Civil War Washington

CASE 366.—Private David Walker, company D, 49th Pennsylvania volunteers; admitted July 30, 1863. Chronic diarrhœa. Had suffered from this disease since April 12th. When admitted he was very much emaciated, and had considerable fever; tongue flabby and furred; pulse 64; bowels loose; stools thin, and varying from four to twelve daily; appetite poor. August 7th: Is very restless; has no appetite; suffers much from thirst; tongue parched; has high fever, and some sordes on the teeth; lies in a half unconscious state. August 8th: The stools are involuntary, quite watery, and produce green stains on linen. Died, August 9th. Autopsy twenty-three hours after death: Body emaciated; rigor mortis well marked; apparent age 23; height five feet nine inches. The brain was moderately firm, and weighed forty-nine ounces and a half. The mucous membrane of the trachea was of a greenish color, probably due to post mortem change. The lymphatic glands at the bifurcation of the trachea were very large, soft, greenish, and contained some calcareous matter. The right lung weighed seventeen ounces and a half; the posterior portion of its upper and middle lobes and the whole of the lower lobe were engorged with venous blood; the left lung weighed fourteen ounces; its upper lobe was congested at the apex, healthy elsewhere; the lower lobe was œdematous, purplish exteriorly; on section a large quantity of thin watery fluid poured out. The heart weighed six ounces and a half; its valves were healthy; it contained no clots; the endocardium was purplish. The liver was very flabby; it weighed forty-three ounces; the gall-bladder contained four drachms of bile. The spleen was firm and of a mahogany color; it weighed six ounces. The pancreas was healthy, and weighed three ounces. The cortical substance of the kidneys was pale, the pyramids purple, the pelves bluish; the kidneys weighed five ounces and a half each. The walls of the small intestine were quite thin; its mucous membrane presented a dark-purple congested appearance; Peyer's patches, which were not swollen, were of a dingy stone color, with central dots of pigment in the follicles composing the patches. The large intestine presented nothing remarkable except in its lower portion, where the mucous membrane was of a deep crimson color; there was no ulceration or exudation of lymph on its surface.—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.