Civil War Washington

CASE 644.—Private W. Stanley, Co. H, 53d Pennsylvania, aged 26 years, was wounded at Fredericksburg, December 13, 1862. He was admitted to a Second Corps field hospital, and thence transferred to Washington. Assistant Surgeon C. C. Lee, U. S. A., reported: "The patient entered Douglas Hospital December 26th, having received a comminuted fracture of the upper third of the right leg, for which amputation through the knee joint was performed the following day. He stated that hæmorrhage was profuse both before and since the amputation. The stump sloughed somewhat and did badly. On March 1, 1863, when I took charge of the case, the stump was tightly bandaged from above downward, the extremities being swollen and bulbous, and the thigh completely honeycombed in appearance by small abscesses and sinuses for six inches above the condyles. The bandage was removed and the sinuses and abscesses laid open. The patient was also greatly enfeebled by chronic diarrhœa, from which he had suffered for six months, and which, though checked from time to time, always returned with full force. In this state he vacillated from better to worse until April 20th, when, without any ostensible cause, he was seized with obstinate nausea and vomiting. This resisted every means employed to remedy it and exhausted what little strength remained in the patient. He sank steadily until the night of April 26, 1863, when he expired of sheer debility. At the autopsy, the thoracic viscera were found healthy with the exception of old pleuritic adhesions on the right side; lungs crepitant throughout and without tubercular deposit. The liver and kidneys were shrunken and showed evidence of chronic congestion, but were otherwise normal; stomach and spleen healthy. In the large intestines well-marked congestion was observed and partial maceration of the mucous membrane, which was here and there dotted with dark maculæ. These spots were surrounded by depressions and apparent cicatrices in the mucous membranes, and were thought to be the result of ulcers that had already cicatrized. The condition described was chiefly noticed in the upper portion of the rectum. The small intestines were here and there greatly congested, but no ulceration was detected. The stump had healed completely; but from the removal of the patella in the operation and the subsequent emaciation of the patient the edges of the condyles were too superficial to have borne pressure with success. A large abscess, which had been very troublesome during life, existed between the rectus and cruræus muscles. The latter was wasted to the last degree, but seemed to have protected the bone, which was not diseased. A very complete calcareous degeneration of the mesenteric glands should also have been noted above." The lowest portion of the femur was saved and contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A. (Cat. Surg. Sect., 1866, p. 363, Spec. 1240.)