Civil War Washington

CASE.—Private Dennis B——, Co. I, 22d Massachusetts, was wounded at Fredericksburg, Virginia, December 13th, 1862, by a ball, which entered above and a little forward of the posterior fold of the left axilla, passed inward, upward, and forward, and emerged just above the convexity of the left clavicle, which it shattered, again entered an inch nearer the neck, preserving nearly its original direction, finally emerging through the right cheek, breaking a few small pieces from the middle of the lower edge of the jaw. He was conveyed to Washington, and, on December 18th, admitted to Judiciary Square Hospital. There was considerable offensive discharge, particularly from the first wound of exit. About December 30th, his mind became somewhat affected, and there was great and increasing tendency to sleep. On the night of January 12th, 1863, he was attacked with violent pain in the left hypochondrium, which was partly relieved by the application of sinapisms. On January 13th, two fragments of bone were removed with the forceps from the acromial portions of the clavicle from which they had become partially detached. On January 14th, he went to sleep after eating heartily; his breathing was shorter than usual. Upon being spoken to he opened his eyes, but closed them again; his breathing became still shorter, and with longer intervals, for about five minutes, when he died, perfectly quiet, and apparently without pain. At the autopsy, the head of the humerus was found destroyed, and the shaft fractured for three inches below it. The glenoid cavity and neck of the scapula were destroyed as far back as the supra-scapular notch; a partial fracture extended across the infra-spinous fossa. The front of the thyroid cartilage had been carried away. A notch was cut out of the under surface of the inferior maxilla, right side. The left lung was compressed by an abundant pleuritic effusion, and contained a single abscess. The parenchyma of the left lung was not examined. There was not any opening into the pleura. A drop of blood taken from the axillary vein exhibited nearly as many white as red corpuscles. The specimen, consisting of the left clavicle, scapula, and upper third of the humerus, is numbered 695 of the Surgical Section of the Army Medical Museum, and was contributed, with a history of the case, by Medical Cadet Burt G. Wilder, U. S. A. The ball entered the posterior aspect of the shoulder-joint, and emerged at the centre of the clavicle, causing extensive comminution of the glenoid cavity and head of the humerus. The clavicle is fractured obliquely. A fissure extends transversely through the body of the scapula below the spine. The acromion and coracoid processes are detached. The shaft of the humerus exhibits several fissures. The fractured extremities of the clavicle are necrosed. The specimen shows but little attempt at repair.