Civil War Washington

Selected for photographic illustration is a specimen in which the solitary glands are enlarged to the size of bird-shot, but in which a little ulcer has formed on the apex of each, although the patient had been sick but a few weeks. The case was one of typhoid fever accompanied by a smart catarrhal inflammation of the colon:

CASE 882.—Private George Hayes, company B, 12th U. S. infantry; age 25; was sent to the guard-house at Russell barracks, Washington, D. C., May 10, 1866. He continued under the charge of the guard, but apparently in excellent health, until about August 1st, when he came to sick-call suffering with diarrhœa, and was excused from fatigue duty. Assistant Surgeon E. Bentley, post surgeon at Russell barracks, states that he had not been on sick report at any time previously. The diarrhœa continued in spite of treatment, and soon after symptoms of typhoid fever were recognized, and the patient was sent to post hospital. Acting Assistant Surgeon George P. Hanawalt reports that he was admitted to the post hospital, Washington, D. C., August 25th. On admission he was found to be quite stupid, though he could readily be aroused. The following prescriptions were ordered: ℞. Nitro-muriatic acid one fluid drachm, water six fluid ounces. Take a tablespoonful every four hours, alternating with the following: ℞. Carbonate of ammonia one drachm, oil of turpentine two fluid drachms, powdered gum Arabic half a drachm, cinnamon-water six fluid ounces. Dose, a tablespoonful every four hours. Beef-tea. On the afternoon of the 26th he became delirious, and during the night constant watching and restraint were required to keep him in bed. This continued until the forenoon of the 27th, when almost complete loss of sensibility ensued. The patient could not swallow the milk-punch which had been ordered in the morning. An attempt was made to give him beef-tea, but a teaspoonful of it almost strangled him. Heavy stupor continued until noon on the 28th, when he died. Autopsy: The arachnoid at the base of the brain was opaque, and there was some effusion of lymph on the posterior portion of the spinal cord just below the medulla oblongata. All the viscera appeared healthy with the exception of the intestinal canal. The solitary glands of both large and small intestine were greatly enlarged and ulcerated at their apices, and there was considerable thickening and ulceration of the patches of Peyer. The intestinal canal was forwarded to the Army Medical Museum by Assistant Surgeon William Thomson, U. S. A., surgeon in charge of the post hospital.

Nos. 815 to 821, Medical Section, are from this case. Nos. 815, 816 and 817 are successive portions of the ileum, in which Peyer's patches are much thickened and ulcerated; the villi are greatly hypertrophied. In Nos. 815 and 816 the solitary glands are enlarged to rounded tumors, many of them as much as a fifth of an inch in diameter, or even larger, and some of them, especially in No. 816, ulcerated at their apices. In No. 817 the enlarged solitary glands have the same character, but are much less numerous. No. 818 consists of the last inch of the ileum, with the ileo-cæcal valve and cæcum. Both the ileum and cæcum present a number of enlarged solitary glands similar to those above described; those in the cæcum are ulcerated at their apices. No. 819 is from the ascending, No. 820 from the transverse, and No. 821 from the descending colon; all present enlarged solitary glands ulcerated at their apices, similar to those shown in the plate representing No. 820. These little tumors in No. 819 are smaller, in No. 821 larger, but in both less numerous than those in No. 820.

The plate facing page 306 is reproduced from a photograph of No. 820, which, as just mentioned, is a portion of the transverse colon from this case. The numerous enlarged glands vary from one-tenth to one-fifth of an inch in diameter, and project from the surface as small sessile tumors. The ulcers vary from little circular dot-like depressions to more irregular excavations one-tenth of an inch in diameter. The mucous membrane is nowhere ulcerated or abraded except on the summits of the enlarged glands.

PLATE VII. TRANSVERSE COLON WITH ENLARGED GLANDS ULCERATED AT THEIR APICES. No. 820. MEDICAL SECTION.