Civil War Washington

Case from the case-book of LINCOLN HOSPITAL, Washington, D. C.; Surgeon Henry Bryant, U. S. V., in charge to May, 1863.

CASE 358.—Private Stephen Chambers, company F, 145th Pennsylvania volunteers; admitted February 20, 1863. Diarrhœa and ascites. Died, March 30th. Autopsy two hours after death: Height five feet five inches and a half; body rigid and considerably emaciated. The brain was firm and weighed forty-seven ounces and three-quarters; there were several globular cysts in the choroid plexus, giving it a racemose appearance. The lungs were anæmic and bluish; there was slight lobular emphysema of the apex of the right lung, and in its posterior part a carnified spot which measured two inches by an inch, was of deep-purple color on section, and sank in water; a similar carnified spot was observed in the lower lobe, which was adherent posteriorly. The pulmonary pleura between the lobes was roughened by a number of minute whitish points of exudation. The upper lobe of the left lung was normal, but bound to the lower lobe by tough adhesions; its edge was also adherent to the pericardium; the right lung weighed fifteen ounces and three-quarters, the left fifteen and a quarter. The pericardium contained twenty-seven drachms of serum. The heart was flabby, its surface œdematous; there was no adipose tissue about it, and it contained no clots; the valves were healthy. The aorta presented several small whitish spots of atheroma just above the semilunar valves. The arteries of the body were filled with black blood. The abdominal viscera were agglutinated together and to the abdominal parietes by firm recent adhesions. The omentum was obliterated. The liver was congested, presented the nutmeg appearance, and weighed fifty-five ounces and a quarter. The spleen was rather firm, of a uniform dark-lake color on section, and weighed seven ounces and a quarter. The suprarenal capsules were rather dark colored. The right kidney was pale, of a light-ash color, its pelvis highly injected; it weighed five ounces; the left kidney was similar to the right, and weighed five ounces and three-quarters. The pancreas was normal, and weighed two ounces and a quarter. The mucous membrane of the œsophagus and stomach was pale; the duodenum yellowish; the jejunum of a stone-gray color; Peyer's patches were pale and inconspicuous; the solitary glands not observable: the summits of the villi, especially on the valvulæ, presented blackened points. The mucous membrane of the large intestine was of a dark-gray color; that of the rectum of a dark dirty red; the entire large intestine, externally, was irregularly contort with a greenish exudation of lymph. In the cæcum there was a ragged dark-green ulcer.—Assistant Surgeon Harrison Allen, U. S. A.⃰

⃰ September 14, 1864, Dr. Allen presented to the Pathological Society of Philadelphia a brief "Synopsis of Autopsies made at Lincoln General Hospital," to which the reader is referred.—(Proceedings of the Pathological Society of Philadelphia, in the American Journal of the Medical Sciences, January, 1865, page 133.) In this paper he analyzes the appearances observed in forty-one cases of diarrhœa and dysentery, thirty-five of fever, twenty-one of pneumonia, and five of diphtheria. The notes of Dr. Allen's autopsies, from which the accounts here presented have been condensed, were not contained in the case-books of Lincoln hospital turned in to the Surgeon General's Office at the close of the war, but have since been copied into them from the originals, loaned for the purpose.