Lieutenant Charles H. Evans, 55th Regiment, aged nineteen years, was
wounded on the evening of the 5th of August, 1855, about eleven o’clock
P.M., while on duty in the trenches. The ball entered the right side of
the neck, close to the angle of the jaw, and passed apparently between
the hyoid bone and the arytenoid cartilages, and then downward, having
its exit below the cricoid cartilage on the left side. The pharynx
and larynx were wounded, and the trachea was contused and displaced.
Respiration somewhat hurried; a quantity of mucus collects in the
trachea, and is expectorated in fits.
About seven o’clock P.M. of the 6th, the respiration becoming more
difficult, with a degree of lividity of the lips, indicative of the
non-oxygenation of the blood, it was deemed advisable to have recourse
to tracheotomy, which, in consequence of the displacement of the parts
and the swelling, was effected with considerable difficulty. The
usual tubes were found too short for the purpose, and a large silver
catheter was inserted, through which the air passed freely. Whenever
he attempted to drink, the liquid passed into the trachea through the
openings caused by the ball. From the operation no benefit arose, and
he continued very restless until within an hour of his decease, which
took place about twenty-six hours after the receipt of the wound. The
voice was never heard above a whisper.
Post-mortem examination, twelve hours after death. The ball would
appear to have passed through the hyo-thyroid membrane, fracturing and
shattering the thyroid cartilage. The membrane lining the glottis was
torn and destroyed. The vessels escaped without injury, the ball having
passed anteriorly.
ARCHD. GORDON. M.D.,
_Staff-Surgeon, 1st Class, in Med. Charge, 2d Division_.
Camp before Sebastopol, September 3, 1855.
Deputy Inspector-General Taylor, who was present during the operation,
adds: “The want of a longer tracheal tube than is commonly supplied
for such operations was obvious, and is a good practical hint. For
the first time in my life I found my two forefingers transfixing a
man’s neck from side to side. The fingers did not cause any cough or
irritation, but those symptoms were occasioned by the least attempt to
swallow water. The thyroid cartilage was separated into two pieces.”
The following cases, one of wound of the profunda femoris, the other of
the popliteal, deserve attention:--
Late in the afternoon of the 14th of August, Private George Irvine,
aged twenty-five, was brought from the trenches, having been struck by
a Minié-ball of the largest size, which had penetrated the left thigh,
about two inches below Poupart’s ligament, just in the course of the
femoral artery. The ball passed slightly outward, fracturing the femur,
and was cut out at the back of the limb, completely flattened. As there
was considerable hemorrhage, both venous and arterial, no examination
with the finger was permitted. Dr. Taylor, superintending the Division,
having been informed of the case, a consultation was held.
Amputation at the hip-joint was forbidden by the prostration of the
man, who had lost much blood before he was brought to camp. Excision
of the head of the femur was also inadmissible, from the evident wound
of a large artery, with probably that of a large vein. Search for
the wounded artery, for the purpose of applying a ligature, was then
determined upon, but before the operation had well proceeded, the
hemorrhage was so great that it was found impossible to continue it,
and pressure by means of graduated compresses was resorted to, with
complete success.
On the following morning an operation was still out of the question.
Prostration continued, with great irritability of stomach, and a small,
quick pulse. No return of hemorrhage, though the pressure of the
tourniquet was but very slight.
On the 16th, the pulse was more quick and irritable, with the same
irritability of stomach, and urgent thirst. He had passed a better
night, however. At the consultation this morning, the circulation
through the posterior tibial artery was so evident that the question of
the femoral artery being wounded was set at rest. It was decided, as
no return of hemorrhage had occurred, that the case should be left to
nature.
On the 17th, he suffered from starting pains in the thigh. There
was less irritability of stomach, but the pulse was very small and
weak. During the night there was slight hemorrhage, owing to his
restlessness, but it was easily arrested by a turn or two of the
tourniquet.
On the evening of the 20th, this restlessness increased; delirium set
in, and early in the morning of the 22d he died.
The limb was examined after death, when the following appearances
presented:--
Femoral artery intact. Femoral vein wounded, with more than half its
caliber shot away. At about two inches from its origin there was a
wound of the profunda artery, on which an aneurism, nearly the size of
a pigeon’s egg, had formed, and passed upward through the wound made
by the ball. The profunda vein was intact. The injured vessels having
been removed for preservation, the bone was then cut down upon, when a
fracture, nearly transverse, and not at all comminuted, was observed
below the trochanters. No splitting of bone upward; downward its outer
plate was slightly cracked, but nothing more. The preparation is in the
museum of the Royal College of Surgeons.
Private James Ross, a lad of eighteen, was brought up from the
trenches, on the morning of the 3d inst., having had his right
leg blown off below the knee by a round shot. He had lost a very
large quantity of blood before the tourniquet was applied, and was
consequently so much collapsed that an operation was out of the
question. He was therefore dressed and the tourniquets (two had been
put on) removed. He never rallied, and died on the 12th, nine days
after the receipt of the injury. No hemorrhage ever occurred, though
all pressure had been removed from the artery.
R. V. DE LISLE,
_Surgeon, 4th King’s Own Regiment_.
Camp before Sebastopol, Sept. 14, 1855.
The following is worthy of publication, as showing the successful
effects of strychnia, when carried to the extreme verge of propriety,
in injuries of the spinal cord.
Sergeant William Aldridge, 46th Regiment, aged 39 years, during a
sortie from Sebastopol, was knocked down in the trenches, and his back
formed a bridge over which Russians and English passed. The result was
serious injury to the spine, causing paralysis of the lower extremities
and bladder. The pain was excruciating, and the patient could not be
moved in bed for several weeks.
On the 4th of March, 1855, he was placed under my charge in the
military hospital at Portsmouth, when he complained of great pain
and tenderness along the spine, and incontinence of urine, together
with wandering day dreams and insomnolency at night. Solution of the
muriate of morphia ʒj was prescribed without any effect. (ʒj contains
1 gr.) The dose was gradually increased to ʒij of the solution.
15th March.--Fell out of bed during the night, trying to hide himself.
Is wandering, and fancies that he has deserted from the Crimea, and
will be shot. The narcotic has been omitted for several days. Strychnia
was now ordered, one-sixth of a grain three times a day.
20th.--Continues much the same, with slight twitchings of the face.
25th.--Has been unconscious for three days. Now complains of intense
pain in the back and violent cold perspiration.
28th.--Returning consciousness; feels easier, having slept
uninterruptedly for forty-eight hours. Expressed a desire to make his
will, and send to Dublin for his wife; both wishes were complied with.
30th.--Sensation and motion are gone from the lower extremities, and
the urine is still passed involuntarily. One-eighth of a grain of
strychnia was ordered twice a day.
31st.--Is powerfully under the influence of the remedy, with
convulsive movements of the upper and lower extremities; wild stare
and fixed jaws. The lower extremities had not moved for several months
previously. This paroxysm lasted for one hour under my own observation,
after which the muscles became relaxed, the face bedewed with a gentle
perspiration, and resumed its ordinary tranquil appearance.
April 2d.--Feels greatly relieved from pain, and is comparatively
comfortable; sleeps calmly. His appearance is entirely changed; looks
natural; features calm; is cheerful, and reads the papers. Strychnia
was omitted for some days after the last paroxysm, and replaced by the
tincture of the sesquichloride of iron with quassia, and a generous
diet.
6th.--Continues to improve. Has now and then slight twitchings in the
legs and arms. The strychnia was resumed and omitted, as the symptoms
indicated, to the end of the month.
May 1.--Is greatly improved; goes about the balcony in a chair.
Returning sensation in the right leg. Bladder still not under the
control of the will.
20th.--Sensation much improved in both legs, and motion increasing in
the right leg.
25th.--Convulsive movements all over the body, resulting from the use
of the strychnine. Lower extremities decidedly improved both in motion
and sensation.
June 1st.--Maintains his improved condition. Recommenced the strychnine
to-day, without any marked effect at the moment.
10th.--Violent tetanic spasms followed the employment of the remedy,
producing considerable increase of motion in both extremities. The
paroxysms _usually_ continue about fifteen minutes, when the muscular
system resumes its ordinary appearance.
20th.--Continues the same. Strychnia not resumed since last entry, as
occasional twitchings occur about the head and face, and he is now
affected by the smallest dose.
July 1st.--General health excellent.
10th.--Continues to improve daily in regaining the use of his limbs.
Is now able to walk on the ramparts with crutches, but is exceedingly
sensitive to every change of weather--damp always causing pain in the
spine. Continued to improve to the end of the month.
August 1st.--No change worthy of note.
14th.--Discharged to Chatham.
T. H. BURGESS, M.D.,
_Military Hospital, Portsmouth_.
The following case of injury of the abdomen, sent to me by Dr. Rooke,
civil surgeon with the army in the field, is very remarkable:--
Robert Cousins, aged 20, 77th Regiment, was admitted into the general
hospital, camp, June 8th, with severe injuries caused by a round shot,
which struck him when he was on duty in the advanced trenches. When
the shot struck him he was standing up, half-face toward the enemy,
his right arm extended in front of the right hip; he was in the act of
reaching his water-can, which rested against the parapet of the trench.
On admission he was in a state of semi-collapse, the integuments of
the right hand and forearm greatly lacerated, the wrist-joint laid
open, the bones of the carpus comminuted; the radius and ulna were also
fractured at the middle third. There was a lacerated wound in the right
iliac region, the size of the palm of the hand; over this space the
skin and muscles of the abdominal wall were torn away, the peritoneum
lining it was also lacerated, and at the bottom of the wound was seen
a coil of intestine in situ; there was no tendency to protrusion, nor
were its coats at all injured. The crest and body of the ilium were
much comminuted, the fracture extending downward between the anterior
superior and anterior inferior spinous processes. The anterior superior
spinous process was broken off. There was another wound just below the
great trochanter; this apophysis was also shattered. The right limb
was two inches shorter than its fellow, the foot everted, but, from
the great comminution of the pelvis and the extreme pain produced by
examination, it was not satisfactorily made out that the neck of the
femur was fractured, but the shortening of the limb and eversion of the
foot were in favor of that diagnosis. The injuries which the patient
had received were considered mortal; it was thought unnecessary cruelty
to amputate the forearm. Such pieces of the ilium as were loose were
removed; wet lint applied to the wounds; and brandy and water with
opiates were ordered. One of his comrades volunteered to watch over
him, and he was left, as all thought, to die. The next day (June 9th)
he had partially rallied from the state of collapse; had taken liquid
nourishment--beef-tea, arrow-root, etc. There was no pain or tenderness
of the abdomen; had passed his water without difficulty. The surface
of the abdominal wound was sloughy; intestine still visible; complains
of pain in the arm. It was not yet considered advisable to perform any
operation. He was ordered opium gr. j every four hours; also a dose of
morphia at night, arrow-root, beef-tea, and port wine, which he prefers
to brandy.
10th.--Has rallied completely; no pain or tenderness of the abdomen;
complains greatly of his arm, and is anxious that something should
be done. He slept well after taking the morphia; his face is
tranquil, breathing natural, pulse weak; no irritability. Deputy
Inspector-General Taylor saw the case in consultation with Dr. Mouat,
P. M. O. of the hospital. It was decided to amputate the forearm. This
was done at the upper third; chloroform was administered, and produced
no ill effects. He was ordered any fluid nourishment he might fancy,
with port wine, and an opiate at night.
11th.--No symptoms of peritonitis; suffers no pain; tongue clean
and moist; pulse quiet; passes his water regularly; the bowels have
not acted. The abdomen is quite soft and fallen, not the slightest
tenderness on pressure. To continue on the same plan. He could now give
some account of the way in which he was wounded. He stated that he
thought it must have been a round shot that struck him. It first struck
his arm, then entered the right iliac region, emerging at the lower
wound. The surface of the wound in the iliac region is in a sloughy
state from the severe bruising of the parts. The coil of intestine is
still visible at the bottom of the wound.
12th.--No symptoms of peritonitis; bowels have not acted; tenderness
down the outside of the thigh, with redness of the skin, and pitting
upon pressure. Stump dressed to-day and looking well.
13th.--No unfavorable constitutional symptoms. The outer part of the
thigh is tender and the skin red; free incisions were made; the fascia
was sloughy. He takes nourishment; has eight ounces of port wine daily,
eggs, arrow-root, and essence of beef. Bowels not acted.
21st.--He had no symptoms worthy of remark since the 13th. The bowels
have not been moved; he complained to-day of not being able to pass
his motions. Two injections of warm water were administered in the
course of the day. He passed a large quantity of hardened feces, which
relieved him greatly. The sloughs are separating from the incisions
in the thigh; the crest and ala of the ilium are exposed; healthy
granulations are springing up from the bottom of the wound. Stump
healing favorably.
July 26.--The case has progressed without a bad symptom. At first
it was thought that the greater part of the ala of the ilium would
exfoliate, but some red points appeared on the surface, and the
concavity of the bone became covered with granulations. The exfoliation
was limited to the anterior part of the crest of the ilium, which
separated on the 17th instant. At various times pieces of bone have
been removed as they became detached; there are others still left
to come away. The granulations on the upper wound are on a level
with the skin of the abdomen. The crest of the ilium is covered with
granulations; the wound is contracting, but there is a deficiency of
skin to cover the projecting portion of the ilium. The lower wound
is also open, and has been enlarged to remove pieces of bone; the
incisions in the thigh have healed. The bowels have acted regularly
without medicines until to-day, when he required a castor-oil
injection. The right thigh is more than two inches shorter than the
left; union appears to have taken place; he has no pain on motion. The
dead bone that still remains alone prevents the wounds from closing,
their surfaces being covered with healthy granulations. His general
health is good. He has taken at intervals some oleum jecoris aselli,
and, for a mild attack of bronchitis under which he suffered at the end
of June, expectorants and diaphoretics. There has not been a single
symptom of any abdominal complication. He has an opiate at night. The
stump has been healed nearly three weeks.
September 14th.--Since the last report no unfavorable symptoms have
occurred. The stump of the forearm has been healed some weeks; his
health is good; indeed, from first to last, he has not had a single
symptom denoting constitutional disturbance. All the dead bone from the
crest of the ilium has separated; the wound of the abdomen is skinned
over, with the exception of a small spot about the size of a sixpence.
This is healthy, and is gradually healing. The bowels act regularly.
There are still two sinuses on the outer side of the thigh--one above,
the other below, the great trochanter. On probing these, dead bone is
felt, which has not yet separated. The right limb is about three inches
shorter than the left, is freely movable in any direction without
pain. He can raise the knee from the pillow, but cannot lift the
heel from the bed; he can, however, turn himself over on to the left
side without assistance. The prominence of the crest of the ilium is
greatly diminished from loss of bone. The trochanter major is unusually
projecting; the natural appearance of the hip-joint is entirely
gone. The injuries to the bones have been so severe, it is difficult
to say what changes have occurred. The ilium and pubis have been
greatly comminuted, the fracture most probably extending through the
acetabulum. Immediately below Poupart’s ligament, to the outside of the
femoral artery, a hard substance is felt beneath the skin. This, when
he was admitted, was at first supposed to have been a piece of a shell,
but it is now thought to be a portion of the pubis driven downward upon
the thigh.
He may now be said to be convalescent.
* * * * *
John Shehan, aged nineteen, 57th Regiment, was wounded in the left
thigh before the Redan, on the 18th of June. He was brought to the
general hospital, and placed under the charge of a gentleman of
considerable skill and experience. The wound presented two openings,
an anterior and a posterior; the latter offered greater facilities for
examination than the former; the finger, passed from behind, detected
several fragments, which were removed, and as a tolerably uniform
surface of bone (_vide_ specimen) was then felt, it was determined,
after consultation, to make an attempt to save the limb. The injured
extremity was accordingly bound up with a long splint in the most
careful manner, and matters promised favorably for a time. He, however,
complained of a good deal of suffering in the limb from time to time,
gradually wasted, suffered from diarrhœa, and finally sank on the 6th
of August. On examination post-mortem, I found the chief organs in a
normal condition. There was some congestion of the ilium, and the colon
presented a few points of ulceration. The condition of the parts in the
left lower extremity was very remarkable. Beneath the integuments, all
the muscular and other textures, from the seat of injury to the groin,
were converted into a soft, broken-down, black, rotten mass; and I may
here observe that this low but intense disorganizing process, extending
through the greater part of the limb, has presented itself in several
of my examinations of somewhat similar injuries, and appears to me
to be connected with _a peculiar pathological state in which all the
vital organs remain sound, but the vis vitæ is remarkably reduced below
par_. The fractured bone it is unnecessary to describe. The vertical
and cross infraction of the fragments and its almost “arborescent”
appearance are most remarkable. I look upon it as a specimen of no
ordinary value, conveying more than one most useful lesson. The bones
are in the museum of the Royal College of Surgeons.
R. D. LYONS,
_Pathologist to the Army in the East_.
Camp before Sebastopol, August 30, 1855.
Private William Leah, 30th Regiment, aged twenty-one, was brought to me
on the 27th of June, while I was on duty in the trenches, with fracture
of the external condyle of the humerus of left arm, by a musket-ball,
which had entered the joint between it and head of radius, and had
made its exit over olecranon process of ulna. Artery uninjured. On
being sent to camp, the joint was excised by Mr. Dowse, surgeon of the
regiment. The patient progressed favorably, and the wound has been
healed for nearly a month. He can use all the muscles of the forearm,
except the flexor of the little finger, and is regaining the motion
possessed by the elbow-joint.
DAVID MILROY, M.D.,
_Assistant-Surgeon, 30th Regiment_.
Camp, Second Division, Heights of Sebastopol, Sept. 5, 1855.
J. Maguire, 31st Regiment, aged twenty, wounded in the advanced
trenches.
July 12, five A.M.--Carried into hospital, wounded by a splinter of
shell in left elbow and on left hip. The splinter struck him in an
oblique direction, from behind, fracturing olecranon process and
internal condyle of humerus, lacerating and otherwise injuring the
joint, the ulnar nerve being also injured. The splinter continuing its
onward course, inflicted a lacerated wound on the hip, with comminuted
fracture of about the anterior fifth of the crest of the ilium, several
small pieces of bone being driven in on the peritoneum, causing pain on
the slightest motion. All the loose portions of bone were removed, and
several others separated from the muscles. Abdomen painful, and swollen
at that side. Abdomen continued painful during the day; bowels acted;
he also passed water freely.
13th.--Pain in abdomen much less; little, if any, constitutional
disturbance; elbow extremely painful; the pain accompanied with partial
paralysis of the little and ring fingers. Staff-Surgeon Dr. Gordon
having seen him, and not apprehending any danger from the wound in the
side, the operation for excision of the elbow-joint was determined
on, and performed under chloroform, by a single straight incision
passing through the original wound, including the upper and lower
fourths of the forearm and arm. There was very little hemorrhage. The
arm was then put up in an angular splint. It continued to progress
favorably, the greater part healing by the first intention. There was
some suppuration, but a free exit being given to the matter, it did not
retard recovery.
August 19th.--This patient was discharged from the regimental hospital,
to general hospital, Balaklava. The wound nearly healed; sensation
partially restored to the fingers; slight motion at the bend of the
elbow; but he has not power to raise the hand.
THOMAS J. ATKINSON,
_Assistant-Surgeon, 31st Reg. in Med. Charge_.
Camp before Sebastopol, Sept. 1, 1855.
Private Anthony Murray, aged twenty-eight, 41st Regiment, a healthy
man, was struck, while on duty in the trenches before Sebastopol, on
the night of the 23d of July, 1855, by a portion of a shell, which
penetrated the left elbow-joint; the head of the radius and the outer
half of the articulating surface of the humerus were comminuted,
fragments being impacted in the cancelous structure of the humerus,
and driven in between that bone and the ulna. Excision of the joint
having been determined on, it was performed in the following manner: a
straight incision was made along the posterior surface of the joint,
the olecranon cut through, and the extremities of the several bones
removed in succession; the parts were then brought together by suture,
and the limb placed in a flexed position; about a third of the wound
healed by the first intention; no inflammation supervened. On the
3d of August the wound was granulating in a healthy manner; on the
22d, it had almost healed, and the limb was put up permanently, the
forearm at right angles to the arm; on the 31st, some union had taken
place between the bones; the man can move the thumb and three fingers;
he is free from pain; his health is very good, and he appears to be
progressing favorably in every respect.
J. E. SCOTT, M.D., _Surgeon, 41st Regiment_.
August 31st, 1855.
Private Jesse Lockhurst, 31st Regiment, aged twenty-six, was wounded in
the advanced trenches, 17th of August, 1855.
August 17th.--Six o’clock A.M., carried into regimental hospital,
having received an extensive lacerated wound of right cheek: very
little apparent hemorrhage, but the power of deglutition was
completely lost, and respiration impeded. On making an examination
of the wound, it was ascertained that the right superior maxillary
bone was fractured, and a portion of the hard palate with the molar
teeth driven in on the tongue; there was a large piece of shell or
shot lodged at the bottom of the wound, lying on left palate, and,
as far as could be ascertained, on the back of pharynx. Staff-Surgeon
Dr. Gordon being present, the ball, after much labor, was extracted,
and found to be a grape-shot of seventeen and a half ounces weight.
During the operation it was found necessary to dilate the wound by
dividing the lip near its external angle--the portions of bone that
were removed were the alveolar process, with all the molar teeth,
including part of the palate and a portion of the orbital plate and
nasal process of the superior maxillary bone, and all the malar bone.
There was no serious hemorrhage during the operation, nor immediately
after the extraction of the shot. The cheek was then plugged with lint
and the wound brought into apposition by sutures. The man experienced
immediate relief after the operation, sat up in bed, washed out his
mouth, and drank some water; he seemed extremely thankful, and blessed
the doctors. During the night and part of the next day there was some
oozing from the mouth. No bad symptom occurred until the 20th, when an
active hemorrhage came on from the back of the palate. The exact source
could not be ascertained. He became very weak and almost pulseless; but
the hemorrhage was eventually restrained by means of ice and plugging
the wound with lint moistened in tincture of matico. Iced drinks
occasionally.
31st.--The man is now doing extremely well, can talk, and takes a
pint of jelly daily; the external wound is not yet quite healed,
in consequence of the saliva flowing through it. The right eye is
uninjured, and sight unaffected.
September 1st.--He has just been discharged to general hospital,
Balaklava, from the regimental hospital.
THOS. J. ATKINSON, _Assistant-Surgeon_,
_31st Regiment, in Med. Charge_.
Camp before Sebastopol, September 1, 1855.
On the morning of July 24th, Private Francis O’Brien, a lad of
eighteen, was brought from the trenches, with a wound from a
musket-ball in the right temple. It entered about two inches above
the orbit, passed downward, and drove out a large portion of the
supra-orbital ridge, which appeared to be imbedded in the upper eyelid,
and was cut down upon by the medical officer in the trenches, in
mistake for the ball, which it certainly very much resembled. As no
ball could be found, it was supposed to have passed out at the opening
of entrance.
The finger when passed into the wound could feel the pulsation of
the brain, yet from that day to the present no symptom of cerebral
disturbance has appeared, unless it be that since his convalescence the
muscles of the face work convulsively when he feels faint and weak from
remaining too long in the erect posture. About a month after admission,
the detached portion of the bone above the orbit was removed from the
eyelid, though with considerable difficulty, and on the following
morning the ball fell from the wound, much to the poor lad’s horror,
who thought his eye had dropped out.
Both wounds have now healed, but he is unable to raise the right
eyelid; the eye is perfect, but apparently without power of vision,
though sensible to the stimulus of light, for on turning the wounded
side to the light, the left pupil contracts. His general health is good.
R. V. DE LISLE,
_Surgeon, 14th King’s Own Regiment_.
Camp, Sept. 10.
Private Joseph Bourke, 17th Regiment, admitted on 9th of September,
1855, with fracture of anterior superior angle of right parietal bone,
with depression of about one-third of an inch, for the size of a
florin. No attempt was made to elevate the depressed portion. Has not
had a bad symptom. Wound of scalp nearly healed.
W. P. WARD,
_Surgeon, 17th Regiment_.
Private Michael Caffrey, 88th Regiment, wounded at the attack upon the
Redan on the 8th of September, was brought to the hospital of the 38th
Regiment on the morning of the 9th. A round rifle-ball struck him at
the anterior part of the left parietal bone, and passed through the
brain in a line which brought it out at the vertex, fracturing the
parietal bone of the opposite side; the ball at its entrance split,
and one-half pushing before it a small piece of bone, both lodged at
the entrance; the other half of the ball was found lodged in the brain
at the upper and back part, having detached a circular portion of the
skull.
A director was passed along the track of the wound, and the scalp
laid open; the brain was found to protrude through the fracture. In
this condition the patient lived for eleven days, utterly unconscious
of everything passing around him, the urine and feces coming away
involuntarily. There was paralysis of the opposite side.
A post-mortem examination showed the brain to have been reduced to a
pultaceous mass only in the direction of the passage of the missile;
the remaining portion of the wounded hemisphere and that of the
opposite side were healthy.
The absence of the usual train of head symptoms, and the length of time
which so extensive an injury permitted life to remain, render this case
worthy of some remark.
FREDERIC WALL,
_Surgeon, 38th Regiment_.
Camp before Sebastopol, Sept. 20, 1855.
Private William Doyle, 19th Regiment, aged nineteen years, was wounded
in the head by a rifle-ball, in the advanced trench of the right
attack, on August the 30th. The scalp and pericranium were cut about
two inches, and a portion of the cranium, a little in advance of
the posterior and superior angle of the right parietal bone, close
to the sagittal suture, about an inch in length and half an inch in
breadth, was depressed. According to statement the man was rendered
perfectly senseless and motionless, from the instant of being struck
by the bullet. On reaching camp he presented all the usual symptoms
indicating compression; pupils dilated and fixed, warm surface, total
unconsciousness, complete paralysis, etc. On examination of the
depressed portion of bone, no opening whatever could be felt; the edges
of the sunk bone and the bone adjoining were in contact, and it was
presumed to be an ordinary case of fracture with depression simply.
Some very minute portions of cerebral substance were observed to be
mixed with the clot of blood about the wound, such as might be squeezed
through a fissure. Trephining being determined on, it was performed
at once, and the depressed bone raised without difficulty. No relief
of symptoms followed. The dura mater bulged slightly upward into the
opening. On passing the finger over its surface, a little beyond the
space exposed by the trephine, a defined cut edge was felt about an
inch in advance of the depressed piece of bone, being the boundary of
an opening into the cerebral substance.
Three hours after arrival in camp the patient died. On examination
post-mortem, a wedge-like section of the ball was found to have
entered and penetrated the cerebral substance; it was discovered in
the anterior lobe on the right side, just above the orbitar plate.
It had not completely penetrated, but was lying just above the
membrane covering the lobe. The ball--a conical rifle-ball with three
cannelures--was cut smoothly from apex to base, as if by a sharp knife.
This must have been done by the edge of broken bone above the opening
made in the parietal bone, one-half of the ball flying off, the other
entering the skull. On close examination, several very small points of
lead were found to be imbedded along the margin of the bone alluded
to. The depressed portion of bone, directly after the piece of ball
entered, must have sprung up again by its own resiliency, or been
forced up by sudden pressure from within, so that no evidence of an
aperture, but merely a fissure and depression remained. The inner table
was separated, and nearly detached, for a space rather more extensive
than that of the depressed part of the outer table. The superior
longitudinal sinus was wounded by the sharp edge of the broken inner
table, and a very considerable quantity of blood extravasated upon the
surface of the brain.
The portion of bone implicated in this injury has been preserved.
THOMAS LONGMORE,
_Surgeon, 19th Regiment_.
Camp before Sebastopol.