A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office.
- Date:
- 1871
Licence: Public Domain Mark
Credit: A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![of the bowels and complete paralysis of the bladder. His miud was clear, and sensation was normal over the face and upper portion of the chest; respiration abdominal and slow; pulse slow and regular. Although the skin and extremities were hot to the touch, the patient complained of coldness of the surfixce. The track of the bullet could not be ascertained, as the wound had nearly healed; but from the symptoms described above, which were present immediately after receiviug the wound, it was surmised that the spinal cord had been injured. During the first week of his treatment in the hospital there was no perceptible improvement in the paralysis. A large bed-sore formed over the sacrum. Mucus accumulated constantly in the lungs, threatening suffocation, which was averted by the use of stimulant expectorants. The bowels were relieved by injections and purgatives, and the bladder by the catheter; otherwise the treatment was expectant. During the second week there was a partial recovery of motion in the right arm, but none of sensation; the patient could by an effort draw his arm across his breast; oedema of the left leg set in, and was managed by bandaging. During the third week there was no improvement; permanganate of potassa, charcoal, and Peru- vian bark poultices were applied to the bed-sore, which was large and sloughy. During the fourth week, on the suggestion of Dr. A. K. Smith, iodide of potassium, and afterward tincture of ergot, were used, and the patient improved perceptibly. The mucus diminished in quantity, expectora- tion became easj^, and the appetite increased. During the first part of the fifth week, improvement was very encouraging. The bed-sores looked healthy, and improved under the alcoholic applica- tions, the appetite remained good, bowels acted readily, and respiration became more normal. On Friday, November 20th, the patient complained of stiff neck, headache, and extreme coldness, and toward night had a slight fever. On Saturday, the 21st, the fever had disappeared, but he still complained of coldness and headache, and I diagnosed that suppuration had set in. On Sunday morning I found the patient comatose, with the left pupil dilated, and the right pupil contracted. A blister was applied to the nape of the neck, purgatives, »&c., given, but to no purpose; the patient died at 11.15 P. M. At the autopsy, fifteen hours after denth, j^ost-inortem rigidity present. On dissection of the muscles of the right side of the neck, it was ascertained that the bullet had passed directly from its point of entrance toward the spinal column, crossing the carotid sheath externallj, and just missing it. A probe i^assed through its course, impinged against the spinal cord, through the third right condyloid foramen of the cervical spine, which was patent, the nerve having been destroyed. Believing that the bullet would be found lodged in the canal between the third and fourth vertebra^, the cervical spine was opened, and, the bullet not being found, the dorsal and lumbar vertebra? were also included in the search, with a like result. Search was then made for the bullet among the muscles of the neck and scapular region, without finding it. The ])ossibility of the bullet having lodged in the body of one of the vertebra? was disproven, by boiling to fi'ee them from the soft structure; and a subsequent examination of the brain demonstrated that it had not lodged in that organ. The possibility of its having passed down the canal into the sacrum was not ascertained. The membranes of the cord and left hemisphere of the brain were found extensively disorganized from inflammation. Plastic lymph, forming a continuous layer, was found effused on the visceral surface of the dura mater of the cord throughout its entire length. The sub-arachnoid space was distended with a pyoid serum, by which the cord was comi)ressed and softened opposite the third and fourth cervical vertebra?, and, corresponding with their posterior faces, the dura mater was ecchymosed, and separated from the bone. This was a point of great interest, taken in con- nection with the supposed course of the bullet. The effusion of plastic lymph had extended into the brain, and, with the exception of the base of that organ, was confined to the left hemisphere. In the left anterior lobe of this hemisphere circumscribed softening was found, presenting the appearance of an abscess. The base of the brain was also the seat of effusion of plastic matter, which extended as far forward as the optic commissure. The gray substance of the left lobe of the brain had evidently been involved in the inflammatory process, being changed in color and consist- ence. The medullary substance was injected, the lateral ventricles were marked by radiating blood-vessels. The corpora striata and thalami optici were injected. LXI.—Memoranda of Fire Cases of Gunshot Wound of the Nccl: {Condensed from lleports). I'rivate John r>ut]er, Co. F, 10th Cavalry; Colorado Territory; January 9, 1801); gunshot flesh-wound of left side of iu>ck. l^uty, February 13, 1869.](https://iiif.wellcomecollection.org/image/b21970695_0032.jp2/full/800%2C/0/default.jpg)
