The lion of the union: The pelvic wound of Joshua Lawrence Chamberlain

Purpose: Major General Joshua Lawrence Chamberlain is a true American hero. His medical history and war wounds provide a rare snapshot of Civil War er a medicine. In particular the most devastating injury was a rifle shot thro ugh the pelvis rupturing the bladder and urethra. We describe this injury a nd how it affected his life to provide insight into late 19th century urolo gical care. Materials and Methods: All available references, including biographies, let ters, surgical reports, military documents and prior medical summaries, wer e reviewed regarding Chamberlain's urological history. Results: While leading the Union charge to Petersburg, Virginia on June 18, 1864, Chamberlain was struck with a minie ball anteriorly below the right greater trochanter. The ball coursed obliquely upward disrupting the bladde r and urethra, and embedded behind the left acetabulum. An unprecedented wo und exploration in the field hospital was performed to extract the bullet a nd "reconnect severed urinary organs." Hope for recovery was nonexistent as urine was seen exiting the lower wound postoperatively. This genitourinary injury required 4 subsequent repairs during Chamberlain's lifetime and ult imately left him with a draining urethrocutaneous fistula at the penoscrota l junction. Conclusions: Survival from catastrophic Civil War wounds was rare, especial ly from "gut wounds" which had a mortality rate of greater than 90%. Chambe rlain not only survived but thrived with his sense of duty carrying him bac k to the battlefield and beyond. He was plagued during his life with recurr ent cystitis and epididymo-orchitis, which in an era without antibiotics wa s especially miserable. Urosepsis is listed as the cause of death on his de ath certificate and whether this was true is debatable. However, even if th is wound did not cause his death, it surely contributed to it.