Civil War Washington

CASE 45.—Diarrhœa; cough; sordes; rose-spots on 8th day, succeeded by others on the 11th, 14th and 17th days; deafness; delirium; epistaxis; otorrhœa on 22d day, with relief to all symptoms; death from pneumonia on the 31st day.—Private Z. McLaughlin, Co. A, 3d Pa. Cav.; age 18; was admitted Oct. 20, 1861. Diagnosis—typhoid fever. He had been healthy until Oct. 14, when he was seized with chills followed by fever and sweating. On admission he had epistaxis, diarrhœa, anorexia, thirst and cough. Next day his eyes were dull and slightly injected; pulse 91 and quick; skin hot and dry, presenting a profusion of colored spots on the chest and some on the abdomen; tongue slightly moist, red at the tip and edges but coated white in the centre; lips black with sordes; two stools were passed during the twenty-four hours; there was some meteorism and also a slight cough. Tincture of iron was prescribed. Next day eight stools were passed, and there was some cough with expectoration of tenacious mucus. Turpentine emulsion, lead, tannin and opium were prescribed. The diarrhœa, which was attended with much tympanites, became checked in the course of a few days and the bowels thereafter remained quiet or with not more than one movement daily; the skin continued hot and dry throughout. Fresh crops of rose-colored spots appeared on the 24th, 26th and 30th, and were reported on November 2 as fading and unelevated; but on the 3d and 5th the chest is noted as covered with sudamina. Deafness was recorded on Oct. 24; buzzing in the ears on the 27th; epistaxis and delirium on the 29th, the former recurring on the 31st and on November 3 and 4. On Oct. 30 the patient was kept from sleeping by the cough, and there was much delirium, deafness and tinnitus; at this time the tongue was dry and its papillæ prominent. On November 1 the tongue was swollen, dry and brown. On the 3d the deafness was very great, but a discharge occurred from the ear, and with this the tongue became moist and the deafness lessened. On the 4th, when the last attack of epistaxis occurred, the pulse became so faint that it could scarcely be counted; but the appetite improved. On the 5th the tongue was moist and yellowish, pulse 100 and feeble; there was no abdominal tenderness and less cough. On the 8th the pulse was 105 and the respiration 22. Next day the pulse was 120. Death took place on the 12th with pneumonic symptoms.