1 OBSERVATION BOOK. containing certain inductions and .classifica- m6kteS»s. Ante Mortems by / m^j ° T*/ MEDICAL OFFICERS OF WA^tgf g $3 Post Mortems bv the W3 a: a: 0) K "A UP AX OMNIA PEUPETir—Ho-rat. Carmin B. I. III. Xational, U. S. Army General Hospital, BALTIMORE, MD. 4STED AND PUBLISHED AT THE NATIONAL, U. 8. ARMT GENERAL HOSPITAL, PRINTING OFFICE, BALTIMORE, MD. > 1 / f \ "> \ \\v .ft-. A H L\*^ [CASE No. 1.] Hospital Number, ) 2,484. \ Demarcns Ward, aged 19 years, Corporal, Co. H., I8th Va. Regt. Was admitted to this Hospital trom the fiold October 26, 1804. HISTORY.—(ANTE MORTEM.) Patient when admitted was in an anajmic condition, the femer protruding from the stump about one-half (J) inch. Suppuration in the cellular tissue of the thigh, as far up as the great trochanter had ensu» d. Incisions were made at several times, large quantities of pus escaping each lime. The opera- tion of resection was postponed until the patient's condition was sufficiently improved to permit it, which was performed December 30th, removing about four (4) inches of the femur. On the 15th of January, 1865, symptoms ofjjyaemia set in, which increased, until the patient died on the following day. Case reported by W. G. SMULL, A. A. Surg., U. S, A. POST MORTEM. > Number of hours after death unknown. ■ ♦ Patient emaciated. Having made the usual incisions, dis- ced back the pectoral muscles, and removed the sternum itli the cartilaginous portions of ribs, some pleuritic effusion e left sac was observed. A1N—Slight opacity of the arachnoid, inner surface of; of pia-mater covering the cerebra were filled with blood; ^antity of reddish serum in lateral ventricles; choroid ip rather pale; commissures third ventricle in a normal ej Near the nib of calamus scriptoreus, a V shaped con- gestion was detected, somewhat rough to the feel; congestion 4 of the pons, similar to or slightly iu excess of that observed in eubstince of cerebra. Lung carnified on left side, lower lobe; some hypostatic congestion on right side. Heart.—Large fibrinous clot in right ventricle, extending from auricle, closely adherent to valve; also small clut in left ventricle nearihe valve. Liver was one-fourth (*) larger than natural ; heavier ; rather light colored, of finely granular appearance, and quite solid consistence. Spleen was three (3) shades too dark, presenting a dark purple appearance; twice the natural fize ; presenting at intd. nost. border two (2) fibrinous (exudation) uia.-ses about the 8ize of a chestuut, the superior the larger,, the lower present'. ed some pus. Kidneys of natural size and light color.] Stomach abnormally large. Intestines.—Several mesenteric glands enlarged; the intestinal canal, natural. Right thigh, super. 3d. Upon dissecting the tissues they were found to be flabby; otherwise natural; end of femur de- nuded of periosteum for one (1) inch, and periosteum peeled off readily some distance upwards. , Femoral vein examined and found occupied at extremity by white elastic thromb two (2) inches long. Examination obscure ; no acute inflama'ion observed. Femoral artery.—A clot five lines long was found from the occlusion to its distal branch ; in other respects healthy, Specimen preserved. / » i [ r - . \ [CASE No. 2.] Hospital Number ) 30. \ C. B. Kittle, age 32 years, priv. 10th "Wisconsin Battery, was ad- mitted to this hospital from Medical Director's office Jan. 10th 1865. HISTORY.—(A-NTS MORTEM.) Diarrhea.—Extremely irritable stomach, and pain in the right iliac fossa. Was treated v. ith Turpentine and suppor- tives with temporary relief. Ah >ut the third day after admission he had low fever, with muttering delirium at night; some,fine crepitation, not very di>tinct. was observed over the tight lung—arrteriorioy, low- Oi lobe ; had slight cough ; diarrhea increased, and death en- sued on the 17th Jan. Reported by J. G. KELLER, A. A. Surg., U. S. Army. / POST MORTEM. Pitient emaciated. Right side of chest one-fourth (|) greater in size anteriorly, than left. In right iliac region, C\.(l -vti,ii\sj >^rC posterior part of caecum, to right of me&enteilc band-, connect- ing ascendmg color wilh.-abdominal wa4t, adhesiorrs-Tvere ob- ■se+ved. Upon traction these gave way and revealed a per- foration—escape from which had been prevented by them. A small opening was found in the iliac fascia, communicating with divi-ion of the iliac and psoas muscles, in which there was a srrnll collection of dark colored, o^nsive, caseous, puruloid material estimated at two fluid ounces. The exten- sion ofthis collection was upwards, over crest of the ilium upon the lumbar fascia towards the origin of psoas muscle. The abs- cess terminated iiiferiorly in a cul-de-sac in advance of the iliac muscle under iliac fascia opposite anterior inferior spinous process. Jl^ Lungs. — LoiveH"!obe right lung hop .tized m-d : posterior third of uppermost lobe same ; central portion town lobe left t-ibe same. When this hepatized past of lung su'j.st.ince was broken and pressed, a grayish puruloid fluid was expres.-cd abundantly. &•.+<£, Liver waS one fourth (J) larger than naural and in^eMi d with b!o')d ; an-terior inferior portion of right lobe presented a region -of black ■•corujestibn. Kidneys oi pale^wfror, and-pre&ehted4rr^girlarcherry color- ed congestion 44rfe+twtly. Inflammatory spots cen^ccwd with ulceration and asso- ciated-wrth softenings were observed in the large intestines and lower portion of ilium, with great thinning and wasting of the mucous membrane. Splekn solid, of natural siz°, w4th bhck congestiow on an- terior and inferior border. Substance of normal consistence ; a little hard. Brain normal. Specimen of caecum and ascending colon preserved. [CASE No. 3.] Hospital Number 37. James York, age 30, Private, Co----,13th Ind. Inft. was admitted from Provost Marshal's, Jan 14th; 1865. HISTORY.—(ANTE MORTEM.) Patient walked into hospital, gave his name and regiment, and to'd how his name was spelt. He presented a somewhat Btupid expression of countenance. No history of case could be obtained, except that he had been sick only a short time. About noon he became restless and crazy; roliingand tossing about in bed and attempting ot get up, requiring two men to 7 lestrain him. His eyes were somewhat injected, pupils rather dilated but re>ponded to the action of li_,bt. Pulse fiequent and full, but soft. lie could not be made to swallow or utter an articulated word. He appeared to suffer pain in the abdomen, and shrank from pressure, especially over the right i'iac fossa. The lungs could not be satisfactorily examined, on account of his extreme restlessness, but no marked abnormal sounds were heard. Counter-Irritation was ma'le at the b:ck of the neck; a tenbinthinat • injection administered, which was m-t returned until seve>.i| hours afterwards. During t!ie night his condition remained about the same ; occasion illy he was quiet for a few moment*, but most of the time, roiling from side to sidy, and unking violent effjrts to get up. A sheet was tied across his body to ih.» sides of the be.il. Next morning (Sunday) he was more quiet, and there seern- e.t to be rather more intelligence in the expression of his eyes ; tjom times he appeared to partially comprehend a question, and answered it by a nod. His tongue*and throat were covered with sordes ; his pul.-e was ralller softer and weaker; the pupils natural or a little contracted. Some ecchymosis was observed over his -.inn;-., chest, and abdomen, which wis ascribed to fric- tion against the sheet tied across him. About three pints of urine, natural in appearance, were drawn off. He swallowed with great difficulty a little beef es- sence; beef essence and quinine were ordered per anum ; tur- pentine emuMou, milk punch and beef essence internally. Deputation was very difficult, but he oecasionly swallowed small quantities of fluids. Lite in the afternoon he became worse; more heavy and comatose with some, stettor in breathing. The power of deglutition was entirely lost. He was quiet during the night, with occasional restlessness. His bowels and bladder were several times involuntarily evacuated. When seen the following morning (Monday) the patient was evidently sinking; the stertor was well marked, with puffing expansion. A number of different sized blotches, resembling purpura hemorragica, and some small pinkish snots, were observed over the lower part of the chest and abdomen. Their diagnosis was obscured from the fact that the man during his violent struggle, had for ________8________________ fotty-eight hours, been rubbing his body against the sheet with which he was fastened in bed. During the day, paralysis of the right side was observed ; the man frequently moved the left arm or leg, but never the right. Some contraction of the flexor muscles on the right side had been previously noticed. He sank slowly and died at 3. o'clock A. M., Jan, TSth, 18G3. Case reported by G\ n. DARE; A. A. Surg.,-U. S. A. POST MORTEM. 1-2 hours after death. Bkaim:— veins of pia-mater very full of blood ; also fine in- jection of same membrane observed. Dura-mater was remarkably adherent to the summits of cer- ebrum, and somewhat congested. Wtiite substance of cerebra three (3) timps as full of b'ood, by estimation, as natural, and of pinkish color on cut surface. Pia-mater firmly adherent to cerebral surface. Its covering of arachnoid had lost its transparency. Fluid found in lateral ventiicles. Vein* of chorid plexus distended. Fluid resembling pus was observed about the pes hippo-camp, major, of right side. The lining membrane of posterior horn of rivj'it lateral ventricle, much congested, and veins enlarged. Veins of Velum Interpositum exhibited smallvfibrinous gran- ules. Third (3d) ventricle contained serum, Fourth(4th)Ventricle was covered with what was considered plastic exudation, and exhibited small quantites of puruloid fluid; the former so marked as entirely to obscure the usually shining surface.* Pineal body presented a gelatinous appearance, and was of three (3) times the natural size, It vvas preserved. Lungs:—lower lobe, left side, congested intensely, and bo filled with products of inflammatory reaction, th it a portion one and a half(n)inch square, readily sank in wa'er. Supposed at first to be in the first stage of pneumonitis; this character not established. Lobulated solidification was observed in lower lobe of ri^ht * The serous lining of the ventricles generally was opacified. (Remark made two days after P. M.) 9. si do.—Heart, natural size. Tenacious and well formed , -white fibrinous clots observed in both ventricles ; that of right side connected with tough, mixed, fibrinous clot in right auricle. Liver full of blood; not much enlarged. (tall.—Bladder full. Spleen, normal size, rather pale externally, in view of liver, lungs and heart. Kidneys, normal size and full of blood, in common with other internal organs. Bladder filled. The congestions of the lungs were more allied to an apoplectic condition than a pneumonic. Urine was not, examined for albumen. Blood was fluid and of a dark brick red color.f [CASE No. 4.] Hospital Number ) •2,739. j John Keul, age 26, Priv. Co, K. 199th Pa. Vols.; was admitted to this Hospital Dec. 2nd, 18iil, and died Jarj. 28rd, 18G5. HISTORY.—(ANTE MORTEM.) IV.io.nt came into Hospital with typhoid symptoms, dry tongue and partial coma. Was placed under the ordinary treatment of Emulsion Terebinth, beef essence and typhoid diet. Chronic diarrhoea supervened, and continued from time to time, until deatlv His mental faculties were never clear from the time,of his admission. Case reported bv W ■ CL SMELL, A, A. &urg.,U. S. A. ------o----— POST MORTEM. J.m. 23rd 1865, at 3 o'clock. P. M. Nine hours after death. Slight rigor mortis. Considerable emaciation. Fluid in sac of pericardium, estimated at two oz. Adhesion upper lobe, left lung, about two thirds. Some slight f &*muk aaadc froai memory tis w acts alter autopsy. 10. adhesions (band) to diaphragm. Blood clotted in the great veins. Lungs.—Dark color, hypostatically congested. The outer por- tion of lowest lobe, right lung, was so congested as to be of nearly the specific gravity of water; doughy to feel, yielding, when press- ed, bloody serum. Po-L'r surface, left lung in which the bands were observed, was "cuirassed" * Heart.—Organ small, contracted upon white fibrinous clots. extending on the right side of heart, from the right auricular appendix through the aur. vent'r. opening, firmly adherent to the two ant. cusps of the tricuspid valves, and sending an arm from these cusps upwards into the pulmonary artery. Opposite the valves of the pulmonary artery, clot-ears were observed. In the left side a clot corresponded firmly adherent to the ant. face of the mitral valve, after issuing from the auricle, and extend- ing by arms into the aorta. Opposite, semilunar valves dot ears were observed. Liver.—Piather small, vessels on surface marked with lines. Organ of solid consistence (hard) with a somewhat wavering bor- der. Color an ash red. Gall.—Bladder contained light colored bile. Over surface of liver there was fine arborescent congestion. Great vessels of organ well marked and strong, and its substance had a decided order. S^leex, nearly normal size, a little larger, very dark color; full of blood; tough and presenting no variation in structure. Brain.—On opening meninges about an ounce of serum es- caped. Yellowish serum present, a drachm, (minimum esti- mated) in each of the lateral ventricles. Substance of cerebellum had a watery look. The whole brain was flaccid. Demonstration of organs was easy and perfect, There was a small quantity of fluid in the fourth ( iib) ventricle. Communication between the ventricles was unusually large. I.\ti:stix;;s.—Upper part of rectum studded with small ulcers with white tops. Inferior portion of sigmoid flexure presented same appearance ; transverse colon exhibited wasting of mucous membrane; right hypochondriac region, along posterior band col-, lection of ulcers; long diameter of individual ulcers transverse ; * Meaning, made red tough, fibrous, leathery, sotuewhat elastic—no i easly broken by pressure. 11. cajcum and ascending colon slightly congested in large spots and mucous membrane wasted. Iliac congestion near cascal valve ; congested spot eighteen (18) inches up; such congested spots continued throughout ileum, met with tho. rare in jejunum. Je- junum in upper portion apparently healthy. Spots of apparent softening of mucous membrane were rare; duodenum marked with bile. Stomach, flaccid; grayish internally. Kidneys, left congested; darkly, mferiorly and externally, this superficially about one eighth inch deep; general conges- tion of substance of kidney; distingiushing line between the cortical and medullary part indistinctly marked. Eight kidney presented same appearance, except that the general congestion was of a deeper hue. Urine-slightly albuminous. [CASE No. 5.] Hospital Number, ) 2,884. J John Burke, Private, Co. I, 1st. New York Lincoln Cavalry ; aged 23 years. Admitted to this Hospital December 26th, 18(54. HISTORY.—(ANTE MORTEM.) Patient was unmarried; by occupation, a laborer. Was sub- ject to frequent colds, resulting in obstinate coughs. Patient took a severe cold in October 1864, while on picket duty; was admitted into Regimental Hospital, and afterwards transferred to this Hospital December 26th, 1864. Consumption not heredi- tary in his family. December 27th 1864.— Suffers much from cough. Dyspnoea. Pulse weak, but regular; bowels regular. Appetite poor. Aphonia, much debilitated. Treatment.—Gave expectorants. Opiates at night; brandy. December 30th. The lungs were examined to-day. Inspection.—Sternum prominent; the sides of thorax flatten- ed ; right side somewhat more than left. Ribs prominent. Percussion.—" Cracked Pot/' sound on upper part of right lung. Dullness below. Upper part of left lung somewhat tympanitic; normal below, 12. Auscultation.—Tinnitus mctallicus on right side, upper part. Gargouillement rattling sounds in upper part of left lung, lower part normal. Diagnosis.—Phthisis Pulmonah's: both lungs affected, par- ticularly the right, a cavern on upper part of right side, prob- ably one also on left side. Treatment continued. Jauuary 5th, 1865.—No change. " 10, ''■ Somewhat better to-day. Treatment nv.uinued, with addition of Cod liver oil. January loth, 18(55.—Not so well to-day. Diarrhoea. Cod liver oil discontinued because it nauseated him. Only opiates and stimulants. January 20th.—Diarrhoea stopped, bloody sputa, becoming weaker. Dyspnoea increased. .January 25th.—Failing rapidly. ■; 29th.—Died at 2 o'clock, P. M. Ctse reported by J. G. KELLER, A. A. Surgeon, U. S. A. ------o------ POST MORTEM, .January 30th,.at 3 o'clock P, M.—Height, six feet; body generally well formed ; some rigidity. Lungs.—Extensive, firm and old pleurisy bands connected the surfaces (opposing) of right pleural sac. None observed on left. Bronchial tubes reddened. Mucous membrane rough- ened. On right side tubes connected by open mouths of third branch, with a vomica of irregular form, which was excavated in the consolidated substance of all the uppermost lobe, having its walls of a bluish gray color, lightly colored with purnloid fluid. No odor. In middle and lower lobes of right lung a large number of vomica?, varying in size from one capable of containing a pea, to one of the size of a hickory nut were observed, and were ^o numerous, indeed, as to make a central cut surface present a honey-comb appearance. Tubercles in all stages, from a mili- ary tubercle of pearl color, to the broken-down collection in a recent vomica, were observed. Very little of right lung; not 13. more, in fact, than substance corresponding in quantity with one half mid. lobe was available for purposes of function. Right lung weighed three and a half pounds, (3£ lbs.) In left side, sup. part, upper lobe, a vomica that would con- tain a hen's egg was observed, freely connecting with bronchus of one-fourth diameter. In post, part of this lobe and post. part lower lobe, as in right lung, great numbers of small vomica with tubercles (of miliary type) were observed ; the stages of these seemed to be more advanced than the stages of those of right side. The large vomica was clean walled and oderless. The general size of these lungs was that of the lungs two- thirds (§) inflated.* Left lung weighed three pounds and seven ounces (3 lbs 7 oz.) Heart.—In right auricle a central massive clot was attached to the auricular appendix, and had three arms, one running in- to either cava, a third connecting with a white fibrinous clot in the right ventricle which was firmly attached to tricuspid valve, connected with the tendinous cords of anterior surface of ven- tricle and which had an arm extending into pulmonary artery, ear marked opposite valves ; bifurcating. In left ventricle a clot connected by a slender baud with left auricular appendix, arose from the surface of anterrior cusp, extended downward to be firmly attached to borders of ventricle, so that blood coming from auricle passed on the sides of the valves' opening ; an arm extended from the ant. portion of the cusp attachment of this clot into the aorta; ear marked opposite valves by slender ear marks indistinct and stretched. Heart weighed 11 ounces and 7 drachms. Liver of firmer texture and well filled with blood, not con- gested ; homogeneous and having a strong peculiar odor. Liver weighed 4 pounds and 5 ounces. Kidneys rather large, of firm consistence and well developed cortical substance ; pelvis somewhat dilated. Each weighed 7h ounces. Spleen.—Small, presenting one spot of superficial black con- gestion. Weighed 4J ounces. * NOTE. Appearances would lead one to suppose that the older disease was on the left side from (1) the darker color of a cut surface, and (2) the more advanced condition of the tubercles ; while the exis- tence of a larger vomica and of pleuritic bands bear testimony in this favor for the right side. 14. Intestines.—Duodenum, jejunum (lower part,) and ileum congested in points, probably about the solitary glands. In opening, the gut was easily torn. In upper part of ileum tubercles were seen, yellowish gray, not ulcerated. Peyers patches tuberculous. Towards the lower part of gut tubercu- lous matter had softened, and a caseous substance was express- ible from some of the little tumors. Spots of ulceration began in transverse colon and extended to rectum. Increasing inten- sity of ulceration towards rectum, varying from single round ulcer slightly raised, of pale color, to a large intensely red, well raised graulating surface. In rectum there was deep purplish congestion with ulceration. Weighed 5S£ ounces. Brain.—Nothing unusual observed, except distention of veins in lateral ventricle. [CASE No. 6.] Hospital Number, ) 67. J Jacob Gillman, Private, 18th Wisconsin Volunteers. Admitted for burial January 31st, 18G5. Caso.one of death by R. R. accident. Particulars unknown. post moete:i. January 31st, 1865, at 3 P. M. Extensive fracture of back of skull. Fracture observed in the occipital bone, extending from left transverse process, through left arm of occipital cross, to near apex or summit of bone. A line of fracture extended from near centre of postr. border of foramen magnum half way to Torcular Herophili, ihencc at right angles, serrated twice, half inch to left; line of fracture was also seen in mastoid portion of temporal bone. postr. portion, proceeding upwards and forwards. Eiiain.—On opening the meninges a quantity of blood, black and clotted, flowed from both sides. Veins of pia mater greatly distended and appeared to have given way at postr. fourth of supr. borders of cerebrn, near attachment of Pacchionian bodies. Blood was seen to issue on right cerebruni, in one of these locations, from an orifice 15. of a vein (clearly demonstrated,) through the arachnoid. Underneath the arachnoid an apoplectic spot was observed on surface of right cerebrum near outer termination of fissure of Sylvius. In removing the brain from bony case a clot of blood was observed in front of optic commissure, another clot observ- ed near perforated space to outside of right- optic tract just above the commissure. As to substance of brain the puncta were somewhat more numerous than usual. A clot of blood was also observed in antr. part of left lateral ventricle, semi- fluid. Large vessels, chiefly on right side, were observed in floor of fourth (4th) ventricle. Heakt.—White fibrinous clot was observed in right ventri- cle connected with one in right auricle ; an arm of the former extended into pulmonary artery and was marked opposite pulmonary valves with ears. Auricular clot had its origin in auricular appendage; clot easily detached. On left side of heart, left ventricle, clot extending from infr. border of antr. cusp was attached to tendinous cords near apex ; divided left ventricle into antr. and postr. chambers, Heart weighed 10 ounces. Lungs.—Left lung intensely congested in postr. portion of postr. lobe, substance was black and friable and detached por- tions sank in water. When broken up a frothy, blackish fluid was expressed. Right lung, postr. portion, lowest lobe con- gested in a similar manner (as in left side.) less intensely and extensively. Left lung weighed 29 ounces. Right lung weighed 26|- ounccs. Intestines.—Colic glands, somewhat congested. Solitary glands somewhat eularged ; otherwise intestines normal. In stomach (fundus of,) a reticular congestion observed apparent- ly sub-mucous. NOTE .—No accurate history ofthis man's injuries could be ascer- tained, he was, however, living at the time ot reception of the order of admission, by the statement of the Officer giving order. So it was eviih-nt that he must have lived twelve horns or thereabouts, having been injured the night before, and brought from where the accident occurred to this city, (Baltimore, Md.) The fact of well defined clots having been formed :.fter rupture of veins of pia mater in consequence of contre coup affecting the conglomerate of meninges resulting from the acfiop ofthe Pacchionian bodies shows that the man did not dje in- stantly. 16. Kidneys.—Of natural size, congested sufficiently to present a bright red hue. Left kidney weighed 4 ounces and 2 drachms. Right kid- ney weighed 3 ounces and 2 drachms. Spleen.—Normal; some difference of color in different portions ; change supposed to be post mortem. Spleen weighed 6 ounces and 8 drachms. Pancreas.—Normal. Weight, 29 pounds and 4 ounces. [CASE No. 7.] Hospital Number, ") •2,797. j John Jordan, aged 30 ; Private, Co. H, 173d Regiment New York Vol. Infantry. Admitted December 21st, 1864. HISTORY.—(ANTE MORTEM.) John Jordan, native of Nova Scotia. Extremely weak and emaciated when admitted; unable to move himself in bed; states that he has been suffering with Diarrhoea for two months; tongue dry and thicklv coated ; bowels moved nearly every hour. On percussion there was slight dullness over the chest posterior- ly ; skin dry, and presented a yellow color; liver enlarged. Mass. Hyd. given in small doses, with the various vegetable astringents from time to time, with the view of checking the bowels, but with little effect. January 17th.—Symptoms of Pneumonia observed on the right side of the chest anteriorly; treated by counter irritation and stimulants. Died from prostration Jany. 21st, 18G5. Case reported by J. G-. KELLER, A. A. Surgeon, U. S. A. POST MORTEM, Twenty hours after death. Extreme emaciation. Brain.—Light colored, normal. Measured 7 inches; 38^ 17. ounces in weight. Llncs.—Somewhat small, containing nodules with pus in centre, the largest involving not more than three (3) pulmon- ary lobules, the smallest, part of one. In the left lung these were remarked unaccompanied by other grave changes of the pulmonary tissue, but in right side accompanied by sporadic tubercles, of which a number were observed of miliary type, and by a serous congestion so intense as to make the pulmon- ary tissue engaged ofthe sp. gr. of water. Melanic matter in more than usual (quantity was observed on surface, and to per- vade parenchyma of both lungs. Live p..—In removing thoracic viscera such tension was made upon diaphragm as to break up certain adhesions formed be- tween the postr. supr. surface of right lobe of liver corresponding with phrenic surface and make an orifice, out of which pus issued abundantly, of a gray color, odorless, very fluid, which, however, became of such a consistence presently as to escape by original orifice ouly on pressure. When liver was removed it was found that the left lobe and an homogeneous portion of right was of a pale ash reel, (jail bladder quite full; was of a bright yellow color. Inferior portion of right- lobe was also ash red in color, except anteriorly, where a bluish black, fibri- nously veined, superficial substance was observed. The abscess contained, by rough estimate, a quart of pus; had well marked fibrin, walls of firm consistence, and its contents varied from the walls in fluidity; its contents, moreover, were viscid and flaky ne:r the walls ; an eighth (|) of an inch beyond the outer line of abscess wall the substance of the liver was dark red, and ap- peared to present signs of greatly increased organic action, and scarce!y to retain any functional properties. It was thought that the binding together of the diaphragm and liver, in part through the peritoneal fold, indicated a disposition of nature to discharge the pus through the lung. Spleen.—Very firm consistence; marked trabecular; some capsular thickening, (general,) and generally of a dark watery red color. Length, 6 inches; weight, Cy ounces. Kidneys.—Somewhat light colored. Length, 5J inches ; wciyht, G ounces. Intestines.—Solitary ulcers in large intestine. In the de- lding and transverse colon these were circular, a line or two 18. in diameter, having bottoms of most discolored and dark, of some not discolored, presenting increased number and size in transverse colon; a spot of congestion and superficial ulceration met with in latter; dark bottomed and solitary ulcers, amid slight congestion in lower part ileum; arborescent and finely granulated mucous membrane was generally presented in ileum. Peyer's patches were not diseased; one long spot of arborescent conges- tion finer than that preceding was observed in upper part of ileum. Lower part of jejunum gas of some kind observed under mucous membrane causing appearances like flocculi of soap-suds; two spotsoftheseflocculi in Peyer's patches, above these flocculi no disease found. Heart.—Pale and flabby. Hospital Numeer, ) 58. . ] [CASE No. 8.] Thcmas O. Herring, age 44, Private, Co. E, 91st New York Volun- teers. Admitted January 30th, 1865. Died February 2d, 1865. HISTORY.—(ANTE MORTEM.) Patient was brought into the Hospital in the evening, after a debauch, suffering from nausea, wdth some febrile action, for which two doses of Prot.Chlo. Hyd. were prescribed1. On the following morning nausea continued with occasional vomiting; medicine acted freely. Slightly restless during the clay. Pulse 100,—evening round. Administered 10 gr. Dov. Powder to allay nervous irritability, Following day slightly delirious, administered Valerian and Laudanum. Diet light but nutri- tious. Patient complained of no pain from the time of his admission to time of death. On the day preceeding death ate his meals heartily. About 10 o'clock, P. M., was found mori- bund and died following morning at 7 o'clock. Case reported by VT. (4. SMULL, A. A. Surgeon, U, S. A, 19. POST MORTEM, EightJiours after death. Suggillation in dependent parts; muscular system well develop- ed; rigor mortis. Stomach.—Natural size, some thinning of mucous membrane, with spots somewhat arborescent, following lines of mucous folds; chiefly found in fundus; dark red, in part apparently blood extravasations. Right Lung.—Healthy, ra~ little leathery posteriorly, lower lobe, and remarkable in not having a middle lobe. Melanic matter following course of ribs. Left Lung.—Recent adhesions closed the posterior and infe- rior portions of the left pleurabsac and agglutinated the opposed surfaces of the upper and lower lobes of the lung. The inferior lobe was found in second stage of pneumonia, portions sinking readily in water, and yielding wdien broken and pressed, a puruloid fluid. On a clean section close observation revealed a fine granular appearance. Kidneys.—Of somewhat light color, pyramidal bodies redder than natural, and readily torn in direction of tubular length. Right Kidney, length 5 inches. Weight 5J ounces. Left kidney, length 4| inches, Weight GJ ounces. Liver.—Organ enlarged, solid, friable, full of blood; pun- gent hepatic smell. Gall bladder filled with black bile. Liver, length 10 inches. Weight 4pounds and 7 ounces. Spleen.—Flexible, nearly black internally, easily broken, yielding upon pressure little or no fluid. Spleen, length 7 inches. Weight 1 pound and 3 ounces. Pancreas.—Normal excepting size. Pancreas, length 9 inches. Yvreight 3| ounces. Heart.—Atheromatous spots observed in aorta separated and small; borders of valves were hard, especially ofthe right and left. A white fibrinous clot strongly marked by ears arose from the anterior cusp, lower border connecting with a free band from the"' auricle. Clots extended in pulmonary veins partly white and black. A well developed clot arising in the right auricular appendix extending into right ventricle filled Itfi apex, and constituted a species of false septum by which 20. blood was cast upon mouth of artery. Extending at an angle of forty-five degrees with the long diameter of the body of the clot, a thick clot slightly ear-marked extended into pulmonary artery bifurcatiug with the same. It was thought that the left ventricle was slightly hypertrophicd. Intestines.—Mucous membrane ofthe ileum slightly thinned. Peyers patches healthy. Brain.—Pacehionnian bodies well developed; union of menin- ges, so that when the calvarium was removed blood flowed from ' a torn orifice; surface of substance of brain was of a somewhat red color. Brain, length antr. postr. diam., 7-|- inches, Weight, 47 ounces. Hospital Number, ") 2,47G. j [CASE No. 9.] John Garden, age 28, Piiv. Co. D, 15th New York Volunteers ; admitted Oct. 26th, 1864, from the field. Died .February 4th, 1865. HISTORY.—(ANTE MORTEM.) Admitted with amputation of mid. 3d of left thigh ; operation performed on the field Oct. 19th, 18G4. At the time of his admission the femur was protruding an inch beyond the place of amputation. The patient was very anaemic and subject to chronic diarrhoea, more or less profuse, which with the profuse suppuration rendered an operation for the time unadvisable. On Dec. 30th, the operation of resection was performed by Surg. Z. E. Bliss, U. S. Y., with the removal ofthe femur up nearly to trochauter major. The subsequent result was a slow improvement of the wound for some weeks, when colliquatiue diarrhoea set in, and the patient sank rapidly until death. Case reported by W. G. SMULL, A. A. Surg.,U. S. A. ------o------ POST MORTEM, Twenty-two hours after death. 21. Extreme emaciation; slight rigor mortis; no marked suggilla- tion. Brain.—Very flexible, normal; about one drachm of limpid serum in each of the lateral ventricles; pia mater readily de- tached. Pacchionian bodies, numerous and well developed. Brain, weight 45 ounces. Lungs.—Crepitant throughout, presenting no nodules of con- gestion ; marked well with melanic matter along courses of ribs. Right lung weighed 121 ounces. Left lung weighed 8|- ounces. Liver.—Very flexible, tracts of vessels marked with white lines; of a firm feel; with appreciable lined, or semi-lobulated feel upon firm pressure. The bile secreted was of an amber color and very fluid. Gall Bladder was very full. The color of liver was somewhat dark and faintly mottled. Substance quite tough in breaking by the finger. Weight of liver, 2 pounds 13 ounces. Length of liver 9 inches. Supra-renal capsules remarkably firm, and upon section present a sac filled with white matter; a red line varying in intensity of color from within outwards, the outer third and outermost Hue of a pinkish color ; fine lobules observed upon surface. Left Kidney.—Tubular portion of pyramids contrasting strongly with cortical portion in color; both well filled with blood. Right Kidney.—Similar ; a little fuller of blood. Right kidney Avas 5 inches long and weighed 6J ounces. Left kidney was 4| inches long and weighed 4} ounces. Heart.—Small but normal. Weighed G| ounces. Intestines.—In the colon grayish flakes adhered closely to the surface throughout the sigmoid flexure ; descending colon presented fine red congestion. Light flakes of white material met with in company with deeper congestion in ascending colon. In ileum (lower part) the same flaky spots, very small, however, were observed; apparently some wasting of substance of ileum; fine granulations apparent by reflected lio-fit; about half-way up the ileum a black spot was met with in which the gut was readily torn. Jejunum healthy. Weight of intestines, 3 h pounds. 22. Stomach.—Somewhat contracted, and reddened at fundus. Pancreas, weight 1-| ounces. Spleen weighed 8| ounces and was 6 inches long. Vessels.—A clot was found 2 J inches long in the extremity of femoral artery ; vessels apparently in natural state. Conical clot, extending to first small branch, with base uppermost, clot was of a light brownish or pink color. Femoral vein be- low the profunda became much narrower with thick walls- terminating in thick cord. Internal saphenous vein pointed and corded at extremity; not opened Anterior crural nerve convoluted, terminating in a large mass of fibrin tissue, almond shape, connected with large fibrin masses in stumps proper. Sciatic nerve slightly_cli:l>bed at extremity. The bone terminated in a rounded bare face (in opposition) ensocketed with fragments of new bone, apparently products of periosteum shreds. ^JNOTE.—The disease apparent in the liver is thought to be speciea of cirrhosis, and the death of the patient theoretically attributed to liver defect. That is to say, tissue required materials of plasm that could not be furnished on account ofthe disorganization ofthe catalytic plasm former—the liver. An effort at life was manifested in the con- dition ofthe osseous tissue ofthe stump.J -----—«^----- [CASE No. 10.] ] Hospital Number, ) 93. ) Austin Vacon, Priv. Co. G, 186th New York Volunteers, admitted for burial February 5th, 1865. POST MORTEM, Thirty-six hours after death. Brain.—There was a slight opacity of the visceral arach- noid near vertex. Near origin of auditory nerves upon floor of fourth (4th) ventricle a central line of congestion was observed with lateral spots, clearly marked. Brain weighed 53 J ounces. Lungs.—Left apparently liealthy with (ha exception of a 23. lobulatcd portion consisting of congestions ; portions cut from which were nearly of the specific gravity of water. On the right side flakes of lymph were observed, some cpiite extensive, which bound together the opposed surfaces of lobes. The parietal pleura was thickly covered with a sheet of lymph, so was also the diaphragmatic pleura, but there was little or no effusion of fluid into the sac. Right lung, lowest lobe, near the centre a mass of black congested lung substance was found, portions of which sank in water, while the greater part was nearly of the same sp. gravity. Left lung weighed 1 lb. J oz.; measured 8§- inches. Right weighed 1 lb, 13 oz.; measured 8J inches. Liver.—Presented a light color, was somewhat full of blood and exhibited black congestion on anterior inferior surface. G-all bladder, light colored, had contents of light color. The capsule of the liver was easily torn off—outlines of the acini well marked. Liver weighed 3 lb. J oz,; measured 6 J inches. Kidneys. —Right well marked, left same. Outlines of tu- bular portions well marked. Right weighed 5 oz.; measured 41 inches. Left -weighed 5 oz., measured 4J inches. Spleen.—-Natural size, flexible, black congested internally. Spleen weighed 5 1-2 oz.; measured 5 1-4 inches. Heart.—Auriculo-ventricular clot on right side strongly attached to cusps of tricuspid valve and an arm was ear-marked opposite artery valves. Heart weighed 9 oz.; measured 4inches, Intestines.—Large intestines slightly congested in portions ; small ulcers in ileum ; thinning of mucous membrane in upper part of ileum. No other lesion observed. Stomach.—Darkly congested. 1 Pancreas weighed 3 1-2 oz., measured G inches. Normal, [CASE No. 11.] Hospital Number, ) 94. J Admitted for burial, (name unknown,) Peb. 4, 1SG5. 24. POST MORTEM, Thirty-six hours after death. Body of very good form and well proportioned. On opening the thorax a great deal of serum was observed in the serous sacs. The mesenteric glands were enlarged. The supra renal capsules were well developed and markedly sacculated. Brain.—Slightly marked with the pacchionian bodies; the surface of the ash-colored brain matter much lighter than usual; of natural consistence. The lining membrane of the 4th ven- tricle near nib of calamus scriptorius was somewhat rough to the feel and slightly discolored, (red.) Lungs,—Healthy. Watery infiltration and partial discolora- tion in the posterior surface of right lung ; similar condition in the left lung, only one a little more advanced. Left lung weighed 1 lb. 12 oz.; measured 8 inches. Right lung weighed 1 lb. 8 oz.; measured 8f inches. Liver.—Enlarged; friable; of violet color; black congestion on inferior surface. Liver weighed 4 lb. 13 oz.; measured 10 inches. Kidneys.—Similar in color to liver, with black congestion in the dependent portions. Upon pressure a serous fluid was ef- fused from portions of the kidneys. Right kidney weighed 8|- oz.; measured 5 inches. Left kidney weighed 9J oz.; measured 5 inches. Heart.—Somewhat loaded with fat externally, and contain- ing small white clots, one extending free from right auricular appendix, the other extending free from the apex of right ven- tricle, another extending free from the anterior cusp of the bi- cuspid valve. Heart weighed 11J oz. Spleen weighed 3 1-2 oz.; measured 5 1-2 inches. Intestines.—Great thinning and softening of mucous mem- brane of jejunum and ileum, detachment upon touch. Mucous membrane blackened (cadaveric?) from stomach to caecum. Peyer's patches also dark, with black points and small oval ulcers; a lower Peyer's patch clearly ulcerated, and from this down these patches were ulcerated. Near caecum oval ulcers appeared again, deep in midst of blackness and softening. Ex- cept softening of mucous membrane, blackish and probably cadaveric, no other lesions observed in large intestines. 25. [CASE No. 12.] Hospital Number, ) Chancey James, Co. D, 6th New York Heavy Artillery, admitted for burial. POST MORTEM, Thirty-six hours after death. Brain.—Pacchionian bodies quite large. Pia mater de- tached with difficulty. Substance firm, color natural. Arach- noid natural. When meninges were opened about a half ounce of serum flowed. The liuiug membranes of lateral ventricles had a leathery feel. Brain weighed 47 oz , measured 7 1-2 inches. Lungs.—Normal. Some infiltration in posterior portion of left, supposed to be cadaveric. Right lung weighed 18 1-2 oz., measured 9 inches. Left weighed 15 1-2 oz,, measured 8 inches. Heart.—Left ventricle somewhat enlarged; no heart clots found. Weighed 6 1-2 oz., measured 3 inches. Liver.—Somewhat large; universally black; friable—strong liver smell. Gall.—Bladder of light color, filled with amber colored bile. Liver weighed 2 lb. 13 oz., measured 9 1-2 inches. Spleen.—Large (thick) and of similar color to liver ; flexible, soft, uniformly colored. Weighed 15 1-2 oz., measured 6 1-2 inches. Kidneys.—Right of a brick red hue internally; little difler- ence in color between cortical and tubular portions. Marked black congestion inferioiiy about a line in thickness. Left kidney similar to right. Pancreas.-—Normal. Weighed 2 1-2 oz., measured 7 -v- inches. # Intestines.—Mucous folds in large intestines somewhat red- dened ; no ulcers observed nor wasting of mucous membrane. Congestion in the lower part of the ileum above which the gut becomes yellow; mucous membrane thinned near the upper portion of the ileum, congestion again met with in the form of a small collection of blood spots, apparently effusions, underneath 26. the mucous membrane. Above the first region of congestioir similar spots were observed along the lines of mucous folds and clustered around small patches of Peyer, above these again a darkly congested region was observed with similar blood effu- sions along the mucous folds, and still higher tendency again observed to effusions of blood along mucous folds. In Jejunum (lower part of,) similar congestion met with; effusion more general. Ascending still, these congestions were met with as far up as the middle of jejunum—to be met with again, strikingly marked, with dark red spots of blood effusion in the valvulse conniventes—disappearing again—again to appear with less intensity, but more extensively ; toward upper part of jejunum met with again in form of a general congestion. . Duodenal glands plainly felt. Stomach of a light pink color near pyloric extremity with gray- ish mucous membrane not easily detached. In fundus and anterior portion of stomach pink color not so well marked, but very well marked in posterior superior portion. Organ some-- what enlarged. [CASE NO 13.] Hospital Number, 74. James Simonds, age 39, Priv. Co. A, 3d New Hampshire Vols.; admitted February 2d, 1865, and died February 7th, 1865. HISTORY.—(ANTE MORTEM.) Patient was admitted with marked evidence ofthe first stage of pneumonia in left lung, extending nearly over its entire surface. The respriatory murmur was finely crepitant. Crepitation became more crude on the evening of February 6th. Symptoms of Laryngeal inflamation set in succeeded by those of oedema of glottis, which continued until Laryngoto- | mey was deemed essential which -was accordingly performed i by the Surgeon in Charge, The patient died about twelve I hours afterward. Case reported by W. C. SMULL, A, A. Surg.,U, S, A, 27. [Note by George M. McGill.] When the operation was performed the patient was apparently dying. The respiration was excessively labored and ineffective. A blue color pervaded the surface—the pupils were sublated and the extremities cold. The operation was extremely simple—performed by a straight inci- sion. After entrance between the thyroid and cricoid cartilages was effected, it was maintained by a gutta percha tube—finally, to make the breathing very easy, by two gutta percha tubes. As soon as the operation was performed all breathing by the glottia ceased, except a little valvular sough. Warmth returned to the ex- tremities and a faint color appeared in the face. But the pneumonic prostration was too great to permit life. ------0------ POST MORTEM. Ten hours after death. Brain.—Normal. Weighed 49 oz., measured 7 inches. Heart.—Loaded with fat externally, the mass of this lying opposite the anterior border of the right ventricle and posterior border of the same and along the auriculo-ventricular lines. Heart clot arising in the right auricular appendix extending through tricuspid valve communicated with septum clot, bind- ing anterior cusp to apex of ventricle. From its origin in tricuspid valve and anterior portion of right ventricle an arm extended into pulmonary artery ear- marked opposite pulmonary valves. Left ventricle clot extended from anterior cusp into aorta ear-marked opposite valves—same communicated with an au- ricular clot from pulmonary veins. Heart weighed 7 1-2 ounces. Measured 4 \ inches. Lungs.—Upper part of right lung (otherwise healthy) con- tained numerous hard black granules, section of which present- ed a white centre; one or two masses were large as peas, even these were surrounded by unirritated pulmonary tissue. The left lung, both upper aud lower lobes except the very anterior portion of lower lobe, was solidified in second stage of pneumonia. Substance was friable, easily separated from pleura, presenting on a cut or torn surface a fine granular appearance, yielding upon expression a grayish fluid and readily sinking when thrown into water. The left pleural sac was inflamed throughout, thick masses of lymph observed anteriorly and iiiferiorly. Right lung weighed 28. 1 lb 5 oz., measured 8 f inches. Left lung weighed 3 lb 10 oz., measured 9 1-2 inches. Spleen.—Had the color of liver, perhaps a little lighter, very flexible and easily broken down. Weighed 10 oz., mea- sured 5 1-2 inches. Pancreas.—Normal. Weighed 3 oz., measured 8 inches. Kidneys.—Right weighed 6 oz., measured 5 inches. Left weighed 7 1-2 oz., measured 5 1-2 inches. Supra-renal capsules enlarged, hardened and their sac filled with a bloody fluid. The capsule ofthe right kidney was torn off with difficulty, substance underneath it granulated in appear- ance, of light gray color mixed with red externally. Tubular portion of a dull red color. Left kidney similar in all respects to the right—perhaps a little fuller of blood. Liver.—Enlarged, of a rather light brown color, capsule easily detached, granulated appearance very plain. Substance containing little blood and very friable. Weighed 4 |- lbs., measured 10 inches. Intestines.—Black spots observed in rectum. Colon some- what congested in ascending part and in caecum; upper part of jejunum of a very light color; sonic' congestion of mucous membrane of fundus of stomach. Great oedema of glottis observed—meaning by this a light colored swelling which so distended the borders of the opening into the air passages as to close them in natural situation almost perfectly. No disease except a universal reddening was observed in the larynx and trachea below the vocal membranes. Just about the entrance of the tubes a bloody plug of mucous was observed, which could have however exerted no influence in causing death. Bronchial glands enlarged and blackened. The blackening not universal. Tissue of these glands friable and readily break- ing with a pulpy mass of a grayish or blackish color. [CASE No. 14.] Hospital Number, ) 96. } George P. Thomas, age 26, Priv. Co. G, 43d Ohio Vols., was ad- mitted to this Hospital on the ground of humanity, February 4th, 1865, and died February 12th, 1835. 29. HISTORY.—(ANTE MORTEM.) Patient came in with the measles; eruption well defined. Was treated with febrifuge medicines and in a few days the eruption had almost entirely disappeared. Symptoms of Typhoid fever manifested themselves two days before his death from which the patient gradually sank. Case reported by W. G. SMULL, A. A. Surgeon, U. S. A. ------o------ POST MORTEM. Brain.—Normal. Pacchionian bodies somewhat adherent. Weighed 56 oz., measured 7 \ inches. Lungs.—Congested posteriorly. Nodulated inflammations were observed, sections from substance implicated in which, sank in water. Miliary tubercles in great numbers filled the poste- rior portion of the lungs and were more numerous in the lower portions of the same. Right lung weighed 37 oz., measured 10 inehes- Left weighed 35 oz., measured 15inches. Heart.—Auriculo-ventricular clot in right side, arising in the auricular appendix, extended into ventricle. In left ven- tricle clot arising by delicate attachment from anterior cusp, ex- tended into aorta. Heart weighed 13 oz.; measured 5 inches. Liver.—Weighed 66 oz., measured 14 1-2 inches. Spleen.—Rather small and blackened internally. Miliary tubercles found in this organ also. Weighed 6 oz., measured 4i inches. Pancreas.—Normal. Weighed 3 \ oz., measured 7 inches. Kidneys.—Somewhat enlarged; much lobulated, especially the left, so that the capsule was so attached in the lobular in- terstices as to be with difficulty torn off. Each kidney weighed 8 oz, ; measured 5 inches. Intestines.—Congestion of rectum; reddening of trans- verse and descending colon. No ulcers observed ; darkening and tumescence of first Peyers patch met with in ascending the small intestines. In the ileum small raised points were observed hard to the feel; Peyers patches generally tumid and 30. dark; deeply congested mucous folds observed half way up the ileum. Above these a long Peyers patch enlarged and reddened was situated in the midst of another congested region, above this again congestion was deep and extensive. When well among the valvulae conniventes amidst another congested region a structure resembling a patch of Peyer, enlarged as similar patches of the ileum were, a foot in length, Avas ob- served. Stomach. —Small (contracted.) Mucous membrane thrown into great folds and somewhat congested. Intestines weighed 4 lb. 14| oz. [CASE No. 15.] Hospital Number, > 154. § Joseph Bryner, age 19, Priv. Co? E, 88th Penna. Vols.; admitted from City Point, February 11th, 1865. HISTORY,—(ANTE MORTEM.) Patient came in delirous ; pulse 120 ; could give no connect- ed account of his history ; stated that the ball was extracted at the place of entrance. Abdomen tumid and excessively tender could not bear pressure. States that his appetite was good and that his functions were regular. His delirium in 24 hours assumed a low muttering form from which he did not rally. Died, February 13th, 1865. Case reported by W. G. SMULL, A. A. Surg., U. S. A, -----o----- POST MORTEM, Twelve hours after death. On making the incision opening thorax and abdomen, blad- der was punctured in the pre-peritoneal space and a large quantity of urine flowed out. Blood fluid. In the auscultatory examination just before death dullness of percussion was observed in the right side 31. posteriorly with bronchial respiration, but nothing but the subcrepitant rale was heard over the whole surface of the left lung and anterior surface ofthe right. The orifice of entrance of ball was at the junction of a line drawn from the anterior superior spinous process perpendicular to one drawn horizon- tally from pubis. Right hip joint opened ; head of bone fractured; ball lodged with stellate fracture in anterior hemisphere of head. Frac- ture of four rays—two horizontal rays and one perpendicular. The leaden surface of the missile was observed at bottom of bone wound. Joint occupied with a reddish consistent puru- loid fluid. Synovial surface generally reddened or blackened with a dull or granulated surface ; offensive smell about the ligamentum teres, the attachment of which to caput was black- ened. Specimen preserved for transmiss. to the Surg. Gen. Lungs.—Right lung posterior portion of uppermost lobe was nearly of blood color; of smooth section, though of greater sp. gr. than water ; not friable but leathery in consistence, very flexible and elastic; upon section it was observed that bronchial tubes of minute calibre had a pointed feel, while the adjacent bloodvessels were large and patulous: this morbid structure was merged, islanded as it were, in comparatively healthy pulmonary tissue. NOTE.—A similar description to that given would apply to what has frequently been observed to exist, in isolated lobules or lines of lobu- les in posterior surfaces of lungs of patients dying of no pulmonary disease; and the condition is theoretically ascribed to an organic en- gorgement or tissue-proper inflammation distinct from the air cell fibrinous inflimmation and exudation held to exist in what is ordinarily called pneumonia. Lobules in color, consistence, and general qualities resembl- ing the mass described in posterior portion of uppermost lobe were observed in posterior portion of lowest lobe of right lung. In a collection of such at upper back portion of this lobe the outlines of the pulmonary lobules were very clearly defined. Posterior portion of lower lobe of left lung a stratum of pulmonary substance of this character, (that observed in right lung,) which may well be called carnification, two layers of lobules deep, was observed. Right lung weighed 28J oz.; measured 11 inches. Left lung weighed 15| oz,; measured 8f inches. Kidneys,—Normal, 32. Liver.—Light color ; friable ; capsule of it readily torn off; acini conspicuous on a torn surface; organ somewhat mottled superficially. Weighed 5 lbs. 11 oz.; measured 12 inches. Heart.—Open septum between auricles, (specimen pre- served ;) large yellow fibrinous clot in right auricle communi- cating with a clot in right ventricle. The latter clot enveloping the tendinous cords and the right anterior cusp extended in a sheet to the apex and was there attached to the mut;~**%cctir nati. The same pyramidal clot gave rise by the left angle of its base to a pyramidal clot which arched over the smooth sur- face leading to the pulmonary valves and extended, ribbon-like, into the pulmonary artery with distinct ear marks opposite valves. Substance of right ventricle somewhat thickened and loaded with fat externally about the vessels and in vicinity of the auri- culo-vcntricular line. Left auricle, small ribbon-like clot joining a left vent, clot, extending from anterior cusp of mitral valve to apex formed a solid acute angle of pyramidal planes, leaving a sinus opening to the left, from attachment of the right borders.* A clot arm arose from the anterior cusp of bicuspid valve, and extended into the aorta; ear marked by the valves; sub- stance of left ventricle thickened, as was the substance of the auricles. Heart weighed 15J oz. Brain.—Serum found in lateral ventricles, half an ounce in each, (estimated;) on floor of fourth ventricle a star-shaped congestion was observed on the right side, about the origin of the auditory nerves. Congested vessels were distributed on floor of fourth ventricle, chiefly on right side; a rough feeling at nib of calamus scriptorius. Brain of firm consistence; pia mater readily detached; visceral arachnoid somewhat opacified in certain localities, and under this opacity the pia mater was detached with more difficulty. Pacchionian bodies very well marked. Below origin of auditory nerves lines of congestion converging to nib were observed. Weighed 3 lbs. 7 oz.; mea- sured 8£- inches. Intestines.—Normal throughout. * The blood that came from the auricle was reflected in the ventriclo from this remarkable angle, being thrown upon the left buperior angle of that cavity. 33. Stomach.—Internally ingested along the longitudinal mu- cous folds. Intestines weighed 4 lbs. 3 oz. Spleen weighed 13J oz.; measured 5 inches. ' [CASE No. 16.] Hospital Number, ") 175. } John W. Tucker, Priv. Co. A, 4th U. S. C. T. Admitted for burial Feb. 13th 1865. POST MORTEM, Number of hours after death unknown. Such disease of the pleura as united opposed surfaces; lung substance friable posteriorly on the right side, somewhat leath- ery on the left crepitating in the latter, and filled with miliary tubercles. Lung substance torn in removal of organs from chest. Right Lung weighed lib. 3 oz.; measured 7 inches. Left Lung weighed lib. 2 oz.; measured 7]: inches; sac of per- icardium contained 28 fluid ounces of serum. Upon the parietal and visceral surfaces pericardium presented numerous patches granulated ; and in the sac, clusters of granules, one-tenth of a line in diameter, of the size of an apple, were met with free. No clots in heart. Miliary tubercles in the spleen and liver ; weight of splecn[jl3 :V oz.; organ measured 6 inches. Kidneys.—Normal. Right kidney weighed 6 f oz.; measur- ed 5 inches. Left weighed 7 oz.; measured 5 inches. Tuber- cles observed in the peritoneum. Tuberculous mass found in white substance of anterior lobe of right cerebrum, f- of an inch in diameter. Specimen preserved; No. 16. Mass of tubercles in bronchial glands. Pancreas weighed 4oz. Intestines.—No ulcers found in intestines, and no abnormal appearance observed; this whole tract was carefully examined. Mucous membrane slightly thinned. Intestines weighed 7 lbs. ] oz. Mesenteric glands not greatly enlarged, nor were they observed to be tuberculous. Liver weighed 4 lbs. 11 oz.; meas- ured 10 inches. Patient emaciated, feet, leg?, and face, swollen ; large abscess on neck, left side. 34. [CASE NO 17.] Hospital* Number, \ A Rebel. Name unknown. Age supposed to be about thirty. Admitted for burial. POST MORTEM, Number of hours after death unknown. Height, 5 feet 11 inches. Body a little emaciated. Blood fluid. Lungs.—In lowest lobe, right lung, red hepatization with gray merging into it. Red and gray hepatization in middle lobe such as to present a mottled appearance upon section. Some fibrin formed in pleural sac, recent. About eight (8) ounces of serous fluid found in right pleural sac. Right lung weighed 4 lbs. 8| oz.; measured 10 -*- inches. Left weighed 1 lb 12| oz.; measured 10| inches. Heart.—Large, with black and yellow clots following the usual arrangement. Cusps of the tricuspid valve were closely bound together. Heart weighed 14A- oz.; measured 4 iuches, BRAiN.^Scrum found in the lateral ventricles. The pos- terior horns extended unusually far back. Brain weighed 49 oz.; measured 1\ inches. Liver.—Of firm consistence presenting black bile in the bladder. Liver Aveighed 3 lbs. 10|- oz,; measured 9| inches. Spleen.—Natural size and firm. Weighed 7 1-2 oz.; meas- ured 6 inches. Kidneys,—Markedly lobulated, Right Aveighed 7 1-2 oz,; measured 5 inches. Left 8 1-2 oz.; measured 5§ inches, Pancreas weighed 3 oz.; measured 8 inches. Stomach,—Large; fundus congested. Duodenum congested; so was also the upper part of jejunum also the lower part of same. Mucous membrane thinned in small intestinesr No ulcers ob- served nor any striking abnormality, 35. [CASE No. 18.] Hospital Number, ) A Rebel. Name and age unknown. Admitted for burial. POST MORTEM. No of hours after death unknown. A part ofthe upper portion of the right cerebrum was retain- ed as illustrative of a morbid process in the pia mater, by which itself with the arachnoid and dura mater Avere bound together in a remarkable manner. The whole brain in this case was very full of blood, of a firm consistence and presented such an effusion of serum under the pia mater and in the ventricles as sustained the opinion that immediate cause of death was serous apoplexy. Cerebellum Avas not so full of blood as cerebrum; consistence of latter firmer; color natural. The arachnoid membrane seemed to be opacified. Weight of brain 31bs. measured 7 1-2 inches. On the anterior portion of the lower lobe of the left lung, a large number of isolated lobules were found in a consolidated or pneumonified condition, so as to sink when separated and cast into water, and to break up under the finger as ordinary pneu- monified pulmonary tissues. Right lung weighed 2 lbs. 54 oz.; measured 10 inches. Left weighed 1 lb. 13 oz.; measured 9§ ipchcs. Liver.—Large and pale, weighed 4 lbs. 7 oz.; measured 11 inches. Heart.—Black clots with ear marks found. Weighed 8 1-2 oz.; measured 4inches. Spleen.—Normal. Weighed 7 oz.; measured 9 inches. Kidneys.—Normal. Right weighed 61-2oz.; measured 5 inches. Left weighed 61-2 oz.; measured 6 1-2 inches. [CASE NO. 19,] Hospital Number, ) 208. J Orlando Jonea, Priy. Co. C, 81st Penna. Vols; Died Feb. 17th 1865, 30. HISTORY.—(ANTE MORTEM.) The patient Avas admitted Feb. 16th, in a state of partial coma; extreme palor with gurgling respiration, pupils much dilated. He could give no rational account of his previous history. Coun- ter-irritation was applied to the back of the neck and revulsives by the usual means. In about six hours he was able to speak and stated that he had been sick only a feAV days, There was slight tenderness in pressure in right iliac fossa, attended with retention of urine, about 24 oz. of urine draAvn off by ca- theterization. Evacuation by the boAvels free. On the following morning the patient Avas more conscious; respiration similar to that mentioned above, with involuntary expectoration of frothy mucus. There was slight dullness interiorly and posteriorly of both lungs, also loud ronchus in both lungs anteriorly and posteriorly. Pupils still dilated. Palor increased. Tongue somewhat dry so far as examination could be conducted. The liver was found of normal size. Pulse being feeble and the patients vital powers becoming exhausted, and his condition being almost moribund no farther examination was at that time instituted. Catheterization was again performed on the morn- ing of the patients death, and some 20 oz. of urine were dnuvn off. Case reported by W. G. SMULL, A. A. Surg., U. S. A, -----o----- POST MORTEM, Three hours after death. Body in good condition. Form good and muscular system well developed. Blood fluid throughout. Brain.—Of firm consistence, someAvhat full of blood, partial reddening of the floor of the fourth ventricle Avas observed. Weight of Brain 46 oz.; measurement 7 inches. Lungs.—Slight hypostatic congestion in the posterior por- tion lower lobe, left lung; when this lobe was cut into, spots of in- tense congestion were observed along the tracts of the bronchial tubes of about J calibre. Melanic matter existed in such abun- nrr dance upon the surface of the lung as to give to the whole organ superficially a black appearance. Weight of right lung 1 lb. measurement 9J;inches. Left 1 lb. 5 oz.; measurement 9J- inches; small clots observed in the heart, these evidently, mainly post mortem. Weight of heart 9|- oz,; measurement 5 inches. Brain.—The Pacchionean bodies, resembling in appearances and physical characteristics recently thrown out fibrin, in great number, were found on the summits of the cerebra. Serum was observed in small quantities in the ventricles. The veins of the pia mater were quite full. Weight of brain 46 oz.; measurement 7 inches. Liver.—Of dark color, having very black bile in the gall bladder, more solid than natural, marked Avith fibrinous lines along the tracts ofthe vessels. Weight 3 lbs 13 oz.; measured 11^ inches. Intestines.—Canal somewhat reddened in jejunum and ileum. SrLEEN.—Apparently normal. Weight 7 oz.; measured 6£ inche,s. KiDNEYs.-Somewhat full of blood; urine healthy. Supra renal capsules someAvhat enlarged and quite firm. Weight 1 oz. ; measured 2 \ inches. Pancreas.—Normal. Weight 4 oz.; measured 8| inches. [CASE No. 20.] Hospital Number, ) 133. \ John H. Thomas, age 22 years. Private, Co. I. 32nd Mass. Was admitted Feb. 11th, was wounded at Hatcheis Run by a minie ball, which entered the left shoulder to the hit of and somewhat above cor- acoid process, passed obliquely through and was extracted according to his own statement one inch to the left ofthe spinal column, near tho 8th dorsal spinous process. Died Feb. 17tb, at 8 o'clock .f M. HLSTORY.—(ANTE MORTEM.) Patient Avas admitted much enfeebled and unable to sit in an upright position or to lie doAvn. A large amount of grumous offensive matter discharged in great profusion from the posterior opening. Respiration avus partly performed through the same 38. orifice. Patient continually suffered from irritative fever Avith deficient appetite, all efforts to arouse his vital powers failed until he died. Case reported by W. G. SMULL, A. A. Surgeon, U. S. A. ------o------ POST MORTEM. Held at 4 P. M. February 18th 1865, Body of good form, no rigidity of mucles notable. Intestines.—In the rectum a large number of areolated black points were observed; the same Avere observed through- out the larger intestine : The large intestine was hypersemic arborescently, in spots, in Avhich as a rule it was somewhat thinned. Mucous membrane of ileum someAvhat thinned and congested; black points still observed and seen in Peyers patches. Mucous membrane readily washed aAvay in the upper part of the ileum. The jejunum someAAdiat blackened in the middle portion ; in the upper part the congestion became intense, then a lighter color was presented and then again a dark color, The upper part ofthe jejunum Avas of a light color. Weight 3 lbs. 12 oz. Stomach.—Mottled about the fundus, regionally hyperaunic and small. Supra renal capsules firm and Avell developed. Buain.—Normal in every respect. Weight 47 oz. Me- dulla oblongata was Avell developed and of firm consistence ; at the nib of calamus, there Avas a granulated appearance and feel, Measurement 7| inches. Lungs.—The ball entered to the left and somewhat above the coracoid process passed downwards, imvards, and back- Avards, breaking the third rib near the middle and in exit fracturing the 7th rib near the angle ; penetrating in its cour.se, the left lung from before, backwards, and without inwards, entering the superior lobe and leaving the inferior lobe. Right lung Aveighed 1 lb. 7 oz, ; measured 8| inches. Left weighed 1 lb. 4 oz.; measured 6| inches, The lung was cuirassed ; compressed upon its root and upon the superior anterior surface ; adhesions, Avhich had formed between th$ visceral and parietal pleural in the form of a rip The opposed surfaces between the lobes about course of the missile, were thoroughly united. A large quantity of black fluid, about 20 fl. ounces, of strong odor of sulphuretted Hy- drogen, and gas were found upon*-opening sac of pleura. Por- tions of sac of left side not secluded by defining lines were thickly covered with granulated fibrin of a blackish gray color; and the membrane of sac was thick, It was about half a line in diameter. The whole left lung had a black appearance mottled with closely adherent layers of fibrinous matter. Right lung and pleural sac occluded by very numerous fibrinous bauds, especi- ally posteriorly, so that in removing the organ the lower portion of the lowest lobe was torn. The substance of the lung of the torn lobe was tough, though broken on firm pressure; crepi- tant, full of blood, and of a dark color. Detached portions floated in water, but were so nearly of thesame specific gravity, as to remain sometime under it when plunged in. Anterior portion ofthe middle lobe was in the same condition, while the uppermost lobe was nearly healthy, although modally affected as tho lowest, that is, Avas what we have termed >' Cuirassed." Specimen of Avounded lung preserved. Heart.—Fibrinous clots ear-marked opposite the pulmonary valves; thicker and whiter on the right side; connected with auricular appendices. *____The ring itself as observed in its remains was appreciably raised from the pleural surface; sharply defined upon Us cuter as- . pe«t, arid of a -rw*.red color and somewhat-firm in consistence. Trabeculae clearly marked. Weighed 4 oz.; measured 5 inches. > Pancre as . —Flexible and of a r cddLIueoIor. Weighe 11 oz.; measured 6-in-elietJ. 50. Intestines.—There was great thickening of the rectum and in the sigmoid flexure of the colon ; and as high up as the trans- verse colon ; Avith a red granulated surface. Th-ere was observed also a white rough surface in the sigmoid flexure. A dark sur- face appeared above this with region of ulceration. The thick- ening of rectum was to about'four lines. In upper part of the sigmoid flexure one ulcer perforated the mucous membrane de- cidedly. Specimen preserved. The remainder of the intes- tines Avas considered normal. Intestines had generally a pinkish color.* Weight 55 pz. [CASE NO 27.] Hospital Number. ) 2. 891, j Gilbert Shaumway, Priv. Co. C, 10th New York Heavy Artillery, age 28 years ; was admitted December 26,1864, and died Feb. 27 1865. HISTORY.—(ANTE MORTEM,) The patient had a contusion over the right eye, Slight local inflammation supervened which on the following day was followed by erysipelas. This was treated Avith local application of ace- tate of lead and internally with Tinct. Ferri Chloric!. In forty- eight hours all symptoms of erysipelas disappeared and desqua- mation ensued. The patient at this time manifested slight mental aberration. Subsequent to this, partial unconciousness ensued. The treatment during this period was counter-irri^ tants and rcAmlsives. Case reported by Cadet for W. G. SMULL, A. A. Surgeon, JJ. S. A, ------n------ POST MORTEM, TA\-enty hours after death.---......—- *......*" Much emaciation, slight rigidity of muscles. Brain.—Aboreseent congestion on floor of 4th ventricle. *----The specimen was considered one of cancerous disease, al" though no microscopic examination was made of it. 51. Two small clots of blood equal together to a minim were found over the Pneumogastric Lobule. Serum was found in lateral ventricles. Fornix was so softened as to be readily broken up. There was a pinkish hue ofthe commissural substance generally. Some ingestion of the pia mater and a considerable quantity of serous fluid were found under the visceral arachnoid. Lungs.—Left lung congested in the inferior lobe. About the middle of the outer border of lower lobe there was a small abcess surrounded indefinitely by congested and eechymosed tissue the effect of actual effusion of blood apparently. Right lung congested in posterior portion. Seroid .fluid was found tinder the visceral pleura, detaching it to some extent from the lung, and old pleuritic adhesions connected the detached pleura to the parietal pleura. The congested pulmonary tisrme of right lung was dark red, somewhat mottled, and yielded a bloody serum upon pressure. Weight of right 22 oz.; measurement 9 inches. Left 14 oz.; measurement 8 inches. Heart.—A clot observed in left ventricle was of a granular appearance. It Avas attached to the anterior aortic valves hav- ing little or no connection with the anterior cusp of the bicus- pid valve, aorta was found reddened internally as were also the surfaces of cusps and tendinous cords generally. A clot arose from the anterior cusps of the tricuspid valve and extended into the pulmonary artery. Weight 10 oz.; measurement 3-J inches. Blood, generally fluid. Kidneys.—Masses of white substance were met with in both kidneys varying in size from that of a pins head to that of a pea, somewhat firm in consistence and of yelloAvish fibrinoid material; others exhibited a puruloid substance. Right weighed 6 oz.; measurement 5 inches. Left weighed 6 oz.;—measure- ment 5 inches. Spleen.—Along the anterior and exterior border of this organ there Avas a region of lighter color than Avhat seemed the normal portions, having an irregular, coast-like, defined and elevated border. There Avere tAvo such regions, one su- perior. Upon section the loAver region extended, cone-like, to the internal surface of Spleen, while the upper region extend- ed squarely three-fourths of an inch into the tissue. That part termed normal Avas mottled, ingested and firm. Weight 1 lb,; measurement 6 inches. 52. Liver.—This Avas of shiny, nearly homogenous section ami dark color, presenting no apparent disease. Internal surface slightly mottled. Gall AAras perfectly black. Weight 27 oz. ; measurement 8J inches. Sutra-renal Capsules.—BctAvecn the left and the kidney of same side, under the transverse fascia, quite a large abscess Avas observed. This capsule Avas much enlarged. Pancreas.—Somewhat enlarged and reddened. Weight 4 oz. ; measurement 8 inches. Intestines.—Lower part of the ileum was found congested, so also the large intestine. The mucous membrane Avas readily detached in the upper part of the ileum. There was a blackish gray discoloration in jejunum. This color Avas partly washed off and the water used became blackened. Some congestion was observed in the fundus of stomach. Weight 4 lbs. tz9-<^-8& [CASE No. 28.] Hospital Ncaieer, ) 162. I Jacob Newburger, Age 2G yeaTS. Private Co. F, 1st Md. Vols.; admitted from City Point, Feb. Mary 11th 1865 ; wounded at Hatcher's Run, Febuary 6th; died March 1st, LSCo. DIAGNOSIS. Gun-shot wound right side of thorax, just beneath spine of scapula. Ball remains in the wound. HISTORY.—(ANTE MORTEM.) NeAvburger admitted as described. Exploration of the AA-ound by probing only revealed an opening through the scapula, be- low which, examination was deemed injudicious on account of the proximity of the lung posteriorly. A few days after ad- mission tumefaction began near the spinal column, in the cellular tissue, covering it; this tumefaction increased until fluctuation became manifest. An incision of an inch in length Avas made at the point where the Avail Avas thinnest and discharged about twelve fluid ounces of pus. This discharge continued and was \ cry profuse for about five (5) days when hemorrhages super- 53. vened from tho posterior opening. These occurred daily at times, until patient gradually sank from exhaustion. Case reported by W. Gr. SMULL, A. A. Surg.,U. S. A. ------o------ POST MORTEM, Eight hours after death. Great rigidity of the muscles. Somewhat emaciated. Brain.—About two ounces of serum were found in the sac of, and under the visceral layer of, the arachnoid. The surface of the brain Avas somewhat reddened viewed with the pia mater on ; this, the pia mater, Avas readily detached. The brain sub- stance was found somewhat injected; puncta were found nu- merous and bleeding; the substance was of firm consistence, standing like Avax. About tAVO drachm3 of fluid Avere found in the left lateral ventricle and serum was observed in the 5th also in the 3d and 4th ventricles, a small quantity only in the latter, much having escaped from this in removal ofthe brain. Serous membrane of the 4th ventricle had a dull white appearance. Brain weighed 50 ounces ; measured 6| inches. Lungs.—Right lung apparently normal. In the lower back part at the bottom ofthe lower lobe ofthe left lung about 1-5 of the whole was solidified; easily broken up and yielding a grayish dark colored and reddish pulp, at the same time the exterior of this*portion had a lobulatcd feel. A portion of the lower anterior portion of the upper lobe equivalent to J of lobe was solidified in like manner, advanced hoAvever, so far, as to yield upon breaking up a lighter gray pulp. A cut portion of the solidified part sank in water. Seroid fluid was observed in the pleural sac. Right lung weighed 14 ounces; measured 10 inches. Left weighed 18" ounces ; measured 8 | inches. Heart.—About an ounce of fluid Avas found in the sac of the pericardium; a large Avhite clot was found in the right ventricle attached in the usual ay ay; Avith flaps, the opposed surfaces of Avhich were smooth; and the open face of their an"le avus directed upAvards and to the left. In the left ven- tricle one thromb clot Avas found arising from the anterior cusp and extending into the aorta ; a black clot Avas observed in the 54. left auricle and a mixed one in the right. Auricular septum imperforate. Heart generally of tinged red color ; the lining membrane of the vessels Avas red also. Heart Aveighed 12 oz.; measured 5 inches. Lia'er.—This organ Avas of light broAvnish red color; of firm consistence and yielded strongly the peculiar odor. Bile nearly black and fluid, about one fluid ounce in the bladder. Liver Aveighed 68 oz. ;■ measured 11 inches. Spleen.—Of someAvhat light color and finely mottled on section. Substance nearly normally firm. Weighed 8 oz.; measured 5 inches. Kidneys.—Left kidney small and of light color. Right much larger Avith someAvhat more blood but still of light color. Right kidney Aveighed 4 oz.; measured 4 inches. Left Aveigh- ed 5 oz. ; measured 4| inches. Intestines.—Some discoloration Avas observed in the caecum, The large intestines other'.\ise Averc normal. Ileum someAvhat ironed and red in spots. Mucous membrane thinned but the muscular tissue is not readily uncovered. The upper part of the jejunum and the duodenum discolored and yelloAv. Pancreas.—Normal, Weighed 2 oz. ; measured I inches. Tin; Wound. ^-The ball entered the scapula near the origin of the spinous process passed forAvards, imvards and to the left at an angle of 60°, struck betAveen the angles of the 5th and Gtli ribs- bearing more heavily upon the 5th ; was reflected upAvards, foi-Avards and to the left, breaking the spinous pro- cess of the 5th dorsal vertebra and lodging under the rhomboid muscle beneath the deep fascia on the left side, A large piece of blue cloth carried into the Avouud lodged on the right side of the spinous processes. A sac filled Avith black matter, in great part clotted blood, averaging in breadth from 2 inches in the crevical region to 3 inches in the scapular, and 4 inches in the dorsal and 14 inches in length (extending from the 5tlr cervical to the 1st lumbar vertebra) Avas observed.* On the left side confined by the deep fascia was an abscess extending from the last cervical vertebra to Gth dorsal, about one inch in hteadth. Thf Spinal Cord.—ILr.ing cut through the laminje the *----The matter that was thrown out of this sac was very offensive in smell q.nd of a granular, brownish red, olcl appearance. spinous processes Avere removed. The large veins near the lamina that Avas broken by the ball Avere found. The torn extremities of a vein Avere seen. The torn vessel Avas found Avhite, and old looking near thepoint of injury. A dark clot mixed Avith a Avhite clot interiorly Avas observed near the point of injury; the anterior face of this clot Avas firmly attached to the dura mater of the spinal cord. The pia mater here was congested arborescently in a similar manner to a portion observed beloAV the medulla, finely and rcticulatedly. The arachnoid was reddened and opacified. It Avas thought that the substance of the cord Avas someAvhat thickened and of an abnormally dark color. The substance Avas of firm consis- tence ; there Avas no inflammatory exudation matter. Specimen preserved. |CASE No. 20.] Hospital Number, ) 109. i Nathan M. Hildreth, Company B, 94th New York Volunteers, aged ?1 years. HISTORY.—(ANTE MORTEM.) Patient was admitted to the Hospital February 11th, 1*05, with left thigh amputated primarily at the middle third con- sequent upon gun-shot wound received at the battle of Hatcher's Run, February 7th, producing a compound fracture. Opera- tion performed on the field, Feb. 8th. When admitted the patient's general condition Avas very favorable, though the ap- pearance of the'stump was pale. Moistened oakum was applied with solution of Chlor. Zinc as a wash. About the 20th of February there Avas considerable irritation of the system mani- fested by small and frequent pulse, coated tongue, headache, impaired appetite i. ated line of separation. The Avhole lung seemed filled av an aqueous fluid exuded into the connective tissue so that parts unaffected by disorganizing lesion Avere heavier than natural and doughy. Substance of the left lung similar to that of the right, just described. The anterior inferior border ofthe Ioav- er lobe of this lung Avas mixed Avith an elastic firm Avhitish mass of fibrinous material. A collection of sanious pus was obser\'ed superiorly through the middle of sac containing which a A'essel passed to the inferior fibrinous mass referred to. The mass described as fibrinous upon minute inspection appeared composed of pulmonary substance having cells filled as in pneu- monia and having in the middle of it a small mass of what was apparently effused blood. Upon pressure a puruloid substance was effused from many points as if from sections of ultimate lobules. The more normal substance in addition to being gene- rally loaded with blood and having a doughy feel Avas specially loaded in the lower lobe and the posterior portion of the upper with blood. Another abscess Avas observed in the lower portion ofthe left lung, in which the matter had a bluish appearance, being at the same time viscid and puruloid. Left lung Aveighed 1 lb. 12| oz.; measured 9 inches. Note.—Hildreth appeared to be more than ordinarily in- telligent. Spoke gramatically and exhibited a sharp interested attention when any fact of importance was mentioned to him, although at the time exceedingly ill. Bralx.—Clear serum was seen in both lateral ventricles. In left side posterior horn extended back an inch farther than on the right Corpus callosum thin and soft. Brain was found in other respects apparently healthy. Double soft commissure in the third ventricle. Weighed 3 lbs. 9 oz.; measured 7-J inches. Heart.—This contained clot in the right side, attached to that portion of the right ventricle in Avhich there are musculi pectinati throAving all the blood from the right auricle directly over the smooth approach to the pulmonary valves. A clot was observed arising in the right auricle, connected with the auricular appendix. There Avas a small white clot in the left ventricle closely connected with the bicuspid valve, connecting with clot originating in left auricle; ear marked near aortic valves. Weighed 7-i oz.; measured 4J inches. * *58. Lever.—An abscess one inch in diameter, of irregular form Avas observed in the right of the right lobe of the liver. This was also deep seated. Anterior part ofthis organ, right lobe, Avas someAvhat enlarged and of more granular appearance than usual, breaking up and exhibiting the'acini Very readily. The liver was generally of a light color, mottled and finely congested on the surface. It Avas thought that signs of commencing dis- ease such as would lead to an abscess, similar to the one obser- ved in right lobe existed in the portions described as finely congested. Weighed 5-J lbs.; measured 11 inches. Spleen.—Of a light color ; flexible, exhibiting upon section a speckled condition, especially in tissue of the dorsum, the speckling being caused by what appeared upon close examina- tion to be numerous spots of blood, the results of extravasation, N. B.—The patient complained of pain upon percussion over the silaen. Organ Aveighed 12 oz.; measured 6 inches. Kidneys.—Of a light color, flexible and easily torn ; no ab-. normality observed. Right kidney Aveighed 7\ oz.; measured 5 inches. Left Aveighed 1\ oz.; measured h\ inches. Pancreas.-—Apparently normal. Weighed o\ oz.; measmv ed 8 inches. Intestines.—With the exception of a few blood spots and some thinning of the mucous membrane the intestines were natural, Weighed 4 lbs., 11 oz. The Wound,—In the extremity of the femoral artery, in the auii putated thigh, extending to the distal artereal branch, a clot Avas found, the lower part of which, was honeycombed, below Avhich there was a small patulous sac. Ip the femoral vein there Avas a clot extending from the junction of the pro- found vein to the extremity of the vessel; black and loose below, betAveen the attachment and extremity. Specimens of the lung, double commissure of the brain, and blood vesi-cls of the thigh Averc preserved. ■ 59. [CASE No. 30.] Hospital Number, ") 2.356. j George Shearer Private Co. I, 8th Ohio Volunteers; admitted (or burial. Was killed by cars on N. C. It R. near Mr, Washington, Md., on the 3d March, 1865. Residence :—Napoleon, Henry Co., Ohio. The body was sent to Major Weigle, Provost Marshal, who delivered it for burial at the National Hospital. POST MORTEM, March 4th, 1865.—Brain.—Blood was observed in sac of arachnoid, and beneath the same; many puncta were observed in brain substance; some blood was also found in the lateral and fourth ventricles. Brain weighed 3 lbs.; measured 7 inches. Linos.—The right was torn in the upper and back part of the loAver lobe; left was found uninjured. The Fracture.—Occipital bone was broken ; a quadrilateral fragment was separated about the Torcular Herophili, the lower portion or base of-which involved the Foramen-Magnum in great part. There was complete separation along the base of skull between its two halves, the fracture isolating the sella turcica, [CASE NO 31.] Hospital Number, ) 286, } J. T. St. John, Acting Asst. Surg., TJ. S. Army. HISTORY.—(ANTE MORTEM.) Indianapolis, Ind., March lGth, 1865. Doctor :— In obedience to your request I give you the folloAving his- tory of Dr. J. T. St. John during the time he was under my care. He came aboard the "John Rice" at Aikins Landing, March 1st, at 2 P. M. I immediately examined him and found his pulse about 120, feeble ; countenance pallid and anxious ; complete aphonia and great dyspnoea. The trachea and fauces Avere lined Avith a thick tough false membrane which inter- fered Avith both deglutition and respiration. I at once cauter- ized the threat well Avith Arg. Nit, fus., which disengaged GO. large quantities ofthe false membrane, enabling him to breath and swallow much easier. I gave him thirty gtt. Tinct. Ferri Chloridi every three hours together Avith Quin. Sulph., gr. 3 ; Potass chlor. gr. 4, and Pulv. Doveri gr. 5. I applied extern- ally Vol. Lin. and gave him freely of brandy and beef essence. This constituted the treatment up to the time I sent him to the Hospital at Baltimore. For the first 12 hours he seemed to improve and gave slight hope that he might recover ; after that time he greAV Avorse all the time I Avas with him. He lived longer than I expected.* Respectfully, Yours &c. W. P. PARR. P. S.—He had been sick five days before I saAv him. P. To Surgeon in charge of National, U. S. A. Gen. Hospital, Camden Street, Baltimore, Md. Age about 25 years; of ordinary muscular development; was brought by steamer from City Point, and admitted to this hos- pital March 3d, 1865. He was much exhausted and prostra- ted; countenance anxious and presenting a slightly venous hue. There was dyspnoea and partial aphonia; he had to be propped up in bed, and what he said could not be understood unless the ear was closely inclined to him. s Partial paralysis of the left arm Avas observed, and he complained of tenderness on pressure over the wrist. Examination of the throat revealed a grayish white exudation over the tonsils and soft palate. On account of the difficulty in breathing and speaking, a full and exact history of the case could not be obtained from the patient. He stated that he had been attacked about ten days before with sore throat; the Avhite exudation made its appearance. A strong solution of nitrate of silver was applied, and it removed the exudation; it returned, and the solution was again used, but not with the same good result. His voice was not materially affected till the day before admission. He had been taking the Tine. Ferri Clor. 20 drops every 3 or 4 hours with brandy and beef tea, There was a phthisical element in his family, and he had suffered occasionally with laryngeal trouble. At the suggestion of Assistant Surgeon,M'Gill, U. S. A., in charge of Hospital, 10 grs. of capsicum and a tea-spoonful of mustard were given as an emetic. That not acting, a scruple of the *---Letter written in response to request for particulars. 61. sulph. of zincwKS administered. Vomiting resulted, and some of the shreds of the false membrane w*ere got rid of, but Avith very little result to the patient. Dr. M'Gill recommended that a concentrated solution of capsicum be used as a local applica- tion to the throat. This was applied with a probang every 3d hour, and caps'cum used externally over the larynx. The iron brandy and beef' tea wei'e continued. During the afternoon and evening the Doctor had several copious serous alvine evac- uations, which he ascribed to the emetic; at night Avas anxious, nervous and restless; 30 drops of tr. opih administered per anum; the diarrhoea was checked, the nervous symptoms quieted, and sleep induced. During sleep respiration Avas noiseless. March 4th.—Condition about the same; the exudation was ■diffused, and a considerable quantity of it was expectorated, some shreds being of quite firm consistence, and presenting a cartilaginous appearance. The lungs were resonant on percussion, and the respiratory murmur heard over all parts of the chest. Deglutition could not be effected. Local constitutional treatment continued. At night was worse; more feeble, restless and nervous; making continued efforts to get rid of the obstruction in the air pas- sages, Avith only partial success; -|- gr. morphia was given, and the dose repeated. During the night he slept a little, but Avas somewhat delirious; this he ascribed to the morphia March 5th.—Said his throat was better, but the-e Avas some oppression about his lungs. The tonsils muila half arches and epiglottis still covered with the exudation. IPs voice Avas about the same as Avhcn admitted. On auscwlte/con marked difference was observed in the distinctness of the respiratory murmur on the right and left sides. Over the right lung it Avas much more feeble than over the left, A mixture of mustard and turpentine was applied over the chest and throat. By advice of Dr. M'Gill, a blister was put on each deltoid muscle. In place of the red pepper, liq. ferri per sulph. was applied with si probang every 3d hour to the throat. In the afternoon a portion ©f the exudation had been removed, and the rest ap- peared somewhat detached, but the general condition of the patient was more unfavorable. During the night he became SBtich worse; carb. ammonia Avas given. 3Iaich Gth.—Death evidently impending.. The face and (12. hands Averc of a venous hue; breathing loud and hoarse; puis© feeble; the intellect was not affected. The respiratory sound was perfectly distinct over the left lung, and but barely per- ceptible over the right. The presence of a greater quantity of exudation matter in the right than the left bronchial tubes was sH'T'/ost-Ml as an explanation ofthis difference in the respiratory- sounds.* 12 M.—Patient dying; respiration continued after the heart's action had apparently ceased. Reported by G. H DARE, A. A. Surgeon, Y. S. A. -------o----— POST MORTEM. March 6th, 3|P. M.—Body still warm, but slight emacia-. tion. Lungs.—-The left lung presented a peculiar mottled appear-: ancc, the mottlings varying from the light color of pulmonary tissue to a dark cherry red, and blood red. When section was made in the cherry red tissue, the cut surface presented a fleshy appearance, (upon minute inspection exhibiting, as Avas thought, fine points of ultimate lobules, with difficulty seen;) and upon pressure there Avas exuded from the same cut surface a great quantity of bloody, aqueous liquor, apparently allied to exudation serum. A portion of the tissue presenting these appearances, sank readily in water. When adjacent, more healthy pulmonary tissue, was pressed, so much air made its appearance in the consolidated lung substance, as to define the pulmonary lobules. In this lung, formed between the lobes in an unusual lobe division in the upper part of the inferior lobe, an apoplectic clot about ^- cubic inch in amount was ob^ served near a vessel in Avhich no orifice Avas seen. Several spots besides Averc found, not only in the inferior lobe, but also in the superior, of (Lis side,, presenting in one case blood, in the other cases ecchymoses. In bronchial tubes of left lung, lying collapsed, easily torn and longitudinally lined, a shred-liko fibrinous substance Avas observed connecting in continuity Avith the main tube described beloAv as existing in the trachea.—- sBao^This suggestion was niade. hy Dr. Dare. 63. This substauce in the bronchial tubes of the Inn" formed a O tree of corresponding hollow involucrcd tubes. In right lung similar appearances Avere presented, except that Avhat Avere re- garded as apoplectic spots, Avere absent. The lowest lobe of the right was more intensely affected by collapse as evidenced in the appearance noted as chevry-colored substance, than any other lobe of the lungs. In this lung the bronchial tubes to those of 3d magnitude, and even farther, Averc occupied by hollow, fibrinous tubes, and the vacant tubes of lesser magni- tude presented an abnormally white appearance. These fibrin- ous tubes were best developed in the tubing, supplying tho lower and middle lobes. Right lung Aveighed 32J oz,; meas- ured '8^ inches. Left lung Aveighed 2H oz.; measured oz. ; measured 1} inches. Left kidney Aveighed 6^- oz.; measured 4h inches. Lntestinks—Glands in the caecum, Avell developed; the caecum itself slightly congested; Peyer's patches slightly reddened (scarlet ;) ileum of light gray color ; geuerally, tho summits of the solitary glands and edges of mucous folds wcro reddened ; slight dark discoloration in the, loAver part ot the j'jumun; the jejunum in middle and upper part scarlet or pink ; especially in region of strongly developed valvula con- niA-entes. The duodenum in the upper part Avas dark colored. The stomach Avas ash colored internally, and presented cherry colored spots, and A\hat seemed to be more clearly congestions or ecchymcsis, under the mucous membrane. BlOod Avas met Avith clotted in the large vessels ; this clotting was not so great as to prevent a free Aoav of blood from the large veins when these Avere cut. Panoreas—Normal, except in a slight congestion near its head. Weighed 2^- oz.; measured 7 inches. The urine was examined and found to contain albumen. Specimens of larynx trachea and bronchial tubes preserved. Autopsy by GEORGE M. M'GILL, Asst. Surgeon U. S. A., Surgeon in Charge. [CASE NTo. 32.] Hospital Number, ) 266. j William Doty, ago 27 years, Private Co. D, 91st New York Vols.; admitted to this Hospital, March 2d, 1865. HISTORY.—(ANTE MORTEM.) A friend of the patient's states that he (the patient,) was a man of temperate habits and social disposition. On entrance into Hospital, patient presented no signs of disease Avhatever. According to his statement, he had been afflicted for seven years with epilepsy, and had a fit on the day previous to his admission. March 4th.—Had feA*er; severe pain in fheleft side, and faint friction sound over lower lobe of left lung anteriorly. A blister Avas applied and a large dose of Dover's poAvder given. March 5th.—Complained very little, and seemed to be getting aton"1 Avell through the day but at night Avas delirious. March 6th.—Extremely restless, tossing about in bed. Dur- ing the absence of the nurse Avould get up and Avander about the room; pulse feeble and rapid ; eyes fixed ; and pupils nat- GO. ural but insensible to light. Blisters were applied to the nape of the neck, and opium given internally. The opium produced no change of the pupil of the eye. The head Avas thrown back and rigidly held by the posterior muscles ofthe neck. March 7th.—No change in symptoms; head still retained tOAvards the back. March 8th.—Died early in the morning. Case reported by J. G. KELLER, A. A. Surg., U. S. A, -----o----- POST MORTEM, Seven hours after death. Brain.—Congestion externally of capillaries and veins of pia mater ; little or no fluid found in sac of arachnoid. The arachnoid, clear and smooth on the visceral surface, contained beneath, it, especially along tracts of the larger pia mater atcs- sels, Avhite and fibrin-like substance. Lateral ventricles being opened in each of the anterior cornua, about three drachms of fluid Avere observed. In the left there Avas rather more ; and at the bottom or fundus of each ante- rior cornua, about half a drachm or less of bluish puruloid sub-; stance was found. In posterior cornua (middle and posterior,) about tAVO drachms of fluid mixed with about one drachm of similar puruloid substance (adherent, in part, quite closely to the Avails of cornua, and making in all nearly three drachms of scro-puruloid fluid,) were found in each. A grayish appear- ance Avith somewhat dark general color, Avas presented in cho- roid plexuses, Upon the Avails of the lateral ventricles, amid fine congestion and aborescence, especially posteriorly, and on the walls inferiorly, connected, with the finely congested vessels, there were numerous small spots of ecehymosis. These were more numerous on the left than right side. The membrane lining the bottom of lateral ventricles was readily broken up in both the anterior and posterior cornua, and had lost its usual shining appearance in great measure. In superior portion of left lobe of cerebellum, one inch with- in posterior semi-circular border, there avhs a small clot from ydnch blood vessels radiated irregularly. On right side i<4 [similar position, there was a second clot. On right hand side of posterior cleft (valley) of cerebellum, a thin small clot was observed. The floor of the fourth ventricle Avas covered with a bluish, tenacious, viscid, slightly tart puruloid substance.— \\'hen scraped with a knife, the membrane covering it remained dim. Fine irregular aboresccnt congestions were observed on t?te floor. These were arborescences of the fine vessel branche-. The substance of the floor of ventricle appeared reddened. In the central axis of medulla oblongata in cross section, a red spot appeared. The inferior portion of the pons, between arachnoid and pia mater, and the perforated spaces and their vicinity, Avere covered, along the courses of vessels especially, with bluish fibrinoid substance. Substance of cerebellum was congested as Avas the cerebral substance. Blood was found fluid throughout.the body. Brain weighed 3 lbs. 4 oz.; measured 7 inches. Lungs.—The posterior surface of the right lung, superiorly and inferiorly, Avas somewhat uneA'en by undue prominence of certain lobules, and Avhen the same surface was cleaned, it. had a spotted appearance, due to the presence of gechymofis be- neath the pleura. Section in its middle revealed the extreme lobules bright red, and apparently well filled with air; more internally, dark substance. A portion of the superior lobe in anterior poition of right lung, sank in water. Left Lung.—Pleuiitic adhesions were observed; interlobar and saccular. Some sub-pleural ecchymosis observed over surface; and in one part of substance of left lung, there ap- peared to be intense congestion, even to ecchymosis. Bronchial tubes reddened internally. Right lung weighed 1 lb. 7 oz.; measured 9 inches. Left lung Aveighed 1 lb. 3 oz.; measured SJ inches. Liver—:Was full of blood, and very dark red inferiorly.—- Gall bladder large and full, contained black bile. Liver weighed 5 lbs. 2 oz.; measured 12 inches. Sl'LEex—Large; pf light color; very flexible, and easily broken up. Weighed 12 oz.; measured 5 inches. Pancrioas.—Apparently somewhat .congested. Weighed 31 oz.; measured 8} inches. Kidnkys.—Congested arboresccntly upon posterior surface. The renal pyramids Avere congested so as to present, upon sec* tion, a kind of speekled appearance, indicating, probably, ve- nous stasis; capsule not readily detached. Right weighed 7^ oz.: measured 5} inches. Left weighed S 02.; measured -> inches. llr.ART—Very small: black clot in right auricle ; large white riot in right ventricle, adhering to {interior Avail; small clot in left aurieular appendix of blacl; color, though somewhat mixed : a few black clots in the left ventricle ; substance of heart generally reddened. Weighed 12.1 ounces with clots; and with vessels attached, e'.c, measured V>\ inches. Intestines.—Large intestines, slightly reddened; regions of intense congestion in jejunum, duodenum and stomach. S:mx.\i. Cord.—Thirty three hours after death. Pura mater and sac of tho arachnoid Avere accidentally opened nearly opposite first lumbar vertebra. A scroid fluid mixed with flakes of lymph, to the amount of nearly one drachm Avas seen to pour forth Avhcn the theea Avas opened. Quite closely adherent to the surface of sac of arach- noid, and accordingly enveloping the spinal marroAV, Avere bluish flakes of fibrin, especially posteriorly. No marked congestion in pia mater Avas observed. About the middle of dorsal region, a cross section revealed such softening of the proper substance of the cord, as if the substance itself had .become puriform; and although the substance of the cord was freely opened, no spot of suuilar softening, (or consistence) Avas found. The anterior vein of pia mater and blood vessels in the bottom of anterior cleft of cord, were full of blood; especially in the hitter position. Some spots of ecchymosis or exudation wen; observed a short distance aboATethe softened spot referred to. Albumen in large quantity Avas found in the urine. [CASE No. 33.] Hospital Number, ) 308. j John Maquilla, Priv. Co. C, 11th Md. Vols. 1IISTOR V. —(AN T E MORTEM.) Age supposed to be forty years. Was found in a bawdy house and reported by inmates to baye died from an attack of mania a potu. L' < ■ ■ ,/V r/ ,/4 44 y / .// / ■ y y 44 < r , 4< r ,> s u '4, ■, {',/d4'4(' 4„ A 4 ^ ■'/■/. 44--'Jm /<■>■?; fa.' 4? 'sn // /t // ' y'y,/r// „ /, ^ A"«/< /1'4 //' \/ ; // • 4 /- V />< *", 'A ^ff/4ArO '. t 4 Ui 11no ,/ 'r v < /. 4a//ifn, , // 4i//a/>' tf f's//,'' // " 1 A- y- t/ji../y-< / /, /6u! ' A */4fr A/.,, /// / , v /.,' /- A/*/■?, 4 /A // '■) # f/-4s. -V ''?4v. (44 f 4 ' / ;, //, A<>0,'/'/ y 4 V /