Civil War Washington

BUCKLEY, JOHN B., Corporal, Co. D, 62d Pennsylvania Volunteers, aged 24 years, received a bayonet wound of the forehead, through the right superciliary ridge, at Chancellorsville, Virginia, May 3d, 1863. It was found, on examination, that the weapon had penetrated the frontal sinus, and passed horizontally backwards into the brain. The patient was transferred to Washington, and was admitted to Finley Hospital on the 9th, in a perfectly conscious condition, with a natural pulse and freedom from febrile excitement. Acting Assistant Surgeon Lewis Heard passed a bougie along the track of the wound into the right anterior lobe of the brain the distance of four inches, without force, and without the least pain to the patient. The perforation in the skull barely admitted the point of the index finger. There were found a few small fragments of bone still hanging at the inner edge of the orifice. There was no hæmorrhage. Perfect quietness was strictly enjoined, a saline laxative was ordered, and cold water dressings were applied. The diet was light. On May 14th, he continued conscious and comparatively comfortable, complaining of but little pain in the head. Temporizing treatment was continued. For the next two days signs of mental disturbance were noticeable, and partial loss of vision, with optical illusions. He complained of headache, and a febrile movement arose, with intense thirst. The bowels were kept open by Epsom salts. Pus and disorganized brain tissue were discharged from the wound. At noon, on the 16th, he moved his arms about tremulously, catching at imaginary objects, arousing, occasionally, from the stupor into which he had fallen, complaining of increased pain in the head, and then talking incoherently. The skin was of natural temperature, and the pulse at 80. On May 17th, the patient had passed a quiet night. The pulse was at 125; there was greater tremulousness of the arms, with increased stupor, and vision was nearly extinct. The patient had great thirst, but no appetite. The discharge of pus and disorganized brain substance continued. Slight convulsions occurred in the afternoon, and the patient sank gradually, and died at six o'clock P. M., thirteen days after the reception of the injury. At the post mortem examination, made fourteen hours after death, the sinuses and the dura mater were found to be highly engorged with blood. The right hemisphere of the brain was sliced off, and over the right lateral ventricle a slight prominence was observed, which, on being punctured, gave exit to a quantity of pus. The wound penetrated through the anterior lobe of the brain under the right edge of the corpus callosum, opened the right lateral ventricle, and extended back to the posterior crus of the fornix, which seemed to have sustained injury. The two lateral and third ventricles were filled with pus, and pus was also found in the fourth ventricle, and beneath the cerebellum around the medulla oblongata. Acting Assistant Surgeon Lewis Heard reported the case.*

* American Medical Times, June 10, 1863, Vol. VI, p. 292.