Civil War Washington

CASE 67.—Headache; epistaxis; hebetude; abdominal symptoms not marked; rose-spots on the 9th day, with perspirations and sudamina about the beginning of the 3d week, accompanying defervescence.—Sergeant John Evans, Co. H, 12th Pa., had a chill on the morning of Aug. 30, 1861, followed next day by fever which increased towards evening, and was associated with headache and pains in the bones and small of the back. To these symptoms, on September 2, epistaxis, lassitude and a tendency to stupor were added; but the bowels remained regular and urination free. On the 4th he was admitted to hospital as a case of typhoid fever: pulse 78, skin hot and dry, tongue coated white, bowels constipated and tender on pressure. Two grains each of compound cathartic mass and blue-pill were given at once, with sulphate of quinia, by which the bowels were moved three times. He rested well during the night, and on the morning of the 5th his pulse was 80, skin warm and moist, but his tongue was dry, red, coated and flabby, and he complained of pain in the limbs. During the day he had three small thin stools, and in the evening the pulse was 72, the tongue red, flabby and coated white, the skin dry and warm; there was also some dizziness. A ten-grain dose of Dover's powder was given. During the progress of the disease there was but little variation in the pulse; it did not go over 80, and on the 11th fell to 64, coincident with a warm moist skin and the development of an abundant crop of sudamina on the abdomen and shoulders. The skin was warm and generally dry, but sometimes it felt moist; it was covered with perspiration on the 11th and 14th, after which latter date it was generally either cool or natural. The tongue became brown-coated and dry on the 7th coincident with the occurrence of anorexia and some obtuseness of the intelligence followed by drowsiness; it became moist again, but very red and coated on the next day, when also the appetite showed signs of return, and a few rose-spots were noted on the abdomen, with slight tenderness and borborygmus in the right iliac fossa, but it was not until after the appearance of the sudamina on the 15th and 16th that the mental hebetude was removed. The bowels were not notably loose at any time save immediately after admission, as already related; but there was a tendency to laxness, as two drachms of castor oil on the 9th produced two thin stools:—on the other hand, ten grains each of calomel and jalap on the 14th, after yielding three thin stools, created no further disturbance of the intestinal tract. During the night of the 6th he had a colic, which was relieved by the application of mustard. On the 16th, as a slightly jaundiced hue of the face was apparent, small doses, two grains each, of blue-pill and quinia were given with port wine three times daily. After the 20th the patient did some light duty about the ward, and was returned to his command October 5.