Civil War Washington

Case from the case-book of LINCOLN HOSPITAL, Washington, D. C.; Surgeon J. Cooper McKee, U. S. A., in charge.

CASE 402.—Private Andrew King, company A, 8th Illinois cavalry; age 44; admitted April 6, 1864. Acute gastro-enteritis. About ten days before admission this man began to suffer from a looseness of his bowels. At first the evacuations were large and fæcal in character, but rapidly became more fluid in consistence, and assumed a fetid odor and yellowish color. Very soon after, the stomach became so irritable that little could be retained. A few days before admission he had a chill followed by increased febrile action, cough, and pain in the right side of the abdomen; the frequent evacuations, inability to retain nutriment, and severe abdominal pain which prevented sleep for several nights, rapidly wasted his strength and flesh. On admission he complained of severe pain in the stomach and abdomen, great thirst for cold drinks, frequent desire to evacuate the bowels, the stools being liquid, fetid, and of a yellowish color; weakness, and inability to sleep. He had cough, which was accompanied by a slight expectoration of yellow tenacious mucus, but which did not annoy him much. The physical signs indicated solidification of the lower lobe of the right lung, more marked posteriorly. The respirations were 26, the pulse 120 and feeble; the surface was cold, the extremities purple; the tongue was dry, with a heavy brownish fur in the centre, its edges being red. Ordered a sinapism to the epigastrium, and a powder containing ten grains of subnitrate of bismuth, one of powdered opium, and one of powdered ginger, to be given every two hours; two drachms of brandy in ice-water every hour. April 8th: The stomach will not retain anything; the bowels are moved about once every two hours; considerable griping precedes and attends the stools; he asks for cold water constantly, but instantly vomits it again. Ordered half a grain of sulphate of morphia by enema after each stool; turpentine stupes to the abdomen. To allay the irritability of the stomach lime-water, creasote, chloroform, dilute nitric acid, opiates, bits of ice, &c., were by turns carefully tried without effect. The severity of the symptoms gradually increased, the patient rapidly emaciated, and notwithstanding he took, by enema, nearly a grain of sulphate of morphia hourly, for the last forty-eight hours of his life, sleep and freedom from pain could not be obtained. Died, April 11th, at 12 midnight. Autopsy nine hours after death: Rigor mortis marked; body considerably emaciated. The brain was normal, and weighed fifty-three ounces. The left lung was united to the thoracic walls throughout by old fibrous adhesions; it was healthy, and weighed fifteen ounces. The posterior portion of the lower lobe of the right lung and small portions of the upper and middle lobes were in the third stage of pneumonia, the rest of the lung healthy; the lung weighed forty-two ounces. The pericardium contained two ounces of serum. On the external surface of the heart near its apex was an opaque patch the size of a three-cent piece; the right auriculo-ventricular opening was somewhat dilated, four fingers being readily admitted; the walls of the left ventricle were somewhat thickened, but no valvular disease was discovered; the heart weighed fourteen ounces. The liver weighed seventy-seven ounces; the spleen seven; the pancreas three; the right kidney six, and the left seven and a half; all appeared to be normal. The mucous lining of the lower six inches of the œsophagus was eroded, fissured, and of a greenish-brown color, easily peeling from the subjacent connective tissue. The stomach was very vascular; its mucous membrane, which was of a dirty greenish-yellow color, was thickened, and presented numerous ecchymosed spots. The whole intestinal canal was very vascular, the vascularity increasing in intensity in the lower portion of the ileum, and thence to the anus; the lower two feet of the ileum and the whole of the large intestine were studded thickly with small recent ulcers, very few exceeding a pin's head in size.—Acting Assistant Surgeon William W. James.