Civil War Washington

CASE 199.—Private Wm. S. Armstrong, Co. B, 7th Me.; age 21; was admitted June 14, 1863, with high fever and delirium, a furred and fissured tongue, sordes on the teeth, frequent retching and diarrhœa, the stools numbering about twenty daily. He was much emaciated and so weak as to be unable to sit up. During the next few days his stools became less frequent, but on the 19th the passages were involuntary, the delirium continued, the pulse, which had fallen from 120 to 80, was very weak, the countenance pinched, the extremities cool, the perspiration cold. He died on the 20th. Post-mortem examination fourteen hours after death: The brain was healthy. The mucous membrane of the œsophagus was of a bright-ochre color and rather softened; the trachea was of a dark-purple color, its mucous membrane slightly softened. The lower lobe of the right lung and the whole of the left lung were congested. The endocardium was somewhat darkened; the right ventricle contained a fibrinous clot; the aorta was reddish. The surface of the liver was generally of a grayish-blue color, but anteriorly the right lobe presented a more healthy appearance; minute collections of air were disseminated throughout the parenchyma of this organ, which was softened, of the color of sanious pus and possessed of a disagreeable odor; the air-cavities and the transverse section of the portal veins gave a honey-combed appearance to the interior; Glisson's capsule was smooth and easily torn. The mucous lining of the stomach was of a dark-slate color but healthy. The spleen, fifteen ounces and a half, was unusually firm and of a deep mulberry color; the pancreas was healthy. The intestines were distended with air; the mucous membrane of the upper portion of the small intestine was of a light-yellow color; in the lower third Peyer's patches were ulcerated and the mucous membrane, in some places very pale, was in others intensely injected; at the ileo-cæcal valve it was indurated, thickened and blackened and in the large intestine pale and irregularly dotted with blackish spots. A cavity containing about four drachms of pus was found between the peritoneum and the cellular tissue on the right side of the abdomen, about two inches below the diaphragm; the omentum was healthy. The kidneys resembled the liver in having air-cavities disseminated through their parenchyma; the distinction between the cortical and pyramidal portions was almost obliterated, the latter being purplish; the organs generally were tumid and flabby. Two large bed-sores were noted, one over the sacrum, the other over the great trochanter of the right femur.—Ass't Surg. Harrison Allen, U. S. A., Lincoln Hospital, Washington, D. C.