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

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

31/1050 (page 9)

$glands; they presented black points, and projected somewhat beyond the level oi the mucous membrane. Remarks—T\\\s is another case where inflammation of the membranes existed only in a very small extent of the external surface of the brain. The pia mater was injected merely towards the anterior and upper part of each hemisphere ; and in this part the grey substance of the circumvolutions participated in the irritation of the membrane covering it. This is all that was found to explain the serious nervous disturbances which manifested themselves on the last days of the patient s life. No doubt but the patient died in consequence of the lesion of the nervous centres. The entire disease, however, did not reside here ; for, on entering the hospital, nothing manifested itself but mere continued fever, without any well marked local symptom ; the intestine was then diseased, and we doubt not but that, at first, there was follicular enteritis, which was in progress of cure, as appeared from the post mortem ; then the partial meningitis supervened, which rapidly gave the most serious character to a disease till then mild. Case 8.—False membranes of recent formation on the arachnoid, lining the convexity of the left hemisphere—No other appreciahle lesion of the meninges Headach at the outset—Delirium—Tubercles in the lungs and spleeii. A man, forty-three years of age, entered the Hospital la Pitie at the commence- ment of the month of April, 1831, presenting the ordinary symptoms of pulmonary phthisis. On the 19th of May he complained of an acute pain, seated in the left temporal region. This pain, which was not increased by pressure, became occasionally insupportable, and then radiated towards the parietal and orbital regions of the same side of the head. This was the first time he complained of such a pain ; it had appeared the night previous, and prevented him from enjoy- ing a moment’s sleep. No other change in the state of the patient ; the pulse was, as we usually found it in the morning, from 70 to 80 ; no appreciable disturbance in sensation or motion. This pain, then single, and unaccompanied by any other symptom, was considered mere temporal neuralgia, and nothing particular was prescribed. However, the following day and night the patient suffered dreadfully in the temporal region. On the 20th of May, though seeing no reason to change our diagnosis, we had him bled from the arm to twelve ounces ; the blood, examined the next day, consisted of a small clot, rather black, without any appearance of the buffy coat, and encompassed by a great quantity of serum. The pain of the left temple had not diminished ; no other new symptom manifested itself. On the 21st, still headach ; no change at all ; twenty-four leeches were applied to the left mastoid process, which bled freely; still the headach as intense as ever. Still conceiving the affection to be a neuralgia, we applied an opium plaster to the left temple, and ordered a grain of hyoscyamus to be taken inter- nally. On the 23rd, 24th, and 25th of May, no change ; but on the 26th we remarked, for the first time, that the skin of the two eye-lids, as also those of the cheeks, was raised by serum accumulated in the cellular tissue ; this skin still preserved its natural colour ; headach still continuing ; the pulse was, as usual, 80 ; a blister was applied to one of the lower extremities. On the night of the 27th, the intellect disturbed for the first time ; he arose from bed, and became very noisy. Towards morning the delirium ceased, and at the visit we found him as usual, except that he complained less of the temple. On the night of the 28th, the intellect again disturbed, and delirium returned ; in the morning he answered questions very incoherently ; the oedema of the face increased, without the skin being red ; pulse 88, and the temperature of the skin raised. In the course of the day the patient became comatose, and died on the 29th. Tost mortem twenty-nine hours after death.—The cranium being raised, and the dura mater divided, we found covering the convexity of the left hemisphere of the$