Civil War Washington

One of eight cases observed at the FREEDMAN'S HOSPITAL, Washington, D. C., during 1865, 1866, and 1867.⃰ In none of them were the patients soldiers. Five are of interest as examples of tubercular ulceration of the intestines. Besides the specimens from these cases, several other examples of tubercular ulceration of the intestines are preserved at the Museum, which were obtained from autopsies of colored women who died at the same hospital during the period mentioned. . . . In all of them extensive tubercular deposits were found in the lungs and other organs. Most of the specimens are portions of the ileum with tubercular ulcers of the mucous membrane and miliary tubercles on the peritoneal surface opposite:

CASE 862.—Stephen Green, a dark mulatto; age 31; admitted September 5, 1865. When admitted he had dulness​ on percussion under both clavicles, pain on pressure under the clavicles and over the stomach, and cough causing pain in the præcordial region. He was extremely emaciated and had night-sweats; his bowels were constipated; his appetite good up to three hours before death. Died, December 17th, at 10 A. M. Autopsy sixteen hours after death: Height five feet three inches; weight about 120 pounds; some emaciation; rigor mortis well marked. The brain weighed forty-six ounces and a half; the pia mater was congested; there was an ounce of serum in the subarachnoid space, a drachm in each lateral ventricle; the substance of the brain was soft. The cerebellum was congested, its substance very soft; the posterior fossæ of the cranium contained two ounces of serum. The upper portion of the left lung was slightly adherent to the pleura costalis; there were a number of small vomicæ throughout its upper lobe; the lung was filled with gray tubercles; it weighed twelve ounces; the upper portion of the right lung was firmly adherent, the lower portion adherent by numerous fibrinous bands; the upper lobe contained numerous vomicæ, some as large as a hulled walnut, and was filled with tubercles; the lower lobe was congested and contained many tubercles; it weighed nineteen ounces. The pericardium contained no fluid. The heart was very dark colored and congested; there was a large firm white clot in the right ventricle extending into the pulmonary artery; a similar one in the right auricle; also a small one in the left ventricle, which extended into the aorta; the valves were normal; the heart weighed eight ounces. The liver was small and congested; it presented a mottled appearance externally and was of a dark reddish brown internally. The spleen was small and shrivelled; it was of a light-blue color and weighed three ounces and a half. The right kidney was small; its cortical substance congested and fatty; it weighed three ounces; the left kidney weighed three ounces and a half and was in the same condition as the right. The mucous membrane of the stomach was thickened and slightly congested; that of the duodenum much thickened and unusually congested; that of the jejunum thickened, congested, and a few of the solitary glands ulcerated. In the upper portion of the ileum Peyer's patches were slightly ulcerated and the gut considerably congested; in the middle portion a number of the glands were ulcerated; some of the ulcers were scooped out, with rough irregular edges, others had thickened raised edges; some of the patches contained deposits of tubercles [?]; in the lower portion Peyer's patches were extensively ulcerated; near the ileocæcal valve the ileum was very much congested. The cæcum was filled with hard fæces, was much congested, and presented ulcers over nearly half its surface. The ascending colon was much distended at the hepatic flexure with a collection of hard fæces; the transverse colon was very large, and distended with gas to fully three inches in diameter; the descending colon was sacculated and contained a collection of hard lumpy fæces. The sigmoid flexure was distended with gas. The rectum contained lumps of hard fæces. The colon presented numerous points of ulceration throughout its whole extent, particularly at the points containing fæces, which had the appearance of having been confined for some time at these places. The bladder was small, its walls slightly thickened; it contained a small quantity of pus like fluid.—Hospital Steward Samuel S. Bond. [No. 674, Medical Section, Army Medical Museum, is from this case. The specimen is a portion of the ileum taken from near the ileocæcal valve, showing a Peyer's patch, which is moderately thickened and presents a considerable number of small ulcers.]

⃰ During this period two of the hospital stewards on duty in the Museum, D. S. Lamb and S. S. Bond, were frequently sent to the Freedman's Hospital for the purpose of making autopsies. A considerable number of specimens illustrative of the diseases of the freedmen were thus obtained.