CASE 695.—Private G. F. Skinner, Co. H, 6th Maine, aged 30 years, was wounded at Chancellorsville, May 3, 1863, and admitted to Douglas Hospital, Washington, five days afterwards. Assistant Surgeon C. C. Lee, U. S. A., reported: "This man suffered a comminuted fracture of the left leg from a musket ball, which entered one-half inch internally to the spine of the tibia, passed through antero-posteriorly, and emerged at a corresponding point at the back of the leg. Much contusion and ecchymosis existed at the time of his admission to the hospital, and but for the high state of inflammatory action then existing the leg would have been removed. The limb was then placed in a fracture-box filled with bran, and covered with water dressings; nutrients and stimulants were given freely. No change was perceptible until the morning of May 16th, when the foot and leg were found in a state of advanced gangrene. To show how rapidly this condition supervened it is only necessary to state that a most careful examination during the previous evening failed to reveal anything of the kind, the patient in all respects seeming as well as usual. By the next morning this condition of the leg was rapidly extending up the thigh, the soft tissues of which became boggy and crepitant; the patient being bathed in clammy sweats, and his circulation so depressed that the pulse was imperceptible at the wrist, though at the groin it was 160 per minute. At the same time the patient's spirits were not at all depressed, and he could hardly believe he was in any danger. His prostration was such that amputation was deferred; but the most energetic stimulation failed to bring his condition into one of sufficient reaction to bear the operation. He gradually sank, and died at 2 o'clock on the morning of May 17, 1863. At the autopsy, the internal organs were discovered to be generally healthy. The bone was found to be extensively comminuted, with a portion of the bullet lying upon the lacerated and obliterated posterior tibial vessels, thus probably furnishing the main cause of the gangrene. No secondary abscesses were found, and it was concluded that the patient had died in the primary stage of blood poisoning." The upper halves of the injured bones, showing a transverse fracture of fibula and comminution of the tibia, with the battered bullet attached, were contributed to the the Museum by Assistant Surgeon W. Thomson, U. S. A., and are shown in the annexed cut (FIG. 268).

FIG. 268.—Shot fractures of upper third of left tibia and fibula. Spec. 1249.