A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office.

Date:: 1871

Credit: A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$than formal excisions. Of six operations on the bones of the hand, one terminated fatally on account of pyaemia. These cases were reported as excisions ; but would probably be more suitably described as extractions of diseased phalanges, resections of the ends of the metacarpals—a finger being shot off—or extraction of splinters of metacarpals or phalan- ges. These abstracts are followed by an interesting report of a successful intermediary excision of the upper portion of the radius for gunshot fracture, and this by seven cases of excision in the continuity of the humerus, three primary, two intermediary, and two secondary, all performed on account of gunshot fractures and all terminating successfully. Two men recovered from excisions of head and upper extremity of the humerus, after gunshot fracture involving the shoulder-joint, with the excellent results that frequently follow this excellent operation. The excisions in the lower extremities were fewer in number, but of greater importance. They were all performed for gunshot injury ; one on the calcaneum, one on the first metatarsal, one on the tibia, one on the fibula, and four on the hip-joint. Every reader must be impressed and gratified by the successful issue of the excisions of the head and trochanter of the femur. Three of the four cases were eminently successful, and the fourth and fatal case w^is practiced on a patient broken down by disease and intemperate habits, and unlikely to bear even a trivial operation satis- factorily. The twenty-seven reports of ligations of the larger arterial trunks (see summary on p. 235) include one in which the common carotid was successfully tied for secondary hoemorrhage following a gunshot-wound of the face and neck, supposed to involve the external carotid near its origin. That there should not have been recurrent haemorrhage from the distal orifice in the vessel is surprising. A compulsory ligation of the aorta for rupture of an aneurism of the common iliac is reported from one of the freedmen hospi- tals. One of three ligations of the external iliac proved successful. Three of the four ligations of the femoral resulted happily. The fatal case was one in which Anel's operation was performed, neither experience nor theory having convinced the operator that tying the femoral in its middle third would not preclude the fatal consequences of recurrent haemorrhage from a wound of the popliteal. It is almost incredible, but there are still many surgeons who think it unnecessary to place two ligations on wounded arteries, but are satisfied in securing the proximal extremity or in tying the main trunk at a distance. The reports indicate that acupressure was not employed to any great extent. Styptics and tourniquets were sometimes too freely substituted for more effective haemostatics. An interesting case of brachial aneurism successfully treated by compression is recorded on p. 155. The reports under the head of Various Operations comprise accounts of four operations on the eye, and one on the ear; of four operations on the face, including one of rhinoplasty and one of extraction of a large salivary calculus; and five cases of bron- chotomy, in three of which the opening was made in the trachea and in two in the larynx. One of the two cases in which the operation was done for traumatic inflammatory swelling occluding the air-passages was successful. Three other cases, one of oedema of the glottis and two of membranous croup, terminated fatally ; yet the observation of the two latter convinced the experienced surgeon in charge of them of the propriety of trache- otomy in all hopeless cases of croup. The only reported case of much interest among the operations on the abdomen is one$