The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876
Date:
1836
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Licence: Public Domain Mark

Credit: The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan. Source: Wellcome Collection.

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    dim and languid ; slight involuntary motion of the muscles which move the com- missure of the lips 5 his answers accurate j gives a perfect account of his state, and of every thing which happened to him since the commencement of his illness ; the pulse moderately frequent, and regular; everything else natural. It was difficult to assign a precise seat to this group of symptoms ; the first complaints, however, regarded the head ; the vomiting might be considered as connected with a commeneing cerebral affection, and the severe headach seemed to point out the head as the seat of the disease. The absence of any morbid phenomenon, with respect to the alimentary canal, repelled the idea that the headach was sympathetic of gastro-intestinal irritation. The absence of all febrile disturbance precluded the possibility of its being mere continued fever. The state of the patient, however, appeared very alarming ; the appearance of his countenance, and, amidst this absence of local symptoms, the great alteration already of his features, obliged us to form a rather unfavourable prognosis. M. Lerminier suspecting a state of encephalic congestion, applied, notwithstanding the extreme paleness of his face, twenty leeches across each jugular vein. Demulcent drinks, and sinapisms to the lower extremities. No change in the patient on the following morning. On the 20th, he was very much cast down, and answered questions with diffi- culty and reluctance ; light was painful to him ; he kept his eyes closed, and his head concealed under the bed-clothes ; face very pale ; pain of head not great ; the convulsive movements of the lips more frequent and more marked ; pulse and skin natural (blister to the nape of the neck). In the night he emerged from a state of stupor, in which he had been for the last twelve hours. He got up out of bed suddenly, saying that some persons were pursuing him to do him harm. He raved during the night, and occasionally uttered several piercing cries. On the 21st, he was kept in bed by force. The face had now become red ; the head was agitated by a continual movement, which carried it from right to left, and left to right ; the muscles moving the lips, the alæ nasi, and the eyebrows, were in the highest degree of convulsive agitation ; saliva, slightly frothy, flowed in great abundance from the mouth ; he spoke incessantly and with energy, but his articulation was unintelligible ; great subsultus tendinum, which prevented the pulse from being felt ; its frequency did not seem very great (bleeding from the arm, twenty leeches to the neck, cold applications to the head). No change on the 21st. On the 22nd, violent delirium ; convulsive motions of the muscles of the face ; risus Sardonicus ; continual motion of the right arm ; subsultus increased ; pulse more frequent ; tongue moist and red (two blisters to the thighs ; ice to the head). On the 23rd, head turned back, and to the right ; strong contraction of the right arm ; respiration very irregular ; occasionally accelerated ; it then becomes slower than natural. The patient silent, and quite still ; eyes fixed, and void of expression ; mouth open and unmoved ; pupils neither contracted nor dilated ; answers no questions ; does not even seem to understand them ; original paleness of face returned ; pulse sixty a-minutc, and regular ; bowels not free ; tongue cannot be seen ; teeth not dry. He remained quite torpid during the day, but at night violent delirium reappeared ; uttered very loud cries. On the 24th, this excitement was succeeded by profound coma ; extremities cold ; a clammy sweat covered the face ; respiration ralant. Died in the course of the day. Post 7ïwHem.~On the upper surface, a considerable difterenee in the colour of the two cerebral hemispheres, the right being pale, whilst the left presented a well-marked red tint, which resided entirely in the subarachnoid cellular tissue, which was traversed by numerous vessels ; neither serum nor pus in this tissue ; the grey substance constituting the most superficial portion of the convolutions of the left hemisphere j)articipatcs in the injection ot the pia mater covering