Civil War Washington

CASE 97.—Private Clark D. Dexter, Co. L, 10th N. Y. Cav.; age 21; was admitted Feb. 19, 1863, as a convalescent from typhoid fever. He improved and in a short time had entirely recovered. On March 21 he complained of pain in the upper part of the chest on both sides and of some cough, but no dyspnœa; sonorous ronchus​ was heard, but both sides were resonant. Two days later, having been treated in the meantime with dry cups, blue-pill and ipecacuanha, the pain and cough had increased, the expectoration was slightly tinged with blood, and there was dulness​ with subcrepitant râles over the upper part of the left side. He suffered much from pain during the night of the 24th and did not sleep; next morning the expectoration was decidedly pneumonitic. Calomel, muriate of ammonia and Dover's powder were given every three hours; a blister was applied over the left lung and the whole chest was covered with an oil-silk jacket. On the 26th the abdomen was so painful and tender that complaint was made of the weight of the bedclothes. On the 28th there was bronchial respiration with dulness​ on percussion over the entire left lung. Carbonate of ammonia, syrup of squill and camphorated tincture of opium were given, with beef-tea and milk-punch. Next day the upper part of the right lung became involved; respiration was hurried and laborious. He died on the 31st. Post-mortem examination: Body somewhat emaciated. The brain was healthy. The right lung, twenty-five ounces, was partly adherent; the posterior part of its upper lobe was consolidated and grayish-purple; the remaining lobes were healthy. The left pleural sac contained nine ounces of serum; the lung, twenty-five ounces, was adherent to the parietes by thick, tough, recent lymph; its upper lobe was hepatized red, the lower lobe highly congested but not solidified. The right cavities of the heart were filled with fibrinous and mixed clots which extended into the pulmonary artery, and there were some patches of atheroma in the aorta. The omentum was contracted and drawn to the right side; the knuckles of intestine were united by a soft exudation. The liver, seventy-three ounces, was rather soft and adherent to adjoining organs in several places. The spleen, seven ounces and a half, was soft; the pancreas normal; the kidneys pale; the suprarenal capsules dark-colored; the mucous membrane of the bladder was injected and presented a number of black-bordered brown spots about a quarter of an inch in diameter. The mucous membrane of the stomach and duodenum was gray and not injected; in the rest of the small intestine the mucous membrane was of a light red-lead color; Peyer's patches were healthy to within four feet of the ileocæcal valve, below this point they were dark-colored but not elevated; the solitary glands were not visible, and there was no softening of the mucous membrane; the small intestine was distended with gas. The mucous membrane of the cæcum was gray and the solitary follicles numerous and prominent; the transverse colon was contracted; the rest of the large intestine normal.—Ass't Surgeon Harrison Allen, U. S. A., Lincoln Hospital, Washington, D. C.