Civil War Washington

CASE 45.—Private Silas Tomlinson, Co. K, 24th Mich., was admitted Nov. 30, 1864. The patient had been sick for some time in hospital at City Point, Va.; he suffered much and received but little attention during his journey to Alexandria. On admission: Pulse weak, thread-like and from 90 to 100 per minute; skin hot and dry; tongue very dry, red and slightly coated; thirst urgent; appetite small; epistaxis; deafness; expression stupid; delirium; abdomen generally tender, tympanitic and showing a few sudamina and many petechial spots. December 1: No change. 2d: Pulse somewhat stronger, fuller and less frequent; tongue less dry; expression of countenance brighter and hearing improved; diarrhœa less active, but tenderness and tympanites of the abdomen unchanged. 3d: Pulse 80 and decidedly stronger; diarrhœa checked; tongue throwing off its fur; appetite improved; patient intelligent. 4th: The favorable symptoms continued; tenderness of the abdomen lessened. 5th: At 2 A. M. a change for the worse took place; the pulse became weak and ran up to 100; the patient had slight chills; his tongue became dry and red and sordes gathered on his teeth, gums and lips, while the whole surface was bathed in a cold clammy sweat; petechial spots assumed the appearance of purplish blotches, and the abdomen became exceedingly tender, swollen and tympanitic. Ten hours after this change took place the patient had several involuntary stools of a dark-greenish color, after which he fell into a semi-stupor from which he could with difficulty be aroused, and when aroused gave imperfect answers to questions proposed; his face was sunken and there was much twitching of the muscles of the upper extremities. He died on this day. Post-mortem examination twenty-three hours after death: A few purple-colored points, said to be of ante-mortem formation, were noticed on the chest and abdomen; there was also purple hypostasis of the posterior part of the body. There was a quantity of fluid under the arachnoid at the vertex of the brain, but the substance of the brain was normal. The heart was dilated on its right side and almost completely filled by a large semi-transparent clot. The left lung was crepitant, although somewhat dark colored posteriorly. The right lung was closely adherent by firm tissue and apparently compressed or drawn over to the right side; the posterior part of its upper lobe was of a dark brown-red color, softened and with minute points, apparently bronchi, filled with a yellow froth; the remainder of the lung was normal. The liver was large and of a uniformly pale clay color; the spleen large and softened; the cortical part of the left kidney of a yellow, semi-fatty appearance. About twelve inches from the colon the small intestine was perforated by a black-margined aperture the size of a small shot; recent lymph glued the perforated coil of the ileum to the bladder and sigmoid flexure. Liquid fæces of a yellow color had to a small extent escaped into the pelvic cavity.—Act. Ass't Surg. W. C. Minor, General Hospital, Alexandria, Va.