Civil War Washington

CASE.—Sergeant Charles B. Hummell, Co. D, 127th Pennsylvania Volunteers, aged 22 years, was wounded at the battle of Fredericksburg, Virginia, May 1, 1863, by a spherical case-shot which penetrated the right parietal bone near the junction of the sagittal and coronal sutures. On the morning of the 6th, he was conveyed by steamer to Washington, and was admitted to the Stanton Hospital, in a state of unconsciousness, suffering from the shock of injury; his pulse was one hundred and sixty and very feeble. By the afternoon of that day he had rallied considerably, though he still remained insensible. No paralysis of any part of the body could be detected. He lay upon his back, apparently sleeping, his respiration being perfectly natural. During the examination of the pupils, which were found somewhat contracted, though still symmetrical, he exhibited manifestations of consciousness by offering some resistance. A probe was readily passed a considerable distance along the track of the missile into the brain substance. Very little hæmorrhage from the wound occurred. The patient swallowed without difficulty and passed his urine involuntarily. After shaving the head a bag of ice was applied; a stimulating injection was then employed, which acted well, and nutriment was given in the form of beef tea. The next morning the pulse was one hundred and fourteen and somewhat stronger; the pupils were natural in size, and contracted readily under the action of light. He readily flexed and extended his legs, raised his hands to his head, rubbed his eyes, which he kept closed, stretched and yawned like one awaking from a sound sleep, and endeavored to remove the ice bag. He manifested dislike to beef tea and seemed to recognize the sound of his name when addressed, but took no notice of surrounding objects. The enema was repeated. On the morning of the 9th, the pulse had risen to one hundred and thirty, with further dilatation of the right pupil. Half grain doses of calomel, with one-eighth grain of ipecac, were now given every eighth hour. On the 10th, stupor became profound, with paralysis of the right buccinator muscle. No other face muscles were involved and there were no convulsions or paralysis. On the 11th there was full dilatation of the right pupil, the left remaining natural. The respiration, still without stertor, was greatly increased in frequency, the diaphragm assisting but little in the breathing. The power of deglutition was lost and the right arm was partially paralyzed. The enema was repeated but the patient continued to sink, and died at eight P. M. on the 11th of May. At the autopsy, some fragments of bone were found at the wound of entrance. On removing the calvaria, a large quantity of serum, slightly tinged with blood, escaped from the cavity. The missile had passed downward, backward, and to the left side, into the left cerebral hemisphere. Several small pieces of bone, a piece of scalp, and some hair, were distributed along the track, around which, for the distance of half an inch, the brain was softened by inflammation. A large clot of blood lay along the right side of the falx cerebri. The pathological specimen, No. 1137, Sect. I, A. M. M., showing five fragments of bone, with a round bullet, removed at the autopsy, was contributed, with the history, by Surgeon John A. Lidell, U. S. A.