Civil War Washington

Case from the case-book of LINCOLN HOSPITAL, Washington, D. C.; Assistant Surgeon Roberts Bartholow, U. S. A., in charge from August 21st to December, 1863.

CASE 382.—Private Thomas Shannon, company F, 42d New York volunteers; age 25; admitted September 12, 1863. Chronic diarrhœa. [This man appears on the register of the regimental hospital of the 24th New York volunteers, admitted August 24th—diarrhœa—sent to general hospital September 10th.] The patient stated that he had been sick four months; was extremely emaciated; his hair was dry and long; his eyes were dim, but ulceration of the cornea had not yet taken place; the skin was of a dull yellowish-slate color, and slightly furfuraceous; the abdomen was much depressed; the feet and toes were persistently cold, the toes bluish. About the 13th of October he began to sink rapidly, but with singular vitality he reacted from a condition bordering upon death, and for several weeks improved so greatly that hopes of his recovery were entertained. He subsequently became languid and exhausted, the diarrhœa became again more violent, and he died November 19th, at 7.30 A. M. Autopsy six hours after death: Height five feet nine inches; rigor mortis well marked; body much emaciated. The brain was healthy, and weighed fifty-seven ounces; the ventricles contained a drachm of serum; the quantity of subarachnoid fluid was larger than usual. The mucous membrane of the trachea was pale. The right lung was collapsed, and weighed eight ounces and a half; it contained an abundance of pigment and some softened tubercles at its apex; the left lung was also collapsed, and weighed nine ounces. The pericardium contained six drachms of serum. The heart was healthy, and weighed eight ounces; its right cavities contained a soft black clot, and a similar one was found in the left ventricle. The liver was of a pale-yellowish color, apparently fatty; it weighed fifty-five ounces and a half; the gall-bladder contained eight drachms of dark tar-like bile. The spleen was firm, of a reddish mahogany-color, and weighed eight ounces and a half. The kidneys were pale and anæmic; the right kidney weighed three ounces and a half, the left four and a half. The pancreas was hard and tallow-like; it weighed two ounces. Seven feet above the ileocæcal valve the mucous membrane of the small intestine assumed a granular appearance, which became more marked farther down, assuming more and more the characters of an exudation of lymph. The exudation was arranged on the surface of the valvulæ conniventes, or in lines parallel to them, for they were quite indistinct, and in some places entirely obliterated; toward the ileocæcal valve the deposit was yellowish, pultaceous, and resembled the false membrane in diphtheria; just above the ileocæcal valve, midway between the mesenteric attachment and Peyer's patches, there was an ulcer which had perforated the ileum and communicated with a perforating ulcer in the cæcum; between the two ulcers was a small cavity containing pus, which was bounded by the intestinal walls, the iliac muscle, and a portion of the great omentum, which had become adherent, and appeared to have prevented the extravasation of the intestinal contents into the abdominal cavity. The colon was ulcerated throughout.—Assistant Surgeon Harrison Allen, U. S. A.⃰ [Nos. 116 to 118, Medical Section, Army Medical Museum, are from this case. Nos. 116 and 117 are successive portions of the thickened ileum; the mucous membrane is coated with pseudomembrane, and presents a number of ulcers. In No. 117 the opening of the abscess above described into the ileum is seen. The corresponding portion of the cæcum was, unfortunately, not preserved. No. 118 is a portion of the colon of the same patient, which is greatly thickened, and coated with pseudomembrane.]

⃰ 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.