Civil War Washington

CASE 935.—Lieutenant H. Holt, Co. F, 130th New York, aged 20 years, was wounded in the right foot, at Bull Run, August 30, 1862. Surgeon C. L. Allen, U. S. V., described the injury as follows: "The ball entered at the top of the foot, fracturing the fifth metatarsal bone, and was cut out on the field from the sole of the foot. He went on horseback to Centreville, where during the afternoon of the following day he was placed in an ambulance. The next day he came to Washington, taking the cars at Fairfax Station and entering Emory Hospital for a day or two, when he removed to a private boarding-house and was attended by a private physician. On September 28th, foot was swollen; abscesses opened, and the original wounds were all discharging freely. The patient was much emaciated, his countenance expressing suffering and showing the strongly marked hectic flush; appetite gone; thirst considerable; pulse 130, feeble and fluttering; pain and stiffness in the jaws, with inability to open the mouth more than to admit the tip of the little finger between the teeth. This condition (trismus), he stated, had been coming on for two or three days. Huxham's tincture, brandy, beef-essence, etc., with an occasional full dose of morphia was prescribed. On October 5th another abscess opened. October 9th: The patient has slowly and steadily improved in general appearance since my first attendance; pulse 110 to 116 with more strength. It was thought advisable to put the patient under the influence of ether and examine and perform any operation considered necessary, Surgeons M. Clymer and J. H. Brinton, U. S. V., being requested to see the case. The foot was still enormously swollen, and the probe passed readily from the wound of entrance to the opening below the external malleolus. In the upper opening four inches above the inner malleolus the probe rapped distinctly upon the denuded tibia. Surgeon Clymer made an incision nearly the whole length of the external side of the foot, and removed the fragments of the fifth metatarsal bone together with the little toe. Since it appeared at this stage that all or nearly all the tarsal and metatarsal bones were diseased, as well as the lower third of the tibia, it was decided that amputation was necessary, but that the patient at this time could not endure any further operation. The tonics, stimulants, and nourishments were now crowded as much as possible. On October 12th the patient had somewhat improved. On the following day tincture of cantharides, in doses of twenty drops every four hours and to be increased if necessary, was prescribed in addition to his other treatment. For three or four days the patient steadily but very slightly improved, after which he evidently failed for a few days. He had taken nearly two ounces of tincture of cantharides and suffered a little of strangury. All remedies except his nourishment and a little brandy were now omitted, and on the following day compound syrup of phosphate of lime and iron was ordered. On October 23d the patient was still very feeble, but looked a little brighter and had a little appetite; pulse 120 to 130. After this he steadily improved, and by November 1st he had a good appetite, his pulse having gradually lessened to from 80 to 90 per minute. On November 8th he was dressed and able to sit in a chair, and about two weeks later he first went down stairs on crutches. The wounds on the external side of the foot had completely healed by December 21st, while the openings on the other side, both above and below the malleolus, were still discharging. All the openings healed up about December 31st, but several days after more swelling appeared toward the toes, and on January 3d an opening occurred over the second metatarsal bone, near the distal extremity. This discharged freely for several weeks, denuded bone being detected by the probe. On January 29th the patient was able to wear his boot all day, and one week afterwards he walked with a cane. By February 15th the last opening had closed. On March 13, 1863, the patient was mustered out of service, walking with ease by the aid of a cane and without much difficulty without one. He subsequently informed me by letter that he was holding a position on the staff of Brigadier General Pierce in Massachusetts." Lieutenant Holt is a pensioner, and was paid February, 1879.