Civil War Washington

Bits of clothing driven into the bladder were ordinarily eliminated by the urethra or by the wound-canal; but in one instance, occurring in the practice of Surgeon D. W. Bliss, U. S. V., a foreign body of this description became the nucleus of a calculus.¹ This concretion is represented by FIGURE 4 of PLATE VIII. The facts of the case, as compiled from the reports of nine surgeons,² are as follows:

CASE 811.—Private Sherman E. Perry, Co. K, 16th New York, aged 27 years, was wounded near Salem Church, in General Sedgwick's advance at the battle of Chancellorsville, May 3, 1863, and made a prisoner. A conical ball penetrating his canteen, entered the groin, and, passing backward and to the right, made its exit at the right lesser sciatic notch, lodging under the skin. His body was inclined forward when he was struck, and he fell to the ground on receiving the wound, and believes that there was copious bleeding. He soon rose and walked forty rods to a small house. On May 7th, the ball was extracted by one of the medical officers of the 121st New York, who was also a prisoner, and who continued in attendance until May 12th, when Perry was taken with others to United States Ford, paroled, and delivered to the provost marshal, and placed under the care of Surgeon L. W. Oakley, 2d New Jersey, at the Sixth Corps hospital at Potomac Creek, who reported that no urine was passed by the urethra for eight days, but that blood and urine passed freely through the wound. Surgeon H. Janes, U. S. V., remarked that "the ball entered the left groin,³ passed through the bladder, and emerged through the right sciatic notch," and that "the urine passed through the anterior wound till May 29th, through a catheter kept in the bladder." At the end of May, Dr. Janes reports that the wound is now healing." On June 13th, the patient was sent to Washington on a hospital transport steamer, and entered Armory Square Hospital the same day. Surgeon D. W. Bliss, U. S. V., reported that the wound had nearly healed. A flexible catheter was constantly retained in the bladder for about four weeks previous to his admission, and continued for three or four days afterward, about which time, on withdrawing the catheter, a piece of blue cloth immediately followed, which was rolled upon itself, and was being very nicely encrusted with fine sand, serving as a nucleus for the formation of a stone. On June 21st, and after the introduction of a catheter, a small flat piece of bone passed through the urethra. It was well known that something yet remained in the bladder from the fact of his having pain and difficulty in urinating, and at times the urine would suddenly cease to flow; which condition of things continued until July 21st, when he experienced unusual pain in attempting to urinate, and the cause soon became apparent in the shape of a stone, measuring about three-fourths of an inch long and half an inch in diameter, which resembled a peanut more than anything else in size, shape, and color. He suffered very severe pain during its passage to the fossa navicularis, from which place it was extracted with a small forceps." On September 9th, the evidence of further deposits in the bladder being conclusive, and giving the patient trouble, Dr. D. W. Bliss, surgeon in charge, performed the lateral operation for stone and removed a soft calculus of a flat oval shape, three-fourths of an inch long, one-half inch wide, and one-fourth inch thick, the nucleus of which seemed to be cloth.⁴ Weight, twenty-three grains. "September 19th: The patient has done well up to date." On October 28th, the patient was transferred to New York, and admitted to DeCamp Hospital. Assistant Surgeon J. Sim Smith, U. S. A., reports him convalescent from a shot wound of the bladder, and furloughed October 31st. >Acting Assistant Surgeon Mason F. Cogswell reported Perry as admitted to the post hospital at Albany, November 3, 1863, with a "gunshot flesh wound of the abdomen," and as "discharged from service January 22, 1864." This soldier was pensioned. Examiner J. B. Smith, of Washington, reported, April 2, 1864: "Ball entered above left pubis, perforated the bladder and pelvis, and passed out of the right buttock. Operation for stone, in the bladder was done, and the nucleus found to be a portion of dress carried thither by the ball. He has now lameness of the right lower limb and incontinence of urine. General health good; disability two-thirds; will probably improve." Examiner C. C. Bates, of Potsdam, reported, September 12, 1865: * * "There is lameness in the back, extending down the left thigh as far as the knee; the left thigh has a palsied feeling, he has never been free from a burning pain extending from the scar in the left groin into the bladder; hips are very weak; the bodily health otherwise pretty good." The same examiner reported, November 29, 1869, that this pensioner suffers severe pains, every two or three weeks, in the abdomen, and excessively severe in the bladder and urethra, extending to other parts while passing water. There is always much trouble in urinating, and during these exacerbations he can neither lie, sit, nor stand still. He has used uva ursi infusion every day during the past year, consuming nearly five pounds of the leaves. His urine leaves always a whitish sediment, and sometimes contains pure blood. All these symptoms have increased since his discharge. The disease is permanent. * * He works a little at the carpenter's trade. * * The paroxysms last several days." On September 10, 1872, the same examiner reports that this pensioner "has chronic cystitis, following gunshot wound of the bladder. Frequently the pain in making water becomes intense and burning. The kidneys are now diseased. * * The pensioner's habits are correct." On September 5, 1873, Examiner S. L. Parmelee, of Gouverneur, after describing the wound and operation, adds that this pensioner "still has symptoms of stone; occasionally passes blood; a good deal of sediment in the urine; also tenderness of the abdominal scar, and of the inside of the thigh. His disability continues total."

¹ Examples of calculi formed about cloth or textile fabrics are extremely rare: 1. NICOLAS TULPIUS (Obs. med., 1716, Lib. III, Cap. IX, p. 195) relates the case of a West Indian youth, who had been gored by a buffalo in the hypogastric region, with lesion of tho bladder. The wound healed, but calculous symptoms supervened and lithotomy was performed, and a stone removed having as a nucleus a piece of lint, a part of a tent used in dressing the lacerated wound. 2. HUTIN (Mem. sur la nécéssité d'extraire les corps étrangers, 1851, p. 16, Obs. IV) relates the case of Marsat, shot, in 1808, above the right pubis, the ball perforating the bladder and emerging at the left buttock. Urine passed at first through both wounds, which afterward gradually closed. In 1827, PASQUIER, aided by YVAN, practiced lithotomy and removed three calculi, each with a piece of cloth as a nucleus.

² Portions of the history of this case have been published by W. H. BUTLER, M. D. (Buffalo Med. and Surg. Jour., 1864, Vol. III, p. 459), and republished by H. A. ROBBINS, M. D. (Am. Jour. Med. Sci., 1868, Vol. LV, p. 124).

³ Surgeon H. JANES, U. S. V., and Pension Examiners T. B. SMITH, H. C. BATES, and S. L. PARMELEE state that the ball entered the left groin, which is, doubtless, true (see Cat. Surg. Sect., A. M. M., 1866, p. 493). Acting Assistant Surgeons W. H. BUTLER and H. A. ROBBINS describe the entrance orifice as on the right side. Drs. BLISS, J. S. SMITH, and M. F. COGGSWELL do not specify the point of entrance.

⁴ This specimen consists of a flattened ovoid vesical calculus measuring ¹²/¹⁶ X ¹⁰/¹⁶ X ⁶/¹⁶ inches, and weighing 23 grains Troy. Its exterior is of a light reddish gray color, compact, and smooth, but extremely soft and granular. It has been broken open and is seen to be composed of a nucleus and one coat. The nucleus comprises about one half of the whole calculus, and is composed of matted cotton cloth mixed with crystals of triple phosphate. (Mic. Spec. No. 161, S. S.) The coat of the nucleus is made up of numerous concentric laminæ, and is very friable. It agrees with the description of the exterior in physical characters. A small quantity heated on platinum blackened but cleared up with little loss, and dissolved in hydrochloric acid without effervescence. The solution nearly neutralized by ammonia, and heated with oxalate of ammonia, gave no precipitate. Under the blowpipe it is infusible. A fresh portion was insoluble in boiling water and liquor ammonia, but was entirely soluble in acetic acid, from which it was precipitated by ammonia as a gelatinous deposit containing numerous crystals of triple phosphate.—(Mic. Spec. 162, S. S.) (Spec. 1687, Surg. Lect.)

Plate VIII. VESICAL CALCULI REMOVED AFTER SHOT WOUNDS. Fig. 4. Dr. D. W. Bliss's Case. (Spec. 1687)