Civil War Washington

CASE 119.—Typhoid fever following remittent fever; prognosis favorable until the advent of peritonitis.—Private Abraham Haner, Co. D, 14th N. Y. Vols.; age 21; was admitted Sept. 23, 1861, as a case of remittent fever. He had been epileptic from infancy to the age of 19, when the fits ceased. He was taken two weeks before admission with a convulsion. Quinine was given but the convulsions recurred. On admission his face was flushed, eyes injected, bowels loose and abdomen painful. A slight fever was present on the 25th; appetite deficient, thirst considerable, pulse 88, full and strong, skin warm and moist (he had perspired profusely at night), tongue light-brown and fissured; he had a little headache and dizziness. Acetate of ammonia was prescribed with five drops of Fowler's solution four times daily. He did not sleep well at night, and on the 26th was restless, his cheeks flushed, eyes suffused, pulse 96, skin hot and moist, tongue brown and dry in the centre, fissured and moist at the edges; he had headache and slight delirium, pain in the stomach, pain and great tenderness in the iliac region, some cough and difficulty in retaining urine. The acetate of ammonia was continued and turpentine emulsion was ordered for administration every two hours. In the evening the skin was moist, the pulse 102, the tongue yellowish. Hoffmann's anodyne was prescribed in drachm doses every four hours. He slept but little during the night, and on the 27th the pulse was 96, skin hot and dry, tongue dry in the centre, moist at the edges; he had headache, anorexia, tympanites on the right side, tenderness in the right iliac region and his bowels had been moved six times. Turpentine emulsion and Fowler's solution were renewed and pills of opium, lead and tannin prescribed. In the evening the pulse was 104, the skin hot and moist but with no eruption nor sudamina, the tongue rather yellow in the centre but less fissured; the headache was lessened and the diarrhœa reduced to one stool, but the tenderness and tympanites continued. Sweet spirit of nitre and wine of antimony were administered during the night. He slept well and perspired early in the morning; no stool was passed. On the 28th the skin was hot and moist, tongue brown, dry and fissured in the centre, its edges moist and white; the anorexia, headache and cough persisted, and there was partial retention of urine, with pain in the hypogastrium. Extract of buchu was given. In the evening the face was flushed, eyes bright, pulse strong and regular, skin soft but somewhat hot, tongue moist, white and fissured; bowels moved once, tender and tympanitic; the cough had subsided and the appetite was returning. Dover's powder was ordered. He slept well during the night, and on the 29th the face was somewhat flushed, eyes injected, pulse 88 and strong, skin hot and moist, tongue brown and dry in the centre, moist at the edges, the bowels quiet but a little tender and tympanitic. In the evening there was slight headache; the bowels were moved once, but the tenderness and distention continued; the appetite was good. Tincture of opium and essence of peppermint were administered. On the 30th the skin was soft and its temperature decreased; the tongue moist at the edges, brown and dry in the centre, the appetite moderate; three stools were passed and there was much tympanites with marked tenderness in the right iliac region and some in the left side. On October 1 the skin was natural, the tongue slightly coated in the centre and fissured, the appetite good and the bowels quiet. He improved after this, so that from the 3d to the 6th no note of his condition was recorded. On the 7th the pulse was 85, skin natural, tongue moist but red at the tip and edges, yellow and fissured in the centre; bowels moved three times. No marked change occurred until the 10th, when the skin became hot and dry, followed on the 11th by a profuse eruption of rose-colored spots; on this day the tongue was slightly moist, yellow in the centre, the appetite good and the bowels quiet, but the abdomen was tender and tympanitic, especially in the umbilical and right iliac regions. Tincture of iron was prescribed. Fresh crops of rose-colored spots appeared at intervals until the 28th, when they faded. The heat of skin gradually lessened until on the 16th it became normal; two days later the skin was moist. The bowels were moved once or seldom twice daily, but a good deal of tenderness and distention was noted in the umbilical and right iliac regions. On the 20th extract of senna was administered and two passages followed its exhibition. The patient usually slept well and his appetite was good; the tongue was moist and clean, faintly furred or yellow-coated in the centre. He appeared to be doing well when, on the 29th, he was seized with extreme tenderness of the abdomen. After a wakeful night his eyes on the 30th were dull, cheeks flushed, pulse 100, skin hot, tongue moist, brown and fissured, lips and teeth covered with sordes; he had some deafness and mental dulness​, anorexia and thirst; there was no diarrhœa, but much general abdominal tenderness and some tympanites. A blister was applied to the abdomen and calomel and opium prescribed for administration every three hours. On the 31st the pulse was 140 and irregular and the skin bathed in perspiration, but the abdomen was less tender. Death took place on this day.