CASE 439.—Private G. Cox, Co. K, 1st North Carolina Cavalry, aged 27 years, was wounded at Brandy Station, June 09, 1863. He was admitted to a field hospital of the Fifth Corps, whence Assistant Surgeon B. Howard, U. S. A., reported the following history: "The patient was a man of usual good health but had the bloated appearance of a habitual drinker. He was shot in the right thigh, and was brought to Kelly's Ford, a distance of about three miles, in an ambulance. On examination I found a wound of entrance on the outer side of the thigh, a little above its middle, but there was no wound of exit. The wound of entrance was very small, as if made by a pistol ball. The femur was badly shattered. The patient complained of having lost a good deal of blood on his way to Kelly's Ford. I immediately proceeded to amputate near the upper third by the circular mode. The patient suffered considerably from shock, but rallied comfortably, and was transported eight miles the next morning in an ambulance, and thence by cars to Alexandria. On examination of the amputated leg the femur was found to be shattered more than six and a half inches, but not comminuted as finely as often happens in fractures by a minié rifle ball, this fracture being more vitreous in appearance and furnishing but one small fragment, all the others being large ones. The ball had entered the outer side of the thigh, passed behind and partially around the femur, entering at its inner aspect, and lodging in the medullary canal. The interesting point in the case is the relation of the extensiveness of the fracture to the weight and the diminished velocity of the ball; that the bone should have been so extensively shattered by a pistol ball, which, when subsequently weighed, did not exceed five scruples and six grains, and that the mischief was all done, too, after the ball had been so much deflected from its original course." Surgeon T. R. Spencer, U. S. V., reported the patient's admission to Prince Street Hospital, and the result of the case as follows: "On June 19th and 23d, hæmorrhage occurred from the external circumflex artery, for which compression and cold applications were made. The loss of blood amounted to six ounces. The patient looked anæmic, and there was considerable sloughing of the stump. Death followed on June 24, 1863." The amputated portion of the femur was contributed to the Museum by the operator, and is numbered 1233, Surg. Section (FIG. 179).

FIG. 179.—Comminution of middle third of right femur. Spec. 1233.