Civil War Washington

CASE 27.—Private Francis Cook, Co. K, 2d Michigan Volunteers, was wounded at Bailey's Cross Roads, Virginia, September 4th, 1861, by a conoidal ball, which penetrated the lungs. Surgeon William O'Meagher, 37th New York Volunteers, in a report of the case in Am. Med. Times, Vol. IV, p. 6, says: "While on picket duty near the Cross Roads, he received from the enemy's picket a gunshot wound through the lungs, and when discovered by his comrades, who had hastened to the spot, was found faint from profuse hæmorrhage, and lying on the wounded side. By them he was conveyed in a blanket to the main body stationed at the Cross Roads, the distance being about a mile, and on their arrival I saw him immediately. On examination, his clothes behind were found saturated with blood, while several large clots were removed from the immediate vicinity of the wound. As he was extremely prostrated, some stimulants were gradually administered until reaction took place, and, in the meantime, I was searching for the exit of the bullet, which had entered the left side posteriorly, fracturing the tenth rib and making a large irregular wound. On introducing my finger for about two inches for the purpose of exploring and removing foreign substances, I felt the lung tissue, and found the wound itself partially filled with coagula and extending toward the opposite side in a transverse direction; emphysema appeared to some extent in the vicinity. I did not attempt a further exploration, especially as the wound, as far as I could discern, appeared free from foreign substances and partially closed. Shredded lint was then applied to the wound, and the patient gently turned over on the wounded side. On searching for the exit of the ball, the only indication of its presence was a patch of emphysema on the opposite side, somewhat higher up than the aperture, but the ball itself could not be felt, so I resolved to wait awhile in order to allow the patient to recover somewhat, hoping that, in the meantime, the respiratory efforts, increased by a pretty tight bandage, would force the ball outward and thus render it palpable. Accordingly, in about four hours, be began to experience severe pain in this part, and on removing the bandage, at the same time directing him to take a full breath, which he did with ease and evident relief, I was exceedingly gratified to find the ball presenting itself in the sixth intercostal space. On cutting down I found it firmly imbedded in the costal pleura, and after a little delay, occasioned by a desire not to make a large opening, removed it with a common forceps, and immediately closed the wound with interrupted sutures. The bandage was again applied, and a full anodyne administered, after which he slept well for two hours and felt very much relieved. The missile, contrary to my first anticipations, turned out to be a small triangular-shaped rifle-bullet, irregular and rough at the edges, as if it were so designed to produce greater mischief. He continued very comfortable for two days, taking light nourishment and appearing quite cheerful and intelligent, occasionally only being attacked with dyspnœa, which, however, was never sufficient to cause any apprehension. Obedient to directions, he lay perfectly still, without talking, except in answer to a necessary question as to his condition. His bed was a canvas field-stretcher, with poles inserted into the folded canvas, which was also attached to the end pieces by buttons and cords. The iron framework at the ends raised it from the ground sufficiently to afford a safe, easy, and efficacious means of transportation, far superior, in my opinion, to any other thus far presented, and certainly better than field ambulances over rough roads. On this he was conveyed, on the third day, a distance of perhaps ten miles, to the general hospital in Alexandria, where he died on the fifth day. I am indebted to Dr. H. Laurence Sheldon, the surgeon in charge, for the following record of the autopsy: Left side of chest filled with bloody serum; lung compressed, and a space between anterior parietes and surface of lung filled with air. Lymph covered the visceral and parietal pluræ, and clots of blood were on the most dependent portion of the cavity. The ball struck the tenth rib, fracturing it three inches from its articulation with vertebræ, passed through the lower lobe of left lung, where there was intense inflammation in its track, with numerous spiculæ of bone carried two inches into substance of lung from the fractured rib, thence through body of tenth vertebra, through diaphragm and upper surface of liver, a distance of two inches; again through diaphragm, and was removed externally between sixth and seventh ribs. There was a patch of pneumonia on the right lower lobe. Half a gallon of serum and blood was taken from both pleural cavities.' I should have mentioned as rather remarkable, that for three days, though he had considerable dyspnœa, and pain referred to in both places, he had neither cough nor expectoration until the fourth day, leading some to suppose that both lungs were not seriously wounded, as I had at first reported, the ball rather making a circuit outside the lung. But I think it almost impossible that the right lower lobe could escape when the ball passed twice through the diaphragm and upper surface of the liver, being finally removed from the sixth intercostal space; besides, 'there was a patch of pneumonia on the right lower lobe, and half a gallon of serum taken from both pleural cavities.' "