CASE 694.—Sergeant J. McLeer, Co. C, 84th New York, aged 23 years, was wounded by a shell in the left arm and left leg, at Bull Run, August 29, 1862. He entered Mount Pleasant Hospital, Washington, several days afterwards. Assistant Surgeon C. A. McCall, U. S. A., in charge, describes the injury of the arm as a compound comminuted fracture of the radius, ulna, and elbow joint, and that of the leg as a fracture of the tibia and fibula, lower third, and reports: "On or about the 2d of September I amputated the arm at the middle third (Second Surgical Volume, TABLE LXXVIII, p. 765, No. 167), and would have also amputated the leg, but that the utter prostration of the patient threatened death upon further surgical procedure. Operating on the leg was therefore left to a future time; but as symptoms of promise developed themselves afterwards, an effort was made to save the leg, which, after long and critical treatment, was successful, although the limb was left somewhat shortened and to a considerable extent unfit for useful progression. The case was one of singular interest to myself and staff, proving as it did the wonderful endurance of the human system and the almost strained limit to which conservative surgery may trust nature. It had been looked upon and classed by me as an excision of the lower portion of both bones of the leg: for though no special operation was performed, yet I know I was over half an hour cleaning out the broken fragments and adjusting loosened spiculæ before trusting it to the fracture-box." In a published account of the case¹ it is mentioned that, under a tonic and stimulant treatment and the application of simple absorbent dressings to the parts, the stump of the arm healed rapidly. The patient was discharged from service July 27, 1863, and pensioned. On September 22, 1880, he was examined by the Brooklyn Pension Board, who certified to the loss of his left arm and added: "There is evidence of a compound comminuted fracture of the tibia and fibula of the left leg in the lower third. Portions of both bones were removed. The cicatrices of entrance and exit of the missile are found upon the internal and anterior aspects of the part. In the latter situation, over the tibia, a firmly adherent cicatrix, three inches long by one inch wide, is present. The leg is bowed outward to a very marked degree, the fibula being very prominent and thickened. There is shortening of the limb of about one inch. The extensor tendons are not full in their movements, being partially bound down by cicatricial tissue, and the ankle is somewhat stiffened and restricted in its motion. The great toe is not supple, since the plantar tendons are somewhat contracted. Altogether the objective signs show that the original wound was of the most severe character. In manual labor, walking, standing, etc., the member would speedily become the seat of great swelling and pain, as is the case after any unusual exercise."

¹ COUES (ELLIOTT), Report of some Cases of Amputations and Resections from Gunshot Wounds, performed at the Mount Pleasant U. S. General Hospital by C. A. McCALL, M. D., U. S. A., in Medical and Surgical Reporter, New York, 1862-3, Vol. IX, p. 229.