Successful Treatment GSW Without Amputation

[lelliott19]

Although we usually hear about "all the amputations" that were performed during the Civil War, there were also many cases of successful treatment without amputation. Private Philip Sweeney of the 3rd New York Infantry is one such case.

From the Medical and Surgical History of the War of the Rebellion, Volume 3; Part II, page 73-75.

Case 151 - Private Philip Sweeney, Co C, 3rd New York [Infantry] was wounded in the affair at Big Bethel, June 10, 1861, by a conoidal musket ball, which shattered the trochanters of the right femur. He was admitted to Hygeia Hospital, Fort Monroe, on June 13th, and was treated by Surgeon R. B. Bontecou, USV, by moderate extension and dilation of the wound by sponge tents in order to facilitate the extraction of primary sequestrae*, of which many were removed. Suppuration and exfoliation persisted until March 1862. In April, there were two severe attacks of erysipelas, involving the entire limb, which greatly reduced the patient, but he quickly rallied, and in May was able to run a race on crutches with his wounded companions.

He was transferred to Albany in June 1862; but his name does not appear upon the hospital reports until March 1863, when he was admitted to the Ladies' Home, in New York City, where a number of necrosed fragments were removed. On May 25, 1863, he was discharged, being able to walk without a crutch and the limb being but slightly shortened. He soon afterward engaged himself as a laborer at an iron foundry in Troy, NY, where he has since worked without intermission. On July 20, 1866, he was examined by Brevet-Colonel R B Bontecou, who found him in perfect health, the injured limb a trifle shortened, and the knee rather stiff, owing to the destruction of connective tissue....and the formation of adhesions..... By September 1875, Surgeon R B Bontecou certified that "adhesions have rendered the knee immovable and the limb comparatively useless."

*Sequestrum - a piece of dead bone that has become separated from sound bone during the process of necrosis. plural = sequestrae

 

[lelliott19]

I thought it was unusual to hear of a "sponge tent" being used to dilate a gunshot wound during the civil war, but doctors may have understood the mechanics of healing even earlier.

In A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris, 2nd ed, published in 1733, Pierre Dionis describes the purpose of using a "tent":

"The first is to convey the Remedy [medicine], and keep it applied to the deepest part of the Wounds; The second, to absorb the corrupting Sanies [serum, blood and/or pus discharged by the wound], which easily filter through the Pores of the Tents, by which the Air is also rarified by the heat of the Part: The third is to keep the Wound open, and prevent the Lips re-uniting before the bottom is fill'd [with regrown of healthy flesh]; and the fourth is that of drawing forth the Matter which ought to come out, whence they are always plac'd at the lowest part of the Wound."​

Dionis further explains that, specifically, a sponge tent swells with the Humidity [discharge] of the Ulcer and dilates the wound.

So the sponge, inserted into the tract, absorbed the discharge of the wound and swelled, keeping the wound tract open so that healing could occur below. And, in the case of Private Sweeney, so that, as the sequestrae (spicules of dead bone) were sloughed off, Dr Bontecou could easily remove them.