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.

    43/1050 (page 21)
    raised ; constipation still continues.—(eight leeches behind each ear ; two blisters to the thighs ; mineral lemonade). On the 28th, comatose state quite gone ; he puts out his tongue when asked, but gives no other signs of intelligence ; utters not a word ; pupils a little dilated ; tongue natural ; no stool ; apyrexia (purgative lavement, &c.). 29th, No change ; but on the 30th agitation and delirium, as on the 26th; con- stantly rubbing his hands together ; belly tympanitic ; pulse not frequent ; tongue moist and pale (twenty leeches to neck ; twelve grains of calomel). 1st May, delirium continues; retroversion of the head; carphology ; pupils dilated ; pulse very frequent ; abdomen tympanitic (twelve grains of calomel ; frictions to the abdomen, with linim. ammon. camphor., and aromatic fomentations to the same part). 2d May, delirium continues, as also the carphology ; continual tossing of the head alternately from right to left, and vice versa; moaning; sudden shocks of the trunk and limbs, like those of tetanus; carotids beat strongly; the heart raises the parietes of the thorax; tympanitis considerable. Death at eight o’clock at night, after discharging a considerable quantity of blood from the nose and mouth. Post mortem. On a level with the centrum ovale of Vieussens, on each side of the corpus callosum, we perceive a manifest fluctuation ; an incision made into the lateral parts gave exit to a considerable quantity of liquid, like whey not clarified, in the middle of which albuminous shreds are seen to float. From the surface of the parietes of each ventricle, a very thin membrane is detached, which is traversed by very minute vessels curiously injected. On some points of the free surface of this membrane, small greyish bodies exist, the size of a pin’s head, like the rudiments of false membranes, which, under the form of granulations, are sometimes scattered over the peritoneum. Thorax. The pleura costalis and pulmonalis adhere by well organised cellular tissue. The lung of this side contained a great number of tubercles, principally miliary, some were larger, and softened. The bronchi of this lung were very red, and the bronchial ganglia hard and black. The left lung also adhered to the pleura, but contained not a trace of tubercle. The two serous folds of the pericardium were internally united to each other by a false membrane several lines in thick- ness. Abdomen. The anterior wall of this cavity projected considerably before the thorax ; when struck, it sounded like a drum. The intestines were enormously distended with gas ; stomach contained a great quantity of mucus, and the small intestine a great quantity of bile. In the cæcum and colon, ascending as well as transverse, the mucous membrane was very much injected. The left lumbar colon, filled with verv hard fæcal matter, was white on its internal surface, as was the sigmoid flexure and the rectum ; above this last intestine was a very marked circular contraction. The gases and fæces accumulated in the colon could with difficulty get through it ; rectum empt3\ Remarks.—In this patient the nervous symptoms were much more marked and varied than in the preceding. In both the cerebral lesion was of the same nature, and had the same seat. In the latter case, as in the former, the lesion discover- able by anatomy existed only in the lateral ventricles. With this inflammation of the ventricular membrane coincided different sy^mptoms, some of which are gene- rally regarded as characterising meningitis of the convexity of the hemispheres, and others more especially connected with meningitis of the base ; thus on the one hand there was delirium and frequent tossing, on the other a state of coma. We often see these two orders of symptoms replace each other, and at the same time there are observed very remarkable disturbances in the muscular contraction, characterised by shocks of tlie trunk and limbs like those of tetanus, and a forcible reversion of the head. If we refer to the period when we first saw the case, we shall again And some phenomena worthy of remark, connected with the nervous