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 341.—Private John Curdy, company E, 140th New York volunteers; admitted December 30, 1862. Typhoid fever. [This man appears on the register of the regimental hospital of the 140th New York volunteers as admitted November 14th—fever; no disposition recorded.] When the first notes were taken, January 24th, the patient was emaciated; pulse 95; severe cough; expectoration muco-purulent; bowels loose, three or four evacuations daily; appetite tolerably good. Treatment: Nutritious diet, tonics, and astringents. Died, February 14th. His mind remained clear to the last. Autopsy three hours after death: Height five feet four inches; body somewhat emaciated; no rigor mortis; apparent age 28 years. The brain weighed forty-six ounces; it was of a light color and moderately firm. The right lung weighed twenty-eight ounces and a half, the left thirty-one ounces and a half; both were blackened externally by deposits of pigment, and contained abundant deposits of tubercles, many of which were softened; several large vomicæ were found in the upper lobe of each lung; the total capacity of these cavities was estimated at about twelve cubic inches; the remaining portion of the upper lobes was solidified. The bronchial tubes were congested, contained pus, and those leading from the solidified lobes were plugged with fibrinous exudation; extensive pleuritic adhesions, corresponding with the consolidated lobes, existed on both sides. The heart weighed seven ounces and a half; it was flabby and presented but little adipose tissue externally; the blood was fluid, but coagulated readily; the pericardium contained eight fluid drachms of a greenish-yellow fluid. The peritoneum generally was inflamed and slight adhesions had taken place. The liver weighed forty-eight ounces; it was of a dark brick-red color, firm, very faintly mottled, its acini rather indistinct; minute miliary tubercles were observed on its surface; the gall-bladder contained four drachms and a half of thin straw-yellow bile. The spleen weighed seven ounces and a half; it was of a blood-red color, firm, and contained miliary tubercles. The pancreas weighed three ounces and a half; it was of a light slate color and firm. The right kidney weighed four ounces and three-quarters, the left kidney four ounces and a quarter; both kidneys were firm and light colored; the right contained tubercles. The suprarenal capsules were of medium size, tough, and of an ochre color. The stomach was large; its mucous membrane thick and soft. The duodenal glands were enlarged. The mucous membrane of the small intestine was thin; the valvulæ conniventes indistinct, and disappeared in the lower part of the jejunum. The lower third of the ileum was congested, and the patches of Peyer in this region were ulcerated. Other ulcers, not seated in Peyer's patches, were situated as follows: In the upper part of the jejunum was a ragged ulcer, with a soft centre and raised sharply-defined edges; on the outside of the gut its situation could be detected by a moderately hard white ring corresponding to its internal edges. In the inferior third of the jejunum was a small ulcer on a raised base, surrounded by irregular congestion; viewed from the outside its situation was marked by a white spot. A similar ulcer, of medium size, occurred still lower down, and in the upper portion of the ileum were a number of small ulcers of the same general character. One ulcer in the lower third of the jejunum exhibited on the peritoneal surface a number of small white round masses supposed to be tubercles. The cæcum was congested and ulcerated, as was also the ascending and transverse colon; one large ulcer in the transverse colon measured two and a half by two inches; the mucous membrane of the rectum was slate colored; it presented a number of ulcers and some formations which were thought to be deposits of tubercle. The mesenteric glands were enlarged.—Assistant Surgeon George M. McGill, U. S. A.