CASE 69.—Flabby tongue; gastric irritability; recurring epistaxis; diarrhœa and general abdominal tenderness; headache; delirium; sordes; prostration; inflammation of parotid; rose-spots and vibices; discharged on account of typhoid fever.—Private Patrick Devine, Co. K, 3d Vt.; age 18; was admitted Oct. 1, 1861, with typhoid fever. He had been taken, September 26, with headache, chills, fever, diarrhœa and epistaxis (which last had been of frequent occurrence during the previous month), and on the 28th with retention of urine. On October 2 the patient's face was congested; his eyes dull and heavy; pulse 112, quick and strong; skin hot and dry; tongue moist and coated brown; teeth covered with sordes; stomach irritable and unable to retain food or medicine; he had headache and pain in the back, with tenderness over the whole of the abdomen and slight borborygmus. Repeated doses of calomel and opium, with turpentine emulsion, were given. Quinine, extract of buchu and sweet spirit of nitre were administered on the 4th, and beef-essence, milk-punch and astringents on the 6th, as diarrhœa began to be a prominent symptom. On the 7th the pulse was 90 and strong, the skin natural, the tongue slightly moist, red at the tip and edges, heavily coated brown and fissured in the center and at the base; eight stools were passed, and micturition was difficult. Rose-colored spots appeared on the following day; there was some mental dulness​ with headache and occasional delirium; cough was troublesome, and the diarrhœa was accompanied with general abdominal tenderness which was especially acute in the right iliac region. Epistaxis occurred on the 11th and next day the bowels were quiet. With the moderation of the diarrhœa the tongue became flabby and remained dry and brown-coated in the centre, although the appetite improved. Epistaxis recurred on the 14th with some headache and delirium; the tip and edges of the tongue became red, the lips covered with sordes and the bowels relaxed to five stools daily. Next day the nose bled again, some rose-colored spots appeared, and the patient was unable to protrude his tongue on account of swelling of the parotid gland. Epistaxis, profuse perspiration and vibices on the neck and chest, with headache and increased swelling of the parotid, but no delirium, were noted on the 17th; the diarrhœa continued with general tenderness and some meteorism, especially marked in the right iliac region. Vibices were numerous on the abdomen on the 18th, and fresh rose-spots appeared on the 20th, 22d, 23d, 25th and 28th; during these days the diarrhœa moderated, but the tenderness continued, being sometimes general and at others specially marked in the umbilical and right or left iliac regions; some headache and cough were noted but no delirium; the appetite was good, the skin generally moist, and the tongue moist and but slightly coated; the patient continued unable to protrude his tongue. Epistaxis recurred on the 28th and on November 2d, 4th, 6th and 8th, during which days there was some heat and dryness of skin, with headache and tinnitus, relaxation of the bowels, abdominal tenderness and coated tongue, the appetite continuing good and the cough subsiding; pulse 80 to 100. No change took place in his condition up to the 18th, when he was transferred to Annapolis, Md. [whence he was discharged on the 29th on account of typhoid fever].