Case at the Hospitals of Alexandria, Va.

CASE 72.—Private William E. Tappan, Co. H, 28th Mich.; age 17; admitted Jan. 31, 1865. Skin hot and dry; tongue dry and somewhat fissured, red at the edges and coated dark yellow in the middle; pulse quick and feeble; bowels rather loose; urine scanty and high-colored; respiration somewhat hurried; he was rational and complained of pain in the back of the head and neck. He did not rest well during the following night, and next day, although his tongue was less dry, his pulse was fuller and the pain more intense, extending from the head down the spine and over the body generally; he was peevish, fretful and slightly delirious at times, though he answered questions correctly. A blister was applied to the back of the neck and alteratives administered. On February 2 delirium was constant; the patient muttered, tried to get up, and had occasional attacks of opisthotonos which increased in violence, but there was no paralysis; he refused all food. Wet cups were applied along the spine. Next day opisthotonos was less marked, but delirium continued with dilated pupils; the catheter was required to relieve the bladder. On the 4th the pulse became weak and intermitting; the respiration labored and accompanied with a rattling in the throat; he was semi-comatose but easily aroused; the tetanic convulsions returned with violence, and he died at 11 P. M. Post-mortem examination: Body not emaciated. The veins of the cerebral membranes were distended with black blood; the brain was firm and slightly injected; its lateral ventricles contained thick pus and their veins were black and engorged; the velum interpositum, valve of Vieussens and the membranes from the optic commissure down the medulla as far as could be seen were covered with lymph and pus; the gray matter of the cerebellum was so pale as to be scarcely distinguishable from the white matter; the cerebellum and spinal cord were softened. The upper and lower lobes of the right lung were somewhat congested and showed dark-purple or blackish patches of softened tissue; the middle lobe was œdematous, of a gray color tinged with pink, and presented at its margin a patch of shrunken liver-red tissue full of enlarged bronchial tubes containing pus; the left lung was similarly affected but in a less degree. The heart was normal. The liver was somewhat enlarged, yellow and granular; the spleen small, its trabeculæ and Malpighian bodies enlarged, dry and bloodless; the intestines and kidneys normal; the bladder largely distended and the overlying recti muscles of a bright-red color.