Civil War Washington

CASE 529.—Private O. F. Reams, Co. B, United States Engineers, aged 23 years, accidentally cut his right knee joint open with an axe while in the act of chopping down a tree in camp, on March 12, 1864. He was admitted to hospital in Alexandria, March 21st. at which time there was but little suppuration, the external wound having partly healed by first intention, so that a probe could not be made to enter the joint. The patient was doing very well and had a good appetite, and hopes were entertained that the joint might be saved. On April 12th, the limb was somewhat swollen and painful, and his appetite began to fail. On April 22d, fluctuation was distinctly detected, when an opening was made and two ounces of pus escaped. On April 24th, the thigh was amputated in the upper third by lateral flaps, by Surgeon E. Bentley, U. S. V. The tissues below the point of amputation were found to be infiltrated with pus and badly disorganized. The patient reacted well, though not very promptly. Pyæmic chills began two days afterwards, and secondary hæmorrhage set in on April 28th, when the femoral artery was ligated just below Poupart's ligament. The patient died from the effects of pyæmia, May 1, 1864. At the autopsy large quantities of serous fluid were found in the pleural cavities and a number of pyæmic abscesses in the left lung. One abscess was also discovered in the spleen. The latter organ, together with the bones of the amputated knee, were contributed to the Museum, with the history, by the operator, and constitute specimens 2253 and 2234 of the Surgical Section.