The lion of the union: the pelvic wound of Joshua Lawrence Chamberlain.
OBJECTIVE
Major General Joshua Lawrence Chamberlain is a true American hero. His medical history and war wounds provide a rare snapshot of Civil War era medicine. In particular the most devastating injury was a rifle shot through the pelvis rupturing the bladder and urethra. We describe this injury and how it affected his life to provide insight into late 19th century urological care.


METHODS
All available references, including biographies, letters, surgical reports, military documents and prior medical summaries, were reviewed regarding Chamberlain's urological history.


RESULTS
While leading the Union charge to Petersburg, Virginia on June 18, 1864, Chamberlain was struck with a minié ball anteriorly below the right greater trochanter. The ball coursed obliquely upward disrupting the bladder and urethra, and embedded behind the left acetabulum. An unprecedented wound exploration in the field hospital was performed to extract the bullet and "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 ultimately left him with a draining urethrocutaneous fistula at the penoscrotal junction.


CONCLUSIONS
Survival from catastrophic Civil War wounds was rare, especially from "gut wounds" which had a mortality rate of greater than 90%. Chamberlain not only survived but thrived with his sense of duty carrying him back to the battlefield and beyond. He was plagued during his life with recurrent cystitis and epididymo-orchitis, which in an era without antibiotics was especially miserable. Urosepsis is listed as the cause of death on his death certificate and whether this was true is debatable. However, even if this wound did not cause his death, it surely contributed to it.
Harmon
W J
WJ
Wilford Hall Medical Center, Lackland Air Force Base, University of Texas Health Science Center at San Antonio, 78250, USA.
McAllister
C K
CK
D005197:Famous Persons; D049672:History, 19th Century; D008887:Military Medicine; D008889:Military Personnel; D014481:United States; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014857:Warfare; D014948:Wounds, Gunshot / Q000601:surgery