Civil War Washington

Case from the case-book and medical descriptive lists of the HAREWOOD HOSPITAL, Washington, D. C., Surgeon Thomas Antisell, U. S. V., in charge from October, 1862, to September, 1863:

CASE 278.—Private Charles S. Postles, company C, 1st Delaware cavalry; age 29; admitted January 25, 1863. Diarrhœa. At the time of admission this man appeared to be in feeble health. He said he had been shipwrecked on the coast of New Jersey in the winter of 1852, and had almost perished from exposure to wet and cold. His feet were frost-bitten, and he had not enjoyed good health since. January 27th: Had a slight chill last night. He complains of pain in the head; mouth somewhat dry; tongue slightly coated and of a brownish color; pulse 100 and easily compressible; eyes somewhat suffused; respiration natural. To take two grains of mercury with chalk every six hours. February 2d: Complains that he cannot sleep; pulse 100. To take four grains of Dover's powder every four hours. February 5th: Pulse about the same; skin continues dry; tongue moister and not so dark; less heat of surface than before; still complains of loss of sleep. Continue the Dover's powder. February 10th: Pulse 95; tongue and mouth moister; skin natural to the touch; slight moisture about the forehead and neck. Continue treatment. February 15th: Pulse 90; tongue clean; skin relaxed; slight perspiration. Stop the Dover's powders. To take a tablespoonful of whiskey every hour. February 18th: Patient still improving; pulse 90, fuller and softer; again complains of sleeplessness. Continue the whiskey. To take six grains of Dover's powder every six hours. March 1st: Continues to convalesce; is able to sit up and walk unsupported several steps; appears cheerful, and has a moderate appetite. March 7th: Slight diarrhœa. To take ten drops of laudanum, with twenty of tincture of catechu, every four hours; brandy in tablespoonful doses. March 15th: Discharges from the bowels, consisting of serum and mucus only, very frequent since last night. The patient is quite prostrated, and refuses to take nourishment. To take four grains of quinine every four hours in a tablespoonful of brandy, and alternating with this every four hours a powder containing two grains of acetate of lead, half a grain of tannic acid, and three-quarters of a grain of opium. An enema of starch and laudanum was also directed. The diarrhœa, however, continued unchecked, and the patient died March 19th, at 6 A. M. Autopsy: The pericardium was somewhat thickened, and contained about four ounces of serum. Heart and lungs normal; no pleuritic adhesions. The stomach hung perpendicularly, the pyloric end reaching two inches below the umbilicus; its mucous membrane was normal but somewhat pale. The mucous membrane of the lower portion of the jejunum was dark-red and soft. The ileum was not as red as the jejunum, but presented many ulcerated patches with raised edges; these corresponded in position to the patches of Peyer. The colon was very much thickened, ulcerated, and coated with patches of pseudomembrane. Rectum in the same state as the colon. Liver and spleen normal. The gall-bladder somewhat larger than usual, and filled with bile. The left kidney was greatly enlarged, perhaps six times its normal size, and presented numerous cysts filled with fluid, varying in size from a line to three-quarters of an inch in diameter; the right kidney was also full of cysts, and about twice its natural size.—Surgeon Thomas Antisell, U. S. V. [Nos. 161 to 164, Medical Section, Army Medical Museum, are from this case. No. 161 is a portion of the ileum with hypertrophied villi, and a thickened Peyer's patch in which there are two ulcers. Nos. 162 and 163 are successive portions of the colon plastered with pseudomembrane, which has irregularly separated, exposing the submucous coat, from which the portions of pseudomembrane project as little islets, giving the appearance of coarse granulations. No. 164 is the cystic kidney above described; the cysts were filled, when fresh, with fluid of various colors yellow, bluish, brownish, and greenish.]