Civil War Washington

SMITH, WILLIAM, Private, Co. G, 4th New York Heavy Artillery, aged 18 years, was wounded, at the battle of Hatcher's Run, Virginia, March 31st, 1865, by a conoidal ball, which caused a contusion of the left parietal bone. He was, on the following day, admitted to the hospital of the Second Corps. On April 5th, he was transferred to the Emory Hospital, Washington, D. C., and on April 9th, sent to the Cuyler Hospital, Philadelphia, Pennsylvania. On admittance no osseous lesion could be detected. The case progressed favorably until April 16th, when the patient had two or three slight convulsive paroxysms, lying in a somewhat soporose condition during the intervals. He afterwards became delirious, and finally almost completely comatose. The muscles of the left side of the body were observed to be in a state of spasmodic contraction, and a large collection of pus formed beneath the left side of the scalp, anterior to the wound, and was opened on April 29th. The pathological condition was supposed to be, that an abscess, resulting from the original shock to the brain substance, was exciting irritation, and would probably eventually burst into one of the lateral ventricles. Mercurials, tartarized antimony, and the fluid extract of veratrum viride were exhibited internally, while the head was kept somewhat elevated. Death ensued on the night of April 30th, 1865, one month from the reception of injury. An autopsy was made about fourteen hours after death, with the following results: there was no fracture of the skull to be detected when the scalp was removed, and the bone was not bared beneath the abscess, which has been described as having formed a few hours before death, but was manifestly necrosed just below the original wound. On removing the skull cap it was found that a plate of bone, about one inch long and three-quarters of an inch broad, had been separated by exfoliation from the inner table, and was adherent to the dura mater immediately beneath the position of the original scalp wound. The brain was removed with the membranes entire, but a moderate quantity of blood and serum being found beneath the dura mater and the skull. On reflecting the dura mater of the right hemisphere, the arachnoid over the middle lobe of the cerebrum was found to be acutely inflamed, presenting an abundant deposit of soft coagulable lymph. The membranes of the left side presented merely a slight pearliness, and the adhesion of the dura mater to the sequestrum, already referred to. The brain substance on the right side was healthy; on the left side, it was softened beneath the position of the wound, and, at the depth of about three-quarters of an inch, was a small abscess, not larger than a small hickory-nut. All other parts of the body examined appeared normal. The muscular contraction on the same side of the body as the wound was now accounted for by the existence of intracranial disease upon the opposite side. The case is reported by Henry S. Schell, Assistant Surgeon U. S. Army.