Civil War Washington

CASE.—Corporal Amos G. Schofield, Co. F, 1st Minnesota Volunteers, was wounded at the battle of Bull Run, Virginia, July 21st, 1861, by a conoidal ball, which entered two inches behind the left mastoid process, and escaped at the mouth, fracturing the lower maxilla, and carrying away a portion of the primativeprimitive carotid and its branches from the left side. He was admitted to the 3d division hospital, Alexandria, the next day; an aneurismal​ tumor had formed. The case did well, except that there was a hard circumscribed swelling beneath the left ear. On August 4th, a hæmorrhage occurred from the wound of entrance, which was controlled by a graduated compress, but which was gradually succeeded by a swelling which extended from the mastoid process to the clavicle, and which was caused by the escape of blood into the tissues of the neck. Frequent hæmorrhages occurred from the wound in the mouth, which could not be controlled but by compression on the left carotid. The compression on the veins of the neck induced great œdematous swelling of the face, the left eye was closed, the tongue hung from the open mouth, and articulation became impossible. The hæmorrhage from the mouth having returned about 5 A. M., on August 11th, compression was made over the carotid, when the patient appeared to have drawn into his glottis a clot of blood, during an effort at inspiration. Apnœa ensued, followed in a few moments by death, his strength being entirely exhausted by his losses of blood and rest, and his continued suffering. At the autopsy the left side of the neck was found distended by effused blood. The internal carotid was uninjured, but, the external was lost in the tumor, which seemed to be a true aneurism​ undergoing consolidation. Behind the pharynx was found a quantity of dark fluid blood. In the right ventricle of the larynx was found a soft clot, which was the immediate cause of death, since it acted as a valve permitting of expiration, but preventing inspiration. Assistant Surgeon H. Lawrence Sheldon, U. S. A., decided against an operation, as he could not satisfy his mind as to the source of the hæmorrhage. The pathological specimens, consisting of a part of the lower jaw and a portion of the primitive carotid and its branches exhibiting a tumor, were contributed to the Army Medical Museum, with a history of the case, by Assistant Surgeon William Thomson, U. S. A., and are numbered 4923 and 4925 of the Surgical Section.