Civil War Washington

CASE 525.—Sergeant James A. B——, Co. I, 8th Illinois Cavalry, aged 29 years, of good constitution, was admitted to Stanton Hospital, September 25, 1862, with a shot wound of the abdomen, received on September 22d at Jack's Shop near Madison, Virginia. The ball entered just below the margin of the last right rib. On admission, the wound presented a ragged appearance. He complained of pain in the abdomen, which was tympanitic; the bowels were constipated; pulse 130 and quick, respirations thoracic and 26 per minute; the expression of countenance was natural. His urine contained blood. He was ordered a grain of opium every three hours, and beef-tea at discretion, and simple dressings to the wound. On the 26th the condition was unchanged; the dose of opium increased to two grains every two hours; the urine continued bloody. On the 27th he appeared somewhat better; pulse 120, respirations 22. On the 29th the bowels moved spontaneously; the stool contained some blood. On September 30th, in the morning, the pulse was 116, respirations 20. At five o'clock P. M., the abdominal pain and tympanitis​ had increased; pulse 120, respirations 22; his countenance expressed great anxiety. Resumed two grains of opium every two hours. On October 1st the patient was much easier; pulse 116, respiration 18; tympanitis​ and pain diminished. In the afternoon, he had an evacuation from the bowels containing blood. At five o clock P. M., the pulse was 110, respirations 14. On October 2nd the patient's appearance was improved, but he was somewhat drowsy; the pupils were not contracted; pulse and respirations unchanged in frequency. On the morning of October 3rd the pupils were contracted to one-half their natural size; pulse 110, respirations 11; tympanitis​ slight; drowsiness marked. On the 4th, in the morning, the pulse was 120, respirations 12; tympanitis​ increased; ordered a third of a grain of sulphate of morphia every two hours. In the afternoon, the pulse was 130 and feeble, respirations 14; tympanitis​ augmented since morning; pupils not contracted; the patient was sinking. Morphine continued, with sherry added, one-half ounce every two hours. On October 5th the pulse was 128 and feeble, respirations 18, and much embarrassed; morphine continued; allowance of wine doubled. At six o'clock P. M., pulse 136 and scarcely perceptible, respirations 22. He died at midnight. Autopsy, eighteen hours after death: the body emaciated; the abdomen protuberant; a large ragged wound about one inch in diameter, in the right hypochondriac region, immediately below the margin of the ribs. On opening the thorax, the heart and left lung appeared normal but forced somewhat to the left by a large effusion of blood into the right pleural cavity. The lower lobes of the right lung were compressed and flattened, and sections immediately sank in water. Both the pulmonary and costal pleura were covered with a thick layer of whitish-yellow, recent lymph. An abscess which had formed between the oblique and transverse abdominal muscles had burrowed up under the right crus of the diaphragm and opened into the right pleural cavity. The liver appeared normal; the intestines and stomach distended. The great omentum and mesentery loaded with extravasated blood of a dark color. Immediately below the caput coli was a large abscess, which burrowed along the psoas magnus, and down among the muscles of the back. It was lined throughout by a thick layer of false membrane, and, in its lower part, immediately against the sacrum, was found a cylindro-conical ball, somewhat flattened. It had, in its course, perforated the ascending colon and lower end of the right kidney, and fractured the transverse process of the third lumbar vertebra. The kidney presented a ragged wound at the lower end; the surrounding cellular tissue had become much thickened, and lined by a layer of lymph, forming part of the wall of the abscess. The kidney, on section, appeared of a pale-pink hue and granular, softened and flabby, the pyramids almost entirely effaced, except one, at the upper extremity, which was of a dark brownish hue; its tubes were distinct; the pelvis was of a greenish color, its veins much distended with blood. In the accompanying wood-cut (FIG. 126), the ball is represented in the direction in which it traversed the kidney, not in the locality in which it was found.

¹ LIDELL (J. A.), Injuries Of the Abdominal Viscera by Firearms, etc., in Am. Jour. Med. Sci., 1867, Vol. LIII, p. 356.