Jordan, John F.a machine readable transcriptionSusan C. LawrenceKenneth M. PriceKenneth J. Winkle2011med.d1e19872Civil War WashingtonUniversity of Nebraska–LincolnCenter for Digital Research in the
Humanities319 Love LibraryUniversity of Nebraska–LincolnLincoln, NE 68588-4100cdrh@unlnotes.unl.edu2011
The following are responsible for particular readings or for changes to
this file, as noted:
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 21870543-544Medical and Surgical History of the War of the Rebellionwounds and injuries of the chestoperations on the chestligationstraumatic aneurismaneurysmcircumscribed aneurismaneurysm from gunshot injurycircumscribed traumatic aneurismaneurysm of the axillary arteryold tuberculosiswounds of axillary artery and brachial plexus of nervesarm paralyzed, loss of sensibilty and mobilitygeneral anesthesia, etherligation of subclavian artery external to scalenusligations of the subclavianautopsy performedblessedadded figure encodingadditional proofing of transcription and encodingcase text extracted and transformed from larger
fileenriched encodingvalidated fileencodedinitial checking of OCR text against PDF; encoded
The complete report is given in the author's own language:²
CASE 20.— "Captain John F. Jordan, Co. B,
13th Virginia Cavalry, aged 31 years, and of sound constitution, was admitted to
Stanton United States Army General Hospital, June 23d, 1863. He had been wounded on June 21st, in action near Middleburgh, Virginia, by a shot from a carbine. The bullet, which, by the way,
was conical in shape, penetrated the pectoralis major muscle of the left side, at a point on
a level with the axillary artery, and about one and a half inches from the margin of the
armpit, passed directly backward beneath the shoulder, wounding the axillary artery,
together with the brachial plexus of nerves, and escaped behind. Patient said he lost a
great deal of blood immediately after the wound was inflicted, so much indeed that he
fainted, when the hæmorrhage ceased of itself, and did not return. On admission to
hospital, his left arm exhibited some swelling, œdematous in character, and its inner
side was ecchymosed nearly down to the elbow-joint. It was also paralyzed, the loss of both
sensibilty and mobility being complete. There was no radial pulse in that arm, and pulsation
could not be detected in the brachial or any other artery thereof. From this we inferred
that the axillary artery had been severed by the bullet. The temperature of the limb was not
below the normal standard; on the contrary, we thought it to be somewhat warmer than the
limb of the opposite side. There was nothing remarkable in the appearance of the wound. The
patient's general condition was good. He did not look as if he had suffered from
hæmorrhage. His bowels were constipated; ordered a saline purge, together with a spare
diet, and, with a view to lessen the tendency to secondary hæmorrhage, he was directed
to remain quiet in bed, to exert himself as little as possible, and to have ice applied
constantly over the injured artery. He was also directed to take morphine at night if
necessary to procure rest. Under this treatment the patient progressed without an
unfavorable symptom; the wound cleaned itself and closed up in a satisfactory manner, and we
congratulated the patient in that he was likely to get well without suffering the terrible
secondary hæmorrhage, which frequently attends gunshot wounds of the axillary artery.
The limb continued to be completely paralyzed as to motion, but sensation had gradually been
restored to the fingers, hand, and forearm. On the morning of the 12th of July, we noticed
the appearance of a small, rounded, circumscribed swelling of the size of an egg, at the
seat of injury to the artery. The scar of the anterior orifice of the gunshot wound was
exactly on the summit of the convexity of the swelling, as the patient lay in bed. The tumor
was tense in feel, and pulsated distinctly and synchronously with the heart. There was,
however, an entire absence of the aneurismalaneurysmal thrill and aneurismalaneurysmal bruit. By compressing the subclavian artery against the first rib, the tumor
became soft, much less in size, and ceased to pulsate. On withdrawing compression the tumor
speedily filled up, became tense, and pulsated again. Patient stated that during the
preceding night he felt something "give way" in his left armpit, while attempting to change
the position of this arm by the aid of the right hand. During the day the aneurismaneurysm increased rapidly in size, and in the evening was fully twice as large as when
first noticed in the morning. July 13th, the aneurismaneurysm continued to increase steadily in size, and in the evening was about half as large
as the clenched fist. July 14th, the aneurismaneurysm had grown but little since previous day; it was still rounded, distinctly
circumscribed, and somewhat oval in shape. By compressing the subclavian, it ceased to
pulsate, became soft and much shrunken, but the prior condition of things was restored
speedily on withdrawing compression; as on a previous occasion, there was still no thrill or
bruit. Diagnosis: Circumscribed traumatic aneurismaneurysm of the axillary artery. From the entire absence of pulsation in all the
arteries beyond the aneurismaneurysm, which existed even at the time of admission to hospital, and the complete want of
thrill and bruit in the aneurismaneurysm itself, we believed that the aneurismaneurysm had been developed from the proximal end of the severed artery, and that opinion
was strengthened by the fact that the swelling had not expanded outward and downward into
the armpit, where there was but little in the anatomical structure of the parts to obstruct
its growth, any more rapidly than it had done in another direction, where it was covered
over and bound down by the pectoral muscles. The swelling had expanded so equally in all
directions, that the scar of the anterior wound still remained exactly over the centre of
the tumor, as when we first saw it. The aneurismaneurysm was so distinctly circumscribed that, although its origin was traumatic, it was
deemed advisable to attempt a cure of it by the Hunterian method. As there was not
sufficient space to secure the artery below the clavicle without opening the sac, I
proceeded to tie the left subclavian artery external to the scalenus, on the afternoon of
that day (July 14th). The patient being
under sulphuric ether, that operation was performed without difficulty by the ordinary
method. On tightening the ligature the tumor ceased to pulsate, shrunk a good deal, and
became soft. The left arm was directed to be wrapped in cotton wool, and to be kept warm by
the further aid of bottles of warm water, to be renewed from time to time as occasion might
require. A full dose of morphia was prescribed. He was enjoined to preserve the recumbent
posture, and to avoid exertion of every kind. A milk diet was allowed. July 10th, patient
had a comfortable night; temperature of arm not diminished: discontinued the warm water.
July 16th, patient doing well in every respect; arm warm; color thereof good; discontinued
the cotton wool. July 17th, bowels being confined, he took an ounce of sulphate of magnesia.
July 19th, aneurismalaneurysmal sac opened spontaneously last night through the anterior sear of the gunshot
wound, and discharged two or three ounces of very dark-colored blood, mixed with pus.
Suppuration of the sac had been threatened ever since the day after the operation. He was
allowed a full diet. July 20th, a moderate discharge of old blood and pus, accompanied with
a gradual diminution in the size of the aneurismaneurysm, and but a moderate degree of inflammation of the sac continued on this and
several days following, the patient s general condition being unexceptionable all the while.
July 27th, the aneurismalaneurysmal swelling had entirely disappeared; suppuration of the sac, moderate in quantity,
still continued, the pus being of a good quality. August 1st, the ligature separated and was removed to-day,
without the occurrence of hæmorrhage or any other difficulty; discharge from sac
good in quality and steadily diminishing in quantity; discovered some excoriation at the
inner side of the left elbow, occasioned probably by pressure, the patient having followed
very closely the injunction to keep as still as possible in the recumbent posture; directed
a stimulating plaster to be applied, and the pressure to be removed to other situations by
arranging pillows. August 5th, discharge from sac had subsided to a small quantity of
healthy pus, and the orifice was manifestly contracting. We hoped that adhesion of the sac
was taking place. Patient's condition seemed to be favorable in every respect, except that
he had been losing flesh rapidly for several days without obvious cause. For want of any
other reason, we attributed it to the extreme heat of the weather, the temperature both day
and night having been unprecedented ever since July 25th, the mercury at midday ranging from
90° to 100° in the shade, and seldom falling below 80° at night. August 6th:
a profuse flow of blood from the sac came on this morning without warning; the loss of blood
being so rapid as to threaten speedy death. The officer of the day was close at hand, and
stopped the bleeding by injecting about one ounce of liquor ferri persulphatis into the
bottom of the sac, through a female catheter, introduced for the purpose. The
hæmorrhage ceased immediately. We had been emboldened to use the persulphate of iron
freely in this way, because we had a few weeks before (June 22d) stopped a troublesome
secondary flow, in alarming quantity, of arterial blood from the cavity of a large abscess,
associated with gunshot fracture of the right thigh, by injecting about two drachms of
liquor ferri persulphatis through a catheter, carried into the neighborhood of the supposed
source of the hæmorrhage, a branch of the profunda artery, and no unpleasant effect of
any kind followed it. Again, about the same time, we had been troubled to manage a case of
general oozing of blood from the cut surface of a thigh, amputated secondarily for gunshot
injury. After trying exposure to the air, ice-water, and even ice, without effect, we
stopped this bleeding immediately by covering the end of the stump with pledgets of lint
soaked in liquor ferri persulphatis. Aside from pretty severe pain, which soon subsided, no
unpleasant consequence of any kind followed. We did not discover any evidence of even the
feeblest action as an escharotic, and indeed have since thought that the case progressed
better than other amputations of the same class. In consequence of the secondary
hæmorrhage and the efforts to repress it, the aneurismalaneurysmal sac became filled up again to the original size. August 10th, another severe
hæmorrhage occurred from the same orifice; it was readily stopped by again injecting
persulphate of iron in solution. August 11th: profuse hæmorrhage occurred to-day
through the opening of the posterior orifice made by the bullet, after it had been healed
for more than a month. This bleeding was also suppressed immediately by injecting liquor
ferri persulphatis through a catheter. After this there was no more hæmorrhage. During
the next few days he seemed to rally from the depression produced by these repeated losses
of blood. He was ordered to have wine, and anything in the line of supporting treatment that
he would take. August 18th: the aneurismalaneurysmal sac has again suppurated, and there is a profuse discharge of dark-colored and
very offensive pus. August 25th: patient failing rapidly; suppuration very profuse and
extremely offensive in character. August 29th,
he died worn out with the suppuration and the hæmorrhages, forty-six days after the
operation, and twenty-eight days after the ligature came away. Autopsy eighteen hours after
death: Emaciation extreme; rigor mortis moderate; a large elongated cavity, with ragged
dark-colored walls, occupies the original seat of the aneurismaneurysm, and extends beyond it outward into the axilla; the axillary artery is found to
have been severed obliquely by the bullet about one and one-half inches above its
termination in the brachial; the divided extremities are separated widely apart (to the
extent of about three inches); the distal end appeal s to have been pushed away from the
proximal end, either by the original aneurismaneurysm, or the subsequent hæmorrhages and suppuration; the proximal end is oblique
and closed, while the bruised and lacerated portion of it appears about to be cast off by
the ulcerative process, as a distinct line of demarcation has been formed; the distal end is
oblique and unclosed, but the calibre of the artery is contracted down to about a line in
diameter, and it is blocked up by a coagulum three-eighths of an inch long; the branches of
the axillary given off above the point of injury, especially the superior thoracic and the
acromial thoracic, are much enlarged; the axillary vein is greatly diminished in size about
the track of the bullet, but it is still pervious; the brachial plexus of nerves was also
wounded by the bullet, all the trunks being cut off except that of the musculo-spiralradial and circumflex nerves. The proximal extremities of the divided trunks were
somewhat bulbous. At the seat of the operation the wound, which at one time was nearly
closed, is now open quite down to the artery at the point of ligation, the new granulations
having been reabsorbed to that extent, but the artery for a distance on each side thereof is
surrounded by a dense mass of new connective tissue, so thick and dense as to make it a
little difficult to get at and remove the specimen without injury. On the proximal side of
the ligature the vessel is blocked up to a distance of about five-eighths of an inch; on the
other side of the ligature it is blocked up to the extent of about two-eighths of an inch.
In the cavity of the thorax we find old pleuritic adhesions on both sides, and old
tuberculous cicatrices at the apex of each lung; but both lungs are now entirely free from
tuberculous deposits; abdomen not opened." The specimen, represented in the above
wood-cut (FIG. 249), and also specimen 3243, showing the brachial
plexus, were contributed by the operator.
²LIDELL, On the Wounds of Blood-vessels,
Traumatic Hæmorrhage, Traumatic Aneurism, and Traumatic Gangrene. In Surgical
Memoirs of the War of the Rebellion, Vol. I, p. 101, New York, 1870.