Civil War Washington

CASE.—Private William L——, Co. B, 6th Ohio Cavalry, aged 18 years, was wounded in a skirmish on the Rapidan River, Virginia, September 8th, 1863; one ball entered the left side of the thorax on a level with the fourth rib, posterior to the junction of the cartilage with the bone, and emerged eight and one-half inches posterior to the wound of entrance, and three ribs lower down, fracturing the seventh rib anterior to its angle. The second ball entered on a level with the tenth rib, passed from behind forward, and fractured the ninth rib about one inch posterior to the junction of the cartilage with the bone. He was conveyed to Washington, and admitted, on the 12th, to Lincoln Hospital. On admission, he was very pale and anæmic and suffered greatly from his wounds; no emphysema of surrounding integument. Respiration 40 per minute, short and labored. Cough harassing, though no sputa was brought up. No difference in measurement existed between the two sides of the chest; pulse, 108; sleeps poorly; orthopnœa prominent. September 17th: It was observed that, in addition to the empyema which was present on the left side, a violent pleurisy had attacked the right. The combined sources of depression rapidly exhausted the remaining vital power of the patient. On the 20th, several spiculæ of bone were removed from the wound of exit. The coughing would occasionally cause large quantities of purulent matter to be discharged from the wound. The person and surroundings of the patient became offensive in the extreme, rendering him a pitiable object. On the 25th, pericarditis was detected. At this time, he presented the following symptoms: orthopnœa; sits up in bed with head-frame behind him; respiration 45 per minute and laborious; face expressive of great exhaustion, pallid; nostrils dilated strongly at every inspiration; wild expression of eyes, pupils contracted. Pulse variable, generally rapid, compressible, and soft. No fever or delirium. Death resulted on October 6th, 1863. Necropsy: Right lung displaced; almost the entire space of anterior part of the thorax occupied by distended pericardium; left lobe of liver united to omentum by a recent exudation of lymph; thirty ounces of fluid in right pleural cavity, twenty ounces of pus in left. Right lung covered from apex to base with a layer of yellowish lymph, and in many places erected into trabeculæ uniting lung to pleura costalis; lobes agglutinated together and to the diaphragm; posterior portion of lung engorged with blood; left lung semi-solidified and filled with minute abscesses. Upper part of pleura covered with layer of lymph, lower part thickened and discolored by pus. Abscess in first lobe completely circumscribing second lobe; the pericardium contains thirty ounces of a clear colored mahogany serum and, together with the heart, was covered with a thick layer of yellowish lymph. The liver was somewhat softened. Acini somewhat indistinct. Spec. No. 1722, Sect. I, A. M. M., shows a wet preparation of the sixth, seventh, and eighth ribs. The specimen shows firm pleuritic adhesions. Specimen No. 2243 of the same section shows a wet preparation of the heart and pericardium. Both of the serous surfaces are shaggy with profuse deposits of lymph, which, in the recent state were pinkish in color. Toward the posterior surface the two sides of the pericardium are united. Both specimens were contributed, with a history of the case, by Assistant Surgeon H. Allen, U. S. A.