Civil War Washington

CASE.—Private George Gold, Co. I, 155th Pennsylvania Volunteers, aged 23 years, was admitted to Harewood Hospital on October 7th, 1864. He had been wounded at Poplar Grove Church, on September 30th, by a musket ball, which struck the scalp, passing from before backwards, tearing up a portion about three inches in length by one inch in breadth, laying bare the skull and denuding it of its pericranium for the space of three inches in length and one inch in breadth, through the middle of which space the sagittal suture passed, meeting the coronal at the anterior border. The patient was carefully watched for symptoms indicative of cerebral or meningeal inflammation; but none were manifested up to the moment of his death, unless a slight drowsiness, which, at the time, was attributed to the administration of eight grains of Dover's powder, might be so regarded. He was up and about the ward, complaining of nothing except the wound in the scalp, and receiving no treatment, except simple dressings, until the morning of October 18th, when he spoke of a slight pain in the left side of the chest, over the lower lobe of the lung. There was some dullness on percussion over the part complained of, but no marked physical signs of inflammatory mischief. On October 19th, the patient was worse. The pain in the left chest was more severe, resembling that of pleurisy; the pulse was full and frequent; the tongue brown and rather dry; there was very little cough, and no expectoration. On percussion, the right side was very dull over the lower lobe, less so over the upper lobe. The respiratory murmurs were nearly if not quite normal, over the whole of the right lung. Examination by auscultation unsatisfactory, on account of the turbulent action of the heart and the catching character of the respiration. There was no cephalic or nervous symptoms. On October 20th, the patient appeared more comfortable in the early part of the day, the respiration less labored, and pulse more quiet, and tongue more moist; towards the latter part of the day, however, the symptoms increased in severity. Great dullness over whole of left side of chest was noticed, and greatly diminished resonance on the right side. The vesicular murmur was heard over a small portion of the superior lobe of the left lung only. Moist friction sounds over nearly the whole of the left lung could be heard, together with bronchial respiration, and, at some circumscribed parts, a very coarse crepitation. On the right side the vesicular murmur was rather faint, and greatly obscured by bronchial respiration. On October 21st, there was less pain and dyspnœa, very little cough, with a soft infrequent pulse, pale countenance, and increasing dullness on percussion over the right side. Towards the latter part of the day there was less drowsiness. The patient died at half-past eight o'clock, on October 22d, 1864. He was perfectly sensible and rational within ten minutes of his death. A post mortem examination was made three hours afterwards. Cadaveric rigidity was strongly marked; the skin of the chest and face was of a deeply jaundiced hue. On making an opening into the chest, about twenty ounces of yellow serum was found in the left pleura, none in the right. The pleural cavities of both sides, but particularly the left, were covered to a considerable extent with coagulable lymph of considerable firmness. The left costal and pulmonary pleural were bound strongly together by broad, thick bands, the result of some former disease. There were also a few much less firm attachments on the right side. The lower lobe of the left lung was in a state of gray hepatization, the upper lobe in that of red hepatization, and in both, at various points, were found circumscribed deposits of pus, containing from one-half a drachm to a drachm each. The lower lobe of the right lung was in a state of red hepatization, and the middle and upper lobes were greatly congested. In the lower lobe were found two or three purulent deposits, which appeared to form centres of inflammation, or metastatic foci. The wound along the scalp appeared as during life. Pus was found along the coronal and sagittal sutures, throughout the whole extent, dissecting the scalp from the bone, to the breadth of one inch. The skull was roughened, and deprived of pericranium to that extent. The portion of the wound which had been originally denuded had begun to exfoliate, a line of separation being visible around it. On removing the calvaria, a thin layer of pus was found between the bone and dura mater, extending along the sagittal and coronal sutures to the same extent as on the external surface, the amount of pus within the skull being less than one drachm. There was a narrow strip of the dura mater each side of these sutures which was inflamed; at other parts this membrane was healthy. The arachnoid and pia mater were perfectly normal. The brain and its ventricles, the cerebellum, medulla oblongata, and roots of all the cerebral nerves, were carefully examined, and no lesions were discovered. The heart and its valves, the vena cava and azygos, the pulmonary veins and arteries, the jugulars, and the blood-vessels of the brain, were in a normal condition. The liver was apparently healthy. Acting Assistant Surgeon Cobb recorded the case.