Civil War Washington

Case from the case-book and medical descriptive lists of the DOUGLAS HOSPITAL, Washington, D. C., Assistant Surgeon William Thomson, U. S. A., in charge from February, 1863, to September, 1864, and after September, 1865:

CASE 317.—Private Lewis W. Kopp, company H, 48th Pennsylvania volunteers; admitted September 9, 1864. Chronic diarrhœa and pleurisy. [This man appears on the register of the field hospital of the 2d Division, 9th Corps, as admitted August 21st—diarrhœa—sent to hospital August 27th. He is borne on the register of the field hospital, 9th Army Corps, City Point, Virginia, as admitted August 27th—typhoid fever—sent to general hospital September 8th.] He stated that he had been unable to do duty for several weeks on account of a bad cough and diarrhœa. He had a hacking cough but no expectoration, and a troublesome diarrhœa; was much emaciated; had severe night-sweats; pulse about 90; and the brilliant eye of a patient with hectic fever. Respiration was rude on both sides, and percussion quite flat on the right side posteriorly. He says phthisis is hereditary in his family. The symptoms continued with but little change until the 27th, when, toward nightfall, he was suddenly seized with a feeling of great oppression and became quite unable to keep the horizontal position. This feeling passed off in a few hours, but returned with great violence on the morning of the 30th; he rapidly sank, and died during the evening of the same day. On testing the urine by heat and nitric acid it became almost solid from excess of albumen. Autopsy fourteen hours after death: The right lung was congested but healthy; in the left pleural cavity there was a large effusion of a greenish-yellow sero-purulent fluid, which had completely compressed the lung against the vertebral column; both lung and costal pleura were coated with a thick layer of lymph, the heart was covered with a layer of fibrinous lymph, and there was in the pericardium a considerable effusion of serum in which shreds and flakes of lymph floated free. The liver was healthy, but adherent to the diaphragm; the adhesions were old and tough. The spleen was contracted and firm. The ileum presented a few ulcers. The large intestine was thickened and ulcerated throughout, its entire extent. The left kidney was healthy; the right kidney was situated over the second lumbar vertebra, completely atrophied, and converted into a large cyst containing several ounces of a clear amber-colored liquid,—a patulous ureter led from it and emptied into the bladder at its usual place.—[Nos. 361 and 362, Medical Section, Army Medical Museum, are from this case. No. 361 is the bladder, right kidney, and bifurcation of the aorta. The kidney is converted into a cyst the size of an orange, with fibrous walls about four lines thick. The cyst is connected by a patulous ureter with the urinary bladder. Two renal arteries the size of crow-quills proceed from the aorta just above its bifurcation and ramify in the walls of the cyst. No. 362 is a portion of the thickened colon, the mucous surface of which presents numerous superficial ulcers resembling those produced by the irregular separation of a diphtheritic layer.]