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.

    52/1050 (page 30)
    of these alterations was of a long standing, namely, the cellular adhesions uniting the two layers of the arachnoid. It is very probable, that on these depended the headachs which so long annoyed the patient. Anatomy, however, does not inform us why the pain of the head was more severe on the left than on the right. The exasperation of this pain of head, marked the commencement of the acute disease, for w'hich he entered the hospital, and which was sufficiently accounted for by the purulent effusions found on the upper surface of the brain, its base, and in the ventricles. We may observe, that the purulent layer of the base was con- fined to one of the cerebral peduncles, the left, and also to the left pons varolii and medulla oblongata. We may also observe the purulent sheath, surrounding the nerves, arising from the left side of this part of the brain. Is it in consequence of these anatomical circumstances that, towards the termination of the disease, the left eye- lid, and cheek of the same side, became paralysed, at the same time that all motion seemed extinct in the right arm? Violent pain of head, fever, general illness, were all that we observed during the first days of the disease. Some delirium set in on the 4th, which, on the 5th, was succeeded by a state of coma, which went on increasing to the 10th day, wffien he died, a little after symptoms of paralysis appeared. To explain this succession of phenomena, shall we say that the meninges of the convexity of the hemispheres were, at first, irritated, and that it was then the delirium appeared, and that the coma which succeeded this delirium, announced the extension of the meningitis towar(^ the base of the brain and into the ventricles ? We have already seen, however, that it is not alw^ays possible to determine, from the prevailing symptoms, w'hat portion of the meninges is especially affected. The circulation did not present that slowness here wffiich it did in other cases. The pulse, which w^as natural on coming to the hospital, became frequent and febrile, in proportion as the state of coma became more and more developed. We have observed the contrary in other cases. CHAPTER V. DISEASES OF THE MEMBRANES OF THE SPINAL CORD. Case 26.—Spinal arachnitis—Arachnitis of the base and convexity of the brain— Milky serum in the ventricles.^ A w'oman, twenty-eight years of age, the mother of four children, had been very much distressed by certain insulting proposals made to her ; her menses were suddenly suppressed in the midst of their course, and she was instantly seized with violent shivering, which lasted tw^enty-four hours. The next day, great heat of * The following very interesting cases, which serve to illustrate the principal circumstances connected with disease of the upper cervical vertebræ, are condensed from Dr. Bright’s Medical Reports, vol. ii. part 1, page 415. They were communicated to him by Mr. Key :— Case 1. — Slight Paralysis from disease of the Cervical Vertebræ. A young lady, aged thirteen, had been for about twelve months troubled with pain in the neck, which at first was considered as the effect of a cold. This not going off, was treated by her medical attendant as a glandular affection. This pain continued to increase, until at last she could not rise from the horizontal position without great pain, being also obliged to support her head by placing her hands on each side. When Mr. Key first saw her, she was emaciated, and her countenance betrayed great suffering. On examining her neck there appeared a general fulness, which gave her pain on pressure; she had the power of slightly moving the head backwards and forwards, but the lateral movement was accompanied with so much pain that she could not be prevailed on to attempt it. The case seemed evidently an affection of the two upper cervical vertebræ. After some time a tumour was perceived at the back of the pharynx, wliich, on puncture, yielded about three ounces of pus, and which Mr. E. concluded