Civil War Washington

CASE.— Private Charles H——, Co. G, 61st Ohio Volunteers, aged 37 years, was found lying in the street, at Alexandria, Virginia, on September 27th, 1863, in a comatose condition, with a wound on the right side of his head. He was conveyed to the New Hallowell branch of the 3d Division General Hospital, by the provost guard. On admission his breathing was stertorous, laborious, slow; his pulse was at 48, full and regular. There was a punctured wound over the lower portion of the right parietal, and an examination by the probe showed that the bone was fractured and depressed. A crucial incision was made through the scalp, and the cranium being freely exposed, it was found that the fracture was much more extensive than had been supposed. A disk of bone was removed by the trephine, and several detached pieces were removed by the elevator, so that, altogether, a portion four inches in length by two inches in width of the skull-cap was taken away. The flaps of the integument were then brought together and were united by sutures. Cold water dressings were applied. The immediate effects of the operation were very remarkable. In less than three minutes after the removal of the depressed fragments, the patient opened his eyes, and appeared to awake to consciousness, and in less than a minute more he spoke, articulating distinctly. For the first week after the operation his diet was restricted to barley water. On October 4th, seven days after the operation, he was reported to have had no bad symptom and he complained of nothing but hunger. The sutures had been removed, and the greater portion of the incision had united by first intention. He was now allowed the "extra diet" of the hospital, consisting of oyster broth, rice pudding, and the like. On October 20th, the patient was up and about the ward. No untoward symptoms had intervened meanwhile, and the treatment had been unchanged. At this date the patient was put on "half diet," and the nearly cicatrized wound was dressed with simple cerate. He continued to do well until November​ 26th when he was visited by his brother, who brought him some bad news from home which disturbed him very much, and he immediately went to bed and became stupid and sullen, taking no notice of anything. Is it not possible that his brother brought him some stimulant as well? On October 27th the patient had become comatose, with every sign of compression of the brain, and on October 28th, 1863, he died. At the autopsy, twenty hours after death, there was found to be an abscess in the right hemisphere and the neighboring brain substance was softened. The thoracic and abdominal viscera were healthy. The edges of the aperture were found to be rounded off and in process of repair. The notes from which the abstract is compiled were made by Acting Assistant Surgeon S. B. Ward, and the specimen was forwarded to the Army Medical Museum by Surgeon E. Bentley, U. S. V. It is represented in the wood-cut (FIG. 22) on the preceding page.