Civil War Washington

CASE 778.—Corporal G. B. Scott, Co. K, 8th New York Cavalry, aged 19 years, was wounded in the right lower extremity, at Beverly Ford, June 9, 1863. He was conveyed to Washington and admitted to Lincoln Hospital on the following day, whence Surgeon G. S. Palmer, U. S. V., contributed the pathological specimen (No. 1347) represented in the adjoining wood-cut (FIG. 307), with the following description and result of the injury: "The wound was of the right ankle joint, affecting the internal malleolus and bones of the foot. The ball entered over the inner malleolus and was not extracted. Incisions with the knife were made over the external malleolus, allowing the free flow of pus, and fragments of bone were daily extracted. The leg was amputated at the lower third on June 20th. The patient never recovered from the shock of the operation. On the second day he had a severe chill, followed by profuse sweating. His tongue became dry and he complained of great thirst; pulse 130; appetite capricious. The flaps of the stump grew whitish around the ligatures, and a watery offensive discharge commenced to escape from the stump. On the third day the anterior flap became tawny, having a decided tendency to slough, and the limb became decidedly erysipelatous. On June 24th, profuse diarrhœa set in and the patient complained of pain in the loins, but his mind was yet clear and he was in excellent spirits. The stump now had no sensation in it whatever. The chills followed each other in rapid succession, the patient having as many as two daily, followed in each case by diaphoresis. He rested well until the evening of June 29th. On the following day twenty-five drops of laudanum were administered, which produced a quiet slumber. On awakening from this he became delirious and very restless; pulse 183 and compressible; respiration thirty-five per minute and labored; fever intense. He died on the morning of July 1, 1863. The wound at no time discharged purulent matter, but profuse, thin, and offensive fluid, staining the dressings with a dirty blood color, The flaps retained their proper relations, the ligatures not loosening. No erysipelas existed beyond the knee, which was slightly swollen. At the post-mortem examination the stump was found to have become blackened, the epidermis being readily detached from its base, and a large bleb full of brownish serum was discovered on the inner side of the knee. The anterior flap was perfectly black, and the muscles in the posterior flap had become a softened pultaceous mass. The periosteum of the fibula was detached and of a dark green color; the muscles were affected as far up as the union of the tibia and fibula. The anterior portion of the fibula and the crest of the tibia were dotted with a reddish color, the rest of the bones being pure white." The specimen consists of the amputated lower extremities of the bones of the leg, the external malleolus being broken off.