Civil War Washington

CASE 567.—Private C. H. S——, Co. E. 2d Michigan, aged 17 years, was wounded at Petersburg, June 17, 1864, and was taken to the Ninth Corps Hospital, where it was found that a ball had entered two inches above and to the left of the ensiform cartilage, and passed out in the left hypochondriac region. The injury was regarded as a flesh wound, and the patient was sent to Washington, entering Emory Hospital June 24th. Acting Assistant Surgeon E. B. Harris reports that " he was much exhausted, on his arrival, from loss of blood and exposure in transit to this point. Pulse 98 and feeble; skin hot; bowels constipated; urine scanty and high colored. There was slight hæmorrhage when the patient arrived in hospital, and extensive ecchymoses and swelling of the left side, extending to the axilla [interstitial hæmorrhage], attended with some difficulty of breathing." * * "The patient was bathed and cleansed, and placed in bed, with the wound in a depending position and dressed with iced water. The bowels were opened with sulphate of magnesia; spirits of nitric ether, with a nourishing diet and stimulants, and an anodyne at night, were directed. On June 25th, the patient had slightly improved, having rested quietly during the night; bowels opened; cold-water dressings continued, with laxatives. On June 27th, the wound was discharging slightly a very offensive matter. On June 30th, the wound discharged pus with slight traces of blood; no abatement of swelling in the side; breathing more free. On July 1st, the swelling of the side was less, the breathing easier; the cold water dressings were continued, and nourishing diet and stimulants were given. On July 2nd, the wound discharged pus and blood; treatment continued, with anodyne at night. On July 3rd, in the morning, the patient was apparently improving. At two in the afternoon, secondary hæmorrhage set in profusely, and was supposed to proceed from branches of the internal mammary artery; patient lost considerable blood; his countenance was sunken, with a haggard expression; breathing short and hurried; bowels tympanitic, and the meteorism rapidly increasing; pulse 120 and feeble; ice-water dressings were applied, and sponges saturated with the solution of the persulphate of iron were passed into each wound, and compresses applied over them; stimulus was given and the patient kept on his back." [These measures appear not to have controlled the bleeding.] Dr. Harris resumes: "On July 4th, no particular change; some hæmorrhage again; no change in treatment, save repeating the compression and persulphate of iron to suppress the bleeding; gave a mild laxative to open the bowels in hope of removing the tympanitis​, which was accomplished, with relief to the difficulty of breathing. On July 5th, on exposing the wound, there was no bleeding; gave stimulants, with nourishing food, and an anodyne at bedtime. On July 6th, at three in the morning, hæmorrhage set in, and the patient expired in a very few moments. Post mortem: The ball had made furrows through the cartilages of the fourth, fifth, and sixth ribs, and, passing down, had carried away portions of the seventh and eighth ribs, and passed out opposite the spleen. Found that the hæmorrhage must have been produced from the musculo-phrenic and superior epigastric arteries, as their mouths were exposed. Found the pericardium altered from the diseased parts contiguous to it, and also partially filled with blood. Also found the transverse portion and upper part of the descending colon were gangrenous; also a portion of the peritoneum contiguous to the wound and diseased parts. There was extensive inflammation of the soft parts extending to the axilla. The lower part of the left lung and parts contiguous were highly congested. There were traces of a nutmeg appearance in the left lobe of the liver, which was slightly inflamed. The stomach, heart, right lung, and the upper part of the left lung were normal in appearance;. There was also found a mass of coagulæ, pus, spiculæ of bone, and pieces of cartilage in a sac between the points of entrance and exit of the ball. A preparation of the anterior extremities of five ribs, the fifth to the ninth inclusive, with the costal cartilages, was forwarded to the Museum by Surgeon N. R. Moseley, and is mounted as specimen 2809. "The seventh and eighth ribs are fractured at their extremities, and are necrosed."—(Cat., p. 77.)