Civil War Washington

CASE 16.—Private James Beckwith, Co. F, 2d Me.; age 23; was admitted Sept. 6, 1861, with typhoid fever occurring as a relapse. The patient had a full strong pulse, 120, heavily coated and dry tongue, hot and dry skin. One ounce of sulphate of magnesia was ordered. He rested poorly during the night, having had some head symptoms; his bowels were moved twice, although by mistake the Epsom salt had not been taken. His skin at the midnight visit, September 7, was warm and perspiring, tongue dry and brown in the centre, pulse full, 114. Half an ounce of tincture of rhubarb with ten drops of oil of anise was administered, by which the bowels were moved rapidly. In the evening he was unconscious, and during the night delirious with involuntary stools of a brown color. Next day there was rather less fever; pulse 104. Quinine, which had been given the previous day, was continued in eight-grain doses, with whiskey-punch and beef-essence, and an astringent injection at night. His bowels were moved twice on this day, the 8th, and he had tenderness in the right iliac region. During the following night there was walking delirium, and a few minute red spots were discovered, which did not disappear on pressure. At 11 A. M. of the 9th he had a severe congestive chill; during the paroxysm his pulse was strong and rapid; he raved and showed much strength. Morphia was given to quiet him. His bowels were moved involuntarily during the day, and he was very restless, requiring to be held in bed. On the 10th, after a quiet night, he was dull and stupid, his pulse 117, skin hot, face flushed, teeth covered with sordes; in the evening he became drowsy and was quiet during the night. Turpentine emulsion was given. On the 11th his pulse was quick and weak, 130, tongue cracked and protruded with difficulty, stools involuntary, countenance haggard and eyes fixed; he had also subsultus, grinding of the teeth, rose-colored spots and sudamina. In the evening his skin became cool, the prostration increased and the involuntary stools were large and fetid. On the 12th the symptoms were: Pulse 137, soft, small and weak; respiration 14; skin hot and moist; hands and feet cold and clammy; face pale; nose pinched; eyes and mouth half closed; lips livid; nausea; subsultus; black vomiting. He died at 3 P. M. Post-mortem examination: The ileum was much thickened, inflamed and ulcerated for five feet above the ileo-cæcal valve; Peyer's glands were elevated, extensively ulcerated and perforated in two places near the valve. No fæcal matter was found in the peritoneal cavity. The stomach was not examined.—Seminary Hospital, Georgetown, D. C.