Civil War Washington

CASE 92.—Private John Davis, Co. E, 8th Vt.; age 28; was admitted July 26, 1864, with quotidian intermittent of moderate severity. This was immediately checked by quinine, and the patient seemed in a fair way to recovery when, on the morning of the 31st, he remained in bed feeling weak and without appetite. The tongue was clean; about midnight he had been seized with great restlessness which lasted twenty minutes, but he had not slept until towards morning. He did well during the day until 5.30 P. M., when he was again attacked with restlessness and convulsive movements resembling those presented by certain cases of hysteria. He became delirious, tossing himself about in bed and uttering shrill screams; his pupils were dilated; respiration 14; pulse 100 and full. Ice was applied to the head and spine and mustard to the epigastrium; a turpentine enema was given. No medicine was prescribed by the mouth as the ability to swallow appeared to be lost. Coma gradually supervened, and the patient died at midnight, twenty-four hours after the onset of the attack and six and a half hours after the full development of its character. Toward the last he was bathed in perspiration. Post-mortem examination: Body well developed; surface of back of neck and shoulders showing twenty-five or thirty dark-purple spots from the size of a mustard-seed to that of a pea, circular, somewhat elevated, with well-defined margins, and consisting of an infiltration of dark-colored blood in all the layers of the skin and to some extent in the subcutaneous connective. During the removal of the skull-cap about six ounces of serum colored with blood flowed away; the Pacchionian bodies were unusually numerous, large and adherent for a subject of 28 years; the arachnoid was opaque, especially over the vertex, and some limpid serum lay beneath it; the ventricles contained a moderate quantity of serum; the choroid plexus in the fourth ventricle was thickened and looked like a lamina of pale flabby granulations, but the vessels in the other ventricles presented no abnormity​; the substance of the cerebrum, cerebellum, pons and medulla oblongata was moderately congested throughout. The theca vertebralis was well filled with serum, notwithstanding the large quantity which had escaped during the examination of the brain, and the cerebro-spinal fluid contained flocculi in the lumbar region; the arachnoid was opaque and the vessels beneath it intensely congested; the substance of the cord seemed healthy. The lungs were engorged and the middle lobe of the right lung contained an apoplectic extravasation as large as a walnut. The heart-clots were small. The blood was much more fluid than natural. The liver and intestines were healthy; the kidneys congested; the urine highly albuminous.—Stanton Hospital, Washington, D. C.⃰

⃰ JOHN A. LIDELL, U. S. V., published this case in an article on Epidemic Cerebro-spinal Meningitis in the American Jour. Med. Sciences, June, 1865.