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 353.—Private Charles E. Edgely, company F, 13th New Hampshire volunteers; age 21; admitted February 18, 1863. Chronic diarrhœa. Had been sick three weeks, the symptoms being debility, chills, cough, and diarrhœa. When admitted he was much emaciated, but slept pretty well, and had a good appetite. February 20th: Pneumonia supervened. He had a slight chill, and took to his bed complaining of cough and excessive weakness; subcrepitant rales were heard on both sides; after a few days the rales on the right side were replaced by puerile respiration, on the left side by bronchial respiration and bronchophony. Died, March 7th. Autopsy nine hours and a half after death: The body was very rigid and slightly emaciated. The brain weighed fifty-two ounces and a half; it was firm and of a flesh color. On section the puncta vasculosa were quite conspicuous; the pia mater was congested; the subarachnoid fluid abundant. The right lung weighed twenty-two ounces and a quarter, the left thirty-eight and a half; the lower lobe of the right lung was very much congested; its upper lobe contained a few consolidated lobules. The right bronchial tubes were congested. There were extensive old pleuritic adhesions on the right side. The lower lobe of the left lung was in a state of gray hepatization; its substance was friable, and exuded pus on pressure. Recent pleurisy was manifested by false membrane covering the whole surface of the lower lobe, most of the upper, and binding the lobes together. The bronchial tubes proceeding from the hepatized lobe were obstructed by white fibrinous plugs. The heart was firm, its valves normal; in its right side was a firm fibrinous clot which extended into the pulmonary artery; a similar clot in the left side extended into the aorta; in the left side there were also some black coagula. The pericardium contained an ounce of light greenish-yellow serum. The liver weighed seventy-four ounces and a half; it was congested, firm, its acini distinct; the gall-bladder contained ten drachms of light straw-colored bile. The spleen weighed fifteen ounces; it was quite firm, and of a dark-purple color with whitish spots. The pancreas weighed three ounces and a quarter; it was quite full of blood. The suprarenal capsules wore small, of a light coffee-color, and soft. The right kidney weighed six ounces and a half, the left seven and a quarter; both were pale, but firm. There was some congestion in the stomach, the mucous membrane of which was soft. In the upper part of the jejunum the mucous membrane was congested and of a dark-purple color; below, the congestion was irregular, and regions of apparently healthy mucous membrane were observed. The ileum was congested and distended with gas. Peyer's patches were slightly thickened and injected. The mucous membrane of the cæcum had a dark-purple color; the ascending colon was but slightly congested, the transverse colon intensely so, the descending colon appeared healthy; the rectum presented the same dark-purple congestion which was observed in the cæcum.—Assistant Surgeon George M. McGill, U. S. A.