Civil War Washington

CASE 1106.—Corporal J. Quick, Co. G, 38th New York, aged 21 years, was wounded in the face, at the, battle of Fredericksburg, December 13, 1862, a ball passing behind the left, condyle of the lower jaw and making its exit on the left side of the nose. The wounded man was admitted to Eckington Hospital, at, Washington, five days after receiving his injury, his face being very much swollen on the left side and the left eye being closed but uninjured. The treatment consisted of rest, aperients, low diet, and lead-wash locally. No fever ensued, the swelling abated, and the patient did very well until December 25th, when secondary hæmorrhage occurred at 4 P. M. The blood gushed from his mouth and left nostril, amounting to a quart in a few minutes. Acting Assistant Surgeon H. N. Fisher, assisted by Acting Assistant Surgeon A. Edelin, quickly plugged the nares with bits of muslin strung on threads and thrust into the nostril, which promptly stopped the hæmorrhage. It occurred again, however, and was controlled by thrusting in more of the tampon. The patient slept pretty well all night, being carefully watched and having his head well elevated. At 10 A. M. on December 26th he commenced bleeding again, the blood spouting from the wound at the side of the nose. A compress then applied over the orifice, and snugly bandaged, controlled the hæmorrhage. On the morning of the following day the patient had another free attack of hæmorrhage, but it was promptly checked by increased pressure on the compress, after which, on consultation, it was determined to tie the common carotid artery. Acting Assistant Surgeon Fisher accordingly ligated that vessel just above the omo-hyoid muscle, the patient not being etherized. The plugs were then removed from the nostril and the compress from the face, and no hæmorrhage recurred. The patient was put to bed, and the face and fresh wound were dressed with cold water. With the aid of an anodyne the patient slept well during the following night. The next morning his pulse was 120, a very slight pulsation being detected in the left temporal artery and that side of the head preserving its warmth. He was now also afflicted with diarrhœa, the discharges being thin and light colored. Beef tea and stimulants were ordered. On December 30th the pulse had increased to 150; patient's mind wandering; very restless; diarrhœa still continuing. Opium pills were now prescribed and the stimulants continued. On January 2, 1863, the patient was quite insensible, but gave answers when aroused; diarrhœa still continuing; stools frequent and involuntary; skin cold; pulse 140 and weak; wound looking sunken and glassy. In addition to opiates vegetable astringents were now ordered. Being unable to swallow solids and feeling choked by swallowing liquids, he was ordered oysters, which he ate greedily and swallowed readily. On January 4th the patient was still in a stupor; skin cold; pulse 146; some little redness about wound of face; wound of neck suppurating. In the afternoon a sanious discharge came on from the place of operation, giving reason to fear hæmorrhage from the artery. Ihe oozing from the neck continued, and the patient's condition was about the same on the following day until 2.30 P. M., when the attending surgeon was called in haste and found that the carotid had given way and the blood was gushing per saltum from the wound. Death supervened in a few minutes. At the post-mortem examination the artery was found to have ulcerated through anteriorly where the ligature was applied. No attempt at union of the inner coats of the vessel was discovered, and no fibrinous deposit was found on the cardiac side, it having doubtless been forced out by the hæmorrhage. The distal side was, however, occupied by a plug extending up to the bifurcation of the vessel. The history of the case, together with the injured portion of the ligated artery (Spec. 898), represented in the annexed cut (FIG. 421), was contributed to the Museum by the operator.