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 378.—Private Kinkin Clark, company C, 44th North Carolina volunteers; admitted October 20, 1863. Chronic diarrhœa. Died, October 24th. Autopsy twenty-two hours after death: Apparent age 45; height five feet nine inches; rigor mortis slight; body not much emaciated. The brain was firm, and weighed fifty-one ounces and a half; there was but little fluid in the ventricles. The mucous membrane of the trachea was irregularly purplish in spots, between which it was pale. The lungs were engorged with venous blood, but crepitant throughout; the right lung weighed fifteen ounces and a half, the left fourteen ounces. The pericardium contained nine drachms of fluid. The heart was normal, and contained no clots except a very small one in the right ventricle. The liver weighed seventy ounces and a half; its substance was normal in color and consistence, except at the left extremity of the left lobe, where it was firmer than elsewhere, coated by old exudations, and attached to the spleen; the gall-bladder contained six drachms of bile resembling coffee-grounds. The spleen was firm and weighed twenty-three ounces; it was of a pale grayish-blue externally, and of a dark-mulberry color internally; it was firmly agglutinated to the liver; the adhesion was extremely thick, and cut like cartilage. The pancreas was of normal consistence, and weighed four ounces. The kidneys were large; the right measured five inches by two and a half, and weighed seven ounces and a half; the left measured five inches by three, and weighed eight ounces; the cortical substance of both was pale but injected, the section appearing as if sprinkled with red pepper; the bases of the pyramids were of a very dark-purple color, the capsules readily elevated, the pelves highly injected. The mucous membrane of the small intestine was softened and of a stone-blue color, which increased in intensity toward the ileocæcal valve; the agminated glands were not elevated or thickened, but presented a few ulcers which varied from the size of a mustard-seed to that of a split-pea; the solitary glands were prominent, but not ulcerated. The ileocæcal valve was the seat of an irregular shallow ulceration. The cæcum was intensely congested, its solitary glands conspicuous and whitish; the mucous membrane of the rest of the large intestine was softened and of a pale yellowish-slate color.—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.