Civil War Washington

CASE 797.—Private D. Bussler, Co. K, 93d Pennsylvania, aged 19 years, was wounded near the left ankle during the engagement near Fort Fisher, before Petersburg, March 25, 1865. Surgeon S. F. Chapin, 139th Pennsylvania, reported his admission to the field hospital of the 2d division, Sixth Corps. Assistant Surgeon H. Allen, U. S. A., contributed the pathological specimen, numbered 195 of the Surgical Section, A. M. M., with the following description and result of the injury: "The wound consisted of a compound comminuted fracture of the fibula; a conoidal ball had entered the outer aspect four inches above the external malleolus, and emerged at the inner aspect one and a half inches above the internal malleolus. The patient was admitted to Mount Pleasant Hospital, Washington, one week after receiving the injury. Circular amputation of the leg was performed by Acting Assistant Surgeon H. Craft, on May 6th, at the junction of the middle and lower thirds. Eight ligatures were applied and sulphuric ether was used. At the time of the operation the leg presented a large open surface on the posterior region, extending from one inch below the ankle joint to the junction of the middle and lower thirds of the limb. Several spiculæ had been removed previously and there had been gangrene; the patient had lost his appetite and was very weak; pulse small. Reaction came on slowly. On the evening of May 9th he had a severe chill; suppurative process not yet established; stump dark looking and flaps somewhat discolored; two ligatures now came away. Tincture of chloride of iron, with stimulants and nourishing diet, were prescribed, also a camphor and opium pill every liquid stool. On the following day there was another chill, followed by profuse cold sweat; previous treatment continued, and one-half drachm of bi-sulphate of soda dissolved in water was given every two hours. There was very little discharge from the stump, which was dressed with solution of bromine. On May 11th there were two chills and the treatment was continued. In the evening the bi-sulphate of soda was stopped, but resumed the next morning. Several rigors occurred during the night and a slight chill on the morning of May 13th, when the patient had great pain in the stomach, and the bi-sulphate of soda was again stopped and morphia prescribed. In the afternoon the doses of bi-sulphate of soda were again resumed. He suffered great pain in the stomach through the night, and the next day the remedy was again stopped. There were now symptoms of gastritis and the patient was gradually sinking. The slough had all separated from the stump, which looked quite healthy. Poultices of charcoal, flaxseed, yeast, and creasote had been used for several days. On the morning of May 15th the patient was very low and in a dying condition, and all medicines except stimulants and beef-essence were stopped. Death, caused by pyæmia, supervened at 3 P. M. on May 15, 1865. At the autopsy the thoracic viscera were found to be normal with the exception of old adhesions of the right lung. The left lobe of the liver and the spleen contained metastatic abscesses; other abdominal viscera were normal. The stump was in a gangrenous condition. The medulla of the upper third of the femur was greatly inflamed, particularly so about one inch below the great trochanter; cancelli of upper part of femur very vascular; cancellous structure of tibia slightly vascular." The specimen consists of the amputated portion of the fibula, showing the seat of the injury without any attempt at repair.