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 361.—Private Albert Hopkins, company E, 89th New York volunteers; age 43; enlisted December 4, 1861; admitted February 8, 1863. Chronic diarrhœa. The first notes were taken April 1st. At that time the patient still suffered from diarrhœa. He said that he contracted the disease in September, 1862, and had not been free from it since. He had on an average four thin watery passages daily. He was weak and somewhat emaciated. There was marked tenderness on pressure over the abdomen, but no enlargement of the liver or spleen could be detected. His face was nearly covered with a pustular eruption resembling acne; his feet and legs were œdematous. On examination of the urine nothing abnormal was detected. The heart and lungs appeared to be healthy. His mind was disturbed, and at times he appeared to be perfectly demented. He was ordered to take, every three hours, a pill containing a grain and a half of acetate of lead and a grain each of opium and capsicum; also a laudanum enema at night. Farinaceous diet. April 7th: Has had but two passages in the past twenty-four hours; complains of severe pain in the loins. Ordered half an ounce of castor oil. Discontinue the pills until the oil operates. Also six dry cups over the seat of pain. April 16th: Since last date the patient has resumed the pills and seems a little better, but still complains of pain in the back. Continue treatment. Again apply six dry cups over the seat of pain. April 25th: I learned that he was in the habit of getting various kinds of indigestible food from the sutler; he was, therefore, confined to his bed. May 1st: The discharges from the bowels are nearly natural, and the patient is again allowed to sit up. May 7th: He was seized with severe pain in the loins, which was relieved by dry cups. May 8th: He had a return of the pain, which was not relieved by cups, but yielded to the influence of a large opiate enema. It was observed that his back was œdematous. May 9th: He had a severe epileptiform convulsion, preceded by retention of urine. The urine was drawn off by the catheter. On examination it was found to contain nothing abnormal. May 10th: He had four convulsions, and was delirious from this date until death. Died, May 16th, at 12.15 A. M.—Acting Assistant Surgeon G. K. Smith. Autopsy ten hours and three-quarters after death: Height five feet four inches; body rigid; no emaciation. The brain was apparently healthy; weight forty-five ounces and a quarter. The trachea and bronchial tubes, including the smaller ramifications, were filled with a fine bronchial secretion; the mucous lining was slightly injected. The upper lobe of the right lung was small and of a grayish color anteriorly; posteriorly it was congested; there were old adhesions at its apex, and the pigmentary deposit was rather abundant; the middle and lower lobes were also hypostatically congested. The left lung was congested posteriorly in a similar manner; on the surface of its lower lobe were numerous small ecchymosed spots. The heart was normal. The pericardium contained two drachms of fluid. The liver weighed sixty-nine ounces; there was a thin layer of recent lymph on its upper surface; on section it was of a pale flesh-color, its acini almost obliterated; the gall-bladder contained eleven drachms of ochre-colored bile. The spleen was six inches long and four inches wide, of a dull lake color and very soft. The pancreas was normal; it weighed two ounces and three quarters. The right kidney weighed seven ounces and a quarter, the left seven ounces and a half; the cortical substance of both was rather pale. The œsophagus was pale; the stomach slightly congested; the small intestine apparently normal. The large intestine was inflated with gas; its mucous membrane was slate-colored.—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.