CASE 28.—Dizziness; deafness; diarrhœa; eruption on the 9th day, not disappearing on pressure; manifest improvement coincident with epistaxis on 16th day; hemorrhage from bowels on 19th day, with subsequent inflammatory action in the pulmonary and urinary organs, and delirium lasting until the 33d day, when improvement was again manifested.—Private James Scoffield, Co. K, 6th Wis.; age 20; became subject about Sept. 25, 1861, to faintness and feelings of weakness, chills, fever, diarrhœa, pain in the head and back and anorexia. He was admitted October 2 as a case of typhoid fever. His face was flushed darkly; eyes suffused; expression dull and heavy; pulse 100, strong and full; skin hot, dry, smooth and without eruption; tongue slightly moist, red at the tip and thickly coated grayish-white in the centre; bowels relaxed but not tender; he was somewhat deaf and had a slight cough. Next day the patient was drowsy and had headache with dizziness and increasing deafness; the skin hot and slightly moist, showed a few spots which did not disappear on pressure; the bowels were moved four times and were tender. No change took place until the 7th, when tinnitus aurium and epistaxis were noted, the tongue having become clean, dry, red and fissured. On the 9th the tongue became very rough, red and grayish-white in the centre; epistaxis recurred; four stools were passed, and there was slight tenderness in the right iliac region; the urine was scanty and very dark-colored. Next day epistaxis again occurred, the pulse was 100 and strong, the skin soft although hot and dry; the expression was less anxious, the eyes clearer, the hearing improved and the tongue moist and cleaning in the centre, but the patient complained of headache and pain in the back and side, a dry hacking cough and much thirst; he had two thin stools with much tenderness and gurgling and slight meteorism. On the 13th a profuse hemorrhage occurred from the bowels; the patient became very pale and stupid, pulse 120, skin hot and husky, tongue moist, fissured and slightly coated; the abdomen was soft and tender. Next day the pulse was 101, the skin dry and husky, the tongue dry, dark, cracked and rough, the countenance pinched and somewhat anxious, the teeth and gums covered with sordes; the bowels moved three times during the night, about eight ounces of blood coming away with one of the passages. No hemorrhage took place on the 15th, but the patient had subsultus tendinum and some bronchitic cough. His expression on the 16th was wild; he was very wakeful and complained much of pain in his heels and legs. On the 17th he perspired profusely and had frequent epistaxis but no stool; the bladder was so distended as to require the employment of the catheter; the tongue was dry, furred and scaly; pulse 112, feeble; mind dull; countenance anxious; respiration normal. Two stools were passed on the 18th; the bowels were tympanitic and acutely tender; the skin was dry but at times moist and perspiring; the delirium present was not of a violent character. From this date until the 27th the patient was dull, drowsy and more or less delirious, sometimes crying out loudly; the skin was dry and husky but occasionally moist; the tongue dry, fissured and scaly and the teeth black with sordes; two or three stools were passed daily, and there was much right iliac and hypogastric tenderness, with meteorism and borborygmus; the catheter had to be used, and the urine withdrawn was strongly alkaline, containing blood, mucus, pus, epithelium and excess of phosphates. Some sibilant râles were heard in the upper parts of both lungs, and the respiration at one time became increased to 28 per minute. He was emaciated and very weak; but on the 27th the mind became clearer. On the 28th the eyes were bright, the skin warm and sweating, the tongue moist and cleaning, the bowels quiet, the abdominal tenderness much diminished, but still acute in the right iliac and hypogastric regions. On the 29th some appetite was manifested. The teeth and gums were clean on November 1. Micturition was free and natural on the 4th, but for some days after this he had at times much pain in the penis and bladder. On the 9th bed-sores are mentioned; the skin was hot and dry; the tongue dry, smooth and fissured; the bowels were quiet, but tenderness continued in both iliac regions; the appetite was good. No further record was made except that on the 20th the patient was transferred to Annapolis, Md. This case was treated with turpentine emulsion on October 7th. Dover's powder on the 9th, acetate of ammonia on the 10th, extract of buchu on the 11th, and thereafter with quinine, opium and stimulants.