NATIONAL
NLM  00551451*7  1
NATIONAL LIBRARY OF  MEDICINE
Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
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        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH No. 1.   .4 Portion of Uranium, with Gonoldal Ball
   imbedded In the Ethmoid and Frontal Bones.
   Corporal G. W. S., 12th Massachusetts Volunteers, aged  29 years, was
 wounded  at  the battle  of  Fredericksburg,  December 13th, 1*02. and
 admitted into the Camden Street, U. S. A. General  Hospital, Baltimore,
 Maryland, December 19th,  18(32.   The globe of  the right eye was des-
 troyed.  There was a slight  slit in the lower lid.  The patient did not
 complain of much pain.   The functions  of the  other  eye were not dis-
 turbed, although the organ  was  observed  to be unnaturally prominent.
 Slight  headache  was the only  brain  symptom  present.   Neither the
 patient nor medical attendants suspected that  the ball  had  entered the
 orbit.  The wound healed  kindly,  and after three weeks the man  went
 about the city habitually, with a pass.  He continued well,  with  the ex-
 ception of an occasional  pain over the left eye, until  February 6th, 1863,
 when he had a chill, followed by febrile reaction.   There were, however,
 no marked cerebral symptoms, until February 10th, 1863. when delirium
 came on.  On the following day the patient became comatose, and at mid-
 night of February 11th,  1*63. he died.  The autopsy revealed a conoidal
 bullet,  entering at the inner angle of the right  orbit, through the orbital
 plates of the frontal and ethmoid bones, and resting between the sphenoid,
 ethmoid, and frontal bones, pressing back  the left  orbital plate of the
 latter.  The I all was in contact with the dura mater,  which had ulcerated
 at  this  point.   At the base of the anterior lobe of the left cerebral hemis-
 phere was an  abscess containing  two  drachms  of pus.  A formation of
callus encrusted the  ball and diminished the opening originally made by
it.   There was no necrosis.   The specimen is numbered  1108 in  the  Sur-
gical Section of the  Museum.
           Photographed at the Army Medical Museum.
 BY ORDER OF THE SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass'c Surg.  U. S.  A„ Curator A. M.  M. 
 
/
        JPurgcxm   (BmmY$   (Dffiu\

       ARMY  MEDICAL  MUSEUM.

Photograph Xo. 2.  Perforation of the Right Femur, just above
  the Condyles. Li/ a Musket Ball.
  Private Samuel S. Kopp. Co. E. 10th Pennsylvania Reserves, was shot
through the lower third of the right thigh, by a musket ball, at the second
battle of Hull Hun, August 28th, 1862.  The ball entered just above the
patella, and made its exit in the poplitial space.  The patient was taken,
after a few days, to Alexandria, and admitted to General Hospital.  On
September 20th, 1862. his thigh was amputated at the middle by Surgeon
Charles Page, U. S. A.  He survived ihe operation two days.   The speci-
men presents a very good example of a gunshot perforation through the
cancellated portion of a long bone.  Two  fissures, which extend through
Cie diaphysis, are seen running lo the middle third of the shaft.   A nar-
rjwer fissure separates the condyles.
          Photographed at the  Army Medical Museum.
   BY ORDER OF  THE  SURGEON GENERAL:

                          GEORGE  A.  OTIS,
             Bv't Lt. Col.  and Ass11 Surg. U. S. A., Curator  A. M. M. 
 
        ARMY  MEDICAL MUSEUM.

 Photographs Xos. 3,  1<>6  and IDT.   Case  of successful pri-
   mary amputation at the Nip Joint.
   Private James E. Kelly, company B, 56th Pennsylvania  Volunteers,
 aged twenty-eight years,  was wounded at about 9 o'clock of the morning
 of April 29, 1863, in a skirmish of the First Division, First Corps, on the
 Rappahannock, nearly opposite  the  "Pratte House," below  Fredericks-
 burg.   A  conoidal musket ball, fired from a distance of about three hun-
 dred yards, shattered  his  left femur.  A consultation of the senior sur-
 geons of brigades decided that exarticulation of  the femur was expedient,
 and  the operation was performed, at four in the afternoon, at  the  "Fitz-
 hugh House," by Surgeon Edward Shippen, U. S. Vols., Surgeon-in-chief
 of the First Division.  The single flap method was adopted, and the am-
 putation was accomplished with  slight loss  of blood.   The patient was at
 first  placed in a hospital tent,  and was transferred,  May 22, to the Corps
 Hospital, progressing favorably.   By May  28, all the ligatures 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 symptoms.  On July 14, 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  Washington, and obtained
 an honorable discharge from service,  and a pension.  At this date, the
picture  from  which the  photograph was taken was drawn by Hospital
 Steward Stauch, U. S. A., one of the artists of the Army Medical Museum.
 Kelly then  went to his home, near Black Lick P. 0., Indiana County, Penn-
sylvania.  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 1868, Kelly went to New York and had an artificial
limb  adapted by Dr. E.  D. Hudson. At  that time the photograph was
taken.  He could  walk quite well after the  adaptation of the artificial
limb.  The specimen is preserved at the Army Medical Museum and is No.
1148  of the Surgical Section.
           Photographed at the Army Medical  Museum.
   BY ORDER  OF THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
            ■  Bv'l Lt. Col. and Ass't Surg. U, S. A., Curator A. M. M. 
i'ht 
        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH Xo. 4.   Left Femur fractured by a  conoldal mus-
   ket ball.
   Private John Draker, company I. f>7th Pennsylvania Volunteers, aged
 twenty-five years, was wounded on picket  duty on the Rapidan, Novem-
 ber 27, 1863.   A conoidal musket ball passed through the  muscles of the
 right thigh, and, entering the  middle  of the left thigh at its inner side,
 flattened itself against the femur,  and shattered  the bone.  The patient
 was transferred to Alexandria by rail, and admitted, on December 4, 1863,
 to ihe Prince Street Hospital, under the care of Acting Assistant Surgeon
 J. Cass.  The left thigh  was  very much  swollen.  On  December 7, the
 patient became delirious.  The soft parts of the left thigh  were in a gan-
 grenous condition.  He  died  on December 13,  1863.   He had bloody
 expectoration and  other  symptoms  of plcuro-pnemonia at the last.   At
 the autopsy, the periosteum was found separated from a large part of the
 shaft of the femur: there were large abscesses  in the thigh, and the soft
 tissues were greatly disorganized nearly to the  hip;  there was a large
 amount of scro-purulent  offensive fluid  in the right pleural cavity.  The
 specimen of the  fractured  femur is No. 1907 of the Surgical Section of
 the Army Medical Museum,  and is a  good example of a  comminution of
the shaft of a long bone by a ball moving at a low rate of  velocity.  The
ball must have struck with its  long diameter parallel to that of the shaft
of the femur.
           Photographed  at the Army Medical  Museum.
   9Y ORDER  OF  THE  SURGEON GENERAL:

                            GEORGE A.  OTIS,
              JJv'l Lt. Col. and Ass11 Surg.  U, S. A., Curator A. M. M. 
 
        Jfargwa   ®inw&Y$  (©Hire.

      ARMY MEDICAL  MUSEUM.

PHOTOGRAPH No. 5.  Left Femur of a Confederate Soldier, ex-
  hibiting Attempts  at  Repair  of  a Gunshot  Fracture  of the
  Upper Third.
  Private E. W. A----, Co. G, 5th Florida Regiment, 18 years of age, was
wounded July 3d, 1863, at the battle of Gettysburg, by a conoidal musket
ball, which shattered the upper third  of  the left femur.  He was first
treated in a field hospital, but on August 5th, 1863, was admitted  to Camp
Letterman General  Hospital.  At that date, the  patient was reduced by
profuse suppuration; he was greatly emaciated, and  large bed-sores had
formed on his back.  On  August  12th, a troublesome diarrhoea set in.
He lingered till September  15th, 1863,  when he died from exhaustion.
The large foliaceous masses of callus uniting the  fragments are extremely
delicate and brittle. The Specimen is numbered  1938  in the  Surgical
Section of the Museum.
          Photographed  at the  Army  Medical Museum.
 BY  ORDER  OF  THE  SURGEON GENERAL:

                         GEORGE  A.  OTIS,
             Bv't Id. Col. and Ass't Surg. U. S. A., Curator A. M. M. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph No. 6.   Head  and  six Inches of Shaft of Right
   Humerus suecessfidly excised for  Gunshot Fracture.
  Private John F. Reardon,  Co.  C, 6th New York Cavalry, aged twenty-
two years, was wounded at Culpeper, Virginia, October 11th.  1863, and
entered Armory Square Hospital, at Washington, on the following day.   It
was found that his  right humerus  was shattered by a fragment of shell,
which was removed fi om its lodgement under the deltoid muscle.  It was
four inches long, one inch broad and weighed nine ounces.  The head and
six inches of the shaft of the  humerus  were excised through a straight
incision on the outside of the limb.   During the after treatment the elbow
was well supported.  The patient recovered without a bad symptom, and
with a remarkably useful limb.   In March, 1S66, Reardon was reenlisted
in the U. S.  Army General Service,  and was assigned to  duty as an
orderly at the Army Medical Museum.   From that date until the present,
(.September, 1868), he ha* served continuously,  suffering very Utile incon-
venience from the mutilation he has  undergone.  Without difficulty he
can place his right hand  on  the lop of his head; he can lift a weight of
200 pounds or m re with the injured limb without pain.   The movements
of the forearm and  hand are not in the least impaired, and there is great
freedom of all the movements  of the  arm except abduction   The mus-
cular development of the arm equals that of its fellow.   No apparatus is
requisite, and altogether the result is most satisfactory and successful.
The case effectually disproves the dictum of the older military surgeons
on the inutility of excisions of the  humerus  in cases in  which it is neces-
sary to saw the shaft below the insertion of the deltoid.
           Photographed  at the Army  Medical Museum.
  BY ORDER  OF THE SURGEON GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Axis'I Surg. U. S. A., Curator A. 31. M. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph  No  7.   Sequestrum  of  the Lnft  Femur, Eight
   Weeks after the Amputation of the Left Thigh.
  Corporal  H. H. Ellis,  Co. I, 16th New  York Volunteers, aged twenty-
three years, was wounded at Fredericksburg, May 3d, 1863, and admitted
into Douglas Hospital at Washington,  May 8th, 1863.  A conoidal ball
had comminuted  the  left patella,  (Specimen  1852, A. M. M ,) and the
knee-joint was  involved.  On the 13th of May, the thigh was amputated
at the lower third, by the circular method, by Acting Assistant Surgeon
J. E. Smith, U. S. A.   This patient's health was much impaired by chronic
diarrhoea, and after the operation his condition was very unsatisfactory.
Secondary haemorrhage occurred on May 20th, and  recurred on the 21st,
when the femoral artery was tied in Scarpa's triangle.   For many weeks
this man clung to life  by the  slenderest  thread.   The thigh stump was
greatly swollen and very tender on pressure.  The line of incision,  how-
ever, was not unhealthy  in appearance, and the discharge was moderate.
From the inner angle of  the stump  the necrosed  extremity  of the femur
protruded.  August 9th, 1863, the sequestrum was found to be loose, and
Dr. Smith was directed to remove it.   After its extraction there was con-
siderable haemorrhage, nevertheless, convalescence now proceeded rapidly.
A formation of new bone replacing the original diaphysis could be readily
felt   The stump was  not  shorter than at first.   It soon closed  entirely,
was firm, and in every  respect  satisfactory.   The man was discharged
from the hospital, and from the service of the United States, October 26th,
1863.  In December, 18'4, he reported himself in good  health.   The
Specimen and a history from which the foregoing  facts are derived, was
contributed  by Assistant Surgeon William Thomson, U. S. A.  It is num-
bered 1853 in the Surgical Section of the Museum.
           Photographed  at  the Army Medical Museum.
  BY  ORDER  OF  THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg.  U. S. A., Curator A. M. M. 
 
       jpinjtcm   ffimxiiYn   f&fiitt.

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. S.   Section of a posterior Portion of a Cra-
  nium.   Both Par let a Is arc fractured  bij a Sabre Cut near  the
  Lambdoidal Suture.
  Private James T. Bedell,  Co. F, 7th  Michigan Cavalry, aged forty-two
years, was captured on July 3d, 1863, at Gettysburg, his  horse being shot
from under him.  He was hurried to the rear with other prisoners: in the
subsequent retreat  lie was unable to  keep up  with  the  column, and all
efforts to goad him  on being unavailing, a confederate lieutenant, in com-
mand of the provost guard, cut him  down, and left him  for dead by the
roadside.  He was  brought  in by one of our scouting parties, and admitted
to the Cavalry Corps Hospital.   On the 25th  of July, he  was sufficiently
rational to give the  above account to Surgeon  Rulison. 9th New  York Cav-
alry.  He was in a  very depressed state at this time.  His pulse was weak
and beat from 40 to 45 per  minute.   He was  indisposed  to mental exer-
tion; but  when roused and  interested, was quite rational.   He lingered
until August 15th,  1863, the  tendency  to stupor becoming greater and
greater towards the close.   The autopsy revealed a  sabre cut  six inches
long, which had raised an osseous  flap, adherent at  its base, from the
left parietal, and a fracture of the right parietal, with great splintering
of  the vitreous  plate.   The sabre had  penetrated the  dura  mater on
the left side, and on the right side the meninges were  injured  by the
depressed inner table.   The posterior lobes  of both hemispheres of the
brain were  extensively disorganized.   The specimen  with  the above
history was contributed by  Surgeon W. H. Rulison, 9th  New York Cavalry,
since killed in battle.   The Specimen is numbered  1672 in the Surgical
Section of the Museum.
           Photographed at the  Army Medical Museum.
   BY  ORDER OF THE SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg.  U. S. A.,  Curator A. M. M. 
.x^s^o o 4c.i'. I.J 
        JfanjMm  fitnttnYn (Bfiltt.

      ARMY MEDICAL  MUSEUM.

Photograph No. 9.   Cranium extensively fractured  by a Shell.
  A confederate soldier,  wounded in the demonstration on  Washington,
July 17th, 18 4, was admitted into Lincoln U. S. General  Hospital, on
that day,  and died two hours after admission.  Over the anterior superior
angle of the left parietal  bone, there was an extended scalp wound.  On
reflecting the  scalp, multiple depressed  fractures  of  the  vault of  the
cranium came into view.  The point of greatest depression  is an inch to
the left of the median line, near the coronal suture.   The depressed frag-
ments measure from before  backwards  two i:iclic:, and from r.ght to left
three inches, and involve both parietals  and  the os frontis.  A fissure
runs through the squamous  portion of  the left temporal, and all the
sutures of this  bone are separated.  The autopsy was made and the
specimen  forwarded by  Assistant Surgeon Henry M. Dean, U. S. A.  It
is numbered 2871 in the  Surgical Section of the Museum.
          Photographed  at the Army Medical  Museum.
 BY  ORDER  OF  THE SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
             Bv't Lt.  Col. and Ass't  Surg.  U. S. A., Curator A. 31. 31. 
 
         jFnrgwa  $>tnmY&  Mint

       ARMY  MEDICAL MUSEUM.

Photograph No. 10.   Gunshot  contusion  of the outer  Table of
   the Frontal bone, with Fracture of the  Vitreous Plate.
  Private Abram L----, Co. C, 78th New York Volunteers, was wounded
hy a conoidal musket ball  at the  battle  of the Wilderness, May 6, 1864,
and entered Armory Square Hospital, at Washington, on  May 12th.  He
was in a comatose condition when admitted, and died on May 24th eigh-
teen days  after receiving the injury.  No  farther particulars of the case
can be obtained.   The specimen presents a fracture of the inner table of
the frontal bone, near the  coronal suture, to  the left of the median line.
There is no solution of the continuity in the outer table; but it is softened
where the pericranium was destroyed by  the  ball.   A fragment an inch
and a half in length and half an inch broad, is completely detached from
the vitreous  table.   The specimen is an  excellent  illustration of that
variety of fracture of the skull, in which the outer table remains intact,
and the thinner and more friable vitreous table is splintered;  an accident
resulting always, it  is  believed,  either  from  the  shock of a projectile
striking the cranium very  obliquely, or  else from a comparatively slight
blow from a  body with a large plain surface.   Preparations illustrating
this variety of fracture of the skull are very rare.  M. Legouest presented
one to the  Dupuytren Museum, and Mr. Prescott Hewett, in his paper on
injuries of the head, in Holmes's System of Surgery, refers to the existence
of such specimens, and Williamson (Military Surgery, pp. 29, 30) gives the
history of specimen  2893,  of the Netley Museum, which is of this
character.   The Army Medical Museum possesses eleven examples  of this
form of injury.  This specimen  was presented by Surgeon D. W.  Bliss,
U. S. Vols.

          Photographed  at the Army Medical  Museum.
   BY ORDER OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 31. M. 
 
'-"//.
       ARMY  MEDICAL  MUSEUM.

 SPK-IMK.V No. 1206   ^„„W Frac'ur* of the U,ad of the riaht
     fl™p.   *  Conoidal Ball imbedded.   Se^diy ^Z


 ■MaPvri^l8STp^,(;,,,Tny  '"  75th 0hi0 VorBfw» wounded

Z\l   ■>-   ?V1S1°n' ^ Sl A' General  H°-l'Ua1'  at  Ahxandria, Va.
 finrr '•' -'*h' SurScon Charles P»Se' <T- S. A., explored the wound, and
it£i? h  'T °f I""  hCad °f the  rig,U  hUm^'  limited ^ the
 Wuis, he performed excision.  Much inflammatory action  ensued
 which was treated by irrigation.   On June 4th  the  patient had  a Chili-
an abscess pointed near the insertion of the deltoid, and w.v opt ned  On
•June 7th, 1863, the case terminated fatally.
  The specimen exhibits a conoidal  ball imbedded in  the upper part of
the anatomical neck and  articulating surface of the heal  -plifin-the
head into two fragments.  It ,uuy b-s tvgardol as , , vpical ca, e for the
operation of ex .ision of the head of the humerus.
          Photographed at the Army Medical Museum.

          _________GEORGE  A.  OTIS,
      ^  „...._.._.             ^ -  v s  y 0urator A     M 
 
                               —♦—
       ARMY  MEDICAL   MUSEUM.

 Siwimen  Xo.  59.    Lower  third of right Femur,  the  outer
     Condyl,-  split off by  a round  Musket   Ball.   Amputation.
     Death.
   Private  iileharci  William^  28th  Pennsylvania  Volunteer,,  was.
 wounded  September 16th, 18H-J. ar the  battle of South  Mountain, by a
 round musket ball, which catered  near  the  outer hamstring, and lodged
 between the conddes of Uk- right femur,   lie was conveyed to Wash-
 ington. D.  C,  and admitted  into Mount  Pleasant  U. S.  A.  General
 Hospital.  September 22d, 1862.  On September 30th, his right thigh was
 amputated, by flap  incisions.    At this date  the  limb  was  excessively
 -ivollcn; the discharge of pus  was profuse;  absc-si-es  had burrowed ins
 the soft parts, and  irritative fever  existed to an alarming degree.   The
 '■w terminated fatally on October 2d, 1862.
  flu ball, which remained imbedded in the cancellated  structure of the
 femur, between the condyles, had  cau-od a very oblique fracture into the-
Wcjoint, separating the external condyle from the shaft, and breaking
*»ff a fragment from the anterior surface of the inner condyle.
          Photographed at the Army Medical  Museum.

                         GEORGE  A. OTIS,
                                 Surg.  U. S. V., Curator  A.  M. Af_ 
 
       Jinjimi  l&mmYs   Mint

       ARMY  MEDICAL MUSEUM.

Photograph  Xo. 13.   Ipper Fourth of the Left  Femur frac-
  tured by a Musket Ball, which entered the Pelvis.
  Private-----was wounded, August 28, 1862, at Gainesville, Virginia,
in the engagement between General King's division of the  First Army
Corps and the Confederate forces under General Jackson.   The diagnosis
was that the trochanters and neck of the left femur were badly splintered,
and  that the  ball had lodged near the  acetabulum.  The symptoms were
grave, and the prognosis unfavorable; but it was decided  to remove the
fractured  extremity of the  bone.  The operation was  performed  by
Brigade Surgeon Peter Pineo, U. S. Vols.  The head and the upper fourth
of the femur were excised, the shaft of  the bone being sawn  about two
inches  below  the  lesser trochanter.  It was  found that  the  ball had
entered the pelvis, and that there was internal haemorrhage. The  patient.
fell into the hands of the enemy.  In  all  probability he survived but a
short time.  The trochanter major is separated into five fragments, and a
long oblique fissure produces a complete  solution  of continuity of  the
shaft of the femur.  (Compare  the Pieport on  Excisions of the Head of
the Femur for Gunshot Injury, promulgated by Circular Xo.  2, S. G  0.,
i8<j;i, p 21.)
          Photographed at the Army  Medical  Museum.
 BY ORDER  OF  THE  SURGEON  GENERAL:
                         GEORGE A.  OTIS,
                           Ass't Surg. U.  S. A,, Curator A. M. J/. 
 
        ARMY  MEDICAL  MUSEUM.

 Photograph Xo. 14.   ipper Portion of Bight Femur, the Neck
   and  Trochanter Major shattered by a Conoidal Musket Ball.
   Private P. Johnson.  Co.  C,  2d Delaware  Volunteers, was wcunded at
 the battle of Fredericksburg, December 14th, 1802. by a conoidal  musket
 ball, which entered the upper part of the right thigh in front and passed
 out at the nates, having, in its course, divided the femoral artery and per-
 forated the great trochanter.   Except that the primary hasmorrhage was
 slight, little is known of the early history of the case.   On December 2">th,
 the wounded man was conveyed to Washington, and placed in the Douglas
 Hospital.  On admission, nearly the entire injmed  limb was gangrenous,
 and it was believed that the fracture extended into the hip-joint.  Brigade
 Surgeon P.  Pineo.T. S. Vols.,  in charge  of  the  hospital,  decided  to
 amputate at the hip-joint,  "with no  hope  of a favorable result, but to
 mitigate the patient's distress in the last moments of life.7'   On December
 27th, anesthesia being induced by  ether, the operation was performed.
 The p;itient survived it only a few hours.  The pathological specimen was
 sent to the Army Medical  Museum and is numbered 710 in the Surgical
 Section.  It exhibits a  perforation of the great trochanter, with radiating
 fissures, which  sepal-ate the trochanter and neck into four fragments, and
run obliquely down the shaft.   Traces of  the  results of periostitis are
visible along the shaft.
           Photographed  at the  Army Medical  Museum.
   BY ORDER  OF  THE  SURGEON  GENERAL:

                            GEORGE A.  OTIS,
              Bv't Lt. Col. and Ass'tSurg.  U. S. A., Curator A. M. M. 
 
         f urncoii  (BtnmYs  ©ffite.

        ARMY  MEDICAL  MUSEUM.

 Photograph Xo. 15.   Skull-Cap, exhibiting a Bayonet Perfora-
   tion of the Left Parietal.
  Private Thomas Graham, Co. B, 90th Ohio Volunteers, was admitted
 into Hospital No 1, Nashville, Tennessee, on November 27th, 18G8, with
 a bayonet wound behind the  left parietal protuberance,  inflicted by a
 sentinel, whom the patient, being intoxicated, had refused  to obey.   For
 several days after admission, he was somnolent and obstinately const ipated.
 Under the use of powerful purgatives this condition was removed, and
 the  wound nearly  cicatrized.   But  on December 8th, the patient com-
 plained of headache, and a probe passed through the small orifice of the
 wound, revealed the presence of denuded and detached bone.  A semi-
 crucial incision was made and  the fragments of  dead bone were removed.
 On December  11th,  there was  more headache, and  a tendency to stupor;
 the pulse was  at 48; there was intolerance of light and sound; the scalp
 was tumid; the wound gaping and filled  by fungous granulations.   The
 incisions in the scalp were  extended;  an  ice bladder was  applied  to the
 head, and purgatives and purgative enemata were employed.  A day or
 two subsequently cerebral hernia took place; then  extended suppuration
 in the left hemisphere; then delirium  and coma, and death on December
23d, 1803.  The description and specimen were contributed by Assistant
Surgeon C. J.  Kipp, U. S. Vols.  The  Specimen is numbered 2179 in the
Surgical Section of the Museum.
          Photographed at the Army Medical Museum.
 BY  ORDER OF  THE  SURGEON  GENERAL:

                           GEORGE A.  OTIS,
             Bv't Lt.  Col. and Ass't Surg.  U. S. A., Curator A. 3f. 31. 
 

  J^p^u    ^.eaimiPs    iftitht.


     ARMY   MEDICAL   MUSEUM.

 Kpkcimkx  Xo. 1481.   Amputated  Extremity of  the  Right
  Femur and  Ifper Extremity of Tibia. with a Round Musket
  Ball impacted near the Spinous  Process of the Articular Sur-
  face of the  Tibia.
  Private-----, a soldier  of the 3rd Division of the 1st Army Corps
 was wounded at  (4-ttvsburg, Penn., on July 1st, 1865, by a musket ball
 which entered through the right popliteal space, fissured the internal
 condyle of the femur, and lodged in the head of the tibia.
  He underwent amputation of the lower third of the thigh on July 15th
and died  July 17th, 1863.  The specimen was contributed by Surgeon
P- A. Quinan, in charge of the Division Hospital.

         Photographed  at the Army Medical Museum,
 BY ORDER  OF THE SURGEON GENERAL:
                   GEORGE  A. OTIS.
          Hr't TA. Cut. ondSurtj. V. S. ]'., Curator A. .17. _\J, 
 
       ARMY MEDICAL  MUSEUM.

 Photograph Xo.  17.   Successful Excision of the  Head  of the
   Left Humerus and Coracold Process of the  Scapula.
  Private R. Jones, company D, C7th New Vork Volunteers, aged twenty-
 two years, was wounded May 12. 1864, at  the  battle of Spottsylvania, by
 a conoidal musket ball, which comminuted the surgical neck of the left
 humerus and and the coracoid process of the  scapula,  and lodged just
 below the clavicle.  He was  removed to  Fredericksburg, and thence to
 Washington, and was admitted to Carver U. S.  General Hospital, May 16.
 At that date  the  shoulder  was highly inflamed,  and the arm greatly
 swollen.  The patient was placed under the influence of ether, on May 17,
 and the head and two inches of the shaft of the humerus, and the frag-
 ments of the coracoid process, were removed through an U shaped incision
 by Surgeon 0. A. Judson,  U. S. Volunteers.  The case progressed rapidly
 towards recovery, and without any unfavorable complications.   Attention
 was paid to supporting the elbow, in order to approximate the upper ex-
 tremity of the humerus to the  glenoid cavity, and  the wound was kept
 open for a time by  dossils of lint.   The coraco-brachialis and the short
 head of the biceps doubtless formed new  attachments at the base of the
 coracoid process.   The photograph of the  patient was taken December 1,
 1864, at which date the cicatrix  was perfectly  sound, and the patient's
control over the movements of  the  limb  eminently satisfactory.  Jones
was discharged from  service December 12,1801.   The specimen is  2479
of the Surgical Section of the Army  Medical Museum.
          Photographed  at the  Army  Medical Museum.
 BY ORDER  OF  THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
             Bv't Lt. Col. and AssSt Surg. U. S. A.,  Curator A. Al  At 
• -:.-.•:}« 
   -       Juirgeai    (&mxnYt   (8tiitt



          ARMY  MEDICAL  MUSEUM.


 PHOTOGRAPH  Xo.  18.     Penetrating   Gunshot   Wound  of  the

    Thorax and Abdomen.   A Round Musket Ball having entered

   the Left  Pleural  Cavity passed  through  the  Diaphragm  and

   thence into some  Part of the Intestinal Canal.   Recovery.

   Captain Rot.ert Stolpe, Co. A, 29th New York  A'olunteers. was wounded at Chancellors-
 ville, on the 2d of May, 1863.  A  round  musket ball, fired from a  distance of about one
 hundred and fifty yan's, entered the eighth intercostal space of the left side, at a point nine
 and a half inches to the left of the extremity  of  the  ensiform cartilage, aiid fractured the
 ninth rib.  Without wounding the lung, apparently, the ball passed through the diaphragm
 and entered some portion of the alimentary canal.  Captain S. walked a mile and a half to
 the rear, and entered a field hospital.  On examining the wound, the surgeons found a pro-
 trusion of the lung of the  size of a  small orange, which  they unavailingly attempted to
 reduce.  The wound was enlarged, and still  it  was  impracticable to replace the protruded
 lung. On May 3d, the field hospital where Captain  Stolpe  lay, was exposed to the enemy's
 fire.  lb' walked half a mile farther to the rear, and  was there  placed in an ambulance and
 taken across the Rappahannock, at United States Fold, to one of the  base hospitals.  Here
 fruitless efforts were again made to reduce  the hernial  tumor, after which a ligature was
 thrown around its base and tightened.  A day or two  subsequently the patient passed into
 the hands of Surgeon Tomaine, who removed  the  ligature  from the base of the tumor.   V
 small portion of the gangrenous lung separated  and leltaclean granulating surface beneath.
 On May 7th, the ball was voided at stool.   On May  *th, the  patient was visited by Surgeon
 John H. Brinton, U. S. Vols, who found  him  walking about the ward,  smoking a cigar.
 There was an entire absence of general constitutional symtoms; no cough, no dyspnoea," no
 abdominal pain ;  the bowels were regular and appetite good. The protruding portion of
 lung  was carnified,  and there was  dullness on percussion and  abs.enc. of the respiratory
 murmur in a zone an inch and a half in width around  the circumference of the base of the
 tumor.  Surgeon Tomaine stated that the hernia had been gradually diminishing in volume.
 It was at this date half  the size of an egg, and  covered with florid  granulations.  On May
 10th.  a drawing of the parts i Xo. IX ; was executed by  Mr. Stanch, artist of the Army  Medi-
 cal Museum. On June 2d, Captain Stolpe was  transferred  to Washington, and  was'visited
 by Suigeori  Brinton and Dr. Henry (1. Clark, of Boston. There was  an elastic partially
 reducible tumor, over which was an oval  granulating  surface, an inch and  a half by three-
 quarters of an inch.  The vesicular murmur was perfect throughout the lung except in the
 immediate vicinity of the tumor.  Compression  of the tumor was advised.  After a visit to
 Kaston. Pa, and a furlough of sixty  days. Captain  Stolpe returned to Washington. On
 November 13th. lSf.:{, he was  again  examined by  Surgeons  ISrinton and (ioldsmith. and
 Assistant Surgeon Woodward,  U. S. A. The  wound  had entirely healed;  the respiratory
 Bounds were normal; there was still a slight hernia of  the lung  Tin- general health of the
patient was excellent.  At this date the second  drawing (No. X) was executed  by direction
of Surgeon J. II. Brinton, who also recorded the foregoing facts in relation to the case.

            Photographed at the  Army Medical Museum.

   BY   ORDER  OF  THE  SURGEON  GENERAL;


                                GEORGE  A.  OTIS,

                BvH Lt.  Col. and Ass''t Surg.  U.  S. A.,  Curator A. 31. 31. 
 
       ARMY MEDICAL  MUSEUM.

Photograph Xo.  19.   Lower Half of Right Femur, with Ball
  impacted above the Inner  Condyle.
  Private Orson B. Norwood, Co. K, 3d Michigan Cavalry, was wounded,
July 15, 1868, in a skirmish near Jackson, Tennessee.   He was acting as
a vidette at the time,  and was stationed on a bridge.  The ball, fired from
below, produced a long fissure in the lower third of the inner aspect of
the femur, and was itself split by the compact lamina of the bone.  This
patient was removed to the  general hospital at Lagrange, Tennessee, Julv
22, 1863.  The thigh was then erysipelatous, and amputation was deemed
inadvisable.  September 27, 1803, the patient was removed to the Wash-
ington Hospital at Memphis, where he died of pyemia, October 2, 1863.
The fragment on  the inner surface of the femur, though but slightly
separated from the diaphysis, was found to be necrosed.  The specimen
was forwarded by Assistant Surgeon Joseph P. Wright, U. S. Vols.
          Photographed  at  the  Army  Medical  Museum.
  BY ORDER  OF THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg. U. S. A., Curator A. 31. M. 
 
ci./LJP<yQ^nyyvyJ'  e~\   -^La^-^U  ■ r^-^^f k^^-c^j-PyxT £/>-\^0
       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No.  20.   Second,  Third,  and Fourth Lumbar Ver-
  tebrae., with a Conoidal Ball imbedded in the Left  Side of the
  Body of the Third Lumbar  Vertebra.
  Private Thomas Durning-.vfihi».K. 1st Michigan  Sharpshooters, aged
nineteen years, was wounded; June  -if, 1864,  and admitted into Stanton
U. S. General Hospital, Washington  July 1,  1864.  An elongated musket
ball, entering the loins just above the crest of  the left ilium, buried itself
in the body of the  third  lumbar vertebra, carrying  with it a portion of
the man's blouse.  On  July  4th, symptoms  of tetanus appeared,  which
became rapidly of the gravest nature, and the case terminated fatally on
the next day, July 5, 1864/^The specimen was contributed by Assistant
Surgeon George A. Mursick, U. S. Vols.

          Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass't Surg.  I/. S. A., Curator A. M- 31. 
 
      ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 21.   Skull, exhibiting an  extensive Fracture
  from Grape-shot.   The Missile entered  the Left  Parietal Bone
  near the Lambdoidal Suture, and emerged through the Squam-
  ous portion of the Temporal Bone.
  The specimen was picked up by Surgeon Frederick Wolfe, 39th New
York Vols  in June  1863, under an abatis near the stone bridge over Bull
Run, and is supposed to be the cranium of a confederate soldier, killed
in the second  battle of Manasses, August, 1862.  At that action a portion
of Longstreet's Corps  charged upon  one  of the federal  batteries in
position near  this locality.
         Photographed at  the Army Medical  Museum.
  BY ORDER OF THE  SURGEON GENERAL:

                          GEORGE  A.   OTIS,
             Bv't Lt. Col and Ass'tSurg. U. S. A., Curator A.  31. M. 
 
       Jfainjrfln   (&mxaYs   ©flirt

       ARMY MEDICAL MUSEUM.

 Photograph  No.  22.   Section of a  Cranium, exhibiting fee
   Trephine Perforations for the Evacuation of Pus, the re.~ult of
  a  Gunshot  Contusion  of  the Right  Parietal.   The Patient
  survived the Operation Twelve Hours,
  Private Joseph R----, Co. E, 151st New York Volunteers, received in a
 reconnoissance near  (he Rapidan, Nov. 27th, 1863, a  gunshot wound of
 the scalp.  The nature of  the missile  was unknown.  The  patient was
 removed to Fairfax Seminary General Hospital.  There were no cerebral
 symptoms at the time of his admission, and it was hoped that the peri-
 cranium had escaped uninjured.   He  was up and apparently well  on
 December  13th, 1863, when he was suddenly seized  with convulsions,
 which were followed by coma.  Surgeon D. P. Smith, U. S. Vols , laid
 bare the calvaria at the seat  of  injury, and finding the  bone diseased,
 applied the trephine.  Matter was found immediately  beneath the bone
 and oozing from the diploe.   It  was thought expedient to make five per-
 forations with the trephine, in order to remove the diseased bone, and
 give free exit to pus.  Convulsions did not recur, but the comatose condi-
 tion continued, and  the case terminated fatally  twelve hours after the
 operation.  The autopsy revealed diffused  inflammation of the arachnoid
 and dura mater.  The Specimen is numbered 2000 in the Surgical Section
of the Museum.
          Photographed at the  Army  Medical Museum.
  BY ORDER OF THE  SURGEON GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt.  Col. and Ass't Sutq. U. S. A., Curator A. M. M. 
 
       jfttrgMH   ^>tmmY&   (Bffitt,

       ARMY  MEDfcAL  MUSEUM.

 Photograph No.  23.    SJcull-cap, exhibiting  Gunshot Fracture
   near the Vertex  by a  Conoidal  Musket Ball, which has split
   against the Lamina of the  Left  Parietal.   The Patient died
   Twenty-three days after the infliction of the Injury.
  Private  C. C. W-----, Co. I, 6th Wisconsin Volunteers,  aged twenty-
 one years, was  wounded in the Wilderness,  May  12, 1864, and was
 admitted to Douglas Hospital, in Washington, four  days subsequently.   It
 was ascertained that the cranium was fractured, but the  symptoms were
 not urgent, being limited to slight paralysis of the  right upper extremity,
 and operative interference was deferred.  On  May 31, a conoidal musket
 ball, and several fragments of the left parietal were removed by Assistant
 Surgeon Wm. F. Norris, U. S. Army.  One large fragment of the vitreous
 plate was pressing on the dura mater;  this  was elevated and removed.
 The next day symptoms of compression of  the brain were manifested.
 An exploration  of the  wound was made,  and a quantity of pus evacuated.
 On June 4, 1864, twenty-three days after the injury, the case terminated
 fatally.  At the autopsy, the arachnoid was found little altered.  There
 was an abscess in the  posterior lobe of left  hemisphere  near  the long-
 itudinal sinus of the size of a walnut.  Its  walls were of a greenish
yellow  color.  It communicated  with the lateral ventricle.   The  right
ventricle was filled with  sero-sanguinolent fluid.  There was a  deposition
of lymph at the base of  the brain,  extending from the medulla oblongata
to the  bifurcation of the optic nerves.   The specimen and history were
contributed by Assistant Surgeon William Thompson, U. S. Army.

          Photographed at the Army Medical Museum.
 BY ORDER  OF  THE SURGEON  GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt.  Col.  and Ass't Surg. U. S. A.,  Curator A. 3L 31. 
 
         Jjwgwn  $tnmY8  Mim.

       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH No. 24.   Three Dorsal  Vertebrse, with a  Musket
  Ball lodged in the  Vertebral Canal.
  Private  Frederick Lord,  Co.  H, 8th New York Volunteers, aged  26
vears, was wounded at Cold Harbor, June 3,  1864, and admitted into Car-
ver Hospital, at Washington, D. C, June 11th.   He stated that, immediately
upon the reception of his injury, he lost all sensation and power of motion
below the wound.   On admission, he was in a very feeble state;  his pulse
was slow,  his respiration labored, his skin  cool, clammy and cyanosed,
his excretions involuntary.   In  this wretched condition he lingered till
the 27th of June, when symptoms of extreme gastric  irritability  super-
vened, and every  form of  nourishment  was promptly  rejected  by the
stomach.  He died July 2, 1864.  At the autopsy it was  found that the
transverse  articular processes of the  eighth  and  ninth dorsal vertebra-
were shattered by the ball.   The spinal cord  appeared  to have been com-
pletely severed at the seat of injury.  It was disorganized above and
below.  In several places the omentum was agglutinated to the intestines
by recent effusions of lymph.
          Photographed  at the  Army Medical Museum.
  BY ORDER  OF  THE  SURGEON  GENERAL:
                         GEORGK A.  OTIS,
                           Ass't Surg. U. S. A., Curator A. 31.  M. 
 
       ARMY  MEDICAL MUSEUM.

Photograph No. 25.  Fourth, Fifth, and a portion of the Sixth
  Dorsal  Vertebrse, sawn  asunder to show the Point  af a Knife-
  blade, which, passing between the  Transverse  Processes  of the
  Fourth and Fifth Vertebrse, and traversing the  Vertebral Canal,
  has entered the body of  the Fifth  Vertebra.
  Private George Sweeney, Co. B, 15th New Y'ork Engineer Regiment, in
an altercation with a comrade,  was stabbed  in the back with a dirk, at
Falmouth, Virginia, the 20th of April, 1863.  He  was admitted to Armory
Square Hospital, at Washington, on April 22d, completely paraplegic.
On April 27th, he began to pass Mb faeces and  urine involuntarily, and
bed-sores appeared on the portions of the lower part of the body exposed
to pressure.  He sank  very  slowly, dying from exhaustion on May 27,
18G3.  The specimen was contributed by  Assistant Surgeon C. C. Byrne,
(J. S. Army.
          Photographed at the Army Medical Museum.
  BY ORDER OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
             Bv't Lt. Col.  and AssHSurg. U. S. A.,  Curator A. 31. M. 
'-  ,Cs„.'"i-J.//./ -i
 
       Jfttrgetfs   GtmnVt   §(ikt

       ARMY MEDICAL  MUSEUM.

 Photograph No. 26.   Portion of Left Parietal Bone, exhibiting
   a slight Fracture of the External Table and Extensive  jSplinter-
   ing of  the Vitreous Table.
  Private Leonard L-----, C>>. F, 74th New l*ork Volunteers, was wounded
 at the battle of Williamsburg, May 5, 1862, and was admitted into Broad
 and Cherry Streets Hospital, at Philadelphia,  May 13, 1862.   A musket
 ball had struck near the left parietal eminence, and,  producing a slight
 depression of the outer table, had lodged under the scalp, whence it had
 been removed by a surgeon on the field.  The wound  had an healthy
 aspect when the man was admitted, and there  was no cerebral disorder.
 This favorable  condition  continued  unaltered until May 20th,  when a
 febrile movement set  in, accompanied by nausea and  vomiting; drowsi-
 ness and stupor followed,  and  the  patient  died comatose on  May 23d,
 eighteen days after the injury.  At  the autopsy,  a small  clot was found
 beneath the depressed portion of the vitreous plate; the  dura mater was
 uninjured; the arachnoid, near  the  seat of injury  was opaque, and
studded with deposits of  lymph;  the grey  matter  of  the brain was
softened.   The specimen and history were contributed  by Acting Assistant
Surgeon E. Livesey, U. S. Army.
          Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass't Surg.  U. S.  A.,  Curator A. M- M. 
 
       ARMY   MEDICAL  MUSEUM.

 Si'K<'IMK\  No   i>4.")l.    E.i foliation  from  the Right  Temporal
   uiifl I'uri-tal Bones. re<id'lng from (luudiot J u jury.
   Privati- William Ki-lier, Co.  C<.  -isth  IVnn.  V"<>1-.,  was   wounded
 near Fort Stevenson, defences  of Washington, July  12th,  1S64, by a
 "•lancinii" shot from a conoidal mii-dod ball,  and \va- admitted into Mount
 Pleasint Hospital on the following day.
   A little above the right  auditory nieatti-  was a scalp wound an inch and
 a half long.   A piece of the mastoid process w:i- chipped off. and a  frac-
 ture extended into the petrous portion of th:* temporal.
   The patient did well with simple dressing and n-t and gentle cathartics.
 till the 20th  of  May, when th c wound began to slouch.    Applications ,»i
 nitric a --id. creosote, etc.. failed to arrest the slouch in-;, which presently
 «;\vc rise to repeated lncmorrhages from branches of the te-iu[)or:il artery.
  Tiie gangren" continued to spread until  August Oth,  when the eschars
 separated, leaving a space five inches in diameter on  the  right  lateral
 region of the head den tided of integument, fascia and muscle-.
  During this long period, the patient compla ined of no inconvenience at
 the feat of fracture, though there Mas at times acute frontal pain.
  E>.u-Iy in September, it wa- evident that  tit"  e\-po..,,l  p >rtions of  the
temporal and parietal bones were necrosed, and <»nS mt. 6th. a fragment oi
die squamous portion of the temporal wa? removed by Aei. Asst. Surgeon
 H. Craft, V.  S. A.   Two  days  subsequently other fragment-  became
detached, and on the 10th  Dr. Craft  extracted a portion of tin temporal
that, had been driven through the dura mater.
  At't'-r this the  wound b-'gantoc'tcatfize rapidly, iind on Dee. :',d. 1 Kill, the
[nitiein was report-dto b?.  entirely out of danger, and. in fa-t. nearly well.
 The specimen,  with  memoranda, from  Aa-,  A-:.  Surg,-.,,,-  l'ortei .
Kmi. and Crafts, was contributed by Asst. Surgeon 0. A.  Met lull. C.S.A .

           Photographed at  the Army  Medical Museum,
 BY  ORDER  OF THE   SURGEON GENERAL:
                          GEORGE  A.  OTIS.
                              Surg. C S. Y.A'aruior A. M. M 
 
       ARMY  MEDICAL  MUSEUM.

 Hl'i'.ciMKX  Xo.  3452.    Exfoliation  from  the Right  Parietal
   Bone, resulting  from  a  Gunshot ■ D pressed Fracture.    The
   Patient recovered.
  Private John McKane, Co. H, 105th Pennsylvania Vols., was wounded
 at Petcrslmrgh, Ta., June 14th, 18D4. by  a conoidal musket ball, whick
 struck the right side of the skull very obliquely, and produced a slightly
 depressed fracture of the right parietal bone.  He was admitted to Mount
 Pleasant General Hospital,  "Washington, on June 24th, with  the  report
 that the progress of the case had been, so  far eminently satisfactory.
  After admission, he was found to be insensible, and a few hours  subse-
 quently, convulsions supervened in rapidly recurring paroxysms.  Twelve
 ounces of blood were taken from the temporal artery without apparent
 benefit.  A trephine was then applied at  the seat of fracture.   A portion,
 Of the inner table was found slightly depressed.  This was elevated, and
 the patient soon afterwards regained consciousness.
  On the 28tli of June, the wound in the scalp  became erysipelatous, and.
 before the inflammation subsided there  was extensive loss of substance of
 the integuments and pericranium, denuding a large portion of the parietal.
 bone  Necrosis ensued, and embraced the whole thickness of the bono.
  In September, 1864, it portion of the  parietal three inches by lour, had.
 become so much loosened that it was readily removed by Act.  Asst. Surg.
 H. Craft  After this, cicatrization went on.rjpidly, and, at the date of
 the last report, December 2d, VM\, the wound  had contracted to an ulcer
 less than an inch in diameter.
  The patients  mental  faculties were impaired more or less, the ward
physician thought, but not to a great extent.
 '' The specimen was contributed by Asst. Surgeon  V. A. McCall, U  S A
Photographed  at the  Army Medical Museum.
               GEORGE  A.  OTIS,
                   Surg- U- S. V., Curator A, M, 
 
       ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH Xo. 28.   Greater  Portion of Right Superior Max-
   illa, necrosed and detached as a Result  of Mercurial Poisoning.
   Private Carleton Burgan, Co.  1!. Purnell's Legion  of Maryland Volun-
 teers, aged twenty years, was admitted to General  Hospital at Frederick,
 Maryland, August 4th,  1*02. in a prostrate condition.  He had a bed-sore
 over the sacrum; his body was bathed in sweat and covered with sudamina;
 his tongue was dry,  and his teeth covered with sordes.  It was reported
 that he had been sick in camp  since  June oth, and  that he  hail recently
 taken, us treatment for pneumonia,  two scruples of calomel, one scruple
 of mercury with chalk, and sixty-five grains of »blue pill.   On August 6th,
 a jagged ulcer was discovered on  the right edge of the tongue.  On the
 10th, a slough appeared on the gum at the root of the right upper bicuspid
 tooth, and rapidly extended to the cheek and the roof  of the mouth.  On
 the 21st, sloughing had  nearly  reached  the orbit, and the entire upper
 maxilla, was exposed.   From  this  date, the  parts  gradually assured a
 healthy action.   On  October 1st, the entire right  superior  maxilla, the
 vertical plate of the  palate bone, and a narrow strip of the left maxilla,
 being quite separated from the  healthy  bone, were removed.   The great
 loss of substance on  the right side of the face caused frightful deformity.
 On December 23d, I860,  the patient  was discharged from the service of
 the United States.  A colored plaster cast  of his face was prepared pre-
 vious  to the patient's  discharge, and  deposited  in the Army .Medical
 Museum.  The patient was  subsequently the subject of a very successful
 plastic operation by  Dr. Gurdon 15uck, which is described by that eminent
 Surgeon in an illustrated paper in the Transactions of the New York State
 Medical Society, for 1804.  The Specimen was contributed  by Assistant
 Surgeon It. F. Weir. U. S.  A.   It is numbered  ">57 in the Surgical Section
 of the Museum.   The history  of  the  case was contributed by Acting
Assistant Surgeon J. H. Bartholf, U.  S. A.
          Photographed at  the  Army  Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Asst Surg. U. S. A„ Curator A. 31. 31. 
 
      ARMY    MEDICAL    MUSEUM.


Si'ecijien Xo. 2334.—Photographic Series, No. 29.   Case  of
  Successful Secondary  Amputation at the Right Hip Joint.
 Private Eben J?. Smith, Co. A, 11th Maine  Vols., aged 19 years, was  wounded at the
engagement at Deep Bottom, near Drury's Bluff. Ta., on August 16th, 1864, by a musket
boll, wbich fractured the head of the  right tibia.  He was admitted at the V. <?. General
Hospital at Beverly, Now Jersey, on August 22d, 1864.
 On admission, the injured knee-joint was swollen and painful, and there was irritative
tar of a moderate grade.  On September  12th, secondary hemorrhage occurred,  and  the
thigh was amputated by circular incisions at the lower third, by Acting Assistant' Surgeon
I. M. Morton. V. S. A., the patient being under chloroform.  The case progressed favorably
until OctobertTtk, when secondary haemorrhage recurred,  and was arrested by ligating the
Simoral Artery in Scarpa's triangle.
 The stump remained swollen and painful, and  furnished a profuse fetid suppuration
Jsteomyelitis supervened; the end of the femur  protruded, and was removed by the chain
w. Xerosis finally extended as high as the trochanters, and numerous abscesses  formed
 On January, 19th, ISGo, amputation at the hip-joint was performed, under chloroform  by
toinR Aawtant Surgeon J. A. Packard, U. S. A, the anteroposterior flap operation taint
doptod.  On January 27th, there was ha-morrhage from the stump, and the external iliac
rtery was tied.  The ligature separated on February 17(1,, and two days afterwards there
•as profuse bleeding from the divided artery, which was contracted by pressure for fourteen
ays.  After this the patient rapidly  improved.   In April, ho was"reported" well and
lospitul Steward Baumgras, one of the artists of the Anny M'-di.-a! Museum, was' sent to
ewrly, and made the drawing from which the photograph was taken.   It is' numbered 67
i the Surgical Series of Drawings.
On April 12th, 1865, Smith was transferred to "White Hall Hospital, near Bristol penn
distant Surgeon W. II. Forwood, IT.  S. A., reports that, on May 27th, 1885, he was dis-
lanjiMfrom service, quite well and strong,  the wounds being entirely healed.
Hip necrosed lower portion of *ho femur is Specimen 3703 : the upper portion is Specimen
 a. a. jr.

         Photographed  at  the  Army Medical  Museum,

! y ORDER OF  THE  SURGEON  GENERAL:

                          GEORGE  A.   OTIS,
          lU-'t Lt. Col. andSvi-g. U.  S.  V.,   Curator A. M. M 
 
      ARMY   MEDICAL   MUSEUM.

 Si'Kcr.MEX Xo. S4").  Portions of the  FJ, r,-Hth and  Tu-elfth Ribs
   of the Right  Side, exhibiting  Guusho"  Fractures of the  Shafts.
   with Attempts at Reparation.
  Private Silas Beckwith, C>.  A.. 83d .\<-\v York Vol-., was wounded at
the battle of Fredericksburg, and was admitt<-d into the JJncoln JTo-jiital,
at  Washington, December 23d, l.%2.
  Hi- had been struck by a conoidal musket ball in the back of the riirht
chest, the ball entering over the attaclirn >nt of the - -venth rib, and passing
forwards.  The ball was extracted, and simple dres-in^s were  applied.
Pleuropneumonia ensued, and resulted  in empyema.    On January 3d,
ISHo, a pint of pus  was  evacuated from tin;  pleural  cavity.   Tin- ease-
terminated fatally on, January 21st. 1863.
  The >pccimen was contributed by Surgeon H. Bryant. V. S. Vols.. m,d
the particulars of the ctw were furnished by Surgeon  J. Cooper MrK.ee,
r.  s. a.
 At the point of fracture, necrosed splinters are seen, att-iehed  by large,
irregular  formations of callus.
          Photographed at the Army Medical Museum,
 |Y ORDER OF  THE SURGEON  GENERAL-.
                         GEORGE A.  OTIS.
                             Surj. V.  S.  V.,<Mrah>r A. M. M 
 
       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH  Xo. 31.   Left  Femur, exhibiting a partly consoli-
  dated Gunshot Fracture of the Middle  Third of the Shaft.
  Corporal H. Burns, Co. H, 31st New York Volunteers, was struck by a
conoidal musket ball at the battle of Chanceilorsville, May 3, 1863.   The
missile fractured the shaft of the left femur, with the usual longitudinal
splintering.  On  May 8th, the patient was admitted to Douglas Hospital
at Washington, and it was decided to attempt to save the limb.   The limb
was first suspended by Smith's  anterior splint.  Afterwards  Hodgen's
apparatus was applied, and  apparently  answered  a better purpose; but
large abscesses  having formed in the thigh, and free incisions  becoming
requisite, a long fracture box, filled  with bran, was substituted.  On June
16, 1863, the ball and several  fragments of detached  bone  were  removed.
The patient died ou July 11, 18<<3, from exhaustive  suppuration.   Several
days before his death, gangrenous patches appeared on the left leg.  The
preparation shows well the extent of the fracture  and of the reparative
process.  There are several sequestra enclosed in the large deposit  of
callus.  The  specimen, and the facts concerning it, were contributed bv
Assistant Surgeon William Thomson, V. S. Army.
          Photographed at the Army Medical  Museum.
  BY  ORDER OF THE  SURGEON  GENERAL:
                           GEORGE A.  OTIS,
                             Asst Surg. U. S. A., Curator A. 31.  U. 
 
       ARMY  MEDICAL   MUSEUM.
                              ----s----
 i'lfOTOORAI'IIlc SKRIKS  Xo.  32.   £/„-#  Wound of t/„: Fan:
  Private William H. Xims, Co. I), (il-t y,.w York Vols., was wounded'
 June 17th.  1804, in front of Pete-lm,^. Ya., and was  admitted into
 Columbian College Hospital, at Washington.  June ■>.•>([. 1 Sf>4.
  He was struck by a fra-nient of shell,  which evacuated the luunoiu-s of
 the right eye, and fractured the nasal bones and right- superior maxilla.
  The treatment consisted  in  the removal of fragments  of bone, and
 adjustment of the lascerated soft parts.
  At this date, April 2oth, 1*0-3, there is a small fistula, communieatino-,
probably, with a norro-ed fragment of the spongy bones.

           Photographed  at the Army Medical  Museum,
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                         CiKORGE A.  OTIS,
                             Surg.  r. S. V.,Curator A...!/. J/,. 
 
   fuvpow    ®$.n.ivr.il!'5    i.Ofi-'m^
                            -  -»—
      ARMY   MEDICAL  MUSEUM.


 Sl'KCIMKN  Xo. 3001.   Bones of the Right Leg, commlnntrd  by-
  a Cowlihd  Uusl,-''t Ball.
  A genera! officer was wounded tit tin-assault on Port Hudson, .day 27th,
 18153. by it conoidal musket ball, which pas-sod from, the inner to the outer
 i|.<peet of th" right leg, and shattered the upper thirds of the tibia and
 fibula.
  A >tatf surgeon extracted a number of detached fragments of bone, and
then sewed up the wounds  by the glover's suture.
  On Juti" 2d, the patient was  removed t >  New Orleans;  th-- sutures
were clipped, and  decomposed eoagula, pit-, and bone splinter-  in large
quantities were  evacuated.  The constitutional symptoms  were;  of the
most aggravated character.
  About the middle of June, amputation was performed at the lower
third of the  thigh  by Professor Warren Stone, with the. very  slightest
hope of succe-s. The patient, however, struggle I through, and, ultimate-
ly, wore an artificial limb  with comfort.
  The specimen and the particulars of the ca-.- were contributed by Prof.
!''• liiicon, of Yale College, formerly Surgeon  V. S. Vols.
         Photographed at the  Army Medical  Museum,
 BY ORDER OF  THE  SURGEON  GENERAL:
                       Gi:ORGE  A.  OTIS,
                           Surg. r. S.  V.,Curator A. M. M... 
 
<)
//.,
   %uvgjcon    irn mil's    •HW-iu.


      ARMY   MEDICAL  MUSEUM.

Sl'ECi MI'.N  Xo. 1257.    Section of the flight  Parietal Hone, ex-
  hibiting a Gunshot Fracture.   Tin  Out> e  Table of the  Sku'l
  is slightly and the  Inner  Table extent!rely depressed.
  Private (.enrge V------, Co. C. *4th X'\v York Vols., was wounded
nt Chanceilorsville. May :>d. ]*('e>. and admitted into Carver Hospital, at
Washington, 1). ('., on May 7tb, lsij:-J.
  His injury was suppled to  be a simple  scalp  wound  from a musket
ball,  it was situated  over the right parietal  protuberance,  and,  on
admission, wa< granulating kindly.
  Ten days  Mihsefpaently.  the  patient, after a walk out of doors, bad
headache  and nausea,  and the wound gaped, and its edge^ ulcerated.
  On  the 18th of May. the probe detected denuded bone; but no frac-
ture was discovered.  There were no febrile or cerebral symptoms.
  On May 20th, a depression of the outer table of the skull was detected.
At night, there  was  delirium, and the following day the pulse became
feeble  and irregular, the stomach irritable, the  tongue  heavily furred.
  The patient died  on  May 22d, 180:!. being conscious and  rational  to
the last.
  At the autopsy, extensive inflammation of the dura mater was observed,,
imfl softening of the  middle lobe <»f the right cerebral hemisphere.
         Photographed at the  Army  Medical  Museum,
 BY ORDER OF  THE  SURGlON  GENERAL:
                       fiKORGK  A. OTIS,
                           S!t.ir<p  C.  S. V.,Curator A.3I. M. 
 
'■•    tf      '             '~*^-

   JnrptHi     Sciuvnl^    (Dffvcr,


      ARMY  MEDICAL   MUSEUM.
                             ♦- —
 ^PECIMEN  Xu.  o207.   Ijoicer fkdj  of ],< ft Femur, exhibiting  a
  [jurtiid.li/  Consolidated Gunshot  Fracture of the Shaft.   Tin
  deformed Callus encloses  several Xeerosed Splinters  and  a
  hutterrd  Musket Ball.
  Sergeant Sewell  T. Douglas, Co. <>. 1st. Regiment  Maine Heavy
 Artillery, aged 2* years, was wounded at the battle of Spottsylvania. and
 ft-as admitted to Emory Hospital, at Washington,  May 22d, ISO I.   A
 musket ball, entering posteriorly, bad fraetured 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 wa~ used.   Internally, stimulants and  tonics were employed.
  In August, 1804,  the patient suffered  from severe  diarrlnea.   Then*
 «';is :;   -;■.'. -us ill-conditioned discharge from the  wound.
  Tin-  patient died,  September 2titb, 1H'>4. from exhaustion.
  Aefing Assistant  Surgeon J. M.  Do-wn-s.  V.  S. A., in charge of ihc
ease, made the post-mortem examination and  forwarded the specimen.
         Photographed  at the  Army Medical Museum,
 BY ORDER  OF  THE  SURGEON GENERAL:
                      GEORGE A. OTIS,
                          Surg. C.  S.  V.. Curator A. M. M 
 
      f mpm   §numlfs   §Uut

      ARMY  MEDltCAL  MUSEUM.

PhOTOORAPII Xo. 36.   Partially  Consolidated Gunshot Fracture
  of the  Ipper Third of the Left Femur.
  Private  Christian Holzworch, Co.  B, 20th Indiana Volunteers, was
wounded at the second  battle of Manasses, August 20, 1802, by a con-
oidal musket ball, which entered  on  the anterior  aspect of the  upper
third of the left thigh,  and lodged against the femur, which was fractured
with extensive longitudinal  splitting.   He  was conveyed  to  Armory
Square  Hospital at Washington.   No particulars of the  treatment em-
ployed can be ascertained;  but it is reported that in  March, 1803, he was
able to  go about on crutches, and  that he was "doing well'" until  the
latter part of May, when an  attack of cerebro-spinal meningitis super-
vened, and terminated  fatally  on the 2oth of May, 1803.  Upon the exam-
ination of the  injured  limb, the fractured extremities of the femur were
found to be united, with great angular deformity, by irregular arches of
callus.  A fragment of the ball was enclosed  between the arches.  The
specimen was contributed by Assistant  Surgeon (.'. C. Byrne, U. S. Army.
It is figured on page 280 of the Catalogue of the Surgical Section of the
Museum.
        Photographed at the  Army Medical Museum.
 BY ORDER  OF THE SURGEON  GENERAL:
                         GEORGE  A.  OTIS.
                          Asst Surg. U.  S. A., Curator A. M 31. 
 
       fnrgwu   j&tnmYn   §iiltt

       ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH No. 37.    ipper  Third of Left  Humerus shattered
  hy a Musket Ball.
  Private  George  B. Stannard, Co. F,  17th Vermont  Infantry,  was
 wounded before the entrenched  lines of Petersburg, Virginia, September
 80,18G4, by a conoidal  musket ball, which entered the upper part of the
 left arm posteriorly, comminuted the humerus, and lodged.   The patient
 was  transferred by  an hospital steamer to  Alexandria, Virginia, and
 entered King Street Hospital on October 13th.  At that date the arm was
 much swollen.  There was an incision, three inches in length, extending
 upwards and downwards  from  the wound of entrance;  its lips were
 everted, and of an unhealthy aspect.  The patient stated that he had beeu
 put under the influence  of ether at the field hospital, and that the wound
 had  been carefully explored; but he could  not tell whether the ball or
 fragments of bone  had  been removed.  On October 16th, there was pro-
 fuse  secondary hemorrhage.  The incision was extended, and a battered
 musket ball, impacted just below the  anatomical neck,  was  removed,
 together with the  head and five inches  of  the shaft of  the humerus.
 Three bleeding  vessels  were secured, and the wound  was left open for
several hours, when, all oozing having ceased, it was  closed by sutures
and adhesive strips.   On the following day there was a chill,  followed  by
an intense febrile  reaction,  with  irritability  of  stomach,  hiccough, a
glazed tongue, and an ichorous offensive discharge from the  wound.  On
the 18th, the wound was gangrenous, and haemorrhage recurred, and at
night the case terminated fatally.   The specimen, No. 3289, Section  I,
and history were contributed by Surgeon Edwin Bentley, U. S. Vols.
         Photographed at the Army Medical Museum.
 BY ORDER  OF  THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS.
                           •Ass't Surg. U. S. A., Curator A. 31. Si. 
 
                              —^—

       ARMY  MEDICAL  MUSEUM.

 SPECIMEN  X(».  1042.    Upper  I'ad.f of Right Emm: showing a'
   firmly consolidated (lunshnf  Fracture  immediately  below  the
   Trochanters.
  Private Luman .31. Millius. Co. K. Oth lleg-imeut Pennsylvania IJeservos,
 was wounded at  Antietain. Sept. 17th.  1862. by a  conoidal mti-ket ball,
 which  entered a  little below the great  trochanter of the  right  thigh,
 shattered the upper third of the femur, and lodged  beneath the skin on
 I he inner part of the thigh, whence it was extracted through an meNinn.
  The patient was treated in a field hospital until the  middle of  October,
 when he was transferred to the general hospital  at Suiokotown.  Although
 it slender man, with a narrow chest and feeble organization, id- condition
 mi admission was satisfactory.
  During the autumn of ISi>2.  the  suppuration was copious,  and  frag-
 ments of necrosed bone were occasionally discharged.   Under a nourish-
 ing diet the  patient's strength was supported remarkably.
  On January 21st 1863, the fracture was firmly consolidated.   The limb
 was shortened four inches.   There was  no onlema.    The wound on the
 inner side of the thigh had  closed.  There was a  slight fistula with trifling
 discharge at the wound of entrance.   The patieot  passed several hours
 daily in the open air on crutches.
  About thi> time cough  and  night  sweats  and  other indications of
 tuberculosis  of the lungs  appeared,  and  confirmed  phthisis  was soon
 |-tablislied.  The patient died March Oth,  1*63.
  The specimen and account of the ease  were contributed by Surgeon 1>.
0. Vanderkieft, V. S. V.
         Photographed at the Army  Medical  Museum,
 BY ORDER OF THE SURGEON GENERAL:
                        G-EORQE  A.   OTIS,
                            Sun/, r. S.  V.,  Curator A. M.  .1/. 
 
       ARMY  MEDICAL   MUSEUM.

 SPECIMEN  Xo.  1210.   Right Clavicle fraetured tranxrerse/y !,,
   the Midrib by a  Conoidal Musket Bali.
  Sergeant  Samuel Adam.son,  Co.  F. 12oth Pennsylvania Vols., wa<
 wounded at  Chanceilorsville, May Md, and admitted into Carver Hospital,
 at Washington. May sth, 18(io.
  He had been struck by a conoidal musket ball, which entered a little
 to the right  of the third dorsal vertebra, fractured the neck of the. third
 rib, passed through the upper lobe of the right lung, and having  frac-
 tured the clavicle, lodged behind it.
  There was cough and bloody  expectoration.   Air entered the wound.
 freely.  On  the loth symptoms of pneumonia supervened.   There was a
 copious discharge of >ei-o-sanguinolent pus.
  On May 20th, I860, the  case  terminated  fatally.   The ball was found
in contact with the fractured clavicle, as represented in the preparation.
The fracture  in this case is perfectly transverse, a result due. undoubtedly
to the greatly diminished momentum of the ball.
  The specimen and history were contributed by Dr. II. F. Craig.
          Photographed  at the Army Medical  Museum.
 R Y O^DER OF  THE SURGEON  GENERAL:
                        GEORGE  A.  OTIS,
                            Sura. ('■  S.  V., Curator A. M. M, 
 
J,4
    ^nvi]icon     inunU'ri    uHiUt*


       ARMY  MEDICAL   MUSEUM.

  Spi.il.MKN  X<».  1 !>!.">.   Snpicst rum from  Right  Tibia. Imrolvln;}
   nearly the Entire Shaft.
   Private West ley Frost. Co.  E, 8">th Illinois  Yok. aged 20 years, was
 admitted to a branch of Hospital  No. 1, N'ashville,  Tennessee, with a
 -imple ulcer on the right leg, and its a convalescent from pneumonia.
   In a day or two, the ulcer began to slough, when it was treated bv free
 applications of bromine, tonic, and stimulating constitutional  measures
 hcing adopted at the same time.
   About May 1st, the tibia became denuded, and small exfoliations were
 from time to time thrown off from it.   By the middle of June, two-thirds
 of the crest of the tibia was exposed, and the greater portion  of the shaft
 of the bone was affected with necrosis.
  On July 27th, the  sequestrum. 11.] inches  in  length, was found  to be
 iyimr loosely in the imperfectly  formed involucruin, and it was  n-moved
 without  the aid of the knife or bone forceps.
  The general health now  improved and the  process of repair of the
 i-xtciisive loss of schstance in the leg went on rapidly until August 20th,
 when an attack of jaundice supervened;  subsequently  the  patient sank
 Into a typhoid condition; abscesses  burrowed in the affected limb, bed
 -oivs formed,  incessant gastric irritability occurred, and symptoms  were
 manifested that were  regarded as conclusively indicative of the presence
 nfpytemia.   On September 23d, 1868, the patient died.
  The specimen and fact- connected with it were contributed by Surgeon
Caleb W. Homer.  V. S. Yob.
        Photographed  at the Army  Medical Museum,
 BY ORDER OF THE SURGEON  GENERAL:
                      GEORGE  A. OTIS,
                          Sar<).  V. S. \'.. Curator A. M. M. 
 
ARMY  MEDICAL  MUSEUM,
 Photographic Series Xo. 41.  Recovery after Excision of the
  Ifemi and  Upper Portion of the Shaft of the Left  Femur
  shattered by a Musket Ball.
  Lieut. Jarratt, of the 15th  North Carolina,  (Confederate) Regiment,
 having a comminuted gunshot fracture of the upper extremity of the left
 femur, underwent,  January 9th, 1864, an excision  of the head, tro-
 chanters, and several inches of  the shaft.  The  operation was performed
 ut Richmond, Ya., by Dr. Read,  formerly of  the  Savannah Medical ,
 College.
  The patient is said  to have  so far recovered at the expiration of six
 weeks from the date of the operation, as to be able to  be removed to his
 home in North Carolina.  He was last heard from in  September, 1864,
 when all sinuses  had healed, and considerable weight could be borne by
 the injured limb.
 These particulars and the photograph of the patient were communicated
hy Assistant  Surgeon  E. W.  Latimer, of  the  Confederate Army,  to ,
Acting Staff Surgeon  W. H.  Palmer, IT. S. A., by  whom they were
forwarded to this Office.

         Photographed at the Army Medical Museum,
 BY  ORDER  OF  THE  SURGEON GENERAL:
                       GKORGE  A.  OTIS,
                           Surg.  lT- S.  V., Curator A.  M. ,M. ,, 
s- 
.snywiB    (i$>$MxnVn    (Office*
ARMY   MEDICAL   MUSEUM,
Specimen  N<-  -7 10    Right  Humerus and Elbow—Necrosis of
  the  Entire  Hum< rns  following  Gunshot  Fractur,   of  the.
  ty,physis.
 Private Barney White. Co. I. 87 th >T. Y.V., aged 22 years, was wounded
lit Williamsburg, Ya., May -">th,  J8o2. in the right elbow  by a conoidal
ninsk"t ball.   -V  simple dressing  was applied, and he was removed to
Vorktown, and thence to Phihidelphia, wliere hq was admitted to Race
Street Hospital.
  No report can be obtained of the progress of the ca--e until March 18,
IB']:!, when thepatient was transferred to the  YcClellan General Hospital,
:it Nicetown, with extensive necrosis of the shaft of  the  humerus and
furies of the elbow joint.   About the joint and arm, there were numerous
sinuses, through  wbich a profuse purulent  discharge  escaped, and,
occasionally, small fragments 0f detached hone.
  tinder a supporting treatment, the  general condition improved.
  About the middle of July, it was first noticed  that the pr.ti.mt's legs
tore .-edematous.   General anasarca ensued, and  an examination of the
urine showed  that  it was  highly  albuminous.   The  patient became
rapidly worse,  and, on August 12th,  an uncontrollable diarrlnva set in,
accompanied by vomiting.  The case terminated fatally, August 22d, 1803.
 The characteristic lesions of Bright's disease wore revealed at  the
autopsy.
 ™             „. +■ ,.-.,-.,•,(, ,1  liv  Acting  Assistant Surgeon C. II,
 The specimen  was tov\\o<t<u  "}   '1-UI^              ^
Bosmlmrm, IT.  S. A.  Additional  particulars of the case were contributed
by Surgeon Lewis Taylor. V. S. A.
         Photographed at  the Army  Medical Museum,
 BY ORDER  OF  THE  SURGEON  GENERAL:
                       GEORGE  A.  OTIS,
                          Surg.  U. S.  V-, Curator A. M. M. 
 
^  -  * •"-.   ? />/  ^x^ >^
£•
«s>
       ARMY   MEDICAL   MUSEUM.

 Specimen \o.  1 :-{:.{.>.   /,'/r//,/ Tibia and Fibula comminuted !>/,<*
   Caiiium Ball.
   Major (leneral I)., Iv Sickles, <  . S, Vols , was wounded on the evening;
 nf the second day of the hattle of  Gettysburg, by a twelve pounder solid
 diet, which .-battered his right ieg.
   General Sickles was  on horseback at the time, and unattended.   Ho
 succeeded in quieting his affrighted horse and in  dismounting unassisted..
 Aid arriving promptly, he wa- removed a short distance to tie- rear to  a,
 sheltered ravine, and amputation was performed low down in the  thigh,
 by Surgeon Thomas  Sim, V. S. Vols., Medical  Director of  the 3d Army
 Corps.  The patient was then sent to tin- rear, and the following day wtu
 transferred to Washington.
  The stump healed with great rapidity.  On July  ldth. the patient was..
 able to ride about in a  carriage.   Early in  September, 1*03,  the  stump,
 was completely  cicatrized,  and the general  was abb- ngain  to mount
 his horse.
  fhc specimen was  contributed to the Army Medical  .Museum  by
bVneral Sickles, and the facts of the case by his staff surgeon, Dr. Sim,

         Photographed at the Army Medical Museum,
 BY ORDER OF THE SURGEON GENERAL:
                        ii KoRGE A.  OTIS,
                            Surg. U. S.  [A Curator A.  31.  XL, 
 
   fimiMn    §mnnVs     Mint,


      ARMY  MEDICAL  MUSEUM.

 I'lroTOdRAPHic Series Xo.44.   Gunshot Fracture of both Parie-
  ta/s.  Recovery.
  Private John W. Snyder. Co. B, 4','th Pennylvania Vols., was wounded
 by a conoidal musket ball, April 1, 1865, in an assault upon the entrenched
 lines at Petersburg, and  was  admitted to Judiciary Square Hospital, at
 Washington, April 12th, 1865.
  On  admission,  he had dilated pupils,  a slow pulse—56 per minute,,
 restlessness and stupor.   He could  be aroused to consciousness.  There
 was no paralysis.  On April  13th, a. fragment of depressed bone, three-
 fourths of an inch square, was removed, and the symptoms of compression
 of the  brain gradually subsided.
  During his convalescence, it was noticed that his vision was  impaired,.
 especially on the left side. On June 13th, the wound had cicatrized except
at one  minute point.  It is probable that there was here a communication
 with a small necrosed fragment of bone.
  The  facts of the case were contributed by Assistant  Surgeon Brinton;
Stone,  U. S. Vols.
        Photographed at the Army Medical Museum,
 8Y ORDER  OF THE  SURGEON  GENERAL:
                     GEORGE  A.  OTIS,
                         Surg. V. S. V., Curator A. M.  Mi. 
 
      ARMY   MEDICAL  MUSEUM.

 Photographic  Series  Xo.  do.    Consolidated  Fracture  <>p
  Right Femur.
  Private Clement If. Schellingei\Co. ('. '1th New York Heavy Artillery,,
 vyas wounded at the assault on. Fort Fisher, Xorth Carolina. April 2nd,
 1865, by a musket ball,  which fractured the lower third of the shaft of the
 right femur.
  He was treated,  by maintaining the limb  in  position bj-  sand  bags.
 simply, and subsequently by a straight splint.   The progress of the case-
 Was throughout  favorable,, and,, early in June, the wound bad (dosed.
 At the date at which the photograph was taken, a sinus had opened and.
 discharged .slightly.  There appeared,, however, to be but little  doubt of
the patienfs ultimate recovery with a useful limb.   There was  slight
aversion and one and a  half inches shortening-.

         Photographed at  the  Army Medical Museum,
 ?Y  ORDER OF THE  SURGEON  GENERAL:
                       GEORGE  A.  OTIS,
                           Sure/. U. S. V., Curator A,.  31... 3k 
 
      ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 46.   Consolidated  Gunshot  Fracture  of  the
  Lower Third of the Right Femur.
  Private Jacob Durst, Co. D, G9th New York Volunteers, aged 21 years,
was wounded, March 25, 18u->, at the battle of Hatcher's Run, by a con-
oidal musket ball, which passed through the right thigh, five inches above
the patella,  from  before  backwards, splintering the femur.  The patient
was admitted to  Armory Square Hospital,  March  30,  1865,  and was
treated with Hodgen"s apparatus until April 14th, and subsequently by
Buck's method. There was comparatively little constitutional disturbance
at any time,  and the suppuration was  slight.  On June 9, 1865, the frac-
ture had  firmly united, with 1]  inches  shortening.   On June 23, 1865,
the photograph was  taken.   The movements  of the knee-joint were
perfect.  The wound  of  exit was still  open, and  discharged  a trifling
quantity of healthy pus.  The  patient was able to walk about briskly on
crutches, and his  general health was excellent.  He was transferred on
July 21, 1805, to Albany,  to be mustered out.  His name does not appear
on the rolls of the Pension Office.   The particulars of  the case were fur-
nished by Acting Assistant  Surgeon  George K.  Smith, U. S.  Army, by
whom the treatment had been conducted.
          Photographed  at  the Army Medical  Museum.
  BY ORDER  OF  THE SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg.  U. S. A.,  Curator A. 31. 31. 
.y
s 
      ARMY   MEDICAL  MUSEUM.

 Specimen Xo.  2803.—Photographic  Series. Xo. 47.    United
   Gunshot  Fracture  of the Lower  Third of the Left Femur.
  Private Michael Burns, Co. B, 28th Massachusetts Vols., was wounded
 by a conoidal musket ball, at the  engagement  at Hatcher's Run  Ya.,
 March 25th, 1865.  The ball entered the anterior portion of the thigh!
 about four inches  above the outer margin of the patella, and passed back-!
 wards, fracturing the femur, and  making its  exit posteriorly on a level
 with the wound of entrance.
  Burns was admitted into Armory Square  Hospital, at  Washington,
 April 3d, 1865.   There was but slight constitutional disturbance, and
 the wounds discharged but about half an ounce of laudable pus intwentv-
 tour hours.  The injured limb was shortened two inches.   It was  placed
 on a mattrass and supported by sand bags, and  extension was made bv
 a weight of sixteen pounds.   A liberal diet was ordered and twenty-drops
 of the tincture of the sesquichloride of iron thrice daily; but no stimulants.
 On April 14th, the discharge was diminished to one drachm daily, and
 the shortening was reduced  to one and a quarter inches.   On May 11th,
 union  was believed to be complete, and extension was removed and the
 patient allowed to walk about on crutche-. On June 25th,  the photograph
 was taken at the Army Medical Museum.    The wounds were entirely
healed,  and the femur  appeared to be firmly united   On  July 5th, 1865,
the patient was transferred to the  IT. S. General Hospital at  Readville,
Massachusetts.
        Photographed at the Army Medical Museum,
 BY ORDER  OF THE  SURGEON GENERAL:
                       GEORGE A. OTIS,
          Bv't Lt, Col, and Surg. U. S.  V., Curator A. M. M, 
bt 

argjwi  dtucriils  (
       ARMY  MEDICAL  MUSEUM.

 Photograph  Xo. 48.    United Gunshot Fracture of the  Uvver
   Third of the Left Femur.                         '        tr
  Private  Thomas  L.  Delap, Co.  B,  32d  Wisconsin  Volunteers,  was
 wounded February 3, 1864, in an engagement on the Coosahatchie River,
 by a conoidal musket ball, which fraetured the  left femur a little below
 the trochanters,  and  lodged.  Delap was  conveyed to the U. S. General
 Hospital at Beaufort,  South  Carolina,  and  was treated  there, upon a
 double inclined plane, until May  6, 1865. when he was  transferred to
 Armory Square.Hospital, at Washington  On admission to Armory Square,
 May 10,  1865, the fracture  was found to  be firmly united with one and
 three-quarters of an inch shortening, and slight deformity.   There was a
 slight discharge from the wound.   The ball had not been extracted.   The
 patient was unable to walk  on crutches.   On June 23, ISVAi, the photo-
 graph was taken. The wound had  then healed.  The ball  remained in
 the limb.  The patient could walk  satisfactorily on crutches.   He com-
 plained of inability to flex the injured thigh.  The fracture had probably
 involved  the insertion of the psoas and iliacus muscles.   On July 13, 1865
 thepatient was transferred  to the  TJ. S.  General Hospital at Madison!
 Wisconsin.   He was discharged the service June 12, 1865, and pensioned,
his disability being rated total and temporary.  On March 19, 1867, Pen-
sion Examiner J.  Bennett reported this man to be confined  to bed with
several fistulous openings  in the thigh,  and  suffering from  pain, fever,
and debility.

         Photographed  at the  Army Medical Museum.
  BY ORDER   OF  THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                           A.is't. Surg. U. S. A..  Curator A. 31. 31. 
 
 fu11$o 11     (f)tnwwVs     (Mix.cjp*


    ARMY    MEDICAL   MUSEUM.

SPECIMEN' X(). 4982.--PllOTOiiRAPHir  Sk.RIK^. X(».  49.  United
  Gunshot Fracture  of the Lower  Third of the Left Femur.
 Private James O'Connor, Co. F. 16th Michigan Yols., was wounded at
Cold Harbor. Ya.. dune '2d, 1864, by a conoidal musket ball, which  passed
through the thigh, three inches above the  patella, fracturing the femur.
 Tin patient was conveyed to Armory Square Hospital, at "Washington.
The limb was maintained in position by Hodgen's Splint.  Xo extension
Wits made.  In the  course of the treatment, eight  small fragments of
bone were removed through the wounds of exit,
 In February, 1865. the fracture was firmly united, and the patient  was
able to walk  briskly without any artificial assistance.   The posterior
wound was not entirely healed.  In the latter part of the month he  was
aligned to the 4*ih  Company of the  Second  Battalion of the  Veteran
Reserve Corps, by order of the Provost Marshal (4eneral, and was put on
guard duty.   Being unable to boar the fatigue of guard  duty, he  was
returned to the hospital for treatment.
 The photograph was taken June i'2d. 1865,  The wound  was still open
and there was slight discharge of sero-punilent matter.    There was an
inch unci a quarter shortening, but no angular  deformity.  At the --at of
fracture, the femur was somewhat enlarged.
 O'b'onnor was discharged from the service, July 18th, 1865.
 The particulars of the case were furnished by Acting Assistant Surg.-on
1;"<».K. Smith, i*. S. A.

        Phoiooraphed  at the Army  Medical Museum,
 BY ORDER OF  THE  SURGEON  GENERAL:
                   GEORGE A.  OTIS,
         Br't  Lt.  Col. find Surg.  V. S.  V., Curator A. M. 31. 
 
       jFiJttjflan   ®mx%Y»   ©ffirt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 50.  Completely Consolidated Gunshot Fracture
  of the Lower  Third of the Left Femur.
  Private Charles Westerfield, Co. B, 5th New York Cavalry, aged twenty-
two years, was wounded at the battle of  the Wilderness, May 5, 1864, by
a conoidal musket ball, which produced a  comminuted fracture of the
lower third of the left femur.  He  remained for two  days in a field hos-
pital, and was then transferred to Fredericksburg in  an ambulance.  He
was  treated at  Fredericksburg  with  a  starch bandage and moderate
extension.  On May 25th he was transferred to Armory Square Hospital,
at Washington,  where the fractured  limb  was  supported  by Smith's
Anterior Splint.  During May and June,  a number of fragments of  bone
were eliminated.   In August, the wounds closed and the fracture appeared
to be firmly united, and on September 3, 1864, the patient was discharged
from service,  and  was  afterwards  pensioned, his  disability being rated
one half and permanent.  In the  middle of September, 1864,  Westerfield
was able to walk without crutches.  In April, 1865, his limb was photo-
graphed at the Army Medical Museum.   It was observed that there was
complete consolidation of the fracture, with two and a half inches short-
ening, and slight eversion of the leg.  On July 25, 1865, Westerfield was
engaged in active out-door  employment. He could  walk  rapidly and
without limping, with the aid of a high-heeled boot.  There was no sign
of necrosis about the fracture, and the wounds had never re-opened.
         Photographed  at the  Army Medical  Museum.
 BY ORDER  OF  THE  SURGEON GENERAL:
                         GEORGE A.   OTIS,
                           Ass't Surg. U. S. A., Curator A. M  M. 
 
  fnfpua     AtuuVs    ibttiu.


     ARMY  MEDICAL  MUSEUM.

 Photographic  Series  No.  51.    Successful Excision of the
  Ihud of the Right Humerus.
  Sergeant Chauneey  A.  Winser. Co. A. 6th Wisconsin Vols., was
 Wounded at the battle of Gravelly Run, March 31st, 1865, by a conoidal
 musket ball, which entered below the middle of the right clavicle, and,
 passing outwards and backwards, shattered the head of the right r  merus-.
 The same day the head of  the bone was excised  by Surgeon "■/>], 6th
 Wisconsin Vols., through a  straight incision parallel to the axis of J  arm.
  May 4th.  1865. Winser was  transferred from  the field hospital to
Judiciary Square General  Hospital, at Washington, in good condition,
Save an interruption from an attack of erysipalas, which supervened
about the middle of  .May, the case continued to  progress most  favorably.
 June 13th, 1865. when thepatient was photographed, the prospect of an
useful limb was very encouraging.

        Photographed at the Army Medical  Museum,
 BY  ORDER OF THE SURGEON  GENERAL:
                     GEORGE  A.  OTIS,
                        Surg.  U. S.  V..  Curator A. 31. :\i 
 

r<
                             —»—
      ARMY  MEDICAL  MUSEUM.

 Specimen-  Xo.  3310.   Right  Tibia   affected  with  SrrofulouA
   Varies and Necrosis.
  John "William Southard, an orphanladof 14 years, a refugee at Mound
 City, Illinois, was  admitted to hospital in October, 1864. on  account of
 scrofulous disease of the right leg, of four years duration.
  The knee-joint  was  implicated;  and  numerous  old  sinuses  com-
 municated  with the shaft of the tibia, which appeared to he necrosed in
 its entire extent.
  On October 5th^  1864, amputation  at the lower third of the thigh was
 practiced by Surgeon II. Wardner,  U. S. Vols.
  The lad's general health  improved after  the operation.   In December.
 'Sld, a ring of bone exfoliated from the femur.  The stump then healed,
 undattheend of May, 1865, Dr. "Wardner wrote that the result was all
 tliat could be desired.
 The specimen  and  the  facts  relating  to it were contributed by the
operator.
         Photographed  at the Army  Medical Museum,
 BY  ORDER OF  THE SURGEON  GENERAL:
                       GEORGE  A.  OTIS,
                          Surg. U, S. V., Curator A.  31. M. 
 
                        —»—
ARMY   MEDICAL   MUSEUM.
  Specimen  Xo.  337.).    /ieao7,  ^YecZ-,  ««,/   Trorlantera  of fh-t
   Right  Femur. ^ shattered  by  a   Conoidal  Musket  Ball.' and
   successfully excised.
   Private Hugh "Wright. Co. G, 8th New Jersey Vols., was wounded at
  the battle of the  Wilderne-s,  May  5th, 1864, and was admitted into
  Stanton Hospital, at Washington, May 25th, 1864.
   A conoidal musket hall, entering an inch  to the inner side of the right
  femoral artery, two  inches helow Poupart's Ligament, had passed back-
  wards and downwards, shattering the neck and trochanters of the  femur,
  and lodged against hone.
   On May 27th. Assistant Surgeon George A. Murs!?".., U. S.  Vols., made
  avcitieal incision  over the great trochanters, six inches in lemrth, and
 extracted the ball and splinters, and excised the head :-eck, am! | rochanters
 of tie- femur.   Duriny   the  nperatioiiranaMhr-sia   was   maintained
 by ether.                                                   *"~
   The shock of the  operation  was great, and reaction tardy.  On the
 Micceeding day there  was much nervous agitation, the pulse was frequent
 imd feeble, the tongue dry, and thirst excessive.    On dune 1st, these
 itnfavorahle symptoms  had disappeared:  the  wound  looked  well, and
 di.-ehnrged laudable pus.
   Prom  this  date,  a  tonic  and  supporting  regimen  was diligently
 enforced, and the patient's progress towards recovery  was satisfactory.
 hi Xovember, 1864. and again in February.  1865. abscess'-- formed  in the
 thigh, hut. after poulticing and incision, they gave little trouble.
  In April. 1865, Wright  moved about on  crutches.   On  the  1.7th  of
 April, he was discharged from the hospital and from the  service of the
 United States.   There  was still a trifling   fistulous  orifice near the
acetabulum;  but  the  general  health  was  excellent,  and the prospect of
ultimate recovery most encouraging.
  The specimen and  the history of the case were  contributed by the
operator.

         Photographed a+ tbe Army Medina! Museum.
 BY ORDER OF THE SURGEON  GENERAL:
                        GEORGE  A.  OTIS,
                            Surg. U.  S. V..  Curator A. 31. 31. 
^   .'  I 
  | II$|jK U Jit     *|U% f *l'$     # f fJf 11


     ARMY   MEDICAL   MUSEUM.

 Specimen  Xo. 3o76.—Photographic  Series.  X<>.  54.    Cast
  of Successful Excision of  the Right Elbow-Joint  for  Gunshot
  Injury.
  Private William 1). Eiley, Co. O. 86th New York Voh., aged 21 years,
 ivasaccidentally wounded, at Brandy Station, Va., Nov. 26th, 1863, by a
 musket ball, which shattered the inner condyle of the right humerus and
 the olecranon process of the ulna.   He  was  admitted to Mansion House
 Hospital, at  Alexandria,  the same  day, having  bled  quite largely on
 the way.
  On December l'.»tb, 1863, Surgeon  Charles  Page, l.  S. A., excised the
 elbow-joint, employing the H shaped incision.  Two and a half inches of
 the lower extremity of the humerus, an, inch of the upper extremity of the
 ulna, and a small portion of the  head of the radius were removed.
  The case progressed most favorably, and in May,  1864, Eiley went to
 lits home on furlough, with a useful arm.  He was subsequently discharged
 from  service.
  In  18H5. he re-enlisted  in. Co. K,. 5th Regiment,  First Army Corps,.
 yith the approval of Lieut. Colonel Dougherty, Medical Director of the
 lorps.   -'The man went through the manual  before  me," Surgeon
 Dougherty writes,  '-and  staled  his readiness  to  do  all the duties  of a
soldier.  He wished it recorded that  he  was competent and  prepared, in.
order  that during the term of his service he might be  held  to full duty.
 I lie degree of motion was  perhaps one third of the normal  amount."
 The photograph was taken  in June. 1H65.

        Photographed at the Army Medical  Mu9eum,
 IV ORDER  OF  THE  SURGE.ON  GENERAL:
                      GEORGE A. OTIS,
          Lu- / Lt. (ol. oltd. S•'>•(!, U S.  J.',,. Curator A, 31  31 
 
lire
       ARMY   MEDICAL  MUSEUM.

  Photographic  Series No. 55.   Consolidated Gunshot Fractur
   of Left Femur  Firm  Union after the Removal of Large  Fraa
   menfs of the Shaft.                              '       J      J
   Private Richard Hanlon,  Co. C, 5th IT. S. Cavalry, was wounded at
  the engagement at Beverly Ford, Virginia, June 9th, 1863, by a conoidal
  musket ball, which fractured the left femur below the middle, and  caused
  extensive longitudinal  splitting  of the  bone.    The  following  dav
  he was admitted into Lincoln Hospital, at Washington.
  ' Anesthesia being induced by ether, the wound was explored by Actin-
I  Assistant Surgeon  G. K. Smith, and then sufficiently enlarged to permit
  the removal of numerous fragments of  bone,  comprising about  three
  inches of the continuity of the shaft.  The ball could not be found.   The
  limb was maintained in the straight position by sand bags..
   On June 23d, 1863, an abscess opened near the periiueum, and the ball
  was extracted from its cavity.
  On October 1st, 1863, there was enough union to allow the patient  to
 rotate the limb on  its  axis.  There  was three  inches  shortening.    On
 December 16th, while walking on crutches, the patient fell  and re-frac-
 tured the femur.   By March 6th, 1864, the bone was firmly united, and
 the wound of entrance was  closed.   In  the middle of  June the wound
 re-opened, and there was a slight discharge  until March, 1865.    The
 patient was able to walk about during this period, and served as a watch-
 man at the Government Repair Shops.
  The photograph was taken, June 20th, 1865.  At that date  the  limb
 appeared to be perfectly sound.  There were no sinuses,  and the  fracture
 » apparently firmly consolidated.  The patient could walk long distances
 without fatigue.  There was false anchylosis of the knee-joint.
  The facts connected  with the case were communicated  by Acting
assistant Surgeon G. K. Smith, under  whose direction the treatment
*iis conducted.

         Photographed at the  Army Medical  Museum,
 BY  ORDER OF THE SURGEON  GENERAL:
                      GEORGE  A.  OTIS,
                          Surg. U. S.  V., Curator A. 31. M.. 
I
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f
I' 
   f  U » jO ;D 0 H    #4? 11  lvVa 1 'Ai     (fif f 1 i" it-,..


       ARMY  MEDICAL   MUSEUM.

 >l'Ki'i.ME.N  Xo.  1M;51.   Exclsid  Head and  Comminuted  Uppci
   Portion  of Shaft of Left  Humerus, vlth a Conoidal Musket
   Ball.
  Private Jennison j.. Jurying, Co. L, 8th Illinois Cavalry, was wounded
 at Rixeyville, Va-,  on November 8th. .186:!, by a conoidal musket ball.
 He  was on  horseback, with  his left  side, towards the enemy, when the
 projectile  struck  the  outer  border of the left  scapula, and-,  glancing
 upwards, shattered  the neck and upper portion of the shaft of the left
 humerus.    The  humerus was  badly comminuted, and its  bead  wa-
 displaced from the glenoid cavity, but. there was no  lesion of  import ant
 vessels or nerves.
  Primary excision was performed by Surgeon K.  W.  II.. Peek.  45th
 Indiana Vols., through a single straight.incision.    Tie- head and frag-
 ments of four inches of the shaft were removed.   The wound  was closed
 liy sutures and adhesive  strips.   The following  day the  patient  rode
 twenty-two miles  in an ambulance to the  Cavalry Corps Hospital, and
 was transferred a few days subsequently  to Columbian College Hospital.
 at Washington.   In the middle of January, 1*64. an abscess  formed in
 the deltoid region, and a small fragment of necrosed bone was eliminated.
 By the end of January the wound was entirely healed.
  On March 25th,  1864.  the hospital report states that  Krving could
slightly flex the left  fore-arm, and  that  the  power  of pronation and
supination and of moving the hand was perfect.
  Erving was discharged  from service, September 26th, lxi;4.   On .June
25th. 1x65. he visited the Army .Medical Museum, and a photograph  was
then taken to  accompany the specimen.    He had  little motion at the
left shoulder-joint:  but the movements of the fore-arm .wore unimpaired.
          Photographed at the Army Medical  Museum,
 1K  ORDER  OF  THE  SURGEON  GENERAL:
                        GEORGE A.  OllS,
                            Sura-  I ■ S.  V.,  Curator A..  31.  \! 
 
      ARMY  MEDICAL   MUSEUM.

 Si-ehmex Xo.  565.   Upper extremity of Left Femur showim/  a
   Pctnmfion  between  the Trochanters  by a  Conoidal  Musket
   Ball.
  Captain James M.  L------, Co. I, 20th Indiana  Vols.. Was admitted
 into Columbia College Hospital, at Washington, June 20th, 1862. with
 two gunshot wounds, received a  day or two previously, in' one of the
 battles before Kichmond.
  The first  wound was through the lumbar  muscles of the left side.
 After receiving it the  officer fell, and  while lying on the field, he was
 »Kain struck by an elongated musket ball, which entered on the outer side
 of the left  thigh,  a  little below the great trochanters,  and.  passin-
 upward* and inwards, lodged.
  A finger could be readily passed into the perforation in the femur but
 the ball could not be reached.   Three  formal attempts to ascertain its
 position and accomplish its removal were made unsuccessfully.
  The patient  died from  exhaustion on August 10th, 1862.   At the
 autopsy, tlio ball was  found in the position in which it isflx.-d'in the
 specimen,  the apex pointing  to the wound of  entrance.   The near
 proximity of the ball had not induced any disease of the hip-joint.
 The specimen and the facts relating to it were contributed by Assistant
M^'on "William M. Xotson, IT. S. Army.

        Photographed at the  Army Medical  Museum,
 8Y ORDER  OF  THE SURGEON  GENERAL:
                      gkorgp: a.  otis,
                          Surg. U. S. ['., Curator A. 31. 31. 
 

        ARMY   MEDICAL  MUSEUM.
                                  4.—
 PhotohraI'HK' Sehh;.->. So.  -S.— Case of Corporal Bemis. thrice
   severely wounded in Three Battles.
   Private  Edson  D.  I5emis. Co.  K.  12th  Massachusetts Vols.,  was
 wounded at Antietam by a musket ball,  which fractured the shaft of his
 left humerus.   The fracture united kindly, with very slight angular dis-
 placement and a quarter of an inch shortening.
   Promoted to be corporal. Bemis received 3Iay r.th. I.X64, at the battle
 of the Wilderness, a wound from a musket ball in the right iliac fossa.
 He was treated in the Chester Hospital,  near Philadelphia.  There was
 extensive sloughing about  the wound, but it ultimately healed entirely.
 leaving a large cicatrix, parallel.with Poupart's ligament.  Ei^hv months
 after the injur}-, Bemis returned to duty with his regiment.
   On February oth, 1865, Corporal  Bemis  was again severely  wounded
 at the engagement at Hatcher's Bun, near  Petersburg, Virginia.  A
 musket ball fractured  the  scpuamous portion of the left  temporal bone,
 and the patient .states that the surgeons found it  lodged  in the substance
 of the  left cerebral  hemisphere,  whence it was extracted, together with
 several fragments of bone, on February 8th, 1865.
  The photograph was taken July 15th, 1*65.  The wound in  the  head
 ivas then nearly healed.  There  was a  slight  discharge of healthy  pus
 tiom one point.  The  pulsations of the briiin  could be felt  and seen
 under the integument.  The mental and  sensory  faculties were unim-
paired.   The  Corporal had been discharged from service, and  recom-
mended for a pension.

           Photographed  at the Army Medical Museum,
 BY  ORDER  OF  THE  SURGEON GENERAL:
                          dEOKGE  A.  OTIS,
             Br'f Lt. Cot. unit Suet;. ('. S.  ['.,  Curator A. 31. M. 
 
   Si^pon*    $n\»m¥#    Mint.
                           - ♦-  -
      ARMY   MEDICAL  MUSEUM.
                            —.4.—
 Photographic Series. Xo.  59.—Resection, of  Portions of tin
   Metacarpus and  Corpus, and of the Lower  Ex fremiti/ of the
   Ulna.
  Major C. W Hobbs. 7th New York Heavy Artillery, was wounded at
 Cold Harbor, Virginia, June  3d, 1864.  by  three musket balls.  One
 inflicted a flesh wound of the left thigh, passing across the popliteal
 -pace, eb's.- to the hamstring tendons.  A  second fractured the third and
 fourth metacarpal bones of the left hand, and made its exit near the
 wrist.  The third entered the left hand between the distal extremities of
 the first and second metacarpals, comminuted the second and third meta-
 carpals, the unciform and cuneiform bones, and the lower extremity of
 the ulna, and made its exit on the outer side of the forearm.
  Primary excision was performed by .Surgeon J.  K. Poinfn-t. 7th  .\\.w
 York Heavy Artillery.  Two  inches of the distal extremity of the ulna
 were removed, with the fractured bones of the carpus  and metacarpus.
 :tnd three outer fingers.  The case progressed without any untoward com-
 plication, and recovery was complete in two months.
  The photograph was  taken July 7th, 1865.  The remaining portion of
the radio-carpal articulation was not anchylosed. and the movements of
the thumb and fore-finger were unimpaired.
         Photographed at  the Army Medical  Museum,
 BY ORDER OF THE  SURGEON  GENERAL:
                      (fEORGE  A.  OTIS.
           Bet L1-. Col. and Sura. TJ. S. J--".,  Curator A. 31. M. 
 
                               -  -♦- -
        ARMY  MEDICAL   MUSEUM.

"Specimen- Xu. HQ2.   Body of the Sjdicnoid Bone transfix, d  by
   the Point of a Sword, which  lias fractured the Paste view  CI 1,mid
   Proofs.
   Private John Higgins. ad. 25. of the guard of Lovell General Hospital.
 Portsmouth Grove,  Rhode  island, was confined for four hours, on the
 night of February  28fh. 1863, in a strong-box,  as a "punishment for
 bringing liquor into  camp.   When released,.he rushed upon the sergeant
 of the guard and struck hint; whereupon the sergeant drew his sword
 I regulation  pattern  for   non-commissioned  officers of  infantry),  and
 stepping backwards a pace, put himself en garde.   In  this position, the-
 prisoner made a second assault, but  the ground being uneven and the
 grass covered by frost, lie slipped  and fell heavily on the  point of the
 sword and to the ground.
  When raised, the assailant's face was bleeding, and he was insensible.
 He was  examined by the medical  officer of the day. who found a slight
 cut on the ala of the nose,.and ascribed the insensibility to intoxication
 and to the tall on the head.    The prisoner  was removed to the guard
 house, and there spent the night.   in  the morning, he was  found to be
 still unconscious, to be breathing stertorously, moaning occasionally,  and
 to have  a slow full pulse and dilated pupils.    He- was removed to a ward
 in the  hospital, and  the  remedies commonly  employed in  cases of
 apoplexy were prescribed.  There was no return of consciousness,  and the
 case terminated fatally on March 2d, .thirty-one hours after the injury.
  At the autopsy, it was found that the sword had entered  at  the right
 nostril, pierced  the right  superior turbinated bone  and tin-  body of the
 sphenoid, and caused a transverse  fracture  at the  base of the  posterior
 clinoid processes.  A slight  indentation  marked  where  its point  had
 impinged upon the right clinoid process.  There was much e.vtravasated
 blood  in the  cranial cavity,  especially over the surface  of the right
 hemisphere.
  A minute account of the case was compiled  by Acting Assistant Surgeon
 X'.vrfarth. TT. S. A., and forwarded, with the  specimen, by Surgeon L. A.
 Kdwards. V. S.  a., in charge of the Lovell Hospital.

           Photographed at the Army Medical  Museum,
 DY  ORDER  OF  THE  SURGEON GENERAL:
                         GEORGE A.  OTIS.
                             Surg. I'. S. K,. Curator A, 31.. 3Li, 
 
  Julian     {4mv,»l's    \Miut.


      ARMY   MEDICAL  MUSEUM.

Photographic  Series  Xo. 61.    Thigh  Stump from which  n
  Cylindrical Sequestrum has been extracted.
  Private William Cotter,'set. 27, Co. E,  9th New  Hampshire Vols.,
Underwent primary amputation of the right thigh  at  the lower part- of
the middle third, on account of gunshot fracture of the lower third of the
femur, at Petersburg, Va., July 30th, 1864   The operator made a long
posterior skin  flap, which  was turned up and attached anteriorly by
sutures.
  On August 3d, 1864, the patient was admitted  to Douglas Hospital,
at Washington. The stump was swollen from the retention of pus by the
bag-like flap.  Two  sutures were removed  and an incision was made
in the dependent portion of the flap, and the stump was poulticed.
  On August 13th, the swelling was much  reduced and the  constitional
irritation had greatly abated; the ligature from the femoral  artery came
away on that day.
  On November 29th, 1864, the wound was cicatrized with the exception
of a small fistulous orifice, through which dead bone had been felt for
two months previously.   An incision  was made here and a cylindrical
sequestrum, nearly six inches long, was extracted.   (Specimen 252, A. M.
Mi.  The sequestrum was surrounded, as usual in such cases, by  a thick
shell of new bone.  Within it, near the middle, was a beautiful  transparent
osseous flake.
 The  patient was photographed, July 16th, 1865.   The fistula  in  the
dump had not entirely healed.   Various stimulating injections had been
unsuccessfully employed.  The patient's general health was excellent.
 The facts of  the case were communicated  by Assistant Surgeon Wm.
F. Noi-ris.  1J. S. A.
          Photographed at the  Army Medical  Museum.
 BY  ORDER  OF THE  SURGEON  GENERAL:
                       GEORGE  A.  OTIS.
           Bv'tLt. Col. and Surg. U. S. V..  Curator A. 31. 31. 
 
   f  it i n jp a«     § f n f a h Ts    (Office


       ARMY   MEDICAL   MUSEUM.

Specimen Xo. 1820.—Photographic  Series. Xo. 62.   Gunshot
  Fracture of the Head of the Left Humerus, successfully  treated
  without Excision or Amputation.
  Private James Keenan, aged 87 years, Co. H, 66th Xew  York Vols.,
was wounded May 12th, 1864,  at the battle of Spottsylvania, by a musket
ball, that entered a little below and in front of the acromion process of the
left scapula, and, passing inwards and  downwards, comminuted the bead
of the humerus, and made its exit at the posterior fold of the axilla.
  On May 28th, 1864, the patient arrived at Douglas Hospital, at Wash-
ington.   The  constitutional condition was satisfactory.   The wounds
were discharging pus mixed with synovia quite freely. A digital explora-
tion indicated that the head of the humerus was almost pulverized: but
that there were no considerable fissures extending into the diaphysis.
  Fpon consultation, it was decided to make a free incision into the joint
to permit the removal of fragments and a free discharge  from the wound.
But the  patient earnestly deprecated  any operative  interference, and,
in obedience to his wishes, he was put to bed and allowed a generous diet:
while, except to keep) the arm at re~t. to facilitate free discharge from the
wounds,  and  to  apply dressing of cold water, no local treatment  was
instituted.
  Under these measures, the patient steadily improved.   Fragments of
necrosed bone  occasionally  came  away.   As convalescence progressed,
passive motion of the joint was made whenever the wounds were dressed.
On January 20th, 1865, the wounds were entirely  healed.   The patient
had good use of his arm, and  could perform most varieties of manual
labor.  The power of the deltoid was unimpaired, yet there was sufficient
anchylosis to  prevent the patient from putting  his hand to his head, or
raising his elbow to a level with the shoulder.
  The result is certainly  more satisfactory than  the average result in
excisions of the head of the humerus.
  The photograph was taken. July  0th, 1*05.   The history of the cast-
was furnished by Assistant Surgeon  Win.  F. Xorris, V. S. A.

          Photographed  at  the Army Medical Museum,
 *Y ORDER  OF THE  SURGEON  GENERAL:
                         GEORGE A. OTIS,
              ',' IA. Col. and Surg. U. S. V., Curator  A. 31.  3L 
 
   ,§'nvi].con     t|rmx¥al  .5     #£Ciu\


       ARMY  MEDICAL   MUSEUM.


 Specimen No. lH!b>.—Photographic  Series.  \o. ti;{,   Recovery,
   without Amputation, after a tluus/mt  Wound through  the  Right
   Knee-joint.
  1'iivatc Peter Mm k. Co. E. lltith l'cnn. Vols., a't. In, was wounded on May lvitli, 1m!+, at
 the battle of Spottsylvania, and was admitted, on  May lstli. to Douglas Hospital, in Wash-
 ington.  The  projectile, which was probably a conoidal musket  ball, had entered at the
 inner edge of the right patella, passed ilirectly through the articulation, and made its exit
 near the centre of the popliteal space.   The inner condyle was  slightly grooved; but the
 ball passed mainly through the intercondyloid notch. There was an abundant thin discharge
 uf mingled pus and  synovia.  The joint was somewhat  swollen,  but the  inflammatory
 symptoms and constitutional  disturbance were moderate.  The  patient was]uf a delicate
 urbanization.
  'file treatment ns limited to rest andjwator dressings.
  On June 9th. there was swelling and pain in the joint and a febrile re-action.  I'ouiticeg
 were applied to the wound cit'exit, the anterior wound having healed.  In a  few days the
 bad symptoms abated.
  In the latter part of August. ^64. the. patient  began to  walk about on  crutches, the leg
 being flexed at an angle of 135° with the thigh.  In October, the limb was bandaged to a
 moveable angular splint, and the flexion was gradually reduced.   Almost complete  exten-
 sion was obtained without exciting inflammation  in the joint.   The patient kept his bed
 during this period of the treatment.
  For the following eight  months,  nothing of special interest  transpired.   There were
 •f-veral attacks of inflammation of the joint; but they were  moderate in  degree and wen-
 readily subdued by poulticing.  On such occasions, abscesses sometimes formed in the thigh.
  For the greater  part of the time, the  patient's  appetite was fair, his bowels regular, his
deep refreshing. When inflammatory mischief was threatened, poultices, hot formentations
with flannel covered with oiled silk,  and applications of tincture of  iodine wero employed.
At other times, cold water dressings with* charpie to absorb the discharge were used.  Ice
was never applied.
  The photograph was taken, July !»th, and the  patient was discharged from service and
the hospital. July Utli. ISfi.'i.  The posterior wound was still  open, and a probe  could be
introduced through it for three inches.  There Wa.- a large deposit of  new bone The patella
was firmly anchylosed to th* femur.
 The facts, of the case were compiled by Acting Assistant  (Surgeon Henry  (iibbons. Jr.,
I. S. A., and forwarded by A-iMiiul Surgeon AVm. K. Norn's, C. .«. A.

            Photographed  at the  Army Medical  Museum,
 BY  ORDER   OF THE   SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
              tied Bt,  C"l. and  Surg. V. S,  ]'., Curator A,  31. 3i- 
 
  &MJ) 4, 0 1)     # jpn * :V it 1 '.5    ($ f f i f  C ♦


      ARMY   MEDICAL   MUSEUM.

Photographic Series, So. t)4.—Recovery, without Amputation.
  after Gunshot Fracture  of the Right Patella.
  Private G. W. Warrington, Co. C.  110th Ohio Vols., was wounded on
April 2nd, 1865. at Petersburg, Virginia, by a round ball from a spherical
case shell.  The ball entered  the centre of the patella, and, producing  a
stellate fracture of that bone, passed downwards, backwards, and inwards.
and was cut out, on the field, one and a half inches below the tuberosity of
the tibia.
  On April 12th. 1865, the patient was  admitted into Judiciary  Square
Hospital, at Washington.   Tliere was  no pain in the knee-joint, and  but
little swelling.   The treatment had been limited  to  dressings  ,,f c0](|
water,  which were  continued for  a few days, and  followed  by applica-
tions of ice.
  The patient was removed to Douglas Hospital, June l'.Hh,  1865, when
three small necrosed fragments of the patella were removed.
  The photograph of the  case was taken, July 9th, 1865.  The wmiinE
had healed, and the patient walked about with a cane.   There was at no
time any indication of the formation of pus within the joint.
  The facts of the case were communicated by Acting Assistant Surgeon
H. S. Colton. U. S. A.

         Photographed at the  Army Medical  Museum,
 BY ORDER OF THE  SURGEON  GENERAL:
                        GEORGE  A.  OTIS,
           li<-'t Lt. Cot. and Surg.  U. S. V., Curator A. 31. *i 
 
   Iwpua      $)$mx&V$      Mint.


 1      ARMY   MEDICAL   MUSEUM.


  Specimkx  X<>.  oo'3.—Photographic  Seriks  Xo.  ()5.   Recovery
 j   a/i-cv  «  Penetrating Wound of the Abdomen with  Fracture  of
 f   the Left  Os Innominatum.

 ' /^f Jf" E l1. C°; E' ™h Xw V°>* Vol.., aged 45 year., ms admitted into Douglas
  Hnspdal. at V.aslnngton. May nth, 1804, with a penetrating gunshot wound of the
  abdomen, received on May 9th. at the battle of the Wilderness
   A mnoidal musket ball had entered at the junction of the left twelfth rib with  its  carti
  lag... and, pass.ng down wards, backwards, and outwards, through the ilium, lodged in the
  ihtteal muscles, whence it was removed l.y incision.
   On admission,  the wound copiously discharged a  thin  translucent fluid  resembling
  .Muted bde, which evidently came from the small intestine, for. among other reasons it had
[  »ml odor.  Were further proof of the origin of the discharge  required, it would be
■  tomshedhy the fact that three ascaridos lumbricoides escaped from the wound durin- the
  wmd and third we~ks of the treatment.   The discharge for nine days prior to admission
  »a<. according to the patient, similar to that above noted.
  Th, patient was kept perfectly quiet, in a recumbent  posture.   The discharge from the
 mmn.1 was facilitated, large masses of eharpie  being used to absorb it.  For several weeks
 the patient was nourished solely by milk, milk punch, and beef tea.  His appetite was poor
 hwrtoq. much disturbed by eou-rh.   But there was „o abdominal pain or tenderness  Pn,,'
 :d no tune throughout the treatment, was there any symptom of peritonasal inflammation:
  Un May 22.1, a  soap and water enema was administered without result.  Nothin"- more
 ™ attempted in this direction, as the patient was doing well and nature seemed competent
 to meet every indication.
  On June ai. the discharge had entirely ceased, and the patient was much improved.   <)„
 Jim..- 6th, he had a large alvine evacuation,  the first since May 9th.  On May 11th. with the
 ■'■'A <'fan enema, he had another large dejection.   From this time lie improved rapidly.
  On August 16th. a fragment of necrosed hone, that could be recognized as a portion of the
 thulium, was removed from the wound in the gluteal region.   About the same period bits
 »necrosed cartilage were taken from fistulous orifices opening near the wound of entrance.
 Hi" bowels were disposed to costiveness. v-!,..\ flatulence was troublesome.  Early in October,
 ''"■re was an attack of dysentery which lasted one week.
 On May Oth, 1X65. a needle shaped bit of bone  e?ra])e,l from the  wound of  entrance.   Oi,
Hay8th, both wounds were entirely healed.
 On July Kith, the photograph was  taken.  The patient was in good health, sufl'erimr only
"'"in occasional attacks of flatulency.
 Tin. facts of the case  were drawn up by Acting Assistant Surgeon  Henry Gibbons,  Jr..
' ■ s- •*.. and forwarded by A-^i-tant  Surgeon Win. V. Norn's, V. 8. A.

          Photographed  at the  Army Medica! Museum,
 6 V  ORDLR OF THE  SURGE.ON   GENERAL:
                           GEORGE  A.  OTIS,
            Bet JA.  Col. and S.v.-1-g.  U. S.  V., Curator A. 3T. 31, 
 
       ARMY  MEDICAL   MUSEUM.

 Photographic Series. Xo. 66.   Successful Excision of the Head
   of the Left Humerus.
  Piivai   Charles  Koss, Co. H.  90th Penn.  Vols., aged 19  years, was
 admitted  to Douglas Hospital, at  Washington, on May 14th, 1864, with
 a comminuted gunshot fracture of the head of the left humerus, received
 on May 10th, in action near Spottsylvania,  Va.
  The head of the humerus was  completely shattered  by a musket ball;
 but there  was no injury of the shaft.  There was much irritative  fever,
 and copious suppuration.   It was determined to excise  the head  of the
 humerus,  and the operation was done, under  ether,  through a  single
 vertical incision, by Assistant Surgeon  Win. Thomson, U. S. A.   There
 was little loss of blood, and the patient promptly re-actcd and then steadily
 improved.
  By the  20th of September, 1864, the wounds had healed completely.
 The patient had a very useful arm.  The elbow-joint, forearm  and hand
 were as good as on the uninjured side.
  The photograph was taken July 19th, 180").   At that date, the patient
 had not accpuired  much power over the movements of his arm: but he
 could raise his hand to his mouth, ani the result compared very favorably
 with  the  average results in excisions of the head of the humerus.   He
 was able to do good service as an  attendant  in the kitchen  and hospital
from  November, 1864, till August 21st, 1865, when he  was discharged
from service.  The excised bead of the humerus is numbered:  .Specimen
1278,  A. M. M.
  The history of the case was compiled by Assistant Surgeon Win. V.
Morris, IT. S. A.
          Photographed  at the Army Medical  Museum,
 S Y  ORDER  OF THE  SURGEON GENERAL:
                        GEORGE A.  OTIS,
           Bv't Lt.. Col., and Sv.rg.  U. S. V., Curator A. 31..  31. 
 
       ARMY   MEDICAL  MUSEUM.

Pl'OTOtiKAPHK  Series, Xo. 07.   Partly  Consolidated  Gunshot
  Fracture of the Tvoeheinters of the Left Femur.
  Private Isaac Wetzel, Co. I, 184th Pennsylvania Vols., aged 21 years,
was wounded on October  3d, 1864, near Petersburg, Va, by  a  conoidal
musket ball, which entered the  anterior portion of the left  thigh, .at  a
level with the trochanters, and, having fractured the femur very high up,
made its exit through the left nates.
  The patient was taken  to  "Washington, and  was treated at  Armory
Square Hospital, by Hodgen's apparatus, without extension.
  On June 1st, 1765, the fracture had  apparently firmly united,  with
three and a quarter inches shortening.   The limb  was  everted, and the
knee-joint stiffened by false anchylosis.
  On July 6th,  1S65, the patient was conveyed  in  an ambulance to the
Army Medical  Museum, and the limb  was photographed.   The  wounds
were still open, and discharged  an ounce of pus daily.   The  patient's
general health was satisfactory..   He was still unable to walk, even with
the aid of crutches.
  The  particulars of the case were furnished by Acting Assistant Surgeon
H. A.  Pvobbins. IT. S. A.

          Photographed at the Army Medical  Museum,
 8 Y  ORDER  OF THE  SURGEON  GENERAL:
                        GEORGE  A.  OTIS.
            Bed Li, Col. and Surg.  (  ,V. \'.,  Curator A. 31. 3L. 
 
   0 U I i) i u U    i§»M X >! I '"8     ■(!» f£ t M +


       ARMY   MEDICAL   MUSEUM.

I  Photographic  Series.  No.  68.   United Gunshot  Fracture uj
    the Middle  Third of the Right Femur.
    Private John H.  Green, Co.  E, 14th New York Heavy Artillery, aged
  47 years, was wounded, June 1st, 1804. near Bermuda Hundreds, Va., by
  aconoidal inu>ket ball, which passed through his right thigh, comminut-
  ing the shaft ot the femur.
    He was conveyed to Washington, and was admitted to Armory Square
  Hospital, June loth, 1864.   He  was treated  by Hodgen's apparatus,
  without extension.
    During March, 1865, several fragments of bono were extracted without
  enlarging the wounds.  Or.'-  of them was two-and-a-half inches in length.
    In June. 186-5, the  fracture  was found  to  he united, with five  and  a
  half inches  shortening, much angular deformity,  and  inversion  of the
  {._>ot.  There was little motion at the knee-joint.  The wounds were still
  open, and discharged about an ounce of laudable pus, on the average, in
  twenty-four hours.
    On July 6th, 1865, the photograph  was taken, and the following day
  the patient was transferred to the U. S. A. General Hospital at Albany,
  Xew York.  His general health was excellent.
    The particulars of the case were furnished by Acting Assistant Surgeon
   H.A. Bobbins, U. S. A.
            Photographed  at the Army Meaica! Museum,
    BY ORDER  OF  THE SURGEON  GENERAL:
                       (aKOK'iK  A.  OTIS,
              HCt  Li. Col.  and Surg. U.S. 1'., Curator A. 31.   . 
 
      ARMY  MEDICAL  MUSEUM.
                             —♦—
Photographic .Series,  Xo.  69.   United  Gunshot  Fracture  of
  the Upper  Third of the Right Femur.
  Private J. E.  Norwood,  Co. H. 9th Georgia (Rebel)  Regiment, was
wounded on February 14th, 1865, near Lee's  Mills, Va., by a conoidal
musket hall, which entered the right thigh opposite the trochanter minor,
and, passing forwards and downwards, fractured  the femur, and made its
exit anteriorly at  the junction  of the middle  with the upper  third
of the thigh.
  Norwood was captured, and conveyed to Washington, and admitted to
Armory Square  Hospital, on  March 23d, 1865.   There was not  much
constitutional disturbance, and the suppuration was moderate.   Buck's
method of treatment was adopted.   The case progressed  without any
unfavorable complications, and, by June 25th, there was firm union of the
fracture, and the patient was enabled to walk about on crutches.
  On July 15th, 1865,  the patient was  photographed at the  Army
Medical Museum.  The fracture was firmly consolidated, with little more
than one inch shortening.   The anterior wound was still open, and dis-
charged a little healthy pus.    The general condition of the patient was
encouraging.
  The facts of the case were  communicated by  Acting Assistant Surgeon
Geo. K. Smith, U. S. A.

          Photographed at the Army  Medical Museum,
 BY  ORDER  OF  THE  SURGEON  GENERAL:
                        GEORGi:  A.  OTIS,
           Bv't Lt.  Col. and Su.rg. U. S. V., Curator A. 31. 31. 
 
^:
     ARMY   MEDICAL  MUSEUM.

 PP0T0«RAPnrc Series,  No.  70.   Modd 0f a Modification of the
  Ordinary Tvo-horse Ambulance employed in the  U.  S Army
  several improvements in the two-horse ambulance, sometimes known
Mbe • Wheeling Ambulance," which has been so generally employed
m our armies during the late war, were originated  by Brevet Col  C H
Tompkins,  U. S. A, and Surgeon  T. H. Hewson, V. *. V., and were
embodied in a model which was presented to the Army Medical Museum
l>y Col. Tompkins.
 The improvements consisted chiefly in the arrangement of the springs
 It is believed that no ambulances of this pattern have been constructed

         Photographed at the Army Medical  Museum,
BY  ORDER OF  THE SURGEON  GENERAL:
                   GEORGE  A.  OTIS,
          llr't Lt.  Col. and Surg. U. S. F.,  Curator A. M. 3f, 
 
  f'ufp^n    $$MViiV$    i$iim.


      ARMY   MEDICAL  MUSEUM.

Photographic Series No. 71.   United  Gunshot  Fracture of
  the Shaft of the Right Femur.
  Private Henry Shelter, Co. D, 7th  Wisconsin Vols., was wounded  by
a conoidal musket ball, March 31st, l*6-\ at Stony Creek, Virginia. The
ball entered the external portion of  the right thigh, a little below the
middle, fractured the femur, and lodged.
  Shelter was admitted to Armory  Square  Hospital, at  Washington,
April 5th, 1865.  On  April  19th, the ball  was detected beneath the
integument, on  the inner part of  the thigh,  two inches below the
perinoeum. and was removed.   The limb was then bandaged, supported
by sand-bags, and extended by a weight and pulley.  The constitutional
disturbance was slight, and the discharge from the wounds moderate.  A
few necrosed fragments of bone were removed.
  On July 5th, the patient was able to ride in the invalid  chair, and, a
few days subsequently,  he walked on crutches.  On July 16th, the photo-
graph was taken.  There was  still a slight  discharge from the wound of
entrance.  The injured limb was shortened  one inch.  The patient's
general health was excellent.  He was about to be transferred to Madison,
 Wisconsin.
  Thp facts were communicated by Acting Assistant Surgeon George K.
 Smith, T. S. A.
          Photographed at the Army Medical Museum,
  6Y  ORDER  OF THE SURGEON GENERAL:
                      GEORGE  A. OTIS,
           Bvt Id.  Col. and Surg. V. Y V.. Curator A. 31. M. 
 
 I'Ht'jj.CftM     <£>»M*U^jS     (Offitjh


     ARMY    MEDICAL   MUSEUM.

Specimen No.  2<W7—Photographic Series No.  72.   United
  Gunshot Fracture of the Middle Third of the Jjcft Femur.
 Sergeant  Anson  slider; CV II, ii'lst X,.w V<-rk Vols., was wounded by a
t'oiioidal musket  ball, on April  2d,  1865; in an  engagement on  the
Soutliside Railroad, near Petersburg, Va.  The ball struck the left thigh,
in front, six inches above  the patella, fractured the  shaft of the femur,
und lodged.
 He was transferred from the Ba>" Hospital, at City Point, to Washing-
ton, as soon as practicable, and  was admitted to Armory Square  Hospital
mi April 12th.  Tliere was but  slight constitutional disturbance, and the
discharge from the wound  was very moderate in quantity.   The injured
limb was shortened an inch and a quarter.  The position of the ball could
not be ascertained.  The patient was treated on Dr. Gurdon Buck's plan.
 On June 9th, the wound was healed, but bony union was still incom-
plete.   Extension by means of weights was continued.
 On July  Sth, the femur was  firmly consolidated, and the patient was
allowed to  rise and walk about on crutches.  On July 25th, 1865, he Mas
taken to the Army Medical Museum, and photographed.   The injured
limb was shortened less than an inch.  The general health was good.
 The ease was  treated by Acting Assistant Surgeon George K. Smith,
wh()coimnunicat"(l the facts relating to it.
         Photographed at the Army Medical  Museum,
 8Y ORDER  OF  THE  SURGEON GENERAL:
                     GEORGE  A.  OTIS.
           Ur't L1: Col. and Snr<h E  -s'- ''-, Curator A. M. 31, 
 
I      ARMY   MEDICAL   MUSEUM.

 Specimen No. 2461.—Photographic  Series. No.  73.   United
   Gunshot Fracture of the Shaft of the Right Femur.
  Corporal David A. Smith, Co. I, 20th Mass. Vols.,  was wounded on
 February 5th,  1865. at Hatcher's Bun, Va., by a  conoidal musket  ball,
'■ which entered the middle of the external surface of the  right thigh, frac-
 tured the femur, and made its exit from the inner and posterior aspect of
 the thigh.
  He was admitted into the Second Corps Hospital, and  was  treated by
 Buck's method,  for six weeks.   Extension was made by a weight of six-
 teen pounds.
  He was transferred to Armory Square Hospital, at Washington, March
 18th, 1805.   The fracture gradually united with four inches shortening,
 and very considerable angular deformity. On April 30th, the patient fell
 from his chair,  and fractured the imperfectly consolidated  callus.   The
 opportunity was embraced to  straighten the limb, and to employ as much
 extension as the  patient could bear.
  On July 25th, 1865, the photograph was taken.   The man was  dis-
 charged from service the same day.  The fracture had firmly united, with
 three inches shortening.   There was still  a small fistula  and  a slight
■purulent discharge.  The general health was remarkably  good.

          Photographed at the Army Medical  Museum,
  fV ORDER OF  THE  SURGEON  GENERAL:
                       GEORGE A.   OTIS,
           Bv't Lt. Col, and  S".rg. V. S.  E,  Curator A. 31. 31. 
 
      ARMY    MEDICAL   MUSEUM.

Specimen No. 142E—Photographic Series. Xo.  74.   Aorta.
   Car a, and  Branches, showing a Lxigation  of the Common. Iliac
   Artery.
  Private George Clark, Co. 1, 4th New Jersey Vols., was admitted into
the Warrenton Field General Hospital, in August, 1863, on account of a
swelling of the left thigh,  which  was supposed to be due either to  a
malignant tumour or to an aneurism, resulting from a wound of the vessel,
eight years previously, by the blade of a pocket-knife.
  He was transferred to Washington, and  thence to the Ward  Hospital
at Newark, New Jersey, where he was admitted on  October Eth, IXi;::.
  On February fith, 1864,  the left external  iliac  was tied,  bv Acting
Assistant Surgeon J. B. Cutter, ES. A., by direction of Surgeon George
Taylor, E. S. A.  After the operation the tumour  diminished  in size,
and for several weeks a cure was anticipated;  subsequently, the swelling
gradually returned, and  in September,  18t>4. it was  greater thai!  lH'ore
the operation.
  On September 17th, 1864,  a  ligature was placed  on the trunk of the
common iliac.  The patient survived the  operation five days and died
of peritonitis.
  The autopsy showed that the  disease  was aneurismal varix. the com-
munication between the femoral artery and the  enlarged vein  being  nt
the lower part of Scarpa's  triangle.  The femoral  vessels were  not
preserved.
  The injected  specimen was  forwarded  by Assistant Surgeon Clinton
Wagner, II. S. A., and is numbered  6507, A. M. M.   A detailed account
of the first operation is published in the American Journal of the Medical
Sciences. Vol. XLVIII, page -°>6.
          Photographed at the Army Medical Museum,
 *Y  ORDER OF THE  SURGEON   GENERAL:
                      GEORGE A. OTIS,
            Bv't Id. Col- and, Surg. <\ S. E, Curator .1.  .17. 31. 
 
        ARMY  MEDICAL   MUSEUM.
                               —♦—
 Specimen  No. 4S4.—Photographic Series  No. 75.   Success-
   ful Amputation at the Ljeft Ankle, by  the Method of Pirogoff.
   Lieut.  W.  C. Weeks, Co.  I, 5th  Michigan Cavalry, was  wounded
 April 1st, 1865, at the battle of Five  Forks,  by a  conoidal  musket ball,
 which passed through his left ankle joint.   He was immediately carried
 to the hospital at City Point, and amputation at the ankle was performed,
 on the same  day, by Surgeon  St. Clair, 5th 31ichigan Cavalry.   The
 articulating surfaces of  the tibia and  calcancum were removed, and  the
 cut surfaces were brought into apposition.
   On April  16th, 1865, the patient was transferred to Armory Square
  Hospital, at Washington.   On admission, he was  in a feeble condition.
  An erysipelatous blush extended above the knee on the  injured side; an
  abscess had formed in the lower part of the leg; and no union of the flap
'  had taken place.
   With the employment of  stimulants and nutritious diet with emollient
  applications to the limb, there was a gradual improvement  until April
  28th, 1865, when symptoms of pyamiic infection supervened.   Rapidly
  recurring chills, an icteroid coloration of  the skin and  conjunctiva,
  anorexia, and a frequent feeble pulse suggested the gravest prognosis.
  Energetic treatment was adopted.  An ounce  of brandy was  given every
  two hours, and  quinia, sesquichloride  of iron and  beef tea  were freely
  administered.   On May 6th, the grave symptoms began to subside, and,
  by the end of the month, the patient was fairly convalescent.
    On June 26th, the patient was  pronounced well.   The  os calcis had
  firmly united to the  tibia, and there was a good solid stump.    A. cast in
  plaster was taken of it, (A. M. M., Spec, lV2'»K; and  a  few  days subse-
  quently,  a photograph.

            Photographed at  the Army  Medical  Museum,
    BY ORDER  OF THE SURGEON  GENERAL:
                        GEOUGE  A.  OTIS,
               Tivt TA.  Cot. and Surg. E S. V., Curator A. M.  31. 
 
      ARMY    MEDICAL   MUSEUM.

 Specimen Xo.  427-K—Photographic  Sissies, \o.  70.  United
   Gunshot Fracture of the  Upper Third of the lllijht Femur.
  Corporal Thomas Crossloy, Co. K, 6'lfh. New York Vols., was wounded
 March 25th. 1H05, in the assault on Fort Steadman, near Petersburg. Va..
 by a musket ball, that fractured the upper third of the right femur.
  The patient was admitted to Armory Square Hospital, at Washington,
 April 1st.  lie progressed very favorably, and, by midsummer, the frac-
 ture  was firmly united  with slight deformity, and  only  one  inch
shortening.
  The photograph was taken July  20th, and on  July 25th. 1*65. Crossley
was discharged from service.
           Photographed  at the Army Medical Museum,
 EV  ORDER OF THE SURGE.ON  GENERAL:
                         OEORGK  A.  OTIS,
            11,'t 1.1. Col, and y".rg.  T. .->'. I'..  Curator A. 31. 3!. 
 
  fui'paM    (gtuwl's    H)tfhtt


     ARMY  MEDICAL   MUSEUM.
                         ---♦---
Specimen Xo.  I'M.—Photographic  Series.  Xo. 77.  United
  Gunshot Fracture of  the Middle  Third of the Right Femur.
  Private John VV. Hutchinson, Co. G, First Maine Veteran Vols.. Was
wounded at. the battle of the Wilderness, May 5th, 1864, and admitted
into Armory Square Hospital, on May 26th, with a comminuted gunshot
fracture of the middle third of the right femur.
  Tiie photograph was taken July 20th, 1865.  There was still a  slight
discharge: but the fracture was firmly united, with two inches  shorten-
ing, and the patient's general health was excellent.

         Photographed at the Army Medical Museum,
 BY  ORDER  OE THE  SURGEON  GENERAL:
                   GEORGE A.  OTIS,
           Bet Lt. Col. and Surg. E S. }'., Curator A. 31. 31. 
 
  ^ufpan    Kami's     &Uk$.


      ARMY   MEDICAL   MUSEUM.
                            -  ♦—
 N'iriMEN No. :-»7A—Photograph 10 Series, No. 7S.  Recovery,
  without A mputatlmi. after a Gunshot Fracture of the Head, of the
  Left Tilda. Inro/vlng the Knee-joint.
  Lieut. Th<<mas W. Robertson, Tilth New York Vols., was wounded, on
 June 16th. 1*62. in the assault on the works  on James island. South
^Carolina, by a musket ball, which struck the outer side of the head of the
 tibia, and passed upwards and lodged, as was believed, in the intereon-
 dyloid notch of the femur, or somewhere about the knee-joint.
  Amputation of the. thigh was advised but refused by the patient.   Tin-
 limb was then placed in an easy position and cold water dressings were
 applied.
  On June 28tli, the patient was s«.-nt to  New York.  On July 6th. there
 was profuse haemorrhage from  the  anterior tibial artery.  On July 8th,
 the femoral artery was tied by  Professor  Willard Parker.   At this date,
 (he  knee-joint was excessively swollen and  there  was free suppuration
 from the wound.
  Afer a very protracted confinement, the patient ultimately recovered,
 with complete  anchylosis of the knee-joint, the straight position of the
 limb being preserved.
  Lieut. Ejbertson was transferred to the Veteran Reserve Corps, on
 February 2'.ith, i*64, and was on duty at Kmory  Hospital, at AVaJiing-
 ton, in 1865.  On July 18th, 1865, the photograph was taken.
  The facts of the  case were communicated by Surgeon  X. H.  Mosely,
 U. S. Vols., who reported that  Profe-sor  Parker and  the othei-surgical
 adviser; of Lieut.  Robertson, entertained no doubt that the knee-joint
 was primarily involved in this case.  The exact location of the ball wa-
 never ascertained.
          Photographed at  the  Army  Medical Museum,
  BY ORDER OF  THE SURGEON GENERAL:
                     GEORGE A.  OTIS,
            Hr't  Lt. Cut. and Surg. L\ S. V..  Curator A. 31. 3.1. 
 
                       —♦—
ARMY   MEDICAL   MUSEUM.
 Specimen  No. 34<E.—Photographic  Series,  No.  79.   Shell
   Wound of the Face, with great Destruction of the  Soft Parts.
  Private Joseph Harvey, Co.  C, 149th New York Vols.,  was wounded
 at the  battle of Chanceilorsville, May 3d, lSf>), by a fragment of shell.
 The right eye was destroyed, the right superior maxilla was fractured,
 a fragment was  chipped off" the lower jaw, and the right cheek was
 frightfully lacerated.
  The patient fell into the hands of  the enemy, and remained a prisoner
 eleven days.
  In the middle  of June, 1863, he  was  admitted  into Mansion  House
 Hospital at Alexandria.   In August, portions  of exfoliated bone were
 removed.  A ferrotype, representing the appearance of the  wound at this
 date, was forwarded to the Army Medical Museum.
  On 3Iay 7th, 1865, Harvey was discharged from service  on account of
 physical disability.  He was subsequently employed as a night-watchman
 ■it the Commissary Hospital in  Alexandria.
  The  photograph was taken June  32d, 1865.  The loss of substance in
the cheek was  still unrepaired, and liquids  and saliva escaped from it-
There was slight deafness and partial facial paralysis on the right side.

          Photographed at the Army Medical Museum,
 BY ORDER OF THE  SURGEON GENERAL:
                        GEORGE  A. OTIS,
            UCt Id.  C„l. and S.v.rq. U. S. V.. Curator A.  31. 3f 
 
     ARMY   MEDICAL   MUSEUM,

specimen No. 315:>.—Photographic  Series. No. 80.  United
  Gunshot Fracture of the Inferior Maxilla.
  Private Ferdinand Lauersdorf, Co. D, 6th Wisconsin Vols., aged 2S
years, was wounded,  on  March  31st,  186.-,, in  an engagement on the
rfouthsidc Railwav, near Petersburg, Virginia, by a fragment of shell
Which struck the body of the lower jaw, and tore away the entire ante-
rior portion of the bone.
  The photograph was taken July 14th. 1865.  The fractured extremities
of the jaw had united, and the  wound had nearly healed.   The  move-
ments of thojaw were  very limited, bit  deglutition  was lmt shghtly
interfered with.                                          .
  The patient had  been discharged from service, and was on his way to
his home in Watertown, Jefferson County,  ^ isconsm.
           Photonraphcd at the  Army Medical Museum,
  ,V ORDER OF  THE  SURGEON  GENERAL-.
                         GEORGE  A.  OTIS,
             f>,V T.i Col. and  S-n-q.  U. S. V.,  Curator A, 31. 31. 
f 
       ARMY   MEDICAL   MUSEUM.
                              —♦—
 Photographic Series, No. 8l.   Recovery  after  a  Perforating
   Gunshot Wound, of the Abdomen producing Artificial Anus.
  Lieut. G-. P. Deichler, Co. I, 69th Pennsylvania Vols., aged 22 years,
 was wounded by a conoidal musket ball, at Hatcher's Run, Va., in March,
 1865.   The ball entered the right iliac region, and, passing  through  the
 ascending colon, made its exit a little to the left of the last dorsal vertebra.
  The patient was taken to a field hospital, and from thence to Armory
 Square Hospital, at Washington, where he  was  admitted on April  1st,
 in an exhausted condition,  with grave symptoms of peritonitis.   There
 was a copious foecal discharge from both wounds.   Appropriate dressings
 were applied, a fourth of a grain of sulphate of morphia was  ordered to
 be given every second hour, and stimulants were directed.
  On April 7th, sloughs separated from both  wounds, and  left  a clean
 granulating surface.   A large piece of sphacelated omentum was removed
 from the anterior wound.
  The opiate treatment was continued till April 27th, when  there was a>
 fcecal  evacuation  by  the  anus, for  the first  time after  the  injury.
  On June  12th, the discharge from  the wounds  was very slight.   The
 edges of the wounds were now  refreshed  and approximated  by adhesive
 strips.
  On August 10th, the anterior wound was firmly healed.   There was »
 small fistulous sinus at  the posterior  wound, discharging pus scantily.
 On this day the photograph was taken, and the patient left  the hospital:
 for his home in excellent general health.
  The particulars of the case  were  communicated by Acting Assistant
Surgeon Charles A. Searle, U.  >S. A.

           Photographed at  the Army  Medical Museum,
 EY  ORDER  OF  THE SURGEON  GENERAL:
                         GEORGE  A.  OTIS,
            Bv't Lt. Col.  and Sv.fg. U. S.  V., Curator  A. 3.1. AL 
 
    J^tffjf0i   ^innaVs   Mint.


      ARMY    MEDICAL  MUSEUM.

 Photographic Series, No. 82.—Negative. No. 42So.  Necrosis
   of  the  Shaft of the Left  Tibia,  resulting from a  Gunshot
   Injury.
  Private Henry Kail. Co. D, 4th Xew York Heavy  Artillery, aged 22
 years,  was wounded at Old Church, Va., May 30th, 1864, by a  musket
 ball, which struck the spine of the left tibia, four inches below the knee,-
 and denuded the bone of its periosteum.
  On admission at Stanton Hospital, in Washington, the injured limb
 was found to he much swollen and inflamed.  In July, free incisions
 evacuated a large collection of pus and revealed the existence of extensive
 necrosis of the shaft of the tibia.
  In the spring of 1865, the sequestrum was found to  be detached  and
 rnoveable, and,  on March 14th, an operation was performed for its removal,
 a sufficient aperture being  chiseled in the involucruin.  This very largo
 sequestrum is numbered 4337 in the Museum Collection.
  On June 6th, 1865, Rail was discharged from service on a certificate of
 physical disability.  The wound was not entirely healed; but the  patient
 could walk with ease and comfort.
  In July the photograph was taken.  Rail was at this time engaged as a
contract nurse at the Stanton General Hospital.
  The  particulars of the case were  furnished by Surgeon Benjamin  B.
Wilson, IT. S. Vols.

         Photographed at the Army Medical Museum.
    ' ' -  ^ F. R  OF THE SURGEON GENERAL;
                       GEORGE  A. OTIS,
           liv't Id. Col.  and Sv.rg. U. S. V., Curator A. 31. 3t 
 
      ARMY   MEDICAL   MUSEUM.
                             —♦—
Specimen No. 2241.—Photograpjuc Series,  No. 83.   United
   Gunshot Fracture of Middle  Third of Left Femur.
  Private George Bauer, Co. C, 15th New York Heavy Artillery, was
wounded on April 1st, 1865,  near Hatcher's Run, Va., by a conoidal
musket ball, which entered the external aspect of the left  thigh at the
junction of the upper and middle thirds, fractured the femur, <and emerged
on the opposite side an inch lower than the point of  entrance.
  On admission at Armory  Square Hospital, April  4th, 1865, he was
treated by Buck's apparatus, with a weight of eleven pounds.   On June
23d, there was firm union of the fracture, though the wounds still dis-
charged freely.
  An August 10th, the photograph Mas taken.   The wounds had nearly
healed, and the discharge was very  scanty.   The  limb was shortened one
inch without other deformity.  The patient walked about comfortably on
crutches.  On August 17th, he was transferred to Douglas Hospital.
  The facts of the case were communicated by Acting  Assistant Surgeon
G. K. Smith, U. S. A.

          Photographed at the  Army Medical Museum,
 BY  ORDER  OF T H?E  SURGEON  GENERAL:
                     GEORGE  A.  OTIS,
           Bv't Lt.  Col. and Surg. U. S.  P., Curator A. 31. 31. 
 
  $m\]»®n     4$ rM nil's    (!.)fxk*.


      ARMY  MEDICAL  MUSEUM.

Specimen No. 4150.—Photographic Series. No. S4.   United
  Gunshot Fraefuri of the Shaft of the Right Femur.
  Sergeant William Brown, Co, H, 69th Penn., Vols., aged 24 years, a
man of vigorous  constitution, was  wounded  at Hatcher's  Run, Ya.;
.March 25th, 1865, by a conoidal  musket ball that entered the posterior
aspect of the right thigh, two inches below the level of the trochanter
margin, fractured  the femur, and made its exit  a  little  outside  of the
femoral vessels, four inches below Poupart's ligament.
  The patient was conveyed to Armory Square Hospital, tit Washington.
wliere, on April 4th, the  anterior wound was enlarged, and five large
fragments of bone  were removed, the patient being under the influence ol'
chloroform.  The fragments are numbered, A. M. M., Specimen  414:!.
  The case progressed very favorably, and on August 7th, 1865, the femur
was found to  bo firmly united, with three  inches  shortening.   At this
date the photograph was taken, the patient being ordered to be transferred
to the Mower  Hospital at Philadelphia.  There was still a slight purulent
discharge.
  The history of the case was communicated by Acting Assistant Surgeon
George  K. Smith, E. S. A.

          Photographed at the Army Medical  Museum.
  BY ORDER  OF  THE  SURGEON  GENERAL:
                     GEORGE  A. OTIS,
            llCt Lt. Col. and Surg. U. S. P., Curator A. 31. 31. 
 
     ARMY   MEDICAL   MUSEUM.
                            —♦—
Specimen No. 23Pi.—Photographic Series. No. 85.   Simjde
  Fracture of the  Middle   Third of  the  Left  Femur. United
  without  Deformity.
  Lieut. A. W. Starkweather, 6th Indiana Cavalry, was thrown from his
horse, at Black  and White Station, Va., on April 28th, 1865, and the
shaft of his left femur was fractured.
  He was admitted to Armory Square Hospital, on May 7th, and was
treated by Buck's method of extension by a weight and pulley, until June
7th;  a dextrine bandage was then substituted.   In the latter part of June,
the patient began to walk about with the aid of crutches.
  The photograph  was taken early in August, 1865.   The fracture was
then firmly consolidated without deformity, and with very slight shorten-
ing.  The case was selected as  an interesting  illustration of a successful
result in a simple fracture of the femur.
  The facts were communicated by Acting Assistant Surgeon C.  B. Porter..
by whom the treatment was conducted.

          Photographed at the Army Medical Museum,
 BY ORDER  OF THE SURGEON  GENERAL:
                       GEORGE  A.  OTIS,
           Bv't  Lt. Col.andSvrg. U. S. P., Curator A, 31.  31.. 
 
ARMY   MEDICAL  MUSEUM.
 Specimen  Xo.  S09.—Photographic  Srries.  X,,. so.   Left
   Scapula, showing a  Gunshot  Fracture nearly parallel with tin
   Stuui  of the Scapula, with two Fragments of a Conoidal M„<l<t
   Ball.
  Private  AVilliam  Puller,  (Jo.  P; istl,  .Massachusetts  Vols., a«*ed  :;..
 years, was wounded at the second battle of Bull  Run, An-mst 30111° 1*6-
 by a conoidal musket ball, which entered to the  left of thc&spinal column
 :md passing outwards, traversed the body of the scapula and the muscles
 of the upper part of the arm.
  Thepatient was conveyed to Union Chapel Hospital  at  Alexandria
 On the 3d, and again on  the 5th of September,  misshapen  pieces of ball
 and a few fragments of bone were extracted through an  incision on  the
 outer edge of the scapula.
  On September 19th, symptoms of purulent infection were manifested.
 An  active  treatment  by stimulants, quinia, iron, and  ammonia,  was
 instituted,  but unavailingly,  and  on  Septemoer  25th,  1862,  the  ca«-
 terminated fatally.
  At the autopsy, a large collection of extravasated blood  was found
beneath the scapula and between the muse! es of the shoulder.  There was
fxtensive  serous  effusion in  the  left  pleural  cavitv.  and   numerous
metatastatic foci in both lungs.
  The scapula is numbered;  Specimen 188. in the Museum Collection.
  Full notes of the  case were  forwarded bv Acting Assistant  Sur«-eon
\T. H. Butler, U. S. A.

          Photographed at the Army  Medical Museum,
 BY ORDER  OF THE  SURGEON  GENERAL:
                     GEORGE A.  OTIS.
           net TA. Col. and Surg. U. S.  V . Curator A. 31. 31. 
 
-4
      ARMY    MEDICAL   MUSEUM.

^cimex Xo. 1586 -PnoToc^Pinc  Serxes, No.  87.   Button
  of Bone removed  by the Trephine on account  of a Deformed
  ET7? ^ ?™«™>l>roduced by a Blow from a Stone.
  r> •   ,  T ,                'J-       w "if "' ^Jiviv /rum
  Private John Kughts, Co. H.  2nd Michigan Vols., aged 41  y
woundecl in a street fight in Washington,™ Julv 17th, 186./
admitted into Armory Square Hospital  on the afternoon of the follow
and was
  He had  our scalp  wounds, produced  by stones  thrown at him    One
^a  over  he rignt frontal eminence and penetrated as far as the apoZ
 .08,, of  he occipito-trontalis; a second was at the middle oi' the ciona.
.utureand slightly denuded the pericranium, but no injury of  th
in bone
 could be detected; a third, in the  temporal  region, involved the intern-
 mentonly; while the fourth, over the right parietal protuberance  p-
 sented a very slight  depression of the outer table  of the skull of an
 ^regular shape and of an average diameter of a third of an inch'   The
 patient was conscious, his pulse somwhat accelerated, his voice tremulous'
 his pupils contracted.  He had no nausea and little pain
   He was  placed  under the  influence  of ether,  and  the  fracture  was
 exposed by a crucial incision  of the scalp.  The crown of a large trephine
 was so applied  as to  surround the depressed fragment.  Tlie  button of
 bone that was removed exhibited a depressed rectangular fragment of the
 vitreous plate, nearly an inch in length and half an  inch in'width   The
 dura mater was  uninjured.   No  unfavorable  symptoms  followed  the
 operation, and on August 24th, 1865, the patient was transferred to  the
 1.-. S. General Hospital at Detroit, .Michigan.   The osseous specimen is '
numbered 1452, A. At.  M., and was forwarded  by  the  operator, Brevet
Colonel D.  W. Bliss, Surgeon U. S. Vols.

           Photographed at the Army Medical Museum,
 BY  ORDER OF THE  SURGEON  GENERAL:
                        GEORGE A.  OTIS,
            Bv't Lt. Col. andSvrg.  XJ. S.  V.,  Curator A. 31. 3' 
 
       ARMY   MEDICAL   MUSEUM.

  Specimen No. lol«3.—Photographic Series, No. 88. Fragment
    of a  Grenade encrusted with Clculous Matter, extracted from
    the Bladder by Lithotomy.
   Private Conrad Lotes, Co.  A, 2*1  Indiana Vols., aged 32 years, was
  wounded at Vicksburg, Miss , June 25th, 1863, by a fragment of a hand
  grenade, which entered the right  nates two inches  outside of the end of
  the coccyx, and passed into the bladder, where it lodged.   Urine passed
  by the wound immediately after its reception.
   The patient  was admitted into the  General  Hospital at Jefferson
  Barracks,  ML-ouri, August  5th, 1863.   His  general health was much
  impaired.   Tim urine passed mainly by the wound and was largely mixed
  with pus and blood.  The treatment directed comprised warm fomenta-
  tions, mild diuretics, stimulants and nutritious diet.
   On February 20th. 1864, a  catheter was  with much difficulty  passed
  by the urethra  and the presence of a foreign body was ascertained.  On
  March l!Uh, the general condition was improved; the wound was so far
 closed as to admit only a large sized probe.   Attempts to  pass a catheter
 or to probe the wound caused chills and febrile irritation.
  On April 2d, 1864. the lateral operation of lithotomy was performed bv
 Surgeon John P. Randolph, V. S. A., the patient being anesthetized by
 equal parts by bulk of chloroform and ether.  A rectangular fragment of
 shell, largely encrusted with earthy phosphates, was extracted.   It was
 two inches in length, seven-eighths of an inch in width and three-eighths
 of an inch in thickness.  It weighed two ounces and live grains, trov.
  On April  12th, the urine passed by the wound.   On April 27thj the
 wound had healed,  and the patient was  soon afterwards restored  to his
 ordinary condition of health.
  A detailed report of the case is  published  in  the American  Journal of
 Medical Sciences, Vol. XLVIII, p.  271.
  The encrusted  fragment of shell is preserved in the  collection of the
Army Medical Museum, (Spec. 88).   It  weighs  808 grains, portions of
the plmsphatie deposit having crumbled away.

          Photographed at the Army Medical Museum,
 BY ORDER  OF  THE SURGEON  GENERAL:
                     GEORG-K  A.  OTIS.
           Bed Lt.  Col,  and Sum.  U.S. P..  Curator A. 31.  3f 
 
     'wt§Hi&     (&$muV&    Mint,


      ARMY  MEDICAL  MUSEUM.

Rpecimkx Xo.  L]i)l.—Pitotoouaphic Series. No. 89.  United
  Gunshot  Fracture of the  Upp-'r Third of the 1Uold  Femur.
  Lieut. James J.  Boeder, Co. G, Holcomb's South Carolina (Rebel)
Legion, 31 years of age, was wounded at Hatcher's Run, A'a., March 29th,
1865, by a conoidal  musket ball, which entered near the right external
abdominal ring, and, passing downwards, backwards and outwards, made
its exit behind the right trochanter major, having fractured the femur at
the trochanters and injured the anterior crural nerve.
  The patient was made  prisoner, and was conveyed to the 5th Corp?
Hospital at City Point, and was treated with the injured limb on a double
inclined plane till May 1st, when  he  was removed  to Washington, and
admitted to Armory Square Hospital, on May 2d.  It was found that the
fracture had united with an inch shortening.  There was  a large deposit
of callus in the trochanteric region.  Wound of entrance closed, slight
discharge from wound of exit, inability to flex the thigh, and severe pain
from passive  motion.
  On July 15th the patient was able to sit up.   Passive  motion of  the
thigh had been  frequently insisted on.   On  August 15th, 1865,  the
photograph was taken.  The patient was able to walk on crutches;  but
he had still but little control over the flexor muscles of the injured limb.
The wounds  seemed to be completely healed,  and  the  fracture firmly
consolidated.
  The facts of the case were furnished by Acting Assistant Surgeon Geo.
K. Smith, V. S. A.

         Photographed at the  Army Medica! Museum,
  BY ORDER  OF THE  SURGEON GENERAL:
                       GEORGE  A.   OTIS,
           11C/ Lt.  Cot, and S:crg. IT. S. p.,  Curator A. 31. M. 
 
     ARMY   MEDICAL   MUSEUM.

Specimen Xo. 1028.—Photographic Series. No. 90.   Gunshot
  Fracture of the Shaft of th'-  Right  Femur, united with  great
  Shortening and Deformity.
  Private John Friedrich, Co. F, 127th New York Vols, aged 19  years,
was wounded at Honey Hill, South  Carolina, November 30th,  1864, byU
round musket ball, which entered the internal surface of the right thigh
about the middle,  fractured the femur, and lodged under the skin opposite
the point of entrance, whence it was removed by an incision.
  The  patient was conveyed to Hilton Head LT. S.  General Hospital, and
was treated for one month with Smith's Anterior Splint, and, afterwards,-
for four weeks, by Hodgen's apparatus.   The limb was then placed in i»
long fracture box,  and so remained until May, 1865, when the patient was-
transferred to Armory Square Hospital, at Washington.
  On admission at Armory Square, May 10th,  1865, the fracture  was-
found to be united, with seven inches shortening, and marked lateral
deformity.  The  knee-joint  had but limited motion.   The overlapping
extremity of thajipper fragment presented itself just above the outer con-
dyle of the femur, and the skin was ulcerated at this point, and the end
of the bone was exposed.
  Two  months subsequently the  ulceration became  phagedenic,  and
destroyed the skin and fascia over the  exterior  surface of  the  thigh.
Bromine was applied.   13y the end  of July, there was an healthy granu-
lating surface.
  The photograph was taken  August 15th, 1865.   The  ulcer was rapidly
cicatrizing, and the general health  was good.  The fracture was  flrmly
consolidated, and  the patient walked on crutches.

          Photographed at the Army Medical  Museum,
  3Y  ORDER  OF  THE  SURGEON   GENERAL:
                      GEORGE  A.  OTIS,
            lie t Lt,  Col, and Surg. U. S.  P.,  Curator A. 31. Al.- 
 
Mp&n     $&im&Vs    §i(m»
ARMY   MEDICAL  MUSEUM.
Specimen  Xo. 1G7(>.—Photographic  Series. Xo.  91.   Con-
  solidated Gunshot j Fracture of the  Upper  Third of the Luft
  Femur.
  Captain, David Lewis,] Co.  G, 8th Ohio Vols., •^agedj_26 years, was
wounded at the battle of the Wilderness, May  6th, 1864, by a musket
ball, which entered the external part of the left thigh, about the junction
of the upper with the middle third, fractured the femur, and emerged  at
the nates, two inches to the left of the anus.
  He was  conveyed to Fredericksburg,  and was treated with a  double
inclined plane for three weeks.   He was removed to Washington on May
26th, and was treated, in quarters, by Dr. G. K. Smith, Acting Assistant
Surgeon, U. S.  A., by Buck's method.   There was  little  suppuration  or
constitutional disturbance, and,  on July 9th, the fracture  was  so far
united as to  permit the patient to walk on crutches.   On July 13th,
Captain Lewis was mustered out of service on account of the expiration
of his term.   In October, the wounds had entirely healed, and soon after-
wards the patient was able to walk on his limb.
  On August 22d, 1865, the photograph was taken.  The injured limb
was shortened one and a half inches, but there was no other deformity.
Captain Lewis was in excellent health.  He walked without a cane and
without limping, and was actively engaged  in business in  one  of the
bureaux of the Treasury Department.

         Photographed at the Army Medical Museum,
 BY ORDER OF THE  SURGEON  GENERAL;
                    GEORGE  A. OTIS,
           Bet LI. Col, and Surg. U.  S. P.. Curator A. 31. 31. 
 
mpon     ®tmwV$    MUm.
ARMY   MEDICAL  MUSEUM.
Specimen Xo.  664.—Photographic Series, Xo.  92.    United
   Gunshot Fracture of the Middle Third of the Left Femur.
  Private Jonathan Wallace, Co. F. 21st Georgia (Rebel) Regiment,
was wounded in the assault on Fort Steadman in the  intrenched  lines
before Petersburg, on March 25th, 1865.
  A conoidal musket ball entered at the external lower portion of the left
thigh, passed obliquely upwards  and  backwards,  fractured the femur in
the middle third, and made its exit posteriorly.
  The patient was made a prisoner, and was treated in a field hospital ^f
the 9th Corps,  where several  fragments  of bone were extracted,  until
April 8th, when  he was conveyed to Washington, and  admitted into
Armory Square Hospital, April 10th,  1865.  The  injured  limb was here
placed in Buck's apparatus, and extension was made by a weight of eleven
pounds.
  On August 15th, the photograph was taken.  The limb was shortened
three-fourths of an inch.  There was a very slight purulent discharge
from the posterior wound.  The general health was good, and the  frac-
ture was apparently firmly consolidated. On August 17th, 1865, the
patient was transferred to Douglas U.  S. General Hospital.
  The facts of the case were communicated by Acting Assistant  Surgeon
G. K. Smith, U. S.  A.
          Photographed  at the Army  Medical Museum,
 BY  ORDER OF  THE  SURGEON  GENERAL;
                    GEORGE A.  OTIS,
           Bot Lt.  Col, and Surg.  U. S. P.,  Curator A. 31. 31. 
 
                       —♦—
ARMY   MEDICAL   MUSEUM.
  Specimen Xo. 4293.—Photographic Series. Xo. 93.   Recovery
   after a  Penetrating   Gunshot   Wound  of the Abdomen  with
   Perforation of the Left Ilium.
   Major H. A.  Barnum, 12th Xow York Vols., was wounded at Malvern
  Hill, July  1st,  1862, by a conical musket ball, which entered midway
  between the umbilicus and the anterior superior spinous process of the
  left ilium, passed through the middle of the ilium, and emerged posteriori v.
   The wound was  regarded as fatal  and the patient was left in a field
  hospital.
   On July 2d, he was captured and was taken to Libbv Prison, a distance
  of eighteen miles, in an express wagon.   On  July 17th, he was  taken to
  Aikin's Landing, in an ambulance, a distance of seventeen  miles, and
  exchanged^ He was conveyed by water to Albany, and thence by rail to
  Syracuse, Xew York.   At no time  were anv  symptoms  of  peritonitis
  manifested.
   On October  1st,  Major Barnum went  to Albany,  where Dr. March
 dilated the anterior wound  by an incision, and extracted several frag-
 ments of the ilium,  and directed that a tent should be worn.
   Promoted  to  the command of the 149th Xew York Vols.,  Colonel
 Barnum took the field in  January,  1863.   He wore the tent about a
 month, when the anterior wound healed.   About the middle of March,
 a large abscess formed and  evacuated  itself at the  site of the anterior
 wound.  In April. Dr. March again cut down to the ilium, and introduced
 a tent.   Xo loose fragments of bone were found.   The Colonel resumed
 his duties, and commanded  his regiment  at  Gettysburg.   In January,
 1864,  another large  abscess  formed and  discharged  posteriorly.  The
 orifice was enlarged by Dr. L. D. Sayre of Xew York, and a seton of
 oakum was passed from before backwards through the entire track of the
 ball.   This  was worn for several  weeks,  when Surgeon M. K. Hogan,
 1. S. Vols., substituted a seton of candle wick, which was gradually
 reduced in size, and finally replaced by a single linen thread.
  The photograph was taken at the Army Medical Museum in August,
 1865.  The wound still discharged slightly, and the thread seton was still
 worn.
  Promoted to be a brigade commander, General  Barnum  has been
 almost continually in the field for the past two  years.   He participated
 in the  campaigns of Atlanta, Georgia, and Carolina, was  shot  through
 the right forearm at Kenesaw Mountain, and received a shell wound of
the side at Peach Tree Creek.

          Photographed at the Army Medical Museum,

  BV  ORDER OF THE  SURGEON  GENERAL:

                        GEORGE  A.  OTIS,
            HCt Lt.  Col. andSv.vg.  U. S. P.,  Curator A. 31. 31. 
 
ARMY  MEDICAL  MUSEUM.
  PifOTOfiW.APrnr  SKUIB.S.  No.  94.    Gunshot  Fracture  of  the
     Vitreous  Tabk   of  the   Cranium   without  Fracture  of  the
    External Tail.
    Private David Pugli Co. (.', .5th  Wisconsin  VoK, was wounded at
  Tupelo  Mississippi j„iy 18thf 1R,J4?  liy n imiskpt hal]) wIi.ph rtfi]ck thp
  Rkull obliquely,  and apparently inflicted a scalp wound merely, between
  the sagittal suture and the left parietal protuberance.
    There were no signs of cerebral disturbance.  The  wound was dro^d
  simply,  and  the  patient  was  conveyed to Memphis, Tennessee  and
  admitted into the Adams P. S. General Hospital on dulv 2:ld.   He 'was
  then perfectly rational and free from head symptoms.
   Two days subsequently, indications  of compression  of  the brain were
  observed, and, on the  afternoon of the  25th, then had rapidly become
  aggravated.  The pulse was slow,  the respiration laboured, the pupil-
  dilated, the sphincters relaxed.  A very careful exploration of the wound
  was made,  but, of course,  no cranial  fracture could  be detected.  The
  treatment was limited to cold applications  to  the head, scarified cups to
 the nucha, and brisk purging.   On the 26th, the patient gradually became
 comatose.   The discharges from the bowels and bladder  were involuntary,
 Thepatient continued  to sink on the 27th,  and died at 1, A  M   on the
 2Sth of July.
  At the autopsy, the internal tabic of the left parietal was found to be
 fractured and depressed at a point corresponding with the  wound in the
 scalp.   The dura  mater was wounded, and  there was  a large abscess in
 the left cerebral hemisphere.
  The specimen  is preserved in  the  Army  Medical   Museum, and is
numbered 1568.   It  was  forwarded, with an  account of  the ease, bv
Acting Assistant  Surgeon P. M. Coale, P. S. A.

           Photographed at the  Army Medical Museum,
 BY ORDER OF  THE  SURGEON GENERAL;
                      GEORGE  A.  OTIS,
            Bv't Li. Col. and Sura. V. S. P.. Curator  A. 31. 31. 
 
        ARMY   MEDICAL  MUSEUM.

  Piiotoo.aph.c  Series.  Xo.  95.    Bone,  ,f th.  ]{!tfht  ,W/
    exhibiting Reparative  Attempts after a  Gunshot  Urforatlm,
    Fracture of the Head of the Tibia and the Pesu/ts of Seconding
    In I fan i mat ion of the Knee-joint.
    Private Peter Costello, Co. E, mh Illinois Vols.,  was wounded at
  Mtssion Kidge.^ov. 25th,  1863, by a musket ball, which entered the
  inner side of the head of the tibia, an inch and  a half below the articular
  -a.- ac,, perforated the bone from left to right, and comminuted the head
  of the fibula.
    He was treated at Chattanooga until Januarv 2Stb, l,st;4 when he wis
  eonveyedto Hospital No, l't, Nashville. Ten.i,, thence on February 4th  to
  Hospital Xo. 7,  Louisville. Ky., and filially to  the General Hospital.' at
  Madison, Indiana, where he was  admitted on  April  8th.   Hopes  wen
  entertained  of saving the limb  when the patient arrived at Madison  but
  soon afterwards the discharge became very copious and olfonsive, abscess,-'
  formed about the joint and  pus burrowed  in the miiscles of  the  thigh.
  and the patient was prostrated by a colliquative diarrluea.
   In  May, 1864. the thigh was amputated  at the lower third bv Surgeon,
 G. Grant,  P. S. Vols.  In the middle of July, there was  sloughing  of'
 the stump, and an application of bromine was made, with benefit, as was
 believed.
   "ii  August 1st, Assistant Surgeon P. McCluer  reports the cast! as likely
 to recover.
  The reports ascribe the injury to the action of a conoidal bullet, but the
 remarkable absence of longitudinal lissuring and, indeed, of splintering of
 any sort, seems to preclude this supposition.  Tliere is a large deposition of
 callus  about the perforation in the head of  the tibia, and the removal of
 cartilage and destruction of ligaments common in suppurative inflamma-
 tion of the knee-joint was  conspicuous.  The Specimen is numbered 3006.
 ■v M  M  The details of the case are compiled  from the records of  this
Office.

          Photographed at the Army Medical Museum,
 BV ORDER  OF THE   SURGEON  GENERAL:
                         GEORGE  A. OTIS.
            B.CtLt. Co!, and S:'rg. f. s.  P., Curator A. 31.  M 
 
   ^uriumi    ffinmnl's    (Mint.


      ARMY  MEDICAL  MUSEUM.

 PiroTOiiKAiJiir  Seiues. Xo. 9(5.   Ununited Gunshot Fracture
  of the Upper Third of the Right Femur. Seven Months a ft cr th <
  Injury.
  Lieut. Goodwin, Co. K. 4th Minnesota, was wounded at the battle of
 Inka. September 19th, 1SU2. by a conoidal musket ball, which entered
 behind the neck of the right  femur and fractured the shaft of the bone.
 If' was transferred to the City G-ncral Hospital, at St. Louis, Missouri,
and was treated by simple extension.  There  Mas  comparatively little
reparative  effort at the seat of fracture,  and the patient  died from
exhaustion, April 18th, 1*63. See Specimen 1325, A.  M.  M. forwarded
with notes, |,y Surgeon J. T. Hodgen, P. S.  Vols.

         Photographed at the Army Medical Museum,
 BY ORDER  OF THE SURGEON  GENERAL;
                   GEOIU.-K  A.  OTIS.
          Bed Lt.  Col, and Surg. U.S. )'..  Curator A  31. 31 
 
Jt*.  Jvn* .1U6- ft-
       ARMY  MEDICAL  MUSEUM.

 Photograph Xo. 97.   Perforating Gunshot Wound of the Abdo-
  men.

  Private J. D. Smith, Co.  D. 28th New York  Volunteers, was wounded
 on May 1, 1863, at Chanceilorsville  by a conoidal musket ball,  fired at a
 distance of not more than  thirty  yards.   The projectile entered nearly
 over the left abdominal ring, traversed the abdominal cavity and made its
 exit at the upper part of the right buttock.  He walked an hundred yards
 after he was hit.  There was quite free bleeding from the anterior wound.
 He was treated in the Twelfth Corps Hospital.  There were no symptoms of
 peritonitis.  The appetite was good,  the bowels regular, the functions of
 the bladder perfect.  By the 21st of  May, his wound was entirely healed,
 and he was discharged from service by  reason of  the  expiration of his
 term of enlistment.  The drawing was made by  direction of Surgeon J.
 II. Brinton, U. S. V., by Hospital Steward Stanch,  U. S. A., a  few days
after the reception of the wound.   The facts of the case were communi-
cated by Surgeon E. Goodman, U. S. V., Medical Director of the Twelfth
Army Corps.

          Photographed at the Army  Medical  Museum.
 BY ORDER OF THE  SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                            Ass't Surg. U.  S. A., Curator A. M  M. 
 
        ARMY    MEDICAL   MUSEUM.
                                    —♦—
 Seroicae Series of Drawings. X"o. 17.-Photographic Series,
   Xo. 98.    Great  Destruction of the Soft Parts  in the   Gluteal
   and Ljuinbar Region* by a  Fragment  of Shell.
  Private John E. Tucker, Co. A, 17th Maine A'ols., aged 20 years, was wounded, by the
 explosion of a shell, at the battle of Chanceilorsville, May 3d, 1S63.   The integuments over
 the gluteal and lumbar regions were torn away, and, on the right side, a large portion of
 the gluteal muscles were removed.  He was admitted to Armory Square Hospital, at 'Wash-
 ington, on May sth. lie sufTcred but little pain, and his appetite was good.  He was ordered
 Hie be»t of diet,  with porter; lint, wet with a disinfectant lotion, to the wound, and an
 anodyne at night.
  The patient did well  till the forenoon of May loth, when lie complained of inability to
 separate his jaws, and of stiffness of the muscles of the neck.  He took a full dose of mor-
 phia; but on  the following  day the trismus was more confirmed, and there was slight
 opisthotonos.  The report makes the contradictory statement, that there was no spasmodic
 action of the muscles.   No trouble  in deglutition or  respiration.   Turpentine stupes  were
 applied to the neck, and the  fourth  of a grain of sulphate of morphia was given  every four
 Lours with milk punch.  On May ISth, the jaws could bo separated more, and there was
 less stiffness about the  neck.  On the 20th, there were  frequent involuntary  twitchings of
 the dorsal muscles.   The wound was more painful.   It was dressed with olive oil on cotton
 batting, and, later in the day. with a solution of morphia.  The internal administration of
 morphia was continued.  On the 21st and 22d, the symptoms continued to amend.  The
 patient could separate his jaws, and  protrude his  tongue.  He had a fourth of a grain of
 sulphate of morphia every hour, applications of ice to the spine, and the wound was dressed
 every dx hours with u  lotion containing six grains of morphia.   On the 22d, there was a
 dejection from the bowels.
  From this date the patient  steadily improved.  On July 10th he received a furlough.  He
 H-turned to the hospital on Nov. 24th, 18G3.  He was then able to walk with  a cane.   On
 Dec. 5th, 1803, he was  examined  by Surgeon J. II.  Brinton, U. S. Vols.   The wound had
cicatrized except over a space the size of the palm of the hand, which  surface was granu-
lating kindly.  The right buttock was flattened and wasted.  The gait was feeble and uncer-
tain.  The general health appeared to be good.
  The date at which  the drawing was made by Hospital Steward Stanch, U. S. A., is not
recorded nor the date of the patient's discharge from service.

            Photographed at  the  Army Medical  Museum,

  BY   ORDER  OF  THE  SURGEON  GENERAL;
                          GEORGE  A.   OTIS,
              Bv't Lt.   Col. and Surg. U. S. V., Curator A. 31, 31- 
 
        ARMY  MEDICAL  MUSEUM.

  IWmjrapiih' Skries. No. !•!>.   Hyperostosis of the Extremities
   of the Right  Tibia and Fibula, after Amputation of the Leg
   Private William  Nevelling, Co.  A, 71st Penn. Vols., was wounded at
  White Oak Swamp, June 20th, ISiW. I,y a conoidal  musket hall, which
 shattered the right ankle-joint, and splintered the tibia longitudinally for
 ~cveral inches.
   Amputation was performed, a lew hours subsequently, at the middle of
 the leg.  On July 1st. the patient was made a prisoner." and was conveyed
 to Richmond.  He was released on  July 2">th. and w.as sent to Broad ami
 Cherry Street Hospital, in Philadelphia.   Here the stump was irritable'
 iind indisposed to  heal: the  tibia became  necrosed, and a ring of hone.
 ^;is thrown-df from its extremity.    On  June lOtl), list;:!,  the patient
 was transferred  to Satterlee General Hospital.   The slump was still open,
 and the extremities of tin- tibia and  fibula were  greatly enlarged.   Over
 die hyperostosis, the soft parts were continually ulcerating.
  On August 27th, ls.j:j. the  disease of  the bones had extended a  high,
 as the insertion.of the ligamentum patella-, and re-amputation was decided
 ;ipon.   The operation was performed at  the knee-joint, by Acting Asst
 -nirgeon T. (4. Morton, I'. S. A.  He made a long anterior flap, leaving
 die patella in position, and a short posterior flap.  The patient promptiv
 recovered with a iirm, well rounded stump.  A  photograph of the stump
 iiecompanics the Specimen,   which  is numbered 277*  in  the  .Museum
 Collection.
  The extraordinary osseous formation,at the divided extremities of the
tjbia and fibula is due to an exaggeration of the  natural process by which ,.
the extremities of bones  are  rounded off, and  presents the histological.,
characters of ordinary callus.

          Photographed at the Army Medical Museum,
 BY ORDER  OF THE SURGEON   GENERAL:
                      GEORGK  A. OTIS.
            li-'t Lt.  Col. and Surg. C.  S. I'.. Curator A. 31. 3J- 
 
         ARMY  MEDICAL  MUSEUM.
                               --*--
  Photographic  Skkie.s, No.  100.   ^ven  Heads  of Humeri
    excised for Gunshot Injuries.
    Specimen 2914 shows a fracture of the surgical neck of the ri~ht humer-
  us, in  the  case of Private J. L, Butler, Co. G. 45th  Penn Vol*   He
  was  wounded June 3d,  1864.   Excision was  performed  June 11 th at
  Carver Hospital.  The wound  did well  for several weeks, but the  «-,„<
  terminated fatally August lGth, 1864, from chronic diarrhoea
    Specimen  2599 is from Private John Parrel, Co. C, 7"d Penn Vob
  Hn was wounded at Gettysburg, July 3d, is,;s.   Excision was performed
  on July 22d, and death ensued on  July 27th
    Specimen  1999.  Corporal Easelas Machine. Co. C,  1st  U S  Sharp-
  shooters, had a conoidal musket  ball lodged in  the head  of  the ri„ lit

  outri«r,Nc;vrbr27th'l863-    Excision ^ ^«*»«^^
  Mh  863, at Fairfax Seminary  Hospital. Xo bad symptoms supervened
  and the patient was discharged  from service on February ->d  1S04
   Specimen 2363 was furnished bv Private D.  B.  ffi™;,, Co  F  Ut

  !L7eiR?r7^,ArtilIery' W°Unded at the battlG0f North'Anna. May
  19th  1864  The operation was  performed at Armory  Square  Hospital
  on May 23d,  and the patient died on June 8th
  Sjuximen 2830 is  from Private  William Whitconib, C„: B. .JOth < mi„
  i olunteers.
^TSpeciinen  » is  a  singular  example  „, an  ^.^  rf ^
 titrennty of a humerus, necrosed in consequence of a gunshct injury the
 mvolnerum having previously been perforated  by a trephine. ' Case „f
 tnvate Theodore Peterson.  Death, April 22d  1863
  Specie   25n- is the bead of the left hnmeriw Qf ^^^^  ^
 Baylor, Co. I, 11th New York Vols., who was  wounded  Mav 3d   1W3
 excision  performed  August 16th, 1863, by Dr.  J.  II. McChdlan    The
.es.tlt was yen- satisfactory and  Nay lor was transferred to the  Veteran
Reserve Corps, February 2")tli, 1864.

         Photographed at the Army Medical Museum,
 &Y ORDER OF THE SURGEON  GENERAL:
                       GI-ORGE   A.  OTIS.
           Hv't LI-. Col: and S::rg. V. S. V., Curator A.  3d. M 
 
at
        ARMY    MEDICAL   MUSEUM.

  PHOTOGRAPH.r Skrikh  No.  UU.   Group of  O^ers.  who  have
    undergone Amputation for Gunshot Injuries
    The officer on the right of the group is Captain Charles H. Houghton
  who was wounded before Petersburg, March 25th, 1865, by a frao-ment
  of shell, which comminuted the condyles of the right femur   Circular
  amputation at the middle third was performed the same day'   On  July
  80th Captain Houston was discharged from hospital well ' '
    Next  in order  is  Captain Edward A. Whaley,  6th Wisconsin Vol,
  »hose right lemur  was fractured by a musket ball, at Five  Forks  ya"
  April 1st, 180.,.   Amputation was performed immediately.    ()„'  \Vly
  15th, he walked on crutches, and on August 15th went to his home well
    H,s neighbor, Lieut,  Moretz  Lowenstein, was similarly wounded at
  the same battle.   He  underwent immediate amputation, and record
  sufficiently to use crutches on May 12th,
   Lieut.  \V. H. Humphreys had  both bones of the right  ic- shattered l,v
  it shell, on April 2d, in the assault on the lines before  Petersburg    ^m
  putatmn at  the lower third of the thigh  was performed on the field ' He
  was discharged from hospital August 14th,  lwr,
  Co]„„el George  R. Maxwell, 1st Michigan Cavalry, had hi. left femur
 fractured by a musket  ball at Five Forks,  Va.,  April 1st,  lmr,    His
 thigh  was ampututed at Armory Square Hospital on April lftth   He  left
 the hospital  "well'' on August 13th.
  Lieut -\V.  c.  Weeks. 5th Michigan Cavalry, was shot through the left
 ankle joint on April 1st, IKr.o, and a Pirogoff amputation  was performed
 the  same day by the surgeon of his regiment, Dr. St. Clair.   He had a
 firm stump by the latter part of June.
  Behind  the other figures stands Lieut.  J. G. Turku, whose right humer-
 us was shattered at Fort Haskell, near Petersburg, March 25th. 1865,
 by a musket  ball.   He made a rapid recovery after an amputation at th«
shoulder joint.
  The  other standing figure is Acting  Assistant  Surgeon C.  P. Porter,
U- *. A., who communicated the memoranda of the cases.   All of  them'
*''ri' Seated at Armory Square Hospital at Washington.

         Photographed at the Army Medical  Museum,
 8Y  ORDER  OF THE  SURGEON  GENERAL:
                     (tMORGE  A.  OTIS,
           liv't LU Col, and Surg. IT. S. V.} Curator A. 31.  31. 
 
          #«wje0n  (tomxtiYit  t&tfitt.


        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH 102.  Encephalold Tumor at the Angle of the. Jaw.
  In December, 1X64,  William P------, aged sixty-two years, thirty of
 which were passed in the army of the United  States, an inmate of the
 Soldier's Home, at Washington, complained of a small indolent swelling.
 under the angle of the lower jaw, on the left side.   The  tumor was
 painted  with  tincture  of iodine  for about three weeks; but  its growth
 was not  arrested.  The patient then left the Asylum, but returned after
 an absence of  three months.  During  this period  the  tumor increased
 rapidly  in bulk.  In  October, I860,  its attachments extended from  the
 mastoid  process of the left temporal backwards to within half an inch of
 the spinous process of the upper cervical vertebra', upwards  over  the
 occipital  bones and the ramus of the  inferior maxilla, and  downwards
 along the  sterno-cleido-mastoideus to within two inches of the middle of
 the clavicle, deflecting  the trachea and oesophagus to  the right.  Brevet
 Lieutenant Colonel C.  H. Laub, Surgeon, U. S. A., regarded the tumor as
 a malignant one, and  in  view of the great  danger  that its  extirpation
 would involve  and the probability of its recurrence, decided  against any
 operative interference.  The tumor enlarged rapidly, and greatly impeded
 respiration and deglutition, and there  was grave constitutional disturb-
 ance.  On October 22, ]Xli">,  the patient died.  The tumor was removed
post-mortem.  It is preserved in the Surgical Section of the Army .Medical
 .Museum  as No. 4003.

           Photographed at the Army Medical Museum.

  BY ORDER  OF  THE  SURGEON  GENERAL:

                            GEORGE  A. OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A, Curator A. 31. 31. 
 
         ARMY   MEDICAL   MUSEUM.


  VE™To7Ur  £*%**  X"    1^E-^^^-nd Portion of
    Slant of Left  Humerus, comminuted big a Mmhct Ball        '
   s-cond Lieutenant Horace Ci. Jacobs, Co. G. 6th M.iino  Vol*  ,„,,i
  wounded at Rappahannock Station, V;,.. November 7th  1S,-'Y     "'   ,"'"  ■vears'WM
  entered the left shoulder posteriori v. two inches from   '     '  ?'  " C°"0,l1aI ba"' W,,lch
  upper extremity of the humerus and mal    if  •  T       °U l,lwcs*> "'^"red the






 ., r,   •     r      °        seiMce.  He was subsequently employed in the office of
  e o,n„1Is.saryGeneral,atWaSlungto
   . th, upper extremity of the humerus exfoliated.   After  this the cicatrix appeal   flnu
  ^oand.   In the spring- of 180;, the photograph was taken at the Army Mod"!,, M,™

 ^e .SHt ITI Cr;tr°'  0Vel' tUC m°Venie,ltS °f **  a™-  Tht' ^« °f "Unction
 me   t l! v re,',ark"Wp U^'-ee-   Thfi SP-™™ of the excised portion of bone is pre-

 «.g eal Records, 8. G. 0., Excisions, Vol. I, p. 22.  On January  16th, 1S66, Dr. Otis examined
Lieut. Jacob s shoulder.  His ccntrol over the mutilated arm  was more complete than exists
Jii any other case of excision of the head of the humerus which has come under his observa-
tion. He could put his band on  the  top of his head, and could lift  a heavyweight.   The
amount ot shortening was precisely three inches.

           Photographed at  the Army  Medical Museum,
   BY ORDER  OF THE SURGEON  GENERAL:

                        GEORGE  A.  OTIS,
                 Brt. Lt.  Col. and Surg.,  U. S.  V., Curator,  A. 31. 31. 
 
    f ifigMtt   $> muni's   'Mint,

      ARMY  MEDICAL  MUSEUM.

Photograph  Series  Xo.  104.—Excised Knee-joint.   A Round
  Musket Ball in the Inner  Condyle of the Right Femur.
  Private Gardiner Lewis. Co. B, 19th Indiana  Vols., aged  twenty-two,
was wounded in  the battle of  Gettysburg, July  1st, 1863,  by  a  round
musket ball, which lodged in  the internal condyle of the right, femur.
On November 27th, 1863, he was admitted  into Jarvis TJ.  S. A. General
Hospital, Baltimore, Md., the knee being disorganized and  discharging a
foetid pus.   On December 1st, Acting Assistant Surgeon F. Hinkle, U. S. A.,
excised the articular ends of the tibia  and femur,  sawing off an inch of the
condyle of the femur, and three-fourths of an inch of the head of the tibia.
An H incision was  employed.   At the time of the operation the patient
was feverish, anxious, without appetite, and sleepless  from intense pain.
He did well  until several days after the operation, when he  had a chill.
Chills recurred each alternate day, and other symptoms of purulent  infec-
tion were manifested.  On December 23d, the case terminated fatally.  The
autopsy revealed metastatic foci in the  lungs, and six ounces of pus in the left
pleural cavity.  The incisions were healed, and the ends of the bones were
found in apposition, but no union had occurred.   The excised portions of
the femur  and  tibia are  preserved  in  the Army  Medical  Museum, as
Specimen No. lOoti, and the history of the case is recorded in  the Surgical
Records, S. G. 0., Excisions, Vol. VI., p. 122.
          Photographed at the Army Medical Museum,
  BY ORDER  OF THE SURGEON  GENERAL:
                    GEORGE A. OTIS,
               Brt. Lt. Col.  and Surg.,  U. S.  V., Curator, A. 31. 31. 
 
       ARMY   MEDICAL   MUSEUM.

Photograph   Series Xo. 10").—Perforating  Gunshot  Wound
   of the  Abdomen followed by Ffecal Fistula.
  Private Franklin Harsh, Co. G, 7th Ohio Vols., was wounded at  Chan-
ceilorsville, May 3d. 18G3, by a conoidal musket ball, which  entered the
abdomen six inches to the right of the  umbilicus,  and passed out  poste-
riorly, having wounded the  ascending colon and  the  crest of the  right
ilium.  He was admitted to Armory Square  Hospital, at Washington, and
remained there for a long time with a frecal fistula.   On  September   13th,
18H3. the anterior wound had closed, and the discharge from the posterior
wound was much diminished.   Ultimately the posterior fistula  closed, and
the patient was  discharged from service May  7th, 1864.  Early in the
history of the  case.  Hospital Steward Stauch, U. S. A., one of the artists
of the Army Medical Museum, prepared a colored drawing of  the patient,
from which the photograph is copied.  (Nos. 21  and 22. Surgical Series of
Drawings.  S.  (r. 0.)   A  brief  history of  the ease was furnished by
Surgeon D. W. Bliss, TT. S. Vols.  See Surgical Records,  S. ft.  0., Wounds
and Injuries. Vol. 14, p. 121.
           Photographed at the  Army Medical  Museum,
   BY  ORDER OF  THE SURGEON GENERAL:
                       GEORGE A. OTIS,
               Bet. Lt. Col., and Surg., U. S.  V., Curator, A. 31.  31. 
 
          ARMY  MEDICAL   MUSEUM.

Photographs 106 AM)  107.    sioxessjul  Excision  of the Upper
   1 art ion of the Shaft of the Right  Femur.           '
 Attlielpattl(M.froldIIarbor,Juiie3,18eS4,l'riya'tr.lasoiiW loJv,, r„ T th, y   v  i  n


was made,  through a  yertica,  .in^'inc^' =«^S? V^S^
 and fully reported, and instructions ,., this  effect w^rc senlo  rt^  Z,    ™
 Dale Hospital.  Assistant Surgeon  D.  C.  Peters, V. S. Army,  in chargt of "a -y ill 0 ,,ita
 reported as the result of his  examination,  that in c nsequencc <,f fra Mre of t  e  n'ck'and
 great trochanter by a fragment of shell, the head and about two inches of the shaft adl.een
 ren„yed:that the limb was shortened  six  in, hes and  could  be  swung backw  nl ™d ter
 wards but not rotated or abducted.  Surgc-on Cyrus X. Chamberlain.  V. S \  unte ■ s i ,
 charge ot Dale Hospital,  reported on March :51, lKiift. that  J,„|v„ was in perfec  1 ealt h  tl
 wound healed and tree trom tenderness, the limb moveable in every direction an lperfot y
 -mder the control  of the muscles, and  shortened six  inches.  'I he patient t^l that the
 ..prater had sent a letter to the surgeon in charge of Hospital N„. 2  ,|, .„,•, ibing the onera-
 .0,, as an excsion ot the head and  six inches of the shaft' of the R-im.r.   Br. Uianw,erh in
 .... nd that the upper extremity .,f the femur was much  enlarged, and that a good falgooi,,
 had formed  On tins test......,,,-, the case was included in the tabular statement of  excihs
 ..  the head of in-femur published at  page OS of Oheular No. .1 Surgeon General's Office
 *'';  «"i ,vliile that report was 11, press,  evidence  was adduced  that the excision did not
 involve an exart.cnlat.o...  It  was  to,, h.t,- to withdraw  the case from the table-  but  ,
 memorandum was  inserted that the  report  might not mislead  On Annus* 29 lh65  Josh-
 was transterred to  I»e • amp Hospital, D.» ,d"s Island, Xew  York.   Here a crit cal  exami',
 tion of the 1.1..0  was n.ade by Assistanr s„rg.-0„ Warren Webster.  U. S. Army, and Professor
 Ltl'lmi !   Ti,        ™n  hl\uo '.'""l"  ",at  tllP ,,ead nf tlle frm»r still occupied the
 S?lfti?2        T "''-" ,l ?',at 'lei'OSlt of neW boi,t' :lt the  re"I,i"n of *'"' trochanter major
 witl, the upper extremity of the resected shaft.  The shortening was six  and one-half inches
 by caretui measurement.  Joslyn could bear  his  entire weight  on the  limb.  The thigh
 i-oult be flexed and extended  naturally. When it was rotated, the trochanter major could
 be felt going through its circuit.  The thigh and leg were  atrophied;  the cicatrix was
extensive, owing probably to the sloughing  that took pla.
and toes.  V ith this apparatus .b.slyn could walk with ease,' aided by a light cane,  lie was
'liscliargc.l from service, and went to his home in Oxford, Massachusetts, on October 'T. ISO.j
llio photographs representing the apj.earai.ee of thepatient with ami without the apparatus
w .recontributed by Assistant burgeon Warren Webster, V. S. Army.

             Photographed  at the  Army  Medical  Museum.

  BY  ORDER  OF  THE  SURGEON   GENERAL:

                                  GEORGE  A.  OTIS,
                 Bv't Lt. Crd. and .tw-V Surg. U. S. A. Curator A.  31. 31. 
 
         ARMY  MEDICAL  MUSEUM.
                                     —«—

PHOTOWitAPlis llll) am.) 107.    Successful  Excision of  the  Upper

   Portion of the Shaft  of  the Right  Femur.
 At the battle of Cold Harbor, J une 3, lsiU, Private Jason W. Joslyn, Co. 1,7th New York Heavy
Artillery, aged 24 years, was struck in the right gluteal region by a conoidal musket bali,
which passed forwards and downwards, striking the femur a little below the trochanter major,
mid comminuting the upper third of the shaft.   He fell into the hands of the  enemy and 01,
June 5, fifty-four hours after the reception of the injury, an  excision of the shattered femur
was made, through a vertical  linear  inc'sion. commencing near the upper point of the
trochanter major and carried downwards seven  and a half inches, in the axis of the limb.
The femur was .1 vi.le.l between  the trochanters by a chain  saw and again, six and one-half
inches below. The operation was performed at  a  field  hospital by a confederate surgeon.
On the same  day, the patient was placed i:i :"i ambulanc? and sent to  Richmond, a distance
i>f thirteen miles, ami placed in hospital No. 21, in charge of Surgeon G. W. Semple.  lie slates
that he was very weak and exhausted on arriving at the hospital.   His limb was placed in a
fracture box, and he was ordered two ounces of whiskey  twice daily, and a diet of corn and
wheat bread  with soup  Towards the end of June there was extensive sloughing of the soft
parts on the outer  side  of  the thigh.   Joslyn remained in  hospital in  Richmond, until
August 22, 1S6I, when he was paroled  and sent into the Union lines,   lie was conveyed on
the steamer New York to  the  general  hospital nt Annapolis.  He was treated there until
November 2S. and then transferred to Jarvis Hospital at  lialtimore, and again, on January
:'.l, IS60, to D'le Hospital, at Worcester, Massachusetts.  The report from Annapolis having
stated that Joslyn had survived an excision of the  bead  and  a portion of the shaft of the
femur, it was directed by the Surgeon  General  that  the case -I..mid be carefully observed
und fully rep. rtc.l, and instructions to this effect were sent to Jarvis and subsequently to
Dale Hospital.  Assistant  Surg.-On D.  C. Peters,  U.S. Army,  in charge of Jarvis Hospital
reported as the result of his examination, that in c"l,seipience of fracture  of the neck and
great trochanter by a fragment of shell; the head and about two inche< of  the shaft had been
removed: that the limb was shortened  six inches and could  be swung backwards and for-
wards but not rotated or abducted.   Surgeon Cyrus N.  Chamberlain, V. S.  Volunteers, in
charge of Dale Hospital, r< ported on March 31, lSbo, that. Joslyn was in perfect health, the
wound healed and free from  tenderness, the limb moveable in every direction and perfectly
under the control of the inus.les, and  shortened  six inches.  The patient stated that the
operator had sent a  letter to the surgeon in  charge of Hospital No. 21 describing the opera-
tion as an excision of the head and six inches of the shaft  of the femur.  1 r. Chamberlain
found that the upper extremity of the femur was much enlarged, and  that a good false joint
had formed.  On this testimony, the ease was included in the tabular statement of excisions
of the head of the femur published  at page 6S of Circular No. 6. Surgeon General's Office,
1865.  But while that report was in press, evidence was adduced  that the excision did not
involve an exarticulation.  It  was too  late  to  withdraw  the case from the table:  but a
memorandum was inserted that the  report  might not mislead  On August 29. l>-65, Joslyn
was transferred to lie Camp Hospital,  David's Island, New York.  Here a critical examina-
tion of the limb was made bv Assistant Surgeon Warren Webster, U. S, Army, and Professor
F.H. Hamilton.  There ran be no  doubt  that the  head  of the femur still occupied the
acetabulum.  There was a great deposit of new bone at the reunion of the trochanter major
with the upper extremity of the resected shaft.  The shortening was six and one-half inches,
by careful measireiuent." Josh 11 could bear  his entire weight  on  the  limb.  The thigh
.•.'.aid be flexed and  extended naturally.  When  it was rotated, the trochanter major could
In-felt going through  its circuit. The thigh and  leg  were  atrophied;  the cicatrix was
extensive, owing probably to the sloughing that took place soon after the  operation, but it
was firm and healthy; the gastrocnemius and the extensors of the loot were rigid: th- foot
was extended to the'utmost.  In Otobor, 1M.5, Dr.  E. D. Hudson supplied the patient with
in,  ingenious prothetic apparatus, consisting of a  case of raw hides, laced upon the thigh
and leg, and  terminating  in an  artificial toot, with ginglymoid articulations at the ankle
and toes.  With this apparatus Joslvn could walk with ease, aided  by  a light cane.  He was
discharged from service, and  went to his home in Oxford, Massachusetts, on  October 2(5, lMw.
The photographs representing the appearance of the patient with and  without the apparatus
were contributed by Assistant Surgeon Warren Webster, I . S. Army.

              Photographed at  the Army  Medical Museum.

  BY  ORDER   OF THE  SURGEON  GENERAL:


                                   GEORGE   A.  OTIS.

                  Bv't Lt.  Col,  and ,1«7 Surg.  U. S.  A, Curator  A. 3T. 31. 
 
      ARMY   MEDICAL  MUSEUM.

Photograph  Series  No.  I.08.—Ambulance   Wagon  designed
  by Brig. Gen. D.  H. Rue her.
  This ambulance has been recommended as the regulation ambulance for
the U. S. Army.   It weigh.s lloO pounds.  Its principal  dimensions are
as follows:
Length, including footboard and step,                 10 feet 7 inches.
Width, from outside of hubs,      -                   5 feet 11 inches.
Length of body inside,  ------     7 feet 4 inches.
Length, including seat box,   -----     8 feet  6 inches.
Width of body inside,   ------      3 feet  11 inches,
Height of body inside,   ------     4 feet 10 inches.
Diameter of hind wheels,     -----     4 feet 3 inches.
Diameter of front wheels,    -----     3 feet 8-J inches.
Width of foot board,    --_..-         13} inches
Width of step.    -------          9} inches.
          Photographed at the Army  Medical  Museum,
  BY ORDER OF  THE SURGEON  GENERAL:
                     GEORGE A.  OTIS,
               Brt.  Lt. Col. and Surg., U. S. V., Curator, A. 31. 31. 
 
§,
ARMY  MEDICAL   MUSEUM,
 Photooraph Xo. 109.  Planof the Fitting* „r the P. S. Hospital
   transport - General J. K. Barnes."
  The steamship  -'General,!. K.  Barnes" was  originally built  for the
 Havre line, and was purchased by the Government of the' United States.
 and fitted out at New York, under the supervision of Surgeon A. H. Hoff,
 IS. Vols., as an hospital transport.  This steamer  is "of 1400 tons,  is
 -'2s feet in length, and  is provided with 477 beds   During  the la>t  two
 years of the war, it was continually employed in transporting sick  and
 wounded from the southern military departments to the Department of
 the East..
  The photograph is taken from  drawings furnished by Brevet Major
«iid A.-istant Surgeon Thomas M<-Milieu. [J. S.  A.

          Photographed at the Army  Medical  Museum,
 BY  ORDER OF  THE  SURGEON GENERAL.
                               GEORGE  A.  OTIS,
                 /.(•  t Lt.  Col. and Surg.  C. S. V., Curator A. 31.  31. 
 
   fnt;<rcn*     i&m»xnY$    MHz?.


      ARMY  MEDICAL  MUSEUM.

Photograph Xo. 110.   Successful Excision of the  Head of the
   L ft Femur for Gunshot Fracture.
  Privat" Joseph Brown, Co. I. 3rd  Michigan Vols., aged thirty-eight
years, was wounded at the second battle of Bull Run, August 29th. 1802,
oy a musket ball,  which fractured the left femur throughtlie  trochanter
minor. He laid on the battle field three days, and was" then removed to
Centreville.   On September 11th,  hS'iii, he  was admitted to Fairfax
Seminary Hospital, near Alexandria.   The limb was kept  in position by
appropriate apparatus; but suppuration was profuse, and, on  two occasion^.
fragments of bone were  removed from the  wound.   Early in March,
1863, there was great swelling of the thigh ; the discharge became scanty
and foetid, and pus burrowed timid the muscles of the thigh.  On March
21st, an exploratory incision was  made  from  three inches above to live
inches below the  prominence of the  great trochanter.   The  neck and
upper extremity of the shaft of the femur wero found to be cxtensively
diseased, and excision was decided on.   The  shaft of the  femur was
divided six inches below the great trochanter, and  the head  wa< then
disarticulated.  The shock from the operation was great, and the patient
rallied slowly.  Two days after the  operation, an erysipelatous  blu-li
pervaded the  limb; but it passed away, and the case progressed favorably.
A tube was introduced to the bottom of the wound, which was  frequently
washed out  b}' this means.  Stimulants  and  concentrated nourishment
were perseveringly administered.
  In May, 1803, the patient was considered out of danger.   In Septem-
ber, he was reported as '• recovered" and a sketch of the appearance of the
limb was made by Hospital Steward Stauch, from which a  careful draw-
ing was subsequently executed by Mr. Baumgras  i Surgical  Series  of
Drawings, Xo. 73.)  The upper extremity of the femur was sent to the
Army Medical Museum, where it is  preserved as  Specimen  1192.   On
August 23d, 1863,  Brown was discharged from the service of the United
States.  On  March 21st, 1804, one year from the date of the operation,
he reported from  his home in  Coopersville, Michigan,  that  he was  in
;?ood health.   On  September 2>ith, 186-5, he again  wrote, and gave  a
particular account of the  amount of motion  in his limb, and stated that
there had been no  breaking out of abscesses or other inconvenience since
his last communication.  This letter is quoted in Circular No. 0, S. G. O.,
180-3, p. 7-3.  Afterwards Mr. Brown sent a photograph taken in Novem-
ber. Ihho, of which this is a copy.

          Photographed at the Army Medica!  Museum,
  BY ORDER OF  THE  SURGEON  GENERAL:
                               GEORGE  A.  OTIS.
                  Bv't Lt.  Col. and Surg.  V. S. J"., Curator A. 31. 31. 
 
      ARMY   MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 111.  Consolidated Gunshot Fracture of Upper
  Third of Right Femur.
  Private "William Piigney,  Co.  G,  21st  New  York Cavalry, aged
eighteen  years, in attempting to escape from camp, through  the  line of
sentinels, on "ray 27th, 183-3, was shot at a distance of fifteen yards, by
a Colt's army pistol ball, which entered the right nates, and passed out
at the anterior part of the thigh, having fractured the upper third of the
femur.  He  was  admitted to Stanton General Ilo.-pital on  May 29ih.
The details of the treatment are not entered on the records of  that hospi-
tal.  On September 13th, he was transferred to Harewood Hospital.  The
report  from  Harewood states that  his  constitutional  condition  was
good at that date,  that he was able to go about on crutches, and  that
the prospect  of his having a useful  limb was  good.  The injured femur
had  united firmly,  with two  inches shortening and very slight angular
deformity.   A photograph of the case was taken  in October, 18!)"), from
which this is copied.
          Photographed at the Army  Medica! Museum,
  P V ORDER OF THE  SURGEON  GENERAL:
                               GEORGE  A.   OTIS,
                 Bv't Lt.  Cot. and Surg.  U. S. U,  Curator A.  31. 31. 
 
       Jiinjftan   $tnmil't   Witt

       ARMY  MEDICAL  MUSEUM.

Photographs Nos. 112 and 148.   Successful  Excision  of the
  Head of the Left  Humerus, followed by Necrosis and Secondary
  Excision of the remainder of the Humerus and  the Upper Ex-
  tremities of the Radius and  Ulna.
  Private John E. F. Cleghorn,  Co.  K,  1st New Jersey Cavalry, aged
twenty-seven years, was wounded at Mine Run, Virginia November 27,
1863, by a musket ball, which shattered  the head of the left  humerus.
Three days afterwards the head and a small portion of the shaft were
excised, at a field hospital, by Surgeon Henry K. Clark,  10th New York
Cavalry.  On December 5th the patient was transferred to the 3d Division
Hospital at Alexandria, Virginia.  On April 28, 1864, he was transferred
to Ward Hospital,  Newark,  New  Jersey,  the  wound being healed, with
the exception of a slight fistulous sinus  communicating with  the sawn
extremity of the shaft of the bone.   Subsequently the entire shaft and
condyles of the humerus  became necrosed, and abscesses formed about
the elbow.  On  July  21, 1864, an incision  was made  along the  whole
length of the outer aspect  of the arm, and  the diseased humerus was
removed, together  with the upper extremities of the radius and ulna.
The wound left by  this extensive operation healed rapidly, and on Octo-
ber 20, 1864, he was discharged  from the hospital  and  from the service
of the United  States.  In November, 1864,  a  prothetic apparatus was
adapted  to the  arm by Dr.  E. D. Hudson, which  enabled the patient to
exercise considerable control over the movements of the limb.  A commu-
nication from the  Commissioner of Pensions, dated September 10, 1866,
states that this man is  a pensioner, his disability being rated equal to the
loss of a hand.

         Photographed  at the Army  Medical Museum.
 BY ORDER OF THE  SURGEON  GENERAL:
                         GEORGE A.  OTIS,
                           Ass't Surg. U. S. A., Curator A. M M. 
 
      ARMY   MEDICAL   MUSEUM.
                           —♦—
PHOTOGRAPH  113.    Successful  Secondary  Amputation  at  the
  Right Iligjolnt.    The  Thigh  had prerlonsly been  amputated
  at the Middle.
  Private Lewis Francis, Co. I, 14th New York Militia, aged forty-two
years, was wounded July 21st, 1861, at the first battle of Bull Run, by a
bayonet thrust,  which opened his 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 '28th, 1801, 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 18'J2  the patient was exchanged  and sent to Fort  Monroe.
Thence he was transferred to a  Washington hospital, and thence to his
home in Brooklyn, in  March, 18G2.   There  was necrosis of the  femur,
and in May, 1862, its extremity was again resected by a civil  surgeon.
On October 28th, 1863, Francis was  admitted  to the Ladle- Home Hospi-
tal, New York.   Xeeru.-is had apparently involved the  remaining por-
tion of the femur.  On May 21st, 1864, Surgeon A. B. Mott. U. S. Vols.,
laid open the flaps and  exarticulated  the bone.   The patient recovered
rapidly and had  a sound stump.   He was discharged August 12th, 1864.
The photograph  from which this is copied, was  taken October 1st, 1865.
Francis was then in good health.  Dr.  Mott reports that the pathological
preparation of the exarticulated femur was stolen from his hospital.
          Photographed at  the Army  Medical  Museum,
  BY  ORDER OF  THE SURGEON  GENERAL:
                             GEORGE  A.   OTIS,
                 Bv't Lt. Col, and Surg. U. S. V., Curator, A. 31. 31. 
 
  # u v t) * .om    $ 0 ,ii t y a 1' s    # f f i r r,

      ARMY   MEDICAL   MUSEUM.
                           —  ♦---
Photograph  No.  114.    Consolidated  Gunshot Fracture of the
  Middle Third, of the Left Femur.
  Private Thomas Miller,  ('...  G, 116th  Penn. Vols., aged  eighteen
years, was wounded May ">th, 1*1)4. at the battle of the Wilderness, by a
tonoidal musket ball which fractured his left femur at the upper part of the
middle third.  There was copious haemorrhage after the injury.   The
patient was taken to  Fredericksburg, and his  limb was  placd in a frac-
ture box.  There was much  pain and swelling.   On May 2r,th, he was
conveyed to Armory Square  Hospital, at Washington   On August loth,
lxii-i. he was transferred to Harewood  Hospital,  convalescent.   The
injured limb  wis shortened two inches and three-quarters.   The wounds
were closed, and it  was believed that the patient would have a useful limb.
  The photograph from which this is copied, was taken in October,  18i.J.>.
         Photographed at the Army  Medical Museum.
 BY ORDER  OF THE  SURGEON GENERAL:
                           GEORGE A.  OTIS.
                BvA.Lt.  Col.  and Surg.  TJ. S.  V..  Curator, A. 31. 31. 
I 
      ARMY   MEDICAL   MUSEUM.

Pimi'1\h;raph  No.  11;").    Consolidated  Gunshot Fracture of the
  ipper Third of tlie Right Femur.
  Private L.-onard  Felder, Co. F, lstMa^s. Vols., aged twenty-two years,
was  wounded June Kith,  1864, in front of Petersburg, by two musket
bulls.  One passed  through the lower  third of the right fore-arm, com-
minuting the ulna ; the other entered the outer aspect of the right thigh
and fractured the upper third of the femur.   He  was admitted to Hare-
woed Hospital, at "Washington, on June 22d. 1864. The  ball that entered
the thigh  was extracted through an incision  in the groin.   Extension
was made by raising the foot  of the bed, the limb being secured, and the
weight of the body making counter-extension.    The fractured ulna was
treated by simple dn-ssiugs.  The case progressed favorably.   The frac-
tured femur united firmly with two inches  shortening.   The  wounds
were closed, and the patient was in good condition when  discharged from
service on July 13th, 1865.   At this date the  photograph of which this
is a copy, was taken at Harewood Hospital.
          Photographed at the  Army  Medical Museum,
 BY  ORDER  OF  THE SURGEON GENERAL:
                            GEORGE  A.  OTIS,
                 Bv't Lt.  Cvl. and Surg, V. S.  V., Curator, A. 31. 31. 
f I 
ARMY   MEDICAL   MUSEUM.
PHOTOGRAPH  Xo.  116.    United Gunshot Fracture of the Middle
  Third of the Right Femur.
  Corporal Sylvester Boyee, Co.  B, -3th Michigan  Vols., aged twenty-
five years, was wounded at the battle of the Wilderness, May 6th, 1861,
by a conoidal musket ball, which fractured the middle third of the right
femur.
  On June 1st, 1864, he was conveyed  to Harewood  Hospital, at  Wash-
ington. There was no great constitutional disturbance, and the fracture
was not extensively comminuted.   A sustaining general treatment, with
moderate extension of the limb was determined on, and the case progressed
towards recovery  without  any untoward complication.   The  fracture
united firmly with no angular deformity, and with less than  an inch of
shortening.
  On July 14th, 186"). the wounds  were closed, the fracture was consoli-
dated, and the corporal was able to walk upon the injured limb without
discomfort.   At this date the photograph of which this  is a copy was
taken, and Boyee was discharged from the military service of the United
States.
          Photographed  at the Army Medical  Museum,
  BY  ORDER  OF  THE  SURGEON  GENERAL:
                               GEORGE  A. OTIS,
                  Bv't Lt. Col. and Surg.  U. S. V., Curator A.  31. M. 
 
  fiu'i}«H    €tn»xftV»    Mint.

      ARMY  MEDICAL  MUSEUM.
                           ■ -♦-
PHOTOGRAPH  No. 117.   United Gunshot Fracture, of the  Ipper
  Third of the Left Femur.
  Private Peter Riley, Co. A,  10th  New York Heavy  Artillery, aged
twenty-eight years, was wounded at Cold Harbor, Va., June 3d, 1864,
by a ccnoidal musket ball, which entered the  anterior aspect of the left
thigh high  up,  fractured the upper third of the femur,  and lodged
posteriorly in the muscles.
  He was admitted to Lincoln  Hospital, at Washington, on Juno 11th,
1KU4. At first,  extension and counter-ex+en-i.m were employed, but on
account of the severe pain induced, this treatment was discontinued. TL-:
ball was extracted through an incision, ar.d, in July, free incisions were
made for the evacuation of pus.
  The patient slowly recovered, the injured  limb  being shortened four
and a half inches.  He was discharged from service in I860
  The photograph was taken at Lincoln Hospital, by direction of Surgeon
J. C. Mr.Kue, U. S. A., on June 2d, 1865.
       Photograph Printed at the Army Medical Museum,
 BY  ORDER  OF THE SURGEON  GENERAL:
                            GEORGE  A.  OTIS,
                Bv't Lt. Col. and Surg.  U.S.  V.. Curator A. 31, 31, 
 
     ARMY   MEDICAL   MUSEUM.

'llOTOGRAPH  No.  118.   United  Gunshot  Fracture of the  Tro-
 chanter Major of the Left lemur.
 Private Charles II. Hodsdon, Co. G. 7th Maine Vols., was wounded at
lie battle of the Wilderness, May 5th, 18G4, by a conoidal musket ball,
diicli shattered the left trochanter major and buried itself in the gluteal
uiscles near the sacrum.
 He was admitted to Lincoln  Hospital, at Washington, on May 26th,
804.  The location of the ball was detected by means of a Nelaton probe,
nd on April 25th, I860, it was extracted through a deep incision.
 The fracture  united firmly, and  on June 4th, 1865, the  wound  was
ealed and the patient was nearly well.
 At  this date the photograph was taken  by direction of Surgeon J. (J.
ileKee, IT. S. A., in charge of Lincoln Hospital.

       Photograph Printed at the Army  Medical Museum,
CY  ORDER  OF  THE  SURGEON GENERAL:
                           GEORGE  A.   OTIS,
                Bed Lt. Col. and Surg. U. S.  V., Curator, A. 31.  31 
 
      ARMY   MEDICAL  MUSEUM.

Photograph Series, No. 119.   Consolidated Gunshot Fracture
  of the Middle  Third of the Right Femur.
  Private John  Hamilton, 1st  Delaware Volunteers, aged 1° years, was
accidentally wounded while on picket duty at Camp Hamilton, near Fort
Monroe, Va., on November 10th, 1861,  by a  conoidal musket ball, which
fractured the right femur  a little above the middle.  On the following-
day he was admitted to Hygeia General Hospital at Fort Monroe.  Not-
withstanding the extensive comminution of  the bone, the fracture was
consolidated  at the end of five  weeks, though there was moderate suppu-
ration and exfoliation of necrosed fragments at intervals until June,  1862.
The  limb was kept in a straight position, and moderate extension was
employed uninterruptedly.   The wounds were at times dilated  with
sponge tents.  In July, 1862, Hamilton was sent home with a sound  limb,
shortened not more than an inch.  In the Spring of 1866, he reported
himself to Surgeon and Brevet Lieut. Colonel  R.  B. Bontecou, U. S. Vols.,
by whom the treatment was conducted,  as entirely well, and  possessed of
a most useful limb.  The photograph is  enlarged from a card picture fur-
nished by Dr. Bontecou.
          Photographed  at the Army Medical Museum,
  BY  ORDER OF THE SURGEON  GENERAL:
                     GEORGE  A.  OTIS,
                         Asst. Surg., U.  S. A., Curator, A. M.  M. 
 
^c4^.^.^^^^^
    ARMY   MEDICAL   MUSEUM.
                        —♦—
'HOTOGRAPH No.  120.   Gwishot Fracture of the Left Ilium.
 Commissary  Sergeant George  E. Corson, 1st  Battalion,  17th  U. S.
nfantry, was wounded tit the b-utlo  of Spottsylvania, May 12th, 1864,
j-a conoidal musket ball, which entered  six inches to the left of the
mbilicus, and passed directly backwards, fracturing the crest of the ilium.
 He was taken to the 5th Corps Hospital, and four days subsequently
us sent in  an ambulance to Belle Plain,  and thence to Washington,
here ho  was admitted to Judiciary  Square Hospital.   There was no
fmptom of  peritonitis at any time, and the wound gave little trouble,
xcept from the rather copious suppuration  attending it.  In the  latter
art of July. 1864. Sergeant  Corson was ordered to the headquarters of
is regiment, at Fort Preble, Maine.   On August 29th,  he  was dis-
harged from service.  On  October  10th,  1864, he wa< appointed an
lospital Steward, and was assigned to clerical duty in the Office of the
urgeon General.  At this date (December 14th, 1865,) the entrance and
xit wounds  are still open.   From  time to time fragments of  necrosed
one escape.  It is possible  to pass a probe through the track  of the
round without causing pain.   There is but slight suppuration.   The
teward's general health is good.

        Photographed at the Army Medical Museum,
BY  ORDER  OF THE  SURGEON  GENERAL:
                         GEORGE  A.  OTIS,
               Bv't Lt.  Col. and  Surg. U.  S.  V., Curator, A. 31. 31. 
 
       ARMY    MEDICAL    MUSEUM.

 PHOTOGRAPH   SERIES  No.  121.— Three Heads  of Humeri  ex
   vised on account of  Gunshot  Fracture.
  The fSp.-ciinen on the left, No. 'Mi, A.  51.  M.. is from a  successful secondary operation by
Asst. Surgeon 0. Wagner, l:. S. A.  Private Robert C------, 4th N. Y. Vols., aged 28 years.
was wounded at the battle of Fredericksburg, December 13th, 1S02. by a musket ball, which
shattered the head of the left humerus and lodged in the axilla.  lie was sent to the Gene-
ral Hospital at Point Lookout, Md., and, on January  17th, 1863, when he had sufficiently
rallied from a severe chronic diarrhoea,  the head of the humerus was removed through a V
shaped incision, and the ball was  extracted.   The wounds healed  in about eight weeks, and
th" patient was discharged from service  April 10th, 1863, with a  useful arm.   The case is
recorded in Surgical Records, S. G. 0., Excisions, Vol. I, p. 11.
  The Specimen in the middle of the Photograph, No  451, A. M. M..  is  from  a successful
intermediate operation of excision, performed at Frederick, M.I.. October 4th, 1SB2..  by Dr.
J. If. Peabody.  Tin- subject of it, Private James L. II------, Co. I,  27th Indiana Vols., was
wounded at Antietain, Sept. 17th,  1862, by a conoidal musket ball, which entered three  inches
to the right of the sternum, between the first and second ribs, passed obliquely backwards
and outwards, and made its exit an inch  and a half below the acromion, at the external mar-
gin of the scapula.  At the time  of the  operation, there  was  much constitutional disturb-
unre, and the. shoulder was swollen and extremely painful. The operative method was by a
single vertical incision.  The humerus was first sawn through the surgical neck; but the
lione  being denuded lower  down,  a second section was made.   The wounds  were entirely
licaied in six  weeks, and the patient was  discharged from service, December 17th, 1862. with
ii "tolerably useful arm and forearm."   See  Surgical  Records, S.  O, 0., Excisions. Vol.
1, p. S.
 The Specimen on the  right. No.  10, A. M. M., represents  the extent of  the  injury in  the
case of Private William V------, Co. E. 9th  Mass. Vols., aged 22 years.  He was  wounded at
Malvern hill, Va., July 1st, 1862. by a conoidal musket ball, which entered the onter side of
the left shoulder and passing obliquely upwards shattered  the head of the  humerus and  car-
ried away the tip of the coracoid process.   On July 18th, Surgeon R. H. Coolidge, ('. S. Army
wised the head of the humerus, at Epiphany Church Hospital,  Washington, D. C,  and
removed the  detached portion of the coracoid.  A large abscess  below the clavicle  was
opened.  The patient was  discharged from service December 15th, 1862.   In a  letter dated
December 25th, 1865. Surgeon General Dale of Mass., reports that this man was employed as
:i farmer at North Bridgewater, Mass.: that there had been no fistulous  openings or other
inconveniences since the operation: that  the man could put his hand to his head, and that
the voluntary movements of the arm were  otherwise eminently satisfactory.   The case is
recorded in Surgical Records. H. G. 0.. Excisions, Vol. I, p. 3.

            Photographed  at the  Army  Medical Museum,

   BY  ORDER OF THE  SURGEON  GENERAL:

                           GEORGE  A.   OTIS,
                 Bet. Lt.  Col., and Surg.,  V. S. V-, Curator, A.  31.  31.

8504 
 
       ARMY  MEDICAL  MUSEUM.
                             — ♦—
Photograph 122.   Three  Heads of Humeri excised for Gunshot
  Fracture
  Specimen 2510, of the Surgical Section,  A. M.  M., consists of the head
and two inches of the  left humerus, with a conoidal ball impacted in the
head, which  it has broken into  several fragments.  Specimen 1715. is from
a successful primary operation by Surgeon A. Hard, 8th Illinois Cavalry:
Private Martin Francher, Co  1, 8th  Illinois Cavalry, was wounded in a
skirmish near Rochelle. Virginia, September '-3, IHCi'A. by a conoidal ball,
which  perforated  the  surgical  neck of the left humerus,  fracturing the
articular surface,  lie was taken to  Culpepper, Virginia, nearly thirty
miles, the next day. and excision was performed through a longitudinal in-
cision  iu the deltoid muscle.   The wound healed rapidly, and the patient
was  discharged from the service on April G, lSt>4.   Specimen 2(325 shows
the  head and three and a  half inches of  the  shaft of the left humerus
excised for comminuted fracture of the surgical neck.  The ball is lodged
in the bone;  the  epiphysis is  not  implicated,   lt is believed to be from
the  ease of Private .John Trombly, Co. II,  1st.  Michigan Volunteers, who
was wounded at the  battle of the  Wilderness,  May  5,  l^b-l,  and who
underwent excision on the same day, at the 5th Army Corps Hospital, the
operation being performed by Surgeon Jacob Ebersole, 19th Indiana Vol-
unteers.  Trombly was afterwards treated in Harewood Hospital, and was
discharged November 15, lHfih  His forearm was  in good  condition; but
he had little  control over the muscles  of the arm.  With an appropriate
apparatus, supplied by Dr. K.  J). Hudson,  his  limb subsequently became
very useful.

          Photographed  at  the  Army Medical  Museum.

 BY ORDER OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS.
              Brf Lt. Col. and Ass't Surg. I'. S. A.  Cum/or A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.

 Photograph VIS.   Three Heads of Humeri, Excised for  Gun-
   shot Fractures.
  The specimen on the left, 3954, Surgical  Section, is from a successful
 primary operation by  Assistant  Surgeon R. F. Weir, U  S Army   The
 patient, private Simeon Cole,  Co. G, 106th  New York Volunteers  aged
 nineteen years, was wounded at Monocacv, Maryland, July 9 1864 '  The
 ball shattered the surgical neck of the  left humerus.   The excision was
 performed at  Frederick, Maryland,  on  July 11, 18(14, through a straight
 incision  The case progressed admirably, and on June 13, 1865, the patient
 was discharged from  service.   In January, 18(15, he was last heard from
 He could raise his hand to his forehead, lift a bucket of water from the floor
 to a chair, and move his arm forward and backward about twenty degrees
 .Specimen 1180 represents the  extent of the injury  in the case of private
 George R.ggs, Co. E,  12th  Xew Jersey  Volunteers, who was wounded at
 the  batle of  Chanceilorsville, Virginia, May 8, 1863.  A musket ball
 entered over the right clavicle and made  its exit over the surgical neck of
 the right humerus.  The excision  was performed at Washington, D  C  on
 the2othday of May,  1863, by Assistant  Surgeon C.  A.  McCall, U. S
 - i eL   ™  Patient recovered and was discharged from  service November
 i, 1«W.  The Specimen on  the right, 2505, is from a successful secondary
 operation by Acting Assistant Surgeon J. H. McClellan.   Private Charles
 .\aylor  Co.  I, ]]th  New Jersey  Volunteers, was wounded at Chan-
 ceilorsville, Virginia,  May 3,  1863, by a  musket ball,  which carried
 away the posterior portion of the head of the left humerus.  The excision
was performed at Philadelphia, August 16, 1863.   The patient, recovered
ana was transferred to the  Veteran Reserve Corps on February 25, 1864.

          Photographed at the Army Medical Museum.

  BY  ORDER OF THE  SURGEON  GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass'I Surg.  U. S. A. Curator A. M. 31. 
 
       ARMY MEDICAL MUSEUM.

 Photograph  124.   Two Heads  of Humeri excised  on account
   of  Gunshot Fractures.
  The specimen ou  the left, 387, Surgical Series, is  from a  successful
 secondary operation by Acting Assistant  Surgeon  S. 1). Cross.  Private
 Freeman Snow, Co. C, 37th Xew York Volunteers, was wounded at.  Glen-
 dale, Virginia, June 30, 18(12,  by a musket ball, which  fractured  the
 shaft of the right humerus  in its upper  third.  He was taken prisoner,
 sent to Richmond, Virginia, exchanged, and on July 27 admitted to  the
 Fourth and George Streets Hospital at  Philadelphia, where the excision
 was performed on August  1, 1862.  The wound discharged freely  for
 several weeks, but healed kindly, and  on October 20,  1862, the patient
 was discharged with a useful arm.  The  specimen on the right is from a
 successful primary operation performed  by Assistant Surgeon H. L. \V.
 Burritt, U.  S. Volunteers, at  Knoxville Tennessee. Private  George Howe,
 • '". F,  10th Michigan Cavalry, was wounded at Flat Creek Bridge, Ten-
 nessee, August 24. 1864, by a conoidal ball, which fractured  the upper
 third of the right  humerus, involving the  shoulder joint.   The excision
 was performed on August 26, through a single  straight incision.   The
 patient was feeble from profuse hemorrhage and  reacted slowly, but
 improved gradually.  On September  12, healthy granulation  had'  com-
 menced, and on September  30, the wound  was nearly closed.  He was
discharged  from service  on May 2, 18(15. having good  use of the forearm
of the injured side.

          Photographed at the Army  Medical Museum.

  BY  ORDER OF   THE  SURGEON  GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. Col,  and Ass'I Surg. U.  S. A. Curator A. M. M. 
 
           burgeon     ininaVs    (Office



           ARMY  MEDICAL  MUSEUM.


 PHOTOGRAPH  1 L>.).    //, ads ond'lVagna ,,ts of I/, ads of Humeri

 Pvc!'C\Tv"rn °" !h-° 'C,t- ^ l'ons'st> of fr;'g,,,e»fs of the h-ad  „f ,l,c 'right humerus,
 excited h> A- -,;.Nt mi recoil William Thomson. V. >  Univ  l«e|vc weeks  after inin.v
 C,.r,,oral Thomas M.Cidh-y.tVR. 62.. IVnnsyUania V,,,,,,,,,,:,:  was woundtd  attteiTt ft
 of lliimellorpi le,  \  rgiuia May 3, Imi::, l.y a com,.la!  I.,! I, which entered the left eve,
 pa-sed through the  antrum of II ghinore and hud palate, fractured the right side of the
 int.noimax.lla. entered  ih- riuhl si, mldcr no,,- the  corac.c.l pro, ess  pissed through the
 i,.a.l,.t the humerus ;,,d ,■,,„,,-..,1 at the posterior ,mg',- ol th- axilla.   The  excision was
 performed at the Dougla- Hospital. Washington. IV C. on the 2'Jth ot .Inlv.  K,.r three wecU-
 the patient was t,-d hv moans of a  stomach tube.  Tie-  wounds healed with the exception of
 a -!iiu> leading t.. a  -  jiiestrinnat  the inner aspect of the shaft of the humerus, a few inches
 hel.ov  the >l,ouliler joint.  Th  j.-.T-.-i.t was transferred to Pittsburg,  Pennsylvania, and on
 July J. IM.t. returned to  In- i  gimeut. to be mustered out of service. Specimen 200-2, was
 from a «,.,.,  -m! intermediate excision.  .*. i -"ant John Ora\.  Co   K. tii'th Pennsylvania
 Volunteers. w.-s wounded at .Mine Kim.  Vir'_-in'a. November 2'.t. pr:i  l.y a conoidal ball
 glancing around th" anterior portion  of the  head of the  left humerus.  The operation was
 done at the Pairfax > ajinary Hospital, on December 2o,  l.-ftt.  The wound healed rapidly
 and the patient was   ii- barged from service, March 5. ISiU.  Th -third spcciini n No ::c. H
 was contributed by s -rger,,, ,,. rulherfs n, ('. - Volunteers  It  represents tlic head and on '
 im-h of the shaft of the humerus jM a -arious condition.  Private William H. Williams, Co.
 A. 2d Wiscon-in \ ..litiitcer-. was wounded at the battle  of the Wililernes-, May  4, ISbt i.y a
 conoidal ball, which  Ira. tilled and dM.-cate 1  the head of th. ri-l.t humerus. ' The excision
 was performed by the contributor at  the llu-vey  Hospital. Ma.lis,,n. Wisconsin, on the 20th
 of June.  The Ion- tendon of the bio-ps aid that of tic pectornlis major with their attach-
 ments to tin-huiirrus were  preserved. The  wound  was closed w.tli  wire sutures and the
 arm s..cim.d l.y the patient's side.  Th incision h-aled raj.iillv  by first int.-nt'on. mid the
 pati.-nt w.- discharged r,.,m service on July 27. 1>*U.  Tie- specimen ,,n the right. No. 21'n.
 Kpre-nts the extent of the injury in the case of Julius  Sachs,., 1st  Servant, Co  K". 2d
 Mi-soiiri Volunteers, aire 1 :c; years.  lb was  wound-1  at  the battle of Chi.-Uaniniiga,  Sep-
 tniberlfi. Is.;- |,v a conoidal ball,  which fractured the head and luck of the right humerus.
 "n September 25, le-  was adm tied to  H.»sp ' .1  No. 1. Na-lnille, T. nucssee, and on November
 1". A-sistant Surgeon Charles.). Kipp, U.  S. Volunteers, excised  the head and a portion of
 the shaft of the humerus by a straight incision four inches in length.  The operation was
 follow, d by sev.-re inflammation.   The discharge from the wound   was profuse and very
 ftetid.  In Pet-ember flu- pati.-nt had a —sere rigor, followed by violent reaction: the entire
 arm became tumified. hot and -\\o!b n.  The inflammation  su'si.lc.l at tic-  end of the n...nth.
and on  the loth of January P-bl. th- wound had  nearly healed.  The arm  is short.-tied one
and a half inches, is  little deformed and admits considerable lateral  motion.  Sacbse  was
discharged from service on July 11. 1 >ii J.

              Photographed  at the Army  Medical  Museum.

    BY  ORDER   OF  THE   SURGEON  GENERAL:


                                   gkoi.'(H-:  a.  otjs,

                   Bv't Lt. C,.l. and A.** t Surg.  U. S. A.  Curator A. M. 31. 
 
ARMY MEDICAL  MUSEUM.
PHOTOGRAPH 12«>.   Two Heads  of Humeri excised for Gunshot
   Fractures.
  Specimen H30 Surgical Section, Army Medical Museum, is the head and
nearly three  inches of the shaft of  the  left humerus fractured  by  a
conoidal ball, which lodge! at the line of excision.   Assistant Surgeon
George M. McGill, U. S. Army, who contributed the specimen, was unable
to give the history of the case.   The specimen on the right, 2260, exhibits
the head and nearly four inches of the shaft of the left humerus, excised
for a severe fracture at the surgical  neck.   Sergeant George F. Cleaver,
Co. L. 3d Indiana  Cavalry, was wounded  near Knoxville, Tennessee, on
the 2nth day of February, 1**34.   The excision was performed by Surgeon
A. M. Wilder, U. S. Volunteers, on the same day.  The patient gradually
improved until March the 10th, when the wound ceased to discharge pus;
a slight chill with vomiting -upei-veiied, typhoid  symptoms ensued and
death took place on March 11.  is.; j.

           Photographed at  the Army Medical  Museum.

  BY  ORDER OF THE  SURGEON  GENERAL:

                            GKORGE  A.  OTIS,
               Bv't Lt. Col. and  Asst Surg.  U. S. A. Curator A. M.  31. 
 
<
        ARMY  MEDICAL  MUSEUM.

PiidTtXiRArn  1-7.   Two  E.ramphs of Excision  of  the  Elbow
  Joint.
  Specimen o4»'>»'. is from a secondary operation by Acting Assistant Sur-
geon G. \Y. Fay.  Private A. X.  Perkins, Co. K,  2d Connecticut Heavy
Artillery. wa<  wounded at  Cold Harbor, Virginia,  June 1, 1804. by a
conoidal ball, which entered tho external condyle of the left humerus and
lodged in the joint.  The excision was performed  at the Patterson Park
Hospital, Baltimore, Maryland,  on  July 10.  Two and a half inches of
the  lowr extremity of the  humerus, one  inch of the radius  and two
inches 0f the ulna, including the olecranon were removed.  On August 1,
the  external wound  was nearly closed, and the arm  could  be moved at
nearly right angle without pain.   August 3, chills and diarrhoea super-
vened: August y the patient complained of pain in his right chest and he
died on Augu-t  30 with plcuro-pneumonia.   The  specimen on the right,
3015, represents the extent of injury in the case of Corporal I'evry Long,
Co.  \). 3d New Hampshire  Volunteers,  who was  wounded  at Bermuda
Hundred, Virginia,  June 10, 1*0-1,  by a conoidal ball, which fractured
the   olecranon.   He wa< sent  to Mower Hospital, Philadelphia.   Tho
articular surfaces had  become necrosed.  On July 12.  Acting Assistant
Surseoii W. P. Moon excised the lower extremity  of the right humerus.
one meh of the radius,  and one and a half inches of the ulna. The patient
died on Align"*  3, 1*04, from exhaustion.

           Photographed  at the Army Medical Museum.

  BY ORDER  OF  THE SURGEON  GENERAL:

                             (Jl-iOliGK  A.  OTIS,
               Bv't Lt. Col. and As  A Surg. U S.  A, Curator A. 31. 31. 
 
      ARMY   MEDICAL   MUSEUM.

Photograph  Series, No. 128.   Consolidated Gunshot Fracture
  of the Middle Third of the Right Femur.
  Private  Charles Quail, Co. A, 4th Vermont Volunteers, aged 32 years,
was wounded  at the battle of the Wilderness, Va., May 6th, 1864, by two
musket balls, one of which shattered the middle third of the right femur,
and the  other fractured  the  right humerus.  He was removed to Fred-
ericksburg, whence he was transferred to Armory Square  Hospital, Wash-
ington, D. V.,  May 28th,  1864.  By the end of June  the fractures were
sufficiently united to admit the patient to leave the hospital on a furlough.
On September 8th, 1804, he was transferred to Sloan Hospital, Montpelier,
Vt.   On  the 31st of December the report  states that his wounds were
entirely  closed.   On March  14th,  1X65, he  was discharged the  service,
with two inches  shortening, and some eversion of the  leg, and with  but
slight deformity of the arm.   The photograph is enlarged from  a card
picture forwarded by Surgeon Henry Janes,  TJ. S. V.
           Photographed  at the  Army  Medical  Museum,
   BY ORDER OF  THE  SURGEON GENERAL:
                       GEOKGE  A.  OTIS,
                          Asst.  Surg.,  U. S. A.,  Curator, A. M. M. 
 
       ARMY  MEDICAL   MUSEUM.

 Photograph Series. Xo. 120.   Consolidated Gunshot Fracture
   of the  Upper  Third of the Right Femur.
  Corporal Erastus Worth en, Co. B, 2d Vermont Cavalry, aged 2o years,
was  wounded at the battle of the Wilderness,  Va.. May  5th, 1864, by a
conoidal ball, which comminuted the upper third of the right femur.   He
was removed to Fredericksburg, and thence to the 1st Division Hospital at
Alexandria; thence, on February 26th, to the 2d Division  Hospital, Alex-
andria, and. finally,  to the Sloan Hospital, Monipelier. Vt., where he was
admitted .ui March  18th, 1865.   The  fracture was treated without exten-
sion.  On  June 24th, 1865, the patient, was  discharged from service, the
b'mb bei■!,-• shortened three inches, with considerable angular deformity
and eversion.   Sinuses leading to diseased  bone were still scantily dis-
charging a thin pus.  The photograph is enlarged from a card picture
forwarded by Surgeon Henry Janes, TJ. S. V.
           Photographed  at the Army Medical Museum,
   BY ORDER OF THE SURGEON GENERAL:
                       GEORGE  A.  OTIS,
                           Asst Surg..  U. S. A.,  C.irator, A. 31. M. 
 
      ARMY   MEDICAL  MUSEUM.
                              —*—
Photograph  Series.  No. 130.   Consolidated Gunshot Fracture
  of the Middle Third of the Right Femur.
  Private William  D.  Gilbert, Co. C, 6th Vermont Volunteers, aged  50
years, was wounded at the battle of the Wilderness, Va.,  May 5, 1864,  by
a conoidal musket  ball, which entered a  little below the middle of the
thigh, and made its exit at about the same level of the posterior external
surface of the thigh.   He was removed to Fredericksburg, and thence,  on
the 26th of May, to the 1st  Division  General  Hospital, Alexandria, Va.,
where the fracture was treated in a straight position, with moderate ex-
tension.   On February 20th, 1805, the patient was transferred to the 2d
Division Hospital at Alexandria, and on  March 18, to Sloan Hospital, at
Montpelier,  Vt.   Here a number  of necrosed fragments  of bone were
removed. On September  25th, 1865, the wounds  were still discharging
moderately.  The patient  was then able to move about on crutches, and to
bear  about half his weight on the fractured leg.  On October 12th, he was
discharged from the service,  with three inches shortening  of the limb, and
awkward inversion of the  leg.  The photograph is enlarged from a card
picture forwarded by Surgeon Henry Janes, TJ. S. V.
           Photographed at the Army Medical Museum,
   BY ORDER  OF THE  SURGEON  GENERAL:
                        GEORGE  A.  OTIS,
                          Ass I. Surg., U. S. A., Curator, A. M. M-. 
 
        ARMY   MEDICAL  MUSEUM.

 Photograph Series, No.  131.   Consolidated Gunshot  Fracture
   of the Upper Third of the Right Femur.
   Sergeant Rufus M. Pray, Co. K,  3d Vermont Volunteers, aged 23 years,
 was wounded  at the battle of "Cedar Creek, Va,. October 19th. 1864, by a
 conoidal musket, ball, which fractured the upper third of the right, femur,
 without extensive splintering.  He was treated at the Sheridau Field Hos-
 pital at Winchester, Va., by rest, with moderate extension.   The fracture
 united  with great rapidity.   On December  14th, he was removed to Fred-
 erick, Md.; the wounds were then closed, and the fracture was apparently
 firmly consolidated.  On January 17th, 1865, he was transferred to Sloan
 General Hospital, Montpelier, Vt.  The injured limb was shortened three
 inches, and there was slight angular deformity. t  The  patient was dis-
 charged from the service May 8th,  1865.  The photograph is enlarged
from a card picture forwarded by Surgeon Henry Janes,  TJ. S. V.
           Photographed at the Army Medical  Museum,
   BY ORDER OF THE SURGEON  GENERAL:
                      GEORGE A.  OTIS,
                           Asst. Surg., U. S. A., Curator, A. 31. 31. 
 
         Jurrp0B  ■©rncrnls   ©ffia,

       ARMY  MEDICAL  MUSEUM.

Photographs Nos. 132 and  133.   Amputation of both Thighs
  for Gunshot Injury.
  Private Columbus G. Rush, Co. C, 21st Georgia Regiment, was wounded
March 25, 1805, in  an assault on Fort  Steadman, in the lines  before
Petersburg, Virginia, by a fragment of shell, which laid open the right
knee-joint, and shattered the upper third ot  the left tibia, and produced
great laceration of the soft parts of the left leg.  He was made a prisoner,
and four  hours after  the reception of the injury, he  was  placed  under
chloroform and both thighs were amputated, by the antero-posterior flap
method, at the lower thirds, by Surgeon D. W. Bliss, U. S. V. The patient
was removed to the base hospital at City Point, and thence,  on May 17,
1865, to Lincoln Hospital, at Washington.   In  August, 1865, he was sent
to St. Luke's  Hospital, Xew York, and on February 22, 1866,  he was fur-
nished by subscription with artificial limbs, adapted by Dr. E. D. Hudson.
With the  aid of two canes  he was enabled to walk about the wards of
St. Luke's.  His residence is at Atlanta, Georgia.  His appearance while
at Lincoln Hospital is shown in Photographs of Surgical Cases, S.  G, 0.,
Vol. 3, No. 36.
          Photographed at the Army  Medical Museum.
   BY ORDER OF THE SURGEON GENERAL:
                           GEORGE A.  OTTS,
                             Axs't. Sura. II. S. A..  Curator A. 31. M. 
 
        ARMY  MEDICAL  MUSEUM.

Photographs  Nos. 132  and 133.   Amputation of both Thighs
  for Gunshot Injury.
  Private Columbus G. Rush, Co. C, 21st Georgia Regiment, was wounded
March  25, I860, in an assault  on  Fort  Steadman, in the lines before
Petersburg, Virginia, by a fragment of shell, which laid  open the right
knee-joint, and shattered the upper third of the left tibia, and produced
great laceration of the soft parts of the left leg.  He was made  a prisoner,
and four hours after  the  reception of the injury, he  was placed  under
chloroform and both thighs were amputated, by the antero-posterior flap
method,  at the lower thirds, by Surgeon D. W. Bliss, U. S.  V.  The patient
was removed to the  base  hospital at City Point, and thence, on May 17,
1<<0o, to  Lincoln Hospital, at  Washington.   In  August, 180-3, he was sent
to St. Luke's Hospital, New York, and on February 22, 1866, he was fur-
nished by subscription with artificial limbs, adapted by Dr. E.  D. Hudson.
With the aid of two  canes he was enabled to walk about the wards of
St. Luke's.   His residence is at Atlanta, Georgia.   His appearance  while
at Lincoln Hospital is shown  in Photographs of Surgical Cases, S.  G, 0.,
Vol. 3, No. 36.

           Photographed at the  Army  Medical Museum.
   BY  ORDER OF  THE SURGEON GENERAL:
                            GEORGE  A.  OTIS,
                              Asx't Surg. 11. S. A.. Curator A. M. M. 
 
      ARMY   MEDICAL   MUSEUM.
                            ---♦---
 Photograph Series  No. 134.—Recovery after  Amputation of
   the Right Thigh, the Leg having been  carried away by a Can-
   non Ball.
  Captain Charles T. Greene, A. A. G., U. S. V., aged 22 years; had his
right leg carried away by a cannon ball at Ringgold, Ga., November 27th,
1863.  The knee-joint was opened.  As soon as he had  partly recovered
from the shock, chloroform was given, and amputation was performed at
the lower third of the thigh by the circular method.  The stump healed
very rapidly and recovery was complete  in about two months.   In May,
1864, an artificial limb was adapted, and Captain  Greene  resumed  his
duties as a staff officer.

          Photographed at the Army  Medic?1 Museum,
   BY ORDER  OF THE SURGEON  GENERAL:
                       GEORGE  A.  OTIS,
              Bvt. Lt. Col, and Surg., U. S. V., Curator, A. 31. M. 
 
       ARMY  MEDICAL  MUSEUM.

 Photograph   Sertes   No.   135.— Successful   Blepharoplastlc
   Operation.
  Lieut.  Adam  Miller. 2d  Mass. Vols., aged  23 years,  was wounded
 August 9th, 1802. at the battle of Cedar Mountain, by an elongated musket
 hall  which entered below  the  right orbit, and traversing  the  nasal
 fossae, emerged through the left orbit destroying the globe of the left eye,
 and lacerating the left lower eyelid.   He was made a prisoner and taken
 to an hospital at Charlottsville, Va., where his wound ultimately cicatrized
 with great deformity.  Having been exchanged, he entered the New York
 Eye Infirmary, and on April 10th, 18(33, a plastic operation was performed
 by Dr. Henry B. Sands, for the restoration of the eyelid.  The  operation
 was eminently successful, and  on April 22d, 1863, the parts were suffi-
 ciently healed to permit the insertion of an  artificial eye.   Although the
 lachrymal sac and  puncta were destroyed,  little  inconvenience  was
 experienced from stillicidium.   Lieut. Miller was subsequently transferred
 to the 7th Regiment Veteran Reserve Corps.  The photograph was taken
in April, 1866.

           Photographed at the Army Medical Museum,
   BY ORDER OF THE SURGEON  GENERAL:
                      GEORGE  A.  OTIS,
                Brt. Lt. Col. and Surg.,  U. S.  V., Curator, A. 31. 31. 
 
           JFnrgwn  $tnmYt   <&ftitt.


         ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPHS Nos. 136 AND  137.   Successful  Secondary Ampu-
   tation at the Left Hip-Joint.

  Private George W. Lemon, Co. 0, 6th Maryland  Volunteers, aged thirty years, was
 wounded at the battle of the Wilderness, May 5,1864, by a musket ball which shattered the
 left femur at the junction of the upper and middle thirds.  He was left upon the field until
 removed by the enemy to a neighboring temporary hospital.  On May 13th,  this hospital
 fell into the hands of the Union army, and Lemon was transported to Alexandria, Virginia.
 He was in a pitiable condition, suffering from diarrhoea and bed sores as well as from the
 constitutional disturbance produced by the fracture of the femur.  Apparently no attempt
 had been made to keep the limb in position.   After the patient's admission  to the Third
 Division U. S. A. General Hospital at Alexandria, and the  employment of suitable dressings
 and medicines, his general condition was somewhat improved, but the suppuration from the
 wound in his thigh was copious, and the fractured extremities of the femur were extensively
 necrosed.  Notwithstanding a careful supporting regimen  his strength gradually failed,
 until in the autumn of 1865 seventeen months  after the reception of the wound, operative
 interference of some sort appeared imperative.   Accordingly. Surgeon Edwin Bentley, U. S.
 V., in charge of the Alexandria Hospital, decided to amputate at the hip-joint.  The opera-
 tion was performed by Dr. Bentley by the antero-posterior flap  method, on October 12, 1S65.
 On November 15th, Dr. Bentley reported that  the ligatures  had  come away and that the
 wound was granulating kindly.  At the  end of January, 1866, cicatrization was complete,
 and a colored drawing of the patient was made by  Mr. Baumgras, one of the artists of the
 Army Medical Museum.  (Surgical Series  of Drawings, Surgeon  General's Office, Xo. 89).
 On January 31,1866, the patient was transferred to Harewood Hospital, Washington, D. C.
 where a plaster cast of the perfectly sound stump  was prepared.   (Specimen 4167, Army
 Medical Museum, Piaster Cast 31.3). A photograph of the patient was also taken. (Photo-
 graph Series Nos. 136 and 137, Army Medical Museum).   On  February 3,1866, Lemon was
discharged the service of the United States at his own request.  The  exarticulated femur ia
preserved at the Army Medical Museum, (Specimen No. 43S6).

             Photographed at the Army Medical  Museum.
   BY  ORDER  OF THE  SURGEON GENERAL:

                                GEORGE  A.  OTIS,
                                  Ass't Surg.  II. S.  A..  Curator A. At.  it. 
 
          ARMY   MEDICAL   MUSEUM.

  Photographs Nos.  136 AND 137.    Successful  Secondary Ampu-
    tation  at the Left Hip-Joint.

   Private George W.  Lemon, Co. C, 6th Maryland  Volunteers,  aged thirty  years,  was
 wounded at  the battle of the  Wilderness, May 5,1864, by a musket ball which shattered the
 left femur at the junction of  the upper and middle thirds.  He was left upon the field until
 removed by the enemy to a neighboring temporary hospital.  On  May 13th, this hospital
 fell into the hands of the Union army, and Lemon was transported to Alexandria, Virginia.
 He was in a  pitiable condition, suffering from diarrhoea and  bed sores as  well as from the
 constitutional disturbance produced by the fracture of the femur.  Apparently no attempt
 had been made to keep the limb in position.  After the patients  admission to the Third
 Division U. S. A. General Hospital at Alexandria, and the employment of suitable dressings
 and medicines, his general condition was somewhat improved, but the suppuration from the
 wound in his thigh was copious, and the fractured extremities of the femur were extensively
 necrosed.  Notwithstanding a careful supporting regimen his  strength  gradually failed,
 until in the autumn of 1865 seventeen months after the reception of the wound, operative
 interference of some sort appeared imperative.  Accordingly. Surgeon Edwin Bentley, U. S.
 V., in charge of the Alexandria Hospital, decided to  amputate at the hip-joint.  The opera-
 tion was performed by Dr. Bentley by the antero-posterior flap  method, on October 12,1865.
 On November 15th, Dr. Bentley reported that the ligatures  had come away and that the
 wound  was granulating kindly.  At the end  of January, 1866, cicatrization was complete,
 and a colored drawing of the patient was made by Mr. Baumgras,  one of the artists of the
 Army Medical Museum.  (Surgical  Series of Drawings, Surgeon General's Office, No. 89).
 On January 31,1866, the patient was transferred to Harewood Hospital, Washington, D. C.
 where a plaster cast of the perfectly  sound stump was  prepared.  (Specimen 4167, Army
 Medical Museum, Plaster Cast  313).  A photograph of the patient was also taken.  (Photo-
 graph Series Nos. 136 and 137,  Army Medical  Museum).  On February 3, 1866, Lemon was
discharged the service of the United States at  his own request.  The exarticulated femur is
preserved at the Army Medical Museum, (Specimen No. 4386).

             Photographed  at the Army  Medical Museum.
   BY  ORDER   OF  THE   SURGEON  GENERAL:

                                 GEORGE  A.   OTIS,
                                    Asx't Surg. U. S. A.. Curator A. 31.  31. 
 
       ARMY MEDICAL  MUSEUM.
                             ---♦---
Photograph,  No. 138.   Recovery  after  Penetrating   Gunshot
   Wound of the Abdomen, with Faecal Fistula.
  Lieutenant J. Edmund .Mallette,  Adjutant  of the 81st New York Volun-
teers, was wounded at the battle of Cold Harbor, Va., June 3, 1864, by a
musket ball which entered three inches to the left of the umbilicus, and
made its'exit a little to the right of the spinal column.  He was  admitted
to the Armory Square Hospital,  at AVashington, on June 6, 1864.   There
was a copious faecal discharge, and the evidence of an  extensive opening
of the descending colon was conclusive.  At first there  was nearly com-
plete paraplegia, which gradually  amended, and disappeared in August,
1864.  Tenderness and abdominal pain persisted  until the latter part of
September, 1864, and undigested food from  time to time escaped through
the anterior orifice of the wound.  On September 27, Lieutenant  Mallette
ivas transferred on a  litter to his  home in Oswego, New York.   Shortly
afterwards a  suspender button was discovered in the track of the wound
and was  extracted by Acting  Assistant Surgeon  C. P. P. Clarke.  The
wound was still discharging  October 29,  1864,   when the patient was
honorably mustered out of service.  In December,  1864, the wound finally
healed.   In December, 1866, Mr. Mallette was in excellent health.
            Photographed at the Army  Medical  Museum,
BY  ORDER  OF  THE  SURGEON   GENERAL:
                        GEORGE  A.  OTIS,
              Bv't  .Major ami Ass c Surg.. U. S. A., Curator, A.  31. M. 
 
          ARMY   MEDICAL   MUSEUM.

 Photographs  Xos.  139,  ITS.  179  a.m.  292.   Partial!,,  Con-
    solidated  Gunshot  Fracture  of the   Upper Third  of the Rlaht
    Femur.

   Private George Kunss, Co. G, 7th  New  York Volunteers, aged twenty-seven years was
 wounded in an engagement at the South Side Railroad, near Petersburg, Virginia, on March
 31,1865, by a conoidal musket ball, which struck the anterior and outer aspect of the right
 thigh, about three inches below the great trochanter, and,  passing  inwards and a little
 downwards, comminuted portions of the upper and middle thirds of the femur, and emerged
 posteriorly, about the middle of the gluteal fold.  He was taken to the Base Hospital at City
 Point, and on April 6th, was transferred to Campbell Hospital at Washington.  On July 8th,
 he was removed to Stanton Hospital, and. on September 1:2th, to Harewood  Hospital.  On
 his admission to Harewood,  he was able  to sit up,  and the constitutional condition was
 tolerably good.  The fracture had united with great deformity;  there were several fistulous
 orifices, through which fragments of necrosed bone were extracted almost daily.  On May 1,
 1866, Ruoss was transferred, on the closure of Harewood, to the Post Hospital at Washington.
 On June 8th, he was etherized, and Assistant  Surgeon \V. Thompson, U. S. A., made a V
 shaped incision at the upper and outer part of the thigh, and removed several fragments of
 diseased bone.  September 30, 1866: the wound has nearly healed;  there are three sinuses,
 (two on the upper, and one on the lower surface,) which lead to what is evidently necrosed
 bone.  December 31, 1S66: Sinuses  still open  and discharging, general condition feeble;
 there is great deformity, and about  five  inches shortening of the limb, with almost complete
 anchylosis of the knee joint.   The  photograph was taken in July. 1867. A communication
 from Assistant Surgeon John Brooke, I". S. A.,  dated July 6, 1868, furnishes  the following
 additional information:—On  taking charge of the  patient in November, 1S67, he found the
 limb in the same condition as that  previously described, except that  a collection of pus,
 which had formed on the inner aspect of the thigh, just above the knee, had been opened,
 and that there was a sinus connecting with the seat of fracture.  This sinus, with the open-
 ings above mentioned, continued until death. The patient  was extremely feeble, greatly
 emaciated, and suffered much from  diarrhoea and  anorexia.  These symptoms continued
 until the patient's death, which occurred  June  27th, 1868.  At  the  autopsy, the liver was
 found enormously enlarged, weighing ten pounds and ten ounces ;  and the right lung con-
 tained a small mass of calcareous matter.  Portions  of  the  tibia and fibula, and the femur
 with the os innominatum and patella attached, were  removed. The  femur, imperfectly
 united with great  displacement  and a deposit of  foliaceous callus, shows that extensive
periostitis had taken place.  The upper portions of the tibia and fibula and the patella, also,
show similar pathological changes.  The specimen is No. 5450 of the Surgical Section.
             Photographed at the  Army Medical  Museum.
  BY  ORDER  OF  THE  SURGEON   GENERAL:

                                  GEORGE  A.   OTIS,
                                    Asu'r Surg.  U. S. .-!.,  Curator A. 31 M. 
 
        ARMY MEDICAL  MUSEUM.

 PHOTOGRAPH, Xo. 140.   United Gunshot Fracture of the  Upper
    Third of the Left Femur.
  Private Timothy F. Pridgen, Company K, 18th North Carolina  (rebel)
 Regiment, aged twenty-two years, was wounded and captured at Deep
 Bottom, Virginia, on July 28, 1864.  A  conoidal musket ball, striking the
 left femur at the junction of the upper and middle thirds, fractured the
 bone, but without extensive comminution.   He  was sent to Lincoln Hos-
 pital, at Washington, whence he was transferred, on August 14, 186-">, to
 Htanton Hospital, and, on  September 13, to  Harewood Hospital.  When
 received at Harewood he  was able to move  about, the fracture having
 firmly united, though the wound was still open and the discharge indicated
 the  presence of  necrosed bone.   On  November  9, 1865, with his wounds
 closed and every prospect  of a useful limb,  he was  transferred  to  the
 Provost  Marshal of the Department of Washington.  He took the pre-
 scribed oath of allegiance, and was furnished transportation to Elizabeth-
town, North Carolina, on the same day.
  The negative was taken at Harewood Hospital, by direction of Surgeon
R. B. Bontecou,  U. S. V.
        Photograph printed  at the Army  Medical Museum,
BY  ORDER  OF THE  SURGEON  GENERAL:
                         GEOMGE  A.   OTIS,
               llv'I 3tujor and Ass ( Surg , U. S. A., Curat or. A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.
                              --*--
PHOTOGRAPH, Xo. 141.    United Gunshot  Fracture of the  ipper
   Third of the Right Femur.
  Charles Last, Musician, 125th Illinois Volunteers, aged thirty-five years,
was  shot by a sentinel  at Washington, D. C, on June 7th, 1865.  The
projectile, a conical musket ball, fired at short range, entered the external
aspect of the upper third of the right thigh, and  passing  forwards, In-
wards, and downwards, comminuted  the femur.  The patient was treated
at Stanton Hospital, by a  long straight splint with extension and counter
extension.   On September 13th, he was transferred to Harewood Hospital.
convalescent, and able  to move about on crutches.  On October 6th, ISii.j,
he was discharged from service, having every prospect of a useful limb.
        Photograph  printed at the Army Medical  Museum,
   [Negative contributed by Brevet Colonel R. B. Bontecou. U. S. V.]
BY  ORDER OF THE SURGEON  GENERAL:
                         GEORGE A.   OTIS.
               Bv't 3Iajor and Ass t  Surg , U. S. A., Curator. A. 31. M. 
 
        JfaMjwm  &tnml't   tottxtt.

        ARMY  MEDICAL MUSEUM.

 PHOTOGRAPH, 142.   Consolidated  Gunshot Fracture of the Mid-
   dle  Third of the Left Femur.

  Captain R. T. Shillinglaw, 79th New York volunteers, was wounded at
 the battle of Bull Run, Va.,  July  21, 1861,  by a conoidal ball which
 obliquely fractured the middle third of the left femur.  He was made a
 prisoner, and removed to Richmond, where the fracture was treated for
 one week at the Alms House Hospital by a Desault splint, and for twelve
 weeks subsequently by Smith's Anterior Splint.  On December 31,  1861,
 he was exchanged.  For nearly a year after the injury there was a slight
 suppuration, with the occasional elimination  of bits  of necrosed bone.
 From November, 1862, to February, 1863,  Captain Shillinglaw served in
 the field as Acting Aid de Camp to General Wilcox.  He was transferred
 to the Veteran Reserve Corps in August, 1863,  and served in Washington
 till he was honorably mustered out on  August 2, 1865.  Beside the frac-
 ture of the femur, he incurred  three other wounds at the first  battle of
 Hull Run;  a large pistol ball remained lodged near his right elbow for
 eight months;  he had another wound in his hand, and yet another, a flesh
 wound, on one of his extremities.   Captain Shillinglaw visited the Museum
in June, 1866,  when this photograph was taken.   The injured  limb was
shortened nearly three inches,  but he walked briskly and without a limp.
He used no cane, and experienced little or no  inconvenience from his
wounds. On  February 2,  1861),  Captain Shillinglaw  visited the Army
Medical Museum in good health.
          Photographed at  the Army Medical Museum.
 BY  ORDER  OF THE SURGEON GENERAL:

                          GEORGE A. OTIS,
             Bv't Lt. Col. and Ass't Surg.  U. S. A„ Curator A. 31. 31. 
 
       ARMY  MEDICAL   MUSEUM.

Photograph  Series Xo.  143.— Recovery after Excision of the
   Head of the Left Humerus for  Gunshot Fracture.
  Private Stephen C. Foster, Co. D, 56th Mass. Vols., aged 21 years, was
wounded at the battle of North  Anna River, Va., May 24th, 1864,  by a
musket hall, which fractured the upper third of the left humerus'.   On
the following day, the head and a portion of  the shaft of the left humerus
was excised on the field, and on May 29th, the patient  was  admitted to
Lincoln Hospital, Washington, D. C.  On February 9th, 1865, the incision
was perfectly healed and Foster was  in good health.  At this date the
photograph  was taken,  by direction  of Surgeon J. C. McKee, U. S. A.
The patient was  transferred to General Hospital, at Readville, Mass., on
March 7th, 1865, and was discharged the service June 19th, 1865.

     Photograph  Printed at the  Army Medical  Museum,
   BY ORDER OF THE SURGEON GENERAL:
                       GEORGE A.  OTIS,
              Bvt.  Lt. Col., and Surg., U. S. V., Curator, A. 31. M. 
 
     &aigfitt  GntwVft   QHitt,

       ARMY  MEDICAL   MUSEUM.
                            ---♦---
 Photograph Series, Xo. 144.  Sxiccessful Primary Excision of
   the Head and three inches of the Shaft  of the Left Humerus
  for Gunshot Fracture.
  Sergeant Jacob P. Yakey, Co. D, 125th New York Volunteers, aged 21
 years, was wounded at the battle before Petersburg, Va., June 22d,' 1864,
 by a conoidal ball, which entered the left shoulder at the anterior edge of
 the deltoid muscle, and fractured the humerus. On the same day Surgeon
 Wm. S. Cooper, 125th New York Volunteers, excised the  head and three
 inches of the shaft of the left  humerus through  a V shaped incision, the
 patient being  under chloroform.   The case progressed well,  and on
 September 17th, Sergeant Yakey was furloughed, and  subsequently dis-
 charged from the service.  In January,  1865, he was admitted to General
 Hospital  at Troy, N. Y., as a contract nurse.  He had an abscess of the
left arm,  which was. incised by Surgeon Hubbard,  U. S.  Vols., and a small
fragment of necrosed bone was removed.  After this the wound healed
firmly.  Yakey resides in Troy,  N. Y.  He has a useful  arm.
        Photograph Printed at the Army Medical Museum,
   BY ORDER  OF  THE  SURGEON GENERAL:
                     GEORGE  A.  OTIS,
                         Asst. Surg., U. S. A.,  Curator, A. M. M. 
 
      ARMY  MEDICAL   MUSEUM.

Photograph Series. Xo. 145.   Successful Intermediate Excision
  of the  Head and two  and a half inches  of the Shaft of the
  Right Humerus.
  Private Adolph Zirsse, Co. A. 16th Michigan Volunteers, aged 32 years,
was wounded at the battle of Peeble's Farm, September 30th, 1864, by a
musket ball, which fractured the upper third of the right humerus.  On
October  3d, while  under  chloroform, an  excision  was made of the  head
and two  and a half inches  of the shaft  of the humerus.  He was admitted
to Lincoln Hospital, Washington, D. C, October 8th, 1864.  The  patient
improved very rapidly, and on December 26th the cicatrix was clean and
free from discharge.  Zirsse  was transferred to Detroit, Mich., January
18th, 1865, and was discharged the service June  2d, 1865.   The photo-
graph was taken January  10th, 1865,  by direction of Assistant Surgeon
J. C. McKee, U. S. A.  At that date he had perfect use of his hand, but
little control over the movements of the arm and forearm.
        Photograph Printed at the  Army Medical Museum,
   BY ORDER OF  THE  SURGEON GENERAL:
                        GEORGE A.  OTIS,
                          As&t Surg., U. S. A.y Curator, A. M. M. 
 
     f wp^i   @>tntnl'8   QHitt,

       ARMY  MEDICAL   MUSEUM.

 Photograph Series, Xo. 146.   Successful Intermediate Excision
   of the Head and three  inches of the Shaft of Right Humerus
  for Gunshot Fracture.
  Private Samuel  T.  Tineker, Co. D,  14th Indiana  Volunteers, was
 wounded at the battle of the Wilderness, May 6th, 1864, by a musket ball,
 which entered the  posterior  surface of the right humerus,  and passed
 forwards, making its exit  at  the anterior surface, fracturing the head of
 the humerus and the anterior and posterior borders of the glenoid  cavity.
 On May 30th he was admitted to Lincoln Hospital, Washington, D. (\, and
 on June 1st was etherized, and the  head and three inches of the shaft of
 the humerus were excised by Surgeon J. C. McKee, U. S. A., through a
 straight incision, commencing at the coracoid  process of the clavicle and ex-
tending downward five inches.  On October 10th. 1864, the parts were
entirely healed.  The patient was subsequently transferred to the Soldiers'
Home, and discharged the service of  the United States.
          Photographed at the Army Medical  Museum,
   BY ORDER OF THE SURGEON  GENERAL:
                    GEORGE A.   OTIS,
                         Asst. Surg., U. S. A., Curator, A. 31. 31. 
 
<yy
       ARMY  MEDICAL   MUSEUM.

 Photograph Series. Xo. 147.   Successful Primary Excision of
   the Head and three inches of the Shaft of the  Right Humerus
   for Gunshot Fracture.
   Sergeant John B. Yost,  Co. A, 4th Pennsylvania Cavalry, aged 23 years,
 was  wounded at the battle of Stony Creek, December 1st, 1864, by a mus-
 ket ball, which entered posteriorly above  the  spine of the scapula, frac-
 tured the head and surgical neck of the right humerus,  and  made its exit
 above the clavicle about  its middle third.  The following day the patient
 was placed under chloroform, and Asst. Surgeon  Marsh, U. S. A., excised the
 head and three inches of  the shaft of the right  humerus, through a longi-
 tudinal incision, four inches in length, made on the outer side of the arm.
 The  patient was  admitted  to  Lincoln   Hospital,  Washington, D.  C,
January  19th,  1865, where  this  photograph was  taken by  direction  of
Surgeon J.  C. McKee, U. S.  A.  On January 25th, 1865, the wound was
entirely  healed, and callus had been  thrown out in some quantity.   The
patient was discharged the service on May 6th, 1865.

        Photograph Printed at  the  Army Medical Museum,
   BY ORDER OF  THE  SURGEON GENERAL:
                        GEORGE A.  OTIS,
                          Asst. Surg., U. S.  At) Curator, A. M. M, 
 
       J>unjwm  $tnmY*   -ffiffitt

       ARMY  MEDICAL MUSEUM.

Photographs Nos.  112  and  148.  Successful  Excision  of the
  Head of the Left Humerus, followed by Xecrosis and Secondary
  Excision of the  remainder of the  Humerus and the Upper Ex-
  tremities of the Radius and Ulna.
  Private John E. F.  Cleghorn. Co. K, 1st  New Jersey Cavalry, aged
twenty-seven years, was wounded at. Mine Run, Virginia November 27,
1863, by a musket ball, which shattered the  head  of the left  humerus.
Three days afterwards the head and a small portion of the shaft were
excised, at a field  hospital, by Surgeon  Henry K. Clark,  10th New York
Cavalry.  On December 5th the patient was transferred  to the 3d Division
Hospital at Alexandria, Virginia.  On April 28,  1864, he was transferred
to Ward  Hospital, Newark, New Jersey, the  wound being healed, with
the  exception of a slight fistulous  sinus communicating with  the sawn
extremity of the shaft of the bone.   Subsequently  the entire shaft and
condyles of the humerus became necrosed, and  abscesses formed about
the  elbow.  On July 21, 1864, an  incision was  made along the  whole
length of  the outer  aspect of the arm, and the diseased humerus was
removed, together with the upper extremities of the  radius and ulna.
The wound left  by this extensive operation healed rapidly,  and on Octo-
ber 20, 1864, he was discharged  from the hospital and from the service
of the United  States.   In  November, 1864, a prothetic apparatus was
adapted to the arm by Dr. E. D. Hudson, which enabled the patient to
exercise considerable control over the movements of the limb.  A commu-
nication from the Commissioner of Pensions, dated  September 10, 1866,
states that this man is a pensioner, his disability  being  rated equal to the
loss of a hand.
           Photographed at the  Army  Medical Museum.
  BY  ORDER  OF THE  SURGEON GENERAL:
                          GEORGE  A. OTIS,
                            Asst Surg. U. S. A., Curator A. M M. 
 
   J?ttt(l«*tt   ttettml'*   totfitt,
                            —♦—
      ARMY   MEDICAL  MUSEUM.

Photograph Series, Xo. 149.   Successful Primary Excision of
  four inches of the  Upper  Third of the  Shaft of  the  Right
   Humerus for Gunshot Fracture.
  Private John  Kelly, Co. G, 5th U. S. Cavalry, aged 40 years, was
wounded at the battle of Winchester, Va., September  19th, 1864, by a
conoidal ball, which fractured the upper third of the right humerus.  On
the following clay Surgeon Newton excised four inches of the shaft of the
right humerus, through a linear incision, six inches in length, through the
belly of the  biceps.   The patient was  admitted  to U. S.  Hospital at
Frederick City,  Md.,  on January 2d, 1865.   He was transferred to
Carlisle Barracks, Pa., February 23d, 1865, and from thence to Lincoln
Hospital at Washington, where he  was admitted June 18th, 1865.  The
wound was entirely healed.  This photograph was then taken by direction
of Surgeon J. C. McKee,  U.  S. A.   The patient was discharged the
service June 29, 1865.   The arm was slightly atrophied, and the muscles
and ligaments thickened, impairing the action of the arm; atrophy of the
biceps also diminished the control over the forearm.
        Photograph  Printed  at the Army Medical Museum,
   BY ORDER  OF THE SURGEON GENERAL:
                       GEORGE  A.  OTIS,
                        Asst. Surg., TJ. S.  A., Curator, A. M. M. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph 150.   Resection of  the Shaft of the Humerus for
   Gunshot Fracture.
  In the assault on the lines before Petersburg, April 2, 1865, Private
John Lemmel, 5th Wisconsin Volunteers, aged forty  years,  had his left
humerus shattered by a conoidal musket ball,  the  vessels and nerves
escaping injury.  Five hours afterwards a formal excision of  three inches
of the shaft was made at a field  hospital by Surgeon Wilbur, all of the
comminuted fragments being removed.   The arm  was then placed on an
angular splint, and the patient was sent to City Point and thence to Wash-
ington.  On April 3, he was  admitted to Lincoln Hospital.  The wound
healed rapidly, and on June 2, 1865, when the photograph was taken, by
order of Surgeon J. C. McKee, U. S. Army, it had entirely cicatrized.  The
patient, however,  had  little use of his arm or forearm on account of
rigidity of the flexors  and extensors.  He  was soon  afterwards trans-
ferred to David's Island, New York, and discharged from service October
15, 1865.   Soon  afterwards  an  apparatus was supplied to him by Dr. E.
D, Hudson which materially improved his power of moving  the forearm
and fingers.

           Photographed at the Army Medical Museum.

  BY ORDER  OF THE SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A,  Curator A. 31.  31. 
 
          JftKgetfii  totnmVt  tottitt.

        ARMY  MEDICAL  MUSEUM.

 Photograph  Xo.  151.  Consolidated  Gunshot Fracture of the
   Upper Thirds of both Femurs.
   First Sergeant William  Shakespeare, Co.  K, 2d  Michigan Volunteers,
 aged eighteen years, was wounded in action  before  Jackson, Mississippi,
 July 11th, 1863, by a conoidal musket ball entering  on the outer  aspect of
 the left thigh, in its upper third, causing a compound  comminuted  frac-
 ture of the left femur, emerging externally in the upper third of  the  right
 thigh, breaking  the right  femur  in its course.   About the same time a
 conoidal  ball shattered the head- of the left  fibula,  and another gave him
 a flesh wound.  While lying on the field he was severely wounded by some
 missile over the  sacrum.  He was admitted to the General Hospital of the
 Ninth Army Corps on the same day, from whence he was transferred to
 Cincinnati, Ohio, and admitted to Washington Park  Hospital on  the  12th
 of August, 1863.  Union of the fragments of the left femur had taken
 place, with about seven inches shortening, the  fragments crossing each
 other  at  a considerable angle, one  of them  protruding from the wound.
 Surgeon Norton, of the Washington Park Hospital, on the 14th of August
 broke up the temporary  union  of the fragments of the left femur,
 extended and dressed the limb.  July 15th, 1864,  discharged  from service.
 April 2d,  1866: the union  is complete; he is now,  when standing on the
 right leg, one and one-quarter inches shorter than when he entered the
 service, and the left limb is one and  three-quarter inches shorter  than the
 right.   The left femur is a little  straighter  than is normal; the left leg
 can be flexed upon  the thigh to about 30°; the foot is contracted, rather
 stiff, and is sometimes painful.  He walks with a light cane rather slowly,
and with a halting gait.  He suffers considerably from neuralgia, and is
not as robust as formerly.
          Photographed at the Army Medical Museum.
   BY  ORDER  OF THE  SURGEON  GENERAL:
                          GEORGE A. OTIS,
              Bv't Lt.  Col. and Ass't Surg. U. S. A. Curator A.  31. At. 
 
          burgeon  $tnmY&  Mint.

        ARMY  MEDICAL  MUSEUM.


 PHOTOGRAPH Xo  152.   Consolidated  Gunshot  Fracture  of the
   Upper Third of the Left Femur.
   Private Henry  A. Wiggins, Co. K,  37th  Massachusetts Volunteers,
 was  wounded at  the  battle  of  the  Wilderness, May  6,  1864, by a
 conoidal musket ball,  which  struck  the left femur  at the junction of
 the  upper and   middle   thirds   and  produced  great   comminution.
 The  patient was  removed  to  the Base  Hospital  at Fredericksburg,
 where the ball and  six or eight large fragments of bone were removed
 by Acting Assistant Surgeon W.  J.  Saw in.  From Fredericksburg the
 patient  was  moved  in an ambulance to Acquia Creek, and  thence by
 steamer to Alexandria,  Va.,  and  entered  the 3d  Division Hospital.
 Here numerous small detached fragments of bone were removed, and the
 case  was reported as an  excision  of the continuity  of  the  shaft of the
 femur.  But it would appear from the records of the hospital, and from
 letters of Dr. Sawin and the patient that no  formal excision was made.
 After the usual protracted  suppuration  in extensively comminuted frac-
 tures of the femur, union  gradually took place, and, on  May 28, 1865,
 the patient was well enough  to be transferred  to the Dale Hospital, at
 Worcester, Massachusetts, near his home.  Upon  the closure of this hos-
 pital, he was transferred. August  28,  1865. to  DeCamp  Hospital, New
 York, where, on September 21, 1865. he  was discharged  from the service
 of the 1'iiited States.  The injured  limb was shortened more than five
 inches, and the muscles were much  atrophied  and contracted.  On Octo-
 ber 20. 1865, he was supplied with an  apparatus by Dr. E. D. Hudson,
 who reported that  the patient  walked  firmly with the aid  of a  cane.  In
July, 1866. Wiggins stated that there were three small  fistulous orifices
in the ihigh, and that he had laiieidy removed a necrosed bit of bone one
inch  long, being the fifty-fifih fragment of  the femur that  had been
extracted.  He added that his  weight,  was 174 pounds at the date of his
wounds,  had been reduced to 129 pounds, and was steadily decreasing.
            Photograph enlarged from a Card Picture.
BY ORDER  OF THE SURGEON  GENERAL:
                        GEORGK A. OTIS,
              liv't 31ajor and Ass't Surg., U. S.  A., Curator, A. M. 31. 
 
ARMY  MEDICAL  MUSEUM.
PHOTOGRAPH  153.   Recover,,  after a  Fracture  of  the  Middle
  of the  Shaft of the Left Femur by a Round Mushet Ball.
  Private Henry E. Gumbert, aged eighteen years, of an  Indiana militia
regiment, had the middle of the shaft of his left femur  fractured by a
round musket ball, at Camp Carrington, Indiana, on May 13, 1864, and
on the same day he was admitted to  the  Indianapolis  General ilopsital.
The fracture was treated in the straight position, and the case went  on
without  any untoward  incident, and  with  such rapidity that  union was
firm  and the wounds were healed  on September 5,  1864, when Gumbert
was discharged from hospital fit for duty.  The limb was shortened  an
inch  and a half, but there was no  other deformity.   Acting Assistant
Surgeon Kitchen,  who  conducted  the  treatment, received a letter from
Gumbert in  January, 1866, stating that he could "run and jump as well
as ever.''  At the same time Dr.  Kitchen procured and contributed  to the
Army Medical  Museum  the photograph of the case frcm which  this is
copied.

           Photographed at the Army Medical  Museum.

  BY  ORDER  OF THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
               Bv't Lt. Col. and Ass't Surg. U. S. A, Curator A. 31. 31. 
 
       #ttwjwii   ®tnmYt   Mint


       ARMY MEDICAL MUSEUM.

Photographs 154 and 155.  Successftd Double  Amputation—
  Right  Thigh and Left Leg.
  On July 8, 1863,  Private Charles  N.  Lapham, Co.  K, 1st Vermont
Cavalry, aged 23 years, in a skirmish near Boonsborough, Maryland, was
struck by  a solid shot, which carried away both legs.  The shock was, of
course, excessive;  but he rallied, and forty-eight hours afterwards, he
was placed under the influence of chloroform and the right limb, in which
the knee joint was gravely  injured, was amputated at mid-thigh, while
the left was disarticulated at the knee.   Antero-posterior flap operations
were done in both instances.  He recovered with extraordinary rapidity,
inasmuch as on  August 25,  six weeks after the  reception of the injury,
the stumps were firmly cicatrized and he was discharged from service.
Eleven months afterwards, he was supplied with artificial limbs by Dr. E.
D. Hudson,  In October, 1864, he wrote from the Poughkeepsie Collegiate
Institute, where he was studying, that he could walk well on level ground
and ascend and descend a staircase readily; and he contributed the pho-
tographs from which these are enlarged.

          Photographed  at the Army  Medical Museum.

   BY  ORDER OF THE  SURGEON GENERAL:

                         GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass'tSurg. U. S. A. Curator A. M. M. 
 
       Jitrgwa   $tnml't  #ffirt


       ARMY  MEDICAL  MUSEUM.

Photographs 154 and 155.   Successfid Double Amputation—
  Right  Thigh and Left Leg.
  On July 8,  1863, Private  Charles N. Lapham,  Co. K, 1st Vermont
Cavalry, aged 23 years, in a skirmish near Boonsborough, Maryland, was
struck by  a solid shot, which carried away both legs.  The shock was, of
course, excessive;  but  he rallied,  and forty-eight  hours afterwards,  he
was placed under the influence of chloroform and the right limb, in which
the knee joint was  gravely  injured, was  amputated at mid-thigh, while
the left was disarticulated at the knee.  Antero-posterior flap operations
were done in both instances.   He recovered  with extraordinary rapidity,
inasmuch as on August  25,  six  weeks  after the reception of the injury,
the stumps were firmly  cicatrized  and he was discharged from service.
Eleven months afterwards, he was supplied with artificial limbs by Dr. E.
D. Hudson,  In October, 1864, he wrote from the Poughkeepsie Collegiate
Institute, where he  was studying, that he could walk well on level ground
and ascend and descend a staircase readily;  and he  contributed the pho-
tographs from which these are enlarged.

          Photographed  at the Army Medical  Museum.

   BY  ORDER OF THE  SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg.  U. S. A. Curator A. M. 31. 
 
        ARMY  MEDICAL  MUSEUM.
                              ---♦---
Photograph, Xo. 156.  Recovery without an  Operation, after a
   Gunshot Fracture involving the Right  Acetalmlum and Head of
   the Femur.
  Lieutenant Colonel  James  C.  Strong, 38th New Vork Volunteers, was
wounded at the battle  of Williamsburg, Virginia,  May 5th, 1H62, by a
conoidal musket ball, which entered over the right sartorius muscle, about
four inches below its origin, and made its exit  near the right margin of
the lower portion of the  sacrum.   Surgeon A. J. Berry, 38th New  York
Volunteers, examined the wound and found that the ball had deeply groov-
ed the head of the femur, and had fractured the upper rim of the acetab-
ulum.  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 pa-
tient was transferred by a steamer from  Queen's Creek Landing, to the
Hygiea 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,  New York.  The injured limb was semi-flexed and rotated
inwards, 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 prespiration and  great  prostration,  after which  a very
gradual  amendment took place.  On December 12, 1862, the patient was
removed to Philadelphia,  and  entered  at  the Officers' Hospital at  Cam-
mack's Woods, where he  was able to bear treatment by Buck's method of
extension by weights.  Here a number of spiculaj of bone were extracted
or washed from the wound.  On  January  6, 1863, the  patient was  dis-
charged from hospital.  On June  1. the  wounds  were nearly closed, and
he rejoined his regiment  on crutches, and was mustered out with the regi-
ment'on June 22, 1S63.   On September 29, he was appointed  Colonel in
the Veteran  Reserve Corps.  He  was subsequently  brevetted Brigadier
General.   In July, 1866,  when the photograph was taken, Gen. Strong was
in good health.   His limb was shortened nearly five inches, but by the in-
clination of the pelvis and extension of the toes he was enabled  to walk
with surprising ease and  activity with or without a cane.  The  head of
the femur was firmly anchylosed on  the dorsum of the ilium.   The cica-
trices appeared sound.
            Photographed at the Army Medical Museum,
BY  ORDER  OF  THE SURGEON  GENERAL:
                         GEORGE  A.  OTIS,
               Bv't .Major and Ass I Surg.. U. S. A.. Curator. A. 31.  M. 
 
        ARMY  MEDICAL  MUSEUM.
                              ----♦----
 Photograph Xo.  157.   Gunshot  Fracture  of the  Upper  Third
   of the Left Femur united  with slight deformity.
   Private Andrew F. Dinsmore, Co. E, 3d Michigan Volunteers, aged 19
 years, was wounded at the battle of  Fair Oaks, May 31, 1862, by a musket
 ball, which fractured the upper third of the left femur and lodged.  His
 wound was dressed on the field by Surgeon Bliss, U. S. Vols., and he was
 removed to the Hygeia Hospital at Fort  Monroe.  In  the middle of June
 he was transferred to the DeCamp  Hospital at  David's Island, and was
 there treated by Acting Assistant Surgeon Root, by moderate extension
 and counter-extension, and by the removal of numerous  detached frag-
 ments of bone.  By the end of 1862, firm union had taken place, and on
 April 19, 1863, the wound having healed, Dinsmore was discharged from
 the service of the  United  States, having a strong and useful limb, with
 trivial shortening and deformity.  On July 11,  1863, he  enlisted in the
 2d Battalion, Veteran Reserve Corps,  and served  three  years.   From
 time to time a fistulous orifice would appear in the cicatrix  and  discharge
 a small quantity of pus.  On  December  21,  1866, Mr. Dinsmore was in
 good health, suffering little or no inconvenience  from his  injury, though
 the ball remained in the limb.  He is employed as a clerk  in the General
 Land Office.

            Photographed at the Army Medical Museum,
BY ORDER OF THE  SURGEON  GENERAL:
                        GEORGE A. OTIS,
              Bv't Major and Ass't  Surg., U. S.  A., Curator, A. M. M. 
 
ARMY MEDICAL  MUSEUM,
PHOTOGRAPH  Xo.  158.   United  Gunshot Fracture through the
   Trochanters of the Right Femur with trifling deformity.
  Private Philip Sweeny, Co. C, 3d  New York Volunteers, 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 Monroe, on June  13, and was treated  by Surgeon
R. B. Bontecou, U. S. Vols., 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 exfoliation
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 Junej
1862; buthisname 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,
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,  wliere 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 suppuration following  the erysipelatous attacks, and,
doubtless, the formation  of  adhesions.   The knee-joint was in good con-
dition, and had sufficient motion to allow a firm, good gait.

         Photograph printed  at the  Army Medical  Museum,
   (Negative furnished by Brevet Colonel R. B. Bontecou. U.  S. Vols, i

BY  ORDER OF THE  SURGEON GENERAL:
                          GEORGE  A. OTIS,
                Bv't Major  and Ass't Surg.,  U.  S. A., Curator, A. 31. 31. 
 
          ARMY   MEDICAL   MUSEUM.


 Photograph   Xo.  159.    Stump after  a  Reamputatlon  at  the
    Left  Hip Joint.

   First Sergeant Edwin D. Ulnier, Co. O, 15th New Jersey Volunteers, aged twenty-one years
 was wounded at the battle of Cedar Clock. October  19th.  1S64, by a conoidal musket  ball!
 which entered the inner face of the left thigh, fractured the bone, and lodged under the  skin
 on the outer side of the limb.  The femur was badly comminuted, fissures extending  into
 the knee joint and upwards for seven inches.  There was but little ha-morrhage at the time
 of the injury.   The  ball was readily extracted at the Field Hospital of the Fir»t  Division of
 the Sixth Corps, and it was determined to attempt to save- the limb.  Tho wounded man was
 conveyed to Baltimore, and received at Jarvis Hospital on October 24lh.  The  train of symp-
 toms consequent upon gunshot injuries implicating the knee were soon developed.  Intense
 arthritis supervened, with deep dissecting abscesses in the thigh. On November 14th,  twentv-
 six days after the injury, hemorrhage 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  Edward
 G. 'Waters.   The patient  was very weak and nervous at the time, but he rallied promptly
 after the operation  and  convalesced rapidly, and  in a few weeks was  able to get about on
 crutches.   Yet the stump continued open and painful, and the extremity of the femur was
 found to be necrosed. In March. 1865, it was found that a  cylindrical sequestrum  was louse.
 This was removed on March f-th,  by Acting Assistant Surgeon B. B. Miles, with forceps.  The
 patient's general condition rapidly improved after  this operation.  On May 2!ith,  1KG5, he
 was discharged from the service of the United States, tho  stump still  discharging (.lightly.
 On the following day he started for Philadelphia, and, unfortunately, on the journey he fell
 with violence upon the  stump.   After  this, there was inereased'suppuration, with deep-
 seated pain in the stump. On the 22d of January, 1866, fifteen  months after the  original
 injury, while dressing the part as usual, a ha-morrhage 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 Hm-pital.  The usual
 local remedies  were applied  to  guard against its return; he  was  put upon a stimulating
 treatment,  with the best diet.  The patients general health  improved, and there was no
 further hemorrhage until about the 15th of February, when  the discharge  again  became
 mixed with blood.   On the 17th. in the hospital amphitheatre, before  the clinical class, the
 patient being etherized, an exploratory operation was  made.  An incision upon  the outer
 side of the  thigh revealed a diseased condition of the bone as high as the neck. Amputation
 was decided upon in consultation with Drs. Hunt and Aguew.  The abdominal tourniquet
 having been applied, antero-posterior integumentary flaps were dissected up; the  femoral
 artery, which was exposed with some difficulty on account  of the hardened and altered  con-
 dition of the tissues, consequent upon the previous inflammation of the soft parts was then
 tied.   The muscles having then been cut. circularly, close to the pelvis, the head of the bone
 was readily disarticulated.  The aorta was so completely controlled by  the tourniquet of Mr.
 Syme, that no arterial jet was observed during the operation; the loss of blood being very
 trifling, hardly amounting to three ounces.  About sixteen  ligatures were applied.  The flaps
 were approximated with adhesive plaster, no sutures being deemed necessary.  The subse-
 quent dressings consisted of lint soaked in pure laudanum,  until the parts had   almost
 healed, when simple cerate dressing was substituted.  The  patient was  much  prostrated by
 the operation, but reacted well.  The discharge was very profuse, and during  the first week
 the edges of the flaps appeared a  little sloughy.  Under vigorous stimulating treatment  and
 the local application of permanganate of potash in solution he  rapidly  recovered.  Xo other
 unfavorable symptoms having occurred, and the ligatures being all  away by the end of the
 second week, two small openings  in the stump alone remaining, he left  the hospital  March
 27th, thirty-eight days after the operation, for his home in  the  northern section of the city.
 On May luth, the patient was able to get about town on crutches.   On the 20th, he left for
 Xew Jersey to fill a situation as telegraph operator.   On July 24th, he  sent a letter to  this
 office from Milford, New Jersey, announcing that his health was excellent, and a few weeks
 subsequently he corroborated  this statement by transmitting his photograph.  On October
 27th, 186<i, he was supplied with an  artificial limb by Clement, of Philadelphia.  On Juno
 28th, 1867, Mr. Ulnier 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 h:'s artificial limb an excel-
 lent one, and could  walk on it "right well." but found it inconvenient at his work, which
 requires him to sit all day on a high stool.  In July, 1S67, he was again  photographed by
 Mr. Bell.
              Photographed at  the  Army  Medical  Museum.

    BY  ORDER   OF  THE  SURGEON  GENERAL:

                                   GEORGE  A.  OTIS,
                   Bv't Lt. Col.  and Ass't Surg.  U.  S.  A. Curator  A.  M. 31. 
 
        Jfovgeen  $tnmY$  fatittt.

       ARMY  MEDICAL  MUSEUM.

Photograph, No. 160.   Amputation of the Right  Thigh.
  Private Charles Myer, 5th Connecticut Cavalry, was accidentally wound-
ed, on April 5,  18G5, at Alexandria,  Virginia, by a musket ball,  which
shattered the right knee-joint.  On the following day his limb was remov-
ed, by the circular method, by Surgeon Edwin Bentley, U. S. Vols., at the
middle third  of the  thigh.  The  after treatment was conducted  at the
Sickles Hospital,  in Alexandria,  and presented  no incident worthy of
remark.  In ten weeks the stump  was firmly healed, and on July 10, 18tjf>,
Myer was discharged from the service of the United  States.

       Photograph printed at  the Army Medical Museum,
BY  ORDER OF  THE SURGEON GENERAL:
                      GEORGE A. OTIS,
             Bv't Major and Ass't Surg., U. S. A., Curator, A. 31. 31. 
 
        JFurgtera   $nmY»   (Dffi«,

        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH No. 161.   United  Gunshot Fracture of the  Upper
   Third of the Left Femur
  Private James C. Housten, Co. G, 2">th Ohio Volunteers, was wounded
 on August 30, 1862, at the second battle of Bull  Hun. by a  musket ball,
 which shattered the upper portion of the left femur and lodged.  He was
 conveyed to Alexandria, Va., and was admitted to the King street branch
 of the 3d Division Hospital, on  September  4.  The limb was treated in
 the straight position with extension and counter-extension.   The hospital
 records afford no information respecting the progress of the case, but the
 cicatrices indicated that there must have been protracted suppuration and
 probably the discharge of bone  splinters through  several orifices.  Re-
 covery  was  unusually rapid, the man being discharged from service,
 cured, on January 12. 18(33.  He was  subsequently an  employe  of the
 quartermaster department, and performed the laborious duties of a team-
 ster for several years.  In the summer of lSidi. when the photograph was
 taken, his general health  was excellent ; his limb was strong and useful,
 and but slightly shortened, and  except  from varices, which affected the
 uninjured limb almost equally, he suffered from no inconvenience.

            Photographed at the Army Medical Museum,
BY ORDER  OF  THE SURGEON GENERAL:
                        GEORGE  A.  OTIS,
              Bv't 3Iajor and Ass't Surg., U. S. A., Curator, A. M. 31. 
 
        J«tq.eo»   general's   (Mfw,


        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH  162.    Lwolncra and  Sequestra  of  a  Diseased
   Femur-Slum p.
  Private  Henry  S. W------,  Co. K, 38th Xew York Volunteers, was
 struck by a fragment of shell, at the battle of Williamsburg, May 5, 1862,
 and his right knee was shattered.  Primary amputation at mid-thigh was
 performed on the field.  The patient was "then sent in  an  ambulance to
 the landing at York  River, and  thence on an  hospital transport  to the
 hospital at David's  Island,  New York.   When he was admitted he had
 diarrluea.  and a bad bed-sore on the sacrum.  The end of the femur was
 necrosed.  He was put on a water-bed, and a supporting  regimen was
 ordered.   After three or four months, it appeared probable the patient
 would succumb unless something was  done to arrest the exhausting sup-
 puration ;  and it was determined to  remove the diseased bone.  On October
 9, the operation was  undertaken by Acting Assistant Surgeon E. B. Root.
 He first resected an inch of the necrosed  extremity of the femur, by
 means of the  chain  saw,  but,  finding that  the alteration  of the bone
 extended much  higher up, he laid open the flaps and sawed off two
 inches more  of  cylinders of double involucra and sequestra.  In this
 stage of the operation the femoral  artery was divided;  but little  blood,
 however, was lost.   Although the limits of  diseased action  had not been
 reached, Dr. Root did not  consider it prudent to go farther, and the
 patient was put to bed, when, on recovering from the insensibility induced
 by sulphuric  ether, he vomited obstinately.  Nothing allayed  the gastric
 irritability, and the patient died  seventy-two hours after the operation.
The specimen, forwarded with its history by Surgeon  S. W. Gross, U. S.
 Volunteers, is an interesting example  of the formation and death of an
involncrum, which  in its turn was enclosed by another deposit of osseous
material.

           Photographed at the  Army  Medical  Museum.

   BY ORDER  OF  THE SURGEON GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col.  and Asst Surg.  U. S.  A. Curator A. 31. 31. 
 
       JfanjjM   (&mxnYt   Mint


       ARMY MEDICAL MUSEUM.

Photograph  163.   Amputated Portion of Left  Femur, with a
  leaden Ball  in the Medullary Canal.
  At. the  battle of Chanceilorsville, on May 3,  1863, Brigadier General
Edmund K-----, U. S.  Volunteers, First Lieutenant, 1st 17. S. Artillery,
was wounded by two leaden balls from  a spherical case shot,  which
entered the lower part of the  left  thigh.  One of the missiles fractured
the  femur and was impacted in its medullary canal, the other lodged in
the vastus externus.  The wounded man was conveyed to Washington on
May u and, on May  10, Surgeon  Basil  Norris,  U. S. A., amputated the
thigh by the  circular method. Pyoeniia supervened, and death on May
28, 1803.   The specimen, contributed by the operator, is one of the few
illustrations in  the Museum,  of the lodging of balls  in the medullary
cavity of long bones.

          Photographed  at the Army Medical Museum.

  BY ORDER OF  THE SURGEON  GENERAL:

                          GEORGE A. OTIS,
              Bv't Lt.  Col. and Ass't Surg. U.  S. A. Curator A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph  164.   Diseased Stump of the Right Femur, ampu-
   tated in the Middle.
  In the battle of Spottsylvania,  May 12, 1864, Private William C_____,
Co. B, 2d Pennsylvania Cavalry, aged forty years, had his right leg  shat-
tered near  the knee by a fragment of shell.   The soft parts were much
torn, and the popliteal artery was divided. It was amputated immediately,
near the middle of the thigh by Surgeon Bower.   He was then sent to
Washington, and  admitted, on July 16, 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 apthae.  There was diarrhoea, from which, in a chronic  form
the patient  had long  suffered.   He died on July 27, 1864.  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.

           Photographed at the Army Medical  Museum.

  BY ORDER  OF THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A. Curator A. M. M. 
 
        burgeon  GtnmYt  ©fffe.


       army  medical  museum.

Photograph  165.  Diseased Stump of Left Femur, amputated
  at the Junction of the Lower Thirds.
  Corporal Thomas C. T-----, Co. C, 12th Georgia (Rebel) Infantry,
aged twenty-nine  years, was shot  through the  left knee joint by a con-
oidal musket ball, on July  12, 1864, near Silver Springs, in General
Early's demonstration against Washington.  He was left on the field, and
two  days afterwards was conveyed to Lincoln  Hospital.  The bal! had
grooved the inner condyle of the femur and fractured the patella, as is
shown  in Specimen 2842, from the same case.  Assistant Surcreon J. C.
McKee, U. S. A., amputated  at  the lower third of the thigh, on the 14th,
by Dupuytren's method.  Osteomyelitis supervened, and the patient died
from exhaustion, December 26, 1864.  At this time the femur protruded
two or more inches from the stump. It presents a loose sequestrum, lying
in a very perfect  involucrum.  It is numbered 3518 in the Surgical Sec-
tion, A. M. M.

         Photographed at the  Army Medical Museum.

 BY ORDER OF THE  SURGEON GENERAL:

                       GEORGE  A.  OTIS,
            Bv't Lt. Col. and Ass't Surg. U. S. A, Curator A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph  166.   Case of Recovery after  a Penetrating Gun-
  shot  Wound of the Ascending Colon.
  Colonel Edward W. Hinks, of the 19th Massachusetts Volunteers. 2d
Division 2d Army Corps, was wounded at the battle of Antietam, about
noon of September 17, 1862, by two musket  balls of which one shattered
the right radius, and the other entered on a level with the umbilicus, three
inches above the middle of  the crest  of the right ileum,  and, having
traversed the ascending colon, emerged a little to the right of the lumbar
vertebra?.  He lay upon the field until about noon  of ihe following day,
when he was removed to a vacant house, and  thence to  a field hospital,
where  he  was  attended by Surgeon  J. Franklin  Dyer,  19th Massa-
chusetts Volunteers.   On  September 21, fcecal matter began to escape
from the wound of exit.  On the  16th there were  grave symptoms of
peritonitis, which were treated  by  entire  rest,  morphia,  and cold water
dressings.   Impacted fceces in the lower part  of  the descending colon
were removed mechanically.  On October 12,  he was removed to a Balti-
more Hospital.  Foecal discharges  from the wound  continued about lour
weeks longer.  In November the patient was removed to Boston, and was
treated by Dr. George  M. Gay,  at  the  Massachusetts General Hospital.
He ultimately  recovered  entirely, and  was commissioned Lieutenant
Colonel of the Fortieth U. S.  Infantry, July 28, 1866, on there-organization
of the Army.

           Photographed  at the Army Medical Museum.

  BY ORDER  OF THE SURGEON GENERAL:

                            GEORGE  A.  OTIS.
               Bv't Lt. Col. and Ass't Surg.  II. S. A, Curator A. 31. 31. 
 
            f mt\wn   animal's   (Office.



          ARMY  MEDICAL  MUSEUM.


 Pn >T ;<; iaph*  Nos.   167,  168,  169,  170  and  186.     Case  of

    Chedop'osty.

  Private Rowland Ward,  Co  E, 1th New  York Heavy Artillery, aged forty-six years, was
 wounded at Ream's .Station.  Virginia, August 25th,  1861, by  a fragment of sin II, which
 destroyed and completely  carried away  the inferior maxillary  bone and soft part's, com-
 mencing two inches anterior to the angle on the right side, carrying away the chin and all
 the soft parts down the neck, on a level  with the hyoid bone, destroying the floor of the
 mouth completely, allowing  the tongue to protrude ami hang down on the neck. Three of
 the right lower incisor teeth,  with  the  corresponding  alveoli  loosely connected with the
 tissue, remained, and were allowed to  stay  in that  position until the healing process took
 place, as they gave a partial support to the  tongue and submaxillary gland, which was not
 injured. The wound extended across to the left side, carrying away all the teeth and  jaw
 bone, except those previously mentioned, to a point as high up as the angle of the inferior
 maxillary on the left side.  He was admitted to Lincoln Hospital, Washington, I). C, August
 28th, 1S61.  The  patient did well,  and  improved rapidly.  On  December 9th he was fur-
 loughed for thirty days, and at the expiration of his furlough he was readmitted to hospital.
 On January 20th, 1865, an  operation  was performed to construct a floor for the mouth—no
 ana'sthesia was used. Pi eliminary to the operation, two molar teeth were extracted from
 the right hand fragment of the lower jaw.   An incision  was made two and a half inches in
 length down the median line of the  neck, terminating one inch above the thyroid cartilage.
 Two lateral incisions, one upon each side, of equal length, right-angled to the vertical
 incision, these incisions corresponding to the base of the jaw.  These flaps were then care-
 fully dissected up, brought together at the  middle  incision, and secured by three hare-lip
 needles, the parts being supported by adhesive straps.  Frequent application of dry lint was
 made to protect the parts from  from  the injurious effects  ot the saliva, which was being con-
 stantly secreted.   The healing proceeded  rapidly,  the parts  uniting by first intention.
 Power of articulation and  degustation was  much impro\ed.  The needles wore removed on
 the  third day.  On April  22d, 1865,  the parts  being  in  a favorable condition, ether  was
 administered and a  second operation was performed.  Two  incisions, one on the right  and
 one on the left, parallel to the  inferior border of the inferior maxillary bone, each three
 inches in length, severing both the  facial arteries, which wero secured  by ligatures.  The
 upper flaps were carefully  dissected up, as far back as the angle of the jaw upon each side.
 The anterior edges of these flaps were freely incised, as well as the superior edge of the parts
 remaining after thefirst operation. The flaps were then brought into apposition and retained
 by four hare-lip needles, two in the  upper  flap  forming the lip, and  one upon each side,
 uniting the lower edge of the flap to  the freshened edge of the parts after the first operation.
 Dry lint dressings were applied, and the patient was fed through a gum catheter.  The hare-
 lip pins were removed from  the longitudinal incision  on  the third day, the others being
 removed on the fourth day. at which time the remaining pins, together  with all the sutures,
 wore removed, the parts being  supported throughout the  remainder  of the treatment by
 straps of adhesive plaster. On  the  morning of the 27th of April, secondary hemorrhage
 occurred from the left facial artery,  which  was  readily  controlled  by digital compression.
 Owing to the constant secretion of saliva from the sub-lingual gland, which was carefully
 preserved during the operation, a slough was produced at the junction of the inferior angle
 of the flaps.  This was checked by the application of a weak solution of nitric arid.   On
 June 2od the patient was discharged  at his own request.  A fistulous orifice, one-fourth of
 an inch in diameter, only remaining, in consequence of the constant secretion of saliva from
 the  sub-lingual gland, which prevented the parts from closing by granulation.  He is able
 to articulate quite plainly,  which he  has hitherto been unable to do since the date of his
 injury.  Lntil  the  completion of this  operation the  patient was compelled to assume a
recumbent position  to receive his nourishment, or even a swallow of water.  He can now
 take his food and drink without any  difficulty in  an erect posture.  By the use of a rubber
button, properly adjusted to the fistulous orifice, the secretion of saliva  was prevented from
making its exit externally   The photographs were  printed from  negatives prepared at
Lincoln Hospital, under the direction of Surgeon J. C. Cooper .McKee, who was the operator
in the case.
             Photographed at the  Army Medical Museum.
  BY  ORDER  OF  THE  SURGEON   GENERAL:
                                  GEO hop:   A.  OTIS,
                 Bv't Lt. Col. and Ass't Surg  U. S. A., Curator A. M. M. 
 
            f urgecn  ferals   ©ffia,



          ARMY  MEDICAL   MUSEUM.


 Photographs  Nos.  167,   168.  169,  170  and  186.    Case  of

    Cheiloplasty.

   Private Rowland Ward. Co.  E,  4th New York Heavy Artillery, aged forty-six years was
 wounded at Reams Station, Virginia, August  25th. 1861,  by a  fragment  of she II which
 destroyed and completely carried  away  the inferior  maxillary  bone and soft pan's com-
 mencing two inches anterior to the angle on the  right side, carrying away the chin and all
 the soft parts down the neck, on a level with  the  hyoid  bone, destroying the floor of the
 mouth completely, allowing the tongue to protrude and hang down on the neck.  Three of
 the right lower incisor  teeth,  with the  corresponding alveoli loosely connected with tho
 tissue, remained, and were allowed to  stay  in  that position until the  healing process took
 place, as they gave a partial support to the  tongue and submaxillary gland, which was not
 injured.  The wound extended across to the  left  side, carrying away all the teeth and jaw
 bone, except those previously mentioned, to  a point as high up as the  angle of the inferior
 maxillary on the left side,  lie was admitted to Lincoln Hospital, Washington, D. C, August
 28th, 1861.  The  patient  did  well, and  improved rapidly.  On   December 9th he was fur-
 loughed for thirty days, and at the expiration of his furlough  he was readmitted to hospital.
 On January 20th, 1865, an operation was performed to  construct a floor for the mouth—no
 am-esthesia was used.   Pieliminary to the operation, two molar  teeth were extracted from
 the right hand fragment of the lower jaw.  An incision was made two and a half inches  in
 length down the median line of the neck, terminating one inch above the thyroid cartilage.
 Two lateral incisions, one upon  each  side, of equal  length, right-angled'to the vertical
 incision, these incisions corresponding to the base  of the jaw. These flaps were then care-
 fully dissected up, brought together at  the  middle incision, and secured by three hare-lip
 needles, the parts being supported by adhesive straps.   Frequent application of dry lint was
 made to protect the parts from from the injurious effects of the saliva, which was being con-
 stantly secreted.   The healing proceeded rapidly, the parts uniting by first intention.
 Power of articulation and degustation was much improved.  The needles were removed on
 the third day.  On April 22d, 1865, the parts  being in a  favorable condition, ether was
 administered and a second operation was performed.  Two  incisions, one on the right and
 one on the left, parallel to the inferior  border of  the inferior maxillary bone, e-u-h three
 inches in length, severing both the  facial arteries, which were secured  by ligatures.  The
 upper flaps were carefully dissected up, as far back as the angle of the jaw upon each side.
 The anterior edges of these flaps were freely incised, as well as the superior edge of the parte
 remaining after the first operation.  The flaps were then brought into apposition and retained
 by four hare-lip needles, two in the upper  flap forming the lip, and  one upon each side,
 uniting the lower edge of the flap to the freshened edge of the parts after the first operation.
 Dry lint dressings were applied, and the patient was fed through a gum  catheter.  The hare-
 lip pins were removed  from the longitudinal  incision  on  the third day, the others being
 removed on the fourth day. at which time the remaining pins, together with all the sutures,
 were removed, the parts  being supported throughout  the  remainder of the treatment by
 straps of adhesive plaster.  On the morning of the 27th of  April, secondary hemorrhage
 occurred from the left facial artery, which was readily controlled by digital compression.
 Owing  to the constant secretion of saliva from the sub-lingual gland, which was carefully
 preserved during the operation, a slough was produced at the junction  of the inferior angle
 of the flaps.  This was checked by the  application of a weak solution of nitric acid. On
 June 23d the patient was discliarged at  his own request.  A  fistulous  orifice, one-fourth  of
 an inch in diameter, only remaining, in consequence of the constant secretion of saliva from
 the sub-lingnal gland, which prevented the parts from closing by granulation.  He is able
 to articulate quite plainly, which he  has hitherto  been unable to do since the date of his
 injury,  t'ntil  the  completion of this operation  the  patient was compelled to assume a
 recumbent position to receive his  nourishment, or  even a swallow of water.  He can now
take his food  and drink without any difficulty in an erect posture.  15y the use of a rubber
button, properly adjusted to the fistulous orifice, the secretion of saliva was prevented from
making its exit externally.  The photographs  were printed  from  negatives  prepared at
Lincoln Hospital, under the direction of Surgeon J. C. Cooper McKee, who was the operator
in the case.
              Photographed at  the  Army Medical Museum.
  BY  ORDER   OF  THE  SURGEON  GENERAL:
                                  GEORGE  A.  OTIS,
                 Bv't Lt. Col.  and  Ass't  Surg.  U. S.  A„ Curator A. M. M. 
 
                                     tnmYs  i&iiitt.



          ARMY  MEDICAL   MUSEUM.


Photographs  Nos.  167,  168,   169,  170  and  186.    Case  of

    Chelloplasfy.

  Private Rowland Ward,  Co. K, 4th Xew  York Heavy Artillery,  aged  forty-six years, was
wounded at Ream's Station, Virginia, August  25th. i^61,  by a  fragment  of shell, which
destroyed and completely  carried away the inferior  maxillary bone and soft part's, com-
mencing two inches anterior to the angle on the  right side, carrying away the chin and all
the soft parts down the neck, on a level  with  the  hyoid  bone, destroying the floor of the
mouth completely, allowing the tongue to protrude and hang down on the neck.  Three of
the right lower incisor teeth,  with  the corresponding alveoli loosely connected with the
tissue, remained, and were allowed to  stay  in that position until the healing process took
place, as they gave a partial support to the  tongue and submaxillary gland, which was not
injured. The wound extended across to  the left  side,  carrying away all the teeth and jaw
bone, except those previously mentioned, to a point as high up as tiie angle of the inferior
maxillary  on the left side.  He was admitted to Lincoln Hospital, Washington, I). C, August
28th, 1864.  The  patient did well,  and improved rapidly. On December 9th he was fur-
loughed for thirty days, and at the expiration of his furlough he was readmitted to hospital.
On January 20th, 1865, an operation was performed to construct a floor for the mouth—no
muesthesia was used.  Pieliminary to the operation, two  molar teeth were extracted from
the right hand fragment of the lower  jaw.  An incision was made two and a half inches  in
length down the median line of the neck, terminating  one inch above the thyroid cartilage.
Two lateral incisions, one  upon each side, of equal  length,  right-angled to the vertical
incision, these incisions corresponding to the base  of the jaw.  These flaps were then care-
fully dissected up, brought together at the  middle incision, and secured  by three hare-lip
needles, the parts being supported by adhesive straps.   Frequent application of dry lint was
made to protect the parts from from the injurious effects of  the saliva, which was being con-
stantly secreted.   The healing proceeded rapidly, the parts uniting by first intention.
Power of articulation and degustation was  much improved. The needles  were removed on
the  third  day.  On April  22d, 1865, the  parts  being in a  favorable condition,  ether was
administered and a second operation was performed.   Two incisions, one on the right and
one on the left, parallel to  the  inferior  border of the inferior maxillary bone, each three
inches in length, severing both the  facial  arteries, which were secured by ligatures.  The
upper flaps were carefully dissected up. as far  back as the angle of the jaw upon each side.
The anterior edges of these flaps were freely incised, as  well as the  superior edge of the parts
remaining after tin-first operation. The flaps were then brought into apposition and retained
by four hare-lip needles, two in the upper  flap forming the lip, and  one upon each side,
uniting the lower edge  of the flap to the  freshened edge of the parts after the first opcrat ion.
Dry lint dressings were applied, and the patient was fed through a gum catheter.  The hare-
lip pins were removed  from the longitudinal  incision on the third day, the others being
removed on the fourth  day, at which time the remaining pins, together wilh all the sutures,
were removed, the parts being  supported  throughout  the remainder of the treatment by
straps of adhesive plast r.  On  the  morning  of the 27th of April, secondary ha-morrhage
occurred from tlie lelt facial artery,  which  was readily controlled  by diuital compression.
Ow.nii- to the constant secretion of saliva from  th ■ sub-lingual gland, whicn was carefully
preserved during the operation, a slough  was produced  at the junction of the inferior angle
of tie-flaps.  1 his was  checked by the  application of a weak solution of nitric acid.  On
June 23d the patient was d scharged at  his own request.  A  fistulous or.fice, one-fourth of
an inch in  diameter, milv remaining, in consequence of the constant secretion of saliva from
the sub-lingual gland, which prevented  the parts from closing by granulation.  He is able
to a-ticn'a-u nn.t-! plainly, which he  has hith-rto  been unable to do since the date ot his
injury,  until  the completion of this  operation the patient was compelled to assume  a
recumbent position to receive his  nourishment,  or even a swallow of water.  He can  now
take his food and drink without any difficulty in an erect  posture.  By the use of a rubber
button, properly adjusted to the fistulous orifice, the secretion of saliva was prevented from
making its e\it'externally.  The photographs  were primed from  negatives prepared  at
Lincoln Hospital, under the direction of Surgeon J. C. Cooper McKee, who was the operator
in the case.
             Photographed at the  Army Medical  Museum.

  BY  ORDER OF  THE  SURGEON  GENERAL:
                                   GEORGE  A.  OTIS,
                 Bv't Lt.  Col. and  Ass't  Surg.  U.  S. A„ Curator A.  M. M. 
 
         ARMY   MEDICAL  MUSEUM.


Photographs  Nos.  167.  16S,   169,  170  and  1*6.    Case of

   Cheiloplasty.

  Private Rowland Ward, Co. E, 4th New York Heavy Artillery, aged forty-six years, was
wounded at Ream's Station,  Virginia, August  25th. 1864,  by a  fragment of shell, which
destroyed and completely  carried away the inferior  maxillary  bone and soft parts, com-
mencing two inches anterior to the angle on the  right side, carrying away the chin and all
the soft parts down the neck, on a level  with  the  hyoid  bone, destroying the floor of the
mouth completely, allowing the tongue to protrude and hang down on the neck.   Three of
the right lower incisor teeth,  with the  corresponding alveoli loosely connected with the
tissue, remained, and were allowed to stay  in  that  position until the healing process took
place,'as they gave a partial support to the  tongue and submaxillary gland, which was not
injured.  The wound extended across to  the  left side, carrying away all the teeth and jaw
bone, except those previously mentioned, to a point as high up as the angle of the inferior
maxillary on the left side.  He was admitted to Lincoln Hospital, Washington, D. C, August
28th, 1SG4.  The patient did well,  and  improved  rapidly.  On  December 9th he was fur-
fougiied for thirty davs, and at the expiration of his furlough he was readmitted to hospital.
On January 20th." 1865, an operation  was performed to construct a floor for the mouth—no
anaesthesia was used.  Pieliminarv to the operation, two  molar teeth were extracted from
the right hand fragment of  the lower jaw.  An incision was made two and a half inches in
length down the median line of the neck, terminating one inch above the thyroid cartilage.
Two lateral incisions,  one  upon each side, of equal  length, right-angled  to the vertical
incision these incisions corresponding to tho base of the jaw.  These flaps were then care-
fully dissected up. brought together at the middle  incision, and secured by three hare-lip
needles the parts being supported by adhesive straps.  Frequent application of dry lint was
mule to protect the parts from from tho  injurious effects ot the saliva, which  was being con-
stantly secreted.   The healing proceeded rapidly, the  parts  uniting by first intention.
Power of articulation and degustation was  much improved.  The needles were removed on
the  third day  On  Vpril  22d.  1865, the parts  being in  a favorable condition, ether was
administered and a second operation was performed.  Two incisions one on the right and
one on the left, parallel to  the  inferior border of  the inferior maxillary  bone, each three
inches in length, severing both the facial arteries, which  wen; secured by ligatures  llie
upper flans were carefully dissected up. as tar  back as the  angle ol  the jaw upon each side.
The  Interior e.b-cs of these flaps were freely incised, as well as the superior edge of the parts
remaining after'the first operation.  The flaps were then brought.into apposition and retained
by four hare-lip needles/two in the upper flap  forming   the lip a.nl one upon each sue,
uniting the lower edge of the flap to the freshened edge of  the parts after the n st ope . to  •
Dry lint dressings were applied, and the patient was ted through a gum catheter,   lhe haie-
MpV "s  e,-e removed from the longiti.lU.al incision on the third day  he o hers being
removed on tin- fourth day.  at which time the remaining pins, together will, all tluM.tu.e,
  e'e removed the parts being  supported  throughout the remainder of  the treatment by
  trans of adhesive plast r.   On  the  morning  of the  27th of Apr. . secondary hie.no, rhage
oreum-d from the 1% facia, artery,  which was  readily  controlled  Uy ^al-mpyess .on.
Ow ng to th- constant secretion of saliva from tlij
JK2 I^taCundlr tile du'ecti'o'n of Surge- J. C. Cooper McKee, who was the operator

in the case.    ph()tographed  at  the Army Medical Museum.

  BY  ORDER  OF THE  SURGEON  GENERAL:
                                   GEORGE  A.  OTIS,
                 Bv't Lt.  Col. and Ass't Surg.  U. S. A.,  Curator A.  M. 31. 
if 
       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH 171.   Two Examples of Gunshot  Fracture of  the
   Upper Third of the Femur.   Amputation at the Hip Joint was
  performed in each
  The specimen on the left, No. T098,  Surgical Section, Army Medical
Museum, is from the patient on  whom Surgeon E. Bentley performed a
secondary amputation at  the  hip joint, August  10, 1864.  The case is
described in  detail  in Circular No. 7,  S. G. 0.,  1867, p. ?>9.  The speci-
men on the right, No.  2288, Surgical Section, is from Dr. J. C. McKee's
secondary coxo-femoral disarticulation, recorded at page 41 of tlie same
Report.

          Photographed at the Army Medical Museum.

   BY  ORDER OF THE SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A. Curator A. 31. M. 
 
       gntptm  (&twnY%   Witt.


       ARMY MEDICAL MUSEUM.

Photograph 172.   Specimens of Gunshot  Fractures of the Fe-
  mur in Cases treated by Primary Amputation at the Hip Joint.
  The specimen on the left, No. 3080, Surgical  Section, Army Medical
Museum, shows the comminution of the left femur by a large fragment of
shell, in a case in which Surgeon C. C. Jewett, 16th Massachusetts Volun-
teers, amputated at the hip.  An abstract of the case is published at page
30, of Circular No. 7,  S. G. 0., 1867.  The other specimen,  No.  2273,
Surgical  Section, exhibits a fracture by a  rifle ball.  Surgeon A. C.
Gorgas, U. S. Navy, amputated at the hip joint.  See Circular No. 7, S.
G. 0., 1867, p. 29.

          Photographed at  the Army  Medical Museum.

  BY  ORDER OF THE SURGEON GENERAL:

                        GEORGE  A. OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A. Curator A. M. M. 
 
        Jfovgftfn ®tnmY& Mint.


      ARMY  MEDICAL MUSEUM.

Photograph  173.  Specimens of Gunshot Fractures of the Fe-
  mur.  Intermediate Amputations at the Hip were performed.
  No. 4237, Surgical Section, Army Medical Museum, is from the patient
whom Surgeon Griswold, TJ. S. V., amputated at the hip, April 12, 1865.
See Circular  No. 7, S. G. 0., 1867, p. 39, for an abstract of the case.
Surgeon Edwin  Bentley's intermediate amputation at the hip furnished
the other specimen.  See Circular No. 7, S. G. 0., 1867, p. 38.

         Photographed at the  Army  Medical Museum.

  BY  ORDER OF THE SURGEON GENERAL:

                       GEORGE A.  OTIS,
            Bv't Lt. Col. and Ass't Surg. U.  S. A. Curator A. M. 31. 
jm<
tftf:


sum ,iAOKi^r:,': ymha
   • ■■•■<» )■: I-.-: .
 ■ • .  ■; fTii -f,,t .' :

 I  '• A ,.Q .Sj'a ,7 ,

i':>«?uW! leoibaM ■,?".-;■•' 
ARMY  MEDICAL  MUSEUM.
PHOTOGRAPH  174.  Specimens of Xecrosls of the Femur follow-
  ing Gunshot Injury.
  The smaller specimen is from Dr.  Packard's successful exarticulation,
in a case in which  the thigh had previously been amputated in the con-
tinuity.  In Circular No. 7, S. G. ()., 1867, at page 49. an abstract of the
case will be found.  The other specimen, No. 84 of the Surgical Series,
Army Medical Museum, is from Dr. Wagner's case of secondary amputa-
tion at the  hip joint for necrosis following contusion of the femur by a
musket ball.  Circular No. 7, S. G. 0., 1867, p. 41.

           Photographed  at the Army  Medical  Museum.

  BY  ORDER  OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A, Curator A. 31. 31. 
 
        ARMY MEDICAL MUSEUM.

PHOTOGRAPH 175.   Gunshot Fractures of the Femur from Cases
   In which Amputation at the Hip Joint was performed.
  Specimen 710 is  from the patient on whom Lieutenant Colonel Pineo,
Medical Inspector, U. S. A., performed  an  amputation at the hip joint,
December 27,  1802,— case NXVII of the series described  in the Report
on amputations at the hip joint in Circular No. 7, S. G. ()., 1867.  Speci-
men 1148 is from the successful primary amputation at the hip joint by
Surgeon E. Shippen, TJ. S. V., Circular No. 7, S. G. 0., 1867, p. 26.

           Photographed  at  the Army Medical Museum.

   BY  ORDER OF THE SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A. Curator A. 31. M. 
 
       jPurgftm   (&mmY&  (Btiitt.


       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH 176.   Successful Primary  Excision of  the  Head
  and Four Inches  of Shaft of the Right Humerus for Gullshot
  Fracture.
  Major Thomas G. Morrison, 66th Indiana Volunteers, was wounded at
Big Shanty,  Georgia.  October 4,  1864, by a conoidal ball, which passed
through the  surgical neck of the right humerus, severing the head from
the shaft.  Surgeon A. Goslin, 48th Illinois  Volunteers, excised the head
and four inches of the shaft through a single straight incision on the day
after  the injury.  The  wound healed kindly.  In  January, 1866, an
exfoliation from the  remaining portion of the humerus was removed by
Drs. Crozier and Reed at Nashville, Tennessee.  In March, 1867,  Major
Morrison visited the Army Medical Museum.  He had tolerably good use
of his arm and fingers and could flex the forearm at a right angle.   Pro-
nation and supination were partially preserved.

           Photographed at the Army Medical  Museum.

  BY ORDER OF  THE  SURGEON GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A. Curator A. 31. 31. 
 
jz^-e-e/.  td^usiM-  -/^°-  ^
        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH 177.   Recovery  after Fracture of the Right Ilium
   by a  Musket Ball.
  At the battle of Cedar Creek, October 19, 1864, Private Henry Reems,
Co. I, 30th Massachusetts Volunteers, aged twenty-one  years, was struck
on the right side of the abdomen by a musket ball, which passed through
the crest of the ilium, and emerged posteriorly, six inches from the wound
of entrance.   He was sent to the general hospital at Frederick.  Numer-
ous bits of bone were removed  from both orifices of the wound.   On
November 18,  the patient was transferred to Filbert  Street  Hospital in
Philadelphia.  There  was protracted suppuration,  and the patient was
unable to bear his weight on the limb of the injured side for five months.
On April 26, 1865, he  was moved to Turner's  Lane, Philadelphia, where
the diagnosis  of "Epilepsy" was  recorded.  On May 10,  he was again
transferred to McClellan Hospital,  and here the diagnosis, "gunshot
wound of the ilium" reappears.  He was discharged from service June4,
1865.   On April 3, 1867, he  visited the Army  Medical Museum.   The
anterior cicatrix was adherent to  the  bone.   There was  partial  false
anchylosis  of the hip,  and the knee was also somewhat stiff.

           Photographed at the  Army Medical Museum.

   BY  ORDER OF  THE  SURGEON GENERAL:

                           GEORGE A.  OTIS,
              Bv't Lt. Col. and Ass'I Surg.  U. S. A. Curator A. 31.  M. 
 
         JFurgwti   <&mx&l'i    Witt


         ARMY   MEDICAL  MUSEUM.

 Photographs  Nos.  139,   178,   179  and  292.   Partially  Con-
   solldeded  Gunshot  Fracture  of  the  Upper Third of the Right
   Femur.

  Private George Ruoss, Co. G, 7th New  York Volunteers, aged twenty-seven  years, was
 wounded in an engagement at the South Side Railroad, near Petersburg, Virginia, on March
 31,1865, by a conoidal musket ball, which struck the anterior and outer aspect of the right
 thigh, about three inches below  the great trochanter, and, passing inwards and a little
 downwards, comminuted portions of the upper and middle thirds of the femur, and emerged
 posteriorly, about the middle of the gluteal fold.   He was taken to the JSaso Hospital at City
 Point, and on April 6th, was transferred to Campbell Hospital at Washington.  On July 8th,
 he was removed to Stanton Hospital, and, on September 12th,  to Harewood Hospital. On
 his admission to Harewood,  he was able  to sit  up, and  the constitutional condition was
 tolerably good.  The fracture had united with great deformity;  there were several fistulous
 orifices, through which fragments of necrosed bone were extracted almost daily.  On May 1,
 1866, Ruoss was transferred, on the closure of Harewood, to the Post Hospital at Washington.
 On June Sth, he was etherized, and Assistant Surgeon W. Thompson,  U. S. A., made a V
 shaped incision at the upper and outer part of the thigh, and removed several fragments of
 diseased bone.  September 30, 1866: the wound has  nearly healed; there are three sinuses,
 (two on the upper, and one on the lower surface,) which lead to what is evidently necrosed
 bone. December 31, 1866: Sinuses  still open and discharging, general condition feeble;
 there is great deformity, and about five inches shortening of the limb, with almost complete
 anchylosis of the knee joint.  The photograph was taken in July, 1867.  A communication
 from Assistant Surgeon John Brooke, U. S. (A., dated July 6, 1868, furnishes  the following
 additional information:—On taking charge of  the  patient in November, 1867, he found the
 limb in the same condition as that previously described, except that  a collection of pus,
 which had formed on the inner aspect of the thigh, just above  the knee, had been opened,
 and that there was a sinus connecting with the seat of fracture.  This sinus, with the open-
 ings above mentioned, continued until death.  The patient was  extremely feeble, greatly
 emaciated, and suffered much from diarrhoea and  anorexia.   These symptoms continued
 until the patient's death, which occurred June  27th, 1868.  At the autopsy, the liver was
 found enormously enlarged, weighing ten pounds and ten ounces; and the right lung con-
 tained a small mass of calcareous matter.   Portions  of  the tibia and fibula, and the femur
 with the os innominatum  and patella  attached, were  removed.  The femur, imperfectly
united with great displacement  and  a deposit of  foliaceous callus, shows that extensive
periostitis had taken place.  The upper portions of the tibia and fibula and the patella, also,
show similar pathological changes. The specimen is No. 5150 of the Surgical Section.
             Photographed  at  the Army Medical  Museum.
  BY ORDER   OF THE  SURGEON  GENERAL:

                                GEORGE  A.  OTIS,
                                  Ass't Surg. U.  S.  A., Curator A. M  M. 
 
m   (&tntnl't    Witt
         ARMY  MEDfCAL  MUSEUM.

 •hotographs Nos. 139,  178,   179  and  292.   Partially  Con-
   solidated  Gunshot Fracture  of the  Upper Third  of  the Right
   Femur.

  Private George Ruoss. Co. G, 7th New  York Volunteers,  aged  twenty-seven years, was
 'ounded in an engagement at the South Side Railroad, near Petersburg, Virginia, on March
 1,1865, by a conoidal musket ball, which struck the anterior and outer aspect of the right
 high, about three inches below the great trochanter,  and,  passing inwards and a little
 ownwards, comminuted portions of the upper and middle thirds of the femur, and emerged
 osteriorly, about the middle of the gluteal fold.   He was taken to the Base Hospital at City
 'oint, and on April 6th, was transferred to Campbell Hospital at Washington.  On July 8th,
 le was removed to Stanton Hospital, and, on September  12th, to Harewood Hospital.  On
 lis admission to Harewood, he was able  to sit  up,  and the constitutional condition was
 olerably good.  The fracture had united with great deformity; there were several fistulous
 n-ifices, through which fragments of necrosed bone were extracted almost daily.  On May 1,
 866, Ruoss was transferred, on the closure of Harewood, to the Post Hospital at Washington.
 m June 8th, he was etherized,  and Assistant Surgeon W. Thompson,  U. S.  A., made a V
 ihaped incision at the upper and outer part of the thigh, and removed several  fragments of
 liseased bone.  September 30, 1866: the wound has  nearly healed; there are three sinuses,
 two on the upper, and one on the lower surface,)  which lead to what is evidently necrosed
 aone.  December 31, 1866:  Sinuses  still  open and discharging,  general condition feeble;
 there is great deformity, and about five inches shortening of the limb, with almost complete
 mchylosis of the knee joint.  The photograph was taken in July, 1867.   A communication
 from Assistant Surgeon John Brooke, V. S. A., dated July 6, 1868, furnishes the following
 additional information :—On taking charge of the patient in November, 1867,  he found the
limb in the same condition as that previously described, except  that a  collection of pus,
which had formed on the inner aspect of the thigh,  just above the knee, had  been opened,
and that there was a sinus connecting with the seat of fracture.   This sinus, with the open-
ings above mentioned, continued until death.  The  patient  was  extremely feeble,  greatly
emaciated, and suffered much from diarrhoea and anorexia.  These symptoms continued
until the patient's death, which  occurred  June 27th, 1868. At the  autopsy,  the liver was
found enormously enlarged, weighing ten pounds  and ten ounces; and the right lung con-
tained a small mass of calcareous matter.  Portions of the tibia and fibula, and the femur
with the os innominatum  and patella  attached,  were removed.  The femur, imperfectly
united with  great displacement  and a deposit of  foliaceous  callus,  shows that extensive
periostitis had taken place. The upper portions of the tibia and fibula and the patella, also,
show similar pathological changes.  The specimen is No. 5450 of the Surgical Section.
             Photographed  at  the Army Medical Museum.
  BY ORDER   OF THE  SURGEON  GENERAL:

                                 GEORGE  A.  OTIS,
                                   Ass'i Surg.  U. S.  A.. Curator A. M if. 
j)#. 
        Jfywjftcw  ffammYn   Witt

        ARMY  MEDfcAL  MUSEUM.

Photograph No.  lsn.   Diseased  Thigh Stump.
  Private William Cotter, (Jo.  K, 9th  Xew Hampshire  Volunteers, aged
twenty-seven years, underwent primary amputation of the right thigh at
the lower part of the middle third, on account of gunshot fracture of  the
lower third of the femur, at  Petersburg, Virginia, July 80,  18G4.   On
August 3, 1 H04, the patient was admitted to Douglas Hospital, at Wash-
ington.  The stump was  swollen from the retention of  pus.  On August
13,  the swelling  was much reduced and  the constitutional irritation had
greatly abated; the ligature from the femoral artery came away on that
day.  On November 29, 1804, the wound  was cicatrized, with the excep-
tion of a small fistulous orifice through which dead bone  had been felt,  for
two months previously.  An incision was made  here, and  a  cylindrical
sequestrum, nearly six inches long, was extracted.  A photograph of the
stump was made at this time, (Photograph 61, Surgical Series,  A. M.  M.)
The stump remained irritable, and abcesses formed from  time to time.
Exploration with the probe indicated that the involucrum was spongy and
unhealthy.  On June 6, 1W>, Assistant Surgeon William Thomson, TJ. S.
A., resected six  inches of the new  bone.  After this the stomp healed
firmly, and the patient was discharged October  15, 18G<'•.
           Photographed at the Army  Medical Museum.
   BY  ORDER  OF  THE  SURGEON  GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. C,A. and Ass't Surg. U. S. A., Curator A. 31. 31. 
 
ej^W  *4*W. *U<rO.  ft/.
        jPimjwn  $>mx&Y$   Witt


        ARMY  MEDICAL MUSEUM.

PHOTOGRAPH 181.  A Perineal Fistula—Unsuccessful  Urethro-
  plasty.
  Peter  Fox,  quartermaster  department, aged twenty-one years, was
admitted into  the Post Hospital in Washington on May 1, 1866, with two
fistula' of the membranous portion of the urethra, the result ol a severe
lacerated wound of the perinaeum, caused by falling astride of a plank.
Cauterization of the edges of the fistulas by bromine, nitrate of silver,
and the  actual cautery was at intervals unavailingly essayed.  A plastic
operation had already been performed by Dr. X. S. Lincoln without suc-
cess.  On June 3, Assistant Surgeon W. Thomson, TJ. S. A., pared the
edges  of the apertures  and  approximated them  by  silver sutures.  A
catheter  was retained in the bladder, the  urethra having  been dilated
freely  by the  daily  use  of bougies.   There was dysuria and frequent
micturition on  the following  day, and  on  the  6th,  the  sutures were
removed.  The posterior  orifice appeared to have closed; but it reopened,
and recourse was again had to cauterization, without  advantage.  There
was so much loss of substance, nearly  a third  of the cylinder of the
urethra being  destroyed, that  the restoration of the  canal was a  very
difficult problem.

          Photographed at the Army Medical Museum.

   BY ORDER OF  THE SURGEON  GENERAL:

                          GEORGE A.  OTIS,
              Bv't Lt.  Col. and Ass't Surg. U. S. A. Curator A. 31. M. 
 
       jlitrpoif   (&tnmY&   Witt

       ARMY  MEDfcAL MUSEUM.

PHOTOGRAPH No. 182.   Successful excision of the  Head  of the
  Right  Humerus.
  Private Sylvanus B. Crane, Co. II,  13th Infantry,  was struck, at tlic
engagement at Chickasaw Bayou, near Vicksburg, December i!9, 18' 2, by
n  conoidal musket ball, which entered his right shoulder anteriorly, com-
minuted the head of the  humerus and lodged under the superior angle of
the scapula.  Two hours after the reception of  the injury, Surgeon George
S. Walker, 6th .Missouri Volunteers,  excised the  head and upper  portion
of the shaft, about five inches altogether.   He employed a vertical incision
carried from the tip of the acromion  about six inches downwards through
the belly of the deltoid.   The patient was placed on a hospital transport
and sent to  St. Louis, and admitted to the Lawson Hospital on January 17,
1863.   He made a  rapid  recovery,  and  on April 27, 1863, he was dis-
charged from  the hospital, cured,  and  from  the  military  service of
the  United  Slates.  The photograph was made more  than  five years
afterwards.  At that period  Crane was sent  to  Xew  York by order of
General .Madison Mills, Surgeon U. S.  A., and was furnished  by  Dr.  E.
D. Hudson with an apparatus which greatly facilitated  the movements of
his arm.  Prior to this,  he had full  control over the forearm and hand,
hut the ligamentous attachments of  the upper extremity of the humerus
to the scapula were so long that movements of the arm were very imper-
fect.   The arm was shortened only one and a half inches and its size was
nearly normal,  except that  the  deltoid was wasted from disease.   After
the  application  of the apparatus, Crane enjoyed  a highly satisfactory
power over the movements  of  the arm.  The photograph  was made in
September, 1868.
           Photographed at the Army Medical Museum.
   BY  ORDER OF  THE  SURGEON GENERAL:

                           GEORGE  A.  OTIS,
              Bvt Lt. Col. and Ass  I Surg. U. S. A., Curator A. 31. 31. 
 
       ARMY MEDICAL  MUSEUM.

Photographs 183 and 184.  A LargP Oxalate of Lime. Urinary
   Calculus removed by Lithotomy.
  This remarkably large mulberry calculus is numbered  4848 of the
Surgical Section of the Army Medical Museum.  Before the section was
made it weighed 77.23 grammes, about two and  a half ounces Troy.   Its
principal diameters are two and a fourth, one and seven-eights, and one
and five sixteenths inches.   It was contributed by Dr. Nathan S. Lincoln,
who removed it by the lateral operation  for lithotomy from the bladder
of a man  who  had long suffered  from  the symptoms of stone  in the
bladder.  It was necessary to make an additional section in the right lobe
of the prostate, in order to extract the stone.   The patient did well for a
fortnight; but ultimately died.   The calculus consists mainly of oxalate
of lime, with a little coloring matter.   The light colored layers contain a
little uric acid mixed with various organic matters.

           Photographed at the  Army Medical Museum.

  BY  ORDER  OF THE SURGEON  GENERAL:

                           GEORGE A. OTIS,
              Bv't Lt. Col. and Ass't Surg. U.  S. A, Curator A. M. 31. 
 
         Jjtvgwn  (&tnmY$ Witt


       ARMY  MEDICAL  MUSEUM.

Photographs 183 AND 184.  A Large Oxalate of Lime Urinary
   Calculus removed by Lithotomy.
  This remarkably large mulberry calculus is numbered 4848  of the
Surgical Section of the Army Medical Museum. Before the section was
made it weighed 77.23 grammes, about two and  a half ounces Troy.  Its
principal diameters are two and a fourth, one and seven-eights, and one
and five sixteenths inches.  It was contributed by Dr. Nathan S. Lincoln,
who removed it by the lateral operation for lithotomy from the bladder
of a man  who  had long suffered from  the symptoms  of stone in the
bladder.   It was necessary to make an additional section in the right lobe
of the prostate, in order  to extract the stone. The patient did well  for a
fortnight;  but ultimately died.   The calculus consists mainly of oxalate
of lime, with a little coloring matter.  The light colored layers contain a
little uric  acid mixed with various organic matters.

           Photographed at  the Army Medical Museum.

  BY  ORDER  OF THE SURGEON  GENERAL:

                         GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass't Surg.  U. S. A, Curator A. M. 31. 
 
         JFitvgttfn ®tnmY$  Witt


       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH 18.").  Successful Trephining in a Case of Depressed
  Fracture produced by a Fall.
  Jesse Smith, a colored  lad of sixteen  years, employed  by a  cattle
drover, was sent to sleep, on the night of August 11, 1867,  in a hay-loft
over a stable.   He  rolled off the hay mow during the night, and fell to
the floor of the stable, and  was found in the morning cold and unconscious.
He was taken  to the Freedmcn's Hospital in  Alexandria,  Virginia, and
was examined  by Acting  Assistant  Surgeon R. X. Atwood, who found a
contused crucial wound of the scalp, and a  depressed fracture of the
right parietal eminence.   The boy had recovered his consciousness:  the
symptoms of concussion of the brain had passed away, and there was no
evidence of compression.   An expectant  treatment was adopted, and no
unsatisfactory symptoms appeared for twelve days.   On August 22, there
was severe headache,  and, at night,  a convulsion.   On August 23, the
pain had increased,  and there  was stupor, and it was decided to elevate
the  depressed bone.  Assisted by  Acting Assistant  Surgeon  A.  W. K.
Andrews, Dr. Atwood enlarged the  wound and trephined.  On removing
u button of bone, there was a free escape of pus.   A depressed frag-
ment of the inner table extending  three-fourths of an inch beyond the
fracture in the outer  table  was,  with much difficulty,  elevated and
removed.   The patient was rendered insensible during the  operation by
sulphuric ether.  On recovering from the anaesthetic, he had intolerable
pain, and one grain  of sulphate of morphia was given him.  For the next
ten  days he took from two to three grains of the sulphate of morphia
daily, and no other medicine.   He was fed on bread and milk acidulated
with vinegar, to suit his taste, and  he had vinegar and water to drink.
His bowels acted regularly.  Three days  after  the operation, the brain
began to protrude;  and on the tenth day the cerebral hernia was half the
*ize of an  hen's  egg.   Gentle compression  of the fungous mass was
essayed, but immediately  provoked violent convulsions.  After the tenth
day, the tumour began to diminish  in size, and by the end of September
it had disappeared, and the wound had cicatrized.  At this period, the
boy was brought to  the Army Medical Museum and photographed.   His
health was perfectly good  and his  faculties unimpaired.   The specimen
of the disk and depressed  fragment  of the parietal was presented  to the
Museum hy Dr. Atwood.   It is 4817, of the Surgical Section.

           Photographed at the  Army  Medical  Museum.

  BY  ORDER  OF  THE   SURGEON  GENERAL:

                           GEORGE   A. OTIS.
              Bv't Lt.  Col. and Asst Surg. l\ S. A.  Curator A. 31. 31. 
 
            jFijrjjtoi  ^rnrraVis   Witt



         ARMY   MEDICAL  MUSEUM.


 ?iiotouraphs  Nos.   1G7,   168,  109,  170   and  186.     Case  of

    Chelloplasty.

  Private Rowland Ward, Co. E.  -ttli New York Heavy Artillery, aged forty-six years, was
 rounded at Ream's Station.  Virginia.  August -Jaili.  IStH, by  a fragment of sin II. which
 lestroyed and completely carried aw.iy  the inferior maxillary  bone and soft pans, com-
 nencing two inches anterior to the angle on the  right side, carrying away the ch  n and all
 he soft  parts down the neck, on a level with  the  hyoid bone, destroying the floor of the
 mmth completely, allowing  the  tongue to protrude and hang down on the neck.  I hree of
 :he right lower incisor teeth,  with tho  corresponding  alveoli  loosely connected with the
 tissue, remained, and were allowed to st iy in that  position until the healing process took
 place, as they gave a partial support to the tongue and submaxillary gland, which was not
 injured. The wound extended across to the  left side, carrying away all the teeth and jaw
 Ijone. except those previously mentioned, to  a point  as h:gh up as the angle of the inferior
 maxillary on tlie left side.  He was admitted to Lincoln Hospital, Washington. 1). C, August
 28th. IStil.  The patient did well, and  improved  rapidly.  On  December nth he was lur-
 louglu-il for thirty days, and at the expiration of his furlough he was readmitted to hospital.
 On .lanuary 20th, lStio, an operation  was  performed to construct a floor for the mouth—no
 ana'sthe.-ia'was used.  Pi eliminary to the operation, two molar teeth were extracted from
 the right hand fragment of the lower jaw.  An incision was made two and a half inches in
 length down the median line of the neck, terminating one inch above the thyroid cartilage.
 Two lateral incisions,  one upon  ea'h  side, of equal length, right-angled to the vertical
 incision, these incisions corresponding to  the base  of the jaw.  These flaps were then care-
 fully dissected up, brought together at  the  middle  incision, and sei-ureil by three hare-lip
 needles, theparts being supported by adhesive straps.  Frequent application of dry lint was
 made to protect the parts from from tho injurious effects ot the saliva, which was being con-
 stantly  secreted.    The  healing  proceeded  rapidly, the  parts  uniting by first intention.
 Power of articulation and degustation was much improved.   The needles were removed on
 the third day. On April 22d, 1865, the parts  being in  a favorable condition, ether was
 administeredand a second operation was  performed.  Two incisions, one on the right and
 one on the left, parallel to the inferior border of  the inferior maxillary  bone, each three
 inches in length, severing both the facial arteries, which were secured  by ligatures.  The
 upper flaps were carefully dissected up. as far back as the angle of the jaw upon each side.
 The anterior edges of these flaps were freely incised, as well as the superior edge of the parts
 remaining after the first operation. The flaps were then brought into apposition and retained
 by four  hare-lip needles, two in the  upper flap forming  the  lip. and  one upon each side,
 uniting the lower edge of the flap to the freshened edge of the parts after the first operation.
 Dry lint dressings were applied, and the patient was fed through a gum catheter.  The hare-
 lip pins  were removed from  the  longitudinal incision on the third day, the others being
 removed on the fourth day, at which time the remaining pins,  together with all the sutures,
 were removed, the parts  being supported throughout the remainder of the treatment by
 straps of adhesive plaster. On the morning of the 27th of April,  secondary ha-morrhage
 occurred from the lett facial artery, which was readily  controlled  by digital compression.
 Owing to the constant secretion of saliva  from tin- sub-lingual gland, which was  carefully
 preserved during the operation, a  slough was produced at the junction of the inferior angle
 of the flaps.  This was checked by the application of a weak solution of nitric acid.  On
 June 23d the patient was discharged at his own request.  A fistulous orifice, one-fourth of
 an inch in diameter, only remaining, in consequence of the constant secretion of saliva from
 the sub-lingual gland, which prevented the  parts from closing by granulation. He is able
 to articulate quite plainly, which  he has  hitherto  been unable to do since the date of his
 injury.  Until  the  completion of this operation  the patient was compelled to assume a
 recumbent position  to receive his   nourishment, or even a swallow of water.   He can now
take his  food and drink without any difficulty in  an erect posture.  Ily the use of a rubber
button, properly adjusted to the fistulous orifice, the secretion of saliva was prevented fioin
making its exit externally.   The   photographs were printed  from  negatives  prepared at
Lincoln Hospital, under the direction of Surgeon J. C. Cooper McKee, who was the operator
in the case.
              Photographed at  the  Army  Medical Museum.
  BY ORDER  OF  THE SURGEON  GENERAL:

                                  GEORGE   A.  OTIS,
                 Bv't Lt. Col. and Asu'i Surg. U. S. A„ Curator A. M. M- 
 
        furpoi   $>mx&Yt   Witt


        ARMY  MEDICAL  MUSEUM.

I'lidTOiiRAPH  187.  Successful  Excision  of a  Portion  of  the
   Shaft of the Right Femur for  Gunshot Fracture.
  In tlie assault upon the heights of Fredericksburg by (ieneral Sedg-
wick's  command, May 3, 18fi:i,  Sergeant Joseph B. Kendall, Co. K, 5th
Wisconsin Volunteers, was struck by a musket ball, which split upon the
shaft of the right femur, a portion of the missile lodging in the cylinder
of the bone, and  a  portion traversing the thigh and making its exit pos-
teriorly.  He was conveyed on a stretcher to a house  in Fredericksburg,
and on the following morning to  the Sixth Corps  Hospital on Falmouth
Heights.  On  May  10, he was  sent on the cars  to  Ac-quia  Creek, and
thence  on a hospital transport  to Washington, and placed in Campbell
Hospital.  The injured limb was suspended by Smith's Anterior  Splint.
There was intense irritative fever, with copious suppuration. On May lii,
Acting Assistant  Surgeon  F.  W. Kelly made a long incision on the pos-
terior aspect of the thigh, removed a fragment  of ball and numerous
detached fragments  of bone, and turned out  and sawed  off the  sharp
extremities of the fractured shaft.   The limb was then supported in a
wooden  trough by cushions.  The surgical fever  and suppuration grad-
ually abated.  Ultimately, firm  union took place and the wounds closed,
and the patient was discharged  from the hospital and fron\ the military
service on May 4, 18(14.  On  several  occasions, subsequently, abscesses
formed in the thigh, and  bits of necrosed bone were eliminated.  The
sinuses  did not  close  definitively until August,  l*iii'>.  In  September,
18(iG, Mr. Kendall was appointed a clerk in the Quartermaster General's
Office.  On November 6, 18fi7, he visited the Army Medical  Museum, and
his limb  was photographed.  At this date his general health was excel-
lent.   The injured limb was shortened  two  and one-half inches.  There
was false anchylosis of the  knee.  The fracture appeared  to be firmly
consolidated, and  the  cicatrices  were sound.  Notwithstanding the stiff-
ness of his knee, Mr. Kendall walked briskly with a very slight limp.

          Photographed  at the Army Medical  Museum.

   BY  ORDER  OF  THE SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S.  A. Curator A. 31. 31. 
 
          i?»wjwr»  (^tntnYs  Witt

        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH Xo.  18S.   Successful Intermediate Excision of the
   Head.  Neck and Trochanters of the Right Femur.
   Private  Hugh AVright, Co. G. 8th New Jersey Volunteers, was wounded
 it the battle of the  Wilderness, May  5th, 1 S> 14, and was admitted into
 ■Uanton Hospital, at  Washington, May 25th, 18G4.  A conoidal  musket
 ■mil, entering an inch to the inner side of the right femoral artery, two
 inches below Poupart's Ligament, had passed backwards and downwards,
 ■shattering the neck and trochanters of  the femur, and lodged against the
 trochanter minor.   On May 27th, Assistant Surgeon George A. Mursick,
 I". S. Vols., made a vertical incision over the great trochanters, six inches
 in length, and extracted the ball and  splinters, and excised the head, neck
 and trochanters of the femur.  During the  operation,  anaesthesia was
 maintained by ether.  The shock of the operation was great, and reaction
 was tardy.  On the succeeding day there was much nervous agitation, the
 pulse  was frequent and feeble, the tongue dry, and thirst  excessive.  On
 June 1st, these unfavorable symptoms had disappeared; the wound looked
 well, and discharged laudable pus. From this date, a tonic and support-
 ing regimen was dil gently enforced, and the patient's progress towards
 recovery was satisfactory.  In November, 186),  and again in  February,
 1 Sti5,  abscesses formed  in the  thigh, but,  after poulticing and incision,
 they gave little irouble.  In April, 1865, Wright moved about on crutches.
 On the 17th of April, he was  discharged from the hospital and from the
 service of the United States.  There was  still a trifling fistulous  orifice
 near the acetabulum;  but  the general health was excellent, and the pros-
 pect of ultimate recovery most encouraging.  For a long time it was im-
 possible  to obtain any intelligence of Wright; but, in the summer of 18GG,
 it was learned that he was an inmate of an Alms House in Orange, New
 Jersey.  Subsequently he  was employed as  a day laborer.  In October,
 1908, he was in good health and could walk without a cane, and had been
for some time an hod carrier.   He had very satisfactory control over all
the movements of the mutilated limb.   He received a government pension
of  fifteen dollars a month.  The  fragments of bone removed  am: num-
bered ;>!75 in the Surgical Section of  the Army Medical Museum.

           Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                           GEORGE A. OTIS,
             Bv't Lt. Col. and Ass't  Surg.  U. S. A,, Curator A. 31 31 
 
        ARMY  MEDICAL  MUSEUM.

 Photograph No. 189.
  Private Jacob Eggerstedt, McRae's Battery, was wounded at the battle
 of Valverde, New Mexico, February 21, 18G2, by a  ball which fractured
 his right humerus.  The arm was put in splints.  There was no comminu-
tion to warrant an operation for the extraction of fragments or resection.
The patient recovered from the injury;  but  with  pseudarthrosis.   He
visited the Museum in the Summer of 18G7, and his photograph was taken.

          Photographed at the Army  Medical Museum.
 BY ORDER OF THE SURGEON  GENERAL.

                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. M- M. 
 
       Jiirpoi   $>mmYt   Witt


       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  190.   Stump of Left  Thigh amputated primarily
  for Gunshot Fracture.
  Private John N. Taggart, Co. G, 1st Virginia Light Artillery, had the
shaft of his left femur shattered by a fragment of shell at Rocky Gap,
Virginia, August 26, 1803.  Surgeon Wynne, 14th Pennsylvania Cavalry,
amputated the limb at the junction of the upper thirds of the femur on
the same day, by antero-posterior flaps.  The wound healed very rapidly.
He was sent  to an hospital at Pittsburg. Pennsylvania.  In less than a
month the stump was firmly healed.   In  April, 1864, he was transferred
to the Christian Street Hospital, in  Philadelphia, and was thence dis-
charged from service on June 14,  1804.  On  November 12,  1807. Mr.
Taggart visited  the Army Medical Museum, in excellent health, and his
stump was photographed.

          Photographed at the Army Medical  Museum.

  BY ORDER OF THE SURGEON GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. Col.  and Ass't Surg.  U. S. A. Curator A. 31. 31. 
I 
        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH 191.   Successful Secondary  Excision of the Heap
   of the Left Humerus.
  Lieutenant David  H. Cortleyou, 6th New York Cavalry, was  wounded
in an affair at Bottom Bridge, June  3, 1864, by  a musket ball, which
struck the  right  side of the neck, and  lodged  in  the left  shoulder,
whence  it was  extracted on the field.  He was  admitted to  Armory
Square Hospital, at Washington, on June 10.   Surgeon D. W. Bliss, U. S.
V., on the 13th  made  an incision in the left supra clavicular region and
evacuated a large abscess; but was unable at the time to decide whether
the head of the humerus was  injured.  On  June  25, another incision was
made through the deltoid, commencing two inches below the  shoulder
joint, to evacuate pus.  On July 20.  Mr.  Cortelyou  went on  leave of
absence.  On November 24.  1864, he entered the Officer's  Hospital at
Annapolis.  Here  Surgeon  B. A. Vanderkieft,  U. S. V., removed, on
several occasions, more than fifty necrosed fragments of bone, constituting
the major portion of the head of the humerus.  On March 18, 1805, Mr.
Cortelyou was discharged from service. In December, 1867, he visited the
Army Medical Museum. He had a very useful arm.  He was subsequently
commissioned in the regular army.

           Photographed  at the Army Medical Museum.

  BY  ORDER  OF  THE SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't  Surg. U. S. A, Curator A. 31. 31. 
 
       Jiirprnt   (&mx&Yt   Witt


       ARMY MEDICAL  MUSEUM.

Photograph 192.   Successful Excision of the Head of the Left
  Humerus for Gunshot Injury.
  Sergeant Michael Dolan. Co. E, 2d United States Infantry, aged twenty-
five years,  was wounded on December 13,  1802, at the  battle of Fred-
ericksburg, and was sent to the hospital at Point Lookout, Maryland.  A
conoidal musket ball, entering  near  the lip  of  the left acromion had
lodged in the head  of  the humerus, comminuting the epiphysis, and
making fissures which extended about two inches down the shaft.   When
admitled to hospital, on December  16, he was suffering from surgical
fever, and was  in  an unfavorable  condition  to undergo  an  operation.
Interference wns postponed until March G, 1863, when Assistant Surgeon
Clinton Wagner, l. S. Army, excised the injured bone through a V shaped
incision.  The patient was anesthetized by  ether,  during the operation.
The wound healed in about a  month,  and on  February 19, the Sergeant
was discharged from hospital and commissioned as Second Lieutenant in
the 2d Infantry.   He was promoted  to a First  Lieutenantcy January 31,
1806.  In January, 1868, he visited the Army Medical Museum, and per-
mitted a photograph of the injured shoulder to be made.  He had a very
useful arm.  The excised  bone, with the  ball lodged in it, constitutes
specimen 999, of the Surgical Section of the Museum.

          Photographed at the Army Medical  Museum.

  BY ORDER OF THE  SURGEON GENERAL:

                          GEORGE  A.  OTIS,
             Be'l Lt. Col. and Ass't Surg. U. S. A. Curator A. 31. 31. 
 
       jfttuftmi   $tmmY$  §ttm,

       ARMY  MEDICAL MUSEUM.

 Photograph  No.  193.  Case of coxalgia, with luxation  of the
  Head of the Femur.
  Private Richard B. Yeaton, 16th  Massachusetts Battery, aged forty-
 four years.  Admitted to Lincoln Hospital, Washington, August 2, 1864,
 with an old dislocation of the femur  in the sciatic notch.  On February
4, 1865, he was admitted to Armory Square Hospital, and transferred to
Philadelphia,  May 26th.   He was discharged from the White  Hall
Hospital, Philadelphia,  and from the  service of the United States, on
June 23, 1865.

         Photographed at the Army Medical Museum.
 BY ORDER OF THE  SURGEON GENERAL:

                       GEORGE A.  OTIS,
           Bv't Lt. Col. and Ass't Surg. U. S. A„ Curator A. M. M. 
« 
           Sfnx^ttm  (&tnmY$   Witt


         ARMY   MEDICAL  MUSEUM.

 PHOTOGRAPH Xo. 194.    Great Shortening of  the Left Thigh,  the
   Result of  Comminuted Fracture,  of the  Upper   Third  of  the
   Femur by a  Conoidal Musket Ball,  icltlt   Remand  of  Fragment
   of Bone.

  Private John Durkin, Co. G, 11th  United States Infantry, aged  thirty years, was wounded
 nt (lettysburg, July 2, 1863, by a conoidal musket  ball, which entered the outer side of the
 upper third of the left thigh, and, passing obliquely inwards and downwards,  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 ^Y. R. Ramsey, U. 8. A., made an inci-
 sion 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,  Mas used.   At  this hospital, a surgeon who
 took charge of the case on August 19th, "found the limb lying in bed, without either splints
 in-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 September 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 trans-
 ferred to the Xewton  University Hospital at  Baltimore, where, on December 2d, Acting
 Assistant Surgeon W. S. Sniull made an incision three inches in length, down to tho injured
 part, and removed a small fragment of bone.   On February lit. 18(34, the wound was still
 suppurating freely, and presented indications  of the presence of necrosed bone.  The limb
 was shortened four inches. The patient was furloughed on June 30, 1S64, and, at its expira-
 tion, 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 disa-
 bility arising from gunshot fracture  and  " excision of  four inches of the upper third of the
 femur, performed previous to  admittance." The wound  was still suppurating, and there
 was partial anchylosis of knee.  Prior to his  admission to the  latter hospital,  there is no
 mention of an excision of the shaft of the femur.  The patient became  an  inmate of Old
 Soldiers' Home; and, on August 3, 1868, he visited the Army Medical Museum, and had his
 photograph taken. He states, that Dr. Smull excised four  inches of the shaft of femur at
 Xewton University Hospital in December, 1 Si i'l; 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 Xewton  University
Hospital, coupled with the report of  the operation made the same month, it is most plausible
t<> believe, that the great shortening  is to be attributed to causes other than excision.

             Photographed at  the Army  Medical  Museum.
   BY  ORDER  OF THE SURGEON  GENERAL:

                                GEORGE  A.  OTIS,
                                   As* t Surgi  II. S. A., Curator A.  M  it 
 
       ARMY  MEDICAL  MUSEUM.

Photograph No. 195.  Aneurism of the Innominate Artery.
  A patient of Dr.  R.  K. Stone,  of  Washington,  Mr.  Joseph Brown, a
man of about fifty years, with a huge aneurism of the innominate artery,
visited the Army Medical Museum in  July, 1868, and sat for his picture.
Tlie sac was so thinned at some points that the skin was quite discolored.
A few days subsequently, July 30, 1868, the sac ruptured, and the unfor-
tunate man instantly expired.

          Photographed at  the Army Medical  Museum.
   BY  ORDER  OF THE  SURGEON  GENERAL;

                          GEORGE A. OTIS,
             Bv't Lt. Col. and Asst Surg. U. S. A., Curator A. 31. 31. 
 
        Jjimjwb  (8«jwwr*  Witt

      ARMY  MEDICAL  MUSEUM.

Photographs Nos.  3,  196  and 197.   Case  of  successful pri-
  mary (imputation at the Hip Joint.
  Private James E. Kelly,  company  B,  56th  Pennsylvania Volunteers,
a^ed twenty-eight years, was wounded at  about 9 o'clock of the morning
of April 2D, 1*63, in a skirmish of the First  Division, First Corps, on the
Rappahannock, nearly opposite the "Pratte House," below Fredericks-
burg.  A conoidal musket ball, fired from  a  distance of about three hun-
dred yards, shattered  his left femur.  A  consultation of the senior sur-
geons of brigades decided that exarticulation of the femur was expedient,
and the operation was performed, at four in the afternoon, at the  "Fitz-
hugh House," by Surgeon Edward Shippen, U. 8. Vols.,  Surgeon-in-chief
of the  First Division.  The  single flap method was adopted, and the am-
putation was accomplished with slight loss of blood.  The patient  was at
first placed in a hospital tent, and was transferred, May 22, to the Corps
Hospital, progressing favorably.  By  May 28, all the ligatures 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 symptoms.   On July  14,  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  Washington,  and obtained
an honorable discharge from service,  and a pension.   At  this date, the
picture from which the  photograph was taken was drawn by Hospital
Steward Stauch, U. S. A., one of the artists of the Army Medical Museum.
Kelly then went to his home, near Black Lick P. 0., Indiana County, Penn-
sylvania.   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 1868. Kelly went to New York and had an artificial
limb adapted by  Dr  E.  D. Hudson. At that time the photograph was
taken.  He could  walk quite well after  the adaptation of the artificial
limb.   The specimen is preserved at the Army Medical M useum and is No,
11 IS of the Surgical Section.
          Photographed  at the Army  Medical  Museum.
   BY  ORDER OF THE  SURGEON"GENERAL:

                          GEORGE A.  OTIS,
            Bv't Lt. Col. and Ass t Surg. U. S. A., Curator A. 31. M. 
 
         #ttM|Mitt  (Jknwar*  Witt

       ARMY  MEDICAL MUSEUM.

 Photographs Xos.  3,  196  and 197.   Case  of successful pri-
   mary amputation  at the Hip Joint.
  Private James E.  Kelly, company B, 56th  Pennsylvania  Volunteers,
 aged twenty-eight years, was wounded at about 9 o'clock of the morning
 of April 29, ]H'>3, in a skirmish of the First Division, First Corps, on the
 Rappahannock, nearly opposite the "Pratte House," below  Fredericks-
 burg.  A conoidal musket ball, fired from  a distance of about three hun-
 dred ynrds, shattered  his left femur.  A  consultation of the senior sur-
 geons of brigades decided that exarticulation of the femur was expedient,
 and the operation was  performed, at four in the afternoon, at the  "Fitz-
 hugh House," by Surgeon Edward Shippen, U.  S. Vols., Surgeon-in-chief
 of the First Division.  The single flap  method was adopted, and the am-
 putation was accomplished with slight loss  of blood.  The patient was at
 first placed in a hospital tent, and was transferred, May 22, to the  Corps
 Hospital, progressing favorably.   By May  28, all the ligatures 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 symptoms.  On July 14, 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 Washington, and obtained
 an honorable discharge from service, and  a  pension.  At  this date, the
 picture from  which  the photograph was  taken was drawn by Hospital
 Steward Stanch, U.S. A., one of the artists of the  Army Medical Museum.
 Kelly then went to his home, near Black Lick P. 0., Indiana County, Penn-
 sylvania.  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 1*68. Kelly went to New York and had an artificial
limb adapted by Dr  E.  D. Hudson.   At  that time the photograph was
taken.  He could  walk quite  well after the adaptation of the artificial
limb.   The specimen is preserved at the Army Medical Museum and is No.
1148 of the Surgical Section.
         Photographed  at  the Army Medical Museum.
  BY  ORDER OF  THE  SURGEON  GENERAL:

                          GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass t Surg.  U. S. A., Curator A. 31.  M. 
 
        J^itvgeon  (&mmY&  Witt

       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH No. 198.   Successful  excision  of the Head of  the
  Right Humerus.
  Private Charles Mitchell, Co. C, 4th Cavalry, aged thirty-one years, a
rcan of good constitution and habits,  was wounded on June 2, 1867, by
the accidental discharge of his (Spencer) carbine, which he let fall, while
in a stooping posture.  The ball inflicted four wounds: a flesh wound at
the lower inner part of the  left thigh, a destruction of the last phalanx
of the left little finger,  a perforation  of the  flexors of the left forearm,
and a fracture of the left humerus.  The neck of the humerus was badly
shattered.   The ball finally lodged in  the  infra-spinatus  muscle.   Eight
hours after  the reception of the  injuries, Acting Assistant  Surgeon D.
Jackson, the post surgeon at Fort Clark, Texas, where Mitchell was sta-
tioned, excised the head and nearly one-half of the shaft  of the humerus
through a V shaped incision.  The case  progressed favorably, and the
wounds had entirely healed on October 12,  1867.  On November 10, 1867,
the patient  was discharged  from  hospital.  His term of service had ex-
pired on July 1.   He  was made a watchman  of a military storehouse at
San Antonio, Texas.   He had no  control over the movements of the arm
or forearm,  and his hand was partly paralyzed.  In June, 1868, he was
-cut to New York, and an apparatus was adapted to the limb by Dr. E. D.
Hudson.  This enabled him to move the arm and forearm sufficiently to
carry his hand to his mouth  or to  the top of the head.  At this date sen-
sation was returning in the hand, and a little more power of motion over
the fingers.
          Photographed at the Army  Medical Museum.
 BY  ORDER OF THE SURGEON  GEt. EGAL:

                         GEORGE  A.  OTIS,
            Bv't Lt. Col.  and Ass't Surg. U. S. A„ Curator A. 31 M 
* 
       ARMY  MEDICAL  MUSEUM.

Photographs Xo. 199 AND  -100.   Successful secondary angula-
   tion at the Knee Joint.
  Corporal David  D. Cole, Co. A, 2d New York Cavalry, aged twenty-
three years, was wcunded at Amelia Court House, Virginia, April 7, 1865,
by a conoidal musket  ball which passed through the left leg.   It was
thought that the tibia and fibula were uninjured.  He was  admitted to
Hick's Hospital, in Baltimore, on June 28.  The tibia had become bare
for nearly its whole  length, the limb was much tumefied,  and the inter-
muscular  spaces were filled with  pus.   On August 1,  1865, Assistant
Surgeon George M.  McGill, U. S.  A., amputated the  limb at the  knee
joint, by making a long  anterior and short posterior flap, and retaining
the patella.  The stump healed favorably.   Four months after the injury,
the patella having  greatly retracted, was drawn over the super condyloid
space  and fixed by  a bandage.   On  November 22, 1865,  Corporal Cole
was discharged from service and sent  to  New  York to have an artificial
limb applied by  Dr. E. D.  Hudson.   Tlie broad condyles  offered  an
admirable base of  support.  The cicatrix was  firm.   The limb answered
an excellent purpose.   In 18G8, Cole was  living at his home at Spring
Valley. New York, and walked without a  cane.
           Photographed at the Army Medical Museum.
   BY  ORDER OF THE SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg.  U.  S. A., Curator A. 31. 31. 
 
        ARMY  MEDICAL MUSEUM.

Photographs Xo. 199 and  200.  Successful secondary amputa-
   tion at the Knee Joint.
  Corporal David D. Cole,  Co. A, 2d New York Cavalry, aged twenty-
three years, was wounded at Amelia Court House, Virginia, April 7, 1865,
by a conoidal musket ball  which passed  through the left leg.  It was
thought that  the tibia  and  fibula were uninjured.  He was admitted to
Hick's  Hospital, in Baltimore, on June 28.  The tibia had become bare
for nearly its whole length,  the limb was much tumefied, and the inter-
muscular spaces were  filled with  pus.   On August  1, 1865, Assistant
Surgeon  George M. McGill, U. S.  A., amputated the limb at the knee
joint, by making a long anterior and short posterior flap, and retaining
the patella.  The stump healed favorably.  Four months after the injury,
the patella having greatly retracted, was drawn  over the super condyloid
space and  fixed by a bandage.   On  November 22, 1865, Corporal Cole
was discharged from service and sent to  New  York to have an artificial
limb applied by Dr. E. D.  Hudson.  The broad condyles  offered  an
admirable base of support.   The cicatrix was firm.   The limb answered
an excellent  purpose.  In 1868, Cole was living at his home at Spring
Valley, New Y'ork,  and  walked without a  cane.
           Photographed  at the Army  Medical Museum.
   BY  ORDER OF  THE  SURGEON  GENERAL:

                            GEORGE  A.  OTIS,
               Bv't Lt. Col. and Ass'tSurg. IT. S. A.,  Curator A. 31. M. 
 
        JiinjMM   i&mxniYa   Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  Xo. 201.   Results of an Excision of  the  Head
  and Upper Third of the Shaft of the Left  Humerus for Gun-
  shot Fracture, complicated by a Perforation of the Scapula.
  William T. Massey, private Co. I, 7th Illinois Volunteers, was wounded
at the  battle  of  Altoona, Georgia, October 5, 1864, by a conoidal  ball
entering anterior aspect of arm and emerging through the body of scap-
ula, below the spine, producing  a  compound comminuted fracture at
upper third of left humerus.  Seven  hours after the  reception  of the
injury, while on the field, Surgeon Sylvester II. Sawyers, 36th Iowa Vol-
unteers, excised the upper third of the shaft, removing four and a half
inches  together with the head of the humerus, through a linear incision
between the biceps and  deltoid muscles.  The wound  healed well, with
flexion of fore-arm impaired by contraction of the injured triceps extensor.
The wound through the scapula was yet open, and the arm useless for labor
when  the man was discharged the service.  His arm was shortened one
and a half inches, but was nearly normal  in size.  He was  discharged
from service  March 12, 1865, while  at Chattanooga,  Tennessee.  An
apparatus was furnished him by Dr. E. D. Hudson three years and eleven
months after the excision, which greatly improved  the  power of  moving
the limb.
           Photographed at the Army Medical  Museum.
  BY ORDER  OF THE SURGEON  GENERAL:

                           GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass't Surg.  U. S. A„ Curator A. 31 31. 
 
        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  No. 202   Excision of the Head of Left Humerus
  for Gunshot Injury.
  Henry D. Fulton, private Co. E, 30th Indiana Volunteers, was wounded
at  the battle  of Chickamauga, Georgia,  September 19,  1863, by  a
canister  shot.   The missile entered  at the surgical neck  of  the  left
humerus,  passed upward and  backward, commin ited the  head of  the
humerus,  and made its  exit beneath the base of the acromion.   The
patient was  sent to the Cumberland  hospital at Nashville, Tennessee.
Extensive exfoliation followed, and abscesses burrowed beneath the clavi-
cle  and scapula.   On November 1, 1863,  Assistant Surgeon  C. F.  Haynes,
U. S. V., excised the head of the left  humerus, the outer portion of the
acromion  process, and  a portion of the articular surface of the scapula,
through ti  linear incision on  the anterior aspect of  the arm.  The case
progressed favorably, suppuration beneath the clavicle and scapula ceased,
the external wound cicatrized,  and his general health rapidly amended.
Unfortunately, firm anchylosis took place between the scapula and upper
extremity of the  humerus, and the  muscles of the  shoulder wasted front
disuse.  The patient was transferred to  hospital at Madison, Indiana, on
March 11,  1861, and was discharged  from service April  22, 1864.   In
September,  1868, this  pensioner  went to New York,  and  was provided
with an apparatus by Dr. E.  D.  Hudson,  who reported that the shortening
of the arm was about half an inch, the motions of the  forearm and hand
were normal, that the muscles  of the shoulder were much atrophied,  and
that the only motion of the shoulder  was the limited movements permitted
by the scapula following the humerus.   Dr. Hudson  was of the opinion
that the  apparatus which he applied mechanically aided muscular-action
to a satisfactory  degree.
            Photographed at the Army Medical Museum.
   BY ORDER  OF  THE  SURGEON  GENERAL:
                            GEORGE  A.  OTIS,
              Bv't Lt. Col.  and Ass't Surg.  U. S. A., Curator A.  31. 31. 
 
        Jfttvgtoti   fttuml't  Witt

        ARMY MEdTcAL  MUSEUM.

 Photograph  No. 203.  Stump of a Reamputation at the Right
   Hip, Two and a half years Subsequent  to the  Operation.
  Private Eben E. Smith, Co.  A, 11th Maine  Volunteers, aged nineteen
 years, was wounded at the engagement at Deep
 Bottom, near Drury's Bluff, Virginia, on August
 16, 1864, by a musket ball, which fractured the
 head of the right tibia.  He was admitted to the
 Q. S. General Hospital, at Beverly, New Jersey,
 on  August  22,  1864.  On September  12th, the
 thigh was amputated at the lower third.   On
 January 19, 1865, re-amputation at the hip was
 performed by Acting Assistant  Surgeon J. H.
 Packard. On January 27th, there was secondary
 hemorrhage,  and the external  iliac  was tied.
 On  May 27th,  he was  discharged from service,
 well and strong.   He was received as a pensioner
 in the  Eastern  Branch  of the  U. S.  Military
 Asylum for Disabled Volunteer Soldiers, in May,
 1867.  On July  11,  1867, Surgeon B.  B. Breed
 had the negative taken from  which the photo-
 graph is printed, and  reported Smith  to be in
 excellent health.  In the  spring of  1870  his
 health remained  good.   He had been pensioned
and supplied with an  artificial limb.  The ne-
crosed upper extremity of  the femur  is repre-
sented in the wood cut.  A more detailed account
of the earlier history of the case will be found with Photograph No. 29.
           Photographed at  the Army Medical Museum.
  BY ORDER OF THE SURGEON  GENERAL:
                          GEORGE A. OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 31- 31.
 
I

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         JpjttgMti  ®tumY$  Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  Xo.  204.   Recovery after Shell  Wound of the
  Knee-Joint treated by Partial Primary Excision.
  Allison Shutter, Drummer, Co. C, 7th Pennsylvania Reserves, received,
in one of the earlier of the seven days' battles before Richmond, in June,
1862, a shell wound of the left knee-joint.  He was taken prisoner, and
while he was in the enemy's lines  it was decided  that primary excision
of the knee-joint  should be performed on the field.  The operation was
commenced, but was interrupted by an advance of the Union troops, who
regained the ground they had lost earlier in the day.   The 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.
On 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 dis-
charged  February  5, 1863,  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.
           Photographed at the Army  Medical Museum.
   BY ORDER OF THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. M. M. 
 
         Sfnvgeon (&tnmY*  i»fi«.

       ARMY  MEDICAL  MUSEUM.

Photograph Xo. 205.   Double Amputation of the Forearms for
  Injury caused by the Premature Explosion of a  Gun.
  Private Samuel H. Decker, Co.  I, 4th U. S. Artillery, while  ramming
his piece at tlie battle of Perry ville, Kentucky, October  8, 1862,  had half
of his right forearm, and somewhat less of the left, blown off by the pre-
mature explosion of the gun.  At the same  time his  face and chest were
badly burned.  Five hours after the accident, both forearms were ampu-
tated by the circular method, about the middle,  by an Assistant Surgeon
of the regular  army whose name he cannot recall.  He lay in the field
hospital at Perry ville until  the wounds  were partially  cicatrized, when,
on November 1st, he went  to  Louisville, Kentucky, and,  on  the 3d of
November, 1862, he was  discharged the service.  About the middle of
January, 1863,  the stumps were completely healed.   In the Autumn of
18.4, Mr. Decker began to make experiments for providing himself with
arliiicial limbs.  He produced, in March,  1865, an apparatus hitherto
unrivaled for its ingenuity and utility.  He  receives a pension of $300.00
per year, and is a doorkeeper at the House of Representatives.   On No-
vember 29, 1867, Mr. Decker visited the  Army Medical  Museum, where a
number of  photographs of his stumps were  made.   With the aid of his
ingenious apparatus he is enabled to write  legibly, to pick up any small
objects, a pin for example, to carry packages of  ordinary weight, to feed
end clothe  himself, and in one or two  instances  of  disorder in the Con-
gressional gallery has proved himself a formidable police officer.
           Photographed  at the Army Medical  Museum.
   BY  ORDER OF THE  SURGEON  GENERAL:
                           GEORGE A. OTIS,
              Bv't Lt. Col. and Ass'lSurg.  U. S. A., Curator A. 31. 31. 
4 
         $nw)w»  $tnmY#  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph, 206.  Amputation of Forearms for Injury by a
  Brick  Midline.
  Franklin Guy, brick maker, aged thirty-four years, had his hands
caught in  a steam  press, October 12, 1868.  The right hand was torn off
just above the wrist, and the left hand at the wrist.   He was conveyed to
Providence Hospital, Washington, D. C, and five and a half hours after
the reception of the injuries both forearms were amputated a little above
the carpus by Dr. J. Ford Thompson.  No haemorrhage had taken place
before the operation.  The wounds  healed with great promptitude.  On
October 23, the patient left the hospital, and in three and a half weeks,
botli stumps were completely healed.  Mr. Guy visited the Army Medical
Museum on January 13, 1869, and a photograph of the stumps was made,
and he was advised to obtain the artificial limbs devised by Mr. Decker, a
sufferer from the same mutilation, figured in Photograph 205.
          Photographed at the  Army Medical Museum.
   BY  ORDER OF THE SURGEON  GENERAL:
                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass t Surg.  U.  S. A., Curator A. 31. 31. 
 
       JiittjOT   i&vntxnl't   Witt

       ARMY  MEDfcAL  MUSEUM.

Photograph Xo.  207.   Amputation of Both Arms for Gunshot
  Injury.
  This photograph represents a discharged soldier of many months, who
was seen at the corner of Seventh street and  Pennsylvania avenue, with
a one armed companion, who turned a barrel  organ, while this more
mutilated man had suspended about  his neck a chest for alms, the lid of
which he opened by a backward movement of his left shoulder.  He was
photographed at the Museum in 186(J.  He gave his name as Sergeant War-
den; but a  history  of  t'.ie case is not found on the Surgical Records.
After a long search it  has been impracticable to  identify the case with
any of those of double  amputation reported  at this Office.  A news-
paper item states that this man was found dead  in the streets of Buffalo
in 1869.
           Photographed at the Army Medica! Museum.
  BY ORDER  OF THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg.  U. S. A., Curator A. M M. 
V 
         Jitrgwn   l&mxsiYit   Witt

        ARMY MEDfcAL MUSEUM.

 Photograph Xo. 208.  Excision of the Head and three inches of
   the Shaft of the Right Humerus for Gunshot  Injuiy.
   Private John Brink, Co. K, 11th Pennsylvania Cavalry, aged nineteen
 years, was wounded May 21,  1863, by a musket ball, which struck two
 inches below the right acromian process  and shattered the surgical neck
 of the humerus. He was with a scouting party which was fired upon by
 a guerilla band, near Windsor,  Virginia.  He  was taken at  once to the
 regimental hospital at Suffolk, and a few hours after the reception of the
 injury, Surgeon George  C.  Harlan, 11th Pennsylvania  Cavalry, excised
 the upper extremity of the bone through a straight incision on the outside
 of the arm.  Surgeon T. H. Squires, 89th New  YTork,  who saw the patient
 on June 2d, states that the patient was then  doing very well, though he
 was pale; and adds that  Dr. Harlan observed that he had lost much blood
 before and during the operation, and also mentioned that the splintering
 did not extend beyond the  anatomical neck of  the bone.  On  June 23d
 the patient was transferred to Chesapeake Hospital.  On September 23d he
 was discharged, his disability  being  rated at one-half by Surgeon A. E.
 Stocker,  U. S.  Vols , and  was pensioned from that  date   He went to
 reside at Kingston, Luzerne County, Pennsylvania.  The pension examin-
 ing surgeon for that district, Dr.  G.  Urquhart,  reported to the Pension
 Office, September 22, 1866,  that the arm  was  "entirely powerless to raise
 it or to use it in any  other position than hanging by his side."  It is
 probable that the examiner  was deceived; for the pensioner was employed
 as a telegraph operator, and always used his right hand, and could readily
 place that hand on  his left  shoulder.  In March, 1868, Dr. Harlan, ex-
 amined the patient  in Philadelphia, and found that the arm was shortened
 one inch.  Two or three  inches of the upper  extremity of the shaft must
 have been regenerated.  The arm was  nearly  normal in size.  A few
 months subsequently Brink visited the Army Medical Museum, and was
 examined by Dr. Otis and others, and it was found that the results of the
 excision were very  satisfactory.  The motion of the upper arm was better
preserved than after most cases of  excision of the head of the humerus,
and the functions of the forearm and  hand were unimpaired.
           Photographed at the Army Medical Museum.
 BY  ORDER   OF  THE SURGEON  GENERAL:
                           GEORGE  A. OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A„  Curator A. 31- M. 
 
         ARMY  MEDICAL  MUSEUM.

 Photograph  Xo.  209.   Old  United Depressed  Fracture  of the
    Cranium.
   This photograph represents the inner and outer aspects of a segment
 of a cranium, deeply indented at a point above and external  to  the right
 frontal eminence, and exhibits  the repair of  a deeply depressed fracture
 of both  tables.  Outwardly there  is  a  smooth, circular, cup like depres-
 sion, and within three  firmly  consolidated  triangular plates, the edges
 smoothed off, and the fissures  filled in with callus.   Unfortunately there
 is no account of this  accident  on  record.  The  patient, Private Thomas
 Powers, Co. D, 30th Maine Volunteers, aged forty-one years, was admitted
 to the Jarvis Hospital,  Baltimore, Maryland,  on  April  5, 1865, suffering
 from an  attack of typhoid fever, for  which he was  treated.   He  had
 nearly  recovered,  when  he suddenly grew  worse again,  and a decided
 inability  to raise  his right arm and leg could be noticed.  These symp-
 toms gradually increased, and at last his head was turned to the left side,
 and also his tongue, and  he was  entirely unable to move his right side.
 He remained in this condition for several days, being unable to take much
 medicine or  nourishment, and  died on the  2d  of  July,  1865.   At the
 autopsy, the  brain was found  turgid  with  blood,  with many  minute
 extravasations.  The  right vertebral artery was  plugged by a clot.   The
 specimen, No. 2619, Surgical Section, was presented by Surgeon De Witt
 C. Peters, U. S. Army.   In endeavoring to  trace this  case,  it  has been
 found that this patient  was a  "substitute," that  he was "mustered  in"
 July 28, 1864. and probably did not reach the  battle field till many weeks
 afterwards, if at all; but it must  have  required  a period of much more
 than  twelve  months to   have brought about the  extent of repair that is
 here  observed.  The  closure of solutions of continuity of the skull by
 complete  ossification rarely takes  place, and  when  it does, always occu-
 pies, as Rokitansky observes,  a very long period.  It is probable  that
long prior to  his enlistment as  a substitute that this man had received a
punctured fracture of the frontal region, which consolidated,  and escaped
the notice of the examining surgeon, as it subsequently escaped the notice
of the hospital physician.
           Photographed at the Army  Medical Museum.
  BY  ORDER  OF  THE  SURGEON GENERAL:
                             GEORGE   A. OTIS,
               Bv't Lt. Col. and Ass't Surg. U. S.  A., Curator A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph  Xo.  210.   Successful Primary Excision  of  the
  Head and Neck of the Right Femur.
  This case is fully described in the Report on Excisions at the Head
of the Femur for Gunshot Injury in  Circular No.  2, S. G. 0., January,
1869,  Case XXX, page 32.   There has been much dispute  as to who
should have the crdit of the operation.  It is claimed by Dr. N. Y. Leet,
late Surgeon 76th Pennsylvania Volunteers, and by Surgeon C. M.  Clark,
29th Illinois Volunteers.  The statement of Dr.  Leet is corroborated  by
the  entries on the  register of the Tenth Corps Field Hospital, and  by
reports signed by  Surgeon Barlow, 62d Ohio, and  Surgeon Kitlinger,
100th New York.  That of Dr. Clark is sustained by the patient, and by
his  attending physician Dr. G. D. Bailey, of Havana, N.  Y., where the
patient now resides.
           Photographed at the Army Medical Museum.
   BY  ORDER  OF THE  SURGEON GENERAL:
                           GEORGE  A. OTIS,
              Bv't Lt. Col. and Ass'tSurg. U. S. A., Curator A. 31. 31. 
 
        JForpoit  $$nmY$   Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 211.   Pmetratlng  Gunshot  Fracture  of the
   Cranium.
  An unknown rebel was admitted to Lincoln hospital on July 17, 1864
with a gunshot penetrating wound of skull, received at the demonstration
against Fort Stevens, Washington, D. C.  He died the same day.  The
post-mortem examination revealed a wound of the scalp two inches above
the right ear, and one-half inch in diameter.  The ball had entered the
skull through the squamous portion of the right temporal bone, making
an orifice through both tables, one and a half inches perpendicularly, and
one inch horizontally.  A fissure  extended from the  upper and anterior
edge of  this  orifice, forwards and downwards  the whole length of the
squamous suture, and another at the anterior and inferior edge extended
one and  a  half inches forwards and downwards to the tubercle.  The
brain in  the region of the wound was pulpy,  and contained a large num-
ber of spicule of bone which had been driven in by the ball.  The vessels
of the left hemisphere were very much injected, and the whole brain was
softened.  No ball could be found in the skull.   The specimen was pre-
sented to the Army Medical Museum by Acting Assistant Surgeon H. M.
Dean, and is numbered 2870 of the Surgical Section.

           Photographed at the Army Medical Museum.
  BY ORDER OF THE SURGEON  GENERAL:

                          GEORGE A. OTIS,
             Bv't Lt. Col. nnd Ass't Surg. U. S. A.. Curator A. 31. 31. 
 
          jFttnjKrn  (BmxnYs  Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 212.   Gunshot Fracture of the Cranium caused
   by a Musket Ball striking with great obliquity.
  Private Edward Yolk,To. D, 55th  Ohio Volunteers, was wounded at the
second battle of  Bull  Run, August 30,  1862, by  a  musket  ball, which
struck the forehead at a  point half an  inch  above  the right eyebrow,
comminuting  and  carrying away both tables of the os frontis, to the
extent of one and one-fourth by two  and one-fourth  inches.  He remained
on the battle field  six days, and was  then conveyed  to Washington, D. C,
and admitted  to the Emory Hospital on the 6th of  September.  About
one-third of the missile was found lodged against the fractured edge of
the frontal bone.   One-half of the plates which compose the frontal  sinus
were  found in broken  fragments  piercing the brain, and were carefully
removed.  About a teaspoonful of brain matter escaped.  There  was no
cerebral disturbance, and  the patient was perfectly conscious.  On Sep-
tember 8th, hernia  cerebri appeared, the protrusion being about the size
of a  walnut.  On  the  19th the edges of  the  wound  were healthy; the
hernia had receded, but diarrhoea supervened,  which greatly reduced the
patient's strength.  He died on the 25th of September.  The post-mortem
examination  revealed a more  extended fracture than  was supposed to
exist, reaching through the parietal to within two inches of the occipital
bone.  The orbital place of the right  superior maxillary was fractured
and depressed, and a fissure an inch  long ran down  the body of the bone.
The specimen was  contributed by Surgeon W. Clendenin, U. S. A'., and is
numbered 276 of the Surgical Section.

           Photographed at the Army  Medical  Museum.
   BY ORDER  OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U.  S. A.,  Curator A. 31.  31. 
 
        burgeon   ®tnmY»   Witt

        ARMY  MEDfcAL  MUSEUM.

 PHOTOGRAPH No.  213.    Gunshot  penetrating Fracture of the
   Frontal Bone.

   Thomas Brennen,  Private.  Co.  I, 65th  New  York  volunteers, aged
 thirty years, was struck  at the battle of Cedar  Creek, on October 19,
 1864, by a musket ball, about the  middle of the frontal bone   He was
 taken to Baltimore andadinitted into the Jarvis U. S. A.  General Hospital
 on the 24th, and died on the following day.   For two days previous to his
 death, he had hemiplegia of the left side.   At  the  autopsy twenty-four
 hours after death, the frontal bone was found to have  been perforated
 near the right  prominence.   Two pieces of bone, each the size of a dime
 were driven into  the  dura-mater for the distance of half an inch.  The
 brain substance near  the seat of  injury was very much softened.  The
 left hemisphere was  covered  with clotted blood.   The veins of both
 hemispheres were engorged  with blood.  A piece of the bullet was found in
 tlie third ventricle of  the left  hemisphere.  The specimen was  presented
 to the Army  Medical  Museum by Acting Assistant  Surgeon B. B.  Miles
 and is No. 3413 of the Surgical Section.  It consists of the vault of the
 cranium, perforated in the frontal region by  an opening three-fourths by
 one and  a  fourth inches.   Long fissures extend from  this perforation,
 and on its left edge is a partially fractured fragment of the inner table,
 au inch long and  a  fourth of an  inch  wide,  depressed quarter of an
 inch.  On the right maigin  of  the  perforation the outer table is removed
leaving a sharp edge.   It  is probable that the ball  split, a part passing
out externally.

           Photographed  at the  Army Medical Museum.
 BY  ORDER  OF THE  SURGEON GENERAL:

                           GEORGE  A.  OTIS.
              Bv't Lt. Col.  and Ass'i Surg. U. S. A., Curator A. 31  31. 
 
         Jnirpon  $nm'aV;s   Witt

       ARMY  MEDICAL  MUSEUM.

Photograph X(».  214.   Cranium Perforated by a  Musket Ball.
  This cranium was presented to the Army Medical  Museum by Surgeon
Jerome B. Green, U. S. V., and is numbered 830 of the Surgical Section.
A  musket ball entered at the centre of the left branch  of the  coronal
suture, and passed out at the posterior inferior angle of the right, parietal
bone, the opening of entrance being three-fourths of an inch, and that, of
exit one. and one-fourth  inches  in  diameter.  There is a fracture of the
right orbital plate of the frontal, of the squamous  portion of the right
temporal, and of  the body of the  right superior maxilla, probably by
contre coup.  A fracture of the occipital bone extends from the  opening
of  exit to the right jugular  foramen.  The frontal  suture remains dis-
tinct, though the  skull is that of a middle-aged  man.  The specimen is
believed to have come from the 12th  Army Corps hospital after the second
battle of Bull Run.

           Photographed  at the Army Medical Museum.
   BY ORDER  OF  THE SURGEON  GENERAL:

                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A.,  Curator A, 31. 31. 
 
         Jfanjm  (&tnmY$   Witt

       ARMY  MEDICAL  MUSEUM.

Photograph Xo.  215   Perforation of the Cranium by a Mus-
   ket Ball.
  This cranium was picked up on the first Bull Run battle-field by Dr. F.
Schaf hirt. and presented to the Army  Medical Museum.  It is numbered
3251 of the  Surgical Section.  It  displays a fracture caused by a musket
ball  which,  entering at  the right  fronto-parietal suture, and temporal
ridge, and fractured the os  frontis in  a long fissure, which runs in frunt
one inch above the orbits, and  downwards through the  greater wing of
sphenoid and squamous portion of the left temporal into  the mastoid
process.   One fissure branches off above the left orbit  and downwards
through the  maxillary sinus.  Another fissure  passes posteriorly from
the wound of entrance and upwards through the right to the left parietal
protuberance.  Another fissure downwards  through the  right auditory
meatus has divided  the petrous bone.   Yet  another fissure  passes back-
wards through the upper portion of right temporal into the occiput.  The
ball passed  out at  the upper part  of  occipital  near the inter-parietal
suture.

           Photographed  at the Army  Medical Museum.
   BY ORDER  OF  THE  SURGEON GENERAL:

                         GEORGE A.  OTIS,
             Bv't Lt. Cot. and Ass't Surg. U. S. A., Curator A. 31. 31. 
 
        $ttW)M»   1&tnml't   Witt

        ARMY  MEDICAL MUSEUM.

 Photograph  Xo. 210.   Gunshot Fracture of Slndl.

   At a post mortem examination of the  body of an unknown soldier, at
 Lincoln Hospital, September 22, 1864, it was ascertained, that a conoidal
 musket ball had entered about one and  a  half inches above the left ear,
 causing a compound comminuted fracture of the squamous portion of the
 temporal bone.  The ball was  found imbedded in the lower portion of the
 parotid gland.  The vessels of the  meninges of the brain were very much
 injected.  The middle lobe of the left  hemisphere was  softened to the
 middle corner of the lateral ventricle, which contained a small quantity
 of fluid, resembling blood.  The specimen  was contributed to the Army
 Medical Museum  by Acting  Assistant  Surgeon  H.  M. Dean,  and is
 numbered 32-34 of the  Surgical Section.  It is a section of the cranium,
 showing penetration  and fracture  of the  left temporal  bone just above
 and including the meatus auditorius  externus, with fracture  of  the
 occipital by contre coup, caused by a conoidal ball, which  is attached.
 Tlie opening is just above the  root  of the zygoma and is three-fourths of
an inch in diameter.  The condyle of the lower  jaw and the posterior
half of the  glenoid fossa are  carried away, together with the extremity
of the petrous portion of the temporal bone, the line of fracture passing
through the internal meatus auditorius.  From the left jugular foramen
two lines of fracture pass to the foramen  magnum, one in front of and
the other behind  the condyle. On the  right side  the occipital  bone is
traversed by a fracture which runs from  the foramen magnum to the
posterior angle of the right parietal.

           Photographed at the  Army Medical  Museum.
  BY  ORDER OF THE  SURGEON  GENERAL:

                           GEORGE A.  OTIS.
             Bv't Lt.  Col. and Ass't Surg. U. S. A., Curator  A. 31  31. 
 
            JiwgMra   $tnmY&   Witt



         ARMY  MEDICAL  MUSEUM.


PHOTOGRAPH  No.  217.    Successful Intermediate Excision of the

   Right Knee-Joint.

  Captain Charles Knowlton, 10th Louisiana Regiment, of Ewell's Corps, aged twenty-six
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. 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 Surgeons 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 upwards 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 sec-
tion of the femur was made obliquely downwards and backwards; the section of the tibia
was the reverse of this, so  that when the extremities were  approximated the limb was
slightly flexed. The synovial sac was  reddened and  contained a turbid flocculant 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 persulphate of iron.  There was
tumefaction about  the  joint and  burrowing of  pus, until   Acting Assistant  Surgeon
Howell D. Thomas  suggested 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 tho
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, and to dance even the  round
dances.  His address as a purser on one of the Pacific mail steamers having been discovered,
Surgeon Charles McCormick, U. S. Army, at San Francisco, examined his limb, December 17,
1868, and had made the negative from which  this  photograph  is printed.  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 grati-
fying as it is unusual.

             Photographed at  the  Army  Medical  Museum.

    BY ORDER  OF  THE  SURGEON  GENERAL:

                                 GEORGE  A.   OTIS,

                 Bv't Lt. Col. and Ass'tSurg.  U. S. A., Curator  A. 31.  M. 
 
ASW
JxjwtucC sSaaaxj. V<r&,iAJ
        JitnjMm   toraFs   Witt.

        ARMY MEDICAL MUSEUM.

Photograph No. 218.   Perforation of Stomach by a Conoidal
  Musket Ball.

  Private John  Brown, Co. I, 9th  Minnesota  Volunteers, aged twenty-
eight years, was wounded in front of Nashville, Tennessee, December 16,
1864, by a conoidal musket  ball,  which penetrated the left chest at the
cartilaginous junction of the eighth and ninth ribs, three inches below
the nipple.  On the night of the same  day he  was admitted  to Hospital
No. 8, Nashville.   The shock of injury was very great, and he suffered
intensely from sharp pain in the  chest and abdomen.   There was, also,
paralysis of motion and of  sensation in the left  lower extremity.  Ex-
pectant treatment was used, but the patient soon collapsed,  and died tit
8.30,  P.  M., on December 17, 1801.  At an autopsy,  twenty-two hours
after death, pleuritic adhesions were found; the capacity of left lung was
much  diminished; the abdominal  cavity showed evidences  of intense
peritonitis, and the viscci a were softened and of a dark green color.  The
missile had  passed downwards, inwards and backwards, and piercing the
diaphragm near its anterior  border, leaving an  opening  two inches in
length through which a portion of  omentum had  escaped into the lower
cavity of thorax, perforated  the splenic  end of the stomach, leaving an
interval  of three inches between the openings;  thence, it passed through
the transverse colon, and (cecal matter,  with a  large amount of escaped
blood, was found in the abdominal cavity; it then struck the left anterior
side of the fourth lumbar vertebra, grooving deeply its left border,  passed
through  the spinal cord to its left surface, fractured the left horizontal
and spinous processes of the third lumbar vertebra, and was found imme-
diately to the right of the second lumbar vertebra, underlying the integu-
ment and fascia of that region, very  much changed from its original shape.
The injured vertebra3 are shown in Specimen 3748, Army Medical Museum.

           Photographed  at the  Army Medical Museum.
 BY   ORDER  OF THE SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A., Curator  A. M 31. 
 
         jFurgMm  (BtmxnYs  Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  Xo.  219.   Hypcrfrophied  Prostate  Gland  and
  Bladder, containing twelve large  Uric Acid Calculi.
  This specimen was  taken  from  a private  patient, aged  sixty-seven, a
native of Frederick. Maryland,  who died August  3, 1857.  Besides the
large  concretions,  the bladder  contained numerous hemp-seed calculi,
many  of which were discharged during life.  In  1849 more than three
hundred were  discharged through  the fenestra of  a very large  catheter.
The lobes of the ptestate are much enlarged.   On the right and middle
lobes  are several ulcers.   The walls of the bladder are much thickened.
The specimen measures as follows:  from fundus to membranous portion of
urethra, six inches;  across  fundus and body of bladder,  in which the
calculi are contained, four and  one-eighth inches; from external wall of
fundus to top of middle lobs, two inches and  seven-sixteenths; thickness
of walls of bladder, seven-eighths of an inch.  The width of the left lobe
of enlarged prostate is one inch ; that  of the right  lobe two inches.  The
width  of the divided and  degenerated prostate  is four inches  and ten-
sixteenths.  An analysis of the calculi by  Dr. B. F. Craig shows that
they consist almost entirely of uric acid.   The specimen with the history
was contributed by Dr. Robert K. Stone, of Washington.

           Photographed at the Army Medical  Museum.
   BY  ORDER OF  THE SURGEON GENERAL:
                           GEORGE  A.  OTIS,
                             A**'l Surg. U. S. A., Curator A. M.  it. 
 

        ARMY  MEDfcAL  MUSEUM.

Photograph Xo. 220.   Ligamentous Preparation of tlie Bones of
   the Left Foot and  Lower Portions of the Leg Bones, from a Case
   of Confirmed Talipes Varus.
  This specimen, No. 8-32. Army Medical Museum, was taken from a Freed-
man, who died of syphilis on November 2-3, 18(5(5, at the Freedman's Hos-
pital in Washington.  It  was contributed, with the  history, by Hospital
Steward A. M. Squier, TJ  S.  A.  The foot is  completely inverted,  and the
os calcis, which is  small, is nearly parallel with the shafts  of  the leg
bones,  and presents an  irregular,  knotted  appearance.   The  patient
walked chiefly upon the anterior surface of the calcancum  and the astra-
galus and dorsal surfaces  of the other tarsal  bones.  The metatarsals are
unusually slender, and the great toe overlaps the two  adjoining ones.
           Photographed  at the  Army Medical Museum.
  BY ORDER  OF  THE  SURGEON  GENERAL:
                            GEORGE A.   OTIS,
                              Ass't Surg. U. S. A.,  Curator A. M M. 
 
       JitrgMn  ®mxml'fi  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph No. 221.
  This is a representation of Specimen 5188 of the Surgical Section of
the Army Medical Museum, showing the bones of the right leg and foot,
with a luxation forward of the astragalus.   The  fibula exhibits an extra-
ordinary concavity in its external middle third. The specimen is from
the Van Wyck private collection, and was received  with the Gibson Col-
lection.
          Photographed at the Army Medical  Museum.
 BY  ORDER OF  THE SURGEON  GENERAL:
                        GEORGE A. OTIS,
                          Ass'i Surg.  U. S. A., Curator A. M M. 
 
         jFMM}i0ti  ($>tnmYs  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph No. 222.   Ligation of  the  Abdominal Aorta for
  Aneurism.
  William Fancy, a negro of thirty years, a wood chopper, was admitted
to the Howard Grove Hospital, at Richmond, Virginia,  March 20, 1868.
He stated that a week  before while pursuing his ordinary avocation  he
felt something give  way in the  lower  part of his abdomen, a sensation
followed by nausea and great pain.  Dr. Hunter McGuire examined, and
found in the left iliac and hypogastric regions  an aneurismal tumor the
size of a goose egg.  No pulsation could be discovered in the left femoral;
but no change in the temperature  or size  of the left leg was observed.
His generel health was good.  The patient said ihat the tumor gradually
increased in size and was  daily growing worse.  Best in  bed, with dig-
italis, iron,  acetate of lead and opiates seemed to alleviate the pain and to
diminish the size of the tumor;  but the relief was but temporary.   On
March 26th, compression of the aorta was resorted to; but had to be dis-
continued because of the tenderness of  the tumor.   On March 30th, at
1, P. M., Dr. McGuire, after consultation with Professors Joynes, Wellford
and others,  determined to cut down and to ligate the common iliac above
the aneurism.  When the aneurism was  exposed, it was found to involve
the whole of the common iliac,  and the aorta near  its bifurcation.  The
sac was very thin.  Dr. McGuire now determined to tie the aorta, when  the
sac suddenly ruptured, although it had been  handled with  the utmost
delicacy,  and a profuse discharge  of blood took  place.   The  aorta was
instantly  compressed by the finger an inch above the  tumor, and sur-
rounded by an assistant with a ligature and tied.   About a pint of  blood
was removed from the  cavity of the abdomen.  The  lips of  the wound
were brought together. Sutures  and bandages were applied.   A stim-
ulating enema was  given.   The  patient was put to bed and  the lower
extremities  were  surrounded by  warm  applications.  In a few moments
the effects of chloroform passed  off, and slight reaction took  place.  He
complained  much of numbness of the lower extremities.  The temperature
of the axilla never rose above 96.  He died half an hour after midnight,
eleven and a half hours after the operation.  At the autopsy, the ligature
was found to embrace the aorta  at the origin  of the inferior mesentery
and included the left ureter.  The rent in the sac was  just over the bifur-
cation of  the aorta.  A careful report of the case is  published by Prof.
II. McGuire in the American Journal of the 31edical Sciences, Vol. LVI, p.
415  October, 1868.  The  pathological specimen was contributed to  the
Army Medical Museum by Dr.  McGuire, and is numbered 5256, Section I.
           Photographed at the Army Medical Museum.
   BY ORDER  OF THE  SURGEON  GENERAL:
                            GEORGE  A.  OTIS,
              Bv't LA. Col. and Ass't Surg. U. S. A.,  Curator  A. 31. 31. 
 
        JFiirgecm   $mxriY&   Witt


        ARMY  MEDICAL  MUSEUM.

PnoTOGRAPH' No. 228.   1'cslcal Concretions resulting from Gun-
  shot Injuries.

  This photograph represents  a series  of  seven specimens  of  foreign
bodies removed from the bladder,  all of which were  directly  or indi-
rectly the result of gunshot, injuries.  These cases will be fully described
in the forthcoming Surgical History  of  the War.  A simple memoran-
dum is here given.  The left hand  figure of the upper row, (Specimen
5019)  is a round leaden bullet slightly encrusted,  removed from the
bladder  of a South Carolinian  soldier in 1865,  by Dr. F. T. Miles,  of
Charleston.  The man was struck  at  the first battle of Bull Bun, July,
1861, above the pubes.   The wound healed kindly  and he returned  to
duty, and fought through the war,  and  never  had any  dysuria until the
march to Appomattox Court House in April, 1865, when suddenly he had
extreme pain in the  bladder, bloody urine; and other symptoms of a
foreign body in the bladder.  A few weeks subsequently,  the encrusted
ball was successfully removed by lateral lithotomy.  The middle figure  of
the upper row,  (Specimen  4712)  represents half of a urinary  calculus
formed after a  gunshot wound  of  the fundus  of the bladder, with in-
spissated mucous probably  as its nucleus, and consisting of mixed phos-
phates.  It was successfully removed  by lateral lithotomy  by Prof. J.  J.
Chisolm.  The right hand  figure,  (Specimen  5520)  represents  an iron
shrapnel ball encrusted with uric acid and triple phosphates, which was
successfully removed  by Dr. A. N.  Dougherty, at the New Jersey Home
for Disabled Soldiers, in August, 1868.  The man was wounded in April,
1865.  The operaticn done by Dr. Dougherty (formerly Medical Director
of the Second Army Corps) was by an external incision as for bilateral
lithotomy,  with a deep inci.^-ion  as  in the lateral method.  The operation
was very successful.   The  concretion weighed one  ounce and  twenty-
three grains avoirdupois.  The  left  hand figure in the lower row, (Speci-
men 5041) represents a large phosphatic  calculus sawn  in half.   Its
nucleus  is  a portion of the pubic bone, which was driven into the bladder
by a musket ball,  which passed out through  the* rectum.  Three and a
half years after the reception of the injury, this calculus was removed by
lateral lithotomy by Prof. Hunter McGuire, who  has  given an account of
the case in the Richmond 3Iedical Journal, of April,  1868.  At the time  of
its removal, the calculus weighed two and a quarter ounces.  With a good
lens, the Haversian canal in the bone  which forms the  neucles can  be
readily made out.   The two  middle figures in  the lower row, (Specimen
2507)  represent two  uric acid calculi  found post mortem in the case of a
soldier who was shot  through the  bladder at  the  second  battle of Bull
Run, by a  musket ball, which entered above the  pubes and passed down-
wards and backwards through the cocyx.  The specimen was contributed
by Surgeon D.  W,  Bliss, U. S. Vols.  The right hand lower figure, (Speci-
men 88) represents one view of  a  fragment of a grenade removed from
the bladder by Surgeon J.  F. Randolph,  U.  S.  Army.  The case is re-
corded in the Surgical Beport in Circular No. 6, Surgeon General's Office,
1865, p.  29.

           Photographed  at  the  Army Medical  Museum.

  BY  ORDER  OF THE SURGEON  GENERAL:
                            GEORGE   A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A.  31  31. 
 
          jlm|i0E  i&tnmYn  Witt

        ARMY  MEDICAL MUSEUM.

 PHOTOGRAPH Xo. 224.   Four Urinary Calculi in the collection of
   the Army Medical Museum.
   All the figures in this group are much reduced.  That on the left repre-
 sents a very large  mulberry  calculus.  Its length is two  and  a quarter
 inches, breadth one and seven-eighths inches, thickness  one  and five-
 sixteenths inches, and weight 2.48 ounces Troy.   It was removed  by
 lateral lithotomy by Dr. N. S. Lincoln, of Washington, who has published
 a description of the case in the Richmond and Louisville 3Icdical Journal.
 The next figure, (Specimen 5058) represents a  calculus presented  to the
 late Dr.  William Gibson, in 1843,  by Dr. Stout, of Easton, Pennsylvania.
 The nucleus is a large darning needle.  (See Gibson's Surgery, 7th Edi-
 tion, Vol. II, p. 230.)  It was removed from the bladder of a negro girl.
 The next figure, (Specimen 4833) represents a phosphatic calculus sawn
 asunder, and weighing 27.054 grammes.  It was obtained by exchange
 from the National  Medical College, at Washington.   The  nucleus was a
 watermelon seed.   It was removed by lithotomy from the bladder of a
 nasty fellow.  The right hand figure,  (Specimen 4866) represents a very
 large ovoid phosphatic calculus, weighing 159.53 grammes.  It was suc-
 cessfully removed from the bladder of a man  from Ohio,  by Surgeon J.
 G. F. Holston, U.   S. Vols.,  by lateral lithotomy.   Its surface is quite
 smooth, and its composition unusually homogeneous.   It is rarely that so
 large a concretion  is removed by  lithotomy without being crushed and
 removed in fragments.  The  long diameter of  this  calculus is two and
three-eighths inches, and the smallest diameter is two inches.  There are
larger vesical calculi in the collection, but they  were removed after death-
           Photographed  at the Army Medical Museum.
   BY  ORDER OF THE SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
              Bv't Lt. Col.  and Ass'tSurg. IT.  S. A., Curator A. 31. 31. 
 
          jlrajwu  $zmx%Y&  Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  Xo.  225.    Transverse Fracture  of the Femur  in
   the Middle Third by an unknown Missile.
  Elijah Brown, a colored civilian, aged fifty years, and by occupation a
farm laborer, was injured August 15, 1864, at City Point, by the explosion
of ordnance stores.  An unknown missile produced a compound fracture
of the femur in the middle third, leaving a  wound similar  to that made
by a conoidal ball.  He was  sent to Philadelphia, and,  on  August 20th,
was admitted to Satterlee Hospital,  No  foreign  body could be detected
in the wound.  The limb was shortened  some two and  a  half  or three
inches;  the thigh was much swelled;  and there was a profuse discharge
from the  wound,  and  a commencing  bed  sore over the  sacrum.  The
patient's bowels were loose,  and he was thin and debilitated, but,  withal,
was cheerful and had a good appetite.  An  angular wire splint, thought
not to meet the required indications, was removed, and a straight wooden
one, with the counter-extending band in  the perineum,  was substituted.
Fifteen drop doses of  tincture of iron were also administered three times
a day.  This treatment continued until August 27th, when  the splint was
removed, and extension made by.  means of  weights suspended from leg
by adhesive strips, husk bags being placed along either side.   This ar-
rangement, along with the  straight board splint, was  extremely incon-
venient, and could not be kept in proper order.  The bed sore had become
the source of great discomfort, the discharge being profuse and exhausting.
Simple dressings and expectant treatment were used.  On September 1st,
all appliances were removed  from the leg.  The patient was much reduced
by suppuration from the wound and from the bed sore. He was extremely
restless, and there were no  signs  of union of the fragments.  A profuse
diarrhoea withstanding all treatment now set in, and continued until the
patient's death, which occurred at 8, A. M., on September 12, 1864.  The
specimen, showing considerable exfoliation near the tivo ends of the frag-
ments, was contributed, with the history, by Acting Assistant Surgeon
A. L. Eakin.

           Photographed at the Army Medical  Museum.
   BY  ORDER OF THE SURGEON  GENERAL:
                           GEORGE A. OTIS,
                             Ass't Surg. U. S. A., Curator A. M. M. 
 
        JFuwgwm   ®tnmY&  Witt

        ARMY MEDICAL  MUSEUM.

 Photograph No. 226.   United  Simple  Fracture of the Right
   Femur of a Mound Builder.
  In 1868, Acting Assistant Surgeon  A. J. Comfort made a minute  and
 painstaking exploration of several tumuli in  the vicinity of Fort Wads-
 worth, Dakota Territory.  He was fortunate enough to obtain from these
 mounds, which, from the large size of the  trees upon their summits, were
 evidently of great antiquity,  about forty human  skeletons, more  or  less
 complete, which he  sent to the Army  Medical Museum.  They furnish
 several 'examples of  fracture of the long bones.  In  the  united fracture
 of the long bone of the femur which is exhibited in the photograph, there
 was less than two inches shortening, the length being fifteen and seven-
 eighths inches, while the companion femur, which shows a kind of post-
 mortem fracture, is seventeen and three-fourths  inches  in length.   The
 angular deformity is  slight, and the result  is  not discreditable to pre-
 historic surgery. The bones are yellow, and very fragile.  A full account
 of Dr. Comfort's interesting researches,  together with other archaelogical
reports, is in process of compilation at this Office for publication in  the
next volume of the Smithsonian Contributions to Knowledge.
           Photographed at the  Army  Medical Museum.
  BY  ORDER  OF  THE  SURGEON GENERAL:
                          GEORGE A. OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 31- 31. 
 
     .    jl'iinjMra  $>mmYs  Witt

        ARMY MEDICAL MUSEUM.

 Photograph  Xo.  227.   Distal Extremity  of the Right Femur
   showing  a Perforating  and Longitudinal  Fracture, iclth  Com-
   minution, by a Spherical Musket-shot.
  Private Reuben Donelly, Co. A, 21st Ohio Volunteer, was wounded  at
 Bull Run, August 30, 1862, by a spherical muskct-shot, which entered the
 right thigh  just above the patella, and, passing directly through the limb
 from front to rear, divided the condyles, split the shaft upward several
 inches, and  comminuted the bone at the inter2ondyloid notch.  He was
 admitted to  the King Street Hospital at Alexandria on September 3, 1862,
 and, two days afterward, Surgeon J. E. Summers, U. S. A., amputated the
 thigh at the junction of the lower and middle third by the antero-posterior
 flap operation.   The case progressed favorably until October 3d, (a cold,
 rainy day) when the patient had a severe chill, which recurred on the fol-
 lowing afternoon.  Tonics and stimulants were freely administered, not-
 withstanding which he gradually sank; absorption of the new granulations
 took place;  the edges of the flaps retracting, left the bone exposed; osteo-
 myelitis  occurred; and there was extreme emaciation, with great prostra-
tion, and inability to take or retain  nourishment or stimulants, resulting
in the death of  the patient October 20, 1862.   The specimen and history
were contributed by Acting Assistant Surgeon  Thomas 0. Barker, U. S. A.

           Photographed at the Army Medical Museum.
   BY ORDER OF  THE  SURGEON GENERAL:
                          GEORGE  A.   OTIS,
                             Ass't Surg. U. S. A., Curator A. M. M. 
 
        jliinjvM   fikiraFs   Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 22S.  Amputated Portion of the Right Femur,
  showing  United Fracture,  with a  Fragment  of Lead  Imbedded
  In the Callus.
  Private Jesse M. Jones, Co. K, 21st Indiana Volunteers, aged twenty-
nine years, was wounded at Baton  Rouge, Louisiana, August 5, 1862, by
a musket ball, which fractured the right  femur at the junction of middle
and upper third.  He  was taken to  the regimental hospital  the night
after, remained a  day, and was  thence sent  by a transport steamer  to
New Orleans,  the limb meanwhile being supported by bandages and
pillows.   On arrival, August 7th, he was  admitted to the St. James Hos-
pital, where a long splint was applied, seventeen days after the reception of
the wound.  The patient was discharged the service April 15, 1863, since
when, up to January, 1809, he suffered much pain from frequent exfolia-
tions and abscesses.  At the latter date, he entered  Providence Hospital
at Washington ; and on the 23d, Doctor D. W. Bli*s, late Surgeon, U. S. V.,
amputated the  thigh in the upper third, and  afterwards contributed the
pathological specimen to the  Army Medical Museum.  It  is No. 5558 of
the Surgical Section, and shows great, deformity and exfoliations on pos-
terior aspect.   On  March 9, 1869, he visited the Museum, recovered, and
his  photograph was taken to accompany the specimen.  (A. M. M. Card
Photographs, Vol.  1, page 27.)

           Photographed  at the Army Medical Museum.
  BY ORDER  OF  THE SURGEON  GENERAL:
                           GEORGE  A. OTIS,
                             Ass't Surg. U. S. A., Curator A. M M. 
 
        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 229.  Lower Half of tlie Left Femur  Success-
  fully Amputated.

  Private  C.  H.  Bowen,  Co.  A,  27th Indiana Volunteers, had his left
femur fractured by a musket ball, at the battle of Antietam, on September
17, 1862.  He was admitted to Hospital No. 1, at Frederick, Maryland,
where Buck's apparatus was applied.  Nine months subsequently, he was
removed to Baltimore.   There were numerous  abscesses, and the patient
underwent two operations for the removal of necrosed bone.  On Septem-
ber 7, 1863, he was discharged the service, with the limb greatly deformed.
He received a pension, and was employed  in  the  Interior Department.
Owing to recurrence of abscesses he was admitted to Providence Hospital
in the autumn of  1867, and on November lltlr, the limb was amputated in
the middle third by Dr. D. W. Bliss.   The wound healed well, and a pho-
tograph was taken at the Army Medical  Museum on January 9, 1868, at
which time the stump was firm and  healthy.   The specimen, with the
history, was cont ributed by the operator.  The fragments are considerably
overlapped, having  undergone unusual disturbance, and  the amount of
callus exceeds what is necessary for complete union.

           Photographed at the Army Medical Museum.
   BY  ORDER OF THE  SURGEON GENERAL:
                           GEORGE A.  OTIS,
                             Ass't Surg.  U. S. A., Curator A. M. il. 
 
         Jfanjoon  fBxnmY&  Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 230.   The Greater Portion of the Right Femur,
  exhibiting an oblique Fracture, from  a  Conoidal  Musket  Ball
  Impinging against the Inner Aspect, a little below the Middle.
  Private James H. Wager, Co. H.  125th New York Volunteers, aged
twenty-one years, was wounded at the battle of Hatcher's Run, on April
2, 1865, by a conoidal musket ball which passing upward  and  backward
and producing two wounds, fractured the right femur at the junction of
the lower and middle third.  He was sent to the field hospital of the 2d
Corps at City  Point, Virginia,  and, on the 4th, was transferred to the
Douglas Hospital at Washington, where he arrived, on the 5th, in a very
low condition,  being anaemic and debilitated,  with rapid  pulse,  flushed
cheeks, and icterus.   The knee joint  was also much swollen.  The fol-
lowing day  he  was  etherized  and the wound thoroughly examined  by
Acting  Assistant Surgeon C.  Carvallo,  who  extracted pieces of bullet
from each wound.  Stimulants and concentrated nourishment were freely
administered without  effect,  and the patient died from  exhaustion on
April 10,  18G5.  At  the autopsy, twelve hours after death, decomposition
was rapidly setting in;  the thoracic and abdominal viscera appeared
healthy; the fractured femur was disarticulated and sawn  longitudinally,
the  medullary  substance appearing inflamed, red and hardened.  The
case is interesting from the number of pieces into which the bullet was
split; viz., one which made its exit, two taken from the wounds, and one
found near the  bone at the post mortem, making four  in all. The patho-
logical specimen was contributed by Assistant Surgeon  W. F. Norris, U.
S. A., and is No. 3168 of the Surgical  Section.

           Photographed  at the Army Medical  Museum.
   BY  ORDER OF THE SURGEON GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A.,  Curator A. M. il. 
 
         JNrgtan  (&xnmY$  Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo.  231.  Lower Half of Right Femur, exhibit-
  ing an Osteoplastic Operation and a Secondary Amputation.
  Private Grey Y. Barrett, Co. F, 5th  New Hampshire Volunteers, aged
twenty years, was wounded at Fredericksburg on December 13, 1862, by
a musket ball, which entered the outer condyle, 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 First Division, Ninth
Corps, where, on the 16th, Assistant Surgeon J. W. S. Gouley, U. S. A., am-
putated the  femur a short distance above the wound of entrance, the pa-
tella being  included in the anterior flap;  the line of section not having
escaped the  wound, another third of an inch was removed; the femoral
surface of the patella  was then sawn off, and the two cut surfaces of the
bone were brought in apposition.  The laminated portion of the femur,
however, was fractured half an inch above this point, and fissures extended
two inches further.  On  the sixth  day 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 haemorrhage from the propliteal.  No plastic deposit could be
observed immediately  after the operation.  On the  next  day he was
transferred to Washington, and  admitted to the Douglas Hospital, where
he died on December 27, 1862.   The pathological specimen,  which is No.
536, Surgical Section,  was contributed, with  the history, by Surgeon J.
P. Prince, 36th Massachusetts Volunteers.

           Photographed at the  Army Medical Museum.
   BY ORDER OF THE SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A.,  Curator A. 31. M. 
 
         JFiMgnm  (&tnttnYs  Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo.  232.   Shaft  of  the  Left  Femur,  exhibiting
   Comminution  in the Middle Third, with Extensive  Longitudinal
   Fracture, produced by a Conoidal Musket Ball.
  Private Thomas Holmes,  Co.  D,  1st  Michigan  Sharpshooters,  aged
twenty years, was  wounded at Spottsylvania Court  House on  May
10, 1864, by a conoidal  musket  ball, which entered  the inner aspect of
the left thigh,  one inch above the patella, and, passing upwards and out-
wards, made its exit ou the  outer surface of thigh  at  the middle third.
He was carried nine  miles in an ambulance to the general hospital at
Fredericksburg, and  was, afterwards, admitted  to  the Armory  Square
Hospital at Washington on  May  26,  1864.  No  apparatus had  been
applied to the limb.  Shortly after admission chloroform was adminis-
tered, but, after a consultation, it was decided that he could not bear am-
putation.  The injured limb was then placed in a fracture box, and
strong stimulants were given.  The patient lingered until June 10, 1864,
when  he  died from exhaustion.  The pathological specimen, which is
superficially necrosed, was contributed, with history, to the Army Med-
ical Museum by Surgeon D. W. Bliss, U. S. V.,  and is numbered 2486,
in  the Surgical Section.
           Photographed at the  Army  Medical Museum.
   BY  ORDER  OF  THE  SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg. U. S. A., Curator A. 31. M. 
 
       ARMY  MEDfCAL MUSEUM.

Photograph No. 233.  Reproduction  of the  Metacarpals and
  Phalanges after Necrosis.
  The specimen is  from the Gibson Collection, and is numbered 5251 of
the Surgical Section, Army Medical Museum.
          Photographed  at the Army  Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                           Ass't Surg. U. S. A., Curator A. M M. 
 
        J>nnjnm   <&mx&Ys   Witt.

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH Xo. 234.  Excision of Five  Inches of the Shaft of
   the Right Humirus.
  Private Herman L. Maynard,  Co.  C,  17th  New  Hamshire Volunteers,
aged thirty-one years, was wounded  at Olustee,  Florida, on February 20,
1864, by a conoidal musket, ball,  which entered the right arm at the middle
and outer aspect, and fractured  the humerus at the upper third.   On the
25th, he was admitted from Jacksonville, Florida, to the hospital at Hilton
Head, South Carolina, where the arm was  unsuccessfully treated with
splints.  On March 9th, being etherized, a portion of the bone, about five
inches long, was excised.  The arm was much  swollen, very painful, and
the soft parts  were much lacerated.   His constitutional condition was
good.   Water dressings and a concave coaptation splint were applied.  In
about two months, there was sufficient deposit of bone to  render the arm
firm without shortening.  On June 25th, the patient was admitted  to the
Central Park Hospital, New York City.  The wound  was in  a sloughing
condition, and numerous fragments of exfoliated bone  were removed.
He was discharged the service   on September  7, 1864, at which date the
wound was reported healed and  the  arm firm.   On September 14, 1864,
Pension Examiner J. Clough reported  the wound discharging profusely,
and,  every  few  days,  pieces of bone  were extracted.    The arm  was
anchylosed, and he rated  his disability total and doubtful.   On August 12,
1869, a photograph  was taken, which was contributed to the Army Medical
Museum by Dr. J. 0. Webster,  of the  National Asylum  for Discharged
Volunteer Soldiers at Augusta, Maine.   The limb was almost as strong as
its fellow, but it had shortened nearly two inches, and the wound of exit
had not healed.
              Printed at the  Army  Medical Museum.
  BY  ORDER  OF  THE  SURGEON  GENERAL:
                           GEORGE  A.  OTIS.
                             Ass't Surg. U. S. A., Curator A.  M  31. 
 
          ^'ttnjwa  $>mmY#   Witt

          ARMY  MEDICAL MUSEUM.

   PHOTOGRAPH  Xo.  235.   Partial  Recovery from  a  Compound
     Fracture of the Left Thigh in  the  Upper  Third, caused by a
     Conoidal Musket Ball.
     Private  Thomas Welch, Co. F, 6th Maine  Volunteers,  aged  twenty
   years, was wounded on November 7, 1863, at Rappahannock Station, Vir-
   ginia, by a  conoidal musket ball, which entered the front  aspect of the
   left thigh in the upper third, fractured the femur, and escaped at  a point
   nearly opposite.  When admitted to Armory Square Hospital, on Novem-
   ber 9, 18C>3, his limb was slung in a frame, with a. weight suspended from
;   the foot, which was removed a few days afterward.   Two pieces of bullet
   were extracted, and cold water dressings applied.   On May 26, 1864, he
   was sent to Chester Hospital, Pennsylvania, and on March 7, 1865,  was
   transferred  to the Satterlee Hospital at Philadelphia. He was discharged
   the service  March 2D,  1865, by expiration of enlistment, and pensioned.
   On August  20, 1866, Pension Examiner J. Cummiskey reported  the in-
   jured limb shortened some three inches, and completely anchylosed at the
   knee joint.  Exfoliation was still  going on and the patient suffered much
   pain, and was obliged to use a crutch, the limb being entirely useless.
   On August  20, 1869, at  the time the photograph was taken, he had good
   use of the limb; but it felt weaker than the other, and was apt to swell
   if he walked much.  He then walked without a cane, and was an  inmate
   of the  National Asylum for  Disabled Volunteer  Soldiers at  Augusta,
   Maine.
             Photographed at  the Army Medical  Museum.
    BY ORDER  OF THE SURGEON  GENERAL:
                             GEORGE A.  OTIS,
                               Ass't Surg. U. S. A., Curator A. 31 M.
I 
 
            jFnrjjrxrn   ®>tnmY$   Witt

            ARMY  MEDICAL  MUSEUM.

    PHOTOGRAPH Xo.  23G.  Partial Recovery after Compound  Com-
       minuted Fracture of the Femur by a  Connoidal Bullet.
      Private Michael Murtha, Co. II,  159th  New  York" Volunteers, aged
    eighteen years, was wounded on April 14, 1863, in an engagement at Irish
    Bend, Louisiana, by a conoidal musket ball,  which entcredthe right thigh
    anteriorly in its upper third,  and escaping at a point nearly opposite,
    lodged in the pants.  On the 17th, he was admitted to the Marine Hospital
    at New Orleans, where the limb was treated by sand bags, and by manual
    extension once daily.   It united in bad shape, and another Surgeon com-
    ing in charge, it was  rebroken, and Boyer's splint was applied.  He was
    able to bear his weight on  it about eight  months afterward.  On March
    9, 1864, he was transferred to the Veteran Reserve Corps, the limb having
|    shortened three inches.  On August 24, 1864, he was admitted, for chronic
    ulcer, to the Augur Hospital at Alexandria, Virginia, from Camp Distri-
    bution, and on August 27th was transferred to the Second Division Hos-
    pital at the same place.  lie was  discharged  the service  May 31, 1865,
    and was pensioned. On July 28,  1865, Pension  Examiner Charles Row-
    land reported that the patient  suffered  from a large abscess, from  which
    many pieces of bone  had been extracted.    He was  quite lame, being
    obliged to walk with a crutch.  His habits  were moral and  temperate.
    His disability is rated total and  permanent.  On  August 14, 1869, at
    which time a photograph  was  taken, the patient was  an inmate of the
    National Asylum for  Disabled  Volunteer Soldiers  at  Augusta, Maine.
    The wound had not healed, and the  thigh discharged in four places, but,
    with the assistance of  a cane, he was able to walk comfortably.

               Photographed at the Army Medical Museum.
      BY ORDER  OF THE   SURGEON GENERAL:
                               GEORGE  A. OTIS,
                                Ass't Surg.  U. S. A., Curator A. M- M. 
 
        J^nrgjoa   (&mx%Y&   Witt

        ARMY  MEDICAL  MUSEUM.

Photograph Xo. 237.   Successful Excision of the Left Tibia.
  Lieutenant 0. R. Tj'ler, Battery I, 2d Connecticut Heavy Artillery, was
wounded at Opequan Creek, near Winchester, Virginia, on September 19,
1864, by a conoidal musket  ball, which fractured  and  comminuted the
left tibia in the middle third.  On the same day  he  was sent to the depot
field  hospital, where  Surgeon  Henry  Plumb,  2d  Connecticut Heavy
Artillery, by a linear incision  along the inner  anterior aspect, excised
three inches of the bone, which  was much  comminuted.  The patient's
general condition was satisfactory;  simple dressings were applied.  On
November 12th he was transferred to the hospital at Frederick, Maryland,
where, on December 15th, the missile and fragments of bone were removed.
By January 1>, 1865, when he was furloughed,  there had been no bony
deposit in the interspace.  He was discharged from service March 9, 1865.
In June, 1865, Dr. E. D. Hudson, who furnished  the patient an apparatus
for supporting the limb, reported that  there was no shortening of the
leg, but that it was considerably atrophied, with lateral excurvature; the
head of the fibula was partially detached by reluxation of the ligaments,
and the flexor muscles of the foot were impaired.  A thin osseous tissue,
not continuous or united,  sjpplied the  place  of the missing  bone, but
afforded  no support.
           Photographed  at the Army Medical Museum.
 BY  ORDER OF THE  SURGEON  GENERAL:
                           GEORGE A. OTIS,
                             Ass't Surg. U. S. A., Curator A. ii  H. 
 
      fnrgwrn  (g^ml's   Witt

      ARMY MEDICAL  MUSEUM.

Photograph Xo. 238.  A Cranium, with  the Atlas luxated to
  the Right and Firmly Ossified to the Occipital Condyles.
  The specimen is 5119 of the Surgical Section, and formerly was No.
115 of the Gibson Collection.
         Photographed at the  Army Medical Museum.
 BY ORDER OF THE SURGEON GENERAL:
                      GEORGE A. OTIS,
                       Ass'r Surg. U. S. A., Curator A. M M. 
 
                         &e»*rxlviS  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph Xo.  239   Shaft  and Proximal  Extremity  of the
  Left Femur, showing Lateral Deformity, with  Necrosis and Ex-
  foliation, the Result of a  Gunshot Wound.
  Private M. D. Powell, Co. H, 26th Alabama Regiment, aged twenty-two
years, was wounded at Antietam, September 17, 1862, by a missile, which
produced a compound comminuted fracture of  the upper third of the left
femur and lodged.  He was admitted to the Hospital  at Frederick, Mary-
land,  January  2, 1*63.   No apparatus  was applied; but the limb was
placed in easy position  under a pillow, the missile was  extracted, and
nitric acid was applied  to the sloughing wound.  On January 26th. the
wound had an unhealthy appearance, at first supposed to  be gangrenous.
The  patient had a troublesome cough, for which a stimulating cough-
mixture  and cups  to chest were prescribed.   His general condition im-
proved until ervsipelas  set in, which was ineffectually  treated by the
expectant plan.  He died March  16. 1863,  from exhaustion.  At the
autopsy, the fracture was found united at  an angle of forty-five degrees;
the  hip-joint contained  pus,  and  the cartilage of the acetabulum was
softened. There was bronchitis in the upper lobe of the right lung, and
a calcareous deposit, of buckshot  size, was found  in the middle lobe.
The  heart and liver were fatty, and in the  pelvis of the kidneys phos-
phatic deposits  were found.  The specimen, which is No. 3841, Surgical
Section,  was contributed by Assistant Surgeon R, F.  Weir, U.  S. A.

           Photographed at the  Army  Medical Museum.
   BY ORDER OF THE  SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A., Curator  A. 31. if. 
 
       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH  Xo. 240.   Dislocation of the  Occipital Bone from
  the Atlas, with Osseous Anchylosis.
  This specimen, which is No. 5118 of the  Surgical Section, is  marked
Paris, 1847, and,  formerly, was  No. 155 of  the Gibson  Collection.   The
atlas is dislocated laterally and to the right, the lateral masses and  right
lamina? being strongly united to the  occipital bone.  The rudimentary
spinous process is wanting, and the laminae do not  unite.
           Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                              Ass't Surg.  U. S. A., Curator  A. M M. 
 
        $j>nx$ttin   ®mxal'*   Witt


        ARMY  MEDfCAL  MUSEUM.

PHOTOGRAPH Xo. 241.   Tubular Sequestra from Two Stumps of
   Femur after Amputation

  Private John Nash, Co. G, 143d Pennsylvania Volunteers, aged twenty-
one years, wis wounded in an engagement  at North  Anna  River, Vir-
ginia, May 24, 1864, by a ball which  fractured the right knee-joint.  On
the same day, he was admitted to the hospital of the Fourth Division, Fifth
Corps: thence, was conveyed on a transport to Washington, and, admitted,
on May 29th, to the Armory Square Hospital.  While  on the way,  on the
28th, his thigh had been amputated at the lower third.  By December 21 st,
he was pronounced convalescent, and was transferred to Judiciary Square
Hospital.  Suppuration indicating the presence of dead bone, Acting As-
sistant Surgeon F. II. Hill,  on April 9,  1865, removed  the sequestrum.
The patient was discharged from service  on June 22,1865, and pensioned,
his disability being rated total.  The  sequestrum  was contributed to the
Army Medical Museum  by  Surgeon E.  Griswold, U. S. V., and is num-
bered 144 of the  Surgical  Section.   It  is  about eight inches long and
completely tubular, and is represented on the right of the photograph.
  Private John Glassie, Co. B,  63d New York  Volunteers,  aged twenty-
two years, was wounded  at  Cold  Harbor,  Virginia,  June 3, 1864, by a
canister-shot which fractured the  left ankle-joint.   On the same day, he
was admitted to the hospital of the First Division, Second Corps, where
Surgeon P. E.  Hubon, 28th Massachusetts  Volunteers,  amputated the
lower third of the leg.  On the 11th, he  arrived at Washington, and was
admitted to the Emory Hospital, where, on the 25th, Surgeon  N.  B.
Mosely, U. S. V.,  amputated the lower third of the thigh by the bi-lateral
flap operation.  Extensive sloughing ensued, the femur became diseased,
and gangrene supervened.  An  abscess  that had formed, was opened on
October 12th, and poultices were  applied.   On November 1st, the stump
was much swollen, and was still  discharging;  and on  March 11, 1865,
when he was transferred and  admitted  to  Central Park Hospital, New
York City, the end of stump was reported  red  and inflamed, with three
sinuses leading to necrosed  bone.  On March 19th, Acting Assistant Sur-
geon S. Teats made an incision on face of stump and removed the seques-
trum.   The patient was discharged from service on August 15,  1865, and
pensioned, his  disability being  rated total.  The  sequestrum was con-
tributed to the Army Medical Museum by  the operator, and is No. 3100
of the Surgical Section.  It is eight inches long, is tubular,  and is repre-
sented on the left of the photograph.
           Photographed at the Army Medical Museum.
  BY ORDER  OF THE SURGEON  GENERAL:

                           GEORGE A.  OTIS,
                             Ass't Surg.  U. S.  A.,  Curator A. M M. 
 
         JFurjjMrtt  (&mxnY&  Witt

       ARMY MEDICAL  MUSEUM.

Photograph No. 242.   Upper Portion of the Right Femur show-
  ing  its  Condition Eleven Months  after  Fracture by a  Conoidal
  Musket Ball.
  Lieutenant George A. Connor, Co. A, 7th West Virginia Volunteers, aged
twenty-four years, was wounded at Beam's Station, August 25, 1864, by a
conoidal musket ball, which  fractured  the  femur at the junction of  the
middle  with the upper third, and caused considerable haemorrhage.   His
limb was placed on a lateral splint whilst on the  field.   On August 28th,
he was  admitted to the Armory  Square Hospital at Washington  in a very
feeble condition and suffering intense pain.  Stimulants and  anodynes
were freely administered, and the limb was placed in a fracture box with-
out  extension.  On November 5th,  the patient  had intermittent fever,
which,  continuing five days, was checked by quinine.  On April 1st,  the
femur had united, but sinuses extended to  the necrosed bone which  the
patient at first refused  to  have removed;  however, becoming much
emaciated and daily loosing strength, he consented to the operation, and,
on June 21th, Surgeon D. W. Bliss, U. S. V., removed portions of necrosed
bone and fragments of lead.   He suffered  greatly from the effects of  the
operation for three days subsequently, when healthy granulationsappeared.
In the meantime, he was  treated expectantly.  On July 10th, an uncon-
trollable diarrhoea set in,  and he died from exhaustion  on July  31,  1865.
The pathological specimen, showing a  certain degree  of union  by folia-
ceous callus, was contributed, with the history, to the Army Medical
Museum by Acting Assistant Surgeon C.  B. Porter,  and is  No. 4382,
Surgical Section.

           Photographed at the Army  Medical  Museum.
  BY  ORDER OF THE  SURGEON GENERAL:
                           GEORGE A. OTIS,
                             Ass't Surg. U. S. A., Curator A. M. il. 
 
          ARMY   MEDICAL   MUSEUM.


PHOTOGRAPH  Xo.  243.     Sequestra  removed from  Femurs  after

   Amputation.

  Private William B. Biddle,  Co. K, 138th Pennsylvania Volunteers, aged twenty-seven years,
was wounded at Cedar Creek, Virginia,  October  19, 1864, by a conoidal musket ball, which
struck the extemal condyle of the left femur and penetrated the knee joint.  On the same
day, he was admitted to field hospital;  his wound  was dressed;  and. on the '24th,  he was
transferred to Baltimore, and admitted to the  Jarvis Hospital, where Acting Assistant Sur-
geon B. B. Miles administered  ether, and amputated  the  thigh, at the lower third, by the
circular operation.  On February 22, lM3o. a sequestrum, about four inches long, was removed,
and was contributed, by the operator, to the Army Medical Museum, where it  is Xo. 109 of
the Surgical Section,  i'he patient was  furloughed  on March  20th, and, on April 25th, was
admitted to the South Street Hospital at Philadelphia.  On  May  9th,  he was sent to the
Hospital  at Chester, Pennsylvania, where, on  July  IS. 1865,  he was discharged the  service
and pensioned, his disability  being rated at three-tourths.
  Private .lames M. Knnyaii. Co. H,  59th  Now  York  Volunteers, aged  sixteen years, was
wounded at Antietain. September 17, 1862, by a projectile which struck the right thigh.  He
was conveyed to tin- field hospital at the Sherman House, where the wound was considered
so serious that the thigh was amputated in the  middle  third  by the circular method.  No
further details of the case can  be found until October 17th.  when he was admitted to the
hospital at Smoketown, Maryland, suffering from diarrhoea, and the stump, with about two
inches of the bone protruding,  and covered with maggots,  was secreting an ichorous pus,
and showing some gangrenous spots.  The protruding bone was removed with a chain saw:
the diarrhoea was checked in a few days, by the use of injections, and a nourishing diet; the
stump was covered with a cold poultice of yeast and  charcoal, and as soon as it presented
the desired healthy appearance, a dry linen compress was applied.   By January 20,1863, the
stump had healed "with a slight protrusion of the femur.  Attempts were  made to remove
the sequestrum without instrumental interference, but it was not till March 14th, that the
result was successful.  The specimen  is about live inches long,  and was contributed to the
Army Medical Museum by the operator,  Surgeon B. A. Vauderkieft, where it is Xo.  1041 of
the Surgical Section.  The patient recovered, was discharged from service on May 4,1S63, and
was pensioned, his disability being rated total and permanent.
  Private Peter Walker, Co"  C.  37th  'Wisconsin  Volunteers, aged  thirty-eight years, was
wounded at Cold Harbor. Virginia, June Is. 1864, by a ball which severely wounded the right
knee joint; lie also received  a gunshot flesh  wound of the  left thigh.  He was admitted to
the  hospital  of  the Third  Division, Ninth Corps.   The injured knee  being lacerated
and much swollen, Surgeon S S. French, 20th Michigan Volunteers,  amputated the right
thigh, at  the junction of the lower thirds,  by the circular method. He was sent to Wash-
ington, and was admitted to the Emory Hospital  on June  24, 1864, where a tubular  seques-
trum of bone, four inches long  was  extracted from the stump;  but the  patient died on
August 22. 1864.  The sequestrum was contributed to the Army Medical Museum by Surgeon
N It Most'] v. U. S. V., and is numbered 312S of the Surgical Section.
  Private John Frederick. Co. D, 15th Massachusetts Volunteers, aged  thirty-five years, was
wounded  at Bristow Station, Virginia,  October  14, 186::,  by  a fragment of  shell, which
entered the middle third of the left thigh posteriorly, and. passing directly forwards, pro-
duced a comminuted fracture of the femur, with  great  destruction of the muscular tissue.
He lay neglected on the field until the afternoon of the next day,  when he was conveyed, a
prisoner,  to Gordonsville, where the  thigh was  amputated, by the circular method, at the
junction'of the upper thirds.  On November 8th,  he arrived at Annapolis, from Richmond.
and was admitted to the First  Division  Hospital.  The patient gave evidence of  haying
endured considerable exposure and neglect, and made the above statement.  He complained
of diarrhoea and loss of appetite;  the wound was  open, the skin retracted, and the sawn
extremity of the femur protruded an inch and a half;  but it was thought advisable  to pur-
Bue the expectant plan, and, accordingly, the stump was dressed with alcohol, and generous
diet was ordered.  By December 1st, the  diarrhoea was no longer troublesome, his appetite
was good  and the stump was granulating finely, and slowly extending towards extremity
of bone one inch, onlv, remaining exposed.   On  January  20, 1864, a sequestrum was first
detected  but not being sufficiently loose, it was  allowed  to  remain for the present.  4 he
thigh "-r'adually enlarged four inches in circumference, and, on  the 1st of April, the  patient
suffering severely from the presence of necrosed bone, be was chloroformed, and Surgeon 1).
A Vanderkieft U  S V.., seized the extremity with huge forceps, and,by a combined  motion
of traction and rotation, removed the separated portion,  entire.   The  operation was per-
fectly successful;  and,  on May  24,  1864, the patient was discharged the service, and was
pensioned for  disability, rated at total.  The  specimen,  which is tubular and  nearly five
inches long, was contributed, with the history, by Assistant surgeon V\. S. Idy, U. fc.  V.. and
is numbered 22o2 of the Surgical Section.

              Photographed at the  Army  Medical Museum.

   BY  ORDER  OF  THE  SURGEON GENERAL:

                                   GEORGE  A.   OTIS,
                                      Ass't Surg.  U.  S. A.,  Curator A.  31. M. 
 
        ARMY  MEDICAL  MUSEUM.

Photograph  No. 244.   Necrosis and  Exfoliation and Deposits
  of Spongy Callus after a Gunshot Fracture of the Left Femur.

  Private John  E.  Keith,  Co. C.  13th  Massachusetts Volunteers, aged
twenty years, received a gunshot fracture of the lower third of the left
femur, at the second battle of  Bull Run, August 30, 1862.  He lay on the
field until September 2d, when he was removed to Washington in a wagon
so heavily laden with wounded that the  springs  were no protection from
the  jolting of the wagon over  the rough  roads.  The fracture  being com-
minuted and very  oblique, the  patient  suffered  intensely  during the
journey, and when  he was admitted to the Ascension  Hospital, the lower
fragment of  the femur was protruding through the external wound to the
extent of an inch.   After restoratives had been given him, he was etherized
and the fracture was coaptated without much  difiieulty.  The limb was
then suspended by Smith's anterior splint,  and cold water was applied,
and tonics with a nutritious regimen were prescribed.  At the beginning
of the third week abscesses began to accumulate in the inner and posterior
lower portion of the thigh,  and bursting through the skin in numerous
places discharged profusely.  The openings were so  numerous that the
rollers used  to confine the  splint could  not be  applied without covering
some of them, which necessitated their daily removal, and as the patient
could not  endure the slightest handling of the limb he was partially
etherized every day while  the warm weather  continued and afterwards
every other  day, in order to  apply clean rollers around the splint and
renew the dressings.  Liquor soda} chlorinate, diluted with four parts of
water was freely used at each dressing, being injected through the open-
ings by a syringe.   To add to the discomfort of the patient, about the end
of  the fifth week gangrene of the integuments of the sacro-lumbar region
and the iliac projections set in, and the patient was transferred to a water
bed, but now it was found impossible to  keep  the limb from rolling and
causing great agony.  The anterior splint was removed, and one similar
to Desault's substituted, with  a short anterior  one, it being impossible to
apply them  either  laterally or posteriorly on account of the number of
openings.   The fragments  remained in apposition rather better  by this
apparatus;  but it was so uncomfortable that it was removed in a few days
and there being no hope of union, short splints covered with oiled silk
were placed around tlie thigh, and the leg swung in a fracture  box  this
being the most comfortable support  that could be devised.  He died  on
October 24  18»ili   The limb  was examined six hours after  death,  ihe
soft parts from the knee  to  the  groin were utterly disorganized  The
femur was removed and sent  to the Army Medical Museum   The broken
extremities  were covered with spongy  callus;  but a cylindrical seques-
trum interposed between the  fragments, and there was no union.

            Photographed at the Army Medical Museum.

  BY  ORDER OF THE  SURGEON  GENERAL:
                             GEORGE  A.  OTIS,
               Bv't Lt. Col. and Ass't Surg.  U. S. A., Curator A. 31. 31. 
 
         JFitvgeon  fatntxtiYn  Witt

       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH  No. 245.  Upper Portion  of  the  Right  Femur
  fractured by a Conoidal Musket Ball just below the Trochanters,
  with Profuse Deposit of Callus without Union.
  Private S. Manley, Co. A, 63d New York Volunteers, aged twenty-six
years, was wounded  at the battle of Gettysburg, July 2, 1863, by a con-
oidal musket  ball, which  fractured the upper third of the right femur.
He was sent to Camp Letterman Hospital at Gettysburg on August 4th,
where the limb was treated by  the double inclined  plane and  simple
dressings.  Partial union had taken place.   On September 3d there was
a profuse discharge from the wound, and the patient was rapidly sinking.
There was, also, great shortening of the limb.  He died October 8, 1863.
The history reports "a complete  false joint, the head and socket being
covered with  a dense, smooth, and apparently fibrous membrane;" but
this is  not seen  in  the  pathological specimen, which is No. 1935 of the
Surgical Section,  and was contributed by Acting  Assistant  Surgeon E. P.
Townsend.
          Photographed at  the  Army Medical  Museum.
   BY  ORDER  OF THE SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg.  U. S. A., Curator A. M. 31. 
 
        jFnrgwm   (&mx%Y&   Witt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 246.   Gunshot  Fracture of  Upper  Third  of
  Left Femur, treated, by Smith's Anterior Splint with  Partial
  Recovery.
  Private Josiah Jones, Co.  D,  12th  New  Hampshire Volunteers, aged
twenty-four years, was wounded at Chanceilorsville  on May 3, 1863, by a
missile which fractured the left femur in the upper  third.   On May 15th
he was admitted to the hospital of Whipple's Division, Third Corps; and
on June 14th he was sent to the Second Division Hospital at Alexandria,
where, on November 20, 1863, he was  discharged on  surgeon's certificate
of disability;  afterwards, he was pensioned.  A  communication from
Surgeon Isaac F. Galloupe, U. S. V.,  dated September 22, 1869, states,
that the patient received  no  appropriate treatment until he arrived  at
Alexandria, where Smith's Anterior Splint was applied, and the limb kept
suspended nearly four months.  The upper  posterior cicatrix, as shown
in the photograph, represents the wound  of entrance;  the one below it,
the location of the last fistulous opening which closed in November, 1868,
after discharging,  from time  to time, fragments  of  necrosed bone.  The
outer scar,  in front, indicates the wound of exit; the remaining two, the
result of abscesses.

          Photographed at the Army Medical Museum.
  BY  ORDER   OF THE  SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't  Surg. U. S. A., Curator A. M M. 
 
        gnxptm  ®tnmlf&   Witt

        ARMY  MEDICAL MUSEUM.

PHOTOGRAPH No. 247.  Successful  Secondary  Amputation at
   the Hip-Joint, following an Excision of the Head of the Femur
  for Gunshot Injury.
  Private John Schranz, 7th  Austrian  Feldjiigers, was wounded at the
battle of Palestro, May 30, 1859, by a ball which fractured the trochanter
of the left femur, the splintering involving the joint, either directly or by
exciting  traumatic arthritis.   The formation of abscesses in the thigh
rendered some operative interference  necessary, and  on November 27,
1839, Dr. Neudorfer, chief surgeon of the Eighth Austrian Army Corps,
excised the head, neck, and trochanters of the bone.   The operation did
not result favorably, and four days subsequently Dr. Neudorfer removed
the entire limb by the double  flap method.   A rapid recovery followed,
and on January 1, 1860, the patient was walking about.  A photograph,
presented to Dr. (Mis by Dr. Neudorfer, which now hangs in the Army
Medical  Museum, was taken  April  12, 1868, represents the  patient in
excellent  condition more than  eight years  after the  operation.   This
photograph  is a copy from that referred to.  A detailed account of this
case  will be found in Dr. Neudorfer's Handbuch  der  Kreigschirurgie.
Leipzig, 1864.
           Photographed at  the Army Medical Museum.
 BY ORDER OF THE  SURGEON GENERAL:
                          GEORGE  A. OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A,, Curator A. M. M. 
 
        ^nxptm   $mxnY*   Witt

        ARMY  MEDICAL MUSEUM.

 Photographs  No.  248, 260, and  261.    Successful  Secondary
   Excision of the Head of the Femur for Gunshot Injury.
  These three  photographs illustrate the case of Private C. F. Read, Co.
 I, 37th Infantry, who received a gunshot fracture of the head of  the left
 femur, while on picket, sixty miles from Fort Stanton, New Mexico, June
 8, 1868.  The nature of the injury  to the bone
 will be understood from the adjacent wood cut,
 copied from the specimen contributed  to the
 Museum  by the operator, Assistant  Surgeon
 J. R. Gibson, U. S. Army,  and  numbered 5576,
 Section 1, A.  M.  M.   The  case is very fully
 detailed in  the Report in Circular No. 2, S.
 G. 0., 1869, page 117.   The operation was per-
 formed on August 14, 1868, through a T shaped incision.   By November
 20, the patient was  able to  walk about the hospital building, and the
 further progress of the case was as rapid as it was favorable.  Early in
 1869, this soldier was discharged from the service.  He came across the
 plains by the next train, and in September, 1869, reported at the Surgeon
 General's Office,  where the  photograph,  No.  248, was taken.   At that
 time the patient's general health was  excellent.  The cicatrix was per-
 fectly 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. Assistant Surgeon
 Otis,  U. S. Army,  who  was  instructed  to recommend  a  suitable
 apparatus, suggested one;  but advised that  he  should  not  use it at
 present, but  should continue to  exercise the  limb cautiously for some
 months, to increase  by exercise  the strength of the muscles and liga-
 mentous attachments, and  the freedom of the  newly formed joint.  The
 next week Read  went to  New York, and the apparatus  proposed, and
 figured in photograph 261,  was ingeniously adapted 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 his apparatus.

           Photographed at the Army Medical Museum.
  BY ORDER  OF  THE SURGEON GENERAL:
                           GEORGE  A.  OTIS,
              Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 31- 31.
 
 
         $£nx$wn    ®tnml'&    Witt


         ARMY  MEDICAL  MUSEUM.

Photograph No.  249.

  The figure on the left of the group represents a section of the left radius and ulna, show-
ing a fracture of each, for which  amputation  was performed.  The ulna is  transversely
fractured, with necrosis of the borders; the radius is broken into four pieces.  Thepatient
was B. F. Surby, a civilian attach^ of the  army,  who was wounded at Fredericksburg, on
December 14,1862, by a projectile which produced the above described injury.  He was sent
to the Douglas Hospital at Washington on the 2Gth, where, on  December 29th, the forearm
was amputated, just below the elbow, by Surgeon Peter Pineo, U.S. V.  The patient recovered;
and on September 29,1865, he visited the Army  Medical Museum, when the stump, which
was in excellent condition, was photographed.   The specimen is  Xo. 711 of the Surgical
Section, and was contributed by the operator.
  The figure on the right represents the upper portion of the right radius and ulna fractured
in their upper thirds. A ball has apparently passed between tho two, fracturing the radius in
an irregularly transverse manner, and chipped off two  inches from the posterior surface of
the ulna.  A longitudinal fissure extends one and a half inches on the posterior surface of
the radius, and the borders of the fracture are necrosed.  The  patient was  Thomas A. Mar-
tin, a private of Co. O, 91st Xew York Volunteers, aged twenty-two years, who was wounded
at the South Side Railroad on March 30, 18G5.  He was seut  to Philadelphia, and was ad-
mitted to the Mower Hospital on April 7,1865.  After his admission several slight hemorr-
hages took place, and. on the evening of April 16th, a profuse one occurred from the ulnar
artery, high up, which necessitated  ligation of the brachial artery in its lowest third.  On
the 18th, the haemorrhage  recurring, led to the  conclusion  that  the artery had bifurcated
above the point of the ligature ; and; as the prospect of checking  the haemorrhage was un-
favorable, and the injury to the bones and soft parts extensive, amputation at the middle
third of humerus, by the circular method, was decided  on, ond was, accordingly, immedi-
ately performed.   The patient reacted well. The case  progressed favorably, and, by June
6th, the stump had nearly healed, it being kept open only by a slight exfoliation from the
end of the bone.   A dissection of the amputated arm confirmed the opinion held in reference
to the artery: two large trunks had formed, showing bifurcation above the point of ligation.
Ou August 17, 1865, the patient was sent to the  head-quarters of his regiment to be mus-
tered out. The specimen is Xo. 15S8 of the Surgical Section, and was contributed, with the
history, by Acting Assistant Surgeon ^V. S. Hendrie.
  The central figure represents the lower  two-thirds of the left radius and ulna, apparently
amputated.  About two inches of the ulna in  the  lowest third is wanting; and the radius,
directly opposite, is transversely  fractured without displacement, (probably  by  the same
missile nearly spent.)  with slight Assuring, extending, posteriorly, to the styloid process.
The specimen is Xo. 2-371 of tho Surgical Section; the contributor and history are unknown.

             Photographed at the Army  Medical Museum.
  BY  ORDER  OF  THE  SURGEON  GENERAL:

                                 GEORGE  A.  OTIS,
                                   Ass'i Surg.  U. S.  A., Curator A.  M M. 
 
       J^nvgMra   fatntxul't   Witt

       ARMY MEDICAL MUSEUM.

PHOTOGRAPH No.  250.   Specimens exhibiting Comminuted Frac-
  tures of the Right and Left Forearm
  The Left shows a transverse fracture of the radius in the middle third,
without displacement.  The ulna is fractured,  with the loss of one inch
in the middle third.  This specimen, in which no pathological changes are
noticeable, was contributed by Surgeon J. E. Summers, U. S. A., and is
No  320 of the Surgical Section.
  The Right shows a transverse fracture of the radius in the lower third,
with both fragments longitudinally fissured.  The ulna has two transverse
fractures;  one in the middle third, and one just above the lower extremity.
These bones are the result of an unsuccessful amputation, performed on
Private A. P. Bush, Troop F, 1st  Massachusetts Cavalry,  aged  twenty-
nine years, who was wounded at Bristow Station, Virginia, in October,
1863, by a solid shot, which  caused the above mentioned  injury.   On
October loth, he was admitted to the First Division Hospital at Alexandria,
in a feeble and exhausted condition.  The  limb was extensively swollen,
and the patient suffered intense pain.   Three days subsequently,  the arm
was amputated in the middle  third by the circular operation.   On the 23d,
he seemed to improve; but, on the 25th, the flaps sloughed apart.  On the
29th, the stump was granulating finely, and he continued to improve.   On
November 1st, the patient had a violent chill, which, lasting twenty min-
utes, was  followed by a fever of two hours duration. The chills recurred
on the 6th, 7th and 8th, and,  by the 19th, he was in a very low condition.
On the 20th, he was much improved, and  the  wound looked finely;  but
he did not seem to rally sufficiently to  warrant hopes of  his recovery.
Pyaemia supervened, and death  occurred  on  November 21, 1863.  The
autopsy revealed an abscess at the  shoulder joint,  filled with six ounces
of pus.  The abdominal viscera  were normal,  with the exception of the
stomach, which was  highly  congested.   This specimen,  exhibiting no
noticeable pathological changes, was contributed  by Surgeon E. Bentley,
U. S. V., and is No. 1841 of the Surgical Section.
           Photographed at the Army  Medical  Museum.
  BY ORDER  OF  THE SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. U.  S. A„ Curator A.  M M. 
 
            $mpm   QtnmY*    Witt


             ARMY  MEDIAL  MUSEUM.

    Photograph No.  251.

     The figure on the right of the group  represents  the bones of the right leg,—the tibia
    extensively comminuted in the upper third, and the fibula transversely fractured —with a
    portion of a conoidal musket ball attached. The patient was G. F. Skinner, a private of Co.
    H, 6th Maine Volunteers, aged thirty years, who was wounded at Chanceilorsville, on May
    3,1S63, by a conoidal musket ball which  entered the  leg on the inner aspect, a half inch
    from the spine of the tibia, and  produced the above mentioned  injury.  A portion of the
    ball escaped at the back of the leg.  He  was  sent to Washington, and was admitted to the
    Douglas Hospital on May 8th.  On admission,  there was much contusion some ecchymosis,
    and, but for the high state of inflammation which  co-existed, amputation would  have been
    performed.  Water dressings were applied to the wound, and  the  leg was placed in a frac-
    ture box filled with bran, and expectant treatment  was used.  Xo change was perceptible
    until the morning  of May 16th, when a state of advanced gangrene had supervened, which
    was rapidly extending up the thigh. The soft tissues became  "boggy and crepitant."  The
    patient was bathed in a clammy sweat,  and his pulse was 160 and very weak; notwith-
    standing which, he manifested no alarm or depression of spirits.  The previous evening he
    had seemed as well as usual; and a careful examination of the limb had failed to reveal any
    indication of the presence of gangrene.   Amputation was deferred in the hope of reaction
    under strong stimulation, but, he gradually sank, and died, about 2 o'clock, on the morning
    of the 17th.  At the autopsy, sixteen  hours after death,  it  was found that  the internal
    organs, generally, were normal;  but, at the seat of injury, in addition to the excessive com-
    minution of bone, a portion of the ball was found lying upon the posterior tibial vessels,
    which were compressed and lacerated.   Xo secondary abscesses were formed, and it was
    concluded that death had occurred from gangrene in its primary  stage.  The notes in this
    case were furnished by Assistant Surgeon C.  C. Lee, U. S.A.; the specimen was contributed
    by Assistant Surgeon W. Thomson, V. S. A., and is No. 1249 of the Surgical Section.
     The central figure represents the right tibia  and  fibula transversely fractured, with some
    comminution, in the middle third, by a horse falling upon the  subject.  There is no attempt
    at union.   The patient was Harvey M. Lambert, a sergeant of Troop D, 12th Illinois Cavalry,
    aged twenty-nine years, who received the above injury at Stevensburg, Virginia, on October
    10,1SC3. and was conveyed to Washington on the same day, and was admitted to tho Emory
    Hospital.  The patient was of good constitution, but, becoming weak and debilitated, tonics
    and stimulants were given with the  desired result.  On the 25th, there being a copious dis-
    charge of sanious pus from the wound, and the  swelling having extended to the knee, Acting
    Assistant Surgeon W. H. Ensign amputated the leg,  at the upper third, by the double flap
    operation.  The stump had almost healed,  when, on November 8th, a haemorrhage supervened
    which graduated compresses were unable to control. On the 10th, the patient having become
    very weak, re-amputation at the lowest third of the thigh, by the same method, was performed.
    The stump, again, had nearly healed, when, on November 26th. the  haemorrhage recurred,
    but was controlled by Dr. Mott's tourniquet. By January 18,1804, the patient had recovered
    his strength, and the wound had healed.  On May 16, 1864, he was transferred  to Judiciary
    Square Hospital where he was discharged the service on July 30, 1864.  The specimen is No.
    1744 of the Surgical Section, and was contributed by the operator.
     The figure on the left shows the left tibia and fibula amputated in the middle third.  The
   fibula, just above the malleolus, and the tibia,  two  inches above the joint, are transversely
\   fractured by a conoidal musket ball which is attached.  There is no history, but the absence
   of comminution in  a fracture by such a missile, is noteworthy.  The specimen is  No. 490 of
   the Surgical Section, and was contributed by  Assistant Surgeon George M. McGill, U. S. A.,
   from the field Hospital of  the Ninth Corps at Falmouth, Virginia.

                 Photographed  at the Army  Medical  Museum.
     BY  ORDER  OF  THE  SURGEON  GENERAL:

                                    GEORGE  A.  OTIS,
                                       Ass't Surg.  U. S.  A., Curator A. M  M. 
 
         jliw§f0i  fatnmYi  Witt


       ARMY  MEDICAL  MUSEUM.

Photograph No. 252.

  The figure on the left of the group represents the lowest third of the
right femur nearly transversely fractured, with a slight fissure extending
upward on the anterior surface, and a large one downward  on the posterior
surface.   The specimen, which was received  from the field without his-
tory, is No.  4030 of the Surgical Section, and was contributed by Assistant
Surgeon 8. Adams,  U. S.  A
  The left central figure shows the right humerus  transversely fractured
by gunshot in the middle  third, and slightly chipped at tlie point of im-
pact on the anterior surface, with two  extensive longitudinal fissures up
the shaft and one spiral, extending downwards three inches.  The speci-
men was contributed, in 1862, from Fredericksburg, without history, by
Dr. S. Perry, and is No. 682 of the Surgical Section.
  The right central figure represents eight and a half inches of the shaft
of the left femur, exhibiting a longitudinal fracture with extensive Assur-
ing and comminution.  The specimen,  No. 2614 of the Surgical Section,
was received, without history,  after the battle of  the AVilderness, and is
said to have been excised at Fredericksburg.
  The right figure represents a  portion of the shaft  of the left femur
transversely fractured, with  comminution,  and  extensively  fissured, ob-
liquely.   The patient was Nathan* Fisk, a  private of Co. F, 89th  New
York Volunteers, aged  twenty-two years, who was wounded at Suffolk,
Virginia,  April 19,  1863,  by a grape shot, which  struck  the left  thigh
three inches and a half above the knee, a  little to the outer side of the
median line, and, passing upwards, backwards and inwards, produced the
above described injury to bone, and emerged on the intero-posterior aspect,
about four inches from the anus, and about  nine inches from the  wound
of entrance.   The wound of entrance was circular and an inch and a half
in diameter; that of exit was smaller and not so perfectly circular.  He
was admitted to the general hospital in the Methodist Church at Suffolk.
On the next day, he reacted promptly,  and, whilst  under  the influence  of
chloroform,  the wound  was examined,  and amputation decided on;  but,
upon advice, it was abandoned, and was substituted by conservative treat-
ment, which, however,  was  unsuccessful, the  case proving fatal at noon
of the 22d.  At the autopsy, it was found  that the muscles were much
injured, but that there was no wound of the blood vessels or nerve.  The
bone, on the inner face, was  denuded of  periosteum nearly two inches;
but this was thought to be the  result of causes subsequent to the injury.
The specimen is No. 1056 of  the  Surgical  Section, and was contributed,
with the history, by Surgeon T. H. Squire, 89th New York Volunteers.
 *]his soldier was borne on tho rolls as "Charles" Fisk: his brother Charles had enlisted,
but, having a family, and Nathan none, the latter assumed his name and place in the ranks.

           Photographed at the Army Medical Museum.
  BY  ORDER OF THE SURGEON  GENERAL:

                           GEORGE A.  OTIS,
                              Ass't Surg.  U. S. A., Curator A. M. M. 
 
         &$XQtttn  $tnmY&  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph No. 253.   A  Group of Specimens of  United Sim-
  ple Fracture of the Patella.
  The seven specimens of simple fracture of the patella united by liga-
mentous or osseous union, represented in this photograph, comprise all in
the possession  of the Army Medical Museum in July, 1870.  The examples
of compound,  and  especially of gunshot fractures, are of course  much
more numerous.  The three  specimens in the lower row are illustrations
of firm bony  union.  In 5413 the fracture was  transverse; in 5414
vertical; and in 5415 stellate.  The specimens in the upper  row illustrate
union of fractured patella by ligaments.  In 5355 and 5364 the fragments
are so nearly approximated that the motions of the limbs were probably
not much  impaired. In  5353 separation  is considerable, and in 5354
the separation was so  great  that, without the use of some apparatus, the
functions  of the quadriceps femoris must have  been abolished  almost.
Nearly all of these specimens were purchased from the cabinet of the late
Professor  William Gibson, and the clinical  histories of  the cases are
wanting.
          Photographed at the Army Medical Museum.
   BY ORDER  OF THE SURGEON  GENERAL:
                          GEORGE A. OTIS,
             Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 31. 31. 
 
          $j>nx$*m  (&tnmY$   Witt

        ARMY MEDICAL  MUSEUM.

 PHOTOGRAPH No.  2-U.   Transverse Fractures of the Humerus at
   the Junction of the Lower Thirds.
   The figure on the left represents the lower half of the right humerus,
 amputated four weeks after injury.   The patient was Job Strange, a pri-
 vate of Co. H, 62d New York Volunteers,  aged  sixty years,  who w;is
 wounded at the Wilderness on  May  5,  1861, by a conoidal musket ball,
 which, passing  directly  through  the arm, fractured and slightly com-
 minuted the humerus  at, the junction of the lower thirds,   lie was admitted
 to the hospital of the Second  Division,  Sixth Corps, on  the same day,
 where a simple dressing  was used.  On  the  25th,  he was admitted to the
 Lincoln Hospital at Washington,  in  a very irritable condition, the arm
 being much swollen and inflamed, owing to the absence of proper support
 from splints or bandages.  By June 3d. the patient's health had so much
 improved, that he was taken to the operating room, where the wound was
 explored whilst  under the influence of ether; the upper fragment of bone
 beingdenuded of its periosteum to the extent  of two inches, it was decided
 to amputate by the  circular operation, the first incision being made about
 one inch above the course of the missile.  But little  blood was lost,  tlie
 subclavian artery being  thoroughly  compressed  and six ligatures used.
 The patient died from  exhaustion on June 10, 1864.  The pathological
 specimen was contributed by the operator. Acting Assistant Surgeon H.
 M. Dean, and is No. 2426 of the Surgical Section.
  The figure on tlie right represents a part of the left  humerus trans-
 versely fractured at the junction  of the lower thirds, the edges in close
 apposition.  Private Horatio Bacon, Co. A, 77th Illinois Volunteers, aged
 iventy-one years, was accidently run over by a horse car, in New Orleans,
 Louisiana, December 25, 1863.   He was  admitted to the University Hos-
 pital, where an  examination  revealed a compound fracture  of the left
 humerus with extensive  laceration  of  soft  parts. No external  marks
 indicated other injuries;  but  he died from the shock in two hours and a
 half, and, the autopsy revealed lac-ration of the  stomach, duodenum,
spleen, liver and left kidney.  The  specimen, with the history, was con-
tributed by Assistant Surgeon P.  S. Connor,  TJ. S.  A,, and is No. 2993 of
the Surgical Section.
          Photographed  at  the Army Medical  Museum.
  BY  ORDER  OF THE  SURGEON  GENERAL:
                           GEORGE  A.   OTIS,
                             Asu't Surg. U. S. A., Curator A. M. 31. 
 
          Jjtrgfftii  HbtnmYa  Witt


        ARMY  MEDICAL MUSEUM.

 PHOTOGRAPH  No. 255.   Exhibiting  Transverse  Fractures  of the
   Leg Bones from Gunshot.

   The figure on  the left of the group represents the left tibia, twenty-four
 days after injury.  The bone transversely fractured in the middle third,
 shows no signs of union or deposit of callus.  The patient was Alexander
 Vancian, a  private of Battery  I,  1st  Maine Heavy Artillery who was
 wounded at Petersburg on June  18,  1864, by a conoidal musket ball,
 which, entering the middle third of the leg anteriorly, fractured the tibia,
 and, passing downwards, lodged  on the  tarsal cartilage.  When admitted
 to the Third  Division Hospital  at  Alexandria (.June 29th),  there were
 several incisions in the leg, and  the patient stated  that  the ball had
 been removed.  The wound  looked healthy, but discharged  freely, and
 there seemed to be several sinuses parallel with the bone.   Water dressings
 were applied and stimulants administered.  After failing rapidly, death
 occurred July 12, 1864.  At the autopsy, it was found that the bullet had
 raked the whole length  of the tibia, and  had lodged  in the joint on the
 upper surface of the  tarsal  bones.  Profuse suppuration had extended
 along its whole course.  The  several openings had, probably, been made
 in vain attempts to find the ball; some,  however,  were caused  by ulcera-
 tion.  The anterior surface of  the  tibia was  necrosed nearly its whole
 length.  There was great emaciation.  The specimen is No. 33-14 of  the
 Surgical Section, and was contributed by Surgeon E. Bentley,  U. S. V.
   The figure on the right represents the right tibia and fibula transversely
 fractured in the upper third, and the fibula again fractured in the middle
 third.  The want of comminution is marked and remarkable.  The lowest
 third of the tibia is missing.   The patient  was  private Josiah Johnson,
 Co. B, 27th Connecticut Volunteers, aged  twenty-two  years, who was
 wounded at Fredericksburg on December 13, 1862, by an unknown missile,
 which produced compound fracture of the right leg.   He was sent to  the
 hospital of the Ninth Corps, whence he was transferred, on December
 17th, to the Harewood Hospital  at  Washington,  where, on the 23d,  the
 thigh was amputated at the junction ot  the lower thirds.  The patient
 was anaemic, and, on December  31st,  secondary haemorrhage  occurred
 from the femoral artery, which was ligated at Scarpa's triangle.   He died
 January 5, 1863, from exhaustion.   The pathological  specimen was con-
 tributed  by Acting Assistant Surgeon W. A.  Harvey, and is No. 982 of the
 Surgical Section.
  The middle figure represents the  left tibia transversely fractured in  the
middle third.  There is some  comminution, and a longitudinal fissure is
seen  in the upper fragment.   The  specimen  is No. 480 of the Surgical
Section, and was contributed by Surgeon W. H. Leonard,  U. S. V.

           Photographed at the Army Medical Museum.
   BY ORDER  OF THE  SURGEON  GENERAL:

                           GEORGE  A.  OTIS,
                              Ass'tSurg.  U. S. A., Curator A. M. M. 
 
       jFimjwn (&txm%Y$  Witt

      ARMY  MEDICAL MUSEUM.

Photograph No. 256.
  These specimens, respectively numbered 5234 and 5236 of the Surgical
Section, are from the Gibson Cabinet, and nothing is known of their his-
tory.  The former is a left humerus, showing united simple fracture; the
latter, a right humerus, showing a united simple fracture of the shaft,
with overlapping.
         Photographed at the Army Medical Museum.
  BY  ORDER OF THE  SURGEON GENERAL:
                       GEORGE  A. OTIS,
                        Ass'tSurg. U. S. A., Curator A. M. M. 
 
         Sfmcpen  <&tnmY&  Witt

       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH No. 257.  Illustrations of  Gunshot Fractures of the
  Humerus.
  The figure on the right of this group represents three  inches excised
from the lower portion of  the  right humerus.  The patient was Major
Benjamin C. Stanhope, of the 6th  Ohio Cavalry, who  was wounded at
Aldie Gap, Virginia, on June 17, 1863, by a carbine ball,  which  entered
the right arm,  and, transversely fracturing the  humerus, passed down-
wards, opened  the joint, and escaped at the anterior inferior third of the
forearm.  On the same day, he  was sent to the  hospital  of the Second
Division, Cavalry Corps, where, six  hours after the injury, excision of the
elbow joint was performed by Assistant Surgeon G. M. McGill, U. S. A.
On the next day, he arrived at Alexandria and was admitted to the Second
Division Hospital.   The patient  was a  young  man, of short stature, and
very adipose.  He died of tetanus on June 25, 1863.  The pathological
specimen is No. 1282 of the Surgical Section,  and was contributed, with
the history, by the operator.
  The middle figure represents the lower half of the right humerus trans-
versely fractured in the lowest third by gunshot.  The specimen, which
shows a fissure about two inches long on the posterior surface of its upper
extremity, is No. 2410 of the Surgical Section, and was received after the
battle of Chanceilorsville.
  The remaining figure  exhibits the lower half  of the right humerus
transversely fractured near the junction of the lower thirds, by a conoidal
ball, which is attached.   It is No. 250 of  the Surgical Section, and was
contributed by Surgeon J. H. Brinton,  U. S. V.
          Photographed at the  Army Medical  Museum.
  BY  ORDER OF THE  SURGEON GENERAL:
                          GEORGE  A. OTIS,
                            Am't Surg. U. S. A., Curator A. 31.  M 
 
         jpjtrgwn $$>tnmY$  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph No.  258.  Illustrations of Gunshot Fractures  of
   Long Bones.
  Specimen 146 is a portion of the right humerus  at the junction of the
upper thirds, showing a transverse fracture by an unknown missile, and
is the result of an excision performed upon Heinrich Geyer, a private of
Co. A, 68th  New York  Volunteers, aged twenty-three years,  who was
supposed to have been wounded at the Second Bull  Run about August 30,
1862.  On  September 1st, he was  admitted to  the Carver  Hospital at
Washington, where the limb was  treated  with the  ordinary fracture ap-
paratus without success  until September  18th, when the middle third of
the shaft, to the extent of nearly  two inches, was excised by Acting As-
sistant Surgeon J. 0.  French.  Chronic diarrhoea is reported to have been
the immediate cause of death, which occurred on October 18, 1862.  The
specimen was contributed by Surgeon 0. A. Judson, U. S. V.
  The remaining three  specimens exhibit fractures of the femur  from
gunshot.
  The middle one of the three shows the middle third of tlie femur trans-
versely fractured, with moderate comminution, and  longitudinal Assuring.
This specimen was  received after the battle of Gettysburg,  and is No.
1307 of the Surgical Section.
  The one on the left represents the middle  third of the femur nearly
transversely fractured.  There are  several slight  fissures, with no  com-
minution.   Tlie inferior portion shows a fissure, not communicating with
the fracture.  Tlie fragments are in very  close apposition.   This speci-
men is No. 673 of the Surgical Section,  and was contributed by Surgeon  /
W. H. Leonard, ter-Hr^i.                                              £]
  For a description of the remaining specimen, sec  photograph 225.      /
           Photographed at the Army  Medical  Museum.
   BY ORDER OF  THE SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                             Ass'I. Surg. II. S. A., Curator A. 31.  M. 
 
        jliiiTgwi  <&tnmY$  Witt

       ARMY MEDICAL MUSEUM.

PHOTOGRAPH No.  259.   Three  Specimens exhibiting Gunshot
  Fracture of the Femur.
  The first, showing the lower half  of the left femur, transversely frac-
tured in the middle third, without fissuring or comminution, is No. 249 of
the Surgical Section, and was contributed by Surgeon J. H. Brinton, U.
S. V.  The second shows the greater  portion  of  the right  femur com-
minuted and longitudinally fissured, by gunshot, at the upper  part of the
lowest third.   It is, evidently, from a  young subject, and is remarkably
slender.  It was contributed  by Surgeon G. W. McMillin, 5th East Ten-
nessee Volunteers, and is No. 2161 of the Surgical Section.  The  third is
the shaft of a femur fractured transversely.  It is considerably necrosed,
and most of the shaft shows superficial exfoliation.
          Photographed at the Army  Medical Museum.
   BY  ORDER  OF  THE SURGEON GENERAL:
                         GEORGE  A.  OTIS,
                           Ass't Surg. U. S. A.. Curator  A. M. M. 
 
        tfttvgwn   ®tntx&l'#  Witt

        ARMY  MEDfCAL  MUSEUM.

 Photographs  No.  248,  260, and 261.   Successful Secondary
   Excision of the Head of the Femur for Gunshot Injury.
   These three photographs illustrate the case of Private C. F. Read, Co.
 I, 37th Infantry,  who received a gunshot fracture of the head of the left
 femur, while on picket, sixty miles from Fort Stanton, New Mexico, June
 8, 1868.  The nature of the  injury to the bone
 will be understood from the adjacent wood cut,
 copied from  the specimen contributed  to  the
 Museum  by  the operator,  Assistant Surgeon
 J. R. Gibson, U. S.  Army, and numbered 5576,
 Section 1, A. M. M.   The  case is very fully
 detailed in  the  Report  in Circular  No. 2, S.
 G. 0., 1869, page 117.  The  operation was per-
 formed on August 14, 1868, through a T shaped incision.   By November
 20, the patient was able to  walk about the hospital  building, and the
 further progress  of the case was as rapid as it was favorable.  Early in
 1869, this soldier was discharged from the service.  He came  across the
 plains by the next train, and in September, 1869, reported at the Surgeon
 General's Office,  where the  photograph,  No.  248, was taken.  At that
 time the  patient's general health was excellent.  The cicatrix was per-
 fectly 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.  Assistant Surgeon
 Otis, U.  S.  Army,  who  was  instructed to  recommend  a suitable
 apparatus, suggested one;  but advised  that  he should not use it at
 present, but  should  continue to  exercise the  limb cautiously for some
 months, to increase by exercise  the  strength of the  muscles and  liga-
 mentous attachments, and the freedom of the  newly formed joint.  The
 next week Read  went to  New York, and the apparatus proposed, and
figured  in photograph 261, was ingeniously adapted  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 his apparatus.

           Photographed at the  Army  Medical  Museum.
 BY ORDER  OF  THE SURGEON  GENERAL:
                           GEORGE A.  OTIS,
             Bv't  Lt. Col. and Ass't Surg. U. S. A,, Curator A. 31. M.
 
 
        Mxpou   ®tnmYt   Witt

        ARMY  MEDICAL  MUSEUM.

 Photographs No.  248, 260, and 261.   Successful Secondary
   Excision of the Head of the Femur for Gunshot Injury.
  These three  photographs illustrate the case of Private C. F. Read, Co.
 I, 37th Infantry, who received a gunshot fracture of the head of the left
 femur, while on picket, sixty miles from Fort Stanton, New Mexico, June
 8, 1868.  The  nature of the injury  to the bone
 will be  understood  from the adjacent wood cut,
 copied from the  specimen contributed  to  the
 Museum  by the  operator, Assistant Surgeon
 J. R. Gibson, LT. S. Army,  and  numbered 5576,
 Section  1, A.  M. M.   The case is very fully
 detailed in the Report in Circular No. 2,  S.
 G. 0., 1869, page 117.   The operation was  per-
 formed on August 14, 1868, through a T shaped incision.   By November
 20, the patient was able  to walk about the hospital  building, and the
 further  progress of the case was as rapid as it was favorable.  Early in
 1869, this soldier was discharged from the service. He came  across the
 plains by the next train, and in September, 1869, reported at the Surgeon
 General's Office, where the photograph,  No. 248, was taken.  At that
 time  the patient's  general health was excellent.  The cicatrix was per-
 fectly 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.  Assistant Surgeon
 Otis,   U. S. Army, who  was instructed to  recommend  a  suitable
 apparatus, suggested one;  but advised that he should not use it at
 present, but should continue to exercise the limb cautiously for some
 months, to increase by exercise the strength of the  muscles and liga-
 mentous attachments, and  the freedom of the newly formed joint.  The
 next  week Read went  to  New York, and the apparatus proposed, and
 figured in photograph 261,  was ingeniously adapted 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 his apparatus.

           Photographed at the  Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON GENERAL:
                           GEORGE A.  OTIS,
             Bv't Lt.  Col. and Ass't Surg. U. S. A,, Curator A. 31. M.
 
 
         $£nx$ttm  ®tnmYn   Witt

       ARMY  MEDICAL  MUSEUM.

Photograph No. 262.  Double Amputation of the Arms at the
   Upper Thirds.
  Private A.  Stratton, Co. G. 147th New York, had both  arms  carried
away by a solid cannon shot from the defences in front of Petersburg on
June 18, 1864.  The projectile struck both limbs about the elbow, tearing
off the forearms, and greatly lacerating the soft parts above the elbow.
Cordials were given, and immediate amputation of both arms was per-
formed  by Surgeon A. S. Coe, 147th New York Volunteers.  The patient
was then transferred  to City Point.  On June  28, he was sent to the
Second  Division Alexandria  Hospital,  both wounds progressing  very
favorably.  The stumps rapidly  cicatrized,  and on October 3,  1864, he
was discharged from the service,  and pensioned at twenty-five dollars per
month, and supplied with artificial  arms of  Grinnell's make.  He called
at the Army Medical  Museum, in good health, on December 24, 1869, to
have his photograph taken.
          Photographed at the  Army Medical Museum.
   BY  ORDER OF  THE  SURGEON  GENERAL:
                         GEORGE A. OTIS,
             Bv't Lt. Col. and  Ass'tSurg.  U. S. A., Curator A. 31. 31. 
 
        ARMY  MEDICAL  MUSEUM.

 Photograph No. 263.   Excision  of Right Elbow-Joint for Gun-
   shot Injury.
   Private Frederick Pilgrim, Co. D, 8th New York Cavalry, aged twenty-
 two years, was wounded at an engagement at Dinwiddie Court House,
 Virginia,  April 1, 1865, by a ball which fractured the  bones of the right
 elbow, leaving the main vessels and nerves intact.  He was sent  to City
 Point, and thence to Washington on the hospital transport Metropolitan,
 and was admitted to Harewood Hospital.  He did well  up to May 1, 1865*
 when the whole arm became erysipelatous and highly inflamed.  Under
 the use of the tincture of the sesqui-chloride of iron internally, and cold
 lotions externally, the inflammation  entirely  disappeared in a few days,
 and on May 5th, Surgeon R. B.  Bontecou, U. S. Vols., excised the articular
 extremities of  the humerus,  radius,  and ulna,  through  an H-shapcd
 incision.   The wound sloughed badly ;  but by vigorous supporting treat-
 ment  and  the  opportune employment  of  escharotics  the  gangrene was
 arrested.  On July  15th cicatrization had far advanced, the patient was
 able to flex and rotate the forearm and  appeared in a fair way of recovery.
 On July 31st he was transferred to  Douglas Hospital, and on September
 25th, to Ira Harris Hospital,  at Albany.   On November 6, 1865, he was
 discharged from service with his wound entirely healed and  the  elbow
 anchylosed.  His disability was reported as total by Assistant Surgeon J.
 H. Armsby, U.  S. Vols.   In  October, 1866, Pension Examining Surgeon
 John Root reported that the right upper extremity was practically useless,
the motions of the hand  even being much impaired, the arm and forearm
atrophied.  Pilgrim was pensioned at fifteen dollars a month and at last
accounts was doing well,  at his home in Dodge County,  Nebraska.
           Photographed at the Army  Medical  Museum.
   BY  ORDER OF  THE  SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
             Bv't  Lt. Col. and Ass'tSurg. U. S. A., Curator A. 31.  31. 
 
        Jiiwjeitt   ®mxnYt  Witt

        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH No. 264.   Excision of the Right Elbow for Gun-
   shot Injury, followed by Anchylosis.
  Private Daniel Miller, Co. A. 1st Maryland Volunteers, aged  eighteen
 years, was wounded at  the battle of  Hatcher's Run, Virginia, February
 6,  1865, by a ball which penetrated the right elbow joint.  He  was  sent
 by way of City Point to Point Lookout Hospital.  On February  15, 1865,
 Assistant Surgeon  John Vansant, U. S. Army,  excised the articular
 extremities of the radius and ulna.  After the operation, the forearm was
 semi-flexed, and supported  by an angular splint.   On July 24, 1865, the
 patient was transferred to  Lincoln Hospital at Washington, and  thence
 transferred to Armory Square on August  5. and thence to Harewood on
 August 15.  On October  11, he was discharged from service by Surgeon
 R.  B.  Bontecou,  U. S. V.   He  was  pensioned  at fifteen  dollars  per
 month.   On November 2, 1868, Pension Examiner J. A. B. Muse  reported
 that the  elbow was completely anchylosed, and the functions of the  arm
and forearm were  almost destroyed,  and rated  his disability  as total,
third grade.

          Photographed  at  the Army Medical  Museum.
 BY  ORDER  OF  THE SURGEON  GENERAL:
                          GEORGE  A. OTIS,
             Bv't Lt.  Col.  and Ass't Surg. U. S. A., Curator A.  31. 31. 
 
         jiuvgMm  (&tnmY&  Witt

        ARMY MEDICAL  MUSEUM.

 Photograph No. 265.   United Gunshot Fracture of the Upper
   Third of the Right Femur.
  Captain J. Stuart Lowery, 146th New York Volunteers, aged twenty-
 one years,  was  wounded by a  conoidal rifle  ball while on  picket near
 [?ethesda Church, Virginia,  June 3, 1864.  A conoidal musket ball entered
 at the middle of the right thigh  towards its inner aspect, and  was cut out
 on the field  by Assistant Surgeon Fossard,  146th New York  Volunteers,
 above the right trochanter.  The femur was fractured in its upper third.
 Captain Lowery was brought six miles on a stretcher to the Field Hospital
 of the Second Division, Fifth Army Corps, where Surgeon T. M. Flandrau,
 140th New York Volunteers, determined not to amputate, and supporting
 the limb on  folded blankets so that it was very comfortable.  The patient
 was then carried to  White  House, fifteen  miles  distant,  by  Lieutenant
 Eggleston and some men belonging to the quartermaster's department.
 He was left  on his stretcher on the steam hospital transport on which he
 embarked at White House, and was not removed from it till put to bed at
 Armory Square  Hospital, at Washington, four days after the receipt of
 the injury.  Acting Assistant Surgeon Bannister had the immediate care
 of the case.  The patient stated  that the limb was placed in a box.   Little
 extention was used, or counter extention.   Three or four small pieces of
 bone were discharged within a short time.   Another small piece has been
 cut out since from under the skin.   An abscess was opened on the outer
 side of  the thigh,  the scar of  which is  conspicuous  in the photograph.
 He left  the hospital on crutches  on the  22d of September, the  wounds
 having closed within four or five weeks,  and the bone  united promptly.
 He was discharged  from service  on  January 13,  1865.  He used  his
 crutches till  the following April.  The limb is shortened two and five-
 eighths  inches, and the thigh cannot be fully flexed on the pelvis, but the
 limb is strong, sound  and fully  movable  with  the  above exception, and
 wearing a boot slightly thickened in the sole, he limps but little.  He  has
lately, March, 1870, walked  six  miles  without  difficulty, and is actively
engaged in business.  His photograph  was  prepared under the direction
of Dr. Flandrau, of Rome, New York, who contributed it, with the fore-
going memoranda, to the  Army Medical Museum.
           Photographed at the Army Medical Museum.
  BY ORDER OF THE  SURGEON  GENERAL:
                          GEORGE A.   OTIS,
             Bv't Lt. Col.  and  Ass'tSurg.  U. S. A., Curator A. 31. 31. 
 
         Jjtvgftfii  ®tnmY&  Witt

       ARMY  MEDICAL  MUSEUM.

 Photograph  No. 266.   United Gunshot Fracture of the  Shaft
   of the Right Femur.
  John Buckley, 1st Lieutenant and Assistant Quartermaster, 140th New
 York Volunteers, while acting Aid-de-Camp at Spotsylvania Court House,
 May 8,  1864, had his right femur fractured in the middle third by a rifle
 ball. Surgeon T. M. Flandrau, 146th  New  York Volunteers, decided to
 attempt to save the limb, and, aided by Surgeon H. C. Dean, 140th New
 York Volunteers, dressed  it in a Smith's  anterior splint, suspended it
 from the bows of an army wagon.  His servant steadying  the foot, this
 officer was carried to Belle Plain, and thence up the Potomac by steamer.
 He reached the  Seminary Hospital, Georgetown, D. C, May 17th, when
 the thigh was found shortened five inches.   During the second, third, and
 fourth months after the fracture he was treated by an extension weight
 of sixteen pounds, a counter-extending band, and lateral sand bags.   On
 August  20th, he  had three profuse haemorrhages,  jeopardizing  his life;
 but the  bleeding was controlled by pressure.  He left the hospital Novem-
 ber 17th, on crutches, and five months after he laid these aside.  He was
 discharged from  service January 13, 1865.   He has since been employed
 as a bookkeeper.  The shortening amounts to two and a  half inches, and
 the knee is somewhat stiffened.   A fistulous opening still, March  16, 1870,
 exists on the back of the  thigh which  discharges a little.   The limb is
very useful and the limp  not conspicuous.   The photograph was taken
under Dr.  Flandrau's supervision, in March,  1870.

          Photographed at the Army Medical Museum.
  BY ORDER  OF THE SURGEON   GENERAL:
                         GEORGE A. OTIS,
            Bv't Lt.  Col. and Ass'tSurg. U. S. A., Curator A.  31. 31. 
 
       JFtirgrflii   (&tnmYa   Witt

       ARMY MEDICAL  MUSEUM.

Photograph  No.  267.   Excision  of  the Head of the Humerus.
  Private Benjamin E.  Rice.  Co.  II,  7th Wisconsin  Volunteers, was
wounded at  Gainesville  on  August 28, 1862,  by a musket ball, which
entered the  right  shoulder  joint anteriorly.   He  was admitted to the
regimetal hospital;  thence, on the 30th,  he was sent to the Columbian
Hospital at Washington, where, after a  number of days, the head of the
humerus was excised. He was discliarged the  service on December 22,
1862, and pensioned.  On March  21, 1870,  Doctor L. G. Armstrong en-
closed the patient's  picture and stated, that  the wound had  healed in six
months; tlie joint was anchylosed, and the humerus shortened two inches;
the forearm,  only, could be used, which  could not be raised laterally, and
ndmiited of but little motion to and fro;  and that  there was very little
neuralgic pain, and  the patient's general health was good.
          Photographed at the Army  Medical Museum.
 BY ORDER  OF  THE  SURGEON GENERAL:
                         GEORGE A.  OTIS,
                          Ass'i Surg. U. S. A., Curator A. M M. 
 
       Jitrgfloa  CSjnmVs   Witt

       ARMY  MEDICAL  MUSEUM.

PiiOTOtiRAPli Xo. 268.  Excision of the Ileiid of the Left Humerus
  and a Portion of the Glenoid Cavity of the Scapula.
  Private Jerome  B.  Mead,  Co.  K,  12th  Wisconsin  Volunteers,  was
wounded at Vicksburg, on June 23, 1863, by a musket ball, which struck
beneath the left clavicle,  and  passed directly through the shoulder joint.
He wus admitted to  the  hospital  of  the  Fourth  Division, Seventeenth
Uoips, where the above mentioned operation  was performed.  On July
!)th, he was conveyed, on the  hospital transport  '-City of Memphis," to
the Jefferson  Barrack Hospital,  .Missouri, where  he arrived on the 18th.
and where he was discharged the service on August 21, 18!33, and pen-
sioned.  On September 25, 1863, Pension  Examiner J.  II. Hyde reported
that pieces of bone were occasionally  discharged from the wound, and
rated his disability total and permanent.  On  March 21, 1870, Doctor L.
G. Armstrong enclosed a  picture of the patient and stated that the wound
had healed by  granulation  in  fifteen  months;   the shoulder joint was
firmly anchylosed, the arm being useful only from the  elbow,  and admit-
ting of no motion but that which the scapula would permit by swinging
to and fro; and that  there  was little neuralgic pain, and  the patient
enjoyed good  health.
             Printed at the  Army  Medical Museum.
 BY ORDER  OF THE  SURGEON  GENERAL:
                         GEORGE  A.  OTIS,
                           Ass't Surg. U. S.  A., Curator A.  M  M. 
'.\>  .. 
       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH No. 269.   Successful  Double  Amputation at the
  Ankle, by Syme's Method, for Railway Accident.
  John Miller,  a  Scotchman, now  residing at  Gore's Landing, Ontario
County, New York,  had his feet crushed  by a railway car, on February
25, 1859, at Edinburg.  The metatarsals and anterior tarsal bones of both
feet were comminuted.  He was taken to the Royal Infirmary,  and four
hours after the  accident, Mr. Lister, temporarily in charge of Mr. Syme's
ward, amputated  both feet at the ankle by Mr.  Syme's method.   The
malleoli were sawn off on both sides.  The muscles of the leg were  much
atrophied.   The patient had walked on these stumps, their bases  being
extended by leathern bonnets, for nine years, balancing himself  with two
canes.   His general condition was healthy.   On December 25,1869, Miller
visited New York, and had  a pair  of artificial feet adapted by Dr.  E. D.
Hudson.  He was then able to walk well without a cane, and the apparatus
applied by this  ingenious Surgeon gave so little inconvenience that Miller
was reluctant to undress his limbs at night.  In his  report of  the case,
from which these notes are taken, Dr. Hudson, who has bestowed partic-
ular attention to the adaptation  of prothetic  apparatus after amputation
at the ankle, remarks that "there can be no improvement upon a stump of
a well performed Syme's amputation.
           Photographed  at the Army Medical  Museum.
   BY  ORDER OF THE  SURGEON  GENERAL:
                           GEORGE A.  OTIS,
              Bv't Lt. Col. and Ass'tSurg.  U. S. A., Curator A. 31. M. 
 
        Jforgwu  (&tnmYti  Witt

      ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 270.   Successful Pi'rogoff Amputation for Com-
  pound Dislocation.
  Private Leonard S. Fitch, Co. K, 8th  Michigan  Cavalry,  had his left
ankle dislocated, and the left tarsus  crushed by the fall of his  horse, at
Covington, Kentucky, about the end  of May, 1863.   He was sent to Hick-
man's Bridge Hospital,  whence he was transferred, on October 12, 1863,
according to the report  of Assistant  Surgeon A. C. Swartzwelder, to the
Second Battalion of the Invalid Corps.  On March 21, 1864, the patient
was discharged and pensioned.  On February 8, 1867, his foot was ampu-
tated by Pirogoff's method by  Dr. Nash, assisted by Drs.  Kenny and
Jackson.   On April 21,  1867, this pensioner was reported in good health,
with a sound stump.  He was furnished with an artificial limb by Dr. E.
D. Hudson on January 6, 1870.  Dr.  Hudson had the negative prepared.
He describes the stump  as sound and useful, and the utility of the artificial
limb gratifying and creditable.
         Photographed  at the Army Medical  Museum.
  BY ORDER OF THE SURGEON  GENERAL:
                        GEORGE A.  OTIS,
                          Ass'tSurg. U.  S. A., Curator A. M. M. 
 
       jHinjtcm   tannic   Witt

       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH  No. 271.   Successful Intermediate Excision of the
  Head of the Femur for Gunshot Injury.
  In his work on  Gunshot Wounds, published in Berlin  in 1868, Dr. B.
von Langenbeck describes a successful operation by Dr. Schonborn at
Dresden, Saxony,  giving  the following  particulars:  Private  Maxim
Glutschack, aged twenty-four years, 8th Austrian Lancers, was wounded
at the battle of Sadowa or Koniggratz, July 3, 1866, receiving a gunshot
fracture of  the head of the right  femur.  On  August  23, 1866, the head
of the femur was excised, a curved incision being made behind the great
trochanter,  the bone being sawn close below the trochanter minor.  In
May, 1867,  the patient  was entirely cured.  The limb was shortened nine
centimetres (three  and a half inches), but the patient could walk very
well.  The head of the bone was shattered into fragments, and it is quite
probable that the acetabulum was fissured.  In December, 1869, Surgeon
General Grimm of Prussia, sent to the U. S. Army Medical Museum  a
card picture of this man, who remained in good health, and with a com-
paratively useful  limb.  (See  Card Photographs,  A. M.  M., Vol. IV,
page 1.)  The accompanying photograph is copied from the card picture.
          Photographed at the Army  Medical  Museum.
 BY  ORDER OF THE  SURGEON  GENERAL:
                          GEORGE  A. OTIS,
             Bv't LB Col. and Ass't Surg. U. S. A.,  Curator A. 31. 31. 
 
       ^nvtjwa   (BmmYs   W\tt

     ARMY   MEDICAL   MUSEUM.

Photograph No.  272.  A Case of  Elephas in which tlie Result
  of an Operation was Fatal.
  This case occurred in the person of Mrs.  J. G-----, a widow, aged
fifty years, a resident of Fall  River, Massachusetts,  and  the mother of
nine children.  None of her ancestors, so far as she was aware, ever had
any constitutional disease, and the longevity of her mother was so great
as to be the subject of considerable notoriety. She had  never been afflicted
with varix or puerperal phlegmatia;  the menstrual function was normal,
and nothing unusual had occurred in her pregnancies except at her last two
confinements, when considerable swelling of the left leg supervened, which
subsided without treatment.  About ten years previously she had an attack
of insanity resulting from domestic troubles and the privations of poverty.
Remaining in a lunatic asylum two years, she subsequently recovered her
mental equilibrium, and was restored to her family.  A few years later,
after unusual muscular exertion in  a damp cellar, she was attacked with
erysipelas in the left foot, which inflammation subsided under treatment.
Soon after, however, she observed  the  foot to be larger than its fellow.
The limb gradually increased  in bulk  for  more than six years, during
which time she had undergone all  kinds  of treatment.   Ligation of the
main artery of  the limb was proposed,  but to this stout  objection was
made, the patient declaring that she and her family had decided upon ampu-
tation as the only alternative.  After much reflection and consideration,
the patient's feelings were acquiesced with.  On  January 27, 1870,  after
the usual preliminaries had been arranged, the  thigh was amputated at
the junction of middle and upper thirds  by Dr. Isaac Smith.  The circular
integumental operation  was the one  chosen.   Very little haemorrhage
occurred.  The patient survived the  operation but half  an hour.  The
amputated limb weighed a trifle over one hundred  pounds.  At the time
of operation the limb presented an unsightly  huge  mass of deformity,
measuring at its greatest circumference three and a-half feet.  The digits
and foot had a glabrous and scaly  appearance.  Upon the integument of
the anterior and i^ner aspect of the leg  was a cuticular tubercular indura-
tion and ulceration with an amber-colored aqueous discharge.  An account
of a microscopical examination of portions  of  this limb by Dr. J. C.
Warren, of Boston, Massachusetts,  is published with Dr. Smith's report
of the case, p. 119, Vol. LX, American Journal of Medical Sciences, for
July, 1870.
          Photographed at the Army  Medical  Museum.
 BY ORDER  OF THE SURGEON  GENERAL:
                           GEORGE  A. OTIS,
                            Ass't Surg. U. S. A.,  Curator A. M. M. 
 
                           t&mmYit  Witt

        ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH  No.  273.   Anchylosis  of  the Right  Hip from
   Traumatic Arthritis.
  Lieutenant Seth W. Clark, Co. C, 9th New York  Cavalry, aged thirty-
two years, was wounded in a  cavalry  engagement at Trevillian Station,
Virginia, June 11, 1864, by a conoidal musket ball.   The regimental sur-
geon, Dr. W. H.  Rulison, reported the injury as  a gunshot flesh wound of
the right groin.   The Lieutenant remained in the hands of the enemy,
and was confined in Libby Prison  until September 2, 1864, when he was
exchanged and sent to the Officer's  Hospital at Annapolis,  where the
injury is recorded  ou  the  hospital register ai a "gunshot wound of the
right hip."  The patient states, however, that Surgeon B. A. Vanderkieft,
U. S. Vols., asserted that the neck of the femur was fractured, that there
was three inches shortening, and further, that the case was exhibited to
several  surgeons  as a  remarkable  instance of  recovery after  gunshot
fracture of the upper extremity of the femur.  The wound healed, and
the patient was  discliarged from service  on February 21,  1865.  The
patient  further stated that an operation had been performed by Acting
Assistant Surgeon Ely, for the  removal of dead bone.  My examination
leads me to believe that the patient was wounded by a musket ball, which,
passing from left to  right,  struck near the root  of the penis, inflicting a
superficial wound, not dividing  the  urethra, and then  entered the right
thigh an  inch below the fold  of the groin and lodged.  I  presume it
passed below the neck of  the femur in close proximity to the hip-joint,
and that secondary traumatic arthritis ensued and resulted in false anchy-
losis.  The shortening is apparent rather than real.  From  the  anterior
superior spinous process to the edge of the inner condyle of the femur
is seventeen and a half  inches on both sides; but the pelvis is so much
inclined that an appearance of excessive shortening is produced.   On the
extertor of the thigh, below and a little in advance of the great trochanter,
is a large cicatrix.   This, the  patient states, reopens from time to time,
and freely discharges pus.  The femur is  very firmly anchylosed in an
extended position, which makes it very inconvenient for  the patient to sit.
The right testis  is  atrophied.   I could find no  evidence of injury to the
bone tissues, or testimony that any  excision had  been practiced.
          Photographed at  the Army Medical  Museum.
   BY ORDER  OF THE  SURGEON GENERAL:
                           GEORGE  A.  OTIS,
             Bv't Lt.  Col. and Ass'tSurg. U. S. A., Curator A. 31.  31. 
 
       jPMgjwtt   (&tnmlf»  Witt

       ARMY  MEDfcAL  MUSEUM.

Photograph No.  274.   Anterior  View  of a Necrosed  Femur-
  stump.
  Private  Julius  Fabry, Battery K, 4th U. S. Artillery, had his left leg
nearly carried away  by a shrapnel shot  at Deep Bottom,  Virginia,
August 16, 1864.  After primary amputation at the place of election, and
intermediate disarticulation at the knee, secondary amputation or rather
resection of the projecting extremity of the femur, chronic osteomyelitis
resulted in the death of the shaft of the bone.  Fragments of the folia-
ceous mass of callus thrown out, and bits of necrosed bone frequently
detached, gave rise to much suppuration.   In 1867, Assistant  Surgeon
J. S. Billings, U. S. Army,  perforated the involucrum  with a trephine,
and removed fragments of-la. bone.  On May 15, 1870, Assistant Sur-
geon George A. Otis, U. S.  Army,  reamputated at the  hip successfully.
The  head  and neck of the  bone  were  not  diseased.  This pathological
specimen is deposited in the Surgical  Section of  the Army  Medical
Museum.  Other  particulars of the case are  recorded in  the histories
of photographs No. 275 and 276.
          Photographed  at the Army Medical Museum.
 BY  ORDER  OF THE  SURGEON  GENERAL:
                          GEORGE A. OTIS,
            Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. M. 31. 
 
       j^ttwjeaa   (fomxnY*   Witt

       ARMY MEDICAL  MUSEUM.

Photograph No.  275.   Stump of Left  Femur, Exarticulated
  at the Hip for Necrosis.
  Private Julius Fabry, Battery K, 4th U. S. Artillery, aged thirty-eight
years, had his left leg nearly carried away by a shrapnel shot, at Deep
Bottom, Virginia, August 16, 1864.  He was amputated below the knee
on the field, and again amputated at the knee-joint, and subsequently at
the lower third of the thigh, at Satterlee Hospital, Philadelphia.  Chronic
osteomyelitis followed, and all that remained of the shaft of the  femur
necrosed.  An unusually large involucrum  surrounded the dead bone.
The thigh stump was the seat of constant abscesses, as exfoliations from
time to  time took place.  On May 15, 1870,  reamputation at the hip  was
performed by Assistant Surgeon  George A. Otis, TJ. S. Army.    The
patient was about on  crutches in twenty-one days.  The Specimen  is  No.
5684, of the Surgical  Section of the Army Medical Museum. An anterior
view of the same specimen is given in photograph No. 274.
          Photographed at the Army  Medical  Museum.
 BY  ORDER  OF THE  SURGEON GENERAL:
                         GEORGE  A. OTIS,
            Bv't Lt. Col. and Ass't Surg. U. S. A., Curator A. 3L M. 
 
         Jpitvgttfii  (btnmVt  Witt

       ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH No. 276.   Appearances of Stump after a Success-
  ful Reamputation at the Hip.
  Private Julius Fabry, Battery K, 4th U. S. Artillery, aged thirty-eight,
 years, was wounded at Deep Bottom, Virginia, August 16, 1864.  He was
 sitting on his horse, when a shrapnel shot shattered the lower part of his
 left leg.  He was amputated, on the field, at the place of election, and
 then sent to  hospital at Philadelphia.  The stump turned out badly, and
 it was necessary to amputate again through the knee.  The condyle pro-
 truded, and yet a third amputation, or rather a resection of the protruding
 bone, was found necessary.  Nearly the whole of the shaft of the femur
 then necrosed.  For six years the patient suffered from frequently recur-
 ring abscesses,  as pieces of  dead bone or foliaceous  callus  became
 detached.  On May 15, 1870, reamputation at the  hip was performed by
 Assistant Surgeon George A. Otis, U. S. Army.  The patient recovered
 rapidly, being about on crutches in  twenty-one days.  On July 15, 1870,
the patient, then a pensioner at the Soldier's Home, rode into Washington
and visited the Army Medical Museum, and had this photograph taken.
The stump had  then healed.   His  general health was much  improved.
The pathological specimen of the old thigh stump is 5685, Section 1, A.
M. M., and the diseased femur is specimen 5684.
          Photographed  at the Army Medical Museum.
  BY ORDER OF THE  SURGEON GENERAL:
                          GEORGE A.  OTIS,
             Bv't Lt. Col. and Ass'tSurg.  U. S. A., Curator A. 31. 31. 
 
        <f"Mj)wm   $.mv.nVs   W\tt


       ARMY   MEDICAL  MUSEUM.

PHOTOGRAPH  No.  277.   Gunshot  Wound  of  the Knee Joint re-
  sulting in Recovery.

  Morris Huffman, a private of Co. H, 8th New Jersey Volunteers, aged
twenty-seven years, was wounded at the battle of Williamsburg, Virginia,
May 5, 1862, by a spherical musket ball  which entered  about one ineh
below  and behind the  left knee, directly in- the  median line of the limb,
and passing upwards,  forwards and inwards through the head of the tibia,
lodged, as was surmised at the time, somewhere  in the centre of the joint
between the head of the tibia and internal  condyle of femur, causing the
limb to remain fixed at an angle  of  about l->5 degrees.   Being admitted
to Hyge a Hospital at  Fort Monroe, he was strongly  advised by  the sur-
geou in .charge to submit to amputation of  the thigh  but stoutly objected,
and was shortly  after  sent  to  his  home  in  Asbury,  Warren  Co., New
Jersey, on a furlough.  Dr. Robert B.  Browne, late Surgeon of Volun-
teers,  writes under date of February 28. 1869, that he first saw and com-
menced the treatment  of this case about June 1, 1862, at  which time he
searched carefully for  the  missile,  but was  unable to  reach it.   The
patient had but little pain,  was in good health,  strong and robust.   The
wound suppurated finely, there was little or no inflammation of the  joint,
nor could any synovia be detected in the discharge.  Emollient applica-
tions were made and the patient was allowed  to  move carefully about the
house.   The wound had healed about the middle of July and he was able
to g■■> about on crutches, but unable to extend the limb  beyond the  angle
of 135 degrees.  At the expiration of  his furlough he  returned to the
hospital at Fort Monroe, whence he was discharged the service September
6, 1862.  Dr. Browne  states that he  lost sight  of his patient until the
summer of  1863, when he had regained some mobility of the  joint, and
could,  by giving the limb a peculiar twist, make  apparent the position of
the ball. On September 7. 1*63, Dr. Edward  Swifi of East on, Pa., having
anaesthetized the patient, Dr.  Browne  entered  a narrow bladed bistoury
immed ately over the middle and inside of the joint,  fortunately striking
the ball in the centre about  one inch below  the integuments; the opening
was then enlarged, and the  ball extracted with the aid of forceps, the
wound being quickly closed  so  as to  admit as little air as possible.  A
small quantity of synovial fluid made  its escape.   The ball, five-eighths
of an inch in diameter,  was slightly battered. It appeared to have imbedded
itself between the articular extremities of femur and tibia, and was fairly
covered by the synovial sac.   The limb was placed in a splint and perfect
rest enjoined until all  fear of inflammation of the joint had subsided.  In
one month the wound  had healed  by the   first intention, and the patient
wns again able to get about with the aid of a crutch and cane, which he
dispensed with at the end of five months.   In July,  1868, he could walk
with scarcely a limp;  no deformity existed, with the exception of a  slight
bony prominence at the point from  which the ball was extracted.   The
joint retained all its motions except that of extension which was limited,
the leg assuming an angle of about 170 degrees when fully extended.  He
was in perfect health aud free from all pain.

           Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE SURGEON  GENERAL:
                             GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A., Curator A. 31. 31. 
 
         i?im]eo»  ftmmYt   W\tt


      ARMY   MEDICAL   MUSEUM.

 PHOTOGRAPH  No.  278.  A Case of Intermediate Excision of the
   Knee Joint for Gunshot Injury.

   Alexander Rider, a private  of  Co. I, 76th Pennsylvania Volunteers,
 aged twenty-five years, was admitted into Hospital No. 1, Beaufort, South
 Carolina, October 24,  1862, having  been wounded at Pocotaligo, South
 Carolina, October 22,  1862, by a rough  lead  canister  ball, which entered
 over the external condyle of the right  femur, and passing through the
 articulation lodged in the popliteal space.  On October  24th, Surgeon R.
 B. Bontecou, U. S. V., removed the ball, and making an H-shaped incision,
 sawed off the lower portions of the condyles  of the femur, and excised a
 very thin slice from the head of the  tibia.  The azygous artery was tied,
 and the transverse  cut was  accurately  brought together by lead-wire
 sutures.   The circulation and appearance  of the limb  were good, but
 there was some swelling of the knee  joint, which was painful on pressure
 or when moved.  At the date of operation the patient was in good health.
 An ice bag and lint wet in a solution of morphine were  applied to the joint.
 On October 25th, a saline aperient was  administered.   The  ice dressing
 was continued until November 2d.  About this time there was troublesome
 diarrhoea which was checked by pills of opium and nitrate of silver. On Oc-
 tober 27th, the limb was placed in a trough, stuffed with hay, which afforded
 much relief.  Before this the pain had been excessive.   By November 8th,
 the evidence of inflammation about the knee had disappeared.   The trans-
 verse incision healed without suppuration.  On December 1st, the bones
 had apparently united, and the incisions  had  healed except at a point on
 either side of the joint, from which a few drops of pus escaped on pressure.
 December 20th. a starch bandage was  applied.  December  26th, febrile
 disturbance with an erythematous blush over  the skin  of lower extremity
 occurring, the bandage was removed.   On  December 28th,  the febrile
 symptoms had disappeared, and the  patient was transferred  North.  He
 was seen by Dr. Bontecou at Fort Wood Hospital, New York  Harbor, in
 July, 1863, at which time  he was unable to walk, but subsequently did so
 with the aid of a cane.  He was discharged from service in August, 1863,
 and pensioned.   On  March  6,  1867,  Pension Examiner E.  H. Pentz^
 reported him to have become paralyzed   since the operation and  to be
 helpless.   He rates his disability permanent and  equivalent to the loss of
 both limbs.  A letter from the patient  to Dr. Bontecou, dated July 29,
 1870, reports his helpless and forlorn condition.  Another letter from the
9ame source, dated September 5, 1870, leads us to infer that his condition
was not improved.

          Photographed at the Army Medical Museum.
 BY ORDER OF  THE  SURGEON GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg.  U. S. A., Curator A. M. M. 
 
       f uvi){wi   $n\mYa   W\tt

     ARMY   MEDICAL   MUSEUM.

PHOTOGRAPH Xo.  279.   A Successful Secondary Excision of the
  Knee-Joint for Gunshot Injury.
  James Trail, private Co. I, 2d Kentucky Volunteers, aged thirty-two
years, was wounded at Chickamauga,  Georgia, September 19, 1863,  by a
conoidal ball, which  entered externally  just above the condyles of the
right femur, and  passing downwards  through the knee-joint and upper
end of the tibia, emerged on the inner and anterior aspect of the leg.  He
was treated at the field hospital, Huntsville, Alabama,  thence was sent to
Jefferson Hospital, Indiana, and on December 14,  1864, was admitted to
the Main Street Hospital, Covington, Kentucky, whence he was discharged
the service, the wound  having healed.   On October  5,  1866,  he  was
admitted to the Good Samaritan  Hospital,  at Cincinnati, in an  anaemic
condition, but improved under iron and  generous  diet.   Openings had
formed, through which large quantities of pus and fragments of necrosed
bone were  discharged.  The leg was  somewhat  atrophied, and the joint
firmly anchylosed. On October 15th,  some  necrosed  bone was removed
through a crucial incision, and on November 20th, there was a large dis-
charge of pus with fragments of necrosed bone.   On December 14, 1866,
Dr. George C. Blackman excised one inch and a-half of  the head of the
tibia through an H-shaped incision on the  anterior aspect of  the joint.
The patella was also removed.  The leg  was  firmly placed in  a fracture
box.  Considerable haemorrhage occurred shortly after  the operation from
no particular vessel.  Cold applications  were made.   On the eighteenth
day after the operation secondary haemorrhage occurred, which was con-
trolled by pressure.  In  ten weeks he was able to go about  on crutches,
and went to his home in Ironton, Ohio.  His name does not appear on the
records of  the Pension Office.
          Photographed at  the Army  Medical  Museum.
 BY ORDER  OF  THE  SURGEON GENERAL:
                          GEORGE A.  OTIS,
                           Ass't Surg. U. S. A., Curator A. 31. 31. 
 
        ^'.lrfgwm   $nifraVs    W\tt

       ARMY  MEDICAL  MUSEUM.

PHOTOGRAPH No. 280.   Successful  Excision of  the Elbow-Joint
  for Gunshot Injury.
  J. T. Hertzog. a private of Co.  K.  47th  Pennsylvania Volunteers, a
German of remarkably temperate  habits,  having never used stimulants,
tobacco, tea nor coffee, and of excellent constitution, was wounded at the
battle of Pocotaligo, October 22. 1862,  by a  ball which entered the right
elbow joint at the outer and emerged just above the inner condyle of the
humerus at the opposite side.  He  was admitted to Hospital No. 1, Beau-
fort, South Carolina, on October 24th.  Two days subsequently the lower
end of the humerus with the articulating ends of the ulna and radius were
excised by Surgeon R. B. Bontecou, U.  8. V , and the arm laid upon an
angular splint of two parallel  strips leaving  an open  space  the whole
extent, thus facilitating approach to the  wound of exit.  Morphine was
applied to the wound;  it was covered with cerate cloth, and bags of ice
were  directed to be kept applied.   By November 1st. supuration was con-
siderable, but the  great tumefaction of the  arm and forearm was much
diminished.   The  lead-wire sutures were removed on November 15th, the
wound having healed sufficiently to keep the parts in shape.  On Decem-
ber 1st, the wound had nearly closed, there being but a  slight discharge;
the general condition of the patient was  good,  and he sat up to take his
food.   Some days previous to December 15th, the patient had been walking
about the hospital  grounds: the  wound was nearly healed, and the elbow
joint presented free mobility  in  every direction.   On December 28th, he
was transferred North, the wound being healed.  The excised portions of
bone with the history were presented to the  Museum by  the operator,
and are numbered 2^)23 of the Surgical Section.   This man was discharged
the service February  24,  18i;3,  and pensioned.   On  March 18, 1863,
Pension Examiner Lewellyn Beaver reports "an open running sore."   In
June, 1864, Dr  Bontecou writes that  he  saw  his  patient at Fort Wood,
Xew York Harbor, in July,  1863,  and that he  had good motion of the
elbow.  Another report from Pension Examiner Beaver, dated September
11, 1866, states that this  man had completely  lost the use of his arm.
There was four inches shortening.  He rated his disability total.
           Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE SURGEON  GENERAL:
                             GEORGE  A.  OTIS,
                             Ass't Surg. U.  S. A.,  Curator .1. 31. M. 
 
        Jin'fjrow   $rarviu'ji   (Dffir*.

       ARMY  MEDICAL  MUSEUM.
                             ---♦----
 Photograph No. 2S1.   A  Successful  Case of Excision  of  the
  Elbow-Joint, for Gunshot Injury.
  C. H. Lovell, Sergeant, Battery D, 14th New York Heavy Artillery, aged
 twenty-three years, was wounded at the battle of Cold  Harbor, Virginia,
 June 2, 1864, by a conoidal ball which entered the right arm at the outer
 condyle of the humerus and emerged at the inner aspect of the arm nearly
 opposite, shattering the lower extremity of the bone.  On June 3d, twenty-
 four hours after the  reception of the injury, chloroform was administered
 and four inches of the distal extremity  of  the humerus was  excised
 through a linear incision over the external condyle.   The patient was in
 good condition at the time of operation.  Simple dressings were applied.
 The wound healed and he was transferred  to Philadelphia and admitted,
 on July 22, 1864, to the Mower  Hospital,  whence  he was discharged  the
 service September 6, 1864, and pensioned.  On January 16, 1866,  Dr. E.
 D. Hudson furnished this patient with a prothetic apparatus, which in its
 incipiency proved highly useful.   At that time the  arm was shortened
 nearly four inches and slightly atrophied.   There was no use of the fore-
 arm but the functions of the hand were  normal.  On  October 22, 1866,
 Pension Examiner J. B. Graves,  who reports the  patient to be suffering
 from caries of the lower  end of the humerus  with a continuous discharge
 and pain, rates  his disability total and permanent.   A communication
from Dr. H. C. May, late Assistant Surgeon  of  Volunteers, dated March
18, 1868, states that this man has  been  employed for two years as a fire-
man in a factory at Corning,  New  York,   and  is able to do any  work at
arm's length like pitching wood, shoveling coal,  etc.
          Photographed  at the Army  Medical Museum.
 BY  ORDER  OF THE  SURGEON GENERAL:
                            GEORGE  A. OTIS,
                            Ass't Surg. TJ. S. A., Curator A. 31. 31. 
 
        *uri].rou   (gmrvaVg   (Dffi«.

     ARMY    MEDICAL   MUSEUM.

PHOTOGRAPH  No. 282.   Showing the Result of a Plastic Opera-
  tion for the Relief of a Deformity caused by a  Gunshot Wound
  of the Face.
  Elbert Hewitt, a private of Co. C, 6th Vermont Volunteers, aged twenty-
one years, was admitted into the Frederick LT. S. A. General Hospital on
September 27, 1864, having previously been wounded at Winchester, Vir-
ginia, September 19,  1864, by a fragment of shell, which carried away a
large portion of the superior and inferior maxillae. The wound was treated
with simple dressings. On November 19, 1864, he was transferred to New
York City, and on the  same date was  admitted to St. Joseph's Hospital.
On December 26, 1864, he was furloughed.   Being readmitted to hospital,
a plastic operation was performed by Dr. Gordon Buck on  February 28,
1865. Previous to the operation the mouth could neither be freely opened
nor entirely closed, and there was constant escape of saliva.  A cast repre-
senting this condition is numbered 265 of the Surgical Section of the Army
Medical Museum.  Another showing the patient's appearance two months
after the operation is numbered 485.  The right half of the lower lip and
the symmetry of the mouth are in a great measure restored  A third cast,
taken January 8, 1866,  prior to a second reparative operation, represents
substantially the same  condition.  These  casts were contributed by the
operator.  It will be seen from the photograph that the mouth is tolerably
symmetrical as to the lips, but much drawn to the right side.
          Photographed  at  the Army  Medical  Museum.
 BY ORDER  OF THE SURGEON  GENERAL:
                          GEORGE  A. OTIS,
                           Ass't Surg. U. S. A., Curator A. 31. 31. 
 
         jFimjflon  (&xnxx%Y$  Witt

       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH  No. 283.  Recovery after a Severe  Gunshot Wound
  of the Face  and Ligation  of the Left Common  Candid  Artery.
  John F. Ames, a private of Co. G,  91st New York  Volunteers, aged
twenty-four years, was wounded at Gravelly  Run, Virginia,  March 31,
1865, by a conoidal ball which entered the left side of the face beneath
the malar bone,  passed across through both maxillary bones, and emerged
below the centre of the left eye, destroying the  eye, and fracturing the left
nasal and superior maxillary bones.  He was  admitted  to the  Columbian
Hospital, Washington, on April  4. 1865.  Secondary haemorrhage occurred
on April 5th, from a branch of  the internal maxillary artery, and on the
7th, Surgeon Thomas R. Crosby, U. S. V., ligated the left common carotid
artery at its upper third.   The patient was in good condition  at the time
of the operation.  Simple dressings were applied; tonics, stimulants  and
nutritious diet were given.  He was transferred to Carver Hospital, Wash-
ington, June 21st, and discharged the service July 3, 1865.
          Photographed at  the Army Medical Museum.
   BY ORDER OF THE  SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                            Ass't Surg. U. S. A., Curator A. M. 31. 
 
            jpiinjtra  (&xnmY$   Witt


         ARMY  MEDICAL   MUSEUM.

 Photograph  No.  284.    Successful Second  Ligation of  the Left
    Common Carotid for Secondary Hxm orrhag- from  the Temporal
    Artery,  the result of Fracture of the  Left  Temporal Bone by a
    Conoidal Musket Ball.

  Private John Brooks, Co. I, 57th Pennsylvania Volunteers, aged seventeen  years, was
 wounded at the battle of the Wilderness,  May C, 1M!4,  by it conoidal  musket ball, which
 entered over the left ear. passed forwards, making an irregular opening through the tem-
 poral bone large enough to admit the introduction of two fingers  into the cavity of the
 skull, and escaped three inches anterior to the wound of entrance.  The membranes of tho
 brain, however, were not injured.  He was treated in a field hospital, and, on May l-.th, was
 sent to the Columbian Hospital at  Washington.  He was pale, emaciated, and complained of
 acute cephalalgia; otherwise, his bodily functions were  normal.  On the 17th, the headache
 had increased, and the pupils had become contracted.  Expectant treatment was used, not-
 withstanding which, delirium gradually came on, and, on May :2(ith, the patient was coma-
 tose and unable to swallow.  Tlie pulsations of the heart  were  rapid and feeble; the pulse,
 at the wrist, imperceptible.  He remained in this condition sixty hours, when, it was found,
 that if fluids were placed in his mouth in small quantities, he would swallow them.  From
 this time he slowly improved.  On June 2d, the patient was able to  sit np ;  but, his bowels
 were constipated, ho voided his urine unconsciously, and his  mental faculties were much
 impaired. He was unable to articulate, had no recollection of the past or proper perception
 of present things, and stared vacantly around the tent.  His appetite was ravenous.  The
 pnpil of the right eye did not respond to light;  otherwise, there was no paralysis.  At this
 date a haemorrhage occurred from the posterior wound to the amount of about two ounces,
 followed by great improvement in  all the symptoms.  Hemorrhage recurred every two or
 three days, and was not altogether  checked until the 1Mb of June, as it  seemed to aid much
 in restoring his mental faculties.  On the latter date, an attempt  was made to ligate the
 temporal artery; and this failing, the common  carotid was lig.itecl at its upper portion, on
 the  20th of June, by Surgeon T. E. Crosby, U. S. V.  Tho bleeding still continuing, the pos-
 terior wound was enlarged, and some small fragments of exfoliated bone were removed; the
 wound was then plugged with lint, which  entirely arreted the hemorrhage. It w;is esti-
 mated that fifty ounces of blood had been  lost during the last  hemorrhage. Liberal diet
 was  prescribed, and the patient gained rapidly in  llc.-h.  The ligature came away on tho
 tenth day after the operation, and the wound united, except at  the point of ligation, where
 a fistulous opening remained, which diseh irged daily a small amount of pus.  On August
 loth, blood was found to oozo from the place of ligation ; and. ths patient hiving lost about
 twenty ounces, the artery was cut  down  upon  by Surg-on Crosby, and ligatod below tho
 omo-hyoid muscle.   The vessel was found dilated to more than double its normal size, and,
 firmly attached to it on tho inner side, was  a  well-formed clot.  Low diet was ordered ;
 tincture of aconite was given to keep tho heart's action as much reduced as was consistent
 with the safety of the patient.  On September loth, the wound had fully healed, and, on
November 15th, the patient was furloughed, apparently entirely restored in his bodily func-
tions.  He was discharged from service on June 8,1S65.  'Ihe case is report.-d by  Surgeon T.
R. Crosby, U. S. V.
             Photographed  at  the  Army Medical  Museum.
   BY  ORDER  OF  THE  SURGEON  GENERAL:

                                 GEORGE  A.   OTIS,
                                    Ass't Surg.  U. S. A..  Curator A.  M. 51. 
 
        ^itvgtfott   ®mx\\Yii   Ww.

     ARMY   MEDICAL   MUSEUM.

PHOTOGRAPH No.  2S5.   Successful Removal  of the Right  Arm
  at  the  Shoulder-Joint,  with  Portions  of  the  Clavicle   and,
  Scapula.
  Captain E. L.  Severn, Co. K, 96th  Pennsylvania  Volunteers, a robust
young man  of temperate  habits,  was wounded at Spottsylvania  Court
House, Virginia, May 10, 1864. by the explosion of a case-shot, which
comminuted  the  entire right humerus and  involved the elbow-joint.  A
fragment of  the missile had  also passed through the top of the shoulder,
carrying with it a considerable  portion of the clavicle and superior part
of the scapula.  The unanimous  conclusion of several medical officers
being for immediate removal  of the arm at the shoulder-joint with  as
much of the  clavicle and  scapula as were seriously involved, the patient
was chloroformed, and Surgeon D. Webster Bland. U. S. V., removed the
injured member at the shoulder  joint,  making a superior flap from the
deltoid  muscle, disarticulating the head of the bone, and cutting the
lower flap from the inner side of the arm.   Haemorrhage being arrested
by ligatures, the  wound  over  the  clavicle was enlarged  by an  incision
in the  direction  of  the  bone;  the loose  spiculse  were  carefully re-
moved,  and either end of the clavicle sawn off, thus removing about four
inches of this bone.  The fragments of the  superior part of the scapula
with the loose and damaged integument where then removed; the wounds
over the scapula and clavicle were closed  with the  interrupted suture,
and a stimulant with an anodyne administered.  The operation was per-
formed in the midst of a dense wood at 5 o'clock, P. M., aided by the
light of half a dozen candles.   At midnight the patient, with hundreds of
others  seriously  wounded,  was sent  to Fredericksburg, a distance of
twenty  miles over a corduroy-road.  Sixty  hours after the operation the
wound  was dressed, and the subject made as comfortable as circumstances
would permit.  Subsequent progress being favorable the patient was sent
to Washington, and on May 25th was admitted to the Seminary Hospital,
Georgetown, where he made a rapid  and satisfactory recovery, and was
furloughed  July  1,  1864.   Captain Severn was discharged  the service
August 17, 1864, and pensioned, his disability being  rated total and per-
manent.  On March 27, 1867,  Dr. Bland writes from Pottsville, Pennsyl-
vania,  that  his patient superintends a colliery,  and  enjoys  excellent
health.
            Photographed at the Army Medical Museum.
  BY  ORDER  OF  THE  SURGEON  GENERAL:
                             GEORGE  A.  OTIS,
                              Ass't Surg. U. S. A., Curator A. 31. M.
1521 
 
        >iw)Wtt  6.cnfraVB   (Office,

       ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH  No.  28(5.   A  Successful Amputation  at  the  Hip
   Joint for Scrofulous Degeneration of the  Femur.
  The subject of this operation, Richard Eaton,  a fisherman of temperate
 habits, aged thirty-seven years, was admitted to the Washington (D. C.)
 Infirmary on November 5,  1850, having been bedridden for many months
 from disease of the femur and knee joint.  On admission there were as many
 as four deep sinuses extending down to the shaft  of the  bone, and opening
 by fungoid orifices on the  thigh, which was throughout  enormously en-
 larged and much inflamed.  The knee  joint was destroyed by ulceration
 to such an extent that the foot fell to either side; the  discharge of pus
 from the sinuses was very great;  and the parts presented  a most  disgust-
 ing aspect from the  free  generation of maggots in  the  limb and joint.
 The pulse was 106 ;  there was anaemia,  emaciation, and decubitis.  Not-
 withstanding these symptoms,  and  the nightly  administration of from
 three to six drachms of laudanum, the digestive organs were in a tolerably
 good condition.  Under a generous diet and tonics, the patient's condition
 had slightly improved by November 14th, when it was decided to remove
 the thigh at the hip joint.  After administering ether the artery was com-
 pressed by an assistant and Professor J. F. May removed the limb, making
 an anterior and a posterior flap.  Very little blood was lost.   Ligatures
 were applied in all to twelve arteries; the edges of the  flap were approx-
 imated by four points  of the twisted suture and adhesive  strips;  a water
 dressing was applied  to  the  wound, and an anodyne  administered.   A
 longitudinal section of the  femur immediately after  removal showed its
 cancellous portion to be, throughout, a mass of disease;  the  cartilage
 about the enarthrodial articulation appeared normal; the  soft parts were
 infiltrated with serum; and  the muscles were  pale and flabby, being
 blended together and disorganized in the lower half of the thigh.  During
 the entire treatment of the case the  patient took daily brown stout and
 iron, and  animal food, while  the  stimulus of  smoking was not with-
 held.  Opiates were  also freely administered.   By January 1, 1851,  the
 patient moved about the room on crutches, for the first  time, and improv-
 ing rapidly in  flesh and  strength, he left the  Infirmary on January
 26th.   On July 18, 1851, Dr.  M:iy  reported his  patient to  be actively
 employed in business, supporting by it a large family, and in all respects
to present the appearance of a strong and healthy  man.
          Photographed at the  Army Medical Museum.
 BY ORDER  OF THE  SURGEON  GENERAL:
                            GEORGE  A. OTIS,
                            Ass't Surg. U. S. A., Curator A. M. M. 
 
         JFunjwu  <&tntx%Y$  Witt

       ARMY  MEDICAL  MUSEUM.

Photograph Xo. 287.   The First  Case of Hip'Joint Amputation
  in the United States.
  Louisa Adelade Walters, a negro girl in her twelfth year, was operated
on for morbus coxarius at the Moyamensing Alms-house in the year 1840.
The operator, Dr. AVashington Joseph Duffee, of Philadelphia, under date
of January 28, 1868, communicates the following information relative to
this case:—"As the first step of the operation I secured the femoral artery
by ligation as it emerged from under  Pouport's ligament, then made two
lateral flaps, and after removing  the limb  at the joint, the flaps  were
united by the free use of the interrupted suture, and the usual dressings
of the day applied.   Only  six arteries required ligation—about two fluid
ounces of blood being lost during the operation, which occupied  nine
minutes and two seconds, including bandaging, etc.   In six weeks she
was discharged, well, and  has so remained  until the present time.  The
head of the femur was  entirely absorbed, yet the acetabulum  presented a
surface entirely free from disease.   The woman has since married, and is
now the  mother of two children, one a male, aged  twelve years, the
other a female, aged five years."

          Photographed at the Army Medical Museum.
  BY ORDER OF THE SURGEON  GENERAL:
                          GEORGE  A.  OTIS,
                            Ass'tSurg.  U. S. A., Curator A. 31. M. 
 
         ^nwjwii   $mx\iVs   W\tt

        ARMY  MEDICAL  MUSEUM.

 PHOTOGRAPH  No.  288.   Showing a  Gunshot Wound  in which
   Fracture was limited to the Inner Table of the Skull.
   Private Denis S-----, Co. E, 2d West Virginia Cavalry, was wounded
 in an engagement at Harper's Farm,  near  Appomattox  Court  House, on
 April 6, 1865, by the oblique  impact of a musket  ball which denuded
 and contused the frontal bone a little  below the coronal suture and to the
 left of the median line.   Being taken prisoner he was  placed  in a field
 hospital where a water dressing was applied, the hair being shaved off to
 a  suitable extent.  A  few days subsequently, he was sent to the rear,
 and reaching Washington  a  fortnight after  the reception of his wound,
 was placed in Harewood  Hospital on April 19th.   He  had a chill soon
 after his admission and reported that  for some days he had suffered from
 two paroxysms daily.   He had no pain in  the head  nor any symptom to
 excite apprehension as  to the condition of  the  brain  except  the chills
 which were ascribed to malarial influence.  They proved, however, not to
 be amenable to quinia, which was freely  administered,  for several days,
 without advantage.  On April 24th, a slight  congestion of the lower lobe
 of the right lung was  noticed.   The next  day pneumonia  was  fully
 developed here, and on  the 26th, the greater portion of the right lung was
 involved, and there was acute pain in the cardiac region, with a scuffle
 accompanying the first sound of the heart and a murmur of regurgitation
 the second sound.  The pulse rose rapidly to 156;  but fluctuated greatly
 in frequency and force.   At ten in the evening  of  this day the patient
 became comatose.  Shortly afterwards Surgeon R. B.  Bontecou, U. S. V.,
 applied the crown of a small trephine on the right  of the space in which
 the pericranium was removed.   When  the  outer  table was passed, pus
 began to exude from the cells of the diploe.   When this was penetrated
 a depressed fracture of the inner  table was  discovered.   Another per-
 foration was now made  to obtain space to remove the depressed fragments
 of the vitreous plate.  A small fragment, and another measuring nine by
 six lines, was found completely detached. They were removed by common
 dissecting forceps.  The operation had  no  influence upon the profound
 coma, that persisted until the patient's death, which took place on the fol-
 lowing morning, April  26,  1864.   At the  autopsy  a large abscess was
 found in the substance of the right cerebral hemisphere.  The pathologi-
 cal specimen, consisting of a segment of the  frontal  bone, with the two
 disks and the larger fragment of the inner table removed at the operation,
 was contributed by the  operator, and  is  numbered 4344, Section I,
A. M. M.
          Photographed at the Army Medical Museum.
 BY  ORDER  OF  THE  SURGEON GENERAL:
                            GEORGE  A.  OTIS,
                            Ass't  Surg.  TJ. S. A.,  Curator A. M. M. 
 
        .^'nygtaa   ®mm\Ys   W\tt


      ARMY   MEDICAL    MUSEUM.

PHOTOGRAPH Xo. 289.   .4  Case  of Recovevy  after Excision of
  the Humerus for Gunshot Injury involving the  Trachea, Clavicle
  and Shoulder Joint.

  James P. Kegerreis,  a  private  of  Battery B, 2d Pennsylvania Heavy
Artillery, aged nineteen years, a robust healthy man, was wounded at the
battle in front of Petersburg, Virginia, June  17, 1864. by a conoidal ball
which entered three-fourths of an inch  below  the thyroid cartilage  just
to the left of  the trachea, passed a little  downwards and  to  the  right
under the jugular vein, carrying away one of the wings of the trachea,
and emerging half an inch above the  clavicle, three inches from point of
entrance, was deflected in its course by hitting the butt of the musket,
and again entered in front  of the right  clavicle  two  inches from the
acromial end, passing through the surgical  neck of the humerus, and
emerging near the centre of  the  deltoid muscle.   He  was taken to the
field hospital  and marked for an  amputation  on the  following day,  but
teariug off the label  he  crawled away among the "slightly wounded," and
was sent to City Point  where the wound  was first  dressed,  three days
after the reception,  at which time it was found to  be filled with vermin;
several pieces of bone were extracted.   Air passed through the wound in
the  trachea, and he  spat up considerable blood; this wound, however, did
well, and healed in about four weeks.   In July, 1864, he was admitted to
the  Third Division  Hospital, Alexandria.  Virginia, where a number of
spiculae of bone were removed.   On January 17,  1865, Surgeon Edwin
Bentley, U. S. V., excised the head and three inches  of the shaft of the
right humerus through  an incision five  inches in  length from acromion
through the deltoid muscle.  Several abscesses formed in the arm, and one
on the side two inches below the axilla and  on the  posterior boundary of
the space, all of which  healed readily.   He  was  discharged  the service
May 29, 1865, the wound of exit being  still  open.   He states that about
one  year afterwards nine fistulous openings  discharged,  the  arm from
shoulder to elbow becoming greatly enlarged and his general health fail-
ing rapidly.  On December 17, 1867, a  sequestrum  six  inches long was
removed by enlarging the orifice through which it pointed.  The incision
extended from the point of resection to the elbow, the patient being under
the influence  of nitrous oxide gas.   No untoward symptoms  occurred.
The wounds were all healed on  April 1, 1868,  and  never reopened.  The
elbow-joint is anchylosed in a semi-flexed  position and  firm ligamentous
union has taken place in the arm, so that the subject is able to lift about
135 pounds with the injured limb.  Eleven well marked cicatrices appear
on the arm and side.  The temperature of the limb is normal.  In October,
1870, Mr. Kegerreis was employed as a clerk in the Pension Office and
received a pension of §15 a month.  The excised head with a sequestrum
of the shaft is numbered 5711, Section  I, Army Medical Museum.   The
specimen and the particulars of  the  case  were  contributed  by H. W.
Sawtelle, M. D.

          Photographed at the Army Medical Museum.
 BY ORDER  OF  THE  SURGEON GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. U. S. A., Curator A. M.  M. 
 
       ARMY  MEDICAL MUSEUM.

PHOTOGRAPH Xo. 290.  Recovery after Amputation of the Thigh,
  Secondary Hsemorrhage, and Ligation of the Femoral Artery.
  Thomas Lenihan, a private of Co.  D,  37th New York Volunteers, was
wounded at the battle of Fair Oaks,  Virginia,  May 31, 1862.  The right
femur was fractured at the middle third, the fracture extending downward
to the knee.   He was taken prisoner, exchanged in four days and admitted
to the Hygeia Hospital at Fort Monroe, where he remained until June 20,
1862, when he was transferred to Camden Street Hospital, Baltimore.  On
June 27th, Acting Assistant Surgeon George H. Dare amputated  the right
thigh at the upper third; secondary haemorrhage set in on the night of the
operation, and Assistant Surgeon Roberts Bartholow, U. S. A., ligated the
femoral artery.  The patient  recovered and was discharged  from service
September 26, 1862.  He was furnished  with an  artificial limb about
eleven months after the amputation.   On  October  4, 1870,  Mr. Lenihan
called at the Army Medical Museum and stated that his stump had never
bothered him.   He was at that time on duty in the Interior Department.
          Photographed at the Army  Medical  Museum.
  BY ORDER OF  THE SURGEON  GENERAL:
                           GEORGE  A.  OTIS,
                             Ass'tSurg. U. S. A.,  Curator A. M.  M. 
 
        jrurijMif   fervaVs   W\tt

       ARMY   MEDICAL   MUSEUM.
                             -—*—
PHOTOGRAPH Xo. 291.   A  Dry Preparation of the Left  Hand
  and Lower  Portion of the  Fore-arm, showing Incipient Necrosis
  of most of  the Metacarpals and Phalanges
  The disease for which this member was amputated, it would seem, was
involved in considerable obscurity, several distinguished  surgeons having
differed  widely in their diagnoses.  One  considered it a  disease  of the
blood vessels, another elephantiasis, whilst a third, from  a microscopical
examination, called  it chronic  cellulitis.  The  subject of the operation
was Mary McFarland, a housekeeper, aged twenty-seven,  who had an in-
flammation in the first phalanx of  the little finger about  January, 1868.
Some  six months later the  disease invaded the metacarpal bone,  and
gradually extended  during the year 1869.  Becoming pregnant in Sep-
tember, she gave birth to a healthy child, which was carried the full term.
Her appetite was insatiable.  In March, 1870, she was examined by Doc-
tors Parker and Hamilton and  a number of others.  In April, the hand
becoming enlarged and painful, several punctures were made through the
skin, one of which  discharged  daily from one to three pints of bloody
serum.   This discharge continued till the limb was amputated. When the
punctures closed  the hand would  again become swollen and painful.  In
May a seton was introduced, but soon ulcerated, and the opening never
healed.  At no time was there any marked tenderness  in working the
joints.   On August  10th the little finger was amputated.  On the 15th
it became necessary to remove the  hand  and a portion of the forearm.
The pathological specimen was contributed to the Army Medical Museum
by Dr. J. C. Snively, of Brooklyn,  New York, and  is numbered 5,705 of
the Surgical Section.  A microscopical examination of several sections of
the  soft parts of this specimen was made at the Army Medical Museum
on August 25, 1870, and nothing new observed except the  ordinary exu-
dation products of inflammation.  It was then directed that the specimen
Bhould be dissected  and prepared  in the dry way.  A cheesy abscess was
discovered under the palmar fascia, and periostitis of the metacarpals
and phalanges with incipient necrosis. On January 10, 1871, Dr.  Snively
reported  the amputation to have healed promptly, but  that within the
last month a redevelopment of the disease has occurred, implicating the
several glands extending to the  axilla.
           Photographed at the Army Medical  Museum.
 BY  ORDER  OF  THE  SURGEON GENERAL:
                             GEORGE   A.  OTIS,
                             Ass't Surg.  U. S. A., Curator A. 31. 31. 
 
          &nx$wn    t&mml's   Witt


         ARMY  MEDICAL  MUSEUM.

 Photographs  Xos.  189,   178,   179 and  292.   Partially  Con-
   solidated  Gunshot  Fracture  of the  Upper Third of tlie Right
   Femur.

   Private George Ruoss, Co. O, 7th New  York Volunteers, aged twenty-seven  years,  was
 wounded in an engagement at the South Side Railroad, near Petersburg, Yirginia, on March
 31,1865, by a conoidal musket ball, which struck the anterior and outer aspect of the right
 thigh, about three inches below the great trochanter, and,  passing inwards and a little
 downwards, comminuted portions of the upper and middle thirds of the femur, and emerged
 posteriorly, about the middle of the gluteal fold.  He was taken to the Base Hospital at City
 Point, and on April 6th, was transferred to Campbell Hospital at Washington.  On July 8th,
 he Tvas removed to Stanton Hospital, and, on  September  12th,  to Harewood  Hospital.  On
 his admission to Harewood, he was able to  sit up, and the  constitutional condition was
 tolerably good.  The fracture had united with great deformity;  there were several fistulous
 orifices, through which fragments of necrosed bone were extracted almost daily.  On May 1,
 1866, Ruoss was transferred, on the closure of Harewood, to the Post Hospital at Washington.
 On June Stli, he was etherized, and  Assistant Surgeon W. Thompson, U. S. A., made a V
 shaped incision at the upper and outer part of the thigh, and removed several  fragments of
 diseased bone.  September 30, 1866: the wound has nearly healed;  there are three sinuses,
 (two on the upper, and one on the lower surface,) which lead to what  is evidently necrosed
 bone.  December 31, 1866:  Sinuses still  open  and discharging,  general  condition feeble;
 there is great deformity, and about five inches shortening of the limb, with almost complete
 anchylosis of the knee joint.  The photograph was taken in July, 1867.   A communication
 from Assistant Surgeon John Brooke, U. S. A., dated July 6, 186<\ furnishes  tho following
 additional information:—On taking charge of  the  patient in November, 1S67, he found  the
 limb in the same condition as that previously described,  except that  a  collection of pus,
 which had formed on the inner aspect of the thigh, just above  the knee,  had been opened,
 and that there was a sinus connecting with the scat of fracture. This sinus, with the open-
 ings above mentioned, continued until death.  The patient  was extremely  feeble, greatly
 emaciated, and suffered  much from  diarrhoea  and  anorexia.   These symptoms  continued
 until the patient'.s death, which occurred June  27th, 1868.  At the autopsy, the liver was
 found enormously enlarged, weighing ten pounds and ten ounces;  and the right lung con-
 tained a small mass of calcareous matter.  Portions of  the tibia and fibula, and the femur
 with the os innominatum and  patella attached, were  removed.  The femur, imperfectly
 united with  great  displacement and a deposit of  foliaceous  callus, shows that extensive
periostitis had taken place.  The upper portions of the tibia and fibula and the patella, also,
bhow similar pathological changes.  The specimen is Xo. 5450 of the Surgical Section.
            Photographed  at the Army  Medical  Museum.
 BY  ORDER  OF  THE  SURGEON  GENERAL:

                                GEORGE  A.   OTIS,
                                   Ass'l Surg.  U. S. A.,  Curator A.  M 31. 
 
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           fiifOMi   (6iwpvnV5   W\tt

         ARMY  MEDICAL  MUSEUM.

   Photograph  Xo.  293.  Proximal Extremity of the Left Femur
     with a Round Musket Ball, excised for Gunshot Injury.
     This photograph illustrates  specimen 5658 of the  Surgical Section of
   the Army Medical Museum, which was  contributed  with  a fully detailed
   account by the operator,  Assistant  Surgeon F.  Meacham, U.  S. A.  The
   subject of the operation was Hubert Erne, a private of Co. D, 4th  United
   States Infantry,  aged forty-eight years,  and an old soldier of very intem-
   perate habits, who had been wounded several times in the late war.  The
   wound  in question was inflicted, December  2, 1869, while acting  as one
   of the  corporal's  guard escorting  the  mail  wagon from Fort  Laramie,
   Dakota,  to Fort Fetterman.   The nature of the injury  to the bone  is
   well explained by the photograph.   Excision was performed  through a
   curvilinear incision twenty-four hours after the reception of  the wound.
   Very little blood was lost, and the patient rallied promptly after the opera-
   tion, having suffered but little from the shock.  The after treatment was
   conducted in accordance with the general principles common to all joint-
   excisions. By the end  of March,  1870,  the patient was convalescent,
   being able to sit up.  On the 10th of April, he walked a short distance on
   crutches.  There was a great disinclination  on  the part of  the patient to
   exert himself.  In July and August abscesses formed in the muscles of the
   thigh.  March 9, 1871, the patient was  reported  to be entirely well, but
   persisted in lying abed.  April 1, 1871,  Dr. Meacham reported his patient
   to be able to walk  comfortably on crutches, and  to have slight control over
   the limb, which  admitted of a to-and-fro motion  with rotation inwards.
   The Doctor called at the Museum on June  2,  1871,  and stated that his
   patient is not doing well, being troubled with dilatation  of the heart,  in-
   digestion, irregular bowels,  and hypochondriasis.  By  an order, dated
   A. G. 0., June 9, 1871, it was provided  that Private Erne should  be sent
   to the Soldier's Home.   A communication from Dr. Meacham, dated June
   11, 1871,  informs  that this man is  much better, and will soon be able to
   comply with the provisions of the above order.
             Photographed at the Army Medical  Museum.
    BY ORDER  OF THE SURGEON  GENERAL:
                               GEORGE  A.  OTIS,
                               Ass't Surg.  TJ.  S. A., Curator A. 31. 31. 
 
       JFiirgwm   (&mxs,Y$   Witt

       ARMY MEDICAL  MUSEUM.

PHOTOGRAPH  Xo. 294.  Portions of Bones of the Buffalo  trans-
  fixed by Indian Arrow Heads.
  The figure on the right of the group represents Specimen 4735 of the
Surgical Section, which is a portion of rib, apparently a false  rib of the
right side, transfixed by an arrow head.  Specimen 4736 of the Surgical
Section, showing a portion of rib of the right side similarly transfixed, is
represented by the figure on the left.  Both specimens were presented to
the Army Medical Museum June  8, 1867, by Professor Joseph Henry,  of
Washington, having been previously sent to the  Smithsonian Institution
from Nebraska Territory by Surgeon F. V. Hayden, U. S. V.   The centre
of the group represents a piece of the left scapula  perforated by a
Cheyenne  arrow head.  The specimen was found in the vicinity of Fort
Sedgwick, Colorado  Territory.  The  animal furnishing it was supposed
to have perished some six or eight years  previously.  This specimen was
contributed to the Army Medical  Museum by Hospital  Steward Richard
Wall, U. S. A,, and is numbered 47-7 of the Surgical Section.
          Photographed at the Army Medical Museum.
 BY  ORDER  OF THE  SURGEON  GENERAL:
                          GEORGE A.  OTIS,
                           Ass't Surg. U- S. A., Curator A. M M. 
 
        JFurgton  (BmmYs Witt

      ARMY MEDICAL MUSEUM.

Photograph Xo. 295.
  The specimen illustrated  by this photograph is numbered 5417 of the
Surgical Section of the Army Medical Museum, and is from the Gibson
Collection.  It consists of the left innominatum and upper half of the
femur, showing a firm anchylosis at the hip with immense osseous deposits
and great spines of bone projecting from  the trochanteric line  and linea
aspera.
         Photographed  at the Army  Medical  Museum.
  BY  ORDER OF THE  SURGEON GENERAL:
                       GEORGE  A. OTIS,
                         Ass't Surg. TJ. S. A.. Curator A. M. 31. 
 
         §"»rg.pxr»   $mXi\Y$   Witt

      ARMY   MEDICAL    MUSEUM.

 PHOTOGRAPH  No.  296.   A Gunshot Fracture of the Femur in the
   Middle Third terminating In Recovery.
  Hiram B. Smith, a private of the 9th Company of Ohio Sharpshooters,
 aged eighteen years, was admitted August  24,  1864, to Armory Square
 Hospital,  Washington, having been wounded at the battle of Weldon Rail-
 road, August 19,  1864,  by a conoidal  musket  ball,  which entered the
 internal surface of the left thigh, produced a comminuted fracture of the
 middle third of the femur, and  emerged on the outer surface about two
 inches below the point of entrance.  Simple dressings were applied.   By
 November 24,  1864, the bone had united leaving an abscess on the outer
 side of the thigh extending from the seat of  injury to the knee but not
 communicating with the joint.   This abscess had been opened on Novem-
 ber 20th, the discharge therefrom being profuse.  The  patient improved
 slowly until April 20, 1865,  when he was transferred to Harper Hospital
 at Detroit. Michigan.  From this hospital he was discharged the service,
 the wound not yet healed ; and was subsequently pensioned.   In March,
 1867, Pension Examiner E.  D. Peck reported this man to be still suffering
 from his wound,  his leg being shortened six inches and useless.   He rated
 his disability  more than equal  to the  loss  of limb  and permanent.  A
 communication from Dr. Geo. K. Smith, of Brooklyn, N. Y., dated March
 18, 1871, states that several fragments  of bone  coming to the surface of
 the wound were removed by the patient himself.  In October, 1866, he
 (the patient) removed a fragment three  inches long by three-quarters of
 an inch wide  The last fragment was removed in 1868, the wound healing
 a few days afterwards.  Since then he  has been able to do most kinds of
 farm labor nearly as well as ever.   On February 22,  1871,  when this
 photograph was taken, Mr.  Smith  was in excellent  health.   There was
 five inches shortening of the limb, but  he averred that it feels as strong
 as ever it  did,  and causes no inconvenience,  except after a walk of four
 or five miles when the ankle inclines a little outward.  The knee joint
 appears to be perfectly sound,  but flexion  at the knee is limited.  The
 pelvis tilts to the left, the degree of  obliquity being shown  by the two
 spots on the anterior superior spinous processes of  the ilia, which  were
painted there previous to taking the photograph.
           Photographed at the Army Medical Mus urn.
 BY  ORDER OF THE SURGEON GENERAL:
                           GEORGE  A.  OTIS,
                             Ass't Surg. TJ. S A., Curator A. 31.  31. 
 
 
 
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