Civil War Washington

CASE.—Private John Keil, Co. K, 102d Pennsylvania Volunteers, aged 25 years, was wounded at the Wilderness, Virginia, May 5th, 1864, by a conoidal ball, which entered at the inner canthus of the left eye, passed through under the nose, and lodged in the right antrum of Highmore, penetrating the right superior maxilla, and knocking out the second molar tooth on the right side. He was conveyed to Washington, and admitted into the Stanton Hospital on May 11th, 1864. On May 23d, the wound of entrance had nearly healed; there was a purulent discharge from the right nostril, and a fissure in the anterior part of the superior maxilla, the length of which could not be satisfactorily ascertained. A probe was readily passed into the antrum. Assistant Surgeon George A. Mursick, U. S. V., made an incision from the angle of the mouth to the lower edge of the malar bone, turned up the flap of the cheek, applied a large trephine over the antrum, removed a button of bone, and extracted the ball, which was found lying loose in the antrum. The patient's constitutional condition was good. On May 24th, he had some fever and swelling of the cheek. On May 25th, the swelling of the face had increased and was erysipelatous in character. On May 27th, the swelling having nearly subsided, the sutures were removed. The lower half of the incision had united by first intention; the remainder was suppurating; the discharge from the nostril had diminished, and the patient was doing well. On August 1st, the wound had not healed; there was an opening over where the bone was trephined. Some small pieces of bone were discharged, both from the wound of operation and the nostril. The patient was able to chew his food well. On September 3d, 1864, his term of enlistment having expired, he was discharged the service. The wound of operation had not entirely healed; a small sinus was leading to the antrum, the orifice of which was surrounded by pouting granulations, and a small piece of necrosed bone could be felt at the bottom. The cicatrix was rather large, but there was no other deformity. The specimen is No. 3374, Sect. II, A. M. M., showing the disk of bone removed from the superior maxilla, with the battered and flattened ball. The specimen and history were contributed by the operator. On March 8th, 1865, Pension Examiner G. S. McCook reports that the jaw is exfoliating, and rates the patient's disability three-fourths and permanent.