Civil War Washington

CASE 143.—John Kemper, substitute, age 44; admitted July 20, 1864. He caught cold about a week before admission, while en route to his regiment. His countenance was pale and he suffered from cough, dyspnœa and acute diarrhœa. There was dulness​ over the apex of the right and lower part of the left lung. The heart-sounds were muffled and indistinct, but a clear metallic sound was heard over the apex during the first beat. The diarrhœa was checked, but the cough and dyspnœa became so distressing that the patient had to sit up constantly. From August 15 till death, on the 30th, the heart-sounds could not be heard or the pulsation felt. Post-mortem examination: The upper anterior edge of the left lung adhered to the right costal cartilages, the outer inferior edge to the left costal wall, the inner inferior edge to the diaphragm; a long membranous band stretched outward, forward and slightly upward from the anterior surface of the upper lobe to the parietal pleura about the third rib; the lung was compressed by two pints of liquid, but a space of half-gallon capacity remained anterior to the effused liquid. The heart was rolled over to the right side so that the outer side of the left ventricle presented forward under the anterior edge of the left lung, and the anterior surface of the right ventricle was pushed under the adherent inner edge of the right middle lobe. The right lung was compressed anteriorly and adherent by its entire outer surface to the parietal pleura; its apex contained a cartilaginous-walled abscess the size of a small orange, and its remaining parts were darkened by close, black, mottling deposits; the middle lobe and lower lobe posteriorly were crepitant and dark-red. The substance of the left lung was speckled with scattered tubercular deposits of the size of raisins and also with dark deposits as on the right side; the anterior edge of the lower lobe contained two abscesses of the size, respectively, of a walnut and of a raisin. The heart was enlarged, pale and softened; a large black coagulum, tipped with fibrin, filled its right side. The liver was large, smooth on its surface, granular, dotted clay-yellow; the spleen of normal size, light-colored, bloodless, softened; kidneys small; intestines healthy. —Third Division Hospital, Alexandria, Va.