Civil War Washington

CASE 106.—Remittent fever not amenable to treatment by quinine; record deficient, but typhoid fever suggested by diarrhœa, tenderness in the right iliac region, brown tongue and subsequent discharge for debility.—Private James Ellison, Co. F, 19th Ind.; age 24. This man contracted tertian ague about Aug. 20, 1861. The chills were broken up by quinia. He was admitted September 4 as a case of typhoid fever. On the morning of the 5th the fever was slight, the pulse 72, skin natural, tongue flabby and coated yellowish-brown, appetite good, bowels somewhat relaxed and tender on pressure. Quinia was ordered. In the evening there was a moderate fever with flushed face, hurried respiration, hot and dry skin and a burning in the mouth and throat; the bowels were moved twice during the day. Dover's powder was given. He rested well during the night, and next morning was sweating and without fever; but in the evening the skin became hot and dry, the tongue pale, dry and slightly coated, and seven loose stools had been passed accompanied with umbilical pain. A similar remission and exacerbation occurred on the 7th, the dejections on this day being thin, small and lumpy. The remission on the morning of the 8th was not so well marked, although the bowels had not been disturbed during the night; the mind was clear. On the 9th, in the morning, the face was flushed, the pulse 68, the tongue pale, flabby and coated in the centre and at the back, the skin warm and dry; one thin stool had been passed without pain but with borborygmi. In the evening the pulse was 86, the skin warm and dry, the tongue pale and coated brown in the middle; there were no rose-spots; three thin small stools had been passed without pain; the appetite was improving. Dover's powder with small doses of blue-pill and citrate of iron and quinine were ordered. The 10th gave a similar record, but in the evening the tongue was dry and coated brownish, and in connection with four thin small stools passed during the day, it is stated that there was some right iliac tenderness. The blue-pill and iron were omitted and the Dover's powder and quinine continued. On the 11th an acetate of lead and opium pill was given three times, but the diarrhœa continued with slight fever in the evening, and a moist tongue, coated brown in the centre, up to the 13th, when he was transferred to hospital at Baltimore, Md. [He was discharged October 15 on account of general debility.]