PROCEEDINGS 
OF THE 
CLINICO-PATHOLOGICAL SOCIETY OF WASHINGTON, D.C. 
1865. May 6. Pseudo-Membranous Croup.—Dr. H. P. Middleton, 
reported the following case :— 
Joseph Fronvvald, aged fifteen and a half years, was admitted to the 
Episcopal Hospital, Philadelphia, March 20th, 1864, suffering with an 
ugly and peculiar looking ulceration of the upper lip and nose, with 
which he had been afflicted some eighteen months. The disease had ex- 
tended up beyond the anterior nares, wholly including the nasal passages, 
destroying the cartilaginous septum, and rendering the boy a most pitia- 
ble object to behold. Respiration, of course, was carried on through the 
mouth, and the voice was decidedly husky—supposed to be due to the 
condition of things just related. I may here state that his general health 
appeared to be perfect. About two weeks after his admission to the 
hospital, he one morning complained of sore throat. I examined the 
throat and found an ulceration, similar to that upon the lip and nose, 
about the posterior nares, and a little to either side. The surface was 
raw and bossilated. The fauces were inflamed, and there was a feeling 
of heat and great soreness extending down the larynx, but no white or 
ash-coloured exudation could be seen. As might be expected, there was 
considerable febrile reaction. A saline cathartic, a cooling diaphoretic, 
the external application of lin. ammonise, with some restrictions in diet, 
constituted the treatment for this throat complication. In the course of 
three or four days the boy was relieved of everything except the ulcera- 
tion, which continued to be as obstinate as that of the face. 
On the 4th of May, about six weeks after admission, the patient again 
complained of sore throat, etc., which was again met by the same general 
plan of treatment as was previously adopted—tr. iodine being substi- 
tuted for the ammon. liniment—but this time without relief. 
On the following day the voice was more husky, but unattended by 
cough or expectoration. The dose of febrifuge was increased, and a 
steam bath ordered. On the evening of the same day the fever had 
greatly decreased, and the boy’s condition seemed much improved, though 
he continued to complain of great soreness in the throat. Leeches were 
ordered but could not be obtained. 
On the following morning the patient was worse, the fever had increased, 
and the general condition seemed to be pretty much as it had been two 
days previously. Some slight modification was made in the medicine that 
was being administered, and eight leeches applied to the anterior and Proceedings of the 
sides of the neck. At 7 P. M. I was summoned hastily by the nurse, 
who said he thought Joseph was dying. On reaching the ward I found 
him gasping for breath ; he would grasp the throat with his hand and 
pull at it as though to enlarge the opening for the admission of air. The 
voice had degenerated to a mere whisper; respiration similar to that of 
a person labouring under a severe attack of asthma. I desired him to 
cough, but he declined—but finally complied with the request—and, in 
doing so, revealed the character of the trouble by the croupy sound. I 
at once called in the other medical gentlemen of the hospital, and the 
diagnosis being confirmed, we immediately commenced to administer 
powdered alum in teaspoonful doses at short intervals, which failed, how- 
ever, to produce emesis or even nausea, although was taken. 3j 
sul. zinc and 3ss ipecac were then given, and in a short time free vomiting 
followed, but not a particle of false membrane was ejected. During the 
time consumed in the administration of emetics, symptoms of exhaustion 
had supervened, and the prostration wTas now extreme. The lips, por- 
tions of the face, ends of the fingers had become permanently livid ; the 
pulse was imperceptible at the wrist, and a cold, clammy sweat bedewed 
the whole surface. Stimulants were freely administered, .but. all to no 
purpose. The pitiable sufferer, after repeated convulsive efforts, sprang 
from his bed, and fell upon the floor a corpse—dying literally from “want 
of breath.” 
An autopsy was made eighteen hours after death, and thg specimen, 
which is herewith presented to the Society, obtained. (The specimen 
consisted of larynx and a portion of the trachea, so slit open as to show 
the interior, which was almost entirely closed by a coating of false mem- 
brane.) 
There are two or three points connected with this case which I wish to 
bring to the attention of the Society. 
First. The age of the patient; as before stated, he was fifteen and a 
half years old. Now, although this is not unprecedented, it certainly is 
unusual, the disease being one almost exclusively confined to childhood. 
Meigs does not report a case occurring after the seventh year ; Watson, 
in referring to ninety-one cases reported by Jurin, states that only one 
case occurred after the tenth year. Dickson says that it is very seldom 
seen in children before they are weaned, or after the age of puberty, al- 
though he reports one case of a lady fifty years of age, who was subject 
to it all her life. 
Secondly. I would call attention to the rapidity with which the disease 
progressed, or, at least, manifested itself, during the last ten or twelve 
hours of the boy’s existence. 
May 20. Traumatic Tetanus.—Dr. J. Ford Thompson reported the 
following case :— 
Steward B. P. Blewitt, 24th Regiment Yeteran Reserve Corps, age 
thirty; of rather delicate constitution, but enjoying tolerably good health. 
May 8th, 9 P. M., in turning over the seat of a wagon, received a small 
punctured wound, from a nail, in the palm of the right hand immediately 
over the metacarpo-phalangeal articulation. The wound bled quite freely, 
but ceased in a short time, when he applied a compress wet with water 
and tr. opii to relieve the pain, which he said was quite severe. By 1L 
P. M. the pain had much increased, extending up the forearm, and there 
was also contraction of the digital muscles. Becoming very uneasy with Clinico-Pathological Society oe Washington. 
3 
that feeling of impending evil, so characteristic of this disease, the sur- 
geon in charge, Dr. Frisbie, was summoned, and prescribed the local 
application of warm fomentations with laudanum and camphor, and a 
dose of opium internally. 
May 9, 2 A. M. The treatment has afforded no relief, and the spasms 
have extended up the arm, with well-marked trismus and great difficulty 
in deglutition. Dr. Frisbie again saw him, and administered tr. opii, 
spts. seth. comp., aa gtt. xh, remaining with the patient during the re- 
mainder of the night, giving him twenty-five drop doses of laudanum 
every half hour, until 7 A. M., when he fell asleep and slept until 9 A. M. 
Saw him in consultation with Dr. Frisbie at 8.15 A. M., when he was 
sleeping soundly, with a good pulse, no spasmodic contractions, and the 
muscles of the jaws perfectly relaxed. 
A few minutes after 9 A. M. the patient awoke, and was soon seized 
with the same symptoms, with an extension of the spasms to the muscles 
of the back of the neck and of the back; though there was no opistho- 
tonos, the contractions not being tonic in character. At 10.30 A. M. 
the inhalation of chloroform was commenced, and he was kept partially 
under its influence until 5 P. M. This treatment greatly diminished the 
frequency and force of the muscular spasms, but it was found that he 
was growing much weaker, and therefore the use of the chloroform was 
suspended. He was then put upon opium and whiskey, but continued 
to fail, dying May 10, 1 A. M., twenty-eight hours after the receipt of 
the injury. 
In his summary of this case Dr. Thompson referred to the assertion 
made by Erichsen in his work on surgery, who says : “ Wherever the wound 
may he situated the first symptoms are observed in the portio-dura of the 
seventh pair of nerves,” and cited a case which had occurred during his 
army practice, which would tend to disprove such assertion ; the case 
being that of a soldier who had had his leg amputated at the point of 
election, and in which the spine of the tibia had ulcerated through the 
anterior flap ; in this case the spasms of the muscles of the thigh pre- 
ceded several days any evidence whatever of an affection of the portio- 
dura. 
In speaking of the treatment, he referred to two cases treated by Dr. W. 
Y. B. Bogan, of this city ; in the first of which the patient recovered, the 
treatment being mainly injections of sulphuric ether. In the second case 
(the patient being a lady in whom the disease supervened seven or eight 
days after an abortion had taken place) the same treatment was pursued, 
but death resulted. He also referred to a case treated at the Armory 
Square Hospital, in which tetanus ensued after a severe lacerated wound 
of the buttocks; this case recovered, being treated by the applications 
of ice over the spinal column, and the local application of morph, sulph. 
to the wound. 
In the discussion which ensued after the reading of the paper, Dr. 
Middleton mentioned a case which occurred at Blockley Hospital, Phila- 
delphia, under his notice, in which tetanus ensued as the result of an 
injury to the ulnar nerve ; the nerve was divided and the patient recovered. 
May 27. Compound Fracture of Ulna ; Resection of Elbow-Joint.— 
Dr. S. J. Todd reported the following case:— 
C. S., mulatto, thirty-five years of age, tall, robust, and of good 
general health, came under my care July 21st, 1864. He had received a 4 
Proceedings of the 
wound on the anterior aspect of the left forearm, one inch from the joint, 
and extending towards the hand a distance of three inches. The wound 
was caused by a blow inflicted by a spade in a street fight; his arm, at 
the moment of the accident, being in a semi-flexed position, protecting 
his head, to which the blow was directed. The edges of the wound were 
rough, and venous hemorrhage profuse. Passing my finger into the 
wound, I found there was a comminuted fracture of the ulna, two inches 
from the extremity of the olecranon process, and involving three or four 
inches of the shaft of the bone. The following day, in the presence and 
with the assistance of Drs. Dove, Lincoln, and Wordsworth, resection of 
the joint was performed. The wound having been enlarged, and the 
olecranon dissected out, the end of the bone was then sawn off, and all 
spicula and clots removed. The wound was filled with lint, the limb 
placed in a semi-flexed position, and cold water-dressing applied until 
the 30th, when a deeply-seated abscess was detected two inches above, 
and extending towards the joint, but not communicating with it. This 
was opened. The patient then slowly improved ; the wound looked 
healthy, pus laudable, appetite good, and there was but little pain in the 
arm, until the 26th of August, when two more abscesses, situated on the 
anterior aspect of the arm, were discovered and opened. About this 
time he was admitted to the Quartermaster’s Hospital, in charge of Dr. 
Lincoln, where I continued to attend him. I may here remark that his 
diet throughout his sickness had been good and nutritious. He had also 
been taking the muriated tincture of iron. On the 13th of September 
the wound and the abscess previously opened, suddenly ceased to dis- 
charge. In a few days he complained of pain in the lumbar region, loss 
of sleep and of appetite ; his pulse rose to 110 ; urine scanty and highly 
coloured. On the 11th of September anasarca was noticed. His urine 
was tested by heat and nitric acid, and some little albumen detected. 
Powders of uva ursi and bicarb, soda were ordered him. On the 1st 
of October he was discharged, his wound being in a healthy condition 
and all symptoms of renal disease having disappeared. On the 10th of 
October I was again called to see him, and found the same condition 
of things as in the former attack, except that the dropsy was more gene- 
ral, respiration being impeded by the abdominal distension. I again 
tested his urine, and found it loaded with albumen. Wine of colchicum 
and bitartrate of potash were given, and gr. of elaterium twice a day. 
On the 15th of October I opened afidVher abscess, which had formed 
on the inner side of the forearm ; it discharged freely, and from this 
time he improved rapidly. 
The limb is now partially anchylosed in a semi-flexed position, being 
still of some use to the patient. - 
The first and most prominent question that suggests itself in connec- 
tion with this case, is this : Was the subacute inflammation of the kidneys, 
with the symptoms of general dropsy following it, dependent upon the 
cessation of the discharge of pus ? Or, was it simply incidental—a coin- 
cidence—and not an effect ? 
(Oct. 1st, 1867. Dr. Todd wishes to add to the above report that he 
has at this date had an opportunity of examining the elbow of the patient, 
and that he now has free motion both of the elbow-joint proper and of 
the humeral end of radius, in pronation and supination. In the language 
of the patient—“that arm is as good as its fellow.”) Clinico-Pathological Society op Washington. 
5 
November 25. Operation for the Radical Cure of Hernia.—Dr. Pren- 
tiss reported the following case :— 
Daniel King (col.), a stout mulatto, aged about 25 years, apparently 
of good constitution, was admitted to Quartermaster’s Hospital, July 12, 
1863, with pneumonia—from which disease he speedily recovered. 
During the treatment for this affection, a reducible inguinal hernia of 
the left side was discovered ; the tumour was about the size of an egg, 
and did not extend into the scrotum. Upon this hernia, the patient con- 
sented to have the operation for radical cure performed. The operation 
was performed July 22d by the surgeon in charge of hospital—in the 
following manner : An incision was made downwards in the course of the 
spermatic cord about two inches in length, commencing two inches above 
the external abdominal ring, and the tissues laid back until the sac was 
exposed. The hernia was then reduced, and a curved needle with a 
handle, threaded double near the point, was passed in by the incision, 
through the columns of the ring, and brought out through the skin of the 
abdomen, where one thread was left. The needle was then carried back, 
and passed again through the columns of the ring at a different place, 
care being taken not to pinch the spermatic cord—and again brought out 
at the same point, where the other thread was detached and the needle 
withdrawn. These two threads were next tied together over a smooth 
wooden block provided for the purpose, thus drawing together the ex- 
ternal ring like the strings of a bag. The wound was sutured with fine 
iron wire, compress and bandage applied, morphia administered, and the 
patient left. Chloroform was the anaesthetic employed. 
For two or three days after the operation, there was great pain in the 
part, until suppuration was freely established, when the threads becoming 
loose were taken away ; the sutures were also removed, and the wound 
enlarged to promote the free escape of pus. Intense tenderness over the 
abdomen, with tympanitis, was developed, and treated by emollient 
poultices and full doses of morphia to relieve pain. A distressing cough 
harassed the patient from the beginning, rendering the prognosis un- 
favourable from the constant strain upon the external ring. Slight 
hemorrhage occurred several times from the new incisions. 
On the 6th day after operation, pyaemia set in with its usual pheno- 
mena—severe chills, anxious countenance, icterode appearance, etc., and 
in addition great pain over region of the liver. These symptoms con- 
tinued to increase until the night of August 1, when a severer hemor- 
rhage than any previous, occurred, which terminated the patient’s life, 
eleven days after the operation. 
There was no autopsy, but the evidence first of peritonitis and secondly 
of pyaemia, was undoubted ; and had not the patient died of hemorrhage 
(which was probably from the spermatic artery), he must have shortly 
succumbed to the constitutional disease. 
December 9. Gunshot Wounds of the Bladder.—Dr. Robbins re- 
ported the following two cases :— 
Case I. Private Sherman E. Perry, Co. B, 16th New York Volun- 
teers. Age twenty-seven ; wounded at battle of Salem Church near 
Fredericksburgh, Ya., late in the afternoon of May 3d, 1863. While 
leaning forward in the act of stooping down, he was struck by a conical 
ball, which, after passing through his canteen and clothing, entered his 
body on the right side, half way between the anterior and superior spinous 6 
Proceedings op the 
processes of the ilium, and the symphysis pubis, and two inches below a 
line drawn from one anterior superior spinous process of the ilium to the 
other. The ball passing downwards and backwards, and a little to the 
right, lodged midway between the sacro-coccygeal articulation and the 
great trochanter of the right femur. When struck he fell, but soon got 
up, and walked to a house about forty rods to the rear. Four days fol- 
lowing the ball was extracted, at the point mentioned as its having 
lodged, by a surgeon of the 121st New York Volunteers, who attended 
him nine days, when he was conveyed to the Potomac Creek Hospital, 
and came under the care of Surgeon Oakly, of the 6th Army Corps. No 
urine was passed through the urethra for eight days, but blood and urine 
passed freely through the wounds. On the ninth day a catheter was 
passed, and kept constantly in the bladder. On the 13th day of June 
he was transferred to the U. S. General Hospital, Armory Square, 
Washington, D. C. The wound where the ball was extracted was com- 
pletely healed—the one made by the entrance of it, nearly so. The 
catheter was withdrawn four days after his admission into Armory Square, 
and following its withdrawal he passed, per urethra, a piece of blue cloth, 
beautifully incrusted with calcareous deposit. Quite a large calculi 
passed during the night of 20th, accompanied with intense pain. Symp- 
toms of stone being present, the lateral operation of lithotomy was per- 
formed on the 9th day of September, by Dr. D. W. Bliss, the surgeon 
in charge of the hospital, and a soft calculus, weighing twenty-three 
grains, was extracted; the nucleus being a piece of cloth. The patient 
bore the operation well, and returned home the following month, appa- 
rently perfectly well. Information was obtained from him during the 
following year, when he was suffering no inconvenience from his wound. 
Case II. John Mahay, Co. A, 101st New York Volunteers. Wounded 
at battle of Bull Run, August 29, 1862. Conical ball entering upon the 
crest of the pubis, an inch to the right of the symphysis, passed through 
it and through the bladder in a downward and outward course, and 
made its exit between the spine of the ischium and the coccyx. Seve- 
ral pieces of bone passed through the urethra, during the first few months 
after his entrance into the hospital. The wounds made by the entrance 
and exit of the ball would close up for a longer or shorter period of 
time, and would again open and discharge urine, pus, and blood, and 
when urinating, that fluid would pass as freely through these fistulous 
openings as through the urethra. He generally urinated freely, but never 
without pain, referring it to the penis and perineum. The urine was 
always albuminous and muco-purulent, sometimes mixed with blood. A 
catheter was retained in the bladder during the earlier part of the treat- 
ment, but was discontinued on account of the great pain it produced. 
This patient was under the care at various times of quite a number of 
surgeons. When Dr. T. E. Stuart took charge of the case, about nine 
months after the patient’s admission into the hospital, he dilated the 
wound made by the entrance of the ball, and extracted quite a large 
irregular shaped piece of bone—at the same time he introduced his 
finger through the opening, and felt a stone in the bladder. The patient’s 
condition was such that it was not deemed prudent to operate for its 
removal. I do not know the precise day of the patient’s death, but am 
convinced that he was an inmate of the hospital for a year and a half or 
more. He finally died from exhaustion. The bladder was found to be 
very much contracted, and three-eighths of an inch in thickness; its cavity Clinico-Pathological Society of Washington. 
7 
was nearly filled by two calculi, one weighing two drachms and ten 
grains, and the other four drachms. 
1866. Jan. 20. Abscess of Liver.—Dr. Young reported the following 
case, which occurred while he was acting House Physician in Bellevue 
Hospital :— 
P. R., Irishman, set. 35; hackman; intemperate; admitted June 2, 
1864. Came under ray care July 1. He was then extremely emaciated; 
his abdomen and lower part of thorax very much enlarged. Right leg 
very oedematous. The liver extending below the umbilicus, and con- 
siderably to the left of median line. Some effusion within the peritoneal 
sac. The bowels being flatulent and thereby increasing the permanent 
embarrassment to respiration, aromatics were administered with good 
effect, and, subsequently, small doses of podophyllin every four hours 
until the bowels were freely acted upon and the oedema of leg had disap- 
peared. He was now enabled to move slowly about the ward. 
July 10. At a point between the eighth and ninth ribs, and to the 
right of the median line eight inches, he had for several days experienced 
pain, but there was no redness present, but as fluctuation was discovered 
hepatic abscess was diagnosticated. 
22c?. Dr. Loomis, the visiting physician, by using an exploring needle 
at that point discovered pus, whereupon he made a small incision with a 
scalpel, and the pus gushed forth in a steady stream until five and a half 
quarts were collected. The patient bore the operation well, and expressed 
himself as greatly relieved. The breathing became easy; pulse feeble, 
112. A binder was placed around the body and a siphon of tow put in 
the opening. He was given eggnog and beef-tea during the evening. 
23d. Appetite enormous. He was ordered, in addition to the regular 
diet, two pounds beef steak, two pounds mutton chops, nine eggs, two 
quarts milk, and twelve ounces of whiskey, all of which he consumed and 
called for more. In two or three days he was able to sit up on the side 
of the bed. 
21th. Commenced sweating profusely; took very little nourishment; 
two grains of quinia with a few drops of aromatic sulphuric acid were 
given every three hours. 
On the 29th the sweating had stopped, and his appetite was regained; 
he put on his clothes, walked to the portico, and there sat for two hours 
smoking his pipe. From the time of the operation the abscess was 
syringed out every day by means of a stomach-pump. 
About the 15th of August maggots appeared in the matter washed out, 
but these were destroyed by creasote in a short time. He continued to 
improve until October 28, when I left the hospital. He had gained more 
than forty pounds, and was feeling so well that he was making prepara- 
tions to leave for home in a few days. At that time the abscess was dis- 
charging about two ounces of healthy pus daily. Dr. A. Flint, in his 
recent work on practice, has referred to this case. (p. 465.) 
March 24. Idiopathic Endocarditis.—Dr. Roberts reported the fol- 
lowing case :— 
A. H., twenty-one years of age, a soldier, had been under my observa- 
tion about three weeks, with a gunshot flesh wound of the calf of the leg, 
which had nearly healed, when he was attacked with a chill, followed by 
high febrile excitement. I saw the patient during the fever, but passed 8 
Proceedings of the 
him by, prescribing a simple diaphoretic, supposing it to be a case of 
ordinary intermittent fever, then quite prevalent in this locality. I found 
the next morning the fever, instead of having subsided, had increased ; 
the pulse was 120, full, hard, and regular; the face flushed ; tongue dry 
and coated ; and the man complained of a dull, burning pain in the region 
of the heart. I auscultated the organs situated in the chest, but could 
find no trouble there beyond the excessive action of the heart. I directed 
my measures to reducing the inflammatory excitement, and gave to that 
end hyd. chlor. mit. and pulv. jalap grains v each, adding antim. et potass 
tart. gr. i to each dose of the diaphoretic mixture. Upon making my 
evening visit the general condition of the patient was unchanged ; he 
had a copious evacuation of the bowels. The next morning I found a 
great change had taken place during the night; the face was no longer 
flushed, but pale, and covered with a cold perspiration ; pulse 140, and 
very irregular; breathing quick and laboured. Upon auscultation I dis- 
covered murmurs at the apex, over the body, and at the base of the heart, 
and coexistent with the first sound ; the murmur was also transmitted up 
the carotids; the heart was not enlarged, the apex could be distinctly 
seen beating in its normal position. I now considered that I had a well- 
marked case of acute endocarditis to deal with, not having been preceded 
as is almost invariably the rule, by acute rheumatism. The patient said 
he had never had rheumatism, and there certainly was no evidence of the 
joints being affected at this time. I ordered tr. verat. viride, gtt. iij every 
hour; this was afterwards increased to five every hour, the effects being 
closely watched; the old fashioned prescription of hyd. chlor. mit., opii 
and ipecac was also given. When the patient had been under this treat- 
ment ten or twelve hours, his condition was much improved ; the heart’s 
action was less violent; the breathing much easier ; the pulse had dimin- 
ished twenty beats per minute; the patient altogether more quiet and 
comfortable. This treatment was persisted in four days, the doses being 
increased or diminished as the symptoms seemed to require, the patient 
gradually improving, with every prospect of recovery ; the heart mur- 
murs, however, increased in intensity, and remained very loud after con- 
valescence. On the twentieth day of the disease the patient was enabled 
to leave his bed. From this time he took slight exercise each day, and 
was discharged the service some two months subsequently with hyper- 
trophy and valvular disease of the heart. No enlargement was observed 
until several days after the discovery of the valvular trouble. The mur- 
murs were unusually loud, being heard over the whole of the chest with 
the first sound of the heart, evidently the combined aortic direct and 
mitral regurgitant. 
March 31. Amputation of the Thigh followed hy the Formation of a 
Large Sequestrum.—Dr. J. Ford Thompson reported the following case :— 
Albert Paris, aged 24 years, admitted into Providence Hospital, Dec. 
22, 1865, with wound of right knee-joint from a pistol-ball injury received 
on the night of December 14. Ball entered at the external aspect of joint, 
between the patella and external condyle of the femur, opened the joint 
and lodged. Upon probing the wound a small piece of the condyle was 
found chipped off, but the ball could not be found (this examination being 
made on the eighth day after the receipt of the injury ; previous to his 
entrance into the hospital he had been treated with purgatives and cold 
lotions locally applied). Limb very much swollen both above and below Clinico-Pathological Society or Washington. 
9 
the joint; the joint itself being distended with synovia and pus, a little 
of the latter was oozing from the wound. Patient with high inflammatory 
fever; restless and sleepless, with a quick pulse. Was of a good consti- 
tution, having up to this time enjoyed excellent health. After a consul- 
tation with Drs. Lincoln and Ford, and with the consent of the patient, 
it was decided to amputate the limb, but first a long incision was made 
into the joint partly for the purpose of ascertaining the point at which 
the ball had lodged and to see the condition of the joint; a large quantity 
of synovia mixed with pus escaped, which had been pent up on account 
of the small valvular opening made by the ball not being sufficiently free 
to admit of its exit. Synovial membrane intensely inflamed and softened, 
but there was no injury to the bone except the pieces chipped off from 
the external condyle as already noticed ; the ball, however, was not found. 
Amputation was then performed by the conical circular operation at 
the junction of the lower and middle third of the thigh ; chloroform was 
administered and four ligatures applied. Hemorrhage slight and patient 
rallied in a short time from the effects of the chloroform and operation, 
feeling quite comfortable. Wound closed transversely by wire sutures 
and supported by a bandage. 
On third day stump was dressed, union having taken place over a con- 
siderable portion ; at that time, and during the interval since the operation, 
the patient’s condition was good with the exception of a very quick pulse. 
After the sixth day no dressing was used, and on the twelfth day the 
ligatures were taken away, the flaps having united except in the middle 
where a suture had been removed on the third day to allow of the exit of 
pus; in a few days this had filled up, leaving a small sinus from which 
there was a slight discharge. During this time the quick pulse continued 
with an irritative fever. One month after the date of admission, being 
anxious to leave the hospital, and the wound having healed with the ex- 
ception of the small sinus mentioned (which was supposed to be due to 
the presence of a ring of exfoliated bone), he was allowed to return home. 
Several days after the patient left the hospital he sent for Dr. Thomp- 
son, who found him suffering from a very high fever, with the limb swollen, 
hot and shiny in appearance. He diagnosticated the presence of an 
abscess as the result of diseased bone. Ordered fever mixture and ap- 
plied hot fomentations to the stump. On the next day patient’s condition 
very much improved, there having been a large discharge of offensive 
matters from the sinus during the night. On introducing a probe into 
the sinus diseased bone was felt, which, however, was quite firm and not 
entirely detached. 
March 1, 1866. Considering sufficient time had elapsed to allow of the 
detachment of the diseased bone, although it appeared to be quite firm 
to the touch of the probe, an incision was made upon either side of the 
sinus sufficient to uncover the end of the bone, and, on the application of 
necrosis forceps, steady traction was made in the line of axis of the bone, 
and with the exercise of no great force the sequestrum was removed. 
The sequestrum was six inches in length, extending, doubtless, up to the 
base of the trochanters, having the size and shape of the femur; quite firm, 
honeycombed in appearance, and having new bone in considerable quan- 
tity thrown out all around it. A large quantity of fetid pus was discharged 
at the time of the removal of the bone, and some hemorrhage ensued, but, 
on the application of a sponge compress for a couple of hours, the latter 
was checked. On the next day, the fever and swelling of the stump having 10 
Clinico-Patiiological Society of Washington. 
very much subsided, the patient expressed himself as much relieved and 
more comfortable than he had been since the amputation. The cavity 
left by the extraction of the bone has filled up, and the stump is appa- 
rently as firm as ever. 
After the amputation had been performed the knee-joint was carefully 
dissected out, and a small, round pistol-ball found imbedded in the tissue 
of the ligamentum patellae. 
Dr. Thompson, in commenting on the case, referred to the means em- 
ployed by surgeons in order to prevent the exfoliation of bone after ampu- 
tations, and stated that in this case he had been careful to dissect back 
the periosteum sufficiently to entirely cover the cut end of the bone, but 
he thought that at the time of the operation the periosteum with its sur- 
rounding tissues was already inflamed.