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 360.—Private Walter Evans, company E, 111th Pennsylvania volunteers; age 21; in service twenty-three months; health previous to enlistment very good; admitted January 18, 1863. Chronic diarrhœa, from which he had suffered more or less for six months. He is anæmic, somewhat emaciated, and has about eight very copious evacuations daily of a thin gelatinous substance tinged with blood; the abdomen is tender. To take tincture of the chloride of iron, twenty drops, three times daily; also tannin and opium pills. To be confined to bed. Diet strictly farinaceous. This treatment was persevered in for about ten days, by which time he was much improved, the number of stools being reduced to three or four daily. The violence of the disease soon, however, returned after some slight imprudence, when he was put upon cod-liver oil, with tincture of the chloride of iron, and low diet. Solution of persulphate of iron and opium were subsequently tried, without any advantage; also the following: ℞. Extract of nux vomica eight grains, nitrate of silver two grains and a half, opium five grains; make ten pills. Take one every six hours. Under the influence of the last prescription the stools were again reduced to one or two daily, but the patient did not improve in strength or flesh. March 31st: He was suddenly seized with severe pneumonia. Died, April 3d.—Acting Assistant Surgeon Daniel Weisel. Autopsy thirteen hours after death: Height five feet five inches; rigor mortis moderate; some emaciation. The bronchial tubes were filled with a dark-purplish fluid. The upper lobe of the left lung was in the state of gray hepatization; on pressure a muco-purulent fluid exuded from its cut surface in large quantity; the lower part of the upper lobe and the upper part of the lower lobe of the right lung were hepatized, the rest of the lung congested; the right lung weighed twenty-one ounces, the left twenty ounces. The heart weighed eight ounces; there was very little fat on its external surface; in the right auricle and ventricle was a firm fibrinous clot which extended into the pulmonary artery; in the left cavities was a similar hut smaller clot which extended into the aorta. The pericardium contained six drachms and a half of fluid. The liver had the nutmeg appearance, and weighed seventy-five ounces and a half; the gall-bladder contained very little bile. The spleen was soft, of a dark-mulberry color, and weighed six ounces and a quarter. The left kidney weighed nine ounces and a half, the right eight ounces and a half; both kidneys were firm, their cortical substance of a light-pink color, the pyramids purple. The pancreas weighed three ounces. The stomach was dark colored, almost black in the fundus. The mucous membrane of the small intestine was firm and of a variegated pink; Peyer's patches were not enlarged, and the solitary glands were inconspicuous. The solitary glands were numerous in the cæcum and also in the vermiform appendix; the rest of the large intestine was of a dark-purple color mixed with red.—Assistant Surgeon Harrison Allen, U. S. A.⃰

⃰ September 14, 1864, Dr. Allen presented to the Pathological Society of Philadelphia a brief "Synopsis of Autopsies made at Lincoln General Hospital," to which the reader is referred.—(Proceedings of the Pathological Society of Philadelphia, in the American Journal of the Medical Sciences, January, 1865, page 133.) In this paper he analyzes the appearances observed in forty-one cases of diarrhœa and dysentery, thirty-five of fever, twenty-one of pneumonia, and five of diphtheria. The notes of Dr. Allen's autopsies, from which the accounts here presented have been condensed, were not contained in the case-books of Lincoln hospital turned in to the Surgeon General's Office at the close of the war, but have since been copied into them from the originals, loaned for the purpose.