An essay on infantile remittent fever, with especial reference to its diagnosis from hydrocephalus : for which a prize of thirty guineas was awarded by the South London Medical Society, October 1849 / by Charles Taylor, M.R.C.S.

  • Taylor, Charles, M.R.C.S.
Date:
1851
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Licence: Public Domain Mark

Credit: An essay on infantile remittent fever, with especial reference to its diagnosis from hydrocephalus : for which a prize of thirty guineas was awarded by the South London Medical Society, October 1849 / by Charles Taylor, M.R.C.S. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    meut, which he now takes freely. Sometimes, it' drink is taken, and in the erect posture, it will coine forth in a slight stream from the umbilicus. His bowels are open three, four, or five times a day; is only taking the Pulv. Ipec. Gomp. in doses gr. ij. to v., as required. His countenance is ema elated greatly these last few weeks, and is indicative of great distress; he sits in the semi erect posture in bed, liis legs drawn up to the abdomen, which is very tender, and will not allow it to be examined. 28th.—Din-iug the last few days the discharge has almost ceased, the child continuing in the same condition, and with no perceptible change to his parents, except that last evening he would not eat his supper—a most un- usual thing, as he liad been hitherto voi'acious. The nicrht was passed quietly, but without sleep, and about 9 am. he died, the pain in the abdo- men having been more severe the last 36 hours. Autopsy.—29th, 12 a.m., 23 hours after death—Weather hot.—Abdomen not much distended; an increased hardness around the innbilicus ; de- composition advancing rapidly; the ab- domen alone permitted to be examined. By an incision from tlie ensiform cai'tilage to the pubis, not through the umbilicus, but allowing that to remain in an oval form, connected with sub- jacent structure. The peritoneum covering the muscles was univei'sally adherent to that of the intestines, and could only be separated by force and tearing away. There ap- peared a double false membrane— namely, one attached to the peritoneum lining the abdominal walls, and another to the i)eritoneal covering of the intes- tines. Tubercles of the size of a small pea were in a small number on the peritoneal surface of tlie intestines, with etfusion of firm coagulable lympli bind- ing the intestines together. The me- senteric glands were enlai'ged and tuberculated: on cutting them, they were seen softened in the centre. The liver was much enlarged, having tubercles in its substance, and also in its covering, and was firmly adherent to tlie adjoining ])!irts There was eirnsion of letid ]ins gra.- vitating towards lli - lumbar and pelvic regions, and the loft hide of the intos- t' les had some ycUowisli matter on them, similar to the cheesy contents of the tubercles: it did not appear to have a faecal smell. By careful examination we could not discover any opening externally from the umbilicus to the anterior of the in- testines; a probft only passed tln-ough the skin, and the intestines were so matted together that they toi-e on en- deavouring to separate them. Most probably there was some minute open- ing in the intestine which we could not discover. There were some small ulcers of the mucous membrane of the intes- tine. The kidneys were somewhat tubercu- lated, but had no tubercles in them. V. Brain Affection. Of all the diseases with which remit tent fever may be confounded, or of the complications which may arise in its course, brain affection, in whatever de- gree or form it occurs, is the most im- portant, whether we regard it in refer- ence to tlie diagnosis, the treatment, or the probable termination of the case. A. Sympathetic disturbance.—As I have previously rernarked, disturbance of the nervous centres is met with, in the majority of cases, in the mildest cases,—merely as starting in the sleep, talking, and slight delirium; but in younger children, and in the acute form, the disease occasionally commences with an attack of convulsion, as sometimes occurs in the exanthemata (see Case XIX). In the more severe cases, toge- ther with the delirium, stupor ensues; and these require to be detected from the more serious signs of cerebral dis- turbance. In general, there will be no great difficulty in this; for, as Dr. West says, the stupor of fever is so different fi'om the coma which supervenes on brain affection, and the iusensibility which characterizes it is so much less 2)rofound, that one can hardly be mis- taken for the other. The delirium in remittent fever is generally during the night, or, if otherwise, when the pa- roxysm of fever is present: this circum stance, together with the absence of other symptoms, will tend to distinguish this state from more decided signs of inflammation. But at this time the greatest care is necessary in watching the child, especially if there is any family tendency to brain disease; for some- times cases terminate fatally, and little or nothing is found to account for the
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