"Case 616. — Captain Charles Knowlton, 10th Louisiana, of Ewell's Corps, aged 26 years, was wounded at Mine Run, Virginia, November 27, 1863, by a conoidal musket ball, which grooved the outer condyle of the right femur, barely touched the cartilage, opened the synovial sac, was deflected, and lodged near the upper edge of the patella, whence it was removed, on the field, through an incision, after the wounded man had walked half a mile to the rear leaning on the shoulder of one of his men. He was then transported over rough roads in an ambulance to the nearest railway station, and conveyed to Richmond, and entered general hospital No. 4 two days after receiving the injury. His condition on admission was good. There appeared to have been no haemorrhage. The movements of the knee joint were perfect. Moist dressings, absolute rest, and saline aperients were ordered. On December 2d, a serous or synovial discharge from the wound was observed. This became slightly puriform on the following day. Still there was no mark of inflammatory reaction. On December 8th, there was much pain in the joint and the discharge was increased. Warm fomentations were substituted for the cold dressings His pulse rose to 104. On the 9th, the joint was excessively inflamed and the pulse was 128. Surgeon James B. Read, P. A. C. S., in consultation with Surgeons C. B. Gibson and M. Michel, decided that excision of the joint was expedient. The operation was performed by Surgeon Read. An elliptical incision with its concavity upward was made to extend from one condyle to the other, passing below the patella and dividing its ligament. The joint was then laid open, and an inch and a half of the condyles of the femur and an inch of the tibia were sawn off. The patella was also removed. No ligatures were required. The section of the femur was made obliquely downward and backward; the section of the tibia was the reverse of this, so that when the extremities- were approximated the limb was slightly flexed. The synovial sac was reddened and contained a turbid flocculent fluid. The sawn ends of the bones were then wired together. The limb was then placed in a long well padded fracture box. After a few days a long bracketed splint was substituted for the fracture box. He had a liberal stimulating diet of eggs, oysters, and beef tea, with half an ounce of brandy every two hours. The patient was restless and irritable, and on December 16th, and again on the 20th, had venous hemorrhage to the extent of a few ounces, the bleeding being arrested on both occasions by the use of persulphate of iron. There was tumefaction about the joint and burrowing of pus, until Acting Assistant Surgeon Howell L. Thomas suggested a suspension of the limb by Smith's anterior splint. By January 3d, the internal half of the horse-shoe incision had closed. The patient enjoyed an excellent appetite, which was appeased by venison, turkey, partridges, and other hearty food, and a pint of porter daily. By the middle of February there was only a small fistulous orifice remaining of the wound, which discharged a thin, sero-purulent matter. A starch bandage was now applied, with an aperture over the unhealed portion of the wound. All the wires had been removed at this date except one. In March, the patient sat up daily and attempted to walk on crutches. In April, he was discharged from the hospital; his limb was supported by a leathern splint. There was still slight motion between the femur and tibia, but the ligamentous union appeared quite firm. He subsequently went to the West Indies. At Nassau, Dr. Hunt, of New Orleans, removed the starch bandage and found the consolidation was very firm. In a few months Captain Knowlton laid aside his crutches and walked very satisfactorily. He returned to Louisiana in 1866. He was able not only to walk almost as well as ever, but to dance even the round dances. His address as a purser on the steamship "Senator," one of the Pacific mail steamers plying between San Francisco and San Luis Obispo, having been discovered, Surgeon Charles MeCormick, U. S. A., at San Francisco, examined his limb, December 17, 1868, and had prepared the photograph from which FIGURE 1 of the lithographic plate (Plate LXV) opposite p. 388 was taken. There was no evidence of disease about the cicatrix. The muscular development of the limb was good; and the inability to flex it at the knee was the only inconvenience suffered, a result as gratifying as it is unusual. A letter from Surgeon Charles C. Keeney, U. S. A., Medical Director at San Francisco, dated April 20, 1877, mentioned that he had met Captain Knowlton about a year previously and learned that he experienced no disability save that due to the shortness and stiffness of the limb, and walked for miles without fatigue." -- The Medical and Surgical History of the War of the Rebellion. Part III, Volume II. (3rd Surgical volume) by U.S. Army Surgeon General's Office.