CASE 223.—Private Timothy Greely, Co. C, 74th New York, aged 20 years, was wounded October 5, 1861, by a round musket ball, which entered near the fold of the left natis, struck the left femur at the digital fossa, splintered the neck into the articulation, and made its exit outside the vessels anteriorly. He was conveyed to the E street Infirmary, Washington, on the same day. A stream of blood and another of clear and pellucid synovia issued from the wound of exit. There was but little constitutional irritation, the pulse was but slightly depressed, and the patient congratulated himself on having escaped with what he regarded as a slight injury. On the morning of October 6th Assistant Surgeon John W. S. Gouley, U. S. A., assisted by Surgeon C. H. Laub, U. S. A., Assistant Surgeon C. B. White, U. S. A., Surgeon T. Sim, and Assistant Surgeon H. E. Brown, proceeded to operate. Insensibility having been induced by chloroform, Dr. Gouley made an incision seven inches long, commencing above and behind the trochanter major and continued downward in the axis of the limb. The neck of the bone was found to be badly shattered, but the fracture did not extend to the shaft. A section through the great trochanter and base of the neck was made with the chain saw. The head of the bone was then disarticulated and removed, and the fragments of the neck were extracted. There was very little loss of blood. The wound having been approximated and dressed simply, the patient was put to bed, and the limb was kept in position by pads and cushions. Surgical fever set in soon after the operation; pyæmia was developed, and the patient gradually sank, and died on October 12, 1861. His friends would not permit an autopsy. The pathological specimen and Dr. Gouley's notes of the case were destroyed in the conflagration which shortly afterwards consumed the Infirmary.