Civil War Washington

CASE 392.—Private J. Shimrock, Co. A, 55th Ohio, aged 20 years, was wounded at Chancellorsville, May 3, 1863. Surgeon G. Suckley, U. S. V., reported that he was left in the hands of the enemy, and described his injury as "a shot fracture of the femur." Twelve days after being wounded the man was paroled and admitted to the Eleventh Corps field hospital at Brook's Station, and one month later he was transferred to the Stanton Hospital at Washington. Surgeon J. A. Lidell, U. S. V., contributed the specimen (FIG. 153) and made the following report of the case: "Examination at the time of admission showed that the right femur was broken near the junction of the lower with the middle third, and that union had not yet taken place. There was a copious discharge of thin pus from the wound of the soft parts. The fracture had been treated in a simple straight fracture-box, and the limb was still in it when the patient was brought to this hospital. He stated that the bullet had not yet been extracted from the wound. He was pale, thin, and weak, with a frequent pulse. His tongue was smooth, dry, and red, and he complained of diarrhœa, but said this was an old affair, and that he had also had chills and fever some time back. The prognosis was very unfavorable. The broken limb was placed in Hodgen's splint; pills of camphor and opium were given to control the diarrhœa, and the system was supported with a nourishing diet, using eggs, milk, beef tea, farina, etc., together with milk-punch. June 18th, diarrhœa checked; tongue continues red and smooth; has considerable irritability of the stomach. The pills were suspended, but the supporting treatment continued. 22d, secondary hæmorrhage from the wound, to the extent of about three ounces, occurred this morning; there was also slight bleeding yesterday, some branch of the profunda being the probable source. Two drachms of solution of persulphate of iron was injected into the bottom of the wound through a catheter, and the hæmorrhage did not again occur. 24th, complained of pain in the thigh, was restless, and had some diarrhœa. Gave one-grain opium pills every four hours until the 26th, when the diarrhœa was again checked. Suppuration continued profuse; tongue smooth and red. July 2d, patient appeared to be slowly failing. Fluctuation having been detected above the internal condyle of the femur, an incision was made and about two ounces of pus evacuated. Two grains of quinine was prescribed three times a day, and six ounces of whiskey daily was substituted in place of the milk-punch, which, the patient thought, did not agree with him. 8th, patient began to exhibit night sweats, with increase of pallor and anæmia; suppuration profuse, unhealthy and fetid; necrosed bone at the bottom of the wound firmly impacted. 18th, had a chill, followed by a hot and sweating stage. Administered ten grains of quinine three times a day: chills did not return for four days. 20th, patient very pale and feeble, with smooth red tongue; in addition to quinine he takes muriated tincture of iron, and porter two pints daily, with nourishing diet. 21st, diarrhœa returned and was checked by pills of opium. 22d and 23d, chills occurring at irregular intervals, associated with hot flushes and profuse perspiration. 25th, some unhealthy fetid pus was evacuated from the inner side of the thigh by incision. 27th, had pyæmic rigors and sweats again; is much emaciated and very pale; pulse 120 and feeble; tongue glazed and of bright red color. 29th, continuance of pyæmic rigors and sweats, the perspiration being very profuse; left leg and thigh œdematous and blue colored, the superficial veins looking like dark blue knotted cords; all of which denotes obstruction of the left iliac and femoral veins. The patient continued to sink, and died of exhaustion on July 31, 1863. Post-mortem twenty hours after death: Fracture of right thigh firmly united; necrosed bone closely surrounded by involucrum; muscles of right thigh extensively infiltrated with pus. The missile, a conical and much flattened bullet, was found at the lower and inner side of the thigh. The femoral artery opposite the seat of the injury contained an oval-shaped clot of blood (embolus) which completely occluded it; no other abnormity of the artery was noticed. On examination of the left thigh a metastatic abscess was found in the popliteal space containing about an ounce of pus, and the external iliac and femoral veins were discovered to be distended with coagulated blood. The femoral and iliac veins of the injured limb appeared to be normal. The liver was somewhat enlarged, nutmegged and fatty; kidneys beginning to be granular; spleen enlarged, softened, and reddish brown in color; lungs containing some frothy serum, otherwise natural; left ventricle of heart containing some coagulated blood." The specimen consists of the lower half of the injured femur with a battered piece of lead attached, and exhibits a fragment four inches long by one and a half wide, which preserved the vitality of its periosteal surface. The effusions from this fragment connect, as a bridge, the broken shaft; its internal surface is carious. Besides this, other and smaller fragments are entangled in the newly formed bone, some of which are necrosed and some serve as bonds. A wet preparation of portions of the common and external iliac and femoral arteries of the right side, showing an embolus in the latter near the seat of the fracture of the thigh, was also contributed by Surgeon Lidell¹, and constitutes Specimen 3454 of the Surgical Section of the Army Medical Museum.

¹ Dr. LIDELL, in an article on Thrombosis and Embolism, in the American Journal of Medical Sciences, 1872, Vol. LXIV, N. S., p. 343, gives a minute account of this important case.