Civil War Washington

CASE 55.—Private John McVea, Co. B, 10th U. S. Inf.; age 32; was admitted October 20, 1865, having been sick five weeks, first with diarrhœa for two weeks and afterwards with chills and fever. He had a chill daily at 3.30 P. M., for which five grains of quinine were ordered at 8, 10, 12 and 2 o'clock. During the paroxysms the patient's intellect was clouded and his replies delayed; he fainted on sitting up; passed his urine involuntarily; had pain in the head, back and limbs; the heart's action was tumultuous; the pulse too rapid to count, and most frequent at the commencement of the sweating. Some roughness of the heart-sounds were observed. The tongue was coated, dry during fever, moist at other times; the bowels were open. On the 22d the quinine was repeated, but the chill and fever recurred in a more aggravated form. The patient was very weak; had sordes on his teeth; pulse scarcely perceptible at the wrist; urination involuntary. Whiskey was given and mustard applied to the epigastrium. Next day he had hiccough, stertor, profuse sweats, vomiting of small blood-clots, dysphagia, insensible pupils and involuntary passages; crepitation was heard over the lower part of the left side of the chest. He died at 2.30 P. M. Post-mortem examination twenty hours after death: Right arm flexed and rigid; left arm flaccid. There was a quantity of serum in the ventricles of the brain; the brain-substance was of a darker ash color than usual, and sections presented many points of black engorged vessels. The right lung was healthy; the lower lobe of the left lung much congested, nearly hepatized. The pericardium contained three ounces and a third of light-pink serum; the apex of the heart adhered to the pericardium by a lymph-patch the size of a shelled almond; the right ventricle of the heart was unusually flaccid, the mitral valve thickened and of a dull yellow color. The omentum was thin and dark lead color. The liver weighed eighty-five ounces; it was of a dull slate color. The spleen was pulpy, weighed twenty ounces and a half. Some patches of congestion were observed in the ileum. The kidneys were large but healthy.—Douglas Hospital, Washington, D. C.