Civil War Washington

CASE.—Private James S——, Co. B, 1st District of Columbia Cavalry, robust and well-developed, received a gunshot wound of the liver and spine, in a bar-room fracas in Washington, on October 18th, 1863. He was admitted, at two o'clock, A. M., October 19th, to Douglas Hospital. When admitted, the surface was cold and pale; pulse small and feeble; countenance anxious; great depression of the vital powers and pain at the seat of injury. This state of collapse, together with dyspnœa, and a peculiar rattling of the throat, as also a dullness of the abdomen, on percussion, indicated that internal hæmorrhage existed. The lungs were not implicated. The wound was a small hole, circular in form, depressed, of a livid color, and incapable of admitting the little finger. It was situated on the right hypochondrium, just below the cartilage of the tenth rib, one-fourth of an inch externally to the mammillary line. The wound was continually discharging a small quantity of venous blood and bloody serum. The patient was perfectly conscious. He complained incessantly of great coldness and pain near the wound. Upon removing his clothing it was found that alvine discharges passed involuntarily from him. Stimulants were given freely, and water dressings applied to the wound, with mustard poultices to the calves of the legs to restore the circulation of blood to the superficial skin. An anodyne was given. At nine and a half o'clock A. M., he had somewhat revived. The paleness was not so well marked, and his strength had rallied from the nervous shock. Death resulted at a quarter past eleven o'clock P. M., October 19th, 1863. Necropsy: The ball had entered the anterior superior aspect of tho right lobe of the liver, and, after traversing it inward, downward, and backward, emerged at the inferior posterior aspect, external to the vena-cava, penetrated the body of the eleventh dorsal vertebra anteriorly on the right side, passed obliquely upward and backward through the body of the tenth, completely shattering it posteriorly and breaking off the right pedicle, passed upward and to the left, and emerged through the left lamina of the ninth vertebra, resting against the corresponding rib. There was a considerable quantity of extravasated blood in the abdominal cavity. The lungs were congested, but otherwise healthy. The other organs were apparently intact. The pathological specimen, consisting of the last six dorsal vertebræ, is No. 2238, Section I, A. M. M., and was contributed, with a history of the case, by Acting Assistant Surgeon Carlos Carvallo.