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 376.—Private Hezekiah S. Palmer, company E, 42d Mississippi (rebel) volunteers; admitted August 18, 1863. Chronic diarrhœa. Died, October 10th. Autopsy: Rigor mortis not marked; body not much emaciated. The brain was healthy; it weighed fifty-two ounces. The right pleural sac contained three ounces and a half of fluid, the left four ounces. The trachea was filled with a thin bronchial fluid; its mucous membrane was pale. The right lung weighed nineteen ounces and a half; its upper and middle lobes appeared pale on section, and exuded a quantity of thin bronchial secretion; the lower lobe was congested, and the bronchial secretion was mixed with blood; this lobe was bound to the thoracic parietes by old fibrinous adhesions; the left lung weighed twenty-three ounces and a half; its upper lobe resembled that of the right lung; the lower lobe was purplish-red externally, with a quantity of shreddy recent lymph adhering to its surface; the upper two-thirds of this lobe were in a state of red hepatization. The heart weighed ten ounces and a quarter; its valves were healthy; the right auricle contained a venous clot, the right ventricle a large, soft, fibrinous one; there was a thin ribbon-like clot in the left auricle. The liver weighed forty-seven ounces; it was pale, firm, its capsule easily torn, its acini prominent; the gall-bladder contained eight drachms of brownish flocculent bile. The spleen was readily broken up; it weighed ten ounces and a half. The pancreas weighed three ounces and a quarter. The right kidney weighed five ounces and a half, the left five. The intestines were anæmic and of a stone-gray color externally; the mucous membrane was flaccid and pale; the valvulæ conniventes were nowhere prominent, and in some places were absent; the mucous membrane was extremely soft and readily removed. This case is interesting inasmuch as chronic diarrhœa had existed for a long time and no ulceration of the large or small intestine was observed after death.—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.