Civil War Washington

CASE 125.—Private William Williams, Co. K, 9th Pennsylvania, received a shell contusion of the abdomen, three inches below the umbilicus, at Fredericksburg, December 13, 1862. He was carried to the field hospital, whence he was transferred, on the 23d, to Washington and admitted to Lincoln Hospital. Two days after admission, an abscess, which had formed at the point of injury, opened and discharged pus which was apparently mixed with fæcal matter; this discharge continued from day to day, and the abdominal walls sloughed about the opening until it was three inches long by two inches wide. No inflammation of the bowels or peritoneum, except this abscess, appeared until January 11, 1863; nor was there swelling or meteorism, nor any prostration or disturbance of the system. The patient appeared to be free from the influence of shock; he suffered no pain, ate well what was allowed him, chiefly bread and milk, without nausea, and was able to get out of bed without assistance; pulse normal, bowels regular. On January 11th, he began to be restless, had some fever, much thirst, and considerable nausea; the bowels became swollen, inflamed, and painful. Fomentations and poultices were applied, and calomel and Dover's powders given without relief. The nausea increased, fæcal matter apparently being constantly thrown up. The pulse was rapid, small, and easily compressed. He died on January 16, 1863. The autopsy was made nineteen hours after death. The lungs exhibited intense hypostatic congestion. On the left side posteriorly was a circumscribed pleuritis with a thick deposit of fibrinous lymph. Throughout the lung substance were numerous black spots averaging one line in diameter. The lungs weighed thirty-five and one-half ounces. The auricles of the heart were distended with black clots; a white fibrinous clot appeared in the right ventricle, attached by its base to the tricuspid valve. The left ventricle was empty and firmly contracted. The heart weighed nine and one-half ounces. The liver weighed fifty-seven ounces. Fibrinous lymph was found upon the peritoneal coating; it was irregularly mottled—blue and dark; its substance was decidedly hard. One fluid ounce of pale, yellow serum was found in the cavity of the pericardium. The spleen weighed five ounces, and was of a pale reddish color. Pus, in considerable quantity, was found in the peritoneal sac. The kidneys weighed five ounces. Upon opening the abdomen and raising the injured portion of its wall, dark yellow pus came through an opening opposite to the injury; there was thickening and injection of the intestinal walls, especially those of the large intestine. The lower part of the ileum had apparently lost both its mucous and muscular coats, and was contracted so as to resemble a cord. The mesentery was enormously thickened, its glands inflamed, and large collections of black fœtid pus were found in it, which communicated with the sac of the peritoneum nearly opposite the opening through the mesentery and abdominal walls. Abscesses were found on the outside of the peritoneum in the left iliac region, which communicated with abscesses in the course of the lymphatic glands following the course of the great vessels. Peritonitis was found connecting the omentum by adhesions to the anterior wall of the abdomen. The subject was five feet eight inches high, and emaciated.