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.

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    seiits a miiiiber of ciiscs of licmiplcgiii wlii(;li were tlie ultimate i-osult of the, meningeal inflammation, and calls attention to tiie pain wiiieli ])re- cedes the hemiplegia, and which is always produced wiien pressure is made upon the cranium. A feature of the hemiplegia is the absence of any loss of consciousness. A form of syphilitic pachymeningitis may follow external syphilitic dis- ease of the cranial bones. I may illustrate the features of sucli an attack by the following case, reported by Dr. Jas. R. Wood: Marie C, aged 20, was admitted to Bellevue Hospital, Jan. 7th, on ac- count of an eruption of two weeks'duration, wiiicli had steadily progressed from a few points until it had become general, being most profuse on the face, neck, arms, and scalp. Tiie eruption presented a distinct coppery hue, and was of two varieties. There w^ere three rupitic phlegma on tiie head, each of wliich contained a little pus, and three or four on the shoulders and back of the same cha- racter. Tlie rest were tubercular. She stated tliat, though often exposed, she had never suffered from jn-i- mary syphilis, but that there was a sore on her thigh, near the vulva, which appeared two weeks before the eruption. On examination, a simple chancre was found at the point complained of; there was also a chancre of limited extent in the vagina. Soon after admission she Avas observed to have a shuffling gait, and when questioned about it stated tliat her riglit arm and leg seemed to be getting weak. The treatment consisted in the use of the corrosive chloride of mercury in Huxham's tincture of bark, combined with generous diet. Tiie eruption on the scalp was left undisturbed. Tlie quantity of pus contained in each point was quite small, and it was deemed best to let them alone. One of them situated over tlie parietal bone of the left side was sometliing larger tlum its fellows; none of them, liowever, increased in size materially. There was very little improvement in the eruption, but the hemiplegia steadily increased. Her appetite became poor, she began to have vomiting, and exliibited a cachectic appearance. The bichloride was necessarily discontinued, and mercurial vajjorization substituted. The hemiplegia became more complete, and her mind began to be ob- scured. Tlie stu]iidity gradually deepened into profound coma, in winch condition she died on the 30th. Autopsi/ Tliere was a denudation of the parietal bone of the left side of the periosteum, at a point corresponding Avith the rupitic spot above spoken of. On removing the calvarium, the dura mater was found inflamed and firmly adlierent to the skull, just beneath the denuded spot on the parietal bone and the eruption. A small opening was found communicating between them, perforating the cranial walls, and looking very much like a worm-hole. Tiie brain at a point corresponding with the inflamed dura mater pre- sented a greenish appearance. There was also an evident fulness and fluctuation. On making an in- cision an abscess was discovered which contained about giij of pus. The other organs were healthy.