CASE 377.—Private William Ziliox, Co. F, 29th New York, aged 31 years, was wounded at Chancellorsville, May 3, 1863. He was standing erect and in the act of firing. The missile, a conoidal ball, entered the outer and middle portion of the left thigh, passed upward, fractured the femur, and lodged in the surrounding muscles. He was left on the battlefield and fell into the hands of the enemy, and received no treatment until his return within our lines, May 15, 1863. He was then admitted into the field hospital of the Eleventh Corps, at Brook's Station, where his leg was dressed in splints. On June 14th, he was admitted into the Lincoln Hospital, Washington. Assistant Surgeon H. Allen, U. S. A., reports: "When admitted his affected limb looked as though no extension had been employed. The ball had not been extracted, there was no union, and there was four and a half inches shortening. Acting Assistant Surgeon D. Weisel, under whose care the patient was placed, removed the splints and applied the anterior splint. This treatment was continued until June 20th, when, suppuration becoming so great, fear was entertained of pus burrowing toward the hip joint, and it was discontinued, and sand bag supports and extension, produced by a bag of stones suspended by a rope run through a pulley and attached to the base of the foot, substituted. The case progressed favorably. August 1st, small abscesses appeared near the knee, not, however, troublesome. There was little burrowing of pus. August 7th, Dr. Weisel opened a small abscess on the posterior portion of the thigh immediately behind the seat of fracture. August 26th, several spiculæ of bone were extracted through this opening, together with the bullet, which was flattened and contorted to a very irregular form. Early in September, the pus was observed extending down the inner side of the thigh and opening two inches above the internal condyle of the femur. By pressure pus could, at any time, be made to pass out of this opening, it, no doubt, communicating with the injury above. The constitutional symptoms were still favorable. October 1st, effusion in the knee joint of the corresponding side was first noticed; the skin over the joint had an erysipelatous hue, and the joint was swollen. It was at first thought that the opening on the inside of the thigh communicated with the joint, and that pyarthrosis was caused thereby; but it was afterwards thought to be a case of suppurative arthritis and in no direct way connected with the pus-producing surface about the seat of fracture. From the first appearance of this complication the patient sank rapidly, the tongue became dry and brown, the stomach rejected all aliment; hiccough was a constant and distressing symptom. Severe pain was experienced in the limb. These signs of constitutional exhaustion continued without relief until the day of his death, October 6, 1863." The secondary inflammation of the knee joint is shown in PLATE XXV, opposite p. 184. The fractured femur, showing fractures in the upper third, large deposits of callus, but without union, is Spec. 176l of the Surgical Section, A. M. M. (FIG. 145.)


FIG. 145.—Shot fracture of upper third of left femur. Spec. 1761.