페이지 이미지
PDF
ePub

repeated; but sometimes, as already stated, such About the seventh or eiglith day some of these symptoms repetition is unnecessary. When there is pain at the subside; the vomiting ceases; but the ferer still con. epigastrium, and other signs of gastric irritation, I tinges; the pulse and respiration are irregular; tho would recommend the application of leeches to the belly is retracted, and finally partial convulsions ensue, part, taking care to encourage the bleeding by warm rollowed by coma and death. fomentations and light poultices. Next to bleeding Diagnosis. The diseases which are apt to be conI would rank severe counter-irritation. Colchicum, founded with acute meningitis, are, as may be imagined, digitalis, and antimonials, I have repeatedly employed numerous. Before we mention these diseases, wo with great advantage. The observation applies like shall enumerate those symptoms of the convulsive and wise to mercury.

phrenitic forms which are most worthy of confidence in When the disease recurs it generally has not the a diagnostic point of view. same intensity, and is, I think, more under the power in the convulsive form, we should attach great of medicine; we should now abstain from employing importance :--1. To the constant repetition of convul. the same active treatment as during the first attack, sions at short intervals. 2. To the acceleration of the abd should content ourselves with combating the respiration, which cannot be accounted for by any inflammation by the moderate use of topical bleeding

pulmonary lesion. 3. To the absence of all visceral and counter-irritation.

inlammation, and of any indication of an exanthematic eruption. In the pbrenitic form, the cardinal

symptoms are intense headache, accompanied by ON SIMPLE ACUTE INFLAMMATION OF THE frequent bilious vomiting and constipation, followed by MEMBRANES OF THE BRAIN IN INFANTS. delírium and agitation, alternating with stupor. By Dr. Rilliet, of Geneva.

Differential Diagnosis of the Convulsive form.-Con. (Translated for the Provincial Medical and Surgical Journal.)

| vulsions in early infancy are very frequently symp

lomatic; but in this case ibey are seldom riolent or so (Continued from page 181.)

frequently repeated. Moreover, in the interval, tho IV. GENERAL DESCRIPTION OF THE DISEASE.

little patient recovers bis sensibility, the respiration is Form, Duration, Termination.--Acute meningitis not permanently accelerated, and the pulse quickly declares itself under two forms, to one of which we regains its normal standard. It must, however, be give the name of " convulsive," the other“ pbrenitic." | admitted that in many cases the diagnosis can only be We do not, however, wish it to be understood either establisbed by the progress of the disease. that convulsions are nerer present excepting in the The distinction between convulsive meningitis, and " convulsive" form, or that the “phrenitic" is the other cerebral affections is still more obscure, and indeed form exclusively characterized by perversions of the it is often impossible. The error is not, however, one intelligence; we merely wish to notify by these terms of importance, as the treatment, and too often the ter. the predominance of certain symptoms.

mination of all is the same. The convulsive form is most commonly seen in The first disease which we shall endeavour to dis. very young infants. It commences suddenly by an tinguish is hydrocephalus, with infiltration of the pia attack of convulsions, general or partial, with more or | mater, the Wasserschlag of Gölis. less febrile disturbance. There is neither romiting por In certain cases this condition complicates inflam. constipation. When the convulsions, which are re.matory meningitis, and the main features of each are peated at brief intervals, subside, the infant is left then undistinguishable. In other cases the “hydro. either in a state of agitation, or profoundly comatose, meningitis'' is the principal lesion, and we find only with squinting, and sometimes perfect hemiplegia. In slight traces of purulent effusion. This disease, like certain cases there is an approach to sensibility between the one from which we wish to distinguish it, also the fils, but the amendment is but momentary, and attacks very young infants; it sels in with fever, and a death rapidly approaches either by coma or during a violent attack of convulsions, or with agitation and subsequent paroxysm. The conrulsive form of menin. stupor, with transient and fallacious signs of amelioragitis sometimes sate in more slowly, and the convulsions tion. The analogy between the disease and the are not so closely approximated. The duration of this convulsive form of meningitis is therefore perfect latter variety is longer, being from a week to a fortnight. In hemorrhage into the arachnoid, we observe repeated

Phrenitic meningitis is commonly observed in convulsions as the earliest symptoms, but they are in early childhood, and in many respects resembles the general less violent than in meningitis, and the coma acute meningitis of the adult. It commences with does not ensue so rapidily. According to M. Legendre, fever preceded by a rigor; violent headache ensues, children attacked with meningeal apoplexy, exbibit with photophobia, vomiting, and sometimes constipa. contraction of the fingers and toes,-a symptom which tion. The intellect suffers by the end of the first or is not observed in meningitis; wbile, on the other second day, and the face assumes the peculiar wild hand, the excitement of the pulse and circulation look of the disease. Agitation and stupor alternate, which are witnessed in the latter disease, are not seen and delirium is generally present. Subsequently there in meningeal apoplexy. Hæmorrhage into the pia inater is grinding of the teeth, partial convulsions, rigidity of also in some respects resembles convulsive meningitis, the limbs, a drawing of the head backwards, strabismus, but it is a lesion of such rare occurrence that it need and contraction followed by dilatation of the pupils. I scarcely enter into our consideration.

ON INFLAMMATION OF THE BRAIN IN INFANTS.

235

These remarks conclude what we have to say diagnosis is to be drawn from the ensemble of symptoms, · respecting the diagnosis of convulsise meningitis from and not from the individual characters of a disease.

other organic lesions of the brain; but we must remember 2. The main element in forming our diagnosis is the that the most important part of tbe diagnosis of the consideration of the point of time at which the disturbdisease consists in its distinction from essential or

ances of the intellect and mobility originate. 3. That symptomatic convulsions, since the treatment of the the inrasion of tubercular meningitis may take place two forms of convulsion is obviously different..

under three different states of the system-Ist, after a What we have said in connection with “convulsive

longer or shorter duration of precursory symptoms; 2nd, meningitis," applies equally to the phrenitic form.

during the progress of iubércular disease in other Cerebral bæmorrhage, encephalitis, &c., may be con.

organs; 3rd, in perfect health. 4. That the first and founded with it without any great damage; but it is not

third species are readily distinguished from acutc 80 with regard to cérebral congestion, tubercular

simple meningitis; the error is more likely to be made meningitis, and those sympathetic affections of the

between the latter and the second form. These prelibrain which arise during the course of the eruptiye or

minaries established, we shall proceed to lay down a typhoid fevers. The following paragraph deserves the

brief summary of the differential symptoms as below:earnest attention of our readers :- .

Simple Meningitis. " Tubercular Meningitis. Cerebral Congestion. We have often propounded to ourselves the following question :-Ought we to consider

1. The children attacked 1. The subjects of tuber. those violent cerebral attacks, which either quickly

are in general vigorous and cular meningitis are deli. prove fatal, or as rapidly subside, and the symptoms

wall-developed, and do not cute, and often precocious of which are precisely those which indicate the onset of

exbibit any signs of tuber. children. They are subject

cle. Their relations too, to glandular enlargements, acute meningitis, as real instances of that disease ? Post-mortem esaunination in these cases discovers

are healthy.

and chronic eruptions of

the skin. Their blood.repeither pus nor false membranes, but only simple con. gestion. Is this congestion to be regarded as the

latives generally bear the

stamp of the strumous dia. initiative stage of inflammation ? The question is difficolt of solution ; but we neverthless consider that it

thesis. sbould be answered in the negatire, and for these

2. The disease may ap. 2. The disease is always reasons :--Infammatory products of the brain form pear as an epidemic. sporadic. with such rapidity, that its whole surface may be covered 3. Prior condition. The 3. Prior condition. The with false membranes in a few hours, consequently the attack takes place during insant is observed to pine cases we have just mentioned ought to be distinguished robust health, or if it is away and lose its Aesh from meningitis, both anatomically and by their secondary, it follows some and strength. The disposi. symptoms. The diagnosis may, however, be here palpable external cause, or tion is altered, the appetite plainly established by the following comparative arises in the course of a fails, and the prime vie Lable:

non-tubercular malady. become deranged. Cerebral Congestion.

Meningitis.

4. Mode of attack. Vio. 4. Mode of atlack.-Con. Declares itself by sudden In the phrenitic forin, lent convulsions, intense vulsions never the first stopor or more complete the first symptom is par. fever, quick respiration if symptoms; the transition insensibility, with dilata- tial or general headache.

the infant is very young; from the first to the second tion of ghe pupils ; or its Delirium does not appear or headache, fever, bilious period of the disease in. first symptoms are acate in general until the lapse vomiting. After a lapse of sensible; the coming on of delirium, with difficult res. of twenty-four or thirty. I twenty-four hours, exces- the second stage marked piration, quick small pulse, six hours. Vomiting is sive agitation, delirium, by headache, vomiting, and slight convulsions. generally present,

and prostration.

and constipation; the inTbese symptoms appear

telligence sometimes un. almost instantaneously.

affected. When the preVomiting is for the most

cursorg symptoms are ab. part absent.

sent, the disease is ushered Cerebral Hemorrhage.--In some cases cerebral

in by vomiting, moderate bæmorrhage closely simulates acute meningitis. Head

headache, anil fever. ache, convulsions, delirium, romiting, and constipation,

5. Symplums.--Headache 5. Symptoms.-Headache mark the onset of both diseases, and it is, therefore,

intense, vomiting incessant, not intense, vomiting not difficolt to decide, with certainty, which disease is

rever high, delirium fierce, so urgent, constipation ob. present. The best guide to a correct conclusion is the

constipation moderate. slinate, fever moderate, high febrile excitement wbich characterizes meningeal inflammation.

6. Progress.-Rapid; con. 6. Progress.- Slow. Tubercular Meningitis.We now arrive at the most vulsions incessant. important portion of this essay, and shall endeavour to 7. Duration.-Death in 7. Duration.-More propoint out the main distinction between simple and 24 hours, in some cases; longed - a fortnight to tabercolar meningitis. For clearness sake we would but generally at the end three weeks. remind the reader of four circumstances:-1. That' of the third day.

We bare thus gone through the list of the cerebral continuing, he had thirty minims of liquor opii sedativus, affections with which simple meningitis may be con. every hour, and belladonna to the neck and jaws. He founded, we shall now notice the distinction between it was perfectly under the influence of opium, but without and certain fornuidable cerebral symptoms, which any remission of the symptoms of opisthotonos. declare themselves without any appreciable lesion Monday evening. The spasms now most violent. of the brain,-as for instance, during the progress Half a drachm of æther, added to each dose of opium, of fevers. And first of

and calomel freely given through the night. Small.pox.-This disease is sometimes at the onset Tuesday morning. No better, but decidedly worse. mistaken for meningitis. The most important ele. We now determined to try æther. This was adminisments in the diagnosis, are the consideration of the tered by means of Boott's apparatus. He was soon reigning epidemic, the lumbar pains, and the time under its influence, and immediately all contraction at which delirium appears, which in small pos, is and spasm ceased, and he got into a most comfortable seldom earlier than the third day.

sleep, which lasted full ten minutes. As soon as he Scarlatina.-In adynamic scarlatina, children fre. became sensible the spasm and contraction returned, but quently complain of headache, and are seized with scarcely so violent. He again inhaled the æther with the vomiting. We must look for our guide to the state of same result. He had it a third time; it again relieved the tongue and throat, and the great heat of the skin, him, and he was left asleep, and on visiting him taking likewise into consideration the fact of the I found he could open his mouth better. He was most prevalence of the disease at the time.

anxious to have it again, but a violent spasm came on Typhoid fever. The same rules for forming a diag. before I could get it to him, followed by another, and nosis ara applicable in this disease as in small-pox, he immediately sank. &c.; but in addition we are to remember, that in typhoid

I am, Sir, fever the headache is less intense thàn in meningitis,

Yours truly, that the vomiting is less urgent. Some useful informa

H. H. BROUGHTON. tion may also be drived from the state of the lips and Dobcross, near Manchester, tongne, the pain in the body, the diarrhea, and the Saturday, April 24, 1847. state of the chest. Moreover, the symptoms which are analogous in the two diseases appear at different periods,-in meningitis at the commencement, in ferer

Hospital Reports. towards the termination. (To be continued.)

· QUEEN'S HOSPITAL, BIRMINGHAM.

CLINICAL REPORTS OF SURGICAL CASES CASE OF TRAUMATIC TETANUS: ADMINIS UNDER THE TREATMENT OF WILLIAM TRATION OF ÆTHER.

SANDS COX, ESQ. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

By Peter Hinckes Bird, one of the Resident SURGICAL JOURNAL,

Medical Officers. SIR,

(Continued from page 181.) I beg to forward you the following brief report of a

Case XXVII. case of traumatic tetanus in which äther was most successful in arresting the spasm.

EXTENSIVE INJURY OF THE BAND. On Saturday, March 20th, I was called at 6 a.in., to Eli Holloway, aged 15, admitted into the Queen's Charles Prescott, a miner, residing iwo miles from this Hospital, on August 24th. He states that about half place. I found the left arm completely shattered by a an hour previously his hand was severely wounded by a large stone falling on it; he had pot lost much blood, circular saw, which cut off the little finger of the right his comrade had tied a piece of cord tight round his arm, hand, and severely lacerated the two next; he lost but which completely checked the bleeding. He had walked little blood at the time. home, a distance of a mile from the shaft where the When admitted the little finger was found gone, and accident occurred. I immediately amputated below there was present a deep lacerated wound on the back the elbow-joint; three arteries required ligatures. He of the hand, extending from just below the head of the went on exceedingly well for some days. On Wed.metacarpal bone of the little fivger to that of the nesday, the 24th, he was most anxious to get up, and on middle finger; the metacarpal bones of the middle and the wound being dressed, union had taken place by the ring fingers being shattered. He was rather pale; he first intention. On Saturday, the 27th, I found him did not complain of much pain in the parts; pulse sitting up and dressed; he said he was quite tired of 75, pretty strong. bed. In the evening he sent down, stating lie had It was determined that the middle and ring fingers taken cold. He had some aperient medicine sent him. should be removed. An incision was made on the back

On Sunday the symptoms of tetanus became of the hand below the seat of injury; the metacarpal marked; there was considerable rigidity of the muscles bones were sawn through, and a flap formed from the of the neck and jaw, and difficulty in swallowing. He palm of the hand; there was not much hæmorrhage; had an enema with turpentine, calomel, and an the patient bore the operation remarkably well; the - active aperient, which soon operated. The symptoms 'slump was dressed, and a roller lightly applied ; be

ILLEGAL PRACTICE OF MEDICINE.

237

was then put to bed, and ordered to keep the hand the leg has subsided; two fresh wounds have broken damp with a cold lotion.

out and discharge freely. 26th. Doing well; wound discharges healthy matter; June 27th. Since last report Afteen pieces of bone, not in any pain; sleeps well.

some of them an inch and a half long, hare come away September 1st. Improving; the wound is looking at various times; is in no pain; can walk about; very healthy, and heals rapidly.

little inflammation present; health improved. 10th. Healing ; looks healthy; appetite good. July 14th. Seven pieces of bone have come away 17th. Nearly healed; general health improved. since last report, two of which came from an opening in 21st. Quite well.

the upper part of the tibia.

20th. Much better in all respects; no more bone has In injuries of the hand no more should be be removed

come away; inflammation subsiding. To be dressed

come away: inflammation tban is absolutely necessary, but in this case the l as before; the fungous edges of the wound require to . extensive injury would not permit the attempt of

be touched with Argeuti Nitras. saring more than the thumb and fore-finger, which

August 3rd. The skin again became red and painful. forms a useful but rather an unseemly member. The Apply vonltice. fore-finger and thumb are much more useful than the September 21st. Since last report as many as twenty other fingers, for indeed all the delicate movements are pieces of bone have been discharged; the matter is performed by them, and should therefore, if possible, healthy, and the parts not painful; general health good. be saved; there are other fingers to compensate in

28th. He still remains in the hospital. some measure for the loss of one, but the loss of the thumb can never be supplied.

The tibia is the most frequent seat of necrosis, and

this disease is most common from twelve to eighteen Case XXVIII.

years of age. Every bone in the body is subject to NECROSIS.

necrosis ; but those bones which are superfical, and Edward Ferraday, aged 16, of strumous diathesis,

enter into the formation of the extremities, are more zinc-worker, admitted into the Queen's Hospital April

frequently affected than others whose situation is

deeper. This case is renarkable for the great number 171b, 1846, under the care of Mr. Sands Cox. He states that about nine weeks ago he dropped off

of pieces of bone of various sizes which came away at

different times, and also for the slight nature of the from some height, and sprained bis ankle, the foot

accident which is said to hare been the cause of the becoming quite numbed at the time; was under

disease. The scrofulous constitution of the patient medical care, and had leeches and cold lotions applied,

had probably some share in bringing on the disease. and was lanced near the ankle in two places. He states that he felt two pieces of bone loose before he came into the hospital.

PROVINCIAL Present stale. There is much swelling about the Medical & Surgical Journal. ankle-joint of the right foot; there are also four fistu.

WEDNESDAY, MAY 5, 1847. Jous openings, with sungous granulations, three on the ipner sido, and one on the outer; the ends of the tibia

The law has been compared to a net, and fibula near the ankle.joint appear enlarged, and feel rough; various depressions can also be felt on the

through the meshes of which little fishes are apper third of the tibia : the ulcers discharge a thin allowed to escape, and great fishes to break. flaky pos; the motion of the joint is impaired, it Such is very certainly the case in respect to that causes him but little pain; the skin is red and shining, portion of it which relates to questions of and painful to the touch; the redness extends half. medical practice, and though occasionally one of way up the leg; appetite good; tongue clean; sleeps the smaller fry may be caught, as in the instance well. Ordered to have the parts constantly poulticed. of the singularly unfortunate individual whose

191h. A small piece of bone was remored from one trial is reported in another column, the excepof the openings this morning.

tional occurrence is chiefly remarkable on 23rd. Since last report two pieces have been dis-l account of its extreme infrequency, and the charged, and another wound formed; he feels easier ; | difficulty of securing the captive, who after all, health improved.

will shortly be returned to his original element, 27th. Two pieces of bone have come away since last

doubtless again to follow up his former malreport, one of them was about an inch and a balf long.

practices, though perhaps with more cunning 30th. Rather better. To have the wounds dressed

and caution, so as to escape the consequences. with simple dressing, with apertures left for the discharge, which is now thick and yellowish; also to have

The mischievous part of the matter is that the a damp roller loosely applied.

| judicial institutions of the country are not May Ist. The roller caused much inflammation and merely set at nought, but are continually pain, so that it was obliged to be discontinued ; two or brought into contempt, and the public are the openings have healed, and the rest discharge a thick fleeced by the cupidity, and miserable sufferers bealthy pas. To continue the poultice.

in every way from the ignorance and most cul22nd. Much better; the inflammation extending up | pable rashness, of a host of sharpers, of variqus

descriptions, who are virtually upheld in their | of strength and activity,* the offender is allowed depredations by those whose province it is to to escape. Well does one of our contemporaries, protect the unwary from all such designing in an admirable analysis of the evidence given pretenders.

on this trialt remark, that “this Cronin case The spirit of quackery is widely extended has an influence far beyond that which it derives through all ranks of the community, and for the from the pseudo-scientific evidence given on simple reason, that with all the outcry about the the occasion; that influence extends to the increase of knowledge, the intellectual pabulum lives of the public, which are, by the result, afforded by the literature of the day is of the left at the mercy of all sorts of prescribers and most unsubstantial and trashy description. The dispensers, the neglect of the one and the wisdom of the nineteenth century is but a wide ignorance of the other are not regarded as spread of shallow waters, and accordingly noisy culpable; and while we are left to infer, that quackery and superficiality of every kind find according to that perfection of reason-the favour, when the more solid acquirements which law-there was no criminality in this case, result from study and reflection are neither appre- no pains are taken by the legislature to ciated nor understood. All ranks of the com- prevent the recurrence of instances of a similar munity, as we have said, are more or less imbued kind."

• See page 247. with this spirit of quackery; the main difference

+ Medical Gazette, April 16, is, that the altogether ignorant are caught by the grossest delusions of the itinerant mountebank, who parades his worm-nostrums,-his vegetable

Beview. . powders.—his rapid cures in “cases of secresy," &c.; while the so-called educated classes flock in on the Pathology and Treatment of Scrofula ; being crowds to fashionable hydropathic establishments, the Fothergillian Prize Essay for 1816. By ROBERT or complacently swallow the infinitesmal doses MORTIMER GLOVER, M.D., &c. London, 1846, of fashionable homeopathic doctors, together Bro, pp. 315. Plates. “ with the infinite deal of nothing" in the guise From the very extensive analyses which have of reasoning, with which the absolute inertness

already appeared of the chapters of this excellent of the one system and the dangerous activity of work, which treat of the chemical and microscopical the other are commonly accompanied.

investigations into the nature of scrofulous and tuber. Cases of manslaughter arising out of the

becular matter, we shall, in the present notice, devote practices of quackery, are becoming fearfully.

fearfully attention mainly to other poiots, and more especially frequent; but it would almost seem, that in

to the etiology and treatment of the disease. the ratio of the ignorance and presumption of

Dr. Glover gives a concise, and at the same time, a the offender, are the chances of his escape from

comprehensive statement of the results arrived at by punishment. In the case of Flitcroft, though

his fellow labourers in this most interesting field, the man was proved to be an ignorant uneducated

together with those of his own carefully-conducted person, utterly unacquainted with disease, and

investigations and experiments, which entitle bim to every way incompetent, and it was shown that

the greatest credit, both for impartiality and candour. two lives had been sacrificed to his incapacity,

He is a strong advocate for the identity of scrofula and had the trial been on a charge of manslaughter,

tubercle, as will presently be shown. The analogy he would, in all probability, have escaped-the rights of a corporate body, being considered

existing between them has not been unknowo to, or in the eye of the law more worthy of protection

denied by, observant medical men, even prior to the

| light which chemical analysis and the microscope than the lives of the unfortunate individuals who were deluded by his pretensions. And had the

have thrown upon the subject. Their absolute identity offender, instead of being absolutely ignorant

is still, however, a matter requiring fartker elucidation, of medicine, as he was, been the most accom

| as these means, like morbid anatomy, may be regarded plished physician or surgeon of the age, he

as showing the effects of morbid action, rather than would have incurred the same penalties. In affording information on the nature of such action the case of Cronin, where the charge was for

itself. One thing, howerer, is certain-viz., that the manslaughter, though poisonous agents of the

more intimate our acquaintance with the pathological most active and dangerous character were changes which diseases produce, either in structure or prescribed, and where in particular, there was, functions, becomes, the more rational also will be tbe to say the least, a lamentable and most culpable system of therapeutics used for the obviation of such carelessness, in not sufficiently designating conditions. Dr. Glover's opinion may be at once a preparation not to be fuund in the national known by the following brief extract, from pages 25 pharmacopæia, and for which the formulæ given and 26:-"We adopt, in its fullest extent, the stateby different authorities, vary greatly in pointment of Lugol, which makes scrofula,-1. e., the

« 이전계속 »