Civil War Washington

CASE.—Sergeant Thomas N. Hillard, Co. H, 70th New York Volunteers, aged 22 years, was wounded at Manassas Gap, Virginia, July 23d, 1863, by a conoidal ball, which entered the right side of the thorax, one inch below the clavicle and three and a half inches to the left of the acromion process, fractured the second rib near its sternal extremity, passed directly through the lung, and emerged one inch to the right of the spinal column, opposite the spine of the scapula. The fifth rib was shattered at its superior surface, near its angle, but its continuity was not severed. He was taken to the hospital of the 2d division. Third Corps, where the wound was hermetically sealed by Assistant Surgeon B. Howard, U. S. A. On July 30th, he was transferred to Lincoln Hospital, Washington. When admitted, the wounds had partially opened, and were ragged from the tearing out of the sutures. The patient coughed incessantly, and spat up large quantities of frothy sputa, more or less mixed with blood. Respiration was 46 per minute, and labored with extreme orthopnœa. The pulse was 96, and small. Every fit of coughing was accompanied by a profuse discharge of dark sanguinous fluid through either wound. It was evident that the attempt to permanently close the orifice had proven a failure. Acting under instructions from the Medical Director of the department the treatment already inaugurated was continued. An attempt was made to renew the coating of collodion, which was accomplished after some difficulty; but before the ether had had time to evaporate, a profuse discharge of the pleuritic fluids took place which rendered every effort at restoration impracticable. By August 5th, the discharge from the posterior wound had almost entirely ceased, while that from the anterior one continued to be large in quantity and of a purulent character. The discharge of this fluid was invariably accompanied with coughing, and always followed by an amelioration of all the rational symptoms. The hope was therefore entertained, that the accumulation of pus in the pleural cavity would be prevented, and that recovery would eventually take place; but as the necessity for repeated effort to throw off the pus became more frequent, the strength of the patient became proportionately exhausted. On the evening of August 12th, he was seized with an unusually severe paroxysm of coughing, followed by a copious discharge of pus, which flooded his person and the bedding, and reduced him to a state of syncope from which he was imperfectly aroused under the administration of stimulus, but expired in a short time. The necropsy revealed extensive deposit of lymph over the entire right lung, and one-half pint of thick empyemic fluid in the cavity. The track of the wound was closed anteriorly. The upper portion of the right lung was permeable to air. Only part of the first and the whole of the second and third lobes were impermeable and compressed. The left lung was well filled with air and weighed thirteen ounces; right lung eighteen ounces. The case is reported by Assistant Surgeon H. Allen, U. S. A.