Phelan, Johna machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d2e5443Civil War WashingtonUniversity of Nebraska–LincolnCenter for Digital Research in the
Humanities319 Love LibraryUniversity of Nebraska–LincolnLincoln, NE 68588-4100cdrh@unlnotes.unl.edu2011
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Kenneth WinkleAJ HowellMatthew BosleyElizabeth LorangStacey BerryElisabeth TraceySarah SynovecThe Medical and Surgical History of the War of the Rebellion.
(1861-65.)Washington, DCGovernment Printing
OfficePart 3Volume
21883107-108Medical 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 excisionscompound comminuted fracture of neck and upper extremity of femurball entered in front, passed toward great trochanterfemur comminuted, great trochanter shatteredfractured upper femurgeneral anesthesia, ethersuppuration moderateevery bed occupied by patient with suppurating woundsblessedadded figure encodingadditional proofing of transcription and encoding, identified
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CASE 250.—Captain John
Phelan, Co. A, 73d New York, aged 22 years,
received a compound comminuted fracture of the neck and upper extremity of the left femur at the
battle of SpottsylvaniaSpotsylvania Court House, on May 14, 1864. On
May 16th, he was admitted to Mount Pleasant Hospital, Washington. The rapid and incessant influx of wounded
was such that the attention of the overworked hospital staff was not especially drawn to his
case for some time after his admission, and the delay in minutely examining the case was
extended by the uncomplaining fortitude of the sufferer, who expressed his wish that the more
serious cases should first be attended to, and declared that his own sufferings were
comparatively slight. When, however, Acting Assistant Surgeon
Mulford, the ward surgeon, proceeded, on June
3d, to adapt apparatus to what he supposed to be an ordinary gunshot fracture of the
upper third of the thigh, he was led to apprehend that the injury extended to the coxo-femoral
articulation, and requested the opinion of the surgeon in charge of the hospital, Assistant Surgeon C. A. McCall, U. S. A., as to the diagnosis and treatment. Dr.
McCall immediately visited the patient, and found him to be a large, muscular, finely
formed man, whose previous health had been excellent. When lying quietly in bed, he suffered but
little. His appetite was good; and his strength, so far, had diminished but little. Altogether,
his general condition was extraordinarily good, in view of the gravity of the injury he had
sustained. The ball had entered in front, just over the point at which the profunda is given off
from the left femoral artery. The aperture of entrance was small and characteristic as an
entrance wound of a conoidal musket ball. The missile had passed toward the great trochanter and
shattered it. Further, its course could not be ascertained at the time. Any movement of the limb
caused extreme pain. Though the femur was much comminuted, Dr.
McCall was not positive that the hip joint was implicated, and, with a view to a full
exploration of the injury, he directed Dr. Mulford to make
a longitudinal incision three inches in length over the trochanter, to explore the parts
thoroughly, and to ascertain by digital examination the condition of the articulation. If it was
uninjured, Dr. Mulford was instructed to extract detached
fragments of bone and foreign matters, to close the upper part of the wound, and to avail of the
lower portion for drainage. In the afternoon the patient was etherized, and the exploratory
incision was made, and it was found that the fracture extended to the head of the femur. It was
then decided to excise the head. The patient was again rendered insensible by the inhalation of
sulphuric ether, and Dr. McCall extended Dr. Mulford's incision upward an inch or more, and then made an
oblique incision across its upper extremity, as represented in the accompanying figure (FIG. 61). The two flaps thus marked out were reflected, and the joint
was readily exposed, the round ligament divided, and the head of the femur exarticulated. The
acetabulum was carefully examined and found to be uninjured. Seven large and numerous small
fragments of the neck and trochanter major were then removed, a task requiring much time and
patience, many fragments being driven into the gluteal muscles, or deeply retracted by the
muscles attached to the great trochanter. The fractured upper extremity of the femur was then
brought out at the wound, by adducting and pushing upward the knee of the injured limb, and all
diseased tissue was removed. The periosteum was in a healthy condition quite up to the end of
the bone. The wound was now thoroughly washed out, and approximated by three stitches, and by
adhesive strips. A grain of sulphate of morphia was administered, and the patient was put to
bed. The operation lasted three-quarters of an hour. Dr.
McCall thinks that the ball was removed during the operation; but is not positive on
this point. The hospital report, which is quoted at page 69 of Circular
No. 6, S. G. O., 1865, states that the patient's pulse was quick and irritable at the time of
the operation, that he had a furred tongue and diarrhœa, and was reduced by suppuration.
But Dr. McCall (letter of February 11, 1868) thinks that
this report exaggerates the gravity of the constitutional symptoms, and is quite sure that the
general condition was favorable. The patient rallied well from the operation. For two days the
wound was dressed with lint. Suppuration then commencing, the limb was placed in Fergusson's
apparatus for excision of the head of the femur, the counter-extension straps being left off.
The wound was freely syringed with cold water containing a little permanganate of potassa. A
nourishing diet was ordered, with tonics and stimulants. For a week or ten days subsequently,
the case progressed favorably. Suppuration was moderate in amount, and of a healthy character.
About the middle of June, the weather became intensely hot. The atmosphere of the wards, in
which nearly every bed was occupied by a patient with suppurating wounds, became intensely
oppressive. About this time, the patient began to grow worse. The cheerful resolution and
hopefulness he had hitherto evinced, gave way. Diarrhœa supervened, and he lost strength
rapidly. The fatal event was thought to have been delayed by the plan which was pursued of daily
removing the patient in his bed at nine in the morning to a spot beneath the shade trees near
the hospital, where he had pure air and escaped the distressing scenes of the ward; he remained
each day until five in the afternoon. He died on June 21,
1864. The portion of bone excised was forwarded at the time of the operation to the
Army Medical Museum. The preparation is No. 2618 of the
Surgical Series. It is represented in the adjacent wood-cut (FIG.
60).