Civil War Washington

CASE 3.—Private Peter C. Farnsworth, Co. F, 31st Maine Volunteers, aged 17 years, received a shell wound of the right side of the chest at Petersburg, Virginia, June 17th, 1864; the eighth rib was fractured at its centre, and the seventh and ninth ribs denuded on the same line. He was at once conveyed to the 2d division hospital of the Ninth Corps, where simple dressings were applied. On June 20th, he was transferred to Mount Pleasant Hospital, Washington. When admitted, the patient s general health was good. There was slight inflammatory action in the integuments immediately about the wound. The fractured ends of the rib did not interfere with the action of the pleura. June 24th: Inflammation subdued, but no efforts at granulations; stimulant injections and resin cerate dressings. On June 30th, physical signs of pneumonia made their appearance, localized about the seat of injury. July 4th, pneumonia resolved. Wound and adjacent tissues in a sloughing condition. Secondary hæmorrhage occurred from the intercostal artery, which could not be secured on account of the mass of slough. The wound was thoroughly injected with tincture of muriate of iron and plugged with lint saturated with the same. The slough still advancing, the patient was etherized on July 8th, and the wound was thoroughly cauterized with nitric acid; a yeast and charcoal poultice was then applied. The remainder of the slough came away on July 12th; hæmorrhage recurred, and, the artery eluding search, the treatment of the 4th was successfully resorted to. The outer ends of the fractured rib were found to have caused irritation by their friction motion on the pleura; and, on the 15th, Acting Assistant Surgeon F. S. Barbarin administered an anæsthetic and removed the diseased portions of the fractured ends of the eighth rib; all the diseased portions of the seventh and ninth ribs looking toward the eighth rib were removed by the nippers and smoothed with a lenticular. But little blood was lost, and the patient reacted promptly. After the excision, the condition of the patient improved in regard to breathing and appetite. He did well until July 25th, when by some sudden movement, while walking in the hall of the hospital with the assistance of crutches, he fractured the ninth rib. July 26th: Treatment continued; quite comfortable, but irritable. August 8th: In a very feeble condition. Suffering acute pain over the whole abdomen, with frequent discharges from his bowels. Pulse 120. He gradually became weaker, and died August 13th, 1864. At the necropsy the upper and middle portions of the right lung were found to be partly adherent to the costal pleura by thin fibrous bands. Assistant Surgeon C. A. McCall reported the case.