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 340.—Private Alexander R. Bowser, company B, 139th Pennsylvania volunteers; age 26; admitted January 2, 1863. Diarrhœa. The patient had been sick ten days and was much reduced. The stools numbered eight to ten daily and were very thin and watery. He had no appetite; the tongue was dry; there was little or no abdominal tenderness. ℞. Blue mass thirty grains, ipecacuanha and opium of each two grains; make ten pills. Take one every two hours; on alternate hours ten grains of chlorate of potassa. Beef-tea, wine-whey, brandy. January 11th: The number of stools has been reduced to three or four daily, and are more consistent; the tongue is moister and shows some tendency to clean; the appetite has improved somewhat. January 22d: There are now two stools daily; the tongue is quite moist and clean. January 28th: The diarrhœa has returned with increased severity without any apparent cause. January 30th: The diarrhœa is no better; he complains for the first time of pain in the abdomen; the tongue is dry and brown; sordes on the teeth and gums. Typhoid fever was diagnosticated. Ordered stimulants and beef-tea to be given freely, also ten grains of chlorate of potassa every two hours. February 2d: The patient is much reduced; the diarrhœa but little better; the abdominal pain continues. Symptoms of pneumonia on the right side have made their appearance; there is considerable stupor, and he can scarcely be aroused to take nourishment. February 7th: There is great stupor; had fourteen involuntary stools last night. Died, February 13th, at 6.15 A. M.—Acting Assistant Surgeon Daniel Weisel. Autopsy fourteen hours after death: Height five feet eight inches; body emaciated and quite rigid. The brain weighed forty-nine ounces and a half; it was light colored and soft. The right lung weighed thirty-six ounces and a quarter, the left twenty-two ounces and a quarter; there were a number of cretefied tubercles in each; the middle lobe of the right lung was congested, the lower lobe hepatized, partly red, partly gray; the anterior portion of the upper lobe of the left lung was slightly congested, the lower lobe very much congested; there was but little black pigment in either lung. The bronchial tubes on both sides contained pus; their walls were thickened and the caliber of the tubes increased. The heart weighed seven ounces and a half; its muscular substance was pale; there was but little adipose tissue about it; there was a black clot in the cavities of the right side, a white fibrinous clot in those of the left; the clots weighed an ounce; the pericardium contained an ounce of fluid. The liver weighed sixty-two ounces and a quarter; it was of a light yellowish brown color and considerably mottled superficially, its acini indistinct; there were numerous peritoneal adhesions between the liver and the parietes of the abdomen; the gall-bladder contained a small amount of thick yellowish bile. The spleen weighed nine ounces and a half; it was of a dark brick-red color, tolerably firm, its trabeculæ distinct; like the liver it was firmly bound to the adjacent parts by peritoneal adhesions. The pancreas weighed two ounces and a half; it was light colored and firm. The suprarenal capsules weighed three-fourths of an ounce; they were large, red, and tough, with thick whitish borders and hard centres. The kidneys were firm and slightly congested; in the lower part of the right kidney was a small cyst. The urinary bladder was empty. The cardiac extremity of the stomach was slightly congested. The upper two-thirds of the jejunum were congested, its lower third blackened; in the latter portion the mucous membrane was thin and the valvulæ conniventes indistinct. The ileum was distended and slightly congested, its solitary glands enlarged; a number of patches of exudation of a grass-green color were observed in the ileum; they were arranged transversely to the length of the gut and parallel to each other; the lowest of them was three inches above the ileo-colic valve; it was quite granular in appearance; there were also a number of ulcers in the ileum which were surrounded by areas of congestion. The cæcum was intensely congested; its mucous membrane and that of the colon presented patches of pseudomembrane similar to those in the ileum, which increased in number and extent, until in the sigmoid flexure they formed an almost continuous coating to the mucous membrane. There were also a number of ulcers in the descending colon, sigmoid flexure, and rectum; many of them were coated with the pseudomembrane; when this was removed their bases were red and resembled granulations.—Assistant Surgeon George M. McGill, U. S. A.