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 373.—Private George W. Beam, company F, 1st Pennsylvania cavalry; age 42; admitted September 12, 1863. Chronic diarrhœa. [This man appears on the register of the hospital of the 1st Pennsylvania cavalry, admitted August 11th—intermittent fever. He is borne on the register of the hospital of the Cavalry corps of the army of the Potomac, admitted August 15th—intermittent fever—returned to duty August 30th. No subsequent record can be found prior to his admission to Lincoln hospital.] Died, September 16th. Autopsy thirteen hours after death: Height five feet nine inches; rigor mortis slight; body not much emaciated. The vessels of the pia mater were slightly distended with blood; the ventricles contained three drachms of fluid; the brain was a little softer than usual, but otherwise healthy; it weighed fifty-three ounces and a half. The mucous membrane of the œsophagus was firm; its upper portion had a faint purplish tinge, the lower portion was light-yellow. The trachea contained a quantity of frothy secretion; its mucous membrane was pale, but had a slight purplish tinge between the rings. The lungs were of a dark bluish-slate color externally. The right lung weighed seventeen ounces and a half; its upper and middle lobes were bound together by old adhesions; it was crepitant throughout, of a dirty red mottled with green on section, and venous blood mixed with frothy mucus exuded from the cut surfaces on pressure; the lower lobe was rather more congested than the others; the left lung weighed sixteen ounces, and presented the same characteristics as the right. There was very little pericardial fluid. The heart weighed eight ounces; its right cavities contained large, firm, fibrinous clots, which extended into the pulmonary artery beyond its bifurcation; the left ventricle contained a small fibrinous clot extending into the aorta; there was a small quantity of venous blood in the left auricle. The liver weighed sixty-four ounces; it was unusually pale, its capsule readily separated, its acini indistinct; the gall-bladder contained a drachm of thick orange yellow bile. The pancreas was white and firm; it weighed three ounces and a half. The spleen was firm; its parenchyma was of a pale chocolate-color; it weighed four ounces and a half. The right kidney weighed four ounces, the left four and a half; the cortical substance of both was pale, the pyramids injected, the pelves pale. The small intestine was healthy down to the lower part of the ileum, the mucous membrane of which was of a deep-purplish color, thickened and coated with shreds of coagulated lymph, which was in some places yellowish, in others of a dark-green hue. The cæcum presented a few ovoid ulcers with marked vascular congestion around them. The lower part of the large intestine was extensively ulcerated, the mucous membrane in some places being almost entirely destroyed; the ulcers were small, ovoid, and the mucous membrane between them was coated with a thick layer of lymph, which was greenish in some places, reddish in others.—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.