Dr. Howard was either remarkably innovative or had read well in the European literature of military medicine, as he suggested a (then) very unique method of treating penetrating injuries of the chest (presumably injuries penetrating the lungs as well). He proposed, after cleaning and debriding the wound, to hermetically seal the wound from further exchange of air into or out of the pleural cavity through the chest wall, and then allow the patient to breathe as well as he could to re-inflate the collapsed lung gradually. This (we know now) approximates the current treatment of pneumothorax—from which the large majority of these patients likely suffered acutely—although without the additional measure of inserting a tube into the pleural space, sealing the insertion area, and creating a negative pressure gradient to more immediately evacuate air and fluid from the pleural space and allow the lung to re-inflate more quickly. Howard was severely doubted and derided for his idea, although he was allowed to try it on a limited number of patients, and many did improve relatively remarkably. However, the ultimate mortality of his patients did not vary greatly vs. others, so he was then criticized even more. [The additional complication of wound infection, probably followed by fatal bacterial sepsis, was not yet known.]
See The Medical and Surgical History of the War of the Rebellion, Part 1, Volume 2. (Multiple cases and narrative, pp. 497-514)
