Civil War Washington

CASE 20.—Private David G. Hatch, Co. H, 13th N. H.; age 23; was admitted Dec. 30, 1862, with typhoid fever. On Feb. 23, 1863, he had high fever, pulse 144, and a dry hacking cough; his throat, lips and tongue were much swollen and his mouth and fauces dry and inflamed. He continued to take food till March 1, when he complained that he could not swallow. At this time the chest was dull on percussion and bronchial breathing was heard; respiration was painful and difficult, the pulse low, breath offensive and the extremities cold; acrid discharges came from the nose, sordes accumulated on the teeth and the expectoration was mixed with putrid masses. He died on the 3d. Post-mortem examination: The brain was pale and firm. The trachea, larynx, posterior half of the left side of the fauces, the pharynx on the line of the nares and the posterior part of the floor of the nares were covered with a fibrinous mass, grayish-white in the larynx and red in the trachea. [Specimen 7, Med. Sec., Army Medical Museum, shows a diphtheritic layer coating the posterior surface of the soft palate and the under surface of the epiglottis; it is notably present at the rima glottidis.] The right lung weighed thirty-nine ounces; its bronchial tubes were occluded with plugs of white fibrinous lymph, which, when detached with difficulty, revealed longitudinally striated mucous membrane, roughened and in places granulated; on section the tubes appeared as yellowish-white spots; the lower lobe was almost entirely consolidated; the middle lobe, shrivelled and partially carnified, had its main bronchus totally occluded by a large plug; the upper lobe was generally consolidated, but the bronchial plugs were less adherent and there were neither striæ nor granulations in the bronchi. Some of the bronchial glands were in a state of cheesy and calcareous degeneration. The heart was pale and contained fibrinous clots in both sides; nineteen drachms of brownish serum were found in the pericardium. The duodenum was stained; Peyer's patches were much congested and spotted; the valvulæ were thin and irregularly congested and the mucous membrane of a livid flesh-color. The large intestine was normal. The liver, fifty-nine ounces, was mottled, pale and softened; the spleen, seven ounces and a quarter, was mottled of a light-purple color, its trabeculæ distinct and firm and its substance pulpy; the pancreas firm and purple; the kidneys reddish flesh-colored and firm; the suprarenal capsules enlarged, straw-colored and of natural consistence.—Ass't Surgeon Geo. M. McGill, U. S. A., Lincoln Hospital, Washington, D. C.