Civil War Washington

CASE.—Private Ambrose Campbell, Co. A, 2d Pennsylvania Heavy Artillery, aged 21 years, was wounded near Petersburg, June 29th, 1864, by a conoidal ball, which entered the left side near the junction of the osseous with the cartilaginous portion of the second rib, and emerged near the sterno-costal articulation of the second rib on the opposite side of the chest, tearing away in its course the cartilage of the rib on the left side, producing an extensive comminuted fracture of the sternum and separating the cartilaginous attachment of the second rib on the right side of the chest. The cavity of the left pleura was laid open to the extent of two inches, and the corresponding lung wounded by a spicula of bone driven inward from the sternum at the time of injury. He was at once conveyed to the hospital of the 1st division, Ninth Corps, and thence transferred, on July 3d, and admitted into Carver Hospital, Washington, on July 5th. On admission, patient manifested symptoms of pleuropneumonia, accompanied with low muttering delirium with a tendency to sleep, with somewhat lucid intervals. There was involuntary discharge of urine ever after admission, as also of feces, with some two or three exceptions. Pulse not more frequent than in health, full, yet more hard; skin harsh and dry, yet not much above the natural temperature; respiration oppressed, but not labored. The cavity of left pleura was filled with a dark-brown fluid, which was occasionally removed by gently placing the patient in a prone position, allowing the fluid to escape through the orifice of the wound, but for four or five days prior to death it was partially removed by the use of a syringe. In the latter stage of the disease, fully four ounces of serum were effused into the cavity daily. These symptoms continued with little variation until July 13th, when profuse hæmorrhage occurred, probably from the internal mammary, which was ligated by Surgeon O. A. Judson, U. S. V.; there was not less than twelve ounces of blood lost, and the patient sank more rapidly, and died on July 19th, 1864. Autopsy showed the following: Condition of right lung, normal; left lung in situ, firmly bound down to wall of chest by recent adhesion; a lacerated wound of upper surface of upper lobe about two inches in extent, which was gangrenous; lower anterior portion of upper lobe gangrenous; this lobe was congested elsewhere, except at apex; lower lobe in a state of red hepatization; liver enlarged, pale, and of a nutmeg appearance; spleen enlarged, did not present its usual granular appearance. During life, the pulsations of the aorta and heart were exposed whenever the effused fluid was removed. The treatment of the case consisted, in the earlier stages, of moderate doses of quinine, with punch, castor oil, and cough mixture; in latter stages, diffusible stimulants and nourishing diet. Specimen No. 2925, Sect. I, Army Medical Museum, consists of the seventh cervical and first three dorsal vertebrae, with the corresponding ribs and part of the sternum. The second left rib was struck at its costal extremity by a bullet, which, passing transversely, tore away the cartilage, comminuted the sternum, and separated the cartilaginous attachment of the second right rib; the sternum is extensively necrosed, especially on its internal surface, the second portion of which shows traces of periosteal disturbance. The specimen and history were contributed by the operator.