Civil War Washington

Case from the case-book of the THIRD DIVISION of the ALEXANDRIA HOSPITAL, Surgeon Edwin Bentley, U. S. V., in charge:

CASE 524.—Private Clancey, 102d company, 2d battalion, Veteran Reserve Corps; age 26; admitted May 25, 1864. Diarrhœa. Had been sick three weeks. This man was wounded in the left arm at Malvern Hill, July 1, 1862, in consequence of which he suffered amputation of the humerus at the junction of the middle and upper thirds August 15th. He was subsequently transferred to the Veteran Reserve Corps. The first notes of the case were taken August 25, 1864. He had then from eight to twelve feculent stools daily, with some nausea and griping. Alteratives and astringents were prescribed. A few weeks later he complained of cough and pain in the upper part of his chest. On percussion, considerable dulness​ was observed below the left clavicle and extending over the upper portion of the left lung; over the same region rude respiration and a slight mucous rale were heard. His diarrhœa now averaged from five to six passages daily. Cod-liver oil and syrup of iodide of iron were added to the former remedies, but without permanent benefit. He began to emaciate, became very low-spirited, lost his appetite, and soon took to his bed. Finally the stools became involuntary, and he died December 13th. Some two weeks before death an abscess formed near the anus and discharged a thick dark-colored pus. Autopsy Autopsy twenty-four hours after death: The body was greatly emaciated. The pericardium was filled with serum mixed with lymph. Both lungs contained tubercles and vomicæ, the upper part of the left lung being most extensively diseased. The spleen was normal; the liver and kidneys fatty; the mesenteric glands enlarged. There was tubercular ulceration of the ileum. The mucous membrane of the colon was thickened and presented numerous ulcers. The vermiform appendix was adherent to tlie upper part of the rectum, and the cavities of the two communicated through an ulceration. On the left side of the anus was an incomplete fistula leading to an abscess cavity the size of a walnut.—Acting Assistant Surgeon W. C. Minor. [Nos. 463 and 464, Medical Section, Army Medical Museum, are from this case. No. 463 is from the upper portion of the ileum, and presents near its centre a group of small irregular ulcers, opposite which, on the peritoneal surface, there are a number of minute tubercles. No. 464 is the lower part of the rectum, with a portion of the skin surrounding the anus; the mucous membrane is thickened, and presents numerous small follicular ulcers; at the margin of the anus there are two small fistulous orifices communicating with an abscess-cavity rather larger than a walnut, situated in the areolar tissue just outside the sphincter ani.]