Civil War Washington

The notes of the next case were forwarded, with the specimens, from COLUMBIAN COLLEGE HOSPITAL, Washington, D. C., Surgeon Thomas R. Crosby, U. S. V., in charge:

CASE 434.—Private Jacob Hilgert, company E, 104th Pennsylvania volunteers; admitted from Stone hospital January 10, 1865. Diarrhœa and consumption. [This man is borne on the register of Stone hospital, Washington, D. C., admitted December 9, 1864—chronic bronchitis—sent to Columbian hospital January 10th.] He had a distressing diarrhœa, together with a severe cough, and expectorated large quantities of muco-purulent sputa​ streaked with blood. There was dulness​ on percussion over the upper third of the right lung, and tubular respiration was heard on both sides. Treatment: Cod-liver oil with six ounces of whiskey daily. Diet: Milk, beefsteak and toast. The cod-liver oil appeared to increase his diarrhœa, and, January 16th, fusel-oil in five-drop doses was substituted, to be taken in his whiskey. January 25th: The expectoration is more copious, and his strength is failing; appetite very poor; he has four or five stools daily. He died February 6th.—Acting Assistant Surgeon H. D. Vosburgh. Autopsy fourteen hours after death: Both lungs contained numerous minute tubercles; near the apex of the right lung there was a cavity about the size of an orange, and on the surface of the upper lobe of the left lung a large and much puckered cicatrix-like depression was observed; there were pleuritic adhesions on the right side. Both small and largo intestines presented tubercular ulcers. The mesenteric glands were enlarged. [Nos. 480 to 487, Medical Section, Army Medical Museum, are from this case. No. 480 is the upper lobe of the right lung, the cut surface of which shows a large number of minute tubercles. At the top of the lobe there is a cavity the size of an orange, with distinct firm walls. No. 481 is the upper lobe of the left lung, presenting on its convex surface a large and much puckered cicatrix-like depression. No. 482 is a portion of the upper part of the jejunum, presenting three small tubercular ulcers. No. 483 is from the upper part of the ileum of the same patient, and presents a large oval tubercular ulcer the long diameter of which is transverse to the gut. No. 484 is from the lower part of the ileum of the same patient, and presents a Peyer's patch which is the seat of three small tubercular ulcers. No. 485 is the lower extremity of the ileum, with the ileocæcal valve and part of the cæcum; there is a transverse ulcer just above the valve, and the cæcum is thickened and ulcerated. No. 486 is the vermiform appendix, which is deeply ulcerated. No. 487 is a portion of the transverse colon, which is thickened, and presents a number of deep ulcers.]