Savannah, Dec. 11. 1864. Pistol ball fracture of lower third right femur. Burks- ville, April 6,1865. Conoidal ball fracture of up- per middle and lower thirds of femur. August 4, 1864. Conoidal ball fractured up- per third right femur, also wound of the left thigh, etc. May 29, 1864. Conoidal ball comminuted fracture of upper third of left femur. Fredericksburg, Dec. 13, 1882. Shot entering immediately over femoral artery, right thigh, splintering trochan- ter minor. Hanover C. H., May 28, 1864. Conoidal ball wound of left thigh, injuring femur in the middle third. Cedar Creek, Oct. 19, 1864. HEMORRHAGE. Femoral artery sloughed. Dunn, B. M., Pt., D, 1st Louisiana. Floyd, J., Serg't Major, 13th PennsyvaniaCav., age 32. Freeman, A., Pt., 11,61 st New York, age 19. Geitz, H., Pt., C, 15th New York Heavy Artil- lery, age 26. Harper, J., Pt., B, 16th Infantry. Surg. Ill—45 Conoidal ball beveling fem- oral artery and fracturing middle third of right femur. Gettysburg. July 2, 1863. Conoidal ball comminuted fracture upper third of left femur. May 28, 1864. Partial fracture in the upper third of the left femur by conoidal ball. Antietam, Sept. 17, 1862. Conoidal ball fracture right thigh. May 18, 1864. Shot fracture of right thigh. Stone River, Dec. 31,1862. Suppuration fetid; severe haemorrhage from vessels in neighborhood of popliteal space; controlled tempora- rily by plugging. A pril 17, haemorrhage caused by a sharp spicnla of bone piercing the popliteal art'ry. August 13, haem. amounting to 60 ounces from femoral. June 10, haem. 8 oz.; profunda ligated and ligature placed under the femoral. June 13, haem. recurred, 2 oz. January 9.1863, severe haem- orrhage, controlled by cold water and compress. Jan- uary 10, recurred. June 8, haemorrhage amount- ing to 5 oz. from femoral. June 9, haemorrhage recur- red, 8 ounces. Extensive sloughing March 5, 1865. ha-iu. 8 ounces from branch of ext. circumflex; lig. of profunda. March 9, femoral sloughed; haemor- rhage 20 oz. June 19. neighborhood of wound much disorganized; haemorrhage from profunda, 30 ounces. Nov. 3. profuse haemorrhage from femoral artery. May 29, haemorrhage from profunda artery. Ligation akd Operator. Ligation of femoral artery. Ligation of femoral. January 2, 1865, ligation of femoral artery; Scarpa's triangle, by Acting Ass't Surgeon E. L. Mola. April 17, ligation of femoral artery below origin of pro- funda. August 13, ligation of fem- oral artery in continuity in Scarpa's space. June 13, ligature around the femoral artery by Assistant Surg. W. Thomson, U.S.A. January 10, ligation of fem- oral artery by Acting Ass't Surgeon R. Carroll. June 9, ligation of femoral artery below profunda by Ass't Surgeon W. Thom- son, U. S. A. March 10, 1865, ligation of femoral artery in continuity in Scarpa's triangle, one inch below origin of pro- funda, by A. A. Surgeon W. P. Moon. July 2, ligation of the fem- oral in Scarpa's triangle. June 19, ligation of femoral in continuity just below Poupart's ligament by Act. Ass't Surg. J. Newcombe, November 3, ligation of fem- oral artery. May 30, ligation of femoral artery in continuity by Sur- geon D. W. Bliss, U- S. V. Ligation of femoral artery. Result and Remarks. Complete recovery. Exch'd. C.S.A.Med.and Surg.Jour., Jan., 1865, Vol. II, p. 9. Exchanged April 27, 1864. Incision healed: ligatures came away on January 14 Discharged July 8, 1865, U. S. San. Com. Memoirs Surg. Vol. I, p. 263. Died April 20, '65. Post-mor- tem : ant. wall of artery had sloughed fths of an inch A.M.M.,Specs. 4084,4085. Hsem. did not recur, but pa tient died of exhaustion from loss of blood, Aug. 13, '64 Died June 13,1864; asthenia A. M. M., Spec. 3557. Died Jan. 10,1863; autopsy; artery torn for an inch or more, apparently by slough- ing. Died June 10, 1864; exhaus- tion and gangrene; autopsy. Died March 10, '65; exhaus- tion. A. M. M., Spec. 1357. Sept. 6, ligature rem'd; con- siderable haem., arrested by persulp. iron. Died April 13, 1864. June 20,21, bleeding recur'd. Died June 25, 1864; haem- orrhage. Died November 24,1862; ex- haustive suppuration. A. M. M., Spec. 740. June 7, haem. recurred. Died June 8, 1864. Died February 14, 1863. 351 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. Name, Military Description, avd Ace. Date and Description of Injury. HEMORRHAGE. Ligation and Operator. Result and Remarks. 15 16 17 18 19 20 21 Johnson, V.. l't., I, 13th Indiana, nge 22. Kelly, J. A., Lieut.. C, 9th Missouri. Parker, J., Corp'l, H, 58th Mass., aire 38. Root, .1. L., Pt.. H. 77th New York, age —. Sexton. J. M., Pt., A, 4th Virginia Cavalrv, age 22. Smith, D. R., Pt., 1, 93d Illinois. Walter, V., Pt., E, 8th Ohio, age 24. Conoidal ball fracture upper third of left thigh (also wound right). Petersburg, May 9, 1864. Shot'fracture upper third left femur. July 4, 1863. Conoidal ball fracture of mid-dle third of the left femur. Conoidal ball fracture, splin-tering left thigh. Cedar Creek, Oct. 19, 1864. Conoidal ball comminuted fracture mid. third of right femur. Monocacv, July 9, 1864. shot fracture of the right femur. Mission Ridge, No-vember 25, 1863. Conoidal ball fracture upper third of right femur. Spott-sylvania, May 10, 1864. May 19, hsemorrhage from profunda; ligated in contin-uity; hsem. recurred May 22, 26 ounces. July 12, 13, haemorrhage, 7 ounces, from profunda. Haemorrhage. May 22, ligation of femoral artery above profunda. July 13, ligation of the fem-oral artery. June 27, ligation of femoral artery. October 19, ligation of the femoral artery. August 5, ligation femoral in continuity below profunda, above wound, by Act. Ass't Surgeon J. H. Coover. November, 1863, ligation of femoral art'y bv Ass't Surg. J. S. Prout, 26th Missouri. June 9, ligation of femoral artery above profunda. Mav 24, haemorrhage recur-red. Died May 26, 1864. Died July 13, 1863. Died July 2, 1864. Died November 1, 1864. Aug. 6, haem.recur'd, 12 oz.; ligation of profunda. Died from exhaustion and loss of blood. A.M.M., Spec.3971. Died December 5, 1863. Died June 17, 1864. August 5, femoral artery sloughed; haemorrhage 10 ounces. June 7, haemorrhage, 16 oz , from femoral artery. The profunda was successfully tied in one case, and the circumflex of profunda and the popliteal arteries1 were unsuccessfully ligated in one instance each. In one case it is stated that the femoral vein was successfully ligated on the day of the injury; but unfortu- nately neither the records of the field hospital nor of the Columbian Hospital at Washing- ton, where the patient was treated during the first five months after the injury, allude to the ligation of the femoral vein, and not until the soldier reached the hospital at Madison, Wisconsin, is the operation, said to have been performed on the field, mentioned, probably upon the patient's own statement. A brief account of the case is appended: Case 501.—Corporal G. Bulman, Co. G, 36th Wisconsin, aged 22 years, was wounded through the upper third of the left thigh, at Hatcher's Run, October 27, 1864. He was sent from the field to Columbian Hospital, Washington, several days after the injury, and five months later he was transferred to Harvey Hospital, Madison. Surgeon H. Culbertson, U. S. V., in charge of the latter, reported that the femur was fractured by the missile, and that the femoral vein had been ligated on the day of the injury. The patient was discharged from service May 22, 1865, and pensioned. Examiner W. II. Walker, of Fond du Lac, certified, August 11, 1865: " He was wounded by a ball through the upper third of the thigh from without inward, frac- turing the femur. The muscles are adherent and the thigh is diminished in circumference two and a half inches. The circula- tion of the limb is much impeded from extensive lo*s and induration of the soft parts from hospital gangrene." Several years after the same examiner reported "deep and extensive varices and ulceration on the outer aspect of the calf" from the obstruc tion of the circulation of the limb. The pensioner was paid December 4, 1879. A fatal instance of ligation of the femoral vein and the profunda artery for secondary hsemorrhage is reported by Acting Assistant Surgeon T. J. Dunott: Case 502.—Private E. Gilkey, Co. C, 17th Maine, age 27 years, was wounded at Petersburg, June 18,1864, and admitted into Campbell Hospital, Washington, ten days afterwards. Surgeon A. F. Sheldon, TJ. S. V., reported : " Shot fracture of upper third of right femur. Hasmorrhage to tlie amount of twelve ounces occurred on July 5th, when the femoral vein and the pro- funda artery were ligated, the ligature of the former being applied at the seat of the injury. Hsemorrhage recurred on July 7, 1864, when the case resulted fatally." Among the three thousand four hundred and sixty-seven cases of shot fracture of the femur treated by conservation referred to in this Section, were two thousand eight hundred and thirty-nine Union and six hundred and twenty-eight Confederate cases. The ratio of 1 Surgeon G. M. B. Maui;us, P. A. C. S. {Conservative Treatment of Compound Comminuted Fracture of the Femur, with Cases, in Confederate States Med. and Surg. Jour., 1865, Vol. II, p. 9), reports that Private W. T. Ivy, 19th Mississippi Cavalry, aged 40, was wounded at Harrisburg, July 14, 1864; compound comminuted fracture of femur, upper third; ligation of arteria profunda; treated by position; union complete; shortened one inch. Acting Assistant Surgeon T. J. DUNOTT reports that Private E. H. Gibson, Co. A, 14th New Jersey, aged 15, was wounded at Monocacy, July 9, 1864. A conical ball perforated the right thigh in the upper third, on the anterior aspect, fractured the femur without producing much comminution, aud emerged near the anus. The patient was admitted into the hospital at Frederick, and, on July 13th, the limb was placed upon a double-inclined plane. On July 19th, haemorrhage set in, a large and continuous stream flowing out of the anterior wound. Dr. DUNOTT immediately enlarged the wound and tied the circumflex of the profunda above and below; on July 20th, violent haemorrhage occurred from the wound. Compression was made at once, and a plug of lint introduced. A hot-air bath was ordered and stimulants given, but the patient died July 19,1864, two hours after the recurrence of the haemorrhage. Surgeon R. Nicoi.I.s. U. S. V.. reports that Private C. A. Knight, Co. L, 2d Illinois Cavalry, aged 24, was accidentally wounded at Sikeston, Missouri, May 4, 1862, by a pistol ball, which fractured the left femur three inches above its lower extremity. He was admitted into tbe hospital at Quincy on May 10th, and the popliteal artery, which was wounded, was ligated above and below the wound. Buck's apparatus was applied. The ligatures came away on the fourteenth day. The wound of operation had nearly closed by the latter part of August, but the patient was reduced by diarrhoea and died September 29, Is-62. sect, in.] SHOT INJURIES OF THE FEMUR. 355 mortality of the completed cases was 51.1 per cent, on the Union, and 44.0 per cent, on the Confederate side, as exhibited in the following table: Table L. Numerical Statement of Union and Confederate Soldiers treated by Conservation after Shot Fracture of the Femur. POINT OF FRACTURE. i CO CI COO 421 304 85 79 71 60 68 40 58 Point of Fracture not specified ......... Aggregates.................. 3,467 2,839 1,361 1,426 52 51.1 628 328 258 42 44.0 The rate of fatality among the Confederates as exhibited in this table is remarkably low; but it must be taken into consideration that in the enumeration of the Union cases, made up to a large extent from the casualty lists of the various corps, are included even those patients who died within the first few hours after the reception of the injury, before means of transportation could reach them, while the Confederate cases of a similar nature do not appear in these statistics.1 Excisions in the Shaft of the Femur.—Although the number of excisions in the shaft of the femur practised was comparatively large, little need be said about the operation, which, as already stated, was generally considered with disfavor by the American surgeons, and frequently those who had practised it became its strongest opponents.2 Amputations in the Thigh.—While the experience acquired during the War of the Rebellion indicates that the attempts to save the limb after shot fractures of the femur have, in many instances, met with favorable results, there are a large number of cases in which primary amputation remains the only alternative. When the fracture of the femur is accompanied by great comminution, or by extensive longitudinal Assuring, or by grave laceration of the soft parts, or by primary injury of the femoral artery or vein, the limb should be removed at once. Furthermore, the crowded condition of the field hospitals after large engagements, the infectious diseases likely to arise, the scarcity, and sometimes 1 In the Confederate States Medical and Surgical Journal, Richmond, June, 1864, Vol. I, p. 89, will be found a consolidated statement of compound fractures of the femur treated without operation, compiled from the records of the Confederate Surgeon General's Office from June, 1862, to February 1, 1864, inclusive. The total number of cases treated was 221, of which 116 recovered, and 105 or 47.5 per cent., had a fatal termination. 2 Surgeon C. A. COWGILL, U. S. V., who excised a portion of the shaft of the femur in the case of Private I. W. Hall, S)2d New York (TABLE XXVI, No. 17, p. 2l0, ante), writes, in a letter to the editor dated Dover, Delaware, July 12, 1866: "The result of this case determined me never to attempt again to save a femur fractured by a gunshot wound by excising any portion of its continuity. The extraction of fragments almost entirely detached and displaced is all that I would do in a similar case. In severe injuries where there is no hope of saving the limb, the fracture involving the upper third, I would prefer waiting for some weeks until all primary irritation had subsided, and a degree of tolerance acquired by the system, and then amputate, believing that secondary amputations are more frequently followed by successful results when performed in the upper third of the femur than is the case when operations are performed imriiediately following the injury. The result has been equally unfavorable in formal excisions of the contin- uity of the humerus where there has been much shattering of bone and injury to the soft parts. There is danger of extensive sloughing, secondary haemorrhage, and pysemia following these operations, causing loss of life or necessitating a subsequent amputation. Conservative surgery is very popular in theory, but frequently dangerous to life when permitted to be the sole guide in practice." Surgeon A. F. SHELDON, U. S. V., who operated in Cases Xos. 12, 18, 22, and 25 of Table XXVI, p. 210, ante, in a letter to the editor dated July 5, 1866, remarks: " The prospects of recovery would have been much better in the enlisted men had no operation been performed. I should now excise very seldom in any part of the body, and I have never seen a caso where excision of a portion of the femur in the continuity was performed, where I think the patient was benefitted by it." Surgeon W. H. TwiFORD. 27th Indiana, who excised in the cases of Private Wishmire, 27th Indiana (TABLE XXIV, No. 61, p. 206, ante), and Private Wilson, 13th New Jersey (Table XXV, No. 9, p. 206, ante), in a letter to the Surgeon General dated July 27, 1866, advises primary amputation rather than excision, providing the patient is able to bear up under the 6hock of the amputation, and remarks: 'T am therefore opposed to excision of the shaft of the femur unless the exigencies of the case demand it." Surgeon A. J. Phelps, U. S. V., in his Report of the Operations of the Medical Department of the Left Wing of the Fourteenth Corps at the Battle of Murfreesboro', in Appended Documents to Part I, Vol. I, Med. and Surg. History of the War of the Rebellion, Wash- ington, 1870, p. 260, says: "I consider exsections in the case of the shaft of the femur should very generally give way to amputation." 3f>(> INJURIES OF THE LOWER EXTREMITIES. icn.\r. x entire want, of surgical appliances to make the patient with a fractured thigh bone com- fortable, the rough transportation to which the wounded man is liable to be exposed, are circumstances which will sometimes urge the military surgeon to forego all conservative inclination and prefer to sacrifice the limb rather than to expose the patient to the risks attending the attempts at preservation. Here, as well as in all questions of surgical inter- ference, medical officers in the field will always be guided by the circumstances surrounding each case. The modes of operating employed were the flap method1 and its various modifications— the anterior, posterior, antero-posterior, and lateral flaps—in one thousand one hundred and forty-one, the circular method in eight hundred and sixty-three, the oval flap with circular division of muscles in one hundred and eight instances; but it is difficult to draw correct conclusions from the recorded cases regarding the value of the modes practised. Surgeon E. Batwell,2 14th Michigan Volunteers, observes: "The sort of operations per- formed is worthy of'comment, and has been very closely watched, to try and give a prefer- ence to either circular or flap operations, based on observations as to their relative merits as far as healing was concerned; but no difference was discernible, except in lateral flaps, where the protrusion of the bone through the incision prevented the rapid union that took place in the antero-posterior ones. The only cases in which the healing process seemed retarded were those in which the operation urged by Malgaigne was performed—oval flaps with circular division of muscular tissue. The chief points in which they seemed to be deficient was the small anterior flap being unable to support the weight of the posterior larger one. This again granulated very freely, and thereby prevented approximation of the edges, and a large granulating surface was the result, instead of the nicely adjusted linear mark observable in either the flap or circular operations. From the observations made on the subject, I would urge that no modifications are worthy of being noticed by surgeons, and that the circular or flap operations amply fulfil all the requirements necessary." The Army Medical Museum possesses seventy-nine casts of stumps after amputations in the femur, six of which are shown in the accompanying plate (Plate LXXIII). Figures 1, 2, 3, arid 5 represent stumps after the anterior, posterior, antero-posterior, and lateral flap methods, Figure 4, after the circular method, and Figure 6, after an operation by the flap of skin and circular division of muscles method. An amputation after the method of Grritti,3 of Milan, is reported by Surgeon W. Child,4 5th New Hampshire Volunteers, to 1 Surgeon A. J. PHELPS, U. S. V., in his Report of the Operations of the Medical Department of the Left Wing of the Fourteenth Corps, at the Battle of Murfreesboro', remarks: "The method of amputation employed was, very generally, the flap. Those cases of flap operation, however, that approached ucarest to the circular method did best, and I have thought that our success would be greater if the circular method was adopted more gen- erally. Tbe only hope we have of an entire success is union b3* the first intention in the flap operation, and this depends upon the subsequent attention of the surgeon. We can seldom expect to realize it while we have to depend upon inexperienced nurses for dressers. The weight of an unsupported flap will invariably break those tender bonds of union that nature so readily attempts. (Appended Documents to Part I, Vol. I, of the Med. and Surg. Hist. of the War, Washington, 1870, p. 262.) 2 Extract from a Report on the Surgical Operations performed after the Engagement at Jonesboro', Georgia, in Appended Documents to Part I, Vol. I, of the Med. and Surg. Hist, of the War, Washington, 1870, p. 304. 3K. GRITTI (Dell amputazione del femore al terzo inferiore e delta disarticolazione del ginocchio. Valore retativo di cadanna coll' indicazione di un nuovo metodo denominato amputazione del femore ai condili con Umbo patellare, in Annali Universali di Medicina, Milano, 1857, Vol. CLXI, p. 5. This operation will be referred to iu the succeeding section. 'Child (W.), Giutti'S Supra-condyloid Amputation of the Thigh, in the Boston Med. and Surg. Jour., 1879, Vol. CI, p. 783. Dr. CHILD says: " After the battle of Antietam (September 17, 1862) it was determined to establish upon that battle-field a hospital for such severe cases as could not be conveniently removed to the general hospitals. Dr. Bernard Vandekkieft, United States volunteer surgeon, was detailed surgeon in charge of this hospital. Among the patients was a soldier with an amputation of the right leg. After some weeks it was found that the leg must be amputated at or above the knee joint. Dr. Vanderkieft decided to amputate at the knee joint by ua new operation'' (as he said), and the operation was certainly new to his associates and assistants. He made a circular incision from the internal tuberosity of the tibia across the leg below the patella to the head of the fibula, dissected this flap up to about the middle of the patella, cut through the ligamentum patellae close to the lower border of the bone, and turned back the flap. He then made the posterior flap by passing the knife beneath the femur and cutting outward and downward. He then sawed through the femur just above the condyles, and removed a section from the posterior or internal surface of the patella by the saw. Next he adjusted the sawn surface of the patella to the sawn extremity of the femur and adjusted the flaps in the usual manner. The patient died in about sixteen hours, on account of previous exhaustion." HS^1 -*'*■' ^ .|%'^Y WOK"-'.' "r+*A, '' . it . li ■■ Y' : • :.! !;uy-y, '.. :■ ■ '■ ant y.v . i ; i t.i -' ■: .• ''en.-- ■ <>:;•.• hundred 'Al ri-p w.itii y.:: ;o di*aw ■■» ■■M-i.i.^'d. '■■' MUlpYi.'!":1 ■ •. .1.1-' poili's • •• :■ ;' 'r ; ■< • rt; u.- •■ ■Y-y prevent*: ■■• • . ■ ■■ .. '■ "■■..,! of 1,„: !•!••■ .:■• I'Y.rn th" ';'-at iO';.- . VY'..r. iv e»f --H"-i Y1. uri[.-!y fii'ii. all the tv..; i i... : ■. iv nm. >S of stuMifT- ,r •ys::s),. •:■.;■-..late (h ., ' . - -'i'l'l '■' ie. on '() T-onsi, The ! I l r.ho i ve tu>' ' >f,r Me.! f. i r id.l- Si'yn: ■ r.1 ,-„t ;•<■ tit- filer . : ti,'> ■•:' Hist of the War of the Rebellion Part III Vol II Chap N T SincldirS-Sou CliromoUth. PLATE LXXIII THIGH STUMPS I . Stump afler amputation l>v anterior flap. Spec .'>()" ;■?._ Stump tiller amputation liv luitcro-posterior flaps. Spec. Ml" o... Slump after amputation bv lateral flaps. Spec. 3.")l>5. '1. Stump idler amputation by. posterior flap. Spec 117 I. Stump after amputation by circular flap. Spec ;W2'2 (>. Stump after amputation by flap of skin find circular of .ruusele,.s Spec. 2.'"5()t>. • SECT. III.] SHOT INJURIES OF THE FEMUR. 357 Fig. 220.—The same have been performed by Surgeon B. A. Vanderkieft, U. S. V., who was in charge of the Smoketown Hospital after the battle of Antietam, September 17, 1862. Another operation of this character was performed by Assistant Surgeon J. W. S. Gouley, U. S. A., December 16, 1862, three days" after the battle of Fredericksburg:1 Case 503.—Private Grey Y. Barrett, Co. F, 5th New Hampshire, aged 20 years, was wounded at Fredericksburg, December 1.?, 18C2, by a musket ball, which entered at the outer condyle of the femur, passed inward and upward, and, escaping posteriorly in the middle of the lower third of thigh, left the bone much comminuted at its exit. He was admitted to the hospital of the 1st division, Ninth Corps, where, on December 16th, Assistant Surgeon J. W. S. Gouley, U. S. A., amputated the femur a short distance above the wound of entrance, the patella being included in the anterior flap; the line of section not having escaped the wound, another third of an inch was removed (Fig. 219); the femoral surface of the patella was then sawn off, and the t\*> cut surfaces of the bone were brought in apposition (FlG. 220). The laminated portion of the femur, however, was fractured half an inch above this point, and fissures extended two iuches further. The operation was well borne, and the case continued to do well until the sixth day, when sloughing commenced; on the eighth, signs of gangrene were noticed; and, on the ninth, December 25th, Surgeon J. P. Prince, 36th Massachusetts Volunteers, amputated the femur in the middle third, on account of the burrowing of pus, for secondary hsemorrhage from the pop- liteal. No plastic deposit could be observed immediately after the operation. On the next day he was transferred to Washington, and admitted to the Douglas Hos- fig. 219.—The lower pital, where he died on December 27, 1862. The pathological specimen, which was half of right femur am- contributed to the Army Medical Museum by Dr. Prince, with a history of the case, with the sa^n surfaces putated above the con- . /.,„.,„. of the patella and femur dvles. Spec. 536. is numbered 53b of the Surgical Section. in apposition. Extension as a means of covering protruding bones after amputation of the thigh was successfully employed at the City General Hospital, St. Louis, after a plan2 devised by Acting Assistant Surgeon A. S. Barnes. How far the size of the thigh presented for amputation influences the result of the operation cannot be ascertained from the cases recorded in the preceding pages. M. Bras- dor,3 in 1774, observed that "plus la plaie de l'amputation a de surface, plus, toutes choses, egales, le danger que court le malade est grand," and Surgeon M. Goldsmith, U. S. V.,4 in a letter to this Office notices the influence of the size of the limb upon the mortality of 1 An account of this case by Surgeon JAMES P. Prince, 36th Massachusetts Volunteers, has been published in the Boston Medical and Surgical Journal, 1863, Vol. LXV1II, No. 4, p. 69, and by Dr. ROBERT F. WEIR in his excellent paper On GRITTl's Supra-Condyloid Amputation of the Thigh, in The Medical Record, New York, 1879, Vol. XV, p. 338. 2HODGEN (J. T.). Letter to the Surgeon General, dated April 30, 1863: "The accompanying drawing (Fig. 221) shows its application to the thigh. The same is also applied to the arms, forearms, or legs. From three to six adhesive strips are applied, extending from the end of the stump up the limb to near the next joint; this is then covered by a smoothly applied bandage. The free ends of plaster are brought together several inches below the end of the stump and fastened by a cord, to which is attached a bag of sand weighing from 1 to 3 or 4 pounds; the cord, passed over a pulley placed at a proper point on the bedstead, the bag is suspended, thus making gradual constant extension on the flaps, which soon elongate and cover the protruding bone. Great numbers of such stumps have been brought to this hospital, in many the bone protruding three inches or more. and in but one case have we thought it best to saw off the end of the bone; and that was done before this method of treatment was practised. There have been very few cases in which the ends of bones have exfoliated, and then only a small part of what would have been lost if the usual course had been pursued. The credit of introducing this new method of covering protruding bones is due to Acting Assistant Surgeon A. S. BARNES of this city." Dr. W. W. Keen, jr., in a letter to the Surgeon General's Office, dated U. S. A. General Hospital, West Philadelphia, May 26, 1863, ascribes this plan to Assistant Surgeon A. H. SMITH, U. S. A : "Assistant Surgeon A. H. SMITH, U. S. A., who was with me at Frederick, and after- wards here and now at Nashville, while at Frederick devised a very ingenious apparatus, which was afterwards adopted at hospitals nearer the battle- fields, and there claimed as original, and now, I learn, is claimed by J. T. Hodgen, Surgeon U. S. V., of St. Louis. The apparatus is the application of adhesive strips to the flaps after amputation (especially in the thigh), and the attaching to them of a weight running over a pulley, very much after the plan of BUCK'S apparatus for the thigh, the object being to prevent retraction of the flaps, and to overcome it if already established." 3BRASDOR, Essai sur les amputations dans les Articles, in Mim. de VAcad. Roy. de Chir., Paris, 1774, T. V, p. 757. ■•Goldsmith (M.). Letter to the Surgeon General, dated Jeffersonville, Indiana, October 18, 1865: "It has been a subject of general remark in the Army that a much larger proportion of the lean, lithe, active men—hardy men, without a particle of encumbering fat, recovered from amputation, than equally hardy men—men oftentimes of much more muscular development and strength, whji a larger accumulation of fat. Or, in other words, that small, light, active men, bore amputation of the thigh better than larger, stronger, and stouter men did. That other things being equal, the general Fig. 221.—Dr. A. retracted flaps. S. Barnes's method of treating amputations with 358 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. amputations, especially in the thigh, a subject which seems to him of "importance enough to challenge the attention of medical men." Considering the results of the amputations according to the ages of the patients, as represented in Table LI, the mortality rate of four hundred and'seventy-six patients under twenty years of age was 41.0 per cent.; of thirteen hundred and fifty-one patients Table LI. Statement of the Ages of Six Thousand Two Hundred and Nine Patients who submitted to Amputation of the Thigh for Shot Injury. AMPUTATION OF THIGH. Under 20. 20-1-2-3-4. 25-6-7-8-9. 30-1-2-3-4. 35-6-7-8-9. 40 AND OVER. Age Unknown. > c fa v 5 P c K 60 179 276 7 58 64 7 32 39 1 2 7 6 738 1 35 84 160 13 20 86 140 1 10 16 21 3 3 6 3 9 610 a ~ is s o 3-P 1 1 U c M 39 110 155 1 6 19 25 5 16 16 4 1 2 399 19 56 93 6 8 30 49 3 2 O P 1 S> o c Oi tf 23 67 77 2 5 11 18 a fa 16 31 57 4 8 16 35 a II P 1 a fi-ts o V K "a fa > O o 10 25 32 1 7 11 3 7 16 46 6 5 14 21 a 3l W a P 1 > 0 0 2 "3 fa a Ph a P • /-Upper Third........................ 29 72 111 I 2 12 25 9 28 60 5 6 21 34 2 4 6 10 I 9 28 41 4 8 7 8 20 35 1 6 9 24 90 205 279 34 26 90 67 7 13 34 26 174 226 470 245 44 90 154 13 8 16 33 4 12 15 46 187 4 7 12 20 4 5 19 % J Middle Third....................... S 5 Middle Third....................... H S S 4 6 10 2 3 5 1 2 1 1 2 1 •3 6 § O Middle Third.................... 13 15 1 1 3 6 2 305 I 2 4 10 3 220 8 10 2 2 2 2 4 197 9 4 Op*/ § S. V., reported the ease, and that the man entered the City Hospital at St. Louis three weeks after tlie reception of the injury. He was transferred to the Veteran Eeseive Corps July 15, 1863; he is not a pensioner. Cask 510.—Musician B. Williams, Co. C, 1st New York, aged 17 years, is reported by Acting Assistant Surgeon P. B. Goddard as having been treated at the Master Street Hospital, Philadelphia, from August 12 to November 26, 1862, for "syno- vitis of the knee joint from puncture by a nail of a cracker box on which lie fell." There is no record of his ever having applied for a pension. Case 511.—Private T. A. Jackson, Co. II, 1st Rhode Island Cavalry, aged 23 years, entered Satterlee Hospital, Phila- delphia, May 7,1863. Acting Assistant Surgeon W. W. Keen, jr., reported : "The case is one of punctured wound of the knee joint followed by partial anchylosis. The patient states that in December, 1862, he fell from his horse, and that a pair of scissors in his knapsack punctured the right knee joint and broke off'; that the points were removed three days after the accident, being three inches deep, and that severe inflammation followed, and a large number of abscesses formed about the joint. When admitted the injured joint was smaller than the sound one, the hamstrings were contracted, and motion was limited from com- plete flexion to an angle of 135° with the thigh. On motion there was marked crepitation, the movement of the patella being much restricted. The cicatrix of the wound is located just to the inside and above the tubercle of the tibia, and all about the joint are old cicatrices from abscesses. The evidence of penetration of the joint is manifest, both by the position of the cicatrix as well as the escape of synovia, which took place according to the patient's statement. The patient walks about on crutches, and is unable to bear weight on the limb." He was discharged from service June 1, 1863. There is no record of his ever having applied for pension. Case 512.—Private E. Eice, Co. E, 100th Indiana, was discharged from service February 28, 1863, by reason of anchy- losis of the right knee joint. Medical Inspector G. T. Allen, TJ. 8. A., reported that the disability arose from a wound inflicted, September 16, 1862, by a pointed knife entering beneath the patella and penetrating the knee joint. The man is not a pensioner. Case 513.—Private D. E. Ewell, Co. G, 39th Massachusetts, received a knife wound of the left knee in April, 1864. He was successively admitted to the regimental, Harewood, and Portsmouth Grove hospitals, and returned to duty May 26, 1864. He is not a pensioner. Incised Wounds of the Knee Joint.—The thirty-nine cases of this group were axe or hatchet wounds with the exception of perhaps one, in which the instrument with which the injury was inflicted is not named. Thirty-three cases were treated without operative interference and six were followed by amputations in the thigh. Incised Wounds of the Knee Joint treated without Operative Interference.—Thirty- three cases, of which four proved fatal, are included in this category. In the majority of the cases the reports are brief, and the evidence regarding the penetration of the joint is very vague. A few cases of recovery are cited: Case 514.—Private N. Bacon, Co. C, llth Michigan, aged 17 years, entered Cumberland Hospital, Nashville, May 17, 1864, with an incised wound of the left knee joint, caused accidentally by an axe two weeks previously. Surgeon B. Cloak, U. S. V., reported the case and that the patient was returned to duty June 4, 1864. The man is not a pensioner. Case 515.—Private J. H. Fuller, Co. K, 3d Massachusetts, age 28 years, received, October 20, 1862, an injury of the left knee joint by a hatchet, which penetrated outside of the patella and made quite a deep cut, causing much arterial hsemor- rhage. The patient recovered, and was discharged April 1, 1863. He was pensioned on account of lameness and anchylosis of the joint. The case is reported by Surgeon Z. B. Adams, 32d Massachusetts. Case 516.—Private L. H. Hudson, Co. K, 1st Missouri Engineers, received an accidental blow from an axe iu the left knee joint, at Waverly, June 3, 1864. The patella, half the capsular, and all the lateral ligaments were severed, allowing the synovia to escape from the joint. The patient passed through various hospitals, and was discharged January 11, 1865, and pensioned. Examining surgeons describe him as very badly disabled and suffering from looseness of the joint, the consequence of loss of parts of the outer side of the knee. Case 517.—Private W. Trahey, Co. H, 71st New York, was discharged from service May 31, 1862, by reason of lame- ness and partial anchylosis of tbe knee joint. Surgeon A. J. McKelway, 8th New Jersey, certified that the disability was caused by a wound made with an axe iu February, 1862, which laid open the joint. The man is not a pensioner. Case 518.—Sergeant A. E. Waterman, Co. H, 1st Michigan Light Artillery, is reported by Acting Assistant Surgeon D. O. Farrand as having been admitted into St. Mary's Hospital, Detroit, August 20, 1864, with an "accidental incised wound of tbe right knee, penetrating the joint," and that he was returned to duty October 3, 1864. He is not a pensioner. Case 519.—Private J. Williams, Co. H, 2d Sharpshooters, aged 32, received an accidental wound of the right knee by an axe, April 3, 1864. Assistant Surgeon W. Webster, TJ. S. A., in charge of De Camp Hospital, reported that the joint was penetrated and that the patient was returned to duty May 27, 1864. He is not a pensioner. Surg. Ill—46 362 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The evidence in the remaining twenty-three cases1 of recovery after incised wounds of the knee is of a similar nature. The fatal cases are: Case 520.—Private (i. M. Sadler, Co. B, 22d Michigan, was admitted into hospital No. 3, Nashville, where he died February 8. 1864 Surgeon S. D. Turney, U. S. V., reported^ that the cause of death was "an accidental incised wound of the left knee joint, caused by an axe, and inflicted during the previous month. Cask 521.—Servant J. A. Wynkoop, Co. E, 39th Iowa, aged 26 years, was accidentally wounded at Athens, Georgia, April 30, 1864. He was admitted into hospital No 19, Nashville, whence Surgeon W. H. Thorn, U. S. V., reported: "An axe wound of the left knee, penetrating the joint. Death on May 26, 1864." Case 522.—Private A. Hatfield, Co. I, 129th Illinois, aged 25 years, was admitted into the hospital of the 3d division, Twentieth Corps, October 7, 1864, with an accidental incised wound of the right knee, inflicted with an axe. On October 31st, he was transferred to hospital No. 1, Chattanooga, whence Surgeon J. H. Phillips, U. S. V., reports that he died on December 7, 1864, " of incised wound of right knee." Case 523.—Private A. G. Hill, Co. G, 43d New York, aged 25 years, was admitted into Finley Hospital, Washington, March 25. 1864. with an incised wound of the right knee, inflicted with an axe, accidentally, at Brandy Station, Virginia, Feb- ruary 19, 1K>4. Surgeon G. L. Pancoast, U. S. V., reports that he died May 21, 1864, from the effects of the wound. Amputations in the Thigh after Incised Wounds of the Knee Joint—Burrowing of pus, extensive sinuses above or below the knee, and sloughing, necessitated amputation in the thigh in six cases of incised wounds of the knee joint. Only one of the patients survived the operation: Case 524.—Private F. O'Brien, Co. A, 4th New York, aged 24 years, was cut in the left knee by an axe during a fight in a private house near Baltimore, February, 1862. He was admitted to hospital in Baltimore, where, on account of the diseased condition of the injured joint and adjacent parts, the limb was subsequently amputated about the middle of the thigh by Surgeon U. Tavlor, U. S. A. The patient was discharged from service April 28, 1863, and supplied with an artificial limb. A cast of the stump was contributed to the Army Medical Museum by Assistant Surgeon J. W. S. Gouley, U. S. A., and constitutes specimen . 919 of the Surgical Section. The man subsequently served in the Veteran Reserve Corps, and was discharged December 15, 1H>4. His application for pension was rejected. Cask 525.—Corporal M. J. Allen, Co. I, 33d Indiana, aged 22 years, while putting up a tent on June 17, 1865, received an axe wound of the right knee joint. He was admitted to Brown Hospital, Louisville, several days afterwards, and on July 27th to Crittenden Hospital. Assistant Surgeon J. C. G. Happersett, U. S. A., in charge of the latter, reported that the injured knee was affected with synovitis; also that pus had penetrated the joint and was burrowing in the tissues above and below, necessitating amputation of the thigh, which was performed July 31st, by Acting Assistant Surgeon D. J. Griffiths, at the middle third. The patient died of diarrhoea August 11, 1865. Cash 526.—Private H. C. Frazer, Co. A, 40th New York, while cutting wood, on June 20, 1862, accidentally struck the left knee. He entered Ascension Hospital, Washington, July 4th, whence Acting Assistant Surgeon J. W. Bulkley reported that the cut ran obliquely across the outside of the joint and had nearly healed when the patient was admitted. About ten or eleven days afterwards, however, the leg and joint became greatly swollen and inflamed, the skin rapidly assuming a bright red color. This ivas attended with excessive pain in the joint upon motion. Ice, cold irrigations, and tincture of iodine were applied, and salines, small doses of tartar emetic, and sweet spirits of nitre were administered. Bandages were applied from the foot to the knee joint with good effect. On July 20th, a small incision was made inside the ligamentum patella and gave exit to a htnje amount of sanious and highly offensive pus. About July 27th, the pus was noticed to be accumulating in the joint and burrowing above it in the muscles of the thigh. The bandage was still used, and cold, alternated with warm, applications were continued. Quinine and tincture of iron was now given, and beef tea and brandy punch freely. About the beginning of August an incision, made in the calf of the leg, gave exit to still more offensive pus. After August 5th the patient was slowly sinking. A small blackish discoloration was then seen on the inside of the leg, midway between the knee and the ankle: the foot, which from the first had remained oedematous, was puffed aud pitting on pressure. On August 13th the black spot was noticed to be rapidly increasing and was recognized as gangrene, when a lotion of nitric acid was applied. On the following day, the necessity of amputation becoming manifest, two doses of one-half grain of morphia each were administered, after which the limb was removed about six inches below the trochanters by the antero-posterior flap method. The operation was performed by Surgeon J. C. Dorr, U. S. V., assisted by others, the patient being under the influence of chloroform, and losing but a slight amount of blood. Dead and disorganized tissues were found in the flaps and dissected out, after which the lips of the wound were closed by silver sutures and adhesive plaster. Stimulants were freely given, but the patient sank rapidly, and died at 5 P. M. on the same day. An examination showed that the soft parts were extensively disorganized nearly to the trochanters; also that the original wound had communicated with the knee joint. Case 527.—Private R. B. Swift, Co. H, 1st Regiment Michigan Engineers and Mechanics, aged 23 years, was accident- ally cut in the right knee joint by an axe, while engaged on duty on the Northwestern Railroad in Tennessee, November 24, 1863. •The cases are: 1. Pt. D. Bird, Co. G, 107th New York; 2. Pt. ft. Blucher, Co. C, 119th New York; 3. C Bradley, Government employ6; 4. Pt. A. Capp, Co. H, 13th Illinois; 5. Pt. J. M. Condon, Co. B, 3d New York Cavalry; 6. Pt. H. Coon, Co. F, 143d New York; 7. Pt. T. Decker, Co. D, 15th New Jersey ; 8. Pt. J. Elliott, Co. E, 4th California; 9. Pt. D. Oeigheimer, Co. B, 131st New York ; 10. Corp'l J. Howard, Co. D, 78th Illinois; 11. Pt. M. Kelley, Co. B. 59th Illinois; 12. Pt. J. Kimball, Co. A, 1st Wisconsin Cavalry; 13. Pt. L. B. Lewis, Co. C, llth New Hampshire; 14. Pt. H. T. Marsh, Co. I, 8th Ohio; 15. Pt. J. Martin, Co. D, 159th New York; 16. Pt. R. M. Morris, Co. C, 84th Indiana; 17. Serg't J. L. Morse, Co. D, 21st N. York Cavalry; 18. Pt. G. W. Proctor, Co. D, 16th Illinois; 19. Pt. H. A. Smith, Co. G, 141st New York; 20. Pt. E. S. Spangler, Co. F, 145th Penn- sylvania; 21. Pt. D. A. Stephens, Co. B, 2d Penn. Cavalry; 22. Pt. A. M. Sutton, Co. L, 4th New York Artilley; 23. Pt. J. Wood, Co. G, 79th Ohio. SECT. IV.l SHOT INJURIES OF THE KNEE JOTNT. 363 On the following day he was admitted to hospital No. 3, Nashville, where the limb was amputated on January 5, 1864, by Sur- geon S. D. Turney, IJ. S. V., at the lower end of the middle third of the thigh. The operation was performed by the circular method with little loss of blood, chloroform and ether being used and four ligatures applied. At the time of the operation the knee was greatly swollen and very painful, the internal condyle was laid bare by sloughing, and the joint had opened exten- sively, the discharges being very offensive. There were also extensive sinuses above the joint, and below it free incisions had been made to effect drainage. The patient had become quite reduced and was unable to sleep without opiates. He slept some during the night following the operation. Milk punch and beef tea were freely given, but the patient died from exhaustion January 7, 1864. The case was reported by the operator. Cask 528.—Private R. H. Turner, Co. E, 1st Maryland, aged 23 years, was admitted to hospital at Frederick, October 15. 18G4, having received an axe wound of the left knee joint. Acting Assistant Surgeon P. O. Cornish reported that the patient was not a very strong man and apprehensive of a fatal result from the first. Two and a half hours after the injury the wound was firmly closed with a stitch and adhesive plaster, after which cold lotions were used. Two days afterwards the joint became swollen and painful, and, on October 12th, synovia was flowing from the wound, the patient's tongue was coated, and his appetite poor. On October 15th, pus having formed in the joint, it was freely opened on both sides, also an abscess located above the knee but not communicating with the joint. Diarrhoea now set in and indications of pyaemia came on, and all the symptoms growing worse, amputation of the thigh at the middle third, by the circular method, was performed by Assistant Surgeon R. F. Weir, U. S. A., on October 18th. An examination of the amputated limb disclosed abscesses above and below the knee and in the popliteal space, and showed that the cartilages of the joint had commenced to break down. The treatment consisted of tonics, opiates, and stimulants. Tlie stump having commenced to discharge unhealthy pus, it was opened rTn October 21st, and washed with bromine solution. Subsequently iodide of starch wa.s administered, and iodine was applied to the stump. The patient died October 25, 1S<)4. The post-mortem examination confirmed the existence of the pyaemie infection. The stump showed no reparative process around the bone, numerous small abscesses being present in the cellular tissues nearly to the hip joint. The fascia surrounding the femoral vein was closely adherent from inflammatory action, the coats of the vein being much thickened and filled with broken down clots. The valves of the vein and the coats of the femoral artery were also thickened and very friable. Xo pus was found in the hip joint. In the next case the external wound had partly healed by first intention so that a probe could not be made to enter the joint, but insidious burrowing of pus and disorgan- ization of the tissues finally rendered amputation unavoidable: Case 529.—Private O. F. Reams, Co. B, United States Engineers, aged 23 years, accidentally cut his right knee joint open with an axe while in the act of chopping down a tree in camp, on March 12, 1864. He was admitted to hospital in Alex- andria, March 21st, at which time there was but little suppuration, the external wound having partly healed by first intention, so that a probe could not be made to enter the joint. The patient was doing very well and had a good appetite, and hopes were entertained that the joint might be saved. On April 12th, the limb was somewhat swollen and painful, and his appetite began to fail. On April 22d. fluctuation was distinctly detected, when an opening was made and two ounces of pus escaped On April 24th, the thigh was amputated in the upper third by lateral flaps, by Surgeon E. Bentley, U. S. V. The tissues below the point of amputation were found to be infiltrated with pus and badly disorganized. The patient reacted well, though not very promptly. Pyaemie chills, began two days afterwards, and secondary haemorrhage set in on April 28th, when the femoral artery was ligated just below Poupart's ligament. The patient died from the effects of pyaemia, May 1, 1864. At the autopsy large quantities of serous fluid were found in the pleural cavities and a number of pyaemie abscesses in the left lung. One abscess was also dis- covered in the spleen. The latter organ, together with the bones of the amputated knee, were contributed to the Museum, with the history, by the operator, and constitute specimens 2253 and 2234 of the Surgical Section. SHOT INJURIES OF THE KNEE JOINT.—Of the three thousand three hun- dred and ninety-eight cases of shot wounds involving one or more bones of the knee joint, forty-three were designated on the reports as shot contusions, and three thousand three hundred and fifty-five as shot fractures. SHOT CONTUSIONS OF THE KNEE JOINT. —Contusions of the knee joint1 involving the condyles of the femur, the patella, or the head of the tibia by small projec- tiles or fragments of shell, were noted in forty-three instances. Thirty-three were treated without operative interference, and ten were followed by amputation. 'Examples of shot contusions of the knee joint are reported by JOliERT DE LAMliALLE (Plaits d'armes dfeu, Paris, 1833, p. 265), who cites two successful cases. CHENU (J. C.) (Rapport, etc., pendant la Campagne d'Orient, Paris, 1865, p. 410) tabulates 70 cases of shot contusions of the knee joint, of which 4 proved fatal. Ciikxu (J. 0.) (Stat. Med. Chir. de la Campagne d'ltalie en 18.3!) et 1860, Paris, 1869, T. II, p. 766) records 21 cases of shot contusions of the knee joint; 17 patients recovered and 4 died. HEINE (C.) (Die Schussverletzungen der Unteren Extremitdten, Berlin, 186t>, p. 57) cites a case in which a bullet struck the lower third of the thigh on the inside just above the knee, passed over the knee, hugging the hone closely, and escaped on the outer side of the knee. On the third day after the injury a viscid fluid escaped from the wound of entrance. During the first days the symptoms were slight, and the wounds looked well, but they soon assumed an angry appearance. Immense infiltration and pyasmia supervened, and death occurred 14 days after the injury. At the post-mortem examination the bone was found entirely intact; no roughening was noticeable, the peri- osteum only being partially destroyed where the ball had passed along the bone. . . The synovial sac was opened at its iuner and upper circumfer- ence and was filled with pus. Stkomeyek (L.) (Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 55) tabulates 8 shot contusions of the knee joint, but gives no results. KurPRECHT (L.) (Militdrdrztliche Erfahrungen todhrend des Deutsch-Franzosischen Krieges im Jahre 1870-71, Wurzburg, 1871, p. 10) tabulates 8 cases of shot contusions of the knee joint and patella but does not indicate the results in the cases. 364 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Shot Contusions of the Knee Joint treated by Conservation. — Of the thirty-three cases oi this group, eleven, or 33.3 per cent., were fatal. More or less swelling, extensive inflammation often involving the synovial membranes, necrosis, and exfoliations of small pieces of bone, abscesses, and effusions into the joint were the most prominent symptoms following shot contusions of the bones of the joint, and the cases of recovery were followed by wasting of the limb, partial or complete anchylosis, and, in a few instances, by perma- nent enlargement of the joint and exacerbations of pain and swelling during damp seasons. Il'ooverws after Shot Contusions of the Knee Joint treated by Conservation.—Twenty- two cases of this group are reported. The patella was the seat of the contusion in nine, the condyles of the femur in seven, the patella and condyles of the femur in two, and the head of the tibia in one instance; in three cases the parts injured are not specified. Four were Confederate and eighteen were Union soldiers. Of the latter, one was returned to duty and afterwards killed in battle; fifteen became pensioners, of whom one died of phthisis four years after the injury; two have not applied for pensions. Case 5:50.—Private C. Bowers, Co. D, 84th Pennsylvania, aged 23 years, was wounded in the left knee, at Winchester, March 23, 1862, a ball striking the patella, passing upward one and a half inches, and lodging. He was admitted to St. Joseph's Hospital, Philadelphia, April 2d, where the missile was extracted by an incision. Considerable pain and inflammation ensued, and an abscess formed above the wound, discharging itself through the opening made for the removal of the ball. The patient was discharged July 16, 1862, and pensioned. Examining surgeons report him suffering from weakness in walking. Case 531.—Private G. AV. Clark, Co. G, 126th Ohio, aged 27 years, was wounded at Winchester, September 19, 1864, by a musket ball, which passed through the right knee, grazing the patella. He was treated at various hospitals, and was ultimately mustered out June 25, 1865, and pensioned. Examining surgeons report partial anchylosis of the knee, difficulty in walking up and down hill, and considerable wasting of the limb. Case 532.—Private G. Deacon, Co. G, 14th Virginia Cavalry, aged 25 years, was wounded at Boonsboro', July 8, 1863, by a spent ball, which entered the outer and lateral surface of the right knee, passed inward and forward, striking the patella and lodging. He entered Frederick Hospital one week afterwards. The patient stated that he worked the ball out with his fingers on the field. About July 25th, an abscess formed at the point where the ball had lodged, when the external opening was enlarged, allowing the escape of about half an ounce of pus. Though no synovial fluid escaped, marked evidence of the joint being involved existed, the swelling being more extensive on the following day and fluctuation well marked. Tincture of iodine was then freely applied and the limb was placed in Smith's anterior splint. By August 10th the wound was nearly closed, the effusion within the joint had almost entirely subsided, and the patient was comfortable. On August 20th the wound was entirely healed, the appearance of the joint being natural, though considerable anchylosis existed, partly perhaps from deposit and partly owing to long continuance in one position. About a week later the splint was removed, and, on September 1st, passive motion was exercised without producing much pain or tenderness. On September 5th, the patient was transferred to Baltimore, having considerable and daily increasing motion of the knee. The man was paroled for exchange September 25,1863. Case 533.—Private J. Hammond, Co. B, 98th Ohio, aged 25 years, was wounded in the left knee by a musket ball, at Chickamauga, September 20, 1863. He was admitted to hospital at Chattanooga, whence Surgeon J. T. Woods, 99th Ohio, reported: "The missile entered at the inner hamstring precisely opposite the centre of the patella, and emerged an inch from the inner border of the patella." The patient was transferred to hospital No. 1, Nashville, where he was discharged from service March 3, 18(14. by reason of "chronic synovitis and anchylosis of the knee joint." His name was subsequently admitted on the Pension Rolls, examining surgeons certifying to his disabilities, and reporting some enlargement of the bone and also swelling of the leg. Case 534.—Sergeant J. Hendricks, Co. F, 105th Pennsylvania, aged 32 years, was wounded in the right knee, at Gettys- burg, July 2. 1663. He was admitted to hospital at Annapolis two weeks after the injury, and several months later he was transferred to Philadelphia. Surgeon I. I. Hayes, U. S. V., in charge of Satterlee Hospital, reported that the wound was caused by "a rifle ball striking the inner portion of the patella and involving the knee joint. The patient recovered with an anchylosed joint. He was assigned to the Veteran Reserve Corps December 11, 1863." On September 16, 1865, the man was discharged from service, aud subsequently he became a pensioner. In 1878, the examining surgeons reported: "The power to extend and flex the injured knee is still slightly impaired." Case 535.—Private G. Hodges, Co. B, 7th Michigan, aged 25 years, was wounded at Gettysburg, July 2, 18C3, and entered Satterlee Hospital, Philadelphia, one week afterwards. Acting Assistant Surgeon M. J. Grier noted: "A shot wound of left knee by a minie" ball passing over the patella, cutting through the outer laminae of the ligamentum patella and scratching the surface of the bone." A portion of the patella became necrosed during the progress of the case. The wound closed about October 1st. but reopened some ten days later, when a small piece of bone exfoliated. The wound healed about November 1st. Some days afterwards, however, the patient, while wrestling, fell on his injured knee, breaking open the tissues down to the ten- don over the patella for an inch and a half in length. After this rupture reclosed the patient had an attack of facial erysipelas, which was cured, and subsequently he suffered with otorrhoea. On March 24, ld64, the patient was returned to his regiment for duty. He was killed at the battle of the Wilderness, May 6, 1864. SECT. IV.) • • SHOT CONTUSIONS OF THE KNEE JOINT. 365 Cask 536.—Corporal L. P. Miller, Co. G, 124th New York, aged 27 years, was wounded at Chancellorsville, May 3, 1863, by a minie ball, which entered the left knee one-half inch external to the inner condyle of the femur and emerged two inches anteriorly, bruising the bone. Surgeon D. W. Bliss, U. S. V., reported his admission to Armory Square Hospital, Wash- ington, May 8th, with the knee joint in a swollen condition. Irrigation was made by water dressings, and subsequently tincture of iodine was applied to the knee. By June 6th the wound had nearly healed, but there was considerable effusion in the joint and contraction of the flexor tendons. The patient subsequently passed through several hospitals, was assigned to the Veteran Reserve Corps March 2, 1834, and ultimately discharged August 13, 1865, and pensioned. Examining surgeons report swelling of the knee, owing partly to enlargement of bone and partly to oedematous condition of the tissues; also anchylosis from injury of the bony structures and from contraction of the tendons and ligaments. Cask 537.—Private M. Piggott, Co. K, 88th New York, aged 19 years, was wounded at Savage Station, June 29, 1862, by a mini6 ball, which grazed the right knee joint between the patella and the inner condyle of the femur. He was captured and remained a prisoner for nearly a month, when he was exchanged and conveyed to Philadelphia. Acting Assistant Surgeon J. B. Bowen reported that the patient was admitted to Fourth and George Streets Hospital, suffering from synovitis and a very painful wound as well as a much swollen knee. The treatment consisted of cold-water dressings, and afterwards fly blister and solution of lead and opium was used. On August 24th, the adhesions were broken up by Acting Assistant Surgeon S. D. Gross, and splints were applied. This was followed by more severe painfulness and enlargement of the knee. The patient was discharged from service and pensioned February 10, 1863, Assistant Surgeon L. I). Harlow, U. S. V., certifying to the "wound causing an external communication with the knee joint and resulting in permanent anchylosis. Surgeon E. P. Vollum, U. S. A., reported that the pensioner subsequently served in the 43d Infantry (Invalid Regiment), his injured knee being free of pain, but perfectly anchylosed and considerably bent inward, and flexed so that the heel did not reach the ground by about four inches. On May 10, 1869, the man was again discharged and re-admitted on the Pension Rolls. Case 538.—Brigadier General T. G. Pitcher, U. S. V., was wounded at Cedar Mountain, August 9, 1862, by a musket ball, which entered the right knee at the internal condyle of the femur, striking the bone perpendicularly upon its anterior face. The result of the injury, as apparent nine months after its reception, was recorded by Surgeon Ii. S Satterlee, U. S. A., before whom the patient appeared for examination in April, 18C3, as follows: "There is an unusual accumulation of fluid in the joint, enlargement of and more or less painfulness generally of the knee, and inability to extend the leg completely. The knee is sub- ject to pain and swelling during cloudy weather, and the General is, at all times, required to use a crutch and cane. It would be exceedingly imprudent for him to travel. It is not known whether the missile remains in the knee or came out." General Pitcher was mustered out of the Volunteer service April 30, 1863, returned to the Regular Army, and was ultimately retired June 28, 1878. Case 539.—Adjutant J. B. Youre, Caswell's Georgia Sharpshooters, was wounded at Liberty Gap, June 25, 1863, and admitted to hospital at Murfreesboro' the following day. Assistant Surgeon W. P. McCullough, 78th Pennsylvania, iu charge, recorded the following history: "A gunshot wound of left knee by a mini6 ball. The missile struck the outer condyle of the femur, glancing downward and opening the capsular ligament of the joint, aud making its exit at the middle of tbe fibula. The wound looked healthy and there was no inflammation. Ice was applied to the knee. One-half ounce of whiskey was given three times a day, and anodynes at bedtime. On July 27, 1833, the patient was sent to the prison at Nashville, his wound being entirely well, and there being but partial anchylosis of the joint."1 Fatal Cases of Shot Contusions of the Knee Joint treated by Conservation.—Ten cases of shot contusions of the knee joint terminated fatally. The patients survived the injury from twenty to seventy days, experiencing extensive burrowing of pus and ulceration of the joint, erysipelatous swelling, arterial bleeding, and, in one instance, gangrene. A few cases are.detailed: Case 540.—Private G. W. Perkins, Co. G, 1st Massachusetts Cavalry, aged 22, was wounded at Beverly Ford, June 9, 1833, by a pistol ball, which entered the left knee at the lower outer edge of the patella, passed downward, and came out over the head of the fibula. Three days after the reception of the injury he was admitted to Douglas Hospital, Washington, where he was etherized and an incision made to examine the wound, when the head of the tibia was found to be grazed and the joint opened, allowing synovia to escape on motion of the limb. Ice-water dressings were applied for a couple of days. It was then resolved by Assistant Surgeon W. Thomson, U. S. A., in charge of the hospital, to lay the knee joint freely open by means of liberal incisions on either side of the patella and through the original track of the wound. By this means it was hoped to give free exit to pus, which was already filling the joint, and to save the limb with anchylosis, the operation being adopted as the only alternative to amputating the thigh. A large quantity of bloody pus and synovia escaped when the lateral incisions were made; two or three cutaneous vessels were tied, and by means of a syphon the limb was kept constantly under the effect of ice water. The patient, though having some fever and retention of urine, had very little pain in the knee and felt comfortable. Morphia and sweet spirits of nitre were prescribed. • On June 17th, there was some fluctuation along the base of the internal condyle, for which a free horizontal incision was made, and flaxseed poultices were applied. All the incisions about the knee continued to discharge freely. About one week later an erysipelatous swelling was noticed, a deep-seated abscess having appar- ently formed and fluctuation being detected below the head of tbe tibia. A large quantity of pus was then liberated by a careful dissection, and the painful tension of the leg was thereby relieved. On June 26th, the patient had a severe chill for the first time, and his stimulants were at once increased and quinine and capsicum added to the prescription of morphia. On the follow- ing day the fever had disappeared, but pneumonic symptoms were detected, and a mustard plaster was applied over the left chest. 1 This case has been noted by Surgeon I. MOSKS (Surgical Notes of Cases of Gunshot Injuries, etc., in the American Journal of Medical Sciences, 1864, Vol. XLVII, p. 340). 3W INJURIES OF THE LOWER EXTREMITIES. ' • ICHAP. x. Suppuration still continued freely from all the openings. On the morning of July 1st, a large amount of arterial blood was found to have escaped through the incision along the gastrocnemius muscle, and compression was at once made in the groin and the wound was (leaned out carefully, the source of the bleeding being apparently the anterior or posterior tibial artery near the bifurcation, and too deeply seated to be reached without careful dissection. Meanwhile the patient, already moribund, was stimulated, but without avail. He died within a half hour, from the immediate effects of the hsemorrhage. At the autopsy a diffused abscess was found following the course of the vessels in the popliteal space into Hunter's canal but not otherwise involving the thigh; all the connecting tissue in the ham was in a sloughing condition. When the artery was dissected out the perforation was found in the anterior tibial, about three-fourths of an inch from its origin, the vessel being much thickened, soft, and tough, though not materially diseased. The left lung was found firmly adherent and much congested. The bones com- prising the injured knee joint were contributed by Dr. Thomson (Cat. Sure/. Sect., 1866, p. 323, fyer. 1339), and the history of the case was furnished by Assistant Surgeon C. C. Lee, U. S. A. Cask 541.—Private J. McAllister, Co. C, 72d Pennsylvania, was wounded in the right knee, at the Wilderness, May 6, 1864, by a minie" ball, which entered four inches above the external condyle and lodged on the outside of the patella, without perforating the capsular ligament. Surgeon D. Prince, LT. S. V., reports that the following treatment was resorted to in the case: "The bone was cut down upon and the missile pulled out. No inflammation of the joint ensued until the eleventh day after the injury, when the joint swelled and became excruciatingly painful, attended with free discharge of synovia from the wound in front, on the outer side of the patella. On May 18th, this opening was enlarged and a counter-opening was made behind the external lateral ligament and tendon of the biceps, the patient being under the influence of ether. The limb was subjected to moderate extension for the following purposes: 1st, to separate the opposing joint surfaces and obviate the ulcera- tion attending contact and pressure, at the same time lessening the amount of irritation; 2d, to obviate the caries and necrosis of bone apt to follow, and making bony anchylosis impossible; 3d, to preserve the limb in a position to be afterwards useful. The patient was relieved of suffering by the incision and experienced a feeling of comfort from the moderate extension." The records in this case show that the patient was admitted to the field hospital of the 2d division, Second Corps, with "shot wound of knee," and Surgeon T. R. Crosby, U. S. V., reported that the man entered Columbian Hospital, Washington, May 28th, with "shot wound of right knee joint," of which he died on the following day, May 29, 1864. Case 542.—Private A. D. Seelye, Co. A, 136th Pennsylvania, was wounded at Fredericksburg, December 13, 1862, by a musket ball, which entered the right knee over the external condyle of the femur and passed out in the popliteal space. He was admitted to Lincoln Hospital, Washington, ten days after the injury. Cold-water dressings and afterwards iodine tincture were applied at first; subsequently warm dressings. The wound did badly; the joint became inflamed, and unhealthy pus was secreted in large amounts. On January 16, 1863, an incision was made extending six inches from the wound of entrance up the thigh. Considerable bleeding followed and several small vessels were tied, after which the wound was packed with cotton bandages soaked in persulphate of iron. Another lateral incision, two and a half inches long, was made below the popliteal, opening an abscess. On January 25th, an opening was made opposite the large one for the purpose of better drainage. Up to this time his appetite had been good, but now it failed, and the patient became delirious and had a troublesome diarrhoea. The wound remained open and exposed the blackened surface of the femur for the space of three inches. Death supervened on February 3, 1863. At the post-mcrrtem examination the internal condyle was found to be injured in its posterior aspect. The cartilages of the joint were destroyed and the surfaces of most of the bones roughened and honey-combed. An abscess in the thigh had dissected the femur half way up the limb. The history of the case was recorded by Acting Assistant Surgeon T. H. Dearing. Case 543.—Private J. Tetlow, Co. F, 23d New Jersey, was wounded at Fredericksburg, December 13, 1862, by a ball entering the outer side of the popliteal space of the right leg. The patient, a strong healthy man, was admitted to hospital at Alexandria six days after receiving his wound. The knee was tender and the inflammation slight at first, but soon grew worse. On December 23d, the patient had a chill and there was high constitutional fever, with great swelling and pain in the knee. On tlie following day the ball was discovered lying loose in the wound and was removed. On December 29th, pus was detected and let out by free incision, giving much relief. Subsequently the patient became delirious at times, and on December 31st he again had a chill, with pain in the stomach. He died January 2, 1863. At the autopsy it was ascertained that the ball had impinged upon the under side of the internal condyle, killing the periosteum for over a space of half a dime. The other articu- lating bones were also found bare of periosteum, and pus had filled the knee joint and dissected up the lower third of the femur. The case was reported by Acting Assistant Surgeon G. F. French.1 Case 544.—Private L. D. Wells, Co. D, 74th Indiana, aged 22 years, was wounded at Chickamauga, September 20, 1863, by a musket ball, which entered about two inches above the inner condyle of the right femur, passed obliquely under the bone between the two condyles, grazing the inner, and emerged about three inches below the head of the fibula. He was admitted to hospital at Chattanooga, and thence transferred to hospital No. 8, Nashville, on October 30th. There was little swelling of the parts, and the relative constitutional condition of the patient was good until he became greatly prostrated from hsemorrhage, the precise seat of which could not be determined. Ou November 17th, the femoral artery was ligated at Scarpa's space by Surgeon W. C. Otterson, U. S. V. Reaction was perfect by the following day. The limb was wrapped in cotton bat- ting. No particular change occurred until November 24th, when the wound suppurated excessively and injections of solution of sulphate of iron were ordered. The leg and foot were oedematous. On the next day the wound made by the operation broke open and suppurated freely. On November 27th, the patient was worse in every respect and marks of gangrene appeared. Remittent haemorrhage from the anterior tibial artery caused death on December 1,1863. The autopsy showed that the ligature had not yet cut away. The femoral was obliterated on the cardiac side for about one inch; the profunda was greatly enlarged. The femoral vein was discolored and contained a clot three or four inches long and not entirely obstructing the circulation. The structures at the seat of the hsemorrhage were greatly disintegrated. The hi:- >ry of the case was reported by the operator. 'Bella.VGER (J. B.), Report of Five Cases of Gunshot Injury of the Knee Joint treated at Man.iio,i House Hospital, Alexandria, Virginia, May 10', lfti3, in American Journal Medical Sciences, 1863, Vol. XLVI, p. 44. SECT. IV.] SHOT FRACTURES OF THE KNEE JOINT. 367 Cask ."15.—Private C. Werth, Co. K, 1st New York, aged 2'2 years, was wounded in the left knee and right ankle, near Richmond. June 30, 1862. Aetinu; Assistant Surgreon J. B. Bowen reported: "A ball entered one inch above the knee, and em rged at the inner portion of the leg one inch below the patella, grazing that bone and the head of the tibia; the other ball entered at the external malleolus and comminuted the tarsal bones. The wounded man was taken prisoner and sent to Rich- mond. He was received at the Fourth and George Streets Hospital, Philadelphia, July 2'Mh, in a debilitated state and with both wounds in a very bad and painful condition, there being synovitis of the knee and purulent di*<■liaf^e.-. Linseed poultices and solution of sulphate of copper were applied to the ankle, and cold-water dressing and subsequently blister, followed by solution of lead.and opium, were used to the knee. The patient gradually sunk, and died from exhaustion August 8, 1862." Ampi'.tatio/is after Shot Confusions of the Knee Joint.—The ten instances comprising this group have already been cited in the tables of amputations in the thigh in the pre- ceding section of this Chapter. Five were intermediary and five secondary operations.1 Eight of the ten operations terminated fatally. SHOT FRACTURES OF THE KNEE JOINT.—The cases to be considered in this group are those involving primarily the bones composing the knee joint. They number three thousand three hundred and fifty-five, and are classified in the subjoined table: Table LII. Numerical Statement of Thirty-three Hundred and Fifty-five Cases of Shot Fractures of the Bones of the Knee Joint. PARTS INJURED. MODE OF TREATMENT. Conservation. Excision or Knee Joint. Excis. op Knee j't followed bv amputat'n of Thigh. Amputation at Knee Joint. Amp. at Knee J't followed by Amputat'n of Thigh. 1 Amputation of Thigh. o 69 9 7 1 84 22 6 56 84 89 8 15 3 30 25 4 80 267 •a c 'b u <0 a •a 1 3 1 4 11 s« 56. 3 47.0 68.1 75.0 26.3 53.1 40.0 58.8 76.0 £> 10 4 2 3 8 2 1 5 14 49 y o a> K 3 1 1 2 1 8 .d "5 8 INJURIES OF THE LOWl'-R EXTREMITIES, [chap. X. the tibia was involved; and in one thousand eight hundred and three the fractured portion of the articulation was not specified. Eight hundred and sixty-eight were treated on the expectant conservative plan ; forty-nine by excision; seven by excision and subsequent ampu- tation of the thigh; forty-nine by amputation through the articulation; five by amputation at the knee joint and subsequent amputation of the thigh; two thousand three hundred and seventy-seven1 by amputation of the thigh, six of which were followed by amputation at the hip." SHOT FRACTURES OF THE BONES OF THE KNEE JOINT TREATED BY CONSERVATION.—Of the three thousand three hundred and fifty-five cases of shot fractures of the bones of the knee joint, eight hundred and sixty-eight, or about one-fourth, were treated throughout without operative interference.3 The results in nine instances 1 There are noted in this table 2,381) amputations of the thigh for shot fractures of the bones of the knee joint, of which 12 had been preceded by excisions or amputations at the knee joint, and 6 had been followed by disarticulation at the hip. To these 2,389 amputatious should be added 10 opera- tions for shot contusions of the knee joint, making the total of 2,399 cases of thigh amputations for shot injuries of the knee joint, as indicated in Table XLVI, on page 332, ante. 2Cases of Pt. Julius Fabry, Co. K, 4th Artillery (CASE 330, p. 153, and No. 2 of Table XVII, p. 159); Pt. Eben E. Smith, Co. A, llth Maine (Cask 332, p. 155, and No. 4 of Table XVII, p. 159); Serg't E. D. Ulmer, Co. G, 15th New Jersey (Case 333, p. 156, and No. 5 of Table XVII, p. 159); Pt. R. A. Vick, Co. F, 43d North Carolina (Case 334, p. 157, and No. 6 of Table XVII, p. 159); Henry Campbell, sutler's clerk (Case 335, p. 157, and No. 7 of TA11LK XVII, p. 159), and Pt. Lewis Larry, Co. A, 1st New Orleans Regiment (Case 336, p. 158, and No. 9 of TABLE XVII, p. 159). 'Examples of shot wounds of the knee joint treated without operative interference have been cited by Framuesakius (N. A.) (Canonum et Con- sultationum, Libri III, quibus aphoristica methodus medendi omnibus affectibus corporis continetur, Paris, 15!I5): A ball lodged in the knee joint appeared afterwards on the surface and was cut out. Schmidt (J.) (Speculum Chirurgicum oder Spiegel der Arztnei. Augspurg, 1656, pp. 153 et seq.): On Decem- ber 12, 1632. a Swedish dragoon was shot through both knees; both patellas were fractured; the patient recovered, but could walk only poorly on crutches. In October, 1647, a Bavarian soldier was shot through the right knee; he remained for three days without assistance; a "jury of six " recommended ampu- tation ; Dr. SCHMIDT refused to operate, dressed the wounds, and placed the limb in a straight position ; pieces of bone came away; recovery in six weeks. G. Uasch, shot through the left knee joint, May 18, 164?; fracture of bones; recovery. Th. Rosen, shot through right knee ; recovery. Z. Neschin, shot through right knee, May 20, 1648; swelling; suppuration relieved by incision; recovery. Guillemeau (J.) (Les Oeuvres de Chirurgie, ltouen, 1649, Chap. IV, p. 652): M. de la Tour received, in the barricades of Paris, a shot wound of the left knee joint; ball entered above the crest of tbe tibia, fractured "lepetit fossile" in several pieces. Barber-surgeon Habicot made an incision and removed the spiculse ; recovery. WISEMAN (R.) (Severall Chirurg.call Treatises, London, 1676, p. 430): A page of Lieut. General D. L--- was shot through the knee, the ball fracturing the joint; excessive pain and aneurismal bleeding; putrefaction, delirium, spasms, death. Beli.Oste (Le Chirurgien d'Hopital, Paris, 1716, p. 21C): A captain, shot through the right knee, at Pignerol, in 1C91; extensive suppuration; wound of entrance enlarged by incision; recovery in five months. Mouakd (Opuscules de Chirurgie, Paris. 1768, T. II, p. 252): General Keith, shot at the siege of Okzakow, in 1738, through the right knee ; extensive suppuration followed; two pieces of cloth escaped; the General recovered and was afterwards killed at tbe battle of Chemnitz. Despoijt (Traite des plaies d'armes a feu, Paris, 1749. p. 22,' et seq.): A cannonier, at the siege of Milan, in 1733, received a shot wound of the knee joint, fracturing the inferior extremity of the femur; wound enlarged and the ball, found embedded in the femur, removed. The patient recovered in two months.—A soldier, shot in the right knee, at the battle of Parma, in 1.733; the ball lodged iu the joint. The external condyle of the femur was fractured; the ball was extracted, and the patient recov- ered with complete auchylosis. A volunteer was shot, in Corsica, in the outer and anterior part of the knee. The wound was enlarged and fragments of the outer condyle of the femur and of the patella were removed, and the ball extracted; the patient recovered in two and a hp.lt months. Theden (J. C. A.) (Neue Bemerkungen und Erfahrungen zur Bereicherung der Wundarzneykunst, Berlin, 1782, B, I, p. 76): Major Kamke, wounded at Striegau, in 1745: the ball perforated both condyles of the femur; the wound was enlarged and a large number of spiculae removed from the extremity of the femur; recovered with a stiff knee joint. BOUCHER (Observations sur des playes d'armes dfeu, etc., in Mim. de VAcad. Roy. de Chir., Paris, 1753, T. II, p. 295): A drummer, wounded May 2, 1749, at Lille, through the internal condyle of the femur; wound enlarged and fragments removed; recovery, with stiff knee and one and a half inch shortening. BELMAS (Boruexave) (Precis de plusieurs observations sur les playes d'armes d feu, etc., in Mem. de VAcad. Roy. de Chir., Paris, 1753, T. 11, p. 527): A captain of an Algerian vessel was shot through the knee, the ball carrying away about three inches of the upper part of the tibia, a small portion of the patella, the head of the fibula, and a portion of the condyle of the femur. Dr. Belmas removed several fragments, and the patient recovered with anchylosis of the knee joint. Two similar cases are detailed by Mehee (J.) (Traite des plaies d'armes dfeu, Paris, An. VIII (1800), p. 175): A cavalier, wounded at Ludzerberek; the ball passed through the right knee from before backwards, shattering the patella and the condyles of the femur; extensive incisions were made and numerous pieces of bones, some loose, some partly attached, were removed; recovery, with complete anchylosis. A laborer of Meaux was shot through the right knee from the outer to the inner side, shivering the articulation ; swelling of the thigh and gangrene; large incision to allow the escape of fetid pus; a piece of bone tbe size of a dollar, and of the thickness of the little finger, from the condyles of the femur, was removed, and other sharp points of bone were cut off; 15 days later another piece of bone, an inch long, from the loc .se portion of the shaft of the femur, was removed; recovery, with hardly any defect of the articulation. Hunter (JOHN) (A Treatise on the Blood, Inflammation, and Gunshot Wounds, London, 4to, 17S4, p. 531): A French soldier at Bellisle, in 1761, shot through the knee, the ball traversing the joint without fracture of bones; recovery. L. J. Rauasse (Sur les plaies des articulations faites par les armes dfeu ou les instrumens tranchans, These a Paris, Yl 1. No. 84, pp. 10, 18): General Chailes de Lameth, wounded at the siege of New York 1783,[H the ball traversing the left knee through the condyles in its greatest diameter from the right to the left. The patient, who was treated by Surgeon-Major Robillaud, of the French army in the United States, recovered without the least immobility of the limb. In a second case the condyles of the femur were fractured, and the ball lodged. The missile could not be found. Extensive swelling followed, but the patient recovered in about three months, with anchylosis of the knee. The author regrets that the man's pantaloons were not examined, as the ball might have been found. Desault (Journal de Chirurgie, Paris, 1791, T. I, p. 321): V. Viry, aged 15 shot in the right knee on January 6, 1790; fracture of the patella and the condyles of the femur; recovery without anchy- losis. Germain Levtels (Essai sur les avantages qu'il peut y avoir a amputer la cuisse, lorsqu'un coup de feu a traverse Varticulation du genou, ou lorsque la balle y est demeuree profondiment engagee, Paris, These, Vol. XXXII, An Xl-1803, p. 40 et seq.) cites six fatal cases: J. Bourdon, wounded in I'.aly, November 22. 1793; shot wound of knee joint; bones not fractured; fatal. Young man, aged 20; shot through knee joint in June, 1797; bones crushed; amputation refused; fatal. Two soldiers shot in the knee joint in October, 1793. The patella and the condyles of the femur were fractured in one case; the ball lodged; erysipelatous swelling; death. In the other case the ball passed through the joint, perforating the condyles of the femur; several spiculae were removed; suppurative fever and death. Captain Milet, 72d Grenadiers, shot through the knee joint June27, 1798; no bony lesion; suppuration relieved by incision; fever; death. Barot, 72d Grenadiers, shot in the right knee on October 2. 1799; extreme pain, swelling, inflammation, and death. Pehcy (Manuel du Chirurgien-D'Armie, Paris, 1792, p. 164) alludes to the case of M. d'Almons, an engineer; sect. 1V.| SHOT FRACTURES OF THE KNEE JOINT. 369 could not be ascertained. Three hundred and thirty-eight were successful, and five hundred and twenty-one fatal, a mortality of 60.6 per cent. Bccoveries after Shot Fractures of the Bones of the Knee Joint treated by Conserva- tion.—Examples of the three hundred and thirty-eight recoveries after shot injuries of the bones of the knee joint treated throughout on the expectant plan, will be cited in the order of the groups indicated in Table LIT. In the following five cases the joint was opened and the condyles of the femur injured: Cask F>4(>.—Captain A. P. Fisk, Assistant Adjutant General, U. S. V., was wounded at Fair Oaks, June 1, 1862, by a conoidal musket ball, which entered the inner side of the right knee and was cut out from beneath tlie skin on the outer aspect. The hemorrhage following the injury was slight. The case was reported by Surgeon G. Grant, I'. S. Vv who, together with Surgeons J. A. Lidell and A. X. Dougherty, was satisfied that the joint was implicated. Immediate amputation was advised but rejected by the patient. The pain in the joint was excruciating. Surgeon (irant dressed the wound, after which the patient the ball encrusted itself in the condyle of the femur, and the patient recovered. WepjEKIND (George) (Nachricldtn ueber das Franzosische Kricgs- spitalwcsen, Leipzig. 17f8, li. II, p. 205): J. H. Bnrzon, Corporal, 10th demi brigade of Fight Infantry; shot comminution of right knee, in 1795, near ltastadt: tetanus: death. Chevalier (T.) (A Treatise on Gunshot Wounds, 1804, p. 11 ti): J. T----, aged 19, August 27, 1799, external condyle of femur split; October 1st, a piece of bone removed; 10th. amputation proposed but abandoned as the patient fainted on moving ; death in a few days. At the post-mortem the ball was found in the internal condyle of the femnr. LARREY (D. J.) (Mem. de Chir. Mil. et Camp., Paris, 1812, T. Ill, p. 256); Ibrahim, a mameluke, received, in August, 1799, a shot fracture of the patella; the ball traversed the knee joint; the patient recovered. Fexech (E.) (Obs. recueillies d Varme.t d'Espagne svr les plaies d'armes a. feu aux extremites, Paris Thesis. 1813, pp. 13, 19): Obs. XIII. soldier of 62d regiment, wounded at Vimeira, in Spain, August 17, 180S ; fracture of inner condyle of femur; recovery. Obs. XX VII, Gracieux, Adjutant, 62d regiment, wounded August 17, 1808; fracture of patella and inner condyle of femur; fatal. MEALONIER (Sur les plaies de Varticulation du genou faites par les armes a feu, Paris. Thdse No. 16, 1814, pp. 19, 22, 24): Lecoeur, 50lh line, shot through the right knee, at Salamanca, July 12, 1812; the ball traversed the joint; no bony lesion ; death. A dragoon, 15th line, in Galitzia, in 1806, was shot in the left knee; ball lodged in the external condyle of tlie femur; incision made, and ball and large fragment of bone removed; death. A soldier, at Pnltusck, December 26, 1806, received a shot fracture of the inner condyle of the femur, the ball traversing the joint; tumefaction; death. Deguise (Ch.) (Dissertation sur les plaies des articulations, Paris These, 1815, Ko. 4, p. 17): A sub-lieutenant of the 80th line; shot in Spain, through the knee; no lesion of bone; complete recovery. BLOX'deau. (J.) (Propositions de pathologic fond.!es sur des observations, Paris, 1815, These No. 64, p. 21, Obs. X): A soldier at the battle of Aropiles, in Spain, in 1810, was shot in the right knee, the ball lodging under the patella, whence it was removed; he recovered. Bell (C) (Report on Gunshot Wounds of the Knee Joint in Surgical Observations ; being a Quarterly Report of Cases in Surgery treated in the Middlesex Hospital, London, 1816, p. 429): D——, shot in the knee September 6, 1812; ball lodged in condyle of femur; recovery. TROWHUlDGE (A.) (Gunshot Wounds, in Boston Medical and Surgical Journal, 1838, Vol. XVIII, p. 342): Colonel McNeil, shot in the knee, at the battle of Bridgewater, July 25, 1814; the ball-entered above the patella and injured the condyles of the femur; recovery, with partial anchylosis. Manx (Jamks) (Medical Sketches of the Campaigns of 1812-13-14, etc., Dedham, 1816, p. 211): A soldier of the 33d regiment, admitted into hospital at Burlington with a shot wound through the knee; amputation proposed but refused; sinuses laid open and a spiral bandage applied from foot to trunk; recovery, with a stiff joint. EHRLICH (J. A.) (Chir. Beobachtungen, Leipzig, 1815, B. II, p. 115): A soldier of the 5th Italian regiment, aged 22, shot at Ltttzen, May 3, 1813, through the right knee joint, fracturing the external condyle of the femur and internal condyle of tibia; recovery, with anchylosis of joint. Champion (L.) (Traite de la Resection des OS caries dans leur continuiti ou hors des articulations, Paris, 1815, No. 11, p. 77, Obs. XIV): Chauveau, 42d demi-brigade, shot in the right knee, at Liitzen, May 2, 1813; ball struck internal condyle of tibia and lodged, and was removed in April, 1814, by chiseling away the carious surface of the bone; recovery, with good use of limb. BLENKIXS (G. F.) (Article Gunshot Wounds, in COOPER'S Dictionary of Practical Surgery, London, 1861, Vol. I, p. 816): A soldier of the 95th regiment was shot through the knee joint, at Merksam, near Antwerp, in 1814; he died alter several mouths' suffering. Cambray (Journal de Chirurgie, par M. Malgaigxe, 1846, T. IV, p. 361): A young man, aged 15, shot through the patella, at the storming of Cambria, near Water. loo, in 1815; recovery. HENNEN (JOHN) (Principles of Military Surgery, London, 1829, p. 147 et seq.): A soldier, shot in the knee joint at the storming of Nivelle, Nov. 10, 1813, the ball perforating the joint: inflammation, and death on the fourth day. Lieutenant-Colonei It----, shot in the right knee joint, June 18,1815; the patella was fractured; the missile lodged; recovered, with good use of limb, in about five weeks. Major B----, aged 28, received a shell wound of the right knee, June 18, 1815; the patella was fractured and the femur grazed; fever; swelling of lower part of thigh; incision on external part of thigh four inches deep; a pint of pns evacuated; July 6th, portion of patella removed; recovery, with complete anchylosis. Begin (L. J.) (Mimoire sur le traitcment des plaies des articulations, in Rec. de Mem. de Med. de Chir., etc., 18C5, T. XVI, 1st ser., p. 6): J. A----, chasseur, wounded at Barcellona, Spain, September 1.1, 1823; fracture cf patella and condyle of femur; recoveiy. JOBERT DE Lamballe (Plaies d'armes dfeu, Paris, 1833, p. 266 et seq.) gives brief details of 11 penetrating wounds of the knee joint from the revolution in Paris, in 1830; 10 recovered and 1 proved fatal. In the fatal case the femur and tibia were interested ; of the 10 cases of recovery the condyles of the femur were injured in 5, and in 5 there was no bony lesion. Lakkey (H.) (Rel. chir. des icintmens de Juillet, 1830, Paris, 1831, p. 110): C----, 50th line, in July, 1830, received a shot in the left knee; the internal condyle of the tibia was fractured; swelling, pain, and infiltration, and death on August 25, 1830. Meniere (P.) (L'Hotel Ditu de Paris en July et Aout, 1830. Paris, 1830, pp. 314-320) briefly cites 5 cases ; 4 were fatal and the result in 1 is not indicated. In one case the head of the tibia was fractured; in the other 4 cases no mention is made of fracture of the bony structure. Aknal (Mini, sur quelques particularitCs des plaies par armes a Jtu, in Jour. univ. et hebd. de Med. et de Chir., Paris, 1831, T. Ill, p. 38) alludes to 8 cases of shot wounds of the knee joint, tf-ith injuries of the bony structure; all recovered with false anchylosis. De Mortaix (Observation d'un coup de feu ayant traverse Varticulation tibio-fimorale droite,- guerison avec ankylose, in Rec. de Mem. de Med. de Chir. et de Phar. Mil., 1839, 1st s§r., T. XLVI, p. 99): C----, 48th line; perforation of knee joint; articular surfaces ploughed through ; recovery, with anchylosis. Al.COCK (R.) (Observations on injuries of Joints, in Med.-Chir. Transactions, 1840, Vol. XXIII, pp. 260, 261) tabulates 18 cases of shot wounds of the knee joint; 3 recovered, 15 were fatal. HOME (William) (Report on various cases of Gunshot Wounds received in actions in Upper Canada, in 1838, in Edinburgh Med. and Surg. Jour., 1840, Vol. LIV, p. 28) relates a case of fracture of condyle of femur, the ball traversing the joint; recoveiy, with anchylosis. WARD (Branshy COOPER, The History of a Gunshot Wound in which 'he Patella was carried away and ihe Knee Joint completely laid open, in Guy's Hospital Reports, 1840, Vol. V, p. 88): F. M----, patella shot away, November 2, 1838; joint opened; recovery, with considerable motion of joint; walks without a cane. Baudens (L.) (Clinique des Plaies d'Armes JHJ r :Y.'fe;i!iS^j *y ■+& ^ /. .; wf- A ■ }■ y; f \ & 1.1 ,.'*', "• *■/! if* "■: t^hi*.,., . ? -•fe 'A'AA. : ^' !*' V ■ 5: ■ ■ :• "•* ■i.*' £:•'? fa 4.: 1 A* *:&■ 4' 'U't. (il,.-l '■" Y»Yfe»: j. . ., •);• t" . rt - ■'i.i'.. ?;-':.-, . • !f:':''-'''' ■■A. ,-rfy ,;Aa** ' » V \ -'.u'!;'a',./ %-.,- ■ : ' ' ■ '• ,-! ■'"!>: fa \F ■':' i> ■•» ,.n lilh PLATE LXVIII ._ RESULTS OF :.shL '' INJURIES OF THE KNYE - JOINT I Cum.- mC I. „.„|, .ml I'. \V. KoUH.ho.i - lu«' ol-M-ivnt.- I Vic- St, ;<) ih \(.,.. A>r\< "*' "'""s^lv"»i, . ' . ,. w!.,re he was •■: • '• i • v -' . •:•( ; '•• ' B t.J r, {'. S. \., who stated i>,,;.t I .. n-r :':■■ *•.,"! < ,n'.ir*»d vk' ! ■ la ■ ■ Th'.1 ;, event was snb-rnM, ,,tly * ..v'. , A -'Turk, ., ■■!• •.. (ai-.- of f.'v. >YiL:«.<: v ' . ' i (r i,i.nl, 1.; S. A.. August 19, l«oY cm: ■' t<> w (,• . ui ; ;.;LM-ted' '' ' I ■<:•■ I.1' ■:• ' YY-xcd. The <.i ili...cs oi the woi'.Y are he:. :•■;"' but :.,. . ,<, jt Y si,! (., , i to pa*-*', •■. : ■•. <■ rr\" In a r.irtificatc dated tYco monuis la'.et, ■: a'.'-:.! .-(.j-iurted: ' H'1 Y ^radunJ't ■ •' ."■■''■ :• ■* md of the knee joi:-.* d. scribed in ry fort.'.er :: : :. .1 tit.-?: Y l,e.<". cede Y , ■ ' ■• '•-,:* ' ■•'.n.'n1. ami s^iv.v v h-n exeni:.:d," •:,<:. : . ,.„].: .)],-.: re <■>> that Caprd/ ' ••' ■ ■■ ,,■••■■ h Assierjuii ' ■ ., ir t «"!enev J Jii the ■ , , .,,,;,)■; htf K-. .. ;r.. >!-:i-t i.;uttered cu: Y --■•'.■. '■ : ■ oi' f,''" -vpiv n>. . ■:■: • ■'i^v until ijrjirly •'.-.■ r- il: .T.'.ar .,. , htu the New York (".. ;• .•:-..:■■.: : '. • >.s .ollowi-: ' " " "firmm . • : Yj. -I.:,-. ;, ... ;tLT..;ia i,i)i--half imh hii.,,' . l-». '■ ■■■ ' .;;■, ;\.rim find tib'.i,. ;......jectioii on •'''--..■:;...-:'•• ca ■ >Y Motion of extensi "e:-rh :■■■.. Y-r :: •• ■:■ -u d. ]>'■■') :;. . • .un- ,4' tho ■. ■■• •■ " -< n motion ip j'unt; ; :;ai from AY:. :■■•'■' :•• ■ ■''".. a «■.'':.::• !• amino; ■. a--.]:;.' !.■■••.' •;:•: Ling particularly irk-. -MK!,' t-t/ . ' :.: i • : ■■■■>.-■ ■■■■ ■■:..■• Sepicc.,,:' ■:. J.YY *:■■: V. Stuck.1 ■■:<.). E. 116-1. Penney!va> iu. .■(.;■■'.! ' ..':.!:-. .. ..m right *!•<-. •' r^-itt- '■■'.. • d i.ntereu LY.-rY,* Hospital, AVashin iU .,--ix dayi-. ;Y ".-:■. !• -. h.^iefna Snrj. :■. ■■ II Gih- •■■ 'I; • .-;•■> as follows: .'-'ill- ic- 'Y. probably u u i i.n5 ball, e: •(<:'«! ■..'.■ ':•. <■ ,:i. ; 'Y!a and • ■■-•: t'.; center i die j.o:Y.i-d tpaco. going d:- -etly Tiro Ylh h>:i" ,: . .; A- ftrtia '.u ■ ■urrfacc ■ •• ; i | assng m-'.inly i'.'U ugl, the inteiv.ondyloi 1 notch. '!>,•.■ fuent •• ;-. .....•'' iifcafce organizatio:), . ■ .• ■ '■.,.] disturbance -s >.»I '-.'>: rau-h iothiiimati.)!) in i'lu.- ■.■A.w, which. !«■;« ,■... ■ . .,. :."un^vi). : .- . .' <■ .- ;■ ..-plied. The di-th.i .'/.' v..,? :V< . abimdin't. :,nd •- ;i, ;'il0 pui- Ir . • ;Y Pjnovial fluid, :..■ « is: ( f appetiic. %v 11:. •'i.di \>.m:.. ot pulse. t,.,d ..'n Y;c corn pi ,i •■■ --.I ... aY.ri-:'*-', v.'hico I'lax-.'cd ponitites. .j.plitd fo: ,■> cr (hut drvv • _•,••'■,■•!■-••■< .!.;'• .•.■■A-.: .;.:■ >he pOBienor •:'l '■ iving heal, c'1, wliei. the sympicL-rr iaunr-diately :i'o:: I. ■ i.--. ■.•■! !.(-•• : ■•■;•.'•. .• .v>. the patient ' ' •' (•••. ■ !'.:cui«, tbe )r: ■ ■' ig f. ,-:ed :,t an ans.le of about 131° ".nY 1; ■ i; •..■'-. TV. Av..'A, :f :. ■ • ..a not &(■ .mi -,: 'ii* ivere; "',is .. : tit>: i\ as fair, bowels regulnr slec|-> rciVi-.-iY...-;,:, cr.c . .n- h;u! ii': ■ ■.-. >• ■'. '''.■: cu*> ..fY ;■■ ;. "'.'■ 1.1 ;;n-,c. Y .' . ;t: -t part-ii October, in or.ier to rvduce !l;c i'le3r;oii. Use lunh '.v.;. : :i ...ged to a ■.■i.."'" jt .■'•«•: '. >■ Ym h i-,-.-' : Ld ;-?,ost eiitire exfensi.;.n wii.liont'■'.'.-usiobii..; any bad symp'oms in t! if ,":r. i or con - '. .; ' ■ ;.,i;i:':i. ;<■ I;.: :. .i : o; ■!,• !, iWjiig eight month.-, i...'tiling of spt-.-.'iil Lntei-ist occurred, though there t.-.-.w ^evrral :,; ...in . .: .y H'i.cks ' nii-r Y .! ;.•((.• m.i! l-eadily s'ihd:.id :y iiovltici;1.^ \''ii tb.-st1 .'.ccasions aliscossi ■: s'>meii'i;i.i- ibrniet :■ :.o ■ '-i-terior lbi;::h. Th. :^(- i.- u-nibly i' •cro^tW:^ 'eia tin. '",.•• 'atll'e wo-.icd ....Ij, ; i'c-ived the o.dii.a'j dres«:'i.. ■-•;' c Y ' ;- "i. "loth*, \Aa): i-h-i.pin Y ai-. i !■ the • :-chai':' 'Tinctu^o :.-■' . .dine and j.'oti'ii.vs. -i hot Comcivatio: ivitu "...■■-.'A en' 'a ■ '••' rd" i r'A'x, were iiS'-.t ■\tu--. ' ir- . : .■.?,. ■■.:i:i.>n shewed tln-mstI>."•:*. ?. i< • - ■■. nsci in tlie fi't..i'!i''Ti " , • '■> - .:'•-.;!' ■ -•'■..■■ f':.-'.. .Vri-... NY. •::*, .• Y M. ! o? ":• km -int, taken July 9, lrY . ! .!_)■ i;>, . ■'•. :•■ gooa health, ih .- »..-.or .v.:i;;•,'; ».-:n..:' -'il* open ai ■' ■•• ■ ":Y' ;iu; Y..: .•ut :•;>:•.:!•';• ..ii ;i ("■ i be for tl ee inches. There v •>...'.:■ .-.'arge ■ try freely, end 'Yt.'':' i.-, ■ vidi-. t^. --.•n:-. . "..ee of tl... t • .'. ..' ; ,.• ■■ ■■•• ~\><'C <.,...• •■•■■: :: ■, '^-charge. I». .':.i:i'.a.-. , . ' -1 same t'-.-unir- ;t i (.ilfi: " Ihe _t'-.' ; is comph- ->'.:_>' . . .•.• '.•. • . A-/ '■ ■ ■■ : ■ < ■ :':■.--,. t- i.h;o. r.hc lice; -.:■ '■ '• .-.. to I. ■"■' :l. g-oiind. Hov:.:: ■> "ii Tie fro,. • ••'' si.ni. !■:■ ; ;; . :" ■'. . , ,.,, j ,.... ;s ci.l.'ii'iri'ii. unesi. :nY i' : > ivbich reuuc^ \. . ng very d:-f:U: '. • ■/.-. : , •' '■ !r....ot'!".iii'' atrophied. Jit" I'OndiY a - -.■■.: di-ally srowiiu• v,"• ' The P''-r>:u.i . • • ,:: i . ■■ ■ . ;.: C >iSK Ylr— V\. -:,i ! i ■ : n:Dv.':m; ■ . • . V.v. ne Corp ; .-, ■• ' :-." , . ■ . • . ^t. amor .Mi'.oiifotj, 'vi!.. woun : u :'• .to I'm :., :';<• nitack on I':.it I-Y •..,■..-. ,, ,, .,._. \..,.; 1 Hot. .■•in' at V.. "s..-«» d-s. i>. i'^.-d J'in.; 15, 1865, .:... - ... ■,. : . .-. , . ..,. ,.:' ..:'• \nee joim, ' '-..l'.c. - i-:•' -' . i.nv ai.d l.'-i^iti!:!.! ii: ..,-i.hy!..-:■? ..- ;.i '. .' •...:.::...• ■ . •. "•'.■■jAiely requh ■; ■ui .■■..!• I:: ■ --'iica'-eding y--r, 'Jii'.' at Thih-deiphui., ■•'. ; :■..,,:(■ •!•- a ,. , |r, j)r. ft \[ '' a" ■'•'j'- ■'■■' ' ■■■■■< <■'■ i with '■:.■• \ivy and vidi the V).:iy, wr-.. .oadc :•<■•■ ;■ ■ . ,. , VAt..: [Medical md • .-.riii'I . ■ ■ '. ' 1 Hl.T. p 307): ''He • vas struck, while Iviry down :.«■ 'nncr condy:.o if ■'\m: .•<■.■■■ :.-.., h i.n :n iculation. When disc>in."'ed from i.ost' " .' . .: ,.-d ficx •» at .. .'hi '■ -'v:., •■ *. ■ i -. ;: :■•■•. 5 Ynr d^cliargc ai.-. the p .izxugo frt ■:*• -i: i . :. j.Mthc,. ' i'.t d.; i i j:-on. 'A'hen he p,'. ited Limaelf at Y.t: .ii '• ■ ■■.,• i:, ,,;' vhc w c . . 1 j,jio;;. ■.., . ;o,al, vith t.'ie »in latthe diftanc: Y :■■•-. ..... .,rc-.pc.cdi ,l . ..kwiw . Tin. ,,p nlY'ii ■• li-d-i. ■ ,n break'uii uiYi, ■•■..• h:-:.i i» by ineiio-- •■■ i.e.'lbrators ■ ■-. h" istriiL -■ i:-,- jes \v. divided .-■..."-.. ■ • ..- Ihen bar.-'.i/i ■ --.lugh >ut its :•-a-. ...s piacir-l niton a doiii.h-i..( h-M.;... .. . : . .. n,Y, so thai. ■ . ,i-..«.l he- gmdua.;-. v ■ icoii-h.'- alter the <.-.«i-rati.," 'i. ■ i. t. •■ ■ ■ ; ..Uiib\e hi;u ro n-v!. on the hall of ., ^ lies*:-.*' .ne he- ', :;it down at some future time by ,:'-v' !'; H>-••-■■■ :, ■.., n: 1867, Tie patient writes that '•'•■; 1 " " 1'.:.. tJhilaii'.d|>hii Excrniuing Boai I, Y ■ "'''•' ■*■■'■ '■" :.'.':ic- (h.-r Trom, togv-h, a-vrh diJc-cation ^i •"••• ''"■ -- . .. ■ .,' ;i:o0. nd two y^ '.as*: - f» ■ «arc! phot. !• Mml:iii-8*ui, Villi PLATE LXVIII _ RESULTS OF SHOT INJURIES OF THE KNEE-JOINT. i /■ .• i ■ i t\\'I* l„..i^,„, A (as*- oMVivat*' IVter Slurb. I (,;ih<- ol Lieutenant 1. \\. Itobrrt.ioil .,,,,, v V I 116 f'fiiiisNlvjima . /'.) V' .New toi-k. SECT, rv.] SHOT FRACTURES OF THE KNEE JOINT. 371 Examiner J. A. Armstrong, of Camden, reported, September 17, 1877: "At present the leg is in a straight position, the knee joint anchylosed, and tho parts surrounding it calloused and indurated." At a subsequent examination by the Board the thigh and leg were represented as being much wasted, and the condition of the foot was described as that of a case of "talipes equinus." The pensioner was paid December 4, 1879. Case 549.—Private N. Gray, Co. H, 4th Maine, aged 24 years, was wounded in the right knee joint, at the Wilderness, May 5, 1864, and entered Harewood Hospital, Washington, three weeks afterwards. Surgeon R. B. Bontecou, U. S. V., con- tributed the following history: "The ball entered in the middle of the internal condyle three-fourths of an inch above the inferior margin, passing in an oblique direction inward and downward. At the time of bis admission the general state of his health was good and color of skin normal; knee joint a little swollen. The patient complained of a fixed pain right below the centre of the patella, which was increased by pressure upon the patella. The thigh was swollen, especially on the inner side, about five inches upward, and fluctuating. On enlarging the opening upward a quantity of pus was discharged and the ball was discovered and removed. The hole made by the ball was one inch deep; its direction inward and downward. An ice bag was applied to the joint. On June 2d, an incision was made in the fossa poplitea three inches long, and the lower third of the pos- terior side of the femur was found to be surrounded with pus, but the bone was yet covered with periosteum. The discharge was free and copious; the ice was still kept on. On July 20th, there was cedema of the right leg, which was bandaged from the toes to the knee joint; discharge healthy and copious. Solution of chlorinate of sodae was now used in the dressing. By September 1st, the wound was doing well, discharging but little, and the incision in the fossa poplitea being healed. Exudation below the patella had disap- peared, and the movements of the knee joint were perfectly free and painless. The patient went on furlough, and returned on September 14th. Small pieces of bone were coming from the wound in the condyle; movement of the joint perfect! On December 1st, erysip- elas of the right leg commenced below the patella, attended with high fever, vomiting, and headache. For this ten drops of muriated tincture of iron were given every three hours. By December 10th, the erysipelas had disappeared and the patient was doing well. The process of exfoliation was going on slowly on January 1, 1865. On February 13, 1865, the patient was discharged from service, the process of exfoliation not yet having terminated, but the knee joint being of normal size and color, and its movements perfectly free and painless in every direction." Examiner I. H. Harding, of Ellsworth, Maine, Feb- ruary 1, 1867, certified to the injury and added: "The joint and leg are weakened and atrophied so much that he walks quite lame." The Boston Examining Board reported, September 13,1875: " There are two large adherent cicatrices in the popliteal space, which impair the motions of the hamstrings." The pensioner was paid December 4, 1879. The wood-cut (Fig. 222) is a copy of a photograph contributed by Surgeon Bontecou (Card Photographs, Vol. 3, p. 22). In the next instance a conoidal ball struck the left knee, passing through the centre of the patella and through the inner condyle of the femur: Case 550.—Private J. T. Long, Co. G, 16th Wisconsin, aged 26 years, was wounded at Shiloh, April 6, 1862. Acting Assistant Surgeon J. A. Murphy, in charge of Third Street Hospital, Cincinnati, described the injury as "wound of the left knee joint," and reported: "A ball entered the centre of the patella and passed inward and backward, escaping through the inner condyle of the femur. The patient entered this hospital May 2d, having been brought here on a hospital boat from Pittsburg Landing. He was free from fever and diarrhoea, and his general health on admission was excellent. In stature six feet and two inches, well and strongly developed in every respect, he was a man who had always enjoyed very good health and never indulged in ardent spirits. The injured joint was much swollen and very red when he arrived here; a copious discharge of pus and synovial fluid was escaping from the wounds. A few days afterwards a large abscess, exterior to the joint, developed itself and was opened, discharging about one pint of pus. After this, from time to time until the wounds healed, sixteen abscesses formed around the joint and in the leg as low down as the middle third. They were opened and healed readily. Cold-water dressings and fomenting poultices were the only applications used to the wounds. He was kept on low diet throughout the treatment. Tonics were given for a very short time and then discontinued, as the inflammation about the wound seemed to increase under their use. On the subsidence of the inflammation about the joint crepitation could be heard in moving the patella; a fissure could also be felt in the patella. On July 16, 1862, the patient was discharged from service. At that time he had mobility of the joint and was able to walk with great ease to himself. Just before completing extension or flexion, however, he would feel a slight obstruction, causing him to make an increased effort to complete the extension or flexion, when the former or the latter was accomplished." The man subsequently became a pensioner, the nature of his injury being corroboi'ated by various examining surgeons, the last of whom, Dr. W. T. Nichols, of Menomonee, stated November 17,1877, that " the wounded joint is weak and the leg a little lame." The pensioner was paid June 4, 1879. Case 551.—Sergeant P. H. McGrew, Co. F, 17th Ohio, aged 22 years, was wounded in the left knee while on picket near Corinth, May 22, 1862. He was discharged from service at Camp Chase, March 18, 1863, Surgeon D. Stanton, U. S. V., certifying to "partial anchylosis and necrosis of head of tibia resulting from a shot wound through the knee joint." Dr. W. L. Schenck, late Surgeon 17th Ohio Volunteers, who personally treated the case, communicated the following history: "The mis- sile, supposed to have been a small conical ball, entered just above the outer tuberosity of the left tibia and passed diagonally through the joint, slightly fracturing the articulating surface of both condyles of the femur and the spine of the tibia. I was at Fig. 222.—Shot fracture of internal con- dyle of right femur. [From a photograph.] °>7'2 INJURIES OF THE LOWER HXTRKMITIES. FIG.223.—Wouu the Brigade Hospital at the time, a mile or two in the rear, and did not see the wound for two days. The knee had become very painful then and was greatly swollen, so I coucluded there was no time to consider tbe propriety of an operation, and put the patient upon active antiphlogistic treatment with irrigation to the parts. The next day Medical Directors Smith and Si row. with several other surgeons, called to see the case, and all, excepting Surgeon I. A. Coons, 38th Ohio, and myself, decided in favor of exsection or amputation ; but I was allowed to use my own judgment, declined to operate, and continued the treatment. When the acute stage had passed and suppuration was well established, I used water dressings and proscribed a liberal diet, with some preparation of iron—hydrochlorate of the sesquioxide, iodide, citrate with quinine, or phosphate with lime, etc. When the pain was intense or destructive meta- morphosis greatly in excess, opium and brandy was administered. On the 15th of June, I received a leave of absence, and was permitted, through the kindness of the General Com- manding and the Medical Director, to take the patient with me to Ohio. He was carried on a stretcher over all the bad roads from Corinth to Pittsburg Landing and there placed on a cot, from which he was not removed until he reached my home in Franklin, Ohio, where I treated him until the expiration of my furlough. During that time several small pieces of bone were removed, and when I left him the outer wound had healed and he was able to go about his room on crutches. I left him in charge of the Ladies' Aid Society, who cared for him until he was able to go to his home in Lancaster, Ohio. On .the 15th of December following he wrote to me: 'Since leaving Franklin there have two tolerably large and twenty-three small pieces of bone come out of my knee. It is getting along fine. I can put out my foot and take a good old-fashioned step, such as I used to take in the long inarches down in Dixie. I do nothing for it now but wash it in salt water. I am in a hurry for it to get well that I may get satisfaction out of those rebels,' etc. After McGrew and of ha(i been discharged from service for disability, he recovered sufficiently to again enter FlG.224.-Woundof entranced leftknee. the army, and accepted a commission as 1st Lieutenant of the 178th Ohio. On April 2, exit at left knee joint. Dr'^miNCKl 18:',')- he wrote to me from Shelby ville, Tennessee: 'Thanks to you this leg of mine, which ])r. schekck.) so many predicted would have to come off or be worthless, is worth a good many cork legs yet. I can do anything with it but run, and that is not in our line. I was at a ball the other evening and danced several sets. That is better than even you expected.' By this time the injured joint was sound and the leg could be straightened or bent to a right angle." Lieutenant McGrew left the service in April, 1865. He had been a pensioner under his former designa- tion until his re-entry into the service in September, 1864, since when he has not communicated with the Pension Bureau. Drawings of the wounds of entrance and exit, shown iu the wood-cuts (Figs. 223, 224), were contributed by Dr. Schenck. In the following remarkable case the ball passed diagonally through the left elbow, entered the left knee joint, and lodged in the outer condyle of the femur, where it remained innocuously for over fifteen years:1 Case 552.—Lieutenant E. B. Blake, Co. F, 35th Massachusetts, aged 25 years, was wounded at the battle of Antietam, September 17, 1802. While he was stooping down to tie his handkerchief around the thigh of a bleeding comrade whose leg had been carried away by a cannon ball, he received a shot which passed diagonally through the left elbow and entered the outer aspect of the left knee joint. Copious bleeding from the exit wound in the elbow denoted injury in the large vessel. The bleeding was checked by a strap around the arm. He limped off on his injured leg to the nearest ambulance station, where the wound in the knee joint was examined by a surgeon. The probe entered the joint freely; but the ball could not be detected. From the strongly bent ■fe i "i "( ^ position of the limb, it had apparently escaped the tibia and passed in be- tween the condyles of the femur, where it was securely lodged and concealed. His arm and leg had water dressings applied, and were put in splints; and he was immediately placed in the cars and transported to Boston, where he arrived in the course of a week, with many other soldiers, some of whom had received equally serious wounds, and to whom the danger of transporta- tion, except under existing circumstances, would have been considered almost a fatal movement. The foregoing account is taken from J. Mason Warren's Surgical Observations, with Cases, etc., Boston, 1867, p. 5(53. Dr. Warren attended Lieutenant Blake on his arrival in Boston. He was then in a feeble Fin. 225.—Anterior and posterior views of the left elbow condition, having an almost constant diarrhoea. Dr. Warren remarked: "It is probable that to this condition he owed his safety."' The knee joint was tree from pain and inflammation, but the wound on the outside suppurated slightly. It was dressed with a ham splint and kept in a state of entire rest. The elbow joint was quite loose, both condyles broken off, the joints swollen, with an effusion on 1 Examples of missiles remaining lodged in the bones of the knee joint have been reported by Pekcy (Manuel du Chirurgien d'Arm'e ou Instruc- tion de Chir. Mi'., Paris. 1792, p. 1(54), who alludes to a case in which the missile became incrnsted in the condyles of the femur "hasard heureux dont on a eu un exemple dans la personne de M. d'Almons, ingenieur employi dans la demiere guerre." RABASSE (L. J.) (Considerations g'nerales sur les plaies des articulations faites par les armes Hfeu ou les instrumens Iranchans, Paris, 18)1, These Xo. 84, p. 18) reports that Weber, a miner at the siege of Dantzig, in April, YY. was struck by a ball at the outer portion of the left knee joint. From the depression and cavity in the external condyle of the femur Ihe ball was believed to have lodged in the articulation, as there was no wound of exit. Futile searches for the missile were made; extensive swelling followed, but the patient recovered in about three months with anchylosis of the knee. Bell (C.) (Report on Gunshot Wounds of the Knee Joint in Surgical Observations; being a Quarterly Report of Cases in Surgery treated in the Middlesex Hospital, London, 1816, p. 429); Russian General Baron Driesen. wounded at Borodino, September 6, 1812; musket ball struck the inner condyle of the left femur; ball remained in condyle; improved in spring of 1813. Wound closed and reopened in 1 s*l(>: inflammation, abscess, incision; amputatiou January 7. 1817; recovery. Alcoijk (H.> Cb-irra- :li.'R*bflli..o. P«rt lll.Vol T< hnp.X ■J: ••' ,AA %■•* :.]■ ■ ,.;,".^.ili re,.., V-*. ■ .: ft* ':':C ,*t*::'l ;t■•': '' ™^™:'.V»iM •" '; •''■'• A.A a.,,•:. '■ i:- :iyMm\& ■,■' ::v"'.-.#.!■..:. ■•*«■:'■;;■'■ . • •■ .•.;.:,.;; ,,.T*j jgV'•:>•£.. ■ ip. WxS- ■*';■'.■; •t-?1 *:»■>:■ ■'" a- ...:i■-.*■■' -a. J a > yuw[-^ji,a«i ■' aiY'^rs ' .ft'Ti^ -:■>.'-■< :- Y ■ tv'V^tf *& *•■*&£&-: '%■*■ .# 1$;"' '' ' "■' •■■'■"-; J mKfA.;r t**A^;0^A^0^Ay0 * •*$ i;^'.\ ■k '''*'•:I"W*^- ''%^- "'f^ :J^^<,^!ArSfc^'''': ; , ':: 'AH'''-' ;Ya.Y:'i 'i>* :■' Y ''.'i'' :'' .ii'!*i;: ' ''", f;. ,^-V 'i''''f''J'«Ki^ :: At^A? '.•'<*' .i/. 'ffi-SSfe, '" ^ ':il:' '$ ^ ^•i|i!^.^;a':'W,J^li^;i':'Y Wf i'' r"'4': •' •' Y;' '' '*i!;;;^'.'.■■'■'; Ivi''. ':':';::i''!: ■.'•'::'i:^::Y'v :;:.; •, < ■■'• *'>!.: j : !::'--y!;v-%l|: :l^r.:|;;''C^"":.; M"'- V:r; ,"^t:vy:-;%l Jiff m •: *,**>• •*» . '■.'. '- .,1'.^ . ■.'■■'Y x,< "*? ''i'3£i■'- ' ' A1: '■';■. *■■ mVH^'-iI:^:-' 'r'*'< 'V^.'^'^wi »''.i'H:- ': .-.. •■'■ :• ■.■:1-A i •> '*'':*A ••S* ■tgfe.'i: '•V:t:aj@iSi:i:t,H:^ ■:•■:'..:-i ~* -■"•■■ *;:?£•■ jfev .■■.■:■;:*■*■■■*■■ • ;'v%.'H'.'?:fcV.' ''V ■! 'iA'.'':: i; irf* ._ ■Y:: ''.''*:V ^':'.^':.' ^.i:^;:^^'?^i ■'S' 'ii|'?fl]|lP'-;::'' ■'■^f .::-;ft:Y::V^:!>:.'' ft$S:"-'v .r'- ^Elk'^ :' '. ■■'■. A)A^.''S'l^iM. .v.Tre-.'.-'."••!.• .1.'J i,clair ft i*on lith XVII _ BALL Y.X)GLO IN U : •? CONDYLE OF LEFT FfVUR OVER 15 YLARS I us.' Y i ui.it ]'-. \A A'oF, 3r>iu MnM.-.tii.hii.s\\t;\< la .' j'fepan.r.iiii ■;•!' iron—hydrochlorat......... ipdie , . .nr pliosp], :t... \, ,;,, lime. ere. Wien de ; ^ inmpi .*U ^rtaitiy ii <'i*. •■ *s • -piiim and br'indy w.n-. .Y; vciv-ii ;i !. •!■•.■ .; :,bs-e;ice, e.'.l was permitted, th;..-;,.:!• '■ Handing :i:,d t.'i" M.'dieal X">iru;tor, to take the .mi ■■■■ . .-.; "i -i .-ire:! in'i m -i ;ij] tie bad ro.iih? from Curie.ii . . • a cot, 1'n.rn whir. -, iiv w.is not reriuwiYl iuiH Y ,. ■, 'lie.-e I treated him v. ufd ihe expira'-ou < fmv Ya •■ .. .. ,i ■eiesif i.oiie wew r» i'.iiim d, and when I J'.-iY:: a ; •■ , Ye to-v aY.nt Lis room ou crutches. I A- .... :.,■•: ; >■• !•< •'i YiYiiiu until l,v vas able ■ -.<.>< . ; I,,,,... ., , ..,.- "■ -ii'li' r f'ilowing he wiote to me. -ie,e leaving v'- ...... ..\\'-!Pty-thr..-c-small pice * of A-::* come out of iv i : . * iiiy (e.nt :uid take a goof. Yd fashioned sti p. ■ .■■■ if! li;\iir. IdiiiHit'iiiiL' 1'or it now bY ' ..-. a L'i--'.ell that I may ^'t satisfaction out oitli-K "i ^isaM'artred ''mm Hervic t-i- Yuibility, be n-.ovei '.■.i.'i -:'''vjited .i •:■( mmi ■-: a . ) .-.\ Lieutereint A ': '■■■■ ■;•■•■' Yrin-fr..i Y'Om.] \ Y ; .... ,,*„■ „. -T'liiT-kv ! ■ -ii ■ ■■'<■ '■■•' wnY ! '•■..,••.. i. . v -,r !,.; v. wrf..>.: ' :! " "'' ' '' ■ ; " • . , .(: e.nr line. I »a;.- ' '.....■ " ■'' ' "•.' - Y le .be injii'v-d i'Y Y .. • ■ : v i i in April, I.W.Y i ia '..... --. Yiu fiiic-i .vhei i. ■i- -veod Yil, I'.'- ■■. . •: wi-n'.i.'l .I'-r two day i ■•■. .■•!■•• rb.' propri. ' i ii ■:: ..I iv M.dica! i' [ .' • •. ■!,. :;H;', Da ;i '•. '. ■ {..'Mi'', mi ■ .Y'f . ■•e». and ;..■• ..... a.di'.e • ■>,.,:, 'I ill k; i • •', . I, ' M. "oeriv. .. '.Of* fimit.'i :,. . ■ md myself di i. ' ijiued the ;i* :r v*. edied m lil.i , :i.i :;> re-enti.i. iieo Y.. '•' ..ii.;- im tile wound', ut ■• '. . [ii tho following i■■■>■■ :'.'■ ■ deeding w,i- .-lieeked %y a f?tmp nv> . ". ';■ ■.>'.. .VI,,-x:kbusieM.- .;•;.; : -j\ y,.ar, .vas »v. 'bwe ,■■:- Y, aandkereY.. m>-,iu.i tl.i- tliijj-b !^ce-;v,' ;L - ,.' '.v];ieh pjisei-,i: iL-jgonal! * hrnugl '•ed:ng fii.!.: ' j a- wound .Y :he elbow >\■7JoHa Ul. IT., iiri-.p. ■'' ..If ,m hj-i i;.a;-,,,! l.-ir to the ala' wound in Yr.;ee ..,;■■ >-v..:i tK ,;m\n, -,\ ! '■■'■' ■'■■» v.il' i aili-^ not 'le •''■■! that 1.0 M);.. -de bupp-i ■ , betli co:■■;• :-ei.ia".. | aMiced sevi'l ;ii straightened m >TOer designa- "i, ]->ureau. ..■ Yin. .'• ■■'• '.~X '-'.'li 'V ,,i th, • ■> . Tie ■'. mi-.;- tlie ' I' wa.-. OlF. the Ii- lYii.. v i v- !• Vi.ur.d i.l . •• ■■: ■- i;.. -si- .if Hi.. K . ■•'! '/eated in the • rf e.<" irim r enad\-!i ■'•': ,'i/YYai ! . , , . ; ti *'iQdmie Med.a Surg. Hist.of the War of the Rebellion. Part JJl.VoLIl.Chap.X. m ®y.p* Ward phot. T Sinclair a Son lith PLATE LXVII._BALL LODGED IN OUTER CONDYLE OF LEFT FEMUR OVER 15 YEARS. Case of' Lieutenant E.B.-CoF, 35^ Masauehiusotts S|)viimon H0I2 Sui'£ Section A.M.M. spot. iv.j SHOT FRACTURES OF THE KNEE JOINT. 373 Fig. 226. — Appearance of knee joint nine years after in- jury. [From a photograph.] the inside, a bullet hole below the joint on the outside aud above it on the inside. The elbow was made immovable with splints, and, after a moderate amount of inflammation, which at no time amounted to anything threatening, both tbe knee joint and the elbow joint did perfectly well; and at the end of two months he was able to go out of doors. He finally recovered all the motions of the elbow joint; he could walk without the least sign of lameness, the ball still remaining in the knee. The power of entire flexion only of the leg was wanting. He continued actively engaged in business until February 11, 1878, when he died of pneumonia. An autopsy was made by Dr. J. Foster Bush,1 of Boston, who presented the specimens of the injured elbow and knee to the Army Medical Museum, where they are numbered 6811 and 77 pensed with after a period of five months. When last I saw him, in July, 1868, the man was walking with scarcely a limp, free from all pain, in perfect health, and without deformity excepting a slight bony prominence where the ball bad been extracted. The joint retained all its motions except-that of extension, which was limited, the leg assuming an angle of about 170° when fully extended." Various examining surgeons at successive dates have certified to the pensioner's disability, which is rated one-half. His pension was paid June 4. 1879. The following interesting case was reported to this Office as an illustration of control- ling inflammation of the knee joint through ligation of the femoral artery. The details were given by Assistant Surgeon A. A. Woodhull, U. ft. A., in an essay on "Bigation of Arteries as a Means of modifying Traumatic Inflammation of the Joints," read before the Atlanta Academy of Medicine, at its meeting,1 June 1, 1874. The subject of preventing or controlling inflammation of the joints through cutting off tlie supply of blood was, in the early part of the present century, considered bv D. L. Rogers: Case 563 —Captain W. H. Jordan,''' 9th Infantry, was wounded in the right knee, at the battle of Gaines's Mill, on the afternoon of Friday, June 27, 18(>2. " I saw him not far from the line of battle shortly after be was shot, and had him conveyed to my field station bard by. By examination with the little finger I satisfied myself that the joint was perforated and that the articulating surface of tbe tibia was grooved as if by a round ball or buckshot. He was immediately put into an ambulance wagon and sent across tbe Cbiokahoniiny to the field hospital at Savage Station, a few miles distant. This was the general ren- dezvous for the disabled of General MeClellan's army, and in addition to the commissioned medical officers there were present a few civil surgeons who bad volunteered their temporary services. Among them was Dr. David L. lingers, of New York, who had long been an advocate of the control of traumatic inflammation of tbe joints by the liga- tion of tbe main artery of supply.3 As I am informed, tbe wounded officer would not consent to primary amputation as was proposed, and Dr. Rogers then suggested the ligation of the femoral at the apex of Scarpa's triangle, with the view of preventing, or at least of modify- ing, the inevitably ensuing inflammation of the joint. This was acceded to, and it was at once done I believe by Dr. Rogers himself. The operation must have been performed within forty hours of the reception of the injury, and was probably done on tbe succeeding day, for the hospital was abandoned on Sunday, the 29th, the second day after the battle. The gen- eral belief that the serious operation of ligating the femoral would add to instead of detracting from the perils already due to the wounded joint, the fact, as it was understood, that the severely wounded whom tbe Army of the Potomac was obliged to leave at Savage's were conveyed to Eichmond, a distance of about fifteen miles, over rougli roads, and tbe unfortunate condition of that city as to temperature, supplies, and general accommodations, precluded, in my mind, tbe possibility of this officer surviving the double injury, as we were tempted to call it. Accordingly, in writing to his friends at the north, he was reported as having prob- ably died of bis wounds in tbe bands of the enemy; for, at that time, there was no exchange of prisoners. Between three and four weeks after the battle, however, an exchange or release on parole of tbe wounded was negotiated, and, with the first boat load from Kiehmond that passed Harrison's Landintr. I was sent north for a few days. To my great surprise, on this boat I found my friend, greatly emaciated and suffering; but the ligature had come away successfully, and the primary violence of the joint inflammation was fairly overcome. At that time, although both wounds were suppurating, the incision over tbe artery gave quite as much apparent trouble as the original injury. His general strength was much prostrated and be appeared to be in a condition of hectic irritation. Ho was carried to Baltimore, and t"n;. 229.—Appearance of limb 18 years I saw no more of him until the following December, when, on being ordered out of tbe field, a ei ,njury- L 'rom api° °§lap ''J it so happened that I was for a time placed in charge of sick and wounded officers in that city. At this date bis general health was good, the wound in the knee had healed, the incision in the thigh, singularly, had not entirely cicatrized, and, which was of the most inconvenience, the leg was partly flexed upon the thigh and was fixed by false anchylosis. This condition must be attributed to the position that tbe limb had naturally assumed under the influence of whatever inflammation had occurred at tbe time of the severest suffering, and which his medical attendant had neglected or feared to alter while the healing was in progress lest tbe inflammation might be again excited. Fortunately there was no torsion, whence it may be inferred that the morbid action was not severe. In a week or two be passed from under my charge to that of Surgeon Thomas P. Gibbons, V. S. V., but I saw him frequently during the winter of 1862-63. By the repeated application of force, sometimes with the hands and 1 The essay is only briefly adverted to on page 288 of the Atlanta Medical and Surgical Journal, 1874-75, Vol. XII. A manuscript copy of the lecture was forwarded to the .Surgeon General's Office by its author. . 2 The ease is identical with the case referred to at the meeting of the New York State Medical Society in February, 1803, by Dr. JOHN Swix- BUKNE (Resection of Joints and Conservative Surgery, in Transactions of the Medical Society of the State of New 1'orL; for the year 1663, Albany, 18G3, p. 170, and Medical and Surgical Reporter, 1803, Vol. IX, p. 401): "A captain in the Regular Army was wounded by a ball passing through the knee joint. We could not ascertain to a certainty that the same was injured, as the course of the ball was directly through the centre of the joint, from side to side, so it is possible that only the cartilage was wounded. Er. ROGERS tied the femoral artery, so as to interrupt and break the current of blood to the injured parts. When I last saw him, thirty days after the injury, there had been little inflammation, and the prospects were good for entire recovery. I have since learned that he has entirely recovered, with a good limb." 3riOOEBS (David L.), A memoir on the utility of tying Large Arteries, in preventing Inflammation in wounds of the principal joints and important surgical operations, illustrated by cases, in New York Medical and Physical Journal, 1824, Vol. Ill, p. 453. Surg. Ill—48 378 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. sometimes with a screw apparatus, the adhesions were gradually broken up, and he gained a fair passive use of the joint; in the spring he was able to go on sick leave to his home in Ohio, and in the summer of 1863 was, I believe, assigned to duty as a mustering officer. He saw no more campaign service, but, while the war was still in progress (I think in 1863), joined his regi- ment on the Pacific coast. It is now nearly twelve years since he was shot, and it is more than eleven years since I have seen or heard directly from him ; but I have seen officers who have served with him in garrison who were not aware that he had been wounded. 1 should suppose that he is practically a sound man, although it is probable that he cannot discharge the more fatiguing duties of the field." A letter of inquiry by the editor, in March, 1880, elicited the following response from Captain Jordan: "Recruiting Rendezvous, U. S. Army, No. 9 South Clark Street, Chicago, Illinois, April 2d, 1880. Dear Doctor: Your letter of the 29th ult. was received yesterday. In reply thereto, I would inform you as follows—viz: The ball (spherical) with which I was wounded entered just below the patella through the left side of the ligament of the same and the head of the tibia, and passed out a little below the centre of the popliteal space. The synovial sac, I think, was injured, although I did not have synovitis, as the doctors feared, but am under the impression that some synovial fluid escaped from the joint. There was profuse bleeding; so much so, that my pantaloon leg and stocking had to be cut off on account of being so stiff from the blood. I have never had any pain in the knee except when I have hurt it. There is no stiffness except after using the limb in march- ing or much dancing. The joint is nearly as good as the other one, although I cannot flex the wounded limb quite as much as the other one. No bone came out of or was removed from the wounded joint. The patella of the wounded limb is one inch and a half lower than the other one. The femoral artery was ligated a little over half way up from the knee, to prevent inflamma- tion. I am not certain whether Dr. Rogers or Dr. A. K. Smith did it. Dr. Woodhull attended me in hospital iu Baltimore as late as February, 1863, and saw me on the ferry boat between Oakland and San Francisco in September, 1877. A few days after I was wounded I was takeu prisoner and remained so about three weeks. I was then taken to Baltimore, Maryland, where I remained in hospital until, iu February, 1863,1 was granted a sick leave, and was on crutches thereafter for about six months. When my wound had healed while in hospital, my limb was stiffened with the lower part of the leg at right angles to the upper part. Dr. Woodhull and another surgeon placed me under the influence of chloroform and partially removed the stiffness. I then wore an apparatus for about six months until the limb had become very nearly as straight as the other, i. e., straight enough, my other leg being a little knock-kneed. * * Very respectfully, your obed't servant." (Signed.) Wm. H. Jordan, Captain, 9th Infantry. The letter was accompanied by a photograph, a copy of which is shown in FlG. 229. Ligation of tbe femoral artery for secondary haemorrhage was successfully performed in two instances of shot fracture of the head of the tibia: Case 564.—Lieutenant Thomas W. Robertson, 79th New York, was wounded, on June 16, 1862, in the assault on the works on James Island, by a musket ball, which struck the outer side of the head of the left tibia and passed upwards and lodged, as was believed, in the intercondyloid notch of the femur, or somewhere about the knee joint. Amputation of the thigh was advised but refused by the patient. The limb was then placed in an easy position and cold-water dressings were applied. The patient was treated in the regimental hospital until June 28th, when he was sent to New York. On July 6th, there was profuse hsemorrhage from the anterior tibial artery. On July 8th, the femoral artery was tied by Professor Willard Parker. At this date the knee joint was excessively swollen, and there was free suppuration from the wound. After a very protracted confinement the patient ultimately recovered, with complete anchylosis of the knee joint, the straight position of the limb being preserved. Lieutenant Robertson was transferred to the Veteran Reserve Corps on February 29, 1864, and was on duty at Emory Hospital in 1865. On July 18,1865, the photograph (Surg. Phot. Series, No. 78, A. M. M.) was taken, a copy of which is shown in FlG. I of Plate LXVIII, opposite p. 370. The facts of the case were communicated by Surgeon N. R. Moseley, U. S. V., who reported that Professor Parker and the other surgical advisers of Lieutenant Robertson entertained no doubt that the knee joint was primarily involved in this case. The exact location of the ball was never ascertained. Lieutenant Robertson was discharged and pensioned. Examining Surgeon E. Bradley, of New York, reported October 24, 1866: "Ball shattered upper third of left fibula; resection of a portion followed. The femoral artery had to be tied. Knee is anchylosed, foot atro- phied, cold, paralyzed, and limb of little more use than an artificial limb." Examiner Th. F. Smith, in September, 1873, states: "Ball entered outside of upper part of left leg and has never been removed; there is a large cicatrix on the opposite side of the leg, the result of an abscess; complete anchylosis of the knee joint." Drs. J. F. Ferguson and M. K. Hogan report, Septem- ber 7, 1875: "The femoral artery has been tied. The knee joint is solidly anchylosed." The Examining Board, consisting of Drs. S. S. Burt, A. B. Judson, and Wm. O. McDonald, state, September 14,187? : "Left knee anchylosed, nearly straightened; femoral artery tied on left side." Pension paid March 3, 1880. Case 565.—Private A. J. Scott, Co. A, 9th Maine, aged 24 years, was wounded at Deep Bottom, August 16, 1864, and admitted to hospital at Beverly six days afterwards. Assistant Surgeon C. Wagner, U. S. A., reported: "Shot wound of right leg, injuring the head of the tibia. Secondary haemorrhage took place from the anterior tibial artery and sixteen ounces of blood was lost on December 17th, when the femoral artery was ligated in its continuity at the lower third of the thigh by Acting Assistant Surgeon J. C. Morton. Chloroform was used and the patient reacted promptly. Two weeks after the operation he had recovered." He was discharged from service June 6, 1865, and pensioned. Examiner C. E. Snow, of Calais, Maine, March 7, 1866, certified to the wound and to its being "well healed; but there is considerable lameness as yet, the weakness of the joint forbidding any continued use of the limb." Examiner E. H. Vose in his report, April 15, 1874, stated that the ball lodged and remained in the bone for four months; also that when it was extracted haemorrhage occurred and necessitated liga- tion of the femoral. "Head of tibia enlarged and somewhat tender to the touch. Rheumatism from the joint downwards. Leg weak, and he cannot bear his weight upon it when at work; foot slightly extended; walks lame with a peculiar swinging gait." In the following year the same examiner described the joint as stiff; circulation feeble; considerable numbness on inner side of leg, etc., and added: "He has been under my personal observation for eight years and the disability has largely increased." The pensioner was paid December 4, 1879. SECT. IV.l SHOT FRACTURES OF THE KNEE JOINT. 379 The series of recoveries after shot fractures of the knee joint will be concluded with three examples, in which particular bones injured were not specified: Case 566.—Private H. W. Pomroy, Co. F, 1st Maine Heavy Artillery, aged 36 years, was wounded at Laurel Hill, May 19,18G4, and entered Mount Pleasant Hospital, Washington, three days afterwards. Assistant Surgeon H. Allen, U. S. A., reported: "The wound was apparently through the knee joint. A conoidal ball entered at the inner border of the right patella and made its exit posteriorly at the external central part of the popliteal space, on a line with the inferior border of the condyles. The progress of the case has been imperfectly recorded. All that can be ascertained is to the effect that the patient was bed- ridden for eight weeks; that in the third week two pieces of bone were removed from tbe posterior wound, and in the fifth week two others were taken out; also that he suffered greatly, and according to his account had marked rigors. The patient came under my notice in January, 1865, when presenting himself for discharge. At this time the appearance of the limb was as fol- lows : The entire extremity was rigid, the knee joint permanently anchylosed, and the region of the joint much swollen: all original contour of the outline was destroyed, and the integuments were semi-oedematous up to the hip joint. The skin was of a dead purplish red color and extremely sensitive, especially around the knee joint. The surgeons at the field hospital were desirous of amputating the limb, but the patient refused to give his consent, and the case was then treated conservatively. The patient was discharged from service January 26, 18G,r>, and asserted, prior to his departure for his home, that should the limb continue to be so excessively painful he would have it amputated. Thus it is shown that, should conservative treatment be successful in this class of cases, the limb resultant of months of suffering is apt to be worse than useless." Examiner R. K. Jones, of Bangor, Octo- ber 8, 1886, certified: " The wound is healed and he retains the power of flexing the leg slowly and feebly to an angle of 135°. He walked with crutches till the fall of 1865. He now walks with one cane, flexing the body on the left thigh and swinging with much effort the right limb forward—not flexing the knee. The foot and leg swell much after use and are now oedematous. The outside of the leg and foot are numb. He suffers much from pain after use," etc. Subsequent examiners substantially show the same disabling effects, and the Bangor Board in September, 1876, described the exit wound as very tender, and stated that a solid substance like a buckshot or a spicula of bone could be felt under the cicatrix. The pensioner was paid June 4, 1879. Case 567.—Allison Shutter, Drummer, Co. C, 7th Pennsylvania Reserves, received, in one of the earlier of the seven days' battles before Rfchmond, in June, 1862, a shell wound of tbe left knee joint. He was taken prisoner, and while he wa"s in the enemy's lines it was decided that primary excision of the knee joint should be performed on the field. The operation was com- menced, but was interrupted by an advance of the Union troops, who regained the ground they had lost earlier in the day. Tbe parts were brought in apposition and the limb secured to a splint, and the patient was sent to Fort Monroe, and admitted to Hygeia Hospital on June 30th. Ou July 6th, he was sent to Philadelphia on the steamer Daniel Webster. He was admitted, on July 7th, to the Satterlee Hospital. The wound cicatrized and left a comparatively useful limb. This soldier was discharged February 5, 1883, by Surgeon I. I. Hayes, U. S. V., for "lameness resulting from a shell wound of the left knee." His name does not appear on the Pension List. The photograph of the patient (Surg. Phot. Series, No. 204, A. M. M.), represented in FlG. 230, was contributed by Surgeon R. B. Bontecou, U. S. V. Case 568.—Private C. Volgel, Co. F, 14th Connecticut, aged 37 years, was wounded before Petersburg, October 2,1864, and admitted to the field hospital of the 2d division, Second Corps, where Surgeon I. Scott, 7th West Virginia, recorded: " Shot fracture of right knee." Surgeon J. C. McKee, U. S. A., reported that "the patient was admitted to Lincoln Hospital, Wash- ington, October 8th, with shot wound of right knee joint, the ball entering antero-posteriorly, severing the capsular ligament on its internal aspect and opening the joint. When admitted, the parts were highly inflamed and synovial fluid was constantly discharging from the wound. The limb was placed in a box splint and surrounded with bran. Improvement followed the treatment. In the course of three months recovery had taken place with complete anchylosis of the joint." On June 2, 1865, the patient was discharged from service and pensioned. Examiner H. L. Burritt, of Bridgeport, Connecticut, at successive periods certified to the character of the wound and to the leg being fixed "in a nearly straight position; joint painful and whole limb swollen on motion and useless." The pensioner was paid December 4,1879. A photograph of the injured limb, taken at Lincoln Hospital, was contributed by Surgeon McKee (Contributed Photographs, Vol. 3, No. 34), and is represented in the wood- cut (Fig. 231). The records in the cases of recovery after shot fracture of the bones of the knee joint treated by conservation show that of the three hundred and thirty-eight patients, fifty- nine recovered with complete, and one hundred and sixty-five with partial anchylosis; in twenty-three instances impaired motion, with lameness or weakness of the limbs, or partial FlG. 230.—Appearance of left knee joint about 2 months after injury. [From a photograph.] FIG. 231.—Anchylosed knee joint, about G months after injury. [From a photograph.] ;;so INJURIES OF THE LOWER EXTREMITIES. [CHAP. X paralysis with atrophy of muscles, was indicated; in eight instances the motions of the joint were reported perfect, and in eighty-three cases the condition of the limb lias not been ascertained. Thirty-two of the patients were Confederate and three hundred and six Union soldiers. Two hundred and thirty-six of the three hundred and six Union soldiers became pensioners; but twenty of them have died, since the close of the War, of phthisis and other diseases, and one has committed suicide. Fatal Cases of Shot Fractures of the Bones of the Knee Joint treated by Conserva- tion.—This group comprises five hundred and twenty-one cases. The graver complica- tions were pyaemia in seventy-seven instances, tetanus in two, gangrene in seventeen, and ervsipelas in eighteen instances. Forty-three of the patients were Confederate and four hundred and seventy-eight Union soldiers. Case 569.—Private 8. Kisner, Co. E, 7th Michigan,1 aged 29 years, was wounded on picket near Chantilly, June 19, 1hi;:>, by a carbine shot, which entered the left thigh anteriorly at about its middle, passed downward and inward, and lodged beneath the integument on the inner side of the knee joint. He was brought to Washington and admitted to Stanton Hospital six days after being wounded. On June 27th. a conical ball was readily extracted through an incision, its situation being superficial. The joint at this time was neither swollen nor tender and did not appear to be involved in any way. On July 2d, some pain and swelling was noticed for the first time, when an ice-bag was applied to the knee. Two days later the swelling had extended up the thigh, and by July 6th there was well-marked erysipelas as well as effusion in the knee joint. Tincture of iodine was applied and tincture of muriate of iron was administered; stimulants were given freely. By July Sth, the erysipelas had extended clear up to the groin. On July 12th, the discharge of pus \v;is free, and in consequence the tension and swelling of the thigh were sensibly diminished. The patient, however, was manifestly failing. On July 18th, he was seized with diarrhoea, and death supervened in the evening. The autopsy showed that the bullet had lacerated the sartorius muscle extensively and splintered the internal condyle of the femur. The joint and the cellular tissues of the thigh were filled with dark colored and very otfeitMve pus, and the articular surfaces of the femur and tibia were denuded of cartilage. Surgeon J. A. Lidell, U. S. V., who furnished the history, with the pathological specimen (FlG. 232) and the missile (Specimen 3074, Surgical Section, A. M. M.), remarks : "The case interested me greatly, because when the bullet was extracted there was not the slightest evidence of injury to the inner condyle, nor indeed to any other bone whatever. The bullet was located quite superficially and not in relation with the injured condyle. During the eight days which elapsed between the receipt of the wound and the extraction of the missile said bullet must have slipped away from the bone into a new position. When, therefore, on July 2d, some inflammatory trouble in the knee appeared, we thought it was not due to an injury of the bone, but that the involvement of the joint originated from the soft parts. The case also affords a good illustration of the obscurity of the symptoms and the difficulty of diagnosis which may attend a serious gunshot injury of an articulation so thinly covered with soft parts and so easy of examination from every side as tbe knee joint.-' Case 570.—Private A. Simms, 19th Georgia, was wounded in the right knee, at Antietam, Sep- tember 17, 1862. and treated at a hospital near Sharpsburg. Surgeon J. H. Ranch, U. 8. V., forwarded the specimen (Fig. 233), with the following history: "This was a robust young man, 19 years old. The surgeon who first attended him could not find the ball, tbe external opening of the wound being about four inches below the knee joint, but was satisfied that it had passed obliquely in the direction of the knee joint. Acting Assistant Surgeon H. De Young called my attention to this case five weeks after the man was wounded. His limb was much swollen, and his constitutional symptoms such that I decided against amputation, which was proposed, and placed him on a stimulating and nourishing diet, hoping that we thus might get him into a fit condition for an operation. For a week he seemed to improve, but after this he lost his appetite, and gradually sank from exhaustion, aud died on November 10, 1862. This man's life would no doubt have been saved had an immediate amputation of his limb been made." Tbe specimen consists of the bones of the knee, with the outer condyle shattered, and shows that there has been a trivial deposit of callus, with much caries and destruction of the articular- surfaces of tbe joint. Case 571.—Private I. N. Sarvis, Co. C, 131st Pennsylvania, was Avounded at Fredericksburg, December 13, 1862. and was admitted to Mount Pleasant Hospital, Washington, four days afterwards. Acting Assistant Surgeon J. C. Wyer forwarded the pathological specimen (Fig. 234) and reported the following detailed history: "Sarvis received his wound by a ball perforating the patella of the left leg. passing through the knee and making its exit at a point nearly opposite in the popliteal space. When admitted his whole constitution was suffering from the effects of the injury ; the pulse quick and frequent (120), denoting irritability; the skin dry and hot; appetite poor; sensibility of the joint extreme, the patient shrieking on account of the pain occasioned by the slightest motion of the limb. The discharge from the wound consisted of synovia and 1 A brief abstract of this case was published in Circular No. 6, War Department, S. G. O.. Washington, 1865. p. 36. Fig. 232.—The bones of Ihe left knee; the posterior portion of the internal con- dyle is split off. Spec. 1399. Fig. 233.—The right knee with outer condyle of femur shuttered. Spec. 35-1. srXT. iv.] SHOT KIIAOTURKS ()F THE KNEE JOINT. 381 thin unhealthy pus. There was nothing peculiar about the aspect of the limb except a general tumefaction. The tongue was furred lightly, and the expression anxious; bowels constipated. On the tenth day after admission be was attacked with a severe chill, which was followed by fever, and from this period the hectic Hush began to appear upon the cheeks periodically. Sub- sequently there were recurrences of the rigors. Occasionally the mind wanders. The features are pinched, the skin is sallow, and countenance exhibits tbe icteroid appearance always present in pysemia. There is great thirst, and the respiration is quick and irregular. On December 2Sth, he was attacked with a cough, the expectoration being tough, gelatinous, and streaked with blood. Auscultation revealed crepitant and sibilant rales through both lungs. On tbe 5th of January, 1833, Surgeon J. H. Brinton, U. S. V , visited*the hospital and bis attention was called to tbe ease. At this period the case was one of well-marked pyaemia; the lung complication Dr. Brinton pronounced as multiple or metastatic abscess. 6th, no abatement in any of the symptoms. 7th, rales and rhonchi still audible through the lungs; pulse continues 120 beats in the minute; skin dry and hot; tongue dry and fissured; appetite much impaired; patient lies drowsy and dull most of the time. Tbe discharge from the knee is profuse, ichorous, and of a sickening odor. From the ^th to 13th tbe symptoms have continued the same: respiration quick, pulse 130; tongue dry and crusty; discharge from the knee ichorous and extremely offensive; expectoration rusty and gelatinous. Has had slight, rigors. Rales and rhonchi still present. Complains of pain on the least, motion of his body. Urine scanty and turbid; bowels constipated; loss of appetite. Continues in a semi-comatose, dull condition. 14th : This morning he is unable to protrude bis tongue; the features are pinched and sunken; pulse very feeble and rapid ; deep hectic flush. Evening: has been moaning all day and refused his stimulants. Tbe peculiar odor is very evident. Died at 4.30 A. M. on January 15, 1H(>:{. Autopsy eight hours after death: Rigor mortis was still present; emaciation extreme. The thorax being laid open revealed the superior lobes of the lungs apparently healthy, but upon removing them the inferior lobes were found to be consolidated and studded with abscesses varying in size from a pea to larger ones, the diameter of which measured about half au inch. The consolidation and effusion extended also to the ieft 'knee!-Patella and dependent portions of the superior lobes. There was considerable effusion in the left pleural cavity. The condyles of femur perfo- , ~ , , , . , „ , ,• ■, . , . , rated. Spec 700. heart was perfectly normal; no deposit upon the valves. A small clot was discovered in the right ven- tricle; there was also some of the separated fibrin; no effusion in the pericardium. Tbe inferior lobes of both lungs sank readily in water. On making the incision to resect the knee joint, pus escaped from beneath the muscles of the lower third of the thigh. There was a good deal of disintegration of the tissues. The extremities of the femur and tibia were entirely sep- arated, the crucial ligaments having been destroyed by the ball in its passage through the joint and the capsule ulcerated through at several points. The patella was perforated about its centre, dividing it into several fragments, which, however, were retained in position by the ligamentum patellae. The internal condyle of the femur was crumbled into small fragments, and a deep furrow marked the course of the ball." In addition Dr. Wyer remarks that " at no period since his admission has an operation been admissible," also that the patient had likewise a wound of the right shoulder, involving the joint. The specimen consists of the bones of the injured knee. Case 572.—Private E. Overman, Co. H, 1st Ohio Cavalry, received a shot wound of the right knee joint, at Mission Ridge, October 24, 1863. Surgeon I. Moses, U. S. V., contributed the pathological specimen (Cat. Surg. Sect., 1836, p. 362, Spec. 2137), with the following history: "A ball entered the external condyle of the femur, penetrating the joint and lodging in the cancellated structure. He was taken to hospital in Chattanooga, where the missile was extracted, and where he remained for nearly two months. On December 20th, I saw him for the first time in hospital at Murfreesboro', to which place he had been removed by railroad, a distance of a hundred miles. The knee was very much swollen, the joint and surrounding tissues infil- trated with pus, and there was general prostration of vital force. Incisions were freely made to evacuate pus, and the symptoms generally improved. But on January 10, 1864, the patient was attacked with vomiting and prostration, and the left leg as far as the knee became gangrenous. He died on the following day." The specimen comprises the bones of the injured knee joint and shows the articulating surfaces to be completely destroyed by suppurative action. Case 573.—Private W. J. Lowry, Co. E, 25th Ohio, was wounded at Bull Run, August 30, 1802, and admitted to hos- pital at Alexandria several days afterwards. Surgeon E. Bentley, U. S. V., reported: "A minie ball passed through the right thigh antero-posteriorly, terribly shattering the lower third of the femur, opening the knee joint, and driving fragments of bone into it. The wounded man laid exposed on the battle field for two days and was then removed in an army wagon. He was treated by rest and stimulants. The patient died from pyaemia and exhaustion October 3, 1862, not having been in condition for an operation at any time before his death." In a case of grapeshot wound of the left knee an abscess was found, at the post- mortem examination, which extended from two inches below the greater trochanter to a point two inches below the articular surface of the tibia: Case 574.—Private T. J. Burnett, Co. I, 40th Illinois, aged 24 years, was wounded at Mission Ridge, November 25, 1863, and admitted to the field hospital of the 4th division, Fifteenth Corps. Surgeon W. W. Bridge, 46th Ohio, described tbe injury as "a severe grapeshot wound of the left knee joint," and reported that the patient was transferred to the General Field Hospital at Chattanooga, December 20th. Acting Assistant Surgeon C. E. Ball communicated the result of the case from the latter hospital as follows : "When admitted the patient was very much emaciated, his injured knee and leg being badly swollen aud the knee very painful on the slightest touch or movement; pulse 110. About a pint of pus, thin, very fetid, and of greyish color, was discharged daily. The wound ceasing to suppurate sufficiently, I made an incision just above, and by keeping the whole extent of the leg bandaged reduced tbe swelling in a few days. The discharge of pus, however, continued the same in amount and character. The patient was kept on nourishing diet, tonics, stimulants, and anodynes the whole time he was in hospital; but he gradually grew weaker, and died January 14, 1864. The autopsy disclosed a large sloughing wound on the 382 INJURIES OF THE LOWER EXTREMITIES. [CHAT\ X. FIG. 235.—The bones of the ripht knee, with the inner con- dyle and the head of the tibia fractured posteriorly. Spec. !>8:i. anterior surface of the knee joint; the patella fractured in four fragments. On laying open the thigh an abscess was found extending from two inches below the great trochanter to a point two inches below the articular face of the tibia, containing ichorous pus with masses of cheesy appearance and consistence. The knee joint was opened posteriorly as well as anteriorly, and the ligaments and cartilages were somewhat softened. A portion of the articular surface of the tibia was laid bare; the limb generally infiltrated with serum." The lowest third of the femur of the wounded limb, being also injured, was forwarded to tbe Museum by Dr. Ball, and constitutes specimen 2168 of the Surgical Section, showing a longitudinal fissure to the extent of four inches on the posterior surface of the shaft, the articulating surface being destroyed by suppuration. Case 575.—Private W. J. D. Parks, Co. H, 132d Pennsylvania, was wounded at Freder- icksburg, December 13,1862, and entered the Harewood Hospital, Washington, on December l^th. Surgeon T. Antisell, TJ. S. V., recorded as follows: "Gunshot wound in right knee, opening the joint. Ball entered on the inner side of the patella on a level with it, and emerged at the popliteal space. Patient in general poor health and anaemic. Cold-water dressings were used December 22d; irritative fever; tongue dry; pulse 100. He continued to decline, there being no time at which he could bear an operation. He died on December 28, 1862. Post-mortem: Inner condyle of femur fractured. Ball passed directly into the joint, cutting a part of the crucial ligament and emerging from below into the popliteal space. Suppuration and burrowing of pus existed on outer side of thigh, extending four inches above the joint." The bones of the injured knee are shown in the annexed cut (FlG. 235). The specimen was contributed by Acting Assistant Surgeon W. A. Harvey, and shows that, besides the injury to the inner condyle of the femur, the head of the tibia was fractured posteriorly. Case 576.—Private J. Traverse, Co. I, 7th Michigan, aged 26 years, was wounded at Antietam, September 17, 1862, and admitted to hospital No. 1, Frederick, twelve days afterwards. Acting Assistant Surgeon R. Davies furnished the follow- ing minutes of the case: ''Wound in the left knee by a bullet. No inflammation followed. The missile was first perceived October 27th, being situated at the outside of the patella, two inches from the tubercle of the tibia and directly under the integument. On extracting it about half a dozen drops of synovia escaped, the joint being opened to a very small extent by the edge of the base of the bullet. Wound closed by plaster. October 29th, inflammation of the joint having set in, cupping to the amount of six ounces was resorted to; ice applications and opiates; low diet. October 30th, measurements around the left or affected knee show, above the patella, thirteen and a half inches; across the patella, fourteen and three-quarter inches; and below the patella, eleven and a half inches; while at the right or sound knee they show thirteen, fourteen, and eleven inches respectively. November 4th, patient had a sleepless night and pain, notwithstanding a dose of morphia. There is an opening on the outer side of the patella, from which pus is freely escaping. The injured knee now measures fourteen inches above, sixteen and a half inches across, and thirteen and a half inches below the patella. 13th, measurement shows fourteen, fifteen, and thirteen inches above, across, and below the patella. Two openings have been made on the inner side, one opposite the upper border of the patella and the other four inches above. Pus of a healthy character exudes. Complains of much startling pain at times, in the intervals is not in much pain ; pulse 100. 14th, there was a chill, and again the next day. 16th, another chill. Burrowing of pus on the inside of the thigh. Discharge thin in quality, like dirty greenish water. The slightest pressure above and below the patella, especially on the inner side, induces an immediate escape of pus. No pain or redness in course of the saphena vein. Has hiccough; skin hot; pulse 120. 20th, discharge as thin and watery as possible, emerging upon the slightest pressure at any part of the thigh; surface of body and extremities bathed with perspiration; pulse too fast to be counted. Patient evidently sinking. Died on November 21, 1862. Post-mortem: A collection of partially fluid dark blood was found in the thigh, corresponding to the attachments of the inner and outer layers of the fascia. The periosteum was easily detached over the lower two-thirds of the femur, on the anterior, interior, and external portions; bone laid bare for about the size of a sixpence at the lower portion of the femur. The articular surface of the femur was entirely bare, as was also its anterior and lateral borders. The borders and the articular surface of the head of the tibia were bare and the bone rough- ened, and there was fracture and bony separation of the patella into three portions. There was a sequestrum about the size of a nut on the left side of the tubercle of the tibia." The bones of the knee were contributed to the Museum by Acting Assistant Surgeon Davies, and are represented in the annexed wood-cut (Fig. 236). Case 577.—Private W. West, Co. C, 51st Georgia, aged 17 years, was wounded at South Mountain, September 14,1862, and admitted to hospital at Frederick three days afterwards. Acting Assistant Surgeon W. W. Keen, jr., reported: " Gunshot wound of left knee joint, a ball passing through the head of the tibia, involving the joint. There was also a flesh wound of the right leg just below the knee joint. Irritative fever ensued and continued for one week after the patient's admission. The treatment was supporting and poultices were applied to the joint, which improved in external appearance. Pieces of the artic- ular surface of the tibia were nearly detached on September 25th. Two days later suppuration was free and of a flocculent character; tongue dry and furred; pulse 116. On October 4th, the joint was laid open by free incisions on each side of the patella, when the pus was found to be burrowing up the thigh to a very great extent. On October Sth, the condition of tlie thigh was apparently improved, but the pulse was no better and the patient had a severe chill. He continued to grow weaker. On October 13th, there was some haemorrhage from the wound, and on the following day the patient died. At the post-mortem examination a broad abscess was discovered to extend from the knee to the groin. The ball was found to have passed directly through the joint from side to side, knocking off pieces of the internal condyle of the femur and the articular surface of the tibia. This patient had been told at an early stage of the treatment that his limb ought to be amputated. But he expressed his certainty of recovering without amputation and begged off) declaring his readiness and willingness to incur all risks of that FIG. 236.—The bones of the left knee; the patellais fractured and the head of the tibia involved. Spec. 753. SECT. IV.] SHOT FRACTURES OF THE KNEE JOINT. 383 FIG. 237.—Shot perforation of inner tuberosity of the left tibia. Spec. 356. Fig. 238.—Shotcoinminution of head of right tihia. Spec. 760. course. He was therefore not operated upon." Tbe bones of the injured knee joint, showing the articular surfaces to be eroded, were contributed to the Museum by Acting Assistant Surgeon J. H. Bartbolf, and constitute specimen 825 of the Surgical Section. Cask 578.—Private./. W. Shettles, 2d Mississippi, was wounded at Antietam, September 17,1862, and admitted to a hospital near Sharpsburg. Surgeon J. H. Ranch, U. S. V., contributed tbe specimen represented in the annexed wood-cut (FlG. 237), and reported: "This man was wounded through tbe knee joint, from the effects of which he died on November 9, 1S02. Had this man been operated upon, I am satisfied his life would have been saved." The specimen consists of the bones of the left knee with the inner tuberosity of tbe tibia perforated obliquely down- ward by a round ball. The articular surface is eroded by suppuration. The bullet is seen at tbe point of entrance, whither it appears to have gravitated through its own track and where the fragments are necrosed. The partial fracture of the shaft of the tibia has been slightly consoli- dated by effusion of callus. Case 579.—Private V. Gregory, Co. H, 1 st 1 Mawarc, was wounded in the right knee, at Antietam, September 17, 1862. Surgeon I. Scott, 7th West Virginia, noted his admission to the field hospital of the 3d division. Second Corps, with "wound of leg." On September 27 tb, the wounded man was transferred to hospital No. 1, Frederick, where he died October 16,1802. Tbe specimen, shown in the cut (FlG. 238), was preserved at the post-mortem examination and contributed to tbe Museum by Acting Assistant Surgeon W. W. Keen, jr. It consists of the upper portion of the bones of the leg, with the head of the tibia shattered by a ball passing through it transversely. The fragments are necrosed. Case 580.—Private J. McNulty, Co. E, 22d Michigan, was wounded in both knees, at Chickamauga, September 19,1863, and admitted to hospital at Chattanooga some days afterwards. Surgeon J. T. Woods, 99th Ohio, reported: "Fracture of head of each tibia; patient suffering from chronic diarrhoea; simple treatment. Haemorrhage occurred; popliteal artery and branch, with popliteal vein, ligated. Gangrene set iu below the location of the ligatures, and death supervened October 15, 1862." Case 581.—Sergeant J. McCarthy, Co. C, 149th New York, was wounded at Wauhatchie, October 27,1863, and admitted to tbe field hospital of the 1st division, Fourteenth Corps. Surgeon W. M. Wright, 79th Pennsylvania, reported: "He was wounded by a conical leaden bullet, which entered on the posterior aspect of the right leg about four inches below the knee, taking an upward course, and passing out just one inch beneath the patella. The wound was probed by a competent surgeon, who concluded that it was not a case warranting amputation, although in the end it might prove to have been judicious. Two or three days afterwards the patient complained of severe pain in the knee which required large doses of anodyne to alleviate. The pus assumed a thin watery consistence of a brownish coffee-like appearance and discharged quite freely; odor somewhat unpleasant though not fetid. The limb was greatly increased in size throughout its whole extent, and to the touch it gave evidence of oedema. Several days later pressure upon the knee gave a crackling sensation to the hand, giving unmistakable evidence that the joint was implicated. Tbe patient died on the morning of November 8, 1863, after extreme suffering during the previous twenty-four hours. During the period succeeding the first three days there was great gastric irritability which remedies failed to correct. During the last two days tbe discharges from his bowels were black, and for twelve hours previous to death a black substance, resembling thin coffee grounds somewhat and amounting to a pint probably, was discharged from the mouth. An examination of the limb after death showed a fracture of the head of the tibia behind, external to the popliteal notch, extending into the articulating surface from an inch and a half below it. Necrosis of the bone had commenced to a slight degree. The femur and fibula were untouched." Case 582.—Private B. Madden,1 Co. A, 28th Massachusetts, was wounded at Fredericks- burg, December 14, 1862, by a shell in the left knee joint. He was admitted to Douglas Hos- pital, Washington, twelve days afterwards. Medical Cadet S. T. Kingston, U. S. A., contributed the pathological specimen, represented in the annexed wood-cut (FlG. 239), and reported that "the patient died December 29, 1862, from the effects of a shell wound in the left knee." The specimen consists of a ligamentous preparation of the injured knee, showing fearful laceration and , ., complete destruction by the missile, two fragments of which are mounted with the preparation, by a shell explosion. Spec. 709. Case 583.—Private F. L. Mellott, Co. K, 12th Pennsylvania Reserves, was wounded at South Mountain, September 14, 1862. Acting Assistant Surgeon G. W. Corey reported: "He was wounded by a musket ball entering the left knee near the lower border of the patella, a little to the outer side of the ligamentum patella, passing obliquely backward and outward through the outer tuberosity of the tibia and through the head of the fibula. The man was brought to the temporary hospital at Middle- town some time in the night following the battle, and the second day after the injury the femoral artery of the wounded limb was tied by the Surgeon in charge for the purpose of keeping down the inflammation and saving the limb. Water dressings were applied and stimulants and anodynes freely administered. About six days after the battle the hospital was permanently established and the patient came under my care. At this time I found him suffering from severe pain, the redness and swelling 1 This case has been alluded to and the specimen figured in Circular No. 6, "War Department, S. G. O., Washington, 1865, pp. 37, 38, FIG. 50. 384 INJURIES OF THE LOWER KXTR KM ITIES. [CHAP. X. of the joint being moderate, suppuration profuse, and the temperature of the parts below as I expected to find it. In fact so marked was this latter symptom that I feared the occurrence of gangrene of the part and immediately discontinued the water dressing. Gangrene, however, did not set in; but the soft tissues, wherever the limb rested on the pillow, sloughed very rap- idly, indicating tbe low vitality of the parts. The treatment from this time consisted of emollient applications and stimulant and astringent lotions, with a free use of alcoholic stimulants internally. The case went on for some time without any marked change, the discharge becoming more profuse and the sloughs extending and presenting no disposition to granulate. Finally diarrho a. loss of appetite, night-sweats and delirium supervened, and death resulted on October 2S, 1862,—forty-three days after tbe reception of the injury. An examination of the joint after 'death showed the most perfect destruction of the synovial membrane and of the articular cartilages and other soft tissues." The bones of the fractured knee joint were contributed to the Museum by Dr. Corey, and constitute specimen 915 of the Surgical Section. The specimen shows the condyles to be split vertically, the inner one being broken posteriorly and nearly detached, and the articular space eroded by suppuration. The fractured extremities of the tibia and fibula are thoroughly carious. Four hundred and seventy-eight of the five hundred and twenty-one fatal cases of shot fractures of the knee joint treated by conservation were Union and forty-three were Confederate soldiers. Specimens illustrating the nature of the various injuries of the bones of the knee are preserved in the Army Medical Museum in ninety-nine cases. The side of the injury was reported in seven hundred and ninety-seven of the eight hundred and sixty-eight cases of shot fractures of the knee joint. The right side was involved in four hundred and thirty-one, the left in three hundred and sixty-six. Of the former, one hundred and seventy-four were successful, two hundred and fifty-four were fatal, and three undetermined, giving a mortality rate of 59.3 per cent.; of tlie latter, one hundred and fifty-two were successful, two hundred and thirteen fatal, and one undeter- mined—a mortality rate of 58.3 per cent., or 1 per cent, in favor of the injuries of the left side. Of eight hundred and sixty-eight patients, seven hundred and eighty-seven were Union soldiers. Three hundred and six recovered; four hundred and seventy-eight proved fatal, and in three cases the result was not ascertained—a fatality of 60.9 per cent. Of eighty-one Confederate soldiers, thirty-two recovered, forty-three died, and six cases were undetermined—a mortality of 57.3 per cent., or 3.6 per cent, less than the percentage of • deaths among the Union soldiers. In forty-four instances, with twenty-four recoveries and twenty deaths, fragments of the patella or of the articulating ends of the femur or tibia were removed. EXCISIONS AT THE KNEE JOINT FOR SHOT INJURY.—As far as the records of this Office indicate, fifty-seven excisions at the knee joint for shot injury were performed during the American civil war, the first operation having been done on September 15, 1S62. at the Fairfax Seminary Hospital, near Alexandria, Virginia. It is to be regretted that the name of the operator in this instance is not reported. Prior to that time there were recorded eighteen examples of this operation for shot injury,—fifteen in Europe,1 and 1 Excision of the patella for shot fracture is mentioned by J. Ch. A. THEOEN (Neue Bemerkungen und Erfahrungen zur Bereicherung der Wund- arzneykuitst, Berlin und Stettin, 1782, B. I, p. 101): "I cannot, therefore, approve of the excision of the patella fractured by shot, which I have seen undertaken by somebody but very unfortunately, as gangrene and death supervened." No particulars are recorded. KAJETAX V. TEXTOR (LUDWIG KUCHS. Ueber Resection im Kniegelenke, Inaug. Diss., AViirzburg, 1854. p. 9, No. 13) resected, ou November 4, 1847, the fractured condyles of the femur of a laborer, aged 37, shot in the left knee while poaching; death from pyaemia, November 11,1847. KN'ORRE, of Hamburg (L. STUOMEYER, Maximen der Kriegsha'HiUTist, Hannover, 1861, p. 523, note, and GURLT (E.), Die Gelenk-Resectionen nach Schussverletzungen, Berlin, 187(J, p. 1189), resected the joint in the ca^e of Carl Kunscli, aged 21, wounded August 13,1849; missile entered the upper part of the right leg, at the inner side of the crest of the tibia, and emerged at the same height posteriorly; inner half of upper portion of tibia shattered. On August 15th, decapitation of tibia and fibula, sawing off 2$ inches of each. By November 1st, firm union between femur and leg. Left hospital in June, 1850. Seen by the operator in the summer of 1859, carrying a heavy basket, entirely well, and, with the exception of stiffness, not suffering from any inconvenience from the leg. On January 17. ls75, the operator reports the patient as having a blooming complexion, being well fed, and having maintained his family without assistance. He was able to carry 130 pounds ; for the past two years the strength of the leg has diminished, compelling him to earn his bread as a night-watchman. He was able to walk two or three miles (German) a day without tiring. He has continuously used a linen bandage two inches wide and four yards long to support the leg since leaving hospital. Cicatrix sound, pale, and movable. The limb is 6 centimetres shortened. Fahi.E (F. ESMARCH, Ueber Resectionen nach Schusswun- den. Kiel, 1851, p. 133) operated in the case of Philip Blumenthal, volunteer, 2d Chasseur Corps, 2d Co., wounded in a reconnoissance, December 31,1850, a ball entering the outer side of the left knee. On January 3, 1851, by Dr. Stromeyeu's advice, the patella, 1* inches of the condyles of the femur, and portions of the tuberosities of the tibia were excised; death February 3, 1851. J. H. Lakjn (T. P. Matthew, Med. and Surg. Hist, of the British Army which served in Turkey and the Crimea. London, 1858, Vol. II, p. 379, and GURLT (E., loc. cit., p. 126): Case of H. Gribbins, 77th British Regiment, aged 19, wounded Sept. 8. 1855, during the retreat from tbe Redan, in the left knee; Sept. 30, 1855, excision of about 1$ inches of the condyles of the femur and SECT. IV.] EXCISIONS AT THE KNEE JOINT. 385 three on this continent.1 Eight of the operations had been successful, nine fatal, and in one instance the result had not been ascertained. The results of the fifty-seven cases of excision of the knee joint of the American civil war are indicated in the following table: Table LIII. Classified Statement of Fifty-seven Cases of Excisions at the Knee Joint for Shot Fractv/re. PARTS EXCISED. TOTAL CASES. TIME OF OPERATION. Primary. Intermediary. Secondary. Time not speci-fied. s a O 6 0) > 3 J3 to P ■3.5 5s Batio of mortality of determined cases. O) 3 u 2 2 10 6 5 1 6 32 > 8 1 3 4 3 O 2 10 3 5 1 5 26 u . •si 1 1 2 8 3 o l 1 6 1 2 1 1 > O) OS 1 1 a O 1 1 5 1 2 1 1 12 0) 3 l 0) k o o 0> W 1 1 > o V « 0) Q 1 O) ^ |S 5 3 19 7 9 4 10 l l 3 3 1 1 4 1 16 4 9 3 7 l 2 80.0 50.0 84.2 57.1 100.0 75.0 87.5 Condyles of the Femur, Patella, and Head of Tibia Condyles of the Femur and Head of Tibia....... 3 2 1 1 2 1 1 1 1 1 .... Head of Tibia................................. 3 5 1 1 1 3 1 1 7 4 3 57 10 44 3 81.4 13 In three instances the terminations were not ascertained; ten operations were followed by recovery and forty-four by death, a fatality of 81.4 per cent. As indicated in Table a thin slice of the head of the tibia; patella removed; death Oct. 28, 1855. JOHN BROWN, Assistant Surgeon Bengal Medical Service (Edinburgh Med. Jour., 1860, Vol. VI, p. 320): Case of Mahun Singh, aged 30, wounded Jan. 16,1858, in an attack on the English at Alumbaugh. Wound over the left knee; limb severed and hanging by a shred of skin ; also compound fracture of patella of right knee. Left femur immediately amputated at middle third, and right knee resected by an H-incision; no hsemorrhage, no anaesthetic used; death on the evening of Jan. 17,1858, from the effects of shock. J. NEUDORFER (Handbuch der Kriegschirurgie und der Operationslehre, Leipzig, 1872, Zweite Hftlfte, p. 1545 et «eq.) gives details of six operations performed by himself: Jobann Zelenka, Austrian Infantry Regiment E. H. Rainer, wounded at Solferino June 24, 1859. Shot fracture of left hand, causing amputation of index and middle fingers, and shot wound of thoracic parietes, and a shot fracture of the left knee joint. November 20, 1859, resection of about 2$ inches of the end of the femur, a thin slice of the head of the tibia, and part of the patella. Wound healed in three months, leaving several fistulas. He could bend the joint to an angle of from 5 to 8 degrees. Johann Dubon, Prince Hohenlohe Austrian Infantry Regiment. Shot fracture of the right knee joint. September 8, 1859, secondary operation, by reason of progressive caries; death September 24, 1859. Michael Fonta, 5th Austrian Infantry Regiment. Wounded at Solferino June 24, 1859. Shot fracture left knee joint. Resection February 10, I860; death from exhaustion February 28, 1860. Abraham Maksa, Prince Wasa Austrian Infantry, 3d Co., wounded at Solferino June 24, 1859, in the right knee joint. Resected February 11, 1860. Complete recovery. Antonio Mazzini; shot fracture of right knee joint. Resection March 20, 1860, of condyles of femur (about nine months after injury), in hospital at Verona. Sent home six weeks after the operation in a fair way of recovery. Not heard of afterwards. Anton Potesch, Austrian Infantry Regiment " Kaiser." Wounded in right knee joint. Resection May 18, 1860 (about a year after injury); death from pyemia May 22, 1860. D. W. Crompton, of Birmingham (Medical Times and Gazette, 1861, Vol. I, p. 518): George W., aged 19, wound in left knee joint by accidental discharge of gun, December 26,1860. Admitted the same day into Birmingham General Hospital. Resection of the joint, sawing off a thin portion of the head of the tibia and corresponding thin portion of the condyles, after which nearly the entire shattered condyle of the femur was sawn off diagonally, and numerous shot were removed. The patella, as well as the articular cartilage of the parts not resected, was left intact. April 5,1861, discharged from hospital cured. Could walk with ease with the aid of a cane. Limb from J to f inch shortened. HUTCHINSON, of London (Lancet, 1861, Vol. I, p. 386): A healthy young.man, who had been severely wounded February 13, 1861, in both legs, at a distance of twelve paces, by the accidental discharge of a gun loaded with No. 6 shot and a pasteboard stopper. The charge penetrated just over the right knee, going diagonally downward through the condyles of the femur, and entering the inner side of the left leg below the knee and behind the inner margin of the tibia, lodging superficially on the outer side of the left leg. Admitted into London Hospital February 13, 1861. Resection an hour after injury, removing about an inch and a half of the femur, a very thin slice of the tibia, and extirpating the entirely intact patella; death February 23, 1861, of tetanus. Henry Smith (Medical Times and Gazette, 1863. Vol. II, p. 376): John H., aged 29, private, English Fusileer Guard, wounded at the battle of Inkerman, November 10, 1854, iu the left knee joint. Ball lodged in popliteal space and extracted in hospital at Scutari. Resection September 6, 1862, at King's College Hospital, London. Discharged from hospital December 9,1862, cured. The cases of Laukey, Percy and Laurent, and Champion, cited by Oscar Heyfelder (Lehrbuch der Resec- tionen, Wien, 1863, p. 135) and by H. Culbertson (Excision of the Larger Joints, Prize Essay, Philadelphia, 1876, p. 188, in Trans. Am. Med. Assoc., Supplement to Vol. XXVII), have been omitted. In Larrey's case (D. J. LARREY, Mem. de Chir. Mil. et Camp., Paris, 1812, T. Ill, p. 256) of an Arab, named Ibrabam, only loose fragments of the patella were removed. The cases ascribed to PERCY and Laurent are evidently the operations referred to by them in their article Resection, in Diet, des Sci. Mid., Paris, 1820, T. XLVII, p. 555: the operations were for disease of the knee joint and were performed by MOREAU. In the operation ascribed to CHAMPION, which is found in his Traiti de la Resection des os caries dans leur continuity ou hors les articulations, Paris, 1815, No. II, p. 77, carious bone was chiseled away from the tibia to allow the removal of the ball. 'GURDON BUCK (Excision of the Knee Joint for Anchylosis, in New York Med. Times, March, 1854, Vol. Ill, p. 205): Gunshot wound of knee joint, received about April 20, 1853; healed with anchylosis at an angle of about 135 degrees upon the thigh. August 9, 1853, adhesions broken up; a slice removed from the inferior surface of the condyles of the femur, including the pulley-like surface intervening between, and the articular surface of the tibia on a level with the upper extremity of the fibula; coaptation of cut surfaces, which were held together by a wire; the wound healed in nine weeks. Dr. Buck exhibited the patient to th? New York Academy of Medicine, February 1, 1854. E. S. Cooper (Cose of Exsection of the Knee Joint in emistqum.ee of Disease of Banes caused by a gunshot wound, in The Cleveland Medical Gazette, 1861, Vol. HI, p. 604): N. F., aged 24, shot through the SURG. Ill—49 386 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. LII, page 367, the articulation was primarily involved in fifty-six instances; in the remain- ing case the operation was performed for shot fracture of the upper thirds of the bones of the leg. Primary Excisions at the Knee Joint.—In thirty-two of the fifty-seven cases of excision of the knee joint performed during the American civil war the operation was done within forty-eight hours after the reception of the injury. The results in two of the thirty- two cases could not be ascertained; four of the patients survived the operation, and in twenty-six instances death resulted, a mortality rate of 86.6 per cent. Recoveries af{er Primary Excision of the Knee Joint.—Portions of the condyles of tbe femur and the head of the tibia were removed in three of the four cases of this group; in the remaining case the extremity of the tibia and the patella were excised. Three operations involved the right limb and one the left. Two were Confederatesv and two Union soldiers. In one of the four instances amputation of the thigb became necessary on the fifth day, and, although the patient survived both operations, the case cannot well be cited as an instance of recovery after primary excision at the knee joint: Case 584.—Surgeon A. W. Bailey, 1st South Carolina Infantry, of Barnwell District, reports1 the following remarkable example of successful partial excision of the right knee: "Lieutenant J. W. Harlee, Co. I, 1st South Carolina Regiment, Brat ton's Brigade, aged about 27 years, and of robust constitution, was wounded in the battle of the Wilderness, May 6, 1864. 1 miui6 ball passed laterally through the right knee joint, fracturing the head of the tibia. A curved incision was made, extend- ing from one condyle to the other, reaching just below the inferior border of the patella. All the ligaments, with the synovial sac, were divided, and the semilunar cartilages removed. A transverse section of the head of the tibia, embracing the fractured portion, was made above the articulation with the fibula. The patella was not ablated. The wound was closed with sutures and adhesive straps, and the limb secured to a long outside splint. The next day he was transported about twenty-five miles over a rough road to the rear, and two of the sutures cut out, thereby exposing the internal condyle. In a short thne the exposed surface was covered with healthy granulations and the space soon filled up. In the course of six or eight weeks true anchylosis had taken place, and the wound healed, except a small place where the condyle was exposed, leaving a small fistula, which healed in a short time afterwards. This officer, who returned to his command to be retired on the Invalid Corps, gives the following account of the treatment carried out after being sent to the General Hospital: He was furnished with a quart of good whiskey daily, and requested to drink as much as he could, and use the balance on his leg. He says he drank the quarter portion each day, and dressed his wound twice daily with one part of whiskey to three of water. His leg is about three inches Bhorter than the other; he wears a high heel and thick sole to his boot, by which means he is enabled to walk without crutches, and even dance with ease." Case 585.—Private W. F. Jackson, Co. G, 6th South Carolina, aged 21 years, received a shot fracture of the left knee joint, near Richmond, October 7, 1864. He underwent the operation of excision on the day of the injury, at the hands of Sur- geon Stony, C. S. A., who removed the condyles of the femur and the detached fragments of the patella through a straight incision in the line of the wound. Fragments of bone continued to discharge for about twelve months after the operation, after which time the wound remained perfectly healed. The case was reported by Dr. C. H. Ladd, late Surgeon 56th North Carolina, who stated that when last heard from, in December, 1872, the man had very limited motion of the injured joint. The records of Jackson Hospital (Confederate), Richmond, show that the patient was admitted with "shot wound of knee joint, treated by ablation of patella," and that he was furloughed March 13, 1865. In a letter, written and forwarded in 1868, the man repre- sented his wounded limb—which, in the opinion of all who examined it, had undergone "one of the most remarkable surgical operations"—as "a good sound leg, which answers every purpose." Case 586.—Private A. Rider, Co. G, 76th Pennsylvania, aged 25 years, was wounded in the right knee, at Pocotaligo, October 22,1862, and admitted to hospital No. 1, Beaufort, two days afterwards. Surgeon R. B. Bontecou, U. S. V., contributed the pathological specimen (Fig. 240) and the following report: " The missile was a rough leaden canister ball of ordinary size, which entered the limb over the front of the external condyle, passing through the posterior margin of it, opening the capsule and lodging in the popliteal space. The circulation and appearance of the limb was good, but there was some swelling of the knee and pain on motion or to the touch. The bullet was removed from beneath the integuments by incision on the morning of his admission. Resection of the lower portion of the condyles of the femur was done the same day, at 3 P. M., and the semilunar cartilages removed from the tibia. The H-incision was employed, and the transverse cut united by lead wire accurately. Morphia was applied to the wound, and wet lint and the ice bag kept constantly in use. On the next day, the patient's bowels not having knee joint, in June, 1857; fracture of condyle of femur and upper part of tibia. October 25,1857, excision of condyles of femur, of more than an inch of the head of the tibia, and of the patella; complete recovery. Charles A. POPE (Complete Osseous Anchylosis of the Knee Joint. Successfully operated on by Barton's metliod, in Am. Jour. Med. Sci., 1861, Vol. XLII.»p. 298, and St. Louis Med. and Surg. Journal, May, 1861, Vol. XIX, p. 211): Mr. A., a healthy man, aged 40, received, when about 10 years old, an accidental shot wound of tlje knee, the ball passing just below the right knee Joint. The articulation became secondarily involved and complete osseous anchylosis resulted. For long years he wore a wooden peg with the knee resting in a socket at its upper extremity, for purposes of locomotion. March 14,1861, resection of knee by Dr. POPE, assisted by Drs. SMITH, GttEGQRY, and Dewey. Recovery; walks without a stick ordinarily. 1 Bailey (A. W.), A case of Knee-joint Resection, in Southern Medical and Surgical Journal, 1806, Vol. XXI, p. 460, :V' .f.*'' I -•••4. •"•";<'' >. LHE 'V. T.E3. [Cll/M' ;•> 30". Hy . .y'.'imi \vras )aMniarly mm ihe ■■•• ■ ; • 'y^ performed for c--h-.it :':?: Knvo Joint •-• L,S.< a: 'IJ?. .t i 10 p. "..!i:y rate < ''•■ \.?we ,:,.i.i"Ve'i it: IJy: tibia f-.i. r ■■■ .. ., o..' a^'-e t •...; :■ : ;i^':'.4 death r»..:Aiit<~d. u ■>"■ .'''"('.'r F'ivo.ry Jix ■[.■■.: • ' i ii-; :'.! YO Y.'O lit'Yt ' •' :: ..:;ig f ti;<.'". for !' :• V.M.. ';•: ai'\!,..iY. '. survived L-' • . -iiM'Tv exc" ■>:, .:■■■ •'•. ",V. !'■: ■> Yl .-.i..ui. f ..: ..- It.Yi •. [■iiOUgli L..f j Yinoes; in the K-.'rdfl of the I ti.i- ,-■ ■'■. V.'. H: ■> Yi. .-..-.ai. f .. *'...'< nfrfll"' * it! 'lY I'jwCiaju:. ':" 1 ■:!:! k<> ; ..i.-, Jtged ai").'! ':7 ye:«r», aiY • !' r- > .it ••■ i .• ,•:• i'-.uwed lalfia:!>" 'ilrough tii'' rig lit irf-.! ; '••< • i'.«- condy'e rr ;tie other, rt.-Hliing ; . • be ih i, . i 'i ,ii with 'i .■ Jj: Yi. T'> v-i;. - ; '• a iY:: ".'O'lrfl t< ;i ung (.-itsi'!n .'•p' '•' '-' V .'.. ..•a ••.. ('the sutures > Y ■ ui. , .»■?. ' v . •>!••..• :. • ■;,.>"'" .i inrlstions -. i ' . .-^acr ' ■<• fi!l*>l r i • i '* J.-.1 t-tc» [I-. ■ .i. ■!; place '-v.Y.'io h» i::!vk .' '■•' i <■ '.•;:• Jloefi.T:-•: uch u* ' ■■ coulii - ■ ■ '. li'ii.Hi.ce on hit- i> i .laily v;i!, one pur'•. • ■•.••' • ii.roeof >:. kI tbi<:k vom? to 1;'-■■ • ■■ ■ m i- e.>i> 1< ;itty-S'-v 0' "^IT'TX ...■-' ' 'rv'yl .'9 of • <:'■■ ..- • . ■ ! . L':,0"p; 'V^r <. \ Y' '.'..'il-.1' ('onlYleri:l' .;\y:,I ^.v- r;: hecame liccestdry on .•• -uee cdiiuot well he .P.!.; ; TtK1 tlifc followin;; n.>ni!.rK '. • ■ •. ( ari>li;ia L'^-l:"n-. " L. <. Y ir.y>v, Miiy <.• 1- A. ;■ • " •: v:i-, ni-Mik:, OKtei'.ii- •• :•!.". w ilii the sj uo.'.a! ■. -u .i .'■ i]n- fiat' i •! ■1 v. itii Muttnva • >it iitnt im ,...-■ ■ :' -fix ■>• ■ ' ri't wwlcv . ■ . I- .j a ■ ' i-:*M I '. '( HlUlil I >!l.'J .I-.' . •• •.',♦• IjlV-.lilli Cl'ljIS, !.,'''H .o ■ !'.i"iiirf-eil-.vitli a iji.i.-i v.'f. ?• a,ir:- hi ili-A!i\' '.l)i' I<> ;.- a' out tb Y.iiti? ". ->!*i to V.\A.W \V;.",!..,I , i' :,.IH".> iii'ii'rwen.' iiftd .11.0 'iii'V fri.f.. .,■(• ali>r>a I'tiough n ^'ri.iahi . • ,-. i.fi't ; «';i-:ra".)i., ri'tr. - > .:.:,. .V.- Nt-rtli <".'aro]'.n i, ■ ■ ■ '•• t K in'.' T';»: I'lrui is 1 ' r'''L -oa.f,, ti. utH' iu 'ifnt'a*!, •'<■" —'via dr 'Y- triTidve. I, <■ ■. -.:.;ljt Vn«e, .' I'oi !••: 'igi'i, ' i. 'ii.. "... S. V .. c ' tr.li.iffil •■ -;: iv.'l ::' irilii.r,'y >-i;'i a'" ..,-it.; Ml" . ,.1':' . • • velliiif* i,:- T ■l«n I tKl.'llt. '•[ i ; ../' H* Knrr . .-:■■■ 'lav. - . ! ''.miif. '"■. .. ud inol. .r .'I'.'ill/uVli/ AIX, ;i. tf'li- .:!'.t V' C" •• ;':: l/.s .SldtT' I'rL/. '' 1. xxr, ;• "'.;, Med.ft Sur£ Hist, of the War of the Rebellion, Part III.VoL.II Bradley fc Bulof»on pl.nl PLATE LXV_SUCCESSFUL EXCISIONS OFTHE KNEE JOINT AFTER SHOT INJURY. Pie.l.tYpiHin <" . Knowltnn. IO^Louiruhiu Kijj.2. I Vi\-.-«l «• A Kirlc-r 76 «»• I'linnsyli SECT. IV.l PRIMARY EXCISIONS AT THE 'KNEE JOINT. 387 been moved for some days, an ounce of sulphate of magnesia was administered. October 30th, diarrhoea having been trouble- some for twenty-four hours, pills of argentum, opium, and camphor were given, and on the following day, the diarrhoea still continuing and there being some febrile symptoms, spirits of mindererus was prescribed and milk pori'idge for diet. Wet dressings with ice were continued until November 2d, when cerate dressings and dry lint with ice bag were ordered. Starch and laudanum injections arrested the looseness. The limb had been kept on a pillow, and great pain was experienced on the slightest movement until I constructed a rest for it out of two parallel cushions of hay tacked on a plank, leaving a space under the knee unstuffed. When laid on this, on October 27th, the limb was very comfortable. Before that time the poor fellow had frequently regretted that it was not removed. The transverse incision healed without suppuration, and no swelling of the limb, above or below the knee, took place. The only ligature employed was on the azigos artery, which came away November 16th. Scarcely any inflammation about the knee took place until November 18th, when I observed that the line of incision, which had healed many days ago, reopened in places and discharged pus. Cerate dressings were applied and straps to approximate the lateral wound; the limb exposed and a wet napkin kept on the knee. December 1st, the bones have apparently united and there is very little discharge, the incisions having healed, with the exception of a point on either side of the joint, from which a few drops of pus are escaping. The patient suffers no pain, and I shall to-day flex the knee a trifle permanently. The leg was kept on a straight plank and between the hay cushions until December 20th, when I put the limb in a starch bandage, well stiffened by strips of pasteboard. On Decem- ber 26th, I slit the bandage open from the toe to the hip and discovered some erythematous blush on the skin, also a slight general disturbance, accompanied by dry tongue. The febrile symptoms yielded readily to acidulated drinks and a little spirits of mindererus. On December 28th, the patient was sent to a Northern hospital by the steamer Star of the F^T240.-Condyles of ri^ht femur South. I saw the man in hospital at Fort Wood in July following. He was not able to primarily excised. Spec. 2030. walk then, but subsequently he did so with the assistance of a cane, and was discharged." The records of Fort Wood Hospital, Bedloe's Island, show that the patient was admitted December 31st, and that he was discharged August 28, 1863, Acting Assistant Surgeon O. W. Gibson certifying to the disability arising from "resection of knee joint." Five months afterwards, when making an application for pension, the man was examined by Surgeon J. A. Wolf, 29th Pennsylvania, who certified to the following disabilities as resulting from the wound: "He has anchylosis of the injured joint, also paralysis of both inferior extremities. He is now permanently confined to his bed, being entirely unable to move his body or inferior extremities." The reports of different examining surgeons show no improvement in his condition up to September, 1874, at which time the pensioner was exempted from further examinations. The photograph represented in Figure 2 of Plate LXV, opposite page 386, was obtained from Dr. Bontecou, who mentioned that the paralysis came on some time after the patient's recovery from the operation and after his arrival at home. He also suggested that the attack "may have been caused by malarial poison." In several letters received from the pensioner, the last one being dated April 14, 1877, he depicts his condition as that of "a poor wreck," and states that owing to "the lower portion of his body being entirely powerless from the effects of the wound" he is obliged to keep in his bed all the time. His pension was paid December 4,1879.1 In the following instance the primary excision was followed five days later by a suc- cessful intermediary amputation of the thigh at the junction of the middle and lower thirds of the femur: Case 587.—Private W. M. Constable, Co. H, 1st U. S. Cavalry, aged 26 years, was wounded in the right knee, at Din- widdie Court House, March 31, 1865. He was admitted to a Cavalry Corps field hospital, whence Assistant Surgeon E. J. Marsh, U. S. A., reported: " Severe fracture of external condyle of femur and of head of tibia by a bullet; treated by excision; missile removed; chloroform used." Five days after the date of the wound the limb was amputated by the circular method at the junction of the middle and lower thirds of tbe thigh. This operation was done at Judiciary Square Hospital, Washington, by Acting Assistant Surgeon F. H. Colton, who also, three months later, at Douglas Hospital, performed a second operation, removing a sequestrum, two inches long and one-fourth inch wide, from the stump. By August 29th the stump had entirely healed, and one week afterwards an artificial limb was fitted by the Jewett Patent Leg Co. The patient was subsequently dis- charged from Harewood Hospital, November 18, 1865, and pensioned. Several years afterwards he served for a period in the 44th Regiment (Invalid) of Infantry. The pensioner was paid March 4, 1880.2 Fatal Cases of Primary Excision at the Knee Joint.—Twenty-six primary excisions of the knee joint terminated fatally. In ten instances, the condyles of the femur, the head of the tibia, and the patella; in two, the condyles of the femur; in three, the con- dyles of the femur and head of tibia; in one, the head of the tibia; and in five, the patella were the parts excised; in five instances the excised portions were not specified: Case 588.—Private J. F. Black, Co. H, 26th Illinois, was wounded in the left knee, at Jonesboro,' September 2, 1864. Surgeon W. M. Cake, 53d Ohio, reported his entrance into the field hospital of the 4th division, Fifteenth Corps, with "a frac- ture and comminution of the patella by a bullet; exsection of patella by Surgeon D. Halderman, 46th Ohio, six hours after the injury, under chloroform." Two days after the operation the patient was transferred to the general field hospital of the Fifteenth Corps, where he died September 11, 1864. ' See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 58. Lyox (I. W.), Excision of the Knee and Hip Joints, in Am. Jour. Med. Sci., 1865, Vol. XLIX, N. S., p. 64 ; CULBERTSON (H.), Excision of the Larger Joints of the Extremities, Prize Essay, in Transactions of the Am. Med. Assoc., Philadelphia, 1876, Supplement to Vol. XXVII, p. 182. 2See Table XXXV, No. 43, p. 280, 388 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Case 589.—Private T. Clark, Co. D, 2d New Hampshire Cavalry,1 was wounded near Alexandria, Louisiana, May 4, 1864. Surgeon C. Powers, 160th New York, in charge of the Alexandria Hospital, reported his admission with "a wound of the right knee joint, a ball entering the inner condyle of the femur, passing behind the blood-vessels, and emerging two inches above the joint on the outer side. The internal condyle was shattered, but there was no appearance of injury to the blood- vessels. Prostration was not great, the pulse being 90, but not strong. Amputation was immediately advised, but the patient positively refused to submit to it, preferring rather to lose his life than his limb. ChlorofoYm was then administered and excision was performed by Assistant Surgeon J. Homans, jr., U. S. A., removing two inches of the femur and half an inch of the tibia through a horizontal incision. The patient reacted slowly. The wound was brought together with sutures and the limb was placed in a fracture-box. A full anodyne was administered to enable the patient to sleep. Next morning all that part of the limb below the incision was found to be cold and without pulsation in any of the arteries. On May 5th, the patient was moved on board of a transport for the purpose of being conveyed to hospital at New Orleans. He continued to sink, and died." The records of the Hospital Steamer Laurel Hill show that the patient's death occurred on May 7, 1864. Four years afterwards the operator communicated the following additional information in the case: "My view of the cause of death is this: The bullet in its course lacerated somewhat the coats of the popliteal artery. The anastomosis was cut off by the division of the arterial branches of the popliteal in the incision, which was the usual semilunar one, running from the posterior edge of one condyle to the other. The dorsalis pedis beat strongly for several hours following the operation, after which pulsation gradually ceased in it, and the limb became cold and then gangrenous below the line of the incision and the bullet wound. Undoubtedly a clot formed in the popliteal, and, afterwards, the coats of the artery gave way more or less, thus causing the haemorrhages. The weather was very hot and the hospital boat very crowded and on a narrow river; but these circumstances had nothing to do with the patient's decease, which was caused, I believe, by occlusion of the popliteal artery." Case 590.—Corporal S. B. Carlton, Co. I, 4th Maine, was wounded at Chancellorsville, May 3, 1863, and admitted to the field hospital of the 1st division, Third Corps. Surgeon E. L. Welling, llth New Jersey, recorded: "Shot wound of left knee; resection of internal condyle of femur;" and reported the patient's death May 9, 1863. Case 591.- Private C. Crowley, Co. C, 8th New Hampshire, was wounded at Port Hudson, May 27, 1863, and entered the field hospital of the Nineteenth Corps. Surgeon M. D. Benedict, 75th New York, reported: "Shot wound of right knee by musket ball; resection." Surgeon A. H. Van Nostrand, 4th Wisconsin, recorded that the wounded man was admitted to hospital at Baton Rouge, May 30th, with a "shot injury to the right knee joint," of which he died June 17, 1863. Case 592.—Corporal C. Dewell, Co. F, 74th Indiana,2 aged 27 years, was wounded by a round ball, at the taking ol Missionary Ridge, November 25,1863, the missile entering the inner aspect of the right knee joint, fracturing the inner condyle of the femur, passing obliquely downward and outward, and lodging in the head of the tibia. He was conveyed to hospital No. 6, at Chattanooga, where, on the next day, he was placed upon the operating table, when the wound was examined. On consultation it was determined to practise exsection as affording the best means of saving the man's life. A semilunar flap was resorted to, the incision including the wound made by the ball as well as the opening made in examining the wound. The patella, seven-eighths of au inch of the femur, and five-eighths of an inch of the tibia were removed; no arteries were tied—two or three were twisted with the forceps. The patient did well until about Christmas, when he began to show marked symptoms of nervous exhaustion, which continued to increase in spite of the most sustaining treatment. He gradually sank until Jan- uary 18,1864, when he died. The operation was performed by Surgeon J. Haller, 38th Ohio, and the history was communicated by Surgeon J. R. Alter, 31st Ohio. Case 593.—Private J. Forster, Co. C, 15th New York Artillery, was wounded before Petersburg, July 9, 1864, and entered the field hospital of the 2d division, Fifth Corps. Surgeon T. M. Flandrau, 146th New York, reported: "Severe shell wound of both legs. Exsection of left and part of right patella." Three days after the reception of the injury the patient was moved to the corps hospital at City Point, where he died July 25, 1864. Case 594.—Private J. P. Goforth, Co. K, llth South Carolina, aged 25 years, was wounded near Petersburg, and sent to the division hospital iu the city about two hours after the injury, June 24,1864. Surgeon Samuel Logan,.C S. A., reported:3 "A gunshot wound, penetrating the left knee joint obliquely, tearing away both articular surfaces, but producing no splintering of the cancellated structure or shafts, merely grooving the articular surfaces and fracturing the patella. The pulse was at 90, and there was slight shock or constitutional disturbance." As the general hospital where he could be permanently treated was less than a quarter of a»mile from the place where he was wounded, and the excellent state of the patient's general health and nature of the wound were encouraging, Dr. Logan considered the case as one in which excision was justifiable, the patient pre- ferring any risk to the loss of his limb. He was placed under chloroform a few hours after the injury, June 24, 1864, and the operation was performed by H-incision, the cross cut including both orifices of the wound. The contused soft parts were removed with the patella after the articular surfaces of the femur and tibia had been sawn off. The parts seemed to present favorable conditions for a speedy union. A long splint was applied to the wound. On June 28th, Dr. Logan found the patient comfortable, the pulse at 110, skin warm and moist. The wounds were slightly swollen but not painful. The limb was dressed with Smith's anterior wire splint and suspended, water dressing being employed by irrigation. July 1st, the patient was found restless, the pulse at 120; tongue dry; the wounds were erysipelatous in appearance and swollen. The patient sank and died. Surgeon Logan could not ascertain the precise date, but it was prior to July 14, 1864. Case 595.—Private G. Gregory, Co. K, 57th New York, aged 28 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. S. Wood, 66th New York, reported that he was admitted to the field hospital of the 1st division, Second 1 See Circular No. 6, War Department, Surgeon General's Office, Washington, 1865, p. 59, and Culbertson (H.), Excision of the Larger Joints of the Extremities, Prize Essay, in Transactions of the American Medical Association, Philadelphia, 1876, Supplement to Vol. XXVII, p. 184, Case No. 15. 2 See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 58, and CULI3ERTSON (H.), Excision of the Larger Joints of the Extremities, In Transactions of the American Medical Association, Philadelphia, 1876. Prize Essay. Supplement to Volume XXVII, p. 182, Case 10. 3 LOGAN (Samtkl), Report of Tioo Cases of Primary Resection at the Knee Joint for Gunshot Wounds, in Southern Med. and Surg. Jour., 1866, Volume XXI, p. 203. SECT, rv.] PRIMARY EXCISIONS AT THE KiNKK JOINT. 389 Corps, with "exsection of the left knee joint, performed by some unknown Burgeon," and that the limb was placed in a long padded splint, bandaged in its whole length, and dressed with cold-water applications. Surgeon W. Clendenin, U. S. V., reported that the patient was admitted to Emory Hospital, Washington, December 26, 1862, with gunshot wound, and that he died the same day. Case 596.—"Private E. M. Hogston, Co. D, 4th Virginia, aged 29 years, was wounded in the right knee joint, at Chan- cellorsville, May 3, 1863, a ball entering through the patella, fracturing the inner condyle and lodging. In addition there was a flesh wound of the same leg. The patient positively and persistently declined amputation, which was urgently recommended. As a final resort, resection was advised and accepted in preference to amputation. The operation was performed on May 5th, the joint being opened by an H-incision, and the fragments of the fractured patella removed with the ball lodged in the inner condyle. The synovial membrane and articular cartilages of the articular surfaces were carefully dissected out, and, in addition, a thin slice of bone was removed from the contiguous surfaces of the condyles and upper surface of the tibia, so that when the parts were brought into apposition an obtuse angle was formed at the joint site. The limb was firmly fastened to a well padded and suitably arranged posterior angular splint; the joint was dressed with dry lint and oiled silk covering. On May 10th, the wound was suppurating freely. 12th, still doing well. 14th, weaker, with tendency to diarrhoea. 15th, gangrene of thigh. 17th, patient died." The history was contributed by Dr. I. W. Walls, late Surgeon P. A. C. S., in November, 1877. Case 597.—Private J. Lambert, Co. E, 1st Michigan Cavalry, aged 33 years, was wounded in the left knee joint, at Cold Harbor, May 31, 1864. Surgeon W. H. Rulison, 9th New York Cavalry, reported that resection was performed at the field hospital of the 1st division, Cavalry Corps. Acting Assistant Surgeon S. Graham reported that the patient was admitted to Emory Hospital, Washington, June 7th, in a weak and debilitated condition, caused by a "shot fracture of the knee joint, the head of the tibia having been excised" before admission. Tonics, stimulants, and nourishing diet constituted the treatment, and water dressings and bandages were applied locally. The patient became delirious June 12th, and died June 16, 1864. Case 598.—Private E. Lewis, Co. B, 87th Pennsylvania, was wounded at Winchester, September 19, 1864. Surgeon R. Barr, 67th Pennsylvania, described his injury as a "severe wound of the right thigh by a minie' ball, fracturing the con- dyles" of the femur, for which "resection" was performed at the field hospital of the 3d division, Sixth Corps. Acting Staff Surgeon N. F. Graham reported that the patient was admitted to the general field hospital at Sandy Hook six days after the date of the battle, and that he died of his injury, a "shot wound of the right knee," on October 10, 1864. Case 599.—Sergeant Henry J. Moore, Co. F, 7th Maine, aged 24 years, received, May 12, 1864, a shot wound of the left knee joint, at the battle of Spottsylvania. Surgeon F. M. Everleth, 7th Maine,1 practised a primary total excision on the morning of the reception of the injury "by making an anterior incision across just below the joint, curving up over the external condyle, and joining at right angles an incision extending over the internal condyle; one inch and a half of the femur, with a conoidal ball implanted, was removed by sawing squarely through the condyles, and the articular surface of the tibia was removed, being bruised. No ligatures were required. The specimen was sent to the Museum at Washington with an account of the case." The patient was admitted May 24, 1864, to the Third Division Hospital, at Alexandria, with the left lower extremity in a fracture box, the wound being partially closed by sutures and discharging little pus. The patient was prostrated by the fatigues of transportation, and he died of exhaustion May 26, 1864. Case 600.—Private I. Moore, Co. B, 44th Alabama, received a shot fracture of the right knee joint October 1, 1864, for which resection by a semilunar flap was performed on the following day. The record of the case was found on the Confederate register of Howard Grove Hospital, Richmond, where the patient died October 22, 1864. Case 601.—Lieutenant G. W. Pettigrew, Co. A, 26th Georgia, was wounded and captured at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, recorded his admission tb the field hospital of the 2d division, First Corps, with "shot wound of left knee; patella removed." Acting Assistant Surgeon J. D. Robinson reported that the patient was admitted to the Patent Office Hospital, Washington, December 25th, and that he died of his injury, "a shot wound of left side and knee," December 30, 1862.2 Case 602.—Dr. J. J. Knott, late Surgeon of the Confederate army, in a letter from Griffin, Georgia, November 6, 1868, makes mention of the following: "I practised excision of the knee joint in one case only. This was performed on a German, belonging to the Federal army, after the battle of the Wilderness, in May, 1864. The patient died from the effects of chloroform." Case 603.—Private J. Wheeler, Co. E, 97th New York, was wounded at Fredericksburg, December 13,1862. Surgeon C. J. Nordquist, 83d New York, recorded his admission to the field hospital of the 2d division, First Corps, with " shot wound of knee; patella removed." On December 25th, the wounded man was admitted to the Patent Office Hospital, Washington, whence Assistant Surgeon G. W. Hoover, 132d Pennsylvania, reported that the patient died from the effects of a "wound of the left knee joint," February 1, 1863.3 1 At the date of the publication of this case in Circular No. 6, S. O. O., 1865, p. 59, the operator's name and the date of the excision were unknown; but these particulars were communicated in a letter to Assistant Surgeon General C. H. Ceane, dated Waldoboro," Maine, March 26, 1868, by Dr. F. M. Everleth. The specimen, with the impacted ball in the condyles, and the account of the case, alluded to by Dr. Everleth, it has been impossible to trace in the Museum. See also CULBERTSON (H.), Excision of the Larger Joints of the Extremities, Prize Essay, in Trans. Am. Med. Assoc., Philadel- phia, 1876. Supplement to Vol. XXVII, p. 184, Case 16. 2 A letter of inquiry was addressed, in February, 1868, by the editor to Dr. B. S. Dana, formerly Surgeon 107th Pennsylvania, who, in an answer dated March 23, 1868, stales: "I have written to several of the surgeons who were there, to learn if possible more of the case than I can recollect; one answer only has been returned. From all that I can learn or remember of the case, Lieutenant Pettigrew was operated on by Dr. E. G-. Chase, Surgeon 104th New York, and Dr. J. F. Hutchinson, at that time Surgeon of the 107th Pennsylvania. The operation was the resection of the head of the fibula, which was destroyed by a ball, the operation not involving the knee joint proper." 3In response to the editor's letter of inquiry, Dr. R. S. Dana, of Morrisville, Pennsylvania, formerly Surgeon 107th Pennsylvania, wrote under date March 23, 1868: " Private Jerome Wheeler I cannot be so positive about, but think that he was operated on by Drs. Nordquist and Coxe, Surgeons of New York regiments, and that in his case the joint was penetrated by a ball, and the operation consisted in the removal of the upper portion of the head of the tibia and the opposing surface of the condyles of the femur, calculating that bony union and a fixed knee would result, shortening the limb from 1 to!J inches. The result of the operation we know nothiDg about, as the hospital was cleared as rapidly as possible." 390 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Case 604.—Corporal J. White, Co. I, 21st South Carolina, aged 25 years, was wounded June 24, 1864, at Petersburg He was conveyed to the division field hospital in the city, and, two or three hours after the injury, was examined by Surgeon Samuel Logan,1 C. S. A., who found that the missile, probably a conical musket ball, had passed through the external condyle of the right femur, laying open the joint freely and carrying away a portion of the articular surface. There was a slight flesh wound in the right arm. The case was considered favorable for excision, and the operation was done immediately by Dr. Logan, through an H-incision, removing an inch from the condyles of the femur, slicing off the top of the tibia, and removing all con- tused soft parts. The limb was bound to a long external splint. June 26th, the wounds were somewhat swollen, and tlie dressing had caused pain by undue pressure. The patient was restless, with pulse at 115. June 27th, general symptoms unaltered. The limb is as much swollen but is more comfortable since the dressings have been arranged. June 28th, the Hesh wound in the arm is painful and swollen. The leg is less swollen, and union appears to betaking place. July 8th, general con- dition favorable; pulse 110; leg somewhat swollen. All retentive apparatus was removed; every movement of the body or limb thus disturbed the relations of the osseous surfaces. Dr. Logan did not see the patient again, but he heard that death occurred prior to July 15, 1864. In three instances of primary excision at the knee joint recourse was had to amputa- tion of the thigh. Death ensued in two, four, and thirty-nine days, respectively: Case 605.—Private J. W. Derr, Co. E, 7th Maryland, aged 18 years, was wounded at Hatcher's Run, March 31, 1865, and admitted to the field hospital of the 2d division, Fifth Corps. Surgeon A. A. White, 8th Maryland, reported : "A musket ball struck the patella of the right knee laterally, shattering the patella into a number of fragments, but not involving the knee joint proper. I excised the entire patella, carefully dissecting it from its covering." Surgeon A. F. Sheldon, U. S. V., reported that the patient was admitted to Campbell Hospital, Washington, April 5th, with the incised wound of the operation healing by first intention. After doing well for three weeks, inflammation commenced and suppuration became very great. Circular ampu- tation through the lower third of the thigh was performed on May 15th, by Acting Assistant Surgeon F. Hall, after which there was favorable progress for a time. On June 10th, there were signs of morbid poisoning, and on June 15th the stump was opened, allowing a canal filled with pus to discharge. Death resulted from exhaustion June 23, 1865. The amputated part of the femur, together with the upper portions of the tibia and fibula, were contributed to the Museum by Surgeon Sheldon, and constitute specimen 4199 of the Surgical Section. Case 606.—Corporal A. Glazier, Co. B, 1st Minnesota, aged 29 years, was wounded at Reams's Station, August 25,1864. Surgeon N. Hayward, 20th Massachusetts, reported the injury as a "shot fracture of the left knee joint," for which he performed excision at the field hospital of the 2d division, Second Corps. Surgeon D. W. Bliss, U. S. V., reported that the patient was admitted to the Armory Square Hospital, Washington, August 28th, in a low condition and suffering severe pain from nervous spasms of the limb, caused .by a wound of the knee joint with slight fracture of the external condyle, the patella having been removed on the field. Circular amputation at the lower third of the thigh was performed by Acting Assistant Surgeon D. W. C. Van Slyck on the day after admission. Chloroform inhalation induced alarming symptoms, and electricity was resorted to. Opium and alcoholic and diffusible stimulants were administered. Gangrene appeared in the stump the second day and spread rapidly. Death resulted on September 2, 1864. Case 607.—Private W. E. L. Morrison, Co. I, 29th Connecticut, aged 21 years, was wounded near Richmond, October 27, 1864, and admitted to the Flying Hospital of the Tenth Corps. Surgeon M. S. Kittinger, 100th New York, recorded: "Shot wound of left knee; excision of knee by Surgeon A. C. Barlow, 62d Ohio." The subsequent progress and the result was reported by Assistant Surgeon E. McClellan, U. S. A., as follows: "The patient was admitted to hospital at Fort Monroe, October 30th, with shot fracture of knee joint. Circular amputation at the middle third of the thigh was performed on November 10th by Acting Assistant Surgeon J. Pitkin. Chloroform and ether constituted the anaesthetic. The patient died November 12, 1864, of exhaustion." To the primary cases of excision at the knee here detailed should be added six instances observed by Professor Hunter McGuire,2 of Richmond, formerly Surgeon of the Confederate States Army: Cases 608-613.—"In May, 1864, at Spottsylvania Court House, the operation was performed in six cases by some surgeons sent from this city to our assistance. Not to subject them to the danger of transportation, I left these cases, with others too badly hurt to be moved, in a hospital, prepared for them near the field of battle, and in charge of one of the best surgeons in the army, Dr. Taylor, who gave them every possible attention. Three of them died before the end of the third day. In two of the cases, secondary amputation was performed with a view of preserving life, but unsuccessfully, and the sixth lingered for about four weeks, I think, and proved fatal from sheer exhaustion. Such, as far as I can gather, is the melancholy record, and although the number is too small to justify a comparison with amputation, I do not think there is any one who saw the six patients I have reported—men who a day or two before were stout, strong and brave soldiers—who would not agree with me in saying, this operation for wounds occurring upon the battle field is nothing more nor less than butchery." Primary Excisions at the Knee Joint of Undetermined Result.—The results of two of the thirty-two primary excisions at the knee joint could not be ascertained: Case 614.—Private A. McDowell, Co. K, 1st Nortli Carolina, received a shot fracture of the patella and the external 'LOGAN (S.), Report of two cases of Primary Resection at tlie Knee Joint for gunshot wound,- death resulting in both cases, in Southern Medical and Surgical Journal, 1866, Vol. XXI, p. 295. *McGUiKE (Huxtee), Clinical Remarks on Gunshot Wounds of Joints, delivered January 10, 1866, at Howard's Grove Hospital, in Richmond Medical Journal, 1866, Vol. 1, p. 263. CULHeiitson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVIL pp. 184, 186. SECT. IV.] INTERMEDIARY EXCISIONS AT THE KNEE JOINT. 391 condyle of the femur by a minie' ball, at Hanover Junction, May 24, 1864. He was admitted to the Receiving and Wayside Hospital, Richmond, where, on May 26th, he was placed under the influence of chloroform, and excision of the fractured parts was performed by Surgeon C. B. Gibson, C. S. A. Splints and water dressings were used after tbe operation. Reaction was fully established on the following day. On May 30th, the wound looked well, and the patient was transferred to another hospital at the request of Dr. Gibson. The record of the case was obtained from the Confederate register of the Receiving and Wayside Hospital, Richmond. Case 615.—Among the names of wounded men admitted to the Nineteenth Corps field hospital from the battle of Port Hudson, May 27, 1863, Surgeon M. D. Benedict, 75th New York, includes that of "Private A. W. Mousky, Co. B, 4th Wiscon- sin," whose injury was reported as follows: "Shot wound of right leg; excision of knee joint." It has not been practicable to ascertain the termination of the case. Intermediary Excisions at the Knee Joint.—Thirteen cases were referred to this group; one only proved successful, a ratio of fatality of 92.3 per cent. The operations were practised on ten Union and three Confederate soldiers. Recovery after Intermediary Excision at the Knee Joint.—A successful intermediate operation1 was performed on a captain of the Confederate army wounded at Mine Run, November 27, 1863. He was last heard from in 1877, fourteen years after the operation. He then experienced only little disability, principally due to shortening, and he could walk for miles without fatigue. Case 616.—Captain Charles Knowlton, 10th Louisiana, of Ewell's Corps, aged 26 years, was wounded at Mine Run, Virginia, November 27, 1863, by a conoidal musket ball, which grooved the outer condyle of the right femur, barely touched the cartilage, opened the synovial sac, was deflected, and lodged near the upper edge of the patella, whence it was removed, on the field, through an incision, after the wounded man had walked half a mile to the rear leaning on the shoulder of one of his men. He was then transported over rough roads in an ambulance to the nearest railway station, and conveyed to Richmond, and entered general hospital No. 4 two days after receiving the injury. His condition on admission was good. There appeared to have been no haemorrhage. The movements of the knee joint were perfect. Moist dressings, absolute rest, and saline aperients were ordered. On December 2d, a serous or synovial discharge from the wound was observed. This became slightly puriform on the following day. Still there was no mark of inflammatory reaction. On December 8th, there was much pain in the joint and the discharge was increased. Warm fomentations were substituted for the cold dressings. His pulse rose to 104. On the 9th, the joint was excessively inflamed and the pulse was 128. Surgeon James B. Read, P. A. C. S., in consultation with Sur- geons C. B. Gibson and M. Michel, decided that excision of the joint was expedient. The operation was performed by Surgeon Read. An elliptical incision with its concavity upward was made to extend from one condyle to the other, passing below the patella and dividing its ligament. The joint was then laid open, and an inch and a half of the condyles of the femur and an inch of the tibia were sawn off. The patella was also removed. No ligatures were required. The section of the femur was made obliquely downward and backward; the section of the tibia was the reverse of this, so that when the extremities were approx- imated the limb was slightly flexed. The synovial sac was reddened and contained a turbid flocculent fluid. The sawn ends of the bones were then wired together. The limb was then placed in a long well padded fracture box. After a few days a long bracketed splint was substituted for the fracture box. He had a liberal stimulating diet of eggs, oysters, and beef tea, with half an ounce of brandy every two hours. The patient was restless and irritable, and on December 16th, and again on the 20th, had venous haemorrhage to the extent of a few ounces, the bleeding being arrested on both occasions by the use of pei-sulphate of iron. There was tumefaction about the joint and burrowing of pus, until Acting Assistant Surgeon Howell L. Thomas sug- gested a suspension of the limb by Smith's anterior splint. By January 3d, the internal half of the horse-shoe incision had closed. The patient enjoyed an excellent appetite, which was appeased by venison, turkey, partridges, and other hearty food, and a pint of porter daily. By the middle of February there was only a small fistulous orifice remaining of the wound, which discharged a thin, sero-purulent matter. A starch bandage was now applied, with an aperture over the unhealed portion of the wound. All the wires had been removed at this date except one. In March, the patient sat up daily and attempted to walk on crutches. In April, he was discharged from the hospital; his limb was supported by a leathern splint. There was still slight motion between the femur and tibia, but the ligamentous union appeared quite firm. He subsequently went to the West Indies. At Nassau, Dr. Hunt, of New Orleans, removed the starch bandage and found the consolidation was very firm. In a few months Captain Knowlton laid aside his crutches and walked very satisfactorily. He returned to Louisiana in 1866. He was able not only to walk almost as well as ever, but to dance even the round dances. His address as a purser on the steamship "Sen- ator," one of the Pacific mail steamers plying between San Francisco and San Luis Obispo, having been discovered, Surgeon Charles McCormick, U. S. A., at San Francisco, examined his limb, December 17, 1868, and had prepared the photograph from which Figuee 1 of the lithographic plate (Plate LXV) opposite p. 386 was taken. There was no evidence of disease about the cicatrix. The muscular development of the limb was good; and the inability to flex it at the knee was the only inconvenience suffered, a result as gratifying as it is unusual. A letter from Surgeon Charles C. Keeney, TJ. S. A., Medical Director at San Francisco, dated April 20, 1877, mentioned that he had met Captain Knowlton about a year previously and learned that he experienced no disability save that due to the shortness and stiflness of the limb, and walked for miles without fatigue. 1 DE ItOSSET (M. J.), Read's Case of Excision of Knee Joint, in Confederate States Medical and Surgical Journal, 1864, Vol. I, p. 83, and Savan- nah Journal of Medicine, 1866, Vol. V, N. S., p. 33; Read (J. B.), Report on Wounds of Large Joints, made lo the "Confederate States Association of Navy and Army Surgeons," Richmond, Va., 1864, in Southern Medical and Surgical Journal, 1866, Vol. I, 3d series, p. 213, and New York Medical Journal, 1866, Vol. IU, p. 73. 392 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 242.—Left knee after excision. Spec. 629, A. M. M. FIG. 243.—Soft parts from same excision. Spec. 600. Fatal Instances of Intermediary Excision at the Knee Joint.—This group comprises twelve cases, ten in the Union and two in the Confederate armies: Case 617.—Private O. Derocher, Co. 1,1st Maine Heavy Artillery, aged 31 years, was wounded in the right knee, at Spottsylvania, May 19, 1864, by a conoidal musket ball, which fractured and comminuted the patella. Three days after the reception of the injury he was admitted to Emory Hospital, Washington, the soft parts about the knee being badly swollen. On May 23d, the inner half of the patella was excised by Surgeon N. R. Moseley, U. S. V. The operation was followed by cold-water dressings. By May 30th erysipelas had invaded the limb, for which carron oil and copper wash was applied, and tincture of iron was administered. Stimulants and generous diet were allowed liberally. The patient died from the effects of constitutional irritation and exhaustion, June 10,1864. The history and the excised bone (Fig. 241), consisting of two fragments (Cat. Surg. Sect., 1866, p. 363, Spec. 1065), were contributed by the operator.1 Case 618.—Private Charles F. Gould, Co. I, 1st Pennsylvania Reserves, was wounded at the second battle of Bull Run, August 30,1862. A musket ball appeared to have entered the outer side of the joint near the head of the tibia. The patient was sent to Fairfax Seminary Hospital, near Alexandria, September 9,1862. On September 15th, an excision of the knee joint was performed. The condyles of the femur, the patella, and the heads of the tibia and fibula were removed through an H-shaped incision. The wound united, and there seemed every prospect of a satisfactory result, when, on October 8th, symptoms of pysemia were developed, and death ensued October 12, 1862. The pathological preparation was forwarded to the Army Medical Museum by Acting Assistant Surgeon T. O. Bannister. The specimen represented in the left-hand wood-cut (Fig. 242) shows the osseous portion, while the appearance of the soft parts are shown in the right-hand wood-cut (FlG. 243). (See Cat. Surg. Sect., 1866, pp. 336, 500.)* Case 619.—Corporal G. W. Hays, Co. K, 2d Michigan, aged 19 years, was wounded in both knees, at Petersburg, June 17, 1864. Surgeon R B. Bontecou, U. S. V., reported: "He was admitted to Harewood Hospital, Wash- ington, June 20th, suffering from amputation at the lower third of the thigh, performed on the field for a shot wound of the knee joint by a ball, which frac- tured the condyles of the femur and the patella. The right knee was also wounded, a ball entering the joint, fracturing the patella, and denuding the condyles of the femur and- the head of the tibia. Extensive suppuration followed in the right knee, and an abscess burrowed half way up the thigh; the joint itself became entirely disorganized and much swollen." Ou June 24th, resection of about two-thirds of the condyles of the femur, with the entire patella and the articular face of the tibia, was per- formed by Surgeon R. B. Bontecou, U. S. V. Sulphuric ether was used as the anaesthetic. The stump of the left thigh progressed very satisfactorily towards healing, while the resected joint com- menced to fill up with healthy granulations also and looked well in other respects. Profuse suppu- ration of healthy looking pus, however, continued. The constitutional treatment was mainly directed towards supporting the strength of the patient, and consisted of stimulants, tonics, and nourishing diet. The right thigh and leg were supported and kept in place by means of a wide board, to which a bag of bran was attached and so arranged as to embrace the parts on either side, it being readily adjusted and kneaded to suit the manipulations during dressing. The entire extremity, from the foot to the great trochanter, was confined in a Scultetus' bandage. The patient did tolerably well up to June 30th, from which date he became drowsy and was only waked with difficulty. He continued so, with intervals of wakefulness, until his death, which occurred on July 2,1664, from exhaustion. There were no pyaemie symptoms. The exsected patella and condyles of the femur were contributed to the Museum by the operator and are represented in the cut (FlG. 244).3 Case 620.—" Private J. W. Holtzman, Co. B, 2d Virginia, about 35 years of age, was wounded at Chancellorsville, May 3, 1863, a ball entering the knee joint through the patella and lodging in the head of the tibia. The patient persistently declined amputation and other active interference until much suffering and pain induced him to accept the chances of a resection, which was reluctantly performed on May 10th. The joint was laid open by a semilunar incision, the synovial membranes and cartilages were removed, and thin slices of the contiguous surfaces of the condyles and head of tibia were taken off. The limb was placed in a posterior angular splint and carefully watched. The patient, however, finally succumbed to diarrhoaa and exhaustion about May 20, 1863." The history of the case was communicated by Dr. I. W. Walls, late Surgeon P. A. C. S., in November, 1877. Case 621.—Private M. B. Horan. Co. F, 63d New York, was wounded at Antietam, September 17, 1862, and entered Frederick Hospital one week afterwards. Surgeon H. S. Hewit, U. S. V., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 290, Spec. 445), and reported the case as a "partial resection of the knee joint, performed, October 4th, for a shot injury of the condyles of the femur, and followed by death October 14, 1862." The specimen consists of thirteen minute frag- ments of dead bone. 1 See also Culbeetson (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Assoc, Philadelphia, 1876. Supplement to Vol. XXVII, p. 188, Case 11. * Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60; Culbeetson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., 1876, p. 182, Case 8. * Circular No. 6, War Department, S. G. O., Washington, 1865, p. 09; Culbeetson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Transact. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH, p. 184, Case 17. Fig. 244.—The patella and condyles of the right femur. ■Spec. 3046. SECT. IV.] INTERMEDIARY EXCISIONS AT THE KNEE JOINT. 393 Case 622.—Private H. Lawson, Co. D, 30th Colored Troops,1 aged 17 years, was accidentally wounded March 5, 1864, and entered Point Lookout Hospital six days afterwards. Surgeon A. Heger, U. 8. A., reported: "He was admitted with shot fracture of the right knee joint, caused by a conical musket ball, which entered one-half inch inside of the tuberosity of the tibia and emerged at the middle of the popliteal space. The knee joint was inflamed and suppurating; the patient, suffering from acute bronchitis, was otherwise in good constitutional condition. On March 12th, resection of the knee joint was performed by a longitudinal incision seven inches long over the anterior border of the internal lateial ligament, dividing the capsule and crucial ligament, and removing the fractured portions of the tibia and the articular cartilages. All the cartilaginous covering of the femur and the tibia was removed with a scraper; the synovial membrane was destroyed by iodine; no arteries ligated; wound closed by sutures of iron wire. The anaesthetic, consisting of chloroform, .acted well for forty-five minutes. After the operation, which was performed by Acting Assistant Surgeon T. Liebold, the limb was placed at once in a plaster of Paris splint, enclosing the whole extremity. The next day an opening was cut over the wound so as to permit its being syringed with tepid water four times a day. Solution of permanganate of salts was also applied, and oakum was used to absorb the discharge. For the bron- chial affection wine of antimony and infusion of ipecacuanha was prescribed. The patient died during a paroxysm of cough- ing, March 24, 1864. The post-mortem examination exhibited extensive inflammation of the bronchii, the smallest ramification being filled with pus; other organs healthy. The parts operated on looked well. Good pus was found in the bursa mucosa quadriceps." Case. 623.—Private J. Miller, Co. A, 3d Pennsylvania Cavalry,2 aged 38 years, was wounded at Mine Run, November 27, 1863, by a conical ball, which entered the right knee above and internal to the patella and emerged below and external to that bone. The missile fractured the patella, denuded the external condyle of the femur of a portion of its articulating surface, and fractured the outer articulating surface of the tibia. The wounded man was admitted to the Third Division Hospital, Alexandria, December 5th, considerably prostrated and the parts being tumefied. Two days after admission chloroform was administered and resection was performed by Surgeon E. Bentley, U. S. V., who removed the patella and half an inch of the articulating surfaces of the femur and tibia. The subsequent treatment consisted of simple dressings, tonics, stimulants, and nourishing diet. There was profuse suppuration. The patient progressed favorably for one week, when he was seized with chills accompanied by loss of appetite, quick and feeble pulse, and sallow hue of skin. He died of pyaemia December 18, 1863. The history was reported by the operator. Case 624.—Sergeant G. Northard, Co. G, 2d Ohio Cavalry,3 aged 23 years, was wounded at Five Forks, April 1, 1865. Surgeon W. W. Bowlby, 3d New Jersey Cavalry, reported his admission to the field hospital of the 3d division, Cavalry Corps, with "severe shot wound of right knee." Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, Washington, subsequently operated on the injured limb, of which he contributed a photograph (Contr. Photo's, S. G. O., Vol. I, No. 41), with the following history: "The patient was admitted April Sth. He had been wounded by a ball entering just above the patella, through which it passed and which it fractured into six fragments. Ranging downward and outward the missile fractured the external condyles of the femur and escaped. On April 8th, the patient was etherized, when the fractured patella and a fragment of the external condyle of the femur were removed. Tbe constitutional state of the patient at the time of the operation was very good. After the operation the limb was placed in a box containing bran and the patient was put on low diet. Subsequently the limb was placed upon a light open splint, extending from the tuberosity of the ischium to a point near the heel, and suspended by a cord. The patient was put on nutritious diet, with wine and porter. On April 13th, he was transferred to a tent ward. Up to this time he had suffered considerable pain in the joint and was very restless and irritable. His appetite now became poor, and hiccough and vomiting set in. Suppuration was profuse. The patient died April 22, 1865, from exhaustion." Case 625.—Private J. Noble, Co. D, 30th Ohio, was wounded at South Mountain, September 14, 1862, and admitted to hospital No. 5, Frederick, four days afterwards. Surgeon H. S. Hewit, U. S. V., recorded: "Comminuted fracture of right knee by minie ball. Excision of a large portion of knee joint on September 30th. Death on October 5, 1862." Case 626.—Private D. F. Rogers, Co. I, 49th Georgia,4 aged 34 years, was wounded at Petersburg, April 2, 1865, by a musket ball, which struck the right knee joint anteriorly, passed through the patella, comminuting it completely, and the outer condyle, and made its exit at the outer posterior aspect. He was admitted to the general hospital at Fort Monroe, April 13th. Surgeon D. G. Rush, 101st Pennsylvania, who operated in the case after applying an anaesthetic composed of chloroform and ether, reported as follows: "My attention was called to the case on April 18th, wlien the patient was suffering from great pain, and the knee, leg, and thigh were extremely swollen. A dense fibrous involucrum of the joint closed the track of the ball, thus preventing the escape of pus. I at first decided to lay the joint freely open and to remove the patella only, but discovering the disorganized and injured state of the condyles, they were also removed, with little hope of saving the patient, however, the operation being performed at Fig.245.—Bones of right knee too late a period. A piece of catheter was fixed in the joint to drain it. Cold-water dressings were applied. The patient rallied perfectly and lived comfortably for six days. He died of exhaustion the eighth day. He could not have survived amputation twenty-four hours. I think this operation could be performed with success primarily in cases in which the patella and condyles alone are involved." The excised bones were contributed to the Museum by the operator, and are represented in the cut (FlG. 245). 1 Culbeetson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH, p. 190, Case 17. 2 See Culbeetson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supple- ment to Vol. XXVH, p. 184 ; Circular No. 6, War Department, S. G. O., Washington, 1865, p. 59. 3Culbeetson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH, p. 186, Case 29. 4See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60; Culbertson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH. p. 186, Case 30. SURG. Ill—50 394 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Case 627.—Corporal J. Sims, Co. B, 4th Ohio,1 aged 23 years, was wounded at Mine Run, November 27, 1863, by a conoidal ball, which entered the right knee joint just below the patella, on the inner and anterior aspect, fracturing tlie inner con- dyle and opening the joint, passed downward and forward, and was extracted about four inches from point of entrance. He was admitted to the Third Division Hospital, Alexandria, December 5th. "At the time of admission the joint and thigh were very much inflamed and discharging pus copiously, and the man was much prostrated and terribly anxious as to the result of the wound. But after being washed and fed and otherwise cared for, he appeared much recruited. On the 8th of December the operation of excision of the knee joint was performed by Surgeon E. Bentley, U. S. V., who removed one inch of the femur and about one and a half inches of the tibia and fibula. The haemorrhage was slight, but the condition of the tissues was not very satisfactory. The patient endured the operation well under the influence of chloroform, and reacted well. On the following day he complained of severe pain over the lung on the right side of the chest, which continued for several days. On the 10th, he had a severe chill at night, which was followed by two, more severe, on the llth. Stimulants were freely given with raw eggs well beaten up, and beef essence for diet. He continued to have chills till the night of the 13th, when he was seized with a very severe one, from which he never rallied. He died on the morning of December 14, 1863. The post-mortem examination showed no attempt .at repair, there being considerable sloughing, while on the inside of the thigh there were numerous small abscesses. The heart and left lung were healthy, but the right lung was infiltrated with pus, and a single large abscess appeared upon the surface of the inferior lobe. There was no pus tibia.' ^""'ful^after nor abscess found in the liver, but it was very much softened." The history, with the post-mortem speci- excis'n of joint surfaces. mell; represented in the cut (FlG. 246), was contributed to the Museum by the operator. Surgeon J. B. pe°' ' Brinton, TJ. S. V., who examined the limb two days after the patient's decease, found "the whole joint one suppurating mass; pus extending up and down, far down under the gastrocnemius and up between the muscles on the inside of the thigh; a long abscess in the sheath of the vessels, extending up to the middle of the thigh; small clot in femoral artery, thin and three inches long; none in femoral vein; surrounding tissues of vessels hardened in some places where pus had not reached; long membrane of femoral vein of dirty gray color and softened; clot in saphena vein." Case 628.—Corporal I. Wells, Co. A, 33d Wisconsin,2 aged 42 years, was wounded at Tupelo, July 15, 1864, and admitted to Adams's Hospital, Memphis, five days afterwards. Assistant Surgeon J. M. Study, U. S. V., reported: " Shot wound of left knee by a conical ball, fracturing the patella and opening the joint; missile emerged over internal condyle. On July 21st, the inner third of the patella was removed through a vertical incision by Acting Assistant Surgeon R. W. Coale. The constitutional condition of the patient at the time of the operation was good. Cold-water dressings were applied to the parts, and stimulants, with beef juice, was given freely. The patient appeared to improve up to July 26th, after which date he commenced to decline. Pyaemia developed on July 29th, and from that time he continued in a comatose condition. Death resulted on August 2, 1864." Secondary Excisions at the Knee Joint.—Seven examples of secondary excision at the knee joint are recorded; four were successful and three fatal, a rate of mortality of 42.8 per cent. The patients were all Union soldiers. Examples of Recovery after Secondary Excision at the Knee Joint.—Of the four patients of this group, two were pensioners in 1880; one has never applied for a pension, and one died two years and a half after the operation: Case 629.—Private E. Jewell, Co. I, 8th New Jersey, aged 19 years, was wounded at Williamsburg, May 5, 1862, a musket ball fracturing both bones of the right leg near their articulation at the knee. He was sent to Hygeia Hospital, Fort Monroe, and thence in the following month to Philadelphia, where he entered Fifth Street Hospital on June 8th. Acting Assist- ant Surgeon A. C. Bournonville, in charge of the latter, reported that "the leg was bent at a right angle with the thigh and had been in that position since the injury. Caries had taken place, and an excision of the head of the fibula and partial resection of the head of the tibia was performed. The patient is now (November 6th) doing well, and has been able to rise and walk about the ward with the aid of crutches." The patient was subsequently transferred to Haddington Hospital, and was discharged February 23, 1863, and pensioned. Pension Examiner A. W. Woodhull, of Newark, October 24, 1868, described the injury: "A conoidal ball fractured both bones of the right leg just below the knee joint. Large portions of bone have been lost either by operation or nature. The bones are now extensively necrosed and enlarged, and there are two large sinuses, which always suppurate. The leg is shortened four or five inches," etc. The Newark Board reported, in September, 1875, that the limb is greatly atrophied and deformed. Two years later the same board reported "contraction of muscles of calf, producing talipes equinus; anchylosis of ankle and partial of knee. " Wound open." The pensioner was paid March 4, 1880. Case 630.—Private J. E. Berry, Co. B, 5th Missouri State Militia, aged 22 years, was wounded by guerrillas in Carroll County, Missouri, December 1, 1862, a musket ball fracturing the external condyle of the femur and lodging in the knee joint. Acting Assistant Surgeon J. Thorne, who described the injury, reported that the wounded man was successfully treated in hos- pital at Kansas City for pyaemia, the systemic infection of which had appeared prior to the patient's admission, and was attended with formation of pus in the knee joint. In addition, Dr. Thorne also reported that the operation of removing the external con- dyle of the femur, together with the bullet, was performed on May 10,1863, the missile being found embedded in the articulation. ■See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 59; Culbertsox (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH, p. 184, Case 13. !See Culbeutsox (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supple- ment to Vol. XXVII, p. 190, Case 15; Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60. sect, rv.i SECONDARY EXCISIONS AT THE KNEE JOINT. 395 The records of the hospital do not show the exact dates of admission or disposition of the patient. Adjutant General S. P. Simpson, of Missouri, communicated that Berry was mustered out of service June 22, 1863. There is no record of his ever having applied for pension. Case 631.—Private J. Friel, Co. F, 2d Kentucky, aged 29 years, was wounded in the right knee joint, at Chickamauga, September 19, 1863. Dr. G. E. Fuller, of Brooklyn, late Surgeon U. S. V., reported the following history: "The wound was caused by a musket ball, which entered just over the external condyle of the femur, passed obliquely downward and inward, and emerged at the juuction of the middle and lower thirds of the tibia. He was in the hands of the rebels for eleven days, and was then taken to hospital No. 3, at Chattanooga. On January 18, 18(i4, he was transferred to hospital No. 8, at Nashville, where he first came under my observation. At this time the leg was flexed upon the thigh at something less than a right angle. Anchylosis of the knee joint had taken place and the patella was firmly attached to the condyles of the femur. Both the original wounds were healed, but there was still some purulent dis- charge from an abscess about four inches below the knee joint. Under a general tonic treatment he rapidly improved in strength and flesh, the abscess healed, and he was about the ward on crutches, being anxious to be discharged. On March 19th, he was transferred with other convalescents, and I lost sight of him. I had no reason to doubt the entire recovery of this patient, after a fracture of the femur and also a wound of the knee joint. The external treat- ment consisted of cold-water dressings." Surgeon G. F. French, U. S. V., under whose notice the patient came before his transfer, in a communication citing instances of successful conservatively treated cases of shot fractures of the knee joint, corroborated Dr. Fuller's description of the wound and its results, and added that the missile in its course "fractured the head of the tibia into the joint." The patient subsequently entered Jefferson ville Hospital, and lastly Main Street Hospital, Covington, where he was mustered out, by expiration of service, January 26, 1865, and pensioned. About twenty months afterwards the pensioner, with his injured knee joint in a diseased condition, entered the Good Samaritan Hospital, at Cincinnati. Dr. G. W. Haile,1 the resident physician, reported: "The patient, being in an anaemic condition on admission, was ordered iron and generous diet, under which his health soon began to improve. On October 15, 1866, Professor G. C. Blackman operated for the removal of the dead bones, which could be readily felt with the probe. A crucial incision was made along the outer aspect of the joint, when some detached fragments of bone were found and removed, as was also the outer por- tion of the head of the tibia, which was in a carious condition. The wound healed very kindly, and the parts seemed for a while to be in a healthy condi- tion ; but in the course of a month from this operation the patient suffered at times violent pains in the part, and, on the 20th of November, a large collection of pus had formed in the joint, nearly a pint, mingled with fragments of necrosed bone, having been discharged during the twenty-four hours. His health began again to fail, but under the influence of tonics and a generous diet it was so far improved on the 14th of December, that Professor Blackman, in the presence of the class of the Medical College of Ohio, exsected the joint. An incision, resembling the letter H, was made on the anterior aspect of the joint, exposing the articular surfaces of the tibia and femur. With the ordinary amputating saw an inch and a half of the condyles of the femur, in a softened and carious condition, was removed, together with about one inch of the head of the tibia. The bone-gouge forceps were then employed to take away every suspicious looking portion and to round off the posterior margins of the divided surfaces, so as to render the popliteal vessels less liable to injury. The patella was removed. As the leg had been for a long time somewhat flexed upon the thigh, it was necessary to resort to considerable and prolonged force to overcome this contraction. At length the ends were found to be in apposition, and more of the soft parts included, when the flaps were brought together, and the limb was placed in a neat and carefully padded fracture box. During the operation the loss of blood was trifling; but shortly after the patient had been removed to his bed considerable haemorrhage occurred. It appeared to come from no partic- ular vessel, but there was a general oozing from the cut surfaces, which lasted several hours. The dressings were not disturbed for four days, the blood being wiped away as far as practicable, with a sponge, while the odor of that which could not be removed without disturbing the parts was corrected by disinfectants. Cold applications were applied over the joint; but little irritation followed, and the transverse incision healed by primary adhesion. A little pus was discharged for several days through the lateral incisions, after which it became very slight, and on the twenty-first day the entire wound seemed to have almost perfectly united. On the eighteenth day after the operation there was secondary haemorrhage from a small superficial vessel and about ten or twelve ounces of blood were lost before it was discovered. It was readily controlled by pressure. Although perfect union between the tibia and femur seemed about this time to have taken place, the patient was ordered to remain per- fectly quiet until the end of the eighth week, when he was allowed to walk on crutches. Just ten weeks from the operation he left for his home in Ironton, Ohio, and from a letter since received from him he seems highly pleased with the result of the operation." Examining Surgeon G. K. Taylor, of Cincinnati, June 25, 1867, certified to the injury and that "the joint is com- pletely anchylosed, with the leg shortened several inches. He has also 'talipes equinus' of the right foot." Examining Surgeon D. C. Wilson, of Ironton, Ohio, at several subsequent examinations, also described the leg as "anchylosed in a straight ■Haile (G. W.), Good Samaritan Hospital, Surgical Clinic, by Prof. Blackman. Exsection of the Knee Joint for Gunshot Injury, in Cincinnati Journal of Medicine, 1867, Vol. H, p. 157. FIG. 247.—Appearance of right knee after excision of the patella and the articular ends of the femur and tibia. [From a photograph.l 3% INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. position, with four inches shortening." Examiner C. K. Crennit, of Jackson, Ohio, on April 29, 1879, reported the "muscles below the wound considerably atrophied, but sufficient to bear the weight of the body." The pensioner was paid December 4, 1879. The wood-cut (FlG. 247) is a representation of a photograph contributed by the operator. Case 032.—Private S. Miller, Co. L, 1st Missouri State Militia Cavalry,1 aged 27 years, was accidentally shot in the right knee, by the discharge of his pistol, near Independence, December 28, 1862. The ball passed through the outer condyle of the femur, going obliquely through the patella and lodging in the head of the tibia. Three months after the injury the wounded man entered the Kansas City Hospital, where, on April 7,1863, Acting Assistant Surgeon J. Thorne performed excision of the outer condyle of the femur, with part of the shaft, removing, by an oblique section, two and a half inches of the femur, together with the patella and the articulating surface of the tibia. No anaesthetic was used. At the time of the operation the leg had become extensively inflamed, the wound was found full of shattered bone, and an extraordinary amount of pus was coming out of the joint. Metastatic abscesses had appeared in the popliteal space. The patient had been suffering from severe pain and was almost insensible; pulse 120 and feeble. He had also severe diarrhoea and was much emaciated, his skin being dark aud dry almost like parchment. The patient sank after the operation, but on the next day he revived and continued to do well. London porter was given as tonic. Complete union took place and complete anchylosis resulted, with the limb bent about ten degrees, so as to be almost as good as ever in walking. The details of the case were reported by the operator. The patient was discharged from service December 7, 1863, and pensioned. He died August 15, 1865. Dr. F. A. Simmons, of Rochester, Mis- souri, certified that he attended the pensioner from the time he returned to his home, and found that the injury had produced extensive suppuration, involving the leg and the thigh; also that he was very much emaciated, and that metastatic or pyaemie abscesses appeared in various parts of his body, which caused his death. Fatal Cases of Secondary Excision at the Knee Joint.—Three instances are recorded. In one the entire knee joint was excised; in the second case the patella was removed; and in the third case the heads of*the tibia and fibula were resected: Case 633.—Private G. Lewis, Co. B, 19th Indiana,2 aged 22 years, was wounded at Gettysburg, July 1, 1863. He remained for two months at the First Corps field hospital, was then admitted to Camp Letterman, and subsequently transferred to Baltimore, where he entered McKim's Mansion and afterwards Jarvis Hospital. Assistant Surgeon D. C. Peters, U. S. A., in charge of the latter, reported: "The patient was admitted November 17th, with a wound of the right knee joint by a round musket ball, which lodged in the inner condyle. The position of the missile was detected by the N61aton probe. Two weeks after the date of admis- sion the wounded joint Was in a state of disorganization and pouring off a large quantity of highly offensive pus, and the entire knee joint was excised by Acting Assistant Surgeon F. Hinkle, the patient having protested against amputation. Ether was used and an H-incision employed; wire sulures were applied to draw the sawn bones together. At the time of the operation the patient was feverish and unable to sleep from pain in the wound; pulse 100; skin dry; secretions scanty; appetite wanting. On the twelfth day he was seized with a violent chill, which lasted two hours and recurred every other day. Death resulted from pyaemia on December 23, 1863. At the autopsy both lungs were found filled with pus, the right being covered with abscesses. Six ounces of pus was also dis- covered in the left pleural cavity and four ounces of fluid in the pericardium. The wounded parts were healed externally and the bones in apposition; but no signs of union were manifest." The excised bone, embracing five-eighths of an inch of the upper extremity of the tibia and nearly two inches of the lower portion of the femur, with the bullet remaining lodged in the inner condyle, was contributed to the Museum by the operator, and is represented in the annexed cut (FlG. 248). Case 634.—Private D. Sexton, Co. H, llth Massachusetts, aged 18 years, was wounded at Bull Run, August 29, 1862. Surgeon D. P. Smith, U. S. V., recorded his admission to Fairfax Seminary Hospital, September 9th, with "shot wound of left knee joint," and reported that secondary resection of the patella was performed, also that the patient died November 6, 1862, from the effects of his wound and " exsection of the patella." The wood-cuts are representations of two post- mortem specimens, contributed by Surgeon Smith, one of which (FlG. 249) consists of a dried ligamentous preparation of the bones of the knee, presenting the appear- ance of inflammation having been followed by anchylosis; the other (FlG. 250) comprises the soft structures of the knee, and shows an H-shaped cicatrix, the horizontal portion being four inches and the upright three inches in length. The integument appears to have sloughed over a large portion of the front of the knee and to have cicatrized imperfectly, while on the lateral and posterior portions there are marks of several abscesses. Case 635.—Dr. H. Culbertson tabulates3 a secondary operation, performed by Surgeon J. T. Hodgen, U. S. V., at the City Hospital, St. Louis, Missouri, in the fall of 1862, on a United States soldier, for a transverse shot wound of the head of the tibia, in which a U-incision was employed, and one inch of the head of the tibia and the tip of the fibula was removed, resulting fatally in three days. FlG. 248. —Extremities of the right femur and tibia; the missile rests in the inner con- dyle. Spec. 1956. FIG. 24L' —Bones of left knee after excisiou ofthepatella. Spec. 556. FIG. 250-Soft structures of the knee after excision of the patella. Spec. 607. ' Circular No. 6. S. G. O., 1865, p. 60. 3 See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 59; Culbeetson (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Assoc., Philadelphia, 1876. Prize Essay. Supplement to Vol. XXVH, p. 182. 'Culbertson (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVH, p. 188, Case 9. SECT. IV.] AMPUTATIONS AT THE KNEE JOINT. 397 Excisions at the Knee Joint of Uncertain Date.—Five cases belong to this group; one proved successful, three were fatal, and the result in one is undetermined. The meagre details of these cases are of little value for statistical purposes: Case 636.—Sergeant L. B. Mc Whorten, Co. C, 60th Georgia, appears recorded on the Confederate register of Jackson Hospital, Richmond, as having undergone "excision of knee joint" for gunshot wound received August 28, 1862, and as having been "furloughed September 24, 1864." Cask 637.—Private E. Bigman, Co. D, 26th South Carolina, appears recorded on the Petersburg Confederate general hospital as having been admitted August 6, 1864, with " resection of the patella and partial resection of the knee joint," per- formed by reason of "gunshot wound," and as having "died August 23, 1864." Case 638.—Lieutenant J. M. Dickens, Co. C, 44th Tennessee, aged 30 years, appears recorded on the register of Con- federate hospital No. 4, Richmond, as having received a " shell wound of both patellas and of the left little finger," for which "ablation of the left patella and amputation of the injured finger was performed May 20, 1864." His entrance into the hospital was dated two days after the operation, and his death, preceded by febrile excitement, was noted June 5, 1864. Case 639.—Private S. Lininger, Co. H, 74th Indiana, aged 32 years, was wounded at Chickamauga, September 19,1863. He was admitted to the general field hospital near Chattanooga (date not recorded), where Surgeon J. A. Stillwell, 22d Indiana, noted the following: "Shot wound of right knee joint; excision of internal condyle of femur. Thigh amputated at junction of middle and lower thirds on November 19th. Stump opened and dressed November 23d. Milk punch given freely. November 26th, stump granulating some; resin cerate applied and stump bandaged as tight as it would bear. On November 30th, the sutures all sloughed out; granulations poor. December 6th, patient transferred." Surgeon L. D. Waterman, 39th Indiana, reported that the patient was admitted to the general hospital at Bridgeport, and that he died on the following day, December 7, 1863. Case 640.—Private L. T. Huffman, Co. E, 57th North Carolina, appears noted on the records of Confederate hospital No. 4, Richmond, as having been admitted December 15, 1862, with " excision of knee joint," performed for shot wound. The result of the operation was not recorded. AMPUTATIONS AT THE KNEE JOINT.—One hundred and eighty-nine exam- ples of exarticulation at the knee joint1 for shot fractures are found on the returns. The results of two cases could not be ascertained; eighty-one were followed by recovery, and one hundred and six by death, giving a mortality of 56.6 per cent., thus exceeding the 1 The operation of amputation at knee joint, mentioned by HIPPOCRATES (QSuvres completes, par E\ LlTTRE, Paris, 1844, T. IV, p. 285) and GUT DE ChaULIAC (La Grande Chirurgie de GUY DE CHAULIAC, Rouen, 1615, p. 464), was advocated by J. GUILLEMEAU (Les OSuvrcs de Chirurgie, Rouen, 1649, p. 710) as preferable, under certain circumstances, to amputation in the thigh : " Vray est que si la gangrene, ou fracas d'os, finissoit a la joincture da genouil ou fort proche d'icelle, sans monter au dessus, comme au commencement de la cuisse, l'amputation se doit plustost faire en la joincture que de coupper plus haut, et principalement en la cuisse: car les accidens en seroient tousiours pires, a raison des vaisseaux, veines, arteres et nerfs, lesquels tant plus on tire et montevers le haut, tant plus sont trouuez gros: joint aussi qu'il conniendroit appuyer la partie cicatrisee sur la jambe artificielle, comme si on la couppoit a la joincture." The statement of R. B. Sabatiek (Mid. Operatoire, Paris, 1824, T. IV, p. 548) and others that the operation had been performed by FABRICius HlLDANUS in 1581, is evidently erroneous. The latter (Opera qute extant omnia, Fraccofurti, 1646, p. 805) amputated the hand at the wrist joint for shot injury, in a young man of Dusseldorf, in 1581, and adds: "Sin Sphacelus poplitem superarit, in ipsa genu articulatione incisio facienda veniet." Cases of amputation at the knee joint for disease are cited by J. L. Petit ((Entires Completes, Paris, 1844, p. 814), BRASDOR (Essai sur les amputations dans les articles, in Mim. de VAcad. Roy. de Chir., Paris, 1774, T. V, p. 771), and others; but the first examples of this operation in military surgery are mentioned by: MlCHAELIS (Briefe aus New York, in RlCHTEu's Chirurgische Bibliothek, Gottengen, 1782, B. VI, p. 125), who visited the wounded French in Charleston, left there by Count D'Estaing after his unsuccessful expedition to Savannah, in September, 1779. He found 4 cases of amputations at the knee joint; all proved fatal. The surgeon in charge ascribed these unfortunate results partly to venereal poisoning, partly to scorbutus, and partly to the insalubrious air of Charleston. JOBERT DE LAMBALLE (Plaies d'armes d feu, Paris, 1833, p. 293): A. M., aged 15, shot in left leg July 28, 1830; amputation at the knee joint two months after injury. VELPEAU (Nouveaux Elements de Midecine Operatoire, Paris, 1839, T. II, p. 521) states that disarticulation of the leg had been successfully practised once since 1830, by M. NlVERT, of Azai-le-Rideau, on a man whose leg had been fractured by shot. BAUDENS (L.) (Clinique des plaies d'armes dfeu, Paris, 1836, pp. 532, 536): A soldier, wounded at Tafua, January 26,1836, in right knee; patella shattered; ball lodged in condyle of femur; amputation through joint; portion of condyles removed; recovery, with serviceable stump. A soldier of the 13th regiment, wounded April 1, 1836, at Atlas; fracture of the head of the tibia; amputation through joint; recovery. SEDIL- LOT (G.) (Campagne de Constantine de 1837, Paris, 1838, p. 266) tabulates 3 fatal cases of exarticulation at the knee for shot injuries. SMITH (STEPHEN) (Cases in Surgery—Amputation at the Knee Joint, by W. PARKER, in New York Jour, of Med., 1852, Vol. IX, p. 318): A saddler, shot in the leg; ampu- tation at the knee joint with a razor, the surgeon having no other instrument; recovery with a good stump, which was tender on pressure. Dr. I. MOSES (T. M. MARKOE, Amputation at the Knee Joint—Illustrated by the Cases which have occurred in American practice, and mainly by those which have been treated in the New York Hospital, in The New York Jour, of Med., 1856, Vol. XVI, p. 30) operated in the case of J. Senno, a Mexican, aged 26, who had received a shot fracture of the left tibia in June, 1854; amputation at the knee November 22, 1854; recovery, with firm stump, in six weeks. MAZANOWSKY (JOSEPH) (Zur Exarticulation im Kniegelenke, in LANGENBECK'S Archiv fur Klin. Chir., 1866, B. VII, S. 489): Osman Babassy, aged 2 j. wounded in tbe Crimea, July 17, 1854 ; fracture of bones of both legs; January 30, 1855, exarticulation at knee joint after BAUDENS; recovery. Chenu (J. C.) (Rapport, etc., pendant la Campagne d' Orient en 1854-55-56, Paris, 1865, p. 416) tabulates 67 cases of amputation at Ihe knee joint; 5 were successful and 62 proved fatal. The successful eases are: J. P. Bemad, 80th line, shot fracture of left leg, September 8, 1855; primary disarticulation. A. A. Boullier, 97th line, shot fracture of right leg, June 7, 1855; primary amputation at the knee. J. N. Dewatine, 82d line; shot comminution of right leg, September 20, 1854, atthe Alma; amputation on the 6ame day. L. A. Roudil, 3d Zouaves; shot fracture of right leg at Inkerman, November 5, 1954; exarticulation at knee. J. B. Sainpy, 26th line, shell fracture of left leg, September 8, 1855; primary exarticulation. MATTHEW (T.' P.) (Med. and Suig. Hist, of the British Army in the years 1854-55-56, London, 1858, Vol. II, p. 368) tabulates 7 amputations at the knee joint; 3 were suc- cessful and 4 fatal; the 3 successful cases were all primary; of the 4 fatal cases, 3 were primary and 1 secondary. CHENU (J. C.) (Stat. Mid.-Chir. de la Camp, d'ltalie en 1859 et 1860, Paris, 1869, T- N, p. 775) tabulates 4 cases of amputations at the knee occurring in the French army during the cam- paign in Italy in 1859-60; 1 recovered, 3 died. The instance of recovery is detailed: L. Dumas, 37lh line, comminuted fracture of upper third of left leg, Solferino, June 24, 1859; amputation at the knee December 19, 1859; recovery, with good stump, February 2.5,186Q. The same author states that 398 INJURIES OF THE LOWEK EXTEEMITIES. [CHAP. x. fatality of amputations in the continuity of the femur by 2.8 per cent. One hundred and eight were primary operations, fifty-one intermediary, and twenty-six secondary, while in four instances the period of operation was not indicated: Table LIV. Summary of One Hundred and Eighty-Nine Amputations at ihe Knee Joint for Shot Fracture. OPERATIONS. Cases. Death. Unde- termined. Mortality Rate of Determined Cases. Primary................... Intermediary............... Secondary................. Time not specified.......... Aggregates 108 51 26 4 53.2 68.0 53.8 25.0 106 56.6 Fifty-four of the one hundred and eighty-nine exarticulations1 at the knee were per- formed for lesions of the bones of the knee joint. In the remaining one hundred and thirty-five cases the original injuries were: Fractures of one or both bones of the leg in one hundred and sixteen, fractures of the ankle joint in thirteen, and fractures of the bones of the foot in six instances. Primary Amputations at the Knee Joint.—Of one hundred and eight operations of this group, fifty were followed by recovery, fifty-seven by death, and, in one instance, the final result could not be determined. The mortality rate, 53.2 per cent., exceeds that of the primary amputations in the lower third of the thigh (Table XXIX, p. 213) 4.5 per cent., and that of the primary operations in the thigh, whether in the upper, middle, or lower thirds, 3.2 per cent. Recoveries after Primary Amputations at the Knee Joint.—Thirty-eight of the fifty successful primary operations were performed on Union, and twelve on Confederate soldiers. Thirty-seven of the thirty-eight Union soldiers became pensioners, and six have since died, one, one year; one, two years; one, five years; two, sixteen years; and one, eighteen years 3amputations at the knee were performed on Austrian soldiers; all proved fatal. According to B. BECK (Kriegs-Chirurgische Erfahrungen wahrend des Feldzuges, 1866, Freiburg, i. B., 1867, p. 340), the operation was successfully performed in 1866, in Wiirzburg, by LmHART. OTIS (G. A.) (A Report of Surgical Cases treated in the Army of the United States from 1865 to 1871, Circular No. 3, War Department, S. G. O., Washington, 1871) records 2 successful operations: Pt. T. Nipple, 3d Cavalry; March 31,1870, pistol ball wound of right knee, perforating head of tibia; May 3, amputation through knee joint, sawing off about an inch of the condyles after the manner of Mr. CARDEX, of Worcester, by Ass't Surgeon J. D. HALL, U. S. A.; recovered, with a well rounded stump. Pt. L. Shire, 3d Cavalry; wounded by Apache Indians October 6, 1870; ball embedded itself in internal condyle of left femur; October llth, amputation, sawing off about an inch of the condyles, by Ass't Surgeon J. D. HALL, U. S. A.; recovery, with a good stump. CHENU (J. C.) (Apercu Hist. Stat, et Clin, etc., pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493) tabulates 23 amputations at the knee; 5 were successful and 18 fatal. BECK (B.) (Chirurgie der Schussverletzungen, 1872, p. 852): U. O. L., 43d East Prussian Infantry; shot fracture of both bones of right leg January 15, 1871; exarticulation at knee joint January 23, 1871; periostitis of femur; recovery in 6 weeks; stump not well covered. Fischer (G.) (Dorf Filing und Schloss Versailles, in Deutsche Zeitschrift fiir Chirurgie, 1872, B. I, p. 187) tabulates 1 secondary amputation at the knee joint; the result is not stated. GRAF (E.) (Die Koniglichen Reserve-Lazarethe zu Diisseldorf wahrend des Krieges, 1870-71, Elberfeld, 1872, p. 53): Martinet, shot fracture of fibula; exarticulation at knee by BuCHKER; death. LOSSEN (H.) (Kriegschirurgische Erfahrungen, in Deutsche Zeitschrift fur Chirurgie, 1873, B. H, p. 137) mentions a case of successful primary exarticulation at the knee. SOCDJ (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 153) tabulates 3 fatal cases of amputation at the knee joint, but gives no details. Of the 128 cases referred to in this note 25 recovered, 102 died, and the result in 1 case is undetermined; 11 were primary, 2 intermediary, 7 secondary, and 108 were operations of undetermined date. lTo these 189 cases of amputation at the knee joint for shot fractures should be added 6 exarticulations for shot flesh wounds, cited in the first section of this Chapter, on page 56, making a total of 195 cases, with 82 recoveries, 111 deaths, and 2 undetermined results. In an article by Dr. J. H. BKINTOX, On Amputation at the Knee Joint and at the Knee, in The Am. Jour, of the Med. Sci., April, 1868, Vol. LV, p. 311, occurs the following: " In a communication from Surgeon Otis, received since the preceding pages were penned, the following additional information has, with the permission of th6 Surgeon General, been furnished to the writer. The whole number of cases of knee joint amputations recorded in the Surgeon General's Office is two hundred and eleven. Of these, ninety-six recovered, one hundred and six died, one is still under treatment, and in eight the result is undetermined." This information was furnished to Dr. Brinton in the early part of 1868, when every moment of the editor's time was occupied with the analysis of the injuries of the head, and when, with the limited clerical assistance at his command, it had only been possible to examine into the details of such cases as were under immediate discussion. Although there were entered on the records at that time 211 cases of alleged exarticulations at the knee, it has been ascertained from subsequent careful analysis and comparisons, and from additional information gathered from artificial limb statements and pension records, that 16 of these 211 cases were, in reality, amputations of the femur immediately above the condyles. The editor exceedingly regrets to have been the cause of this, although unavoidable, erroneous statement in Dr. Bkixton'8 excellent paper on knee joint amputations. sect, IV.] PRIMARY AMPUTATIONS AT THE KNEE JOINT. 399 after the exarticulation at the knee. In one instance, the case of Corporal Lapham, 1st Vermont Cavalry, detailed on page 224, ante, the opposite thigh was simultaneously removed at the middle third; in six instances the exarticulation was followed by amputation in the thigh, viz: four in the lower and two in the middle thirds. Case 641.—Private L. J. Matson, Co. K, 2d New York Cavalry, aged 21 years, was wounded at Petersburg, April 1, 1865. Two days after the reception of the injury he was admitted to the Depot Hospital at City Point, whence he was forwarded to Washington. Surgeon R. B. Bontecou, U. S. V., contributed a photograph of the wounded man (Contrib. Photo's, S. G. O., Vol. VIII, p. 21), with the following history: "The patient was admitted to Harewood Hospital, April 5th, suffering from amputation at the left knee joint, which was performed on the field by the antero-posterior flap method, for shot wound of the leg involving injury to the knee joint. The operator and the extent of the injury were unknown. At the time of admission the condition of the stump and the constitutional state of the patient were tolerably good. The parts subsequently became gangren- ous; but by timely application of escharotics, and by supporting treatment throughout, the patient did well and made fair progress in his recovery. A part of the femur was removed with the dressing forceps." The patient subsequently passed through Lin- coln and Armory Square Hospitals, and on September 2, 1865, he was discharged from service, and furnished with an artificial limb by the Jewett Patent Leg Company. The pensioner was paid December 4, 1879. In his application for commutation he represented the stump as being in a sound condition. Case G42.—Private R. Kelly,' Co. A, U. S. Engineer Battalion, aged 23 years, was wounded in the left knee by one of the sharpshooters iu front of Petersburg, August 18, 1864. Assistant Surgeon G. M. McGill, U. S. A., reported: "The ball entered somewhat to the left of the median line, near the tuberosity of the tibia, passed upward and backward, and lodged in the face ol the external condyle, partially embedding itself crosswise. On consultation with Surgeon J. R. Ghiselin and Assistant Surgeon J. R. Gibson, U. S. A., and Acting Assistant Surgeon B. F. Goodrich, who had charge of the case, it was decided to amputate through the knee joint. I introduced a scalpel opposite the termination of the external condyle and outlined an anterior flap— the lowermost part of which was two inches below the terminal insertion of the quadriceps extensor—with a firm cut that divided the skin and the superficial fascia: terminating the primary incision of the anterior flap opposite a point of the internal condyle corresponding to the point of introduction opposite the external condyle. From this termination the scalpel was reversed and the inner half of the posterior flap formed, the depth of my incision being sufficient to insure section of the superficial fascia as well as the skin proper. The knife was then removed and reinserted near tbe original point of entrance from which the outer half of the posterior flap was formed. This posterior flap was very long, extending fully halfway down the leg, and the angles of the union of the anterior and posterior lines of incision were made very acute, so that retraction would not tend to separate the angles of the stump by drawing the sac of the stump tightly over the large extent of bone substance left. The anterior flap was now raised, and in raising it I took care to dissect so as to inflict as little injury as possible to the superficial fascia. The ligament of the patella was incised closely above the tuberosity of the tibia, and the patella, with its connections, was left untouched so far as practicable. The ligaments remaining were then divided at their insertion and so cut through that the semi- lunar cartilages remained in the stump. All the ligaments having been thus severed, I cleared the posterior flap with a large operating knife, cutting in the plane of the retracted posterior skin flap, outlined as described above. This procedure afforded a base of flesh to what was essentially a skin flap, in addition to which I found that by the method adopted the fleshy part ol the posterior flap had been so formed as to expose so much of the anterior surface of the deep posterior layer of crural fascia that a fibrous sheet fitted upon the synovial surfaces exposed by the removal of the tibia. I now cut away all points and strips of cartilage or fibrous tissue accidentally made in operating. The ball was elevated from its bed in the face of the external condyle and this bed cleared. Nothing unusual took place in the subsequent steps of the operation; unfortunately, however, the silk ligature threads used were rotten. There was also a ball hole in the anterior flap besides the wound in the face of the condyle to complicate the case. The latter was oozing blood from its sides when last observed. Throughout the operation any injury to what was left of the synovial sac was avoided. September 9th, patient is doing very well; none of the ligatures hare yet come away, and gentle traction met with firm resistance this morning. The patient is afflicted with pains of a darting lanci- nating character, shifting in location. The wound of entrance in the outer border of the anterior flap has healed rapidly by granulation, and to a great extent the flaps have united. A sinus, the mouth of which is to the right of the middle of the cicatricial line, communicates with the bed of the ball; but so little discharge takes place through this that the bed is thought to be already filled with callus. A peculiar 'leaden' feeling about the patella has been observed by the patient. He is not able to move this bone, but moves the thigh without pain. September 14th, patient is doing finely. One of the ligatures on the inside, that of an articular artery, has broken off short. The popliteal ligature has not yet separated. September 22d, the patient has steadily improved. The tumor of the stump has subsided and the line of the cicatrix is somewhat depressed. There is still discharge from where the ligature is broken off, and it is probable that the knot of this ligature will remain in the stump for some time. The main ligature has not yet come away; the thread being fine and rotten, I dreaded to pull it even gently. The patella is now freely movable up and down, to the right and left. The capsule of the joint, as a whole, has adhered strongly to the condyloid surfaces of the femur, and affords a sufficient stay to the connected muscles. On September 27th, the patient was sent away to West Point, New York. He was then able to walk on crutches, and I had only to regret that knots of all the ligatures remained in the stump, having considered it inexpedient to search for them. On his way to West Point the patient— as he informed me by letter—was attacked with what he termed gangrene, rendering some operation necessary, which, I believe, was performed at West Point. From his description of it I understood that this operation did not extend to interference with the bone or the remains of the synovial sac." Surgeon J. F. Head, U. S. A., certified to the patient being treated in hospital at West Point. The man was discharged by expiration of service, January 23, 1865, and pensioned, and after reaching his home lie was supplied with aii artificial limb by the Palmer Arm and Leg Company. The Brooklyn Examining Board, December 16, 1 Abstracts of this case have been cited by MAKK.OE (T. M.), Amputation at the Knee Joint, in New York Medical Journal, 1868, Vol. VI, p. 503, Case XXXII, and in Circular No. 3, War Department, S. G. O., Washington, 1871, p. 278. 400 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. 1874, certified to the amputation, and to the patella being unremoved and remaining embedded in the extensor muscles of the anterior surface of the stump; also to the integuments being adherent to the stump and parts so thin that an artificial limb can be worn but little of the time without creating inflammation. The pensioner was paid December 4, 1879. Case 643.—Private E. Baker, Co. A, 38th Wisconsin, aged 17 years, was wounded in the right leg, before Petersburg, July 17, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon M. K. Hogan, U. S. V., recorded: "The ball entered at the outer tuberosity of the tibia, ranged inward and slightly upward, and embedded itself between the tuberosities. The synovial membrane was lacerated and synovia escaped. The leg was amputated by Surgeon A. F. Whelan, 1st Michigan Sharpshooters, the operation being performed on Butcher's plan." From the field hospital the wounded man was moved to City Point, and thence to Philadelphia. Surgeon S. J. W. Mintzer, U. S. V., reported that "the patient was admitted to South Street Hospital, July 26th, his right leg having been amputated on the field, on the day following the injury, at the knee joint, and the patella removed. When admitted, parts of the integuments had sloughed away, leaving the extremity of the bone exposed. On July 30th, haemorrhage occurred without much loss of blood, from which the patient rallied, though much weakened by diarrhoea. A narrow semicircle of bone was removed, after which granulations began to cover it. There was considerable suppuration from the depth of the posterior flap." About eight months afterwards the patient was supplied with an artificial limb, and on May 30, 1865, he was discharged from service. The pensioner was paid December 4, 1879. In his application for commutation he stated that the stump of his amputated limb remained in good condition. Fatal Cases of Primary Amputation at the Knee Joint.—Fifty-seven cases were reported; in fifty-one instances the patients were Union, and in six Confederate soldiers. Seven deaths were referred to pysemia, two to tetanus, three to hsemorrhage, one to gan- grene, one to typhoid fever, and seventeen to exhaustion. The average period between the day of the operation and the date of death was forty-one days. Case 644.—Private W. Stanley, Co. H, 53d Pennsylvania, aged 26 years, was wounded at Fredericksburg, December 13, 1862. He was admitted to a Second Corps field hospital, and thence transferred to Washington. Assistant Surgeon C. C. Lee, U. S. A., reported: "The patient entered Douglas Hospital December 26th, having received a comminuted fracture of the upper third of the right leg, for which amputation through the knee joint was performed the following day. He stated that haemorrhage was profuse both before and since the amputation. The stump sloughed somewhat and did badly. On March 1, 1863, when I took charge of the case, the stump was tightly bandaged from above downward, the extremities being swollen and bulbous, and the thigh completely honeycombed in appearance by small abscesses and sinuses for six inches above the condyles. The bandage was removed and the sinuses and abscesses laid open. The patient was also greatly enfeebled by chronic diarrhoea, from which he had suffered for six months, and which, though checked from time to time, always returned with full force. In this state he vacillated from better to worse until April 20th, when, without any ostensible cause, he was seized with obstinate nausea and vomiting. This resisted every means employed to remedy it and exhausted what little strength remained in the patient. He sank steadily until the night of April 26, 1863, when he expired of sheer debility. At the autopsy, the thoracic viscera were found healthy with the exception of old pleuritic adhesions on the right side; lungs crepitant throughout and with- out tubercular deposit. The liver and kidneys were shrunken and showed evidence of chronic congestion, but were otherwise normal; stomach and spleen healthy. In the large intestines well-marked congestion was observed and partial maceration of the mucous membrane, which was here and there dotted with dark maculae. These spots were surrounded by depressions and apparent cicatrices in the mucous membranes, and were thought to be the result of ulcers that had already cicatrized. The condition described was chiefly noticed in the upper portion of the rectum. The small intestines were here and there greatly congested, but no ulceration was detected. The stump had healed completely; but from the removal of the patella in the opera- tion and the subsequent emaciation of the patient the edges of the condyles were too superficial to have borne pressure with success. A large abscess, which had been very troublesome during life, existed between the rectus and crurasus muscles. The latter was wasted to the last degree, but seemed to have protected the bone, which was not diseased. A very complete calca- reous degeneration of the mesenteric glands should also have been noted above." The lowest portion of the femur was saved and contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A. (Cat. Surg. Sect., 1866, p. 363, Spec. 1240.) Case 645.—Major A. McQ. Corrigan, 9th New York Cavalry, aged 27 years, was wounded in the right leg, at Meadows Bridge, May 12,1864. Surgeon A. P. Clark, 6th New Yoi'k Cavalry, described the injury as follows: "At the time of receiving the wound he was in command of a detachment of his regiment and at a considerable distance in advance, endeavoring to force the enemy from his entrenchments on the other side of the bridge, when he was struck by a conical musket ball, which passed from the anterior to the posterior aspect of the limb, fracturing the upper extremity of the tibia and wounding the anterior tibial artery. The haemorrhage was, in a measure, controlled by the men who brought the patient a short distance to the rear, where a tourniquet was applied. A few minutes afterwards the enemy was dislodged, when orders were received for the troops to cross as speedily as possible, and the train was not allowed to halt until it reached Mechanicsville, five miles distant, where Acting Assistant Surgeon C. Rodgers, assisted by another medical officer and myself, amputated the leg at the knee joint, adopting the method of double flaps and removing the patella and a section of the condyles of the femur. The patient was then placed in an ambulance and taken to Haxall's Landing, which place was reached on May 15th, and whence he was sent by water to general hospital." Acting Assistant Surgeon T. Liebold communicated the following termination of the case: "The patient was admitted to Point Lookout Hospital May 16th. The stump was much inflamed and the pus retained by sutures, which were removed. Two days after his admission, secondary haemorrhage came on at noontime. Happening to be near at the time I was enabled to stop it immediately, so that not more than from four to six ounces of blood was lost. The stump was then opened again entirely and the anterior tibial artery, from which the ligature had come off, was religated in a few minutes by Surgeon A. Heger, U. S. A., in charge of the hospital. The patient died May 28,1864, from exhaustion, having had severe diarrhoea and profuse discharge of pus from an abscess in the stump. He was also attacked with vomiting of bile." SECT. IV. | PRIMARY AMPUTATIONS AT THE KNEE JOINT. 401 Table LV. Sammanj of One Hundred and Fight ( 'axex of Primary Arnputatioii at the Knee Joint for Shot Fracture. [Recoveries, 1-50; Deaths, 51-107; Result unknown, 108.] Name, Military Description, and a< Date Oi? Injury, Baker, E. V., Pt., A, 38th July 17, Wisconsin, age 17. 1864. Beeker, II.. Serg't, V. 5th July 3, Mich. Cavalry, nge 27. 1963. Begle. G., Pt.,*F, 91st Imli- Aug. 3, ana, age 22. 1864 Bowen. Ii., Pt., K, 52d North July 3, L'amlina. 18ti:>. Bragg, \V., Serg't. F, 8th May 27, Penn. Cavalry, age 23. 1864. Brooks, J. M.. Pt., A, 17th June 21, Penn. Cavalry, age 28. j 1863. Credon, J., Pt., A, 91st New i May 27. York, age 45. 1*03. Darkes, J., Pt,, B, 10th In- Aug. H», fan try, age 33. 1864 David, T., Pt., A, 90th Peun- Dec. 13, sylvania, age 27. 1862, Dow, G. E., Pt., G, 12th N. June 3, Hampshire, age 22. 1864. Everett, J., Serg't, G, 142d May 23, Pennsylvania, age 27. 1864. Freeman. C. Pt., B, 210th Mar. 31 Pennsylvania, age 32. lsoo. Gallot. E. F., Pt., E, 146th June 2. New York, age 26. 16o4. Hare, F., Corp'l, B, 6th Wis- ! .May 5. eonsin, age 23. \ 1864. Harkins, J. B., Pt.. K. 119th Pennsylvania, age 22. Heinle, J., Pt., G, 51st Penn- sylvania, age 23. Herbert, C, Pt.. C, 69th X. York, age 19. (Alias Chas. St. J. Nichols.) Hopkins, W., Pt., E, 6th Michigan Cavalry, age 32. Howard, J. W., Corp 1, D, 61st Virginia. Ivey, A., Serg't, D, 7th Wis- consin, age 26. Jones, II. C, Lieut., E, 15th Virginia. Karnes. W. II., Pt., G, llth" Virginia Cav.. age 40. Kaul, J., Pt.. G, 29th New York, age 21. Kelly, R„ Artificer, U. S. Engineers, age 23. Kerr, G„ Serg't, H, 2d Cav- alry, age 41. Kuhn, A., Pt., P, 99th Ohio. age 28. Lapham. C. N.,Corp'l, K, 1st Julv 8, Vermont Cavalry, age 23. 1863. Dec. 13. 1862. June 3, 1864. Aug. 25, 1864. Sept Hi. 1863. Mav 12, 1864. Julv 1, 1863. May 16, 1864. June 9, 1863. Aug. 29 1862. Aug. 18 1864. June 11, 1864. Julv 19, 1864. Leonard, W. J.. Pt., K. 43d Alabama, age 20. Matson, L. J.. Pt., K, 2d X. York Cavalry, age 21. McGee, J.. Pt.. G. 2d Rhode Island, age 22. McMullen, R. J.. Pt., I, 4th Georgia, age 20. May 16, 1864. April 21 1865. May 5, 1864. May 3, 1863. Nature of Injury. Rifle ball fracture of bones of right leg, involving knee. Conoidal ball comminuted head of left tibia. Conoidal ball fracture of left leg, involving knee joint. Shot fracture of left leg. (Also wound of right ankle.) Conoidal ball fracture of left tibia. Cannon shot fracture two ins. below left knee joint, sever- ing leg. Musket ball comminuting left patellaand opening knee joint. Disrupture of left leg at upper third by a solid shot. Shot fracture of right tibia and fibula, upper third. Grape shot fracture of left leg. Conoidal hall fracture of right tibia and fibula. Conoidal ball fracture and great splinteringof patella and tibia of left leg. Conoidal ball comminuted frac- ture of upper third of left leg. Shot fracture of bones of left leg. Shot wound of the left leg..... Shell wound of right leg, upper third. Two shot wounds of right leg by conoidal balls, fracturing heads of both bones and their lower thirds. Conoidal ball penetrating cav- ity of left knee joint. Shot wound of knee joint...... Shot fracture of upper third of left tibia. Shot wound of knee joir.t..... Conoidal ball fri' t'.Y.c of head of left tibia. Musket ball perforated head of right tibia; joint not involved. Conoidal ball entered near tu- berosity of left tibia, lodging on external condyle of femur, slightly injuring it. Conoidal ball wound of upper third of right leg. Conoidal ball comminuted frac- ture of right tibia, extending nearly to knee joint. Both legs carried away by a solid shot. Shot comminution of tibia and fibula just below knee joint. Conoidal ball wound of left leg, injuring knee joint. Conoidal ball fracture of right libia and fibula. Shot fracture of the leg....... OPERA- TION. Julv 18, 1864. Julv 4, 1863. Aug. 3, 1864. July 3, 1863. May 27, 1864. June 21, 1863. Oil IIAIKIN AM) OPERATOR. Flap ; remov'g patella; Butch- er's operation, by Surg. A. F. Whelan, 1st Mich. S. S. Antero-posterior flap......... Flap ; thro' condyles of femur, by Surg. J. T. Woods, 99th O. Amputation at knee joint...... Flap amputation, by Assistant Surg. II. G. (liritzman, 8th Penn. Cavalry. Amputation at knee joint...... May 27, Ant. and post, flaps; one half of 1863. | patella retained, by A. Surg. i J. T. Myers, 91st New York. Aug. 20, Anterior rectangular flap ampu- 1864. tation, involving patella, lat- eral and inferior surfaces of condyles, by Surg. A. A. White, Sth Maryland. Dec. 13,! Flap amputation at knee, re- 1862. taining patella and condyles, by Ass't Surg. C. C. Lee, U. S. Army. June 3, 1864. May 24, 1864. April 1, 1865. June 3, 1864. May 6, 1864. Flap amputation at knee joint. Lateral flap; patella retained; a small section of condyles size of ahalf dollar remo'd, by Surg. J. Ebersole, 19th lnd. Anteroposterior flap; remov- ing patella, by Snrg. J. J. Comfort, 190th Penn. Antero posterior flap, by Surg. La Grange, C. S. A. Amputation at knee joint, by a Confederate surgeon. Dec. 13,1 Amputation at knee joint, by 1862. | Surgeon J. P. Leidy, 119th Pennsylvania. June 3, 1864. Aug. 27, 1864. Sept. 17, 1863. May 12, 1864. July 1. 1863. May 16, 1864. June 10, 1863. Aug. 29, J 862. Aug. 18, 1864. June 11, 1864. July 19, 1864. July 10, 1863. May 16, 1864. April 1, 18(55. Flap; by Surg. A. F. Whelan, 1st Michigan S. S. Long posterior flap, by a Con- federate surgeon. Amputation at knee joint, by a Confederate surgeon. Amputation at knee joint...... Bilateral skin flap, by Surg. J. Ebersole, 19th Indiana. Amputation at right knee joint. Amputation left knee joint, by a Union surgeon. Double flap amputation....... Antero-posterior flaps; patella not removed, by Ass't Surg. G. M. McGill, U. S. A. Amputation at knee joint, by Union surgeon. Short flap, leaving condyles of femur intact, by Surg. J. T. Woods, 99th Oliio. Amputation left knee joint by ant.-post, flap 'also amp. right thigh, middle third), by Surg. L. P. Woods, 5th N. Y. Cav. Antero-posterior flap; remov- ing patella. Antero-posterior flap amputa- tion. May 5. ! Short post, flap; patella remo'd, 1664. I by Surg. G. W. Carr, 2d R. I. Mav 4, Amputation at knee joint 1863. Result and Remarks. July 30th, haem. Semicircle of bone removed. Disch'd May 30, 1865. Stump hcal'd by first inten. Disch. Dec. 14, '63. '(Also fract. jaw.) Stump perfectly healed. Disch. June 21, 1865. Recovery, January 12, 1864. Discharged April 6, 1865. Sept. 10, amp. lower third thigh. Disch'd July 28,1865. (Table XL, No. 14. p. 320.) September 1st, entirely healed. Discharged Mar. 29, 1866. The stump is tender. August 30, gangrene. To regi- mental headquarters Dec. 17, 1864. Stump healed. Disch'd Feb. 21,1863. Died Feb. 25, 1870. Brinton (J. H.), On Amp. at the Knee. Joint, etc., in Am. Jour. Med. Sci., 1868, Vol. LV, p. 324. June 23d, haem.; 24th, lig. fem. artery. Disch'd Nov. 18, 1864. Discharged January 22, 1865. Spec. 4857. Discharged Aug. 3, 1865; good stump. Discharged January 20, 1865. Healthy stump. Gang. Aug. 6, re-amp. mid. th'd thigh. Disch'd Mav 22, 1865. (Table XXXIX, No.39, p. 314.) Disch'd Mar. 19,1863. Diseased stump: violent neuralgia ; hec- tic fever: exhausting diarrhoea. Died May 19,1867. Discharged June 1, 1865. Died May 1, 1870. Discharged June 9, 1865. Can- not wear an artificial limb. Sound stump. Disch'd March 23, 1864. Recovery. Discharged May 14, 1864. Recovery. Exchanged and furloughed Mar. 12, 1864. Mar. 12, 1863, patella raised and movable. Disch'd April 30, '63. Died Dec. 13. 1878; dropsy. Disch'd Jan. 23,1865. Markoe (T. M), Amp. Knee Joint, in N. Y. Med. Jour., 1867-68, Vol. VI, p. 503. Stump tender. Disch'd October 17, 1864. Died 1865. Discharged June 21, 1865. Disch'd August25, 1864. (Case 436, p. 224, and No. 336, Table XXXI, p. 231.) Recovered July 31,1864. ('.angrene; sloughing. Portion of femur removed with forceps. Discharged Sept. 2, 1865. Discharged Oct. 15, 1864. Stump never healed entirely. Protrusion of condyle. May 23d, amp. thigh, lower third. June Sth, haein.; lig. femoral artery. Recovery. (Table XXXVI, No. 130, p. 295.) Surg. Ill—51 402 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military j £™ Description, and Age. !jvjuky Milrhdl.A., Pt., F. Palmetto ; May 24, S. S., ago 17. 1864. Muir, I... Pt., I, 5th Vermont, Mav o, age 25. 186-1. D'linen, P., Pt., F, 39th X. Aug. 14. York, age 27. 1864. Pace. 11.. Pt.. G, 143d Penn- May 5, sylvania. age 33. 1864. Padgett, C. S., Serg't, K, i June 3, 12tii New Jersey, age 23. j 1864. Raflay, P., Pt., C, 21st Mis- \ May 6, sissippi, age 40. • 1864. Rist, C. 11., Pt., A, 36th Wis June 1, consin, age 19. ! 1864. Rogers, J. W., Pt., D, 6th Wisconsin, age 47. Sholes, II.. Pt.. D, 26th New York, age 20. Stewart, AY., Pt., K, 2d Mich- igan, age 22. Stratton. E. L., Capt . F. 12th New Jersey, age 24, Struble, E. II., Pt., F, 19th Ohio, age 25. Swittenburg, J. C. Capt., II, Kith Miss., age 27. Trent, S. A.. Pt., 2d Rich- mond Howitzers. Turner, J. L., P., G, 1st S. Carolina, age 20. Unknown, age about 30. Wheeler, T. H., Serg't. E, 1st Mich. Cav., age 32. Woodruff, A. O., Corp'l, D, Sth Artillery, age 23. Young, L. C, Pt., A, 3d Vir- ginia Cavalry, age 31. Bargcr, J. C, Pt., G, 52d Virginia, age 40. Barker, J., Pt., I, 58th Mass., age 42. Bates, O. S., Pt , A, 20th Mass., age 24. Bingham, D.,Corp'l, H,118th Pennsylvania, age 36. Briggs.'j., Pt.. A, 26th New York. Brooks, E., Pt., K, 19th Vir- ginia, age 26. Butler. G.. Pt., C, 8th New Jersey, age 19. Campbell, B. J.. Pt., II. 5th New York, age 22. Chase, J. P,., Pt., K, 24th X York Cavalry, age 49. Aug. 18, 1864. Dec. 13, 1862. June 17. 1S64. Mav 3, 1863. Mav 22, .1862. Aug. 21. 1864. May 12, 1864. Julv 1, 1863. Dec. 13. 18C2. May 31, 1864. July 3, 1863. May 12, 1864. Mav 30, 1864. June 17, 1864. June 24, 1864. June 26. 1864. Dec, 13, 1862. April 20, 1865. Aug. 16, 1864. Aug. 19, 1864. June 16, 1864. shot wound of the upper ex- ■ Mav 25, treinity of tibia. 18*64. Shot fracture of left leg four , May 6. inches above ankle. 1864. Conoidal ball fracture of left Aug. 15. tibia two ins. below knee j't. | 1864. Conoidal ball fract. of articula- May 5, ting surface head of right tib. 1864. Conoidal ball Comminuted frae- June 4, ture of right tibia aud fibula. 1864 (Also fracture of left radius.) Shot wound of left knee.......i Mav 6, i 1864. Conoidal ball fracture of upper June 1, third of left tibia, extending ' 1864. into knee joint. Conoidal ball fracture of left Aug. 19 tibia and fibula immediately 1864. below knee. Shot wound of right knee.....' Dec. 15 I 1862. Shell wound just below right knee, nearly severing leg. Conoidal ball fracture of head of right tibia. Shell, taking off left leg below knee. Conoidal ball shattering upper third left leg. Gunshot wound of knee....... Shell wound of right leg, in- volving knee joint. Shot fracture of the leg...... Shot wound of right tibia and fibula, implicating knee joint. Conoidal ball fracture of upper third of left tibia. (Also wound of right leg.) Pistol ball injuring both right tibia and femur, involving the knee joint. Shot wound right leg and left shoulder. Shot wound left leg and right thigh. Shell fracture of middle third of left leg. Shot shattering right leg ex- tensively. Shot fracture of left tibia..... Shell fracture of right leg..... Fracture of left leg by a frag- ment of shell. Shot wound of right leg, in- volving knee joint. Shot fracture of left tibia and fibula. June 17, 1864. May 4, 1863. May 22, 1862. Aug. 21 1864. May 12. 1864. Julv 2, 1863. Pri mar j May 31. 1864. July 3, 1863. .May 14. 1864. Primary June 17. 1864. June 24. 1864. June 26. 1864. Dec. 13, 1862. April 20, 1865. Aug. 16, 1864. Aug. 20. 1864. June 16, 864. Clark, W., Pt., A, lllth LSept. 17,: Shot fracture of right leg..... Sept. 17, Pennsylvania. 1862. 1862. Cole, F., Pt., G. 61st New July 3, ] Shot fracture of both bones of July 3, York. i 1863. left leg. J 663. Conland. ()., Pt,, I, 61st X. Mar. 25. Shot wound of the left knee I Mar. 25, York. 1S65. joint. j 1865. Cornell. J.. Pt.. B, 7th West May 31, Shot fracture of left knee joint. [Primary Virginia. 1864. Corrigau, A. McQ.. Major, May 12, Conoidal ball fracture of upper i May 12, Pth New York Cavalry,! 1864. , extremity of right tibia and 1864. age 27. , I wound of ant. tibial artery, j Councell, E. C, Col.. 16th Aug. 21. Musket ball fracture of right Aug. 21. Miss., age 32. 1864. \ leg near knee. ! 1864. Douglass. J, Serg't, G, 63d Nov. 24,1 Fractureof right leg. extending .Nov. 24. Indiana. 1864 j to knee j't. by a cannon ball. 1864. Draher, W.. Pt., B, 51st June 3, j Shot fracture of upper third of j June 3. Pennsylvania, age 32. 1864. \ leftleg. (Woundofshoulder.) ' 1864. Fitzsimmons, J. M.. Pt., E. June 18. Conoidal ball fracture of right June 18. 19th Indiana, age 22. 1864. leg. 1864. Gervig, H., Pt., K, 15th X. Star. 31, Conoidal ball fracture, involv- Mar. 31, York Artillery, age 28. 1865. , ing right knee joint. j 1865. Slough'g; both condyles exposed. Furloughed Sept. 10, 1861. Discharged May 22, 65. Stump enlarged: cannot use anil. leg. Discharged June 19. 1865. Died August 11, 1866. Discharged August 31, 1861. DischartredJulv 13, .186.".. Bkjv TON (A.M.).Am. Jour. Mid. Sri 1868, Vol. 55, p. 322. Retired January 31, 1865 Osteoplastic, leaving patella Ulceration of cartilages. Dec. 15, and condyles, by Surg. J. M. amp. thigh, lower third. Dis- Amputation at knee joint. Circular amputation at knee joint. Flaps, by Surg. X. Hayward, 261 h Mass. Skin flaps, by Surg. J. Eber- sole, 19th Indiana. Antero-post. flaps; retaining patella but removing articular surface of condyles, by Surg. A. Satterthwaite, 12th N. J. Amputation at knee joint...... Burr, 42d New York. Flap amputation at knee joint. Amputation, bv Surg. T. Sim, U. S. V. Antero-posterior flaps; remov- ing patella and condyles, by Surg. S. S. French, 20th Mich. Amputation knee joint, leaving patella intact, by Ass't Surg. J. T. Calhoun, U. S. A. Flap amputation, by Surg. F. 'J'. Hurxthal, 19th Ohio. Amputation at knee joint, by Surg. J. Ebersole, 19th lnd. Amputation at knee joint, by Surg. — Capers, C. S. A. Amputation at knee joint...... Long ant. and short post, flaps: patella and condyles retained, by Snrg. J. H. Brinton.U.S.V. Flap amputation, by Surg. G. K. Johnson, 1st Mich. Cav. Amputation, by Ass't Surg. B. Howard, IJ. S. A. Long anterior flap, by Surg. C. B. Gibson, C. S. A. Amputation at knee joint..... Oval flap amput'n at left knee and amp. low. third r't thigh. Antero-posterior flap, at left knee joint, by Surg. N. Hay- ward, 2Uth Mass. Double flap; condyles of femur sawn off and patella removed. Amputation at knee joint, re- taining patella. Amputation at knee joint...... A mputation at knee joint...... Flap amputation at knee joint. A mputation at knee joint..... Amputation at knee joint...... Amputation at knee joint, by Surg. C. S. Wood, 66th N.Y. Amputation at knee joint, by A.Surg.C.S.Hoyt,126th N.Y. Amputation at knee joint, by Surg. M. Rizer, 72d Penn. Antero-posterior flap; remov'g patella and a section of con- dyles of femur, by A.A. Surg. C. Rodgers and Surg. A. P. Clark, 6th N. Y. Cavalry. Antero-posterior flap,.bv Surg. A.A. White. 8th Maryland. Amputation at knee joint...... Lateral flap amp. at knee joint, by Surg. A. F. Whelan, 1st Michigan S. S. Amputation at knee joint...... Amputation at knee joint, by Surg. A. A. White, 8th Md. charged May 2(),'65. Spec. 3514, (Case 492, p. 318, and Table XL, No. 82, p. 321.) Bone protruded. Disch'd March 23, 1865. Gang. March, 1863. amp. thigh, low. third. Disch'd Dec. 11,m (Table XL, No. 84, p. 321.) Slougbiug. Discharged May 4, 1865. Tender cicatrix. Discharged Januarys, 1864. Discharged March 16, 1863. Exchanged February 23, 1865. Retired November 5, 1864. Exchanged March. 3,1864. Recov'd, withgoodstump. BRIX- TON (J. H.), On Amp. atthe Knee Joint, etc., in Am. Jour. Med. Sci., 1868, Vol. LV, p. 316. June lCth, gangrene. Disch'd Nov. 12, 1864. Discharged May 28, 1864. Poor stump, with very thin covering. July 27th, amp. thigh, mid. third; gangrene; recovery. Spec. 5514. (TAB. XXX]X, No. 100, p. 315.) Died June 14, 1864. Died June 28, 1864. (TABLE XXXII, No. 1014, p. 257.) Gangrene. Died August 19,'64; exhaustion. Gang.-, haem. Died July 25, '64; pyaemia. Died December 13. 1862. Erys.; bed sores; large abscesses. Died May 11, '65: exhaustion. Died November 22, 1864 : chronic diarrhoea. Died September^, 1864. July 7th, lig. fem. artery. Died July 9,1864 ; constitutional irri- tation. Died October 10, 1862. Died July 9, 1863. Died April 19, 1865. Died June 3, 1864. May 18th, hsem., 6 oz.; popliteal artery ligated: diarrhoea. Died Mav 28, 1864: exhaustion. Sept. 2d, haem., 14 oz.; Sept. 3d, lig. femoral: Sept. 10th, ham. recurred and proved fatal. Died November 25. 1864. June llth, h»m. Died June 24, 1864; exhaustion. Parts gangrenous. Died August 17, 1864, of injury. Died April 7, 1865; exhaustion. sect. IV.] PRIMARY AMPUTATIONS AT THE KNEE JOINT. 403 Name, Military Description, ami Age. 70 Gooley, N., Pt., C, 73d Ohio. May 25, 1864. May 14, 1864. Sept. 29, 1864. Aug. 27, 1863. Aug. 4, 1864. Gould, M. W.. Corp'l. 11, 36th Illinois, age 20. Grice, T., Pt.. E, 38th Col'd Troops, age 22. Gulick, W. O.. Corp'l, M, 1st Iowa Cavalry. Harbor, E., Pt., G, 21st Vir ginia Cavalry, age 33. Naturic ok Injury. Hedder, W., Pt,, C, 56th N. York. Hughes, A. J., Pt., B, 14th Infantry, age 26. Johnson, T. R., Pt., F, 95th Ohio. Judd, W. B., Adjutant, 97th New York. Kennedy, J. A., Corp'l, H, 38th Ohio, age 24. Koch, J. R., Serg't, P, 69th Penn., age 22. Krowlow, H., Pt., A, 66th Xew York, age 18. June 1, 1862. May 5, 1864. Aug. 311, shot wound of the knee. (Also wound of neck.) Conoidal ball fracture of left tibia and fibula in mid. third. Conoidal ball fracture of right leg. Shot fracture of the right leg. Shell fracture of right tibia and fibula, extending into knee j't. Shot fracture of leg, involving the knee joint. Conoidal ball wound of left knee. Gunshot wound.............. 1862. Feb. 7, Shot fracture of knee, severe 1865. Sept. 1, 1864. June 16, 1864. Conoidal ball fracture of the right tibia. Grapeshot fracture of left knee joint. Mar. 31 1865. Lepper, W. F., Pt.. H, 143d -May 5, Pennsylvania. 1864. Long, J. W., Serg't. I, 8th Dec. 16, Kansas, age 23. " ' 1864. 84 Long, W., Pt., A. 1st Mis- Sept. 21, souri Artillery, age 40. 1862. 85 Matthews, S," Pt., A. 93d May 15, Pennsylvania, age 28. 1664. 86 McCullough. W. T.. Serg't. Aug. —, I, 2d New York. 1862. 87 i Merrill, S.. Pt., I, 39th Mass., Feb. 7, age 39. 1865. Opperman. J., Pt.. E, 8th May 5. New Jersey. 1864. 89 Parmenter, 'E. M., Pt., I, Sept. 17, 15th Massachusetts. i 1S62. 90 Rathbnrne, E., Pt., C, 36th j May 31, Wisconsin, age 27. 1864. 91 Rea, J., Pt., H, 24th Virginia. May 16, i 1864. Ribinger, R., Pt., B, 27th June 11. Pennsylvania. 1862. 93 Roberts", E. P.. Corp'l, G, Feb. 18, 107th Illinois, age 20. 1865. 94 Russell, J.. Pt., D, 27th July 30, Michigan, age 51. I 1864. 95 Scott, J., Pt., F, 1st N. Y. May 31, Dragoons, age 33. ! 1864. 96 Slater. P., Pt., I, 170th New I May 24, York, age 45. I 1864. !'7 Smith, H., Pt., I, 14th New June 7, Jersey, age 24. 1864. 98, Stanley, W., Pt., H, 53d Dee. 13. Pennsylvania, age 26. 1862. 99 Storey, J. M., Pt., H, 37th July 30 Wisconsin, age 30. i 1864. Shot wound of the right leg. Conoidal ball fracture, involv- ing right knee joint. Opera- tion. May 25, 1864. May 15, 1864. Sept. 29, J8Ij4. Aug. 27, 1863. Aug. 4, 1864. June 1, 1862. May 5, 1864. Aug. 31, 1862. Feb. 7, 1865. Sept. 2, 1864. June 16, 1864. April 1, 1865. May 5, 1864. Operation and Operator. Amputation at knee joint, by Surg. I. N. Himes, 73d Ohio. Circular amput'n at knee joint. Amputation at knee joint..... Result and Remarks. Died August 14, 1864........... Died September 19,1864; chronic diarrhoea. Died March 21, 1865. ' Disartieulationatknee joint, by Died September 3, 1863. Surg..I.C.Lynch, IstMo. Cav. Anterior skin llap; patella re- j Died Aug. 20, 1864; exhaustion moved; condyles of femur consequent upon excessive ich- undisturbed. Amputation at knee joint... Conoidal ball fracture of right leg. Shot wound, involving head of right tibia and patella. Shot comminuted fracture of left tibia and fibula. Gunshot wound of leg . Shot fracture of upper third of right tibia. Conoidial ball fracture of left knee joint. Gunshot fracture of leg....... Dec. 17, 1864. Sept. 21, 1862. May 17, 1864. On field. Feb. 7, 1865. On field, Anteroposterior flap at knee joint. Amputation at left knee joint. orous discharge; autopsy. J une 13th, amp. thigh, mid. third; 29th, ha;m. Died July 3, 1862; exh., diar., bed sore. Spec. 4933. Died June 6,1864. Card Photo's A.M. M., Vol. 2, p. 45. Died September 21, '62; tetanus. Amputation at knee joint...... Died February 19, 1865. Flap amputation at knee joint. Circular amput'n at knee joint, by Surg. G. L. Potter, 145th Pennsylvania. Antero-posterior flaps at knee joint. Antero-posterior flaps at knee joint, leaving condyles and patella, probably by Surg. J. H. Brinton, U. S. V. Flap, by Surg. J. R. Ludlow, U. S. V. Amputation at knee joint. Lateral flap at knee joint. Conoidal ball fracture of right tibia. May 31. 1864. Conoid.ball fract.of patellaand May 18, articiil&rsurf. of head of tibia. | 1864. Gunshot wound of the knee June 11, joint. ! 1862. Shell shattering both bones of i Feb. 18, left leg in upper third. | 18G5. Fracture of upper third of right J uly 30. leg by a conoidal ball. 1864. Conoidal ball shattering bones June 1, of left leg. 1864. Fracture of upper third of left May 26, leg by a conoidal ball. 1864. Conoidal ball wound of left leg June 7, and right thigh. 1864. Conoidal ball fracture of upper Dec. 14, third of right leg. 1862. Amputation at knee joint...... Flap amputation al knee joint. Amputation, by Surg. N. Hay- ward, 20th Mass. Amputation at left knee joint.. Flap, through the knee joint, by Surg. N. Hayward, 20th Massachusetts. Long posterior flaps, by Surg. C. B. Gibson, C. S. A. Amputation at the knee joint.. Antero-posterior flap, Bauden's operation, by Surg. E. Ship- pen, U. S. V. Double skin flap, by Surg. A. F. Whelan, 1st Mich. S. S. Amputation at knee joint...... Sutton, G. H., Pt., B, Pur- Aug. 18. nell's Md. Legion, age 34. I 1864. Swan, D. K.,Pt, F, 38th i Sept. 1, Ohio, age 18. | 1864. Thompson, I. R., Pt., I, 6th May 11, Wisconsin, age 29. 1864. Tilburv, G., Pt., E, 74th May 27, Illinois. 1864. Turner, W. H., Serg't, 6th New York Battery, age 26. Waldenburg, G , Pt., A, 46th New York, age 29. May 6, 1864. July 30, 1864. Grapeshot fracture of left tibia and fibula. Fract. of mid. third of left tibia and fibula by conoidal ball. Shot fracture of the right tibia. Shell comminuted fract. of left tibia and fibula near knee. Shot fracture of the right leg.. Cannon ball struck left leg, fracturing the tibia and the fibula. Conoidal ball fracture of right tibia. (Also wound of left heel.) Julv 31, 1864. Aug. 19, 1864. Sept. 1, 1864. May 12, 1864. May 27, 1864. May 6, 1864. July 30, 1864. Amputation at left knee j't, by Surg. N. Hayward, 20tli Mass, Flap amp. at left knee j't and amp. right thigh, lower third. Amputation at knee joint, re- moving the patella. Amputation at knee j't, Butch- er's operation, by Surg. A. F. Whelan, 1st Mich. S. S. Amp. at knee joint, by Surg. A. A. White, 8th Maryland. Antero-posterior flaps; remov- ing condyles. Antero-posterior flaps, by Surg. A. J. Ward, 2d Wisconsin. Amp., by Surgs. W. P. Pierce, 88th 111., and H. E. Hasse, 24th Wis. The patella, condyles, and sy- novial surfaces were not re- moved: and the capsules of thejoint.dividedat their distal extremities, were preserved. by Ass't Surg. G. M. McGill, U. S. A. Butcher's operation ; long ant. flap; small portion of condyles sawn off articulating surface, by Surg. A. F. Whelan, 1st Michigan S. S. Died December 24,1864; chronic pneumonia. July 3, 4, haem., 15 oz.; lig. fem. artery. Died July 12, 1864; exhaustion. Gang.; slough.; femur protrud.; haem; femoral artery lig.; June 23d, recur'd; re-lig. Lied June 24, 1865; exhaustion. Died May 15, '64, haem. (0 Biu.v TOX (J.W.),Am. Jour. Med. Sci., 1868, Vol. 55, p. 316. Dec. 18th,haem.; lig.int. artic. art.; Dec. 25th, haem. from ext. artic. art., 1 qt. Died Dec. 26,1864. Died October 27, 1862; pysemia. Spec. 467. May 30th, haem.; rec. June3,5,8, 12; lig. pop. artery; haem. June 16. Died June 17,'64; pyaemia. Lig. sloug.; haem.; attempt to lig.; tetanic symp. Died Sept. 7, '62. Typhoid symptoms. Died March 3, 1865; pyaemia. Bone removed. Died May 15, 1864. Died October 13, 1862. Sloughing. Died June 9, 1864; pyaemia; autopsy. U. S. San. Com. Mems., Surg.Vol. I, p. 372. lione protruded. Died July 19, 1864. Died June 15, 1862. Slough.; cond. pro. Died Apr. 22, '65; pyas. BRINTON (J.H.), Am. Jour. Med. i'ci.,'68,Vol.55,p.321. Thigh inflam.; disch. from end of stump. Died Aug. 18,'64 ;asthe. Slough. June 16, hsem.: 18th, lig. fem. art. Died June 18,'64 ; col. Died June 4, 1864; effects of wounds. Died June 17, 1864. (Table XXXII. No. 1745. p. 265.) Stump swollen and bulbous,thigh honey-comb, by small abscesses; chronic diaiTh. Died April 26, 1863: exhaustion. Spec. 1240. Slough. Aug. 15th, haem.; Apr. 14, 1865, amp. thigh, mid. third. Died July 3,'65: gang. (TABLE XXXIX, No. 157, p. 316.) Died September 7, 1864; exhaus- tion. Died December 26, 1864. Died June 27, 1864; exhaustion. Died June 12, 1864. May 20th, haem., 4 oz.; haemorrh. recurred; flaps opened, sloughy tissue removed; end of bone necrosed. Died May 27, 1864 ; pyiemia. Abscess : diarrhoea. Died Aug. 15, 1864; exhaustion. 404 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X NO. ""'"" 106 107 108 Name. Military ' ^P1 Description, and Ace. iNn7KY Nature of Injury. Shot fracture of leg.......... Shot wound of leg............ Conoidal ball fractureof patella and head of tibia. Date of Opera-tion. Dec. 13, 1862. Oct. 8, 1862. May 13, 1864. Operation and Operator. Result and Remarks. Westacott. It., Pt., V, 19th Dec. 13. Massachusetts. i 1862. Wood, W. ]!.. Serg't, I, 16th \ Oct. 8, Tennessee. j 1862. Baker, J. S., Pt., D, 25th-May 12, Virginia. i 18-64. Amputation at knee joint......| Died December 30, 1862. Amputation at knee joint......j Died November 14, '62 ; typhoid fever. Large posterior flap, by Surg. May 15th, transferred to private C. B. Gibson, C. S. A. quarters. Intermediary Amputations at the Knee Joint. — Fifty-one intermediary operations gave a fatality of 68.0 per cent., only sixteen of the fifty determined cases having a suc- cessful issue. Three patients submitted to re-amputation in the thigh; one survived and two succumbed. Recoveries after Intermediary Amputation at the Knee Joint.—Of the sixteen cases of this group three were Confederate and thirteen Union soldiers. The latter are all pen- sioners, and were living in August, 1880. In one instance primary amputation in the upper third of tlie leg had preceded the exarticulation at the knee, and in a second case hsemorrhage to the amount of sixteen ounces occurred from the popliteal artery seven days after the amputation. The bleeding vessel was ligated, but hsemorrhage recurring three days later, the femoral was successfully ligated: Case 6 Hi.— Private D. Meikle, Co. B, llth Massachusetts, aged 20 years, was wounded at Bull Run, August 30, 1862, and admitted to Fairfax .Seminary Hospital nine days afterwards. Surgeon D. P. Smith, U. S. V., reported: "The case was one of gunshot wound of left knee joint, and the sequence of the injury was an amputation at the knee joint, performed by lateral flaps, on September 23th. Secondary hsemorrhage to the amount of sixteen ounces occurred on October 4th from the popliteal artery, when the stump was opened, the vessel dissected up for about two inches, and again tied. Three days afterwards haem- orrhage recurred ; the stump was again reopened and the artery dissected up into Hunter's canal, where, becoming the femoral, it was then ligated. Ko furjher bleeding took place, and the patient recovered with a beautifully firm and broad stump." The patient was discharged from service December 16,1862, and pensioned. He was paid March 4, 1880. The stump was described to be in good condition in the pensioner's application for commutation. Case 647.—Private J. M. McGee, Co. E, 119th Pennsylvania, age 19 years, was wounded at the Wilderness, May 5, 1864. Surgeon E. B. P. Kelly, 95th Pennsylvania, recorded his admission to the field hospital of the 1st division, Sixtli Corps, with " shot wound of right knee by a conical ball.'' Surgeon E. Bentley, U. S. V., who operated in the case, made the following report: " The patient entered Third Division Hospital, Alexandria, three weeks after receiving a wound of the right knee joint, the ball passing beneath the patella. The bones were not much fractured, but the joint was swollen and painful and the leg oedematous. Circular amputation at the knee joint, by skin flaps, was performed on June 2d, sulphuric ether being employed as the anaesthetic. At the time of the operation the patient had become very weak, his pulse quick and feeble, and he perspired considerably, had cough and spat np blood. He reacted very well. Tonics, stimulants, and nourishing diet were given, and simple dressings used. The wound healed up kindly, and the patient's general condition became much improved." The patient was subsequently treated at various hospitals, and finally, after being provided with an artificial leg, he was discharged Septem- ber 9, 1865, and pensioned. Examining Surgeon E. A. Smith, of Philadelphia, certified to "amputation at the knee joint, with preservation of the patella." The pensioner was paid March 4, 1880. In his application for commutation he represented the stump of the amputated limb as being in a "sound" condition. Cask 648.—Private W. II. Thomas, Co. A, 17th Infantry, aged 19 years, was wounded at Bull Kun, August 29, 1862, receiving a shot fracture of the upper third of the right leg. Assistant Surgeon B. Howard, U. S. A., reported that he ampu- tated the leg on the field, on September 1st, at the knee joint, including the removal of the patella in the operation, which was performed by the double flap method. Several days after the date of the injury the wounded man was removed to Washington and admitted to Ascension Hospital, whence Surgeon J. C. Dorr, U. S. V., described his case as follows: "After his admission, the sutures were found upon examination to have given away and the flaps were gaping. The patient had been much exhausted by long marching prior to the battle, and it was feared that he would not survive the effects of the operation. Stimulants, beef tea, and quinine were freely given, and finally, after repeated relapses, he has now (December 3d) nearly recovered, the stump being covered with fine granulations, and his strength having recuperated to its normal standard." The patient subsequently passed through Carver and St. Elizabeth Hospitals, and on June 16, 1863, he was discharged, having been previously furnished witli an artificial leg. He afterwards entered the Veteran Reserve Corps, and was ultimately discharged from service April 5, 18 il. and pensioned. He was paid March 4, 1880. In his application for commutation he reported the stump as being in a good condition. Fatal Cases of Intermediary Amputation at the Knee Joint.—The thirty-four opera- tions wore performed on three Confederate and thirty-one Union soldiers. Primary excision of three inches of the fibula, and primary amputation of the leg at the upper third, had SECT. IV.] INTERMEDIARY AMPUTATIONS AT THE KNEE JOINT. 405 preceded the exarticulation at the knee in one instance each. Death was ascribed to pysemia in eleven, to hsemorrhage in two, to gangrene in six, and to exhaustion in eight instances. Autopsies were recorded in tour cases, and of nine cases specimens are preserved in the Army Medical Museum. Case 649.—Private M. B. Aseltyne, Co. F, 10th Vermont, aged 22 years, was wounded in the left foot, at Mine Run, November 27, 1803, and entered the Third Division Hospital, Alexandria, one week afterwards. Acting Assistant Surgeon A. P. Crafts reported: "A conical ball entered the anterior surface of the foot, fractured the cuneiform bones, and was extracted through the orifice of entrance, on the field. At the time of the patient's admission there was much tumefaction and inflamma- tion of the foot and leg, which at first seemed to yield to treatment. But, on December 10th, evidences of gangrene began to show themselves, and four days afterwards the leg was amputated at the knee joint by ISurgeon E. Bentley, U. S. V. The operation was performed by the circular method, and by retaining Ihe patella after disarticulating the joint. Chloroform constituted the anaesthetic. Simple dressings were used to the stump, and tonics and stimulants, including iron and quinine, and acetate of ammonia were given in the treatment. On December 20th, there were symptoms of pysemia. The patient's countenance became sallow and anxious, a severe chill occurred, and hiccough set in, followed by loss of appetite and by profuse sweating. Death supervened on December 27, 18(>Y At the post-mortem examination the liver, kidneys, spleen, and intestines were found healthy, the lungs much discolored, and some effusion in the cavity of the chest. There was also great hypertrophy of the heart and some effusion within the pericardium." A section of the stump, made by Surgeon J. H. Brinton, U. S. V., showed the femur to be healthy, although denuded of periosteum for six inches above tbe joint. The synovial membrane on the crucial ligament was congested, and the cartilage of the femur was thinned and softened, the whole color being changed and absorption commencing. The ligature of the popliteal artery had partially sloughed, and the base of the long internal clot had come down and projected through the opening made by sloughing in the walls of the vessel. The artery, showing its condition as described, was con- tributed to the Museum by the operator. A wet preparation of it constitutes specimen liX-O of the Surgical Section, and a chromo-lithographic representation is shown on Plate XXII, opposite page 736 of the Second Surgical Volume. Case 650.—Corporal A. A. Lepper, Co. L, 8th Iowa Cavalry, aged 27 years, was wounded in the left leg, at the battle of Cassville, May 20, 1864. He was admitted to hospital at Chattanooga on the following day, and ten days afterwards he was transferred to hospital No. 8. Nashville, whence ActiDg Assistant tSurgeon R. T. Higgins made the following report: "The injury consisted of a compound fracture of the tibia at the upper third. The day after admission the leg was placed in a box splint and kept there until, finding that the limb could not be saved, amputation or excision was determined upon; the foot having become considerably swollen and slightly oedematous, and the wound discharging ichorous pus. On June 8th and 10th, the patient also had severe chills, each attack lasting from twenty minutes to half an hour; pulse feeble and frequent; appetite wanting. Upon a thorough examination of the parts, amputation was decided to be the more advisable operation, and was per- formed at the knee joint, on June 13th, by Surgeon li. R. Taylor, U. S. V., in charge of the hospital. Rectangular flaps were made, with circular section of muscles, and the condyles of the femur were taken off in the operation, chloroform being employed as the anaesthetic. Two ounces of whiskey and forty drops of laudanum were administered at once after the operation, and mustard plasters were applied to the ankle and wrists. The patient reacted slowly. Milk punch and beef tea were given alternately every twenty minutes in half-ounce doses. On the following day he was troubled with colliquative diarrhoea and involuntary discharges and began to sink rapidly. There was also another chill, but not so severe as the previous ones, and on the second day the upper flap was found to be sloughing, dark in color, and gangrenous. Stimulants and nourishments were continued freely. Death occurred on June 16, 1864. At the post-mortem examination the lungs were found to be engorged and slightly hepatized and the intestinal canal slightly inflamed, the other organs being normal. The clot found in the femoral vein was slightly adherent and the internal coat of the vein very much inflamed. . The cause of death was thought to be pyaemia." The upper half of the tibia of the amputated leg, a large fragment of it being partly necrosed and remaining in position, was contributed to the Museum by Assistant Surgeon C. C. Byrne, U. S. A., and is specimen numbered 3758 of the Surgical Section. Table LVI. Summary of Fifty-one Cases of Intermediary Amputations at the Knee Joint for Shot Fraeturi [Recoveries, 1—16; Deaths, 17—50; Unknown result, 51.] Name, Military Description, and Age. Butler, T. J., I.ieut., A, 38th Virginia, age 28. Clark, O. H., Serg't, H, 1st Mass. Cav., age 30. Desmond, H., Pt., I, 28th Mass., age 29. 4 Frame, J. M. F., Pt., B, 4th Virginia, age 33. Hawley, I,. M., Serg't, I, 71st New York, age 21. Lassiter, V. M., Pt.. E, 32d Texas, age 17. July 3, 1863 Nov. 27, 1863. Dec. 13, 1862. Sept. 19, 1864. Julv 2, 1663. May 20, 1864. Nature of Injury. Fracture of upper third of left leg by conoidal ball. Pistol ball wound of left knee joint. fracture of head of right tibia and patella; conoidal ball. fracture and extensive com- minution of right tibia 3 ins. below knee joint. Shot fracture of both bones of left leg in lower third. Conoidal ball fracture of both bones of right leg in middle third. Opera- tion. July 19, 1863. Dec. 2, 1863. Dec. 21, 1862. Sept. 22, 1864. July 5, 1863. June 5, 1864. Operation and Operator. Amputation at knee joint, by A. A. Surg. L. Fisher. Flap amputation at the knee joint. Amputation at the knee joint. Circular amputation, patella retained, by Assistant Surg. G. M. Uurdette, P. A. C. S. Flap amputation, by Surg. F. Prentice, 73d New York. Amputation through condyles, removing patella; long ant. short post, flaps. Result and Remarks. To prison April 23, 1864; after- wards exchanged. Discharged Oct. 4,1864. Stump tender. Secondary amp. lower third of thigh. Disch'd Dec. 29, 1863. (Table XL, No. 25, p. 320.) Stump sloughed; typhoid fever. Released June 28, 1865. Sept. 24th, entirely healed. Dis- charged April 19, 1865. Post, flap slough.; June 10, hsem.; stump cicat'd; recovery. C. S. Med.andSurg.Jour.,Mol.2, p.28. 40(^ INJURIES OF THE LOWER EXTREMITIES [CHAP. X Name, Military DESCRIPTION, and AcE. Date of Injury. nature of Injury. . Date I OF Opera- tion. Operation and Operator. 7 McCaigue. S. B., Corp'l. H. I ] 183d l'enn., age 21. 8 McGee. J., Pt., K. 119th Pennsylvania, age 11*. 9 Meiklc. D., Pt., 11, llth Massachusetts, age 20. 10 Nolan. P., Pt., G, 13th Mass.. | age 21. 11 | Palmer. E., Pt., 6th Maine Battery, nge 19. 36 37 Pittman. W., Pt., G. 148th Penn., age 23. Shambaugh, C, Corp'l, 11. llth Penn. Res., age 24. Sheppard, P., Pt.. C, 34th New York, age 25. Thomas, \V. U.. Pt.. A, 17th Infantry, age 19. Wright, O., Pt., B, l£th Penn. Res., age 20. Aseltyne, M. 13., Pt., F, 10th Vermont, age 24. Bailey, W. H.. Pt.. A, 2d New York Cav., age 23. Blancheau, P., Pt., I, 28th Massachusetts, age 22. Britton, M , Corp'l. F, 7th Penn. Res., age 21. Carroll, F., Pt., K, 45th Pennsylvania, age 23. Danzenbaker, L. H., l't., 1), 10th New Jersev, age 21. Kno, C, Pt., Ii.' 91st Ohio, age 23. Farley, A., l't., I. 83d New York, age 51. Fuller, C. E., Pt.. D. 36th Wisconsin, age 2."i. Glazier. J. M., Pt.. II. 55th New York, age 27. Headley, S. G., Pt.. F, 12tli New Jersey, age 34. Henncssy. D., Pt., I. Sth Alabama. Hicks, W.. Serg't. B. 14th Tennessee, age 28. Mav 12, 1864. May 5, 1864. Aug. 30, 1862. Aug. 29, 1862. Aug. 9, 1862. May 9, 1864. Aug. 29, 1862. May 31, 1862. Aug. 29, 1862. Dec. 11, 1862. Nov. 27, 1863. June 9, 1863. June 4, 1864. Dec. 13, 1862. June 3, 1864. June 2, 1864. July 20, 1864. Mav 9, 1864. June 3, 1864. Shell fracture of bones of left May 27, leg; primary amputation up- 1864. per third; sloughing. Conoid.ball passedben'thpatel. June 2, r't knee, bones not much fract. j 1864. Shot wound of left knee joint. Sept. 28, 1862. Musket ball fracture of right Sept. 3, tibia and fibula. 1862. Shell fracture of right tarsus, Aug. 14, metatarsus, and tibia. j 1862. i Shell, carrying away external j May 16, of malleolus of right ankle. Musket ball fracture of both bones of left legin upperthird. Shot fracture of right leg 30 ! Hoscid, A.,Pt.. I, 4th Mary- land, age 27. 31 Jarrll, W., Pt., D, 59th Georgia. 32 i Lepper. A. A.. Corp'l, L, Sth Iowa Cavalry, age 27. 33 McConnell, D. W.. Pt., H, 46th Ohio. McFarland, A., Pt.. 1, 150th Penn., age 23. McKenna, J., Pt., I), 39th New Jersey, age 29. Mansfield, M.. Corp'l, V, 2d Connecticut H'vv Artillerv, age 21. Marys, D., Pt., C,90th Penn- sylvania. Mav 10, 18*64. Mav 5, 1862. Julvl, 1863. May 7, 1864. Mav 10, 1864. May 20. 1864. April 6, 1862. Mav 10, 1864. April 2, 1865. Mav 31, 1864. Mav 5, 1864. Conoidal ball fracture of right tibia and fibula 3 ins. below joint. Musket ball wound of right 1 leg, involving knee joint. Conoidal ball fracture of cunei form bones left foot: inflam- mation of foot and leg. Shot fracture of right leg...... Fracture of exter. condyle and slight fract. of inter, condyle of right femur. Musket ball fracture of cuboid and astragalus of right foot. Shot injury of right fibula; primary excision. Grapeshot struck inner condyle of femur; joint opened. Musket ball fract. right tibia; leg swollen and ecchymosed. Shot fract. inter, malleolus of r't ankle j't; tissues oedematous, pus extend, nearly to knee j't. Conoidal ball tract, of os-calcis ; left foot and leg in very bad condition. Wounds through both ankles ; comminution left; fract. right; swollen and sloughing. Conoidal ball commin. fract. of up. third of right tib. and fib.; j't swollen and erysipelatous. Shot fract. up. third left tibia; knee joint opened by fissures. Left tibia seriously injured and partly fractured; sloughing; hsem. from post, tibial artery. Conoidal ball fraot. of malleo- May 15, lus and astragalus; left foot 1864. and ankle much swollen. Conoidal ball fracture of ineta- May 22. tarsal bones. ]fc(>4. Comminuted fract. up. third of , June 13, left tibia by con. ball; foot 1864. swollen and oedematous. Shot fracture of the leg ......April 10, 1862. 1864. Sept. 4, 1862. June 5, 1862. Sept. 1, 1862. Dec. 14, 1862. Dec. 14, 1863. June 18. 1863. June 8, 1864. Dec. 26, 1862. June 18, 1864. June 7, 1864. July 31. 1864. Mav 15, 18*64. June 9, 1864. June 4, 1862. Mav 18, 18*64. Mav 17, 1862. July 25, 1863. 38 Mearns, J., Pt., D, 154th N. May 4, York, age 22. 1863. 39 | Murray, J., Pt., B, 51st N. May 6, York. 40 i Ostre, P., Pt., H, 72d New York, age 21. 41 | Parks, L. C, Pt., E, llth Vermont, age 28. 1864. Mav 10, 18*64. June 1, 1864. Ball lodging in articulation be- May 27, side right external malleolus; 1864. tissues oedematous. Conoidal ball wound of left April 24 ankle; infiltration of pus in tissues of leg. Shot fracture of right tibia, ex- tending into knee joint. Shot wound of right leg; parts gangrenous. Shot wound of leg......... Shot wound of right ankle. Conoidal ball fracture of tibia, ankle joint opened; leg swol- len to knee. Ball lodged in condyle of left femur, splitting it into knee joint. 1865. June 4, 1864. Mav 10, 18*64. May 14, 1863. May 18, 18*64. Mav 21, 1864. June 7, 1864. Amputation, l>v Ass't Surg. A. Delaney, U. S. A'. Circular skin flaps, by Surg. E. Bentley, U. S. V. Lateral flaps, by Surg. D. P. Smith, U. S. V." Markoe's operation; patella re- tained ; condyles sawn off, by Surg. E. Donnelly, 2d Pa. It. Anterior operation; articular surfaces of condyles sawn off, leaving patella, by Surg. E. Bentley, U. S. V. Poste. muscular flap, by Surg. E. Bentley. I'. S. V. Single upper flap, patella not removed, by Ass't Surg. B. Howard. I'. S. A. Circular amputation at knee joint. Double flap 2J ins. long, rem'g patella and art. surfaces, by A. Surg. B. Howard,!'. S.A. Flap amputation, by a Confed- erate surgeon. Circular amp., leaving patella, by Surg. E. Bentley, U. S. V. Amputation at the knee joint. Skin flap, 1 inch of condyle, in- cluding fract. portion, rem'd, by A.Surg.S.B.Ward.U.S.V. Circular, by Surg. E. Bentley, U.S.V. Ant.-post. flap, rem'gpatella.by Surg. R. B. Bontecou, U. S.V*. Circular amp., skin flaps, by Surg. E. Bentley, U. S.V. Antero-posterior flap, by Surg. J. B. Lewis, V- S.V. Circular bv skin flaps, by Surg. K. Bentley, U. S. V. Skin flap, £ inch of condyle removed, by Ass't Surg. S. B. Ward. U. S. V. Antero-post. flap at left knee joint, by Surg. R.B.Bontecou. V. S. V. Flap amputation, by A. A. Surg. W. H. Ensign. Amputation at knee joint, by A. Surg. J.S.Billings, U.S.A. Long ant. flap, leaving patella and condyles, by A. A. Surg. J. A. Draper. Ant. post. flap, retaining pa- tella and condyles, by Ass't Surg. H. Allen, U. S. A. Long post, flap, by Surg. C. B. Gibson, C. S. A. Rectangular flaps; circ. sect. muscles; condyles sawn off, by Surg.It. It. Taylor,U.S.V. Amputation, by Ass't Surg. W. D. Turner, 1st Illinois Light Artillery. Anterior oval skin flap, by Surg. E. Bentley, U. S. V. Circular amputation at knee joint, by Surg. E. Bentley, U. S. V. Post, flap; ant. incision from condyle over mid. of patella, and condyles sawn off, by A. A. Surg. J. F. Thompson. Amputation at knee joint, by Surg. J. Ebersole, 19th lnd. Amputation at the knee joint. Amputation at the knee joint. Long anterior, short post, flap, leaving patella, byAss't Surg. G. A. Mursick, U. S. V. Ant. skin and post. muse, flaps; £ inch of condyles of femur removed, by Surg. E. Bent- ley, U. S. V. Result and Remarks. Mustered out July 13,1865. lie has caries of right tibia. Stump tender. Discharged September 9, 1865. Oct. 4, haem.; lig. of popliteal; 7th, haem.; lig. fem. Dis. Dec. 16,'62. Patella raised 4 inches. Disch'd August 29, 1863. Discharged Oct. 23. 1862. Spec. 53. BRINTON (J.H.), Am. Jour. Med. Sci., 1868, Vol. 55, p. 322. Disch'd June 22,'65. 1870, stump sound. Stump healed; patella movable 4 ins. up the limb. Discharged May 22, 1863. Discharged April 2, 1863. Can- not wear artificial limb. Sutures gave way; flaps gaped. Disch'd April 5, 1864. Stump good, 1870. Discharged January 19, 1863. Died Dec. 27, 1863; pyaemia. Autopsy. Spec. 1989. Sloughing; haemorrhage, 20 oz. Died June 29, 1863. June 12th, gang.; 14th, haem. Died June 16th, '64; gangrene and haemorrhage. Spec. 2656. Jan. 7,'63, haem.; lig. fem.; gang. Died Jan. 12,1863. Spec. 4541. Haem. from ant. tibial ait. Died June 22. 1864 : exhaustion. Died June 12, 1864 ; gangrene. Diarrhoea. Died August 9,1861. Died June 1, '64 : pyaemia. Spec. 2655. Gangrene. Died June 13, 1864; pyaemia. Spec. 2660. (Ampu- tation was a last resort.) Died June 10,1862; pyaemia. Tendency to slough. Died Mav 30, 1864. Died August 27. 1862. Spec. 929. Slough. Died Aug. ]().'63 ; o.xh. Spec. 2051. Brinton (J. H.). Am. Jour. Med. Sci., 1868. Vol. 55, p. 324. Slough. Died May 28.'64 ; gang.; absorption. Am.Jour.Med.Sci.. 1865, XLIX. p. 33. Mav 24th, delirium. Died Mav 29. 1864. Slough.; gang.; colliquativediar. Died June 16, 1864; pvaemia. Spec. 3758. Slough.; intermed. amp. thigh. Died April 25, 1862. (Taiilk XXXVI, No. 481, p. 300.) May 29th, gang., which caused death June 7, 1864. Died May 2, 1865; exhaustion. Died June 16, 1864 ; pyaemia. Popliteal sloughed; haem.. 50 oz. Mav 20th, amp. thigh. Died Mav 20.'64. Spec. 2340. (Taisle XXXVI. No. 475, p. 300.) Died June 7, 1863; haemorrhage and anaemia. Died May 20, 1861. Died June 1. '61; pyaemia. U. S. San. Com. Mcms., Surg. Vol. 1, p. 522. June 10th. gangrene. Died June 17, 1864; prostration. SECT. IV.] SECONDARY AMPUTATIONS AT THE KNEE JOINT. 407 Name, Military Description, axd Ac;e. Rhinchart, ('.. Pt.. K, 74th Pennsylvania, age 21. Sandford, W. W.. Pt., F, 103d Pennsylvania, age 21. Schroiber, A.. Pt., A. 50th Pennsylvania, nge 17. Sheldon. C. S., Serg't, G. 12th New Hampshire, age 21. Sweeney, J., Pt., H, 9th Maine. Unknown, age about 35..... Veazie. C. II.. Pt., C, 1st Mass. Cavalry, age 21. Velsor, A., Pt., D, 127th N. York, age 36. Wilhelm. J., Pt., A, 37th Ohio. Chandler, A. J., Lieut., G. 40th Georgia, age 25. Aug. 27 1862. Dec. 18, 1862. Mav 10, 1864. June 3, 1864. July 18, 1863. Nov. 27 1863. Nov. 30. 1864. Mav 17 18*62. May 26, 1864. Nature of Injury. Shot wound of leg; primary amputation up. third : slough- ing. Ball passed between bones of right leg 3 ins. below knee joint; tibia indented ; pus in synovial cavity. Wound of both logs ; fracture of right tibia; round ball; 19th. hsem.; lig. post. lib. art. Grapeshot fract. left ext. malle- olus, communicating with an- kle joint; gangrenous. Right leg shattered by a grape- shot. Shot fracture of head of tibia, extending into knee joint. Tract, and exteusive comminu- tion of r't tibia and fibula near ankle j't; much ecchymosed. Ball thro, head of tibia, fract. tibia and fibula; knee joint involved. Musket ball fracturing both bones of left leg in middle; sloughing. Fracture of right tibia, middle third; conoidal ball; large ulcer in leg. Opera- tion. Sept, 21 1862. Jan. 10, 1863. Mav 19, 1864. June 22, 1864. July 27, 1863. Some days af- ter inju- ry. 1 )cc. 6, 1863. 9, May 31, 18*64. June 21 1864. Operation and Operator. Circular amputation at knee joint, by Surg. E. Bentley, U. S. V. Antero-posterior flaps; condyles were sawn off and patella re- moved, by Surg. E. P. Mo- rony 2d Maryland. Antero-posterior flap, remov'g patella, by Surg. It. B. Bonte- cou, H. S. V. Anterior post, flap, bv Surg. It. 11. I'.ontecou, U.S.V. Posterior flap amputation at the knee joint. Disarticulation at knee joint, leaving patella; sawing off tips of condyles, by Ass't Surg. C. C. Lee. U. S. A. Antero-posterior flap through knee joint, by Surg. E. Bent ley, il. S. V. Anteroposterior skin flaps, by Ass't Surgeon C. P. Reber, U. S. V. Amputation at the knee joint, bv Surg. J. F. Gabriel, llth Ohio. Amputation at knee joint thro' condyle/, leaving patella. Result and Remark.6. Died September 23, 1862; gan- grene. Jan. llth, chill and dyspnoea. Died Jan. 12, 1863; pyaemia. June 1st, pyajmic symp. Died June 9, 1864 ; pyaemia. Progress unfavorable. Died June 27, 1864; exhaustion. Died July 28, 1863. Died about three days after oper- ation; exhaus.: pyaemie symp. Brinton (J. H.), Am. Jour. Med. Sci., 1868, Vol. 55, p. 324. Dec. 10th, gangrene. Died Dec. 21. 1863; pysemia; autopsy. Died Dec. 22,1864; pyaemia. Diffused abscess extending to hip. Died June 14, 1862. June 30, '64, sloughing of stump. C. S. Med. and Surg. Jour., Vol. 2, p. 33. Secondary Amputations at the Knee Joint.—The secondary exarticulations at the knee joint numbered twenty-six; twelve were successful and fourteen were fatal, a mortal- ity of 53.8 per cent. In four cases excision in bones of the leg, in four amputation of the leg, and in one amputation of a toe, had preceded the amputation at the knee. Successful Cases of Secondary Amputation at the Knee Joint.—-The patients were ten Union and two Confederate soldiers. Two of the ten Union soldiers have since died; the remaining eight were pensioners in 1880. In the following instance primary amputation in the middle third of the leg had been performed for shot fracture of the ankle joint. Sloughing and ulceration followed, and the limb was exarticulated at the knee fourteen months after the ablation of the leg: Case 651.—Private W. Nevelhig, Co. N, ?lst Pennsylvania, aged 26 years, was wounded at White Oak Swamp. June 30, 1682. and was admitted to Broad and Cherry Streets Hospital, Philadelphia, one month afterwards. Surgeon J. Neill, U. S. V., reported : "The injury was produced by a rninid ball, which entered the outer side of the right ankle joint and passed directly through, severely comminuting the bones. Amputation of the leg at the middle third was performed the same day on the field, the operation being performed by the double flap method. The wounded man was taken prisoner and remained on the field for ten days, when he was sent to K'icli- mond. After being paroled he was brought to this hospital, entering on July 30th, at which time the flaps had sloughed and both bones were protruding from the stump. There was also profuse discharge of unhealthy pus, and the patient's health was very much broken down. Stimulating poultices were applied, and the patient was ordered extra diet, with tonics, milk punch, and beef tea. Under the treat- ment adopted new tissue developed in the stump and the patient improved; but his recovery was neces- sarily slow. On November 13th, a piece of necrosed bone, four inches in length, was removed from the fibula, and three days later a large piece was removed from the tibia. After this the stump improved rapidly and the patient's general condition continued very good until March 15, 1833, when he injured the stump by a fall. Immediately after, sloughing recommenced, which was not checked until a month had elapsed and produced a condition of the parts from which recovery was slow. Under the application of fermenting poultices, with solution of chloride of zinc and sulphate of copper used alternately, the ulcer slowly diminished. On June 22d, when the patient was transferred to Satterlee Hospital, the lower end of the stump appeared to be made up of a carneo-osseous matter, on the extremity of which there remained an ulcer about two inches in diameter." Acting Assistant Surgeon T. G. Morton reported the subsequent progress of the case at Satterlee Hospital as follows: "At the time of admission the stump was still unhealed, and from the end of the bone a bulky exostosis sprang out as large as an orange. The tissue over this growth was constantly ulcerating and painful, and the disease continued to involve the tibia further up, reaching as high as the liga- mentous patella. On August 27th, I proposed amputation at the knee joint for the reason that less shock follows that operation and a better stump is obtained, with more power, from non-division of the muscles of the thigh and non-interference with the medullary canal, lessening the danger of pyaemia. I made a long anterior and short posterior flap, leaving the patella in. FIG. 251.—Hyperostosis of bones of right leg. after amputation. Spec. ^776. 408 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No necrosis followed tbe operation, and the patient recovered with a most useful and firm stump." The patient was discharged from service March 3, 1864, and pensioned. He was paid December 4, 1879. The specimen, numbered 2778 of the Surgical Section, is represented in tbe annexed cut (FlG. 251), and forwarded to the Museum by the operator, shows an extraordinary osseous formation at the divided extremities of tbe tibia and fibula, due to an exaggeration of the natural process by which the extremities of the bones are rounded off, and presents the histological characters of ordinary callus. The sequestrum, removed from tbe fibula prior to the second amputation, was also contributed by Surgeon Neill, and a cast of the stump of tbe disartic- ulated knee was furnished by Surgeon I. I. Hayes, U. S. V. The former is numbered specimen 668, and the latter 2458 of the Surgical Section.1 Cask 652.—Corporal E. C. Wright, Co. H, 21st New Jersey, aged 19 years, was wounded at Fredericksburg, May 3, 1S63. by a solid shot, which carried off his right foot. Amputation of the leg by posterior flap, at the junction of the middle and lower third, was performed on the field by Surgeon D. McNeill, 21st New Jersey, and several days afterwards the patient was sent to Washington, where he entered Judiciary Square Hospital. He was discharged from service June 13, 1863, and pen- sioned. Subsequently the stump became diseased, inducing tbe pensioner, in January following, to seek relief by treatment at St. Luke's Hospital, New York City. The tibia became necrosed and cloaca formed, leading to sinuses in the substance of the bone, so that an injection would find its way through the canals. On June 23, 1864, amputation through the knee joint by antero-posterior flaps was performed by Dr. Gurdon Buck, tbe cartilages and patella being allowed to remain. Sulphuric ether was used as tbe anaesthetic. At the time of the operation the patient was in feeble condition, owing not only to the amount of pus discharged from the stump, but also to the presence of an abscess in the region of the liver, which had formed some months after the first amputation. This abscess discharged itself by a track passing between the ribs over the right lobe of the liver. There had been no admixture of bile, however, in the discharge, nor did jaundice exist at any time. A succession of abscesses formed during the healing of the stump. The first appeared at the upper boundary of the synovial sac and was freely laid open by Dr. Buck. Six days after tbe operation a tendency to slough appeared, and permanganate of potash was applied to the affected parts. Dr. Buck's method of extension by weight and pulley, with bands of* adhesive plaster, was also used to prevent the retraction of tbe edges of the flaps and maintain them in apposition. This afforded great relief to the patient, steadying the limb and taking all the strain off the flaps. On September 1, 1864, the patient was discharged from hospital, the stump being solid and well rounded. The abscess in the side had ceased to discharge. In tbe following month the pensioner was fitted with an artificial leg by Dr. E. D. Hudson, of New York City. Pension Examining Surgeons who have inspected the stump have described it as a "very good" one, and tbe pensioner has reported its condition as ''sound and healthy." He was paid March 4, 1880. Case 6!"-3.—Private H. A. Steward, Co. B, 8th Pennsylvania Reserves, aged 23 years, received a fracture of the right leg by a fragment of a shell, at Gaines's Mill, June 27, 1862. He was conveyed to "Washington, where he remained under treatment at the Cliffburn Hospital until November 20,1862, when he was discharged and pensioned, Surgeon H. Bryant,U. S. V., certifying to "exsection of a large portion of tbe tibia in consequence of tbe wound." Examiner George McCook, of Pittsburg, December 17, 1863, testified to the injury, and that "exfoliation is going on in a slight degree. He can walk inconveniently," etc. The pensioner subsequently entered the Good Samaritan Hospital, Cincinnati, where tbe injured limb was amputated on April 1, ls(i7, by Dr. Thomas H. Kearney, who certified as follows: "I amputated the leg through tbe knee joint, the section of the bone being performed through the condyles of the femur. The amputation was rendered necessary in consequence of inflam- mation of the tibia, leading to abscesses and general infiltration of the tissues. Removal of tbe condyles was necessitated in consequence of tbe want of sufficient healthy integument to cover them. The wound he had received involving the tibia, doubt- less left it impaired in vitality and prone to attacks of inflammation, such as rendered its removal ultimately necessary." The Quincy Examining Board, in 1872, reported that "the flaps have sloughed from gangrene, leaving the bone only covered with tender cicatricial tissue, which often gives away and becomes an open ulcer," etc. The pensioner was paid March 4, 1880. Fatal Cases of Secondary Amputation at the Knee Joint.—Fourteen operations were performed, three on Confederate and eleven on Union soldiers. The fatal results were attributed to pysemia in three, to erysipelas in one, to exhaustion in eight instances: Case 654.—Private P. Fallon, Co. D, llth Infantry, aged 20 years, was wounded in the left leg, at Gaines's Mill, June 27, 1S6"2. He was captured by the enemy aud remained a prisoner for one month, when he was exchanged and conveyed by the Hospital Steamer Daniel Webster to Philadelphia. Acting Assistant Surgeon R. R. Thomas recorded the following description of the case: "The patient entered tbe Episcopal Church Hospital July 30th, there being an irregular cavity in the front of bis injured leg, running into the tibia but not reaching the fibula. He had been wounded by a bullet, which entered about nine inches above the iuter-malleolar space, and was extracted, in part, two days after his admission. The opening in the leg was about one and a half inches square and about one inch deep, its sides being formed by necrosed bone and injured flesh. Pieces of bone had been taken out on previous days, and the patient was doing well. On August 6th, Acting Assistant Surgeon R. S. Kenderdine amputated the leg at tbe knee joint. On August 22d, secondary hsemorrhage occurred from ulceration and resulted in considerable loss of blood, tbe patient being found quite blanched. A tourniquet was then applied and the instruments were gotten ready to tie tbe bleeding vessel; on loosening tbe tourniquet, however, the bleeding was found to be arrested and no liga- tion necessary. Tbe patient died October 6, 1862, worn out by puriform discbarges and of pyaemia. The end of the stump was in pretty good condition, but large abscesses bad formed in the tbigh, and his back was covered with bed sores." The upper half of tbe amputated tibia, with tbe integument over tbe wound of entrance, enlarged by sloughing, attached, was contributed to tbe Museum by the operator (Cat. Surg. Sect.. I860, p. 396, Spec. 500). The specimen shows an oblique fracture of the bone, with comminution, and a portion of the bullet remaining in the medullary canal. The cavity in the shaft is also exhibited, and the posterior surface of the sbaft is covered with a moderate layer of new osseous tissue. 1 A brief abstract of this case was published by Dr. John H. BRINTON, On Amputation at the Knee Joint and at the Knee, in Am. Jour. Med. Sci., \St,8. Vol. LV, p. 3i9. SECT. IV.J SECONDARY AMPUTATIONS AT THE KNEE JOINT. 409 Table LVII. Summary of Twenty-six Cases of Secondary Amputation at the Knee Joint for Shot Fracture. [Recoveries, 1—12; Deaths, 13—26.1 Name, Military description, and agk. Brady. J. W., Pt., E. 6th Aug. 29, Louisiana. 18b'.?. Brunchard, A., Pt., A, 5th April 7, New Hampshire, age 31. j 1865. 3 Frost, N. G., Pt., G, 32d July 30. Maine, age 34. 4 Marseiu, J., Pt., A, 115th Feb. 20, New York, age 28. 1864, Neveling, W., Pt., N, 71st June 30, Pennsylvania, age 26. 186; Pattee, J. H., Pt., D, 26th Sept. 19, Ohio, age 23. 1863. 7 Perigo, H. th Indiana (MOSES, loc. cit., p. 341. Case IV). also wounded at Hoover's Gap, Tennessee. June 24, 1863, and admitted to hospital at Mur- freesboro', June 27th; recovered, and was discharged September 20, 1864, witli almost complete anchylosis. He is a pensioner, and Pension Examiner G. VV. Mears reported, on September 24, 18H4 : " Ball entered inside right knee, and ranging outward and downward, escaped about two inches lower down, upon outside, passing into joint on inside and through upper part of head of tibia on outside ; . . leg weak, and a partial anchylosis exists with slight angle at the knee." In September, 1877, the Dayton Board of Examiners stated: " There is a creaking in the joint on motion being made, and par. tial anchylosis; leg is weak, and he carries a cane constantly." Granting that in the two cases cited last the articular extremities of the femur or tibia were implicated, which is by no means certain, we find that of the 8 cases treated conservatively, possibly 3, or, considering the case of Youre as unde- termined, only 2 recovered, a mortality rate of, respectively, 62.5 or 71.4 per cent. As the cases cited by Surgeon MOSES have been made a basis for the advocacy of conservative measures in shot fractures of the knee joint by DeiningKU (C.) (Ueber die conservative Behandlung der Schusswunden des Kniegelenkes, MUnchen. 1867, p. 28) and by other European surgeons, it has been deemed best to refer to the cases here somewhat in detail. 2 MOSES (1.), Surgical Notes of Cases of Gunshot Injuries occurring near Chattanooga in the Battles of September, October, and November, 1863, in American Journal Medical Science, October, 1864. Vol, XLVIII, p. 363. 114 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. dyles of the femur or head of the tibia, under the usual circumstances of bustle and con- fusion of the field, and repeated removals of wounded in ambulances to the rear." When it is considered that of three thousand three hundred and fifty-five shot injuries of the knee joint with lesion of the articulating surfaces of the bones, grouped in Table LII, on page 367, only eight hundred and sixty-eight, with three hundred and thirty-eight recoveries, were conservatively treated, and that in these eight hundred and sixty-eight cases are included one hundred and seventeen, with eighty-four recoveries, in which the synovial cavity was not primarily opened and only the patella fractured; furthermore, that with the exception of a few instances, in which amputation was refused or in which the cases came to the notice of the surgeons at a period when the proper time for amputation had passed, the cases reserved for conservative treatment were those deemed to have the best chances of a favorable result, the percentage of mortality (60.6 per cent.) must be regarded as very large, and the question naturally arises whether fewer attempts at con- servation would not have saved more lives. It has already been pointed out on page 332 that the mortality of the two thousand three hundred and ninety-nine amputations of the thigh after shot fracture of the knee joint was only 51.1 per cent. Of these two thousand three hundred and ninety-nine amputations in the thigh for shot wounds of the knee joint, one thousand five hundred and twenty-five, with six hundred and sixty-nine deaths, were primary operations, giving a mortality of 43.8 per cent., while eight hundred and thirty- nine, with five hundred and thirty-two deaths, or 63.4 per cent, fatality, were intermediary or secondary operations, performed, generally as a last resort, when it became evident that a continuance of the conservative treatment would inevitably lead to a fatal issue. Thus it will be seen that the mortality after shot fractures of the bones of the knee joint treated conservatively, even under the most favorable circumstances, exceeded the mortality after primary amputation in the thigh by 16.8 per cent. Shot fractures of the knee joint by small projectiles, in their early stages, are among the most deceptive of serious injuries. Surgeon H. S. Hewit, U. S. V., observed, in a report from Frederick Hospital, in January, 1863: "The conical wedge-like missile, pro- pelled by an irresistible force and revolving with the rapidity of a steam augur, pierces, bores, and comminutes without occasioning great displacement. The bones are broken into a great number of minute .fragments which are still held together by their capsular and ligamentous investments. The destruction is as great ab interno, as it would be ab externo by crushing between a railroad carriage wheel and the iron rail." Deluded by the seeming insignificancy of the external injury, the patient not rarely refuses to submit to amputation until the moment of hopeful operation has passed. Several cases of recovery after severe comminuted fractures of the bones of the knee joint are, it is true, recorded in the annals of surgical literature. Such examples have been cited among the cases of shot injuries adduced in Note 3, on page 368, and similar instances will be found among the cases col- lected in the appended table (Table LIX, page 417), in which it has been attempted to give a numerical summary of the cases of this nature recorded by writers on surgery; but these fortunate results only seem to indicate, as Professor von Langenbeck1 remarks: "that if amputation is refused, the surgeon must never despair of saving life." It has been shown on page 28 that of three hundred and fifty-one cases of shot wounds of the knee joint with either primary or secondary involvement of the joint capsule, but without lesion of the bony structure, ninety-eight, or 27.9 per cent., proved fatal. The 1 Lanoexbkck (B. v.), Ueber die Schussfracturen der Gelenke und ihre Behandlung, Berlin, 1868, p. 28. SECT. IV. j SHOT INJURIES OF THE KNEE JOINT. 415 attempt to .save the limb should always be made in injuries of this nature, and amputation has not been advocated by military surgeons, although Schwartz1 remarks that: "According to our experience we cannot find fault with the surgeon who, in a case of clearly defined extensive wound of the joint capsule, prefers immediate operation to generally useless attempts at conservation with subsequent secondary amputation." Stromeyer, Langen- beck, Legouest,2 and others believe simple wounds of the joint capsule, without lesion of the bonv structure, to be very rare; but the records of the American civil war, of the Franco-Prussian War of 1870-71, and of the Uusso-Turkish War of 1877 (Table LIX, page 417), furnish examples of such injuries, and the experiments of Woods,3 Simon,4 and 1 Sihwaktz (Haisalu), Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, p. 173. 2STKOMEYEK (L.) (Erfahrungen iiber Schusswunden im Jahre 186(i, Hannover, 1867, p. 57): "I will not deny that there are cases in which an opening in the knee joint made by a bullet will heal, but they must be very rare. 1 have not and do not expect to see one, because a ball which opens the joint must, as a rule, interest one of the articulating ends." Lanckmieck (I!. V.) (Ueber die Schussfracturen der Gelenke. und ihre. Behandlung, Berlin, 18iit<. p. 38): "That the knee joint can be shot through from before backwards without lesion of bone I cannot think possible. There will always be more or less deep grooving of the condyles, and I have been able to feel the grooving in two cases of recovery." Legouest (L.) (Trait' de Chirurgie d'Armee, Paris. 1872, p. 444): " On voit ecpendant quelquefois des balles atteindre et meme traverser de part en part de grandes articulations sans toucher les os. Xous avons traite, pendant la campagne d'Orient (1855), un militaire qui eut manifestement l'articulation du genou ouverte par une balle: le pro- jectile passa immediatement au-dessus de la rotule entre le tendon de cet os et les condyles du femur sans fracturer ni les uns ni les autres et sans meme determiner d'accidents serieux ; mais ce sont la de rares exceptions." 3 WOODS (J. T.) (Gunshot Knee Joint Injuries, in Ohio Med. and Surg. Jour., 1864, Vol. XVI, p. 295): " The joint is only traversed by the ball, no fracture being inflicted, or at most simply a grooving or abrasion of tho articular cartilages occurring. This idea seemed to lind confirmation in the fact that in these cases the ball uniformly passed antero-posteriorly, or laterally in certain directions at the level of the joint, thus affording the first quali- fication of this occurrence. Passing antero-posteriorly the nearly level articular surface of the tibia, the large size of the inter-condyloid notch would, especially if the knee were partially bent, render the passing of a ball, without violently impinging on bony structure, quite easy of occurrence; and similar considerations of anatomy and varied position seemed to afford a similar explanation to the harmlessness of tlie balls—cases where their course was laterally through the anterior third>of the joint. These theoretic views it was found quite easy to demonstrate upon the dead subjects; making a slit in the ligamentum patellae below the patella itself, passing in a narrow bladed knife to clear away the soft parts, and slightly flexing the leg upon the thigh. I was enabled to introduce through the joint into the popliteal space a round piece of wood one-third greater in diameter than a minie ball, and by flexing the leg to a right angle with the thigh, the space between the bones of the joint on the anterior aspect was found to he quite sufficient for the passage of a minie ball laterally, and through the tense skin the opening would be so small that when the leg was straightened it would appear to have entered immediately below the inner condyle." 4 Simon (Kriegschirurgische Mittheilungen. Zur Prognose und Behandlung der Schusswunden des Kriegelenkes, in Deutsche Klinik, 1671. B. XXIII, p. 258 et seq.) tried to "determine these questions by experimental means, and obtained surprisingly clear results. I had three round iron rods made pro- vided with very sharp points; one of the rods had the thickness of a Chassepot missile, the other that of the Prussian Langblei, and the third a yet greater thickness; and with these 1 attempted to penetrate the knee joints of dead bodies in various directions. With the limb extended it was impossible to push any one of the rods through, bone being struck everywhere. But on very little flexion, with the knee bent at 170°, the joint became so far opened that one could put the thinner rod through the intercondyloid notch with the greatest ease, and without touching the bones immediately below the lower margin of the patella through the ligamentum patellae as well as by the sides of the same (Flo. 252). The rod penetrated antero-posterior- FlG.252.—Perforation of the joint, at trifling genu-flexion ly through the middle of the FIG. 253.—The same, with greater flexion, r After Simon.] from before backwards. [After SlMON.l . . . , . . ., ,. 1 J .loint, and appeared in the popli- teal space or several centimetres above the same. When the rod was pushed in at the median line of the extremity immediately below the patella, or through the ligamentum patellae, it would also appear in the median line on the posterior aspect; but when it penetrated beside the ligamentum patellae, the rod had to be forced through the joint in a somewhat oblique direction, and its point would appear on the posterior aspect one to two centimeters distant from the median line. The rod of the calibre of the Prussian Langblei could be pushed through the joint in the same direction without injury to the bone, if the flexion of the joint was increased to an angle of 150°; and, with a still greater flexion, at an angle of 130°, the perforation could be accom- plished with ease by the third or the thickest of the rods. But in these greater flexions the point of the rod appeared in the posterior side of the thigh much higher, about 6 to 12 centimeters, above the popliteal space (FIG. 253), and these various experiments proved that the greater the flexion in which the knee was perforated the higher the exit wound came to be located. Nor could the joint be penetrated from side to side when the limb was in a straight position. But when the knee was bent to an angle of 165°, the front portions of the articular surfaces of the femur and tibia would separate sufficiently to allow the thinner rod to be pushed through the anterior third of the joint, and, SO 52.9 .0 85.7 50.0 86.6 .0 80.0 33.3 Primary. Intermediary. 35 « a Secondary. 10 22 'VERNEUIL (A.) (De la risection du genou, in Gazette Hebd. de Med. et de Chir., Paris, 1862, T. IX, No. 46, p. 722): A young man, aged 18, in the fall of 1862 received a pistol shot in the knee joint; resection, five days after injury, of the articulating ends of the bone; cicatrized in seven weeks. In a communication to the Societi de Chirurgie ( Gaz. des H6p., Paris, 1864, No. 54, p. 215), at their meeting of April 27, 1864, VERNEUIL related the case of a poacher shot through the patella in 1863; neither femur nor tibia fractured; secondary excision of condyles of femur and tibia; recovery with anchylosis in 3£ months.—2 Neudorfer (J.) (Handbuch der Kriegschirurgie und der Operationslehre, Leipzig, 1872, Zweite Halfte, Zweite Abtheilung, p. 1546, and GURLT (E.) (Die Gelenk-Resectionen nach Schussverletzungen. Ihre Geschichte, Statistik, Endresultate, Berlin, 1879, p. 278): Ferd. Blumauer, 27th Austrian Infantry Regiment, 1st Co., wounded February 6, 1864, at Oversee, by ricochet shot in the left knee. March 11, 1864, resection in hospUal at Schleswig. Death April 2, 1864. Wasil Dumma, 30th Austrian Infantry, wounded at Oversee, March 5, 1864, in the left knee joint. Wound healed rapidly in seven weeks, but broke open again and suppuration ensued. Resection March 13, 1864. Amputation of thigh April 8, 1864. Death from exhaustion April 13, 1864.—3 Prussian Staff Surgeon Lcewenhardt operated in the case of Peter Jensen Ugle, 4th Danish Infantry, aged 27, wounded at Alsen, June 29,1864; epiphysis of the right femur perforated antero-posteriorly, and external condyle shattered. July 13,1864, resection, by H-incision, in hospital at Ulderup: about 4 inches of the femur, the patella, and a slice of the tibia removed. Recovered, and living in 1874 (C. Heine, Die Schuss- verletzungen der Unteren Extremitdten, Berlin, 1866, p. 393, and Gurlt, loc. cit., p. 318).—4OCHWADT (A.) (Kriegschirurgische Erfahrungen, etc., wahrend des Krieges gegen Danemark 1864, Beriin, 1865, Anhang, Tabelle der Operationen, p. VI, No. 20, and GURLT, loc. cit, p. 319): Soren Jacobsen, 9th Danish Infantry, wounded at Diippel, April 18,1864, in the left knee; epiphysis of the femur split into three parts and joint opened; patella and tibia intact. Resection April 19,1864, in hospital at Flensburg. Only the epiphysis of the femur was removed. Death May 7, 1864.—6ESMAHCH's case of Chremers Petersen, Sth Danish Infantry, wounded at Diippel, April 18, 1864, in the right knee; joint opened; resection in hospital at Broacker, April 21, 1864, by oval incision; patella retained. Death May 1, 1864 (GURLT (E.) (loc. cit., p. 319).—6B. V. Langenbeck twice excised the knee joint in the Schleswig-Holstein campaign of 1864: Jensen, 3d Danish Infantry, wounded at Alsen, June 29, 1864, through the right joint, shattering the bone; ampu- tation was refused; subperiosteal resection, with inner longitudinal incision; patella retained, July 19, 1864. Death July 22, 1864. Stjernholm, 18th Danish Infantry, wounded at Alsen, June 29, 1864; penetrating shot wound of right knee joint. August 1st, subperiosteal resection of both carious ends of the joint. Death August 7, 1864 (GURLT, loc. cit, p. 319).—7 Neudorfer (J.) (Handbuch der Kriegschirurgie und der Operationslehre, Leipzig, 1872, Zweite Halfte, Zweite Abth., p. 1550, and Gurlt, loc. cit, p. 328): Kaspar Ruppnik, 1st Austrian-Mexican Chasseur Co., aged 41, wounded at Tlapa- coyan, November 22, 1865, in the left knee; patella shattered, joint opened on the outer side. December 28th, resection. Living in 1872, his confessor writing from Schwarzenberg that the injured extremity is entirely stiff; that he is unable to do any hard labor, but can make considerable journeys with the aid of a cane.—8Dauve (Lesions traumatiques des deux genoux par coup de feu.—Articulation du genou gauche ouverte et broyee ; resection du genou, in Rec. de Mim. de Mid. de Chir. et de Phar. Mil., Paris, 1867, T. XIX, 3me ser. p. 29): An Arab, nearly 20 years of age, was shot in both knees, on July 26, 1865, and, on the following day, was admitted into the hospital at Boghar. The upper part of the internal condyle of the right femur was frac- tured, but the capsule was not thought to be interested; two small pieces of bone were removed. The injury of the left limb was more severe. The internal condyle of the femur was crushed and the articulation largely opened. Amputation proposed but not allowed by the patient. July 27th, patella removed, aud portion of condyles of femur and tibia excised. Death August 13, 1865.—9 BAERWIXDT, of Frankfurt, operated in the case of W. Rauch, 2d Silesian Grenadiers, No. 11, 8th Co., aged 26, wounded at Vettingen, July 26,1866, in the left knee joint. September 2d, admitted into Garrison hospital in Frankfurt, a. M. Resection of both condyles in their middle September 12th; ball not found. Death October 5,1866 (GURLT, loc. cit, p. 397)- I0BlEFF.L (R.) (Im Reserve-Lazareth. Kriegschirurgische Aphorismen von 1866, in LANGENBECK'S Archiv fiir Klin. Chir., Berlin, 1869, B. XI, p. 450): Joh. Palyo, 34th Austrian Infantry, 13th Co., aged 24, wounded at Koniggratz, July 3, 1866, in the left knee joint, shattering the patella. July Sth, admitted into reserve hospital at Landeshut. Resection August 9th. Death September 14, 1866.—n Dr. BURCHAEDT excised the knee in the case of Josef Drozdz, 20th Austrian Infantry, aged 27, wounded at Koniggratz, July 3, 1866, close beneath the right knee. Resection July 10th, removing the patella and portions of the tibia and condyles of the femur. July 19th, haemorrhage from popliteal artery ; ligation of femoral artery. Death 20 minutes afterwards, July 19, 1866 (GURLT, loc. cit, p. 487).—12Dr. Busch (Scholz W.) (Bericht iiber das Verwundeten-Spital Schloss Hradek bei Koniggratz vom 28. August bis zu dessen Auflbsung am 6. November 1866, in Allgemeine Militdrdrztliche Zeitung, 1867, S. 324, 357, and GURLT, loc. cit, p. 480): Case of Joh. Necasek, Corporal, 74th Austrian Infantry, aged 24, wounded at Probhw, July 3, 1866, in the right knee joint; the ball lodged and was removed SECT. IV.] SHOT INJURIES OF THE KNEE JOINT. 423 Amputations at the Knee Joint.—As indicated in Table LIV, on page 398, the fatal- ity of one hundred and eighty-seven cases of amputation at the knee joint in which the on the 6th day. July 13th, conveyed to Castle Ilradek Hospital. Resection July 15th ; fistulas, erysipelas, etc., ensued, and on July 3,1867, at the solicita- tion of the patient, amputation was performed in the middle third of the thigh. Dr. BUSCH performed two additional operations in 1866: Alfred Graf, sublieutenant, Austrian Cuirassiers Regiment, No. 2, nged 18, wounded at Koniggratz, July 3, 1866, through the right knee joint, Assuring the femur extensively. Admitted into Castle Hradek Hospital. Resection, July 27th, of about four inches of the lower end of the femur and patella. Death Aug. 2, 1806. Anton Dunda, 8th Austrian Infantry, aged 25, wounded at Koniggratz, July 3,1866, in the left knee joint. Admitted into Castle Hradek Hospital. August 1st, resection of about 1} inch of end of femur. August 6th, ligation of femoral artery below Poupart's ligament on account of arterial haemor- rhage. Death August 7, 1866 (Gurlt, loc. cit, pp. 487, 488).—l3 Fibber (Carl) (Chirurgische Studien und Erfahrungen mit Zugrundelegung der im italienischen Fcldzuge des Jahres 1866 gemachten Beobachtungen, in Allgemeine Wiener Med. Zeitung, 1875, No. 21, p. 202): Nicolo Pinosco, 1st Italian Grenadier Regiment, wounded at Cnstoza, June 24, 18(ili, in the left knee by a grenade splinter; patella shattered, joint opened. Admitted into hospital at Verona. Resection July 7th; pieces of patella entirely extirpated; both condyles removed. Death on the evening of July 9, 1866.—l4Dr. Hahn operated on Carl Bohm; 42d Austrian Infantry, wounded at Koniggratz, July 3, 1866, through the right knee joint. Admitted, July 6th, into hospital at Horic. August 7th, resection of about 1 inch of tibia and fibula and li inch of femur. August 27th, haemorrhage, followed by death in a few minutes (GURLT, loc. cit, p. 488).—,6Dr. JUNG, of Frankfurt, a. M., operated in the case of Gustav Hornbogen, non-commissioned officer of Magdeburg Fusileer Regiment, No. 36, aged 23, wounded at Vcttingen, July 26, 1866; penetrating shot wound of the knee joint. Admitted into Relief Hospital No. 4, Frank- furt, August 9th. Resection, August 15, 1866, of knee joint. Death from pyaemia August 19, 1866 (GURLT, loc. cit., p. 398).—,6K6NIG (Beitrage zur Resection des Kniegelenkes, in Archiv fiir Klin. Chir., 1868, B. IX, s. 465, and GURLT, loc. cit, p. 485): Leopold Anzenberger, Austrian Infantry Regi- ment, No. 49, aged 25, wounded near A schaffenburg, July 14, 1866, in the left knee joint. On September 10th he was admitted into hospital at Hanau. Resection, September llth, of about 2J centimetres (broad) of the femur, tho fractured patella, and a piece of the tibia about a centimetre broad. Living October 19,1874, having been engaged in shoemaking for three years. Leg shortened 2 inches.—" B. v. Langenbeck (Ueber die Schussfracturen der Gelenke, etc., Berlin, l^liS, p. 33, and GURLT, loc. cit, p. 398): Case of Simon Bach, Pommeranian Field Artillery, aged 24, wounded at Koniggratz, July 3, 1866; right knee joint shattered by splinter of grenade; capsule opened. Admitted into hospital at Milowic, July 30th. Subperiosteal resection of the knee joint. Death August 5, 1806.—I8Dr. MlDDELDORPF operated on Constantin v. Memerty, 2d Lieutenant, 7th East Prussian Infantry, No. 44, aged 23, wounded at Koniggratz, July 3, 1866. Besides two slight flesh wounds, the left knee joint was shattered by a piece of grenade, the patella carried off, and the joint opened. Resection, July 10th, in hospital at Koniginhof. Death from pyaemia, July 27, 1866 (GURLT, loc. cit., p. 398).— 19 Surgeon BAST excised the knee in the case of Michael Maier, 1st Bavarian Infantry, aged 26, wounded at Vettingen, July 26, 1866, at inner condyle of left knee. Admitted into hospital at Wiirzburg August 18th ; resection, August 30th, of condyles, patella, and a slice of tibia. Death, September 17,1866, from pyaemia (GURLT, loc. cit., p. 418).—20 Professor KARL TEXTOR, in the case of Andreas Jorg, 9th Bavarian Infantry, 3d Co., resected the knee joint in hospital at WUrzburg. Death August 16, 1866 (GURLT, loc cit, p. 419).—21 Generalarzt WAGNER, in the case of Franz Skazel, Field Chasseur Bat- talion, No. 27, aged 20, wounded at Koniggratz, July 3, 1866, in the left knee, and admitted into hospital at Gorlitz on July 30th, removed, on August 31st, the patella. Death September 29,18(i6 (GURLT, loc. cit, p. 488).—22Surgeon BUXMANN: Case of Corporal H. Schildgen, Hessian Sharpshooter Corps, aged 30, wounded accidentally, September 16, 1866, in the right knee; joint opened, tibia and fibula uninjured. Resection of knee joint about 16 or 18 hours after injury; removal of patella, head of fibula, articular portion of tibia, and the splintered femur IJ inch above its articulating extremity. Recovered July 21, 1875; shortening 10 centimetres; walks about all day, but feels very tired in the evening. Cicatrix adherent; total anchylosis of joint; leg entirely straightened; can walk up hill easier than down hill; uses no supporting apparatus (GL'RLT, loc. cit, p. 1191).—"THOMPSON (HENRY) I Gunshot Wound of the Knee—Excision of the Knee Joint, in The Dublin Quarterly Journal of Medical Science, 1868, Vol. XLVI, p. 27): Case of Peter McSorley, a carpenter, shot February 29, 1868, in his bent right knee. Admitted into Tyrone County Infirmary at Omagh. March 1, 1868, resection of 2J inches of the femur, a very thin slice of the head of the tibia, and all the fragments of the patella, shot, and pieces of lead. For weeks afterwards pieces of bone, lead, shot, etc., continued to discharge. July 1, 1868, patient able to go about with the aid of a crutch and cane and without splints, limb being shortened about H inch.—M Oatman Ura T.) (Excision of the Knee Joint, in Pacific Med. and Surg. Jajir., 1869, Vol. Ill, N. S.. p. 56): C. G----, of Yolo County, California, aged 16, wounded March 10, 1868; penetrating shot wound of knee joint, resulting in caries. Resection May 21, 1868; removal of lower portion of condyles, anterior articular surface of femur beneath the patella, the patella, head of tibia, and fragments of fibula. October 15, 1868, amputation of thigh on account of continuous progress of caries of the femur and leg; recovered.—:6 For details of the cases of excision of the knee joint of the Franco-Prussian War of 1870-71, the reader is referred to the exhaustive work of Professor E. GURLT, Die Gelenk-Resectionen nach Schussverletzungen, etc., Berlin, 1879, pp. 602, etc. From a careful and critical examination of the sources at his command, Dr. GURLT collects 75 authentic cases of excisions at the knee joint performed during that short but decisive struggle: 15 were successful and 60 proved fatal, a mortality rate of 80.0 per cent.—'"• Newman (Wm.) (Gunshot Wound of Right Knee Joint, twenty-five years ago—Removal of Lower Half of Patella (carious), and of shot imbedded in inner Condyle of Femur, from a patient aged 55, in St. Bartholomew's Hospital Reports, London, 1874, Vol. X, p. 392), in the case of J. T---, accidentally shot in the right knee. Excision March 29, 1871. Recovery, with bony anchylosis.—27 Miner (J. S.) (H. CULBERTSON, Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. A in. Med. Assoc., Philadelphia, 1876, Supp. to Vol. XXVII, p. 186, Case No. 37): Thomas S. Cobb, of Buffalo, N. Y., aged 35, received, on November 8, 1871, a pistol shot in the articulating surface of the tibia. Resection, on November 10th, of both surfaces of joint. Died 15 days afterwards of pyaemia.—28Dr. Meusel (Eine Kniegelenkresection nach Schussverletzung, in Ber- liner Klin. Wochenschrift, 1875, XII Jahrg, S. 272): Case of Zeiss, aged 25, wounded November 1, 1873, by a revolver shot in the left knee; ligamentum patellae perforated, missile lodged in the epiphysis of the tibia about 5 centimetres deep. Resection November 9, 1873, removing a piece from the con- dyles of femur 4 centimetres thick, without touching the patella, and resecting the tibia so as to leave the fibula joint unopened. Discharged from treat- ment April 8, 1674, walking on crutches; he subsequently accustomed himself to walk with a light cane; shortening 5 centimetres.—29REYHER (G. Tiling, Bericht iiber 124 im Serbisch-Turkischen Kriege im Baracken-Lazareth des Dorpater Sanilats-Trains zu Swilainatz behandelte Schussverlet- zungen, Dorpat, 1877, pp. 67, 68, and GURLT, loc. cit, p. 1160) performed 3 excisions at the knee joint during the Russo-Turkish War, 1876-78: Rista Bokowitsch, aged 35, wounded September 18,1876, in the external condyle of the right femur; ball removed. Resection of knee joint September 21,1876, at Swilainatz. Death September 22,1876. Radojiza Schiwanowitsch, aged 40; admitted into hospital at Swilainatz, September 2,1876, with penetrating shot wound of left knee joint, fracturing the femur, received several days previous. Resection of entire lower portion of femur. Died September 13,1876. Gaja Miliwojewitsch, aged 34, admitted into hospital at Swilanatz, August 22,1876, with a shot wound of left knee joint received two and a half weeks previously. Resection of both condyles of femur, August 23, 1876. Death from pyaemia August 31, 1876.—30Bergmann (E.) (Die Behandlung der Schusswunden des Kniegelenks im Kriege, Stuttgart, 1878, pp. 30, 31): Aleksei Neboschenko, Russian Regiment Wolhynien, aged 27, wounded at the crossing of the Danube, June 15, 1877, in tbe right knee joint. Primary resection of the shattered condyles of femur. Death July 2, 1877, from pysemia. 31 Kade (E.) (Das tempordre Kriegslazareth des Ressorts der Anstalten der Kaiserin Maria im Kloster Mariahimmelfahrt bei Sistowa, in St. Peters- burger Med. Wochenschrift, 1877, S. 381. 1878, s. 19): Peter Petrunja, 14th Russian Sharpshooter Battalion, wounded on the Nicolai Mountain, August 13, 1877, through the left knee. Resection, October 5, 1877, in hospital at Sistowa, of articulating ends of femur and tibia. Death October 8, 1877.— 32Rudduck operated twice during the Russo-Turkish War, 1876-78 (SociCte ottomane de secours aux blesses et malades militaires constitute d'apris la Convention de Genive, Vol. Ill, Ambulances fixes et mobiles du Croissant rouge, Constantinople, 1878, pp. 137, 232): Ahmed Ibrahim, wounded September 8, 1877, in the right knee. Resection, September 22, 1877, of the condyles and articular facet of the tibia, in hospital Le Mevle-Hane, at Philippopolis. Hassan Ali, penetrating wound of right knee joint; ball in one of the condyles of the femur. Resection, October 25, 1877, of knee joint, in field hospital No. 5, at Orkhanie. Death from pyaemia.—33 RICHARDSON (A. P.) (Proceedings of the Connecticut River Valley Medical Association, in Boston Med. and Surg. Jour., 1878, Vol. XCVIII, p. 43): A girl, aged 14, accidental shot wound of knee joint, in 1876; excision of articular end of bones by Dr. TWITCHELL, of Keene, N. H. Recovery, with 2 inches shortening and a useful leg. 424 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. tinal issues were determined was 56.6 per cent., viz: fatality of one hundred and seven primary operations, 53.2 per cent.; of fifty intermediary, 68.0 per cent.; of twenty-six secondary, 53.8 per cent.; and of four operations in which the date of the amputation was " not ascertained, 25.0 per cent. These results do not sustain the opinion expressed in the preliminary report, issued in 1865, that the mortality, especially of primary amputa- tions in the lower third of the thigh, is much larger than that of the exarticulations at the knee joint. It will be remembered that the fatality of the amputations in the lower third of the thigh was 53.6 per cent., and of the primary amputation in the lower third only 48.7 per cent. (Table XXIX, p. 213), or 3 and 4.5 per cent., respectively, less than that of the corresponding groups of amputations at the knee joint, and the former operation would, therefore, seem to give a better chance for life than the latter. It must also be taken into consideration that in 8, or nearly 10 per cent., of the eighty-one cases of recovery after amputation at the knee, amputation in the thigh subsequently became necessary. The mode of operation in amputations at the knee joint has been varied in many ways: by a semilunar incision in front and a long posterior flap behind, as practised by Hoin, in 1764-,1 by the long anterior flap of LeVeilleV by the anterior and posterior semi- circular flaps of N. Smith,3 the patella being retained; by the circular method of Velpeau,4 three or four inches below the patella; by the oval method of Baudens,5 consisting of one flap, long anteriorly and short posteriorly; by the lateral flaps of Rossi ;6 and by three sub- cutaneous flaps (one anterior and one posterior, the latter split up along the middle of the popliteal space) from the circumference of the upper part of the leg, as proposed by Pan- coast.7 Syme,8 in 1845, made a semilunar incision on a line with the upper edge of the patella and a long flap from the calf of the leg, after the manner of Hoin, but he removed the condyles and the patella. Carden,9 since 1846, cut an anterior semioval skin flap, removing the patella and portions of the condyles of the femur. Operations similar to Carden's were performed by Melchiorj10 in 1850 and 1851, but the patella was retained in these cases. In 1857; R. Gritti proposed to cut an anterior rectangular flap, to saw through the condyles of the femur, to remove a segment of the inner portion of the patella and to place the sawn surfaces in apposition, to secure in this manner a sound surface to 1BRASDOR (Sur les amputations dans les articles, in Mem. de VAcad. Roy. de Chir., Paris, 1774, T. V, p. 773 >, who practised the operation at Dijon, in 1764, on a laborer who had fallen from a building. 2Leveille (J. B. F.), Nouvelle doctrine chirurgicale, Paris, 1812, T. IV, p. 586. 3 Smith (Nathan) (On Amputation at the Knee Joint, in the American Medical Review and Journal, 1825, Vol. II, p. 370) marked " two points one on the out and the other on the inside of the limb, the latter half an inch below the head of the tibia, and the other opposite to it. Then draw a semicircular line from one point to the other, oyer the anterior part of the leg, and in such a direction that its lower part shall touch the lower part of the tubercle on the tibia into which the ligament of the patella is inserted, and then mark another circle on the posterior part of the leg, exactly corresponding to the former. The above lines limit the two flaps, the former of which will be formed of the patella and its ligament, together with the investing integuments, and the latter of the bead of the gastrocnemius, the tendons of the flexor muscles, and the popliteal blood-vessels and nerves. The operator should first raise the anterior flap with the patella, which will expose the anterior part of the joint and render the division of the lateral ligaments easy. Two or three strokes of the knife will then complete the section of the lower flaps, with the crucial ligaments." 4 VELPEAU (A.), Mimoire sur l'amputation de la jambe dans Varticulation du genou, et description d'un nouveau procidi pour pratiquer cette operation, in Archives Ginirales de Medecine, 8mc annee, T. XXIV, 1830, p. 58. 5 Baudens (L.) (Clinique des plaies d'armes d feu, Paris, 1836, p. 537, and Disarticulation coxofimoral et tibio-fimoral, in Bulletin de I'Aiad. Roy. de Med., Paris, 1836, T. I, p. 324) recommends a combination of the oval and flap methods. A long oval flap anteriorly, commencing five inches below the patella, is dissected and turned up ; the ligaments, muscles, and vessels are next divided by a circular incision, the articulation is opened, and the semilunar cartilages and crucial ligaments detached as in the circular process of Velpeau. 6 ROSSI (R.), El&mensde Medecine Opiratoire, Turin, 1806, T. II, p. 227. tPancoast (Joseph), A Treatise on Operative Surgery, Philadelphia, 1846, p. 171. 8Stme (JAMES), Surgical Cases and Observations, in London and Edinburgh Monthly Journal, 1845, p. 339. 'CARDEN (HENRY D.) (On Amputation by Single Flap, in British Medical Journal, 1864, Vol. I, p. 416): It consisted "in reflecting a rounded or semi-oval flap of skin and fat from the front of the joint; dividing everything else straight down to the bone; and sawing the bone slightly above the plane of the muscles ; thus forming a flat-faced stump with a bonnet of integument to fall over it." The patella was not retained in this operation. 10 MELCHIORJ (G.) (Caso di amputazione sopracondiloidea del femore col metodo del dott. ROCCO GuiTTl, cioi con Umbo patellare, per ferita da arma da fuoco; preceduto da altri due, in cuifu conservata larotella disarticolando ilginocchioedamputandoaicondilifemorali; in Annali Universali di Medicina, Milano, 1817, Vol. CC, pp. 370, 371); but in these operations the entire patella was retained. One of the patients on whom the amputation was performed recovered from the operation, but died of recurring cancerous tumors four and a half months after the operation. The patella, deprived of its cartilage, was found, held by adhesions, in the intercondyloid notch; the skin of the flap adhered to the condyles. In the other case, the operation was performed at the level of the condyles for a railroad accident, in 1851. The anterior flap sloughed, but finally the patella became anchylosed to the outer part of the femur and the patient recovered with an excellent stump. SECT. IV.] SHOT INJURIES OF THE KNEE JOINT. 425 the stump.' From the records it would seem that this mode of amputating at the knee joint was practised once only during the late civil war in the case of Private C. H. Rist, 36th Wisconsin (Case 492, p. 318, and Table LV, p. 402, No. 38), who subsequently underwent secondary amputation in the lower third of the thigh; although, as already stated on page 357, ante, similar procedures were employed by Surgeon B. A. Vanderkieft, U. S. V., and Assistant Surgeon J. W. S. Gouley, U. S. A., in two instances of amputations in the lower third of the femur. In the Danish War of 1864, the Austro-German War of 'R. Gritti, Dell' amputazione del femore al terzo inferiore e della disarticolazione del ginocchio. Valore relativo di cadauna, coll'indicazione di un nuovo metodo denominato amputazione del femore ai condili con Umbo patellare, in Annali'Universali di Medicina, Milano, 1857, Vol. CLXI, p. 5. The author, who found no occasion to practise the amputation on the living subject, gives, on page 18, a minute description of the operation, of which the following is a brief outline: An incision is made from the upper edge of the head of the fibula transversely across the leg, about one inch below the patella, to the inner tuberosity of the tibia. From the extremities of this incision a vertical cut is made upward to the level of the middle of the patella. The rectangular flap thus outlined is dissected, the joint is opened by cutting through the ligamentum patella?. The patella is then thrown back, and a segment, about two lines in thickness, removed from the inner surface by a small saw. The condyles of the femur are sawn through. The posterior flap is then made by an incision direct to the bone, connecting the upper extremities of the lateral cuts. This flap is separated from the femur for a short distance, the periosteum cut through, and the limb removed. The vessels are ligated, the sawn bony surfaces are placed together, and the edges of the flaps secured by several interrupted sutures. Professor J. NeudSrfer, in the preface to his Handbuch der Kriegschirurgie. Ein Vademecumfiir Feldarzte, Leipzig, 1864, Erste Halfte, p. IX, claims that he performed an operation similar to GlUTTl's in 1859: "The work of GRITTI was unknown to me; but it struck me, in the fall of 1859, to combine exarticulation at the knee with resection, and to practically test it," and on p. 1559 of the Zweite Halfte states that he performed the operation in 1859, but he fails to give details of the case. In an article, Beitrag zur Amputation, in Vierteljahrschrift fiir die Praktische Heilkunde, Prag, 1860, Vol. I, p. 80, Professor SZYMANOWSKY advocates GRITTl's mode of operation, and details his experimental efforts on the cadaver; but at that time he found no occasion to employ this method on the living subject. SAWOSTITZKI seems to have been the first to prac- tically test GRITTl's operation, in 1862. The case is published in the St. Petersburger Medicinische Zeitschrift, 1862, B. Ill, p. 372: The patient, aged 19, fell from a wagon and received a fracture of the right leg. The operation was performed according to GRITTl's mode as described by SzY'MANOWSKY; the sawing of the patella caused the only difficulty; the sawn surfaces of the femur and patella fitted readily; the wounds healed principally by first intention. On the sixth day after the operation the patella was found to have been drawn upwards on the anterior surface of the femur by the quadri- ceps, and could not be replaced. The patient recovered with a good stump. The first recorded operation after shot injury is a case reported by Szy- MANOWSKY (Die Rechtfertigung der GRITTl'scTierc Operation durch Wort und That, in Vierteljahrschrift fiir die Praktische Heilkunde, Prag, 1866, B. 11. S. 38): " February 5, 1863, shot fracture of leg, gangrene; GRITTl's operation with dissection of the synovial pouch; gangrene of thigh ; death. The patella was found unmoved upon the sawn surface of the femur." In the Schleswig-Holstein War of 1864,10 cases of GRITTI'6 operation were reported.— A. LCcKE (Kriegschirurgische Aphorismen aus dem zweiten Schleswig-Holsteinschen Kriege im Jahre 1864, in LANGENBECK'S Archiv fiir Klin. Chir., Berlin, 1866, B. VII, pp. 23, 24, 134, 147) reports 4 cases.—2. Christian Balzer, 24th Regiment, shot wound of left knee joint, June 29,1864; amputation June 30th, by Surgeon SCHILLING; fatal.—3. Thomas Thomsen, 9th Danish Infantry, shot wound of right knee, April 18,1864; amputation April 27th, by Dr. LUCKE; death May 1, 1864.—4. Carl Neumann, 4th Guards, shot wound of right knee joint, April 18, 1864 ; amputation by Dr. LUCKE, April 26th; recovery.—5. Hoffmann, wounded in right knee, February 2, 1864 ; amputation February 10th, by Dr. LUCKE ; death about the end of February. Six other cases of the War of 1864 are mentioned by C. Heine (Die Schussverletzungen der unteren Extremitdten, etc., in Langenbeck's Archiv fiir Klin. Chir., 1866, B. VII, p. 607.—6. Prussian soldier, shot fracture of the leg. Operation by Generalarzt von LANGENBECK; fatal.—7. Primary operation by Professor ESMARCH, at the hospital at Broaker, April 18, 1864, for shot wound of upper extremity of tibia; fatal.—8. L. Chr----, Sth Prussian Grenadiers, comminution of left leg, April 18, 1864. Operation, April 18, 1864, by Staffsurgeon OCHWADT, at Flensburg; fatal. (See also OCHWADT, Kriegschir. Erfahrungen, Berlin, 1865, No. 18 of Table of Operations).—9. Private J. K"----, 9th Danish Infantry, wounded April 18, 1864; operation, April21st, by Staffsurgeon FISCHER, at the Latin School Hospital at Flensburg, for shot fracture of the tibia with splintering into knee joint; the patient died eight days after the operation. The autopsy showed that no consolidation of the femur and patella had taken place.—10, 11. After the naval engagement at Helgo- land, in 1864, two of these operations were performed; one at the hospital at Altona, by Dr. STEINLECHNER (H. KUCINIC, Bericht iiber die Verwundeten, der K. K. Kriegsmarine, in Allgemeine Militdrdrztliche Zeitung, 3864, B. V, p. 52): Sailor A. Gasparo, of Frigate Radetzky, shot fracture of left leg, May 9th; amputation after GRITTI, May 13th ; recovery. The other (HEINE, loc. cit, p. 6C8, and SALZMANN, Die GRITTl'sc7ie Operationsmethode und ihre Verwerthung in der Kriegschirurgie, in B. VON LANGENBECK'S Archiv fiir Klinische Chirurgie, Berlin, 1880, B. XXV, p. 662) was the case of an Austrian naval cadet, wounded in the same engagement; amputation after GRITTI on the day of the injury, May 9, 1864. It is stated that union of the patella had taken place, but that on his return to Austria the patient fell upon his stump, necessitating amjiutaticn in the middle third of the tbigh.— 12. MELCHIORJ (G.) (Annali Universali di Medicina, 1867, Vol. CC, p. 374): P. Pietro, 5th Italian Artillery, aged 27, shot in the right leg, July 21,186(i; GRITTl's amputation August 16th; recovery. Of the Austro-Prussian War of 1866, 6even operations after GRITTl's method are reported by Salzman X (loc.cit, p. 669, etc.).—13. Austrian soldier, aged 17, comminution of left leg by shell, at Konigsgratz, July 3, 1866; operation July 3d; healed by first intention; August 12th, recovered.—14. Prussian Infantry soldier, comminution of bones of right leg, Konigsgratz, July 3,1866; operation at Castle Prim, July 15th, by Dr. BUSCH; death same day.—15. Franz Walichowski, comminution of lower third of left tibia and fibula, and of right elbow joint; July 15th, resection of elbow joint; July 27th, GRITTl's amputation at knee joint; death August 15,1866; operation by Dr. BUSCH.—16. JohannBielin, 8th Aus- trian Infantry, fracture of tibia and laceration of the peronaeus, July 3, 1866; operation by Dr. BROCK, July 27,1866; death from pyaemia.—17. Austrian soldier, shot fracture of head of tibia, July 3d; amputation at Nechanio, August 10, 1866, by Dr. BUSCH; death from pyaemia, August 10, 1866.—18. Austrian soldier, shot fracture of leg; operation at the hospital at Nedelist, by Dr. SPANNER; death 50 days after the operation.—19. O. Weiser, 3d Baden Infantry, shot fracture of right leg, Werbach, July 24, 1866; operation by Dr. MULLER, August 2d; death August 9, 1866. Of the Franco- Prussian War of 1870-71, Staffsurgeon Salzmann (loc. cit, p. 674, etc.) collects 15 cases, viz: 20. G----, 94th French Infantry, shell laceration of both calves, August 22, 1870; GRITTl's operation at the knee on one limb; amputation in the thigh on the other, August 23d; operation by Dr. MULLER; death August 24,1870.—21. T. H----, 1st French Infantry, shell fracture of left leg, August 18, 1870; operation, August 24th, by Dr. MARQUAKDT; death.- 22. Private A. Ihl, 88th Infantry, comminution of left leg, September 1, 1870; amputation, September 4th, by Dr. LANG (?); recovery, with good stump.—23. A. Brauer, 3d Grenadiers, splintering of left tibia, August 18, 1870; GRITTl's operation by Dr. MATZ, September 7th; recovery, with tender stump.—24. Reimann, 14th Bavarian Infantry, shot fracture of right leg; gangrene; operation, September 13th, in hospital at Aix-la-Chapelle, by Dr. BRAND18; death in a week.—25. C. G. Renner, 46th Prussian Infantry, shot fracture of right leg; GRITTl's amputation performed by Dr. STAHL, October 17th, at the 7th field hospital of the IXth Corps; recovery, with good stump.—26. W. Pluta, 1st Posen Infantry, No. 19; groove shot of right tibia, with opening of the joint, October 7, 1870; amputation by Dr. MULLER, October 25th, at the 7th field hospital of the Xth Corps at Hagondange; death October 31, 1870.—27. Private P. H. KOpper, 65th Infantry, comminution of left leg. October 28,1870; operation by Dr. M ULLER, November 19th, at Hagondange; death from pysemia, November 24, 1870.—28. J. Ollagnon, 13th French Infantry, shot fracture of left tibia, August 18, 1870; operation by Dr. MOller, in hospital at Nancy, March 2, 1871; recovery in 29 days.—29. Lieut. W. von du Prel, Infantry body guard, shot fracture of left knee joint, September 1, 1870; GRITTl's operation, by Professor v. Nussbaum, at Bazeilles, September 1st; September 14th, resection of exposed portion of femur; death September 25,1870.—30. P. Zoll, 10th Bavarian Infantry, shot fracture of left leg at Remilly, August 31,1870; operation by Dr. Lotzbeck, September 8th; death September 17, 1870.—31. O. Willner, 9th Bavarian Infantry, aged 24. shell fracture of leg near the knee joint, October 7, 1870; GRITTl's amputa- SUKG. Ill—54 42() INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 1866, and the Franco-Prussian War of 1870-71. Gritti's operation was performed in a number of instances, and, in 1870, a modification of Gritti's plan was presented by Stokes,1 but the results of these operations in war surgery have not been very favorable, and the opinions of military surgeons generally are recorded against its performance." In nine of the one hundred and eighty-nine cases of exarticulation at the knee the condyles of the femur and the patella were removed; in sixteen the condyles were removed and the patella retained; in seven the condyles were retained and the patella removed; in twenty-eight the condyles and the patella were retained; and in one hundred and twenty- nine instances this point was not indicated. Regarding the value of the stump after knee joint amputations, the records would seem to confirm the opinions of Velpeau, Stephen Smith, Markoe, and Syme,3 that the stump formed by the articular surface of the lower extremity of the femur is as well, and perhaps better adapted to the successful wearing of an artificial limb than the thigh stump. Of the eighty-one cases of recovery after amputation at the knee, the condition of the stump is known in sixty instances; in forty it is recorded as sound and healthy, and, in twenty, as tender or painful, or as not allowing the use of an artificial apparatus. tion, by Neuhofer, October 8th; discharged the service July 17, 1871, and died in February, 1872; stump had healed after tedious exfoliations of small particles of bone, but union of bone of the cut surfaces of the femur and patella had not taken place.—32. F. Borron, 9th French Chasseurs, aged 29, shot fracture of right leg, October 11, 1870, at Artenay; operation by v. NUSSBAUM, October llth; result undetermined.—33. J. Krum, 1st Bavarian Jaegers, shot fracture of left leg, October 11, 1870; operation, October 15th, by LOTZUECK; result unknown.—34. G. Kofler, 3d Bavarian Infantry, shot fracture of left knee joint, October 11, 1870; operation by LOTZBECK, October 21st; death October 25, 1870. The results of two of the 34 amputations at the knee after GRITTl's method, here cited, are not recorded; 10 had successful and 22 fatal issues, a mortality rate of 68.7 per cent. 'STOKES (William) (On Supra-Condyloid Amputation of the Thigh, in Medico-Chirurgica! Transactions, London, 1870, Vol. LIII, p. 180). The author claims that his mode differs from GRITTl's in the following particulars: "1. That the femoral section is made in all cases at least half an inch above the antero-superior edge of the condyloid cartilage. 2. That in all cases the cartilaginous surface of the patella is removed. 3. That the flap is oval, not rectangular. 4. That there is a posterior flap fully one-third of the length of the anterior flap." In regard to the second point of modification, Dr. Stokes remarks that "much importance was not attached by GRITTI to the removal of this portion of the bone," and, in proof thereof, cites three cases reported by MELCHIORJ, in two of which the articular surface of the patella was not removed. Dr. STOKES evidently overlooked the fact that these two operations were performed 6 and 7 years before Dr. R. GRITTI proposed his osteoplastic operation, while the third operation, in which the inner surface of the patella was removed, was performed in 1866, or 9 years after Dr. GRITTl's plan had been published. Dr. GRITTI (loc. cit., p. 18) clearly insists upon the division of the patella, and, in FIG. Ill, at the conclusion of his article, delineates the manner of the division. 2BECK (B.) (Kriegs-Chirurgische Erfahrungen wahrend des Feldzuges 1866, Freiburg, i. B., 1867, p. 62): "GRITTl's operation, which must be designated as one entirely without purpose, is to be rejected as one too complicated, having no advantages and only disadvantages." ZEIS (E.) lEinige Bemerkungen zur Wiirdigung der Exarticulation des Unterschenkels im Kniegelenke, in Arch, fur Klin. Chir., Berlin, 1866, B. VII, p. 770): "I confess that my great predilection for this operation, by which, when successful, unquestionably great advantages are gained for the patient, has greatly dimin- ished, and I, therefore, do not feel encouraged to perform the operation after GRITTI, as the dangerous consequences alluded to bv me must be the same." Dr. R. F. Weiu (On Gritti's Supra-condyloid Amputation of the Thigh, in the Medical Recoi-d, New York, 1879, Vol. XV, p. 342) tabulates 76 operations after GRITTI, of which 54 recovered and 22 died, and remarks, on p. 341: " For gunshot wounds or compound fractures involving the condyles of the femur, its practicability is yet undetermined, and time will probably record an adverse judgment against it in such cases. For diseases of the knee joint it affords a better operation, in my judgment, than disarticulation, which has lately been revived." The unfavorable results of the few cases of Gritti's amputation after shot injuries that the editor has been able to collect would seem to confirm the conclusions of Dr. Weir. Dr. Salzmann (loc. cit, in Archiv fiir Klin. Chir., Berlin, 1880, B. XXV, p. 658): "Taking into consideration, besides the high mortality, the disadvantages of a complicated operative technic, requiring a certain aptitude and at least 36 minutes time, the readily injured and for transport little adapted stump, liable to displace- ment of the patella, and bleeding from the popliteal artery; farthermore, the slow healing process with its uncertain results; we must come to the conclusion that neither on the field of battle nor in tbe field hospitals GRITTl's operation seems to have any value as an operation in war surgery." 3 Velpeau (A.) (Memoire sur l'amputation de la jambe dans Varticulation du genou, et description d'un nouveau procede pour pratiquer cette opiration, in Archives Ginerales de Medecine, 8"" annee, T. XXIV, 1830, p. 60) considers amputation at the knee preferable to amputation in the thigh as being less dangerous, easier performed, and furnishing a good stump for the use of a wooden leg. SMITH (Stephen) (Cases in Surgery.—Amputation at the Knee Joint. By W. PARKER, M. D., Professor of Surgery in the College of Physicians and Surgeons, New York. Reported by Stephen Smith, in the New York Journal of Medicine for November, 1852, Vol. IX, p. 326) arrives at the following conclusions: "1. That amputation at the knee joint is a justifiable operation, as respects the nature of the structures engaged. 2. That it is a justifiable operation as respects the point of election. 3. That the stump formed by the articular surface of the lower extremity of the femur is as well adapted to the adjustment of au artificial limb, and to sustain and transmit the weight of the body, as when the operation is performed in the continuity of the thigh-bone." MARKOE (T. M.) (Amputation at the Knee Joint, Illustrated by the Cases which have occurred in American practice, and mainly by those which have been treated in the New York Hospital, in New York Jour, of Med., New York, 1856, Vol. XVI. N. S., p. 35, etc.) presents eight points of comparison between this operation and the amputation in the thigh, all favoring knee joint amputation. Syme (Jamesj (On A mputation at the Knee, in Edinburgh Medical Journal, Edinburgh, 1866, Vol. XI, p. 874) concludes that the resulting stump is comfortable and serviceable. MARKOE (T. M.) (Amputation at the Knee Joint, in New York Medical Journal, 1868, Vol. VI, p. 509) sums up the cases of amputation in the thigh and at the knee joint performed from 1830-1864, in the New York Hospital. both showing a mortality of 54 per cent., and admits that as far as the percentage of fatality is concerned " this exhibit shows no advantage on the side of the knee joint operation," but claims a decided advantage for the usefulness of the knee joint stump. In this opinion he is corroborated by Dr. E. D. HUDSON, the ingenious deviser of various mechanical appliances for the relief of maimed soldiers; but the latter (Mechanical Surgery.—Prothetic Appliances and Apparatus for Amputations, Resections, etc., New York, 1878, p. 24) deprecates the removal of the condyles as an operation neither "sustained by any rational hypothesis nor practised on any scientific principles. Except disease or injury of the condyles compel their excision, their thin anatomical and functional vestments should be kept inviolate from knife and saw. The condyles, their cartilage and vestment, as constituted, are nature's strongest, most tolerant and important supports in the entire body, and when these parts are amputated or disturbed, a valid, a positive reason should exist for so doing." SECT. V.] WOUNDS AND OPERATIONS IN THE LEG. 427 Section V. WOUNDS AND OPERATIONS IN THE LEG. The consideration of examples of simple and compound fractures, of burns, frost-bites, and other miscellaneous injuries of the leg will be reserved for Chapter XII, and as no cases of sabre or bayonet injuries of the tibia and fibula are recorded, it remains therefore only to examine the instances of shot injuries of this portion of the human structure. There are found on the registers one hundred and eighty-three shot contusions, and eight thousand nine hundred and eighty-eight shot fractures, making a total of nine thousand one hundred and seventy-one shot injuries of the bones of the leg. Four thousand one hundred and three were treated by conservation, and in five thousand and sixty-eight instances operative interference was resorted to, viz,: excision in the bones of the leg or at the knee in three hundred and eighty-eight; amputation in the leg in three thousand seven hundred and thirty-six; amputation in the leg and subsequent exarticulation at the knee in three; amputation in the leg and subsequent amputation in the thigh in thirty-nine; exarticulation at the knee joint in one hundred and one; exarticulation at the knee and ablation in the thigh in seven; and amputation in the thigh in seven hundred and ninety- four instances. The exarticulations at the knee joint and the amputations in the thigh following shot fractures of bones of the leg have already been considered in the preceding sections of this Chapter, leaving the amputations in the leg to be examined in this Section. SHOT CONTUSIONS OF THE BONES OF THE LEG.—One hundred and eighty- three examples of shot contusions of the bones of the leg are entered on the records. The injuries involved the tibia in one hundred and thirty-six, the fibula in twenty, the tibia and fibula in twelve instances, and in fifteen cases the precise seat of the injury was not specified. One hundred and sixty-five cases, of which fifteen resulted fatally, were treated throughout by expectation; in eight amputation in the leg was resorted to, unsuccessfully in four; one was followed by an unsuccessful amputation at the knee; and nine—three successful and six fatal—by amputation in the thigh. Shot Contusions of the Bones of the Leg Treated by Conservation.—Of the one hundred and sixty-five cases of this group, fifteen, or 9.09 per cent., had fatal terminations. The right limb was injured in sixty-six, the left in seventy-eight, and in twenty-one cases the side was not indicated. Sequestra or exfoliations were removed in twenty-two instances. In one hundred and thirty-two of the one hundred and sixty-five cases the tibia was the seat of the injury, the lesion generally being on the inner anterior flat surface. Recoveries after Shot Contusions of the Bones of the Leg treated by Conservation.— Generally the healing process was very slow, and not rarely attended by necrosis of the bone and tedious exfoliation, as in the following instances: 428 injuries of the lower extremities. [CHAP. X. Fig. 256.— Exfoliation from right tibia. Spec. 2620. Case 655.—Sergeant J. Meier, Co. H, 52d New York, aged 43 years, was wounded at Spottsylvauia, May 12, 1864, by a musket ball, which entered the middle third of the right leg and injured the tibia. Surgeon D. II. Houston, 2d Delaware, reported that the wounded man was admitted to the field hospital of the 1st division, Second Corps, where the missile was extracted. Two weeks after the reception of the injury he was sent to Washington, and several days later to Philadelphia. Assistant Surgeon T. C. Brainerd, U. S. A., reported that "the patient entered Broad and Cherry Streets Hospital May 31st, the wound being healthy at date of admission aud continuing so until July 3d, when sloughing set in. This was successfully treated by applications of nitric acid, followed by dressings of coal oil, together with internal administration of tincture of chlo- ride of iron, porter, and generous diet. By July 12th, the wound was again granulating and his general health improving. Complete cicatrization being prevented by the presence of dead bone, that portion of the tibia was removed by Acting Assistant Surgeon D. W. Cadwallader, on October 1st, through an incision over the spine. The small fragments of bone were then thoroughly washed out with a syringe and the parts coaptated by adhesive plaster, over which simple water dressing was applied. Cicatrization progressed rapidly and was complete by October 28, 1864, when the patient was discharged from hos- pital," his term of service having expired three weeks previously. The removed sequestrum, six inches long, and contributed by the operator, is represented in the* wood-cut (FlG. 255). Examining Surgeon G. J. Fisher, of Sing Sing, N. Y., August 22,1865, certified to the injury, and stated: "The front of the injured leg is covered with delicate blue integument, not perfectly healed. He is unable to labor, and an artificial leg would be far preferable." The New York Examining Board reported, September 3, 1873: "There has been considerable loss of osseous substance. The entire anterior and inner aspect of the middle and upper portion of the leg is covered with encrustations, and there is periostitis and necrosis of bone at present." At subsequent examinations the same indurated, ulcerated, and partly indolent condition of the parts, interfering with locomotion, was reported. The pensioner was paid December 4, 1879. Case 656.—Corporal G. Ditch, Co. D, 82d Ohio, aged 21 years, received ashot wound of the right leg, with injury to the tibia, at Gettysburg, July 1, 1863. He was admitted to Satterlee Hospital, Phil- adelphia, eight days after the injury. Acting Assistant Surgeon M. Lampen contributed the patholog- ical specimen, represented in the annexed cut (FlG. 256), with the following report: "The injury was caused by a round ball, which entered the leg anteriorly at the junction of the upper with the middle third of the tibia. On admission the wound was in a healthy condition. Hospital gangrene first appeared on July 23d, and spread rapidly for several days. Creasote mixture and yeast poultices were used to the wound and tonics internally, which treatment was continued for two weeks, when all signs of the disease had disappeared, a small portion of the tibia being left exposed. The patient's general health was good with the exception of an obstinate intermittent fever, which yielded but temporarily to quinine. On September 26th, a segment of bone about five inches long, one and a half inch in width at its widest part, and from one-eighth to one-fourth of an inch thick, was removed from the wound, the entire exfoliation of it having taken place in a few days from the time it was first observed. During the succeeding days several small spiculae of bone were removed, after which exfoliation still pro- gressed downwards, indicating that more bone would have to be removed." In October the patient was transferred to Seminary Hospital, Columbus, and lastly he was sent to Camp Dennison, where he was discharged March 30, 1864, and pensioned. Examining Surgeon R. L. Sweeney, of Marion, Ohio, describes the injury as follows: "A gunshot wound by a musket ball impinging on the leg just above the junction of the middle and upper thirds of the tibia. Contraction and adhesion of the muscles afterwards resulted from gangrene." The same Examiner reported, in 1870, that the wound had reopened and after- wards again closed imperfectly. On June 21, 1874, he stated that "the wound is still open and the bone diseased;" and in September, 1877, he reported a "large, adherent, and irritable cicatrix over the spine of the tibia, with malformation of the bone." The pensioner was paid December 4, 1879. Case 657.—Corporal H. Rail, Co. D, 15th New York Heavy Artillery, aged 22 years, was wounded at the battle of Old Church, May 30, 1864. Surgeon L. W. Read, U. S. V., reported his entrance into the field hospital of the 3d division, Fifth Corps, with "shot wound of left leg." Surgeon B. B. Wilson, U. S. V., in charge of Stanton Hospital, Washington, contributed the path- ological specimen (No. 4337 of the Surgical Section, A. M. M.), with the following history: "This young man was admitted to this hospital on June 4th. He had been wounded by a minie" ball, which passed across the spine of the tibia about four inches from the head of the bone, bruising it and denuding it of periosteum along the track of the ball. He was somewhat debilitated when admitted, but being young and of good constitution, his general condition was not unfavorable. He was treated with applications of cold water and ice dressings to the wounded limb, and stimulating and supporting constitutional remedies. During the month of June and the beginning of July the limb was highly inflamed, and there was profuse suppuration and some sloughing in the vicinity of the wound; with considerable sympathy of the general system as manifested by chills, great debility, loss of appetite, and general febrile action. In the month of July, deep-seated fluctuation having been observed in the course of the shaft of the tibia, the pus was evacuated by free incisions in the direction of the length of the limb, with great relief to the patient. The periosteum was found to be extensively separated and the shaft of the bone necrosed. During the months of September, October, November, and December his condition gradually improved as the process of formation of the involucrum and the separation of the necrosed portion went on. A number of cloacae formed in the line of the incisions for liberating pus, through which the necrosed bone could be felt gradually becoming detached from the living portion. The limb was, during this time, for the most part treated with emollient poultices. About the first of January the upper part of the shaft of the tibia could be distinguished at the position of the original wound, and about March 1st, upon seizing it with a forceps the whole dead mass could be moved within the sheath of the investing new bone. The operation for FIG. 257.— Appearance of limb fourteen months after in- jury. [From a photograph.] .vn'tli«' : .1. 'fit... ' ;.»• Y* ■ -• ¥■&... , A "^ ¥ ■ ;- '.■• •A'yS- K^^'*' '•■"-■' v '••■'& ■■■•■ :&> ■V.?Y.'%i i Af •"•;#■.,. V ■ • ■-:K*', .■>&■' .' *??*#■•■■■ -'Y '.% |f*:|- •V A* %m ■■?*■ ij. ';, '•ffiTf"!) •ftf' :|:' Wnrd pKot. PLATt • Fi";l f'ui'lHH1"' D. IS Wk York Ii v . . . . :.i" Fig.H.-rYiwWi .h-wi,:, ■■'-"olio. A. 7 WJMon.sin ToIa. .H|« :CJ k:; '■•' >'l]|l;,.d ! ■■ A.-li* ..t>.. ■•on T. C. ! ::,jury .. • ■»■. i . . . A., rep'ivfi J tha ' •■.■ i. . >'.' a.mis.-ion and continuing c> Mini .1 '• <"' ;.. i ad ti.llow.'d by d-'.-"ings of ^a'aYiil, t, ■ d u>'.i rou? ;.:■! 1 i■:> - ■.'•■•I by t;•. >!>ernt<">r, i- represented .n th'/%» ••..-. )' A':; -'V. J -»''"., Certified to f" ill'- ' .! a. •:. '.;<-ate ■ <■:_ u.iein. not per+Y t] /ieY..-ri. : ■'« ■ :'-t;i '". i New Yo ■" ' x.aii:ii.ii.cr 't :.n. .. • • ■-' "•■» subst'i. The«:i; ■:\l,'r ■■ • i.Y J"/ ',:- , •■ ertd with *ri • rustatioriB, ;• : :re: • : ■ ■■u.— ' : > ■.iuinati"i>s rh>' s: a. ri:diir»ted :!. ::;:■>: • .r.^ •••'■'> lucomuiYr.. vas r.'p« j-i'-d. «' • |,v,;i ■•:!:•.r- • *-■•>. t> - Co7", ..d (J. DUch, < o D -Y Ohio, ngt • • '■ •■ ■?}■■• ;ii \n, at GettygburL'. .Iu '.. ]H ■ '..;•-• iirttr 'be injury. N'-;. .iY-r.'. : :. i■•-• ><'Ue:',- , •• . ,■;■>..■. • .' >/><•■ ;, ..; ;, A > ...d i:,.; • • .- ; ut tin . *(.'i- • i|i. Y.-:i._ ,"''' heni Ii ■. us jjood ■•'.■ d -■ .: ic. ptlM, (•' :i,, 26th , , s.'gui'. "!t ■ ! !>ir:i ab< ;:' five i'n'rn-.- ! p •' u ) ::lei- il, k. 'as .••.'•.!•.. ■ • i-'l lion thi ' ■ ' !, i , ! 1 •■ si'i", •.•.;. IHi' n : b • Fii-.-'-.-i'rtii • i-ii .!:••.', n yviiij.-. iridi. ., . / i 'i:U. : are '■>.■<• •^ )-ral, Col ■ • , ."•-' \< ':,<■ ,. w in..it'. r. • :. 'big S> : _r''" i ■ •' 1 " i-. -•■■■, >»1 Msr'on, • .,'L' on .! -•.. . - •'■>'« • the : --ti'ja (.: - I't.i , ;• ..: '"'.•Ml gUIl: • "fl:'.' J ■ • i..' • i: On Ji.ne '. •. ! ■ -■ "a r. ! .■ ■. 'large, :• . •■ ■|-ii.«i.'l!n i : l>ce.:'nb.; A i > "^ Cash Cm" . -.. ? > d.-d ..: tb. t.. S ........... • . \\. Wi. '.fill'.!'. o " ' :■ ■■ ,i-H- ..: i!'i • , : n !•' 11 ; :i- .i hen! .'■'"' ! 11... >:. r; ■•, as- highly influued. f ■:'. ( ■■ • !..:!• n- ■■■■■:•., .M:.. .-(.'. iw;i. ■.: '.♦• 3:- ...il le syupathy ot : Y -: n aipet.Y, :,.r .- ,'iietal febrile neti.;i . si:, i". observed in 1,;: :.,>.r»e ot the 'hr:f • f • , *.);■., i- .-fiiin of the 1« m.- '»f tho 'a. ;,. -.,;■!. _,,.,..a ..,.];. > vi, :.pj\Vlv -i.p^j.itti a,i,] tin: s!,:.H 0f the bon b'i. N' riM,- -nA December hie L.tiditiou s ' Y. ■ i..),, illK, tin separate n of tlie ihct.j<" ; " :.- •■!.*. fhrr'.ajli which it.■•_• nerrt-'Sed bo: ■ ?•. ''■■'•=• *"'.:k !■•'• ihe n.i -t p;«rt treated - •• • •' •■<. h' i.a- ■• : :-.;;;ii..-;. :.-| ni Ye poii-.." ■ • <• ...'•* ' • 4 ».;. .......j, a.i i 'ta \V n .■• '>•*, \\ bi-i' the v 'W- ' VUU< '»ye lni ;r to I'ii -a(:el|]r';i Street- '•■>;••» =' M' . 1 ...u. T,^ ; :s - ,....:• ■ Mtration . t t "■ •> '. ', : ."••neral '" •.» tt, . '■■: iT.^: !» .\.- ;: : '- " ..*v .ents it' I • .rde v ,1< .''•-p (l;sih:v.^'»-1 ' • :ni;ji, six in.ih*« 'i '. .i''ii • a. j. Fhb. ■ • Mil.^ . ' r I't'l' • ' , ■ •■:_-■ „i!(l jk •• has be :n mil .•-■ i. d upper fjM • ■■-• nt." ■ | ortf, jl • rlffht Hi ivnil- rl«k •■■ '•off- mW r\. '' xi. r< ■. f| '.,.■ ' I'.n i--t: , m n •ed toSf.ii;:.-n r.nd \u>\*\ • i-, iniit-1 .'! '.''li'S.-n; ii; i :-:0.1 :u..i a- . •.•red;: Hud : r ••W'tioll <>{ •■{ v-?ar*, ..*; ., .rted 1. ^ ■; ft leg • "•" pall rt. * ■■•:/! -fr.oer, ■•••<■ 'ton of •:ed in Med a- Sni-i lh>t of (lie War "i the k'et>elIion, Part III Vol.ll.Chap X Ward phot. T Sinclair ft Son lith PLATE LXXI. _ TUBULAR SEQUESTRA AND PIECES OF NECROSED BONE FROM TIBIA. Fig. 1 ^Corporal Henry Rail, D. IS New York HA, Spee. 4337, A.M. M. Pig.2-Private Joseph Walker, A, 7 Wisconsin Vols. Spee. 3283, AMM Fig 3- Private O.M. Armstrong, B, 120 New \brk Vols. Spec. 3284, AM.M. fig 4._Private George Culloiu, D, 83 Ohio Vols. Spec. 2098, .VMM SECT, v.] SHOT CONTUSIONS OF THE TIBIA AND FIBULA. 429 the removal of necrosed bone was performed by Surgeon A. N. Dougherty, U. S. V., on March 14, 1865, by turning back the soft parts on each side from an incision through the centre of the cloacae, and cutting away with the mallet and chisel sufficient of the new growth to permit the sequestrum to be lifted directly from its bed. It was found to consist of the entire shaft of the tibia from one epiphysis to the other, except small portions eroded by the absorbents. The after-treatment consisted of simple water dressings with slightly stimulating applications, and was unmarked with any noteworthy complication. On June 6,1865, the patient was discharged on certificate of disability, being able to walk with ease and comfort, though the wound was not entirely healed. In July a photograph was taken, of which the adjoining wood-cut (FlG. 257) is a copy. He left the hospital in July and returned in the following month, asking to be employed under contract. Since that date he has been doing duty aa chief nurse of one of the wards of this hospital, being in robust health, though his limb was not yet entirely healed." The speci- men, consisting of a sequestrum nine inches long and eleven smaller pieces of necrosed bone, is shown somewhat reduced in Fig. 1 of Plate LXXI, opposite page 428. Examiner T. F. Smith, of New York City, September 22, 1873, certi- fied: "Shot fracture of left tibia, with union and great loss of bone substance, leaving a cicatrix over the anterior 1 surface of the bone nine inches in length, red, unhealthy, and ulcerating," etc. The Brooklyn Examining Board || reported, Septembers, 1877: "We find an adherent, chronically inflamed cicatrix extending along the anterior face of ml the left tibia from below its head to within three inches of the ankle. There is tenderness on pressure. He requires wk the application of a bandage, and complains of pain in damp or cold weather. The usefulness of the limb is well f& nigh destroyed." The pensioner was paid March 4, 1880. f| Case 658.—Private W. Hargrave, Co. C, 1 I'M New York, aged 25 years, was wounded at Chapin's Farm, Iffl September 29, 1864. Assistant Surgeon E. McClellan, U. S. A., reported his admission to hospital at Fort Monroe, 1|| October 4th, with " shot wouud of right leg at middle third by a minie" ball." On December 20th, the patient was fl| permitted to leave for his home on furlough, and in June following he entered the Ira Harris Hospital, Albany, Ctf whence Assistant Surgeon J. H. Armsby, U. S. V., contributed the specimen, represented in the annexed cut (FlG. raj * 258), with the following description: "The ball struck the tibia without fracturing it. The leg became inflamed and fi tender and a number of fistulous openings appeared. By exploring with the probe a large sequestrum was discovered Wj on July 15th, when chloroform was administered and the necrosed bone was withdrawn with a forceps through a W straight incision four inches long. After this operation the wound healed rapidly." The patient was mustered out of service July 17, 1865, but, owing to his becoming insane for a time, he did not apply for a pension until seven years Fig. 258.— afterwards. Examining Surgeon B. F. Sherman, of Ogdensburg, N. Y., October 9, 1872, certified to the injury, and questrum added that "the skin is now closely attached to the bone, and the slightest abrasion produces a sore difficult to heal. \?Sm iejv There are now two small unhealed surfaces. The man states he suffers great pain iii the leg at night after walking." 420. In 1877, the wound was reported as healed. The pensioner was paid March 4, 1880. Case 659.—Private J. C. Coats, Co. I, 5th Vermont, aged 22 years, was wounded at Fredericksburg, December 13, 1862. He was conveyed to Harewood Hospital, Washington, and transferred to Satterlee, Philadelphia, December 23d. Acting Assistant Surgeon W. W. Keen, jr., from the latter hospital, described the wound as " an injury of the right tibia," and reported: "The man had been hit by a fragment of a shell, which struck his left shoe without seriously injuring the foot; it then glanced and struck the right tibia antero-internally in the lower third. On admission to the hospital there was a swelling, fluctuating but quite tense, at the point of the injury in the leg, which I opened by an incision about three-fourths of an inch long. About an ounce and a half of coagulated blood and some pus was evacuated, and poultices were ordered to be applied. The wound did well till January 1, 1863, when it began to enlarge and look very much like hospital gangrene. I suspected this the more from the prevalence of this disease at that time in the ward. The edges of the wound had become everted, its base rather ashy grey, and the discharge unhealthy, and a considerable circle of inflammation was around the opening. But the characteristic stinging pain being absent, I determined not to treat it as hospital gangrene but by the ordinary measures for inflammation. I ordered three compound cathartic pills to be taken and tincture of iodine to be applied locally, also a large poultice. On Jan- uary 6th, the wound had increased to two and one-fourth inches in diameter, but was still entirely without the peculiar pain of hospital gangrene, when I ordered a mixture, consisting of half an ounce of hydrochloric acid, two ounces of laudanum, and one pint of water, to be used locally with lint. The acid wash was gradually diluted, and finally abandoned on January 25th. The patient being rather anaemic, I ordered two grains of quinine and four ounces of milk punch to be given daily. On Jan- uary 30th another abscess was opened, and on February 9th yet another, each being preceded by severe pain, tenderness, and swelling. No doubt they as well as the original one were the result of severe local periostitis. They were readily subdued by cathartics and poultices, with morphia at night. No bone was at any time discharged, although considerable depression existed on the tibia from absorption of the tissue. On February 20th, the patient was transferred to Brattleboro', the wound having almost entirely healed and there being but little depression." The man entered the Marine Hospital at Burlington, and on March 8, 1864, was assigned to the Veteran Eeserve Corps, and discharged July 13, 1865, and pensioned. Examining Sur- geon A. P. Belden, of Whitehall, N. Y., reported the wound as being in an inflamed condition, and added that "it opens at any time the limb is much used in standing or walking. There is adhesion of the peroneus longus muscle aud ligament, and inflam- mation produced partial anchylosis of the ankle joint." Examiner J. Lambert, of Salem, N. Y., August 10, 1878, reported that " the injured bone is necrosed for about three inches and demands an operation." The pensioner was paid September 4, 1880. In the next instance copious hsemorrhage followed the injury, and the femoral artery was successfully ligated in Scarpa's triangle: Case 660.—Private T. Dassel, Co. G, 60th Indiana, aged 25 years, was severely wounded in the right leg, at Arkansas Post, January 11, 1863. He was placed on board of a hospital steamer several days after the reception of the injury and con- veyed to St. Louis, where he entered Lawson Hospital, January 22d. Surgeon C. T. Alexander, U. S. A., in charge, reported: "The wound was located on the inner side of the upper third of the leg and the tibia was slightly injured. Haemorrhage to the amount of eight ounces occurred from the anterior tibial artery on February 20th, on account of which the femoral artery 430 INJURIES OF THE LOWER EXTREMITIES. [CHAP, x was ligated in Scarpa's triangle. Pyaemie infection also existed, which was successfully combated with the administration of quinine and brandy." The patient was discharged from service December 22, 1863, and pensioned. Examining Surgeon B. J. Day, of Evansville, Indiana, on April 25, lb'64, certified to the anterior wound as "still discharging," and reported the same as "recently healed, in September, lt'Oo, leaving a deep and adherent cicatrix." Examiner I. Casselberry subsequently certified: "The ball injured the tibia without fracturing it." At later examinations chronic inflammation of the bone and the impaired usefulness of the leg was described. The pensioner was paid March 4, 1880. Fatal Cases of Shot Contusions of the Bones of the Leg treated by Conservation — Fifteen of the one hundred and sixty-five cases of this group proved fatal: Case 661.—Private J. Buchfinck, Co. A, 16th Michigan, aged 26 years, was wounded at Poplar Grove Church, Septem- ber 30, lfcf>4. and admitted to the field hospital of the 1st division, Fifth Corps, with "severe wound of left leg, caused by a musket ball." A week later the man was transferred to Harewood Hospital, Washington, whence Surgeon R. B. Bontecou, U. S. V., contributed the specimen and reported the result of the case: "The leg was wounded in the lower third, the ball passing anterior to the tibia and injuring the periosteum. The patient, although weak, did tolerably well up to October 13th, at which time the parts became gangrenous, destroying the tissues from the ankle joint to the upper part of the middle third of the leg and leaving the tibia exposed for about six inches. Under the application of escharotics the wound became healthy and the limb improved until January 2,1665, when gangrene reappeared and the tissues of the heel commenced sloughing, the exposed tibia being necrosed and exfoliating. In addition to escharotics the treatment was supporting throughout. The patient died of exhaustion January 26, 1865." The specimen (No. 3609, Surgical Section, A. M. M.) consists of the tibia, and shows one longi- tudinal half of the bone to be necrosed and nearly separated, the other portion being sheathed with callus. Case 662.—Corporal T. N. Chapln, Co. H, 21st Michigan, aged 35 years, was wounded at the battle of Stone River, January 1,1863, and admitted to the field hospital of the 1st division, Fourteenth Corps, with "shot wound near the left ankle." Assistant Surgeon C. C. Gray, U. S. A., contributed the specimen {Cat. Surg. Sect., 1866, p. 375, Spec. 1916), with the following history: "The ball entered at the inner side of the middle of the calf of the leg, passed obliquely downward under the bone, and came out a little above and posterior to the malleolus. The patient was admitted to hospital No. 8, Nashville, January 19th, his wound being erysipelatous, with great swelling of the entire leg. Gangrene invaded the limb so as to destroy the soft struct- ures covering the tibia for nearly half way around the leg, and from within two inches of the insertion of the tendon of the patella to a point about three inches from the ankle joint. The bone was exposed and became badly necrosed. Chlorinated solution of soda in its full strength, and applied with picked lint, was used three times a day in the treatment, with general stimulants, bromine being used in the room as a general fumigant. The gangrene was arrested in about four weeks. The patient died June 1, 1863. Two weeks previous to his death granulations were feebly struggling to extend over the diseased bone, much of which was covered. The patient's general condition had become very low; his stomach refused almost every- thing, and the first symptoms of hydrothorax presented themselves. The autopsy disclosed the chest full of serum, also slight recent pleuritic adhesions." The specimen shows the diseased portion of the contused tibia encircled with a fringe of callus. Case 663.—Private N. Hollenbeck, Co. F, 7th New York Heavy Artillery, aged 37 years, was wounded at Tolopotomy Creek, May 30, 1864. He was admitted to Emory Hospital, Washington, June 8th, with "shot wound of left leg, over tibia." Acting Assistant Surgeon A. McLetchie contributed a specimen {Cat. Surg. Sect, 1866, p. 519, Spec. 3133), with the following report: "The wound was caused by a mini6 ball, which entered the leg directly over the spine of the tibia, middle third, injuring the periosteum but not splintering the bone itself. The missile was extracted through the wound of entrance. The wounded man was admitted to Patterson Park Hospital, Baltimore, June llth. He was in a very asthenic condition, and I ordered stim- ulants and good nourishing diet. About the 18th of June gangrene set in, manifesting itself by constitutional symptoms, fever, loss of appetite, etc., some days before the distinctive symptoms appeared in the wound. The disease was treated with nitric acid, cautery, dressings of.chlorinate of soda, linseed poultices, charcoal, turpentine, and linseed oil, with frequent use of the syringe. On August llth, he was returned from the gangrene ward with the wound much enlarged, but entirely free from gangrene, and nearly four inches of the bone exposed. Tincture of chloride of iron was administered daily, and milk punch, from the first appearance of the disease. Diarrhoea, which had been checked on his entrance into the hospital, now set in again, complicated with acute dysentery, and was treated with chalk mixture, vegetable astringents, and pulverized iron and opium. But the patient gradually wasted away from the steady strain on his system, and died August 26, 1864." The specimen is a wet prep- aration of the leg, showing a contusion in the middle third of the tibia, and necrosis extending up the shaft of the bone on its posterior surface to near its head, also two openings from ulceration in the lower third. Shot Contusions of the Bones of the Leg followed by Amputations.—In eighteen instances the shot contusions of the bones of the leg were followed by amputation: eight in the leg, one at the knee joint, and nine in the thigh. The cases of amputation in the thigh and at the knee joint have already been cited in Sections 2 and 3 of this Chapter.1 The cases of amputation in the leg will be briefly reported: •Amputations in the thigh for shot contusions of the bones of the leg: Corp'l S. B. Besley, H, 147th New York (TABLE XXXIX, Ko. 6, p. 313), secondary, middle third; recovery. Pt. C. C. Cannivan, G, 88th Pennsylvania (TABLE XL, Ko. 123, p. 321), secondary, lower third; fatal. Pt. C. P. Cobb, F, 1st Michigau (TABLE XXXIX, Ko. 113, p. 315,, secondary, middle third; fatal. Serg't H. A. Colby, G, 2d U. S. S. S. (TABLE XL, Ko. 125, p. 321), secondary, lower third; fatal. Pt. J. C. Lemar, B, 97th Illinois (Table XXXIX, Ko. 136, p. 315), secondary, middle third; fatal. Serg't Z. H. Mather, M. Sth Michigan Cavalrj' (Table XXXVI, No. 476, p. 300), intermediary, lower third; fatal. Pt. J. Moran, 1, 6th New York (Table XXXI, No. 979, p. 238), primarj-, middle third; fatal. Corp'l E. McGinley, I, 23d Wisconsin (Table XXXVI, Ko. 126, p. 295), intermediary, lower third; recoveiy. Corp'l S. H. Powell, C, 14th Kew Jersey (Table XL, No. 77. p. 321), secondary, lower third; recovery. Amputation at the knee joint for shot contusion of the tibia was performed in the case of Pt. W. W. Sandford, F, 103d Pennsylvania (Table LVI, No. 43, p. 407), intermediary; fatal. sect, v.] AMPUTATIONS AFTER SHOT CONTUSIONS OF THE BONES OF THE LEG. 431 Case 664.—Sergeant K. T. Beatty, Co. H, 22d reimsylvania Cavalry, aged 27 years, was wounded in the right leg, at Mount Vernon Forge, September 27, 1864, by a musket ball, which injured the tibia. He was discharged from service for dis- ability, December 20, 1804, and pensioned. Extensive necrosis followed the injury, finally involving nearly the entire shaft of the tibia and rendering amputation necessary. The operation was performed, December 27, 1865, below the knee, by Pension Examining Surgeon C. A. Rahter, of Harrisburg, Penn., and resulted successfully. .In his application for commutation, the pensioner described the stump as being in a fair condition. Cask. 665.—Private W. Bell, Co. I, 7th Michigan, aged 34 years, was wounded in both lower extremities and the head, at Antietam, September 17, 1862, one ball grazing tbe right tibia and fibula on their posterior surfaces just above the ankle joint. The patient became a great sufferer from extreme irritation of his nervous system and great irritability of the stomach. Repeated appearances of gangrene necessitated amputation, which was performed on November 3d, about one inch below the tubercle of the tibia, by Surgeon J. 0. Bronson, U. S. V. Under the administration of vigorous tonics and strong stimulants, including narcotics, the patient gradually improved, and was able to start for his home December 5, 1862, when he received his discharge from service. He died March 30, 1874, of typhoid fever. A ligamentous preparation of the bones of the foot and the lower portion of the leg constitutes specimen 254 of tbe Surgical Section of the Museum, contributed by tbe operator. Case 666.—Private J. L. Hosford, Co. H, 4th Vermont, aged 21 years, was wounded at the Wilderness, May 5, 1864, by a musket ball, which entered the right leg, striking the tibia above the malleolus and lodging. He was admitted to Camden Street Hospital, Baltimore, where, on May 21st, an abscess was opened, through which the missile, together with several pieces of bone, were discharged. Considerable erysipelatous inflammation followed, attended with profuse and very fetid discharge, and tbe limb became exceedingly painful, necessitating its removal. The operation was performed by the skin-flap method, at the middle third, by Surgeon Z. E. Bliss, U. S. V., on May 31st. The patient recovered and was furnished with an artificial leg. He was discharged March 20, 1865, and pensioned. Case 667.—Private J. Esses, Co. K, 108th Ohio, aged 16 years, received a gunshot contusion of the right tibia, near Kenesaw Mountain, June 23, 1864. He entered hospital No. 2, Nashville, where flap amputation of the leg at the upper third was performed, by reason of gangrene, on July 26th, by Acting Assistant Surgeon J. A. Hall. The patient recovered, and was discharged May 22, 1885, and pensioned. Four of the eight cases of amputation in the leg for shot contusions of the tibia or fibula had fatal terminations: Case 668.—Private J. Dicey, Co. F, 17th Michigan, received a flesh wound of the left thigh and a contused wound by a shell on the fore part of the middle of the right leg,.at Antietam, September 17, 18(52. He entered Casparis Hotel Hospital, Washington, October 13th, with the latter wound in a gangrenous condition and the tibia denuded of periosteum for four or five inches. The best antiseptic remedies failing to check the spreading of the disease, the limb was amputated on October 21st, by Acting Assistant Surgeon L. Heard, some five or six inches below the knee. The patient was very feeble and failed to rally. He died October 24, 1862. The amputated bones of the leg were contributed to the Museum by the operator, and constitute specimen 212 of the Surgical Section, A. M. M. Case 669.—Private G. Wilson, Co. B, 1st Ohio Artillery, aged 21 years, was wounded in the left leg, at Chickamauga, September 20, 1863. Acting Assistant Surgeon M. L. Herr, who amputated the injured limb at hospital No. 1. Nashville, contributed the specimen (Fig. 259), with the following history: "The injury was caused by a mini6 ball, which passed across the crest of the tibia at its middle third, merely cutting the tissues covering it and slightly injuring the bone. The man bandaged his wounded leg and remained with his regiment about a week, when the limb became very sore. He was then sent to hospital at Stevenson, Alabama, where he remained until he came here on October 14th. On examination I found the tibia denuded of periosteum for about four inches below the wound and for some distance above. The integuments were in a highly inflammatory condition, excessively painful, and suppurating freely, the pus being of a very offensive character. The patient was pale, though not much emaciated; his appetite good; bowels costive. Tincture of chloride of iron and whiskey were prescribed. The leg was bandaged from foot to knee so as to maintain equable pressure, and constant application of cold water was made. He continued to grow worse, the leg being very painful and tbe discharge very profuse, and on Octo- ber 25th I found upon examination that the patient also had hypertrophy of the heart, from which he suffered considerably. On November 2d, I observed hectic or indication of irritative fever for the first time. His appetite was still good, and he complained of no pain except in the leg; but he was very weak and pale. Quinine, with morphia, was administered every three hours. On November 6th, the patient having expressed his wish of taking advantage of surgical interference, the limb was amputated at the upper third. Chloroform and sulphuric ether constituted the anaesthetic. No reaction took place, and tbe patient died the next morning. At the post-mortem examination four ounces of watery fluid were found in each pleural cavity, with slight pleuritic adhesions on the right side and small multiple abscesses through both lungs, the posterior portion of each being engorged. Some of the abscesses contained an inspissated matter or pus, not well broken up. The heart was very much enlarged and weighed seventeen and a half ounces; the pericardium contained two or three ounces of fluid, but the valves were Portion of left not diseased. Four or five large abscesses were found on the anterior surface of the right lobe of the liver, which tibia amputa- i-i -, , ,/. n „ m, • • „...,.,.,. , , , ted for shot organ contained eight and a half ounces of pus. The specimen consists of the injured tibia, being thoroughly contusion. denuded of periosteum and necrosed iu its greatest extent. Spec'1920, Case 670.—Corporal G. L. Stephens, Co. I, 30th Maine, was wounded at Cane River, April 23, 1834, by a musket ball, which entered the left leg, injuring the tibia but not fracturing it. One week after receiving the injury he was admitted to hos- pital at Baton Rouge, where the missile was extracted from the calf the leg on May 15th. By reason of erysipelatous inflam- mation of the foot and leg, attended with sloughing ulceration, circular amputation of the leg at the middle third was performed, on August 2d, by Surgeon D. W. Taylor, 34th Indiana. The patient died August 15, 1864, from exhaustion. 432 " INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Cask 671.—Captain F. L. Thompson, Co. D, 36th Mississippi, aged 2!) years, was wounded at Nashville, December 16, 1864, by a musket ball, which entered the right leg over the anterior aspect of the tibia, five inches above the ankle joint, passed downward, and lodged directly over the dorsum of the foot. Erysipelatous inflammation ensued; the ankle joint opened; tibia denuded of periosteum. On December 31st, the patient suffering from much pain and'being apparently threatened with tetanus, the leg was amputated, by the circular method, at the junction of the upper and middle third, by Acting Assistant Surgeon ('. H. Fisher. The patient was much emaciated, and died of exhaustion January 9, 1865. SHOT FRACTURES OF THE BONES OF THE LEG.—Eight thousand nine hun- dred and eighty-eight cases of shot fractures of the bones of the leg are reported, and the results have been ascertained in all but two hundred and seventy-eight cases. The tibia was injured in two thousand five hundred and eighty-eight, the fibula in one thousand and thirty-three, the tibia and fibula in one thousand four hundred and fifty-one instances, and in three thousand nine hundred and sixteen cases tbe diagnosis failed to indicate the precise seat of the bony lesion. Table LXI. Numerical Statement of the Nature and Treatment of Eight Thousand Nine Hundred and Eighty-eight Shot Fractures of the Bones of the Leg. TREATMENT. Cases. Fractures of the Tibia. Fract. of the Fibula. Fractures of the tibia ano Fibula. Bone not Spe-cified. 8 > o « *2 a en 0> K-3 Cm >> o.t: .2 "3 II M > O O 3 £1 0 rt 721 119 2 3 78 41 1 1 1 5 «| 7 0 rt Fatal. ResuTfUnY determined. > 0 0 rt "3 s1 11 (21 3,938 339 19 2 5 22 1 3,728 3 39 100 7 785 3,296 248 15 2 10 1 2,354 o 19 40 3 344 528 87 4 2 3 12 114 4 13.8 25.9 21.0 100. 60.0 54.5 1,737 109 11 201 39 1 34 2 295 19 2 75 7 2 1 1 2 4 543 1 174 69 Followed by Excision in the Bones of the Leg................ Excision in Bones of Leg1 and Amp. of Leg...... Excision in Leg—Amp. in Leg—Amp. in Thigh.. 2 5 1 4 5 Excision in Leg—Amp. in Thigh................ 1 Excision nt the Knee Joint...................... 1 539 1 9 15 2 130 1,215 1 20 59 4 441 159 1 34.0 33.3 51.2 59.6 57.1 56.1 151 88 1 8 13 206 10 1,656 1 6 14 I 137 2, 359 908 1 11 26 2 217 148 Amputation in Leg—Amp. at Knee Joint........ Amputation in Leg—Amp. in Thigh............. 3 11 3 20 1 1 6 13 109 Amputation at Knee Joint....................... 69 95 8 864 20 160 9 .... 1 mY 8,988 6,334 2,376 278 27.2 14 1, J40 ~± 1 2 588 1,033 1,451 ! 3,916 Three thousand nine hundred and thirty-eight, or less than one half of the cases, were treated by conservation, and five thousand and fifty, or 56.2 per cent., were followed by operation, viz: three hundred and forty by excision, forty-eight by excision and subse- quent amputation, and four thousand six hundred and sixty-two by amputation either in the leg, at the knee, or in the thigh. It has already been stated on page 175, ante, that of the six thousand five hundred and seventy-six instances of shot fracture of the thigh bone, operative interference was resorted to in three thousand one hundred and nine, or 47.3 per cent., thus showing that the percentage of operations after shot fractures of the bones of the leg exceeded that after shot fractures of the femur by 8.9 per cent. SHOT FRACTURES OF THE BONES OF THE LEC TREATED BY CON- SERVATION.—The results as to fatality were ascertained in three thousand eight hun- dred and twenty-four of the three thousand nine hundred and thirty-eight shot fractures of one or both of the bones of the leg treated without operative interference, giving a mortal- SECT. v.| SHOT FRACTURES OF THE TIBIA TREATED BY CONSERVATION. 433 ity rate of 13.8 per cent. In seven hundred and eighty-six cases the seat of injury was not specified; in the remaining three thousand one hundred and fifty-two cases the tibia was implicated in nineteen hundred and seventy-two, the fibula in eight hundred and six, and both bones in three hundred and seventy-four instances, with death rates of 10.3, 7.8, and 20.3 per cent., respectively. SHOT FIJACTURES INVOLVING THE TIBIA TREATED BY CONSERVATION.--The tibia alone Was involved in nineteen hundred and seventy-two instances, or in over one-half of the total number of cases of shot fractures of the leg treated conservatively. Of the nineteen hun- dred and thirty-eight instances in which the results were determined, two hundred and one proved-fatal, a mortality of 10.3 per cent. Recoveries after Shot Fractures of the Tibia treated by Conservation.—A few of the one thousand seven hundred and thirty-seven instances of this group will be detailed: Case 672.—Private J. Wells, Co. G, 71st Pennsylvania, aged 26 years, was wounded in the right leg, at Spottsylvania, May 12, 18li 1. He entered Columbian Hospital, Washington, and was subsequently transferred to Harewood Hospital. Surgeon R. B. Bontecou, U. S. V., in charge of the latter, contributed the photograph {Card Photographs, Vol. 3, p. 30, A. M. M.), and reported that the patient was discharged from service June 29, 1865, by reason of "shot comminuted fracture of the tibia at the middle third." Examiner C. C. Halsey, of Montrose, Penn., December A. 1865. certified to the injury, and stated: "The wound at point of entrance is not sound and the skin for from two to three inches around it is a mass of scabs and sores. He complains of pain about the ankle and foot." The man drew pay as a full pensioner until September 4.1866, after which time he ceased to communicate with the Pension Office for nearly thirteen years, when he reapplied and was restored, having in the meantime changed his resi- dence to the State of Mississippi. Examiner T. G. Birchets, of Vicksburg, reported, February 16, 1880: "The wound is about the middle of the shaft of the tibia, resulting in a very large scar, and, from feeling, there has been loss of bone. His personal appearance is healthy. There is no disability." The pensioner was paid March 4,1880, having his rate, in consequence of the last Examiner's report, reduced from total to one-fourth. Cask 673.—Private W. Kelly, Co. C, 149th New York, aged 30 years, received a shot fracture of the left tibia by a mini6 ball, at Williamsport, July 11, 1863. He was admitted to Frederick, and subsequently passed through various hospitals, being ultimately discharged from service at Harewood, Washington, June 19,1865. Surgeon R. B. Bontecou, U. S. V., in charge of the latter hospital, contributed the photograph represented in the annexed cut (Fig. 260), and reported that the patient's disability was total. Examiner G. W. Cook, of Syracuse, N. Y., February 25, 1867, certified to "shot wound of left leg at middle third, fracturing the tibia. A part of the bony substance' was removed, leaving a large and extensive excavation, cicatrix, and deformity, with several minute fistulse. Abscesses frequently form; the knee is stiff and the leg bad." Subsequent examiners report the same description of the injury and its results. The pensioner was paid March 4,1880. Case 674.—Private S. Prillaman, Co. G, 24th Virginia, aged 28 years, was wounded and captured at Williamsburg, May 5, 1862. He was admitted to Camden Street Hospital, Baltimore, nine days after the injury, whence Acting Assistant Surgeon E. G. Waters reported the following history: "A bullet entered the anterior and inner aspect of the left leg five inches above the ankle joint, fracturing the bone at that point through its continuity and comminuting the entire shaft for four inches upward, where a second solution of the continuity was produced. The missile on coming in contact with the bone separated into three portions, one passing inward, backward, and slightly upward, and emerging posteriorly through the calf of the leg; the second passed upward, backward, and outward, lodging under the integuments on the outer aspect of the leg; the third passed into the canal of the shaft, then upward, destroying tbe continuity of the bone and lodging some four inches above the point of entrance. The two last mentioned fragments were subsequently discovered and removed. When admitted the patient was much broken down in health, having little or no appetite and his complexion being sallow. The leg was much swollen and discharging profusely. It was placed at once in the anterior splint and emollient poultices were applied. Some days later the limb below the knee assumed a livid hue, giving rise to apprehensions of gangrene. This appearance, however, readily yielded to the free exhibition of quinine and stimulants, with cataplasms of bran and yeast applied locally, and the attempt to save the limb was persevered in. On June 24th, the patient was put under the influence of chloroform and the denuded fragments of bone were removed. The centre of the entire length of the fractured shaft was taken out, leaving only a thin scale on each side attached to healthy periosteum. It was hoped that nature would fill the cavity thus left and consolidate the limb. This expec- tation was fully answered in the sequel. During his stay in the hospital the patient suffered nine distinct attacks of erysipelas, several of them being of extraordinary severity, even for cases of gunshot fracture, the writer having had under his care nearly two hundred cases of the disease resulting from such causes and met with not more than two or three of equal violence. The first attack came on about July 1st, extending no higher than the knee, and yielding after five days treatment. Ou September 28th, the patient was suffering from the fifth attack, and several fistulous orifices were noticeable over the anterior aspect of the SUKG. in—55 Fig. 260.—Shot fracture of left tibia. [Fi'om a photograph.] 134 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. leg, between the point3 of the fracture, through which the probe detected necrosed bone. It was then deemed expedient to remove several more detached fragments of bone, and with this view the fistulous orifices were dilated and a number of pieces were seized and withdrawn. Afterwards the leg became enormously swollen and the discharge grumous and offensive. The tissues around the knee joint also began to sympathize with the general disturbance and swelled to twice their natural size. About October 6th, fluctuation manifested itself over an extensive surface about the joint, when a bistoury was carefully intro- duced to the depth of an inch, giving exit to a quantity of sero-purulent fluid. The patient was actively plied with stimulants and tonics, the leg was maintained in the suspensory splint, and bran and yeast cataplasms were kept constantly applied, under which treatment the inflammation and swelling rapidly subsided, the discharge soon became healthy, and the patient's strength and spirit revived. He finally recovered with a strong and fine limb, an anchylosed knee joint, and a semi-flexed leg. On June 27, 1863, he left the hospital cured, to be sent south, having been for thirteen consecutive months under my care. All of the sinuses (of which there were many) had healed prior to his discharge except two, and these were satisfactorily ascertained not to communicate with dead bone but with aponeurotic expansions. Bony union had taken place to an ample extent, the entire canal of the shaft—which as above stated had been opened for the distance of four inches—being filled in its entire depth with new osseous tissue." This patient was heard from at his home in Franklin County, Virginia, in 1877, fifteen years after the injury, when his condition was described in a letter as that of a "had cripple." Case 675.—Private T. Schrup, Co. B, 10th New York Cavalry, aged 22 years, was wounded in the left leg, near the South Side Railroad, April 2,1865. He was conveyed to the Depot Hospital at City Point two days after the injury, and transferred to Washington April 30th. Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, contributed the photograph shown in the adjoining cut (FlG. 261), and described the injury as "a shell wound, severely fracturing the tibia, lower third. On admission the patient was in good health; condition of injured parts good, although severely lacerated. Treatment: Simple dressings, splints, and supporting diet. The parts healed kindly, and the patient was doing well when transferred to Lincoln Hospital, July 20, 1865." He was discharged from service, at the latter hospital, August 12, 1865, Surgeon J. C. McKee, U. S. A., certifying to "partial paralysis of the left foot and leg, resulting from the wound." Immediately after being discharged the patient made an application for pension, and was examined by M. D. Ben- edict, Pension Examining Surgeon, who described the fractured bone as "united with slight shortening and some deformity," and the limb as useless for the time being. The man has not been heard from since filing his application. Case 676.—Sergeant J. R. Rice, Co. K, 1st Vermont Cavalry, aged 30 years, was wounded in a cavalry charge between Hagerstown and Williamsport, July 6, 1863, by a mini6 ball, which entered the outer aspect of the lower portion of the right leg, fracturing the tibia and lodging in the bone. Two days after the injury he was admitted to hospital at Frederick, whence Acting Assistant Surgeon W. S. Adams reported as follows: "The patient was admitted under care of Acting Assistant Surgeon W. P. Morgan, who removed a few fragments and placed the limb in Smith's anterior splint. His general condition was good. On July 22d the patient came under my care, when I found that he had considerable irritative fever; tongue disposed to be dry; slight diarrhoea and but little appetite; lower third of left tibia. [From limb painful and oedematous. I took off the splint to examine the limb and removed several frag- a photograph.] ments of bone and the missile, which was found embedded in the medullary cavity about two inches below tbe point of the injury. Stimulants, with tonics and good diet, were ordered. By August 1st, the appearance of the limb had much improved, the patient having experienced but little pain since the removal of the ball; appetite and general condition improving. On August 14th, his countenance had assumed a sallow appearance, and he had a slight headache, accompanied by constipation of bowels, for which three compound rhubarb pills were administered. Three days later there was well-marked jaundice, when pills of blue mass and compound extract of colocynth were prescribed. By August 21st, the jaundice was disappearing; condition of leg good. On September 1st, union of bone seemed quite firm; wound yet discharging quite freely. The limb now was allowed to rest on pillows during the day time and suspended in splints at nights. On Septem- ber 20th, the splint was removed from the leg, union being firm, with no evidence of necrosis, and the wound healing kindly. About October 1st, the patient was going around on crutches, and two weeks later he laid these aside and walked with a cane, the wound having all closed with the exception of an opening barely large enough to admit a probe. On February 1, 1864, the patient was furloughed, having been able for a considerable time to walk without the aid of a cane and the wound being healed." He was subsequently promoted to Lieutenant, and ultimately mustered out of service June 21, 1865. In 1876, when applying for pension, he was examined by Surgeon C. B. Currier, of Middlebury, Vermont, who reported that "from loss of bone there is a depression as large as a twenty-dollar piece and about one-eighth of an inch deep; cicatrix tender to the touch; oedema of leg and foot; leg one and a half inch shorter than the other; muscles of leg flabby and evidently weak. He cannot stand or walk much; health good." The pensioner was paid September 4, 1880. Case 677.—Captain W. W. Ellis, Co. D, 61st Pennsylvania, aged 23 years, was wounded in the left leg, at Chancellors- ville, May 3,1863, and entered Douglas Hospital, Washington, five days afterwards. Assistant Surgeon W. Thomson, U. S. A., reported: "This officer suffered a fracture of the tibia near its middle by a ball, which entered posteriorly at the gastrocnemius muscle, and was retained. The fracture united without exfoliation, necrosis, or even free suppuration. The leg was placed in a bran box and dressed with cold-water applications. The patient suffered from severe catarrh, which "yielded to treatment. There was also hyperassthesia of the foot, for which, before the patient left on furlough in June, I made an incision in search of the ball and disturbed the cicatrix with good effect, relieving the nervous irritation of the foot. When the patient returned from furlough, September 1st, he was ordered to report to Surgeon M. Clymer, U. S. V., for treatment, and I lost sight of him. His recovery was good, but the leg was yet feeble and contracted, owing to want of passive motion while at his home." Cap- tain Ellis resigned January 1,1864, and was commissioned in the Veteran Reserve Corps, in which organization he served until ':,<<,} a A . V"<:!'* ■*'' $ "'.. :;.;. ' . '•' ;'■ 'I'*' ' '•' *:" ,. PLATF uXXIV. UPP£P< POR ! L'. l>"!< ; V» v. j (,,:,•• Y I (tlLll. I ' 'li" '■ .. ^; V',;'• V .'-*'' y ' ■'' ' • W •' * v \V* Yv '' l^: • ■'., V-.-jflv^i• ■.. V. \ ayr M"»C. ■■■'''■ •'■■' ":',; ■' 'jii-l' .■■i.rtvi' 'S ■'■■'•. 'V.', ,;* 4' v,.v ■':©;' *■■■"*'': ."%:% 'Y. jf ■. ' ,*^: % ■';!:■"• !'.v'' ■'t ■;:■:,■* •■ '*■'. ■ ■ # ■ v *•$'■<* ■■■■■■ L-& y'|a * ■'*■ '/'j^ '. ••■faT ■ ' ?.■/■<;-4. .''«' ■:• ■•. >'.f",;V '.( •'• '• '' VlHJ' a-aY .A I'll! !• ! W'll. -. !l .. | Yv:p,Y, ; A fwJt ' .■' ,. ) "'\-^ ri, Onl. I,ir,' ' r , a iil.-v uf'i! ; t Y ' >■ Ol ' U.iv '.■ A the ;i,;m -•■ .111-':. •■ <. ■'.' ■ ?a:i::- i.'1 •i.M'uVvd, >'• Il' !•• ' , e,.p..'{ ..,-.• : >.m :j>. On . • i >Ufll-!l:iti" ■■■ .vhich.threi •■ " ....:»« ::rY ■■ ."«..d. <";-■* •>!! i)i:i .(.-.iu ■•mi rr,,i tl ja.. * ''. \.-e r. \ i " In.me-.li.iie' v ,e 1-yll. IJ. B..-.'. . Yjht tdior'mhi: 1 ..■■ >■;. iie.,rd f'i ,.'■! a. ■• i. ;-i i,.i ;i|:ii. in: .' .• . i. ' ! il- ,j ;>el e; : lt-f.|.a. •',[ ., , . ,;lJ fn,p.. } i..'\ ry .il.i.M1 : ■--.■ mobo '-' l':" .Ipp' .1' , il :i ' f CM' i: ; pp-. ;-t . ■. i iiii'i ,' . , (r! il-;. |I ■ ■ ■■'. . •■ • '■ c scharL'n : ...I. Yr, S •; '-ni ' ' n!.!i.' ) Y in Teb; uai v • , irv ., ■ ni the wouu<. ..«-»:• _• 1-<&",. In laC6, whc.i : f from ]:<'* nt'bone '.• 'hit fi/iH'li; iedema ' I'- ir.r.v ; stand or .o.'7H4 , Sin y Sect AM M SECT, v.j SHOT FRACTURES OF THE TIBIA TREATED BY CONSERVATION. 435 March 13, 18C6, when he was mustered out and pensioned. Examining Surgeon G. Urquhart, of Wilkesbarre, Pennsylvania. August 22,18G6, certified to half an inch shortening of the limb; also to painfulness, weakness, and occasional lameness. Exam- iner J. W. Martin, of lied Oak, Iowa, reported, September 4, 1873: "There are large cicatrices on the left side of tbe tibia; leg bent and shortened; foot swollen and tender, and muscles shrunken above the ankle. He suffers extreme pain in the leg and is unable to bear much weight upon it; general health not good." The pensioner was paid September 4, 1880. Case (i?8.—Private J. Walker, Co. A, 7th Wisconsin, aged 27 years, was wounded at the Wilderness, May 6, 1864. Surgeon C. N. Chamberlain, U. S. V., reported his admission to the field hospital of the 4th division, Fifth Corps, with "shot fracture of left leg, caused by a mini6 ball." On May 12th, the wounded man entered Armory Square Hospital, Washington, where his injured leg was operated on by Surgeon D. W. Bliss, U. S. V., who made the following report of the case: "The ball was found embedded in tbe shaft of tbe tibia at about its middle, whence it was extracted on August 13th. The leg went through all the symptoms of necrosis of one or both the bones, the first signs of which appeared on August 19th. On October 10th, the patient was placed upon the operating table and four inches of the shaft of the tibia was removed, together with all the necrosed spicula of bone. Chloroform was used as the antesthetic. Simple dressings, stimulants, and nourishing diet constituted the treatment. The patient did well after the operation." He was discharged from service January 24, 1865, and pensioned. Examiner A. McBean, of Chippewa Falls, Wisconsin, certified, July 9, 1867: "The remaining portion of the bone from the ankle joint to within four inches of its head has become carious. A large open ulcer is the consequence." Examiner F. A. Reckard reported, March 4, 1874: "The wound is yet open and discharging from an orifice some four inches in length. The remainder of the tibia is badly diseased and portions have come away at different times. The limb is very much swollen at times and retains him in bed for months." The pensioner was paid March 4, 1880. The bone removed consists of a sequestrum six inches in length, and for four inches is tubular. It was contributed to the Museum by the operator, and is numbered specimen 3283 of the Surgical Section. The specimen is shown in FIGURE 2 of Plate LXXI, opposite page 428. Case 679.—Private A. Elmer, Co. I, 69th Pennsylvania, aged 21 years, was wounded at Petersburg, June 18, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported: "Shot fracture of left leg by minie" ball; anterior tibial artery divided. Ligation performed by Surgeon N. Hayward, 20th Massachu- setts." Surgeon B. B. Wilson, U. S. V., reported that the wounded man was admitted to Stanton Hospital, Washington, July 1st, with " shot fracture of left tibia, lower third," for which splints and simple dressings were used, and that he was furloughed January 4, 1865. Tlie patient was subsequently transferred to Satterlee Hospital, Philadelphia, whence he was discharged July 7, 1865, by reason of "lameness resulting from the injury," and pensioned. Examiner A. D. Newell, of New Brunswick, N. J., March 5, 1878. certified to the wound and fracture, and stated: "The bone is not sound now. The wounded leg is smaller. The tendo-achillis has contracted 60 that in walking his toes strike the ground—is quite lame." The pensioner was paid December 4,1879. In the following instance a portion of the missile remained lodged in the tibia, keeping the wound open until the time of the officer's death, twelve years after the injury: Case 680.—Colonel W. F. Lynch, 58th Illinois, aged 25 years, was wounded at Yellow Bayou, May 18, 1864. Surgeon G. L. Lucas, 47th Illinois, reported his admission to the field hospital of the 1st division, Sixteenth Corps, with "a bullet frac- ture in right leg; missile extracted by Surgeon J. E. Murta, 8th Wisconsin." From the field hospital the patient proceeded to his home, and, on February 7, 1865, he was mustered out by expiration of service. His condition at this time was described by Surgeon B. Norris, U. S. A., as follows: "The wound is a very remarkable one of the tibia, about two inches from the knee joint, being a perforation of the bone to the depth of more than an inch, and open as an augur hole. A fetid discharge escapes through the opening, and the soft tissues around it are inflamed over a circle of more than two inches in diameter. These signs indicate disease which can only be entirely removed by amputation of the leg. I further certify that in conse- quence of this wound his nervous system has become morbidly excitable and his health so much impaired as to unfit him for any regimental duty." About a year after his muster out of service Colonel Lynch received a commission as an officer of the Regular Army, and, on December 15,1870, he was finally placed on the retired list with the rank of Brigadier General. Acting Assistant Surgeon F. H. Atkins reported that this officer died, from the ultimate effects of his wound, on December 29, 1876, at Fort Lamed, Kansas, and contributed the pathological specimen numbered 6734 of the Surgieul Section, and represented in Plate LXXIV, opposite p. 434, with the following information in regard to the case: "A portion of lead was cut out on the inner aspect of the limb a long time after the injury, while another portion remained lodged in the bone. The wound of exit healed early, both the soft and osseous tissues; but tbe anterior wound remained open up to the time of his death, small pieces of dead bone being occasionally removed, and a profuse and extremely offensive discharge continuing. All efforts on the part of many able surgeons to induce tbe patient to submit to the removal of the dead or diseased interior of the tibia were futile until within three months of his death, when he desired an operation, which I refused in view of his previous disease and present prostration, a position concurred in by Assistant Surgeon W. S. Tremaine, U. S. A., who saw him during consultation on December 11, lir76. Meanwhile, in the winter of 1875-6, he had a serious illness, apparently of pysemic character. About July 1, 1876, a severe pneumonia, followed by diarrhoea, nearly proved fatal, and after that there was constant diarrhoea and almost complete interrup- tion of the digestive functions. From October until his death the apparently tuberculous disease in bis left lung progressed rapidly, a large cavity forming. His death seemed to result from inanition. No general autopsy was permitted, though the upper half of the tibia was allowed to be removed. The bone was ripped by a saw longitudinally, the incision running obliquely backward and inward to avoid cutting the wound of entrance. A condition of the bone was displayed which, in my opinion, would have given prompt and absolutely favorable results had excision of the diseased portion been performed at any time prior to tbe winter of lb75-6. A cavity averaging one and one-fourth inch in diameter, and located most favorably for removing the dead bone successfully, was found directly behind the wound of entrance. The cavity was lined throughout by a membrane continuous with the edges of the soft tissues and the skin. The dead bone approached the surface of the tibia rarely as near as one-third of an inch, and the knee joint about one inch, extending only one-half to three-fourths of an inch below the wound of entrance. At the lowest part of the cavity, on the posterior segment, there was a group of black masses, white internally. A 4:W INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 262.—Shot fracture of upper third of Ipft tibia. Spec. 3549. FIG. 263.—Shot fracture of right tibia. Spec. 3549. minute portion of this substance, treated w ith carbonate of soda on charcoal under the blowpipe, gave numerous metallic globules malleable under pressure, showing that the mass was part of the missile—now carbonate of lead within and sulphuret without. The upper third of the tibia was greatly hypertrophied." Fatal Cases of Shot Fractures of the Tibia, treated by Conservation.—Two hundred and one cases of this group were reported, the fatal issue being generally ascribed to pysemia, gangrene, or exhaustion: Case 681.—Private I. D. Mason, Co. D, 17th Maine, aged 30 years, was wounded at the Wilderness, May 5, 1864, by a musket ball, which entered the external aspect of the left leg, fracturing the tibia immediately below its head, passed into the right leg about two inches lower down, fracturing the right tibia also, and lodging. The wounded man was treated at Fred- ericksburg until May 25th, when he was admitted into Douglas Hospital, Washington, in a typhoid Btate. Death took place from exhaustion May 31,1864. The upper halves of the bones of both legs are represented in the adjacent cuts (FlGS. 262, 263), exhibiting each tibia to be shat- tered in the upper third, and showing incipient necrosis as the only observable change. The history and the specimens were contributed by Assistant Surgeon W. Thomson, U. S. A. Case 682.—Corporal W. Smith, Co. K, 1st Louisiana, aged 18 years, was wounded at Gettysburg, July 2, 1863, by a musket ball, which fractured the left tibia at the lower third. On July 27th, he was adipitted to Camp Letterman, the leg being considerably swollen and painful. Acting Assistant Surgeon P. S. Leisenring reported that the limb was placed in a fracture box and solution of lead and opium applied. On August 6th, the use of flaxseed poultices was com- menced, and an abscess opened posterior to the wound. After this there was some improvement. On August 18th, the fracture-box was removed, and four days later the patient was able to move his limb. The administration of febrifuge remedies, including quinine, was subsequently prescribed, the patient having a severe chill on August 25th. Another abscess, forming anterior to the tibia, was lanced several days afterwards, after which there was improvement for some days. On September 14th, the patient came under the care of Assistant Surgeon R. G. Southall, C. S. A., who found him very much emaciated and with several ulcers on the leg. The patient was also troubled with diarrhoea and had lost his appetite. Under the administration of tonics, stimulants, and astringents, and the application of stimulating lotions and nitrate of silver, the patient slowly mended until September 22d, when the ulcers assumed a phagedenic form and the improvement ceased. On September 28th, two spiculse of considerable size were removed from the tibia. Acting Assistant Surgeon W. M. Welch reported the termination of the case as follows: "The case came under my charge on October 13th. The bone had united, but the leg presented two ulcers near the region of the wound, which had sloughed largely. Nitric acid applications were resorted to, under which treatment the leg improved until October 24th, when the ulcers again became phagedenic and nitric acid was again resorted to. Bromine was also used, but neither remedy produced any salutary effect, (lie patient's system lacking sufficient vitality to separate the sloughs from the living tissues. The patient also continued to be a sufferer from obstinate diarrhoea, which baffled all treatment. He died from exhaustion November 3, 1863. On examination, the fractured portion of the tibia was found to be very feebly united; callus insufficient in quantity and unhealthy in quality. The proximate portion of the fibula was also diseased." The lower third of the bones of the wounded leg, represented in the cut (Fig. 264), were contributed to the Museum by Acting Assistant Surgeon E. P. Townsend. The specimen, to which a sequestrum remains attached, shows the fractured shaft of the tibia to have been invaded by caries to a considerable degree and a large portion of it lost by suppuration. Case 683.—Private J. Guy, Co. D, 39th North Carolina, aged 19 years, was wounded in the left leg, at Stone River, December 31, 1862. Surgeon C. W. Horner, U. S. V., reported: "The injury was caused by a conical ball, which passed from the inner to the outer aspect of the middle third of the leg, producing a comminuted fracture of the tibia and carrying away one and a half inch of its shaft. The man was captured soon after the reception of the wound aud carried to hospital at Murfreesboro', where he remained until August 1, 1863, when he was sent to the Prison Hospital. According to his statement no splints had been applied to the limb. On January 4,1864, the patient was adinitted to Hospital No. 1, at Nashville, at which time he was very much reduced, even to emaciation, numerous and large abscesses having formed about the leg and particles of bone being brought away with the discharge from the wound. The upper fragment of the tibia was displaced outward and forward, and an interval of about an inch existed between it and the lower fragment. The head of the fibula, too, was displaced upward and outward, and the slightest motion of the limb produced excessive pain. The patient had no appetite; stomach irritable; pulse quick and weak. Erysipelas also supervened, and severe cough and diarrhoea. The former was checked and the wound healed; but the cough and diarrhoea continued troublesome and persistent. The pulmonic trouble became more aggravated, and the patient died February 15, 1864." The bones of the injured leg, represented in the annexed cut (FlG. 265 \ were forwarded to the Museum by Acting Assistant Surgeon R. T. Higgins, and a cast of the limb, taken some weeks prior to the patient's decease, and contributed by Ass't Surgeon C. J. Kipp, U. S. V., constitutes specimen 6683 of the Surgical Section. Fig. 264.—Shot fracture of lower third of left tibia. Spec. 1936. FIG. 265.— Por- tions of the bones of the leftleg, witli shot fracture of tibia at junction of middle and upper thirds. Spec. 2184. SECT. V.) SHOT FRACTURES OF THE FIBULA TREATED BY CONSERVATION. 437 SHOT FRACTURES OF THE FIBULA TREATED BV CONSERVATION.--The results of the injUlieS were ascertained in seven hundred and ninety-nine of the eight hundred and six cases of this group. Seven hundred and twenty-one recovered and seventy-eight died, a mortality of 9.7 per cent. Examples of Recovery after Shot Fractures of the Fibula treated by Conservation.— These injuries healed without serious complications; but it would appear from the records of the Pension Office that the movements of the ankle joint frequently remained impaired: Case 684.—Private A. McPhee, Co. B, 16th New York, aged 20 years, was wounded in the left leg, at Gaines's Mill, June 27. 18ti2. He was conveyed to hospital at Fort Monroe, and several days afterwards to Philadelphia. Assistant Surgeon C. W. Horner, U. S. V., in charge of Wood Street Hospital, reported: "He was wounded by a minie ball, which entered the leg on its outside at the middle, fractured the fibula extensively, and passing downward made its way to tbe inside of the limb below the ankle, where it was retained, and whence it was removed at tbe Pennsylvania Hospital about tbe 10th of July. He was transferred to this hospital October 6th. His treatment consists of bandaging, occasional poultices, and cerate dressing. The patient is progressing favorably." He was discharged January 19, 1863, and pensioned. Examining Surgeon J. Cummis- key, of Philadelphia, February 6, 18(i:>, certified to "elevation of the heel and stiffness of the ankle joint resulting from the wound. He is very lame, and obliged to carry a cane in walking." Examiner E. H. Lewis, of Car- ver, Minnesota, reported, August 5, 1874: "At present the lower or articulating portion of the fibula is in a process of acute caries; ankle joint anchylosed, pus discharging from six sinuses," etc. The St. Paul Examining Board reported, several years afterwards, that "tbe wound continually opens and discharges, small pieces of bone escaping. Cicatrix large and weak; motion of ankle much impaired. The greater toe is doubled under and the tendo-achillis hampered by tbe wound." Tbe pensioner was paid March 4, 1880. Cask 685.—Corporal C. A. Woodruff, Co. A, 10th Vermont, aged 19 years, was wounded through the right leg, at Cold Harbor, June 3, 1864. He was admitted to Mount Pleasant Hospital, Washington, four days after the injury, and subsequently to Brattleboro'. On December 27th, the patient was transferred to Sloan Hospital, Montpelier, whence Surgeon H. Janes, U. S. V., contributed the photograph (Fig. 266), with the following history: "The wound was caused by a musket ball, which entered about the middle of the leg, on the outer and posterior aspect, passed forward and emerged anteriorly between the tibia and fibula, two inches below the point of entrance, fracturing the fibula. Several pieces of bone were removed at the time of the injury. Gangrene followed, and the wound opened to the size of an open hand. The wound of entrance closed in April, 1865, but that of exit bad not healed at the time of his discharge from service. He was then obliged to use a crutch in walking. The.patient also had a congenital malposition of the heart, which he never discovered until the time of his enlistment, the location of it being on the right side, with the apex beating under the right nipple. His chest was well formed, and he was a stout and, excepting his wound, a healthy man." The patient was discharged from service August 18, 1865, and pensioned. Examiner G. B. Bullard, of St. Johnsbury, Vermont, certified, on January 25, 1866, that particles of bone were still being discharged from the wound, and the pensioner complained of stiffness of the ankle joint, and that he was unable to bear his weight on his right foot or walk without crutches. He was last paid September 4, 1866, since when he has not been heard from. Fatal Cases of Shot Fractures of the Fibula treated by Conservation.—Seventy-eight cases are recorded in this group. The fatal issue was frequently due to complications, as in the following instance, in which the patient died with the ordinary symptoms of typhoid fever eight days after the reception of the injury: Case 686.—Sergeant D. P. Spicer, 1st Iowa Battery, was wounded in the right leg, at Resaca, May 15,1864, and admitted to the field hospital of the 4th division, Fifteenth Corps. Dr. J. M. Woodworth, Surgeon 1st Illinois Light Artillery, and Med- ical Inspector, contributed the following report: "A gunshot wound just below the knee joint, fracturing the head of the fibula and passing out at the centre of the lower border of the popliteal space. Tbe artery was not wounded. The subject was a large, healthy, muscular man, about 30 years old. After his admission to hospital tbe fragments of bone were removed, the wound was cleansed and cold-water dressing applied. The wound looked well until the morning of the 18th, when it presented a red inflamed margin, with tumefaction of the surrounding soft parts and enlargement of the veins of the thigh. A thin sanious discharge exuded from the opening, and the entire limb as far as the swelling extended was remarkably hot; pulse full and strong. Tbe patient was separated from the rest of the wounded, and his treatment was the same as in similar cases. On May 20th, the wounded limb was tensely swollen from the ankle to the body. At first tbe surface of the inflamed part was florid, but it became yellowish and mottled with greenish-purple gangrenous blotches. It was completely blistered with the stronger preparation of iodine, and kept imbued with a mixture of tincture of chloride of iron, creasote, and tincture of iodine in alcohol. The patient was also kept on a full course of tonics, stimulants, and generous diet. The disease or erysipelatous inflammation did not extend further, but the pulse grew more and more feeble. The patient became incoherent in mind and sank steadily, expiring on May 23,1864. He died with the ordinary symptoms of the more grave form of typhoid fever." Fig. 266.—Shot fracture of right fibula. [From a pho- tograph.J 438 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. SHOT FRACT! RES INVOLVING BOTH BONIS OE THE LEG TREATED BY CONSERVATION.---TllC shot fractures involving both bones of the leg, while far less numerous than those of the tibia or of the fibula, largely exceeded them in fatality, seventy-five of the three hundred and seventy determined cases having resulted in death, a mortality of 20.2 per cent. Examples of Recovery after Shot Fractures involving both Bones of the Leg treated by Conservation.—There were two hundred and ninety-five instances belonging to this group. In nearly all the cases there was more or less shortening of the limb, and in some instances considerable deformity, especially convexity, but many of the patients recovered with useful limbs: Case 687.—Private B. F. Hayner, Co. H, 125th New York, aged 19 years, was wounded at Gettysburg, July 3, 1863. He remained at the Second Corps Hospital for one month, when he was transferred to Camp Letterman. Acting Assistant Surgeon W. B. Jones reported: "Compound fracture of right and left tibia, lower third, by a piece of shell, which struck the outer side of the left leg, passed transversely, and grazed the anterior aspect of the right leg. Cold-water and simple cerate dressings were used; splints, etc Union took place in both legs, and by September 10th the patient was cured, but still unable to walk." He was transferred to McKim's Mansion Hospital, Baltimore, October 23d, and subsequently to Camden Street. Surgeon Z. E. Bliss, U. S. V., in charge of the latter, corroborated the description of the injury, and reported that the fracture box was used in the treatment of both legs; also that in April, 1864, the wound of the right leg had closed, while that of the left leg was still unhealed, there being slight lateral curvature in both legs; the patient able to walk well with the aid of a cane. The patient subsequently passed through different hospitals, and on August 27, 1864, he was returned to his command in the field. Being found entirely unfit for duty, he was returned to hospital for treatment until June 5, 1865, when he was mustered out of service and pensioned. Examining Surgeon R. B. Bontecou, of Troy, N. Y., reported April 7, 1875, that "the tibia and fibula were both broken in the right leg, and have united, with some deformity, leaving a useful limb. The left leg has united with an outwardly curved deformity, and there remains some carious bone in the tibia, with a fistulous opening and constant discharge, considerable tumefaction and inflammation in the vicinity of the wound. There is considerable loss of soft parts, leaving a long cicatrix, and the limb is lame in consequence of the injury." Substantially the same was reported at subsequent examinations. The pensioner was paid December 4, 1879. Case 688.—Private M. Lynn, Co. I, 26th Pennsylvania, aged 26 years, was wounded at Chancellorsville, May 3, 1863. He was admitted to the field hospital of the 2d division, Third Corps, where Assistant Surgeon E. Marshall, 124th New York, recorded "shot fracture of left leg." Surgeon J. A. Lidell, U. S. V., reported as follows: "The patient entered Stanton Hos- pital, Washington, June 15th, with compound fracture of tibia and fibula at the middle third, caused by a mini6 ball entering at the posterior and inner side of the calf of the leg and escaping in front. At the time of his admission the leg was in a fracture box; the wound suppurated freely; patient's general condition good. Previous to his entrance to this hospital several detached fragments of bone had been removed, and a portion of the bullet had also been extracted; subsequently about half a dozen more fragments of bone were removed at different times. Splints and water dressings were used. About July 1st, the fracture had united, and one month later there was firm union of the bones and the wound was healing rapidly. On September 22d, the patient received a furlough and was allowed to go to his home for two months. The orifice of entrance healed about the 1st of October, and before the patient was transferred to Philadelphia, in April, 1864, the orifice of exit had also closed. The atrophy of the wounded limb had disappeared entirely and the muscles of the leg acted freely, the patient being able to walk well with- out the aid of a cane and without limping. There was no shortening, and no deformity aside from some loss of osseous tissue at the seat of the fracture. The patient stated that the wounded limb had not caused him to feel sick at any time. He made the best recovery of any case of shot fracture of the leg that has come under my observation." After his transfer the patient was admitted to McClellan Hospital, whence he was returned to duty May 31st, to be discharged. He was mustered out of service June 18,1864, and pensioned. The Philadelphia Examining Board at different dates certified to the injury, and reported that an adherent cicatrix resulted, causing impaired use of the limb; also that the fractured space had filled with cartilaginous tissue. The pensioner has been exempted from further examinations since 1873. He was paid December 4, 1879. In the following cases a longitudinal incision was made along the crest of the tibia, and a number of pieces of both the tibia and fibula were removed: Case 689.—Private S. McNitt, Co. D, 4th Delaware, aged 23 years, was accidentally shot in the left leg, while in camp near Fairfax^ Court House, October 22, 1863. Surgeon D. S. Hopkins, 4th Delaware, reported: "The ball entered the limb posteriorly, at the junction of the upper with the middle third, passed directly through, causing a compound comminuted fracture of the tibia and fibula, and came out anteriorly, carrying with it fragments of bone. Comparatively slight haemorrhage ensued, and that principally of a venous character. An examination showed that although extensive laceration of the soft parts had taken place, yet the arteries were found entire and pulsation at the extremities very perceptible. The leg was, therefore, placed in a horizontal position and loose spiculae of hone were removed. Cold-water dressings were applied, and the patient was made as comfortable as circumstances would permit. Solution of morphia, two grains to an ounce of water, was adminis- tered at intervals of an hour until the patient became quiet. Next morning, October 23d, his system seemed to have suffered but little from the shock, he being comparatively comfortable. More minute examination revealed the fact that a number of pieces of bone still remained in the wound, which it was deemed necessary to remove. Accordingly a longitudinal incision was made along the crest of the tibia, the patient being under the influence of chloroform, and several spicula; of bone were taken out varying in length from one to two and a half inches. The largest, from the crest of the tibia, included in its thickness much sect, v.] SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 439 of the cancellated structure of the bone, as was the case with each piece removed; the average breadth was three-fourths of an inch. After the fragments had been removed the parts were coaptated, the limb was adjusted in a fracture-box, and cold-water dressings were reapplied. The patient was comparatively comfortable during the night." Some months after the reception of the injury the patient was admitted from the field into hospital at Alexandria, and lastly he was transferred to Tilton Hospital, Wilmington, where he was discharged June 19, 1835, Surgeon E. I. Baily, U. S. A., certifying to the shot fracture resulting in "necrosis and shortening of the leg." The Wilmington Examining Board, in describing the injury, December 6, 1871, reported: "Large and irregular cicatrices in front and rear of the limb; unnatural condition of skin; shortening of leg by an inch and a half. On account of occasional suppuration and exfoliation the limb has become much weakened and the convexity of it more marked. The disability is permanent in its present degree." After another inspection two years later the pensioner was exempted from further examinations. He was paid September 4, 1880. In the next case a sequestrum nine inches and a half in length was removed. New bone of sufficient thickness had formed to hold the limb in its normal position. The patient died, nine years after the reception of the injury, of dropsy: Case 690.—Lieutenant C. G. Martyn, Co. A, 2d New York Heavy Artillery, aged 29 years, was wounded at Deep Bot- tom, August 14, 1S34, and entered Armory Square Hospital, Washington, three days afterwards. Assistant Surgeon C. A. Leale, U. S. V., contributed the pathological specimen (FlG. 267), and the following history of the case: "He was wounded by a miuie' ball, which entered the right leg between the tibialis anticus and extensor longus digitorum muscles, opposite the centre of the middle third of the tibia, passed through the leg transversely, fracturing the tibia and fibula, and made its exit at the anterior lateral aspect of the soleus muscle. Immediately after the reception of the injury the patient was removed to a field hospital, and on the following day he was placed under the influence of chloroform, when several spiculae of bone were removed. Splints were then applied, and he was transferred to Washington, where the wound was dressed and the limb placed in a fracture-box. The general condition of the patient at that time was good. On account of great pain the fracture-box was removed on October 7th, and Smith's anterior splint was adjusted, which allowed the patient to rest more comfortably. On November 1st the splints were removed, and the limb was laid on a pillow and dressed twice a day with simple dressings. The wound had now nearly closed, but several sinuses existed and communicated with the bone, and the fracture had not yet united. By March 16, 1865, the patient was able to leave his bed and walk on crutches. He first came under my charge on April 1st, when, on an examination with the probe, I found the sinuses to communicate with dead bone; the discharge of pus was about three ounces per diem; appetite and general condition good. The discharge continuing to increase and the patient gradually grow- ing weaker, he was placed under the influence of ether on April 25th, and an incision was made nine inches in length over the anterior portion of the tibia, when it was found that necrosis extended to within two inches of the ankle joint and nearly to the head of the tibia. A sequestrum nine and a half inches long was then removed, also several small pieces, and in the operation a longitudinal piece of newly formed bone had to be withdrawn. After the removal of the necrosed portion, new bone was found of sufficient thickness to hold the foot in its proper posi- tion. The loss of blood during the operation amounted to about ten ounces. The wound was dressed with charpie and cold water, and the patient took stimulants and an anodyne every four hours. On the next day he was very weak and had continued nausea, no appetite, and vomited all food as soon as swallowed, not being able to retail] brandy even, which increased the nausea. Two ounces of beef tea was then given every four hours, but it also was nearly all thrown off. On April 27th, he was still weaker and the nausea continued, when two ounces of champagne with ice was administered every four hours, and four ounces of beef tea, per enema, was given three times a day. This was continued for two days, when the patient had a well-marked chill and was sinking fast, ins. long, from his nausea having increased to such an extent that the sight of other patient's food caused him to vomit. On April ^pec.1489! 30th, he was worse in every respect, when doses of five grains of oxalate of cerium was ordered to be given when- ever the patient felt as though he would immediately vomit. By 9 o'clock P. M. he had used six powders, not having vomited once since taking the first, and having retained food eaten at noon. The champagne and beef tea were continued. By May 6th great improvement was noticed, and, there being no nausea or vomiting, the powders were discontinued. The wound was now granulating finely, and the discharge consisted of perfectly healthy pus. About June 25th, the patient could leave his bed and sit in a chair, the cavity having nearly filled and the wound being healthy and reduced to about half the size of the incision. He had perfect use of the ankle joint and the tibialis anticus muscle, and there was all probability of a very useful limb. By July 15th, he could bear considerable weight on the injured leg." The patient was subsequently transferred to Douglas Hospital, where he was discharged from service by special order of the War Department, October 13, 1865. In his publication1 of the case Dr. Leale mentioned Surgeon D. W. Bliss, U. S. V., as the operator, and added that he saw the patient again just before he left Douglas Hospital, at which time the limb was in a healthy condition and the wound had nearly closed, leaving three small openings, which were prevented from closing by the great tension on tbe newly formed integuments. There was also slight contraction of the teudo-achillis, which could be easily overcome, although every possible care had been taken to guard against that result. The patient's name was subsequently admitted on the Pension Rolls, and afterwards he obtained employment in the New York City Custom House. Dr. G. K. Smith, of Brooklyn, May 11, 1874, certified that the patient, after receiving his dis- charge from service, entered Bellevue Hospital, New York City, where "Professor J. R. Wood performed an operation on his leg, cutting the tendo-achillis, and, I think, he also removed a large portion of the fractured bone. The wound healed in 1866, but soon broke open again, and continued to discharge until the month of June, 1873, when it finally healed. After leaving Bellevue Hospital he came under my care, and though his health was feeble, he performed his duties at the Custom House, with occasional loss of time, until the wound healed, in June, 1873. From that date his health failed rapidly His liver began to 1 LEALE (C. A.), Extensive Necrosis of the Shaft of the Tibia following Gunshot Fracture of the Bone, in United States Sanitary Commission Memoirs, Surgical Volume I, New York, 1870, p. 492. 440 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. increase in size, the heart became irregular in its action, respiration difficult and circulation very feeble. At length dropsy set in, and he died December 1, 1873. An external examination showed the liver to be nearly twice its normal size, and I have no doubt that death was caused by a waxy degeneration of the liver, the result of the shot fracture." Case 691.—Captain E. Bernard, Co. I, 65th New York, aged 29 years, received a gunshot wound through the left leg just below the knee, fracturing the tibia and fibula, at Malvern Hill, July 1, 1862. He was conveyed to Harrison's Lauding, and thence by steamer to Fort Monroe. From there he proceeded to his home in New York City, where he obtained the profes- sional attendance of Dr. L. A. Sayre, who subsequently furnished the following report of the case: "I was called to see Captain Bernard on July 12th, when he had just arrived from Fort Monroe, and was supposed to be in a dying condition from septicaemia. Many surgeons who had seen him at Harrison's Landing and Fort Monroe had all advised amputation of the wounded limb. The leg had become about two and a half inches shorter than the other and very much twisted on its axis. Extensive suppuration extended up the thigh and down the leg, both openings having been hermetically sealed with closely packed lint, which, when soaked off, caused the escape of a greater amount of imprisoned pus than I have ever seen from a single wound. Mingled in the pus there was also a large quantity of very finely broken up and macerated bone, and over the tubercle of the tibia a loose fragment was detected which, when cut down upon, escaped, having the appearance of a polished metal, like a silver sixpence, and the shape of a hollow segment of a robin's egg. This fragment, which, before extracting, I had suspected to be a loose piece of bone, the patient declared to be 'the end of an explosive ball.' His thigh at this time was so infiltrated with pus as to make amputation hazardous. I therefore made free incisions for its escape and drainage, and treated the limb by extension and plaster-of-paris, using adhesive plaster, weight and pulley over the foot of the bed, which was elevated to make the body act as a counter-extending force. Several large fragments of bone, having been macerated in the pus so long, were subsequently easily picked out without removing the periosteum. He made a very satisfactory recovery with but very little shortening, although there must have been more than an inch of entire bone removed. There is still (1874) a small piece of dead bone remaining, which, however, gives no trouble as long as he wears the tent to keep up the drainage. Whenever he leaves this out and the wound closes, he becomes sick until the discharge again takes place. I have been anxious to remove the diseased part, but he can never find time for that purpose, having to work constantly for his living and being -too poor to lay up for the operation." The New York City Examining Board, on October 1. 1877, reported the sinus leading lo dead bone as still open, having never ceased to discharge, and requiring constant dressing. Captain Bernard obtained his discharge from service October 22, 1863, and has since become a pensioner. He was paid September 4, 1880. In a number of cases of recovery after shot fracture of both bones of the leg, the knee joint or the ankle joint or both became partially or totally anchylosed: Case 692.—Major A. J. Bolar, 12th Pennsylvania Reserves, aged 31 years, was wounded in both legs and captured at Fredericksburg, December 13, 1862. After remaining a prisoner some weeks he was exchanged and conveyed to Annapolis, where he was admitted to hospital on February 21, 1863. Acting Assistant Surgeon J. H. Longnecker reported: "This officer was wounded in the left leg by a round ball entering three inches below the knee joint and fracturing the fibula; also by a buck- shot in the same locality and a minie" ball entering the external upper third of the leg. There was compound fracture of both the tibia and fibula. The ball has never been found, and is supposed to have lodged in the muscular part of the leg. The right leg was also wounded by a mini6 ball entering at the outer tuberosity and passing under the patella. At the time of admission the wound of the right leg was open and discharging. On September 9th, when the patient was put under my care, it had closed and there was anchylosis of the knee joint. The left leg was very much swollen and inflamed, there being two angry looking ulcers about three or four inches below the knee joint, with a tendency to sloughing. The patient's general health was good. Charcoal poultices were ordered, to be renewed twice a day. On September 21st, flaxseed was substituted for the charcoal, the wound looking more healthy and granulating, with not so much swelling or redness, and the pain less acute. On October 1st, two small fistulous openings remained, discharging a thin, sanious, and offensive ichor with small parts of decayed bone, which were injected with a mixture of opodeldoc and sweet oil twice a day. By November 1st, the discharge was much less and of a better quality, the leg of natural size, and the patient able to walk mucft easier with the aid of crutches. About December 1st, there was still slight discharge, the pus being mixed with small black particles, indicating exfoliation. Gradual improvement continued, and one month later the patient was able to walk by the support of a cane." He was honorably dis- charged from service January 30, 1864, and subsequently entered the Veteran Reserve Corps, being ultimately mustered out June G, 1865, and pensioned. Examining Surgeon G.-R. Lewis, of Indiana, Pennsylvania, certified, February 8, 1867: "The pensioner was wounded iu the left leg by several balls, one being still unremoved. The wound is still discharging and requires to be dressed daily. He was also wounded in the right knee, the ball lodging. Complete anchylosis resulted." On September 21, 1875, the same Examiner reported: "The ball in the left leg has not been removed and the wound still discharges, etc. There is partial stiffness of the knee joint, and he is totally disabled for manual labor." Examiner M. L. Miller, of Blairsville, Pennsylvania, September 4, 1877, certified to the injuries and added: "There has been much muscular waste and tenderness of the parts (left leg), and there is discharge of offensive matter from the place of injury, requiring daily dressing." The pensioner was paid September 4, 1880. Ca8E 693.—Assistant Surgeon A. H. Landis, 35th Ohio, aged 39 years, wras wounded near Kenesaw Mountain, June 22, 1864, by a twelve-pound solid shot, which, after hitting a tree and bounding off, struck his right leg, causing fracture but not breaking the skin. Surgeon F. D. Morris, of the regiment, reported that the missile fractured both bones of the limb midway between the knee and the ankle, and that the soft parts were much contused. The patient was admitted to the field hospital of the 3d division, Fourteenth Corps, where he received a leave of absence on the following day. He was mustered out of service September 27, 1864, and pensioned. Examining Surgeon J. S. McNeeley, of Hamilton, Ohio, certified, October 31, 1865: "The leg was struck at the posterior part of the middle third, fracturing both the tibia and fibula and lacerating the gastrocne- mius and soleus muscles. The resulting cicatrices have formed adhesions to the adjacent parts, entirely destroying their action. In adjusting the fracture complete apposition was not attained, and, from extension of inflammation, there is partial anchylosis SECT, v.] SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 441 of both knee and ankle joints, rendering locomotion both painful and difficult." Subsequent examiners report no additional information. The pensioner was paid September 4, 1H79. Both bones of the left leg as well as of the left forearm were fractured in the next case. The arm was amputated at the middle third, but the patient was so utterly prostrated that amputation in the leg was deemed inadvisable: Case 694.—Sergeant J. McLeer, Co. C, 84th New York, aged 23 years, was wounded by a shell in the left arm and left leg, at Bull Run, August 29, 1862. He entered Mount Pleasant Hospital, Washington, several days afterwards. Assistant Surgeon C. A. McCall, U. S. A., in charge, describes the injury of the arm as a compound comminuted fracture of the radius, ulna, aud elbow joint, and that of the leg as a fracture of the tibia and fibula, lower third, and reports: "On or about the 2d of September I amputated the arm at the middle third {Second Surgical Volume, Table LXXVIII, p. 765, No. 167), and would have also amputated the leg, but that the utter prostration of the patient threatened death upon further surgical procedure. Operating on the leg was therefore left to a future time; but as symptoms of promise developed themselves afterwards, an effort was made to save the leg, which, after long and critical treatment, was successful, although the limb was left somewhat shortened and to a considerable extent unfit for useful progression. The case was one of singular interest to myself and staff, proving as it did the wonderful endurance of the human system aud the almost strained limit to which conservative surgery may trust nature. It had been looked upon and classed by me as an excision of the lower portion of both bones of the leg: for though no special operation was performed, yet I know I was over half an hour cleaning out the broken fragments and adjusting loosened spiculse before trusting it to tbe fracture-box." In a published account of the case1 it is mentioned that, under a touic and stimulant treatment and the application of simple absorbent dressings to the parts, the stump of the arm healed rapidly. The patient was discharged from service July 27, 1863, and pensioned. On September 22, 1880, he was examined by the Brooklyn Pension Board, who certified to the loss of his left arm and added: "There is evidence of a compound comminuted fracture of the tibia and fibula of the left leg in the lower third. Portions of both bones were removed. The cicatrices of entrance and exit of the missile are found upon the internal and anterior aspects of the part. In the latter situation, over the tibia, a firmly adherent cicatrix, three inches long by one inch wide, is present. The leg is bowed outward to a very marked degree, the fibula being very prominent and thickened. There is shortening of the limb of about one inch. The extensor tendons are not full in their movements, being partially bound down by cicatricial tissue, and the ankle is somewhat stiffened and restricted in its motion. The great toe is not supple, since the plantar tendons are somewhat contracted. Altogether the objective signs show that the original wound was of the most severe character. In manual labor, walking, standing, etc., the member would speedily become the seat of great swelling and pain, as is the case after any unusual exercise." Fatal Cases of Shot Fractures of both Bones of the Leg treated by Conservation.—Of the seventy-five instances of shot fractures of the tibia and fibula with fatal issues three will be detailed: Case 695.—Private G. F.* Skinner, Co. H, 6th Maine, aged 30 years, was wounded at Chancellorsville, May 3, 1863, and admitted to Douglas Hospital, Washington, five days afterwards. Assistant Surgeon C. C. Lee, U. S. A , reported: " This man suffered a comminuted fracture of the left leg from a musket ball, which entered one-half inch internally to the spine of the tibia, passed through antero-posteriorly, and emerged at a corresponding point at the back of the leg. Much contusion and ecchymosis existed at the time of his admission to the hospital, and but for the high state of inflammatory action then existing the leg would have been removed. The limb was then placed in a fracture-box filled with bran, and covered with water dressings; nutrients and stimu- lants were given freely. No change was perceptible until the morning of May 16th, when the foot and leg were found in a state of advanced gangrene. To show how rapidly this condition supervened it is only necessary to state that a most careful examination during the previous evening failed to reveal anything of the kind, the patient in all respects seeming as well as usual. By the next morning this condition of the leg was rapidly extending up the thigh, the soft tissues of which became boggy and crepitant; the patient being bathed in clammy sweats, and his circulation so depressed that the pulse was imperceptible at the wrist, though at the groin it was 160 per minute. At the same time the patient's spirits were not at all depressed, and he could hardly believe he was in any danger. His prostration was such that amputation was deferred; but the most energetic stimulation failed to bring bis condition into one of sufficient reaction to bear the operation. He gradually sank, and died at 2 o'clock on the morning of May 17, 1863. At the autopsy, the internal organs were discovered to be generally healthy. The bone was found to be exten- sively comminuted, with a portion of the bullet lying upon the lacerated and obliterated posterior tibial vessels, thus probably furnishing the main cause of the gangrene. No secondary abscesses were found, and it was concluded that the patient had died in the primary stage of blood poisoning." The upper halves of the injured bones, showing a transverse fracture of the fibula and comminution of the tibia, with the bat- tered bullet attached, were contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A., and are shown in the annexed cut (FlG. 268). Case 696.—Private J. Bailey, Co. B, 211th Pennsylvania, aged 29 years, was wounded at Petersburg, April 2, 1865. Surgeon A. F. Whelan, 1st Michigan Sharpshooters, reported his admission to the field hospital of the 3d division, Ninth Corps. with "Canister shot fracture of right leg." Surgeon E. Bentley, U. S. V., recorded the result of the injury as follows: "The 'COUES (ELLIOTT), Report of some Cases of Amputations and Resections from Gunshot Wounds, performed at the Mount Pleasant XT. S. General Hospital by C A. McCall, M. D., U. S. A., in Medical and Surgical Reporter, New York, 1862-3, Vol. IX, p. 229. Surg. HI—56 FIG. 268.—SJiot frac- tures of upper third of left tibia and fibula. Spec. 1249. 442 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. man was admitted to Slough Hospital, Alexandria, four days after receiving his wound. The tibia and fibula were badly shat- tered. Cold-water dressings were employed, and tonics and stimulants were freely administered, together with all the nourish- ment the patient would take. He died May 2, 18G5, from the severity of suppurative inflammation of the wound. The autopsy Bhowed the tibia to be comminuted for several inches at the upper third and the fibula fractured at the lower third, no union having taken place. The wound was gangrenous." In the following instance of lesion of both bones of the leg in the middle third, osteo- myelitis of the medulla of the femur was noted at the autopsy. The upper and lower thirds of the tibia were found upon opening to be quite healthy: Case 697.—Musician G. H. Potter, Co. E, 60th Ohio, aged 14 years, was wounded in the right leg, before Petersburg, July 16, 1864. Surgeon P. A. O'Connell, U. S. V., recorded the following description of the injury at the field hospital of the 3d division, Ninth Corps: "A ball entered the outer side of the limb about the upper third of the fibula; exit below on anterior aspect, gouging tibia and fibula." The wounded man was conveyed to the Depot Hospital at City Point the day after the injury, and one week later he was transferred to Fairfax Seminary Hospital. Assistant Surgeon H. Allen, U. S. A., in charge of the latter, made the following report: "On entering the hospital the lad was in fine spirits, though somewhat anaemic; wound look- ing well. On August 5th, the wound assumed an indolent appearance and the discharge became greater and more fetid. Bro- mine was thoroughly applied in the ordinary way and at first checked the progress of the disease. But the patient appeared to have no recuperative energy and a tendency to subcutaneous sloughing was evinced, which, by the 12th of August, had increased so far as to necessitate the slitting up of the integuments and a second rigorous application of bromine. It was observed during the operation that the tibia was exposed and a superficial area of bone was being thrown off. The patient was exceedingly irritable, appetite capricious. The wound still presented a gluing and unhealthy appearance, and the tendency to undermining continued in spite of all efforts to check it. The patient gradually sank. By September 15th, violent and persistent vomiting came ou, and from this time until the date of his death, September 26, 18Y1, he was almost entirely sustained by beef tea enemata. He had no chills and no discoloration of skin, and his mind at all times was clear. Autopsy: emaciation extreme; limb not much swollen; foot somewhat oedematous; ulcer extending from four inches below the knee to the ankle joint; femoral vein healthy; internal organs all healthy except the liver, which was exceedingly fatty. The outer surface of the tibia at the middle third was dead and much blackened from the action of the vapor of the bromine, and the living bone around its borders was covered with several roughened spiculae of bone. Upon opening the tibia the upper and lower thirds were found to be quite healthy, but the middle third was the seat of varied diseased action. The walls at this point were partially necrosed, of a greyish slate color, roughened, and so thin that at one point they appeared to be nearly destroyed. The medullary substance at this place was shrunken, of a blackish grey color, and closely adherent to the posterior and lateral walls of the cavity. No new deposit of bone was seen. The tissues both above and below this point had taken on active efforts of repair. The cavity of the medulla was much contracted by delicate cancelli extending from either side, and the original walls of the cavity for the extent of a full inch either way were vascular and thickened. The medulla lying in the diminished calibre of canal was of a lively red color, filled with blood, and presented all the appearance of a highly nourished medium. As above observed, no inflammation was noticed in either extremity of the affected bone. Upon examination of the femur an interesting appearance was presented. The walls of the bone were much thickened and dotted with reddish spots; the enlarged nutritious arteries and the periosteum were also thickened, vascular, and easily detached. When the bone was opened the upper two-thirds of the medulla were found to be acutely inflamed, which as usual was more intense towards the neck of the bone than elsewhere." The tibia and fibula of the injured leg, contributed, with the history, by Dr. Allen, constitute specimen 2633 of the Surgical Section of the Museum.1 The precise seat of the bony lesion was not indicated in seven hundred and eighty-six of the three thousand nine hundred and eighty-eight cases of shot fractures of the bones of the leg treated by conservation. The results in sixty-nine of these cases were not ascertained; five hundred and forty-three patients recovered and one hundred and seventy- four died, a mortality of 24.2 per cent. An analysis of the cases of shot fracture of the bones of the leg treated by conserva- tion indicates that pyaemia was noted in eighty-one instances (six recoveries and seventy- five deaths), gangrene in seventy (forty recoveries, thirty deaths), tetanus in twenty-four (two recoveries, twenty-two deaths), erysipelas in forty-five (thirty-five recoveries, ten deaths), and in three hundred and forty-seven cases (two hundred and ninety-nine recov- eries, forty-two deaths, and six undetermined results) fragments of bone or sequestra were removed. Secondary haemorrhage is reported in sixty-five instances (twenty-four recov- eries, forty-one deaths), and in twenty-six instances ligation of the tibial, popliteal, or fem- oral arteries were performed, viz: ligation of anterior tibial artery in five (three recoveries, two deaths); of anterior tibial and popliteal in one (fatal); of anterior and posterior tibials 1 Alli:x (H.), Remarks on the Patliological Anatomy of Osteomyelitis, with Cases. Gunshot Wound of the Right Leg; phagedena; no pysemia; in American Journal Medical Sciences, 1865, Vol. XLIX, N. S., p. 44. SECT, v.] SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 443 in one (fatal); of posterior tibial in eight (five recoveries, three fatal); of-----tibial in one (fatal); of popliteal in five (two recoveries, three fatal); and of femoral in five (two recoveries and three fatal). Details of the five cases of ligation of the femoral artery are adduced: Case 698—Private J. W. Moore, Co. I, 13th Mississippi, aged 23 years, was wounded and captured at Gettysburg, July 2, 1863. Surgeon H. Janes, U. S. V., reported: "Compound fracture of right leg, middle third. Hemorrhage from the posterior tibial artery occurred to the amount of one pint daily from July 12th to July 17th, when the femoral artery was ligated in the continuity." Tbe patient recovered, and was transferred to Baltimore October 15th, the wound having entirely healed. Surgeon T. H. Bache, U. S. V., reported that he was paroled from West's Building Hospital, and sent south November 12, 1863. Case 699.—Corporal P. Lahany, Co. G, 5th Vermont, aged 21 years, was wounded at Petersburg, April 2, 1865, and admitted to the field hospital of the 2d division, Sixth Corps, where Surgeon S. F. Chapin, 139th Pennsylvania, recorded: "Shot fracture of left leg." Surgeon D. P. Smith, U. S. V., reported the wounded man's entrance into Fairfax Seminary Hospital, April 6th, with " Shot fracture of left fibula," but made no record of any surgical treatment in the case. On May 30th, the patient was transferred to Baxter Hospital, Brattleboro', and subsequently to Sloan Hospital, Montpelier. Surgeon H. Janes, U. S. V., in charge of the latter, contributed a photograph of the patient, which is copied in the wood-cut (Fig. 269), together with the following history: "The wound was produced by a mini6 ball, which entered the leg on the outer side two inches below its middle, passed backward and inward, fracturing the fibula, and emerging posteriorly one inch lower than the point of entrance. Several fragments of bone were removed on the field four hours after the injury. Secondary haemorrhage occurred on April 9th, for which tbe femoral artery was ligated in Scarpa's space by Dr. Smith, at Fairfax Seminary Hospital. The patient was much prostrated after the operation, and artificial heat was required for about a week to keep up the temperature of the limb. No recurrence of the hsemor- rhage took place, and the wound closed rapidly after the operation. At the time of his admission to Sloan Hospital, June 12th, both wounds were nearly healed and he could walk without crutches, but could not bring the heel to the ground on account of contraction of the muscles of the calf. In the early part of July an abscess formed at the place of ligation, which healed however in a short time. On August llth, the patient was discharged from service, though unable to leave the hos- pital on account of an abscess at the original wound, caused by a fragment of necrosed bone. Three weeks afterwards the abscess had nearly healed and he left the hospital in good health, but still unable to get the heel to the ground. This patient had also been wounded through both buttocks, at the Wilderness, May 5, 1864, from which injury he had recovered in three months, when he rejoined his command for duty." Various surgeons, at consecutive intervals, certified to the injuries, ". i ju. «jy.—ouoi immure oi iuu and Examiner F. W. Goodall, of Bennington, October 5, 1877, adds: "The left leg below the knee fibula and ligation of femoral. is one-half smaller than its mate, one-half smaller at the calf, and one-quarter at the ankle; muscles lFrom a photograph.] attached to the integument on back of leg, impairing the action of the tendo-achillis. I also find a large cicatrix in the left triangle of Scarpa, from ligation of the femoral artery." The pensioner was paid March 4, 1880. Case 700.—Corporal J. Ferguson, Co. G, 142d Pennsylvania, was wounded in the right leg, at Fredericksburg, Decem- ber 13, 1862. He remained at a First Corps field hospital for one week and was then transferred to the Patent Office Hospital, and subsequently to Stanton Hospital, Washington. Surgeon J. A. Lidell, U. S. V., in charge of the latter, described the case as follows: "The wound was produced by a bullet, which passed through the calf of the leg in the upper third in a downward and outward direction. The wound did well until the middle of January, when the granulations assumed an unhealthy appear- ance and the discharge became thin and serous. The patient also exhibited typhoid symptoms, having a hot skin, frequent pulse, and dry red tongue, watchfulness, and no appetite. This went on until the morning of January 23d, when haemorrhage occurred unexpectedly from the external orifice behind the fibula. The bleeding was readily controlled by application of pressure by bandage and ice, the patient having lost about ten ounces. Throughout the day and the night following the loss of blood by oozing was very little, but on the following morning haemorrhage recurred from the internal orifice, behind tbe tibia this time. This amounted to from four to six ounces, and was also readily controlled by the application of persulphate of iron, lint, ice, and bandaging. In the meantime the typhoid symptoms became more marked. The patient also complained of great tenderness throughout the leg and thigh; the inguinal glands were somewhat swollen and tender, and there was dusky redness, with soreness in the track of the long saphenous vein. His skin was now pale and yellow. On the morning of January 25th, another slight bleeding occurred from the internal wound and was readily controlled by pressure. A marked increase of the swelling was now noticed, extending from the leg to the thigh, especially over the external and internal condyles and the pop- liteal space, and infiltration with blood was suspected. The patient was now very pale and expressed a great deal of anxiety, his pulse being 120, quick and weak. The first day the haemorrhage was thought to come from the peroneal artery, the next day from the posterior tibial, but now we were uncertain in regard to the source of the bleeding, and the case presented an unpromising appearance on account of the debility from tbe loss of about eighteen ounces of blood superadded to his typhoid condition. We then decided to tie the femoral artery at the apex of Scarpa's space as affording the best chance of benefit, which operation I performed without any difficulty on the afternoon of January 25th, forty-three clays after the reception of the wound. On the following morning the patient appeared brighter; pulse 130; tongue more moist; leg getting warmer down to the ankle. The plugs being removed some dark offensive blood flowed away. In tbe evening his foot was cold, leg cooler, and blackness was extending across the leg in the track of the wound. Patient had a slight chill; somewhat delirious; pulse 130 and weak; tongue dry. On the morning of January 27th the patient looked better; pulse 132 and stronger; leg warm and blacker; foot pale and swelled; serous infiltration and discoloration extending up the thigh. The next day the patient presented a pale yellow hue; blackness of limb deepening and extending, having reached the lower end of the incision made for the liga- 444 INJURIES OF THE LOWER EXTREMITIES. [chap. x. tion : odor gangrenous. Death supervened on the evening of January 29, 1863. The autopsy showed that the bleeding did not come from the posterior tibial or peroneal artery, but from the lower part of the popliteal, which had been opened to a large extent by ulceration. Some loose splinters of bone were also found, the ball having grazed the hind part of both the tibia and fibula. On the proximal side of the ligature the clot was firm, closely attached to the walls of the artery, and about three-fourths of an inch long, with its apex pointing upward towards the heart. There was also a firm clot on the distal side, adherent to the walls of the artery, but much smaller than the proximal one." A piece of the femoral artery, about four inches long and embracing the seat of the ligature, was contributed to the Museum by Surgeon Lidell, and constitutes specimen 1140 of the Surgical Section. Case 701.—Sergeant J. Daly, Co. K, 82d New York, aged 27 years, was wounded in the left leg, at the Wilderness, May 6, 1864, and admitted to Douglas Hospital, Washington, six days afterwards. Assistant Surgeon W. Thomson, U. S. A., described the injury as "a gunshot fracture of the fibula," and reported: "On May 17th, a bullet was extracted from the inner side of the leg. through a deep and oblique incision two or three inches below the knee. Three days afterwards three haemor- rhages occurred from the posterior tibial artery, amounting to one, three, and ten ounces respectively, and necessitating ligation of the femoral artery, which was performed below the profunda in Scarpa's space by Assistant Surgeon W. F. Norris, U. S. A. Ether was used as the anaesthetic. On the following day there was venous haemorrhage to the amount of four ounces. A further loss of eight ounces of blood took place on May 25th, and of one and a half ounces the next.day. Four more attacks followed on June 1st, each causing the loss of one-half ounce to an ounce of blood, and being checked by compression over the femoral where it emerges from the pelvis. Death resulted from exhaustion, June 3, 1864. At the post-mortem examination the ligature was found to have nearly sloughed through; clot below, but none above it." Case 702.—Corporal H. Day, Co. A, 6th Alabama, was wounded in the right leg, at Chancellorsville, May 3,1863. The records of Chimborazo Confederate Hospital No. 4, Richmond, show his admission May 14th, with the following description of tbe injury and its result: "The ball entered at the external malleolus, slightly fracturing the fibula, ranging upwrard and inward, and making its exit about an inch and a half from the posterior edge of the tibia and about four inches from the knee joint. On May 26th, a haemorrhage from the upper wound estimated at from ten to twelve ounces, and probably coining from the posterior tibial artery, was arrested by compression of the femoral on the pubis, after which a tourniquet was applied to the thigh. On May 28th, another hsemorrhage occurred from the upper wound and from fifteen to twenty ounces of blood were lost, when it was checked by introducing the fingers into the wound and seizing the vessel and adjacent tissues. Liga- tion of the femoral artery was then performed. The tissues were found to be disorganized and reduced to a soft pulpy mass, in which it was impracticable to define any healthy structure. While preparing for the operation the patient had a slight convulsion, and for a few moments all proceedings were suspended in anticipation of immediate death. Haemorrhage did not recur after the operation. On June 2d, there was a slight chill followed by fever. On the next day the discharge from the upper wound was of a greenish-gray color, offensive in odor, and indicative of gangrene. Gangrenous symptoms increased, and by June 4th the foot and leg were livid and swollen, odor very offensive. He died in a comatose condition, June 5, 1863, the whole leg and thigh having become thoroughly gangrenous. It is probable that the posterior tibial artery was not divided by the ball, but opened by the softening of the tissues subsequent to the occurrence of the wound." EXCISIONS IN THE CONTINUITY OF THE BONES OF THE LEG FOR SHOT INJURY.—Three hundred and eighty-seven examples of excision in the bones of the leg are recorded. Two hundred and fifteen, or over one half of the* total number of these operations, were primary, eighty-seven intermediary, and fifty secondary; in thirty- five instances the interval between the dates of injury and operation could not be ascer- tained. Two hundred and seventy-five of the patients survived the operation, one hundred and eight died, and in four the results were undetermined, a mortality rate of 28.2 per cent. In comparing the results of the excisions and amputations in the long bones of the upper extremity it will have been noticed that in the upper arm the fatality of the excisions (28.5) exceeded that of the amputations (23.6) by 4.9 per cent., while in the forearm the mortality of the amputations (13.9) was 2.7 per cent, in excess of the death rate of the excisions (11.2). Similarly, in the lower extremity, we find that while the fatality of the excisions in the shaft of the femur (69.4) surpasses that of the amputations through the thigh (53.8) by 15.6 per cent., the excisions in the continuity of the bones of the leg show a death rate of 28.2 per cent., or 4.7 per cent, less than the fatality after amputations in the leg (32.9 per cent.). It would appear, therefore, that in the arm and thigh amputations were less fatal than excisions, while in the forearm and leg the mortality of the amputations exceeded that of the excisions. The low rate of fatality after excisions in the forearm or leg may be ascribed to the fact that in the large majority of the cases of recovery portions of one of the bones of the forearm or the leg only were excised; in the cases in which the excision extended to both bones of the limb, the mortality exceeded that of the amputations. SECT. V.] PRIMARY EXCISIONS IN THE BONES OF THE LEG. Table LXII. 445 Numencal Statement of Three Hundred and Eighty-seven Excisions in the Bones of the Leg for Shot Fracture. OPERATIONS. w ID ■< EXCISIONS Cases. Tibia. Fibula. Tibia and Fibula. Bones not specified. o « 148 58 42 27 275 P 67 29 8 4 108 31 s. s 4 4 ;~ ra «? ° 31.1 33.3 16.0 12.9 >>• c IV a 69 24 26 17 136 ft 30 9 Hi ga (? i» o Ph 78 31 13 9 131 a 0) Q 32 15 1 1 49 ■S'd 5's ^2 " *s a 29.0 32.6 i 7.1 10.0 27.2 ID t W 0> BS 3 3 1 7 «S Q 5 4 2 t. g 1 <^ 100. 0 57.1 40.0 1 .a i 0 Primary Excisions............................ 215 87 50 35 387 30.3 27.2 16.1 15.0 1 5 - - Time between injury and operation not recorded. 3 47 2 2 11 61.1 1 Aggregates.......................... 28.2 25.6 1 Primary Excisions in the Shaft of the Tibia, of the Fibula, or of both bones.—The series of two hundred and fifteen primary excisions in the bones of the leg contains one hundred and forty-eight recoveries and sixty-seven deaths, a mortality rate of 31.1 per cent. Portions of the tibia were excised in ninety-nine, of the fibula in one hundred and ten, and of the tibia and fibula in five instances; in one case the seat of excision was not specified. The operations were performed on one hundred and ninety-two Union and twenty-three Confederate soldiers. Recoveries after Primary Excisions in the Continuity of the Bones of the Leg.—There were one hundred and forty-eight recoveries after primary excisions in the continuity of the bones of the leg; in sixty-nine, portions of the tibia, and in seventy-eight, parts of the fibula had been excised; in one instance the bone was not indicated. No instances of recovery after primary excision in both bones of the leg are recorded. The one hundred and forty- eight operations were performed on seventeen Confederate and one hundred and thirty-one Union soldiers. Of the latter one hundred and twenty-four were pensioned; but ten have died since the date of their discharge—two of phthisis, and three of remote effects of the injury; in five instances the cause of death was not reported. In the following five cases from three to six inches of the tibia were excised: Case 703.—Private J. Hogan, Co. F, 127th Pennsylvania, aged 41 years, was wounded in the right leg, at Fredericks- burg, December 13, W>2. Surgeon J. E. MacDonald, 79th New York, reported his admission to the field hospital of the 1st and 2d divisions, Ninth Corps, and described the injury as "fracture of the tibia," for which "resection of six inches" of the bone wns performed. Assistant Surgeon W. Thomson, TJ. S. A., contributed the following history of the case: "This man was struck by a minie ball four inches below the knee joint. The tibia was extensively comminuted, the fibula being uninjured. A resec- tion of the shaft of the tibia from a point just below the tubercle to (about) seven inches below was performed by Surgeon J. P. Prince, 36th Massachusetts, at a field hospital. The man was admitted to Douglas Hospital December 26th. The dressing consisted in keeping the incision open with charpie to encourage granulations from tbe bottom of the wound. On February 26, 1863, a crown-shaped exfoliation {Spec. 2237, Sect. I, A. M. M.) was removed from the end of the lower portion of the tibia. The wound now healed rapidly, no change having been made in the dressing and the leg being retained in quietness by a frac- ture box filled with bran. His general health became perfect as the discbarge ceased. On May 1st, several small exfoliations were removed from the spongy portion of the tibia at the superior part of the wound. There was of course no reproduction of the tibia and no conservative hypertrophy of the fibula, and hence the leg was perfectly helpless. Before the fistulous orifice had entirely closed at the upper portion of the incision, well marked but mild hospital gangrene appeared. The sloughing extended very deeply as far as the lower side of the tibia. Several applications of bromine checked the spread of the gangrene but not until a large excavation had been caused. This filled up gradually, tbe patient got up on his crutches and with the aid of a starched bandage hobbled painfully about the wards. His term of enlistment expired on May 29, 1863, but he remained until October 12th, when he returned to his home. No more useless or unphilosophical operation could be devised than the one done in this case. The leg was perfectly helpless, a hiatus of nine or ten inches existing in the tibia and there being no hope of any further improvement from the lapse of time; fibula no larger than natural. Unless some novel means of support can be 4.46 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. .... applied this man will be infinitely worse off than with an artificial leg." Examining Surgeon S. T. Charlton, of Harrisburg, reported in October, 1866: "There is complete atrophy of the whole limb, as well as deformity from curvature at the point of resection and the pushing out of the head of the fibula from its articulation. He cannot walk or stand upon the limb without the use of a cumbrous apparatus furnished by the Government," etc. At subsequent examinations no change or improvement was reported. The pensioner died May 24, 1877.' Case 704.—Lieutenant O. R. Fyler, Co. I, 2d Connecticut Heavy Artillery, aged 25 years, was wounded in the left leg, at Opequan Creek, September 19, 1664. He was admitted to the field hospital at Winchester, where Surgeon E. B P. Kelly, 95th Pennsylvania, recorded a "shot fracture of the tibia, middle third, by a mini6 ball, followed by exsection, the same day, of three inches of the bone by Surgeon H. Plumb, 2d Connecticut Artillery." Acting Assistant Surgeon J. H. Bartholf made the following report: "The patient entered Frederick Hospital on November 12th. On December 15th, I discovered and removed the ball, or what appeared to be the greater part of it, from the lower part of the wound, close to the upper extremity of the lower fragment. It was embedded about two inches and found to be exceedingly battered and misshapen. The patient informed me that Smith's anterior splints were used and con- tinued for three weeks after the injury. A plaster-of-Paris splint was then applied, with which he came here, having traveled by the rough railway from Winchester without inconvenience. I found him with his limb looking well, but there was no union of bone and no coaptation even of the ends, the fibula of course holding the extremities apart. Besides removing the ball, as stated, and a few small fragments of bone, the patient's treatment in this hospital consisted of simple dressings and the continued use of the plaster-of-Paris splint. On January 13, 1865, he left on leave of absence, his general condition being excellent and the wound presenting a granulating surface five inches long. Xo deposit of bony matter in the interspace between the ends of the bone could be discov- ered. The sawn face of the upper fragment came away in the early part of January." The patient was discharged from service April 6, 1865, and pensioned, and subsequently supplied with a supporting apparatus for his injured limb by Dr. E. D. Hudson, of New York City. Examining Surgeon H. E. Gates, of Litchfield, Connecticut, certified, June 4, 1877: "The wound was from a minie" ball received directly in front, striking the tibia, mashing that bone and lodging in it; it remained there two months, causing exfoliation, profuse discharge, and au attack of gangrene. Resection was done the day the injury was received, the periosteum being removed (or badly torn) with three inches of the bone. It is supposed that the periosteum was so badly torn as not to be able to repair the loss of bone substance. Present aspect: whole leg and thigh atrophied. The fibula is bowed outward and there is partial dislocation of its head. The leg bends easily at the seat of the injury and no weight can be borne upon it. I have no doubt the fibula would instantly give way if the applioant stood upon it. There is great tenderness at the head of the fibula from stretching of the ligaments, the line of support from the bending of the leg being thrown outward towards this articulation. The pensioner wears an appliance weighing seven pounds, which incases the limb and gives the only support. The disability is progressive on account of displacement and bending of fibula, etc. I consider his present condition worse than if he had amputation above the knee; locomotion is very painful indeed," etc. The pensioner was paid March 4, 1880. In the accompanying wood-cut (FlG. 270) the appearance of the limb about one year after the excision is shown. Case 705.—Colonel W. T. Fitch, 29tb Ohio, aged 40 years, was wounded at Mill Creek, May 8, 1864. He entered the field hospital of the 2d division, Twentieth Corps, where Surgeon A. Ball, 5th Ohio, recorded: "Shot compound fracture of right tibia; resection at middle third by Surgeon A. K. Fifield, 29th Ohio." Surgeon J. E. Herbst, U. S. V., reported that the patient entered the Officers' Hospital, Nashville, four days after he was wounded, having undergone excision of about three inches of the shaft of the tibia by a longitudinal incision of four inches over the crest. Chloroform was used and prompt reaction followed the operation. The limb was placed in a box-frame splint and wet applications were made. On June 20th the patient left for his home on leave of absence, the wound being in excellent condition. On October 13, 1864, Colonel Fitch resigned and obtained his discharge from service, and subsequently he became a pensioner, his physician testifying that "the wound on the surface has healed, but the vacancy caused by the removal of the bone has not yet filled up." Examiner W. M. Eames, of Ash- tabula, Ohio, certified, September 15, 186."), that "the leg is now very small and weak and of no manner of use in walking, a source of constant discomfort. The foot is cold and swollen and not under the control of the muscles." On December 8, 1870, when the pensioner visited the Army Medical Museum, he was in good general health and his wound soundly healed; but the bone remained ununited, the calf of the leg entirely atrophied, and the foot swollen and useless. He also stated that "he regretted greatly that amputation had not been performed." The Cleveland Examining Board at subsequent dates reported that the pensioner was obliged to wear steel splints on the outer and inner aspect of the leg. In September, 1877, the cicatrix was described as being quite irritable and as ulcerating and discharging often. The pensioner was paid December 4, 1879. Case 706.—Private D. M. Gould, Co. D, 102d New York, aged 21 years, was wounded in the left leg, at Dallas, May 27, 1864. Surgeon A. Ball, 5th Ohio, reported his admission to the field hospital of the 2d division, Twentieth Corps, with "shot fracture of tibia; resection of four inches by Surgeon C. H. Lord, 102d New York." Ten days after receiving the injury the wounded man was conveyed to Chattanooga, and subsequently he passed through different hospitals, entering Ira Hands Hospital, Albany, on February 9,1865. Assistant Surgeon J. II. Armsby, U. S. V., in charge of the latter, contributed a plaster 1 A detailed history of the ca^e will be found in American Journal of Medical Sciences, New Series, 18(i4, Vol. XLVII, p. 395, Report qf Cast* of Hospital Gangrene treated in Douglas Hospital, Washington, D. C, by William Thomson, M. D. Fig. U70.—Excision of three inches of the left tibia. [From a photograph.] SECT. V.] PRIMARY EXCISIONS IN THE BONES OF THE LEG. 447 Flo.'-71.—Left leg af- ter excision of 4 inches of shaft of tibia. Spec. 2552. [From a cast.] cast {Spec. 2552, Sect. I, A. M. M.) of the injured limb, represented in the annexed cut (FlG. 271), and reported the patient's discharge from service July 20, 1865, by reason of disability resulting from the wound. Examining Surgeon J. B. Chapin, of Canandaigua, N. Y., reported, July 2, 1869: "The disability had its origin in a gunshot wound of the upper third of the tibia. The bone was shattered, leaving the head uninjured. The operation of resection, by which four inches of the tibia was removed, was performed. The fibula is thrown out of line externally by the action of walking and the weight of the body, and a false joint exists below the knee joint. The limb requires a splint and bandage to be applied constantly for support, and in addition the pensioner requires the aid of a cane," etc. The Canandaigua Examining Board certified, September 4, 1877, to the following: "Leg shortened about two inches; false joint, large cicatrix along spine of tibia; upper end of fibula projecting. Leg curved outward." The pensioner was paid March 4, 1^80. Case 707.—Sergeant J. Measor, Co. 0, 137th New York, aged :>7 years, was wounded in the left leg, at Wauhatchie, October 29, 1863, and admitted to the field hospital of the 2d division, Twelfth Corp*. Surgaon G. Perin, U. S. A., reported the injury as a "fracture of the tibia," for which excision was per- formed at the upper third by Surgeon A. K. Fifield, 29th Ohio. Assistant Surgeon H. T. Legler, U. S. V., reported that the wounded man entered the general hospital at Bridgeport three days after receiving the injury, and that he left for his home on furlough April 4. l8o4. Acting Assistant Surgeon J. W. Robie reported that the patient was subsequently admitted to Ladies' Home Hospital, New York City, where a second operation for the removal of bone became necessary, by reason of necrosis, on August 22d. He was discharged from service April 5, 1865, and pensioned. From a description of the case by Dr. E. D. Hudson, of New York City, who supplied the pensioner with a surgical apparatus for the wounded limb, it appears that the total amount of bone removed comprised three and a half inches, the first operation consisting of the posterior and main part of the shaft of the tibia, while, at the second, the remaining anterior portion was removed by Acting Assistant Surgeon J. C. Stone. Examining Surgeon D. W. Hunt, of Fairmont,Minnesota, reported: "The wounded limb is much smaller than the other, the muscles being shrunken and somewhat shorter than the other. The deformity modifies his gait very much, causing an appearance of lameness." The pensioner was paid December 4, 1879. In the next case six inches of the fractured fibula were excised, and the posterior tibial artery was successfully ligated for secondary hsernorrhage: Case 708.—Private J. Leichty, Co. F, 8th Pennsylvania Reserves, aged 21 years, received a shot fracture of the fibula of the left leg, at Spottsylvania, May 11, 1864. Surgeon L. W. Read, U. S. V., reported that he was admitted to the field hospital of the 3d division, Fifth Corps, where "resection was performed by Surgeon T. Jones, 8th Pennsylvania Reserves." Assistant Surgeon A. Ingram, U. S. A., contributed the following history: "The wounded man entered Judiciary Square Hos- pital, Washington, May 18th. About six inches of the injured fibula had been excised on the field. Secondary haemorrhage occurred from the posterior tibial artery to the amount of thirty-two ounces, when the vessel was ligated in the wound. By June 14th the patient was progressing well. Cold-water dressings were used, and milk punch and a supporting treatment was administered." The patient was subsequently transferred to hospital at Alexandria, whence he was discharged from service January 11, 1865, and pensioned. Examining Surgeon J. McCullock, of Huntingdon, Pennsylvania, April 18, 1867, described the wound, and added that the "leg has sloughed largely and discharged a number of pieces of bone, the last one about three weeks ago. Since that time the wound has healed; tendons back of knee contracted; walks lame; wound painful," etc. Exam- iner A. B. Brumbaugh reported, in 1877, that, as a result of the resection, " The foot cannot be plauted even, as it would turn outward from the want of fibular support, and he has to keep his shoe blocked up accordingly to support the foot. The toes of the left foot tend to turn downward, like hooks, from injury to the nerves and muscles. The leg is not quite but almost useless for all purposes of manual labor." The pensioner was paid March 4, 1880. Of the one hundred and forty-eight survivors after primary excision in the bones of the leg nineteen submitted to subsequent operations, viz: fourteen1 to amputation in the leg; one2 to exarticulation at the knee; and four3 to amputation in the thigh. Fatal Cases of Primary Excision in the Continuity of the Leg.—The sixty-seven fatal cases of primary excision in the bones of the leg comprised thirty excisions in the shaft of the tibia, thirty-two in the shaft of the fibula, and five of both bones of the leg. Subse- *----———----——--------------------------------a__________________________________________________________________________________- 1 In nine of the fourteen cases of amputations in the leg the operation was performed in the upper third, viz: Pt. S. B. Andrews, Co. F, 72d Penn., right leg, secondary operation ; Pt. L. Arnold, Co. G, 143d Penn., right leg, intermediary operation; Lieut. Col. W. W. Dudley, 19th Indiana, right leg, intermediary operation ; Corp'l W. H. Goldsmith, F, 2d New Hamp., left leg, secondary operation; Pt. D. A. Hatch, C, 2d Mass., right leg, secondary operation, Spec. 2155, A. M. M.; Corp'l C. McCarty, E, 1st N. Y., right leg, secondary operation; Pt. T. Powell, F, 6th U. S. C. T., left leg, secondary operation: Musician C. A. Runyan, F, 9th N. Y. H. A., left leg, secondary operation; Pt. P. O'Eourke, F, 7th N. Y. H. A., left leg, intermediary oper- ation, (Specs. 1502 and 3546, A. M. M. In five cases the operation of amputation was performed in the middle third, viz: Pt. T. Beirn, G, 60rh Illinois, leftleg. intermediary operation; Pt. J. R. Cowling, A, 62d Penn., right leg, secondary operation ; Pt. P. Steif, K, 139th N. Y., right leg, intermediary operation; Pt. J. Koehler, I, 150th Penn., left leg, intermediary operation, Specs. 2404 and 3533, A. M. M.; Pt. J. J. Toomey, I, 29th Penn., left leg, intermediary operation, Spec. 3361, A. M. M. These cases will appear in the tables of amputations in the leg. 2 Amputation at the knee joint was resorted to in the case of Pt. J. H. Pattee, Co. D, 26th Ohio (Table LVII, p. 409. No. 6). 3Two o Jhe four cases of amputation in the thigh were done in the middle third, viz: Pt. S. Montgomery, I, 139th Penn., left thigh, secondary operation (TADLE XXXIX, p. 314, No. 63): Pt. W. Stocdale, D, 48th Indiana, right thigh, secondary operation (TABLE XXXIX, p. 314, No. 87); anrt two in the lower th'.rd. viz: Corp"! M. Dunn, H, 46th Penn., both thighs, primary operations, Spec. 3193 (CASE 448, p. 242, and TABLE XXXII, p. 248, Nos. 239, 240); Pt. P. Walsh, A, 69th N. Y., left thigh, intermediary operation (TABLE XXXVI, p. 296, No. 202). 448 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X quent amputation was performed in fourteen instances, three times in the leg,1 twice at the knee joint,2 eight times in the thigh,3 and once in the leg with subsequent re-amputation in the thigh.4 The patients were sixty-one Union and six Confederate soldiers. Pyaemia was noted in eight, gangrene in twelve, erysipelas in four, and haemorrhage in fifteen instances. Case 709.—Private N. Biehl, Co. I. 155th Pennsylvania, aged 27 years, received a shot fracture of the right tibia, at Petersburg, June 19, 1804. He was conveyed to the field hospital of the 1st division, Fifth Corps, where excision was performed but not recorded, and whence he was transferred to City Point and subsequently to Alexandria. Surgeon E. Bentley, TJ. S. V., who amputated the limb, reported the following history: "The patient was admitted to the Third Division Hospital June 28th. Exsection had been performed on June 21st, in the field, by Surgeon J. A. E. Read, 155th Pennsylvania, who removed two inches of the middle third of the tibia by a straight incision four inches in length. When admitted the lips of the wound were widely separated, having apparently never been brought together closely or supported except by straps and bandages. The incision remained open in its whole length, leaving a portion of the crest of each extremity exposed and uncovered of periosteum. The granulations were healthy and covered with laudable pus; but the leg and foot were badly swollen, particularly about the ankle, where the integument was oedematous and pitted deeply on pressure. Water dressings were applied to the wound and stimulants were given internally. On July 14th, gangrene appeared in the wound. Remedies used successfully in other cases signally failed in this. The disease extended along the medullary cavity of the bone and the muscles behind, seemingly bidding defiance to local applica- tions and becoming very offensive. The patient sank very rapidly under the effects of the pain and poison, and the loss of blood from an artery opened by ulceration. On July 19th, amputation at the middle third of the thigh was performed by circular skin flaps. The patient was much prostrated at the time of the operation; had no appetite, great thirst, and dry tongue; face sunken and anxious; pulse quick and tremulous. Alcohol was applied to the stump, which was covered with a compress wet with the same. Whiskey and morphine was given internally. The next day gangrene attacked the stump, spreading rapidly on its face and extending three inches up the inner side of the thigh. The patient died on July 21, 18G4, of exhaustion. The post-mortem examination, twenty-two hours after death, revealed extensive gangrene of the stump and mortification extending to the body." The bones of the wounded leg, showing the tibia to be dead for one inch on each side of the excision, were contributed by Dr. Bentley and are shown in the annexed cut (Fig. 272). Case 710.—Corporal P. Lovell, Co. C, 10th Missouri, aged 41 years, was wounded at Mission Ridge, November 25, 1863. He entered the field hospital of the 3d division, Fifteenth Corps, where Surgeon J. L. Prout, 26th Missouri, noted: "Fracture of leg and wound of right shoulder, resection of portion of tibia." Assistant Surgeon J. J. Whitney, 8th Wisconsin, reported the following history: "The patient was of previous good constitution, but asthmatic. He was severely wounded, the left tibia being fractured at the junction of the middle and lower third. Two and a half inches of bone were resected the evening following the injury. Up to the time of the patient's admission to the general field hospital at Chatta- nooga, December 20tb, no attempts at repair had taken place, the wound granulating feebly and suppuration being profuse. On January 10, 1864, secondary haemorrhage occurred from the posterior tibial at its superior portion; tissue of the calf infil- trated, and blood flowing from the posterior wound at the seat of the fracture. Up to this date the patient had been generally quiet and had had a good appetite; no diarrhoea, chills or fever. Assistant Surgeon R. Bartholow, U. S. A., in charge of the hospital, being called in consultation, it was determined to amputate below the knee, which operation was then immediately performed bv him, at the junction of the upper and middle thirds, by the circular flap incision. During the operation the fibula was found to be fractured just below its articulation with the tibia, when a longitudinal incision was made and the upper fragment was smoothly excised. On January 15th, the stump was sloughing somewhat; discharges comparatively healthy, patient having no constitutional symptoms. On the following day there was a profuse haemorrhage, the ligatures having sloughed away, and the patient losing about sixteen ounces of blood. The bleeding was controlled by the application of cold and pressure. The skin about the stump now assumed a puffy erysipelatous character; patches looking gangrenous; bone protruding and healthy look- ing; pulse 100 and feeble. The treatment up to this time had been decidedly supporting, such as quinine, wine, beef tea, and milk. On January 17th, another haemorrhage occurring, I opened the wound down to the bleeding point and applied actual cautery, which instantly staunched the flow. The dead portions of tissue were all cut away and the stump was dressed with common solution of bromine. This treatment was continued until the 19th, when the artery opened again late in the evening, but the bleeding was controlled so soon that he lost only about four ounces; actual cautery was again employed. On January 1 The three amputations in the leg were done in the upper third, viz., cases of: Pt. J. S. Dewes, H. 18th Virginia, primary operation ; Capt. H. R. Schwerin, C, 119th New York, right leg, intermediary operation: Pt. It. Whistler, H, 49th Ohio, right leg, secondary operation. 2 Amputation at the knee joint was performed in the cases of: Pt. F. Carroll, K, 45th Penn., right leg, intermediary operation (TABLE LVI, p. 406, No. 21): and Corp'l T. Sharp, I, 38th Illinois, right leg, secondary operation (TABLE LVII, p. 409, No. 23). 'Subsequent amputations in the thigh were performed in the cases of: Corp'l C. Jackson, G, 2d Michigan, left thigh, intermediary operation in upper third (TABLE XXXIV, p. 276, No. 91); Pt. J. H. Carpenter, E, 110th Ohio, left thigh, intermediary operation in middle third, Spec. 2759, A. M. 51. (TABLE XXXV, p. 283, No. 241); Pt. N. Biehl, I, 155th Penn., right thigh, intermediary operation in middle third, Spec. 3337, A. M. M. (TABLE XXXV, p. 283, No. 223); Pt. N. H. Atwood, C, 6th Vermont, right thigh, intermediary operation in lower third (TABLE XXXVI, p. 296, No. 230); Pt. C. A. Eaton, K, 39th Mass., right thigh, intermediary operation in lower third (TABLE XXXVI, p. 298, No. 324); Pt. D. A. Johnson, E, 43d N. V., right thigh, secondary operation in lower third (TABLE XL, p. 322, No. 148): Pt. J. liader, F, 59th Illinois, left thigh, secondary operation in lower third (TABLE XL, p. 322, No. 181); Serg'tL. Heath, D, 2d Michigan, right thigh, intermediary operation in lower third, Spec. 2867, A. 51. M. (TABLE XXXVI, p. 299, No. 390). «Case of Corp'l P. Lovell, Co. C, 10th Missouri, left tbigh, secondary operation, Spec. 2108 (Table XL, p. 322, No. 160). FIG. 27i!.—Bones of right leg. with 2J inches of tibia excised. Spec. 3337. SECT. V.l PRIMARY EXCISIONS IN THE BONES OF THE LEG. 449 21st the patient was much the same; stump looking better; pulse 110 and full; appetite good; no pyaemie symptoms. Actual cautery was applied every third day, thus anticipating the occurrence of haemorrhage. On January 28th, the outer portion of the stump was gangrenous and looked badly; patient now failing; slough cleansed aud bromine applied with good effect. On January 31st, the artery gave away further above, bleeding again profusely, when actual cautery and pressure were successfully employed ; patient losing eight ounces of blood ; very feeble ; gangrene progressing. Haem- orrhage recurring on the morning of February 2d, I consulted with the other members of the faculty, when it was lesolved to re-amputate, which was promptly done by Assistant Surgeon R. Bartholow by circular incision above the condyles of the femur. The operation was endured but indifferently well. Ether was solely employed in tbe production of anaes- thesia. The patient did not rally, his stomach rejecting all food and stimulants; pulse 100 and very feeble ten hours after the operation. He died February 3,18G4." The specimen (No. 2108, Surg. Sect.), comprising the two lower thirds of the tibia and fibula and repre- sented iu the wood-cut (Fig. 273), was contributed by the operator. Cask 711.—Sergeant L. Heath, Co. D, 2d Michigan, aged 22 years, received a shot fracture of the right leg, before Petersburg, June 18, 1864. He was admitted ,to the field hospital of the 3d division, Ninth Corps, where excision was performed but not recorded. Assistant Surgeon A. Ingram, U. S. A., contributed the pathological specimen, shown in the annexed cut (Fig. 274), with the following report: "The patient entered Judiciary Square Hospital, Washington, July 1st, with a wound about the junction of the upper and middle thirds of the tibia. Resection of about two inches of the continuity of the bone was per- formed on the day of the injury. The tibia was somewhat shattered for about an inch thirds of left tibia above aud below the points of resection. Amputation at the lower third of the thigh was performed in this hospital on July 7th, by Acting Assistant Surgeon J. H. Thompson, the condition of the injured parts and the constitutional state of the patient rendering the opera- tion necessary. The circular method was chosen and ether was used as the anaesthetic. Tonics and stimu- lants were administered after the operation. Haemorrhage to the amount of six ounces occurred from the femoral artery on July 12th, when the vessel was taken up in Scarpa's triangle. Death occurred from pyaemia July 28, 1864." The specimen (No. 2867, Surg. Sect.) consists of the upper half of the injured tibia and shows the extremities to be somewhat irregularly necrosed. and fibula. 2108. Spec. Fig. 274.—Upper half of right tibia. Two inches of 6haft have been excised. Spec. 2867. Table LXIII. Summary of Two Hundred and Fifteen Primary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1—148; Deaths, 149—215.1 Name, Military Description, and Age. Adams, I. N., Pt., D, April 2, 110th Ohio, age 29. 2, 1865. -, Major. Andrews, S. B., Pt.. F, 72d Penn., age 28. Arnold, L., Pt., G, 143d Penn., age 20. Bain, T., Pt., G, 60th Illinois, age 34. Bell, H. V., Pt., I, 5th Virginia. Bennett, N., Corp'l, A, 7th Michigan. Bingham. J. M., Pt., K, 56th N. C, age 37. Bovie, P. P., Pt., B, 129th Indiana. Bowers, G., Pt., B, 77th New York, age 31. Brandon, J. a,Pt.,Clay- borne's Escort, age 19. Brown. W.C., Corp'l, K, 141st Penn., age 21. Burton, G. W., Pt., E, 5th Wisconsin, age 20. April 6, —, 1862. May 10, 10,1864. May 25, 25, 1864. July 4, 4, 1864. July 2, 2, 1863. Oct. 8, 8, 1864. Mar. 25, 25. 1865. July 4, 4, 1864. Sept. 19, 19, 1864. Nov. 30, Dec. 1, 1864. Aug. 16, 17, 1864. April 2, 2, 1865. Operations, Operators, Result. Name, Military Description, and Age. Left; 5 inches lower part tibia ex- cised; amputation leg April 12. Disch'd Sept. 11, '65; leg useful. Right; 6 inches fibula. Surgs. B. W. A vent and J.W. Thompson, C. S. A. 1866, walks well. Right; 2£ inches tibia, middle third: amputation leg .Sept. 27. Discharged Nov. 27, 1864. IMght; tibia; amp leg May 29. Discharged June 17, 1865. Left; 4 inches tibia, lower third. Surg. E. Batwell, 14th Mich. Gangrene; non-union. Aug. 1, amp. leg. Disch'd May 9, '65. Right: 3£ inches fibula, middle third. Recovery. Left: middle third tibia excised. Discli'd July 18, 1865 ; perma- nent^ lame. Right; mid. third tibia excised. Ass't Surg. E. M. Smyser, 48th Penn. Released Aug. 2,1865. Left; 1J inch lower third fibula. Surg. C. D. Moore, 13th Ky. Disch'd May 20,1865; partially anchylosed ankle. Right; 5 inches lower half fibula excised. Surg. G. T. Stevens, 77th N. Y. Gang.; hsem.; lig. post, tibial. Disch'd June5.'65. Right; 4 inches mid. third tibia excised. Sent to Provost Mar- shal March 27, 1865. ^ight; portion of middle third of ibia; removal exfoliated bone. Disch'd June 27, '65; necrosis. Left: middle third tibia (fracture and trephining of occipital). Discharged July 24, 1865; leg disabled. Carson, J. \\Y Pt., B, June 18, 7th Ohio, age 25. 19, 1864. Chandler, N. W., Lieut., June 17, H, 109th New York, 18, 1864. age 21. Clark, G., Lieut. Col., April 2, 119th Penn.. age 44. 2, 1865. Clark, J., Pt., D, 26th Sept. 3, Illinois, age 49. 3, 1864. Coddington, R., Pt., C, May 3, 21st New Jersey, age 3, 1863. 23. Collier, C, Pt., G, 4th May 3, Ohio. 5, 1863. Collins, F., Pt., A, 184th Oct. 19, New York, age 35. 19, 1864. Cooper, J., Pt., C, 10th April 2, N. Y. Artillery, age 25. 2, 1865. Copeland, M., Pt., M, 1st Mar. 31, Maine Cav., age 18. 31-, 1865. Cowling, J. R., Pt., A, Julv 2, 62d Penn., age 21. 3, 1863. Crawford, L. S., Pt., F, Sept. 22, 126th Ohio, age 21. 22, 1864. Croston. W., Pt., F, 1st Aug. 15, Mass. H. Art., age 24. 15, 1864. Crow, E., Pt., C, 123d June 22, New York, age 20. | 22, 1864. Denny, M., Serg't, F, July 20, 70th Indiana, age 37. 20, 1864. Operations, Operators, Result. Left; 4 inches of fibula. Dis- chargedjuly5,'65; legdisabled. Left; portion of upper third tibia excised. Surg. \V. B. Fox, 8th Mich. Disc'd Nov. 5,'64; unable to walk without assistance. Right; 3 inches upper third tibia excised. Must'dout June 19,'65. Left: 2| inches of fibula excised. Ass't Surg. D. Halderman, 46th Ohio. Disch'd June 29, 1865: can only walk with crutch. Right; 4 inches fibula excised. Musteredout June 19, '63; limb useless. Died May 4, 1867. Right; 5 inches mid. third tibia excised. Disch'd Mar. 31, '64 ; use of splint necessary. Left; 2 ins. fibula, middle, exe'd. Disch'd May 22, 1865. Left; 2 inches middle third tibia excised. A. Surg. O. S. Cope- land, 10th N. Y. Artillery. Dis- charged July 19, 1865; partial anchylosed ankle joint. Right; upper third fibula excis'd. Disch'd July 19, 1865. 1867, bone discharged. Right; 3 inches mid. third tibia excised. Surg. J. Kerr, 62d Penn. Mustered out Julv 13, 1864. Amp. leg Sept. 21,'l864. Left; 3 inches mid. third fibula excised. Disch'd Mar. 6, 1865. Right; portion of fibula. Dis- charged July 27, 1865. Left; 2 inches middle third fibula excis'd. Surg.J.Chapman, 123d N. Y. Disch'd March 27, 1865. Left; lower third fibula excised. Disch'd July 7, 1865. 'THOMPSON (J. W.), Cases of Resection. Fractures of Upper Third of Femur. .Gunshot Wounds of Knee Joint, etc., in Nashville Medical Jour- nal, 1866, N. S., Vol. I, p. 341; and Resection of the Long Bones, in the Medical Record, New York, Vol. Ill, 1868-69, p. 28. Surg. Ill—57 450 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. Operations, Operators, Result. 31 Dickerson, C, Corp'l, C, 51st Indiana, age 25. Dodds. 11'. P., Pt., D, 17th Miss., age 21. Driggs, J.A.,pt.,E,67th Ohio, age 22. Dudley, W. AV., Lieut. Col., 19th lnd., age 22. 32 Dunham, H., Pt., I, 2d Ohio, age 23. Dunn, M., Corp'l, H, 4fith Penn., age 21. 56 Farnsworth, R. R., Pt., C, 7th Mich. Cavalry, age 32. Ferguson, W. J., Pt., H, 81st Ohio, age 34. Fitch, W. T., Col., 29th Ohio, age 40. Flynn, J. P., Pt., E, 56th Mass., age 34. Frair, J. E., Pt., F, 9th N. Y. H. Art., age 19. Freeman, D. B., Pt., G, 10th Vermont, age 22. French, G. W., Pt., A, 27th Mich., age 27. Fuller, A., Pt., G, 109th New York, age 22. Fyler, O. R., Lieut., I, 2d Conn. Artillery, age 25. Gardner, C. J., Pt., B, 6th N. Hamp., age 32. Gibbons, J., Corp'l, C, 90th Illinois, age 22. Gibbons, T..Pt., A, 125th New York. Goldsmith, W.H.,Corp'l, F, 2d New Hampshire, age 24. Gould, D. M., Pt., D, 102d New York, age 21. Graham, J., Pt., B, 74th Illinois. Green. F.F., Pt.,B,12th Georgia, age 21. Gurley, W. H., Pt., D, 4th N. Carolina, age 30. Hall, J.. Corp'l, A, 107th New York. Hannowav, J., Pt., A, 69th N. V., age 39. Harris, H. A., Lieut., B, 16th Mass., age 22. Hatch, D. A., Pt., C, 2d Massachusetts, age 25. Hendley, J. B, Pt., D, 46th Ohio. Henry, C, Pt., I, 29th Pennsylvania, age 19. Dec. 4, 5, 1864. July 2, 2, 1863. Oct, 27, 27, 1864. July 1, 3, 1863. Dec. 31, 1862, Jan.1,'63 May 25, —, 1864. July 3, 4, 1863. July 22, 22, 1864. May 8, 8, 1864. May 6, 6, 1864. Oct. 19, 21, 1864. Sept. 19, 21, 1864. June 3, 3, 1864. July 30, 30, 1864. Sept, 19, 19, 1864. Oct, 1, 1, 1864. Dec. 13, 15, 1864. June 16, 16, 1864, June 9, 9, 1864. May 27, 27, 1864. June 21, 21, 1864. July 1, 3, 1863. July 3, 3, 1863. Mar. 19, 19, 1865. Aug. 15, 15, 1864. July 2, —, 1863. July 3, 5, 1863. June 27, 27, 1864. May 15, 15, 1864. Right; 2 inches fibula excised (also fracture left tibia). Mus- tered out Mar. 8. '65; paralysis. Left; portion of fibula. Paroled November 12, 1863; union. Right; 2 inches mid. third tibia excised. Surg. A. C. Barlow, 62d Ohio. Disch'd May 16, '65; ligamentous union only. Right; 3 inches mid. third fibula excised. Surg. J. E. Ebersole, 19th lnd. Gang.; haem. July 9, amp. leg. Discli'd April 9, '64. Right; most of mft. third of tibia excised. Disch'd August 3,'63; shortening 3 inches. Left; head of fibula excised (also amp. rightthigh). May27, amp. left thigh ; re-amp. right thigh. Disch'd August 17,1865. Died October 23, 1877. Spec. 3193. Right; upper and middle thirds tibia. Aug. 6, excised. Disch'd July 1, 1864; bone diseased. Left; 4£ inches tibia, upper third, exc'd. Surg.W. C.Jacobs, 81st Ohio. Oct. 7, spicula? removed. Disch'd May 12, 1865; caries. Right; 3 ins. tibia, middle, exc'd. Surg. A. K. Fifield, 29th Ohio. Resigned Oct. 13, 1864. 1870, bone not united. Left; 1 inch fibula, lower third, exc'd. Surg.J. Barber. 1st Penn. Reserves. Disch'd July 12, '65; ankle lame. Right; 4 inches mid. third fibula; necrosis. Disch'd May 31,1865; requiring continuous bandaging. Left; 3 inches middle third fibula exc'd. A. Surg. W. G. Bryant, 122dOhio. Disch'd May 31,'65. Left; 3 inches upper third fibula excised. Surg.H.E.Smith, 27th Mich. Disch'd April 18,1865. Left; 3 ins. fibula, low.th'd, exc'd. Surg.W.C. Shurlock, 51st Penn. Disch'd May 16,'65; walks well. Left; 3 inches middle third tibia excised. Surg. H. Plumb, 2d Conn. Art. Disch'd April6,'65; deformity of tibia. Left; middle third fibula excised. Surg. S. Cooper, 6th N. Hamp. Disch'd June 19, 1865. Right; 3 inches mid. third fibula exc'd. Surg. I. N.Barnes, 116th 111. Mustered out June 5,1865. Left; fibula, lower third, excised. Surg. P. E. Hubon, 28th Mass. Mustered out May 31, 1865. Left; 4 inches middle third tibia excised. Surg. G. P. Greeley, 4th N. Hamp. May 15,'65, amp. leg. Disch'd Oct. 14, 1865. Left; 4 inches up. third tibia ex- cised. Surg. C. H. Lord, 102d N. Y. Disch'd July 20, 1865; constant support required; false joint. Spec. 2552. Right; middle third tibia excised. Surg.W. P. Pierce, 88th Illinois. Disch'd June (i. 1865; necrosis. Left; lower portion of fibula ex- cised. Paroled Nov. 12,1863. Left; 3 inches middle third tibia excised. Exch'd Nov. 12,1863. Left; portion of fibula excised. Discharged July 15, 1865. Right; \ inch fibula, lower third, excised. Surg. G. Chaddock, 7th Mich. Disch'd June 23, '65. Left; 4 inches fibula, upper third. Disch'd Dec. 19, 1863. Died June 24, 1865. Right; 2 inches mid. third tibia excised. Surg.W. H. Heath, 2d Mass. Amp. leg Dec. 16. Dis- charged April 2,'64. .Spec. 2155. Left; 3£ inches mid. third fibula exc'd. A. Surg. D. Halderman, 46th Ohio. Disch'd Apr. 10,'65. Right; 3 ins. low. th'd tibia exc'd. Surg. G. P. Oliver, lllth Penn. Disch'd June 29,1865; necrosed bone removed; deformity. 59 73 76 Name, Military Description, and Age. Hersh, Z. E., Capt., B, 87th Penn., age 24. Hinsdale, A., l't., "E, 137th N. York, age 20. Hogan, J., Pt., F, 127th Pennsylvania, age 41. Hollcroft, W., Serg't, L, 2d N. Y. Cav., age 24. Hope, J., Pt., D, 51st New York. Hoy, M., Pt., B, 61st New York. Hurst, W. L., Corp'l, E, 115th Illinois. Ibach. F., Pt., A, 93d Pennsylvania, age 16. Johnson, J. F., Serg't, H, 9th Indiana, age 26. Johnson, S. P., Pt,, B, 13th South Carolina, age 29. Jones, S. W., Corp'l, A, 4th Delaware, age 29. Keeeh, H., Pt., K, 2d N. York Cavalry. King, J. R., Serg't, H, 6th Maryland, age 21. Koehler, J., Pt., 1,150th Pennsylvania, age 36. Lamb, J. M., Pt, A, 58th Mass., age 22. Lawcock, T.,Pt,,K,151st New York, age 31. Leichty, J., Pt,, F, Sth Pennsylvania, age 21. Lewis, J., Pt,, G, 12th Mass., age 19. Lisle, J. D., Pt., C, 1st Maryland. Lyon, C, Pt., D, 190th Pennsylvania, age 25. Mattern, L., Pt., F, 184th Pennsylvania, age 19. Mayes, J. H., Corp'l, F, 6th Ky. Cavalry. McCandless, A., Corp'l, K, 8th Ohio Cavalry, age 35. McCarty, C, Corp'l, E, 1st New York, age 28. McCracken, R.W., S'g't, C, 170th N. Y., age 32. McDonald, B., Pt.,A, 8th Kansas, age 28. April 2, 2, 1865. July 2, 2, 1863. Dec. 13, 14, 1862. April 8, 8, 1865. July 30, 30, 1864. May 3, 3, 1863. Sept. 20, 20, 1863. May 5, 5, 1864. June 20, 20, 1864. July 28, 28, 1864. Oct. 8, 8, 1864. May 2, 3, 1864. May 5, 6, 1864. May 5, 5, 1864. June 18, 18, 1864. Oct. 19, 19, 1864. May 11, 11, 1864. May 30, 30, 1864. July 3, 4, 1863. May 12, 12, 1864. May 30, 30, 1864. Mar. 25, 25, 1863. Sept. 3, 6, 1864. June 30, 30, 1862. June 17, 17, 1864. F-c. 16, . : 1864, Operations, Operators, RKSl'LT. McGuire, J., Pt., F, 20th Dec. 13, Massachusetts. 13, 1862. 84 McKim, W., Pt., L, Sth l'enn. Cav., age 23. June 11, 11, 1864. Left; 3 inches of fibula excised. Mustered out June 29, 1865. Left; 4 iuches lower third tibia excised. Surg. H. E. Goodman, 2feth Penn. Discli'd May 15,'65; ankle joint anchy.; deformity. Right; 6 ins. middle tibia exc'd. Surg. J. P. Prince, 36th Mass. ■Exfol. of sequestra. Mustered out May 29, 1863; 8 ins. separa- tion ; deformity. Died May 14, 1877. Spec. 2237. Left; 3 inches middle third fibula excised. Disch'd July 3, 1865. Left; portion of tibia excised. Mustered out May 19, 1865. Left; portion of fibula excised. Surg. T. C. Wallace, 6Jst N. Y. Recovery July 14, 1863. Left; 3 inches middle third fibula excised. Disch'd Aug. 3,1864. Left; 2 inches middle third tibia excised. Disch'd Oct. 6, 1864; permanently disabled. Left; 4 ins. middle tibia excised. Disch'd Nov. 4, 1864; shorten- ing 2 ins. and firm union. Right; portion of tibia excised. Surg. D. W. Maull, 1st Del. Sent to prison Feb. 5,1865. Left; 2 inches fibula excised; lig. post, tibial and peroneal arteries. Surg. A. A. White, 8th Mary- land. Disch'd June 22, 1865 Left; 2 inches fibula, up. third, excised. Ass't Surg. C. H. An- drus, 128th N. Y. Furloughed June 19, 1864. R't; 2 ins. mid. third fibula exc'd. Ass't Surg. R. L. Disbrow, 14th N. J. Disch'd May 18, 1865. Left; 4 ins. low. third fibula exc'd. Surg. W. T. Humphrey, 149th Penn. May29, amp. leg. Disc'd April 19,'65. Specs. 2404, 3533. Right; 2 inches upper third fibula excised. Disch'd July 31,1865; wears bandage. Left; 2 ins. low. third fibula exc'd; caries. Disch'd June 12, 1865; ankle deformed. Left; 6 ins. mid. third fibula exc'd. Surg. T. Jones, 8th Penn. Res. Hajm., 32 oz.; lig. posterior tibial artery. Disch'd Jan. 11, 1865; bone discharged, 1867. Right; 3 inches mid. third fibula exc'd. Surg. W. H. W. Hinds, 12th Mass. Disch'd March 8, '65; regeneration of bone. Left; portion of tibia exc'd. Surg. A. Chapel, U. S.V. Removal of fragments. Disch'd May 14,'64. Spec. 1655. Left; 1J inch up. third tibia exc'd. Surg. B. Rohrer,l0th Penn. Res. Disch'd January 16, 1865; one inch shortening; deformity. Left; 4 inches middle third fibula excised. Surg. M. Rizer, 72d Penn. Disch'd May 27, 1865. Right; 5 inches mid. tibia exc'd. Disch'd Sept, 16,1863. Left; 6 inches middle tibia exc'd. Discharged June 28,1865; limb shortened 2 inches. Died Feb. 18, 1877; phthisis. Right; 3 inches middle third tibia excised; nec.; slough. Aug.28, leg amp. Disch'd May 11,1863. Died August 21, 1867. Right; upper third fibula excised. Surg. F. Douglas, 170th N. Y. Also wound of anterior tibial art- ery and side. June 22. ligation. Disch'd Jan. 20, 1865; anchy- losis of ankle joint. Right; 3 inches lower third fibula excised. A.A.Surg. M. L. Herr. Duty August 1, 1865. Right; 4 inches mid. third fibula and splinters of tibia excised. Disch'd May 28, 1863; shorten- ing; deformity. Left; middle third fibula. Dis- charged Nov. 10, 1864. SECT. V.] PRIMARY EXCISIONS IN THE BONES OF THE LEG. 451 Name, Military Description, and a< Measor, J., Serg't, C, 137th X. York, age 37. Oct. 29, 29, 1863. Montgomery, S., Pt., I, ' Mav 12, 139th Pennsylvania. | 12, 1864. Moore, J.W.,Major, 97th Ohio. Moore, W., Corp'l, E, 71st Peun , age 29. Morse, F. E.,Pt.,H, 17th Maine, age 23. Morse, S. C, Pt., F, 97th New York, age 25. Mosier, W., Pt., C, 148th Pennsylvania, age 35. Moury, B. S., Pt., B, 137th New York. O'Connor, J., Pt.,G, 90th Illinois, age 23. O'Maley, J., Pt., L, 2d N. Y. M. R., age 32. O'Rourke, P., Pt., F, 7th N.Y. H'vy Art., age 41. Pattee, J. H.,Pt.,H, 26th Ohio, age 23. Peden, W. H, Corp'l, A, 17th Mississippi. Penroad, G. W., Pt., E. 13th Ohio Cavalry, age Pitts, B. F., Pt., K, 123d New York, age 25. Posey, O., Pt., H, 31st Illinois. Powell, T., Pt., F, 6th Colored Troops, age 30. Powers, R.M., Serg't, E, 49th Tenn., age 25. Ready, W. B., Corp'l, E, 2d Michigan, age 25. Ried, J. H., Lieut., K, 3d Miss., age 20. Rogers, S. T., Lieut., A, 86th Illinois, age 23. Ronald, J. S., Corp'l, A, 97th New York, age 30. Rose, F., Pt,, L, 1st Mis- souri Artillery, age 19. Rosemond, W. E., Capt,, A, 97th Ohio, age 23. Runyan.C. A., Musician, F, 9th New York H'vy Artillery, age 19. Rusk, J. D.,Pt,,G, 107th Illinois, age 26. Ryan, P.. Pt.,K,9th Con- necticut, age 19. Sieger, J., Pt., K, 16th Michigan, age 21. Smith, E. J., Corp'l, H, 56th Pennsylvania. Smith, S. B., Pt., I, 15th Alabama, age 25. Snooks, I., Serg't, H, 23d Ohio. Snow, H., Pt., L, 4th Va. Cavalry, age 23. June 22, 22, 1864. June 3, 3, 1864. May 12, 12, 1864. May 10, 11, ISM. May 10, 10. 1864. Oct. 29, 29, 1863. Dec. 13, 13, 1864. Julv 1, 1, 1864. May 31, 31, 1864. Sept. 19, 21, 1863. Nov. 29, 29, 1863. Sept. 30, 30, 1864. May 25, 27, 1864. July 22, 22, 1864. Jan. 15, 15, 1865. Nov. 30, 30, 1864. Nov. 16, 16, 1863. Nov. 29, 30, 1864. June 27, 27, 1864. June 18, 18, 1864. Dec. 25, 26, 1863. June 22, 22, 1864. May 3, 3, 1863. May 31, 31, 1864. Jan. 5, 5, 1864. May 8, 8, 1864. May 23, 23, 1864. Oct. 7, 7, 1864. Oct. 19, 19, 1864. May 5, 5, 1864. Operations, Operators, Result. Left; post, portion up. third tibia exo'd. Surg. A. K. Fifield, 29th Ohio. Aug. 22, 1864, excision anterior portion. Disch'd April 5,1865; shortening; deformity. Left; 2 inches tibia excised. July 29, amputation thigh. Disch'd August 2, 1865. Left; 2 inches lower third fibula excised. Surg. E. B. Glick, 40th Indiana. Resigned Oct. 7,1864. Right; portion of fibula excised. Discharged March 22, 1865. Right; lower third tibia excised. Disch'd May 11, 1865 ; necrosis and exfoliation. Right; 2J inches low. third fibula excised. Disch'd Dec. 12,1864. Left; 3J inches fibula excised. Disch'd May 9,'65. 1869, caries, Left; portion of mid. third tibia exo'd. Surg. J. L. Dunn, 109th Penn. Disch'd May 24, 1865. Right; 5 inches mid. third fibula excised. Ass't Surg. C. B. Rich- ards.U.S.V. Disch d June 6,'65. Left; upper third tibia. Disch'd July 31, 1865; leg flexed. Left; 6 ins. low. third tibia exc'd. Surg. G. L. Potter, 145th Penn. June 6, leg amputated. Disch'd July 28, '65. Specs. 1502, 3546. Left; 2 ins. low. third tibia exc'd. Jan. 21, 1864, amp. knee joint. Discharged July 14, 1864. Right; amp. left leg. Surg. J. P. Prince, 36th Mass. Exchanged! Left; 2 inches middle third fibula excised. Surg.W. C. Shurlock, 51st Penn. Disch'd Nov. 21,'65; cartilaginous union to tibia. Left; 21 inches mid. third fibula exc'd. A. Surg.L.W. Kennedy, 123d N. Y. Disch'd April 3, '65. Left; 3 inches lower third fibula excised. Disch'd July 19,1865; ligamentous union. Left; 3 inches lower third tibia excised; necrosis. April 26, '65, amp. leg. Disch'd Oct. 14, '65. Left ; 2 inches upper third fibula excised. Transferred to Provost Marshal Jan. 3, 1865. Right; por. low. thud tibia exc'd. Disch'd June 11, 1864; perma- nently lame. Died Sept. 9, '66, ulterior effect of injury. Right; 5 ins. fibula excised. To Provost Marshal March 7,1865. Left; 2 inches upper third fibula excised. July 17, excision head of fibula. Disch'd Oct. 25,1864; passive motion only. Left; 4 inches lower third fibula excised. Disch'd June 23,1865; constant bandaging; anch. ank. Left; 41 inches middle third tibia excised. Disch'd Jan. 27,1865. Left; 11 inch middle third fibula excised. Surg. E. B. Glick, 40th Indiana. Disch'd Oct. 7,1864. Left; 4 ins. tibia excised. Surg. S. A. Sabin, 9th N. Y. Heavy Artillery. Oct, 17, leg amputa- ted. Disch'd July 26, 1865. Left; 4 inches lower third fibula excised. Surg. J. W. Lawton, U. S.V. Disch'd Dec. 12,1864; uses crutches. Right; li inch upper third tibia excised. Surg. E.A.Thompson, 12th Me. Disch'd May 17,1865; knee joint anchyl'd; 3 inches shortening. Spec. 2530. Right; middle third tibia excised; caries. Disch'd Feb. 20, 1865; deformity. Left; middle third tibia excised, Disch'd July 1, 1865; shorten- ing 1 inch. Right; 4 ins. middle third fibula excised. Retired Feb. 9,1865. Left; mid. th'dtibia exc'd; necro. Disch'd May 9,1865; deformity. Right; portion of head of fibula excised. To prison Jan. 27, '63. Name, Military Description, and Age. Sodon, R. D., Corp'l, I, 33d New Jersey. Sprague, O., Pt., I, 8th Connecticut. Spring, W.F., Serg't, C, 44th Illinois, age 29. Steih, D., Pt., F, 9th N. Y. H'vy Artillery. Stermcr, F., Pt., F, 5th Iowa, age 25. Stevenson, J. A., Adj't, llth Penn., age 27. Stief, P., Pt., K, 139th N. York, age 39. Stineback, B., Serg't, E, 2d Michigan, age 27. Stocdale,AV., Pt., B, 48th Indiana, age 28. Strass, G. N, Serg't, E, 10th Alabama, age 25. Sweet, B.R.,Pt.,A, 26th Conn., age 45. Sweitzer.C, Pt.,A,208th Pennsylvania, age 44. Taylor,W.C., Pt., M, 4th Wisconsin Cav., age 23. Thiebeau, A., Serg't, I, 24th New York Cav. Thistlewood, R. K., Pt., E, 7th Maine. Thomas, W.,Pt.,K,110th Ohio, age 24. Toomey, J. J., Pt,,I,29th Pennsylvania, age 21. Trent, J. L., Corp'l, B, 63d P.cnn., age 24. Tucker, N., Pt., B, 43d Colored Troops. Verstrappen, J., Pt., H, 1st Maine, age 20. Walsh, P., Pt., A, 69th New York N.G., age 29. Warfield,A.B.,Serg't, E, 7th Rhode Island. Warren, D. A., Serg't.C, 55th Ohio, age 29. Wehmhoff, H., Pt., F, 12th Missouri, age 30. Weyl, J., Serg't, E, 5th Minnesota, age 32. Wiggs, H., Pt., K, 43d North Carolina, age 24. Willcins,J.S., Lieut., H, 21st Miss., age 20. Williams, J.O., Capt., D, 12th Mass., age 43. Williamson,R.J., Lieut., D, 66th 111., age 27. * Wilson, S., Pt., E, 7th West Virginia. Wilson, T. C, Capt., D, 27th Virginia, age 23. Zimmerman, J., Serg't, E, 1st West Va., age 23. Adams, M.,Pt.,B, 130th Indiana, age 24. Alley, S. D., Pt., B, 99th Indiana. May 25, 25, 1864. June 15, 15, 1864. Mav 14, 15,1861. Oct. 19, 20, 1864. Nov. 25, 25, 1863. April 1, 1, 1865. July 30, 30, 1864. Nov. 24, 25, 1863. May 14, 14, 1863. June 30, 30, 1864. June 14, 14, 1863. Mar. 25, 25, 1805. Aug. 25, 27, 1864. April 6, 6, 1865. Sept. 19, 19, 1864. Mar. 25, 25, 1865. May 15, 15, 1864. May 5, 5, 1864. July 30, 31, 1864. April 6, 6, 1865. June 3, 3, 1864. May 25, 25,'1864. Mar. 19, 19, 1865. May 14, 14, 1864. Deo. 16, 16, 1864. July 11, 11, 1864. Sept. 3, —, 1864. July 3, —, 1863. Mav 29, 29, 1864. Oct. 27, 27,1864. July 9, 9, 1864. Oct. 19, 22, 1864. July 21, 21, 1864. May 25, 25, 1864. Operations, Operators, Result. Left; portion of tibia excised. Surg. J. Reily, 33d New Jersey. Disch'd July 14, 1865. Left; portion of fibula excised. Disch'd July 19, 1865; partial anchylosis of ankle joint. Left; 6 ins. tibia excised. Surg. W. I". Pierce, 88th 111. Disch?d Mar. 18, '65; non-union ; useless. R't; inn. part low. th'dtibiaexc'd. Disch'd June 20, 1865; necrosis. Left; 3 ins. low. third fibula exc'd. A .Surg.W. II. Harrow, 5th Iowa. Disch'd July 18, 1864. Right; 3 inches middle third tibia excised. Surg. J. W. Anawalt, llth Penn. Disch'd Julyl,'65; separation of IJ inch. Right; lower third tibia excised; hsem. Aug.10, amp. leg;. Disc'd. Right; 31 ins. fibula exc'd. Snrg. J. P. Prince, 36th Mass. Disch'd May 25, 1864; lame. Right; portion of fibula excised. July 6, amputation thigh. Dis- charged July 15, 1865. Left; 2 inches of tibia excised. Furloughed Sept. 30, 1864. Left; upper third tibia excised. Mustered out August 17,1863. Left; 3 inches middle third fibula excised; gang. Disch'd July 15, 1865. Died March 14, 1875. Right; 2 inches internal edge up. third tibia excised. A. A. Surg. J. F. Musgrave. Dis. Mar. 5,'65. Left; middle third fibula excis'd. Discharged June 28, 1865. Left; lower third tibia excised. Surg. G. T. Stevens, 77th N. Y. Discharged April 3, 1865. Right: mid. third fibula excised. Discharged June 26,1866. Left; lower third tibia excised., Surg. H. B. Whiton, 60th N. Y. May 31, amputation leg. Dis- charged July 2, '65. Spec. 3361. Right; lower"third tibia excised. Surg. G. T. Stevens, 77th N. Y. Disch'd May 4,'65; 3 ins. short. Left; 21 ins. low. third tibia exc'd. Surg. F. M. Weld, 27th C. T. Disch'd May 27, 1865 ; atrophy. Left; 4 inches middle third fibula excised. Must, out July 2, '65; anchylosis ankle joint. Left; portion of upper third tibia exc'd. Surg. J. A. Spencer,69th N. Y. June 9, amputat'n thigh. Disch'd Sept. 20, 1865. Left; small portion fibula excis'd. Surg. J. Harris, 7th R. I. Dis- charged June 3, 1865. Left ; lower third fibula excised. Discharged July 3,1865. Left; 2 inches middle third tibia excised; necrosis. Discharged Sept. 19,1864; anchy. ank. joint. Right; 2| inches lower third tibia excised. Disch'd April 14, '65. Died Jan. 20, '77; absc. of liver. Left; 3 inches middle third fibula exc'd. Surg.—Brewer, C.S.A. To prison February 5, 1865. Left; 2 inches lower third fibula excised. To prison Dec. 9, '64. Right; upper third tibia excised. Disch'd June 8,'64. Died April 4, 1875; phthisis pulmonalis. Left; 3 ins. up. third tibia exc'd. Surg. J. Pogue, 66th Illinois. Disch'd Jan. 4, '65; leg useless. Right; lower third fibula excised. Surg. W. I. Buit, 42d N. York. Mustered out June 29, 186.1. Left; 2 inches lower third fibula excised. To prison Oct. 9, '64. Right; 4 inches lower third fibula excised. Disch 'd July 27,1865; partial anchylosis ankle. Left ; 2 ins. mid. third tibia exc'd. Surg. J. W. Lawton, U. S. V. Gangrene. Died Sept. 26.1864. Left ; 11 inch fibula exc'd. Surg. R. Morris, 103d Illinois, T Sept, 3, 1864. Died 152 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age 151 Atwood, N. H., Pt., C, 6th Vermont, age 22. 152 [ Babcock, E. H., Pt., K, 1st Michigan Cavalry, age 39. Barrett, J. E., Lieut., D, 91st Indiana. Biehl, N., Pt,, I, 155th Pennsylvania, age 27. Blair, W. F., Pt,, H, 5th Ponn. Res., age 28. Canfield, D., Serg't, M, 14th N.Y. H.A., age20. Canter, J., Pt., E, 53d Ohio. Carpenter, J. H., Pt., E, U0thPenn.,age40. Carroll, F., Pt,, K, 45th Penn., age 23. Carter, T.F.,Pt.,E, 12th Indiana. Chaffee.A. J.,Pt.,E, 44th New York, age 28. Cook, J. T., Pt.,K,2dN. York Cavalry. Cosman, W. T., Corp'l, F, 9th New York S. M. Cramp, T., Pt., G, Sth Minn., age 33. Davis, S., Pt., P, 27th Michigan. Deegan, T., Capt., C, 107th Pennsylvania. Dewes, J. S., Pt., H, 18th Virginia. Dodson, J. S., Serg't, H, 99th Indiana. Eaton,C. A., Pt., K, 39th Mass., age 40. Greenstreet, J., Pt., F, 32d Missouri. Haas, P., Pt., E, 64th Ohio. 172 Harrison, G. C, Corp'l, K, 102d New York. Heath, L., Serg't, D, 2d Michigan, age 22. 174 Henderson, W., Serg't, E, 83d New York. 175 Hensler, J., Pt., F, 29th Pennsylvania. 176 ; Herzog, F., Pt., C, 8:?d I New York, age 29. 177 Hiney, W. H., Lieut., C, I 50th Pennsylvania. 178 Hitchings,W..Pt,,H,8fh i Illinois. 179 j Hughes, N., Pt., M, 3d Artillery. 180 Jackson, C, Corp'l, G, 2d Michigan. 181 Jackson, W., Pt., E, 97th New York, age 34. Operations, Operators, Result. April 2, Right; portion of fibula excised; 2,1865. slough'g. April 13, amp. thigh. Died May 23, 1865; pyaemia. July 3, Left; port. up. third fibula; gang. 3, 1863. Oct, 18, hseni., 3 pts.; lig. anle. tibial artery. Died Oct. 18, '63, effects of lnem. Spec. 2611. June 15, Left: 2 inches middle third fibula 15, 1864. excised. Surg. J. W. Lawton, U. S. V. Died July 20, 1864. June 19, Right; 2 ins. mid. third tibia exc'd. 21, 1864. Surg. J.A. E. Reed, 155th Penn. July 19, amp. thigh. Died July 21,1864; exhaust'n. Spec. 3337. May 12, Left; 3 inches lower third fibula 12, 1864. excised. Surg. B. Rohrer, 10th Penn. Res. Wire sutures. Died June 12, 1864; pyaemia. June 17 Right; 2 ins. lower third excised. 17, 1864. Died July 28, 1864. June 27, Left; 3 inches middle third tibia 28, 1864. exc'd. Surg. A. C. Messenger, 57th Ohio. Died July 3, 1864. June 22, Left; 11 inch upper third fibula 22, 1864. excised. Julv 5,1864, amputa- tion thigh. Died July 16,1864; pyaemia. Spec. 2759. June 3, Right; 3 ins. middle third fibula 4, 1864. excised; haem., 8 oz. June 18, 1864, amput'n knee joint. Died June 22, 1864 ; exhaustion. May 13, Right; 2 inches tibia and fibula 14,1864. excised. Surg.W. Lomax, 12th Indiana. Died May 31, 1864. July 3, Right; 3 inches tibia exc'd; also 4, 1863. wound left leg. Died Aug. 16, 1863; diarrhoea and erjTsipelns. April 1, Left; portion of tibia exc'd; also 1,1865, w'nd of arm. Died April 11,'65. Sept. 17, ---; portions of tibia and fibula 20,1862. exc'd. Died Oct. 2, '62; pysemia. Dec. 16, Right; 4 ins. low. third tibia exc'd. 17, 1864. Surg. V. B. Kennedy, 5th Minn. Lac. wound post, tibial artery. Dec. 27, lig. Died Feb. 4,1865. May 24, Left; portion of fibula excised. 24, 1864. Surg. A. F. Whelan, 1st Mich. S. S. Died May 30, 1864. Deo. 13, Left; portion of fibula excised. 13, 1862. Died January 9, 1863. May 12, ---; portion of lower end fibula 12, 1864. excised. May 14, amputation of leg. Died May 21,1864. July 22, Right; 3J inches 'tibia excised. 23, 1864. Ass't Surg. D. Halderman, 46th Ohio. Died August 18, 1864. May 9, Left; portion of upperthird fibula 9, 1864. excised. May 17, haemorrhage, 30 oz.; amputation thigh. Died May 29, 1864; exhaustion. May 27, Left; 3 inches fibula exc'd. Surg. 27,1864. G.L.Carhart, 31st Iowa. Died June 20, 1864. Jan. 1, Left; middle third tibia excised. 4, 1863. A. Surg. L. C. Fonts, 94th Ohio. Died Jan. 26,1863 ; gangrene. May 27, : Left; portion of tibia excised. 27, 1864. I Surg. C. H. Lord, 102d N. York. Died June 9, 1864. June 18, Right; 2 inches tibia. July 7. 18, 1864. amp. thigh. Died July 28, '64. Spec. 2867. June 1, Right; middle third fibula exc'd. 1, 1864. Died June 11, 1864. June 21, Right; fibula; lig. ant. tib. artery. 21, 1864. Sufg. J. A. Wolf, 29th Penn. Died July 9, 1864. May 12, Right; 3 ins. fibula exc'd. Died 12, 1864. ! May 30, 1864 ; exhaustion. June 1, ! Right; 3 inches upper third fibula 1, 1864. excised. Died July 8, 1864. April 9, j Left; middle third fibula excised. 9, 1865. ; Died April 17, 1865; gangrene. Nov. 16, Right: portion of tibia excised. —, 1863. ■ Died December 18, 1863. June 25, : Left; partial excision of fibula. 25. 1864. | Surg. A. F. Whelan, 1st Mich. j S. S. June 28, '64, amp. thigh. Died July 2, 1864. May 11, | Left; 4 inches middle third fibula 11, 1864. j exc'd. Surg. W. B. Chambers, 97th N. Y. Died June 1, 1864. v! Name, Military Tw.nro "• Description, and Age. a,ATE8- Jamison, B. A., Pt., A, 21st Virginia, age 21. July 3, 6, 1863. 183 I 184 185 186 187 Johnson, D. A., Pt., E, i Nov. 7, 43d New York, age 37. j 7, 1863. Lancaster, W. B., Pt., B, June 18, 66th N. C, age 20. ; 18, 1864. 205 206 207 208 209 210 211 212 213 214 215 Lay, T. S., Pt., D, 53d Mar. 25, Georgia, age 21. 25, 1865. Lemon, T. A.,Corp'l, A, May 11, 61st Pennsylvania. 111, 1864. Lohser, A., Pt., I, 24th i May 25, Michigan, age 20. I 25, 1864. Lovell, P.,Corp'l, C,10th j Nov. 25, Missouri, age 41. i 25, 1863. Mann, A. A., Corp'l, A, , April 1, 16th Maine. 1, 1865. Martz, S. V., Pt., I, 87th May 18, Pennsylvania. [ 18, 1864. ■Mclntyre, A.,Corp'l, D, June 22, 6th New York Heavy 23, 1864. Artillery, age 37. Meade, L., Pt., B, 2d N. June 18, York M. R., age 17. 18, 1864. Munn, J., Pt., E, 15th Oct, 7, Alabama, age 32. 7, 1864. Norman, C. H., Pt., K, May 8, 8th Maryland, age 20. 8, 1864. Rader, J*., Pt., F, 59th Aug. 19, Illinois, age 21. 19, 1864. Reed, N. H., Pt., H, 30th June 15, Iowa. 15, 1864. Rice, H., Corp'l, C, 36th May 25, Massachusetts. —, 1864. Rice, W., Pt., B, 14th June 22, Kentucky, age 29. 22, 1864. Robbins, J. A., Capt., G, June 29, 129th Indiana. 29, 1864. Root, W. R., Pt., E, 7th June 3, N. Y. H'vy Artillery. 3, 1864. Rutledge, T., Lieut., G, Dec. 15, 33d Missouri. 15, 1864. Sanders, G. W., Corp'l, Sept. 19, K, 26th Ohio. 21, 1863. Schwerin, H. R., Capt., Slay 2, C, 119th New York. 5, 1863. Sharpe, T., Corp'l, J,38th Feb. 6, Illinois, age 30. 7, 1864. Smith, J., Pt., I, lllth July 20, Pennsylvania. 20, 1864. Smith, J., Pt,, F, 17th June 17, Vermont, age 40. 17, 1864. Springer, J. M., Chap- May 15, lain, 3d Wis., age 37. 15, 1864, Thompson, W. B., Pt., Dec. 17, K, 124th Ohio, age 19. 18, 1864, Utzey, G. C, Pt., G, 4th May 29, South Carolina Cav. 30, 1864. Walton, J., Corp'l, G, July 27, 20th Ohio, age 28. ! —, 1864. Whistler, R., Pt.,H, 49th | June 2, Ohio. j 2, 1864. I Williams, J. S., Pt., F, ! Nov. 30, 127th New York, age Deo.2,'64 35. Willingmire, R.. Pt., C, | May 25, 29th Pennsylvania. 25, 1864. May 5, 5, 1864. Dec. 13, 13, 1862. Operations, Operators, Result. Wilson, J. M., Pt., D, 2d U. S. Sharpshooters. Woodward, E. F., Pt., I, 53d Pennsylvania. Left; lower third tibia excised. Snrg. J. A. Wolf, 29th l'enn. Died July 18. 1803; tetanus. Right; portion of tibia excised; non-union. July 2, j864, amp. thigh. Died August 6, 1864. Right; middle third tibia exc'd; gangrene. Died July 16, 186-1. Left; head of fibula and pan of tibia exc'd. Died April 21,'65. Left: 8 inches tibia excised. Died May 16, 1864. Left; 31 inches mid. third fibula excised; also wound of right ankle. Died June 17, 1864. Left; 21 inches lower third tibia exc'd. Jan. 10, 64, haem. from post. tib. art.; amp. leg; slough.; bsein.; gang. Feb 2, amp. thigh. Died Feb. 3, 1864. Spec. 2108. Right; middle third tibia exc'd. Died April 24, 1865. Right; upper third fibula exc'd. Died June 4, 1864. Left; 2 inches upper third fibula exc'd. Aug. 5, parench.; htem. Died Aug. 10, 1864; pyaemia. Right; middle third tibia exc'd. Died July 17, 1864. R't; 31 ins. mid. th'd tibia exc'd. Died July 9, '65; chr. diarrhoea. Left; portion of fibula excised. Died May 22, '64; haemorrhage. Left; 41 inches middle third tibia exc'd. Dec. 7, '64, amp. thigh; gang. Died Jan. 4,'65; exhaus. Right; middle third tibia exc'd. Surg. B. A. Bond, 27thMissouri. Died July 10, 1864. Right; head of fibula excised. Died June 1,1864, of wound. Right; 3 inches mid. third fibula excised. Surg. J. W. Lawton, U. S.V. Died Sept. 22, 1864. Left; 21 inches upper third fibula, including the head, excised. Snrg. S. K.Crawford, 50th Ohio. Died July 24, 1864. ---; portion of fibula excised. Surg. G. L. Potter, 145th Penn. Died June 9, 1864. Left; 2 inches middle third fibula excised. Surg. A. T. Bartlut, 33d Mo. Dec. 26, haein., 32 .'.. Died Dec. 28,1864. Spec. 6634. Left; 2 inches lower third tibia excised. Died Oct. 22, 1863. Right (May 3, spicula and ba! rem.); exc. in mid. third. Surg J.D. Hewett, 119th N.Y. Maj 9, amp. of leg. Died May 10, '63. Right; por. of tibia exc'd. Surg. J. Y. Finley, 2d Ky. Cav. April 5, amp. knee joint. Died June 23, 1864; erysipelas. Right; portion of fibula excised. Died July 21, 1864. Right; portion of fibula excised. Died July 6, 1864. Right; 21 inches mid. third tibia exc'd. Died May 22,'64; pj'aeui. Right; 3 inches excised. A. A. Surg. L. Sinclair. Died Feb. 2, 1865; gangrene. ---; 5 inches of tibia excised. Surg. C. B. Gibson, C. S. A. Died June 24. 1864. Left; port, of fibula exc'd. Died Sept. 26, 1864; dysentery. Right; portion of tibia excised. July 5, leg amputated. Died July 14,1864; pyaemia. Left; 4 inches of fibula excised. A. A. Surg. H. Leaman. Gan- grene. Died Dec. 4, 1864. Right; portion of tibia excised. Surg. G. P. Oliver, llltb Penn. Died June 17, 1864. ---; portion of upper third tibia excised. Died May 29, 1864. Left j part of tibia and radius ex- cised. Died Jan. 6,1863. 'LIDELL (J. A). Re.wtion of Fibula in Continuity for Gunshot Fracture, etc., in United r-tate* Sanitary Commission Memoirs, New York. 1870 8nrgic3l Volume I. p. 530. SECT. V.] INTERMEDIARY EXCISIONS IN THE BONES OF THE LEG. 453 Of the two hundred arid fifteen primary excisions in the continuity of the leg, forty-two with twelve deaths were in the upper, eighty-four with twenty-one deaths in the middle, forty-six with eight deaths were in the lower third of the leg, and in forty-three instances with twenty-six deaths the seat of the operation was not indicated. Intermediary Excisions in the Continuity of the Bones of the Leg.—Eighty-seven excisions in the leg were intermediary operations; of these twenty-nine proved fatal, a mortality rate of 33.3 per cent. Portions of the tibia were excised in thirty-three, of the fibula in forty-six, and of both bones in seven instances, and in one case this point was not recorded. Recoveries after Intermediary Excisions in the Continuity of the Bones of the Leg. The fifty-eight successful intermediary operations were performed on fifty-one Union and seven Confederate soldiers. One, an officer, is still (November, 1880) in active service, another has been placed on the retired list, and forty-nine became pensioners. Of the lat- ter, five have died since the date of their discharge—two from debility, one from phthisis, and two from causes not recorded. Four patients submitted to subsequent operations—one to amputation in the leg1 and three to ablation in the thigh.2 Case 712.—Colonel H. A. Morrow, 24th Michigan, aged 33 years, received a shot fracture of the upper third of the fibula of the right leg, at the Wilderness, May 6, 1864. Five days after being wounded he entered the Seminary Hospital, Georgetown, where his injured limb was operated upon by Surgeon H. W. Ducachet, U. S. V., who reported the following: " When admitted the patient had no appetite and was feverish, very nervous and irritable, complaining of every noise. The wounded leg was very much swollen, painful, and discharging an unhealthy sanious pus. Resection of three inches of the upper third of the fibula was performed on May llth, chloroform being used. The patient suffered intensely for twenty-four hours after the operation, when he began to improve. There were no unfavorable symptoms afterwards. Simple dressings were applied. The patient left the hospital on leave of absence July 1, 1864." Colonel Morrow subsequently returned to the field and again held active commands. He was mustered out of the Volunteer Service after the close of the war in 1865, and recom- missioned in the 36th regiment of Infantry of the Regular Army in the following year, since when he has been promoted to Colonel of the 21st Infantry. Case 713.—Private G. Fuller, Co. H, 19th Maine, age 18 years, was wounded in the left leg, at Eeam's Station, August 25, 1864, and entered Emory Hospital, Washington, three days afterwards. Acting Assistant Surgeon J. M. Downs forwarded the specimen (Fig. 275), with the following description of the injury: "The wound was produced by a musket ball, which passed through the leg near the ankle, shattering the lower third of the fibula in its course. Upon examination the operation of excision was thought advisable, and was performed, on August 29th, by Surgeon N. R. Moseley, U. S. V., who removed two and a half inches of the fibula near the ankle joint through an incision three and a half inches long. Ether and chloroform constituted the anaesthetic." The patient was subsequently transferred to Webster Hospital, Manchester, and on May 27, 1865, he was mustered out of service and pensioned. Various examining surgeons certified to the injury and operation, and Dr. C. B. Pearson, of Spring Green, Wisconsin, February 5, 1873, added: "The wound is healed, but the muscle has grown fast to the tibia so as to destroy action of the tendons," etc. Subsequent examiners corroborate the previous reports. The pen- sioner was paid December 4, 1879. Case 714.—Private W. H. Curtin, Co. H, 23d Massachusetts, aged 20 years, was severely wounded in the left leg, at Whitehall, December 15, 1862. Surgeon C. A. Cowgill, U. S. V., reported: "The wounded man was admitted to Academy Hospital, New Berne, five days after receiving the injury. The fibula was badly comminuted and shattered. On December 26th, I excised six and a half inches of the bone, including the finely comminuted portion. The patient recovered pleasantly and has gone home on furlough, able to walk comfortably." He subsequently entered Foster Hospital, where he was discharged May 28, 1863. Examining Surgeon W. C. Robinson, of Portland, October 10, 1863, described the injury and reported: "A Fio.276.— large cicatrix nearly the whole length of the leg, showing the nature of the operation. It appears that nature is in hlaU inches a measure restoring the bone. A large ulcer still exists at the point where the ball entered the leg. He has walked of fibula ex- cised. Spec. with a crutch until recently; is now able to walk with a cane." Several months after being discharged the man 1326. re-enlisted in the Veteran Reserve Corps, whence he was ultimately mustered out November 16,1865, and pensioned. The Portland Examining Board reported, September 4, 1873, that "the nerves were injured so that the foot is greatly impaired in its motions." At a subsequent examination it was stated that "the tendo-achillis is contracted, so that there is but little antero- 'Case of Private D. P. Griswold, Co. C, 76th New York, right leg, secondary amputation in the middle third. 'Cases of Pt. W. II. Burdick, Co. B, 82d Pennsylvania, right thigh, secondary operation in lower third (TABLE XL, p. 320, No. 17); Pt. I. A. Angell, Co. D, 1st Wisconsin Cavalry, right thigh, secondary amputation in lower third (TABLE XL, p. 320, No. 2); Pt. E. A. Bennett, Co. F, 44th New York, left thigh, secondarj- amputation in lower third (TABLE XL, p. 320, No. 7). 454 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. posterior motion of the ankle joint. The leg is atrophied and the parts bound down by the indurated cicatrix." The pensioner was paid December 4. 1H79. The specimen represented in the wood-cut (FlG. 276) was contributed by the operator. Fatal Cases of Intermediary Excisions in the Bones of the Leg.—The twenty-nine operations of this group were performed on Union soldiers. Pysemia was noted in eleven, gangrene in eight, and erysipelas in one case. Subsequently, amputation in tbe leg was performed in one,1 exarticulation at the knee in one,2 and amputation through the thigh in five instances.3 Reports of post-mortem examinations were received in five instances. Case 715.—Private H. M. Grimes, Co. C, 116th New York, aged 24 years, was wounded at Port Hudson, May 27, 1863. Surgeon C. B. Hutchins, 116th New York, reported his admission to the field hospital of the 1st division, Nineteenth Corps, with "shot wound of leg; severe." Assistant Surgeon P. S. Conner, U. S. A., who operated in the case and contributed the pathological specimens (FiGS. 277, 278), reported the following description of the injury and its results: "The man was wounded in the left leg by a minie" ball, which was found to have struck the tibia anteriorly, causing compound comminuted fracture. He was admitted into University Hospital, New Orleans, May 30th, where, a few days later, several loose fragments of bone having been removed and the extent of the injury determined, the entire fractured portion was resected, amounting to nearly five inches of the tibia, and including the shaft to within less than an inch from the ankle joint. The ball was found to be wedged in among the fragments and the fibula uninjured. The case progressed very favorably until early in July, when diarrhoea came on, which caused the patient's death August 14, 1863. The bones of the injured leg (FlG. 278) indicate the extent of the reparative process, and the probabilities that the man would eventually have had a serviceable leg had he lived." The extremity of the lower fragment is carious, a spur from the upper fragment projecting three inches downward, and the face of the fibula is involved in callus. Case 716.—Private H. Mink, Co. H, 4th New York Heavy Artillery, aged 20 years, was wounded at Petersburg, April 2, 1865, and was conveyed to City Point two days afterwards. Acting Staff Sur- geon J. Aiken recorded his admission to the Depot Hospital of the Second Corps with " compound fracture of left leg." On April 15th the wounded man was transferred to the First Division Hospital, Annapolis, where the injured limb was operated on by Surgeon B. A. Vanderkieft, U. S. V., who reported as follows: " The wound was produced by a roinie' ball, causing a compound comminuted fracture of the tibia and oblique fracture of the fibula at the middle third of the leg. Resection was performed on April 17th, removing a longitudinal portion of the fibula and parts of the upper and middle thirds of the tibia, one being five inches in length, two others one and a half inches each, and three smaller pieces. Very little inflammation existed at the time of the operation, and the patient was in good condition. Chloro- form constituted the anaesthetic. Oakum dressings were applied and quill sutures used as means of partial coaptation of the flap. Purulent accumulations were removed by the syringe. Eight ounces of wine were given daily. Progress was favorable." Three weeks after the date of the operation the patient was transferred to the Second Division Hospital, Annapolis, where he died of exhaustion, May 11, 1865. Surgeon G. S. Palmer, U. S. V., in charge of the latter hospital, reported that the patient when admitted was in a moribund condition, also that the wound was in an unhealthy state and filled with maggots. The excised bone, shown in the wood-cut (FlG. 279), was contributed by the operator. Case 717.—Corporal W. N. Esworthy, Co. E, 1st Pennsylvania Cavalry, aged 24 years, was wounded in the left leg, at White House Landing, June 21, 1864, and admitted to Carver Hospital, Washington, two days afterwards. Surgeon O. A. Judson, U. S. V., reported: "The missile, sup- posed to be a conoidal ball, entered the leg anteriorly about three inches below the knee joint, passed backward and outward, making its exit posteriorly and producing a compound comminuted fracture of the upper third of the tibia. Supporting treatment was adopted and simple dressings applied. Erysipelas attacked the wound on June 27th, but yielded readily to an application of solution of copperas. By July 1st no erysipelatous spmptoms were present; constitutional state of patient good; wound secreting laudable pus in large quantity. On July 6th, the patient was anaesthetized and excision of about five inches of the upper third of the shaft of the tibia, by means of the chain saw, was performed by Acting Assistant Surgeon 0. P. Sweet, making a straight incision over the crest of the tibia. The wound was then filled with scraped lint, cold-water dressings were applied, and stimulants given freely. The patient appeared to be doing quite well up to July 18th, the wound filling with healthy granulations and secreting laudable pus. For ten days previous, however, he had anorexia, and this morn- ing he had a very severe chill. A recurrence of chills followed every morning and sometimes two or three times during the day, and these were followed by other pysemic symptoms, the integuments assuming a deep icteric tinge; pulse rapid; slight cough; 'Case of Private A. E. Luther, Co. E, 3d Massachusetts Cavalry, left leg, intermediary operation at junction of upper and middle thirds. 2Case of Private S. M. Grainger, Co. A, 38th Indiana, left leg, secondary operation (TABLE LVII, page 409, No. 19). ' Cases of Pt. II. Conrad, I, 24th Mich., left thigh, intermediary operation in middle third, Spec. 3653 (TABLE XXXV, p. 283, No. 253); Pt. A. Allen, H, 5th U. S. Artillery, intermediary operation, lower third (Table XXXVI, p. 296, No. 223); Corp'l E. Gay, H, 18th Wisconsin, intermediary operation in lower third (Table XXXVI, p. 298. No. 357); Pt. M. Gilmore, D, 54th Mass., left thigh, intermediary operation in lower third (Table XXXVI, p. 298, No. 365); Pt. J. Bloomer, K, 170th N. Y., rightthigh, intermediary operation in lower third, Specs. 3250, 3269, A. M. M. (TABLE XXXVI, p. 297,No. 246). Fig. 278.—Bones of the left leg, with four and a half inches of tibia excis'd. Spec. 2956. Fig. 279.- Six inches of left tibia excised. Spec. 4101. FIG. 280.—Five ins. of left tibia exc'd. £;pec.2940. SECT. V.] INTERMEDIARY EXCISIONS IN THE BONES OF THE LEG. 455 anorexia continuing. The treatment, decidedly stimulating and tonic, was continued. The symptoms continued in a more aggravated form and the patient steadily sank, the whole surface of his body being of a deep yellow color. He died on July 23, 1804. At the autopsy a large number of metastatic abscesses were found in both lungs; liver enlarged; spleen also enlarged, dark colored, and soft. A purulent offensive fluid mixed Avith lymph was shown in the left pleural cavity, and a large disinte- grated clot in the femoral vein." The excised bone, contributed by Surgeon Judson and exhibiting superficial necrosis, is rep- resented in the wood-cut (Fig. 280). Table LXIV. Summary of Eighty-seven Intermediary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1-58; Deaths, 59-87.] Name, Military Description, anu Age. Angell, I. A., Pt., D, 1st Wisconsin Oav'ry, age 23. Bennett! E. A., Pt., F, 44th N. York, age 41. Boger, G. C. Pt., H, 2d North Carolina, age 26. Burdick, W. H., Pt., B, 82d Pennsylvania, age 24. Burke, J. C.,Pt.,H, 78th New York, age 20. Carse, G. B., Capt., C, 40th New York. Casper. J. M., Corp'l, K, 7th Wisconsin, age 21. Charles, R Y., Corp'l, G, 1st New Y ark Drag's, Collins, O., Pt., D, 151st New York, age 32. Coyle, M., Pt., B, 81st Pennsylvania, age 23. Crowley, J., Pt., E, 5th New York, age 25. Curtin.M. H., Pt.,H,23d Massachusetts, age 20. Farran, J., Lieut., I, 1st Kentucky, age 25. Fellows, J., Corp'l, D, 100th Illinois, age 24. Fuller, G., Pt., H, 19th Maine, age 18. Griffin, D. 0.,Pt.,K, 17th Illinois, age 24. Gould, J. A., Pt,,H, llth New Hamp., age 39. Green, W. C, Lieut., H, 37th New York, age 22. Griswold, D. P., Pt., C, 76th N. York, age 19. Harvey, G., Pt., D, 63d Pennsylvania, age 24. Hayward, R., Pt., E, Knapp's Penn. Bat'ry, age -A. Herrald, S., Pt., H, 2d Kentucky Cavalry. July 23, Aug. 1, 1864. May 22, 31, 1864. Sept. 19, 25, 1864. April 6, 13, 1865. Mav 3, 18, 1863. Slav 2, 30, 1863. May 23, June 13, 1864. June 1, 15, 1834. Nov. 27, Dec. 9, 1863. June 3, 15, 1864. Sept. 20, Oct. HO, 18G2. Dec. 15, 26, 1862. De.31,'62, Jan. 5,'63 Sept. 19, 24, 1863. Aug. 25. 29, 1864. April 6, —, 1862. Sept. 30, Oct. 9, 1864. June 1, 20, 1862. July 1, 5, 1863. May 3, 12, 1863. Oct. 29, Nov. 12, 1863. Sept, 19, 29, 1863. Operations, Oferators, Result. Right; gang.; 7 inches mid. third tibia excised. A. A. Surg. J. C. Thorpe. Sept. —, hsem.; 18th, amp. thigh. Disch'd Jan. 7,'65. Re-amp. June 16,'05. Spec. 5549. Left; middle third fibula excised. A.A. Surg. R. Ottman. Disch'd Oct. 11, '64. Amputation thigh March 2, 1869 ; re-amputation. Left; 2 ins. in length, J inch in depth of upper third tibia exo'd. Surgeon A. Atkinson, C. S. A. To prison Feb. 16, 1865. Right; 2 inches middle third tibia excised. Disch'd Oct. 12, 1865. Amp. thigh March 27, 1866. Right; 2ins. mid. th'd tibia exc'd. Disch'd March 18, '64 ; caries. Right; 3 ins. fibula exc'd. Disc'd Deo. 15, 1863; slight shortening. Right; partial excision of upper third fibula. A. A. Surg. P. C. Porter. Disch'd Mar. 24, 1865; partial paralysis foot. Left; 3 ins. mid. third tibia exc'd. Surg. R. B. Bontecou, TJ. S. V. Disch'd May 6, 1865; necrosis; shortening. Left; 3 inches lower third fibula exc'd. {jurg. E. Bentley.U.S.V. Ligation post, tibial art.; haem. Disch'd Feb. 25, 1865. Right; 3 inches mid. third fibula exc'd. Surg. E. Bentley.U.S.V. Disch'd Oct, 3,1865. Died Jan. 27, '76; debility, result of w'nd. Right; head and 3 ins. up. third fibula excised. Disch'd Nov. 22,1862. Bone diseased. Died July 10, 1871. Left; fij inches fibula excised. Surgeon C. A. Cowgill, U. S.V. Disoh'd May 28,'63. Spec. 1326. Right; large portion mid. third tibia excised ; fibula exfoliated. Disch'd June 18,'64; short, ljin.; deformity. Left; 3 inches middle third tibia excised. Disch'd Aug. 11,1864; caries; shortening. Left; 2J inches lower third fibula excised. Surg. N. R. Moseley, U. S. V. Disch'd May 27,1865. Spec. 1910. Left; 14 inch lower third tibia excised. Disch'd Oct. 15,1862; toes and heel contracted. Left; 3 ins. low. third fibula exc'd. Surg. G. L. Pancoast, U. S. V. Gangrene. Disch'd Feb. 6, '65. Left; middle third fibula excised. Disch'd Sept, 13, 1862: bone united; J inch shortening. Right; portion of mid. third tibia excised. Disch'd Sept, 23,1864. May 11, 1869, amputation leg. Right; 2 ins. lower third fibula excised. May 21, haem., 12 oz. Discli'd Jan. 22, 1864. Right; upper third----excised. Surg. I. Moses, U. S.V. Disch'd August 13, '64; union; deform- ity; shortening. Right; middle third tibia exc'd. Surg. I. Moses, TJ. S.V. Disch'd Nov. 12, 1864; reproduction of bone. Spec. 2148. Name, Military Description, and Age. House, T. J., Pt., K, 16th Illinois, age 22. lUugh, S. R., Serg't, A, 107th Penn., age 32. Howard, J. M., Pt., F, 49th N. C, age 24. Jenkins, W. H., Pt., Ash- land Battery, age 25. Jordan, W. B., Corp'l, I, 6th Vermont, age 20. Langton, A., Pt., E, 27th Indiana. Lohr, S. G., Serg't, G, 19th Infantry, age 26. Lotts, P., Pt., K, 5th — Lucas, W. J., Pt., H, 148tb Penn., age 21. 'Lynn, A., Pt., F, 47th Pennsylvania, age 18. Lytle, H., Serg't, A, 83d Pennsylvania, age 22. Malow, L., Pt., F, 24th Illinois. Mann, O. L., Lieut. Col., 39th Illinois, age 31. Merrihew, D. J., Corp'l, I, 121st N. Y., age 22. Minor, W.W., Pt., H,2d Wisconsin, age 46. Morrow, H. A.,Col., 24th Michigan, age 33. Nash. O. T., Pt,, K, 12th Wisconsin, age 21. Oberrender, J. S..Lieut., E, 96th Penn., age 35. 01inger,G.,Pt.,D, 100th Ohio, age 22. Peters, M. H., Lieut., F, 74th Ohio, age 21. Pfeifer, J., Pt,, F, 108th Ohio, age 19. Pierce, W. K., Serg't, D, lB3d Penn., age 20. Raymond, J. O., Serg't, E, 60th N. Y., age 29. Sept, 30, Oct. 15, 1803. Sept. 17, Oct.4,'0^ May 16, 23, 1864. Sept. 17, Oct. 15, 1862. Aug. 21, 29, 1864. May 3, 17, 1863. Dec. 13, 25, 1862. Mav 3, 9, 1863. Aug. 25, 29, 1864. Oct. 19, Nov. 1, 1864. Sept, 30, Oct. 17, 1864. Sept. 19, 29, 1863. May 20, June 8, 1864. Mar. 25, April 8, 1865. May 5, 30, 1864. May 6, 11, 1864. Aug. 23, 29, 1864. May 6, 14, 1864 Aug. 6, Sept.], 1864. May 9, 15, 1864. May 14, 21, 1864. May 10, June 5, 1864. May 3, 17, 1863. Operations, Operators, Result. Right; head of fibula and part of shaft excised. Duty Nov. 14, 18G3. Died Dec. 26, 18(ili. Left; 5J inches upper third tibia excised. Disch'd Feb. 3,1864; non-union; limb useless; deform- ed ; should be amputated. Right; 3 inches of tibia excised. Furloughed August 22, 1864. Left; 3 inches fibula in middle third excised. To prison April 10, 1863. Right; 2J ins. lower third fibula excised. A. Surg. C. Bacon, jr., U. S. A. Disch'd July 19,1865. Right; 4 inches middle third tibia excised. Disoh'd Feb. 19, 1864 ; exfol.; short. 1 inch. Spec. 1280. Right; 6 ins. iniddla third fibula excised; gang. Disch'd Fob. 25, 1863; paralysis of toes. ----; 2 inches upper third tibia exc'd. Recovery; useful limb. Left; 2£ins. low. th'd fibula exc'd. Surg. N. R. Moseley, U. S. V. Disch'd Mar. 27, '65; anch. ank. Died June 7, 1868. Spec. 1982. Right; 2J ins. middle third tibia excised. A. A. Surg.W. Kemp- ster. Disch'd Oct. 14, 1865. Right; 2i ins. mid. th'd fibula and half the thickness of tibia exc'd. A.A.Surg. J. H. Robinson. Dis- charged July 31, 1865; necrosis. Left; upper third tibia excised. Surg. I. Moses, U. S. V. Disch'd August 6, '64; periostitis. Died June 10, 1876. Spec. 2149. Left; portion of mid. tibia excised. A. Surg. E. McClellan, TJ. S. A. Disch'd Dec. 6, '65. 1870, bone discharging. Right; 2 inches lower third fibula excised. A. A. Snrg. J. H. Rob- inson. Disch'd Aug. 2,1865. Right; 8 inches lower part fibula excised. Disch'd Sept. 23,1864 ; bone carious. Right; portion of up. third fibula excised. Surg.H.W. Ducachet, U. S.V. Disch'd June 30,1865. Left; 4 inches middle third fibula excised and artery lig. Surg. A. J. Miller, 13th Iowa. Discli'd Juno 30, 1865. Left; 2 inches lower third fibula excised. A. A. Surg. J. O. Stan- ton. Discli'd Sept. 20, 1864; anchylosis ankle joint. Left; 4 inches mid. third fibula excised. Gangrene. Disch'd May 26, 1865. Right; 2J ins. middle third tibia excised. Surg. C. N. Ellinwood, 74th 111. Disch'd July 10, 1865; boue discharging. Left; 2 inches lower third fibula excised. A. Surg. C. C. Byrne, U.S.A. Disch'd May 23,1865; anchylosis ankle joint. Left; 2 inches upper third tibia exc'd. Surg. E. Bentley, U.S.V. Disch'd July 15, 1865; * inch shortening; exfoliation. Left; 2 inches lower third tibia excised. Disch'd Mar. 21,1864. Sept., 1877, exfol.; deformity. 1 Kempster (W.), Report of an Exsection of Right Tibia,- Recovery, in American Journal of Medical Sciences, 1866, N. S., Vol. LI, p. 279. 456 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military DiiicRii'Tiox. and a«e. Operations, Operators, Result. 66 Salsbury, D, Pt.,K,24th Wisconsin, age 29. 'Saunders, N , Pt., 18th Sloan, J., Pt., K, 100th Illinois. Smith, J. E., Corp'l, E, 7th Conn., age 28. Stinson, W. C, Pt., H, 49th Virginia. Swift, F. B., Pt., C, 8th Michigan, age 25. Taunt, II., Pt., B, 2d Wisconsin, age 19. Washburn. A. S., Serg't, C, 127th N. Y., age 27. Welch, P. H., Lieut., C, lllth New York, age 23. Wilcox, M. B., Corp'l, B, 58th Mass., age IS). Williams, F. M., Pt., D, 12th Tenn.. age 24. Wright, R. C, Capt., G, 42d New York, age 26. Young, W. H, French's Division, age 34. Allen, A., Pt., II, Sth Artillery. Barney, W., Pt,, F, 1st Ohio Artillery. Bloomer, J.. Pt.,K. 170th New York, age 44. Brown. (>., Pt., A, 147th New York. Bull, J. 11., Serg't, H, 94th Ohio, age 21. Conrad. II., Pt., I, 24th Michigan, age 21. Curtis, F.. Pt., 17th Ver- mont, age 31. Do Witt, J. E., Pt., A,9th N. Y. Cavalry, age 23. De.31,'62, Ja. 15/63. Oct. 21, 31, 1861. Sept. 19, 23, 1863. Aug. 16, Sept. 7, 1864. Julv 3, 8, 1863. Mav 12, 28, 1864. Oct, 19, 29, 1663. Nov. 30, Dec. 7, 1864. Mav 6, 16, 1864. May 12, 29, 1864. May 15, 30, 1864. May 7, 17, 1864. Nov. 30, Dec. 24, 1864. April 6, 10, 1862. Jan. 2, 11, 1863. Aug. 25. Sept. 12, 1864. Julv 1, 6, 1863. May 15, June 13, 1864. May 6, 19, 1864. June 2, 9, 1864. June 21, 25, 1864. Left; 2 inches middle third tibia excised. Disch'd Aug. 12,1865; great lameness. Left; 5 inches lower third fibula exc'd (haemorrhage). Sent home in two months. Left; 2 ins. low. third tibia exc'd. Disc'd Feb. 19.1805; limb much deform.; false joint; short 3 ins. Right; 6 inches fibula excised. Disch'd May 22,1865; clubfoot, anchylosis ankle joint. Right; middle third tibia excised. Surg. J. A. Wolf, 29th Penn. Paroled Sept. 25, 1863. Left: 2& inches lower third fibula excised. A. Surg. S. B. Ward, 1:. S. V. Gangrene. Disch'd Oct. 6, 1864; anchy. ank. joint. Left; head and 2£ inches fibula and frag's of tibia exo'd. Surg. O. A. Judson, U. S. V. Disch'd January 17,1865; lameness and paralysis foot. Right; 5 inches lower third fibula excised. A.A.Surg. H.Leaman, Disch'd May 26, 1865. Left; 4 ins. tibula, middle, exc'd. A. A. Surg. J. O. Stanton. Dis- charged Oct. 29, 1864 ; exfol. Right; 3 inches mid. third fibula exc'd. Surg. E. Bentley,U.S.V. Disch'd July 20, 1865. Right; 4 inches middle third tibia exc'd. To Pro. Mar. June 11,'65. Left; lower third fibula excised. A. A. Suigoon J. M. McCalla. Discli'd July 13, 1864; partial anchylosis ankle joint. Lclt; 'U inch lower third fibula exc'd. A. A. Surg. M. L. Herr. To Provost Marshal Feb. 6, '65. ----; por. of tibia and fibula exc'd. A. Surg. W. D. Turner, 1st 111. L. A. Mortilicat'n. April, 1862, amp. thigh. Died May 11,1862. Right; 6 inches lower part fibula excised. Died July 14, 1863; phthisis pulmonalis. Right; mid. third fibula excised. A.A.Surg.W.II.Ensign. Gang.; hsem.; lig. femoral. Sept. 18,'64, amputation thigh. Died Sept. 21, 1864; constitutional irritabil- ity. Specs. 3250, 3269. Right; portion of tibia excised. Died July 14, 1863. Left (necrosis); 3i ins. tibia exc'd. A. A. Surg. lire. May. Died Juue23,'Gl; pyaem. Spec. 3367. Left; 1 inch up. thirdfibnlaexc'd. Surg. O. A. Judson. U. S. V. Post, tibial art. divided : gang. May 22, amp. thigh. Died Mav 27, 1864 ; pyaemia. Spec. 3653. Right; 2.V inches low. third fibula excised. Surg. O. A. Judson, U. S. V. June 11, 1864, haem. Died June 17, 1864; exhaustion. Right; por. up. third fibula exc'd and peroneal artery lig. A. A. Surg. O. P. Sweet. Prostration and haemorrhage. Died June 25,1864; exhaustion. Name, Military Description, and Age. Dates. Esworthy.W. N., Corp'l, June 21, E, 1st Penn. Cavalry, I July 6, nge 24. I 1864. Forester, G. W., Pt., A, ! June 3, 188th Penn., age 45. 15, 1864. Freeman, G. B., Pt., F, 58th Mass., age 32. Gay, E., Corp'l, H, 18th Wisconsin. Gilmore, M., Pt., D, 54th Massachusetts. Golden, J. P., Pt., F, 6th New York H'vy Art'y, a<*e 07. Grainger, S. M., Pt., A, 38th Indiana, age 23. Grimes, 11. M., Pt., C, 116th New York. Jones, A. M., Pt,, H, 21st Mass., age 22. Luther, A. E., Pt., E, 3d Mass. Cavalry, age 32. McGuire, T., Pt., D, 53d Pennsylvania, age 19. Mink, IL, Pt,, H, 4th N. York Heavy Artillery, age 20. Mitchell, S., Pt,,D, 188th Pennsylvania, age 23. Partridge.G.V., Saddler, B, 4th Mass. Cavalry, age 21. Perkins, P. D., Pt., B, 12th New Hampshire, age 32. Shorey, B., Pt,, D, 3d Maine, age 30. Sprague, O., Pt., F, 73d New York, age 45. Tobin, T., Pt., E, 61st New York, age 23. Travis, S., Pt,, H, 137th New York, age 22. Welsh, D. G.,Pt.,F, 28th New Jersey. White. S. G!,Pt..A,14th New York H'vy Artil- lery, age 37. Operations, Operators, Result. June 3, 9, 1864. April 6, —, 1862. July 18, 23, 1863. May 19, 29, 1864. Dec. 31, 1862, Jan. 14, 1863. May 27, June —, 1863. June 2, 25, 1864. Mar. 4, 13, 1864. Dec. 13, 31, 1862. April 2, 17, 1865. June 3, 27, 1864. April 2, 9, 1864. June 3, 13, 1864. May 10, June 8, 1864. May 5, June 2, 1864. June 3, 8, 1864. Oct. 28, No.19,'63. Dec. 13, 26, '62. Aug. 21, Sept. 1, 1864. Left; 5 ins.*up. third tibia exc'd. A. A. Surg. O. P. Sweet. Died July 23,'64 ; py*m. Spec. 2940. Right; 4 ins. lower third fibula excised. A. A. Surg. F. G. II. Bradford. Died July 6, 1864; irritative fever. Right; lower third fibula exc'd and lig. posterior tibial artery. Surg. O. A. Judson, U. S. V. Died June 17, '64; exhaustion. ----. Ass't Surg. W. D. Turner, 1st Illinois L. Art'y. April, '62, amputation thigh. Died April 22, 1862; pysemia. Left; 6 ins. tibia and 1 inch lower part fibula exc'd. Mortification. July 27, ampntat'n thigh. Died July 27, 1863. Right; 4 inches lower third fibula exc'd. A. A. Surg. O. P. Sweet. Died June 9, 1864; pyaemia. Left; fract. portions of tibia and fibula excised. Gang. Mar. 15, amp. knee joint. April 1, hsem. Died April 23, 1863. Left; 4J inches lower third tibia excised. Died Aug. 14, 1863; diarrhoea. Specs. 1307, 2956. Left; 4 ins. mid. th'd fibula exc'd. A. A. Surg. F. G. H. Bradford. Died June 30, '64 ; exhaustion. Left; 3 inches fibula, lower third, excised. A. A. Surg. R. W. W. Carroll. Peroneal art. wounded. Mar. 15, haem.; 19th, amp. leg. Died April 6,1864 ; pyaemia. Left (haem.); 3 ins. up. extremity fibula excised; lig. fem. artery; sphacelus. Died Jan. 3, 1863. Left; portion upper third tibia and fibula exc'd. Surg. B. A. Van- derkieft, U. S. V. Died May 11, 1865; exhaustion. £>/>ec. 4101. Left; 2 inches fibula, upper third, exc'd (haem.); lig. peroneal art. A. A. Surg. H.W. Merrill. Died Aug. 7, 1864 ; chronic diarrhoea. Left; portion of tibia exc'd, also lig. ant. tibial art. A. A. Surg. W.A.Greenleaf. April 27, haem. Died May 2, 1864; pysemia. Left; IJ inch fibula exc'd, upper third. A.Surg. H. Allen,U.S.A. (Hsem.) Died June 25. 1864 ; pyaemia. Right; 6 ins. tibia excised. A. Surg. A. Delany, U. S. V. June 26, gang. Died July 1, 1864. Right; 2 ins. middle third tibia excised. Surg. R. B. Bontecou, U. S.V. Died July 6, 1864 ; ex- haustion. Right; 3 inches lower third tibia exc'd. Surg. E. Bentley, U.S.V. Died June 22, '64; pyaemia. Left; portion middle third tibia exo'd. Died Nov. 23,'G3; pyaem. Right; lower third fibula exc'd. Died Jan. 5, 1863. Left; 2 inches lower third fibula exc'd. A. A. Surg. It. E. Price. Sloughing. Died Sept. 13,1864; exhaustion. Twenty-one intermediary excisions, with eight deaths, were in the upper third of the leg; thirty-five, with seven deaths, in the middle third; twenty-four, with nine deaths in the lower third; and in seven, with five deaths, the precise locality was not indicated. Secondary Excisions in the Continuity of the Bones of the Leg.—In point of mor- tality, the secondary excisions in the bones of the leg were attended by better results than tlie primary and intermediary operations,.only eight of the fifty cases of this group having fatal issues. The excision included both bones in five, the tibia alone in thirty-one, and the fibula in fourteen instances. 1 HOLLOWAY (J. M.), Consecutive and Indeterminate Hsemorrhage from Large Arteries after Gunshot Wounds; with Report of Cases treatal by Different Methods; Appreciation, in American Journal Medical Sciences, 1865, Vol. L, N. S., p. 348. SECT, v.] SECONDARY EXCISIONS IN THE BONES OF THE LEG. 457 Recoveries after Secondary Excisions in the Continuity of the Bones of the Leg.—This group includes forty-two operations, five performed on Confederate and thirty-seven on Union soldiers. Three of the latter, it appears, never applied for pensions, and thirty-four became pensioners after their discharge from the service. Four have since died—two from remote results of the injuries, one from phthisis, and one from cause not stated. Of the complications during treatment are noted gangrene in five instances and hsemorrhage in one. Case 718.—Corporal J. Downey, Co. D, 56th Pennsylvania, aged 23 years, was wounded in the left leg, at Bull Eun, August 28, 1862. He was sidmitted to Eckington Hospital, Washington, several days afterwards, where the injury was noted but no treatment recorded. Surgeon J. Hopkinson, U. S. V., in charge of Mower Hospital, Philadelphia, made the following record of the case: "The wound was caused by a ball, which entered the outer side of the tibia, fractur- ing the bone, and emerging on the inner side of the leg at the lower third. The tibia was resected at Eckington Hospital, from where the patient was transferred to this hospital September 23, 1863, the wound being nearly healed."' Subsequent entries show that in addition to applications of water dressings to the wound the patient for a time received treatment for a syphilitic affection. He remained in the hospital until January 17, 1865, when he was mustered out and pensioned. Examining Surgeon D. W. Shindle, of Sunbury, Pennsylvania, certified to the fracture and excision, and added: "The wound healed, leaving the leg, however, very crooked, shortened, and necessarily much weakened, and rendering his locomotion unsteady, difficult, and at times painful, also liable to tire in standing as well as walking. General system much impaired." The pensioner died of phthisis pulmonalis, October 20, 1876, his attending physician testifying that the injury remained "a constant source of irritation until a Fig.281.— short time previous to his death. Exfoliation of bone was frequent, resulting in nervous prostration, innutrition, lef^tjbuf'ex- and impairment of his general health, a condition favorable to the development of tubercle. He never would cised. Spec. undergo an operation for the removal of sequestra," etc. The specimen (Fig. 281), embracing the removed portion of the tibia and showing some periosteal thickening, was forwarded by Surgeon J. R. Smith, U. S. A., having been excised on October 4, 1862. Case 719.—Private J. Lagro, Co. F, 10th Vermont, aged 18 years, was wounded at Cold Harbor, June 3,1864. Surgeon R. Barr, 67th Pennsylvania, reported his admission to the field hospital of the 3d division, Sixth Corps, with " shot fracture of left leg, caused by a musket ball." Assistant Surgeon W. Webster, U. S. A., described the injury as a " compound fracture of the tibia and fibula at the upper third," and reported: " The patient entered De Camp Hospital, David's Island, twelve days after he was wounded. On July 30th, the parts being gangrenous, excision was performed by Acting Assistant Surgeon H. Sanders, who removed about four inches of the tibia and three inches of the fibula. Ether was used as the anaesthetic. The patient did well after the operation." On February 10, 1855, he was transferred to Burlington, and subsequently to Sloan Hospital, Montpelier. Surgeon H. Janes, U. S. V., in charge of the latter, contributed a photograph {Card Photographs, A. M. M., Vol. II, p. 1), and reported that the patient was able to walk with crutches, but could not bear much weight on the limb. Several months afterwards the patient was re-transferred to De Camp Hospital for the purpose of having his wounded leg fitted with an apparatus, which was supplied by Dr. E. D. Hudson, of New York City. He was ultimately discharged October 26, 1865, and pensioned. Examiner O. F. Fassett, of St. Albans, certified, September 10, 1866: "Wound of left leg, with fracture of both bones. It is now an open sore from necrosis. The bones have never united except by ligament, so that a false joint now exists. The bone is much denuded and so much deformity exists that no treatment but amputation can be of any benefit; the leg is worse than useless." In 1877, the same examiner again reported "the wound still an open, suppurating, and discharging sore, the bone being extensively diseased. The disease is so near the joint that amputation must be above the knee. His con- dition now is worse than with loss of the leg above the knee. The leg is bent into a curve and greatly deformed." Three years later the disease of the bone was reported to be extending almost or quite to the joint, and the pensioner's health as failing in consequence of the suppuration, his appearance being pale, anaemic, emaciated, and weak. He was paid June 4, 1880. Case 720.—Private R. L. Noe, Co. D, Sth Michigan, aged 35 years, was wounded at Fair Oaks, May 31, 1862, and entered De Camp Hospital, David's Island, two weeks afterwards. Acting Assistant Surgeon J. E. Steel reported: "He was wounded by a rifle ball, which passed through the fibula of the left leg about the middle. The patient had received no previous treatment. After the removal of several small pieces of bone and some blue cloth the wound healed; but subsequently it again suppurated and continued to do so for two months. I then deemed it necessary to exsect (with the approval of Surgeon J. Simons, U. S. A., in charge of the hospital) the entire fibula. The patient having been placed under the influence of chloroform, I made an incision from the head of the bone to within an inch of the external malleolus and found that it was difficult to remove the bone in longer pieces than about three inches, some of them of course being much smaller and adherent to the tendons, which had to be pulled off with the forceps. On carefully examining the bone I found that about one inch of the external mal- leolus could be preserved, which was done, thereby avoiding the opening of the ankle joint. The operation was attended with a great deal of venous haemorrhage; but there being no artery of any importance severed, it was not found necessary to apply any ligature. No sutures were employed, the lips of the wound being brought together by adhesive plaster and then firmly bandaged. The wound healed two-thirds of its length by first intention. The patient recovered in three weeks and was able to leave the hospital six weeks after the operation." He was discharged from service December 31, 1862, and pensioned. Examiner M. L. Green, of Pontiac, Michigan, certified, May 7, 1863: " The fibula has been removed and the leg is now useless, having no support upon the outer side. Can never be of any service to him." Examining Surgeon C. Earl subsequently reported: "There remains a cicatrix extending from knee to ankle, involving the tendons and muscles and causing loss of power of leg. The tibialis anticus muscle is destroyed." In September, 1877, the same examiner stated: "Near the ankle the cicatrix has the appearance of breaking out again soon, as the tissues are getting dark and infiltrated." The pensioner was paid March Surg. Ill—58 4oS INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. 4. l--(0. The head of the removed fibula together with part of the necrosed shaft, contributed by the operator, constitute specimen 1003 of the Surgical Section of the Museum. Three of the forty-two survivors of secondary excision in the bones of the leg after- wards submitted to amputation in the lower third of the thigh.1 Fatal Cases of Secondary Excisions in the Continuity of the Bones of the Leg.—The eight operations of this group were performed on Union soldiers. The fatal issue was ascribed to pyaemia in one, gangrene in one, hasmorrhage in one, shock of operation in one, and to exhaustion and typho-malarial fever in two cases each. In one instance the excision was followed by amputation in the leg and subsequent amputation in the thigh.2 Case 721.—Private E. J. Wyman, Co. A, 6th Wisconsin, aged 22 years, was wounded in the right leg, at Hatcher's Run, February 7, 1865. Surgeon D. C. Chamberlain, 94th New York, reported his admission to the field hospital of the 3d division* Fifth Corps, and described the injury as a "fracture of tibia." From the field the wounded man passed to the Point Lookout Hospital, subsequently to Judiciary Square Hospital, Washington, and on June 15th to Harvey Hospital, at Madison. Surgeon H. Culbertson, TJ. S. V., in charge of the latter, who operated in the case, communicated the following description of the result: "The tibia was fractured in the upper fourth. On July 2d, when the operation was performed, the wound was apparently healing, but had recently beeu gangrenous. Venous hsemorrhage appeared, and the bone was carious and softened. Some new bone had been thrown out at the seat of the fracture and had also become diseased. This presence of diseased bone and unheal- thy discharges induced the hsemorrhage and previous gangrene and caused the patient's constitutional condition to be much impaired. The operation consisted of the excision of five inches of the shaft of the tibia, beginning opposite the opening of the interosseus membrane, making an incision in the middle line of the bone, and separating the skin, periosteum, and muscles by enucleation. The chain saw was then passed beneath the bone below, the shaft sawn through and raised from below upward. At the upper part the bone was divided with the forceps. No vessels were divided or important nerves injured during the oper- ation. Chloroform was used as the anaesthetic with good effects. The edges of the wound were approximated, having been packed with lint, and persulphate of iron was used at the seat of the venous hsemorrhage, a light bandage being applied over all. The limb was secured in a plaster-of-Paris splint and arranged so as to expose the wound. The treatment consisted of animal broths, alcoholic stimulants, quinine, and iron. The case did well for one week, when the patient had a slight chill, which recurred at regular intervals morning and evening, and was followed by fever and sweating. Antiperiodics were persistently used without any good effect. The patient died of exhaustion, resulting from typho-malarial fever, July 23, 1865. The wound had been lacking in action, but the matter, though sparse, was healthy." Table LXV. Summary of Fifty Secondary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1-42; Deaths, 43-50.] NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 1 2 3 4 5 6 7 8 Barber, C, Pt., E, 88th Penn., age 30. Bounting, R. A., Corp'l, K, 16th Mich., age 26. Brown, J., Pt., D, 5th U. S. Artillery, age 25. Brunett, N., Pt., G, 1st Penn. Rifles, age 22. Bryant, J., Pt., B, 62d Pennsylvania, age 40. Bullock, J. L., Corp'l, C, 5th Minnesota, age 36. Canty, T. F., Pt., D, 63d New York, age 24. Collins, J., Pt., B, 12th Mass., age 19. Julyl, Dec. 19, 1863. July 1, Sept. 4, 1862. June 27, Sept. 6, 1862. June 17, Nov. 28, 1864. June 27, July 29, 1862. De.16,'64, Jan. 25, 1865. Aug. 14, 1864, ---,'66. Sept. 17, Nov. 11, 1862. Left; portion of upper third fibula exc'd. Surg.C. N. Chamberlain, U. S.V. Disch'd Sept. 17,1864; ankle joint anchylosed. ---; por. of up. third tibia exc'd. A. A. Surgeon A. W. Colburn. Disch'd Nov. 17,1862; lame. Left; por. of tibia, mid. th'd, exc'd. Discb 'd Dec. 29, '62. Leg short-ened and distorted. Spec. 412. Left; head and 2 ins. fibula exc'd. A.A. Surg.C. B. King. (Necro.) To Vet. Res. Corps May 1,1865. Right; portion of middle third tibia excised. Disch'd Jan. 30, 1863; necrosis; shortening and deformity. Left; 3J inches middle third tibia excised. A. A. Surg. J. Butter-baugh. Disch'd Nov. 23,1865; leg scarcely of any use; cartil-aginious union only. Right ;5ins. low. th'd fibula exo'd. Dr. J. E. Pomfret. Disch'd May 30, '65; bone exfol.; unhealed in 1872 ; requires bandages, 1875. Left; por. of up. third tibia exc'd. A. A. Surg. A. V. Cherbonnier. To Vet. Res. Corps July 1,1863. 9 10 11 12 13 14 15 16 Collins, M., Pt., G, 1st Michigan. Davis, W., Pt,, D, 89th Illinois, age 27. Downev, J., Corp'l, D, 56th Penn., age 23. Fergus, J., Pt., A, 70th Indiana, age 34. Fitzgerald, T. J., Pt., K, 6th Louisiana. Fowler, L., Pt., E, 6th Wisconsin, age 27. Gray, E. T., Pt., B, 38th Ohio, age 23. Harris, J., Pt., H, 12th South Carolina, age 30. Aug. 30, 1862, Mar. 17, 1863. Nov. 25, 1863, June 10, 1864. Aug. 28, Oct. 4, 1862. May 14, June 24, 1864. Sept. 19, De.—,'64. Au.30,'62, Feb. 16, 1863. Aug. 4, Sep.4,'64. Sept. 17, 1862, Jan. 26, 1863. Right; head of fibulaexc'd. Surg. D. P. Smith, U. S. V. (Necro.) Disch'd April 27,'63; anchylosis knee joint. Spec. 1193. Right; mid. third of tibia exc'd. Surgeon L. D. Harlow, U. S. V. Feb. 4,15,1865, sequestra rem'd. Disch'd June 17, '65. Died July 26, 1876; bone diseased. Left; 4 J ins. low. third tibia exc'd. Disch'd Jan. 17,'65; leg crooked. Died Oct. 20,1876; phth. pulmo. Spec. 555. Left; 3 ins. mid. third fibula exc'd. A. A. Surg. T. H. Hammond. Gang.; post, tibial art. sloughed; haem. Aug. 15,1864, amputat'n thigh. Disch'd Jan. 20, 1865. Left; 2$ inches middle third tibia exc'd. Released Aug. 25,1865. Right; 3 inches lower third tibia, § of its thickness excised. Duty July 1, 1863. Left: 4 ins. tibia and 8 ins. fibula excised. Disch'd May 12,1865. ---; fract. por. upper thirds tibia and fibula exc'd. A. A. Surg. A. North. To Provost Marshal May 16, 1863. 1 Cases of: Pt. J. Fergus, A, 70th Indiana, left thigh, secondary operation in lower third (Table XL, page 320, No. 34); Corp'l T. O'Dell, Co. H, 5th Michigan, left thigh, secondary operation in lower third (Table XL, page 321, No. 73); Serg't J. Lowth, M, 4th Wisconsin Cavalrj', right thigh, secondary operation in lower third (Table XL, p. 320, No. 57). 2Case of Pt. H. Linn, A, 6th Pennsylvania Reserves, left leg amputated Dec. 4, 1862, in middle third; January 15,1863, amputation in thigh at middle third; hemorrhage, Feb. 4, 1863. ligation of femoral artery; death March 31,1863. Specs. 748, 3818, 3983 (Table XXXIX, p. 315, No. 137). SECT. V.] EXCISIONS IN THE BONES OF THE LEG OF UNCERTAIN DATE. 459 Name. Military Description, and Age. Holt, T., Pt., G, 15th Mass., age 19. Jones, E. P., Pt., K, 22d Michigan. Lagro, J., Pt., F, 10th Vermont, age 18. Lennox, W., Pt., F, 82d New York. Lord, B. E., Pt., H, 24th Georgia, age 23. Lowth, J., Serg't, M, 4th Wisconsin Cav., age 26. Luce, J. B., Pt., F, 179th New York, age 30. Mcllheran, J., Pt,, C, HGth Illinois, age 24. McQuiggan, J., Pt., E. 82d Penn., age 20. Mears, J. E., Pt., G, 81st Pennsylvania, age 20. Noe, R. L., Pt., D, 5th Michigan, age 35. OdeU, T., Corp'l, H, 5th Michigan, age 20. Ohmit, S. K., Pt., D, 1st Penn. Res., age 20. Peters, W., Pt., B, 8th Penn. Res., age 20. Pritchard, R., Pt., K, 119th Penn., age 29. SimmoBS, A. R., Pt., I, 2d N. Hamp., age 20. Sept. 17, 1862, Feb.2,'63 Sept. 20, 1863, Jan. 10, 1864. June 3, 1864, July 30, 18C4. July 3, Sept. —, 1863. Sept. 14, Nov. 26, 1862. Aug. 24, 1864, May 27, 1865. June 17, Oct. 24, 1864. July 22, 1863, March 7, 1864. July 1, Sept.], 1862. Julyl, Aug. 21, 1862. May 31, Nov. —. 1862. June 18, Sept. 7, 1864. June 30, 1862. Sept. 23, 1862. June 27, 1862, Feb.2,'63 May5,'64, Jan. 15, 1865. Aug. 29, 1862, Sept. 16, 1864. Operations, Operators. Result. Left: head of fibula exc'd. Surg. S. D. Freeman, 11. S.V. Dischvd Feb. 4,18G4. Spec. 1109. Left; necrosed ends of mid. third tibia exc'd. A. A. Surg. D. O. Farrand. Gang. Disch'd Oct. 12, 1864. Left; 4 inches tibia and 3 inches fibula, up. third, exo'd. A. A. Surg. H. Sanders. (Gangrene.) Disc'd Oct. 26,'65; much deform.; false joint. Left; middle third tibia excised. Surgeon A. B. Mott, U. S. V. (Necrosis.) Discharged July 25,1864. Left; 3J inches upper third tibia excised (caries and necrosis). Paroled April 27, 1863. Right; 6 inches upper part fibula excised. Surg. H. Culbertson, U. S. V. Lig. post, tibial artery (caries; gang.). June 2, amp. thigh. Disch'd July 17, 1865. Right; 8J ins. tibia exc'd. A. A. Surg.W. P. Moon. (Sloughing; bone diseased.) Disch'd Dec. 31, 1864 ; leg useless. Right; up. third and head of tibia, except shell of bone articulating, excised. Surg. J. G. Keenon, U.S.V. (Carious.) Disch'd Feb. 24, 1865. Left; middle third tibia excised. A. A. Surgeon G. H. Dare. De- cember, 1862, another operation. Discharged July 3, 1863. Spec. 428. Right; middle third tibia excis'd. Disch'd Feb. 27,1863; consider- able shortening and deformity. Spec. 398. Left; almost entire fibula excis'd. A. A. Surg. J. E. Steele. Disc'd Dec. 31, 1862; leg of not much service. Spec. 1003. Left; up. third tibia exc'd. A. A. Surg. J. M. Boisnot. Sloughing. Jan. 13,'65, amp. thigh. Disch d May 22, 1865. Left; 6 inches lower third tibia excised. A. A. Surgeon J. H. Boone. Disch'd Feb. 23, 1863 ; complete anchylosis ankle, and partial knee joints. Left; 31 inches upper third fibula exc'd. A. A. Surg. T. Artaud. Discharged November 28, 1865. Spec'. 1110. Left; 3 inches lower third tibia excised. Discharged June 19, 1865. Necrosis. Died March 2, 1871. Left; 3 inches middle third fibula excised and sequestrum of tibia removed. Ass't Surg. H. Allen, TJ. S. A. (Discharged Nov. 20, 1862; non-union; necro.); w'nd re-opened. 1877, bone carious. Name, Military Description, and Age, Smith, <;., Pt., A, 1st N. York Cavalry, age 34. Thompson, T. E.,Corp'l, I, 89th New York, age 24. Vaughn, A. S., Pt., K, 57th Virginia, age 24. 36 Vollmer, M.,Pt.,C, 136th New York, age 29. 37 Waldron, S. H., Pt., B, 17th Maine, age 19. White, J. W., Pt., C, 113th Ohio, age 19. Williams, J. M., Serg't, G, 2d Georgia, age 23. Williamson, J., Pt., G, 57th New York, age 42. Wilson, G. E., Pt., D, 30th Mass., age 23. 42 Wilson, J., Pt., E, 15th Infantry, age 21. 43 Ackley, J. B., Pt,, I, 7th Infantry. Evans, L., Pt., D, llth Michigan, age 19. Hockirk, O. D., Pt., A, 46th New York, age 25. 46 Holmes, H., Pt., H, 50th Colored Troops. 47 Linn, H., Pt, A, 6th Penn. Res., age 25. Pickell, G. F., Pt., K, 13th New York, age 17. Richardson, H.S., Lieut., 27th Michigan. 50 Wyman, E. J.,Pt,,A,6th Wisconsin, age 22. March 9, Sept. —, 1863. May 20, 1864, July 1, 1864. July 1, Aug. 4, 1863. July 4, Au.25,'63. May 3, Nov. 3, 1863. June 27, J'y30,'64 J'e 24,'63, Feb. 15, 1864. June 16, Nov. 7, 1864. Oct. 19, 1864, March 2, 1865. Aug. 7, Nov.5,'64 June —, J'y29,'G2 July 26, Oct. 4, 1864. Sept. 29, Dec. 4, 1864. Nov.9,'64, J'y20,'65 Sept. 17, Dec. 3, 1862. Aug. 30, Oct. 6,'62, July 12, 1863, Jan.5,'64 Feb. 7,. July 2," 1865. Operations, Operators, Result. Left; portion of lower third tibia excised. Surgeon A. B. Mott, U. S. V. Discharged Aug. 5, 1864; 1866, bone diseased; 1873, bone healed. Right; 2 inches tibia, lower third, exc'd. Ass't Surg. W. D.Wool- verton, U. S. A. Disch'd Oct. 11, 1865. Died May 3, 1873; lungs diseased. ----; 31 inches lower third tibia exc'd. A. A. Surg. E. Borck, jr. (Necrosis.) Paroled August 22, 1863. Left; IJ inch fibula, lower third, excised. Disch'd July 8,1865. Right: 3 inches middle third fibu- la. A. A. Surgeon E. Seyffarth. (Caries; sloughing.) Disch'd July 6, 1865. Right; 3 inches tibia, lower third, excised. Disch'd Feb. 22,1865; wound open. Right; 3 inches lower third tibia excised. Assistant Surg. J. E. Link, 21 st 111. Provost Marshal April 15, 1864. Left; 5 inches middle third tibia excised. A. A. Surgeon W. P. Moon. Discharged June 28, '65; new bone formed. Right; 3J inches fibula, in middle third, excised. A.A.Surg.W.P. Moon. (Necrosis.) Disch'd July 22, 1865. Spec. 1479. Right; 3 inches tibia excised. Disch'd April 1, 1865. Left; ^ of shaft of fibula excised; missile extracted. Died August 13, '62; typh. fever. Left; 3 inches middle third tibia excised. Ass't Surg.W.B.Trull, U. S. V. Died March 12, 1865; exhaustion. Left; small por. upper thirds both bones exc'd. A. A. Surg. B. N. McCleery. July, 1865, erysip.; gang.; diarr. Died Aug. 14,'65. Right; por. of tibia exc'd. Died July 24, '65; shock of operation. Left; large por. of tibia and fibula exc'd. A. A. Surg. A. V. Cher- bonnier. Dec.4, amp. leg; hsem.; gang.; necro. Jan. 15, 63, amp. thigh. Feb. 4, lig. fem. artery; necro.; haem. Died March 31, 1863. Specs. 748, 3818, 3983. Left; fractured ends upper third tibia excised. Died October 29, 1862; pysemia. Left; 4 inches middle third tibia exc'd. Surg.C.S.Tripler.U.S.A. (Necrosis.) Died Jan. 31,1864; malignant measles. Right; 5 inches upper third tibia excised. Surg. H. Culbertson, U.S.V. (Bonecarious; venous hsem.; gangrene.) Died July 23, 1865; typhoid malarial fever. Excisions in the Continuity of the Bones of the Leg of Uncertain Date.—In thirty- five instances of excision in the bones of the leg, either the time of injury or of operation or of both were not recorded. Twenty-seven of the patients survived the operation, four died, and in four the final issue could not be ascertained. The excision was confined to the tibia in twenty-two, to the fibula in twelve instances, and in one case portions of both tibia and fibula were excised. Of the cases of recovery of this group nineteen were Union and eight Confederate soldiers. Seventeen of the nineteen Union soldiers 'were subse- quently borne on the Pension Roll; one has since died, and another had the limb removed at the knee joint.1 The four fatal operations were performed on three Confederate and one Union soldier; pysemia being cited as the cause of death in two instances. •Case of Pt. H. A. Steward, Co. B, 8th Pennsylvania Reserves, secondary operation at right knee joint (Table LVII, p. 409, No. 9). 460 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Table LXVI. Summary of Thirty-five Ctfses of Excisions in the Bones of the Leg for Shot Injury of Uncertain Date. [ Recoveries, 1—27; Deaths, 28—31; Unknown Results, 32—35.] NO. Name, Military Dates. Operations, Operators, NO. Description, and age. Result. 1 Davis, J. L., Pt., F, 27th June 27, Right; lower third tibia excised. 19 New York. ----, *62. Disch'd Sept. 24, 1862 necrosis. i 2 Freeland, It., Pt,, G, 1st Nov. 8, Right; portion of tibia excised; Cavalry, age 22. ----, '63. necrosis. Duty Feb. 16, 1865. 20 3 Gardner, W. H., Lieut., July —, ----; por. of tibia excised. Pa- K, 3d Alabama. ----, '63. roled October 24, 1863. 4 Garrett, J., Pt., H, 12th Aug. 21, Right; 4 ins. middle third fibula Miss., age 24. '64, --- excised. Retired Mar. 25,1865. 21 5 Harrcll, J. P., Pt, F, 82d Sept. 19, Right; portion upper third fibula Indiana. '63,--- excised. To Vet. Res. Corps. Disch'd June 17, 1865. 22 6 Harris, J. V., Serg't, C, May 6, Right; portion of fibula excised. 14th Alabama, age 31. --- '64. Retired Feb. 15, 1865. 7 Hull, F. S., Pt., G, 8th June 14, Right; por. of middle third fibula 23 Vermont, age 34. '63,--- excised. Disch'd June 22, '64. 1865, exfoliation necrosed bone. 24 8 Imbrie, D., Pt., K, 10th June 27, Right; 1 inch of fibula excised. Penn. Res., age 19. ---, '62. Disch'd Nov. 27, 1862. 9 Johnson, W. B., Lieut., Nov. 25, Left; 2 inches lower third tibia 25 E, 26th Ohio. '63,---- excised. Disch'd Oct. 19,1864. 1866, bone carious and exfol'ing. 26 10 Jordan, N., Pt., C, 19th Nov. 30, Left; 3 ins. mid. third tibia exc'd. Tennessee, age 19. '64,---- To Pro. Marshal April 6,1865. 11 Kuhn, H., Pt., H, lllth Sept. 17, Left; portion of lower third fibula 27 Pennsylvania, age 21. 1862. excised. Discli'd Jan. 10,1863; anchy. ankle joint. 12 Lautenshlager, S., Pt., July 1, Left; por. of low. third tibia exc'd. 28 G, 24th Michigan. '63,---- Disch'd March 28, 1864; false joint in tibia; unable to bear his weight on leg. 29 13 Lewis, W. B., Pt., B. 1st July 1, Right; 4 ins. middle third tibia Texas, age 20. '62,--- excised. Recovery. 14 Marshall, M. F., Pt,, B, May 5, Right; por. of middle third tibia 30 5th New Jersey. ----, '62. excised. Disch'd Sept. 25,1862. 15 Metcalf, J.,Serg't, 1,54th Mar. 25, Left; 11 inch of lower third tibia 31 North Carolina, age 29. ----, '65. excised. Released Aug. 25,'65. 16 Mullins, J., Serg't, D, July 1, Left; 5 ins. tibia and por. of fibula, 32 12th Massachusetts. ----, '63. upper third, exc'd; gang. Dis-charged May 6, '64. 1877, bone still diseased. 33 17 Perrin, J. T., Capt., E, May 20, Right; portion of upper third tibia 34 26th Virginia. ----, '64. exc'd. Furloughed Aug. 29,'64. 18 Pettee, L., Lieut., llth July 2, Right; IJ inch lower third tibia 35 Infantry. ---,'63. excised. Duty Nov. 24, 1863. Name, Military Description, and Age. Quirk, P., Lieut., 2d Cavalry. Steward, H. A., Pt., B, 8th Pennsylvania Re- serves, age 23. Stineman, M. C.,Pt., M, 62d Penn., age 25. Walker, R., Serg't, I, 104th New York. Walker, W. T., Pt., G, 12th Massachusetts. Warren, O., Serg't, B, 44th N. C, age 24. Wheeler, G., Pt., K, 6th N. Y. Artillery, age 43. Williams, J. H., Corp'l, E, 15th Massachusetts. Williams, J. O., Pt., E, 143d Penn., age 25. Baldwin, H. J., Pt., E, 27th Indiana. 1Dukoy, S. L., Pt., D, 15th Texas, age 24. Farr, T. A., Serg't, B, llth South Carolina. Gray, J. F., Pt., B, 4th Georgia. Knowles, L. T., Pt,, F, 9th Georgia. Parnell, J., Pt., I, 14th South Carolina. Sullnot, J. B., Pt., C, 44th Georgia. Tatley, S., Pt., C, 41st Virginia, age 25. June 9, '63,---- June 27, ----, '62. July 2, ---, '63. Sept. 17, ----, '62. Sept. 14, ----, '62. Oct. 27, ----, '64. May 19, ----, '64. Oct. 21, '61,---- July 1, ----, '63. May 3, ----, '63. Mar. —, ----, '65. Aug. 15, '64,--- Aug. 16, '64,--- Oct. 19, '64,--- Aug. 19, '64, —■ Operations, Operators, Result. Left; 3 inches lower third tibia excised. Retired Jan. 5, 1865; uses staff in walking. Right; large portion tibia, upper third, excised. Disch'd Nov. 20, 1862. April 1, 1867, amputa- tion at knee joint. Right; 5J inches mid. third tibia excised. Disch'd Sept. 8,1864; leg shortened and bent. Left; 3 inches lower third tibia excised. Disch'd Dec. 20,1862; 11 inch shortening. Left; 5 inches upper third fibula excised. Disch'd Dec. 13,1862. Right; portion of tibia, low. third, excised. Retired Feb. 28, 1865; partial anchylosis ankle joint. Left; middle third fibula excised. Disch'd Jan. 7, 1865. Left; por. low. third tibia exc'd. Disch'd Oct, 14, 1862. Died April 6, 1863. Left; 3 inches lower third fibula excised. Disch'd May 9, 1864; shortening; anchy. ankle joint. Left; 4 ins. tibia exc'd. (Necrosis.) Died June 15, 18C3; pysemia. Spec. 1283. Left; 4 inches middle third tibia excised ; erysipelas; gangrene. Died of pyasmia. Left; portion of tibia excised. Died May 29, 1864. Left; 12 inches of fibula excised. Died April 28, 1865. Right; portion of fibula excised. Right; portion of tibia excised. Left; partial excision of tibia. Left; 21 inches fibula excised. The side injured was not indicated in twelve of the three hundred and eighty-seven cases of excisions in the continuity of the bones of the leg. The right limb was fractured in one hundred and sixty-three—one hundred and sixteen recoveries, forty-five deaths, two unknown results,—and the left in two hundred and twelve—one hundred and fifty-four recoveries, fifty-six deaths, and two unknown results. AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT FRAC- TURES.—The precept of Guthrie2 that "a leg should be seldom amputated for a fracture from a musket ball" seems to have been very generally disregarded by the surgeons of the American civil war. Of eight thousand nine hundred and eighty-eight cases of shot frac- tures in the continuity of the bones of the leg, of which 88.4 per cent, were caused by musket balls,3 amputation was performed in four thousand seven hundred and ten,4 or 52.4 per cent. Of these four thousand seven hundred and ten cases of amputations for shot 1 AKUElibOX, Pyemia supervening upon Hospital Gangrene, in U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 443. 'Guthrie (G. J.), Commentaries on the Surgery of the War, etc., sixth edition, London, 1855, p. 150: "The bones of the leg being more exposed, admit of greater liberties being taken with them, and of larger portions, or even parts, being taken away successfully, than ought to be attempted in the thigh. A leg should therefore be seldom amputated for a fracture from a musket ball." 3 The nature of the missile was reported in 6,336 of the 8,988 cases of shot fractures in the continuity of the bones of the leg without primary injury to the knee or ankle joints: 79 were caused by cannon or solid shot; 654 by shells; 5,603 by mu6ket, pistol, or other 6mall balls; and in 2,652 instances the missile was not specified. 4 See Table LI, p. 432, ante. The cases are: 19 excisions in the leg followed by amputations in the leg; 2 excisions in the leg with subsequent amputations in the leg and thigh; 5 excisions in the leg followed by amputations at the knee joint; 22 excisions in the leg followed by amputations in the thigh; 3,728 amputations in the leg; 3 amputations in the leg and subsequent amputation at the knee joint; 39 amputations in the leg followed by ampu. tations in the thigh ; 100 amputations at the knee joint; 7 amputations at the knee joint followed by amputations in the thigh; and 785 amputations of thigh; a total of 4,710 amputations following shot fractures in the bones of the leg. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 461 fractures of the bones of the leg, eight hundred and seven performed in the thigh and one hundred and twelve performed at the knee joint have already been considered in the pre- ceding two sections of this chapter. Deducting these from the four thousand seven hundred and ten cases of amputations for shot fractures in the bones of the leg, there remain three thousand seven hundred and ninety-one cases of ablation in the leg, to which should be added one thousand six hundred and sixty-one amputations in the leg following shot frac- tures of the ankle joint or foot, making a total of five thousand four hundred and fifty-two cases of amputations in the leg to be considered in this section. A numerical statement of the cases is contained in the following table: Table LXVII. Numerical Statement of Fifty-four Hundred and Fifty-two Amputations in the Leg for Shot Injury. OPERATIONS. Primary...................... Intermediary.................. Secondary.................... Time between injury and oper- ation not specified.......... Aggregates. 3,392 1,046 444 5,452 « 2,307 682 327 3,561 1,032 364 117 1, 753 30.9 34.7 26.3 Upper Third. 1,029 296 133 1,509 1,094 a> I a Q 'P — — 249 9 102 37 18 406 9 Middle Thiud. 892 368 174 1,481 736 258 137 1,170 Lower Third. Seat not Re- corded. 900 335 121 1,407 676 215 86 1,011 a; p P 215 9I 120 -1 35 17 387 9 571; 124 47 15 1 1,055 286 655 In one hundred and thirty-eight of the five thousand four hundred and fifty-two instances of amputations in the leg the final result could not be ascertained; three thousand five hundred and sixty-one had successful, and one thousand seven hundred and fifty-three fatal terminations, a mortality rate of 32.9 per cent. Three thousand three hundred and ninety-two were primary, one thousand and forty-six intermediary, four hundred and forty- four secondary, and five hundred and seventy were operations of unspecified date, the primary amputations, by far the most nujnerous, comprising 69.4 per cent, of the cases in which the time between the injury and the operation could be ascertained. PRIMARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY.—Of the three thousand three hundred and ninety-two primary operations, one thousand and twenty-nine were in the upper third, eight hundred and ninety-two in the middle third, nine hundred in the lower third, and in five hundred and seventy-one the seat of the operation was not indicated. Primary Amputations in the Upper Third of the Leg for Shot Injury.—The results in nine of the one thousand and twenty-nine instances of this group were not ascertained; seven hundred and seventy-one had successful, and two hundred and forty-nine fatal term- inations, a mortality of 24.4 per cent. Examples of Successful Primary Amputations in the Upper Third of the Leg.—The seven hundred and seventy-one amputations of this group were performed on seven hun- 462 INJUKIES OF THE LOWEE EXTREMITIES. dred and sixty-six patients, five being successful amputations of both 'legs in the upper third. One of the cases of double amputation will be given in detail: Case 72-2.—Private S. L. Willson, Co. D, ?2d New York, aged 18 years, was wounded at Gettysburg, July 2. 1863. He was admitted to the field hospital of the 2d division, Third Corps, whence Surgeon C. K. Irwin, 72d New York, reported: " Compound comminuted fracture of right and left leg by mini€ ball, followed by amputation of both legs." Surgeon H. Janes U. S. V., forwarded the following history: "The patient entered Camp Letterman August 30th. Both of his lei^s had been shattered at the lower third, and amputation was performed at the upper third on the day following the injury. The stumps granulated well and the patient's general health was good. Simple dressings, with tonics and stimulants, constituted the treat- ment. On October 21st, when the man was transferred to another hospital, the stumps were in tolerable good condition. Then; had been ulcers in the cicatrices, threatening gangrene, which was controlled with citrine ointment, leaving small abrasions." The patient subsequently passed through hospitals at Baltimore and Alexandria, aud lastly he was transferred to Eochester, where he was discharged May 31, 1865, and pensioned. Since leaving the service he has been furnished at regular intervals with artificial legs of the " Bly" pattern, which he reports as satisfactory, and the use of which enabled him to accept and hold employment as messenger of the U. S. Senate at the Capitol building for a number of years. In his several applications for these artificial limbs he described the stumps as being in good condition. His pension was paid March 4, 18£0. Brief histories of the remaining four instances of successful primary amputation in the upper third of the leg are related in the foot-note.1 Case 723.—Corporal J. H. Wilkins, Co. E, 1st Louisiana, aged 25 years, was wounded at Port Hudson, June 14,1863, and conveyed to New Orleans three days afterwards. Assistant Surgeon P. S. Conner, TJ. S. A., recorded his admission to University Hospital, with "amputation of left leg performed on the battle field," also his departure on furlough October 26th. Several weeks afterwards the patient entered Central Park Hospital, New York City, whence Surgeon B. A. Clements, U. S. A., reported the following history: " The wound was caused by a musket ball, which passed through the middle of the leg antero-posteriorly, comminuting both bones badly and wounding the arteries. There was much hsemorrhage. Amputation through the upper third, by autero-posterior flaps, was performed under chloroform one-half hour after the injury. At first sutures and water dressings were applied. Tbe parts united mostly by first intention and had entirely healed at the end of six weeks. When admitted to this hospital, November 12th, the stump was in good condition and the patient's general health good. On December 20th, he contused the stump by a fall, which was followed by great swelling, heat, and pain. Four days later an abscess, which had formed two inches above the cicatrix on the anterior face of the stump, was opened, when one-half ounce of pus was discharged. By Feb- oneIyearaftTra^put^in°eS/)ecS4U3nI! ruary 25, 1864, the inflammation and swelling had subsided, but there remained considerable rigidity of the knee joint, flexion and extension being imperfect. Three weeks later the swelling of the stump had entirely subsided, and several months afterwards flexion was again restored, though extension was not perfect. When discharged from service, August 9, 1864, the patient had had an artificial limb for about one month, not being able to use it very well owing to the want of perfect extending power, but improving with it constantly." The pensioner was paid March 4, 1880. A cast of the stump {Spec. 4371, A. M. M.), presenting an excellent appearance, with the wound well united, was contributed by Acting Assistant Surgeon G. F. Shrady, and is represented in the wood-cut (Fig. 282). Case 724.—Private Z. Holcomb, Co. B, 36th Ohio, aged 26 years, was wounded at Opequan Creek, September 19,1864. He was admitted to the field hospital at Winchester, and thence removed, on November 12th, to Frederick Hospital. Assistant Surgeon E. F. Weir, U. S. A., in charge of the latter hospital, made the following report: "On examining the patient it was found that he had undergone an amputation of the right leg at the upper third, which was performed for a shell wound of the same at the middle and lower thirds. The stump is nearly healed. He had also a shot wound of the thigh of the same limb, the ball lodging. The latter wound was supposed to be a simple «esh Avound and had entirely healed, the missile having evidently passed downward, for it could not be felt. On December 1st, there was evidence of the formation of an abscess on the posterior portion of the thigh, at the lower part of the upper third, and poultices were ordered to be applied. On December 5th, the fluctuation being well marked over the abscess, a free incision was made and about an ounce of pus evacuated. On introducing the finger the missile was then discovered, which proved to be a cast-iron ball from a Shrapnell shell, and was removed by means of a forceps by Acting Assistant Surgeon W. S. Adams. On further examination of the limb quite an amount of callus was found around the femur at the junction of the upper and middle thirds, and on questioning the patient he stated that his surgeon had informed him that a non-comminuted fracture was produced by the missile; also that a coaptation splint had been applied for the same. On measurement there was found to be a little over one inch shortening. On December 'The remaining four successful primary double amputations in the upper third of the leg are: 1. Lieut. E. H. Fisher, Co. A, 21st Indiana, wounded at Atchafalaya Bay, La., October 20,1862. Half an hour after the injury Surgeon Ezra Read, 21st Indiana, removed both legs about four inches below the knee, on board Steamer St. Mary. The Lieutenant was discharged November 20, 1863, and pensioned. Examiner S. T. Williams certified, June 16, 1870, that the cicatrices of both stumps were very tender. The pensioner was paid September 4, 1878.—2. Corp'l John Lorence, Co. K, 9th New Jersey, age 30, wounded at Roanoke Island, February 8, 1862, by a cannon ball. Two hours after the injury Surgeons J. H. Thompson, U. S. V., and H. W. Rivers, 4th Rhode Island, removed both legs about two inches below the knee joint. The patient was discharged and pensioned September 30, 1862. In 1875, the pensioner declared that the knee joints are without motion and the stumps tender. He was paid March 4, 1877.—3. Pt. 5. H. Trim, Co. B, 41st Alabama, age 19, wounded at Drury's Bluff, May 21, 1864, by explosion of a shell. On the same day Surgeon John D. Jackson, 44th Ten- nessee, removed both legs at point of election by circular operation. He recovered without the intervention of a single bad symptom, and was furloughed to Beaverdale, Alabama.—4. Corp'l James Tanner, Co. C, 87th New York, received a shell wound of both legs, at Bull Run, Virginia, August 30, 1862. Both limbs were removed on the field, at the upper thirds. The stumps healed perfectly, and the patient was discharged October 15,1862, and pensioned. In 1874, he declared that the cicatrices had become adherent to bone and were very tender. He was paid June 4, 1880. SECT. V.] PEIMARY AMPUTATIONS IN THE LEG. 463 21st, when the patient was transferred, his general condition was good and the wounds were entirely healed." The missile was contributed to the Museum by the operator, and constitutes specimen 1498 of the Surgical Section. The patient subsequently entered Camden Street Hospital, Baltimore, and afterwards Broad and Cherry Streets Hospital, Philadelphia, and on May 20, 1S65, he was discharged from Chester Hospital and pensioned. Two months afterwards he was supplied with an artificial limb by the Palmer Arm and Leg Company of Philadelphia. Examiner A. B. Monahan, of Jackson, Ohio, September 6, 1876, certified: "The pensioner has lost his right leg three inches below the knee joint. The stump is tender and be cannot wear an artificial leg. There is also a wound of the right thigh, the ball striking the femur, upper third, and passing down about three inches, where it lodged and was removed. There is caries of the femur and the wound is open, small spiculse of bone being sloughed through the opening. The thigh is painful, lame, etc." The pensioner was paid September 4, 1880. In the following instance the amputation was performed close to the knee joint, through the tuberosity of the tibia, and the fibula was disarticulated—a method advocated and frequently performed by the elder Larrey •} Case 725.—Private J. Strider, Co. K, 56th North Carolina, aged 34 years, was wounded at Plymouth, April 20, 1864, by a mini6 ball, which produced a compound comminuted fracture of the right tibia. Surgeon C. H. Ladd, C. S. A., who ampu- tated the leg on the day of the injury, reported: " The operation was performed by the circular skin-flap method close to the knee joint, and the fibula was disarticulated. Tbe stump healed by first intention. I have never before or since performed an amputation so close to the knee joint; think it might often replace disarticulation at the knee joint or amputation above." The patient recovered and was retired from service January 17, 1865. One of the seven hundred and seventy-one survivors after primary amputation in the upper third of the leg subsequently underwent amputation at the knee joint, and nine, amputation in the thigh: Case 726.—Private J. Morrin, Co. G, 126th New York, aged 21 years, was wounded at Gettysburg, July 3, 1863, and admitted to the field hospital of the 3d division, Second Corps. Surgeon I. Scott, 7th West Virginia, recorded: "Compound comminuted fracture of left leg by mini, 3447, 3448 (TABLE XL, No. 200, page 323). SURG. Ill—59 166 INJUKIES OF THE LOWER EXTREMITIES. Table LXVIII. [CHAP. X. Summary of One. Thousand and Twenty-nine Cases of Primary Amputations in the Upper Third of the Leg for Shot Injuries. [Recoveries, 1—771; Deaths, 772—1020; Result unknowu, 1021—1029.] Name, Military description', ano agk Abrams, A. J., Serg't, K, 9th N. Y. Heavy Artil- lery, age 33. 2 Adams, J. H, Pt., F, 3d Arkansas, age 21. 3 Adams, W., Pt., D, 7th South Carolina, age 38. 4 Alkin, A. S., Serg't, K, 18th Indiana, age 27. Allen. J. W., Pt., King William Artillery. 6 Allen, L. F., Pt., 1, 35th New York. 7 Andrews,A.,Pt., G,27th Ohio, age 39. Andrews, J. N., Serg't, F, 5th Ala., age 29. 9 Andrews, O. T., Lieut., C, 15th Illinois. 10 Andrus, C. E., Pt,, K, lOGth Penn., age 20. 1 Aney, T. L., Pt., K, 56th Penn., age 18. 2 Arnell, J., Pt., B, 14th Iowa, age 19. 13 Avers. J. .U.,l>t.,F, 76th Pennsylvania. 14 Bagwell, N. B., Serg't, B, 38th Georgia. 15 Barrett, F. J., Corp'l, D, 59th New York. 5 Barron, \V., Serg't, B, 2d Corps d'Afrique,age24. 17 Bartholomew,G., Corp'l, D, G7th Penn., age 23. 8 Bartlett, J., Pt,, G, Sth N. Y. H'vy Artillery, age 20. Basine, C, Pt,, H, 8th Penn. Res., age 20. 0 Battelle.C. P., Serg't.A. 59th Mass., age 20. 21 Baughman, J., Pt., M, 5th Col'd Cavalry, age 20. Beach, J. (alias Smith), Pt., D, 28th Mass., age 20. 23 Bean, W. H.,Vt, K, Sth North Carolina, age 26. 24 Beardsley, W. W., Pt., II, 82d Ohio. 25 Beaumont, S., Capt., E, 29th Penn., age 26. 26 Beeson, TV H., Pt., G, 82d Penn., age 22. 27 Berschig, A., Pt., A, 23d Ohio, age 20. 28 ; Bierce, P., Pt., A, 1st Ohio Artillery, age 20. 29 Bigby, W. A., Pt., K, 1st South Carolina. 30 Bingenheimer, C,Corp'l, A, 33d Wis., age 30. 31 Bird, S. A., Pt., G,.12th South Carolina, age 26. 32 Black, L. C, Lieut., F, 12th Georgia, age 21. 33 Blake, C. A., Pt., C, 14th New .Tersev. age 24. 34 Blomley, A*. Corp 1. A, 91st Penn., nge 27. 35 Bobo, J. £., Pt".. E. Hol- comb's Legion, age 18. 36 Bodwell, J., Serg't, G, 71st Ohio, age 22. 37 Bohannan, J. W., CorpM, G, Sth Georgia, age 24. 38 Boon, W. J., Pt., A, 5th North Oirolina, age 27. Bornnian, J. M., Corp'l, I, 61st Penn., age 28. 40 Byaner, N. J., Pt., I, 33d Mississippi, age 22. June 22, 22, '64. July 2, 2, '63. May 16, 16, '64. July 20, 20, '64. Sept. 14, 14, '63. Dec. 13, 13, '62. July 3, 3, '63. July 1, 1, '63. April 6, 8, '62. June 3, 3, '64. July 1, 3, '63. April 30, 30, '64. Julv 11, 13,*'63. Sept. 17, 19, '62. May 3, 4, '63. April 9, 9, '63. Sept. 19, 19, '64. Oct, 19, 19, '64. Sept. 17, 17, '62. Mar. 25, 25, '65. Aug. 15, 15, '64. Mar. 25, 25, '65. June 17, 17, '64. Aug. 29, 30, '62. Dec. 17, 17, '64. June 1, 2, '64. Sept. 22, 22, '64. Nov. 13, 13, '63. June 27, 27, '62. Mar. 30, 30, '65. July 1, 2, '63. Sept. 19, 19, '64. Oct. 19, 19, '64. June 18, 20, '64. Mar. 29, 29, '65. Dec. 15, 15, '64. Aug. 14, 14, '64. May 3, —, '63. Sept. 22, 22, "64. July 10, 11, '64. Operations, Operators, Result. Right; ant. post. flap. Surg. S. A. Sabin, 9th N. Y. H'vy Art'y. Disch'd Feb. 25, 1865. Left. Surg. — Rouch, C. S. A. Paroled Nov. 12, 1863. Right. Furloughed July 28,'64. Left: flap. Disch'd Mar. 13, '65. ----. Surg. — Robertson. Re- covery. Left. Discharged June 6, 1863. Right. Discharged Jan. 11,1864. Left; circular. Exchanged Sept. 25, 1863. Right. Discharged August 21, 1862. Left; circ. Surg. M. Rizer, 72d Penn. Disch'd Dec. 28, 1864. Right; circular. Disch'd Jan. 17, 1865. Right; flap. Discharged Nov. 15, 1864. Left; circ. Mustered out Nov. —, 1864. Left. Union surgeon. Retired Dec. 30, 1864. Right; flap. A. Surg.W. J. Burr, 59th N.Y. Disch'd April 18,'64. Right; post. flap. Disch'd Oct, 5, 1863. Spec. 1420. Left; flap. Discli'd Juue 1,1865. Died Nov. 14,1867. Right; lateral flap. Confederate surgeon. Disch'd July 4, 1865. Spec. 3092. Right. Discharged Dec. 6,1862; gang. . Dec, 1862, amp. thigh. 1870, stump sound. Left; ant. post. flap. Discharged July 13, 1865. Right; flap. Surg. G. W. Bowen and A. Surg. J. Swan, 5th Col'd Cavalry. Disch'd Feb. 15,1865. Left; circular. Surg. M. C. Row- land, 61st N. Y. Disch'd July 15, 1865. Left; circular. Furloughed Sept. 16, 1864. R't; flap. A.Surg.A.W.Munson, 82d Ohio. Disch'd Nov. 3,1862. Left; ciro. Surg. J. A. Wolf, 29th Penn. Must, out July 11, 1865. Right; flap. Disch'd July 20, 1865. Died Jan. 3, 1870. Left; ant. post. flap. Discharged Jan. 5, 1865. Left; flap. Dee. 25, amp. arm. Disch'd August 29, 1864. Right. Surg. — Evans, C. S. A. Disch'd August 6, 1864. Left;flap. Surg.J.W.Green,95th 111. Disch'd June 20, 1865. Right. Exchanged Nov. 12, '63. Left. Surg. J. M. Lawson, 30th N. C. To prison Dec. 9, 1864. Right; ant. post. flap. Disch'd July 7, 1865. Right; circ. Surg. J. Kerr, 62d Penn. Disch'd Sept. 27,1864. Right; circ. Released June 14, 1865. Right; ant, post. flap. Surg. D. C. Patterson, 124th Ohio. Dis- charged May 12, 1865. Left; double flap. Released June 28, 1865. ----. Furloughed July 23,1863. Right (also w'd left leg and hand); flap. Surg. G. R. Lewis, 61st Penu. Disch'd July 21,1865. Left; circular. Provost Marshal March 7, 1865. No 51 'Brannan, M., Corp'l, 9th Mass., age 30. Name, Military Description, and Age. Bouch, W. B., Pt., B, 139th Penn., age 24. Bovee, J. N., Pt., E, 18th New York, age 19. Boyle, J., Pt., G, 34th Mass., age 20. Bradley, H., Corp'l, Ord- nance Depart., U.S.A., age 34. Bradley, L. F., Corp'l, I, Sth Conn., age 22. Bradley, P.,Pt., E, 164th New York, age 38. Brady, J., Capt., G, 26th Massachusetts, age 33. Branch, E. B., Pt., D, 77th N. York, age 20. Brandenberg, A., Serg't, II, 6th Maryland. Brannan, J., Pt., C, 44th New York, age 26. Sept. 21, 22, '64. June 27, 29, '62. Oct. 13, 14, '64. Aug. 9, 9, T64. Sept. 29, 29, '64. June 16, 16, '64. Sept. 19, 20, '64. May 3, 3, '63. April 2, 2, '65. July 2, 4, '63. B, June 3, 4, '64. Breen, J., Pt., B, 15th Connecticut. Breeze, S., Pt., C, 76th Penn., age 45. Brest, J. P., Pt., E, 100th Penn., age 24. Bridge, J., Pt,, K, 57th New York, age 20. Bridges, J. W., Pt., K, 6th Georgia, age 24. Briggs, H. E., Pt., G, 3d Wisconsin. Brith, J. if.,Surgeon, 1st Missouri. Britten, W. B., Serg't, F, 60th Ohio, age 23. Britton, J., Serg't, H, 18th Massachusetts. Brockham, A., Pt., E, 58th Penn., age 47. Broderick, J., Pt,, 36th New York. D, Brondstetter, W., Pt., G, 9th N. Jersey, age 21. Brown, H., Pt., K, 22d Col'd Troops, age 19. Brown, M., Ft., E, 99th Ohio, age 20. Bruback, D., Pt., B, 1st Penn. L. Artv, age 21. Bryan, D. M., Pt..B, 84th Penn., age 19. Buckner,R.,Pt., G, 16th New York H'vy Art'y, age 43. Bullett. J., Pt., C, 13th Col'd Troops, age 24. Bumm, J., Pt., F, 29th Pennsvlvania, age 20. Burk, J., Pt,, F, 38th Georgia, age 23. Burnett. J., Pt., D, 107th New York, age 22. Bun-ell, J., Pt., K, 9th New Jersey. Byers, A. F., Pt., H, 1st Tennessee. Byrne, J., Pt., F, llth North Carolina. Cadon,Z. P., Pt.,E,llth Virginia, age 26. Dates. Dec. 13, 13, '62. Aug. 16, 16, '64. June 2, 3, '64. May 3, 3, '63. Aug. 19, 20, '64. Sept, 17, 17, '62. June 9, 9, '63. June 17, 17, '64. Sept. 30, 30, '64. Sept. 29, 29, '64. May 3, 3, '63. Dec. 16, 16, '62. July 30, 30, '64. Aug. 6, 7, p64. June 30, J'y 1,'62. Oct. 27, 28, '64. Aug. 13, 13, '64. Dec. 16, 16, '64. June 15, 15, '64. Feb. 6, 7, '65. May 3, 5, '63. Feb. 8, 8, '62. Jan. 6, 6, '65. Julv 3, 5, '"63. July 2, 3, '63. Operations, Operators, Result. Left; ant. post. flap. Surg. E. R. Umberger, 93d Penn. Disch'd July 11, 1865. Right, Confed. surgeon. Dis- charged Sept. 15, 1862. Right. Disch'd March 18, 1865. Left; circ. Surg.W. OMeagher, 69thN.Y. Disch'dMay.31,'65. (Also wound of left foot.) Left; flap. Disch'd Oct. 8,1865. Left; ant. post. flap. Discharged July 31,1865. Spec. 257. Died July 30, 1870. Left. Surg. J. G. Bradt, 26th Mass. Disch'd Dec. 31, 1864. Left; circ. Surg. G. T. Stevens, 77th N. Y. May 17, '64, re-amp. leg. Disch'd Sept. 20, 1864. Right; circ. Surg. E. K. Fore- man, 6th Marvland. Disch'd July 13, 1665. " Right; flap. July 12, haem.; post. tibial lig.; 15th, hsem.; femoral ligated. Recovery. Right; dou. skin flap. A. Surg. J. Ryan, 9th Mass. Disch'd August 20, 1864. Right. Discharged June 18, '63. Left; flap. Disch'd Nov. 29, '64. Died of prostration August 11, 1869. Left; ant. post, flap. Surg. H. Ludington, 100th Penn. Dis- charged May 6, 1865. Right; circ. Surg. C. S.Wood, 66th N. Y. Gangrene. Disch'd Sept. 24, 1863. Left; lat. flap. To prison March 28, 1865. Right. Discharged Dec. 27, '62. ---. Surg. B. D. Lay, C. S. A. Recovered. Left; flap. Surg.W. B. Fox, 8th Mich. Disch'd Jan. 10,1865. Left; double flap. Disch'd Aug. 21, 1865. Left; post. flap. Discli'd June 27, 1865. Right; circ. Surg. C. N. Cham- berlain, U. S. V. Disch'd Aug. 7, 1863. Left; double flap. Surg. G. A. Otis. 27th Mass. Disch'd Jan. 21, 1864. Right. March 19, 1865, amp. left thigh. Disch'd Mar. 20,1865. Left. Surg. A. M.Wilder.U.S.V. Nov. 14, re-amp. Mustered out May 30, 1865. Right. Confed. surgeon. Dis- charged Dec. 3, 1862. Left; flap. Disch'd Sept. 2, '65. Right; ant. post. flap. Disch'd Nov. 17, 1864. Died March 3, 1865; inflammation of stump. Right; flap. A. A. Surg. J. S. Giltner, U. S. A. Disch'd July 15, 1865. Right; flap. Surg. J. A. Wolf, 29th Penn. Disch'd Aug. 4,'65. Right; circular. To prison June 8, 1865. Right; circ. Disch'd Sept. 18,'63. Left. Surg. L. Braann, 9th New Jersey. Disch'd Aug. 18,1862. Right: circular. Disch'd May 26, 1865. Left. Surg. - White, C. S. A. Recovered. Left. Union surgeon. Exch'd Nov. 12, 1863. 'Lidell (J. A.), Primary Amputation of Right Leg, for Injury inflicted by a CannonBall; Pysemia developed thirty-one days afterwards with well-marked symptoms, in IT. S. Sanitary Commission Memoirs, Surgical Volume I, New York, 1870, page 535. SECT, v.] PRIMARY AMPUTATIONS IN THE LEG. 467 Name, Military Description, and Age. 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 Cage, J., Serg't, E, 7th Tennessee, age 24. Cahill, T. J., Lieut., D, 7th N. C, age 26. Calkins, E. 1>., Pt., A, 6th Wisconsin. Callaghan, D.,Pt.,C,lst Kansas. Callahan, R., Corp], G, 203d Penn., age 23. Campbell. W. R., Pt., K, 2d Arkansas, age 24. Cantelli, A., Pt.^ A, 1st Artillery. Carbeny, J.,Corp'l, Ches- apeake Artillery. Carey, J., Pt., H, 3d N. Hampshire, nge 37. Carmady, R., Pt.,B, 13th Michigan, age 34. Carpenter, J. V., Pt., B, 70th New York, age 43. Carson, W., Pt., K, llth New Jersey, nge 22. Casada, A. P., Serg't, E, llth Ga., age 20. Cashdollar, L. W., Pt., C, 128th N.Y., age 21. Castatar, A. J., Serg't, G, 80th Indiana. Cavanaugh, G.E., Serg't Major, 20th Indiana. Cavanagb, W., Pt., D, 5th N. Y. H. A., age 30. Cavil, £., Pt,, B, 44th Miss., age 19. Champeau, A. L., Pt., E, llth Vermont, age 24. Cbapin, A., Pt.. B, 10th Wisconsin. Cherry, I., Pt., C, 19th Indiana, age 17. Childers, N. A., Pt., F, 2d N. C, age 19. Christner, W., Corp'l, B, 2d Man-land, age 26. Clark, j., Pt., I, 41st Ohio, age 45. Clark, L. R., Capt., F, 117th New York. Clark, P. D., Corp'l, E, 3d Vermont, age 24. Clark, S., Pt., F, 12th Georgia Bat'ry, age 20. Clark, S. W., Corp'l, G, 2d Penn. H. A. Clay, R., Pt., B, 65th Dlinois, age 23. Cleary, M., Pt,, D, 5th Cavalry, age 24. Clements, J., Pt., F, 18th Massachusetts. Clements, S. W., Pt., F 40th Indiana. Closser, S., Pt.. F, 104th New York, age 26. Cobangh, W. D., Pt, H, 3d Penn. Cav., age 27. Cobett, G. W., Serg't, F, 22d Mass.. age 30. Cole, E., Pt., F, 120th New York, age 24. 1 Coles, H. C., Pt., B, 4th Tenn. Cav., age 18. Colestock.W.W.,Corp'l, K, 16th Mich., age 24. Collier, J. W., Pt., Hart's Battery. Conklin, A.,Pt.,K,109th New York. Conklin, A. J., Pt., D, 106th Penn., age 23. Conley, J. H., Serg't, G, llth Virginia, age 30. Conley, W., Pt., G. 17th New York, age 25. Connel, J., Pt., C, 7th Missouri. Conner, C. R., Corp'l, B, 19th Ohio, age 19. Connolly, D., Pt., B 164th N. Y.. age 22. April 2, 2, '65. July 3, 4, '63. Sept. 17, 17, '62. Oct, 5, 5, '62. Jan. 15, 15, '65. Nov. 30, 30, '64. Mav 27, 27,"'63. May 2, 2, f63. May 16, 18, '64. Jan. 2, 2, '63. May 12, 12, '64. July 2, 3, '63. July 2, 2, *63. Sept, 19, 20, '64. Aug. 29, 29, '62. Dec. 13, 13, '62. July 18, 19, '64. Dec. 16, 17, '64. Aug. 21, 21, '64. Oct. 8, 10, '62. June 18, 19, '64. Oct. 19, 19, '64. July 26, 26, '64. Nov. 25, 25, '63. Oct. 27, 27, '64. May 5, 5, '64. July 9, 9, '64. June 17, 17, '64. Nov. 26, 26, '64. Nov. 4, 4, '62. Dec. 13, 14, '62. Nov. 25, 27, '63. July 1, 2, '63. Jan. 7, 7, '64. May 10, 10, '64. July 2, 4, '63. May 19, 19, '64. May 8, 9, %4. May 3, 3, '63. June 17, 17, '64. Dec. 13, 13, '62. Nov. 27, 27, '64. Mar. 16, 17, '65. May 12, 12, '63. May 27, 28, '64. June 3, 3, '64. Operations, Operators, Result. Left; circular. Released May 30, 1865. R't. Surg. R. Gibbon, 28th X. C. Retired March 1, 1865. Left. Disch'd January 5, 1863. Left; flap. Discharged May 30, 1863. Right; circ. Surg. G. C. Jarvis, 7th Conn. Discharged. Right; ciro. To Provost Mar- shal March 15, 1865. Left; circular. Disch'd Feb. 27, 1864. Spec. 1026. ----. Surg. — Hunter, C. S. A. Recovery. Right; circular. Disch'd May 30, 1865. Right; flap. Surg. F. Pratt, 13th Mich. V. R. Corps. Died 1876. Right; post. flap. Mustered out Dec. 5, 1864. Right; flap. Disch'd June 10, 1865. Right. Surg. — Means, C. S. A. Exchanged Jan. 10, 1864. Right; flap. Surg. C. H. Andrus, 176th N.Y. Oct. 27, haem.; post. tib. lig. Disch'd May 30,1865. ----. Discharged Feb. 11, 1863. Left. Discharged April 9,1864. Right; ant. post.'flap. Confed. surgeon. Disch'd Oct. 21,1865. Right; circ. Surg. — Brothers, C. S. A. Pro. Mai-. Mar. 30, '65. Left; circ. Surg. C. B. Park, llth Vermont. Disch'd July 25,'65. Right; flap. Surg. S. Marks, 10th Wis. Disch'd Dec. 9, 1862. Right; flap. Disch'd June 13, 1865. Died Oct. 13, 1867. Right; circ. Exchanged Octo- ber 27, 1864. Right. Disch'd March 8, 1865. Left. Disch'd July 28, 1864. Right; flap. Surg. H. W. Car- penter, 117th N. Y. Disch'd March 20,1865. Right; circ. Disch'd June 5, '65. Died Nov. 14, '68; dis. of liver. Left. Exchanged Sept. 21,1864. Left; circ. (also wound right leg). Disch'd April 29, 1865. Right. Discharged June 5,1865. Left; circular. Disch'd August 18, 1863. Left. Disch'd August 28, 1863. Right; flap. Surg. H. McHenry, 125th Ohio. Disch'd Oct. 7,'64. Right; flap. Disch'd March 25, 1864. Left. Disch'd June 15, 1864. Right; ant. post. flap. Disch'd October 17, 1864. Right; flap; haem.; lig. muscular branch. Disch'd April 20,18fi4. Right; circ. Furloughed June 30, 1864. Right; ant. post, flap. Disch'd Dec. 9, 1864. ----. Surg. A. Bowie, C. S. A. Recovered. Left; flap. Disch'd May 15, '65. Left; circ. Disch'd Oct, 1,1863. Right; circular. Recovery. Left; ant. post, flap. Surg. E. Batwell, 14th Mich. Disch'd July 25, 1865. Left; circ. Disch'd Dec. 3,1863. Right; circ. Surg. T. F. Duncan, P. A. C. S. Disoh'd Aug. 2,'65. R't; flap. Con. surg. (Alsoother wounds.) Disch'd June 19,'65. Name, Military Description, and Age. Conover, J., Pt., C, 82d Pennsylvania. Cook, N. W., Pt., F, 55th North Carolina. Cook, W. W., Pt,, G, 2d Vermont. Coons, H., Pt.. I, 103d Illinois, age 28. Copps, W. P., Pt„ A, 40th Mass., age 27. Corley, J. D., Corp'l, H, 1st Arkansas, age 32. Coughlin, M., Pt., A,15th Infantry, age 42. Cowan, W., Pt., E, 21st Michigan, age 33. Coyle, P., Pt., E, 90th Penn., age 22. Crabtree, N.,Pt.,F,112th Illinois, age 22. Craig, W., Pt., K, 53d Indiana, age 33. Crallwell, W. H., Pt,, A, 14 th Ohio, age 19. Cranston, D. J., Pt., H, 2fith Iowa, age 21. Cresswell, W., Pt,, C, 1st New York Rifles. Critohett, T., Pt,, 1,12th Massachusetts. Crocker, A. B., Corp'l, I, 64th New York. Crocker, P. B., Serg't, F, 14th New York. Crooks, A., Pt., D, 149th Pennsylvania, age 23. Crowe, J., Pt,, I, 63d New York. Curie, H., Pt., F, 7th Connecticut, age 27. Currier, C. P., Serg't, I, 39th Mass., age 27. Currey, J. B., Corp'l, F, 4th Texas. Dale, G.B., Pt., Ii. 22d North Carolina. - Damon, A., Serg't, I, 19th Mass., age 20. Danbert, J., Pt,, D, 24th Michigan, age 23. Davenport, J. C, Pt., C, 53d Georgia. David, A., Pt., H, 1st New York. Davis, C, Pt., G, 48th Colored Troops, age 23. Davis, J. H.. Pt,, D, 97th Ohio, age 22. Davis, J. S., Pt., G, 17th North Carolina, age 38. Decker, P.., Pt., E, 38th ■New York. Decker, H., Pt., B, 95th New York, age 42. DeForrest, D.. Pt., H, 100th N. York, age 26. DeJean, C, Corp'l, H, 55th Ohio. Delany, W., Corp'l, A, 5th N. Hamp., asre 29. Delbriger, W., Pt., E, 25th Indiana, age 24. Dempsey, J., Pt., C, 116th Penn., age 26. Devlin, J., Pt., I, 61st New York, age 20. Deyoe, N. W., Corp'l, E, 61st New York, age 21. Dickson. A. S., Corp'l, H, 125th 111., age 26. Diedrich, H., Corp'l, I, 30th Iowa, age 23. May 3, 3, '63. Mav 2, 2, '63. May 3, 3, '63. Nov. 25, 27, '63. June 3, 3, '64. Oct. 15, 17, '64. Aug. 7, 7, v64. Mar. 19, 19, '65. May 5, 6/64. Nov. 18, 18, '63. Mar. 10, 10, '65. Sept. 1, 2, '64. Nov. 27, 27, '63. Jan. 9, 11, '63. April 30, 30, '63. Sept. 17, 18, '62. Aug. 29, 30, '62. July 1, 2, '63. Feb. 1, 1, '62. Aug. 16, 17, '64. May 8, 9, '64. Sept, 19, 20, '63. July 2, 2, '63. July 2, 3, '63. Feb. 7, 7, '65. May 3, 3, '63. Aug. 29, —, '62. April 2, 2, '65. June 27, 27,'64. Mar. 10, 12, '65. May 3, 3, '63. Oct. 27, 28, '64. Dec. 10, 10, '63. Mav 2, 4, '63. Aug. 25, 27, '64. Oct. 5, 5, '62. Dec. 13, 14, '62. Dec. 7, 8, '64. July 2, 2, '63. June 27, 27, '64. Oct, 21, 21, '63. Operations, Operators, Result. Left; flap. Surg. L. M. Emanuel, 82d Penn. Disoh'd Sept, 5, '63. Right, A. Surg. W. J. Green, 44th N. C. Recovery. Left; flap. Surg. W. J. Sawin, 2d Vt. Disch'd April 12, 1864. Left, Discharged June 8, 1864. Right; flap. Surg. D. M.Good- win, 3d Vermont. Gangrene. Disch'd Feb. 15, 1865. Right; flap. Surg.W. B.Water- man, 1st Ark. Disch'd July 20, 1865. Left; flap. Disch'd July 15, '65. Died April 13, 1870. ' Left; circ. Disch'd July 20, '65. Right. Mustered out July 1, '65. Left; flap. Disch'd July 23, '64. Left; circ. Mustered out Aug. 11, 1865. Right; flap. Surg. C. N. Fowler, 105th Ohio. Disch'd Nov. 18,'65. Left; flap. Disch'd April 26, '65. Left; circ. Surg. —White, C.S.A. Gang. Disch'd Sept. 26,1863. Right; flap. Surg. A. M. Clark, U. S.V. Disch'd Aug. 19,1863. Left. Surg. D. E. Kelsey, 64th N. Y. Bone cut off. Disch'd Dec. 6, 1862. Left. Disch'd January 15, 1863. Right; post. flap. Surg. W. T. Humphrey, 149th Penn. Disch'd July 26, 1865. Left. Disch'd April 30, 1862. Left. Confed. surg. Re-amp. in thigh Aug. 19, 1864. Disch'd June 10, 1865. Left; fla-o. Surg. — Mitchell, C. S. A. Disch'd March 10, 1865. Left. Surg. W. O. Hudson, 4th Alabama. Recovery. Right. Surg. —McCadden, C. S. A. Retired Feb. 13, 1865. Left; flap. Surg. N. Hayward, 20th Mass. Disch'd April 12,'64. Right; circ. Surg. J. H. Beech, 24th Michigan. Disch'd May 16, 1865. ----; flap. Furloughed July 1, 1863. ---. Disch'd Nov. 30, 1862. Left; ant. post, skin flap; circular sect. mus. Surg. N. N. Horton, 47th C. T. Disch'd Aug. 7, '65. Right; flap. Surg. E. B. Glick. 40th lnd. Gangrene. Disch'd October 31, 1865. Left; circ. Released May 19,'65. Left, Disch'd August 28, 1863. Left; circ. Ass't Surg. F. Whit- man, 58th Mass. Mustered out. Died Sept. 25, 1867, of injury. Right; ant. post. flap. A. Snrg. J. W. Applegate, U. S. V. Dis- charged Sept, 22, 1864. Left; flap. Disch'd December 29, 1863. Left. Confed. surgeon. Disch'd October 29, 1864. Left; flap. Disch'd April 7, '63. Left; flap. Disch'd April 19,'64. Left; ant. post. flap. Surg. — Richards, C. S. A. Discharged Nov. 7, 1865. Left; ant. post. flap. Discharged March 2, 1664. Spec. 4374. Right; ant. flap. Surg. J. W. McGee, 57th N. C. Mustered out June 9, 1865. Right; circ. Surg. J. C. Morgan, 29th Mo. Gangrene. Disch'd May 15. 1865. 'O'KEEFE (D. C.j, Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., etc., in Confed. States Med. and Surg. Jour., Vol. 2, p. 30 468 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Name, Military Description, and Age. 164 Dines, D., Pt., D, 27th Ohio, age 21. 165 Dolley, T. W. Corp'l, K, 30th Maine, age 22. 166 Donaghy, W., Seaman, gunboat Ta inah ,age 27. 167 Donahue, J., Pt., H, 67th Penn., age 38. 168 Donaldson, L. J., Pt., F, 20th Ohio. 169 Donnelly, J.. Pt., A, 124th Illinois. 170 Doolan, P., Pt., B, 90th Penn., age 45. 171 Dooley. H. O, Pt., C, 26th Indiana, age 27. 172 Dorsey. J., Corp'l, H, 16th Kentucky, age 21. 173 Dor.ney, IC. W., Lieut., B, llth'N.C. age 24. 174 Dougall. J. S., Pt., H, 44th New York. 175 Dougherty, H., Colonel, 22d Illinois. 176 Douglass, J. C, Capt., II, 2d Missouri. 177 Dow, J. IL, Pt., H, 29th Massachusetts, age 36. 178 Dowliug,W., Pt.,F, 59th New York, age 28. 179 Downing, F. T., Corp'l, F, 108th New York. 180 Dresson, G. F., Pt., A, 35th New York. 181 Duffy, J. P., Pt., 0,28th Pennsylvania. 182 Duffey, O., Serg't, G, 48th New York, age 23. 183 Dunlap, J. R., Pt., C, Davis Cavalry, age 20. 184 Dunn, W. F., Serg't, E, 93d Illinois, age 36. 185 Durand, E., Pt,, K, 31st Wisconsin, age 37. 186 Durnap, J. R., Pt., D, Perrin's Ala. Battery. 187 Dwyer, A., Serg't, G, 3d New York. 188 Eakes, M., Pt., I, 23d North Carolina, age 19. 189 Echols, J., Pt., H, 24th Virginia. 190 Edmunds, C, Pt., L, 1st Ohio Battery. 191 Edson, S.W.,'Pt,, E,22d Massachusetts, age 29. 192 Edwards, F. W., Pt., H, 1st Mass., age 22. 193 Elliott, J. H., Corp'l, G, 34th Mass., age 21. 194 Elliott, P., Pt., K, 15th Massachusetts. 195 Ellis, A.. Pt., A, 142d N. York, ago 40. 196 Ellis, T. S., Pt., G, 2d IT. S. Sharpshooters. 197 Ellis, W., Pt., A, 14th Illinois, 198 Ellis, W. T., Capt., B, 24th N. C, age 32. 199 Ellison, X. A., Ft.. B, 16th Georgia, age 16. 200 English, W. W., Pt., II, 71st Indiana. 201 Erway, J. B., Pt., G, 149th Pennsylvania. 202 Evans, A., Serg't, H, 66th New York. 203 Evans, J., Pt., C, 96th Penn., age 30. 204 Evans, S. P., Capt., A, 5th Tennessee. 205 Evans, W., Lieut., F, 100th N. Y., age 27. 206 Evers, B., Pt.. G, 16th Michigan, age 20. July 22, 22, '64. April 9, 9, '64. Nov. 4, 4, '64. Oct. 19, 21,'64. May 12, 12, '63. Mav 17, 17,"'63. May 5, 5, '64. Mar. 27, 27, '65. Nov. 29, 30, '64. July 2, 2, '63. Aug. 30, 30, '62. Nov. 7, —, '61. Oct. 4, 4, '62. July 30, 30, '64. Aug. 14, 15, '64. Dec. 13, 14, '62. Dec. 13, 13, '62. Sept. 17, 17, '62. Aug. 16, 16, '64. July 3, 3, '63. Oct. 5, 5, '64. June 4, 5, '64. June 20, 20, '63. Oct. 7, 7, '64. July 1, 2, '63. Mav 16, 17,*'64. May 3, 3. '63. Mav 10, 10,"'C4. Mav 19, 19," '64. Oct. 13, 14, '64. Sept. 17, 17, '62. May 16, 1(5, '64. Aug. 29. 30, 'CH. April 6, 6, '1)2. Aug. 21, 21, '64. July 3, 3, '63. Aug. 30, 30"" '62. Slav 3, 3. A.i. Doc. 13, 13, '62. May 12, 13.* '64. Mav 14, 15,"'64. Mav 16, 17.''64. Mav 23, 23,*'64. Operations, Operators, Result. Right; flap. Surg. A. B. Mono- han, 63d Ohio. Disch'd July 24, 1865. Left; circ. Disch'd Nov. 22, '64. Died Aug. 4, '67; phth. pulmo. and chr. diarrhoea. Spec. 4299. Right; circ. Surg. L. C. Fouts, 2d Tenn. Duty Feb. 7,1865. Right; circ. Disch'd June 28, 1865. Left; flap. Surg. E. L. Hill, 20th Ohio. Disch'd August14,1863. Left; flap. Surg. E. Harrison, 68th Ohio. Discli'd Aug. 10,63. Right; flap. Disch'd Dec. 10,'64. Right. Surg. T. W. Flora, 26th lnd. Disch'd June 2, 1865. Right; gangrene. Disch'd July 17, 1865. Right; circ. To prison January 29, 1864. Left. Surgeon W. Frothingham, 44th N. Y. Disch'd Oct. 27, '62. Left (also w'nds of arm and lung). Mustered out May 7, '63. Died April 7, '68; wound of lung. ----. Recovered. Left; circular. Disch'd May 26, 1865. Left; long ant. post. flap. Surg. S. H. Plumb, 59th N. Y. Haem. Disch'd August 18, 1865. Rigid. Surg. J. F. Whitbeck, 108th N. Y. Disch'd Aug. 6,'63. Left. Disch'd August 29, 1863. Right. Disch'd June 27, 1863. Right; double flap. Confederate surgeon. Disch'dNov. 30,1864. Right. Exchanged September 25, 1863. Left; flap. Disch'd June 14, '65. Right: circ. Surg. P. S. Arndt, 31st Wis. Disch'd Feb. 9, '65. Died April28, '70: consumption. ----. Surg. W. H. Lipscomb, C. S. A. .Recovery. Right; flap. Disch'd March 28, 1865. Left. Exchanged Sept. 25,1863. ----: flap. Surg. C. B. Gibson, C. S. A. Transferred. Right. Surg. C. S. Wood, 66th N. Y. Disch'd Feb. 22,1864. Left; ant, post. flap. Surg. I. H. Stearns, 22d Mass. Disch'd Jan. 8, 1865. Right; flap. Disch'd July 8,'64. Right; circ. Disch'd February 4, 1865. Left; circ. Disch'd Dec. 4,1862. Died Dec. 4, 1863. Spec. 4200. Left; flap. Discharged. Left; circ. Disch'd April 25, '63. Right. Disch'd June 7, 1862. Left; comb'n flap and circ. Surg. — Wilson, C. S. A. Furl'd Oct. 21, 1664. Right. Surgeons Schaffer and Busch, C. S. A. Retired Feb. 1, 1865. Right; circ. Confed. surgeon. Disch'd Nov. 28, 1862. Left. Surg. W. F. Humphrey, 149th Penn. Discharged. Right. Surg. C. S. Wood, 66th N. Y. Discli'd Feb. 21, 1863. Left; circ. Disch'd March 23, 1865. Left; circ. Mustered out, 1865. Left; circ. Confederate surgeon. Disch'd Jan. 26, 1865. Right; flap. Disch'd June 19, 1865. NO, Name, Military Description, and Age. Dates. Operations, Operators, Result. 267 Evercost, G., Corp'l. B. 27th Ohio, age 26. Everett, D., Pt., L, 15th Kansas Cav., age 18. 209 210 211 212 213 214 215 216 217 218? 2195 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 240 247 248 Failing, J., Pt., A, 122d New York, age 21. Farnsworth, J. W., Pt., F, 57th Massachusetts. Farry, M., Pt., I, 38th Massachusetts, age 30. Fehrman, H., Corp'l, I, 1st Maryland, age 25. Felloon, R., Pt.. E, 6th Michigan, age 43. Fentress, H, Pt., C, 6th Virginia. Ferguson, A., Lieut., 33d Alabama, age 32. Fink, J., Pt., E, 8th N. Y. Heavy Artillery. Fisher, C. S. M., Pt., H, 2d Penn. Arty, age 23. Fisher, E. H., Lieut., A, 21st Indiana. Fitch, G., Serg't, C, 6th Vermont, Flaherty, T., Pt., C, Sth New Hampshire. Flanders, W.M. F., S'g't, G, 16th Mass., age 23. Flanigan, M.,Lieut.Col., 24th Mich., age 37. ^Fleming, R. J., Serg't, D, 20th Tenn., age 25. Fletcher, D. M., Pt., 10th lnd. Battery, ago 24. Foley, W., Pt., I, 62d N. York, age 43. Ford, T., Pt., K, 35th Mass., age 33. Foreman, R., Pt., D, 151st N. York, age 17. Forrester,M., Pt.,E, 26th North Carolina. Foster, W. G., Pt., E, 16lh Maine. Foust, E., Sergeant, C, 126th Ohio. Fowler, E. B., Pt., F, 27th Connecticut. Francis, W.,Pt,, A. 117th New York, age 21. Frank, C, Pt., K. 149th New York, age 34. Freed, J. M.,Pt.,G, 89th Indiana, age 23. Freeman, J. D., Pt., F, 15th W. Va., age 33. French, B. F., Pt., H, 20th Maine, age 21. Frum, P., Corp'l, F, 3d West Virginia, age 28. Fuller, W. H., Pt., H, Sth New York Cavalry, age 23. Furman, R., Corp'l, B, 8th New York Heavy Artillery, age 24. Galavan. D., Pt., H, 26th Connecticut. Gale, A., Pt., B, 51st New York. Gallant, AV. H., Pt., F, 122d Ohio, age 23. Gant,M.,Pt.,B, 8th Penn. Reserves, age 18. Ganto, L. M., Pt,. H, 9th Georgia. Garland, J. C, Capt., A, Glen's Reg't, age 31. Geary, M., Serg't, C, 128th Pennsylvania. Geddes, G., Pt., K, 126th Pennsylvania. July 4, 4, '64. June 15, 17, '64. May 6, 7, '64. June 17, 18, '64. Oct. 19, 19, '64. Aug. 18, 19, '64. June 27, 27, '63. Aug. 30, 31, '62. Nov. 30, 30, '64. June 16, 17, '64. June 18, 19, '64. Oct. 20, 20, '62. June 3, 3, '64. May 27, 27, '63. June 18, 19, '64. July 1, 1, '63. May 14, 14, '64. Oct, 27, 28, '64. Mar. 25, 25, '65. Aug. 19, 20, '64. July 9, 10, '64. July 3, 3, '63. July 2, 3, '63. Oct. 19, 19, '64. July 3, 4, '63. Sept, 29, 30, '64. Mav 25, 26,*'64. April 9, 9, '65. Sept. 19, 19, '64. July 2, 4, '63. Aug. 29, 29, '62. Sept. 19, 19, '64. June 3, 4, '64. June 14, 14, '63. Sept. 14, 15, '62. Mar. 25, 25, '65. Sept. 14, 14, '62. Oct. 7, 7, '64. July 4, 4, '63. Sept. 17, 19, '62. Dec. 13, 14, '62. Left ; flap. Surg. F. M. Rose, 43d Ohio. Gangrene. Disch'd Julv 17, 1865. Right; ant. post, flap; slough.; gangrene. June 20, re-amp. in thigh. Disch'd Aug. 19, 1864. Left. Disch'd July 6, 1865. Left; flap. Surg. T. F. Oakes, 56th Mass. Mar. 23, '65, re-amp. Disch'd June 2, 1865. Right; flap. Disch'd July 12,'65. Died Oct. 12, '69; consumption. Left; flap. Disch'd June2, 1865. Right; post. flap. Disch'd Oct. 5, 1863. Died Nov. 6, 1867; chronic diarrhoea. ---. Surgeon J. H. Clairborne, P. A. C. S. Recovered. Right; ant. post. flap. To Prov. Marshal Feb. 14, 1865. Right; flap. Snrg. N. Hayward, 20th Mass. Disch'd July 4, '65. Right. Disch'd Feb. 7, 1865. Both. Surg. E. Reed, 21st lnd. Disch'd Nov. 20, 1863. Right: double flap. Discharged Oct, 28, 1864. Left; circ. Disch'dNov. 1,1863. Right; circ. Disch'd December 28, 1865. Left. Disch'd Nov. 24, 1863. Right; flap. Surgeon — Hall, C. S. A. Sloughing. Recovery. Right; flap; re-amput'n in thigh. Mustered out July 10, 1865. Right; ant. post, flap. Disch'd Oct. 26, 1865. Right; ant, post. flap. Surg. G. W. Snow, 35th Mass. Disch'd April 1, 1865. Right; flap. A.A. Surg. G. M. Paullin. Disch'd Sept. 4, 1865. Spec. 2341. Left. Exchanged March 3,1864. Right; flap. Disch'd Nov. 24, 1863. Right; flap. Disch'd May 17, 1865. Left. Surg. G. L. Potter, 145th Penn. Disch'd July 27, 1863. Left; ant. posterior flap. Disch'd May 31,1865. Left; circ; gangrene. Disch'd August 18, 1865. Right; flap. Disch'd June 5, '65. Right; lateral flap. Discharged June 19, 1865. Right; circ. Disch'd June 14, 1864. Left. Surg. R.W. Hazlett, 2d W. Va. Gangrene; re-amp. in thigh Sept. 21,1862. Disch'd July 7, 1864. Spec. 1665. Right; oval flap. Surg. O. H. Armstrong, 5th N. Y. Cavalry. Disch'd March 16, 1865. Left; long post. flap. Ass't Surg. C. H. Pegg, 8th N. Y. H. Art'y. Gang. Disch'd Aug. 30, 1865. Right; circ. Disch'd August 17, 1863. Right. Surg. J. L. Dodge, 51st N. Y. Disch'd March 4, 1863. Left. Discharged July 1,1865. Left; flap; gangrene. Disch'd January 16, 1863. Left. Surg. T. C. Pugh, C. S. A. Recovery. Right. Union surgeon. Haem. To prison April 21, 1864. Left; flap. Ass't Surgeon T. A. Helwig, 128th Penn. Mustered out May 19. 1863. Left; circ. Disch'd March 19, 1863. 1 O'Keefi: (D. C), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Medical and Surgical Journal, Richmond, 1805, Vol. 2, p. 30. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 469 Name, Military Description, and Age. Gerhard, P., Corp'l, K, 1st Maryland, age 45. Gervin, J. C, Corp'l, D, 8th Tenn. Cav., age 31. Getehell, H. W., PL, K, 1st Me. H. Art,, age 24. Gibbony, S. H., Pt., C, 7th Mich., age 25. Gibbs, G., Pt.. G, 25th Indiana, age 36. Gibson, T., Pt., B, 5th New Jersey. Gibson, W.*l!., Pt., F, 33d Iowa, age 24. Gillighen, J. M., Pt., A, 16th Georgia, age 30. Gillis, S., Pt., K, 68th Ohio. Gillroy, B., Pt., H, 6th Tennessee. Godfrey, A. A., Pt,, A, 2d Maine, age 23. Godfrey, C. P., Pt., F, 109th N. Y., age 22. Gough, J. F. K., Pt., B, 173d New York. Good, A., Col'd laborer, Quartermaster Depart- ment, age 30. Goodsell, J. B., Corp'l, K, 114th N. Y., age 23. Goodwin, S. U., Pt., E, 188th Penn., age 24. Graham, J. Q., Pt., D, llth Infantry, age 18. Gray, E., Pt., C, llth Pennsylvania, age 21. Gray, J., Pt., K, 1st West Virginia, age 26. Gray. J. R., Pt., C, 2d Arkansas, age 25. Greanev, P., Serg't, D, 80th New York, age 43. Green, B., Pt., H, 37th Col'd Troops, age 27. Green, G., Corp'l, H, llth Ohio. Green, J., Pt,, H, 65th Indiana, age 36. Green, W. H.. Pt., H, 2d South Carolina. Greenwald, A., Seaman, U. S. Steamer J. P. Jackson, age 22. Gridley, C. W., Corp'l, G, 53d Penn., age 27. Griffin, J., Pt.. G, 2d Colored Trooris. Grimaldi, M., Pt., I, 82d New York, age 23. Grimes, W. M., Pt., B, 3d South Carolina. Grimm, L., Pt., A, 121st Penn., age 44. Groove, W. S., Pt., B, 93d Peun., age 16. Gross, E., Pt., E, 102d Penn., age 28. Grove, G.W., Serg't, D, 6th Maryland, age 24. Gulledge, J. W., Pt., K, 59th Alabama. Gulseth, O., Pt., K, 3d Wisconsin, age 24. Hafferin, C, Pt., F, 65th New York, age 19. Haganeier, F. H., Pt., F, 73d N. York, age 23. Halderman, P., Pt., K, 13th Penn. Cav.,age 20. Haley, R. F., Corp'l, E, 18th Mississippi. Hall, L. J., Pt., I, 147th New York, age 19. Halleck, S. K., Pt., B, 148th N. York, age 18. Mar. 31, 31, '65. Deo. 17, 17, '64. June 18, 19, '64. May 31, J'e 2,'62. Oct. 5, 5, '62. Aug. 29, 29, '62. April 30, M'y2,'64 Jan. 11, 11, '65. May 16, 16, '63. April 6, 6, '62. Deo. 13, 13, '62. May 12, 13, '64. June 14, 14, '63. Aug. 9, 9, 764. Sept. 19, 20, '64. June 3, 3, '64. May 12, 12, '64. April 2, 2, '65. July 18, 18, '64. Nov. 30, De. 1,'64. Sept. 17, 19, '62. Sept. 30, 30, '64. Mav 14, 14,*'64. Aug. 6, 6, '64. Sept. 19, 19, '64. June 28, 28, '62. Mar. 31, 31, '65. Mar. 5, 5, '65. May 12, 13, '64. Dec. 13, 13, '62. Dec. 13, 13, '62. May 6, 6, '64. Sept. 19, 19, '64. June 22, 22, '64. May 16, 17, '64. Mar. 16, 16. '65. Oct. 19, 20, '64. May 3, 4, '63. Oct. 28, 29, '64. Sept. 17, 19, '62. May 6, 6, '64. Oct. 27, 28, '64. Operations, Operators, Result. Left; large post., short semi-lunar flap. Disch'd Oct, 11, 1865. Right. Surg. G. W. Brady, Sth Tenn. Disch'd Juno 26, 1865. Left; ant, post. flap. Disch'd June 6, 1865. Right. Surg. G. Chaddock, 7th Mich. Disch'd Sept. 25, 1862. Right. Surg. P.. V. Stephenson, 14th 111. Disch'd April 7,1863. Left; ciro. Disch'd Feb. 9,1863. Left; flap. Discharged Sept. 2, 1865. Right, Transferred to Confed- erate hospital. Left; flap. Surg.E.Harrison,68th Ohio. Disch'd Dec. 10, 1863. Left. Recovered. Left. Discharged July 23, 1863. Left ; flap. Surg. W. B. Fox, 8th Mich. Disch'd May 23, 1865. Right; flap. Disch 'd October 19, 1863. Right; circ. Ass't Surg.W. Blun- dell, 5th N. J. Recovered June 26, 1865. Spec. 4153. Left; flap. Ass't Surgeon C. H. Allen, 8th Vermont. Disch'd April 13, 1865. Right; flap. Surg. D. Merritt, 55th Penn. (also wound left leg). Disch'd Sept, 19, 1864. Died August 12, 1867. Right; flap. Disch'd April 30, 1865. Right; flap. Surg. J.W.Anawalt, llth Penn. Disch'd Sept. 30,'65. Right; flap. Disch'd Nov. 26, '64. Died December 17, 1873. Right; ant. post. flap. To Prov. Marshal March 7, 1865. Left; flap. Surg. R. Loughran, 80th N. Y. Disch'd Dec. 6, '62. Died July 31, 1874. Right; ant. post. flap. Disch'd April 14, 1865. Left. Surgeon J. McCurdy, llth Ohio. Mustered out June, 1864. Left: flap. Surg. A. M. Wilder, U. S. V. Disch'd June 9,1865. ----. Transferred Nov. 15,1864. Right. Discharged April 24, '63. Left; circ. Mustered out Sept. 8, 1865. Right; flap. Surg.W. A. McCul- ley, 2d Col'd Troops. Disch'd June 9, 1865. Right; circ. Surg. S. H. Plumb, 82d N. Y. Disch'd Dec. 6,1864. Loft. Surg. J. Evans, 3d S. C. Recovery. Right. Disch'd August 10,1863. Right. Surg. E. R. Umherger, 93d Penn. Disch'd June 15, '65. Right: flap. Disch'd May 31,'65. Right; flap. Disch'd August 18, 1865. ----; flap. Surg. C. B. Gibson, C. S. A. Retired Jan. 2,1865. Left; ant. post. flap. Disch'd July 18, 1865. Right; circ. Surg. C. B. Hutch- ins, 116th N. Y. Haemorrhage. Disch'd October 28, 1865. Right; post. flap. Discharged October 6, 1864. Left; flap. Discharged March 29, 1865. Right. Surgeon G. Chad wick, 7th Michigan. Left; double flap. Surg. H. H. Hubbard, P. A. C. S. Disch'd March 18, 1865. Left; circ. Disch'd October 5, 1865. Name, Military Description, and Age. Hammond, G.,Pt.,A, 1st Maryland Cav., age 25. Haucock.E. A., Capt.,B, 9th Penn. Cav., age 25. Harlocker, H. H., Pt., C, 6th Wisconsin, age 18. Harris, W. C, Lieut., D, 2d Louisiana. Harris.W. II., Pt., K, 1st Potomac Home Brig- ade, age 22. Hart, A.W., Pt.,B,185th New York, age 19. Hart, W. H., Serg't, C, lllth N. York, age 41. Hartley, H. H, Pt., 7th Mississippi Artillery. Harwood, T. F., Serg't, K, 53d Virginia. Hastings, W., Pt,, E, 2d Artillery, age 27. Hastness, 0.,Pt., E.llth Penn. Cav., age 21. Hawkins, F. A., Pt., B, 13th North Carolina. Hayes,A.G.,Pt.,C, 110th Pennsylvania, age 20. Haynes, S. M.,Corp'l, B, 59th Mass., age 32. Hays, J. R., Pt., G, 28th Georgia, age 18. Heary, P., Pt., B, 46th New York, age 20. Helm, E. B., Pt., B, 4th New Jersey, age 28. Henderson, W. P., Pt., I, Hampton Legion. Henrv, E., Pt., C, 1st Colfd Troops, age 21. Henthorne, E., Pt., E, 116th Ohio, age 24. Herron, J.,Pt., I,4th Del- aware, age 23. Hershberg, D., Pt., F, 62d New York. Hill, C. M., Pt., G, 64th New York, age 28. Hill, G. A., Pt., K, 13th West Virginia, age 18. Hill, R. A., Pt., A, 155th Pennsylvania, age 20. Hill, S. P., Pt., A, 7th Kentucky Cavalry. Hilton, N., Pt., B, 16th Infantry. Hiltz, J. W., Capt., C, 23d Ohio, age 33. Himelberger, H., Pt., F, 5th Mich., age 26. 'Hobart, H., Lieut., 2d Louisiana, age 26. Hodge, A. D., Corp'l, A, llth Penn. Cav.,age 32. Hodge, T., Pt,, A, 17th Alabama. Holcomb,Y.,Pt.,B,36th Ohio, age 26. Holley, J. H., Pt,,C,38th Col'd Troops, age 19. Hollinger,C.,Pt.,F,55th Ohio, age 21. Hopes, J., Pt,, M, 2d Horton, F. B., Pt., D, 8th North Carolina, age 18. Horton, J. R., Serg't, D, 17th Penn., age 41. Horton, S. J., Corp'l, E, 7th Texas, age 23. Hovatter, M. J., Pt., F, 15th West Va., age 40. Howard, E., Pt., F, 3d Infantry, age 32. Howard, J. W., Corp'l, D, 61st Virginia. Dates. Aug. 16, 16, '64. Mar. 16, 16, '65. May 5, 7, '64. Nov. 27, 27, '63. July 9, 9, '64. Mar. 29, 30, '65. Julv 2, 3, '63. June 2, 3, '63. Julv 1, 3, f62. April 4, 4, '64. June 14, 14, '63. Sept. 17, 18, '62. May 6, 6, r64. Sept. 30, Oct. 1,'64. June 17, 17, '64. July 30, 31, '64. April 2, 2, '65. Oct. 27, —, '63. Feb. 20, 20, '65. June 5, 6, '64. Aug. 21, 21, '64. Nov. 23, 23, '61. May 12, 12, '64. Oct. 19, 19, '64. Sept. 14, 15, '62. Aug. 23, 24, '62. Dec. 31, 31, '62. Sept. 19, 19, '64. June 16, 17, '64. Sept. 17, 17, '62. Jan. 30, 30, '63. July 20, 20, '64. Sept. 19, 19, '64. Sept. 29, 29, '64. Mar. 16, 16, '65. June 9, 9, "63. Sept. 29, 30. '64. Mar. 31, Ap. 2,'65 Julv 22, 22,"'64. Oct. 13, 13, '64. Julv 2, 4, '03. May 12, 12, '64. Operations, Operators, Result. Left; ant. flap. Surg. 1!. A. Dod- son, 1st Mar viand Cav. Disch'd May 18, 1865. Left; flap. Surg. (J. Helms, 92d 111. Mustered out J uly 18,1665. Right: flap. Discharged May 26, 1865. Left. Surg. — Mitchell, C. S. A. Recovery. Left; circ. Surgeon — Newell, C.S.A. Disch'd June 6,1865. Right; flap. Discharged Sept. 25, 1865. Right; flap. Surg. F. Wolf, 39th N. Y. Disch'd March 12, 1864. ----. Surgeon F. M. Hereford, P. A. C. S. Recovery. ---. Surgeon — Harris, C. S.A. Recovery. Left; ant. post, flap ; profuse pri- mary haemorrhage. Discharged Jan. 20, 1865. Left. Surg. G. C. Harlan, llth Penn. Cav. Disch'd May 3, '64. Right. Surg. McAden, 13th N.C. Recovery. Left; flap. Surg. D. S. Hays, 110th Penn. Disch'd April 6,'65. Left; flap. Disch'd July 3,1865. Right. Transferred July 14, '64. Left; ant. post. flap. Surg.W. B. Fox, 8th Mich. Disch'd March 30, 1865. Right; flap. Disch'd June 20, 1865. ----. Recovery. Left; flap. Ass't Surgeon H. C. Merry weather, 5th Col'd Troops. Discli'd Oct. 18, 1665. Left; flap. Surg. D. Baguley, 1st W. Va. Disch'd July 5, 1865. Right; flap. Disch'd May 29, '65. Right; post. flap. Ass't Surg. J. R. Smith, U. S. A. Discharged April 23, 1862. Left; circ. Surg. J. W. Wishart, 140th Penn. Disch'd July 13.'64. Right; ant. post. flap. Disch'd June 7, 1865. Left; ant. post. flap. A. A. Surg. W. H. Butler. Gang. Disch'd June 9, 1863. Spec. 179. Right; flap. Surg. — Gurley, C.S.A. Disch'd Julv 14,1863. Right. Surg. C. S. Muscroft, 10th Ohio. Recov'd June 27, 1863. Right; flap. Surg.W. S. Newton, 91 st Ohio. Disch'd Aug. 2, '65. Right; circ. Surg. H. F. Lyster, Sth Mich. Disch'd April 11,'65. Right; post. flap. Recovery. Left; flap. Surg. G. C. Harlan, llth Penn. Cavalry. Disch'd August. 27, 1864. Left, To prison Oct. 31,1864. Right; flap. Disch'd May 20, '65. Spec. 1498. (Also w'd at thigh.) Right; flap. Disch'd Sept. 7, '65. Left; flap. Disch'd July 19, '65. Right. Disch'd Nov. 10, 1863. Died 1868. Left. Sent to prison May 30, '65. Right; ant. post. flap. Disch'd August 12, 1865. Left; ant. post. flap. To Provost Marshal Deo. 8, 1864. Right; ant. post. flap. Surg. W. S. Walsh. 15th West Virginia. Disch'd July 4, 1865. Right; circ. Disch'd October 12, 1863. Left. Confederate surgeon. Re- covery. 1 Fischer (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., after the battle of Antietam, etc., in American Journal Medical Sciences. 1863, Vol. XLV, p. 48. 170 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. Hubbard, G. E., Pt., F, 9th New Hamp., age 18. Dates. Sept. 17, 17, '62. 370 Hummel, G., Lieut., B, ' Sept. 17, i8th Ohio. Huston, R., Corp'l, I. 58th Illinois, age 19. Hutchinson, J., Pt,, I, 2d Connecticut, age 20. Hutson, W., Pt,, G, 28th Pennsylvania. Ingram, J., Pt., A, 1st Pennsylvania Artil'ry. Jackson, G. L., Serg't, B, 17th Alabama, age 21. Jarrell, C, Pt., G, 30th Virginia. Jensen, P.,Corp'l,G,15th N. Y. II. A., age 24. Jesse, T. H., Pt,, A, 15th Georgia. Johnson, A. £>., Pt., C, llth Georgia, age 19. Johnson, E. B., Pt., E, 4Cth Indiana, age 26. Johnson, G., Col'd serv- ant, age 21. Johnson, J., Pt., D, 9th New Jersey, age 20. Jones, G. H., Pt., I, 2d Mississippi, age 20. Jones, L., Pt., E, 5th Conn., age 40. Jones, W. B., Pt., B, 5th Kentucky, age 38. Joseph, C, Pt., B, 100th Pennsylvania. Joyce, A. J., Pt., E, 16th Michigan, age 20. Jubb, O. A.,Pt., M,7th Mich. Cavalrj', age 24. Keenan, L., Pt., E, 140th Pennsylvania, age 18. Kelly, P., Pt., G, 3d Ar- tillery, age 27. Kenney, J., Corp'l, E, 10th Conn., age 33. Kenney, J., Pt., K, 20th Massachusetts. Kennidy, I. S., Pt.. H, 5th Virginia. Keiner, W., Serg't, E, 6th Penn. Reserves. Kerrin, J., Pt., G, 19th Infantry, age 27. Kiscaden. J., Pt., C, 99th Pennsylvania, age 21. Kitson, T. W., Miss. Ma- rine Brigade. Knight, M., Pt., D, 56th Colored Troops. Knittle, J., Pt., D, 150th Pennsylvania, age 19. Koehler, F., Pt., I, 7th Connecticut. Kuchman, D.,Pt.,B, 29th New York. Kuemmel, H., Corp'l, H, 2d Michigan, age 22. 367 Kuen, W., Corp'l, E, 55th | Pennsylvania, age 22. 368 , Kuhn, L., Serg't, B, 88th Indiana, age 24. 369 ! Kvner, J. H., Pt., F, 46th Ohio. Lackey, L., Pt., A, 209th Pennsylvania, age 20. Latum, R. E., Lieut., F, 23d Georgia. Latimer, O. P., Pt., E, 105th Ohio, age 29. Lawrence, R. E., Pt., F, 81st New York, age 20. Laws, B., Pt., E, 30th Col'd Troops, age 23. 18, '62. May 11, 12, '64. Oct. 19, 19, '64. Sept. 17, 19, '62. Dec. 13, 13, '62. July 28, 29, *64. June 3, 3, '64. Feb. 6, 6, '65. June 27, 28, '62. July 2, 3, '63. Sept. 2, 2, '64. Dec. 14, 14, '64. Aug. 18, 18, '64. July 1, 3, '63. Mar. 16, 16, '65. Nov. 25, 26, '63. June 16, 16, '62. July 3, 3, '63. Aug. 25, 25, '64. July 3, 4, '63. May 4, 4, M52. April 2, 2, '65. Sept. 17, 17, '62. May 3, 4, '63. July 24, 24, '61. Aug. 13, 13, '64. Oct. 27, 28, '64. Mar. 26, 26, '62. Mav 27, 27,"'65. June 1, 3, '64. July 11, 11, '63. Aug. 29, 29, '62. July 30, 30, '64. May 16, 16, '64. Nov. 25, 25, '63. April 6, 8, '62. Nov. 17, 18, '64. Aug. 30, 30, '63. Sept. 1, 1, '64. June 3, 3, '64. Feb. 11, 11, '65. Operations, Operators, Result. Left; flap. Ass't Surg. J. S. Em- erson, 9th N. H. Disch'd Feb. 4, 1863. Left. Disch'd Feb. 15,'63. Died May 25,1865; cong. pneumonia. Right; flap. Surg. H. M.Craw- ford, 58th 111. Mastered out. Left; long post. flap. Surg. H. Plumb, 2d Conn. H'vy Artil'ry. Disch'd Sept. 13, 1865. Died Sept. 10, 1869. Right; circ. Surg. H. E. Good- man, 28th Penn. Disch'd July 21, 1863. Right; circ. Disch'd July 11, 1863. Spec. 1775. Right; circ. To Provost Marshal Dec. 1. 1864. ---. Surg. — Hunter, C. S. A. Recovery. Right; double flap. Discharged Nov. 20, 1865. Right; ant. Surg. R. Q. Stoney, C. S. A. Recovery. Right. Exchanged Nov. 12, '63. Right; circ. Disch'd January 28, 1865. Left; flap. Surg.W. F. Smith, 73d Penn. Duty June 1,1865. Left: circ. Disch'd April 14, '65. ---; flap. Surg. — Hubbard, 2d Miss. Retired Aug. 29,1864. Right; post, flap; gang. Disch'd August 11, 1865. Left; circ. flap. Disch'd June 22,1864. Left. Surg. H. Luddington, 100th Penn. Disch'd Sept. 17, 1862. Left; antero-post. flap. Surg. J. Thomas, 118th Penn. Haem. Disch'd March 18, 1864. Left; circ. Surg. G. S. Dilts, 5th N. Y. Artillery. Gang. Disch'd August 9, 1865. Right. Surg. C. S. Wood, 66th N. Y. Disch'd Jan. 25, 1864. Died Feb. 22, 1868. Left. Disch'd June 26, 1862. Left; circ. Mustered out Sept. 29, 1865. Left. Discharged Feb. 10, 1863. Right; circular. Recovery. Left; circ. Surg. C. Bower, 6th Penn. Reserves. Disch'd Mar. 26, 1862. Right; flap; gang.: re-amputat'n thigh. Disch'd June 4, 1865. Left; ant. post. flap. Discharged August 7, 1865. Left. Surgeon J. Roberts, Miss. Mar. Brig. Disch'd Nov. 21,'63. Left; flap. Surg. D. A. La Force, 56th Col'd Troops. Discharged. Right; circ. Discharged June, 1865. Left; circ. Disch'd May 14,1864. Died Oct. 4. 1875. Spec. 1510. Right. Disch'd January 27,1863. Right; lateral flap. Sursr. A. F. Whelan, 1st Mich. S. S. Disch'd March 17, 1865. Right; flap. Disch'd April 29, 1865. Right; flap. Surg. L. D. Water- man. 39th lnd. Disch'd July 4, 1864. Right; flap. Disch'd June 30, '62. Right; long post, and short ant. flap; gangrene. Disch'd April 11, 1865. ---. Surg. — Morgan, C. S. A. Recovery. Left; circ. Surg. C. N. Fowler, 105th Ohio. Disch'd Mar. 7, '65. Right; circ. flap. Disch'd May 23, 1865. Right; flap. Disch'd Oct. 18, 1865. Died Oct. 5, 1868. 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 ( 398 \ 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 Name, Military Description, and Age. Lawson, B. F.,Corp'l, F, 89th Illinois, age 23. Lee, C. P., Pt., H, 8th New Jersey, age 21. Lee, D.L.,Serg't, E,71st Ohio, age 21. Leggett, R., Lieut. Col., 10th Connecticut. Lennox, J. H., Pt,, B, 3d Leonard, H. D., Corp'l, D, 92d N. Y., age 29. Lewis, E. O, Pt., K, Sth New Jersey, age 18. Leuscher, W.,Pt,, C, 6th Conn., age 36. Lewis, R., Lieut.,B, Pal- metto S. S., age 23. Lewis, W., Corp'l, C, 39th Ohio, age 30. Linker, J., Corp'l, B, 7th North Carolina, ago 24. Little, G. W., Pt., I, 24th Georgia. Livennore, W. H., Pt., H, 55th Illinois, age 17. Loafman, W. J., Pt,, F, 9th Kentucky. Loeweg, M.,Pt.,D, 125th New York, age 19. Lohr, N., Pt., F, 55th Pennsylvania, age 26. Long, G. P., Pt., 4th In- diana Battery. Long, J. J., Pt., C, 139th Pennsylvania, age 30. Long, J. S., Pt., F, 33d Ohio. Long, L. R., Pt., I, 17th Pennsylvania. Loomis, J.,Serg't,B,56th New York, age 23. Loomis, R. D., Pt., H, 57th Mass., age 82. 'Lorence, J., Corp'l, K, 9th New Jersey, age 35. Lovering, H. B., Pt., C, 3d Mass. Cav., age 23. Lovett, J. H., Corp'l, F, 40th Mass., age 19. Lowell, C, Lieut.,C, 7th Maine, age 29. Lowry, T., Pt., F, 48th New York. Luckenbach,O.A.,Capt., C, 46th Pennsylvania. Luffman, M. M., Pt., A, 3d Delaware, age 22. Luke, J., Pt., K, 99th Pennsylvania, age 20. Lunon, G., Pt., B, 22d Iowa. Lupton, T., Corp'l, A,2d N. Y. H. Art'y, age 19. Macomber, C, Pt., B, 20th Mich., age 29. Maggard, J., Pt.,K, 13th Mississippi, age 18. Mahony, G., Pt., B, 19th Georgia. Manchez, E., Pt., B, 17th Missouri, age 23. Mangan, M., Lieut., E, 6th Wisconsin, age 33. Mann, E. M., Pt., llth New York Battery. Manning, W., Corp'l, I, 20th Mass., age 21. Mars, U., Pt., K, 34th Indiana. Martin, A. B., Pt., G, 17th Ala., age 39. Martin, E.T., Pt,,B, 56th Pennsylvania, age 21. Martin, F., Pt., H, 19th Massachusetts. Dates. Dec. 16, 16, '64. May 5, 6, '64. Dec. 16, 16, '64. Julv 25, 25,"'63. April 6, 6, '62. June 2, 2, '64. April 2, 2. '65. July 18, 20, '63. Oct. 7, 7, '64. July 22, 22, '64. July 3, 4, '63. May 6, 6, '64. Julv 28, 28," '64. April 7, 7, '62. June 17, 17, '64. June 17, 18, '64. Mar. 16, 16, '62. May 12, 13, '64. Mar. 19, 21, '65. July 14, 14, '63. April 9, 9, '65. May 12, 13, '64. Feb. 8, 8, '62. Sept, 19, 19, '64. May 16, 16, '64. May 5, 5, '64. July IS, 20, '63. Aug. 9, 11, '62. June 18, 39, '64. May 5, 5, '64. Sept. 19, 20, '64. June 16, 17, '64. May 12, 12, '64. Oct. 19, 20, '64. Aug. 29, 29, '62. May 27, 27, '64. July 2, 3, '63. May 3, 3, v63. Aug. 16, 16, '64. May 2, 2, '63. July 28, 28. '64. June 20, 20, '64. Julv 1, 2, '"62. Operations, Operators, Result. Left; flap. Transferred July 31, 1865. Left; flap. Disch'd Sept. 12, '64. Died May 18, 1867. Left; flap. Surg.C.N. Hoagland, 71st Ohio. Disch'd April 22,'65. Left. Surg. M. T. Newton, 10th Conn. Disch'd Aug. 23, 1864. Died Sept. 18,'74; chr. phthisis. ---. Confederate surgeon. Re- covery. Right; flap. Disch'd Jan. 19, '65. Died Mar. 21, '70; consumption. Right; circ. Disch'd Nov. 4, '65. Left. Surg. — Colton, C. S. A. Disch'd Sept, 6, '64. Died since. Left; flap. Released May 8, '65. Left; flap. Discharged June 27, 1865. Left. Surg. — Higginbotham, C. S. A. Transferred Nov. 25, '63. Right. Surg.—Mitchell, C. S.A. Recovery- Right; circ. Surg. I. N. Barnes, 116thHlinois. (Haem.) Disch'd February 5, 1865. Left. Disch'd June 24, 1862. Right; lateral flap. Discharged October 21, 1865. Left; flap. Surg. G. T. Stevens, 77th New York. Disch'd March 16, 1865. Left; flap. Surg. E. Swift.U.S.A. Disch'd Dec. 8,1863. Left. Surg. S. F. Chapin, 139th Penn. Disch'd May 12,1865. Right; flap. Disch'd June 28, 1865. Left; flap. Discharged Nov. 16, 1863. Right; double flap. Surg. C. E. Briggs, 54th Mass. Discharged October 13, 1865. Left; circ. Ass't Surg. S. Adams, U. S. A. Disch'd Sept. 12,1865. Both; flap. Surg.H.W.Rivers,4th R. I.,and Surg. J. H. Thompson, U. S. V. Disch'd Sept. 30, '62. Left; circ. Surg. D. F.Leavit, 3d Mass. Cavalry. Discharged June 10, 1865. Left; circ. Disch'd June 14, '65. Right; flap. Surg. W. Buck, 6th Maine. Disch'd Oct. 3,1864. Right; circ. Surg. G.W. Miller, 97th Penn. Disch'd Aug. 25,'63. Right; flap. Surg. T. Antisell, U. S. V. Disch'd Oct. 2,1862. Right; flap; gangrene. Disch'd. Left; flap; gangrene. Discli'd March 16, 1865. Right; circ. Surgs. J.W. H.Vest, 28th Iowa, and J. C. Shrader, 22d Iawa. Disch'd May 29,'65. Right; circ. Surg.J.W.Wishart, 140th Penn. Disch'dNov. 28,'64. Left; flap. Surg. S. S. French, 20th Mich. Disch'd Jan. 26,'65. Left; post. flap. Ass't Surg. E. L. De Long, 77th New York. To Provost Marshal April 1, 1865. Right. Surg. R. Batty, 19th Ga. Recovery. Right; circ. Ass't Surg. D. C. Greenleaf, 4th Iowa. Disch'd September 15, 1864. Right; flap. Resigned April 3, 1864. Right. Discharged. Left; flap. Surg. N. Hayward, 20th Mass. Disch'd May 10,'65. Right. Disch'd July 17, 1863. Left; ant. post. flap. To Provost Marshal Dec.28, 1864. Right; circ. Disch'd Mar. 31,'65. Died Jan. 18,'69; absc. of brain. Right; flap. Disch'd April 9, 1863. 'THOMPSON (J. H.), Report of Cases occurring at the Battle of Roanoke. Island, Virginia, in Am. Med. Times, Vol. IV, 1862, page 199 SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 471 419 420 421 422 423 424 425 426 427 429 430 431 432 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 Name, Military Description, and Age. Martin, R., Pt., A, 13th Cold Troops, age 40. Martin, R., Pt., y7th N. York, age 24. Martin, W., Corp'l, 1,6th Indiana, age 30. Mason, R. O., Pt., Ash- land's Va. Bat'y,uge36. Matins, W. M., Pt., I, 11th Ala., age 27. Matthews, D.,Pt,,B,39th New Jersey, age 28. Matthews, S. J., Serg't, I, 9th Ala., age 22. Matthews, T., Lieut., F, 46th Pennsylvania. Maxwell, W. E., Corp'l, G,95thN. Y., age 22. McCaigue, S. B., Corp'l, H, 183d Pennsylvania. McCarty, J., Pt., M. 4th Artillery. McClure, W. H., Pt., A, 137th N. York, age 46. McCluskey, P., Pt., B, 69th New York. McConnell, J. E.,Pt.,B, 24th Mich., age 19. McCord, M. D., Corp'l, A, 4th N. Y. H. Art'y, age 25. McGalliard, W.M..Caj>., E, 8th La., age 25. McGee, A.. Serg't. D, 7th South Carolina, age 23. McGee, A. S., Pt., D, 5th Vermont, age 43. McGlynn, M., Pt., D,63d New York, age 36. McGowan, J., Pt.,C,94th New York. McGrath, W., Pt., E, 3d Rhode Island H. Art'y, age 46. McGuire, C, Corp'l, G, 19th Indiana, age 31. McHane,H, Maj.*, 12th Louisiana, age 2.'i. McHenry, G. W., Pt., K, 105th Penn., age 21. Mclntire, G., Pt., I, 7th Maine, age 24. Mcintosh, J. B.,»Brig. General U. S. V. McKalvey, J., Pt., D. 102d Pennsylvania. McKennon, if. J., Pt., F, 8th Georgia. McKnight, J., Pt., B, 2d Delaware, age 45. ilcLaugldin. A., Pt., C, 24th N.C.. age 17. McLaughlin, T. A., Pt., K. 29th Maine, age 22. McLean, G.,Pt.,E, 173d New York, age 28. McMurtrie, T., Lieut., 12th Pennsylvania. McXab, J. H., Pt., G, 3d Tennessee, age 21. McNamee, G., Pt., 1st Virginia Art'v, age 19. McRay, G. A~, Pt., G, 5th N. C. Cav., age 22. Measels, J., Pt., G, 31st Georgia, age 42. Medley, J., Pt,, A, 22d Col'd Troops, age 25. Meekins, J. D., Pt„ E, 148th Penn., age 23. Merry, T. H., Pt., E, 4th North Carolina, age 20. Messmore, J., Pt.,D,10th Infantry, age 22. Meyer, P., Serg't, A,16th Indiana, age 26. Meyers, J., Pt., E, 5th New Jersey, age 36. Meyers, W., Pt., G, 2d Infantry. Dee. 17, 17, '64. June 20, 21, '64. Sept. 19, 21, '63. July 2, 3, '63. Aug. 21, 21, '64. April 2, 2, '65. July 2, 3, '63. Aug. 9, 11~62. Mav 8, 8, '64. May 12, 12, '64. Nov. 5, 5. '64. July 2, 3. '63. Dec. 13, 13, '62. June 16, 18, '64. Aug. 25, 27, '64. July 2, 3, '63. Oct. 19, 20, '64. June 29, 30, '62. Sept. 17, 17, '62. April 2, 3, '65. Feb. 2, 2, '64. July 1, 2, '63. Nov. 30, De. 1,'64. July 2, 2, '63. May 10, 10,'64. Sept. 19, 19, '64. May 31, 31, '62. June 27, 28, '62. Dec. 13, 14, '62. Mar. 25, 25, '65. Oct. 19, 20, '64. April 9, 9, '64. Dec. 13, 14, '62. May 10, 12, '64. July 1, 2, '63. April 2, 2, '65. Oct. 19, 19, '64. Oct. 27, 27, '64. June 3, 3, '64. May 3, 3, r63. May 19, 19, '64. Aug. 24, 24, '64. July 3, 3, '63. Aug. 30, 31, '62. Operations, Operators, Result. Left; flap. A. A. Surg. J. S. Gilt- uer. Disch'd August 12,1865. Left; circ. Duty Sept, 12, 1864. Left; Surg. — Gardner. Disch'd June 8, 1864. Right. Confed. surgeon. Retired March, 1865. (Also w'd left leg.) Right; circular. Transferred. Left; circ.; gangrene. Recovery August 2, 1865. Right; circ. Paroled Sept. 25, 1863. Left; circ. Disch'd Dec. 29, '62. Right; flap. A. Surg. J. T. Duf- field, 7th Indiana. Disch'd Jan. 7, 1865. Left. Surg.W. J. Burr, 42d New York. May 27, amp. knee joint. Mustered out July 13, 1865. Left; flap; gangrene; subsequent operation. Discharged. Left; post, flap; haem. Disch'd May 17, 1864. Right. Discharged August 17, 1863. Left; flap. Surg. J. H. Beech, 24th Mich. (Also wound right leg.) Disch'd Sept. 12, 1865: Left; flap. Confederate surgeon. Disch'd May 20, 1865. Right; circ. Haemorrhage. To prison Mar. 2, 1864. Right; post. flap. Ass't Surg.W. A. De Long, 77th New York. To Provost Marshal April 1,'65. Right; flap. Confed. surgeon. Disch'd Feb. 11, 1863. Left. Discharged Dec. 30,1862. Right; circ. Disch'd July 27, 1865. Right; ant, post. flap. Surg. M. S. Kittinger. 100th New York. Disch'd Oct. 14, '64. Spec. 2910. Left; flap; haem. Disch'd June 11, 1864. Died Feb. 7, 1870. Left; oval flap. To Pro. Marshal March 27, 1865. Right; flap. Disch'd July 11, 1865. Right. Surg. F. M. Everleth, 7th Maine. Oct. 16, amp. thigh. Disch'd June 16, 1865. Right. Retired July 30, 1870. Left. Discharged June 10,1863. Right. Confederate surgeon. Re- covery. Right; circ. Disch'd April 13, 1864. Died in 1864. Left; circ. A. Surg. E. P. Roche, 35thMass. Releas'djunel4,'65. Left; circ. Surg. G. T. Stevens, 77th N. Y. Disch'd July 19,'65. Right; circ. Disch'd August21, 1864. Left; flap. Confederate surgeon. V. R. Corps Oct. 18. 1863. Left. Surg.D.L.Heath, 23dMich. Disch'd July 6, 1865. Left; flap. A. Surg. J. W. Jones, C. S. A. Retired Sept. 28,1864. Left. Released June 29, 1865. Right; flap. Surg. H. F. Butt, P. A.C.S. To prison Jan. 5, '65. Right; circ. Mustered out Mar. 16, 1865. Left; circ. Surg. J. W. Wishart, 140th Penn. Disch'd May 29,'65. Left; flap. Transferred Sept. 8, 1863. Right; ant. post. flap. Disch'd April 8, 1865. Died May 27, 1871; epilepsy and consumpt'n. Right; flap. Disch'd Jan. 13, 1865. Died Dec. 4, 1868. Left. Disch'd December 13, '63. Left. Disch'd November 13, '62. Name, Military Description, and Age. Michaels, J., l't, A, 16th Wisconsin. Micue, P., Pt., G, 34th Massachusetts, nge 33. Miles, A., Pt., G, 15th N. Y. H. Arty, age 18. Miles, F. N., Pt., F, 29th Maine. Miller, J. K., Serg't, E, 205th Pennsylvania. Miller, W., Pt., E, 15th Iowa, age 25. Mink, J., Pt., A, 61st N. York, age 18. Mishaw.E., Pt.,C, 118th Pennsylvania. Mitchell, W., Pt., K, 27th Pennsylvania. Mizner, W.,Pt., H,34th Illinois, age 21. Moats, M., Pt., F, 15th West Virginia, age 24. Moffatt, R., Sergt, K, 121st Penn., age 23. Moneyhan, B. F., Pt., D, 24th Indiana, age 26. Monroe, II., Pt., I, 20th Maine, age 25. Mooney, J., Pt., D, 13th New York, age 29. Moore, C. W., Lieut., 15th Ohio Battery. Moore, D., Colonel, 21st Missouri. Moore, D. A., Capt., B, 61st New York, age 29. Moore, J. A., Pt., G, 38th Virginia, age 26. Morgan, J., Pt., K, 142d Pennsylvania. Morgan, J., Pt., B, 26th Virginia, age 21. Morgan, J. C., Serg't, D, 7th Wisconsin, age 25. Moris, U., Pt,, K, 34th Indiana, age 36. Morningstar, J. J., Pt,, D, 76th Penn. Morrin, J., Pt,, G, 126th New York, age 21. Morris, A.W., Pt., B, 6th Iowa, age 21. Morrison, A., Pt., K, 23d Dlinois, age 23. Moss, J. E., Corp'l, E, 36lh Illinois. Mount, D. M., Serg't, B, 35th New York. Mullen, J., Pt., C, 30th Mass., age 20. Muller, H., Pt., E, 45th New York. Muller, M., Pt., F, 4th N.Y. H'vy Artillery. Mulligan, j., Pt., E, 5th N. Y. Cavalry, age 18. Munday, L. G., Pt., I, 26th Virginia, age 38. Mundy, F. H.,Pt.,G, 83d New York, age 20. Murray, J. H.,Pt,D, 2d Vermont. Myers, H., Pt., F, 119th Penn., age 39. Neal, T., Pt., C, 28th Iowa, age 1!). Neif, J., Corp'l, B, 25th Mass., age 25. Newton, W. J., Lieut,, K, 40th Virginia. Nicholson, J., Pt., C, 8th N. Y. Cavalry, age 47. Nimocks, R. J., Pt., B, 25th Wis., age 44. Nolan, K., Pt., K, 22d Indiana, age 20. Operations, Operators, Result. April 6, 8, '62. Oct. 13, 13, '64. Mar. 31, Ap. 1, '65 Oct. 19, 20, '64. April 2, 3, '65. July 5, 5, '64. April 7, 7, '65. Sept. 20, 22, '62. June 8, —, '62. Mar. 19, 20, '65. Sept. 19, 19, '64. Julv 15, 15,'YI. April 17, 17, '65. June 22, 22, '64. May 10, 11, '64. Dec. 10, 10, '64. April 6, 6, '62. June 30, 30, '62. May 16, 16, '64. Dec. 13, 15, '64. Oct. 19, 19, '64. Mar. 31, 31, '65. May 16, 16, '63. July 11, 13, '63. July 3, 4, '63. June 16, 16, '64. July 24, 24, '64. Nov. 25, 27, '63. Dec. 13, 13, '62. Oct. 19, 20, '64. June 3, 3, '62. April 2, 2, '65. Mar. 22, 23, '64. June 20, 20, '64. Dec. 13, 14, '62. May 3, 3, '63. Nov. 7, 7, '63. May 15, 15,*'63. May 16, 18, '64. Mav 3, 3, '63. Aug. 20, 20, '64. July 22, 23, '64. May 17, 17, '64. Left; circ. Surg. G.W. Eastman, 16th Wis. Disch'd Aug. 15, '62. Left; ant. post. flap. Disch'd May 20. 1865. Right; lateral flap. Discharged August 2, 1865. Left.- flap. Discli'd January 21, 1865. Right; post. flap. Disch'd Aug. 18, 1865. Right; llap. Surg. E. M. Rogers, 12th Wis. Must, out Feb. 11, '65. Right; ant. post. flap. Disch'd November 25, 1865. Right. Surg. J. Thomas, 118th Penn. Disch'd April 21,1863. Kight. Disch'd Oct. 17, 1862. Left; circ. Disch'd June 16, '65. Right; flap. Disch'd June 9, '65. Left; flap. Surg. F. C. Reamer, 143d Penn. (Also excis. hum.) Disch'd June 29, 1865. Right. Surg.V. H. Coffman, 34th Iowa. Disch'd Sept. 12,1865. Right; flap; haem.: lig. femoral. Disch'd January 13.1865. Died May 16, 1870; phthisis pulmo. Left; flap. Disch'd May 27, '65. Left; flap. Mustered out June 20, 1865. Right. Mustered out Feb. 12, 1865. Right; flap. Surg. A. N. Dough- erty, U. S. V. To V. R. C. ----: circ. Furloughed July 29, 1864. Right; flap. Confed. surgeon. Disch'd June 22, 1865. Right. Surg. G. McDonald, 22d Va. To prison Feb. 16, 1865. Right; oval flap. Surg. D. C. Ayres, 7th Wis. Disch'd July 20, 1865. Right; flap. Disch'd July 18, '63. Left; circ. Confederate surgeon. Disch'd J.-yi. 17,1664. Spec. 473. Lett: post.flap. Surg. J. Aiken, 71st l'enn. Haem.Yamp. thigh Nov. 3. Discli'd June Jf, 1865. Specs. 1416. 26H-1. Left; circ. Ass't Surer. D. Hal- dernian, 46th Ohio. Disch'd July 10, 1865. Left: circ. Discharged March 1, 1865. Left; flap. Surg. H. McHenry, 125th Ohio. Disch'd Sept. 24, 1864. Right. Mustered out June 5, '63. Right; flap. Disch'd February 12. 1865. Left; ant. post. flap. Surg. H. Ideler, 45th N. Y. Discharged Nov. 1, 1862. Left; flap. Disch'd October 1, 1865. Right; flap; gangrene. Disch'd October 28, 1864. Right; circular. Recovery. Left; circ; gangrene. Disch'd Nov. 22, 1863 Left; double flap. Ass't Surg. A. A. Atwood, 2dVt. Disch'd April 13, 1864. Left. Surg. P. Leidy, 119th Penn. Disch'd June 27, 1864. Left; flap. Disch'd Oct. 3, 1863. Right; circ. Confed. surgeon. Disch'd Sept. 6, 1865. ----. Surg.W. A. Spence.C.S.A. Recovery. Left; lat". skin flap. Surg. A. Hard, 8th Illinois Cav. Disch'd Nov. 19, 1864. Right; circ. Disch'd June 30, 1865. Right; circ. Disch'd Feb. 13, 1865. Died May 26, 18G7. 472 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age 506 Norton, E. D., Corp'l, I, llth Conn., age 21. 507 Norton, J., Seaman.U.S. S. Montauk, :\Q.e 25. 508 Xowell, IC. II--;, Corp'l, 1',49th Va., age 22. 509 O'Brien, J., Pt., A, 7th Missouri. 510 O'Brien, M., Pt., E, 2d Massachusetts, age 26. 511 Ogden, M. H., Pt., H, S;8th Penn., age 21. 512 Ohm, 1 ., Pt., G, 37th Wisconsin, age 40. 513 Oliver, J. W., Corp'l, D, 12th Georgia, age 21. 514 O'Neil, J., Pt., (). 28th Pennsylvania. 515 Oppennan. P.,Pt.,E, 6th Missouri Cavalry. 516 Ormsby, S. S.,Corp'l, K, 50th Penn., age 26. 517 Osbom, J. H., Serg't, I, 6th N. Y. Cav., age 24. 518 O'shaughuessy, J., Pt., 1 >. 42d Mass. 519 O'Sullivan, D., Corp'l, F, 3d Infantry, age 28. 520 Overman, A. A., Serg't, A, 93d Indiana. 521 Owens, J. P., Serg't, D, Purnell Legion. 522 Paden, I'., fireman,U.S. Gunboat Diana. 523 Palin, R. D., Pt., B, 9th N.Y. H'vy Art., age 26. 524 Parker, B., Pt., G, 2d South Carolina, age 27. 525 Parker, C, Pt, C, 150th Penn., age 23. 526 Parker, C.W.,Pt.,D,13th New Hamp., age 21. 527 Parker, H, Pt., H, 44th Georgia, age 21. 528 Paries, J. M., Serg't, B, 20th N. C, age 27. 529 Parlon.A. B., Pt.,G,193d New York. 530 Parmenter, J., Capt., E, 118th N. Y., age 42. 531 Paxton, J. T., Pt., H, irth Iowa, age 21. 532 Peet, G. W., Serg't, A, 20th N.Y. S. M., age26. 533 Pels, A., Pt, B, 4th New- York Artillery, age 29. 534 Pennington, J. J5..Pt.,D, 26th Alabama, age 18. 535 Perkins, M.V. B., Corp'l, F, 7th New Hampshire. 536 Perry, A., Pt., C, 44th New York. Peters, A., Pt., E, 37th Wisconsin, age 37. 538 Peters, S., Pt, C, 139th i Pennsylvania, age 19. | 539 ] Petersfield, W. J., Pt..C, j 1st Alabama, age 21. j 540 Pettigrew, F., Pt., K, 13th North Carolina. 541 Petty, G. B., Corp'l, E, 5th Vermont. j 542 i Phillips, B. F., Captain, ! 543 Phillips.J.J., Serg't, H, 33d Tennessee, age 32. Dates. operations. Operators, Result. No June 17, 19, '64. July y, 9, '"64. May 31, J'e 1,'62. May 22. 22, '63. Aug. 9, 11, '62. June 18, 18, '64. April 2, 2, '65. May 3, 3, '63. Sept. 17, 17, '62. Aug. 16, 17, '62. June 18, 19, '64. June 29, 29, '64. Jan. 1, 3, '63. Julv 2, 2, '63. May 19, 19,' '63. Sept, 17, 17, '62. Mar. 28, 30, '63. June 8, 8, '64. July 3, 3, '63. July 1, 1, '63. Sept. 30, 30, '64. May 2, 3, '63. July 20. •21, '64. Oct. 14, 14, '65. June 3, 3, '64. Mar. 27, 27, '65. Dec. 13, 13, '62. June 17, 19, '64. Mav 3, 4, '*63. July 18, 20, '63. Dec. 13, 13, '62. June 17, 18, '64. Sept. 21, 21, '64. Nov. 30, Dec. 2, 1864. June 1, 1, '64. June 29, 30, '62. Nov. 30, De.1,'64. Mav 15, 17,"'64. 544 Pidffeon, J.. Pt., G, 22d Sept. 18, Colored Troops, age38. 20, '64. 545 I Pierce, D. M., Pt., A, 4th < June 18, Delaware, age 19. ! 18, '64. "46 I Pierce, W., Lieut., Aus- j Sept. 20, \ tin's Sharpshooters. I 2o. '63. 547 I Pike, H. L., Lieut., Bat- May 5, i tery H, 1st Artillery. 5. '62. 548 I Plant, R., Pt., D, 7th In- Dec. 13, ' fantry, age 19. | 14, '62. Left; post. flap. Disch'd Nov. 26, 1864. Left. Surg. — Johnson, U. S. N. Disch'd Oct. 24, 1864. Right. Surg. J. M. Holloway, O. S. A. Retired Mar. 15, 1865. Right; circ. Disch'd June 4, '64. Right. Surgeon E. McDonnell. U. S. V. Disch'd Dec. 6, 1862. Left; flap. Disch'd July 21,'65. Left: flap. Surg.W. C. Shurlock, 51st Penn. Disch'd Sept. 7,'65. Left; flap. Furloughed. Left. Surg. II. E. Goodman, 28th Penn. Disch'd Nov. 15,1862. Right; flap. Surg. B. E. Osborn, 1st Mo. S. M. Cav. Disch'd Jan. 9, 1863. Right; circ. Surg. W. C. Shur- lock, 51st Penn. Disch'd May 29, 1865. Left; circ. A. Surg.O.H. Adams, 8th N. V. C. M. O. June 7, '65. Right; circ. Surg. A. I. Cum- ming, 42d Mass. Discharged. Right; circ. A. Surg.C.Wagner, U. S. A. Disch'd Jan. 8, 1864. Spec. 4375. Left; flap. Disch'd August 10, 1863. Right; circ. Disch'd December 6, 1862. Right; post. flap. Surg. — Ellis, I'. S. N. Disch'd Dec. 31,1863. Loft; post. flap. Surgeon S. A. Sabin. 9th N. Y. Disch'd Jan. 20, 1866. Rigid. Paroled Nov. 12, 1863. Right; ant. post. flap. Disch'd January 29, 1864. Left. Discharged June 21,1865. ---; circ. Transferred May £6, 1863. Left; ant. post. flap. Surg. J. H. Aycrs, 34th Ohio. To Provost Marshal Nov.], 1664. Right; flap. A.Surg. L. Phinney, 193d N. Y. Discharged. Right; ant. skin flap. A. Surg. J. G. Porteous,118th N.Y. Disch'd Nov. 15, 1864. Right; circ. Surg. P. Harvey,U. S.V. Must, out July 10, 1665. Left. Discharged March 8, 1863. Right; circ. Disch'd Sept. 28, 1864. Left: flap. Transferred May 24, 1863. R't; circ. A.Surg. F. P.. Kimball, 3d N. II. Disch'd Nov. 14, '63. Left; flap. Disch'd Feb. 28,'63. Left: circ. Surg. W.C. Shurlock, 51stPenn. Gangrene. Disch'd May 23, 1865. Spec. 3129. Left; ant. post. flap. Discharged June 6, 1865. Right; circ. Surg. — Hamilton, 1st Ala. To Provost Marshal May 6. 1865. Right; circ. Retired Jan. 18,'65. Right; flap. Confed. surgeon. Discli'd Jan. 31, 1863. Right; circ. To Provost Marshal April 6, 1865. Right; ant. post. flap. A. Surg. H. E. Goodman, U. S. V. To Provost Marshal Dec. 1,1864. Right; flap. Disch'd May 22,'65. Right; circ. Disch'd May 12, 1864. Right. Surg. — Kratty, C. S. A. Kecoverv. Left. Surg. St, John W. Mintz- ner, 26th Penn. Retired Feb. 21, '67. Died March 25,1875. Left. Disch'd September 8,1865. Name, Military Description, and Age. Platz, A., Musician, A, 19th Infantry, age 18. Popp, M., Pt,, E, 55th Illinois. Porter, IL, Pt., G, 13th Massachusetts. Pylc, J. M., Pt., H, 89th Indiana, age 24. Rabbidan, L.,Pt.,F, 14th Wisconsin, age 21.. Radichel, C, Pt., F, 6th Wisconsin, age 40. Rady, D., Colored. Ralston, R., Musician, C, 26th Iowa, age 22. Ralyea, A., Pt., G, 147th New York, age 25. Rauscher, C, Pt., B, 42d Indiana, age 26. Rawls, H., Pt., D, 2d Georgia. Read, C. A., Serg't, A, 1st Mass. Cav., age 24. Reoh, F., Pt.,E, 2d Dela- ware, age 21. Redman, T., Serg't, K, 5th Cavalry, age 26. Reeder,G.W*.,Pt., B.llth Penn., age 31. Reeves, J. H.,Pt.,G,39th Illinois, age 24. Refolt, E., Pt., G, 22d Indiana. Reider,G.W.,Pt..C,14th Infantry, age 34. Reiff, E.,*Pt., A, 12th In- fantry, age 19. Reiley, J., Pt., C, 7th N. York Heavy Artillery, age 29. Restle, M., Serg't, G,52d New York, age 28. Reynolds, J. S., Lieut., H, 10th N. Y. Cavalrv, age 38. Rice, F.R., Lieut,, F,lst Michigan. Rider, J. A., Pt., A, 4th Virginia, age 30. Riley, J., Ordinary Sea- man, U. S. S. Wabasb. Roberts, G. VV., Pt., B, 1st Maryland Artillery, age 16. Roberts, H., Lieut., H, 1st Massachusetts. Roberts, J. B., Corp'l, K, 88th Indiana, age 31. Roberts, M., Pt., H, 21st N. Y. Cavalry, age 18. Robinson, J. B., Lieut., C, 2d Penn. Reserves, age 32. Robinson,W.,Pt., D, 82d New York, age 41. Rodgers, T. J., Pt., D, 50th Georgia. Rodgers, W. H., Corp'l, A, 146th N. Y., age 38. Ross. I. C, Pt., F, 15th Indiana, age 29. Rosselit, M.,Pt,F, 118th Ohio, age 25. Rouischkolb, F., Pt., E, 66th New York, age 41. Rouse, T. B., Pt., F, 2d North Carolina, age 20. Rudrauff, W. H., Lieut., F, 82d Penn., age 24. Russell, E.M.,Pt., A, 1st Penn. Reserves. Russell, J. H.,Pt.,B,29th Connecticut, age 20. Russell, P. A., Corp'l, G, 89th New York, age 24. Dates. May 22, 22, '64. May 22, 22, '63. July 1, 2, '63. May 18, 18, '64. June 23, 23, '64. Feb. 5, 7, '65. May 14, 14, '63. Oct. 26, 26, '63. Feb. 6, 6, '65. Aug. 15, 15, '64. Aug. 31, 31, '62. Sept, 13, 13, '63. May 10, 10, '64. Julv 10, 10,"'63. May 5, 5, '64. May 16, 18, '64. Oct. 9, 10, '62. May 24, 24, '64. July 2, 3, '63. June 17, 18, '64. Feb. 3, 3, '65. May 28, 29, '64. Dec. 13, 13, '62. Mav 3, 4, '63. Jan. 15, 16, '65. July 1, 1, '62. Aug. 29, 29, '62. Mar. 19, 20, '65. April 1, 3, '65. May 12, 12, '64. May 10, 11, '64. July 3, 3, '63. May 5, 6, '64. Nov. 25, 27, '63. Dec. 29, 30, '63. Sept. 17, 17, '62. 2, r63. June 1, 1, '64. Sept. 14. 14, '62. Oct. 27, 28, '64. June 18, 18, '64. Operations, Operators, Result. R't; flap. A. Surg. J. C. Norton, U. S. V. Disch'd Jan. 17,1865. Left; flap. Disch'd Sept. 26, '63. Died June 13, 1874. Left; ciro. July 30, re-amputat'n. Disch'd Jan. 30, 1864. Right; flap. Disch'd May 21, 1865. Right; flap. Surg. H. McKennan, 17th Wis. Disch'd Sept. 1, '65. Right. Disch'd August 23,1865. Left. Recovery. Spec. 1809. Right; flap. Surg. A.T. Hudson, 26th Iowa. Disch'd June 25,'64. Left; ant. post. flap. Surg. A. S. Coe, 147th New York. Disch'd June 14, 1865. Left; flap. Disch'd April 5, 1865. ----; anterior. Ass't Surg. F. R. Gregory. C. S. A. Recovery. Right; flap. Surg.W. H.Wilbur, 1st R. I. Cav. Disch'd April 16, 1864. Right; flap. Surg. J. W. Wis- hart, 140th Penn. Mustered out June 3, 1864. Right; post. flap. Veteran Re- serve Corps Oct. 30, 1863. Left; circ. Surg. J.W. Anawalt, llth Penn. Disch'd Aug. 16,'64. Left; flap. Surg.-----, C. S. A. Disch'd March 19, 1665. Right; flap. Disch 'd Feb. 28, '63. Died April 16, '64; small-pox. Right; circ.; erysipelas; gang. Disch'd March 6, 1866. Left; circular. Discharged. Left; lat. flap. Surg. J. W. Wis- hart, 140th Penn. Disch'd Mav 16, 1865. Died Feb. 14, 1876; consumption Left; long post, and short anterior flap. Disch'd Dec. 1, 1865. Left; circ. Surg. H. K. Clark, 10th N. Y. Cav. Disch'd Sept. 8, 1864. Left; flap. Surg. D. P. Chamber- lin, 4th Michigan. Veteran Re- serve Corps July 2, 1863. ----; circ. Surg. — Walls, C. S. A. Nov. 12, 1877; good stump. Right. Disch'd July 14,1865. Right; circular. Ass't Surg. J. S. O'Donnell, Purnell Legion. Disch'd May 18, 1863. Left; circ. A. Surg. T. F. Oakes, 1 st Mass. Disch'd Feb. 5,1864. Left; oblique flap. Confederate surgeon. Gangrene. Mustered out June 7, 1865. Right; double flap. Discharged September 14, 1865. Right; ant. post. flap. Surg. C. Bowers, 6th Penn. Res. Disch'd June 16,1864. Spec. 4511. Right; circ. Surg. S. H. Plumb, 82d N. Y. Disch'd Nov. 10, '64. Spec. 4372. Right. Confed. surgeon. Ex- changed March 17, 1864. Right; flap. Snrg. LeG. Capers, C. S. A. Disch'd Nov. 19,1864. Left; circular flap. Surg. H. E. Hasse, 24th Wisconsin. Disch'd April 21, 1864. Left, Surg.J.W.Alexander, 15ih Penn. Cav. Disch'd Nov. 21 ,'64. Died July 11,'71; tuber, disease. R't; lat. flap. Surg. C. S.Wood, 66th New York. Disch'd Dec. 31, 1862. Right. Exchanged Nov. 12, '63. Left; circ. Surg. L. Emanuel, 82dPenn. Disch'd Sept. 22,'64. Left. Disch'd November 99, '62. Right; flap. Surg. A. C. Barlow, 62d Ohio. Disch'd May 16, '65. Left; flap. Discharged Nov. 4, 1864. sect, v.) PRIMARY AMPUTATIONS IN THE LEG. 473 606 607 608 609 610 611J 612 J 614 615 616 617 619 620 621 622, 623 624| 625 626 Name, Military description, and age. Ruth, R. A., Pt., E, 59th Massachusetts, age 19. Ryan, J., Pt., E, 10th Wisconsin, age 23. Sampson, C. H., Serg't, A, 3d Maine, age 30. Sanders, J. A., Corp'l.E, 7th S. O. Bat'v, age 30. Santy, J., Pt.," C, 91st Ohio, age 21. Saul, F., Pt., G, 183d Pennsylvania, age 21. Saxon, 'T. H, Pt., E, 4th North Carolina, age 20. Scott, J. G., Pt., D, 77th New York, age 23. Scott, O. D., Pt., F, 17th Vermont, age 21. Scroggs, IP., Pt., I, 39th North Carolina, nge 19. Scroth, J.,Seigt,C, 19th Infantry, age 24. Seaman, W. P., Pt., C, llth Missouri. Seaver,C. E., Pt., 1,13th Vermont, age 28. Secor, J. S., Pt, A, 9th N.Y. H'vy Art., age 19. Segar, E., Pt., K, 22d New York, age 21. Seiforth, M., Pt., 1,124th Indiana, age 17. Sellers, J. B., Pt., I, 27th Indiana, age 21. Shanger, A., Serg't, B, 86th New York, age 31. Shappee, W. A., Pt., A, 81st Pennsylvania. Sharp, W. H. II., Serg't, L, 9th Penn. Cavalry, age 24. Shaw, J., Pt., C, 19th Maine, age 28. Sheehan, M.,Pt..H,100th New York. Shephard, G., Pt,, K, 3d Vermont, age 32. Shields, T., Pt., G, 62d New York. Shoals, J., Corp'l.C, 27th Mass., age 19. Sibley, R., Pt., E, 6th Missouri, age 27. Siegrist, J. E., Serg't, C, 7th Pennsylvania. Simmons, H. H., Capt., F, 2d Miss., age 24. Simmons, W. S., Lieut., A, 5th Colored Troops, age 24. Sine, J. F., Pt., G, 90th Pennsylvania. Singleton. J. R.,S'g't,M, 16th N.Y. Cav., age 26. Skelton, J.,Serg't Major, 27th Ohio, age 27. Skinner, M. C, Pt., E, 36th Illinois, age 22. Slavan, J., Pt., B, 170th New York, age 48. Small, R., Pt., F, 34th Colored Troops, age 18. Smallwood, W.J. .Lieut., A, 7th Kentucky. Smith, A. A., Pt, A, 3d Rhode Island Art'ry. 627 I Smith, G. T., Pt.,F, 13th I Mass., age 22. 628 Smith, II., Pt,, E, llth Vermont, age 19. 629 Smith, H. C, Pt,, E, 5th Mississippi, age 24. June 2, 4, '64. Sept. 19, 21, '63. July 1, 1, r62. Aug. 21, 21, '64. Oct. 6, 7, '64. June 16, 17. '64. Mav 3, 3, '63. Mav 6, 6, '64. June 7, 7, '64. Juno 18, 19, '64. May 14, 14, '64. Aug. 14, 14, '62. Julv 3, 4, '"63. Oct. 19, 20, '64. April 29, Mavl, 1863. Mar. 10, 10, '65. May 25, 26, '64. Julv 2, 2, '63. April 6, 8, '65. Mar. 16, 16, '65. July 3, 4, r63. July 18, 18, 63. Oct. 19, 19, '64. May 3, 3, '63. Mar. 8, 10, '65. Aug. 31, 31, '64. Sept. 17, 17, '62. July 2, 2, fe. Feb. 20, 20, '65. Dec. 13, 14, '62. Sept. 19, 19, '64. June 28, 28, '64. June 18, 18, '64. June 16, 17, '64. Nov. 30, 30, '64. Oct. 1, 1, '62. April 9, 9, '63. June 21, 21, '64. Sept. 13, 13, '64. July 22, 23, '64. Operations, Operators, Result. Right; flap. Disch'd June 13, 1865. Left: circ. Surg. I. Moses,U.S.V. Disch'd Sept. 30, 1864. Right; flap. Disch'd Deo. 4, '62. Died Jan. 28, 1870; effects of sunstroke. Left; flap. Exchanged. Left; flap. Surgeon J. M. Leet, U. S.V. Disch'd May 20, 1865. Right; circ. Surg. J.W.Wishart, HOthPenn. Disch'd Apr. 27,'6:"i. ----; ant. and post. flap. Rapid- ly improving. Left; circ. (also amp. right at low. third). Surg. E. B. P. Kelly, 95th Penn. Disch'dNov. 3,'64. Spec. 513. Right; ant. post, flap. Disch'd May 18, 1865. Right; flap. Provost Marshal October 21, 1864. Left; circ. Disch'd November 10, 1864. Right; flap. Disch'd October 10, 1862. Right; flap. Surg. G. Nichols, 13th Vt. Disch'd Nov. 7, 1863. Right; flap. Disch'd June 29, 1865. Left; anr. posterior flap. Surg. J. Ebersoie, 19th Indiana. Disch'd Nov. 19, 1864. Spec. 1146. Left; post. flap. Surg. V. H. Gregg, 124th Indiana. Disch'd June 30, 1865. Left; circular. Discharged. Left. Disch'd June 4, 1664. Right; flap. Disch'd June 28, 1865. Left; ant. post, flap. Surg. C. Helm, 92d Illinois. Discharged Sept. 12, 1865. Right. Surg. N. Hayward, 20th Mass. Disch'd Feb. 8, 1865. Right; ant. post. flap. Assistant Surg.W. D. Murray, 100th N.Y. Disch'd Feb. 3, 1864. Right; flap. Disch d September 1. 1865. Left; post. flap. Discharged. Left; flap. Confederate surgeon. Disch'd Sept. 4, 1865. Right; circ. Disch'd July 15, 1865. Left; flap. Disch'd Feb. 17, '63. Right; circ. Surg. — Hill.C.S.A. Haem.; lig. fein. Provost Mar- shal March 17, 1864. Left; post. flap. A. Surg. H. C. Merry weather, 5th Col'd Troops. Disch'd May 15, 1865. Left; flap. 'Disch'd April 15, 1863. Left; ant. post. flap. Discharged June 1, 1865. Right; flap. Surg. A. B. Mona- han, 63d Ohio. Discli'd Feb. 17, 1865. Left; circ. Surg. W. P. Pierce, 68th 111. Disch'd Feb. 27, 16fia. Left; ant. post. flap. Discharged Nov. 7, 1865. Died March 30, 1873; pyaemia. Right; ant. post. flap. Disch'd Dec. 23, 1865. Left; circ. Surg.C.W. McMillin, 1st Tenn. Resigned Jan. 2:t, '63. Left; flap. Surg. F. L. Dibble, 6th Conn. July 10, amp. right leg. Disch'd August 25, 1864. Spec. 1163. Left; flap. Surg.A.W.Whitney, 13th Mass. Disch'd Oct. 17, '64. Left; flap (amp. arm). Surg.C. B. Park, llth Vermont. Sept. 26, haem.; ant. tib. lig. Disch'd Sept. 14, 1865. Ki*ht ; circ. Provost Marshal and exchanged. Name, Military Description, and Age 630 Smith, J., Pt., C, 22d Indiana, age 22. 631 Smith, J., Pt., C, 69th New York, age 24. 632 Smith J. B., Pt., H, 9th Michigan. 633 Smith, J. L., Lieut., F, 4th Michigan. 634 Smith, J. R., Pt., C, 14th South Carolina. 035 Smith, P., Pt., K, 12th Illinois, age 42. 636 Smith, V., Pt,, E, 49th Indiana. 637 Smith, W., Pt., H, 93d Pennsylvania, age 23. 638 Smith, W. D., Serg't, D, 6th N. Jersey, age 35. 639 Smith, W. K., Pt., F, 4th Georgia. 640 Smith, W. N., Pt., H, 52d Penn., age 19. 641 Smith, W. P., Pt., 1st Richmond Howitzers. 642 Snarr, P. H, Lieut., B, 18th Va. Cav., age 33. 643 Snodgrass, J. A., Pt., F, 6th Texas. 644 Snyder, J., Pt., B, 4th N. Y. H'vv Art'y, age 48. 645 Snyder, J., Pt,, G, 149th j Pennsylvania, age 19. 646 ! Southard, S. M., Pt., I, 14th Vermont, age 33. 17 Spare, A., Pt., K, 187th Penn., age 37. 648 *Spath. J. F., Serg't, 1st Louisiana, age 26. 649 Spenard, B., Pt., G, llth Vermont, age 21. Spence, J. D., Corp'l, C, 3d S. Carolina, age 20. 51 Spencer, M. L., Pt., K, 4th Kentucky, age 24. 652 Sperry, E. F., Ft., B, 3d Iowa, age 20. 653 Sprague, O., Pt., B, 9th Vermont, age 18. 654 Sprowl, T. J., Corp'l, C, 12th N. Jersey, age 19. 655 Starin, F. D., Pt., H, 43d Wisconsin, age 19. 656 Stebbins, M. M., Serg't, K, 26th Mass., age 23. 657 i Steineman, J., Pt,, K, j 37th Ohio, age 19. 658 , Steingraber, W., Pt., E, 25th Iowa, age 20. 659 J Steinwater, J., Pt., Pur- cell's Battery, Virginia. 660, Stephens, J., Serg t, K, 19th Illinois, age 25. 661! Stevens, R., Pt., F, 107th New York, age 25. 662! Stevens, W. P.,Corp'l.B, 184th N. York, age 19. 663 ! Stitle, W., Pt., 1, 29th Ohio, age 21. 664 ' Stoddard, T.,Pt.,G, 64th | New York, age 19. 665 Stone, J. G., Pt., K, 7th N. Hampshire, age 21. Stone, S. H., Serg't, B, 37th Wis., age 27. Stonebreaker, D. T., Pt., F, 14th W. Va.,age22. Stonehouse, J.,Pt.,F,7th Wisconsin, age 21. Storey, J. H. R., Serg't, F, 109th Penn., age 25. Storm, H. F., Pt., C, 71st Indiana. Stout, J., Pt., D, 101st Illinois, age 25. Stratton, C. H., Pt,, F, 25th Massachusetts. June 27, 27, '64. May 16, 16, '64. July 13, 14, '62. June 27, 28, '62. July 1, 2, '63. April 7, 7, '62. Dec. 28, 28, '62. Sept. 22, 22, '64. July 2, 3, f63. May 5, 5, '64. Aug. 12, 12, '64. July 2, 3, '63. Sept. 19, 20, '64. Jan. 10, 10, '63. Aug. 25, 26,'64. May 10, II, '64. July 3, 3, '63. June 18, 19, '64. Sept, 17, 18, '62. Oct, 19, 19, '64. Oct. 19, 20, '64. July 30, Au.1,'64 April 6, 7, '62. Sept. 29, 30, '64. May 12, 12, '64. Nov. 5, 5, '64. Sept. 19, 19, '64. Aug. 31, 31, '64. July 22, 23, '64. Aug. 30, 30. '62. Sept. 20, 21, '63. May 25, 26, '64. Oct. 19, 19, '64. Mav 8, 9, '64. Mar. 25, 26, '65. Oct, 1, 1, '63. Dec. 28, 28. '64. Sept, 22, 22, '64. June 18, 18, '64. May 28, 28, '64. Aug. 30, 30, '62. May 15, 15, '64. Feb. 8, 8, '62. Operations, Operators, Result. Right; post. flap. A. Surg. S. A. Simpson, 52d Ohio. Disch'd June 26, 1865. Left; flap. Surg. J.W.Wishart, 140th Penn. Disch'd Mar.10,'65. Right; flap. Discharged. Left. Resigned March 7, 1863. Right. Surg. J. J. Knott, P. A. C. S. Recovery. Left. Surg. H.Wardner, U.S.V. Disch'd August 1, 1862. Left; flap. Disch'd March 29, 1863. Left; ant, post. flap. Recovered Nov. 27, 1864. Left; flap. A. Surg.C. Bacon, jr., U. S. A. Disch'd Nov. 21, 1863. ----. Surg. W. P. Young, 4th Georgia. Recovery. Right; ant. post. flap. Assistant Surg. J. Flowers, 52d Penn. Disch'dNov. 14, 1864. Right. Surg. — Jones, C. S. A. Disch'd Feb. 18, 1864. Left. Exchanged November 22, 1864. Right. To prison May 4, 1863. Left; single flap. Disch'd Feb. 7, 1865. Right; flap (amp. left leg, lower third). Disch'd July 21,1865. Left; ant. post. flap. Surg. O. Munson, 108th N. Y. Disch'd Dec. 2, 1864. Left; flap. Disch'd Jan. 13, '65. Right; posterior flap. Right; ant. post flap. Surg.C. B. Park, llth Vermont. Dis- charged July 21, 1865. Right; posteriorflap. Surg. J. G. Hardy, 6th N. C. To Provost Marshal April 8, 1865. Right; circ. Disch'd March 27, 1865. Right; flap. Disch'd August 4, 1862. Left; ant. post. flap. Discharged Sept, 6, 1865. Left; flap. Disch'd Jan. 15,1865. Right; flap (amp. left leg, lower third). Disch'd July 2, 1865. Left; posterior flap. Surg. J. G. Bradt. 26th Mass. Disch'd Julv 3, 1865. Right; flap. A. Surg. C. B. Rich- ards. 30th Ohio. Disch'd May 18, 1865. Left; lateral flap. Disch'd July 12, 1865. Right. Disch'd August 14,1863. Left; flap. Confederate surgeon. Disch'd June 24, 1864. Right; flap. Surg. P. H. Flood, 107th N. Y. Disch'd Mar. 2,'65. Right; ant. post. flap. Disch'd July 27, 1865. Right; circ. Surg. A. K. Fifield, 29th Ohio. Disch'd Aug. 16, '65. March 15,1866, amp. thigh. Left; circ. Surg.W. J. Burr. 42d N. Y. Disch'd August 2, 1865. Right; circ. A. A. Surg. W. H. Finn. Disch'd April 28, 1864. Spec. 4188. Left. Surg.W. C. Shurlock, 51st Penn. Disch'd June 18,1865. Right; flap. Disch'd June 16,'65. Left; lateral flap. Disch'd Sept. 28, 1864. Right; circ. Mustered out Jan. 17, 1866. Left. A. Surg. J.D. Gatch, 16th lnd. Disch'd Nov. 27, 1862. Right; ant. post. flap. Disch'd January 18, 1865. Right; circ. Disch'd August 7, 1862. •FISHER (G. J.), Report of Fifty-seven Cases of Amputations in Hospitals near Sliarpsburg, Md., etc., in Am. Jour. Med. Sciences, Vol. XLV, p. 48. SURG. Ill—60 474 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Ne. Name, Military Description, and Age. 673 SlriUer, J., Pt., K, 56th North Carolina, age 34. 674 Strock, S. D., Corp'l, F, 140th Penn., age 36. 675 Sullivan, J., Pt., E, 64th Illinois. 676 Sullivan, M., Pt.. H, 2d Michigan, age 27. 677 Summers, J., Capt., B, 5th Alabama. 678 Sumner, A., Pt., B, 3d North Carolina. 679 Swank, H. J., Pt., G, 126th Ohio, age 23. 680 Swarman, F., Corp'l, E, 12th Massachusetts. 681 Swarthout, O., Corp'l.G, 86th N. Y., age 19. 682 Sweet, J. O., Serg't, C, 12th Ohio, age 21. 683 Sweetland, L. D., Pt., E, 128th Ohio. 684 Sweezy, L. A., Pt., F, 7th Mich. Cavalry. 685 Swett, G. W., Serg't, K, 30th Maine. 686 Swett, V. W., Pt., A, 14th Infantry, age 22. 687 Swords, W. J., Pt., H, 51st Georgia, age 20. 688? Tanner, J., Corp'l, C, 6895 87th New York. 690 Tanton, H. J. D., Pt,, C, 47th Alabama, age 33. 691 Tatro, L., Pt., E, 27th Massachusetts, age 19. 692 Taylor, J., Pt., K, 8th Kansas, age 23. 693 Taylor, S., Pt., E, 22d New York, age 24. 694 Tebbetts, E. W., Pt., D, 7th N. Hamp., age 44. 695 Thoinas,C, Pt,, D, 121st Pennsylvania, age 26. 696 Thompson.A. E., Pt., A, 29th Wisconsin, age 16. 697 Thompson, J. M., Pt., F, 21st Miss., age 20. 698 Thompson, J. S., Pt., F, 31st Miss., age 21. 699 Thompson, L., Pt., B, 78th Illinois, age 22. 700 Thompson, R., Pt,, I, Sth Artillery, age 20. 701 Tinker, W. H., Pt..B,5th Mo. S. M., age 23. 702 Traut, W., Pt., C, 20th Michigan, age 31. I5?{ Trim, S. H, Pt., B, 41st ,m> Alabama, age 19. 705 Troy, B. F., Pt., G, 10th Iowa. 706 Tucker, J. M., Pt., A, 20th Indiana. 707 Turner, C.A.,Pt., 1,13th Mass., age 21. 708 Twaits, J. B., Serg't, H, 14th N.Y. S. M..age24. 709 Twinem, H., Pt..A, 122d New York. 710 Uncleson, J.. Landsman, U. S. Gunboat Com. Barnev, age 23. 711 VanAlstyne, I., Pt., B, 7th N. Y. Heavy Artil- lery, age 23. 712 Van Fosson, W. E., Pt., F. 52d Virginia. 713 Vincent, G. W., Pt., D, 86th New York, age44. 714 Vining, R. H., Pt., H, 112th Illinois, age 16. DATES. Operations, Operators, Result. Vogt, G-. Pt., D, 61st Ohio, age 27. Vorce, E., Pt., B, 14th Infentry, age 35. Vossler, J., Pt., G, 16th N. Y. H. Art'y, age 20. April 20, 20, '64. July 2, 3, '63. Oct. 4, 6, '62. June 17, 18. '64. May 3, 4, '63. May 2, 3, '63. Sept. 19, 19, '64. Sept. 17, 18. '62. May 12, 12, '64. June 9, 9, '64. June 14, 15, '63. July 3, 4, '63. April 23, 23, '64. July 2, 4, '63. Oct. 19, 20, '64. Aug. 30, 30, '62. July 2, 3, '63. May 16, 16, '64. Sept. 20, 20, '63. Sept. 14, 14, '62. May 10, 10, 64. Dec. 13, 13, '62. July 12, 12, '63. July 2, 3, '63. Nov. 30, Dec. I,'64 Sept. 1, 1, '64. Sept, 17, 17, '62. Sept. 27, 27, '61. June 17, 17, '64. Mav 21, 21,' '64. May 16, 16, '63. Aug. 29, 29, '62. June 5, 5,'64. Aug. 29, 30, '62. May 6, 7, '64. Mav 3, 4, ''63. June 3, 3, '64. July 3, 5, '63. June 16, 18, '64. June 15, 15, '64. July 20, 21, '64. May 12, 12, '64. Oct. 7, 7, '64. Right; circ. skin flap: fibula dis- articulated. Surg. C. H. Ladd, 56th N. C. Retired Jan. 17, '65. Right; circ. Surg. J.W.Wishart, 140th Penn. Disch'd Jan. 4,'64. Left: flap. Disch'd April 6, '63. Died Dec. 2, 1867. Left; flap. Surg. S. S. French, 20th Mich. Disch'd Mar. 29,'65. Left; circular; gang. Recovery. ---. Ass't Surg. R. E. Dennis, C. S. A. Recovery. Right; flap. Discharged April 3, 1865. Right. Disch'd and pensioned. Left; ant. post. flap. Disch'd Nov. 10, 1864. Right; flap. Surg. S. Maguire, 45th Ky. Disch'd Dec. 20,1864. Left; flap. Disch'd August 26, 1863. Right; flap. Disch'd December 14, 1863. Right; circ. Surg. S. C. Gordon, 1st La. Disch'd June 23, 1864. Left; flap. Disch'd Jan. 19, '64. Died Mar. 24, '72; phth. pulmo. Left; posterior flap. Surg. G. T. Stevens, 77th N. Y. Exchanged Feb. 16, 1865. Both; flap. Discharged October 15, 1862. Right. To Pro. Marshal Sept. 10, 1863. Right; flap. Disch'd August23, 1865. Left; flap. Surg. E. M. Seeley, 21st 111. Disch'd May 20, 1864. Left; flap. Surg.W. F. Hutchin- son, 22d N.Y. Disch'd Dec. 19, 1862. Spec. 2303. Right; flap. Disch'd June 3, 1865. Left; gangrene. Disch'd Aug. 12, 1863. Left. Surg. J. L. Dicken, 47th Indiana. Disch'd Oct. 1, 1863. Died July 16, 1864. Left; flap. Paroled November 12. 1863. Right; circular. Transferred. Right; circ. Surg. S. C. Moss, 78th HI. Disch'd May 26,1865. Right; circ. A. Surg. S. Adams, U.S.A. Disch'd Mar. 30,1863. Right. Dr. E. McCuen, Louis- iana, Mo. Disch'd Feb. 10,1862. Right; half circ. with posterior flap. Surg. S. S. French, 20th Mich. Disch'd June 24,1865. Both; circ. Surg. J. D. Jackson, 44th Tenn. Furl'd July 13, '64. Right; left leg amp., mid. third. Disch'd Sept. 3, 1863. Left; circ. Disch'd Mar. 6, 1863. Died March 20, 1864. Left; ant. post. flap. Surg. A.W. Whitney, 13th Mass. Disch'd Nov. 6, '65. Died Aug. 17,1875. Left. Discharged Feb. 9, 1863. Left; flap. Surg. Gillispie,C.S.A. Disch'd July20,'65. Died, 1874. Right. Disch'd April 3, 1865. 1875, chronic ulcer; necrosis. Left; circ. Surg. J.W.Wishart, 140th Penn. Disch'd Aug. 9, 1865. Right; circ. Surg. C. B. Gibson, C. S. A. Retired Feb. 17,1865. Right; ant. post. flap. Surg. J. W. Wishart, 140th Penn. Dis- charged March 2, 1865. Left; circular. Surg.G. A. Colla- more, 100th Ohio. Discharged Feb. 21,1865. Left. Discharged June 22,1865. Left; flap. Disch'd May 20, '65. Died August 23, 1870. Right; circ. Disch'd July 6, '65. 742 743 744 745 746 747 748 749 750 751 752 753 754 755 m lOlf 758 759 760 76] 762 Name, Military Description, and Age. Wagner, D., Pt., H, 90th Penn., age 23. Wagner, J., Pt., C, 69th Penn., age 36. Walbert, J., Pt., D, 25th Michigan, age 21. Wallace, D., Corp'l, A, 10th N. Y. Cavalry. Walker, J., Corp'"l, C, 139th Penn., age 24. Walker, J. S., Pt., K, llth Penn., age 22. Walker, L. J., Pt., B, 13th N. C, age 21. Walker, W.S., Brigadier General, age 42. Walsh, J., Pt., A, 57th Mass., age 39. Ward, J., Corp'l, H,56th Penn., age 31. Warner, J. C, Pt., A, 121st Ohio, age 21. Warner, N. C, Lieut., E, 39tb Illinois, age 34. Warner. T., Pt., H, 8th N. Y. H. Art'y, age 32. Warren, J. M., Pt., H, 106th N. York, age 21. Washburne, J., Pt., A, 142d N. York, age 32. Wathier, F., Pt,, D, 2d Artillery, age 28. Weber, A., Pt., D, 20th New York. Weber, J., Pt., H, 150th New York. Webner, C, Pt., E.lllth New York, age 22. Weeks, H. C, Serg't, E, 6th N.Y. H.A., age 21. Weeks, T., Pt., G, 1st South Carolina, age 19. Welch. J., Corp'l, A, 52d New York, age 35. Welsh, A., Pt., H, 9th Pennsylvania Cavalry. Werner, F., Pt., C, 13th New York. Whatley, T. J., Pt., D, Sth Alabama, age 23. Wheeler, W. W., Corp'l, D, 22d Indiana, age 25. Whitbeck. G. H., Pt., E, 134th N. Y., age 19. Whitney, A., Pt., B, 5th Vermont. Whitten, L. T., Pt., B, 40th Mass., age 23. Wieland, J., Pt., A, 43d Illinois. Wike, G., Pt., F, 55th Pennsylvania, age 23. Wilbur, M. J., Pt., C, 26th Maine. Wilds, J., Pt., K, 121st Pennsylvania, age 25. Wilkins, J. H.,Corp'l, E, 1st Louisiana, age 25. Williams, G.,Pt.,G,50tb ColoredTroops, age35. Williams, G., Lieut,, 4th Infantry. Williams, G., Quarter- mast's emplov6,age 20. Willson, C. C.,*Pt., I, 6th Michigan. Willson, S.L.,Pt.,D,72d New York, age 18. Wilson, J. E.,Pt.,G, 67th New York, age 23: Winklehaus, J., Pt., K, 66th New York. Winn,B.D.,Pt, A, 143d Pennsylvania, age 24. Winn, j. W., Corp'l, B, 6th Wisconsin. Winstead, T. T., Pt., I, 30th N. C, age 18. Dates. Dec. 13, 13, *62. Dec. 13, 13, '62. June 16, 16, '64. June 19, 19, '64. Sept. 19, 20, '64. July 1, 2, '63. July 1, 2, '63. May 20, 20, '64. Mar. 25, 25, '65. July 1, 2, '63. Mar. 19, 20, '65. Aug. 16, 16, '64. June 3, 4, '64. June 1, 1, '64. Sept. 29, Oct.1,'64, Nov. 8, 8, '63.* Sept. 17, 17, *62. Mar. 2, 3, '65. June 1, 1, '64. Oct. 19, 19. '64. July 3, 3, '63. June 16, 16, '64. June 29, —, '62. July 21, 23, '61. July 2, 2, '63. May 27, 28, '64. July 2, 3, '63. June 29, 30, '62. Aug. 19, 19, '63. April 6, 6, '62. Sept, 29, 29, '64. May 27, 27, '63. Feb. 6, 6, '65. June 14, 14, '63. April 10, 10. '65. July 2, 3, '63. May 25, 26, '65. Aug. 5, 5, '62. July 2, 3, '63. June 16, 16, '64. Sept. 17, 17, "62. May 6, 8, '64. Sept. 14, 14, '62. July 2, 2, '63. Operations, Operators, Result. Right. Disch'd August 24,1864. Left. Disch'd December 16, '63. Right; circ.; gangrene. Disch'd Sept. 13, 1865. Left; flap. Discharged. Left; flap. Surg. S. F. Chapin, 139th Penn. Disch'd Apr. 20,'65. Right; flap. Disch'd May 31, 1865. Left; flap. Surg. J. H. McAden, 13th N. C. Paroled Oct. 22, '63. Left (also other wounds). Ex- changed Sept. 19, 1864. Left; flap. Surg.W. C. Shurlock, 51st Penn. Disch'd Sept. 12, '65. Spec. 4018. Died after 1875. Left; circ. Disch'd May 21, '65. Right; flap. Surg.T.B.Williams, 121st Ohio. Disch'd June 25, '65. Right; flap. Disch'd Dec. 15, 1864. Right; flap. Surg. G. Chaddock, 7th Mich. Disch'd Dec. 12,'65. Right; circ. Disch'd Oct. 16, 1864. Left; circ. Confederate surgeon. Disch'd June 14, 1865. Left. Discharged July 2, 1864. Left; ant. post. flap. Snrg. J. Hausen, 20th N. Y. Disch'd Dec. 6. 1862. Left; circ. Disch'd August 30, 1865. Left; flap. Surg. P. E. Hubon, 28th Mass. Disch'd J uly 4, '65. Spec. 4878. Left; circ. Disch'd June 8, '65. Left. Surg. — Frost, C. S. A. Exchanged Sept 25, 1863. Left; flap. Surg. J. W. Wishart, 140th Penn. May, '65, necrosed end of tibia removed. Disch'd July 29, 1865. Left. Surg. — Kelly, 12th Ala. Disch'd Sept. 26, 1862. Died Oct. 16, 1865. Right; flap. Disch'd March 6, 1862. Left; ciro. To Provost Marshal Sept. 17, 1863. Right; circ. Disch'd January 8, 1865. Right; flap. Disch'd May 30, '64. Died July 21, '77; cerebritis. Left. Oct. 11, 1862, re-amputa- tion. Disch'd Sept. 25, 1863. Right; circ. Surg. S. A. Green, 24th Mass. Discharged. Right; flap. Disch'd October 10, 1862. Left; flap. A. Surg. H. C. Merry- weather, 5tb Col'd Troops, and Surg. T. H. Squire, 89th N. Y. Disch'd May 17, 1865. Right; circ. Surg. B. B.Wilson, U. S. V. Disch'd Aug. 17,1863. Right; circ. Mustered out May 18, 1865. Right; ant. post. flap. Disch'd Aug. 9, 1864. Spec. 4371. Left; ant. post, flap; circ. sect. muscles. Disch'd June 10, '65. Right; flap. Retired November 11, 1863. Left; flap. Act. Staff Surg. C B. Richards, U. S. A. Left; flap. Disch'd October 16, 1862. Both ; flap, 72dN. Y. Left; flap. 15, 1865. Left; lat. flap. Surg. C. S.Wood, 66th N. Y. Disch'd Nov. 6, '62. Left; circ. Disch'd June 15,'65. Left. Disch'd December 22, '62. Right; flap. S urg. J.W. Tracey, 14th N. C. Exch'd Nov. 12, '63. Surg. C. K. Irwin, Disch'd May 31, '05. Mustered out July SECT. V.I PRIMARY AMPUTATIONS IN THE LEG. 475 769 770 771 772 773 774 775? 7765 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 Name, Military Description, and Age. WiMier. T. \\\. la' !., n. 97th Illinois. Wondcns, G..Pt.,B, 14tli Pennsylvania. Wood, J. 1!.. Lieut., M. 17th l'enn. I'm..a»c 24. Woolley. H. A., l't.. F, 6th Alabama, age 52. Wucherer. <_'.. Pt., D, 61st Ohio. Ynrian, .1., l't., A. :C>th Indiana, age 27. Yodor, A..Corp'l, E,55th Pennsvlvania, age 24. Young,*L. R.,Pt., K, 31st Maine. Yunkings, E.,Pt..H, 42d Pennsylvania. Abbert. C, Pt., A, 38th Wisconsin. Adams, I. N., Serg't, K, 125th Illinois. Adams, J., Pt., G, 59th Massachusetts, age 21. Albert, J., Pt., F, 91st New York, age 19. Alexander, R., Pt., L, 2d N.Y. H'vy Art., age 42. Atkinson, J., Pt., I, 4th Iowa. Babcock, E., Pt., B, 10th N.Y. H'vy Art., age 39. Barry, J., Pt., D., 2d N. Hampshire, age 20. Bartholomew, A. L., Pt., F, 3d Vermont, age 25. Basum, A., Pt., F, 63d Pennsvlvania. Bell, J.W., Corp'l, 1,73d Ohio. Bennett. C, Pt., G, 2d New York Artillery. Bemhard, A., Pt., K, 4th Ohio Cavalry, age 35. Bing, A., Lieut., A, 2d Iowa. Blair, L., Pt., F, 9th Ver- mont. Boring, R. M., Pt., K, 4th Georgia. Boughton, S. E., Pt., G, 134th N. York, age 21. Bowen, F. P., Lieut,, L, 4th Penn. Cav., age 26. Boyd, J.. Pt., D, 52d Ohio, age 20. Boyer, J., Pt., I, 102d New York. Boyle, P., Pt., B, 19th Georgia, age 51. Bradley, J., Maj., 142d Pennsylvania. Branson, W., Pt., I, 8th New York Cavalrj-. Briley, B., Pt., F, 2d Tennessee, age 26. Brodes, E., Pt., E, 8th Maryland, age 23. Brooks, H., Ft., K, 20th Michigan, age 22. Brown, G., Laborer, Quartermaster's Dep't- ment. Brown, H. G., Corp'l, B, 37th Wisconsin, age 21. Brown, W., Pt., B, 174th Ohio, age 32. Bryan, C, Pt., H, 119th Pennsylvania, age 24. ■Bundy, C, Pt., F, 6th Wisconsin, age 30. Burns, J., Pt., F, 140th Indiana, age 22. Dates. April 9, !l, \k>. June 2, 2, '61. June 21, 21, '63. July 2, 3, '6:1. Aug. 22, 23, '62. Dee. 16, 16, '64. Mav 16, 16.''64. June 17, 17, '61. Do 13. June 17, 17, '64. Sept. 1, 1, '64. June 30, 30, '64. Oct. 12, 13, '64. Aug. 14, 14, '64. July 12, 14, '63. April 2, 2, '65. May 16, 16, '64. June 5, 5,'64. May 5, 5, '64. Mar. 19, 19. '65. June 28, 28, '64. Feb. 25, 25, '64. Oct. 3, 4, "62. Sept. 28, 29, '64. July—, —, '63. June 27, 27, '64. May 28, 28, '64. June 28, 28, '64. July 2, 3, '63. Aug. 26, 26, '64. Dec. 13, 13, '62. Julv 5, 5, '63. Sept. 27, 27, '64. Aug. 21, 21, '64. Mar. 25, 25, '65. Aug. 9, June 17, 17, '64. Dec. 7, 7, '64. May 10, —, '64. May 10, 11, '64. Dec. 7, 7, '64. Operations, Operators, Result. Left. Surg. C. Davis, 97th 111. Mustered out May 15, 1865. Right. Discharged Aug. 6,1861. Right; post. flap. Disch'd Oct. ti, 1863. Right. For exchange Nov. 12, 1863. Left. Confederate surgeon. Dis- charged Nov. 27, 1862. Left: ant. posterior flap. Disch'd May 25, 1865. Lett; flap. Confederate surgeon. Disch'd June 8, 1665. Right: circ. Surg. J.D.Mitchell, 31st Maine. Disch'd Jan. 14,'65. Left; ciro. Disch'd June 29, '63. Left. Died June 21, 1864. Left. Died November 4,1864. Right; ant. posterior flap. Died August 8, 1864 ; pyaemia. Both. Died November 4, 1864; pysemia. Right; circ. Died Sept. 7,1864; gangrene. Left; flap; headof fibula excised. Died August 3, 1863. Left. Died May 9,1865; exhaus- tion. Right; haem., 20 oz. May 25, amp. thigh. Died May 30, '64 ; exhaustion. Left. Died June 28, '64; pyaemia. ----. Surg. G. T. Stevens, 77th N. Y. Died May 18, 1864. Right. Died March 30, 1865. Right. Surg. J.W.Wishart,140th Penn. Died July 27, 1864. Right. Mar. 5, 18, haem., 16 oz. each time; lig. popliteal. Died March 22, 1864; pyaemia. Left (haemorrhage)! Died Oct. 5, 1862. Left. Died November 13,1864; py«mia. Right. Died July 23, 1863. Right; flap. Surg.W. H. Hoag, 134th N. Y. Died Feb. 17, "65 typhoid pneumonia. Left; circ. Died June 15, 1864 pyaemia. Right; circ. Died Aug. 7,1864 exhaustion. Right. Died July 3, 1863. Right (also wound of thigh and scrotum); ant. post. flap. Died Sept. 2, 1864; exhaustion. Left. Died Jan. 3,1863; tetanus. Right (also wound lung). Died July 25, 1863. Spec. 3843. Left; circ. Died Nov. 9, 1864; exhaustion. Right; circ. Died Oct. 6, 1864; gangrene. Right; typhoid symptoms. Died April 1*4, 1865. Right. A. Surg. J. T. Calhoun, U.S.A. Died August 29,1864; pyaemia. Spec. 4152. Right; circ. July 21, amputat'n thigh; 31, three inches femur removed. Died Aug. 3, 1864; pyaemia. Specs. 2897, 2945. Left; ant. post. flap. Surg. F.W. Morrison, 174th Ohio. Died Dec. 23, 1864 ; pyaemia. Left. Died June 23, 1864. Left; circ. Died June 17, 1864; pyaemia. Left; flap. Surg. H. B. Johnson, 115th Ohio. Died Feb. 26, 1865. Name, Military Description, and Age, Cain.C, Pt., D,52dNew York. Cain, T., Pt., E, 96th N. York, ago 40. Camp, W. IL, Pt., I, 40th Alabama. Campbell,D.,Pt.,E, llth N. Humpshire, age 28. "^Cannon, S. D., Pt., I), 2d Ala. Cav., age 22. Carman, L.A.,Serg't, A, 24th Iowa, age 22. Carnoy, P., Pt., A, 48th Illinois. Carr, C. C, Pt., D, 14th N. Hampshire, age 21. Carroll, P.,Corp'l,C, 22d Kentucky. Carter. J., Pt., I, 10th Florida, nge 46. Cecil, H.,Pt.,B,3dIowa. Chaffee, W. R., Pt., A, 142d N. York, age 28. Chase, H. C, Serg't, B, 30th Maine, age 28. Clark, G.W., Ft, C, 93d Penn., age 36. Clark, J. W., Serg't, I, 129th Indiana, age 37. 3Cloar, W. F., Pt., A, 33d Tennessee, age 24. Closson, 1. H., Capt., H, 91st Pennsylvania. Cochrane, J., Lieut,, K, 67th Ohio, age 28. Coleman, J., Pt., F, 75th Ohio. Collins, T., Pt., K, 1st Me. H'vy Art., age 21. Corey, O. M., Pt., H, 114th N. York, age 21. Corser, C. M., Pt., H, 1st Ohio Artillery. Coverdale, J. B., Pt, A, 22d Dlinois. Croyle, J., Pt., I, 54th Pennsylvania, age 20. Cummings, J. S., Pt., B, 70th Ohio, age 16. Davis, J. D., Corp'l, D, 33d Missouri, age 23. Dawson, H., Pt., A, 49th New York, age 25. Dean, W., Pt., B, 1st Cavalry, age 39. DeHoff.E., Ft, H, 38th Ohio, age 33. Dempson, C, Corp'l, G, 32d Mass., age 32. Densmore, F. M., Pt., F, 40th Indiana. Dewes, J. S., Ft., H, 18th Virginia. Dillon, J., Pt,, E, 56th Mass., age 43. Dimond, J., Serg't, K, 61st New York. Droker, A., Pt., B, 57th Indiana. Dunham, J. H., Pt, D, 117th N. Y., age 32. Eldred, H. E., Pt, E, 2d U.S.Sharpshooters.age 27. Engleman, W., Pt, K, 9th Iowa Cav., age 14. Evans, M., Pt., E, 25th South Carolina, age 45. June 16, 16, '64. Sept. 29, 29, '64. June —, —, '64. June 3, 3, '64. May 18, 18, '64. Oct. 19, 20,'64. July 12, 12, '63. Oct. 19, 20, '64. Dec. 29, 29, '62. Aug. 21, 22, '64. July 12, 12, '63. May 16, 16, '64. April 9, 10,'64. April 2, 3, '65. July 19, 19, '64. Aug. 30, 30, '64. Oct. 27, 27, '64. Mav 16, 16,' '64. May 7, 7, ''62. June 18, 19, '64. Oct, 19, 19, '64. June 19, 20, '64. Nov. 7, 9, '61. Sept. 19, 20, '64. June 18, 18, '64. June 6, 6, '64. May 10, 10, '64. Oct. 29, —, '64. Aug. 7, 7, 764. May 12, 12, '64. July 20, 20, '64. Mav 12, 14," '64. July 30, 30, '64. May 12, 12,"'64. Dec. 31, 31, '62. Oct. 27, 27, '64. June 18, 18, '64. June 10, 10, '64. Aug. 21, 21, '64. Operations, Operators, Result. Right Surg. G. L. Potter, 145th l'enn. Died June 24, 1864. Right. Died October 15, 1864; exhaustion. Left. Died July 3, 1864. Right; circular; bone necrosed. Died July 12, 1864. Left. Died June 25, 1864; gan- grene. Right Ass't Surg. H. M. Lyons, 24th Iowa. Died Nov. 14,1864; irritative fever; exhaustion. L't. A. Surg.R.L.VonHarlingen, 53d Ohio. Died July 26, 1863. Left; circular; sloughing. Died Nov. 25, 1864; anaemia. Left; erysipelas. Died Feb. 2, 1863. Left; flap. Died Sept. 15, 1864; pyaemia. Left. Died July 22, 1863. Right; flap. Died August 31, 1864. Right. July 18, bone exfoliated. Died July 20, 1864; gangrene. Left: circular. Died April 28, 1865; pyaemia. Left. Surg. E. Shippen, U. S. V. July 19, haem.; lig. of ant. tibial; gangrene. Died Sept. 19, 1864. Right; flap. Sept. 21, gangrene. Oct. 5, haemorrhage. Died Oct. 12, 1864; pyaemia. Right, Died November 22,1864. Left. Died May 28, '64 ; exhaus- tion from haemorrhage. Left. Died May 10, 1862. Left; ant. post, flap; gangrene. Died July 9, 1864. Right. Oct. 29, haem.; amputa- tion thigh. Died Nov. 11,1864. Right (wound of arm, hip, and foot). Died June 25, 1864. Left. Died November 28, 1861. Right; ant, posterior flap. Died Dec. 20, 1864 ; typhoid fever. Left; circ. Surg. B. N. Bond, 27th Mo. Died July 7, 1864; pneumonia. Left; ant. post. flap. Surg.A. T. Bartlett, 33d Mo. Died Oct. 11, 1864. Left; ant. post. flap. Surg. F. M. Everleth, 7th Me. Died June 16,1864; exhaustion. Right; flap. Died March 25, '65; chronic diarrhoea. Left; ant. post, flap; gangrene. Dec. 5, amp. thigh. Died Jan. 16, 1865. Left. Died June 9,'64; pyaemia. Left. Died July 24, 1864. ----; post flap. May 12, partial exc. Surg. C. B. Gibson,C.S.A. Died May 21, 1864. Right; long posterior flesh flap. Surg. T. F. Oakes, 56th Mass. Died Aug. 6, 1864; exhaustion. Left. Surg. J. W.Wishart, 140th Penn. (Tibialarteiy wounded.) Died May 12, 1864. Left. Died January 8, 1863. Right. Surg. N. Y. Leet, 76th Penn. Died Nov. 17,'64; pyaem. Left; circ. June 25, gangrene. July 1, amputation thigh. Died July 6, 1864; tetanus. Right; circ. Surg. J. Wasson, 9th Iowa Cavalry. Died July 1, 1864; exhaustion. Right. Died September 11,1864. •Lidell (J. A.), Example of Pyarthrosis and Spreading Osteomyelitis, in XT. S. Sanitary Commission Memoirs, New York, Surg. Vol. I, p. 395. 20'KEEFE (D. C), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Medical and Surgical Journal, Volume 2, p. 29. 3 JONES (J.), Case of Pysemia Supervening upon Hospital Gangrene, in IT. S. San. Com. Memoirs, New York, 1871, Surg. Vol. II, pp. 337 and 439. 476 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. NO. Name, Military DLSd'.It'l ION. AND Al Dates. Operations, Operators, Result. 844 Everson, J., Pt., F, lllth New York. 845 Fieger, J., Corp'l, B,98th Pennsylvania, age 30. 846 Flesh man, E., Pt, E, 118th Ohio. 617 Fry, G., Pt, K, 16th I Kentucky. 848 ! Fuller, B. #.,Pt,B, 12th Georgia. 849 Gavlurd, A., Pt, B, 75th Illinois. 850 Gibson, W., Serg't, C, 27th Michigan. 851 GillatfC.W., l't,A,56th Pennsylvania, age 19. 652 Gillespie, J., Pt, F, 59th Illinois, age 29. 853 Goddard, J. F., Pt., A, 57th Georgia, age 28. 854 Goodell, L., Pt, C, 2d Vermont, age 23. Gould, J. L., Serg't, G. 4th Texas. Greeuhart, H., Pt.,G,9th Connecticut, age 45. Groesbeck, W., Pt, B, 74th Indiana. Hagan, P., Pt., A, 7th Michigan. Hammer, H., Pt, F, 15th Indiana, age 24. Hammond, S., Pt., B, 97th Indiana. Harrison, W. H., Pt, B, 4th Michigan, age 24. Haskill, J. M., Serg't, A, 32d Mass., age 28. Hawkins. G. W., ('apt., I, 97th Pennsylvania. Hayden,F.W.,*Scrg't,F, 34th Mass., age 25. 'Hill, J., Pt, A, 32d Massachusetts, age 49. Hindman, W. S., Pt, E, 155th Penn., age 20. Hoasch, G., Pt„ E, 110th Ohio, age 45. 857 860 863 Holmes, R. A. R., Pt, I, 3d N. Hamp., age 35. Hough, J.,Serg't.H, 15th N.Y. H'vy Art, age 47. Hufnagle, J., Pt., A, 4th Vermont, age 34. Hughes, G., Pt, I, 8th North Carolina. Hunt, T., Pt., A, 44th New York. Hunter, J., Corp'l, B, 7th Illinois. Ingram, G. W., Pt., A, 68th Penn., age 25. Johnson, C. L., Pt, B, | 1st Tennessee. i i Johnson, F., Pt., D,117th Col'd Troops, age 20. Johnson, J., Pt., E, 57th ' Indiana, age 31. j Johnson, H., Pt., D, 7th I N. Hampshire, age 21. 879 I Johnson, R. H., Pt., C, | 139th New York. 680 | Kahler, N., Pt, A, 100th I Illinois, age 24. 661 Kennedy, /Y Pt., E, 13th [ Virginia, age 25. 882 Kennedy, J.. Pt., A,69th I New York, age 30. 883 Kenion, R., Pt., E, 149th New York, age 25. ,k: June 19, 19, '64. April 2, 2, '65. June 27, 27. '64. Mav 14. 14,"'64. July 9, 10, '64. Oct, 8, 8, '62. June 17, 17, :64. Julv 1, 2, '63. Dee. 15, 15, '64. July 22, 22,"'64. Nov. 4, 4, '63. July 2, —,''63. Oct. 19, 19, '64. Aug. 6, 6, '64. Sept. 19, 19, '64. Nov. 25, 27, '63. July 12, 12. '63. May 10, 10, '64. July 2, 3, '63. Oct. 27, 27, '64. Oct. 13, 14, '64. May 11, 12, '64. May 23, —, '64. Julv 9, 11, '64. May 16, 16, '64. Aug. 19, 19, '64. May 12, 12, '64. June 1, 2, '64. July 3, —, '63. Oct. 5, 5, '64. July 2, 4. '63. Aug. 6, 6, '64. Oct. 27, 27, '64. May 27, 27, '64. June 17, 17, '64. Sept. 29, 29, '64. Nov. 25, 27. '63. Feb. 7, 7, '65. June 3, 5, '64. June 27, 27, '64. Kennerson, A.. Serc't.K, J June 16, 17th Maine, age 33. ! 16. '64. 885 Kimple, A., Lieut., C, 25thl<>w:i. 886 King, 11. M., Corp'l. H, 145th Penn., age 27. Aug. 31, 31. '64. May 5, 7, v64. Right. Surg. G. L. Potter, 145th Penn. Died July 8, 1864. Right; circ. Died May 18,1865; exhaustion. Left. S urg. A. M.Wilder, U.S.V. Died July 19, 1864. Left. Died May 19, 1864. ---; double flap. Surg. C. H. Todd, 0. S. A. Died Aug. 19, 1864; exhaustion; diarrhoea. Right. Died October 14, 1862. Right Died June 18, 1864. Right Died June 23,1864; chr. diarrhoea; phthisis pulmonalis. Right: ant. post flap; gangrene. Died Feb. 2, 1865; gangrene. Right; ant. post. flap. Died Jan. 1, 1865; chronic diarrhoea. Left; ant. post. flap. Surg.W. J. Sawin, 2d Vt, Erysip.; gang.; tibia exfol. Died June 6,1864 ; pseudo-membranous croup. Left. Died July 8, 1863. Left; flap; erysipelas. Died Oct. 31, 1864; tetanus. Right, Died August 25, 1864. Left; oval skin flap; anaemia; gang. Died Oct. 19,'64; pyaem. Right; circ.; gang. Died Dec. 6, 1863. Left. Surg.W. Lomax, 12thlnd. Died August 5, 1863. Right: ant. post, flap : sloughing. Died Slay 21, 1864; pyaemia. Left (also right knee); sloughing. Died Aug. 25, 1863; diarrhoea. Left. Surg.M. S. Kittenger,100th N. Y. Died Oct. 27, 1864. Left; ant, post. flap. Died Nov. 9, 1864; exhaustion. Right; ant. post flap. May 22. haem. DiedMay 22,'64 ; pyaem Left. June24, amputation thigh Died June 24, 1864. Left; circ. A. A. Surg. AV. S Adams. Aug. 4, haem.; lig. post tib. Died Aug. 8, '64; haemor- rhage. Spec. 3829. Right; circ. Died May 27,1864 exhaustion. Right; flap. Died Aug. 31,1864 exhaustion. Right; circ. Died June 8,1864 dysentery. Left; apparently flap. Died July 9, 1864; exhaustion. Right. Died July 25, 1863. Left; flap. Died Oct. 21, 1864; exhaustive suppuration. Left. July 20, haemorrh., 12 oz. Died July 24, '63; haemorrhage. Right (alsoamputat'n left thigh). Died August 21, 1864. Right (also flesh wound). Died Nov. 16, 1864; exhaustion. Right; flap. Surg. E. B. Glick, 40th Indiana. Died Sept, 1, '64. Left. Died June 29, 1864. Right. Surg. T. H. Squire, 89th New York. Death (?). Left; including head of fibula; gang. Died Dec. 16, 1864. Left; circular. Died -------; exhaustion. Right: flap. Surg. J.A.Spencer, 69th N. V.N. G. DiedJuuel2, 1864; exhaustion. Left; flap. Surg. J. L. Dunn, 109th Penn. Died Mar. 4,1865; smallpox. Right; lateral flap. Died Aug. 4, 1864. Right. Died September 17,1864. Right, Surg. J.W.Wishart,140th Penn. (Gangrene.) Died May 27, 1864; exhaustion. 914 915 916 917 918 919 920 921 922 923 924 925 926 927 Name, Military Description, and Age. King, T., Serg't, C, 71st New York, age 20. Knapp, A. J., Pt, F, 93d Indiana. Knowlton, C. C, Pt., I, 22d Mass., age 22. Kronmiller, G., Pt., C, 14th New York Heavy Artillery, age 38. Laws, C, Pt,, E, 43d Colored Troops. Lease, H. A., Pt.,E, 14th Missouri. Lee, H., Pt, D, 9th Col- ored Troops, aged 21. Leininger, A., Pt., E, 98th Pennsylvania. Lenzenmeyer, R., Serg't, F, 2d Pennsylvania. Lewis, J. R., Pt., G, 53d North Carolina, age 32. Limb, W. F., Pt., B,26th Ohio. Linch, N., Pt., B, 163d New York. Lympns, N. S., Pt., K, 10th Iowa. Lynch, M., Serg't, C, 2d Vermont, age 22. Maddox, W. I, Pt, A, 53d Georgia. Marcev, H. P., Pt., K, llth Penn. Cav.,age 23. Martin, D., Pt, C, 28th Pennsvlvania. McCard'le, J., Pt, E, 2d Penn. Artillery, age 23. McCarmichael, A., Pt., D, 7th Miss., age 43. McCluskev, P., Serg't, F, 26th N. Y., age 27. MoDemitt, T. J., Pt,, E. 49th Penn., age 25. McDermott, O., Pt., M, 1st Mass. H'vy Art'y, age 30. McDevift, J., Pt, I, 7th Rhode Island, age 27. MoElbannon, W. J., Pt, B, 45th Illinois. McLean, M., Pt., B, 80th Illinois. McMillan, J., Pt, H, 4th Penn. Cavalry, age 18. McNeil, F., Pt, E, 114th New York, age 23. Mensen, M., Pt., E, 22d Wisconsin. Metz, J. H., Pt,, G, 9th Veteran Reserve Corps, age 33. Mier, J., Pt., I, 113th Ohio. Miller, J., Pt,, D, 157th Pennsylvania. Miller, L., Pt., K, 56th N. Carolina, age 26. Miller, M., Pt., B, 40th Indiana. Miller, W.,Serg't,G, 45th New York. MofHtt, B. L., Lieut, —, 1st New Jersey. Molter, P., Pt., H, 6th Wisconsin, age 23. Monaghan, M., Pt, C, 2d Michigan, age 43. Moody, J., —, —, age 20. Moore, J. H., Lieut., A, 100th Indiana. Moore, W., Pt., K, 14th West Virginia, age 34. Morse, J.,Pt.,B, 2d Penn. H'vy Artillery, age 22. Dates. July 2, 3, '63. May 14, 14, '63. Sept. 20, 20, '62. Julv 9, 10, ''64. July 30, 30, '64. Oct. 4, —, '62. Dec. 5, 6, '64. April 2, 2, '65. July 3, 3, '63. July 3, 3, '"63. June 20, 20, '64. Dec. 13, 13, '62. Dec. 13, 13, '64. Oct 19, 19, '64. May 3, —, '63. May 17, 17, '64. Nov. 27, 27, '63. July 2, 2, '64. Nov. 30, Dec.1,'64. Deo. 13, 13, '62. May 10, 10,* '64. June 20, 20, '64. June 3, 3, '64. June 26, —, '63. May 27, 27, '64. June 24, 26, '64. Sept. 19, 19, '64. May 25, 25, '64. Julv 11, 11,*'64. June 27, 27, '64. June 17, 17, '64. April 19, 19, '64. Dec. 31, 31, '62. May 2, 3, '63. May 5, 5, '64. May 10, 11, '64. June 16, 17, '64. May —, —, '63. Sept. 1, 2, '64. July 20, 21, '64. July 16, —, '64. Operations, Operators, Result. Left. July 15, haem. Died July 15, 1863. ----. Surg. J. B. Rice, 72d Ohio. Died July 27, 1863. Left. Oct.—. slough.: maggots; bed-sores. Died Oct. 13, 1862. Left. Surg. T. F. Oakes, 56th Mass. Died October 8, 1864. Spec. 6529. Left; circ. Surg. D. MacKay,29th Col'd Troops. Died Aug. 6,'64. Left. Died Nov. 14, '62; wound and amputation. Right; flap. A. A. Surg. J. S. Giltner. Died Dec. 23, 1864; pyaemia. Right; flap. Died May 17,1865; exhaustion. Right. Died July 23, 1863. Right (also ainputat'n left thigh). Surgeon J. J. Knott, P. A. C. S. Died July 10, 1863. Right. Surg. W. B. McGavran, 26th Ohio. Died Aug. 8,1864. Right. Died December 21,1862. Left; flap. Acting Staff Surg. C. B.Richards, U.S.A. (Alsow'nd of arm.) Died Dec. 14, 1864. Right. Died December 14,1864. Right. Surg. J. J. Knott, P. A. C. S. Died June 18, 1863. Right;flap. June8,haemorrhage. Died June 25, 1864; ham. Right. Died December 17,1863. Left (also amp. right, low. third). Died July 3, 1864. Left; ant. post. flap. Died Mar. 3, 1865. Left. Jan. 3, '63, haem.; lig. post. tibial. Died January 11, 1863. Right; flap. Died September 8, 1864. Left; ant, post, flap. Surg. C. C. Jewett, 16th Mass. Died July 17, 1864. Spec. 4579. Left; circ. Surg. J. Harris, 7th R. I. Gangrene. Died July 8, 1864; pyaemia. Right (also five other wounds). Died July 15, 1863; pyaemia. Right. Surg. J. T. Woods, 99th Ohio. Died June 1,1864. Right; circ. A.Surg.W. B. Price, 4th Penn. Cavalry. Died July 9, 1864; asthenia. Right; circ. Surg. L. P.Wagner, 114th N. Y. Died Oct, 8,1864 ; pyaemia. Left, Died June 12, 1864. Left; lat, flap. Surg. J. Wilson, Med. Insp. U. S. A. Died July 28, 1864; exhaust'n. Spec. 3166. Left Died July 6, 1864. ----. Died June 23, 1864. Left; aut. skin and post. mus. skin flap. Surg. C. H. Ladd, 56th N. C. Probablv died. Left. Died December 31, 1862. Left; flap. Died May 28, 1863. Right (also flesh wound of leg). Died May 8, 1864. Left; circ.; diarrhoea. Died July 6. 1864; exhaustion. Spec. 3574. Left; circ. July 20, lig. femoral; gangrene. Died July 25, 1864 ; hsemorrhage. ----. Died May 28,1863. Left. Surg.W. Lomax, 12th lnd. Died October 1, 1864. Left. Died Aug. 4, '64; nervous prostration and emaciation. Right, Haemorrhage. July 25, 1864, amp. thigh. Died August 10, 1864; pyaemia. ■Lidell (J. A.), Example of Osteomyelitis with Thrombosis, in XT. S. Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 404, and American Journal Medical Sciences, N. S., 1672. Vol. LXIV, p. 358. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 477 928 929 930 931 932 933 934 935 936 937 538 939 940 941 942 943 944 945 946 947 948 949 950 951 952 953 954 955 956 957 958 959 960 961 962 963 964 965 966 967 968 969 970 971 972 Name, Military Description, and Age. Morris, S. P., Serg't, K, 26th Pennsylvania. Mullen, W., Pt., I, 105th Pennsylvania, age 40. Murphy, R. I., Pt., C, 45th Georgia, age 35. Murphy, T. J., Pt., H, 30th North Carolina. Newell. R.J., Corp'l, D, 19th Maine. Nichols, F. C, Pt, F, 159th New York. O'Daniel, T., Pt., F,37th Kentucky, age 18. Odom, J., Serg't, H, 21st South Carolina, age 30. Oliver, H., Ft., K, 19th Maine. Osborne, W., Serg't, K, 57th New York, age 42. Owens, T. D., Pt, H, 81st Illinois, age 25. Parks. J., Pt, E, 91st Pennsylvania, age 36. Parsell. M., Pt., K, Sth Wisconsin, age 33. Parsons, J., Pt., F, 80th Indiana. Phillips, N., Pt., A,1 86th New York, age 20. Pierson, E. J., Pt, B, 19th Virginia. Pierson, J., Pt., F, 80th Indiana. Posey, E.,Corp'l, E, 30th Colored Troops, age 41. Posey, J., Pt., D, 21st Kentucky, age 34. Pouge, L.'G., Corp'l, E, 17th North Carolina. Ramer, J. P., Corp'l, K, 5th N. Hamp., age 25. Ranaghan, J., Pt., E, 69th New York. Rathburn, J. H., Pt., F, 149th Penn., age 22. Reddiclc, W. J., Pt, C, 20th North Carolina. Reinhart, C.,Pt. K, 74th Pennsylvania, age 21. Rhodes, J. H., Pt.K, 5th New Jersey. Ring, P., Pt, E, 69th New York, age 45. Rouch, J. T., Pt, A, 8th Maryland. Rouse, G. W., Adjutant, 100th Illinois. Ryan, J. C, Corp'l, K, 6th New Hampshire. Sanders, C. W., Pt., B, 4th S. C. Cav., age 23. Savage. J., Major, 2d Massachusetts, age 20. Sawney, L., Serg't, F, 79th Pennsylvania. Schoeneck,J.,Pt.,B,55th Pennsylvania, age 30. Scott, S., Pt, A, 48th Colored Troops. Sheridan, S., Pt., B, 12th Colored Troops, age 28. 1 Shields, R., Corp'l, G, 4th Iowa, age 24. Sholan, A., Pt., D, 121st Pennsylvania, age 40. Shull, V., Pt, D, 13th Indiana, age 22. Sill, W. J., Lieut, C, 75th Pennsylvania. Skinner, J., Col'd team- ster, age 56. Smith, G. W., Pt., E, 63d Tennessee, age 30. Smith, J. C, Corp3, A, 14thN.Y.H.A.,age27. Smith, J. J., Pt, D, 5th Tenn. Cavalry, age 21. Smithus, E., Pt,F, 127th Illinois, age 25. July 2, 2, '63. Aug. 12, 12, '64. Mav 3, 3, '63. Sept. 19, 19, '64. July 1, —, v63. Sept. 19, 19, '64. June 11, 11. '64. Aug. 21, 21, '64. July 3, 3, '"63. June 17, 17, '64. May 22, 23, '63. June 18. 18, '64. April 6, 8, '65. May 14, 14, '64. Feb. 6, 6, '65. Mar. 31. Ap. ],'65. Mav 14, —."'64. Oct. 4, 4, '64. June 20, 20, '64. Mar. 25, 25, '65. Juue 6, 6, '64. May 18, 18, '64. June 16, 16, '64. Sept. 19, 19, '64. Aug. 27, —, '62. May 3, 3, ^63. June 3, 3, '64. Mav 5, 5, '"64. July 28, 28, '64. Dec. 13, 13, '62. May 31, 31, '64. Aug. 9, 9, Y62. June 25, 26, '63. June 3, 5, '64. April 1, 1, '65. Dec. 15, 17, '64. Nov. 27, 27, '63. May 18, 18, '64. May 19, 19, '64. July 1, —, '63. Sept. 20, 20, '64. Sept, 29, 29, '64. April 2, 2, '65. April 7, 9, '62. July 28, 28, '64. Operations, Operators, Result. Left Died July 12, 1863. Left; flap; diarrhoea. Died Aug. 29, 1864. Left; ant. post, flap; erysipelas. Died Maj' 24, 1863; gangrene of stump. ---; ciro.; typhoid fever. Died October 10, 1864 ; cachexia. Hight Surg. S. H. Plumb, 82d N.Y. Died July 16, 1863. Right; flap. Died October 5, 1864; gangrene. Right. Died July 4, 1864. Right. Surg. A. A. White, 8th Md. Died Sept. 13, 1864. Right Surg. A. J. Billings, 19th Maine. Died July 11, 1863. ----. Surg. G. L. Potter. 145th Penn. Died July 2, 1864. Left; pvaemia. Died July 12, 1863. Left; lat. flap. June 30, haem.; femoral lig. July 6, fem. delig. Died July 12, '64; haemorrhage. Left; ant. post. flap. Died April 19, 1865. Right. A.A. Surg. L. Darling. Died July 15, 1864. Right; circ. Died February 18, 1865; pyaemia. Left A. Surg. W. B. Hartman, 116th Penn. Died April 12,'65. Right. Died June 15, 1864. Right: circ. Died November 9, 1864; pyaemia. Right; flap. Surg. J. T. Woods, 99th Ohio. Died Aug. 12,1864. Right. Surg. D. C. Roundy, 37th Wisconsin. Died April 10, '65; irritative fever. Spec. 4032. Left. Died June 25, 1864. ----. Surg. G. L. Potter, 145th Penn. Died June 10. 1864. Right; ant. post flap; dysentery. Died July 10, 1864. ----; circular. Died November 7, 1864; pyaemia. ----; ant, post flap; sloughing; re-amp. knee joint. Died Sept. 23, 1863; gangrene. Right, Surg. G. P. Oliver, lllth Penn. Died May 13. 1863. Right; circ. Died June21,1864. Left. Died May 18, 1864. Right. Died August 4,1864. ----. Died January 6, 1863. Right; ant, post flap; sloughing. Died June 11, 1864 ; pyaemia. ----. Died October 22, 1862; haemorrhage. Left; flap. Died July 1, 1863; pyaemia. Left; ant. post, flap; sloughing. Died July 9, 1864; gangrene. ----. Surg. H. Osborne, 51st C. Troops Died April 3, 1865. Right; flap. A. A. Surg. J. S. Giltner. Died Jan. 2, 1865. Right. Surg. D. B. Allen, 30th Iowa. Died Jan. 14, '64 ; pyaem. Right; circ; slough.; diarrhoea. Died May 26, 1864; exhaustion. Right. Died June 16, 1864. Left. Died July 21, 1863. Right. Died September 25,1864. Right; flap ; sloughing. Died October 21, 1864. Right; ant. post. flap. Died May 16, 1865. Right; circular. Died May 21, 1862. Right; double flap. Act, Staff Surg. C. B. Richards, U. S. A. Died Aug. 18, 1864. Name. Military Description, and Age. Snoddery,L.,Pt.,H,57th j June 14, Indiana. —, '6J. Snodgrass, J., Pt,C,36th Juik ~7, Illinois. 27, '64. Operations, Operators, Result. 975' Snow, J., Pt., (\ 169th New York, age 27. Stalze, W. B., Corp'l, B, 62d Ohio. Stanley, W., Lieut., G, 12th Mo. Cav., age 36. Sullivan, H., Ft, D.llth Mass., age 39. Swain, F. F., Capt, E, 123d Indiana, age 45. Taft, G. R., Capt, A., 53d Massachusetts. 993 994 995 I 996 997, 998 999 1000 1001 1002, 1003 1004 1005 1006 1007 1008 1009 1010 LOU 1012 1013 Theobald, D.,Pt,G,97th New York. Thewing, H. S., Pt, C, 4th Michigan, age 18. Tichenor, G., Pt. F, 9th N. Y. H'vy Artillery. Titan, N., Pt, II, 7th New York, age 21. Tompkins, G., Ft., G, 1st N. Y. Heavy Artillery, age 45. Toomey, J., Pt, I, 1st New Jersey Cavalry, age 30. Torrence, G. A., Corp'l, A, 4th Iowa. Tripp, J.W., Pt, A, 1st Michigan, age 18. Turner, H. IF., Serg't, G, 1st Alabama, age 24. Unknown, I. B., 148th Pennsylvania. Unknown, J., Colored servant, age 30. Vail, W., Pt, A, 2d N. York. Valentin*, R. H., Pt., D, 5th New York. Van Garder, J., Pt, F, 58th Penn., age 22. Vannatter, W. A., Pt.,I, 121st Penn. Reserves. Walker, F., Corp'l, K, 47th Ohio. Walker, J. B., Serg't, K, 12th Missouri Cavalry, age 22. Wallick. E. F , Pt., E, 126th Ohio. Walters, B. G., Pt, H, 19th Maine, age 19. Wannamaker, J. lF.,Pt, F, 25th S. C, age 27. Ward, L..Corp'l, B, 94th New York, age 18. Warren, R., Pt, C, 17th Connecticut. Weaver, C. D., Pt, II, 43d Mississippi, age 33. Weed, A.N.. Pt.,C,10th Georgia, age 24. Weight, J., Pt., A, 148th Pennsylvania. Westerman, W., Pt., C, 2d New Hamp.. age 28. White, L., Serg't, F, 7th New Jersey. Whiting, T. J., Serg't. Major, 2d Michigan. Whittaker, J. P., Pt, A, 17th N. C, age 44. Williams, C. D., Pt., E, 35th North Carolina. Williams, J. M., Pt, H, 26th Ohio. Williams, J. H., Major, 18th Indiana. Wilson, R., Pt, E, 29th Colored Troops. June 30, 30, '64. July 18. —, '63. Deo. 15, 17, '64. July 2, 4, '63. Aug. 6, —, '64. June 14, 14, '63. June 18, 18, '64. May 31, 31, '64. Oct. 19, 19, '64. April 7, 8, '65. July 3, 4, '63. Aug. 29, 29, '64. May 13, 13, '64. Mav 25, 25,"'64. Nov. :;o, Dec.1,'64 May 3, —, '63. Dec. —, —, '64. Oct. 19, 19, '64. April 7, 7, '65. Sept. 28, —, '64. Dec. 13, 15, '62. May 22, 22, '63. Sept. 14, 14, '64. Sept, 19, 19, '64. Oct. 15, 15, '64. Aug. 22, 22, '64. June 18, 19, '64. July 1, -, v63. Dec. 15, 15, '64. May 3, 4, %3. July 3, 3, '63. June 3, 3, '64. May 5, 5, '64. May 6, 6, '"64. June 16, 16, '64. June 19, 19, '64. Sept. 19, 19, '63. Oct. 19, 20, '64. July 30, 31, '64. Left. Died July 14, 1864. Left; circ. Surgs. H. E. Hasse, 24th Wis., and W. P. Pierce, 88th Illinois. Died July 17, '64. Left; large post and mus. flap; sloughing; haemorrhage. Died October 15, 1864. Right; haem. from gangrenous stump, fatal July 31, 1863. Left; circ. A. A. Surg. A. Rolls. Mortification. Died Deo. 19,'64. Left. Died November 25,1864. Right. Surg. J. VV. Lawton, V. S.V. Gang. Died Aug. 23,64. light; gangrene; harm >i INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. 1014 Name. Military Dates. Operations. Operators, ' v 1 Name, Military Result. ■ i Description, and Age. Dates. Operations, Operators. Description, and Ace. Result. Winters, L., Pt, K, 50th Jul\ 3. Right. Aug. 25. slough.; haem. 1022 Gorntoe, M. Z., Pt., H, Oct. 7, Left Georgia. 3, t,a. Sept 11, amput'n thigh. Died ] 9th Georgia. —, '64. Sept. 30, 1863; pyaemia. 1023, McCowan, W. C, Pt., 2d Julv —, ---. Surg. C. S. Wood, 66th 1015 Wise, G.A.,Vt,F, 25th Aug. 21, Right. Died September 2,1864; j Mississippi. —, '63. New York. South Carolina, age 24. 21, '64. effects of wound. 1024 Mast, D. P., Lieut, D. Mar. 31, Right. 1016 Wolf, A. M., Pt., C, 62d May 8, Right. Died July 20, 1864. 1 1st North Carolina. 31, '65. Pennsyl\ania. 8, '64. ! ]1025[ ' O'Brien. M. J., Pt., 10th Sept. 17, Right; circular; sloughing. 1017 Wood, R.H., Pt, D, 19th April 12, Left. Died May 14, 1865; men- Georgia, age 31. 18, '62. Virginia Art'v, ago 18. 12, '65. ingitis. 1026 Scott, J. C, Corp'l, A, July 1, Left; flap. 1018 Yates, T., Pt, F, 21st Sept. 19, Right. Died. i 1 42d Miss., age 30. 2, '63. Ohio. 19, '63. ■11027 Steward,----, Lieut, I, Nov. 22, Left, Surg. W. Graham, 40th 1019 Ze.llman. I. C, Pt., B, Mav 25, Right. A. Surg. J. P. Dowling, | llth Georgia, age 41. 22, '64. Illinois. 58th Alabama, age 18. 25, '64. 29th Penn. Died Aug. 28, 1864. ' 1028 Tutter, G. W., Pt, G, 3d May 18, Left. Surg. G. L. Potter, 145th 1020 Zimmerman, M., Pt, II, Dec. 13, Left (thigh and chest wound). | Arkansas. —, '64. Penn. (Alsowoundofrightleg.) 81st Pennsylvania. 13, '62. Surg. C. S. Wood, 66th N. Y. Died Dec. 13, 1862. 1029 Vanzoger, J., 2d Missis-1 sippi Battery. Oct. 5, —, '62. 1021 Bennett, M.. Pt, A, 69th May 18, Left. Surg. N. Hayward, 20th New York. —. '64. Massachusetts. 1 Primary Amputations in the Middle Third of the Leg for Shot Injury.—Eight hun- dred and ninety-two of the three thousand three hundred and ninety-five primary amputa- tions in the continuity of the bones of the leg were performed in the middle third. The result in six of these cases was not determined; seven hundred and thirty-six proved suc- cessful, and one hundred and fifty were fatal, a mortality of 16.9 per cent., or 7.5 per cent. less than that of the primary ablations in the upper third of the leg. Examples of Successful Primary Amputations in the Middle Third of the Pones of the Leg.—The operations of this group numbered seven hundred and thirty-six; one hundred and fifty-five were performed on Confederate and five hundred and eighty-one on Union soldiers. Of the latter the names of five hundred and seventy-six are found on the Pension Rolls; two are retired officers, and three do not seem to have applied for pensions. Twenty-seven have died since the date of their discharge from the service—one of erysip- elas, one of epilepsy, one of congestion of the brain, seven of phthisis, three of accidents, and fourteen of causes not stated. Case 732.—Private D. S. Crawford, Co. A, 47th Pennsylvania, aged 20 years, was wounded at Cedar Creek, October 19,1864, and admitted to Camden Street Hospital, Baltimore, one week afterwards. Assistant Surgeon G. M. McGill, U. S. A., contributed the pathological specimen shown in the adjoining wood-cut (Fig. 286), with the following description: "The patient had received a shot fracture of the right leg at the lower third, for which amputation was performed the same day at the middle third. Necrosis of the stump of the tibia ensued to the extent of several inches, necessitating resection, which was per- formed by Acting Assistant Surgeon W. G. Smull on March 24, 1865, chloroform being used and the operation performed by lateral flaps. The patient did very well afterwards. The upper portion of the stump healed by first intention." The patient was subsequently transferred to Jarvis Hospital, where he was discharged from service May 31, 1865, and afterwards supplied with a "Palmer" artificial leg. His pension was paid June 4, 1880. In his applications for commutation he described the condition of the stump as "continuing good.'' The specimen, No. 4225, Surgical Section, A. M. M., consists of bones of the stump, removed at the second operation, and measuring five inches in length. A large sequestrum extends the entire length, embraced by an involucrum, which is wanting on the anterior border; and the fibula, well rounded, has joined its extremity to the tibia. Case 733.—Private D. Jerman, Co. F, 190th Pennsylvania, aged 23 years, was wounded before Petersburg. July 11. 1804. He was admitted to the field hospital of the 3d division, Fifth Corps, whence Surgeon L. W. Read, U. S. V., reported: " Severe wound, with fracture of right leg, caused by a solid shot, and followed by amputation at middle third." The operation was performed by the flap method. From the field the patient was transferred to City Point, thence to Beverly Hospital, and subsequently he passed through various hospitals in Philadelphia, where he was supplied with a "Palmer" artificial leg. On August 7, 1805, he was discharged from service and pensioned. In his subsequent application for commutation for an artificial limb he represented the stump as being "sore occasionally," and mentioned Surgeon L. W. Read, U. S. V., as the operator. The pensioner died May 'J, 1880, his attending physician certifying that "the stump of the limb was diseased and in an ulcerating condition, resulting in his death." The colored lithograph opposite (Plate LXXVI) is a copy of a drawing by Hospital Steward E. Stauch, made immediately after the amputation, and shows the comminution of the bone, and especially the terrible laceration of the soft parts, caused by the missile, a solid shot. 1 FISHER (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., in Am. Jour. Med. Sci's, 1863, Vol. XLV, p. 48, I'IG. iSd.—Bony stump of right leg, five months alter amputation. Spec. 4-'i5. ■■•••■ ^'Vfl. & ,;€':■ A : ■ ■'"*''■ v'$' ", ;W^ \r4> -V ^. - • j ' ■'** l'''- A.;t -t ji'-2ijl•••S8 $t,4;:'■:&'■?■• *•' : ...''"■"^''^'yI :."I;;':.':I'" ^x;^K:' fo..^ ■••.'■'. ' '■[■■;■ *■ #(( *'■%•■£ >■;*/ ;'V ';,;-r ; *::- ' ''*. j :*!V' •'•'',,."v»'.V,V.-m', T-S, , 1- ■ / ■*. ;itfY ''.':' !v ;*j!' . ^:; ■■■£<><■*.:. .!!':-' ■ T,'.;V;; •••'•., .-,. :.,I' ; ;V|vV'a, f-'. H a X; .ty'- ''p^A'V. AAf^'i^''.' J- '' ? t ^&tMA •**Y ■'?■■' fcVf.A 4'*"'•!■.' '-^ ! >-»f; S'.v •. Y ' J«4 IU'.- A'-'r ■t ■ . imm! . at-..:., I ''ilt:, \\ V. ! Y I . ,..,■■>. f '•'-' 'tiiiptf* \ ii" 01" ,- ri"> v o:' tlijiuy F.: '- ■ ■'' :V-MX pi Y'.Y ;■ ■ : . "■ /.?) I ■ i ■ /,-„< ."' the idre^ tion U'.Y' : ' .' i "11 i-iav., ■\':<--i ... •■ •iii'J-N. nilO Ni !' ,-:■ y rM.f -> ask ?;".' '"«L. i i-(•;,-, •■■• ■>,;■'. ' lo. A. .tTid J lo Camden .8c. & ' ■$ V". Y-*. il! - l.< : M \ •: - ' ., contril"iied tin- •*i^ I '-.a! out : } i . . ii itt the I.'.v.r • m'iipiY..,. ;Th< ■■'■ m \\a* ( ei lorn n •' i'.'-' f " ■• Mi ' il i>!>: ' ; • \lc.!l >' n'i : v ' ■ ■' i "\ ■,,I. '"■, :' V ■ pDhu hi; ■:>■.• ,i '■'■ i.lti I oi '.' .". Y 8:null ..:. ..I. ' lvitlllhll . a ■ ' * 7' . 5 "•;. Ii."iir-| i.: ■ i- uis-iliart-wi •. •r-' II W IH M> .; ,! , • A.-. . •'(■lit W'l . -•; " ■ .md .'itu-. ,,.. •• '■' I'l'ic: lions i X f f -I'.il' ■ HR "t.:<"li i •' ;n.>, I'l'iriuv •• . : . a.l'I.SUilll ' '. '.'1,"'! ' ' 1'iYQ !"! "ai.i iJ a-rvir. i' : •;l''.'W.'r. i- i • ...i;«..i.. .^ ..■ !■•''■ ■ ! !li« right "r'Crt.'^l.f '! i as per- . '..ni th-. a /,' ' |),. a iv;.t-r« ill: ■.,! !• . . Hi* ■' '■" the . . -rtuftl..' . , xt t.l • 1 '••■ill., ni':' 'r.'iflllh.}}\. '\ il 'I ' •.:■'!. 1- M* «.;;. ai'.'. u .'nt:..,,.-.: . ' I . W. Iv' a "I < -' .l.|. of til. lilnil .; I'i'nv. J .XXVI) is :. ■ ,i\ • > ■ ■■ i .'uiitioi of the b< ia ■ ti: •!. Hi.' : "l3l;o :< \< suiting .11 :h.k1i. iiiliIh .•t-..f- :..-.«>, If sp. ;. \i,\,p.48. Med.H Surg. Hist .of the War of the Rebellion. Part HJVoLJl Opp. |>a;>e l-7(i Kd. Kbur.li fintlrt T Si.iulmi- X S„„ . luo.noj.lh PLATE LXXVI __ LACERATION OF RIGHT LEG BY SOLID SHOT. Case of I), .lei-man. 1'. UK) IVmiHvlv;uii;i SECT- v-l PRIMARY AMPUTATIONS IN TH?: LEG. 479 FIG. 287.-Bony stump of the left leg, five months after amputat'n. Spec. 4330. Fig. 288.—Stump after an- tero-posterior flap amputa- tion. Spec. 4305. CASE 734.—Private F. W. Knight, Co. E, llth Vermont, aged 21 years, was-wounded in the right leg, at Winchester, September 19, 1864, by a minie" ball, which passed through the ankle joint. He was conveyed to the Depot Hospital of the Sixth Corps, where amputation was performed but not recorded. Surgeon F. V. Hayden, U. S. V., noted the following history: "The wounded man was admitted to Sheridan Hospital, Winchester, October 5th, with amputation of the right leg at middle third, performed the day after the injury by Surgeon W. A. Barry, 98th Pennsylvania, the flap method being used, with circular section of the muscles. Erysipelas appeared a few days after the operation. One and a half inches of protruding bone was removed on October 10th. The treatment consisted of stimulants and tonics, including quinine, etc." On December 5th the patient was transferred to Frederick Hospital, and two weeks later to Central Park, New York City, whence Acting Assistant Surgeon S. Teats contributed the specimen, No. 4330, Surgical Section, A. M. M., represented in the annexed cut (Fig. 287), with the following result of the case: "The stump became painful and tender, its end cold and bluish in appearance, and a circular exuberant ulcer formed in the cicatrix. On February 15, 1865, chloroform was administered and re-amputation was performed by the circular method by Surgeon B. A. Clements, U. S. A. Sutures, adhesive straps, and water dressings were applied after the operation. The result was favorable and the stump healed.'' The patient was discharged from service August 17, 1865, and pensioned, having been previously furnished with an artificial leg by Dr. E. D. Hudson, of New York City. In his applications for commutation the pensioner reported the stump as remaining in "good condition." His pension was paid March 4, 1880. The specimen consists of the re-amputated stumps of the tibia and fibula, showing an excellent deposit of callus but being carious internally. Case 735.—Private J. Shaud, Co. K, 93d Pennsylvania, aged 26 years, was wounded at Fair Oaks, May 31, 1862. He was conveyed to White House Landing and thence by transport steamer to New Haven, Connecticut. Surgeon P. A. Jewett, U. S. V., iu charge of Knight Hospital, recorded the wounded man's admission, June 9th, with " amputation of leg," and reported that he recovered and was transferred to New York City January 19, 1864, "to be furnished with a wooden leg." Surgeon B. A. Clements, U. S. A., reported that the patient was dis- charged from service at Central Park Hospital March 9,1864, by reason of " loss of right leg by primary amputation, performed for shot fracture involving the ankle joint." A cast of the stump {Spec. 4305, Surgical Section, A. M. M.), showing the cicatrix to be located on the anterior face above the extremity, was contributed by Acting Assistant Surgeon G. F. Shrady, and is shown in the adjoining wood-cut (FlG. 288). Dr. E. D. Hudson, of New York City, who supplied the pensioner with an artificial leg before he left the hospital, described the stump as having been formed by an "antero-posterior flap amputation at the junction of the middle and lower thirds" of the limb. The pensioner was paid June 4, 1880. He reports the condition of the stump as remaining sound and healthy. In the following instance both legs were successfully amputated at the middle thirds one day after the injury: Case 736.—Private E. B. Higginbotham, Co. F, 38th Georgia, appears recorded on a Confederate hospital register as having had "both legs fractured by gunshot, at Spottsylvania Court House, May 12, 1864," for which "both limbs were ampu- tated at the middle third by Surgeon W. J. Arrington, P. A. C. S., on the following day.rt The man recovered, and was subse- quently furnished with artificial legs by the Confederate Association for the relief of maimed soldiers. Fatal Primary Amputations in the Middle Third of the Pones of the Leg.—The one hundred and fifty operations of this group were performed on twenty-two Confederate and one hundred and twenty-eight Union soldiers. Exhaustion, pysemia, and gangrene were reported as the principal causes of death. Case 737.—Private E. J. Valleley, Co. A, 3d Rhode Island Artillery, aged 18 years, was wounded by the explosion of the magazine of the Gunboat "George Washington," near Beaufort, S. C, April 10, 1863. His injuries comprised two scalp wounds of no great importance, a compound fracture of the upper fifth of the right ulna, a fracture of the right femur at its middle, and compound comminuted fracture of the bones of the right leg and foot. There was most alarming nervous depression. Stim- ulants and nourishment were liberally supplied, but no decided reaction followed. Forty-eight hours after the receipt of the injuries it was thought best to amputate the leg, which operation was performed at the middle third on April 12th. After the operation the thigh continued to swell till it reached an enormous size, which circumstance gave reason to believe that the femoral artery had been ruptured by the fractured ends of the femur. The patient was delirious a good part of the time after the operation. He died on the morning of April 14, 1833. There was no attempt at union in the incisions that were made for the removal of the limb, and the stump had an unhealthy look, the discharge being of an ashy color and pasty consistence. For tw7o days before he died he was isolated from the other wounded patients. After death a large quantity of bloody serum was found in the cellular tissue of the thigh; the artery and vein were entire in their whole length. The lower fragment of the femur was pushed up behind the lower end of the upper fragment, denuding the latter of its periosteum for more than three inches. The amputated portions of the tibia and fibula were found to be both broken at the junction of the malleoli with these bones, the tibia being stripped of peri- osteum for about four inches upward from the joint. The fibula was also broken about three inches above the joint. The posterior end of the os-calcis was broken off, and this bone was extensively fissured and otherwise injured; the cuboid bone was comminuted. The wound in the soft parts was about four inches long, running upward from the superior surface of the astrag- alus on the inner side of the leg, and the tibia protruded some two inches. The history, together with the specimen (No. 1165, Surg. Sect, A. M. M.), consisting of the amputated bones of the leg, was contributed by Surgeon F. L. Dibble, 6th Connecticut. ISO INJURIES OF THE LOWER EXTREMITIES. [(HAP x. Case 733.—Brigadier General G. W. Taylor. U. S. V., was wounded in the left leg, at Bull Kim, August 27. 1802. The cliaracter of the injury and its result was reported by Assistant Surgeon J. B. Brinton, IT. S. A., as follows: "A ball entered at the inner edge of the tibia, about six inches above the internal malleolus, passed directly through and comminuted the bone very badly for about six inches above and below, making two openings of exit on the anterior and outer aspect of the leg about five inches above the external malleolus. The patient was admitted into the Mansion House Hospital, Alexandria, thirteen ho*rs after the reception of the injury, where Surgeon J. H. Brinton, V. S. V., amputated the limb by the double flap method at the middle third. The operation was performed twenty-six hours after the reception of the injury, the patient losing considerable blood aud all the vessels requiring ligation. He had been with the army through the Peninsular campaign and his blood appeared to be very much vitiated by morbific influence of malaria. After the amputa- tion it was discovered, what was previously suspected, that the fibula was not broken by the force of the ball, but by the weight of the patient coming upon it suddenly when the support from the tibia was destroyed by its fracture. The patient's arterial system did not fully react; his pulse, which was feeble, tremulous, and very irregular nt times, evidently denoted a depraved condition of the system. He refused to take stimulants except sparingly. This condition continued until September 1, 1862, when he died at 4 o'clock A. m. He was under the influence of chloroform during the operation." The amputated parts of the tibia and fibula {Spec. 313, Surg. Sect., A. M. M.), represented in the wood-cut (FlG. 289), were contributed to the Museum by the operator. Case 739.—Lieutenant C. J. Sergeant, Co. F, 7th Iowa, aged 31, was wounded in the left leg, during the siege of Atlanta, August 11, 1864. Surgeon J. M. Woodworth, 1st Illinois Light Artillery, described the injury as an "extensive fracture of both bones of the leg, produced by a musket ball, for which amputation was per- formed on the same day by Surgeon W. R. Marsh, 2d Iowa, at the field hospital of the 2d division, Sixteenth Corps." Five days after the date of the injury the patient was moved to the field hospital at Marietta, and two months later he Avas transferred to Chattanooga, thence to Nashville, and later to the Officers' Hospital at Louis- ville. Surgeon F. Greene, U. S. V., in charge of the latter, described the amputation to have been performed by the "antero-posterior flap method at the middle third," and reported that "for a month after the operation oozing of blood continued from the stump, the patient's condition being feeble. Gangrene supervened in the latter part of September, chiefly attacking the anterior flap. The bone became necrosed, and in October two pieces were removed and the gangrene controlled." The patient was lastly admitted to Grant Hospital, Cincinnati, where he obtained a leave of absence on December 12th. He died at his home in Ottumwa, Iowa, April 10, 1865, his attending physician, Dr. J. C. Hinley, certifying that "his disease was pysemia, being caused by the amputation of one of his lower extremities, the stump of which never healed." Fie:. LWi.-Left tibia fractured by a musket ball;fibulafraO' tured by the subject's weight suddenly com- ing upon it.— Spec. 313. Table LXIX. Summary of Light Hundred and Ninety-two Cases of Primary Amputations in the Middle Third of the Leg for Shot Injuries. [Recoveries, 1—736; Deaths, 737—886; Results unknown, 887—892.J Name. Military Description, and Age. 1 Abbott, F.A., Pt., K, 7th j May 16, N. Hampshire, age 38. 17, '64. 2 j Ackerrnan, J. II., Pt., C, I Jan. 11, 31st Iowa, age 24. j 11, 63. 3 I Allen, li. 1 ..Pt., V, I'20th Nov. 2, Now York, age 20. 2, '64. 4 j Alt, M., Pt., V, 26th May 16, 17, '63. Mav 7, 7. '64. July 22, 22, '64. Mi 5 I Ambrose, R., Pt., F, 8th Conn., age 27. 6 Anderson, J.,Pt., K, 18th Missouri, age 20. Anderson. W., Pt.,H, 5th Sept. 29, Col'd Troops, age 18. 29, '64. Andrew*. A. S., Capt., B, 2d North Carolina. Anglim, N. J., l't., I, 24th Tennessee. Apple. L., Pt., I, 1st Flor- ida Cavalry, ago 33. Armstrong, j.M.,Pt.,K, 13th Iowa. AsUlerman, J., Pt., B, 51st Ohio. Augustine, F., Pt..I,2lst Wisconsin, age 24. Averili, J. R., Pt., E, 8th Vermont, age 23. Babbitt, J. W., Pt., C, 24th Michigan. 16 j Bailey, A. \V., Pt., A, 24th New York. June 9, !•, '63. De.:;i.'(!2. Jan. 2,'63 Dec. 7, 8, '64. July 21, 21,"'64. June 17, 18, '62. Mav 14, 14,''64. Sept. li), 19, "64. July 1, 2, '63. Sept. 14, 16, '62. Operations, Operators, Result. Left; double flap. Mustered out December 22, 1864. Left; flap. Surg. G. L. Carhart, 31st fowa. Disch'd April 13,'63. Left; flap. Snrg.H.A.Reynolds, 1 st Me. H'vy Art'y. Recovery. April 9, 1870, stump good. Right; circ. Surg. J. S. Prout. 26th Missouri. Gang.; erysip. Disch'd Oct. 24, 1863. Right; flap. Surg. M. Storrs, 8th Conn. Disch'd Maj- 7, 1865. Right; flap. Surg. A. B. Mono- han, 63d Ohio. Disch'd Aug. 2, 1865. Left; circ. Surg. II. C. Merry- weather, Sth Colored Troops. Disch'd May 8, 1865. ----. Surgeon — Gill, C. S. A. Recovery. ----. Recovery. Right; circ. Provost Marshal March 4, 1865. Left; flap. Surg. M.W. Thomas, 13th Iowa. Discli'd July 21,'65. Left; flap. Surg. M. C. Wood- worth, 51st Ohio. Disch'd Feb. 23, 1863. Left: flap. Discharged. 1870, stump sound. Right: circ. Surg. J. G. Thomp- son, 77th N. York. Gangrene. Discli'd Oct. 11, 1865. Right; flap. Surg. A. J. Ward, 2d Wis. Disch'd Nov. 6, 1863. Left; flap. Disch'd Dec. 13, '62. Died October 11, 1867. Name, Military Description, and Age. Bailey, B., Pt., D, 7th S. Carolina Bat'ry, age 44. Baird, J. N., Corp'l, A, 34th Illinois. Baird, J. 'J'., Lieut., C, 16th Virginia, age 31. Baldis, J., Pt., C, 39th New York, age £7. Ball, R. G., Serg't, D, 147th N. York, age 20. Ballentine., G. W., Pt., H, 14th Tennessee, age 25. Barber, S. M., Capt., II, 42d Ohio. Bates. O, Corp'l, G, 51st New York, age 23. Bates, O. W., Pt., M, 1st Me. H'vv Art., age 37. Baum, F."W., Pt.,C, 10th Missouri. Baxter, W. IL, Lieut., K, 113th Ohio, age 21. Bean, W. It., Pt., 7th Maine Bat'rv, age 27. Beaton, D. P.* Serg't, M, 2d Ohio Cav., age 21. Beatty, T., Pt., I, 4th N. York Artillery, age 39. Bee, D. IL, Pt, A, 61st Penn., age 25. Beeman,G.W.,Pt., K,2d Conn. H. Art., age 20. Beer, A. G., Pt., D, 26th Ohio. Aug. 21, 21, '64. April 7, 9, '62. Aug. 19, 20, '64. Julv 2, 2, '63. Mar. 31, Ap. 1,'65. Oct. 1, 1, '64. May 22, 22, '63. Sept. 17, 18, '62. April 6, 6, '65. Nov. 25, 25, '63. June 27, 27, '64. May 12, 12," '64. June 9, 10, '63. June 3, 3, "64. July 12, 12, '64. Oct. 19, 20, '64. De.31,'6£ Jan. 1,'63. Operations, Operators, Result. Right. Provost Marshal April 1, 1865. Left. Discharged. Left; circular; gangrene. Trans- ferred Nov. 9, 1864. Left; ant. post. flap. Surg. F. Wolf, 39th N. Y. Discharged April 16, 1864. Left; lateral flap. Surg. A. S. Coe, 147th New York. Disch'd August 2, 1865. L't; oval flap. Surg. A. G. Emory, C.S.A. Retired Jan. 20, 1865. Right; flap. Surg. J. Pomerene, 42d Ohio. Disch'd Mar. 15, '64. Left; ant. post. flap. Surg.W. II. Leonard, 51st N. Y. Discli'd January 17,1863. Right; flap. Discharged Sep- tember 12, 1865. Left; circ. Surgeon It. J. Mohr, 10th Iowa. Disch'd Apr. 22,'64. Right; flap. Discharged Dec. 29. 1864. Lett: circ. Discharged Septem- ber 5, 1864. Right; flap. Surg. W. H. Mc- Roynolds, 2d Ohio Cavalry. Disch'd Oct. 15. 1864. Left; flap. Discharged January 26, 1864. Right; ant. post. flap. A.A.Surg. M. F. Price. M. O. Sept. 7, '64. Right; circ. Surg.W. A. Barry, 98th Penn. Disch'd July 25,'65. Left. Surg. M. M. Stimmel, 26th Ohio. Disch'd Aug. 9, 1863. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 481 34 35 36 I* i :» ! 39 I 40 Name, Military Description, and Age. Beers, B., Pt., D, 69th Ohio, age 21. Beers, J. B.,Pt., E, 146th New York, age 29. Bennett, M..Pt.,B, 125th New York. Bennett, R. 11., l't., 1), 7th ('. Troops Benson, L. W 16th Conn., aj Berg, M.,Pt..15, 7th Kan- sas Cavalry. Biddle, A. H., Pt., K, 24th New Jersey. Biggert, H, Pt.. L, 15th Penn. Cavalry. 42 Bitten, L. ('.. l't., K, 1st U. S. S. S., age 21. Bixby. L. C, l't.. (I, 45th Illinois. Blake, J., Pt., K, 20th Massachusetts. Blokrh-i/. H. P., Pt., F, 14th South Carolina. Blakla, W., Pt., E, 46th New York, age 29. Blevins, J., Pt., E, 49th Illinois, age 21. 48 49 50~ 51 55 56 57 58 59 60 HI 62 63 64 65 66 Bloxon, W. N., Pt.. E, 22d C. Troops, age 20. Bocklay, H., Pt., D, 2d Maryland, age 22. Bodley, C, Corp'l, K, 28th "Iowa, age 24. Boehme, F., Pt., C, 20th Mass.. age 27. Bond, J. D. M.. Pt., C, 78th 111., age 38. Bonedun. C. W.. Pt., G, 7th Virginia Cavalry. Book, G., Pt.,E, 6th Col- ored Troops. Booth. J. I.. Pt., B. 12th W. Virginia, age 22. Boucher, P., Pt., I, 28th Massachusetts, age 26. Bowen. J., Pt., C, 42d Illinois, age 21. Bowland,W.,Pt„C, 142d New York, age 21. Bowman, H. A.. Pt., G, 2d N. Hampshire. Boyd, J. £'.. Pt., I, 44th Tennessee. Bradin, R.. Lieut., E.7th N. York Heavy Artil- lery, age 34. Bragg, J. Jv\.Pt.,G, 25th Virginia. Braillie, J., Pt., A, 1st Artillery, age 33. Brannon, P., Pt., E, 28th Illinois. Brantley. L. G., Pt., C, 33d North Carolina. Bray, P., Pt., G, 1st Mas- sachusetts H'vy Artil- lery, age 33. Bremenkamp, F.. l't.. A, 9th Illinois. Bridgem, L. H., Serg't, H, 26th Xeiv Jersey. Britting, J., Pt., E, 116th New York, age 19. Bronson, D.. Pt., H. 6th N. Y. Artillery, age 29. Bronson. J. B..Pt..1.1.4th Ohio, age 18. Brookings, D., Serg't. H, 17th Maine, age 22. Brotherson, C, Pt., G, 151st N. Y., ago 30. Brott, J. C, Pt., B, 2d N.Y. H'vy Art., age 24. Brower, H.'H.,Serg't, B. 10th N. Y., age 21. Hire 23. Pt., I, >40. Nov. 25, 27. '63. Sept. 16, Sept. -^, 311. '(il. Sept. 17, 19. '62. Dec. 24, 24, '62. Dec. 13, 14, '62. Julv 2, 2, '63. Mav 31, 31," '64. Feb. 11, 11, '62. Dec. 13, 15, '62. Julv 2, 3, '63. Aug. 16, 16, '64. April 9, 9, '64. Sept. 7, 8, '64. Dee. 13, 13. '62. Mav 16. 16.''63. Mav 6, 7. '64. Sept. 1, 2, '64. July 1, 1, '63. Feb. 11, 11. '65. June 13, 14, '63. June 3, 3, '64. Dec. 30, 31, '62. Oct. 13, 13, '64. July 21, 23, '111. Dec. 14, 14, '63. June 16, 17, '64. Dec. 13, 13, '61. July 3, 3, '63. Oct. 5. 5, '62. Julv 3, 4, '63. Oct. 2, 4, '64. April 6, 7, '62. Mav 3, 3, '"63. Oct. 19, 20, '64. May 30, 31, '64. Aug. 5, 5, '64. June 16, 16, '64. Sept. 19, 19, '64. June 2, 2, '64. May 10, 10," '64. Operations, Operators, REsn.T. Right: circ. Disch'd May 20, 1864. Right: circ. Snrg. A. A. White. 8th Md. Disch'd March 23, '65. Left: llap. Sing. \V. S. Cooper. 125th N.Y. Disch'd Aug. 12,'l»5. Right; llap. Disch'd May 17, 1865. Right ; llap. Sing. A. S. Warner, Kith Conn. Disch'd Jan. 23,'63. Lett. Discharged April 7, 1H63. Lett. Discharged June 29, 1863. Right; flap. Surg. J. W. Alex- ander, 15th Pennsylvania Cav- alry. Disch'd June 16, 1864. R't: circ. Sing. G. M. l'.ivmian, 1st Sharpshooters. Disch'd Sept. 13, 186-1. Reamp. April7, Mi. liiyht: llap. June. 1862. re-amp. Disch'd July 23. 1862. Left. Sing.' N. Hayward. 20tli Mass. Discli'd Oct' I. 1863. Right. Confederate surgeon. Pa- roled Sept. 5. 1863. Right; flap. Surg. W. B. Fox, 8th Michigan. Discharged. Right; ant. post. flap. Surg.C. L. Lucas, 47th 111. Mustered out Sept. 9, 1865. Left; flap. Disch'd May 26, '65. Right: circular. Discli'd April 21. 1863. Right; flap. Disch'd June 16, 1865. Died June 17. 1870. Left; circ Confederate surgeon. Discharged. 1870, stump good. Right: flap. Surg.T.B.Williams. 121st Ohio. Disch'd May 6,'65. Left. Union surgeon. Recovery. Left: circ. Surg. N. S, Barnes. U.S.V. Recovery May 6, 1865. Right; ant. post. Hap. Confed. surgeon. Disch'd May 15. '65. Right: lateral Haps. Surg. P. E. Hubon. 28th Mass. Disch'd Nov. 28. 1864. Right. Surg. T. D. Fitch, 42d Illinois. Haan. June 20,1863, amp. thigh. Dis. April 28,1864. Left; flap. Surg. D. McFalls, 142d N. Y. Gang. Oct. 27, re- amput'n. Disch'd Sept. 11, '65. Left; flap. Surg. E. T. Perkins, 71st N. Y. S. M. Disch'd Nov. 1, 1861. Right. Surgeon G. McDonald, 22d Virginia. Recovery. Right; ant. post. flap. Surg. J. E. Pomfret, 7th N. Y. H'vy Art. Disch'd January 27. 1865. ----. Surg. — Blandy, C. S. A. Recovery. Right; circ. Disch'd February 29, 1864. Left. Surg. W. F. West. 28th Illinois. Disch'd April 7, 1863. Left. Surg. J. A. Vigae, 33d N. Carolina. Recovery. Right; circ. Surg. O. Everts, 20th Indiana. Gangrene. Dis- charged June 14, 1865. Left; circular. Disch'd March 13, 1863. Right. Disch'd Sept. 15, 1863. Right: flap. Discharged Aug. L 1865. Right; ant. post, skin flap; circ. sect. mns. Disch'd Feb. 25,'65. Right. Surg. G. E. Sloat, 14th Ohio. Amputation thigh. Dis- charged June 21. 1865. Right; ant. skin and post. muse. flaps. Disch'd Jan. 10, 1865. Died Dec. 6, 1870. Left: ant. post. flap. Discharged August 11, 1865. Left: circ. Surg. G. L. Potter, 145th Penn. Recovery. Right; flap. Surg. M. Rizer, 72d Penn. May 15, amputation leg. Disch'd Nov. 2, 1865. Name, Military Description, and Age. Brown, C. K., Pt., A, 7th Wisconsin, age 24. lirinrn. J. M„ Pt., D, 5th Alabama, age 28. Brown, W. M., l't., F, 91st Ohio, age 23. Bullard, ]•'. W., Pt., B, 57th Mass., age 19. liunigardnor, S.. Serg't F, 14th W. Ya.,age 35. Bunger.W'., Pt.JI, I 18th Illinois. Burd, S..Corp'l. B, 188th Pennsylvania, age 24. Burke. J., Pt., A, 13th New Hamp., age 23. Burns, 1!., Pt., B. 22d New York, age 24. hums. R., l't., A, 35th Illinois. Hur»s,R. K.,V\.,V. 14th Tennessee, age 25. Burr, D. 11.. Pt., A, 14th Connecticut, age 28. Burst,.I.W.,Lieut„105th Illinois, age 22. Bush, J. F., Pt.. G, 13th Bnslmell, M. D., Corp'l, H, 154th New York. BusiJ;. />."'.. Serg't. E, 22d North Carolina. Butler, J. H., Pt..E,3(>th Cold Troops, age 26. Butts, J. W., Capt.. H, 4th (I eorgia, age 25. Cady, E. A., Pt., H, 33d New York, age 21. Cain, F„ Pt., E, 40th Indiana, age 19. Cain, R.M., Pt., C, 18th Mississippi. Campbell. J. F., Pt., G, 9th Alabama. Canfield, M., Pt., B, 34th Mass., age 34. Carpenter.C.G., Pt.,Bat- tery H, 1st Art., age 25. Carroll, F., Pt,, D, 32d Col'd Troops, age 29. Carroll. P., Pt., G, 19th Penn. Cavalry. • Carter, S. H., Corp'l, A, 36th Mass., age 20. Catlin, I. S., Col., 109th New York, age 30. Caywood,P.,Pt.,B,110th Ohio. Chadwiek. J. A., Pt., D, 9th Maine, age 22. Chalfant, F. D., Serg't, F, 4th W. Va.,age21. Chamberlain. I)., Serg't, I), 21st l'enn. Cavalry, age 30. Chamberlain. T., Corp'l. 15, 79th Penn., age 26. Chamberlain, W. H., Pt., H, 42d Illinois, age 21. Chapman, J. H., Capt., B, 5th Connecticut. Charlton, O., Pt,, E, 34th Ohio. Chichester. A., Pt., E, 127th N. Y., age 24. Chiddes, (.!., Pt,, D, 13th Colored Troops. Christenson, W., Pt., I, 115th N. Y., age 23. Clardy, J.B., Pt.,C,24th Alabama. Clark, E. T., Pt,, E, 77th Penn., age 20. May 8, 9, '64. July 2, 2, '63. July 20, 21, '64. May 6, 8. '64. Sept. 22, 23, '64. May 1, 1, "63. Sept. 29, Oct. 1,'64, June 4, 4, '64. Sept. 17, 62. Mar. 7. 7, '62. June 26, 26. '64. Dec. 13, 13, '62. May 26, 26. '64. July 9. 11, *64. June 24, ■ 24, '64. July 2, 2. '63. June 20, 20. '64. July 12, 12, '64. May 3. 3. '63. Nov. 25, 26, '63. Sept. 9, 9. '63. June 27, 27, '63. June 5, 5, '64. May 3, 5. '63. Dec. 6, 6. '64. Feb. 16, 16, '65. June 6, 6, '64. July 30, 30, '64. June 14, 14, '63. Aug. 16, 17, '64. July 18, 19, '64. April I, 2, '65. Mar. 19, 19, '65. Nov. 25, 27, '63. Aug. 9, 11, '62. Sept. 10, 10, '62. Nov. 30, 30. '64. Dec. 17, 18, '64. May 7, 7, '64. Sept, 20, 20, '63. Nov. 30, De. 1'64. Oi'kkatioxs. Operators, Rksui.t. Left; circ. Surg. A. J.Ward, 2d Wis. Disch'd July 16, 1864. Feb. 6, '65, amp. leg. Recovery. Right. A. Surg. T. C. Hill, 5th Ala. Paroled Sept. 25, 1863. Left; ant. post. flap. A. Surg. A. Titus, 31st W.Virginia Cavalry. Disch'd January 31, 1865. Left; flap. Confederate surgeon. July 7. 1865, reamputation leg. Disch'd Nov. 23. 1865. Left (also amputation right foot). Disch'd March 4. 1865. Left; flap. Discli'd August 1, 1863. Right; ant. post. flap. Disch'd September 23, 1865. Left; flap. Disch'd May 25, '65. Died March 31, 1870: epilepsv. Right; circ. Disch'd May 6, '6*3. Sim: 2540. Right: flap. Disch'd August 2, 1862. Left. Retired February 20,1865. Right, Surg. G. T. Stevens, 77th N.Y. Reamp. Disch'd Mav 23, 1864. Died April 28, 1868; consumption. Right; flap. Surg. A. M. Reagan, 70th lnd. Gangrene. Discli'd October 19. 1864. Left; circ. Surg. C. H. Todd, C. s. A. Exchanged Sept. 21, '64. Right; flap. Surg. J. Reily, 33d N. J. Gangrene. Disch'd Aug. 12, 1865. Died June 5, 1866. Left. Surg. P. G. Robinson, 22d N. C. Paroled Sept. 12, 1863. Right; circ. Surg. G. J. Potts, 23d Colored Troops. Disch'd July 25, '65. Died Nov. 10,'67. Left. Surg.W. P.Young, 4thGa. To prison Feb. 5, I86S Left; circ.; re-amp.: gangrene. Disch'd Nov. 14, 1863. Right; gangrene. Disch'd Oct. 12, 1864. Left. Surg. — Green, C. S. A. Recovery. ----. Surg.C.C. Clarke, C.S.A. Recovery. Left; flap. Surg. R. R. Clarke, 34th Mass. Disch'd May 31,'65. Right: flap. Surg. C. S". Wood, 66th N.Y. Disch'd Feb. 23,'64. Left; post, flap. Surg. C. M. Wight, 32d Col'd Troops. Dis- charged May 24, 1865. Right. A. A. Surg. J. E. Lynch. Disch'd June 7, 1865. Left: circ; gangrene. Disch'd June 16. 1865. Left. Surgeon W. B. Fox, Sth Mich. Mus. out June 4, 1865. Right; flap. Asst Surg. R. R. McCandliss, 110th Ohio. Dis- charged Aug. 26, 1863. Left. Disch'd January 20, 1865. Right. Confed. surgeon. Disch'd June 24, 1865. Left; flap. Disch'd June 28. '65. Right; double flap. Confederate surgeon. Disch'd June 28, 1865. Left; circ. Surg.A. M.McMahon, 64th Ohio. Gangrene. Disch'd Sept, 27, 1864. Right, Surg. A. M. Helmer, 28th N. Y. Veteran Reserve Corps September 2, 1863. Right; flap. Disch'd March 15, 1863. Di$d Sept. 4, 1870. Right; post. muse. flap. Disch'd Mav 23. 1865. Right: flap. A. A. Surg. J. S. Giltner. Disch'd Aug. 8, 1865. Right; circ. Confed. surgeon. Disch'd May 30, 1865. ---. Surg. J. L. Cunningham, 24th Alabama. Recoveiy. Right; flap. Surgs. White and Hanna, C. S. A. Disch'd April 21, 1865. Surg. IU—61 482 INJURIES OF THE LOWER EXTREMITIES. NO 117 118 119 120 121 122 123 124 12 12G 127 128 129 130 131 132 133 134 135 136 137 38 139 140 141 I 12 143 144 145 146 147 148 149 150 151 152 153 154 156 157 Name, Military Description, and Age, Clark, H. B., Ft., F, 20th Maine. Clark, J. B., Pt., llth Vermont, age 29. Class, ('., Pt., G, 25th Mass., age 26. Clayton, H., Pt., E, 77th New York, age 20. Clement, J. M., Serg't, I, 43d Georgia, age 25. Clements. F. S., Pt., D, 6th N. Y.H. A., age22. Clingman, G.W., Pt., A, 88th Penn., nge 33. Clinton, F. D.. Pt., C, 25th New Jersey. Closs, W., Pt., K, 10th N*. Y. Heavy Artillery, age 37. Clunk, J., Pt., F, 76th Ohio, age 18. Cobb.G.W., Pt., K, 20th Maine, age 21. Cobb, J. P. C, Capt., H, 2d North Carolina. Cobb, M. A., Lieut., K. 23d Alabama, age 37. Cochennour, J. S., Capt.. H, 60th Illinois, age 34. Cogswell, A. H.. Pt., B. 1st Mass. II. A., age 18. Cole, A. J.. Pt.. C, 44th New York. Cole, W„ l't., H, 31st Massachusetts, age ~1. Coogan, R., Pt., E, 4th Artillery. Cook, A., Pt., E, 31st Iowa, age 34. Coombs, L., Pt., K, 4th Infantry, age 28. Cooper, J., l't., F, 47th Ohio, age 25. Corbet, J., Pt., G, 12fh Maine, age 26. Curlew. H. M..Corp'l. G, llth Vermont, age 19. Costello. II., Pt., 11,24th Massachusetts, age 30. Cotton. S. O., (apt., A. 4th Louisiana. Crago, G.W., Pt.,D,89th Ohio. Crane. A. F., Serg't, H, 145th Penn. Crao-ford, D., Pt., G, 1st S. C. Ritles. age 34. Crawford. D. S., l't., A, 47th Penn., age 20. Crosby, D. P., Pt., I, 6th South Carolina. Crowe, D.. Pt., E, 107th New York. Cuniff, J.. Pt., H, 35th New Jersey, age 26. Cunningham, C, Ft., D, 140th Penn.. age 22. Curley, M.. Ft., G, 2d Conn. H. A., age 26. Curran, T., l't., H, 2d Iowa. Curry. J.. Pt., H. 7th Maryland, age 21. Daicv. G. W., Corp'l, D, 53d* Penn., age 29. Dale. H., Pt., F, 5th N. Hampshire, age 26. Daller, J., Pt.. D. llth Indiana, age 25. Dalrvmple. J., Pt., B, 79th N. York, age 29. Daugerfield, L. J., Pt., Richard's Cavalry- Operations, Ope.:atoi:: Rr.SI'LT. Mav 4. 6, '64. Sept. 19, 19, '64. Feb. 8, 8. '62. Oct. 19, 19. '64. Julv 22, 23,"'64. June 1, 1, '64. Mav 8, 8, "64. Dec. 13, 14, '62. April 2, 3, '65. June 18, 18, '64. Mav 5, 7, '64. Sept. 19, 20. '64. Dec. 15, 17, '64. Sept. 1. 1, '64. Oct. 27, 29, '61. Dec. 13, 15, '62. May 18, 18.*'64. Oct. 16, 16, '62. June 27, 27, '64. Mav 24, 26.''64. July 22, 23, '64. Oct. 19, 20, '64. June 2, 2, '64. Aug. 16, 16,' '64. Mav 6, 6, '64. Sept. 20. 22. '63. Dec. 13, 13, '62. Julv 28, 28,"'64. Oct. 19, 19, '64. Sept. 30, 30, '64. Sept. 17 19, '62. Feb. 15, 15, '64. Julv 2, 4, '63. June 1, 1, '64. April 6, 6, '62. Mav 5, 6, '64. June 3, 3, '64. June 3; 3, '64. May 16, 16, '63. Oct. 10, 10, '63. June 3, 3, '61. Left; circular. Confed. surgeon. Disch'd Nov. 22, 1864. Right: flap. Surg. ('. B. Park, llth Vt. (W'ndarm,necrosed.) Disch'd Sept. 28, 1865. Left: circ. Surg. G. A. Otis, 27th Mass. Disch'd Aug. 14, 1862. Right: ant. post. flap. Surg.G. T. Stevens, 7'itli N. Y. Disch'd. Left; ant. post. flap. Returned to Provost Marshal Dec. 1, 1864. Right: circ. Disch'd September 17, 1864. Left; circ Disch'd September 21, 1864. Right; circ. Surg. J. Riley, 25th N.J. Disch'd Feb. 2. 18*63. Left: circ. Surg. G. H. Blick- hahn, 28th C. Troops. Disch'd August 11, 1865. Right; flap. Surg. A. Sabine, ■ibih Ohio. Disch'd May 23, '65. Left: ant. post. flap. Confederate surgeon. Disch'd Ma}' 7, 1865. Left: circ. Surg.B.M.Crowell,1st N. C. Exch'd Dec. 9, 1864. Right; circ. A. A. Surgs. J. C. Thorpe and J. R. Holmes. Gan- grene. Jan. 9, '65, amp. thigh. Provost Marshal June 3. 1865. Left: circ. Surg. E. Batwell, 14th Mich. Disch'd Dec. 14, 1864. Left; flap. Confederate surgeon. Disch'd Sept. 11, 1865. Right: circular. Disch'd April 8,' 1863. Right: flap. To Veteran Reserve Corps Nov. 19, 1864. Right. Disch'd Jan. 12, 1863. Right; flap. Surg. E. J. MeGor- risk, 9th Iowa. Gang. Disch'd January 26, 1865. Right: flap. Confed. surgeon. Disch'd November 14. 1865. Right; flap. Surg. I. N. Barnes, 116th 111. Disch'd Dec. 3, 1864. Left; double flap. Ass't Surg. W. C. Towle, 1 -..-th Maine. Dis- charged June 21. 1865. Right; double flap. Surg. C. B. Park, llth Vt. Dis. Oct. 27,'64. Left; post.flap: necro. Disch'd January 25. 1865. ----. Union surgeon. Recovery. Right; circular. Disch'd Feb. 7, 1864. Left. Disch'd February 6, 1863. Right: flap. Surg. D. W. Maull, 1st Del. To prison Jan. 21, '65. Right: flap. A. A. Surg. W. G. Smull. Necrosis. Discharged May 31, 1865. Spec. 4225. ----. Union surgeon. Recovery. Right. Discharged May 15,1863. Left; flap. Ass't Surg. J. T. Lanning, 35th N. J. Disch'd June 4, 1865. Right; ant. post. flap. Confed. surgeon. Disch'd Feb. 22,1864. Left; circ. Surg. H. Plumb, 2d Conn. H.A. Disch'dMar.18,'65. Left; flap. Subsequent opera- tion. Disch'd Oct, 14, 1862. Right. Confed. surgeon. May 19, 1865, re-amp. Discharged November 3. 1865. Left: circ. Surg. G. L. Potter, 145th Penn. Disch'd July 6, '65. Right; flap. Surg. J. H. Buck- man, 5th N. H. Disch'd May 6, 1865. Right; flap. Surg. J. A. Cotnin- gor. 11th Indiana. Disch'd July 31. 1863. Left: circ. Surg. J. P. Prince, 36th Mass. Gangrene. Disch'd Feb. ] 5,1865. Re-amp. 1868. Left. Surgs. Yost and White, C.S.A. Recovery. Name, Military Description, and Age. Corp'l, B, iv., age 23. Serg't, A. Daniels, IL, Pt., (', 5th N. Hampshire, age 22. Daniels, J., Pt., K, 47th Indiana. Danniker, E. T.. Serg't, A, 1st Maryland Art'v. Davey, T. P., l't., I, 6th Texas. Davis, B. W. 24th N.Y. C Davis, F. M. 32d Tenness Davis, H. T.. Pt., G, 5th Vermont, age 24. Davis. J. B., Pt., I, 96th Pennsylvania. Dawson, A. J., Pt., G, 49th Virginia, age 30. Day, C. H., Pt., A, 32d Maine, age 30. Decker, P., Ft., I, 23d Indiana. Deckertt, A..Pt., B, 79th Penn., age 19. DeForest.A., Pt., D,]5th N.Y. H'vy Art., age 40. Demasner, J. G., Pt., H, 30th Mass., age 36. Deniston, W. H., Corp'l, A, 15th Ohio. Dennis, A., Pt., G, 79th Pennsylvania. Dennis, A., l't., I). 38th Indiana, age 32. Demiv. F. J., Serg't, A, 1st Cavalry, age .26. Drpratto. J.', l't., H, 1 Ith Virginia, age 27. Devall, E., Pt,, K, llth Connecticut, age 19. Dewalt, J. S., Pt., M, 100th l'enn., age 19. Dewey. G., Pt., D, 51st New York. Dibble, C. A., Serg't, E, 29th Wisconsin. Dibble. H., Corp'l, G, 14th New York Cav. Dicker son, J. M., Pt,, I, 18th Alabama, age 23. Dickson, J. H., Pt., C, llth Infantry, age 19. Dickson, W.,Pt., 1, 109th Pennsylvania, age 24. Donley,J.P..Pt.,L, 18th Penn. Cavalry, age 40. 1 Donsheidt, W., Pt,, I, 5th Artillery, age 29. Doty, J. S., Pt., D, 19th Michigan. Dougherty, J.L., Serg't, M, 18th Penn. Cavalry, age 24. Dougherty, S..PL, I, 8th Penn., age 27. Douglas, W., Pt., B, 6th Wisconsin, age 34. Downing, D. J., Capt., H, 97th N. Y., age 22. Drake, A. H.,Pt., C,13th Michigan. Drake, C. N..Pt., C, 12th N. Hampshire, age 24. Duddenhausen, A., Pt., G, 17th N. Y., age 24. Dudley, W. F.,Pt.,F, 1st Maine Cavalry. Duey, J., Pt,, C, 54th Ohio, age 25. Duffy, P. H., Pt., B, 2d Colorado. Durkee, W. P., Pt,, B, 4th Vermont, age 22. Eades, J. M., Corp'l, F, 70th Indiana, age 23. June 2, 2, '64. Mav 16, 17."'63. Sept. 17, 17. '62. Mar. 5, 5, '64. June 17, 19, '64. Sept. 19, 21. '63. Mav 5, 7. '64. Sept. 14, 15, '62. Mar. 25, 25, '65. May 12, 12, '64. Mav 12, 14. '63. Mar. 19, 19, '65. Mar. 31, 31, '65. Oct. 19, 20,'64. April 7, 8, '62. Sept. 19. 19, '63. Dec. 11. 12. '64. Julv 28, 28,''64. Julv 2, 3. '63. Mar. 14, —, '62. June 2, 3, '64. Dec. 13, 14, '62. Mav 1, 3, '63. June 15, 15. '63. May 15, 15,"'64. May 12, 12, '64. July 20. 2(),''64. June 15, 15, TA Sept. 19, 19, '62. June 16, 16. '64. July 6, 7, '*63. Dec. 13, 13, '62. June 18, 19, '64. July 1, 1, '63. Mar. 18, 20. '65. July 2, 3, '63. Sept. 2, 3, '64. Mar. 1, 2, '64. July 22, 23, '64. Feb. 22, 23, '62. Dec. 13, 14, '62. June 15. 15, '64. Operations, oi'i:i;aioi;s. Result. Left; circ. Surg. J. W. Buck man, 5th X. H. Disch'd Oct 15, 1861. Right: circular. Disch'd Oct. 14, 1863. Right; llap. Surg. M. Rizer, 7 2d Penn. Disch'd Julv 4, 1863. ----. A. Surg. R. E. Hill, C. S.A. Retired December, 1864. Left: circ. Surg.W. C. Shurlock, 51st Penn. Disch'd May 31, '65. ----. Surg. J. '1'. Grant, 32d Tennessee. Recovery. Right; ant. post, flap.' Disch'd January 13. 1865. Right; circular. Disch'd March 1. 1863. Left. Released June 24, 1865. Right; circular. Disch'd Aug 26, 1864. Left; flap. Surg. M. Brucker, 23d lnd. Disch'd Aug. 8, 1864. Right; flap. Disch'd June 11, Left: circ. Disch'd September 20, 1865. Left; flap. Discharged Septem- ber 5, 1865. Left; flap. Surg. S. T. Trow- bridge, Sth Illinois. Disch'd June 2, 1862. Left; flap. Surg.W. M. Wright, 79th Penn. Disch'd Feb. 9, '64. Left; ant. post. flap. A.A.Surg. E. Jennings. Dis. Mar. 10,1865. Right; circ: gangrene. Disch'd Nov. 22, 1864. Left. Surg. J. Harrison, C. S.A. Exchanged Nov. 12, 1863. Right; flap. Surg. (',. Derby, 23d Mass. Hsem. Disch'd Oct. 15,'(i2. Left: ant. post. Hap. Surg. H. Ludington, 100th l'enn. .Mus- tered out Sept. 7, 1864. Left; slough. Dec. 28, re-amp. Jan., 1863, amp. thigh. Disch'd Oct. 23, 1863. Left: circular. Disch'd Septem- ber 7, 1,863. Left: circular. Disch'd Septem- ber 24, 1863. Right; circ. Surg.C. J. Bellows. 7th Ohio. To Provost Marshal December 1, 1864. Right; flap. Discharged Jan- uary 3, 1865. Right; ant. post. flap. Surg. J. A. Wolf, 29th Penn. Disch'd April 20, 1865. Left; ant. post. flap. Dec. 23, re-amp. Disch'd Mar. 15, 1865. Left; circ. .Ass't Snrg. S. Adams, U. S. A. Discli'd May 3, 1863. Left; flap. July 7. re-amputat'n. Disch'd July 17, 1865. Left; flap. Drs. F. Dorsey and N. B. Scott, Hagerstown, Md. Disch'd Dee. 19, 1864. Left; flap. Disch'd March 14, 1864. Left; ant. post. flap. Ass't Surg. J. C. Hall. 6th Wis. Dischyd May 4, 1865. Left- flap. Surg. E. G. Chase, 104th N.Y. Resig'd Feb. 12, '64. Left; flap. Disch'd July 26,'65. Left. Surg. H. B. Fowler, 12th N. H. Disch'd March 16, 1864. Right. Discharged May 4, 1865. Left. Surg.W. A. Spence, C.S.A. June 14, amp. thigh. Disch'd August 14, 1865. Left; circ. Surg. I. N.Barnes. 116th 111. Mustered out Oct. 24, 1865. Died July 22, is;0. Left: flap. Ass't Surg. B. Norris, U. S. A. Disch'd July 16,1862. Left: circ: gangrene. Disch'd April 25, 1863. Right: flap. Snrg.A.W. Reagan. 70lhlnd. Disch'd June8, 1865. > Fisher (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam September 17, in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 483 Name, Military Description, anu Age. Eaton, D. C, Corp'l, H, 5th N. Hamp., age 30. Operations, Operators, Result. Sept. 17, 17, '62. Eaton, G., Pt., D, 121st ! Nov. 7, New York, age 27. | 7, '63. Eckerman, D. F.,Pt., H, I Aug. 5, 2d Iowa. Edleman. W., Pt., K, 129th 111., age 26. Ehret, J., Pt., G, 1st X. Jersey Cav., age 19. Ehrman, C, Serg't. C, 17th Mo., age 28! Eisert, C. H. F., Pt., C, 17th Infantry, age 38. Elliott, T., Corp'l, A, 119th Penn., age 20. Erving, R. M.,Pt.,B,26th Mass., age 20. Estis, F. M., Pt., D, 34th Virginia. Everts, D., Pt., H, 142d New York, age 24. Faas, C, Serg't, I, 7th Massachusetts. Facks, J., Corp'l, B, 6th Wisconsin, age 32. Fairley, H., Pt., I, 28th Massachusetts, age 34. lFaiver, A. J., Pt,, 18th Miss., age 19. Fallon, T., Pt., D, llth Massachusetts. Farmer, N., Pt., —, 13th North Carolina. Farmer, T. F., Serg't, G, 51st New York. Farnsworth.E.,jr..Lieut., C, 26th Massachusetts. Farrell, W., Pt,, F, 158th New York, age 32. Farthing. W. G. W., Pt., D. 5th Texas, age 26. Faulkner, L.. Pt., C, 2d Artillery. Fellers, J. A.,Pt, I, 87th Pennsylvania, age 21. Felman, J. R., Capt., I, 108th New York. Fenlin, W. H., Serg't, F, 88th Pennsvlvania. Ferguson, j'. W., Pt., I, 19th Alabama, age 24. Ferriter,J..Pt., Letcher's Battery. Fieldson, T., Serg't, F, 14th New York Heavy Artillery, age 21. Fink, F., Pt., B, 5th New York, age 18. Fletcher, T., Pt,, I, 82d New York, age 23. Foote, D. W., Lieut., I, 3d Iowa, age 33. Foss, J. A., Serg't, C, 1st Maine, age 22. . '64. June 15, 16, '64. July 28, 28, '64. June 25, 25, '64. Mav 12, 12,' '64. May 10, 10, '64. Sept. 19, 19,'64. July 30, 30. '64. Oct. 27, 27, '64. June 1, 1, '62. July 1, 3, '63. July 2, 4, '63. Sept. 17, 18, '62. May 3, 3, fe. Aug. 16, 16, '64. Sept. 30, 30, '64. Oct, 19, 20, '64. Sept. 29, 29, '64. Julv 2, 3, '63. April 13, 14, '63. Sept. 19, 20, '64. July 3, 3, '63. Dec. 13, 15, '62. Julv 22, 23," '64. July 2, 2, '63. Mar. 25, 25, '65. June 2, 2, '64. Julv 2, 2, '63. Oct. 5, 5, '62. April 2, 2, '65. Foster, M. F., Serg't, H, June 17, 59th Mass., age 26. 18. '64. Foughty, G. W., Serg't, I Dec. 28, B, 57th Ohio. [ 28. '62. Franklin. J. S., Serg't, i Aug. 29, A, 74th New York. ' 3(1, '62. Franklin, S., Pt., G, 54th , Nov. 30, Massachusetts, age 42. Dec .1, '64. Frazier, W., Pt., 1,140th j April 6, Pennsylvania. 6, '65. Free, S. S., Pt., B, 170th New York, age 20. Freidrich, J., Corp'l, K, 2d Michigan, age 28. Frost, L. G., Pt., C, 3d Maine, age 23. Frost, N. G., Pt., G, 32d Maine, age 34. Fry, H. S.,Corp'l, B,12th Iowa, age 24. May 18, 18, '64. June 18, 18, '64. May 10, 10. '64. July 30, 30, '64. Mar. 27, 27, '65. Left. Surg. L. M. Knight, 5th N. II. Gangrene. Dec. 29, amp. thigh, lower third. Discharged Mar. 13. 1863. Died Julyl,'63. Right. Disch'd June 15, 1864. Right; flap. Surg.W. R. .Marsh, 2d Iowa. Disch'd June 20, 1865. liight: circ. Surg. D. Johnson, 129th 111. Gangrene. Disch'd June 6, 1865. Left; circ. Surg.W.W. L. Phil- lips. 1st N. J. Cavalry. Disch'd Nov. 11, 1864. Right; ciro. Surg.A.Sabine,76th Ohio. Disch'd March 14, 1865. Left; ant. post, flap; sloughing; exfol. Veteran Reserve Corps Maroh 3, 1865. Right; circ. Surg. P. Leidy, 119th Penn. Disch. June 15,'65. Died Oct, 29, '73 ; cong. brain. Right; long post, flap ; slough.; necrosis. Disch'd Nov. 7,1864. ----. Surg. — Mason, C. S. A. Retired Feb. 17, 1865. Right; circ. Surg. G. C. Jarvis, 7th Conn. Discli'd June26,'65. Right, Surg. O.Adams.7th Mass. Disch'd Sept. 28, 1862. Left; flap. Disch'd March 16, 1864. Left. Surg. Z. E. Bliss, U. S. V. Bone removed; hsem. Disch'd March 22, 1865. Left; posterior flap. Right; flap. Disch'd September 21, 1863. Right, Surg. — Bace, C. S. A. Retired Jan. 9, 1865. Left; flap. Confederate surgeon. Disch'd Jan. 5, 1865. Left. Surgeon J. G. Bradt, 26th Mass. Disch'd Feb. 11, 1865. Left; circ. Disch'd April 11, '65. Left. Paroled November 12, '63. Right; flap. Disch'd October 10, 1863. Left; flap. Mar. 22, '65, re-amp. Disch'd May 20,'65. Spec. 4198. Right. Surg. F.Wolf, 39th N. Y. Disch'd April 22, 1864. Right; flap. Disch'd June 14, 1864. Right; circ. Transferred Sept, 22, 1664. Right. Retired February 9,1865. Right; flap. Surg. W. C. Shur- lock, 51st Penn. Disch'd Nov. 6, 1865. Spec. 1145. Right; flap. Confed. surgeon. Duty Oct.'19, 1864. Right; flap. Disch'd July4, '64. Left. Surg. B. F. Keables, 3d Iowa. Resigned Aug. 21,1863. Left. Surg. F. M. Everleth, 7th Me. Disch'd July 2, '65. Bone removed in 1867. Left; flap. Disch'd May 23, '65. Died Aug. 23, '76; tuberc. dis. Right: flap. Surg. E.O.F. Roler; 55th 111. Disch'd Mar. 7,1863. Right. Surg. J.T. Calhoun, 74th New York. Disch'd Oct. 29,'62. Left; circ. Disch'd July 2,1865. Right; flap. A. Surg. B. F. Hill, 140th Penn. Disch'd June 27, 1865. Right; flap. Surg. D. W. Maull, 1st Del. Disch'd Nov. 10,1864. Right; flap. Surg. W. B. Fox, 8th Mich. Discli'd July 4,1865. Right; flap. Surg. T. HMdreth, 3d Me. Disch'd Nov. 19, 1864. Left; flap. Disch'd Feb. 8,1865. May, 1865, amp. knee joint. Left; flap. Disch'd September 25, 1865. Name, Military Description, and Age. 242 Fryer, E„ l't., A, 1st Delaware, age 33. 243 Fuller, C, Pt,, K, 14th N.V. H'vy Art., age 19. 244 Fnrney, M., l't., (!, 126th Ohio, age 26. 245 ' Fyans, A., Corp'l, F, 32d New York. 246 ; Gallup, E. A., l't., L, 1st : Vt. H'vy Art., age 21. 247; Ganster, W. A., Pt., I). Independent Penn. Ar- tillery, age 21. 248 Garner, J., Pt., I, 5th N. Carolina. 249 Garvin, M., Corp'l, C, 40th New York, age 33. 250 Gaskins, J., Pt., D, 4th Virginia Battery. 251 Gates, E. B., Capt., H, 4th Pennsvlvania. Gieseke, A." Pt., I, 12th Missouri. 253 Gilbert, D. iJ.,Pt.,K, 23d South Carolina, age 35. 254 Gillen.J., Pt., A, 35th N. Jersey, age 23. 255 Gilkerson, J., Corp'l, G, 140th Pennsylvania. 256 Gillighan. H.,Pt., K,22d Mass.. age 23. 57 Gilmore, T., Pt., 1,107th New York, age 21. 258 Ginnings, E. K., Pt., K, 26th Illinois, age 19. 59 Glatzel, P. P., Pt., E, 26th Wisconsin, age 28. i0 Glynn, M.. Pt., A, 107th New York, age 48. 261 Godchalke, A., Capt.,H, 79th Pennsylvania. 52 Goery,L., Serg't, B,90th Pennsvlvania. 263 Goodno'w, A. H., Pt., C, 30th Iowa, age 22. 264 Goslon, L., Lieut., I, 33d N. Carolina, age 22. 265 Gosper, J. J., Lieut., C, 29th C. Troops, age 24. 266 Graham, G. W., Serg't, E, 7th Minnesota, age 24. Graham, R., Pt., A, 98th Illinois, age 19. 58 Grant, J., Pt., F, 12th Rhode Island. 19 Graves, B. V., Pt,, Cren- shaw's Va. Batter}'. 270 Greely, P., Pt., A, 1st Wisconsin, age 22. 271 Green, D. M., Pt,,A,97th New York, age 26. Green, E., Pt., H, 5th N. Carolina Bat'v, age 23. 2731 Grreuismi. S.W., Pt., E, 4th Georgia. 274 CmiiuvU.J. ,t.,Pt,.Bal- tiniore I/ght Artillery. 275 j Gritlith.W.'C. P., Pt., H, 80th Indiana, age 20. Grim, G. W., Corp'l, V, 6th Ohio Cav., age 30. Gross, W., Pt., C, 7th Penn. Res., age 27. Grove, S., Pt,, K, 3d Iowa. Groves, C.H.,Pt.,K,18th Massachusetts, age 23. Hackle.r,J.P., Serg't, K, 3d Mississippi, age 23. Hadlow, H., Pt., H, 81st New York, age 21. Halm, M., Serg't, C, 26th Wisconsin, age 32. Haight, O., Pt., L, 2d N. Y. H. Art'y, age 26. June 3, 3, '64. June 18, 20. '64. Sept. 22, 23, '64. May 7, 8, '62. June 1, 2, '64. Aug. 38, 18, '64. Sept. 17, 17, '62. June 18, 18, '64. July 1, 1, '62. June 30, J'y i,'62. July 17, 17, '63. July 2, 3, '63. Dec. 9, 9, '64. April 6, 6, '65. May 11, 11, '64. May 25, 27, '64. Mar. 22, 22, '65. June 1, 1, '64. Mar. 16, 16, '65. Sept. 19, 19, '63. Sept, 17, 17, '62. May 13, 13, '64. April 2, 3, '65. Dec. 4, 4, '64. Dec. 16, 17, '64. April 17, 18, '64. Dec. 13, 14, "62. Jnne 27, 27, '62. July 21, 21, '64. June 12, 13, '64. May 5, 6, '62. Aug. 21, 21, '64. Sept, 17, 17, '62. May 14, 15, '64. Feb. 5, 5, '65. Dec. 13, 13, '62. July 12, 14, '63. Nov. 7, 7, '63. Nov. 30, 30, '64. May 31, J'e r,'62. Mar. 19, 19, '65. April 7, 8, '65. Operations, Operators, Result. Left; flap. Surg. D. W. Maull, 1st Del. M.O.Nov. 19, 1864. Right; flap. Disch'd July 7, '65. Left: flap. Disch'd March 27, 1865. Left. Surgeon F. II. Hamilton, U. S. V. Disch'd July 15, 1862. Left; double flap. Gangrene. Discharged Oct. 21, 1865. Right; circ. Surg. E. Jackson, 30th Colored Troops. Disch'd Jan. 3,1865. Right. Union surgeon. Fur- loughed Doc. 19, 1862. Right. Surg. O. J. Evans, 40th N. Y. Disch'd March 4, 1865. ----. Recovery. Left. Surg. M. S. Kittinger, 100th N. Y. Disch'd Oct. 3L, 1862. Left: flap, Surg.J.Spiegelhalter, 12th Mo. Disch'd April 14,'64. Right. Exchanged Nov. 12, '63. Left; double flap. Surg. A. B. Monahan, 63d Ohio. Trismus. Transferred April 14, 1865. Right; circular. Mustered out. Left; ant. post. flap. Surg. I. H. Stearns, 22d Mass. Discharged October 17, 1864. Left; circular. Discharged July 20, 1865. Right; lateral flaps. Surg. A. T. Hudson, 26th Iowa. Disch'd June 27, 1865. Left; flap. Disch'd Sept. 21,'65. Right; circ. Surg. P. H. Flood, 107th N. Y. Disch'd Feb. 20,'66. Left; flap. Surg.W. M.Wright, 79th Penn. Nov. 21, '65, re-amp. 23d, haem. 31. O. June 30,1866. Right. Disch'd Nov. 20, 1862. Right; flap. Surg. A.T. Hudson, 26th Iowa. Disch'd June 16,'65. Right: circular. Released June 9. 1865. Left. Surg. D. 3IacKay, 29th C. Troops. Discli'd May 15,1865. Right; flap. Surg. V."B. Kenne- dy, 5th Minn. Disch'd April 4, 1865. Right; flap. Ass't Surg. A. T. Barnes, 98th 111. Disch'd July 23, 1864. Right. Ass't Surg. J. G. Wilbur, 18th Mass. Disch'd Mar. 13,'63. ----. Surg.W.C.Warren,C.S.A. Retired Feb. 22, 1865. Left; flap. Surg. L. J. Dixon, 1st Wis. M. O. March 1, 1865. Right: circ. Surg. W. B. Cham- bers, 97th N. Y. Disch'd June 13, 1865. ----: flap. Discharged October 17, 1862. Right. Snrg.W.P.Young.C.S.A. Exchanged. Right, Surg. R. A. Lewis,C.S.A. Recovery. Right: ant. post. flap. Ass't Surg. W. P. Welborn, 80th Indiana. Discli'd May 18, 1865. Right; ant. post. flap. Disch'd August 16, 1865. Right. Gangrene. Discharged May 2, 1863. Left; flap. Discharged October 13, 1863. Left. Surg. W. Holbrook, 18th Mass. Disch'd March 28,1864. Left: circ. To Provost Marshal March 7, 1865. Right. Confed. surgeon. Gang. Aug. 1, amp, thigh; 15, re-amp. thigh. Disch'd May 2, 1863. Left; circular. Disch'd Nov. 23, 1865. Right; flap. Disch'd June 6, '65. •Fisher (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antietam, September 17 1862, in American Journal Medical Sciences, Volume XLV, page 48. ■M INJURIES OF THE LOWER EXTREMITIES. Name. Military ! Description. anl a< Operations. Operators. Result. Name. Military Description, and Aoe. Operations, Operators, Result. 281 I Hallam.H.C.,Pi., Fred- ericksburg Artillery. 28.5 Hallett. D., Serg't. F, ] 67th Ohio, age 24. Ilalscy, II., Pt.. F, 48th Pennsylvania, age 26. Ham it,'T., Serg't.E,12th Georgia. Hamilton, T. P., Pt., K, 13th Georgia. Hamilton, W. J., Serg't, I, llth Pennsylvania Reserves, age 23. Hammer, G.. Serg't. E, 52d New York, age 37. Hanlon, W., Pt., E, 27th New York. Hannah, G., Pt., G, 3d Florida, age 24. Hardin, J., Lieut,, G, 101st Illinois, age 39. Hunting, W. R., Pt., C, 15th North Carolina. Ilftrjiir.F. M., Pt..(', (ith Missis-ippi. Barrett, II. D., Pt., G, 31st X. Carolina.age 22. Harrigan, J. M., Corp'l, A, 26th Ohio, age 22. Harriger, J., Serg't, B, 105th Penn., age 19. Harrington, G. W., Pt., «, 38th Ohio, age 22. 288 289 290 291 292 293 294 295 296 297 2! >8 299 300 301 302 303 304 305 306 Horny. J. M., Pt., D, 37th Virginia. Harris, I,., Corp'l. G. 143d Pennsylvania. Harris, L. S.. Corp'l, C, Jeff. Davis Legion. lHarwood. E. F., Pt., 18th Mississippi, age 30. Hascnour, G., Pt., I, 49th Indiana. Havens. J. S..Pt.,H, 33d New York. Hawkins. W.W., Serg't, I, 93d X. York, age 21. Haynes, C. H..Serg't, E, 20th Maine, age 28. Heist. E., Pt., E, 27th Pennsylvania. Heist, j. A.. Pt., G, 6th Michigan Cavalry. Hemingway, N. M., Pt., H, 32d Mass., age 17. Hemminway, A., Pt., K, 49th New York, age 25. Henderson, S. R., Pt., F, 36th Virginia. Hendricks. 31., Pt., K, 79th Indiana. llendnckson, J., Lieut. Uol., S3d New York. Hessler, P., Pt., K, 82d New York, age 23. May 5, 7, '64. June 8, 10, '62. July 6, 6, '63. 316 , Hibbs, T., Pt., G. 2d N. I June 1, Y. H'vy Art,, age 47. 1, '64. 317 Hickey, P., Pt., E, 3d Mav 14, ' N. \\ Artillery, age 31. 14.' '64. 318 Hicks. J., Pt., B, 6th \ Jlav 14, j Tennessee. : 14.''64. 319( Higginbotham,E.B.,Vt., ' Mav 12, 320), F, 38th Georgia. 13."'64. | 321 I Higgins, V. X., Pt., H, I 3Iav 4, 2d Maine, age 24. ! 5. '63. 322 Hiller, J. A., Corp'l, D, I Sept. 26, 9th New York Cavalrj', 26, '64. age 26. 323 j Hines, G.W., Pt.,C, 9Sth Dec. 17, I Ohio, ago 19. i 17, '64. 324 i Hinson. J. L., Lieut., I, Sept. 19, 6th Alabama, age 29. 19. '64. 325 Hinson, J. W., I't.C. 33d j June 29, i Indiana, age 22. | 29, '64. 326 Hobbs, J., Pt., B, 39th I Sept. 19, Indiana. 19, '63. Right. Ass't Surg. H. L. Hines, (.'. S. A. Recovery. Right; ant. post. flap. Disch'd July 29, 1865. Left; circular. Disch'd January 5, 1865. Right; flap. Surg. — Lamar, C. S. A. To Fort McHenry Jan. 5, 1865. Left. Surg. J. Ebersole, 19th lnd. Prison June 25, '63. Spec. 4819. Left; circ. Surg. C. Bower, 6th Penn. Reserves. Mustered out June 13. 1864. Left; circ. Surg. J.W.Wishart, 140th Penn. Discli'd May 22,'05. Right; flap. Surg.— Smith, C. S. A. Must, out .May 31, 1863. Left; circ. To Provost Marshal Dec. 1, 1864. Left; flap. Disch'd Oct. 13, '64. Oct., 1865, re-amputation. Right. Furloughed. ----. Confederate surgeon. Re- covery. Left. To prison January 23, '65. % Right: circular. Di-rli',1 Mav 15, 1865. Right; flap. Surg. — Fattersyn, C.S.A. Disch'd Sept. 8, 1864. Left; flap. Surg. J. Haller, 38th Ohio. Gangrene. Discharged Mav 27, 1865. Right. Surg. — Butler, C. S. A. Exchanged March 3, 1864. Left; Hap. Disch'd Jan. 23,'65. ---. Surg. — Metcalfe, C. S. A. Recovery. Right; post. flap. Doing well. Left: flap. Surg.J.A.Ritter,49th Indiana. Disch'd Feb. 8, 1864. Right. Discharged. Right. Ass't Surg. A. B. Haines, 20th lnd. Mav 16, amp. thigh. Disch'd July 12.'65. Spec. 4497. Left; Hap. Confederate surgeon. Disch'd April 10, 1865. Left; flap. Discharged Septem- ber 16, 1862. Left; flap. Confederate surgeon. July 27, re-amp. Discharged May 21, 1864. Right; circular. Disch'd June 18, 1863. Right; circ. flap. Discharged March 30, 1865. ---. Surgs. Bell and Cross, C. S.A. Retired Dec, 1864. Left. Discharged February 28, 1863. Right. 31ustered out June 30, 1866. Right; circ. Surg. S. H. Plumb, 82d New York. Disch'd June 9, 1865. Left: circ. Surg. G. L. Potter, 145th Penn. Gangrene. Disch'd Nov. 4, 1865. Re-amp. 1866. Right. Discharged December 7, 1864. Left; circular. Discharged No- vember 21, 1865. Both. Surgeon W. J. Arrington, P. A. C. S. Recovery. Left. Discharged June 9, 1863. Left; post. flap. Surgeon A. P. Clark. 6th N. Y. Cav. Disch'd June 29, 1865. Right: circular: gang. Disch'd May 26, 1865. R't: circ. Surg. — Weatherby, C. S. A. To prison Dec. 9,'64. Right; flap. Surg. J. Bennett, 19IU Mich. Disch'd July 21,'65. Right; flap. Disch'd January 9, 1864. 361 362 363 364 365 366 367 368 Hochstetler, C, Pt., D, 54th Penn.. age 19. Hoffses, R.W.,Corp'l, E, 20th Maine, age 29. Hogue, W., Pt., G, 83d Pennsylvania, age 24. Holladay, J. F., Pt., C. 48th Ohio, age 22. Hood, J. E., Serg't, F, 35th Mass., age 23. Hooks, B.A., Pt., B, 59th Georg-ia, age 27. Hope, J., Pt., H, 2d Vir- ginia, age 30. Horton, B. J.. Lieut., I, 24th Ohio. Hough, W., Pt., A, 58th Illinois. Howard, W. F., PL, I, 14th N. Hamp., age 24. Howie, J.N.,Vt., B, 53d North Carolina, age 31. Hubbard, J. M., Serg't, H, 2d Miss., age 26. Hudson, J., l't., H, 31st Indiana, age 25. Huffman, ('., Pt.. K. 7th Illinois, iige 17. Huggins, A. C, Serg't Maj., 24th N. Carolina. Hunn, W. R., Corp'l, A, 122d N. Y., age 35. Idner, G. AV., Pt., I, 23d Indiana. Ingraham, .ff.,Pt..H,43d North Carolina, age 49. Inman, S., Pt., F, 16th Maine, age 31. Irvin, J., Lieut, E, 45th Penn., age 36. Irving, W., Major, 38th Ohio, age 30. ' Isham, F. W., Corp'l, D, 7th Wisconsin, age 32. Jackson, J., Serg't, F, 12th Mo. Cav., age 22. James, J., Pt., B, 57th Illinois, age If. Jecko, P., Serg't, D, 15th Missouri, age 29. Jedowin, T., Pt,, C, 1st Vt, H'vy Art., age 17. Jellison, N. F., Pt., llth Ohio Battery. Jenne, R. C, Corp'l, 1, 17th Vermont, age 20. Jerman, D., Ft., F, 190th Penn., age 23. Johnson, A., Pt., K, 1st N. J. Cavalry, age 19. Johnson, G., Pt., A, 43d Colored Troops, age 38. Johnson, J., Pt., G, 17th Virginia, age 18. Johnson, J. M.,Pt.,C, 3d Delaware, age 31. Johnson, AV. T., Pt., I, 113th Ohio, age 21. (Alias T. F. Ricker.) Johnstone, R., Pt., G, 121st Penn., age 31. Joline,W.H.,Pt..E,12th Penn. Reserves, age 20. Jones, VV., Corp'l, II, Sth New York H'vy Art,. age 25. Junes, W. M., Serg't, K. 50th Georgia, age 22. Jones, W. P:, Pt,, F, 12th Wisconsin, age 24. Jones, W. S., Lieut., I. 2d Arkansas, age 21. Jones, Z., Pt,, B, 24th N. Carolina, age 25. Jordon, J. P., Lieut., B, 7th Virginia Cavalry. June 18, 18, '64. May 5, 6, %4. July 1, 1, '62. Mar. 12, 13, '63. July 30, 30, '64. Aug. 14, 14, '64. Nov. 6, 8, '63. De.31,'62, Jan.1,'63. July 14. 14, '64. Sept. 18, 19, '64. Sept, 5, 6, '64. Sept, 17, 17, '62. May 12, 12, '63. Feb. 15, 15, '62. April 20, 20, '64. Oct. 19, 20,'64. May 12, 12," '63. May 30, June 1, 1864. April 1, 2, '65. May 18, 18, '64. Aug. 5, 5,v64. Mar. 31, 31, '65. Dec. 17, 18, '64. Oct. 5, 5, '64. Nov. 29, 29. '64. Mar. 25, 25, '65. Sept, 19, 20, '62. April 2, 2, '65. July 11, 11,*'64. July 7, 8, '64. Oct. 27, 27, '64. Nov. 11, 12, '64. June 3, 3, '64. Aug. 6, 6, v64. April 1, 2, '65. May 10, 10, '64. June 22, 23, '64. July 2, 4, '63. July 21, 21,"'64. Jan. 2, 3, '63. April 2, 2, '65. May 29, 29, '64. Right: ant. posterior double flap. Disch'd April 1, 1865. Right; circular. Disch'd Decem- ber 12, 1864. Right. Discharged May 30,1863. Right; flap. Disch'd July 23, 1863. Left; circ. Surg. G. W. Snow, 35th Mass. Disch'd April 12,'65. Right, To prison October 15, 1864. Left; flap. Surg.W.Wynne, 14th Penn. Cav. Disch'd June 29,'64. Left, Resigned June 10, 1863. Right.; flap. Mustered out Mav 3, 1865. Right; flap. Surg.W. H.Thayer, 14th N. H. Disch'd Jan. 9, '65. Right; flap. Surg. L. Hill, 53d ' N. C. Recovery Jan. 8, 1865. Left ; flap. Transferred Decem- ber 14, 1862. Left; circ. A. Surg. A. C. Mills, 125th 111. Disch'd Oct. 16,1863. Right; double flap; re-amput'n. Discharged May 1, 1862. ---. Surg. W. R. Wilson, 24th N. C. Retired Feb. 24, 1865. Right; Hap. Snrg. (1. T. Stevens, 77th N.Y. Disch'd Jlav 31, '65. Right: circ. Surg. 31. Brncker, 23d lnd. Discli'd Aug. 7, 1863. Right: circ. A. Snrg. .1. T. Duf- rield, 7th Indiana. To prison Dec. 30, 1864. Right; flap. Discharged August 23, 1865. Right; circ. Surg. H. E. Smith, 27th Mich. Disch'd Jan. 18, 1865. Died April 17,1871. Left; flap. Surg. J. Haller, 38th Ohio. Must, out July 12, 1865. Left; circ. Surg. D.C. Ayers,7th Wis. Disch'd June 13, 1865. Right; circular. Disch'd July 2, 1865. Right; ant, post. flap. Surg. J. R. Zearing, 57th 111. Discharged Julv 22, 1865. R't; flap. A.Surg.W. L. Graves, 6th Ark., C.S.A. Disch'd July 31, 1865. Also amp. forearm. Left; flap. Surg. J. J. Meigs, 3d Vermont. Disch'd Sept. 14, '65. Left, Disch'd April 4, 1863. Right; flap. Surg. L. W. Bliss, 51st N. Y. Disch'd Oct. 13, '65. Right: flap. Surg. L. AY. Read, U. S. V. Disch'd Aug. 7, 1865. Died May 9, '80 : ulcera. stump. Left; circular. Discharged. Right; circ. Surg. E. Jackson, 30th C. T. Disch'd Sept. 14,'65. Right; circular. To prison Feb. 10, 1865. Right, Surg. D. E Wolf, 3d Del. (Also amp. at left ankle joint.) Discharged June 8, 1865. Left; flap. Surg. T. B.Williams, 121st Ohio. Disch'd May 23, | 1865. DiedJIay 11, 1874. Right; circular. Disch'd Sept. 30, 1865. Left; circ. flap. Surg. B. Rohrer, 10th Penn. Reserves. Disch'd March 24, 1865. ' ' Left: ant. post. flap. Surg. G. Chaddock, 7th Mich. Disch'd Decembers, 1864. Right. Exchanged March 17. 1864. Left; flap. Surg. E. M. Rogers 12th Wis. Disch'd June 1, 1865. Left; flap. Discli'd November 7,1864. Left. Released July 22, 1865. ---. Surg. — Price. 7th Vir- ginia. Furloughed. 1 Fisher (G.J.I. Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg. Md., after the battle of Antietam. September 17, J8G2. in American Journal Midicul Sciences, Volume XLV, page 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 485 I Name, military | hates ^"•i Description, and Age 369 370 371 372 373 ;i74 389 390 391 392 393 394 395 396 397 398 399 J400 401 Jowers, IF, Pt., F, 17th Miss., age 39. Kapp, J., PL, I, 17th Missouri. Kaufman, W., Serg't, 10, 3d .Missouri. Keon. R. M.. l't., F, 50th Georgia. Keller. IL, PL, 11, 55th Pennsylvania, age 23. Krister, J. ir..Serg't,6th Alabama. Keller, I. X., Corp'l, B, 21st Ohio, age 22. Kelly, E., PL, A, 29th Massachusetts. Kellv. L. C, Corp'l, K, 52dOh'n«, age 21. Keltner. S., PL, 1. 66th Ohio, age 18. Kendall, T. C, Capt., B, ! 21st X. J., age 35. j Kenfield, C. B., PL, K, 35th Massachusetts. Kennedy, J., Pt., Sth Ohio Battery. Kent, L. S., PL, G, 4th Louisiana. Kenworthy, L., PL, B, 22d Indiana, age 23. Kerr, J. H, Lieut., H, 57th X. C, age 20. Ke:iuh. I'.C.Pt., P,35th North Carolina. *Kiild. W. J., l't.. 49th Virginia, age 26. Killebrew. U. if.. Pt., C, 12th Georgia, age 22. Kissinger. H., PL, F, 34th Virginia. Knight. C.10..PL.F, 19th Iowa. Knight, F.W., Pt., E, 1st Vt. H'vy Art., age 21. Knowles. J., Corp'l, K, 114th Illinois. Kocb, D., PL, A, 54th New York. July 2, 3, '63. Jan. 11, 11, '63. Jan. 11, 11, '63. Julv 2, 4, '63. .lime 3, :i, '6-1. Mav 5, 6. '64. t. 1, 1. 64. Sept. la 18, '62. Jan. 27, 28, '64. Dec. 19, 19, '64. Mav 4, 6, '63. Sept. 17, 19. '62. June 5, 5, '63. Aug. 31. 31. '64. Mar. 16, 16. '65. July 20, —,''64. May 19. 20.''64. Sept. 17, 17, '62. July 2, 2, '63. Sept. —, 29, '64. Dec. 7. 8, '62. Sept. 19, 20, '64. July 15, 15, '64. Aug. 29, 29, '62. Koch, H., Serg't, F, 82d May 25, Illinois, age 26. 26, '64. Koehler, A., Pt.. D, 4th Dec. 13, New York. I 13, '62. Kopp, E., Pt., K, 12th Mar. 25, New Jersey, age 32. I 27, '6~>. 2Kosack, O., PL, K, 2d Maryland, age 26. Kriner, J., PL, B, 48th Pennsylvania, age 26. Lacy, j. F., Capt., B, 44th Virginia. Laird, P. P., Pt., D, 49th New York, age 19. Langfit, J. W., Pt., A, 100th Penn., age 21. Lariviere, A.. PL, D, 5th Mich. Cavalrj-, age 35. Larkins, W., Pt., G, 91st New York, age 19. Lathrop, W., Pt., F, 67th Ohio, age 18. Latimer, J. T., PL. L, 3d Alabama, age 21. Latta, W. T., Pt.. A, 53d Georgia, age 22. Law, A. H., Pt., C, 33d Indiana, age 24. Lawrence, C. P., PL, B, 32d Mass.. age 21. Dec. 13. 13, '62. Oct. 29. 29, '64. May 3, 3. '63. Aug. 21, 21, '64. May 5, 7. '64. July 10. 10, '63. Mar. 31, 31, '65. April 2, 2, '65. May 2, 3, f63. July 10, 10, '63. July 20, 20, '64. July 2, 3, '63. Operations, Operators, Result. Right; flap. Reainpnt'n. Ex- changed March 17, 1864. Right; ant, post. Hap. Surg. 10. C. Franklin, V. S. V. Disch'd Jan. 22, 1864. Right; llap. Discharged May 29, 1863. ____. Surg. J. L. Harris, C.S. A. Paroled Nov. 12, 1863. Left; llap. Discharged March 2, I860. ____. Surg. iseh'd Mar. 3, '63. Right ; tlap. Surg. M. M. Booton, 86th 111. Disch'd Jan. 26, 1865. Right; ant. post. flap. Disch'd June 30, 1865. Right; circ. Surg.E.G.Greenleaf, 54th X. C. Mustered out June 19, 1863. Right; flap. Surg. G. W. Snow, 35th Mass. Disch'd Mar. 4, '63. Left. Surg. ('. Carle, 41st 111. Gangrene. Disch'd Sept. 8,'64. Left. Recovered. Left; flap. Surg. J. A. Stillwell, 22dlnd. Disch'd June 12,1865. Left. Confederate surgeon. To prison February 16,1865. ----. Surg. C. J. O'Hagan, 35th N. C. Recovery. Left: post.flap. Transferred. Left. Surg. — Etheridge, C.S.A. Exchanged Nov. 12. 1863. Right, Doing well October 25, 1864. Right; flap. Surg. M. B. Coch- ran, 1st Iowa Cavalry. Disch'd April 25, 1863. Right; flap of skin, circ. of mus. Feb. 15, reamputat'n. Disch'd Aug. 17, 1865. Spec. 4330. Left: flap. Discharged October 9, 1864. Right. Surg. C. W. Hagen, 54th N. Y. Sept. 3, re-amp. up. third. Disch'd April 14,'64. Spec. 6707. Left; circular. Discharged Aug. 31, 1865. Right, Discharged August 28, 1863. Left; flap. Surg.A.Satterthwaite, 12th X. J., and A. Stall'Surg.W. J.Bnrr.F.S.A. (Alsoamp. right leg, low. third.) April 2. slough. Discharged Oct. 3. 1865. Left; gangrene. Disch'd June 15, 1864. S/»re. 6706. Right: circ. Surg.W.O'Meagher. 69th N. Y. Disch'd June 6, '65. Right. Surg. P. F. Whitehead, C. S. A. R< Right; Hap. Surg.G. T. Stevens, 77th N.Y. Discli'd July 18,'65. Left: flap. Surg. W. V. White, 57th Mass. Dis. Julv 18, 1865. Left; Hap. A. Surg. A. R. Stone, 5th Michigan < 'uvalrv. Disch'd December 7, 1863. Left; ant. post. flap. Surg. R. Morris, 91st N. Y. Discharged July 21, 1865. Left; circ. Surg. J.Westfall,67th Ohio. Disch'd Aug. 12, 1865. ----; flap. Transferred June 9, 1863. Right. Surg. 10. M. Waters, P. A. C. S. Exch'd .March 17, 1864. Left; flap. Gangrene. Disch'd July 21, 1865. Left; circ. Surg. Z. B. Adams, 32d Mass. Disch'd July 27, '64. Name, Military Description, and Age. 3Lati'rencr, J. R., Lieut., I, 1st Louisiana, age 33. Lee, A. \V., l'i., K, 2d N.Y. H'vy Art.,age 22. Lemmon, E.,Pt., 10. 16th Ohio. Lentz, I)., PL, L, 5th l'enn. H'vy Artillery, ago 40. Leonard, A. (J., PL, B, IstW.Vn. Cav., age23. Lewis. J.W., Pt., K, 13th Kentucky, age 21. Light,*). II, Pt., F, 12th Ithode Island. Little, A., Pt., F, 106th Penn., age 22. Locke, W. X., PL, K, 41st Mississippi. Lor.kett.K. /''.,Pt., C,23d Virginia. Loeketl. W. F., Pt., E, 36th Virginia, age 20. Operations, Operators, Result. Sept. 17, 17, '62. Aug. 16, 17, '64. Dec. 29, 30, '62. Oct. 6, 6, '64. Sept. 26, 28, '64. Nov. 16, 17, '63. Dec. 13, 13, '62. June 1, 1, '64. Sept. 20, 20, '63. Mav 3, 3, '63. Oct. 19, 19, '64. Loeteeh.C, Serg't, B,2d June 18, Penn. Art'ry, age 36. —, '64. Long, J. C, PL, A, 3d Oct. 11, Indiana Cav., age 22. 11, '63. Long, J. D., PL, C, 15th De.31,'62, Indiana. :Jan.l,'63. Lord, T. W., Lieut., K, I May 3, 17th Maine. | 3, '63. j Lorell, B. L., Pt., B, 17th j Aug. 7, Virginia Cavalry. | 7, 64. Lucore, L., Pt., C, 1st ; Dec. 13, Penn. Rifles. I 13, '62. Luzader, T., PL, C, 33d \ Sept. 27, Ohio, age 21. 27, '62. Lyons, W., PL, E, 1st | Oct. 12, Tennessee Cavalry. I 12, '63. Habers,H. S.,-Pt.,H,nth\ July 2, Alabama, age 24. j 3, '63. Mainor, J. M., PL, B, 37th Georgia, age 22. Male, G. W., Seaman, Baron DeKalb, IT. S. N. Maley, J., PL, II, 7th Conn., age 26. De.31,'62, Jan. 1,'63. Mar. 13, 13, '63. May 14, 14,' '64. Malloy, P., PL, A, 10th Sept, 19, Tennessee, age 38. 21,'63. Malters, B.. PL, A, 108th '•■ July 3, New York, age 17. i 3, r63. 433: Manahard, W. E., PL, May 31, G, 2d Mississippi. 31, '62. 434 Mangan, II., Lieut., D, June 24, 75th Illinois. 24, '64. 435 | Mnnsnn.H. IF., Serg't.H, i April 2, 7th Tenn., age 22. ' 2, '65. 436 i Mopes. IF W., PL, F, Oct. 19. 5th X. Y. Cav., age 42. 20, '64. 437 Martin, F. S., Pt., F, 2d Oct, 19, Vermont, age 21, | 20, '64. 438 | Martin, J., PL, L, 2d June 16, N.Y. H'vy Art, age21. j 16,'64. 439 Martin, W., Pt., D, 7th : May 18, Maine, age 16. , 18, '64. 440 ! Mason, D. L.,Pt..IS, 38th July 30, Wisconsin, age 15. : 30, '64. 4411 .Mason, E. F., Pt.,0, 29th I July 3, Ohio, age 19. , 3, '63. 442 | Masterson, P.,Pt.,A,59th ' Aug. 25, New York, age 51. 27, '64. 443! Maury, J., Pt., E, 31st I Georgia, age 38. 444 May, E. A., Pt., A, 27th Michigan, age 21. June 2, 3, '64. Nov. 16, 17, '63. Right; post. flap. Transferred November 28, 1862. Right; circ. Disch'dJune27,'65. Died Sept. 25,'68; consumption. Left; flap. Surg. J. Pomerene, 42d Ohio. Disch'd April 3, '63. Left; circ. A. Surg. J. McCann, 5th Penn. Heavy Artil'y. Dis- charged June 8, 1865. Right: flap. Discharged March 27, 1865. Left; flap. Discharged .May 17, 1864. Right; circ. Discharged April 6, 1863. Right; flap. Surgeon M. Rizer, 72dPenn. Disch'd April 15.'65. tight. Surg. J. S.Cain, C.S. A. Recovery. .eft. Ass't Surg. — Dennis, 23d Virginia. Recovery. tight; circ. Surg. J. Watkins, 36th Va. To Provost Marshal February II, 1865. .eft: Hap. Surg. E. Griswold, 2d Penn. Disch'd Oct. 19, 1865. light. Surg. E. W. H. Beck, 3d lnd. Cav. Discli'd April 6, '64. . Discharged March 6, 1863. Left; flap. Surg. C. S. Wood, 66th N. Y. Disch'd Sept. 10, 1863. Re-amp. November, 1864. ----. Surg. R. Fleming, C. S. A. Recovery. Right; flap. Discharged Sep- tember 28, 1863. Left. Discharged October 29, 1862. ----. Ass't Surg. M. P. Shelton, C. S. A. Recovery. Left. Surg. L. L. Saunders, P. A. C. S. 8th, reamputation. Ex- changed Nov. 12, 1863. Right. Surg. — Gardner, C.S.A. Recovery. Left; flap. Surg. J.Wise, U.S.N. Disch'd Oct. 22, 1863. Left; flap. Surg. G. C. Jarvis, 7th Conn. March 2,'65, re-amp. Discharged Sept. 13,1865. Right; flap. Surg. — Pitts, 2d Miss. To Provost Marshal June 14, 1864. Right; ant. post. flap. Surg. O. Munson, 108th N. Y. Ham.; lig. ant. tibial artery; necrosed. Disch'd Nov. 3, '64. Spec. 4323. ----. Surgeon H. H. Hubbard, P. A. C. S. Recovery. Left, Surg. S. H. Kersey, 36th Indiana. Disch'd Dec. 2,1864. Right; circular. Released June 14. 1865. Right; ant. post, flap. Surg. N. D. Ferguson, 8th N. Y. Cavalry. Disch'd May 3, 1865. Left: ant. post. flap. Surg. M. J. Hyde, 2d Vt. Oct. 31, bone re- moved. Disch'd Aug. 25,1865. Accidentally killed Oct. 11, '65. Right; circ. Amp. toes, left foot. Disch'd Nov. 11,1864. May 11, 1865, reamputation. Right; flap. Confederate surgeon. Recovery. Right; ant. post. flap. Surg.W. B. Fox. 8th Michigan. Disch'd July 11, 1865. Left; flap. Surg. A. K. Fifield, 29th Ohio. Discharged Novem- ber 20, 1863. Left; double flap. Discharged July 24, 1865. ----. Retired January 31, 1865. Right; flap. 3, 1864. Discharged June 'Fisher (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam, September 17, 1862, in American Journal Medical Sciences, Vol. XLV, p. 48. "THOMSON (William), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C, in American Journal Medical Sciences, Vol. XLVII, p. 380. 3Fisher (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam, September 17, 1862, in American Journal Medical Sciences, Vol. XLV, p. 48. 1S6 INJURIES OE THE LOWER EXTREMITIES. [CHAP. X. N ame, Military Description, and Age. 445 | May, J. H., Pt., D, 22d i Col'd Troops, age 37. 446 May. P. J., PL, C, 1st R. Island Art'ry, age 20. 447 McCandless, G., Pt., K, ■ 118th Peun., age 48. 448 j McCloy. R., Pt., A, 10th New York, nge 18. 449 McClure, S.. Pt., H, 83d Indiana, age 28. 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 J479 480 481 482 483 48-1 485 486 M( Comas. D. H., Serg't, 10, 8th Mich., age 21. McCoy, J., PL, A, 64th Ohio, age 20. McCoy, IF, Pt., G, 5th Tenn. Cav., age 19. McDonald, .Ai/., PL, A, 23d Miss, age 19. McFarland, G. F., Lieut. Col., 151st Penn. McFarland, J. H.,Capt., G, 1st Missouri. McGiveney, J., Corp'l, D, 155th N. Y., age 26. McGowan, J., PL, C, 6th Vermont, age 26. McGrath, M., Pt.,K,27th Mass., age 26. McGuire, J., Pt., A, 12th Massachusetts, age 27. McGuire,T.,Pt.,A,105th New York. McMullen, W., Pt., H, 66th Ohio. MoNaughton, C, Serg't, I, 5th Michigan. Mears, T., Pt, H, 61st Virginia. Meinhardt, J., Corp'l, D, 12th Missouri. Meissner, G. H., Pt., F, 3d Wisconsin, age 26. Merry, E. W., Serg't- Maj., 21st Ohio, age 21. Metz, L., Lieut,, E, 78th New York, age 28. Miller, I. D., Pt., C, llth Infantry, age 24. Miller, J., Pt,, C, 19th Wisconsin, age 27. Miller, J. H, PL, A, 54th Ohio, age 35. Miller, J. T., Lieut., E, 38th Virginia, age 24. Miller, W., Pt., A, 4th Artillery, age 28. Milliken, G. A., Corp'l, I, lstMinnesota,age21. Mills, H. L., Serg't, H, 7th Minn., age 31. Milner,S.,Serg't,G, 10th Ohio. Mitcbelfelder, E., PL, B, 163d New York. Monaghan, T., Pt., A, 63d New York, age 50. Monroe, J. M.,Pt.,G,42d Ohio. Moon, J. B., Pt., E, 71st Indiana. Moore, S. H., PL,A, 30th Iowa, age 31. Moore. T., PL, B, Aus- tin's Louisiana Bat'ry. Morse, B. F., Corp'l, A, 5th New Hampshire. Morse, W. B., Pt., H, 1st Mass. Artillery, age 23. Mortanto,L.,Pt..G,57tb New York, age 59. Mosely, W. D., PL. G, 25th Va. Cav., age 27. Muller, W., Pt., H, 20th Louisiana. Sept, 21, 21, '64. May 3, 4, r63. Nov. 7, 7, '63. April 6, 7, '65. May 19, 20, '63. Sept. 30, 30, '64. May 9, 10, ''64. Aug. 5, 5, '64. July 20, 21, '64. July 2, 2, '63. May 16, 17, '63. May 18, 18, '64. May 5, 5, '64. Mar. 14, 14, '62. Dec. 13, 14, '62. Dec. 13, 14, '62. Aug. 9, 11, '62. May 2, 2, '63. June 23, 23, '64. Mar. 8, 8, '62. Aug. 3, 3, '64. July 20, 20, '64. June 15, 16, '64. May 12, 13, '64. Oct. 27, 29, '64. Julv 22, 23,"'64. Julv 1, 1, ''63. July 3, 4, '63. July 2, 3, '63. Dec. 16, 16, '64. Oct. 8, 10, '62. Dec. 13, 14, '62. Dec. 13, 14, '62. Dec. 28, 28, '62. Aug. 30, 31, '62. Nov. 27, 27. '63. Mav 25, 25,''64. Sept. 17. 17, '62. Jurfe ]8, 19. '64. Aug. 25, 27, '64. Sept. 20, 20, '64. Jan. 2, 2, '63. operations, Operators, Result. Right; circ. Discharged May 22, 1865. Right; ant. post, flap; nec. bone removed. Disch'd Aug. 9,1864. Right. Disch'd May 3, 1864. Perished Nov. 20, 1868, in a se- vere snow storm. Left; ant. post, flap.; sloughed; exfol. Disch'd Oct. 21, 1865. Left; circ. Surg. E. C. Franklin, U. S. V. Gangrene. Disch'd February 23, 1864. Right, Surg.W.C. Shurlock, 51st Penn. Disch'd June II, 1865. Right; circ. Confed. surgeon. Disch'd April 27, 1865. Right; lateral flap. To Provost Marshal Nov. 23, 1864. Left; circular. To Provost Mar- shal December 1, 1864. Right. Mustered out July 27, 1863. Right. Surg. — Node, C. S. A. Recovery. Right; circular. Disch'd March 17, 1865. Right; circular. Disch'd Aug. 2, 1865. Left; circ. Swrg. G. Derby, 23d Mass. Disch'd Sept. 21,1862. Left; circ. Surg. A.W.Whitnev, 13th Mass. Disch'd Apr. 30,'63. Left. Discharged, 1863. Right; flap. Discharged Jan- uary 15, 1863. Left; circ. Ass't Surgeon R. A. Everett, 5th Mich. Discharged' Dec. 11. 1863. ---. Recovery. Left: flap. Surg. G. Cook, 12th Missouri. Discharged. Right. Surg. J. Chapman, 123d N. Y. Disch'd May 27,1865. Left; flap. Surg. D. S. Young, Mustered out May Discharged July 12, Discharged March Discharged 21st Ohio. 31. 1865. Left; flap 1864. Right; flap. 27, 1865. Left; ant. post. flap. May 22, 1865. Right; flap. Ass't Surg. C. B. Richards, 30th Ohio. Disch'd May 20, 1865. R't. Surg. J. McAlpine, C. S. A. Exch'd and furloughed, 1864. Left; post. flap. Surg. H. M. Mc- Abee, 4th Ohio. 11a, 1,11.11. r- March 26, 1864. Left; flap. Surg. J. B. LeBlond, 1st Minn. Disch'd Dec. 15, '63. Right; flap. Disch'd October 5, 1865. Left. Surg. C. S. Muscroft, 10th Ohio. Disch'd Dec. 14, 1862. Left; double flap. To Veteran Reserve Corps Feb. 29,1864. Right. Surg. L. Reynolds, 63d N. Y. Disch'd Aug. 31, 1863. Died December 25, 1874. Left: flap. Discharged April 2, 1863. Right; flap. Discharged Octo- ber 1, 1862. Right; flap. Surg. A.T. Hudson, 26th Iowa. Disch'd Jan. 1, '65. ---. Surg. W. A. Holt. C. S. A. Retired March 21, 1865. Left, Discharged December 6, 1862. Left: flap. Discharged July 8, 1865. Right: dou. flap. Surg. — Tay- lor. C.S.A. Disch'dJunel6,'65. Right; circ. Surg. J.W. Lawson, P. A. C. S. Toprison Jan. 5.'65. Right. Surg.W. A. Holt, C.S.A. Recovery. NO. Name, Military Description, and Age. Dates. Sept. 17, 17, '62. Sept. 16, 16, '64. Sept. 5. 5, '64. July 28. 28,' '64. Julv 4, 6, '63. Sept. 20, 20, '63. Mav 22, 22,' '63. July 20, 20, '64. June 30, 30, '62. Oct. 5, 6, '62. Jan. 16, 16, '65. July 1, ], '62. May 18, —, '65. Sept. 17, 19, '62. May 16, 16, '64. Sept. 21, 21, '63. Oct. 7, 7, '64. July 22, 23, '64. May 28, 28, '64. Aug. 25, 27, '64. May 9, 10, '64. May 6, 7, '64. Nov. 30, 30, '64. July 20, 21, '64. May 19, 20, '64. Dec. 31, 31, '62. Julv 20, 20,"'64. Oct. 8, 9, '62. Sept. 19, 19, '64. Sept. 30, 30, '64. Nov. 25, 25, '63. 518 Payne, M., Corp'l, A, ! June 26, 14th N. Y. H'vy Art'y, | 26, '64. age 26. 519 ^Peebles, B. P., Pt., D, | Sept. 17, 18th Miss., age 22. 1 19, '62. 520 Penet, J. D., Capt., A, Oct. 30, 144th N. York, age 25. 30, '64. 521 Perry, E. J., Corp'l, C, April 2, 61st Mass., age 21. 3. 05. 522 Peters, J., Pt., K, 1st ; Sept. 14, Kansas. 15, '63. 523 Peterson, D. M., Pt., M, , Oct. 18, 2d Mass. Artillery. ! 18,'64. 524 Pfeiffer, O.. Pt., B, 47th ' Aug. 18, Pennsylvania, age 19. ' 19, '64. 525 Phelps, H., PL. K, llth j Oct. 19. , Vermont, age 20. | 20, '64. 5261 Phelps, M., Pt.. F, 10th Mar. 21, Illinois, age 35. - j 21, '65. Munger, L. L., Pt., E, 105th New York. Murphey, J. F., Pt., B, 28th North Carolina. Myers, P., Pt., M, 1st Wis. Cav., age 22. Nance. R. G., Capt., B, 40th Illinois, age 42. Neeley.J. T., PL, F,2Ist Mississippi, age 19. Neighbors, W.R.,Lieut., G, 4th Tenn. Nelson, E., Pt,, H, 7th Kentucky. Nelson, S., PL, B, 22d Wisconsin, age 20. 'Neveling, W., PL, N, 71st Penn., age 26. Newton, J. B., Lieut.,K, 28th Illinois. Noyes, C. II.. Serg't, H. 169th N. York, age 21. Nutter, L. S., Pt.. A, 5th New Hamp., age 16. Nutter, W. S., Pt,, A, 42d Missouri, age 22. O'Brian. T., Corp'l, D, 69th New York. O'Brien, J., Pt., E, 188th Pennsylvania, age 26. ^O'Connor. D., PL, C, Cobb's Legion, age 28. O'Keefe, R., Pt., A, 1st Artillery, age 21. Oliver, B. S., PL, E, 6th Kentucky, age 24. Oliver, J. B., Corp'l, 6th N. Y. Battery, age 21. Orkney, J. A., Corp'l,A, 4th Ohio, age 25. O'Rourke, M., Pt.,M,6th N.Y. H'vy Art., age 23. Ostrander, C.W., Lieut., C, 122d N. Y., age 31. Ostrander, M., PL, F, 15th N.Y. Cav., age 19. Otts. F. M., Serg't, B, 3lst Miss., age 23. Parker, J., Lieut., B, 14th Louisiana. Patterson, G. G., PL, B, 44th Illinois. Patterson, J. M., Pt., K, 50th Alabama, age 34. Patterson, J. W., PL, E, 42d Indiana. Patterson, T. B., Serg't, H, 51st Ala., age 30. Pattern, J. F., Pt.,K, 6th G eorgia. Paul, D., PL, I, 103d Illinois, age 23. 527 Pickett. H, PL, G, 27th ! Oct. 14, North Carolina. j 15, '63. Operations, operators, Result. Left; circular. Discharged. ----. Surg. — Trescott, C. S. A. Retired January 30, 1865. Left: circ. Surg.W. II. Thorne, U. S. V. Disch'd Aug. 30, 1865. Right; flap. Surg. A. Goslin, 48th 111. Aug. 2, re-amputat'n. Discharged Jan. 7, 1865. Left, Exchanged March 17, '64. ----. Surg. — Berton, C. S. A. Recovery. Right; flap. Surg.W. Berry, 7th Kentucky. Disch'd Aug. 8,'63. Left; flap. A. Surg.C. S. Blanch- ard, 22d Wis. Disch'd July 4, 1865. Died Feb. 25, 1867. Right; double flap. Sept. 1,1863, amp. knee joint. Disch'd Mar. 3,1864. Specs. 668,2458,2778. Right. Discharged June 10,1863. Left; ant. post. flap. Discharged Nov. 3, 1865. Spec. 3512. Left; flap. Surg.G. B.Coggswell, 29th Mass. Jan. 3,'63, re-amp. Disch'd Sept, 25, 1863. Right; flap. Surg.S.Hart.TJ.S.V. Disch'd June 28, 1865. Right; flap. Surg. L. Reynolds, 63d N.Y. Disch'd Mar. 4,1863. Right; flap. Disch'd Dec 23, '64. Insane Asylum 1870. Left: circ. April 14, '64, re-amp. To prison Oct. 4,'64. Spec. 2212. Right; flap. Discharged Aug. 28, 1865. Right; ant. post. flap. To Provost Marshal Dec. 8, 1864. Left; circ. Surg. A. Wood, 1st Mass. Cav. Disch'd Aug. 18,'64. Right; ant. post. flap. Disch'd December 21, 1864. Left; flap. Disch'd March 16, 1865. Right; ant. post. flap. Confed. surgeon. Disch'd March 10, '65. Right; lat.double flap. A. Staff Surg. N. F. Graham. Disch'd August 18, 1865. Left; circ. To Provost Marshal April 2, 1865. Left. Snrg. — Dickson, C. S. A. Recovery. Left; flap. Discharged March 31, 1863. Left; circular. Furloughed Oct. 18, 1864. Right; flap. Surg. J. A. Still well, 22dlnd. Disch'd Dec. 17. 1862. Left; flap. Surg. W. S. Love, C.S.A. To prison Jan. 5, 1865. Right; double flap. Transferred October 8, 1864. Right; flap. Surg. R. Morris, 103d Illinois. Disch'd June 6, 1864. Died June 12, 1870. Left; ant. post. flap. Surg. I. V. Mullen, 14th N. Y. H'vy Art y. Disch'd Dec. 29, 1864. Right: post. flap. Discharged November 10, 1862. Left; circ. A. A. Surg. H. R. Durant. Must, out June 25, '65. Left; flap. Surg. J. II. Kimball, 32d Me. Disch'd July 27,1865. Right; flap. Surg. B. F. Ste- venson, 14th 111. Mustered out June 17, 1864. Left circ. A.A.Surg.J.L.Wade. Disch'd March 30, 1865. Left; flap. Discharged March 15, 1865. Right; post. flap. Discharged September 11, 1865. Left; bilateral flap. Surg. A. B. Monohan, 63d Ohio. Disch'd June 30, 1865. Right; flap. Confed. surgeon. Recovery. 1 BRINTON (J. H.), On Amputation at the Knee Joint and at the Knee, in American Journal Medical Sciences, 1868, Vol. LV, p. 319. 2 LIDELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 459. :: Fisher (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., etc., in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. SECT. V.I I'lUMARY AMPUTATIONS IN THE LEG. 487 028 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 .545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 Name. Military '.SCRIP ITON. AND Ai Pierce, A. J . Corp'l, E, 104th N. York, age 21. Pinckney, J., Pt., E, 5th Cold Troops, age 20. Pleasants, G. S., PL, Page's Virginia Bat'ry, age 19. Pool, J. D., PL, I, 148th New York, age 19. Porus, J., PL, F, 25th Connecticut. Potts, J. O., Pt., B, 14th N. Y. S. M., age 32. Pousch, J.. PL, B, 47th Illinois, age 22. Powell, K. H, Serg't, C, 6th Georgia. Powers, L. J., PL, F, 2d Massachusetts. Presan, H., Pt., I, 1st Maryland Cavalry. Prettyman, J. J., Pt., I, llth" West Va., age 25. Price, J. T.. PL, C, 5th North Caroliua, age 26. Priest, A.M., Pt., M, 1st D. C. Cavalry, age 20. Priest, J. T., PL, D, 36th Massachusetts. Prueller, F., PL, H, 39th Illinois, age 46. Purman, J. J., Lieut., A, 140th Penn., age 22. Quinlan. M., Pt., E, 14th Louisiana. Quinn, J., PL, D, 12th Infantry, age 19. Quinn, j., Pt., C, 73d Pennsylvania, age 34. Race, J., Pt., B, 194th New York, age 42. Rackmyer, P. N., Pt., I, 115th N. York, age 21. Ramaley,L.,PL.F,139th Pennsylvania, age 20. Rand, M.. Serg't, C. 16th Massachusetts. Ranger, G., Pt., I, 122d New York, age 42. Rankin, J. S.. PL. Orr's S. C. Rifles. Ranzow, H., PL, H, 16th Illinois, age 34. Ratcliffe, J. R., Corp'l, H, 18th La., age 28. Raymond, J. R., Serg't, A, lllth Penn., age 22. Reed, G. R., PL, I, 18th Massachusetts, age 29. Reeve, J. H.,CapL, K,3d New York, age 24. Resa, F.,Pt.,B, 3d Iowa, age 29. Reynold, J., Corp'l, D, 12th Conn., age 24. Reynolds. J., PL, A, 6th Connecticut, age 24. Reynolds, S. H., Serg't, A, 1st Mass. Battery. Rice. C, PL, D, 87th Indiana, age 33. Richardson, J. M., Capt. and A. A. General. Rider. J., PL, B, 49th New York, age 40. Riggins, J., PL, H, 99th Pennsylvania, age 29. Roache, F. T., Pt., A,32d Virginia. Robb, L. A., Corp'l, L, 28th Pennsylvania. Roberts, H., Serg't. K, 47th Illinois, age 38. Robertson, J. F. .1/., Cor- poral, H, 13th Tenn. Robinson, B., Serg't, D, 5th Vermont. Rode, C, Pt., G, 123d Ohio. Roe, D. W., PL, E, 69th New York. operation's, operators, Result. Julv 1, Right, llap. Surg. E. O. Chase, 2, '63. '. 104thN.Y. Disch'd Aug. il,'61. Mar. 20, Lclt ; llap. Surg. L. Barnes, (ith 21. '65. | ('.Troops Discli'd Oct. 18,'65. Julyl, Right. Exchanged .March 17, 3, '63. | 1864. June 18, Right; circ : gangrene. Disch'd 18, '64. July 27, 1865. May 28, Left. Surg. C. Robertson, 159th 28,''63. | N.Y. Discli'd Aug. 26, 1863. July 1, Right; flap. Surg. .1. M. Farley, 2, '63. I 84th N.Y. Disch'dNov. 28, '63. Mar. 31, Right; flap. Surg.V.B.Kennedy, 31, '65. 5th Minn. Disch'd Feb. 16, 1866. Sept. 7, ----. Surg. — Swann, C. S. A. !», '64. Recovery. June 9, Right. Surg. A. Hard, 8th 111. 9, '63. Cavalry. Discli'd January 25, 1864. Spec. 1219. Aug. 16, Left; flap. Discharged January 16. '64. j 15, 1865. Oct. 19, , Right; ant. post. flap. Mustered 20. '64. ! out June 17, 1865. Sept. 19, I Left: circ. Surg. I. F. Pearson, 19. '64. t 5th N.C. ToprisonFeb.25,'65. Right; flap. Discharged July 21, 1865. Left; Hap. Discharged June 17, 1865. Right. Confed. surgeon. Dis- charged October 17, 1865. Left; flap. Discharged May 23, 1864. ----. Surg. — White, C. S. A. Recovery. Right; circular. To regiment June 27, 1864. Right; ant. post. flap. Disch'd June 28, 1865. Left; circ. A.A.Surg. J. F.Cleve- land. Disch'd July 19,1865. Right; ant. post. flap. Confed. surgeon. Disch'd April 6,1865. Right; lat. flap. A. Surg. S. B. Sturdevant, 139th Penn. Disc'd February 10, 1865. Left; flap. Surg. C. C. Jewett, 16th Mass. Disc'd April I2,'64. Left; ant. post. flap. Discharged July 6, 1865. Left; double flap. Surg.------, Orr's S.C. Rifles. Left; flap. Surg. E. Batwell, 14th Mich. Disch'd July 6, 1865. Right. Discharged August 22, 1863. Left: flap: gangrene. Disch'd May 22, 1865. Right. Discharged April 21, '63. Right; ant. post. flap. Surg. G. C. Jarvis, 7th Conn. Disch'd June 26, 1865. Spec. 6934. Right; flap. Discharged April 7, 1863. Right; lat. oval flap. Surg. N. S. Snow, 153d X". Y. Discharged March 10,1865. Left; ant. post. flap. Discharged November 4, 1865. Right. Discharged June 5,1863. Left. Discharged April 17,1864. ----. Surg.W. T. Sutton,C.S.A. Recovery. Right; flap. Surg.G.T. Stevens, 77th N. Y. Discharged Dec. 19, 1864. Spec. 2460. Left; flap. Disch'd Sept. 24, '64. Died Aug. 15, '68; consumpt'n. R't; circ. Surg.W.V. Harrison, C. S. A. Trans. Oct. 26,1864. Left; circ. Surg. H. E.Goodman. 28th Penn. Dis. Nov. 27,1862. Left; flap. Discharged May 30, 1864. ----. Surg. —McAden, C.S.A. Recover}'. Right; circ. Surg.W. P. Russell, 5th Vt. Disch'd Oct. 22, 1862. Left. Discharged Aug. 26,1863. Right; circ. Discharged Aug. 25, '64. June 3, 3, "64. Oct. 13, 13, '64. July 2, 3, '63. July 1, 2, '63. May 12, 13, '64. Dee. 16. 16, '64.' Mar. 22. 22. '65. Sept. 29, Oct. 1,'64. Sept. 19, 19, '64. July 3, 4, '63. Mar. 25, 25, '65. Julv 28, 28.''64. Dec. 13, 13. '64. April 13, 13, '63. July 20, 20, '64. Dec. 13, 15, '62. Jan. 12, 12, '65. Oct. 5, 6. '62. Sept. 19, 19, '64. May 9, 10, '64. Dec. 13, 13, '62. Sept. 19, 20, '63. Sept. 19, 19, '64. Aug. 21, 21, '64. Mav 12, 12. '64. Sept. 24, 21, '64. Sept. 17, 17, '62. May 22, 22."'63. Julyl, 2, '63. June 29, 30, '62. June 13, 14, '63. Mar. 25, 26, '65. Name, Military Description, and Age. Rogers, .1. H., PL, 1), 125th N. Y., age 35. Rollslmi, G. IF, Capt., H, 9th Ark., age 33. Ropp, S„ l't., I, 42d Illinois, nge 42. Ross, L., Corp'l, C, 39th (Hi ', ag 30. Ross, L. T., Serg't, A, 81st Illinois. Rowley, R., PL, G, 29th Wisconsin. Rueker, A., PL, B. 10th West Virginia, age 35. Rudiger, J., Corp'l, A, 66th N. York, age 24. Ryan, S. W., Corp'l, B, 191st Penn., age 20. Sanborn, J. O., PL, E, 10th Maine. Sanders, C. H., PL, H, 38th Georgia, age 25. Sans Souci, L.,Corp'l, E, 5th Minn., age 45. Sargent, C. A., PL, B, 4th Vermont, age 24. Sargent, L. N., Pt., G, 9th N. Hamp., age 28. Sarver, W. J., PL, D, Virginia Artillery. Sawyer, O., Pt., E, 29th Maine, age 33. Sayles, H., Serg't, E, 8th Wisconsin. Schaniski,L.,Saddler,G, 1st Louisiana Cavalry, age 43. Schweitzer, J., Pt., H, 47th N. York, age 35. Scott, J. r., Serg't, A, Philips's Georgia Le- gion, age 21. Seagle, P., Serg't, B, 23d N. (.!., age 27. Seaton, J.A., PL,B, 13th Iowa. Secor, E. C, Serg't, H, 61st New York, age 20. Seibert, J., Pt., E, 100th New York. Seng, T„ PL, A. 41st New Jersey. Shafor. J.. Sergeant. K, 198th l'enn.. age 44. Sharp. J. 11.. PL, F. Cobb's (la. Legion. Sharpe. (I., l't.', C, 38th Massachusetts, age 27. Shaud. J., PL, K, 93d Pennsylvania, age 26. Shears,'!'. R.. Serg't, C. 26th Michigan, age 31. Sherwood, I).. PL, E, 131st New York. May 10, 10, '64. Dec. 16, 16, '64. 64. 604 Siemers, II., Pt., B, 39th I New York, age 26. 605 Skeen, Wm., PL, G, 87th Pennsylvania, age 21. 606 Skinner, J., Pt., E, 5th Connecticut, age 20. 607 , Slater, E., PL, D, 10th Ohio Cavalry, age 31. 608 \ Slaver. H. P., Corp'l, E, 36th Virginia. 609 j Sloan,W. A., Pt., H,10th Vermont, age 26. 610 Small, T., PL, H, 60th New York, age 19. 611 ! Smith, A., Pt., G, 18th Georgia. 612 Smith, D. F., Pt.,B, 12th New Hamp., age 20. D b July 2 —, '6 May 22. 22, '63. May 1, 2, '63. Oct. 19, 20, '64. July 2, 3, '63. May 9, 10,''64. Sept. 17, Dec. 13. 13, '62. May 31, 31, '64. Aug. 16, 16, '64. Oct. 19, 19, '64. May 22, 22, '63. Nov. 3, 3, '63. Aug. 16, 17, '64. July 2, 3, '63. Sept. 19, 20, '64. May 12, 12, '63. July 3, 4, '63. Aug. 30, 30, '63. July 2, 4, '63. April 1, 1, '65. Oct. 19, 19. '64. May 31, J'e 2,'62. Mav 11, 13,' '64. May 27, 27, '63. Julv 3, 4, '63. April 2, 2. '65. June 22, 23, '64. Nov. 19, 19, '61. 613 Smith, E., PL, G, 45th June 3, Pennsylvania, age 26. 3, '64. 614 Smith, G. H., Pt., F, 7th July 1, Wisconsin, age 21. 2, '63. 19. '64. Sept. 19 19, '64. Nov. 27, '63 27. Aug. 29, 31, '62. July 2, 2, ''63. Operations, Operators, Result. Left; ant. post. flap. Surg.W.S. Cooper, 125th N. Y. Disch'd June 24, 1865. Right; circ. Surg.— Mitchell, 4th Ark. To Provost Marshal March 7, 1865. Right; ant, post. flap. Disch'd July 6, 1865. Left, Furloughed Nov. 10,1864. Left; flap. Discharged August 5. 1863. 8 h Left; flap. Discharged July 16, 1863. Left; circular. Discharged May 14, 1865. Right; circ. Surg. ('. S. Wood, " 66th N. Y. Discli'd Dec. 8,'63. Left; flap. Surg. B. Rohrer, 10th Penn. Reserves. Disch'd Feb. 16, 1865. Right; circular. Disch'd March 23, 1863. Left. Recovered and paroled. Left; flap. Surg. V. B. Kennedy, Sth Minn. Disch'd April 25, '65. Left. Feb. 7, '63. haein.; lig. ant. tibial. Disch'd August 25, '63. Right. Discharged July 18, '65. Spec. 3072. Left; circular. Left; circ. Surg. J. F. Day, jr., 29th Me. Disch'd May 30, '65. Left; flap. Surg. J. E.'Murtha. 8th Wis. Disch'd June 3, 1864. Left; circ. Confederate surgeon. Pieces of necros'd bone remov'd. (Also left little finger shot off.) Disch'd Feb. 1, '64. Died Sept. 20, '70; erysipelas and p3raemia. Spec. 4310. Right; double flap. Confed. sur- geon. Disch'd June 24, 1865. Right; circular. Retired Feb- ruary 7, 1865. Left; flap. Surgeon — Atkins, C. S. A. To prison Feb. 16, '65. Left; circular. Disch'd October 5, 1863. Left; flap. Discharged August 24, 1864. Left; circ. Surg. M. S. Kittenger, 100th N.Y. Disch'd SepL 22,'64. Left: circular. Discharged May 17, 1864. Right; circular. Disch'd June 21, 1865. Right: circ. Furloughed Octo- ber 17, 1864. Right: ant. post. flap. Disch'd March 30, 1865. Right; ant. post. flap. Disch'd March 9, 1864. Spec. 4305. Right; circ. A. A. Surg. D. O. Farrand. Diseh'd May 2, 1865. Left: flap. Surg. C. Robertson, 159th N.Y. Discharged Octo- ber 20, 1863. Right: flap. Mustered out June 29, 1864. Died Dec. 10, 1867. Left: ant. post. Hap. Discharged September 25. 1865. Left ; circ. Confederate surgeon. (langrcne. Disch'd Aug. 22.'65. Right: flap. Surg. M. Ilawes, lllth Ohio Cavalry. Discli'd June 18, 1865. ----. Surg.W. S. Love, C. S. A. Retired Feb. 14. it^o. Right; flap. Surg. W. A. Barry, 98th l'enn. Disch'd Sept. 11,'65. Left: circ. Yet. Reserve Corps Nov. 19, 1864. Died July 6, IS'iO: consumption. Left. Surg. A.J. Semmes,C.S.A. Recovery. Lett; flap. Surg. J. M. Merron, 2d N. H. Discharged March 17, 1864. Left; circ. Surg. T. Christ, 45th Penn. Disch'd July 4, 1865. Left; flap. Discharged Decem- ber 22, 1863. ss INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. 615, Smith, IL, Pt., H, 13th Connecticut, age 34. 616 Smith, H. D., PL, C, 2d Delaware, age 31. 617 lSmilh, L., Serg't, H, 10th Georgia, age 31. 618 Smith, T. A., Corp'l, A, Sth Conn., age 21. Sniithsou, C, PL, (', 116th Col'd Troops. Snelling, E.A., PL, Not- taway's Artillery. Snow. E. X., PL, C, 97th New York. Snyder, G., PL, K, 200th Pennsylvania. Speer, A. C. Lieut., A. 14th Mich., age 30. Speer, A. C, Pt., K, 4th Georgia, age 37. Spellinan,T.,PL, F, 37th Massachusetts, age 21. Spiker, J., PL, K, 100th Pennsylvania, age 21. Spivey,A.A., Pt., D, 54th North Carolina, age 21. Sprague. F. E., PL, A, 26th Mass., age 20. Springer, F., Pt., G, Cobb's Ga. Legion. Springsteen, W. E., Pt., G, 14th Mich., age 24. Stampe.n. W. H., PL, D. 43d N. Carolina, age 22. Stan-, R. IL, Serg't, K, 36th Illinois, age 24. Steece. J., PL, G, 4th Ohio Cavalry. Steel, S.G., l't., H,149th Pennsylvania, age 33. Stever, O.. SergT, A. 96th New York, age 28. Stewart, ('. W., PL, D, 4th Maryland, age 18. Stiles. J. Corp'l, D, 27th Kentucky, age 22. Stinebaug'h. G. B., Pt., It. 38thOhio, age 24. 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 646 647 648 April 9, 10. '64. May 3, 3, '63. Sept. 17, 18. '62. Aug. 9, 11, '62. Oct. 1, 1, '64. June 22. 22, '64. Sept. 17, —, '62. Mar. 25, 25, '65. July 5, 5, '64. Mar. 25, 25, '65. Sept. 19, 20, '64. July 11, 11, '64. Aug. 21, 21, '64. Sept. 19, 20, '64. Sept, 14, 15, '62. Sept. 1, 1, '64. Aug. 21, 21, '64. May 17, 18, '64. Oct. —. —, '62. May 8, 8, '64. Sept. 29, 29, '64. May 5, 5, '64. Dec. 14, 14, '63. Sept. 1, I, '64. operations. operators, Result. St. Julie,,, J., PL, C, 8th , May 4, Louisiana. 'j 5, (13. Stonehonse. S., PL, H, ! June 18, 27th Michigan, age 31. ! 20, '64. Stratton. J. P.. Serg't.I). Dec. 16, 31st Indiana, age 22. 16, '64. Strode, C. IC. Pt., H, 5th Texas Cavalry, age 19. Stubbs. R.. Pt.. F, 4th Rhode Island, age 25. Sullui, R. C. Pt., A, 4th Mississippi. Switzer. J. C.,Pt., A,22d Iowa. Sykes, A., Pt., B, 6th Alabama. Tait. G. F., Captain, B, 10th New York. Taylor. M. A., Corp'l. D, 13th New Hamp- shire, age 40. Taylor, T., PL, G, 155th Pennsylvania, age 22. Terrell, J. J.. Lieut., I, 1st North Carolina. Thomas. A.. Seaman, U. S. Gunboat Choctaw, age 26. Thomas. F., Pt., I, 7th Ohio Cavalry, age 40. Thomas, H, PL. K, 13th Georgia, age 18. Thompson, C. H.,Pt..C. 18th Massachusetts. June 28, 28. '63. Sept. 1" July 6, 6, '63. Sept, 19, 21, '64. June 2, 2, '64. Mav 6, 6, '64. Dec. 13, 14, '62. Sept. 30, 30, '64. Julv 1, 1. '62. Aug. 20, 20, '64. Dec. 15, 16, '64. April 29, 29, '63. Dec. 13, 14, '62. Right; circ. Disch'd Jan. 30, 1865. Died June 28, 1869. Right; flap. Discharged Aug. 10, 1864. Left; circular; gang. Disch'd March 6, 1863. Right; flap. Surg. W.C. Bennett, 5th Conn. Gangrene. Disch'd July 30, 1863. Left : flap. Surg. D. Meeker, U. S. V. Disch'd May 31, 1865. Left (alsoright, low. third). Con- federate surgeon. Recovery. Left. Discharged November 30, 1862. Right; flap. Discharged July 4, 1865. Right; flap. Surg. E. Batwell, 14th Mich. Disch'd Nov. 1, '64. Right; circular. Released June 28. 1865. Left; circ. A. Surg. J. G.Thomp- son, 77th N.Y. Disch'd Jan. 17, 1866. July 8, '68, re-amputat'n. Left; flap. Surg. W.C. Shurlock, 51st Penn. Disch'd June 1,'65. Left; circular. To Provost Mar- shal October 25, 1864. Left; circ. Surg. J.G. Bradt,26th Mass. Disch d Nov. 7, 1864. Left; circular. Furloughed Dec. 19, 1862. Left; flap. Surg. E. Batwell. 14th Mich. Disch'd Aug. 11, 1865. Right. Exchanged October 27, 1864. Right; circ. Surg. W. P. Peirce, 88th 111. Disch'd Jan. 6, 1865. Left, Discharged March 12. '63. Left; flap. Discharged July 4, 1865. Right : long post. flap. A. Surg. II. G. Merryweather, 5th Col d Troops. Discharged. Left; flap. Discharged May 6, 1865. Right; flap. Surg. A. Nash, 9th Mich. Cav. Disch'd May 17, '64. Left; flap. Surg. ('. N. Fowler, 105th Ohio. Discharged July 14, 1865. Right. Surg. — Mammir,C.S.A. Recovery. Left; flap. Surg. H. E. Smith. 27th Mich. Bone rem'd. Disch'd June 8, 1865. Spec. 3263. Left; ant, post. Hap. A. A. Surg. T. C. Eakin. Erysipelas. Dis- charged April 11. 1865. Right; circ. A. Surg. A. Mather- son. II. S. N. Bone removed. To prison April 28. 1864. Left; post. flap. Ass't Surg. C. L. Duffell, 51st l'enn. Disch'd Nov. 7. 1863. Reamputation Sept. 19. 1865. ----. Surg. — Redruff, C. S. A. Recovery. Right; circ. Ass't Surg. W. G. Bryant, 122d Ohio. Disch'd October 4. 1865. ----. Ass't Surg.— Weatlierly, P. A. C. S. Recovery. Left: circ. Surg. B. Gesner, 10th N. Y. Disch'd Aug. 16, 1864. Right : ant. post. flap. Surg. C. Gray, 7th N. Y. Disch'd June 8. 1864. Spec. 6700. Right; ant. post. flap. Surg. J. A. E. Reed, 155th Penn. Dis- charged June 8,1865. ----. Surg. — Manson, C. S. A. Recovery. Left. Recovery March 7, 1865. Left; circular. A. A. Surg. J. H. Mclntyre. Disch'd May 17, '65. Left. Surg. J. Ebersole," 19th In- diana. Exch'd June 25, 1863. Left; circular. Discharged Sep- tember 18, 1863. Name, Military Description, and Age. Thurber, F. N., PL, H, 3d New Hampshire. Tilbe, R., Corp'l, E, 17th Connecticut, age 24. Tillson,W. F., Lieut., G, 4th Vermopt, age 22. Todd, J., Pt., C, 43d N. Carolina, age 38. Traurnicht, H., PL, E, 2d Missouri. Trindle, J., Pt., K, 56th Massachusetts, age 22. Tripp, E.,CorpT. 1,140th New York, age 28. Trisket, A. J., PL, E, 1st Michigan, age 30. Troy, B, F., Pt., G, 10th Iowa. ^Tucker, W., Pt., K, 13th Mississippi, age 21. Tyson, J. H., PL, H, 51st North Carolina, age 22. Urich, C, Pt., E, 45th New York, age 20. Ftz, C. E., PL, 5th Ohio Batterv. Valentine, L.W., Pt., H, 6th Maine. Van Doozer, B. S., Pt., B. 58th Illinois, age 19. Van Kirk, J., Pt,, C, 1st Penn. Cavalry, age 23. Vann, L., Pt., A, llth Florida. Van Ness, J., PL, C, 43d New York, age 20. Verner, W., Landsman, laS.S.Hartford,age20. Vick. E. C, PL, E, 7th North Carolina. Waber, W., Pt., C, 44th Illinois. Wade, G. B., Pt.,G, 13th Missouri. Wagner, G.,Pt.,D, Inde- pendent Battalion New York Vols. Walcott, W. H., Lieut., B, 17th Infantry. Walker, F., Pt., F, 24th Michigan, age 24. Walker, J., PL, B, 8th New York Heavy Ar- tillery, age 19. Wallingford, G., PL, G, 17th Maine, age 46. Walsh. J., PL, A, 64th New York, age 42. Walsh, J.,Corp'l, K, 37th Massachusetts, age 24. Wandrey, A., Serg't, K, 2d Wisconsin, age 25. Ward. .,., Pt., C, 88th Pennsylvania, age 25. Warden, W. H., Serg't, F, 76th Illinois, age 22. Warford.S. J.,PL, B,8th Kentucky, age 24. Warner, J. T., Corp'l, K, 118th N. York, age 22. Warwick. N.,Pt.,B,13th Infantry. Watson/W., PL, M, 2d Artillery, age 27. Weatherlow, S., Serg't, 1,126th N.Y., age 25. Weaver. T., PL, H, 66th Georgia, age 25. Weber, W., PL, K, 2d New York Heavy Ar- tillery, age 22. Wells, IL W., Serg't, H, 16th Maine, age 26. Welsh, M., Pt., E, 162d New York. Dates. June 16, 16, '62. Aug. 21, 21, '63. April 2, 2, '65. Aug. 21, 21, '64. Oct. 8, 8, '62. July 21, 21, '64. June 18, 18, '64. June 12, 12, '64. May 16, 16, '63. Sept, 17, 17, '62. Sept. 30, 30, '64. July 1, 2, '63. July 12, 12, '63. May 3, 5, '63. April 9, 9, '65. May 28, 28, '64. Sept. 17, 18, '64. Oct. 19, 19, '64. Aug. 5, 5, '64. Nov. 14, 14, '62. De.31,'62, Jan. 1,'63. April 6, 6, '62. Sept. 9, 9, '63. Julv 3, 3, '63. Oct. 7, 7, '64. June 3, 4, '64. Mav 6, 7, '64. May 12, 13, '64. April 2, 2, '65. July], 3, '63. Aug. 29, 30, '62. April 9, 9, '65. Jan. 2, 2, '63. Sept. 30, 30, '64. May 18, 20, '63. June 11, 11. '64. July 4, 4, '63. Nov. 30, De.1,'64 June 10, 11, '64. Dec. 13, 14, '62. July 27, 27, '64. Operations, Operators, Result. Left. Discharged September 9. 1862. Right: ant, post. flap. A.Surg. C. Mudge. 1st N. York Engineers. Disch'd July 2, 1864. Right; necrosed bone removed. Mustered out Sept. 28. 1865. Right: circ. Surg.W. T. Brewer, 43d N. ('. Trans. Jan. 8, 1865. Left; circ. Surg. C. Spinzig. 2d Mo. Disch'd Dec. 17, 1864. Lett: flap. Discharged August 23. 1865. Right; flap. Surg. T. M. Flan- dreau, 146th N. Y. Hsemor= rhage. Discli'd June 24,1865.' Right: flap. Surgeon — Wier. ('. S. A. Discli'd Sept. 8, 1865. Left (amp. right, upper third). Discharged Sept. 3, 1863. Left; flap. Surg. J. T. Gilmore, C. S. A. Retired Jan. 31, 1865. Left. Released July 26, 1865. Left: post. flap. Disch'd April 2, 1864. Died June 12, 1870. Spec. 4307. Left. Surg. W. S. Edgar, 32d Illinois. Discharged. Left; double flap. Surg. F. S. Holmes, 6th Me. Hsemorrhage. Disch'd October 27, 1863. Right; circ. Discharged July 6, 1865. Left; ant. post. flap. A. A.Surg. W. H. True. M. O. Sept. 9. '64. ----. Surg. — Bacon, O. S. A. Recovery. Left; double flap. Surg. G. T. Stevens, 77th N. Y. Gangrene. Disch'd May 16. 1865. Right. Surg. J. C. Palmer, U. S. Navy. Disch'd May 5,1865. ----. Retired February 11,1865. Left; flap. Discharged Mav 19, 1863. Right; flap. Discharged Aug. 21, 1862. Right;, lat. flap. Surg. S. W. Gross, U.S.V. Discli'd June 23, 1864. Left. Ass't Surg. J. S. Billings, U. S. A. Re-amputation. Re- tired January 7, 1865. Right. Duty Feb. 10, 1865. Left; long post,, short ant. flap. Surg. C. H. Pegg, Sth N. York, II. A. Disch'd Sept. 14, 1865. Right; ant. post. flap. Confed. surgeon. Disch'dNov. 29, 1864. Right; lat. flap. Surg. C. T. Kel- sey, 64th N. Y. Disch'd Julv 30*. 1865. Right; circ. Surg. E. M.White, 37th Mass. Discli'd Sept. 12,'65. Right: circ. Ass't Surg. P. S. Arndt.2dWis. Dis. April 1.'64. Left; ant. post. llap. Surg. J. S. Jemison, 86th N. Y. Disch'd September 29. 1863. Left; double lateral flap. Dis- charged June 24, 1865. Left; flap. Discharged Novem- ber 16, 1863. Left; ant. post. flap. Discharged September 12, 1865. Left; flap. Discharged. Left; circular. Disch'd March 18, 1865. Right. Discharged December 25, 1864. Right; circ. To Provost Marshal March 7. 1865. Right ; circ. Surg. J. W. Wis- hart, 140th Penn. Discharged December 9, 1864. Right, Discharged May 3,1864. Right; lat. flap. Disch'd Oct. 21,1865. Reamputation. 1 FISHER (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antietam, in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. 2FISHER (G. J.), loc. cit., p. 48. SECT, v.] PRIMARY AMPUTATIONS IN THE LEG. 489 Name, Military Description, ami Ai Welsh, M., PL, II, 49th Pennsvlvania, age 20. Welsh, 'l'., PL, C, 34th Ohio, age 27. West, O. F., Pt., 1. 5th Wisconsin, age 18. Westbrook, J., PL, A, 104th New York. Wester. .1.//., Pt.,1, 30th North Carolina, age 24. Wheeler. O, PL, 1, 4th Colored Troops. Wheeler, E. IL, l't., G, 17th Maine, age 22. Wheeler. H..l't..I),125tIi New York, age 22. Whit.-onib.W.W..Corp., C. llth Mass., age 21. Whitlock, <>. ./., PL. li. 44th Virginia. Whitman! F. M., PL, G, 35th Mass.. age 25. 707! Wicks, W., PL. II. Sth New Jersey, age 23. 708 Wierman, J. IL, l't.. A, 69th Indiana, age 24. 709 Wilburn, J. M., PL, D, 63d Indiana, age 23. Wiley. W. C, Pt., E, 70th New York. Wilkinson, J. A., Serg't, F, 23d Virginia. Williams, J., Pt., B, Sth Penn. Reserves, age 24. May 10, 11,' '64. June 18, 18, '64. April 2, 2, '65. Sept. 17, 17, '62. July 3, 3, '63. Feb. 11, 11, '65. May 3, 3, '63. July 2, 3, '63. July 2, 4, '63. Mav 3, 4, '63. May 18, —."'64. Oct. 27, 29, '64. April 9, 9, '65. May 14, 15,* 64. July 3, 3, '63. Aug. 25, 2.Y'64. May 8. 8. '64. Operations, ( ht'.rators, Result. 713 Williams, J. H, PL, I, ! Aug. 5, I 2d Kentucky. 5, v62. 714 I Williams. R. W., Serg't. Mar. 25. I, 57th .Mass., age 22. 25. 'i',r>. Williams. T., Serg't, K. ' June 4, 5th Illinois Cavalry. , 5, '63. Williams. T..PL, E, 17th Dec. 14, Col'd Troops, age 25. | 15, '64. 756 !757 60 °i 723 724 Williams. T. G., PL, I. 23d North Carolina. Willis. F. J., Serg't, A. 51st New York, age 24.. Willis. N. .L, PL, D. 15th N.Y. Ilv'vArt.,agel9. Wilson, W.L..Lieut,, H. 15th Alabama. Wilson, W. P., Serg't. F. 19th Indiana, age 35. Wilson, W. W., Serg't, G,66th Ohio. Winus, T., Pt., A,4thN. Y. H'vy Art., age 20. Wood, E. It., PL, B, 18th Connecticut. July 2, 3, '63. July 30, 30, '64. May 20, 20, '64. Nov. 25, 26, '63. Julv 1, 2, '63. June 9, 10, '62. Aug. 23, 24, '64. June 17, 18, '64. 725. Wood. G., l't., D, 33d Mar. 19, 1 Ohio, age 25. ; 20, '65. 726 | Wood, M.. Serg't.C, 11th Sept. 19, Vermont, age 19. 19, '64. Woodrnt!'. S. B., Serg't, F,20th Ky., age 21. Woodward'. W., Pt., B, 116th New York. Workman, H., Pt., E. 83d Ohio, age 18. Wright, E. ('., Corp'l, H, 21st N. Jersey, age 19. Wunderlin, J. E., Pt., C, 33d New York, age 27. Yaeger, W., PL, B, 26th Wisconsin, age 24. Yoder, N. W., Lieut., A, 51st Ohio. York, J. C, Pt., C, 94th New York, age 28. Zibble, A. H., PL, L, 7th Mich. Cavalry, age 18. Zwicker. E., Pt., B, 7th Ohio. Alcock, A.O.,PL,C,10th New York, age 41. Aldrich. J., Corp'l, F, 188th N. York, age 43. Anderson, D., Corp'l, H, 7th Maryland, age 41. Aug. 10. 10. '64. Oct. 19, 211, '64. Jan. 11. II, '63. May 3, 3, '63. Mav 3, 5, '63. May 14, 14, '64. Jan. 2, —, '63. Aug. 19, 20, 'C4. July 10, 10, '64. Aug. 9. 11. '02. May 10, 10,* '64. Feb. 6. Right; circular. Disch'd Janu- ary 22, 1865. Right; Hap. Discharged April 1. 1865. Left; circ. Discharged July 12, 1865. Right; ant. post. flap. Disch'd December 26, 1862. Right. Surg. (I. W. Briggs, 30th : 744 N.O. Paroled Nov. 25, 1863. j, (tight; circular. Disch'd July 25, 1865. Left. Surg. N. A. Hursam, 17th Maine. Discli'd Dec. 16, 1863. Right; Hap. Surg.W. S. Cooper, 125th N. Y. Dis. June 21), 1864. Right: circ. Surg. II. It. Fowler. 12th N. II. Disch'dNov. 21.'63. ---. Surg. P. F. Whitehead. P. A.C. S." Retired Dec. 28. '64. Right ; ant. post. Hap. Snrg. T. F. Oakes. 56th Mass. Disch'd ' Dec. 15, 1864. Re-amputation. 750 Right ; circular. Disch'd Sept. 23, 1865. i 751 Left; circ. Surg.W. A. Babcock, !j 76th 111. Disch'd June 5. 1865. Left; flap. Surgs. B. (!. Pierce, j 752 96th 111., and H. E. Basse, 24th Wis. Disch'd Nov. 21. 1864. Left; Hap. Surg. J. Ash, 70th i 753 N. Y. Discharged. ----. Surg. C. C. Henkel.C.S.A. 754 Retired December 30. 1864. Right: circ. Surg. IS. Rolirer, 755 10th l'enn. Res. 'Disch'd June 8. 1865. Spec. 2969. Lett. Surg. — Patton, C. S. A Recovery. Right; circ. A. Surg. S. Adams. F. S. A. Disch'd Oct. 30,1865. Spec. 4028. Right; flap. Surg. J. B. Ensey, 5th 111. Cav. Dis. Aug. 11, '63. Riffht; flap. Surg. P. H. Clem ons, 17th Col'd Troops. Mus- tered out May 31. 1865. Left. Paroled September 25, '63. j „,... Right; circ. Surg. L. W. Bliss. ,76'2' 51st N.Y. Discli'd Mar. 1, '65. 763 Left; circular. Discharged De- cember 30. 1864. 764 Left. Surg. — Gunnal, C. S. A. [ Recovery. ! 765 Left; flap. A. Surg. P. S. Amdt, \ 2d Wis. Disch'd Dec 13, 1863. 766 Right; flap. Confed. surgeon. Disch'd Jan. 6, 1863. i 767 Left; flap. Surg. G. L. Potter. ! 145th Penn. Dis. June 16, '65. 768 Right. Surg. L. Holbrook, 18th ' Conn. July 29, amput'n thigh. ! 769 Discharged May 4, 1865. ! Left; circ. Confederate surgeon. ' Discharged July 31, 1865. i j 770 Left; double flap. Surg. 0. B. Park. jr.. llth Vermont.' Disc'd 771 July 6. 1865. Left:* circ. Surg. J. C. Welch, 20th Ky. Disch'd Mar. 10.'65. 772 Left: circular. Discharged June 6. 1865. 773 Left- circ. Surg. J. Pomerene, 42d Ohio. Disch'd Dec. 17,'64. i 774 Right; posterior Ha).. Surg. 1). ! McNeill. 21st N. J: Disch'd.I une 775 13, 1863. Amp. knee joint. Left: flap. Mustered out April 1776 1, 1864. Left; flap. Surg. J.W. Hastings, !, 777 33d Mass. Done rem. Discli'd. i| Left. Discharged July 30, 1863. ! 778 Drowned March 9. 1877. Right: circ. Discharged March 779 17, 1865. 11 Right; circ. Confed. surgeon. ; 780 Discharged May 19, 1865. i 1 Right; double flap. Discharged 781 October 27, 1862. | Left. Died June 16, 1864. 782 ji Left; double flap. Died March! 783 2, 1865; pyjemia. 1 Right (also* amp. left leg, lower 784 third). Died Oct. 1, 1864. I! * Name, Military Description, and Aoe. Armstrong, J. G.,Pt.,G Sth Michigan. Austin, E. B., PL, A, lllth Ohio. Axtelle, F.lI..Pt.,I'.,34th Massachusetts. Bailey. S. (;., Lieut., H, Sth 'Maine, age 29. Bailey, S. W.,'Serg't, I, 2d Vermont, nge 31. I'.allard, .)., PL, G, 143d Pennsylvania. tla in ntoiiil, C., PL, Car- ter's 1st Virginia Bat- tery, age 38, llu,'ncs, It. .f..PL,E, 10th South Carolina. Ringer, I... PL, 10, 5th Kentucky. Hohrcr. ('.', 1'L.G, 107th Ohio. Bradley, .)., PL, K, 1st .Mass. 11 vv Art..age33. Brongher, S. IL, Serg't, C, 142d l'enn., age 20. Bruce, L. H. ('., Corp'l, K, 14th Iowa. Brugart, C, Lieut., I, 26th Wisconsin. Burdett, C, Corp'l, H, 2d Massachusetts. Burns, F., PL, H, 88th New York. Operations, Operators, Result. Carter. ('., Pt Col'd Troops Cassidy. I., Ft Kentucky. Chapel. G., P \ irgini i -igt Clevantine, J., 150th Pennsy Colcord. C. E., 4th N. Hamp , A. J., age 35. G, 61st , age 40. ., H, 16th L, B, 6th 19. Serg't, F, lvania. Serg't, C, , age 26. Pt., D, 3d Mis Cork. I., Serg't, C. 4th Col'd Troops, age 25. Craig, J. S., PL. H. 14th Indiana. Crumley, H. W., Corp'l, D, 110th Ohio, age 20. Curran, (}., PL, 1,124th New York, age 33. Curry, D., Pt., K, 0th Louisiana. Curtis, J., PL, C, 28th Massachusetts, age 26. Day, J. E., Lieut,, K, 3d West Virginia. Deneza. ('., PL, L, 5th ' Oct. 23. Mo. Mil. Cav., age 30. i 23, '64. Drain. J. F., PL, A, 53d I July 2. Virginia, age 26. , 4, '63. Nov. 29, 29, '63. May 14, 14, '64. June 5, 6, '64. Mav 3, 3, '63. SepL 19, 20, '64. May 5, 5, '64. Mav 14, 14,''64. July 22, —,''64. Nov. 25. 26, '63. July I, —, '63. May 19, 19, '64. May 5, 5, '64. May 18, 18, '64. July 1, —, '63. Jnlj-3, 4, '63. June 19, —, '64. July 15, 15, '64. June 17, 17, '64. June 3, 3, '64. May 16, 16," '64. Dec. 15, 16, '64. Sept. 29, 29, '64. Dec. 13, 13, '62. July 18, 18.*'64. July 29. 29.''64. July 9, Right. .Mass. Right. Surg. J. P. Prince, 36th Died Dec. 27, 1863. Died June 30, 1864; py 11. May 10, II, '64. Aug. 28, Durkin, J. W., Pt., F, 120th X. York, age 35. Edwards, R. T., Serg't, F, 19th S. Carolina. Elmer, A., PL, F, 1st New York Cavalry. Emerson, C. A., PL, II, 97th Ohio. Farman, D., Corp'l, II, 155th Penn., age 23. Fisher, (!., PL, I), 24th N. Y. Cavalry, age 44. Folkarts. J., PL, K, 5th Michigan, age 50. French. I). H., Serg't, E, 34th Mass., age 24. Gibson, C. O., PL, H, 4th Vermont, age 31. Ginnicker, C. B., Lieut.. D. 9th Mass., age 27. Givens. S., l't., A, 9th Col'd Troops, age 28. Goodrich, M. B., Lieut., II, 93d Peun., age 25. Goudy, C. W. C, PL, D, 1st Mass. H. A., age 22. Mar. 31, 31, '65. ---, '64, Primary. Mar. 31. 31, '65. June 27, 27, '64. Aug. 16, 16, '64. May 18, 19, '64. July 2, 3, '63. Oct. 13, 14, '64. Oct. 19, 19, '64. May 5, —, '64. SepL 29, 29, '64. May 5, 5, '64. May 19, 19, '64. ----; circular. Died July 21, 1864; pya-mia. Right. Died May 30, 1863; py a'inia. Right; flap. Surg.G. T. Stevens, 77th N. Y. Died October 21, 1864; diphtheria. Right. Surg. II. F. Lyster, 5th Michigan. Died May 16, 1864. Right. Surg. II. F. Lyster, 5th Michigan. Died May'26, 1864. Left. Surg. M. W. Robbing, 4th Iowa. Died July 30, 1864. Right; circular; gangrene. Died December 17, 1863. Right. Died July 16, 1863,. i Left. Died June 22, 1864. Right; ant. post. flap. Surg. L. Holt, C. S. A. Died April 4, 1865; pleurisy. Right; circ. Surg. C. Powers, 160th N. Y. (Also wound of | thigh.) Died June 14, 1864. Right. Died July 16. 1863. Left; circular. Died July 26, 1863. Left, Surg. P. E. Hubon, 28th Mass. Died June 26, 1864; ty- phoid fever. Right; circ.; erysipelas; gang. Died Aug. 5, 1864; gangrene. Right. Surg. J. T. Kimbly, llth Kentucky. Died June 17,1864. Left; ant. post. flap. Died May 27, 1864; prostration. ----. Died June 12, 1864. Left. Died June 27,'64: tetanus. Both; circ. Died Jan. 2, 1865; exhaustion from sloughing. Left; flap. Died October 1,1864. Right. Died January 6, 1863. Left. Died July 28, "64; tetanus. Left; ant. post, flap; gangrene. Died Aug. 26, 1864 ; exhaust'n. Right; circ. Surg. C. H. Todd. C.S.A. Died July 16,1864. Left; flap. Surg. P. E. Hubon, 28th Mass. Died Mav 17, 1864. Left. Surg. R. XV. Hazlett. 5th West Virginia Cavalry. Died Sept. 27, 1862; pvamiia. Left. Died Nov. 10. 1864; gan- grene. Left. Oct. 1, haem.: 9th, amp. thigh. Died Nov. 5, 1863; ex- haustion. Specs. 1963,1975. Left; gangrene. Died April 25, 1865. Right. Died. ----. Died May 14, 1865. Right. Died July 18, 1864. Right. Died October 10, 1864; exhaustion. Right. Died July 14, 1864 ; ex- haustion. Right. Died Septembers, 1863; exhaustion. Right; ant. post. flap. Died Nov. 13, 1864; exhaustion. Right. Died November 26,1864 ; diphtheria. Right, Died June 9, 1864. Left. Died October 21, 1864; exhaustion. Left; flap. Died June 14, 1864; pysemia. Right; gangrenous. Died May 24, 1864. Sfrg. Ill—62 l.'O INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Nave, MlLllARY , t,.™. Description, and Age. UAiBt>- Operations, Operators, Result. 785 Gray, J. C, PL, B, 10th Texas, age 20. 786 Green, M., PL, B, 2d Michigan, age 20. Greene,W. P., Lieut., A, 14th West Virginia. Hatch, A., Serg't, A, 7th Connecticut, age 22. Hatch. T.. l't., D, 1st Me. Heavy Arty, age 45. Ilaynes, H., PL, C, 14th Infantry, age 19. Hayward, J. W., PL, A, 9th C. Troops,* age 25. Hella, C, PL, B, 121st Pennsylvania. Hewlett, J., Pt., E, 30th Virginia. Ilobart, C. J., PL, I, 27th New York. Hollanbeck, S., Corp'l, D, 52d N. Y., age 28. Hopkins.'S. M..Lieut., I, 12th Rhode Island. Irwin, D., Pt.,G, IstMd. Cavalry, age 21. Irwin, T., Pt., C, 14th New Jersey, age 20. Jacobson, F., Pt.,C, llth Connecticut, age 18. 788 789 790 791 792 793 794 795 796 797 798 799 800 Job. J., l't.. M, 2d New York Artillery. 801 Johnson, J. II'., Pt., H, 19th Arkansas, age 25. 802 Johnson, M. B., Pt., (1 Kith Georgia. 803] Jones, L., PL, D, 58th I Massachusetts, ago 45. 804 Jullivett.N., l't., I), 98th New York, age 19. July 22, 24, '64. June 17, 17, '64. Sept. 22, 23. '64. Aug. 16, 16. '64. June 19, 19. '64. Mav 24, 25," 64. Sept. 29, 30, '64. Dec. 13, 13, '62. Mar. 25, 25, '65. Sept. 14, 15, '62. Aug. 15, 16, '64. Dec. 13, 13, '62. Aug. 16, 16, '64. May 10, 10, '64. June 18, 18, '64. June 16, 16, '64. Nov. 30, Dec.1,'64. Sept. 14, 16, '62. June 3, 3, '64. Sept. 29, 30, '64. 805 Kirk, A., Pt., K, 95th May 12, New York. 12, '64. 806 Klock, M., PL, B, 9th Dec. 16, Minnesota, age 51. 16, '64. 807 Korff, C Corp'l, B, 6th Dec. 4. Indiana. 4, '64. 808 Kruppel, L., Corp'l, D, June 17, 46th New York, age 37. 17, '64. 809 Larabee, J., PL, E, 75th July 1, Ohio, age 19. 1, '63. 810 LaRose, C. Corp'l, H. May 5, 6, ^64. 93d New York, age 27. 811 Lee, T., PL. E, 43d New July 12, York, age 45. 12, '64. 812 Leyan, G. W., Pt., C, Dec. 13, 131st Pennsylvania. —, '62. 813 Lewis, N., Lieut., C, Oct. 19, 114th New York. 19, '64. 814 Lewzader, W., PL, B, June 15, 9th Indiana, age 24. 15, '64. 815 Licingstone,L. .4.,Capt,, July 2, F.Sth Alabama, age 23. 3, '63. 816 Long, O., Ft., G, 49th Sept. 19* Pennsvlvania. 19, '64. 817 Longe. J., Pt., L, llth Junel, Vermont, age 18. 2, '64. 818 Lozo. .1., Corp'l, B, 21st Mar. 19, 19, '65. 819 Magner. 1-;., PL, I, 69th Sept. 17, New York. —, '62. 820 Mann, B. H, Lieut., I, May 20, 59th Virginia, age 44. 20, '64. 821 Manny, D., Pt., 7th New June 28, York Battery, age 24. 28, '64. 822 Marshall, B. F., PL, A, Sept. 14, 1st N. Hampshire H'vy 14. '64. Artillery. 823 McCarthy, D., Corp'l, C, Sept. 19, 26th Massachusetts. 19. '64. 824 Met'lure. D..PL, D,28th Julv 30. Colored Troops. 30, '64. 1825 I | e26 McCullough, L., Corp'l, H, 31st Miss, age 19. McDermott, E., Pt., H. 7thN.Y.H.ArL, age48. July 20, 21, '64. June 20, 20, '64. Right; ant. posterior flap. Died March 13, 1865. Right. Snrg. S. S. French, 20th Mich. Died July 2, 1864; irrita- tive fever. Left; circ. Died Oct. 31, 1864; irritative fever. R't. Surg.G. C. Jarvis. 7th Conn. Died Sept. 9, 1864 ; exhaust'n. Right; flap: pysemia. Died July 13, 1864; exhaustion. Left; circular. Died August 20, 1864. Right. Died October 31, 1864; tetanus. Left. Died March 5, 1863 ; gan- grene. Right. Died April 25, 1865. Right; circular; slough. Died October 28, 1862 ; pleur. eff'n. Left; flap. Died September 7, 1864. Left; flap. Died December 26, 1862. Left, Died September 1, 1864; mortification. Right; circular. Died June 10, 1864; gangrene. Right; circ; gangrene. Aug. 20, re-amp. thigh ; gangrene ; haem. Died August 26, 1864. Right. Surg. J.W.Wishart, 140th Penn. Died July 11, 1864. Right; circ. Surg. — Ruskin, C. S. A. Died May 27. 1665. ----. Died October 7, 1862. Right: flap. Died July 1,1864. Right (also amp. arm). Surg. J. A. Bigelow, 8th Conn. Died October 9, 1864 ; exhaustion. Left; circular. Died May 31, 1864; exhaustion. Right; ant. post, flap ; sloughing. Died Dec. 29, '64 ; irrita, fever. Left: ant. post. flap. A. A. Surg. J. E. Patterson. Died Decem- ber 11, 1864. Left. Died June 24, '64; pysemia. Left; haem.; lig. femoral. Died August 20, 1863; pneumonia. Left. Died May 30, 1864. Right; circ. A. A. Surg. M. F. Price. Died Nov. 14, 1864. Right. Died. Right; sloughing. Died Nov. 30, 1864; pyaemia. Left; gangrene. Died July 4, 1864. Left; erysip. July 14, amp. thigh; haem. Aug. 4, three ins. bone removed. Died Sept. 27, 1863 ; erysipelas; haemorrhage. Left; flap. Died October!!, 1864 : exhaustion. Right. Died September 2, 1864. Right. Died May 18, 1865: py- semia. ----. Died October 29. 1862. Right. Died May 24, 1864; ex- haustion. Left; sloughed. Died July 24, 1864. Right; Teal's method. Surg. R. B. Bontecou, U. S. V. (Also wound of thigh, fract. left foot.) Haemorrh. Died Sept. 14.1864 ; exhaustion. Spec. 3245. Left; circular. Died October 7, 1864. Right; flap. Surg. D. Mac Kay, 29th Cold 'I'roups. Died July 30, 1864. Left; circ. Died Feb. 26, 1865; chronic diarrhoea. Left; circular. Died June 27, 1864; exhaustion. Name. Military Description, and Age. 827 McEntvre, D., Pt., B, j lOOth'N. Y., age 22. 828 McLane,W., Pt., D, 69th ! Penns3'lvania. 829 I Mecbam. J. E..Corp'l,H, 114th 111., age 20. 830 Mills, A., Pt., K, 6th Mississippi, age 24. 831 Modlin. J. H., Serg't. C. 36th Indiana, age 24. 832 Moore, A. J., Pt., D, 50th Pennsylvania. 833 Morris, W. F., PL, A, i 116th Illinois. Dates. May 15, 15, '64. May 12, 12, '64. Dec. 15, 15, '64. Nov. 30, Dec.1,'64 Mav 30, 30,* '64. May 10, 10, '64. July 22, 22, '64. 834 Munu, "W., PL, I, 27th May 10, Michigan, age 31. i 10, '64. 836 837 838 839 840 841 842 843 844 845 846 847 848 849 850 851 852 853 854 855 856 Nason. IL, Pt., C, 1st Rhode Island Artil'ry, age 38. Neff, J., Pt., K, 10th Massachusetts, age 27. Noe. A. "W., Pt., E, 13th Illinois. Nolan, R., Pt., B, 12th Col'd Troops, age 24. Page, J. C, Serg't, II, 15th Miss., age 25. Park, A. G., PL, K, llth West Virginia. Pierson, II'. C, Pt., F, 14th Texas, age 25. iPowell, W. H., PL, I, 3d South Carolina, age 20. Nov. 30, Dec. 2,'63. May 10, 10, '64. Nov. 27, 27, '63. Dec. 15, 17, '64. Nov. 30, Dec.2.'64. Sept. 19, 19, '64. Dec. 16, 16, *64. Sept. 17, 18. '62. Operations, Operators, Result. Preston. J. A., Serg't,A, May 11, 1st Mich. Cav., age 32. | 11,'64. Pyles. W. H., PL, H, Aug. 4, llth West Virginia, age 5,'64. 32. Queen, G., PL, E, 1st ; Aug. 17, Col'd Troops, age 20. : 17. '64. Quin, J., Pt., A, Austin's De.30,'6'2, Sharpshooters, age 30. J an. 1. '63. Raymond. W. M., Capt., Dec. 16, D, 52d Indiana. 16, '64. Remkwitz.G. A.,Pt.,G, 24th Illinois. Roberts, I., Pt., F, 100th Cold Troops, age 22. Robinson, G. 11.. Pt., D, 39th Illinois. Roehl, C., Corp'l, E, 21st Iowa. Sapp. W. E., Musician, A, llth N. J, age 20. Saunders, J., PL, E, 95th New York, age 33. Schweichardt, F., PL.D, 16th Illinois, age 38. Seerwald. C, PL, A, 8th Ohio. Sergent, C. J., Lieut., F, 7th Iowa, age 31. 857 Sharp, D. C, PL, B, 23d Iowa, age 25. 858 Sherman. R. T., Pt., F, 2d Pennsylvania Res., age 21. 859 Sinkswiller, J., Pt., K, 52d Virginia, age 34. 860 Small, J. W. M., Corp'l, D,17thlnfautry,age32. 861 Smith, G. R., Pt., T, 59th New York. 862 Smith, L. C. Serg't, G, : 4th Mich., age 26. 863 Spriggs. I. B., PL, D, 118th Ohio, age 20. 864 Storm, J., Pt.. A, 17th Wisconsin. 865 Stout, C. R., Pt., K, 25th I Massachusetts, age 20. 866 , Sturtevant.L., Serg't, F, I 1st Me. H. Art'y, age 22. Oct. 8, 8, '62. Dec. 15, 15, '64. May 12, 12, '64. May 1, 1, '63. June 23, 23, '64. Feb. 6. 6, '65. June 26, 26, '64. July 3, —, '63. Aug. 11, 11. '64. Oct. 28, 29, *62. May 12, 12, '64. May 30, 31, '64. July 2, 3, '63. Oct. 27, 27, '64. May 10, 11, '64. May 14, 15, '64. Mav 19, 19, '63. Julvl, 1, '64. April 2, 2, '65. Right; single post. flap. Gang. Died July 20, 1864. Right. Died May 26, 1864; py- aemia. Right; flap. Died January 16, 1865. Right; ant. post. flap. Surg. — Wayles.C. S.A. Died May 13, 1865; exhaustion. Right. Surg. S. II. Kersey, 36th Indiana. Died July 23, 1864; chronic diarrhoea. Left (also flesh wound right leg). Died May 13, 1864. Right; circ. A. Surg.C. B. Rich- ards, 30th Ohio. Erysipelas. Died August 5, 1864. Right; circ; gangrene. SepL 20, amp. thigh. Died Oct. 4, 1864 ; exhaustion. Spec. 3330. Left; flap (also amp. right-leg, lower third). Died December 21, 1863; pyaemia. Left; flap. Died May 28,1864. Left. Surg. S. ('. Plummer, 13th Illinois. Died Dec. 19, 1863. Left. A. A. Surg. J. S. Giltner. Died Dec. 30,1864 : gangrene. Left; circular; gangrene. Died March 26, 1865; pneumonia. Left, Died October 23, 1864. Right; circular. Died February 11, 1865; exhaustion. Right; flap; slough.; necrosis. Nov. 30, amp. thigh. Died Mav 2, 1863; exhaust'n. Specs. 3962, 795, 3837. Right; flap. Died August 20, 1864. Left; circ. sect, skin and muscles. A. A. Surg. W. B. Grain. Ery- sipelas. Died August 11, 1864. Left. Died September 11, 1864; exhaustion. Left. Surg. E. Swift, V. S. A. Haem. Died January 8, 1863. Left; ant. post. flap. Jan. 12,'65, re-amputation. Died Jan. 13, 1865; irritative fever. ——: typhoid fever. Died Nov. 19, 1862. Left; flap. Died December 22, 1864; effects of amputation. Right. Died May 25, 1864. Left; double flap; slough. Died May 20, 1863. Left.' Died July 31, 1864. Right; post. flap. Died March 19. 1865; tetanus. Left. Surg. C. S. Frink, U. S. V. Died Julv 7, 1864. Right. Died August 7,1863. Left; ant. post. flap. Surg.W. R. Marsh, 2d Iowa. October, '64. necrosed bone removed. Died I April 10, 1865. Left. Nov. 10, erysipelas. Died Nov. 18, 1862; erysipelas and pyaemia. Spec. 470. Right. Surgeon B. Rohrer, 10th Penn. Res. Died June 3, 1864; exhaustion. Spec. 4510. Right; circular. Bone removed. Died August. 12, 1864. Left, Died July 14, 1863; py- aemia. Right. Died October 30, 18G4. Right; flap. Died May 27,1864. Right; circ. Surg. S. K. Craw- ford, 50th Ohio. Died Sept. I, 1864; pyaemia. Right. Died July 15, 1863. Right. Died July 14. 1864; tet- anus. Right; lateral flap. Died May 14, 1865; exhaustion. 'Fishee (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antietam, in American Journal Medical Sciences, 186.3. Vol. XLV. p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 491 v. Name, military tut™ N0'| DESCRIPTION, AXI) Age. I UATES' 867! Taylor. A., Pt., I, 15th: Oct. 19, New Vork, age 46. I 19, '64. 868 ! Taylor, G. W.. Brig. I Aug. 27, I General U. S. V. 28, '62. Thibaek, II., PL, D, Sth Wisconsin, age 30. Thompson, J. T.. PL, II, 51st X. Carolina,age 19. Thompson, T. X., 1'L.n, 8th New York Heavy Artillery, age 17. Tracv, G. B^ Serg't, E, 9th *N. Hamp-, age 28. Tronpe, S., PL, B, 12th Col'd Troops, age 28. Twining, L. C, Serg't, B, 136th New York. Twining, P.E.,Serg't,F, 36tli Wisconsin, age 26. Valleley,E.J.,Pt.,A,3d R.I. Artillery,age 18. Vetter, J. C, Pt., G,26th Wisconsin. Wait, B., Corp'l, C, 16th Michigan, age 30. "Waters,W.,Pt.,K,123d New York. May 10, 10, '64. Sept. 30, 30. '64. June 2, 3, '64. Dee. 15, 16, '64. Mar. 19, 19, '65. June 1. 3, '64. April 9, 11, "68. Mav 3, 3, '63. Aug. 19, 20, '64. Mav 15, 15,' '64. Operation's, Operators, Result. liiglit; llap. Died November IS, IH64; py;emia. Left; double flap. Surg. J. H. Brinton, II. S. V. Died Sept, 1, 1862; exhaustion. Spec. 313. K't: circ. Surg. C. F. < 'raue, Sth Wis. Died June 5. '64 : pyaemia. Left (also w'nd of pelvis).* Died (let. 10, 1861; exhaustion. Right (also w'dofthigli and fract. left leg). Surg. S. II. Plumb, 82d N. V. Died June 24, 1H64. Left. I lied June 6. '64: pyaania. Left; flap. A.A. Surg. J. S. Gilt- ner. Died Dec. 30, 64; gang. Right (also fracture left fibula). Died April 8, 1865; pviemia. Left: eir-. Surg. s. li. Plumb, 82d N. Y. Sept. 14, amp. thigh. Died October 16, 1864. Right (also fract. ulnaand femur). Died April 14, '63. Spec. 1165. Left. Died May 18. 1863. Right; flap. Died September 18, 1864 ; pyaemia. Right (also amp. left hip joint). Surg. J. W. Brock, 66th Ohio. Died May 15, 1864. No. Name, Military Dates, Operations, Operators, Description, and Aoe. Result. 880 Watson, W., Pt., C, 4th May 13, Left. Surg. J.Spiegelhalter, iith Iowa. 13, '64. Missouri. Died May 14, 1864. 881. White, A., PL, C, 2d Oct. 19, Right; eire. Died October 21, Virginia Cavalry. 19, '64. 1864: erysipelas. 882 Winslow, S., PL, I, 37th April 2, Left. Died April 24, 1865; py- Massachusetts. 2, '65. temia. 883 Word, W. F., Corp'l, G. May 16, Right; flap. Died September 48th New York, age22. 16,*'64. 23, 1864. 884 Wyinnn. A. I'., Corp'l, June 22, Left; circ. Surg. W. A. Child, II, 9th New Vork H'vy 22, '64. 10th Vermont. Died July 10, Artillery, age 27. 1864; tetanus. 685 Yardley,'w.,Pt.,—,85th Mar. 10, Right; circular. Died March 27, New York, age 19. 10, '65. 1865; typhoid fever. 886 Young. 11. F, PL, 15,1st A pril 26, Right. Surg. J. Robnrts, IstM. Marine Brigade. May 15, re- Miss. Marine Brigade, 26, '63. age 18. amputat'n; haemorrhage. Died May 31, 1863. 887 Bradford, F. L.. PL, A, SepL 1, Left. lOtb Mississippi. 1, '64. 888 Emfini/er, E., PL, E, 7th Aug. 31, --. Mississippi. 31, '64. 889 Gambill, A. M., l't., A, May 1, Right. 6th Missouri. —,''63. 890 iO'Brien,J.,lt.,Ht\u., SepL 17, Left; post, flap; sloughing. Re- age 30. 19, '62. covery doubtful. 891 Oxford, E. J, Serg't, E, Aug. 31, Left. 2d Georgia. 31, '64. 892 Weaver, T.. PL, 11, 66th Nov. 30, Right; circular. Georgia, age 25. Dec.1,'64. Primary Amputations in the Lower Third of the Leg for Shot Injury.—There appear on the records of this Office nine hundred examples of primary amputation in the lower third of the leg. Six hundred and seventy-six terminated successfully, two hundred and fifteen fatally, and the results in nine instances are not recorded, a fatality of 24.1 per cent., exceeding the mortality of the primary amputations in the middle third 7.2 per cent. Successful Primary Amputations in the Lower Third of the Pones of the Leg.—The six hundred and seventy-six operations of this group were performed on six hundred and seventy-three patients, three being amputations of both limbs. Five hundred and thirty- two were Union and one hundred and forty-one were Confederate soldiers. Of the former, five hundred and twenty-eight were pensioned or placed on the retired list; forty-three of these have died since the date of their discharge. In fifty-two instances re-amputation in the leg and in six amputation in the thigh was subsequently performed. Case 740.—Lieutenant E. F. O'Brien, Co. A, 28th Massachusetts, aged 29 years, was wounded at Cold Harbor, June 3, 1YG4. Surgeon W. 8. Cooper, 125th New York, reported his admission to the field hospital of the 1st division, Second Corps, with "shot fracture involving the left ankle; leg amputated at lower third by Surgeon P. E. Hubon, 28th "Massachusetts." Five days after the reception of the injury the patient entered Armory Square Hospital, Washington, and one mouth later he proceeded to his home on leave of absence. He was discharged from service October 13. 18'*4, and afterwards entered the Veteran Reserve Corps, in which organization he served until April 17, 1867, when he was mustered out and pensioned. Subsequently he obtaiued employment as clerk in the Post Office and Interior Departments at Washington. In May, 1869, when visiting the Army Medical Museum, he was in excellent health, and stated that he had worn a •"Salem'' artificial leg with satisfaction for over five years. In his application for a new artificial limb, supplied in 1880, the pensioner reports the stump as continuing in "very good condition." His pension was paid September 4, 1880. The amputated bones of the leg, together with the astragalus {Spec. 4494, Surg. Sect., A. M. M.), were contributed to the Museum by the operator, and are represented in the wood-cut (FlG. 290), showing the tibia to be shattered into the ankle and the fibula fractured transversely. Case 741.—Lieutenant Robert Catlin, 5th U. S. Artillery, was wounded in an engagement on the Weldon Railroad, near Petersburg, August 21, 1864, by a twelve-pound round shot which crushed his left foot. Three hours after the reception of the injury the limb was amputated in the lower third, by circular incision, by Surgeon W. B. Fox, 8th Michigan. The wound healed rapidly, and Lieutenant Catlin was able to be about in a month. Dr. S. Weir Mitchell,3 who had the patient under treatment for a period of three years on account of neuralgia of the leg stump, published an 1 Circular Xo. 6, S. G. O., November 1, 1865. Circular No. 7, S. G. O., July 1, 1867, pp. 29, 58. 2FISHEU (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antietam, September 17, 1862, in American Journal Medical Sciences, Volume XLV, page 48. 8 Mitchell (S. W.), 27ie Relations of Pain to Weather, being a study of the natural history of a case of Traumatic Neuralgia, in American Journal of Medical Sciences, 1877, Vol. LXXIII, p. 306. 492 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. l'IG.291.-Sixins. of the stump of the bones of the left leg. show- ing a massive invo- lucrum. Sjiei: 1526. elaborate account of the results of his observations. In July, 1866, Lieutenant Catlin was promoted Captain. Dr. John 11 Brinton, in the spring of 187"), at the request of Dr. Mitchell, exsected one and a half inches of the peroneal nerves, but without material influence on the neuralgic pains. The patient was furnished with an artificial limb by A. A. Marks, of New York. Ho was placed on the retired list as captain December 15, 1870. Cask 742.—Private J. Cavanaugh, Co. C, 7th Wisconsin, aged 27 years, was wounded before Petersburg, June 18, 1864, by a shell, which caused a fracture of the lower portion of the left leg, involving the ankle joint. Surgeon 0. N. Chamberlain, U. S. V., reported that the injured leg was amputated at the field hospital of the 4th division, Fifth Corps. Surgeon B. B. Wilson, U. S. V., contributed the pathological specimen, No. 1526, Surg. Sect, £. M. M., shown in the adjoining wood-cut (Fig. 291), and reported the following history of the case: "The patient was admitted to Stanton Hospital, Washington, from City Point, July 1st. He had suffered amputation of the leg at the lower third, by the circular method, the day after he was wounded, beintr, according to his statement, in a high fever at the time of the operation. He was treated with stimulants, and ice dressings locallv. During the month of September the limb became much swollen and abscesses formed in the line of the middle third of the bone, which, after discharging, left fistulous openings, clearly indicating necrosis of the shaft of the tibia. His term of service having expired, the patient was discharged October 5, 1864. but being unable to leave, he Avas retained as a patient in the hospital. The shaft of the tibia being evidently extensively necrosed, I determined to perform another amputation above the diseased portion. This operation—though opposed by the medical staff of this hospital and by Surgeon A. X. Dougherty, U. S. V.. as well as Surgeon T. F. Betton, 1st U. S. V. V., who saw the case—was preferred by me to that of exsecting the sequestrum for the reason that it involved no more danger and would give the patient a much better stump (though six inches shorter) for fitting an artificial limb. The operation was performed one inch below the tubercle of the tibia, by the cir- cular method, on February 25, 186"), and the stump was treated with cold-water dressings. Traumatic erysipelas followed (an epidemic of erysipelas breaking out in the hospital the same week), and for a few days fears were apprehended as to the result. The patient, however, made a good recovery, and by March 15th the inflammation, which had extended to the abdomen, had subsided. Before he finally left the hospital the patient received an artificial limb, on which he walked with great ease and comfort. The specimen indicates clearly and in a marked degree the efforts of nature in throwing off dead bone and supplying its place by new growth. The adventitious process, thrown out to unite the amputated ends of the tibia and fibula and thus give ihe extremities of those two-bones firmness and solidity, shows to how great an extent the reparative process can be carried. By what agency the want of bony matter at this point was perceived and its deposit determined at the proper place and in the proper form is beyond the scope of human knowledge at the present time. The fact. however, evidences the powers of nature to accommodate herself to circumstances and to repair in a limited degree the effects of losses which are irremediable.-' The specimen, consisting of the re-amputated stumps of the bones of the leg joined by osseous deposit at their lower extremities, shows a massive involucrum except on the anterior border, where a heavy sequestrum is visible. The patient became a pensioner after leaving the hospital. On September 2, lt74. he was examined by Dr. C. F. Falley, pension examiner at Lancaster, Wisconsin, who certified to the loss of the leg and reported: "The amputation has left rather an irritable stump, but, as his cork leg does not press on it, I do not think it any great injury in wearing an artificial limb. He can flex and extend the stump freely," etc. The pensioner was paid March 4.1880. In his application for an artificial leg he reported that Surgeon D. C. Ayres. 7th Wisconsin, performed the first amputation. Case 743.—Private F. ('rahame, Co. A, 6th Wisconsin, aged 26 years, was wounded at Spottsylvania, May 10, 1864. Surgeon C. N. Chamberlain, U. S. V., reported his admission to the field hospital of the 4th division, Fifth Corps, with "shot fracture of right ankle joint, followed by amputation of leg at lower third." The wounded man was conveyed to Armory Square Hospital, Washington, several days after the reception of the injury, and two months later he was transferred to Harvey Hospital at Madison, where, on September 7th, a second operation was performed by Surgeon H. Culbertson, U. S. V., who made the following report: "The stump of the tibia became necrosed from the lower end to its tuberosity. New bone formed, but the necrosed portion was not separating. There were several cloacae, and the lower end of the tibia projected through the soft parts of the stump. The patient was in an anaemic condition and his system was failing from the constant discharge and reflex irritation from the diseased stump. Designing to resect the diseased tibia, I made an incision from the tuberosity of the bone down to its lower extremity, but on separating the soft parts I found the disease so extensive as to lead me to amputate by a short anterior and a long posterior flap at the tuberosity of the tibia. In notching the tibia the periosteum was pushed back, the notch sawed off. and the periosteum laid over the surface of the bone. The anterior and posterior tibial arteries were ligated. Simple dressings were applied after the operation, and quinine and iron was administered. The sutures were removed on the fifth day and the ligatures came away on the fourteenth day. The wound steadily healed." The re-amputated stump of tlie tibia and fibula (Spec. 3696, Surg. Serf., A. M. M.), the latter being well rounded and united at its extremity with the former, were con- tributed to the Museum by the operator, and are represented in the wood-cut (FlG. 292). The specimen shows a sequestrum in the tibia six inches long; over the upper part of the anterior border the involucrum is wanting. The patient was discharged from service August 22, 1865, and pensioned, having been previously furnished with a "Bly" artificial leg. In his application for commutation he described the stump as continuing in "healthy condition." This pensioner was paid March 4. 1880. In tlie following instance both legs were amputated in the lower thirds on the day of the injury. The patient survived the operation ten years: Case 744.—Private D. Lee, Co. G, 2d New York Artillery, aged 20 years, was wounded in both legs by a shell during the siei_e of Petersburg, June 16, 1864, and entered Harewood Hospital, Washington, six days afterwards. Surgeon R. B. Flc 292.—Re- amputated por- tions of the right tibia and fibula. Spec. 369C. K1XT. V.] PRIMARY AMPUTATIONS IN THE LEG. 193 Bontecou, U. S. V., reported: "The patient had both legs amputated by Assistant Surgeon O. S. Paine, 2d New York Artillery, on the day he was wounded, the operation being performed by the circular method at the lower thirds. He stated that he was in good health at the time of the operation. At the time of his admission he was suffering from diarrhoea, and there were symptoms of gangrene in the stump of the right leg, the tibia and fibula protruding; granulations of stump of left leg not very good. The treatment was supporting, and included opiates, astringents, and the external application of solution of chloride of lime to the gangrenous stump. By June 26th the patient was improving and the granulations had become healthy." He was subsequently transferred to the General Hospital at Rochester, discharged May 31, 1Hli.">, and pensioned, having been previously furnished with artificial legs of the "Bly" pattern. In his application for artificial limbs, dated 1870, the pensioner described the stumps as being iu a "sound condition." He died September 25, 187 1. Though tho immediate cause of his death was not ascertained, the pensioner's health had been reported as having become very much impaired. Fatal Primary Amputations in the Lower Third, oj the Leg.—Two of the two hun- dred and fifteen operations of this group were double amputations; the operations were therefore performed on two hundred and thirteen patients,—one hundred and ninety-one Union and twenty-two Confederate soldiers, lie-amputation in the leg was performed in seven and amputation in the thigh in two instances. Case 745—Private 71'. ,/. Holmes, Co. G, 33d Mississippi, aged is years, was wounded in the left leg, at the en^airement of Peachtree Creek, near Atlanta, July 20, 1S64, and suffered amputation two days afterwards. About four months after losing his limb he was taken prisoner at Franklin, Tenn., whence he was conveyed to Nashville and sub- sequently to Louisville. Surgeon R. R. Taylor, U. S. V., who contributed two post-mortem specimens from the stump, reported the result of the case as follows: "The patient was adinitted to Crittenden Hos- pital on December 9th. He was suffering from chronic diarrhoea, of which he died December 23, 1HSI. His left leg had been amputated by the circular method, at the lower third, in consequence of gunshot fracture of the lower portion of the tibia and fibula. In October a portion of the fibula came away, after which the stump healed rapidly. At the time of his death the stump was entirely well. The accompany- ing specimens are intended simply to illustrate the changesin the cut ends of the bones and nerves. The latter, consisting of the extremities of the posterior and anterior tibial and of the musculocutaneous nerves, are bulbous." The nerve portions constitute specimen 4244 of the Surgical Section of the Museum. A representation of the specimen of the bones of the stump {Spec. 4243, Surg. Sect., A. M. M.) appears in the wood-cut (FlG. 293). In the history of the specimen on page 400 of the Catalogue of The Surgical Section of the U. »v. A. Medical Museum, Washington, 1866, it is remarked that "though the stump is said to have been entirely healed, * * the specimen shows the extremity and posterior surface of the tibia necrosed.'* In a letter dated December 18, 1867, Dr. II. M. Lilly, late Acting Assistant Surgeon, states that he prepared this specimen, and adds: "I can corroborate Surgeon R. R. Taylor's statement that the 0f ieft je„ five'montbs stump was entirely healed. In explanation of the necrosed appearance, of the end and posterior portion jf*1" a,nP"ta,lon- sPec- of the tibia, I offer the following history of the preparation of the specimen as possibly giving it the appear- ance of necrosis. Owing to the inconvenient arrangements of the hospital (the hospital not being finished at that date), I macer- ated the specimen in a tin can in my private room. Under such circumstances it was of course desirable to destroy completely all effluvium. To this end I supplied the water in the can liberally with the solution of permanganate salts furnished by the Medical Purveyor. May it not be that the chemical action of these salts has slightly damaged the specimen, giving it a partially necrosed appearance?" Case 746.—Private B. Sprigyle, Co. I, 17th Pennsylvania Cavalry, aged 28 years, was wounded in the engagement near Funkstown, July 10, 1863, and entered the General Hospital at Frederick ten days afterwards. Assistant Surgeon R. F. Weir, U. S. A., reported: "He was wounded by a minie ball, which entered the outer side of the left foot just below the external malleolus, passing directly through, involving the bones of the ankle joint and emerging three-fourths of an inch below the internal malleolus. The leg was amputated*at its lower third by flap operation the same day he received the injury. At the time of admission the stump looked well and there was healthy suppuration; patient doing well constitutionally, suffering none and having good appetite. He was allowed a generous diet, and in addition one-half pint of port wine daily, and the stump was dressed with adhesive plaster straps and cold-water applications. On August 4th, the flaps having firmly adhered, the straps were taken off the stump and simple cerate dressing was applied. Two days afterwards the patient was able to sit up for a few hours in a chair, and on the next day an abscess was opened which had formed near the end of the stump. The patient's appetite now had become a little depraved and he had some irritation of the stomach. During the evening of August 7th he had a severe chill, followed by some fever the next morning. Quinine and fever mixture was then prescribed and the wine con- tinued. August 9th, pulse 106 and rather feeble; appetite not improving; some discharge still coming from the superficial abscess. On August 10th, the patient had improved a little, but the granulations were not looking very healthy and the stump was ordered to be dressed with Hay's lotion. On the following day there was another chill; pulse 130; no improvement. On August 12th, the chills continued, the tongue looking pale, and the pulse being accelerated; but the patient was apparently much better. A bandage was applied to prevent the burrowing of pus towards the knee joint. August 13th, pulse 134 and very irregular; tongue dry; patient complaining of a great deal of thirst, having some cough, and gradually sinking. Milk punch was now substi- tuted for the wine. The next day the patient was very delirious, the pulse accelerated and threadlike; great deal of tenderness in the knee; joint doubtless involved; fluctuations detected. August 15th, patient sinking and still very delirious; pulse 156; a good deal of subsultus; very little diarrhoea; tongue red and dry; knee joint seemingly enlarging. Patient taking no nourish- ment but beef tea, having no relish for other food; stimulants and opiates administered in large doses. Death occurred at 11.55 191 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. a. M. on August 16, 1863. On dissecting up the iuteguments and opening the chest during the post-mortem examination, the lungs were found to be healthy and weighing eighteen ounces; heart normal and weighing eight ounces; liver healthy and weighing three pounds and fifteen ounces; weight of spleen seven ounces, and weight of kidneys nine ounces. On removing both bones of the leg from the point of the operation to the knee joint, a circumscribed abscess, containing about an ounce of pus, was found in the belly of the gastrocnemius muscle. The knee joint contained between three and four ounces of pus. The capsule was broken down and the pus extended up the outer side of the thigh about six inches above the joint; cartilage quite soft and commencing to erode around its edges." The bones of the stump, exhibiting a minute sequestrum, nearly separated on the carious extremity of the tibia, were contributed to the Museum by Acting Assistant Surgeon .'. C. Shinier, and constitute specimen 'S>78 of the Surgical Section. Case 747.—Private A. C. Paiue, Co. F, 42d New York, aged 30 years, was wounded in both lower extremities, at the battle of Gettysburg, July 3, 186:'. He was admitted to the field hospital of the 3d division, Second Corps, where Surgeon I. Scott, 7th West Virginia, recorded the injury as "fracture of both feet, caused by a solid shot," necessitating "primarv ampu- tation of both legs at the lower third, which operation was performed by Surgeon H. M. McAbee, 4th Ohio." Surgeon II. Janes, U. S. V., recorded that the patient died at the Seminary Hospital, Gettysburg, July 23, 1863, from the effects of his injuries. 'Table LXX. /Summary of Xine Hundred Cases of Primary Amputations in the Lover Third of the Leg for Shot Injuries. [Recoveries, 1—676; Deaths. 677—891; Results unknown, 892—900.1 Name, Military Description, and Age. Abbey, C. !•"., Serg't, C, 107th New York. Abbott, H.S.,Pt.,D,32d Wisconsin, age 20. Allen, C., Lieut., H, llth Wisconsin. Almany, J., Pt., B, 9th Kentucky, age 39. Amelunxen, M., Lieut., H, 68th New York. Andrew, J. J., Pt., E, 26tb North Carolina. Annand, A., Adj't, 28th Massachusetts, age 30. Antis, T. S., Pt., L, 2d N. Y. 31. R., age 22. Armstrong, A. H., Corp'l, A, 106th N. Y., age 22. Armstrong, S. J., Pt., C, 1st Michigan Cavalry. Augustine, A., Pt., B, 50th Pennsylvania. Auman, P.. Pt., H, 211th Pennsylvania. Ayres, H., Pt., B, 27th North Carolina. Babb, J. A., Corp'l, K, 10th Indiana, age 24. Babeock, E. A., Pt., G, 146th N. Y., age 18. Mar. 16, 16, '65. Aug. 14, 14, '64. May 22, 23, '6.3. Sept. 19, 20, '63. Aug. 29, 29, '62. Oct. 22, 24, '64. May 18, 19, '64. July 2, 3, '64. Sept. 19, 19, '64. July 14. 16, '63. Sept. 17, 17, '62. April 2, 2, '65. Aug. 25, 26, '64. Aug. 3, 3, \*4. June 18, 18, '64. 16 , Babe, R., Pt., D, 97th May 20, Pennsylvania, age 22. 20, '64. 17 , Badger, S., Pt.. F. 26th j July 1, | North Carolina. age 17. j 1, '63. 18 Baker. L. A., Capt., A, Aug. 16, i 39th Illinois, age 29. 16Y64. 19 j Baldwin, R. F.. Lieut.. Nov. :;0, ]•'. 1st Arkansas,age25. Dee.1,'64 I 20 i Bales. A.. Pt, A. 4th June 1, [ Indiana Cav., age 19. 1, '64. 21 ' Banton. S. A., Pt., K, ! July 2, 26th N. ('., age 19. 2, '63. 22 Barber, C Pt., F, 6th May 13, j Iowa, age 2?. 13," '64. Operations, Operators, Result. 23 ' Barfield, T., Serg't, L. Sth South Carolina. opt. 20, il, '63. 24 I Barge, A. L., Corp'l, B, Aug.24, 28th Georgia. 24,'64. 25 \ Barnes, I. M., Pt,, F, Jan. 29, d Illinois. 29, '63. 26 Barnes, M. J., Pt., E, July 6, 65th Illinois. 6, '62. Left; circ. Surg. P. H. Flood, 107th N. Y. Disc'd Aug. 23,'65. Right; lateral flap. Surg. J. C. Denise. 27th Ohio. Discharged July 17, 1865. Right. Surg. H. P. Strong, 11th Wis. Resigned Jan. 11, 1864. Left; flap. Discharged January 28, 1864. Right. Surg. L. Sehultz, 68th N. Y. Mar. 29, 1863, re-amp. mid. third. Disch'd Aug. 3, "63. ----. Confederate surgeon. Re- covered. Left. Nov. 20, removal of ne- crosed bone. Disch'd May 6,'65. Left; circ. Surg. II. T. Paine, 2d N. Y. M. R. Discharged Feb. 25, 1865. Left; flap. Surg. J. N. Freeman, 106th N. Y. Discharged. Left. Discharged December 26, 1863. Left; circ. Discharged Dec. 13, 1862. Died Aug. 20, 1869. Left; flap. Surg. W. G. Hunter, 211th Penu. Disch'd July 20,'65. Left. Surg. E. L. Howard, 27th N. C. Furloughed. Left; circ. Discharged July 18, 1865. Died Feb. 17, 1866. Left; circ. Surg. T. M. Flan- drau, 146th N. Y. Discharged May 18, 1865. Right; circ. Surg. J. R. Ever- hart, 97th Penn. Discharged August 20, 1864. Right. Gangrene. Transferred for exchange March 3, 1864. Left. Surg. C. M. Clark, 39th 111. Discharged Dec. 17, 1864. Left; ant. post. flap. Surg. — Mitchell, 1st Ark. Transferred to Pro. Mar. Feb. 6, 1865. Left; circ. Asst. Surg. H. D. Garrison, 4th lnd. Cav. Dis- charged Nov. 1, 1864. Left. Paroled Sept. 22, 1863. Right; ant. post. flap. Surg. W. Lomax, 12th lnd. Discharged July 10, 1865. ----. Surg. — Walker, C. S. A. Recovered. ----. Surg. — Mathis, C. S. A. Recovered. Right; flap. Asst. Surg. J. P. McClanahan, 83d 111. Disch'd April 10, 1864. Left. Surg. G. II. Parks, 65th 111. Discharged Aug. 19,1862. 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Name. Military Description, and Age. Barnes, W.H..Pt., B, 3d Ohio. Bartholomew, C. F., Pt., D, 3d Iowa. Warwick, J. H, Pt.,—, 6th S. C, age 20. Bass, G., Pt., B, 34th Massachusetts, age 21. Bass, J. C., Pt., I, 5th Yirginia Cavalry. Bassett, O. J., Pt., F, 70th Indiana, age 18. Bates. C. A., Pt., D, 57th Massachusetts, age 18. Bauvais, D., Pt., H, 97th New York, age 25. Bay, M. S., Lieut., K, 38th N. C, age 36. Bayless. B. J., Pt., F, 137th N. Y., age 20. Jan. 3, 4, '63. July 12, 12, '63. Sept. 17, 17, '62. June 5, 5. '64. Oct. 19, 19, '64. June 15, 15, '64. Aug. 19, 20, '64. Feb. 6, 7, '65. July 3, 3, '63. Julv 20, 20, '64. Beath, R. B., Capt., G, j Sept 29, 6th C. Troops, age 25. iOot.1,'64 Bedford. P. B., Corp'l, B, 50th Ga., age 36. Beers, C. E., Serg't, G, 81st New York, age 25. Beers, E. J., Corp'l, C, 113th Ohio, age 27. July 3, 4, '63. June 30, 30, '64. June 27, 27, '64. Bell, F.. Capt., I, 1st 1 July 3, Pennsylvania Rifles. | 3. '63. Bell. J., Pt., G, 12th Ga. i Sept. 19, Battalion, age 26. j 20. '64. Bell, J. H., Lieut,, D, ' July 20, 61st Ohio, age 92. | 20, '64. Bender, P., Pt., B, 74th ! July 2, New York, age 35. 3, '63. Bennett, E. F., Pt., B, July 11, 76th Pennsylvania. 13, '63. Bennett, F. H., Corp'l, G, 48th New York, aere 23. S Bennett, G. B., Serg't, I, 3d Wisconsin, age 36. Benton, E., Pt., Hart's Battery. Bergeron, J., Pt., H,39th Massachusetts, age 20. Beto, R. IF., Lieut., II, 56th N. C, age 20. Betterley, C. M., Pt.,H, 198th l'enn., age 27. Beverly, D., Serg't, D, 97th New York. Birns, W. G., Pt., D, 50th Virginia. May 16, 17,"'64. Mar. 16, 16, '65. Oct. 14, 15. '63. May 9, 9, '64. May 13, 14, '64. Mar. 29, 29, '65. Sept. 17, 18, '62. July 3, 3, '63. Operations, Operators, Result. Left; circ. Surg. AV. L. Peck, 3d Ohio. Discharged. Left, Surg. J. B. Hinkle.C. S.A. Discharged Dec. 29. 1863. Right; circular. Doing well. Right; circular. Discharged Oct. 17. 1864. ----. Recovered. Right: circ. Discharged Feb. 27, 1865. Died June 10. 1872. Right; flap. Surg. W.V.White, 57thMass. Disch'd Mar. 10,65. Right; lateral flap. Discharged Aug. 17, 1865. ----. Exchanged September 15, 1863. Right. Surg. E. Hutchinson, 137th N.Y. Aug. 8, '64. re-amp. at up. third. Discli'd June 16,'65. Right; circ. flap. Surg. D. G. Rush, 101st Penn. Discharged Sept. 20. 1865. Right. Transferred to prison De- cember 5, 1863. Left; flap. Surg. VV. II. Rice, 81st N. Y. Disch'd Dec. 29, '64. Right, Surg. T. 15. Williams, 121st Ohio. Re-amput'n. Dis- charged 31ay 16. 1865. Right, Surgeon C. Bower, 6th Penn. Res. Disch'd Oct. 19, 63. R't. Surg. S.V. D.Hill,P. A.C. S. Trans, to Pro. Mar. Apr. 1. '65. Left; flap. Surg. H. K. Spooner, 61st Ohio. Discli'd Dec. 15, '64. Oct. 27, '70, amp. thigh at mid. third for neuralgic aff. of stump. Right; circular. Discharged July 25, 1864. Left. Confed. Surg. Necrosis. Oct. 6. amp. at mid. third. Dis- charged July 21,'64. Spec. 4308. Right; ant. post. flap. Surg. J. L. .Mulford. 48th N. Y. Dis- charged May 24, 1865. Left: circ. Surg. P. H. Flood, 107th N.Y. Disch'd Junel4,'65. Left. Surg. — Green, C. S. A. Recovered. Right; flap. Discharged April 7, 1865. Right (also flesh wound left arm); gangrene. Exch'd Aug. 18, '64. Right; flap. Discharged July 6," 1865. Left. Discharged Dec. 6, 1862. Right. Surg. —Baxter, C.S.A. Recoverd. ' Fisher (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam, September 17, 1862, in American Journal Medical Sciences, 1863, Vol. XLV, page 48. SF.CT. V.| PRIMARY AMPUTATIONS IN THE LEG. 495 Name, Military | Datks Description, ANn Age. Black, G., Serg't, C, 4th Maryland, age 23. Blair. J.E., Pt., A, 10th Alabama. Blanchard, C, Pt., H, 96th N. Y., age 29. Bloom, C, Pt., D, 2d N. H., age 22. Boehme, C. F., Pt., A, 52d New York, age 25. Bonhomme, E., Pt., E, 73d C. Troops, age 27. Bonner, R., Pt., D, 1st Mississippi. Sge 21. Boyle, P., Pt., G, 24th Mississippi, nge 48. Brackett, E. J., Pt., D, 35th Mass.. age 22. Brady, F., Pt., K, 46th Pennsvlvania, age 22. Brazell," M.. Pt., F, 61st Illinois, age lit'. Bickford, C, Corp'l, G, 14th Maine, age 21. Brian, VV., Capt., K, 3d Pennsylvania Res. Brockway, J. W., Capt., C, 29th C. T.. age 29. Brooks, F. C, Pt.. D. 3d East Tenn.. age 20. Brothers, C. P., Serg't, H, llth South Carolina. Brown, T., Pt., K, 15th Massachusetts, age 21. Brown, W. F., Serg't, G, 24th New Jersey. Brubaker, D., Pt., C, 127th Pennsylvania. Bryan. W. A., Pt., C, llth Penn. Reserves. Burditt,I.J., Pt., Hamp- ton Legion. Burk, C. J., Serg't. A, 140th Penn., age 44. Burke, M., Pt., D, 20th Mass, age 22. Burkett, J., Pt., M, Sth Cavalrj-. Burr, C. M., Pt., E. 2d Conn. H. A., age 21. Burt, A. W., Lieut,, A, 7th S. C. age 22. Burtner, J., Corp'l, 1", 103d Penn., age 19. Bushey. F. P., Pt., C, 56th Mass., age 22. Butler, J. H., Lieut., G, 2d Artillery. Byington, A., Corp'l, I, 6th N.Y. Cav.. age 25. Caldwell, J. P., Pt., A, 115th N. Y., age 39. Call, C. K., Pt., K, 35th Massachusetts, age 24. Cann, C, Pt,, D, 30th New York. Carey, J. H.,Pt.,D, 27th Michigan, age 26. Mav 8, 8, '64. Sept. 17, 18, '62. Sept. 29, 29, '64. June :;, 4, '64. April 2, April 10, 10, '65. Nov. 30, Dec.1,'64. Oct. 8, 8, '62. Sept. 30, 30, '64. July 20, 21,'64. July 20, 21,"'64. Oct. 19, 20, '(14. Dee. 13, 13, '62. July 30, Au."l.'64. July 1, I,'64. Aug. 21, 21,'64. Julv 3, 4, '63. Dec. 13, 13, '62. Dec. 13, 15, '62. Dec. 13, 15, '62. May 31, J'e *1,'62. Nov. 27, 28, '63. May 10, 10, *64. April 9, 9, '65. Oct, 19, 20,'64. July 2, 3, '63. April 19, 20, '64. May 18, 18, '64. Nov. 8, 8, '63. June 2, 2, '64. July 30, 30, '64. Dec. 13, 14, '62. July 30, Au.1,'64. June 3, 3, '64. Carney, P., Pt., A, 2d Dec. 13, Maine. Carpenter, S. B.. Pt., F, llth Vermont, age 20. Carr, H. C, Pt., B, 22d Indiana. 13, '62. June 10, 10, '64. Oct. 8, 9, '62. Operations, Operators, Result. Left; circ. Surg. — Mitchell, C. S. A. Disch'd Nov. 11, 1864. Left; Surir. R.V.Koyston.C.S.A. IIei'iivere.1. Right ; llap. A. Surg. M. Hines, 96th N.Y. Disch'd Apr. 17,'65. lie-amp. at mid.th'd Juno 15,'65. Lett; circular. Discharged Jan. 8, 1865. Lett: circ. April 10, hiem. from nnt, and post. tib. arteries; necro. bone removed. Disch'd Nov. 14, 1865. Died Aug. 18, 1874. Left; ant. post, flap; slough. Apr. 24, '65, re-amp. low. third thigh. Discharged June 17,'65. Died June 3, 1867; marasmus. Right; circular. Provost Mar- shal March 2, 1865. Left. Feb. 9, 1863, re-amp. mid. third, ciro. lat, flaps. Trans- ferred Oct. 8, 1863. Left; flap. Surg. S. Cooper. 6th N. H. Discharged Jan. 18, '65. Right; eirc. Discharged Aug. 25, 1865. Right; flap. Disch'd Apr. 26, '65. Re-amp. mid. third July 17, '65. Left; circ. Disch'd Mar. 30, '65. Died Jan. 27, '69; consumption. Left. Confed. Surg. Discharged Sept. 15, 1803. ,, Left; circ. Surg. J. P. Prince, 36th Mass. Disch'd Mar. 9. '65. Left; circ Surg. C. W. McMil- lan, 1st Fast Tenn. Gangrene. Discharged Feb. 26, 1865. ----. Surg. — Loben, C. S. A. Recovered. Left; ant. post. flap. Discharged Jan. 29, 1864. Lett; circular. Discharged June 29, 1863. Left; flap. Mustered out May 29, 1863. Right, DischargedFeb.il, 1863. ----. Surg. — Darby, C. S. A. Recovered. Right; circ. Surg. J. W. Vis- hart, 140th Penn. Discharged March 16, 1865. Right. Surg. N. Hayward. 20th Mass. Discharged Oct. 12, 1864. Spec. 517. Right: flap. Surg. A. IC. St.CIair. 1st Michigan Cavalry. Dis charged August 10, 1865. Right; circ. Surg. 11. Plumb, 2d Conn. H. A. Discli'd June9,'65. Left. Paroled Nov. 14, 1863. Left; ant. post. flap. Surg. — Gott, 21stGa. Discharged Apr. 19, 1865. Left; flap. Surg. VV. V. White, 57th Mass. Necrosis. Dec. 25, lateral flap amp., middle third. Discli'd Apr. X, '65. Spec. 4336. Left. Surg. E. W. H. Beck, 3d lnd. Cav. Aug. 5. 1864, rem. 6 ins. tibia from stump. Retired Feb. 7, 1865. Right; circ. Surg. A. P. Clark, 6th N. Y. Cav. Discharged Sept, 20, 1864. Left; flap. Discharged May 23, 1865. Left; flap; bone removed. Dis- charged Mar. 5, 1863. Left; circ. Surg. D. Mue.Kay, 27th C. T. Discli'd Dec. 20, '6*4. Right; circ. Surg. A. I'\ Whelan, 1st Michigan S. S. Discharged October 28. 1864. Right, DischargedApril7, 1863. Left; flap. Surg. <'. 15. Park, llth Vt. Discharged Dec. 24, 1864. Left; flap. Discharged Feb. 10, 1863. Name, Military Description, and Age. Carshaw, W. K., l't.. 10, 14th N.Y.Stut Age. 128 (nnner. 11., Pt, D, 20th Massachusetts, age 35. Conover, J., l't.. C, 33d New Jersey, age 45. 129 130 131 132 133 134 135 136 t'ouley. S.I.,Pt,K,97th New York, age 23. Cook, S. A.. Pt, A, 2d Wisconsin. Cornell. M. E.. Pt. E. 36th Illinois, age 21. Cornish. J.. Serg't. B, 39th Colored Troops. Cornish. J., Pt. F, 8th Colored Troops, ago 35. Corson, G. F., Serg't, P.. 7th N. II., age 27. Cotton, G. E., Pt., M, 4th N.Y.H. A., age 25. 137 ('(.use. F. H., Pt, B, 83d Pennsylvania. 1361 Cox, E.. l't, I, 13th Louisiana. 139 Cox. L. ('.. Corp'l, D, (ith Tenn.. age 29. 140 Coy, S.. Pt., K. 2d .Mich- igan, age 33. 141 ] ('rain. L. (1., Serg't, C, 39th Ohio, age 23. 142 j 'Crawford, R. I)., Pt., 6th S. Carolina, age 27. 143! Crcgar. H., Pt, l'\ 35th Ohio, age 20. Crew, J., Pt., K, 31st Illinois, age 30. Crilley. ().. Serg't. E, 81st Pennsylvania, age 21. Croft, A. (J., Pt, D. 7th Wisconsin. Cross, II., Pt, A. 10th Infantry, age 19. Cunningham, R., Pt, E. 8th Iowa Cav.. age 18. Cunningham. VV.. Pt. H, 1st VV. Virginia, age 23. Daniels, I). B.. Pt., K, 7th Illinois. Daniels. V.. Pt. F, 76th New Ycrk, age 39. Daniels. W. IL, Pt, B, 1st Mass. H'vy Arty. Danley, S. 15.. Serg't,'P.. 15th N. J., age 27. 154 i Danver, J. II., Pt., H, 1 st Virginia. 155 Davidson, A. J., l't., P». 17th Virginia. 156 Davis. E., Pt, I). 76th Cold Troops, age 37. 157 Davis, G.,Pt.,F,2d Micli- | igan, aged 23. 158 Davis, J., Pt., A, 28th Pennsylvania. 159| Davis, j. A.. Pt.. F, 5th Iowa Cavalry, age 23. 160 | Davis, R. L, Pt. B, Pur- cell Battery. 161 I /)<■«», .*. //.' Pt., F, 6th I Georgia Cavalry. 162 Dearolf, E.. Pt, II. 127th i Illinois, age 31. 163 Deforest, M. J., (apt., B, ' 81st N. V., age 25. 164 Dcight.m, J.. Pt, I, 6th Colored Troops. 165 Be LauqhU-r. A., Lieut, D, 5th Florida. 166 Denni.-. A. W., Pt, D, 1st N. Y. Artillery, age 18. 167 Dcrr, J., Pt., "K, 148th Pennsylvania, age 26. 168 De Tar", T.. Capt., D. 32d Iowa, age 37. 169 Dewev. D. .V, Serg't. B, 121st X. V.. ;ige23. May 24, 24," '64. Mav 25, 25.''64. June 18, 18, '64. Sept. 17, 17, '62. May 14. 15," '64. July 30, Au.1,'64. Aug. 15, 16, '64. Oct. 1, 1, '64. Aug. 25, 26, '64. Dec. 13, 14, '62. Sept. 20, 22, '63. Dec. 15, 16, '64. June 17, 18, '64. July 22, 24, '64. Sept. 17, 18, '62. July 21. 21,''64. May 27, 27, '63. June 21, 21, '64. Sept. 14, Hi, '62. Sept. 1, 1, '64. May 7, 7, '64. Aug. 29, 29. '62. Feb. 15, 17, '62. April 1, 1, '64. May 20, 20, '64. Mav 12, 12,''64. July 3, 3, '63. Aug. 7, 7, "64. April 12, 12, *65. Nov. 16, 16. '63. Sept. 17, 17. '62. Dec. 15, 17, '64. June 26, 26, '62. Feb. 12. 12. '62. Mav 19, 19," '63. June 3, 3, '64. Sept. 29, 29, '64. Aug. 21. 21. '64. May 5, 6, '62. May 10, 10."'04. Dec. 16, 17, '64. May 6. 7, '64. Operations, Operators, Result. Name, Military Description, and Age. Left: antpost.flap. Discharged April 17, 1865. Loft : ant. post. flap. Surg. J. Roily. 33d N. J. Discharged March 16, 1865. Right; circ, Surg.W. B. Cham- bers. 97th N. Y. Discharged Oct. 27. 1864. Loft: flap. Surg. A. J. Ward, 2d Wis. Discharged Dec. 6, 1862. Right: flap. Surg. W. P. Pierce. 88th 111. Discli'd Oct. 29. 1864. Right; circ. Surg. F. M. Weld. 27th Colored Troops. Disch'd Dec. 21, 1864. Right; circ. Discharged Feb. 11. 1865. Left; circ. Surg. C. M. Clark, 39th 111. Re-amp. mid. third. Discharged May 7, 1865. Right; circ. Snrg. J.W.Wishart, 140th Penn. Disch'd July 6, '65. Left : circ. Discharged August 27. 1863. Right. Surg. L. Holt, C. S. A. Recovered. Right; ant. post flap. A. Asst. Snrg. J. K. Simmons. Disch'd. Left: flap. Disch'd Apr. 15, '65. Died Nov. 20, 1868, of phthisis pulmonalis. Right; flap. Surg. A. 15. Mnna- han, 63d Ohio. Discharged August 9, 1865. Right; circular. Recovered. Left; circ. Surg.C. N. Fowler, 105th Ohio. Disoh'd June26,'65. Died November 29, 1866. Left; circ. Disch'd Dec. 3, 1863. Died Dec. 23, 1869. Left; ant. post. flap. Surg. J. VV. Wishart, 140th Penn. Dis- charged January 6. 1865. Left; circular. Discharged Julv 23, 1863. Left; circular; gangrene. Dis- charged May 20. 1865. Right; flap; eiysipelas. Dis- charged. Left; circ. Surg. D. Baguly, 1st W.Va. Disch'd Mar. 16,1863. Right; circ. Discharged Mav 1. 1862. Right. Discharged July 7,1864. Spec. 2211. Left; circular. Discharged Mar. 11, 1865. Left: ant. post flap. Surg. R. Sliarpc, 15th X. J. Discharged May 23. 1865. Right. Paroled Sept 25. 1863. ----. Surg. — Fleming, C.S.A. Recovered. Left; ant. post, skin flap and circ. section of muscles. Discharged June 17, 1865. Left; flap. Discharged May 31, 1864. Right; flap. Discharged Sept. 25. 1863. Right; circ. A. A. Surg. J. H. Mclntyre. Disch'd June 29, '65. Right Surg. — Caput. C. S. A. Discharged Oct, 28. 1864. Right Snrg. C. J. Towles, C. S". A. Recovered. Right; flap. Surg. J. R. Gore, 127th 111. Disch'd Aug. 27. '64. Left; flap. Discharged October 27. 1864. Right; flap. Discharged April 19, 1865. ----. Surg. G. S. West, C. S. A. Recovered. Left: circular. Discharged Jan. 13, 1863. Right; flap. Discharged Feb. 10. 1805. Right; flap. Surg.V.B. Kennedy, 5th Minn. Disch'd Mav 1\ '65. Right: flap. Surg. — Moffatt. C. S.A. Disch'd June 29, 1865. Dates. Diamond, R., Pt, K, 3d Sept. 19, Alabama, age 25. 19, '64. Dietrich, C, Pt, E. 91st j April 13. New York. 13. '63. Dillon, J., Pt, K, 20th Dec, 13, Massachusetts. ' ' 13, '62. Divers, P. D., Pt., K, 1st May 5, Virginia. | 5. (if Douglas, J. H., Pt., G. Julv 3. 91st Penn., age 33. 3. '63. Dowd. J., Farrier, M. April 18, 10th .Missouri Cavalry, 19. '63. age 24. Operations, oi era ions, Result. Downing. H., Pt. (', 4th Rhode Island Artil'ry. Downs, S. N., Pt., H, 19th Maine, age 25. Dreibilbis, A., l't., G, 96th Penn., age 21. Drost, M., Pt, K, 1st Maryland, age 29. Drury, J. T., Lieut., I. 17th Indiana, age 25. Dunkin, J.H., Pt, E, 6th Virginia. Dunn, J. R., Pt., H, 96th New York, age 35. Durall, A., Pt, A, 1st Virginia Art'y, age 18. Dyer, C. F., Pt, A, 12th Mass., age 24. Eaton, G.W., Pt, A, 6th Maine, age 21. Edmunds, J., Pt., I, 32d Cold Troops, age 27. Edwards. J. A\, Pt, G, 10th Mich., age 24. Eisenhart,S.A.,Corp.,M, 8th Penn. Cav., age 26. Eldridge, N., Pt, D. 77th New York, age 27. Elligott, T., Pt, I, 105th New York. Elliott, J., Lieut., 2d Artillery. July 1, 1, ;62. June 18, 18, '64. June 1, 3, '64. June 3, 4, '64. Sept. 19, 19, '63. Mav 12, 13.' '64. May 15, 15. '64. July 14. 14, '64. Dec. 13, 14, '62. June 3, 3, '64. Feb. 11, 11, '65. Sept. 1, 2, '64. June 24, 25, '64. Mar. 25, 25, '65. Dec. 13, 14, '62. Aug. 21, 21, '64. Elliott. AV., Pt., A, 7th Oct. 23, New Hamp., ago 22. I 23, '64. Ellis, L.. Pt, 6th Maine Battery, age 23. Engle, G. \V., Pt., E, llth Ohio Cav., age 19. Erskine, W. M., Pt, B, 1st-Maine Heavy Artil- lery, age 20. Evertson, J.. Lieut., G. 82d New York, age 27. Fairy, P. IF, Serg't, G, 4th S. C. Cav., age 29. Farrell, T., Pt., E, lllth New York. Favour, C. L., Corp'l, H, 16th Maine, age 21. Fayent, F., Pt., D, 7th Wisconsin, age 23. Fennee, J., Pt., E, 6th Missouri. Ferguson, A.,Pt.,G.88th Pennsylvania, age 21. Ferris, J. A., Pt., A, 2d Conn. H. Art, age 29. Fezer, H., Pt, K, 7th Ohio, age 21. Fink, R. P., Pt, F, 16th Penn. Cavalry, age 21. Finkbeiner, C.,"Pt. L, 3d Ohio Cavalry, age 18. Fisher, J., Pt., E, 8th Indiana Cav., age 18. Fisher. J., Pt, D, 76th Pennsylvania, age 21. Fisk, J.. Corp'l, D, 19th Iowa, age 24. Fitch, E., Corp'l, D, 23d Virginia. Flemmer, C.,Pt., H,4th Col'd Troops, age 20. June 3, 3, '64. Aug. 28, 29, '62. May 31, 31, '64. July 3, 4. '63. May 28. 29,"'64. Mar. 31, 31, '65. July 1, 2, '63. May 5, 7, '04. May 22, 22, '63. May 8. 9. ''64. June 1, 1, '64. Nov. 27, 27, '63. April 21, 22, '64. Oct. 25, 25, '64. Mar. 9, 9, '64. July 30, 31, '64. Mar. 27, 27, '65. Sept. 19, 20, '64. June 15, 15, '64. Left: circ. Surg. A. Bowie. 3d Ala. To prison Jan. 5, 1865. Left. Discharged April 10, 1864. Left. Surg. X. Hayward, 20th Mass. Disch'd Aug. 12, 1863. Left. Surg.— Graham. ('. S. A. Recovered. Right: ciro. Asst. Surg. E. T. j WhiUingliam. I'.S. A. Discli'd Feb. 8, '65. Died June 30, '77. Right Surg. P. X. Woods. 39th Iowa. Disch'd. Jan. 25. 1864, amp. thigh : necro. Nov., '67, re-amp. Died Nov. 15, 1867. Left. Discharged Aug. 30, 1862. Right: flap. Surg. S. H. Plumb, 82d N. V. Di.JHi'd Mar. 16,'65. Right; circ. Surg. I >.W. Bland, 96th Penn. I >iseli\l Apr. 6, '65. Right; flap. Discharged June 3, 1865. Left; circ. Surg. A. Ewing, 13th Mich. Discli'd June 1, 1864. Left; circ. Surg. T. B. Ward. 6th Virginia. Recovered. Loft; flap. Discharged January 25, 1865. Right. To prison March 22, '65. Left; ant. post. flap. Oct. 8, '63, re-amp. middle third. Disch'd March 17, 1864. Left; flap. Discharged Decem- ber 3, 1864. Right: circ. Discharged Octo- ber 28, 1865. Right: Hap. Surg. ('. H. Mills, 125th 111. Discli'd July 1, '65. Right; circular. Discharged Oc- tober 19, 1864. Left; circ. Surg. E. Phillips, 6th Vermont. Disch'd Aug. i2,'65. Left: long post flap. Discharged Nov. 6, 1863. Spec. 2714. Loft: circa Surg. A. F. Whelan, 1st Mich. S. S. Retired Feb. I, 1865. Died April 18, 1871. Right; flap. Surg. G. C. Jarvis, 7th Conn. Disch'd June 13,'65. Left; flap. Disch'd December 29, 1864. R't; dou. flap. Surg. J. E. Sum- mers. U.S. A. Disc'd Mar. 14,'63. Died Jan. 18, 1871. Spec. 314. Left. Surg. C. 11. Pegg, 8th N.Y. Art. July 6, re amp. atup. th'd. Disch'd (lot. 28,'64. Spec. 3173. Left. Surg. G. Chaddock, 7tb Mich. Disch'd June 12, 1864. Left; ant. post. flap. Recovered. Right; flap. Surg. W. Vosburg, lllth N.Y. Disch'd July 25, '65. Left: flap. Discharged Novem- ber 28, 1863. Right; circ. Discli'd Oct 3, '64. Stump never healed permanent- ly. Died Oct 8, 1870. Right: flap; gangrene. Disch'd October 18, 1863. Right: circ. Surg.J.W. Rawlins. 88th Penn. Disch'd July 4, '65. Right; circ. Surg. H. Plumb, 2d Conn. Art. Gangrene. Discli'd August 4, 1865. Left; circ Surg. C. J. Bellows, 7th Ohio. Disch'd June 24, '64. Right: circ. Disch'd September 28, 1864. Right; flap. Disch'd March 17, 1865. Left. Discharged June 25, 1864. Left: circ. Surg. I). Morritt, 55th Penn. Re-amputation. Disch'd January 27, 1865. Left. Snrg. L. M. Sloanaker, 19th Iowa. Disch'd June 5. 1865. Left: circ. Surg. J. M. McGuire, 0. S. A. To prison Jan. 5, 1865. Left; circular. Discharged Fob. 10, 1865. 'FI8HF.R (G. .1.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Batlh of Antietam September 17, 1862, in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 497 Name, Military description", and aoe. Flesh. J., Pt , B, 73d I Mav 14, Ohio, age 23. 14, '64. Flower, E. W., Pt, E, | May 24, 8th Michigan, age 22. : 24. '64. |214 I Flnctscli—I. I... Pt. K, Mav 14, I.".tli Missouri, age 30. 14. '64. I 215 I'lviin, Patrick. Pt, C, May 5, 12th Infantry, age 31. 5. '64. 216 ! Foley..)., Soig'l, 1", 35th ' July 14, Iowa, age 25, Folk, N., Pt., K, 93d Pennsylvania, age 31. Polsom, II. VV., Pt. E, 31st Maine, age 26. Ford, T., Pt., C, 69th In- diana. Foster, T. F., Lieut., H, 55th Alabama, age 24. Foy, P., Pt, H. 8th Pennsylvania. Friel, J., Pt, H, 63d Pennsylvania. Fry. J. J., Pt, D, 78th Illinois, age 20. Fulkineer, J. M., Pt., E, 3dW.Va. Cav., age 19. Gallup, S. H., Corp'l, G, 18th Conn., age 43. Ganthrop, H., Lieut, F, 4th Delaware, age 24. Garrity, T., Pt, 1), 24th Massachusetts. Gatchell, C. H., Serg't, E, 1st Maine Heavy Artillery, age 24. Gault, T." J., Pt., F, 3d Tennessee, age 22. Gavin, S., Pt, L, 15th Connecticut Geiger, J., Pt, D, 46th Pennsylvania, age 27. Geissler, E., Corp 1, K, 3d N. J. Cav., age 36. Gibson, IL, Corp'l, F, 21st Michigan, age 30. Gilmore, G., Pt, G, 33d Illinois, age 19. Gladsim, W. D., Serg't, D, 44th N. Carolina. Glascoe, W., Pt., G, 29th Connecticut Glaser, J., Serg't, C.15th N.Y. H'vy Art., age 37. Glassie, J., Pt, B, 63d New York, age 22. Gondermau, C. Pt., C, 98th Penn., age 19. Goodwin. A., Corp'l, B, 30th Ohio, age 20. Goodspeed, H. M., S'g't, C, 30th Indiana, age 25. Gordon, C. H.. Pt., B, 33d Miss., age 24. Gordon, J., Teamster U. S. service, age 38. Gordon, W.. Pt, C, 2d Iowa Cavalry. Grahame, F., Corp'l, A, 6th Wis., age 26. Grant, A. A., Pt, A, 2d Vermont, age 27. Grant, A. D., Pt.. C, 8th South Carolina, age 19. Grant E.L..Pt,F,145th Pennsylvania, age 20. Grant. T., Pt,, D, 21st South Carolina, age 19. Green, P., Pt, A, 66th Illinois, age 23. Green, W. J., Pt, F, 42d Georgia, age 20. Greene, J. R., Pt., A, 7th Rhode Island. 14, '64. Sept. 22, 22. '64. April 6, (i, '(i."i. April 9. 9, '65. Julv 20, 21,"*64. May 1, opera 1 ions, operators, Result. Aug. 29, 29, '62. Sept. 1, 1, '64. July 24, 24, '64. June 5 5, '64. April 1, 1, '65. June 1, 1, '63. May 18, 19, '64. May 14, 14, '64. Mar. 8, 10, '65. June 20, 20, '64. Aug. 17. 19, '64. Mar. 19. 20, '65. Mar. 31, 31, '65. Aug. 21, 21, '64. Oct. 27, 27, '64. July 8, 9, '64. June 3, 3, '64. June 8, 8, '64. Jane 27, 27, '64. Julv 4, 4, '64. Nov. 30, 30, '64. Aug. 30, Sep.1,'62 May 9, 9, r62. Mav 10, 10," '64. Mav 5, 6, '64. July 2, 2, '63. June 8, 8, '64. June 18, 19, '64. Mar. 21, 22, '65. May 15, 16, '64. Dec. 13, 13, '62. Right; llap. Surg. I. X. Mines, 73d Ohio. Discli'd Sept. 21,'61. Died Dec. 3, 1868; consumption. Right; circ. Surg. W. ('. Shur- lock. "Ost Penn. Discharged Fcliruarv I. 1865. Left: circ. Surg. W. P. Pierce, 88th 111. Disch'd Mar. 20, '65. Left; tlap. Surg. G. T. Stevens, 77th N. V. Disch'd Feb. 28,'65. Died April 13. 1872. Left; . Left; circular. Discharged Oct. 21, 186-1. Right; flap. Surg. W. B. Fox, gth Michigan. Discharged. Left: circular. June 7, re-amp. mid. third. Disch'dMar. 31,'65. Left: circular. Discharged June 9, 1865. Left; circular. Released July 5, 1865. Left; circ. (also right arm at up. third). Surg. D. MacKay, 29th Col'd Troops. Also w'd of face. Discharged Dec. 6, 1865. Left; flap (also w'd right elbow). Disch'd Oct 5, '64. Spec. 4498. Left; circ. June 23,'65, re-amp. in middle third. Disch'd Sept. 8, 1865. Spec. 4334. Left. Ass't Surg. H. S. Bradlev, C. S. A. Discli'd March 27, '65. Left; ant. post flap. August 20, re-amp. Disch'd March 22,'65. Died Nov. 4, 1879. Left; lateral flap. Surg. J. A. Spencer, 182d N. Y. Disch'd April 13,'65. Oct. 3,'68, re-amp. at middle third. Left; ant. post. flap. Disc'd June 23, 1865. Oct. 12, '65, re-amp. Left; flap. Surg. J.W. Hastings, 33d Mass. Disch'd Nov. 2.'64. Left. Surg. G. L. Potter, 145th Penn. Disch'd Jan. 20, 1866. Died May 29, 1868. ----; ant. post flap. Surg. — Richardson, 7th Texas. Pro- vost Marshal March 7,1865. Left; flap. Surg. C. T. Simpers, 6th Md. Disch'd Nov. 10,1864. Right; circ. Disch'd August 11, 1865. Right; bi-lat. Hap. Disrlmrged Sept, 19. '65. Died September 26, 1866: chronic diarrhoea. Right; ant. post. Hap. Surg. II A. Martin, IT. S.V. Discharged May 6, lo65. Right; circ. Disch'd May 17, 1865. Right; flap. Surg.W. A. Barry, 98th Penn. Discharged Octo- ber 3,1865. Left; circ. Disch'd June 16,'65. Left; flap. Surg. A. Goslin, 48th 111. Discharged Nov. 12, 1864. Died April 5, 1868. Left. Disch'd January 7, 1863. Died June 12, 1863. Name, Military Description, and Age. Melnturf, S., Pt, I, 2d Last Tenn., age 29. McLain, K., l't.,D,125th Ohio, age 20. McLean, J., Lieut., A, 40th Illinois. ;t McOuaid, F-, Pt., C, 95th New Vork, nge22. Mender, G. P., Pt., G, 29th Maine, age 25. Merreti, ./..Serg't, l),8th Arkansas, age 20. Mershon, J. N., Pt., 6th N. V. Battery, age 19. Metz, J., Pt.', G, 142d Penn., age 20. Miller, C, Pt, H, 2d Penn. Arty, age 44. Miller, H. H., Corp'l, K, 117th N. Y., age 24. Miller, P. D., Corp'l, I, 87th Penn., age 25. Miller,li. 31., Pt.,G, 14th North Carolina. Miller, W. S., Pt., H, 116th Penn., age 19. Mills, H., Pt, A, 14th N. Y. Art'y, age 22. Miser, J. W. K., Pt, G, 30th Ohio, age 20. Mitchell, C. L., Serg't, F, 55th Mass., age 35. Molter, J., Pt., D, 39th New York, age 25. Moore, J. B., Pt.,D,l2th Tennessee. Moore, W. H., Comm'y Serg't, 8th New York Cavalry, age 24. Morris, T., Pt., F, 4th R. Island, age 22. Morrison. T. W., Pt,, I, 83d Indiana, age 30. Morrison, W. H., Pt., F, 90th New York. 4Morrissey, P., Pt, K, 20th Mass., age 39. Morrow, B. M., Major, 205th Penn., age 30. Mullen, E., Pt., G, 16lst New York. Mulvay, M., Pt, G, 25th Virginia. Murdock, J., Pt, I, 7th Maine, age 44. Murphy, J. I., Pt., D, 14th Virginia, age 21. Murphy.W.H., 1st S'g't, B, 31s"t Mo., age 20. Mnsseltnan, A. L., Corp'l, D, 71st Ohio, age 22. M>ie(,r, F., Pt, B,2dVa. Reserves. Nellis, L\, Serg't, B, 6th Connecticut. Neville, W., jr., Pt,, A, 3d Alabama. Newman, J., Pt, F, 84 th New York, age 31. Newman, P., Pt.,C, 182d New York, age 37. Oct. 10, 10. '63. May 14, 16,' '64. April 6, 6, '62. June 18, 18, '64. Oct. 19, 20, '64. Nov. 30, Deal.'04, Mav 30, 31,' '64. May 22, 22, '64. Sept. 29, 30, '64. Aug. 29, 29, '64. June 1, 1, '64. May 3, 3, '63. May 18, 18, '64. July 10, 10, '64. July 3, 3, '64. Nov. 30, Dec.1,'64. Dec. I, 3. '63. July 20, 20, '64. Mar. 2, 2, '65. July 30. 31.'64. July 28, 29, '64. June 14, 14, '63. Dec. 11, 12, '62. April 2, 2, '65. Feb. 16, 16, '63. Julv 3, 3, f63. Oct. 19, 21, '64. Julv 2, 4, '63. Nov. 16, 16, '64. Dec. 16, 16, '64. July 9, 9, '64. Aug. 28, 28, '64. May 3, 3, '*63. May 8, 9, '64. Aug. 25, 27, '64. Operations, Operators, Res ci. i. Left: ant post. llap. Surg. J. T. Smith, 2d Ohio Cav. Disch'd. Lett; circ. Discharged June 21, 1805. I Left. Resigned September 23, 1862. Right: ant. post. Hap; gangrene. Disch'dNov. 29.1864. Nov. 28, I86.r), sequestra removed. Left. Disch'd August 12, 186:,. Left; circular. Provost Marshal March 7, 1865. Left; circular. Discharged Sep- tember 24, 1864. Left; circular; gangrene: bone removed. Disch'd July 4, 1865. Right; double flap. Confederate surgeon. Disch'd July 12, '65. Left; Hap. Surg. H. W. Carpen- ter, 117th N. Y. Discharged May 31, 1,865. Right : circ; gangrene. Disch'd October 13, 1864. Right. A.Surg. J. E. Logan, 14th N. C. Recovered. Left; circ. Surg. J.W.Wishart, 140th Penn. Disch'd July 10,'65. Feb., 1871, re-amp. in up. third. Right; flap. Surg. G. W. Snow, 35th Mass. Disch'd June 19, 1865; subsequent operation. L't; circ. A. Surg. C. P.. Richards, 30th Ohio. Disch'd June 15,'65. Nov. 24,'66, re-amp. upper third. Right; flap. Disch'd Aug. 29, 1865. Left; circ. Confederate surgeon. Disch'd August 31, 1864. Right; circular. Recovered. Right; ant, post. flap. Surg. P. E. Sickler, 8th N. Y. Cavalry. Disch'd June 19, 1865. Right; ant. post, flap (also w'd of left leg). Disch'd Mar. 11, '65. Right; flap. A. Surg. C.B. Rich- ards, 30th Ohio. Discharged November 29,1864. Left; lat. flap. Surg. E. S. Hoff- man, 90th N. Y. Disch'd Sept. 29, 1864. Died July 8, 1869; consumption. Left. Surg. N. Hayward, 20th Mass. Disch'd June 18, 1864. July 25,'64, re-amp., flap. Died October 26, 1870. Right; circ. Surg.W.G. Hunter, 211thPenn. Disch'dJune3,'65. Died March 7, '67; consumpt'n. Left; circ. A. Surg. J. S. Dolson, 161stN.Y. Disch'dMav31,'83. Left Surg.G. L. Miller, C.S. A. Retired January 4, 1865. Right; ant. post. flap. Surg. G. T. Stevens, 77th N. Y. Disch'd June 22, 1865. Left; circ. Transferred for ex- change Nov. 12, 1863. Left; ant. post. flap. Surg. B. N. Bond, 27th Mo. Disch'd April 24, 1865. Right; flap. Disch'd June 2,'65. Right. Surg. — Carter, C. S. A. Recovered. Left; circ. Sun Conn. Disch d Aug. Left. Surgeon G. A. Nott, P. A, C. S. Recovered. Right; circ. Surg. O. Smith, 14th N.Y. State Militia. Oct 5, seq. removed. Disch'd June 6, '65. Spec. 3278. Left; flap. Surg. L. G.Hunt, 27th N. C. Also four other wounds. Disch'd Sept. 13, 1865. rg. G.C. Jarvis, 7th hvd Aug. 14, 1865. 'O'Meagher (VV.), Surgical Cases from Field Hospitals, in the Medical and Surgical Reporter, 1865, Vol. XII, p. 253. 2 Mo KG as (C. R.), Re-amputation for Intense Neuralgia in a Stump. Anesthesia induced by Nitrous-Oxide Gas. Surgical Clinic by Dr. T. G. MORTON, in Medical and Surgical Reporter, 1865, Vol. XIII, p. 365. 3 LIDELL (J. A.), Chronic Osteo-myelitis of Tibia following Primary Amputation and Sloughing of Stump, etc., in U. S. Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 297. 4THOMSON (Wm.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, B. C, in American Journal Medical Science, 1864, N. S., Vol. XLVII, p. 384. 500 INJURIES OF THE LOWER EXTREMITIES. |CHAP. X. NO. Name, Military Description, and Age. 453 Newman, W., Pt., D, j May 25, 149th N. York, age 26. 26, '64. 454 Nichols. J. B., Pt, A, Sth Nov. 4, I Michigan, age 35. 4. '64. 455 Norman, W. H. H, Pt., ' July 2, 1 H. 50th Ga.. age 22. , 3, *03. 456 Northrop. A.. Corp'l, ('., t June 20, I 107th Pennsvlvania. I 20, '64. 457 '0'Beirne, VV., Pt, D, I July 27, | 28th Mass., age 23. 27. *64. 458 O'Brien. E. F., Lieut..A, i June 3, 28th Mass., age 29. i 3,'64. O'Brien, IL, Pt., C. 170th j June 16, New York, age 35. j 18, '64. 467? 4685 469 470 471 472 473 474 475 476 477 478 479 48(1 481 483 481 485 486 487 O'Brien, J., Pt, G, 66th New York, age 50. O'Doughorty, B., Serg't, H, 33d N. j., age 29. O'Driscoll, B. J., Lieut, C, 188th New York. O'Keer, J. M., Pt., D. 1st Texas, age 27. Osborne, E. J., Pt., B, 18th Ohio, age 21. Ostrander, P. V. L., Pt.. B, 100th N. Y., age 28. Overslrut, W. J., Pt., K, 43d Miss., age 20. Page, F., Pt,, K, 3d Michigan. Palmer, J.,Corp'l, F, 62d Ohio, age 22. Parker, D., Pt., F, 61st New York, age 29. Partain, J., Pt., D, Phil- ip's Legion, Georgia. Patten, G. W., Corp'l, F, 1st Maine, age 18. Paul, P., Pt, F, 3d In- fantry, age 27. Percy, J., Serg't, B, 5th Alabama. Perkins, P., Pt., G, 7th Kentucky, age 20. Perry, L., Corp'l, CI, 3d Arkansas, age 25. Peters, W., Pt., C, 139th Penn., age 22. Pettet, J. A., Pt., B, 8th Wisconsin. Pheiffer, P., Pt, A, llth Penn. Cav., age 35. Pickering, B.,Pt,A,llth Michigan, age 22. Pierce, F. O., Serg't, B, 14th N. H., age 28. Pleasants, J. W., Pt, B, Richmond Howitzer Battery, age 22. Plumstead.M, F.,Serg't. II, 131st N. Y., age 21. Pohner, M., Pt, D, 23d Kentucky, age 21. Polly, M. H., (orp'l, A, 10th N.Y. II.A., age 23. Poole, W. />., Serg't, I, 5th S. C, age 33. Porter, J., Pt., E, 16th i Penn. Cav., age 20. I Porter, W., Pt., B, 60th Ohio, age 22. June 22, 23, '64. June 22, 22, '64. June 16, 16, '64. Nov. 7, 7, '64. Dec. 15. 17, '64.' May 13, 13, '64. Nov. 30, 30, '64. April 16, 16, '62. Oct. 13, 13, '64. July 2, 4, '63. Mav 6, 6, '64. Mar. 25, 25, '65. May 1, 1, r63. Sept. 17, 17, '62. Sept 18, 19, '64. July 2, 2, '63. Sept. 19, 19, '64. Mar. 23, 23, '65. Aug. 22, 22, '64. Nov. 25, 25, '63. Oct. 19, 20, '64. Sept. 19, 19. '64. June 3, 3, '63. Julv 27, 27,"'64. July 3, 3, '64. Nov. 16, 16, '63. Aug. 16, 16, '64. April 2, 2, '65. 489 i Powell, J. E.. Pt, H, 7th May 14, S.C. Battery, age 26. 14,"'64. 490 Prize,; W. J., Serg't, A. I Nov. 30, 9th Arkansas, age 24. Dec.!,'Ii4 491 Quinn, J. A.,Pt, K, 109th Julv 30, New York, age 20. ?,(),''64. 492 Quinn. P., Pt., D, 5th N. Julv 18, Y. H vv Art'v, age 27. 19,"'64. 493 Rafford.O.. Pt„ H, 20th Sept. 30, Maine, age 28. Oct. 1,'64 494 Rank, B. H.. Pt., K, 51st June 3, Penn.. age 27. . 3, '64. 495 Rathburn, W., Pt., H, ; Dec. 13, 7th Rhode Island. \ V.S, '62. Operations, operators, Result. Right; flap. Surg. J.V. Kendall, 149th N.Y. Disch'd Oct. 5,'65. Left; circular. Discharged May 25,1865. Left; flap. Surgeon —Davids, C. S. A. Also w'nd right thigh, Exchanged Nov. 12,1803. Left; flap. Discharged April 20, 1865. Left: circ. Surg. P. E. Hubon, 28th Mass. Disch'd Oct. 9, '64. Nov. 15, '67, re-amp. mid. third. Left; circ. Surg. P. E. Hubon, 28th Mass. Disch'd Oct. 13,'64. Subs. V. R. C. Spec. 4494. Left; flap. Surg. F. Douglas, 170th N.Y. Disch'd Oct. 16,'65. Mar. 1, 1867, bilateral flap am- putation at middle third. Right; lat, flap. Confed. surgeon. Disch'd Oct. 21, 1865. Right; circ. Surg. J. Reily, 33d N. J. Disch'd April 3. 1865. R't; flap. Surg.W. O'Meagher, 69th N. Y. Disch'd Jan. 17,'65. Left. Transferred to prison Mav 30, 1865. Right; flap. A. A. Surg. F. G. Albright, Disch'd April 6, '65. Right; circ, Ass't Surg. W. D. Murray, 100th New York. Dis- charged January 13, 1865. Right; ant. post. flap. To Provost Marshal March], 1865. Both; circ. Discharged August 16, 1862. Left; circular. Snrg. A. CJ. Bar- low, 62d Ohio. Discharged. Left; circular: gangrene. Dis- charged Dec. 8, 1864. Right (also amputation middle third right arm). Recovered. Left; circular. Discharged Sep- tember 11, 1865. Left; circular, Discharged Feb- ruary 11, 1864. Right, Confederate surgeon. Re- covered. Left: circular. A. A. Surg. M. H. Head. Disch'd Oct. 5,1864. Left. Transferred for exchange November 12, 1863. Right; flap. Discharged May 6, 1865. Left; flap. Discharged May 22, 1865. Right; sloughing. Dec. 8, flap re-amp. middle third. Disch'd. Right. Discharged August 22, 1864. Right; ant post. flap. Surg. E.F. Ward, 38th Mass. Discharged September 11. 1865. Left: circ. Surg. G. W. Semple, P. A. C. S. To Provost Marshal April, 1, 1865. Right; circ. Discli'd Mar. 30,'64. Died Jan. 11, 1807; typh. fever. Right; circ. Surg.A.M.Morrison, 23d Ky. Disch'd April 28, '65. Right; circ. Surg.O. S.C'opcland, 10th N.Y. Art. Dis. May 31,'65. j Right: circ. To Provost Mar- shal December 1, 1864. Right; lat. flap. A. Surg. A. F. Hermau, 16th Penn. Cavalrj-. Hsem. Disch'd April 6, 1865. Left; ant. post flap. A. Surg.W. Carroli, t\ S. V. Discharged July 17,3SC,r>. Spec. 4140. Died June 22, 1868. Right; circ. Confed. surgeon. Furloughed July 23, 1864. Right; lateral flap. To Provost Marshal March 7. 1865. Right. Surg. W. C. Shurlock, 51st Penn. Disch'd Jan. 30,'65. Left; flap. Discharged October 17. 1865. Died May 17, 1S74. Right; circ. Discharged Feb- ruary 21. 1865. Left; flap. Discharged July 18, 1865. Right; circ. Discharged March 6, 1863. Name, Military Description, and Age, Ray, AY Capt, D, 6th North Carolina, Rea, W. M., Pt.K, 140th Pennsvlvania. Reed, J. M., Pt., B, 10th Iowa. Reen, C. Lieut. Col., 98th Penn.. age 35 Regan, D., Pt., A, 59th Mass., age25. Reifert, L.. Serg't, D, 29th New Vork. Reisinger, O. S.. Serg't. H, 150th( Penn., age 25. lielyea, W., Pt, H. 77th New Vork. Rennoe, D. M., Pt., H, 29th Indiana. Reynolds, M.,Pt,1,114th New York, age 27. Rice, C. IL, Pt, F, 129th Pennsylvania. Rice, M. G., Pt., I, 27th Mass.. age 31. Rich, W. H., Corp'l, F, 4th N. H.. age 20. Ridenour, G, Corp'l, I, 7th Maryland, age 22. Rifenverrick,W. M.,Cor- poral. H, 149th Penn., age 30. Riley, S., Pt, K, 10th Indiana, age 23. Ristcr, T. W., Pt, H, 13th S. C. age 19. Rittenhouse., J. H., Pt., E, 51st Georgia. Robar, A., Pt, I, 6th Vermont, age 16. Robertson, W. r.,Pt, D, llth Mississippi. Robinson, S. C, Pt, C, 12th New Hampshire. Robinson, T. B., Corp'l, B, 72d Penn., age 32. Robnault, J., Pt,,B, llth Pennsylvania, age 27. Roe, E., Pt„ Texas Bat- tery, age 20. Rogers, J., Pt., B, 29th Conn., age 38. Rosevelt, G. W., Serg't, K, 26th Penn. Runeiman, F., Pt, H, 27th Mich., age 30. Runyon, S. C, Pt., H, 2d Penn. Arty, age 46. Ryerson, J.. Pt, E, 13th Ohio Cavalry. Rynearson, I., Pt., B, 110th Ohio, age 20. Sanders, J. H., Pt., D, 34th Mass.. age 31. Savage, H. ¥., Pt, A, 1st Maine Art'y, age 18. Scofield, R., Pt, A, 9th Colored Troops. Scott, H., Pt., C, 2d Del- aware. Scott, J. G., Pt., D, 77th New York, age 23. Dates. May 30, 30, '64. May 8. 8, '64. May 22, 23, '63. April 2, 2, '65. July 7, 7. '64. Oct. 3, 4, '61. June 19, 19, '64. May 3, 3. '63. Jan. 2, 2, '63. Oct. 19, 20. '64. Dec. 13, 14. '62. June 18, 18, '64. Sept. 8, 8, '63. May 5, 5, '64. Mav 12, 12,"'64. Aug. 3, 3, '64. May 3, 4, M33. Sept. 26, 26, '64. May 10, 11, '64. May 31, J'e 2,'62. July 2, 3, '63. May 12. 12, '64. Dec. 13, 14, '62. Dec. 15, 16, '64. Oct. 27, 27, '64. July 2, 4, '63. Nov. 22, 22. '63. July 6, 6, '64. July 30, 30, '64. May 5, 6, '64. Sept. 19, 19, '64. Aug. 26, 26, '64. Sept. 29, 29, '64. May 2, 4, '63. May 6, 6, '64. 531 Scroggins, T. G., Serg't, '■ Julv 9, A, 31st Ga., age 22. , 9, '64. 532 ; Scullion, J., Pt., E, 155th j June 16, I New York, age 20. ! 17, '64. 533 | Secor, I., Pt., D, 28th | June 3, j Mass., age 23. 3, '64. 534 , Seibert, J., Pt, H, 53d Nov. 27, Penn., age 21. ! 27, '63. 535 Seitzmeyer, J.L.,Pt, E, Sept. 29, Sth Penn. Cav.. age 21. ' 29, '64. 536 Sessions, G. IF., Pt, K. July 1, Sth Alabama, age 22. 1, fa. 537 Setley, S., Pt. F, 58th April 17, 1 Penn., age 19. 17, '63. 538 Shaff, P., Pt, F, llth , Oct. 2, Mich. Cav., age 38. 2, '64. Operations, Operatoisb, Result. Lett. Surg. J. G. Hardy. C. S. A. Recovered. Right; circ. Surg. J.W.Wishart, 140th Penn. Disch'd May 29, '65. Right: circ. Discharged Septem- ber 28, 1863. Left. Discharged June 29. 1865. Left; flap. Surg. T. F. Oakes, 56th Mass. Disch'd June 2,'65. Died April 22, 1869. Spec. 6533. Left. A. Surg. J. W. S. Goulev, U.S.A. Disch'd Dec. 13,1861. Left; flap. Surg. W. F. Hum- phrey, 149th Penn. Discharged. Left; flap. Discharged Novem- ber 3, 1863. Right; flap. Discharged March 23, 1863. Right; lateral flap. Discharged June 12. 1865. Right; flap. Discharged May 25, 1863. Left; circ. Surg. G. T. Stevens, 77th N. Y. Disch'd Oct, 3, '65. Left; ant. post. flap. Surg. S.W. Gross, U. S.V. Disch'd June 1, 1864. Spec. 4315. Right; flap. Discharged Decem- ber 12, 1864. Left; flap. Surg. W. F. Hum- phrey, 149th Penn. Discharged January 26, 1865. Left; circular. Discharged Feb- ruary 21, 1865. ----; circular. Recovered. ----. Surg. — Hoyt, C. S. A. Retired February 36, 1865. Left. Discharged August 25,'64. Left. Union surgeon. Recovered. Right; circ. Recovered. Dis- charged. Left; flap. Surg. M. Rizer,72d Penn. Disch'd Feb. 15,1865. Right; flap. Discharged Decem- ber 10, 1863. Left; circular. To Provost Mar- shal March 7, 1665. Right; circ. A. Surg. H. Grange, 7th Col'd Troops. Discharged April 11, 1865. Left; flap. Surg.SLJ.W.Mintzer, 26th Penn. Disch'd Mar. 14.'64. Left: circ. Surg. J. P. Prince, 36th Mass. Disch'd Jan. 26,'65. Right; posterior flap. Disch'd July 18, 1865. Left; circ. Surg.W. B. Fox,8th Michigan. Discharged. Left; circular. Discharged Nov. 2, 1864. Right; circ. Discharged June 8. 1865. Left: flap. Disch'd Dec. 29, '64. Re-amp. at middle third. Right; circular. Discharged Sep- tember 7, 1865. Right; circ. Discharged August 20. 1863. Right; circ; flap (also left at up. third). Surg.E.B. P. Kelly,95th Penn. Discharged Nov. 3,1864. Spec. 513. Left. Exchanged September 21, 1864. Right; circ. Discharged June 1..1865. Left: circ. Surg. P. E. Hubon, 28th Mass. Disch'd Feb. 6, '65. Left; ant. post. flap. Surg. J.W. Wishart, 140th Penn. Disch'd March 28, 1865. Killed Dec. 22. 1879; railroad accident. Lett; circular. Discharged July 18. 1865. Right; ant. Surg. T. C. Hill,5th Ala. Exchanged Nov. 12,1863. Left; circ. Surg. F. P. Morong, 2dMd. Disch'd Oct 7, 1864. Left; circ. Surg. L.C.Woodman, llth Michigan Cavalry. Dis- charged July 1,1865. 1 O'MEAGHER (W.), Surgical Cases from Field Hospitals. Amputation of Left Beg, Lower Third, Stump healed in three weeks, in Medical and ,1 Reporter, Pliiladelphia,(1865, Vol. XII, p. 253. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 501 Name, Military Description, and Age. Sharp, J. W., Pt., G, 5th Georgia, age 26. Shay, M., Pt, K, 94th New York, age 21. Sheets, J. S., PL, E, 52d Virginia, age 22. Sheibly, T. J., Pt., B. 1st Penn. Rities, nge 19. Shell, J., Pt., H. 13th Tenn. Cavalry. 'Shell. W.T., Sergt, 18th Mi: Mi. ,ippi 24. C. It, l't, K, . Cav. Pt,L. 6th age 21. Simmons. R., Pt, I, 20th Miss., age 22. Simmons, W. J., Pt, K, 37th Georgia, age 22. Simpson, E. A., Serg't, B, 30th Mass., age 34. 550 Simpson, J. A'., Pt, I, 7th S. 0., age 29. I 5511 Sinclair, F. C, Lieut,C, 13th Mississippi. 552 , Slade, S. G., Pt., A, 13th ! Georgia, age 24. 553 j Smedberg, W. R., Capt, F, 14th Infantry. 554 I Smith,A. R., Pt., F, 16th South Carolina, age 24. 555 Smith, C, Pt., K, 1st I Maryland, age 42. 556 j Smith, C. G., Pt, F, 4th Infantry, age 26. 557 Smith,C. G-, Pt, H, 102d Illinois, age 18. 558 Smith, D., Pt, G, 21st Penn. Cav., age 24. 559 Smith, F.. Serg't, G, 7th Louisiana, age 28. 560 Smith, H. C, Pt,G, 30th Iowa, age 32. 561 Smith, J. C, Pt., I, 24th Iowa, age 20. 562 Smith, J. L., Pt,, C, 12th North Carolina. 563 Smiin, J. M., Pt., I, 23d Georgia. 564 Smith, J. M.,Pf ,K,155th New York, age 53. 565 Smith, N., Pt, H, 2d Iowa Cav., age 26. 566 Smith, S., Pt., K. 4th Georgia, age 17. 567 Snelling, E. A., Pt, Not- taway's Artillery. 568 Snuggs, W., Pt, H, 14th North Carolina, age 18. 569 Snyder. J. D., Pt., G, 149th Penn., age 19. 570 Soper, L., Serg't, A, llth Vermont, age 32. 571 Spraker, W., Serg't, I, 64th N. Y., age 24. 572 Spratt J. R., Lieut, E, 33d Indiana, age 27. 573 | StairfM. M. M., Pt, B, 50th Tenn. 574 I Stanwcll, B. L., Pt, A 12th Alabama, age 22. Starin, F. D., Pt, H, 43d Wisconsin, age 19. Stark, H.M.,Pt.G, 18th Infantry, age 19. 7 Starr, A. D., Pt., H, 4th Iowa, age 20. 78! Steel, E. B., Pt, I, 35th New York. 579 Steger, J., Pt, G, 52d New York. Oct. 19, 19, '64. June 18, 19, '64. Oct. 19, 19, '64. Mav 8, 9, '64. Nov. 11, 12, '64. Sept. 17, 18, '62. June 17, 17. (14. Sept. 19, 19, '6-1. July 20, 20, '64. Nov. 30, Dec.1,'64. Oct. 19, 21,'64. Sept 3. 4, '64. 8, '63. July 9 Nov. 30, 30, '64. April 1, 2, '65. Sept. 17, 17, '62. May 15, 16, '64. Aug. 21. 21, '(it. Mar. 25, 25, '65. Nov. 24, 25, '63. May 16, 16, '63. Mav 3, 3, '63. July 6, 7, '64. Oct. 27, 28, '64. May 9, 9, '62. Mar. 25, 25, '65. June 22, 22, '64. May 12. 12, '64. May 10, 11, '64. April 2, 2, '65. July 2, 4, '63. Mav 25, 26,' '64. Sept. 16, 16, '63. Sept. 19, 21, '61. Nov. 5, 5, '64. May 31, 31, '64. May 27, 27, '64. Dec. 13, 13, '62. June 1, 1, '62. Operations, Operators, Result. Left; circ. Surg. R.Watts, 133d N. Y. To Pro. Mar. April 8, '65. L't;circ. Surg.D.A.Chamberlain, 94th N. Y. Disch'd Mar. 2, '65. Left; flap. Surg. C. B. Gibson, C. S. A. Trans, for exchange February 10, 1865. Left; circ Surg. .1. .1. Comfort, 1st Penn. liihYs. Disch'd Nov. 18, 1864. Right; flap. Surg. VV. H. Mat- lock, 13th Tenn. Cav. Disch'd July 21, 1865. Right; circular. Doing well. Left; ant post. flap. Discharged May 11, 1865. Bight; flap. A. Surg.C. R. Rich- ards, 1st Mich. Cavalry. Dis- charged May 3, 1865. Left; circular. Transferred Sep- tember 22. 1864. Right: circular. To Provost Mar- shal March 7, 1865. Left; ant. post. flap. A. Surg-. B. Fordyce, 160th N. V. Gang. Oct. 26, re-amput'n thigh, low. third. Disch'd Oct. 16, 1865. Left, Surg. J. Evans, 3d S. C. To Provost Marshal for exch'ge February 11, 1865. Right; ant Surg. S. V. D. Hill, C.S.A. Recov'd; exchanged. Left. Exchanged. Right. A. Surg. J. S. Smith, U. S. A. June, 1864, re-amputat'n mid. third. Retired Dec. 15,'70. Left ; circular. To Provost "Mar- shal March 29, 1865. Right; flap; gangrene. Disch'd October 11, 1865. Left: circ. A. Surg. J. R.Gibson. U. S. A. Disch'd Aug. 22, '64. Right; circ. Surg.W. Hamilton, 102dlll. Disch'd May 18, 1865. Left ; ant. post, flap; gang. Dis- charged August 2, 1865. Right; ant. circular. Surg. H. N. Young, C. S. A. Released June 14,1865. Right; flap. Surg. A.T. Hudson, 26th Iowa. Disch'd Feb. 1, '65. Left; flap. Discharged Septem- ber 18, 1863. Left; gang. Transferred June 9, 1863. Right. Surg.—Morgan, ('. S. A. Retired February, 1865. Right: flap. Surgeon F. Wylie. 155th N.Y. Disch'd May 2V05. Right Surg. G. Reeder.l'd Iowa Cavalry. Disch'd Aug. 12, '62. Left: circular. Released June 14, 1865. Right (also left li Confed. surgeon Right; flap. To 17. 1864. Left .Hap (also ai rat mid. third). Recovery- prison October ,p. n it U up third). Disch'd July 21, 1865. Left; flap. Surg. C. B. Park, llth Vermont. Disch'd Sept. 14, '65. Left; circular. Disch'd May 3, 1864. Spec. 4364. Right Surg.W. C. Bennett, U.S. V. Discharged Feb. 3,1865. Left Surg. — McFarland.C.S.A. Recovered. Right; circ. Surg. —Weatherby, 6th Alabama. To prison Jan- uary 5, 1865. Left; flap (also amp. right leg, up. third). Disch'd July 2, 1865. Left; circ. Surg. S. Marks, 10th Wis. (Also wound right foot.) Disch'd Dec. 22, 1864. Left; circ. Surg. B.N. Bond, 27th Mo. Disch'd May 23, 1865. Left. Surg. W. A. Madill, 23d New York. Disch'd June 6,'63. Left. Discharged September 14, 1862. Name, Military Description, and Age, Stein, F., Pt, H, 10th Infantry. Stetler, J. A., Pt, A, 143d l'enn., age 19. Stevens. J., Pt, C, 79th Ohio, age 45. Stewart, J., Pt., K, 1st Maryland, age 24. Stewart, R. la. Capt, B, 17!)th N. York, age 34. Stewart, T. G., Pt., D, 36th Illinois, age 41. Stills, J., Pt., D, 90th lndiaua, age 20. Stokes, C., Serg't, C, 7th Florida, age 35. Stone, J. F., PL, E. 29th Mississippi, age 23. Street, T.G., Pt, C, 7th Maryland, age 19. Striep, M.. Corp'l, B, 6th N. V. Cavalry, age 25. Strohnber, G., Pt, A, 188th N. Y., age 20. Strong, L. M., Pt, K, 3d Vermont, age 21. Stroup, C. W., Pt., II, 52d N. C, age 29. Suidon,J. K., Lieut., F, 24th Virginia, age 22. Suratt, J. G., Pt, F, 7th North Carolina. Talesfero, W. M., Corp'l, E, 2d Va. Cavalry. Taylor, J.W.,Pt.,C, 5th N. Y. Cavalry, age 44. Taylor, J., Pt., B, 5th Colored Troops. Taylor, W. T., Serg't Maj., 56th N.C., age 24. Teel.H, Corp'l, H,122d Ohio, age 22. Temple, R., Serg't, E, 21st Virginia. Thayer, W. S., Lieut., H, llth Virginia. Thomas, H.H., Serg't,B, 26th N. C, age 23. Thomas, H. §., Major, 1st Penn. Cav., age 26. Thomas, J., Pt, I, 30th Col'd Troops, age 22. Thomas, S. B., Pt, H, 37th Virginia, age 40. Thomas, W. B.,Corp'l,E, 7th Georgia. Thornton, M. L., Pt., E, 31st Georgia, age 22. Thornton, R. B., Pt., F, 12th N. C, age 21. Thurlkil, J., Pt, G, 31st Col'd Troops, age 29. Torreyson, T. N., Corp'l, C, 35th Va. Battery. Torry, A., Pt., H, 99th Penn., age 30. Travis, C, Pt, E, 23d Missouri, age 30. Tribou, D. W., Corp'l, C, 29th Mass. 'Trimble, J. E., Major General, C.S. A. Tullis, J. IF.Lieutenant, I July 2, ' 2, ''63. July 3, 3, '63. June 18, 18, '64. July 20, 21, '64. Alter 19, 20, '64. June 17, 17, '64. Dec. 16, 16, '64. Sept. 4, 4, '63. Dec. 7, 7, '64. Nov. 30, De.1,'64 May 6, 7, '64. Aug. 29, 29, '64. Oct. 27, 27, '64. April 2, 2, '65. July 3, 3, '63. Julv 2, 3, '63. July 3, 3, '63. Oct. 11, 11, '63. April 27, 27, '64. Feb. 19, 20, '65. Mar. 25, 25, '65. Sept. 19, 19, '64. July 2, 2, '63. April 18, 18, '64. July 3, 3, '63. April 5, 5, '65. July 30, 30, '64. Mar. 25, 26, '65. May 6, 7, r64. Oct. 19, 19, '64. Operations, Operators, Result. July 1, 2, '63. Oot. 27, 28, '64. Mav 8, 8, '64. Sept. 16, 16, '64. July 29, 29, '64. Sept 17, 17, '62. July 3, 3, '63. Hardawny's Alabai flattery, age 21. Turner,' G.' l't, E, 1st Mich. Cav., age 34. Tattle. R. S., Corp'l, F, 27th Michigan. Tyrrell, J. ('., Serg'tL 28th New Jersey. Mav 31, 31,"'64. Julv 11, 11,*'63. Dec. 13, 13, '62. Right. Discharged December 23, 1863. Spec. 1454. Right; flap. Surg. F.C. Reamer, 143d Penn. Disch'd June 1,'65. Re-amp. at mid. third Jan., 1867, Left; circular. Discharged. Right; circ. Surg. A. A. White, 8th Md. Disch'd Aug. 1, 1865. Left; circ. A. A. Surg. W. H. Randolph. Discli'd Jan. 0,1865. Died August 30, 1870. Left; circular. Discharged July 12, 1865. Died July 1, 1870. Left; flap. Surg. A. C. Fosdick. 90th lnd. April 22, '64, re-amp. at mid. third. Disc. Nov. 11, '64. ----; circular. To Provost Mar- shal March 7, 1865. Left; circ. Surg. -— Lynch, C. S. A. To Pro. Mar. May 6, '65. Right; circ. Discharged March 24, 1865. Right; flap. Discharged. Left; circular. Discharged May 26, 1865. Left; ant. post. flap. Surg. J. J. Meigs, 3d Vermont Disch'd. Right, July 11, reamp. Trans ferred for exch. Nov. 12, 1863. Right; circ. Recovered. Ex- changed. Right. Paroled September 5. 1863. ----. Surg. — Lee, C. S. A. Re- covered. Left; flap. A. Surg. O. H. Arm- strong, 5th N. Y. Cav. Disch'd Oct. 6, 1864. Spec. 2244. Left; ant. circ. Ass't Surg. G. V. R. Merrill, 6th Colored Troops. Discharged Nov. 10,1865. Right; circular. Released June 19, 1865. Left; ant. post. flap. Ass't Surg. J. G. Thompson, 77th N. York. Discharged August 14,1865. ---. Recovered. Transferred July 15, 1863. Left." Surg. J. R. Ward, C.S. A. Recovered. Right, Paroled October 24,1863. Right; flap. Discharged August 17, 1865. Right; flap. Surg. G. R. Potts. 23d Col'd Troops. Discharged August 23, 1865. Right; circ. Surg. E. P. Roche. Released June 14, 1865. ----. Surg. G. S. West, C.S.A. Retired February 11. 1865. Right; circ. (also amp. right arm at mid. third). Surg. G. G. But- ton, 31st Georgia. To Provost Marshal April 8, 1865. Left. Transferred for exchange September 25, 1864. Left; circular. Discharged Aug. 23, 1865. ----. Surg. W. J. Allen, C. S. A. Recovered. Left; circular flap. Surg. D. S. Hays, 110th Penn. Discharged June 1, 1865. Spec. 4113. Left; flap. Discharged January 20, 1865. R't. Surg.G. B. Coggswell, 29th Mass. Disch'd Jan. 13, 1863. ----. Surg. H.McGuire.C. S.A. Transferred August 18, 1863. Left. Surg. J. McC. Greene, C. S. A. Recovered. Trans, for exchange March 17, 1864. Right; flap. Discharged Sep tember24, 1864. Right; circ. Surg. J. P. Prince. 36th Mass. Discharged Sept 16, 1863. Right; flap. Surg.W. D. Newell, 28th N. J. Discharged July 6, 1863. 'FISHER (G. J.), Reportof Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., etc.,'m American Journal Medical Sciences, 1863, Vol. XLV, N. S., p. 48. 2 McGuire (H.), Clinical Remarks on Gunshot Wounds of Joints, etc., in Richmond Medical Journal, 1866, Vol. I, p. 150. r>02 INJURIKS OF THE LOWER EXTREMITIES. [CHAP. X. NO. Name. Military description", and age. 1 Dates. !620 Underwood, L. A., Cor- April 2, poral, F, 4th Vermont, 2, '65. age 21. 621 Van Kirk, A. J., Pt., D, May 12, 140th Penn., age 21. 12, '64. 622 Van Kuren, J., Corp'l. Mav 8, j B, 1st Mich., age 25. 8, '64. 623 Vanocker, L., Pt, F, Aug. 30, 104th New York. 30, '62. 624 Vanpelt, P. P., Pt., I. June 1, 14th N. J., age 24. 1, '64. 625 Van Scheffelin, A., Pt, Nov. 18, E, 76th N. Y., age 30. 19, '63. 626 Vincent, 11. G., Ft, II, April 6, 15th Iowa, age 21. 7, '62. 627 i Yoaglin, P., Pt, G, 44th Sept. 17, Alabama. 17, '62. 628 Wallace, G. H., Pt., I, Julv 9, 9th C. Troops, age 22. 9, '64. 629 1 Wamer, G., Lieut, K, Mar. 14, 27th Mass., age 26. 14, '62. 630 Waterbouse, B. VV., Pt, July 24, G, 23d Ohio, age 27. 24, '64. 631 Watrous, R. S., Pt., A, July 1, i, to. 2d Artillery, age 20. 632 Watson, IF. H, Pt., A, Aug. 18, 33d Alabama, age 24. 18, '64. 633 Weaver, J., l't.,E, 126th Sept. 19, Ohio, age 20. 19, '64. 634 Webb, J., Pt, C, 155th May 8, Penn., age 26. 8, '64. 635 Webber. W. A., Capt, A, Mav 10, 23d Virginia. 10," '64. 636 Weber, 1., Pt., 5th Ohio July 12, Battery, age 20. 12, '63. 637 Weeks, J., Pt, K, 4th Dec. 7, Florida, age 20. 7, '64. 638 Welch, J. M., Pt, B, 9th Oct. 29, Iowa, age 19. 29, '63. 639 Weschke, G.Pt, D, 67th May 12, New York, age 30. 12, '64. 640 West, J. M., Pt, C, 97th Mav 26, Ohio, age 30. 26," '64. 641 Wetherbee, J. M., S'g't, Nov. 27, B, 151st N. Y., age 25. 27, '63. 642 B"7iartum,Jr.,Pt,K, 10th May 2, Louisiana. 2, '63. 643 Wheeler, J. R., Pt,C, 2d Dec. 13, Vermont, age 25. 13, '62. 644 White, A., Pt., E, 52d Sept. 5, Penn.. age 23. 5, '63. 645 White. B.E.,Pt,E, 16th July 3, Vermont.. 4, *63. 646 White, J. E., Serg't, F, Oct 19, 160th N. York, age 34. 21, '64. 647 Whitesell, D. A., Serg't, July 2, C, 5th Art'y. age 20. 3, '"63. 648 Whitlow, J. H., Pt., A, Julv 2, 57th Virginia. 3, '63. 649 Wilcox, B. F., Pt, E, Julv 20, 149th N. York, age 22. 20,"'64. 650 Wilder, W. W., Pt., K, Aug. 29, 3d Mich., age 27. 30. "62. 651 Williams, II., Pt,K,98th April 9, Pennsylvania, age 23. 9. '65. 652 Williams, J. B., Pt, H, Julv 19, 2d Penn. Art., age 27. 19,"'64. 653 Williams. S. W., Serg't, Oct. 26, C, 27th Mo., age 29. 26, '63. 654 Williams, W. P., Pt, B, Sept. 29, 188th Penn., age 18. 29, '64. 655 Willis, W., Pt, I, 8th Mar. 26, Maine. 27, '63. 656 Willison, S. D., Pt., C, June 3, , 2d Micb.,age28. 3, '64. 657 Wilson. R., Pt., A, 73d Oct. 29, Ohio, age 2p. 29, '63. 658 j Wilson, R. F.., Major, Nov. 30, 37th Georgia, age 33. Dec.1,'64 659 Wilson. S. L., Lieut, F, Dec. 29, 114th Ohio. 29, '62. 660 Wire. IF M.. Lieutenant. May 15. 15, '64. Operations, Operators, Result. Left; flap. Disch'd Aug. 10, '65. (Also wounds of right shoulder and left hand.) Right; circular. Surg. J. W. Wishart, 140th Penn. Disch'd April 16, 1865. Left; flap. Confederate surgeon. Discharged May 11, 1865. Left. Discharged October 29, ] 862. j Left; circular. Discharged Feb- ruary 3, 1865. Right". A. Surg. N. R. Barnes, 76th N.Y. Disch'd July 22,'64. Right. Discharged June 18, '62. | Left. Dec. 16, resec. of nec. tibia. Furloughed March 2, 1863. Right; flap. Discharged March 21, 1865. Right; circ. Surg. G. A. Otis, 27th Mass. Recov., prom., and transferred to Vet. Res. Corps. Right; ant. post. flap. Surg. — Duffy, C. S. A. Disch'd May 18, 1865. Left. Trans, to Headquarters January 17, 1864. Right; circular. Recovered. Right; circular (also wound left leg). Discharged June 2,1865. Left; ant. post. flap. Discharged April 6, 1865. ----. Surg. C.C. Henkle.C. S.A. Recovered. Left: ant. post. flap. Surg. C. Carle, 41st 111. Gang. Oct. 7, re-amp. by Luke's flap method. Discharged Sept. 13, 1864. Left; circular. To Provost Mar- shal March 21, 1865. Left; flaps. Surg. D. B. Allen, 30thlowa. Disch'd Aug. 26,'64. Right; ant. post flap. Surg. R. Sharp, 15th N. Jersey. Disch'd May 1.1, 1865. Left; circ. Surg. E. B. Glick, 40th lnd. Disch'd Nov. 12, '64. Spec. 3395. Left. April 4, 1864, re-amp. in upper third. Discharged July 6,1865. Right Recovered. Left. Re-amp. in upper third in 1863. Disch'd April 22, 1864. Spec. 1358. Right; flap. Disch'd Sept. 20,'64. Re-amputation May, '65. Died May 8, 1865. Left. Discharged October 29, 1863. Left; lat. flap. A. Surg. D. H. Armstrong, 160th New York. Discharged April 28, 1865. Left; flap. A.Surg.H.K.Spooner, 55th Ohio. Disch'd Oct. 12,'63. Right Retired February 2, 1865. Right flap; gangrene. Disch'd August 8, 1865. Right; double flap. Discharged July 30, 1863. Left: circ, (amp. right foot, Ifev's method). Disch'd Oct 6. 1865. Left: flap. Discharged Julv 4, 1865. Right: ciro. Discharged Feb. 4, 1864. Died Dec. 19. 1871. Left: circular. Disch'd March 26, 1865. Right: lateral flap. Surg. J. D. Mitchell, 8th Maine. Disch'd December 24, 1863. Right. Discharged February 4, 1865. Right. Discharged February 24, 1864. Died in 1865. Left: circular. To Provost Mar- shal March 18, 1865. Left. Discharged August 14,'63. Right. Surg. F. A.Walker. Re- covered. Furloughed. Name. Military Descriptiox, and Aoe Woerts, C. Pt. 1. 108th Ohio, age 26. Wolcott, II. P., Lieut.. K, 41st Ohio. Wolf, M., Pt, A, 160th New York, age 21. Wood, W. H., Pt, I, 126th N. Y., age 23. Woodruff, J., Pt., K, 57th Mass.. age 26. Woodward, J., Pt., C, 14th N. Y.S. INI. Worley, C. L. F., Pt., A, Sth Ala., age 22. Wrieth, H., Pt., B, 20th Mass., age 26. Wright, P., Pt., H, 39th Cold Troops, age 29. Wyboum,W. A., Serg't, 1. 147th N. Y., age 23. Yates, S., Corp'l, H, 33d Virginia, age 38. Yerkes, W. H., Pt, C, 128th Pennsylvania. Young, F.V.,Pt,I, lllth New York, age 18. Young, G. A., Pt., F, 5th Artillery, age 23. Young. j'.P,..Pt,K, llth Indiana, age 21. Ziegler,S. R., Pt.,A,49th Penn., age 23. Abbott, J. I., Pt., C, 2d Conn. H. A., age 26. Adams, N., Pt., D, 36th Wisconsin, age 34. Anderson, LV, Corp'l, H, 7th Maryland, age 41. Angell, G. W., Pt, K, 18th Ohio. Arahood, J., Pt., C, 17th Ohio. Arte, Ph., Saddler, H, 17thPenn.Cav., age24. Austin, J., Pt, G, llth Michigan. Austin, S. J., Pt, A, 33d Massachusetts. Baker, S., Pt., B, Sth W. Virginia. Bakehouse, H., Pt., B, 82d Penn., age 36. Banks, S., Pt, C, 43d Colored Troops. Barstow, T. A., Serg't, B, 15th New Hamp. Barnett,D. J.,PX., B, 42d Alabama. Bassett.G. L.,Pt,G,19th Michigan. Bates, E. C, Pt. C, 9th Maine, age 17. Baysman,T.,Pt,D, 14th Col'd II. Art'y, age 22. Billings, D., Serg't, A, 149th New York. Bird. E., Pt., H, 8th Michigan, age 19. Black, A.. Pt, A, 3d N. Jersey, age 43. Boling. R. E., Corp'l, D, 6th Kentucky Cavalry. Borosky, J., Pt.,A, 199th Pennsylvania. Bounds', O.J., Pt. II, 39th Alabama, age 18. Bowen, S., Pt., E, 32d Alabama. Bowman, D..Pt, B, 15th Infantry, age 24. Boyd, IF. J., Pt, D, 21st North Carolina, age 28. Briggs, F. C, Pt., B, 125th Ohio. Brown, A., Pt.. A, Sth N. Y. Cavalry, age 47. Bryan, M. W., Pt, G, 11th Michigan. Aug. 14, 14, '64. Dec. 31, 31, '62. Oct. 19, 20, '0-1. Julv 3, 5, '63. July 4, 4, '64. July], 1, '63. July 1, 1, '63. July 28. 29, '64. Feb. 11, 11, '65. Feb. 6, 6, '65. Mar. 25, 26, '65. Sept. 17, 17, '62. May 6, 6, '64. Nov. 7, 7, '63. May 16, 17," '63. May 5, 6, '64. June 27, 27, '64. June 17, 17, '64. Aug. 21, 21. '64. Dec. 31, —, '62. Sept. 19, —, '63. Aug. 11, 11, '64. De.31,'62 Jan. 1,'63 June 1, 1, '64. Aug. 23, —, '63. June 3, 3, '64. July 30, 30, '64. May 27, 27, '63. May 15, —, '64. May 15, 15, '64. June 30, 30, '64. Mar. 30, —, '65. July 20, 20, '64. Sept. 30, Oct 1,'64 J n I v 30, 30,"'64. June 24, 24, '64. April 9, 9, '65. Dec. 16, 16, '64. Mav 15, —,' '64. June 3, 3, '64. Oct. 19, 19, '64. Sept. 19, 19. '63. Julv 7, 9, '64. Aug. 7, 7,?64. Operations, ' H'erators, Result. Left; circ. Surg. C. Spinzig, 2d Mo. Disch'd June Hi, 1865. Left; flap. Surg.A.G. Hart, 41st Ohio. Discli'd May 27, 1863. Right; circ. Discharged July 10, 1865. Right; circ. Discharged July 24, 1S65. Left Dec. 18. re-amp. at junc. of mid. and up. thirds. Dec. 22, haem. Disch'd June 27, 1865. Right; ant. post. flap. Surg. J.M. Farley, 14th N.Y. S. M. Disc'd Feb. 26,1864. Spec. 4309. Right. Retired October 14,1864. Left; flap. Confederate surgeon. Discharged August 13, 1865. Left; flap. A. Surg. F. B. Kim- ball, 3d New Hamp. Disch'd October 19, 1865. Right; circ. Surg. A. S. Coe, 147th N.Y. Duty April 3,1865. Prom. Lieut. Dis. June 7,1865. Left: circular. Released J une 14, 1865. Right. Discharged May 1 I, 1863. Right; flap. Confed. surgeon. Discharged June 16, 1865. Left. Discharged August 19,64. Left; flap. Surg. R. B. Jessup, 24th lnd. Discharged August 31, 1864. Left; flap. Discharged Novem- ber 10, 1864. Right; circular. Died August 20, 1864; typhoid fever. Left. Died June £9, 1864; gan- grene. Left (also amp. right leg at mid- dle). Died Oct, 1, 1864. ----; erysipelas. Re -ampntat'n. Died March 18.'63; exhaustion. Left. Died October 17, 1863; pneumonia. Left; flap. Died November 17, 1864. Right Died January 20,1863. Right. Died July 18, 1864. Left. Died September 20,1863. Left; circular. Died April 9, 1865. Left (also amputat'n right thigh). Surg. D. MacKay, 29th Colored Troops. Died Julv 31,1864. Right. Died May 27, 1863. Left. Surg. E. Hutchinson, 137th N.Y. Died Mav 25, 1864. Left. Died May 20, 1864. Right. Died Angust 12, 1864 : exhaustion. Right (also w'd left 1 eg and hand); sloughing. Died May 16, '65. Right. Died October 9, 1864. Left. Died October 24, 1864; exhaustion. Left; circular ; sloughing. Died August 28, 1864: pvaemia. Left. Died July 25," 1864. Right. Surg. O. M. Clark, 39th Illinois. Died May 8, 1865. Right; circular. A. A. Surg. R. L. McClure. Died Feb. 2,1865; | chronic diarrhoea. j ----. Died May 23, 1864. Left. Died July 18. 1864. Right; circular. Died Novem- ber 10, 1864; pvaemia. ----. Died October 21.1863. Left. Died July 24, 1864. Right (amputation arm). Died September 6, 1864. •OTIS (G. A.), Army Medical Intelligence, in Boston Medical and Surgical Journal, 1862, Vol. LXVI, p. 239. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 503 705 796 707 708 709 710 711 712 713 714 715 716 717 718 719 720 721 723 724 725 726 727 728 729 730 731 732 733 Name. Military Description, and Age. Bryant, J., Pt, G, 23d Michigan. Bunn, J. K., Pt., 6th N. York Battery, nge 19. Burge, W., Pt, K, 103d Illinois. Bun-, G., Pt., K, 25th Mass., ago 39. Campbell, S., Pt . A, 63d New York. Carknard, J. E.. Pt. E. 7th N.Y. Heavy Artil- lery, age 21. Carne'i, A. B., Pt, E, 55th N. Carolina. Caninglon.W.II..Serg't, K. 51st New York. Chcdistcr, J. A., Pt., I, 15th West Va.. age 30. Childcrs.M., l't, G, 15th Virginia, age 42. Christy, D. L., Serg't, C, 102d Penn., age 24. Cobleigh, J. VV., Serg't, A, IstVt, H. A., age24. Cogan.W. H.,Pt., B,69th Ohio, age 25. lCox,J. F.,Capt.,D, 29th Mississippi, age 31. Crowley, J., Pt., K, 88th New York. Culler, M., Pt, H, 73d Illinois, age 22. Daugherty, J., Pt,C, 1st Delaware. Dart's, A. W., Corp'l, F, 14th N. C., age 24. Davis, W., rt, H, 48th Pennsylvania, age 28. Davis, "\V., Pt, A, 31st Maine, age 19. DeBarr, G-, Pt., B, 169th New York, age 35. Detchon, W. F., Pt., 9th Co., 60th Ohio, age 19. Devereux, C Corp'l, F, llth Vermont, age 33. Dungan, C, Pt., II, 32d Alabama, age 28. Easterbrook, S., Pt, F, R. Island Art., age 48. Edson, H., Pt, C, 22d Massachusetts, age 35. Elder, W., Pt., F, "63d Pennsylvania, age 21. Fisher, D. E., Pt., B. 6th Pennsylvania, age 31. Flore, C, Pt., G, 10th Minnesota, age 23. Fogle, M. P., Corp'l, A, 133d New York, age 31. Forbes, J. K., Pt, A, 5th Iowa. Foster,C. B., Pt., D, 27th South Carolina, age 29. Fox, J. M., Pt, C, 61st Ohio. Francis, C, Pt, H, 83d Pennsylvania. Frost, A. C. Pt,C, 15th Massachusetts. Fry, W. IL, Pt, II, 56th Pennsylvania, age 21. Galligher, T., Pt., D, 4th Delaware. Gerhart, J., Pt., B, 49th Pennsylvania, age 32. Gibbs, M., Pt., C, 139th Pennsylvania, age 32. Gillam, J. H., Pt, K, 15th North Carolina. Goodsell, C. IL, Pt,, C, 124th New York. Goodwin, T., Pt, H, 22d Wisconsin. Graff, S., Pt., B, 83d Pennsylvania. Grant, P., Pt, B, 67th Ohio. Oi'i-.i; vnoxs. Operators May 14, 14, '64. May 28, 28, '64. Nov. 25, 25, '63. June 30, 30, '64. June 3, 3, '64. June 16, 17, '64. Mar. Mar. 14, 14, '02. Sept, 3, 4, '64. April 6, 8, '65. May 5, 6, '64. Mar. 25, 25, '65. Aug. 16, 16. '64. Aug. 31, 31. '64. Mav 1, 1, '63. Nov. 30, Dec.1,'64. Julv I, 1. '63. July 12, 12, '64. June 3, 3, '64. July 30, 31," '64. July 14, 14,''64. July 30, 30, '64. Oct. 19, 19, '64. Nov. 25, —, '63. May 12, 12, '64. May 10, 11, '64. May 5, 6, '64. July 20, 20, '64. April 5, 5, '65. June 14, 14, '63. Sept. 19. 19, '62. Aug. 21, 22, '64. July 22, 22, '64. June 27, 28, '62. July 2, —, '63. Mav 12, 13,"'64. June 3, 3, '64. May 10, 10, '64. April 2, 2, '65. Sept, 14, 16, '62. May 3, 3, *63. May 15, 15, '64. May 3, 3, r63. May 12, 12, '64. Right. Died July 14, 1864. Left; circular. Died June 22, 1864; pyaemia. Left. Surg. J. Hutchison, 15th Michigan. Died Deo. 16, 1863. Left; sloughing, Died July 12, 1864; exhaustion. ----. Surg. J.W.Wishart, 140th Peun. Died June 8, 1864. Left; circ. Surg. .1. 10. Ponil'ret. 7th N. V. H'vy'Artillery. Died July 28, 1864* Right. Died April 19, 1865. Left. Died May 9, 1862. Left. A. A. Surg. J. R. Uhler. Died October 3, 1864. Left Died Maj' 5, 1865; gan- grene. Left; circular. Died June 18, 1864; exhaustion. Right,- flap. Died March 28, '65; exhaustion. Left. Died September 16, 1864 ; irritative fever. Left; gangrene; erysip. Died October 31, 1864. Right (also amp. left great toe); hsem. Died May 26, 1863. Left Died December 28, 1804. Left (also w'd of leg). Surg.G. W. New, 7th lnd. Died July 3,'63. Right. Confed. surgeon. Aug. 4, re-amp. upper third. Died Aug. 10, 1864. Spec. 2923. Right; circular. Died Septem- ber 5, 1864 ; diarrhoea. Left; ant. post. flap. Died Sept. 6, 1864; pytemia. Left; pyaemia. Died September 25, 1864. Left; circular; sloughing. Died August 13, 1864; exhaustion. Right; ant. post. flap. Died Nov. 17, 1864; exhaustion. Left. Died March 2, 1864; in- flammation lungs. Right Died May 24,1864 ; ery- sipelas. Left; ant. post flap. Surg. I. H. Steans, 22d Mass. Sloughing. Died June 30,1864; exhaustion. Right (also fract. cranium); circ. Died May 30, 1864. R't. Surg. A. M.Wilder, TJ. S.V. Died Nov. 12, '64 ; exhaustion. Left; circ. A. Surg. F. H. Milli- gan. 10th Minn. April 20, re- amputation. Died May 11, '65. Right. Surg. R. Watts, jr., 133d N. Y. Haem.; lig. post tibial. Died Nov. 17, 1863. Left. Died September 23,1862. Right; circular; pj'aemia. Died September 17, 1864. Left Died August 27, 1864. Left. Aug. 6, rc-amput'n. Died August 9, 1862; pyaemia. Left. Sept 12, amp. thigh. Died Sept 16, 1863; gangrene. Left. Died June 14, 1864. Left, Died June 11, 1864. Left. Died June 1, '64; pytemia. Left; ant post flap. Died May 10, 1865; exhaustion. ----; sloughing. Died October 12, 1862. Left. Died August 3, 1863. Left; circ. Surg.W. C. Bennett, U.S.V. Died July 12,1864. Right Died July 3, 1863. Left. Died May 24, 1864. .. Name, Military ' Description, and Aoi Operations, Operators, Result. 749 ! Green, J. L. W., Pt, F, I 26th New Vork. 750 Green, R. B., Pt., G, 7th Rhode Island. 751 Gritlith, ,L, Pt., H, 4th Delaware, age 39. 752 Hall, It, l't, K, 50th Ohio, age 20. 753 1 Hall, J. F., Pt., B, 68th Pennsvlvania. 75-1 , Hanson! J., Pt, K, 3d I Wist.....sin. IIarrigan.VV.,Ptj.,M,24th X. Vork Cav., age 21. Harris, It.. Pt., G, 132d New Vork, age 26. Hart, J., Pt., (i, 74th Indiana, age 29. Hartman, T. R., Serg't, K, 88th Penn., age 21. Henry, P., Pt, C, 78th Pennsvlvania. Higgins", A.,Pt.E, 104th New York, age 23. Hilsondegen, J., Pt, F, 16th Michigan. Hinkle, J. H.,Pt, I, 70th Indiana. Hobson, .I.E., Pt, Brook's 1st Va. Art'y, age 23. Dec. 13. 13, 62. Dec. 13, —, '62. June 2, 4, '64. July 22, 22, '64. July 3. —, '63. July 4, —, '64, June 16, 16, '64. Feb. 1, 2, '64. July 22, 22,"'64. Mar. 30, 31, '65. Mav 31, 31, '64. Aug. 19, 19, '64. Sept. 30, 3d, '04. May 15, May 4. Holmes, W. j'.,Pt.,(i, 33d j July Mississippi, age 18. : 22, '( Honestea, L.,Pt, B, 10th Infantry, age 18. Howell, J. H.,Pt,C, 23d Michigan. 2Hoyt, H. H., Pt, D, 6th Connecticut. May 5, 5, "64. May 14, 14, '64. Oct. 22, 24, '62. Dec. 14, 14, '62. May 16, 16,"'64. Aug. 21, 21, '64. June 24, 24,'64. July 30, 30, '64. Nov. 30, 30, '64. May 9, —, '62. Sept. 29, 29, '64. June 1, 1, '64. Dec. 13, 13, '62. May 5, 5, '64. July 2, 4, '63. June 30, 30, '64. July 30, 30, '64. Jan. 11, 11, '63. June 19, 20, '64. May 25, 25,''64. May 4, 4, '64. Nov. 24, 24, *63. May 19, 19,' '64. May 9, 10, "'64. Lockland, B., Pt., C, 3d j Sept, 23. Artillery, age 25. \ 23. '03. Long. M. B., Pt, B, 12th Aug. 30, Wisconsin, age 24. | 30, '64. 3Looney, M., Pt., B, 1st May 31, Mass. Cav., age 23. |J'el,'64. Hubbard, J., Pt., I, 10th Connecticut, age 38. Hukill, W. T., Pt, E, 66th Illinois. Hyatt, C, Capt,, E, 6th Wisconsin. Ingraham, G. M., Pt., M, 4th N.Y. H. A., age 19. Johnson, J. M., Pt, E, 43d Col'd Troops. Johnson, T. B., Pt., H, 19th Arkansas, age 35. Johnson, Z., Pt., "I, 8th Wisconsin. Jones, P., Pt, I, 9th Col'd Troops, age 23. Kendall, Z., Pt, G, llth Vermont. Kent, H. O., Pt., E, 4th Vermont. Kipp, G. J., Pt, I. 1st New Jersey, age 21. Krappman, A., Pt., A, 40th N. York, age 29. Lamphere, L. (>., Pt, E, 21st Conn., age 19. Larkins, J., Pt., E, 37th Wisconsin. Laughlin, E. W., Pt., E, 77th Illinois, age 19. Layton, J., Pt, F, 4th N. Y. Heavy Artillery. Leesholts, W., Pt, G, 147th Pennsylvania. Leight. E. P..Serg't JIaj., 1st Mass. Cav, age 2-1. Lieber, J.. Corp'l, B, 1st Ohio. Littlefield, L. P., Pt., K. 1st Mass. H'vy Art'y. Livingston, J., Pt, A, 1st Mich. S. S., age 18. Hight; circular. Died January 2, 1863. Left, Died January 2, 1863. Right; circular; sloughing. Died Julyl, 1864. Right. Surg. J. C. Welch, 20th Kentucky. Cangrene. Died September 8, 1804. Right. Died August 1,1863. Left. Died July 9, 1864. Right Died July 13, 1864. Left: circ. A. Surg. J.W. Gray, 118th N. Y. Died May 20, 186*4, under inil. clilo. during operat'n. Right. Died August 14,1864. Right; lateral flap. Died June 7, 1865. Left. Died July 15, 1864. Left; antpost.flap. Surg. E. (i. Chase, 104th N. Y. Died Sept. 23, 1864; erysipelas. Left. Died November 6, 1864 ; pyaemia. Left Died June 1, 1864. ----; flap; typhoid fever: hsem. Died May 2!i. 1863. Left; circ. Died Dec. 24, 1864; chr. diarrh. Spies. 4243, 4244. Right Died November 2, 1864; variola. Left Surg. I). L. Heath, 23d Mich. Died July 6, 1864. Right: post. flap. "A. A. Surg. T. T. Smiley. Died Oct. 30, 1862: gangrene". Spec. 733. Left :"cirr. Surg. (I. A. Otis, 27th Mass. litem. ' Died Dec. 16,'62. Right. Surg. J. Poguc. 66th III. Died Julv 0. 1864: pyaemia. Left. Died September 22, 1864. Left; circular. Died August 10, 1864. Left; circ. Surg. F. M. Weld. 27th C. T. Died Aug. 5,1864. Left: circular. Died Maj- 27, 1865. Left. Died June 6, 1862. Right. Died October 12, 1864. Left Surg. H. Plumb, 2d Conn. H. A. Died Oct. 31, 1804. Right. Died December 19,1862: tetanus. Left. Died June 20, 1864. Left. July 16, haemorrhage, 24 ounces; fatal. Right (also amput'n left thigh); sloughing. Died July 22Y64; tetanus. Right; circ. Surg. G. VV. Snow, 35th Mass. Died July 30,1864. Left. Feb. 9, re-amput'n. Died February 19, 1863 ; pyaemia. Right Surg. W. Watson, 105th Pennsylvania. Died June 28, 1864. Spec. 2649. Right. Surg. H. B.Whiton, 60th N. Y. Died June 4,1864. Right; circular. Died July 12, 1864. Left. Died December 27,1803. Right: flap; erysipelas; gang. Died May 24, 1864. Right: lateral flap. Surg. S. S. French, 20th Michigan. Died ,I one 21. 1864; pyafimia. Left. Died October 11, 1863. Left, Surg. E. M. Rogers, 12th Wis. Died Nov. 23, 1864. Left; circular. Died June 8,'64: pyaemia. 1 JONES (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene, etc., in TT. S. San. Com. Mem., Surg. Vol. II, p. 260. 2SMILEY (T. T.), Twenty Cases of Gunshot Wounds, in Boston Medical and Surgical Journal, 1863, Vol. 68, p. 419. 3 LIDELL (J. A.), On the Secondary Traumatic Lesions nf Bone, etc., in "7. S. Sanitary Commission Menioirs, Surgical Volume I, N. Y., 1870, p. 283. 50-1 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X Name. Military description", ami a. 92 L.pcr. It., Pt., F, 25th Mav 14, Michigan. 14, '64. 93 j Lottridge, D. P., Pt, M. Dec. 6, 2d New York Cavalry. 6, '(J4. 94 Lovilett, P.C , l't, II, 1st : May 19, Mass. II. Arty, age 23. | 19,"'64. 795 Luther, /'., Corp'l, F., Julv 3, 52d North Carolina. I —, '63. 796 Magnus. N., Pt, A, llth Aug. 25, Colored Troops. ' 26. '61. Operations. Operators, Result. Name, military Description, and Age. Operations, Operators, Result. 797 798 799 800 801 802 | 803 80-1 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 Marks, P., Corp'l, A. 1st M i nnesota. Marquis, W. IL, Pt, F, 83d l'enn., age 20. Marsh,W.W..Pt, I, ]4th New York Heavy Ar- tillery, age 29. Martin, F., Pt., K, 9th Maine, age 20. Mo.Moot G. W., Pt., A. 6th Penn. Res., age 26. MeCahan, J. D., Pt, H, 46th Pennsylvania. McCaidle, J., Pt, E, 2d Pennsylvania, age 23. McCool'A., Pt, E, 188th Pennsylvania, age 21. McCool, J.G..Pt, I, 44th Illinois. MeGraw, F., Pt., K, 42d New York. McGuire, J., Corp'l, D, 40th New York, age21. McMillan,T., Col'd serv- ant, odth Pennsylvania. Meckins, J., Pt, F, 2d Penn. Arty, age 45. Mitchell. C." B., Lieut., E, Nth Ohio. Mitchell, W. J., Pt., F, 56th Mass., age 40. Middle, R., Pt., D, 17th North Carolina, age 18. Monson, J., Pt, H, 2d Conn. II. Art., age 27. Moore, A., Pt, A, 61st Pennsylvania, age 25. Moreloc'k,AY..Pt, 1,19th Michigan. Murray, J., Pt,, 1), 51st New York. Mvres.G..Corp'l, B, 14th Infantry, age 23. Yas7i, .7." C., Serg't, K, ■lllth .Miss., age 17. Nason, II., l't., ('. 1st R. Island Any. age 38. 820); Nock, P., l't, E, *Lst 821): Louisiana. 822 O Neil. E.. Pt, K, 124th Ohio. 8237 Paine, A. C, Pt, F, 42d 824) New York. 825! Palm, J., l't.. F, 22d 1 Peun. Cavalry, age 19. 826. Parker, M. l". l't., E, 1 19th Michigan. 827 Patterson, J., Pt., G, 2d Tenii. H. Art'y, age 29. 826 Perry, A., Pt, E, 6th New Hampshire. 629 Perry, O., Pt., F, 41st Illinois. 830 Phillips, W. A., Pt, B, 14th Georgia, age 25. 831 Pickle, A. IL,Pt,G, 68th 1 Pennsvlvania, age 25. 832 Potter, "II. W., Pt., G, i 14th Infantry. 633 Price, R. S., Pt, B, 1st N. J. Artillery, age 25. 634 ; Quinn, J.. Sergeant, A. ! 170th New York, age | 45. ! 835 Ransom, J. D.. Capt, C, ' j 142d N. Y.. age 29. j 836 Reed. J. M.. Adj't, 10th ' i Vermont. 837 Reither. J. G., Pt., F, 142d N. Y., age 26. 638 Riley, J., Pt., B, 9th Vermont, age 21. July 2. 2, '63. Aug. 27, 27, '63. July 26, 26,''64. July 21, 24,"'64. Dec. 13. 15. '62. Julv 20, 20, '64. Julv 2, 2, '64. June 1, 1, '61. Sept. 19, 1 19. '63. Julv 3, 3, '63. Mav 5, 5, '64. Nov. 25, 25. '63. July 18, 18,''64. Sept. 1, —,'64. June 17. 18. '04. May 21, 21, '64. June 1, 3, '64. July 12, 12, '64. May 15, 15,"'64. Mav 6, —, "'64. Aug. 16. 18." '64. July 20, 20." '04. Nov. 30. Dec. 2,'63. Mav 27, 27,' '63. May 31, 31, '64. July 2, 3. '63. Aug. 21, 22, "64. Mav 15, 15,"'64. June 16, 16, '64. Dec. 13, 13, '62. July 12, 12, '63. July 12, 13, '64. July 2, —, '63. July 2, 4, r63. July 3, 4, '63. Aug. 25, 25, '64. Sept. 29, Oct. 1,'64. April 2, 0. '65. Oct. 27, 27, '64. Sept. 28, —. '64. Lett. Died July 29, 1864. Left: circular. Died December 20, 1864; exhaustion. Right; flap. Died June 7, 1864. Right. Snrg. C. S.Wood, 60th N. Y. Died Sept. 14, 1863. Left; Teal's method. Surg. CE. Swasey, I*. S. V. Died March 12. 18(i5. Right Surg. C. S. Wood, 66th N.Y. Died July 24, 1863. Left (amp. right shoulder joint); lig. brachial: Died Sept. 12,'63. Left; flap. Surg. AV. V. White, 57th .Mass. Died Jan. 23. 1865 ; phthisis pulmonalis. Left: flap. Died Aug. 7, 1864; exhaustion. Left: erysipelas. Died April 11, 1863; pyaemia. Left. Died July 25, 1864. Right (also amp. left upper third). Died Julv 3, 1864. Right (also flesh w'd right thigh); circular. Died Julv 21,1864. Left Died < Ictober 13, 1863. Right Died August 14, 1863. Left. Died May 14, 1864; haem- orrhage and exhaustion. Left. Surg. A. M.Wilder.F.S.V. Died December 3. 1863. Right: flap. Died August 11, 1864. Left. Died September 20, 1864. Right. Died July 21, 1864. / Left; circular. Died August 1. 1864. Left: circular. Died August 30, 1864. Left: gangrene. Pied August 7. 1864. I Left. A. Surg. I ).L. Jewett. 20th | Conn. Died June 24. 1864. Right. Died May 20, 1664. Right; circular. Died Septem- ber 11, 1864. Right Sept 20, reamputation. Died October 4, 1864. Right (also amp. left, mid. third); circular: gangrene. Died Dec. 21. 1863; pvaamia. Both. Died"May 27, 1863. Right Died June 21, 1864. Both. Surg. H. M. McAbee, 4th Ohio. Died July 23, 1863. Left: circular. A. Surg. C. W. Stinson. 23d III. Died Sept. 2.'64. Left. A. Surg. (L M.Trowbridge, ISth Mich. Died May 25,1864. Right Died June 22, 1864. Right. Died January 27, 1863. Right; gangrene; amp. thigh. Died September 12. 1863. Left; circ. Surg. AV. P. Young, 4th G eorgia. Died July 24, '64. Left. Julv 10, haemorrhage, 24 oz. Died July 12, 1863. Right. Died August 18, 1863. Right (also amp. forearm); colliq. diarr. Died Aug. 22,'63; exh'n. Right; double flap. Surg. N. Hayward, 20th Mass. Necrosed; removal of 6 ins. tibia. Died Nov. 5.1864. Spec. 3320. Right. Surg. D. G. Rush, 101st Penn. Died Nov. 1<).'64; pyaem. Right. Died April 6, 1865." Left. Surg. A. M. Clark, 1 *. S.V. Died Nov. 28, 1864; pyaemia. Left. Died October 31, 1864; exhaustion. 839 | Roach, VV., Pt, F, 27th Massachusetts, age 44. 840 j Rogers, J. F., Pt.,G, 24th I Iowa. 841 : Rosser, J., Pt, B, 110th I Ohio. 842 Ryan. T., Pt, E, 8th Maryland, age 23. 843 I Sabine, C. D., Corp'l, II, i 100th New York. 883 Sackhimcr, G.F., Serg't. II, 81st Penn., age 27. Sancerman, G,Corp'l, G, 105th Penn., age 34. Sanford, L., Bugler, C, 73d Ohio. Schappie, N., Pt, K, 7th New York, age 36. Schmehl. M., Pt. D, 198th Penn.. age 19. Seville, J., Pt., H, 123d Pennsvlvania. Shannon, E.. Pt., I, 38th Massachusetts. Shea, D., Pt, F, 13th New Hampshire. Simmington, J. S , S'g't, B, 10th Illinois ('av. Smiley, W. J., Pt. F, 9th Alabama Cavalry. Smith. G. M., Pt, B, 6th ()hio Cavalry, age 38. Smith, J. S., Pt, F, 2d N.Y. IFvvArt, age 17. Smith. W. II., Pt, H, 23d Penn.. age 22. Southworth. AV. B., Pt, F. 42d Illinois, age 25. Spriggle, B., Pt, I, 17th Penn. Cavalry, age 28. Stahli, U., Pt.,*B, 187th Penn., age 17. Stiers, AV., Pt., A, 97th Ohio. Stiteler, C, Pt, D, 16th Infantry. Stover, j. II., Pt, 18feth Pennsylvania, age 21. Sutfin. M.. Pt, H, Sth N. Y. H'vy Arty, age 28. Swinger, J., Pt.K, 130th Indiana, age 16. Sykes. W. E., Corp'l, G, 1st N. Y. Art'y, age 47. Taylor, W. IF, Pt, G. 25th S. C. nge 25. Taylor, AV., Pt, II. 65th Ohio. Thilks. M. J., Pt.,A, 19th Virginia. Thomas, F., Corp'l, 10th Michigan. Tibbetts, S., Corp'l, D, 1st Me. H. A., age 29. Flnier. F., Pt., F, 189th New York. ATan Buren, J. H., Pt., G, 2d Conn. H'vy Art'y. Vandruff, H. C, Corp'l, A, 97th Ohio. AVakefield,AV.,Pt, E, 2d Ohio Cavalry, age 26. Ward, T., Capt., F, 67th Ohio, age 31. Wassenberg, J., Pt., I, 27th Penn., age 23. AVebster, G. AV., Pt., I, 7th Maryland. Welch, J.'B., Pt., G, 35th Iowa. Wells, AV.AV., Lieut, F, 58th Penn., age 30. AVeyman, J. B., Pt., A, 6th Kentucky, age 22. Wheatly, J., Pt., C, 61st Ohio. Whitticr, F. M., Pt.. K, 14th Kentucky. Wilson, A. N., Pt., I, Sth New York. Wilson, W. C, Pt., B, 4th Vermont. June 18, 18, '64. April 8, 8, '64. Oct. 19, 19, '64. Aug. 21, 21, '64. April 9, 11, '63. June 22, 24.'64. May 5, 5, '64. July 3. —, ''(53. April 7, 8, '65. Mar. 31, 31, '65. Dec. 13, —, '62. April 13, 13, '63. June 3, 3, '64. Sept. 10, 10, '63. June 24, —, '64. June 20, 21, '63. June 2, 2, '64. June 1, 1, '64. Nov. 25, 25, '63. July 10, 10, '63. Aug. 19, 20, '64. June 22, 22. '64. Sept. 19, 19, '63. June 1, 1, '64. June 3, 3, '64. Aug. 3, 3, '64. May 19, 19, '64. Aug. 20, 21 ,'04. Sept. 19, 19, '63. July 2, —, '63. July 14, —, '64. June 18, 20, '64. Mar. 30, 31, '65. Sept. 19, 19, '64. Dec. 16, 16, '64. Mar. 31, A p. 1,'65. Oct. 13, 13, '64. Nov. 25, 25, '63. May 6. 6, r64. July 14, 14, '64. May 26, 26, '64. July 20, 21, '64. Mav 3, 3, '63. June 27. 27, '64. Aug. 30, 30, '62. Dec. 13, 13, '02. Left Surg. G. T. Stevens, 77th I New York. Died July 6,1864; exhaustion. Right, Died May 17, 1864. Left. Died October 24,1864. Right; circ. Surg. A. A. White, 8th Md. Haem., 32 oz. Died Sept, 16, 1864; haemorrhage. Left; circ. (also w'nd clavicle); slough.; pneum. Died April 30, 1863; pyaemia. Spec. 1188. Left; circular. Died June 29, 1864; gangrene. Left: circular. Died May 30, J 804; exhaustion. Left. Died July 12, 1863. Left; flap; gangrene; anaemia; diarrhoea. Died May 12, 1865. Left April 24, re-amput'n. Died April 25, 1665: tetanus. Left. Died December 26, 1862; tetanus. Left. Died May 5, 1863. Left. Died June 25, 1864. Right. Surg. E. A. Clarke, 8th Mo. Cav. Died Oct. 9,1863. Right. Died September22,1864. Right. Died July 18, 1863; py- aemia. Left; flap. Dr. A. Garcelon, of Maine. Died July 29, 1864. Left Died June 28, 1864. Left. Died April 2, 1864, of ty- phoid fever. Left; flap. Died August 16, '63. Spec. 3878. Left; circular. Died September 7, 1864; pyaemia. Right. Died July 27, 1864. Right Died September 29, '63 : tetanus. Left; ant. post, skin flap. Died June 30, 1864; gangrene. Left. Died August 13, 1864. Right Surgeon J. AV. Lawton, U. S.A'. Died Sept. 1,1864. Left; flap. Died June 1, 1864. Right; circular. Died Septem- ber 12, 1864; pyaemia. Left. Died October 13, 1863. Right. Died August 6, 1863. ----. Died July 17, 1864. Left; circular. A. A. Surg. O.AV. Peck. Died July 30, 1864. Left: gangrene. Died April 28, 1865; exhaustion. Left; circular. Died October 7, 1864; exhaustion. Left, A. A. Surg. J. C. Thorpe. Died January 9, 1865. Left. Surg. S. H. Plumb, 82d N. York. Died June 4, 1865. Left. Died October 21, 1864. Left. Surg. J. Reily, 33d N. J. Died April 19, 1864. Left, Died May 27, 1864. Left. Died July 19, 1864. Left; circ. Surg. C. A. Cowgill, I". S. V. June6, re-amputation. Died June 11, '64 ; exhaustion. Left: circular. Died September 27, 1864; chronic diarrhoea. Right. Died May 21, 1863. Right. Died July 18. 1864. Right. Died October 10,1862. Left Died January 13, 1863. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 505 N.VMl", MIL11AKV Dates. OTERATIONS, Ol'EH.VIOKS, |No. Name, Military Dates. Operations, Operators, NO. DEsciill'TioN, ami Aoe. Result. DEscuirTioN, and Age. Result. 885 Wilts, B. F., Pt.. A, 21st Dec. 31, Left. Died January 7, 1863. 893 Ball, P., Pt., F, 3d In- May 3, 3, "63. ----. Ass't Surg. J. S. Billings, Illinois. 31, '62. 1 fantry. II. S. A. 886 Wimpfler, S.. Pt, C, Sth Nov. 25, Left (alsoamp. elbow joint). Died 894 Black,,;!!, W., Pt., B, Mar. 19, Right. Ohio. 25, '63. December 9, 1863. 1st S.C. Artillery. 19, '65. 887 Widget. C. li.. Pt, P., 1st June 3, Left; circ. Surg. A. F. Whelan, 895 Culp, T. H., Lieut., II, Oct, 7, Left Michigan, age 45. 3, (if 1st Mich. S. S. Died July 5, 9th Georgia. —, '64. J 1864 : exhaustion. 896 Pai/e, L. L., Pt., F. 24th May 18, Right 868 Wimlrum, J , Sergeant, Aug. 16, Right; circ. Surg. AV. F. Rich- Ceorgia. —, '64. French's Virginia Ar- —, '64. anNon, P. A. C.S. Died Sep- 897 Reel, J. IF.. Pt, K, 2d Mav 6, Right tillery. tember 3, 1864 : pvannia. Louisiana. —,*'64. 869 Weeds, I., Pt, F, 199th April 9, Right. Died May 29, 1865. 898 Si turns, l>. L., Pt, C, 1st Oct. 1, Left; circular (also severingtibial Penn.. age 57. 9, '65. Battery Va. Artillery. 1, '64. artery). 690 Wright, A. M., Capt, F. June 16, Left. Died July 2, 1664. 899 Speck, A., l't, A, 17th Oct. 21, 57th N. York, age 22. 16, '64. Tennessee. —, '61. 891 Wright. 1)., l't.'c. 92d June 27, Left. Died July 17,-1864; py- 900 Th ---- ---; circular. Ohio, age 24. •.••;, '(it emia. 1st S.C. Rifles. 692 Bailey, \„ Pt.. 1!, 14th May 12, Left. Infantry. —,"'64. in thirty-eight of the nine hundred cases of primary amputations in the lower third of tlie leg, the side was not reported; four hundred and sixty-nine operations involved the left, and three hundred and ninety-three the right limb. Specimens of forty cases belong- ing to this group are preserved in the Army Medical Museum. Primary Amputations in the Leg for Shot Injury in -which the seat of Operation was not indicated.—In five hundred and seventy-one of the three thousand three hundred and ninety-two primary amputations in the continuity of the bones of the leg the seat of the operation Avas not specified. The results in twenty-nine cases were not ascertained. One hundred and twenty-four operations proved successful, and four hundred and eighteen fatal, a mortality of 77.1 per cent. Examples of Recoveries after Primary Amputations in the Continuity of the Pones of the Leg, seat of operation not specified.—The one hundred and twenty-four operations of this group were performed on one hundred and twenty-three patients, in one instance both limbs having been removed. One hundred and seventeen were Confederate and six Union soldiers: Case 748.—Private J. B. Barron, Co. I, Cobb's Georgia Legion, was wounded in the leg, and captured at South Moun- tain, September 14, 1862. Assistant Surgeon H. A. Du Bois, TJ. S. A., described the injury as a "gunshot compound commi- nuted fracture of both bones. The man was admitted to the field hospital at Burkettsville, where amputation by the circular method was performed forty-eight hours after the reception of the wound. The patient recovered." After his recovery he was paroled and sent south. The Confederate hospital records show that he was admitted, on December 4th following, to the general hospital at Petersburg, whence he was furloughed two weeks later and proceeded to his home. In the following instance both legs were successfully amputated by a Confederate surgeon on the day of the injury: Case 749.—Corporal J. W. Alexander, Co. K, 13th Mississippi, was wounded at the battle of Fredericksburg, December 11, 1862. His injury appears recorded on a Confederate hospital register as "gunshot fracture of both legs, followed by ampu- tation of both legs the same day by Surgeon J. T. Gilmore, ('. S. A." The man recovered, and was subsequently furnished with artificial limbs by the Confederate Association for the relief of maimed soldiers. Of the six Union soldiers one, an officer, remained in the service and was afterwards killed in battle; three were pensioned, and two do not seem to have applied for pensions; one of the pensioners died six years after the operation. Case 750.—Lieutenant-Colonel George H.Ward, 15th Massachusetts, was wounded in the action at Ball's Bluff, October 21, 1861. Surgeon A. B. Crosby, U. S. V., states : "The wound was inflicted by a bullet; primary amputation was performed, the ankle being shattered and the circulation cut off." Lieutenant-Colonel Ward recovered, was promoted to the Colonelcy of his regiment, which he rejoined in February, 1863, and was killed at the battle of Gettysburg, July 2, 1863. Case 751.—Private M. Higman. Co. B, 46th Pennsylvania, aged 29 years, was wounded by a shell in the right leg, at Cedar Mountain, August 9, 1862. He fell into the hands of the enemy and suffered primary amputation. Two weeks after- wards he was conveyed to the Hotel Hospital, at Piedmont, where he remained until exchanged during the following month. Surgeon R. B. McCay, U. S. V., recorded that the patient, after bein'g paroled by the enemy, was admitted to the Chesapeake SnRo. Ill—01 r,OG INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Hospital, Port Monroe, and Surgeon A. E. Stockcr. U. S. V., reported that he Avas discharged January 6, 18C>'*. by reason of "loss of right leg." He was a pensioner until June 14, 1868, Avhen lie died. The cause of his deatli has not been ascertained. Fatal Cases of Primary Amputations in the Leg, seat of Operation not indicated.-— This group includes four hundred ajid eighteen amputations performed on four hundred and twelve patients; three hundred and forty-nine were Union and sixty-three Confederate soldiers. In three instances re-amputation in the thigh became necessary. Case 752.—Private J. Jameson, Co. A, 29th Illinois, aged 24 years, was wounded at the battle of Spanish Fort, Jlarch 'J1.'. lSi'5, by the explosion of a shell, which caused flesh wounds of the left shoulder and left hip and fracture of the tibia and fibula of the right leg. Assistant Surgeon W. E. Waters, U. S. A., reported that the wounded man was adinitted to the Six- teenth Corps Field Hospital, where the injured "leg was amputated by Surgeon S. L. Cheaney, 29th Illinois." Surgeon J. B. G. Baxter, U. S. Y., reported the following result: "The patient entered Barracks Hospital at New Orleans eight days after being wounded. He had undergone antero-posterior flap amputation of flie leg on the field. The flesh wounds Avere granu- lating feebly. Secondary hsemorrhage took place from the anterior tibial on April 4th, amounting to thirty ounces, and being controlled by manual pressure on the groin for forty-eight hours. The patient was also troubled with some diarrhoea; he had a good constitution, however. Both bones protruded from the stump, and no union of tbe flaps took place up to April 12th, when one inch of the fibula was resected by Assistant Surgeon E. McClintock, U. S. V., who performed the operation without using anaesthetics. The patient died April 18, 1865." Case 753.—Private »S. Watson, Co. C, 118th Pennsylvania, was wounded in the left leg during the engagement at the crossing of the Potomac, on September 20, 1862. Surgeon E. McDonnell, U. S. V., contributed the following description of the injury and its result: "The Avounded man Avas conveyed to the German Reformed Church Hospital at Sharpsburg, where the leg was amputated below the knee on September 21st. The operation was performed for compound fracture of the leg. On September 28th the patient's condition was favorable, but during the following two days it was critical. On October 1st, the aspect of the stump was unhealthy, the entire flap threatening to slough; no union; discharge black, sanious, and unhealthy. During the next two days he mended somewhat, and on October 4th he was much improved. The difficulty in the case was a complete falling apart of the flaps, there being no union whatever. The posterior flap was large and heavy and composed of the thick muscles of the calf of the leg, making a bad wound to heal by granulations, the bone being exposed. October llth, the patient's system has been sinking. He has some diarrhoea and tympanitis, and was restless and delirious during the night. He must die unless the whole stump is removed by an operation above the knee, and I have become sick of amputating thighs secondarily. October 13th, condition very low; pulse at times not perceptible; jaws and body rigid. Patient had a passage from the bowels during the night and passed Avater quite freely. Small doses of brandy and morphine were administered; no relief. October 14th, at 8 P. M., applied a large bread poultice to stump. Haemorrhage from stump occurred during the follow- ing night. Death at 11.30 a. m. on October 15, 1862." Table LXXI. Summary of Fire Hundred and Seventy-one Cases of Primary Amputations in the Leg for Shot Injury, the point of operation unspecified. [Recoveries, 1—124; Deaths, 125—542; Results unknown, 543—571.1 No. Name, Military Dates. Operations, Operators, NO. Name, Military Dates. Operations. Operatoks, Descwii'tiox, and Age. Result. Description, and age. Result. Alexander, J. IP., Corp'l, Dec. 11, Both. Surg. J.T.Gilmore.C.S.A. 16 Byrd, L. S., Serg't, D, May 3, ---. Surg. A. S. Flinn, C. S. A. K, 13th Mississippi. 11, '62. Recover y. 10th Virginia. 4, '63. Recovery. 3 Anderson, J. G., Pt, D, Sept. 17, ----. Surg. — Black, C. S. A. 17 Calhoun, P. J., rt., C, July 1, Left Surg.H. F.Campbell, P. A. 4th A'irginia. 17, '62. Recovery. 1st Texas. 3, '62. C. S. Recovery. 4 Atwell, C. I., Pt, L, 1st Aug. 2ft, Right. Surg. AT. H. Priolean, P. 18 Calvert, J. W., Pt., A, Mav 6, ---. Surg. — Brown, 2d S. ('. South Carolina. 2')." '62. A. C. S. Recover}-. 2d South Carolina. Ci, r64. Rifles. Recovery. 5 Bailey, A. B., Serg't. K. Nov. 25, Left. Snrg. — Smith, C. S. A. 19 Carney, A., Pt, F, 3d Dec. 12, . Surg. . 7th S. C. 29th Tennessee. 25, '63. Recovery. South Carolina. 13, '62. Recovery. C Barnard, A. B., Pt, H, Sept. 30, Left (right leg wounded). To 20 Carroll, J., Serg't, C, 2d Dec. 13, ---. Surg. D. A. Maxwell, P. A. Sth N. C. age 26. 30, '64. prison February 22, 1865. South Carolina. 14, '63. C. S. Recovery. 7 Barney, J., l't, I, 28th Julv 12, Left. Discharged October 31, 21 Carroll, S., Pt, A, 52d Aug. 28, Right. Surg. — Leethe, C. S. A. Illinois. 12." '63. 1863. A'irginia. 28, '62. Recovery. 8 Barrnn, J. B., Pt, G, Sept. 14, ----; circular. Furloughed De- 22 Claxton, A. J., Pt., E, May 14, Right. Transferred May 28, '64. Cobb's Ga. Legion. Ki. '62. cember 9, 1862. 18th Tennessee. —, '64. 9 Berry. J. H., Pt, G, 25th Mav 5, ----. Recovery. 23 Clayburn, E., Pt., H, May 2, Left; flap. Furloughed Septem- A'irginia. (i. '64. 55th Virginia. 2, '63. ber 24, 1863. 10 Bickett.N. J..Pt.. A, 48th Oct. 14, ----. Ass't Surg. B. Chears, 48th 24 Clinton, T. L., Pt, H, May 2, Right. Surg. R. J. Hicks. 23d North Carolina. 15, '63. North Carolina. Recovery. 23d North Carolina. 2, '63. North Carolina. Recovery. 11 Bi June 30, ----. Sur jr. —^lapeheart, C.S.A. 25 Cofy, D., Pt, IJ, 32d Julv 22, Left. Transferred. Kith Virginia. 30, '62. Recovery. Alabama. 22,"'64. 12 Blakemore, W. T., Cap- May 20, Right. Surg. R. D. Jackson, 26 1 Collins, J., Pt., F, 10th Sept. 19, ---; flap. Recovery. tain. 20, '64. (_'. s. A. Recovery. South Carolina. 19, '63. 13 Boatwright, J. D.A., Pt, May (i, ----. Surg. M. S. Thomas, P. A. 27 Conrad, B. F., Lieut., A, May 6, ---. Surg. — Horton, C. S. A. D, 2d Florida. 6, '64. C. S. Recovery. 35th Virginia. 7, '64. Recovery. 14 Broksher, C. E., Serg't. Julv 2. Right. Paroled September 25, 28 Cooper, A. B., Pt, D, May 14, Right. Transferred June 10, '64. K, 24lh Oh, nge 27. 4. '"63. 1SH3. 18th Alabama. —, "64. 15 Browne, S. 5.". Pt, B, June 30. ----. Confederate surgeon. Re- 29 Cormick, R. M., Pt, H, Oct. 11, ---. Surg. — Owens. Recov- llth Alabama. 30, '62. covery. 4th A'irginia Cavalry. 11, '63. ery. | 1 TEKitY (C), Report of Wounded treated in Field Hospital of Hindman's Division after the battle of Chickamauga, in Confederate States Medical and Surgical Journal, 1S64. A'ol. I, p. 76. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 507 Name, Military Dates. Operations, Operators, N ' Name, Military : Description, and Age. 77 McXiel, II. M., Pt., H, Dates. Operations, Operators, NO. DESCRIPTION, AND AGE. Result. Result. 30 Crawford, E. D., Pt., A, June 11, ---. Union surgeon. Recovery. April 20, Left; nnt. skin, post mus. skin 7th Georgia. 11, '64. 56th N. (.'., age 26. 20, '64. flap. Surg. C.H.Ladd.C. S.A. 31 Cross. J. H"„ Pt., (', Ga. Aug. 1, 2,1)3. Lett. Surg. — Metcalf, C. S. A. Disch'd June 15, 1864. Legion Cavalry. Kecovevy. 78 Mid,,,: D., Pt, A, Jeff. July 9, Left. Recovery. 32 Vrn, C. F.. Pt", 13, 2d June 27, Right. Surg. H. H. Hubbard, 1 Davis Legion. 9, '63. Mississippi. 27, '62. l». A.C. S. Recovery. 79 xMiddlelon, J„ Pt. L, Sept. 19, ----;flap. Surg.T.P. BaileylOth 33 Eehalaz, .1. F.. Corp'l, May 31, Left. Discharged December 12, 10th South Carolina. 19, '63. S. C. Trans. Oct. 31, 1863. II. 65th New A'ork. 31," '62. 1802. 80| JI7/7/.T. L., l't, Purcell's Aug. 29, Left. Surg. — Ihiynes, C. S. A. 34 Falkland, J. B., Pt, D. Sept. 30, Lett. To prison April 13, 1865. Haller v. 29, '62. Transferred Jan. 30, 1803. 8th N. <_'., age 22. 3d, 'lit. HI Miller, '/'., Pt., II, 33d July 21, ----. Surg. H. McGuire, C. S. A. 35 Fisher, C, Pt, G, 2d July 3, --. V ii-niiiia. 21,"'01. Recovery. North Carolina. 3. '63. 82 | Mills. .1. /'.. Lieut. (J, May 3, Left. Transferred July 9, 1863. 36 Flaherty, G. W.. Pt., A, July 20, Left. To prison November 10, 'JIM Mississippi. —, '63. 31st Mississippi. 20," '64. 1864. 83 | Mitchell, r. I: /."., Pt., July 3, Left. Paroled September 5, '63. 37 Folkes, W. C, l't, Shoe- July 1, ---. Recovery. 1). Isl Tennessee. —, '63. maker's Battery. 2, '"63. 84 Mooihi. It../., l't, H, Sth May 5, Left Paroled A ugust 31,1862. 38 Ford, J. A., Pt,*H, 23d May 2, ■---. Ass't Surg. B. Howard, North Carolina. —, "'62. North Carolina. 2, '63. I1. !S. A. Recovery. 85 Moore. A. E., l't., K, 4th Nov. 1, Left. Ass't Surg. F. Gilliam, C. '39 iForu-orth, C. B., Pt.. I, Sept. 19, ■---. Transferred October 9,'63. ' Virginia Cavalry. 1, '62. S. A. Recovery. 10th South Carolina. IS), '63. Recovery. 86 Moore, G. W., Pt, C, July 28, Left. To prison February 18, 40 Prazier, G. W., Pt, D, Mav 8, ----. Surg. I*. F. Whitehead, P. 19th Alubama. 28, '64. 1865. 37th A'irginia. 8, '62. A. C. S. Recovery. 87 Mayer, D., Pt, B, 19th July 22. Right To prison November 10, 41 Fuller, IF., Serg't, G, 1st July 21, ----. Surg. — Sloan, ('. S. A. South Carolina. 22, '64. 1864. South Carolina. 22,' '63. Recovery. 88 : Nash, P. W., Pt, E, llth Aug. 29, ----. Surg. — Ward, C. S. A. 42 Green, H. W., Pt., Beau- JulvL ----. Recovery. ' Mississippi. 30, '62. Recovery. regard's Artillery. l,-f62. 89 Nolen, F. J., Pt., A, 83d June 27, Right. Discharged January 20, 43 Gregory, J. T., Pt., E, May 6, ----. Surg. — Brown, 3d Ark. Pennsylvania. 27, '62. 1863. 3d Arkansas. 7, '64. Retired March 20, 1865. 90 Norton, 11'. ('., Pt., B, July 1, Left Surg H. H. Hubbard, P. A. 44 Hanlin, P., Lieut., I, Sept. 17, ---. Ass't Surg. ------, 16th 2d Mississippi. 1, '63. C. S. Recovery. 16th Mississippi. 1 17, '62. Mississippi. Recovery. 91 O'Niel, C, Pt., G, 5th Right. Paroled August 31,1862. 45 Harrell. E. H., Pt., D, Mav 4, ----. Ass't Surg. — Saunders. North Carolina. 48th Georgia. 4, '63. Recovery. 92 Outlaw, J. E., Pt, A, Oct. 19, Left; post.flap. Surg.R.J.Hicks, 46 Hart, R. A., Pt., D, 12th May 2. ----. Surg. T. B. Wilkinson, P. 23d N. Carolina, nge 26. 19, '64. 23d N. C. Trans. Jan. 8, 1865. North Carolina. 1 2, '03. A.C. S. Recovery. 93 Parker, J. C, Pt., A, Sept. 30, Right To prison April 13,1865. 47 Ban-ey, J„ Pt, E, 5th , May 5, ----. Transferred June 8, 1862. 8th N. Carolina, age 26. 30, '64. North Carolina. 1 5. '62. 94 Peden, W. H, Corp'l, A, Nov. 29, Left (also resection bones of right 48 Hatfield, D., Pt., H, 5th .—.--- Right Furloughed February 20, 17th Mississippi. 29, '63. leg). Surg. J. P. Prince, 36th Tennessee. 1S62. 1863. Mass. Exchanged. 49 Higgins, J.. Pt., C, 63d June 22. ----. Surg. — Hunt, C. S. A. 95 Proctor, S. A., Pt, F, July 1, ----. Surg. T.P.Bailey, 12th S. A'irginia. 22, '64. Recovery. 12th S. Carolina. 3, '63. Carolina. Recovery. 50 Higman. M., Pt.,B, 46th Aug. 9, 9, 1J2. Right Discharged Jan. 6, 1863. 96 1 Putnam, W. A., Pt., B, Aug. 21, ----. A ss't Surg. C. Duffy, 24th Pennsylvania, age 30. Died June 14, 1868. 49th North Carolina. 21, '64. N. C. I'etired Jan. 28, 1865. 51 Howell, C Pt, E, 5th Oct. 4, ---. Union surgeon. Feb. 6,'63, 97 Raburn, J. M., Corp'l, F, Sept. 19, ----. Ass't Surg. F. R. Gregory, Miss/>uri. 4, '62. reamputated. Recovery. 25th Tennessee. 19, '63. C. S. A. Recovery. 52 Hubbard, J. A., Pt. A, Mar. 31, Right Surg. M. C. Rowland.61st 98 Richardson, D., Pt., I, Dec. 11, ----. A ss't Surg. R. R. Murphy, 18th A'irginia. A p. 1, '65. N. Y. Released June 6, 1865. 61st N. Carolina. 11, '63. 16th N. C. Recovery. 53 Hunter, J. H, Pt., I, June 30, ----. Surg. H. W. Thompson, 99 Roberts, J., Lieut., I, May 3, ----. Surg.—Flemrning,C.S.A. 28th Virginia. 30. '62. C. S. A. Recovery. 48th Virginia. 3, '63. Recover}-. 54 James, D. H, Corp'l. G, Sept 30, Right. Released June 21,1665. 100 Rodgers, T. M., Pt., C, Jan. 1, Right. Surg. — Manney,C.S.A. 8th N. Carolina, age 23. ; Oot],'64. llth Tennessee. 1, '63. Transferred August 3, 1863. 55 Johnson, C. L., Serg't, May 6, ----. Surg. J. E. Chancellor, 101 Ruby, C. W., Pt, D, 42d July 1, ----. Paroled August 22, 1863. L, 7th South Carolina. 6, '64. C. S. A. Recovery. Mississippi, age 29. 2, '63. 56 Jones, B. C, Capt, E, 1 June 27. ---. Surgeons Dunn and Lee, 102 'Russell, W., Corp'l, I, Sept. 19, Left. Transferred September 30, 56th A'irginia. 27. '62. C. S. A. Recovery. 28th Alabama. 19, '63. 1863: 57 Kirkland, J. G., Pt., D, ' May 25, ----. Surg.— Lamond, C. S. A. 103 Russ.J. J., Pt., D, 18th May 2, ----; circular. Transferred June 2d South Carolina. 1 25,"'01. Recovery. N. Carolina, age27. 2, '63. 5, 1863. 58 Kirklcy, D. C, Lieut., ! Sept. 19, ----. Surg. — Johnson, C. S. A. 304 Sadler, A. D., Serg't, G, Dec. 11, Right (also amp. left foot). Surg. D, 15th S. Carolina. lit, '63. Recovery. 21st Mississippi. 11, '62. — Hill, C. S. A. Recovery. 59 Lansing, J., Serg't, K, July 1, Left. Surg. —Strickland, C.S.A. 105 Saunders, G. L., Pt, G, May 5, ----. Recovery. Sth Louisiana. 3, :63. Discharged Dec. 8, 1864. 24th Virginia. 5, '62. 60 Leach, B. F., Pt., H, May 27, Left. To Provost Marshal Aug. 106 Scarborough, D. J.. Pt., Aug. 24, Right. Surg. P. B. Henderson, 10th Arkansas. 27. '63. 7, 1863. H, 14th S. Carolina. 24, '64. P. A. C. S. Recovery. 61 Lewis. T. N., Pt, A, Mav 16. Left. Recovery. 107 Sharver, J., Pt, H, 48th June 22, ---. Recovery. 57th Georgia. 10," '63. Mississippi. 22, '62. 62 Lewis, W. M. Pt., D, Julv 14. Right. Recover}'. 108 Shedd, W. B. H., Pt, C, Sept 21, Right. Surg. — Powell, 41st 1st Tennessee. 14,"'63. 41st Mississippi. 21, '63. Mississippi. Recovery. 63 Lietner, W. Z., Capt., E, July 2, Right. Surg.— Lnmond, C.S.A. 109 Slusser, S. S.,Px.,H, 12th Mav 6, ----. Surg. W. H. Burton. 7th 2d South Carolina. 3, '63. Recovery. 1 Virginia. 6. '64. A'a. Cavalry. Recovery. 64 Lilly, E. J., Pt, C, 23d May 3, ----. Surg. R. J. Hicks, 23d X. 110 1 Still, B.,Pi.,C, 9th Ga. Oct. 14, Left. Surg. G. F. Cooper. Re- North Carolina. 3, "63. Carolina. Recovery. 1 14, '64. covery. 65 Logan, W. R., Capt., G, May 14, Right. Surg. J. B.Edelin, C.S.A. 111 Slinespring, W. H., Pt, May 3, ----. Surg. — Campbell, C. s. A. 4th Georgia Cavalrj-. 15, '64. Recoveiy. E, 10th Virginia. 3, '63. Recovery. 66 Love. W., Lieut, K, 40th July 20, Left. To prison November 10, 112 Stone, S., Pt, B, 37th May 3, ----. Surg.C. C. Henkle, C.S.A. Mississippi. 20, '64. 1864. Virginia. 3, '63. Recovery. 67 Lowell, E. P., Pt, II, Mav 5, —. Surg. L. P. AVarren, 26th 113 Tulifero, J. A/., Pt, H., Sept. 16, ----. Surg. — Bland, C. S. A. 26th N. Carolina. 5, f64. North Carolina. Recovery. 52d Virginia. 18,'62. Recovery. 68 Mallard, W. W., Pt., E, May 3, ----. Furloughed June 10,"l863. 11.4 Terry, R. L., Pt, C, 78th June 27, Left Mustered out June 7,1865. 3Cth X. Cage 30. —. '63. Illinois. —, '64. 69 Marburg, E., l.ieut, 7th July 4, —, m Left. To prison August 13,1863. 115 Thompson, J. W., Corp'l, Dec. 11, Right. Surg. — Austin, C. S. A. Missouri Cavalry. II, 13th Mississippi. 11, '62. Recovery. 70 Mayer, C, Serg't'lf, 6th July], ----. Surg. AV. A. Robertson, C. 116 >Todd,W.F.,Pt.,— ,10th Sept. 19, ----; erysipelas. Louisiana. 1, '62. S.A. Retired Feb. 1, 1865. South Carolina. 19, '63. 71 McClendem, W. M., Pt., July 2, Right. To prison January 25, 117 Tracy, J. N.. Corp'l, I, May], Left Recovery. D. Sth Georgia. —, '63. 1864. 5th Missouri. 1, '63. 72 McCoy, E. C, Pt., B, 1st Aug. 29, ----. Surg. AV. A. Robertson, C. 118 Triplett, H. F., Pt, Stu- Oct. 15, Right Surg. J. H. Murray, P. A. South Carolina. 29, '62. S. A. Recovery. art Horse Artillery. 15, '63. 0. S. Recovery. 73 McDoul, J., Pt, G, 21st May 2, ----; flap. Transferred May 26, 119 Vann, C, Pt., F, 12th Dec. 16, Right. Exchanged January 16, Georgia, age 21. 3, '63. 1863. Georgia, age 16. 16, '64. 1865. 74 McFall, J. A., Pt, F, Mav 14, Left. Transferred June 9, 1864. 120 Walker, H. C, Pt., B, July 1, ----. Paroled August 22,1863. 18th Tennessee. 14,"'64. 26th N. C, age 19. 3, '63. 75 McLewis, A., Major, 2d Sept. 19, ----. Surg. — Headly, C. S. A. 121 Walker, J., Pt, A, 23d June 27, Right Surgeon—Rievers, 28th Georgia. 19, '63. Recovery. Virginia. 27, '62. Virginia. Recovery. 76 McNeely, W. W., Serg't, i May 2, ----. Recovery. 122 Ward, G.H., Lieut Col., Oct. 21, Left. Recovery. Killed at Get- B, 9th Louisiana. 4, '*63. 15th Massachusetts. 21, '61. tysburg. 1 Terry (C.), Report of Wounded treated in Field Hospital of Hindman's Bivision after the battte of Chickamauga, in Conf ederate States Medical and Surgical Journal, 1864, Vol. I, p. 76. 508 INJURIES OF THE LOWER EXTREMITIES. [('MAP. X. 123 124 125 126 127 128 129 130 131 132 133 134 135 136) 137( 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 [ 159 160 [161 162' 163J 164 I 165 166 167 168 1169 170 1171 172 Name, Military description, and age Wayland, W. /i\.l't.,K, 19th Virginia. Webb, J. B., Serg't, C, 13th A'irginia Cavalry. Abbott, o., l't, H, 7th New Hampshire. Ackcnnan, AV., Pt, H, 8th New Vork. >t. D, 4th , Pt., k, 3d Pt, C, 25th Lieut., I, Acres, (I. (' Iowa. Adsit. .1. E.. Pt, F,97th New Vork. Anderson, A., Pt, G, 26th Missouri. Andrews, A. J., Lieut., C, 104th New Vork. Andrews, T., Pt, C, 20th Michigan. Amick, W. AI., Serg't, H, 55th Penn., age 22. Amidon, K. H., Pt, B, 36th AVisconsin. Allen, J. AV., Pt, H, 1st Tennessee. Alverd, A. O., Pt., C, 100th New A'ork. Arkerson.A., Pt., D.llth Infantry. Arnold, *T., Pt., F, 7th Infantry. Atheain, J., Serg't, H, 25th Iowa. Bailey, S. AV., Pt., H, 6th Michigan. Baker, A., Pt., G, 3d Missouri. Barrett, E., Pt., K, 14th Indiana. Baxter, W. Wisconsin Leekert, K., Dliio. lieekstini', F 82d Illinois. Becson, AV. II., Serg't, ti, 62d Pennsylvania. Beers. V,., Pt.', K, 7th New Jersey. liilil. A., Pt, E, 82d Illinois. Bingham, IF. II. M., Pt, B, 54th N. Carolina. Bitner, J., l't., IC, 102d Pennsylvania. Blackwell, G., Pt, B, 7th Minnesota. Blnkley. J. L., Pt., A. 52d New Vork, age -17. lilanehurd. J.. Pt, C, 91st New Vork. Bloomestine, J., Pt., F, 4th New A'ork. Bower, J., Pt, A, 5th New Jersej-. Bowman, J., Pt., I, 46th Pennsylvania. Boyles.'C, Pt., G-, 55th Alabama. Brady, P., Corp'l, H, 3d Ohio. Branson, J., Serg't, F, 40th Illinois. Brierly. J., Pt., D, 97th Pennsylvania. Brink, E., Seaman, Gun- boat Maratanza. Brinkmau, A., Pt, G, 79th Pennsvlvania. Bronsher. 1,,'l't. D. 81st Illinois, age 25. Brown, A., Pt. I North Carolina. Brown. C. Lieut, 1". 100th New A'ork. Brown, II. 1Y Corp'l, I, 14th New Hampshire. Brown, J. D., Pt., P., 3d North Carolina. Brown. R.. Pt, G. 4!!th Colored Troops. Brown, W.Ik.Vx.. Ander- son's Chesapeake Bat'v. Brown, AV. M., Pt, G, 12th Illinois. Bryant, AV., Pt., D, 19th Ohio. Oct. 15, 15, '61. Aug. 1, 1, ?63. July 11, —, '63. June 8, 8, '62. July 28, 28, '64. Sept. 17, 17, '62. Sept. 19, 19, '62. Dec. 13, 13, '62. June 3, —, '64. June 18, 18, '64. June 19, 19, '64. Oct. 8. 8, '62. May 31. —. '62. June 18, 18, '64. Feb. 2). Jan. 11, —, '63. Mav 27, 27, '63. Nov. 27, Mar. 23. 23. '62. May 15, —,"'()4. Dec. 13, —, '61. July 20, 20, '64. Julv 2, 4, '62. July 3. 3, '63. Mav 3, 3, '63. Sept. 19, 19, '64. Oct. 19, 19, '64. July 14, 14, '64. June 16, 17, '64. June 14, 14, '63. Sept. 17, —, '62. May 4, —, "'62. July 20, 20,"'64. July 20, —," '64. Oct. 8, 8, "62. June 27, 27, '64. Mav 20, —,"'64. Oct. 11, —, '62. Aug. II, 11. '64. Mav 22, 3d ! Nov. 27 —, '63. July 18, 20, '63. Sept. 19, 19, '64. July —. —," '63. June 7, —. '63. Julv 3, —,"'63. May 14, —, 64. Jan. 2, —, '63. Operations, Operators, Result. ---. Surg.J. T. Gilmore.C.S.A. Discharged February 22, 1S62. ---. Recovery. Right. Died. ---; gangrene. Died June 15, 1862; tetanus. Left. Surg. B. N. Bond. 27th Mo. Died Augusts, 1864. Right Died October 17, 1862. ----. Died January 10, 1863. Right. Died January 26, 1863. Right (also wound of shoulder). Died June 8, 1864. Right. Died August 11, 1864. Left. Surg. C. Miller, 36th Wis- consin. Died July 9, 1864. ----. Died October 20, 1862. Left. Died June 12, 1862. Both. Died June 19, 1864. ----. Died February 26, 1862. Left. Died February 5, 1863. Left. Died May 28, 1863. Left (also amp. fingers). Died December 28, 1863; pyaemia. Right. Died April 2, 1862. Right. Died June 18, 1864. ----. Ass't Snrg. H. R. AVirtz, U.S.A. Died Jan. 28, 1862. Left. Died July 20, 1864. ----. Died July 10, 1862. Right. Died July, 1863. Left. Died May 31, 1863. ----. Died October 6, 1864. Left. Died October 20, 1864. ----. Surg. A. T. Bartlett, 33d Mo. Died August 6, 1864. Left; post. flap. Died July 2, 1864; pyaemia. Right. Surg. T. B. Reed, U.S.Ar. Died June 21, 1863. ----. Died September 21,1862. ----(also wound of arm). Died Mav 17, 1862. Right. Died September 7, 1864. Left. Died July 21, 1864. Left. Died November 7, 1862. Left. Surg. W. Graham, 40th Illinois. Died July 23, 1864. Left Died May 22, 1864. Right. Died June 28, 1864 ; ex- haustion. Both. Died August 12, 1864. Left. Died June 14, 1863; py- semia. Right. Died December 14,1863. Right. Died August 13, 1863; tetanus. Right. Died September 19, 1864. ----. Died July 18, 1863. Right. Died June 14, 1863. ----. Died July 11, 1863. ■ Right Died June 1, 1864. Left. Died January 20, 1863. 173 174 175 176 1 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 Name, Military Description, and Age. Bucklin, G., Pt., K, 12th Rhode Island. Bulley, J., Pt., E, 16th New A'ork. Bunker, C. L., Pt, I, 1st Me. Heavy Artillery. Burke. P. E., Colonel, 66th Illinois. Burnes, J. P., Pt., II, 13th AVest A'irginia. Butler, M., Pt, D, 15th New A'ork. Buxton, A., Capt, II, 2d U. S. Sharpshooters. Bybee, J., Pt., F, 21st Kentucky. Byers, —, Pt., E, Sth Alabama. Byrne, AV.E.,Pt.,K,42d New A'ork. Cahill, D., Pt, E, 10th Cain. Wm., Pt, F, 7th N. Y. H'vy Arty, age 23. Calloway, R. W., Capt., K, 22d Georgia. Campbell, J. B„ Pt., F, 3d Tennessee. Campher, L., Serg't, 1), 4th C. Troops, age 26. Carr, AV., Serg't, I, 12th Massachusetts. Cathcart, B. F., Pt., G, 141st Pennsvlvania. Chalker, W.'IL, Pt, A, 48th Georgia. Champlain, J., Pt, D, 12th Infantry. Chandler, J. *S., Pt, E, lllth Illinois. Chedister, J. O., Pt., I, 7th Iowa. Chism, R., Serg't, K, 91st Penn., age 21. Church, R., Pt, C, 40th Ohio. Clayton, J., Pt., F, 4th N. Y. H'vy Artillery. Cliff, J., Recruit, Col'd Troops. Cleoman,P.,Pt, K, 86th New York. Clyde, C. C, Pt., Phil- lips's Legion. Georgia. Cole, J., Serg't, Kane's Penn. Rifles. Cole, M. R., Pt, A, 6th Indiana. Cole, S. B., Pt, II, 18th New York. Colsten, R., Lieut-Col., 2d A'irginia. Colum, W., Corp'l, G, 21st Mississippi. Conrad, C, Pt., G, 12th Missouri. Cooper, W., Pt., D, 2d Cavalry, age 22. Crowell, S.W., Lieut., I, 1st Me. H'vy Artillery. Crowningshield, L. C., Pt, G, 142d N. Y. Cuppemell, L., Pt., E, 121st New A'ork. Curtain. P., Pt, E, 152d New A'ork, age 32. Davenport, C. O., Pt., G, 36th A'irginia. Davis, J., rt, E, Sth A'irginia. Dean, AAr. J., Pt., D, 10th Missouri. De Gouth, B., Pt, M, 5th Artillery. Demay, H., Pt, D, 20th Connecticut. Demby, W. H., Serg't, G, 4t'h Col'd Troops. Dennison, C. E., Capt., B, 18th Infantry. Dettmer, G., Pt, E, 82d Illinois. Dixon, J., Pt., —, 18th Infantry. Dolph, L, Pt., C, 136th Pennsylvania. Dates. Dec. 13, 13, '62. May 3, 3, r63. June 16, —, '64. May 16, 16, '64. Oct. 19, 19, '64. June 3, 3, '64. May 5, 6, v64. June 20, 20, '64. July 3, —. '63. Julv 2, —, '63. Oct. 8, —, '62. June 16, 16, '64. July -, —, '63. Mav 15, —,"'64. Sept. 29, 30, '64. July 3, —, '63. July 3, —, ^63. July 3, —, '63. July 3, —, "'63. Mav 14, 14," '64. Nov. 7, 7, '61. May 7, —, '64. Nov. 24, 24, '63. June 18, 18, '64. 1864. Mav 3, 3, *"63. July 1, 3, '63. June 8, 8, '62. Mav 31, 31," '64. Sept. 14, 16, '62. Operations, operators, Rem-i.t. July 1, 1, '63. May 14, 14, '64. A ug. 28, 28, '61. Juno 18, 18. '64. Dec. 25, 25, '64. May 3, 3, '63. Nov. 6, 6, '64. Sept. 19, —, '64. Julv 2, —, "'63. Sept. 19, 19, '62. May 6, 6, ^64. May 3, 3. 1)3. Feb. 11, 11, '65. Dec. 31, 31, '62. July 20, 20, '64. Aug. —, —, '64. Dec. 13. 13. '62. Right Died January i), 1863. ---. Died May 20, 1863. Right. Died June 28, 1864. Left. Surg. AV. R. Marsh, 2d Iowa. Died May 19, 1864. Left; flap. Died October 28, 1864; pyaemia. Left (also wound buttock). Died June 19, 1864 ; pyaemia. ---. Died May 7, 1864. ---. Surg. C. J. AValton, 21st Kv. Died June 20, 1864. Right. Died July 24, 1863. ---. Died July 24, 1863. Left. Died October 15, 1862. Left. Surg. S. H. Plumb, 82d N.Y. Died July 25, 1864. ---. Died July 16, 1863. Left. Confederate surgeon. Died May 24, 1864. Left. Died October 27, 1864; exhaustion. Left. Died July 14, 1863. Right. Died August 10, 1863. ---. Died July 16, 1863. Left. Died July (i, 1863; haem- orrhage. Left. A. Surg. J. F. Smith, 55th Illinois. Died May 16,1864. ---. Died November 30,1861. Left. Died June 1, 1864. Right. Died December 4,1863. Right. Died June 28, 1864. Left. Died November 16, 1864. Right. Died May 20,1863. Right. Died July 20, 1863. Left. Died June 11, 1862. ---. Died May 31, 1864. ---. Died October 21, 1862; exhaustion. ---. Died December 23, 1863. ---. Died July 6, 1863. Left; flap. Snrg. J. Spiegehalter, 12th Mo. Died May 22, 1864. Right. Died October 24, 1864. Right. Died June 28, 1864. Right (also amp. arm). Died January 11,1865. ---. D*ied May 15, 1863. ---. Surg. J. L. Brenton, 8th Ohio. Died Nov. 12, 1864. ---. Died September 25, 1864 ; exhaustion; shock. ---. Died July 11, 1863. ---. Died September 30, 1862. Right. Died May 13, 1864. Right. Died May 31,1863. Left; circular. Died. Right. Died January 15,1863. Right. Died August 8, 1864. Left. Died August 10,1864. Left Died January 15, 1863; pyaemia. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 509 I Name, Military j „ N0- Description, and Age. Operations, Operators. Result. Name, Military Description, and Age. Operations, Operators, Result. 221 Doimhay, T., Pt,A,19th I Michigan. 2-2-2 Doster, J., Pt., C, 90th ' Ohio. 223 ! Dongan, S. W., Corp'l, C, 8th Kansas. 224 i Duncan, J. B., Capt., H, ! 32d Illinois. 225 Duugan, J. AV., Lieut., A, 113th Ohio. 226 j Eaton. I. V., Pt., D, 4th ! Maine. 027 Eberly, C, Pt., C, 98th Pennsvlvania. 228 Efford,*VV., Pt., G, 53d Indiana. 229 ; Ellinwood, A. AV., Pt., F. ■.'•"'th Muss , age 21. 230 I Emmel. P.. Pt., E, 163d New A'ork. 231 ! Enos, J., Teamster, 39th Indiana. 232 Erisman, J., Pt, D, 57th Indiana. E---.J.N.P........ Esson, H. J., Pt., G, 17th Michigan. Faber, AV., Pt, H. 47th Ohio. Farrell, J., Pt., F, 2d R. Island, age 33. Farrington, P., Pt., G, 82d New Vork. Feller, J.. Serg't, A. 21st Ohio. Fightmaster, G. AV., Pt., F, 22d Kentucky. Fincheler. H. £.,"Pt., A. 40th Alabama. FoUet, L. D., Pt., D, 92d New A'ork, age 38. Ford. J. H., Pt., C, 9th Iowa. 243 Foss, C.A., Lieut,C,72d New York. 244! Foss, J., Serg't, C, 59tb j New A'ork. 245 j Fowler. R. H., Serg't, A, 27th Connecticut. 246 Frener, D. C, Pt, G, 141st Pennsylvania. Friel, 67., Pt* D, 2d Ky. 1247 248 249 250 2.51 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 Fritz, J., Pt., A, 124th Ohio. Fulton,G., Lieut. ,C, 88th Pennsylvania. Garrison, M.,Pt,B,126th New York. Gear}-, AV. T., Pt., E, 10th Conn., age 19. Gehring. J., Pt, ft 59th Illinois. Gentry, L., Pt., B, 33d Mississippi. Gilbert.P.,Seaman,Gun- boat "Tyler. Gilchrist, J. E., Pt., B, 78th Pennsylvania. Glenni, J.. Pt, H, 81st Pennsylvania. Goodwin, A. N., Lieut., A, 9th Maine. Grant, W. D., Lieut., B, 18th Georgia. Green, J., Pt, D, 69th Pennsylvania. Gregory, O, Pt, H,7th Ohio. Grey, A. R., Pt, G, 7th Wisconsin. Gridley, E., Pt., H, 57th Pennsylvania. Gridley, AV., Pt, A, 136th Pennsylvania. Griffith, J. L., Pt, I, 22d Iowa. Grogan, C. H., Serg't. I, 6th Connecticut. Grossman, AV., Pt., C, llth Penn. Res.,age 23. Grotenhaus, J., Pt., D, 8th Michigan. Mav 15, 15,''64. Dec. 31, —, '62. Sept. 19. 19. '63. Oct. 5, 5, '62. .1 une 27, 27, '64. Julv 2, 2, '*63. May 12, 12," "64. Oct. 5, 5, '62. June 3, 3, '64. Deo. 13, 13, '62. Oct. 8, 8. '62. Sept. 1, —. '64. Julv 3, 3, '63. May 12, 12,"*64. Mav 26, 26," '63. Mav 5, 5, '64. July 3, 3, '63. Aug. 21, —. '64. Mav 22, —,"'63. July 28, 28, '64. June 1, 1. '64. Mav 22, —,' '63. July 3, —, "'63. Sept. 17, 17. '62. Dec. 13, 13, '62. Mav 8, 3, ''(',3. Sept 19, 19. '63. Mav 15, —," '64. Dec. 13. 13, '62. Julv 2, 2. '63. Sept. 27, 28, '63. Oct. 8, 8, '62. July 20, —. '64. Mar. 1, —, '62. May 31, 31. '64. Dec. 13, 33, '02. July 20, —, *63. April 5, 5, '65. May 5, 5, r62. Mar. 23, 23, '62. May 8, 8, '64. Deo. 13, 13, '62. Dec. 13, 13, '62. May 22, 22, '63. July 11, -, '63. Mav 8, 9, '64. May 6, —, '64. Right. Surg. .1. Bennett, 19th Mich. Died May 23, 1864. Left. Died February 9, 1863. Left (also wound of right wrist). Died September. 1863. ----. Died July 18, 1861; debil- ity resulting from injury. Lett. Died July 4, 1861. Right. Died August 18, 1803. Left. Died May 20, 1864. ----. Died. Left. Died July 6, 1864. Left. Died January 5, 1863. Right. Died October 25, 1862. Left. Died September 20, 1804. ----. Died July 3, 1863. ----. Died May 21. 1864. Left. Died September 7, 1863. Right. Died June 6, 1864. Right Died July 10, 1863. Left. Died October 2, 1864. Right. Died May 28, 1863; py- aemia. Right. Died August 11, 1864. Left Died June 14, 1864. Right; double flap. Surg. A. T. Hudson, 26th Iowa. Died June 24, 1863. ----. Died July 7, 1863. ---- (also amp. other thigh and w'd of arm). Died Sept. 21,'62. ----. Died December 17, 1862. Right. Died May 20, 1863. Left. Died December 1, 1863, while a prisoner. Right. Died July 18, 1864. ----(also wound of side). Died December 30, 1862. Right. Died July 18, 1863. Left (also partial tract right leg), Died October 7, 1863. ----. Died October, 1862. Lett. Died September8, 1864. ----. Died March 4, 1862. Left. Died June 5, 1864. Right. Jan. 1, '63; re-amp. thigh. DiedJan. 2,'63; shock and exh'n. Left. Died July 27, 1863. Right. Died April 16, 1865. Left. Died May 5, 1862. ----. Died April 12, 1862. Left. Died May 13, 1864. Right. Died December 17,1862. Right. Died December 18,1862. ----. Died May 24, 1863. ----. Died July 23, 1863. Right. Surg. B. Rohrer, 10th Pa. Res. (Also amp. arm.) Died August 3, 1864. ----. Died May 19, 1864. 268 269 270 271 273 4 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 Grover, C. D., Serg't, F, 25th Connecticut. Groves, J., Pt, F, 7th Massachusetts. (luild, J., Pt, C, 153d New York. Halfhill, (1., Pt, I, 21st Iowa. Hall, .1. F., Pt, B, 22d A'irginia, age 25. Hanky, O., Pt, B, 3lBt Mississippi. Ilarard, .1. VV., Pt, E, 3d Colored Troops. Hardy, lI.F.,l't., F, llth Mississippi. llnrrimnn, C, l't., E, 19th Maine. Harris, A.C, Pt,A,43d Georgia. Haskall,lI.A.,Pt,C, 4th New Hamp., age 24. Haskinson, A., Pt, G, 84th Illinois. Hatley, —, Pt., I, 52d North Carolina. Hawkins, A., It., K, 4th Maine. Heath, J., Serg't, K, 2d Colored Troops. Heighly, H. O., Pt, C, 1st U. S. Sharpshooters, age 25. Hess, T. W., Pt., K; 8th North Carolina. Hesterly, P., Pt., B, 12th Alabama. Hevener, AV. O, Serg't, E, 28th Illinois. Higgins, F. M., Pt, B, 5th New Hampshire. Hill, AV. S., Serg't, F, 62d Penn., age 24. Hinchman. J. 1!., Serg't,. L, 54th Penn., age 23. Hogan, J., Pt, I, 56th Massachusetts. Holloway, R. H, Corp'l, D, 13th Georgia. Holmes, F., Corporal, Kane's Penn. Rifles. Hoover, F. M., Pt., B, 83d Penn., age 24. Horminger, G., Pt., H, 1st New Jersey. Home. G., Pt, A, 15th N.Y. H'vy Artillery. Horner,W., Pt, H, 15*5th Pennsylvania. Horton, D. F., Pt, D, 25th North Carolina. Horton, H.R., Pt,F. 7th R. I. Battery, age 37. Howard, H., Pt., D, 20th Massachusetts. Howe, D., Serg't, C, 1st New A'ork. Howe, G. W., Pt. E, 34th Massachusetts. Hubbard, E., Corp'l, B, 3d Kentucky. Hubbard, W.'B., Pt., E, 2d Kentucky. Hughes. J. H, Pt., A, 28th Virginia. Hughs, P.AV., Pt,A,5th New A'ork. Hunt, J., Pt, H. 7th Ohio. Hyatt, J., Corp'l, F, 48th New York. Jackson, J., Pt, D, 1st Maine H'vy Artillery. Jacobs, O, Pt, B, 19th Ohio. Jamison, J., Pt, A, 29th Illinois, age 24. Jesse, J. P.. rt., C. 37th Virginia. Johnson, C, Pt., G, 1st Wisconsin Cavalry- Jollife, J., Pt., F,"70th New York. Jones, W. P., Pt.. D, 2d Georgia. April 13, 13, '63. May 3, 3, r63. Sept. 19, 19, '64. May 22, 22," '63. May 3, 4, NS3. July 20, —, '64. Sept 30, 3D, 64. July 2, 3. '63. ----. Died April 16, 1863. Left. Died June 11, 1863. Right Died September 28,1804. ---- (wound of both legs). Died June 9, 1863. ----; flap. Died May 24, 1863; typhoid fever. Left. Died August 27, 1864. Bight Died October 2, 1864. Left Surg. II. AI. McAbee, 4th Ohio. Died July 20, 1803. Left (also fract. right leg). Died July 7, 1803 : haemorrhage. Left. Died May 22, 1864. July 2 2, '63. May 11, —,''M. Sept. 29, Oct. I.'64 Dec. 31, I Left. Died January 8, 1863. 31. '62. I July Left. Died October 9, 1864. —, '63. May 6, 7, '64. 1864. July 2, 3, '63. Sept. 30, 30, '04. Sept. 17, 17, '62. Oct. 5, 5, '62. Dec. 13, 13, '62. June 3, 3, '64. July 18, 18, '64. May 6, —, '64. July 3, —, '63. June 8, 8, '62. May 6, 6, f64. May 3, 3, '63. June 19, 19, '64. June 17, —. '64. May 14, 14, '64. June 24, —. '64. Julyl, 1, '63. May 12, 12,"'64. Mav 15. 15,"'64. Dec. 29, —, '02. April 6, Julv 3, —, '63. June 1, —, '64. Mar. 23, —, '62. July 18, 18, '63. June 20, 20, '64. Sept. 19, 19, '63. Mar. 29, 29, '65. July 2, 4, '63. April 26, 26, '63. Julv 2, 2, '63. July 2, —,'63. ----. Died July 17, 1863. Right. Died May 13. 1864 Right, Died October 24, 1864. Left Julv 17, hsem.,24 oz., from post, tibial. Died July 18,1863; hasmorrhage. Left. Died October 7. 1864 ; irri- tative fever. Left. Died October 11, 1862. ----. Died October 5, 1862. Right. Died December 27,1862. Right (also w'nd of back). Died June 14, 1864. Left, Died July 25, 1864. Right. Died May 13, 1864. ----. Died July 10, 1863; py- aemia. Left Died June 14, 1862. Left. Died May 27, 1864. ---. Died May 24, 1863. Right Died June 26, 1864. Left. Died June 24, 1864. Right: circ. (also left leg). Died June 13, 1864. Left. Died July 4,1864 ; exhaus- tion. Left Surg. N. Hayward, 20th Mass. Died July 8, 1863. ----. Died May 22, 1864. Right. Died May 21, 1864. ----. Died January 1, 1863; ty- phoid symptoms. Right, Died April 18,1862; py- aemia. Left. Died July 28, 1863. Right (also wound of left leg). Died June 4, 1864. ----. Died April 5, 1862. Right Died August 9, 1863; chronic diarrhoea. ---. Died June 25, 1864. Left Died September —, 1863. Right; ant post. flap. Surg. S. L. Cheaney, 29th Illinois. April 4, haem. Died April 18, 1865. Left Died July 4, 1863. Left. Died April 26, 1863. Left. Died August 4, 1863. ----. Died July 20, 1863. 5K INJURIES, OF THE LOWER EXTREMITIES. [CHAP X. Name, Military Description, and Age. Dates. Operations, Operators, Result. 315 1316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340{ 341) 342 343 344 34; 341 34 348 349 350 351 352 353 354 355 |356 1357 358 359 360 361 362 363 Jones, AV., Corp'l, 23d Wisconsin. Kahoe, M., Pt, I, 113th Ohio. Kalchback, J., Pt, —, 16th Infantry. Keely, B., l't , F, 7th Illinois. Kellogg, T. A., Corp'l, A, 14th Infantry. Kiles, J.G.,Pt, A, 124th New York. King, G., Pt., K, 54th Massachusetts. King, I., Pt, E, 126th Ohio, age 21. Krumelbein, W., Corp'l, E, 2d Missouri. Kuster, J. W., Pt, F, 57th Pennsylvania. Laib, F., Serg't, A, 7th New Jersey. Lambert, AV. H., Pt., H, 160th N. A'., age 31. Lamponi, D., Pt, II, 8th New Hampshire. Langdon, B., Pt, II, 93d New York, age 19. Lawrence, j. B., Capt., H, 9th N. J., age 36. Lehman, J. J., Pt, C, 50th Pennsylvania. Lerch, J., l't, B, 9th Penn. Reserves. Lewis, H. V., Lieut, D, 145th Pennsylvania. Lewis, L., Pt., E, 55th Pennsylvania, age 18. Lininger,AV.,Pt.,B,145th Pennsvlvania. Lively,"L., Pt., K, 12th Massachusetts, age 27. Livingstone, J., Pt., B, 60th Ohio. Locke, P., Pt,, F, 22d Indiana. Logan, N. J?., Pt., I, 4th A'irginia. Lotzrc, Corp'l, K, 151st Pennsylvania. Luallen", .1., Ft., D, 13th Indiana. Lynch, M., Pt., E, 9th Massachusetts. Madden, M., Pt, A, 4th Kentucky. Mahorner, II., Pt, F, llth Mississippi. Manson, J. P., Pt, A, 121st Pennsylvania. Markteller, W., Pt, E, 5th Peun. Cavalry. Maron, J., Pt., C, 55th Alabama. Martin, J., Pt., E, 8th Connecticut, age 19. Marx, A., Pt, C, 14th Indiana. Marx, P., Pt., A, 1st Minnesota. Mason, M., Pt., G, 5th North Carolina. Mathews, J., Corp'l, B, 47th Georgia. Mattoon, H., Pt, D, 2d Conn. H. Art., age 30. Maynard, G., Pt, 145th Pennsvlvania. Maywood, D., Pt,, E, 74th New York. McCafferty, VV., Serg't, C, 121st Penn. McCartney, O., Pt, E, 106th New A'ork. McCune, A., Capt., G, 74th New Vork. McDonald, E. P., Pt., H, 28th Kentucky. McDowell. A., Corp'l, D, 72d Pennsylvania. McGinniken, C. B-, Lt., D, 9th Mass., age 25. McGraw. F., Pt., A, 40th Massachusetts, age 28. July —, —, '63. June 27, 27, '64. Sept. 5, —, '64. Oct. 4, 4, '62. July 3, —, '63. May 5, —, '63. Aug. 30, 31, '62. May 21, 21, '64. Nov. 24, 24, '63. 1862. July 3, 3, '63. April 9, 9, '64. May 27, 27, '63. May 23, 23, '64. May 16, 16, '64. May 12, 12, '64. Sept. 14, —, '62. July], —, *63. June 5, —, '64. July 2, 2, r63. Dec. 13, 13, '62. Aug. 21, —, '64. Oct. 8, —, '62. April —, —, '65. July 2, 2, '63. Jan. 15, 15, '65. Dec. 13, —, '62. Sept. 19, 19, '63. July 2, 3, '63. Dec. 13, 13, '62. Dec. 10, —, '64. July 20, —, '64. May 9, 9, '64. Mar. 23, 23, '62. July 2, —, '63. July 2, —, '63. May 14, 14, '64. June 10, 10, '64. May 12, 12, '64. July 2, 2, '63. Julv 1, 1, '63. June 2, 2, '64. June 6, 6, *64. Dec. 16, 16, '64. July 1, —, '63. May 5, 5, '64. May 16, 16, '64. Right. Died July 17, 1863. Right. Died August 21, 1864. Right. Died September 10,1864. ---. Died October 4, 1862. Left. Died July 24, 1863; gan- grene. Right. Died May 24, 1863. Right. Died August 31, 1862. Right. Died May 29, 1864; py- aemia. Right. Died February 12, 1864. Right, Died June 25, 1862. ---. Died July —, 1863. ---. Died May 26, 1864. Left. Died June 1, 1863. Left. Died June 8, '64; pysemia. Left. Died May 30, 1864. Right. Died May 25, 1864. Left Died October 21, 1862. Left. Died July 2, 1863. Left, Died August 2, 1864; ex- haustion. Right. Died July 18, 1863. ---. Died December 15, 1862. Left. Died en route to hospital. Left. Died October 16, 1862. Right. Died April 6, 1865. Left. Died July 9, 1863. Both. Surg. L. Barnes, 6th C. T., and Ass't Surg. H. C. Merry- weather, 5th C. T. Died Jan- uary 23, 1865. Left. Died December 31, 1862. Right. Died December 20,1863. Right. Surg. H. M. McAbee, 4th Ohio. Died July 27, 1863. Both; flap. Died December 25, 1862. Right, Died December 28, 1864. ---. Died July 29, 1864. Right. Died September 8,1864; exhaustion. Left. Died April 8, 1862. ---. Died July 24, 1863. Right. Died July 9, 1863. Right. Died June 12, 1864. Left. Died June 14, 1864. ---. Died May 16, 1864. Right. Died July 15, 1863. Left, Died July 12, 1863. Left (also wound left shoulder). Died June 3, 1864. Left, Died June 9, 1864. Right. A. A. Surg. J. C. Thorpe. Died December 16, 1864. Left. Died July 3, 1863. Right. Died May 5, 1864. Left. Died May 22, 1864. t Name, Military Description, and Age. Dates. Operations, Operators, Result. Mclntyre, S.,Pt.,A,30th Illinois. McKeney, J., Pt, K, 108th New A'ork. McKenna, P.,Pt.,G,10th Infantry. McLaughlin, M., Pt, C, 46th Pennsylvania. McMurtrie,A. H., Lieut., D, 3d Iowa. Medway,AV.,Pt.,C,75th Colored Troops. Merwin, C. N., Drum- mer, A, 13th Conn. Middleton, J., Pt., H, 22d Iowa. Miller, C, Pt, H, 20th Pennsylvania. Miller, J.W., Pt, E, 21st Maine. Miller, L., Pt, G, 96th Illinois. Miller, W., Pt., C, 13th Ohio. Miller, W., Pt, E, 153d Pennsylvania. Millsaps, G. W., Pt., A, 7th N. Carolina, age 18. Mitchell, M. L., Pt., G, 74th Indiana. Mobley, H. M., Pt., A, 55th Alabama. Montgomery, R. S., Pt., I, 105th Pennsylvania. Moore, C. H, Pt., F, 13th Mississippi. Morrill, F. L., Lieut, D, 3d New Hamp., age 23. Moser, J., Pt., H, 15th New York Artillery. Moss, J., Pt, H, 3d Ohio. Mounts, N., Pt, B, 121st Ohio. Mowers, H., Pt., 1,117th New York, age 38. Muller, IF., Corp'l, G, 1st Virginia. Mullins, C. P., Capt, A, 130th Illinois. Munsell, E., Pt,, I, 22d Massachusetts. Munson, L. F., Pt., A, 10th Connecticut. Murphy, C, Pt, A, 63d New York. Murphy, J. C, Pt., G, llth Massachusetts. Nance, T. J., PL, H, 30th Texas Cavalry. Newton, T., Pt, A, 10th Louisiana. Nichols, G-, Serg't, E, 4th Colored Troops. Nicholson, G., Pt., H, 126th New York. Nolan, P., Serg't, K, 19th Massachusetts. Nutter, H. F., Corp'l, L, 31st Maine. O'Neil, H., Corp'l, K, 79th Penn., age 28. Osborn, W. D., Corp'l, I, 26th Connecticut. Owens, J., Pt., F, 8th Tennessee Cavalry. Paisley, W., Pt., H, 32d Illinois. Parker, A. M., Lieut., B, llth Georgia. Parks, G.,Pt.,I,3dIowa. Parr, "VV., Pt., D, 38th New York. Patterson, J., Pt, G, 30th Missouri. Paul, E., Pt, I, 1st Min- nesota. Pelley, R., Serg't, G, 53d North Carolina. Perkins, D., Pt, F, 8th Maine. Perkins, D., Pt., H, 4th Penn. Reserves. July 22, 22, '64. Sept. 17, 17, '62. July 3, —, '63. May 30, 30,"'64. July 12, —,' '63. May 27, —, '63. June 14, —, '63. May 22, —, '63. July 2, —, '63. June 14, 14, '63. May 14, —, '64. July —, —, '64. July 2, —, '63. June 22, 23, '64. Sept. 19, 19, '63. July 20, —, '64. Deo. 13, 13, '62. July 3, —, '63. June 30, 30, '64. Sept 19, 19, '64. Oct, 8, —, '62. June 27, 27, '64. May 14, 14, '64. July 3, —, '63. April 8, 8, '64. May 7, 7, '64. Dec. 14, 14, '62. Sept. 17, 17, '62. Mav 3, 3, '"63. April 4, 4, '64. 1864. Sept. 24, 24, '64. July 2, 3, '63. June 19j 19, '64. April 2, 2, '65. 1865. June 14, 14, '63. Dec. 17, 17, '64. Oct. 5, 5, '62. July 3, —, "'63. Oct, 5, 5, '62. May 5, 5, '62. May 18, —, '63. July 2, 2, '63. July 2, 2, '63. July —, —, '64. Sept, 17, 18, '62. Right. Died August 18, 1864. ---. Died September 24,1862. Left. Died July 11, 1863. Left. Died June 23, 1864. Right. Died July 25, 1863. Right. Died July 3, 1863; gan- grene. Left. Surg. E. A. Thompson,12th Maiue. Died July 6, 1863. Left. Died May 28, 1863. Right. Died July 10, 1863. ---. Died June 17, 1863. Rrght. Died May 27, 1864. Left. Surg. W. M. AVright, 79th Penn. Died August 18, 1864. Left. Died July 9, 1863. Left; circular. Died September 1, 1864; exhaustion. Right. Died October 9, 1863. Left Died July 30, 1864. Left Died December 23,1862. Left, Died July 7, 1863. Left. Died July 13, '64; tetanus. Left. Died October 11, 1864. ---. Died October —, 1862. Right (also wound of shoulder). Died June 28, 1864. Right; gangrene. Died June 27, 1864; exhaustion. ---; tetanus. Died from ex- haustion. Right. Died May 6, 1864. Right. Died May 7, 1864. Left. Surg. F.G.Snelling,U.S.V. Died Dec. 29, 1862; exhaust'n. ---. Died September 18,1862. Left (also wound of right leg). Died May 11,1863. Right. Surg. C. E. Swasey, U.S. V. May 1, amp. thigh. Died May 8, 1864; pysemia. ---; gangrene. Died May 24, 1864. ---. Died September 24,1864. Right. Surg. F. Wolf, 39th N. V. Died July 15, 1863. Left. Surg.AV. J. Burr,42d N. Y. Died June 21, 1864. Left (also wound left arm). Surg. L. AV. Bliss, 51st N. Y. Died April 3, 1865. Left. Died February 9, 1865. Right. Died June 24, 1863. Right. Died. ---. Died October 5, 1862. Right. Died July 21, 1863. Left. Died October 17, 1862. ---. Died May 11, 1862. Left. Surg. S. C. Plummer, 13th Illinois. Died June 16,1863. ---. Died July 13, 1863. ---. Died July 4,1863. Left. Died July 5, 1864. ---. Died October 2,1862; ery- sipelas. SECT. Y-] PRIMARY AMPUTATIONS IN THE LEG. 511 Name, Military Description, and Age, Dates. Operations, operators, - Result. 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 43.'! 434) 435< 437 438 439 440 441 442 443 444 445 446 447 448 449 450 453 452 453 454 455 450 457 May 9, 9, '64. 1 Julv 3, June 8, Phillips, P., Pt. B, 1st Rhode Island Artillery. Pickett, J. 11'.. Pt, ti, 13th Alabama. Fierce. A., l't. 1, 7th Rhode Island. Pierce, L. D., l't., K, 63d Ohio. Pike, AV., Pt, B, 75th | Oct. 8 Illinois. 8, '62. Pilgrim, M., Pt., C, 1st i June 14, Louisiana. 14, '63. Pine, J., l't, I, 3d In- I July 3, fautry. J —, *03. Finney, A. N., ('apt. II, July 30, 27th Colored Troops. I 30, '64. 8, '64. Mav 9, 9, '02. F, Planter, A. E., Pt, C, 19th Maine, age 31. Pool, J., Pt, B, Kith Georgia. Poole, M. C Pt, I, 13th Georgia, age 20. Potter, H. H.. Pt, G, 14th Mississippi. Potter, W. A., Pt., B, 55tb Illinois. Potts. J. C, Capt 39th Indiana. Powell, J., Serg't, 1,10th Iowa. Price. A., Pt., A, 58th Illinois. Proctor, I.. Pt, E, 110th Ohio. Proseus. E., Pt, E, lllth New A'ork. Prugine, J. L., Pt.. F, 1st Penn. Artillery. Pullin, C. B., Corp'l, II, 35th New Jersey. Purdy. J. A., Pt, E, 72d Illinois, age 24. Putnam. S., Serg't, E, 145th Pennsvlvania. Quinly. J., Pt, B, Sth AV. Arirginia, age 42. Randall. A.. Pt., (', 35th New A'ork. Mav 10, 10, '64. Julv —, —,"'63. May 12, 14,"'64. July —, —,' '63. April 6. Sept. 19, 19, '63. May 16, —,"'63. April 8. 8, '64. June 1, —, '64. July 2, 3, '63. July 3, 5, '63. Dec. 14, 14. '62. 13. '62. Aug. 30, 3d," '62. Dec. 13, 13, '62. Raper, IF, Pt, 0, 5th .May 5, North Carolina. ! 5. *02. Ray. A. J., Pt.. K, 34th North Carolina. Lav. S-, Serg't. D. 84th Illinois. Reed, C. H. Serg't F, 7th North Carolina. Reedcr. 0., Pt, F, 134th New Vork. Reeees.L. A.,Pt . D, 15th Georgia. Renninger. A., Pt., F. 131 st Pennsylvania. Itliinehart, A. It, Ft., II, 121th New A'ork. Rice. II. J., Ft, A, 3d Ohio. Ric. J. IL, Pt.. B, llth New Jersey. Richard. J." Corp'l, B, 143d l'enn.. age 23. Riekard. N., Ft., A, "(Ith Pennsylvania. Roberts, P., Pt, II, 41st Illinois. Robinson, AV., Pt., I, 6th New Jersey. Rodgers, S. E., Pt., C. loth Kentucky. Rogers, It, Pt., B, 6th Michigan Cavalry. Rollins, E. u INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. No. Kami:, MILITARY DESCRIPTION", AND A(!E. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 506 Tiffany, J.. Lieut, D, 27th Virginia. July 3, 3, '63. ----. Died July 10, 1863. 539 A'antz, J., Pt., I, 9th Iowa. Mar. 7. —, '62. Left. Died March 12, 1862. ■ 507 Tinkhnm, C. (!.. Serg't, A, 12th Mass., age 36. Sept. 17, 17, '62. Left. Died September 30,1862. 540 York, B. V., Pt, F, 2d Maine. Dec. 13, 13, '62. Right Died December 27. 1862. 5( 8 ; Tolbogs. R. A'., ~Pt., C, Oct. 5, Right. Died October 14, 1864. 541 York, J. M., Pt., F. 66th Mav 16. --. Died May 22, 1864. J 39th Iowa. i —, '64. Illinois. Ki. '(il. 509 Trowbridge, J. F... S'g't July 3, ----. Died July 14. 1863. 542 A'oung, J., Pt, F, 28th Oct. 19, Right Died October 20. 1804. ! F. 5th N. Y. Cavalry. —, '63. Iowa. 19, '64. 510 Trumbull, A., Pt, K, May 27, Right Surg. C. A. Robertson, 543 Bolman,J. IF.,Pt, G,2d Oct. 7. Left. 159th New A'ork. 27, '63. 159th N. Y. Died June 23, '63. South Carolina. —, '64. 511 Tubbs, B.N.. Pt,— ,81st July 2, ----. Captured and died while 544 Boroff, J. H., Serg't, A. June 5, Right Pennsylvania. 4, '62. in prison. 123d Ohio. —, '64. 512 ' Unknown. ____ --- ; Lenoir's method: also Piro-goff's amp. other foot. Snrg. J. 545 Cook, —. Lieut-Col.. 8th Virginia Cavalry. Jan. 11. 11. '65. Left. ! T. Gilmore, C. S. A. Died. 546 Derr, A. J., Corp'l, C, May 3, --; circular; sloughing. 513 A'an Kleet, C. H., Pt., June 3, Left; circ. Surg. G. T. Stevens. 37th N. Cage 31. 4. '63. G, 77th N. Y., age 21. 1 3, '64. 77th N. Y. Died July 26,1804 ; exhaustion, diarrhoea. 547 Harrison, L., Corp'l, F, 63d Ohio. Oct. 4, —, '62. Left. 514 Yanwinkle, AL. Ft, E, > July 2, Left. Surg. H. M. McAbee, 4th 548 Hemingway, T., l't., B, Oct 13, Left. lllth New York. 3, f63. Ohio. Died July 27,'63; gang. Hampton's Legion, S.C. —. '64. 515 Yarncy, A. (.'., Ft, K, '.■th Maine. Aug. 6, 6, '63. Left. Died August 21, 1863. 549 James, F.M., Pt, B, 31st Mississippi. July 20, —, '64. Left. 516 Virgin. A.J. .Pt„K,25th Iowa, age 25. Jan. 11, —, '63. Right. Died January 15, 1863. 550 Kelley, J. IF.,Ft.,G, 40th Mississippi. July 20, —, '64. -- 517 AVagnor. E. R., Pt., A, June 14, Right. Died August 13, 1863. 551 Linebcrger, J. I.., Pt, II, May 2. Left. Ass't Surgeon B. Howard, 75th New York. 14, '63. 23d North Carolina. 2. '63. V. S A. 518 Wales, AY.. Pt, F, 51 st Ohio. Dec. 31, 31, '62. Left. Died January 7, 1863. 552 Lisebone,J. IL, Pt, 28th North Carolina. July 27. —, '62. -- 519 AV'allack. I.. Pt., 0,49th Ohio. Nov. 24, 24, '63. Right. Died November 27,1863. 553 Mason,W. A., Pt, B, 82d Ohio. Aug. 28. —, '62. -- 520 Waller, D. J, —, E, 23d Sept. 14, ----. Sept 25, hoem.; amputat'n 554 McCray, C. B., Corp'l. 1, May 15, Right South Carolina. 15, '62. thigh. Died Oct. 13, 1862. 36th Alabama. —, '64. 521 Walters, J. II., Pt, K, Aug. 22, Left; flap. Died September 3, 555 Razenmand, C, Pt,---- May —, -- 1 14th New York. 22, '62. 1862. —, '64. 522 VV'anzer, J., Pt, G, 12th April 6, ----. Died April 14, 1862. 556 Read.W. H., Pt., A, 58th July 13, Left. Supposed to have died. Illinois. 6, '62. Illinois. 13. '64. 523 Watson, S., Pt, C, 118th Sept. 21, Left. October 14, haemorrhage. 557 Rearly, IF., Pt.. —, 37th Mav 27, -- I Vnns\ lvania. 21, '62. Died Oct. 15, 1862; tetanus. North Carolina. —,' '62. 524 1 Welch,'VV., Pt. L. 8th June 3, Left; gangrene. Died July 13, 558 Reedy, D.E..Pt.E,48th June 3, -- N. A'. II. A., age 43. 4, '64. 1864. Pennsvlvania. —, '64. 525 Welker, J., Ft., G, 35th Sept. 19, Left Died October 11, 1863. 559 Rinehart, L., Pt., E, 32d June 20, Right 1 Illinois. 19, '63. Indiana. 20, '64. 526 Wickham, I., Pt.,A, 13th July 22, Left (also wound left arm). Died 560 Robertson, A. S., Pt., —, Oct. 5, ■------------------- ! Iowa. 22, '64. July 27, 1864. 28th Illinois. —, '62. 527 AVilburn, J. C, Pt. I), Mav 23, Right. Died May 28, 1863; py- 561 Rothrock, B., Pt, B, 81st Dec. 13, Right (also wound of side and • 22d Kentucky. —,"'63. aemia. Pennsylvania. 13, '62. foot) 528 VVilley, C.\V.,"Corp'l. C, June 14, Left. Died June 14, 1863. 502 Scherring, H. P., Pt, —, June 5, Right 2iitb'('oiniecticut 14, '63. 4th Maryland. —, '64. 529 Williams. .1. M.. Corp'l, I, 69th Ohio. Dec. 31, 31, '62. ----. Died January 24, 1863. 563 Sherrill, A. M., Pt, D, 18th North Carolina. 530 Williston, R. S., Serg't, Aug. 9, ----(also wound of hand). Died 564 Smith, .)., Pt, D, 9th Oct. 4, -- G,2d Massachusetts. 9, '62. August 9, 1862. Illinois. —, '62. 531 Willson. J. W., Major, Sept. 1, Right. Died October 3,1864. 565 Songtitery, J.,Px., E,55th July 20, Left. llth Ohio. 1, '64. Alabama. —, '64. 532 Winchester, W. H., Lt, Julv L Left. Died August 1, 1863; py- 566 Stephens, J. F., Pt., A, Mav 3, --; flap. I, 13th N. Cage 23. 2, f63. aemia. 49th Georgia, age 23. Swaford, W. H, Pt., C, 4, '63. 5:13 Winegar.A..Pt.,F,lllth Mav 6, Left. Died June 13, 1864. 567 July 20, Left. New York, age 18. 6, '"64. 33d Mississippi. —, '64. 534 AYiiicmiller, J.C., Serg't, Aug. 16, Right. Died August 24, 1864. 568 Talifcro, —, Lieut, 9th Nov. 5, -- 1 L, 1st Aid. Cavalry. 16. '64. Virginia Cavalrj*. 5, '62. 535 AYood, K.C.Pt, B. 141st Julv 3, Right. Died July 13, 1863. 569 Willard, J., Pt. A, — Aug. 14, Right 1 Pennsylvania. —,"'63. South Carolina. —Y64. 536 Woodsi"de,H.,Pt..C, 81st Mav —, Left. Died July 1, 1863. 570 Williams, T. J, Pt, H, July 28, Left. Illinois. —," '63. 20th South Carolina. —, '64. 537 Worcester, J. IL, Lieut., July 11, Left; flap. Died July 26. 1863. 571 Wilson, A. IF., Pt., C, July 28, Left II. 7th New Hamp. —, '63. 19th Louisiana. —, '64. .".38 ' AV'orcester, O. P., Pt., C, Mar. 23, ----. Died April 15, 1862. 7th Ohio. —, '62. 01' the five hundred and seventy-one operations recorded in the foregoing table the amputation was performed in the right limb in one hundred and seventy-seven, in the. left limb in two hundred and eight cases; in one hundred and eighty-six instances the side was not indicated. INTERMEDIARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY.—One thousand and forty-six of the five thousand four hundred and fifty- two amputations in the leg were intermediary operations. The results were determined in all cases; six hundred and eighty-two were followed by recovery, and three hundred and sixty-four by death, a mortality rate of 34.7 per cent., exceeding that of the primary oper- ations (30.9 per cent.) 3.8 per cent. Two hundred and ninety-six operations were performed ■HOLLOWAY (J. AL), Comparative Advantages of Pirogoff"s, Syme's, and Chopart's Amputations and Excision of the Ankle Joint by Hancock's Method, after Gunshot Wounds and other Injuries, in American Journal Medical Sciences, Vol. LI, p. 85. SECT. V.J INTERMEDIARY AMPUTATIONS IN THE LEG. 513 in the upper, three hundred and sixty-eight in the middle, and three hundred and thirty-five in the lower third of the leg; in forty-seven the seat of the amputation was not indicated. Intermediary Amputations in the Upper Third of the Leg for Shot Injury.—Two hundred and ninety-six operations were recorded; one hundred and ninety-four had suc- cessful, and one hundred and two fatal terminations, a mortality of 34.4 per cent. Successful Lntermediary Amputations in the Upper Third of the Leg.—The one hun- dred and ninety-four operations were performed—one on a civil employe, twenty-two on Confederate, and one hundred and seventy-one on Union soldiers. Of the latter, one officer was placed on the retired list, and one hundred and sixty-eight enlisted men became pen- sioners, of whom twenty have died since their discharge. In three instances the amputa- tion in the leg was followed by amputation in the thigh.1 Case 754.—Colonel F. Fessenden, 30th Maine, aged 25years, was wounded in the right leg during an engagement near Cane River, April 23, 1864, and entered St. James (Officers') Hospital, New Orleans, six days afterwards. Assistant Surgeon S. H. Orton, U. S. A., reported: "The tibia was fractured irregularly for two and a half inches at the upper part of the middle third, two pieces of bone being entirely detached. Flap amputation at the upper third was performed on April 30th, by Surgeon F. Bacon, U. S. V.; chloroform was used. At the time of the operation the periosteum was detached, with infiltration of pus beneath the integuments down to the ankle joint. The patient's constitutional condition was good and he progressed favorably. He was granted a leave of absence, and left the hospital May 18, 1864." The specimen (3603) shown in the annexed wood-cut (FlG. 294) was contributed to the Museum by the operator, with the following supplementary description of the case: "The tibia Avas splintered by a glancing bullet, which did not lodge in the leg and made but a single wound in the integuments. The fibula was not fractured and has not been preserved. I first examined the wound some seven days after it had been received and was surprised—in view of its apparently small extent—to find the bones stripped of periosteum and evidently dead for a distance of several inches above and below. One of the fissures ran directly across tlie nutrient foramen. The artery had been ruptured at that point and considerable haemorrhage had ensued, the blood being evidently infiltrated through the calf of the leg. To this fact I attributed the loss of vitality which had taken place even in the larger fragments of the bone. The leg was amputated without delay immediately after the examination." After leaving the hospital Colonel Fes- senden returned to active service, and was promoted to Brigadier General and subsequently to Major General. He was retired from service November 1, 1866. At the battle of Shiloh, April 7, 1862, he had also been wounded in the arm. Fig. 294.-Right tibia fractured in middle third. Spec. 3603. Case 755.—Private J. Wheeler, Co. A, 8th Connecticut, aged 23 years, was wounded at Antietam, September 17, 1862. Surgeon T. H. Squire, 89th New York, recorded his admission to the Locust Spring field hospital, near Sharpsburg, and noted the following description of the case: "The wound was through the right ankle joint by a musket ball. The leg was amputated one week after the injury by Surgeon W. H. Leonard, 51st New York, at the junction of the upper and middle thirds. The flaps sloughed and the ends of both bones became exposed, being surrounded by red granulations. By a healing pro- cess the stump slowly changed for the better, the efforts of nature being supported by treatment as good as could be, and the patient being cheerful and expecting a good recov- ery. On November 12th, the ends of the bones exfoliated and were taken away, after which the stump improved and the patient's general health became quite good." He sub- sequently passed through hospitals at Frederick, was transferred to Knight Hospital, New Haven, and finally admitted to Central Park, New York City, October 30, 1863. Acting Assistant Surgeon S. Teats reported from the latter hospital that "the stump had healed up perfectly sound by June 1, 1863; also that the patient had been discharged from service November 17, 1863, and received an artificial leg. The man has been paid as a pensioner to September 4, 1880. In his application for commutation, dated 1875, he described the stump as being " very uneven and sensitive;" but five years later he reported its condition as "sound." A plaster cast of the stump (Spec. 2746), contributed by Assistant Surgeon J. W. S. Gouley, TJ. S. A., is represented in the annexed wood-cut (FlG. 295). The specimen indicates the amputation to have been performed by the posterior flap, while the cicatrices resemble those following a circular operation. The integument on the anterior surface appears tightly drawn over the bone. Case 756.—Brigadier-General H. E. Payne, U. S. V., aged 37 years, was wounded at Port Hudson, June 14, 1863. He was conveyed to the field hospital of the 3d division, Nineteenth Corps, whence Surgeon S. C. Hartwell, 38th Massachusetts, reported: "Shot wound of left leg." Two days after the reception of the injury, which involved the fracture of both bones of the leg, he was conveyed to New Orleans, whence Dr. P. C. Boyer reported that the patient "was under treatment at the Hotel Dieu Hospital from June 16th to July 22d for gunshot wound of leg and amputation." The operation was performed by Dr. 1 Two of the operations were done in the middle third of the thigh: Cases of Pt. A. J. Cheever, H, 16th Mass. (Table XXXV, No. 35, p. 280, ante); Corporal H. W. Hughes, I, 133d New York (Table XXXIX, No. 43, p. 314, ante); and one in the lower third: Pt. F. Hoffman, H, 2d Penn. Artillery (Table XL, No. 47, p. 320). Subg. HI—65 FIG. 295. -Stump after flap amputation at junc- tion of upper and middle thirds of leg. Spec. 2746. 514 INJURIES OF THE LOWER EXTREMITIES. [CHAP X Fl0.296.-Frac- tured portion of right tibia: ne- crosis. £_p.2587. Warren Stone, of New Orleans, on June 23d, four inches below the knee; the patient entirely recovered and became able to walk with the aid of an artificial limb. General Paine ultimately resigned his commission May 15, 1863, after which he was pensioned. Since leaving the service he has served as a member of Congress, and has been Commissioner of Patents. Case 7.77.—Private A. Rutter, Co. C, 100th Pennsylvania, aged 20 years, was wounded, at Bethesda Church, June 2, 18G4. Surgeon M. K. Hogan, U. S. V., reported his admission to the field hospital of the 1st division, Ninth Corps, with "shot fracture of right leg by minie" ball." Surgeon G. L. Pancoast, U. S. V., who amputated the limb, made the following report: "The wounded man was admitted to Finley Hospital, Washington, on June 15th, from the field hospital. His injury consisted of a compound comminuted fracture of the right tibia, for which amputation was performed at the upper third on June 20th. The operation was done by the flap method and chloroform was used as the anaesthetic, the patient's general condition being excellent. After two days of suffering the patient's progress of recovery was rapid. Cold-water dressings were applied." Apart of the amputated tibia (Spec. 2587), showing fracture in the upper third and exhibiting well-marked necrosis, was contributed by the operator and is represented in the wood-cut (FlG. 296). The patient was subsequently transferred to Judiciary Square Hospital, where, after being fur- nished with an artificial limb by Jewett's Patent Leg Co., he was discharged from service May 4, 1865, and pensioned. His pension was paid June 4, 1880. In his applications for commutation he reported the condition of the stump as continuing "all right." Case 758.—Sergeant W. F. Johnson, Co. H, 84th Illinois, aged 19 years, was wounded in the right leg, at Dallas, May 30, 1864. Surgeon J. D. Brumley, U. S. V., reported his admission to the field hospital of the 1st division, Fourth Corps, with "shot fracture of tibia, lower third." Assistant Surgeon C C Byrne, U. S. A., who amputated the limb at the Field General Hospital at Chattanooga, made the following report: "The wounded man was admitted June 6th, and on the following day circular amputation was performed at the junc- tion of the upper and middle thirds of the leg. Chloroform constituted the anaesthetic. The patient's consti- tutional condition at the time of the operation was good, but the injured parts were swollen, infiltrated, and oedematous, and there was some erysipelatous inflammation. Two days afterwards the parts assumed a decidedly gangrenous appearance, and the pus become fetid, black, and profuse. This rapidly increased, though liquor of chlorinate of soda was freely applied. On the third day pure bromine was applied, which arrested it. A second application gave the parts a healthy aspect, granula- tions springing up at once. Tonics and stimulants were given internally." On August 29th, the patient was transferred to hospital No. 19, at Nashville, where he obtained a furlough and was allowed to proceed to his home. In the following Novem- ber he entered the Post Hospital at Rock Island, whence Acting Assistant Surgeon P. Gregg reported that "either in conse- quence of deficient flap or subsequent sloughing the bones protruded and became necrosed. It was deemed necessary by Surgeon W. Watson, U. S. V., in charge, and myself to re-amputate. I performed the operation on May 17, 1665. It was necessary to remove the head of the fibula. The joint is useless for any practical purpose." The patient was discharged from service August 10,18G5, and pensioned, since when he has been supplied with artificial limbs at stated intervals. Surgeon G. G. Craig, of Rock Island, who examined the stump on February 9, 1877, reported that "the patella and a portion only of the head of the tibia are remaining, which are drawn back and anchylosed." The pensioner was paid June 4, 1880. Case 759.—Lieutenant-Colonel E. P. Taft, 9th New York Heavy Artillery, aged 32 years, Avas wounded in the left leg, at the battle of Monocacy, July 9, 1864. Assistant Surgeon T. H. Helsby, U. S. A., reported: "The patient was admitted to hospital at Frederick the day after receiving the injury, which consisted of a fracture of the tibia and fibula in the lower third, caused by a conical bullet. Buck's extension apparatus was applied, with water dressings to the wound, and a generous diet was ordered. Secondary hsemorrhage having occurred from the posterior tibial artery, it became necessary on July 22d to amputate the limb. The opera- tion was performed by Assistant Surgeon R. F. Weir, TJ. S. A., in the upper third, near the tubercle, by the circular method. At the time of the operation the parts were in an unfavorable condition from fading erysip- elas and loss of blood, and the constitutional state of the patient was anaemic and depressed. Simple dress- ing was applied and a good diet administered. Secondary haemorrhage occurred from the stump on July 24th, for which the popliteal artery was ligated iu the stump. Moderate sloughing was arrested by the application of a solution of permanganate of potash, and the after treatment consisted of quinine, porter, and stimulants. On September 7th, the patient received a leave of absence. When he left the hospital he was in fine spirits, his appetite and general condition was good, and the stump looked healthy and was almost healed." The amputated bones of the leg (Spec. 3926), showing the tibia to be shattered and the fibula fractured transversely, were forwarded to the Museum by the operator and are represented in the wood-cut (FlG. 297). Lieutenant- Colonel Taft was mustered out November 28, 1864, and subsequently re-commissioned as Colonel. He became a pensioner after being ultimately discharged from service. Dr. William G. David, of Lyons, N. Y., who testified that he was the attending physician of the pensioner, reported that "the shock to his constitu- tion from the wound and loss of the limb, as well as the long-continued and excessive discharge from the stump, so prostrated and reduced him that he never recovered his health, but continued anaemic, and died of dropsy on January 20, 18G7." Fatal Lntermediary Amputations in the Upper Third of the Leg.—The operations belonging to this group number one hundred and two—fifteen performed on Oonfederate and eighty-seven on Union soldiers. Erysipelas was noted in five, tetanus in six, gangrene in eighteen, and pyaemia in nineteen instances. Specimens in twenty-two of the cases are preserved in the Army Medical Museum. Fin. 207 —Lower third, left lejr: tibia shuttered and fibula transversely frac- tured. Spec 392G. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG 515 Case 7G0.—Private J. N. Coder, Co. K, 4Gth Pennsylvania, was wounded in the left leg, at Cedar Mountain, August 9, 18G2. He was admitted to Wolfe Street Hospital, Alexandria, five days afterwards, where amputation was performed by Acting Assistant Surgeon S. E. Fuller, who reported the following history: "A rifle ball passed through the leg, fracturing the tibia about its middle. The limb was amputated three inches below the knee joint by the circular method, by order of Surgeon J. E. Summers, U. S. A., in charge of the hospital, on August 27th. Three days after the operation the stump had become much swollen, with red streaks extending up the limb; no suppuration. Quinine and brandy were ordered internally and warm- water dressings were applied to the stump. August 31st, patient much the same; treatment continued, and limb painted with muriated tincture of iron as far as the redness extended. September 1st, swelling great and no suppuration ; sutures removed and 6ome thick dark-colored fetid matter washed out of the stump. September 4th, redness disappeared; swelling less; no suppuration; treatment continued. On September 7th some sloughing of the stump appeared, when lint wet with solution of chloride of soda was applied, and the parts were occasionally touched with nitric acid. On September 14th about two inches of the soft parts came entirely away, leaving a granulating surface, and the patient appeared better and had good appetite. On September lGth, I called at 2 A. M., found the peroneal artery bleeding freely, and applied a tourniquet to the femoral, giving brandy and opium internally. There was no return of the haemorrhage, but the patient gradually sank, and died September 19, 1802." The amputated tibia, showing periostitis to have covered the shaft with a delicate coating of callus, was contributed by the operator, and is specimen 321 of the Surgical Section A. M. M. Case 761.—Private G. Kimmel, Battery I, 1st New York Light Artillery, was wounded in the right leg, at Chancellors- ville, May 3,1863. Assistant Surgeon J. R. Smith, 13Gth New York, recorded the wounded man's admission to the field hospital of the 2d division, Eleventh Corps, May 15th, and his "death from pyaemia, after amputation of the leg below the knee, June 3, 18G3." Surgeon R. Thomaine, 29th New York, who contributed the specimen (No. 1542) shown in the adjoining wood-cut (FlG. 298), reported that the attempt was made to save the leg, but amputa- tion had to be performed thirteen days after the reception of the injury on account of suppuration. The specimen consists of the amputated bones of the leg, exhibiting the tibia to be shattered in the upper third, and showing a decided effort of nature to throw off the dead bone. Case 762.—Private E. Williams, Co. F, 136th Pennsylvania, aged 45 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, reported his admission to the field hospital of the 2d division, First Corps, with "shot wound of right leg." Surgeon 0. A. Judson, U. S. V., contributed the pathological specimen with the following description: "The wound was caused by a minie" ball entering the upper part of the middle third of the tibia, passing obliquely downward and backward, fracturing the bone in its course and wounding the anterior tibial artery, and emerging through the gastrocnemius muscle. The patient was admitted to Carver Hospital, Washington, December 21st. The leg was placed in a fracture box and the bone kept well in apposition. Water dressings were applied. The patient progressed favorably until December 28th, when a profuse and continually recurring haemorrhage set in which resisted ordinary measures for its control. Amputation was accordingly resorted Fie. 299.— to, and performed at the upper third of the leg by flap operation. On January 1, 1863, haem- mj'i,n'e third orrhage to the amount of thirty ounces occurred from the anterior tibial artery in the stump, of right tibia. which was laid open and the bleeding vessel was secured. But the patient gradually sank, and died the evening of the same day. His system was also infected with pyaemia. Examination revealed an oblique fracture of the tibia, also that a piece of bone had been driven into the anterior tibial artery. The inter-muscular tissues of the limb were distended by pus." Tlie wood-cut (FlG. 299) is a representation of the amputated 6haft of the tibia (Spec. 634), which was comminuted in the middle third but shows very little displacement of fragments. Table LXXII. Summary of Two Hundred and Ninety-six Cases of Intermediary Amputations in tlie Upper Third of tlie Leg for Shot Injuries. LP FIG. 298.—Portions of bones ol" right leg; tibia fractured in up- per third. Spec. 1542. [Recoveries, 1—194 ; Deaths, 195—296.] NO. Name, Military Description, and Age. Dates. OrKUATIOXS, OrERATOKS, Result. NO. Name, Military Description, and Age. Dates. Operations. Operators, Result. 1 2 3 4 5 6 7 8 Adams, W. J., Pt., A, 12tu Ohio. Ames, (I. W., Pt., E, 3d Michigan, age 20. Antry, W. jr., Serg't, C, 24th N. C. age 25. Armstrong, K., l't., G, 14th Inlkutry, age 23. Arnold. L., Pt., G, 143d Pennsylvania, age 20. Baker. D.. I.ieut., G, 8th Kansas, age 30. Panics. 11. II., Pt., B, Sth Vermont, age 47. Barnelt, A. J.. Serg't. D, 32d Georgia, uge 35. Sept. 14, 17, '02. Aug. 30, Sept. 15, 1802. April 6, 9, '05. Julv 2, 9, 03. May 25, 29, '64. Sept. 19, 23, '03. JInv 5, 12. *G4. Julv 2, C, '03. Right. Discharged Nov. 29,1862. Suicide .Innnary 4, 1870. Left; circular. A. A. Surg. R. Ottinun. Discharged July 20, 1803. Left; circular. To prison April 17, 1805. Left (also wound left arm); post. Hap. Ass't Surg.W. K. Knmsav, II. S. A. Disch'd Sept. 15,180*3. Right (May 25. exe'n tibia): flap. A. A. Snrg. C. Darby. Disch'd June 17. I8G5. Left: nnt. post. flap. To Veteran Weserve Corps June 28, 1804. Left; flap. Discharged July 15, 1805. Right: flap. Exchanged Septem-ber 25, 1863. 9 10 11 12 13 14 15 16 Barron, J. G., Pt.. C, 4th Artillery, age 19. Barrows, II. C., Pt., F, 9th Maine. Beaty, M., Pt., C, 149th New York. Beehtel, II., Pt., I, 51st Indiana, age 24. Berkel, M., Pt., A, 25th Illinois. Billings, C. T., Pt., D, 7th South Carolina. Booth, II., Pt., 11, 40th New Vork. Bowen, F. A., Serg't, K, 30th New Vork. May 3, 18, '03. July 18, 21, 03. May 3, 10, '03. Dec. 10, 21, '04. De.31,'02, Jan.6,'03. July 10, 14, '03. Aug. 29, Sep.0,'02. July 1, 6, '02. Left: flap. Surer. C. S. Wood, 00th New York. Discharged August 20, 1803. Left; circ. Confederate surgeon. Discharged March 8, 1864. Right. Ass't Surg. D. II. Strick-land, lllth Penn. Discharged March 31, 1804. Spec. 1271. Loft; ant. post, flap; gangrene. Discharged June :.'7, 1805. Right. Surg. J. Blount, 25th 111. Discharged July 20, 1803. Right; circular. Exchanged July 23, 1803. Left; post. flap. A. Snrg. G. M. McGill, U. S. A. Discharged July 7, 1803. Spec, l'llili. Left; flap. Discharged October 1, 1802. 516 INJURIES OF THE LOWER EXTREMITIES. [ciiap. x. Name, Military Description, and Age, Operations, Operators, Result. Bowers, E., Pt., B, 2d Col'd Troops, age 25. Bowles, J. L., Pt., A, 101st New York. Bowman, F. M., Ft., H, 1st Missouri. Bradish, A. L., Pt., K, 6th Maine, age 40. Briggs, D. J., Pt., B, 1st Michigan. Brooks, E., Pt., C, 145th New York, age 18. Brooks, S. S., Pt., B, 8th Indiana, age 23. Brown, H., Corporal, I, 50th Penn., age 31. Brown,P. .7., Pt., E,24th Alabama, age 24. Buttle, S. W., Pt., G, 3fith New York. Carnaban, T. A., Corp'l, I, 9th Pennsylvania. Case, IL, Pt., I, 12th New York. Catew, J. P., Pt., E, llth Virginia. Cavanaugh, J., Pt, B, 12th Massachusetts. Chapman, J. P., Pt., 1, 61st Georgia, age 27. Cheever, A. J., Pt., K, 16th Massachusetts. Clark, 0."W., Serg't, C, 30th New York. Clark, W. S., Pt., G, 5th Artillery. Clements, I. N., Pt., F, 122d New York, age 23. Colson.C. H.,Pt,,B, 31st Maine, age 22. Connolly, T., Pt., H, 115th N. Y., age 20. Cooper, "VV. II. M., Pt., K, 19th Indiana, age 22. Cotter, T., Pt., F, 30th Massachusetts. Cotton, T., Pt., I, 26th Col'd Troops, age 38. Courtney, A. H., Corp'l, F, 26th N. C, age 26. Covert, A., Pt., I, 12th Michigan. Craft, W. S., Capt., H, 1st Penn., age 23. Curtz, G. R., Pt., H, 61st Penn., age 18. Davis, H., Pt., K, 1st Kansas. Davis, M., Pt., F, 14th New Hamp., age 19. Davis, W. B., Pt., C, 10th New York, age 21. Day, H. I\, Pt., F, 12th New Hampshire. ■ Decatur, D. F., Pt., K, 35th Massachusetts. Dedman, J. H, Pt., A, 56th Virginia, age 30. Deery, S., Pt., K, 90th New York. De Laney, C, colored, civilian, age 47. Dew, A., Pt., I, 31st Ohio, age 20. Diviney, P.,Pt., B, 170th New York, age 23. Down, H., Pt., K, 44th New York, age 22. Mar. 0, !), '65. Sept. 1, 4, *62. May 16, 19, '63. Mav 3, 6, '63. July 21, 26, '01. May 3, 17, '63. Oct. 19, 29, '04. Sept. 30, Oct. 14, 1864. Jan. 3, 1863. May 31, June 20, 1862. June 30, J'y 3,'62. Aug. 29, Sep.8,'62. Julv 3, 10, "63. Sept. 17, Oct. 15, 1862. July 9, 21, v64. July 2, 14, *63. Aug. 30, Sept. 6, 1862. Mav 2, 21, *'63. May 5, 10, '64. July 3, 30, "(64. Feb. 20, 24, '64. Aug. 27, 27, '62. May 27, June 4, 1863. July 7, 10/64. July 1, 6, '63. April 6, Mayl,'62. May 27, June 17, 1864. May 6, 9, '64. Aug. 10, —, '61. Sept. 19, 22, '64. Oct. 27, Nv. 4, '64. July 2, 29, %3. Sept. 17, Oc.17,'62. July 2, 5,'63. July 13, 21, '63. Mar. 10, April 4, 1865. Sept. 20, Oct. 4, 1863. June 16, 20, '64. June 22, J'y 6, '64. Right; circ. Confederate surgeon. Discharged Jan. 18, 1866. Right; post. flap. Discharged February 12, 1863. ---. Retired February 9, 1865. Left; flap. Surg. F. S. Holmes, 6thMaine. Disch'd Aug. 21,'63. Right; circ. Surg. St. (1. Peachy, P. A. C. S. Disch'd Jan. 26, '63. Left; post. flap. Ass't Surg. L. W.Kennedy, 123d New York. Discharged August 21, 1863. Left; lateral oval-flap. A. A. Surg. R. H. Sterling. Disch'd July 28, 1865. Left; anterior posterior flap. Con- federate surgeon. Discharged March 19,1865. Right: circ. Furloughed June 16, 1863. Right; circ. A. Surg.W. Thom- son. Jane 28, hsem. Disch'd May 25, 1863. Died Jan. 28, 1869. Spec. 4937. Left. Discharged September 2, 1862. Right; flap. Act. Ass't Surg. D. Weisel. Disch'd Nov. 11,1862. Left. Union surgeon. Trans- ferred Julv 23, 1863. Left. Surg. B. A. Vanderkieft, U. S. V. Discharged December 27,1862. Left (also w'nd chest and thigh); circ. Snrg. C. II. Todd, C. S. A. Exchanged Oct. 17, 1864. Left. July 18. amputation thigh, middle third. Discharged Jan- uary 27, 1864. Right. A.Surg. B.Howard, U.S. A. Disch'd Nov. 22, '62. Died April 17,1868. Left; circular. Discharged. Left; circ. Confederate surgeoa. Disch'd November 30,1864. Right; circular. Discharged Jan- uary 6, 1865. Left; ant. post. flap. Surg. E. Giddings, O. S. A. Discharged June 9, 1865. Right; flap. A. Surg. Green, 19th lnd. Disch'd August 26,1863. Left; flap. Surg. S. K. Towle, 30th Mass. Discharged August 25, 1863. Right; flap. Discharged July 7. 1865. Left. Paroled September 22, '63. Left; flap. Discharged August 8, 1862. Right; ant?post. flap. A.A. Surg. W. II. Finn. Discharged Sep- tember 27, 1864. Right; flap. Disch'd April 20, 1865. Died December 28,1874 ; chronic bronchitis. Right. Discharged December 30, 1861. Left; circular. Discharged July 19, 1865. Right: ant. post. flap. Disch'd July 27, 1865. Right; ant. post. flap. A.A.Surg. J. Dickson. Discharged July 9, 1864. Spec. 1611. Right. A. A. Surg.W. E. Towns- end. Disch'd March 13, 1863. Left. Surg. —Harrison, C. S. A. Paroled Sept. 25, 1863. Left; flap. Surg. A. H. Van Nos- trand, 4th Wisconsin. Disch'd December 10, 1863. Left; flap. A. Surg. E. Gregory, 17th Conn. April9, haemorrhage. Recovery May 18, 1865. Right (necro.; gang.); ant. post. flap. A. A. Surg. C. E. Boyle. Discharged February 3,1865. Left; lat.flap. Dr. A. Garcelon, of Maine. Discharged Feb. 1, 1865. Spec. 2775. Left; circ. A. Surg. A. Delany. Disch'd Mar. 18,*65. Spec. 2807. Name, Military Description, and Age, Dudley, W. W., Lieut. Colonel, 19th Indiana. Duffy. H., Pt., G, 8th New York, age 19. Duffy, P., Pt., A, 59th Massachusetts, age 45. Duncan, J. F., Pt., H, 4th Alabama, age 19. Elmer. H., Corp'l, A, llth Mass., age 24. Farmer, M. S., Pt., B, 17th Kentucky. Fessenden, F., Colonel, 30th Maine. Fleming, S., Pt., D, 12th West Virginia. Flyhouse,P.,Pt.,A,10th Infantry, age 27. Foss, H., Pt., H, 9th Ohio, age 25. Fox, J. N., Pt., K, 24th Alabama. Friend, J., Pt., E, 43d Ohio. Fuchs, F., Serg't, A, 5th Ohio. Gage, C. F., Pt., I, 15th Massachusetts. Galloway, E. T., Pt., D, 56th Penn., age 15. Garvin, M., Pt., D, 69th New York, age 22. Operations, Operators, Result. July], 9, '63. Oct. 27, 30, '04. May 24, June 17, 1864. July 2, 29, "'63. July 2, 12, '63. Feb. 15, 25, '62. April 23, 30,'64. June 13, 19, '63. May 6, 12, '64. Sept. 19, 23, '63. Nov. 25, Dec.8,'63. Mar. 4, 20, '62. Mar. 23, 30, '62. Sept. 17, 20, '62. Mav 5, 29, "*64. July 1, 18, '62. Gates, O. H., Pt., H, 1st New York, age 20. George, G. VV., Lieut., I, 5th New Hampshire. Glenn, E., Corp'l, D, 24th Wisconsin, age 19. Goodrich, L. H., Pt., B, 6th Vermont, age 30. Graham, W. IL, Pt., E, 1st W. Virginia, age 21. Grant, A. D., Pt., K, 8th Vermont, age 21. Grant, J., Pt., A, 7th Wisconsin. Greenough, L., Pt., B, 1st La. Cavalry, age 23. Grigsby, P., Pt., C, 7th Ohio. Guilford, G., Pt., A, 67th Ohio, age 20. Hachmann, J., Pt., B, 41st New York. Hall, J. O., Pt., D, 8th N. Y. Heavy Artillery, age 28. Hamilton, A. C, Pt., H, 18th Ohio. Hammond, R., Pt., A, 15th Ohio, age 24. Harkins, T., Pt., 1,115th Pennsylvania, age 21. Hatch, O. C.,Pt.,C, 48th Pennsvlvania" age 29. Hauer,"L., Pt., C, 1st Missouri Lt. Artillery. Hay, T. H., Lieut., B, 54th New York. Hibbard, J. J., Serg't, D, 7th Wisconsin. Heart, W. A., Corp'l, D, 29th Ohio. Julv 2, 5, '63. Sept. 17, 21, '62. Sept. 20, 30, '63. May 4, 7, fe. June 5, 25, '64. Oct, 19, Nov. 13, 1864. Sept. 14, Oct. 4, 1862. May 17, 20, '63. De.27,'62, Ja.20,'63. July 18, 21, '63. Aug. 30, Se. 14,'62. June 16, 21, '64. Jan. 1, 15, '63. April 7, 11, '62. July 3, 10, '63. Aug. 29, Sep.5,*62, Aug. 10, Sep.4,'fil July 2, 23, ^63. July 1, 20, N63. June 9, —. '62. Hedgpath, J. P., Pt., A, May 16. 31st N. C., age 25. J'ne7,'64. Hoffman, F., Pt., H, 2d June 18, Penn. Heavy Artillery,' July 18, age 18. I 1864. Right. Dr. S. O. Kinger, Littles- town. (July 3, excision fibula; gangrene; haemorrhage.) Dis- charged April, 1864. Left; circular. Confederate sur- geon. Disch'd Aug. 7, 18C5. Left; ant. post. flap. A. A. Surg. H. M. Dean. Discharged Aug. 24, 1865. B Right. Exchanged November 12, 1863. Right. Discharged February 19, 1864. Left. A. Surg. A. P. Shackleford, 17th Kentucky. Disch'd July 16, 1862. Right; flap. Surg. F. Bacon, U. S.V. Promoted Brig. Gen. May, 1864, and retired. Spec. 3603. Right. A. Surg. S. P. Bryan, 12th West Virginia. Disch'd April 21,1864. Left; circular. Recovery. Acci- dentally killed Jan. 26, 1865. Right. Confed. surgeon. Dis- charged June 4, 1864. Right; post, flap (haemorrhage). Exchanged February 14,1804. Left. Surg. F. M. Rose, 43d Ohio. Discharged August 7, 1862. Left; flap. Discharged July 18, 1862. Left, Surg. S. N. Sherman, 34th N.Y". Discharged Jan. 10,1863. Right; circ. Surg. J. A. Phillips, 9th Penn. Reserves. Disch'd May 19, 1865. Right; circ. A. A. Surg. D. W. Cheever. Disch'dMay22,1863. Died June 23, 1869; consump- tion. Spec. 22. Right; circ. Surg. N. Hayward, 20th Mass. Disch'd Oct. 17,'C4. Left, Surg. L. M. Knight, 5th N. H. Disch'd March 7, 1863. Right; circ. (other w'nds). Surg. T. L. Magee, 51st 111. Disch'd Nov. 28, 1864. Insane, 1872. Left; flap. Confederate surgeon. May 10, ham.; lig. ant. tibial. Discharged March 19, 1864. Left; circ. (recur, haemorrhages). Discharged November 20, 1804. Died December 9, 1807. Left; ant. post. flap. A. A. Surg. A.W.Emory. Discharged June 28. 1865. Spec. 3475. Left. Ass't Surg. A. H. Smith, U. S. A. Gangrene. Disch'd April 2,1863. Specs. 741, 785. Right; flap. Discharged March 14, 1864. Right. Surg. A. K. Fifield, 29th Ohio. Disch'd Aug. 13,1863. Right; ant. post, flap (two w'nds of left leg); gangrene. Disch'd August 23, 1864. Spec. 4304. Left, Ass't Surg. A. M. Clark, U. S. V. DiscVd Oct. 7,1863. Left; circ. A. Surg. G. F.Wins- low, U. S- N. Gangrene. Dis- charged June 19, '65. Spec. 502. Right; flap. Discharged April 27, 1863. Right; flap. Discharged Feb- ruary 21, 1863. Right; flap. Discharged Septem- ber 20, 1864. Right; ant. post. flap. Disch'd September 29, 1863. Right; circular. Discharged. Left. Surg. Z. E. Bliss, U S. V. Discharged June 19,1864. Left; circular. Discharged June 6, 1864. Right. A. A. Surg. W. B. Crain. Disch'd Dec. 23, 1862. Died September 24, '72; colliquative diarrhoea. Spec. 4544. Left; post. flap. Retired Decem- ber 8, 1864. Left; circ. A. A. Surg. J. Money- penny. Necrosis. Dec. 6,1864, amputation thigh. Discharged Aug. 15, 1865. Spec. 3714. SECT. V.J INTERMEDIARY AMPUTATIONS IN THE LEG. 517 99 100 101 102 103 104 105 10G 107 108 109 110 111 112 113 114 115 116 117 118 119 120 122 123 124 125 126 127 128 129 Name, Military Description, and Age Hollinsworth.J. IP"., Ser- geant, G, 22d Alnliama, age 22. Hooper, G. A., Pt., M. 1st Maine Cav., age 25. Housely, H., Cook with the 33d Wisconsin, age 20. Hughes, II. W., Corp'l, I, 133d New York. Hughes, J. D., Serg't, B. Morgan's Cav., ago 31. Hunt, H. C, Pt., C, 22d Wisconsin, age 31. Hutchinson, H., Corp'l, G, 15th Conn, age 25. Irons, D. IL, Pt., A, 0th Colored Troops, age 24. Jeffords, F., l't., C, 77th New York. Johnson, A. C, Pt., C, 3d Michigan. Johnson, W. F., Serg't, H, 84th Illinois, nge 19. JokcL O., Pt., K, 15th Missouri, age 23. Jones, J. A., Pt., I, 8th Colored Troops. Keeney, R., Corp'l, K, 143d Penn., age 21. Kehr, C, Pt., I, 58th N. York, age 35. Kenyon, L., Pt., D, 28th New York, age 20. Kerns, G. D., Pt., H, 155th Penn., age 19. Kinnev, 1. N., Pt., D, 35th "Illinois. Klinker, H., Pt., C, 26th Wisconsin, age 28. Koeth, G., Pt., B, 140th New York, age 24. Krieger, A., Pt., B, 43d Illinois. Lackey, J., Sergeant, G, 14th La., age 23. Lawson, J., Pt., H, 12th Penn. Reserves, age21. Leonard, J., Pt., D, 36th New York, age 21. Lncas, J. P.. Lieut., E, 5th Penn. Reserves. Marble, J. D., Pt., D, 7th Wisconsin. Martin, J., Pt., G, 4th New York, age 27. Martin, S. J., Serg't, G, 6th Kansas Cavalry, age 27. McCracken, J.H.,Corp'l, A, 8th Md., age 24. McDonald, J. S., Capt., B, 15th New Jersey, age 22. McGuire, J., Pt., F, 73d New York, age 17. ■McKnight, J., Pt., A, 17th Mass., age 25. McLaughlin, H., Pt., E, 10th Infantry, age 22. McNanny, C, Pt., G, 106th N. York, age 35. Metcalf, L. H., Pt., E, llth New York. Milan, J., Pt., G, 1st Texas, age 30. Mille, J. M., Serg't, G, 8th South Carolina. Miller, C, Pt., G, 9th Pennsylvania, age 19. Mundhenk, H. W., Pt., B, 93d Ohio, age 20. Mnrphy, J., Pt., F, 52d Pennsylvania, age 21. Dec. 15, 16, '04. Oct, 2, 29, '64. April 2, 11, '65. June 14, 24, '63. Juue 10, 23, '64. July 20, 29, '64. Mar. 8, 14. '05. Sept. 29, Oct. 2,'04 April 4, 7, 02. Sept. 26, 29, '01. May 30, June 7, 1864. Nov 30, Dec.5,'64 Feb. 20, M'h6,'64, May 5, 30, '64. Aug. 30, Sep.2,'62. Aug. 9, 12, '62. June 18, 30, '04. Mar. 7, 26, '62. July 1, 7, '63. May 8, 14, '64. April 6, 9, '62. May 5, 12, '64. Dec. 13, 17, '62. July 1, 13, '62. Dec. 13, 17, '62. Aug. 28, Sep.1,'62. Sept. 17, Oct. 12, 1862. Mar. 14, 21, '64. Mav 8, 12, "'64. May 6, 13, '64. May 4, 21, '63. Dec. 16, 29, '62. June 27, 30, '02. Aug. 26, Sept. 21, 1864. July 21, 26, '61. July 2, 23, rG3. Sept. 20, 27, '63. June 30, July 30, 1862. Mav 9, 29, "'04. May 5, 13, '62. OPERATION!' 1!F.: , Operators, I'l.T. Left; ant, post. flap. A. A. Surg, A. Rolls. Hemorrhage. To Provost Marshal March 27,1805. Right circular. Disoh'd April 15, 1805. Left ; ant. post, skin flap, circ. of muscles. Alsonmp. rightthigh. Surg. F. 10. Piquette, 86th Cold Troops. Recovery. Right. A. Surg. J. Hotnans, jr., U. S. A. Discli'd Oct. 12, 1863. Amputation thigh. Recovery. Left; nnt. post, skin flap. A. A. Surg. I. L. Stockwell. Hcemor. To l'rovost Marshal Oct. 13/64. Left; ciro. Surg. K. L. liissell, Sth Conn. Disoh'd Aug. 22,'05. Bight, Surg. 10. B. Haywood, C. S.A. Disch'd Nov. 7, 1805. Right. Discharged May 10,1805. Right: flap. Surg. A. Campbell, 77th N. Y. Disch'd June 9,'62. Right; ant. post. flap. A. Surg. J.W. S. Gouley, U.S. A. Dis- charged Jan. 26,1802. Spec. 345. Right; circular. A. Surg. C. C. Byrne, U.S.A. May 17,reamp. leg. Discharged June 8, 1865. Right; circ. Confederate surgeon. Discharged August 1, 1865. Left; circular. Discharged Oct. 5. 1865. Left; circ. A.A. Surg. D.G. Cald- well. Disch'd Nov. 17, 1864. Left; circular. Discharged Feb- ruary 1, 1864. Left; circ. Disch'd Nov. 19, '62. Died September 12, 1868. Left; circ. A. A. Surg. W. E. Sparrow. Disch'd Jan. 10,1865. Right, A. Surg. W. S. Grimes, 4th Iowa. Disch'd July 30, '62. Left. Surg. J.A.Armstrong,75th Penn. Disch'd April 9, 1865. Right; post. flap. Discharged April 28, 1865. Left; flap. Discharged August 7, 1862. Left; circular. Paroled July 12, 1865. Right; flap. Discharged August 24, 1864. Left. Surg. A. B. Mott, U. S. V. Discharged May 6, 1803. Right. Confed. surgeon; gang. Discharged Sept. 17, 1803. Right; circ. Discharged Janu- ary 22, 1863. Left; flap. A. A. Surg. J. H. Pea- bod v. Disch'd Dec. 13,'62. Died Dec". 24, '76. Specs. 744, 4433. Right; flap. Surg. J. S. Redfield, 6th Kansas Cavalry. Discli'd October 7, 1864. Right; circ. Surg. S. Moore, O. S. A. Disch'd March 17,1865. Right (also other wounds); circ. Snrg. L. W. Oakley, 2d N. J. Discharged December 15, 1864. Right; circ. Surg. A. B. Mott, U.S.V. Disch'd May 11,1865. Left: flap. Surg. I. F.Galloupe, 17th Mass. Discharged June 2, 1863. Left. Confederate surgeon. Dis- charged January 22, 1863. Left; circ. A. A. Surg. C. H. Jones. Discharged June 1, '65. Spec. 3432. Left; flap. Surgs. Gibson and Peachy, C. S. A. Discharged. Right; short ant., long post. flap. A.A. Surg. B. Stone. Recovery. Spec. 2052. ---. Surg. J. T. Gilmore, C. S. A. Recovery. Left; circular. Aug. 14, hsemor- rhage ; ligation femoral artery. Discharged June 29,1863. Left; circular. A. A. Surg. L. E. Tracy. Necrosis. Discharged February 17, 1865. Left; ant. post. flap. Discharged August 9, 1864. Name, Military Description, and Age. Myers, M. S., Pt., F, 76th New York. Nearce, J., Pt., H, 27th Illinois. Neff, W. W., Pt., G, 0th Michigan Cav., nge 18. Newton, W. C, Serg't, G, 3d Iowa. Niohols, A. F., Pt,, G, 4th Penn., age 22. O'Leary, J., Pt,, A, 8th Infantry. ©'Rourke, P., Pt., F,7th New York Heavy Ar- tillery, age 41. Ovintt, F.V., Pt., A, 37th Massachusetts, age 37. Owens, J.,.Pt., H, 10th Louisiana. Owens, W., Pt., H, Elli- ott's Regiment, age 39. Paine, H. E., Brigadier General, U. S. V., age 37. Portingall, I., Pt., E, 3d N.Y. Artillery, age 21. Post, T. H., Pt., H, 2d Infantry, age 30. Power, W., Corp'l, D, 47th New York, age 23. Proper, J., Pt., K, 20th New York. Rand, W. H., Pt., F, 4th Mass. Cavalry, age 19. Rapp, A., Pt., I, 5th N. Jersey. Rewitzer, E., Pt., 1,15th New Hampshire. Ritter, J. J., Serg't, B, 1st Kentucky, age 30. Ritter, M.*V., Lieut., C, 23d Ohio. Rolph, S., Pt., H, 8th Ohio. Rowe, R. W., Pt., H, 1st Missouri Artillery. Ruffenah, J., Serg't, E, 48th Miss., age 31. Rntter, A., Pt., C, 100th Pennsylvania, age 20. Sandford, R. L., Corp'l, E, 118th Penn., age 30. Sandford, W. R., Pt., D, 23d Virginia, age 25. Shantz, J. J., Pt., K, 1st Michigan, age 33. Smith, R. A., Pt.,G, 77th Ohio. Spahman, J., Pt., F, 62d Pennsylvania. Squire, W. P., Pt,, C, 75th Illinois, age 20. Stack, W., Boatswain's Mate, U. S. Stenmer Meteor, age 25. Starkey, G. L., Pt., D, 19th Maine, age 21. Steele, W., Pt,, G, 70th New York. Sullivan, J., Pt., D, 6th Massachusetts. Sullivan, P., Corp'l, K, 82d Illinois. Taft, E. P., Lieut.-Col., 9th New York Heavy Artillery, age 32. July 1, 22, '63. Nov. 7, 14, '01. .Inly 0, !), '03. Oot. .">, 8, '02. Mav !l, 13, "'04. Aug 9, 14, '02. May 31, June 6, 1864. Aug. 21, Sept. 2, 1864. July l, 21. '62. Oct. 25, Nov. 15, 1864. June 14, 24, '63. May 16, 19, '64. Oct. 19, 24, '63. July 30, Aug. 3, 1864. Sept, 1, 12, '62. July 3, 22, '64. May 3, 10, *i63. May 27, J'e 4,'63, Sept. 19, Oc.17,'63, Sept. 14, 17, '62. Mar. 23, 27, '62. Aug. 10, 24, '61. May 3, 10, '63. June 2, 20, '64. Sept. 17, Oc.15,'62, July 3, 17, "to. Feb. 6, 10, '65. April 6, 11, '62. July 1, 4, '62. Sept. 2, 19, '64. Mar. 20, 26, '65. July 2, 11, '63. July 22, Au.3,'63. Aug. 29, Sep.-,*62, May 2, 6, f62. July 9, 22, '64. Operations, Operators, Result. Right; circ. Discharged Sept. 20, 1864. Spec. 2456. Right; flap. Surg. E. H. Bow- man, 27th Illinois. Discharged August 7, 1863. Left; flap. Confederate surgeon. Disch'd May 24, '64. Spec. 6691. Right, Discharged April 7,1863. Left; circular. Duty September 19, 1864. Left; longpost. flap. Surg. J. E. Summers, U. S. A. Discharged June 16, 1863. Spec. 3046. Left; ciro. A. Snrg. W. Thom- son, U. S. A. (May 31, excision 6 ins. tibia.) Discharged July 28, 1865. Specs. 1502, 3540. Right; semi-oval skin flap, circ. tissue flaps. A. A. Surg. G. H. Dare. Disch'd Aug. 2, 1865. ----; circ. Surg. — Rosser, C. S. A. Retired March 1, 1805. Right; ant. post. flap. A. Surg. W. H.Warner, 3d Wis. Cavalry. Exchanged January 27, 1865. Left. Dr. Stone, New Orleans, La. Resigned May 15, 1865. Commissioner of General Land Office in 1878. Right; flap. Confederate surgeon. Discharged June 25, 1865. Left; circ. A. A. Surg. R. Bartho- low. Nov., gangrene. Disch'd February 18, 1864. Right; flap. A. A. Surg. S. J. Holly. Disch'd March 2, 1865. Died Sept. 18, '70; consumpt'n. Right; circular. A. A. Surg.C. M. Ford. Discharged Novem- 27, 1862. Left; flap. Ass't Surg. H. M. Sprague, U. S. A. Discharged December 13, 1864. Right; post, and ant. flaps. Surg. G. P. Oliver, lllth Penn. Dis- charged Mar. 18,'64. Spec. 6695. Left; flap. Mustered out Aug. 15, 1863. . Left. Surg. — Fithian. C. S. A. Discharged June 18, 1864. Right, Resigned February 14, 1863. Left; circ. Surg. G. W. Clippin- ger, 14th Indiana. Discharged October 25, 1862. Left; flap. A. Surg. S. H. Mel- cher, 5th Mo. Discharged. Left: flap. Retired February 22, 1865. Right; flap. Surg! G. L. Pan- coast, U. S. V. Disch'd May 4, 1865. Spec. 2587. Left, Surg. M. Storrs, 8th Conn. Discharged March 16, 1863. Right. Surg. — Dorbet, C. S. A. Necrosis; haemorrhage; erysip- elas. Exch'd March 17, 1864. Right; circ. Discharged Aug. 4, 1865. Right. Discharged September 29, 1862. Left; flap. Discharged October 14, 1862. Left; circ. A. Surg. T. A. Mc- Graw, U. S. V. Disch'd March 6,1865. Sept., 1865, amp. thigh, middle third; gangrene. Right, Dr. Langler, U. S. N. Discharged August 18, 1865. Died July 29, 1872. Left; circ. A. Surg. H. C. Leven- saller, 19th Maine. Recovery. Died January 31, 1877. Left; flap. Discharged January 30, 1864. Left. Discharged May 5, 1863. Died April 8, '70; lung disease. Left; flap. Discharged Septem- ber 11, 1803. Left (hsem.); circ. A. Surg. R. F. Wier, U. S. A. Ligation popli- teal ttrterv. Disch'd Nov. 28, 1864. Spec. 3926. Died Jan. 20, 1867; dropsy. ■Galloupe (I. F.), Army Medical Intelligence, in Boston Medical and Surgical Journal, 1863, Vol. LXVIII, p. 205. 518 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name. Military Description, and Auk. Operations. Operators, Result. 170 Thomas, J. A., Pt., K, lllth N. York, age 19. 171 201 202 203 204 205 206 207 1208 Tracy, G., Pt., M, 1st Maine Cavulry, nge29. Turner. J. \V., Pt., A, 5th C. Troops, age 34. Tyrrell, P., Pt., I', 4th Rhode Island, age 18. Vangorp, J., Pt., C, 1st Missouri. Wuld, C, Pt., C, 68th New York, nge 25. Warren. E. E., Corp'l, I, 144th New Ycrk. Wu'.son, {'., Corp 1, C, (•tli Kansas Cavalry. Watts, T., Pt., D, 40th New York. Webber, E., Corp], H, 2d Massachusetts. Weiss, E., l't., A, 1st Missouri Lt. Artillery. Welch, T., Pt., D, 30th Illinois. Whalley,E.,Pt.,B, 18th Massachusetts, age 30. Wheeler. J., Pt., A, 8th Connecticut, age 23. White, F., Pt., G, 119th Pennsylvania, age 21. White, J., Pt., I, 14th Indiana, age 23. White, It., Pt., B, 17th Indiana, age 35. Whitehouse, J., Pt., F, 5th N. Hamp., age 17. Whitner, D., Corp'l, A, 107th Ohio, age 21. Williams, S. J., Pt., B, 24th Wisconsin. Wilson, J., Pt., E, 56th New York, age 25. Winter, A.,Corp'l, C, Oth Connecticut. Woods, W. B., Pt., C, llth Alabama, age 25. Yingling, G., Pt., D, 105th l'enn., age 37. •Zuelch, G., Serg't, K. 7th New York, age 25. Ackland, G., Corp'l, H, 21st Missouri, age 25. Adair, F. M., Pt., D, 32d Texas, nge 27. Allen, J. P., Pt., D, 7th Massachusetts. Ash, G. W., Corp'l, K, 23d Kentucky, age 31. Bates, S., Pt., I, 14th N. Jersey, age 18. Beck, W. A., Pt., F, Thomas's Legion. Bee, J. L., Pt., B, 4th S. Carolina Cav., age 21. Benson, N., Pt., C, 45th N. Carolina, age 42. Bland, F. M., Pt., D, 23d Ohio. July 2, 10, "'03. Mar. 31, Ap.18,'65. Sept. 27, Oot.3,'64. Sept. 17, Oct. 5, 1802. Oct. 5, 9, '62. Julv 2, 9, 1>3. Nov. 26, 29, '02. Aug. 24, Se.l9,'C2. Sept. 1, 5, '02. Aug. 9, 12, '62. Aug. 10, Sep.4,'61, De.29,'62, Jan.5,'63. De.13,'62, Jun.3,'03. Sept. 17, 23, '62. May 5, 9, "64. May 5, 18, '64. April 2, 7, '65. April 7, 20, '65. July 1, 24, 63. De.31,'62, Jnn.6,'63 May 31, J'e 3, '62. July 18, 21, '63. June 30, J'y 3, '62. Oct. 27, No.22,'64. Dec. 13, 18, '62. April 4, 24, '65. April 8, 13, '65. Mav 5, 10, "'64. July 27, Au.12,'64. July 9, 29, %4. Sept. 19, Oct. 4, 1864. May 30, June 29, 1864. July 12, Ang.1,'64. May 19, June 17, 1863. Bly, E. P., Pt., A, 83d July 1, Pennsylvania, nge 23. 5, '62. Bond. A., l't., K, 27th ! July 3, Pennsylvania, age 37. 7, 63. Brooks. IL, Pt., K, 20th Mar. 8, Michigan, age 22. 25. '65. Brown. T. C, Pt., F, De.31,'62, 34th Illinois. iJa.l2,*63. Brownfield, G., Pt., ISth Sept. 19, Indiana Bat'ry, age 24. Oct. 8,'0*3. Left. Surg. H. M. McAbee, 4th Ohio. Hsemorrhage. Disch'd April 25, 1864. Left; circ. A. A. Snrg. F. H. Col- ton. Disch'd July 13, 1865. Right; circular; gangrene. Dis- charged March 27. 1865. Right: flap. Snrg. M.W. Rivers, 4th R. 1. Discharged March 6, 1803. Died Dec. 10, 1871. Right j flap. Discharged Feb- ruary 24. 1863. Right; circular. Discharged Jan- uary 19, 1804. Left. A. A. Surg. W. H. Butler. Discharged February 25, 1863. Right; flap. Surg. .l"E. Quidor, U. S. V. Disch'd Aug. 26,18C3. Right; circ. Discharged May 23. 1863. Left. A. Surg. J. AVightman, 2d Mass. Disch'd Jan. 15, 1863. Right: flap. Discharged Novem- ber 29, 1861. Right; flap. Discharged October 12, 1863. Left; circular. Discharged April 25, 1803. Right; post. flap. Surg.W. H. Leonard, 51st N. Y. Ilsemorrh.j exfol.; bone removed. Disch'd November 16,1863. Spec. 2746. Left; cire. Surg. P. Leidy, 119th Penn. Disch'd October 27,1864. Died Dec. 2,'73; consumption. Spec. 1425. Right. Discharged October 11, 1864. Right; flap. A.Surg. R.W.Coale, U. 8. V. Disch'd May 31,1865. Right; circ. A.A. Surg. J. Sweet. Disch'd Sept. 29, 1865. Died February 9,1868. Spec. 4097. Left; circular. Discharged Feb- ruary 7, 1864* Right. A. Surg. H. M. Duff, 52d Ohio. Disch'd Feb. 25, 1863. Right; circular. Discharged Au- gust 9, 1862. Left. Confederate surgeon. Dis- charged February 20, 1864. ----; flap. Surg. A. Wauld, C. S. A. Recovery. Right; circ. Confed. surgeon. Discharged June 26, 1865. Left; circ. Surg. C. Gray, 7th N. Y. Gang. Disch'd May 8, '63. Died July 2,'70; heart disease. Left; ant. post. flap. A. A. Surg. R. W. Tooker. April27, baem.; 29, lig. fem. Died May 1,1865. Left; nnt. post. flap. Surg. J. B. G. Baxter, U. S.V. Died April 22, 1805; typhoid pneumonia. Left. Surg." G. T. Stevens, 77th N. Y. Died May —, 1864. Right; circ. A. A. Surg. C. S. Merrill. Irritative fever. Died August 13, 1804; non-reaction. Right. A. A. Surg. G. M. Paullin. (Haemorrhage.) Died August 23, 1864; pyaemia. Spec. 3941. ----; circular. Ass't Snrg. J. M. Lawson, 30th N. C. Died Octo- ber (i, 1864 : pysemia. Right; oval flap. A. Snrg. J. C. McKee, II. S. A. Died July 2, 1864. Spec. 2716. Left; circ. A.A. Surg. N.A. Rob- bins. Died Aug. 7,T>4; exhaus. Lett. A. A. Surg. J. Thompson. (May 19. Syme's nmp. ankle j't; periostitis.) July 2, amp. thigh. Died July 16,1863; exhaustion. Spec. 1706. Left. Died July 25, 1862. Left. Died September 30, 1863; exhaustion : dinrrhuea. Right (gangrene). Died April 14, 1865. Right. Died January 21,1863. Right: slonghing. Died Novem- ber 19, 1803. 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 Name. Military description", and age. Buck, M. H., Pt., B, — Infantry, age 25. Burns, H. C, Serg't, H, 7th Penn. Cav., age 39. Butts, J. H.,Pt., F, 129th Pennsylvania. Cain, P., l't., D, 88th New York, age 34. Camp, T. S., Serg't, C, 2d Infantry. Campbell, \V. IL, Pt., B. 139th N. York, nge 23. Canfleld, D. W., Pt., M, 14th N.Y. H.A.,nge2l. Castle, W., Pt., D, 17th Maine, age 39. Cecil, R., Lieut., K, 1st Virginia Cavalry. Clare, J., Pt., C, 145th New York. Cloniger, J. W., Pt., K, 72d Indiana, age 22. Coder. J. N., Pt., K,46th Pennsylvania. Crabe,A.B.,Pt.,H, 58th Massachusetts, age 18. Davidson, J.,Pt., E, 88th Pennsylvania. Delaney, J., Pt., G, 67th New York, age 20. Dow, W. R., Pt., E, 15th New Jersey, nge 35. Ellis, C. F., Pt., I, 20th Massachusetts, age 23. Eshleman, I.,Pt.,E, 17th Penn. Cavalry, nge 31. Ettinger, I., Serg't, F, 6th New Jersey. Fisher, A., Pt., H, Cth New Jersey. Ganges. P., Pt., H, 32d Col'd Troops, age 23. Gerral, J., Pt., D, 14tb Indiana. Gray, J. A., Lieut., B, 8th Indiana Cavalry, age 32. Gressnon, E., Pt., Dar- den's Louisiana Batte- ry, age £8. Grube, C. W., Pt., F, 153d Penn., age 31. Haines, J., Pt., A, 26th Michigan, age 46. Hall, W.H., Pt., D, llth South Carolina, age 34. Hathaway.G. R., Pt., A, 125th Illinois, age 24. Herdman,G.,Pt.,G, 121st New York, age 20. Hogan, D., Pt., H, 170th New York, age 40. Holmes, J. B.,Pt.,F, 1st Maine Heav y Artillerv, nge 18. Homer, C. H., Corp'l, L. 10th N.Y. Cav., age 33. Hood, T. M., Lieut., G, 40th Illinois. Hotaling. A , Serg't, A, 7th N. Y. II. A., age 25. Hughs. E., Pt„ G, 124th New York. Hurlbut, A. R., Capt.,A, 5th Vermont, nge 27. Huston, A., Pt., H, 12th Ohio Cavalry, age 18. Jones. J., Pt., I, 27th Indiana. Dates. Nov. 27, Dec. 13, 1863. Oct. 21, Nov. 2, 1864. Dec. 13, 2 i, '62. May 18, June 8, 1804. May 3, 8. 1i3. June 3, 17, '64. June 17, 28, '04. Sept. 21, 29, '64. May 24, —, '64. May 2, 8. '63. Sept. 27, Oc.l4,"64. Aug. 9, 27, '62. June 4, 16, '64. Aug. 30, Se.12,'62. May 6, 27, "'64. May 10, J'e 2,'64. Dec. 13, —, '62. Aug. 25, Sep. 7,'64. Aug. 29, Sept. 19, 1862. May 3, —, '63. Nov. 30, Dee.4,'64. May 1, 15, '63. Sept. 5, 22, '64. Dec. 16, 19, '64. July 1, 19, "'63. May 12, 28, '64. May 9, 16, "'64. June 27, July —, 1864. Nov. 17, 19, '63. May 24, 30, *64. May 19, 25, '64. June 24, Py 9. '64. April 0, 12, '62. June 22, J'vl3,'64. Mav 3, 9, '63. May 5, 10. "'04. July 20, 28,"'64. Aug. 9, 15, '62. Operations, Operators, Result. Left; flap. Surg. E. Bentley, U. S. V. Gangrene. Died Decem- ber 24, 1863; pyaemia. Left; circ. A. Surg. T. A. Mc- Graw, U. S.V. Gangrene. Died November 19,'64; exhaustion. Left. Jan. —, 1863. re-ump. leg; haemorrhage. Died Jan. 30,'63. Left: flap (erysipelas); haemor- rhage. Died June 14, "64 ; l*cin- orrhage. Spec. 2481'. Left. Surg. G. P. Oliver, lllth Penn. Died May, 1803. Left; circ. A. A. Surg. II. M. Dean. Died June 28,'04 : hem. R*t; flap. Surg. G. L. Panconst, U.S.V. Died July 28,1864. Left; aut. post, skin flap. A. A. Surg. J. S. Waggoner. Died Sept. 30, 1864 ; tetanus. Left. (May 24, amput'n at ankle joint.) Died June 22, 1864. ----. Surg. G. P. Oliver, lllth Penn. Died May 15, 1803. Left. Surg. A. T. Barnes, 98th Illinois. Died Nov. 9, 1864. Left; circ. A. A. Surg. S. E. Ful- ler. Erysipelas: hsemorrhage. Died Sept. 19, 1862. Spec. 321. Left; flap. A. A. Surg. J. C. Nel- son. Died; irritative fever and exhaustion. Spec. 2585. Right. Surg. E. Bentley, U. S.V. Died September 25, 1862. Left; circ. Snrg. R. B. Bontecou, U.S.V. Died July 10, 1864; exhaustion. Left. Died June 18, 1864; diph- theria. Left. Surg. P. Pineo, U. S. V. Died January 7, 1863. Left. Surg. Z. E. Bliss. (Gan- grenous.) Died Sept. 23,1864. Right; flap. Surg. E. Bentley, U. S.V. Died September 29, 1862; pysemia. Left. Surg. C. H. Lord, 102dN.Y. (Also w^id of right leg.) Died May 26, 1863. Left. Died December 27, 1864 ; pvieinia. Right. Died May 16, 1863. Left; flap. A. A. Surg. J. H. Green. (Gangrenous.) Died October 2, 1864; pyaemia. Left; ant. post. flap. A. A. Surg. R. Ii. McClure. Died Decem- ber 23, 1864; exhaustion. Left; circular. Died September 4. 1803: erysipelas. Left. Julv 7, hajmorrhage. Died July 8, 1864. Left; circ. A.Surg.H.C.Roberts, U. S. V. Died May 16, 1864. Left. Aug. 11,amputation thigh. Died September 9, 1864; irrita- tive fever. Right: posterior flap. A.A.Surg. W. M. Hudson. Died Novem- ber 24,1863. Right; lat. flap. A. A. Surg. R. Ottman. Died June 26, 1864. Spec. 2472. Right. Surg. D.W. Bliss.U. S.V. Died June 7, '64 ; haemorrhage and diarrhoea. Left: flap. Surg. B. S. Herndon, C.S.A. Died Sept. 9, 1804. ----. Surg. E. ('. Franklin, U. S. V. Died April 20. 1862. Left; circular. A. A. Surg. W. W. Vulk. Died Jul v 20, 1864. Left. Surg. G. P. Ol'iver, lllth Penn. Died .May 19, 1803. Left. Surg. G. T. Stevens. 77th N. Y. Died June 9,'64 ; pyaem. Right: flap. Surg.G. W. Brooks. 12th Ohio. Aug. 28, haemorrh. Died Sept. 15, '04; hectic fever. Left; aut. post. flap. A. Surg. J. B. Brinton. U. S. A. Aug. 18, hiem.: ligation of ant. tibial and interosseous arteries: gangrene. Died August 20, 1862. 'THOMSON (W.), Reportof Cases of Hospital Gangrene treated in Douglas Hospital, Washington, in Am. Jour. Med. Sci's, 1864, Vol. XLVII, p. 389 SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEO. 519 Name, Military Description, and Aok. Kelly, P., Pt., I, 65th New York, age 20. Kiminel, G., l't., Battery I, 1st New York Light Artillerv. Kirby, H. W, Pt., B, 27th S. U , nge 50. Kluinp, G.. l't., D. 98th Pennsylvania, age 50. Lainov," \V. II., l't., I, 97th"New York, age30. Latimer, J. W., Pt., G, 9th Virginia, age 24. Lattin, J. M., Capt., E, lllth X. York, age 28. Loftice, D., Pt., K, Sth Tennessee, age 26. Luther, A. E., Pt., E, 3d Mass. Cavalry, nge 32. McBride, F., Pt., H, 75th Ohio. McDermott, J., Pt., A, 155th New York. McGenry, J. S., Corp'l, II, 8th Pennsylvania Reserves, age 20. McKav, G.W., Capt., K, 34th Ohio, age 23. McKenna, J., Pt., I, llth Pennsylvania. McQune, A., Pt., H, 14th Infantry, age 40. Mc Williams. D. W., Pt., B, 17th Miss., age 34. Mills. N.W., Lieut.-Col., 2d Iowa. Moore, C, Serg't, D, 42d New York. Moore. G.W., Corp'l, C, 8th N. Y. Art'v, age 26. Moore. R. A., Serg't, I, 4th Penn. Reserves. Myres, D. T., Pt., H, 51st Indiana, age 20. Norris. J., Pt., K, 68th Pennsylvania, age 30. O'Leary, T., Pt., K, 4th Artillery. Passenge, C. E., Serg't, E, 37th Illinois, age 23. Randal], C. E., Major, 25th Ohio, age 26. Ray, J. L., Pt., D, 10th Kentucky Cav., age 18. Reddick, M., Pt., E, 1st Florida. Oot. 19, 27, '04. Muv 3, 10, "'03. May 19, 1804. July 11, 20, '04. Mar. 31, April 11, 1805. July 3, 8, '63. June 21, J'y 13,'64 May 14, June 1, 1864. Mar. 4, 19, '64. Mny 3, 9, 1*3. June 3, 12, '64. Dec. 13, 28, '62. Julv 24, 29,"'64. Aug. 30, Sept. 3, 1862. May 12, 23, '64. Julv 2, —, **63. Oct. 4, 11, '62. July 2, Aug. 1, 1863. June 3. 13, '64. Dec. 13, 29, '62. De.16,'64, Jan. 4,'65 July 2, 28, '63. May 2, 8, '63. Oct. 26, Nov. 24, 1864. Nov. 30, Dec.8,'64 June 9, 19, '64. Jan. 2, 5, '63. Operations, Operators, Rksult. Left; circ. A.A. Surg. J. Neff. Died Nov. 8. 1804; pya-inia. Bight. Died June 3,' 1803; py- semia. Spec. 1542. ----: posterior flap. Died May 20, 1804; pysemia. Bight ;circ. (hsemorrhage). Died August 3, 1804. Spec. 2888. Right ; post. flap. Surg. N. R. Moseley, U. S. V. Died April 27, 1805; exhaustion. I.elt. Aug 15, gangrene. Died Sept. 8, 180:!; gang.; diarrhoea. Spec. 1977. Left ; circular. Surg. A. B. Mott, U.S.V. Died July 15,18G4. Left; ciro. A. A. Surg. M. L. Herr. Died June 10, 1864; ex- haustion. Spec. 3503. Left; circ. A. A. Surg. R. W.W. Carroll. (March 13, excision; 15, hemorrhage.) Died April 6, 1804; pyaemia. Right. Died May 12, 1863; py- semia. Left; nnt. post flap. Snrg. N. R. Moseley, U. S. V. Died July 7, 1804. Right; nnt. post, skin flap. A. A. Surg. D. Weisel. Died Teh. 5, 1803; pneumonia. Spec. 200. Right; Hap. A. Surg. C.W. Stin- son, 23d 111. Died Aug. 13, '64. ----. Ass't Surg. B. Howard, U. S. A. Died September 18, 1862; tetanus. ----; flap. A. A. Surg. J. H. Thompson. May 26, haemorrh. Died June 11,1804 ; exhaustion, Left (necrosis). Died Sept. 11, 1863. Spec. 1979. Right; circular. Died October 12, 1802; tetanus. Left (haem.; July 24, lig. post. tibial). Aug. 20, capillary haem. Died Sept. 5, 1863. Spec. 1048. Left; circ. A.A. Surg. C. P.Bige- low. Died June 20,1864 ; hiem. Right. Died January 8, 1863; haemorrhage. Spec. 581. Left. A. A. Surg. W. Anderson. Died January 9, 1865. Left; haemorrhage, 16 oz. Died August 1, 1863. Right. Surg. G. P. Oliver, 111th Peun. (Also wound of leftleg.) Died May 14, 1863. Left; circ. Surg. S. S. Boyd, 84th lnd. (Hemorrhage; ligation.) Died December 13, 1864. Left; circ. Surg. A. Wynkoop, U. S. V. Died Dec. 15, 1864. Left. A. A. Surg. D. Buck. Died June 26, 1864 ; exhaustion. Right. Surg. C. J. Walton, 21st Ky. (Also wound of left foot.) Died January 8, 1803. 276 Namf., Military Description, and Age. Redmond, J. IF, Pt., D, 25th S. C, ago 45. Roberts, W. J., Pt., D, 4th North Curolina. Schwerin, II. R., Capt., C, UUth New York. Sheldon, B., Corp'l, C, 4th N. Y. Heavy Artil- lery, nge 29. Sheppard, M., Pt., 0,7th N. Y. Heavy Artillery, nge 41. Shull, W. J.,Pt.,F,37th Indiana. 1 Skinner, J. S., Pt., K, 2d New Jersey. Stalker.G.W., Pt.,I,83d Pennsylvania, age 23. Stander, C, l't., D, 17th Infantry. Stetson, M., Pt., A, 35th New York. Stout, J. H., Pt., B, 13th Tenn. Cav., age 16. Strasburg, W., Pt., F,8th N.Y. lFvy Art., age 19. Tefft, J. A., Corp'l, I, 140th N. York, nge 25. Tbnyer, A. H., Pt., H, 40th Mass., age 39. Thompson, J. W., Pt., G, 10th Alabama, age 38. Van Bnskirk, I., Lieut., F, 27th Indiana. Van Antwerp, W.,Lieut., F, 13th Indiana, age 24. Vaughn, N., Pt., H, 1st Virginia, age 30. Wade, H. P., Pt., K, 32d Massachusetts, age 30. Whitney, A. S., Pt., E, 3d New Jersey, age 22. Williams, E., Pt., F, 136th Penn., age 45. Wood, J., Pt., A, 3d Maryland Cavalry, age 21. York, M., Pt., E, 120th New York, age 20. Daj-es. Aug. 21, 31, '64. Sept. 19, 24, '64. Mny 2, 9, '03. Oct. 28, Nov. 12, 1804. Muy 21, June 0, 1864. Jan. 2, 5, '63. May 2, 16, '63. July 2, 9, "03. Dec. 13, 20, '62. Aug. 29, Sept. 5, 1802. April 12, 10, '64. June 3, 6, '04. Mar. 31, April 25, 1865. Mav 21, 25,"'64. July 3, Aug. 1, 1803. May 3, 16, '63. May 8, 21, '64. April 1, 20, '65. July 2, 5, 1i3. Mav 8, 28, "'64. Deo. 13, 28, '62. May 18, June 3, 1864. July 2, 27, '63. Operations. Operators, Result. Left: circ. A. A. Surg. .1. Cass. Died Sept. 3, 1804; dinrrlneu. ----; circular. A. Surg. (i. M. Burdett, P. A. C. S. Hemor- rhage. Died October 11, 1804; exhaustion. Right. Surg. J. D. Ilewett, 119th N. Y. (Hiem.: Mav 5, excision.) Amende. Died M*:iy 10, 1803. Right; circ. Surg. O. A. Judson, U.S.V. Died Nov. 10, 1804; pviemia. Right; oval. A. A. Surg. J. C. Nelson. Died June 11, 1804; diarrhoea. Spec. 2475. Left. Surgeon C. J. Walton, 21st Kentucky. Died January 11, 1803; tetanus. Right. Surg. J. A. Lidell.U.S.V. (Also wound of left foot.) Died May 20, 1803; pyaemia. Left. Died July 10, 18G3; tet- anus. Left. Died December 23, 1862. Left; ant. post. flap. A. A. Surg. R. Reyburn. Gangrene. Died September 11, 1802. Right; flap. Surg. H. Wardner, U.S.V. Died April 29, 1804; diarrhoea. Spec 3314. Right. Surg. S. II. Plumb, 82d N. Y. Died July 5,'64; pyaemia. Right. A. A. Surg. C. E.'GoIds- borough. Erysip.; typhoid lev. Died May 2.">, 1665; prostration. Left; circ. A. Surg. II. C. Rob- erts, U. S. V. Died J une 8, '04; exhaustion. Left. (Also flesh wound thigh.) Aug. 19, slough. Stpt. 8, hiem. Died Sept. 18, '63; haemorrhage and gangrene. Spec. 1974. Right. Surg.W. H. Twiford,271h Indiana. Died May 20, 1863. Sprc. 1149. Right; circular. A. A. Surg. G. Coloosdian. Die*May26,1864; exhaustion. Left: circular. A. A. Surg. C. B. Wright. (Gangrene.) Haemor- rhage; ligation posterior tibial. Died April30,1865; exhaustion. Left. Died July 31,'63; pyaemia. Right; circular. A. A. Surg. C. A. Lindsay. Died June 13, '64; pyaemia. Spec. 4570. Right; flap. (Haemorrhage.) Jan. 1, '63, lig. ant. tibial. Died Jan. 3, 1863, haemorrhage. Spec. 634. Right; double flap. A.A.Surg. C. Bausch. Died Juue 11,1864; pyaemia. Left. A. A. Surg. F. Hinkle. (Gang.) July 28, amp. right leg, lower third. Died Aug. 8,1863; exhaustion. Specs. 1605, 1609. The operations were performed in the right leg in one hundred and twenty-seven and in the left leg in one hundred and fifty-eight instances; in eleven cases the side was not indicated. Intermediary Amputations in the Middle Third of the Leg.—Three hundred and sixty-eight cases of intermediary amputations in the middle third of the leg are found on the records. The terminations are ascertained in all: two hundred and fifty-eight ended in recovery and one hundred and ten in death, a mortality rate of 29.8 per cent. Recoveries after Intermediary Amputations in the Middle Third of the Ley.—The two hundred and fifty-eight operations of this group were performed on two hundred and thirteen Union and forty-four Confederate soldiers; in one instance the patient was a citizen employ^. Of the two hundred and thirteen Union soldiers the names of two hundred and 'LIDELL (J. A.), On the Major Amputations for Injuries in both Civil and Military Practice, in Am. Jour. Med. Sci's, 1864, Vol. XLVU, p. 365. 520 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Julv 1, 1863. FIG. 300.—Stump of left leg 10 months after circu- lar amputation in middle third. Spec. 4318. [From a cast, j ten were found on the Pension Rolls. Fourteen have died since the date of their discharge, one from constant discharge of stump, six from phthisis, and seven from causes not stated. In four instances amputation in the thigh was subsequently performed. Case 763.—Private G. W. Smith, Co. F, 76th New York, aged 20 years, was wounded in the left leg, at Gettysburg, He was conveyed to a field hospital of the First Corps, where amputation was performed but not recorded. Surgeon H. Janes, U. S. V., reported that the wounded man was adinitted to Camp Letterman August 20th, his injured leg having been previously amputated, also that the patient did well and required no other treatment than simple dressings to the wound. Surgeon B. A. Clements, U. S. A., reported the following description and termination of the case: "The injury involved the ankle joint and was caused by a mini6 ball, which passed through antero-posteriorly, fracturing the bones. The leg was amputated by the circular method, at the Express Office Hospital, Gettysburg, five days after the reception of the injury. The man at the same time was wounded by another ball in the upper part of the left thigh. This was a flesh wound and healed in about two months. The stump healed kindly, and was entirely well when the patient was transferred to Central Park Hospital, New York City, on October 14th. In December following the stump ulcerated and a portion of a ligature escaped, after which it again healed." On May 20, 1864, when discharged from service at his own request, the patient's general condition was good and motion of the knee joint perfect. After leaving the hospital he was furnished with a "Palmer" artificial leg. In his application for commutation the pensioner describes the stump as remaining in "good condition," and states that Surgeon J. H. Beach, 24th Michigan, performed the amputation. The pensioner was paid March 4, 1880. A cast of the stump (Spec. 4318), showing amputation to have been performed at the middle third, and exhibiting the curious marking of an equal-armed cross on the cicatrix, was contributed by Acting Assistant Surgeon G. F. Shrady, and is represented in the wood-cut (FlG. 300). Case 764.—Private G. Cullom,1 Co. D, 83d Ohio, aged 20 years, was severely wounded in the left ankle joint, at Cham- pion Hills, May 16,1863. He entered and remained at a field hospital for three weeks, when he was sent on board of a Hospital transport. Assistant Surgeon H. M. Sprague, U. S. A., recorded the wounded man's admission on board of the Steamer City of Memphis, June 8th, and his transfer to Jackson Hospital, Memphis, June 14th. Surgeon W. Watson, U. S. V., in charge of Jackson Hospital, contributed the pathological specimen with the following history: "The patient was under the attendance of Acting Assistant Surgeon J. Witham. When admitted he was very much reduced by diarrhoea, greatly emaciated, and suffering from extensive bed-sores over the sacrum. He had undergone amputation of the wounded leg, eight inches below the knee, pre- vious to admission, and both bones were protruding from the stump. Simple dressings were used and adhesive plasters applied to the bed-sores, and he was allowed a generous and nourishing diet, with porter. On June 18th, he was placed upon a water- bed, after which a constant/ but slow improvement ensued and the stump was healing. On August 25th the bone, having become entirely detached, was removed. After this operation the patient's progress was more rapid, and he acquired strength enough to go about on crutches. On September 30th, when the patient was transferred to St. Louis, the stump had nearly healed." The removed fragment (Cat. Surg. Sect., 1866, p. 405, Spec. 2099), consisting of semi-tubular sequestrum from the tibia, five inches in length, is represented on Plate LXXI, FIGURE 4, opposite page 428. The patient was discharged from service, at Jefferson Barracks Hospital, October 19,1863, and pensioned. In the following year he was supplied with an artificial limb by Dr. Douglas Bly who described the amputation as having been performed by the flap method. In his application for commutation, dated 1870, the pensioner stated that his limb was amputated twenty-five days after the reception of the injury. The pensioner died August 27,1872, of consumption, superinduced by the amputation, his attending physician certifying that the stump never healed and never ceased to suppurate, discharging fragments of bone at times. Case 765.—Private J. Sterritt, Co. C, 119th Pennsylvania, aged 39 years, was wounded in the lower part of the leftleg, at Spottsylvania, May 10, 1864. Surgeon O. A. Judson, U. S. V., contributed the patho- logical specimen, shown in the annexed wood-cut (FlG. 301), with the following history: "The wound was caused by a conoidal ball entering the leg anteriorly about three inches above the ankle joint, passing trans- versely through, producing compound comminuted fracture of the lower third of the tibia and involving the ankle joint. The man entered Carver Hospital, Washington, three days after being wounded. At the date of his admission the injured ankle was tumid, red, and painful, and the foot oedematous; but his constitutional state was good and there was no emaciation. On May 14th the patient was etherized and the parts were examined, when the severity of the fracture was discovered and pus was found to have burrowed freely about the ankle joint. Consequently the leg was amputated at the middle third by the skin-flap method and circular Bection of muscles. The operation was performed by Acting Assistant Surgeon O. P. Sweet. The patient reacted well from the shock of the operation and continued to do well. Simple dressings were applied to the stump and stimulants were admin- istered. About half of the anterior flap sloughed, but by June 1st the stump looked well and secreted laudable pus; granulations red and healthy. About June 12th an abscess formed on the crest of the tibia, probably resulting from necrosis of a small por- tion of the bone." The patient recovered and subsequently passed through different hospitals, being ultimately discharged August 7, 1865, and pensioned. Previous to leaving the service he was supplied with an artificial leg. In his application for commutation, dated 1870, he described the condition of the stump as "unhealthy at present," and six. years later he reported it as "inclined to be sore." The pensioner was paid June 4,1880. The specimen (No. 2284) consists of the amputated portions FlG. 301.—Frac- tures in lower thirds of the bones of left leg. Spec. 2284. 1BRYAX (James), Seventeen Additional Cases of Amputations from the Armies of the South- West, in American Medical Times, 1863, Vol. VII, p. 288. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LfiG. 521 of the bones of the leg, and shows the extremities of tlie fibula to have been carried away and the adjacent portion of the tibia to be broken. Another fracture, where the bone was chipped, is also exhibited five and a half inches above the joint, from which longitudinal fractures extend into the articulation. Case 766.—Sergeant J. Peart, Co. A, 21st New York Cavalry, aged 22 years, was wounded in the left leg, at Ashby's Gap, July 18,1864, and entered the Geueral Hospital at Frederick nine days afterwards. Assistant Surgeon R. F. Weir, U. S. A., iu charge, reported tlie following history: "The injury was caused by a ininid ball, which shattered the tibia near the ankle. When admitted here the limb was in a very bad state, being oedematous, ecchymoscd, and discolored. Amputation of the leg in the middle third was performed by Acting Assistant Surgeon J. H. Bartholf on July 31st, by lateral flaps of skin and fascia and circular method through muscles. The patient's constitutional condition at the time of the operation was fair and his health good. One week afterwards the stump became gangrenous, when nitric acid was applied with S'iccess. The patient's progress went on gradually to recovery. Though the stump was not entirely cicatrized at the end of three months it was iu good shape and there was no retraction of the flaps, extension of them by weight and pulley having been adopted at the beginning. The stump was healed, and the patient in good health on December 20th, when he was transferred to Central Park Hospital, New York City, for an artificial limb." The patient was discharged from service at the latter hospital May 23, 1865, and pensioned, and several weeks afterwards he was furnished with an artificial leg. In his application for commutation the pensioner described the stump as continuing in a "healthy condition." His pension was paid March 4, 1880. Case 767.—Private C. Burbridge, Co. K, 88th Pennsylvania, aged 40 years, was wounded at Spottsylvania, May 10, 1864, and entered Mount Pleasant Hospital, Washington, three days afterwards. Assistant Surgeon C. A. McCall, U. S. A., reported: "The injury was caused by a minis' ball entering at the internal malleolus of the right leg, comminuting the fibular extremity and the astragalus and laying bare the tendon. The parts became swollen, tense, and discolored, and synovitis was fully developed. Amputation at the junction of the middle and lower thirds of the leg was performed by the antero-posterior flap method on May 24th, by Acting Assistant Surgeon P. C. Potter. The anaesthetic was made up of two parts chloroform and one part ether. At the time of the operation the patient was in a weak and debilitated condition and failing hourly, suffering from nervous trembling, restlessness, exhausting insomnia, and severe pain, which was lancinating and at times grinding and unsupportable. There was also copious discharge of ichor from the wound, and a sinus and abscess had extended up the limb and was opened a day or two before the operation. Interrupted sutures were applied to the stump, which broke out from ulceration of the flaps on the third day. Straps were then used aud a tendency to slough counteracted by antiseptic poultices. Tonics and malt drinks were administered. By June 30th, the sloughing had stopped and abundant granulations were springing up. The greatest point of difficulty in this case was produced by the flaps falling asunder at each dressing, thus breaking up the nearly healed union and allowing the tibia to protrdde." In the following month the patient was transferred to York, and subsequently he passed through various hospitals at Philadelphia, being ultimately discharged from service at Chester, June 27, 1865, and pensioned. He had been previously supplied with an artificial leg. In his application for commutation, dated 1870, the pensioner described the stump as being "tender;" but in his subsequent statements he represented it in "good condition." The pensioner was paid June 4, 1880. Fatal Cases of Intermediary Amputation in the Middle Third of the Leg.—The one hundred and ten operations of this group were performed on one hundred and nine patients, in one instance both legs having been amputated. Ninety-eight were Union and eleven Confederate soldiers. In one case the amputation in the leg was followed by amputation in the thigh in the lower third. Death is ascribed to pyaemia in thirty-four, exhaustion in eighteen, gangrene in five, and tetanus in four instances. Case 768.—Private J. Heakin, Co. D, 6th U. S. Cavalry, aged 24 years, was wounded in the right ankle, at the battle of Old Church, May 31, 1864. He was admitted to Stanton Hospital, Washington, four days afterwards, where amputation was performed by Surgeon J. A. Lidell, U. S. V., who made the following report:1 "The wound was inflicted by a mini6 ball, which entered anteriorly, passed backward and inward, apparently going close to the posterior tibial artery and escaping behind the lower end of the tibia. The ankle joint was involved. The parts became swollen, red, and tender. During the night of June 7th the patient had secondary haemorrhage from the wound, losing about a pint of blood, bright red in color. On the following day the leg was amputated at the place of election by double flap method, the anterior flap being shorter than the posterior, and the tibia being divided after the procedure of Sanson. Sulphuric ether constituted the anaesthetic. The loss of blood was trifling during the operation and the patient's general condition at the time was favorable, there being no constitutional disturbance worth mentioning. The shock of the operation was little and passed away quickly; reaction moderate. The patient, died of pyaemia June 21, 1864. The examination of the injured member showed the lower end of the tibia to be badly comminuted into the ankle joint, which was filled with pus. The posterior tibial artery was grazed by the bullet and some very small fragments of bone had been driven into it. The haemorrhage occurred on the detaching of these fragments by suppuration, together with the separation of the bruised tissue belonging to the wall of the artery. The astragalus was uninjured." The latter bone and the lower portion of of the right ankle the amputated tibia (Spec. 2470) were contributed to the Museum by the operator, and are represented in the {""^ ^c.247o! wood-cut (Fig. 302).' Case 769.—Private W. Nixon, Co. H, 20th Illinois, was wounded iu the lower part of the right leg, near Kenesaw Mountain, June 17,1864, by a musket ball striking the anterior surface of the tibia and entering the bone. He was admitted to. a field hospital at Big Shanty, and thence, ten days later, to the general hospital at Rome. Slight haemorrhage is said to have 1 Lidru, (J. A.), Secondary Hsemorrhage from Posterior Tibial Artery, etc., in U. S. Sanitary Commission Memoirs, New York, 1870, Vol. I, p. 23. Subg. Ill—66 522 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X occurred on June 21st, and while being transported in the railroad cars from Big Shanty to Rome the patient bled to syncope. After several more slight hemorrhages, which were temporarily checked by plugging the wound, it was found that the bleeding could no longer be restrained, it being impossible to secure the vessel at the point of the injury on account of extensive dis- organization around the wound as well as on account of the depth of the artery and the uncertainty of finding it. Amputation was then decided upon and performed through the middle third of the leg, on July 6th, by Surgeon G. F. French, U. S. V. The ball was found in the medulla of the amputated bone, and the bleeding vessel was discovered to be the anterior tibial artery. At the time of the operation the patient was enfeebled by the loss of blood. Reaction was fair, but his condition was low; pulse feeble; lips and skin very pale. For some days his condition continued very crit- ical. On July 27th, a slight diarrhoea came on and the patient's condition, although improved, was still critical. On August 3d, colliquative diarrhoea set in and the patient's strength was fast failing; pulse flagging; appetite entirely lost. He died on August 19, 18G4, of exhaustion, though every effort had been made from the beginning to sustain his strength by a nutritious diet and the generous use of stimulants. At the time of his death the stump had almost entirely healed The amputated tibia (Spec. 3382), longitudinally frac- tured, with a battered conoidal ball lodging in the lowest third of the bone, was contributed, with the history, by the operator, and is shown in the wood-cut (FlG. 303). Case 770.—Sergeant P. Smith, Co. K, 69th New York, aged 30 years, was wounded at Deep Bottom, August 16,1864. Surgeon J. F. Dyer, 19th Massachusetts, reported his admission to the field hospital of the 2d divis- ion, Second Corps, with "shot fracture of both legs." Four days after receiving the injury the wounded man was adinitted to Satterlee Hospital at Philadelphia, where both limbs were amputated by Acting Assistant Surgeon J. H. Hutchinson, who described the wound as follows: "A conoidal ball entered the left foot a little in front of the external malleolus, which it fractured, thence passing behind the joint and making its exit below aud posterior to the internal malleolus. The missile then entered the right foot just in front of the internal malleolus, penetrated the joint, and lodged ngainst the external malleolus, whence it was removed August 26th. Considerable difficulty was experienced in discovering the position of the ball, a large mass of loose bone having to be removed before it could be found. After the patient's admission it at once became evident that he would have to lose both feet; hut it was considered more prudent to wait for the establishment of suppuration. About September 3d, both feet were discharging a large amount of healthy pus, and the patient was weak in consequence of this excessive drain, but was supported by means of quinine, beef essence, and milk punch. On September 6th I amputated both legs by the circular method, the left one above the ankle joint (at the junc- tion of the middle and lower thirds) and the right one and a half inches higher up, the patient being etherized during the oper- ation. By September 23d the patient, considering his situation, was still doing well. Considerable sloughing had taken place, particularly in the left stump, where the tibia was exposed. There was also two slight bed-sores notwithstanding the very careful nursing the patient received." Surgeon I. I. Hays, U. S. V., in charge of the hospital, reported that the patient died of exhaustion October 10, 1864. The amputated bones of the ankles of both legs (Spec. 3644) were forwarded to the Museum by the operator and are shown in the wood-cut (FlG. 304). In addition to the injuries described the specimen exhibits the left astragalus to be fractured, the base of the right tibia to be shattered, and the right fibula fractured transversely just above the malleolus as if by the propagated force. There are also traces of periosteal disturbance. FIG.303.-Frao- tured lower por- tion of the right tibia. Spec. 3382. FIG. 304.—Bones of both ankles. The astragalus and outer malleolus of the left and the base of the tibia of the right ankle are fractured. Spec. 3644. Table LXXIII. Summary of Three Hwndred and Sixty-eight Cases of Intermediary Amputations in the Middle Third of the Leg for Shot Injury. [Recoveries, 1—258 Deaths. 259—368.1 NO. Name, Military Description, axd age. Dates. Operations, Operators, v Result. a °' Name, Military Description, and Age. Dates. Operations. Operators, Result. 1 2 3 4 5 6 7 Ackley, C., Pt., J, 50th Pennsylvania, age 21. Adams, A. B., Ft., C, 16th Maine, age 19. Allen, C., Corp'l, G, 62d New York, age 20. Allen, H.. Sergeant, G, 119th Penn., nge 22. Atkinson, P., Pt., G. 67th New York, age 34. Bain, T., Pt., G, 60th Illinois, age 34. Barbee, J., Pt., B, 5th North Carolina, age 29. Mav 12, 21," '64. Dec. 13, 22, '62. Oct. 19, 28, '64. May 3, 30, '63. Julv 1, 17, ^62. July 4, Aug. 1, 1864. Mav 12, 20," (34. Right; circular. Disch'd March 28, 1865. Left. Surg. E. Bentley, U. S. V. Disch'dMay20,1863. Spec. 596. Right; lat. flap. A. A. Surg. C. II. Jones. Haemorrhage. Dis-charged Oct. 4,1865. Spec. 104. Right; flap. Surg. J. H. Baxter, U. S.V. Discharged November 14,1863. Specs. 1184, 1185. Right: double flap. Ass't Snr3. May 2, 10, '63. May 10, 13, '64. Sept. 22, Oc.15,'04. Sept. 17, 22, '62. April 9, 12, '64. Aug. 30, Sep. 2,'02. May 10, June 8, 1864. June 5, J'y 2, '64. May 5, June 4, 1862. Sept. 19, Oct.-,'63. Dec. 14, 17, '62. Jan. 2, 5, '03. July 1, 8, *63. July 3, 27, '63. July 1, 14, '63. Aug. 29, Sep. 9,'62. Sept. 19, 26, '63. Julv 8, 28, "'64. Aug. 30, Sept. 15, 1862. July 7, 28, '63. Aug. 9, Sep.3,'62, Julv 3, 12, "'63. Sept. 20, 25. '03. Aug. 9, 15Y62. June 21, 27, '64. July 2, 13, '63. June 17, Julv 3, 1864. Sept. 17, 23, '62. Aug. 16, 27, '64. April 6, 15, '62. Mar. 14, 21, '62. Sept. 17, 21, '62. Sept. 17, 20, '62. Feb. 6, 20, '65. July 2, 26, '63. Sept. 20, Oet.6,'63. July 3, 11, '63. Operations, Operators, Result. Left; circular. A. A. Surgeon S. E. Fuller. Discharged October 29, 1862. Spec. 54. Left; flap. A.A.Surg. S. R. Skil- lern. April 24, 1864, ant. post. flap amput'n thigh, lower third. Disch'd April 28,'65. Spec. 2740. Right; circular. Surg. R. Tho- main, 29th New York. Dis- charged June 20, 1803. Left; circ. Surg. D. C. Ayres, 7th Wis. Disch'd Oct. 8, i864. Right; ciro. A. A. Surg. B. B. Miles. Discharged May 14,'65. Right; flap. Surg. W. II. Leon- ard, 51st N. Y. Discharged. Right; circ. Discharged April 3«, 1865. Left; circular. Discharged May 23, 1863. Left; modificat'n of anterior flap. Surg. D. P. Smith, U. S.V. Dis- charged July 8, '64. Spec. 3300. Left; circular. Confederate sur- geon. Discharged J une 2,1865. Right. (Bone removed; haein.; erj'sip.l Teale's method. Ass't Surgeon J. S. Billings, U. S. A. Old Capitol prison July 21,1862. Right; flap. Discharged Decem- ber 14,1864. Subseq. operation. Left; circular. Discharged J uly 31,1863. Died Nov. 13,1869. Left. A. A. Surg. W. G. Work- man. Discharged June 5,1865. Left; flap. Surg.C. H.Richmond, 104th N.Y. Disch'd Mar. 22,'64. Left; circular. Ass't Snrg. D. C. Peters, U. S. A. Discharged September 14,1863. Spec. 1606. Right. Surg. J. M. Farley, 84th N. Y. Discharged June 25,'64. Right. Surg. H. Black, C. S. A. Retired December 26, 1864. Right; flap. Discharged Novem- ber 11, 1863. Left; flap. Surg. X. R. Moseley, U. S. V. Discharged February 17, 1865. Spec. 2895. Right; double flap. Surg. D. P. Smith, U. S. V. Discharged November 13, 1862. Left; anterior post. flap. Surg. S. K.TowIe, 3Uth Massachusetts. Discharged November 21, 1863. Right; circular. Discharged No- vember 12, 1862. Right. Exchanged November 12, 1803. Left; flap. Discharged. Left; double flap. Ass't Surg. J. B. Brinton, U.S. A. Disced October 27, 1862. Spec. 38. Left; circular. A. A. Surg. J.W. Digby. Discharged July 10, 1864. Spec. 2311. Left. Paroled September 25, '63. Retired from service Feb. 10,'65. Right; post. flap. Ass't Surg. J. H.Frantz, IJ. S. A. Discharged November 28, 1865. Left; post. Hap. Surg. L. Rey- nolds, 63d N. Y. Discharged December 15, 1862. Left; circular. A. A. Surg. E. B. Woolston. Disch'd Nov. 22, "64. Left; flap. Discharged Febru- ary 22, 1863. Left: circular. Snrg. S.A. Green, 24 th Mass. Disch'd Sept. 9, '62. Right; anterior post. flap. Dis- charged April 30, 1863. Died June 15, 1866; continual dis- charge from stump. Spec. 1040. Left. Discharged January 24, 1863. Right. Discharged June 1, 1865. Left; flap. Furloughed Decem- ber 1, 1803. ----. Surgeon G. G. Crawford, P. A. C. S. Recovered. Right; circular. Discharged Au- gust 27. 1864. 1 BRYAN (J.), Seventeen Additional Cases of Amputations from the A rmies of the South- West, in American Medical Times, 1863, Vol. VII, p. 288 ;")24 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Namk, Military Description, and Age. 90 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 109 110 112 113 114 116 117 118 119 120 121 122 123 Hogan, C. IL, Corp'l, A, 89th Ohio, age 26. Hootsell, J. F., Pt., A, 2d Louisiana. House, P. A., Pt , B, 33d North Carolina. Huntzinger, J. W., Pt., A, 21st Indiana. Hutchins, A. J., Pt., K, 25th Ohio. Jamison, R. E., Pt., K, 19th Iowa. Jenkins, D. A., Pt., A, 19th Alabama, age 25. Johnson, E., Pt., G, 54th Massachusetts, age 35. Johnson, T. G., Corp'l, H, 40th Illinois. Johnson.W., Pt.. 1,149th Pennsylvania, age 23. Johnson, W. H., Capt,, F, 144th N. Y., age 27. Jones, B., Pt., A, 5th Col'd Troops, age 18. June, M. F., Pt., L, 9th N. Y. Heavy Artillery, age 17. Kahl, C, Serg't-Major, 75th Penn., age 29. Kehoe, J.,Serg't, H,39th New Jersey, age 29. Kelly, T, Pt., A, -22d Kentuckj'. Kimball,V,\, Pt., K, 88th Illinois, age 29. Rinnan, V., Pt., II, 147th New York, age 22. Kinnej', V. F., Pt., C, 2d Wisconsin, age 21. Knox, It. F., Pt., C, llth Pennsj'lvania, age 28. Koehler, J., Pt., I, 150th Pennsj'lvania, age 36. Koontz, A., Pt., H, 18th Ohio. Laird, S., Pt,, F, 4th Vermont, age 21. Laverty, E., Pt,, E, 53d Pennsj-lvania, age 43. Lease, D., Pt., E, 1st Ohio, age 25. Leslie, G., Pt., C, 5th New Hampshire. Littlelield, A., Pt., C, 2d Rhode Island. Lonergan, T., Serg't, B, 142d Penn., age 39. Loughlin, J., Pt.,A,69th New York, age 36. Lowiy, H., Pt., D, 93d Pennsylvania, age 19. Lubbert.W., Pt., B, 20th Massachusetts, age 32. McAuley, A., Pt., H,7th Louisiana. McCarthy, J., Pt., D, 7Jst New York. McCarty, W.,Pt., B, 23d Illinois, ;i# 10. McFadden, L>., Pt., G, 26th Ohio, age 39. McGivern.L., Pt.,G,5th Kentucky, age 50. Dates. Sept. 19, Oct. 9, 1863. Feb. 8, 15, '62. Aug. 16, 20, '64. Aug. 5, 25, '62. May 1, 26, '63. Dec. 7, 28, '62. De.16,'64, Jan. 11, 1865. Feb. 20, Mar.6,'64 April 6, 14, '62. July 1, 7. '63. Feb. 10, 23, '65. Sept. 29, Oct.2,'64. Oct. 19, Nov. 2, 1864. July 1, 4, '63. April 21, 26, '65. De.29,'62, Jan. 18, 1863. July 20, Aug. 19, 1864. June 19, July 5, 1864. July 1, 4, '63. Aug. 31, Sept. 15, 1862. May 5, 29, '64. Jan. 1, 5, '63. De.16,'62, Jan. 12, 1863. Dec. 13, 30, 62. Sept, 19, 26, '63. Dec. 13, 23, '62. Mav 3, 20, "'63. Dec. 13, 17, '62. July 2, 5, '63. May 12, June 6, 1864. June 3, 9,'64. June 9, 12, '62. May 3, 10. '63. Julv 24, 28,"'64. Sept. 20, 26, '63. Nov. 25, 28, '63. Operations, Operators, Result. Name, Military Description, and Age. Dates. Left; anterior post. flap. Ass't Surgeon C. S. Frink, U. S. V. Discharged December 5,1863. Right. Surgeon G. L. Miller, C. S. A. Recovered. Left. Recovered. Right. Discharged November 15, 1862. Right; posterior flap. Surg. C. L. Wilson, 75th Ohio. Disch'd March 19, 1864. Spec. 6705. Left; flap. Discharged Decem- ber 12, 1864. Right; anterior posterior flap. A. A. Surg. L. Sinclair. To Pro- vost Marshal March 7, 1865. Right; flap. Discharged July 16, 1865. Left. Discharged July 11,1862. Left; anterior posterior flap. Dis- charged January 30, 1864. Left; circ. Ass't Surg. J. G. Mur- phy, U. S. V. Feb. 17, lig. ant. tib. art'y. Disch'd May 15, '65. Right; flap. Discharged June 21, 1865. Right; lateral skin flap and circ. section of muscles. A. A. Surg. J. Neff. Disch'd May 13, 1865. Spec. 3428. Left; flap (also flesh wound of shoulder). Disch'd Feb. 26,'64. Right; circ. (erysipelas). A. A. Surgeon W. B. Chambers. Dis- charged June 8, 1865. Right; flap. Surg. H. P. Steam, U. S. V. Reamputated. Dis- charged June 2, 1863. Right; anterior posterior flap. A. A. Surg. M.W. Benjamin. Dis- charged June 9, 1865. Right; flap. Surg. E. Bentley, TJ. S. V. Discharged October 27, 1865. Specs. 2517,2833. Left; circular. Discharged No- vember 28, 1863. Left; anterior post. flap. A. A. Surg. J. E. Warner. March 12, 1863, removal of exfoliat'n from tibia. Discharged April 24,'63. Left; circular. A. A. Surg. H. Gibbons, jr. (Maj' 5, excision 4 inches of fibula.) Discharged April 19,1865. Specs. 3533, 2404. Right; flap. Discharged May, 1863. Right; circ. Surg. A. M.Wilder, TJ. S. V. Discharged April 5, 1864. Spec. 4319. Left; posterior flap. Surg. O. A. Judson, U. S. V. Discharged October 4,1864. Died January 4,1880. Spec. 6712. Right; circular. Surg. D. S. Young, 21st Ohio. Discharged October 7, 1864. Right; circ. Discharged April 4, 1863. Right; ant. post. flap. Surg. J. H. Baxter, U. S. V. Discharged Oct. 7,1863. Died Dec. 6,1877; phthisis pulmonalis. Spec. 1135. Right; circular. Surg. T. Jones, 8th Penn. Reserves. Discharged March 10, 1864. Right; circular. August 5, re- amputation ; erysipelas. Dis- charged March 18, 1865. Right; anterior posterior flap. Surgeon C. Page, TJ. S. A. Dis- charged March 23, 1865. Left; double flap. Surg. E. Bent- ley, U. S.V. Disch'd Nov., 1865. Died Oct. 6, '66; phthisis pulm. Left. Recovered. Right. Surg. C. K. Irwine, 72d N. Y. Discharged July 30,1864. Left; flap. Ass't Surg. J. S. Tay- lor, 23d 111. Disch'd May 3, '66. Left; flap. Discharged August 26, 1864. Right; flap. Discharged Sep- tember 27, 1864. 124 McGonigle, H., Pt., F, 73d Penn., age 51. 162 Mc Griff, J. C., Pt., B, 7th Georgia. McGukin, W. P., Pt., F, 2d S. C. Rifles, age 30. Mcllvaine, R. I., Serg't, K, 8th Peun. Reserves. McTaggart, J., Pt., D, 46th Indiana, age 35. Magee, W., Pt,, K, 81st Pennsj'lvania. Maguire, S., Serg't, G, llth Penn. Res., age 24. Malone, S. S.,Pt„K,10th West Virginia, age 20. Manning, T., Pt,, H, 5th Ohio, age 23. Marston, B. F., Serg't- Major, 3d Maryland. Masterson, M., Pt., H, 10th Louisiana. Mauk, S. S., Pt,, E, 90th Ohio. Mays, C., Pt., K, 1st Artillery, age 19. Meagher, D., Pt,, C, 5th Connecticut. Men-ill, S., Pt., F, 2d New Hamp , age 33. Miller, C, Pt., D, 53d Pennsylvania. Miller, R. F., Pt.,E, 123d Illinois, age 27. Miller, W. W., Pt,, G, 40th New York, age 27. Minott, J. S., Corp'l, F, 1st Michigan Sharp- shooters, age 31. Mj-ers, D., Pt., K, 12th Pennsj'lvania, age 20. Newkirk, G. W., Pt., I, 42d Indiana, age 22. Newman, O., Pt., K, 7th New York, age 20. Nichols, A., Pt., C, 6th North Carolina, age 20. Norton, M., Pt,, I, 52d New York, age 37. Nussbaumer, B., Pt., B, 67th Ohio, age 27. O'Brien, J., Pt., K, 124th New York. O'Bryan, J. C, Pt., K, 45th Penn., age 18. O'Donall, P., Pt., B, 27th Virginia. O'Donnell, J., Corp'l, F, 81st Pennsylvania. O'Neal, J., Pt., I, 153d New York, age 28. O'Neil, J., Pt,, A, 3d Penn. Reserves. Ortle, H., Pt., A, 5th Louisiana. Paine, J. A., Pt., E, 2d Missouri, age 21. Palmer, W., Lieut., B, 82d New York, age 29. Parris, G. W., Pt., C, 19th Massachusetts. Patterson, W. L., Corp'l, C, 198th Penn., age 21. Patty, T. W\, Pt., E, 40th Indiana, age 18. Paul, L., Pt., C, 28th Massachusetts, age 40. Nov. 25, Dec. 25, 1863. Aug. 30, Se.20,'62. May 3, 7, '63. Aug. 29, Sept. 16, 1862. April 8, 12, '64. De.13,'62, Jan. 1,'63. May 6, 31, *64. July 23, Au.11,'64, Aug. 9, 19, '62. Aug. 9, 12, '62. Nov. 27, De.12,'63. Sept. 20, 24, '63. June 6, 24, '64. Aug. 9, 23, '62. July 2, 5, '63. Dec. 13, 16, '62. Jan. 11, 14, '65. Dec. 13, 16, *62. May 12, 27, '04. June 27, J'y23,'62 Oct. 8, 22, '62. Mar. 31, Aprils, 1865. Julv 2, 30, "'63. May 9, 12, '64. Mar. 23, April 22, 1862. May 3, 9, 153. June 27, J'yl8,'64. July 1, 21, '61. July 1, 22, '62. Sept. 19, Oct. 19, 1864. May 11, 31, '64. May 5, 30, '64. Nov. 30, Dec.2,'64, Julyl, 31, *63. June 30, J'v4,'62. Mar. 29, April 3, 1865. Nov. 25, Dec. 6, 1863. June 2, 9, *64. Peart, J., Serg't, A, 21st July 18, N. Y. Cavalrj', age 22. 31, '64. Operations, Operators, Result. Right; ant. post. flap. Surg. W. H. Gunkle, 73d Penn. Disch'd April 25, 1864. Died April 5, 1868; consumption. ---. Ass't Surg. H.W. Harding, C. S. A. Recovered. Right; circ. Transferred June 9, 1864. Right; circular. A. A. Surg. J. N. Goff. Discharged November 29, 1862. Right; flap. Surg. J. F. Hess, 96th Ohio. Duty July 8, 1864. Left. Surg. D. W. Bliss, U. S.V. Disch'd Dec. 5, 1863. Spec. 943. Left; circular. A. A. Surg. D. L. Haight. Haemorrhage; gang. Discharged. Spec. 1222. Left; circular. A. A. Surg. C. II. Jones. Disch'd June 14, 1865. Right; flap. Ass't Surg. J. F. Day, 10th Maine. Discharged May 5, 1863. Spec. 6708. Left; circular. A. A. Surg. M. H. Barton. Discli'd Nov. 28, 1862. ----. Surg.W. P. Young, C.S.A. Recovered. Right; circ. Surg. H. Herrick, 17th Ohio. Disch'd May 13,'64. Left; circular flap. A. A. Surg. T. Carroll. Disch'd July 17, '65. Right: flap. Discharged October 27, 1862. Left; flap. Surg. J. M. Merron, 2dN. H. Disch'djune21,1864. Left. Discharged September 19, 1863. Left; flap. A. A. Surgeon E. L. Jones. Disch'd June 4,1865. Right. Discharged April 2,1863. Left; circular skin flap. Surg. E. Bentlev, IJ. S. V. Discharged October 17, 1864. Right. Ass't Surg. R. Bartholow, U. S. A. DischM Oct. 16, 1862. Left; flap. Discharged June 19, 1863. Right; circular. Surgeon A. F. Sheldon, U. S. V. Discharged August 2, 1865. Spec. 4877. Left. Surg. — Hawley, C. S. A. Spic. rem. Retired Mar. 14, '65. Left; circular. Discharged Octo- ber 26, 1865. Left. Surg. A. D. Gall, 13th lnd. (Also w'nds of breast and leg.) Disch'd July 28,1862. Caries of stump. 1863, amputation thigh, middle third. Right. Surg. G. P. Oliver, lllth 4enn. Disch'd April 5, 1864. ;ht; flap. Dr. F. Hinkle, of Marietta, Penn. Discharged. Left. Surgeon — Hunt, C. S. A. Recovered. Left. Ass't Surg. J. R. Smith, U. S. A. Disch'd Oct. 16,1862. Right; flap. Surg. L. P.Wagner, 114th New York. Discharged February 11, 1865. Right; flap. Surg. S. A. Welch, 3d Penn. Reserves. Discharged September 23. 1864. ----. Surg. J. R.Page, C.S. A. Retired from military service March 6, 1865. Left; circular. Provost Marshal May 6, 1865. Left; circular. Surg. A. B. Mott, IT. S. V. Transferred to Vet. Res. Corps. Disch'd June 30,'66. Left. Discharged December 11, 1862. Left; circular. A. A. Surg. M. J. Munger. Discharged August 7, 1865. Spec. 4037. Left. March 12,1864, re-amputa- tion 3 inches above. Discharged Januarj- 11, 1865. Right; flap. Snrg. E. Bentley, U. S. V. Discharged March 29, 1865. Died July 24, 1869. Left; lateral flap of skin and ciro. of muscles. A. A. Surg. J.H. Bartholf. Disch'd May 23,1865. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 525 Name, Military Description, and Ace, Peek, H. C, Serg't, B, 5th New York, age 26. Perkins, J. D., Lieut., M, 2d Florida, age 19. Phillips, D. W„ Pt., F, 32d Georgia, age 32. Piggott. M., Capt., F, 66th Illinois, age 29. 57 Pitts, R, Pt., F, 76th New York, age 20. 168 Pollard, J., Capt., H, 9th Virginia Cavalrj-. 109 Poole, C. H., Pt,, G, 39th Massachusetts, age 18. Porter, H. M., Pt., H, llth Infantrj-. ■1 Potts, J., Pt., H, 123d Pennsj'lvania. 172 Price, J. W., Corp'l, I, 20th Conn., age 24. Pnst, H., Pt., K, 104th Illinois, age 25. 174 Reece, B., Pt., K, 49th Illinois. 175 Reynolds, J., Serg't, C, 6th Michigan Cavalry, age 30. 176 Richardson, J. M., Pt., I H, 35th Mississippi. 177 i Richardson. ()., Serg't- Maj., 7tb Minn., age31. 178 j Rigor, D., Pt., H, 36th Indiana, age 26. 179 Rinard, C. B., Pt., K, 4th Iowa Cavalrj-, age 15. 180 Ritzert, P., Pt., K, 100th New York. 181 Roberts, D. R., Pt., B, 3d South Carolina, age 33. Roberts, M. S., Pt., B, 5th Maine, age 23. Robinson, R. R., Gov't employe, ase 24. Rodenhoffer. L., Pt., A, 117th Penn., age 18. Rj-an, J., Pt., H, 20th Connecticut, age 39. 186 Ryan, V., Pt., D, 1st | Arkansas. 187: Sanders, I. J., Pt., E, 31st Illinois. 1881 Scarberry, J., Pt., D, ! 91st Ohio, age 19. 189 j Seism, J., Pt., L, 2d Mis- souri S. M. Cavalry, age 18. 190, Scott, C. L., Serg't, E, 154th New York. Seligar, A., Pt., A, 43d Illinois, age 27. Sercey, W., Colored fire- man, Steamer, age 25. Shaffer, F., Capt., 1,73d Pennsylvania, age 26. Shell, M. C, Serg't, C, 31st Miss., age 32. Shewalter, C.W., Pt., G, 8th Tenn. Cavalrj'. Shute,W. A., Pt., 1,13th Massachusetts, age 31. Skigell, I., Pt., M. 2d N. Y. H'vy Arty, age 22. Slack, R., Pt.,' B, 100th New York, age 27. Aug. 30, Sep.2,'62 July 2, 5, m Deo. 16, 19, '64. May 14, June 5, 1864. July 2, 16, "fei. June 24, J'y 4,'64. May 5, 26, '64. July 2, 9,'63. Deo. 13, 28, *62. July 3, Aug. 1, 1863. Dec. 7, 11, '62. April 7, 13, '62. July 14, 17, '63. Oct. 4, 21. '62. July 13, 31, '64. Sept. 19, 28, '63. July 15, 21, '64. July 18, 22, '63. Nov. 30, Dec. 29, 1864. May 3, 7, '63. Feb. 20, 26, '65. June 18, July 13, 1864. May 3, 6, *63. Sept, 20, 24, '63. Nov. 7, 10, '61. May 9, 26, '64. Oct, 25, Nov. 2, 1864. May 3, 19, '63. April 7, 17, '62. Nov. 1, —, '64. Nov. 25, De.11,'63 Nov. .10, Dec. 26, 1804. April 12, 16, '65. Aug. 30, Sept. 2, 1862. April 7, 18, '65. Mav 3, 13, '64. Operations, Operators, Result. Sraith.C.W., Pt., D. 10th July 3, West Virginia, age 24. 29, ^64. Left; flap. Surg. R. H. Coolidge, F. S. A. Discharged May 14, 1863. Left (also amputation left thumb). Trans, to Provost Marshal Ooto- ber22, 1863. Exchanged. Left; circular. A. A. Surg. R. L. McClure. To Provost Mar- shal Mny 6, 1865. Right; flap. Ass't Surg. T. A. McGraw, U. S. A. Discharged January 24, 1865. Left; anterior posterior flap. Dis- charged August 26, 1864. ----. Surg. J. G. Dudlej-, P. A. C. S. Recovered. Left; circular; gangrene. Surg. D. W. Bliss, U. S. V. DischM Deo. 17, 1864. Spec. 2354. Left; flap. Ass't Surg. W. R. Ramsay, U. S. A. Transferred to regiment Sept. 12, 1864. Left. Discharged March 9,1863. Spec. 981. Left -, post. flap. Surg. H. Janes, U. S.V. Nov. 9, re-amp. atjunc. of middle and upper thirds, flap method. Disch'd June 24,1864. Left; flap. Surgeon R. F. Dyer, 104th Illinois. Anchy. of knee. Oct. 24, 1863, amp. thigh, mid. third. Disch'd March 4, 1864. Right; flap. Discharged July 7, 1862. Right; flap. June 12, 1864, re- moval of necrosed end of tibia. Discharged October 26, 1864. Right. Surg. S. L. Nidet, C. S. A. Recovered. Left; circular. A. A. Surg. J. A. Edmonson. Disch'd April 10,'65. Left; flap. Discharged Septem- ber 21, 1864. Left; circular. A. A. Surg. A. Sterling. Discharged Septem- ber 1,1865. Right: circular. Surg. D. Merritt, 55th Penn. Discharged Decem- ber 22, 1863. Right; anterior posterior flap. A. A. Surg. W. Vance. Trans, to Provost Marshal March 7, 1865. Left. Confed. surgeon. Disch'd March 15, '64. Spec. 6694. Right; circular. Surgeon J. H. Phillips, U. S. V. Recovery. Left; circular; gangrene. A. A. Surg. T. L. Van Norden. Dis- charged March 24, 1865. Right; anterior post. flap. Con- federate surgeon. Discharged June 30, 1865. Right. Surgeon — Sizemore, C. S. A. Recovered. Right, Surgeon T. Sim, U. S. V. Discharged August 2, 1862. Left; flap. A. A. Surg. W. W. Mills. Discli'd July 30, 1864. Left; anterior posterior flap. A. A. Surg. J. H. Page. Necrosis. Discharged June 11, 1865. Right. Surg. R. Thomain, 29th New York. Discharged Nov. 4, 1863. Spec. 1544. Left; flap. A.A. Surg.O. Blanck. Discharged October 7, 1862. Left; anterior posterior flap. Duty Januarj- 28, 1865. Left. Snrg. B. L. Hovey, 136th N. Y. Resigned July 5, 1864. Left; anterior posterior flap. A. A. Surg. T. Morrison. Trans, to Provost Marshal March 7, 1865. Left; flap. Discharged August 11, 1865. Left; double flap. Surgeon J. Jamison, 86th New York. Dis- charged June 4, 1863. Right; circ. Discharged July 29, 1805. Right; anterior post. flap. Ass't Surg.W. D. Murray, 100thX. Y. Discharged December 26,1864. Left; single flap. Surg. F. H. Gross, TJ. S. V. Discharged March 18, 1865. Name, Military Description, and Age. Smith, G., Pt., K, 81 st New York, age 26. Smith, G.W.,Pt.,F, 76th New York, age 20. Snyder, P., Pt,, E, 151st Pennsylvania, age 21. Sparks, M. G., Serg't, I, 10th New Jersey, age 25. Speeltnan, B., Pt., K, 98th Ohio, age 20. Sprauer, H., Lieut., F, 2d Louisiana. Steenis, P., Pt., E, 6th Wisconsin, age 23. Steinhaus, F., Pt., H, 26th Wisconsin. Steinmetz, W., Pt., F, 8th New York. Sterritt, J., Pt., C, 119th Pennsylvania, age 38. Stevens, T. M., Serg't, B, 45th N. C, age 21. Stief, P., Pt., K, 139th New York, age 30. Stigall, R., Corp'l, G, 1st Florida. Stilts, A., Pt., I, 4th New Jersey. Stone, E. W., Corp'l, A, 21st Massachusetts. Storke, L., Pt., A, 72d New York. Strayer, L., Serg't, A, 210th Pennsylvania. Sullivan, J., Corp'l, F, 40th New York. Sullivan, P. T., Pt,, A, 1st Mass. Heavy Artil- lery, age 38. Swing, H, Pt., A, 1st Louisiana. Terry, J. D., Serg't, E, 23d Massachusetts. Texter, G., Corp'l, I, 7th New York Artillerj-, age 27. Thomas, F. M., Serg't, I, 8th Iowa Cav., age 22. Thompson, B., Pt,, C, 28th Pennsylvania, age 33. Todd, J. C., Capt., A, 14th Alabama. Toomey, J. J., Pt., A, 29th Pennsylvania, age 21. Trapp, D., Pt., E, 125th New York, age 32. Trausdale, W. F., Lieut., E, 7th Alabama Cav. Travis, J. A., Serg't, D, 86th N. York, age 26. Truckej', P., Pt., G, 14th Indiana. Trj-on, L. J., Corp'l, K, 81st New York, age 21. Tucker, J. G., Pt., K, 20th Michigan, age 22. Upright, G. T., Pt., B, 8th Ohio, age 21. Van Gundy, J., Pt., K, 4th Iowa, age 18. Walker, J., Pt,, Carpen- ter's Battery. Ward, A. S., Serg't, C, 107th X. York, age 22. Ware, E. S., Serg't, C, 19th Virginia, age 25. Operations, Operators, Result. June 3, 13, '64. July 1, 5, '63. Julyl, 7, '63. April 2, 13, '65. Sept. 20, 24, '63. May 27, 31, '63. Sept, 14, 30, '62. July 1, 12, "63. June 8, 25, '62. May 10, 14, '64. July 3, 6, *63. July 30, Aug. 14, 1864. Jan. 2, —, '63. Sept. 14. 21, '62. Mar. 14, April 6, ' 1862. July 1, 23, ''62. April 1, 14, '65. Aug. 30, Sep.7,'62. June 16, July 9, 1864. May 3, 9, '63. Mar. 14, 22, '62. June 16, 25, '64. July 30, Au. 4,'64. Sept. 17, Oct, 4, 1862. May 3, 15, '63. May 15, 31, '64. June 18, July 2, 1864. May 14, 27, 64. May 3, 20, "63. Sept. 17, 25, '62. June 2, 11, '64. June 18, Julv 8, 1864. July 2, 23, '63. Mar. 3, Apr.l,'62. Mav 25, 29," '62. May 3, 8, f63. Julv 3, 6, '63. Right; anterior post. flap. Surg. A. T. Sheldon, U. S. V. Dis- charged January 6, 1865. Left; circular. Surgeon J. H. Beach, 24th Mich. Discharged May 20, 1864. Spec. 4318. Left; circular. Discharged July 27, 1863. Right; ant. post, skin flap. A.A. Surg. Z. P. Denneler. (April 2, 1865, excis. of fibular portion of ankle.) Disch'd Feb. 2, 1866. Left; flap. Confederate surgeon. Discharged January 31, 1865. Right. Surgeon J. B. G. Baxter, V. S. V. Discli'd July 31, 1863. Left; anterior post. flap. A. A. Surg. W.W. Keen. Discharged Jan. 23. 1864. Specs. 791, 3833. Right; flap. Discharged May 14, 1864. Right. Ass't Surg. T. H. Legler, 8th New York. Discharged December 12, 1863. Left; skin flap and circ. section of muse. A. A. Surg. O. P. Sweet. Disch'd Aug. 7,'65. Spec. 2284. Right. Surgeon J. R. Raine, 45th N. C. Erj-sipelas. Exchanged November 12, 1863. Right; flap. A. A. Snrg. S. J. Holley. (Excision 3ins. shaft of tibia.) Disch'd June 19,1865. Left. Surgeon C. J. Walton, 21st Kentucky. Recovered. Left; circ. Surg. L. W. Oakley, 2d N. J. Disch'd Jan. 3,1863. Right; circular. Surg. George Derbj-, 23d Mass. Discharged February 17, 1863. Left. Discharged. Right; flap. Discharged August 4, 1865. Right. Discharged August 11, 1863. Right; anterior post. flap. A. A. Surg. J. M.Boisnot. Discharged June 13, 1865. Left. Surgeon — Bratton, C.S.A. Recovered. Left; circular. Surg. S. E. Stone, 23d Mass. Disch'd July 7,1863. Left; circular. Surg.W.Watson, 105th Penn. Discharged July 14, 1865. /Specs. 818, 3081. Left; lateral flap. Discharged July 14, 1865. Right; flap; gang.; erj-sipelas. April 14, 1863, circ. amp. thigh, lower third. Discharged May 6, 1863. Specs. 3883, 3965. Right, Ass't Surg W. C. Good- win, C. S. A. Discharged Jan- uary 14, 1865. Left; circular. Ass't Surg. M. C. Woodworth, U. S. V. (May 15, excis. lower third tib.) Disch'd July 2. 1865. Spec. 3361. Left; circular. Surgeon A. F. Sheldon, II. S. V. Discharged Juue 8, 1865. Left. Surg.W. F.Westmoreland, P. A. C. S. Recovered. Right. Ass't Surg. C. C. Byrne, U. S. A. (Haemorrhage.) Dis- charged March 28, 1864. Right. A. A. Surg. J. C. Douglas. Discharged March 4, 1863. Left; ant, post. flap. Surg. N. R. Moseley, IT. S. V. Discharged September 30, 1864. Spec. 203. Right; circ. A. A. Surg. A. F. A. King. Disch'd April 4, 1865. Spec. 2826. Right; circ. A. A. Surg. A. A. Hamilton. Disch'd May 9,1864. Right; flap. Discharged Janu- ary 28. 1863. Left, Surg.W. H. Baldwin, C. S. A. Recovered. Right. Surg. IJ. E. Goodman, 28th Penn. Discli'd July 27,'63. Left. • Surgeon C. S. Wood, 66th New York. Exchanged Nov. 12, 1863. 526 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name. Military Description, and Age. 237 Watson, W., Pt., E, 7th Michigan, age 24. 238 Weaver. J., Pt., C, 154th New York. Webster, E. H., Pt., I, 98th Illinois, age 26. [0 Wclker, C, Pt., K, 9th Michigan. 11 Welsh, J., Pt,, H, 61st New York, age 26. Welsh, M., Pt., I, 154th New York. 243 Weston, W. P., Pt., H, 04th Ohio. 244 Wheeler, H., Ordinary Seaman,U.S.N.,age 23. 245 ' Whitaker, J. F., Pt., K, 8th Tenn., age 26. 246 Whitesel, J. W., Serg't, B, 19th Virginia, age 25. 247 Wieand, J., Pt., B, 47th Pennsvlvania. 248 Wildman, E. S., Lieut., G, 28th Virginia,age 35. 249 Willbnrn, R., Pt.,A,81st Illinois. Willetts, J. F., Pt., B, 1st New Jersej', age 22. 251 William, J., Pt.,E, 118th New York, age 19. Wilson, G., Pt., B, 18th Missouri. Wilson, L.F., Corp'l, K, 88th Penusj-lvania. Yost, S. R., Pt., A, 28th Penusj-lvania, age 24. Young, VV., Pt,, F, 7th Indiana. Zanl, J. H, Pt., A, 37th Georgia. Zerger, J., Pt., B, 53d Pennsylvania. Zook, C., Pt., C, 8th Pennsj'lvania, age 19. Andrews, J., Pt., C, 5th Artillerj', age 19. Apgar, J., Pt., A, 15th New Jersey. Bambauer, J., Musician, II, 56th New York, age 22. Barber, W. B., Serg't, I, 93d New York, nge 32. Baxter, F., Pt., D, 1st Potomac Home Brig. Berry, J., Pt., B, 39th Illinois, age 38. Bigelow, L., Corp'l, B, Mth Massachusetts. Biggs, M. L., Corp'l, A, 53d Kentucky, age 20. Biomson, C, Pt., C, 2d Conn. H. Art , age 33. 268 Blanchard, E. VV., Pt., H, 45th Peun., age 16. 269 ! Blodgett, E. J., Pt., E, 6th New Hampshire, ;ge2-'. 270 Blois, E., Lieut., C, 18th Georgia, age 24. May 15, 21, '64. Mar. 1, 12, '65. Sept. 19, 24, '63. July 12, 15, '62. Sept. 17, 29, '62. May 3, 25, Vj. De.31,'62, Ja. 12,'63. Jan. 15, 30, '65. Mav 16, J'eI2,'64. July 3, 6, "63. Oct. 22, 25, '62. Julv 2, 7, '63. May 22, 26, '63. June 1, 7, '64. May 16, June 9, 1864. April 5, 26, '62. Sept. 17, 21, '62. Sept. 17, Oct. 5, 1862. Aug. 9, 12, '62. Nov. 25, De.18,'63 June I, 5, '62. Dec. 13, 21, '62. Dec. 13, 20, '62. May 2, 16, M33. Nov. 30, Dec. 20, 1864. May 23, 30, '64. July 2, 5, '63. Aug. 16, 21, '64. Aug. 30, -f'62. April 30, May 12, 1865. June 1, 14, '64. June 3, 16, '64. Mnv 6, 26, "'64. April 6, 27, '65. 271 Bolt, S., Pt., A, 77th May 22, Illinois, age 25. I June 3, i 1863. Operations, Operators, Result. Right; flap; gangrene. Disch'd December 29, 18t>4. Spec. 4540. Left -, circular. A. A. Surg. E. L. Mola. Disch'd June 15, 1865. Right; anterior post. flap. Surg. S. B. Hawley, 35th 111. Dis- charged April 26, 1864. Right; flap. Surgeon C. Smith, 9th Michigan. Discharged No- vember 29, 1862. Right. Surg. H. S. Hewit.U.S.V. Gangrene. Disch'd July 23,'63. Died May 4, 1868. Spec. 402. Right. Surg. S. N. Sherman,34th New York. Discharged March 3, 1864. Spec. 1550. Left: flap. Discharged May 11, 1863. Left. Dr. H. N. Adams, TJ. S. N. Discharged October 13, 1865. Right; circular. June 30, 1864, improving. Left; circular. Surg. — Chase, C. S. A. Transferred for ex- change November 12, 1863. Right; posterior flap. Discharged December 3, 1862. Spec. 687. Right. Surg. — Given, C. S. A. To Provost Marshal Sept. 25,'63. Right. A. Surg. H. M. Sprague, U. S. A. Discharged August 22, 1863. Sjyec. 1628. Right; circular. Surg. E. Bent- ley, TJ. S.V. Gangrene. Discli'd June 8, 1865. Died Dec. 10, '66. Right; flap. Surg. — Gibbs, C. S.A. Disch'd May 27, 1865. Re amp. in np. third Dec, 1865. Left; flap. Surgeon S. B. Houts, 18th Mo. Discli'd July 15,1862. Left; flap. Ass't Surg. W. M. Notson, U. S. A. Discharged February 19, 1863. Left; anterior post. flap. Ass't Surgeon C. P. Russell, TJ. S. A. Disch'd March 19,'63. Spec. 810. Left; flap. Discharged Novem- ber 19, 1862. ---. Surgeon G. M. McDowell, C. S. A. Recovered. Left; circular. Subsequent am- putation. Disch'd Nov. 7,1864. Right; anterior post. flap. A.A. Surgeon A.W. Trj-on. Discli'd Nov. 15, 1863. Specs. 650,1596. Left; flap. Surgeon E. Bentlev, TJ. S. V. Died December 30, 1862; pyaemia. Spec. 599. Right; anterior post. flap. A. A. Surg. C. Carvallo. (Ball extr.; gangrene.) Died May 20,1863; exhaustion. Specs. 1251, 2226. Right; lateral flap. Ass't Surg. J. F. Huber, U. S. V. (Dec. 2, excision tarsus.) Died Decem- ber 26, 1864; pyaemia. Right; anterior post. flap. Surg. A. F. Sheldon, U. S. V. Died June 11, 1864 ; gangrene. Right; flap. Died July 26,1863. Left; circular. A. A. Surg. S. J. Holley. Died September 4, '64; irritative fever. ---. Died October 18, 1862. Left; flap. Surg. N. Gay, U.S.V. Died June 17,1865; exhaustion. Left; flap. A. A. Surgeon S. B. Ward. Died June 18/64; gang. Left; circular. Surg. E. Bentlej-, U. S. V. Died June 20, 1864; tetanus. Spec. 2710. Left; anterior post. flap. Surg. A. Delanj-, U. S. V. Died May 30, 1864 ; exhaustion. Left: circular. A. A. Surg. J. P. Arthur. (Also w'nd left thigh. Erysipelas.) Died May 4, 1865; exhaustion. Right. A. Surg. H. M. Sprague, U. S. A. Died June 21, 1863; pyaemia. Spec. 1633. NO. 302 303 Name, Military Description, and Age. Bourn, W. I, Pt., F, 12th Georgia, age 30. Boylan, A., Pt., E, 35th New York. Bradbury, G.W., Corp'l. A, 98th Illinois. Bullen, H. W., Lieut, Darden's La. Battery. Bumpus, M., Pt., A, 5th Maine, age 29. Burton, J. M., Serg't, G, 1st Tenn. Artillerj', nge 38. Butters. T. S., Corp'l, I, 2d Mass., age 22. Buxton, G. W., Corp'l, A, 2d Massachusetts. Castle, E. W., Pt., D, 2d Conn. Heavy Artillery, age 20. Caughej-, L., Lieut., C, 16th Pennsj'lvania Cav- alry, age 23. Cavaugh, G., Pt., 1,10th New York. Cave.W. M., Pt., E, 18th Indiana, age 22. Cearfas, G. W., Pt., D, 100th Penn., age 30. Chase, C. B., Pt., G, 7th Maine. Clark, E. J., Pt., I, Michigan, age 36. 8th Clock, C. IL, Pt.,G, 10th Connecticut, age 23. Covil, G. B., Serg't, H, llth Conn., age 32. Craig, W., Pt., E, 74th Illinois. Crowter, J. D., Pt,, D, 4th N.Y. Heavy Artil- lerj', age 24. Despond, F., Pt., A, 5th Michigan. Detricb, C, Pt., K, 82d Ohio. Dowling, J. T., Lieut., 17th Infantry, age 35. Eastman, C. E., Pt., E, 9th Maine. Evans, A., Pt., E, 1st Illinois Artillery, age 27. Faust, J., Pt., H, 119th Pennsylvania, age 24. Frampton, T. H., Pt., G, 22d Mass., age 18. Fuller, J. P., Pt., F, 4th Michigan, age 35. Gammel, M. A., Pt., G, — Arkansas, age 23. Gibnej', J.,Pt.,L, 2d N. York Heavy Artillery, age 18. Gilmore,J.,Pt.,F, 144th New York. Grace, E. C., Lieut., A, 139th Penn., age 24. Granger, B., Pt., K, 1st Penn. Rifles. Dates. July 9, 13, ,64. Aug. 30, Se.10,'62. Sept. 19, Oc.16,'63. Nov. 30, Dec. 30, 1864. May 10, 24, '64. Mar. 7, 20, '65. July 3, 17, s63. Aug. 9, 15, '62. April 6, 18, '65. July 28, Aug 15, 1864. Aug. 30, Sept, 5, 1862. Oct. 19, Nov. 9, 1864. May 12, 22, '64. Sept. 17, Oct. 11, 1862. May 10, June 4, 1864. Aug. 16, 26, '64. June 3, 10, '64. Nov. 25, 28,'63. April 2, 23, '65. June 17, 20, '64. Aug. 29, Sept, 18, 1862. May 10, 20, '64. July 18, 23, '63. Mar. 12, April 4, 1864. May 2, 17, '63. May 22, 30, '64. May 5, 12, '64. Sept. 17, 30, '62. June 16, —, '64. Feb. 10, 22, '65. May 5, 20, '64. Aug. 29, '62. Int. Operations, Operators, Result. Right; circular. A. A. Surg. T. E. Mitchell. Died August 12, 1864; diarrhoea. Right. A. A. Surgeon W. Eddy. Died October 12,1862. /Spec. 61. Left. Died November 1, 1863; secondary haem. and pyaemia. Right; lateral flap. A.A.Surg. R. McNeilj-. Tetanus. Jan. 6, 1865, amp. thigh, lower third. Died January 7, 1865; tetanus. Right; ant. skin flap and post. muse. flap. Surg.A. F. Sheldon, U. S. V. (May 19, lig. of ant. tibial artery for secondary haem. Diarrhuea; pyaemia.) Died May 29, 1864; toxaemia. Left; anterior post. flap. Surg. B. B. Breed, TJ. S.V. Gangrene. Died March 26, '65; exhaustion. Right. July 21, haemorrhage; diphtheria. Died July 31,1863. Left. A. A. Snrg. O. F. Scheldt. Diarrhoea. Died A ug. 31,1862; pj-aemia. Spec. 43. Left; posterior flap. Surgeon B. A. Vanderkieft, TJ. S. V. Died April 23, 1865. Spec. 4100. . Right; circular. Surgeon A. B. Mott, U. S. V. Diarrhoea. Died August 23, 1864. Left. Ass't Surgeon B. Howard, U. S. A. Died September 13, 1862; pj'semia. Left; lat. skin flap and circ. sect. muse. A. A.Surg. C.H.Jones. Died Nov. 21, '64; exhaustion. Right; lateral flap. Chills. Died June 10, 1864. Left; circular. Ass't Surg. J. H. Searle, 26th N. Y. Died Oct. 30,1862; pyaemia. Spec. 770. Left; circular. Surg. A. F. Shel- don, U. S.V. June 6, haem.; lig. ant. tib. art. Died J une 16,1864; secondary haemorrhage. Right; circular. Ass't Surg. C. Wagner, TJ. S.A. Died Sep- tember 11, 1864; exhaustion. Spec. 3707. Right; circ. Surg. N. R. Moseley, U. S. V. June 13, haem. Died June 14, 1864; secondary haem- orrhage. Spec. 2485. Right; flap; haem.; lig. of post. tib. art. Dec. 4, re-amp. iu upper third. Died Dec. 11, 1863. Right; circular. Ass't Surg. W. F. Norris, TJ. S. A. Died May 7, 1865; pyaemia. Spec. 226. Left. Died June 22, 1864. Left. Ass't Surg. B. A.Clements, U.S.A. Died Oct. 28, 1862; pyaemia. Spec. 62. Right; circular. Med. Insp. F. H. Hamilton. Died June 1, 1864; pvaemia. Left. Surg. D. Merritt, 55th Penn. Haem. July 25, lig. of peroneal artery. Died August 8, 1863. Right. A. A. Surg. A. Sterling. Died May 6,1864; typhoid fever and pj'aemia. Right. A. Surg. C. C. Lee,U.S.A. Died May 19,1863. Spec. 1250. Left; rectangular flap. A. A. Surg. R. Ottman. Died June 9, 1864; exhaustion. Spec. 2474. Left. Died June 21, 1864. Left; gangrene. Died Decem- ber 5, 1862. Right. Ass't Surgeon F. "Wolf, U. S.V. Died July 16, 1864. Spec. 2419. Right; anterior flap. A. A. Surg. E. L. Mola. (Erysipelas.) Died February 28, 1865. Right; circular. Med. Inspector F. H. Hamilton, U. S. A. Died June 5,'64; pj-semin. within one inch below the tubercle of the tibia, exposing the bone, which was denuded of its periosteum. There were two large abscesses, one in the popliteal space and the other in the middle third of the thigh; small thrombi in the veins. The lungs Fig. 308.—Sections of rifflit tibia and fibu- la, three months after nmputation in lower third. Spec 19C2. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 531 contained several superficial abscesses; the liver was enlarged, soft, and fatty; spleen soft and enlarged. All the other viscera were in a normal condition." The stump of the leg, showing the tibia to be exposed for the extent of six inches, was con- tributed to the Museum by Assistant Surgeon G. A. Mursick, U. S. V., and constitutes specimen 2739 of the Surgical Section. Table LXXIV. Summary of Three Hundred and Thirty-jive Cases of Intermediary Amputations in the Lower Third of the Leg for Shot Injury. [Recoveries, 1—215; Deaths, 216—335.1 Name, Military Description, and Age. Adams, S. N., Pt., D, 110th Ohio, age 29. Agan, H., Pt., I, 7th Michigan, nge 17. Anderson, R., Pt.. H, 7b"th Colored Troops, age 25. Armstrong, O. M.,Pt.. B, 120th N. York, nge 33. Babcock, E. G., Pt., I, 34th Mass., age 27. Bachtell, S., Pt., H, 7th Pennsylvania Cavalry, nge 22. Bacon, A., Pt., B. 2d S. Carolina, age 21. Bacon, W., Pt., D, 7th Maine, age 21. Barnett, J. B., Pt., E, 191st Penn., age 33. Bathurst, J. F., Serg't, I, 5th Pennsylvania Re- serves, age 23. Betty, W. M., Pt., K, 7th Arkansas. Biglow, I., Pt., E, 8th Louisiana. Bisbee, A., Corp'l, B, 7th Maine, age 25. Blankenship, W. A., Capt., F, 25th Virginia, age 21. Boardwell, I., Pt., C, 36th Wisconsin, age 18. Bowles, R. A., Pt., H, 22d Virginia Battery. Brady, B., Pt., E, 73d Ohio, age 21. Brennan, W. D., Capt., A, 142d New York, age 24. Bromley, W., Pt., A, 149th N. York, age 33. Brown, A. T., Pt., B, 43d North Carolina. Brown, C. I'., Pt., F, 1st Connecticut Cavalry, age 24. Brown, J. C, Pt., E, 52d Ohio, age 20. Brown, J. D..Pt.,1,109th New York, age 19. Brown, S., Pt., I, 107th Ohio, age 21. Brown, W. A., Pt., F, 38th Alabama. Buist, C. B., Pt., C, 27th .South Carolina. Burke. J., Serg't, H, 7th N.Y. H'vy Ait., age21. Bush. H., Pt., D, 85lh Pennsylvania, age 33. April 2, 12, '65. Sept. 17, 24, '62. April 12, 20, '65. June 3, 10, '64. Jnne 18, July2,'G4 Aug. 18, Sept. 17, 1864. July 2, 26, ,63. July 12, 15, *64. Mar. 31, April 8, 1865. Dec. 13, 28, '62. Sept. 19, 28, *63. Sept. 17, 20, '63. April 16, Mny 12, 1862. July 2, 9, '63. June 6, 19, '64. Jnne 28, Julv3,'62. May 15, June 5, 1864. Sept. 29, Oct. 19, 18(14. May 6, 13, '(14. Oct. 19, 25, '64. J une 20, July 3, 1864. July 21, Aug. 6, 1864. Nov. 3, 6, '63. Julv 2, 5. *63. Nov. 25, Dec. 5, 1803. June 16, 23, '02. June 16, 28, '64. Aug. 29, Sept. 1, 1863. Operations, Operators, Result. Right; flap. A. A. Surg. F. II. Uolton. (Also fracture and exo. left tibia.) Disch'd Sept. 11,'65. Right; circular. S. G. Gray, Act- ing Medical Cadet, U. S. A. Discharged June 6, 1863. Left; nut. post, tfkin Hup; circular section muscles. Surgeon F. E. Piquette, 86th Colored Troops. Discharged June 10, 1865. Left; flap. Dr. H. McLean, Troy. Necrosis; sequestra removed. Disch'd May 31, 1865. Spec. 3284. Died October 22, 1870; softening of brain. Left ; flap. Confederate surgeon. Discharged July 6, 1865. Right; circular. A. Surg. T. A. McGraw, U.S.V. Disch'd Jan. 30, 1866; subsequently re-amp. Left; circular. Surg. S. Baruch, 3d Battalion, S. C. To Provost Marshal September 17, 1863. Left; circular. A. A. Snrg. T. Carroll. Necrosis. Discharged June 16, 1865. Amputation thigh in 1866. Spec. 2841. Left; ant. post. flap. Surgeon N. R. Moseley, U. S. V. (April 1, Syme's amp. ankle joint; slough- ing.) Disch'd J une 28, J 865. Left; circular. A. A. Surg. D. Weisel. Gangrene; exfoliat'n. Discharged December 19, 1863. Right. Surg. P. F. Eve, C. S. A. Recovery. ----. Union surgeon. Recovery. Right; circular. Surgeon R. B. Bontecou, U. S. V. Discharged February 10, 1863. April 8, 1863, amputation thigh. Right. Ass't Surg. W. Black, C. S. A. Exchanged Dec. 5,1863. Left; double flap. Ass't Surg. S. B. Ward, U. S. V. Disch"d May 4, 1865. ----Snrg. —Peticolas, C. S. A. Recovery. Left; circular. A. A. Surg. C. S. Merrill. Erysipelas. Disch'd February 28, 1865. Left; circular. Surg. D. G. Rush, 101st Peun. Discharged May 15, 1865. Left; circular. Discharged May 25, 1865. ----. Surgeon R. T. Baldwin, C. S. A. Recovery. Left; circular. Snrg. A. F. Shel- don, U. S. V. Disch'd March 26, 1865. March. 1868, re-ampu- tation. Specs. 2765, 4700. Right; skin flap. A. A. Surg. S. W. Blackwood. April 22, 1865, reamp leg. Disch'd June 3,'65. Left; circular. Surgeon I). W. Bliss, U. S. V. Discli'd March 27, 1864. Spec. 1764. Right: circular. Discharged Feb- ruary 7, 1864. Left: flap. Snrg. J. C. Morgan, 29th Mo. (Also wound of right leg.) Transferred. ----. Surg. H. lluger, P.A.C. S. Recovery. Left: necrosis. July 16, re-amp. Disch'd Mar. 3, '65. Spec. 28W). Lett: circular. Surg. I). Merritt, 55th Penn. Sloughing; erysip- elas. Discharged July 6, 1864. Name, Military Description, and Age. Bush, J., Pt., B, 54th Indiana. Carver, S., Pt., G, 45th North Carolina. Clnrk, R. A., Pt., F, 14th New Jersey, age 21. Cluck, J., Pt., B, 7th Peun. Reserves, nge 30. Conklin, J. IL, Pt., A, 40th New York, age 22. Conroy, J., Ptu C, 4th Infantry. Coombs, L. D., Corp'l, F, 2d Wisconsin, age 28. Corey, R., Pt., C, 18th Connecticut, age 34. Crocker, N. C, Pt., A, llth Maine, age 28. Crnger, E., Pt., E, 5th New York. Curtis, H. H., Pt.,C,7th Wisconsin, age 22. Curtis, J. B., Pt., I, 8th New York Artillery, age 21. Davidson, S., Pt.,B,7th Indiana, age 23. Davton, B. F., Pt., B, 57th Mass., age 18. Denniston, J. F., Capt. and Commissary, U. S. V., age 24. Dersam, F. E., Pt., H, 8th New York Heavy Artillery, nge 31. Devlin, J. R.,Pt.,E, 20th Massachusetts. Dodge, T. A., Lieut., —, 119th New York. Downey, S. W., Lieut.,G, 28th Alabama, age 39. Driscoll, D. O., Pt., B, 14th Infantry, age 19. Dudley, E. H., Pt., K, 16th Vermont, age 20. Dyer, S. M., Pt., I, Sth Wisconsin, nge 20. Emory, J., Pt., A, 36th Indiana, nge 28. Emory, J. D., Pt., B, 139th Penn., nge 24. Fale, L., Pt., G, 13th Mississippi, age 23. Ferris, K. P., l"t.,F, 101st New York. Fesperman. W. C, Serg't, F, 7th North Carolina. Finnagnn, P., Pt., D, 108th N. York, age 24. Fleetwood, L. A., l't., C, 54th Massachusetts (C. T.), age 22. Flippin, E., Pt., F, 49th Virginia, age 28. May 31, June 3, 1863. May 5, 8, '64. July 9, Aug. 3, 1864. Dec. 13, 28, '62. May 5, 8, %4. Aug. 30, Sept. 4, 1862. May 5, 15, '64. July 18, 28, '64. Aug. 14, 25, '64. Aug. 30, Se.20,'62. May 5, 31, '64. June 3, 14; '64. June 9, 13, '62. May 12, 27, '64. Aug. 25, Sept. 10, 1864. June 3, 9, '64. Sept. 17. 20, '62. July 1, 6, r63. Dec. 15, 18,'64. May 5, 8, Tvt. Julv 3, 18, "'63. May 4, 7, *63. Sept. 19, 22, '63. Mav 5, i:t,*'64. Oct. 19, 28, '64. Aug. 29, Sep.-,*62 Dc.13,'02. Jan.-,'63. Sept. 17, Oc.ll.'62. Julv 18, 23," '63. May 30, J'ne5,'64, Operations, Operators, Result. Lett; flap. A. A. Surgeon M. B. Graff. Trans. July 24, 1863. Died Jan. 14,1870; ulceration of slump. Spec. 1629. Left. Surg. J. B. Edelin, C. S. A. Discharged March 4, 1805. Left; circ. A. A. Surgeon J. C. Shinier. (Also penetr. wound of lung.) Discharged September 11, 1865. Spec. 3922. Left; circular. Surg. H. Bryant, U.S.V. (Also w'nd of hand and back.) Discharged December 11, 1803. Spec. 4548. Left; circular. Discharged Maj' 15, 1865. Right; flap. A. A. Surg. F. H. Brown. Aug. 9, '63, bone rem.; gangrene. Discharged. Right; anterior posterior flap. Surg. E. Bentley, U. S. V. Dis- charged December 22, 1864. Left; circular. A. A. Surgeon J. Goldsborough. Disch'd March 23, 1865. Right; circular. A. A. Surgeon R. O. Sidney. Discharged J une 12, 1865. Right. Discharged Februarj111, 1863. Left; circ. Confederate surgeon. Discharged May 26,1865. Left; circular. A. A. Snrg. A. N. K. Andrews. Sloughing. Dis- charged November 10, 1864. Spec. 2533. Right; circ. Surg. P. F. White- head, C. S. A. Discharged Oc- tober 3, 1862. Left; circular. Surg. O. A. Jud- son, U. S. V. August, 1864, re- amp. Disch'd Dec. 27, 1864. Right; circular. Surgeon D. W. Bliss, U. S. V. (Aug. 25, Piro- goff samp, ankle joint.) Disch'd January 1, 1867. .Spec. 3211. Right; ant. posterior flap. Ass't Surg. S. B.Ward, U. S. V. Dis- charged Sept. 13,'65. Spec. 2664. Left; flap. Discharged Decem- ber 12, 1862. Right: flap. Ass't Surg. G. M. McGill, U. S. A. To V. R. 0. November 26, 1863. Left; circular. A. A. Surg. R. L. McClure. To Provost Marshal February 6, 1865. Right; circular. To regiment October 7. 1864. Left: circular. (July 4. Syme's ainputat'n foot; sloughing); ne- crosis. Dec. 21, reamputation. Discharged April 23, 1864. Left. Confederate surgeon. Dis- charged April 25, 1864. Left; flap. Discharged Septem- ber 21, 1S64. Left: flap. Discharged Febru- ary 25, 1865. Left; flap. To prison June 6, 1865. ----. Discharged November 1, 1862. ----. Surg. — Miller, C. S. A. Recovery. Left; flap: exfol. Discharged November 13, 1802. Spec 386. Left (carious). Nov. 6. re-amp. Discharged June 8, 1864. Died Sepieniber3, 1866. Spec. 4MI. Right; circ. Exchanged March 1. 1865. 532 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. Name, Military Description, and Age- Operations, Operators, . Result. 59 60 61 62 63 64 05 66 67 08 69 70 71 72 73 74 Forloine, R., Serg't, E, ' May 16, 15th Virginia. 29, *64. Friddle, W., l't., D, 21st , June 10, Illinois, age 25. I 26, '64. Fuhrman, J., Pt., K, 27th | May 3, Indiana, age 24. j 21, 63. Gaines, W. R., Lieut., B, 14th Virginia Cavalry. Gardner, C. J., Serg't, (J, 1st N. York Dragoons, age 21. Glenn, W., Pt., A, 10th Pennsylvania, age 25. Grindstaff, J. R., Pt.,A, 7th West Virginia, age 38. Gross, J., Pt., E, 200th Pennsylvania, age 21. Hannon, M., Pt., A, 9th New York Heavy Ar- tillery, age 30. Happe, J., Pt., B, 4th Artillery, age 30. Hardern,*R., Pt., C, 61st Pennsylvania, nge 51. Hare, D., Pt., I, 95th Ohio. Harp, A., Pt., D, 8th Alabama, age 35. Harris, W. W., Pt., B, 18(ith N. York, age 34. Hart, J., Pt., A, 14th Connecticut. Harty, D., Pt., F, 69th New York. Harvey, G. W., Pt., 1, 14th New York Heavy Artillery, ago 20. Hnusbeck, A., Pt., G, 105th Penn., age 19. Hawk, J., Pt., I, 36th Ohio. Iloerr, P., Pt., B, 62d Pennsylvania, age 23. Hombree, J., Vt., B, 16th North Carolina. Hooks, J. -R.,Pt.,K, 12th Georgia. Hosington, G., Pt., E, I'.Cd Ohio, age 36. I'ork, A., rt., D, Sth Mississippi. Hunter, W., Pt., I, 113th Ohio, age 54. Jaeger, C, Corp'l, G, 46th New York, age 27. Jarvis, H. D., Lieut., A, 24th Mass., age 19. Aug. 17, Se. 15/64. Aug. 11, 26, '64. June 27, July 21. 1862. May 12, June 4, 1864. Mar. 25, Ap.24,'65. Oct, 19, Nov. 9, 1864. July 1, 6, NB3. May 12, 28, '64. Mar. 12, 15, '63. July 3, 28, r63. April 2, 17, '65. Dec. 13, 17, "62. Sept, 17, 25, '62. June 17, 20, '64. May 5, June 2, 1864. Sept. 19, Oc.19,'63, July 2, 12, '63. July 1, 22, '63. May 10, J'ne5,'64. June 13, 21, '63. July 2, 28, '63. Sept. 18, Oct. 3, 1864. May 12, 31, '64. June 5, 8, '02. Johns, D. S., Pt., G, 23d Aug. 30, South Carolina. Sep.2,'62. Johnson, D. B., Pt., H, June 3, 8th N. Y. H. A., age 21. 8, '64. Kendall, J., Pt., K, 2d Sept. 17, Delaware, age 21. i Oct. 6, , 1862. Keys, H., Pt., A, 18th Massachusetts, age 20. King, A., Lieut., K, 62d Pennsylvania, age 25. King, S. S., Serg't, I, 190th Pennsylvania. Dec. 14, 19, '62. June 27, July —, 1862. May 22, June 17, 1864. Lamont, H., Pt., B, 8th j Sept. 29, Connecticut, age 40. Oct. 27, 1864. Lane, I., Pt., A, 8th Sept. 17, Michigan, age 24. Oct. 14, 1862. ---. Surg. J. G. Dudley, P. A. C.S. Discharged Oct. 2, 1864. Left. Ass't Surg. C. C. Byrne, U. S. A. Disch'd Feb. 18,1865. Right; ant. post. flap. Ass't Surg W. Thomson, U. S. A. Erysip elas. Disch'd Sept. 16. 1863 Spec. 1851. DiedMarch31,1676 Left. Surgeon — Butler, C. S.A Recovery. Right; long ant. short post, flap A. A. Surgeon G. H. Dare. Dis charged April 28, 1805. Right; sloughing. Sept. 4, re- amp. posterior flap. Discharged July 25, 1864. Right; circular. Surgeon I). W. Bliss, U. S.V. Discharged April 15, 1865. Spec. 2428. Left; flap. Surgeon E. Bentley, U. S. V. Disch'd July 15,186*7. Left; lateral skin flap; circular section muscles. A. A. Surg. B. B. Miles. (Necrosis.) Dis- charged August 2. 1865. Left; circular. Discharged De- cember 9, 1863. Right; ant. posterior flap. Surg. E. Bentley, U. S. V. Disch'd June 8, 1865. Right. A. A. Surg. J. B. Taylor. Discharged August 22, 1863. Right. Exchanged November 12, 1863. Left; flap. A.A. Surgeon W. F. Goodwin. Disch'd July 20,'65. Left; flap. Discharged August 1, 1863. Right; circular. Surgeon H. S. Hewit, U.S.V. Exfol. Disch'd January 2, 1863. Spec. 210. Right; flap. Surg. I. V. Miller, 14th N. York Heavy Artillery. Discharged June 8, 1865 Right; circular flap. Surg. E. Bentley, U. S. V. Gangrene. Disch'd May 25, '65. Necrosis. Nov. 29,1865, re-amputation. Left; flap. Discharged Febru- ary 15, 1864. Left; circular. Surg. J. Thomas, 118th Penn. Discharged July 13, 1864. Right. Recovery. ---. Surg. — Goodlett, C. S. A. Recovery. Left, (June 14, amp. ankle joint.) Necrosis. Sept. 17, re-amput'n. Discharged May 16,1865. Died December 16, 1866. Right. For exchange November 12, 1863. Right; circular. A. A. Surgeon J. B. McPherson. Gangrene. Feb. 27, '65, removed exfoliat'n. Discharged July 3, 1865. Left: circular. A. A. Surg. D. L. Haight. Hsem. Sept. 30, bone removed. Disch'd Oct. 27,1864. Left; circ. Surg. S. A. Green, 24th Mass. Disch'd Sept. 9,1863. Necrosed bone removed in 1866. ---. Surg. — Michell, C. S. A. Recovery. Right; ant. posterior flap. Dis- charged August 2, 1865. Left: ant. post. flap. A.A.Surg. J. Sweet. Necrosis. Discharged January 16, 1863. April, 1864, bone removed. Spec. 2757. Right. A. A. Surgeon W. A. Harvey. Discharged June 10, 1863. Spec. 980. Right. (June 28, amput'n foot.) 1863, re-amput'n. Discharged March 17, '63. Died July 12. 72. Right; circular. A. A. Surgeon M. F. Price. Discharged June 29, 1865. Right; flap. A. A. Surgeon E. K. Deemey. Discharged Octo- ber 28, 1865. Left; circular. Ass't Surgeon J. Oliver, 21st Mass. Discharged April 2, 1863. Name, Military Description, and Age 94 Lavell, M., Serg"t,A, 7th Michigan, age 26. 95 Leary, alias Connell, D., Pt., C, 28th Massachu- setts, age 32. Leary, J., Pt., I, 106th New York, age 45. i7 Leathers, J. A., Pt., K, 19th Virginia, age 24. 98 Leslie, A., Pt., D, 9th New Y'ork, age 21. )9 Lewis, T. A., Pt., I, 2d Illinois Cav., age 25. M) Lindley, T., Pt., L, 1st Penn. Cav., age 21. 101 Lister, J., Pt, M, 2d New York Heavy Artillery, age 26. 102 Loggins, N., Pt., A, 26th N. Carolina, age 23. 103 Lowry, J. C, Corp'l, F, 38th Tennessee, age 26. Mathews, B., Pt., B, 14th New Jersey, age 23. Matteson, P., Pt., C, 186th New York. )6 May, C. H., Pt., B, 16th Massachusetts, age 28. 107 Mayer, H., Pt., B, 12th Maine, age 30. 108 McCann., H., Pt,, D. 127th Illinois. McGuire, G. F., Pt., I, 57th New York, age 21. McLaughlin, I. T., Pt., B, 13th Ala,, age 48. .1 McLaughlin, M.,Pt.,H, 31st New York. 112 McMontry, H., Corp'l, A, 16th Infantry, age 34. 3 McPherson. A. D.,Serg't, A, 105th Pennsylvania. 114 McQuilkin, D. L., Pt., E, 38th Ohio. 115 McQuinn, J., Pt,, K, 35th Massachusetts, age 42. L16 Meinhard, P., Pt., D. 6th Louisiana. 117 Merrill, J., Pt,, B, 5th Wisconsin, age 35. 118 Miller, W., Pt,, A, 72d Pennsylvania. 119 Moffit, "W., Pt., F, 1st Connecticut, age 20. 120 Moore, O., Pt., I, 5th Ohio. 121 Morgan, C. F., Pt., B, 1st Massachusetts. 122 Morgan, G., Pt., E, 97th New York, age 30. 123 Morgan, J. M., Black- smith, H, 13th Penn- sylvania Cav., age 17. 124 Morrill, J. A.,Pt.,A, 10th Vermont, age 19. 125 Morris, J.,Serg't.C,llth Mississippi, age 23. 126 i Mueller, J.,Capt., B,17th | Missouri. 127 Mulligan, J., Pt., D,89th ! Pennsylvania, age 32. 128 Murphy, T., Pt., C, 15th Iowa, age 13. 129 Myers, S.H., Pt., E,75th Indiana, age 20. Julv 3, 14, "'63. June 3, 9,'64. Oct. 19, Nov. 17, 1864. July 3, 17, '63. Dec. 13, 28, '62. April 8, 22, '64. Sept. 13, Oct.9,'63. June 1, 10, '64. July 2, 23, '63. Nov. 30, Dec. 28, 1864. June 1, 28, '64. April 2, 29, '65. Jnne 18, 27. '64. Sept, 19, Oc.10,'64. Jan. 11, 31, '63. Dee. 13, 24, '02. July 3, 6, '63. Mav 3, 17, "'63. May 28, J'ne3,'64 July 2, Aug. 1, 1863. Nov. 25, 28, '63. July 30, Aug. 20, 1864. May 2, 5, '63. May 10, 13, '64. Sept. 17, 28, '62. Sept. 17, Oct. 10, 1862. June 9, 13, '62. Aug. 19, 29, '62. Feb. 6, Mar. 2, 1865. June 16, July 10 1863. June 1, 7, '64. July 3, 7, "63. Nov. 27, Dec.1,'63 Sept. 17, 21, '62. July 21, 28,'64. June 20, 30, '64. Operations, Operators, Result. Left; flap. Discharged June 4, 1864. Right; circular. Surg. E. Bent- ley, U. S. V. Discharged May 25.1865. Spec. 2663. Nov. 30. 1867, re-amp. Died of haem. of lungs February 7, 1873. Right; lateral flap. A. A. Surg. R. H. Sterling. Disch'd June 14, 1865. Left. Exchanged November 12, 1863. Left; ant. posterior flap. A. A. Surg. T. H. Dearing. Discli'd July 29, 1864. Spec. 716. Right; circular. A. A. Surg. H. Smith. Disch'd June 15, 1664. Left. Surgeon D. W. Bliss, U. S. V. Discharged April 14,1864. Left; flap. Surgeon W. Watson, 105th Penn. Discharged Nov. 22, 1864. Spec. 3259. ---. Surgeon — Bork, C. S. A. I Paroled November 12, 1863. Right; flap. A. A. Surg. J. E. Patterson. To Provost Marshal March 7, 1865. Right; ant. post. flap. Surg. E. Bentley, U. S. V. Discharged April 15, 1865. Left; circular. Surg. E. Bentley, U.S.V. (W'nds shoulder, back, and hip.) Disch'd July 15,1865. Left; circular. Discharged Feb- ruary 18, 1865. Right. A. A. Surgeon L. Fassitt. Discharged June 1, 1865. Right; lateral flap. A.A. Surg. T. T. Smiley. Erysipelas; ne- crosis. Discli'd Nov. 6, 1863. Right; circular. Ass't Surgeon G. M. McGill, U. S. A. Dis- charged December 16, 1864. Left. Surgeon C. S. Wood, 66th New York. July 14, tetanus. Exchanged April 27, 1864. Left; circular. Discharged De- cember 8, 1863. Left; circular. To regiment Sep- tember 29, 1864. Left, A. A. Surgeon J. Dickson. | Discharged June 4, 1864. Spec. 1649. Left; flap. Dischareed August 11, 1864. Right; double flap. A. A. Surg. E. Seyffarth. Discharged June 15, 1865. Right. Surg. W. A. Robertson, P. A. C. S. Disch'd Sept. 1, '64. Right; flap. Confed. surgeon. Discharged June 17,1865. Left; circular. A. A. Surgeon P. Middleton. Necrosis. April 28, 1864, amp. thigh. Discharged September 3, 1864. Specs-. 97, 2748, 4172. Left; circular. Surgeon 15. Beust, U. S. V. Discharged August 5, 1863. Left; flap. Surg. P. F.Whitehcad, P. A. C.S. Disch'd Feb. 1,1863. Right; circular. Discharged No- vember 8,1862. Left; lateral flap. A. A. Surgeon B. B. Miles. Disch'd October 13, 1865. Spec. 1025. Left. Surgeon J. H. Baxter, V. S. V. Disch'd March 6, 1865. Left; flap. Surg. E. Bentley, II. S. V. Discharged January 2, 1865. Spec. 2548. Left; circular. Surg. S. R. Cham- bers, P. A. C. S. Recovery. Left; flap. Discharged Septem- ber 14, 1864. Left. Surg. T. II. Squire, 89th N. Y. Disch'd May 21,1864. Right; flap. Surg.W. H. Gibbon, j 15th Iowa. Discharged July 26, 1865. Left; circular. A. A. Surg. E. , Stubbs. (June 21, excision of I ankle joint.) Disch'd March 7, 1865. "Died April 12, 1872. INTERMEDIARY AMPUTATIONS IN THE LEG. 533 139 140 141 142 143 144 145 140 14? 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 Name, Military description, and age. Naso, A., Capt,, K. loth Illinois. Nash, C, Serg't, A, 82d Col'd Troops, age 21. Nason, ('. T., Pt., C, lsl Massachusetts Heavy Artillery, nge 25. O'Connor, J., Pt., I, llth Massachusetts, age 44. Osgood, I., l't., B, llth N Hampshire, age 23. Palmer, ()., Pt., F, 45th Pennsylvania. Parker, G. L., Pt., I, 1st Virginia, age 25. Parrott, J., Serg't, H, 28th Tennessee, age 34. Parsons, H., Pt., C, 9th West Virginia, age 23. Pastorius, IL, Pt., E. 62d Pennsylvania, age 25. Paxton, J., Pt., 1-', 23d Virginia, age 33. Payne, (»., Pt., D, 28th Cold Troops, age 19. Pingel, P., Pt., C, 17th Wisconsin, age 25. Pope, R., Pt., 1, 5>d N. Carolina, age 20. Powers, J.A., Pt., E, 63d Pennsylvania. Price, T., Pt., I, 43d N. Carolina, age 18. Raborn, I., Pt., F, 40th Indiana, age 20. Reagles, E., Pt., A, 36th Wisconsin, age 30. Reden, H., Pt., B, llth New Hamp., age 30. Reeder, S. B., Serg't, U. S. Marines, age 21. Richard, J.. Pt., D, 5th Connecticut, age 19. Richardson, G. O., Pt, K, 13th New York. Ridenour, W. M., Pt., B, 14th W. Va.,age20. Rideout, J. J., Pt., F, 12th Virginia, age 21. Riebe, H., Pt., F, 68th New York, age 40. Rix, O. S., Artificer, A, 8th New York Heavy Artillery. Robinson, E., Landsman, U. S. Steamer Rodolph, age 24. Rose, E. P., Pt., K, 6th Wisconsin, age 25. iJw.',./., Pt., F, 2d South Carolina. Ross, W. W., Pt.. I, 9th New Hamp., age 21. Savage, J. W., Serg't, K, 13th Alabama, age 27. Scullen, M. P., Pt., D, 13th Vermont, age 21. Sears, O. H., Pt., K, 6th Vermont, age 24. Selah, T., Serg't, E, 96th Pennsylvania. Sevael, N. B., Turner's Brigade, age 23. Shappeard, S., Pt., D, 142d New York, age 19. OPERATION'S. Ol'KUA I'Oli Result. April 6, , 24, '62. ' April 4, IK '65. May 19, 22, '64. Aug. 30, Se.11,'62. Dec. 13, 19, '62. Sept. 17, Oct. 2, 1862. July :i, 7, '63. Nov. 30, Dec. 28, 1864. July 20, Aug. 3, 1864. May 25, 31, '64. April 6, 15, '0.-i. June 7, 27, '64. Mar. 16, 19, '65. July 2, 6, e63. Aug. 29, Sept. 3, 1862. Sept. 5, 19, '64. Dec. 1, 13, '64. Aug. 16, Sept. 4, 1864. June 20, 30, '64. Mar. 3, 21, '65. July 4, —, '64. Dec. 13, 16, '62. June 15, .10, '64. July 3, 12, '63. July], 4, '63. June 22, July 7, 1804. April 1, 4, '65. Jnly 1, 6, '63. Julv 3, 20, ''63. June 21, 29, '64. Sept. 30, Oc.15,'04. Julv 3, 19,''63. Sept 19, Oct. 13, 1864. Mav 3, 6, '63. Jan. 8, 14, '65. May 26, June 9, 1864. Right. Surgeon E. S. Kenner, C. S. A. Resigned July 7, 1863. Right; a»t. post, skill Hap; circ. sect, mus. Surg. F. E. l'k[uette. 86th C. T. (April 4. exc. of 3d meta. bone.) Discli'd May 30,'<>-">. Left; ant. post, skin flap. Nov 15, removed nec. bone. Discli'd June 30, 18ti.">. Right; eirculi. 29, 1863. Du Left: circular ; 1863, re-amp. ■V . 47.'.8, 341 I. .■h'd April nod Mar ccrosed. Jan. 2, Discharged May 3, 1864. Spec. 208. Left; flap. Surgeon II. S. Hewit, U.S.V. Necrosis. Discharged March 6, 180.S. Left; circular. Ass't Surgeon P. C. Yates, C. S. A. Erysipelas. Recovery. Right; ant. posterior flap. A.A. Surg. J. E. Patterson. To Pro- vost Marshal March 7, 1865. Left; anterior posterior skin flap. A. A. Surg. M. M. Townsend. Discharged May 31, 1865. Right; circular. ' A. A. Surg. M. F. Price. Disch'd Jan. 18, 1865. Right; circular. Released June 24, 1865. Right; circular. A.A. Surg. A. Transue. Necrosis. March 8, 1865, re-amp. Discharged Aug. 1, 1865. Spec. 4740. Right; circular. Discharged Sep- tember 1, 1805. Right. Paroled November 12, 1863. Left; flap. Discharged January 19, 1863. Died December 5, 1866; consumption. Left. To Provost Marshal April 1, 1865. Right. A. A. Surg. R. McNeilly. Discharged May 20, 1865. Left; circular. A. A. Snrg. J. B. Roe. (Gangrene.) Discharged May 23, 1865. Left; flap. Surg. J. D. Mitchell, 31st Maine. Disch'd Oct. 17,'65. Left. Discharged August 26, 1865. Left. (July 4, exc. 4th and 5th met.) Aug. 12, re-amp. Disch'd May 12,1865. Died Feb. 24,'67. Left; circular. Disch'd March 10, 1863. Right; circular. Discharged. Right. Surg. — Dailert, C. S. A. Necrosis; erysipelas. Exch'd March 17, 1864. Left. Discharged May 21, 1864. Right; circular. A. A. Surgeon W. C. Mulford. Discharged March 27, 1865. Lett. Ass't Snrg. .T. R. Tryon, U.S.N. Discharged November 24, 1865. Spec. 5062. Right; circular. Ass't Surgeon A. D. Andrew, 6th Wisconsin. Discharged January 11,1864. Left. Surgeon — Barnes, C. S.A. Recovery November 12,1863. Right: circular. Surgeon A. F. Sheldon, U. S. V. Discharged November 18, 1804. Right. Retired March 20,1865. Right; anterior posterior flap. Ass't Surgeon J. D. Johnson, U.S.V. Spec. 1696. Left; circular. A. A. Surg. T. J. Dunott. (Amp. rightgreattoe.) Oct. 13, haemorrhage: necrosis. Discharged October 28, 1865. Right: circular. Discharged Au- gust 7, 1863. Left; circular. Ass't Surg. II. T. Legler, U. S. V. To Provost Marshal March 2. 1865. Left; nnt. posterior flap. Ass't Surgeon W. Webster, U- S. A. Discharged April 3, 1865. .Name, Military description, and aoe. Sherman, A., Pt,,D, 20th Massachusetts. Shirk, J. G.,Pt.,F, 207th Pennsylvania, age 26. Simmons, J. J., Lieut., A, (ith Mississippi, age 24. Sitgreaves, J., l't., C,8th Virginia, age 25. Smith, A. S.,Pt.,I), 104tli Illinois. Smith, R. R., Pt., E, 3d Ohio Cavalry, age 23. Smith, T.G.,Pt.,F, 107th New York. Spearse, O. W., Pt., G, 40th Mississippi. Stabenfeldt, E., Pt., A, 3d Wisconsin, age 30. Stamps, J. R.,Pt.,A, 12th Georgia, age 21. Statem, E. S., Pt., B, 45th Virginia, nge 23. Stealey, J., Corp'l, E, 10th W. Va., age 22. Stewart, J. L., Pt., D, 49th N. C, age 30. Stewart, T. B., Pt., G, 21st Massachusetts, age 21. Stewart, T. B., Pt., C, 2d Connecticut H'vy Ar- tillery, age 31. Suite, J. M., Pt., E, 23d N. Carolina, age 20. >S------, £., Pt.,— ,22d N. Carolina, age 21. Terwilleger, T. R., Cor- poral, D, 85th N. York, age 21. Thayer, P. O., Corp'l, F, 8th Georgia, age 23. Thompson, M., Pt., C, 7th Indiana, age 25. Tibbetts, J. G., Pt., M, 1st Maine Heavy Artil- lery, age 28. Tibbler, N. R., Lieut., K, 6th Arkansas, age 26. Toothe, I. H, Pt., B, 61st Georgia, age 23. Turner, S.,Corp'l,H, 21st Virginia, age 20. Valentine, C. L., Pt., B, 5th Wisconsin, age 34. Vermilyea, L., Pt., K, 91 st New York, age 21. Vick, T. W., Pt., C, 3d Arkansas. Wakefield, S. D., Pt., E, 3d Maine, age 24. Waldon, E., Pt., E, 3d Delaware, age 25. Walsh, R., Pt., C, llth Massachusetts, age 20. Wanzer, S. O., Pt., K, 36th Illinois, age 20. Warddle, J., Pt., G, 16th Massachusetts. Warner, J., Pt., C, 3d Wisconsin, age 32. Weaver, H. F., Corp'l, B, 155th Pennsylvania, age 19. Welsheimer, E. W., Pt., G, 73d Ohio, age 19. Welton, J. A., Lieut., E, 51st Indiana. Wheeler, W. W., Pt, E, 16th Maine, age 20. Operations, Operators, Result. Oct. 20, Nov. 14, 1861. April 0. 29, '65. Nov. 30, Dec. 20, 1864. April 6, 12, '65. Nov. 25, De.12,'63 Aug. 20, 24, '04. Sept. 17, 20, '62. Sept. 19, 29, '63. Sept. 17, Oct. 3, 1862. July 9, Aug. 6, 1864. Sept. 19, 23, '64. Sept. 19, 23, '64. April 1, 21, '65. June 2, 24, '64. Sept. 19, 23, '64. May 2, 14, '63. May 3, 25, '63. April 20, May 11, 1864. Julv 2, 5, *63. July 22, Aug. 10, 1864. June 3, 9, '64. Nov. 30, Deo. 29, 1864. Julyl, 4, '63. July 2, 10, '63. May 11, 15, '64. Mar. 31, April 11, 1865. May 6, 9, '64. June 4, 7, '64. April 1, 11, *65. June 25, J'y 6, '62. Sept. 20, 23, '63. Aug. 29, Sep. 3,'62, May 3, 15, '63. July 2, 5, '63. Oct. 29, Nov. 16, 1863. April 30, May4,'63 Dec. 13, 22, '62. Right; circular. Surg. N. Hay- ward, 20th Mass. Discharged February 27, .1802. Right; circular. A. A. Surgeon F. II. Getehell. Disch'd Sep- tember 23, 1805. Right; circular. A. A. Surgeon R. McNeilly. To Provost Mar- shal March 7, 1865. Right. (Erysipelas.) Released June 15, 1805. Left: flap. Surg. R. F. Dyer, 104th III. Disch'd May 6,1864. Left; flap. A.Surg.T.A.McGraw, U.S.V. Disch'd April 8, 1865. Right. Surg. S. N. Sherman, 34th N. Y. Disch'd Dec. 6, 1802. ----. Surg. — Roberts, C. S. A. Recovery. Right; flap. Ass't Surgeon J. B. Brinton, U. S. A. Oct. 8, ligat'n ant. tibial. Disch'd Mar. 6,1863. Left; circular. A. A. Surg. J. H. Coover. Exchanged October 17, 1804. Spec. 3816. Right. Surgeon — Hill, C. S. A. Exchanged November 24, 1864. Left; flap. Discharged February 5. 1865. Left; circular. A. A. Surg.W. E. Roberts. Released Aug. 2,1865. Left; circular. A. A. Surg.W. C. Mulford. Disch'd Oct. 10,1865. Nov., 1867, re-amp. upper third. Both ; right, Sept. 23d : left, 24th. Ass't Surgeon J. G. Thompson, 77th N. Y. Oct. 2, haemorrhage. Discharged A ugust 7, 1865. Left. Surgeon — Lott, C. S. A. Retired March 24, 1865. Left; circular flap. Recovery. Right; circular. Confed. surgeon. Partial anchylosis knee joint. Discharged July 27, 1865. Right. Surgeon — Meoms, llth Georgia. Recovery. Left: double flap. A. A. Surg. E. Seyffarth. (Haemorrhage.) Dis- charged September 20, 1864. Left; circular. Surg.W.Watson, 105th Penn. Discharged Jan. 6, 1865. Died January 6, 1871. Left; anterior posterior skin flap. A. A. Surg. R. McNeilly. To Provost Marshal Feb. 6, 1865. Left. Paroled September 25, '63. Left; circular. Surg. — Black, C. S. A. Exch'd March 3, 1864. Right; circular. Surgeon O. A. Judson, U. S. V. Discharged September 12, 1865. Left; circular. Ass't Surgeon A. Delany, U. S. V. Discharged June 21, 1865. Spec. 4054. ----. Surg. — Brown, C. S. A. Recovery. Left; ant. posterior flap. Surg. A. Garcelon, of Maine. Disch d March 6, 1865. Spec. 4474. Right; circular. A.A. Surg. F. Hall. Discharged October 6, 1865. Spec. 4055. Right. A. A. Surg. C. H. Stowe. Discharged June 10, 1803. Left; circular. Disch'd March 16, 1864. Left. Discharged February 4, 1863. Left; flap. Ass't Surg. W. Tow- ers, 3d Wisconsin. Discharged August 25, 1863. Right; circular skin flap. Surg. J. A. E. Reed, 155th Penn. Re- amputation; hsemonhage. Dis- charged July 21, 1865. Left: anterior posterior flap. A. A. Surg. C. F. Haynes. Haemor- rhage. Disch'd Dec. 30,1664. Left. Confederate surgeon. Dis- charged June 20. 1864. Left; circular. Surg. E. Bentley, U.S.V. Discharged May 21, 1863. Spec. 597. 1 SEMME8 (A. J.), Surgical Notes of the late War, in New Orleans Medical and Surgical Journal, 1866, Volume XIX, p. 534 INJURIES OF THE LOWER EXTREMITIES. [chap. x. No. Name. Military Description, and Age 204 Wheelock, G. C, Pt., K, 7th Michigan, age 20. 15 White, J., Pt., D, 2d Maryland, nge 30. 206 Williams, J. C, Pt., F, 27th Indiana. 207 Winters, Z., Ft., C, 129th Illinois, age 23. 208 Wood, D., Pt., A, 56th Ohio. 209 Woolbright, J. F., Pt., D, Orr's S. C. Rifles. 210 ' Wright, A.,—, H, 9th Kentucky. .1 Wright, H. D.,Pt.,D, 5th Mich. Cavalry, age 21. 212 'Wright, J. B., Pt., H, 16th Mass., age 30. 213 Wright, W. H., Pt., E, 30th New York, age 23. 214 Yates, G., Pt., I, 4th N. Jersey, age 25. 215 Zimmer, D., Corp'l, E, 2d Ohio. 216 » Acker, T., Pt., A, 155th New York, age 40. 217 Adams, W., Pt., D, 3d New York Artillery, age 24. .8 Auliff, M., Corp'l, G, 7th Wisconsin, age 20. Barker, L. A., Pt., E, 37th Georgia, age 43. 220 Barker, M. IL, Serg't, C, 6th Vermont, age 26. 221 Belger, W., Pt., C, 1st Massachusetts Heavy Artillery, age 30. 222 Bliss, G. F., Corp'l, D, 30th Maine, age 21. !3 Bollinger, B.,Pt.,C. 143d Pennsj'lvania, age 32. Brooks, J. P., Serg't, K. 57th Mass., age 26. 225 Brown, A. A., Pt., D, 5th Florida. 226 Brown, J., Capt., H, 92d Ohio. Burch, T. C, Pt., F, 83d New York, age 43. >8 Bums, J., Pt., C, 147th Pennsylvania. 229 C-----, D., Pt., —, —. JO Cain, J. L., Pt., G, 1st Maine H. Art., age 23. 231 Campion. J. D., Pt., H, 33d Iowa. 232 Carthey. M. L., Pt., G, 50th Indiana. Childere, L. H., Corp'l, G, 110th Ohio, age 26. 234 Clark, H., Pt., D, Sth Col'd Troops, age 33. 235 i Cohatci, J., 2d Assistant Engineer, age 24. 236,Cowdrey, E. A., Capt., A, 95th New York, age 31. July 24, Aug. 6, 1804. Aug. 29, Sep. 4, 02. Sept. 17, Oct.5,'62. July 10, 13,"'04. May 16, 19, '63. Mav 5, 12, "'04. Sept. 19, Oct. 1,*63. Nov. 12, 19, '64. Aug. 30, Sept. 13, 1862. Aug. 30, Sept. 7, 1862. May 5, 18, '64. Sept. 20, Oct.14,63. May 28, June 13, 1864. June 27, July 14, 1864. May 10, 16," '64. Dec. 16, 20, '64. May 10, 20, '64. May 12, 23, '64. May 23, 31, '64. June 20, Julv 10, 1864. May 18, June 5, 1864. July 2, 13, '63. Sept. 19, 27, '63. May 8, 15, "'64. Nov. 25, —, '63. Feb. 15, 26, '62. June 18, 21, '64. April 30, M'y3,*64, April 30, May 25, 1804. June 3, 27, '64. Sept. 29, Oct. 4, 1864. June 4, 29, '04. Mar. 31. April 16, 1805. Operations, Operators, Result. Right; circular. Surg G. L. Mil- ler, C. S. A. Discharged Aug. 29, 1865. Right; circular. Discharged Sep- tember 29, 1863. Left; flap. Discharged January 5, 1863. Right; circular. Surgeon A. W. Reagan, 70th Indiana. Disch'd July 29, 1865. Right. Surg.W. X. King, 50th Ohio. Disch'd August 19,1863. ----. Surgeon — Fletcher, C. S. A. Recover j'. Right. Snrg. P. F. Eve, C. S. A. Haemorrhage. Recovery. Left; circular. A. A. Surg.W. P. Moon. Disch'd June 24, 1865. Right; circular. Ass't Surg. C. A. McCall, U. S. A. (Hsem.) Nov. 3,1862, re-amputation. Disch'd June 18, 1863. Spec. 136. Right; necrosis. Jan. 16, 1864, re-amputat'n. Discharged Sep- tember 28, 1864. Died May 20, 1871 ; consumption. Right; flap. Surg. D. W. Bliss, U. 'S.V. Disch'd March 16,1865. Right; circular. Discharged. Right; ant. posterior skin flaps. Surgeon J. A. Lidell, U. S.V. (Haemorrhage.) Died June 22, 1864; exhaustion. Left; circular. Ass't Surg. E. F. Hendrick, 15th Conn. Died July 30, 1864; irritative fever. Right; ant. posterior flap. Surg. E. Bentley, U. S.V. Gangrene. Died June 16, 1864 ; pyaemia. Right; circular. A. A. Surg. R. L. McClure. (Gangrene.) Died December 28, 1864.' * Left; anterior posterior flap. A. A. Surgeon O. P. Sweet. Died May 24,1864 ; pyaemia. Right; circular. Surgeon N. R. Moseley, U. S. V. Died June 16, 1864; pyaemia. Left; circular. A. A. Surg. M. F. Price. Died July 6, 1864; asthma. Right; circular. A. A. Snrg. M. L. Baxter. Died July 15,1864; exhaustion. Left; ant. posterior flap. Surg. C. Page, U. S. A. Died July 14, 1864; typhoid fever. ----. Died July 14, 1863; teta- nus. "Right. Sept. 28, haein.; ligation on face of stump. Died October 5, 1863; haemorrhage. Right; ant. posterior flap. A. A. Surg. A. P. Craft. Died June 9, 1864; exhaustion. Left. (Gangrene.) Died Decem- ber 3, 1863. Right; circular. Died March 9, 1802; erysipelas. Left: circular. Died August 5, 1864; pyaemia. Right. Died May 13, 1804. Left. Died May 28, 1864. Left; circular. A. A. Snrg. G. W. Edwards. Died July 14, 1864; exhaustion. Left; circular. A. A. Surgeon T. Hopkins. Died October 6,1864; tetanus. Left: circular; sloughing. Died July 26, 1804; pyaemia. Right; anterior posterior flap. Surg. H. W. Ducachet, U. S. V. Died May 7, 1865; pyaemia. Spec. 4078. No. Name, Military Description, anu Age 237 Cnuimings, R. AV., Pt., D. 28th N. J., age 21. 238 Defnell, D., Pt., G, 10th Georgia, age 21. 19 Dodge, L., Pt., D, 10th Vermont, age 27. 240 Engleman, C, Adj't, 4th Pennsylvania Cavalry, age 26. 241 Farnham, L., Pt., D, Sth New Hampshire, age 37. 242 Ford, J. E., Pt., A, 33d Ohio, age 29. 13 Frodine, J. W., Pt., G, 6th Wisconsin. 244 4Frost, G., Pt., B, 57th Ohio. 245 Gallagher, E., Pt., F, 69th N. York, age 37. 246 Gaskins, W. H, Serg't, K, 8th Virginia, age 20. 17 Gattan, T., Pt., C, 64th Ohio. 248 Gesner, H., Corp'l, G, 176th N. York, age 18. 249 Gilreath, L. P., Pt., B, 2d S. Carolina, age 22. 250 Gravenstine, C, Pt., E, 95th Pennsj'lvania, age 24. 251 Guntman, C, Pt., A, 27th Pennsj'lvania. 252 i Hall, M. J., Pt., G, 2d New Hampshire. 253 Hannans, J., Pt., K, 97th Pennsylvania, age 23. 254 Harrington, H., Serg't, B, 109th N. Y., age 26. 15 Heagy, P., Pt., C, 7th Pennsylvania Res. 256 Hill, A., Pt., F, 18th Massachusetts, age 27. 257 Hodgkinson, AV., Corp'l, A, 9th New York State Militia, nge 23. 258 Hoffsticker, W., Pt., B, 3d Mississippi, age 19. 59 Holt, J., Pt.,H, 6th Wis- consin. 260 Hudson, II. J., Pt., D, 12th Georgia Battery, age 24. 261 Hulle, H. R., Pt., A, 3d Mississippi, age 24. 262 Hyler, F. H.. Ft., B, 55th Ohio, age 20. 263 Iron, F., Pt., A, 70th | Col'd Troops, age 20. 264 265 266 268 Johl. W. H., Pt., D, 52d New York. 6 Johnson, M.,Pt.,G,23d Wisconsin. Jones. R. IL, Pt., B, 7th Illinois Cavalrj'. Karnes. O. W., Pt., E, 65th New York, age 35. Keller. AV., Pt., I, 1st Cavalrj-, age 39. Dates. Dec. 13, 26, '62. July 2, 18,''G3. Sept. 22, Oct. 12, 1864. Mar. 30, April 19, 1865. June 3, 9, '64. Mar. 19, April 8, 1865. Sept. 17, Oct. 6, 1862. Jan. 3, 22, '63. June 3, 17, '64. July 2, Aug. 1, 1863. Dec. 31, Jan. 4, 1863. Oct. 19, Nov. 7, 1864. July 2, 20, '63. Aug. 2, 2V64. May 3, —, '63. Aug. 30, Sep.8,'62. May 20, June 11, 1864. June 23, July 20, 1864. Dec. 13, 24, '62. Dec. 15, 1862, Jan.4,'63, Dec. 13, 17, '62. Dec. 16. 1864, ' Jan. 2,'65, July 1, —, '63. Julv 9, 22, "'64. Dec. 5, 16, '64. May 15, June 6, 1864. April 1, 26, '65. Mav 3, I7,"'03. Jan. 11, 31, '63. Oct. 9, Nov. 11, 1863. Oct. 19, Nov. 18, 1804. Mar. 28, April 12, 1805. Operations, Operators, Result. ---. Died January 15, 1863; pj-semia. ---. Died August 17,1863; py- aemia. Left; circular. Surg. Z. E. Bliss, U.S.V. Died October 29,1864; pyaemia. Left; circular. Surgeon D. W. Bliss, U. S. V. Died May 12, 1805; pj'femia. Left; ant. posterior flap. Surg. E. Bentlej-, U. S. V. Died June 20, 1864; gangrene. Left; flap. Ass't Surgeon AV. Webster, U. S. A. Died May 13, 1865. Left. Ass't Surg. C. Bacon, jr., U.S.A. (Necrosis.) Haem. Died Oct. 15, 1862; haem. Spec. 363. Left; flap. Surg. J. Shrady, 2d Tenn. Died Jan. 28,'63; pysBin. Right. A. A. Surgeon A. Ansell. Died June 28, 1864; pyaemia. Spec. 2572. Right. Nov. 4, removed 6 ins. end of tibia. Died Nov. 5,1863; diarrhcea. Spec. 1962. Left. Ass't Surg. H. P. Ander- son, 64th Ohio. Died January 8, 1863; gangrene. Right. A. A. Surg. B. B. Miles. Died Nov. 26,1864; exhaustion. Spec. 3429. Left; circular; necrosis of tibia. Died October 2, 1863. Right; circular. Surgeon Z. E. Bliss, U. S. V. Gangrenous. Died August 31,1864: pj-aemia. Left. Died June 7,1863; typhoid fever. Spec. 1548. Right. Died September 16,1802; tetanus. Right; circular. A. A. Surgeon O. W. Peck. Died September 20, 1864; diarrhoea. Left; circular. A. A. Surgeon A. Ansell. (Gangrene.) Died August 26, 1864. Spec. 3125. Left; flap. (Haemorrhage.) Dec. 27, haem.; ligation. Jan. 1, '63, haemorrhage. Died January 30, 1863. Spec. 562. Right. Januarj'25, haemorrhage, 36 oz. Died January 29, 1863; haemorrhage. Left. Died January 27, 1863; pysemia. Right: circular. A. A. Surg. E. AVoodruff. Carious; gangrene. Died Jan. 11,1865; exhaustion. Left. Surg. S. P. Bonner, 47th Ohio. Died July 16,'63; tetanus. Right: circular. A. A. Surg. T. E. Mitchell. Died July 31, 1864; chronic diarrh(pa. iypec. 3942. Right. Died January 14, 1865; amputation and diarrhoea. Left: circular. A. A. Surg. L. Sinclair. Died June 8, 1864; exhaustion. Right: ant. post, skin flap : circu- lar section muscles. Snrg. F. E. Piquette. 80th C. T. (Gangrene; diarrhcea.) Died May 11,1865; hectic feverand acute diarrhoea. Left. Surg. C. S.Wood, 60th N.Y. Died May 26, 1803. Sjkc. 1173. Left. A. A. Surg. T. T. Smilej'. Died Feb. 5. 1803; exhaustion. Left: circular. A. Surg. J. C. G. Happersctt, IT. S. A. DiedNov. 15, 1863: congestive chill. Left; lateral flap A. A. Surgeon R. H. Stirling. Died November 20, 1804: pyaemia. Right: nnt. post. flap. A.A.Surg. J. H. Thompson. Died April 18, 1865; pj-aemia and gangrene. 1 Eve (P. F.I. Cases nf Secondary Hemorrhage, in U. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, pp. 210, 211. 1 Coils (E.), Rfjiort of Some Cases of Amputations, etc.. in Medical and Surgical Reporter, 1862-03, Volume IX. p. 196. SLII"E1.I. (J. A.), On the Wounds of Blood Vessels, etc., in U. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 24. *S(IitAI>Y (J , jr.). Gunshot Wound—Compound Comminuted Fracture nf Left Metatarsus, etc., in Am. Med. Times, 1863, Volume VI, p. 113. •SMILEY (T. T.), Gunshot Wounds from Arkansas Post, in Boston Medical and Surgicat Journal, 1863, Volume LXIX, p. 159. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 535 Name, Military Description, ano Aoe. Kelly, T., Corp'l, D, 4th Maine, nge 42. King, T., Pt., —, 4th Michigan, age 22. Knowles, A. J., Corp'l, M, 1st Maine Heavy Artillerj', age 34. Kurtz, F. E., Serg't, G, 159th N. A'ork, age 22. Lake, J., Pt., D, (ith N. York Heavy Artillery, age 40. .Lauce, S., Pt., I, 29th Missouri. Linekin, J. F., Pt., K, 20th Maine, age 17. Ling, C. B., Pt., B, 56th Penusj-lvania. Long, T., Pt., H, 37th AVisconsin, age 34. McCawley, S. E., Pt., H, 28th Iowa, age 19. McCleary, A. P., Pt., B, 63d Penn., age 25. McClure, R. C, Pt., H, 29th Iowa. McGilUm, J. F., Pt., G, 6th Texas, age 18. 'Minamom, J. G., Pt., L, 1st New York Artil- lerj', age 23. Mitchell, T., Pt., C, 36th Indiana. Mock, L., Pt., I, 119th Pennsylvauia, age 22. Morrison, S., Corp'l, D, 81st New York, age 24. Moulton, B., Pt, H, Gor- don's Cavalry, age 28. Murray, L., Pt., H, 1st Maine Heavy Artillery, age 18. Nailan, P., Pt., H, 3d Rhode Island. Newburg, H..Pt..F, 24th Massachusetts, age 28. Nivemej'er, J., Pt., G, 33d Iowa. Norton, M., Pt., I, 73d N. York, age 23. Owens, G. IL, Pt., F, 6th Maine, age 18. Piles, IP., Pt., A, 3d Vir- ginia. Pinager, J., PL, H, 12th Missouri Cavalry, age 24. Poole, J. H., Lieut., I, 52d Ohio, age 33. Porsno, L., Pt., B, 14th New Jersey, age 23. Porter, G. H., Pt., D, 3d Indiana Cavalrj', age 31. Redd, J. P. D., Serg't, E, 13th Virginia. Relyea, II., Pt., I, 2d N. York Heavy Artillery, age 52. Reynolds. P., Pt., K, 5th New Jersej', age 19. Rickman, F., Pt., K, 55th Massachusetts. Ruth ledge, J.W., Serg't, E, 97th Indiana, age 30. May 5, 15, '64. May 31, June 11, 1864. June 18, July 10, 1864. Aug. 25, 28, '64. May 19, June 18, 1864. De.29,'62, Jan. 19, 186;). May 5, 8, '64. July I, 10, '63. June 18, J'y 2, '64 Oct. 19, Nov. 7, 1864. July 2, 8, '63. April 30, May3,'64 Nov. 30, Dec. 26, 1864. May 18, 21, '64. Sept. 19, Oct. 7, 1863. Nov. 7, Dec. 6, 1863. June 3, 27, '64. Oct. 20, 31, '64. May 27, June 8, 1864. June 16, —, '62. Aug. 12, 24, '64. April 30, May4,'64. July 3, 21, \.i. Nov. 7, 11, '63. Aug. 30, Sept. 10, 1862. Dec. 15, 25, '64. June 27, July 17, 1864. May 6, 17, "64. May 5, 17, "'64. Deo. 13, 16, '02. June 1?, Julv 4, 1864. June 17, 20, '64. July 8, 13, 64. June 15, 30, '64. Operations, Operators, Result. Left; antero-posterior flap. Surg. E. Bentley, U. S. V. Died May 21, 1864; exhaustion. Left; circular. A. A. Surg. H. B. Knowles. Died Oct. 24, 1864. Right; circular. A. A. Surgeon M. L. Baxter. Died July 17, 1864; exhaustion. Spec. 2829. Right; circ. Surg. Z. E. Bliss, U. S. V. Died April 28, 1865. Right; ant. post, skin flap. Ass't Surgeon W. Thomson, U. S. A. Died July 11, 1864. Spec. 3565. Right. Died January 23, 1863. Spec. 1031. Left; ant. post. flap. Died June 19, 1864; exh'n and privation. Right. Died July 18, 1863. Left; flap. Surg. T. R. Crosby, U. S. V. Died July 7, 1864; exhaustion. Right; ciro. A. A. Surg. E. R. Fell. (Necrosis); biemorrhage. Nov. 11, ligation anterior tibial. Died Nov. 19, '64 ; haemorrhage. Right. Died November 7,1863. Right. Died May 22, 1864. Right; circular. A. A. Surgeon L. Sinclair. Died February 6, 1865. Left; double ant. posterior flap. Ass't Surg. G. A. Mursick, U. S. V. Died June 8,1864; pyaemio pneumonia. Spec. 2494. Left; flap. A. A. Surgeon J. A. Romaj'ne. (Gangrene.) Died October 15, 1863; pj-aemia. Left; flap. Surgeon D. W. Bliss, U.S.V. (Necrosis.) Died Dec. 21, 1863; pyaemia. Spec. 1903. Left. Died July 26, 1864 ; py- aemia. Right; flap. Surg. G. W. Hoge- boom, U. S. V. Gangrene. Died Nov. 6, 1864; typhoid fever. Left; circular. Surg. R. B. Bon- tecou, U. S. V. Died June 8, 1864; exhaustion. Right. Died July 27,1862; diar- rhoea. Left; circular. A. A. Surg. W. L. "Welles. Died August 29, 1864 ; mortification of stump. Right. Died May 13, 1864. Left. Died August 1,1863. Spec. 1453. Right; circular. Surgeon D. W. Bliss, U. S. V. Died January 31,1864 ; variola. Spec. 1769. Right. Died October 21, 1862; pj'aemia. Left; ant. post. flap. Ass't Surg. AV. B. Trull, U. S. V. (Gang.; tetanus.) Died December 27, 1864 ; inflammation of lungs. Left; flap. Surg. J. E. Herbst, U. S. V. (Gangrene.) Died J uly 30, 1864 ; pyaemia. " Left; circular. A. A. Surgeon T. Carroll. Died Sept. 24, 1864. Right; circular. Ass't Surg. W. Thomson, U. S. A. (May 5, Sj'ine'sainputat'n.) Died June 4, 1864: pya?mia. Left; circular. Died Januarj- 12, 1803. Left; circular. A. A. Surg.AV. H. True. (Gangrene.) Died July 10, '64 ; exhaustion. Spec. 2703. Left; circular. Surg.W.Watson, 105th Penn. Died July 30,1864 ; exhaustion. Spec. 4578. Left; antero-posterior flap. Died July 28. 1864: pyaemia. Right; circular. A. A. Snrg. J. W. Digby. Died July 6, 1804. Name, Military Description, and Age Schulz, P., Pt., K, 4th Artillery, age 28. Scott.G.B.,Corp'l, K,8th N.Y. Cavalry, age 19. Sliaffle, J., Pt., 11, 90th Pennsj'lvania, age 29. Shlaffly, C, Pt., F, 1st Pennsylvania Rifles. Shoemaker, I., Pt., H, 57th Ohio, age 33. Simmons, N. E., Pt., K, 3d Tennessee, age 26. Simpson, C. H., Pt., C, 143d New York. Smith, IL, Serg't, K, 2d Infantry. Smith, H. S., Pt., F, llth New Jersey, age 21. Smith, L, Pt., D, 12th Infantrj', age 24. Smith, P., Corp'l, C, 3d New Hampshire, age 19. Smith, T., Pt., G, 28th Connecticut. Snyder, A. W., Corp'l, K, 183d Pennsylvania, age 20. Starwalt, M., Pt., K, 5th North Carolina, age 21. Sterling, G., Pt., I, 20th Maine, age 27. Steward, A. R., Pt., B, 34th Illinois. Steward, R., Pt., I, 8th Penn. Reserves. Stoerzer, H., Pt., B, 22d Massachusetts. Stone, W., Pt., D, 2d Connecticut H'vy Ar- tillery, age 32. Thompson, J., Pt., A, 14th N. York Cavalry, age 21. Trumpleman, O., Lieut., C, 119th New York. Vangelder, L., Pt., D, 107th N. York, age 21. Vermillion, J. K., Pt,, B, 1st Virginia Artil- lery, age 20. Wagers, J., Pt., B, 14th South Carolina, age 17. Waters, D. J., Pt., F, 60th Ohio, age 21. AVebber, G. A., Pt., A, 20th Maine, age 19. Wetzel, J., Pt., C, 165th New York. Wilson, IL, Serg't, A, 71st Ohio, age 26. AVood, L., Pt., D, 5th New Hampshire, age 15. Woodward, H. B., Serg't, E, 125th New A'ork, age 22. WnrmsUy, L. IF., Pt.,K, 8th Florida, nge 35. Wright, M. V., Major, 2!lth Ohio, age 26. York, M., Pt.. E, 120th New York, age 20. May 3, 20, "'63. June 9, 20, '63. Deo. 13, 25, '62. Sept. 14, Oct. 3,'62. Jan. 11, 31, '63. May 14, June 8, 1864. Oct. 29, Nov. 18, 1863. Sept. 17, Oct. 3,'62. May 12, 21, '64. May 12, 21, '64. Aug. 16, 22, '64. June 14, —, '63. Mar. 25, April 5, 1865. Oct. 19, Nov. 1, 1864. Sept. 30, Oct. 11, 1804. April 6, 20, '62. Dec. 13, 27, '62. July 1, 27, '62. June 1, 27, '64. April 9, 24, '64. July 3, 20, "'03. May 25, June 24, •1864. July 24, Aug. 5, 1864. April 2, 5, '65. May 11, 25, '64. Mav 6, 29, "'64. Mav 27, J'ne8,'63 Sept. 2, 20, '64. April 6, 18, '65. Aug. 16, Sept. 10, 1864. July 2, 6, *63. Dec. 20, —, '64. Julv 2, 28, "'63. Operations, Operators, Result. Right. Surg. J. II. Baxter, V. S. V. Died May 31, 1863; tetanus. S/>ec. 1130. Right. Died July 1, 1803; ery- sipelas. Spec. 1347. Right. A. A. Surg. D. Weisel. Died January 12, 1863; pviemia. Spec. 479. Left. Surg. H. S. Hewit, U. S. V. Died October 17,1862. Spec. 439. Left. (Jan. —, amp. ankle joint.) Necrosis; gangrene. March 8, re-amp. leg, middle third. Died March 19, 1803; gangrene. Right; circular. Ass t Surg. C. C. Bj'rne, U. S. A. Died June 16, 1864; pj-temia. Left. Ass't Surg. C. S. Frink, U. S. V. Died November 25,1863; pj'aemia. Left. Died October 15, 1862. Left; ant. post. flap. Dr. Lewis, Philadelphia. Exfoliation. Died November 22, 1864; pj-aemia. Left; circular. A. A. Surg. C. II. Osborn. Large bed-sores. Died June 3,'64 ; pj-aemia. Spec. 2739. Left; circular. A. A. Surg. C. F. •Bullen. (Amp. right leg.) Died August 30, 1864 ; exhaustion. Left. Died June 29, 1863. Right; circular. A. A. Surg. H. E. Woodbury. Died April 24, 1865; pj'semia. Left; circular. A. Surg. AV. H. AVilliams, Sth North Carolina. Died Nov. 10, 1864; pleuritis. Left. Lenoir's method. Surg. R. B. Bontecou, U. S. V. Erysip- elas; gangrene. Oct. 15, amp. thigh. Died October 20,1864; exhaustion. Spec. 3285. Left. Died April 25, 1862. Left. Died December 28, 1862. Left. Died July 28,1862. Left; ant. post. flap. Ass't Surg. W.Webster, U. S.A. Died July 24, 1864; pj-aemia. Left; flap (erysipelas). A.Surg. A. Hartsuff, U. S. A. DiedMay 5, 1864; pj'aemia. Right (haemorrhage). Died Julv 24, 1863. Spec. 1459. Left; circular. A. A. Surg. H. C. May. (Necrosis.) Died Julv 29, "1864; diarrhoea. Spec. 3496. ^eft; circular. A. A. Surg. A. R. Graj'. (Necro.): pyasmia. Died August 20, 1864. 'Spec. 3808. Left; circular. Died April 19, 1865; pj-aemia. Left; circular. Surg. R. B. Bon- tecou, U. S. Y. Died June 25, 1864; pvaemia. Left; circular. Ass't Surg.AV. F. Norris, U. S. A. Djed July 10, 1864: exhaustion and chronic diarrhcea. Spec. 3534. Right. Died J une 12,1863. Spec. 1306. Left; flap. A. A. Surgeon D. H. Bell. (Gangrene.) Died Sept. 24, 1864; exhaustion. Right; circular. A. A. Surg. C. II. Pegg. Died April 26, 1865. Spec. 40U8. Left; circular. A. A. Surg. G. P. Sargent. (Sloughing.) Sept. 20, and Oct. 5, haemorrh. Died December 7, 1804; pneumonia. Specs. 3658, 3057. Left: necrosis. Dec. 29, amput'n thigh. Died Dec. 3(1,'63: exh'n. Left. (Dec. 20. excision tarsus.) Died January 7. 1865. Right. (July 27, amp. left leg.) A. A. Surg. F. II inkle. Died Aug. 8, 1863. Specs. 1005,1609. 'Lidell (J. A.), On Thrombosis and Embolism, in American Journal Medical. Sciences, 1872, Volume LXIV, p. 354, and On the Secondary Trau- matic Lesions of Bone, in TJ. S. Sanitary Commission Memoirs. 1870. Surgical Volume 1, p. 330. 536 INJURIES OF THE LOWER EXTREMITIES [CHAP. X. Intermediary Amputations in the Leg, in which the Point of Operation is not specified. In forty-seven instances of intermediary amputation in the leg the precise point of ablation was not indicated. Fifteen operations were successful and thirty-two fatal; they were per- formed on forty-six patients, in a fatal instance both legs having been removed. Twenty- nine were Union and seventeen Confederate soldiers. ,Case 781.—Corporal W. Dunlap, Co. E, Confederate Marine Corps, aged 32 years. Avas Avounded during the naval engage- ment Avith the Confederate Steamer Atlanta, June 17, 1863. He was captured and treated at various hospitals, lastly entering West's Buildings, Baltimore, on February 11, 1864. Surgeon T. H. Bache, U. S. V., in charge of the latter, described the injury as a "shot fracture of the right leg, produced by an iron splinter, for which amputation of the leg was performed on June 25th." Surgeon A. Chapel, U. S. V., reported that the patient recovered and was sent to Fort McHenry April 10, 1864. The Confederate hospital records show that the man Avas ultimately retired from service January 31, 1865. Case 762.—Private B. Field, Co. A, 6th Virginia, was wounded in the leg during an engagement on June 21, 1862. On the following day he was admitted to Confederate hospital Chimborazo No. 2, at Richmond, the records of which show the fol- lowing description of the injury and its result: "There was a gunshot comminuted fracture of the tibia and fibula, implicating the ankle joint, the point of entrance being just above the external malleolus and that of exit three-fourths of an inch above the internal malleolus. When admitted the ankle joint was swollen and painful, but there was no swelling above the seat of the fracture, and no fever. On consultation it was decided to save the limb, which was laid on a pillow, cold-Avater dressings being applied and poultices used to promote suppuration. By June 26th there was high inflammatory fever, which abated on June 30th. The ankle joint was now greatly swollen and red and suppurating considerably; patient very much emaciated; appetite poor. Amputation of the leg was performed on July 2d, and on the night folloAving hsemorrhage took place from the stump. This was checked by elevating the stump and the application of cold water. The patient continued to decline, and died on the next day, July 3, 1862. An examination of the amputated leg revealed extensive injury to the soft parts in addition to the comminution of the bone. The tibia was split for three inches, and the ankle joint was filled with pus." Table LXXV. Summary of Forty-seven Intermediary Amputations in the Leg, the Point of Ablation unspecified. [Recoveries, 1—15; Deaths, 16—47.1 N*D Name, Military Description, and Age. Ammons, S., Pt., G, 23d South Carolina. Branson, J. W.. Pt., G, 1st South Carolina. Cox, J., Pt., K, 58th N. Carolina. Dawson, W. L., Pt., G, 28th Tenn., age 30. Dunlap, W., Corp'l, E, Confed. Murine Corps, age 32. Gibson, J.R., Pt., E, 37th Virginia. Goodman, D. R., Pt., B, 19tb A'irginia. Hill, A. C, Pt., D, 28th New A'ork. Holt, J., Pt., B, 37th Vir- ginia. Humphries, L. D., Pt., H, 31st Virginia. Lowrey, S. B., Pt., E, 2d Georgia, age 39. Right, .C., Pt., I, 48th Colored Troops, age 21. Unknown, 26th Pennsyl- vania. Utt.L.H., Capt., A, 7th Kansas Cav., age 22. Wood, C. E., Musician, Sth Virginia. Anderson, J., Pt., G, 5th North Carolina. Baldwin, G., Pt., F,86th Indiana, age 35. Cogin, J., I»t., B, 20th Tennessee, age 29. Cookson, A., Pt., K, 32d Maine. Crawford, C. N., Pt., A, 104th Pennsylvania. Farley, J., Pt., F, 72d New York. Fellows, H. H.. Pt., H, 12th New York. Field, R., Pt., A, 6th Virginia. Dates. Aug. 30, Sep.2,'62. Aug. 29, Sep. 1, '62. Nov. 25, 28, '63. April 6, —, '62. June 17, 25, '63. June 28, J'y 3, '62. Aug 30, Se.28,'62. Aug. 9, 13, '62. Aug. 9, 14, '62. Aug. 7, 1V64. Julv 2, -, \>3. April 1, 12, '65. Nov. 27, —, '63. April 24, 27, '63. May 17, 25, '62. July —, —, '63. Jan. 1, 11, '63. April 7, 10, '62. May 12, —, '64. Sept. 17, 20, '62. Julv 2, 5, r62. July 2, 5, "62. June 21, J'y 2, '62. Operations, Operators, Result. Left. Surg. W. M. Michel, P. A. C. S. Recovered ----. Surg. — Robertson, C. S. A. Recov'd. Disch'd Oct. 10,1862. Left. Transferred February 14, 1804. Left. Discharged June 27, 1862. Right. Retired from service Jan- uary 31, 1865. ----. Surg. — Staunton, C. S. A. Recovered. ----. Surgs.AV. J.Allen and J. E. Chancellor, C. S. A. Recovered. Right. Discharged January 14, 1863. ----. Union surgeon. Recovered. ----. Snrg. A. Atkinson, C S. A. Recovered. Left. Transferred to Provost Mar- shal September 10, 1863. Right; ant. post, skin flap and circ. section of muscles. Surg. F. E. Piquette, 86th Colored Troops. Disch'd July 22,1865. ----. Ass't Surg. J. T. Calhoun, U. S. A. Recovered. Left; flap. Surg. W. R. Marsh, 2d Iowa. Must, out Sept. 29,'65. ----. Surg. R. F. Baldwin, P. A. C. S. Recovered. ----. Died July 11. 1863. ----. Jan. 26, haemorrhage from ant. tib. art. Died Jan. 15,1863. Right; tubercles; diarrh. Died April 25, 1862. Right. Died May 19, 1864. Right. Died October 2, 1862. ----. Died September 1, 1862. ----. Also wounds of face and shoulder. Died July 6, 1862. ----; haemorrhage. Died July 3, 1862. 24 Name, Military Description, and Age. Fingerle, J. A., Pt., H, 9th Wisconsin. Flemming, C, Pt., A, 35th New York. Foster, S. C, Pt., G, 50th Indiana. Gardner, T., Pt,, G, 10th Mississippi. Grion, II. C, Serg't, G, 29th Iowa. Hibbs, P. F., Lieut., D, 71st Pennsylvania. Hodgeboom, AV. B., Pt., K, 5th New York. Inman, J. T., Serg't, K, 21st Ohio. Laughery. J. M., Pt., B, llth Pennsylvania Re- serves, age 35. 34 Madden, R., Pt., H, 29th Iowa. Mandel, H., Pt., D, 27th Wisconsin. McCollum, A., Signal Corps. McDaniel, M., Pt., K, * 48th Virginia, age 51. Mosely, J. P., Serg't., D, 13th Kansas. ■Newman, L. C, Lieut. Col., 31st New York. Richardson, J. H., Pt., D, 5th Kentucky. Schooling, J., Pt.. D, 29th Iowa. Smith, J. A., Pt.,C,29th Iowa. Taylor, R. C, Pt., K, 19th Virginia. Weber, A., Pt., I, 9th AVisconsin. Winn, M., Pt., G, 14th New York. Wescott, O., Pt.,C, 121st New York. Youch, J., Pt., B, 28th Illinois. April 30, May3,'64. Dec. 13, 18, '62. April 30, May3,'64. July 28, —, '64. April 30, May3,'64. Dec. 13, 22, "62. Aug. 30, Sep.4,'62. Sept, 1, 23, '64. Aug. 30, Sept, 4,. • 1862. April 30, May 26, 1864. April 30, May3,'64. May 3, 7, '63. May 23, June 9, 1863. April 30, May5,'(>4. May 3, 17, "63. June 20, 23, '64. April 30, May3,'64. April 30, May 3,'64. May 10, 13, '64. April 30, May3,'64. Aug. 30, Se.21,'62. May 3, —, '63. April 6, 28, '62. Operations, Operators, Result. Left. Died May 9, 1864. Both. Died December 21,1862. Right, Died May 11, 1864. Right. Surg. J. Spiegelhalter, 12th Mo. Died Aug. 11,1864. Left, Died May 14, 1864. Right; gangrene. Died Decem- ber 30, 1862. ----. Ass't Surgeon B. Howard, U. S. A. Died May 10, 1863. Right. Died October 1, 1864. Right. (Also wounds right thigh and left leg.) Sept. 1, 4, haem. Died Sept. 8,1862; haemorrhage. ----. Died Aug. 16, 1864, while a prisoner of war. Left. Died May 13, 1864. ----. Died May 14, 1863. Left; sloughing; haem. June 27, femoral artery ligated. Died Julv 8. 1863. Left. Died May 11, 1864. Left, Surg. M. Clymer, U. S. V. Tetanus; haem. Died June 7,'63. Right. Died June 29, 1864. Left Died June 4,1864. Left. 1 lied May 5,1865, while a prisoner of war at Tyler, Texas. ----. Surg. C.B.Gibson, C.S.A. Died Mav 18, 1864. Left. Died May 7, 1864. Left. Died October 1,1862; py- aemia. Right. Died May 14, 1863. Right. Died May 15, 1862; py- semia. ' SwiXBUBNB (J.), Unnecessary Amputation of the Leg—Tetanus—Death, in Medical and Surgical Reporter, Philadelphia, 1863, Vol. X, p. 319. SECT. V.| SECONDARY AMPUTATIONS IN THE LEG. 537 In the case of Private M. McDaniel, Co. K, -18th Virginia (No. 37, Table LXXV), the left femoral artery was unsuccessfully ligated eighteen days after the amputation. SECONDARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY.—Of the amputations in the leg for shot injury, the secondary operations give the most favorable results. Of four hundred and forty-four cases, one hundred and seven- teen were fatal, a mortality rate of 26.3 per cent., or 4.6 per cent, less than the fatality of the primary operations. One hundred and thirty-three operations were performed in the upper third, one hundred and seventy-lour in the middle third, one hundred and twenty- one in the lower third of the leg, and in sixteen instances the reports failed to indicate the precise point of ablation. Secondary Amputations in the Upper Third of the Leg for Shot Injury.—Of the one hundred and thirty-three cases of this'group, thirty-seven, or 27.8 per cent., had fatal terminations. In sixty-two cases the right, in sixty-seven the left leg was removed; in four this point was not recorded. Example': of Recovery after Secondary Amputations in the Upper Third of the Leg for Shot Injury.—The ninety-six successful operations were performed—thirteen on Con- federate and eighty-three on Union soldiers. Of the latter, eighty-one became pensioners; ten have died since the date of their discharge from the army. Case 783.—Private B. Fields, Co. C, 27th North Carolina, aged 21 years, was wounded in the right leg and taken prisoner at Antietam, September 17, 1862. He entered hospital No. 5, at Frederick, ten weeks afterwards, where Surgeon H. S. Hewit, U. S. V., recorded the following description of the injury: "A gunshot wound of the tibia and fibula by a minie" ball; continuity of bone entirely destroyed; leg very much swollen, offensive, and filled with pus. Flap amputation at the upper third of the leg was performed on November 28th by Acting Assistant Surgeon A. V. Cherbonnier. The stump was closed with three stitches and wet strips of muslin. Reaction was very satisfactory; patient cheerful. On the next day tbe dressing was removed and some adhesive strips were applied, the stump looking well but there being some pain, for which one grain of mor- phia was administered. On November 30th the patient looked and felt well, having slept nearly all night; appetite good; wound suppurating well; stump dressed with lint and cold water and well supported with a roller. Secondary haemorrhage occurred on December 1st, when the popliteal artery was ligated by Surgeon Hewit. One week afterwards the ligature had not yet come away, but there was haemorrhage from the wound, the cause of which was not very obvious. The tourniquet was then applied to the femoral and the wound filled with charpie saturated with solution of persulphate of iron. By December llth the wound in the popliteal space was suppurating; stump healthy looking and dressed with wet strips of muslin; patient pale in appearance, and ordered to take three grains of quinine and five grains of tartrate of iron and potassa every four hours. Early on the morning of December 15th nnother tolerably severe haemorrhage took place, tlie popliteal ligature not yet having come away; continued the tourni- quet to the femoral and prescribed quinine and iron, cod-liver oil, and egg-nog. Two days later the tibia was found to protrude; tourniquet still kept applied, though a little slackened. On December 18th there was another haemorrhage, the loss of blood being about six ounces, controlled by tightening the tourniquet. By December 20th reaction was slowly established, though the patient's face was still bloodless; appetite tolerably good; treatment continued. An attack of diarrhoea had been promptly arrested bv the administration of rhubarb powder, ipecacuanha, and opium. December 24th, patient rallying, though the stump still gives evidence of a low state of vital powers. Several days afterwards the stump looked healthier, and on Decem- ber 29th, when the patient was transferred to hospital No. 1, he was in good spirits and good granulations were springing up." Assistant Surgeon R. F. Weir, U. S. A., in chaige of the latter hospital, recorded the subsequent progress of the case as follows: "The stump continued to look and suppurate well, the patient having but very little'pain and his bowels remaining in good condition; appetite improving. For three days previous to January 26th he complained of great tenderness along the inner side of the thigh, where, on exam- ination, fluctuation was detected, and where an incision was made which was followed by the evacuation of ten ounces of pus, the sinus extending under the deep muscles of the posterior and outer aspect, Injections of hydrochloric acid and laudanum diluted in water were then used, and by January 27th the ulcer of the Fig. 309. — Un- Btump had nearly cicatrized and the cavity of the abscess was rapidly filling up; patient improving iu general fracture in the right health aud able to sit up most of the time. About two weeks later the patient was in very good condition and tibia and fibula.— going about on crutches, the stump cicatrizing rapidly and looking healthy. On February 28th the patient was discharged from hospital treatment, his general condition having improved very rapidly and the ulcer of tbe stump having healed." Several days afterwards the patient was paroled and sent south. The Confederate hospital records show that the man was admitted, on March 18th, to the General Hospital at Petersburg, and that he was permitted to leave for his home, on furlough, April 6, 1863. The greater portion of the amputated bones of the injured leg (Spec. 751), contributed to the Museum Surg. Ill—68 638 INJURIES OF THE LOWER EXTREMITIES. [£HAP. X. Fig. 310.—Stump of right leg thirteen months after anteroposterior flap oper- ation. Spec. 4373. by Dr. Cherbonnier, are represented in the annexed wood-cut (FlG. 309), showing an ununited comminuted fracture of both bones in the lower part, followed by an effusion of a large amount of callus, fragments being attached to the fibula, while the tibia is carious within. Case 784.—Private B. F. French, Co. H, 7th New Hampshire, aged 21 years, was wounded in the right ankle during the attack on Fort "Wagner, July 18, 1863.~ On the following day he was admitted to hospital No. 9, at Beaufort, where secondary amputation was performed by Assistant Surgeon J. F. Weeds, U. S. A., who recorded " a musket ball wound of the right foot, followed, on September 19th, by amputation of the leg at the upper third, Lake's operation being employed." The patient was subsequently transferred to McDougall Hos- pital at Fort Schuyler, and thence, on November 4th, to Lovell, at Portsmouth Grove. Surgeon L. A. Edwards, U. S. A., in charge of the latter hospital, reported that the stump was the result of an antero-posterior flap amputation, also that it had become unhealthy at the time of admission and showed a disposition to slough, for which bromine was applied. On March 3, 1864, the patient obtained a furlough, and subsequently he entered Central Park Hospital, New York City, where he was supplied with a "Hudson" artificial leg. Surgeon B. A. Clements, U. S. A., reported the following recapitulation and result of the case : "The injury was at the ankle, the missile passing from within outward and fracturing the bones entering into the composition of the joint. Not much hsemorrhage took place. Water dressings were applied at first, and three days, after the injury the ball was searched for but could not he found. Three weeks later the missile was removed, about which' time erysipelas attacked the parts, extending up to the groin, but soon disappearing. The amputation was performed on account of extensive necrosis, the patient being under the influence of chloroform and ether. Sutures and adhesive strips were applied. The stump was very slow in healing, but at the tim"e of the patient's admission to Central Park Hospital, June 21st, it was in good condition." The man was discharged from service at his own request, October 7, 1864, and pensioned. He was paid September 4, 1880. In his applications for commutation he continues to report the stump as being in good and healthy condition. A cast of the stump (Spec 4373), made thirteen months after the date of the amputation and contributed by Acting Assistant Surgeon G. F. Shrady, is shown in the adjoining wood-cut (FlG. 310), and exhibits the cicatrix extending transversely across the face of the stump, which is well formed. Case 785.—Private H. Dimock, Co. K, 52d Pennsylvania, aged 20 years, was wounded in the left leg, fracturing the tibia, at Fair Oaks, May 31,1862. One week after the'reception of the injury the wounded man was conveyed to Philadelphia, where, after undergoing treatment at various hospitals, he was discharged from service April 21, 1863, Surgeon I. I. Hayes, U. S. V., in charge of Saterlee, certifying to "the wound rendering the limb of no use." Examining Surgeon C. Marr, of Honesdale, Pennsylvania, certified, September 25, 1863: "He received a gunshot wound through the leg below the knee, pro- ducing a false joint." Several years later Drs. J. D. Lewis and J. M. Farriugton, of Trumansburg, New York, testified that they examined the pensioner and found him suffering from the effects of the wound, also that they deemed amputation of said leg necessary, which was performed by the former en February 12, 1867, about five inches below the knee joint. They further certified that after the amputation they examined the wound carefully and found the tibia one and a half inches gone, a cartil- aginous union having formed a false joint in its stead, and the fibula being partially dislocated at the knee joint in consequence of the whole weight of the body being thrown upon it in walking. Below the cartilaginous union in the tibia a number of pieces of lead were discovered in the substance of the bone below the periosteum, all of which rendered the leg useless and a source of irritation, causing a decline of his general health, etc. Dr. Farrington also stated that in addition to the condition described the tibia contained an oblique irregular fracture. About a year after the date of the amputation the pensioner was supplied with an artificial leg by the firm of B. F. Palmer, of Philadelphia, who described the operation as having been performed by "flap method." In his subsequent application for commutation the pensioner represented the condition of the stump as " sound." He was paid December 4, 1879. • Case 786.—Private G. C. Flanders, Co. E, 8th Ohio, aged 18 years, was wounded in the left leg, at Winchester, March 23,1862. He was treated at several hospitals and lastly at Camp Dennison, where he was discharged for disability November 1, 1862. Surgeon B. Cloak, IL S. V., certified to "gunshot wound in the upper third of the tibia, producing compound comminuted fracture. At present the flexors of that extremity are very much contracted, rendering the leg nearly two inches shorter," etc. Some months after being dis- charged the man re-entered the service and joined the llth Ohio Cavalry, in which organiza- tion he served until May 26, 1865, when he was finally mustered out and pensioned. At the time of receiving his last discharge he was quite lame, the wound having broken out anew about two months previously and requiring surgical operations subsequently. Examining Surgeon J. W. Toward, of Augusta, Maine, in 1837, certified to the injury, and stated that " some of the bone has been taken out and the ball remains in the leg. The wound frequently breaks out and is painful. He wears an apparatus attached to the boot and extending to the hip, relieving the leg of pressure by the weight being sustained by the hip and thigh. I think amputation will prove necessary," etc. Two years later Dr. J. C. Reeve, of Dayton, Ohio, certified that during the six years following the reception of the wound the pensioner had seven operations performed on the leg without cure, aud added: "On June 17, 18G8, I amputated Flanders' wounded limb, and subsequently I attended him for some weeks. Examination of the bones after the operation showed that the ball, apparently a mini6, had perforated the bone in an upward direction and remained embedded in the head of the tibia just below the lino of the amputation." The ampu- tated bones are represented in the wood-cuts (Figs. 311, 312). The missile is battered, considerably flattened, and embedded FIG. 311. —Por- tions of left tibia and fibula—anterior view. Spec. 5580. FIG. 312.—Pos- terior view of the same specimen.— [Spec. 5580.] SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 589 m* in a projecting form in the posterior surface of the tibia. The specimens were contributed to the Museum by the operator. About nine months after the date of the amputation the pensioner was well enough to commence using a "Palmer" artificial leg. In the following year he described the stump as being in a "sound condition," but stated that the artificial limb did not prove satisfactory. He died on June 16, 1872. The immediate cause of his death has not been ascertained. Case 787.—Private F. Mullen, Co. E, 43d New York, aged 21 years, was wounded in the left leg, at Fredericksburg, May 3,1863, and subsequently underwent secondary amputation. Surgeon J. A. Lidell, U. S. V., who performed the operation,1 forwarded the following descriptive history: "The wound was caused by a minie" ball, which passed through and fractured the tibia in the lower third. The man was brought to Stanton Hospital, Washington, three days afterwards. His general condition was good, and it was judged expedient to attempt to save the limb without operation. It was accordingly placed in Hodgen's splint and celd-water dressings were applied; stimulants administered. After several days the parts suppurated freely, and by June 1st the wounds were discharging a good and healthy pus, consolidation taking place, and appetite and pulse being normal. The parts continued to heal nicely up to July 28th, when the patient fell and re-fractured the limb while attempting to walk across the Ward. On August 2d, several pieces of bone were removed. August 10th, parts oedematous; discharge thin and fetid. On August 19th, several openings for the exit of pus were made, when a small necrosed splinter came away; pulse weak; general health suffering. The leg remained in about the same condition until September 1st, when compression by bandage was applied. About October list there was both general and local improvement, the | ffj discharge being of a thick and healthier character. The splints were now removed and stimulants continued. One month later necrosis of the shaft of the tibia had become extensive, the dead bone being completely encased in an involucrum; condition fair; discharges from several openings. But little change took place up to Decem- ber 1st, and none for the better for one month afterwards. The involucrum was now large and the skin covering the front of it thin and about to ulcerate extensively; the foot being considerably twisted inward by abnormal muscular action (partial talipes varus) and the deformity steadily increasing; ankle joint also becoming stiff. There being now no hopes of preserving a useful limb it was deemed advisable to remove it by amputation. The operation was performed on January 9th, at the junction of the upper and middle thirds, by the flap method (double flaps, the anterior one being short). The sawn end of the tibia was beveled off as recommended by Sanson, that is, by placing the saw obliquely—not on the ridge, but ou the internal surface of the bone. The fibula was divided somewhat higher up than the tibia, as practised by Roux. Throughout the operation the patient was kept insensible by sulphuric ether. He did not exhibit any perceptible shock. The flaps were carefully coaptated and secured at several points by interrupted sutures and strips of isinglass plaster. Several turns of a roller were placed around the leg to serve as a supporting bandage; but no other dressing was applied. A full anodyne, was administered after the operation and another at 12 P. M. On the following day the patient was sitting up in bed reading a newspaper, the stump being in fine condition, free from heat and redness, and almost devoid of pain aDd swelling. On January 13th the sutures were removed and the stump was dressed for the first time and found to be uniting by primary adhesion. There was no constitutional dis- turbance whatever. On January 24th the last ligature, that of the posterior tibial artery, came away. The PlG 313 _The patient had not at anytime nor in any way suffered in consequence of the amputation, and the stump had united lower thirds of by first intention. In short, he recovered precisely in the same way as the most fortunate cases of amputation jeft j-, w;tn -ln_ of the leg on account of disease set well." The amputated bones of the leg (Spec. 2022) were contributed to voluorum of the , r ° tibia. Spec. 2022. the Museum by the operator and are represented in the wood-cut (Fig. 313), showing the fractured tibia, with an abundant involucrum formed to nearly the point of section, and a large detached but imprisoned sequestrum being exhibited through the cloacae. A few points of osseous deposit are also seen on the fibula, which is uninjured. The patient entirely recovered, and was ultimately discharged September 5, 1864, and pensioned. In his application for commutation, dated 1870, he described the condition of the stump as being "in good order." He died March 5, 1871. The cause of his death has not been ascertained. Fatal Cases of /Secondary Amputations in the Upper Third of the Leg for Shot Injury.—The thirty-seven operations belonging to this group were performed—seven on Confederate and thirty on Union soldiers. Pysemia was noted in eight, gangrene in one, secondary hsemorrhage in five, diarrhoea in three, and exhaustion in twelve instances as the immediate cause of death. Case 788.—Private S. R. Twitchell, Co. G, 89th New York, aged 25 years, was wounded in the left leg, at Antietam, September 17, 1862, and admitted to hospital at Chester two weeks afterwards. Surgeon J. L. LeConte, TJ. S. V., recorded the following history: "The injury was just above the ankle joint and was followed by limited necrosis of the tibia and forma- tion of pus, which was evacuated by two incisions, one on the anterior aspect about six inches in length, and the other posteriorly about three inches long. For three weeks after the incisions were made the wound progressed favorably. It then commenced to slough, and this went on until the external Wound measured six inches long and three inches wide. On February 15, 1863, amputation was performed by the flap method at the upper third by Acting Assistant Surgeon L. Fisher. Tonics, stimulants, perchloride of iron, quinine, whiskey, beef-tea, etc., were administered. The case progressed satisfactorily for a week after the operation, when signs of constitutional irritation showed themselves and the patient gradually became worse. On February 28th he had a rigor, lasting twenty-five minutes, and the case was diagnosed as one of pyaemia. After this time the patient continued to sink until March 5,1863, when he died. The post-mortem examination revealed nothing but pus in the knee joint." The amputated two lower thirds of the bones of the leg (Spec. £067), contributed by the operator, show that the tibia was partially fractured iu the lowest third, the injury being nearly repaired by callus, leaviug, however, a sinus in the bone. '"LlDBLL (J. A.), On the Major Amputations for Injuries in both Civil and Military Practice, in Am. Jour. Med. Sciences, 1864, Vol. XLVII, p. 376. 540 INJURIES OF THE LOWER EXTREMITIES. |CHAP. X. FIG. 314.—Por- tions of fractured tibia and fibula of leftleg. .Spec.748. Cask 789.—Private H. Linn, Co. A, 6th Pennsylvania Reserves, aged 25 years, received a shot fracture of the left leg, at Antietam, September 17, 18(52. Two weeks afterwards he was admitted to hospital No. 5, at Frederick, where Surgeon II. S. Hewit, U. S. V., noted the following description and treatment of the injury: "A minid ball entered the lower part of the leg inside the gastrocnemius tendon, and emerged on the outer side of the leg near the crest of the tibia and six inches from the knee joint. On October 15th a fragment of lead was cut out from the outer part of the leg near the wound. Subsequently a sinus formed up the intermuscular space for four inches, for which incisions and poultices were applied, ei^ht [lieces of tibia being removed during the treatment. Towards the last week in November the patient was doin" well. On December 3d a small portion of the fibula above the malleolus was excised. The bones were found considerably necrosed, and amputation, it was thought, would be necessary. On the next day the wound looked badly, the patient suffered a great deal, and amputation at the upper third was performed by flap method by Acting Assistant Surgeon A. V. Cherbonnier. In the following night the stump had to be re-opened in order to arrest hsemorrhage from some of the small vessels, persulphate of iron being used; and when the bleeding ceased dry lint was applied. By December 17th the soft parts of the stump were much retracted, the ends of both bones exposed and necrosed, and there was an apparent effort at formation of an involucrum. Ten days later the granulations were healthy and the patient's condition had improved." On December 29th the man was transferred to hospital No. 6, and subsequently to No. 1. Assistant Surgeon R. F. Weir, U. S. A., in charge of the latter, recorded the following result of the case: "Secondary amputation of the thigh was performed at the junction of the middle and lower thirds of the femur by Surgeon J. B. Lewis, TJ. S. V., on January 15, 1863. The patient progressed favorably until February 4th, when secondary hasmorrhage super- vened, which was checked only by ligation of the femoral at the point of election. February 15th, patient about the same; pulse 135 and rather quick; tongue red and dry; sloughing condition of stump disappeared and healthy granulations commencing. Brandy administered every half hour; also beef-tea and cod-liver oil. After this the patient began to do well; appetite better; pulse much stronger; stump beginning to heal. On February 21st the ligature was removed from the femoral. On March 5th the patient was slightly etherized, and a piece of dead bone about one and a half inches in length was sawn off from the end of the femur; some small pieces were taken out with the forceps; patient doing well otherwise; stump dressed with adhesive strips and cold water. For about two weeks after this the patient still improved and felt quite comfortable; stump assuming a better appearance. At an exam- ination on March 19th a sinus was discovered to be extending up on the posterior aspect to about the middle of the stump, and the bone was found to be dead when felt by the probe, with indications that the process of separation was going on; discharges copious, offensive, and of a dark color. Poultices were continued after syringing the parts with soda wash, and brandy, with generous diet, was ordered. By March 23d the patient's general health was quite poor and he had but little appetite; stump not looking very healthy, there being considerable necrosed bone to come away; suppuration not as healthy as before. Two days later the patient was worse and weaker; tongue coated; teeth covered with sordes; appetite poor; stump suppurating pretty freely and still having an offensive odor about it, but integuments looking healthy. On March 28th the patient complained of soreness over the shoulder; general health about the same; stump looking rather better; appetite improving. On March 30th he was quite weak; tongue coated and dry; pulse 140; skin dry and getting more yellow; stump doing poorly; discharge unhealthy. Extensive necrosis of the femur was felt by the probe; wound syringed with acid and soda wash alternately and poultices applied. The next day the patient failed rapidly. At 1 P. M. he had a slight hsemorrhage from the opening in the stump, losing about one and a half ounces of blood. No bleeding vessel could be found. Death occurred at 4 P. M. On examining the chest eleven hours after death the left lung was found thinly studded with tubercles; lower lobe of right lung thickly studded in upper and middle portion; middle lobe a complete mass of tubercular matter and filled here and there with abscesses from the size of a chestnut to that of a pullet's egg; upper lobe in the same condition. Heart normal in size; liver somewhat enlarged and very fatty; spleen very much enlarged and highly congested; kidneys enlarged and fatty, and pelvis containing a large amount of phosphatic deposit on right side, also renal cal- culi in upper portion of urethra. Specimen 3818 (FlG. 315), consisting of the stump of the femur, shows extensive necrosis from the seat of the operation to within an inch of the trochanter minor, the shaft on the outer tide being thinly covered with an involucrum. On the posterior surface the involucrum is bare from the end of the bone to within three inches of the trochanter major, it having been broken down by ulcerative process, while on the anterior portion of the shaft the sequestrum is exposed at several points from the same cause. The neck of the bone was observed to be very short and its head quite large. Specimen 39b3 (FlG. 316) com- prises a portion of the external iliac and femoral arteries, including the occluded portion of the latter, also part of the profunda and anastomotica magna, the end of which is covered with adipose tissue." The amputated portions of the bones of the leg (Spec. 748), contributed by Surgeon Hewit, are shown in wood-cut (FlG. 314); exhibiting the fibula with loss of substance of one inch in the lower third, and the adjacent portion of the tibia, which is superficially necrosed, while the superior portion of the fibula shows increased periosteal action. CASE 790.—Private J. E. Eames, Co. F, 112th New York, aged 23 years, was wounded in the left leg, during the assault on Fort Fisher, January 15, 1865. He was conveyed to New York, and entered McDougall Hospital at Fort Schuyler ten m Fig. :U5.—Stump of left femur. Spec. 3818. FIC.31C—Portion* cf external iliac, fem- oral, profunda, and anastom mag.: femor- al ligated. SpecZMtt. SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 541 days after receiving the injury. Assistant Surgeon S. H. Orton, TJ. S. A., who amputated the wounded limb, made the follow- ing report: "The wound was caused by a minie" ball striking the outer aspect one and a half inches above the ankle, passing downward, inward, and a little backward, and emerging at the internal border of the tendo-achillis. At the time of the ampu- tation, February 28th, the muscles were pale and flabby and there was not much retraction. The operation was performed by the circular method about three inches below the patella, the spine of the tibia being sawn off after severing the bones. The soft parts were cut above the division of the popliteal, so that was the only artery requiring ligation. After severing the limb the incised edges of the integuments were brought together and held by a suitable number of sutures. Chloroform was used and the patient passed through the operation very well; in the evening his general appearance was better than it had been for a week. Water dressings were applied aud oakum to catch the discharge. Stimulants, tonics, and a"most nourishing diet were administered. On March 3d the ligature came away; stump looking healthy; discharge free; pulse 120. The integument over the upper part of what remained of the spine of the tibia ulcerated, exposing a small portion of the bone. The patient died of exhaustion March 17, 1865. An examination of the amputated limb showed that the ball had passed through the base of the external malleolus and grazed the external border of the articulating surfaces of the tibia and astragalus, both of which were apparently necrosed. The whole ankle joint was filled with pus, as was also the articulation between the astragalus and scaphoid bone. The soft parts were oedematous and filled with sinuses running in every direction. The foot presented the anatomical curiosity—though not bearing on the case—of containing six toes, the supernumerary one being situated between the normal fourth and fifth. On dissection it was found that there were only five metatarsal bones, -but the fifth was double the natural size in breadth and had two phalangeal articulations. The patient stated that both his father and grandfather were afflicted with the same deformity. His right foot was normal." Case 791.—Private H. Loud, Co. A, 183d Pennsylvania, aged 18 years, was wounded at the Wilder- ness, May 8, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, reported his admission to the field hospital of the 1st division, Second Corps, with "wound of left ankle by a musket ball." Surgeon N. R. Moseley, U. S. V., who amputated the fractured limb, reported (he following result of the case: "The wouuded man was admitted on May 28th to Emory Hospital, Washington, where the soft parts became gangrenous and the bones of the ankle joint necrosed; tibia and fibula denuded of periosteum some three inches above the wound. Flap amputation of the leg at the junction of the upper and middle thirds was performed on August 23d, chloroform and ether constituting the anaesthetic. The after-treatment consisted of cold-water dressings, tonics, stimulants, and nourishing diet. Redundant granulations required the application of caustics about three weeks after the amputation. The patient's condition varied much after the operation, alternately recuperating and declining. He became weaker, yet,'being young, hopes were entertained of his recovery until within a couple of weeks of his decease, when his appetite failed and he sank rapidly. Death occurred ou October 14,1864, from exhaustion and nervous irritability." The bones of the stump (Spec. 3318), exhibiting but little healthy action and showing sequestra which are about separating from each bone, were contributed to the Museum by tbe operator, and are represented in the adjoining wood-cut (FlG. 317) FIG. 317.—Bones of stump of left leg seven weeks after amputa- tion. Spec. 3318. Table LXXVI. Summary of One Hundred and Thirty-three Secondary Amputations in the Upper Third of the Leg for Shot Injury. [Recoveries, 1—96; Deaths, 97—133.] Name, Military Description, and Age. Allbee, O. S., Pt., K, 102d Illinois, age 18. Andrews, S. B., Pt., F, 72d New York, age 28. Atkinson, C. T., Serg't, G, llth Ohio, age 27. Barraby, M., Pt., 1,12th Vermont, age 27. Bartrain, A. E., Corp'l, I, Sth Connecticut, nge 21. Bates, E. G., l't., A, 12-ldOhio, age 19. Becker, H., Corp'l, G, 162d New York, age 30. Berry, W. P., Corp'l, G, 7th Missouri. Brashear, Ii. H., Pt., H, 3d Arkansas, age 20. Brown, W., Pt.; C, 15th Infantry, age 30. May 15, J'y 17,'64 May 10, Sept. 27, 1864. Sept. 17, Oct. 21, 1862. Nov. 1, Dec. 20, 18G2. Sept. 29, Dec. 15, 18C4. June 14, \u.l4,'63. April 8, May 13, 1864. May 22, Oct. 6, 1863. July 2, Sept, 1, 1863. Aug. 7, Oct. 18, 1864. Operations, Operators, Result. Left; flap. Discharged March 29, 1865. Right; flap. A. A. Surg. W. S. Ward. (May 10, resection of 2i ins. of tibia; necrosis.) Disch'd November 27, 1864. Right; flap. A. Surg. J. S. Em- erson, 9th N. Hampshire. Dis- charged January 16,1863. Died December 3, 1870. Left; circular. Ass't Surg. C. Wagner, U. S. A. Discharged May 17, 1863. Left; circular. A. A. Surg. T. S. Bartram. (Haemorrhage.) Dis- charged August 23, 1865. Left; circular. Discharged April 26, 1864. Right -. ant. posterior flap. Surg. P. Bacon, U. S. V. Discharged August 12,1864. Spec. 4313. Left; flap. Ass't Surgeon H. R. Tilton, U. S. A. Discharged May 20, 1864. Left. Surgeon R. Batty. C. S. A. Transferred for exchange Nov. 12, 1863. Right; ant. posterior flap. Surg. B. B. Breed, U.S.V., and A. A. Surg. R. McNeilly. Discharged May 23, 1865. " Name, Military Description, and Age. Brown, L. K., Pt., H, Purnell Legion, Mary- land Vols., age 19. Busby, T., Pt,, F, 19th South Carolina, age 23. Chapin, II., Capt,, D, 27th Illinois. Chapman, 11. E., Pt., A, (ith New Hampshire. Charlemaine, A., Pt., A, 55th New York. Connor, J. O., Pt., C, 27th Virginia. Cook, J., PL, H, 101st Illinois, age 19. Copas, W. H., Pt., B, 3(ith Ohio, age 28. Copeland, M., Pt., B, 2d Colored Cavalrj-, age Coy'le, C. D.,Pt., D,83d Pennsj'lvania. Crawford, H. M., Corp'l, K, 116th N. Y., age 28. Au.29,'62. Jan. 8,"64. N'v30,'64. Feb. 20, 1865. Sept. 20, Nov. 27, 1863. Aug. 29, Oct. 4,'62. May 31, J'y21,'62. July 22, Sep.-,'61. May 25, Aug. 10, 1864. Sept. 19, Oct. 26, 1864. Aug. 10, Oct. 24, 1865. June 27, Aug. 1, 1862. April 8, May 16, 1864. Operations, Operators, Res»lt. Left; flap. Surg. D. W. Bliss, U. S. V. Discharged August 18, 1864. Left; oval skin flap. Surg. B. B. Breed, U. S. V. Transferred to Provost Marshal May 6,1865. Right. A. A. Surg. C. C. Shoyer. Discharged September 20,1864. Right. Surgeon C. Page, TJ. S. A. Discharged March 8, 1863. Right. Discharged March 6, '63. Right. Surg. — Cooper, C. S. A. Recovered. Right; oval flap. A.A. f>.rg. J. O'Connor. Discharcroil January 24, 1865. Right; circular Surgeon Z. E. Bliss, U. S. V. Haemorrhage. Oct. 27, ligation of post, tibial artery. Dis-h'd June 5, 1865. Right; circular skin flap. Surg. F. E. Piquette, 86th C. Troops. Discharged January 16,1866. Left; flap. Ass't Siirg. R. Bar- tholow, TJ. S. A. Discharged May 3, 1863. Left; anterior posterior flap. A. A. Surg. H. Smith. Discharged July 14, 1864. 542 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No Name, Military Description, and Age. 22 Crist, A., Pt., F, 70th New York. 3 Daily, P., Pt., E, 48th Mississippi, age 25. 24 Dawley, D., Pt., I, 9th Indiana, age 22. 25 Dimock, H., Pt., K, 52d Pennsylvania, age 20. 26 Dorn, D. H., Pt., E, 1st Cavalry, age 23. 7 Eberhart, A. L., Pt., 1st W. Virginia Cavalry. 28 Field, B., Pt., C, 27th North Carolina, age 21. Dates. xFinnigan, P., Pt., F, 1st Confederate Bat'ry. Fisher, J. P., Pt., A, 7th Missouri Cavalry. Fisher, P. B.,Pt., 1,113th Ohio, age 27. Flanders, G. C, Pt., E, 8th Ohio, age 18. Flynn, M., Pt., A, 24th New York. French, B. F., Pt., H, 7th New Hampshire, Gilson, D., Corp'l, G, 2d U. S. Sharpshooters. Goldsmith, W.II., Corp'l, F, 2d New Hampshire, age 24. Grason, J. A., Pt., D, 6th West Virginia. Green, H.R.,Pt.,F, 81st Indiana. Gurley, W.,Pt.,C, llth Infantry, age 18. Haire, R. IL, Corp'l, E, 31st Illinois, age 32. Hale, II., Pt., E, 84th Pennsylvania, age 20. Harback, M., Pt., D, 5th Kentuckj-, age 21. Hatch, D. A., Pt., C, 2d Massachusetts, age 25. Hitchcock, J. N., Pt., F, 34th Massachusetts. Hubbard, J. A., Corp'l, A, 115th New York. Hyatt, D., Pt, C, 4th Delaware, age 52. Jenni, P., Serg't, C, Jef- ferson Co. State Militia, age 23. Kellerman, M., Pt., D, 75th Penn., age 48. ■*f^«Z/i/,^.J!".,Pt.,A,26th Alabama, age 25. Keyes, C. W., Lieut,, E, 32d Maine, age 33. Lay, R., Serg't, E, 1st Kentucky Light Artil- lerj'. April 2, June 26, 1862. Oct. —, 20, '03. June 2, J'y 6,'64. May 31, 1862, Feb. 12, 1867. June 12, Sept. 25, 1864. Sept. 12, 1862, J'el8,'63. Sept. 17, Nov. 28, 1862. June 2, Aug. 20, 1864. Aug. 16, Sept. —, 1862. June 22, July 28, 1864. Mar. 23, 1862, J'e 17,'68, Aug. 30, Oct. 21, 1862. July 18, Sept. 19, 1863. Sept. 17, 1862, Sept. 17, 1863. June 9, May 15, 1865. Aug. 28, 1864, Au.8,'65 De.31,'62, Mar. 6, 1863. Mav 12, 1864, Feb. 18, 1868. July 2, Aug. 10, 1864. May 12, 1864, Jan.8,'69, May 27, Sept. 6, 1864. July 3, Dec. 16, 1863. May 15, Sep. 5,'64 Sept. 5, Oct, 9,'62 June 18, Nov. 18, 1864. Sept. 11, Oct. 18, 1862. May 2, June 18, 1863. July 28, Oc.18,'04 May 12, June 12, 1864. Dec. 18, 1864, Feb. 13, 1866. Operations, Operators, Result. Right; flap. Surg. A. B. Hasson, U. S. A. Discharged Septem- ber 8, 1862. ---; flap. Surgeon — Holt, 16th Miss. Recovered. Right; circular. Discharged May 15, 1865. Left; flap. Dr. J. D. Lewis of Trumansburg, N. Y. Disch'd April 21, 1863. Left; flap. Discharged May 15, 1865. Left. Dr.W.L.Ctemmcr, Browns- ville, Penn. Recovered. Right; flap. A. A. Surg. A.V. Cherbonnier. Dec. 1, secondary hsem.; lig. of popliteal artery; recurrence. Exch'd. Spec. 751. Right; circular. Ass't Surg. W. F.Richardson, C. S. A. (June 3, Chopart's operat'n.) Recov'd. Right. Surg. E. P. Smith. 7th Missouri. Discharged Februarj* 6, 1863. Right; circular. Ass't Surg. G. W. Burke, 46th Penn. Disch'd June 26, 1865. Left; flap. Dr. J. C. Reeves, at Daj'ton, Ohio. Recov'd. Died June 16, 1872. Spec. 5580. Right. Ass't Surg. J. M. Palmer, 85th N. Y. Discharged Septem-. ber 26, 1863. Right; ant. posterior flap. Ass't Surgeon J. F. Weeds, U. S. A. Discli'd Oct. 7,1864. Spec. 4373. Left; flap. Dr. N. J. Moore, of Nashua, N. 11. Disch'd March 2, 1863. Left; circular. A. A. Surg. J. S. Ross. (June 9, 18C4, res. 4 ins. tibia.) Discli'd Oct. 14, 1865. Right; flap. Dr. J. R. Ramsey, of Clarksburg, West Virginia. Recovered. Left; flap. Surg. F. Sej-mour, U. S. V. Discharged August 1,1863. Right. Dr. II. J. Bigelow, at the Mass. Gen'l Hosp. (June 1,'64, amp. at ankle joint. Necrosis.) Disch'd Feb. 7, '65. Spec. 2421. Left; circular. Surgeon G. L. Lucas, 47th 111. (Gangrene.) Discharged June 22, 1865. Left. Dr. G. L. Potter, of Julian Furnace, Penn. Disch'd April 27, 1865. Right; circular. Ass't Surg. T. A. McGraw, U. S. V. Disch'd June 9, 1865. Right; ant. posterior flap. Surg. C. W. Jones, U. S. V. Disch d April 2, 1864. Spec. 2155. Left; flap. A. A. Surg. A. Traa. Discharged April 19, 1865. Right; flap. Discharged Decem- ber 30, 1862. Left; flap. A. A. Surg. A. Trau. (Eiysipelas.) Discharged June 3, 1865. Right. (Also flesh w'nd of chest; haem. from anterior tib. artery.) Discharged January 19, 1863. Left, Surg. D. W. Bliss, U. S. V. (Hasmorrhage.) Disch'd June 15, 1864. Spec. 1273. Right. Ass't Surg. A. H. Powell, P.A.C.S. (Gangrene.) Recov'd. Left ; flap. Dr. P. Dj-er, of Maine. (June 8, amp. foot.) Disch'd September 27, 1864. Left; flap. Dr. C. P. West, at Louisville, Kentucky. Disch'd August 28, 1865. 79 Name, Military Description, and Age. Operations, Operators, Result. Leighton, B. D., Pt., I, 9th New Hampshire. Lester, J. H., Pt., F, 1st New Jersey, age 20. Logan,W.J.,Pt.,K,9th Penn. Reserves. Loughlin, J., Pt., K, 67th New York, age 22. McCarty, C, Corp'l, E, 1st New York, age 28. McLain, D. P., Pt., F, 4th Cavalry, age 21. Macomber, G. XV., Pt., K, 126th New York, age 20. Masten, D., Pt., G, 4th Illinois Cavalrj-.* Moran, S., Pt., G, 26th North Carolina, age 24. 3 Mullen, F., Pt., E, 43d New York, age 23. Newman, D. J., Pt., G, 24th Wisconsin, age 16. Newton, J. IF., Pt., E, 14th Virginia, age 24. Norris, E., Civilian, age 20. S Ougheltree, G., Serg't., A, 12th Infantry. Perigo, R., Pt., G, 66th Ohio, age 44. Perrin, F., Pt., H, 8th Arkansas, age 25. Phillips, J. L., Serg't, C, 104th New York. Pierce, O. H., Pt., H, 38th North Carolina. Powell, T., Pt., F, (ith Colored Troops, age 30. Pyne, C. M., Lieut., I, 6th Infantry. Redding, J., Pt., K, 42d Illinois, age 28. Renold, C. D., Pt., D, 37th Ohio, age 22. Rhodes, J. H., Pt,, A, 33d Ohio, age 30. Ross, C, Lieut., E, 26th Pennsj'lvania, age 41. Runjan, C, A., Musician, F,*9th N. Y. Heavy Artillery, nge 19. Sampson, T., Pt.,H, 46th Colored Troops. Schmidt, C, Corp'l, K, 39th New York, age 36. Shinn, W. J., Serg't, I, 5th New Jersej-, age 25. June 4, July 29, 1864. June 27, 1862, Feb. 8, 1863. Aug. 30, Dec. 23, 1869. July 2, Sept. 16, 1862. June 30, Aug. 28, 1862. Sept. 17, Dec. 22, 1863. July 2, Sept, 10, 1863. Ap.15,'64 April—, 1866: July 2, Oct, 28, 1863. May 3, 1863, Jan. 9, 1864. June 27, July 31, 1864. July 3, Aug. 10, 1863. April 16, June 2, 1864. June 27, July 28, 1862. Aug. 14, Se. 20,'64. Nov. 30, 1864, Jan. 2, 1865. Sept, 17, Oc.18,'62. June 30, Au.-,'62. Jan. 15, April 20, 1865. Aug. 30, 1862, My 4,'64. Sept. 20, 1863, Jan. 17, 1864. No.25,'63 Feb. 26, 1864. No.25,'63. Jan. 13, 1864. July 2, —, ''63. May 3, Oct. 17, 1863. Sept. 8, Oct. 11, 1864. May 6, 1864, Feb. 18, 1865. J'e 18,'64 Ja.18,'65, Left. Dr. O. H. Bradley, of East Jaffrej*, N. II. Discharged Feb- ruary 11, 1865. Left; posterior flap. A. A. Surg. R. A. Cleeman. Gangrene. Dis- charged December 24, 1863. Left. Dr. J. Kirker, of Alleghe- ny, Penn. 1869, popliteal aneur- ism ; drj' gangrene. Recovered. Left ; flap. Surgeon S. D. Gross, U.S.V. (Erysipelas. July26, Pirogoff's amp. at ankle joint.) Disch'd July 29, '63. Spec. 214. Right. Ass't Surg.W. S. Forbes, U. S.V. (Excision of 3 ins. of tibia.) Discharged May 11,1863. Died August 21, 1867. Right; flap.* Discharged May 26, 1865. Left; ant. posterior flap. (Gan- grene.) Disch'd May 3, 1864. Spec. 4303. Left, Surg. G. R. Bibb, of Jack- sonville, Illinois. (Discharged September 17, 1864.) Right; flap. A. A. Surgeon J. E. Steele. Nov. 8, profuse haemor- rhage; flaps laid open; slough- ing. Trans, to Fort Delaware April 19, 1864. Left; double flap. Surg. J. A. Lidell, U. S. V. Disch'd Sept. 5, 1864. Spec. 2022. Died March 5, 1871. Left; circular. A. A. Surg. J. C. Thorp. (Gangrene.) Disch'd April 9,1865. Right; circular. (July 16, amp. foot, Pirogoff's opera.; slough- ing.) Recovered. Transferred for exchange Nov. 12, 1863. Right; circular. Ass't Surg. J. E. Semple, U. S. A. Disch'd July 17, 1864. Right. (Also fracture of skull.) Transferred to Veteran Reserve Corps August 14, 1863. Left; flap. Discharged June 9, 1865. Died September 4, 1866. Left; bi-lateral skin flap and circ. section of muscles. A. A. Surg. J M. L. Herr. Trans, to Provost Marshal May 6,1865. Right; flap. Discharged March 23, 1863. ---. Surgeon W. A. Carrington, C. S. A. Recovered. Left; circular. Ass't Surg. S. H. Orton, TJ. S. A. (Jan. 15, exc. 3 ins. tibia.) Disch'd Oct. 14,'65. Left; bi-lateral flap. Dr. W. II. Van Buren of New York. Re- tired December 15, 1870. Left; circular flap. Surg. J. Y. Finlev, 2d Kentucky Cavalry. Discharged Sept. 29, 1864. Left; circ. flap. Ass't Surg. B. E. Fryer, TJ. S. A. Disch ft Aug. 24,1864. Died August 17,1870. Left; flap. Ass't Surgeon A. G. Albright, 79th Penn. Disch'd July 15, 1864. Left. Discharged June 18,1864. Died November 30, 1866. Left. Dr. L. Briggs of Auburn, N. Y. (May 3, excision of tibia.) Discharged July 26, 1865. Left; flap. Ass't Surg. J. H. Ben. nett, 46th Colored Troops. Dis- charged March 9, 1865. Right (May 23, 1864, lig. of ant. tibial art'v); ant. posterior flap. Surgeon S. B. Ward, U. S. V. Re-anipntation April 18, 1865. Discharged July 14, 1865. Right; flap. Surg. D. W. Maull, 1st Delaware. Discharged. 1 Smith (Stephen), Analysis of Four Hundred and Thirty-nine Recorded Amputations in the Continuity of the Lower Extremity, in United States Sanitary Commission Memoirs, Surgical Volume II, New York, 1871, p. 140. * Jones (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, In United States Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 292. * LIDEU. (J. A.), On the Major Amputation for Injuries in both Civil and Military Practice, in Am. Jour. Med. Sci's, 1864, VoL XLVII, N. S., p. 376. SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 543 Name, Military description, and age. Smith, A. A., Pt., A, 3d Rhode Island Artillery. Smith, H., Pt., H, 32d Colored Troops, age 37. Snead, A. J., Pt., Court- ney's Artillery. Spencer, C, Pt., A, 1st It. Island Light Artil- lerj', age 32. Spicer. J., Pt., K, 14th K'y Cavalry, age '.'3. Spivey, L. J., Serg't, F, 51st X. Carolina, nge 29. Steinbeck, A., Pt., A, 59th New York, age 23. Struble, C. XV., Corp'l, F, 3d Infantry, age 23. Sullivan, A. W., Pt., F, 69th Ohio, age 20. Swallow, H. R., Serg't, G, 31st Massachusetts. Thompson, II., Pt., K, 6th Maine, age 24. Vogel, P., Pt., I, 6th In- fantry, age 25. Wheeler, C. D., Corp'l, B, 32d Cold Troops, age 21. Wood,C. J., Pt., H, 149th New York, age 44. Woomer, E. M., Corp'l, A, 83d Penn., age 21. Worrell, B. P., Pt., A, 1st New Jersej-. Wurth, L., Pt., C, 41st New York, age 27. Brown, A. C, Serg't, G, 13th Penu. Cavalry, age 36. Cafes, .1. J., Pt., I, 4th Kentucky, age 22. Christiana, G., Pt., A, 120th New York, age 36. Conrad, A., Pt., H, 26th Wisconsin, age 22. Copeland, A. M,, Lieut., C, 81st New York, age 25. Crandall, S, Pt.,G, 17th Michigan, age 18. Eames, J. E., Pt., F, 112th New York, age 23. h Eubanks, L. M.. Pt., I, 30th Alabama, age 33. Frazer, P., Pt., B, 4th Artillery, age 24. Hand, J. C, Pt., C, 3d Mississippi, age 21. Harness, J. C, Pt., A, 33d Ohio, age 21. April 8, July 10, 1863. Feb. 10, Mar. 29, 1865. Au. 9,'62 Aug. 9, 1863. De.13,'62, Deo. 28, 1869. Mar. 9, June 30, 1863. May 16, June 17, 1864. Aug. 16, 1864, April 12, 1866. July 3, Aug. 5, 1863. Sept. 25, Nov. 26, 1863. May 18, 1864, Dec.3,'68, May 3, Sept. —, 1863. June 27, 1862, June 27, 1879. Feb. 10, Mar. 16, 1865. May 3, Aug. 1, 1863. May 5,. July 21, 1864. April 14, Nov. —, 1862. Aug. 30, Dec. 1, 1862. Aug. 15, Oct. 20, 1864. Sept. 20, 1863, May6,'64. July 2, Aug. 10, 1863. May 15, Aug 3, 1864. Sept. 30, Nov. 10, 1864. July 31, Sept. 1, 1864. Jan. 15, Feb. 28, 1865. Nov. 24, 1864. April 30, June 28, 1863. July 20, Sept. 22, 1864. Aug. 3, Sept. 22, 1864. Operations, Operators, Result. Bight; circular. A.A. Surg. J. VV. dishing. (April 9, flap am- putation left leg.) Discharged August 25, 1864. Spec. 1163. Left; ciro. Surg. A. II. Thurs- ton, U. S. V. Discharged J illy 26, 1865. Right. Surg. T. H. Howard, C. S. A. Recovered. Furloughed November 26, 1864. Right; flap. Recovered. Died in 1871. Right. Surg. J. M. Daniel, 47th Kentucky. Discharged March 24, 1864. Right; posterior flap. Surg. — Sutton, P. A. C. S. Retired December 19, 1864. Right. Dr. J. A. McArthur, Sol- diers'Home, Philadelphia. (Dis- charged July 20,1865.) Recov- ered. Died May 6, 1SC8. Left; flap. Surgeon II. Palmer, U.S.V. Discharged December 8, 1663. • Left; lateral flap. Surg. L. Slus- ser, 69th Ohio. March 3, 1864, spiculae removed. Furloughed March 12, 1864. Left; flap. Dr. W. G. Breck, Springfield, Mass. Recovered. Left; circ. A. A. Surg. J. B. Cut- ter. (June 9, diseased bones of foot rem'd.) Discharged May 14,1864. Spec. 4316. Right. Act. Surgeon G. H. Mar- miou, Soldiers' Home, Hampton. (Also w'nds of groin and skull. Necrosed. Rem. of fragments— opening in occipital bone. Dis- charged Aug. 21, 1863.) Specs. 429, 6941. Left; circ. Surg. A. H. Thurs- ton, U.S. V. Discharged Aug. 17, 1865. Died Jan. 22, 1870. Right, Surg. D.W.Bliss.U-S.V. Discharged November 16, 1863. Left; flap. A. A. Surg. E. Harts- horne. Discharged September 9, 1865. Spec. 3678. Left. A. A. Surg. O. F. Scheldt. Discharged January 5, 1863. Left; double flap. A. A. Surg. T. O. Bannister. Discharged September 14,1863. Right; flap. Surg. N. R. Moseley, U. S.V. Died October 29,1864; exhaustion. Spec. 3316. Left. Died May 18, 1864. Right. Sept. 2, baem.; amputat'n thigh. Died September 25, '63.; exhaustion. Right; circular. A. A. Surg. N. R. Morris. (Gangrene.) Died August 25, 1864 ; diarrhoea. Right. Surg. Z. E. Bliss, U. S. V. (Haemorrhage: ligation.) Died January 4, 1865. Left; circular. Surg. A. F. Shel- don, U. S. V. Died September 15, 1864 ; exhaust'n. Spec. 3126. Left; circular. Ass't Surg. S. H. Orton, U. S. A. (Necrosis,) Died March 17,1865; exhaust'n. Left; circulnr. Surg. H. J. Phil- lips, U. S. V. (Gangrene.) Lied November 30, 1864. Right. Died September 18,1863; diarrhcea. Right; circular. Ass't Surg. T. A. McGraw, U. S.V. (Necrosed; gangrene.) Died Sept. 26,1864; exhaustion. Right; circular. Ass't Surg. T. A. McGraw, U. S. V. Died October 4, 1864. Name, Military Description, and Age Ileddon, N., Corp'l, F, 150th New York, age 45. Jackson, 1)'., Pt., K, 2d Florida. Jones, M. M.,Pt.,D, 19th Michigan, nge 25. Keal, J., Pt.. H, 118th Ohio, age 21. Kingsbury, A., Pt., D, 22d Massachusetts, age 18. Levisee, I., Pt., E, 18th Wisconsin. Linn, H., Pt., A, 6th Penn. Reserves, age25. Loud, H., Pt., A, 183d Pennsj'lvania, nge 18. Lovell, P., Corp'l, C, 10th Missouri, age 41. 'Mabry.B. D.,Pt., G, 6th Alabama, age 22. Marlett, G., Pt., M, 1st Michigan Cavalrj', age 19. Merrill, J. A., Pt., G, 51st Tennessee. Moore, J., Pt., E, 8th Penn. Reserves, age 20. O'Connor, J., Serg't, C, llth Massachusetts. Patten, W. F., Pt., C, 9th Mississippi, age 24. Pierson, J. C, Pt., D, 19th Infantry, age 16. Porter, W.C, Serg't, F, 66th Ohio. 2 Rudolph, J., Pt., E,4th Michigan, age 24. Sands, P. E., Serg't, B, 1st Sharpshooters, age 31. Slusser, C. C, Pt., H, 107th Ohio, age 21. Stevens, W. E., Pt., E, Sth Texas, age 18. Tanner, N. A., Pt., 1,2d Michigan. Twitchell, S. R., Pt., G, 89th New York, age 25. Vogle, F., Pt., G, 74th Pennsylvania, age 28. Whistler, R., Pt., H, 49th Ohio. Wilbur, W., Pt,, B, 1st N. York Cavalry, age 27. Aug. 13, Sept. 17, 1864. May 5, June 28, 1862. May 5, July 9, 1864. May 14, June 27, 1864. June 26, Aug. 1, lr62. April 6, May 9, 1862. Sept. 17, Deo. 4, 1862. May 8, Aug. 23, 1864. Nov. 25, 1863, Jan. 10, 1864. Sept. 17, 18C2, Mar. 16, 1863. June 5, July 19, 1864. Nov. 30, 1864, Jan. —, 1865. Dec. 13, 24, '62. June 2, July 5, 1864. May 8, Julv 6, 1864. Operations, Operators, Result. Left; ant. post. flap. A. A. Surg. J. C. Thorpe. (Gangrene; diar- rhoea.) Died September 22,'64; haemorrhage. Left. Teale's method. A. Surg. J. S. Billings, U. S. A. (Erysip- elas.) Died July 6,'62. Spec. 7. Left; circular. A. A. Surg. F. C. Leber. Died July 20, 1864; pyaemia. Left; haemorrhage. 12 ounces. Died Aug. 20,1864; exhaustion. Right. A. A. Surg. S. D. Gross. I Aug. 12, haemorrhage ) Died August 31, 1862; enteritis. ---. Died May 10, 1862; py- aemia. Left; flap. A. A. Surgeon A. V. Cherbonnier. (Excision); hasm. Jan. 15, 1863, amp. thigh ; nec.; lig. of fem.; haem. Died March 31, 1863. Specs. 3818, 3983,748. Left; flap. Surg. N. It. Moselev, U. S. V. (Necrosis.) Died Oct. 15,1864; exhaust'n. Spec. 3318. Left; circular. Ass't Surg. It. Bartholow, U. S. A. (Primary excis.; hsem.) Jan. 15, slough- ing; erj-sipelas; haem. Feb. 2, amputation thigh. Died Feb- ruary 3, 1864. Spec. 2108. Right. Teale's method. (Gang.) Erysipelas; diarr. Died March 22, '63 ; exhaustion. Spec. 3891. Left; circular. A. A. Surg. A. D. Hall. (Haemorrh.) Died Julv 19, 1864; exhaustion. Right. Died January 31, 1865; exhaustion. Left; flaps of skin and circ. sect. of muscles. Ass't Surg. G. M. McGill.U. S.A. (Haemorrhage; diarrhcea.) Died Jan. 19,1863; pj-aemia. Spec. 4577. Left. (Necrosis.) Died June 23, 1863. Spec. 1237. Right; ant. posterior flap. Ass't Surgeon J. C. Thorpe, U. S. V. (Gangrene; necrosis.) Haem., 12 oz. March 24, amp. thigh. Died April 20, 1865; pyaemia. Right; circular. A. A. Surg. E. M. Johnston. Died September 25. 1864; pyaemia. Right. Died October 10, 1862. Spec. 553. Left; ant. post. flap. Surg. J. A. Lidell, U. S. V. (Hemorrhage.) Died Sept. 16,1864 ; exhaust'n. Right; circular. Surg. O. A. Jud- son, U. S.V. (Haemorrh.) Died Nov. 4, 1864; exhaustion. ----(June 15, haemorrhage.) Died June 29, 1863. Right. Died September 4, 1863. Right. (Haemorrh.; gangrene.) Died October 11,1863; pj'aemia. Left; flap. A. A. Surg. L. Fisher. (Sloughing; necrosis.) Died March 5, 1863; pyaemia. Spec. 2067. Right; flap. A. A. Surg. A. Hew- son. (Gangrene; haem.) Sept. 7, haem.; lig. femoral. Sept. 19, lig. ext. iliac. Died Oct. 6,1863; haemorrhage. Spec. 2614. Right. (June2, excision.) Died July 14, 1864; pj-aemia. Right; circular. A. A. Surg. H. B. Butcher. (May 28, Pirogoff's amputation; gangrene.) Died July 6, 1864; exhaustion. ■NORTH (A.), Report of Sixty Cases of Hospital Gangrene, in The American Medical Times. 1S63, Vol. VI, p. 255. 2Lidell (J. A.), Gunshot Wound of Right Ankle Joint involving Tibia and Astragalus, in U. S. Sanitary Commission Memoirs, Surgical Volume I, New York, 1870, p. 191. 544 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In five of the one hundred and thirty-three secondary amputations in the upper third of the leg re-amputation in the thigh became necessary; one patient survived and four succumbed to the operation. Secondary Amputations in the Middle Third of the Leg for Shot Injury. — One hundred and seventy-four cases are included in this group; one hundred and thirty-seven terminated successfully and thirty-seven fatally, a mortality rate of 19.7 per cent. In eighty instances the right and in eighty-seven the left limb was amputated, and in seven cases this point was not indicated. Recoveries after Secondary Amputations in the Middle Third of the Leg for Shot Injury.—Of the one hundred and thirty-seven patients who survived secondary amputa- tion in the middle third of the leg twenty-three were Confederate and one hundred and fourteen Union soldiers. Of the latter one hundred and thirteen became pensioners, but twelve have died since the date of their discharge from the service—one of pysemia, one of continued suppuration of the stump, one of exhaustion, one of apoplexy, one of chronic diarrhcea, one of phthisis, and six of causes not stated. Case 792.—Private 0. L. Bell, Co. D, 1st Delaware, aged 19 years, was wounded in the right leg, at Antietam, Septem- ber 17. 1862, and admitted to hospital at Frederick ten days afterwards. Acting Assistant Surgeon W. S. Adams forwarded the following history: "An examination revealed extensive comminuted fracture of both bones of right leg at the upper portion of the lower third, a transverse fracture at the upper third, and an oblique fracture running down to within two inches of the external malleolus. The limb was in Smith's anterior splint, which had been badly applied; and a piece of adhesive plaster, which had been placed just above the knee, had been allowed to receive the weight of the limb for six weeks. The result was that it cut through the skin, fascia, and to a considerable extent into the muscles, the incision made being seven inches long and at its middle two and a half inches broad. After taking it off the limb was readjusted in the same splint, in which it remained about three weeks longer, when it was placed in a fracture box. After union the leg showed two inches shortening. The patient's condition had remained good throughout, but on the morning of December 26th he had a severe chill, followed at 10 A. M. by considerable fever. On the next day there was some evidence of ery- sipelas on the leg and thigh, and three grains of quinine were prescribed every three hours, also fifteen drops of tincture of chloride of iron every four hours. On the following day erysipelas was very evident and extended from the ankle to the hip; limb hot and much swollen; pulse 130; tongue furred and bowels constipated. Saline cathartics were now ordered and lead and opium wash was applied. On December 29th the patient was no better and there was total loss of appetite. The limb was now suspended in Smith's anterior splint so as to allow a free passage of air beneath and to facilitate the application of local remedies to all parts affected. After this the patient did quite well until January 10, 1863, when there was some evidence of an abscess on the anterior part of the thigh, but no distinct fluctuation could be recognized; patient having no pain and feeling quite well, his appetite having returned for some days. The quinine was now stopped and brandy and tonics were continued. On January 14th an extensive abscess was opened on the anterior part of the thigh and about a quart of pus was evacuated, after which the cavity was syringed with tepid water and a bandage was applied to the entire limb. One week later a solution of zinc was ordered k> be used for syringing. Subsequently the patient continued to do well, requiring no treatment, and on February 10, 1863, he was discharged, the walls of the abscess having become adherent and the ulcer nearly cicatrized." The man subsequently re-enlisted in the 1st Delaware Cavalry and served for fifteen months, when the wound reopened. He then passed through various hospitals, being ultimately discharged for disability, from Jarvis Hospital, Baltimore, June 15, 186"», and pensioned. Examiner I. Jump, of Dover, Delaware, certified July 1, 1871: "There is a large open sore some four or five inches long and the skin or flesh on most of the leg is very much discolored, the discharge being very offensive except when counteracted by disinfectants. The pensioner had to take to his bed last February, being unable to bear any weight on the limb and suffering very much with it. His physician, who had served in the army, insisted on taking the leg off. I am of the opinion that it never will be healed; but I have advised that the diseased portions of the bones be removed; it is barely possible he may FIG. 318.— Posterior and anterior views of the bones of the right leg. Spec. 6569. Fig. 319.—Appearance of stump. [Prom a photograph.] SECT. V.l SECONDARY AMPUTATIONS IN THE LEG. 545 recover." Dr. J. F. M. Forwood, of Chester, Pennsylvania, who subsequently, on August 19, 1872, amputated the leg seven inches below the knee joint, communicated, in connection with the case, that after receiving his final discharge from service the man "roamed about and had one or two operations performed for his relief, staying some fifty days in St. Joseph's Hospital, Philadelphia, and finally drifting here, where I amputated his limb." At an examination of the stump in August, 1879, Examiner Jump reported: "There has been ulceration for ten months continuously, sometimes confining him to his bed." The pensioner was paid March 4, 1881. The amputated bones of the leg (Spec. 6569), together with a photograph of tlie pensioner, represented in the wood-cuts (FlGS. 318, 319), were contributed to the Museum by the operator. * Case 793.—Private W. Holmes, Co. D, 18th Massachusetts, aged 20 years, was wounded in the right leg, at Fredericks- burg, December 13, 1862. He passed from a field hospital to Campbell Hospital, Washington, two weeks after receiving the injury, and six months afterwards he was transferred to Mower Hospital, Philadelphia. Surgeon J. Hop- kinson, U. S. V., in charge of the latter, recorded the following history: "The patient was suffering from a compound comminuted fracture of the tibia and fibula at the lower third. He also complained of diar- rhoea, for which chalk mixture and laudanum were administered. Dead bone was discovered by the probe. The leg had been operated on and several pieces of bone removed. At the time of admission, June 20th, it was very much enlarged and disfigured by cicatrices. The wound was dressed with warm- water poultices every hour. On July 15th a large ulcer had broken out on the limb and a large piece of bone was taken away. Warm-water dressings were still continued, and the foot was kept elevated. On the following day the ulcer was found to be extending, and bread and milk poultices were ordered to be applied. Subsequently chlorate of potassa and muriatic disinfecting lotion were used. On July 19th, creasote was applied to the ulcer; warm-water dressings continued; bone now in a sad state. On July 22d the leg was removed by flap operation by Assistant Surgeon C. R. Greenleaf, U. S- A., half way between the ankle and the knee. The flaps were brought accurately together and dressed with water dressing. On the following day the patient felt eas}-, having slept well during the night after taking a half grain of morphia; pulse 100, full and soft. On July 26th the dressing was removed; stump looking well and patient doing well. Extra diet was given, and porter daily. The stump healed rapidly and the patient's general health was excellent. On September 30th the stump had entirely healed and the patient went home on furlough." He was subsequently transferred to Haddington Hospital, and later to Ladies' Home, New York City, where he was supplied with an artificial leg of the "Bly" pattern, and whence he was discharged April 12, 1864, and pensioned. In his subsequent applications for commutation he described the condition of the stump as continuing in a "healthy state." The amputated bones of the leg (Spec. 2594), contributed by the operator, are represented in the annexed wood-cut (FlG. 320) and exhibit the seat of the fracture, the fibula being firmly consolidated, and much callus being effused about the tibia, but caries having prevented firm union. The pensioner was paid March 4, 1881. Case 794.—Private E. Collins, Co. A, 3d Mississippi, aged 22 years, was wounded above the right ankle, at Peach Tree Creek, July 20, 1864. He was under treatment at Confederate hospitals until June 7, 1865, when he was admitted to the Marine (Union) Hospital at Mobile. Surgeon S. Kneeland, U. S. V., in charge, contributed the specimen (No. 481), represented in the adjoining cut (FlG. 321), with the following description: "The missile, a mini6 ball, perforated the tibia in its course and lodged in the wounded man's shoe. The wound had never healed, and suppuration and haemorrhage had continued up to the time of the patient's entrance into this hospital. For the last few weeks haemorrhage had been frequent and profuse and it was with difficulty controlled by stuffing the cavity in the tibia, which was large enough to allow the finger to be introduced freely. Suppuration was also profuse, and there was great pain and swelling about the lower part of the tibia, the patient being considerably exhausted from these causes. Circular amputation of the leg near the middle was performed on June Sth by Acting Assistant Surgeon E. W. Coale, chloroform being used. The stump at first was disposed to slough, but under atonic treatment and antiseptic applications it soon assumed a healthy appearance. The subsequent progress was favorable, and by June 30th the stump was nearly well." The records of the hospital show that the patient was discharged on parole July 9, 1865. The specimen comprises the lower portions of the bones of the injured leg, and exhibits the cavity in the tibia as well as external deposit of callus. Case 795.—Private P. Larkin, Co. C, 48th New York, aged 24 years, was wounded during the assault on Fort Wagner, July 18, 1863, by a canister shot, which fractured the right foot. Assistant Surgeon J. E. Semple, U. S. A., reported that the wounded man was conveyed to hospital at Hilton Head, where Pirogoff's amputation at the ankle joint was performed one week after the date of the injury. The patient recovered, and was discharged from service December 4, 1863; and pensioned. Dr. E. D. Hudson, of New York City, who supplied the pensioner with an artificial foot several years after- wards, reported that he saw the man some weeks after leaving the service and found that FIG. 320.—Bones of the right leg seven months after fracture. Spec. 2594. Fig. 321.—Bones of the right leg ten and a half months after injury. Spec. 481. FlG. 322. —Bony stump of right leg, af- ter Pirogoff's ampu- the tibia was extensively necrosed, that numerous pieces had exfoliated, and that there i0jnt- spec. 6913. was copious discharge of pus from the leg, which was enlarged about one-third beyond its normal size, an involucrum being present corresponding to the extent of the necrosed bone, and several cloacae having formed. The pensioner subsequently suffered re-amputation of the leg at the middle third (near the junction with the upper third) at the Soldiers' Home in Hampton, whence Dr. G. H. IMarmioii, surgeon in charge, described the case substantially as follows: "After receiving his discharge Larkin was sent to his home in Brooklyn, where he followed his trade as stucco-maker, but was com- Surg. Ill—439 546 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. pelled to desist three months afterwards, necrosis setting in and continuing pretty much up to the present time. He is a man of apparently good constitution, and should have done well had the leg been amputated at the junction of the middle and lower thirds. As it was he led a life of suffering aud mortification, the odor of his leg completely ostracising him from the society of his fellows. I think the operation of Syme or Pirogoff might be profitably abandoned. The re-amputation was performed by me on May 6, 1879, with the assistance of hospital nurses, none of them being professional men. The stump was kept con- stantly wet night and day with a dilute solution of carbolic acid. It healed entirely by first intention, and the patient is now (June 10, 1879) able to walk on crutches a few yards to the hospital piazza. I had some fears of an extension of the disease, but at present there is not nor has there been any indication of the remainder of the tibia being involved. The patient is in excellent physical condition, fat, rosy, and good spirits." The bones of the leg (Spec. 6913), removed at the re-amputation and contributed by the operator, are shown in the wood-cut (Fig. 322 ou the preceding page), aud exhibit a large involucrum embracing a cylindrical sequestrum of the tibia. The pensioner was paid March 4, 1881." Case 796.—Private L. V. Grant, Co. M, 8th Illinois Cavalry, aged 23 years, was wounded in the left ankle, at Beverly Ford, June 9, 1863, and entered Lincoln Hospital, Washington, the following day. Assistant Surgeon J. C. McKee, U. S. A., who amputated the injured limb, reported as follows: "The wound was caused by the ball entering the inner malleolus pos- teriorly, penetrating the base of the tibia, and remaining embedded on the semi-cylindrical face of the astragalus. Upon taking charge of the hospital (December, 1863) I found the patient's condition as follows: Appetite capricious but well guarded by taking acceptable food; constant pain in left breast, accompanied by headache; eyes constantly suffused and face flushed, wake- fulness, restlessness, and night-sweats; also a strong aortic direct murmur of the heart, with considerable hypertrophy and con- sequent labored heart action. He had to be propped up in bed to allow him any rest, his expression being anxious, appetite declining, pain of wound unremitting and excruciating, tissues inflamed aud oedematous, and the joint immovable and firmly anchylosed, rendering it impossible for the patient to put his foot on the ground. He begged again and again to have the limb removed. An examination by the probe indicated diseased bone or foreign substance. The opinion of Acting Assistant Surgeon W. F. Peck—under whose care he had been for some months—as confirmed by the statement of the patient was that the ball had been extracted. Uninfluenced by the patient's constant and urgent solicitation I proceeded carefully to examine the case further; and not being satisfied that I had sufficient authority to remove the diseased and injured joint by amputation, I delayed for accumulative evidence, which was not long in presenting itself. The bad symptoms increasing, it became evident that some measure for relief must be promptly taken to save the life of the patient. Assistant Surgeon R. Bartholow, U. S. A., under whose care the patient had also been for some time, favored immediate amputation, and stated that he had intended to operate before my arrival. Assistant Surgeon H. Allen, U. S. A., was also present and favored the operation. Acting Assistant Surgeon W. F. Peck insisted upon removing the limb some time before I gave my consent; other medical gentlemen present were satisfied that the removal of the limb was called for to rid the patient of a deformity and an encumbrance. Amputation was accordingly performed on December 7, 1863, eight inches below the knee, by circular operation. Sulphuric ether was used and the patient reacted promptly. The stump was left laying open on a pillow and strapped, when the healing process commenced. Simple water dressings were applied. The aggravated symptoms of the heart disease became greatly modified after the operation. The patient's appetite improved, his night-sweats ceased, and he was delighted to be able to sleep and rest, stating that he had not enjoyed any comfort or relief from pain for months before. He obtained an excellent and useful stump. The ligatures came away two weeks after the operation. The patient was furloughed February llth, and subsequently he was transferred to Judiciary Square Hospital to have an artificial limb applied." Ou September 24, 1864, his term of service expired and he was mustered out. He was a pensioner until August 21,1865, when he died. The cause of his death has not been ascertained. The amputated part of the wounded limb, longitudinally bisected and exhibiting the place of lodgement of the missile, was contributed to the Museum by the operator and constitutes specimen 1899 of the Surgical Section. Fatal Cases of Secondary Amputations in the Middle Third of the Leg for Shot Injury.—Thirty-seven operations were performed—-six on Oonfederate and thirty-one on Union soldiers. Erysipelas was noted in one, pysemia in seven, and gangrene in eleven cases; in two instances autopsies were reported. Case 797.—Private D. Bussler, Co. K, 93d Pennsylvania, aged 19 years, was wounded near the left ankle during the engagement near Fort Fisher, before Petersburg, March 25, 1865. Surgeon S. F. Chapin, 139th Pennsylvania, reported his admission to the field hospital of the 2d division, Sixth Corps. Assistant Surgeon H. Allen, U. S. A., contributed the patho- logical specimen, numbered 195 of the Surgical Section, A. M. M., with the following description and result of the injury: "The wound consisted of a compound comminuted fracture of the fibula; a conoidal ball had entered the outer aspect four inches above the external malleolus, and emerged at the inner aspect one and a half inches above the internal malleolus. The patient wa.s admitted to Mount Pleasant Hospital, Washington, one week after receiving the injury. Circular amputation of the leg was performed by Acting Assistant Surgeon H. Craft, on May 6th, at the junction of the middle and lower thirds. Eight liga- tures were applied and sulphuric ether was used. At the time of the operation the leg presented a large open surface on the posterior region, extending from one inch below the ankle joint to the junction of the middle and lower thirds of the limb. Several spiculae had been removed previously and there had been gangrene; the patient, had lost his appetite and was very weak; pulse small. Reaction came on slowly. On the evening of May 9th he had a severe chill; suppurative process not yet estab- lished; stump dark looking and flaps somewhat discolored; two ligatures now came away. Tincture of chloride of iron, with stimulants and nourishing diet, were prescribed, also a camphor and opium pill every liquid stool. On the following day there was another chill, followed by profuse cold sweat; previous treatment continued, and one-half drachm of bi-sulphate of 6oda dissolved in water was given every two hours. There was very little discharge from the stump, which was dressed with solution of bromine. On May llth there were two chills and the treatment was continued. In the evening the bi-sulphate of soda was 'Smith (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, Surgical Volume II, p. 134. sect. V.] SECONDARY AMPUTATIONS IN THE LEG. 547 stopped, but resumed the next morning. Several rigors occurred during the night and a slight chill on the morning of May 1.3th, when the patient had great pain in the stomach, and the bi-sulphate of soda was again stopped and morphia prescribed. In the afternoon the doses of bi-sulphate of soda were again resumed. He suffered great pain in the stomach through the night, and the next day the remedy was again stopped. There were now symptoms of gastritis and the patient was gradually sinking. The slough had all separated from the stump, which looked quite healthy. Poultices of charcoal, flaxseed, yeast, and creasote had been used for several days. On the morning of May 15th the patient was very low and in a dying condition, and all med- icines except stimulants and beef-essence were stopped. Death, caused by pysemia, supervened at 3 P. M. on May 15, 1865. At the autopsy the thoracic viscera were found to be normal with the exception of old adhesions of the right lung. The left lobe of the liver and the spleen contained metastatic abscesses; other abdominal viscera were normal. The stump was in a gan- grenous condition. The medulla of the upper third of the femur was greatly inflamed, particularly so about one inch below the great trochanter; cancelli of upper part of femur very vascular; cancellous structure of tibia slightly vascular." The specimen consists of the amputated portion of the fibula, showing the seat of the injury without any attempt at repair. Case 798.—Sergeant J. C. Schiuid, Co. F, 1st Rhode Island Light Artillery, aged 26 years, was wounded, before Peters- burg, August 10, 1864, by a mini6 ball, which took effect above the malleoli of the left leg and implicated the bone. He was admitted to Satterlee Hospital, Philadelphia, one week after receiving the injury. By September 2d the wound had become gangrenous and was sloughing a little, the muscles and bone being exposed at the point of the injury. The patient was thin looking but apparently of good strength and constitution, having good appetite and being in good spirits. The wound became very large and deep, involving most of the muscular structure on the inner and posterior surfaces and extending from the internal malleolus to within two inches of the point of election*. On September 22d the leg was amputated by Acting Assistant Surgeon G. P. Sargent just above the point of election, by the circular method, the anaesthetic consisting of two parts of ether to one part of chloroform. One week after the operation the patient's condition was weak and his appetite poor, and there was unhealthy inflammation. On October 6th there was gangrene of the stump, the swelling, inflammation, and discolored spots extending to the groin. The patient died at noon on October 7, 1864, having suffered much pain the previous night. The treatment embraced morphine, quinine, iron, and stimulants according to the condition of the patient. Astringent lotions, caustics, and cataplasms of charcoal and linseed meal were used to the wound and lead and opium solution to the thigh. A mixture consisting of one drachm of carbon- ate of ammonia, two ounces of syrup of acacia, and six ounces of brandy was administered in tablespoonful doses every four hours. The history, together with the amputated portion of the bones of the leg (represented in the annexed wood-cut, Fig. 323), was contributed by the operator. The specimen, No. 3647, shows that the tibia was nearly entirely fractured in the lowest third, a deposit of callus around the orifice, and au extensive loss of substance in the body of the bone, which is carious. Case 799.—Sergeant J. Cannel, Co. I, 124th Ohio, aged 27 years, was wounded near Dalton, May 9, 1864. Surgeon R. D. Lynde, U. S. V., reported his admission to the field hospital of the 3d division, Fourth Corps, with "shot fracture of right leg and flesh wound of left leg." Eighteen days after receiving the injury the patient was transferred to hospital No. 1 at Nash- ville, whence Surgeon R. L. Stanford, U. S. V., reported the following: "The wound of the right leg was three-fourths of an inch above the external malleolus and posterior to the tibia, the ball passing inward and downward and emerging three-fourths of an inch below tbe internal malleolus, having fractured tarsal bones and opened the aukle joint. Circular amputation of the leg at the middle third was performed on June llth by Acting Assistant Surgeon H. C. May, chloroform and ether being used. At the time of the operation the foot was tumefied and inflamed and the wounds were discharging sanious fetid pus. Abscesses existed through the whole region of the joint, with extensive necrosis of bone, and the patient was much emaciated by suppu- ration. Thirty-six hours after the amputation the integumentary flaps began to slough so as to expose the bones and face of the stump. Charcoal and yeast poultices were used and stimulants aud supporting diet prescribed." The patient died of exhaustion October 4, 1864. Part of the tarsal bones of the amputated limb, somewhat eroded and showing no attempt at repair, were contributed to the Museum by the operator and constitute specimen 3359 of the Surgical Section. Table LXXVII. Summary of One Hundred and Seventy-four Secondary Amputations in the Middle Third of the Leg for Shot Injury. [Recoveries, 1—137; Deaths, 138—174.] FlG. 323.—Lower portions of bones of the left leg one month and twelve days after injury. Spec. 3647. NO. Name, Military Description', and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, Aim Age. DATE6. Operations, Operators, Result. 1 2 4 5 Ash, W., Pt., I, 15th Ohio, age 19. Babb, L., Pt., B, 5th N. Hampshire, age 43. Baker, J., Pt., K, 4th Penn. Reserves. Ball, T., Corp'l, B, 54th New York, age 23. Barnett, B. W., Pt., E, 3d New York Light Artillery, age 19. Sept. 20, Dec. 18, 1863. April 7, Aug. 12, 1865. June 30, Au. 2,'62. July 4, Sept. 26, 1864. May 16, Aug. 15, 1664. Right; circ. Surg. W. C. Otter-son, U. S. V. Gangrene. Dis-charged July 25, 1864. Right; flap. Ass't Surg. G. M. McGill, U. S. A. Discharged October 5, 1865. Right; circ. Discharged Sep-tember 26, 1863. Right; anterior posterior skin flap. A. A. Surg.W. Balser. Disch'd June 24, 1865. Right; double flap. A. A. Surg. E. Seyffarth. Discharged Feb-ruary 16, 1865. 6 7 8 9 Bassett, A., Pt., H, 22d Massachusetts. Bell, J. A., Pt., I, 22d Indiana. Bell, 0. L., Pt., D, 1st Delaware, age 19. Bennett, F., Pt., G, 57th Virginia. 0c.l8,*6'5, Nov. 29, 1865. De.31,'62, Uec. 17, 1863. Sept. 17, 1862, Aug. 19, 1872. July 3, Aug. 18, 1863. Left; circular. Dr. W. Green, Pittsfield, Mass. Recovery. Left; flap. Discharged Novem-ber 24, 1863. Right. Dr. J. F. M. Forwood, Chester, Penn. (Dec. 1862, limb united; erysipelas. Discharged Feb. 10.18*63.) Two subsequent operations. Spec. 6569. ----. Surg. — Carter. Recov-ery. 548 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 20 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Name, Military Description, ano Age. Blood, J. N., Pt., C, 16th Massachusetts. Boggs, P. F., Pt., A, 1st N. Carolina Cavalry. Brown, T. D., Pt., K, 95th Illinois. Bugg, W. T., Serg't, B, 3d Arkansas. Buiscta, G., Pt., C, 160th New York, age 44. Burbank, B., Pt., H, 95th New York, age 22. Campbell, J. N., Pt., G, 2d Michigan Cavalry, age 32. Campbell, S., Pt., G, 26th Illinois, age 22. Carter, A. L., Lieut., B, 76th New York. Chellis, J. C, Pt.,B, 41st Ohio, age 43. Clinger, I.W., Pt., 1,26th Ohio, age 20. Collins, E., Pt., A, 3d Mississippi, age 22. Covert, B. C, Pt., B, 67th New York. Cowling, J. R., Pt., A, 62d Pennsj'lvania, age 21. Crawford, L. M., Corp'l, M, 13th Pennsylvania Cavalry, age 25. Currin, b.. Pt., A, 63d New York, age 50. Davis, T. F., Pt., E, P2d Pennsylvania, age 24. Dellabella, F., Pt., D, 2d Missouri, age 28. Dougherty, A., Pt., D, 44th Indiana. Douglas, A. L., Pt., H, 2d Maine. 1 Duffy, T., Pt., I, 70th New York, age 21. Dunn, T., Fireman, U.S. Steamer "Juliet," oge 26. * Durau, J., Corp'l, C, 17th Maine, age 38. Duran, J., Pt., D, 1st Maine Cavalry, age 48. Fagan, P., Pt., B, 170th New York, age 41. Ferguson, E., Lieut., A, 1st Wisconsin. Fleming, A. J., Pt., I, 83d Pennsylvania, age 45. Gamble. J., Pt., C, 15th West Virginia, age 23. Gash, J. R., Serg't, I, 16th North Carolina. Dates. July 3, Aug. 27, 1863. July 3. Aug. 27, 1863. May 22, June 27, 1863. July 4, Aug.8,'63 Se.16,'64 Jan. 28, 1865. Jan. 13, April 3, 1863. Nov. 30, 1864, May 22, 1865. May 9. July 10, 1862. July 1, 1863, April 13, 1865. Nov. 25, 1863, Jan. 7, 1865. Dec. 27, 1862, Dec. 18, 1863. July 20, 1864, June 8, 1865. June 1, July 11, 1862. July 2, 1863, Sept. 21, 1864. Aug. 14, Deo. 23, 1864. Sept. 17, Oct. 20, 1862. June 1, Dec. 14, 1864. Sept. 20, 1863, Mar. 21, 1864. April 6, June 25, 1862. July 21, Aug. 21, 1861. June 1, Operations, Operators, Result. 1862. April 26, June —, 1864. May 6, Aug. 28, 1864. Oo.27,'64, April 30, 1865. June 18, Aug. 10, 1864. Oct, 8, 1862, June 15, 1863. June 27, July 28, 1862. July 24, Oct. 12. 1864. July 1, Sept. 10, 1363. Left; antero-posterior flap. A. A. Surg. F. Hinkle. Disch'd May 3, 1864. Spec. 1712. Left. A. A. Surg. B. H. Wash- ington, C. S. A. Recover}'. Left; circular. Surg. C. T. Alex- ander, II. S. A. (May 25, amp. toes.) Disch'd Aug. 12, 1863. Right. Recovery. Left; oval flap. A. A. Surg. A. Trau. Disch'd May 31, 1865. Died July 31, 1876; chr. diarrh. Left; flap. Ass't Surg. J. Ho- mans, ir., U. S. A. Disch'd June 2, 1863. Died Sept. 17, 1868. Left; circular. Ass't Surg. G.M. Sternberg, U. S. A. Discharged July 17, 1865. Left; flap. Discharged October 13, 1862. Died April 17,1870. Right; long posterior flap. Dr, F. Hyde. Cortland, N. Y. (Dis- charged November 9, 1863.) Kight; antero-posterior flap. A. Snrg. G. M. Sternberg, U. S. A. (Necrosis.) Disch'd May 18, 1865. Spec. 3607. Right; antero-posterior flap. A. A. Surg. J. Q. A. Banta. Dis- charged April 10, 1864. Right; circular. A. A. Surgeon R. W. Coale. (Hjemorrhage.) Paroled July 9, 1865. Spec. 481. Right; circ. Discharged Sep- tember 7. 1862. Right. Surg. J. Kerr, 62d Penn. (Primary excis. tibia. Disch'd July 13, 1864.) Recovery. Right; circular. Surg. A. F. Sheldon, TJ. S. V. Discharged June 19, 1865. Spec. 3536. Right; circular. Discharged Jan- uary 12, 1863. Left; flap. A. A. Surg. A. Trau. Discharged April 29, 1865. Right; circular. Medical Cadet C. H. Fisher. (Gangrene; haem- orrhage.) Discharged October 7, 1864. Spec. 2205. Left; flap. A. A. Surg. T. B. Harvey. (Erysipelas.) Disch'd September 12, 1862. Right; flap. Discharged Octo- ber 5, 1861. Left; posterior flap. (Primary amp. aukle joint. Gangrene.) Disch'd July 11.'63. Spec. 4312. Left, Discharged October 24, 1864. Left; circular. A. A. Surg. G. E. Brickett. Mav 18, 1865, amp. thigh. Disch'd August 7. 1865. Left; circular. Discharged Au- gust 12, 1865. Spec. 4231. Left; flap. A. A. Surg. G. W. Miller. (Primary amp. toes. Gangrene.) Discharged May 22, 1865. Spec. 3664. Right; flap. Drs. T. Hatchard and E. B. Wolcott, of Milwau- kee. Resigned-June 17, 1864. Left; flap. A. A. Surg. A. XV. Calhoun. Discharged Decem- bers, 1862. Right; lateral flap. Ass't Surer. G.M. McGill, U.S. A. Disch'd April 16. 1866. Spec. 2415. Left. Surg. Massengale. ('. S. A. Recovery. Vo ! Name, Military L * Description, and Age. Goode, S., Pt., K, 12th Virginia Cavalry. 40 Grant, L. V., Pt., M, 8th Illinois Cavalry, oge 41 Griebe, J., Pt., E, 9th Wisconsin. 42 Grieff.C. H., Pt.,A,96th Pennsylvania, age 21. Grier, W., Pt., K, 2d Maine, age 38. Grimes, M., Pt., A, 16th Kentucky, age 21. Griswold, D. P., Corp'l, C, 76th New York. 46 Growner, H. L., Serg't, A, 20th North Carolina, age 33. 47 Hafer, W. H., Pt., E, 2d Pennsylvania Cavalry, age 24. 48 Hendricks, H., Pt,, D, 49th Pennsylvania, age 18. 49 Henry, W. R., Pt., H, 38th Georgia. 50 Higinton, J. T„ Pt., K, I 10th Tennessee, age 18. 51 ! Holmes, W., Pt., D, 18th | Massachusetts, age 20. 52 Horine, W. T., Serg't, K, 20th Indiana. House, C, Pt., K, 60th Ohio. Houser, W., Pt., D, 5th Cavalry, age 29. Howe, S. O., Pt., K, 57th Massachusetts. Hubbard, A.. Farrier, D, 6th New York Cav- alrj', age 32. Hndler.J. M., Pt,,D, 4th Michigan, age 31. Ingraham, E., Pt., I, 21st Ohio, age 21. Jones, J. F., Pt., D, 7th Virginia, age 29. Jones, J.W., Pt., L, 13th Tennessee Cav'ry, age Kasher, J. A., Pt., G, 145th Penn., age 24. Kelley, W., Pt., M, 1st N. York Cavalry, age 38. King, S. S., Pt,, G, 13th South Carolina. Lackey, G. A., Serg't, D, 58th Massachusetts. Lane, D. C, Pt., A, 20th Massachusetts, age 37. 66 Larkin, P., Pt., C, 48th New York, age 24. 67 L:iws. G. L., Serg't, II, 5th Wisconsin. 68 Leigh, Cr., Pt., C, 3d Ar- tillery, age 19. Oct. 12, Nov. 12, 1863. June 9, w Dec. 7, 1863. Sept. 30, Oct. 31, 1862. June 26, Aug. 1, 1862. June 27, Aug. 21, 1862. May 28, June 29, 1864. J'y 1,'63 May 11, 1869. Sept. 14, Oct. 18, 1862. De.31,'63, Aug. 4, 1864. May 10, 1864, Feb.3,'65 De.13,'62 Feb. 3/63. July 4, Aug. 30, 1864. Dec. 13, 1862, J'y 2, '63. July 2, Aug. 13, 1863. Sept. 15, Oct. 16, 1862. June 27, Aug. 3, 1862. Mar. 25, June 8, 1865. July 22, Sept. 2, 1864. July 2, Aug. 5, 1663. Sept. 20, Dec. 14, 1863. Julv 3, Au. 4,'63. Oct. 28, Dec. 24, 1864. Dec. 13, 1862, Mar. 26, 1863. April 8, May 13, 1865. July 3, Aug. 24, 1863. May 12, July 27, 1864. June 30, 1862, Jan. 2, 1863. July 18, 1863, May 6, 1879. May 5, July 4, 1862. Sept. 24, 1863, Mar. 29, 1864. Operations, Operators, Result. ---. .Surg.-------,9th N. Y. Recovery. Left; circular. Ass't Surg. J. C. McKee, TJ. S. A. Discharged Sept. 24, 1864. Died August 21, 1865. Spec. 1899. Right; flap. Surg. H. Buckmas- ter, TJ. S. V. Discharged Janu- uary 8, 1863. Left ; circular. A. A. Surg. S. I). Gross. Erysipelas; haemonh. Discharged Dec. 5, 1863. Left. Discharged November 1, 1864. Died August 25, 1865. Right; lateral skin flap. Surg. C. McDermont, (J. S.V. Disch d April 1,1865. Left; flap. Dr. J. D. Trips, Vir- gil, N. Y. (July 5. excis. tibia. Disch'd Sept. 23, 1864.) Rec. Left. Exchanged December 20, 1862. Right; flap. Snrg. S. P. Smith, 2d Maryland P. II. B. Discli'd April 10, 1865. Right; circular. A. A. Surg. A. Transue. Discharged May 22. 1865. ----. Recover}-. Left; circular. To Provost Mar- shal November 16, 1664. Right; flap. A. Surg.C. R.Green- leaf, TJ. S. A. Discharged April 12, 1864. Spec. 2594. Right; flap. Surg. Z. E. Bliss, U. S. V. Discharged July 29,1864. Left; flap. Discharged. Left; flap. A. A. Snrg. S. D. Gross. Discharged August 8, 1863. Left; circular. Surg. D.W. Bliss, U. S. V. Discharged August 4, 1865. Left; antero-posterior flap. A. A. Surg.W. K. Cleveland. Jan. 1, 1865, amp. thigh. Disch'd November 7, 1865. Spec. 278. Left; sloughing; exfoliat'n. Dis- charged May 27, 1864. Right; flap. Ass't Surg. J. C. Patterson, 85th 111. Discharged June 20, 1804. Died May 3, 1871 ; consumption. Left; flap. Surg. — Shivers, C. j S. A. Exch'd Nov. 12,1863. Left; anterior posterior flap. Dis- charged June 10, 1865. Right (erysipelas). March 25, 1864. Discharged Right; lateral flap. Ass't Surg. J. XV. Williams, U. S. A. Dis- charged August 14, 1865. Right; flap. A. A. Surgeon '1. Martin. Exchanged March 17, 1864. Spec. 2071. Left; flap. (May 27, amp. foot.) Dr. C. E. Swann, Easton, Me. Discharged March 16. 1865. Left. A. A. Surg. C. J. Morion. Jan. 2, hsem. Disoh'd August 1, 1864. Re-amp. Died Jan. 20, 1866; pysemia. Spec. 861. Right. Dr. G. H. Marmion. (Julv 25, 1863, Pirogoffs amp. ankle. Discharged December 4, IPC,?,. Necrosis.) Spec. 6913. Left. Ass't Surg. R. Bartholow, IT. S. A. Discharged July 29, 1862. Right; double flap. Surg. J. A. Lidell, U.S.V. (Prim. amp. ank. joint.) Disch'd Sept. 17, 1864. Died Sept. 13, 1871. Spec. 2165. ' STEPHET SMITH, Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, Surgical Volume II, p. 138 SECT. V.J SECONDARY AMPUTATIONS IX THE LEG. 549 Name, Military "°- Description, and Age. Lewis, F. D., Pt., I, 22d Illinois. Livengood, J. D., Pt., B, 19th Indiana. Lyons, J., Pt., K, 9th West Virginia, age 19. McCarthy, J.,Pt., F,48th New York, age 38. McCarthy, J.. Pt., A, 9th Massachusetts. McCosh, R., Pt., H,30th Indiana. McDowell, J., Serg't, K, lllth N. York, age 39. McGill, J. H.,Pt.,D, 60th Illinois, age 24. McKelvey, A., Pt., F. 169th N. York, age 20. McKeever, D., Pt., B, 99th Pennsylvania, age 40. McMonigal, N., Corp'l, F, 69th Pennsylvania, age 27. Miller, N., Pt., H, 1st Artillery, age 34. Moore, J. E., Pt., C, 73d Illinois. Moore, W., Pt., G, 1st North Carolina. Morris, S. W., Pt., G, 55th N. Carolina, age 23. Moucha, J., Pt., C, 5th Florida. O'Neill, J., Serg't, E, 1st Louisiana. 'O'Reilly, C, Pt., F, 164th New York, age 23. Palmer, A., Pt., G, 3d Michigan, age 37. Parker, W.B.,Pt.,G, 2d Michigan, age 24. Parkinson, J. R., Pt., A, lllth Illinois. Peet, G. H., Pt., E, 5th Ohio. Philpot, G., Corp'l, I, 8th Kentucky. Potter, J. W., Corp'l, C, 1st Michigan Sharp- shooters, age 22. Rathbum, C.W., Corp'l, B, 1st Rhode Island Artillery, age 29. Reed, J., Pt., E, 89th New York, age 24. Roberts, H., Pt., F, 12th Kentucky, age 23. Rounds, J. E., Pt., E, 2d U. S. Sharpshooters, age 25. Ross, J., Pt., I, 2d N. Y. Heavy Artillery, age 40. Rumbangh, W., Pt., D, 62d Pennsylvania. Russell, A. K., Pt., H, 1st Massachusetts Ar- tillery, age 43. July 1, Au. -, '62 Jan. 1 Apr.1,'63 July 2, Oct. —, 1863. May 9, 1861, Mar. 4, 1867. June 30, Aug. 9, 1864. May 15, 1864, Ja.24,'65. July 9, 1862, Jan.-,'63 June 24, 1864, M'hl,'65 Oct.8,'62, April 4, .1864. June 26, 1862, Ja.13,'63 July 1, Oct. 2, 1863. July 2, Au. 6, '63. J'y 2, '63, M'h-,'64. May 18, Feb. 12, 1865. July 3, Aug. 15, 1863. June 19, Nov. 10, 1864. May 13, July 13, 1864. Aug. 9, Sept. 17, 1862. Dec.9,'62, Jan. —, 1863. Sept. 30, Nov. 4, 1864. De.13,'62, Sept. 16, 1863. Sept. 29, Nov. 5, 1864. No.29,'64, April 20. 1865. May 6, June 22, 1864. May 19, 1864. April 5, July 11, 1862. May 19, 1864. Operations, Operators, Result. Left; circular. Surg. T. D. Fitch, 42d Illinois. Discharged April 23, 1863. Right. Ass't Surg. J. N. Green, 19th Indiana. Disch'd March 13, 1865. Left; nnt. posterior flap. Surg. N. F. Graham, 12th Ohio. Dis- charged. Right; circ. A. A. Snrg. LeR. McLean. (Gangrene; ligation post, tibial artery. Mar. 21, '64, Chopart's amp.) Disch'd June 10, 1865. Died December 19, 1874. Spec. 3007. Lett; flap. A. A. Snrg. J. H. Peabody. Disch'dJune26, '63. Right; flap. Discharged July 8, 1863. Left; circular. A. A. Surg. B. B. Miles. Discharged April 16, 1864. Spec. 1731. Right. Dr. XV. S. A. Cox, Long Prairie, III. (Caries; ulcers; gangrene. Disch'd March 14, 1865.) Recovery. Left; short anterior, long post, flap. A. A. Surg. W. L.Welles. Discharged August 21, 1865. Right; posterior flap. Ass't Surg. S. B. Ward, U. S. V. Disch'd June 15, 1865. Left; flap. A. A. Surgeon J. A. Cross. Discharged A ugust 29, 1863. Left; flap. Surgeon D. P. Smith, TJ. S. V. To regiment June 7, 1865. Right; flap. Dr. J. C. Cook, New- port, lnd. Discharged March 17, 1863. Right. Surgeon J. G. Brodnax, C. S. A. Recovery. Left; antero-posterior flap. A. A. Snrg. J. Priestly. To prison April 20, 1864. Left; circular. Erysipelas. Ex- changed November 12, 1863. ----. Surg. G. A. Nott, P.A.C.S. Retired January 30, 1865. Right. A. A. Surg. W. Robie. (Prim.amp. ank. joint; Syme's.) Discharged May 31, 1865. Left; flap. Sept. 2. hsemorrhage; ligation anterior tibial artery. Discharged May 31, 1864. Left; circular. Surg. E. Bentley, U. S. V. To Vet. Res. Corps February 17, 1865. Spec. 3407. Left: flap. Discharged March 28, 1865. Right; flap. Confederate surgeon. Discharged February 12,18( i3. Right. Ass't Surg. F. L. Town, U.S.A. Discharged April 17, 1863. Left; antero-posterior flap. A. A. Surg. J. S. Wheeler. Dis- charged May 9, 1865. Spec. 4229. Left; flap. A. A. Surgeon E. Seyffarth. Discharged J une 24, 1864. Left; antero-posterior flap. Surg. G. S. Palmer, U. S. V. Furrd April 10, 1865. Left; oval flap. Discharged May 6, 1865. Right; circular. Surgeon D. W. Bliss, IJ. S. V. Discharged May 15, 1665. Left; flap. Surg. D. W. Bliss, U.S.V. (Prim. amp. ank. joint.) Disch'd March 15, 1865. Died Jan.8,'77; apop. andhemiplegia. Left. Dr. R. Wallace, ButlerCo., Penn. Discharged February 5, 1863. Left. Surg. C. N. Chamberlain, U. S. V. (Primary amputation ankle joint; Syme's.) Disch'd June 2, 1865. Name, Military Description, and Aok, Sohafer, W. A., Pt., H, C5th Ohio, age 22. 101 Sclieiiierliorn. .—Private L. Ordway, Co. A, 19th Maine, aged 33 years, was wounded before Petersburg, June 22, 1864, and entered Broad and Cherry Streets Hospital, Philadelphia, eight days afterwards. Assistant Surgeon T. C. Brainerd, U. S. A., reported : "The injury consisted of a gunshot fracture of the left ankle joint, the ball entering directly over the internal malle- olus, fracturing it and a portion of the upper and inner articulating edge of the astragalus. The wound sloughed very badly and the patient became very much emaciated. Amputation was deemed necessary, and was performed by tin circular method, at the lower third of the leg, on July 23d, by Acting Assistant Surgeon F. H. Getehell. Chloroform was used. The patient reacted well for one so weak as he was, and the stump looked healthy for two days, after which sloughing set in. Dry dressings were applied and beef-tea, tonics, and stimulants were administered. The patient continued to sink, and died of exhaustion July 28, 1864." The amputated bones of the ankle, carious and showing no attempt at repair, were contributed to the Museum by the operator and constitute specimen 3663 of the Surgical Section. Fig. 325.—The bones of the right ankle eight months after injury.— Spec. 4248. Table LXXVIII. Summary of One Hundred and Twenty-one Cases of Secondary Amputations in the Lower Third of the Leg for Shot Injury. [Recoveries, 1—86; Deaths, 87—121.] Name, Military Description, and Age. 1 Allhands, F. St.. Lieut., E, 35th Illinois, age 32. 2 Amett, W. W., Pt., I, 14th Miss., age 38. Bailey, D., Pt., G, 3d Iowa Cavalry, age 26. Bisbee, N., Serg't, K, eiHh New York. 1 Bralier, H. H., Pt., E, llth Pennsylvania. 6 , Brinson, J., Pt., G, 38th Indiana, age 42. 7 Bromley, H., Pt., 1,14th | Pennsylvania Cavalry, age 28. 8 j Brouchard, A., Pt., A, 5th New Hampshire, age 31. 9 Brown, R., Pt., G. 28th ! New York, age 19. Operations, Operators, Result. May 11, July 18, 1864. Dec. 15, 1864, Jan. 20, 1865. June 10, 1864, Feb.-,'65. June 18, 1864. A p. 3, '65. Aug. 30, Oct. 5,'62. Dec.1,'62, Feb. 24, 1863. May 28. July 12, 1864. April 7, May 15, 1865. Aug. 9, Sept. 27, 1862. Right; flap. A. A. Surg. J. H. Green. (Synovitis and erysip.) Discharged January 2, 1865. Right; flap. To Provost Mar- shal May 31, 1865. Right. Dr. J. C. Hughes,- (Sloughing; ligation plantar.) Discnarged Sept. 11, 1865. Right; flap. Surg. A. H. Thurs- ton, U. S.V. (Amputat'n toes.) Discharged May 25, 1865. Right; Teale's method (circular). Ass't Surg. C. A. McCall,U.S.A. Oct. 13, re-amputation. Disch'd September 14, 1863. Spec. 167. Right; flap. Ass't Surg. A. T. Barnes, 98th Illinois. Disch'd May 21, 1863. Right; flap. Discharged Janu- ary 27, 1865. Left; circ. A. A. Surgeon J. M. Downs. (April 17, excision met. bones.) Disch'd Aug. 12,1865. 1866, amp. knee j't; amp. thigh. Right; circular. A. A. Surg. S. L. Fuller. Disch'd October 23, 1862. Spec. 326. N | Name, Military Description, and Age. Burnett, W.. Burns, C. E., Pt., D, 12th Massachusetts, age 24. Burrows, E„ Pt., 19th N. Y. Battery, age 31. Burt, F. P., Pt,, C, 22d Massachusetts, age 19. Childers, F., Pt., G, 8th Illinois. 2Connors, J., Pt., F,76th Pennsylvania, age 25. 3 Co veil, E. R., Pt., C, 52d New York, age 38. Crouse, J., Serg't, I, ls( New York Light Artil- lery, age 24. Detwiler, M. L., Serg't, A, 30th Illinois, age 24. 19 Dietz, D., Pt., B, 48th Pennsylvania, age 21. July 4, De.24,'63. Aug. 29, 1862, April 23, 1863. May 1, Aug. 25, 1864. May 8, June 8, 1864. April 6, May 7,'62. July 11, Sept. 27, 1863. May 18, 1864, May5,'69. Julv 2, Aug. 2, 1863. Feb. 5, Mar. 22, 1864. Mav 12, Nov. 10, 1864. Operations, Operators, Result. Loft (necrosis). Discharged Feb- ruarj' 7, 1864. Right; double flap. Snrg. J. H. Baxter, U. S. V. (Sept. 13, '62, Syme's amputation ankle joint.) Disch'd July 11, 1863. Right; flap. A. A. Surg. E. L. Duer. (May 14, amput'n toe.) Discharged September 23,1865. Right; circular. A. A. Surg. H. B. Knowles. Discharged Sep- tember 17, 1864. Right. Surgeon — Fish. Dis- charged August 23, 1862. Right; antero-post. flap. A. A. Surgeon J. M. Fulton. (Syme's amp. ankle joint.) Discharged August 28, 1865. Left; flap. Dr. R. Millar, R I. Hospital. (May 18, '64, Syme's amputation ankle.) Spec. 4369. Left. Discharged Mav 21, 1864. Spec. 1651. Right; flap. A. A. Surgeon A. Sterling. Discharged August 30, 1864. Left; circ. Ass't Surg. A.Delany, U. S. V. Discharged May 19, 1865. Spec. 4052. 1 COUES (E.), Report of some Cases of Amputations and Resections from Gunshot Wounds, etc., in Med. and Surg. Reporter, 1862-3, Vol. IX, p. 196. *" Smith (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, New York, 1871, Surg. Vol. II, p. 138. •Smith (S.), Loc. cit., p. 136. SECT. VJ SECONDARY AMPUTATIONS IN THE LEG. 553 N.VMK. Mll.II'AliY iDKSL'RIPI'IU.N, AM> AOK. Donahue, M.C.,Seaman, U.S. Gunboat " Baron DeKalb." Eastman, J. E., Serg't, L, 1st Muss. Heavy Artillerv. age 39. Egan, o", Pt., E, 17th Massachusetts, age 27. Evans, C, Pt., E, 120th New York. Evans, J., Pt" I. 19th Michigan, age 40. Farren, B., Pt., A, 82d Pennsylvania, age 49. Finegau, P., Pt., H, 16th Infantry, age 34. Foster, T. J., Pt., H, 140th Penn., age 21. Fox, C. W.,Pt,I, lllth New York, age 16. Francis, F., Pt., C, 5th New York Heavy Ar- tillery, age 17 Fulmer. S. D., Pt., F, 105th Penn., age 21. GaHafter,X.Pt.,C,10th Louisiana, age 37. Gardiner, A., Pi., D, 93d New York, age 19. Gibbons, J. S., Pt., K, 30th Virginia. Good, J. P., Pt., K, 203d Pennsylvania, age 31. Grantham, J. W., Corp'l, A, 7th Florida, age 26. Grover, L. G., Corp'l, G, 30th Maine, age 21. Haslam,J.,Pt.,H, 129th Pennsylvania, age 30. Hawley, VV. S., Corp'l, E, 51st New York, age 30. Havden, I., Pt., K, 14th Ohio, age 20. Hefferman, P., Pt., H, 14th Infantry, age 22. Henderson, D. B.,Lieut., C, 12th Iowa. Hoffrichter, H., Corp'l, G, 46th Ohio, age 23. Holden, W. G., Pt., B, 30th Mass., age 29. Hunt, E. W., Pt., I, 57th Massachusetts. Johnson. A. W., Pt., E, 64th New York, age 23. Johnson, S., Pt., C, 24th Missouri, age 25. Jones, W., Pt., G. 5th Texas, age 22. Keefer, H., Pt., K, 74th Indiana. Operations, Operators, Result. Jan. II, Feb. 11, 1863. May 19, Julv 8. 1864. Feb. 1, May 14, 18*64. May 3. J'y—,'63. May 15, June 15, 1864. April 8, Oct. 25, 1865. Dec. 31, 1862, Feb. —, 1866. May 12, June 24, 1864. Mar. 31, May 3, 1865. July 18, Aug. 20, 1864. July 2, Aug. 21, 1863. July 2,. Aug. 24, 1863. May 5, June 21, 1864. Sept. 16, 1862, June 18, 1864. Jan. 15, Feb. 15, 1865. Nov. 30, 1864, Jan. 24, 1865. April 23, Aug. 13, 1864. Dec. 13, 1862, Nov. 17, 1867. May 19, Oct. 15, 1864. Sept. 19, 1863, June 13, 1864. Aug. 29, 1862, Oct. 8, 1863. Oct. 4,'62, Jan. 26, 1863. Mar. 20, April 20, 1865. Aug. 19, Oct. 19, 1864. May 13, Sep.2,'64. Dec. 13, 1862, Oct.9,'63. Feb. 1, Mar. 17, 1863. July 2, Aug. 5, 1863. Feb. 23, Ap.7,'63. Right. A. A. Surg. G. Bigsby. Discharged April 30, 1863. Right; skin flap. A. A. Surg. G. O. Moody. Discharged July 12, 1865. Left; circular. A. A. Surg. J. B. Cutter. Gangrene. Discharged August 3, 1864. Left. Discharged November 16, 1863. Spec. 1346. Left; oircular. Discharged Sep- tember 13, 1865. Right; oircular. A. A. Surg. J. B. Roe. Recovered February 22. 1866. Right. Dr. J. H. Armsby. (Dis- charged Feb. 21, 1865; chronio erysipelas of foot. 27th, partial amputation of foot.) Left; circulnr. A.A. Surg. A. F. A. King. Discharged Septem- ber 28, 1864. Right; circ. Surg. R. B. Bonte- cou, U. S. V. Sept. 7, re-amp. Disch'd Sept. 6, '65. Spec. 2454. Right; long post. flap. Surg. — Miller, C. S. A. March 30,1865, re-amp. Discharged August 11, 1865. Specs. 4301, 4327. Right: circular. A. A. Surg. F. Hinkle. Discharged Aug. 27, 1864. Spec. 1667. Left. Exchanged October 2, '63. Spec. 2050. Right. Surg. N. R. Moseley, U. S.V. June26, gangrene. Sept. 4, necro. bone rem'd. Disch'd May 11, 1865. Spec. 2251. ----. Surgeon — Jett, C. S. A. Retired February 15, 1865. Left; circular. Mustered out May 24, 1865. Right; antero-posterior flap. A. A. Surg. R. McNeilly. Provost Marshal May 6, 1865. Left; flap. Dr. George Collins, Bethel, Maine. Disch'd Jan- uary 8, 1865. Right; flap. Dr. A. H. Halber- stadt, Pottsville. Penn. (Dis- charged May 18, 1863; amp. toes.) 1868, caries; necrosis. June 25, 1868, re-amputation. Left; flap. A. A. Surgeon J. H. Thompson. (May 19, amput'n meta.) Disch'd May 21, 1865. Left; antero-posterior flap. A. A. Surg. J. H. Drury. Erysip- elas. Disch'd August 11, 1864. Left; antero-posterior flap. A. A. Surg. It. J. Levis. (Septem- ber 9, 1863, Chopart's amputa- tion.) Disch'd May 17, 1864. Left; flap. Resigned February 16, 1863. Left; flap. Surg. B. N. Fish, 27th Mass. Discharged August 12, 1865. Left; antero-posterior flap. Dis- charged June 9, 1865. Right. Dr. Gage, Worcester. Gang. Sept. 24, re-amputation. Discharged June 30, 1865. Left ; flap. (December 20, 1862, Syme's amputat'n. Discharged January 29, 1863.) Left; flap (caries). Discharged May 5, 1863. Left. Surg, C. H. Mastin, C. S. A. October 18, bone removed. Ex- changed March 17, 1864. Right; flap. Discharged April 26, 1865. Name, Military Description, ani> Ace 'Keen, G., Pt., A, 8th Indiana. Kelsey. A., Pt., '1), 53d Illinois, age 21. Kock, XV., Serg't, A, 1st Virginia Artillery, age 28. Lee, D., Pt., B, 37th Illinois. Lillibridge, F. W., Pt., B, 2d N. Y. Mounted Rifles. Long, J., Pt., F, 8th Indiana. Martin, T. B., Pt., A, 24th Virginia. May, M., Pt., A, 9th New York, age 22. McDermott, M., Corp'l, 1st Virginia Cavalry. Nash, W., Pt., C, 187th Pennsylvania, age 19. Newman, L., Pt., A, 149th New Vork. Nutter, S. A., Pt., I, 1st Maine Cavalry. Oyler, A., Pt., D, 55th Pennsylvania, age 30. Pendleton, E., Pt., G, 27th Mass., age 21. Perkins, H., Pt., G, 44th Colored Troops, age 18. Peters, H., Pt., A, 59th New York, age 33. Pisher, J. H.,Pt,,C, 38th Wisconsin, age 30. Powers. J. *W., Pt., C, 29th Wisconsin, age 21. Price, S. B., Serg't, A, 2d Ohio, age 22. Pyle, G., Pt., D, 15th infantry, age 19. Quinn, J., Serg't, K, 169th New York, age 21. Reizler, C, Pt., B, 7th New York Heavy Ar- tillery, age 47. Renfro, H, Pt., C, 3d Missouri. Robinson, T., Pt., H, 81st Pennsylvania. Schneider, G., Pt., E, 4th Pennsylvania. Schroeder, J., Pt., C, 2d Missouri. Siddall, J., Pt., A, 90th Pennsylvania, age 20. Snyder, A., Pt., H, 75th New York. Spielman, T., Pt., F, 95th Ohio, age 23. Stackpole, F. A.H., Pt., A, 6th Maine, age 21. Taylor, J. L., Pt., F, 7th Wisconsin, age 39. May 23, July 9, 1863. July 12, Sept. 19, 1863. May 15, Sept. 25, 1864. Mar. 7, June 22, 1862. June 18, 1864. May 22, June 23, 1863. July 3, Aug. 14, 1863. Sept, 17, 1862, Ap. -, '63. Dec. 13, 1862, ----,'64. June 18, 1864, May8,'65. Julv 20, Sept. 21, 1864. June 7, Sept. 13, 1864. Se.29,'64, Jan. 18, 1865. Mar. 8, April 18, 1865. Dec.1,'64, Feb. —, 1865. May 17, Aug. 17, 1864. July 12, Aug. 15, 1864. May 16, Sept. 18, 1863. May 15, June 15, 1864. July 3, Aug. 30, 1864. Mav 16, Aug. 19, 1864. June 3, , July 21, 1864. May 20, 1863, Feb.1,'64. June 3, Dec. 7, 1864. Sept. 14, Dec. 16, 1862. Oct, 8, Nov. —, 1862. Aug. 30, Oct. 3,'62. May 27, J'y -, '63, Aug. 30, 1862, July 10, 1864. May 3, Nov. 24, 1863. May 5, June 5, 1864. Operations. Operators, Result.. Left ; circular. Surg.W.Watson, II. S. V. Erysipelas. Disch'd September 15, 1863. Right; flap. Surg. J. T. Ran- dolph, U. S.A. Discharged May 25, 1865. Right; anterior flap. Ass't Surg. G. B. Parker, U. S. V. Disch?d Mav 19, 1865. Right; flap. Surg. E. A. Clark, U. S. V. Discharged August 23, 1862. Right. (June 18, Chopart's amp. foot.) Discli'd August 10,1865. Circular amput'n leg afterward. Right; flap. Discharged Sep- tember 8, 1863. Left; circular. Snrg. — Gillett, C. S. A. (Hsemorrhage.) Re- covery. Left; lateral flap. (Primary amp. ankle joint. Disch'd Jan. 16, 1863.) 1870, stump sound. Left. Specimen 263, A. M. M. Right; circular. A. A. Surg. H. M. Bellows. Discharged Aug. 3, 1865. Right; circular. A. A. Surg. R. McNulty: Discharged 1865. Re-amputation 1867. Left; flap. Drs. A. Towlo and J. Sawyer. Biddeford, Maine. Discharged July 27, 1865. Right: flap. Surg. W. Watson, 105th Penn. (Gangrene.) Dis- charged May 25, 1865. Left; circular. Ass't Surg. E. F. Hendrick, 15th Connecticut. Discharged Nov. 23, 1865. Left, A. A. Surg. J. S. Giltner. Discharged January 16, 1866. Left; antero-post. flap. March 26, 1865, re-amputat'n. Disch'd June 6, 1865. Spec. 4335. Left : flap. Ass't Surg. H. Allen, U. S. A. Discharged April 8, 1865. Left; flap. Discharged Decem- ber 19, 1864. Left; circular. Surg. R. L. Stan- ford, TJ. S. V. (May 15, Syme's amp. ankle joint; gangrene.) Discharged October 10, 1864. Left; circular. A. A. Surg. C. H. Fisher. Disch'd July 11, 1865. Died March 27, 1870. Left; circular. A. A. Surg. J. H. Thompson. Discharged May 3, 1865. ..Spec. 3102. Left; lateral skin flap. A. A. Surg. F. E. Marsh. Discharged March 31, 1865. Right. A ss't Surg. R. B. Maury, P. A. C. S. Recovery. Left; flap. (Discharged Novem- ber 9, 1864.) Left; flap. Discharged October 14, 1863. Left, Surg. J. G. Hatchitt, U. S. V. Discharged February 19, 1863. Left; flap. Ass't Surg. W. E. Waters, U. S. A. Discharged February 17, 1864. Right; oircular. Discharged Au- gust 29, 1863. Right; circular. A. A. Surg. C. E. Boyle. (Rem. of os calcis.) (Discharged February 4, 1864.) Left; oircular. Surg. J.A. Lidell, TJ. S. V. Discharged June 18, 1864. Spec. 1847. Left ; circular. Surg. — Tucker, C. S. A. Dec. 26, rem. of seq. Disch'd May 26, '65. Spec. 3697. 'Bryan (J.), Seventeen Additional Cases of Amputations frvm the Armies of the Southwest, in American Medical Times, 1863, VoL VII, p. 287. Surg. Ill—70 554 INJURIES OF THE LOWEK EXTREMITIES. [CHAP. x. No Name, Military ' Description, and Age. 80 Thomas, T. M., Pt., E, 155th Penn., age 23. 81 Tuttle, J. B., Pt., F, 14th New Hampshire, age 44. 82 Verdon, J., Pt., A, 17th Infantry. 83 Von Schirach, F. C, Lieut., E, 54th New York. 84 White, A. H., Pt., D 22d Illinois. Williamson, J., Pt,, B, 26th Pennsylvania, age 28 Wilt, Z., Pt., A, 166th Pennsylvania, age 22. Ambrose. II., Pt., H, 20th Indiana, age 24. Ballard, J. H., Pt., E, 28th North Caroliua, age 30. Barrett, J. B„ Corp'l, C, 116th Ohio. Beecher, E., Pt., E, 36th Illinois, age 20. Blackwall, C. C, Col., 23d N. Carolina, age 30. Craps, W. J., Pt., D, 24th South Carolina, age 33. Dudley, S. B., Pt., B, 97th Indiana, age 24. French, C. H., Pt., G, 2d Indiana Cavalry, age 20. Geffney, T., Pt,, D. 74th New York, age 42. Gibson, J., Pt., H, 46th New York, age 22. Goodwin, S. M., Serg't, 1,19th Indiana, age 39. Herman, C, Pt., E, 33d Massachusetts. Hill, T. J.. Corp'l, I, 83d Pennsylvania. Juda, G., Corp'l, F, 8th PennsylvaniaRes., age 23. May 24. Aug.5,'64 Sept, 19, 1864, Jan. 4,'65. July 4, Augi6,'63 Aug. 29, Nov. 28, 1862. Oct.2,'62. Feb. 16, 1863. May 2*, June 2, 1863. April 18, June 11, 1863. July 2, Aug. 14, 1863. July 2, Aug. 20, 1863. June 5, J'y 8,'64 Oct. 8. —, '62. Sept. 19, Nov. 10, 1864. Nov. 30, 1864, Fe.17,'65 June 27, 1864, Feb. 18, 1865. May 9. June 14, 1864. June 3, J'y 9, '64 May 5, June 11, 1864. Mav 23, Julv 19. 1864. May 25, June 26, 1864. June 27, July 30, 1862. May 8, June 13, 1864. Operations, Operators, Result. Left; lateral skin flap. A. A. Surg. I*. E. Marsh. Discharged March 31, 1965. Right; lateral flap. A. A. Surg. J. Neff. Discharged July 10, 1865. Left: flap. A.A.Surg.W.L.Hays. To Regiment. Sept. 28, 1863. Right; flap. Resigned April 26, 1863. Right; flap. A. A. Surg. AV. A. Johnson. Discharged May —, 1863. Left; flap. Surg. J. II. Baxter. U.S.V. Discharged June 18, 1864. Spec. 1187. Left; flap. Discharged July 28, 1863. Left. Died September 8, 1863; pyaemia. Right. Died September 20,1863; pyaemia. Spec. 2062. Left. Died July 10, 1864. Right. Died November 14, 1862. ----; circular. Surg.W. S. Love, P. A. C.*S. Died November 13, 1864; exhaustion. Left; circular. Surg. B. B. Breed, U. S. V. Died March 11, 1865 ; exhaustion. Spec. 4217. Right; circular. Surg. R. R. Tay- lor, U. S. V. Died February 28, 1865 ; erysipelas. Spec. 4248. Right: circular. A. A. Surg. M. L. Herr. Died September 30, 1864. Right; circular. A. A. Surg. A. Ansell. Died August 2, 1864; pyaemia. Left; circular. Surg. A. F. Shel- don, V. S. V. Died June 18, 1864; exhaustion. Left; posterior flap. A. A. Surg. E. Seyffarth. (June 8, renTd carious bone.) Died November 5, 1864; exhaustion. Right; circular: gangrene. Died August 22, 1864; pyaemia. Spec. 3356. Left. Ass't Surg. R. Bartholow, U. S. A. Died August 6, 1862. Spec. 817. Right; circular. A. A. Surg. C. XV. Carrier. Died June 2.r>, '64 ; pyaemia. Name, Military Description, and Age. Kaufman, C. E., Pt., H, 1st Pennsylvania Res. Keneily, A. V., Pt., K, Hampton's South Car- olina Legion. McIIale, J., Pt,, D, 15th Infantry, age 21. McMullen, W., Pt., B, 24th New York. Nevin, G. M., Pt., F, I40th Penn., age 20. 106 Ordway, L., Pt.. A, 19th Maine, age 33. Owens, H. J., Serg't, I, 14th Tennessee. Palmer, S. H. A., Pt., I, 2d New Hamp., age 35. Paugh, J. W., Pt., E, 3d W. Virginia Cavalry. Pepper, G. W., Pt., C, 2d Pennsylvania H'vy Artillery, age 30. Perkins, J. C, Pt., B, 81st New York, age 27. Pollard, J. H, Pt., F, 12th Virginia, age 26. Reynolds, H. G., Pt., K, 7th Mississippi, age 23. Ricker, B. J., Pt., A, 32d Maine. Seawright, W., Pt,, I, 116th Penn., age 19. 1 Shroeder, C, Corp'l, I, 127th Illinois. 2Streef, J. W., —, E, 66th Georgia. Sullivan, J., Pt., C, 56th Massachusetts, age 19. Taylor, S. J., Pt,, E, 30th Alabama, age 21. 120 Wiards, XV. C, Corp'l, D, 80th Ohio. 121 Williams, J., Pt., E, Sth New Jersey, age 27. Dates. Aug. 30, —. '62. Sept. 17, Dec.2,'62. S*ov. 25, 1863, Feb.6,'64. Aug. 29, —, '62. May 12, June 29, 1864. June 22, July 23, 1664. Sept. 17, Oct. 21, 1862. July 3. Aug. 10, —, '63. April 3, J 863. June 25, Aug. 14, 1864. June 3, July 7, 1864. Oct. 27, Nov. 29, 1864. Dec. 15, 1864, M'hl,'65. May 18, June 28, 1864. May 12, June 14, 1864. May 13, June —, 1863. Aug. 31, Oct. 20, 1864. May 6, June 20, 1864. Dec. 16, 1864, Jan. 20, 1865. Oct. 4. No. 7, '62. June 18, Julv 26, 1864. Operation's, Operators, Result. ----. Died October 9, 1862. Right; necrosis. Died Decem- ber 13, 1862. Spec. 10D7. Left: double flap. Died March 6, 1864 ; chronic diarrhoea. ----. Died October 13, 1862. Right; circular. A. A. Surg.W. B.Morrison. Died July II,'64 ; typhoid fever. Left; circular. A. A. Surg. F. H. Getehell. Died July 28, 1864 ; exhaustion. Spec. 3663. Right. Ass't Surg. C. Bacon, TJ. S. A. Died October 30, 1862. Spec. 364. Left (also fracture of ulna); gan- grene Died August 14, 1863; pyaemia. Right; posterior flap. Died April 16, 1863. Spec. 4276. Left; flap. Surg. N. It. Moseley, l*. S. V. Gangrene. Died Au- gust 25. 1864 Spec. 3127. Left; circ. Surg. it. B. Bontecou, U. S.V. (Also fract. right ankle joint; excised.) Died July 17, 1864: exhaustion. Spec. 3035. Left; lateral flaps. Surg. T. It. Crosby, U. S. V. Died Decem- ber 2, 1864 ; exhaustion. Left; lateral skin flap. Surg. B. B. Breed, U. S. V. Died March 11,1865 ; exhaust'n. Spec. 4216. Left. A. A. Surg.W. II. Triplett. July 8, re-amp.; gang.; diarrh. Died July 11, 1864 : pyaRinia. Right; double skin flap. Surg. 3. A. Lidell, U. S.V. Died July 19, 1864; pyaemia. Right; antero-post. flaps. Pro- truding bone removed. Died September 26, 1863. Left; circular. Ass't Surg. P. H. Wright, P. A. C. S. Died Octo- ber 28, 1864; pysemia. Right; circular. A. A. Surg. D. J. Evans. Died August 7,1864. Left; circular. A. A. Surg.W. M. Rodman. (Necrosis.) Died April 8, 1865 ; chronic diarrhcea. Left. Died November 13, 1862; pyaemia. Spec. 1034. Right; circular. A. A. Surg. F. II. Getehell. (Gang.; haemorr.) Died Aug. 19,1864. Spec. 3661. Secondary Amputations in the Continuity of the Leg, Third not indicated.—In six- teen of the secondary amputations in the leg the seat of the operation was not specified; eight proved successful and eight were fatal. The right limb was removed in seven, the left in five cases; in four the side was not indicated. Successful Secondary Amputations in the Leg, Third not indicated.—The eight oper- ations of this group were performed on Confederate soldiers. Meagre histories of the cases are found on the hospital reports: Case 806.—Lieutenant A. Ward, Co. C, 9th Tennessee, was wounded in the right lower extremity at the battle of Chap- lin Hills, October 8. 1862. He was taken prisoner and conveyed to the General Hospital at Perryville, whence Surgeon J. G. Hatchitt, U. S. V., reported the following: "On November 25th I amputated the right leg on account of gangrene of the foot resulting from gunshot wound of the ankle. The operation was performed by the circular method. The integuments where the incision was made were infiltrated with greenish serum. The patient was much exhausted from diarrhoea. He recovered." The records of Perryville Hospital show that the patient was transferred to Danville as a convalescent. Fatal Cases of Secondary Amputations in the Leg, Third not indicated.—Eight oper- ations performed on seven patients belong to this sub-division; five were Union and'two "BBTAN (J.), Seventeen Additional Cases of Amputations from the Armies of the Southwest, in American Medical Times, 1863, Vol. VII, p. 288. * JONK8 (J.), Pysemia Supervening upon Hospital Gangrene, in U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 444. SECT. V.) . AMPUTATIONS IN THE LEG. 555 Confederate soldiers. Pysemia, secondary haemorrhage, exhaustion, irritative fever, and phthisis were reported as the causes of death: Case 807.—Sergeant J. Evans, Co. I, 29th Colored Troops, aged 33 years, was wounded during the engagement near Richmond, October 12, 1864. Surgeon J. J. Craven, U. 8. V., reported his admission to the field hospital of the 3d division, Tenth Corps, with "shot wound of left ankle." Assistant Surgeon E. McClellan, U. S. A., reported the following result of the injury: "The patient was admitted to hospital at Fort Monroe three days after being wounded. His injury consisted of a wound of the foot involving the ankle joint. There was free suppuration and copious discharge of unhealthy pus. The leg was amputated by flap method, on November 17th, by Acting Assistant Surgeon H. B. White. At the time of the operation the patient was in a very weak condition. He died of exhaustion November 19, 1864." Table LXXIX. Summary of Sixteen Secondary Amputations in the Leg for Shot Injury, Point of Ablation not specified. [Recoveries, 1—8; Deaths, 9—16.] NO. Name, Military Description, and Agk. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. 1 2 3 4 5 6 7 1 A. B-----, —, nge 24. Bentley, C, Pt., A, 8th Louisiana. Harter, J. E., Pt., C, 1st South Carolina, age 25. McDaniel, F. H., Pt., C, 26th North Carolina. Mclntire, B. S.. Pt., K, 10th Tennessee Cav'ry. Ward, A.. Lieut., C, 9th Tennessee. Ward, P. H, Pt., B, fith Louisiana. Nov. 25, 1863, Feb.-,'64. June 27, July 28, 1862. Dec. 13, 1862, April 17, 1863. July 1, Oct. 2, 1863. Jan. 29, June 29, 1864. Oct. 8, Nov. 25, 1862. June 27, Oct. 6,'62. Left. Dr. R. H. Taylor, of Mem-phis. (Nov. —, Pirogoff's ainp. ankle; gang.,- caries.) Recov'y. Left. Recovery. ----; flap. Recovery. ----. A. A. Surg. B. JI. Wash-ington, C. S. A. Recovery. ----. Surg. — Reagan, C. S. A. Recovery. Right; circular. Sarjr. J. 0. Hat-chitt, U. S. V. Gangrene. Re-covered February 12, 1863. Right. Recovery. 8 9 10 "J 124 13 14 15 16 Wright, J. L., Corp'l, B, 15th Alabama. Cain, W. H., Serg't, G, 115th N. York, age 23. Calhair, J., Pt.; G, 12th Mississippi. Daniel, J. P., Corp'l, H, llth Virginia. Evans, J., Serg't, I, 29th Colored Troops, age 33. Hillebrand, M., Pt., D, 1st Ohio. Reach, H., Pt., I, 164th New York, age 22. Waters, W. W., Pt., D, 22d Indiana. Aug. 22, Nov. 21, 1862. Aug. 16, Sept. 17, 1864. 1862. July —, Right. Ass't Surg. E. A. Drewry, C. S. A. Recovery. Left. Sept. 25, haemorrh. Died Sept. 26, 1864; hemorrhage. Right. Died September 24,1862. Both; irritative fever. Died Sep-tember 30, 1863. Left; flap. A. A. Surgeon H. B. White. Died November 19, '64 j exhaustion. Right. Died November 2, 1863; pySBmia. Right; flap. A. Surg. — Gibbs, P. A. C. S. Died Aug. 9, 1864. ---; erysipelas. Died August 31, 1862; phthisis pulmonahs. 1863. Oct. 12, Nov. 17, 1864. Sept. 19, —, '63. June 3, J'y 5,'64. Aug. 29, 1862. AMPUTATIONS IN THE CONTINUITY OF THE LEG OF UNCEETAIN DATE. The intervals between the dates of the injuries and operations could not be ascertained in five hundred and seventy cases, either one or the other of the dates and sometimes both having been omitted in the reports. The operations were performed in the upper third in fifty-one, in the middle in forty-seven, and in the lower third in fifty-one instances; in four hundred and twenty-one cases the point of ablation was not recorded. Amputations in the Upper Third of the Leg of Uncertain Date.—Of fifty-one opera- tions of this group thirty-three proved successful and eighteen were fatal; forty-five were performed on Confederate and six on Union soldiers. The side injured was not specified in fifteen cases; in twenty the right, and in sixteen the left leg was amputated. Table LXXX. Summary of Fifty-one Amputations in the Upper Third of the Leg, time of Ablation not specified. [Recoveries, 1—33; Deaths, 34—51.1 No Name, Military Description, and Age. Dates. Operations, Operators, Result. NO. Name, Military Description, and Age. _ ...-- Dates. Operations, Operators, Result. 1 2 3 4 Allen, D., Pt., K, 40th N. C Artillery, age 32. Ballard, I. N., Pt., A, Mosby's Cavalry. Beadle, W. S., Lieut., A, 12th Ga. Bat'y, age 24. Brown, M., Lieut., C, Cobb's Ga. Legion. Jan. 13, —, '65. June 22, —. '63. July 9, —. ""64. Aug. 16, —, '64. Right. Released June 28, 1865. Right. Discharged October 17, 1863. Left. To prison September 21, 1864. Left. To Provost Marshal May 31, 1865. 5 6 7 8 Canady, J., Pt., B, 24th North Carolina, age 25. Coppage, K., Pt., I, 30th Virginia. Cox, H. B., Serg't, D, 48th North Carolina. Criles, P. i., Pt., F,21st Georgia, age 34. Dec. 13, '62, —. April —, 1865. Dec. 10, '64,—. Aug. 21, —, '64. Right. Retired February 17, '65. Right. Recevery. Left. Retired February 17,1865. Right, To Provost Marshal April 1, 1865. 1 Holloway (J. M.), Comparative Advantages of PinoGOFlY, Syme's, and CHOP ART'S Amputations, etc., in Am. Jour, of Med. Sciences, 1866, Vol. LI, p. 85, and Smith (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Comm. Mem., New York, 1871, Surg. Vol. II, p. 116. 556 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. s Namk, Military tutkk *>0, DESCRIPTION, AND AGK. 1 UATES- Operations, Operators, 1N , Name, Military | Description, and Age. Dates. Operations, Operators, Result. Result. 9 Fletcher, R. J., Major, July 2, Right. Furloughed 1864. 30 Tapp, C. T., Pt., C, 60th Nov. 27, Right. Furloughed. J llth Alabama. —, '63. Georgia. 1863. 10 Frarel, J., Pt., V, 10th : JInv 2, Right. Retired January 16,1865. 31 ! Tay, S. L.,Serg't, E, 49th July 9, Right. Retired February 21,'65. Virginia, oge 21. —, '03. j North Carolina, age 35. , —, 64. 11 Freeman, II'. D.. Pt., E,--------- ----. Recovery. | 32 i Watkins, R. H, Serg't, 1 June 18, Right. To prison September 23, 46th North Carolina. 1862. i H, 46th Va., age 23. —, '64. 1864. 12 Green, W. R., I*t.. I, 53d July 14. Left. Exchanged March 3, 1864. 33 ] Wilson, S., Adj't, 10th April 6, Left; anterior skin flap. To Bal- j North Carolina, age 19. j —, 'HG. Va. Battery, age 26. —, '65. timore May 10, 1865. 13 1 Harrington, J. R., Pt., Aug. 31, 1 C, 41st Miss, age 23. i 1864. Right. Retired January 12,1P65. ! 34 , Apperson, J. R., Serg't, Oct. 8, ----. Died October 17, 1862. 1 ! D, 123d Illinois. —, '62. 14 Howard, D. it*., Pt., A, Aug. 19, Right. Furloughed October 28, 35 ', Ault, C, Pt., B, 69th May 9, Left. Died July 7, 1864. 2d Maryland. —, '64. 1164. Ohio. 15 Isbell. W. H., Pt., K, 47th July 3, Left. Gangrene. Discharged 36 Bailey, R. M., Pt., D,--------- Left. Died September 26,1864. Virginia. | —, "'63. Octobers, 1864. i 31st Mississippi. 16 T n~,nlo., T T> T>* (. 1..1.. Right. Exchanged March 17, ! 37 Bowens, G. B., Pt., F, ---. Died July 13, 1862; py- | 3d North Carolina.' | 1863. ' 1864. 13th Georgia. 1862. semia. 17 , Ledyard, W. N., Lieut., ' July —, Right: circular. Exchanged Jan- 38 Brown, E., Pt., E, 49th--------- ---. Died May 29, 1864. A, 3d Alabama, nge 28. 1 —, '63. uary 20, 1864. 1 Georgia. j 18 Lemay, L. A., Pt., II, I May 22, Left. Retired. 39 Corbin, I. D., Pt., 1st--------- ----; circular. Died December 40th Alabama, iige 48. ; —,'63. South Carolina. ] 1862' 31. 1862. 19 McCall. C. S., Pt., F, 21st Sept. 22, Right. Furloughed November 40 .Paris, U., Corp 1, K, 62d ----. Died June 8, 1864. Georgia. 1864. 26. 1864. Virginia. '■ 20 McCarthy, W. E., Pt., K, Sept. 17, Right. Furloughed. 41 ' Davis, XV. XV., Pt., C, 1st — ----. Died March 3,1864 ; small 5th Alabama. —, '62. Ohio Cavalry, nge 19. 1 1863. pox. 21 McDaniel, J. J., Pt., V, Dec. 13, Left. Retired March 15, 1865. 42 Foster, B. C, Lieut., I, ----May ----; posterior flap. Gangrene. 35th Georgia, age 32. —, '62. i 5th Alabama, age 40. 31, '64. Died June 10, 1864. 22 Miller, J. L., Pt., C, 30th July —, Right. Exchanged March 3, '64. 43 Gillman, H. T., Pt., H, Aug. 31, 8th Michigan. 1862. ----. Died September 25,1862. North Carolina. j 1863. 23 Parker. G. W., Lieut., D, Sept. 30, Left. Furloughed. 44 Hancock, J. B., Pt., C, ----; flap. Died December 10, 44th North Carolina. j 1864. 61st Georgia. , 1862. 1862. 24 Raders, J. P., Pt., A, ' Oct. 19, Right. Retired March 8, 1865. 45 Hoover, W. P.. Pt., G, 1st June 18, ----; posterior flap; gangrene. 1 37th Virginia. 1864. | Texas, age 25. | 1864. Died July 20, 1864. 25 ' Rickard. J.............------- Amputation of right leg. Dis- 46 i Love, W., Pt., G, 16th , May 10, Left: sloughing. Died May 25, 1 charged. ! Maine, age 16. —, '64. 1864; pysemia. 26 Roberts. J. P.,Pt.,H, 7th Dec. 16, Left; circular. Surg. — Roberts, 47 Lynch, J., Pt., A, 1st Right. Died May 31, 1863. Texas, age 20. I 1804. C. S. A. To Provost Marshal Louisiana. 1863. \ March 7, 1865. 48 Oaks. J. A., Pt., B, 58th July 3, ----. Died July 15, 1863. 27 Rossou, W. B., Pt., K, , Aug. 2, Left. Retired Februarj' 6, 1865. Virginia. —, '63. 4!)th Virginia. 1864. og v~,.~,^r„ f t> d. r> t»h. 49 Reid, M. J., Corp'l, F, May 16, ---; circular. Died June 16, ----; antero-post. flap. June 4, 8, haemorrhages. Disch'd Jan-uary 16, 1865. 19th Georgia, age 25. 50 Scales, R. E., Pt., C, 2d 1 Mississippi, age 21. 1864. 1864. Virginia, age 24. May 16, 1664. Left; erysipelas. Died Septem-ber 23, 1862; diarrhcea. 1862. 29 Swartz, J. S., Pt., K. 5th Aug. 19, Left. Retired January 30,1865. 51 Sell, J. M., Capt., I, 83d July —, ----. Died July —, 1863. Virginia, age 24. '62. —. 1 Pennsylvania. 1863. Amputations in the Middle Third of the Leg of Uncertain Date.—Forty-seven cases belong to this sub-division; thirty-nine were successful and eight fatal. Forty-one of the patients were Confederate and six Union soldiers. The right leg was amputated in twenty- six, the left in nineteen instances; in two the side was not indicated. Table LXXXI. Summary of Forty-seven Amputations in the Middle Third of the Leg, time of Operation unspecified. [Recoveries, 1—39; Deaths, 40—47.] NO Name, Military Description, and Age. Dates. Operations, Operators, ! „ Result. >.°- Name, Military Description, and Age. Dates. Operations, Operators, Result. I Acree, W. W., Serg't, C, 30th Georgia. Barnett, W.C. D .Corp'l, A, 16th Georgia. Barrim, I, Pt., F, llth North Carolina, age 22. Carr, T. A., Pt., G, 3d Georgia. Cherry, M. G. L., Pt., E, 55th North Carolina. Clinc,M.W., Pt, D,48th Alabama, agre 38. Cox,E., Pt., i, 15th Ala-bama, age 35. Dalton, R., Pt., H, 38th Virginia. Downs, 1. S., Ft., G, 26th North Carolina. Egan, J. A., Pt., E, 3d Missouri. Garner, M. C. Pt., B, llth Mississippi. Hains, J. M.. Pt., D, 37th Virginia, age 23. HaUxburton, C, Pt., E, llth Tennessee, age24. Left. Furloughed November 13, i 14 1863. Right. Recovery. 15 \\ Left. Exchanged March 17, '64. j 16 Right. Furloughed. j 17 1 Right. Furloughed. i 18 Left; gang. Furloughed Sep- 19 tember25, 1864. Left. Released July 17, 1865. " j 20 Right. Furloughed. 21 Right. Furloughed. j| 22 ---. Retired February 6, 1865. i 23 Left. Transferred April 9,1865. 24 Right. Exchanged March 3, '64. 25 Left; circular. To Provost Mar- ! 26 shal March 7, 1865. Hansbrough, J. W., Pt., K, 17th Virginia. Harbison, N. J, Pt.. D, llth North Carolina. Hill, W., Pt.,C, Reeves's Ark. Cavalry, age 35. Hunt, F.N.. Pt., G,47th North Carolina, age 30. Lipscombe, P. E., Pt., F, 9th Virginia Cavalrj-. Malhias, —, Pt., C, 42d Virginia, age 19. Mayor, S. E., Pt., B, 6th S. C. Cavalry, age 25. McAfee, J.T.,Pt., D, 59th Georgia, nge 39. McDaniel,H.,Pt.,~E, 45th G eorgia, age 23. Mcllmunay, J., Pt.,---- Mitchell, F. M., Serg't, G, 61st N. Carolina. Monzan, I. P., Pt., 1,4th S. C. Cavalry, age 30. Moore, C, Pt., F, 5th Louisiana. Right. Surg. — Lewis, C. S. A. Recovery. Right. Furloughed. Left; flap. Oath of allegiance July 7, 1865. Left. Exchanged March 17, '64. Right. Retired November 7, '64. Right; flap. Recovery. Right. Retired December 30/64. Right. Exchanged March 17,'64. Right. Retired December 21/64. Left. To prison March 3, 1865. Right. Furloughed. Right. Retired January 10,1865. Left. Retired January 30,1865. 2 3 4 if 1863. Nov. 30, '64, —. July 3, —, '63. May 10, '64, —. July 1, —, '63. Aug. 17, 1864. Nov. 27, '63, —. May 16, —, '64. June 2, —, '64. Oct. 5, —, '64. 1865. July 3, —, 63. Nov. 30, —, '64. 1861. June 2, —, '64. Sept. 27, 1864. Julv 3, —, ''63. 6 7 8 Sept. 17, —, '62. June 12, —, '64. Julv 3, 1863. 10 11 12 13 Oct. 25, 1864. May 14. —, '64. June 24, '64, -. July—, 1863. SECT. V.] AMPUTATIONS IN THE LEG. 557 NO. Name, Military Description, and Age. Dates. Operations, Operators, Result. No. Name, Military Description, and Age. Dates. Operations, Operators, Result. 27 28 29 30 31 32 33 34 35 36 37 O'Neal, J. J., Pt.,G, 18th Virginia. Phillmore, E. K., Pt., A, 27th-North Carolina. Poole, F., Pt., E, 20th S. Carolina. Pressley, I., Pt., I, 60th North Carolina, age 44. Roche, F. T., Pt., A, 32d Virginia, age 21. Rodarmel, XV. L., Pt., D, 5th Mo. S. M. Cavalry. ShelUm, J. X, Pt.. A, 23d Mississippi, age 23. Smoot, R. W., Pt., A, 1st Va. Battery, age 34. Talbert, M.S., Pt., H,7th S. C. Battery, age 35. Warren, S.. Pt., A, 47th North Carolina. 1 Whitaker, J. F., Pt., K, 8th Tennessee, age 26. April —, 1865. Oct. —, 14, '63. Aug. 27, 1863. Nov. 30, 1664. Sept. 24, 1864. Aug. e, 1862. Nov. 30, 1864. ---- Mav 16, '64." June 3, '64, —. June 12, 1864. Right. Recovery. Left. Furloughed. Right. Retired February 7,1865. Right; antero-posterior flap. To Provost Marshal April 6,1865. Right. Retired March 4, 1865. Right. Discharged March 30/65. Left; circular. To Provost Mar-shal. Left. Retired April 1, 1865. ----: circular. Furloughed Au-gust 15, 1864. Left. Furloughed. Right; gangrene. Reoovered. 38 39 40 41 42 43 44 45 46 47 Whiteside, J. L., Pt., B, 34th N. C, age 45. Williams,N.,Pt.,Qt, 60th North Carolina, age 38. Coupe, I., Lieut., C, 20th Georgia, nge 31. Edmonds, .1. W., l"t., H, 1st Ohio Lt. Artillery. Green, S. R., Pt., A, Sth New Hampshire. Honrie, L., Pt., D, 29th Pennsylvania, ago 22. Houser.L, Pt., H, 1st N. Carolina Cavalry. Stockton, J. R., Pt., I, 71st Pennsylvania. Stovall, J. B., Serg't, F, 15th Georgia. West, P., Pt., K, 42d N. York, age 24. Mar. 25, —, '65. Nov. 29, —, '64. Right. Released June 28, 1865. Right; antero-posterior flap. To Provost Marshal March 7, 1865. Left. Died December 31,1864. Left. Died July 16, 1863. ----. Surg. C. S. Wood, 66th New York. Died July 30,1863. Right; circular. Died August 23, 1864 ; typhoid pneumonia. Left. Surg. J. P. Carroll, (I. S. A. Died April 2, 1864. Spec. 3155. Left. Died July 12, 1863. Left. Died May 29, 1864; py-semia. Right. Died July 23, 1863. July 2, —, '63. July 2, —, '63. May 15, 1864. July 1, —, *63. July —, —, '63. July 2, —, '63. Amputations in the Lower Third of the Leg of Uncertain Date.—Fifty-one opera- tions—thirty-four successful and seventeen fatal—were performed on forty-four Confederate and seven Union soldiers. The right limb was amputated in twenty-two, the left in twenty-five cases; in four instances the side was not indicated. Gangrene was noted in three, pysemia and erysipelas in one instance each. Table LXXXII. Summary of Fifty-one Amputations in the Lower Third of ihe Leg, time of Operation unspecified. [Recoveries, 1—34; Deaths, 35—51.] Name, Military Description, and Age. Bee-man, H.C., Lieut., H, 43d North Carolina. Bland, C. C, Pt., K, 36th N. C. Artillerv, age 18. Bradley, J.H., Pt., H, 2d Mississippi, age 29. Bradley, J. H., Pt, G, 16th North Carolina. Burke. M., Pt., Breath- erd's Battery. Calahan, J., Pt., C, 10th Louisiana. Caldor, P., Pt., E, 4th North Carolina. Cheatham, T. B., Pt., H, 59th Alabama. Clarke, N. B.,Pt.,T,16th Georgia. Dyer, S., Lieut.-Col., 3d Mississippi, age 32. Finley, J. W., Pt., I, 41st Alabama. Gildart, J. B., Pt., K, 16th Mississippi, age21. Goods, D. C Pt., E, 12th North Carolina, age 18. Hannah, S. II., Pt., K, 15th Miss., age 25. Henderson, A. R , l't., B, lith North Carolina. Ireland, R. S., Pt., H, 7th South Carolina. Jones, M. M., Pt., G, 14th Alabama. Koonce, H C, Lieut., K, 61st North Carolina. Larkins, J. P., Pt., B, Cobb's Georgia Legion. Ze#Zer,C*.,Serg't, D,28th North Carolina, age 22. Operations, Operators, Result. May 30, —, '64. Jan. 13, —, 65. July 1, —, "63. Julyl, —, 63. Oc.19,'63. 1862. 1862. Sept. 14, —, '62. Nov. 30, —, '64. 1862. Sept. 28, —, '64. Mar. 25, —, '65. Nov. 30, —, '64. Feb. 6, —, '65. J'e 29/64. Sept. 17, —, '62. Sept. 30, —, '64. Oct. 27, 1864. Mar. 22, —, '65. Right. Furloughed. Left; circular. To Provost Mar- shal April 8, 1865. Left; circ. Exchanged March 3, 1864. Left. Exchanged March 17, '64. ----. Surg. — Murray, C. S. A. Recovery. Left. Exchanged March 3,1864. Left. Furloughed December 9, 1862. Left. Furloughed December 23, 1862. ----. Discharged December 19, 1862. Right; circ. To Provost Mar- shal March 27, 1865. Right. Furloughed December 1, 1862. Left. Retired February 11,1865. Left. Released June 28, 1865. Lpft; circular. To Provost Mar- shal May 2, 1865. Right. Furloughed March 31, 1865. Left. Surg. S.S.Satchell, C.S.A. Recovery. Left. Discharged October 17, 1863. Left. Furloughed. Right. Released July 17, 1865. Right. Released June 28,1865. Name, Military Description, and Age. Long, J. F., Corp'l, G, 41st Georgia. Longshore, E. C. Pt., B, 3d South Carolina. Mott, D. W., Pt., D, 13th N. C. Artillery, age 39. Mulley, W., Pt., E, 2d Virginia Cavalrv. Patterson, E., Pt." H, 1st Alabama, age 27. Patton, J. M.,Pt.,E, 16th North Carolina, age 17. Remey, S., Pt., H, 55th New York, age 19. Rowls, S. H.,Pt, D, llth Alabama. Taylor, J. E.. Lieut., E, 66th North Carolina. Thompson, J. M., Corp'l, B,55th Ala., age 20. 'Underwood, E. £.,Pt.,D, 30th Georgia, age 24. VPashburne, J. N.,Pt.,B, llth North Carolina. White, J. R., Pt., C, 3d N. C. Artillery, age 26. Williams, J., Pt., F, 5th Arkansas. Brown, G. W., Pt., D, 16th Georgia. Edison, E., Pt., C, 39th Alabama, age 26. Estus, B. E., Pt., Price's Virginia Bat'y, age 28. Forsyth, I). i£.,Pt.,G,8th Virginia, ago 32. Hardgrove, W. H, Pt., A, loth Virginia. Hoare, M., Corp'l, B, 131st New York. Oct.8,'62. July 6, —, '64. Nov. 30, —, '64. Deo. 13, —, '62. No.18,'64 May 27, —, '63. Operations, Operators, Result. Right. Transferred February 11, 1863. Left. Furloughed March 14, '65. Left; flap. To Provost Marshal April 1, 1865. Right. Retired February 7,1865. Right; oval flap. To Provost Marshal April 6, 1865. Right. Retired February 7,' 65. Right: circular. Disch'd July 8, 1863. Right. Transferred May 1,1865. Right. Furloughed. Right; antero-posterior flap. To Provost Marshal Feb. 24,1865. ----; gangrene. To Provost Marshal May 4, 1863. Right. Furloughed. Right. Released June 28,1865. Left. Transferred March 11, '63. Left. Died December 1, 1862. Left. Died May 16, 1864. Right. Died May 14, 1865. Right. Died May 19, 1865; py- aemia. Left; circular. Died December 11, 1864; gangrene. Right. Died July 3, 1863. 1 O'Kekfe (D. C), Surgical Cases of Interest treated at Institute Hospital, Atlanta, Georgia, May and June, 1864, in Confederate Uates Medical awl Surgical Journal, 1865, Volume II, p. 28. 1 THOMSON (W.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C, in American Journal of Medical Science, Vol. XLVU, p. 382. 5oS INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. Name, Military DlXIMPTlON, AND Age. Dates. Operations, Operators, Result. NO. 47 48 49 50 51 Name, Military Description, and Age. Dates i Operations, Operators, Result. 41 42 43 44 45 t 46 Jones, McG., Pt., G, 67th North Carolina. Mc Cleary, J. L., Serg't, C, 25th S. Carolina. Moore, D. T., Pt., H, 100th Illinois. Prince, E.S., Pt.,C,45th Alabama, age 35. Richmond. W. G., Pt., D, 57th N C.age 22. Smith, W.R., Pt., B,44th Alabama. 1865. Right. Died April 5,1805. Left. Died September 5, 1862. Left. Died December 17, 1863; small-pox. Left. Died February 2, 1865. Left. Died January 8, 1863. Right; circular. Died October 21,1864; gangrene. Stewart, J., Corp'l, F, 23d Iowa. Wadsworth, W., Pt., I, 4th Massachusetts. Wicenga,V., Pt., F, 37th New York. Woolsey, J. B., Pt., A, 7th South Carolina. Young, G. W., Pt., C, 95th New York. May 17, ---. Died July 21, 1863. —, '63. June 14, ' Left. Died July 24, 1863. —, '63. j Mav 3, Left. Died May 27, 1863. —, '63. 1862. Sept. 19, —, *63. Nov. 29, —, '64. Oct. 8, 1864. 1862. 1 May 12, Left. Died May 27, 1864. —, '64. i Amputations in the Continuity of the Leg of Uncertain Date and without Indica- tion of the Seat of Operation.—In four hundred and twenty-one cases of amputations in the leg neither the interval between the injury and the operation nor the precise seat of the operation was reported. The operations were performed on four hundred and eighteen patients, in three instances both legs having been amputated. Ninety-six were Union and three hundred and twenty-two Confederate soldiers. One hundred and thirty-nine opera- tions resulted successfully, and one hundred and ninety-seven fatally, while the termination of eighty-five cases was not ascertained. The rate of mortality of the cases in which the results were determined was therefore 58.6 per cent. The right limb was removed in one hundred and forty-three, the left in one hundred and fifty-three cases; in one hundred and twenty-five reports the side was not mentioned. As will be seen from the subjoined table, the reports of the cases are very incomplete. Table LXXXIII. i Summary of Four Hundred and Twenty-one Cases of Amputations in the Leg of Uncertain Date and Seat of Operation. [ Recoveries, 1—139; Deaths, 140—336; Results unknown, 337—421.] 1 2 3 4 5 6 l\ 9 10 11 12 13 14 15 16 17 19 10 Name, Military Description, and Age. Abernathy, M. J., Lieut., E, 1st Arkansas. Adair, R., Corp 1, D, 8th Georgia. Akridge, A. W., Pt., H, 3d Florida. Allen, W. A., Pt., Reed's Bat. Artillery. Angling, A. G., Pt., G, 24th Tennessee. Arent,J. M., Pt., H, 12th North Carolina. Barham, W. R, Pt, F, 1st North Carolina. Bellany, L. V., Pt., B, 19th Virginia. Bleavin, C, Pt., A, 36th North Carolina. Bobo, D. P., Pt., D, llth Mississippi. Bossier, S., Pt., I, 9th Louisiana. Bowen, B., Pt., G, Orr's Rifles. Brock, M. C, Pt., 0,48th Mississippi. Brown, H. C, Serg't, B, Cobb's Legion. Brown, P. W., Pt., 1,15th Virginia. Brown, W. J., Serg't, I, 21st South Carolina. Carroll, W., Pt., I, 3d Pennsj'lvania. Cashan, T., Pt., B, 21st Georgia. Chancy, M. M., Lieut., Hart's Regiment. Julv —, 1863. 1864. Sept. 17, —, '62. Mar.9,'63. Feb. 5, —, '65. 1862. 1864. Julv 3, —, "'63. Sept. —, 1862. 1862. 1862. 186*3. Operations, Operators, Result. Name, Military Description, and Age, ----. Transferred June 26, 1865. Left. Paroled November 12, '63. Right. Furloughed April 21, '63. Right. Retired October 30,1864. Left. Furloughed January 1/64. Right. Retired February 3, '65. Both. Furloughed September 23, 1864. Left. Recovery. Right. Furloughed. ----. Discharged October 20/62. ----. Discharged November 5, 1862. Right. Furloughed December 11, 1864. Left. To be exchanged October 28, 1863. Left. Furloughed February 16, 1863. Left (also amputation arm). Re- covery, November 18, 1864. Left. Recovery. Right. Furloughed December 19, 1862. Right. To prisoD April 22,1864. Clayton, W. B., Pt., B, 3-d Mississippi. Connor, D. O., Pt., C, Cobb's Legion. Cooper, W. V. L., Pt., G, 5th Texas. Currie, D. J., Pt., D, 51st North Carolina. Davis, J., Pt., L, 2d S. Carolina. Davis, J. L., Serg't, G, 46th North Carolina. Davis, T., Pt., II, 21st South Carolina. Donahoe, A., Pt., Mc- Gregor's Battery. Donovan, J., Pt., 10th Tennessee. Dougherty, J. N., Pt., D, 8th Alabama. Drum,E. J., Pt., C, 28th North Carolina. Duclos, M., Pt., C, 2d Louisiana Dznne, B. L., Pt., A, 5th Ellis, P. F., Pt., I, 13th Mississippi. Exter, T. C, Pt., H, 8th Georgia. Fagan, J. B., Lieut.-Col- onel, 15th Alabama. Farthram, A. S., Capt., Dates. 1862. Sept. 23, 1863. 1862. Aug. 25, —, '64. 1862. 1862. Au.25,'64. 1862. 1863. 1862. Feltz, C. R., Pt., A, 2d Tennessee. Finley, A., Serg't, D, Sth Arkansas. 1862. Julyl, —, ''63. Sept. 19, —, '64. Dec.7/64 1863. Operations, Operators, Result. Left. Furloughed February 20, 1863. Left. Recovery. Left. Discharged October21, '62. ----. Furloughed August 16, 1864. ----. Discharged August 6, '62. Left. Retired January 20, 1865. Right. Furloughed July 27, '62. Right. Retired October 13,1864. ----. Recovery. Left. Discharged February 2, 1863. Right. Retired February 3, '65. Right. Discharged November 30, 1862. ----. Discharged December 7, 1863. Right. Discharged September 9, 1862. ----. Discharged October 31, 1862. Right. To duty March 10, 1864. ----. Transferred October 11, 1864. Right. To Pro. Marshal March 18, 1865. Left. Furloughed April 28,1863. SECT. V.] AMPUTATIONS IN THE LEG. 559 40 41 40 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 73 74 75 76 77 78 79 80 81 82 83 84 85 | 86 87 Name, Military Description, and Agk. Fisher, E. D., Corp'l, (5. 16th Louisiana. Flavelt, R. H., Serg't, P. 7th Missouri, ago JJ. Fowler, L., Pt., I, 34th X. Carolina, age 34. Fulkard, D. A., Serg't, K, 50th Georgia. Garvey, J., Pt.. C. 18th New York. Goddin, T., Pt., IJ, 8th Florida. Godfrey, J., It., E, 1st South Carolina. Gooding,»'. B.,Capt., K, 22d North Carolina. Goodman, J., It., E, 9th Alabama, age 21. Grant, J. M., Pt., I, 1st Louisiana. Griffin, J., It., K, 7th Michigan. Gulick, D. P., Pt., D, 8th Virginia. Hall,J.,Pt., H, 14th N. Carolina, age 26. Banks, A. G., Serg't, F, 1st Texas. Hartuoan, L., Pt., G, un- assigned, age '23. Hawkins, W., Landsman, U. S. Navy. Hegler, C, Pt., F, 7th North Carolina. Heim, If., Pt, I, 7th Vir- ginia. Heister, F., Pt., A, 2d Maryland. Henderson, J. T., Pt.. K, 7th South Carolina. Hendricks, U. S., Pt., D, 6th Cavalry. Herment, I. A., Capt., C, 12tb South Carolina. Hicks, J. V., Pt., A, 56th Georgia. Hinson, IF., Pt., F, 17th Tennessee. Humphreys, B. F., S'g't, G, 12th Arkansas. Hunter, J. B., Corp'l, G, 1st South Carolina. Hutchinson, J. W., Pt., B, 15th Alabama. Ingram, T., Pt., D, 45th Alabama. Jackson, B. F., Pt., Ketch- am's Ala. Battery. Jackson, E. M., Pt., C, 24th Georgia. James, W. F., Serg't, G, 24th Alabama. Jennings, G. IF., Pt., K, 30th North Carolina. Jennings, H. J., Pt., B, 14th South Carolina. Johnson, H. L. W., Capt., C, 12th Arkansas. Jones, J. J., Pt., D, 4th Alabama. Jones, W. C, Serg't, H, 21st Georgia. Justice, J. G., Lieut, and A. D. C. King, T. L., Pt., E, 55th Virginia. Lanier, C, Serg't, L, 2d Florida. Lemmons, A., Serg't, D, 40th Alabama. Lierum, C. T, Captain, Engineer Corps. Lipsey, R.C., Pt.,A, llth Mississippi. Luck, J. W., Pt., Nel- son's Artillery. McCann, J. F.Corp'I, H, 9th Georgia. McCarthy, T, Serg't, K, 57th Texas, age 29. Manyfield, Q. M., Pt., F, 4th Texas. Miller, H. C, Pt., G, 8th South Carolina. ' Milling, J. H, Pt.. K, 2d Louisiana. 186."). Mav 3, —, "'63. Sept. 17, 1862. 1865. Mar. 14, 1863. 1862. Julv 3, 1863. Sept. 13, —, '64. July -, 1863. June 11, —, '64. Julv —, 1863. Nov. —, 1863. Operations, Operators, Result. Left. Furloughed April 28,1863. : Left. Discharged August 8, '63. Right. Retired February 22, '65. Left. Furloughed February 21, 1863. Right. Discharged March 24, 1863. Left. Paroled August 22, 1863. Name, Military Description, and Age. Operations, Operators, Result. 1862. Mav 12, —,"'63. June 13, —, '64. 1862. June 27, —. '62. July 2, 1863. Right. Furloughed December 1862. 19, 1862. Julv 3, Lett. Surgeon P. G. Robinson, —A<53. C.S.A. Recovery. ----; circular. Furloughed Sep- tember 25. 1862. ----. Exchanged January 11, 1862. 1863. Sept. 7, Right. Discharged February 6, -, '62. 1863. Died March 6, 1870. Right. Recovery, June 3, 1865. 186: May 11, '64, —. 1862 July —, 1863. 1863. 1861. 1862. Aug. 16, 1864. Right. Retired February 23, '65. Right. Transferred Decembers, 1862. Right. Transferred July 31, '65. Left. Discharged March 10, '64. Right. Exchanged March 26, 1863. Left. Transferred July 26, 1863. Right. Furloughed. Right. Paroled November 12, 1863. Left. Retired January 18, 1865. Lett. Paroled October 24,1863. Right. Exchanged February 14-, 1864. Left. Retired January 13, 1865. Right. Transferred on parole. ----. Discharged October 14, 1862. Left. Discharged November 21, I 1862. Left. Furloughed June 12, 1862. ----: Right. Furloughed June 12, '62. Left. Recovery. Right. Furloughed August 19, 1862. ----. Discharged September 28, 1862. Right. Paroled September 5,'63. Left. Transferred on parole. ----. Discharged October 11, 1861. Left. Discharged November 30, 1862. Right. Retired February 28, '65. -----Left. Retired November 3,1864. ------- Left. Discharged November 14, 1862. I 1862. -------Left. Exchanged February 14, 1863. ! 1864. -------Left. Surgeon — Holt, C. S. A. Mar.2/61.! Recovery. ------- ---. Discharged November 3, 1862. 1862. ------- Left. Retired October 27,1864. July 22, Right. Recovery. —. '64. I May 31, i Right. Discharged June 22, '63. —, '62. | -------- Right. Discharged November 1862. | 12, 1862. ------- Left. Furloughed March 16,'65. Right. Discharged September 18, 1862. F.,Pt. D, 26th 1865. /•'.. l't. C. 38th Dec. 13, m.lin; , age 24. '62, — /.,1't. l .aim; E, 27th Oct. 14, 1863. Pt., II, 2d July—, —, '63. Virginia. Mi/ers, J. , North Cii Nichols, A North Ci Nix, '/'., Georgia. Pae,e, M. IF, Pt., B, 5th Alabama. Parker, M., Pt., H, 35th Georgia. Patterson, IF., It., A, 20th South Carolina. Peace, J. }'., Pt., E, 23d North Carolina. Perry, W. A., Pt., E, 48th Virginia. Pickets, J. P., Pt.,K, 5th Texas. Pleger, J. M., Pt., K, 9th Alabama. Plummer, J. B., Pt., K, 37th North Carolina. Price, J. S., Pt., D, 52d Virginia. Proctor, W. H, Capt., F, 13th Virginia Cavalrv. Buckett, H, Pt., A, 28th North Carolina. Ray, J. S.,Lieut.,K, 38th N. Carolina, age 36. Rhom, R., Pt., A, 49th North Carolina. Richardson, H. H., Pt., F, 1st Tennessee. Riley, J., Pt., D, 56th North Carolina. Riley, J. O., Pt., G, 6th Louisiana. RiUell, H. G., Pt., A, 12th North Carolina. Robinson, D., Pt., —, Sth North Carolina. Roland, J., Pt., I, 124th Colored Troops, age 35. Ross, J. M., Pt., A, 3d South Carolina. Sample, W. P., Serg't, F, 9th Louisiana. Semmons, W. J., Pt., A, 9th Louisiana. Shifflett, J., Pt., C, 4th Georgia, age 29. Sholer, G. W, Pt., A, 7th Confed. States Cav'lry. Simmons, A. A., Pt., C, 40th Alabama, age 31. Smith, R. H, Pt., F, 3d North Carolina. Smith, W. M., Pt,,A, 41st Georgia. Snider, T. L., Serg't, C, 25th North Carolina. Stanson, B., Pt., D, 18th North Carolina. Starr, J. T, Pt., I, llth Georgia. Stephens, E., Pt., A, Hoi- comb's Legion. Stockdell, J., Pt., F, 13th Virginia. Switzer, B. IF, Pt., C, 27th Mississippi. Thompson, £., Corp'l, C, 16th North Carolina. Tiveman, D., Pt., E, 42d New York, age 36. Trahan, I., Pt., K, 10th Louisiana. Warford, B., Pt., A, 7th Tennessee. Wassum, P. M., Pt., F, 16th Tennessee. Watson, J. A., Pt., A, 4th South Carolina. Watson, L. S., Pt., K, 28th Virginia. Wells, J. J., Pt., E, 27th Mississippi. Westmoreland, J"., Pt., H, 2d Mississippi. Wilder, F. W., Pt., A, 59th Georgia. Williams, L., Pt., B, 41st Alabama. 1862. Julv —, 1863. 1864. May 12, —, '64. 1862. 1862. Sept 19, —, '63. 1863, Nov. 25, 1863. Sept. 17, —, '62. 1862. 1862. 1862. Oct. 8, —, '62. July —, —, '63. Sept. 17, —, '62. May 3, —, '63. Oct. 8, —, '62. 1862. July 5, —, '63. 1862. Right. Transferred April 9, '65. Left. Retired January 25, 1865. Right. Furloughed. ----. Paroled September 12, '63. Right. Furloughed February 3, 1863. Left. Paroled September 5,1863. Right. Furloughed January 9 1865. ' Right. Retired January 28,1865. ----. Discharged August 6,'62. Right. Transferred September 25. 1863. Right. Furloughed December 19, 1862. Left. Discharged December 4, 1863. Right. Transferred April 8, '65. —. Retired. Right. Discharged September 10, 1862. Right. To prison September 28, 1663. Left. Furloughed August 13, 1862. Left. Transferred February 14, 1863. Left. Furloughed September «J9, 1862. ----. Discharged December 20, 1862. Left. Retired February 3, 1865. Left. Transferred July 18,1863. Right. Recovery, February 19, 1866. ----. Exchanged February 3, 1865. Left. Discharged December 2, 1862. ----. Discharged November 7, 1862. Right. Retired January 9, 1865. Right. Duty May 13, 1864. Left. Retired November 19, '64. Right. Recovery. Left. Furloughed February 21, 1863. Left. Furloughed September 19, 1862. ----. Paroled August 16, 1862. ----. Discharged October 21, 1862. Left. Discharged October 12, 1862. Right. Discharged August 29, 1862. Left. To Provost Marshal April 1, 1863. Left. Taroled September 12, *63. Left. Discharged March 3,1863. Died February 26, 1864. Left. Transferred. Left. Furloughed April 18,1863. Right. Furloughed April 18, '63. Right. Duty June 20, 1863. Left. Exchanged June 5,1865. ----. To Danville February 12, 1863. ----. Discharged October 17/62. Right. Recovery, October 8, '64. Left. Paroled June 17, 1865. 560 INJURIES OF THE LOWER EXTREMITIES. [CHAP.X. NO. 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 jlSl 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 Name, Military Description, and Age. Wilson, C. H, Lieut., F, 16th Mississippi. Witt, G. W., Pt., Brown- er's Virginia Cavalrv. Wood, IT. T., Pt.,I), 29th Georgia. Yawn, N., Pt., H, 5th Florida. Abner, J., Pt., 1. 30th Illinois. Alderman, C. Pt., I, 9th Georgia. Alley, W., Pt., A, 34th Indiana. Alliger, J., Pt.. G, 102d New York. Alloway, S., Pt., G, 1st South Carolina. Amos, IF., It., Peyton'6 Battery. Anderson, I. R., Pt., I, 17tb Mississippi. Angel, J.Q., Pt., I, 21st Iowa. Armstrong, J.W., Pt., E, 5th Ohio. Arthur, R., Serg't, B, 22d Iowa. Averitt, A. D., Pt., G, 50th Georgia. Baker, J., Pt., A, 10th Iowa. Barrett, J. M.. Pt., G, 51st Alabama. Bartholomew, T. K„ Pt., G, 22d Iowa. Beaver, A. D., Pt., A, 57th North Carolina. Bendall, B. F., Pt., F, 53d Virginia. Benham, J., Pt., H, 19th Illinois. Birch, N., PL, F, 5th N. Jersey, age 33. Boiling. H, Capt., Gen. Chambliss' staff. Bowman, J. T., Pt., I, 16th North Carolina. Boyd, J, Pt., E, 7th Louisiana. Brock, J. H, Pt., I, 43d Alabama. Brockett, W., 35th Illinois. Brown, R., Pt., E, 88th Indiana. Brown, S. H., Pt 81st Illinois. Buckingham, M. D., Pt., H, 1st Virginia. Buttrich, P. W., Pt., B, 32d Massachusetts. Calvert, W. J., Pt., I, 1st South Carolina. Camp, G. T, Pt., Gra- ham's Virginia Bat'rv. Campbell, J. R., Serg't, D, 13th S. Carolina. Campbell, IF. IF., Pt., I, 8th Florida. Cantwell, I., Pt., C, 7th Ohio. Carrington. W. IF., Pt., A, 2d Texas. Chaplain, W. E., Lieut.. I, 1st South Carolina. Coe, W. IF, Pt.. M, 21st North Carolina. Connelly, B. C. Corp'l, B, 18ih Infantry. Coons, A., Pt., 11, Ohio. Cooper, G., Lieut 24th Virginia. Coppick, J., Pt Ohio. Couch. H., Pt. Illinois. Daum, C, Pt., K, 25th Ohio. Davidson, B. R., It.. H, 60th Alabama. Davis. J. K., Pt.,B, 10th Iowa. Dixon, W., Pt., G, 5th North Carolina. Pt., K, C, Dates. 1862. 1862. 1863. July 3, —, '63. May 16, —, '63 Sept. 17, —, '62. July 2. —, '63. 1862. May 17, —, '63. Sept. 17, —, '62. May 22, —, '63. May 22, —, '63. July —, —, '63. Dec. 31, —, '62. 1862. July— —, '63. Mar. 7, —, '62. Dec. 31, —, '62. 1863. July 2. —, '63. July 2, —, '63. 1862. 1863. April 6, —, '62. July —, —, '63. Oct. 8, -, '62. 49th I'', D, 74th F, 89th Julv —, —,"'63. Dec. 31, •62, —. 1862. Mav 16, —,"'63. July 3. —, ;63. Operations, Operators, Result. Left. Furloughed December 18, 1862. Left. Furloughed July 10,1863. Left. Furloughed April 18,1863. ---. Discharged December 20, 1862. Right. Died October 12, 1863. Left. Died July 19, 1863. Right. Died June 14, 1863. Right. Died November 19,1862. Right. Died August 10,1863. ---. Died August 8, 1862. ---. Died June 3, 1863. Right. Died June 30,1863; diar- rhoea and fever. Left. Died October 24, 1862. ---. Died June 2. 1863. ----Died October 20, 1864. Left. Died June 6, 1863. Right. Died August 28, 1864. ---. Died August 7, 1863. ---. Died October 20, 1864. Right. (Also amp. left forearm.) Died August 6, 1863. ---. Died March 7, 1863. ---. Died June 22, 1862; py- aemia. Left. Died October 18, 1864. Left. Died October 22, 1863. ---. Died October 20,1864. Left. Died June 2, 1864. Right. Died April 14, 1862. ---. Died January 11, 1863. Left. Died June 4, 1863. Right. Died August 1, 1863. ---. Died August 5, 1863. ---. Died September 23, 1862. Left. Died July 16, 1863. Left. Died June 11, 1864. Left. Died November 16, 1863. Left. Died August 23, 1863. Right. Died May 13, 1862. Left. Died. Right. Died September 17,1863; chronic diarrhoea. ---. Died November 19,1862. Right. Died February 14, 1863. Left. Died July 27, 1863. ---. Died January 18, 1863. ---. Died January 27, 1863. ---. Died June 30, 1862. Left. Died May 31, 1864. ---. Died June 8, 1863. Right. Died Julv 19, Ihi.3. 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 228 229 230 231 Name, Military Description, and Age. Dodds, J, Pt., G, llth Alabama. Dunham, Z., Serg't, A, 18th Infantry. Earp, W. R., Pt.. E, 7th North Carolina. Easters, E., Pt., D, 5th South Carolina. Eldin, T., Pt,, K, 1st S. Carolina Rifles. Ellis, D., Pt., F, 7th N. York Cavalry, age 24. Epzell, E. J., Pt., B, 51st North Carolina. Dates. 1862. Dec. 31, '62, —. Operations, Operators, Result. Etmeir, W., Pt., G, 73d Indiana. Fair, R. H., Serg't, B, 10th Penn. Reserves. Fenton, P., Lieut,, B, 19th Georgia. Ferguson, F. F., Pt., G, 6th Virginia. Finley, A. M., Serg't, E, 55th Alabama. Floyd, C. J., Pt., H, 18th Alabama. Foosler, J., Pt., F, 2d South Carolina. Fowler, H. L., Pt., E, Hampton's Legion. Fox, J. O., Pt., K, U5th New York. Frazier, W., Pt., F, 5th New Jersey. Garlick, A. J., Pt., B, 4th Virginia. Gavitt, E. D., Pt., D, 4th Rhode Island. Gee, J., Pt., G, 137th New York. Gifford, L. S., Corp'l, B, 22d Illinois. Greenwell, J. R., Pt., 4th Virginia. Gregory, J. T., Serg't, C, 27th Georgia. Good, A. H., Lieut., I, 7th Virginia, age 19. Gottbrecht, A., Pt., B, 16th Iowa. Hamm, J. D., Pt., C, 42d Mississippi. Hammond, J., Corp'l, B, 3d Delaware. Handly, P., Corp'l, K, 48th Pennsylvania. Harris, J. P. D., Pt., H, 27th Georgia. Harrold, J. J., Pt., A, 59th Georgia. Hawille, J. C, Pt., K, 13th North Carolina. Hay, VV., Pt., E, 16th New York. Helmick, J., Pt., G, 19th Iowa. Heyer, XV., Pt., E, 41st Illinois. Higgins, M. P., Pt., F, Sth Georgia. Hittle, G. W., Pt., G, 75th Illinois. Hodge, R., Pt., F, 1st Tennessee. Hewlett, J, Pt., D, 2!)th Virginia. Huggeons, J., Pt., E, llth Virginia. Jackson, J. C, Pt., I, 47th North Carolina. James, W. A., Serg't, K, 14th Alabama. Jenkins, J. S. P., Pt.. C, 12th Virginia Cavalry. Jones, G. W., It,. I, 13th N. Carolina, age 30. Jones, R, It., D, 5th North Carolina. Kelley, E., Pt., E, 76th New York. Kellis, J., PL, E, 47th North Carolina. Kelly, W. M., Pt., E, 13th Alabama. Kelsoe, J. G., It., G, 1st Tennessee. Dec. 31, '62, —. June 27, 1862. July 3, '63, —. Aug. 31, —, '62. Mar. 14, —, '62. July 2, —, 'f63. Sept. 19, —, '63. 1862 1863. June 15, —, '64. June —, —. '62. 1862. 1862. July 3, —, '63. June 27, —, '62. Dec. 7, 1862. Feb. 15. 1862.' July 3, —, '63. Oct. 8, —, '62. Oct. 8, —, '62. 1863. May 5, 1862. Aug. 30, —, '62. July 2, —, N63. July 3, —,'63. ---. Died June 30, 1862. ---. Died February 17, 1863. ---. Died January 5, 1863. Right. Died October 19, 1864. ---. Died September 13, 1862. Right. Died May 16,1864. ---. Died June 5,1864; tetanus. ---. Died March 23, 1863. ---. Died. Right. Died January 13, 1863. Left. Died June 1, 1864. Right. Died August 16, 1864. Right. Died August 14, 1864. ---. Died. ----Died September 30, 1862. Right Died June 1, 1864. ---. Died September 11,1862. ----Died March 8, 1864. Right. Died June 11, 1862. Left. Died July 27, 1863. Left, Died October 8, 1863. ---. Died September 8, 1862; gangrene and pyaemia. Left. Died June 28, 1864. Left. Died August 29, 1863. Left. Died September 5, 1864. ---. Died June 16, 1864; py- semia. ---. Died June 29, 1862. Right. Died October 25, 1862. Left. Died June 8,1862. Left. Died September 6, 1863. ---. Died June 28, 1863. Right. Died July 18, 1862. Right. Died January 10, 1863. ---. Died March 8, 1862. Left. Died September 9, 1863. ---. Died November 12, 1862. ---. Died October 25, 1862. Left. Died May 24, 1863. ---. Died September5, 1862. Right. Died September 2, 1862. ---. Died September 8, 1862. ---. Died June 23,1864 ; pneu- monia. Left. Died August 22, 1863. ---. Died June 9, 1862; py- aemia. ---. Died September 16, 1862. ---. Died July 25, 1863. Right. Died July 25, 1863. ---. Died June 15, 1863. SECT. V.J AMPUTATIONS IN THE LEG. 561 Name, Military I j)ATE8 Description, and Age. j Operations, Operators, Result. | Name, Military Description, and Age. 2711 272( 273 274 275 276 277 278 279 280 Kenney, J., Pt., I, 157th New York. Kirk, W. S., Pt., C, 4th Knecht, A. M., Serg't, K, 12th South Carolina. Laffith, J., Serg't, D, 104th New York. Lamford, P.. Pt., G, 3d South Carolina. Lemon, W., Pt., K, 57th Virginia. Lillibridge, D.N.,Pt, F, 12th Iowa. Linsley, S., Pt., C, 100th Col'd Troops, age 24. Lohmann, C, Lieut,, D, 20th New York. Lumsford, H. E., Pt., K, Sth Georgia. Mack, H., Pt., B, 36th Wisconsin. Maltbie, E. P., Pt., F, 2d Conn. Artil'ry, age 57. Martin, M. W., Pt., G, 7th Virginia. Martinson, C, Pt., H, 9th Iowa. Mason, A., Corp'l, K, 93d Illinois. McCauley, —, Pt, E, 47th Alabama, age 45. McClellan, C. H., Pt.,A, 7th Michigan. McCloud, D., Pt., I, 55th Pennsylvania, age 27. McCuny, G. S., Pt., I, 14th South Carolina. McLaughlin, S., Pt., N, 6th South Carolina. McMichael, C, Pt., H, 17th Iowa. McMurrin, H. S., Pt., K, 2d New York. McMurry, W. B., Lieut., K, llth Mississippi. Miller, P., Sergt, G, 3d Iowa Cavalry. Miller, J. A., Corp'l, F, 93d Illinois. Moon, R., Pt., C, 2d New York. Morrow, J., Pt., K, 18th Georgia. Morton, F., Pt., D, 72d Pennsylvania. Mullen, P., Pt., E, 81st New York. Mnmford, S., Pt., E, 1st Delaware. Munroe, T. M., Pt., K, 18th North Carolina. Neal, J. E., Pt., A, 13th Iowa. Oliver, J. J., Serg't, K, 61st North Carolina. Oxford, J. M., Pt., A, 33d Mississippi. Passinger, H. M., Pt., C, 3d South Carolina. Plummer, C. H., Corp'l, F, 18th Wisconsin. Praither, Z.. Pt,B, 13th North Carolina. Price, R. M., Pt.,B, 34th North Carolina. Quack, W., Pt,, E, 27th Mississippi. Rash, R. A., Pt., F, 52d North Carolina. Re.iche, L. J., Pt.. D, 57th North Carolina. Rhoads, W., Pt., A, 53d Pennsylvania. Roach, T. P., Corp'l, K, 6th Maine. Robbins, J. P., Pt,, 53d Virginia. Robinson, J. W., Pt., H, 10th Ohio Artillerj'. Robinson, T. R., Pt., H, 41st Illinois. Rogan, J. L., Pt., E, 4th Texas. Rosin, W., Pt., C, llth Mississippi. April 9, Left, Died September 26, 1865; —, '65. I exhaustion. _______----. Died October 5, 1862. Au<». 16, ' Right. Died September 9, 1864. —,"'64. Julv 2, I Left. Died September 6, 1863. —,"63. I _______ ----. Died December 24, 1862. July -, —, '63. April 6, —, '62. Sept. 17. —, '62. 1861. 1864. June 1, —, '64. Sept. 17, —,'62. Mar. 7, —, '62. Left. Died August 24, 1863. ----. Died October 13, 1862; erysipelas. Left. Died Maroh 10, 1865; phthisis pulmonalis. Right. Died Ootober 9, 1862. ----. Died September 1, 1861. Right. Died June 8, 1864. Right. Died July 2, 1864. ----. Died October 14, 1862. ----. Died March 15, 1862. Right. Died July 30, 1863. ----. Died September 8, 1864. 1863. Julv- —,"'63. Sept. 17, Right. Died October 7, 1862. —, '62. I June 18, Left. Died July 9, 1864. —, '64. j„ly _ Right. Died September 12,1863. —,'63. -------, Left. Died December 28, 1864. May 16, •----. Died July 2, 1863. —, '63. I Sept. 17, Right. Died October 26, 1862. —, '62. -------- Left, Died May 29, 1864. July 11, —, '64. 1863. Sept. 17, —, '62. Sept. 17, —, '62. 1862. Sept. 17, —, '62. April 6, —, '62. July 2, —, '63. Oct, 4, —, '62. Mav 5, —, '62. Oct. 8, —, '62. Sept, 17, —, '62. May 3, —, '63. July 3, —, '63. 1864. April 6, ----. Died February 25, 1865. Left. Died July 13, 1863. Left. Died November 10, 1862. ----. Died September 17, 1862. Right. Died October 14, 1863. ----. Died June 9, 1862. Left. Died October 18, 1862. ----. Died December 27,1862. Left. Died May 4, 1862; haem- orrhage. ----. Died October 29, 1864. Right. Died August 18, 1864. Right. Died September 5,1863. Right. Died November 29,1862. ----. Died May 24, 1862. Left. Died July 5, 1862. Right. Died December 6, 1862. Both. Died January 8, 1863. Left. Died December 18,1862. Left. Died October 9,1862. Right. Died May 28, 1863. ----. Died July 20, 1863. Left. Died June 26, 1864. Left. Died May 10, 1862. ----. Died October 2, 1862. ----. Died September 24, 1862. *! 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 Rugg, A. J., Pt, Mo Intosh's Battery. Sanchez, S. J., Pt, B, 2d Florida. Saunders, H, Pt., C, 4th Virginia. Sawyer W. F., It., B, 37th Tennessee. Scott, J. B., Pt, G, 4th Texas. Scott, J., Pt., H, 47th North Carolina. Senor, F. H., Corp'l, B, 79th Pennsylvania. Shelter, D., Pt., F, 46th Ohio. Sherwood, G. W., Pt., E. 21st Illinois. Shilling, J., Pt, B, 20th Massachusetts. Shrelas, A., Pt, E, 26th North Carolina. Simpson, G., Pt, 21st Wisconsin. Sims, G. T., Pt, I, 12th South Carolina. Singlebnsh, J. W., Pt., G, 73d New York. Sink, J., Pt, F, Sth Virginia. Smith, J., Pt, H, 3d Delaware. Smith, J. C,Pt,C, 112th Illinois. Smith, J., Pt, I, 86th New York. Smith, L. B., Pt., B, llth Mississippi. Smith, R., Corp'l, B, 30th Virginia. Snider, W., Pt, G, 2d N. C. Battery. Spradlin, W., Pt., H, 26th Alabama. Steele, R. C, Pt., I, 7th North Carolina, age 30. Stevens, A. G., Pt., D, 22d Illinois. Stevens, B. F., Pt., K, 38th Virginia. Stever, W. R., Pt., E, 2d Wisconsin. Stewart, J. S., Pt., G, 1st South Carolina. Stribley, W., Serg't, A, 30th Indiana. Summers, W., Pt, D, 17th Iowa. Tarleton, L. V., Pt., G, 47th Missouri. Tate, E. R., Pt, C, 15th Georgia. Thevi, S. B., Serg't, F, llth Georgia. Thomason, W. A., Serg't, E, 2d S. Carolina. Tomlinson, D., Pt, E, 42d Indiana. Traville, J., Pt.,D, Hoi- comb's Legion. Truesdale, J. C, Pt, I, 12th South Carolina. Tullis, A., Pt, G, 28th Iowa. Tyler, H, Pt., C, 25th South Carolina. Vanderfard, A. A., Lt, D, 21st S. Carolina. Van Kuren, J., Serg't, H, 21st Iowa. Vaughn, G. W., Pt, B, 1st Tennessee. Walker, J. A., Pt,, K, 45th Georgia. Walker, N. A., Pt., I, 9th Iowa. Walter, L., Pt., A, 13th Ohio. Waltz, A., Pt, K, 7th New York. Weber, G., Pt., E, 3d Wisconsin. West, O. K., Lieut., K, 40th Virginia. Whealley, F. M., Pt., 2d Maryland. July 2, —, '63. July 21, —, '61. Oct, 8, —, '62. 1862. Operations, Operators, Result. Oct. 8, —, '62. April 6, —, '62. Sept. 19, —, '63. Sept. 17, —, '62. Jul}- 2, Oct. 8, July 2, —, '63. June —, —, '62. 1864. Aug. 30, —, '62. July 2, —, v63. July 3, —,'63. Deo. 31, '62, —. Aug. 31, —, '62. De.31/62, June 26, —, '63. Sept 27, —, '64. July —, —, '63. July —, —, '63. Oct. 8, —, '62. May 16, —, '63. May 1, —, '63. Mar. 7, —, '62. De.30,'62, -, '63. 1862. Sept. 17, —, '62. ----. Died June 1,1863. ----. Died July 17, 1863. ----. Died September 8, 1861. ----. Died November 14 862. ----. Died July 5, 1862. Lett. Died September 19, 1862. Left Died October 26,1862. Right, Died April 20,1862; py- aemia. Lett. Died October 16, 1863. Right. Died November 13,1862. Right. Died July 29, 1863; ex- haustion. ----. Died October 20, 1862. Left. Died September 6, 1864. ----. Died July 29, 1863. ----. Died July 1, 1863. ----. Died June 29, 1862. Left. Died June 24, 1864. ----. Died September 10,1862. ----. Died October 1, 1862. Right. Died June 9, 1864. ----. Died July 17, 1863. ----. Died June 4, 1863. Right. Died August 29, 1863. ----. Died January 15, 1863. Left. Died June 1, 1864. ----. Died September 30, 1862. Left. Died September 16,1864. ----. Died January 11, 1863. ----. Died July 6,1863. Left. Died November 1, 1864. ----. Died August 5, 1863. ----. Died August 8, 1863. Right. Died June 1, 1863. ----. Died November 24, 1862. ----. Died May 9, 1865. Right. Died June 20, 1864. Right. Died July 9, 1863; gan- grene. Right. Died June 20, 1864. Left. Died February 28, 1863. Left. Died June 18, 1863. ----. Died September 6, 1862; pyaemia. Left. Died May 26, 1864; py- semia. Right. Died April 2,1862. Left. Died January 19, 1863. Left. Died December 28,1862. Right. Died November 2, 1862. Left. Died July 23, 1863. Right. Died Ootober 28, 1864. 562 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. 329 330 331 332 333 334 335 336 337 338 339 340 | 341 342 343 344 345 346 347 348 349 350 351 352 353> 3545 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 3 373 374 375 Name, Military Description, and Age. Wilkerson, E., Pt, B. llth Georgia. Williver, J, Serg't, H, 44th North Carolina. Winecoff, H. D., Pt, H, 7th North Carolina. Withington, M., PL, D, 50th Georgia. Wood, A., Pt., K, 1st Mississippi. Woodall, R., Pt., B, 12th Georgia. Wright, L. M., Pt, E, 59th Alabama. Wynn, P. A., Corp'l, I, 3d Georgia. Alkins, H. O., Pt, D, 13th Col'd Troops. Andrews, J. P., Pt., D, 13th Mississippi. Bailey, H. P., Pt., 1st Washington Artillery. Beaufort, J. L., Pt, F, ISth Mississippi. Bell, J. J, Pt., C, 13th Mississippi. Bennett, W. F., Pt, D, 6th Georgia. Bon, F. L., Pt, A, 17th Mississippi. Bridges, J. M., Pt, I, 38th North Carolina. Brockington, W. J, Pt, A, 7th S. C. Cavalry. Brown, R. D., Serg't, H, 45th Georgia. Bruce, J. B., Pt.., I, 1st Tennessee. Brumfeld, J. F., Pt., C, 46th Virginia. Bugg, J., Pt., C, 28th Georgia. Butts, W. J., Pt., B, 60th Georgia. Camble, T., Pt., D, 7th Dates. Operations, Operators, Result. Cameron, J. W., Pt., I, 26th South Carolina. Carpenter, P. J., Pt, D, 13th Virginia. Chamberlain, W. D., Pt., I, 14th S. Carolina. Chapman, R. F., Lieut., E, 9th Virginia. Chestnut, F. M., Pt., F, 8th Arkansas. Clakly,J. T., Pt, A, 10th Georgia. Cone, L., Serg't, D, 8th Georgia. Conner, J., Pt, G, 7th Louisiana. Cox, J. T., Serg't, D, 28th South Carolina. Craft, J. I., Pt., H, 33d North Carolina. Creole, G. D., Pt., E, 27th Georgia. Davis, G. W., Lieut, H, 6th Virginia. Davis, J. TF.,Pt.,K, 37th South Carolina. Duncan, W. F., Pt., K, 44th Tennessee. Edwards, A. D., Pt, C, 28th North Carolina. Evans, W. O., Corp'l, E, 18th South Carolina. Foderfield, N., Pt, B, 16th Georgia. George, W., Pt, K, 7th Louisiana. Green, A.J.,Vt.,D, 29th Georgia. Grace, L., PL, A. 20th Georgia. Gunn.R. 67., Pt., A. 17th Mississippi. Harback, C. B., Pt., K, 21st Iowa. Harder, T. D., Capt., H, 9th Georgia. July —, Right. Died July 22, 1863. —, '63. ' -------'---. Died December 1, 1863; chronic diarrhoea. ------- Right Died February 14, 1863; pyaemia and hectic fever. July 3, Right Died October 17, 1863. —, '63. -------Left. Died September 2, 1863. -------j Left. Died May 25, 1864. Dec. 16, '64,'—. July 3, '63, —. 1865. July 3, "63,—. 1865. July 3, —, *63. 1864. 1862. 1864. April 6, '62, —. July 3, '63, —. 1865. 1864. 1864. Oct. 8, Sept. 19, 1864. Left. Died May 24, 1864. ---. Died June 5, 1864. Left. Right. Right. Right. Right. Right. Right. Right. flap. Right. Right, Left. Left. Both. Left. Right. Left. Right. Right. Right. Left. Left, Right. Left. Left. Left. 1864. Julv 3, ! Right. •63,-. ; 1864. Right. 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 Name, Military Description, and Age, Harris, E. H, Pt., F, 7th Georgia. Harrison, N. C, Pt, F, 44th Georgia. Henson, S. C., Corp'l, F, 4tb Georgia, age 24. How, M. D., Pt, E, 20th Georgia. Jackson, N., Pt., D, 35th Georgia. Jacobs, W. J.,Pt.,F,13th Georgia. Jones, J., Pt., H, 6th Georgia. Jones, W. R., Serg't, A, 13th South Carolina. Koone, G. IF., Serg't, D, 16th North Carolina. Langdon, J. J., Pt, E, 48th Georgia. Lewis. A., Pt,, I, 49th Georgia. Lewis, J. T., Pt, B, 7th South Carolina. Loeb, H, Pt., A, 22d Mississippi. Mags, W. J., Pt,, K, 3d South Carolina. Mallony, M. M., Pt., C, 15th Tennessee. Mc Crary, IF., Pt., B, 26th North Carolina. Melton, B. W., Pt., H, llth Georgia. Mercer, M., Pt., D, 35th Georgia. Miller, W. N., Capt, H, 31st Georgia. Mizells,J.S.,Vt.,B, llth South Carolina. Murray, W. B., Corp'l, D,5th S. C. Cavalry. Myers, T., Pt, A, 45th Georgia. Neal, H. R., PL, G, Pal- metto S. S. S. Carolina. Neely, I, Pt.. D, 1st Tennessee. Newman, W. A., Pt., C, 28th Georgia. Peables, J. C, Pt., H, 28th Alabama. Price, W. KA, PL, K, 44th Tennessee. Reese, T. B., Pt, E, Phil. Legion. Robbins, C. C.......... Ruleau, F., Pt., Wash- ington Artillery. Sair, A.,—,G, 57th N. Carolina, age 31. Sawyer, H. A., Capt, C, 2d N. Carolina, age 24. Shuler, P. H. B., Lieut., A, 2d South Carolina. Smith, I. B., Pt, A, 32d Mississippi. Smith, M. B., Pt., F, 2d South Carolina. Stanfdl, J. W., Pt., A, 20th Georgia. Stewart, A., Pt., D, 1st Tennessee. Strane. G. L.,Pt., D,Hol- comb's Legion Cav'y. Truett, J. D., Pt., C, 38th Georgia. Turner, P. S., Pt, A, 44th Georgia. Vause, W. A.. PL, 1,28th Georgia. Watkins, W". H, Corp'l, C, 20th Georgia. Welch, J, PL, F, 61st Georgia. Whitefield, W. H, PL, C, 14th Georgia. Willis, R. M., Vt., C, 15th Georgia. Winstead, I., Serg't, D, 1st Tennessee. Dates. 1864. 1864. 1864. Aug. 16, 1864. 1865. Au.25/64. 1864. 1864. 1862. Oct. 8, '62, —. 1864. 1865. Oct. 8, —. '62. 1864. Oct. 8, 1862. July 2, 1863. ]862. Julv—, —," '63. Oct. 8, 1862. Sept. 30, '64, —. 1864. April —, 1865. April —, 1865. 1864. 1865. Oct. 8, —, '62. Operations, Operators, Result. Right. Right. Right. Left. Right. Left. Left. Right Left Left. Left. Left. Right. ----; flap. Left; circular. Lett. Left. Right. Lett. Left Left. Right. Right, Left. Right, Left, Left. Left. Left. Left. Left. Right. Right ----; circular. Right. Left, Right. Left. Left. Right. Left. Right. In one instance (Case 16, p. 558) the arm, and in a second instance (No. 155, p. 560) the forearm, was amputated at the time of the removal of the leg. This is the last cate- sect, v.] SHOT FRACTURES OF THE BONES OF THE LEG. 563 gory of the five thousand four hundred and fifty-two amputations in the leg for shot injury performed during the American civil war. Recapitulation.—In thirty-nine instances, with nineteen recoveries, nineteen deaths, and one unknown result, both legs were amputated. The five thousand four hundred and fifty-two (5452) operations were therefore performed on five thousand four hundred and thirteen (5413) soldiers, of whom three thousand nine hundred and seventy-four (3974) belonged to the Union and one thousand four hundred and thirty-nine (1439) to the Con- federate armies. Of the operations on the Union soldiers the results were recorded in all but fifteen cases. Two thousand five hundred and seventy-nine (2579) recovered, and one thousand three hundred and eighty (1380), or 34.8 per cent., died. Of the Confederate soldiers the results in one hundred and twenty-two cases remain undetermined; nine hun- dred and sixty-three survived, and three hundred and fifty-four, or 26.8 per cent., perished. This favorable percentage of mortality among the Confederates, however, would probably be materially affected had it been practicable to ascertain the results in the one hundred and twenty-two undetermined cases. In fifteen of the five thousand four hundred and fifty-two cases of amputations in the leg, the opposite limb was amputated in one instance at the hip,1 in seven in the thigh,2 in two at the ankle joint, and in five through the foot; re-amputations in the leg for diseased stumps or hsemorrhage were performed in one hundred and forty-four cases. In six instances the amputation in the leg was followed by disarticu- lation at the knee, and in seventy-one by ablation in the thigh. The right leg was involved in two thousand three hundred and sixty-nine cases, the left in two thousand five hundred and forty-four, and in five hundred and thirty-nine the side was not recorded. CONCLUDING OBSERVATIONS ON SHOT FRACTURES OF THE BONES OF THE LEG.—As already stated, the shot fractures of the bones of the leg number eight thousand nine hundred and eighty-eight (8,988). They form the most numerous group of shot fractures of the long bones of the extremities, comprising nearly one-third of the twenty-nine thousand and three (29,003) cases of this nature recorded during the American civil war, as follows: Shot fractures of the humerus [Second Surgical Volume, Table LV, p. 666) eight thousand two hundred and forty-five (8,245), or 28.4 per cent.; shot fractures of the radius and ulna [Second Surgical Volume, Table OXXIV, p. 922) five thousand one hundred and ninety-four (5,194), or 17.9 per cent.; shot fractures of the femur (Table XX, p. 175, ante) six thousand five hundred and seventy-six (6.576), or 22.6 per cent.; and shot fractures of the bones of the leg (Table LXI, p. 432, ante) eight thou- sand nine hundred and eighty-eight (8,988), or 31.0 per cent. It will be borne in mind that cases involving the articulations in the upper as well as in the lower extremities arc not included in these tabular statements. It has been shown in Table LXI, page 432, ante, that of eight thousand nine hun- dred and eighty-eight (8988) cases of shot fractures of the bones of the leg the bone injured was specified in five thousand and seventy-two (5072) instances; one thousand and thirty- three (1033) were fractures of the fibula, two thousand five hundred and eighty-eight (2588) 1 Case of Private W. Waters, Co. K, 123d New York. CASE 286, page 135, and No. 24, TABLE XV, page 138, ante. 2 Cases of: Pt. H. Brown, Co. K, 22d Colored Troops, secondary operation, lower third left thigh ; recovered; TABLE XL, No. 15, page 320, ante.— Pt. C. L. Johnson, Co. B, 1st Tennessee, primary operation, lower third left thigh; fatal; TABLE XXXH, No. 1402, page 261, ante.—Pt. J. R. Lewis, Co. H, 53d Georgia, primary operation, lower third left thigh; fatal; TABLE XXXH, No. 1469, page 262, ante.—Pt. S. Banks, Co. C, 43d Colored Troops, primary operation, middle third right thigh; fatal; TABLE XXXI, No. 706, page 235, ante.—Pt. L. O. Larcphere, Co. G, 21st Connecticut, primary oper- ation, lower third left thigh; fatal; Table XXXTI, No. 1445, page 262, ante.—Sergeant J. Foss, Co. C, 59th N. Y., primary amputation thigh; fatal; Table XXXIII, No. 116, page 269, ante.—Cook H. Houseley, Co. F, 33d Wisconsin, intermediary operation, lower third right thigh : recovery; TABLE XXXVI, No. 91, page 294, q,nte. 564 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. of the tibia, and one thousand four hundred and fifty-one (1451) of both tibia and fibula. Of the one thousand and thirty-three fractures of the fibula, fifty, or 4.8 per cent., of the two thousand five hundred and eighty-eight cases of fracture of the tibia, four hundred and forty-two, or 17.0 per cent., and of the one thousand four hundred and fifty-one fractures of both bones, one thousand and forty-two, or 71.8 per cent., were amputated. Three thousand nine hundred and thirty-eight (3938), or less than one half of the eight thousand nine hundred and eighty-eight (8988), shot fractures of the bones of the Table LXXXIV. Results of Shot Fractures of the Bones of the Leg treated by Conservation on ihe Occasions named and from the Authorities quoted. OCCASIONS AND AUTHORITIES. Thirty Years' War, 1618-1648 (SCHMIDT1)..................... Frauco-German War, 1671-1678 (PURMANN2)................... Siege of Douay, 1710 (Cannac3).............................. Battle of Molwitz, 1741 (SCHMUCKEK4)........................ Dettingen, Fontenoy, and Tournay, 1743, 1745, etc. (RAVATON,5 BOUCHEK,6 BORDENAVK,7 BAGIEU8)......................... Seven Years' War, 1756-1763 (Mehee,9Bilguer,10 BOURIENNE11) Napoleonic Wars, 1791-1815 (Laurent,12 Larry,13 Hutin,14 Guthrie, "* Fenech, l6 Hennen")........................... Revolution in Paris, 1830 (ARNAL,18 JOBERT de Lamballe,19 Meniere,20 Larrev2')...................................... French in Algeria, 1830-36 (Baudens,22 Bagre23).............. Spanish Peninsular War, 1836-1837 (Alcock24)................ Mexican War, 1845-48 (PORTER26)............,................ Revolution in Milan, 1848 (RESTELLI26)........................ Revolution in Paris, 1848 ( Malgaigne,27 GOSSELIN.^HUGUIER,29 Jobert,30 Baudens31)...................................... Schleswig-Holstein War, 1848-50 (STROMEYER32).............. British in India, 1857-58 (WILLIAMSON33)...................... Crimean War, 1854-57 (Matthkw,34 Chenu35)................. Italian War, 1859 (CHEXU,*6 DEMME37)........................ New Zealand War, 1863-65 (MOUAT38)......................... Danish War, 1864 (LUECKE,39 Heine,40 OCHWADT41)........... French in Mexico, 1864 (BlNTOT42)............................ Austro-Prussian War, 1866 (Bkck,43 Biefel,44 FISCHER (K.),46 MA AS,46 STROMETER47)..................................... U. S. Army, 1865-1870 (OTIS48).................7.............. Franco-German War, 1870-71 (GERMANS49).................... Franco German War, 1870-71 (French50)...................... Russo-Turkish War, 1876-77 (TILING51)........................ CASES. Aggregates 49 58 19 598 508 3 31 1 296 7 1,030 186 12 5 5 1 3 6 33 ID 26v 9 28 I 6 27 52 18 429 424 3 31 1 225 7 855 125 9 2,989 2,339 534 116 Mortality Rate 18.5 perct. Fractures. Tibia. 521 55 38 13 <~ 614 194 23 14 £ S 231 Tibia and Fibula. 28 a s 287 76 27 390 Bene not Specified. 364 261 3 12 321 106 ■a s S 1,337 380 37 34 1,754 leg treated without operative interference give a mortality rate of 13.8 per cent. From the above table (Table LXXXIV), in which an attempt has been made to collect as far as 1 SCHMIDT (JOSEPH) (Speculum Chirurgicum oder Spiegel der Artzney, Angspurg, 1656, pp. 155, et seq.) details seven cases of shot fractures of the bones of the leg treated conservatively; five recovered and two proved fatal: Steffan, shot fracture left leg, February 20, 1641; recovery. H. Bernet, dragoon, shot fracture left leg, May 6, 1648; pieces of bone removed; recovery. Lieut. RossmaDn, fracture upper third left leg, May 21, 1648; recovery. Lieut. L. Kytzinger, aged 60, shot fracture upper third right leg, May 18, 1648; fatal. M. Zorn, shot fracture left leg; recovery. H. J. Buchrer, shot fracture tibia with great loss of soft parts; recovery. F. T. Marin, shot wound of right leg; fatal. 2PURMANN (M. G.) (Funfftzig Sonder-und Wunder- bahre Schusswunden Curen, Leipzig, 1721) details five successful cases of shot fractures of the bones of the leg: Obs. IV, p. 53, D. Griesing, wounded during Siege of Stettin, August, 1677; fracture of both bones of leg; recovery. Obs. XIII, p. 113, H. Rother, shot fracture tibia, Ancklam, 1676; recovery. Obs. XIII, p. 115, C. Wutke, wounded at Stultin, in 1677; shot fracture left tibia; recovery. Obs. XXIX, p. 222, J. Fischer, shot fracture left leg andleft SECT, v.] SHOT FRACTURES OF THE BONES OF THE LEO. 565 practicable the cases of shot fractures of the bones of the leg recorded by military surgeons of other campaigns, it will be seen that the mortality rate of these cases is 18.5 per cent., or 4.7 per cent, in excess of those of the American civil war. Examining the remote effects arm at Stettin, in 1676; reoovery. Obs. XXXIIX, p. 282, H. H---, shot fracture left fibula and right tibia, Ancklam, 1678; recovery. 3CANNAC (Sur une jambe ecrasie par un obus, ou petite bombe, in Mim. de VAcad. Roy. de Chir., 1753, T. II, p. 494) cites the case of an officer wounded at the siege of Douay, in 1710; shot fracture middle third of tibia, removal of spiculse; recovery. 4 SCHML'CKER (J. L.) (Chirurgische Wahrnehmungen, Berlin und Stettin, 1774, B. II, pp. 503, et seq.) records three cases of recovery after shot fractures of the bones of the leg: Cadet von Sasse, fracture lower third of tibia, Molwitz, April 10,1741; spiculse removed; recovery, with curvature of leg—upper part of fibula movable while walking. Captain Graf le Mede, frac- ture of tibia, Leuthen, December 5, 1757; recovery, with curvature. Major von Ruitz, fracture of both legs, one in middle and the other in the lower third, Schweidnitz, May 16, 1762; splinters removed; recovery. 'Ravaton (Chirurgie d'armie ou traite des plaies d'armes d feu, Paris, 1768) records three cases: 06s. XCII, p. 369, Corp'l La Joie, Regiment Conde, fracture of middle third of left tibia and fibula, July 29, 1743; long incisions, removal of splinters; recovery. 06*. XCVI, p. 376, Grenadier A. Riant, fracture of middle third tibia, Nov. 20, 1759; recovery. 06*. CI, p. 387, F. D'Amour, shot fracture upper third left tibia, Warbourg, August 7, 1760; removal of splinters; recovery, with shortening. 6 BOUCHER (Sur des playes d'armes d feu compliquies surtout de fracas des os, in Mim. del'Acad. Roy. de Chir., Paris, 1753, T. II) records, at p. 463, the case of an English volunteer, wounded at Foutenoy, April 30, 1745; shot fractures of head of humerus and middle third of leg; amputation at shoulder joint; recovery; and at p. 474, the case of a soldier of the regiment de la Couronne, wounded at Tournay, in 1745; fracture of middle third of fibula; fatal. 7BOBDENAVE (Pricis de plusieurs observations sur les playes d'armes d feu en differentesparties, in Mim. de VAcad. Roy. de Chir., 1753, T. II, p. 528) cites a case observed by M. TUKSAN of shot fracture of upper third of tibia; the patient recovered. 8BAGIEU (Examen de plusieurs parties de la Chirurgie, Paris, 1756, p. 132): Engineer, shot fracture middle third right leg; recovery. 9MEHtE (J.) (Traiti des plaies d'armes iXfeu, Paris, an VIII, pp. 133, 143) records three cases of recov- ery following shot fractures of the bones of the leg treated conservatively: Cavalier of the regiment Saint-Jal, shot fracture of both bones of right leg, middle third, Rosbach, November 5,1757; recovered. A soldier of the regiment of Cuirassiers of Gessler, shot fracture of bones of leg; recovery. M. de Alvensleben, Ensign of the Guards, received a shot fracture of the bones of the leg at Torgau, in 1760; recovery. 10BlLGUER (J. U.) (Chirurgische Wahr- nehmungen, etc., Berlin, 1763, Abth. IV, pp. 460, et seq., Obs. 30, 31, 34, 37, 42, 44, 45,49,50, 55, 56, 58, 59, 61, 62, 65, 66, 67, 68, 72, 73, 75, 81, 84, 85, 90, 93, 96, 110): 29 cases of recoveries occurring during the Seven Years' War, 1756-63; in 4 of the cases the tibia was fractured, in 17 both tibia and fibula, and in 8 cases the location of the fracture was not indicated. '* BOURIENNE (06s. sur les grands fracas d'os A la suite des plaies d'armes &feu, in DEHORNE's Journal de Mid. Mil., Paris, 1782, T. I, p. 214): Soldier, wounded July 10, 1760; shot fracture of tibia and fibula in upper third; recovery in six weeks. ■'LAURENT (Memoire clinique sur le titanos chez les blesses, Strasbourg, an V f 1796J-, p. 61): Lefranc, Sergeant of Grenadiers, shot comminution of leg, 1791(?), tetanus 13 days after injury; recovery. 13LARREY (D. J.) (Mimoires de Chirurgie Militaire et Campagnes, Paris, 1812, T. II, p. 261): General Baudot, shot fracture of bones of leg, Aboukir, March 8, 1801; gangreue ; death. 14HUTIN (F.) (Memoire sur la nicessiti d'extraire les corps itrangers et les esquilles, dans le traitement des plaies par armes a feu, in Mem. de VAcad. Nat. de Mid., Paris, 1852, T. XVI, p. 446): 06s. 14, 15, 21, 24, 25, 28, relates six cases of recovery after shot fractures of the bones of the-leg during the years 1793 to 1813. In one case (06s. 15) fragments of bone continued to be discharged for 33 years. In one the tibia, in one the fibula, and in four both bones were fractured. *6 GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, London, 1827,3d ed., p. 398): Soldier, wounded at the battle of Rolica, Portugal, August 17,1808; both bones shattered in two places: recovery 16 Fenech (E.) (Observations recueillies a Varmee d'Espagne sur les plaies d'armes d. feu aux extrcmites, Paris, 1813, These No. 22, 06s. VII, p. 10, and 06s. XIX, p. 16): Soldier, 31st Infantry, shot fracture of right tibia, before Almeida, May 5, 1811; simple fracture of fibula; fatal. Roques, Lieutenant, 70th regiment, shot in left leg, A ngust 21,1808, in Portugal; both bones were fractured in the lower third; fatal. 17 HENNEN (J.) (Principles of Military Surgery, London, 1829, 3d ed., pp. 131, 190): French soldier, wounded in 1814; left tibia fractured, fragment extracted; recovery. Lieut-Col. H----, musket ball partially fractured fibula, Bergen-op-Zoom, March 8, 1814 ; recovered; limb completely varicosed. "ARNAL (Memoire sur quelques partie- ularitis des plaies par armes d feu, in Jour. univ. et hebd. de med. et de chir., Paris, 1831, T. HI, p. 35) records 17 cases of shot fractures of the bones of the leg treated conservatively; in 8 cases the fibula, in 2 the tibia, and in 7 both bones were fractured; no results are given. ** Jobert (DE Lamballe) (Plaies d'armes A feu, Paris, 1833, pp. 285, et seq.) cites 18 cases, with 1 fatal result; in 5 the fibula was interested, in 6 the tibia, in 5 (1 fatal) both bones, and in 2 cases the bone injured was not specified. 20MENIERE (P.) (L'Hotel-Dieu de Paris-en Juillet et Aoiit 1830, Paris, 1830, p. 312); 17 cases (7 recoveries, 10 fatal). 21 LARREY (H.) (Relation Chirurgicale des ivinemens du Juillet 1830, Paris, 1831, p. 119); 2cases; recoveries. 22BAUDENB (L.) (Clinique des plaies d'armes d feu, Paris, 1836, pp. 483, et seq.); 10 cases; 8 of the tibia (5 recoveries, 3 fatal); 2 of the fibula (recoveries). MBAGRE (06*. de Chir., recueillies a I'hSpital Turc, a Alger; in Rec. de Mem. de Mid. de Chir. et de Phar. Mil., Paris, 1831, T. XXXI, pp. 156, 157,159): Frac- ture of tibia 1 (recovery), of tibia and fibula 1 (recovery). M ALCOCK (R.) (Notes on the Med. Hist, and Stat, of the British Legion of Spain, London, 1838, p. 53); 47 cases (28 recoveries, 19 fatal). ^PORTER (J. B.) (Medical and Surgical Notes of Campaigner in the War with Mexico during the years 1845-46-47-48, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., p. 32); 1 case of fracture of tibia; recovery. MRESTELLI (A.) (Note et Osserva- zioni cliniche di chirurgia militare, in Annali Universali di Medicina, 1849, Vol. CXXX, p. 265); 8 cases; fractures of both bones in 2 (1 recovery, 1 fatal), of fibula in 4 (all recovered), of the tibia in 2 (1 recovery, 1 fatal). '"Desplaies d'armes d feu; Communications faites a VAcadimie Nationale de Medecine, Paris, 1849, par MM. MALGAIGNE, p. 45,11 cases (5 recoveries, 6 deaths); ^GOSSKLIN, ibid., p. 46, 3cases (1 undetermined, 2 fatal); ^HUGUIER, ibid., p. 131, 9 cases (7 recoveries, 2 fatal); '"Jobert (de Lamballe), ibid., p. 154,16 cases (6 recoveries, 10 fatal); slBAUDENS, ibid., p. 232, et seq., 10 cases (9 recoveries, 1 undetermined). "STROMEYER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 756), 58 cases: Fractures of both bones in 8 cases (7 recoveries, 1 fatal), of tibia in 27 cases (25 recoveries, 2 fatal), of fibula in 23 cases (20 recoveries, 3 fatal). 33 WILLIAMSON (G.) (Military Surgery, London, 1863, p. XXVI), 19 cases: Fractures of both bones in 2 cases (recoveries), of the tibia in 13 cases (12 recoveries, 1 fatal), of the fibula in 4 cases (recoveries). MMATTHEW (T. P.) (Med. and Surg. History of the British Army, etc., London, 1858, Vol. II, pp. 355, et seq.), 102 cases: Fractures of both bones in 59 cases (31 recoveries, 28 fatal), of tibia in 26 cases (20 recoveries, 6 fatal), of fibula in 17 cases (14 recoveries, 3 fatal). ^Chenu (J. C.) (Rappent Medico-Chirurgical sur la Campagne d' Orient, Paris, 1865, p. 417); 496 cases (364 recoveries, 132 fatal). ^CHENU (J. C.) (Stat. Mid.-Chir. de la Campagne d'ltalie en 1859 et 1860, Paris, 1869, T. II, p. 781), 410 cases: Fractures of tibia, 109 (101 recoveries, 8 fatal); of fibula, 64 (62 recoveries, 2 fatal); bone not specified, 237 (184 recoveries. 53 fatal). & Demme (H.) (Militar- Chirurgische Studien, WUrzburg, 1861, Zweite Abth., p. 278); 98 cases (77 recoveries, 21 fatal). ^MOUAT (The New Zealand War of 1863-64-65, in Slat. San. and Med. Reports, Vol. VII for the year 1865, London, 1867, p. 503); 3 recoveries. "Luecke (A.) (Kriegschirurgische Aphorismen aus dem zweiten Schleswig-holsteinischen Kriege im Jahre 1864, in Archiv fur Klin. Chir., Berlin, 1866, B. VII, pp. 50, et seq.); 5 recoveries: Tibia and fibula fractured in 1 case, tibia in 3, fibula in 1. 4»HEINE (C.) (Die Schussver- letzungen der unteren Extremitdten, Berlin, 1866, p. 294, et seq.); 14 recoveries: Fracture of both bones in 4, of the tibia in 5, of the fibula in 5. 41 OCHWADT (A.) (Kriegschirurgische Erfahrungen, Berlin, 1865, p. 314); 12 recoveries. 42 BINTOT ( Observations de blessures de guerre, in Rec. de Mem. de Med. de Chir. de Phar. Mil., Paris, 1866, T. XVI, III ser., p. 240); 1 fracture of fibula; recovery. 43BECK (B.) (Kriegschirurgische Erfahrungen wahrend des Feldzuges 1866, Freiburg I. Br. 1867, pp. 308, et seq.); 4 cases: Fracture of both bones 1 recovery, of tibia 2 recoveries, 1 fatal. 44BlEFEL (R.) (Im Reserve-Lazareth, in Archiv fiir Klin. Chir., Berlin, 1869, pp. 461, et seq.); 25 cases: Fractures of both bones in 11 (8 recoveries, 3 fatal), of tibia in 14 (13 recoveries, 1 fatal). ^FISCHER (K.) (Militairdrztliche Skizzen aus Suddeutschland und Bbhmen, Aarau, 1867, p. 96); 170 cases (122 recoveries, 14 fatal, 34 unknown results). «Maas (H.) (Kriegschirurgische Beitrage aus dem Jahre 1866, Breslau, 1870, pp. 54, et seq.); 23 cases: Frac- tures not specified, 14 cases (11 recoveries, 3 fatal); of tibia, 4 recoveries; of fibula, 5 cases (4 recoveries, 1 fatal). 47STROMEYER (L.) (Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 59); 74 cases (60 recoveries, 14 fatal). 480TIS (G. A.) (Circular No. 3, War Department, S. G. O., 1871, pp. 80-82); 7 recoveries: Fractures of tibia and fibula, 1 case; of tibia, 5 cases; of fibula, 1 case. 4*>Beck (B.) (Chirurgie der Schussverletzungen, Freiburg, i. Br. 1872, p. 717); 102 cases (85 recoveries, 17 deaths). Billroth (T.) (Chirurgische Briefe aus den Kriegs-Lazarethen in Weissenburg und Mannheim 1870, Berlin, 1872. pp. 234, et seq.); 12 cases: Fractures of both bones in 8 cases (7 recoveries, 1 fatal), of the tibia in 4 cases (3 recoveries, 1 566 INJURIES OF THE LOWER EXTREMITIES. H • 11A I'. \ of the cases treated conservatively, it must be admitted, with Guthrie,1 that the results ought to have been more successful. The reports of the Pension Examiners regarding the conditions of the preserved limb, even at the present time (1881), are replete with accounts of extensive caries and necrosis with continued discharge, enlargement of the limb, irritable ulcers, overlapping with projection of fractured ends, outward or inward curvature, anchy- losis of the knee or ankle or of both, contraction of the toes, outward turning of the foot' giving the ankle the appearance of being dislocated, extensive and adherent cicatrices, atrophy and weakness, and inability to sustain the weight of the body.2 Pseudarthrosis was noted only in seven of the three thousand two hundred and ninety-six survivors of shot fractures of the bones of the leg treated without operative interference. The difficulties in prescribing rules for the proper mode of treating shot fractures of the bones of the leg seem to have been recognized by writers on military surgery, some advocating immediate operation with many restrictions in favor of conservative treatment; others inclining to conservatism, but citing many exceptions in which they consider imme- fatal). CZERNY (V.) (Bericht uber die im College Stanislaus in Weissenburg behandelten Verwundeten, in Wiener Med. Wochenschrift, 1870, p. 1357); 3 cases: Fractures of both bones, 1 recovery ; of tibia, 1 recovery; 1 result unknown. Fischer (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Chirurgie, Leipzig, 1872, B. I, p. 250); 61 cases: Fractures of both bones in 42 cases (28 recoveries, 14 deaths), of tibia in 10 cases (9 recoveries, 1 death), of fibula in 2 cases (recoveries); in 7 cases with unknown results the bone fractured was not specified. FISCHER (H.) (Kriegschirur- gische Erfahrungen, Erlangen, 1872, p. 198); 33 cases (28 recoveries, 5 fatal). GOLTDAMMER (Bericht iiber die Thdtigkeit des Reserve-Lazaretts des Berliner Hilfsvereins in der Garde-Ulanen-Kaserne zu Moabit, in Berliner Klin. Wochenschrift, 1871, VIII Jahrg., p. 151); 14 cases (recoveries). Graf (E.) (Die Koniglichen Reserve-Lazarethe zu Diisseldorf wahrend des Krieges 1870-71, Elberfeld, 1872, p. 71); 20 cases (15 recoveries, 5 fatal). GUTE- KUNST (Bericht iiber die wdhrend des vorigen Jahrs in den Vereinsspital Ludwigsburg (Kinderheilanstalt) avfgenommenen Schussverletzungen und ihre Behandlung, in Zeitschrift fiir Wundarzte und Geburtshelfer, Stuttgart, 1871, p. 145); I fracture of tibia; recovery. Kirchner (C) (Aerztlicher Bericht iiber das Koniglich Preussische Feld-Lazareth, u. s. w., Erlangen, 1872, pp. 67, 68); 82 cases (74 recoveries, 8 fatal). KOCH (W.) (Notizen i'ber Schussverletzungen, nach eigenen im Feldzuge 1870-71 gemachten Erfahrungen, in Archiv fiir Klin. Chir., Berlin, 1872, p. 526); 20 cases (19 recoveries, 1 fatal). KUECHLER (H.) (Analecten aus der Kriegsgeschichte, in Memorabilien, Heilbronn, 1871, Jahrg. XVI, p. 164); 1 fracture of tibia; recovery. Lossen (H.) (Kriegschirurgische Erfahrungen aus den Barackenlazarethen iu Mannheim. Heidelberg und Karlsruhe 1870 und 1871, in Deutsche Zeit- schrift fur Chirurgie, Leipzig, 1873, B. II, pp. 138, et seq.); 14 cases (recoveries): 6 fractures of fibula, 8 bone not specified. Mayer (L.) (Kriegschi- rurgische Mittheilungen aus den Jahren 1870-71, in Deutsche Zeitschrift fiir Chirurgie, Leipzig, 1873, B. Ill, pp. 50, 52); 9 cases: Fractures of both bones in 5 cases (recoveries), of the tibia in 2 cases (1 recovery, 1 fatal), of the fibula in 2 cases (1 recovery, 1 fatal). MOSETIG (Erinnerungen aus dem deutsch-franzosischen Kriege, in Der Militaerarzt, with Wiener Med. Wochenschrift, 1872, pp. 11, 22); 8 cases (7 recoveries, 1 fatal). Ott (E.), Oesterlen und ROMBERG (Kriegschirurgische Mittheilungen aus dem Ludwigsburger Reserve-Spital, Stuttgart, 1871, pp. 45, 47); 10 cases (9 recov- eries, 1 fatal). RUPPRECHT (L.) (Militararztliche Erfahrungen, u. s. w., WUrzburg, 1871, p. 10); 13 cases: Fractures of both bones in 9 cases (6 recov- eries, 3 fatal), of tibia in 2 (1 recovery, 1 fatal), of fibula in 2 (1 recovery, 1 fatal/. Salzmann (Mittheilungen aus dem Vereinsspital in Esslingen, in Med. Correspondenz-Blatt des Wurttembergischen arztlichen Vereins, 1871, B. XLI, p. 161); 6 recoveries: Fractures of both bones in 3 cases, of tibia in 1, of fibula in 2. SCHINZ1XGER (A.) (Das Reserve-Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, i, Br., 1873, pp. 81, et seq.); 46 cases (41 recoveries, 5 fatal). SchOller (M.) (Kriegschirurgische Skizzen aus dem deutsch-franzosischen Kriege 1870-71, p. 16); 1 recovery. Seeger (W.) (Die Leistungen der Wreinsspitdler Kleinkinderschule und Diakonenhaus in Ludwigsburg im Jahr 1870-71, in Zeit.fiir Wundarzte und Geburtshelfer, Stutt- gart, 1870, B. XXIV, pp. 113, et seq.); 3 cases: Fracture of both bones (1 recovery), of tibia (1 recovery, 1 fatal). SOCIN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, pp. 140, et seq.); 33 cases: Fractures of both bones in 9 (recoveries), of tibia in 14 (11 recoveries, 3 fatal), of fibula in 10 (8 recoveries, 2 fatal). Steinberg (Die Kriegslazarethe und Baracken von Berlin, Berlin, 1872, p. 147); 520 cases: Fractures of both bones in 164 (128 recoveries, 16 fatal, 20 unknown results), of tibia in 307 (255 recoveries, 18 fetal, 34 unknown results), of fibula in 49 (41 recoveries, 2 fetal, 6 unde- termined results). STOLL 'Bericht aus dem Koniglich Wurttembergischen 4 Feldspital von 1870-71, in Deutsche Militairarztliche Zeitschrift, 1874, 3. Jahrg. p. 208); 13 cases (9 recoveries, 4 fatal). STUMPF (L.) (Bericht uber das Kriegs-Spital des St. Georg-Ritter-Ordens zu Neuberghausen im Jahre 1870-71, in Aerztliches Intelligenz-Blatt, Munchen, 1872, No. 50, p. 657); 5 cases (4 recoveries, 1 fatal). 60CHIPAULT (A.) (Fractures par armes a feu, Paris, 1872, pp. 7, et seq.); 17 cases: Fractures of both bones in 5 cases (3 recoveries, 2 fetal), of tibia in 5 cases (recoveries), of fibula in 5 cases (4 recov- eries. I fatal), bone not specified in 2 cases (recoveries). Christian (J.) (Relation sur les plaies de guerre observies d. Vambulance de Bischwiller, 1870-71, in Gaz. Med. de Strasbourg, 1872, No. 24, p. 281); 39 cases (33 recoveries, 6 fatal). COUSIN (A.) (Histoire chirurgicale de Vambulance de Vecole desponts et chaussies, in L'Union Medicate, 1872, T. XIII, p. 114); 11 cases (3 recoveries, 8 fatal). DESPRES (A.) (Rapport sur les travaux delaT ambulance a Varmie du Rhin, etc., Paris, 1871, pp. 46, et seq.); 46 cases (£8 recoveries, 17 fetal, 1 unknown result). FELTZ ET GROLLEMUND (Relation clinique sur les ambulances de Haguenau, in Gaz. Med. de Strasbourg, 1871, p. 202); 5 cases: Fractures of both bones in 2 (recoveries), of tibia in 3 (1 recovery, 1 fatal, 1 result unknown). Heyfelder (O.) (Bericht iiber meine Wirksamkeit am Rhein und in Frankreich wahrend des deutschfranzosisclien Krieges, in St. Petersburger Medicinische Zeitschrift, 1871, B. II, N. S., p. 59); 1 fracture of tibia; recovery. JOESSEL (Ambulances de Haguenau, in Gaz. Mid. de Strasbourg, 1871, No. 2, p. 21); 10 cases (9 recoveries, 1 fatal). MacCormac (W.) (Notes and Recollections of an Ambulance Surgeon, London, 1871, p. 118): 43 cases (29 recoveries, 14 fatal). Panas (F.) (Memoire sur le traitcment des blessures de guerre par la mithode antiphlogistique, in Gaz. Hebd. de Mid. et de Cliir., 1872, T. IX, p. 390); 3 cases (1 recovery, 2 fatal). PONCET (F.) (Contribution a la Relation medicate de la guerre de 1870-71, in Montpellier Medical, 1872, T. XXVIII, p. 41); 3 cases (1 recovery, 2 fatal). Vaslin (L.) iStude sur Us plaies par armes d feu, Paris, 1872, pp. 136, etseq.); 8 cases: Fractures of both bones in 1 (recovery), of tibia in 5 (2 recoveries, 3 fetal), of fibula in 2 (fatal). elTILING (G.) (Bericht iiber 124 im Serbischti.rkischen Kriege im Baracken-Lazareth des Dorpater Sanitats-Trains zu Swilainatz behandelte Schussverletzungen, Dorpat, 1877, pp. 63, et seq.); 12 cases (9 recoveries, 3 fatal). / 1G utiiiue (G. J.) (Commentaries on the Surgery of the War, etc., London, 1855, p. 647): " The treatment of gun-shot fractures of the leg ought to have been more successful than it has been, even when both bones were broken ; the want of success may be in part attributed to the remissness which has taken place in supplying the necessary, nay, the essential appliances, by means of which much suffering might have been alleviated, perhaps pre- vented, even if cures could not have been effected." ""BERTHOLD (Statistik der durch den Feldzug 1870-71, invalide gewordenen Mannschaften des 10 Armee-Corps, in Deutsche Militairarztliche Zeitschrift, 1872, Jahrg. 1, p. 505) notices the frequency of anchylosis of the knee or ankle joints in fractures of the upper and lower thirds of the tibia, and ou page 569 remaiks, of the cures of fractures in both boDes, that "the results were, in general, very unfavorable, and a higher average of disability shows itself than in fractures of the lemur.'' SECT, v.] SHOT FRACTURES OF THE BONES OF THE LEG. 567 diate amputation indispensable. Thomson, after the battle of Waterloo in 1815, gives four classes1 of injuries of the leg in which he considers amputation proper; but adds that "it may be doubted whether the practice of immediate amputation would be proper or neces- sary in all these cases, could the wounded be conveyed directly into convenient hospitals." Jobert de Lamballe declares conservative treatment and excision alike ineffective in oblique fractures of both bones of the leg in the lower third.2 Beck, after the European revolutions in 1848,3 and Schwartz after the Schleswig-Holstein War, 1848-50,4 advised conservative measures in transverse or slightly oblique fractures of the tibia only, but counselled the removal of the limb in fractures of both bones; but after his experience in the Franco- German War, 1870-71, Generalarzt Beck greatly restricted the number of cases in which he considered amputation justifiable.5 The conservative views of Guthrie regarding shot fractures of the leg have already been adverted to on page 460, ante. Demme6 asserts that Guthrie has "too far extended the limits of conservative treatment." Stromeyer,7 Se'dillot,8 Legouest,9 and Hamilton10 agree that in extensive comminution of the tibia, or of both bones of the leg, especially near the knee or ankle joints, it is prudent to amputate. Gross" declares that in shot fractures of both bones, "unless the patient is peculiarly fortu- 1 THOMSON (J.) (Report of Observations in the British Military Hospitals in Belgium, after the Battle of Waterloo, Edinburgh, 1816, p. 240): "1st, In cases in which both bones of the leg have been broken ; 2d, in cases in which the bullets have passed through the ends of the tibia and have fractured this bone near to the knee or ankle joints; 3d, in cases in which n bullet is lodged deep in the tibia; and 4thly, in fractures of the tibia, with wounds of the arteries in the leg." 2 JOBERT (DE Lamballe) (Plaies d'armes a feu, Paris, 1833, p. 288): " Toutes les fois qu'une fracture oblique a eu lieu, vers la rfigion inferieure du membre, Chez un hsmme dont les forces musculaires sont, puissantes, malgre* l'appareil le plus convenable, malgre la deini-flexion, malgre la resection des deux extremites de l'os, pratiqufee dans le but de ne pas laisser les parties molles irritees par leurs aspe>ites, toujours, ou presque toujours, la mort est survenue apres une s6rie de symptomes formidafeles, d'inflammation, de suppuration, d'6rysipele et de gangrene, et dans quelques chances que l'on a appelees heureuses, les maladcs ne se sont sauv6s qu 'aprgs avoir 6t6 cent fois au bord de la tomhe, et en conservant un membre deLorme." 3BECK (B.) (Die Schusswunden, Heidelberg, 1850, p. 263): "Is the tibia fractured, and is there only a transverse or slightly oblique fracture, the injury is to be treated as a simple one; but when there is great splintering, or when the fracture is considerable, or the bone injured in several parts, or when the soft parts are much implicated, amputation must be performed; when both bones are fractured the wound generally is a serious one, the frac- ture is more comminuted, and the limb must be removed; simple fractures only give promise of complete recovery of the extremity." 4 SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, p. 184): "Extensive comminuted fractures in the upper or lower thirds of the tibia always require primary amputation. . . Is the fracture in the middle third, as a rule primary amputation is also to be performed: very favorable circumstances only, as good constitution of the patient, easy transportation, excellent hospital accommodations, large and free wounds of the soft parts, defined limits of comminution, etc., can justify the attempt at conservation;" and on p. 186: "Fractures of both bones, with extensive comminution of both bones or of the tibia alone, require primary amputation. . . Isolated cases of this class, it is true, have been treated; yet such attempts will only succeed in a few instances, and will, in the majority of cases, result in death, and even in cases of recovery, imperfectly useful limbs will be obtained." 'BECK (B.) (Chirurgie der Schussverletzungen, Freiburg i. Br., 1872, p. 718): "Since the location of the bones, particularly the tibia, is a very superficial one, since all changes can easily be recognized and operated for, since phlegmon and abscesses are accessible to observation and to the knife from the first moment, and since no particular obstacles are to be met with in the extraction of splinters and dead pieces of bone,—there is a large and fruitful field opened to the expectant conservative treatment of shot fractures of this limb." 6DEMME (H.) (Militiir-Chirurgische Studien, Wiirzburg, 1861, Abth. II, p. 275): "Guthrie has too far extended the limits of conservative treatment. The experiences of the last wars have only too frequently led to the conviction that by sacrificing the limb at the proper time, life may be saved. Here also holds good the general rule according to which especially the comminutions and the extensive lacerations of the soft parts indicate primary amputation. The laceration of the principal blood vessels of the leg come next." 'STROMEYER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 287): "8. Tibia and fibula are fractured by a ball, with extensive splinter- ing. Under favorable circumstances the leg may here be preserved. For example, if only one of the bones was struck by the ball and the other was broken by the weight of the body in falling, or when the fissuring is limited. 9. The tibia alone is splintered to a large extent. Here also the preserva- tion of the leg is possible, but not probable;" and at p. 742: " Shot injuries of the fibula alone, however extensive, never indicate amputation, providing the tibio-tarsal joint is not implicated. . . Extensive comminutions of the tibia alone, and of the iibia and fibula together, do not per se necessitate amputation, as they do not destroy the vitality of the limb. Experience, however, teaches that in the attempt to save the limb, very readily the life of the patient is lost, especially through pyaemia, and that in cases in which the limb was preserved it was of less use than a wooden leg." "SEDILLOT (Du traitcment des fractures des membres par armes de guerre, in Archiv Gen. de Mid., Paris, 1871, T. XVII, VI" ser., p. 451): "L'am- putation immediate parait, indiquee lorsque les deux os sont brises prfis du genou en fragments volumineaux, avec ou sans complication d'hfimorrhagie et de paral3rsie, circonstances qui ajoutent encore a la n6cessit6 de l'operation. . . Les fraotuies completes des deux os de la jambe au tiers moyen et au tiers inferieur guerissent sans doute, mais se consolident difficilement et apres beaueonp d'accidents. II semble done prudent quand les 6clats osseux sont considerables, les pertes de substance Vendues, les parties molles violemment dechirees e contuses, de se decider a l'amputation, soit au tiers sup6- rieur soit jusque dans les condyles du tibia, operation moins sure, pensons-nous, qu'au lieu d'Oection, mais infiniment preferable au sacrifice de la cuisse." 'LEGOUEST (L.) (Traite de Chirurgie d'Armie, Paris, 1872, 2d ed., p. 531): " Les amputations sont tres-souvent indiquees dans les blessures de la jambe: elles sont indispensables lorsque les deux os de la jambe sont fractures dans une giande Gtendue ; larsque le tibia seul est fracturS aveo 6clats volumineux ex perte de substance osseuse considerable." 10HAMt.TON (F. H.) (A Practical Treatise on Fractures and Dislocations, Philadelphia, 5th ed., 1875, p. 512): "Gunshot fractures of the shafts of both tibia and fibula demand amputation where the comminution is extensive, or the pulsation of the posterior tibial artery is lost, or the foot is cold and insensible. We do not mean to say that some limbs thus situated have not been saved, but only that the attempt to save such limbs greatly endaugers the life of the patient, while amputation at or below the knee is relatively safe." "GROSS (S. D.) (A System of Surgery, Philadelphia, 1872, Sth ed., Vol. II, p. 1012): "Gunshot fractures of both bones of the leg are also, gen erally speaking, bad accidents; great swelling, followed by diffuse abscess, usually rapidly sets in, and unless the patient is peculiarly fortunate, he will 568 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FlG. 326.—Petit's fracture box. lAfter Petit, nate he will be very apt to sink under the effects of erysipelas, pysemia, osteomyelitis, or hectic irritation;" while Heine1 and Ochwadt2 contend that by proper conservative treat- ment happy results may be achieved in many of these cases. In conservative treatment of cases of shot fracture of one or of both bones of the leg all loose spicules were removed, the fractured ends coaptated, and the leg placed in an easy position or secured in a fracture box or in splints. Among the latter, many of the appli- ances referred to on pp. 343-349, ante, as used in fractures of the femur, were also employed in fractures of the leg; but Smith's anterior splint and Hodgen's cradle splint seem to have been largely preferred to all others. Of the fracture boxes, that of Petit3 (Fig. 326), so highly recommended by the practical Heis- ter,4 and later by Stromeyer5 and Esmarch,6 was extensively Used. In the register of the Nineteenth Army Corps Depot Field Hospital at Winchester, under the charge of Surgeon L. P. Wagner, 114th New York Volunteers, is found a drawing of a fracture box used at that hospital, a copy of which is shown in the annexed wood-cut (Fig. 327). The bot- tom of the box was filled with earth, and the heel was kept somewhat raised by strips of adhesive plaster [a a) fastened around the foot and over the foot board, as indicated in the drawing. Extension and counter-exten- sion were rarely applied. Generally shot frac- tures of the tibia or of both bones healed very slowly. Of the nineteen examples cited on pp. 433 to 444, the wounds did not close in two until fifteen, and in one until twelve, years after the injury. In a fourth case (Case 690, p. 439, ante) a large sequestrum was removed eight months after the injury; the wound closed but broke out again, and the discharge of pus continued for eleven years, and when the wound finally closed the patient's health declined rapidly and he died in about six months. It should be added that in two of these four cases (Cases 680 of Colonel W. F. Lynch and 692 of Major A. J. Bolar) the missile or a portion thereof had never been removed from the leg. The remaining fifteen patients recovered—one in one month, three in three months, one in five months, one in six, one in eight, two in ten, three in twelve, one in eighteen, and two in twenty-four months, Or at an average, in about ten months.7 be very apt to sink under the effects of erysipelas, pyaemia, osteomyelitis, or hectic irritation, not to say anything of the danger of mortification, which is often very great, especially when the bones arc comminuted at the same time that severe injury has been sustained by the soft parts. Gunshot fracture of the fibula alone is usually much less serious than similar injury of the tibia." ■HEINE (C), Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 300. "*OCHWADT (A.), Kriegschirurgische Erfahrungen, Berlin, 1865, p. 312. » PETIT (JEAN LOUIS), Traite des maladies des os, Paris, 1736, T. II, p. 279. The box is figured on p. 285. 4 HEISTEH (D. L.) Institutiones Chirurgicre in quibus quicquid ad rem chirurgicam pertinet, etc., Amstelaedami, 1739, T. I, p. 215, and Table IX. fc STROMEYER (L.) Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 50. •ESMARCH (FRIEDHICH), Handbuch der Kriegschirurgischen Technik, Hannover, 1877, p. 88. *" Surgeon-Major GAUJOT, in his report from the hospitals at Montechiaro (J.-C. CHENU, Stat. Mid.-Chir. de la Camp, d'ltalie en 1859 et 1860, Paris, 1869, T. II, p. 778), states that according to his experience comminuted fractures of the leg heal slower than those of the thigh: " II est a remarquer que, lors de notre depart, les fractures de la jambe etaient beaucoup moins avancees vers la guerison que celles de la cuisse. Dans aucun cas 'il n'y avait encore trace de formation du cal, mais, au contraire, une suppuration abondante, des fus6es purulentes provoquees par des esquilles nombreuses, s' elimi- uant difiBcilement. Nous n'osons avancer que les d6sordres occasionnes dans les cas de fracture comminiitive de la jambe par coup de feu, sont plus Fir.. 327.—Fracture box used at the field hospital at Winchester. [From a pen-sketch.] sect, v.1 EXCISIONS IN THE BONES OF TttE LEG. 569 Of the three thousand nine hundred and thirty-eight (3938) patients with fracture of the bones of the leg treated without operative interference, three thousand four hundred and eighty-four (3484) were Union and four hundred and fifty-four (454) Confederate soldiers. Of the former, two thousand nine hundred and fifty-six (2956) recovered, four hundred and forty-six (446) died, and eighty-two (82) results were not ascertained, a fatality of 13.1 per cent. Of the latter, three hundred and forty (340) recovered, eighty-two (82) died, and in thirty-two (32) cases the results remained undetermined, a mortality rate of 19.4 per cent. One thousand five hundred and fifty-five (1555) injuries, with one thousand three hundred and thirty-five (1335) recoveries, one hundred and eighty-nine (189) deaths, and thirty-one (31) undetermined results, were on the right side; one thousand seven hundred and seventy- two (1772), with one thousand five hundred and twenty-nine (1529) recoveries, two hun- dred and nineteen (219) deaths, and twenty-four (24) unknown results, on the left side; in six hundred and eleven (611) cases the side was not indicated. Detached splinters and fragments of bone are reported to have been removed in three hundred and forty-seven instances with two hundred and ninety-nine recoveries, forty-two deaths, and six undetermined results. Of the grave complications, pyaemia was noted in eighty-one cases, seventy-five of which terminated fatally; two cases of recovery from tetanus, and twenty-two fatal cases are reported. Of seventy cases of gangrene, thirty had fatal results. There were sixty-five cases of secondary hsemorrhage; twenty-four of the patients recovered, the hasmorrhage having been controlled in twelve instances by compres- sion and styptics, and in twelve instances by ligation; forty-one of the patients died, twenty-seven after treatment by compression, and fourteen after ligation. The femoral artery was ligated in five cases with three deaths, the posterior tibial in nine with four deaths, the anterior tibial in six with three deaths, the popliteal in five with three deaths, and the anterior and posterior tibials in one instance, which terminated fatally. In nine cases the bleeding vessels were secured in the wound, and in thirteen at a distance from the injury. Four of the former and nine of xne latter ended in death. Excisions in the Continuity of the Bones of the Leg.—An examination of the reported examples of excision in the bones of the leg, whether in the tibia or in the fibula, or in both bones, shows conclusively that in a large proportion of the cases the operation was inju- dicious. Not only does the percentage of fatality after excision exceed that of the cases treated by conservation, but the remote results in the cases of recovery in the former were even less satisfactory in regard to usefulness of the limb than those in the latter. The fatality of the conservatively treated fractures of the tibia was 10.3, of the fibula 9.7, and of both bones 20.2 per cent., while that of the corresponding excisions was 25.6, 27.2, and 61.1 per cent., respectively. Excisions in both bones were rarely performed, only eighteen cases of this nature being reported, and the large mortality (61.1 per cent.) following this operation would seem to justify its banishment from military surgery.1 The excisions per- difficiles a conjurer que ceux que pr6sentent les fractures de la cuisse, et cependant cette remarque ressort des faits observes par nous. Le tibia est souvent fendu en eclats dans une grande partie de sa longueur; ses esquilles se detachent lentement; son tissu spongieux et le canal medullaire suppurent ais6ment et la reparation est extremement lente." BILLROTH (TH.) (Chirurgische Briefe aus den Kriegs-Lazarelhen in Weissenburg und Mannheim 1870, Berlin, 1872, p. 272) notes the tedious process of separation of sequestra in shot fractures of the leg. HANNOVER (A.) (Die Ddnischen Invaliden aus dem Kriege 1864, Berlin, 1870, p. 27) observes that "the separation of necrosed bone frequently was of long duration with persistent fistulae." 1 STROMEYER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 743) remarks of the fractures of the bones of the leg that "the hopes built upon excision in the continuity were found delusive, as well in regard to preservation of life as in regard to usefulness of the limbs preserved by excision." Demme (H.) (Militdr-Chirurgische Studien, WUrzburg, 1861, B. II, p. 276): "Resection of the diaphysis of both bones of the leg was performed several times in Italy. I have to mention four cases of this kind in the hospitals of Brescia, which all proved fatal from continued suppuration and pyaemia. The subperiosteal method was here also tried by Larghi, but, for the reasons already stated, had no better results. I believe, therefore, that I must join Stromeyee and the majority of the military surgeons in condemning the operation." PlTHA (F. R. VON) (Krankheiten der Extremitdten, Erlangen, 1868): "For resection the leg offers an unfavorable field; the operation is, therefore, seldom and with great reserve performed." BECK (B.) (Chirurgie Surg. Ill—72 570 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. formed in the tibia exceeded those in the fibula, the former being one hundred and eighty- five, the latter one hundred and eighty-two, with the percentage of fatality slightly in favor of the excisions in the tibia. The results of this operation in European war surgery as exhibited in the following table have been still less satisfactory; of one hundred and fifty- two cases, one hundred and six, or 69.7 per cent., had fatal terminations: Table LXXXV. Results of Shot Fractures of the Bones of the Leg treated by Excision on the Occasions named and from the Authorities quoted. OCCASIONS. Cases. TIBIA. FIBULA. Tibia and Fibula. Bone not Specified. 3 o EH .2 o o es 3 Q o ui 3° 1 CO "3 fi o o o ~ "3 » Q « > o o "3 « Q .2 V > o o « 5 "3 V fi 1 6 1 2 4 3 3 1 8 17 1 1 7 100.0 53.8 ...... 1 2 13 3 4 o 1 1 1 1 1 Campagnes de Kabylie, 1854 (BERTHERAND4)...................! 1 Crimean War, 1854-56 (Matthew,8 CHENU6).................. 2 Italian War, 1859-60 (Demme,** CHENU8)...................... 1 fi 1 12 75.0 1 1 1 4 1 2 7 Danish War, 1864 (Langenbeck,9 LCcke,10 Heine")......... . 3 4 2 11 97 2 o 3 1 o 13 Austro-Prussian War, 1866 (Beck,12 Fischer,13 Biefel14)....... United States Army, 1865-70 (Otis'5).......................... 1 1 3 80 1 25.0 50.0 27.2 82.4 50.0 1 17 Franco-German War, 1870-7i (Germans16)..................... Franco-German War, 1870-71 (FRENCH17)..................... Turko-Russian War, 1876 (TILING,18 Kade19)................... 3 63 1 4 4 1 1 1 1 152 46 106 69.7 » 71 14 20 4 8 3 7 der Schussverletzungen, Freiburg, i. Br., 1872, p. 721): " To saw through the diaphysis in its entire thickness before the necrosed portion has yet demar- cated and separated itself completely, I cannot approve of, because, on the one hand, too much is often taken away unnecessarily, thereby giving occasion to too great a loss of substance, to a colossal defect iu the bone, and, in consequence thereof, to pseudarthrosis; and, on the other hand, infectious processes with fatal results are readily caused by again laying open the bony cavity. One may, therefore, quietly wait until sequestrotomy can be performed under more favorable circumstances." Excision for shot fracture in the continuity of the bones of the leg, in military surgery, does not seem to have been practised before 1848. In tkat year * li. BECK (Die Schuss-Wunden. Heidelberg, 1850, p. 338) excised portions of both tibiae and a portion of the fibula in an Austrian soldier of the Kaiser Franz Josef Regiment, wounded in 1848, near Vienna, by a grape shot: Tbe missile entered the right and passed through the left leg, fracturing both tibiae just below the knee. Amputation of both thighs was advised but not allowed by the patient. A few days later the fractured ends of both tibiae were excised, and spliuts applied; extensive infiltration, fever, and diarrhoea followed, and the patient died on the 7th day after the injury. s F. Esmarch (Ueber Resectionen nach Schusswunden, Kiel, 1851, p. 28) and 3 L. Stromeyer (Maximen der Kriegsheilkunst, Hannover, 1855, p. 756) tabulate 13 cases of excision in the shafts of the bones of Ihe leg, with 6 recoveries and 7 deaths. Portions of the tibia were excised in 7 (3 recoveries, 4 fatal), of the fibula in 3 (2 recoveries, 1 fatal), and of both bones in 3 (1 recovery, 2 fatal). Detailed accounts of several of these cases are found in ROSS (G.) (Militairarztliches aus dem crsten Schlesswigschen Feldzuge im Sommer 1848, Altona, 1850, pp. 30, 53, 60, 61, and 62): Prussian volunteer J----, fracture of head of right fibula with grazing of tibia, Bilschau, April 24, 1848; resection of upper end of fibula by ROSS; pj'aemia, death. Prussian Captain v, K----, DUppel, June 5,1848; ball penetrated the upper third of right tibia; excision of a triangular piece of bone by ROSS; death June 19,1848, of py»mia. J. H. K----, Oldenburg Infantry, wounded May 28, 1848; comminution of left fibula; excision of 3 inches by KUHN, June 11; recovery. H. G----, 31st Prussian Infantry, DUppel, June 5, 1848; fracture of right fibula; June 6, excision of 6 inches by LANGENBECK; June 25, ligation of the crural artery; recovery; n» formation of new bone; limb useless. Captain J. C----, Hochtrup, June 7, 1848; comminution of right tibia; June 8, excision of several inches of tibia by Langenbeck; June 22, ligation of femoral; June 24, amputation of leg; death June 24, 1848. Lieutenant H----, Schlesswig- Holsteinischen Dragoons, fracture of both bones of leg June 12, 1848; excision of over 3 inches of both bones by Langenbeck, June 14: death from tetanus June 22, 1848. In another instance a considerable portion of the upper third of the tibia was excised: recovery with flexed knee; leg useless. ♦BERTHERAND (A.) (Campagnes de Kabylie, Paris, 1862, p. 109): C----, llth Infantry; comminuted fracture of right fibula; excision of sharp points of fibula; recovery in less than 6 weeks. 5Matthew (T. P.) (Med. and Surg. Hist, of the British Army, etc., in the years 1854-55-56, London, 1858, Vol. II, p. 368) tabulates a successful case of excision of lower end of fibula, but gives no details. 6ClIENU (J. C.) (Rapport, etc., de la Campagne dOrient, Paris, 1865, p. 505): Th. Duval, 86th line; shot fracture of left leg August 16, 1855; resection of tibia; recovery with flexion of leg upon the thigh. 'DEMME (H.) (Mil.-Chir. Studien, WUrzburg, 1861, B. II, p. 278) tabulates 7 (2 successful and 5 fatal) cases: in 4 of the fatal cases both bones were excised. 8CHENU (J.-C.) (Stat. Med.-Chir. de la Camp, d'ltalie en 1859 et 1860, Paris, 1869, T. II, p. 8:20), 8 cases (1 recovery and 7 fatal). On pp. 819, 820, he gives details of two of the cases: P. Godin, 76th line, aged 24, received at Solferino, June 24, 1859, a shot fracture of the left fibula in its upper third. He was taken to the hospital at St. Mandrier, where, on October 14, Dr. BUISSON excised the upper third of the fibula; osteomyelitis supervened and death ensued October If. J. Camboulives, 74th line, shot fracture of lower third of left )eg, Montebello, May 20, 1859; resection of 5 centimetres of the fibula; anchylosis of the tibio-tarsal articulation, with rigidity of the toes. CHENU further relates (loc. cit., p. 819) that a resection of both bones of the leg was successfully performed at Brescia on a Garibaldian volunteer by A. BERTANI, chief surgeon of Garibaldi's corps. 9LaNGENHECK (15. v.) (Ueber Resection des Fussgelenks be Schussfracturen desselben, in Berliner Klin. Wochenschrift, 1865, Jahrgang II, p. 31): Corporal Reiss, 60th Infantry, shot fracture of middle third of left tibia and fibula, April 18, 1864; extensive infiltration; subperiosteal excision of 4 inches of tibia and 1 inch of fibula by LANGENBECK. Recovery with 1| inches shortening. The deficiency of bone has been supplied by a voluminous new formation of bone exceeding in thickness the normal size of the tibia. '"LUCKE (A.) (Kriegschirurgische Aphorismen aus dem zweiten Schlesswig-holsteinschen Kriege im Jahre 1864, in Archiv fiir Kkn. Chir., Berlin, 1866, B. VII, p. 126): Heerde, 25th Infantry, shot oomminution of right tibia and fracture of fibula, IJ inchei SECT. V. | EXCISIONS IN THE BONER OF THE LEG. 571 The amount of bone excised varied from one-half inch to twelve inches,1 and in one instance the entire fibula, with the exception of about one inch of the external malleolus, was removed (Case 720, page 457, ante). Forty-nine, or 12.6 per cent., of the three hundred and eighty-seven excisions in the bones of the leg were subsequently followed by ablation of the limb, viz: twenty-one by amputation in the leg, five by exarticulation at the knee joint, and twenty-three by amputation in the thigh. Considering the useful- ness of the limb, especially after excision in the tibia or in both bones of the leg, the results must be regarded as unsatisfactory. In the case of Private J. Hogan, 127th Pennsylvania above ankle joint, in April, 1864. A fenestrated gypsum bandage was applied. Excision of 2 inches of the tibia a month after the injury by Dr. LUCKE; recovery. In November, 1864, the patient walked well, extensive new formation of bone, exceeding in thickness the normal tibia. "' Hkine (C ) (Die Schussverletzungen der unteren Extremitiiten, Berlin, 1866, p. 311): A Prussian officer, Lieut. R----, shot wound of right leg, April 18, 1864, fracturing tibia and fibula in tho middle third, and extensively lacernting the soft parts; free incisions and application of gypsum bandage. June 8, excision of 1 inch of tibia by Dr. Langenbeck ; recovery, with i inch shortening; according to the latest account no union of bone had taken place. I2BECK (B.) (Kriegs- chirurgische Erfahrungen wahrend des Feldzuges 18(56, Freiburg, i. Br., p. 343) twice successfully excised portions of the tibia, retaining as much as possible of the periosteum. Both patients recovered in a short time, and the deficiency in the bone was supplied by nature in a few weeks. '''FISCHER. (K.) (Militairarztliche Skizzen aus Suddeutschland und Bohmen, Aarau, 1867, p. 98) states that he saw an excision of the diaphysis of the tibia per- formed by TEXTOB for shcvt fracture just above the ankle joint, four days after the injury. The lower extremity of the tibia was saved; the patient did well. 14BIEFEL (R.) (Im Reserve-Lazareth. Kriegschirurgische Aphorismen von 1866, in Archiv fiir Klin. Chir., Berlin, 1869, B. XI, p. 468): Joh. Drost, shot comminution of tibia and fibula of right leg, June 27, 1866, by canister shot; enormous infiltration ; excision of about 4 inches of both bones August 7, 1866; periosteum preserved; death August 27, 18HH. "Otis (G. A.) (Oircular No. 3, War Department, S. G. O., Washington, 1871, pp. 227, 228): Pt. W. Hostler, D, 38th Infantry, shot comminution of left fibula, Fort Bayard, New Mexico, July 10, 1868; excision of about 3J inches of fibula and ligation of peroneal artery above and below wound on same day by Acting Assistant Surgeon J. Le Carpentier; death July 12, 1868. Pt. J. Shaw, D, 3d Cavalry, shot wound of right tibia, received in fight with Indians October 17, 1867; necrosis; excision of necrosed portion by Assistant Surgeon W. M. Austin'. U. S. A., February 2, 1868; recovered and returned to duty. I8BECK (B.) (Chirurgie der Schussverletzungen, Freiburg i. Br., 1872, p. 900): G----, artlleryman, fracture of left leg in lower third from canister shot; immediately after the injury excision of portions of the injured bone was performed; subsequent amputation of the leg; recovery. InEM (loc. cit., pp. 907, 909, 910) also reports, from hospitals at Rastatt and Strassburg, 5 instances of excisions in the bones of the leg; 3 were excisions in the fibula and proved successful; 2 excisions in the tibia were fatal. FI6CHER (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Chirurgie, Leipzig, 1872, B. I, p. 253): Unknown, shot fracture of both bones in middle third; 21 days after injury 1 inch was excised from the upper and 2 from the lower ends; also removal of splinter 3 inches long; patient doing well at the end of six weeks. In another case in which the tibia was extensively splintered a fragment of the bone was extracted on the 12th and IJ inches were excised on the 2lst day after the injury ; death 15 days after the operation. RUPPRECHT (L.) (Militardrztliche Erfahrungen wahrend des deutsch-franzosischen Krieges im Jahre 1870-71, Wiirzburg, 1871, p. 86) cites a successful secondary excision in the fibula performed at the Bavarian hospital Xo. VIII, at Antony and Massy. Socin (A.) (Kriegschirurgische Erfahrungen gesammelt in Carlsruhe 1870 und 1871, Leipzig, 1872, p. 141) details 2 cases: H. Scherf, shot fracture of tibia and fibula of right leg in middle third, Toul, August 16, 1870; removal of splinters; resection of pro- truding portion of tibia September 15, 1870; recovery, with 8 centimeters shortening; large callus but no union of bone. Ferdinand Schwand, shot frac- ture of both bones of right leg, Worth, August 6, 1870 ; excision of 3 centimetres of tibia August 17; recovery, with very little shortening and consolida- tion of bone. *tChenu (J.-C.) (Aperfu Hist. Stat, et Clin., etc., pendant la Guerre de 1870-1871, Paris, 1874, B. I, p. 493) tabulates 97 cases of excisions in the continuity of the bones of the leg, in the French army, of which 76, with 13 recoveries and 63 deaths, were in the tibia, and 21, with 4 recoveries and 17 deaths, in the fibula. In the alphabetical enumeration of pensioners after amputations, disarticulations, and resections, in the second volume of Dr. Chexu'b work, the following cases of excision in the bones of the leg are mentioned: J.-B. Bourguignon (p. 21), llth Chasseurs, shot fracture of left fibula, Villorceaux, Dee. 9, 1870; excision of fibula; gangrene; recovery with anchylosis of ankle joint. J.-B. Millot, 23d line (p. 106), comminuted fracture of left leg at Tertre, January 11, 1871; resection ; recovery with considerable shortening. P.-A. Originaire (p. 114), 12th Cuirassiers, shot com- minution of leg at Gravelotte; resection of portion of tibia; incomplete consolidation. C.-V. Ridel (p. 128), 82d line, comminuted shot fracture of left tibia, Villorceaux, Dec. 8, 1870; resection ; atrophy of limb. This case is detailed by Chipault, (A.) (Fractures par armes d. feu, Paris, 1872, p. 157), who states that the operation was performed on May 22, 1871, and that 18 centimetres of the tibia were excised. There is regeneration of bone and no apparent shortening of the limb. E.-I. Schneider (p. 136), shell wound of right leg, received at Villiers-sur-Marne; resection of considerable portion of tibia. A.-J.-B. Soviche (p. 139), llth line, comminuted shot fractures of left forearm and right leg, Sedan; excision in lower third of tibia; atrophy of leg. L.-M.-A. Vedel ip. 147), 76th line, shell fracture of right leg, Strassbourg, September 17, 1870; excision of 4 centimetres of both bones; recovery. Besides the cases mentioned by CHENU, the editor has been able to gather from the sources indicated particulars of the following instances of excision in the continuity of the bones of the leg practised on French soldiers during the Franco-German War, 1870-1871, not detailed bj' CHENU: F. Delalande (CHIPAULT) (A.) (Fractures par armes dfeu, Paris, 1872, p. 173), wounded at Orleans. December 4, 1870, in the lower part of the left leg; no consolidation on December 31, 1870; reseetion of 9 centimetres of the fibula; recovery without shortening. The space between the sawn ends of the bone is filled with a firm substance. Joseph G----(A. COUSIN, Histoire Chirurgicale de Vambulance de Vecole des ponts et chaussees, in VUnion Medi- cate, 1872, T. XIII, p. 1S8), shell fracture of left leg, November 29, 1870; erysipelas; gangrene; excision of about 6 centimetres of tibia; death December 22, 1870. F. Albertini (O. HEYFELDER, Bericht uber me.ine Wirksamkeit am Rhein und in Frankreich wahrend des Deutsch-franzosischen Krieges, in St. Petersburger Med. Zeitschrift, 1871, B. II, N. F., p. 59), 3d Voltigeurs, shot fracture of bones of leg, Landonchamp, October 7, 1870; excision of the fractured portion of the tibia November 18; recovery without deformity and with new formation of bone. E. Terrier (O. HEYFELDER, loc. cit., p. 59), 62d line, shot fracture of tibia received at Gravelotte; secondarj' excision of 4 centimetres of the tibia; reoovery. M. Maze (T. BILLROTH, Chirurgische Briefe aus den Kriegs-Lazarethen in Weissenburg und Mannheim 1870. Berlin, 1872, p. 234, No. 47, and II. LOSSEN, Kriegschirurgische Erfahrungen aus den Barackenlazarethen, etc., in Deutsche Zeitschrift fiir Chirurgie, 1873, B. II, p. 140),----, 48th Infantry, shot fracture of both bones of right leg August 4,1870; ends of tibia excised on the field; loss of H to 2 inches of bone; in March, 1871, the wounds had healed but the parts had not consolidated. I8 TILING (G.) (Bericht uber 124 im Serbisch-turkischen Kriege im Baracken-Lazareth des Dorpater Sanitats-Trains zu Swilainatz behandelte Schussverletzungen, Dorpat, 1877, p. 72): Simeon Raschitsch, aged 40, shot fracture of left tibia, August, 1876; excision of 12 centimetres of tibia, September 7, 1876; ampu- tation in lower third of thigh September 15; death September 16, 1876. 19XADE (E.) (Das tempordre Kriegslazarelh des Ressorts der Anstalten der Kaiserin Maria im Kloster Mariahimmelfahrt bei Sistowa, in St. Petersburger Medicinische Wochenschrift, 1877, B. II, p. 385) 6tates that a successful excision in the diaphysis of the fibula was performed in the hospital near Sistowa under his charge. ■In the 185 excisions in the tibia, IJ inches were removed in 5, 2 inches in 23, 2£ inches in 8, 3 inches in 26, 3£ inches in 7, 4 inches in 14, 4J inches in 5, 5 inches in 7, 5J inches in 2, 6 inches in 7, and 7, 8, and 8J inches in 1 instance each, and in 78 the length of bone removed was not indicated. Of the 182 fractures of the fibula, J-inch was removed in 3 instances, 1 inch in 2, IJ inches in 6, 2 inches in 22, 2J inches in 10, 3 inches in 33, 3J inches in 7, 4 inches in 20, 5 inches in 7,6 inches in 3, 6J inches in 3, 7 inches in 1, 8 inches in 2, 12 inches in 1, and in 1 instance nearly the entire fibula; in 61 fractures of the fibula the amount excised was not stated. In the 18 instances of excisions in both bones of the leg the amount removed varied, according to the nature of the injury in each bone, from 2 to 5 inches in the tibia and from 2 to 8 inches in the fibula; in 3 instances neither the bone implicated nor the amount excised was indicated. 572 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Volunteers (Case 703, page 445, ante), Assistant Surgeon W. Thomson, U. S. A., states that "the leg was perfectly helpless, a hiatus of nine or ten inches existing in the tibia, with no hope of any improvement from the lapse of time," and remarks: "no more useless or un philosophical operation could be devised than the one done in this case." Colonel W. F. Fitch, 29th Ohio Volunteers (Case 705, page 446, ante), who visited the Army Medical Museum in 1870, six years after the operation, greatly regretted that amputation had not been performed. Three inches of the tibia had been excised and the bone remained ununited; the calf of the leg was atrophied, and the foot swollen and useless. In the case of Lieutenant 0. R Fyler (Case 704, page 446, ante), 2d Connecticut Heavy Artillery, Examining Surgeon H. E. Gates reported, in 1877, that "the whole leg and thigh is atro- phied. The fibula is bowed outward, and there is partial dislocation of its head. The leg bends easily at the seat of the injury and no weight can be borne upon it. I have no doubt the fibula would instantly give way if the applicant should stand upon it. There is great tenderness at the head of the fibula from stretching of the ligaments, the line of support from the bending of the leg being thrown outward toward this articulation. The pensioner wears an appliance weighing seven pounds, which incases the limb and gives the only support. The disability is progressive on account of displacement and bending of fibula, etc. I consider his present condition worse than if he had amputation above the- knee; locomotion is very painful indeed." Pseudarthrosis, rarely noted in the cases treated without operative interference, was recorded in at least twenty-eight of the cases of recov- ery after excision in the bones of the leg.1 In the case of Private J. Lagro, 10th Vermont Volunteers (Case 719, page 457, ante), Examiner O. F. Fassett reports that "the bones have never united except by ligament, so that a false joint now exists;" and the same examiner, in 1877, thirteen years after the injury, states: "The wound is still an open, suppurating, and discharging sore, the bone being extensively diseased. The disease is so near the joint that amputation must be above the knee. His condition now is worse than with loss of the leg above the knee. The leg is bent into a curve and greatly deformed." In the cases in which the excision was performed in the continuity of the fibula useful limbs were preserved in several instances, but as a rule the foot could not be planted even, as it would turn outward from the want of fibular support. Amputations in the Leg.—At the time of the publication of the preliminary report of 1865,2 the results of two thousand three hundred and forty-eight (2348) amputations in the leg, giving a mortality rate of 26.02 per cent., had been ascertained. Further exam- ination of the returns has augmented the number to five thousand four hundred and fifty- two (5452) and has increased the rate of mortality from 26.02 per cent, to 32.9 per cent.; yet the final results, as reported in the preceding pages, compare favorably with the results of amputations in the leg obtained in other wars, as exhibited in Table LXXXVI on the opposite page. Of the seven thousand six hundred and thirty-seven cases cited in this table, the final results were ascertained in seven thousand and thirty-eight. One thousand eight hundred and thirty-nine (1839) were successful and five thousand one hundred and ninety-nine (5199) fatal, giving a death rate of 73.8 per cent. This excessive rate of 1 Heine (C) (Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 310), who considers the fracture in the bones of the leg the most favorable field for excision, "as here the reproductive powers of the bony substance, as well as of the periosteum, seem to be especially active and fruit- ful," admits, on page 331, that "when the strength of the patient has not suffered too much, it is unquestionably preferable to await the separative process to be performed by nature, as a resection, in every instance, adds a new wound to the old one witb new dangers, and finally a condition not too rarely resulting, but which we have as yet not mentioned, must not be overlooked, viz: the supervening of pseudarthrosis." ** Circular No. 6, War Department, Surgeon General's Office, Washington, November 1, 1865, p. 47. SECT. V.] AMPUTATIONS IN THE LEG. 573 mortality is principally due to the deplorable fatality attending the operations among the French troops in the Crimean, Italian, and Franco-Prussian Wars. Table LXXXVI. Summary of Seven Thousand Six Hundred and Thirty-seven Amputations in ihe Leg for Shot Injuries on ihe Occasions named and from the Authorities quoted. OCCASIONS AND AUTHORITIES. Pare1.................................................................... Thirty-Years' War, 1618-1648 (Schmidt)'.................................... French Wars, 1740-1756 (BOUCHER, DE GAKENGEOT, FAURE)*1................ Seven Years' War, 1756-1763 (Schmucker)4................................. Napoleonio Wars, 1791-1815 (Larrey, Chavane, Klein, HENNEN, GUTHRIE)'. Fort Erie, 1814 (TROWBRIDGE)6............................................. Revolution in Paris, 1830 (Larket, Meniere, Aunal, Roux, Jobert)'....... Siege of Antwerp. 1832 (Larrey)8......................................... French in Algiers, 1830-1836 (Baudens, BAGRE)'............................ Campaign of Constantine, 1837 (SEDILLOT)10................................. Spanish Peninsular War, 1837-1838 (ALCOCK)11.............................. War in Mexico, 1845-1848 (PORTER)12....................................... Revolution in Paris, 1848 (ROUX, MALGAIGNE, HUGUIER, JOBERT, BAUDENS)13 Revolution in Milan, 1848 (RESTELLI)14...................................... War in Schleswig-Holstein, 1848-1850 (DJ6RUP, STROMETER)15............... Revolution in Baden, 1849 (BECK)16......................................... Bombardment of Sveaborg, 1855 (HEYFELDER)17............................. Crimean War, 1854-1856 (Chenu, Hubbenet, Matthew)18................... British in India, 1857-1858 (WILLIAMSON)19................................... Italian War, 1859-1860 (CHENU, Demme, GHERINl)20........................ New Zealand War, 1863-1865 (Mouat)*1..................................... Danish War, 1864 (HEINE, OCHWADT)22...................................... French in Mexico, 1864 (BlXTOT)28........................................... Austro-Prussian War, 1866 (BECK, BlEFEL, FISCHER, Maas, STROMEYER)24... United States Army, 1865-1870 (Otis)26...................................... Franco-German War, 1870-1871 (GERMANS) (BECK, BILLROTH, CZERNY, etc.)26 Franco-German War, 1870-1871 (FRENCH) (CHENU)27......................... Turco-Russian War, 1876 (Kade, STEDfER, TILING)28......................... Recoveries. 4 12 1 159 2 19 22 2 5 12 3 8 4 94 3 10 2, 698 21 466 2 12 1 93 9 267 3,704 3 117 2 8 17 2 2 11 1 7 2 57 2 2 506 21 188 2 8 1 61 6 150 654 2 7,637 1.1 3 1 2 1 2 37 1 8 1,617 278 4 32 3 106 3,050 1 5,199 Rate of mortality, 73.8 per cent. Unde- termined. As a rule the surgeons of the American civil war amputated in every part of the leg regardless of the point of election, sacrificing as little as possible of the sound portions of An early, and probably the earliest recorded example of amputation in the leg following shot wound is that reported by 'PARE (A.) (OZuvres de, Paris, 1599, p. 408, Chap. XXII): Captain Francois Le Clerc had his foot carried away just above the ankle by a cannon ball. The wound healed, but the leg became troublesome, and the patient had the limb amputated the width of five fingers below the knee. He recovered with a serviceable stump.— Four examples of amputation in the leg are recorded by 2 SCHMIDT (JOSEPH) (Speculum Chirvrgicum oder Spiegel der Artzney, Augspurg, 1656, pp. 153, 156, 157): 2 were successful, 1 fatal, and 1 result unknown : B. Lundlaw, of the regiment Wallenstein, received, November 22,1663, a 6hot fracture of both bones of the left leg; amputation of leg; death November 16, 1663. H. Braunmilller, Oheim's regiment, shot in the left leg May 23, 1663; amputation of leg; result not recorded. Cavalryman G. Burger, Caselcki's regiment; left leg carried away above the ankle; amputation higher up; recovery. A corporal of von Oelter's Bavarian regiment; left foot torn away; amputation in leg; recovery.—s BOUCHER (06s. sur des Playes d'armes d feu com- pliquies sur tout de fracas des os, in Mem. de VAcad. de Roy. de Chir., Paris, 1753, T. II, p. 470) cites five amputations in the leg for wounds received at Fontenoy, April 30, 1745: A captain of Hainaut's regiment had the leg amputated in the field; recovered October 26,1745. In the case of a lieutenant of the regiment Clare, the limb was successfully amputated 6 days after the injury. Of the remaining three, one died from haemorrhage 11 hours after amputation, and the other two survived the operation 16 and 20 days respectively. De GarengeOT (Moyens de rendreplus simple etplus sure l'amputa- tion d, lambeau, in Mim!de VAcad. Roy. de Chir., 1753, T. II, p. 262): A 6oldier of the King's repiment received a 6hell wound of the right foot with fracture of both bones of the leg; amputation 8 days after the injury; healed in 27 days. FAURE (L'amputation itant absolument nicessaire dans les plaies compliquies de fracas des os, etc., in Prix de VAcad. Roy. de Chir., Paris, 1819, T. Ill, pp. 339, 340) details 3 cases of secondary amputations in the leg, the operation being performed, one on the 46th and two on the 47th days after the injury; all recovered. BAGIEU (Examen de plusieurs parties de la Chirurgie, Paris, 1756, p. 97): Shot fracture of tibia and fibula; primarj' amputation of leg; fatal. RAVATON (Chirurgie d'armee ou traiti des plaies d'armes ilfeu, Paris, 1768, p. 372): Shot wound of left leg; amputation 6 weeks after injury; fatal. IDEM (loc. cit., p. 404): Fray, of Schomberg's regiment, shot fracture of left foot in September, 1755; primary amputation ; recovery.—4 SCHMUCKER (J. L.) ( Vermischte Chirurgische Schriften, Ber- lin und Stettin, 1785, B.I): Captain von Wedel, 6hot fracture of ankle joint, August 11, 1760; amputation of leg at upper third; fatal.—6LAHREY (D.J.) [Mim. de Chir. Mil. et Camp., Paris, 1812, pp. 265, 269): Lieut, Bonichon, 21st Light Infantry, shot wound of left foot, October 7, 1798; tetanus; ampu- tation in upper third; recovery. Another amputation for tetanus following shot wound was performed by LARREY on March 21, 1801; tetanus subsided, but the patient died 13 days after the operation. Idem (loc. cit, T. II, p. 195): Captain M----, wounded at the second battle of Aboukir, in 1801; ampu- tation immediately below the knee; recovery. Idem (loc. cit, T. IH, pp. 56, 83, 156, 389, 391, and 378) refers to 16 cases of amputation in the leg: Han- 574 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the bones of the limb. One thousand five hundred and nine (1509) of the five thousand four hundred and fifty-two (5452) amputations were performed in the upper third, one thou- sand four hundred and eighty-one (1481) in the middle, one thousand four hundred and seven (1407) in the lower third, and in one thousand and fifty-five (1055) instances the seat nequin, fracture of leg in upper third, Eylau, February 8,1807 ; amputation through tuberosity of tibia; recovery. During the same campaign Larrey performed 3 similar operations through the tuberosity of the tibia; the patients recovered. At Ulm, in October, 1805, an officer received a shot through the ankle ; gangrene and fever; amputation below the point of election; recovery. In Egypt, in 1799, LARREY twice successfully amputated close to the knee joint, and nearly on a level with the head of the fibula, and at Wagram and Esslingen, in 1809, 9 similar operations were performed by him; but the results are not indicated. Of 3 cases of amputation of both legs performed after Wagram, 1 performed immediately after the reception of the injury proved successful; 2 others were fatal. IDEM (toe. cit., T. IV, pp. 56, 69, 156, and 164) details 4 cases of amputation in the leg during the Russian campaign 1812-13: 3 were successful and 1 proved fatal. Larrey (D. J.) (Clinique Chirurgicale, Paris, 1829, T. Ill, pp. 651, 652, 662, 664, and 665) cites the cases of Dosmenil, wounded at Wagram, in 1809; amputation in middle third; recovery. Lambels, wounded in the Russian campaign, 1812, amputation in upper third; recovery. General Laferriere, wounded at Craonne in 1814; amputation in middle third; recovery. An officer, wounded at Moscow in 1812; amputation in upper third; recovery. General Chfimiueau, wounded at Lutzen in 1813; amputation in upper third; recovery. Robsomen, wounded at Hanau in 1813; amputation in upper third; recovery. IDEM (loc. cit, T. IV, pp. 279, 282): Gault, an officer of dragoons; shot fracture of upper third of right leg; amputation below the knee; recovery. Colonel d'Esclignac, amputation of leg; recovery. CHAVANE (X.) (Consid- erations theo.-prat. sur l'amputation d faire d la suite des fractures comminutives de la jambe, etc., Paris, 1814, These Ko. 99, pp. 7, 9, 10) details 3 successful amputations in the leg. KLEIN (D. C.) (Practische Ansichten der bedeutendsten chirurgischen Operationen, Stuttgart, 1815, p. 31) relate*? a successful case of amputation at the ankle and subsequent ablation in the leg. HENNEN (J.) (Principles of Military Surgery, 3d ed., London, 1829, pp. 275, 277): Chatelot, wounded in 1815, amputation leg; death. M----, 3d guards, amputation of leg July 11, 1815; death August 3, 1815. GUTHRIE (G. J.) (Commentaries, etc., 6th ed., London, 1855, p. 158) tabulates 93 cases with 23 deaths, after the battle of Waterloo, in 1815; 43, with 7 deaths, were primary, and 50, with 16 deaths, were secondary operations. GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, etc., 3d ed., London, 1827, p. 308) reports 28 amputations in the leg performed near New Orleans, from January 8 to April 24, 1815; 26, with 3 deaths and 23 recoveries, were primary operations, and 2, both fatal, were secondary operations.—6 TROWBRIDGE (A.) (Gunshot Wounds, in Boston Med. and Surg. Jour., 1838, Vol. XVIII, p. 342) cites 1 case of amputation of leg and 1 of both legs from the siege of Fort Erie, in 1814; both patients recovered.—'Larrey (H.) (Rel. Chir. des Evenemens de Juillet 1830, Paris, 1831, p. 122): 6 amputations in the leg (3 successful, 3 fatal). MENIERE (P.) (VHotel-Dieu de Paris en Juillet et Aout 1830, p. 325): 3 amputations in the leg; fatal. Arnal (Mim. sur quelques particular His des plaies par armes dfeu, in Jour. Unic. et Hebd. de Mid. et de Chir. Prat., Paris, 1831, T. HI, p. 35): 1 amputation of leg; recovery. ROI'X (Plaies d'armes dfeu. Communications, etc., Paris, 1849, pp. 37, 38): 6 amputations of leg (4 recoveries, 2 fatal). JOBERT (DE Lamballe) (Plaies d'armes dfeu, Paris, 1833, pp. 303-305) cites 3 amputations in the leg (no results).—"Larrey (H.) (Hist. Chir. du Siege de la citadel le d'Anvers, Paris, 1833, p. 334): 22 cases ; 20 primary (16 recoveries, 4 deaths), 2 secondary (1 recovery, 1 fatal.— •Baudens (L.) (Clinique desplaies d'armes Afeu, Paris, 1836, p. 540): 1 amputation of left leg; recovery. Bagre (Obs. de Chir.,recueillies a Vhopital Turc, a Alger, in Rec. de Mem. de Mid. de Chir. et de Phar. Mil., Paris, 1831, T. XXXI, p. 168): 1 amputation; recovery.—lgSEDILLOT (C.) (Camp, de Constantine de 1837, Paris, 1838, p. 266): 5 amputations in the leg (2 recoveries, 3 fatal).—'* ALCOCK (R.) (Notes on theMed. Hist, and Stat. ofthcBritish Legion in Spain, London, 1838, p. 95): 12 amputations in the leg (11 recovered, 1 fatal); 3 with 2 recoveries primary, and 9 recoveries were secondary operations.—12 Porter (J. B.) (Med. and Surg. Notes of Campaigns in the War with Mexico, during the years 1845-1848, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., pp. 31, 32): 3 amputations in the leg (1 recovery, 2 fatal).—l3Des plaies d'armes d feu Communications, etc., Paris, 1849, parMM ROUX (p. 11), 2 amputations (1 recovery, 1 fatal); Malgaigne (p. 46), 2 amputations (recoveries); HUGUIER (p. 143), 2 amputations (recoveries); JOBKUT (p. 154), 1 amputation (recovery); Baudens (p. 233), 1 amputation (recovery).—uRESTELLI (A.) (Noteed Osservazioni cliniche di chirurgia militare, in Annali Universali di Medicina, 1849, Vol. CXXX, pp. 243, 244): 4 cases (2 recoveries, 2 fatal). ,5DJORUP (Bemaerkninger over de i Krigen 1848-50 foretagne Amputationer i Forbindilse med en Statistik over dem, in Hospitals-Meddelelser, Ejobenhavn, 1852, B. V, p. 106): 48 cases (29 recoveries, 19 fatal). STROMEYER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, pp. 756, 757): 46 cases (28 recoveries, 18 fatal).—16BECK (B.) (Die Schuss- wunden, Heidelberg, 1850, Tabella): 3 cases (2 recoveries, 1 fatal).—17HEYFELDER (J. F.) (Die Verwundungen und Operationen in Folge des Bombarde- ments von Sveaborg vom 9.-11. Aug., in Deutsche Klinik, 1855, B. VII, pp. 495 and 575): 10 cases (2 recoveries, 8 fatal).—18 CHENU (J.-C.) (Rapport, etc., pendant la Campagne d'Orient en 1854-'55-'56, Paris, 1865, p. 666): 1,306 cases (368 recoveries, 938 fatal). H0BBENET (C. v.) (Die Sanitdts-Verhaltnisse der Russischen Verwundeten wahrend des Krimkrieges in den Jahren 1854-1856, Berlin, 1871, p. 182): 1,286 cases (69 recoveries, 642 deaths, 575 unde- termined). MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army, etc., in the years 1854-'55-'56, London, 1858, Vol. II, pp. 368, 369): 106 cases (69 recoveries, 37 fatal).—19 Williamson (G.) (Military Surgery, London, 1863, p. XXVII): 21 cases (recoveries).—»CHENU (J.-C.) (Stat. Med.-Chir. de Camp, d'ltalie en 1859 et I860, Paris, 1869, T. II, p. 809): 347 cases (116 recoveries, 231 fatal). DEMME (H.) (Militdr-Chirurgische Studien, WUrzburg, 1861, B. II, p. 278): 113 cases (69 recoveries, 44 fatal). GHERINI (A.) (Rel. chir. dell'Ospedale mil. provisorio di S. Filippo. in Annali Univ. di Med., Milano, 1860, Vol. CLXXIII, pp. 419, 420): 6 cases (3 recoveries, 3 fatal).—21MOUAT (The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports, Vol. VII, for the year 1865, London, 1867, p. 514): 2 cases (recoveries).—*•**■" HEINE (C.) (Die Schussverletzungen der unteren Extremitdten, Berlin, 1866, p. 294): 3 cases (2 recoveries, 1 fatal). OCHWADT (A.) (Kriegschirurgische Erfahrungen, Berlin, 1865, tabular statement): 9 cases (6 recoveries, 3 fatal.—«3 BlNTOT (Obs. de blessures de guerre, in Rec. de Mem. de Mid. de Chir. et de Phar. Mil., Paris, 1866, T. XVI, p. 237): 1 case (recovery.)—MBECK (B.) (Kriegs.-Chir. Erfahrungen wahrend des Feldzuges 1866, Freiburg, i. Br. 1867, p. 331): 43 cases (26 recoveries, 17 fatal). BlEFEL (R.) (Im Reserve- Lazareth, in Archiv fiir Klin. Chir., Berlin, 1869, B. XI, pp. 465, 474): 4 cases (2 recoveries, 2 fatal). FISCHER (K.) (Militairarztliche Skizzen, Aarau, 1867, p. 97): 26 cases (22 recoveries, 4 fatal). Maas (H.) (Kriegschirurgische Beitrage aus dem Jahre 1866, Breslau, 1870, p. 73): 3 cases (2 recoveries, 1 fatal). STROMEYER (L.) (Erfahrungen uber Schusswunden im Jahre 1866, Hannover, 1867, p. 59): 17 cases (9 recoveries, 8 fatal).—»OTIS (G. A.) (Circular No. 3, War Department, S. G. O., Washington, 1871, pp. 196-202): 9 cases (6 recoveries, 3 fatal).—* BECK (B.) (Chirurgie der Schussverlet- zungen, Freiburg, i. Br., 1872, pp. 800, et seq.): 152 cases (91 recoveries, 58 fatal, 3 undetermined). BILLROTH (T.) (Chir. Briefe aus den Kriegs-Laza- rethen in Weissenburg und Mannheim 1870, Berlin, 1872, pp. 232, et seq.): 7 cases (4 recoveries, 3 fatal). CZERNY (V.) (Bericht iiber die im College Stanislaus in Weissenburg behandelten Verwundeten, in Wiener Med. Wochenschrift, 1870, pp. 1355-56): 3 cases (1 recovery, 1 fatal, 1 unknown). Fischer (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Cliirurgie, 1872, B. I, p. 187): 19 cases (14 recoveries, 5 fatal). FISCHER (H.) (Kriegschirurgische Erfahrungen, Erlangen, 1872, p. 213): 8 cases (5 recoveries, 3 fatal). GOLTDAMMER (Bericht iiber die Thatigkeit des Reserve- Lazaretts des Berliner Hilfsvereins in der Garde-Ulanen-Kaserne zu Moabit, in Berliner Klin. Wochenschrift, 1871, Jahrg. VIII, p. 152): 2 cuses (1 recovery, 1 fatal). GRAF (E.) (Die Koniglichen Reserve-Lazarethe zu Dusseldorf wahrend des Krieges 1870-71, Elberfeld, 1872, pp. 31, 49): 9 cases (4 recoveries. 5 fatal). KlRCHNER (C.) (Aerztlicher Bericht iiber das Koniglich Preussische Feld-Lazareth im Palast zu Versailles, Erlangen, 1872, pp. 88, 89): 9 cases (6 recoveries, 3 fatal). KOCH (W.) (Notizen uber Schussverletzungen, in Archiv fiir Klin. Chir., Berlin, 1872, B. XLII, p. 574): 12 cases (9 recoveries, 3 fatal). LOSSEN (H.) (Kriegschirurgische Erfahrungen aus den Barackenlazarethen zu Mannheim, etc., in Deutsche Zeitschrift fur Chir., 1873, B. II, pp. 138-148): 4 cases (4 fatal). MAYER (L.) (Kriegschirurgische Mittheilungen aus den Jahren 1870-71, in Deutsche Zeitschrift fur Chirurgie. 1873, B. Ill, pp. 50, 52): 2 recoveries. Rupprecht (L.) (Militdrdrztliche Erfahrungen wahrend des Deutsch-Frambzischen Krieges im Jahre 1870-71, WUrzburg, 1871, p. 15): 5 cases (2 recoveries, 3 fatal). Schinzingeb (A.) (Das Reserve-Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, i. Br., 1873, pp. 84, 88): 5 cases (4 recoveries, 1 fatal). SEEGER (W. v.) (Die Leistungen der Vereinsspitdler Kleinkinderchule und Diakonenhaus in Lud- wigsburg im Jdhr 1870-71, in Zeitschrift fur WundarzU und Geburtshelfer, Stuttgart, 1871, B. XXIV, p. 117): 1 case, fatal. SOCIN (A.) (Kriegschirur- gische Erfahrungen gesammelt in Carlsruhe 1870 und 1871, Leipzig, 1872, pp. 144, 187): 4 eases, fatal. STEINBERG (Die Kriegslazaretlie und Baracken SECT. V.] AMPUTATIONS IN THE LEG. 575 of operation was not indicated. The fatality of the operations in the upper third was 27.0, in the middle third 20.6, and in the lower third 27.6 per cent.1 Here as well as in the amputations of the thigh (see Table XXIX, p. 213, ante) and in the ablations of the fore- arm and arm (see Table CXXXII, p. 967), and of amputations in the arm (Recapitulation, pp. 805, 806 of the Second Surgical Volume), the operations in the middle third of the limb were less fatal than those in the upper or lower thirds. It will also be noted that the mortality of the amputations in the lower third slightly exceeded that in the upper third,2 a result which appears to argue against the operations in the lower third immediately above the malleoli, advocated and practised by Ravaton3 and White,4 and later by Lenoir, Goyrand, and others.5 Furthermore, of the two hundred and twenty cases of re-amputations in the leg, knee joint, or thigh, the amputations had originally been performed in the lower third of the leg in one hundred and two, in the middle third in seventy-five, in the upper third in forty, while in three the seat of the first operation was not indicated; showing that abla- tions in the lower third contributed nearly one-half of all the cases of re-amputation. The considerations of greater safety of life, as evinced in the results of amputations of the middle third, and the excellent prothetic apparatus furnished at Government expense to the maimed soldiers, outweigh the objections raised by surgeons to the inconvenience of a projecting limb, necessitated by the use of a peg leg, as well as the question of the greater cost of such apparatus. From the returns it would appear that of the modes of operation the flap method was most frequently employed—one thousand six hundred and ninety-eight (1698) instances of this procedure being reported, against one thousand two hundred and six (1206) by the circular, twenty-two (22) by the circular flap, and a few by Teale's6 and Hey's7 methods; but in at least two thousand five hundred (2500) cases the mode of operation was not indi- cated. Assistant Surgeon J. T. Calhoun, U. S. A., in his narrative of service at the 4th von Berlin, Berlin, 1872, p. 148): 13 cases (3 recoveries, 6 fatal, 4 undetermined). STOLL (Bericht aus dem Koniglich Wurttembergischen 4. Feldspital von 1870-71, in Deutsche Militairdrztliche Zeitschrift, 1874, 3d Jahrg., p. 218): 9 cases (4 recoveries, 5 fatal). STUMPF (L.) {Bericht iiber das Kriegs- Spital des St. Georg-Ritter-Ordens zu Neuberghausen im Jahre 1870-71. in Aerztliches Intelligenz-Blatt, Munchen, 1872. No. 50, p. 657): 3 cases, unde- termined.— "Chenu (J.-C.) (Apercu hist, stat, et din., etc., pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493);. 3,704 cases (654 recoveries, 3,050 fatal). mKade (E.) (Das tempordre Kriegslazareth des Ressorts der Anstalten der Kaiserin Maria im Kloster Mariahimmelfahrt bei Sistowa, in St. Petersburger Med. Wochenschrift, 1877, B. II, p. 384): 1 case, recovery. Steiner (F.) (Aus dem Tagcbuchc eines deutschen Arztes, in Wiener Med. Wochenschrift, 1877, B. XXVII, p. 426): 1 case, recovery. Tiling (G.) (Bericht uber 124 im serbisch-turkischen Kriege im Baracken-Lazareth des Dorpater Sanitats- Trains zu Swilainatz behandelte Schussverletzungen, Dorpat, 1877, p. 77, No. 82): 1 case, fatal. 'The precise figures are: Upper third 1,509 cases, viz: 1,094 recoveries, 406 deaths, 9 unknown results, mortality 27 0 per cent. Middle third, 1,481 cases, viz: 1,170 recoveries, 305 deaths, 6 unknown results, mortality 20.6 per cent. Lower third, 1,407 cases, viz : 1,011 recoveries, 387 deaths, 9 unknown results, mortality 27.6 per cent. See Table LXVII, p. 461, ante. "Staffsurgeon GROS8HEIM (Ueber die Schussverletzungen des Fussgelenks wahrend des letzten Krieges und die Resultate ihrer Behandlung imter Benutzung officieller Quellen, in Deutsche Militairarztliche Zeitschrift. 1876, Jahrgang V, p. 223, note *) remarks: " The supra-malleolar amputation has given very unfavorable results during the war 1870-71," and. on page 252, gives the percentage of fatality of the amputations in the lower third of the leg as 53.9 per cent., and adds: " The results of the amputations of the leg in the upper and middle thirds are incomparably better than those in the lower third, their percentages of fatality being only 38.5 and 36.0 per cent, respectively." 'Ravaton, Sur Vutilitt de l'amputation faite prls des mallioles dans les maladies du pied, et sur une bottine de nouvelle invention, in Rccuil periodique d'observations de Medicine, Chirurgie, Pharmacie, etc., Paris, 1757, T. VI, p. 130. 4 WHITE (C), An Account of a new Method of amputating the Leg a little above the Ankle Joint, with a Description of a Machine particularly adapted to the Stump, in Medical Observations and Inquiries by a Society of Physicians in London, London, 1771, Vol. IV, p. 168. 'LENOIR (A.), Quels sont les caset quels sont les lieux, ou il convienl d'amputer la jambe, Paris, 1835; ibid, Note sur une modification de la mithode circulaire appliquee a l'amputation de la jambe, au dessus des mallioles, in Archives Ginirales de Midecine, Paris, 1840, 3" ser., T. VIII, p. 257. Goy- rand (G.), De l'amputation de la jambe, partiquie loin du genou ,■ nonvel appareil de suslentation, in Journal Hebdomadaire des Progris des Sciences et Institutions Midicales, Paris, 1835, T. II, p. 161. LAltliEY, Amputation Sus-Malliolaire, in Bulletin de VAcadimie Royale de Midecine, Paris, 1841-42, T. VH, p. 211. ARNAL et Martin, Memoire sur l'amputation sus-malliolaire, in Annates de la Chirurgie Franfaise et £trangire, 1841, T. HI, p. 129. ARNAL (L.), Mimoire sur l'amputation sus-malliolaire, in Mimoires de V Academic Royale de Midecine, 1843, T. X, p. 59. ROZE (M. A.), De Vamputa- tion tus-malUolaire, in Gazette Medicate de Paris, 1847, 3""" s£r., T. II, p. 987. COOTE (H.), Amputation at the inferior third of the Leg. in the London Lancet, 1847, Vol. I, p. 274. BARNETT (C V.), Supra-malleolar Amputation. Its relative value, in Transactions of the Medical Society of the State of New York, 1857, p. 169. Laborie, Communication sur Vamputation sus-malliolaire, in Bulletin de la SociiU de Chirurgie de Paris, Paris, 1859, T. IX, p. 198; ibid., in Bulletin de la Sociiti impiriale de Chirurgie de Paris pendant Varmie 1866, Paris, 1867, p. 63. GUYON, Amputation sus-malliolaire. par unprocidi nouveau, in Bulletin de la Societi impiriale de Chirurgie de Paris, 1869, 2" sarie, p. 334. CHAUVEL, Amputation sus-mall olaire, in Mem. de la Soc. de Chir. de Paris, Paris, 1873, T. VII, p. 366. Gayraud (E.), De Vamputation sus-malleotaire, in Montpellier Midical, 1877, T. XXXVIH, p. 120. "TEALE (T. P.), On amputation by a lemg and short rectangular flap, London, 1858. 'HKY (William), Practical Observations in Surgery, illustrated by cases, 3d ed., London, 1814, p. 542. 576 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. division, Second Corps hospital, April 1, 1864, prefers the "long posterior flap with a small crescentic anterior flap, and after sawing the bones always removes the sharp projecting angle of the spine of the tibia." Surgeon Burt Gr. Wilder, 55th Massachusetts Volunteers, in his observations of cases at Judiciary Square Hospital, prefers the circular method in amputations in the lower third. "Here at least, the circular method is superior to the flap, that is, results in the best stump, both in appearance and for an artificial limb; * * it is evidently the best method where the patient is obliged to undergo any subsequent trans- portation. The large inferior flap formed from the calf constitutes a very thick cushion at the end of the stump, but the superior edge of the tibia is always thinly covered." Protrusion of the tibia or fibula or both, frequently noted, especially in cases in which the crest of the tibia had not been removed at the time of the operation, was followed by secondary hsemorrhage, sloughing, and exfoliation. Surgeon B. Gr. Wilder, 55th Massa- chusetts Volunteers, remarks of twenty-seven cases of amputations in the leg, observed at the Judiciary Square Hospital at Washington in 1863: "The crest of the tibia was removed at the time of the operation in four cases, and in none of these did the bone afterwards protrude. In three cases sloughing followed a previous secondary hsemorrhage. In eleven cases the tibia or fibula or both protruded through the flap and exfoliation usually followed. Secondary hsemorrhage and sloughing occurred in two, indicating rather a constitutional than a local cause. Omitting these two, there remains nine cases—five of them in the middle third of the leg—in which the crest of the tibia exfoliated to a greater or less extent for no other evident cause than its non-removal at the time of operation. The exfoliations took place at various periods—during the second, third, fourth, sixth, tenth, thirteenth weeks, and in one instance during the fifth month." To prevent as much as possible the protrusion of the bones, which the great weight of the soft parts forming the calf tended to aggravate, Dr. Frank P. Foster, of the New York Hospital, applied with good advantage an apparatus shown in the appended wood-cut (Fig. 329). A piece of adhesive plaster was cut in the shape shown in Fig. 328; the two limbs were «l fe- ll il!1!,' I cut through at C C, the surfaces of the end pieces B B reversed, and fig. 328—Adhesive piaster the pieces joined with reversed ends. . . -■ together again at C C with pins. The adhesive surface of the middle portion A was then applied to the posterior surface of the stump and the ends secured to the outside of an ordinary fracture box, as shown in Fig. 329. Traction downward on the fracture box was efiected by means of a weight and pulley. Fig. 329.—Fracture box with stump supported by adhesive plaster. MOT. VI.| WOUNDS AND OPERATIONS AT THE ANKLE JOINT. 577 Section VI. WOUNDS AND OPERATIONS AT THE ANKLE JOINT. The cases to be considered in this Section are restricted to injuries, by weapons of war, of the bones forming the tibio-tarsal articulation, viz: the lower extremities of the tibia, the fibula, or the astragalus. Injuries of the os calcis and other adjoining bones, unless the ends of the tibia and fibula and the astragalus are likewise involved, are reserved for the next section. Seventeen hundred and twenty-two injuries of the bones forming this articulation were found on the field and hospital returns. All were caused by shot; eleven were contusions, and seventeen hundred and eleven fractures. SHOT CONTUSIONS OF THE ANKLE JOINT.—Of eleven shot contusions of the bones of the ankle joint indicated on the records, seven were treated throughout without operative interference; four were followed by amputation in the leg. The latter cases have already been cited in the tables of amputations in the leg,1 and it remains only to give brief details of the cases treated by conservation. Shot Contusions of the Bones of the Ankle Joint treated by Conservation.—The injuries in the seven cases of this group were confined to the malleoli, in three instances the internal and in four the external malleoli being involved. All resulted in recovery. Case 808.—Private J. G. Clayton, Co. I, 24th Regiment (Confederate), aged 22 years, was wounded in the left ankle, at Drury's Bluff, May 16, 1864. The missile, a ball, impinged upon the lower end of the tibia, glanced downward and passed through the anterior aspect of the ankle joint, lodging under the skin over the neck of the astragalus, whence it was extracted two days afterwards. One week after the injury the foot and ankle were inflamed and swollen and there was excruciating pain upon the slightest motion, while the grating of the inflamed articular surfaces was distinct. After free incisions to favor the escape of confined pus, which was freely mingled with synovial fluid, and the persistent employment of cold irrigation and' anodynes, the local inflammation subsided. In the course of several weeks it entirely ceased and the general condition of the patient became much improved. By the following January the wound had closed and the patient was able to walk with the aid of a cane, though motion of the joint was still imperfect. The history of the case was published2 by Dr. J. M. Holloway, late Surgeon P. A. C. S. Case 809.—Private W. Johnson, Co. B, 147th New York, aged 18 years, was wounded at Hatcher's Run, October 27, 1864, by a minie* ball, which grazed the inner malleolus of the left ankle. He entered Lincoln Hospital, Washington, whence he reported to Elmira for muster out May 27, 1865. Not a pensioner. Case 810.—Corporal A. Daily, Co. A, 42d Illinois, aged 29 years, was wounded in the right ankle, at Murfreesboro', December 31, 1862, by a musket ball, which took effect upon the external malleolus, touching the bone. He was treated at various hospitals, being assigned to the Veteran Reserve Corps November 25, 1863, and ultimately mustered out and pensioned September 8, 1864. Various examining surgeons certify to weakness of the ankle joint, painfulness, and tendency to inversion of the foot in walking. He was a pensioner in June, 1880. Case 811.—Private P. McCabe, Co. G, 87th Pennsylvania, aged 23 years, was wounded in the left ankle, before Peters- burg, June 23,1864, by a musket ball, which contused the external malleolus. He was admitted to Stanton Hospital, Washing- 1 Cases of Pt. P. Reynolds, K, 5th New Jersey, intermediary amputation, lower third of leg; fetal. Spec. 4578, A. M. M. (Table LXXIV, No. 300, page 535, ante). Pt. W. Sharp, I, 8th New York Heavy Artillery, intermediary amputation, middle third of leg; fatal. Spec. 3204, A. M. M. (TABLE LXXIII, No. 349, page 527, ante). Pt. J. F. "Willetts, B, 1st New Jersey, intermediary amputation, middle third of leg; recovery. (Table LXXIII, No. 250, page 526, ante). Pt. C Bennett, D, 9th New Hampshire, secondary amputation, middle third of leg: fatal. Spec. 3637 (Table LXXVH, No. 138, page 550, ante). 2H0LL0WAY (J. M.), Comparative Advantages of Pihogoff's, Symk's, and Chopart's Amputations, and Excision of the Ankle Joint by HAN- COCK'S Method, after Gunshot Wounds and other Injuries, etc., in American Journal of Medical Sciences, 1866, Vol. LI, N. S., p. 88. SVRG. 111—73 578 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. ton, eleven days after the injury, with the limb greatly swollen and intensely painful. An abscess was opened on July 10th, and three weeks later a thin narrow piece of bone, about one inch long, exfoliated from the external malleolus. Subsequently another small necrosed piece was removed, after which rapid and steady improvement began and the pain disappeared. About Septeuilicr -."th the patient began to walk on crutches.1 He was mustered out of service October 13, 1864, and pensioned. The Pension Examining Board in September, 1877, report a "tender and adherent cicatrix, complete anchylosis of the ankle joint, and some atrophy of the leg. In walking he cannot bring the heel to the ground, but puts his weight on the front part of the foot." Ho was paid his pension in June, 1881. Case 812.—Private J. Staton, Co. G, 45th Kentucky, aged 17 years, was accidentally wounded, October 24, 1863, by a pistol ball grazing the external malleolus of the right ankle. He was conveyed to the general hospital at Ashland, Avhere Bimple dressings were applied. The patient was returned to duty December 3, 1863. and mustered out with his command Feb- ruary 4, 1865. Subsequently he made an unsuccessful application for pension. Case 813.—Private T. Ingersoll, Co. E, 8th Kansas, aged 20 years, was wounded by a ball striking the internal malle- olus of the left ankle, nt Chickamauga, September 19, 1863. He passed through several hospitals, and was mustered out of Bervice September 19,1864, and pensioned. Examining surgeons certify to weakness and slight enlargement of the ankle joint. His pension was paid to June, 1879. Case 814.—Sergeant C Shade, Co. F, 46th Pennsj'lvania, age 23 years, was wounded, at Peach Tree Creek, July 20, 1864, by a mini6 ball striking the external malleolus of the left ankle. Simple dressings constituted the treatment. The patient was returned to duty August 13, 1854, aud was subsequently promoted to Lieutenant. He ultimately resigned July 1, 1865, and afterwards became a pensioner. Examining surgeons certify that he complains of pain, weakness, and swelling on over- exertion. His pension was paid to December, 1880. SHOT FRACTURES OF THE BONES OF THE ANKLE JOINT.—Of one thou- sand seven hundred and eleven instances of shot fractures involving one or more of the bones of the ankle joint, five hundred and eighteen were treated without operative inter- ference; twenty-nine were followed by excision; four by excision at the ankle and subse- quent amputation in the leg; fifteen by amputation at the ankle joint; one by amputation at the ankle joint and subsequent amputation in the leg; and one thousand one hundred and forty-four by amputation in the leg, knee joint, or thigh: Table LXXXVII. Summary of One Thousand Seven Hundred and Eleven Shot Fractures of the Tibio-Tarsal Articulation. TREATMENT. Cases. SHOT FRACTUR ES S. OF— LoWHR EXT. OP Tibia. Lower extremity of Fibula. Astrag-alus. Tibia AND Fibula. Tibia an Astragali Fibula and Astragalus. Tibia, Fibula, and Astrag-alus. Bones not Specified. "3 O .9> 3 > o a K a fi "£ 13 c P 12 2 1 i 1 o w « 104 2 P 14 a > o o o> a 69 9 2 g "3 v p 12 2 1 ■C ,| oi £ h > ol o T3 O a i « ~! & 1 ' 52 ■ il 5 P 11 1 *n ? o 13 1 2 , 1 p ' a "5 P 5 P V C Ol > o o V « 2 « P 1 2 ■6 's O) "£ -d a P 1 o o 01 PS 7 1 CJ 2 1 ■c o o PS 154 » P 54 P "(3 U O "3 ■o a P 10 1 518 29 4 15 1 1,083 2 19 11 29 407 19 3 13 I 772 2 14 1 7 99 8 1 1 19.5 29.6 25.0 7.1 0.0 28.7 0.0 26.3 90.9 75.8 3 1 6 2 2 2 1 Followed by 7 1 1 4 1 516 1 12 1 Amputation at Ankle—Amp. in Leg.. 311 50 29 14 15 50 41 69 13 26 19 9 6 38 1 20 168 Amputation in Leg—Amp. at Knee... Amputation in Leg—Amp. in Thigh .. 5 10 22 15 1 157 20 1 3 3 50 7 1 115 17 ! 4 2 10 238 —V-" 941 12 94 3 3 36 131~ 1 1 2 56 L 1 1 i 1 84 10 1 18 2 1 1 2 1 2 50 72 23 3 691 1,711 1,239 457 26.9 62 24~ It is to be regretted that in nine hundred and forty-one of the one thousand seven hundred and eleven cases the bones injured were not specified. The internal malleolus was interested in two hundred and seven, the external in one hundred and thirty-one, the 1 LIDELL (J. A.), On Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. Med. Sci's, 1865, N. S., Vol. L, p. 3d SECT. VI.] SHOT FRACTURES OF THE ANKLE JOINT. 579 astragalus in one hundred and seventy-one, the articular ends'of the tibia and fibula in one hundred and two, the tibia and astragalus in sixty-two, the fibula and astragalus in twenty- four, and all three bones composing the joint in seventy-three instances. SHOT FRACTURES OF THE BONES OF THE ANKLE JOINT TREATED BY CONSERVATION.—The fact that of the one thousand seven hundred and eleven cases of shot fractures of the ankle joint fivejiundred and eighteen only, or less than one third, were treated by expectant conservative measures, would indicate that the surgeons of the American civil war generally adhered to the teachings of the masters of the early part of the present century, Larrey,1 Thomson,2 and Guthrie,3 who considered shot wounds of the ankle joint extremely dangerous and generally requiring amputation. It must be assumed, therefore, that the most propitious cases only were reserved for conservative treatment. Of the five hundred and eighteen cases the results were ascertained in all but twelve; four hundred and seven had successful and ninety-nine fatal terminations, giving a mortality rate of 19.5 per cent. Case 815.—Private J. Dullahan, Co. D, 3d Vermont, aged 24 years, was wounded iu the right ankle, at the Wilderness, May 5, 1864. Six days after receiving the injury he was admitted to Harewood Hospital, Washington, and one week later the man was transferred to South Street Hospital, Philadelphia. Surgeon S. J. W. Mintzer, U. S. V., in charge of the latter hospital, recorded a wound of the ankle with compound fracture of the inner malleolus by a minie* ball, which entered at the inner malleolus and came out just behind the external malleolus. Cold- water dressings were used. On May 23d there was great pain and swelling, and an application of lead water and laudanum was kept wrapped around the limb; morphia, milk punch, and beef essence being administered. Two days afterwards the wounds of exit and entrance were enlarged, after which the foot was again wrapped up in the same application. On May 27th, the pain still continuing, equal parts of tincture of aconite and water were applied, and two days later a plaster of extract of hemlock was made to cover the entire foot. On May 30th quinine pills were prescribed, and another lotion consisting of laudanum and tincture of aconite was ordered to be constantly applied. The entries in the hospital records at this date mention that the patient was evidently sinking. He subsequently mended, however, and became well enough to be transferred to Brattleboro' on June 29th. Several months later he was trans- ferred to Burlington, where he was assigned to the Veteran Reserve Corps February 21,1865. The patient was ultimately discharged from service at Sloan Hospital, Montpelier, July 25, ,Q__ r , . , ~ _ °_ FIO. 330.—Appearance of limb one 1865, and pensioned. Surgeon H. Janes, U. S. V., in charge of the latter, contributed the year after shot fracture of right inner photograph represented in the adjacent cut (FlG. 330), and reported that, according to the ""a"601"8- lFrom a photograph.] patient's statement, the lower end of the tibia became necrosed and was gouged out twice at Brattleboro' Hospital. At the time of the man's discharge his general health was good and the wound was nearly healed, with ligamentous anchylosis of the joint and very slight contraction of the muscles of the calf of the leg. There was no appearance of caries or necrosis, and he could walk a short distance with a cane, gaining some motion of the joint by exercise. Examiner A. L. Lowell, of Burlington, Ver- mont, certified, March 26, 1870: "The cicatrix of entrance is adherent to the bone and healthy, but sensitive to pressure. The inner malleolus is considerably thickened by bony deposit and the new growth is operative in limiting the motions of the foot. The tibio-tarsal articulation is obstructed in its function by false anchylosis. In flexion and extension of the foot the toes describe an arc of but two inches. The foot is inverted to such a degree as to throw the weight of the body on the outer margin of the sole." The pensioner was paid June 4, 1880. Case 816.—Private P. Driscoll, Co. B, 13th Infantry, aged 26 years, was wounded before Vicksburg, May 19, 1863. Surgeon E. O. F. Roler, 55th Illinois, noted his admission to the field hospital of the 2d division, Fifteenth Corps, with "shot wound of right foot." One week after the reception of the injury the wounded man was conveyed to Memphis, where he entered Jefferson Hospital, and six months later was transferred to Marine Hospital, St. Louis. Surgeon A. Hammer, U. S. V., in charge of the latter, described the injury as a "shot fracture of the ankle joint," and reported that the joint being much enlarged and quite painful he lanced the part on June 18, 1864, when several ounces of pus escaped and several spiculse of bone were extracted. The patient was in good health at the time of the operation. Warm poultices were frequently applied and after- wards tincture of iodine. On August 6, 1864, the patient was discharged from service and pensioned. Examining Surgeon A. "■Larrey (D. J.) (Mim. de Chir. Mil. et Camp., Paris, 1812, T. II, p. 468): "Lorsqu'un eclat d'obus, un biscayen ou une balle ont fracasse les extr6mit6s articulaires, surtout celles qui forment Varticulation du pied on du genou, et que les ligamens qui affermissent cette articulation ont 6t6 arrachcs ou rompus, l'amputation immediate devient indispensable. La mfime indication se presenterait, si le corps stranger s'6tait perdu dans l'6paisseur d'une des extr6mit6s articulaires, ou se trouvait enclave^ dans Varticulation, de manitSre a ne pouvoir en etro extrait par les proc6d6s simples et ordinaires." 2 Thomson (J.) (Report of Obs., etc., after the Battle of Waterloo, Edinburgh, 1816, p. 238): " Wounds in which musket balls have passed through, or are lodged in the ankle joint, almost all require immediate amputation. These injuries, by giving rise to high degrees of inflammation and symptomatic fever, not unfrequently prove fatal. Among a great number who had survived the fever, we saw but few in whom secondary amputation was not required; and, in the cases requiring it, this operation was far from being so successful as the primary amputation had been." 3GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, etc., London, 1827, 3d ed., p. 398): " Wounds of the-ankle joint from gunshot are extremely dangerous, and in general require amputation," 580 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. W. Woodhull, of Newark, N. J., certified April 9, 1868: "A conoidal ball fractured the lower extremities of the tibia and fibula, also Beveral of the tarsal bones. The joint is anchylosed and the heel is kept five inches from the ground. The os calcis and astragalus were seriously fractured. Several pieces of bone have been lost and there is extensive deformity of the parts," etc. The Dayton, Ohio, Examining Board in subsequent reports states that the pensioner "walks on the ball of the toes" and requires the use of a cane. The pensioner was paid June 4, 1881. In the following instance the missile was firmly wedged into the articulation, and was finally removed by the aid of two trephines used simultaneously, one on each side of the ball: CASE 817.—Chaplain J. W. W. Bolton^5th West Virginia Cavalry, aged 26 years, was wounded at Cloyd's Mountain, May 9, 1864, by a minie" ball, which entered the right ankle near the external malleolus and lodged. He remained under treat- ment at a field hospital for six weeks -and was then transferred to the general hospital at Parkersburg, whence he was reported as having been "returned to duty November 25, 1864." Some weeks afterwards the patient re-entered the hospital, when his case was reported by Assistant Surgeon W. A. Banks, U. S. V., as follows: " From the time of the injury the patient has been subject to formation of abscesses on either side of the ankle joint. The location of the ball was accurately ascertained with a porcelain pointed probe after all other means had failed. On February 3, 1865, chloroform was administered and the missile was extracted. An incision made below the external malleolus, one and a half inches long, exposed the ball lodging in the articulation, its base being one and a half inches from the surface. The missile was so firmly impacted that it could not be removed by any form of bullet forceps, the metal giving away before the teeth of the forceps. It was finally dislodged by means of two trephine elevators, using one on each side of the ball at the same time. The patient was in good general health at the time of the operation. He did well afterwards. Simple dressings were applied. The wound healed and the patient recovered with an immovable joint." He left the hospital three weeks after the operation, his term of service having expired June 14, 1864. Dr. E. D. Saffbrd, pension examiner, and formerly Acting Assistant Surgeon at the Pakersburg Hospital, in June, 1872, contributed the following supplementary description of the injury: "The ball entered through the external malleolus, into and nearly through the astragalus, where it remained embedded until extracted," etc. "The injury produced extensive inflamma- tion, and as a consequence he has nearly complete anchylosis of the joint and one and a half inches shortening." In his original application the pensioner alleged that seventeen pieces of bone were taken out of the wound at different times. Owing to his disability being considered permanent the pensioner has been exempted from further examinations. His pension was paid September 4, 1881. Case 818.—Private F. Lape, Co. K, 34th Massachusetts, aged 20 years, was wounded in the right foot, at New Market, May 15, 1864. He was captured by the enemy and conveyed to hospital at Harrisonburg, where he was seen and examined by Surgeon T. B. Reed, U. S. V., who described the injury as a "wound of the ankle joint;" also, that an opening was made and the ball was searched for and that poultices were applied. After remaining a prisoner for six months the man was exchanged and conveyed to Camp Parole Hospital at Annapolis, whence he was permitted to leave for his home, on furlough, October 31st. Drs. O. E. Brewster and W. W. Greene, of Pittsfield, Mass., who attended the patient at his home, certified that they removed a detached portion of the astragalus from the wounded foot on February 7, 1865. The patient subsequently returned to Camp Parole, and was discharged from service for disability March 21, 1865, Surgeon W. D. Stewart, U. S. V., certifying to "gun- shot wound by a ball, which entered immediately behind the internal malleolus, passed forward and outward and lodged, frac- turing the end of the tibia and implicating the joint." Examining Surgeon H. Eastman, of Pittsfield, Mass., reported Novem- ber 5, 1873: "From the appearance of the wound of exit I should say that a number of pieces of bone have been removed. The ankle is perfectly anchylosed: the muscles of the calf of the leg are very much atrophied; the limb is more than one-third smaller than the other and is much lower in temperature. The muscles in the calf are so much contracted that when he is standing the heel is one inch above the floor1, obliging him to walk on the anterior portion of the foot." The pensioner was paid September 4, 1881. Case 819.—Private S. Vansiclen, Co. D, 9th New York State Militia, aged 20 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, reported his admission to the field hospital of the 2d division, First Corps, with " shot wound of left ankle." Acting Assistant Surgeon L. Dorsey contributed the following description of the injury: "A rifle ball penetrated the ankle, outer surface, fracturing the astragalus and tibia. The man was admitted to Hare- wood Hospital, Washington, ten days after being wounded. On December 27th he was etherized, when the broken bones were removed from the tibia and astragalus. During the progress of the case it became necessary to make several counter openings. Simple dressings were applied and stimulants and tonics were freely given for a considerable length of time. In May, 1863, the wound had entirely healed and the patient was gradually recovering the use of the ankle joint. On June 4, 1863, he was discharged from service, having regained considerable motion of the joint." He subsequently became a pensioner and entered the National Military Home in Ohio, where he was examiued at successive intervals by the Dayton Pension Board, who certified to the ball having passed through the ankle, aud described the foot and ankle as being in very good condition, but the joint as partially anchylosed and about one-half inch shortened. The pensioner was paid December 4, 1880. Case 820.—Private J. H. Noble, Co. A, 20th Massachusetts, aged 32 years, was wounded and captured at the battle of White Oak Swamp, June 30, 186*2. He remained a prisoner for three weeks, and was then exchanged and conveyed to Balti- more, where he entered Camden Street Hospital. Acting Assistant Surgeon E. G. Waters reported: "The injury was caused by a musket ball, which entered the flexure of the left ankle joint in the median line of the leg, passed downward and backward and emerged posteriorly, to tbe left and one inch above the insertion of the tendo-achillis, completely disorganizing the joint. The patient was admitted in a very prostrated condition. An anterior splint and water dressings were applied, it being deemed advisable to attempt to save the foot. On August 21st the necrosed extremity of the tibia and upper surface of the astragalus were removed with a gouge. At this time a finger could be pressed through the joint and no cartilage could be felt in the line of its passage. On October 20th the splint was removed from the leg and poultices were applied to promote exfoliation. On November 1st a part of the calcaneum and astragalus were removed, and a sinus extending downward from the internal malleo- SECT. VI.] SHOT FRACTURES OF THE ANKLE JOINT. 581 Ins was laid open. The patient subsequently experienced an attack of erysipelas. There was much thickening, but it rapidly yielded to camphor and mercurial ointment. By January 22, 1863, all discharge had ceased and the case promised to leave an anchylosed joint but a serviceable foot. Though not more than three or four such cases have been under treatment, it is deemed proper to state that this is the only attempt that has been made in this hospital to save a foot after gunshot comminution of the joint, and it is gratifying to know that it has resulted successfully." The removed portions of the bone, comprising twenty small necrosed fragments, were contributed to the Museum by Surgeon A. B. Hasson, U. S. A., iu charge of the hospital, and constitute specimen 424 of the Surgical Section. The patient was discharged from service March 23, 1863, and pensioned. Examining Surgeon 0. S. Root, of Pittsfield, Mass., certified November 27, 1K5:!: ''The applicant is walking on crutches, his limb being shortened one and a half inches and the ankle stiff. He cannot get the heel to the ground. The wound has recently broken open and many pieces of bone have come out," etc. The Hartford Examining Board described the injury December 1, 1875, and reported: "The great toe drops and tbe second and third toes override it. He has no power over the great toe; has a very perceptible limp in walking, and is obliged to use a cane. The ankle is completely anchylosed, the leg much atro- phied and two inches smaller than the other. The leg swells and is painful after using it." In September, 1878, the same board reported that the parts " broke out again and discharged last July, confining him to his bed several weeks. The pensioner com- plains of more or less constant pain in the leg, and if he uses it much it swells and becomes painful so that he is unable to sleep. He still has to use a cane. The leg is worse than useless." The pensioner was paid September 4, 1880. Case 821.—Private E. P. Dutton, Co. H, 2d U. S. Sharpshooters (subsequently transferred to the 4th Vermont), aged 18 years, was wounded in the left ankle, before Petersburg, October 13, 1864. He passed through various hospitals, lastly entering Sloan Hospital, Montpelier, on April 30, 1865. Surgeon H. Janes, U. S. V., in charge of the latter, contributed the photograph represented in the annexed cut (FlG. 331), with the following report: " Gunshot wound of ankle joint by a mini6 ball, which entered two inches posterior to the internal malleolus, wounding the tendo-achillis, passed forward and outward, and lodged (as the field surgeon stated) in the ankle joint. The missile was removed the next day. No fragments of bone came away then or subsequently. For about three months the discharge was profuse, offensive, and at times dark colored, after which it gradually diminished. The original wound healed in about four and a half months. Abscesses formed between the ankle and tbe tendo-achillis on each side, which continued to discharge after the wound had healed. About January 1, 1865, the parts became gangreu- ous, which was checked by the use of nitric acid and bromine in the course of a week, the ulcers healing about two months afterwards. When discharged from service, June 14, 1865, the patient was in good health and able to fully extend the foot, but unable to flex it beyond a right angle. He could walk a mile or two without difficulty, but on going too far he felt FjG 331._Appearance ofTeft leg six paiu in the joint. There was also some tenderness at the tibio-tarsal articulation." Exam- months after shot wound of ankle joint. iner L. J. Alleman, of Boone, Iowa, certified to the injury and reported: "Contraction of *■ romBP oo&rap -J tendo-achillis and flexor muscles of first and second toes, drawing them inward and upward and deforming the first and second joint of the first toe; indolent ulcer below the external malleolus, and another above the inner malleolus starting from the edge of the wound. Inability to walk on injured foot in consequence of said condition, and disability equal to loss of foot." The pensioner was paid June 4, 1880. Case 822.—Private G. F. Durkee, Co. B, 9th Vermont, aged 28 years, was wounded in the left ankle during the engage- ment at Newport Barracks, February 2, 1864, and entered Mansfield Hospital, Moorehead City, four days afterwards. Surgeon J. B. Bellangee, U. S. V., in charge, reported the injury and added that the internal malleolus was fractured; also that he removed the comminuted bone two days after the patient's admission. The patient subsequently passed through various hospitals, and on December 14, 1864, he was assigned to the Veteran Reserve Corps. Surgeon H. Janes, U. S. V., in charge of Sloan Hos- pital, Montpelier, contributed a photograph of the case (Card Photographs, Vol. Ill, p. 44), with the following history: "The wound was caused by a minie* ball, which entered at a point just external and above the internal malleolus, passed directly downward and emerged at the inside of the sole of the foot, fracturing the tibia and opening the ankle joint. The patient stated that a number of pieces of bone were removed at first, and that several necrosed pieces came away afterwards. At the time of the injury he was in excellent health, and his appetite continued pretty good all the time. At first suppuration was profuse; large abscesses formed in the leg and he became much prostrated. Free incisions were made and cold-water dressings were applied. About April 1st the wound began to improve. It gradually but steadily grew better, and finally closed about the middle of July. He was not able to do without crutches until the latter part of September. After being transferred to the Veteran Reserve Corps he never had to be excused from duty on account of ill health or lameness. On September 14, 1865, when discharged from service, he could flex the foot on the leg to a right angle and extend it about ten degrees more. He was able to walk four or five miles a day, but the joint would swell after going any considerable distance. There was also some tenderness ou pressure about the joint." Various examining surgeons have certified to the injury and have stated that " tbe ankle joint is restricted in its motion;" also that there is a depression on the inner side of the foot, and that the leg is atrophied and shows several scars from abscesses. The pensioner was paid September 4, 1880. Case 823.— W. H. H. Shaw, a Confederate soldier (regiment not recorded), received a shot fracture of the ankle joint, at Chancellorsville, May 3,1863. He was admitted to the Richmond Confederate general hospital No. 24, from Camp Winder, August 1st. Two weeks later the wound was in a very bad state of gangrene, and nitric acid was used, also disinfectants, tur- pentiue, and coal tar, which were applied to the leg every day. Tonics and stimulants were administered. During the night of August 18th hsemorrhage took place, the patient losing one pint of blood. On the following day the anterior tibial artery was ligated. By September 8th the patient was improving very fast and the wound was healing. On September 15, 1863, when the patient was furloughed, the wound was nearly healed but he had no use of the foot. 58*2 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Case 824.—Private A. B. McDaniel, Co. I, 7th North Carolina, aged 34 years, was wounded and taken prisoner at Gettysburg, July 3, 1863. He was admitted to Chester Hospital two weeks after the reception of the injury, where the nature of the wound was not recorded. Three mouths afterwards the patient was transferred to Point Lookout Hospital, whence Act- ing Assistant Surgeon R. N. Wright made the following report: "The patient was admitted to this hospital with gunshot wound of left ankle joint. The wound was inflicted by a mini6 ball, which shattered the joint to a considerable extent, entering just above the external malleolus, passing obliquely downward and forward and fracturing the bones. A number of bony fragments have escaped from the openings and there has been considerable purulent discharge. Erysipelas made its appearance before the patient entered this hospital. At the present time, March 2, 1864, the wounds are healed and the patient is doing well but has very little motion in the joint." The man was forwarded to City Point for exchange the following day, March 3, 1864. The man being a Confederate soldier, no further history of the case could be obtained. In the next two cases the joint became firmly anchylosed, causing, in each case, the heel to be raised several inches and compelling the patient to walk on the toes: Case 825.—Sergeant T. B. Sturdivant, Co. B, 21st New York Cavalry, aged 39 years, was wounded in a cavalry skirmish near Halltown, March 24, 1864. Acting Assistant Surgeon J. H. Bartholf reported: "Gunshot fracture of left ankle joint by a rifled pistol ball, which entered the inner 6ideof the leg five inches above the ankle, going downward and outward and emerging one and a half inches below the ankle. The patient was admitted to Frederick from his regimental hospital at Halltown two days after the injury. His general condition was not good; pulse 140. He had much pain in the ankle, which, with the foot, was much swollen and of a glistening surface. Pus, retained superficially on the inner side of the leg, was emptied by slitting down two inches; and a few small bits of bone about the size of peas, which were felt by the finger within the lower wound, were removed. Pressure over the outer ankle evacuated pus mixed with a yellow, clear, glairy fluid from the lower opening. Poul- tices were applied to the wounds and a general supporting treatment was ordered; milk punch and morphia at night. Two days after his admission the patient was better in all respects, and by March 31st he had still further improved, the treatment being continued aud good food given. On April 4th the limb as well as the injured joint and the wounds were in a surprisingly good condition; redness and swelling gone; pain and tenderness of joint nearly gone; suppuration slight; nearly a correspond- ing improvement in patient's general condition. On April 28th a piece of bone about the size of a bullet, apparently from one of the tarsal bones, was removed, after which the condition of the foot and ankle improved very much. The patient was now able to sit up all day, and from this time he went on exceedingly well, being almost without pain or any trouble in the joint. He walked on crutches up to the time of his furlough on May 25th. When he returned from furlough in July he walked with a cane, the wounds having closed, leaving the ankle joint somewhat stiffened." He was subsequently transferred to Camp Parole, Annapolis, whence he was discharged May 2, 1865, and pensioned, Surgeon W. D. Stewart, U. S. V., certifying to "anchylosis of the ankle joint and extension of the foot" resulting from the wound. Examining Surgeon L. Darling, of Hammond Creek, Pennsylvania, October 7, 1874, certified to contraction of the gastrocnemius muscle and the tipping of the foot upon the toes, and added: "The pensioners health is very feeble; he is weak and emaciated and has disease of the lungs." Examiner N. Parker, of Wellsborough, Pennsylvania, reported, June 17, 1880: "The injured leg at the calf is three inches smaller than the Other; the weight is borne on the anterior part of the foot; pensioner quite lame. He states that nine months ago an ulcer formed at the outer side of the ankle and pieces of bone came out. There is slight inflammation and soreness at the site of the ulcer." The pensioner was paid September 4, 1880. Case 826.—Corporal C. B. Davis, Co. F, 9th New Hampshire, aged 23 years, was wounded and taken prisoner at Poplar Grove Church, September 30, 1864. He remained in captivity for nine days and was then paroled and conveyed to hospital at Annapolis, whence Acting Assistant Surgeon J. S. Fulks made the following report: "The patient came into my ward suffering from gunshot wound of the left ankle joint, inflicted by a minis' ball passing transversely across and producing compound comminuted fracture. Sloughing commenced and continued until the integument over a considerable space around the wound was destroyed. Strong solutions of nitrate of silver and permanganate of potash failed to arrest the sloughing, but this was successfully accomplished by the application of a concentrated solution of nitric acid. The wound is now (December 31st) progressing favorably and the patient will recover with anchylosis of the joint." The patient was subsequently transferred to Webster Hospital, Manchester, where he was discharged from service May 27,1865, and pensioned. Examining Surgeon T. Sauborn, of Newport, N. H., certified, August 2,1865 : " The fracture appears to have been a comminution. The tendo-achillis sloughed away aud the ankle is anchylosed. The toes point downward and the heel cannot be brought to the ground." Exam- iner W. W. Sleeper, of Salisbury, N. H., reported, September 5, 1873: "The ankle joint is deformed and stiff, causing the heel to be raised about four inches and obliging the pensioner to walk upon his toes. There is necrosis about the joint, which has discharged several pieces of bone but is now healed. The muscles of the leg are much diminished." Tbe deformity and anchy- losis of the joint continued at the time the last payment was made to the pensioner, on June 4, 1881. Of the ninety-nine fatal cases of shot fractures of the ankle joint treated conserv- atively, death was ascribed to pysemia in twenty-five and to tetanus in five instances: Case 8j7.—"Private J. Jiggen, Co. B, 10th Wisconsin, was wounded at Chickamauga, September 19, 1863, by a minte ball, which entered the inner side of the right ankle below the malleolus, passing through the joint and making its exit on the anterior portion of the instep. He was taken prisoner and remained within the enemy's lines until October 2d, when he came through and was admitted into the general field hospital of the 1st division, Fourteenth Corps. The appearance of the wound and limb was then healthy and considered favorable to recovery until October 14th, when the patient was attacked with rigors The limb also commenced to swell about this time, which was accompauied by a cessation of discharge. Poultices were applied to tlie wound and free incisions were made to favor the exit of pus. A stimulant and tonic treatment was administered and con- tinued up to the time of the patient's death, which occurred on October 20, 1863, with all the symptoms of pysemia. At the SECT. VI.] SHOT FRACTURES OF THE ANKLE JOINT. 583 Fio. 332.—Posterior view of the bones of the right ankle. Spec. 2188. Case 829.- FlG. 333.—Anterior view of the bones of the right ankle. Spec. 2188. post-mortem examination of the limb the astragalus was found to be fractured and the three cuneiform bones in a state of com- minution. The articulating surfaces of the tibia and fibula together with that of the astragalus were blackened and eroded, and the cuboid and cuneiform bones with the articulating portion of the astragalus were in a complete state of disintegration." The history was reported by Surgeon W. M. Wright, 79th Pennsylvania, in charge of the hospital. Case 828.—Private J. Conly, Co. A, 90th Illinois, aged 18 years, was wounded in the right leg, at Mission Ridge, November 25, 1863. He remained under treatment at a field hospital for four weeks, and subsequently he was an inmate of the Chattanooga gen- eral hospital urKil the following February, when he was transferred te hospital No. 1, at Nashville, burgeon C. W. Hornor, U. S. V., in charge of the latter, recorded the follow- ing description and result of the injury: "A gunshot fracture of tibia and fibula by a minie* ball, which entered three inches above the external malleolus, fracturing tlie bone, and passing downward and inward. The missile was removed at a point one inch internal to tbe inner malleolus, its presence being suspected only by the formation of an abscess over the seat of its lodgement a few days before its extraction. The patient died March 7, 18G4. At the post-mortem examination old and strong pleuritic adhesions were dis- covered at the apex of the right lung, which contained a few dormant tubercles; the remainder of the lung tissues were healthy. The bronchial mucous membrane was slightly inflamed. The heart was healthy and contained neither light yellow nor blood clots in its cavities, and the blood in the heart as well as in the vessels was remarkable for its fluidity. The liver was healthy and weighed four pounds and one ounce; spleen very soft and puffy and weighing eleven and a half ounces; kidneys healthy, the right one weighing five and a half ounces and the left one six ounces. The stomach and bowels were in a healthy condition. On examining the cranium the vessels were found very much' distended with blood. The arachnoid cavity contained serum; the organs otherwise were healthy." The bones of the injured ankle (Spec. 2188) were contributed to the Museum by Acting Assistant Surgeon H.C. May, and are represented in the wood-cuts (FiGS. 332, 333), revealing that the tibia was split into the joint and showing the fractured portions of the bones to be carious, the articulation being destroyed by suppuration. Private W. H. Perry, Co. C, 1st Massachusetts Heavy Artillery, aged 39 years, received a gunshot fracture of tbe right tibia and fibula, also flesh wounds of both lower extremities, and a wound of the thorax, at Spottsylvania, May 19, 1864. He entered Lincoln Hospital, at Washington, three days afterwards, where he died of pysemia May 30, 1864. The history, with the pathological specimen (No. 4580), represented in the accompanying cut (FlG. 335), was con- tributed to tbe Museum by Assistant Surgeon J. C. McKee, U. S. A. The specimen consists of the greater portion of the bones of the right leg, showing the fibula to be transversely fractured in the lowest fourth and the anterior portion of the tibia shattered into the ankle. < Case 830.—Corporal M. Martin, Co. D, 28th Massachusetts, aged 27 years, was wounded at Hatcher's Run, March 25,1865. Surgeon F. M. Hammond, 126th New York, reported his admission to the field hospital of the 1st division, Second Corps, with "shot wound of left foot." Ten days after the reception of the injury the patient was transferred to Douglas Hospital, Washington, whence Assistant Surgeon W. F. Norris, U. S. A., contributed the pathological specimen shown in the annexed wood-cut (FlG. 334), with the following history: "The wound penetrated the ankle joint. The ball entered in front, about midway between the malleoli, and made its exit posteriorly and a little above the external malleolus, comminuting in its course the lower ends of the tibia and fibula. There was marked constitutional disturbance, headache, high fever, rapid pulse, and loss of appetite. But little swelling or inflammation in the joint, however, took place, and not much discharge. The day subsequent to the patient's admission the joint was carefully examined, when both bones were found to be much comminuted and amputation was decided as the only resort giving a fair chance of recovery. The patient, however, positively declined all operative interference. Towards evening he had a slight chill. On April 7th there was nausea and vomiting, and on the following day he had three chills, followed by fever and profuse sweats. Nausea and vomiting continued, the fluid ejected being tinged with bile; the discharge from both wounds, however, retained its healthy appearance. On April 9th, 10th, llth, and 12th the patient had a chill each day, and on the latter day there was marked^ yel- lowness of the face and conjunctivae; slight cough and delirium. On April 13th there was another chill; pulse 110, respiration 38; severe pleuritic pain in the right side of the chest. Death occurred on April 14, 1865. Rigor mortis was well marked at the autopsy, also the yellow hue of the skin and conjunctivae. On opening the thoracic cavity nearly a pint of intensely yellow fluid was found in the right pleural cavity. Each lobe of the right lung presented numerous patches varying in size from half an inch to two inches in diameter, most of which on incision gave exit to pus; tbe left lung contained similar patches in both lobes. The spleen was much softened, being almost semifluid in consistence; liver enlarged but apparently healthy; other thoracic and abdominal viscera normal." The specimen (No. 253) consists of the astragalus and the lower halves of the tibia and fibula of the injured limb, the extremities of both bones of the leg being shattered. Case 831.—Private G. Abbott, Co. K, 9th Minnesota, aged 39 years, was wounded in tbe left foot, at the battle before Nashville, December 15,1864, and admitted to hospital No. 8 the same day. Two days afterwards the patient was placed under the influence of chloroform, when the wound was examined and ascertained to have been caused by a minie* ball, which entered at the outer aspect of the instep, passed inward aud upward, and emerged one inch below the inner malleolus, badly fracturing Fir?. 334 .-Shat- tered bones of the left ankle joint. Spec. 253. PIG. 3.15.—Tibia shattered into the right ankle joint.— Spec. 4580. 584 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the cuboid, scaphoid, and head of astragalus, and channelling a large passage through these bones. The patient being a robust man, it was thought advisable to attempt to save the limb and to trust to nature to repair the injury. Irrigation was found serviceable to keep down and control the inflammation, swelling, and pain. The discharge was limited for some days, but pro- fuse towards the last. On December 28th an abscess over the inner malleolus was opened, causing a free evacuation of pus. Two days later suppuration was free from the posterior part of the leg as well as about the foot. Lead wash and tight band- aging was applied. From December 30th the patient commenced to fail. He became very icteric in appearance, his pulse rapid, and the discharge from the wound unhealthy. On January 2d he was delirious, and on the following day, January 3, 1865, he died. At the autopsy all the internal organs were found remarkably healthy. The ankle joint was filled with pus and there were sinuses extending up the leg. The capsular ligament of the ankle joint was found to be nearly destroyed, and the articu- lar extremities and surfaces of the bones were eroded. The history, with the specimen (No. 3755), consisting of the calcaneum, the fractured astragalus, cuboid, and scaphoid bones, was contributed by Acting Assistant Surgeon H. C. May. In one of the ninety-nine fatal cases of shot fracture of the ankle joint the tibial artery was ligated, in another the femoral: Case 832.—Private W. Lazier, Co. M, 5th Artillery, aged 25 years, was wounded in the right ankle joint, at Brandy Station, August 1, 1863, by a bullet, which entered close to the anterior edge of the internal malleolus, slightly comminuting it. On the following day he was conveyed to Douglas Hospital at Washington. The missile was supposed to have lodged, there being no external wound of exit and the patient not being aAvare of it having been removed. On the next day Assistant Surgeon W. Thomson, U. S. A., in charge of the hospital, etherized the patient and explored for the missile, but it could not be found. The comminution was so slight that it was deemed possible to save the foot with the aid of free incisions should they become necessary. A prescription consisting of two drachms of fluid extract of rhubarb, one scruple of quinine, and three ounces of whiskey was ordered, on August 5th, to be given in teaspoonful doses every four hours. Dead bone having been felt with the probe, and the inflammation becoming so extensive and severe as to render operative interference necessary, two large incisions were made at the sides of the internal malleolus on August 8th, by Acting Assistant Surgeon C. Carvallo, and several loose frag- ments of bone were extracted. On this day the patient also had a chill of ten minutes' duration, and one-half drachm of quinine dissolved in four ounces of whiskey was prescribed to be taken in tablespoonful doses. On August llth the inflammation became erysipelatous, involving the leg below the knee, and there was another chill. The quinine and whiskey mixture was then repeated and tincture of iodine was used to the limb, after which a wash consisting of one-half ounce of muriate of ammonia, ten grains of acetate of morphia, two ounces of sulphuric ether, and one pint of water, was applied over it. On August 13th there was still pain, swelling, and redness, and another chill of fifteen minutes' duration took place. Fluctuation was well marked, and incisions were made to give free exit to pus. In addition to the quinine, tablespoonful doses of a mixture of two drachms of muriated tincture of iron, two ounces each of spirit of Mindererus and water, and half an ounce of simple syrup, were administered three times a day. On August 15th, incisions were again required over both malleoli and another on the calf of the leg to allow accumulated pus to discharge. The patient's condition was now too much depressed to allow an amputation. Two days later pleurisy developed, which was treated by counter-irritation of turpentine and alcohol fomentations to the breast, and mustard poultices. On August 18th the limb had grown very red, swollen, and painful as high as the knee, and, fluctuation being felt, another incision was made by Dr. Carvallo, after which the leg was placed in a bran-box, and the wash, with one-half drachm of fluid extract of hyosciamus superadded, was re-applied. Haemorrhage from one of the incisions in the calf of the leg, and sup- posed to proceed from one of the muscular branches, came on one-half hour afterwards, when cold water, alum, and compres- sion was applied, and Hoffman's anodyne mixed with brandy and water was given every half hour. Haemorrhages recurred in the afternoon and evening, being decidedly arterial, and were checked by persulphate of iron applied with charpie. Though active interference was demanded, the undoubted disease of the lungs caused by metastatic abscesses from pyaemia, together with the very rapid and difficult respiration and the collapse of the patient from the loss of six or eight ounces of blood, made amputation impossible. The only other resort being ligation of the femoral, ether was carefully administered and that operation was per- formed at 9 p. M., at the point of election, by Assistant Surgeon Thomson, the leg being so distended Avith clotted blood as to make any effort to secure the divided vessels abortive. Tbe clots of blood were removed from the leg by compression, and after the operation the case was treated with the largest doses of stimulants, including aromatic spirits of amnlonia and fluid extract of senega. Though he reacted from the low state he Avas in before the operation, the patient gradually sank during the night and died at 8 A. M. on August 19, 1863. At the autopsy both lungs Avere found to be filled with metastatic abscesses; there was also effusion of serum in both thoracic cavities. No injured artery could be detected, nor could the missile be found. The detailed notes of the case were furnished by the operators. Dr. Thomson also contributed the bones of the injured ankle (Spec. 1682), showing the articular surfaces to be eroded by suppuration and the internal malleolus to be slightly fractured. Case 833.—Private W. Coakley, Co. K, 28th Massachusetts, aged 37 years, Avas Avounded before Petersburg, June 18, 1864, and admitted to the field hospital of the 1st division, Second Corps, Avhere Surgeon W. Vosburgh, lllth New York, recorded: "Shot wound of foot." Acting Assistant Surgeon E. C. Manoch reported the following description and result of the injury : "The patient entered the First Division Hospital at Annapolis June 21st. He was wounded by a piece of shell, Avhich Btruck the iuner aspect of the left ankle, fracturing part of the bones forming the joint. When first admitted the Avound Avas doing well. On June 25th he was isolated, at which time he complained of very severe pain over the Avhole foot, Avhich had become very much distended and increased in temperature. I ordered the parts to be painted with muriatic tincture of iron, also the tincture to be given internally, and Avhiskey and beef-tea. The next day the pain in the foot had grown very intense and the patient's face presented a very anxious appearance, he having passed a very restless night. On June 27th his general condition was the same; pulse rapid and Aveak. The skin at the external front of the ankle noAV presented a purple appearance, being soft and fluctuating on pressure. An incision gave exit to several ounces of foul pus, after which charcoal aud yeast poultices were applied. Iu the evening the discolored part assumed a decidedly gangrenous appearance. The patient sank rapidly notAvithstandiug the strong stimulation Avith plenty of beef-essence, and he died early in the morning of June 29, 1864." SECT. VI.] EXCISIONS AT THE ANKLE JOINT. 585 Case 834.—Dr. D. A. Hoffman, pension examining surgeon at Oskaloosa, Iowa, reports that "Brigadier General S. A. Rice, U. S. V., Avas wounded at the battle of Jenkins's Ferry, April 30, IK>1, a ball entering the external malleolus of the right ankle, carrying with it a portion of his spur and strap, and passing through the ankle joint. I learned from the surgeon Avho accompanied him that previous to his return home he had several attacks of erysipelas On June 1st I examined him and found him suffering with pysemia and an unhealthy condition of the system generally, and the Avound discharging unhealthy pus. On June 15th the patient had another attack of erysipelas in the Avound. During the treatment of the case several pieces of bone were removed. Despite all remedies he gradually grew worse, and died July 6, 1864." EXCISIONS AT THE ANKLE JOINT FOR SHOT INJURY.—During the Amer ican civil war thirty-three excisions at the ankle joint for shot injuries were performed.1 The results in two cases were not ascertained; twenty-two patients survived the operation and nine died, a mortality rate of 29.0 per cent. As indicated in the following table eleven were primary, eight intermediary, and nine secondary operations; in five either the date of injury or operation, or both, could not be ascertained. Table LXXXVIII. Numerical Statement of Thirty-three Excisions at the Ankle Joint for Shot Injury. PARTS EXCISED. End of the Fibula......................... End of the Tibia.......................... Ends of the Fibula and Tibia..........___ Astragalus................................ Portion of the Fibula and Astragalus....... Portion of the Tibia and Astragalus........ Portion of the Fibula, Tibia, and Astragalus Bone not specified.......................... Aggregates It is noticeable that although excision at the ankle joint had been performed'in the latter part of the last century by the elder Moreau,2 and had frequently been repeated, for simple and compound fractures or caries, in the early part of the present century, the operation, prior to the breaking out of the War of the Rebellion in 1861, had only been done three times for shot injuries.3 The first operation was performed in the English army during the Crimean War; the lower end of the fibula was excised and the case terminated in recovery; no details are recorded.4 The second was performed, May 30, 1859, by Von Langenbeck on a Russian General wounded at the Alma, September 20, 1854, in the left ■From the records it would appear that the first excision of the ankle joint during the American civil war was performed by Assistant Surgeou J. S. BILLINGS, U. S. A., on January 6, 1862, for an axe wound involving the external malleolus and the scaphoid bone. The case will be detailed in the next chapter. The first total excision of the ankle joint for shot injury was performed by Surgeon E. Bentley, U. S. V., on October 9, 1862, in the case of Private J. Brennan, lfith West Virginia. Details of the case will be given hereafter. 2JEFFRAY (JAMES), Cases of the Excision of Carious Joints by H. PARK and P. F. MOREAU, with observations, Glasgow, 1806, p. 140, Case V. On April 15, 1792, the elder MOKEAU excised tlie ends of the tibia and fibula and the articulating surface of the astragalus for caries in the case of M. Lucot, who walked without any assistance whatever nine months after the operation. 3The case related by Fauue (L'amputation etant absolument necessaire dans les plaies compliquies de fracas des os, etc., in Prix de VAcadimie Royale de Cliirurgie, Paris, 181!), T. Ill, p. 1352) and cited by CULBEltTSO.v (Excision of the Larger Joints of the Extremities. Prize Essay. Trans. Am. Med. Assoc, Philadelphia, 1876, Supplement to Vol. XXVII, p. 280) and others as the first instance of excision nt the ankle joint, can only be regarded as an instance of expectant conservative surgery. The articular surfaces of the tibia, fibula, and astragalus were fractured by shot at tlie battle of Fontenoy, May 11, 1745, in a soldier named Charles d'Amiens. Dr. Head examined the wound and proposed to amputate the leg, but desisted at the urgent request of the patient. He then removed the detached portions of the tibia, fibula, and astragalus, placed the foot in proper position and secured it by a suitable apparatus. The patient recovered with good use of limb in about four months. 4Mattiiew (T. P.) Med. and Surg. Hist, of the British Army which served in Turkey and the Crimea, etc., London, 1858, Vol. II, in tabular statement on page 368 and brief reference on p. 379. Surg. Ill—74 OPERATIONS. Cases. Primary. INTER-MEDIARY. Secondary. TIME NOT Specified. ■a o'g ■a T3 >> B ^.2 b S * >> >» s *3 c det rtal terr cas 0) 0 "5 •0 ases eoov a 0 — S 0> s 0 a c a H PS Q £ :S-« 0 M « t> O j « Q 0 PS u 0 PS P 12 10 2 16.6 5 3 2 4 4 2 2 1 1 2 4 5 2 2 5 2 2 5 1 2 0 1 I 2 1 1 j 2 50.0 1 1.... 1 2 1 1 I 1 3 1 3 1 1 1 3 1 1 100.0 50.0 60.0 i|.... 1 2 2 1 1 2 I 1 11 1 21 1 i 1 1 1 _ 1 8 2 77 3 9 5 4 5 4 1 33 22 9 2 29.0 586 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. ankle; the astragalus and the internal malleolus were removed by subperiosteal resection; the patient recovered without shortening of the limb; the joint became anchylosed.1 The third was performed on a soldier wounded at Solferino, June 24,1859. J. Neudorfer, several months after the injury, excised the roughened bony surfaces and several osteophytes that impeded the motion of the joint; the patient recovered rapidly with a useful limb.2 Primary Excisions at the Ankle Joint.—A complete excision of the ankle joint, in which portions of all the bones forming the articulation were removed, was performed in one only of the eleven primary operations; the patient recovered. The articular end of the fibula was excised in five cases, of the tibia in two, of the tibia and fibula in one, and of the astragalus in one; in the remaining case the portions removed were not indicated. Eight patients recovered, two died; the result in one case could not be ascertained. Details of the cases are subjoined: Case 385.—Private T. Bell, Co. H, 60th Illinois, aged 19 years, was wounded in the left ankle during the engagement near Marietta, July 4,1864, by a mini6 ball, which fractured the lower end of the fibula. He Avas conveyed to the field hospital of the 2d division, Fourteenth Corps, where the excision was performed. The patient passed through different field hospitals and subsequently through various general hospitals. Surgeon B. B. Breed, U. S. V., in charge of hospital No. 1, Nashville, in reporting the case described the operation of excision as having involved the removal of three inches of bone from the fibula. Acting Assistant Surgeon W. Sturgis reported that when the patient entered Camp Butler, December 5th, his general health was bad. Erysipelas supervened, which Avas treated locally by linseed poultice and iodine, and internally by quinine, tincture of chloride of iron, etc. The patient Avas ultimately discharged from service June 29, 1885, and pensioned. Examining Sur- geon J. Robbins, of Quincy, Illinois, certified, June 30, 1865: "A ball passed through the leg antero-posteriorly, just above the external malleolus, shattering the fibula and severing the tendo-achillis. Three inches of the lower extremity of the fibula have been removed, and complete anchylosis as well as the loss of bone and tendon render the limb useless." Numerous subsequent examiners have corroborated Dr. Robbins's certificate. The pensioner was paid September 4, 1880. Case 836.—Private B. B. Evitts, Co. I, llth Connecticut, aged 23 years, Avas Avounded in the left ankle, before Peters- . burg, June 18, 1864. He was conveyed to hospital at Fort Monroe, thence to McDougall, New York Harbor, and lastly to Brattleboro.' Acting Assistant Surgeon N. G. Brooks, in charge of the latter hospital, reported the man's admission, August 6th, with " shot fracture of tibia, followed by excision of the internal malleolus the day after the injury and favorable progress subsequently." The patient was transferred to the Veteran Reserve Corps February 11, 1865, and five months later he Avas mustered out of service and pensioned. Examining Surgeon C. B. Maltbie, of Falls Valley, Connecticut, June 28, 1868, cer- tified : " The pensioner was wounded by a minie" ball entering the ankle joint from the tibial side and lodging therein, from Avhere it Avau extracted. The injury rendered the joint stiff and incapacitated the man for manual labor. Use of the limb caused the wound to reopen last season and to discharge freely." No changes were reported at subsequent examinations. This pensioner was killed by falling from a locomotive engine July 19, 1875. Cask 837.—Private J. W. Bloyd, Co. H, llth West Virginia, aged 18 years, Avas wounded in the left ankle during the fight at New Creek, August 4, 1864. He Avas conveyed to the Post Hospital at New Creek, where partial excision of the joint was performed, on August 5th, by Acting Assistant Surgeon W. B. Crain, who reported the folloAving description of the injury: "A conical ball penetrated the tissues on the outer aspect of the leg, one and a half inches above the external malleolus, fractur- ing the fibula and burying itself in the ankle joint between the astragalus and the tibia. The articular surface of the astragalus Avas considerably comminuted, and that portion of the articular surface and cancellated structure of the tibia external to the groove of the flexor longus pollicis was also badly comminuted. The external surface Avas apparently uninjured. The opera- tion Avas performed by slightly enlarging the wound on the outer aspect of the leg, Avhere three large spiculse were removed from the fibula. The ball and all the loose fragments were then extracted, and the rough spiculae of the fractured portion of the tibia and astragalus Avere gouged and chiseled out. The constitutional state of the patient at the time of the operation was in every respect favorable, and the limb was but little swollen, but very painful. The patient did well until August 27th, at which time he began to suffer very much from pain, owing to a great accumulation of pus in the joint. To relieve this and to insure a free and constant outlet a large-sized seton was introduced into the wound in the outer aspect of the leg, carried obliquely between the articular surfaces of the tibia and astragalus and passed out in front of the external malleolus. An apparatus similar to Smith's anterior splint Avas also adjusted to the limb in order to insure greater comfort." After he became convalescent the patient was transferred to hospital at Cumberland, where he Avas discharged from service May 6, 1865, and pensioned. Dr. J. C. Hupp, of Wheeling, and other examining surgeons have, at successive periods, certified to the injury. In 1873, the injured ankle and also the lower third of the leg was reported as being enlarged, the extensors of the foot as acting imperfectly, etc. Subsequently the mobility of the ankle joint was described as impaired. The pensioner Avas paid June 4, 1880. Case 838.-Captain A. F. Miller, Co. K, 48th NeAV York, aged 38 years, Avas wounded in the right ankle, at Cold Har- bor, June 2, 1864. He Avas admitted to the field hospital of the 3d division, Sixth Corps, and thence, several days aftenvards, to the Seminary Hospital at GeorgetoAvn. Surgeon H. W. Ducachet, U. S. V., in charge of the latter hospital, reported that the patient obtained leave of absence on June 13th and proceeded to his home. On January 13,1865, the patient was discharged 1 VON LANGENBECK (B.), Ueber die Schussfracturen der Gelenke und ihre Behandlung, Berlin, 1868, p. 46, and ttUKLT (E.), Die Gelcnk-Rcsec- tionen nach Schussverletzungen, Berlin, 1879, p. 133. 'NeudSbfer (J.), Die Endresultate der Gelenkresectionen, In Wiener Medicinische Presse, 1871, Jahrgang XII, p. 405. sect, vr.] PRIMARY EXCISIONS AT THE ANKLE JOINT. 587 from service and pensioned. Dr. G. T. Stevens, formerly Surgeon 77th New York Volunteers, subsequently contributed the following description of the injury and resection of the ankle, which he performed: "The wound Avas caused by a minie ball, which penetrated the ankle, entering just behind the outer malleolus, passing nearly through the bones, and lodging in the inner side of the tarsus. The os calcis and astragalus Avere badly shattered. Two days after the reception of the injury the patient was brought ander the influence of chloroform Avith intent to amputate; but after carefully inspecting the Avound it was decided to attempt to save the foot. The wound Avas then enlarged by crucial incision, splinters of bone Avere removed, and the ball, which laid in the inner side of the ankle, Avas extracted. The shattered fragments of the os calcis and astragalus Avere then removed by a gouge and bone nippers, the Avound was draAvn together and water dressings Avere applied. On June 6th the patient Avas transferred to White House Landing in an army wagon, Avhere he remained three days. Thence he Avas taken to Washington, and a Aveek aftenvards he went to his home in Brooklyn. Water dressings were continued. Exteusive suppura- tion took place, and several deep incisions Avere made near the ankle. In about four weeks a considerable piece of dead bone came aAvay, after which improvement was rapid. In injecting fluids into the original wound they passed freely through the ankle, coming out at an opening on the opposite side. In the course of eight weeks the patient was able to Avalk Avith crutches and from that time his recovery was rapid. He now (March 9, 1868) Avalks with little difficulty and there is no anchylosis." The Brooklyn and Boston Examining Boards in 1874, 1875, and 1877, respectively, certified to "anchylosis of the ankle joint, tendons bound down," etc. The pensioner Avas paid June 4, 1880. Case 839.—Private I. Ostheimer, Co. F, 66th New York, aged 31 years, Avas wounded in the right leg, at Antietam, September 16,1862, and admitted to a Second Corps field hospital. Surgeon C. S. Wood, 66th New York, reported: "A minie" ball struck the tibia anteriorly about four inches above the malleoli, shattering the bone. The fibula and bones of the foot Avere uninjured. I performed resection of the lower four inches of the tibia, removing the bone from the articulation, after which splints were applied to th'e leg; case sent to General Hospital." Acting Assistant Surgeon A. V. Cherbonnier recorded the patient's admission to hospital No. 5, at Frederick, where a large sequestrum Avas removed on November 22d, also that a large portion of the diseased tibia Avas resected on December 2d. About two Aveeks afterAvards the Avound assumed a healthy appear- ance, and by December 28th it was filling up with healthy granulations, the patient being cheerful and feeling well. On the next day he was transferred to hospital No. 1, Avhere he remained until the folloAving June, Avhen he was sent to Patterson Park (Con- valescent) Hospital at Baltimore. On August 10,1863, the patient Avas returned to his command for duty, and while in the field he again came under the notice of Surgeon Wood, who made the folloAving supplementary report: "The man laid in hospital for seven months before he could move his leg. Being possessed of a good constitution and no untoAvard symptoms appearing, at the end of that time he began to walk a little, and now—eleven months after the reception of the injury—he has just been returned to duty. On examination a large cicatrix is found, the bone having refilled its entire length and uniting Avith the astragalus with a moveable articulation. Although less than usual, the bone is not quite so long as its fellow, allowing the foot to turn slightly inward. Otherwise he has a very useful limb. He cannot endure hard marches as well as formerly, and prob- ably never will. Still the case is one of interest, as not one in tAventy saves his limb after the receipt of a like injury." Accord- ing to information from the Adjutant General, U. S. A., this man has been reported as "missing in action" since the battle of Todd's Tavern, May 8, 1864. Case 840.—Private A. C. Rose, Co. H, 10th Illinois, aged 22 years, Avas wounded at Bentonville, March 21, 1865. Assistant Surgeon J. W. Brewer, U. S. A., reported his admission to the Seventeenth Corps Field Hospital Avith "shot fracture of left ankle," for which resection of fibula was performed by Surgeon W. A. Gott, 25th Wisconsin. From the field the wounded man was sent to Foster Hospital at New Berne, thence to McDougall Hospital at Fort Schuyler, and lastly, on August 18th, to DeCamp Hospital, David's Island. On September 23, 1865, the patient was discharged from service and pensioned, Assistant Surgeon W. Webster, U. S. A., in charge of the latter hospital, certifying to the disability resulting from fracture of the fibula. Examining Surgeon I. H. Euden, of Lacon, Illinois, Avbo examined the pensioner periodically, in 1866 described the injury as having been "followed by gangrene in the wound, Avhich caused necrosis of one-third of the bone. Ankle nearly immovable and painful." Some years later he stated that "about two inches of the bone had been removed. The cicatrix is large and firm, so much so that the circulation of the foot is impeded, causing varicose A'eins; it is also so tender that he cannot wear a boot or high shoe. The ankle joint is not free in its movements, owing to adhesions of the tendo-achillis to the heavy cicatrix, and becomes swollen and painful when used to any considerable extent." The pensioner was paid June 4, 1880. In the following three cases the limb was subsequently amputated, in two in the middle, in one in the lower third of the leg. Two of the patients recovered, one died: Case 841.—Sergeant M. G. Sparks, Co. I, 10th New Jersey, aged 25 years, Avas Avounded in the right ankle, before Petersburg, April 2, 1865. He entered the field hospital of the 1st division, Sixth Corps, Avhere Surgeon R. Sharpe, 15th New Jersey, recorded the injury as a "shot fracture of the fibula and tarsus," also that "resection of the fibula" was performed. The patient Avas subsequently transferred to the Depot Hospital at City Point, and from there, on April 12th, to Judiciary Square Hospital at Washington. Surgeon E. Griswold, U. S. V., in charge of the latter, reported that when the patient Avas admitted his constitutional state Avas not good and the injured parts-Avere in a bad condition, necessitating amputation, Avhich was per- formed by antero-posterior skin flaps at the middle third of the leg, on April 13th, by Acting Assistant Surgeon Z. P. Dennler. Chloroform and ether constituted the anaesthetic. After the amputation simple dressings were used and stimulants, etc., were administered. Subsequently the patient passed through various hospitals, and on February 2, 1836, he was discharged from service and pensioned. He was paid June 4, 1874, since Avhen he has not been heard from. Case 842.—Private S. H. Myers, Co. E, 75th Indiana, aged 20 years'was wounded, before KenesaAV Mountain, June21, 1864. He Avas admitted to the field hospital of the 3d division, Fourteenth Corps, Avhere Surgeon F. Lloyd, U. S. V., recorded: "Shot fracture of left ankle; resection of two inches of tibia and fibula." One week afterwards the Avounded man Avas sent to the General Field Hospital at Chattanooga, whence Assistant Surgeon C. C. Byrne, U. S. A., reported that amputation became necessary, and was performed by the circular method at the loAver third of the leg by Acting Assistant Surgecn G. E. Stubbs, 588 INJURIES OF THE LOWER EXTREMITIES. CHAP. X. on June 30th. The patient's subsequent progress was fair, the treatment consisting of water dressings, tonics, and stimulants. About two Aveeks after the amputation he was transferred to hospital at Nashville, and lastly he was admitted to Ekin Barracks, Indianapolis, where he Avas discharged from service March 7, 1865, and pensioned. In his application for commutation he stated that the first operation (meaning that of resection) Avas performed by Surgeon C. N. Fowler, 105th Ohio, five hours after the reception of the injury. The pensioner died April 12, 1872. Case 843.—Private G. W. Velic, Co. C, 24th Michigan, aged 28 years, was wounded at Cold Harbor, June 3, 1864. He entered the field hospital of the 4th division, Fifth Corps, Avhere Surgeon C. N. Chamberlain, U. S. V., recorded: " Severe shell wound of ankle joint; excision of lower end of fibula." Ten days after the date of the injury the Avounded man Avas transferred to Armory Square Hospital, Washington, where Surgeon D. W. Bliss, U. S. V., subsequently amputated the limb and recorded the result of the case as follows: "The injury Avas a lacerated Avound of the right ankle, the outer malleolus being shattered and the joint opened. On June 28th the leg was amputated at the middle third. The circular flap operation Avas performed, the patient being under the influence of chloroform. On July 3d there was sloughing and sanious discharge from the stump. By July 12th there Avas hospital gangrene, which rapidly extended to the knee and was treated with nitric acid and yeast poultices. The patient died July 18, 1864." Case 844.—Private J. Durst, Co. D, 148th Pennsylvania, aged 24 years, was wounded iu the left lower extremity, at Gettysburg, July 2, 1863, and admitted to the field hospital of the 1st division, Second Corps. Surgeon C. S. Wood, 66th New York, reported: " The lower portion of the fibula was shattered by a minie" ball, and resection was performed of the articulation of the bone about four inches in length. The tibia remained sound. A splint was applied to the outer portion of the leg, and cold-water dressings. The case continued to do well, with a fair prospect of getting ultimately a very good limb." Three weeks after being wounded the patient Avas transferred to the Cotton Factory Hospital at Harrisburg, where Acting Assistant Surgeon W. S.Woods noted the case as one of "exsection of the left ankle joint," and recorded the following termination: "The patient, a man of irritable and nervous temperament, was suffering severely from the wound Avhen admitted. There was considerable sloughing of the wound at the time, attended with deep-seated suppuration. Several spiculse of bone Avere taken out. For a time the leg was placed in a cushioned box splint and the usual simple cerate and cold-water dressings were applied twice each day. The weather becoming unusually warm it Avas found necessary to suspend the leg in a cot splint, which proved to be far more comfortable. The same treatment was continued, a tonic course and liberal diet being allowed. By August 13th the wound granulated nicely and the patient Avas considered as doing well. He improved slowly until September 19th, when he had a severe chill, also pain in the inguinal glands, followed by traumatic erysipelas. For the first two days antiphlogistic remedies Avere advised, which Avere followed by quinine and whiskey. The leg was washed with glycerine and iodine. The case resulted fatally on October 6, 1863." Case 845.—Private J. Radford, Co. F, 14th Virginia, received a gunshot Avound of the ankle joint May 9,1864. Excis- ion of the joint Avas performed on the following day, and the patient Avas subsequently transferred to General Hospital. The report of the case was contributed by Dr. H. L. Thomas, late Surgeon P. A. C. S., who obtained the record of the injury and operation from the notes of Confederate Surgeon J. S. Pride, Battle Hospital, Dublin Depot. Intermediary Excisions at the Ankle Joint.—Of the eight excisions of this group five were successful, three fatal. In one case portions of the astragalus were excised, in one the extremities of the tibia and fibula, in four the extremities of the fibula, and in two the surfaces of the three bones forming the articulation were removed: Case 846.—"Private J. Brennan, Co. K, 16th West Virginia, aged 18 years, was admitted to hospital at Alexandria on October 6, 1852, with a wound of the right ankle joint, received accidentally the night previous. On examination it Avas found that a pistol ball had entered the ankle three-fourths of an inch posterior and inferior to the internal malleolus, passed forward and upward, rupturing the capsular ligaments and cutting its way betAveen the articular surfaces of the tibia and astragalus and lodging within the joint. He was in good health at the time of the injury and evidently suffered no great amount of pain. He Avas freely purged and a light and nutritious diet enjoined. The question of procedure was exceedingly perplexing. The single Bmall bullet hole and the slight local and constitutional symptoms presented a case apparently Avell adapted to the performance of resection, while the Avant of success attending this operation was a serious argument against its performance. It was decided, however, to resect the joint, Avhich Avas done on October 9th. The patient being under the influence of chloroform, tAVO lateral incisions were made about four inches in length, terminating three-fourths of an inch below the malleoli. The lips being drawn asunder, a chain saw was then applied to the tibia and about one-third of an inch of the extremity removed; the extremity of the fibula, on a level with the tibia, Avas removed through the opposite opening, and through the same aperture a portion of the articular surface of the astragalus Avas taken away. By this method the division of the extensor tendons and of the anterior tibial artery Avas avoided. Tbe posterior tibial was uninjured. The incisions were closed with silver wire sutures, and the bones were held in apposition by means of adhesive strips extending down the sides of the leg and embracing the sole of the foot. Lateral splints of binders' board were applied. The haemorrhage was trifling, no vessels having to be tied. On the fol- lowing day there was considerable febrile excitement; pulse 100; skin hot and dry. Small doses of antimony and morphia were administered. On the next day the patient appeared more comfortable but complained of slight pain; pulse diminished in force and frequency. On October 12tb the patient was comfortable; skin cool and moist; pulse 80 per minute. Discontinued the medicine. On October 13th suppuration was established and the patient was comfortable; limb suspended by means of Smith's anterior splint; lateral splints retained. From this time the dressings were daily removed. By October 16th the patient was doing well and the wound was discharging freely; diet light, though nutritious. Four days later he began to take solid food. On October 27th the incisions were filled with granulations. The dressings were continued to November 25th, when Smith's splint was removed, the literal splint being still applied. The patient remained in bed until December 20th, when he SECT. VL] INTERMEDIARY EXCISIONS AT THE ANKLE. JOINT. 589 began to move about on crutches. The lateral splints were removed in the early part of February, at which time he moved about freely and Avith little embarrassment. In dressing, the toes of the injured side Avere extended so as to be ou a line with those of the sound side. The advantage of this is apparent when a shoe with a high heel is worn. The elasticity of the instep thus brought into play compensates in a great measure for the anchylosis." The case is reported by Surgeon E. Bentley, U. S. V. The subsequent records in the case show the patient was mustered out at the expiration of his term of service, June 16, 1863. There is no record of his ever having applied for pension. Case 847.—Private N. Lloyd, Co. I, 29th Pennsylvania, aged 38 years, was wounded in the left ankle, at Gettysburg, July 1, 1863. He Avas admitted to the Twelfth Corps field hospital, where Surgeon H. E. Goodman, 28th Pennsylvania, noted that an excision at the lower third of the fibula was performed on July 12th by Surgeon J. A. Wolf, 29th Pennsylvania. Three weeks after being wounded the patient Avas transferred to Camp Letterman, several months later to hospital at Baltimore, and subsequently to Philadelphia. Acting Assistant Surgeon W. V. Keating reported his admission to Broad and Cherry Streets Hospital, December llth, and described the injury as "a compound gunshot fracture of the external malleolus opening the ankle joint, followed, apparently, by resection of a very small portion of the malleolus. The patient apparently did not get along very well. On his admission the tissues around the ankle joint were considerably swollen and there were symptoms of chronic arthritis. A sinus on both the inner and outer side of the ankle connected Avith the joint, Avhere the cartilages Avere found eroded and from Avhich a sanious discharge issued. On January 23, 1864, when the patient was transferred to Mower Hospital, the sAvelling around the joint had somewhat diminished and the sinus on the inner side of the ankle had healed, Avhile the one on the external side still discharged a slight amount of sanious pus." Surgeon J. Hopkinson, U. S. V., in charge of Mower Hospital, reported the result of the case as follows: "At the time of the patient's admission the wound was nearly closed, the joint stiff, the parts swollen, and circulation in the foot very feeble. The cold douche was used to the foot with marked benefit. By February 16th the foot Avas much better, the patient being able to place it on the floor and bear some weight on it. One month later the foot Avas rapidly improving and the treatment was discontinued." On April 20, 1H64, the patient Avas dis- charged from service. Examining Surgeon T. B. Reed, of Philadelphia, February 5, 1866, certified to " compound fracture of left ankle, shattering the outer malleolus and requiring exsection of the same. Permanent anchylosis of ankle. The greatly impaired use of the foot has produced subsequent irritation of the knee joint, with rheumatism. Is obliged to use a cane or crutch constantly. Amputation of the foot and the use of an artificial limb Avould be a great improvement to his present con- dition." Subsequent examiners substantially confirm Dr. Reed's report. The pensioner was paid September 4, 1880. Case 848.—Private D. Stottlemeyer, Co. K, 66th Ohio, aged 17 years, Avas wounded in the right ankle joint, at Cedar Mountain, August 9, 1862, and entered Fairfax Seminary Hospital several days afterwards. Surgeon D. P. Smith, U. S. V., reported that the patient Avas discharged from service October 9, 1862, by reason of "exsection of lower third of fibula, anchy- losis of ankle joint," etc. Examiner S. M. Smith, of Columbus, Ohio, certified, December 22, 1862: "He received a Avound in the right ankle, a musket ball entering the outer portion of the joint, embedding itself in the bones of the joint and fracturing them. Eleven days afterwards the missile and portions of bone Avere removed. At present there is great enlargement of the joint and foot, complete anchylosis of the joint, an open wound and necrosis of bone." Examining Surgeon W. S. Constant, of DelaAvare, Ohio, November 4, 1880, certified to the injury and reported as its result "an occasional suppurating wound of the ankle, partial anchylosis of ankle joint, and shortening of limb from contraction, so that he can walk only on the ball of the foot. The pensioner cannot walk any distance or do much manual labor." Case 849.—Sergeant A. M. Wright, Co. C, 80th Indiana, aged 23 years, Avas wounded in the left ankle, at Resaca, May 14, 1864. Surgeon E. Shippen, U. S. V., reported his admission to the Twenty-third Corps field hospital, whence the wounded man was transferred to hospital at Chattanooga and afterwards to hospital No. 15, Nashville. Surgeon W. M. Chambers, U. S. V., ir. charge of the latter hospital, described the injury and reported that "the bone Avas fractured and necrosed," necessitating "excision of two and a half inches of the lower end of the fibula, Avhich Avas performed on June 13th by Acting Assistant Sur- geon J. J. O'Riley. Gangrene ensued the day after the operation, but was stopped by applying bromine. Simple dressings were used and nutritious diet aud stimulants were administered." The patient subsequently was transferred to Joe Holt Hos- pital, and later to Lincoln Hospital, Washington. In the following March he was returned to duty, and on June 22, 1865, he was mustered out of service. Examining Surgeon H. M. Smith, of Vincennes, Indiana, March 31, 1877, certified: "I find on examination that the applicant received a Avound in the ankle joint. The ball penetrated the lower part of the external malleo- lus and passed through the head of the tibia, making its exit on the front part of the ankle, at which point a large cicatrix exists—as if caused by sloughing—resulting in adhesions of the soft parts and partial anchylosis of the joint," etc. The pen- sioner was paid June 4, 1880. In the following instance gangrene appeared three months after the excision, and amputation was performed in the middle of the leg: Case 850.—Private F. Thorn, Co. D, 63d Pennsylvania, aged 28 years, was wounded in the left lower extremity, at the Wilderness, May 5, 1864. Surgeon O. Evarts, 20th Indiana, reported his admission to the field hospital of tbe 3d division, Second Corps. Three weeks after the reception of tbe injury the wounded man entered Emory Hospital, Washington, Avhere be underwent the operation of excision at the hands of Surgeon N. R. Moseley, U. S. V., Avho reported that "the injury con- sisted of a gunshot wound of the left ankle, the bones being comminuted and the soft parts lacerated, but in a favorable condition. On May 26th chloroform and ether was administered, and resection of the lower third of the fibula Avas performed. The parts Avere kept in coaptation by adhesive straps, and cold-water dressings were used." According to a subsequent report the patient obtained a furlough on July 16th and left the hospital for his home in Erie, Pennsylvania, where "Dr. R. Faulkner amputated the leg at the middle third, on August 17th, by reason of gangrene." Several months later the patient, who had in the mean- time been assigned to the 105th Pennsylvania Volunteers, returned, and was transferred to Judiciary Square Hospital. After being supplied with an artificial leg he was discharged from service March 18, 1865, and pensioned. He Avas paid March 4, 590 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. 1880. Five small fragments of the fibula, removed at the first operation by Surgeon Moseley, and contributed by him to the Museum, constitute specimen 2362 of the Surgical Section. Three of the eight intermediary excisions at the ankle joint proved fatal—two from pysemia and one from exhaustion: Case 851.—Private J. Davis, Co. L, 1st Michigan Cavalry, aged 18 years, Avas Avounded at Salem Church, May 28, 1864. Surgeon W. H. Rulison, 9th NeAv York Cavalry, reported his admission to the field hospital of the 1st division, Cavalry Corps, "Avith shot wound of left foot and hip." Surgeon J. A. Lidell, U. S. V., who operated in the case, made the following report: "The patient was admitted to Stanton Hospital, Washington, June 4th, Avith a gunshot wound of the left tarsus, inflicted by a mini6 ball, which struck the foot a little below the external malleolus and passed through the tarsus horizontally inward and somewhat backward, escaping a little beloAV and behind the internal malleolus. It occasioned compound comminuted frac- ture of the calcaneum, astragalus, and posterior edge of the external malleolus. At the time of the operation, June 10th, the ankle and foot were much swollen, inflamed, and very painful; the leg was also swollen. The edges of the orifices of both entrance and exit were pouting and exhibited no tendency to close; discharge thin and scanty. Since the patient came to Stanton Hospital the wound had been treated Avith ice dressings, but Avas manifestly growing worse. He now had a good deal of constitutional disturbance; pulse quick and ranging from 110 to 120; skin dry and too Avarm; countenance pinched and anxious; tongue coated, and appetite poor. He Avas also restless, got but little sleep, and his general condition Avas daily getting worse. Wishing to avoid secondary amputation of the leg if possible on account of the great fatality which had lately attended it, resection was performed of the anterior extremity and part of the external side of the calcaneum. Some fragments of the astragalus were also extracted, and a splinter from the posterior edge of the external malleolus. The incisions Avere made on the external side of the foot, from the .orifice of entrance, first, to the base of the metatarsal bone of the little toe; second, to the base of the external malleolus; third, to the point of the heel; and fourth, to the dorsum of the foot, two and a half inches. Sulphuric ether constituted the anaesthetic. There Avas no shock. Ice-water dressings were continued. On June llth the patient Avas cheerful and free from pain and the SAvelling and irritative fever had abated. He died of pyaemia on June 20, 1864. Autopsy: The ankle joint contained pus; the bones Avere partially denuded of their cartilage; muscles of leg infiltrated with pus. The left pleural cavity contained a large quantity of dark-colored effusion, and the left lung Avas compressed against the vertebral column; the inferior lobe contained an abscess about the size of an egg, Avhich was filled with dark-colored and offen- sive pus. The right lung contained several superficial abscesses and some patches of lobular pneumonia. Thrombi existed in the femoral vein." In his publication1 of the operation the operator furnished the folloAving supplementary details of the patient's progress, as Avell as of the autopsy, in addition to his comments on the case: After the operation "the limb was placed upon a Avire splint (Smith's) bent to a right angle, which Avas well padded and applied to the posterior part of the leg and sole of the foot, Avhere it was properly secured by roller bandages for the purpose of keeping the ankle joint in a fixed position. The Avound was plugged Avith lint and a full opiate was given. The constitutional treatment consisted in the administration of nutrients, tonics, and stimulants. On June 12th the patient had a severe pyaemie chill and sweat, and quinine in full doses was added to the treatment. On the next day he Avas much Avorse; .wound discharging a thin dark-colored pus; chills and sweats increasing in frequency and severity; complexion assumed a bronzed hue; breath bovine; body exhaling a sweet maAvkish smell; anorexia; debility; diarrhcea set in. Pneumonic symptoms also appeared, and a large proportion of blood Avas mingled with the sputa. He sank rapidly. At the autopsy the calcaneum Avas found to be fractured entirely through and its cancellous structure was gangrenous. The astragalo-scaphoid articulation contained pus and the articulating surface of its bones Avas entirely denuded of its cartilage. The connective tissue on the front of the leg Avas infiltrated with pus from the ankle joint upAvard to the extent of three inches, and the tibia and fibula were denuded of periosteum to the extent of tAvo inches. The liver and spleen were both enlarged aud softened, but the kidneys presented a normal appearance. There Avere clots in both ventricles of the heart. Comments: In this case also osteomyelitis supervened, Avhich Avas conclusively shown by the gangrenous condition of the can- cellous tissue belonging to tbe calcaneum, or, rather, the gangrenous condition of the medullary tissue which filled the cancelli of that bone. Besides, it is probable that if the interior of the tibia and fibula had been examined the marrow would have been found inflamed at and above the place where those bones Avere seen to be denuded of periosteum at the post-mortem examination. It is also probable that the medullary tissue of the denuded portion of the tibia contained collections of purulent matter Avhich were produced by the suppurative character of the inflammatory process involving that tissue. Furthermore, it is probable that the inflammatory process had extended to the medullary tissue of the tibia prior to the performance of the resec- tion of the tarsus, aud if its presence there had then been recognized, it Avould have contra-indicated that operation and called for amputation far up the limb. The thrombosis of the femoral vein Avas of recent occurrence. The coagulated blood which filled that vein presented a fresh appearance and had not yet undergone the puriform transformation, nor even become at all softened. It was therefore obvious that the thrombosis had not occasioned the visceral abscesses nor the inflammation of the lungs, since the morbid process in those organs Avas considerably older than the thrombus of the femoral veiu. The thrombosis was a more recent event than the pyaemia. This circumstance is important, because it shows that the pyaemie process iu this case could not have had its origin in the thrombosis, and that if any relationship or necessary connection existed between them, the pyaemie process induced the formation of the thrombi. The symptoms of in-itative fever (or, speaking properly, the surgical fever of an irritative type), which where so strikingly relieved by the operation, had been produced entirely by local causes, namely, the inflammation of the various structures bordering upon and connected with the gunshot wound, such as the connect ive, the fibrous, the osseous, and the medullary tissues. The symptoms of the purulent infection did not make their appear- ance till two days after the operation. They presented a marked contrast to those of the surgical fever Avhich preceded the operation. They denoted the occurrence of a poisoned condition of the blood and the whole system, under Avhich the patient sank rapidly, and died on the eighth day after its advent." 1 LIDELL (JonN A), in U. S. Sanitary Commission Memoirs, Surgical Volume I, pp. 524-6, and CULBEETSON (H.), Excision of the Larger Joints of the Extremities, in Transactions of the American Med. Association, Philadelphia, 1876, Supplement to Vol. XXVII, p. 314. sect. VI.] SECONDARY EXCISIONS AT THE ANKLE JOINT. 591 Case 852.—Private J. F. Geer, Co. F, 112th New York, aged 22 years, was Avounded at Cold Harbor, June 2, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his admission to the Eighteenth Corps field hospital Avith "shot wound of left ankle." Surgeon R. B. Bontecou, U. S. V., contributed the folloAving description of the injury and operation in the case, Avhich he performed: "The patient was admitted to HareAvood Hospital, Washington, June 15th, suffering from a Avound of the left ankle, the ball passing from the inner to the outer sutface, opening the joint. On admission the condition of the injured parts and the constitutional state of the patient was good. On June 25th resection of the injured joint was per- formed by lateral vertical incisions over the malleoli, exposing tbe articulation. The ends of the tibia and fibula were cut off by the chain saAV, and the upper portion of the astragalus was removed by the cutting forceps. Sulphuric ether was used. Two days after the operation the patient had slight febrile movement and his pulse was a little accelerated. The treatment Avas supporting; simple dressings Avere used. Death occurred on July 24, 1864." Case 853.—Sergeant W. Roberts, Co I, 7th New Vork Artillery, aged 35 years, was wounded in the left ankle, at Cold Harbor June 10, 1864, by a conoidal ball, which passed from before backward, fracturing the external malleolus and opening the ankle joint. He entered HareAvood Hospital, Washington, five days afterwards, at which time his constitutional state was very poor, the injured parts Avere in a very bad condition, and the wound discharged fetid pus. Resection of the ankle joint was performed on June 24th by Surgeon* R. B. Bontecou, U. S. V., who exposed tho articulation by incisions OAer the malleoli and excised the lower articular extremities of the tibia and fibula. Sulphuric ether was used. The patient did well up to July 1st. From that period diarrhoea set in and he gradually sank. There were no pyaemie symptoms. He died July 6, 1864, from exhaustion. The history Avas reported by tbe operator. Secondary Excisions at the Ankle Joint.—Of nine secondary operations the articular surfaces of the fibula were excised in two, of the tibia and fibula in two, of the astragalus in one, of the tibia and astragalus in two, and of the tibia, fibula, and astragalus in two instances. Five patients recovered, four died. Case 854.—Sergeant C. Barber, Co. E, 88th Pennsylvania, aged 30 years, received a shot fracture of the fibula of the left leg, at Gettysburg, July 1, 1863. From a First Corps field hospital be passed to York and subsequently to Philadelphia. Acting Assistant Surgeon M. K. Knorr recorded the following description of the case at the South Street Hospital, where the patient was admitted August 14th: "The wound Avas caused by a minie ball passing in above the external malleolus, fracturing the bone, and passing through the interosseous space. About August 20th hospital gangrene set in and the Avound filled with large sloughs; patient became very weak. Stimulating poultices of yeast and flaxseed were then used, and pulverized persul- phate of iron was applied to the slough. After three applications the patient appeared much better and the slough came off. Poultices were now continued for a while, and afterwards stimulating applications. Still the wound Avas not healing, the dis- charge being yet great and the patient's constitutional state extremely Ioav and weak. On examination Surgeon C. N. Cham- berlain, U. S. V., found the bone to be necrosed and denuded of perios- teum, and concluded to excise the fibula. This operation was accord- ingly performed on December 19th, it being deemed necessary to remove three-fourths of the length of the bone, including the external malleolus. The patient rallied from the operation and made rapid improvement- Tonics and stimulants Avere given and simple dressings used." Surgeon H. Janes, U. S. V., subsequently in charge of South Street Hospital, reported, in April, 1864, that the wound had healed with the exception of the upper part, where a small sinus still existed. The patient was afterwards transferred to Filbert Street Hospital, and on September 17, 1864, he was discharged from service and pensioned. Examining Surgeon H. L. Hodge, of Philadelphia, certified, December 21, 1864: "The limb is now much swollen, the ankle is painful and the foot turned outward. He is very lame and the limb is useless." The Philadelphia Examining Board, April 10, 1872, certified to the injury and operation and described the result as follows: "A long cicatrix Avith musculo- fascial adhesions; a slight varicose condition with tenderness about the ankle joint, and anchylosis of the ankle joint with atrophy of muscles on posterior portion of leg. Increase of pension is recommended on account of increased pain and firmness of anchylosis of the ankle joint." In a communication dated April 18, 1881, accompanying the photographs represented in the annexed Avood-cuts (Figs. 336, 337), the pensioner stated that " the ankle is very painful at present," and added that his disability had obliged him to give up working at his trade of stone cutter. Case 855.—Private W. A. Gavett, Co. K, 141st Pennsylvania, aged 43 years, was Avounded in the right ankle during the engagement near Bristoe Station, October 13, 1863, and entered Judiciary Square Hospital, Washington, three days after- Avards. Assistant Surgeon A. Ingram, U. S. A., made the following report: "The wound was caused by a minie" ball, Avhich entered at the internal malleolus, passed into the ankle joint and lodged. The missile was extracted the next day through the wound of entrance. Partial excision of the ankle joint Avas performed on February 1, 1864, by Acting Assistant Surgeon J. F. Thompson. An incision two and a half inches in size Avas made on the outer side of the ankle and several pieces of bone Avere taken out. Part of the internal malleolus was dissected from the integument and removed through the enlarged wound of entrance, and a portion of the astragalus Avas taken away with the bone forceps. At the time of the operation tbe patient's general health was excellent, but considerable inflammation existed around the ankle joint and there was great discbarge of pus FIG. 33fi.—Outer view of left leg 18 years after excision-of the lower three- fourths of fibula. [From a photograph.] FIG. 337.—Anterior view of the same. [From a photograph.] 592 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Fig. 338. —Excision of right ankle joint. Outer view 17 years after opera- tion. [ From a photograph.] from the wound. A collection of pus had also formed on the outer side at the point of the internal incision. The patient did well for about a month after the operation, at which time both sides had healed. A day or tAvo afterwards an abscess Avas detected in front of the joint, which, on being opened, discharged considerable pus. Carious bone could be felt by the probe, indicating the necessity of another operation." The patient Avas subsequently transferred to Philadelphia, where he Avas admitted to Summit House and afterwards to Satterlee Hospital. On May 6, 1855, he was discharged from service and pensioned. Examining Surgeon C. M. Turner, of Towanda, Pennsylvania, December 27, 1865, certified to the injury and added: "Of course anchylosis has taken place and the tendons of the foot and toes are in a degree contracted and rigid." On August 16, 1869, he reported that the pensioner "walks with difficulty and has much pain after exercise. The joint is often inflamed, and abscesses form in the integuments, which discharge pus for many days. I do not think the joint is carious," etc. At sub- sequent dates the same examiner certified to the heel bone being diminished in size, and to the leg being atrophied up to the kuee and shortened two inches. Examiner C. F. Paine, of Troy, Pennsylvania, September 22, 1879, reported "fistulous open- ings, constantly discharging portions of bone. The pensioner is compelled to use a crutch or cane for locomotion." The pen- sioner Avas paid June 4, 1880. Case 856.—Sergeant W. H. Gaylord, Co. B, 6th U. S. Colored Artillery, aged 26 years, was wounded at Fort Pillow, April 12, 1864, by a minie' ball, which fractured the fibula of the right leg at the lower third. The missile entered above the external malleolus, passed obliquely doAvmvard and backAvard, and emerged below and behind the internal mal- leolus. Four days after the reception of the injury the wounded man Avas admitted to Adams Hospital at Memphis, Avhere Surgeon J. G. Keenon, U. S. V., on May 21st, excised the external malleolus, the comminuted fragments of the fibula, and the end of the tibia through a semilunar incision two inches long. Chloroform Avas used and the hsemorrhage was slight. The patient's physical condition at the time of the operation, though someAvhat emaciated, Avas fair and his spirits Avere buoyant. The wound, Avhich had been suppurating freely, was closing by healthy granula- tions, but necrosed bone could be distinctly felt. The patient did well after the operation. He was permitted to leave the hospital and go to his regiment on June 7th, before his cure was complete. The history was reported by the operator. Sergeant Gaylord Avas subsequently promoted to Lieutenant, and remained in the service until March 28,1865, when he was discharged, Surgeon G. Perin, U. S. A., as a member of an examining board certifying to the injury, and adding that the "wound is healed and ankle joint partially anchylosed. Cannot Avalk without a crutch." The Cleveland Pension Examining Board, Drs. G. C. Ashmun and P. Roeder, in 1877, add that there is "slight lateral motion of ankle, constant enlarge- ment," etc. The pensioner was paid September 4, 1880. Case 857.—Private E. Roberts, 7th Wisconsin Battery, aged 26 years, was wounded in the right foot, at Parker's Cross Roads, December 30, 1862. Surgeon E. D. Kittoe, U. S. V., recorded his admission to hospital at Jackson, and several months aftenvards the Avounded man was transferred to Jefferson Barracks, whence he Avas discharged October 6, 1863, and pensioned. Surgeon J. C. Whitehill, U. S. V., subsequently contributed the folloAving report of the case: " Understanding from Surgeon H. AV. Davis, 18th Illinois, who was in charge of the General Hospital at Jackson for some time in the early part of 1863, that some doubts had been expressed concerning the removal of the os calcis and astragalus from a patient in that institution, and his recovery Avith a foot of comparatively good conformation and use of the ankle joint, I desire to set the matter at rest by furnishing a detailed report of the case. In the latter part of March, 1863, while passing through the wards of the General Hospital at Jackson in the discharge of my duties as Medical Director of the district, my attention was called to a case—that of Private Roberts, 7th Wisconsin Battery—supposed to require amputation. He had been Avounded in the heel by a rifle ball, Avhich grazed the posterior tuberosity of the os calcis and passed out through the sole of the foot about two inches forward. Under the usual treatment the wound soon healed. The heel, hoAvever, remained tender, and the tenderness gradually increased; the integuments became oedematous and glazed; the pain more acute and deep seated; constitutional symptoms supervened; the Avound re-opened, and in spite of all treatment the patient's condition gradually grew worse. He had now hectic fever, some bronchial irritation, diarrhcea, and impaired appetite; the foot and ankle were SAVollen; the integument of the heel was an intense dusky or purplish red, tense, aud glistening, and three sinuses over the posterior part of the os calcis, with everted edges, were discharging fetid sanious pus. Through the sinuses the probe readily detected carious or necrosed bone. After a careful exam- ination I determined to make an effort to save the foot by removing the os calcis, to which, judging from the location of the sinuses, I was in hopes the disease was yet confined. On April 1st, in the presence of Surgeon Davis in charge of the hospital, Surgeon II. E. Foote, 22d Ohio, the Avard surgeons of the hospital, and several other medical gentlemen, the patient was placed comfortably on his side and anaesthesia was induced, after which I commenced an incision at the margin of the sole immediately behind the plantar artery, carrying it around the heel and along the outer margin of the foot to the tarso-metatarsal articulation, and then keeping the knife close to the bone dissected up the flap thus made and exposed the under surface of the os calcis. There Avas slight haemorrhage from a posterior perforating branch of the plantar, but this was readily arrested by torsion of the vessel. A perpendicular incision of about tAvo inches was next made over the heel and along the tendo-achillis, the tendon detached from the os calcis, and the lateral flaps and soft parts carefully dissected up so far as the calcaneo-astragaloid articula- tion, keeping the edge of the knife close upon the bone to avoid Avounding the vessels, and, if possible, to preserve a portion of the periosteum, which Avas much thickened and in some places thickly studded with minute spiculae of bone. The articulation Avas then opened, the interosseous ligaments were divided, and the bone readily removed. The articular surface of the astragalus being diseased, the gouge Avas used for its removal until, finding the greater portion of its structure involved, I decided to remove the entire bone. Keeping the knife close upon the posterior surface of the bone the dissection Avas continued to the ankle joint, which Avas opened, when by using the point of the finger as a lever and at the same time as a guide and sheath for the knife, the FIG. 339.—Inner view of the same injury. sect. vi.J SECONDARY EXCISIONS AT THE ANKLE JOINT. 593 Fig. 340. — Excision of os calcis and astragalus. [From a photograph taken 18 years after the operation.] bones Avere sufficiently separated to allow the ligamentous attachments to be divided by a careful application of the point of the knife. The greatest caution was used on the inner side to avoid wounding the plantar vessels and to preserve the periosteum, which, at this point, like that of portions of the os calcis, Avas thickly studded with minute spiculae or corpuscles of bone. After making a careful dissection to free the bone from its remaining attachments the entire astragalus was removed. Finding the other articular surfaces healthy tbe wound was carefully cleansed, the parts coaptated, light water dressings applied, and the foot and leg fixed in a position by a suitable splint so arranged as to retain them firmly without interfering Avith the dressings of the wound. No part of the integument was removed, nor did a single vessel require ligation. Surgeons Davis, Foote, and several other medical gentlemen, by attending to the administration of the anaesthetic and affording other assistance, rendered efficient aid during the progress of the operation, which, from the large amount of careful dissection required, Avas necessarily someAvhat tedious. The subsequent treatment consisted in the main of a careful retention of the parts in position, simple Avater dressings aud a generous diet, with Avine, ale, and porter. A free suppuration of healthy pus was established; tbe redness and tumefaction of tbe integuments subsided; the cavity of the Avound gradually filled with healthy florid granulations; and Avhen I last saAV the patient, two months aftenvards, the wound Avas healed except at its most dependent portion, from which there was a discharge of laudable pus. The conformation of the foot Avas well preserved and bore but little evidence that so large a portion of its bony structure had been removed. The following extract from a note concerning the case, and received from Assistant Surgeon T. D. Washburn, 12('th Illinois—in charge of one of the Avards of the hospital—described the appearance of the foot about that time (June 1st): 'The patient was not in my ward, but as this was an unusual operation I visited him the more frequently to witness its progress. The parts healed kindly aud by June 1st Avere almost completely closed, and no one would have imagined that so formidable an operation had taken place. The appearance of the foot Avas natural, a neAV formation having apparently taken the place of the removed bone, leaving the configuration good; besides, he had some motion of the ankle, and it certainly promised to make a very useful as well as ornamental member of the body corporate.' I regret that I had no opportunity of seeing the case at a later date, to ascertain the amount of mobility of the joint retained or the character of the 'new formation,' whether fibrous, osteoid, or osseous. I had hoped by preserving a portion of the periosteum to secure a re-formation—in part at least—of the bony structure, and I have but little doubt, judging from the amount of reparative effort evinced by the ossific formation found in portions of the thickened periosteum, that such a result was actually obtained. The case presents several points of practical and pathological interest. There can be no doubt that the success of the operation Avas to some extent dependent on the small amount of interference with the circulation of the part, as already stated, not a single vessel requiring ligation. The granulations by Avhich the cavity of the wound was filled presented a striking resemblance to the medulla of young bone. To what extent Avas the preserved periosteum concerned in the new formation and what Avas its ultimate character? The thickening proliferation of the periosteum was by far the greatest in the vicinity of the larger vessels, and the osseous spiculae were most abundant in the same vicinity. The ossific deposits or formation in several places extended some distance into the adjacent soft parts and were sufficiently abundant to produce a grating sensation under the knife. With- out entering upon a discussion of the method or methods of ihe ' pathological new formation of bone,' I will merely add that it does not seem unreasonable to suppose that the 'new formation' in this case was of an ossific character, aud that the success attending the case is a strong argument in favor of' conservative surgery.' In similar cases I should certainly look upon excision as the rational treatment, and amputation as the dernier resort." Various examining surgeons have from time to time certified to the injury and to tbe disability resulting therefrom. The photograph, represented in the adjacent wood-cut (FlG. 340), was contributed by the pensioner in May, 1881. He states that " the os calcis and astragalus were both removed, which makes the limb two and a half inches shorter. The articulations are now with the tibia, about two inches above the joint." Case 858.—Private R. Fuller, Co. I, 45th Illinois, aged 19 years, Avas Avounded during the siege of Vicksburg, June 20, 1863. Surgeon G. R. Weeks, U. S. V., recorded his admission to the Seven- teenth Corps hospital with "shot wound of left ankle." Six Aveeks after the reception of the injury the wounded man was transferred to Jefferson Barracks Hospital, whence Surgeon J. F. Randolph, U. S. A., reported that "gangrene appeared on August 16th, and was treated by application of nitric acid with favorable result," also that "resection of the external malleolus" was performed. The patient Avas dis- charged from service April 3, 1864, and pensioned. In the folloAving month Examining Surgeon C. Hershe, of Muscatine, Iowa, certified to the injury involving the loss of the external malleolus, causing anchylosis of the ankle joint and leaving the leg "so painful that he cannot put the foot on the ground without enduring pain." The pensioner subsequently re-enlisted in the army and Avas assigned to the 42d Infantry, from which organization he Avas discharged March 31, 1869, when he again resumed his place on the Pension Rolls. Examining Surgeon F. Hooper, of Fall River, certified, November 13, 1869 : " The external malleolus is gone, and the astragalus and os ealcis are anchylosed to the tibia. A large cicatrix covers the outside of the ankle. There is some motion between the scaphoid and astragalus, but it produces pain in walking." In Sep- tember, 1877, the Cleveland Examining Board reported "partial lateral displacement of foot outward, Avith anchylosis of ankle joint and deformity of foot," etc. The pensioner was paid June 4, 1880. The photograph from which the Avood-cut (FlG. 341) is copied was furnished by the pensioner in 1881.' FlG. 341.—View of left ankle 18 years after excis- ion of external malleolus. [From a photograph.] 'CULBBKT60N (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Association, 1876, Supplement to Vol. XXVII, p. 314 SURG. Ill—75 591 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Four cases of secondary excisions at the ankle joint proved fatal—one from pysemia, one from gangrene, and two from exhaustion. Case 859.—Private T. Lister, Co. B, 26th Michigan, aged 26 years, was wounded at Spottsylvania, May 12, 1864. Surgeon J. E. Pomfret. 7th New York Artillery, reported his admission to the field hospital of the 1st division, Second Corps, with " wound of foot caused by a musket ball." Surgeon R. B. Bontecou, U. S. V., who operated in the case, described the injury as a gunshot wound of the left leg, loAver third, the missile fracturing the tibia, entering about one inch above the ankle joint, and lodging in the head of the astragalus. The Avounded man was admitted to Harewood Hospital, Washington, May 26th. On July 5th sulphuric ether Avas administered, and the lower end of the tibia as well as the head of the astragalus, which had become necrosed, were excised. The constitutional state of the patient at the time of the operation was very poor; the tissues had become infiltrated with pus. Five days after the operation the fibula protruded and was somewhat necrosed, the parts other- wise progressing favorably. The treatment was supporting. The result was unfavorable. Death occurred on August 7,1864.' Case 860.—Private A. B. McCool, Co. E, 188th Pennsylvania, aged 21 years, was wounded in both lower extremities, at Cold Harbor, June 3, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his entrance into the Eighteenth Corps field hospital. Secondary resection Avas subsequently performed at Harewood Hospital, Washington, by Surgeon R. B. Bontecou, U. S. V., avIio reported that " the patient Avas admitted June 15th, suffering from gunshot wound of the right thigh and of the left leg at the ankle joint, fracturing the external and internal malleolus. At the time of admission the condition of the injured parts Avas not good, being oedematous and someAvhat infiltrated with pus. Subsequently the parts sloughed exten- sively and the bone became necrosed, the patient's strength failing day by day. On July 12th sulphuric ether Avas administered and the ankle joint was resected, one inch each of the loAver end of the tibia and fibula being removed. A severe and prostrating diarrhcea complicated the case, from the consequent exhaustion of which, together with the excessive suppuration, the patient died July 21, 1864. The treatment consisted of stimulants, sedatives, narcotics, and supporting diet." The excised portions of the tibia and fibula were contributed to the Museum by the operator and constitute specimen 3045 of the Surgical Section? Case 861.—Private J. T. McGuiffin, Co. B, 24th Regiment (Confederate), aged 23 years, received a gunshot Avound of the right ankle joint, at Drury's Bluff, May 16, 1864. The missile, a minie" ball, entered in front and on a line with the internal malleolus, passed through the astragalus, and made its exit through the external malleolus, carrying with it a number of frag- ments. The injury was followed by the escape of synovia. There Avas also another wound of the right foot, fracturing the fourth metatarsal bone. Some days after the reception of the Avounds the patient came under the care of Surgeon J. M. Hollo- way, P. A. C. S., who thought that amputation of the limb, though advisable as a primary operation, Avas not then admissible. Smith's anterior splint was applied and cold irrigation. Subsequently poultices, cerate dressings, and bandaging was used. Several abscesses formed and numbers of small fragments of bone Avere removed on different days. Anodynes, stimulants, and nutritious diet Avere administered as required. After consultation Dr. HolloAvay excised the ankle joint by Hancock's method, on June 21st, completing the operation without injury to nerve, vein, artery, or tendon. The patient Avas not removed from the operating table to his bed until the following day. By the second day the Avounds had become unhealthy and gangrene of the toes was in progress. The patient died suddenly and unexpectedly on the morning of June 25, 1864, after his condition had encouraged the hope that in a few days it would be favorable for amputation of the limb.3 CASE 862.—Private J. C. Perkins, Co. B, 81st New York, aged 27 years, Avas wounded at Cold Harbor, June 3, 1864. Surgeon W. H. Rice, 81st NeAV York, reported his admission to the field hospital of the 1st division, Eighteenth Corps, with "wound of ankles by a mini6 ball." Twelve days after the reception of the injury the wounded man was admitted to Harewood Hospital, Washington, where both limbs Avere operated upon by Surgeon R. B. Bontecou, U. S. V., who made the following report: " The patient was suffering from wounds of the right and left ankle joints, the ball entering above the external malleolus of the right ankle, passing directly through, and entering the internal malleolus of the left ankle. On admission and at the time of the operation the condition of the injured parts was not good. The wounds suppurated freely. There were detached por- tions of bone in each joint, and necrosed fragments came aAvay from time to time. The constitutional state of the patient was poor. Resection of the right ankle joint and circular amputation of the left leg at the lower third Avas performed on July 7th, the anaesthetic consisting of sulphuric ether and chloroform. The result of the operation was unfavorable. The stump sloughed and profuse unhealthy suppuration followed the resection, extending in every direction and burrowing up the leg nearly to its middle. The patient became very weak and sank gradually. He died of exhaustion July 17, 1864. The treatment Avas tonic and supporting throughout." The tarsal bones of the right foot, together with the loAver extremity of the tibia, were con- tributed to the Museum by Surgeon Bontecou and constitute specimen 3035 of the Surgical Section. Excisions at the Ankle Joint, Time between the Injury and Operation unknown.—The five cases of this group would appear to have terminated in recovery, but it has been impracticable to get accurate details of the cases. Two of the operations were performed on Confederate and three on Union soldiers; the names of the latter do not appear on the Pension Rolls. The right ankle joint was excised in two, the left in one instance; in two cases the side was not indicated: Case 863.—Private T. Haley, Co. D, 91st New York, Avas Avounded at Port Hudson, May 27, 1863. Surgeon T. B. Reed, U S. V., reported his admission to a Nineteenth Corps field hospital with "wound of foot." Two days after the recep- 1 Culbertson (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Association, 1876, Supplement to Vol. XXVII, p. 312. 2 CULBERTSON (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Association, 1876, Supplement to Vol. XXVII, p. 312. 'Hallowat (J. M.), Comparative advantages of Pirogoff's, Syme's, and Chopart's Amputations, and Excision of the Ankle Joint by Han- cock's Method, after Gunshot Wounds and other Injuries; with Reports of Cases and the Results ; and proposing another Method Jor Excision of the Ankle Joint, in American Journal Medical Science, 1866, Volume LI, p. 90. sect. VI] AMPUTATIONS AT THE ANKLE JOINT. 595 tion of the injury the Avounded man Avas transferred to University Hospital, New Orleans, where Assistant Surgeon P. S. Conner, U. S. A., recorded: "Gunshot Avound of right foot; resection of astragalus. Patient absent without leave from September 7, 1863." There is no record of this man ever having applied for pension. Case 864.—Surgeon E. Andrews, 1st Illinois Artillery, publishes that "J. K----, 40th Illinois," in one of the Western campaigns received a compound shot fracture of the os calcis and astragalus, and that both these bones were excised, the opera- tion being followed by recovery. Case 865.—Colonel Y. M. Moody, 43d Alabama, received a gunshot Avound through the right ankle joint on June 16, 1864. He entered Confederate hospital No. 4, at Richmond, Avhence he Avas furloughed August 11, 1864. Excision of the loAver end of the fibula Avas performed ; the date of the operation was not recorded. The record of the case was found on the Confed- erate hospital registers. Case 866.—Private H. Gregory, Co. B, 35th U. S. Colored Troops, aged 18 years, was wounded at Olustee, February 20,1864. He passed through various hospitals at Beaufort, one of which was under charge of Surgeon J. Trenor, jr., TJ. S. V., who reported the patient's admission, August 27th, Avith "gunshot wound of left ankle; astragalus excised before admission." Assistant Surgeon J. G. Murphy. U. S. V., reported that the patient Avas discharged from service June 5, 1865, by reason of " anchylosis of ankle joint" resulting from the wound. There is no record of this man ever having applied for pension. Case 867.—"Sergeant P. R. Wright, Co. K, 13th North Carolina, was wounded in tbe engagement near Williamsburg, May 5, 1862. A conical pistol ball entered on the outside of the os calcis near the sole of the foot, and passed up through the outer portion of this bone and through the astragalus, comminuting the lower end of the fibula and lodging between the tibia and fibula, three inches from their lower extremities. The missile was traced to its lodgement with difficulty. A crescentic incision along tbe course of tbe peroneus longus and behind the external malleolus was intersected by a straight incision coming up from the heel, aud another crescentic incision Avas found necessary to be made anterior to the external malleolus. By work- ing under the ligaments the loose fragments of bone were removed from the calcaneum and astragalus; the loAver comminuted end of the fibula was cut and pulled aAvay by means of the forceps, and the bullet was found in its lodgement between the two bones, about three inches from the joint. While the lateral ligaments were left in position Avith their superficial connections, their bony attachments were of course disturbed. The granulation and consolidation, which will probably result, must give the joint greater strength against inversion of the foot than it could acquire Avitbout them. The opening into the joint was made very free by this operation, which is an advantage. It is now well enough settled that an inflamed and suppurating joint is more likely to result well with a free and external opening than with a limited one." The •use Avas reported by Surgeon D. Prince, U. S. V.; tbe result Avas not ascertained. AMPUTATIONS AT THE ANKLE JOINT.—The number of exarticulations at the ankle recorded during the American civil war is one hundred and sixty-one; one hun- dred and three were primary, thirty-nine intermediary, and thirteen secondary operations; in six instances the time between the injury and the operation was not indicated. Table LXXXIX. Numerical Table of One Hundred and Sixty-one Amputations at the Ankle Joint for Shot Injury. OPERATIONS. > o o "3 V Q •6 a © "5 •a a 1 o o o I METHOD OF OPERATION. Pirogoff's. Syme's. Various Methods. 3 > o a 5 a> O 8 o o (2 — *3 O 14 6 1 •d S ■a a & 1 o « 16 2 3 "3 Q 3 6 % 1 103 39 13 6 161 78 25 12 4 23 14 1 2 2 22.7 35.9 7.7 33.3 26 18 4 1 20 10 4 1 6 8 57 19 7 42 IJ G 20 2 o 5 Period of Operation not specified..... 2 119 40 2 25.1 49 35 61 21 1 29 93 r 1 Mortality 28. 5 %. Mortality 25.6 %. Mortality 17.8%. The results were ascertained in one hundred and fifty-nine instances; one hundred and nineteen had successful, and forty fatal terminations, a mortality rate of 25.1 per cent., or 7.8 per cent, less than the death ratio after amputation in the leg. Primary Amputations at the Ankle Joint.—In one instance both feet were removed. The one hundred and three operations were therefore performed on one hundred and two 596 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Fig. :}42.-Stump after PlROGOFFS amputation at left ankle joint. Spec. 3732. FIG. 343.—Stump after Syme's am- putation at ankle. [From a cast.] patients; seventy-eight recovered, twenty-three died, and in two cases the results were not ascertained. Successful Primary Amputations at the Ankle Joint.—Seventy-eight operations per- formed on seventy-seven patients belong to this group; sixteen were Confederate and Bixty-one Union soldiers; the names of the latter were all on the Pension Roll; but six have died since the close of the war in 1865—two of diarrhcea and dysentery, one of apoplexy; 4n three cases the immediate cause of death is not reported. Case 888.—Private O. Leblanc, Co. E, 2d NeAv Hampshire, aged 20 years, was Avounded in the right foot, at Cold Harbor, June 1, 1864, by a shell, Avhich fractured the tarsal and metatarsal bones. Assistant Surgeon J. C. McKee, U. S. A., reported that the man was admitted to Lincoln Hospital, Washington, ten days aft«r receiving the injury, also that the wounded foot had been removed by Pirogoff's method, on the field, by Surgeon J. M. Merrow, 2d New Hampshire. The patient subsequently passed through various hospitals, and Avas ultimately discharged from service June 16,1865, and pensioned, having been previously fitted with a " Palmer" artificial foot. The cast (Spec. 3732), contributed by Acting Assistant Surgeon L. C. Dodge and rep- resented in the adjoining cut (FlG. 34'2), sIioavs an apparently firm cicatrix, but reveals the stump to be a little irregular and without the appearance of being able to sustain decided aveight. The pensioner was paid December 4, 1880." Case 869.—Private J. E. Ayers, Co. E, Sth New York Cavalry, aged 19 years, was wounded in the left foot, at Funkstown, July 10, 1863, and entered the General Hospital at Frederick eight days afterwards. Assistant Surgeon R. F. Weir, U. S. A., reported: "The injury consisted of a compound fracture of the tarsus. Syme's amputation at the ankle joint was performed on the field. During the progress of the case sloughing opened the stump, for which nitric acid wash was applied by injecting. Adhesive straps were used to support the posterior flap, and tonics were given internally; generous diet was allowed. The patient recovered with an excellent stump, and was discharged from service October 5, 1863." After leaving the service he became a pensioner, and subsequently he was an employe" in the Quar- termaster General's Office, U. S. A., for a number of years. In 1879 he received an appointment in the U. S. Treasury Depart- ment. On July 8, 1868, Avhen visiting the Army Medical Museum, the pensioner walked remarkably well on an apparatus furnished by Dr. E. D. Hudson, of New York City, and the stump Avas found to be in good condition. Since then the pensioner has contracted and suffered for a time from frost bite in the stump, but in 1881 the stump Avas in excellent condition. The Army Medical Museum possesses a cast of the stump (Spec. 6056), represented in FlG. 343. A copy of a photograph of the pensioner, taken in January, 1881, is shoAvn in FIGURE II of Plate LXXV,2 on the opposite page. Case 870.—Private H. W. Clark, Co. H, 100th NeAv York, aged 30 years, was wounded by a shell in both feet, at Drury's Bluff, May 13, 1864. He was admitted to a Tenth Corps field hospital, Avhere the injured limbs Avere removed. Assist- ant Surgeon E. McClellan, U. S. A., reported that the wounded man was brought to hospital at Fort Monroe six days after the injury, and that " both feet Avere amputated" before his admission. About tAvo months after- wards the patient Avas transferred to McDougall Hospital, and subsequently to Central Park Hospital, New York City. Surgeon B. A. Clementsr U. S. A., in charge of the latter, reported that " the right foot was shat- tered up to the metatarsal articulation, and the left heel Avith most of the tendo-achillis Avas carried aAvay. There Avas no great amount of hsemorrhage. The amputations Avere performed on the field, while the man was under the influence of chloroform, by Surgeon M. S. Kittinger, 100th NeAv York, the right foot being taken off by Chopart's method. His general condition at the time of the operation was good. At first sutures, bandages, and cold-water dressings were applied, and when the patient arrived at Fort Monroe, adhesive strips and band- ages were used. Both stumps healed kindly, the right one in eight Aveeks and the left one in six weeks. At the time of his admission here, on July 26th, both Avere entirely well, the tendo-achillis of the right stump being considerably contracted." The patient Avas discharged from service December 13, 1864, and pensioned, and Stump subsequently he was supplied Avith artificial feet by Dr. E. D. Hudson of New York City. Plaster casts of the stumps of the legs, contributed by Assistant Surgeon J. W. S. Gouley, U. S. A., constitute specimen 28.77 of the Surgical Section of the Museum. That of the left limb, shoAving an excellent Syme's stump, is repre- sented in the annexed wood-cut (FlG. 344). In his first application for commutation, in August, 1870, the pensioner described the stumps as being "sound and healthy;" but later, in 1880, he reported their condition as "poorly." His pension Avas paid December 4, 1880.3 Case 871.—Private A. K. Russell, Co. H, 1st Massachusetts Heavy Artillery, aged 43 years, Avas Avounded at Spottsyl- vania, May 19, 1864, and admitted to Emory Hospital, Washington, three days afterAvards. Acting Assistant Surgeon J. E. Janvrin reported: "Gunshot wound of left foot, the ball entering the heel posteriorly, passing forward through the os calcis and astragalus, and making its exit anteriorly on the dorsal surface of the foot. The os calcis and astragalus together Avith the metatarsal bones were comminuted, and, according to the patient's statement, the soft parts Avere very much lacerated. Chloro- form Avas administered, and Syme's operation was performed on the day of the injury. When admitted to Emory Hospital the sutures had given way and the flap was pendant, with unhealthy discharges and tendency to slough. Adhesive straps and 1 SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Volume II, p. 132. 2 SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1874, Surgical Volume II, p. 138. 'SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surg. Volume II, pp. 110, 140. Fig. 344. after Syme's arapu tation at ankle joint. Spec. 2857. [From a cast.] K ^'..o&a Idrifiu \M iv' S.-U ■-.'SV'i*?,,.'Nfct-.'t I $*Y™p t.. ^# . -*:-.^.*. . .. .ffeW" y -••:i,.;:",V'.4 -:-.: ? />vfHr ■ -I:, .<£'■!. Sh.x [ 'IAP. \ :-..:S th e re-Y:,s wci'f iv. i'l: opcniti. i6 ;■■'■*• .^nfedei ,f ■ ./.d ;i t* Pi.og ..•Yi'cry, ■)n ■ of l:- :;r;r!tY:,o; .,* Cold . (Y ."IcKf*:.. j. fc. A., 1U0 hat thv voundti", iiu Yt, .'., .■iU. (Ml i ai 1 - j; a.r , :.», ui'ii v .-, j - i '■l.li.!; i u , •ei.^iom: , aa i; •. .iiiinbt-r oi year-; ' •, i .r ,v.\. Army ".leilic-i ."'■' ,i; • Vmk i •*.:>. Mid <.Y-.- ■ , .•'.,■■ «. ■■ ia'. i, tlV '■■■■■ h- :'> ■. ■■ '•!'),, •■•■■.>-. I-.M'K" ' rl'l-: YY, ai? II. '. < a r-.-:-4. i: ..,. . 'i! _reor> >:'. '•'.('.' \ • if'tti trie ,-.i < the patie'it , ) ■■' -'U-9, ■■;•■ 1 ■'•..•, di, :'pU»: I- ''f " 1. " i 11.' !M i-1 ■• cii.it <* , ' a ji t, i'k.. ;j-';.-">iuih[i afitr iSyrn'a atu *• ■ ■'" putat'ai .-ft t,.- kle. . |, .,. [Kror. .-. »>■!., V S. Treasury ' depart . >\Y" .;m an ap ..ivnt'is^ •■hi: then the [» • 'siom.-r . y i! oml n T1 .\rn\v 1 .','ph of :!.« • ■ ■■ ..Yn.'v i' .* HncV m ■■ otb " et, ai '•h -iverr ! m'iuwhI. . • ams .- " hi Bpi: VI at i'ViM V.,»nroe ■*.'..>n. im'<< ii'outh' after- •• y. .:' !•' Hospit Anw .:: '. fo. i 'vi|... f.i -.( 'il Sta' •.ion '; ;:■ That .- A ■ir. AJA. In !■ ■' hva'J'hv,* i. !m ;,ig |„i . ,i a. .1'.".., 03!" . :;!-r,>- an■ of .■.. ^pvi.-iliii.': '. AA1 ,-.-u.up I* . \../.i-,t. 18?' tla .1 '. ' pO'i " ii 'VlCf syl- ■'• ...-eon J , E. i. 'lie 0" P. ■A A~ •;jeih'. ui!. i1 .. ai A t'h ,i- ,. •S*> •• ■■ ips .d ii. a. II. p. 132 ■■..•■• ir p. y.9 '. ■ p.f.: <*i i 0. Med.H Surg. Hist, of the War of the Rebellion, Part ID.Vol.n.Chap.X . PLATE LXXV. AMPUTATIONS AT THE ANKLE JOINT. T. Sinclair » Son lith Fig.l. Case of Lieut W.C Weeks Pirogoff's Operation. Fi«.3. Case of Pt.J.H. Short . S\ine's Operation. Fi£2. Case of Pt.J.E.Ayers Syme's Operation. Fig.4. Case of Pt.A K Russell. Syme's Operation. SECT. VI. J AMPUTATIONS AT THE ANKLE JOINT. 597 cold-water dressings were applied, and subsequently linseed, charcoal, and yeast poultices Avere used. Alteratives tonics aud stimulants were administered, the patient being much exhausted and suffering from loss of appetite, with derangement of the system generally. On June 3d the parts were thoroughly cleansed, and a flat padded splint was applied to the anterior surface of the leg, extending beyond the stump, after which adhesive straps were passed from beneath the leg across the flap and carried over the end of the splint and fastened. These were gradually shortened as tlie healing process went on, thus removing the tension and weight of the flap from the anterior edge of the wound. By July 12th the patient was doing well and the granula- tions were covering the bone. About August 18th the stump had nearly closed and the patient's general health was good. Two weeks afterwards he left for bis home on furlough. The success attending this case is attributed in a large measure to the method adopted for supporting the flap." The patient subsequently entered the general hospital at Readville, whence he waa discharged from service June 2, 18l*,*>. and pensioned. After leaving the service he was furnished with an artificial foot. A photograph of the stump, taken three months after the date of the amputation, and contributed by Surgeon N. R. Mosely, U. S. V., is represented in Figure 4 of Plate LXXV, opposite page 596. The man subsequently underwent a second operation, which was certified to by the Surgeon General of the State of Massachusetts, who communicated the following on January 26, 1871: "The pensioner has sustained re-amputation six inches below the knee, Avhich was performed by Dr. C. N. Chamberlain, of Lawrence, late surgeon U. S. V., assisted by Dr. G. W. Garland, the case being at the time under my observation." In his sub- sequent application for commutation the pensioner described the stump as being in a good condition. His pension was paid December 4. 1880. Case 872.—Private E. R. Covell, Co. C, 52d New York, aged 38 years, was wounded in the left foot, at Spottsylvania, May 18. 1864, and admitted to tbe field hospital of the 1st division, Second Corps. Surgeon J. W. Wishart, 140th Pennsyl- vania, described the injury as a "shell Avound of the tarsal and metatarsal bones," for which he performed "Syme's amputation at the ankle joint." Ten days after being Avounded the patient entered Emory Hospital at Washington, and subsequently he was transferred to Central Park Hospital, New York City. Surgeon B. A. Clements, U. S. A., in charge of the latter, reported the following history of the case: "Considerable haemorrhage took place at the time of tbe injury, and the man's general condition was not very good in conse- quence of his suffering from diarrhoea. Amputation at the ankle joint was performed under chloroform six hours after the reception of the injury, the ends of the tibia and fibula also being removed. Sutures, adhesive strips, and cold water dressings Avere applied. The parts did not unite by first intention, though there Avas no sloughing nor necrosis. When the patient was admitted to Central Park Hospital, August 17th, the stump had healed with tbe exception of a small ulcer in the cicatrix near the external angle of the flaps, and his general coudition Avas pretty good, though he still had diarrhoea. By October 2d the stump was entirely healed and the diarrhoea Avas much improved." The patient Avas discharged from service November 3, 1864, and pensioned, having been previously furnished with an artificial foot. A cast of the stump (Spec. 4369) Avas contributed to the Museum by Surgeon J. J. Milhau, U. S. A., and is represented in the adjoining wood-cut (FlG. 345). After leaving the service the stump was re-amputated at the loAver third of the leg on May 5, 1869. In his subsequent applications for commutation the pensioner described the condition of the stump as joint, "spec. 4369. " sound and healthy." His pension was paid September 4, 1881.1 lFrom a cast-1 Case 873.—Lieutenant W. C. Weeks,2 Co. I, 5th Michigan Cavalry, aged 28 years, was wounded at Five Forks, April 1, 1865, by a conoidal musket ball, which passed through the left ankle joint. Assistant Surgeon C. A. Leale, U. S. V., reported: "He Avas immediately conveyed to hospital at City Point, where Surgeon A. K. St. Clair, 5th Michigan Cavalry, performed Pirogoff's amputation at the ankle joint the same day, removing the articulating surfaces of the tibia and calcaneum and bringing the cut extremities into apposition. On April 16th the patient was transferred to Armory Square Hospital at Washington, where he was admitted in a very feeble condition. Erysipelatous inflammation extended from the stump several inches above the knee joint. Extensive suppuration had taken place, and, although fifteen days had elapsed since the operation, the rough edges of the calcaneum could be rubbed against the denuded end of the tibia, proving that no union existed. The integumentary flap had partially united, thus confining a large quantity of pus in the stump, Avhich prevented the bones from being kept in apposition. Metastatic abscesses had commenced to form along the course of the anterior tibial lymphatic glands, and every symptom prognosticated an unfavorable termination, the only hope being based on the remarkable strong constitution of the patient. The abscess at the stump was freely evac- uated, and the metastatic abscesses Avere freely opened as soon as fluctuation could be detected; the calca- neum and tibia Avere held in proper position by means of adhesive straps after the limb had been thoroughly cleansed with liquor of chloride of zinc. Large linseed poultices Avere applied over the lower third of the tibia and lead and opium Avash over the remaining part of the limb as far as the erysipelas extended; stimu- lants and beef tea were administered. The patient gradually improved until April 28th, Avhen he had a chill, which was soon followed by others. Quinine and tincture of chloride of iron was then prescribed and an ounce of brandy Avas given every two hours. By May 2d the patient had the peculiar sweet odor of breath and the well-marked icteroid hue, especially in the conjunctivae, which Avere exceedingly yelloAV. Several chills occurred each day and were followed by considerable febrile movement and great prostration; but by the frequent administration of stimulants and tbe constant application of artificial heat the patient rallied, after which beef tea was given in quantities as large as could be tolerated. From May 6th he improved, the chills occurring at longer intervals and Avith less severity until May 12th, Avhen they ceased. A slight diarrhoea at this time was checked by starch and opium injections, after which the patient convalesced rapidly. By June 26th he had entirely recovered, the os calcis having united to the tibia and the Avound having closed, leaving a solid, firm stump." A plaster cast of tbe stump, Specimen 2298 of ■Smith (S.), Amputations at tlie Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Volume II, p. 136. 2 Circular No. 6, War Department, S. G. O., 1865, p. 47. Smith (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, pp. 116,132. Fig. 345.—Stump after Sl'ME's am- putation at ankle FIG. 346.—Stump after Piuogoff's amputation at an- kle joint. [From a plaster cast.] 598 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the Army Medical Museum, is shown in FlG. 346, and a photograph of the patient is copied in Figure I of Plate LXXV, opposite page 593. Lieutenant Weeks was mustered out of service July 20, 1865, and pensioned, after Avhich time he com- menced to Avear the "Palmer" artificial foot. In a subsequent report, dated June 28, 1866, Dr. Leale furnished the folloAving information in regard to the case: "I have just received a communication from Lieutenant Weeks (residing at Allegan, Mich- igan), in Avhich he states: 'lam able to do anything that most men can do; my patent foot Avorks like a charm. I am at present engaged in a large flour mill, and my stump has never troubled me but once since I left the hospital, and then it was caused by an accident, Avhich loosened a small splinter of bone. This I had removed at Chicago, since which time it has done well. I adjusted my false foot on October 1, 1865, and never take it off except Avhen I go to sleep. I can easily Avalk Avitbout a cane.'" The pensioner Avas paid September 4, 1881. Case 874.—Private H. Bell, Co. A, 2d New York Artillery, aged 45 years, was Avounded in the left foot, at the battle of White Oak SAvamp, June 30, 1862. He Avas conveyed to hospital at Fort Monroe, whence he Avas transferred to DeCamp Hos- pital, David's Island, three weeks afterwards. Surgeon J. Simons, U. S. A., in charge of the latter, recorded the patient's admission with "amputation of foot." Assistant Surgeon J. W. S. Gouley, U. S. A., in charge of Central Park Hospital, NeAv York City, contributed the cast (Spec. 4218), represented in the annexed Avood-cut (FlG. 347), Avith the folloAving description: "This interesting Avax specimen, a cast of Pirogoff's operation, I regret to say has an incomplete history. According to the patient's statement he Avas Avounded by a shell, Avhich tore off the outside of the foot nearly up to the ankle. He was etherized on the field, and Avhen he awoke he found that he had no foot. When admitted to this hospital, on October 28th, the stump Avas healed and in the condition represented in the cast. The parts Avere perfectly consolidated, and the heel Avas firm and capable of sustaining the Aveight of his Avhole body without giving rise to pain or tenderness. The limb was about three- fourths of an inch shorter than its fellow. The patient Avas furnished Avith an apparatus by Dr. Hudson, Avhich ansAvered admirably, the heel of the artificial limb being made three-fourths of an inch higher, Avhile the ankle joint was loAvered. On the Avhole it Avas as shapely as the width of the ankle would alloAV. The patient Avas FiG.:?47.-Stump discharged from service July 7, 1863. Before he left the hospital he Avas able to Avalk Avitbout the assistance PiuoGOFF'sam- °f a cane and Avithout causing any irritation to the stump." Examining Surgeon W. M. Chamberlain, of NeAv putation at ankle York City, certified to "loss of most of the left foot. Pirogoff's operation has been successfully performed. A cast.] small fragment of the heel only is left, and the pensioner Avears an artificial foot." The pensioner Avas paid March 4, 1871, since Avhen he has not been heard from.1 Case 875.—Captain J. V. Denniston, Commissary of Subsistence, U. S. V., aged 24 years, Avas Avounded in the right foot, during the engagement at the Weldon Railroad, August 25, 1864. Surgeon N. Hayward, 20th Massachusetts, reported his admission to the field hospital of the 2d division, Second Corps, Avith "fracture of ankle," followed by "Piro- goff's operation, performed by Surgeon G. Chaddock, 7th Michigan." Surgeon D. W. Bliss, U. S. V., avIio subsequently re-amputated the limb, reported that "the patient entered Armory Square Hospital, Washington, August 28th. On September 6th haemorrhage ensued, which Avas controlled by styptics and a compress, but commenced again two days afterwards, Avhen the femoral Avas held by the attendants for several hours. On September 10th a fresh and copious haemorrhage set in, Avhen, after a thorough examination of the parts, it Avas deemed proper to amputate at a point about three inches above the ankle, the patient being in good condition at the time. The entire loss of blood probably amounted to a pint, its source being first the anterior tibial and aftenvards the femoral artery. The amputation Avas performed by the circular method and Avithout much shock to the patient's system. The treatment included tonics, stimulants, and nourishing diet. Simple dressings Avere used. Three weeks after the operation the patient Avas doing well." The re-amputated stump, showing the soft tissues and the cut surfaces of the tibia and os calcis softened by suppuration, Avas forwarded to the Museum by the operator and constitutes specimen 3211 of the Surgical Section. In 1881 the soft tissues Avere Fig. 348.—Bones removed from the specimen, when it was found that the tibia Avas fissured to the extent of four inches (FlG. of the right ankle 348). The patient Avas subsequently transferred to the Seminary Hospital, GeorgetoAvn, where he obtained goff s amputa- leave of absence November 25th, when he started for his home. He Avas ultimately mustered out of service tion. Spec. 3211. January 1, 1867, and pensioned. While serving as an officer of the 70th New York, at the battle of Williams- burg, May 5,1862, Captain Denniston had also been Avounded in the right forearm, for which injury he underwent the operation of resection of the continuity of the bones.2 After leaving the service he obtained an artificial leg from the Pittsburgh Artificial Limb Manufacturing Co., and since then he has continued to report the stump of his amputated leg as being in a "healthy condition." The pensioner Avas paid September 4, 1881. Fatal Primary Amputations at the Ankle Joint—The results in twenty-three primary amputations at the ankle joint were fatal. Syme's operation was performed in fourteen, and Pirogoff's in six instances; in three the mode of operation was not indicated. Seven- teen of the patients were Union and six Confederate soldiers. In four instances the exarticulations at the joint were followed by amputations in the leg: Case 876.—Private H. E. Boynton, Co. L, 1st Massachusetts Heavy Artillery, aged 18 years, received a shot fracture of the left foot and of the right arm, at Spottsylvania, May 19, 1864, and was admitted to the field hospital of the 1st division, Second Corps. Sungeon J. W. Wishart, 140th Pennsylvania, reported that he amputated the foot by Syme's method on the day of the injury. Three days aftenvards the Avounded man entered Emory Hospital at Washington, where Surgeon N. R. Moseley, 1 Smith (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Vol. II, pp. 117, 134. 2See Medical and Surgical History of the War of the Rebellion, Part II, Volume II, Table CXXVIII, p. 957, No. 23. sect. VI.J PRIMARY AMPUTATIONS AT THE ANKLE JOINT. 599 U. S. V. excised two inches of the middle third of the fractured humerus. The case resulted fatally on June 22, 1864. The excised portion of the humerus (Spec. 2322) and most of the bone of the amputated foot (Spec. 828) have been contributed to the Museum by tbe respective operators. The latter specimen consists of the metatarsus, scaphoid, cuboid, and outer two cunei- form bones, and shows a large, battered, conoidal bullet occupying the place of the inner cuneiform, the bones adjacent to it being fractured. Cask 877.—Private E. P. Hale, Co. I, 1st Minnesota, aged 24 years, was wounded through the left lung and in the left foot, at Gettysburg, July 2, 1863. He was adinitted to the field hospital of the 1st division, Second Corps, where amputation was performed by Surgeon C. S. Wood, 66th NeAV York, who described the injury of the foot as folloAvs: "A minie* ball entered at the internal malleolus, passed obliquely downward and outward, and emerged about tAvo inches below the external malleolus, comminuting the astragalus and involving the ankle joint. Syme's operation was performed." Five Aveeks after the reception of tbe injuries the patient Avas transferred to Camp Letterman, whence Acting Assistant Surgeon A. B. Shekell reported that tbe wounds discharged freely and that the patient continued in a weak state, his condition and the stump of the leg improving but slightly, though stimulants, quinine, and iron Avere freely administered. Simple dressings were applied. On September 2d an abscess Avas opened on the inner side of the right thigh, which discharged about a pint of pus. The case terminated fatally on September 12, 1863. The lower extremities of the bones of the stump (Spec. 1949), showing the articular surfaces to be destroyed by ulceration, Avere contributed to the Museum. Case 878.—Private G. Harfeter, Co. D, 104th Pennsylvania, aged 22 years, was wounded at Morris Island, September 27, 1863, and was conveyed to hospital No. 5, at Beaufort, the following day. Assistant Surgeon J. S. Smith, U. S. A., reported: "TheAvoundAvas by a fragment of shell in tbe left foot, which was amputated the next day by Surgeon E. B. Bontecou, U. S. V., on board of the hospital transport Cosmopolitan. Syme's operation Avas performed. There was also a slight flesh wound of the right hip and right arm. Simple dressings Avere used and anodynes Avere given at night. On October 1st slight haemorrhage occurred, Avhich Avas easily controlled by slight pressure, about an ounce of blood being lost. Two days aftenvards a profuse haemorrhage took place, reducing the patient's vitality to an alarming extent. The stump was then opened for the purpose of securing the bleeding vessel, but it could not be found, and the anterior tibial Avas ligated two inches above the seat of the haem- orrhage. The bleeding did not recur, but the patient gradually sank. He died October 12, 1863." Case 879.—Private F. M. Bland, Co. D, 23d IoAva, aged 22 years, Avas wounded in the left foot during the engagement at the Black River, May 19,1863, and entered Adams Hospital, Memphis, several weeks afterwards. Acting Assistant Surgeon B. J. Bristol reported: "Syme's operation at the ankle had been performed the same evening the injury was received. At the time of the patient's admission to Adams Hospital, June 13th, nearly the entire flap had sloughed off and tbe bones were exposed to view. An abscess had also formed at the middle of the lower third of the leg, and there was periostitis of the tibia and fibula at the same point. The general condition of the patient was low, he having had diarrhoea for four months. He Avas put upon iron, quinine, stimulants, and astringents. On June 17th his general condition Avas somewhat improved, the diarrhoea checked, and it was decided to operate. Amputation of the leg was accordingly performed at the junction of the middle and upper third by Acting Assistant Surgeon J. Thompson. I saAv the patient for the first time the next day, when, though in a low condition, he seemed to be rallying from the shock of the operation. I administered tonics, stimulants, and beef tea freely, and had water dressings applied to the stump, under Avhich course the general condition of the patient gradually improved. The stump then appeared to do well, but before many days it began to discharge a thin ichorous-looking pus. About June 26th the flaps gaped open, no adhesions having formed in any part of the stump. The flaps soon commenced sloughing, and it was decided that the only chance for the patient laid in another amputation. Accordingly on July 2d the thigh Avas taken off at the middle of the lower third, which operation tbe patient seemed to bear well. The tonic and supporting treatment was continued, and as before the patient seemed at first to be doing well; but the stump soon became gangrenous. An abscess also formed below the clavicle, the edges of which sloughed away, laying bare the thyroid axis, the branches of it too sloughing off. On July 13th the patient was removed to my ward in a rapidly sinking condition. He died three days afterwards—on July 16,1863." The Syme stump (Spec. 1706), removed at the first re-amputation and contributed to the Museum by Surgeon J. G. Keenon, U. S. V., shows the extremities to be necrosed and an absence of reparative action. Table XG. Summary of One Hundred and Three Cases of Primary Amputation at the Ankle Joint for Shot Injury. [ Recoveries, 1—78; Deaths, 79—101; Results undetermined, 102-103.] NO. Name, Military Description, and Age. Date of INJUEY. Nature of Injury. Date of Opera-tion. Operation and Operator. Result and Remarks. I 2 3 4 ■Ayres, J. E., Pt., E, 8th N. York Cavalry, age 19. Baal, M., Pt., E, 21st Iowa, age 20. Barnett, J. B., Pt., E, 191st Pennsylvania, age 33. 'Bell, H., Pt., Battery A, 2d New York Artillery, age 45. July 10, 1863. May 17, 1863. Mar. 31, 1865. June 30, 1862. Conoidal ball comminuted left tarsus. Shot fracture of right foot. Conoidal ball comminuted tar-sal and metatarsal bones of left foot. Shell fracture of tarso-metatar-sal bones of left foot. July 10, 1863. May 17, 1863. April 1, 1865. June 30, 1862. Syme's amputat'n at left ankle joint. Pirogoff's amputation at right ankle joint. Syme's amputation at left ankle joint. Surg. A. A.White, 8th Maryland. Pirogoff's amputation at left ankle joint; lower portion of tibia and anterior portion of calcaneum exsected. Sloughing. Discharged October 5,1863; pensioned. Spec. 6056, A. M. M. Stump in good con-dition in 1881. Discharged Sept 26, 1863; pen-sioned. Stump perfectly healed. April 8, amputation in low. third of leg. Discharged June 28, 1865, and pensioned. Discharged July 7, 1863; stump finely formed; pensioned. Able to walk without aid of cane; portion of calcaneum useless. Spec. 4218, A. M. M. 1 Smith (H.),Amp. at the Ankle Joint in Mil. Surg.,m U.S.San. Com. Mmn., N. Y., 1871, Surg. Arol* II, p. 138. 2 Smith (S.), loc. cit., pp. 117,134. 600 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. IS 18 32 Name, Military Description, and Age. Blake, H., Pt., I, 37th Mass., uge 36. Blakeman, M. A., Pt., D, 36th Ohio, age 36. Blankenbecker, G.R., Pt.,C, 4th Va. Cavalry, age 20. Date , of j Nature of Injury. June 13, 1864. Sept. 22, 1864. June 24, 1864. Bourkney, X.. Pt, K, 155th June 16, New York, age 32. I 1864. Brewster, J., Pt., I, 29th Sept. 29, Conn, (colored), age 22. | 1864. Brink, S. S., Pt., B, 36th June 18, Wisconsin, age 28. 1864. Bunting, J. R., Corp'l, I, 8th April 16 Michigan, age-28. 1862. Shot fracture of right tarsus... Conoidal ball fractured the right ankle joint. Conoidal ball fractured meta- tarsal bones of left foot. Shell fracture of right tarsus .. Grapeshot wound of left foot, fracturing metatarsal bones. Conoidal ball fractured left foot 1 Clark, H. W., Pt,, H, 100th New York, age 30. Collins, W., Pt., F, 3d Mis- sissippi Battery, age 28. 2Connors, J., Pt., F, 76th Pennsylvania, age 25. 3Covell, E. R., Pt., C, 52d New York, age 38. 4Denniston, J. F., Commis- sary of Subsistence, U. S. V., age 24. •Dresser, E. E., Pt., A, 20th Massachusetts, age 21. Dudley, E. II., Pt., K, 16th Vermont, age 20. « Duffy, T., Pt., I, 70th New York, age 21. Foreman, J. M., Pt., B, 7th Louisiana. Freeman, J. C, l't,, A, 9th New York, age 26. Hicks, II. F., Pt., A, 1st R. Island Artillery. *"Holland, R. H, Corp'l. B, 44th Virginia. Holmes, A. IF., Pt., K, 20th Georgia. Hosington, G., Pt., A, 123d Ohio, age 36. Humble, T., Pt., G, 24th Texas. Hunt, J., Pt., C. 19th Indiana, age 38. Hunter, A., Pt,, F, 140th Pennsylvania, age 33. Isham, D. E., Pt., E, 154th New York, age 19. Jackson, F., Pt., E, 86th Colored Troops, age 32. 8 Johnson, F., Capt., K, 26th Michigan, age 22. Johnson, J. M., Pt., C, 3d Delaware, age 31. May 13, 1864. July 22, 1864. July 11, 1863. May 18, 1864. Aug. 25, 1864. June 24, 1864. July 3, 1863. June 1, 1862. May 4, 1863. Sept. 17. 1862. Dec. 13, 1862. May 3, 1863. June 19, 1864. June 13, 1863. May 13, 1864. June 18, 1864. May 8, 1864. May 3, 1863. April 3, 1865. May 12, 1864. June 3, 1864. Daw; OF Opera TION. June 13 1864. Sept. 22, 1864. June 24, 1864. June 17, 1864. Sept. 29, 1864. June 18, 1864. Shot comminution of astragalus ; April 18, and calcaneum. I 1862. Solid shot fractured bones of May 13 both feet. 1864. Conoidal ball fractured the arch July 23 of the left foot. | 1864. Musket ball comminuted the July 12 right tarsus. 1863. Shell wound, carrying away a May 18, large portion of left foot; con- j 1864. siderable haemorrhage. Conoidal ball fractur'd the right Aug. 25, ankle. I 1864. Shell fragm't extensively lacer-. June 24 ated foot and injured tarsal and metatarsal bones. Shell fracture and laceration of tarsal bones of left foot. 1864. July 4, 1863. Musket ball fractured tarsal June 2, and metatarsal bones of left 1862. foot. Gunshot wound.............. Shot fracture of left foot....... Shot wound of both feet....... Shot fracture of tarsus........ Shot wound of right foot...... Wound of left foot by conoidal ball. Shot wound of right foot...... Conoidal ball injured right foot. Shell fracture of all metatarsal bones in right foot. Shell wound, shattering and carrying away most of left foot. Compound fracture right foot by fragment of shell. Conoidal ball comminuted left tarsus. Shell wounds of left foot and right leg. MaAr 5, 1863. Sept, 18, 1862. Dec. 14, 1862. May 4, 1863. June 19, 1864. June 14, 1863. May 13, 1864. June 18, 1864. May 9, 1864. May 4, 1863. April 3, 1865. May 12, 1864. June 3, 1864. Operation and Operator. Pirogoff's amputation at right aukle joint. Amputat'n at right ankle joint by Syme's method. Syme's amputation at ankle joint. Amputation at ankle joint by circular incision. Surgeon N. Hayward, 20th Mass. Syme's amputation at ankle joint. Flap amputation at ankle joint. Surgeon N. Hayward, 20th Massachusetts. Syme's amputation at left ankle joint. Ass't Surgeon C. A. McCall, U. S. A. Syme's amputation at left ankle joint; Chopart's amputation right foot. Surg. M. S. Kit- tinger, 100th New York. Syme's amputation at ankle joint. Syme's antero-post. flap ampu- tation at right ankle joint. Syme's amput'n at ankle joint, end of tibia and fibula rem'd. Surgeon J.W.Wishart, 140th Pennsylvania. Pirogoff's amputation at ankle joint. Svme's amp. at ankle. Surg. N. Hayward, 20th Mass. Soft parts so much destroyed that flaps were made from sides of ankle and foot and exter. sole. Syme's amputation at ankle. Ass't Surgeon C. H. Rich- mond, 104th New York. Syme's amputat'n at left ankle joint. Amput'n at ankle joint. Surg. J. B. Davis, C. S. A. Syme's amp.at left ankle. Surg. G. C. Humphreys, 9th N. Y. Syme's amput'n at right ankle, and Pirogoff's at left ankle. Pirogoff's amputation at ankle joint. Surg. B. F. Whitehead, C. S. A. Amputat'n at right ankle joint. Surgeon C. Cord, C. S. A. Amputation at ankle joint by Confederate surgeon. Amputat'n at right ankle joint. Surg. G. W. Lawrence.C.S.A. Syme's amput'n at right ankle joint. Surgeon J. Ebersole, 19th Indiana. Syme's flap amputation at right ankle joint. Surgeon J. W. Wishart, 140th Pennsylvania. Chopart's amp. attempted, but finding astragalus and cunei- form injured, Syme's operat'n was performed. Surg. C. S. Wood, 66th New York. Syme's amput'n at right ankle joint. Surgeon H. Osborne, 51st Colored Troops. Syme's amputation, left ankle joint. Surg. J. W. Wishart, 140th Pennsylvania. Syme's amputation at left ankle joint: also amp. in mid. third right leg. Surg. G. W. Met- calf, 76th New York. Rksilt and Remarks. Discharged December 16, 1864; pensioned. Stump well healed. Discharged May 8, 1865, and pen- sioned. Stump perfectly healed. Sloughing of flaps; abscesses. Furloughed October 30. 1864. Discharged March 15, 1865, and pensioned. Discharged July 22, 1865, and pensioned. Sound stump. Discharged April 25, 1865; pen- sioned. Stump unsound; bone diseased. Discharged June 27, 1862; pen- sioned. Stump healthy and useful. Discharged December 13, 1864. Spec. 2857, A. M. M. Recovered. Necrosis of tibia. Sept. 27, amp. lower third leg. Disch'd Aug. 28, 1865; pensioned. Discharged Nov. 3, 1864; pen- sioned. May 5, 1869, amput'n lower third leg. Spec. 4:i69, A. M. JI. Haem. from ant. tib. and femoral arteries. Sept. 10, amp. lower third leg. Disch'd Jan. 1,1867, and pensioned. Spec. 3211. Fragments of necrosed bone re- moved. Discharged Dec. 12, 1864. Died Nov. 14,1870, from ulceration of bowels. Inflammation; sloughing. July J 8, amp. lower third leg. M. O. Aug. 10, 1863. Amp. up. third leg Dec. 21, 1863; pensioned. Sloughing of flaps. Nov. 6, amp. middle third leg. Nov. 28, se- questra removed. Disch'd July 11, 1863; pensioned. Healthy stump. Spec. 4312. Furloughed June 23, 1863. Discharged December 30, 1862; pensioned. Stump healed. Discharged September 14, 1863; pensioned. Recovery. 1864, unable to walk without crutches. Parts still swollen and oedematous; heel drawn upward. Discharged August 25, 1864. June 21, amp. leg 3 ins. above ankle joint. Sept. 17, re-amp. in middle third leg. Disch'd May 16,1865; stump entirely healed; pensioned. Died Dec. 16,1866. Retired March 2, 1865. Discharged May 20, 1865, and pens'd. Stump perfectly healed. Declares, in 1875, that his leg is slowly getting weaker. Discharged June 14, 1865; pen- sioned. Discharged January 22,1864, and pensioned. Discharged Aug. 7,1865. Stump perfectly healed. Discharged Nov. 30, 1864; pen- sioned. 3|ins.shortening; flaps retracted. Not heard from since September 4, 1870. Discharged June 8, 1865; pen- sioned. Small ulcer on stump in 1874. 1 Smith (S.), loc. cit., pp. 110,140. *Smith (S.), loc. cit., p. 138. 'Smith (S.), loc. cit., p. 136. ♦Capt. Denniston had received a shot fracture of the bones of the forearm, at Williamsburg, May 5, 1862, for which excision was performed. See Second Surgical Volume, Table CXXVIII, p. 957, No. 23. * Smith (S.), loc. cit, pp. 109, 140. 8 SMITH (S.), loc. cit., p. 138. 'Holloway (J. M.), Comp. Advantages of Pirogoff's, Syme's, and Chopart's Amp., etc., in Am. Jour. Med. Sci., 1866, N. 8., Vol. LI, p. 85, and SMITH (S), Amp. at the Ankle Joint in Mil. Surg., in U. S. San. Co i. Mem., New York, 1871, Surg. Vol. II, p. 134. » 8MITH (S.r. be- <"**<•. P-138. SECT. VI.l PRIMARY AMPUTATIONS AT THE ANKLE JOINT. 601 Name, Military Description, and Age. Injury, Nature of Injury. Opera- tion. Operation and Operator. Result and Remarks June, J., Pt., E, 43d New Vork, nge 25. Kilboru. M., Pt., F, 14th In- fantry, age 29. King, C, Pt., B, 82d Ohio, age 19. ' Le Blanc, L. D„ Pt,, Don- aldsonville Artillery. 8 Le Blanc, O., Pt., E, 2d N. Hampshire, age 20. Leigh, G., Pt., C, 3d Artil- lery, age 19. Luyster, T., Pt., B, 10th N. York, age 19. Lynn, S., Serg't, C, 104th Illinois, nge 28. 'Lyon, B., Pt., C, 12th Mas- sachusetts, age 19. MeConihe, L. A., Pt., F, 3d New Hampshire, age 20. Mclntire, E. P.. Pt., K, 2d Infantry, age 30. Mclntyre, N., Pt., F, 10th Missouri, age 22. Maddox, T., Pt., E, 19th Kentucky, age 23. Marsh, B. F., Pt., K, 12th Alabama. May, M.. Pt., H, 9th New York, age 22. Montaldo, P., Pt., K, 6th Ohio, age 33. Munger, M., Pt., H, Sth Michigan, age 19. Newell, T. F., Lieut., G, 45th Georgia, age 24. * O'Reilly, C, Pt., F, 164th New York, age 23. Patton, A. G., Pt., I, 139th Pennsylvania, age 23. Polley, J. B.. Corp'l, F, 4th Texas, age 24. Porter, A., Pt., K, 106th Pennsylvania, age 22. Price, S. B., Serg't, A, 2d Ohio, nge 22. Ross, J., Pt., I, 2d New York Heavy Artillery, age 34. Russell, A. K., Pt., H, 1st Massachusetts Heav3' Artil- lery, age 43. Smith, G. W., Pt., H, 6th Illinois Cavalry, age 21. Smith, S. B., Lieut., D, 3d Michigan, age 26. Smith, T. A., Pt., H, llth Penn. Reserves, age 18. Smyser, J. W., Pt., A, 27th South Carolina, age 25. Snyder, L., Corp'l, F, 71st Penn., age 24. Spearman. R. F., Pt., D, 25th South Carolina. 6 Stetson, A. L., Pt., G, 20th Massachusetts, age 26. s Stockwell,W. S., Serg't, B, 57th New York, age 23. Thornton, F. C, Pt., K, 34th Virginia. May 10, 1864. Nov. 3, 1862. Mar. 19, 1865. 1862. June 1, 1864. Sept. 24, 1863. May 10, 1864. Nov. 25, 1863. Sept. 17, 1862. Aug. 26, 1863. May 1, 1863. May 14, 1863. May 22, 1863. Oct. 19, 1864. Sept. 17, 1862. Jan. 2, 1863. May 6, 1864. July 2, 1863. May 18, 1864. May 12, 1864. Oct. 7, 1864. July 6, 1862. May 15, 1864. May 19, 1864. May 19, 1864. Sept. 15 1864. May 2, 1863. Dec. 13, 1862. June 24, 1864. Dec. 15, 1862. May 30, 1864. May 2, 1863. May 3, 1863. July 30, 1864. Conoidal ball fractured tarsal 'Mny 12,' Flap amputation at ankle joint bones, left foot. 1864. by Confederate surgeon. Shell wound right foot........ Nov. 3, Syme'samputation,right ankle 1862. joint. Mar. lit, Syme's nmputat'n nt left ankle 1865. I joint. Surgeon J. Chapman, | 123d New York. Shot wound of left foot.......On field.1 Disarticulation at ankle joint.. Left foot badly shattered by shot. Shell fracture tursal and meta- tarsal bones, right foot; great laceration. Shell carried away portion of right foot. Couoidul ball comminuted the right os calcis. Conoidal ball fracturing right foot. Solid shot shattered left tarsus and carried away phalanges and metatarsus. Shell wound of left foot....... June 1, Pirogoff'B amputation at ankle 1864. joint. Surgeon J. M. Merron, | 2d New Hampshire. Sept. 24, Syme's amputation at right an- 1863. kle joint. Conoidal ball injured left foot.. Conoidal ball comminuted the left tarsus and splintered the astragalus. Wound of left foot by conoidal ball. Gunshot wound............... Solid shot comminuted the left foot. Conoidal ball fractured meta- tarsal bones, right foot. Comp. fracture left foot, just below joint, by conoidal ball. Fracture of right foot by a frag ment of shell. Shell wound of right foot..... Wound of left foot by conoidal ball. Shot wound of right foot...... Shot wound left foot, destroy- ing tarsus. Conoidal ball fractured left foot. Conoidal ball passed through metatarsus from dorsal to plantar surface. Conoid, ball lacerated soft parts of left foot and com. os calcis, astragalus, and metatarsals. Shot wound of right foot...... Four of left tarsal bones shat- tered and soft parts extensive- ly destroyed. Wound of right foot by conoid- al ball. Shot wound of right foot. Fracture of left foot by conoidal ball. Conoidal ball fractured tarsus Spiral case shot perforated left ank. joint, destroj'ing articula- tion and soft parts about heel. Unexploded shell comminuted phalanges, metatarsal bones, and port'n of tarsus, right foot. Greater port'n of right foot torn away by fragment of shell. Mav 10, 18*64. Nov. 25, 1863. Sept. 17, 186 J. Aug. 26, 1863. May 2, 1863. May 15, 1863. May 23, 1863. Oct. 19, 1864. Sept. 18, 1862. Jan. 2, 1863. May 6, 1864. Julv 2, 1863. May 18, May 13, 1864. Oct. 7, 1864. July 7, 1862. May 15, 1864. May 19. 1864. May 19, 1864. Sept. 15, 1864. May 2. 1863. Dec. 15, 1862. June 24, 1864. Deo. 16, 1862. May 31, 1864. May 2, 1863. Mav 4, 18*63. July 30, 1864. Circular amputation at right ankle joint. Surg. M. Rizer, 72d Pennsylvania. Pirogoff's modificat'n of Syme's amputat'n at right anklejoint. Surg. C. H. Miller, 125th 111. Syme's amputat'n at left ankle joint. Surgeon J. McL. Hay- ward, 12th Massachusetts. Syme's amp., left ankle joint. Snrg. A. J. II. Buzzell,3dN.H. Amputation at left ankle joint. Surg. G. R. C. Todd, C. S. A. Syme'samputation at left ankle joint. Surgeon H. S. Hewit, U. S. V. Amp. at left ankle joint. Surg. W. K. Sadler, 19th Ky. Amputation at ankle joint by Surgeon — Scott. Syme's amputat'n at left ankle joint. Surgeon G. C. Hum phreys. 9th New York. Pirogoff's amputation at the right ankle joint. Syme's amp. at left ankle joint. Surg. B. Rohrer, 10th Pa. Res. Pirogoff's amputation at right ankle joint, Syme's amputat'n, right ankle. Surg. G. W. Briggs, C. S. A. Pirogoff's amputation at ankle joint. Surgeon S. F. Chapin, 139th Pennsylvania. Syme's amputation at right an- kle joint. Pirogoff's amputation at left anklejoint, Ass't Surgeon P. Leidy, 106th Penn. Syme's amputat'n at left ankle. Surgeon B. F. Miller, 2d Ohio. Syme's amputation at ankle joint. Surg. J. W. Wishart, 140th Pennsylvania. Syme's amputation at ankle joint; sloughing. Pirogoff's amputation at right ankle joint; portion of heel bone retained. Surg. G. P. Christy, 9th Illinois Cavalry. Syme'samputation at left ankle joint. Surgeon C. S. Wood, 66th New York. Pirogoff's amputation at right anklejoint. Syme's amputation at right anklejoint. Pirogoff's amputation at left anklejoint. Amput'n at ankle joint. Surg. C. B. Gibson, C. S. A. Double lat. flap amp. (Syme's modified) at left ankle. Surg. N. Hayward, 20th Mass. Syme's amput'n at right ankle joint. Surgeon C. S. Wood, 66th New York. Pirogoff's amputation at right anklejoint. Discharged March 15,1865; good stump. Pensioned. Discharged September 18, 1863; pensioned. Discharged August 15,1865, and pensioned. Recovery. Discharged June 16, 1865, and pensioned. Stump healed. Flaps sloughed ; March 29,1864, amp. lower third leg. Disch'd Sept. 17, 1864. Died Sept. 13, 1871. Spec. 2165, A. M. M. Discharged April 24, 1865; pen- sioned. Discharged February 23, 1864, and pensioned. Fine round stump. Discharged Oct. 23.1863. Stump highly serviceable; 3 inches shortening. Discharged Nov. 5, 1863; pen- sioned. Stump healed. Discharged July 24, 1863; pen- sioned. Discharged January 21, 1864, and pensioned. Discharged October 5, 1863; pen- sioned. Discharged February 1, 1865. Disch'd January 16, 1863; pen- sioned. April, 1863, amputation lower third leg. Discharged June 22, 1864, and pensioned. Stump healed. Discharged January 27,1865, and pensioned. Transferred for exchange Sept. 27, 1863. Spec. 6688, A. M. M. February 12, 1865, amp. of leg at junc. of lower third. Disch'd May 31, 1865, and pensioned. Disch'd March 16, 1865. and pen- sioned. Stump healed soundly. Retired January 25, 1865. Discharged September 5, 1862; pensioned. Died July 10,1864. Gangrene of stump. June 15, amp. leg at lower third. Dis- charged Oct. 10,1864 ; pens'd. Secondary amput'n of leg. upper third. Disch'd March 15,1865. Died Jan. 8. 1877; apoplexy and hemiplegia. Discharged June 2,1865. Ampu- tation leg at mid. third. Card Photo's, Vol. I, p. 45. Discharged October 17, 1864; pensioned. Transferred to V. R. C. July 2, 1863. Disch 'd January 1,1868; pensioned. Stump sound and healthy. March 14, 1863, gangrene. Dis- charged Sept. 11, 1863; pen- sioned. 1878, stump tender; cannot wear artificial limb. Furloughed August 6, 1864. Discharged May 17, 1864; pen- sioned. Stump perfectly healed. Transferred. Discharged Dec. 29, 1863; pen- sioned. Cicatrization perfect; 2J inches shortening. Discharged Aug. 24, 1863; pen- sioned. Very creditable stump. Healed by first intention. Fur- loughed October 23, 1864. 1 Formesto (F., jr.), Notes and Observations on Army Surgery, etc., New Orleans, 1863, p. 27. •Smith (S.), loc. cit, p. 138. «Smith (S.), loc. cit, p. 136. »Smith (S.), loc. cit, pp. 110,140. Subg. Ill—76. 'Smith (S.), loc. cit, p. 132. •Smith (S.), loc. cit, p. 138. 602 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Name, Military Description, and Age. Date OF INJUEY. 68 Townsend, W., Pt., I, 92d ' Sept. 1, Ohio age 21. 1864. Treadway, W., Pt., H, 13th Tennessee Cavalry, age 20. Unknown, Pt.,----......... Wallace, T. C, Pt., B, 1st West Virginia Cavalry, age 20. 1 Weeks, W. C, Lieut., I, 5th Michigan Cavalry, age 28. Welsh, M., Pt., H, 47th New York, age 26. Wilson, It., Pt.,E, 72d Penn- sylvania, ago 22. Wince!, P., Pt., B, 36th Wis- consin, age 22. Winters, C. II., Corp'l, F. HOthOhio, age 30. Womack, J. K., Pt., II, 14th Virginia, age 21. Yount, J. M., Pt., G, 52d Virginia. Birmingham. A., Lieut., A, 69th New York, age 20. Bland, F. M., Pt., D, 23d Iowa, age 22. Boynton, II. E., Pt., L, 1st Mass. Artillery, ago 18. Bradshaw, G., Pt., D, 19th Ohio. Cecil, It.. Lieut.,