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 386.—Private Ephraim York, company C, 19th Maine volunteers; admitted November 23, 1863. Acute diarrhœa. Died, December 4th. Autopsy next day: Rigor mortis marked; body considerably emaciated; surface slightly jaundiced. The brain was healthy; it weighed fifty-three ounces; the lateral ventricles contained a drachm of fluid. The pharynx was in a state of chronic inflammation; the walls were much thickened, the constrictor muscles very pale, the mucous membrane of a dim yellowish-gray color; beneath it were numerous small abscesses about the size of peas. The epiglottis was thickened and slightly injected on its free anterior border. The mucous membrane of the larynx had the same color as that of the pharynx, except over the cricoid cartilage, where it was of a stone-blue color. The left side of the rima glottidis was tumid and coated by a whitish-yellow exudation, beneath which was an ulcer with ragged irregular edges; the base of the epiglottis on the same side also presented several ulcers, which had everted edges and were filled with a tenacious pus-like exudation; on the right side of the base of the epiglottis there was a small ulcer about the size of a buckshot; the superior borders of the chordæ vocales were also ulcerated, more extensively on the right than on the left side; these ulcers were comparatively superficial, and were coated by a whitish deposit of lymph. The mucous membrane of the trachea was yellowish-gray down to its bifurcation, where it was of an intense red. The right lung weighed twenty-seven ounces; it was very much congested, and filled with a sanguineous fluid, which poured forth on section, but crepitated on pressure everywhere; the left lung was in the same condition as the right, and weighed twenty-eight ounces. The pericardium contained an ounce and a quarter of yellow serum. The heart weighed eleven ounces; its right side contained a large, firm, fibrinous clot, with but little venous admixture; a smaller clot was found on the opposite side. The liver was firm, rather pale, and weighed forty-five ounces; the gall-bladder contained four drachms of bile. The pancreas was purplish and unusually thick. The spleen weighed twelve ounces. The right kidney weighed six ounces, the left seven ounces; both kidneys were of a dark-purple color, the pyramids being a shade or two darker than the cortical portion. The intestines were healthy, except that the lower part of the large intestine was congested.—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.