Civil War Washington

CASE 13.—Private John C. Burk, Co. B, 5th United States Cavalry, aged 28 years, was wounded at Manassas Gap, July 21st, 1863, by a ball, which entered the left side of the body better than half way between sternum and side, between sixth and seventh ribs, passing backwards and upwards, emerging just below the outer and inferior angle of the left scapula, injuring the left lung. There was considerable hæmorrhage at time of injury. He was admitted into Lincoln Hospital, Washington, D. C., on July 30th, 1863, when vesicular murmur was heard over upper portion of lung; dull over lower; but over region of wound, loud crackling; air rushing in and out during respiration; pulse, 84; tongue somewhat flabby and furred; bowels, costive; no passage for nine days. On August 21st, after consultation, paracentesis thoracis was performed by Assistant Surgeon H. Allen, between the sixth and seventh ribs; no pus escaped. Patient improved until September 8th, after which he grew worse, suffering from pain in chest, and failing rapidly; continually calling for water, but refusing food and medicine. He died on September 11, 1863. Post mortem nineteen hours after death; rigidity well marked; not much emaciated; parts in situ; right lung barely visible; left lung bound anteriorly to costal pleura, a little behind the junction of the cartilages in the ribs, extending from the clavicle to the fourth rib. Behind and below it, was a collection of pus measuring thirty-six fluid ounces and six drachms. The pleura everywhere was covered with a thick layer of lymph; a small sac was found between the internal portion of the lung and the pericardium, filled with a straw colored limpid serum. Position of heart somewhat deviated, the apex being in the median line on a level with the fifth rib, the left side of the heart being parallel with the median line, the right side being thrown much beyond it, encroaching considerably on the right thoracic cavity. The left lobe of the liver extended three inches to the left of the median line; the free margin of the right lobe extended down within an inch of the umbilicus. The fundus of the stomach was seen beneath the left lobe. Intestines, normal; a few fibrinous threads were present; omentum not visible; œsophagus of dark purple color; mucous membrane firm; trachea purplish; contained a small quantity of viscid mucus. Bronchial glands enlarged and blackened 1st lobe of right lung; pigmentary matter abundant externally, parenchyma of a darkish red color, paler toward the surface; permeated everywhere with air, and a large quantity of thin frothy matter exuded on pressure. On the second lobe was a conspicuous depressed puckered spot on its anterior surface, which, upon examination proved to be calcareous deposit. Third lobe intensely congested, being of a deep dark reddish color; veins filled with clotted blood, and the same character of bronchial secretion as seen in the first lobe. Left lung much collapsed, being a little over an inch in thickness; much compressed; of a dull mahogany color, and not permeated with air, except the anterior median portion. Right lung weighed nineteen ounces; left lung weighed twenty-two ounces. Heart measured three and a quarter inches in width and four inches long; right auricle contained a small quantity of venous blood, which was entangled in soft clots in the meshes of the tricuspid valve, particularly at the base, and a firm fibrinous clot ran through the auricle into the ventricle, thence up into the pulmonary artery, the valves of which were healthy. The left side of the heart contained no clot; a small quantity of blackish fluid was seen at the base of the ventricle; the organ was perfectly healthy, and weighed ten and a half ounces. Pericardial fluid, twenty-six drachms, of a turbid yellowish color, turbid with lymph. Liver measured twelve by ten inches, and four and a half inches thick; weighed ninety-five and a half ounces; bile, one drachm; of a dark sienna brown color, very viscid, semi opaque; liver perfectly healthy. Spleen, six inches long by three and a half inches wide; of a darkish mahogany color externally and internally; weight, twelve ounces. Right kidney, five inches long by three wide; of a dark purple color throughout; pyramidal bodies of a lighter color than the cortical, especially at their apices. Left kidney, five and a half inches long by two and a half wide; similar in appearance to the opposite kidney; right weighed seven and three-quarter ounces; left, eight and a quarter ounces. Pancreas weighed four and a quarter ounces, ten inches long by two and a quarter inches across head. Brain, membranes healthy; quantity of fluid in the ventricles inappreciable; organ, firm and healthy; weight, forty-eight ounces. Intestines, perfectly healthy. The ball entered in the back two inches below the spine of the scapula, and four inches from the vertebræ, making its exit eight and a half inches below the coracoid process between the seventh and eighth ribs of the left side. The case is reported by the operator, Assistant Surgeon H. Allen, U. S. A.