Volume 1

A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel.

  • Rosenthal, Moriz, 1833-1889.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    testinal innervation, Traube). The pulse, at first a little accelerated and irreg'ular, soon becomes markedly slower (irritation of the centre of the regulating cardiac nerves). It beats 40-45 per minute in the adult, and 60-65 in children. Tlie respirations become slower, irregular, and super- ficial. The skin is cool, and covered with a cold sweat. In the last period, or stage of jyavalysis, the paralyses of the muscles of the face, eyes and limbs, which were at first limited and transitory, become more complete and persisting, and certain muscles (jaw and neck) become contractured. Cutaneous and reflex sensibility, Avhich were at first increased, become entirely lost. The pulse, small and soft, is very rapid (as in section of the pneumogastric, Traube); the abdomen is tympanitic; the bladder and bowels are evacuated involuntarily; deglutition is impossible; the skin is cold and discolored, and covered with a viscid sweat; the patients sink into coma, which, in children, is often interrupted by convul- sions. The duration of the disease should be dated from the appearance of the first well-marked cerebral phenomena. The uncertain prodromata should not be considered in the evolution of the symptoms. The average duration is from two to three weeks. If the disease is superadded to general tuberculosis, it terminates in the first week, rarely in the second. But if tubercular meningitis attacks individuals who ap- peared to be previously healthy, it may last several weeks, sometimes even two or three months, or may terminate in a few days. Diagnosis and Prognosis. Vague prodromata, consisting of general malaise without noteworthy cerebral disturbances, will not lead us to suspect a tubercular affection of the brain, especially when the patient has previously enjoyed good health. In such cases, we cannot make a diagnosis except after a long-continued observation, or after the appearance of serious cerebral symptoms and constitutional disturbances, such as persistent headache, vomiting, fixed look, somnolence, and obstinate constipation. Acute pulmonary and bronchial affections may be recognized by care- ful and repeated physical explorations. The differential diagnosis offers great difficulty when there is a simultaneous tubercular affection of the lungs and meninges, and we must be aided, especially in children, by the history of similar disease in the parents or other relatives. The symptoms of cerebral excitement which precede the eruption in acute exanthemata, or which, especially in children, are due to gastric irritation or the presence of worms, do not give rise to any doubt after the lapse of a few days, when the eruption has appeared or the worms have been passed, after appropriate remedies. The diagnosis between typhoid fever and tubercular meningitis is usually not difficult. The former is characterized from the beginning hy the increasing elevation and exacerbations of the temperature, and the acceleration of the pulse; lively delirium is rarer and appears later; the abdomen is usually tympanitic, and diarrhoea is almost always present; if constipation exists, it is readily overcome by laxatives; in the coma of typhoid fever, the patient is insensible to impressions upon the skin and senses. In tubercular meningitis, on the other hand, the temperature is usually moderately elevated, the pulse and respirations slightly accelerated, and