Civil War Washington

CASE.—Private John L——, 1st United States Volunteers, aged 26 years, was admitted to Douglas Hospital, Washington, April 7th, 1865, suffering from an attack of typhoid-pneumonia. He was apparently doing well until the 20th, when he complained of sore throat. On examination, the posterior wall of the pharynx was found to be a little reddened, and covered with an abundance of tenacious mucus. At about 2.30 P. M., on the 25th, he was suddenly seized with great dyspnœa; respiration stertorous, countenance livid, and lips blue. There was complete orthopnœa, with great restlessness and jactitation, and entire inability to speak above a faint lisping whisper. These symptoms continued to increase in severity in spite of the administration of an emetic. A consultation was held, and it was decided that the symptoms were those of œdema of the glottis, and that unless relief were promptly afforded the patient would die of suffocation. Laryngotomy was thereupon performed by Assistant Surgeon William F. Norris, U. S. A., by plunging a narrow straight bistoury into the larynx, just above the cricoid cartilage. The relief was almost instantaneous, and there was but little hæmorrhage. For want of a trachea tube the lips of the wound were kept apart by bent copper wires, which were carried backward and fastened by a piece of tape behind the neck. During the night the patient took sherry wine and beef tea through an elastic bougie, swallowing small quantities at a time. The following afternoon a trachea tube was introduced into the larynx, which rendered the patient much more comfortable, although it was frequently necessary to remove and cleanse the inner tube, which became, from time to time, plugged by the thick and tenacious mucous which was constantly expectorated. On April 28th, there was a feeling of oppression in the chest; all the symptoms of bronchitis became more marked, and on the following day he was attacked with pleurisy in the right side. May 1st, well-marked pneumonia of the right side; respiration rapid; sputa rusty and frothy. Death resulted from pneumonia on May 4th. A careful dissection was made, and the lungs, larynx, and heart removed together. The larynx was pale. The epiglottis, with the edges and upper portion of the glottis, was swollen and œdematous, almost entirely closing the passage. There was a small irregular opening near the vocal cord of the left side, through which an abscess had evidently discharged. It had previously burrowed down to some extent in the cellular tissue, outside of the larynx, and had evidently been the cause of the sudden and urgent dyspnœa. There was well-marked hepatization of the lower lobe of the right lung. There was one pint of sero-purulent effusion, and numerous recent adhesions between the parietal and viscera pleura. The pathological specimen is No. 2513, Section I, A. M. M., and was contributed, with a history of the case, by Assistant Surgeon William F. Norris, U. S. A.