Civil War Washington

CASE 185.—Private Jos. S. Nelson, 6th Me. Bat'y; age 45; was admitted Oct. 19, 1863, with typhoid fever, and died Nov. 24. Post-mortem examination next day: Body greatly emaciated. The brain was healthy. The epiglottis was lined on the posterior surface with an exudation and ulcerated on either side of the free border, the ulceration being confined to the mucous membrane, which was of a palish pink color and thickened around the edges of the ulcers; an irregular ulcer, with pinkish walls, was seen on the left side of the larynx immediately below the vocal cord and a smaller ulceration of similar appearance in the angle of the thyroid cartilage. The posterior portion of the pharynx opposite the epiglottis was the seat of a superficial ulcer; the œsophagus was pale and filled with a whitish curd-like mass, at first supposed to be a retained portion of ingesta, but on careful examination found to be a true exudation. The right lung weighed twenty-seven ounces; the posterior part of its upper lobe was quite œdematous, its bronchi prominent, feeling like millet-seed under the fingers, and their mucous lining everywhere of a dark-purple color; the posterior surface of the lobe was coated to the extent of an inch and a half with a thick whitish membrane; the lower lobe posteriorly was much compressed by a circumscribed pleuritic effusion measuring fourteen ounces. The weight of the left lung was thirty-two ounces; its upper lobe presented the same general appearance as that of the right side; the bronchial tubes were everywhere prominent, in some parts giving the feel of a cirrhosed liver; the lower portion of the lung was of a dark-purple flesh-color, friable and heavier than water. The heart contained but little clot in its right side and none in its left. The liver was dark and tolerably firm, weighing fifty-seven ounces; the gall-bladder was very prominent and contained twenty drachms of thin brown bile; the spleen weighed seven ounces and was of a dark mahogany color and quite firm. Peyer's patches and the lower portion of the small intestine were ulcerated; the large intestine was also ulcerated and of a stone-gray hue alternating with patches of a dull lardaceous appearance; the ulceration was of the punctated form. A large gangrenous abscess was found on the right of the anus extending deeply into the right buttock; its external opening was small. Just before death a severe hemorrhage had taken place from this abscess; several very large, firm, blackish clots were found in its cavity. It was supposed from the examination that this communicated with the rectum, but the passage to that gut was obtained with some difficulty, and it is not improbable that the force used in manipulation produced the communication. No flatus or excrementitious matter had escaped during life.—Ass't Surg. Harrison Allen, U. S. A., Lincoln Hospital, Washington, D. C.