Nervous diseases : their description and treatment / by Allan McLane Hamilton.

  • Allan McLane Hamilton
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Nervous diseases : their description and treatment / by Allan McLane Hamilton. Source: Wellcome Collection.

    37/540 (page 37)
    CHRONIC PACriYMENlNQITIS. 31 CHRONIC PACHYMENINGITIS. A far moi'e interesting class of cases are those which have lasted for some time, have invaded the underlying membranes, ending in involve- ment of the cortex cerebri. Tlic following is a fair example :— Symptoms John ]\IcM., age 30, of temperate habits. Tlie patient wits a young man of the laboring class, and was employed in a macliine- shop at the time of the accident. Three years ago, while turning a piece of metal, it caught upon the end of his turning tool and flew out of the lathe (which was driven by steam-power), striking his head, and cutting a scalp Avound over the upper part of the right parietal bone. He fell un- conscious, and was carried to his home, remaining in the same state for about eight hours. After this he recovered slowly, was delirious, and evi- dently had had convulsions. From this period to the time when I saw him his history was not very clear, but he had had convulsive paroxysms from time to time, and severe headache, which he complained of when he came for advice. This pain was limited to the right side of the head, and prin- cipally centered at the injured spot. His face was quite putFed and swollen, and his eyes were red and watery. Pressure upon the cicatrix caused intense pain. His right pupil was slightly enlarged, and he com- plained that his vision was imperfect. Sleep was disturbed by the pain which would often occur in paroxysms of a very intense character. He complained that his left arm felt stiff, and that his fingers were cold, but I was unable to find any loss of power. He continued in this state for a year or more, and when I next saw him his speech had become slow and hesitating, and his face wore rather a silly expression. He then com- plained of some feebleness of the left arm and leg. The headache had not abated, and the convulsions had been much m07-e frequent. His fi-iend who came with him stated that his mind liad greatly changed, that his be- havior was eccentric, and that he had had delusions of various kinds. I subsequently lost sight of him. In some features this case resembles one of softening. This form of chronic pachymeningitis is much more obscure when it is connected with syphilis. There is not only a great dispropor- tion between the severity of the symptoms and the extent of the morbid process, but symptoms of great variety may be evinced as expressions of pachymeningitis of syphilitic origin.^ Lagneau fils= reports a case in which this inconsistency was shown. The only symptom Avas headache, which was most violent at night. Post-mortem examination revealed pachy- meningitis over the anterior lobes of the cerebrum, with bony plates and some sclerosis of tlie brain-substance. There was, in addition, extensive perforation of the ethmoid bone. Instances are related by Gama where the {(atients had died conscious, and their meninges were found to be de- cidedly affected. Keyes,' in a most complete and exhaustive memoir, pre- ' Trans. X. Y. Path. Soc., vol. i. p. 1,3. ' Ofwervation 3, Lagneau, ilaladics Hj-philitiques du Systfemc nerveux. Paris, 1860. ' Syphilis of the Nervous System. New York, 1870.