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 525.—Private Calvin Clements, company C, 5th Pennsylvania heavy artillery; age 19; admitted October 10, 1864. Chronic diarrhœa. He so far recovered as to be able to do the duties of an orderly in the office of the hospital. About the first of November he was attacked by fever, accompanied by cough, and pain in the right lung. This was treated by a combination of alteratives, expectorants and opium, and a blister was applied to the chest. The fever assumed a low character, and sordes accumulated on the teeth and lips. A number of small superficial abscesses made the;r appearance on the chest and abdomen. Twenty-five or thirty of these were opened and discharged a thick white pus, after which convalescence set in, and he got well enough to be about the ward. About December 10th he was seized with sudden congestion of the lungs, the symptoms being difficulty in breathing, dry hoarse cough, pain across the upper portion of the chest and over most of the right lung. Stimulating expectorants and alteratives were administered, and counter-irritants applied, without benefit. Died, December 24th, at 5 P. M. Autopsy: Body emaciated; mark of a blister on the right side. The brain was normal, except that the middle commissure was absent; some effusion was observed beneath the arachnoid over the cerebral hemispheres. Firm white clots were found in both sides of the heart. The posterior part of the cricoid cartilage was necrosed and surrounded by a collection of pus; this abscess had no apparent opening. The bronchial glands on the right side were greatly enlarged, and one of them, at the root of the right lung, contained pus and calcareous matter. The lower lobe of the right lung was infiltrated with miliary tubercles; the intervening lung-tissue was in the early stage of pneumonia, and its posterior surface coated with a little coagulable lymph; the rest of the right lung and the whole of the left lung appeared to be free from disease. The liver was large and pale. The spleen was small, and showed on section numerous white spots, supposed to be enlarged Malpighian bodies, but was otherwise of normal appearance. The mesenteric glands were enlarged. The ileum was slightly injected, and there were pigmentary deposits in the colon. The kidneys small, quite granular, their cortical substance yellow.—Acting Assistant Surgeon W. C. Miner. [No. 467, Medical Section, Army Medical Museum, is from this case. The specimen consists of the larynx and trachea with the enlarged bronchial glands attached; the air passages are laid open posteriorly, the section passing through an abscess surrounding the cricoid cartilage, which is necrosed and lies free in the abscess-cavity.]