English: Gunshot Wound of the Brain followed by Fungus Cere-
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-
pression, and then as suddenly subsides.