Civil War Washington

CASE 697.—Musician G. H. Potter, Co. E, 60th Ohio, aged 14 years, was wounded in the right leg, before Petersburg, July 16, 1864. Surgeon P. A. O'Connell, U. S. V., recorded the following description of the injury at the field hospital of the 3d division, Ninth Corps: "A ball entered the outer side of the limb about the upper third of the fibula; exit below on anterior aspect, gouging tibia and fibula." The wounded man was conveyed to the Depot Hospital at City Point the day after the injury, and one week later he was transferred to Fairfax Seminary Hospital. Assistant Surgeon H. Allen, U. S. A., in charge of the latter, made the following report: "On entering the hospital the lad was in fine spirits, though somewhat anæmic; wound looking well. On August 5th, the wound assumed an indolent appearance and the discharge became greater and more fetid. Bromine was thoroughly applied in the ordinary way and at first checked the progress of the disease. But the patient appeared to have no recuperative energy and a tendency to subcutaneous sloughing was evinced, which, by the 12th of August, had increased so far as to necessitate the slitting up of the integuments and a second rigorous application of bromine. It was observed during the operation that the tibia was exposed and a superficial area of bone was being thrown off. The patient was exceedingly irritable, appetite capricious. The wound still presented a gluing and unhealthy appearance, and the tendency to undermining continued in spite of all efforts to check it. The patient gradually sank. By September 15th, violent and persistent vomiting came on, and from this time until the date of his death, September 26, 1864, he was almost entirely sustained by beef tea enemata. He had no chills and no discoloration of skin, and his mind at all times was clear. Autopsy: emaciation extreme; limb not much swollen; foot somewhat œdematous; ulcer extending from four inches below the knee to the ankle joint; femoral vein healthy; internal organs all healthy except the liver, which was exceedingly fatty. The outer surface of the tibia at the middle third was dead and much blackened from the action of the vapor of the bromine, and the living bone around its borders was covered with several roughened spiculæ of bone. Upon opening the tibia the upper and lower thirds were found to be quite healthy, but the middle third was the seat of varied diseased action. The walls at this point were partially necrosed, of a greyish slate color, roughened, and so thin that at one point they appeared to be nearly destroyed. The medullary substance at this place was shrunken, of a blackish grey color, and closely adherent to the posterior and lateral walls of the cavity. No new deposit of bone was seen. The tissues both above and below this point had taken on active efforts of repair. The cavity of the medulla was much contracted by delicate cancelli extending from either side, and the original walls of the cavity for the extent of a full inch either way were vascular and thickened. The medulla lying in the diminished calibre of canal was of a lively red color, filled with blood, and presented all the appearance of a highly nourished medium. As above observed, no inflammation was noticed in either extremity of the affected bone. Upon examination of the femur an interesting appearance was presented. The walls of the bone were much thickened and dotted with reddish spots; the enlarged nutritious arteries and the periosteum were also thickened, vascular, and easily detached. When the bone was opened the upper two-thirds of the medulla were found to be acutely inflamed, which as usual was more intense towards the neck of the bone than elsewhere." The tibia and fibula of the injured leg, contributed, with the history, by Dr. Allen, constitute specimen 2633 of the Surgical Section of the Museum.¹

¹ ALLEN (H.), Remarks on the Pathological Anatomy of Osteomyelitis, with Cases. Gunshot Wound of the Rigid Leg; phagedena; no pyæmia; in American Journal Medical Sciences, 1865, Vol. XLIX, N. S., p. 44.