Civil War Washington

CASE 38.—Delirium and rose-colored spots on the 9th and following days; intestinal symptoms not severe. A favorable change on the 16th day is interrupted by the occurrence of pneumonia; improvement on the 32d day.—Private Hiram Billington, Co. F, 2d Me.; age 29; admitted Oct. 7, 1861. Diagnosis—typhoid fever. He was taken with headache on Oct. 1 and with pain in the back on the 3d, but had no chill, diarrhœa nor eruption. On the evening of the 7th he was somewhat dull, his face flushed dark-red, pupils dilated, head hot and painful in the temporal regions where the arteries throbbed strongly; tongue red at the tip and coated in the middle; skin hot and moist; he had pain in the back, slight cough, abdominal tenderness and slight relaxation of the bowels; pulse 100. Cold water was applied to the head and five grains each of calomel and jalap given at once. Next day he had two thin stools, his tongue was cleaning and his pulse lowered to 90, but to the headache, flushed face and other symptoms of the previous day some deafness was added. Quinine was ordered. The dilatation of the pupils continued on the 9th with increasing dimness of vision and muscæ volitantes; the patient muttered in his sleep, and even when awake his mind was at times disturbed; he had a dry cough and pain in the chest, but his respiration was not accelerated; his bowels were moved twice, and he had acute tenderness in both iliac regions but no borborygmus nor tympanites; his skin was hot and moist and showed a few rose-colored spots on the chest and abdomen; his tongue was quite red, moist and clean, and he had anorexia and great thirst; pulse 88; urine chemically and microscopically normal. He was very drowsy on the 10th and had violent delirium in the afternoon. Next day a few more rose-spots came out, the skin became warm and dry and the tongue very dry, hard and fissured; two thin stools were passed with gurgling but no tympanites. On the 12th the red spots had become darker in color; there was less delirium, but the eyes were somewhat suffused and the expression stupid. Turpentine emulsion and spirit of Mindererus and of nitre were given. On the 13th the mind was clear and the countenance natural, but there was some dizziness at times; pulse 80, steady; skin soft and warm; tongue dry in the centre, moist at the edges, quite pale and slightly coated; the anorexia continued, but the thirst was lessened; three stools were passed. The bowels were moved but once on the 14th and were quiet on the 15th, on which day a few more rose-spots appeared. During the night he slept well, and on the l6th the skin was moist and warm; the tongue cleaning from tip and edges but still coated in the centre; the bowels continued quiet. Citrate of iron and quinine was given. During the ten days which followed there was but little change in the patient's condition; the bowels were quiet or moved once daily, with more or less of tenderness; the skin was warm and moist in the day-time and frequently bathed in perspiration at night, and the tongue was moist; but on the 25th, after a sleepless night, the tongue became dry and fissured, and complaint was made of cough and pain in the præcordia, near which submucous and sibilant râles were heard. A blister was applied, and on the 27th one drachm of Epsom salt and a half grain of tartar emetic were given three times daily. Next day there was mucous expectoration with dulness​ over the lower part of the left lung, and the patient became delirious. Brandy-punch was substituted for the tartar emetic mixture. On the 29th the patient was very drowsy, moaned frequently and muttered in his delirium; his tongue was coated with scales, dry in the centre, pale and moist at the edges; the teeth and gums were thickly covered with sordes; the skin was hot and moist; pulse 96; respiration 33, short, quick and somewhat labored; râles were heard in the lower parts of the lungs, and to a less extent in the upper parts; the expectoration was rust-colored; the bowels were moved twice and were tender and tympanitic. Calomel and opium in repeated doses were ordered on the 30th. On the 31st there was much cough with rusty sputa. A slight improvement was manifested on November 1. He slept well during the following night, and on the morning of the 2d looked bright although very weak; some thirst continued, but there was a slight appetite, and the teeth, gums and lips were clean; the tongue was moist, deeply fissured and covered with white patches; the urine contained a trace of albumen. Slight salivation occurred on the 4th, on which day the urine was found to be normal. The last entry with regard to the case, dated on the 7th, shows the patient as having rested well during the preceding night and as being bright and cheerful at the morning visit, the pulse 88 and of good strength, the skin soft and warm, the tongue soft, moist, fissured and coated; some cough continued and the bowels were moved twice, but there was no tenderness. He was transferred to hospital at Alexandria, Va., on December 20.