Civil War Washington

CASE 81.—Unconsciousness; muscular twitchings; involuntary passages; sordes; diarrhœa during convalescence.—Private Luther Howard, Co. B, 72d N. Y., was admitted Sept. 29, 1861, having been sick for two weeks. Diagnosis—typhoid fever. He was partly unconscious and unable to speak except occasionally; the face was congested, the eyes slightly injected, the facial muscles disturbed and those of the extremities twitching involuntarily in almost choreic movements; he had headache and some laryngeal trouble; the skin was soft and moist; the pulse 88, firm; the abdomen tender. Camphor and opium were given. Next day he was partly comatose, his face congested, pulse 100, full and strong, skin hot and soft; no stool was passed, but the abdomen was tympanitic and tender; no urine was voided for sixteen hours; the muscular twitchings continued, and the patient was unable to open his mouth or speak. Emulsion of turpentine, sweet spirit of nitre, valerian and Dover's powder were ordered. On October 1 sordes appeared on the teeth, the tongue was coated dark brown and the mouth filled with dark tenacious mucus; the patient was indifferent, but ate food when offered to him; the bowels were unmoved. Five grains each of calomel and jalap, with twelve of quinine, were given him. One small stool was obtained next day, and the patient was less stupid; he was very deaf, but answered questions correctly when put to him in a loud voice. On the 3d he protruded his tongue with less difficulty and the choreic movements were lessened, but there was some dysphagia and the stools were passed involuntarily. On the 4th he was rational; the tongue slightly moist; bowels tender and moved once, but not tympanitic. Turpentine emulsion, brandy, Fowler's solution and Epsom salt were given. Two involuntary stools were passed on the 6th, but the dysphagia was lessened, the twitchings had ceased and the patient was able to articulate well and masticate his food. Beef-essence and astringents were ordered. Some headache and delirium were present on the 8th; the tongue was dry and tremulous, showing yellow patches and prominent papillæ, and the bowels were loose. After this the skin was usually hot and dry or of the natural temperature, although on the 18th there was some perspiration at night. The tongue was moist, clean or patched with white or yellow, and usually flabby and with prominent papillæ; but on the 13th it was red at the tip and edges and coated yellow in the centre. The appetite was good, and for several days was recorded as excessive. The bowels were loose, yielding two or three passages daily, with occasional tympanites and tenderness mostly in the right iliac region, he slept well, but was occasionally troubled with a little cough. Epistaxis occurred on the 30th, and on November 1, 5 and 6 there was some headache with dizziness and twitchings of the eyeballs. He was transferred to Annapolis, Md., on the 18th [as a case of typhoid fever, and was returned to duty December 27].