Civil War Washington

CASE 1923.—Private C. W. Hareh, Co. A, 105th New York, age 29 years, was wounded in the left forearm at Antietam, September 17, 1862, and admitted to Cranch Hospital, Washington, about one week afterward. Surgeon A. Wynkoop, U. S. V., noted the injury. Entering Mount Pleasant Hospital December 5th, several days afterward the wounded man was transferred to Philadelphia. Acting Assistant Surgeon L. K. Baldwin reported: "The missile was a minié ball, which entered the left arm about two inches below the olecranon process of the ulna, and was extracted about the same distance above the wrist joint, causing a compound fracture of the bone. The patient was admitted to Satterlee Hospital on December 13th. The wound at the time of his admission presented rather an unhealthy appearance, the discharge being of a thin sanious nature, giving evidence of the existence of a considerable amount of dead bone. The patient complained of a pricking sensation in and around the seat of the injury, as though there were some pieces of loose bone in the wound. After carefully examining the injury with the probe, a number of loose pieces were discovered in the region of the wound of exit, all of which were within reach and were removed by means of a pair of forceps. By this means it was hoped to get rid of the cause of the irritation and to promote the healing; but all was to no effect, the amount of injury being so extensive, and portions of dead bone so numerous, that the irritation was still kept up, rendering an operation necessary to a cure. The patient suffered so much inconvenience from the pricking sensation already alluded to that he was quite anxious to have an operation performed for the removal of the cause of the irritation. He being of a stout and robust constitution, an operation was soon decided on. He was accordingly, in order to better fit him for an operation, placed upon quinine and iron, together with a good nutritious diet, which treatment was continued until January 10th, when he was considered in a fit condition to be operated on. The mode of procedure decided upon was the excision of as much of the ulna as was found to be in any way diseased. The patient having been put under the influence of an anesthetic (pure chloroform has been used on this occasion), an incision was made from a short distance below the olecranon process to within about an inch of the wrist joint. The bone was found to be so much shattered by the passage of the ball as to require exsection​ of nearly two-thirds of its whole extent, which was accordingly done. A number of pieces of bone were found lying loose in the course traversed by the ball; others were firmly united to the main shaft of the bone by granulations which had been thrown out by nature in her effort at reproduction. After the bone was removed the wound was kept open by the introduction of a piece of lint into the bottom of it, which was kept wet with cold water until the third day, when active suppuration had taken place. The wound was subsequently dressed with flaxseed poultices, and the patient's strength sustained by the administration of tonics and good nutritious diet. Active suppuration was kept up, and the wound soon began to heal kindly from the bottom. The granulations were at no time exuberant, and at the present time, January 30th, the wound is almost healed. The patient's health has not suffered any from the effects of the operation. He is beginning to have considerable motion in the arm and hand, and there is every reason to suppose that the normal use of the arm and hand will be almost wholly regained." The specimen (FIG. 708) consists of four and a half inches of the excised portion of the ulna, and shows that the bone was not broken in its entire thickness, a splinter one-fourth of an inch remaining intact. A fragment of about the same diameter and a little more than an inch in length has been fixed by new bone parallel with it. Other small fragments have been consolidated above and below it. The specimen was contributed by Acting Assistant Surgeon J. Leidy. The patient, on July 29, 1864, was discharged and pensioned. Examiner J. H. Helmer, of Lockport, January 8, 1868, certified: "The ulna was removed nearly the whole length. The thumb is flexed upon the palm, and all the fingers are flexed upon the thumb. He has no voluntary motion of the thumb or fingers." The Lockport Examining Board reported, August 4, 1875: "He is totally unable to perform manual labor. The arm is as helpless as if amputated at the shoulder joint." This pensioner was paid September 4, 1875.