Civil War Washington

CASE 85.—Private A. C. Starker, Co. D, 15th N. J., was admitted Nov. 23, 1863, as a case of typho-malarial fever: Pulse 115 to 130, irritable; tongue dry as a pine shaving, glossy and red on its edges; sordes on teeth and gums; urine scanty, densely loaded and very fetid; stools involuntary; friction-sound on right side of chest. In answer to questions he talked incoherently for a few seconds and then relapsed into stupor; he picked at the bed-clothes, and drawing his legs up would suddenly straighten them in an apparent effort to kick off the covering. Subnitrate of bismuth controlled the diarrhœa; stimulants were freely administered. He died on the 28th. Post-mortem examination ten hours after death: Right lung adherent to costal pleura by a strong and dense false membrane; left lung distended with a black fluid, unadherent; heart normal. Liver very pale, much enlarged and softened; spleen larger than usual and softened; kidneys one-fourth larger than normal and indurated, especially in their lower fourth, where their substance could not be crushed between the thumb and finger. Peyer's patches distinct and elevated, their edges ragged and raised one-tenth inch above the surrounding surface; solitary glands of large intestine ulcerated; lymphatic glands enlarged—one, as large as a walnut, was on section much like the spleen.—Act. Ass't Surg. W. H. Letterman, Douglas Hospital, Washington, D. C.