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

  • Clarke, Robert.
Date:
1840
Catalogue details

Licence: Public Domain Mark

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

    4/6 (page 972)
    072 Divide in pil. No. vi. One every three hours.—Continue the wash for the znoulh. 14tb.—Vast quantities of faces have been discharged by stool, dark coloured, highly offensive, and stringy, as if from the tenacity of intermixed bile. During the night she was buried in the most profound sleep. Pulse 112, small and quick ; tongue much loaded at base; the secretion from kidneys sparing, and on application of heat n film of albuminous-like coagula floated on surface: about abdomen, particularly in epigastric region, there is some disten¬ sion as if from flatus: appetite good. p, Bitart. Potass®. 3i.; Aquas font. Ibij. M Ad libitum. To discontinue pills, and the bowels to be kept kept open with R Sulph. Magn. Jij.j Aquas font. Ibij. M. A wine-glassful every four or fiva hours until the bowels are opened. 16th.—Bowels freely open ; says she feels less inclination to sleep: about half a pint of slightly turbid urine passed in the course of the 24 hours. 18th.—Pulse 120, quick but small; ap¬ petite good; tongue clean round the edges and at tip, but base covered with grey sordes; hcrgencral appearance more lively than on previous days. 19th.—Bowels open, but evacuations sticky: during day she walks about the yard and ward, occasionally con versing with girls of her own age, but more frequently moves about without noticing surrounding objects. She has never been observed to laugh since her admission, and often drops asleep after very slight exertion. Urine sparingly secreted. She has continued to use the Solut. Bitart. Potass®, and as a purgative a solutiou of Sulph. Mag. Continue wash for mouth. The diet to consist of soup with arrow root, or well boiled sago and a small quantity of wine. 20th.—Several lumbrici, from eight to nine inches in length, were found in alvinc evacuations. R 01. Ricini. Terebinth. aa.Jss.; Sp. Piment, Ji. M. Statim sumend. 21st.—She is greatly emaciated ; bowels well opened by the medicine; pulse 118, small and quick. ■ P> Sulph. Quinin®, gr. vi.; Infos. Quas¬ si®, 5iij.; Sp.Vin.Rcct.5i. M. A wine-glassful three times a day. The mouth and gums being still tender and spongy, continue wash for mouth. 22d.—A Iumbricus came away this morn¬ ing. The irresistible disposition to sleep cannot be better described than by noticing the fact of her dozing at the moment I was noting her case, although aroused the mo¬ ment before to put some questions to her. The urine is still secreted very sparingly. R 01. Terebinth. 3i.; Sol. Gum. Arabic, 31- M. Statim sumend. 26th.—On the 23d she passed a lumbri. cus ; the bowels have been opened two or three times daily: tongue clean at tip and round edges, but towards the root loaded with greyish coating: pulse 100, small and quick: no improvement of lethargic symp. toms. When dozing I have repeatedly held a candle close to the eye, the pupil remaining fixed and staring. About cpi. gastrium there is distension, but no sense of pain is experienced on pressure: call to pass urine is seldom oftener than three times in the course of 36 hours. P> Emp. Lytt® to epigastric region. —Continue Infus. Quassi® c. Sulph, Quinin®. To be used as formerly. Her strength to be supported with light nourishing food. 27th.—She appears better. At the same time during the night she attends to tho calls of nature, while formerly they fre- quently passed involuntarily. Quantity of urine is now very, considerably increased, amounting toeleven ounces in three hours, 28th.—Has removed blister from abdo. men; appears lively. The bowels to bo kept open by p, Submur. Hydrarg. Ext. Colocynth. comp. aa. gr. iv. M. Divide in pil. No. ij. One to be taken immediately, and the other six hours thereafter,'if the bowels are not previously acted upon. Let the blister be reapplied. 29th.—Blister has risen well; pulse small, 116. Continue Infus. Quassi® c. Sulph. Quinin. May 2d.—Alvine evacuations more na¬ tural : the feet and legs slightly nedematmis. P> Liniment. Sapon. 3'j- The feet and legs to be embrocated, and to bo then bandaged from toes to knees. 4lb.— General appearance bad: alrine evacuations bilious, mixed with frothy- like mucus; quantities of undigested food contained therein; drowsiness evidently on the increase. 5th.—To-day she was asleep when 1 gntered the ward. On light bciug brought close to pupil it remained uncontractcd. 6th.—No change. 7th.—Pulse full, 106: breath is highly foetid: general aspect improved» hn«, however, slight dyspnoea, attended with cough, and complains of pain under left breast. On applying the car to chest the respiratory murmur was distinctly errpi- tous: feeling of hardness about epigastrium has disappeared. MR. CLARKE ON LETHARGUS. 973 p. Emplast. Lytt®. 4 X 4 to chest. R. Tinct. Camph. Comp.,Jiv.; Antim. Tart., gr. ij.; Aqu® Font,,3viii. M. A table spoonful every three hours. 8th.—To day the blister has risen well: she appears, however,aveak. No expecto¬ ration; breath extremely fetid; pulse 100. 9th.—Before visiting hour wns told by matron that she was dying. At 7 a.it. she expired. Autopsia, two and a half hours after death.— Body not much emaciated. Head t Arach¬ noid membrane thickened, firm, and opaque. Substance of brain, when cut into, was closely dotted over with blood¬ vessels. About one dram of serum present in lateral ventricles, and at base of brain half an ounce of same fluid was effused. Thorax: Some effusion between pleura of right side, which was thickened and highly vascular. Lung of same side had a dark and florid aspect: a gangrenously feetid and melanotic-like, fluid covered a great portion of inferior and middle lobes: the inferior lobes slightly adhered to dia¬ phragm. A pretty copious secretion of puru¬ lent matter, intolerably offensive, has j poured out on that portion of diaphragm I‘ where adhesion existed, which being re¬ moved it was found roughened. Corre¬ sponding surface, to the extent of an inch and a half, was of a dark colour, evidently ) from infiltration and inflammation. Heart: Heart of natural size: on laying open its cavities large portions of coagulated lymph were found filling up the ventricles and passing into arterial tubes. There was considerable deposition of fat on parictes. Abdomen : Peritoneum pulpy, and crowded with small blood vessels holding florid blood. Omentum contracted, having a considerable accumulation of adipose tissue. Stomach at its greatest curviture had a blush of redness. A Iumbricus* was found in cavity measuring eleven inches in length. The contents of upper portions of intestines were dark coloured and femi- fluid: f®cal matters of similar colour were found in colon. Patches of ulcera¬ tion were discovered in both great and small portions of tube. Lumbrici, varying from two and a half to eleven inches in length, occupied the canal, and were situated both in duodenum, ileum, and colon. Liver: Gall bladder green exter¬ nally, and impacted with very green ropy bile, otherwise healthy. Weight of liver two pounds two ounces. Kidneys: Kidneys healthy. Coats of bladder thickened and contracted. On laying open the spinal canal a good deal of blood was found dilTused at inferior cervical and dorsal regions; tho neuri- * These parasitical Intruders were found alive after removal from body. lemma of cord had a ycllowlsh-like lymph deposited on surface, which appearance could be observed more especially towards its termination. On carefully removing the sheath a beautiful network of vessels was seen ramified throughout tho whole length of cord. Case 11.—Sara, a fine intelligent and lively boy, ®tat. 10, a native of the Soosoo Nation, was received into hospital on the 17th of April, 1839, from on board the Portuguese schooner, “ Labrador,” a fleeted with glandular swellings of both sides of neck, for which he was treated with iodine ointment, to which treatment they yielded. Bowels regulated by gentle purgatives. A few weeks thereafter he began to lose flesh, his appetite at same time declining. On the 2nd of May lie was first observed to drop asleep while eating: on being roused he was seized with a universal tremor, the motions of his head resembling the symptoms produced by inebriation, the eyes bloodshot, pupils staring, look meagre and emaciated. Bowels costive, tongue white and loaded, pulse 84, skin below natural temperature. Applicentur Hirud., No. xxx. tem- poribus. Bleeding to be encouraged us much as possible by flannel cloths dipped in warm water, then wrung, and applied as hot as possible, which are to be renewed at intervals. p!> Spir. Yini.Rcct.giij-, Aqu® Font. lb.ij. The head to be kept constantly wetted by means of pledgets moistened with the lotion. Jh Emplast. Yesicator. from occipital protuberance along the spine. f Pulv. Jalap®, gr. x., Calomel, gr. iv. M. Statim sumend. These active measures, with repeated large doses of oil of turpentine (which certainly brought several worms away) conjoined, and the production of saliva¬ tion, with the occasional use of the sulphate of quinine, combined with infusion of qunssin, alleviated, although they failed to arrest, the progress of the malady, which terminated fatally on the 2nd of Juno. Post mortem Examination two hours after' death.— Body much emaciated. Head: Skull cap with great difficulty torn from dura mater, to which it firmly adhered round the coronn: about four ouuces of blood, mixed with serous fluid, escaped on its removal: tho skull itself appeared more than usually dense: minute injection of the arachnoid membrane; great engorge¬ ment of the vessels distributed over the convolutions; grey substance of brain of a rather paler colour than natural; choroid plexus pale: serosity between the convo¬ lutions. The ganglions of grey subslance, corpora striata, and optic thalami, were