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 377.—Drummer David Ebert, company I, 126th New York volunteers; admitted from the army of the Potomac September 12, 1863. Chronic diarrhœa. Died, October 22d, of diphtheria and pneumonia. Autopsy thirty-six hours after death: Apparent age 22; height five feet eleven inches; some rigor mortis; body not much emaciated. The brain weighed fifty-seven ounces and a half; it was moderately firm; there was but little fluid in the ventricles; the pia mater was moderately injected. The œsophagus was pale except at its upper portion, where it was of a mottled purple color, and covered by a diphtheritic exudation continuous with that lining the pharynx and larynx; the mucous membrane of the larynx and trachea was of a dark-purple color, and coated with a thick consistent layer of diphtheritic membrane which extended into the bronchial tubes; this pseudomembrane was also of a purple color, being darkest on the side next the mucous membrane. The right lung weighed thirty-three ounces and a half; the greater portion of its upper lobe and the posterior part of the middle lobe were in the stage of red hepatization; there were also a number of hepatized lobules in the lower lobe, the dark color of which contrasted strikingly with the brighter red of the intervening congested but still permeable parenchyma; the left pleural cavity contained twenty-four ounces of straw-colored serum. The left lung weighed twenty ounces and a half; its upper lobe was emphysematous anteriorly, posteriorly it was infiltrated with yellow serum, and portions sank in water; the lower lobe was in a similar condition in its upper portion, its lower portion was hepatized red; in the apex of this lung there were a few tubercles, some of which had become cretefied. The pericardium contained an ounce of fluid. The heart was healthy, and weighed nine ounces and a quarter; the left ventricle contained a whitish fibrinous clot mottled with red in the centre and ragged on its edges. The liver weighed fifty-seven ounces and a half; it was engorged with purple blood, its parenchyma extremely soft, its acini prominent on account of the venous engorgement of the portal veins; the gall-bladder contained ten drachms of dark-green moderately viscid bile. The pancreas was flesh-colored, and weighed two ounces and three-quarters. The spleen was pultaceous and of the color of elderberry juice; it weighed four ounces and three-quarters. The kidneys were much congested; the right weighed five ounces, the left five and a half. The small intestine was healthy except in the lower third of the ileum, where Peyer's patches and the solitary glands were slightly elevated and whitened. The large intestine was contracted, the mucous membrane being in consequence thrown into tortuous folds; it was congested near the cæcum, and of a stone-gray color elsewhere—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.