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 543.—Private Thomas Fitzgerald, company B, 1st Connecticut heavy artillery; age 30; admitted from regimental hospital September 27, 1865. Chronic diarrhœa. The patient was somewhat emaciated, and had been complaining about a month. He had daily from six to eight thin dark-brown stools, attended with much griping pain. To have half an ounce of castor oil with fifteen drops of laudanum at once, followed by five grains of Dover's powder every four hours. Diet: Milk-porridge, mutton-broth, boiled rice, toast and tea. October 1st: Is slightly improved; the stools are more consistent, and only from two to four daily. Continue treatment. October 15th: The stools are again thinner and more frequent. ℞. Subnitrate of bismuth, Dover's powder, of each one scruple; make four powders. Take one three times a day. October 20th: Is no better. Substitute pills of acetate of lead and opium. October 24th: Complains of severe pain in the abdomen. To take lime-water and milk during the day, and half a grain of sulphate of morphia at bed-time. October 27th: Still complains of some abdominal pain, but the stools are less frequent. To have fifteen drops of the tincture of chloride of iron three times daily. November 1st: The stools are again more frequent, numbering six to eight daily; they contain mucus and blood. To have a laudanum enema after each stool. November 4th: Since the last report the stools have varied in number from two to four daily; they are dark and offensive. Continue the laudanum enemata, with the addition of a grain of nitrate of silver to each enema. November 6th: The stools continue as at last date, except that occasionally small masses of normal excrement are passed. Substitute injections of sulphate of zinc, one grain to the ounce of water, and give every six hours a pill containing one grain each of opium and ipecacuanha. November 10th: No improvement. The patient has become extremely emaciated; his hands and ankles are œdematous. Continue the pills; a laudanum enema after each stool. After this the patient grew rapidly worse, and died December 1st. Autopsy: Nothing abnormal was observed except in the colon, the mucous membrane of which was studded with follicular ulcers from the ileo-cæcal valve to the anus. The gall-bladder was moderately full of healthy looking bile.—Surgeon Edwin Bentley, U. S. V. [No. 673, Medical Section, Army Medical Museum, is from this case. The specimen is a portion of the colon, which is much thickened, and presents numerous follicular ulcers, with some adhering pseudomembrane. There are a number of stellate cicatrices between the ulcers.]

Cicatrices . . . are occasionally seen in cases of follicular ulceration of the colon that must be regarded as steadily progressing. Some of the ulcers cicatrize while others are still spreading, or new crops of ulcers make their appearance while those formed first are healing. The colon in case 543 afforded a striking illustration of this possibility. The patient died of a chronic flux in the course of which he became exceedingly emaciated. His colon was studded with follicular ulcers from the ileo-cæcal valve to the anus. A portion of this colon was preserved in the Museum, No. 673, Medical Section. It presents numerous punched-out follicular ulcers . . .