Wednesday, May 16, 2007

A Thorn in the Lion of the Union (Medical Department Column #2)

Below is the second installment of my "Medical Department" column from The Civil War News. Published in the October 2000 issue, it describes some interesting research and new conclusions about the grievous groin injury that Joshua Lawrence Chamberlain received in the Petersburg Campaign. Enjoy!
A Thorn in the Lion of the Union
"Medical Department" by Jim Schmidt
From the October 2000 issue of The Civil War News

Joshua Lawrence Chamberlain, Union hero of Gettysburg’s Little Round Top, was treated for wounds and illness several times during the Civil War, including sunstroke, malaria, typhoid, and several close calls with Rebel lead. Indeed, in the end it was a bullet that killed Chamberlain. In June 1864, while leading a charge against the Petersburg defenses, Chamberlain was struck by a ricocheting minie ball, sustaining a devastating injury. Though Chamberlain lived until the age of 85, he endured the painful complications of the wound for fifty years, and it certainly contributed to his death.

Chamberlain’s experience at Petersburg is the subject of an excellent medical case study in a recent issue of the Journal of Urology: “The Lion of the Union: The Pelvic Wound of Joshua Lawrence Chamberlain,” by Drs. William J. Harmon and Charles K. McAllister (March 2000, pp. 713-716). The article includes a biographical sketch of Chamberlain, an account of his wound and treatment, and a remarkably detailed anatomical description of the bullet’s path and the resulting damage (even if you don’t know a trochanter from a hole in your acetabulum, the article is very readable). Illustrations include photographs of Chamberlain and the actual minie ball that wounded him. Most interesting are computerized depictions of the male pelvic region showing the proposed path of the bullet.

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.

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.

Dr. Harmon, a Major in the United States Air Force, is a staff urologist at Wilford Hall Medical Center, Lackland AFB, San Antonio, Texas. He was kind enough to share with me some additional insights regarding his interest in Chamberlain. “I have always been a bit of a Civil War buff, and as a urologist my eyes remain open to areas in history pertinent to my field,” he said. Dr. Harmon met Dr. McAllister while on duty at Wilford Hall (Dr. McAllister works at Fort Sam Houston’s Brooke Army Medical Center, also in San Antonio).

“Colonel McAllister is the true expert in Chamberlain’s maladies,” Dr. Harmon said. “He mentioned that Chamberlain suffered a pelvic wound at Petersburg and there were several theories as to the path of the bullet and the subsequent surgeries that were proposed to explain his painful fistula.”

The most challenging aspect of Dr. Harmon’s review was sorting through all of the available books, letters, and surgical reports to find facts rather than hearsay. “You could often sense what was happening at any given time by his letters to his wife describing an infection or talking about his surgery,” he told me. The most satisfying aspect for Dr. Harmon was demonstrating that the fistula was probably the result of prolonged use of the catheter rather than the path of the bullet as previously believed. The article has generated a good deal of interest from other Civil War enthusiasts in his field of urology.

According to Dr. Harmon, a soldier facing a similar injury on a modern battlefield faces a much better prognosis than Chamberlain did. Advances in catheter technology allow for proper draining of urine and realignment of the bladder with the urethra. After removal of the catheter, any remaining restrictions could be surgically relieved by a urethroplasty. Complications are rare, but could include impotence or incontinence.

Dr. McAllister has written or co-authored two other excellent articles on Chamberlain: “The Career and Orthopaedic Injuries of Joshua L. Chamberlain” (Clinical Orthopaedics and Related Research, May 2000, pp. 107-114), and “Fire, Blood, and the Lion of the Union: Joshua Chamberlain’s Civil War Ailments” (The Pharos, Spring 1998, pp. 40-41).

Civil War buffs can argue whether Chamberlain “saved the Union” at Gettysburg, but there is little doubt that he lived a very painful life with courage and dignity. When he died in 1914, at age 85, the cause of death was pronounced as a chronic bladder infection and inflammation of the urethra, caused originally by a gunshot wound. And so, in the end, it was a Civil War bullet that killed “The Lion of the Union.”


1 comment:

Anonymous said...

That was a fascinating and informative article