Civil War Washington

CASE 64.—Private Wallace T. Fowler, Co. C, 42d Mass.; age 19; was admitted Oct. 29, 1864, having been taken sick a week before with a decided chill followed by hot skin, thirst, severe headache and backache and a diarrhœa of two or three passages daily. On admission there was no delirium, epistaxis, deafness nor tympanites; pulse 120; tongue furred and dry; some bronchial irritation. Diagnosis—typho-malarial fever. He improved under small doses of blue-pill and ipecacuanha, acetate of potash, squill and spirit of nitre until November 12, when his respiration became hurried and his pulse accelerated. On the 15th he expectorated rusty sputa​, although none of the physical signs of pneumonia were present. Until the day of his death, the 17th, he did not appear to be very ill. Pain in the epigastrium, feeble pulse, great prostration and vomiting, at first of green liquid and afterwards of matters resembling coffee-grounds, preceded death for some hours; his mind was clear to the last. Post-mortem examination sixteen hours after death: Not much emaciation; suggillation posteriorly. Omentum inflamed; intestines reddened and interadherent; peritoneal cavity containing two pints of a turbid yellow liquid emitting an unpleasant fæcal odor. There was a perforation one-eighth of an inch in diameter about the middle of the ileum, the result of ulceration in one of Peyer's patches [Specimen No. 439, Med. Sect., Army Medical Museum], and there were several thickened and ulcerated patches near the perforation and in the lower part of the ileum. Spleen enlarged and softened; liver dark. Other organs not examined.—Surg. E. Bentley, U. S. V., Second Division Hospital, Alexandria, Va.