Civil War Washington

CASE 193.— "Captain James M. L——, Co. I, 20th Indiana, was twice wounded in an engagement in front of Richmond, on June 27, 1862. The first wound was through the lumbar muscles, and, while lying on the field, he was again struck by a conoidal musket ball, which entered on the outer side of the left thigh a little below the great trochanter, and, passing upward and inward, lodged. He was conveyed to Washington, and on June 29th was admitted to the Columbia​ College Hospital. A finger could be readily passed into the perforation of the femur, but the ball could not be reached. There was no shortening or eversion of the limb, interfering with the motion of the joint. Three formal attempts to ascertain the position of the ball and accomplish its removal were unsuccessfully made. The patient died from exhaustion, August 19, 1862." The specimen is represented in the adjoining wood-cut (FIG. 46). It shows the upper portion of the left femur perforated between the trochanters on the posterior surface. The track of the ball is carious. The great trochanter has been split off, but is reunited by callus. The space between the trochanters is bridged over by a displaced fragment of bone, attached in its new position by slight osseous deposits. The missile was found resting against the capsular ligament. Assistant Surgeon W. M. Notson, U. S. A., who attended and reported the case, is confident that the ball was external to the joint; but as the grooving of the neck extends upward nearly to the articular surface of the femur, it is hardly possible that the joint escaped.—(Circular 2, p. 75, CASE 69.)