CASE 728.—Private J. H. Metz, Co. G, 9th Regiment Veteran Reserve Corps, aged 33 years, was wounded in the left leg, near Fort Stevens, Defences of Washington, July 11, 1864. Surgeon O. A. Judson, U. S. V., made the following report of the injury: "A conoidal ball entered the limb anteriorly, passed through transversely, and produced a compound comminuted fracture at the upper third of the tibia, the man by his weight soon after fracturing the fibula. He was conveyed to Carver Hospital, Washington, where the leg was amputated at the upper third, by the lateral flap method, by Medical Inspector J. Wilson, U. S. A., on the day of the injury. The patient was anæmic and very nervous at the time of the operation. Cold-water dressings were applied. On the following day the clot had formed beneath the flaps, rendering it necessary to cut the suture and reopen the wound. The clot was then turned out and the flaps, after remaining open for some time, were closed up again. On July 13th, the flaps looked dark and were opened again, when a strong solution of sulphate of copper was applied. Sloughing commenced the next day, causing the tibia to protrude. Citrate of iron and quinine, with stimulants, were administered freely and the external applications repeated. By July 17th granulations were starting up over a portion of the surface of the flaps. Secondary hæmorrhage occurred on the following day. The patient appeared greatly exhausted, had very poor appetite, and was troubled with diarrhœa. Dry dressings were now applied to the stump. On July 23d an abscess was found to have formed above the knee, after which sloughing extended upwards. The patient continued to sink, his diarrhœa resisting all treatment; pulse rapid; skin of an icteric tinge. Death occurred from exhaustion, July 28, 1864. At the autopsy pus was found to have burrowed up the outer and posterior portion of the leg, extending to the dorsum of the ilium. The pus was of a dark color and contained a large quantity of free fat. The right lung adhered to the wall of the chest anteriorly, otherwise healthy. Both lobes of the left lung were slightly congested; heart normal; liver somewhat congested and gall-bladder distended with bile; spleen covered on lower portion with patches of lymph; stomach distended with dark fluid. The mucous membrane of the small intestine was thickened and covered with pseudo-membrane, easily removable." The amputated bones of the leg (Spec. 3166), represented in the wood-cut (FIG. 285), were contributed to the Museum by Acting Assistant Surgeon A. W. Merrill.

FIG. 285.—Fracture of left tibia and fibula in upper third. Spec. 3166.