Civil War Washington

CASE 941.—Private J. A. Murphy, Co. C, 17th Virgina, aged 20 years, was wounded at Williamsburg, May 8th, 1862, and was treated in a field hospital until the 17th, when he was sent to Cliffburne Hospital, Washington. Assistant Surgeon John S. Billings, U.S.A., made the following special report of this case: "He was wounded while in a kneeling pasition​; the ball entered the external aspect of the thigh five inches below the trochanter major, and then, passing upward and inward, lodged in the buttock of the opposite side. When admitted he was cheerful and comfortable, presenting no symptoms worthy of notice. May 25th: As he began to complain of pain and tenderness in the left natis, an incision was made and the ball found, after a little search, embedded in the fibres of the gluteus maximus. June 1st: He has been going on well up to this date, when a sudden and copious discharge of blood from the anus occurred. A weak solution of persulphate of iron was given in enema, which readily checked the hæmorrhage. Small Doses of opium were given internally, and the patient was restricted to milk diet. June 3d: Hæmorrhage took place from the wound made for the purpose of extracting the ball, and also from the rectum; the persulphate was again resorted to, and followed by an opium suppository, as he complained of intolerable tension and pain. Good nourishment was given, with one grain of opium and ten drops of tincture of iron every four hours. he perspired freely. Up to June 15th, he slowly and steadily improved; no more hæmorrhages taking place, and the discharges being natural, with the exception of containing, now and then, a small clot of blood. The wound made by the entrance of the ball had entirely healed; the discharge from the wound made to extract the ball was purulent and copious, but contained no blood. On the evening of the 14th, however, hæmorrhage occurred from the rectum, not very profuse, but sufficiently so, in his feeble condition, to utterly prostrate him. The same remedies were employed with the effect of checking the hæmorrhage, and beef-essence, brandy, etc., were given. June 16th: Has been very slightly improving up to this date, when hæmorrhage again occurred from the bowels, and he died in half an hour. Examination six hours after death: The ball was found to have passed upward from the point of entrance in the thigh. It entered the pelvis at the obturator foramen, passing directly through the rectum, broke off the spinous process of the ischium of opposite side, and lodged in the fibres of the gluteus medius. The bleeding vessel was one of the inferior hæmorrhoidal arteries; the space between the sacrum and rectum was filled with coagula; the recto-vesical fold was elevated and its peritoneal surface was dark in color. The autopsy was made by Dr. E. Curtis."