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 A rifle ball shot directly through the head; patient recovered but has acquired some peculiarities.  By David Rice, M.D., of Leverett, Massachusetts.  Boston Med. and Surg. Journal, 1849.
Henry W. Richardson, aged 14, son of Francis Richardson. of Leverett on the 28th of September last, received a severe gunshot wound in his head. A considerable portion of substance of the brain was traversed by the ball, but the boy has now quite recovered.  I deem the case of sufficient importance to be reported, being in my opinion, a rare and interesting one.  The circumstances connected with, and leading to, the accident, are as follows: --
George, an elder brother, was in the house loading a rifle, preparatory to firing at a target, at some distance through an open window.  Henry was at the barn, unloading a cart, and not being aware of danger, ran to the house on a footpath leading directly by the window from which George was about to fire his rifle.  He passed by it just as the piece was discharged, the ball entering his head when within two feet of the muzzle.  He fell lifeless, and was supposed to be quite dead for nearly an hour.  He was carried into the house and laid upon a bed. I saw him for the first time in the evening, about four hours after the accident.  I found him comatose, extremely pallid, the whole surface of this body and extremities cold and clammy, pulse hardly perceptible, and the breathing discernible only by close observation.  I found that the ball had passed directly through his head, as considerable portions of brain were hanging both at the entrance and exit of the shot.  I proceeded to shave the hair from around the external wounds, and to appply a temporary dressing, supposing that the lad would probably die before morning; but on visiting him again at sunrise, I found, much to my surprise, that he was still alive, and the the powers of life had considerably rallied.  I removed the dressings, examined the wounds more accurately and removed several comminuted fragments of bone, with shreds of membrane and brain, that hung from the injured parts in view.
He remained entirely unconscious for six days after the injury.  The left side of the body was completely paralyzed up to this time.  On the seventh day, the swelling of the scalp having subsided, I ascertained, on examination, that the skull was considerably fractured and broken up, at the place of exit of the ball.  I made a crucial incision through the scalp at this place, dissected up the corners, and removed, with an instrument, several pieces of bone that had been partially broken off from the skull by the force of the shot, and were making some pressure upon the brain.
From this time the boy evidently began to amend.  His bowels were easily moved by cathartics; where before, there had been but little action, and it was with difficulty that a stool could be procured.  His pulse and breathing assumed a more favorable aspect, and gradually became natural.  He had an evident relish for food, and began to talk.  The parlyzed portion of his body, from this time rapidly regained its normal action.  In four weeks from the accident the wounds had completely healed, and the boy could walk about the house and converse with his friends, although there was as yet but little strength in the left side of his body.
The only dressing applied, through the whole course of treatment, was simple strips of linen, secured over the wound with adhesive plaster.  These were changed as often as they became loosened.  The head was wet freely with brandy and water, and a solution of sugar of lead.  The bowels were kept open with castor oil and a decoction of senna.  The diet consisted entirely of fluids for the first fortnight; after that, he was allowed more nutritious food.
The anatomical facts as to the boundaries of the injury as as follows: The  ball (sixty-seven weighing one pound) entered the head in the right temple, about one inch above, in front of the ear, passing through the lower part of the frontal suture, a little above its junction with the sphenoid bone, and passed out at the back part of the head, through the lambdoidal suture of the same side, a few lines below its apex.  The distance from one would to the other was about five inches and five-eighths.
These measurements show that the ball must have traversed nearly or quite five inches of the substance of the brain.  The boy is at the present time quite well, although he has some peculiarities that he did not have before the injury.  He has a slight stoop in his shoulders, goes with head down, and is more inclined to mirthfulness.  [Source: A Collection of remarkable cases in surgery by Paul Fitzsimmons Eve, 1857; Transcribed by aFoFG (nw)]

           In West Hawley: Little Jean Fisher has been ill for over two weeks with whooping cough for which she and her sister are receiving inoculations. [The North Adams Transcript (North Adams, Massachusetts) 8 Aug 1939, transc. by aFOFG(nw)]

 

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