Civil War Washington

CASE 1827.—Private A. N. Perkins, Co. K, 2d Connecticut Heavy Artillery, aged 35 years, was wounded at Cold Harbor, June 1, 1864, and admitted to the field hospital of the 1st division, Sixth Corps, where Surgeon R. Sharpe, 15th New Jersey, noted: "A gunshot wound of the left elbow." On June 7th, the wounded man entered Lincoln Hospital, Washington, and four days afterward he was transferred to Patterson Park Hospital, Baltimore, where he underwent excision of the elbow joint. Acting Assistant Surgeon G. W. Fay, who performed the operation, furnished the minutes of the case as follows: "The ball entered near the external condyle of the humerus and lodged in the joint. The missile was removed soon after admission. June 30th, patient suffers very much from great swelling and inflammation of arm, and has a bed-sore over the sacrum. Made an incision in the arm near the elbow, which discharged about a pint of pus. Applied bread and milk poultice, and prescribed tincture of muriate of iron, fifteen drops three times a day. July 16th, the swelling and inflammation is so much diminished as to admit of an operation. Administered chloroform, and exsected​ from lower part of humerus two and a half inches, and from the radius and ulna each one and a half inches. Made a vertical incision about seven inches long. August 1, patient suffers much from bed-sore, which is more weakening than the wound itself. The incision is nearly healed. Patient has stealthily procured and eaten unripe pears, causing pain and vomiting followed by diarrhœa. August 3d, had two chills to-day, one in the forenoon and the other past noon. Prescribed two grains of sulphate of quinine thrice daily. August 9th, chills are arrested; there is now pain in right side of chest, with a cough. Prescribed a mixture with squills. August 11th, pain in right breast continues; dullness on percussion over right lung; pulse rapid; cough. Expectorates a thick tough mucus. Ordered a prescription of sulphate of morphia two grains, diluted hydrocyanic acid ten drops, syrup of squills one-half ounce, and mucilage of gum arable two ounces, to be given in teaspoonfuls every four hours. August 12th, patient very feeble; former symptoms continue; alternate cold sweats and paroxysms of fever; administered stimulants. August 13th, patient died. Autopsy: On opening the chest, the right pleural cavity was found to contain about thirty-four ounces of yellowish serum. The lower lobe of the right lung was congested, and a large ulcer near its apex had discharged pus into the thoracic cavity. There was also a small ulcer at the apex of the left lung. The examination of the arm at the seat of operation disclosed that the lower end of the humerus had become deprived of periosteum, subsequent to the operation, for a space of about one and a half inches. This part had become encased with an osseous substance, which completely protected it from the soft parts. In other respects all parts adjacent to the operation had healed favorably." The excised bones of the elbow joint were contributed to the Museum by the operator, and show (FIG. 3, PLATE LI, opposite p. 872) the articular surfaces to be destroyed by suppuration. The line of section in the shafts of the bones of the forearm are very oblique. The outer condyle and head of radius had been fractured and were removed. In the specimen the olecranon has been divided.—Cat. Surg. Sect., 1860, p. 156, Spec. 3466.