Civil War Washington

CASE 23.—Sergeant J. B. E——, Co. D, 30th North Carolina Regiment, aged 19 years, was wounded at Kelley's Ford, Virginia, November 7th, 1863. The ball entered four inches to the right of the spinous processes, between the tenth and eleventh ribs, and emerged between the eighth and ninth ribs, in a line with the middle of the axilla. The eighth and ninth ribs were fractured near the wound of exit. The track of the ball was five inches long. He was taken prisoner and conveyed to Washington, entering Douglas Hospital on the 9th. The wound was considered a non-penetrating one, although the patient stated that he had coughed some florid, frothy blood, and had suffered from dyspnœa. His expectoration was slightly tinged with blood for several days after his admission. The wound discharged freely, and became very tender on pressure. A harassing cough and increasing dyspnœa indicated the presence of traumatic pleuritis. The treatment comprised diuretics, expectorants, with sedatives to procure sleep, tonics and nutrients, with stimulants, and iodine locally, in form of tincture, over the chest, as a counter-irritant. Acting Assistant Surgeon Carlos Carvallo, who reports the case, says : "At four and a half o'clock A. M. of December 8th, he awoke suddenly from a dream, very much frightened, coughed very hard, and expectorated freely an enormous quantity of remarkably thin, mucous, very frothy phlegm. At nine o'clock A. M., I found him exceedingly collapsed, though feeling himself, subjectively, very well—he thought he was strong. On examining his chest, I found a great deal of effusion in right chest, whizzing​ in the bronchial tubes, and some dyspnœa. After consultation, paracentesis thoracis was decided upon, and Assistant Surgeon William Thomson, U. S. A., introduced a trocar into the posterior lateral angle of the right chest, between the tenth and eleventh ribs, which was followed immediately by the exit of thirty-eight fluid ounces of pus. The operation was unaccompanied by pain and produced almost instantaneous relief from the dyspnœa. The whizzing​ also diminished to a great degree. Stimulants were freely administered. In the afternoon, the patient appeared to be in a moribund state, but toward night he rallied considerably and felt comparatively comfortable. He passed a restless night, though he breathed easier than before the operation. At seven and a half A. M., he said he felt strong and hopeful, but he died at quarter to ten o'clock A. M., December 9th, 1863." Necropsy: Several patches of ecchymosis in the intercostal muscles, between the ninth and tenth and eleventh and twelfth ribs. Right lung collapsed and shrunk up, and adherent to costal parietes of pleura. Left lung congested—otherwise normal. No signs of pneumonia. The pleural leaf which covered the internal surface of the right chest was exceedingly thickened and presented the appearance of leather. The pathological specimen, showing the anterior portion of the eighth rib on the right side fractured, with splintering of the internal surface, is No. 1901 of the Surgical Section, Army Medical Museum. A moderate osseous deposit has occurred. It was contributed by Assistant Surgeon W. Thomson, U. S. A.