Civil War Washington

CASE 919.—Sergeant T. Barbin, Co. C, 81st Pennsylvania, aged 18 years, was wounded in the right foot, at Fredericksburg, December 13, 1862. Assistant Surgeon C. R. Greenleaf, U. S. A., contributed the following report of the injury: "He received the wound from a conoidal ball, which passed directly through the boot and entered the heel, passing through the os calcis in an oblique direction from behind forward and from above slightly downward. Considerable hæmorrhage attended the wound, and after an attempt at walking the man was carried to a house near by, where a bandage was applied. Two days afterwards he was taken to Washington and admitted to Mount Pleasant Hospital, where cold-water dressings were applied. Eight days later he was transferred to Mower Hospital, Philadelphia, where, on examination, the bone was found to be carious, and poultices were ordered. From this date until the time of the operation several pieces of bone were discharged and some small abscesses were opened. As no improvement was observed and the probe could be passed entirely through the bone, showing a considerable loss of substance, it was finally determined to remove the os calcis. On May 16th I proceeded with the operation, being assisted by Drs. J. H. B. McClellan and C. R. McLean (Acting Assistant Surgeons), and the patient being freely under the influence of chloroform. An incision was commenced a little in front of the articulation between the cuboid and calcis and carried around the heel, parallel with the long axis of the calcis, to a point just posterior to the posterior tibial artery; another was made at right angles to this, about two and a half inches in length, through the tendo-achillis. The flaps were then dissected back and disarticulation was effected in the manner recommended by Mr. Erichsen, the operation being completed in thirty minutes and no artery requiring ligation being cut. Monsell's solution was used to control the hæmorrhage from the smaller arterial twigs and veins. The flaps were accurately brought together and retained in position by silver-wire sutures, an opening being left posteriorly for the escape of fluids. Cold-water dressings were used. One-half grain of morphia was given, and some little febrile action during the next two days was controlled by spirits mindereri. On May 18th, Smith's anterior splint was applied to the leg and adhesive strips from the toes to a point near the incision. The incisions on the inner side of the foot healed by first intention and the sutures were withdrawn on May 20th, and a sponge tent was ordered to keep open the posterior point of exit, which had closed by granulations. On May 22d all the sutures were removed and adhesive strips re-applied. Large quantities of grumous pus were being discharged. The patient continued to improve, and on the 24th, the splint was removed, a sling made from a sheet being substituted. After this the patient improved rapidly and left his bed on June 12th, the wound having healed with the exception of a slight track at the junction of the two incisions, from which a little healthy pus was being discharged. By June 17th the patient could bear his weight on the foot, the sinus having closed. The contour of the foot was not materially altered, the sole being a little flatter than its fellow. He was in excellent health and fine spirits, and felt no pain when bearing his weight on the foot, but said that it felt very springy." In addition to the history, Dr. Greenleaf also stated that as soon as the parts had become a little hardened and accustomed to their new position, a shoe filled with hair at the heel was to be furnished to the patient. The subsequent records of the hospital show that the patient was able to wear his shoe by July 10th, and could walk without crutch. Afterwards he was allowed to stay at his home in Philadelphia on furlough, getting stronger every day and his foot being entirely healed. On November 30, 1863, he was discharged from service and pensioned. Examining Surgeon W. Jewell, of Philadelphia, September 14, 1866, certified that "the removal of the os calcis has left the pensioner lame in his gait but not otherwise injured. Other examiners report nothing additionally important. The pensioner was paid September 4, 1880. The excised calcaneum​, contributed to the Museum by the operator, and exhibiting general caries, constitutes specimen 1286 of the Surgical Section.¹

¹ A detailed account of this case by Surgeon C. R. GREENLEAF, U. S. A., will be found on page 389 of Vol. XLVI of the American Journal of the Medical Sciences, Philadelphia, 1863.