Civil War Washington

CASE 700.—Corporal J. Ferguson, Co. G, 142d Pennsylvania, was wounded in the right leg, at Fredericksburg, December 13, 1862. He remained at a First Corps field hospital for one week and was then transferred to the Patent Office Hospital, and subsequently to Stanton Hospital, Washington. Surgeon J. A. Lidell, U. S. V., in charge of the latter, described the case as follows: "The wound was produced by a bullet, which passed through the calf of the leg in the upper third in a downward and outward direction. The wound did well until the middle of January, when the granulations assumed an unhealthy appearance and the discharge became thin and serous. The patient also exhibited typhoid symptoms, having a hot skin, frequent pulse, and dry red tongue, watchfulness, and no appetite. This went on until the morning of January 23d, when hæmorrhage occurred unexpectedly from the external orifice behind the fibula. The bleeding was readily controlled by application of pressure by bandage and ice, the patient having lost about ten ounces. Throughout the day and the night following the loss of blood by oozing was very little, but on the following morning hæmorrhage recurred from the internal orifice, behind the tibia this time. This amounted to from four to six ounces, and was also readily controlled by the application of persulphate of iron, lint, ice, and bandaging. In the meantime the typhoid symptoms became more marked. The patient also complained of great tenderness throughout the leg and thigh; the inguinal glands were somewhat swollen and tender, and there was dusky redness, with soreness in the track of the long saphenous vein. His skin was now pale and yellow. On the morning of January 25th, another slight bleeding occurred from the internal wound and was readily controlled by pressure. A marked increase of the swelling was now noticed, extending from the leg to the thigh, especially over the external and internal condyles and the popliteal space, and infiltration with blood was suspected. The patient was now very pale and expressed a great deal of anxiety, his pulse being 120, quick and weak. The first day the hæmorrhage was thought to come from the peroneal artery, the next day from the posterior tibial, but now we were uncertain in regard to the source of the bleeding, and the case presented an unpromising appearance on account of the debility from the loss of about eighteen ounces of blood superadded to his typhoid condition. We then decided to tie the femoral artery at the apex of Scarpa's space as affording the best chance of benefit, which operation I performed without any difficulty on the afternoon of January 25th, forty-three days after the reception of the wound. On the following morning the patient appeared brighter; pulse 130; tongue more moist; leg getting warmer down to the ankle. The plugs being removed some dark offensive blood flowed away. In the evening his foot was cold, leg cooler, and blackness was extending across the leg in the track of the wound. Patient had a slight chill; somewhat delirious; pulse 130 and weak; tongue dry. On the morning of January 27th the patient looked better; pulse 132 and stronger; leg warm and blacker; foot pale and swelled; serous infiltration and discoloration extending up the thigh. The next day the patient presented a pale yellow hue; blackness of limb deepening and extending, having reached the lower end of the incision made for the ligation; odor gangrenous. Death supervened on the evening of January 29, 1863. The autopsy showed that the bleeding did not come from the posterior tibial or peroneal artery, but from the lower part of the popliteal, which had been opened to a large extent by ulceration. Some loose splinters of bone were also found, the ball having grazed the hind part of both the tibia and fibula. On the proximal side of the ligature the clot was firm, closely attached to the walls of the artery, and about three-fourths of an inch long, with its apex pointing upward towards the heart. There was also a firm clot on the distal side, adherent to the walls of the artery, but much smaller than the proximal one." A piece of the femoral artery, about four inches long and embracing the seat of the ligature, was contributed to the Museum by Surgeon Lidell, and constitutes specimen 1140 of the Surgical Section.