Case at the Hospitals of Alexandria, Va.

CASE 69.—Private Marshall Stowell, Co. E, 189th N. Y.; age 16; was admitted Nov. 30, 1864, with typhoid fever. He was restless and noisy, his face flushed, eyes suffused, tongue dry, swollen and with the papillæ much enlarged in the middle and at the base, mouth and throat dry and sore, teeth and lips covered with sordes, pulse frequent and irregular, skin hot and dry; but there was no diarrhœa. He was treated with cold to the head, sinapisms to the feet and abdomen, hyosciamus, brandy-punch, beef-tea and a few doses of turpentine and chlorate of potash. On December 10, having been alternately restless and quiet in the meantime, he was seized with pain in the head, much abdominal tenderness and vomiting, morning and evening, of a thick brownish liquid. The tenderness increased and the patient became very irritable—pulse 130—until the 13th, when there was less pain, some appetite and a better pulse, 100. But on the 16th he became somewhat comatose. As there had been no stool for a week oil of turpentine was given with the effect of producing a full natural evacuation; but the coma gradually increased with quickened and labored breathing, and he died December 20. Post-mortem examination: Body emaciated; face pale; surface showing a little stasis but no petechiæ or spots. The surface of the brain was congested and covered with patches of opaque green lymph; the lateral, middle and fourth ventricles were filled with serum and sticky pus; the substance of the brain was not softened. The posterior and lower portion of the right lung was mostly crepitant but of a dark-red color, and its smaller tubes contained muco-pus; the posterior and upper part of the left lung was dark-red and softened but crepitant. The right side of the heart was distended with a firm white clot and with thick but fluid black blood. The liver was pale and had yellowish spots extending from its surface into its substance; the spleen, about the size of the fist, was firm and of a light red-brown color. The kidneys were fatty and granular; the bladder distended, reaching to within three inches of the umbilicus. The mesenteric glands were enlarged. The ileum was congested on its mesenteric side but not ulcerated. The colon contained a moderate quantity of fæces of normal appearance and presented oval dark spots of a bluish tinge on the mucous membrane from the transverse colon to the rectum. [Specimen 520, Med. Sect., Army Medical Museum, shows part of the left lateral ventricle, the choroid plexus, roughened by pseudo-membrane, with shreds of lymph hanging from various parts of the ventricular lining.]