Civil War Washington

In the specimen the villi are considerably hypertrophied, giving the surface a plush-like aspect. The patient died in the Third Division of the Alexandria general hospital after an illness of about a month. The following account of the case was forwarded to the Museum with the specimens by Acting Assistant Surgeon Wm. C. Miner:

CASE 881.—Private Erastus Boyd, company G, 195th Ohio volunteers; admitted July 29, 1865. Diarrhœa. [This man was mustered into service February 20, 1865, to serve one year. He appears on the hospital register of his regiment as "sick," July 27th; no diagnosis recorded. "Sent to general hospital."] At the time of admission the patient was feeble, his pulse weak, compressible, 80 per minute; tongue moist, slightly coated, its tip and edges clean. He said he had had diarrhœa for three or four weeks. July 30th: ℞. Blue-pill and opium, of each eight grains, extract of nux vomica two grains. Make eight pills. Take one every three hours. Brandy. Milk diet. July 31st: No change. August 1st: The symptoms have assumed a typhoid character; the tongue is black and dry, and delirium has set in. ℞. Chalk mixture four ounces, tincture of catechu one ounce, tincture of opium four drachms. Take a teaspoonful every three hours; also turpentine and tincture of cinchona. August 2d: Better. Continue treatment. August 3d: A good deal better; tongue moist; has had but four stools in the last twenty-four hours. August 5th: Still improving: begins to relish his food. Continue treatment. Died, suddenly, August 6th, having been up fifteen minutes before. The cause of death recorded on the hospital register was "typhoid fever." Autopsy: The only point which attracted attention was the condition of the intestinal canal. The solitary follicles throughout the ileum were enlarged, and there was slight thickening of the patches of Peyer, several of which presented one or more minute ulcers. The colon was closely studded with minute follicular ulcers about the size of pin-pricks.

Nos. 600 and 601, Medical Section, Army Medical Museum, are from this case. No. 600 is a portion of the ileum taken a few feet above the ileo-cæcal valve, and is the specimen selected for representation in this place. No. 601 consists of the last three inches of the ileum, with the ileo-cæcal valve and a portion of the cæcum. The ileum presents appearances very similar to those which will be described in connection with No. 600. The cæcum presents a number of the minute follicular ulcers mentioned in Dr. Miner's account of the autopsy as existing in the colon.

The plate facing page 302 is a reproduction of a photograph of No. 600, which represents it of the natural size. The mucous surface of the piece is marked by a number of transverse rugæ, which are the imperfectly-developed valvulæ conniventes. The hypertrophy of the villi gives the whole mucous surface a plush-like appearance which is exceedingly characteristic, and which can be studied advantageously with a lens. A number of enlarged solitary follicles the size of pin-heads project slightly above the mucous surface as rounded elevations. In the lower half of the specimen there is a Peyer's patch two inches and a half long by three-quarters of an inch wide at its broadest part. The position of this patch is plainly indicated by the absence of the transverse rugæ above referred to, which terminate rather abruptly at the margins of the patch. The surface of the patch, which is not materially elevated above the surrounding mucous membrane, is marked by irregular narrow transverse broken lines, on which are seated numerous hypertrophied villi similar to those of the surrounding mucous membrane; between these are narrow irregular areas on which there are no villi, and which, hence, appear somewhat depressed below the general surface. The general effect of this arrangement is to give the surface of the patch a somewhat reticulated appearance. At the center of the patch there is a shallow oval ulcer an eighth of an inch in diameter. A little more than half an inch below this, near the right-hand margin of the patch, is another similar ulcer, and a third smaller one will be noticed at the upper extremity of the patch.

PLATE V. ILEUM WITH ENLARGED SOLITARY FOLLICLES AND HYPERTROPHIED VILLI. No. 600. MEDICAL SECTION.