Civil War Washington

Case from the case-book of LINCOLN HOSPITAL, Washington, D. C.; Surgeon Henry Bryant, U. S. V., in charge to May, 1863.

CASE 333.—Private Hiram H. Ames, company G, 78th New York volunteers; age 37; admitted January 11, 1863. Chronic diarrhœa of some six months standing. The patient was very weak and much emaciated; he complained but little; the stools averaged about six daily. Died, January 20th. Autopsy twenty-two hours after death: There was slight effusion in the subarachnoid space; the veins of the pia mater were full. The brain weighed fifty-four ounces. The right auricle and ventricle of the heart contained large, firm, white fibrinous clots; the left ventricle a small clot of the same character. Throughout the right lung there were circumscribed condensations of tissue, apparently the result of inflammation, presenting the features of red and gray hepatization; these varied from the size of a pea to that of a large walnut; when excised they sank in water; the left lung contained only one area of condensation, which was found in its upper lobe; both lungs were full of blood; they weighed nineteen ounces each. The liver was full of blood; it was firm and had a granular appearance; the gall-bladder was small, the bile dark and viscid. The spleen weighed four ounces and a quarter; the pancreas three ounces and a half. The left kidney weighed six ounces and a quarter, the right six ounces. The mesenteric glands were large. The stomach was irregularly congested, its mucous membrane soft. The mucous membrane of the middle third of the jejunum was slate-colored; the valvulæ conniventes of the jejunum indistinct. The mucous membrane of the lower third of the jejunum and of the ileum was reddened and very soft; the intestinal walls were extremely thin; just above the ileocæcal valve the redness was more intense, attaining a brilliant purple color, and some gray patches of pseudomembrane adhered to the surface. Large numbers of ulcers were found throughout the large intestine, some of them rather indistinct, others with very sharp edges; they were of very irregular form. The mucous surface of the rectum presented a honeycombed appearance, and was coated with gray pseudomembrane. The whole large intestine was thickened.—Assistant Surgeon George M. McGill, U. S. A. [Nos. 154 and 155, Medical Section, Army Medical Museum, are from this case. The specimens are two successive portions of the thickened colon, with adherent patches of pseudomembrane on the mucous surface and a number of follicular ulcers.]