Civil War Washington

CASE 324.—Corporal Frederick Kelb, Co. G, 7th New York, was wounded at Fredericksburg, Virginia, December 14, 1862, by a conoidal musket ball, which fractured the right femur at the junction of the upper and middle thirds. After remaining for a fortnight in the field hospital of the 1st division of the Second Corps he was conveyed to Washington and placed, on December 25th, in the Patent Office Hospital, where the injured limb was placed in a fracture box and the wound was dressed with oakum. The case progressed favorably, and, on April 2, 1863, the patient was transferred to Judiciary Square Hospital, and, on May 9th, was sent to De Camp Hospital, at David's Island, New York. Acting Assistant Surgeon John C. DuBois reported: "The ball entered about one inch below the fold of the right natis, and, passing outward, shattered the femur at its middle, and lodged in the anterior part of the thigh. The ball was extracted two days afterwards. On January 1, 1863, six pieces of bone were removed. The limb was placed on a double inclined plane and cold water applied. Six weeks after, the long straight external and short internal splints of pasteboard were applied. This was removed in a few weeks and merely the short internal pasteboard splint retained. On April 2d and 8th, pieces of bone came away. The splint was then removed, and the limb suffered to lie on a hair mattress. May 6th, several pieces of bone removed. May 12th, firm union has taken place, with great deformity. External angular curvature, with about 4¾ inches shortening, as near as can be measured. His whole limb is everted, and he is unable to raise it. His general condition is much reduced. As union is firm no treatment can be adopted to relieve the deformity. July 10th, a few more pieces of bone have been removed. The probe reveals rough bone, not loose. Internal wound closed; sinus injected with dilute tincture of iodine. General health pretty good." On July 10th he was removed to McDougall Hospital, at Fort Schuyler; and on January 19, 1864, he was readmitted to De Camp Hospital. On June 8, 1864, he was discharged from the service of the United States. There was evidence of disease of the femur. On June 7, 1865, Kelb was admitted to St. Luke's Hospital, in New York City. There had been a series of recurring abscesses in the thigh, and it was believed that nearly the entire femur was necrosed. It was determined to amputate at the hip joint, and, on June 7th, the patient being anæsthetized by sulphuric ether and the aorta being compressed by Signoroni's clamp tourniquet, the amputation was performed by the attending surgeon, Dr. R. F. Weir, by the method recommended by Dr. Van Buren, an anterior flap being formed by transfixion and a posterior one by section from without inward. The hæmorrhage was slight and the shock was moderate. The case at first progressed very favorably. Three weeks after the operation the healing of the stump was far advanced and the patient was able to leave his bed. After this he began to lose ground very gradually. He died on October 4, 1865, nearly four months after the operation. At the autopsy, the pelvis of the right kidney was found to be blocked up with numerous calculi; there was an abscess in the left kidney, and there was tuberculosis of both lungs at an advanced stage. The stump was still open and the horizontal portion of the os pubis was necrosed. A section of the exarticulated femur presented the characteristic lesions of chronic osteomyelitis.