Marston, Charles E.a machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d2e5360Civil 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
this file, as noted:
Kenneth WinkleAJ HowellMatthew BosleyThe Medical and Surgical History of the War of the Rebellion.
(1861-65.)Washington, DCGovernment Printing
OfficePart 3Volume
21883105-106Medical and Surgical History of the War of the Rebellionwounds and injuries of the lower extremitieswounds and injuries of the hip jointshot fractures at the hip jointexcision at the hip after shot injuryintermediary excisionslaid on battle-field several dayslarge bullet wound anterior to and in line with trochanter majorcomminution of head and neck of femurneck of femur crushed into fragmentsgeneral anesthesia, chloroformautopsy performedblessedadded figure encodingadditional case copied from MSHWR, performed proofing of copy
and XML encoding, and key terms identified
CASE 247.—Private Charles E.
Marston, Co. F, 1st Massachusetts, aged 19
years, a pale and delicate boy, was wounded at the second battle
of Bull Run, August 30, 1862. He was
admitted to the College Hospital, Georgetown, D. C., on
September 6th, having laid on the battle-field
several days, and then moved in an ambulance wagon thirty miles over very rough roads. An
examination revealed a large bullet wound an inch anterior to and on a line with the right
trochanter major, with great comminution of the head and neck of the femur. The limb was
shortened, and the foot was everted. The circumference of the limb exceeded that of its fellow
by half. The pulse was 112, and of moderate volume. The tongue was rather dry. The patient
suffered little pain. The general condition was not promising, and yet not very bad. Excision of
the fractured bone was decided upon, and, on the 27th
of September, Assistant Surgeon B. A. Clements,
U. S. A., assisted by Assistant Surgeon Charles H. Alden, U. S.
A., and the surgical staff of the hospital, proceeded to perform the operation.
Chloroform was administered, and a slightly curved incision five inches in length was made on
the outside of the thigh, the shot hole in the middle of the incision, and the trochanters and
neck were thus exposed. The neck was crushed into about forty fragments, which were extracted.
The head was also much broken, and the round ligament was absorbed or destroyed, so that
exarticulation was easy. The roughened portion of the neck, at its attachment with the
trochanter, was sawn off with a small chain saw. The missile, a conoidal musket ball, was found
on the inner side of the thigh at the bottom of a large cavity, and was removed with difficulty.
After thoroughly syringing the wound and removing the powdered bone, the wound was closed by
silver sutures, except at the bullet hole, and sand bags were placed to keep the limb in
position. Slight extension was made by a weight to the foot. The patient expressed himself as
relieved by the operation, and he slept well that night. On the following day his pulse had
risen to 128, and the discharge from the wound was very copious, thin, and brown. On September
29th, his pulse was still quick and feeble, and his tongue dry, and, though he took nourishment
well, and was free from distress, he gradually sank. He died on September 30, 1862, at half past 8 o'clock A. M., three days after the
operation. At the autopsy, on October 1st, made by
Acting Assistant Surgeon G. K. Smith, the wound made by
the operation was found to be filled with very offensive pus. The upper end of the shaft of the
femur was found to be diseased on its posterior surface near the trochanter minor, and the
periosteum was loosened from the bone for some distance above and below this point. The fracture
of the ischium, which was noticed at the operation, extended obliquely upward and backward from
the lower border of the acetabulum, terminating in the sciatic notch, about an inch and a
quarter above the spine of the ischium. The lower half of the acetabulum had been broken into
several fragments, which were held in position by the cotyloid ligament. The excised portions of
the femur were forwarded to the Army Medical Museum, and
are numbered 328 in the Surgical Section. They are represented in the adjoining wood-cut (FIG. 58).