CASE 298.—Sergeant Lewis Carroll, Co. H, 1st Delaware, aged 23 years, was wounded on October 22, 1864, near the Weldon Railroad.³ A conoidal musket ball entered the right thigh in front, and, striking the femur at the junction of the upper thirds, produced a remarkable longitudinal splintering of the bone, extending from an inch below the lesser trochanter downward for ten inches, together with several oblique fissures. The wounded man was conveyed in an ambulance to one of the field hospitals of the Fifth Corps, where the ball was extracted and the sharp extremity of the upper fragment of the femur was sawn off. The fractured limb was then dressed, and the patient sent to City Point, and thence on a hospital steamer to Alexandria, where he was admitted to the Third Division Hospital on November 2d. The thigh was swollen to three times the size of its fellow. An incision six inches long on the outer side presented inflamed everted edges, between which fasciculi of muscles protruded. There was much febrile irritation, but the patient's strength was maintained to a remarkable degree. On November 11th, there was quite free hæmorrhage from a small artery, and the patient was etherized and the vessel secured, and afterward a thorough exploration of the wound was made. The very extensive longitudinal splintering was recognized; the bone was found denuded in several places; the soft tissues of the thigh were infiltrated with pus of a very offensive character. In view of this condition of things, it was determined to remove the limb at the hip joint. The patient was placed under the influence of chloroform, and the operation was performed by Surgeon Edwin Bentley, U. S. V. An external flap was made by cutting from without inward; then the head of the femur was disarticulated, and an internal flap was cut from within outward. The loss of blood was slight and the patient reacted promptly. The progress of the case for two or three days after the operation was very favorable. Then a chill occurred, followed by a cold clammy sweat. The wound looked badly and the discharge was unhealthy; the stump was kept covered with yeast poultices. Beef essence, stimulants, and anodynes were administered. Six days after the operation there was yellowness of the surface and of the conjunctival membranes; then delirium and coma, and death on November 19th, eight days from the date of the operation. At the autopsy, pus was found in the external iliac vein, metastatic foci in the lungs, and a gangrenous abscess in the enlarged spleen. The preparation of the femur was sent to the Army Medical Museum, and is figured in the adjacent wood-cut (FIG. 94).

³ See Circ. No. 6, S. G. O., 1865, p. 50, CASE 18, and Circ. 7, S. G. O., 1867, CASE XXXVI, pp. 38 and 62, and Cat. of Surg. Sect., of 1866, p. 247.

FIG. 94.—Right fem. fissured by a musket ball. Spec. 1020.