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 370.—Private Robert Johnson, company I, 11th North Carolina (rebel) infantry; admitted August 3, 1863. Chronic diarrhœa. Died, August 25th. Autopsy four hours and a half after death: Body greatly emaciated; rigor mortis very strong; apparent age 20; height five feet six inches. The brain was pale, of normal consistence, and weighed forty-six ounces and a half; the veins of the pia mater contained but a small quantity of blood; the lateral ventricles contained a drachm of clear serum. The right lung weighed twelve ounces, the left nine and a half; both lungs were of a grayish-slate color anteriorly, and posteriorly pink with purplish patches; a considerable quantity of dark venous blood escaped from cut surfaces on pressure; the lower lobe of the right lung presented posteriorly a hard spot about two inches in diameter, which extended into the parenchyma about half an inch, and was apparently the result of former inflammation; numerous delicate adhesions were found between the lobes of the left lung. The mucous membrane of the upper part of the œsophagus was very pale, in the lower part it was slightly injected; that of the larynx and trachea was also pale; the spaces between the trachea rings were slightly purple. The trachea contained a small quantity of yellowish-white mucus. The pericardium contained a drachm and a half of clear light straw-colored fluid. There was some emphysema of the cellular tissue surrounding the pericardium. The heart weighed eight ounces and a half; its valves were healthy; the right cavities contained a firm fibrinous clot of a dirty reddish hue, which extended into the superior vena cava and the pulmonary artery; the left ventricle contained a mixed clot. The surface of the liver was light purple with yellowish spots; internally it was of a yellowish chocolate color; its acini were well marked; it weighed forty-seven ounces; its left lobe was very small, (4½ ✕ 2½ ✕ 1 inch;) the gall-bladder contained an ounce and a half of clear straw-yellow bile with a yellowish flocculent sediment. The spleen weighed three ounces and a half; its surface was in part purplish-blue, in part greenish-slate color, the interior was of a chocolate-red; the Malpighian bodies were numerous and well marked; the organ was rather firmer than usual. The pancreas was firm, yellowish-white, and weighed three ounces. The kidneys were pale, and weighed four ounces and a half each; the right kidney presented on its upper part two elliptical cysts about a quarter of an inch in long diameter. The rugæ of the stomach were unusually well marked. The mucous membrane of the jejunum and upper part of the ileum was pale; in the lower third of the ileum it presented a purplish appearance, and Peyer's patches were somewhat injected. The cæcum was of a deep-purple color; the whole tract of the large intestine presented numerous minute round ulcers, which were thickly crowded together; in the sigmoid flexure and the rectum were irregular patches of a tawny-green color, varying in size from an inch and a quarter to half an inch in diameter, from which the mucous membrane appeared to be entirely removed.—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.