Civil War Washington

CASE 721.—Private E. J. Wyman, Co. A, 6th Wisconsin, aged 22 years, was wounded in the right leg, at Hatcher's Run, February 7, 1865. Surgeon D. C. Chamberlain, 94th New York, reported his admission to the field hospital of the 3d division,Fifth Corps, and described the injury as a "fracture of tibia." From the field the wounded man passed to the Point Lookout Hospital, subsequently to Judiciary Square Hospital, Washington, and on June 15th to Harvey Hospital, at Madison. Surgeon H. Culbertson, U. S. V., in charge of the latter, who operated in the case, communicated the following description of the result: "The tibia was fractured in the upper fourth. On July 2d, when the operation was performed, the wound was apparently healing, but had recently been gangrenous. Venous hæmorrhage appeared, and the bone was carious and softened. Some new bone had been thrown out at the seat of the fracture and had also become diseased. This presence of diseased bone and unhealthy discharges induced the hæmorrhage and previous gangrene and caused the patient's constitutional condition to be much impaired. The operation consisted of the excision of five inches of the shaft of the tibia, beginning opposite the opening of the interosseus membrane, making an incision in the middle line of the bone, and separating the skin, periosteum, and muscles by enucleation. The chain saw was then passed beneath the bone below, the shaft sawn through and raised from below upward. At the upper part the bone was divided with the forceps. No vessels were divided or important nerves injured during the operation. Chloroform was used as the anæsthetic with good effects. The edges of the wound were approximated, having been packed with lint, and persulphate of iron was used at the seat of the venous hæmorrhage, a light bandage being applied over all. The limb was secured in a plaster-of-Paris splint and arranged so as to expose the wound. The treatment consisted of animal broths, alcoholic stimulants, quinine, and iron. The case did well for one week, when the patient had a slight chill, which recurred at regular intervals morning and evening, and was followed by fever and sweating. Antiperiodics were persistently used without any good effect. The patient died of exhaustion, resulting from typho-malarial fever, July 23, 1865. The wound had been lacking in action, but the matter, though sparse, was healthy."