Nervous and mental diseases / by Archibald Church and Frederick Peterson. With 338 illustrations.
- Church, Archibald, 1861-1952
- Date:
- 1903
Licence: Public Domain Mark
Credit: Nervous and mental diseases / by Archibald Church and Frederick Peterson. With 338 illustrations. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![occasionally present and ini])ly cortical irritation. The pulse may be slow and respiratory difficulty present. At first the rectal tempera- ture is reduced, but returns to the normal and rapidly mounts as death approaches. This takes place, as a rule, in from a few hours to a few days. Rare cases have endured a week, and still rarer ones survived. The diagnosis of intrapial hemorrhage is difficult. It closely resem- bles cerebral hemorrhage, cerebral thrombosis, and the hemorrhage arising from pachymeningitis interna. The chief symptoms on which reliance is to be placed are the rapidity of onset and the quickly increasing symp- toms without paralysis and convulsions. An internal pachymeningitis usually presents a significant history of headaches, and occurs in a lim- ited class of patients with gross degenerations. The differential features of cerebral hemorrhage and softening are tabulated in Part III. The outlook is extremely grave and death is almost certain to ter- minate the case. In these days of aseptic cranial surgery an exploratory opening is allowable, and furnishes practically the sole means of con- trolling the hemorrhage and saving the patient. CHAPTER II. INFLAMMATION OF THE PIA MATER. Leptomeningitis, acute cerebral meningitis, cerebrospinal meningitis, purulent meningitis, inflammation of the soft cerebral coverings, is an acute, sometimes epidemic disease of a heteroinfectious character, con- sisting of inflammation of the pia mater and marked by an irregular clinical course. It is not uncommon in systematic works to divide leptomeningitis into numerous varieties, such as simple, serous, purulent, primary, sec- ondary, idiopathic, epidemic, tubercular, basilar, etc. From an etiological and anatomical standpoint this is not required, but epidemic cerebrospinal meningitis will, in the general description, receive such special remark as seems required. Tubercular meningitis, however, is clinically, etio- logically, and anatomically a distinct disease, and will be accorded a separate section. Etiology.—The pial structures can be invaded in but two ways : by traumatic or destructive lesions of the bony and fibrous envelopes of the brain on the one hand, or through the vascular supply on the other. To the first group belong those cases of meningitis arising from direct in- oculation, as in cranial fracture and septic extension from neighboring foci in the scalp, face, cranial bones, the middle ear, the mastoid cells, the nasal fossae, antra, and sinuses, and from the orbit and pharynx. To the second group belong the larger number, which, formerly called idiopathic, are now known to depend on microbic infection. The](https://iiif.wellcomecollection.org/image/b21225953_0079.jp2/full/800%2C/0/default.jpg)
