Civil War Washington

CASE 21.—Private Thomas Kinney, Co. A, 17th United States Infantry, aged 36 years, was wounded at Petersburg, Virginia, September 30th, 1864, by a ball which entered under the inner third of the clavicle, one inch from the margin of the sternum, fractured the second rib, and lodged in the right lung. He was conveyed to the hospital of the Fifth Corps, and on October 7th was transferred to Harewood Hospital, Washington. When admitted, his constitutional condition was good. On October 11th, hæmothorax was diagnosed. The right lung was compressed, there was dullness on percussion, an absence of the respiratory murmur, and dyspnœa. Surgeon R. B. Bontecou, U. S. V., administered ether and performed paracentesis thoracis on the right side, between the sixth and seventh ribs, in the linea axillaris; five quarts of blood and serum were removed. The patient felt much relief after the operation, respiration becoming easy and audible through the whole of the right lung, except in the inferior part of the third lobe. The wound was covered with oil-silk to prevent the admission of air, and a Dover's powder was given every three hours. The case progressed as follows: October 12th, pulse 120. October 13th, feels pretty well; pulse 90; respiration audible as before. The wound discharged a bloody serous fluid. At 6 P. M., respiration was difficult, and percussion in the lower parts dull; respiration was not audible on the posterior side. The finger was introduced into the opening and a large amount of bloody serum discharged; the patient felt somewhat relieved. October 14th, weak; pulse 110; discharges free and of a putrid smell; crepitation. Percussion dull in lower part of left lung; respiration normal. Treatment, supporting; Dover's powder of ten grains every three hours. The patient continued to sink, and died October 20th, 1864, from exhaustion. At the autopsy, ten hours afterward, both auricles, and the right ventricle of the heart, were found to be filled with fibrinous coagula. The pericardium contained a small quantity of serum. The right lung was collapsed and hepatized; the bronchi and their ramifications were filled with matter. The ball entered the inner margin of the middle lobe of the right lung and emerged on the exterior surface of the third lobe, slightly fractured the eighth rib, and was found lying on the diaphragm. The pleuræ were covered with lymph, and a spicula of the second rib was found. There were a few small tubercles at the apex of the left lung.