The Pelvic Wound of Joshua Lawrence Chamberlain

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The following is copied from an excellent medical case study in the March 2000 issue of the Journal of Urology: “The Lion of the Union: The Pelvic Wound of Joshua Lawrence Chamberlain” by Dr. William J. Harmon and Dr. Charles K. McAllister.

***I have added the common medical definitions for some of the words - (these are in parenthesis and italicized).***

"Major General Joshua Lawrence Chamberlain is a true American hero. His medical history and war wounds provide a rare snapshot of Civil War era medicine. In particular the most devastating injury was a rifle shot through the pelvis rupturing the bladder and urethra. We describe this injury and how it affected his life to provide insight into late 19th century urological care.

"All available references, including biographies, letters, surgical reports, military documents and prior medical summaries, were reviewed regarding Chamberlain's urological history.

"While leading the Union charge to Petersburg, Virginia on June 18, 1864, Chamberlain was struck with a minié ball anteriorly below the right greater trochanter." (part of the femur connecting to the hip bone) "The ball coursed obliquely upward disrupting the bladder and urethra, and embedded behind the left acetabulum." (cup-shaped cavity at the base of the hipbone into which the ball-shaped head of the femur fits) "An unprecedented wound exploration in the field hospital was performed to extract the bullet and reconnect severed urinary organs. Hope for recovery was nonexistent as urine was seen exiting the lower wound postoperatively. This genitourinary injury required 4 subsequent repairs during Chamberlain's lifetime and ultimately left him with a draining urethrocutaneous fistula at the penoscrotal junction.

"Survival from catastrophic Civil War wounds was rare, especially from "gut wounds" which had a mortality rate of greater than 90%. Chamberlain not only survived but thrived with his sense of duty carrying him back to the battlefield and beyond. He was plagued during his life with recurrent cystitis and epididymo-orchitis, which in an era without antibiotics was especially miserable. Urosepsis is listed as the cause of death on his death certificate and whether this was true is debatable. However, even if this wound did not cause his death, it surely contributed to it."
 
"The bullet entered Chamberlain’s right hip, severed arteries, fractured his pelvic bones, and damaged his bladder and urethra. He tried to remain standing, but loss of blood forced him to the ground. After being evacuated to a field hospital hours later, Chamberlain must have known that his prospects were grim: “gut wound” soldiers in the Civil war faced a mortality rate of greater than 90%, and were often left to die. Indeed, Chamberlain penned a hasty, but moving, letter to his wife saying as much.

"Tom Chamberlain, still attached to the 20th Maine, recruited Drs. A.O. Shaw and M.W. Townsend to treat his brother. The doctors performed a groundbreaking exploration of the wound; cleaning it, extracting the bullet, and controlling the bleeding. Though he was under anesthesia, the operation became extremely painful for Chamberlain, forcing the surgeons to ask if they should stop. Chamberlain encouraged them to proceed, and they managed to reconnect his severed urinary organs. Hope for Chamberlain’s recovery was still dim as the doctors noticed urine leaking from his lower wound. An indwelling metal catheter was placed in his bladder to drain the urine."

http://civilwarmed.blogspot.com/2007/05/thorn-in-lion-of-union-medical.html
 
"In their case study, Drs. Harmon and McAllister propose that prolonged use of the catheter produced an “urethrocutaneous fistula,” in other words, an abnormal opening between the urethra and the skin, just above his scrotum. Chamberlain suffered greatly from the fistula for the rest of his life, enduring bouts with incontinence, impotence, bladder infections, and bone disease. He required no less than four additional surgeries over the next few decades to relieve pain, which often caused him to leave his duties as politician or college president for extended periods of time."

http://civilwarmed.blogspot.com/2007/05/thorn-in-lion-of-union-medical.html
 
The Pelvic Wound of Joshua Lawrence Chamberlain Revisited: Treatment of Proximal Urethral Injuries in the American Civil War

Lightner, Deborah J. MD*; Evans, Bruce A. MD†

"Objectives: Joshua Lawrence Chamberlain, a hero of the Union during the American Civil War, suffered a major urologic injury in battle. Because of his recent resurgence of fame, there has been interest in his survival from a devastating pelvic wound. The literature has described his treatment as involving a possibly unprecedented repair of the proximal urethra and/or bladder neck. We have reexamined the primary and secondary literature to define, as far as we can determine for the first time, exactly what was done at the time of his injury.

"Methods: We reviewed available primary and secondary sources, including Chamberlain's letters and writings, regarding the time of his wounding and subsequent care, comparing these documents with current urologic management of such injuries.

"Results: Chamberlain's treatment was determined by the then current principles of treatment of urethral and bladder injuries. An invasive reconstruction would have been inconsistent with the abilities and practice of the times. The life-saving procedure referred to by many sources was both crucial and simple: an ultimately successful catheterization of a badly damaged proximal urethra and/or bladder neck.

"Conclusions: The treatment of Chamberlain's wound was difficult but in principal straightforward. Given the technical limitations of the time, this treatment is fully consistent with both modern and urologic principles of 150 years ago."
 
A couple years ago there was a CivilWarTalk Radio program called "The Privates Were Shot" with the guest speaker Guy R Hasegawa. It was all about this kind of injury - there were a lot of them. The CW really made some advances in the field of urology! He talked quite a bit about Chamberlain's injury and how much was learned from it. Poor Chamberlain, though!
 
He was a very brave man and he saw his share of combat and killing both defending and attacking. Chamberlain wasn't a West Pointer or professional soldier but he adapted well and he was an educated man. What a terrible wound he suffered and it had to take years off his life. If my less than perfect memory serves Chamberlain was at the formal surrender of the ANV at Appomattox and he saluted Gordon and his troops. Actually Gordon and Chamberlain had quite a bit in common as both saw plenty of combat and both were wounded and by the grace of God both men survived the war. I wonder if they met or conversed that day? We build 'em tough in America those two men are prime examples of hard fighting highly effective American soldiers/officers of the first order.
 
First off, Little...thank you for taking the time to find this. I really appreciate it and now have a much greater understanding. Secondly...OH MY GOD!!! The h#ll Chamberlain went through sound absolutely horrific, and yet somehow horrific isn't even a strong enough word to describe it. How he survived with all that going on is superhuman. And while I'm at it, those doctors and his brother Tom were some brave and persistent people!!!
 
Winfield Scott Hancock had a severe injury in that area, although not anywhere near as bad as Chamberlain's. His problem was a bullet hit him high in the right thigh and went through his saddle before hitting him. Wood, nails, leather and other stuff was driven into the wound and the bone was shattered. For the rest of his life he had problems with debris and bone working its way out of the wound, which never really healed, and also caused problems with the family jewels. He lived a long time with this open and more or less chronically infected wound, then he developed diabetes. He died of an infected boil in the old wound. So...he was a casualty of Gettysburg in the end. These kinds of wounds were really hard to deal with at that time, and the doctors learned a lot in the college of hard knocks.
 
Winfield Scott Hancock had a severe injury in that area, although not anywhere near as bad as Chamberlain's. His problem was a bullet hit him high in the right thigh and went through his saddle before hitting him. Wood, nails, leather and other stuff was driven into the wound and the bone was shattered. For the rest of his life he had problems with debris and bone working its way out of the wound, which never really healed, and also caused problems with the family jewels. He lived a long time with this open and more or less chronically infected wound, then he developed diabetes. He died of an infected boil in the old wound. So...he was a casualty of Gettysburg in the end. These kinds of wounds were really hard to deal with at that time, and the doctors learned a lot in the college of hard knocks.

That's right I forgot about Hancock's wound at Gettysburg. Yes he suffered quite a bit for the rest of his life. I didn't know he developed diabetes.
 
That's right I forgot about Hancock's wound at Gettysburg. Yes he suffered quite a bit for the rest of his life. I didn't know he developed diabetes.

Look at pictures of Chamberlain, Hancock, heck anyone injured physically, mentally and/or emotionally during the war 5 years later and they are all prematurely grey. Injured or not, it took years off their lives and aged them earlier than the natural course of life should have.
 
First off, Little...thank you for taking the time to find this. I really appreciate it and now have a much greater understanding. Secondly...OH MY GOD!!! The h#ll Chamberlain went through sound absolutely horrific, and yet somehow horrific isn't even a strong enough word to describe it. How he survived with all that going on is superhuman. And while I'm at it, those doctors and his brother Tom were some brave and persistent people!!!
You are welcome Bart. I have always admired Chamberlain, but, now I have a much higher level of respect for the man. Thank you for your inquiry. Glad I could find some answers.
 
Chamberlain remained active in veterans affairs, Bowdoin College and Maine politics after the war. During a tense confrontation with political opponents, someone threatened to kill him. Chamberlain threw open his coat and dared the man to try. "You would not be the first to attempt it." He lived into his eighties, despite this wound.
 
He was a very brave man and he saw his share of combat and killing both defending and attacking. Chamberlain wasn't a West Pointer or professional soldier but he adapted well and he was an educated man. What a terrible wound he suffered and it had to take years off his life. If my less than perfect memory serves Chamberlain was at the formal surrender of the ANV at Appomattox and he saluted Gordon and his troops. Actually Gordon and Chamberlain had quite a bit in common as both saw plenty of combat and both were wounded and by the grace of God both men survived the war. I wonder if they met or conversed that day? We build 'em tough in America those two men are prime examples of hard fighting highly effective American soldiers/officers of the first order.

Exactly, if we had a problem that is the kind of men I like to have in my corner!
 
Was just looking at medical diagrams of what happened to Joshua Chamberlain. Well, this old Indian would have taken the long walk WAY before all that! I can only say he was so fortunate to have the love and support of his family and so many others - a reason to fight. (I have some grisly mountain man stories, though - mostly due to grizzlies! - of guys who were just too tough to die and survived horrific injuries all alone.)
 
Chamberlain remained active in veterans affairs, Bowdoin College and Maine politics after the war. During a tense confrontation with political opponents, someone threatened to kill him. Chamberlain threw open his coat and dared the man to try. "You would not be the first to attempt it." He lived into his eighties, despite this wound.

Thanks for sharing that Matthew. Men like Chamberlain who saw the elephant up close multiple times would hardly be cowed by some political hack spewing idle threats. I'll bet an acre of watermelons to a box of raisins Chamberlain maintained direct eye contact with the one who voiced the hollow threat when he threw open his coat.
 
Thanks for sharing that Matthew. Men like Chamberlain who saw the elephant up close multiple times would hardly be cowed by some political hack spewing idle threats. I'll bet an acre of watermelons to a box of raisins Chamberlain maintained direct eye contact with the one who voiced the hollow threat when he threw open his coat.

I grew up in Maine, where Chamberlain is celebrated. There's no getting away from the fact he wasn't shy about claiming credit.
 
I have heard that war leads to great advancements in medicine, in particular the treatment of traumatic injury. Chamberlain's case seems to bear this out. Good post LT! You are doing a fine job!
 
Was just looking at medical diagrams of what happened to Joshua Chamberlain. Well, this old Indian would have taken the long walk WAY before all that! I can only say he was so fortunate to have the love and support of his family and so many others - a reason to fight. (I have some grisly mountain man stories, though - mostly due to grizzlies! - of guys who were just too tough to die and survived horrific injuries all alone.)
Diane, can you link those diagrams to this forum? I'd be interested in seeing them. Thanks.
 
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