Civil War Washington

CASE 1.—Private Randolph Gideon, Co. C, 2d Tenn.; age 35; a paroled prisoner; was admitted May 2, 1863, having been taken sick while en route from Richmond, Va., to his home. He had severe and persistent vomiting, ejecting a watery fluid mixed with bile and portions of undigested food. He was more or less comatose from the first, but sometimes answered questions rationally. There was no epigastric or hepatic tenderness, and no evidence of pain except on the 12th, when he complained of his right hip. His tongue was dry, thirst excessive, urine copious and passed involuntarily, and his bowels, although constipated, were readily moved by enemata. Oxalate of cerium, creasote, bismuth, morphia and chloroform with counter-irritants were employed, without success, to check the vomiting. Only raw eggs and small quantities of milk were retained. Nourishing enemata were frequently administered. He died on the 14th. Post-mortem examination: Body moderately emaciated. The brain was not examined. The thoracic viscera were healthy. The liver was rather larger than normal, but healthy. The stomach was normal in size and contained some watery fluid; its mucous membrane was reddened and its pyloric orifice contracted. At the commencement of the duodenum there was a firm well-marked constriction, reducing its calibre to less than half an inch in diameter. Around this portion of the intestine were deposits of coagulable lymph, and immediately below, on the posterior aspect of the gut, was a perforation with thickened and introverted edges. The gall-bladder was distended. The kidneys were normal.—Ass't Surgeon Charles B. White, U. S. A., Pittsburgh Hospital, Pa.