Civil War Washington

CASE 98.—Chills and fever with, subsequently, the gradual accession of symptoms of enteric fever; diarrhœal attack on 17th day; rose-spots and delirium on 18th; inflammation of parotid on 24th; aggravation of diarrhœa on 28th and death on 30th day.—Private James Roe, Co. F, 1st Mich.; age 22; was admitted Sept. 28, 1861, having been taken sick about a week before with chills and fever, for which quinine and alteratives had been administered. On admission he was weak, had anorexia and headache, but his skin was natural, tongue moist and slightly coated, pulse 72 and bowels quiet. Up to October 5 there was no marked change in the patient's condition; the coating of the tongue became somewhat thickened; the skin was dry, hot on the 3d, perspiring on the 4th; the bowels were quiet or moved once daily, and there was some tenderness in the right iliac region; the headache continued and there was slight cough. On the 6th the patient vomited some dark-colored matters. On the 7th he was restless for the first time since admission; the bowels were moved four times and the tongue was moist, red at the tip and edges and dark-brown at the centre and base. On the 8th he was delirious; pulse 90 and quick; skin hot and dry, showing a few rose-spots, disappearing on pressure, and mingled with profuse eruption (character not stated); tongue dry, flabby, red at the tip and edges, coated brown in the centre; appetite very good; he had one stool, some tympanites and slight gurgling in the right iliac region. No change was manifested save increasing dulness​ of mind and prostration until the 13th, when the tongue became slightly moist and the delirium lessened. During this period the teeth were covered with sordes and the mouth filled with tenacious mucus. On the 14th the parotids became swollen. Next day the pulse was 120 and feeble and the bowels quiet but tender and distended; the patient, nevertheless, when aroused from his low delirium, expressed himself as feeling quite well. The tongue became moist and its coating yellowish-white on the 16th, and on the following day the patient was more rational; the eruption was present up to this date. A sharp diarrhœa of seven stools occurred on the 18th and the pulse reached 140. A blister was applied to the abdomen. On the 19th vibices appeared; the tongue could not be protruded on account of the parotid swelling; the bowels were moved once only, but they were generally tender and much meteorized. Death took place on the 20th.