Civil War Washington

CASE 992.—Partial excision at the ankle joint.—Private L. Ettinger,¹ Co. K, 58th New York, aged 52 years, was accidentally injured, near Hunter's Chapel, December 6, 1861, by the blow of an axe, which struck his right foot just below the external malleolus, penetrating the ankle joint. Assistant Surgeon J. S. Billings, U. S. A., who operated in the case, made the following report: "The man was admitted to the Union Hotel Hospital, Georgetown, January 1, 1862, being very feeble and emaciated and complaining of great pain in the foot. A large gaping wound existed at the site of the injury, from which sanious fetid pus was escaping and at the bottom of which dead bone could be felt. Sinuses also ran down each side of the tendo-achillis, and the whole integument about the ankle joint was livid and undermined. On January 6th partial excision of the ankle joint was performed by a curved incision three inches long, made just below the external malleolus and including the original wound. The external malleolus, the whole of the astragalus​, and a small portion of the scaphoid were found to be carious and were removed by means of the bone gouge and Liston's forceps. The hæmorrhage was slight. Simple dressings were applied, and ale and good diet were furnished. By March 1st the wound had entirely healed, the skin had resumed its natural appearance, and the patient could walk with a cane. He was then sent to Philadelphia, where he was discharged from service. I saw him eight months afterwards, walking with a cane and with but a very slightly perceptible limp. The age and debilitated condition of this patient rendered the expediency of excision very doubtful; but the result proved entirely satisfactory." The records of South Street Hospital, Philadelphia, show that the patient was discharged September 17, 1862, by reason of "anchylosis of the right ankle joint" resulting from the wound. The man subsequently became a pensioner. The nature of his injury and disability has since then been corroborated by successive certificates of various examining surgeons. The pensioner has been for some years an inmate of the hospital for the insane at Randall s Island, New York Harbor.

¹ CULBERTSON (H.), Excision of the Larger Joints of Extremities, in Transactions American Medical Association, 1876. Supplement to Vol. XXVII, p. 344. Prize Essay.