Civil War Washington

CASE 36.—Delirium; diarrhœa; rose-spots, vibices and bed-sores; pneumonic complications delay convalescence until after the 40th day.—Private George Felter, Co. H, 9th Pa. Vols.; age 22; was taken sick about Sept. 1, 1861, and admitted on the 19th with typhoid fever. The notes of the case on the 20th are: pulse 96; skin hot and dry; high fever; tongue coated white in centre, red at tip and edges, slightly moist; acute iliac tenderness; tympanites; constipation; enlargement of the thyroid gland. Ordered: enema of soapsuds; emulsion of turpentine; Dover's powder at night. On the 21st: pulse 120, full and soft; skin hot and moist; tongue dark-red at the margins, dry and brown in the centre; characteristic rose-spots; no sudamina; less tympanites; tenderness of abdomen on pressure; borborygmus; subsultus; delirium; drowsiness; decubitus dorsal; respiration 30. Gave wine whey four times daily with beef-essence. On the 22nd morning: delirium; subsultus; pulse 118, full and soft; few rose-spots; skin hot and dry; tongue very red and moist; respirations hurried; submucous and sibilant râles in upper part of both lungs; decubitus dorsal; acute general abdominal tenderness; tympanites less; borborygmus; one stool. Ordered: one-fourth of a grain of morphia; cold applications to head. Evening: pulse 120; face flushed; skin hot and dry; tongue dry; rose-spots; high fever; delirium; deafness. No change took place until the 24th, when there was some diarrhœa. On the 25th the tongue became slightly moist and cleaner, the delirium gave place to dulness​, vibices appeared on the chest, the urine and feces were passed involuntarily and a large bed-sore formed over the sacrum. The tongue became again dry on the 26th, and the lungs were found consolidated in their lower portions. On the 27th the pulse was 113 and strong, the face flushed, the skin hot and dry, the respirations 10, with submucous and sibilant râles in the upper part of the right lung and a short dry cough. A blister was applied to the upper part of the chest. The bowels were quiet on the 28th. The tongue became moist on the 29th, red at the tip and gray in the centre; the skin was warm, dry, and soft; the bowels were quiet, but there was tenderness on both sides, with tympanites and borborygmus; the sacral sore was healing and the patient rational. The chest was again blistered; tonics and stimulants were administered. The stools became involuntary on the 30th, with acute right iliac tenderness and some anxiety of expression; pulse 106; surface circulation sluggish; respirations 10; some cough and much dyspnœa. The patient became restless on October 1. Vibices appeared on the abdomen on the 2d; some diarrhœa occurred, the stools being involuntary; delirium occasionally returned at night. On the 4th there was some improvement in the chest symptoms. On the 7th the face was slightly flushed; the pulse 111, steady; the skin hot and dry, moist in some places, the tongue moist, red at tip, coated in centre; the bed-sores showing points of granulation; the stools involuntary at long intervals, with borborygmus and some tympanites but no tenderness; micturition involuntary. On the 8th, 9th and 10th the pulse fell respectively to 108, 106 and 100, one or two stools occurring daily with some tenderness—the skin continuing hot and dry, but the tongue becoming cleaner and its edges moist. On the 10th the eyes were bright and the countenance cheerful. The pulse fell to 90 on the 11th; the condition of the tongue improved and the appetite returned. On the 17th the tongue was clean and moist but redder than natural; the bowels were regular; the appetite good; a slight cough yet remained. The record, which is continued in detail up to the 27th, shows the occurrence of an occasional thin stool but the tongue preserved its clean and red condition, the appetite was good and the sleep sound at night; no further reference is made to the healing of the bed-sores. This patient was transferred to hospital at Alexandria, Va., December 20.