Medical/Surgical History--Part I, Volume II
Chapter V.--Wounds And Injuries Of The Chest.
Section I.--Incised Wounds, Contusions, And Miscellaneous Injuries.
SQUIRES, T. G., Private, Co. L, 11th Pennsylvania Cavalry. Bayonet wound of left side, and gunshot wound of shoulder. Stoney Creek, June 29th, 1864. Treated in 1st division hospital, Annapolis. Returned to duty on November 16th, 1865. Examining Surgeon Martin Rizer, of Brookville, Pa., reported, May 1st, 1866, that there was "nearly entire loss of motion in right arm from gunshot wound of right shoulder, entering just below the articulation, fracturing the spine of the scapula, passing out near the spine. Bayonet wound of right side, fracturing eighth rib. Reams's Station, June 20th, 1864. Disability one-half and permanent."
Medical/Surgical History--Part II, Volume II
Chapter VII.--Injuries Of The Pelvis.
Section II.--Flesh Wounds Of The Back.
[excerpt]
Sometimes, on the contrary, the reparative process was very slow after such lacerations, as would be anticipated from the nature of the vascular supply in this region.
(1) Of the thirteen reported cases of sabre wounds of the back, twelve were received in action, as follows: Pt. T. O'Rourke, K, 6th Pennsylvania Cavalry, Brandy Station, August lst; duty, August 18, 1863. G. Radebaugh, H, 13th Pennsylvania Cavalry, Winchester, June 15, 1863; duty. Pt. J. Barber, K, 1st Colored Troops, September 30, 1864; duty. Pt. J. Jones, H, 11th Pennsylvania Cavalry, near Richmond, October 17, 1864; discharged. Pt. W. H. Cheeny, H, 5th Connecticut, Savannah, December 10, 1864; duty. Corporal H. H. Brownsmiller, H, 1st Pennsylvania Cavalry, Jeffersville, April 5, 1864; discharged. Lieut. J. M. Corns, E, 2d West Virginia Cavalry, Five Forks, April 1st; duty, April 22, 1865. Pt. T. Gray, F, 2d West Virginia Cavalry, Five Forks, April lst; duty, April 18, 1865. Pt. P Gallagher, I, 9th Massachusetts, Gettysburg, July 2d; duty, September 8, 1863. Serg't. T. Taylor, B, 10th New York Cavalry, Brandy Station, June 9th; duty, August 16, 1863. Pt. T. Dewyer, 4th Michigan, Fort Donelson; duty. Pt. C. A. Woods, A, 1st Pennsylvania Artillery, Petersburg, July 1, 1864; discharged. The bayonet stabs appear to have been inflicted, for the most part, by sentries or provost's guards, or in brawls, or through accident. One example only is specified as a wound received in action, and in this single case it does not clearly appear that the wound was inflicted by the enemy.
(2) Sabre wounds of the back are seldom referred to. BILGUER (Chir. Wahrnehmungen, 1763, S. 493) gives an instance in the Seven Years War (1756-63) : A cavalryman, J. R-----, retreating and leaning over his horse's neck, received two severe sword-cuts in the lumbar region. MORGAGNI (De sed. et caus., 1765, Ep. LIII, p. 270) records an autopsy in a case of sabre-thrust in the back. A report by Surgeon S. W. GROSS. U. S. V. (Am. Med. Times, 1864, Vol. VII, p. 136), of a sword-stab in the left flank, penetrating the descending colon, has already been alluded to on page 76 ante.
(3) STROMEYER (Maximen der Kriegsheilkunst, 1855, S. 670) observes: "Shot wounds of the soft parts of the back have not an especial tendency to suppuration. But in long seton wounds it frequently occurs that they heal, and reopen after months and form a fluctuating tumor, which must be opened, as the thick skin of the back is only slowly perforated by the serous substance. Many surgeons err in trying to relieve the ailment by several small incisions or even punctures parallel to the spine; these afford no relief, and it is absolutely necessary to make an incision of several inches in length at a right angle to the spine."
Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Section II.--Fractures Of The Clavicle And Scapula.
The following case is interesting in several points of view, but particularly as demon-strafing that the lumbar ecchymosis, regarded by Valentin and Larrey as of diagnostic value, and even as pathognomonic of penetration of the thoracic cavity, may attend wounds external to it--a much disputed point, to some extent discussed in a note on page 575 of the First Surgical Volume:
CASE 1435.--Private C. Ely, Co. K, 11th Pennsylvania Cavalry, aged 19 years, was wounded in a skirmish near Suffolk, Virginia, March 19, 1863. Surgeon G. C. Harlan, of this regiment, described the case as follows: "Fie was shot with a minié ball in the right shoulder, while mounted, March 17th, at Franklin. Wound of entrance in the anterior fold of axilla. Ball extracted below the spine of the scapula, having passed between the bone and its vessels, ploughing a deep groove in the neck of the former, and passing through the body of the scapula. There was not much external haemorrhage, but enormous effusion between the muscular planes, extending to the spine behind, and dissecting up, and distending, the pectoral muscles in front, inducing a great tumefaction about the shoulder joint. The head of the humerus was apparently uninjured. Cold-water dressings were applied. March 19th, swelling about the same; warm-water dressings substituted for the cold. April 9th, patient up and walking about with his arm in a sling. Wound has discharged very little. The extravasated blood is for the most part absorbed. As the swelling subsided, a displaced piece of bone could be felt under the skin on the outside of the arm, just below the head of the humerus. April 15th, the patient was sent to hospital at Fort Monroe. He had slight motion of the arm, but free motion of the forearm and hand." This soldier was discharged June 15, 1863, and pensioned. Examiner H. Roberts, of Providence, reported, July 3, 1871: "The ball entered in front, fracturing the acromion process, which is now drawn downward. The bal lcame out, apparently through the scapula just below the spine. At present Mr. Ely is unable to raise his arm up to a level with the shoulder, or put it behind him; neither can he put it up to his head except in front. Rotation of the arm not equal to half of the natural limits. The powers of the arm and shoulder are greatly reduced, and the muscles in the region of injury are tender, contracted, and shrunken." Ely was examined by the Scranton Board, Drs. A. Davis and R. A. Squires, September 5, 1873, and September 2, 1874; no material change was reported. He was paid June 4, 1874.
Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Section V.--Wounds And Injuries Of The Elbow Joint.
224 Titus, S. N., Major, 11th Pennsylvania Cavalry, age 36. Oct. 7, 1864. Minié ball gunshot fracture of lower part of right humerus, involving elbow joint. Oct. 7, 1864. Excision of two or three inches lower end of humerus, by a Confederate surgeon. Partial anchylosis. Disch'd Mar. 11, 1865; pens'd. Forearm and hand paralyzed; limb useless.
Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Section III.--Excisions Of The Head And Portions Of The Shaft Of The Humerus
17 Brink, J. H., Pt. K, 11th Pennsylvania Cavalry, age 19. May 21, 1863. Shot fracture of upper third of right humerus. May 21, 1863. Excision of head and neck of right humerus, by Surgeon G. C. Harlan, 11th Pennsylvania Cavalry. Disch'd Sept. 22, 1863; pensioned. Sept., 1866, arm hangs powerless at his side. Photo. 208, Surgical Series.
Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Section III.--Excisions Of The Head And Portions Of The Shaft Of The Humerus
Detailed abstracts of fourteen of the two hundred and thirteen reported successful primary excisions of the head and portions of the shaft of the humerus for shot injury precede the foregoing tabular statement; but the subject is of such interest and importance that some further examples from this group will be selected.
Surgeon George C. Harlan, 11th Pennsylvania Cavalry, adopted, in the following instance, an ingenious plan of counter-extension and of maintenance of the limb at rest:
CASE 1534.--Private J. Brink, Co. K, 11th Pennsylvania Cavalry, aged 19 years, was shot, as the regimental surgeon reports: "At short range, while mounted, by guerillas concealed in bushes by the way-side, May 22, 1863, near Windsor, about twelve miles from Suffolk, Virginia. He was taken immediately to the regimental hospital at Suffolk in an ambulance wagon. He was a good deal exhausted by haemorrhage, which had been only partially checked, by a surgeon near at hand, with lint and bandage. The wound of entrance was in the median line of the right side of the chest two inches below the axilla. The wound of exit was in front of the shoulder, two inches and a half below the acromial end of the clavicle. The joint was not opened, but the humerus was terribly shattered below its head. He was etherized, and five inches of the bone. including the head, were removed by means of a free straight incision through the deltoid, the periosteum being carefully dissected from the fragments, and the sharp end of the bone sawed off squarely below the fracture by an ordinary amputating saw. Only one ligature was needed, and the wound was brought together by lead-wire sutures, except a space at the lower end, left as a drain, in which a piece of lint was inserted. A straight splint was applied to the back of the arm, which was loosely bandaged to the side by a roller. Morphia was administered freely, and water dressings applied to the wound. On May 22d, the patient was doing well; there was slight febrile action, yet a good deal of pain. The splint and bandages were removed, and extension was made from the lower end of the arm, and counter-extension by means of adhesive strips applied to the front and back of the chest and passing over a block above the shoulder, as suggested by Dr. H. Lenox Hedge in the treatment of fractured thigh.(1) These points were connected by an iron bar extending from several inches below the elbow to the back above the shoulder and bent at both ends (FIG. 431). This kept the limb in a favorable and comfortable position and maintained its length, and left the wound free for the application of dressings. He could now be moved in bed, or raised to the sitting posture, without pain. June 3d, doing well. The discharge has been profuse, but is diminishing.
The wound gaped when the sutures were removed, on the fourth day, leaving a healthy granulating surface. He is taking punch and quinia, and full diet. June 8th, doing well; edges of the wound cicatrizing. June 9th, had a chill this morning; his tongue is coated, and he has dizziness and sick stomach. June 10th, the dizziness and nausea continue; the granulations have become pale and flabby, and the discharge dark and thin and sanious; pulse feeble, and expression anxious. These symptoms, in connection with the fact that a patient died of pyaemia in the same ward, on the 8th, left very little hope of recovery. Under active stimulation and most careful nursing, however, he gradually improved; and when the regiment received marching orders, was sent to general hospital, June 24th, still very feeble. March 13, 1868, Brink called at my office to-day. He has been employed for some time as a telegraph operator, always using the right hand at his work. He has perfect use of the forearm and hand, and partial use of the arm. He can place the hand on the opposite shoulder and carry it readily to the mouth in eating, when he always uses it by preference. The wounded arm is about an inch shorter than the sound one. Two inches and a half of new bone have been formed--its rounded extremity reaching to within an inch and a half of the acromion. It is flattened on its posterior surface and rounded anteriorly, and nearly equals the rest of the shaft in thickness. The pectoralis major, deltoid, and scapula muscles seem to be entirely wasted away, but the action of the coracobrachialis, biceps, and triceps is unimpaired, except, of course, by the want of support at The shoulder joint. He states that he was discharged from the Chesapeake Hospital on September 23, 1863; that the wound continued to discharge slightly for some time afterward; that he carried the arm in a sling for two months after ]caving the hospital, and then commenced to use it; that he noticed the new bone harden rapidly after that time, but that it was not perfectly firm for a year and a half after the time when he was wounded." Dr. Harlan contributed a photograph of the patient (FIG. 432), taken some five years after the operation. The records of the Chesapeake Hospital confirm the patient's account. He entered there June 23d, and was discharged September 23, 1863. He was pensioned. Examiners C. Mart', of Scranton, and G. Urquahart, of Wilkesbarre, describe the injury and operation, and the last pension report states that the pensioner was paid March 4, 1874.
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Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Wounds And Operations In The Forearm.
27 Fitchett, C., Pt., A, 11th Pennsylvania Cavalry, age 18. Aug. 26, Sept. 17, 1864. Five and a half, upper, right ulna; by A. A. Surg. W. P. Moon (necrosis). Disch'd Jan. 20, 1865. Not a pensioner.
Medical/Surgical History--Part II, Volume II
Chapter IX.--Wounds And Injuries Of The Upper Extremities.
Section III.--Wounds attended by Fracture of the Bones composing the Shoulder Joint
CASE 1481.--Private D. M. Moore, Co. I, 11th Pennsylvania Cavalry, aged 25 years, was wounded at Franklin, March 17, 1863, and was treated in the regimental hospital until August 13, 1865, when he was discharged the service and pensioned. Surgeon G. C. Harlan, 11th Pennsylvania Cavalry, made the following special report: "Wounded, while charging the enemy's pickets, on horseback. Gunshot wound by minié ball in right shoulder. Examined a few hours afterward at the regimental hospital in .Suffolk. Compound comminuted fracture just below the neck of the right humerus. Bone much shattered, but vessels uninjured. Head of humerus entirely separated from shaft, and several small fragments lying loose between them. Shaft of humerus fissured below the wound, and head apparently split into several pieces. Ether was administered, and the injury carefully and thoroughly examined in consultation with Surgeons Hand, Humphreys, and Kneeland. After some hesitation it was decided not to resect for the following reasons: It could not be determined that the joint was actually opened, as the fracture did not appear to extend through the cartilage. The injury extended so low that at least four inches of the bone would hare been lost by an operation; the patient was young and healthy and in a favorable condition for treatment, and should a secondary operation be necessary there would be a better chance of preserving the periosteum, loosened by suppuration, and reproducing bone. Cold-water applications were accordingly made. The next day there were constant oozing of blood, a good deal of tumefaction, and great pain at the slightest motion. To secure perfect rest and favorable position I applied a long narrow splint to the outside of the arm, extending from a point four or five inches below the elbow to the wound, and continued by an iron bracket to a point four or five inches above the shoulder, making extension from the first point by means of strips of adhesive plaster applied to the lower third of the erda, and counter-extension from the second by strips applied to the chest and back obliquely, and passing over a block above the acromion. A bandage was lightly applied over the arm and a splint from the elbow to the wound, which was left open for the application of cold-water dressings. This was frequently removed without disturbing the position of the limb. March 19th, oozing of blood much diminished; no increase of swelling; pulse a little accelerated; very slight febrile action. Scarcely any increase of temperature locally; no pain. 20th, scarcely any change; ordered sulphate of magnesia in small and repeated doses. 21st, skin and pulse natural; bowels freely moved; a good deal of sanious discharge from the lower wound; applied poultice to this, and continued cold-water dressing to arm and shoulder. April 1st, suppuration well established, moderate, and healthy; several small pieces of bone extracted from the lower opening to-day; he has had little or no pain, and sleeps well without anodyne. April 9th, more bone extracted with forceps; to have ale at dinner. 18th, sitting up; discharge decreasing; some union of fracture. A few days after this date he was sent to his home in Pennsylvania on thirty days' furlough, and on his return was detailed as mail carrier. He continued upon this duty until the regiment was mustered out, after the war. There was almost constantly a slight discharge from the wound, and occasionally small pieces of bone were removed, only one requiring an excision. November 9, 1867, called at my office to-day; says his arm has given him very little trouble since he left the army; is now milling, but has been employed in farming, ploughing, etc. The last piece of bone came away about a year ago; can raise the arm to a right angle with the body, but not higher, from want of sufficient power in the deltoid; perfect motion inevery other direction. On superficial inspection no signs of the injury but four small scars, and a slight atrophy of the deltoid. -No shortening of the arm was detected by careful measurement. A piece of lead the size of a split pea just underneath the skin about the insertion of the deltoid, and another lower down a little deeper. No tenderness produced by either." Examiner P. S. Clinger reported, April 28, 1836: "Was struck in the right arm, the ball penetrating near the shoulder joint and fracturing the os humeri Anchylosis of shoulder joint; muscles agglutinated; wound open." A Board, convened at Lancaster, composed of Drs. W. Blackford and W. R. Grove; September 3, 1873, reported: "Wound open; arm emaciated." This pensioner was paid June 4, 1874.
NOTE: Major Titus is listed as 11th Pennsylvania in the Medical Records however, he is listed with the 12th Pennsylvania Cavalry.
M. E. Wolf