Civil War Washington

CASE 95.—Private S. Brown, Co. G, 134th New York, aged 16 years, was accidentally wounded on August 30, 1862, and entered the Mansion House Hospital, Alexandria, six days afterwards. Assistant Surgeon W. A. Conover, U. S. V., contributed the following report of the injury: "The ball entered the left leg at the posterior middle third, penetrated the tibialis posticus​ muscle, and was extracted at the same opening. At first there was free discharge of laudable pus, but suppuration increased rapidly, and by September 26th infiltration of the tissues had nearly reached the popliteal space. Under a supporting treatment the patient seemed to gain rapidly until November 14th, when, during his sleep, a profuse hæmorrhage occurred from the sloughing of the posterior tibial artery and a great quantity of blood was lost before it was discovered. His condition not admitting an operation, the wound was plugged with styptics and a bandage was applied from the toes to the hip. This treatment controlled the hæmorrhage for eight days, stimulants being given freely in the mean time in order to prepare the system for an operation, if necessary. On November 28th another attack of bleeding was promptly controlled by the attendant, and, upon consultation, ligation of the femoral artery at the lower third was agreed upon as giving the patient a chance for his life. The operation was performed with some difficulty, owing to the abnormal structure of a branch artery which had to be carefully avoided. The patient bore the operation very well considering his condition, and, on the following day, his extremities were perfectly warm and remained so, showing that circulation had been re-established. The discharge, however, continued excessive, and although stimulants and tonics were used very freely, the patient sank steadily, and died of pyæmia on December 7, 1862. The autopsy confirmed the extensive disorganization from infiltration of pus, the artery being in an unhealthy condition up to within an inch of the ligature. The tying of the artery was a success, the clot having been perfectly formed and the circulation re-established by the profunda, which was sufficiently enlarged for the purpose." The ligated artery was contributed by Dr. Conover, a wet preparation of which is shown in the cut (FIG. 16).