Civil War Washington

FARNHAM, NOAH L., Colonel, 11th New York Volunteers (1st Fire Zouaves), was wounded, at the battle of Manassas, July 21st, 1861, by a musket ball, which made a superficial forward wound over the left parietal. He was much stunned, and fell from his horse. He was conveyed to the E Street Infirmary, Washington, and placed under the care of Assistant Surgeon W. J. H. White, U. S. A. The wound healed promptly, and his condition was hopeful until August 10th, when grave cerebral symptoms appeared, terminating in hemiplegia, followed by coma and death on August 14th, 1861. At the autopsy, made by Assistant Surgeon J. W. S. Gouley, U.S.A., an abscess, the size of an English walnut, was found at the seat of injury, with extravasation of blood in the neighboring sulci of the brain. The following description of this case was prepared by Surgeon John A. Lidell, U. S. V.:⃰

* * * "It cannot be doubted that, in at least some instances, this ecchymosis, this extravasation of blood beneath the visceral arachnoid membrane into the meshes of the pia mater (connective tissue), denotes a genuine contusion of the brain or spinal cord, as the case may be; and that, in this way, a positive pathological lesion, perceptible to the unaided vision, is superadded to the concussion. These cases of concussion, complicated with contusion of the nerve tissue, when the cerebrum happens to be the part involved, exhibit a marked tendency to the occurrence of meningo-cerebral inflammation and cerebral abscess. The following case strongly corroborates this statement: * * Colonel Farnham, of the New York City Fire Zouaves, was wounded, at the battle of Manassas, July 21st, 1861, by a spent ball, which hit his head and knocked him off his horse. He was picked up insensible. The wound was small in size, superficial in character, and situated on the left side of the head, three inches above the meatus auditorius. It healed without any difficulty. The principal symptoms in his case, until near the close, were referable to concussion and irritation of the brain. He died on the evening of August 14th, twenty-four days subsequent to the infliction of the injury. It was thought that he would recover, until about four days before death. He was partially paralyzed on the right side (hemiplegia) toward the last. He was comatose in the last moments. At the autopsy, made August 15th by Doctor Gouley, U. S. A., we found that the external wound was superficial; that the skull was not injured; that there was copious subarachnoidian effusion; that there was an unusual quantity of yellow-colored serum in the ventricles, and that there was an abscess of the cerebrum, situated directly beneath the wound of the scalp. This abscess was about the size of an English walnut, superficial in situation, and surrounded by softened cerebral tissue. The visceral and parietal arachnoid over the abscess were glued together, to some extent, by adhesive inflammation, so that, in endeavoring to turn back the dura mater while making the autopsy, though it was carefully done, the abscess was torn open. There were also traces of an extravasation of blood, three or four weeks old, in the sulci of the brain, beneath the visceral arachnoid membrane over the seat of the abscess, and likewise at the anterior extremity of the left cerebral hemisphere. There was a flattened clot of blood, black in color, and apparently three or four weeks old, in the fossa, at the base of the middle lobe of the left cerebral hemisphere. The dura mater, in relation with it, was somewhat thickened, roughened, and opacified." * * *

Medical Inspector F. H. Hamilton, U. S. A., has described this case as follows:†

"First, I would remark, that you may have an injury of the scalp of an exceedingly trivial character, which may, in the end, prove fatal. A ball may simply tear off the hair of the scalp, and create a very slight abrasion of the skin, yet, the bone being so near, and the brain so close to the bone, it is very probable that serious mischief has been done. The bone in that situation may be so injured as to lead to necrosis, or a sufficient shock may be given to the brain and its envelopes to bring on inflammation. I will mention a very remarkable illustration of this fact. Colonel Farnham, after the death of Colonel Ellsworth, took command of the 1st Zouave Regiment. At the battle of Bull Run, July 21st, 1861, he received an injury of the character referred to, and which I examined myself. It was a very slight and superficial wound, which seemed to have taken off very little more than the hair. He was transferred from the field to the Washington Infirmary, where he was reported as doing very well, the wound being considered as a very slight and insignificant one; but, notwithstanding all this, he kept his bed. He did actually seem to be improving until about the ninth day after the reception of the wound, when grave symptoms suddenly supervened, and, in a day or two after, he died. I should notice that, during all the time he was in the hospital, he was very easily disturbed by visitors, and it was his desire to be left alone, showing that there was some cerebral disturbance. I ought also to mention that he was ill before he received the wound, and was unfit to perform duty at the time the battle took place; but, being a gallant officer, he was determined to lead his regiment to the charge. But his previous condition I do not think had much, if anything, to do with his death, which, in my opinion, and in the opinions of many other surgeons who saw him, was due directly to the apparently slight wound which he received during the fight." * * "Next, I called your attention to those injuries of the scalp produced by smaller missiles; for example, where a rifle ball had slightly impinged upon the surface of the scalp, producing a slight abrasion of the integument, which accident is usually accompanied by some degree of concussion, either to the skull, to the meninges of the brain, or to the brain itself, and which I have said you are not to regard as trivial accidents. Although the patient may not seem to have suffered any severe injury, you are to anticipate that sooner or later there may be an ulceration along the track of the ball, or that there may result necrosis, or meningitis, or cerebritis, and that the patient may ultimately die. And I cited, as an illustration of injuries of this class, the case of Colonel Farnham, who assumed command of the Ellsworth Zouaves after the death of Colonel Ellsworth. He received an injury of such a character, which was exceedingly slight and superficial. I saw him myself, and examined him particularly, and all that was visible was a very trivial scalp wound. He was taken into a hospital in Washington, and there I saw him again, at the expiration of seven or eight days. He was then very irritable, and had been quite ill, but still his friends all thought that his recovery was certain. Three or four days after this, if I remember correctly, the symptoms became more grave, and he died, evidently from the injuries which his brain had received." * * *

⃰ American Journal of the Medical Sciences, vol. xlviii, p. 323.

† American Medical Times, vol. viii, pp. 73-85.