Civil War Washington

CASE 31.—Private Oscar Snow, Co. H, 3d Vt.; age 20; was admitted Oct. 1, 1861, with typhoid fever. He had been sick a week, but he was so dull that he could give but little information concerning the early part of his sickness. A bath was ordered for him, and Dover's powder at night. Next day his face was flushed, pulse 135, full, skin hot and dry, tongue slightly moist but thickly coated brown; he had slight delirium, some deafness and ten or twelve characteristic rose-colored spots; his bowels were loose, tender and tympanitic. From this time the condition of the patient gradually changed for the worse. His bowels for some time were not loose, but tenderness, meteorism and borborygmus were present throughout; on October 12 he had three involuntary passages. His pulse, which at first was rapid and full, lost its fulness​ but retained its rapidity, becoming small, weak and fluctuating. His tongue became dry, and on the 9th he was unable to protrude it; on the same day sordes appeared on the teeth. The rose-colored spots disappeared on the 11th. From being somewhat dull mentally, with occasional mild delirium, he fell into a prostrate condition, lying on his back with his lower jaw dropped and his eyes open, taking no notice of anything going on around. On the 8th his breathing became hurried; mucous and sibilant râles were heard in the right lung, and on the 12th a leathery creaking sound was distinguished over both lungs. On the 11th the parotid gland was found to be swollen. The treatment consisted of quinine, turpentine, brown mixture, nourishment and stimulants. On the evening of the 13th his face was ashen-gray in color, lips cold and bloodless, head and extremities cold; there was some deafness and it was very difficult to arouse him; he had also a mild delirium, speaking of going home, and had no idea of his condition. His pulse, about 140, was weak and barely perceptible at the wrist; the superficial circulation was almost suspended—an impression made with the fingers remained a long time. He had no hemorrhage from the nose or bowels; his bowels moved occasionally involuntarily, the passages being very thin; the abdomen was acutely tender and borborygmus frequent. His respiration varied from fifty to sixty per minute; a rattling sound was heard in the throat during expiration, as though from mucus which he had not strength enough to eject; his breath was very offensive for the first time since his illness. His urine, acid and albuminous, had a specific gravity of 1011, and contained mucus, epithelium, urates and a few blood-discs. The parotid gland continued much swollen. On the evening of the 14th he aroused himself and spoke very rationally; his eyes shone brilliantly for a few minutes; he tried to rise from bed, but fell back from weakness; the rattling sound in the bronchial tubes increased, and after a few deep-drawn breaths he was dead. Post-mortem examination fourteen hours after death: Side of face swollen; parotid infiltrated with pus. The pleural cavities contained a number of large blood-clots; the derivation of the hemorrhage was not ascertained. The lungs were congested, but were not closely examined for want of time. The stomach contained a pint of very offensive yellowish matter; its mucous membrane was thick and congested. The liver and gall-bladder were enlarged but healthy; the spleen and kidneys enlarged and congested. The peritoneum was much inflamed. The glands of Peyer and the solitary glands of the ileum were much ulcerated. A foot and a half from the ileo-cæcal valve the ileum presented a diverticulum about four inches long, as wide as the gut from which it was derived, and like it, blackened and much ulcerated. The mesenteric glands were enlarged, the mesentery much congested and inflamed. The mucous membrane of the colon was dark in color but not ulcerated.—Seminary Hospital, Georgetown, D. C.