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.

    54/540 (page 54)
    rature, and the pulse is irregular and ranges from 110 to 120. Tlie tentli day finds him much worse; his excited condition being supplanted by one of stupidity. lie does not recognize those in the room, and is utterly indifferent to the kind attentions of his mother or nurse. WJien the finger is drawn across the skin it leaves a vivid red mark, which has been considered one of the strong pathognomonic signs. The pulse is greatly accelerated, and perhaps reaches 170, while the temperature maybe found to be 104° or 105°. His condition during the tenth and eleventh days is very little changed, though the apathy is if anything exaggerated. Tlie belly is retracted, and hisfacies is highly characteristic, the patient having a worn and pinched look. The skin is dark and congested, and his eyes may be fixed and immobile, and there may be either strabismus or a rolling upwards of both eyeballs, so that a large part of the sclerotic is exposed. Subsultus tendinum and picking at the bedclothes, Avith involuntary passage of feces and urine, are grave forerunners of a fatal ter- mination. Tlie pupils are dilated, the pulse small, thready, and quick, and respiration is very slow. The temperature is still high, though the surface may be cold and clammy, and just before death the pulse cpiickens and becomes almost imperceptible. Slight rigidity now becomes apparent, the patient cannot swallow, stertor follows, and then death. Marshall Hall' tersely describes this last stage as follows : The third stage is denoted by coma and its concomitant diminution of the sentient and volun- tary system, and eventually of the powers of the excito-motory system. There are blindness, deafness, deep stupor, absence of voluntary motion. At first the eyelids are constantly half closed, but still close completely on touching the eyelash. Afterwards this excito-motory phenomenon ceases. The respiration becomes irregular, alternately suspended and sighing, and at length stertorous. The sphincters lose tlieir power, and the feces and urine are passed unconsciously. The appearance of the little patient just before death, is unmistakable. He lies with knit brow and flushed face, one side of which is drawn, while the eyes are fixed and glassy, and utterly devoid of expression. The duration of the disease rarely exceeds twenty-four days. It will be well to dwell more fully upon certain symptoms. Temperature There seems to be at first an elevation of temperature, which lasts through the first few days, say three or four, and after this time the temperature falls, until the sixteenth or eighteenth day, when it may either go much lower, or be again increased. The variations are between the normal standard 98.2°, and 105°. It however rarely reaches this high point. The sur- face temperature of the body is much diminished during the latter stages, but the head is always hot. Pulse.—Infrequent and irregular pulse is characteristic of the earlier stages of this disease, and during the last days there is increased frequency and more evenness. During the first two weeks this infrequency is to be observed, but after this it may steadily increase ten, twenty, or thirty beats more each day until at last it cannot ' Op. cit., p. 93