Civil War Washington

The notes were forwarded, with the specimens, to the Army Medical Museum from CARVER HOSPITAL, Washington, D. C., Surgeon Oliver A. Judson, U. S. V., in charge:

CASE 427.—Private Walter Butler, company B, 56th Massachusetts volunteers; admitted from the field hospital of the 1st Division, 9th Corps, July 5, 1864. Typhoid fever. The patient was considerably emaciated; petechiæ were seen on his abdomen; his tongue was thickly coated in its centre with a dark fur; pulse about 120 per minute; slight diarrhœa. These symptoms seemed to yield readily to the ordinary treatment of typhoid fever. About July 20th, he was able to walk about the ward, slowly convalescing. From imprudence in eating and drinking he was again, July 25th, attacked with severe diarrhœa, which caused him to sink rapidly. He had now anorexia; red, dry tongue; pulse about 80. Treatment: Opiates and astringents to relieve the diarrhœa; brandy. Diet: Boiled milk, beef, beef-essence, &c. He became greatly emaciated, and died August 2d. Autopsy four hours after death: Emaciation great; rigor mortis slight. The right pleural cavity was obliterated by old adhesions; the areolar tissue in the anterior mediastinum was emphysematous. The lungs contained much black pigment, and their upper portion was congested. The right side of the heart contained a large fibrinous clot which adhered firmly to the tricuspid valve; there was no clot in the left side; the valves were healthy; the pericardium contained half an ounce of fluid. The liver appeared to be normal; the gall-bladder was nearly filled with bile. The spleen was about the normal size, pale, and very firm. The kidneys were normal. The suprarenal capsules were dark colored. The walls of the stomach were thin and pale. The small intestine appeared healthy down to about the middle of the ileum, below which the glands of Peyer were congested, the congestion increasing in intensity downward; the solitary follicles of the lower portion were enlarged. The mucous membrane of the transverse colon was thickened and softened, the thickness greatly increasing in the descending colon, sigmoid flexure, and rectum; the thickened membrane presented a peculiar spongy appearance; there were follicular ulcers throughout the colon, which, in the transverse colon especially, had coalesced into large eroding excavations.—Acting Assistant Surgeon O. P. Sweet. [Nos. 356 to 359, Medical Section, Army Medical Museum, are from this case. No. 356 is a portion of the ileum, with pin-head enlargement of the solitary follicles and two very slightly thickened Peyer's patches. No. 357 is from the ascending, No. 358 from the transverse, and No. 359 from the descending, colon; in these specimens the intestinal walls are somewhat thickened, and there are numerous follicular ulcers, which, in the transverse colon especially, have extended into irregularly oval excavations exposing the muscular coat; between the ulcers there is some adherent pseudomembrane.]