Civil War Washington

CASE 487.—Private L. Williams, Co. C, 26th Michigan, aged 23 years, was wounded at Spottsylvania​, May 12, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, recorded his admission to the field hospital of the 1st division, Second Corps, with "shot wound of left knee, caused by a minié ball." Assistant Surgeon J. C. McKee, U. S. A., who contributed the pathological specimen of the case (Cat. Surg. Sect., 1866, p. 343, Spec. 2538), reported the result of the injury as follows: "The wounded man entered Lincoln Hospital, Washington, May 30th. He was a man of nervous and irritable temperament. When admitted he suffered from much constitutional derangement, and the tissues in the neighborhood of the injured joint were much enlarged, tender, and painful. Cold-water dressings were used, and tonics and stimulants were administered. On June 13th, the parts above and below the knee joint being infiltrated with pus and discharging copiously through several openings, amputation was decided upon, and performed at the middle third of the femur by Acting Assistant Surgeon A. Ansell, as the only chance of saving the patient's life. On examining the injured parts after the operation the missile was found to have passed through the joint, comminuting the patella and knocking away the head of the tibia on its inner side. The subsequent treatment consisted of cold-water dressings to the stump and the administration of six ounces of brandy per diem; one grain of sulphate of morphia was given at bedtime after the operation. Iron and quinine were prescribed some days afterwards. The patient did exceedingly well, and the stump healed kindly, the cicatrix forming perfectly with the exception of one small opening, which served as an outlet for a small abscess about the size of a pigeon's egg. Hæmorrhage took place from this part of the stump on July 18th, when the tourniquet was applied to the femoral artery, which had the effect of arresting the flow of blood. A plug of lint saturated with a solution of persulphate of iron was then introduced into the wound and the tourniquet removed. Hæmorrhage occurred again on the morning of the following day, when, on consultation, it was decided to open the stump and ligate the bleeding vessel. This was also done by Dr. Ansell, who tied the femoral as well as two muscular arteries, which had been opened by the incision. The operation was performed at 11.30 A. M., and the patient died at 6 P. M. on the same day, July 19, 1864, not having rallied, and having lost altogether about twenty ounces of blood. The interior of the stump was found to be perfectly healthy, with the exception of the small abscess before mentioned." The specimen consists of the bones of the amputated knee, showing the articular surface to be carious, and a longitudinal incomplete fracture extending between the condyles two and a half inches up the femur, on the shaft of which two trivial points of periosteal thickening appear. The stump of the femur, showing a partially detached sequestrum and handsome but useless foliaceous deposit, together with a wet preparation of the ligated femoral artery, were also contributed to the Museum by Acting Assistant Surgeon H. M. Dean, and constitute specimens 2882 and 2883 of the Surgical Section.