Surgical notes of cases of gunshot injuries occurring during the advance of the Army of the Cumberland in the summer of 1863 / by I. Moses.

  • Moses, Israel, 1821-1870.
Date:
[1864?]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical notes of cases of gunshot injuries occurring during the advance of the Army of the Cumberland in the summer of 1863 / by I. Moses. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    ¥ J$7 transferred to General Hospital at Nashville. Some doubt exists in my mind as to the accuracy of diagnosis in these cases, and I am inclined to regard them rather as fractures near the head of the bone. I have no history of the cases, and cannot recollect the particulars, though I should no doubt have done so had cases of so grave a nature been received, as it was my custom to visit every surgical case of interest in all the hospitals two or three times each week. The third and fatal case was that of Captain Martin, 79th 111. Yols. A minie ball entered the left hip opposite the great trochanter, passed inwardly through the head of the femur, and was reported to be there retained. He was brought to the hospital after a journey of thirty miles in an ambulance, and on arrival was very much exhausted. On the second day after, having rallied considerably in strength and spirits, he desired that an operation should be performed if considered necessary. He was rendered insensible by ether and an exploration made, by which it was discovered that the ball had passed through the neck of the bone, and the finger could follow its track, but no ball was felt—although the fissure could be detected which rendered the fracture complete, yet there was very little comminution and no displacement. It was deemed most proper to leave things as they were. The patient recovered well from the anaesthetic influence, and presented no unfavorable symptoms until the third day after the operation, when he rapidly passed away. It was discovered, after the operation, that the ball had passed through the thigh and made its exit near the auus in the cleft of the nates. (See specimen in Army Museum.) The fourth case, and fatal, was Private W. C. Lesneur, of Confederate Army, who was admitted June 27th with gunshot wound on right side ; the ball had entered opposite the great trochanter of the femur, passing inwards and backwards through the trochanter major and lodging. The finger could be passed into the inner side of the bone, but could not follow the track farther. As this patient was much exhausted by a long and fatiguing journey, no operation was deemed advisable. He lingered along for a few weeks, although supplied with food and stimulants, and sunk rapidly, being at no time in a condition to warrant surgical interference. On examination, eight hours after death, the ball was found to have entered the trochanter major, passing through it and the capsular ligament of the joint, carrying away a portion of the head of the femur, the round ligament, and posterior portions of the acetabulum, and to have lodged beneath the psoas maguus and iliacus internus muscle near the spine, wlnare a large abscess was found filled with dark unhealthy pus. The ligament- ous and cancellous structures in the vicinity of the joint were almost entirely absorbed, and the soft parts infiltrated with sero-purulent matter. In such a case no operation, even if attempted, would have offered any chance of saving life, and would have without doubt hastened the fatal result. The experience of the English and French surgeons in the Crimean war has led them to declare that the attempt to save gunshot wounds of the