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 365.—Private Charles Peifer, company B, 52d New York volunteers; enlisted August 14, 1861; admitted February 27, 1863. Chronic diarrhœa. The patient stated that he had enjoyed good health until June, 1862, when he contracted diarrhœa on the peninsula; had been in regimental or general hospital ever since. He caught cold in January, 1863; since that time he has had more or less cough and dyspnœa. June 22, 1863, when this memorandum was taken, the patient was in a dying condition. He had dyspnœa, constant inclination to cough, and much mucous rattling in the throat. Chest resonant on percussion, but hepatic dulness​ as high as the fifth rib. His feet are swollen, and have been so for the last six weeks. He is exceedingly weak, and his general appearance is that of a consumptive. He has constant diarrhœa; tongue clean and red; pulse 102; abdomen painful on pressure. He died June 23d. Autopsy four hours after death: Height five feet six inches; upper part of body very much emaciated; abdomen swollen; legs œdematous. The lining membrane of the trachea was pale, that of the bronchial tubes purplish. The upper lobe of the right lung was adherent to the thoracic parietes, and infiltrated with tubercles; it contained a cavity the size of a chestnut near its apex; this cavity was filled with pus; in the lower lobe were a number of cheesy tubercles the size of marrow-fat peas; the pulmonary tissue between these tubercles was congested. There were firm pleuritic adhesions on the left side. In the apex of the upper lobe of the left lung were numerous disseminated tubercles; the lower lobe was congested. The right lung weighed twenty-five ounces, the left twenty-four. The pericardium contained two drachms of limpid serum. The heart weighed eight ounces; the right auricle and ventricle contained large clots, the left auricle a small one. The liver presented the nutmeg appearance; it measured thirteen inches by six, and was two inches thick; the gall-bladder contained seven drachms of blackish-green bile. The spleen weighed thirteen ounces and a half, was moderately firm, and of a dull-lake color. The pancreas weighed three ounces and a quarter. The right kidney weighed five ounces, the left five and a quarter; both kidneys were pale, their cortical substance yellowish. The omentum was contracted and doubled up under the stomach. The mucous membrane of the stomach was slate-colored. The duodenum was healthy. Peyer's patches were ulcerated. The large intestine was thickened and extensively ulcerated.—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.