Title: Coulton, Clarence

Source text: Surgeon General Joseph K. Barnes, United States Army, The Medical and Surgical History of the War of the Rebellion. (1861–65.), Part 1, Volume 2 (Washington, D.C.: Government Printing Office, 1870), 296-297.

Keywords:wounds and injuries of the headhernia cerebri after gunshot fractures of the skullfungus cerebrigangrenehemiplegiacerebral abscessautopsy performedshell comminuted parietal bone near posterior superior angle

Civil War Washington ID: med.d1e17163

TEI/XML: med.d1e17163.xml

CASE.—Corporal Clarence C——, Co. G, 123d New York Volunteers, aged 24 years, was wounded at the battle of Chancellorsville, Virginia, May 3d, 1863, by a piece of shell, which comminuted the parietal bone, near its posterior superior angle. A state of temporary insensibility supervened in the course of an hour. He remained on the field for three days, was conveyed to the field hospital, and thence sent to the 2d division hospital, Alexandria, on June 15th; being at the time in a state of heavy stupor. The wound suppurated freely, and presented near its centre a pulsating tumor, covered by granulations; hemiplegia of the left side supervened, and the patient voided the urine and fæces involuntarily; the three smaller toes of the left foot were partially gangrenous. While dressing the wound, Acting Assistant Surgeon T. H. Stillwell removed a fragment of the external table, one-fourth of an inch in diameter. On the afternoon of the 16th, Coulton recovered from his stupor and conversed rationally, though with difficult articulation. On the 18th he again sank into a lethargic state, in which he perspired freely. On the 20th and on the 22d, he was again rational for a few hours. Two small pieces of bone were removed, one of which was a portion of the internal table. On the 24th, his breathing was stertorous all day, but at night a marked improvement in his condition took place; the slough had fallen from one of his toes, disclosing a healthy, granulating surface; he began to regain power over the paralyzed leg, void the excrements at will, and could talk without difficulty. On the 30th and 31st, he suffered from convulsive attacks of nervous delirium. One-fourth of a grain of morphia was administered every half hour. By August 5th, the paralysis of the left side had so far ceased that he could flex his extremities and extend his leg, though not with precision. From this date, nothing unfavorable occurred until September 7th, when he again experienced attacks of delirium. On the 27th, after a slight chill, he fell into a state of insensibility. A tumor, which had formed at the wound beneath the scalp, was opened, and upon its discharging about an ounce of blood, sensibility was at once restored. Again a state of unconsciousness ensued on the 30th, and though in a measure relieved by the administration of purgatives, it was evident that dissolution was near. Death occurred on October 2d. At the autopsy, a circular opening one inch in diameter was found, just above the right parietal eminence, with the edges rounded off and beveled at the expense of the inner table. There was also an opening in the dura mater, through which a hernia cerebri appeared. Upon removing the skull cap, three small fragments of the inner table, depressed one-fourth of an inch at their free edge, were observed attached and agglutinated by new ossific deposit, traces of which could also be seen in the immediate vicinity. A cerebral abscess was found extending from the hernia cerebri to the right lateral ventricle containing about two ounces of very offensive lead-colored pus. The pathological specimens are Nos. 1724 and 1725, Sect. I, A. M. M., and were contributed, with the history, by Acting Assistant Surgeon T. H. Stillwell.