Civil War Washington

Case from the case-book of LINCOLN HOSPITAL, Washington, D. C.; Assistant Surgeon Roberts Bartholow, U. S. A., in charge from August 21st to December, 1863.

CASE 369.—Private Orange Pickett, company K, 7th Michigan cavalry; age 33; admitted August 18, 1863. Chronic diarrhœa. [This man appears on the register of the hospital of the Cavalry corps of the army of the Potomac, then near Warrenton Junction, Virginia, admitted August 16th—diarrhœa—sent to general hospital August 18th.] Died, August 24th. Autopsy twenty hours and a half after death: Body not emaciated; rigor mortis strong; height five feet six inches. The brain was healthy, and weighed fifty-four ounces; the lateral ventricles contained but little fluid. The mucous membrane of the œsophagus œsophagus was pale above, of a light-ochre color toward the cardiac orifice. The trachea contained a small quantity of frothy secretion; its mucous membrane was pale with purplish spots, the spaces between the rings being of a darker hue than the rings themselves. There were extensive old pleuritic adhesions on the right side. The right lung weighed nineteen ounces and a half; it was congested throughout, but sections floated in water; the left lung also was congested, and weighed eighteen ounces and a half. The pericardium contained four drachms and a half of fluid. The heart weighed ten ounces; its valves were healthy; its right cavities contained a large fibrinous clot which extended into the pulmonary artery beyond its bifurcation; the left cavities contained a smaller clot. The liver was firm, its acini well marked, its capsule readily elevated; it weighed seventy-six ounces and a half; the gall-bladder contained eight drachms and a half of thick tar-like sienna-brown bile. The spleen weighed fourteen ounces; it was of a dark flesh-color externally; its trabeculæ were prominent, its texture unusually firm. The pancreas was firm and of a dull white color. The kidneys were flabby, and weighed five ounces and a half each; their cortical substance was unusually pale, with slightly injected vessels, the pyramids of a darker hue, the pelves of a delicate pink; the left kidney was somewhat more injected than the right. The small intestine presented nothing abnormal except in its lower third; here the mucous membrane was of a dark-purple color and greatly softened, being readily detached by the fingernail; the purple color seemed to he below the surface, and was surmounted by a tawny-green appearance resembling an exudation; this was due to the altered color of the villi, as was evident on placing the specimen under water; Peyer's patches were not affected, and the solitary glands were not visible. The large intestine, from one end to the other, presented extensive ragged confluent ulcerations; the surface was studded irregularly with elevated patches of a dark-red color, which at first sight resembled mucous membrane, but which were found to consist of a soft exudation-product readily removed by the finger.—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.