H——, P.a machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d1e16656Civil War WashingtonUniversity of Nebraska–LincolnCenter for Digital Research in the Humanities319 Love LibraryUniversity of Nebraska–LincolnLincoln, NE 68588-4100cdrh@unlnotes.unl.edu2011
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Kenneth M. PriceAJ HowellMatthew BosleyElizabeth LorangStacey BerryElisabeth TraceyThe Medical and Surgical History of the War of the Rebellion.
(1861–65.)Surgeon General Joseph K. Barnes, United States ArmyWashington, D.C.Government Printing OfficePart 1Volume 21870263Medical and Surgical History of the War of the Rebellionon special wounds and injuries of the headwounds and injuries of the headgunshot woundsgunshot fractures of the cranial bonestrephining after gunshot fractures of the skulltrephining practiced, fatal terminationconoidal ball fractured and depressed posterior portion of left parietal boneconvulsionsdeglutition lost, tongue turned to left sidefragment of bone perforated dura mater, removal followed by discharge of
disorganized brain substanceloss of speechparalysis of right sidegeneral anesthesia, etherpus between dura mater and brainred softening and disorganization of brain under seat of injurysero-sanguinolentserosanguinous effusion at base of braindura mater showed marks of inflammatory action, brown color in neighborhood of
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CASE.—Private P.
H——, Co. E, 9th Pennsylvania Reserves,
aged 28 years, was wounded at the battle of Fredericksburg,
Virginia, December 13th, 1862, by a
conoidal ball, which fractured and depressed the posterior portion of the left parietal
bone. He was unconscious for some time after the reception of the injury. On December 15th, he was admitted into the Stanton Hospital, Washington. D. C. A wound of scalp was
discovered through which could be felt a portion of depressed bone; through another wound,
two inches anteriorly, the patient stated that a portion of the ball had been extracted. No
symptoms of brain lesion were manifest, the patient being perfectly conscious and answering
all questions correctly and intelligently. Ice was applied to the head, but, toward evening,
convulsions ensued followed by others at intervals during the night. The next morning a
semi-comatose condition supervened, continuing until the 17th, when it deepened. The power
of deglutition was lost, and the tongue turned to the left side of the month. On the 18th, the condition being unimproved, an
operation was decided upon. Accordingly the patient was etherized, and Surgeon John A. Lidell, U. S.
V., applied the trephine to the anterior edge of the opening in the cranium and
removed a disc of bone. The depressed portion, about an inch long and three-fourths of an
inch wide, and six fragments of bone were easily detached. One of the latter had evidently
perforated the dura mater, its removal being followed by a discharge of disorganized brain
substance. After the operation, the coma lightened somewhat and power of deglutition and
consciousness were restored; the loss of speech, however, continued. The improvement was of
short duration, for on the next day coma and paralysis of the right side again supervened,
with effused blood, which was very dark, amounted, in all, to three ounces, and came from
the longitudinal sinus. These symptoms increased in gravity continuously, the patient
becoming more and more exhausted until the 23d,
when he died. At the post-mortem examination, a thick brown-colored
pus, to the amount of an ounce and a halt, escaped from between the dura mater and the
brain. Under the seat of injury was found red softening and disorganization of the brain
extending to the depth of an inch and a half. There was also considerable effusion of clear
serum in the ventricles, and a sero-sanguinolentserosanguinous effusion at the base of the brain. The cerebrum generally, including both right
and left hemispheres, was congested, the punctiform spots being unusually distinct. The dura
mater, covering the convexity of the left hemisphere, showed marks of recent inflammatory
action, being injected, reddened, roughened, and of a brown color in the neighborhood of the
fracture. It was also lined by a thick layer of false membrane. The specimen is figured in
the wood-cut. The fractured portion of the inner table of the cranium measures three-fourths
by one inch, and is partly included in the disk removed by the trephine. The outer table is
injured to a less extent. The specimen and history were contributed by Surgeon J. A. Lidell, U. S.
V.