O'Neil, Michaela machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d2e6835Civil 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
21883150-151Medical 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 jointamputations at the hip jointcoxo-femoral amputationssecondary amputationsball entered upper anterior thigh, passed backward and slightly upwardcomminuted upper extremity of femur, fissures extended down shaft and through trochanters
halfway up neckwound suppurating freelypus bathing acetabulum and femoral arteryabscess between iliacus externus muscle and iliac fasciaautopsy performedgeneral anesthesia, etherblessedadded figure encodingadditional case copied from MSHWR, performed proofing of copy
and XML encoding, and key terms identified
CASE 327.—Private Michael
O'Neil,² Co. E, 58th Massachusetts, aged
19 years, was wounded at the battle of Cold Harbor, June 3, 1864, by a conoidal musket ball, which entered
the upper anterior part of the right thigh, and passed backward and slightly upward through the
limb, comminuting the upper extremity of the femur. The fissures extended about three inches
down the shaft, and through the trochanters halfway up the neck. The wounded man was sent in an
ambulance to the White House, on the York
River, and thence by a hospital steamer to Alexandria, where
he was received at the Third Division Hospital on June 7th. On admission his limb was much swollen, yet
there was but little pain, and this was not increased by moving the limb. His general condition
was satisfactory, though he reported that he was subject to attacks of intermittent fever. His
limb was arranged in a straight position, supported by cushions and pillows; evaporating lotions
were applied to the wound, and a nutritious diet was ordered. On June 10th, several fragments of bone were extracted. On June 12th the
patient had a chill, and was ordered to take four grains of sulphate of quinia every four hours.
The injured limb was now suspended by means of Smith's anterior splint. On June 24th there was
another chill. The wound was now suppurating freely, and the limb was very sensitive when
handled. On June 31st there was a slight chill. From this date to August 1st there
was little change in the symptoms. It was now decided that there was little hope of
consolidation of the fracture. The suppuration was profuse, and it was believed that the patient
would inevitably succumb ultimately to the constitutional irritation and the drain upon the
system. It was determined, therefore, that amputation should be performed, and the character of
the fracture admitted only of amputation at the hip joint. On August 10th, the patient was anæsthetised by sulphuric ether, and
amputation at the hip joint was performed by the lateral flap method by Surgeon Edwin Bentley, U. S. V.
There was but little hæmorrhage, and the operation was borne well. The patient had an
anodyne, and was freely stimulated. For forty-eight hours after the operation there was some
febrile excitement, with complete anorexia. The fever then subsided and the appetite returned.
The wound looked well, and the amount of suppuration was trifling. The case progressed very
favorably until August 20th, when secondary
hæmorrhage supervened from ulceration of the femoral near the ligature. About six ounces of
blood were lost. A ligature was promptly placed upon the external iliac just above Poupart's
ligament. After the operation the patient was very weak and faint, and stimulants were freely
administered. On August 22d there was an excess of febrile excitement, but this abated on the
following day and the appetite again became moderately good. On August 28th there was nausea and
vomiting, which persisted for forty-eight hours. The wound at this time had assumed a very
unhealthy appearance, and the patient had become much emaciated. On the night of September 1st
there was delirium. The case terminated fatally on the morning of September 3d, twenty-three days after the operation. At the autopsy
the viscera was found to be healthy, except that there was an old cicatrix with cretaceous
deposit at the apex of the left lung. The lips of the wound were united in nearly their entire
extent. There was a large accumulation of pus within the flap, bathing the acetabulum and the
gaping mouth of the femoral artery. The wound left by the incision above Poupart's ligament,
through which the external iliac was tied, communicated with an abscess between the iliacus
externus muscle and the iliac fascia, filled with pus. The ligature on the external iliac was
found to be placed about half an inch below the origin of the epigastric; the circumflex iliac
was given off a little below the epigastric. There was a firm conical plug in the external
iliac, ending at the origin of the epigastric. Through this plug ran a canal communicating with
the mouth of the circumflexa ilii; this canal was closed by a clot colored by included red
corpuscles and of more recent formation than the plugging clot. Ulceration of the external iliac
just above the ligature had commenced. The femoral vein was collapsed and contracted; the
external iliac vein was distended by a dirty fluid, which, when placed under the microscope, was
found to abound in pus globules. Higher up, the contents of the vein consisted of a granular
detritus. The branches of the external iliac vein was blocked up by dense coagula. The
deep-seated abdominal lymphatic glands were enlarged and deeply injected. An examination of the
fractured femur showed that it was shattered, with much loss of substance, just below the
trochanters. The fissures ran up with the capsule, and the fractured extremities of the bone
were carious and had lost tissue by absorption.
² The abstract of this case was compiled from a report by the operator, Surgeon E. BENTLEY, U. S. V. See Circular No.
7, S. G. O., 1867, p. 39.