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 362.—Private George Johnson, company H, 17th Mississippi infantry, (Confederate;) admitted May 13, 1863. Chronic diarrhœa. He was much emaciated and very weak. The motions were frequent, fluid, of a dark-green color and very fetid. His pulse was quick, compressible, and irregular; his skin hot; face flushed; tongue parched, smooth, covered with a brownish fur, and fissured; teeth and lips coated with nearly black sordes. He complained of pain in the chest, also of tenderness in the abdomen; wandered in his mind and was restless, being kept in bed with difficulty. He had at first a slight dry cough with a little frothy expectoration; this, however was soon changed, the cough becoming more violent, the sputa viscid and rusty, the breathing hurried, painful, and very difficult. On auscultation, bronchial respiration and bronchophony were heard on both sides. Treatment: Stimulants, tonics, anodynes, laudanum injections, and counter-irritation to the chest. Died, May 21st.—Acting Assistant Surgeon B. P. Brown. Autopsy eighteen hours after death: Body emaciated; some rigor mortis; height five feet ten inches and a half; apparent age 30 years. The brain weighed fifty-five ounces; was of firm consistence, and not congested. The œsophagus was natural, its mucous lining yellow. The lining membrane of the trachea was darkish green in color; it contained much bronchial secretion, and minute quantities of pus adhered between the cartilaginous rings. The lobes of the right lung were interadherent, and the whole lung was covered externally by recent lymph; on section the upper lobe appeared flabby, of a dark-reddish color, and contained a large quantity of black pigment; on pressure a fine bronchial secretion exuded; the middle and lower lobes were in a state of red hepatization, except parts of the lower lobe, which had advanced to gray hepatization. The upper lobe of the left lung was divided into three distinct lobes; its pigmentary matter was very abundant; the posterior part of this lobe was congested, and of a dark-purple hue; the lower lobe was hepatized, dark-purple, with much pigment externally, and coated by recent lymph; on section the hepatized tissue was of a purplish-red color; the right lung weighed fifty-two ounces and a half, the left thirty-eight and a half. The heart weighed twelve ounces and a quarter; its right side contained a large recent fibrinous clot which extended into the pulmonary artery; the lining membrane of the left ventricle had a dark tinge. A slight atheromatous deposit, was observed in the aorta just above the semilunar valves. The pericardium contained an ounce of serum. The liver weighed seventy-one ounces; its parenchyma was pale, the acini well defined; the gall-bladder contained an ounce of bile. The spleen was soft, and weighed ten ounces and a half. The pancreas was of normal color, and weighed four ounces and a half. The right kidney weighed ten ounces and a half, the left nine and a half; both kidneys were pale and flabby. The stomach was of a dark slate-color, tinged with ochre in the fundus, and pale near the pylorus. The small intestine was apparently healthy, of a pale color, and filled with pasty tenacious fæces; Peyer's glands and the solitary follicles were not conspicuous. The mucous lining of the large intestine was mottled of a pale-gray color, and coated in patches with a peculiar diphtheritic exudation, which was most prominent on the mucous folds; in some places there were superficial ulcerations. The intestines were moderately distended with flatus.—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.