Dnl' ional ?.x*d ,d, U, ^al, Ante ^.or terns and ost Lorten;--. ■'Yi'J ltf '' >. ' ' ./■ if '&L :■ l' v,< J-r *": o \ n fli OBSERVATION BOOK. Ante Mortems and Post Mortems. ANTE MORTEMS BY MEDICAL OFFICERS OF WARDS; POST MORTEMS BY THE SURGEON IN CHARGE. r 91 i NATIONAL AND HICKS' / Z/A ||£«it*& Js^a^ H^raij ^a^iwof ^o$fttftI$7 BALTIMORE, MARYLAND. BALTIMORE, Ml): PKIA'TKD BY i. S. CLARKE 4 BY 1VM. BECK, NATIONAL * HICKS GBN'L UOSriTALS. ^ <\ U58 times, large quantities of pus escaping each time. The opera- v*- tion of resection was postponed until the patient's condition was sufficiently improved to permit it which was performed Dec • 30th, 1864, removing about four inches of the femur. On the *%,, I5.h of January, 1865, symptoms of pyaemia set in, which in- creased until the patient died on the following day. Case reported by W. G. SMULL, A. A. Surgeon U. S. A. POST MORTEM, Xumber of hours after death unknown. Patient emaciated. Having made the usual incisions, dis- sected back the pectoral muscles and removed the sternum with the cartilaginous portions of the ribs, some pleuritic effu- sion in the left sac was_observed. fc*+-*u £• 4. Buain.—Slight opacity of the arachnoid, inner surface of: veins of pia mater covering the cerebrft^were filled with blood: smali quantity of reddish serum in lateral ventricles; choroid plexuses rather pale; commissures third ventricle in a normal state. Near the nib of calamus scriptorius a V-shaped"con- gestion was detected somewhat rough to the feel; congestion of the pons similar to or slightly in excess of that observed in supstance of cerebr** Linos.—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 clot in left, ventricle near the valve. Liver.—One fourth larger than natural; heavier, rather light colored, of finely granulated appearance and quite solid consistence. Spleen.—Three shades too dark, presenting a dark purple appearance; twice the natural size, presenting at middle pos- terior border two fibrinous (exudation) masses about the size of a chestnut, the superior the larger; the lower presented bomo pus. Kidneys.—Of natural .-ize and light color. Stomach—Abnormally large. Intestines. — Several mesenteric glands enlarged; the into- tinal canal natural. Right Thigh, sltki:. third.— I'pon dissecting the tissues they were found to be flabby, otherwi>e natural, end of femur denuded of periosteum for one inch, and periosteum peeled off roa 'a.7 some distance upwards. Femoral Vein.—Examined and found occupied at extremity by white elastic thromb two inches long. Examination ob- scure; no acute inflammation observed. Femoral Artery.- A clot five lines long was found from t'.ie occlusion to its distal branch; in other respects healthy. Specimen preserved. 5. [CASE No. 2.] f ^,.w. » V V Hospital Number, | a > >V . 30. } \r C. B. Kittle, aged 32 years; Private, 10th Wisconsin Batterr. Was admitted to this Hospital from the Medical Director's Office Januarv 10th, 1865. HISTORY.—(ANTE MORTEM.) Diarrhoea.—Extremely irritable stomach, and pain in the right iliac fossa. Was treated with turpentine and supportives with temporary relief. About the third day after admission he had low fever, with muttering delirium at night; some fine crepitation, not very distinct, was observed over the right lung anteriorly, lower lobe; had slight cough; diarrhoea increased and death ensued on the 17th of January. Case reported by J. G. KELLER, A. A. Surgeon, U. S. A. o- POST MORTEM, Patient emaciated. Right side of chest one fourth greater in size anteriorly than left. In right iliac region, posterior part of caecum, to right of mesenteric band, connecting ascend- ing colon with the abdominal wait, adhesions were observed. Upon traction these gave way and revealed a perforation, es- cape from which had been prevented by them. A small open- ing was found in the iliac fascia, communicating with division of the iliac and psosas museles, in which there was a small col- lection of dark colored, offensive, caseous, puruloid material estimated at two fluid ounces.. The extension of this collection was upwards, over crest of the ilium upon the lumbar fascia. towards the origin of psoas muscle. The abscess terminated; interiorly in a cul-de-sac in advance of the iliac muscle undec iliac fascia opposite, anterior inferior spinous process.. 6. Lungs.—Lowest lobe right luug hepatized red; posterior third of uppermost lobe same; central portion lower lobe left side same. When this hepatized part of lung substance was broken and pressed, a grayish puruloid fluid was expressed abundantly. Liver.—One-fourth larger than natural and ingested with blood; anterior inferior portion of right lobe presented a region of black congestion. Kidneys.—Of pale color, and presented irregular cherry col- ored congestion inferiorly. Inflammatory spots connected with ulceration and associated with softenings were observed in the large intestines and lower portion of ileum, with great thinning and wasting of the mucous membrane. Spleen.—Solid, of natural size, with black congestion on anterior and inferior border. Substance of normal consistence ; a little hard. Brain.—Normal. Specimens of caecum and ascending colon preserved. [CASE NO. 3.] Hospital Ncmulk, ] 37. { James York, aged 30 years; Private, Co.----, 13th Indiana Infantry S*- Wus admitted from Provost .Marshal's, Jan. 14th, 1865. HISTORY.—(ANTE MORTEM.) Patient walked into Hospital, gave his name and regiment, and told how his name was spelt. He presented a somewhat stupid 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, rolling and tossipg =&bout in bed and attenipting to get up, requiring two men tfo restrain him. His eyes wore somewhat injected ; pupils rather dilated, but responded to the action of light. Pulse frequent and full, but soft. He could not be made to utter an articulated word. He appeared to suffer pain in the abdomen, and shrank from pressure especially over the right iliac fossa. The lungs could not be satisfactorily examined on account of his extreme restlessness, but no marked abnormal sounds were heard. Counter irritation was made at the Isack of the neck, and a tere- "binthinate injection administered, which was not returned until several hours afterwards. During the night his condition re- mained about the same; occasionally he was quiet for a few moments, but most of the time rolling about from side to side and making violent efforts to get up. A sheet was tied across his body to the sides of the bed. Next morning (Sunday) he was more quiet, and there seemed to be rather more intelligence in the expression of his eyes. Sometimes he appeared to par- tially comprehend a question-and answered it bv a nod. His tongue and throat were covered with sordes; his pulse was rather softer and weaker; the pupils natural or a little con- tracted. Some ecchymosis was observed over his arms, chest and abdomen, which was ascribed to friction against the sheet tied across him. About three pints of Urine, natural in ap- pearance, were drawn off He swallowed, with great difficulty, a little beef essence. Beef essence and quinine were ordered per anum; turpentine emulsion, milk pum-h and beef essence internally. Deglutition was very difficult, but he occasionally swallowed small quantities of fluids. Late in the afternoon he became worse, more heavy and comatose, with some stertor in breathing. The power of deglutition was entirely lost. He was quiet during the night with occasional restlessness. Hi" bowels and bladder were several times involuntarily evacuated. When seen the following (Monday) morning 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 spots were ob- served 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 forty-eight hours, been rubbing hi? body against the sheet with which he was fastened iu bed During the day paralysis of the right side was observed. Th<. man frequently moved the left arm or leg, but never the right. ^orae contraction of the flexor muscles on the right side had- been previously noticed. He sank slowby and died at 8 o'clock,. A. M., January 18th,. 1*05 ('.tee reported by G. II. DARE, A .A. Surg., U. S. A POST MORTEM. Twelve hours after death. Bii.vin.—Veins of pia mater very full of blood; also, fine in- jection of same membrane observed. Dura mater was remark- ably adherent to the summits of cerebrum and was somewhat. congcsti'd. White substance of cerebra three times as full of blood, by estimation, as natural, and of pinkish color on cut surface. Pia mater firmly adherent to cerebral surface. Its eoveriug of arachnoid had lost its transparency. Fluid found in lateral ventricles. Veins of choroid plexus distended. Fluid resembling pus was observed about the greater hippocam-pus, of the right side. The lining membrane of posterior horn of right lateral ventricle much congested and veins enlarged. YVns of velum interpositum exhibited small fibrinous granules.. Third vm' :-i ;le contained serum. Fourth ventricle was covered with what was considered plastic exudation, and exhibited small quantiti. s of puruloid fluid, the former so marked as entirelv to o'iM-ure tho usually shining surface.* Pineabbody present- ed a gelatinous appearance and was of three times the natural size. It was preserved. Lrxos.—Lower lobe, left side, congested intensely, and so< filled with products of inflammatory reaction that a portion one- inl-a-half inches square readily sank in water.. Supposed at Urst to be in the first, stage of pneumonitis; this character not established.. Lobulated solidification was observed in lower lobe of right *----The serous lining 0f the ventricles generally was opacified.___ Utmark made two days after Post Murttiu... 9. pide.__TIeaivt, 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. longs, 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.] (,**■** /'< X- Hospital Number | \, 2,739. j John Keul, age 26, Priv. Co, K. 199th Pa. Vo^.; was admitted to this Hospital Dec. 2nd, ltnJi, and died JaD. 23-rd, 180.3. HISTORY.—(ANTE MORTEM.) »U/- Patientcame into Hospital with typhoid symptomB.-drv ton-rue and partial coma. Wad placed under the ordinary treatm-nt of Emulsion Tercbmth, beef essence and typhoid diet. Chnmio diarrhoea supervened, and continued from time to time, until death. His mental faculties were never clear from the lime of his admission. Case repo/tcd by W- <■!. SMULL. A. A. Sure..!", S. A. POST MORTLM. Jan. 23rd 1865, at 3 o'clock, P. M. Nine hours after daub. Slight rigor mortis, €onsi decide emaciation. j'luid in sac of pc rieardium, estimated at two «z. Adhesion upper lobe, left lung, about two thirds. Some flight ~ f iLainaik xaude iroxa memory six wseks after tutoi^y. 10. adhesions (band) to diaphragm. Blood clotted in the great veins. U.\os.—Dark color, hypostatically congested. The outer por- tion of lowest lobe, right lung, was so congested as to be of v. early the specific gravity of water; doughy to feel, yielding, when press- ed, bloody serum. Po.-t'r surface, left lung in which the bands) were observed, was "cuirassed"1 ■■'- He.vi.it.—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 aut. 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 clot ears were observed. Liveii.—Rather small, vessels on surface marked with lines. Organ of solid consistence (hard) with a somewhat wavering bor- der. Color an ash red. Call.—Bladder contained light colored bile. Over surface of liver there was fine arborescent congestion. Great vessels of organ well marked aiul strong, and its substance had a deeidvd order. Spleen, nearly normal size, a little larger, very dark color; full of blood; tough and presenting no variation in structure. B;L.\.i:v.-—On opening meninges about an ounce of serum es- caped. Yellowish serum present, a drachm, (minimum esti- mated) in eaeh of the lateral ventricles. Substance of cerebellum liad a v, .»:;ery look. The whole brain was flaccid. Demonstration of organs was easy and perfect. There was a small quantity of held in the fourth (-kh) ventricle. Communication between the ventricles was unusually large. Intestlves.—-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 baud col- lection of ulcers ; long diameter of individual ulcers transverse ; * Meaning, made red tough, fibrous, leatlv. ry, somewhat elastic—not easlv broken by pressure. 11. caecum and ascending colon slightly congested in large spoc:i and mucous membrane wasted. Iliac congestion near csecal 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, inferiorly and externally, this superficially about one eighth inch deep; general conges- tion of substance of kidney; distinguishing line between the cortical ami medullary part indistinctly marked. Right kidney presented same appearance, except that the general congestion was of a deeper hue. Urine slightly albuminous. [CASE No. 5.] Hospital Number, > «#*" 2,HS4. ] John Burke, Private, Co. I, 1st. New York Lincoln Cavalry ; aged 23 years. Admitted to this Hospital December 26th., 1861. HISTORY.—(ANTE MORTAL) , Patient was unmarried; by occupation, a laborer. Was sub- *i'/ 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 1804.—Suffers much from cough. Dyspntea. Pulse weak, but regular; bowels regular. Aopefcite poor. Aphonia, much debilitated. TuioATMSNT.—Gave expectorants. Opiates at night; brandy. December 30th. The lungs were examined to-day. Inspection.—Sternum prominent; the sides of thorax f.atten- rd ; right side somewhat more than left. Ribs prominent, ' PimoussiON.—" Cracked Pot,'' sound on upper part of right lung. Dullness below. Upper part of left lung somewhat tympanitic; normal below. 12. Auscultation.—Tinnitus metallicus on right side, upper part, Gargouillement rattling sounds in upper part of left lung, lower part normal. Diagnosis.—PhtJiisis Pdnwnalls: both lungs affected, par- ticularly the right, a cavern on upper part of right side, prob- ably one also on left side. Treatment continued. January 5th, 1865.—No change. " 10, " Somewhat better to-day. Treatment continued, with addition of Cod liver oil. January 15th, 1865.—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. Case 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, havin^ its walls of a bluish gray color, lightly colored with purnhdd fluid. No odor. In middle and lower lobes of right lung a large number of vomicae, varying in size from one capable of containing a pea, to one of the size of a hickory nut were observed, aud were so 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 lun«-; no* 1 " Lo. 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, (3J 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 band with left auricular appendix, arose from the surface of ante.^or 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 car 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. KiDxr.vs rather large, of firm consistence and well developed cortical substance ; pelvis somewhat dilated. Each weighed 71 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) Ihe 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 58|- ounces. Brain.—Nothing unusual observed, except distention of veins in lateral ventricle. [CASE No. 6.] Hospital Number, ) 67. ] Jacob Gillman, Private, 18th Wisconsin Volunteers. Admitted for burial January 31st, 1805. Case one of death by R. It. accident, Particulais unknown. POST MORTEM. 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 marjnum half wray to Torcular Herophili, thence 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. Brain.—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 cerebra, near attachment of Pacchionian bodies. Blood was. seen to issue pn right cerebrum, 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. Heart.—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 wras black and friable and detached por- tions sank in water. When broken up a frothy, blackish fluid was expressed. Right lung, postr. portiou, lowest lobe con- gested in a similar manner (as in left side.) less intensely and extensively. Left lung weighed 21) ounces. Right lung weighed 26| ounces. * Intestines.—Colic glands, somewhat congested. Solitary glands somewhat enlarged ; otherwise intestines normal. In stomach (fundus of,) a reticular congestion observed apparent- ly sub-mucous. NOTE__No accurate history of this man's injuries could be ascer- tained, he was, however, living at the time of reception ofthe order of adm'ssion, by the statement of the Officer giving order. So it was evident that he mu^t 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 denned clots having been formed after rupture of veins of pia mater in consequence of confre coup affdcting the conglomerate of meninges resuUing from the action 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. 3 Pancreas.—Normal. Weight, 2£ |^ss&> msdbounces. Hospital Number, ") [CASENo. 7.] (o-^oy* ^> 2,797. John Jordan, aged 30 ; Private, Co. IT, 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, 1865. 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; 38i 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. Liver.—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 only on pressure. When liver was removed it was found that the left lobe and an homogeneous portion of right was of a pale ash red. Gall 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 near the walls; an eighth (J) of an inch beyond the outer line of ab.- cess wall the substance of the liver was dark red, and ap- peared to present signs of great ty increased organic action, and scarcely 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 trabecuke ; some capsular thickening, (general,) and generally of a dark watery red color. Length, 6 inches; weight, V\ ounces. Kidneys.—Somewhat light colored. Length, 5-|- inches ; weight, 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 ulceratiou ■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 spots of thesefiocculi in Peyer's patches, above these flocculi no disease found. Heart.—Pale and flabby. Hospital Number, ) 58. J [CASE No. 8.] Thomas O. Herring, age 44, Private, Co. E, 91st New York Volun- teers. Admitted January 30th, 1865. Died February 2d, 1865. HISTORY.—(ANTE MORTEM.) 7/ U Patient was brought into the Hospital in the evening, after a debauch, suffering from nausea, with some febrile action, for which two doses of Prot. Chlo. Hyd. were prescribed. On the following morning nausea continued with occasional vomiting; medicine acted freely. Slightly restless during the day. Pulse 100,—evening round. Administered 10 gr. Dov. Powder to allay nervous irritability. Following day slightly delirious, administered Valerian and Laudanum. J let light but nutri- tious. Patient complained of no pain from the time of his admission to time of death. ■ On the day proceeding 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 W. G. SMULL, A. A. Surgeon, V, S. A, 19. POST MORTEM, Eight hours 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 pleural; sac 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 when 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 5| ounces. Left kidney, length 4f inches. Weight 6 J ounces. Liver.—Organ enlarged, solid, friable, full of blood; pun- gent hepatic smell. Gall bladder filled with black bile. Liver, length 10 inches. Weight 4 pounds 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. Weight 3J 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 connoting with a free band from the11 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 jfs 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 bifurcating with the same. It was thought that the left ventricle was slightly hypertrophied. Intestines.—IMucous membrane of the ileum slightly thinned. Peyers patches healthy. Brain.—Pacchionnian 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. diarn., 7J inches. Weight, 47 ounces. Hospital Number, ") "tQ-drrArAt^ [CASE No. 9.] John Garden, age 28, Priv. Co. D, 15th New York Volunteers ; admitted Oct. 26th, 1864, from the field. Died February 4th, 18G5. HISTORY.—(ANTE MORTEM.) Admitted with amputation of mid. 3d of left thigh ; operation performed on the field Oct. 19th, 1864. 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. V., 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. Cr. SMTJLL, A. A. Surg.,U. S. A. • ii"- • '' S~> -----o----- .^ P %y , i^ POST MORTEM, - ," Twenty-two hours after death. > ^ ' i 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 12J 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 line 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. Rigiit Kidney.—Similar ; a little fuller of blood. Right kidney was 5 inches long and weighed 6h ounces. Left kidney was 4|- inches long and weighed 4J ounces. Heart.—Small but normal. Weighed 6^ 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 light; about half-way up the ileum a black spot was met with in which the gut was readily torn. Jejunum healthy. Weight of intestines, 3h pounds. 22. Stomach.—Somewhat contracted, and reddened at fundus. Pancreas, weight 1J ounces. Spleen weighed 8J 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 bficame 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^clubbed at extremity. The bone terminated in a rounded bare face (in opposition) ensocketed with fragments of new bone, apparently products of periosteum shreds. [?yJN OTE.—The disease apparent in the liver is thought to be species 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 of the catalytic plasm former—the liver. An effort at life was manifested in the con- dition ofthe osseous tissue ofthe stump.} [CASE No. 10,] j 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 53J ounces. Lungs.—Left apparently healthy with thv exception of ^ 23. lobulated 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 quite 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 8J 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. Gall 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 6J inches. Kidneys. ^-Right well marked, left same. Outlines of tu- bular portions well marked. Right weighed 5 oz.; measured 4J 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. Pancreas weighed 3 1-2 oz., measured 6 inches. Normal. -----^ • — ----- [CASE No. 11.] Hospital Number, 94. Admitted tor burial, (name unknown,) Feb. 4, 1865 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 8|- 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-J 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 cz.; 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. 1-2.] Hospital Number, 1 Chancey James, Co. D, 6th New Tork Heayy 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 lining 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. Oall.—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 differ- ence in color between cortical and tubular portions. Marked black congestion inferiorly about a line.in thickness. Left kidney similar to right. Pancreas.—Normal. Weighed 2 1-2 oz., measured 7 -} 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 ofthe ileum, congestion again met with in the form of a email collection of blood spots, apparently effusions, underneath 26. the mucous membrane. Above the first region of congestion 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 ao-ain, strikingly marked, with dark red spots of blood effusion in the valvulas 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 mucotis 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.] i Hospital Number, V % ,s 74. \ > v James Simonds, age 39, Priv. Co. A, 3d New Hampshire Vols.; ? *., admitted February 2d, 1865, and died February 7th, 18(55. / \V v HISTORY.—(ANTE MORTEM.) \ \ N) x N >" Patient was admitted with marked evidence of the first stage (j:. of pneumonia in left lung, extending nearly over its entire y *>J surface. The respriatory murmur was finely crepitant. Crepitation became more crude on the evening of February ' a\ 6th. Symptoms of Laryngeal inflamation set in succeeded by ■ V • those of oedema of glottis, which continued until Laryngoto- -A. • V mey was deemed essential which was accordingly performed ^J by the Surgeon in Charge. The patient died about twelve * y hours afterward. Case reported by W. G. SMULL, A. A. Surg.,U. S. A, 27. [Note by George M. McGlll.] 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. Tbe 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 glottis 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 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 unirritatcd pulmonary tissue. The left lung, both upper and 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 inferiorly. 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 of the 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; some congestion ox 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. j 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, IL 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 inches. Left weighed 35 oz., measured 15inches. Heart.—Auriculo-ventricular clot in right Bide, 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 4jr 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 valvuke conniventes amidst another congested region a structure resembling a patch of Peyer, enlarged as similar patches of the ileum were, a foot in length, was 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 Brynor. age 19, Priv. Co: E, 88th Penna. Vols.; admitted! from City Pomt, 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, 18G5. Case reported by W. G-. SMULL, A. A. Surg., IL S. A, ,------o------ POST MORTEM, Twelve hours after death. On making the incision opening thorax and abdomen, blad- der was punctured in fhe pre-peritoneal space and a large quantity of urine flowod 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 eubcrepitant 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 transmits, 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 apt^y to what has frequently been observed to exist, in isolated lobules or lines of lobu- les ia 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. Lobule3 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 6|- inches. Judnfts .—Norm al, 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 musculi pecti- 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 ofthe auri- culo-ventricular 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 ofthe 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 84; inches. Intestines.—Normal throughout. * The blood that came from the auricle was reflected in the ventricle from this remarkable angle, being thrown upon the left sunerior angle of that cavity. 33. Stomach.—Internally ingested along the longitudinal mu- cous folds. Intestines weighed 4 lbs. 3 oz. Spleen weighed lo| oz.; measured 5 inches. ------- <>>i ------ [CASE No. 1C] Hospital Number, ) -"* 175. j John TV. Tucker, Priv. Co. A, 4th U. S. C. T. Admitted for burial Feb. 13th 18G5. POST MORTEM, Number of hours after death unknown. Such disease of the pleura as united opposed surfaces; lung substance friable pn^eviorly 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. 3oz.; measured 7 inches. Left Lung weighed 1 lb. 2 oz.; measured 74; 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 applcv, were met with free. No clots in heart. Miliary tubercles in the spleen and liver ; weight of spleenFjlS i 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, |- 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. 1 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. legs, and face, swollen : large abscess on neck, left side. 34. [CASE NO 17.] Hospital Number, } A Rebel. Kama 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. 8J oz.; measured 10 J inches. Left weighed 1 lb 12J 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 14| oz.; measured 4 inches. Brain.—Serum found in the lateral ventricles. The pos- terior horns extended unusually far back. Brain weighed 49 oz.; measured 7 J inches. Liver.—Of firm consistence presenting black bile in the bladder. Liver weighed 3 lbs. 10J oz,; measured 9| inches. Spleen.—Natural size and firm. Weighed 7 1-2 oz.; meas^ urcd 6 inches. Kidneys.—Markedly lobulated. Right weighed 71-2 oz.; measured 5 inches. Left 8 J-2 oz.; measured 5 f 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 intestines- 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 of the 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 were 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 was 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 9J inches. 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 4 inches. Spleen.—Normal. Weighed 7oz.; 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 Prlando Jone3, Priy. Co. C, 81st Peuna. Vols; Died Feb. 17th J8Q5, 3G. HISTORY.—(ANTE MORTEM.) The patient was 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 few days. There was "slight tenderness in pressure in right iliac fossa, attended with retention of urine, about 24 oz. of urine drawn off by ca- theterization. Evacuation by the bowels free. On the following morning the patient was more conscious; respiration similar to that mentioned above, with involuntary expectoration of frothy mucus. There was slight dullness inferiorly 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 ofthe patients death, and some 20 oz. of urine were drawn 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, somewhat full of blood, partial reddening of the floor of the fourth ventricle was 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 £ calibre. Melanic matter existed in such abun- 37. 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 9 J inches. Left 1 lb. 5 oz.; measurement 9-^- inches: small clots observed in the heart, these evidently, mainly.post uiortem. Weight of heart 9-1 oz,; measurement 5 inches. Brain.—The Pacchioneanbodies, 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 with fibrinous lines along the tracts ofthe vessels. Weight 3 lbs 13 oz.; measured 11 J; inches. Intestines.—-Canal somewhat reddened in jejunum and ileum. Spleen.—Apparently normal. Weight 7 oz.; measured Cl- inches. KiDNEYs.-Somewhat full of blood; urine healthy. Supra renal capsules somewhat enlarged and quite firm. Weight 1 oz. ; measured 2 \ inches. Pancreas.—Normal. Weight 4oz.; measured 8J inches. [CASE No. 20.] Hospital Ni mbee, ) 133. ) John H. Thomas, age 22 years. Private, Co. I. o2nd Mass. Was admitted Feb. 11th, was wounded at Hatchers Run by a minie ball, which entered the left shoulder to the hit of and somewhat above cor- acoid process, passed obliquely through anrl was extracted according to his own statement oue inch to the left ofthe spinal column, near the 8th dorsal spinous process. Died Feb. 17th, at 8 o'clock .P M. HISTORY.—(ANTE MORTEM.) Patient was admitted much enfeebled and unable to sit in an upright position or to lie down. A large amount of grumous offensive matter discharged in great profusion from the posterior opening. Respiration was partly performed through the same 38. orifice. Patient continually suffered from irritative fever with deficient appetite, all efforts to arouse his vital powers failed until he died. Case reported by W. O. SMULL, A. A. Surgeon, U. S. A. 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 were observed through- out the larger intestine : The large intestine was hyperaemic arborescently, in spots, in which as a rule it was somewhat thinned. Mucous membrane of ileum somewhat thinned and congested; black points still observed and seen in Peyers patches. Mucous membrane readily washed away in the upper part of the ileum. The jejunum somewhat 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 was of a light color. Weight 3 lbs. 12 oz. Stomach.—Mottled about the fundus, regionally hyperaemic and small. Supra renal capsules firm and well developed. Brain.—Normal in every respect. Weight 47 oz. Me- dulla oblongata was well developed and of firm consistence ; at the nib of calamus, there was a granulated appearance and feel, Measurement 7^ inches. Lungs.—The ball entered to the left and somewhat above the coracoid process passed downwards, inwards, and back^ wards, breaking the third rib near the middle and in exit fracturing the 7th rib near the angle ; penetrating in its course, tho left lung from before, backwards, and without inwards, entering the superior lobe and leaving the inferior lobe. Right lung weighed 1 lb. 7 oz. ; measured 8| inchos. Left weighed 1 lb, 4 oz. ; measured 6| inches, The lung was cuirassed ; compressed upon its root and upon the superior anterior surface ; adhesions, which had formed between the visceral and parietal pleural in the form of a rjn.j; 39. about the related entrance and exit of the missile, anteriorly, to and from the sac of the pleura, and which had been interfered with by effusion and action in the pleural sac associated with compression of the lung upon its root, were partly ruptured. This rupture involved J inferior posterior portion ofthe defining ring of adhesions.*—The same collapse of the lung separ- ated the whole of the posterior ring of adhesions, the remains of which Avere traceable ; so that discharges from the wounded lung were poured into the pleural sac freely, discharges at least, as great in quantity as those coming from an external wound ; one for instance of a fleshy part of the thigh. Lung does not sink in water though nearly ofthe same specific grav- ity when immersed as a whole. 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 bands, 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 the same 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 the lowest, that is, was what we have termed " Cuirassed." Specimen of wounded lung preserved. Heart.—Fibrinous clots ear-marked opposite the pulmonary valves ; thicker and whiter on the right side ; connected with auricukv appendices, *----The ring itself as observed in its remains was appreciably raised from the pleural surface; sharply defined upon its outer as- pect, and of a <}ark red color, 40. White clots attached to the tendinous cords and cusps of valves and originating much in the manner described in other cases were found to exist. There was, however, no communi- cating band running from the anterior cusp of mitral valve to apex of the ventricle ; but this band is very frequently absent. Heart weighed 12 oz.; measured 5 inches. Kidneys.—Normal. Right, 6 oz.; measured4|- inches. Left weighed 7 oz.; measured 4 1-2 inches. Pancreas.—Hard, tough, and decidedly enlarged ; weighed 3 1-2 oz.; measured 8 inches. Spleen.—Flexible; discolored inferiorly; easily crushed, hav- ing its substance of a brick red color; weighed 6 oz.; measured 6 inches. Liver.—Large ; somewhat mottled; friable; somewhat black- ened on inferior surface, having bile of a brown color ; weight 6 lb; measured 10 1-2 inches. [CASE No. 21.] Hospital Number, ") 168. j Francis Robinson, a rebel deserter, of Ashville, North Carolina; age unknown; admitted Feb. 11th, 1865, and died Feb. 18th, 1865. HISTORY.—(ANTE MORTEM.) Francis Robinson, admitted with every symptom of Typhoid Pneumonia ; pulse 120 and thread like ; tongue dark and crack- ed ; skin dry, and pungent odor characteristic of typhoid con- dition. « Auscultation showed the left lung solidified throughout nearlv it3 entire extent; friction sound manifest in like dcrec. All applications to the chest produced no effect. Patient failed to' rally under treatment, wdiich Avas stimnlating, and tonic and died after being unconscious to all impressions for nearly two days. Case reported by W. G. SMULL, A. A. Surg., U. S. A. 41. POST MORTEM, Fourteen hours after death. Body somewhat emaciated; slight rigor mortis ; surface marked on side of chest by blister applied before death. About eighteen (18) fluid ounces of amber colored serum, possessing slight odor were found in the left pleural sac. Brain.—Organ very flexible ; of an exsanguine color, hav- ing fluid in the arachnoid, more than an ounce, and a little in the lateral ventricles. This organ was remarkable further for having an unusually broad and short middle commissure in the third ventricle and a small pineal body. Brain weighed 51 oz., measured 7\ inches. Lungs.—A sheet of fibrinous matter overspread the surface of the left lung in great part, and this, when thoracic organs Avere lifted out, adhered to the parietal pleura. The loAver lobe of left lung of natural size, Avas found solid, mottled red and gray. Upon section, substance of the same lobe present- ed a finely granulated appearance, the same as has been pre- viously observed in pneumonic cases. This substance was very firm; friable, or granulating under firm pressure, and it did not yield a puruloid fluid, but rather a bloody serum on pressure. It was also elastic, and upon cross section mottled with organically congested regions or blood colored spots varied in character and extent from some red spots observed in cross section of comparatively healthy pulmonary tissue. The. latter appeared to follow and be determined by the course of ves- sels and bronchial tubes, while the former appeared formed by an effusion of blood. The upper lobe was contracted and driven towards summit of the thorax and inwards towards root of the lung by effusion of serum and lymph. Right lung normal. Some seroid fluid in the right pleural sac; little melanic matter found on surfaces of lungs. Right lung Aveighed 12 oz.; meas- ured 8 inches. Left weighed 15 oz.; measured 8 inches. ^ Heart.—In the left Arentricle a large black clot Avas found extending into the aorta ear-marked opposite similunar valves'. The clot was readily broken up and quite elastic. .■> A mixed clot, black and light colored, was observed in the right ventricle. A light colored clot arose in the right auricular 42. appendix and connected with this by the inside of right cusp. Also a light colored clot arose in the left auricle and connected with the clot observed in left ventricle. Auricle septum im- perforate. Heart weighed 12 oz.; measured 4J inches Liver.—Somewhat mottled superficially, thin capsuled, friable and quite full of blood which flowed readily upon pressure. Bile amber colored and murky. Liver weighed 4 lbs. meas- ured 10 inches. Intestines.—Lines of congestion along the longitudinal mu- cous folds ofthe stomach. Two congested and discolored regions in the upper part of jejunum. Solitary glands of the ileum somewhat enlarged and reddened; aside from spots of congestion, enlarged solitary glands and local thinnings of the mucous mem- brane, the condition ofthe intestines was regarded as normal. Intestines weighed 4 lbs. 8 oz. Kidneys.—Normal, Right weighed 5J oz.; measered 1\ inches. Left Aveighed 6 oz.; measured 5| inches, Pancreas.—-.Normal. Weighed 3 oz.; measured 7J inches. Spleen.—Somewhat discolored on its anterior and inferior border ; very flexible ; easily broken into a pulp, and breaking with a crepitating sound with the capsule on. Weigbed 7 oz.; measured 6 in. [CASE No. 22.] Hospital Number, > 157. \ William Fader, of Winchester, Canada West. Age 20 years. Priv, Co. A, 140th N. York. Was wounded at Hatchers Run, Va. Ad- mitted Feb. 11th 18G-3. Wound was by a minie ball Feb. 6th, 1865. HISTORY.—(ANTE MORTEM.) . William Fader, admitted Avith a gun shot Avound in the lower portion of the spine, at the junction of the sacrum Avith the lower lumbar A-ertebra. Patient was in a condition of excessive nervous irritation, apparently partly from the effects of the A.J\0lUul aild partly from the effects of transportation. There V*was only one opening, the edges of which were flabby with'a $- tendency to slough. His appetite was much impaired and his general condifiop unfavorable, although he was of rather larse f/ 43. proportions and of full muscular development. He failed to respond to the action of stimulants and nutritious diet. On the fourth day after admission he had a chill which was followed by decided evidences of Pyaemia from which he gradually sank. Case reported by W. G. SMULL, A. A. Surg.,U. S. A. ----,—o----■— POST MORTEM, 12 hours after death. Body of good form. Blood, fluid. Very offensive odor upon opening the body. The ball struck about the fourth division of sacrum, passing forwards and to the right; fracturing the sacrum, lodging in the junction of the ischium and ilium; breaking the bone there and driving fragments inwards; lodging between the bone and pelvic fascia. Brain.—Normal. In apparent structure flexible ; slightly softened, showing little blood on section and congested arbores- cently on floor of 4th ventricle.; weighed 3 lb. 3J oz,; mea- sured 7 inches. Lungs.—Left lung, inferior lobe somewhat congested and both lobes infiltrated Avith serum. Numerous caseous white substances were met with in the lower lobe, with a few similar in the upper, surrounded on section by an areola of ingested pulmonary substance, and presenting pus in one instance, These were supposed to be masses of fibrinous matter thrown out by the inductive influence of pyaemic disease. Left lung weighed 22 oz.; measured 9 inches. Right Lung.—Similarly affected; melanic matter observed in the-pulmonary substance, Weighed 1 lb. 8 oz.; measured 8|- inches. Spleen.—Discolored inferiorly and very easily pulpified. Weighed 22 oz.; measured 8 inches, Kidneys.—Normal, Avith rather a pale color. Right weighed 7 oz.; measured 4J inches, Left weighed 7 oz.; measured 5 inches. Intestines.—Generally discolored, exhaling an offensive odor as from putrefaction, Weighed 5J lbs. Heart,—White fibrinous clots existed in this organ, one of ivhich formed a complete septum infright ventricle; clots in 44. the auricles connected with appendices; perforate auricular sep turn. Weighed llj oz.; measured 3f inches. Pancreas.—Very much enlarged and reddened. [CASE NO 23.] Hospital Number, ) A Rebel. Admitted for burial. Supposed to be about 25 years of age. HISTORY.—(ANTE MORTEM,) Unknown. -----o----- POST MORTEM, July 22nd, 1864. Body much emaciated, no rigidity. Brain.—No pineal body found in this brain and no commis- sura mollis. The floor of the 4th ventricle was congested. Sub- stance of the brain firm and not too full of blood. Noticed in the congestion of the fourth ventricle that there were three dis- tended veins, one in the middle line just above origin of audi- tory nerves; the others, one on either side, that of the right side lesser. A reddish tinge was over the whole floor. Weight of brain 60 oz.; measurement 74 inches. Lungs.—Very close old pleuritic adhesions nearly obliterated the right pleural sac. The lowest lobe of the right lung wa3 carnified, probably in consequence of these. Right weighed 14 oz.; measured 1\ inches. Left weighed 13 oz.; measured 8 inches. Heart.—The sac ofthe pericardium was also nearly obliter- ated. An awkward incision in opening the heart makes the specimen unsightly. Specimen was, however, preserved. Weight 10 oz.; measurement 4 1-2 inches. Liver.—Normal; quite full of blood. Weight 2 lbs. 14 oz.; measurement 9 inches. Kidneys.—Congested at the bases of the tubular pyramids. Weight of right 5 oz.; measurement 4 1-2 in. Left 5 oz. measured 5 inches. 45. Pancreas.—Normal. Weight 2 oz.; measured 6 1-2 inches. Spleen.—Rather small; of black color and firm consistence. Weight 6 oz.; measured 44; inches Intestines.—Jejunum congested, also congestion through- out the greater portion of ileum. Peyers patches well developed and of dark color; ulcerations found in sigmoid flexure and in the rectum which involved muscular substance. Supra renal capsules, normal. Weight 1|- oz.; measurement '21 inches. [CASE NO. 24.] Hospital Number, ) A Rebel. Admitted for burial, February 22nd, 1865. POST MORTEM. Brain.—Several drachms of liquid found in lateral ventricles. Lining membrane of ventricles somcAvhat reddened, slightly roughened to the touch especially in the right side. Fourth ventricle presented a discolored floor and contained serum. Weight 52 oz. ; measured 7 inches. Liver.—Of reddish ash color, of firm consistence exhibiting acini clearly upon surfaces. Bile dark brown. Capsule of liver AArith difficulty detached. Weight 3 lbs 12 oz.; measured 9 J inches. Spleen.—Light color externally. Somewhat enlarged Avith firm substance. Capsule detached Avith difficulty. Weight 9 oz. ; measured 5 inches. Kidneys.—Of light color externally; one somewhat darker than that of the liver. Right kidney Aveighed 5 oz. ; measured 2 inches. Left weighed 5 1-2 oz. ; measured 5 1-2 inches. Lungs."—In the lower portion of the left lung, posteriorly, numerous extensive dark red nearly black spots Avere found presenting all appearances of a pulmonary apoplexy. This left lung had three lebes Avell marked. No apoplectic spots such as those described, Avere observed outside of the region specified. Right lung Aveighed 11 oz. ; measured 7 1-2 inches. Left Aveighed 14 oz.; measured 7 inches. 46. Intestines.—A feAV surface ulcers observed in the lower part of the large intestines and again in the ascending colon. In the ileum about two feet from the caecum a region was ob- served in which the intestine was somewhat thickened, and faintly granular to the feel ou the mucous surface, color dark red. Lower part inside of the jejunum of dark color. Stomach.—Somewhat congested in the fundus. Heart.—No attached clots observed in this heart, separate fhrombs observed. White fibrinous clots in the right ven- tricle, and black clot in the left. Weighed 8 oz. ; measure- ment 4 inches. [CASE No. 25.] Hospital Number, ) 151. J Daniel A. McMiller, Priv. Co. K, 4th Penna. Cavalry ; age 28 years; was wounded at Hatchers Run, February 6th, 1865 ; was admitted Feb- ruary llth, with a gun shot wound. Ball entered the right thorax one inch to the right and below the nipple ; passed apparently through the right lung and was extracted according to his own statement at the lower border of the scapula. HISTORY.—(ANTE MORTEM.) Air passed freely through the thorax at the point of entrance of the ball. Patient suffered considerably from irritative fever and Avas seemingly much exhausted. Some discharge of grum- ous fluid through the posterior opening became daily more pro- fuse, of darker color and more offensive. The anterior opening was closed on the second day of the Avound by adhesive plaster in order that respiration ofthe trachea might be more decided. By this local treatment the patient was enabled to receive into the lungs a large volume of air. Constitutional symptoms bo- came worse gradually and he sank from exhaustion. No symp- toms of Pyaemia manifest,—Treatment: Stimulant and tonic ^jith neiwous sedatives, Case reported by W. G. SMULL, A. A. Surg., U, S, A, 47. POST MORTEM. Eight hours after death, February 23d, 1865. The body much emaciated and of offensive odor before opened. Owing to the presence and vehement opposition of the man's brother, only the lungs were examined, and these partially. Ball entered thorax, fracturing the 6th rib, and made exit near the angle of the 8th, in its course lacerating the pleura and bruising and slightly tearing (?) the lung substance. Lung substance crepitant and readily torn. The pleural sac had its opposed surfaces very firmly connected by recent bands in the separation of which lung tissue was torn. A dark gray offensive puruloid fluid mixed with more fluid liquid of a darker color to the amount of 10 oz. filled the right pleural sac. In the left side the lower lobe Avas firmly bound by thick tenacious (recently effused) fibrin. In this case the lung tissue was also torn, near the orifices of entrance and exit on the right side pleuritic adhesions Avere numerous and firirfbut not such as to shut off communication with the pleural sac. Hospital Number, j 2. 356. j John E. Stover, Age 4) rears, of N. York City. Priv. Co. C. G2ed N. York vols. Admitted Oct. 22na. 1854. Died Fob. 24th. 1865. HISTORY.—(ANTE MORTEM.) John E. Stover, Avas admitted from the front, after having suffered according to his own statement from the effects of ma- laria for several months, during Avhich time he Avas a patient at the Post Hospital. He Avas suffering from chronic diarrhoea and general exhaustion of vital poAvers. Has no chills but has frequent dejections of slimy and partially fsecal matter. He was placed upon stimulant tonic treatment, consisting of quinia, tannin and morphia. He improved under treatment but his diarrhoea returned at intervals Avith usual severity, the various preparations of mineral astringents and tonics being ■IS. used AAithout effect. Counter-irritation and injections Avere only of temporary effect, occasionally the patient manifested symptoms of mental aberration Avhich at the time Avere attrib- uted to effect of the narcotics. His appetite Avas capricious, but he made no complaints from the effects of any thing eaten. He complained of pain in an undefined part ofthe loAver portions of the abdomen almost continually, about twenty-fours hours before death he Avas attacked Avith convulsions. Muscular rigor extending over the entire body, occasional jactitation and entire Avaut of intellectual association, symptoms manifestly due to some morbid change in the great nervous centres. Ac- tive counter-irritation Avas applied to the upper part of the spinal column. Sedatives also Avere administered internally, the effect of which Avas only temporary. The patient remained in a state of perfect indifference unless aroused ; Avhen he became much excited. This condition remained until death relieved him. * Case reported by W. 0. SMULL, A. A. Surgeon, U. S. A. -----o----- POST MORTEM, Six hours after death. Body much emaciated, little rigidity. Brain.—When the skull cap Avas removed 2 oz of fluid came from the sac of the arachnoid. Substance ofthe brain flexible ; it was not Avhitened, but upon section numerous blood spots were observed. The commissural substance of the brain Avas flesh colored delicately, (a pale pink.) The substance generally was firm. No middle commissure in third ventricle ; serum Avas found in the lateral ventricles in small quantities. In floor of 4th Arentricle a V-shaped discoloration avrs observed of reddish color, |- inch in breadth and fully a line in depth ; the arms of the V were about 4; inch long each. Very near the point there Avas slight roughness to the touch. The membrane von floor of fourth ventricle appeared to be slightly thickened *---This man at one time, about forty-eight hours before death, screamed violently, shrilly and at periods'of about one minutes interval, so as to startle patients in the lowest wards of the .National Hotel Building. 49. and to yield upon pressure. Weight 42 oz.; measurement 7 inches. Cerebellum not as much congested as cerebrum. Lcmip.—The posterior portion ofthe lower lobe left lung was hypostatfcally congested, showing a red carnified section cover- ed with bright red blood. Quite a quantity of melanic matter was found on the surface of this lung. A feAV of the lobules were of a dark color, quite solid to the feel, but easily filled with air by forcible pressure upon another portion of the lung. In right lung nothing abnormal was observed, with the excep- tion of some red bands, bv.t the lobes had an abundance of me- lanic matter on the surface, and one calcareous body was pre- sented. Serous fluid was found in both pleural sacs in large quantity. Right lung weighed 11 oz.; measured 94 inches. Left weighed 11 oz.; measured 9 inches. Heart.—No clots. Substance presented a glistening ap- pearance. The pulmonary artery had its lining membrane red- dened. The aorta presented the same phenomenon. Fat upon the surface of organ was reddish. In the pericardial sac there was a small quantity of serous fluid. Weight 6 oz.; measure- ment 31 inches. Liver.—This organ the smallest yet seen as indicated by measurement, it had a capsule with difficulty torn loose and was marked along the course of its blood vessels, superficially with broad white lines. Its substance Avas shiny and nearly homogeneous, the large hepatic vessels adhered someAvhat more firmly then usual to their proper channels. Weight 27 oz.; measurement 8-J inches. Kidneys.—Normal. One of the supra-renal capsules of large size had a yellowish Avhite substance externally, Avith a dark cherry colored substance internally. Right kidney weighed 8| oz.; measured 4 inches. Left weighed 34; oz.; measured 4 inches. Spleen.—Small size ; externally of light color, presenting a fibrinous appearance under its capsule, which was somewhat thickened, opacified and marbled. Substance of the spleen itself was of dark violet or cherry reel color and somewhat firm in consistence. Trabeculae clearly marked. Weighed 4 oz.; measured 5 inches. Pancreas.—Flexible and of a reddish color. Weighed 1 oz.; measured 6 inches. 50. Intestines.—There was great thickening ofthe rectum and in the sigmoid flexure of the colon ; and as high up as the trans- verse colon ; with a red granulated surface. There wras 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 Avas 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 was considered normal. Intestines had generally a pinkish color.* Weight 55 oz. [CASE NO 27.] IIosriTAL 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 folloAved by erysipelas. This was treated with local application of ace-, tate of lead and internally with Tinct. Ferri Chlorid. In forty- eight hours all symptoms of erysipelas disappeared and descpua- mation ensued. The patient at this time manifested slight mental aberration. Subsequent to this, partial unconciousness ensued. The treatment during this period Avas counter-irri- tants and roAmlsiATes. Case reported by Cadet for W. G-. SMULL, A. A. Surgeon, U. S. A, ^—----^o------- POST MORTEM, IVenty hours aftor death.. Mach emaciation, slight rigidity of muscles, Braix.— Aborescent congestion on floor of 4th ventricle, *----T|,e specimen was considered one of c-ncerous disease, ah tho,ngb 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 Avas 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 Avere found under the visceral arachnoid. Luxes.—Left lung congested.in the'i;inferior lobe.. About the middle of the outer border of lower lobe there Avas a small abecss surrounded indefinitely by congested and ecchymosed tissue the effect of actual effusion of blood apparently. Hi "lit lung congested in posterior portion. Seroid fluid was found under 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 tissue of right lung Avas dark red, soiueAvhat 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 v btiide was of a granular appearance. It was attached to the anterior aortic valves hav- ing little or no connection Avith 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^ inches. Blood, generally fluid. Kidneys.—Masses of white substance were met Avith in both kidneys varying in size from that of a pins head to that of a pea, somewhat firm in consistence and of yellowish fibrinoid material; others ^exhibited a'nuruloid substance. Right Aveighed 6 oz.; measurement 5 inches. Left weighed 6 oz.;—measure- ment 5jnches. 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 two such regions, one su- perior. Upon section the lower 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 germed normal was mottled, ingested and firm. Weight 1 lb,; measurement 6 inches, 52. Livinn—This Avas of shiny, nearly homogenous section and dark color, presenting no apparent disease. Internal surface slightly mottled. Gall Avas perfectly black. Weight 27 oz. ; measurement 84 inches. Supra-renal Capsules.—Between the left and the kidney of same side, under the transverse fascia, quite a large abscess Avas observed. This capsule Avas much enlarged. Pancreas.—SomcAvhat enlarged and reddened. Weight 4 oz. ; measurement 8 inches. IxTESTixxs.—Lower part of the ileum was found congested, so also the large intestine. The mucous membrane was readily detached in the upper part of the ileum. There was a blackish gray discoloration in jejunum. This color was partly washed off and the water used became blackened. Some congestion was observed in the fundus of stomach. Weight 4 lbs. [CASE No. 28.] Hospital Number, ) 162. \ Jacob Newburger, Age 26 years, Private Co. F, 1st Md. Vols.; admitted from City Point. February llth 1865 ; wounded at Hatcher'a Run, Febuary 6th; died March 1st, 1!s6j. DIAGNOSIS. Gun-shot wound right side of thorax, just beneath spine of scapula. Ball remains in the wound. HISTORY.—(ANTE MORTEM.) Newburger admitted as described. Exploration of the Avound 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 ineh in length Avas made at the point where the v/all was tin,most and discharged about twelve fluid ounces of pus. This discharge continued and was very profuse for about five (5) dnys when hemorrhages super- 53. vcned from the posterior opening. These occurred daily at times, until patient gradually sank from exhaustion. Case reported by W. 0. SMULL, A. A. Surg.,IJ. 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 was somewhat reddened viewed with the pia mater on; this, the pia mater, was 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 wax. About two drachms of fluid were 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 6J inches. Lungs.—Right lung apparently normal. In the lower back part at the bottom of the lower lobe of the left lung about 1-5 of the whole was solidified; easily broken ^p and yielding a grayish dark colored and reddish pulp, at the same time the exterior of this portion had a lobulated feel. A portion of the lower anterior portion of the upper lobe equivalent to -J of lobe was solidified in like manner, advanced however, so far, as to yield upon breaking up a lighter gray pulp. A cut portion of the solidified part sank in water. Seroid fluid Avas observed in the pleural sac. Right lung Aveighed 14 ounces; measured 10 inches. Left weighed 18 ounces; measured 8 4 inches. Heart.—About an ounce of fluid Avas found in the sac of the pericardium ; a large Avhite clot Avas found in the right ventricle attached in the usual way ; with flaps," the opposed surfaces of which Avere smooth; and the open face of their angle avus directed upwards 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 51, left auricle and a mixed one in the right. Auricular septum imperforate. Heart generally of tinged red color ; the lining membrane of the vessels was red also. Heart Aveighed 12 oz. ; measured 5 inches. Liver.—This organ was of light brownish red color; of firm consistence and yielded strongly the peculiar odor. Bile nearly black and fluid, about one fluid ounce in the bladder. Liver AAreighed 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 with someAvhat more blood but still of light color. Right kidney weighed 4 oz.; measured 4 inches. Left weigh- ed 5 oz.; measured 44; inches. Intestines.—Some discoloration was observed in the caecum. The large intestines otherAvise were normal. Ileum somewhat 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 4 inches. The Wound, "—The ball entered the scapula near the origia of the spinous process passed forwards, inAvards and to the left at an angle of 60°, struck between the angles of the 5th and 6th ribs bearing more heavily upon the 5th ; Avas reflected upAvards, forwards 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 Avound 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 5th cervical to the 1st lumbar vertebra) was observed,* On the left side confined by the deep fascia was an abscess extending from the last "cervical vertebra to 6th dorsal, about one inch in breadth, Tuv SriyAi^CoRD^—Having cut through the laminae the *---Tllfc matter that was thrown out oi this sac wo^^rv^en^V'- jn smell and oi a granular, bro^rusji red, old apneaiv.nec " spinous processes were removed. The large A'eins near the lamina that Avas broken by the ball Avere found. The torn extremities of a vein Avere seen. The torn vessel was found Avhite, and old looking near the point of injury. A dark clot mixed Avith a Avhite clot inferiorly Avas observed near the point of injury; the anterior face of this clot was 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 bel®Av the medulla, finely and reticulatedly. The arachnoid Avas reddened and opacified. It was thought that the substance of the cord Avas someAvhat thickened and of an abnormally dark color. The substance Avas of firm consis- tence ; there was no inflammatory exudation matter. Specimen preserved, [CASE No. 29.] Hospital Number, ) 169. j Nathan M. Hildreth, Company B, 94th NeAv York Volunteers, aged 21 years. HISTORY.—(ANTE MORTEM.) ^ Patient was admitted to the Hospital February llth, 1865, jf with left thigh amputated primarily at the middle third con- '%j sequent upon gun-shot wound received at the battle of Hatcher's & Run, February 7th, producing a compound fracture. Opera- y tion performed on the field, Feb. 8th. When admitted the j patient's general condition was 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 was considerable irritation of the system mani- \l fested by small and frequent pulse, coated tongue, headache, £ impaired appetite &c, the eyes and skin presenting a yellow ^ hue and the stump looking more unfavorable. February 24th.—Intense pain in the right side; liver en- larged and painful, and a friction sound denoting pleurisy was heard; a slight chill. From 20th had been taking quinine, pon and brandy with beef essence. 56. February 26th.—Pleurisy extending to the left side; chills each day growing worse and more violent, fixing the symptoms of Pyaemia, succeeded by profuse perspiration. Died March 4th, 1865.* Case reported by J. G. KELLER, A. A. Surg., U. S. A. ------o------ POST MORTEM, March 4th, 1865, 4 o'clock, P. M., eight hours after death. Body in good condition ; of fine form ; little or no emaciation ; considerable rigidity of muscles. Pleuritic adhesions on the right side anteriorly and posteriorly were found. No adhesion of the pericardium. Lungs.—The lower lobe of the right presented numerous col- lections of a viscid puruloid substance in cavities of an irregular or spherical form met with chiefly near the outer pleural surface, but also deep in the lung substance. When met with in the substance they were nearer the pleural surface than the centre, generally giving the appearance of pulmonary abscesses point- ing in direction of pleural sac externally. The fluid found in them varied front a sero-puruloid, pearl colored substance to a sanious pus. In separating the united surfaces ofthe visceral and parietal pleura) bounding this lobe a small opening was made in one of the larger cells of pus, from which there was free discharge. The fibrin connecting the said united surfaces Avas thick and white; heart clot like, elastic and tough. It ex- tended somewhat between the uppermost and lowermost lobes, but did not extend to. the anterior surface ofthe lung. In the uppermost lobe two metastatic abscesses Avere found in the an- terior inferior portion, but no inflammation of the pleura was observed in this region. The middle lobe of this lung Avas separated by a posterior cleft only and the two abscesses referred to Avere in the obliter- *----Metastatic abscess of the lung was declared before death in diagnosis. The chills were extraordinarily severe and were more fre- quent directly as dissolution approached. The very severe pain com- plained of and the anxiety, tremors and general nervous sensations were overcome, and the patient was made perfectly comfortable by a hypodermic injection of acetale of morphia, a quarter of a grain. Hil- drcth's mind was clear until-his final coma and yer.y alert.' 57. sited line of separation. The Avhole lung seemed filled Avitli 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, juft described. The anterior inferior border ofthe Ioav- er lobe of this lung Avas mixed Avith an elastic firm whitish mass of fibrinous material. A collection of sanious pus Avas observed superiorly through the middle of sac containing Avhich a vessel 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 Avith blood and having a doughy feel was specially loaded in the Ioavci" lobe and the posterior portion of the upper with blood. Another abscess was 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 weighed 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. Brain.—Clear serum was seen in both lateral ventricles. In left side posterior horn extended back an inch farther than (m 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 74 inches. Heart—This contained clot in the right side, attached to that portion of the right ventricle in which there are musculi pectinati throwing 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 was a small white clot in the left ventricle closely connected Avith the bicuspid valve, connecting with clot originating in left auricle; ear marked near aortic valves. Weighed 74 oz.: measured 4^ inches. 58. Liver.—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 of this organ, right lobe, Avas somewhat 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 ay as thought that signs of commencing dis- ease such as Avould lead to an abscess, similar to the one obser- ved in right lobe existed in the portions described as finely. congested. Weighed 5-| 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 spleen. Organ weighed 12 oz.; measured 6 inches. Kidneys.—Of a light color, flexible and easily torn ; no ab- normality observed. Right kidney weighed 7J oz.; measured 5 inches. Left weighed 7^- oz.; measured 5-J inches. Pancreas.—Apparently normal. Weighed 3J oz,; measur* 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 ofthe femoral artery,in the arm. putatcd thigh, extending to the distal artereal branch, a clot was found, the lower part of which, was honeycombed, below which there was a small patulous sac. In the femoral vein there was a clot extending from the junction of the pro-. fouud vein to the extremity of the vessel; black and loose below, between the attachment and extremity. Specimens of the lung, double commissure of the brain, and, bkood \ressels of the thigh were preserved, 5'.). [CASE No. 30.] Hospital Number, | 2.356. j George Shearer. Private Co. I, 8th Ohio Volunteers; admitted lor burial. Was killed by cars on N. C. R. R. near Mt. 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. Lungs.—The right was torn in the upper and back part of the lower 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 w7as 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., U. S. Army. HISTORY.—(ANTE MORTEM.) Indianapolis, Inp,, March 16th, 1865. Doctor :— In obedience to your request I give you the folloAving his- tory of Dr. J, T. St. John during the time he Avas 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 were lined Avith a thick tough false membrane which inter- fered Avith both deglutition and respiration. I at once cauter- ized the throat avcII 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. Fcrri Chloridi every three hours together Avith Quim Stilph., 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 grew Avorse all the time I Avas Avith him. lie lived longer than I expected.* Respectfully, Yours &c.. W. P. PARR. P. S.—He had been sick five clays before I saAV him. P. To Siirrjeun 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 Avas dyspneca and partial aphonia; he had to be propped up in bed, and what he said could not be understood unless the ear Avas closely inclined to him. 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 Avhite 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 Avith the same good result. His voice Avas 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 zinc v."as administered. Vomiting resulted,, and some of the shreds of the false membrane Avere got rid of, but with very little result to the patient. Dr. M'G ill 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 capsicum used externally over the larynx. The iron brandy and beef tea Avere continued. During the afternoon and evening the Doctor had several copious serous alvine evac- uations, which he ascribed to the emetic; at night was anxious, nervous and restless; 30 drops of tr. opii. administered per anuin; the diarrhoea Avas 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 Avas expectorated, some shreds being of quite firm consistence, and presenting a cartilaginous appearance. The lungs Avere resonant on percussion, and the respiratory murmur heard o\rer all pa^ts of the chest. Deglutition could not be effected. Local constitutional treatment continued. At night was Avorse; more feeble, restless and nervous; making continued efforts to get rid of the obstruction in the air pas- sages, with, only partial success; \ gr. morphia Avas given, and the dose repeated. During the night he slept a little, but was somewhat delirious; this he ascribed to the morphia March 5th.—Said his throat Avas better, but there was some oppression about his lungs. The tonsils uvula half arches and ■epiglottis still covered Aviththe exudation. His voice was about the same as when admitted. On a'uscultation marked difference Avas observed in the distinctness of the respiratory murmur on the right and left sides. Over the right lung it was 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'Glill, a blister Avas put on each deltoid muscle. In place of the red pepper, liq, ferri per sulph. avjs applied with a probang every 3d hour to the throat. In the afternoon a portion of the exudation had been removed, and the rest ap- peared somewhat detached, but the general condition of the rpatiemt was more unfavorable. During the nig'kt he became much worse; carb. ammonia Avas give-w. March Gth.—Death evidently- impending. The face and G2. hands were of a venous hue; breathing loud and hoarse; pulse 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 Avas suggested as an explanation of this difference in the respiratory sounds.* 12 M,—Patient dying; respiration continued after the heart's action had apparently ceased. Reported by Q. H. DARE, A. A. Surgeon, U, S. A- ———o------- POST MORTEM. March 6th, 3|P, M.—JBody still warm, but slight emacia-: tion. Lungs.—The left lung presented a peculiar mottled appear-! a nee, 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 was thought, fine poipts of ultimate lobules, with difficulty seen;) and upon pressure there was 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, Avas pressed, so much air made its appearance ip the consolidated lung substance, as to define the pulmonary lobules. In this lung, formed between the lobes jn ap unusual lobe division in the upper part of the inferior lobe, an apoplectic clot about 1 cubic inch in amount was obr served near a vessel in Avhich no orifice was seen. Several spots besides were found, not only in the inferior lobe, but also hi the superior of this side, presenting in ope case blood, in the other cases ecchymoses. In bronchial tubes of left lung, lying collapsed, easily torn and longitudinally lined, a shred-like fibrinous substance Avas observed connecting in continuity with the main tube described below as existing in the trachea.—: --,-.•.-—*This suggestion was made by Dr. Dare. G3. This substance in the bronchial tubes of the lung formed a tree of corresponding hollow involucred tubes. In right lung similar appearances Avere presented, except that what Avere re- garded as apoplectic spots, were absent. The loAvest lobe of the right was more intensely affected by collapse as evidenced in the appearance noted as cherry-colored substance, than any other lobe of the lungs. In this lung the bronchial tubes to those of 3d magnitude, and even farther, were occupied by hollow, fibrinous tubes, and the vacant tubes of lesser magni- tude presented an abnormally white appearance. These fibrin- cms tubes were best developed in the tubing, supplying the lower and middle lobes. Right lung Aveighed 324; oz,; meas- ured 84; inches. Left fung weighed 28 oz,; measured 8 inches. Trachea.—From the soft palate and half arches, tonsils, the upper part of the pharynx, the root of the tongue, and sides of the laryngeal opening, and from the opiglottis, a white or ash- colored substance closely adherent to the originating tissue, in thickness varying from | line to more than a line from above downwards, covered the internal surface of the trachea, and right and left bronchial tubes, so ,as to form a complete second or inner tube of wdiat Avould, in common parlance, be called false memJjni>i,c. The surface of the lower part of the main tubes, covered by this membrane Avas scarlet; and it was thought that in the spots of deeper scarlet, there was fine gran- ulation.* In right bronchus the tube of false membrane Avas two lines in thickness; in the left not more than j line. On close examination of the cut surface of the main tube, in right bronchus, and superiorly of .shreds, it appeared as if the structure of this tube was laminated. Superiorly about the epiglottis, in the upper part of larynx, and in the pharynx and fauces, the membrane was ragged, The interior of the main tube, as seen in the trachea, was perfectly smooth and shining, presenting in this respect, almost the appearance of serous membrane; and the left bronchial membrane tube and the trachea membrane tube were large enough to pass air enough to the lungs to support life; for which passage, however, the tube supplying the right lung Avas not sufficiently capacious. Heart.—A mixed clot of large size was found in the right auricle communicating with a clot in the right ventricle of pyrn* ?---Tins opinion was unanimous. 111. midal form that arose in apex of ventricle, and had two columns, one a communicating column colored black, con- necting with auricle clot; and another also black running into pulmonary artery. The pyramid from which these columns arose was composed of tough, white clot substance. In left auricle there was a black clot; in left ventricle a small white clot, arising by its apex in the ventricular apex, and joined the anterior cusp clot. Heart normal in other respects; organical- ly, quite full of blood. Weighed 121- oz.; measured 3y inches,. Brain.—Pia mater much congested in veins and capillaries ; consequently the cerebral surface was much reddened. Sub- stance of the brain was quite firm; also well filled with blood. Small quantity of fluid in right lateral ventricle. No commissura mollis. On the floor of 4th ventricle, on right side above the origin of the auditory nerve, there Avas an aborescent spot of congestion. A central vessel was found proceeding from the direction of the right cerebellum £ of an inch long, with six sir eight (four main) descending vessels, and two main aseeiid- in 266. J "William Doty, age 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 ke (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 Avith epilepsy, and had a fit on the day previous to his admission. March 4th. — Had fever; severe pain in the left side, and faint friction sound over lower lobe of left lung anteriorly. A blister was applied and a large dose of Dover's poAvder given. March 5th.—Complained very little, and seemed to be getting along ayuII through the day but at night Avas delirious. March Gth.—Extremely restless, tossing about iu bed. Dur- ing the absence of the nurse Avould get up and wander about the room; pul.3e feeble and rapid ; eyes fixed ; and pupils nat- or.. ural but insensible to light. Blisters Avere applied to the napo of the neck, and opium given internally. The opium produced no change of the pupil of the eye. The head was throAvn back and rigidly held by the posterior muscles of the 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, 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 ves- sels, AArhite and fibrin-like substance. Lateral ventricles being opened in each of the anterior cornua, about three drachms of fluid were observed. In the left there was 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 two drachms of fluid mixed with about one drachm of similar puruloid substance (adherent, in part, quite closely to the walls of cornua, and making in all nearly three drachms of sero-puruloid fluid,) were found in each. A grayish appear ance with somewhat dark general color, was presented in cho- roid plexuses, Upon the walls of the lateral ventricles, amid fine congestion and aborescence, especially posteriorly, and on the walls inferiorly, connected with the finely congested vessels, there \yere numerous small spots of ecchymosis. 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 was a small clot from ffhich blood vessels radiated irregularly. On right side in 07. 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.— When scraped with a knife, the membrane covering it remained dim. Fine irregular aborescent congestions were observed on tjhe floor. These were arborescences of the fine vessel branches. 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, were covered, along the courses of vessels especially, with bluish fibrinoid substance. Substance of cerebellum was congested as was tfie cerebral Substance.. Blood was found fluid throughout the body. Brain jveighcd 3 lbs. 4 oz.; measured 7 inches. Lungs.—The posterior surface of the right lung, superiorly and inferiorly, was somewhat uneven by undue prominence of pertain lobules, and when the same surface was cleaned, it had a spotted appearance, due to the presence of ecchymoti-s 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 portion of right lung, sank in water. Left Lung.—Pleuritic 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 weighed 1 lb. 3 oz.; measured 84; 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. Spleen—Large; of light color; very flexible, and easily broken up. Weighed 12 oz.; measured 5 inches. Pancreas.—Apparently somewhat congested, Weighed 3| oz.; measured 84 inches. Kidnlys.—Congested arborescently upon posterior surface. The renal pyramids were congested so as to present, upon sec- (18. tion. a kind of speckled appearance, indicating, probably, ve- nous stasis; capsule not readily detached. Right Aveighed 71 oz.; measured 5J inches. Left neighed 8 oz.; measured 5 inches. Heart—Very small; black clot in right auricle ; large Avhite dot in right A'entricle, adhering to anterior wrall; small clot in left auricular appendix of black color, though somewhat mixed; a feAV black clots in the left ventricle ; substance of heart generally reddened. Weighed 121 ounces with clots; and with vessels attached, A. Surgeon, U. S. A. ------o------ POST MORTEM, 5 P. M.—Fifteen hours after death. Not mueh emaciation considerable rigidity of the muscular system. Brain.—On taking out brain, about two ounces of a serous fluid flowed out of sac of the arachnoid; veins of the pia mater Avere congested; and this membrane itself was finely congested; congestion and slight reddening of the substance of the brain : some congestion in Avails of the ventricles, especially in those of the posterior portions or horns ; in third ventricle little serum was observed. The floor of the fourth ventricle was arbores- ccntly congested on both sides, b-dow the'origin of the audito- ry nerves ; chiefly centrally above. Substance of brain flaccid; of normal consistence; cerebellum a little more flaccid and softer than cerebrum. Brain weighed 3 lbs. 9 oz.; measured 7i inches. Lungs.—Old pleuritic adhesions at base of the left lung ; pud there were also interlobar adhesions. Tin- lung was uni- vcrsally congested, but not so as materially to exclude the air ; which was present in all except a few lobules that were in a condition of atelectasis, '(so to speak) and that were observed posteriorly in both lobes. Otherwise left lung was normal.—- Bronchial tubes somewhat reddened internally, and covered with a shining mucous, apparently bloody. Right lung gene- rally of a light color anteriorly, and of a dark color and more mottled, posteriorly; presenting a large patch of lobules, black and apparently m a condition of atelectasis, similar to that of certain lobules seen in the left lung. Hypostatic congestion posteriorly. The substance affected by this congestion has an cedematous feel. Right lung weighed 1 lb. 4 oz.; measured 9 kiches. Left weighed 1 lb. 2 oz.; measured 9 inches. Heart.—The auricular septum Avas perforate ; the opening running from behind forwards, and to the left. Such a Avhite clot Avas formed in the right ventricle as bound the valves to the apex tendinous cords and carneous columns, and directed the flow of blood wholly upon the smooth approach to the pul- monary artery. Heart somewhat loaded with fat, and its sub- stance generally had a red tinge. The organ was otherwise normal; blood fluid. Heart weighed 12J oz.; measured 4%- inehes. Liater.—Somewhat dark red externally; presented on supe- rior surface of right lobe, light and dark mottlings, the former from bands and spots, section through Avhich revealed the whi- tened tissue extending to a xery considerable depth. No soft- ening in any of the whitened portions. Substance firm and well filled Avith blood. Left lobe lighter superiorly; Avas con- gested superficially, inferiorly ; as Avas exterior inferior border of right lobe. QuaOrate lobe was superficially (hiferiorly) veined, mottled. Liver weighed 3 lbs. 11 oz.; measured 1U* inches. Spleen.—Very slightly enlarged ; flaccid ; congested black internally and superficially. Substance of somewhat firm con- sistence, tearing with slight resistance superiorly, but easily inferiorly. Weighed 10 oz.; measured 6 inches. Kidneys.—Left flaccid, pale; arborescence of the surface% congested coarsely, having the tubular portions of the pyramids .of a pale cherry color, or water red ; in marked contrast with fhe pinkish or ash cobred, cortical substance. Right similar 7$. to the left. Over the surface of both inferiorly, black speck- ling was observed, due, probably to canal capillary congestion. L ft kidney weighed 4 oz.; measured 4 inches. Right weighed 5 oz.; measured 5 inches. Supra Renal Capsules,—Apparently normal. Paxcreas.—Large and congested. Weighed 3-J oz.; mcas- :"> inches. Intestines.—Some congestion of large intestines; fine con- gestion of the ileum; Peyers patches enlarged, darkened and black pointed ; mucous membrane thinned and granulated. Stomach—Much congested ;. also duodenum and jejunum. TutestineSgWeighed 4 lbs. 8 oz. Parotid Gland.—The right gland was examined and found! infiltrated with a puruloid substance. Larynx.—Apparently normal. ' ;>all Bladder.—Normal; bile black. / [CASE No. 30.] Hospital Number, ) ' 316. / Patrick Conlin, age 36; private Go. E. 25th Massachusetts Volunteer.-. HISTOR Y. —(ANTE MORTEM. > Patient's nativity, Ireland ; temperament sanguine ; stature six feet; complexion dark ; occupation previous to enlistment unknown. March llth, 1865, patient was admitted into Hos- pital from Annapolis, Md., with symptoms of Typho. Malarial Fever. General conditions characterized by great prostration. Febrile symptoms were well established. Skin hot and dry ; no appetite ; much thirst. Pulse accelerated and easily coih- pivssiLle. Breathing hurried; tongue furred and dry. Head- ache exceedingly severe; bowels costive Appearance of the countenance was peculiar, of dusky hue Avith injection of eyes. The mind seemed sluggish, and exhibited a degree of confu- sion. This mental condition rendered it difficult to ascertain duration of disease, also precise time and mode of attack. An truption,. somewhat peculiar, consisting of numerous spot* varying in size from a quarter (4J of to a line in diameter as- 11. peared, chiefly upon chest and abdomen. These spots, more or less elevated above the surface, disappeared in a few instances slowly and imperfectly under pressure. March 13th.—Skin was found unusually hot, with little dis- position to perspiration. Tongue thickly coated and decidedly brown; teeth and gums covered with sordes; pulse quite fre- quent, averaging 128 per minute. Urine scanty and high colored; abdomen tender and painful. Auscultation and per- cussion revealed no abnormal condition of the lungs. Liver and spleen were thought to be enlarged. March 14th.—Prognosis more ttnfavorable:. great general debility ; complete loss of appetite ; dusky hue of countenance and dullness of expression more striking ; bowels costive ; much restlessness and great nervous disorder. March 15th.—No amelioration of symptoms. Headache suc- ceeded by delirium and occasional stupor. Articulation dmi- cult or indistinct. Pupils much contracted with drooping of upper eyelids. Subsultus tendinum and twitching of the muscles of face, also heat of skin, hot and pungent, resembling " calor mordax," were observed. March 16th.—Tongue darker brown and more fissured. Spots on the skin of a dusky crimson color unaffected by pressure ; tremulous movement of tongue and hands; pulse fre- quent and fluttering; extremities cold and clammy. March 17th,—Symptoms more aggravated. Profound coma supervened, which soon terminated in death. General plan of treatment consisted in the exercise of vigi- lance by attendants, and the adoption of remedies best calculated to allay excitement, to subdue local inflammation and to sup- port his failing powers of life. Case reported by J. T. PINDELL, Medical Cadet, U. S. A. -----o----- POST MORTEM, Nineteen hours after death. Brain.—Large quantity of serum was found under arach- noid, and in. its sac. About cerebellum and spinal niarraw 78. the liquid seemed to exist in greater quantity. Arachnoid someAvhat reddened, especially on superior and posterior of cerebrum. Serum in lateral ventricles, in third ventricle, and it probably existed in fourth. Substance of brain moderately firm, presenting fine congestion (capillary.) The floor of the fourth ventricle was discolored, and presented some arbores- cent congestion. Brain weighed 3 lbs. 3 oz.; measured 7 in. Heart.—Normal, loaded with fat externally; substance pinked; blood fluid or coagulated imperfectly. Heart Aveigh- ed 11 oz.; measured 5 inches, Lungs.—Lower lobe of left was congested even to blackness ; had cedematous feel but was crepitant. The upper lobe was also black, but mixed with a more healthy pulmonary tissue. Right Lung.—In this substance was congested; black pos- teriorly ; somewhat lighter anteriorly and not so much congest- ed.1" The inferior portion of krwermost lobe in a pneumonic condition ; gray color ; readily broken doAvn, and yielding when broken doAvn a puruloid fluid. Left lung weighed l lb, 5 oz.; measured 9-J inches. Right weighed 2 lbs.; measured 10 in. Liver.—Of light color ; substance soft; well filled with blood. Presented superficially, inferiorly, anteriorly black congestion, Liver Aveighed 4lbs. 4 oz.; measured 12 inches. Spleen.—Slightly enlarged; flaccid; light red on dorsum; was mottled on internal surface. Gall bladder filled with very black bile, partly concreted. "Weighed 2 oz. 2 dr.; measured 4 inches. Kidneys.—Left apparently normal. Right apparently nor- mal. Tubular portions of pyramids well marked. Both of large size. Left kidney weighed 8 oz.; measured 5 inches. Right weighed 7 oz.; measured 5 inches. Pancreas.—Reddened. Weighed 4 oz.; measured 9 inches, Intestines.—Peyers patches marked and dark colored. Organs generally darker and congested. 79. [CASE NO. 37.] Hospital Number, No. 420. James Williams, private, Co. II, 69th Pennsylvania Vols.; aged 24. HISTORY.—(ANTE MORTEM.) Admitted March lGth, 1865, from Annapolis, Md. Williams was a feeble, emaciated, cadaveric looking boy, of sanguine temperament; was brought among paroled prisoners from City Point. He was in a state of almost mental imbecil- ity ; complained of diffuse abdominal tenderness, particularly along the track of the colon. His dejections were involuntary, and the patient was perfectly helpless'. He became hourly more feeble ; failed to respond to treatment, and died without apparent pain on the following day. Case reported by W. G. SMTJLL, A. A. Surgeon, V. S. A. ------o------- POST MORTEM. March I Nth, ]sT>o, 20 hours after death. Emaciation Arery great; not much rigidity. I'kain.—Tavo ounces of limpid scrum were found in tlie sac ofthe arachnoid. Pacchionian bodies well shown; membrane icstlf pale. Serum Avas found in both lateral ventricles, also in the third ; none was seen in the fourth, probably it had escaped. Substance ofthe cerebellum was readily broken up, more so than that of cerebrum. Middle commissure of the third ven- tricle very well developed. Brain weighed 38 oz.; measure- ment G1,- inches. Lungs.—Pleuritic adhesions on both sides and interlobar. On inspection exteriorly both lungs appeared reddened; the feel, especially of the right side, Avas rough. This roughness Avas due to the presence of miliary tubercles, generally in the gray stage. In section tuberculous masses, apparently of firm gray tubercles exteriorly, were found to have broken down and to have formed in their centres numerous small vomica? one or £wo lines in diameter. Larger vomica) than these were ob- 80.. served associated with a dense Avhite fibrinous mass or Avail in posterior portion of the left lung. Tubercles in this left lung were apparently not so far developed as in the right. Left Aveighed lib. 2 oz.; measured 8J inches. Right weighed 1 lb. 7 oz.; measured 8-1 inches. Heart.—Small and flaccid, pale externally, having in both left and right ventricles long white fibrinous clots attached to valves and apices as usual, connected to auricular appendices and extending earmarked opposite valves into the aortas. Weight 9 oz.; measurement 4 inches. Liver.—Of a dark color externally, generally of dark sub- stance internally, mottled with darker portions. Under capsule superiorly and inferiorly, as well as in substance, tubercles Avere observed. Weight 2 lbs. 9 oz.; measurement 10|- inches. Kidneys.—In left same kind of tub-srcles as in liver were observed, sparse and small in this kidney. In the right tuber- cles were more advanced and larger than in the left, and this kidney was darker and more congested, especially inferiorly. Left Aveighed 4^ oz.; measured 4£ inches. Right weighed 5 oz. 2 dr.; measured 5 inches. Spleen.—Small, black, containing numerous advanced tu- bercles. Substance firm. Weight 4 oz. 2 dr.; measurement 4h inches. Intestines.—Numerous small round ulcers in sigmoid flex- ure and rectum. In ascending colon, near caecum, a large red ulcer was found. Throughout the whole of the ileum tu- bercles were observed under mucous membrane, in many cases associated with ulceration. These numerous miliary tubercles were less frequent in jejunum. Stomach small, contracted and somewhat congested. Mesenteric glands large, and tubercu- lous apparently. Weight of intestines 3| lbs. 81. '■ [CASE No. 38.] Hospital Number, ") 319. j Joseph Lynch, age 44; private, Co. D, 99th New York Vols. Ad- mitted March llth, 1865, and died March 18th, 1865. HISTORY.—(ANTE MORTEM.) Lynch was admitted in a state of insensibility, pallid, and presenting a surface of body somewhat cold. Reaction was at- tempted to be brought on with only imperfect success. Two days after admission a low muttering delirium set in, which was followed by jactation and finally subsided into a profound coma which continued till death. Case reported by W. C. SMULL, A. A. Surg.,U. S. A. —----o------ POST MORTEM. Eleven hours after death. Some emaciation ; not much post mortem rigidity. Brain.—Serum in small quantity in both lateral ventricles. The floor of the fourth reddened and veined. There Avas capil- lary congestion of the cerebrum. In the anterior portion of the left cerebrum a remarkable osseous deposit, a small plate three quarters of an inch, or thereabouts, in diameter, and of crescentic section, channeled for vessels of pia mater, (and of course under the visceral arachnoid,) was observed. A true aneurism was observed in the basilar artery about the size of a pea. Substance of cerebellum softer, than that of cerebrum. Brain weighed 52 oz.; measured 8 inches. Lungs.—Old pleuritic adhesions on the right side. Lung substance black posteriorly ; dark red anteriorly. The lowest lobe of this lung, except a small portion anteriorly, was solidi- fied so as to sink in water. Portions of the same lobe yielded no crepitation nor pulp, but broke granularly. This lung was very full of blood. Left lung was intensely congested; some- what lighter colored in its anterior portion. An apoplectic spot 82. was observed under the pleura in the anterior portion of the lower lobe. Right weighed 2 lbs. 6 oz.; measured 10^ inches. Left weighed 1 lb. 15| oz.; measured 11 inches. Heart.—Imperforate auricular septum, although septal ponches were observed on both sides. White fibrinous clots, small and firm, were found in both ventricles. Heart loaded with fat externally and reddened. Weighed 10| oz.; measur- ed 4 inches. Blood is fluid and does not coagulate. Liver.—Dark red externally, lighter colored internally but full of blood. Orgau friable, of a strong hepatic odor, yield- ing by the gall-bladder gelatinous, yellowish bile in small quan- tity, and presenting superficially black congestion. Weighed 57 oz.; measured 11 inches. Spleen.—SomeAvhat enlarged; soft in substance, Weighed "t\ oz.; measured b\ inches. Kidneys.—Some congestion about the tubules and their roots. Organs of natural appearance generally. Right Aveigh- ed 4 oz. 2 dr.; measured 4| inches. Left weighed 4J oz.; measured 4| inches. Pancreas.—Discolored externally and red internally. Weighed 2^ oz.; measured ~\ inches. Intestines.—Regional discoloration and general congestion of the large intestines. Ileum discolored with bile. Peyers patches developed and somewhat raised. Regional congestion. Mucous membrane somewhat thinned. Arborescent spots were observed in ileum and lower part of jejunum. In fundus of stomach under the mucous membrane there was ecchymosis ir- regularly margined over a region of about 4 inches in diameter, Specimens of osseous deposit and aneurism preserved. 83. [CASE NO. 39.] Hospital Numbeii, ") No. 3S9. j Frederick Bossardo, age 20; corporal, Co. I, 24th Michigan Vols, ■\Vas admitted from Annapolis, March llth, and died March 17th, 1865, HISTORY.—(ANTE MORTEM.) Patient was of bilious temperament; in stature about 5 feet 10 inches; well proportioned and of fair muscular development. Was admitted into Hospital in a state of partial coma with tre- mor. Could be occasionally aroused to take nourishment and stimulants. Patient had at times violent spasams of the ex- tensors and opisthotonos. Evacuations involuntary. Deep pressure in the right iliac fossa caused the patient to manifest symptoms of pain. Treatment.—Sponging with warm alcohol; active counter- irritation to the nape of the neck; stimulants were given and concentrated nourishment. The patient after being aroused would quickly relapse into a state of stupor. Stupor and spasms continued until death. Case reported by W. G. SMULL, A. A. Surgeon, U. S, A. -------o------ POST MORTEM, Thirteen hours after death. Great emaciation; but little rigidity of muscles. Brain.—Pacchionian bodies well developed ; substance of brain firm ; capillary congestion ; limpid serum in large quan- tities in the sac ofthe arachnoid. Serum in small quantity in each lateral ventricle ; lining membrane opacified. Floor of fourth ventricle white; arborescently congested, however, above the origins of the auditory nerves. Substance of cerebellum softer than that of cerebrum. Weighed 52 oz.; measured 7 in. Luxes.—Right was very full of blood, and under visceral pleura two spots of ecchymosis on posterior portion of lowest jobe were observed. Old pleuritic adhesions on the left side 84. lower lobe. Partial indefinite solidification posteriorly, with appearance of ecchymosis, the substance affected by which had a specific gravity about the same as that of water. Right weighed 28 oz.; measured 11 inches. Left weighed 2G oz.; measured 10 inches. Heart.—Small; white fibrin clots in both ventricles, some- what mixed in the right; no clots in the auricles; organ ap- parently normal; less reddened than that of previous case, (No. 38.) Weighed 10 oz. 1 dr.; measured 4 inches. Liver.—Substance of a light color; friable, odorous and yielding a brown gelatinous looking bile. "Weighed 3 lbs. 13 oz.; measured 11^ inches. Spleen.—Enlarged; full of blood ; easily broken down ; flac- cid ; of a dark brown color. Weighed 12 oz. 1 dr.; measured f)| inches. Kidm:ys.—Congested and generally reddened in substance. Right weighed 4 oz.; measured 4J inches. Left weighed 5 oz.; measured 4J inches. Supua-Renal Capsules.—Of natural size and apparently normal. Pancreas.—Reddened. Weighed 3 oz.; measured 10 in. Intestines.—Colic glands enlarged and blackened ; general discoloration of large intestines. Peyers patches very conspi- cuous through whole of ileum. Gut of a yellowish color in- ternally ; mucous membrane thinned; spots of ecchymosis in jejunum ; jejunum generally yellowed ; stomach enlarged ami mottled internally. 85. [CASE No. 40. Hospital Number, "/, <^' Body admitted March 19th, 1865, for burial. Supposed to be that of James Warren, who was reported in the morning papers of the 19th as having been shot the evening previous while attempting to desert. This man was a substitute. POST MORTEM. V* About thirty-six hours after death. !' q o° Body not emaciated. No post mortem rigidity. \ v/\ Brain.—Pia mater reddened and finely congested. Corpus \^ \tailosum, fornix and the walls of the lateral ventricles softened. V inches. Right weighed 3| oz.; pleasured 4 inches. Pancreas.—IL-ddened. Weighed '2\ oz.; measured 8 in. 1 Lntestinks,—A large spot of ecchymosis under the mucous membrane of the fundus of the stomach. Congestion in duo- denum and upper part of jejunum quite intense ; lower part ot jejunum tinted dark red. Ileum intensely congested. Peyer's patches well developed; solitary glands enlarged ; congestion was associated with a deep red tint. A few ulcers in the mu- cous membrane of the large intestines, either round or irregu- larly oval. Internal surface of the large intestines was intensely- congested. No albumen was found in the urine. / ^ [CASE No. 42..] Hospital Number, } 44 s. j Samnel Leonnon, aged 23; private, Co. G, 21st Illinois Vols. Was* admitted March 16th, 18G5, from Annapolis, Md. HISTORY.—(ANTE MORTEM,) Leonnon, an Anglo-Saxon, of sanguine temperament, about 5 feet 9 inches in stature, was admitted into my wards March 18th, 1865, in a debilitated condition. Symptoms on Admission.—Percussion over the chest, ante- riorly, was normal, but posteriorly there was marked dullness over the lower third of the left lung, where no sound was audible. There Avas no expectoration. Respiration was very hurried. Pulse was weak and quick. Tongue brown and dry. Bowels very loose. Emulsion of turpentine was ordered for him, and plenty of brandy and beef tea. March 1-Hh.—Patient no better ; his countenance livid and anxious. 5, P. M.—Diarrhoea somewhat checked but pulse still very weak and quick, and respiration more hurried. Amnion. Carb. and Sulph. ^.Ether were added to the emul- sion of turpentine, and the beef tea and brandy given regular- ly as previously. Patient continued to grow worse, and at 8 o'clock, P. M., March 19th, died. Case reported by C. W. NEFF, A. A. Surgeon, U. S. A. 89. POST MORTEM. Fifteen hours after death. Brain.—Limpid serum observed in the sac of the arachnoid. The pia mater and visceral arachnoid were not easily detached from the convolutions It was thought that the visceral arach- noid was opacified. The white substance of the brain presented numerous puncta, and a cut surface became red, soon, on ex- posure to the air. No soft commissure. On the floor of the fourth ventricle congested vessels on both sides above the au- ditory nerves were observed. Floor of the fourth ventricle otherwise normal in appearance. Weighed 3 lbs. 3 oz.; mea- sured 7 inches. Lings.—In the pleural sacs th^re was effusion of a sero- puruloid fluid. Right lung generally reddened; presented so- lidification (pneumonic) in the back portion of the uppermost lobe, and two nodules of similarly solidified tissue on the exte- rior and interior borders. A section of the posterior solidifica- tion revealed a collection of solidified lobules, the outlines of all of which were clear, and this collection Avas surrounded by an infiltration of serum. The lobules resisted breaking up under the finger, and the outlines of their hard white masses were easily appreciable from the exterior. In the lowest lobe of the right lung, posteriorly, there was another nodule of solidification as big as a hen's egg, the sub- stance of which was black, tough and not broken down readily. This substance was of less specific gravity than water. The pleura over ii was thickened. In the uppermost portion of the posterior lobe of the left lung there was a large mass of solidified substance with clear lobules. Section through the hardened and whitened lobules here presented a surface of a light red color, faintly moitlee,. distinctly granular and elastic. In the middle of this tissue was an abscess Avith caseous puruloid fluid. Nodules contain- ing pus Avere observed in the upper lobe of the left lung and posterior border of the loAver lobe. Centres of these nodula- tions in the upper lobe were filled with puruloid fluid. When a small mass of the solidified portion Ayas pressed, a thread of white fibrinous plastic tissue was driven out. Right Aveighed 24 oz.; measured 9 inches. Left weighed 25 oz.; measured 10 inches. Heart.—Mixed clot in the right auricle and ventricle ; black clot in the left auricle and ventricle. Perforate septum. Heart weighed 9 oz.; measured 3f inches. Liver.—Of somewhat dull color; easily broken up, and ap-> parently of great specific gravity. Capsule could be torn off, but in the tearing there was resistance. Weighed 4 lbs. 12 oz. 6 dr.; measured 12 inches. Spleen.—Enlarged, dark colored and flaccid, presenting numerous firm, Avhite fibrinoid masses of various sizes and lo- cations, chiefly observed, howeA-er, in the upper portion of the organ. Weighed 14 oz.; measured 8 inches. Kidneys.—Right congested black inferiorly ; arborescently under the capsule; presented two white fibrinoid masses, allied in every respect to the morbid masses observed in the spleen. Left kidney similar in appearance to the right, presenting no fibrinoid masses; arborescent congestion under the capsule. Right weighed 7f oz.; measered 5 inches. Left weighed 6 oz. 5 dr.; measured 5 in. Supra-Renal Capsules.—Reddened, apparently normal. Gall Bladder.—Contained very light colored bile. Weigh-: ed 1 oz. 1 dr.; measured 4 inches. Pancreas.—Normal. Weighed 3 oz. 1 dr.; measured 8 in, Intestines.—Large, somewhat reddened in regions; intense congestion of the ileum with £hhming and softening of the niu, pous membrane. Stomach large. Intestiues weighed 4 lbs. 91. [CASE NO. 43.] Hospital Number, } 343. } Aaron James Brown, aged 32; private, Go. I, 52nd Ohio Vols.; ad- mitted March llth, 1805, and died March 21st, 1865. HISTORY.—(ANTE MORTEM.) Brown was about 5 feet 9 inches high; of fair muscular de- velopment; black hair and eyes; dark, sallow complexion; bilious temperament. Was admitted with delirium, which be- came more decided on the first night of admission. The surface tof the body was of the ordinary temperature and very dry. The skin was covered with an eruption of a dark, mulberry color, irregularly circular, each spot about the size of a split pea, and not elevated. These spots did not disappear entirely upon pressure. Tongue was stiff and coated with a dark incrusta- tion. Sordes upon the teeth. Pupils slowly responsive to light. Body exhaled an ammoniacal odor. After the usual process of renovation the patient became more composed and slept at intervals during the night. On the following morning there was no improvement; patient became more delirious, be- ing unaware when food was offered him. He lay with his head ■strongly drawn backward. Conjunctiva deeply congested and pupils almost insensible to light. These symptoms, with in- creased tremor, increased till death. Case reported by W. G. SMPLL, A. A. Surgeon, U. S. A. ------o------ POST MORTEM. March 22nd, 1865. Twenty-four hours after death. Not much emaciation. G.eat rigor mortis. Brain.—No serum in the sac ofthe arachnoid; veins of the pia mater full; numerous puncta on the cut surface of brain substance ; substance somewhat reddened upon section ; bloody serum was found in the posterior horn of the left lateral vcn- jtricle; very Jittle in the anterior horns. The floor of the fourth 92-. ventricle was opacified, and the origin fibres of the auditory. nerves indistinct. The substance of the medulla oblongata was somewhat congested. The pia mater was detached with. difficulty from the conA'olutions. Weighed 2 lbs. 13 oz. 2.dr.;. measured 7 inches. Linos.—Pleuritic adhesions on the right side posteriorly V- none on the left; no effusion of seram. The lowermost lobe^ of the right lung presented several apopleetic spots beneath the pleura near the upper extremity posteriorly. Some mottling was observed over the exterior Lee of the whole lung. All the substance was crepitant. Tougo feel, posteriorly, in the regions of the old pleuritic adheskms. The orjan was not thought to- be congested, although quhe full of b'ood In the left lung inn the posterior part oi the lower lobe, en supeificial examination,. outlines of lobules well defined to sight and feel were observed.. The substance of and about these lobules presented upon section, a conspicuous mottling of comparatively light red polyhedral, spots, in a back ground,, so to speak,, of effused blood. The litter (the effused blood) could be scraped off, and appeared to- be associated with vessels of the interlobular structure. A portion of the tissue in which these phenomena were presented sank readily in water,, and,, when broken up under the finger,. yielded a bloody pulp.* Lung was generally full of blood in. other portionsr but in no place congested (except that describ- ed) so as to have the function of the organ interfered with- Left weighed 1 lb. 4 oz.; measured 9 inches. Right weighed 1 lb. 5 oz.; measured 9 inches. Heart.—Auricular septum imperforate ; no clots. Organs normal. Weighed 9 oz..; measured 5 inches. Liver.—On the superior portion of the right lobe a large- oval discoloration Avas observed; also, spotted discoloration oui the left lobe,, superiorly, near the centre. luregular light col- ored spots, mottlings, were observed superiorly, generally to. the left, in the organ. A section through these light colored spots exhibited the fact of their extension into the hepatic sub- stance. Substance of the organ seemed finely congested, es- pecially in the regions indicai d by ,-pots oi congestion observed superiorly. Weighed 3 lbs. 8 oz.; ..H^med II inches. *----The sections of lobules exhibited, on a close inspection, a fiive granular apnearaace.^iVbte made six months after the auto^s^ 93. Spleen.—Of natural size; somewhat blackened on dorsum. Substance of a dark red color, presenting no striking abnor- mality. Weighed 5 oz.; measured 5 inches. Kidneys.—Left somewhat irregularly developed ; was a little congested ; otherwise normal. Right also irregularly developed and a little congested; both faintly lobuled. Left weighed 5 oz. 4 dr.; measured 4^ inches. Right weighed 4J oz.; mea- sured 4 inches. Supra-Renal Capsules.—Reddened in the sac and torn on extraction. Pancreas.—Enlarged ; of light color and somewhat friable. Weighed 3 oz. 2 dr.; measured 7^ inches. Intestines.—Large intestines normal; lower part of these organically congested. No disease of Peyer's patches observed. Congestion seemed to have a tendency to determine itself in spots variable in diameter and irregular in form; not generally more than one-fourth of an inch in diameter. Upper part of jejunum reddened. fiCchymosis observed under the mucous membrane in the stomach; black, dark, bloody spots. AYeighed 8 ounces. Gall Bladder.—Large quantity of very black bile. Weigh- ed 1| oz.; measured 7^ inches. Numerous dark colored spots, apparently faded, were observ- ed on the cadaArer. Section through revealed nothing. Body presented a measled appearance. Albumen was found in large quantity in the urine. The blood was generally fluid. 94. *- [CASE NO. 44.] Hospital Number, 1 543. J Henrj Brockmeyer, private, Co. E. 1st Maryland Vols.; aged 44 years. HISTORY.—(ANTE MORTEM.) Brockmeyer, a stout muscular German, was admitted into this Hospital March 22nd, 1865, about noon. He walked Avith some assistance to the foot of the stairs leading to the ward. When seen by the ward Surgeon he was sitting up in bed suffering greatly with dyspnoea. His countenance was anxious and of a slightly \Tenons hue. Intellect unaffected, He expressed a desire to be bled, stating that he thought it would relieve him. His pulse Avas frequent find rather feeble, On inspection the left side of the chost was found to remain fixed during respiration ; the right side responded as usual to the respiratory efforts. Percussion revealed dullness amount- ing to flatness over the whole surface of the left lung, both an- teriorly and posteriorly. No respiratory murmur, rales or bronchial breathiug, in fact, little or nothing, was heard ovTer this lung on auscultation. Over the right resonance and re- spiratory sounds were normal. The feeble condition of the patient, and the shallowness of the respiration, prevented a thorough and satisfactory examination of the lungs. The only previous history of the case obtained was that the man had been sick about three weeks. Dry cups were freely applied to the affected, lung, in front and behind, and three grains of Dover's powder, with two of sulph. quiniae, ordered eArery third hour, also one ounce of Avhisky every third hour. At 12 o'clock at night he was lying down breathing with still greater difficulty, and evidently more feeble and prostrated. He had expectorated a considerable quantity of dark and very offensive puruloid matter. Dunn" the latter part of the night the patient became flighty and deli- rious. About 6 o'clock, A. M., he got out of bed and walked across the room to get, as he said, some water. He was led back and laid upon the bed ; his head, had scarcely touched the pillow when he died. Case reported by G. fl. DARE, &\. A. Surg.,r. S, 4, 95. POST MORTEM, Nine hours after death. No emaciation. Slight rigor mortis. Brain.—Glandulae pacchioni very numerous; veins of pia mater engorged, and membrane generally finely congested, [t was readily separated from the convolutions of the cerebrum; substance of the cerebrum apparently somewhat softened ; lin- ing membrane of the lateral ventricles opacified and appeared a little softened, presenting numerous arborescences, at the ter- minal branches of which, in posterior horn of right lateral ven- tricle, there were blood spots a quarter of a line in diameter. These blood spots were ecchymosos, in all probability, and were beneath the lining membrane. Serum in small quantity in both lateral ventricles and in the third ventricle. Substance of the fornix apparently somewhat softened; the floor of the fourth ventricle discolored, having a reddish, somewhat dark hue, and marked by numerous arborescences on both sides, more especi- ally on the right; one very big vein was seen near the mouth of the right cerebellar ventricle : lining membrane of this ven- tricle was thickened When section Avas made superiorly in the Pons Varolii through the marked spots of congestion of both sides on the floor of the fourth A'entricle, the lining membrane of the latter was clearly seen thickened and opacified and mark- ed in the congested regions referred to by a dark line or region of appreciable breadth that existed between it and the substance beneath. There was decided congestion of the Pons. Striated bodies congested. Substance of cerebellum softer than that of cerebrum. Weighed 60 oz.; measured 8 in. Heart.—Mixed clot, chiefly white, in the right auricle, of large size, communicating with a mixed clot in the right ven- tricle which bound togetuer the cusps of the valve and the apex ofthe ATcntricle with its triangular mass, and extended an arm marked opposite the valves iuto the pulmonary artery. The dark part of this clot Avas in the lower and posterior portion of the ventricle. In the left auricle Avas a black clot which com* municated with a clot attached to the anterior cusp and the left external wall of the left ventricle. From the latter a mixed cjot was given oft' Avhich extended into the aorta and was car« OCT. marked opposite the valves. Weighed 12 oz.; measured 4^ inches. Lungs.—About two ounces of serum found in the left pleural1 sac. Adhesions on both sides, chiefly on the right. A number of pleuritic adhesions of recent formation and of tough, thick, Avhite elastic material in layers was observed to cover the exter- nal and inferior surfaces of the visceral pleura of the left lung. Vessels were observed forming in the thick inferior layers of this matter. The whole of the lower lobe of this lung Avas con- solidated, and on section exhibited gray hepatization, readily breaking up into a puruloid pulp, and its substance exhibited a fine gray granuhr appearance on section. Very heavy. The lobes of this lung were bound together by very thick recent pleuritic effusion of plastic lymph, and the surface of the upper lobe was covered with a similar pleuritic formation of the ef- fusion. Oue consolidated lobule was found In it. The lobe had a dark colored appearance. A small hard mass was found on the inner portion of the upper lobe of the right lung. The whole organ reddened and very full of blood. The surfaces of the bronchial tubes of both lungs were reddened. Left Aveigh- ed 4 lb. 6 oz.; measured 9 mches. Right weighed 1 lb. 13 oz.; measured 10J inches. Liver.—Full of blood; presented a someAvhat dark appear- ance externally,, mottled with light colored spots, which were also observed in the substance. Oriran friable, vieldino- a granular appearance when torn.. Hepatic odor faint. Weigh- ed 4 lbs. 10 oz.; measured 12 inches.. Spleen.—Of natural size; flaccid ; blackened inferiorly; sub- stance softened. Weighed 8 oz.; measured -U inches. Kidneys.—Right somewhat congested ; the left also congest- ed ; the substance of left firm. Left weighed 7J oz.; measured 4.L inches. Right weighed 6 oz.; measured 4 inches. Pancreas.—Normal. Weighed 4 oz.; measured 9 inches. Supra-Renal Capsules.—Normal. The cortical substance. if lighter color than usual. Intestines.—LoAver part of ileum generally congested dark red. Peyer's patches marked; not inflamed. In the upper part of jejunum was one spot of intense congestion. Stomach. normal. Weighed 4 lbs. 4 oz. Albumen found in the urine. Specimens of Gallstones Avere;; preserved.. [CASE No. 45.] Hospital Number, ] 347. S John Atwater. aped 22 years; private, Co, I, 44th Ohio Vols. Was admitted March llth, 1805, from Annapolis. Dita March 22nd, 1865. HISTORY.—(ANTE MORTEM.) Atwater was of German descent, about 5 feet 7 inches in stature ; of nervous, sanguine temperament; had light hair and eyes; meagre, muscular development. "Was admitted into the Hospital in a state of extreme feebleness, the result of exhaus- tion from chronic diarrhoea > According to his statement he was taken with it some two months previous, while a prisoner in a southern prison. It has been persistent ever since. He received but little treatment before admission into this Hospital. Kxamination showed an entire want of the power of assimila- tion. The small quantity of ingesta he received passed from him unchanged, mixed with a large quantity of sero-mucous fluid. There was diffused tenderness over the entire abdominal region. Tongue red and glazed.. Cheeks at times hectic. Astringents, both mineral and vegetable, failed to produce anv eft'ect. They Avere combined with tonics and stimulants. The evacuations became more serous and more frequent; finally, in- voluntary, when he died. Case reported by W. G. SMULLr A.. A. Surgeon, I\ S. A. POST MORTEM. Forty-eight hours after death. (Jreat emaciation. Some slight rigidity of the muscles. Brain.—Moderate ingestion of the pia mater. Cerebral: puncta more numerous on the left than on the right side. A vessel was observed in the floor of the fourth ventricle, riglic side, superiorly, above the origin ofthe auditory nerves. Some line congestion of the Pons Varolii.. Weighed 45 oz...; mea.- sured 7 inches.. 98. Heart.—Auricular septum imperforate ; the organ small and flaccid. A flaccid clot of fibrinous tissue in auricle was observ- ed adhering to the anterior cusp ofthe tricuspid valve and ex- tending into the pulmonary artery ear-marked opposite valves. Small white clot in the left ventricle adhering to the anterior cusp. AVhite clot in left ventricle. Heart weighed 8 oz. 2 dr.; measured 4| inches. Lungs.—Specific gravity of the'substance in excess. Gene- ral appearance of the right superficially dark, mottled pink dark red and black. A lobulated feel throughout the lowest lobe and in the back portion of the uppermost lobe. When the substance of the consolidated portions was examined, it Avas found that the lobulated feel, externally, Avas due to Avhat was probably a lobular pneumonic disease. In the posterior portion of the uppermost lobe only, a small part of that termed consoli- dated tissue Avas not crepitant. Section presented a dark color and on pressure a frothy, black, offensive fluid was exuded. The left lung, posteriorly, was of a dark color; anteriorly, of light color. The upper lobe Avas apparently normal. The posterior portion of the inferior lobe presented light colored lobules and a dark smooth surface. Deep blood-red spots of apoplectic effusion or ecchymosis were observed underneath the pleura. No well formed clots were fouud, although amid the in- tense congestion effusion of blood under this organ was undoubt- ed. In a region of smooth black mottling, congestion (and ec- chymosis) was so intense as to conceal the ordinary structure of pulmonary tissue. Right weighed 25 oz.; measured (J| inches. Left Aveighed 17 oz.; measured 9 inches. Liver.—Of light color, presenting a marked nutmeg appear- ance superficially and on section. Substance friable. Outlines ofthe acini ill defined, although perceptible. Tissue of the organ rather soft. Anteriorly, inferiorly, to the left a superfi- cial black discoloration was observed. Weighed 3 lbs.; mea- sured 11 inches. Spleen.—Discolored; dark red posteriorly; dark red and black on the internal surface. Substance flaccid; smooth and shining cut surface. Not softened. Substance generally of a dark, cherry red color. Weighed 7 oz.; measured 6 inches. Kidneys.—Roth of a someAvhat light color. Darkly ingested inferiorly. Right Aveighed 5 oz. 2 dr.; measured 4J inches, Left weighed 4 oz. 4 dr ; measured 4^ inches, 99. Pancreas.'—Small, flaccid and discolored. Weighed 4 oz.: measured si- inches. Gall Rladdek.—Pilled with thick, granular, nearly black hi\\ Weighed 2 oz.; measured l\\ inches. Intestines.—The mucous membrane ofthe rectum, sigmoid flexure of the colon and a small portion of the transverse colon was of a reddish brown color superficially, and at a little dis- tance presented an appearane'e of rough granulation. On close inspection isolated points of mucous membrane were observed standing in the midst of a surface, the result of a disoased ac- tion, by which the surrounding (mucous) membrane was de- stroyed. 3Iost ofthe smaller granules were developed by the progressive increase of the diseased action from the border to the centre; and the islands, so to speak, were observed in all stages from that of a large one nearly healthy in centre, through that of less magnitude with centre blood red, to that of a small one with its surface reddish brown or ash colored. The term Jwni'ij-csjDthcd might with propriety be applied to portions of intestinal surface thus affected. Muscular and fibrous coats found much thickened, longitudinally corded and contracted. The walls of the gut were two lines in thickness. In trans- verse colon the ulceration was somewhat irregular, largely de- veloped as a rule in intercolumnar pouches. Colic glands observed with their black points in ascending colon and eajcum. Evidences of hyperamiia in caxum. In the loAver part of ileum the folds of mucous membrane Avere thick and very distinct. There appeared to be little or no Avasting of the membrane in the tips ofthe folds. In one place these Avere covered with fine ash colored granules. The folds appeared thickened in this region. Peyer's patches not apparently diseased. Above the region of hyperemia the intestines had a greenish hue. Mu- cous membrane began to be thinned ; was apparently discolored by bile. The green hue lasted through ileum and was suc- ceeded by a slate color in the lower part of the jejunum, this ;i'j.,iiu yielding to a greenish color. Evidences of hyperemia in the stomach. Mesenteric glands slightly enlarged. lutes- tines weighed o lbs. 7 ounces. Hospital Ni aiber John Mc Eulnirt, aged 28 ; corporal, Co. D; Tth Xcw York Vols. Wits. admittfed Mardi 11.th, 18*>5, from Annapolis, Md. Died March-4, loU.V IIISTORY. —(ANTE MORTEM.) Patient was of sanguine temperament; pale and emaciated with chronic diarrhoea contracted while a prisoner in the South.. Bowels moved'from ten to twelve times per day, the discharges licing of a dark color, very fluid and offensiAre 'T tongue white im the centre and red towards the edges; appetite good ; slight pain over the abdomen and tenderness on pressure ; pulse small; and feeble. Opium was given in two grain doses with acetate of lead with no resultant diminution of diarrhoea. Various vegetable astringents and tonics Avere employed without avail.. Patient sank from exhaustion. March 24th, 1865. Case reported by J. G. KELLER, A. A. Surgeon, V. S. A. POST MORTEM, Fourteen hours after death.. (ireat emaciation. Slight post-mortem rigidity. Brain.—Arachnoid and pia mater pale. Although the pia- mater Avas pale the vessels were normally full. Pacchionian, bodies Avell developed. A considerable quantity of serum flowed from sac of'araehnoid. Substance of cerebra was of a, delicate pink color. Puncta very numerous. Limpid serum in both lateral ventricles ; large quantity also in third ventricle.. Considerable quantity of serum in the fourth ventricle also.. Arborescence observed in the floor of this ventricle. The floor was generally though.faintly tinted red. Weighed 49 inches;; measured 7 inches. Lungs—The right lung speckled with melanic matter uni- versally ; posterior portion cherry red, much darker in color- than the anterior portion, of someAvhat doughy feel. Old pieu.- 101. ritic adhesions connected the lobes. Consolidated feel of the posterior portion of the uppermost lobe greater than in any other portion. Upon section through lowermost lobe two spots like bruises were observed in the midst of the pulmonary sub- stance that resembled in all respects ecchymoses of other tissues. Cross sections revealed similar ecchymoses. When the sub- stance was pressed a large quantity of frothy liquid was ex- pressed from the cut surface*. In the left lung old pleuritic adhesions interlobar connecting opposed surfaces. The upper lobe ofthe lung was generally speckled with melanic matter. In the lower lobe several spots of ecchymosis or effusion were observed over the posterior portion. Partial consolidation found on the posterior part of the base of this lung. Substance sinks in water; breaks up like and presents the appearance of pneumonified tissue in second stage. Blood was fluid and flowed freely from the large vessels when cut. Right weighed 20£ oz.; measured 7\ inches. Left weighed 15\ oz.; measured 7 inches. Heart.—Small. Auricular septum imperforate ; deep pou- ches in both sides. Small, white, tough clot in the right ventricle; apex, cusp and base attached, having one arm ex- tending from auricle and another into pulmonary artery. Right auricle clot, small, mixed and easily broken. In left ventricle anterior cusp was attached to a clot connecting both cusps, joined with an auricle clot and sending an arm into aorta ear-marked opposite semilunar valves. Weighed 5 oz. 6 dr.; measured '■\\ inches. Liver.—Small and bronzed, presenting white spots on su- perficial observation, which, as in other cases, were found to extend into the substance. On section the substance seemed to be faintly, not very finely mottled. On close observation found still of a brown or bronze color. Outlines of the acini not very distinct on torn surface. Black congestion superfici- ally inferiorly anteriorly and to the left. Substance of the organ of quite firm consistence. Weighed 28 oz.; measured 4 inches. Spleen.—Small, tough and blackly congested inferiorly. Substance itself firm ; shining on cut surface, and of a mahog- any or deep cherry red color. Weighed 3 oz. 4 dr.; measured 4 inches. 102. Kidneys.—Right firm and somewhat light colored. Left dark and congested posteriorly and inferiorly. Tubules dis- tinctly marked. Right weighed 4 oz.; measured 4 inches. Left AA'eighed 4 oz.; measured 4 inches. Gall Bladder.—Filled with gall of an amber color. Weigh- ed 1 oz. 3 dr.; measured 3 inches. Pancreas.—Small and flaccid. Weighed 7 oz.; measured 7 inches. Scpra-Renal Cai'sti.ep.— Large and of a light color. Intestines.—Color of the large intestines very dark slate. Mucous membrane perforated by a number of round or oval ulcers. Regional hypenemia of ileum. Great wasting of the mucous membrane. Intestines present an ironed appearance, Hyperaemia in jejunum with dark colored regions. Stomach small and slightly congested along the mucous folds, Intes. tines Aveighed 4 lbs. [CASE NO. 46.] V Hospital Number, ] 224. ) Abram J. Stokes, private, Co. C, 120th N. Y. Vols.; aged 23 years Was admitted Feby. 21st, 1865, died March 24th. 1865. HISTORY.—(ANTE MORTEM.) Patient, about six feet in stature, of nervo-sanguine tempera^ ment, auburn hair, light eyes, was admitted to Hospital in an advanced stage of Phthisis Pulmoualis, considerably emaciated and much exhausted apparently from coughing. Physical signs very manifest. Cheeks suffused with hectic flush. Eyes large, prominent; conjuctiva injected. Patient coughs almost incessantly ; complains but little of pain in his chest; has slight hoarsness: has more or less aversion to food, and after taking it frequently ejects it upon coughing. He seems to be sufl'erin 107. ventricle was slightly reddened. Considerable congestion of the pons Varolii. At the base of the brain the pia mater was finely and generally congested. Brain weighed 47| oz., measured 7 inches. Lungs.—Left of a dark color, darker posteriorly. Faintly crepitant on the upper part of lower lobe. Some pleuritic ad- hesions on the outer face of the lower lobe of this lung. Sub» stance, on section of posterior portions, of blood red color. Bloody fluid was pressed from it. The whole lobe had a col- lapsed appearance. Under the pleura posteriorly there were some very dark spots. The outer part of the right lung was covered with old pleu- ritic adhesion bands. This whole lung was greatly ingested with blood. Posteriorly and inferiorly sub-pleuritic adhesions of dark color were observed, thought not to be caused by effu- sion of blood. Left weighed 27 oz. 4 dr., measured 8 inches. Right weighed 22 oz. 1 dr., measured 8J inches. Heart.—Small white clot in right ventricle, communicating with a mixed clot, also soft, in right auricle. Perforate auri- cular septum. Small soft clot in left ventricle, somewhat mixed. None observed in left auricle. The organ thick walled, somewhat loaded with fat externally, about the auri- culo-ventricular rings and lines of vessels. Weighed 14 oz. 5 dr., measured 4J inches. Liver—of heavy specific gravity. Smooth on section, of reddish brown color with indistinct acini. In middle superior portion of right lobe a small calcareous mass was found, sur- rounded by a star shaped contraction of capsule. Substance of organ quite firm. Liver weighed 3 lb. 13 oz., measured 11 inches. Spleen much enlarged, capsule thickened. Organ greatly and decidedly softened. Weighed 18 oz., measured 81 inches. Kidneys.—Right congested about tubular portion, some- what large size otherwise normal. Lobulated. Left similar. Right weighed 6 oz. 5 dr., measured 5 inches. Left weigh- ed 7 oz.. measured 5 indies. 108. Gall Bladder.—Bile black, granulated, thick. Weighed 2 oz., measured 5 inches. Pancreas was v- rv large, somewhat congested. A large Caieai-eous mas.-> was found in this organ -vhicb was preserved. Intestines.—Discoloration and hyperemia <~,f amending colon and caecum, flyperamiia of lower part of ileum. Pey- er's patches distinct, hard to the feel and black pointed. Mucous membrane thinned. Intestines presented in certain regions a somewhat ironed appearance. In ascending colon and ileum mucous folds blackened. Dark discoloration in upper part of jejunum. General dark ash red discoloration of stomach internally. The ash . red color affecting the great mucous folds inferiorly towards the pylorus. A cherry red color prevailed in the fundus of the stomach. Mucous mem- brane not apparently softened. Vessels beneath mucous membrane large and well marked. Intestines 4 lbs. 12 oz. m • • [CASE NO. 48.] Hospital Number, ") 474. j Jacob Breaker, corporal, Co. B, 12th TJ. S. Infantrj; age, 21; na- tivity, Indiana; single. HISTORY.—(ANTE MORTEM.) Brubaker, a paroled prisoner of good physical development, was admitted into "National" Hospital March 17th, 1865, after twenty or thirty days sickness. Symptoms when admitted:— Fever; face flushed, pulse quick, anorexia, tongue slightly coated and rather dry, nervous disturbance, hesitation in ar- ticulation, twitching of corners of mouth, some tremulesness of tongue, hyperaesthesia, shrinking from pressure over the abdo- men and chist, slight cough. The lungs were resonant on percussion; auscultation revealed over the posterior surfaces of lungs sibilant and senorous rales. The bowels being consti- pated, mass hydrarg. and ext. colocynth. comp. were given as a purgative; subsequently tinct. cinch, comp. and wine were administered. 109. March l^th.—Netvous" symptoms more marked^rolling restlessly from side so side in bed. A slight rash was observed over the abdomen and chest of a purpura hue, not elevated and not disappearing Under pressure. There were one or two aTvme evacuations a day1. The tongue was drier than when admitted. Emulsion of turpentine was tried but rejected by the stom- ach. He continued in the same typhoid condition for a week, taking quinine, whisky, carbonate of ammonia, (with Brown's mixture as a vehicle), milk punch, beef essence, etc. March 28th.—Seemed better; tongue moister; had some ap- petite; the rash had nearly faded away; he sat up a while in bed. April 3d.—He was attacked with glossitis; tongue was swollen to the thickness of an inch, dry, red and glazed. For twenty-four hours he swallowed little or nothing, he then again took stimulants and nourishment. April 4th.—His condition was somewhat improved but hi3 tongue remained swollen. He said "he felt first rate and wanted to go home." April 6th.—In the morning some stertor was noticed while apparently the patient was asleep. In the afternoon he was much worse. April 7th.—Died comatose at 10 A. M. Case reported by G.H.DARE, A. A. Surgeon, U. S. A. ------o------ POST MORTEM, Twenty-nine hours after death. Slight rigidity of the muscles. Emaciation. Sugillation Brain.—Small quantity of fluid in the sac of arachnoid, Pia mater injested, hard to detach from the cerebral surfaces. Subarachnoid fluid in small quantity about the base of the brain and in the valley of the cerebellum. Numerous puncta upon a cut surface of cerebrum. The'arachnoid observed to be generally opacified. There wasa'smaliquantity of limpid effusion in both the lateral and 110.___________________ •'7:*j—-y— •......... '" ■ • -■ in the third ventricles. Fifth ventricle was conspicuous with its contained fluid. Effusion present in the fourth ventricle also, and it was thought that much that was originally in this ventricle had escaped. A line of congestion nearly an inch in length was observed to the left of the median line, the lower extremity just above the origin of the auditory nerves, on the floor of the fourth ventricle. Numerous and conspicuous puncta were observed on sections of the pons, striated bodies and optic thalami. Substance of cerebrum more dense that that of cerebellum; not normally so, however. Pacchionian bodies well developed. Brain weighed 2 lbs. 12 oz., measured 7 inches. Lungs.—Posterior portions of both congested. The left presented in the upper and lower lobes posteriorly collections of lobules that appeared as if they had been distended and then had the air shut in; this appearance was marked in the upper lobe. Left lung measured 10 inches. The outlines of these emphysematous lobules, so to speak, were very distinct. In the lower lobe posteriorly an incision made through the cen- tre of this collection from behind forwards exhibited dark spots, not exceeding in extent the size of one lobule in which the tissue was consolidated, friable, and of the same or greater spe- cific gravity than water. The bronchial tubes of both lungs presented reddening of their lining membrane and a large quantity of translucent, bloody and tenacious mucus. Right lung measured 10 inches. Heart.—Auricular septum imperforate. Loose coagulum in right ventricle and a similar one in right auricle. Left auricle and ventricle empty. Redness of ecchymosis was ob- served in the surfaces of the heart cavities. Valves normal. Substance of heart generally flabby. Weighed 11 oz. 4 dr., measured 5 inches. Liver of dull reddish brown color. Capsule thickened, pre- senting anteriorly on the upper surface of the right lobe two adhesions of the opposed serous surfaces. Anterior border of liver somewhat irregularly curved. Substance of organ firm and tough. One region of black congestion a line in thickness of small extent anteriorly inferiorly and to the right. Weighed 111. 4 lbs. 1 oz., measured 11 inches. Spleen of large size, firm consistence, generally of a dark red color, mottled on close inspection. Weighed 14 oz. 2 dr., measured 7 inches. Kidneys flabby; cortical substance pale. Left weighed 5 oz. 5 dr., measured 4£ inches; right weighed 5 oz. 2 dr., meas- ured 4| inches. Supra-renal Capsules considered healthy. Cortical sub- stance of a yellowish color. Left more friable than the right. Pancreas presented a large head. Its section had a yellow- ish color. Weighed 4 oz. 5 dr., measured 6 inches. Intestines.—Large intestine presented a blackened surface. In the ileum Peyer's patches were conspicuous and marked with black points. In the lower part of the small intestine hyperaemia (regional) and thinning of mucous membrane were remarked. In certain lines of congestion the blood appeared to have been exuded from the vessels composing them into tissues adjacent, so that aborescences were illy defined. Bile discoloration in the jejunum and duodenum. Fundus of stom- ach bile-stained deeply. Mucous membrane of this part of the organ stringy, firmly attached to the fibrous base; of brown red color, darker superiorly; latter color not apparently associ- ated with hyperemia. Isolated brown spots on mucous mem- brane. Gall Bladder.—Weighed 2 oz, 2 dr., contained about two ounces of amber-colored bile* 112. fCASEJ JTo. 49.J Hospital Number, \ 2326. j lllchael Dougherty, private Co. B, 49th Pa.; age; 35 years. HISTORY.—(ANTE MORTEM.): Dougherty, a tough Irishman, was admitted into" this4 Hos- pital October 22d, 1864. He was wounded at Winchester, Va., September 19th, 1864. Amputation had been performed at the lower third of the left thigh September 26th, 1864. When admitted retraction or sloughing had taken place and the bone was exposed. The granulations looked healthy; l$ov. 4th.—Secondary hemorrhage took place apparently from the femoral artery; reamputation was performed by Act. Asst. Surgeon G. H.Bare, U. S. A.; about two and a half inches of the bone resected, the artery dissected up and religa- ted. The walls of the vessel were found thickened at the ex- pense of the canal, which was very small. Nov. 30th.—When the stump had nearly healed hemorrhage again took place during the night to the extent of about twelve ounces. Next morning the stump was laid entirely open and the bleeding vessel sought for, but it could not be found; hem- orrhage could not be provoked. Lint was introduced and the wound allowed to heal from the bottom by granulations. Tinct. Ferri Chloridi was freely administered. During January two slight hemorrhages took place, which were easily arrested by pressure. February 1st the stump had nearly healed when hemorrhage came on for the fifth time— slight hut frequent—once or twice within twenty-four hours; arrested by pressure on the artery at bleeding point. At the suggestion of the Surgeon in Charge ext. belladonnas was used but without any apparent effect. After continuing at intervals for five days the hemorrhage ceased. Tinct. of iron was again given. The patient's general health improved and he did well in every respect until March 12th, when a series of hemor- rhages again commenced. The stump became much enlarged and had a callous feel. The hemorrhages occurred at inter- vals of from twelve to forty-eight hours; at first slight and easily controlled by pressure. ______________________115. March 17th.—During the night the bleeding was mora profuse, the blood jetting out several inches from the limb. Next morning he had another hemorrhage. Asst. Surgeon Geo. M. McGill, U. S, A., in charge of Hospital, determined to ligate the femoral artery above. The patient was put under the influence of chloroform and an incision made five inches in length, commencing about two inches below Poupart's liga- ment and extending down the course of the limb. When the skin superficial and deep fascia were cut through a thick mass of fibrinous material was found; upon deeper incision a cavity or sinus was opened filled with pus and clotted blood; it ex- tended up several inches from the end of the stump; the sheath and coats of the vessel were disorganized up to the termination of this sinus. Above, the sheath of the femoral vessels was found, two and a half inches below the surface; it was opened; the femoral artery seen and felt; it was apparently healthy but there was no pulsation.* By means of an aneurism needle a ligature was passed around the vessel about an inch below the giving-off of the profunda. Next morning, March 19th, the patient had another quite profuse hemorrhage. The incision was extended up to Poupart's ligament and the sheath exposed above the profunda. The hemorrhage was found to proceed from a solution of continuity! in the femoral above where it had been tied, between that point and the origin of the profunda, thus ac- counting for the absence of pulsation noticed in the previous operation. A ligature was applied just above the profunda. There was obstinate bleeding from a vein on the pubic side at tihe upper end ofthe incision;! this also was ligated. The pa- * Pressure had by this time been maintained for some time over the artery in the swollen groin, and there was no bleeding when this pres- sure wa§ removed. It was thought at the time that a species of com - pression was maintained above by the inelastic tissues compressed about and upon the artery, an adequate means in measure in consideration of the feeble cardiac vis a tergo. t This "solution of continuity" was an anterior slit presented in a portion ofthe artery, about an inch in length, in which there was con- siderable distension with softening and blackening of the coats. This diseased portion ofthe artery might properly be snid to present appear- ances as if macerated and partly putrined. The walls of the diseased portion below the slit flapped together. It is worthy of note that the arterial tissue was healthy below, where first tied. X Probably the remaining portion of the internal saphenous T«ia had keen injured accidentally. 114. tient's condition was, subsequent to the operation, exceedingly feeble and prostrated from loss of blood. For twenty-four bourn he vomited everything taken: his stomach then became retentive and he took stimulants and nourishment freely. His general condition continued to improve uutil March 25th, when during the night the vessel gave way at the ligature and there was a gush of blood, which was immediately arrested by the finger of the prompt and attentive chief nurse, Ben. Carman. As the last and only resort ligature of the external iliac was resorted to. Hemorrhage was easily controlled by the finger applied to the bleeding mouth. An incision was made by Asst. Surg. MoGill, U. S» A., about four inches in length, commencing at the outside ofthe external abdominal ring and extending nearly to the anterior superior spinous process of the ilium. The subsequent steps of the operation were performed in the usual manner and the artery ligated without difficulty or accident. After the ligation of the iliac there was no further bieeding from the upper orifice of the femoral but obstinate and quite profuse recurrent hemorrhage took place from the profunda; its mouth was caught up with the forceps but it gave way under the ligature. The vessel was again seized deeply with the bull-dog forceps which arrested the hemorrhage. The patient's condition was so exceedingly feeble that further attempts to ligate the artery were deemed uinadvisable. The forceps were therefore left oa, being retained in situ by a pyramid of lint. Next morning the patient was found in a remarkably good condition; he had taken and retained stimulants and some nourishment and was smoking his pipe with apparent satisfac- tion. Another hemorrhage occurred in the night following the operation, which through the neglect of the nurse was not observed till the following morning when it had ceased. The second night after there was another bleeding.* Lint saturated with the solution of persulphate of iron was applied and a half- pound weight put on it. March 29th and 30th there was no hemorrhage; the patient's condition continued very feeble. Mareh 31st—Had two chill's in the morning, followed by cold perspiration. The case looked very much like pyjeroia. * Both these bemorrrhages subsequent to the ligation of the iliac and e1.'. *u:r of the profunda wrre nenous. 115. The were no symptoms of peritonitis. During the night pa- tient had two slight hemorrhages. April 1st.—Looked better; took some nourishment; had slight chilliness in the morning. April 2d.—Patient's condition had apparently much im- proved; he had eaten quite a hearty breakfast and was more cheerful The bull-dog forceps still remained in the wound. The majority of the later hemorrhages had taken place appar- ently from above the profunda, and to the inner side, where the vein had been ligated. April 5th.—Had a chill; was more feeble and prostrated. April 6th.—Commenced to expectorate puruloid sputa; this symptom continued until his death. He sank slowly, intellect continuing clear until a few hours before death. At the mid- night round he was smoking his pipe, though he told the med- ical officer of the day that he was dying. April 8th.—He died at 6 A. M. ------o------- POST MORTEM, Thirty hours after death. Slight rigor-mortis; some slight emaciation. Surfuce of body very white and anemic. A great excess of adipose tissue was found over the anterior of the thorax and abdomen. Brain.—About two ounces of serum in the sac of the arach- noid. Substance of the brain presented an anemic appearance; was of firm consistence. Very small quantity of serum found in lateral ventricles. Choroid plexuses and velum interpositum unnaturally anemic. Floor of the fourth ventricle normal. Brain weighed 2 lbs. 15 oz., measured 7 inches. Lungs.—Surfaces of both almost universally covered with melanic matter The lobules on the posterior surface of the lowest lobe of the right lung were filled with air.* Their out- lines were well defined by lines of melanic matter. Substance of both lungs essentially healthy. The bronchial tubes well reddened and lined with mucus, but nothing was found to account for the puruloid character of the sputa observed for * yeaning conspicuously distended. 116. two or three days before death. Weight of right lung 1 lb. 1 oz., measured 11 inches; left lung weighed 1 lb. 6 oz., measured 10 inches. Heart.—A superabundance of adipose tissue over the sur- face. Clots composed of fibrin and black blood found in both ventricles; larger on the right side. Auricular septum imper- forate. Weighed 1 lb, 6 oz.,* measured 6J inches. Liver.—Substance of a pale pinkish color and of firm con- sistence. Weighed 3 lbs. 12 oz., measured 11 inches. Spleen of a light red color. Substance of an almost pulta- ceous consistence. Weighed 7 oz. 4 dr., measure'd 5£ inches. Kidneys.—Substance somewhat pale, organs in other re- spects healthy. Right weighed 6 oz., measured 5 inches; left weighed 6 oz., measured 5 inches. Pancreas normal; weighed 3oz. and measured 6 inches. Gall Bladder filled with amber-colored bile. Weighed 4 dr., measured 2J inches. Intestines.—Throughout the intestinal canal the mucous membrane was thin and pale. Some hyperaemia of the mucous membrane of the stomach, especially in the fundus. Weighed 4 lbs. 4 oz.f Examination of the Stump.—An abcess was found on the inner side of the bone, extending from above the giving-off of the profunda to the end of the stump. At the termination of the abscess there was a large pouch. This abscess contained about four ounces of pus. The tissues of the stump were pale and flabby.| Whole case reported by G. H. DARE, A. A. Surg. r. S. A * Ctotsaad appendages iacladed, ofeenise. t The peritoneum was perfectly healthy. i A firm elot was observed in tb« ilia* m»ft?py, above the ligature 117. [CASE NO. 50.] Hospital Number, ") 345. j Jacob Crow, corporal Co. I, 20th Ohio; age, 32; nativity, Ohio; sin- gle. Was admitted March llth, 1865, from Annapolis, Md. He was a paroled prisoner. HISTORY.—(ANTE MORTEM.) Physique.—■Dark hair and eyes. Slightly emaciated. Condition on Admission.—Patient has symptoms of incipient typhoid fever. Eyes heavy and expressionless; tongue dry and dark in the centre. Slight tenderness in right iliac fossa; some sordes about the teeth. Intellectual faculties obtuse; can give but little history of his past condition. Was placed on the usual treatment of typhoid cases and gradually im- proved until he was able to sit up for several hours a day. About April 1st a red spot appeared on the right cheek, which spread rapidly, and on the following day was pronounced to be erysipelas. The eruption soon covered his entire face to the margin of the hair, and spread over his eyes and to the back of the neck. He was treated with the external applica- tion of iodine, with regular and large doses of niur. tr. ferri. The erysipelas soon disappeared, when he in his sleep scratched off the cuticle from the right side of his face, which brought on a relapse ofthe disease, confined to that side. He became de- lirious at the subsidence of the eruption, which led to the apprehension that it had become plegmonous, which proved to be unfounded. The delirium assumed the form of almost mania. The patient was controled with much difficulty and at times with force. Large doses of opiates only exerted a tem- porary effect. This continued until opisthotonos came on and with it a partial unconsciousness. Mental action became more feeble until he died, April 10th, If 65. Case reported by W. G. SMULL, A. A. Surgeon I". S. A. 11*. POST MORTEM, April llth 1865, eighteen hours after death. Good muscular development. Compact form, about five feet 7 inches in heighth. Slight rigor mortis. Considerable ema- ciation. Brain.—Pia mater congested; not adherent. Puncta nu- merous, especially on the left side. Limpid serum in both lateral ventricles; at least an ounce in each. Floor of fourth ventricle slightly discolored; marked with lines of congestion, especially near the approaches of the cerebellar ventricles an- teriorly, and presenting two small and regular congestions, half an inch apart, in the median line above the origin of the auditory nerves; the upper the smaller but the more intense. There was apparently some fine congestion of the pons and medulla. Cerebellum softer than cerebrum. Brain weighed 3 lbs. 2 oz., measured 7 inches. Lungs.—Substance ofthe right lung somewhat doughy, con- gested hypostatically; marked posteriorly with emphysematous lobules and presenting anteriorly a single band of adhesion adjacent to which was comparative solidification of pulmonary tissue. This was, however, not sufficient to make the specific gravity of the part affected by it greater than that of water. Left lung similar to the right. One interlobar adhesion band presented. A dividing sulcus by which a third lobe was formed was observed in the superior part of the posterior lobe. The small lobe observed was divided into three parts by secondary Bulci. Several hard granular masses were found in this lung. Bronchial glands small and black. In the bronchi of the left side there was a puruloid fluid and the tubes were intensely congested; without tumefaction. The bronchi of the right lung were not so much congested and the fluid in them wag frothy. Right lung weighed 1 lb. 12 oz., measured 10 inches; left lung weighed 1 lb. 9 oz., measured 9 inches. Heart.—Mixed clot in right auricle, mostly white. Mixed white clot in right ventricle, attached as usual—more firmly than usual to the posterior (inner) cusp. Mixed clot in left auricle. White one in left ventricle, connected by a process with the apex. Ventricle clots ear-marked opposite valves. 111). Organ flabby (flaccid and pale colored), otherwise normal. Weighed 9 oz., measured 4| inches. Liver of natural color, consistence and general character- istics. Black congestion anteriorly inferiorly and to the left, affecting also the candate lobe but not exceeding a line in depth. Weighed 2 lbs. 12 oz., measured 10 inches. Gall Bladder.—Bile of amber color, about an ounce in quantity. Spleen large; somewhat blackened internally and inferiorly. Substance very easily pulped. Weighed 1 lb. 1 oz., measured 7 inches. Kidneys slightly congested along the tubular lines. Right weighed 7 oz., measured 5 inches; left weighed 5 oz., meas- ured 4£ inches. Pancreas normal; weighed 4 oz., measured 7 inches. Intestines.—The mucous membrane of the canal was thinned and readily to be separated by the finger. The intestinal sur- face was hyperaemic in the ileum, in the lower and upper part of jejunum and in the mucous folds of the stomach. Peyer's patches well defined, not apparently diseased; presenting black points (the "shaved chin"). Weighed 3 lbs. 14 oz. Urine examined and found to contain no albumen. 120. [CASE No. 51.] Hospital Number, \ 578. ) Robert Minchion, private Co. D, 2d Mass. Vols.; age, 18; natitity, Nova Scotia. Admitted March 27th, 1865. HISTORY.—(ANTE MORTEM.) Physique.—Lightly hair and eyes, fair complexion; mus- cular development good; body beginning to give evidences of emaciation. Personal cleanliness has been much neglected. Patient on admission manifested symptoms of considerable nervous disturbance, was tremulous; tongue dry and coated with a dark yellow crust. But little tenderness over the abdo- men. Evacuations regular. Over the lower extremities, from the hips downwards, was a peculiar eruption with a red areola encircling a dark centre in a state of incipient sloughing. They [these spots of eruption] varied in size from that of a five cent piece to that of a half dollar. Patient complained much of the fatigue of travel and of pre- vious hardships endured on Galloups Island, Boston Harbor. Stated that inferior food and great scarcity of water were the causes of his being in his present condition of prostration and filth. Patient was always perfectly rational when addressed, but slightly deaf Slight stimulation followed by hygienic measures improved him for a time. About one week after admission an eruption appeared on the left side of the face, near the angle of the jaw, extending slightly down the neck and resembling in appearance that pro- duced by croton oil. In two days this became somewhat umbilicated in several places, for which reason he was isolated from the rest of the patients. The centres of the eruptions of the legs gradually sloughed. Symptoms of cerebral compli- cations began to manifest themselves by patient's delirium, occasional incoherent answers to questions; followed by dimness of vision, contraction of the pupils, suffusion of conjunctiva; and gradually increasing opisthotonos. The patient remained in a state of partial coma until within twenty-four hours of death when he became wild and almost unconfrolablc. This 121. was succeeded by great muscular prostration from which he could not be revived. Patient died April 12th, 6 o'clock A. M. Treatment throughout was adapted to indications; chiefly tonics and stimulants counter-irritants and revulsives. Case reported by W. G. SMULL, A. A. Surgeon U. S. A. ------o------ POST MORTEM, April 19th, nine hours after death. Body emaciated and rigid. Body marked by ulcerations, especially the lower extremities and the left side of the face and neck. Brain.—Small quantity of fluid in the sac of the arachnoid, in which, especially on the right side, there were flakes of lymph. Pia mater was finely congested and presented filled veins. About the perforated spaces, commissure of the optio nerves, left fissure of Sylvius, anterior portion of pons and upon the arachnoid membrane stretched over the valley of the cere- bellum, flakes of lymph, well marked, loosely and closely at- tached, were observed. Puncta numerous on cut surface. Large quantity (half an ounce, minimum estimate) of amber- colored flocculent liquid was observed in the right lateral ven- tricle. In the horns of this ventricle flakes of lymph were observed. Its lining membrane was intensely congested. The left lateral ventricle presented less fluid, a greater uumber of flocculi, and more incense congestion of the lining membrane. The third ventricle was filled with similar fluid, full of flocculi; these lodged principally in the infunclibulum. Pineal body very large. The fornix and lower portion of corpus eallosum were greatly softened; the former had the consistency of thick cream. The floor of the fourth ventricle was generally discol- ored. About the origin of the auditory nerves, on. the left side above and below, on the right side upon the origin, small blood spots were observed. On the right side these: spots were less intense—two in number with the smaller one below ar*} to the right. On the left side there were seven spote: 112 five below and two above. The outlines of the originating auditory nerves were indistinct. On the left side superiorly in the approach of the left cerebellar ventricle there was a quadrilateral blood spot one line by two, so far as could be determined, underneath the lining membrane of the ven- tricle. Lower than this on the right side, in a related posi- tion, there was a stellate congestion. In the choroid plexuses of the lateral ventricles lymph was abundant. Brain weighed 2 lbs. 10 oz. 4 dr., measured 7 inches. Lungs.—Bronchial tubes of both finely congested. Left lung presented several atelectases, so to speak; otherwise nor- mal. Posterior two-thirds of the uppermost lobe of the right lung pneumonified. The pneumonified substance was not easily pulped, granulating rather under pressure, still yielding a puruloid fluid. When observed closely a fine granular ap- pearance was readily detected upon a torn or cut surface. The posterior portion of the lower lobe was finely nodulated to the feel and broke up readily under the finger. Substance on section presented a mottled appearance: grey mottlings in a cherry colored base. Substance of greater specific gravity than that of water. Left lung weighed 1 lb. 5^ oz., measured 9 inches; right lung weighed 2 lbs. 12 oz. 4 dr., measured 9 inches. Heart.—Clot originating in right auricular appendix passed through the auriculo-ventricular opening and connected with clots attached along the anterior surface of the ventricle and based upon the three cusps and their tendinous cords. The base supported an arm, partly mixed and auricled, into the pulmonary artery. In the left auricle a clot formed by arms from the pulmonary veins joined a small band connected with the left auricular appendix and proceeded to be attached to the anterior cusp ofthe bicuspid valve. On theanterior surface of this cusp a small pyramidal clot was found, joining the base of which there was an arm extending into the aorta; arm also auricled. Heart weighed 11 oz., measured 4-.1,- inches. Liver presented a mottled appearance superficially and a slight blackish injection inferiorly and anteriorly. , Normal in consistence, color and other phenomena generally. -Weighed 3 lbs. 11 oz., measured 11 inches. Svlexn.—Dorsum mottled, nodulated to the feel. Internal 123. surface mottled, black and injected. Section of substance pre- sented a somewhat homogenous appearance and exhibited a substance of somewhat firm consistence. Weighed 10 oz. 4 dr. Kidneys normal; somewhat injected posteriorly. Right weighed 6 oz. 4 dr., measured 5 inches; left weighed 7 oz., measured 5^ inches. Supra-renal Capsules of large size but of normal appear- ance. Pancreas normal; weighed 2 oz. 2 dr., measured 8J inches. Intestines.—The large intestines were regionally hyper- aunic, presenting a somewhat ironed appearance in the trans- verse and descending colon and somewhat contracted in the ascending. No marked phenomena except enlargement and definition of the colic glands. Peyer's patches were well marked throughout the ileum, but not hypera3rnic. The mucous membrane of the ileum was thinned and ironed. There was congestion of the mucous folds of the stomach. Weighed 4 lbs., measured 36 feet 6 inches. Spinal Cord.—A quantity of seroid fluid flowed out of the sac ofthe arachnoid while the spinal column was being broken open. The sac of the arachnoid was found occupied with a mass of lymph firmly attached to the visceral surface. Pia mater found congested. Spinal marrow was apparently soft- ened and broken about the middle of the dorsal region. Softening also observed nearly opposite the first lumbar verte- bra. The lesion in the dorsal region might possibly have been made accidentally while opening the column. The existence of softenings was undoubted.* * It is my opinion that this case was originally one of modified vari- ola of the confluent variety, in the course of which disease, under the cerebral type of disease prevailing, general cerebro-spiual meningitis supervened. The brain involvement presents the phenomenon of being symmetrical, instead of hemiplegic as ordinarily observed when com" plicating. 124. [CASE NO. 52.] Hospital Number, 1 619. j William Bogardus, Capt. Co. G, 86th 111. Vols.; age, 43; nativity New-York; was wounded near Petersburg, Va., March 19th, 1865, and was admitted to Hospital April 10th, 1865. HISTORY.—(ANTE MORTEM.) The ball entered over the right sacro-iliac symphysis. About four inches from this point, in a line drawn downwards and outwards, in the gluteal region, on a level with the extremity I ^ of the coccyx, an incision had been made through which the , A, fy ball was extracted. The patient stated that he had done well \\ f1 un^il three days before, when he was taken with chills and \ vV V-V rtecame rapidly worse. He was in a very low condition; had ^) ' a- Jl an involuntary alvine evacuation immediately after admission. v.^ ' W\ He talked sensibly, but was nervous and flighty. Had just W Jfj' had a chill which he ascribed to not having passed water for (^ f aj thirty-six hours. About twenty-four ounces of urine were ( x drawn off with great relief to the patient. The lungs were ex- (V^/ amined and no marked abnormality detected. There was little V / or no tenderness over the abdomen. Moist oakum was applied v to the wound and tr. cinch, com., brandy, beef essence, etc., administered. April llth —Was apparently in a dying condition; there had been frequent involuntary evacuations, thin and of a yellow color. Patient had another slight chill; intellect much obtunded; pulse enceedingly feeble. Catheterization nerformed; lead and opium given; stimulants pushed. Afternoon.—Condition apparently improved; the diarrhoea had ceased. April 12th.—Worse; had had several involuntary evacua- tions. Catheter used. Ordered pills of ext. nuc. vomicae, opium and nitrate of silver. Afternoon.—Sinking; bowels quiet. April 13th—Early in the morning the bowels again gave way. Died at 7 A. M. Case reported by (}. II. HARE, A. A. Surg. U.S. A. 12.r>. POST MORTEM, Seven hours after death. Muscular system well developed. Slight rigor mortis. Sugillation. Brain.—A quantity of serum was found in the sac of the arachnoid; about one ounce minimum estimate. Pia mater injected. Limpid serum found in lateral ventricles, and the lining membrane of these ventricles was ingested. No com- missura mollis was found in the third ventricle. Pineal body small. On the floor of the fourth ventricle, in the median line, there was a marked line of congestion half an inch long, be- ginning a quarter of an inch above the origin of the auditory nerves. Puncta conspicuous on a cut surface. Substance of cerebrum firm. Brain weighed 3 lbs, 7 oz., measured 7 inches. Lungs.—Old pleuritic adhesions on the right side, saccular and interlobar. Whole of the right lung ingested. The pos- terior part of the lower lobe found so collapsed, carnified or cuirassed, as to be of the specific gravity of water. In the left pleural sac there was a large quantity of yellowish fibrin de- posited on both the visceral and parietal surfaces. The left lung presented generally an ingested appearance similar to that of the right. In the lower lobe numerous fibrinous de- posits were observed, which were readily broken down, forming thus a puruloid fluid. These deposits were considered so-called metastatic in character, the result of pyaemic* disease. In the middle of the exterior surface of the upper lobe of this lung, in the centre of u nodule of solidification about the size of a walnut, there was a white mass which readily broke up and upon pressure yielded at first a yellowish puruloid Suid and next a vermiform lymph-like matter. Tissue of this nodule sank in water. Most of the masses of white substance observed in the lower lobe broke up granularly. Left lung weighed * During these post-mortems pyaemia was viewed ns a vital condition of action, obtaining with equal force in all the centres of force in the body, originated by induction by contiguity from disenscd surfaces and exhibiting by remainder or by quality in the specially predisposed centres of force the action of ineffective formation of tissues with its resultant fibrinous or, more generally, corpuscular lymph. 120. 1 lb. 2 oz. 4 dr., measured 9 inches; right weighed 1 lb. 2 oz. 3 dr.; measured 9 inches. Heart.—In the right auricle a clot originated in the ap- pendix, was attached along the pectinate muscles of the base and connected with a clot that adhered to the anterior wall of right ventricle and was based upon the anterior and right cusps. The base of the latter clot supported an arm which extended into the pulmonary artery and was auricled opposite (he pulmonary valves. The clots of the auricle and ventricle had a greenish hue; so had the lining membrane of these organs. A clot similarly colored and connected in the usual manner was observed in the left auricle and ventricle. Heart otherwise normal. Weighed 9 oz. 2 dr., measured 5 inches. Liver.—Of reddish-brown color externally; bile tinted upon section; somewhat too friable; nutmegged. The hepatic odor was rank, yet not to be perceived at the usual distance (that is, about four inches). Weighed 3 lbs. 13 oz. 4 dr., measured 11| inches. Gall Bladder.—About one and a half ounces of viscid bile, so tenacious that in pouring from the sac it formed a column eightc#n inches long and quite stable, were contained in the bladder. Weighed 2 oz., measured 4| inches, (extremly). Kidneys.—Tinged yellow. The pelvis of each presented a bile tint. Left weighed 5 oz. 3 dr., measured 5 inches; right weighed 6 oz., measured 5 inches. Sacs of the supra-renal capsules distended with bloody fluid. Substance readily broken down into a greyish pulp. Pancreas normal; somewhat yellow. Weighed 2 oz., measured S£ inches. Spleen of dark color, somewhat mottled externally and on internal section. Consistence normal. Weighed 9 oz. 4 dr., measured 4 inches. Intestines.—In the large intestine which was generally dark colored and somewhat distended there were patches of lymph,* or substance like it, finely granular in structure, one- 's The appearance of lymph on the mucous surface of the large intes- tine, joined to that of the conspicuous patch observed near fhe beginning of the jejunum, suggests the hypothesis of a fibrinous lymph action in the baffement membrane of the intestinal mucous membrane, correspond- ing generally to such fihrinous action of tissue as develops what has been viewed as metastasis and what in this case forms the fibrinous masses observed in the right lung. A diarrhoea under such circum- ytrwieos may be pathognomonic of pyrcmia. 127. layered and generally limited in extent to a single fold of mu- cous membrane. Minute hasmorrhagic spots, sporadic, were seen in descending colon and sigmoid flexure. The caecum and ascending colon were darker than the remainder of the large intestine. In the upper part of jejunum there was a region in which greenish lymph flakes, granulated, were found on a red roughened base. These patches were apparently the result of inflammatory action. The Wound.—Ball entered nearly opposite the transverse process of the right side of the fifth lumbar vertebra, passed inwards forwards downwards through the sacro-iliac junction, probably lodging in or beneath this junction viewed from be- hind. What was thought to be the ball was felt in this posi- tion, although statement had been mado that it had been ex- tracted on the field. Friends of the patient were urging us so just here that it was found impossible to carry the examination farther. "f" [CASE No. -53.] Hospital Number, | Daniel Bivins, private Co. C, 133d N. Y.; age, 25; nativity, New- York; single. HISTORY,—(ANTE MORTEM.) Bivins was admitted on the evening of April llth, 1865. Saw him next morning; he was then very restless and irra- tional, breathing with great difficulty, lips and face blue, pulse rapid and feeble. On percussion there was dullness over the right side of the chest anteriorly and posteriorly with fine crep- itation and pleuritic sound over the lower lobe of the right lung anteriorly and laterally. Tongue was dry, brown and cracked; teeth covered with sordes. During the day he passed his feces and urine involuntarily and freely. Dry cups followed by blisters were applied to the chest and an anodyne given. April 13th.—Not quite as resile.---, as yesterday; unable to give any account of his case. Diarrhoea obstinate; breathing 128. apparently better, though the inflammation has extended over the whole of the right lung. April 14th and 15.—Symptoms continue the same though the diarrhoea is increased. Turpentine has been given from the beginning. Beef essence and milk punch have been plen- tifully administered. He sank during the night of April 15-16th. Case reported by J. G. KELLER, A. A. Surgeon U. S. A. ——o------ POST MORTEM, Thirty hours after death. Body not emaciated and but slighily rigid. The muscular system is pretty well developed. Considerable sugillation pre- sented. Brain.—Fine congestion of the pia mater. Fornix softened. Ingestion of the lining membrane of the ventricles presented. Limpid serum found in both lateral ventricles. Lines of con- gestion on the floor of the fourth ventricle, central and lateral, above the origin of the auditory nerves. Numerous conspicu- ous puncta were observed in the brain substance generally, more especially in that of the pons Varolii. Weighed 2 lbs. 15 oz., measured 7 inches. Lungs,—Evidence of hypostasis was presented in the inferior lobe of left lung, the posterior surface of which was mottled. In a considerable portion of this lobe a cut surface presented numbers of black spots, associated with the vessels and appar- ently formed by the infiltration of blood about the courses of these vessels. These spots broke up readily under pressure, yielding a blood-clot pulp. This lobe did net collapse or crep- itate like healthy pulmonary tissue, except at the extreme anterior border. Black spots resembling bruises were pre- sented on the posterior part of anterior lobe of this lung, (the left). On the surface of the right lung there were old pleuritic adhesions and the lobes were bound together; only two lobes existed. Hypostatis in posterior portion of this lung. Vine 129. mottlings on a cut surface. Solidification tendency in tissue. Color and consistence of the substance of the posterior portion of this lung similar in characteristics to the corresponding part of the left. Substance nearly ofthe specific gravity of water. When the tissue of a black spot was broken up a liquid flowed from it like that which flows from a broken up black clot that manifests a tendency to organize. Heart.—Auricular septum perforate. White clot in right auricle and in right ventricle, attached in the usual manner. Pulmonary arm auricled. A mixed clot found in left auricle. In the ventricle there was a thromb attached to the anterior cusp of the mitral valve Valves and substance normal. Little or no tinging of the coats of the aorta. Weighed 15 oz., measured 5| inches. Liver.—Organ presented when viewed from above a mar- bled appearance, haviug broad dark bands and fine veins especially marked on the right. The basement substance (inter acinos) was of a yellowish red color. Section presented a nutmeg appearance. Consistence firm; organ not very full of blood. The tissue inferiorly had more blood than supe- riorly. Superficial black congestion centrally inferiorly along the anterior border. Weighed 4 lbs. 8 oz„ measured KM inches. Gall Bladder contained about one ounce of bile containing granules of cholesterine and of an amler color. Weighed 1 oz. 4 dr., measured 4 inches. Spleen.—Normal in size; congested black superficially about the hilus. Weighed 8 oz., measured 5| inches. Pancreas flabby and bloody. Weighed 2 oz. 4 dr., meas- ured 9 inches. Kidneys.—Substance had a bluish appearance; no acute hyperaemia; slight hypostasis. Left weighed 6 oz., measured 4 inches; right weighed 5 oz. 4 dr., measured 4J inches. Intestines.—No lesion other than hyperaemia in the larg intestine. In the ileum and lower part of the jejunum there was marked enlargement of the solitary glands. Peyer's patches well defined. Mucous membrane thinned and soft- ened. Hyperaemia well marked in the upper and lower por- tions of jejunum. Valvulae conniventes in the upper part of the jejunum discolored with bile and ingested. 130. In the stomach blood spots were observed under the mucous membrane, following the course of the folds generally. A well marked region of apparent ecchymosis observed under the mucous membrane of the smaller curvature. [CASE NO. 54.] Hospital Number, | 2728. ) John Bramon, private Co. D, 16th Iowa; age, 42; nativity, Denmark. was admitted November 28th, 1864. HISTORY.—(ANTE MORTEM.) Physique.—Light hair and eyes, fair complexion; somewhat enfeebled by previous sickness. Patient stated that he had been attacked by intermittent fever sometime since, from which fever he is much prostrated and still liable to similar attacks. After admission he did not have an attack for one week, after which it (the fever) con- tinued at regular intervals until its periodicity was overcome by quinia and alteratives. Patient so far recovered in about three weeks as to be able to do light duty. With the exception of occasional attacks he enjoyed apparently good health until about April 1st, 1865, when he complained of having taken a heavy cold, This was soon succeeded by high fever, frequent coughing and slight expectoration of light rust-colored sputa. Examination showed dulness posteriorly of both sides of the chest beneath the sca- pula, with the crepitus of pneumonia over a space of a few inches square in each lung. Under treatment symptoms of pneumonia almost entirely disappeared; patient became able to >it up. His appetite returned and he began to gain strength. April 10th.—Patient complained of great lassitude, loss of appetite and sleeplessness. Tongue became dry and dark. There was some abdominal tenderness in the right iliac fossa. Kxcretions scanty. On the following day a diffused eruption appeared on the entire body, of a reddish papular appearance. Patisnt was porfectly rational and co nplained only of execs- 131. nive weakness. Appetite entirely deficient. He remained in this condition without apparent change uutil April 14th, when it was found difficult to elicit answers to questions. There was scantiness of excretions and a peculiar odor of the body. Urine examined and found to contain no albumen. Bowels opened by cathartics and enemas. A sudden change came over the patient on the following day, April 15th. The surface of the body became mottled and cold. The face assumed a dusky hue. Tongue was pro- truded with much difficulty and was covered with a soft dark sordes. Eyes suffused and pupils contracted and responding very feebly to tbe action of light. No amount of revulsion could arouse him. The impulse of the heart bocame more feeble. He died at 5J o'clock, P. M., April 16th, 1865. There was no opisthotonos throughout the case. Case reported by W. G. SMULL, A. A. Surgeon U. S. A. ------o------- POST MORTEM, Surface of body marked by spots of discoloration of different sizes, many of them running together as it were. Marked rigidity. Brain.—About an ounce of serum in the sac of the arach- noid observed in the removal of the brain. Pia mater finely ingested. On the vertex of the right hemisphere there was a spot of ecchymosis as large as a cent; there was also a simi- larly situated spot, not quite so large, on the vertex of the left. The substance of the cerebrum was generally but slightly con- gested. Serum was found in small quantity in both lateral ventricles. A single central line of congestion was found on the floor of the fourth ventricle, above the origin of the audi- tory nerves. Brain weighed 2 lbs. 13 oz., measured 7.V inches. Lungs.—Pleuritic adhesions on both sides. No effusion of scrum. Left lung collapsed and flaccid; ingested posteriorly. Right lung similarly affected. Posterior congestion rescm- 132. bling ecchymosis. Right lung weighed 1 lb. 12 oz., measured 9 inches; left weighed 1 lb. 15 oz., measured 8^ inches. Heart normal; presented clots attached in the usual man- ner. Weighed 12 oz, 4 dr., measured 5^- inches. Liver.—General congestion with regional discoloration of the organ. Substance of high specific gravity. Weighed 4 lbs. 5 oz., measured llj inches. Spleen greatly enlarged and softened. Weighed 2 lbs. 11 oz., measured 9 inches. Pancreas normal. Weighed 4 oz. 3 dr., measured 9 inches. Kidneys normal. Left weighed 7 oz., measused 5 inches; right weighed 6 oz. 4 dr., measured 5 inches. Intestines.—Hyperaemia of the ascending colon. Peyer's patches marked with black spots conspicuously. Some bile discoloration in the upper part of ileum and lower part of jeju- num. Regional hyperaemia in the ileum. Ecchymosis under the raucous membrane of the fundus and lesser curvature of the stomach. Congestion of the duodenum with ironing. Weighed 4 lbs. 3 oz. Gall Bladder.—The bile found in the gall bladder was of a dark brown color. 133. [CASE No. 55. Hospital Nimwei;, [ 051. j Samuel Q. Hnrgnive, private Co. K, 1.V2 Ind.; age, 19; nativity, Ind. Admitteii April llth, 1865. from Stephenson Station Hospital. HISTORY.—(ANTE MORTEM.) History of the case somewhat obscure as the patient was delirious when admitted. Symptoms.—Pulse rapid and thready; tongue dry and of a light brown color; bowels constipated; pain and tenderness in the right iliac region; bladder full of urine. The head was extremely extended and on the back of the neck were marks of recent vesication. Pupils slightly contracted. No erup- tion was observed on any part of the body. Treatment.—His bowels were moved by enemata. Urine drawn off in large quantity. A half grain of morphia waa given and quiet sleep of several hours procured. Five grains each of quin. sulph. and potass, chlorat. were given every four or six hours, and beef essence, milk punch, and occasionally eggs, as a diet. Patient, when not under the influence of anodynes, was ex- tremely restless, tossing about in bed, and when not closely watched by the attendant would get out on the floor. Occas- ionally he would appear rational; and when addressed would answer questions, though briefly and incoherently. As far as could be ascertained he had been sick about ten days previous to admission. Cold applications were made to the head. Blisters were applied to the nape of the neck and down between the shoulders. On the 19th his tongue was observed to be swollen and de- glutition rendered exceedingly difficult. Patient expired April 21st. Opisthotonos continued extreme throughout the disease. An assistant (Mr. A. E. Hall) drew off the urine twice daily, in ordinary quantities, and frequently tested it finding it normal. < W reported by J. 0. KELLKK, A. A. Surgpon T". S A 184. POST MORTEM, Twenty-eight hours after death. Body slightly rigid and much emaciated. Brain.—Between the arachnoid and pia mater, over the pons crura cerebelli perforated spaces and origins of fissures of Sylvius were thick deposits of lymph. At the termination of the fissures of Sylvius were other deposits: also others at the summits of the hemispheres. All these observed to be under- neath the visceral arachnoid. No microscope was used, how- ever in determinatiou of this observation. In the right choroid plexus of third ventricle a sac of the size of a large pea was found, which contained lymph and pus. In the middle horn of the left lateral ventricle flakes of lymph were observed. Floor of fourth ventricle was reddened and presented numerous fine aborescences generally disposed over its surface. In the valley of the cerebellum another lymph deposit was found; this also under the vis ceraL arachnoid. Pia mater was in- tensely congested universally. Veins greatly engorged. Cere- bral puncta numerous. Fornix was thought to be softened. Substance of brain proper not apparently altered in consistence. The blood was fluid in the larger vessels. Brain weighed 5 lbs..3 oz. 4 dr., measured 7 inches. Lungs were found generally congested posteriorly, but not intensely. Outlines of lobules well marked. In certain lobules, especially of the left lung, ecchymosis had apparently taken place. Over the surface of the right lung old pleuritic adhesions were found and its substance was somewhat carnified in consequence. A soft (concretionary) substance, concentri- cally marked, surrounded by well defined pearl-colored mem- brane, was removed from this lung and preserved in view of its probably illustrating the natural process of reduction of tuberculous matter into a calcareous salt. This view was strengthened by the presence of a similar body already calca- reous in another portion of the lung. In the former substance no granulation was found. Right lung weighed 12 oz. 4 dr. measured 8 inches;: Left weighed 15 oz. 5 dr., measured 9 inches. Heart.—Bight side presented a large yellowish clot, dis- 13.'.. posed in the usual manner. A similar clot was observed in the left side. Substance of organ very firm and of a deep red color. Weighed 11 oz. 2 dr,, measured 5 inches. Liver.—Generally of a dark color. Mottled near junction of right and left lobes superiorly, with interjacent yellowish white substance, which affected the tissue of the organ to the depth of two lines or more. Substance generally of firm con- sistence, friable under 'firm pressure, very full of blood and possessing a strong odor. Weighed 3 lbs. 11 oz., measured 10 inches. Spleen.—Normal in size and appearance; full of blood. Weighed 7 oz. 5 dr., measured 5 inches. Kidneys.—Small and somewhat yellow in color; congested in depeudent portions. Right weighed 4 oz. 1 dr., measured 41 inches; left weighed 3 oz. 1 dr., measured 4 inches. Intestines.—Duodenum discolored. Hyperaemia in the upper part of the jejunum. Very marked hyperemia of the ileum, especially of the lower portion. Solitary glands en- larged and Peyer's patches well developed. Congestion was so intense near the cascal valve as to give the organ a dark-red color. Transverse and descending colon somewhat injected. Sigmoid flexure normal. Stomach congested along the mucous folds near the pylorus. Weight of intestines 4 lbs. Gall Bladder contained black and quite fluid bile. Spinal Marrow.—A grayish fluid flowed from the sac ofthe arachnoid of the cord when this was accidentally cut in the lumbar region during the process of extraction. Underneath the visceral arachnoid a great quantity of lymph was found, especially inferiorly: a deposit near the inferior termination of the marrow being from one to three lines in thickness. That it was under the visceral arachnoid and not in its sac was clearly demonstrated. Pia mater found intensely and finely congested. No bulbous enlargements or softenings of the cord were seen. Urina cadaveris tested: found to contain no albumen.- 186. <\ [CASE NO. 56.] Hospital Number, ) 681. j John Henry, an Indian, private Co. E, 1st Vt. YoV; age, 29; nativ- ity, Canada; admitted from Camp Parole, (near Ann.ipolis, Md.,) April 18th, 1865. HISTORY.—(ANTE MORTEM.) The patient was admitted in an extaemely feeble condition, and upon examination was found to be in the last stages of phthisis pulmonalis. Over the whole surface of the chest the sound was dull on percussion, and on the right side anteriorly and posteriorly humid crackling sound well marked was heard on auscultation. Cough very annoying; diarrhoea obstinate. With a view of checking the bowels tannin was prescribed. Stimulants and nourishing diet were given. A slight improve- ment was observed after second day, which proved only tem- porary. Died April 21st, 1865. Case reported by J. G. KELLER, A. A. Surg. I'. S. A. ---.—0------ POST MORTEM. Fourteen hours after death. No rigor mortis. Muscular system not developed. Brain.—About two ounces of serum flowed from the sac of the arachnoid while the brain was being taken out. Substance of organ normal. Limpid serum in small quantity found in lateral ventricles and a few fine lines of congestion on floor of fourth ventricle. Organ weighed 42 oz., measured 7 inches. Lungs.—Pleuritic adhesions general. About eight ounces of serum in left pleurul sac. Substance of lungs of high spe- cific gravity, dull water-red color darker posteriorly, yielding on pressure from sections large quantities of frothy, bloody? watery fluid. About middle of upper lobe of left lung a cut surface presented a collection of tubercles ofthe size of a pea, softer in their centres. Spots of ecchymoids were observed on 1 T>*7 lot. cut surfaces of this lung. The substance of the right lung presented characteristics similar to those of that of the left; but the miliary tubercles, frequent in the left, were very rare and isolated in the right. Left lung weighed 1 lb. 15 oz., measured 9 inches; right weighed 2 lbs. 1 oz., measured 10 inches. Heart normal. Shreddy clots of little apparent significance observed on both sides. Finely granular patches observed on the pericardium were supposed to be collections of miliary tu- bercloe in that membrane. Weighed 11 oz. 5 dr., measured 5 inches. Liver light colored and very flaccid. Substance broke up readily under pressure of the finger without any laceration of the capsule. Weighed 2 lbs. 15 oz., measured 11J inches. Splben.-»—Dorsum of bright red color. Internal surface nearly black. Substance homogeneous of nearly natural con- sistence. Seven clefts of varying depth were observed on the anterior border of this organ, Weighed 5 oz. 5 dr., measured 4 inches. G/all Bladder contained about three ounces of amber-colored bile. Weighed 3 oz. 1 dr., measured \\ inches. Kidneys large and firm, of light color. Left weighed 5 oz. 2 dr., measured 4^ inches; right weighed 5 oz. 3 dr., meas- ured \\ inches. Supra-renal Capsules light colored. Pancreas darkly discolored at the left extremity. Weighed 3 oz., measured 10 inches. Intestines.—Stomach enlarged; mucous membrane soft- ened. Some regional hyperasmia in jejunum. Intestines flaecid and thin. Ileum ironed. In this organ it was thought that isolated tubercles were presented beneath the mucotJs membrane. The distinction however between these and soli- tary glands was not clear. Some hyperamiia of ascending colon. Remainder of large intestine nearly normal. Some dark discoloration. Weighed 3 lbs. 4 oz. 138. 1 [CASE No. 57.] Hospital Number, } 607. ; Thomas Green, private, unassigned; age, 22; nativity, England. Admitted to Hospital April 6th, 1865, and died May 7th, 1805. p HISTORY.—(ANTE MORTEM.) Thomas Green, unassigned sjji>stitute, physically welfdevel- \^ ^ped, was admitted into this Hospital April 6th, shot by a de- /V * *?Ctive the da^ before' The bal1 entered half an inch to the y \^ right of the spinous process of the tenth dorsal vertebra and £ nj- lodged. Complete paraplegia immediately resulted, both of 4^' vfC?ati(>n and motio»- There was very little constitutional {^ frn*«tion; he suffered no pain. Neither the bladder nor the ^ ^bowels were evacuated. A catheter was inserted and half a \v ^ pint of urine drawn off. An anal injection was administered ¥ but it was returned without faecal matter. A dose of castor \^ oil was afterwards given and was followed by several thin in- voluntary discharges. The catheter was introduced twice a day until April 15th, when the urine began to leak away freely and the bladder could be emptied by pressure upon the hypogastrium. The prepuce had become oedematous and so much swollen as to conceal the meatus and give rise to phymosis. April 17th.—A bed-sore made its appearance. Up to this time the patients constitution had apparently suffered but little. He had complained of no pain. His appe- tite had been good and he had slept well at night. The bed- sore extended until it had become twice the size of the palm of the hand, exposing the sacrum. April 23d.—Patient had a slight chill followed by copioua perspiration. The chills persisted one or two a day. The patient lost appetite, assumed a hectic or pyemic appearance and declined rapidly. The excretions continued to be voided involuntarily. April 30th.—The patient was attacked with singultus. May 5th.—Patient was in a partially comatose condition Pupils ddated; pulse rather full but soft. Intellect very much obtundeti. He swallowed with difficulty. Mortification had 139. commenced at various points on the leg where pressure had existed. The coma deepened and the patient died May 7th, 1865. Case reported by G. II. DARE, A. A. Surgeon II. S. A. .-------rO-------- POST MORTEM, Nineteen hours after death. Body very rigid and somewhat emaciated. Sloughing of prejfuce caused by incessant trickling of urine the sphincter muscles of the bladder and urethra being paralyzed. Marks of sloughing on left leg at external malleolus and outside of knee. A large bedsore exposing the sacrum. Great sugilla- tion. Brain.—Pia mater ingested and detached with difficulty from cortical substance. At base of brain ash-colored lymph was observed from the optic chiasm and fissures of Sylvius to the valley of the cerebellum; not extending however to the sides of the cerebral hemispheres. This lymph had bluish color and was soft. Pia mater and visceral arachnoid detached generally with difficulty from brain surfaces. Serum found in both lateral ventricles in small quantity and tinted red. The corpus callosum and fornix, but especially the latter, which was like very thick cream, were much softened. The velum inter- positum was tense, opaque, thick and firmly attached to the choroid borders. The lining membrane ofthe third ventricle, as well as that covering the lateral ventricles, had a red hue. The fourth ventricle was similarly affected and presented in addition three lines of congestion, the middle about one quar- ter of an inch above the centre of audition. The lymph de- posit did not apparently take place upon the floor of this ven- tricle. Substance of brain generally was a little softer than normal. Weighed 2 lbs. 15 oz.', measured 7 inches. Lungs.—Right lung generally dark colored, having natural appearance upon edges anteriorly; posteriorly it had a doughy feel and its substance gave way readily under pressure. In- 140. tense discoloration was confined to certain lobules. A serous infiltration appeared to affect the interstitial tissue of the organ generally, but especially posteriorly. Bronchial tubes normal. Left lung weighed 1 lb. 11 oz., measured 10 inches. Right lung weighed 2 lbs., and was similar in all respects, except that there appeared to be more intense congestion pos^ teriorly. Heart.—Large black clot found in right side; the portion of this in right auricle filled it to distension. Loosely clotted black blood found in left side. Organic tissue of heart normal. Weighed 13 oz., measured 5J inches. Liver.—Large, light colored, of fine consistence, having a strong smell, full of blood, having a substance pungent and sweet and organically homogeneous. Weighed 5 lbs. 4oz., length 12 inches. Spleen of light color, very flexible, of normal consistenee and organically homogeneous. Weighed 7 oz. 2 dr., measured 6 inches. Kidneys somewhat full of blood. Right weighed 5 oz. 5 dr., length 5 inches; left weighed 5 oz., length 5J inches. Supra-renal Capsules very large, eaeh three inches long. Intestines.—Slight hyperaemia in caecum and ascending colon. Solitary glands prominent. Ironing of ileum; Peyer's patches conspicuous. In the lower part of it the jejunum was much discolored with bile. There was congestion of the fun- dus of the stomach. The Wound.—Ball entered to the left ofthe spinous process of the tenth dorsal vertebra and, penetrating to the canal, severed the cord above the lumbar swelling. Adhesions formed between the parietal and visceral arachnoid and lymph, degenerated anteriorly in some localities to a puruloid fluid, covered the cauda equina to the medulla oblongata, Some discoloration on the inside surface of the spinal dura mater, above the seat of injury, was observed; and, at the seat of in- jury, superiorly and posteriorly there was a spot of intense red- ness, such as might lead one to speculate on the conservative process of nature. In the immediate seat of injury the cord appeared to be softened and to have its grey matter thickened. 141. [CASE NO. 58.] Hospital Number, ) 783. J Tobias Gibbins, Rebel paroled prisoner; residence, Cleveland, Ohio; nativity, Maryland: a»e, 45. Admitted to Hospital May 6th, 1865, and |ied May 10th, 1865. HISTORY.—(ANTE MORTEM.) Physique —Brown hair, light eyes ; muscular system cma* ciated. Bilious and sanguine temperament. Patient admitted in a state of great prostration ; answers questions vaguely and without connection of ideas. Can give no definite account of himself nor the history of his sickness. Surface of the body dry and cool. Skin flaccid; circulation feeble, pulse 100; respiration normal in frequency. Eyes heavy and expression- less: pupils respond to light slowly and imperfectly. There was slight tenderness over the abdomen, more intense in the right iliac fossa. Tongue dry and protruded with difficulty. Examination of the chest by percussion showed dullness posteriorly and inferiorly, involving the larger portion of both lungs: on the right side extending almost to the apex of the lung. Auscultation elicited bronchial respiration in the lower half of the right lung, with occasional ronckus; crude crepita- tion was discovered in the posterior portion of the ssme lung. In the left lung (he same character of crepitation was discov- ered in the lower portion posteriorly but became finer towards •the middle and superior portion of the lung. There was no cough, no expectoration indicative of pulmonary disease and patient complained of no thoracic pain. The treatment was essentially stimulant, with all the nourishment that he could be induced to take. Patient sank slowly and perceptibly until early in the morning of .May ICth, when he died without hav- ing been thoroughly conscious from the time of his admission. Case reported by W. G, SMULL, A. A. Surg. U. S A. 142. POST MORTEM, Twelve hours after death. No rigor mortis. Considerable emaciation. Brain normal. Possibly the fornix and corpus callosum were softened. About two drachms of serum were observed in each lateral ventricle. The brain weighed 3 lbs. 9 oz., meas- ured 8 inches. Lungs.—Lower lobe of right was in a state of grey hepatiza- tion. Puruloid fluid was expressed abundantly and the tissue involved was of greater specific gravity than water. Slight pleuritis observed, chiefly interlobar, by which there was lobar attachment. Posterior part of superior lobe was congested to blackness and of greater specific gravity than water. The remaining substance of the lung had a doughy feel. Of left lung the posterior part of lower lobe was intensely congested. Substance engaged wa3 quite tough. From it on pressure a quantity of bloody fluid came. Right weighed 3 lbs. 8 oz., measured 11 inches; left weighed 1 lb. 13 oz., measured 10| inches. Heart normal; perhaps too greatly loaded with fat exter- nally. Its cavities were occupied with white clots, disposed and attached as usual. Weighed 14 oz. 2 dr., measured 6 inches. Liver of somewhat light color and firm substance, presenting superficial black congestion inferiorly. Weighed 4 lbs. 14 oz., measured 11 inches. Gall Bladder half full of semi-transparent brown bile. having a dark tinge. Weighed 1 oz. 3 dr., measured 4J inches. Spleen.—Capsule slightly thickened. Substance firm. Some blackening observed inferiorly. Weighed 11 oz., meas- ured 5 inches. Pancreas normal; very flaccid. Weighed 4 oz. 3 dr., measured 8 inches. Kidneys somewhat enlarged and full of blood. Right weighed 9 oz. 4 dr., raoasured 6 inches; left weighed 8 oz. 2 dr., measured 5^ inches. Scpra-ejenal Capbulec enlarged and £rm. 148. Intestines.—Discoloration and some softening of the walls bo as to make them easily torn, was observed in the large in- testine. Stomach discolored, (blackened). No lesion observed in small intestine. General flaccidity and regional discolora- tion by bile. \ v [CASE No. 59.1 Hospital Number, ) 705. J Sydenham Stahl, private Go. C, llth Md. Vols.; single: nativity, Maryland. Admitted to Hospitnl April 28th, 1865, and died May 12th, 1865. Residence previous to enlistment, Baltimore, Md. HISTORY,—(ANTE MORTEM,) Wanting. Patient was treated by A. A. Surgeon Charles W. Neff, U. S. A., who was requested to fnrnish ante-mortem notes, but never complied, POST MORTEM, Eight hours after death. No emaciation; slight rigidity. Sugillation marked. Brain.—Congestion of the pia mater. Some effusion in the »ac of the arachnoid, reddening of the outer surface of the right hemisphere, and, at the summit of the brain, full veins and such attachment by the action of the pacchionian bodies as caused rupture of the large veins of the pia mater in removal of brain. A little serum was found in the lateral ventricles. There were lines of congestion on the floor of the fourth ventri- cle, chiefly on the left side superiorly. In the white substance of the brain numerous puncta were observed. Pia mater was de- tached with trouble. Brain weighed 54 oz. 5 dr.; measured 7 inches. Lungs,—Both were full of blood. In the posterior part of right lung numerous minute nodules resembling in feel miliary 144. tubercles were observed. On close examination these were found to occupy the centres of pulmonary lobules in association with the bronchial tube of the lobule, which tube was filled with a thick bluish-white puruloid fluid and was itself dark red or dark purple internally. The small bronchial tubes appear- ed to be thickened in several instances and themselves gave rise to a pointed feel. The nodular feel described obtained in both lungs, but more especially in the right. A small portion of the posterior part of uppermost lobe of right lung sank in water.* Right weighed 1 lb. 7 oz., measured 9 inches; left weighed 1 lb, 6, oz., measured 9. inches, Heart,—Large mixed clot in right anricle, connected by an isthmus with pyramidal black clot in right ventricle, which was strongly attached to the anterior cusp of the tricuspid valve. This clot of the right v< u tide was slightly connected with the apex. It gave rise to a clot markedly auricled which extended into the pulmonary artery. Left side was occupied by a loose mixed clot arranged in the u.-ual manner, similarly auricled opposite semilunar valves. Heart weighed 16 oz., measured b\ iuches. Liver.—Of lead color and finely mottled superiorly on the left side and inferiorly on the right. The under surface had a light brown color. Subshmce friable, dark reddish brown on section and very full of blood. Weighed 5 lbs. 2 oz., meas- ured 12 inches. Gall Bladder contained amber-colored bile in small quan- tity. Weighed (contents included) 2 oz., measured 4 inches. Spleen of very dark color; flaccid, Weighed 1 lb., meas- ured 8^ inches. Pancreas normal. Weighed 5 oz., measured 8 inches. Kidneys.—Intercolumnar congestion. Right weighed 5 oz. f> dr., measured 5 inches; left weighed 5 oz., measured 4£ inches. Supra-renal Capsules firm and well developed. Right weighed 2 dr., measured 2 inches; left weighed 2 dr., meas- 4 ared 1^ inches. * The nodular condition was theoretically attributed to the valvular action of the plug at the exit of a primitive lobule in association with ikvcloijment of iiuiied inflammation after collapse, attended with for- mation of inflammatory products in the air cells adjacent. 145. Intestines.—With exception of hyperaemia of the rectum, sigmoid fhxure of colon and of the caecum, the large intestine was normal. A pultaceous yellowish mucus was found in lower part of ileum, associateu with hyperaemia and thinning of the gut. Great congestion in the upper part of ileum, which was not presented in the jejunum. Duodenum con- gested; duodenal glands enlarged. Stomach covered with a greenish puitaceoas mucus. Fundus reddened, the reddening extending to the cardiac orifice. In the oesophagus serrated patches of yellowish lymph like substance, firmly set in the mucous membrane, were observed. The appearances were such as one might have expected had the patient swallowed a piece of red hot iron. Intestines weighed 3 lbs. 10 oz. The lower part of aesophagas preserved. [CASE No. 60.j Hospital Number, } 787. j Anson Morse, private Co. L, 193d X. Y. Vo's.; «be there were two depressions as of cicatrices. Left border was somewhat wavy in outline. The substance was generally of firm consistence and apparently high specific gravity; pre- sented outlines of acini on a torn surface and yielded dark greenish viscid bile. Strong odor. Portions of substance very bloody and accordingly clearly exhibited on section were observed in the right of the organ. Liver weighed 5 lb;. 6 oz., measured 11 n hes. Heart.—Large white clot in right side; white clot in left nide. Substance of organ firm and of a light color. Valves normal. Weighed, without clots, 10| oz., measured 5f inches. Spleen.—Capsule of a light color, presented pits. Sub- stance firm. Weighed 7 oz., measured 5| inches. Pancreas of large size, firm, yellow. Weighed 3£ oz., measured 7 inches. Kidneys.—Cortical portion light colored generally. A pur- plish color externally. Intercolumnar congestion. Right weighed 5 oz., measured 5 inches; left weighed 6 oz,, meas- ure I 5]- inches. Sipua-kenal Capsules of large size. Intestines.—Stomach congested scarlet and speckled in region of fundus. Duodenum ashy. Jejunum occupied by a 177. yellowish viscid gelatinous substance which became darker lower down. Lower part of jejunum and upper part of ileum dark purple; variegated discoloration of valvulae conniventes. .Intestine finely injeeted. Intense hyperaemia and blood color in ileum, a currant jelly look. This gave place to minute cir- cular superficial ulcers the pits of which appeared to be covered with fine light grey granulations. These were observed at termination of ileum. The longitudinal bands of the large intestine were well developed and so contracted as to exhibit the usual pouchings of the large intestine conspicuously. Upon a base of dark purple or currant jelly color, points of which appeared through it at intervals in the ascending colon, there was a large surface of yellow granulations, which when stretched presented a honey-comb appearance, extending from the caecum to the rectum. There was general thicken- ing of the gut and flattening out in descending and left por- tion of the transverse colon. Numerous dark substances were met with in the rectum and lower part of descending colon, apparently clots of blood somewhat altered. The granulations exhibited a general greenish yellow hue. V [CASE No. 14.] Heniiy Stkomajj, private Co. C, 146th Ind.; age, 47; Admitted Au- gust 12th, 1865. HISTORY—(ANTE MORTEM.) Nervous temperament. On admission his skin was hot and dry, tongue coated, pulse 120 and rather full. He sufi re 1 with headache. He had been sick for several weeks. Upon pressure there was pain over the liver and spleen. Abdomen tympanitic. No pain on pressure observed. No diarrhoea. Sudaminaon abdomen and thorax, also an occasional rose spot. Dover's powders given. September 1st.—Pulse 120. Has a sharp and cutting pain in the left side. Friction sound anteriorly inferiorly. A blis- 178. ter applied. There is a large bed-sore. Quinine and whis- key. September 4th.—Left side of the thorax evidently enlarged by a pleuritic effusion. Resonance of the right side greatly diminished. September 6th.—Patient died. Made from notes of Act. Asst. Surgeon J. Bolton, U. S. A. o POST MORTEM, Fifteen hours after death. Little rigidity. Brain.—Injection of pia mater. Marked development of Pacchionian bodies. Membranes somewhat hard to detach from cerebral substance. Arachnoid somewhat opacified on the vertex. A quantity of limpid fluid was found in the lateral ventricles. Substance apparently of normal consistence. Fifth ventricle readily demonstrated and contained fluid. Weighed 3 lbs., measured 9 inches. Lungs.—A quantity of fluid was found in the left pleural sac; flakes of lymph adhered to the parietal and visceral pleurae, especially over lower lobe of lung. This lymph was spread out and firmly attached, tough, elastic and apparently partly organized. Substance was generally collapsed and nou-crepitant, was of dark color, did not break down under pressure, was flexible, of high 'specific gravity, sinking in water. A portion of the substance adjacent to that which gank in water and appar mtly of the same character was readily inflated. In the upper part of the lower lobe ofthe right lung under the pleura there was about a half an ounce of very dark mobile frothy fluid. This collection of fluid was not sharply defined and was loculated. A peculiar odor was perceived in it. Right lung generally crepitant; ingested, posterior infe- rior portions having a darker color. Bronchial glands slightly enlarged. Right lung weighed 15|oz., measured 9 inches; left weighed I lb. oi oz.. measured 8£ inches. 179. Heart.—White clots on both sides. Atheromatous condi- tion of semilunar valves of aorta, functionally of little moment. Weighed 7£ oz., measured 4 inches. Livkr.—Flaccid, generally of light color; some very dark spots (purple) on right lobe superiorly. Capsule was readily removed from over these spots, which were superficial and apparently the result of ecchymosis just beneath the capsule. Substance of normal consistence apparently. Acini indistinct. Weighed 3 lbs. 12 oz., measured 10£ inches. Splekn very flaccid, of light color, substance readily pulped. Weighed 9 oz., measured 6J inches. Pancreas flabby, pale, irregularly ingested. Weighed 2\ oz. The bile was a pale yellow mobile slightly viscid fluid. Kidneys flaccid, irregularly ingested, purplish on section. both weighed 4£ oz., measured 4J inches. Intestines.—Caecum and ascending colon colored yellow (bile tint); mucous membrane somewhat thinned in distension of the large intestine. Congestion in fundus of stomach. This organ very flaccid and much distended as were the small intestines. Throughout the small intestines there was yellow- ish discoloration by bile. [CASE NO. 15.] Patrick Hkhnbsey, private Co. E, 1st Md. Inft.; ape, 25. Admitted September lltn, 1865. HISTORY.—(ANTE MORTEM.) This man stated that he had been on a debauch for eight or ten days in which time he had not taken food of any kind. Pulse was very feeble and intermittent, countenance anxious, stomach irritable, rejecting everything taken. The adminis- tration of digitalis, brandy and morphia was attempted vainly. Beef to;) was given per rectum. 180 September 12th he died. Case reported by B. B. MILES, A. A. Surg. U.S. A. _-----0------ POSTMORTEM, Brain.—Congestion of the pia mater and opacity of the arachnoid generally on the side and summit of the brain. At least two ounces of fluid found in sac of arachnoid. Anomalous distribution of left cerebral artery. Fluid found in lateral ventricles, more in the left, about two ounces in all. Weighed 3 lbs. 6 oz., measured 8 inches. Lungs.—Right lung crepitant except beneath the pleuritic bands on the sides and summit. Organ of very dark red, purplish, or black color. Non-crepitant substance had nearly the specific gravity of water. A few pleuritic bands ob- served on posterior portion of left lung, under which, how- ever, lung substance was found to be crepitant. Lung dark red, very full of blood. Beneath the pleura anteriorly and internally in the surface of the upper lobe a minute body was found, biuck outside pearl colored envelope surrounding a gritty core. Under the microscope observation led to the con- clusion that it was the remains of a mass of tubercle. Right weighed 2 lbs., measured 10 inches; left weighed 1 lb. 15 oz., measured 9^ inches. Hevrt was covered with fat; flaccid, pale internally, pre- s< ntii.g t white clot on the right side attached in the usual i,mnor. Aun-ular septum perforate. A small white clot wiis ''unl iu the left ventricle. Weighed 14 oz., measured b' inches. Li\er.—Large, somewhat pale superficially, blackened infe- riorly und anteriorly, flaccid; substance soft, of an ashy red i-i-ior. Bile of a pale amber color and very fluid. Weighed ;> lbs., measured llf inches. Spleen enlarged; capsule readily detached. Substance very dark red and easily pulped. Weighed 10 oz., measured o.i inches. 181. Pancreas discolored. Weighed 3 oz.. measured 11J inches (?) Kidneys.—Hypostasis in both. Left paler than right. Right weighed 6 oz., measured 4-i inches; left weighed 6-J oz., measured -II inches. Si'I'RA-renal Capsules flaccid and toru in extraction. Not easily crushed. Intestines.—Large intestine distended, flaccid, of greenish yellow color internally, presenting regionally hyperaemia. Bile discoloration and hyperaemia in termination of ileum. Deeper brownish discoloration higher up, which gradually assumed a lighter color again to become darker and again lighter and so on. Peyer's patches were met with unusually high up. Near their uppermost location brownish discolora- tion was presented on the free borders of the valvulae conni- ventes which became fresher higher up and of a brighter bile tint. Hyperaemia of up]tor part of jejunum and duodenum. Stomach very much enlarged, flaccid, of dark reddish ashen <-olor near pylorus, and diffused red in fundus with mottling of darker spots. [CASE No. 16.] William Sibley, private Co. A, 2d Mass. II. A.; age, 25. Admitted September loth, 1805; died September llth, 1865. HISTORY.—(ANTE MORTEM.) This man states that he has been sick for a long time with fever and diarrhoea. He has lost his strength and flesh. lie was delirious on the evening of the tenth and during the fol- lowing day. The temperature of body very much increased; tongue dry aud coated, pulse intermittent aud very feeble. He died on the evening ofthe eleventh. Treatment, brandy with carbonate of ammonia every two 1S2. hours, also solution of the citrate of ammonia. Cold applica- tions to the head. Case reported by B. B. MILES, A. A. Surg. U.S. A. o- POST MORTEM. Ten hours after death. Rigidity. No emaciation. Brain.—Congestion of the pia mater. Two ounces of fluid came from the sac of the arachnoid. An ecchymosis was observed anteriorly in upper part of right hemisphere and a similar spot more anteriorly over left hemisphere, both ecchy- moses located beneath the arachnoid. Pacchionian bodies well marked. Ecchymoses were observed on the very vertex ofthe right hemisphere. About the Pacchionian bodies the mem- branes presented a granulated, banded, inflamed appearance, and in this region there fras a decided opacity of the arach- noid. Small quantity of fluid was found in both lateral ven- tricles. Corpus callosum soft. Lining membrane of ventricles (ependyma) dull. On floor of fourth ventricle, about half an inch above the origin of the auditory nerves to the right of median line, an irregular ecchymoses was seen, two lines by half a line. Symmetrical lines of congestion, consisting of central and lateral congeries, were observed below this. Numerous puncta upon cut surfaces of brain. The latter red- dened on exposure. Consistence generally normal. Weighed 3 lbs. 7 oz. 2 dr. Lungs.—Left lung generally of large size and very full of blood, presenting ecchymoses between lobes anteriorly and a greatly congested lower lobe, a large portion of lower anterior portion of this being in the first stage of pneumonia. The substance pueumoniried was very red, somewhat tou| inches. Heart.—Large, bloody, fat externally; mixed clot in right side. Perforate auricular septum. Valves well developed. Left ventricle contained a very little fluid blood. Weighed 12 oz., measured 5 inches. Liver dark colored, had a rank odor. Substance firm and of high specific gravity. Bile small in quantity, brownish and very fluid. Weighed 3 lbs. 101 oz., measured 11£ inches. Spleen lead colored, flaccid; lead colored on section; ub- stance very readily broken down. Weighed 6 oz., measured 5 inches. Pancreas large, firm and bloody. Weighed 2^ oz., mear- ured 4 inches. Kidneys large, flaccid; fatty pelvis. Right weighed 6|oz., measured 5 inches; left weighed 5^ <•/., measured 5£ inches. Supra-renal Capsules very small—but one found. Intestines.—Large intestine flaccid, regionally discolored, otherwise normal. Solitary glands prominent in ileum, which was aborescently congested regionally. Peyer's patches raised and blood specked. Upper part of intestine thLned with greyish and yellowish green discoloration. Bilious discolora- tion of greenish and brownish hue in upper part of jejunum. Leaden discoloration near pylorus; fundus mottled. Stomach generally flaccid, thin and greatly discolored. m. [CASE NO. IT.] Otto Ziecera. private Co. G, 1st U. S. V. V.; age, 25. Admitted September 13th, 1865; died September 19th, 1865. HISTORY.—(ANTE MORTEM.) He stated that he had had had an attack of remittent fever previous to admission. Countenance was anxious, pulBe inter- mittent, skin natural temperature, perspiring freely, appetite poor, tongue furred, headache. He received stimulants and the best diet. For the next four days he improved, left his bed and was walking about. The day before his death he was said to have had a convulsion which was extremely violent so as to cause him to throw himself out of bed. This attack I considered a congestive chill. Next morning I found him collapsed, pulse almost imperceptible, body covered with a profuce cold perspiration. During the day he rallied. In the morning, while in the act of turning in bed, he was attacked with another convulsion, which was so violent as to cause him to throw his head violently agaimst the wall and expire in an hour. The patient had warmth applied to whole surface of body, and received brandy, carbonate of ammonia and sulphate of (puinia. Previous to his death he had been eating watermelon and boiled eggs. Case reported by B. B. MILKS. A. A. Surg. VS. A. o- POST MORTEM, Light 1 ou.-s after death. Rigidity well marked. Brain —Arachnoid opacified. Numerous white ppots of Huall size were observed, chiefly on tl.c right side over sulci. Pacchionian bodies not numerous but well marked. Ntuner- 185. ous puncta. Little fluid in the lateral ventricles. Opacity of the so-called lining membrane. On the floor of the fourth ventricle, above the origin of the auditory nerves, there were three regions of congestion, central and lateral, central on right of the median line. That on right side was greater and consisted essentially of three lines with a terminal ecchymosis. On left side the region was higher, also associated with ecchy- mosis. On pressure the blood would disappear from part pressed to return again on removal of pressure. Lateral spots of a bright scarlet color. The right region was about one line in width and five lines in length. Spots of ecchymosis on left which Was less wide and three to four lines long. Pia mater congested. Membranes easily removed from convolutions. Substance of normal consistence. No fluid in sac of arach- noid. Weighed 3 lbs, 4| oz., length 9J inches. Lungs.—Right lung was of a dark color, less crepitant in lower lobe, marked with melanic matter (round or oval, one or two lines in diameter), somewhat puckered at the summit. A portion of the tissue was carnified. No evidences of tuber- cle. Between the lobes sub-pleural effusion was seen. Hy- postasis inferiorly posteriorly. A great deal of fluid in pleural sac. Left lung conspicuously marked with melanic matter in large spots and the substance (foreign) of these could be felt by passing the finger over the pleura covering them. At the summit of the left lung there was a puckered appearance and a cuirassed feel. Substance presenting these phenomena was tough, inelastic and of the same specific gravity as water. Remaining lung substance crepitant. Right lung weighed 1 lb. 7 oz., measured 8£ inches; left weighed 1 lb., measured 8 inches. Heart fat externally, especially on the right side. Right ventricle was occupied by a loose ill-formed black clot and was very capacious. Black clot in both auricles. Valves normal; tissue of organ quite full of blood. Heart weighed 12 oz.. measured 5 inches. Liver of red color externally, deep red internally; consist- ence and specific gravity normal. Band on middle of left lobe superiorly. Black discoloration inferiorly and puckered about gall bladder, which was small and much thickened. Gall stone: biliverdine present in excess. 186. Spleen enlarged, flaccid, presenting white deprcb.^i >;•. .1 anteriorly. Substance very soft. Weighed lo oz. I'ancreas of large size. Kidneys and Supra-renal Capsules normal. Intestines large. Blackish color internally n.-u. -; " ..u. i with softening, ulceration or any appreciable lesion, lieum and lower portion of jejunum colored yellow with bile. Upper part of jejunum of pale cream color. Stomach large, of light yellow color internally. Muscular development ge>od. Height 5£ feet. [CASE No. 18.] John Fkjkison. private Co. I, lGth Wis.; age, 24; born in Germany. Died December 13th, 1865. 111 STORY. —(ANTE MORTEM.) The patient was admitted July 24th, 1865, from "Jarvis" Oeneral Hospital. From the history of his disease, given by the nuin, it appeared that it had first commenced with pain in region of left hip joint, shooting down the thigh to knee; in- creased by pressure about the joint or by jerking the head of the femur up against the acetabulum. The patient thought the disease the result of cold. On admission there was pain iu left hip, flattening of nates upon affected side, decided prom- inence of trochanter, thigh slightly flexed and addacted. About November 20th, fluctuation having been discovered a little above and in front of trochanter major, an incision was made at this point and a small quantity of puriform fluid gushed forth followed by a large quantity of 3rellow inspissated pus of a choosy consistence. After this the discharge became ver\ profuse and fetid; hectic fever set in and the patient rapidly sank. When 1 took charge of ward 13 the patient was exceedingly prostrated, very nervou.-. callow and emaciated, with a weak 187. and rapid pulse; he suffered great pain from a large bed-sore over the right trochanter. November 30th,—The matter exhibiting a tendency to bulge lower down in the buttock and to dissect its way down the thigh, a large counter opening was made below and poste- rior to the trochanter major. This opening discharged contin- ually a large quantity of puriform fluid of an exceedingly fetid odor, containing small specks of necrosed bone, and toward the last a quantity of dark clotted blood. An abscess which had formed in the left groin immediately below Pou- part's ligament was also opened and a large quantity of badly elaborated pus discharged. The patient became still mon emaciated, was continually bathed in perspiration of a rank odor. Extremities became oedematous; breathing oppressed, thirst intolerable. He was seized with a severe chill on the evening of December llth, succeeded by another on the follow- ing morning, and died at 3 A. M. December 13th, 1865. Treatment consisted at first of ammonio-citrate of iron with potassii iodidum, cod-liver oil, together with alcoholic stimu- lants and good nourishing diet December 4th.—Sulphate of Soda was administered in 2o gr. doses every two hours with ammonia and brandy. A microscopic examination ofthe blood during life revealed a large proportional increase of colorless corpuscles in blood, supposed to be about one in ten. The red corpuscles showed no disposition to a nummular arrangement. Case reported by H. McELPEKRY, A. A Surg. U. S. A 1^ POSTMORTEM. Fourteen hours after death. Brain.—-Two ounces of fluid found in sac of arachnoid. Pia mater ingested. Bloody fluid found in small quantity in lateral ventricles, also third. The velum interpositum was reduced to its great vessels. Lines of congestion on floor of fourth ventricle, chiefly on left side near the opening of cere- bellar ventricles. To the left of the vermis superiorly there was an engorged vessel in which the blood had clotted and yielded its coloring matter to adjacent tissues. Brain of normal consistence. Weighed 2 lbs. 13 oz.. length 1\ inches. Lungs.—The outlines of pulmonary lobules in posterior por- tion of lower lobe of left lung were very distinct, by reason of the formation of melanic matter over the interlobular spaces. An elastic blackish hematoid substance, about ^ie size of a pea, was observed on the lateral surface of this lobe, which was preserved for further examination. It was situated just beneath the pleura; and in an interlobular sulcus another sim- ilar body was observed that presented many points of resem- blance to an altered blood clot. The upper lobe was of a lighter color, changing from a light yellow to a bluish white and a dark purple. On the posterior portion of the superior surface of the lower lobe there was a thick close well organ- ized old adhesion band, in relation with which, in the superior lobe, there was a vomica an inch in diameter, containing a yellow caseous and somewhat grannlar material, and thick walled. Calcareous masses of small size were met with in the border ofthe upper lobe. Dark brownish gelatinous plugs found in the bronchial tubes of the third magnitude. Right lung reddish posteriorly and greyish anteriorly. Tissue crep- itant, presented sub-pleural black substance having an appear- ance similar to that of the foreign bodies found in left lung. Pulmonary tissue gen ;rally flaccid. Right weighed 1 lb. 3J i z., leit 1 lb. 6 oz.; measurement of both 9 inches. Heart.—Auricular septum imperforate; tracts of vessels mark d vifh fat Substance of heart pale. Organ weigled i!: <•? 18'.». Liver.—Much enlarged, of a scarlet color mottled with minute yellow spots on superior surface. Substance had a yellow look on section. Bile was observed on section of bile tubes. Bile limpid, mixed also with brownish matter, and very viscid. About two ounces present in the gall bladder. Weigheel 5 lbs. 5 oz., measured 12 inches. Kidneys of large size and light color, presenting intercol- umnar congestion and excess of pelvic fat. A gristly white substance was found in one ofthe pyramids ofthe left kidney. Right weighed 6-£ oz., left 7} oz., both measured 5 inches. • Supra-renal Capsules.—Right of large size, readily torn, A hard yellowish white homogeneous substance was found in left supra-renal capsule. Spleen flaccid; substance somewhat tough. Weighed 8 oz., measured 5 inches. Intestines.—Solitary glands of small intestines conspicu- ously developed; thickening of mucous membrane, regional hyperamiia of jejunum and ileum. In smaller curvature of stomach two deep ulcers were observed, one oval the other round. Anteriorly near the cardiac orifice there was another round ulcer. Stomach preserved. Sugillations in different portions of the body. The left in- nominate bone was generally necrosed. Abscesses were found beneath the pelvic fascia, under the iliac and psoas muscles, and about the rotators and adductors of the thigh, commencing with points of dead bone and diseased periosteum such as the head of the femur, the ilium and the pubis presented. (Edema in both feet. Openings for abscesses of left hip artificial and natural. Bed-sores over trochanter major. 190. [CASE No, 19.] John Loix>, private Co. F, 5th U. S. C. T.; age, 18. Admitted July 24th, 1865, from '\\IcKims" General Hospital. HISTORY.—(ANTE MORTEM.) When admitted patient was suffering with gunshot wound of left thigh. The ball, a minie, having entered on the outer side of the limb at the junction of the middle with the upper third, passing upwards backwards and inwards, frac- tured the bone and lodged. The wound was received at Wil- mington, N. C, March 9th, 1865. Until the first part of October the patient's general health was good but his limb was oedematous, especially in the thigh, the tissues of which were muc-h thickened and indurated. There was an indolent ulcer upon the dorsum of the foot causeil by pressure from an anterior splint which had been applied to the limb. Towards the last of September the ball was discov- ered, by a Nelatons probe, deeply imbedded in the bone. The callus scorn.jd to have grown up around it completely enclosing it. It was accordingly found impossible to remove the ball without cutting away a portion of the callus, which was accordingly done and the ball readily extracted.* Several small pieces of necrosed bone were also taken away at the same time. About the middle of October, when I took charge of him, the patient seemed improved in health although the limb still remained oedematous and the wound discharged considerably, the matter seeming to have a tendency to dissect its way under fhe fascia lata. The ulcer of the dorsum of the foot was slowly granulating up. Two bed-sores over the sacrum caused the patient considerable annoyance. Under careful bandaging the oedema of the limb subsided aud ultimately passeel away. The ulcer on the foot healed and the bed-sores slowly cicatrized ewer; at the same time his gen- eral emditim improved under a gooel nourishing diet, with iron and cod-liver oil, porter, and with an occasional anodyne * lly Act. A:>t.:«-ii-:i-o!i il. McEldcrry, Y. S. A. 191. lo procure him a good nights rest. During the whole time the patient was subject to occasional attacks of diarrhoea. which would however quickly yield to simple treatment, to .return it might be in three or four days. Towards the middle of November the matter, notwithstanding the bandage, was found to have dissected its way down the midcle of the thigh under the fascia lata. An incision was made for the more complete discharge and a quantity of laudable pus made its escape. The patient about this time was troubled with a con- siderable degree of gastric irritation which subsided under the use of a little soda and hydrocyanic acid. 1 saw him on the afternoon ofthe 19th: the wound was then discharging kindly, his appetite improving; indeed he was telling me how much he enjoyed his dinner. Thus far every- thing went on well. The next morning on making my round I found him evi- dently dying. On closer inspection I discovered that he was lying in a lethargic state, as if from the effects of some nar- cotic poison, entirely insensible, respiration hardly perceptible, with a small and feeble pulse, pupils insensible and dilated and the temperature of the whole body much reduced. Th ' nurse stated that he had suddenly been taken worse during the night with a fit after which it was found impossible to arouse him. He lay in this stupid state, had several convul- sions and died during the morning, although every effort in the way of stimulating frictions, and injections of ammonia, and brandy and coffee, was used to arouse him. An empty six ounce phial, marked ''Solution of Morphia.' and a box containing three powders, marked "Dover's pow- ders,"' which had been put up by a certain druggist in the city and brought him the day before by a comrade in the same ward, were discovered near his bedside. The man who bought the medicines said that he had obtained them at the earnest solicitation of the patient; that the bottle had been one-third full and the box contained four powders. The nurse had abe. at the patient's request, given him a dose of morphia theevcu. ing before. Case reported by II. McELDEURY, A. A. Sura-. U. S. A. 192: POST MORTEM. Twenty-four hours after death. Slight rigidity. Left thigh wounded and much larger than the right. A white puckered quadrilateral cicatrix on instep. Bed-sore on left part of sacrum. Brain generally flaccid, cerebellum less so,'and the mem- branes almost exsanguine, except that the superior vessels of pia mater were clearly marked. Pacchionian bodies more abundant on left summit. Small quantity of fluid in lateral and third ventricles. Floor of fourth ventricle marked with lines of congestion on the left side in the auditory tract and anteriorly in the approach to the right cerebellar ventricle. There were numerous vessels (puncta) which yielded com- paratively large quantities of blood observed on transverse section of Pons Varolii. Although flaccid when taken in hand the brain was found cpuite consistent and easily examined. Weighed 2 lbs. 4 oz., length 7^ inches. Lungs.—Numerous adhesions were found in right pleural Fac. An amber colored jelly like lymph formation found among these. The pulmonary tissue was abnormally dense and friable, yielding on expression a frothy sanguineous fluid abundantly. It was thought that the appearance of the pul- monary tissue was a result of the statical action of pleuritic adhesions joined to long rest in one position and hypostasis dependent on the latter. Left lung generally similar. In the right pleura there were interlobar adhesions apparently more recent. Right weighed 1 lb. 10 oz., measured 8 inches; left weighed i lb. 2 oz., measured 7J- inches. Heart.—Liver presented generally a yellow color, especi- ally inferiorly and superiorly, and there was vascular reticu- lation, as if from congestion about and between the acini. Under the capsule numerous minute pellucid bodies were observed and considered tuberculous, also minute yellowish specks corresponding to acini the cells of which were in a Btate of fatty degeneration. Tissue nutniegged on section and was apparently dense and not easily torn. Weighed ^.t \hi. 10 oz., length 10 inchcr- 193. Kidneys of a pale color; substance firm, well developed. VV'-ighcd 4 oz. "m'leen.—-Yellowish on dorsum, flaccid; substance of purplish color, exhibiting trabecular distinctly. Weighed 6 oz., mens- ural .)?, inches. Pantueis normal. Weighed 2£ oz., length 7£ inches. Bronchial glands enlarged, containing blackish cortical sub- stance and caseous and calcareous masses of a cream color. Intestines. —Enlargement of solitary glands in ileum and small intestines generally. Valvulae conniventes well devel- oped. Fundus yellow. The mucous surface was pale; and the mucous membrane was readily scraped away. Wound.—Ball entered externally, near junction of upper and middle thirds of left thigh, passed upwards inwards and a little backwards, breaking the upper back part of the diaphysis and imbedding itself among the fragments, whence removed. V large mass of callus formed a discolored cavern there which opened downwards outwards and backwards, the surface of the cavern being covered with gelatiniform substance where nut black, granular or exposed, or exhibiting puruloid fluid. The muscles had a watery look and exuded serum from sec- tion. Formation of adipose tissue in connective tissues of left lower extremity. (ielatiniform substance was formed in the spinal canal, about the middle outside the theca. s .y \ V\v$< * 194. [CASE No. 20. | MtctiAKr. Mklvev, private Co. A, 2d Ma3s. Admitted September loili, 18t>5; died September 22d, 1865. By the "culpability of a Cadet many of the most complete post-mortems made at "Hicks" Hospital in September, Octo- ber'and "November" were destroyed or lost and the following notes are those which remain, HISTORY.—(ANTE MORTEM.) The patient stated that he had been stationed in one of the southern states and had had an attack of fever from which he had a slow convalescence. Previous to being admitted he was attacked with dysentery. Pulse quick; appetite poor. He was somewhat emaciated and went to stool five to ten timed daily, passing blood at each stool. The day after admission he was no', so well and the number of his stools had increased. September 12th.'—Slightly improved. September 14th.--Has improved but eats nothing and is very weak. September 15th.- -He is again worse. There is violent pain over the abdomen. Opium seems to have but little or no effect upon him but morphia gives relief. The pain still continues. Discharges somewhat relieved by the constant use of morphia. He expired on the 22d of Sep- tember, 1865. Milk diet, revulsives, stimulants, anodynes and astringents constituted his treatment. Case reported by B. B. MILES, A A. Sur?. U. S. A. 195. POST MORTEM, Ten hours aft >r death. I>cci led rigidity. Medium stature. Emaciation. I$itain congested. In the pia mater there was an excess of fluid. Brain substance firm. On the floor of the fourth ven- tricle there were lines of congestion, larger on the leftside in the mouths ofthe cerebellar ventricles. The pia mater (visce- ral arachnoid included) was torn in detachment from the sum- mits of the hemispheres. Weighed 8 lbs., length 7h inches. Ecnus. -A blackened region on the anterior surface of the upper lobe left Jung; lower lobe darkened posteriorly. Near some old pleuritic bands on the upper part of the lower lobe Iwueath the pleura there were numerous blood spots, tn some of the larger^spots the effusion of blood was found to have involved the pulmonary tissue. These adhesions were of small extent mid only observed at the back part of upper portion of low.r lobe. Numerous and strong interlobar adhesions. Bronchial glands at roots of luncrs of dark color though of normal size. A single mass of white caseous substauce was found in upper back part of right lung. Very numerous old pleuritic bands in right pleural sac, principally on outer surface of lung. In extraction a portion of the parietal pleura was torn out with the visceral. Numerous ecchymoses were observed under the pleura over the whole surface of the lung, and between the lobes near the junction ofthe middle with the antero-posterior fissure. The middle fissure was incomplete and there were but two lobes in the right lung. Lung substance universally crepitant. Left lung weighed 11 oz., measured 1\ inches; right weighed 1 lb., measured 8 inches. Heart.—Firm white clot in right side,'which was so at- tacbed^to apex of ventricle and to tricuspid valve .as to direct what blood could have passed during its existence upon the smooth approach to the pulmonary artery. Clot in left ven- tricle nearly black. Auricular septum imperforate. Weighed V\ oz., measured 5 inches. Eivkh. C-eneral dark color. Grey spots in a dark basa. Numerous formation* "f *! vfdl^wish color, generally somewhat PV». raised and presenting the appearance of minute clustered ab- scesses, were seen beneath the capsule. Puruloid fluid in eonsiderable quantity escaped from the larger and more united of these clusters, of greyish color and considerable viscidity. I'pon section of any cluster collections of pus were found. These varied from what could be contained in a sac the size of i) pin's head to what could be held in one us large as a hazel- nut.- Still larger collections of viscid pus were met with in the centre of the organ. Gall bladder contained granular greenish bile. Weight of liver, 5 lbs. £ oz. Spleen full and smooth, as if the capsule were firmly ■urctched over its contents. Substance very dark red, of rather firm consistence, readily pulped however. Weighed 15 oz., measured 6} inches. Kidneys of light color, blackened interiorly. Right weighed 5 oz., measured 4.\ inches; left weighed 6 oz., measured 4A inches. Supra-renal Capsules.—In the right, upper portion, there- was an elastic yellowish white substance. Cortical substance thickened, quite soft but breaking up granularly under pres- turc. On surface of left capsule two yellowish pellucid sub- stances were met with, varying in size: the larger big as a grape seed, which broke up readily under pressure. They did not scein to be continuous with the substance of the organ. Left capsule darker than the right. Each weighed f oz., measured 2 inches. Intkstines.—Duodenum presented a markedly mammil- lated appearance. Regional hyperemia of jejunum. About half way down the ileum on the summits of the valvula? con- .liventes on the side of the mesenteric attachment transverse- ulcerations were observed, granulated, yellowish, thready, and superficial. Below where first observed they became very numerous and at the end of the ileum for a space of eight inches the whole surface of the intestine presented a similarly ulcerated appearance. In the midst of this space portions of Mirfacc presented a honey-combed appearance, and in these localities the mucous membrane had been perforated, muscular rent involved and walls of organ thickened. Ueo-coecal valve greatly enlarged. The caecum itself was enlarged and pre- mised transverse lin s cf ulceration extending through mucous m. membrane and involving at least the muscular coat. This ulceration was observed in ascending and transverse colon. In descending colon the ulcers became round, of large size, and so deep as to penetrate muscular and involve the fibrous coat. In sigmoid flexure and rectum ulcers were presented that involved the fibrous coat and the intestine had a feel as if its walls -vere less than normally tough. Upon holding the intestine up to the light the positions of the ulcers were indi- cated readily by the light 6pots. [CASE No. 21.] Lkwis A. Nelsox, private Co. G. 5th Wia.; age, 50. Admitnl July 54th, 1865; died September 30th, 1865. HISTORY.—(ANTE MORTEM.) Patient said he was wounded at Harpersville, Va., on April 6th, 1865. At the time of his admission into the Hospital the wound (which is in the left axilla and was evidently made while the arm was elevated) discharged large quantities of fetid pus which evidently came from the cavity of the chest. The wound closed up and the ball without doubt still remained in the cavity of the chest. There is no respiratory rnurmuf •ver any part of left lung and it is evident that air does not enter it. He is able to sit up and walk about the ward but ia very lean and weak. Treatment, tonics and stimulants. He had extra diet. September 1st.—Patient has been gradually failing since last record. The quantity of pus discharged from wound is increasing and the odor is very offensive. He has some diar- rhoea. Alvine evacuations fetid. September 12th.—Strength fails rapidly and patient ia unable to ii; up; copious discharges from the wound still con- linnf Jind a'er (here is diarrhoea. Emaciation i? extreme. 198. September 30th.—Patient died to-day, his body being re- duced almost to a skeleton. Case reported by GEO. W. FAY, A. A. Surgeon U. S. A o POSTMORTEM, About twenty-four hours after death. Extreme emaciation; anaemia. (Edema of lower extremi* ties. Fetid pus poured from the wound of entrance during evisceration. Brain.—Congestion of large vessels of pia mater. Large quantity of reddish fluid in lateral ventricles. Considerable sub-arachnoid fluid. Congestions of walls and summits of lateral ventricles. No congestion in third ventricle, although this too was full of fluid. Granular matter in the Pineal body. Nervous substance of normal consistence. No abnormality observed in the fourth ventricle. Weight of brain 47 oz., length 7?, inches Lungs—Bight pleural Fac nearly obliterated by bands, which were, however, readily torn. Bloody fibrous tissue appeared to be formed over the anterior and lateral surfaces of the lung after extraction. Strong inter-lobular connecting bands. Substance generally crepitant. Organ rather tumid. On section the inferior border posteriorly presented a dark red appearance, and in it there was a portion of tissue that had hecome solidified in such a way as to become tough. A section appeared speckled. Numerous red spots presented themselves in the midst of tissue generally yellowish. This speckling was not observed in the upper lobe. Left pleural sac contained a quantity of very offensive thin sanious pus. The internal surface of sac was thickly sheeted with formed lymph. Condition of lung itself was such that it was readily torn on extraction. It was very slightly crepitant in lower part of lower lobe und pr\?eDtod generally a bcefv appearance 199.__________________________ and a smooth dark colored section. Substance taken from lower portion of lower lobe floated in water, and the remaining substance, so far as it was examined, appeared to be of less specific gravity than water though indistinctly crepitant in places. The upper portion of lower lobe that was in relation wound described below, that involved the pleural sac in the vicinity of the angles of the fourth and fifth ribs, was of a darker color and of a greater specific gravity than water. Thia lung was functionally useless. Left weighed 8 02., measured 7 inches; right weighed 14 oz., measured 9 inches. Heart of small size, distended with mixed clots. Weighed 3oz. Liver.—Substance of leaden color superiorly, deep red color inferiorly. Capsule opacified near middle superiorly, the opa- city being in relation with some adhesions that connected the middle of right lobe with diaphragm. In the whitened region the eapsule was thickened. Lead colored section; substance friable, exhibiting acini distinctly. There was a large quan- tity of amber colored bile in the gall bladder. Weighed 2\ lbs., measured 9 inches. Spleen.—Normal in consistence, size and color. Weighed 6 oz., measured 5 inches. Kidneys.—Right kidney small and firm; dark section. Left conspicuously mottled, presenting on anterior surface an angular yellowish surface near middle and posteriorly. Simi- lar appearance interiorly; on section nothing abnormal dis- closed. Right weighed 3£ oz., measured 3£ inches; left weighed 3oz., measured 3 inches. Supra-renal Capsules firm, of normal size and general ap- poaranccs. Pancreas normal; weighed 2 oz,, measured 7£ inches. Intestinls,—Superficial ulcerations in the rectum; fine whitish granules observed in their tracts. Reddened places in the descending colon, generally oval in form, of indistinct •outline and smooth surface which presented appearances of healing as if scarred over. Similar ulcerations in transverse and descending colons and in the caecum, chiefly disposed along the tracts of the longitudinal bands. Hyperemia of colon and csecum. Redness, discoloration and hyperaemia of the lower part of ileum. Slight thinning of intestines; yellowish or bile 200 discoloration. Jejunum well developed and generally of a light color. Stomach and duodenum normal. Wound.—Lateral portion of left lung was found torn and irregular and it was thought that this laceration had been caused in removal of the organ from the thorax. Ball entered at middle of posterior fold of axilla and passed inwards down- wards and slightly backwards lodging between the lamina? of the fourth and fifth dorsal vertebrae, the point of the ball en- tering the spinal canal but not pressing upon or interfering with the theca. The pleural sac had been opened between the angles and heads of the fourth and fifth ribs, left side, and outside of this point of opening the callus had formed an arch between the angles so that the finger passed over a smooth surface in approaching from the outside the point of opening of the pleura. An incision was made during examination of the cadaver parallel with the base of tho scapula through which the ball was readily extracted. [CASE No. 22.] Jons Donri.ly, private Co. B, 1st Mass II. A. Admitted on th» mornintr of November 22d, 1865; died at 6 o'clock, A. M., November I3d, 1865. HISTORY.—(ANTE MORTEM.) On first seeing this patient I found him in a drowsy condi- tion, so much so that it was with difficulty he could be suffi- ciently aroused to give his name, rank, etc. The disease uuder which he was suffering was evidently Desquamative Nephritis. He presented an anasarcous condi- tion of the whole surface of tho body, which was particularly noticeable in the penis and scrotum. The countenance was bloated and anemic. There was some dyspnoea which gradu- ally increased during the day. Two hours after admission he was taken with a sudden con- vulsion which w::s followed by others at intervals of from half 201. an hour to an hour. As these convulsions increased he became more and more comatose. During each convulsion hejjassed small quantities of urine. On testing with heat and nitric acid the urine was found to be albuminous. On microscopic examination epithelial scales, tubular casts, and a few blood discs were seen. In the treatment of this case very little was done as stimulants and all articles of nourishment were repeat- edly rejected. Dry cupping over the lumbar region was re- sorted to. Death took place at 6 A. M. the following morn- ing. Case reported by T. II. STCDD1FORD, A. A. Surg. V. S. A. POST MORTEM, Thirty hour.; atV-r death. Brain.- -Pia mater moderately ingested, especially at base of organ. One rpot of ecchymosis superiorly posteriorly over the right hemisphere. Small quantity of limpid serum in sac of arachnoid. Pia mater was torn in shreds from the sulci. On summits of striated bodies, and their inner ventricular as- pects, in the latitude ofthe foramen of Monro there were numer- ous minute ecchymoses, fine speckling as it were, apparently deep set in the grey substance. The ergots were found in sacs of their own and in disclosing them septums of lining mem- brane arching over the entrances of the posterior horns were cut .through. An amber colored fluid was observed enmeshed and traversed by bloodvessels in these sacs proper: Roth ergots were extraordinarily well developed. The walls of the ven- tricles presented a watery appearance and were readily broken through. On floor of fourth ventricle eight or ten lines of congestion well marked and associated with ecchymoses were (»b.icrvod. On the left side of the floor one of the superior origin bundles ofthe auditory nerve passed up making Us exit ;tt upper pirt of ventricle, not passing beneath inferior part of 202. left crus of cerebellum. Puncta throughout brain marked. The dentated body of the left cerebellum conspicuous. Rraiu weighed 3 lbs.r measured 7 inches. Lungs.—The outer aspect of the left presented a pinkish folor, inner aspect a purplish. Its tissue before section had a tough slightly crepitant feel, was evidently of high specific gravity and full of some kind of fluid. Slight crepitation was observed in every part examined by palpation. From a cut surface a quantity of sanguineous fluid a little frothy flowed on pressure. On such surface portions of pulmonary tissue were exhibited which were of a darker color and apparently more dense than the tissue surrounding, non-crepitant, and, when isolated, sank in water. Substance of the upper lobe had a dark watery carnified look and a great quantity of serum could be expressed. The left lung was oedematous in short. The outer aspect of right lung was dark except that of the middle lobe and its inner aspect was pinkish. From a bleb on the diaphragmatic surface of the lower lobe a"sanguineous fluid flowed on section. General characters of upper and lower lobes similar to those of left lung. Substance more filled with a fluid of a darker color and so dense that large portions when detached sank in water. Middle lobe of right lung was apparently more nearly normal, not partaking of oedema. Right weighed 2 lbs. 2 oz., measured 10 inches; left weighed 1 lb. 14oz., measured 9 inches. ITkart of large size, firm substance. Weighed 13 oz., measured 5?, inches. Liver of dark brown and purplish color. Substance on section of lead color, somewhat tough, yielding a marked liver odor. Call bladder of yellowish green color, contained a small quantity of very fluid amber colored bile. Weighed 4 lbs., measured 11 inches. Spleen of large size, purplish color and normal density. Weighed 1 lb., measured 6 inches. A small accessory spleen ofthe size of a hazel-nut was observed. Pancreas of dark color. Weighed 3i oz., measured 9| inches. SupitA-itKNAL Capsii.es of pale color. Each weighed \ oz.. measured 2 inches, Kidneys.- In the lower part of tho right kidney there was 20H a cyst of small size. Cortical substance of a pale color and well developed was readily torn in direction of the tubules. Specific gravity low. Left kidney similar to right in general characteristics. Right weighed 6 oz , measured 5J inches: left weighed 5| oz., measured 5 inches. Stomach large, fundus reddened. Duodenum discolored with bile. Ileum whitened: inferior portion was ironed and discolored with bile. Dark discoloration of caecum and ascend- ing colon and internal surface of large intestine throughout. r- zi v i- i 115 7. f s £ * o £ S? s g s g £ S g o S'« a ~ ^ r? is a g 5 s ^ £ 5» S £ - g o »-T« -.> • iocc ci s i- * tc tt » a u li e >- cr. (,t)HM^*i;ui»-iN!e»-J''eiD*.aM cr. ao ^ xSSB SSS^c'SSSoSSiSSS £S£ SSZ^srSSSISJSSSSStglSSSSoo gg« ____. "" a-. »*— •** * *••"■* _________.**"■"________lv_________-_------- tsi tC tO tO ,-:,E ^.ii ««.£ -* °°w *-.£ ^.^ 5 c-i£ s * r; oc o ^. ^ c-. S ~t .-. -, -.^S^ c-. g.gwff*,- ,£ -*£ » - -I C Si « f *> W O) *. -1 « * 4» .■*» f -' 'J1 *• « -a O 7J *■ C. M H St «I Oi o Si*-x-034i+--ia0 -7 i;< ~ tc ci vi -i No. of case. Brain. Right. £ ----- a Heart. Liver. Gail-Blad- der. Spleen. Right. W Right. M a - j ______EL Xsi re O » . r /> d! » « :;0}* w *- Pancreas. -i r j. (j n s> c. « -- cc><~ Intestines. AND MEASUREMENTS. MEASUREMENTS. Lungs. i Kidn eys. Supra-renal . 5 3 . a Capsules. a '3 ^ u u > "3. ^ 5 *& a 53 m 0$ ^ w hH 3 to »3 ^ «* H Ph iu. in. in. in. in. in. in. in. in. in. in. in. 7 6 5K 5M n 11 9 7 6 5 5 4f 4* 9 H 81 4 61 si 4Yi 4}.i 6 8| 8 10 51 5 5 ', n 9 8 3 91 6i 1 7-J 7 8| H 4.1 10 511 5 5K ! 8 7* 10 15 5 141 44 5 5 7 s| 11 81 12 5 7 U 10 6 5 5 | ** 10$ 10* 4 91 6 5 5| 8 74 10 9I 4 11 9 5 6K 7 9* 94 5 HI 6i 8K ■1-1 8* 6J 5 104 6 ! 4lA 4M 8 71 8 8 41 10 6 71 51 71 7 81 9 3f 41 8 4XA 5 71 71 8 9 41' 4^ 5 91/ 2:< ■6« 7 7A 7 4 94 5 5 5M 7 91 9 31 81 5 4 4 6 9 8 3$ 81 6 5 5 8 6* to 81 5 11 5 4 434 4 4 9 41 11 6 5 5K 8 1 10 8} 8 33 10 51 •4K 4K 7 7 9 81 3* 12 5 5K 5 8M H 10 31 121 51 H 4K n 8* 4 10 41, 4 4 \ 6M 71 9 9 41 101 6 5 4 , 5 7 10 91 5 12 4j 5 5 9 6} 8$ 81 4 101 44; 5 4| 8 ioi 11 4 11 5^ 4K 4K 1M 7 1 11 10 4 HI G4: 4K 41A 10 8 9 ?1 41 11 4 5 5 8 7 9 10 4 11 4 J 4 4K 8' 7 9 10 3| 12 8 i 5 5 ! 8 7 9 9 5 11 5 4 4| 1 8 8 ioi 9 41 12 44 4 4K 1 7 9* 9 41 11 6 4H 4H i 12* 7 71 7 31 8 4 4 4 7 7 11 94 4 11 5J 4K 5% 7K 7 8* 8 41 11 81 5 5 7 10 10 5 11 7 4)4 4K 1 6 7 11 10 61 11 5j 5^ 5)* 6 7 10 9 4j 10 7 5 4K 7 7 1 9 9 4J 11 5 5?i 8 k 7 £1 9 o 111 1 ^ j ' S's 206. WEIGHTS.—Continued. Supra-re- --- 00 Lungs. 1 Kidneys. nal Cap- oi u —* su es. 03 13 <*-© a '3 !&i "^ 3 PQ c c 0 [*s ^ ■5! ^ C m OI fc M «* H m h3 OZ. oz. oz. *i S oz. ^ PL. ►S oz. oz. oz. oz. oz. oz. oz. oz. OZ. 53 47 15 72 11 8 51 6 2A 54 45 28 31 12} 69 43 61 7 4| 67 55 514 124 15tj HI 59 7| 4* H 56 42 33 31 lift 47 3^ ^ 54 H 3 52 57 47 32 27 13 84 7| 5f 5 1)1 81 58 57 56 29 14', 78 n 11 4* 59 54£ 23 22 16 82 2 16 5$ 5 5 58 60 49 19 24 81 641 9 6 5 1 i 5 ADDITIONAL CASE TART II. [CASE No. 23.] Walter Ford, corporal Co. B, 1st C. S. Col. Tnft'j; age 20. Admit- ted July 24th, 1865, from MeKim's TJ. S. General Hospital, Baltimore, Md. HISTORY.—(ANTE MORTEM.) Patient .suffered with a gun-shot wound of left thigh. The ball had entered posterior part of outer aspect of middle third of thigh, passing inwards forwards and slightly upwards, and lodged. It was sought for several times but could never be detected. A large detached piece of necrosed bone was taken out ofthe opening of entrance during the month of September, 1865. The patient complained of continual pain aggravated by pressure in both lumbar regions in which regions there was extended flatness on percussion. Patient continued very weak, had several attacks of erysip- elas and finally sank after a severe attack, February 20th, I860.* Case reported by II. McELDERRY, A. A. Surg. U.S. A. * The Ii-ft thigh was greatly swollen, its skin shiny and somewhat tuhcrc'ilated about sinuses an ! slow healing incisions. The diagnosis ♦ t* tntty depenenition (interstitial formation and proper) was made for 'Aiv left tliiglv and > r ami inferred, for the great orgm?. Ford was « 207. MEASUREMENTS.—Continued. Lungs. ■a Kidneys. Supra-renal *5 =3 . a Capsules. 03 .9 3 1 !"?2 ■i' z "S a 53 J 03 ft! S =, -I O C/J •^ J ^ c- • •^ Ph m. in. in. in. 1 in. in. in. in. in. in. in. in. in. 7 5A | 104 54 4K 4 9 74 9 84 541 114 9 5 5 9 7 8 9 5 10 5 4A 4 7 10 9 5 114 6 A A 4M 10 7 10 54 12 6 5 5W 8 11 104 6 11 5 6 5K 8 7 9 9 54' 12 84 5 4A 2 IK 8 8 9 9 44l 11 5 5^ 7 ■ r -. POST MORTEM, Brain and Spinal Cord.—Pluid in sac of arachnoid. Pia mater ingested. Central canal of spinal marrow visible. Fluid in lateral ventricles. Weight of brain 46 oz., length 7 in., width 5\ inches. Lungs congested, mottled, flaccid. Right lung weighed 10 oz., measured 7 inches; left weighed 15 oz., measured 7 inches. Heart.—Fatty degeneration proper of the muscle of th« heart. Fat globules of various sizes, generally extremely minute, one seventeen thousandth part of an inch for instance. Tendency to longitudinal splitting and lining. Transverse lining barely recognizable. Weighed 10 oz., length 4| in., width 2| inches. Liver of large size, light red superiorly, somewhat mottled and of a darker color inferiorly; congested on anterior border inferiorly. The gall bladder was full of viscid dark brown bile. Great numbers of oil globules were observed in the cells of this organ. Power of three hundred and forty diame- ters. Weighed 4 lbs. 6 oz., length 11J- in., width 8 inches. Spleen of a light red color externally darker internally. Numerous minute whitish translucent granules were observed in its substance and the centres of these became bluish under lonsenteric glands. In this same gland the capillary vessels could be traced far, without special preparation, between glomeruli. Bodies resembling white corpuscles of the blood were numerous and plainly visible. Blood.—White corpuscles were observed to be five to ten timet as numerous as they should have been, having very dis- tinct granulation; presenting nucleoid bodies, some corpuscles three some two and some one, large and plain. Drawings of them pn. served. to — ccooo-jQ3cji^.icto h o a a *i ft v * u tj *.*k.*kW4».cjicjitn*.*.*.tn>^.cniK 4*. o« o» o to g 00-J00CiUtCOOi4».0030-J©COCOaD -jowoop ^_________t^-a»-________________________________>»*• CO HMMHWWNMMMMl-iKWWMMH"' CO CO CO OWlO^-JOtDOJ oouootoffleoowf OJ *w 00 CJl 00 WOOOOOffltnOi^ilktl'WMftCOWg ** © © 00 W 000 0 0>^S)OOOOOOU1W4>.019>N 05WOi06CJlC»OW-Jr-TO>iKOOrf».WOO ClffiUlJ1 C7» CO C5 1^ -T OlO)4kC5^»^»Ol ^OOOltKOOf1 oioooooc j; : - j. - No. of c*«. Brain. /ftgM. r ZeA Heart. Liver. Gail-Blad- der. Spleen. Right. Left. a W Right, co p^ Left. Pancreas. Brain. Right. t+ Left. Heart. 1— to © to !-• i-1 © — CO p Liiver. CO 5' Gall-Blad-der. Oi W O oi Oi W w os en 5' Spleen. ■J\ CO *- U^ Ol *> *■ Oi Oi Right. Left. Right .off •si ^e/<. sri 00 i— -I 00 5" Pancreas. K i-= C > ffi It* H C/J c a >► si > >■ >. to >-= W — 3 T03 <3r I t^ '2\\. NOTE. The preceding pages arc not given forth as perfect in any way. I am sensible of many shortcomings in conception and execution. Microscopic observations, often made, were, as a rule, made so imperfectly as not to be deemed proper to record. What I have seen I have described; and the majority of ob- servations made in public, as it were, with an audience of from five to ten persons having more or le.s professional knowledge were assented to by all present. Every statement was made with the part described in hand or before me and written down generally by a cadet according to dictation. The language of dictation has been preservedjas may he seen. • I do not consider myself in the least responsible for the Ante- Mortems. They are given for the most part precisely as com- posed by the medical officer whose name is attached. I am indebted to the cadets and students of medicine at National -ind Ilicks Hospitals for zealous co-operation. It is my painful duty to say a word in memory of Mr. Caulk, a young gentleman of high promise, a student of medi- cine at the I'niversity of Maryland, who, after assisting us in our examination of the bodies of so-called "spotted fever" cases at National Hospital, himself contracted this disease and died of it. I am indebted to Dr. Henry McElderry, U. S. Army, for compiling the first table of weights and measures. The greatest allowance should be made for typographical errors. I am indebted to J. S. Clarke and William Beck, the printers, for their diligence and general accuracy. This book is only a printed note-book intended for the fSu- geon General's Office and for the officers of National and Hicks Hospitals, who have desired copies. Criticism upon it, there- fore, would be wholly out of place. GEORGE M McGILL, fire ret Major d- Asst. /s'"r«/w/i V. S. A. 212. INDEX. ' 'use. PART I. 1. Pyaemia. "*'i. Perforation of Caecum; Pneumonia. - •*. 3. "Spotted Fever."-----— - 'VyjV'K —4. Chronic Diarrhoea, ^r 5. Phthisis. 6. Fracture of the Skull. —7. Hepatitis (abscess of liver.) ^-8, Pneumonia; Congestion of the Brain. 9. Amputation in Left Thigh; Diarrhoea. — 10. Pleurisy. 11. Typhoid Fever? 12. Congestion of and Blood Effusion in the Mucous Membrane of Small Intestines. —13. Pneumonia. __„ J* Typhoid Fever. 15. Fracture (sclopetic) of bead of Right Femur: Congestion of Brain. w16. Tuberculosis. — 17. Pneumonia. /^ 18. Lobular Pneumonia: Serous Bftrsw*. ^/vlTK^WL* \± —49. Congestion of the Brain; "Spotted Fever?" £#-> 20. Gun-shot Wound of Left Lung. —21. Pneumonia and Pleurisy. 22. Gun-shot Wound of Pelvis; Pyaemia. 23. Chronic Diarrhoea? Adhesions in serous i 24. Chronic Diarrhoea. 25. Gun-shot Wound Right Lung. "na. Cancer of Descending Colon; Congestion of the Brain. 27. Pyaemia; Congestion of the Brain. 28. Gun shot Wound of Spine; Hemorrhage from Spinal Veins. 29. Pyaemia, after primary amputation mid. third left thigh. 30. Fracture of the Skull, R. R. —31. Diphtheria. ^2. "Spotted Fever." 6--\) (£ """--33. Pneumonia. ^34. Pneumonia, Parotitis. *v35. Congestion of Lungs and Brain. -—36. Typhus Fever? Pneumonia; parotitis oomplicating. -»37. Tuberculesis. ^»38. Congestion of Lungs. Heterologous (bone) tumor in brain. Aneur- ism in basilar artery. — 39. Spotted Fever? Typhus? ^-**n *vvP 40. Gun-shot Wound Spleen and Lung. __41. Spotted Fever? Typhus? /IvlW C 1^>\J, " —12 Pneumonia; Congestion of the Brain. 213. Cast. 3. Spotted Fever? '4~b/\rvj"v~ """44. Pneumonia. 45. Chronic Diarrhoea. -46, 1st. Chronic Diarrhoea. "M6, 2d. " " -—«fr7. Spotted Fever? 1 ^j_A-\~*v-v\A k^ ""■48. Congestion of Lungs and Brain, etc. 49. Ligature of Femoral and External Iliac Arteries. ""■"50. Congestion of Brain and Lungs. l\-yvvJU«-CuVi«v*- —*1. Cerebro-spinal Meningitis. /VvwVvt-t^vwW* 52. Gunshot Wound of Pelvis; pyaemia. """?>3. Congestion of the Brain and Lungs. (j/v\>-v^ '"• i4. Typhus? l%_>^^*«-_>rV'>- *"""'55. Spotted Fever. [%J*s~ C^y^j-^- *"56. Tuberculosis. 57. Gun-shot Wound of Spinal Marrow. **»-68. Pneumonia. ^^59. Capillary Bronchitis; disease of aesophagus. "**■ 60. Pneumonia, etc. PART II. N. Typhoid Fever. __ y.. . 2. Abscesses of Liver, hfr-yvu, t *>* lL Hv«C ^uUOi^j. >S. "Typho-Malarial?" ~~4. Cnronic Diarrhoea; peritonitis. 5. Pyaemia, after amputation of left arm. ( Gun-shot Wound of Left Femur. 7. Gun-shot Wound of Left Leg; Fatty Degeneration. ***8. Tuberculosis. \). Typho-Malarial Fever. t(i. Tuberculosis; Diarrhoea. "'11. Pneumonia. ^12. Dysentery. \o. Tuberculosis; Dysentery. NJ. Pleurisy. Nir>. Congestion of Lnngs and Brain, (after a debauch.) v 1(;. Typho-Malarial Fever; pneumonia. -*.J7. Congestion and ecchymosis in 4th ventricle; melanosis, etc., follow- ing malarial disease. l ,-s. Coxalgia. 19. Gun-shot Wound of Left Thigh; death from poisoning by Morphia? **" 20. Chronic Diarrhoea; abscesses in liver; pyaemia. :l. Gun-shot Wound, penetration of left pleural sac, etc' u. Desquamative Nephritis. .:;. Gun-shot Wound of Left Thigh; tatty degeneration. Fatty degen- eration of kidners.