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 371.—Corporal John A. Pitts, company B, 7th Wisconsin volunteers; age 35; admitted June 24, 1863. Chronic diarrhœa. This man was healthy when enlisted. He was first taken sick while on duty near Falmouth, Virginia, about a month and a half ago. Has now four or five watery light-colored passages daily. September 1st: About the beginning of last month the patient seemed in a fair way to recover. He is now much worse, the passages numbering eight or more daily; the abdomen is sunken and painful to the touch, the tongue dry and red. He is very much emaciated. Died, September 10th. Autopsy twenty hours after death: Body slightly emaciated; some rigor mortis; height five feet seven inches. The brain was firm, and weighed fifty-four ounces; the vessels of the pia mater contained rather less blood than usual; the ventricles were empty. The mucous membrane of the œsophagus was of a greenish-blue color, in its lower part it was slightly yellow; that of the trachea was pale, slightly purple between the rings; there was a small quantity of frothy mucus at the bifurcation of the bronchial tubes. The lungs were crepitant throughout, but congested posteriorly, especially in the lower lobes; on section of these a good deal of venous blood exuded, mixed with frothy scrum. The heart weighed nine ounces; its right cavities contained a small fibrinous clot which extended into the pulmonary artery; the left cavities were contracted and empty. The liver was healthy, and weighed fifty-one ounces and a half; the gall-bladder contained five drachms of thick greenish bile of the consistency of molasses. The pancreas was normal, and weighed two ounces. The spleen weighed four ounces and a half; its capsule was greenish and somewhat corrugated; it was lobed at its upper extremity; its interior of a reddish chocolate-brown color; the Malpighian corpuscles and the trabeculæ were prominent. The kidneys were healthy; the right weighed five ounces and a half, the left five ounces. The mucous membrane of the stomach was a greenish color, with minute bloody points at the pyloric extremity. The small intestine was healthy, except that the lower part of the ileum was much congested, and presented at one spot, near the ileocæcal valve, a greenish exudation. The large intestine was extensively ulcerated throughout its whole course; the ulcers were generally of an ovoid form, their long diameter transverse to the course of the intestine; they varied in size from that of a split-pea to that of a pin's head, many of them surrounded by a greenish exudation of lymph; and a similar exudation appeared on the mucous surface between the ulcers.—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.