Civil War Washington

CASE.—Private Jarvis Nunn, Co. A, 12th Kentucky Volunteers, aged 18 years, was admitted into the Old Hallowell branch of the military general hospitals at Alexandria, Virginia, February 1st, 1865, with a compound fracture of the skull by a blow from the muzzle of a musket in the hands of a comrade. The wound and fracture were situated a little above and to the outside of the left frontal eminence. There was no disturbance of the mental faculties, and no especial derangement of the physical functions at the date of the patient's admission, except slight constipation, which was overcome by a cathartic. On February 4th, a slight febrile movement, with a dull frontal headache and swelling of the left parotid gland was observed; but there was no obtuseness of intellect. On the following day, the left side of the face was œdematous. The eyes, particularly the left eye, being watery. The bowels were soluble. The wound had now commenced to suppurate, the discharge being fetid. Cold applications were made to the head. On the 7th, the pupils were dilated, and the tongue was protruded with difficulty. On February 8th, the patient was delirious, deaf, unable to articulate, or to protrude his tongue. He could be roused with difficulty from his comatose state. The respiration was at 44, and the pulse thready at 115. It was necessary to evacuate the urine by a catheter. On the 9th, the coma became profound; respiration 36; pulse 123; pupils widely dilated, and irresponsive to light. On Februrary 10th, the respiration was very labored, the face and neck œdematous; the eyelids firmly closed; but, when forcibly separated, revealing the pupils dilated to almost the extent of the iris. The urine and fæces were discharged involuntarily. The surface was covered by a profuse sweat. The radial pulse was imperceptible. Death took place at three o'clock in the afternoon of February 10th, 1865. At the autopsy there was found, on the left side of the sinciput, a wound covered with yellow pus, and beneath, a depressed fracture of the frontal bone; and on removing the skull-cap a dark coagulum. The dura mater was not inflamed, but was separated from the bone for some distance around the fracture. The anomaly of the right lung being divided into two lobes only was noticed. This lung was emphysematous, and the bronchial mucous membrane on this side was thickened and discolored. The tissue of the left lung was crepitant, but red and slightly softened. The structure of the spleen was softened. The case was reported by Surgeon E. Bentley, U. S. V.