Civil War Washington

CASE 86.—Defervescence on the 22d day checked by chest complications; return to duty delayed to 80th day by diarrhœal sequelæ.—Bugler Henry L. Case, Co. H, 4th Mich.; age 22; was admitted Sept. 6, 1861. Diagnosis—typhoid fever. This patient had good health up to August 26, when he was taken with pain in the head and bones, chills and fever, somnolence, great thirst and epistaxis. His case was not taken up in detail until the 13th, when the morning record shows him to have rested well during the preceding night; he was very weak but had some appetite, regular bowels, a thickly coated brown tongue, a pulse beating 98 per minute and a slight cough; the evening record shows a white tongue, bad taste in the mouth, some fever, bowels regular, abdomen tender and slightly tympanitic, cough, tinnitus aurium and muscæ volitantes. On the 14th anorexia was added to the symptoms already stated. Next day he became dull, complained of heaviness over the eyes, and in the evening seemed drowsy. On the evening of the 16th the tongue became moist and white, but this was not followed by any general improvement; on the contrary, on the evening of the 17th the fever increased with slight nausea, the pulse running up to 106, while next day a pain on deep inspiration was developed. But on the 19th the pulse again fell to 92 and the skin became moist and sweating. There was some tenderness in the epigastrium on the 20th, in the hypochondrium on the 22d and in the right iliac region on the 23d, in addition to the abdominal tenderness which had existed from the time of admission. On the 21st the patient became somewhat deaf in the left ear, and next day his eyes became dull. The abdominal tenderness was relieved on the 24th, when, also, the tongue began to clean in patches, but thirst continued until the 27th. The patient slept badly on the night of the 24th, the only night which furnished such a record, for usually he rested well, and next morning his pulse was 96 and he had a soreness in the chest. On the 26th the tongue was moist and only slightly coated, which improvement was followed next day by a brightening of the eyes, abatement of the thirst and a return of the appetite. The bowels, which to this time had remained quiet rather than lax, now became loose, giving two, three or four stools daily, with iliac tenderness and a yellow fur upon the tongue; but in progress of time this diarrhœa abated and on November 1 the patient was transferred to Annapolis, Md., whence he was returned to duty on the 13th. He was treated at first with Dover's powder and sweet spirit of nitre, and afterwards, on the 23d, with turpentine emulsion and iron, opium, acetate of lead and tannin.