Civil War Washington

CASE 900.—Shot fractures of metatarsal bones.—Private C. S. Wheelwright, Co. M, 1st New Jersey Cavalry, aged 26 years, was wounded on picket duty near Warrenton, January 31, 1864, and admitted to Douglas Hospital, Washington, the following day. Acting Assistant Surgeon C. Carvallo, reported: "The ball entered the external dorsal aspect of the right foot anterior to the fourth tarso-metatarsal articulation, and emerged posteriorly to the metatarso-phalangeal articulation of the big toe, having fractured the fourth metatarsal bone obliquely and passed beneath the others. Water dressings had been applied before admission and were continued. The foot became red, swollen, and painful, and the patient had considerable fever, anorexia, and pain. Epsom salts, weak diaphoretics, and the dressings soothed the symptoms considerably. On February 8th the distal fragment of the fourth metatarsal bone was found to be movable, but still attached by its phalangeal articulation, and an effort to remove it proved impossible without injuring that joint. It was therefore decided to leave its removal to nature, and a seton was conducted through both wounds in order to keep them open and promote suppuration. Subsequently an exacerbation of the symptoms manifested itself, after which the foot showed an erysipelatous tendency by swelling, redness, heat, and puffiness. A solution of nitrate of silver with acacia, constantly applied for forty-eight hours, finally subdued the inflammation, when a profuse discharge of healthy pus followed and gave great relief to the patient. Thenceforward the stimulants were substituted by tonics, and water dressings took the place of all former local applications. In a very short time all the swelling and redness had left the foot, and the wound showed such a healthy appearance and discharged such small quantities of pus that I entertained hopes the fractured bone would heal without being removed. I then applied Sentin's starch bandage, which the patient still had on when he went home on furlough on March 15th. I afterwards heard that he was attacked with erysipelas and had entered Central Park Hospital, New York City." The patient was discharged at the latter hospital May 20, 1864, and pensioned. Examining Surgeon J. T. Burdick, of Brooklyn, N. Y., certified that "the flexor tendons of the middle toes and some of the ligaments of the pedal arch were injured." The pensioner was paid September 4, 1880.