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II. Military Surgery 3nd Operations following the Battle of Rivas, Nica- 
ragua, April, 1856. By I. Moses, M.D., late Surgeon-General of the 
Nicaraguan Army. 
THE 
AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES 
FOR JANUARY 1 8 57. 26 
Moses, Military Surgery in Nicaragua. 
[Jan. 
Art. II.—Military Surgery and Operations following the Battle of Rivas, 
Nicaragua, April, 1856. By I. Moses, M. D., late Surgeon-General of the 
Nicaraguan Army. 
An interesting addition to the records of military surgery has been but 
recently made on our own continent, and in a country to which the eyes of 
all nations, and especially of Americans, have been turned with eager interest. 
The States of Central America, occupying the isthmus between Mexico 
and the republics of South America, have within the last few years, since the 
establishment of our immense national interests on the Pacific, attracted the 
attention of the world. Through them has rushed a tide of population, from 
the east towards the west, unequalled in the annals of history; which has 
founded, in the short period of eight years, a State with cities rivalling, in 
beauty, wealth, and architectural adornment, our oldest Atlantic towns; 
opened a market for the commerce of the world; and sent back 
over this same isthmus, in return, not less than three hundred millions of 
money. Yet, during the same period, this great highway of nations, peopled 
by a degenerate mongrel race, torn by civil wars and sunken in barbarism and 
superstition, has hardly felt the influence which has given an impetus to the 
whole civilized world. 
Little over a year since, a new element was introduced into the army 
of the democratic party of Nicaragua, which rapidly gave it the ascend- 
ency. Invited by the new government to take charge of the medical 
department of the army, now composed of native and American troops, I 
arrived at Granada, Nicaragua, in February last, and was honoured with the 
commission of Surgeon-General. No cases of surgical interest occurred 
until after the battle of Rivas, which was fought on the 11th of April, 
and lasted about fourteen hours. Small arms were only used—muskets, rifles, 
and revolvers on the one side, and Minie muskets on the other. A small 
piece of artillery was taken from the enemy early in the morning, which had 
been discharged but once; but no wound appeared to have been made by 
grape and canister, with which it was loaded. The action on both sides was 
of a desultory character; brisk at first; repelling charges, and sharp shooting 
from loop-holes. After a forced march of about seventy or eighty miles, with 
irregular and sparse rations, an annoying fight, without food for thirty hours, 
it was deemed advisable by the general to retreat, which was safely effected 
at 2 o’clock next morning. The wounded received their primary dressing 
during the engagement, and were made tolerably comfortable in a safe place. 
From the fact of no artillery being used, none of those terrible wounds were 
received requiring operative interference during the day. About sunset the 
wounded, amounting to fifty-five, though many of a trivial nature, were re- 
moved to the church for safety; and, on the retreat, those who could not walk 1857.] 
Moses, Military Surgery in Nicaragua. 
27 
were mounted on mules and horses. Some five or six, who could not pos- 
sibly be removed, were abandoned, and next day bayonetted by the enemy. 
No litters were on hand, in consequence of the rapidity of our movements 
and want of means of transportation, and the roads do not admit of the pass- 
age of light wagons or ambulances. The wounded did well, and were again 
dressed and made comfortable at Irandime, thirty-six hours after the battle. 
They arrived at Granada on the evening of the fourteenth, and were placed 
in hospital. 
In the encounter there were about four hundred and twenty Americans, 
with one hundred and sixty natives, in the Nicaraguan army, opposed to 
nearly three thousand Costa llicans. The official returns reported on our 
side were: killed and missing, sixty-one, of whom many subsequently re- 
ported themselves; wounded, fifty-five, of whom five or six were unable to be 
removed, and forty-six were sufficiently severe to require surgical attendance. 
Of these there were twelve officers, and thirty-four non-commissioned officers, 
privates, and citizen volunteers. 
There were wounds of the head and neck ... 10 
“ “ “ arms and hands . . 12 
“ “ “ chest 7 
“ “ “ thigh and leg ... 17 
Total 4G 
Of which twelve required operative proceedings, viz:— 
Exsection of balls 6 
Amputation of forearm 4 
“ “ arm 1 
Ligation of left subclavian artery .... 1 
Total 12 
As several of the above cases present points interesting to the military 
surgeon, I propose giving a short outline of some of the more important. 
Case I.—Lieut. Potter received a Minie ball about the middle of the left 
arm, fracturing the humerus and coursing towards the shoulder, from which 
I extracted it after our arrival at Granada. Wishing to save the arm, and no 
bad symptoms appearing, it was placed on a pillow for a week. Considerable 
swelling of the entire limb supervened, with general irritability and discharge 
of unhealthy looking pus, and amputation was proposed as giving him the best 
chance. On the morning of the 26th, a fortnight after the receipt of the 
wound, febrile symptoms of an active character set in, and yellow fever de- 
veloped itself, with coma, low muttering delirium, refusal to take medicine or 
nourishment, and black vomit, which terminated the case in a few hours. 
Fevers of a malarial character were prevalent, and yellow fever, in the form 
of a mild epidemic, existed. Unfortunately, the wounded were placed in the 
same hospital with the fever cases; but most perfect ventilation, abundant 
accommodations, and strict police existed. I regretted not having amputated 28 
Moses, Military Surgery in Nicaragua. 
[Jan. 
the arm. The bone was comminuted, the soft parts lacerated and contused, 
but no nerves nor bloodvessels injured. Experience had taught me, and this 
case has confirmed me in my previous opinion, that in gunshot wounds in 
which the bone or bones are fractured and comminuted, as is especially the 
case where the projectile is from the Minie arm, whether rifle or musket, am- 
putation should be resorted to. 
Case II.—Maj. Markham, during a charge, was struck by a ball on the 
inside, and a little above the patella, so as to involve the cavity of the knee- 
joint, and the synovial fluid was oozing out when I saw him, very shortly 
after. He rode on horseback during the retreat, but complained of a sense of 
weight and stiffness more than pain. On arrival at Granada, he was comfort- 
ably placed in private quarters; the most absolute rest and abstemiousness 
were enjoined, and cold dressings applied. He recovered entirely, without 
any particular inflammation of the joint, and with free motion. His happy 
recovery may be attributed to his strict observance of rest, an almost starving 
diet, and his excellent condition for bearing wounds, being a thin, wiry person, 
of placid temper and gay disposition. 
Case III.—Capt. Casey, in the same charge, received a Minie musket-ball 
through the left wrist, shattering the lower portion of the radius and carpal 
bones. His wound was dressed, his arm placed in a sling, and he arrived at 
Granada comfortably, where I amputated at the middle of the forearm. Four 
days after, he was walking about, and the stump healed most kindly. 
Case IY.—Capt. Cook, Quartermaster, wounded in the same charge, the 
ball entering the left shoulder in front, inside of and below the acromial ar- 
ticulation of the clavicle, taking a course downward, backward, and inward, 
and was felt just below the inferior angle of the scapula, whence I extracted 
it the day after our arrival at Granada (14th). He rode, without much in- 
convenience, on horseback from Rivas, and was comfortably quartered in the 
house of a native family, from whom he received every care and attention. 
Of a nervous and irritable temperament, it was impossible to keep him quiet 
during the day or night; he insisted upon sitting up and walking about the 
room, although he was repeatedly warned o£ his extreme danger. He con- 
tinued to do well, however, until the morning of the 21st, when, while sitting 
up in a chair to be dressed, violent hemorrhage took place, and he lost a large 
quantity of blood before it was checked; and, on my arrival, I found him very 
feeble. Believing that the slough in the course of the ball had made an 
opening into the axillary artery just after its passage out of the chest, I in- 
formed the patient that his only hope was ligation of the artery, to which he 
readily assented, and I immediately ligated the subclavian at the middle, or 
very near the first space, it being necessary to apply pressure over the first rib. 
No hemorrhage recurred, but he soon began to sink, became delirious and 
restless, his respiration very slow and laboured, and he died at 4 P. M. of the 
24th, about seventy-nine hours after the operation. 
Twenty-four Lours previously to death, the shoulder and arm became livid 
and oedematous. He was fed with stimulants, but, deglutition being difficult, 
and no prospect of recovery, he was made as comfortable as possible until the 
final issue. 
I regret that circumstances did not permit an examination of the parts. 1857.] 
Moses, Military Surgery in Nicaragua. 
29 
Case V.—Adjutant Britman, 2d Rifles, received a Minie musket ball in 
the left arm, in the upper third, while firing his piece; the ball passing be- 
hind the shoulder, along the ribs, and through the scapula, lodging near the 
inferior angle, from which I removed it after our arrival in Granada. His 
symptoms promised a good recovery for forty-eight hours, when tetanus set 
in, with severe spasm of the muscles of the face and trunk, and he sunk 
twenty-four hours after. He had ridden from Rivas without inconvenience; 
his wounds looked well; no vessels or nerves were involved, and his habits 
and health had always been good. Brandy, assafeetida, and opium in large 
doses were administered, but without effect. 
Case VI.—Lt. Jones received a ball in the left hip, which entered below 
the trochanter, and buried itself deeply in the fleshy part of the nates, where 
it could not be detected by a probe. He was able to move his thigh per- 
fectly, and without pain; he slept well, and was in good condition until the 
23d, when the fever, which was prevalent, set in, assumed a typhoid character, 
and he died on the evening of the 25th with delirium. He was in a separate 
apartment, surrounded with every care and attention, and fell a victim to 
the epidemic, which has carried off many a brave man in this city. 
Case VII.—Capt. Armstrong received a ball on the outside of the right 
leg, which passed through the leg, and lodged beneath the integuments on 
the inside, from which I removed it ten days after the battle. Wound did 
well, and rapidly healed. 
Case VIII.—Sergt. Sarsfield received a wound in the throat, the ball 
entering just above the articulation of the left clavicle with the sternum, 
passing directly backward, wounding the trachea and oesophagus, and lodging 
in the anterior muscles of the spine. He rode on horseback from Rivas to 
Granada, and was perfectly comfortable, and surrounded by the most assi- 
duous attentions from a native family. The wound was of the size of a 
dime, through which liquids flowed when he drank, a part only passing into 
the stomach, mixed with the air as he respired. His voice was a mere whis- 
per. So severe a wound in so important a region called for the most unre- 
mitting watchfulness, which he received. The most absolute repose was 
enjoined, and the most simple articles of diet. The wound progressed well; 
the slough separated, and there was a discharge of healthy pus, the aperture 
becoming large but granulating. Cough was the only annoying symptom. 
May 3. Up to the present date he has continued to do well; his strength 
is much diminished in consequence of his strict diet. Contraction has taken 
place in the oesophagus, and less fluid passes through it. For the last few 
days he has been supported by enemata of beef-soup, sago with wine, and 
baths of aquadiente. His cough has been quite troublesome, for which ano- 
dynes were given. Hemorrhage, which has been most anxiously feared, 
began this morning, darkening the ray of hope which I had of his recovery, 
not a bad symptom having arisen until this morning, the twenty-third day. 
No operative interference could be resorted to, and we could only apply some 
compressed sponge. 
()th. Hemorrhage has continued from time to time through the wound, 
from the nose, and spread beneath the coverings of the neck. Last night he 
became delirious, and died to-day at 5 P. M. 
Case IX.—Finney, citizen volunteer, received a ball in the left shoulder, 
■which lodged beneath the pectoral muscle below the clavicle, from ■which I 
No. LXV.—Jan. 1857. 30 
Moses, Military Surgery in Nicaragua. 
[Jan. 
removed it three weeks after the battle. The ball was of iron, and of very 
large size. He recovered rapidly. 
Case X.—Capt. McArdle, while serving a piece of artillery taken from 
the enemy, was struck by a musket ball in the left forearm, producing con- 
siderable destruction of the tendinous tissues, and comminuting the ulna near 
the joint. Although the wound called for immediate amputation, he was so 
unwilling that the operation was postponed, and no untoward symptom occur- 
red until the thirteenth day, when suddenly violent arterial hemorrhage came 
on, and the arm was immediately amputated about the middle, where the bifur- 
cation of the brachial artery was found. The stump did admirably, and in a 
few days he was up and about. 
Case XI.—McPall, of the Rangers, received a shot, the ball striking the 
inferior maxilla on the right side, fracturing the bone, and passing obliquely 
through the neck, and out posteriorly on the left side about an inch from the 
spines of the vertebrae, without any evidence of serious injury to the internal 
parts. He slept well, eat well, and walked about for ten days, when sud- 
denly, while sitting at the window, profuse hemorrhage came on, and blood 
in large quantities was poured from the mouth and into the lungs, and in five 
minutes he was dead. 
It is difficult to understand how a ball should have taken such a course 
without tearing vessels, nerves, and organs essential to deglutition and respi- 
ration, yet so capriciously do they turn aside and alter their position when 
they have lost momentum, that we may explain in this case the total absence 
of serious injury until within a few minutes of the fatal termination of the case. 
I saw the patient certainly within three minutes of his attack, when pressure 
was made upon the common carotid, the internal being no doubt the source 
of the hemorrhage, hoping to moderate the flow and enable me to ligate the 
vessel; but death was too rapid for surgical art to avail. 
Case XII.—Private Hutchins, while in the act of firing, received a Minie 
ball, which passed through the left wrist and under the right arm, tearing the 
soft parts very much, and making a very ragged wound. Under simple 
dressings both wounds did well, that in the right axilla healing almost com- 
pletely; but on the fourteenth day after the battle the wrist became very 
painful, with general constitutional irritability and febrile symptoms; the 
wound looked foul, and the hand white and pasty. 
On consultation it was determined to amputate, and I took off the forearm 
at the junction of the upper and middle third. Next day he was quiet; had 
rested well; the febrile movement less marked, and expressing himself very 
comfortable, and rejoiced to get rid of the hand. 
May 2. Is now doing very well, and stump healing. 
10th. In consequence of some imprudence, fever again appeared, but not 
of an alarming character, but on the 8th he was reported to me as being 
worse, and on visiting him with the medical officer in whose charge he was, 
I found delirium, subsultus tendinum, and great prostration of the nervous 
energy, and he died delirious the same night. 
On examination of the parts, the flaps were adherent throughout, the hone 
rounded off, and the stump in fine condition. 1857.] 
Moses, Military Surgery in Nicaragua. 
31 
Case XIII.—Private Lott received a glancing shot sideways, which frac- 
Uired the lower jaw of the right side an inch and a half anterior to the angle, 
Wnd tore the soft parts, leaving a large ragged wound. When the wound had 
nearly healed he was attacked with yellow fever, and died with black vomit. 
Case XIY.—Sergt. Pittman was struck by a Minie ball in the upper 
third of the left arm, comminuting the bone, which was followed by effusion, 
which in a few days produced great pain, general constitutional disturbance, 
and a disposition to great nervous prostration. He rode on horseback from 
Rivas, and the day after our arrival, the symptoms not promising more fa- 
vourably, I amputated high up. He passed that night and next day more 
comfortably, and recovered with a good stump. 
Case XV.—Sergt. Dunnigan was struck by a ball sideways, which cut 
away in a very clean manner, half an inch in width, the soft tissues opposite 
the crico-thyroid articulation, but not wounding the larynx. He immediately 
lost his voice, not being able to articulate louder than in a whisper, and had 
some difficulty in respiration. He could not swallow solid food for some 
days, but all the parts healed kindly, and recovery was perfect. 
In connection with the above, I would note a case of gunshot wound of 
the larynx occurring in 1849, showing how much destruction and injury may 
be done to these parts, and recovery follow. While crossing the plains near 
Fort Boise, a corporal of II Co. Rifles was accidentally shot by a fellow 
soldier at not more than forty yards distance with a conical ball, which tore 
away the soft parts extensively, fractured the os hyoides, thyroid, and cricoid 
cartilages, and opening a large hiatus in the laryngeal cavity. The distress- 
ing dyspnoea, and other urgent symptoms, induced me to declare the wound 
mortal, but as we were on march, a canvas tent fly was stretched in a wagon, 
so as to make him as comfortable as possible. The wound was cleansed, spi- 
cula of bone removed, the parts replaced and adapted as well as could be, 
and cold water applied. Being unable to swallow, his mouth was moistened 
with water; a hospital steward placed in the wagon to attend to his wants, 
and we proceeded on our journey. He did not particularly complain during 
the march, except of heat and dust, and to my surprise I found him in good 
spirits and hopeful when we halted for the night. It will be sufficient to say 
that he finally recovered at Oregon City, with an opening in the larynx, and 
entire loss of voice. He made the journey of about four hundred miles in 
a wagon, over a dusty road for the most part; but great care was given to 
the examination and dressing of the wound. Unfavourable symptoms, pre- 
senting two or three times during his recovery, were promptly and successfully 
met. It has been my fortune to have seen several most interesting wounds, 
and injuries about the throat and vocal apparatus, and, except where the 
large bloodvessels were involved, they have all done well. 
Case XVI.—Private Mayer was struck by a small rifle ball in front of the 
ear, which passed through the cartilages, and lodged behind the mastoid pro- 
cess, from which I removed it a few minutes after he was wounded; applied 
a light bandage, and he continued fighting during the day. 32 
Mose3, Military Surgery in Nicaragua. 
[Jan. 
Case XVII.—Captain Bradly received a small wound just beneath the 
angle of the jaw on the left side, and applied to have some foreign body 
removed. On examination, a small piece of metal was found and removed, 
which proved to be a portion of a small bell. It appears that while in the 
church, near the altar, a ball struck one of the ornaments, sending the frag- 
ments in all directions, one of which had buried itself in his neck. 
Of the forty-six cases of which I have notes, there are many of great inte- 
rest to the military surgeon, showing the course of balls; the wonderful 
escape of large vessels and nerves; the extent of the reparative process, and 
how often the severest wounds get well, while the most trifling are the cause 
of sudden death. Yet, I do not propose, at the present time, to relate them. 
The hospital, in which the wounded were placed on our arrival in Granada, 
was a large house, used for governmental purposes, near the Spanish regimd, 
having, inside and outside, along the corridors, sufficient space; it was well 
ventilated, and kept in good police. The beds were such as are used in the 
country, with a hide firmly stretched between the side pieces, rather hard to 
those accustomed to the luxury of mattresses or feather beds, but admirably 
adapted to warm climates. Bedsacks filled with dry soft grass and good bed- 
ding were furnished to the majority, making them very comfortable. It was 
greatly to be regretted that the wounded were obliged to occupy the same 
building with fever cases; but, as soon as circumstances permitted, a separate 
and distinct house was procured as a fever hospital, to which they were re- 
moved ; the first hospital being whitewashed, cleaned, and occupied solely by 
surgical cases. All this, however, could not be effected before there were 
victims. 
Death occurred from secondary hemorrhages in 3 cases. 
“ “ “ tetanus “ 1 case. 
“ “ “ fever “ 4 cases. 
Among the last, Hutchins, whose hand had been amputated, being the only- 
death among those operated on. 
Notwithstanding many depressing circumstances, hot climate and inappro- 
priate hospital diet, no wounds could more rapidly and happily have got well. 
From the earliest dressing, cold water was used universally by the officers 
of the staff who devoted themselves night and day to the care of the wounded, 
who were never left without one ready in case of accidental symptoms. Yet 
here, I regret to say, as in other services, no acknowledgment was ever made 
to those who shared the same dangers in the field with those rewarded by 
military honours, and whose most toilsome duties were continued for weeks 
after, while their companions were resting on their newly acquiffed rank. 
I have ever been opposed to the use of poultices as uncertain and offensive 
applications. To be of use, they should be at least half an inch thick, and 
changed every three hours. This is often wearisome to the patient, requires 
the movement of a limb or part which should be kept quiet, and produces an 
irritability and dread on the part of the patient. It is frequently impossible 1857.] 
Moses, Military Surgery in Nicaragua. 
33 
to prevent the bed from being soiled by the poultice slipping. All this may 
be avoided by water-dressings; if cold be most grateful, by a folded linen 
cloth dipped in water and laid loosely over the part, or kept moist and cool 
by a drip from a vessel suspended above; if warm be preferred, by covering 
the wet cloth with oil silk, it soon acquires the temperature of the part and 
becomes a light and elegant poultice. Various medicinal agents may be thus 
applied of a sedative or stimulating character. 
This dressing is the more applicable in tropical regions, where it is desirable 
to keep the wounded cool and clean. The months of April and May, in 
Granada, are the warmest of the summer season, being at the end of the dry 
period. The climate of Granada is warm throughout the year; the nights 
pleasant enough for refreshing sleep. 
Observations made with the barometer and thermometer during the month 
of April, showed as follows :— 
7 A. M. 
2 P. M. 
9 P. M. 
Monthly 
mean. 
\ Barometer 
. 29.89 
29.85 
29.90 
>- Attached thermometer 
. 80.9 
91.7 
83. 
) Thermometer in open air . 
, 80.4 
91.1 
82.6 
The air mostly dry; no rain falling; the sky clear; the wind light and 
constant from the east. This wind prevailed during nearly six months of the 
year, and blowing over an extensive swampy region lying to the N. E. of the 
city, is the source of the malarial fevers which prevail during the summer and 
autumnal months. During the rainy season, which is perfectly delightful, the 
prevailing wind is from the W. and S. W.; the rain falling in short and 
heavy showers in the afternoon and night, often accompanied by heavy thun- 
der and vivid lightnings. It is during these months, from June to Novem- 
ber, that Nature adorns the land with her garb of most luxuriant foliage, 
when the fields of corn and sugar-cane wave most gracefully in the breezes, 
laden with rich perfume from the orange and gorgeous flowering productions 
of the land. To enjoy nature in perfection, to realize our sweetest fancies, it 
is necessary to dwell in the tropics, where trees never know the age of the 
“sere and yellow leaf,” and the fields ever retain their brilliant verdure; where 
cloudy skies and chilling winds are never felt; where a glowing sun, bright 
blue sky, and a luxuriant and varied foliage ever smile. Such is the climate 
of Nicaragua, varying in its different parts to suit the cooler fancies and more 
material tastes of business men. The city of Granada, on the border of the 
lake of Nicaragua, is the only unhealthy locality in the State, arising from 
the causes above related, but comparing favourable with most of our Southern 
cities. But it is not my intention, at present, to enter in a detail of the 
climatology and productions of the State. 
Gunshot wounds, so rarely presented to the surgeon in civil practice, afford 
the army surgeon a specialty of great interest, especially when occurring in 
numbers, where he himself is a witness of them, and has them under his special 
notice from the time of infliction to their termination in recovery or death. 34 
Moses, Military Surgery in Nicaragua. 
[Jan. 
The miraculous relations of old writers as to effect of windage, spent balls, 
&c., has been long proved to be fabulous in many of their details, while the 
introduction of new and more destructive weapons offer a newer and more 
interesting field of observation, and a class of injuries rarely or never seen, 
except after a battle. 
The introduction of the Minie musket and rifle has created an almost 
entirely new class of gunshot wounds, remarkable for the distance at which 
they strike; the great destruction of soft parts; the complete comminution 
of the bones struck; the greater tendency to secondary hemorrhage, and 
greater urgency for amputations. Following such wounds is a greater 
amount of constitutional disturbance; higher degree of inflammatory action; 
more profuse purulent discharge, and a much more protracted period of re- 
covery; calling on the surgeon for a more patient and devoted attention to 
his cases and the exercise of a careful and experienced judgment in his pro- 
ceedings. This class hold an intermediate place between the ordinary wounds 
of small arms and those produced by artillery, and a full knowledge of both 
must guide the surgeon in the middle course. 
The weight of opinion among British and French Army Surgeons is in 
favour of immediate or primary operations in all cases requiring surgical 
interference; but regard must be had to the circumstances in each particular 
contingency; to the convenience of place, and, to some extent, the anticipated 
result of the battle during which the wounds are inflicted; but this subject 
has been so ably discussed by those far more experienced and capable than 
myself, I do not offer even a concurring assent. Conservative surgery has 
taught us so much, however, during the last few years as to the power of 
saving whole limbs by the exsection of joints, that we may, under the most 
favourable circumstances, preserve for our patients important members which 
our teachers, not long since, would have condemned to the knife. To the 
records of the late European campaign, and the experience arising from so 
vast and instructive a school, we most respectfully look for our most instructive 
lessons. 
In a subsequent paper, I propose to give a short account of the topography 
and climatology of the State, and the prevailing diseases among strangers and 
the native population, and the influence of tropical climates (jenerally upon 
Europeans. Long since, I had doubts of what is termed “ acclimation;” 
but personal experience, confirmed by that of several highly intelligent me- 
dical men, has taught me that it is rare. Individuals may accommodate 
themselves to the habits of a people, and even enjoy a good degree of health; 
but, both physically and mentally, they degenerate. 
The active and exposed duties of the soldier, however, rapidly tell upon his 
effectiveness. I have seen troops in Texas, where military service has been 
severe, exercise on scouts and guard, under the influence of a tropical heat, 
actually wilt down, and for months remain feeble, pallid, and dejected. Such, 
too, has been the experience of the army surgeons in Florida. To keep 1857.] 
Mott, Case of Exostosis. 
35 
troops for a series of years in such a climate, with the idea that they will 
become inured and insusceptible to its influences, is an egregious fallacy. 
The same remarks apply equally to females and children, inducing, among the 
first, obstinate forms of uterine and vaginal diseases; and, in the latter, con- 
vulsions, diseases of the stomach and bowels, and even paralytic affections. 
But, with these preliminary remarks, which are made rather to suggest 
thought upon the subject among those having opportunity of observation, I 
will close my paper, trusting to a more able pen for further teaching upon so 
interesting a topic. 
New York, September, 1856. 
Art. III.— Case of Exostosis occupying the Orbit and Nasal Cavity, success- 
fully removed, and Vision restored. By Alexander B. Mott, M. D., 
Surgeon to “St. Vincent’s Hospital,” and the “Jews’ Hospital in New 
York,” &c. &c. (With a Plate.) 
Tumours in the orbit, combined with exostosis, have long been familiar to 
every surgeon of experience. Sir Astley Cooper, in his Surgical Essays 
(part i. p. 157), in the earlier part of the century excited considerable 
attention by the narrative of one which proved fatal in consequence of making 
its way through the orbitar process of the os frontis to the brain; and Mi*. 
Guthrie, the celebrated English military surgeon who has lately been removed 
from the world of science, records others which especially attracted his notice. 
One of these, however, was on a very small scale, not exceeding in dimension 
the size of a large marble, a point at which it seems to have remained sta- 
tionary; while a second, of larger growth, effectually resisted the application 
of the actual cautery, which seems to have been the only mode of treatment 
that suggested itself to the practitioner. On the continent of Europe we 
find numerous cases detailed by Brassant, Langenbeck and others in the 
various scientific journals of France and Germany, all of which were accom- 
panied by more or less displacement of the eye. But I am not aware of any 
so extensive as that which fell under my observation in the following instance; 
and though Mr. Guthrie, on finding the cautery fail, afterwards proposed the 
use of the saw and chisel, I believe my operation will be found original. 
The patient, William Hoy, aged thirty-three, a native of Edinburgh, Scot- 
land, and a wood-turner by trade, had about seven years previous to his 
applying to me for advice, noticed an enlargement towards the inner canthus 
of the left eye. His previous health had been good, though he had been 
subject to headache, and his attention was first drawn to the seat of disease 
by inflammation around the part, and a troublesome flow of tears over the 
cheek. About eighteen months after he first noticed the tumour, the left