Civil War Washington

CASE 90.—Diarrhœa; delirium; sordes; pneumonic complication; eruption; slightly marked improvement on 15th day, after which free perspirations alternated with diarrhœa; vibices; epistaxis; peritonitis; death on the 31st day.—Teamster Jas. H. Perkins, quartermaster's department; age 23; a Virginian; was admitted Sept. 30, 1861. Diagnosis—typhoid fever. He had been taken with diarrhœa on the 25th and with head-pain and rheumatism on the 27th. On admission his face was flushed, eyes bright, pulse 96, quick and strong, tongue moist and slightly coated white; his bowels had been opened three times during the previous twenty-four hours, and the iliac regions were tender and tympanitic; he had also some cough. Calomel, opium and tartar emetic were prescribed. On October 1 the bowels were quiet, but there was some pain in the chest when coughing, with dulness​ over the lower lobes of the lungs. Small doses of calomel and quinine were given. He had three stools on the 2d. Next day the pulse ran up to 112, and complaint was made of headache and backache. Tincture of iron and camphor with opium were prescribed. He vomited twice on the 4th. His skin became moist on the 5th, and on the following day was covered with a profuse perspiration; but there was some delirium and much twitching of the tendons. On the 6th emulsion of turpentine was administered. On the 7th the pulse was 105, quick and strong, the skin natural, the tongue moist and heavily coated yellow; four stools were passed; the transverse and descending portions of the colon were tympanitic and the umbilical region tender; he had some cough, with slight pain in the right side below the nipple, and there was dulness​ on percussion over the lower lobes of both lungs, especially marked on the right side. On the 8th the skin was hot and dry and the bowels loose. On the 9th the patient was wakeful at night and dull and stupid during the day; the pulse 120, quick and strong; the skin hot and dry, showing some eruption (the character of which is not stated); the tongue red, fissured at the edges and coated dark-brown in the centre; the teeth and lips covered with sordes; he had, moreover, deafness, delirium, anorexia and diarrhœa. He continued in this condition until the 15th, when the tongue became moist, yellowish at the centre and red at the tip and edges, and the delirium and deafness were somewhat less marked; the pulse had fallen to 100. The skin was bathed in perspiration on the 16th and 17th, and this condition recurred on the 19th, 21st, 23d and 25th. Three or four stools were passed on the alternate days when the skin was hot and dry, but on the days when the skin was moist the bowels remained quiet except on the 21st, when they were moved six times. On the 19th vibices appeared on the skin and on the 23d became very numerous. On the 21st the pulse rose again to 120, and there was epistaxis with low delirium and increased deafness. The epistaxis recurred on the 22d. The patient became almost pulseless on the 25th; his skin was bathed in perspiration, and there was acute pain in the abdomen. He died on this day.