CASE 444.—Corporal J. A. Crawford, Co. K, 6th Wisconsin, aged 24 years, was wounded through the knee joint, at Gettysburg, July 1, 1863. He was admitted to the Seminary Hospital, whence Acting Assistant Surgeon W. M. Welch made the following report: "The limb was amputated at the lower third of the thigh on the day following the injury. The patient, came under my care on August 15th, at which time the stump was granulating slowly and there was a free discharge of healthy pus; but the flaps had sloughed, leaving the end of the femur bare. A roller bandage was applied to prevent retraction of the muscles, and warm-water dressings with disinfectants were used, iron and stimulants being given internally. The patient's general health was disturbed, though his appetite was tolerably fair. He improved gradually, and was transferred to Camp Letterman on September 2d." Assistant Surgeon H. C. May, 145th New York, continued the history as follows: "The patient came under my charge on October 12th, being very feeble and troubled with profuse and obstinate diarrhœa, having no appetite, and suffering from hectic fever and much pain, also an abscess along the course of the lower end of the bone. The stump was conical shaped, with the end of the femur exposed, and the granulations were pale and flabby. Astringents and tonics were administered. On October 30th, the diarrhœa was almost controlled, but great pain and irritation was felt about the stump, and, chloroform having been given, a sequestrum four and a half inches long, and consisting of a complete section of the lower end of the bone, was removed by forcible traction. The surfaces of the bone were found to be very rough and surrounded with a wall of callus. The patient did well after the operation; the abscesses ceased to discharge, and the cavity in the stump filled with healthy granulations. By November 6th, he had regained a good appetite, the diarrhœa was entirely checked, and his general appearance and condition were rapidly improving." On the next day the patient was transferred to Newton University Hospital, Baltimore, where the following described operation was performed on February 2, 1864, by Surgeon C. W. Jones, U. S. V., in charge: "The end of the femur being necrosed, an incision six inches in length was made on the anterior aspect of the thigh and four inches of bone removed. Thirty-six hours afterwards hæmorrhage to the amount of four ounces occurred, when the sutures were removed and a large clot of blood was taken out, after which the bleeding ceased. After this the patient's constitutional condition continued to improve and the flaps approximated. By March 24th, the stump had entirely healed with a good cushion." The patient was discharged from service May 3, 1864, and pensioned. He was paid June 4, 1879. The sequestrum was contributed to the Museum by Acting Assistant Surgeon E. A. Koerper, and is represented in FIGURE 180, and an involucrum of new bone, removed at the last operation, is shown in FIGURE 181.

FIG. 180.—Tubular sequestrum removed from stump of the right femur. Spec. 1971.
FIG. 181.—Involucrum, 4 inches in length, from stump of right femur. Spec. 2153.