Civil War Washington

Private William Sands, Co. A, 147th Pa., was admitted May 7, 1863, with a flesh-wound of the thigh, received at Chancellorsville on the 3d. The patient seemed in good condition and complained of nothing apart from his wound. On the morning of the 15th, Dr. A. P. WILLIAMS having been called to see him, found him so near death by asphyxia that no opportunity was afforded to examine the chest during life. At the evening visit on the previous day the patient had some fever and complained of restlessness, for which an opiate was administered. About midnight his mind wandered somewhat, but not more than might be attributed to the opiate. After this the nurse on duty noticed that his breathing was short and somewhat labored; but as he was quiet and made no complaint the attending surgeon was not called. Post-mortem examination: The ball, which had impinged on the femur without fracturing it, was removed from the wound, which showed nothing unusual. On elevating the sternum the thoracic cavity was found filled with black blood. The lungs adhered to the walls of the thorax and the diaphragm; the pericardium to the pleura and the diaphragm; these adhesions were firm and extensive. The heart, enveloped in its pericardium, was carefully removed; the pericardium was firmly adherent to the heart. An opening nearly half an inch in length was found extending through the anterior wall of the right ventricle and its adherent pericardium. On stripping off the pericardium the heart, which was of large size, appeared paler than natural, having evidently undergone fatty degeneration; the opening in the wall of the ventricle was in the direction of the muscular fibres and was rendered valvular by the intrusion of one of the fleshy columns. Every point in the case shows that the cause of death was rupture of the heart not following any violent exertion. The nurse's statement that he noticed the short breath of the patient some hours before death, and his asphyxiated appearance when Dr. WILLIAMS saw him, indicate that death was caused by the gradual effusion of blood compressing the lungs. The man probably lived four or five hours after the rupture of the heart, the columna carnea at the base of the opening preventing an immediately fatal hemorrhage. The opening in the pericardium and heart could scarcely have been made by the knife of the dissector without inflicting injury on the fleshy column at the base of the opening, which, it will be observed, was uncut; nor would the chest have been suddenly filled with blood by a post-mortem cut in the right ventricle, in which was found a large soft clot.—Ass't Surgeon Alexander Ingram, U. S. A., St. Aloysius Hospital, Washington, D. C.