CASE 762.—Private E. Williams, Co. F, 136th Pennsylvania, aged 45 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, reported his admission to the field hospital of the 2d division, First Corps, with "shot wound of right leg." Surgeon O. A. Judson, U. S. V., contributed the pathological specimen with the following description: "The wound was caused by a minié ball entering the upper part of the middle third of the tibia, passing obliquely downward and backward, fracturing the bone in its course and wounding the anterior tibial artery, and emerging through the gastrocnemius muscle. The patient was admitted to Carver Hospital, Washington, December 21st. The leg was placed in a fracture box and the bone kept well in apposition. Water dressings were applied. The patient progressed favorably until December 28th, when a profuse and continually recurring hæmorrhage set in which resisted ordinary measures for its control. Amputation was accordingly resorted to, and performed at the upper third of the leg by flap operation. On Januray 1, 1863, hæmorrhage to the amount of thirty ounces occurred from the anterior tibial artery in the stump, which was laid open and the bleeding vessel was secured. But the patient gradually sank, and died the evening of the same day. His system was also infected with pyæmia. Examination revealed an oblique fracture of the tibia, also that a piece of bone had been driven into the anterior tibial artery. The inter-muscular tissues of the limb were distended by pus." The wood-cut (FIG. 299) is a representation of the amputated shaft of the tibia (Spec. 634), which was comminuted in the middle third but shows very little displacement of fragments.

FIG. 299.—Fracture in middle third of right tibia. Spec. 634.