Civil War Washington

CASE 110.—Private D. F. McLachlan, Co. G. 14th N. Y., was admitted Sept. 20, 1861. He had been taken sick with a chill followed by severe pain in the head, back and sides, with loss of appetite and strength. On admission his skin was warm and perspiring; pulse 92, quick and strong; tongue glossy and pale, slightly colored brown in the centre and at the base; bowels moved eight times in the twenty-four hours; there was tenderness in the iliac and epigastric regions, with meteorism, borborygmus, epistaxis and rose-colored spots (from twenty to thirty) on the abdomen and chest. He was treated with turpentine emulsion, blue pill and opium, and Dover's powder at night. Next day there was slight mental confusion with ringing in the ears, and his tongue was covered with a grayish fur. An eight-grain dose of quinine was added to the treatment. During the week which followed his condition was one of gradual improvement; the pulse did not rise above 90, the meteorism disappeared, his appetite began to return and his tongue lost its fur, becoming moist and pale, but his bowels continued slightly relaxed notwithstanding the use of opiates and astringents. After this his progress was uncertain; at times he felt pretty well. He was treated mainly with wine and quinine in two-grain doses three times daily, but on October 16 the throat and larynx became congested and he had some bronchitic cough. Blisters were applied to the sides of the neck, the throat was swabbed with a strong solution of nitrate of silver and five grains each of calomel and jalap were given. He did not rest well during the night and next day was pale and weak, hoarse and somewhat deaf; his bowels were moved three times and there was tenderness with tympanites and borborygmus. During the day the bowels were again moved three times. He continued thus for three days. On the 21st whiskey punch was substituted for wine. On the 23d his expression became anxious, pulse 111, skin hot and dry, the tongue continuing pale and flabby; he had six thin evacuations from the bowels; cough was troublesome and the throat symptoms had become so aggravated that he swallowed with difficulty and could not speak above a whisper. The treatment consisted at this time of chlorate of potash, muriate of iron, beef-tea and whiskey-punch. During the following night his pulse rose to 140, and next day sordes appeared on the teeth. Soon after this he became delirious, imagining that some large animal was in bed with him; that he was in camp, etc. On the 27th, having passed a better night, he was not so delirious, but he looked pale and anxious; his pulse was weak and small, 94; skin warm and soft; tongue pale, moist and tremulous; his bowels were moved involuntarily. At this time there was noted on the skin dark, almost black, slightly elevated spots somewhat larger than split-peas, without accompanying inflammation; those which had arisen more recently were whitish-yellow, being full of purulent matter. On the 28th he was almost unconscious; his pulse weak, small and irritable, 120; skin warm and soft; tongue heavily coated; mouth moist and its whole surface covered with white sticky mucus; gums covered with sordes; one side of the face flushed very dark red; his bowels had been quiet since an injection given on the previous evening, but there was tenderness on both sides; submucous and sibilant râles were heard in both lungs. On the evening of this day he was quite unconscious, his eyes and mouth open, pulse 130, respiration 50. During the night hemorrhage from the bowels took place and recurred on the afternoon of the next day. His pulse meanwhile becoming weaker and breathing more rapid. On the 30th his extremities became cold and at 2 P. M. he died. Post-mortem examination: The brain, pharynx and œsophagus were not examined. The lungs were much congested and hepatized. The heart contained fibrinous clots in both ventricles. The liver and pancreas were normal: the spleen soft and somewhat enlarged. The right kidney was small and transformed into a thin-walled cyst containing a yellowish liquid; the left kidney presented several large cavities containing pus. "The small intestine showed that inflammation had been rife there some time ago, but no ulcers were seen that had been formed lately; there were places where large and recently healed sores were evidently indicated." The mucous membrane of the colon was broken by several large ulcers. The mesentery was quite healthy.—Seminary Hospital, Georgetown, D. C.