File:Gunshot wound of the brain.jpg

bri, and Recovery with Hemiopsia. BY W. W. KEEN, M.D., AND WM. THOMSON, M.D. PATRICK HUGHES, late private of Company K, 4th Regiment, New York Volunteers; born in 1839, in Ireland; puddler both before and since enlistment; wounded at Antietam, September 17th, 1862. Wound of entrance in the middle line, one and a quarter inches above external occipital protuberance, –a small, depressed wound; wound of exit two by two and a half inches, its centre being two inches to the left of middle line and three inches above wound of entrance. He fell, did not lose con- sciousness, but, blinded by blood, crept towards the enemy till warned by his comrades, when he crawled behind the ranks and was carried, when faint, to an old barn, where he remained nine days. While here, his eyesight, he thinks, was poor. He was then taken to Mount Pleasant Hospital, Washington, D.C., where he lost his consciousness, and was more or less par- alyzed in both right arm and right leg, — whether slowly or suddenly, and whether it extended to the face, he does not remember. The paralysis and unconsciousness lasted some two or three months. He remembers having had fungus cerebri as large as his fist, which was shaved off some five or six times.* When he tried to think, he often used to become almost "out of his head.” His memory was so bad that be- tween calling the doctor and his turning to hear the question he would forget what he desired to say. He had no aphasia. In four and a half months he was able to come to Philadelphia. In walking he was very giddy; noise and laughter used to hurt him badly. His mental and physical power gradually grew better, and in one year his paralysis had almost disappeared. Present Condition, December 20th, 1870.-His memory is quite good, but by no means so good as before the injury. He is rather easily bothered and confused, and more irritable than formerly. The sight of his right eye he thinks is poor. Whiskey affects him as usual. Sexual power undiminished. He has no paralysis. The wound of entrance (see photograph ---the head was shaven in order to have the photograph taken) is marked by a slight depression in the bone, the wound of exit by a hollow two and a half by two inches, and one inch deep. No bone has closed this opening, but the scalp and hair dip down into the hollow. The arterial pulsations are barely perceptible. When recumbent, the hollow is gradually obliterated and re- placed in about one minute by a rounded protuberance. To prevent pain during this change, he supports the parts with his hand. When he coughs, even with moderate force, the de- pressed scalp instantly bulges up in a cone, which nearly reaches the general level of the skull and obliterates the de-