Civil War Washington

CASE 709.—Private N. Biehl, Co. I, 155th Pennsylvania, aged 27 years, received a shot fracture of the right tibia, at Petersburg, June 19, 1864. He was conveyed to the field hospital of the 1st division, Fifth Corps, where excision was performed but not recorded, and whence he was transferred to City Point and subsequently to Alexandria. Surgeon E. Bentley, U. S. V., who amputated the limb, reported the following history: "The patient was admitted to the Third Division Hospital June 28th. Exsection​ had been performed on June 21st, in the field, by Surgeon J. A. E. Read, 155th Pennsylvania, who removed two inches of the middle third of the tibia by a straight incision four inches in length. When admitted the lips of the wound were widely separated, having apparently never been brought together closely or supported except by straps and bandages. The incision remained open in its whole length, leaving a portion of the crest of each extremity exposed and uncovered of periosteum. The granulations were healthy and covered with laudable pus; but the leg and foot were badly swollen, particularly about the ankle, where the integument was œdematous and pitted deeply on pressure. Water dressings were applied to the wound and stimulants were given internally. On July 14th, gangrene appeared in the wound. Remedies used successfully in other cases signally failed in this. The disease extended along the medullary cavity of the bone and the muscles behind, seemingly bidding defiance to local applications and becoming very offensive. The patient sank very rapidly under the effects of the pain and poison, and the loss of blood from an artery opened by ulceration. On July 19th, amputation at the middle third of the thigh was performed by circular skin flaps. The patient was much prostrated at the time of the operation; had no appetite, great thirst, and dry tongue; face sunken and anxious; pulse quick and tremulous. Alcohol was applied to the stump, which was covered with a compress wet with the same. Whiskey and morphine was given internally. The next day gangrene attacked the stump, spreading rapidly on its face and extending three inches up the inner side of the thigh. The patient died on July 21, 1864, of exhaustion. The post-mortem examination, twenty-two hours after death, revealed extensive gangrene of the stump and mortification extending to the body." The bones of the wounded leg, showing the tibia to be dead for one inch on each side of the excision, were contributed by Dr. Bentley and are shown in the annexed cut (FIG. 272).