Observations on the disease lethargus : with cases and pathology / by Robert Clarke.

  • Clarke, Robert.
Date:
1840
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Licence: Public Domain Mark

Credit: Observations on the disease lethargus : with cases and pathology / by Robert Clarke. Source: Wellcome Collection.

    3/6 (page 971)
    coloured, depositing after standing a brownish sediment. Ator dressing the wound I ordered the patient to be kept on low diet, to remain in bed, and tp take tho following draught every four hours:— pk Magnesias Sulphatis, 31'lj.; Anlimo. nii Tartarizati, gr. i.j Inf. Sennaa c. q. s. M. Haust.Jiss. Dec. 29th.—Had n restless night; very incoherent in his talk; pulse full. I took sixteen ounces of blood from the arm ; ordered tho aperient draught to be con¬ tinued, with Pil. Hydr. gr. v. added to each dose. 30th.—Slept about two hours; bowels acting freely, the evacuations dark and very offensive; tongue white, and the edges uneven. Omit the Ant. Tart., and take a teacupful of beef tea in the day. 31st.—The pulse 90; more natural; the mind is becoming tranquillized; the vision still imperfect; complains of a noise in the ears, witli tenderness in the right side. I now determined on continuing the mercury until gentle ptyalism ensued, with a spare diet, perfect quietude of miud and body, forbidding all conversation. The state of mental stupefaction in which he was when he committed the act was after a few days succeeded by feelings of the bitterest re¬ morse and contrition; nothing could pa¬ cify his self-accusations for having at¬ tempted so horrible a deed,until I explained to him that his crime was itself an almost involuntary act, depending upon his de¬ ranged health, and that it was his previous ill conduct and intemperance which had induced the attempt : he said “ he had not been well the last six or seven months past, frequently wandering he knew not where, until hunger or fatigue roused him to reflection; and at other time3 shunning the society of friends, and stupifying himself in the corner of some public-liousc-tap room, imagining that every one distrusted him, and regarded him as unworthy of their friendship.” My reasoning with him in endeavouring to convince him that health of mind was dependent on health of body, seemed to inspire him with hope, and allowed of my furthering the medical treatment, which was continued by atten¬ tion to the sanguineous system and prima vice, by removing the inflammatory condi. tion of the membranes of the brain, with the mercurial and alterative treatment. Feb. 14th, 1840.—I took my leave of hint, after assuring me how gratefully he felt for his restoration to health of miud and body. .Crayford, Kent, August 20, 1840. OBSERVATIONS ON TUB DISEASE LET II ARGUS: WITH CASES AND PATHOLOGY. ByRobert Clarke, Esq. Colonial .Surgeon, Sierra Leone. The attention of the medical profession was, I believe, first directed by Dr. Winterbottom to the frequency and often fatal termination of the disease termed lethargus on the western coast of Africa; but the description given in his work, both of the symptoms and treatment, is much too meagre for prac¬ tical purposes. As deductions leading to a sound and rational mode of treat¬ ment can alone be drawn from an atten¬ tive, patient, and minute investigation of the pathological appearances presented, the following observations, with cases and pathology of this most interesting disease, founded upon my own expe¬ rience as Surgeon to the African Hospital at Kessy, in the colony of Sierra Leone, will not, I trust, be uninteresting, or deemed a work of supererogation. Dr. Mason Good, in his work upon the Study of Medicine, has placed this disease among the class Neurotica ; but, as developed in the cases whicli havo come under my notice, I submit that it may be classed under the variety Cataphora, or short remissive lethargy. Causes of disease. — Lost balance of circulation, inducing irregular distribu¬ tion of blood, and venous congestion; depressing mental emotions ; severe bodily labour; unwholesome, scanty diet; repelled eruptions ; suppressed evacuations: perhapsfunctionaloerange- ment of the nervous system, producing insufficient action or energy to resist the approach of sleep, even without its con¬ comitant existing causes. Symptoms.—On first approach of the disease the patient is observed to be¬ come fat, the demand for food being inordinate. When the disease has, however, existed for some time, the appetite declines, and, in the latter stages of the complaint, the patient emaciates. Uncontrollable desire to sleep, the patient often falling asleep in the act of conveying food to his mouth. Sometimes squinting and con¬ vulsions may be observed. The glands of the neck become tumefied ; hut this is by no means always present. The negroes call this disease sleepy dropsy, and, after it has progressed, never attempt its cure, giving over the patient as incurable ; but, in the first stages, they endeavour to cure it by inducing copious perspiration. Some European doctors, conceiving the disease to be induced by debility, have administered various stimulants, such as camphor, musk, valerian, blis¬ ters, sternutatories, metallic tonics, as sulphate of zinc, &c. The powerful agent, galvanism, has been also em¬ ployed. Others, I imagine with more propriety, have viewed the disease as originating from congestion' of the brain, and have sought its cure in the employment of local depletory measures, and of keeping up an action of the bowels 5 hut it appears to me that medical men have been deterred from the judicious employment of general bleeding by ail unfounded apprehension of danger from debility; nor would it appear that the potent remedy mercury has ever been called in to exert its powerful influence in equalizing the circulation ; indeed the practice I imagine to be novel. A11 esteemed and experienced friend of mine, holding- the chief civil medical appointment in this colony, has informed me that lie has repeatedly tried it with a view to induce ptyalism, but without effect. Another medical friend, of lung standing and experience in the colony, told me that he had treated the disease repeatedly, using blisters and drastic purgatives; hut neither of these gentlemen appears to me to have sufficiently appreciated this medicine (mercury). Dr. Bacon, a gen. tleman practising at Cape Mcsurado, the Americau settlement on this coast, remarked to me that the disease is of frequent occurrence there, accompanied iu its progress by a low type of typhoid fever; hut this I have never observed in any of the cases which have come under my notice. Dr. Winterbottom observes, that the slaves from the Bight of Benin are the most subject to it, and that it prevails much among the Foulalis. I have observed it also equally to pre¬ vail among several other tribes inbauit- ingvparts of the continent far inland. I have chiefly seeu it among the liberated Africans, of whom there arc sometimes from 400 to 500 at one time in the hospital under my charge; aud I have been informed that several cases have occurred even among the Creole in¬ habitants. Case I.—On the 7th April, 1839, Mary Coker, aet. 14, an apprentice from Waterloo Village, a native of Benin, was admitted to hospital. States that about three months ago she was attacked by sleepy dropsy, (country name), or lethargus, for which she was treated by the natives, but without mitigation or the slightest allevia¬ tion of the symptoms. She is of a stout plethoric habit of body ; general appear¬ ance that of an individual roused from sleep, the face and eyes being: devoid of animation—almost of expression ; wears a besotted look; the skin is dry, and above natural temperature; pulse 108, and small; bowels costive; tongue clean about tip, but towards root und in middle coated with a greyish fur: during the day she continues drowsv, and will fall asleep while taking food. pk Emplast. Vesieator. 7x4 inches. Apply from occipital protuberance along the spine: R Ext. ColocynthComp.; Submur. ITy- drarg. aa. gr. xij. Divide in pil. No. vj. One every two hours until the bowels are freely opened. 8th.—Bowels open ; alvine evacuations natural; during night she removed the blister; it had partially risen ; skin cooler. Re-apply blister. R Calomel Dj.; Pulv. Ipecac, gr. x.; Opii. gr. ij. M. Divide in pil. No. vj. One of the pills every three hours. April 9th. — Blister has risen well; bowels open once; a lumbricus about eight inches long discharged ; the urine is secreted sparingly in qunutity and is higldy coloured; docs not however coagulate on application of heat; skin of natural tem¬ perature. 10th.—The mouth has become affected with the mineral; her bowels have been twice opened; micturated once in the space of30 hours: the same lethargy oppresses and weighs down both her physical and Intellectual faculties : pulse 94, small and quiet. Let the mouth be gargled with pk Soiut. Chlorid. Sod®, Ji.; Aqu® font, 3xv. M. Fiat solutio. 11th.—No change. 12th.—Considerable amendment in np. pearance, which is more lively than since her admission; bowels havo been severely purged; appetito good; but it being de¬ sirable to keep up a brisk action from tho intestinal tube, I gave R, Aloes Socot., Ext. Colocynth. comp, aa. gr. xij.; Calomel, gr. xij. M,