CASE 247.—Private Charles E. Marston, Co. F, 1st Massachusetts, aged 19 years, a pale and delicate boy, was wounded at the second battle of Bull Run, August 30, 1862. He was admitted to the College Hospital, Georgetown, D. C., on September 6th, having laid on the battle-field several days, and then moved in an ambulance wagon thirty miles over very rough roads. An examination revealed a large bullet wound an inch anterior to and on a line with the right trochanter major, with great comminution of the head and neck of the femur. The limb was shortened, and the foot was everted. The circumference of the limb exceeded that of its fellow by half. The pulse was 112, and of moderate volume. The tongue was rather dry. The patient suffered little pain. The general condition was not promising, and yet not very bad. Excision of the fractured bone was decided upon, and, on the 27th of September, Assistant Surgeon B. A. Clements, U. S. A., assisted by Assistant Surgeon Charles H. Alden, U. S. A., and the surgical staff of the hospital, proceeded to perform the operation. Chloroform was administered, and a slightly curved incision five inches in length was made on the outside of the thigh, the shot hole in the middle of the incision, and the trochanters and neck were thus exposed. The neck was crushed into about forty fragments, which were extracted. The head was also much broken, and the round ligament was absorbed or destroyed, so that exarticulation was easy. The roughened portion of the neck, at its attachment with the trochanter, was sawn off with a small chain saw. The missile, a conoidal musket ball, was found on the inner side of the thigh at the bottom of a large cavity, and was removed with difficulty. After thoroughly syringing the wound and removing the powdered bone, the wound was closed by silver sutures, except at the bullet hole, and sand bags were placed to keep the limb in position. Slight extension was made by a weight to the foot. The patient expressed himself as relieved by the operation, and he slept well that night. On the following day his pulse had risen to 128, and the discharge from the wound was very copious, thin, and brown. On September 29th, his pulse was still quick and feeble, and his tongue dry, and, though he took nourishment well, and was free from distress, he gradually sank. He died on September 30, 1862, at half past 8 o'clock A. M., three days after the operation. At the autopsy, on October 1st, made by Acting Assistant Surgeon G. K. Smith, the wound made by the operation was found to be filled with very offensive pus. The upper end of the shaft of the femur was found to be diseased on its posterior surface near the trochanter minor, and the periosteum was loosened from the bone for some distance above and below this point. The fracture of the ischium, which was noticed at the operation, extended obliquely upward and backward from the lower border of the acetabulum, terminating in the sciatic notch, about an inch and a quarter above the spine of the ischium. The lower half of the acetabulum had been broken into several fragments, which were held in position by the cotyloid ligament. The excised portions of the femur were forwarded to the Army Medical Museum, and are numbered 328 in the Surgical Section. They are represented in the adjoining wood-cut (FIG. 58).

FIG. 58.—Shot comminution of head and neck of right femur. Spec. 328.