Green, E.a machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d2e13851Civil War WashingtonUniversity of Nebraska–LincolnCenter for Digital Research in the
Humanities319 Love LibraryUniversity of Nebraska–LincolnLincoln, NE 68588-4100cdrh@unlnotes.unl.edu2011
The following are responsible for particular readings or for changes to
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Kenneth M. PriceAJ HowellMatthew BosleyElizabeth LorangStacey BerryElisabeth TraceySarah SynovecThe Medical and Surgical History of the War of the Rebellion.
(1861-65.)Washington, DCGovernment Printing
OfficePart 3Volume
21883310Medical and Surgical History of the War of the Rebellionwounds and injuries of the lower extremitiesinjuries of the shaft of the femuramputations in the shaft of the femursecondary amputations in the shaft of the femur for shot injurysecondary amputations in the middle third of the femurcases of recovery after secondary amputation in the middle third of the femurball entered above and to side of patella, fractured femur in lower third, lodged on
inner posterior side opposite point of entrancedry gangrene of toes and dorsum of foothæmorrhage from femoral arterygeneral anesthesia, etherfemoral artery destroyed popliteal space, evidently by missilelower fragment of femur at angle of thirty degrees with leg, pressed firmly against
wounded femoral artery, preventing fatal hæmorrhagefurnished with artificial legblessedadded figure encodingadditional proofing of transcription and encoding, identified
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CASE 485.—Private E.
Green, Co. K, 119th Pennsylvania, aged 35
years, was wounded in the right thigh, at Rappahannock
Station, November 7, 1863, and was admitted
to Armory Square Hospital, Washington, two days afterwards. Surgeon D. W.
Bliss, U. S. V., furnished the following
description of the injury, and of the operation which he performed: "The missile, a conical
ball, entered one and a half inches above and to the right of the patella, passing across the
limb, fracturing the femur in the lower third, and lodging on the inner and posterior side,
nearly opposite the point of entrance. The limb was treated in a skeleton fracture-box, and
water dressings were used. On November 18th, the
ball was extracted. Hæmorrhage occurred on the following day, and again three days
afterwards. The discharge of pus became copious about December 1st, and dry gangrene of the toes and dorsum of foot appeared. The upper
fragment of the femur protruded one and a half inches, and at every effort to extend the limb so
as to retract the protruding bone violent hæmorrhage ensued. The patient's system was
greatly reduced, and careful attention was paid to retain his digestive powers by a rotation of
stimulants and nourishing diet. A slight change in the position of the limb, on December 28th,
brought on a hæmorrhage to the amount of twenty ounces in three minutes time evidently from
the femoral artery, which was then controlled by pressure. By January 20, 1864, sloughing of the
heel and dorsum of foot had commenced, and the patient's system was still so much debilitated
that a decision to operate, which had been retarded as calculated to prove fatal, was now
arrived at as a last chance to preserve life. On the
following day the thigh was amputated at the middle third by antero-posterior flaps,
four arteries being tied and but little blood lost. Ether was used as the anæsthetic. At
the operation an abscess was discovered in the anterior flap extending upward for three inches,
and the femoral artery was found to be destroyed in the upper part of the popliteal space,
evidently by the missile. Above the point of the amputation the vessel was healthy; but no clot
was found. The vessels of the leg were much constricted. The lower fragment of the femur was
flexed at an angle of thirty degrees with the leg, and, by contraction of the muscles of the
thigh, was pressed firmly against the wounded extremity of the femoral artery, thereby
preventing fatal hæmorrhage. The flaps of the stump presented an unhealthy appearance,
being much indurated and infiltrated with serum. Tincture of chloride of iron was applied to the
entire surface with a view of stimulating the parts and of obtaining its hæmostatic effect
upon the capillary vessels which failed to contract from cold and exposure to the air. A large
tent was placed through the fourchette of the stump so as to prevent the accumulation of pus,
the flaps being gently brought together and tepid water dressing applied. The patient improved
daily, and was in a fair way of recovery one week after the operation." The amputated portion of
the femur was contributed to the Museum by the operator, and is shown in the wood-cut (FIG. 202). The specimen shows the parts about the fracture to be dead
and stripped, and its upper half to be covered with an involucrum of foliaceous callus tolerably
dense posteriorly, also some periosteal deposit above the condyles. The patient subsequently
entered Judiciary Square Hospital, and was discharged
July 7, 1864. He was furnished with an
artificial leg by B. F. Palmer, August 26, 1865, and was paid as a pensioner until September 4, 1867, since when he has not been heard
from.