Civil War Washington

CASE.—Private James Parker, Co. G, 16th New York, aged 24 years, was wounded at Gaines's Hill, Virginia, June 27th, 1862; the ball entered between the eighth and ninth ribs, seven inches from the spine on the right side, and emerged below the head of the tenth rib, one inch from the spine on the same side; the ninth rib was fractured about midway in its course. He was treated in the field and transferred to Ascension Hospital, Washington, on July 4th. On admission, there was no emphysema or other sign of injury to the pleura or lung. Some small spiculæ of bone, which had worked to the surface posteriorly, were removed, and the chest nearly encircled by adhesive straps. Antimonial and saline mixtures were administered, and low diet ordered. August 1st: Some friction sound at point of fracture, but no effusion and no pneumonia. Tincture of veratrum viride was ordered, and, as the pulse was 105, calomel was administered, but a better diet was given as his strength was failing. A pulmonary fistula was established on August 2d. Air issued, with a bubbling sound, anteriorly and posteriorly, on coughing or sneezing. By intercepting the air by pressure between the points of wounding and the point of fracture, the fistula and fracture were found to be identical in position. There was no effusion, no pneumonia, no collapse of the lung, and no emphysema, on account, it was supposed, of the free exit afforded by the wound to the air, and it was, therefore, judged that the pleura was adherent about the point of fistula. His weakness increasing, punch, iron, and quinine were ordered freely. The bandage was still continued. August 4th: The sputum is now tinged with blood; pulse, 105; strength poor; fistula still exists. A slight friction sound was still perceptible, but localized at the fistula. Vomiting and diarrhœa have set in. Anodynes and astringents were given, and the nutritious diet continued, with a diaphoretic for the slight pneumonia. Over the subcutaneous fistulous point a compress was applied, and bandaged firmly in hopes of its closing. August 7th: Pneumonic sputum disappeared. Anterior orifice closed entirely; posterior one cicatrizing; fistula entirely gone. There is now no dulness​, no effusion, though the friction sound continues. No cough; pulse, 95. Compress removed. Bandage and nutritious diet continued. Diarrhœa gone. August 15th: The pleurisy is marked, the fracture uniting. There is no effusion or pneumonia, and the patient is gaining strength decidedly. The fistula has not returned, and the posterior orifice has almost healed. His diet is less nourishing, and the antimonial and saline preparations, with morphia and mercury recommended. He was discharged from service on September 20th, 1862. Acting Assistant Surgeon W. W. Keen, jr.​, reports the case. Under date of October 17th, 1863, Pension Examiner Benjamin J. Moses, reports: "The ball entered the anterior and lower part of the scapula and passed out close to the spine, injuring the right lung and producing the various symptoms of consumption under which he appears to be laboring at present." He died on January 10th, 1864.