Civil War Washington

CASE.—Private Jacob Smith, Co. D, 48th Pennsylvania Volunteers, aged 33 years, was wounded in the engagement near Fort Steadman, Virginia, April 2d, 1865, by a conoidal musket ball, which struck the centre and upper part of the frontal bone, making a vertical incision of the scalp two inches in length. The pericranium was only slightly detached and no fracture was observable. He was taken to the hospital of the 2d division, Ninth Corps; on April 4th, sent to Carver Hospital, Washington, and on May 19th, transferred to Mower Hospital, Philadelphia. Three days later, the right temporal region became swollen, and erysipelas, attended with high fever, quick pulse, and delirium, supervened. An abscess being suspected, an incision was made in the temple, but none could be found. A brisk cathartic was given, and the face and head dressed with sol. sod. sulph. On May 24th, the left side of the head became involved and head symptoms developed rapidly. Chloroform being administered, a crucial​ incision was made by Acting Assistant Surgeon W. P. Moon, and the bone exposed, when the slightest perceptible fissure in the external table was discovered, from which a thin sanious discharge was issuing. Upon removing a portion of the two tables with a trephine, it was ascertained that the fissure extended through both tables, without fracturing or depressing either. Quite an amount of pus escaped from the orifice and considerable disorganization was evident. Death occurred on May 25th, 1865. At the autopsy, the interior lobes were found greatly congested, with formation of pus over a great extent of the longitudinal sinus. All the vessels of the membranes were much enlarged and engorged, and at the point of injury disorganization had taken place. The case is reported by the operator, Acting Assistant Surgeon W. P. Moon.