Civil War Washington

CASE 652.—Corporal E. C. Wright, Co. H, 21st New Jersey, aged 19 years, was wounded at Fredericksburg, May 3, 1863, by a solid shot, which carried off his right foot. Amputation of the leg by posterior flap, at the junction of the middle and lower third, was performed on the field by Surgeon D. McNeill, 21st New Jersey, and several days afterwards the patient was sent to Washington, where he entered Judiciary Square Hospital. He was discharged from service June 13, 1863, and pensioned. Subsequently the stump became diseased, inducing the pensioner, in January following, to seek relief by treatment at St. Luke's Hospital, New York City. The tibia became necrosed and cloaca formed, leading to sinuses in the substance of the bone, so that an injection would find its way through the canals. On June 23, 1864, amputation through the knee joint by antero-posterior flaps was performed by Dr. Gurdon Buck, the cartilages and patella being allowed to remain. Sulphuric ether was used as the anæsthetic. At the time of the operation the patient was in feeble condition, owing not only to the amount of pus discharged from the stump, but also to the presence of an abscess in the region of the liver, which had formed some months after the first amputation. This abscess discharged itself by a track passing between the ribs over the right lobe of the liver. There had been no admixture of bile, however, in the discharge, nor did jaundice exist at any time. A succession of abscesses formed during the healing of the stump. The first appeared at the upper boundary of the synovial sac and was freely laid open by Dr. Buck. Six days after the operation a tendency to slough appeared, and permanganate of potash was applied to the affected parts. Dr. Buck's method of extension by weight and pulley, with bands of adhesive plaster, was also used to prevent the retraction of the edges of the flaps and maintain them in apposition. This afforded great relief to the patient, steadying the limb and taking all the strain off the flaps. On September 1, 1864, the patient was discharged from hospital, the stump being solid and well rounded. The abscess in the side had ceased to discharge. In the following month the pensioner was fitted with an artificial leg by Dr. E. D. Hudson, of New York City. Pension Examining Surgeons who have inspected the stump have described it as a "very good" one, and the pensioner has reported its condition as "sound and healthy." He was paid March 4, 1880.