CZJCLVI C&XLVIZ ^ ■^ REPORT |futcvcsititt0 JtovgicaJ <&\)tn\t'\QM, PERFORMED AT THE U. S. A. GENERAL HOSPITAL, BEVEELY, NEW JEESEY. C. WAGNER, ASS'T SUEGEON U. S. A. COMMANDING HOSPITAL. OJ?jo .~\fip: /11 A c&y&zx. REPORT OP INTERESTING SURGICAL OPERATIONS PERFORMED AT THE TJ. S. GENERAL HOSPITAL, BEVERLY, NEW JERSEY. During the past five or six months many interesting capital operations have been performed at the hospital under my charge, by my assistants and myself. ' August and September brought us a large number of cases of frightful wounds received at the battle of Deep Bottom, Va., and in the numerous engagements before Petersburg, the worst cases 1 have ever seen off the field of battle. Hospital gan- grene and sloughing wounds prevailed among them; both, however, were successfully dealt with by being promptly re- moved to the tent wards, and adopting the plan of treatment described by Dr. Packard in his article on Hospital Gangrene, which appeared in the January number, 1865, of the Am. Jour. Med. Sciences, viz: thorough removal of the slough by the scissors or knife, sugar dressing, bromine or permanganate of potash, although the two last named agents I do not think essential for the success of the treatment. The mortality consequent upon the operations recorded in the accompanying table may appear at first glance unusually large, but if we take into consideration the fact that the suf- ferers were brought hither on transports, having previously undergone the severities incident upon along and tedious cam- paign, that after receiving their wounds, many of them neces- sarily failed to obtain either proper food or care upon the field of battle, the result will then compare favorably with similar operations performed under more fortunate circumstances. REPORT OF SURGICAL OPERATIONS AT THE U. S. A. GENERAL HOSPITAL, BEVERLY, N. J. EXCISIONS. NAME. AGE. CAUSE AND DURATION. J. z. hi J Ha x n. p. p. B. o. B. P. '/' lftvuJ,d*vv /An \{ itrrij 33 18 53 21 W. 11. C. 23 G S. W. right thigh, fracturing head and neck of femur. One month. G. S W. right shoul- der, fracturing head of humerus. Nine- teen davs. G. S. W. left forearm. fracturing ulna. One month. CONDITION AT THE OPERATION. Soft parts in a sloughing condition. Pulse 115 and weak. Appetite wanting. Joint painful. discharging thy pus. Sinuses un heal- Soft parts sloughing. portions of ulna ex- posed and necrosed. G. S. W. left elbow Joint swollen and pain- joint, fracturing ful. Sinuses discharg- bones thereof. Six- ing unhealthy pus. teen days. G. S. W. injuring upper [Soft parts sloughing, part of ulna Two upper part of ulna ex- months, posed and necrosed. OPERATION. Excision of head, neck, Sept. 27, and a portion of tro- 1864. chanter major. Excision of head and 1£ inches shaft of hume- rus. Excision 4 inches shaft of ulna. Oct'r 18, 1864. Sept. 12, 1864. Excision of inner con- Aug. 31, dyle of humerus and 1864. olecranon of ulna. Excision of olecranon and 2\ inches shaft of ulna. Dec'r 11, 18G4. PROGRESS (REMARKS) RESULT. Died Sept. 28, 1864. (See appendix.) Progress favorable, pa- tient recovered with a very useful arm. (See appendix ) OPERATOR. G. Wagner, Ass't Surg. U. S. A. Patient recovered in two months with use- ful arm. C. Wagner, Ass't Surg. U. S. A. C. Wagner, Ass't Surg. U. S. A. Patient discharged the C. Wagner, service in three Ass't Surg. months with useful! U. S. A. arm. Recovered Feb. 22, with every prospect of hav- ing a useful arm. (See appendix.) C. Wagnar, Ass't Surg. U. S. A. REPORT OF SURGICAL OPERATIONS AT THE U. S. A. GENERAL HOSPITAL, BEVERLY, N. J. -A.]VCFXJT-A.TI02SrS. L. T. R. cC J fttJr jl+< .]. s. JU- F. F. 'k-u-. - rr~\ ' Eight clays. PROGRESS (REMARKS) RESULT. OPERATOR. if- J. c. f CU'^u/O G. W. H. Jr-ftv • i Ma^I J. S. 1£L A. J. S. '4 P. H. '26 G. S. W left thigh, I So ft parts sloughing, se- flesh. 22 days. condary hemorrhage, 6 oz. blood lost. 21 G. S W. right side of face, fracturing supe- rior maxillary bone. Thirteen days. Secondary hemorrhage 8 oz blood lost. Oct'r 7, Died Oct. 12, from re- G. A. Chesley, 1864. curring hemorrhage from point of ligation A. A. S. Ligature of femo- Sept'r 10, Recovered Oct. 14,1864 J. H. Packard, ral artery in! 1864. A. A. S. Scarpa's space. Ligature of com- mon carotid ar- tery. I 47 G. S W. upper third of Soft parts sloughing, se- right thigh—flesh condary hemorrhage, Three months. j 6 oz. blood lost. 26 G. S. W. left thigh, in- Secondary hemorrhage, juring femur. Ten weeks. 4 oz. blood lost. 24 G S. W. right leg in-Soft parts sloughing, se- I juring upper part of condary hemorrhage, tibia. Four months. I 2 oz. blood lost. Oct'r 13, 1864. Ligature of exter- Nov'r 10, nal iliac artery. 1864. Ligature of pro- Nov'r 1, funda femoris. 1864. Ligature of femo- ral a rte ry in Scarpa's space. Dec'r 17, 1864. Died Oct. 22, from re curring hemorrhage from point of ligation Died Nov. 17, from re- curring hemorrhage from point of ligation Died Nov. 6, from re- curring hemorrhage. Recovered Jan. 4, 1865. J. H. Packard, f A. A. S. ^ J. C. Morton, A. A. S. J .C. Morton, A. A. S. J. C. Morton, A. A. S. APPENDIX. SUMMARY. AMPUTATIONS—JOINT CASES. Recovered. Died. Remarks. Shoulder, .... 1 2 Hip,......1 l Knee,.....0 3 Ankle (Syme's) . . 2 0 In one of the ankle joint cases a second amputation at the lower third of leg be- came necessary. AMPUTATIONS IN CONTINUITY. Recovered. Died. Arm, ... 6 0 Fore-arm, . . 2 2 Thigh, ... 4 9 Leg, ... 3 3 LIGATION OP ARTERIES. 8 recoveries, 13 deaths. 21 total. RESECTIONS. Only five cases are recorded. The case of resection of the olecranon and 1\ inches of the shaft of the ulna is still under treatment, and will recover with an useful arm. The other cases, viz: resection of the head of the humerus, elbow joint, and shaft of the ulna, recovered with very serviceable arms. CASE OP RESECTION OF HEAD OF FEMUR. Pvt. John Zabrouski, Co. K, 7th Conn. Vols., was wounded at the battle of Deep Rottom, Va., by a minnie ball, which fractured the head and neck of the femur. He was admitted 15 into hospital on the 22d of August. On the 27th of September a resection of the head of the femur was decided upon. He had greatly lost in flesh and strength since his admission, and seemed to be rapidly failing from the exhaustive suppurative discharge from the wound; extensive sloughing of the soft parts had supervened, and, upon the whole, the case was un- favorable and unpromising for so important an operation. Chloroform was administered, the patient placed upon his sound side, an incision four-and-a-half inches in length, extend- ing from about two-thirds of an inch below the anterior supe- rior spinous process of the ilium, towards the tuberosity of the ischium, crossing a transverse incision which had previously been made over the trochanter major to permit of a free exit of pus. The thigh was flexed and rotated inwards, the tendons of the muscles divided, and the chain saw passed under and between the head of the femur and the trochanter major, and the bone sawn through the neck, the soft parts being protected by spatulas; one inch of the trochanter major was removed by a small saw; no blood was lost. The patient survived the operation only thirty hours, dying from exhaustion. A post- mortem examination revealed nothing worthy of note except slight necrosis of the acetabulum. The following case of successful amputation at the hip joint is deserving of special mention. The sufferer has been ope- rated upon six times, and still lives. To the surgical skill, and the kind and unremitting attention on the part of Dr. J. C. Morton, Executive Officer of the Hospital, the successful result is mainly due: >> Eben E. Smith, private, Co. A, 11th Maine, single, aged 19, was admitted into U. S. A. General Hospital, Beverly, N. J., ^August 22, 1864, suffering from gun shot wound of right leg, X received August 16, 1864, in the battle of Deep Bottom, Va. \)V S vThe ball passed from before backward, fracturing head of ' ^ ' ' ^"tibia. When admitted he suffered but little pain, although the \f *■ v Joint was considerably swollen. ;rc. V Sept. 12, 1864, secondary hemorrhage occurred. A careful V) < V rv examination was made, and it was deemed advisable to ampu- \ ^ tate, which operation was performed by the circular method, VNCNf^at the lower third of the thigh. Chloroform was administered, *■> the patient reacted promptly. The patient did well until 2/3 y 'V, ' r-.N. cn 16 October 17, 1864, when secondary hemorrhage occurred from the stump, at which time the femoral artery was ligatured in Scarpa's space, the ligature separated October 27. November 5, end of femur protruding, about four inches of which was removed by the chain saw. Shortly after, the stump became swollen and abscesses began frequently to form. This state of things continued until Jan. 19, when, upon exa- mination, the bone was found to be necrosed up to the tro- chanters. Amputation at the hip joint was deemed advisable, and performed by antero-posterior flaps. January 27, hemorrhage again occurred from the stump, when the external iliac artery was ligatured. Feb. 17, the ligature separated. Feb. 19, profuse hemorrhage occurred from the lower end of the divided artery, and was controlled with great difficulty, owing to the many operations previ- ously performed; pressure was maintained some fourteen days, after which the patient rapidly improved, and has now entirely recovered, (March 31, 1865.) John Williams, private, Co. F, 13th Ohio, married, aged 44, was admitted into U. S. A. General Hospital, Beverly, N. J., October 7, 1864, suffering from gun shot wound of the left thigh, middle third, with partial fracture of femur; wound re- ceived Sept. 30, before Petersburg, Va. His general condition Continued favorable until Feb. 1, when abscesses began to form in i.he upper part of the thigh, which discharged a large amount )trf foetid pus; at the same time the patient was attacked with a severe diarrhoea. V Fob. 17, an examination was made and the femur was found necrosed as high as the trochanters. Amputation at the hip joim was considered the patient's only chance for life, and per- formled by antero-posterior flaps. The femoral artery was caught and vied as soon as divided, and before completing the amputation, by which but very little blood was lost. The patient reacted slowly for about twenty-four hours, when he began to sink, and died twenty-nine hours after the operation. An autopsy revealed nothing worthy of special mention The preceding Report includes nearly all the capital operations that were performed at this Hospital, from the latter part of August, 1864, to March 1st, 1865. A large number of minor operations, such as removal of fingers, toes, Ac. were considered of not sufficient interest to report.