CASE 703.—Private J. Hogan, Co. F, 127th Pennsylvania, aged 41 years, was wounded in the right leg, at Fredericksburg, December 13, 1862. Surgeon J. E. MacDonald, 79th New York, reported his admission to the field hospital of the 1st and 2d divisions, Ninth Corps, and described the injury as "fracture of the tibia," for which "resection of six inches" of the bone was performed. Assistant Surgeon W. Thomson, U. S. A., contributed the following history of the case: "This man was struck by a minié ball four inches below the knee joint. The tibia was extensively comminuted, the fibula being uninjured. A resection of the shaft of the tibia from a point just below the tubercle to (about) seven inches below was performed by Surgeon J. P. Prince, 36th Massachusetts, at a field hospital. The man was admitted to Douglas Hospital December 26th. The dressing consisted in keeping the incision open with charpie to encourage granulations from the bottom of the wound. On February 23, 1863, a crown-shaped exfoliation (Spec. 2237, Sect. I, A. M. M.) was removed from the end of the lower portion of the tibia. The wound now healed rapidly, no change having been made in the dressing and the leg being retained in quietness by a fracture box filled with bran. His general health became perfect as the discharge ceased. On May 1st, several small exfoliations were removed from the spongy portion of the tibia at the superior part of the wound. There was of course no reproduction of the tibia and no conservative hypertrophy of the fibula, and hence the leg was perfectly helpless. Before the fistulous orifice had entirely closed at the upper portion of the incision, well marked but mild hospital gangrene appeared. The sloughing extended very deeply as far as the lower side of the tibia. Several applications of bromine checked the spread of the gangrene but not until a large excavation had been caused. This filled up gradually, the patient got up on his crutches and with the aid of a starched bandage hobbled painfully about the wards. His term of enlistment expired on May 29, 1863, but he remained until October 12th, when be returned to his home. No more useless or unphilosophical operation could be devised than the one done in this case. The leg was perfectly helpless, a hiatus of nine or ten inches existing in the tibia and there being no hope of any further improvement from the lapse of time; fibula no larger than natural. Unless some novel means of support can be applied this man will be infinitely worse off than with an artificial leg." Examining Surgeon S. T. Charlton, of Harrisburg, reported in October, 1866: "There is complete atrophy of the whole limb, as well as deformity from curvature at the point of resection and the pushing out of the head of the fibula from its articulation. He cannot walk or stand upon the limb without the use of a cumbrous apparatus furnished by the Government," etc. At subsequent examinations no change or improvement was reported. The pensioner died May 24, 1877.¹

¹ A detailed history of the case will be found in American Journal of Medical Sciences, New Series, 1864, Vol. XLVII, p. 395, Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C., by WILLIAM THOMSON, M. D.