Civil War Washington

CASE 49.—Relapse. Head symptoms not marked; rose-spots from the 41st to the 59th day; vibices on 50th; bowel affection not prominent until cessation of perspirations; returned to duty in 160 days.—Private M. R. Taggart, Co. A, 9th Pa. Vols.; age 34; was admitted Oct. 10, 1861, having been sick since Sept. 1 with what had been regarded as enteric fever, for which quinine had been given. On admission his eyes were dull, face congested, pulse 110, quick and full, skin hot and dry, tongue moist, red at tip and edges, coated white in the centre, appetite poor; he had some cough. Dover's powder was given. He slept badly during the night and next day was stupid and dull-eyed; a few rose-colored spots were found on the chest and many on the abdomen; the pulse was 100 and feeble; his bowels had not been moved. Tincture of iron was ordered to be taken three times daily and extract of senna in the evening. He slept well, and on the morning of the 12th the pulse was found to have fallen to 90; the eyes were bright and the flush had disappeared from the face; the bowels had not been moved, but there was much tenderness in the right iliac region. On the 13th the patient was covered with a profuse perspiration; pulse 120 and feeble; a slight epistaxis had occurred and one stool had been obtained. Tincture of digitalis and sweet spirit of nitre were ordered to be taken four times during the day. The perspiration continued on the 14th, and the appetite was found to be improved. Five grains of quinine were given every two hours. On the 15th the pulse had fallen to 90 and was more regular, the skin was hot but somewhat moist, the tongue dry, the appetite poor; the bowels had been moved twice. On the morning of the 16th the skin was dry, but there had been a profuse perspiration during the night; the tongue was red and clean but dry, and the appetite poor; one stool was passed, and the patient was troubled with cough. Profuse perspiration recurred nightly until the 22d. On the 17th the tongue became moist and covered with white patches. Next day a few rose-spots appeared on the abdomen; two stools were passed, and there was slight umbilical tenderness. On the 19th the profuse perspiration continued during the day; the pulse rose to 120; tympanites and borborygmus were present but no stool was passed. Several rose-spots and vibices appeared on the abdomen on the 20th; pulse 86; two stools were passed. The skin was soft and natural on the 21st, and next day the tongue was clean and moist and the appetite good. During the following week an occasional nocturnal perspiration was noted, but otherwise the condition of the patient was good. On the 29th some rose-spots appeared and three stools were passed. Four stools were recorded on the following day, and on the 31st nine stools, with dry tongue, heat of skin and accelerated pulse. Twelve stools were passed on November 1, on which day the patient was transferred to Annapolis, Md. [where his case was diagnosed typhoid fever, and terminated in a return to duty on March 19, 1862].