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patient; this information, collated with the symptoms The notes of the following case, taken many years
present at the time of his visit, will generally enable ago, and of course without reference to any particular
him to form a tolerably correct opinion of the nature pathological opinions, would appear to support, as far as
and probable issue of the case he is called upon to it goes, the views propounded by M. Rilliet :-
treat.

CONVULSIVE MENINGITIS.
ARACHNITIS RAPIDLY FATAL.

On Tuesday morning, March 12th, 1833, I was Feb. 8th, 1813. My assistance was desired for the requested to visit a child six months old, who, previously relief of a little girl, nine years of age, whom I found to the commencement of his present indisposition, was with the following symptoms :-Insensible; tonic spasm remarkable for robust health. I was informed by his of the voluntary muscles; limbs extended and rigid; mother, that on the Sunday prerious, (March 10th,) the joints immoveable; mouth firmly closed ; eyes wide child did not appear in his usual spirits, cried, and was open ; left pupil remarkably dilated, but not entirely fretful when played with as beretofore; he passed the insensible to light; pulse 160; heart beating with great Sunday night in a restless manner. On Monday force; skin cool. These symptoms came on suddenly, morping he was manifestly indisposed, and vomited, preceded by headache and sickness for a few days only, throwing up a bilious-looking fluid; he also was and wbich had not caused any alarm for her safety. noticed to be distressed when moved, and the eyes had The child died in three hours from the time of my being a heavy appearance. The symptoms noted on my called in, without any material cbange having taken visit were the following:-Skin hot; frequent pulse; place in the symptoms.

countenance pale; expression idiotic or vacant, eri. I learnt that the patient had not enjoyed robust dently devoid of intelligence; frequent vomiting. health, and was frequently the subject of headache, Leeches were applied to the temples, and a cold lotion and she had also been much troubled with ascarides, to the head ; to these remedies some medicines and a Her eyes were dark; complexion pale; her person tali tepid bath were added. Convulsions came on early ia and thin. I was permitted to examine the head, but the afternoon, and continued the whole of the night, the chest and abdomer were not allowed to be opened. and the two following days and nights, with only very

The following were the morbid appearances presented sbort intermissions, until the patient's death, which on dissection :-The dura mater adhered with great firm. I took place on the 14th, three days after I first saw him. ness to the cranium; the longitudinal sinus was unu. / The following is the account of the examination of sually free from blood or coagulum; the arachnoid the body:-Dara mater somewhat more vascular thau opaline, and somewhat thickened, haring a considerable natural; the longitudinal sinus contained a large pale effusion of fluid beneath it, occupying the interspaces coagulum, with processes stretching into some of the of the convolutions; about two ounces of fluid were

veins of the pia mater. Ou raising the dura mater, a found in the ventricles; the foramina of communica. most extraordinary appearance presented itself: the tion were considerably enlarged; the sides of the third con solutions of both hemispheres were nearly obscured, ventricle a quarter of an inch asunder; a similar effu. and the natural aspect of the pia mater lost by an sion existed beneath the membrane in the ventricles, abundant deposit of yellow lymph into its cellular analogous to the arachnoid, as was observed on the structure, occasioning that membrane in many parts to surface of the cerebrum; there was an abundant effu. be a line and a half in thickness. This effusion sion at the base of the brain; the vessels of the plexus around the reins of the pia mater gare them the choroides were extremely turgid, and those of the velum

appearance of small cords, which when cut across preinterpositum in a similarly congested state ; the served a rounded figure, with a small red point in the medullary substance of the brain was soft.

centre, indicating the situation of the former carity of M. Rilliet, in his account of “ Simple Acute Inflam. the vein, but which was now obliterated by the pressure mation of the Membranes of the Brain in Infants," of the lymph: a few veins escaped this change. The divides it into two formos,-the “convulsive" and the

arachnoid was thickened, and raised in some parts by "pbrepitic." The case I am about to relate comes

a watery effusion. The state of the pia mater abore under the former denomination. It would appear that

described, though more apparent upon the upper

surface of the hemispberes, also existed on the greater these forms of meningitis are distinguished from the

portion of the inferior parts of the cerebrum, and on tubercular by the suddenness of the seizure, the greater

some portions of the cerebellum. The velum inter. violence of the symptoms, and the shorter duration of positum also was similarly affected. The ventricles the disease, not often lasting beyond the third day; 1 contained a considerable quantity of Auid. The saband also from the apparent absence of the strumous stance of the brain was unusually soft and rascular. diathesis. These affections do not differ less in their | The viscera of the chest and abdomen were carefully morbid anatomy than in the circumstances adverted to; 1 examined, but no disease discovered. whilst in the tubercular division of these cerebral | In the abore citation of cases and observations on affections, the violence of the disease would seem to the symptoms of arachnitis or hydrocephalus, which exbaust itself upon the base of the brain. In the simple I have thought might facilitate the diagnosis of cerebral acate inflammation of the membranes in infants, the diseases in children, no particular order has been meninges of the convexity suffer most, and in the latter followed beyond that which a reference to my own there is always an entire absence of tubercles, case book suggested; it is therefore likely that many

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circumstances and symptoms may have been passed be hoped the morbid action within the cranium has not over or slightly touched upon, which by others, may be made a fatal progress, the idea way be entertained supposed important.

that by the timely ase of appropriate means, it is still In the consideration of this subject, it is necessary possible to avert the threatened danger ; but in too that the mind of the practitioner should be duly im. many instances, it is to be feared, that when this sppppressed with the value of premonitory symptoms; they tom has made its appearance, irrevocable injury has will efficiently assist him in appreciating those signs been sustained by the brain or its membranes. Sickness on which his diagnosis is subsequently to be founded. and vomiting being such common occurences at all ages The premonitory symptoms are for the most part and particularly in childhood, and known to arise made ap of some of those phenomena expressive, under very different circumstances, and from such a general malaise, -such as languor; listlessness; erratic variety of causes, it is not perhaps a matter of surprise pains in various parts of the body and limbs; mental that its value in these cases should not have been duly irritability; a tendency to constipation, with some estimated. With care and attention, however, to all the form of gastric disorder, leading to imperfect assimila. existing symptoms, and the previous history ofthe patient, tion of food, and frequently to its sequence-loss of it cannot be very difficult to distinguish the persisting flesh. The complaint is often ushered in with paip sickness and vomiting of the early stage of hydroce. of the head, heariness, and a disposition to lie down phalus, either from that which occurs from teething or and doze, and generally with a great dislike to motion

from ordinary gastric and intestinal disturbance. In of every kind, frelting when disturbed. A due attention all doubtful cases, it is gafer to assume the existenee of to the state of the pulse is of the first consequence; cerebral disorder, since no evil can result from such on this symptom, as is well known, Dr. Whytt bases an error of diagnosis. Iu the bilious remittent fever of his division of hydrocephalus into three stages, the children, the complaint most likely to be confounded first and last being marked by a frequent pulse; the with hydrocephalus, vomiting, though occasionally second by a slow and sometimes an irregular one. | occurrióg, is not a prominent symptom. Whenever But all who are practically acquainted with the disease, sickness takes place in a cbild, no trouble or time know that the symptoms of arachnitis are by nu means should be considered too great in investigating or uniform, and that the stages are often remarkable for searching after its cause or origin. We know that the great diversity in their duration; in some cases, the | vomiting is one of the first symptoms that follow early stage of excitement is not observed, whilst in

injuries of the head. It often happens, when a child others it may last several days; occasionally the second falls on its head from a chair or table, that the accident stage does not appear, or is so slightly marked, as to is almost immediately succeeded by vomiting, after escape notice. To the discriminalion of hydrocephalus which it goes off into a heary sleep, and this is so from the infantile remittent fever, the observation of exactly like what happens in hydrocephalus, that the the pulse may be made very asailable, as in the latter inference is abundantly clear, that the brain must be disease it is rarely erer slow, and never below the suffering either from congestion or more advanced normal standard, even in the remissions from fever. disease. In the slow pulse accompanying diseases of the brain, The high interest with which the subject of the there is a peculiarity which I do not remember to have diagnosis of the cerebral diseases of children is invested, seen noticed, which is, that it is remarkably quickened is scarcely more important with reference to the safety by the slightest exertion, as turning in bed, $c, imme. 1 of the patient than the character of the medical diately resuming its former frequency, as soon as a state attendant. Unhappily, as has already been observed, of quiescence is oblained. This state of the pulse exists

a great portion of these cases has a fatal issue, and after concussion of the brain. The respiration in an should he be misled by the too frequently insidious early period of the disease is sometimes quick and

progress of complaint, and thereby have failed to irregular, but its general character is that of slowness

ness acquaint the parents with the precarious situation of and inaudibility, with occasional or frequent sigbing. their chilů, he has not onls lowered himself in their Strabismus and double vision are common symptoms; ' opinion, but will have the mortification to redect that but the former is rarely noticed before the case is

se is he has let pass a rare opportunity for establishing his passing into the third stage, and the patient all but in

reputation for tact and discernment. Next to the kind a hopeless condition, and the latter, either from the feeling

r from the feelings which are awarded to successful practice, the tender age of the patient, or the state of the intellect, friends of the sick feel most grateful by being forewarded can seldom be availed of as a means of diagnosis.

of the trouble that is to come upon them, and by The one great and important symptom in distin- she

in distibo | shewing that no care or skill has been wanting, that guishing hydrocephalus from other diseases of children

might have brought about a more happy result. is sickness and vomiting. This symptom is not only important as being more pathognomonic than any other individual one, but occurring at a period when it may 1

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scriminat

In considering the late fever of Rugby, such disNOTES ON THE EPIDEMIC FEVER OF RUGBY

advantages as we bave just referred to do not exist. AND ITS NEIGHBOURHOOD, DURING THE

Here the air is without carbon in excess, and altogether AUTUMN OF 1846.

untainted by the fumes arising from factories. None By JAMES Paxton, M.D.

of the poor are destitute; every one is living in a com(Continued from page 536.)

parative state of comfort. It is the custom of those

who move in the superior ranks of life to visit and It is usual, especially in large and populous places, and perhaps very justly, to connect continued fever

reliere tbe poor, and in times of sickness they watch with the idea of organic debility. With these views

over them and administer to their temporal and the chief object in the treatment bas beea to attempt

spiritual necessities. Societies thus constituted have to maintain the circulation with wine, cordials, stimu.

more of the moral and physical elements for maig

taining their natural tone in the bour of trial, than is lants, and nutritious diet; at the same time, while suppressing relaxation of the bowels by opium, to

known to exist under circumstances which bare lately relieve local determinations by leeches, and to meet

been reported as prevailing in Scotland and Ireland. It morbid irritations by counter-irritation of sinapisms

is requested all this may be borne in mind, in account.

ing for results and deviations in practice, in this place, and blisters. With this plan, generally, saline medi

and for adopting a treatment the very opposite to that cipes and doses of mercury were administered.

which has been recommended by practitioners of great “Whenever the circulation became feeble, wine and stimuli were used in sucb quantities that could not

experience and bigh standing in the profession else

where. be supposed to be inert, and the pulse hecame less frequent and firmer under their use"#"Wine is given l. The successful treatment of our epidemic depended for this one lesion of the circulation ; the support of

on the strictest attention to regimen : errors in diet this peculiar function of circulation is your object all / were fatal. All kinds of stimuli had the effect of through :”+ with what success we may be able to increasing arterial action, congestions, and cerebral judge by the following statement:-"Several patients disturbance. It was only in the stage of perfect sube were brought into the hospital suffering from typhus,

sidence of the malady, that wine could be taken with the tongue was natural, and the pulse 70 or 80, and

impunity. I had often to regret the permission I yet the majorits died.”+ Other physicians of equal had given to use wine at too early a period. The eininence, have spoken more guardedly when recom

most mild species of nutriment were the best for the mending wine, they hare entertained suspicions of the patient. Time after time bave I known a generous general expediency of wine in fevers, eren among the diet, such as beef tea and wine, to derange the riscera, same classes as those just alluded to; observing, that and to have a direct tendency to excite organs already "wine should be given a little at a time, when the too much excited by febrile phenomena, and the consecond sound of the heart is wanting.''S There is an sequences were invariably a correspondent depression admirable direction giren in these words-viz., "Wine of the vital powers. The principle wbicb suggests should be administered when the skin is cold."| The wine and the highest putriment in low fever, in theory epidemics of Dublin, Edinburgh, and of the metropolis, is plausible enough. To oppose what was esteemed have been thought to differ from the epidemics of strength to weakness, is a theory which readily gains rural districts. They may. This much is certaio, that an ascendency in the minds of those who are ignorant the constitutions of persons resident in confined situa. of the management of diseases. They are baunted by ations, are little prepared to encounter a struggle with the single perception of debilit

the single perception of debility, but the exhibition of an aerial poison. ' "The very atmosphere of commer

wine to counteract the debility, only involved the cial and manufacturing cities undoubtedly deteriorates patient in additional dangers. At the advanced stage the race of men." They are in an unfarourable of ferer, wine is the medicinal extreme unction for the position to niset disease. Hence the great mortality

patient's dismissal. In the earlier stages it may be of populous districts has been justly attributed to this symbolized by the golden cup filled with aboinizations. cause. In the London ferer bospitals one in seren | There could be no compromise between wine and the die. When we know that there has been a low standard Rugby fever. It was not locg before I found, that of health antecedent to the attack, the expectation of either the nature of the fever, or the peculiar habit of a successful issue under a malignant attack, of an | persons in this locality, would not allow of the epidemic, is but a forlorn hope. I bave gone out of administration of stimulants without decreasing the my way thus far in order that we may estimate the chances of recorery. To give an example relative condition of communities and persons becoming

Mrs. P., aged 27, was seized with fever, attended by the subjects of fevers.

great prostration of strength, and a disordered state of

the bowels. Her appearance is faded, and the • Dr. Alison. + Dr. Corrigan. Ibid. iDr. Stokes.

pulse feeble and frequent. Wine, and afterwards brandy || Dr. Williams. Dr. Black, of Liverpool, and water, were given in considerable quantities, which

ent

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appeared to confort the feelings and to suppress the reduced him to a mere skeleton. The same plan of diarrhea. However, on the fifth day most of the treatment as before pointed out; was adopted with a symptoms became more serious. The typhoidal influ- ' favourable result. ences were fully manifested ;. the skin was dry and

J. B., a boy aged 9, in addition to a severe form of

B burning ; purple redness of the cheeks; tongue loaded

typhus, had peritoneal tenderness, and abdominal with hæmotose brown mucus, the teeth and lips

ups tumefaction, which continued seren weeks. Chloride

mera having an incrustation of the same secretion; the of soda was exhibited with occasional doses of chloride pulse was increased in rapidity and diminished in

saed 10 of mercury. As there was a tendency to constipation, strength. I scarcely weed observe, that with great

tartrate of soda was also occasionally given. When thirst there was not the least appetite. She was

aperients were required, this neutral salt or phosphate - unable to converse with any one for many seconds ;

of soda were observed to act with mildness and good her words may be described as muttering and incohe

efect. This boy's diet was solely grapes, chocolate, rent; there was no voluntary control over the sphincters. None could entertain a favourable impression as to the

whey, and toast water. He passed through the worst

stages of the worst degree of the epidemic. In three result; a very different course of treatment therefore was

months his health and strength returned. pursued. Hydrarg.cum Creta, gr.x., was directed; afterwards Liquor Sodæ Ch. M. xx., e Mist. Camphoræ,

- His sister took the same complaipt, as well as a great quartis boris. Broth was exchanged for chocolate;

number ofpersons resident in that part of the town, (the raspberry vinegar and water was substituted for port neighbourhood of Queen Street,) the disease occasioned wine negus. The hands and feet tere, several times a great loss of mental and physical energy, but fatal day, sponged with warm water. In twenty-four hours terminations were rare. After giving the fairest trial it became obvious that the system was returning to a of, stimulants and the generous plan of treatment, more tranquil state. By the fifteenth day the sensorial

under the notion of opposing debility, I found that faculties were clearer, the pulse had fallen to :20, and

stimulants and cordials were not only unnecessary, but the tongue was inoist and white at the margin. Still as

positively injurious. Given by way of support they she was complaining of much uneasiness in the cæcal | region, with troublesome diarrhea, the same dose of

only occasioned supplimentary ferers. Tea, chocolate, · Hydrarg. cum Creta was repeated, the operation of and fruits, were sufficiently nutrient, and might be which, though attended with much inconvenience to taken with greater safety than broths and jellies. I the nurse, was of decided advantage to the patient. bave learned to attach much importance to the dietetics On the 18th day, having been allowed beef tea, it of patients in sever. Unless there is a desire for food, occasioned an exacerbation of fever and increased the attendants of the sick are unwise in pressing it

turvance of the bowels. Chocolate and wilk was on the patient. In no case did they sink from want therefore resumed as the only nourishment that could

of nutrition, but from morbid actions. be safely recommended. On the 22nd day a copious

E. H., a youth aged 17, for fourteen days took only diaphoresis appeared critical. There remained indeed,

soda water; it was grateful and refreshing, and he extreme emaciation, but the tongue was gradually

eagerly drank from six to twelve bottles a day; subimproving, (i.e.,) the broven receding from the margin

sequently grapes and chocolate constituted his nourisha and apex. On the 25th day, quinine, with small

ment for about a week, and in five weeks he was able quantities of hydrochloric acid were prescribed, and

to walk out. the patient was removed from a confined part of the town to a inile distance, where the house was situated |

As a summary of my observations,—1st. The remote in a garden surrounded by fields. This step immedi. cause of this fever appeared to arise from the reception ately had the effect of improving her appetite. Her

of an intoxicating poison invading the whole system, recorery was slow. Four months elapsed before she and often accompanied by local disorder. The innu. could return to her home and resume the duties of merable varieties were dependent on temperature or her family.

predisposition. 2ndly. This disease, even in healthy The mother-in-law who assisted in nursing this subjects, was lingering; yet in its third degree, and good woman took the ferer and died. Three cases when assuming the most formidable characteristics of occurred in the house adjoining; two of great sererity, typhus, if previous lesion did not exist, a favourable but as soon as there was subsidence of fever, these issue might be predicted. 3rd. The depression from likewise were removed into the country, where they the very commencement of the attack marked its recruited their strength in about five weeks. I might asthenic type ; it would not, consequently, admit of briefly observe of one of the last-named cases, a girl, depletion, unless locally, by means of a few leeches, to aged 6, who, having the epidemic of the third degree, relieve engorgement, or where inflammation co-existed lost ber flesh, bad inulberry-coloured fur on the tongue, with fever. On the other hand, an attempt to strengthen lips and teeth, with stupor and delirium. Now, tea the system by strong animal infusions bad a tendency and pure water constituted the whole of the dietetic to keep up febrile action. treatment for fourteen days, when an inclination for The immediate cause of fever is now supposed to food returning, she was allowed milk diet.

depend on depraved circulating Ruids. There may be Her brother, aged 10, had a similar attack which I in addition, lesions of particular organs, prior or

distu

subsequent to the attack, (as accidents,) generally in. diarrbea and fever. It is rather remarkable, that the creasing the danger. Each required its appropriate trent. three who escaped fever were the servants. In a person, ment. The first demanded the exercise of much patience. where frequent dejections and tenesmus were distressing, Disregarding any complaints of weakness, the question compound ipecacuanha, with aromatic confection, was for our consideration was not the relative strength and given; but it soon became evident in our practice, that weakness of the patient, but the control of morbid whenever any preparation of opium was resorted to for action, and the inducing of healthy functions. The the restraining of the motions and irritability of the reduction of the animal powers, and the absorption of bowels, a greater amount of fever was sure to superadipose tissue, is a matter of little moment, when vene. Opium had also another ill effect, that of compared with the importance of relieving local con bastening congestion of the brain, and producing gestion, or local affections analogous to inflammation. / alarming lethargy or subsultus. For instance, when the complaint assumed the form of Soda-water was a most agreeable and valuable typhus cerebralis, the application of a few leeches beverage. The same may be said of tea, coffee, chocoto the temples became necessary. Sometimes in late and whey. The two last prored just sufficiently these cases blood drawn from the feet by leeches nutritive and in erery respect beneficial, until the seemed preferable to any other method of depletion.

state of subsidence of ferer. When there was cough, This was followed by small sinapisms to the lower as a drink, a table spoonful of powdered gum acacia, in extremities. The hair was cut off, and the head fre

a quart of lemonade, was directed. The unsoplisticated quently sponged with warm water ; I do not mean

taste of children, howerer, at all times instinctirely fomented, but the head merely washed, which had the preferred that fluid which is the greatest of all febrieffect of producing an evaporation from the scalp, and / fuges, pure water. an agreeable feeling. The palms of the hands, and the

Uoder a state of convalescence much caution was soles of the feet, were treated in the same way. When needed in returning to a full diet. The patient in this the temperature of the skin was unnaturally high, then respect required to be kept back. We frequently such ablutions were particularly tranquilizing and observed that the mistaken kindness of friends occarefreshing.

sioned a partial relapse. Pressing nourishment against In typhus pulmonalis frequent small doses of tartar the inclination of the patient, was always attended emetic was useful in relieving bronchial affections con

by ill consequences from the beginning to the end. nected with fever.

The best indications for allowing a better diet was a The most serere type of fever which we witnessed

returning appetite and the patient experiencing a desire was that which has been termed typhus abdominalis;

for food; then, whatever it might be, the appetite in such cases the more urgent symptoms were sub

should be indulged. The permission was seldom dued by the exhibition of Hydrarg. cur Creta ; and

injurious. although diarrhea or intestinal bæmorrhage might be present, this medicine was not on that account to be | ANEURISM OF THE ABDOMINAL AORTA, forbidden, sioce it was proved to be the most efficacious SIMULATING DISEASE OF THE KIDNEY: medicine in correcting the relaxation, and for improring RUPTURE INTO THE LUMBAR ADIPOSE the biliary and intestinal secretions. If the pain in the TISSUE. bowels was acute, the local abstraction of blood by Be GEORGE NORMAN, F.R.C.S., Senior Surgeon to: leeches was preferable to taking blood by the arm.

the Bath United Hospital, &c. Mrs.

S o, aged 31, was affected by the third degree Read at the Quarterly Meeting of the Bath and Bristol of fever, with paroxysms of great pain in the bowels;

Branch of tbe Provincial Medical and Surgical Associa. being of a full habit of body, blood was abstracted

tion, held at Bath, September, 30, 1847.) from the arm, and the pain was relieved, but the ferer

G. M., Esq., aged 68, an Irish gentleman, who had became much more formidable. The pulse, which had

been engaged in active public life, had been subject at

be been 110, rose aftu. the blood-letting to 130; delirium

different times to gout, but not in any severe degree, and involuntary motion of the extremities followed.

and his general health had been good until a year and In this state, for some days, medicines and erery thing

a half since, when his stomach became deranged, and else were refused, except a little tea and soda water; }

he began to suffer from a dull, and at times severe, ultimately she recovered, but her recovery was pro

pain in the loips, more particularly in the right side. tracted.

His physician in Dublin, finding that these pains were A lady who was on a visit to the above also

not removed by any treatment, advised bim to go to

| Bath, to drink the waters and use the baths, as he suffered from a similar attack. In this case doses of

considered the pains to arise from deep seated gouty the grey powder, citrate of potass, and blisters, gare a inflammation. Accordingly he came to Bath, in April saser check to the symptoms, and in three weeks she last, and became the patient of Mr. Church. was able to be removed into the country. All Soon after his arriral, it appeared that he bad brought

of this family, consisting of seren persons, four bad / with him ile infection of the low fever, then prevailing

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