Civil War Washington

CASE 84.—Death, probably from perforation of the intestine, on the 28th day.—Sergeant David Puckett, Co. E, 5th U. S. Cav.; age 27; was admitted Oct, 18, 1861, having been sick since the beginning of the month with headache and pain in the limbs, back and epigastrium. A cathartic, to be followed by quinine, was prescribed. On the day after admission the patient was wakeful, his eyes dull and yellow-tinged, cheeks flushed, pulse 110, full and strong, skin hot, tongue slightly moist, red at the tip and edges but heavily coated yellowish-white in the centre; he had anorexia, thirst, three passages from the bowels during the twenty-four hours, much umbilical tenderness and tympanites, a slight cough and difficult micturition. Sinapisms were applied to the abdomen and emulsion of turpentine given every three hours, with extract of buchu as required. On the 20th the pulse fell to 90, but the condition of the patient was otherwise unchanged. A powder containing three grains of calomel, one grain of opium and one-eighth of a grain of tartar emetic was given every three hours. Next day the tongue became dry; seven stools were passed, and the hypogastric and iliac regions were highly tympanitic and tender. On the 22d the diarrhœa continued, eight stools having been passed; cerebral symptoms were manifested, as headache, hebetude, dizziness and tinnitus; the stomach became irritable and the tongue dry, red at the tip and edges and brown in the centre. On the 23d no change was recorded except the passage of urine without pain for the first time in several days. Lead, opium and tannin with tincture of iron were prescribed. On the 24th the patient was dull, lying with his eyes half closed in a semi-delirious condition; no stool was passed, but there was much vomiting. Two grains of calomel and a half grain of opium were ordered for administration every hour. On the 26th, having slept well at night, the patient was brighter, his mind less obtuse, and there was less abdominal tenderness; but the tongue was heavily coated yellow and the anorexia, thirst and vomiting persisted. Next day five grains of calomel and a quarter of a grain of sulphate of morphia were given, but no marked change was apparent until the 27th, when the patient was partly unconscious and delirious, lying with his eyes rolled up and mouth open, his breathing hurried, pulse 125, tongue dry and coated brown and stomach rejecting everything; there was extreme tenderness of the abdomen and much meteorism. Stimulants were administered by enemata. Death took place on the morning of the 28th.