On the pathology and treatment of delirium and coma : the Lumleian lectures for 1850 / by R.B. Todd.
- Date:
- 1850
Licence: Public Domain Mark
Credit: On the pathology and treatment of delirium and coma : the Lumleian lectures for 1850 / by R.B. Todd. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
60/72 page 60
![vory irritable stoinacli, and could not take stimidaiita ; and slio had an abscess in one of tho upper eyelids, in the case of a young lady whom [ attended in the spring, along witli Mr. Eowman, with seTcrc ery- sipelas, there were no sccoudaiy abscesses ; sliewas treated by brandy and nourishment I’rom the beginning; and I could emime- mte several otlicr instances in winch this desirable result followed the stimulating treatment. Now and then it will happen that an erysipelatous patient will rapidly become comatose, and die in spite of all oui’ reme- dies. There was a man in Sutherland ward a short time ago, alfected with eiysipelas, who appeared going on veiy weU for some time, but suddenly he became comatose, and died, and we could not make out any reason for his death. The only reasonable explanation that I can offer of the sudden change for the worse wliich sometimes oceurs in these cases, is derived from the weU-known tendency they have to form pus, wliich, accumulating at some point, may find its way through the ulcerated coats of some small vein, and thus enter the circulation, producing coma and com- plete prostration. I shall eonclude this leeture by referring to two eases as examples ; the one to show the rapidly fatal influence of the poison of erysipelas, and that the extent of the cuta- neous affection bears no relation to the effects of the poison on the system; the other to illustrate the good effects of an early stimulant treatment. The first case is that of a man named CoUins, ait. 27, who was admitted into the hospital about three weeks ago. He had always been temperate in his habits, and enjoyed good health, with the exception of an attack of erysipelas two years previously. On the 28th of April he noticed a small pimple on his nose, wliich mcreased rapidly in size, and on the first of May, having been exposed to cold, he was seized with shivering. He entered the hospital on the 3d of May. The inflammation had spread on the nose and great part of the face and the eyelids, but not so as to close the eyes. He was ordered five grains of carbonate of ammonia evei’y three hom's. On the 4th he was evidently much lower; several pus- tules fidl of pus had formed upon the nose; but the erysipelas had not spread. Brandy was ordered to be given freely, and chloric tether added to the annnonia. That night, however, he began to breathe quickly, and became comatose, and died on the fom’th day from the rigor. It is very probable that had stimulants been administered fi’om the first in large quantities, this pa- tient might have been saved. I confess tliat wlicn T first saw liim T was not im- pressed witli liis bring in so low a state. Upon examination we could find no evi- dence of inflammation or of any other mor- bid state of tlie membranes of tlie brain ; but there w'erc recent adhesions on tho right side ol tho chest, and, as commonly happens, tliere were signs of recent inflam- mation of the mucous membrane of the bronchial tubes. This case shows you Iiow rapidly a man may be knocked down by a large dose of the poison, although tlie ex- ternal signs by which the disease is distin- guished may be very slight. Tho second case to wliich I shall refer is that of Jones, set. 44, wliich terminated favourably, although m some degree placed under less favourable circumstances than tho former. Tliis man’s habits w'ere intemperate. When admitted, he had very extensive ery- sipelas of the head and face; the eyehds were closed; the tongue dry and brmvn. Tills was on Saturday, the 27tli of April. He was immediately ordered cliloric setlier; beef-tea, two pints, and brandy, two ounces per diem. On the 28th and 29th no material change had taken place. The brandy was increased to six ounces on the former day. April 30.—On the evening of the 29th he became extremely restless and delirious, and it was with great difficulty that the nurse and some of the convalescent patients m the ward could keep huii iif bed. His allowance of brandy was doubled, half an ounce to be taken every hour, and half a drachm of cldoric aether eveiy two lioiu’s. The next day (May 1) it was reported that the pulse had fallen to 92 from 100, and that the delu’ium had ceased. On the 2d of May he was reported to have ]iassed a very good night without any opiate, and was perfectly rational. The pulse had fallen to 76 : this was a most favourable sign. It is especially auspicious when the pulse falls in frequency while the patient is taking stunulants. Urom this time tliis patient recovered rapidly, without the ocem’rence of any ^ purident deposits. This case shows how, by increasing the amount of stimidants, you may subdue ac- tive dehrium and shorten convalescence ; for on the 4th of May this patient was well enough to eat meat. The attack began on the 27th of April, so that in seven days he passed tlu’ough the various stages of a severe attack of erysipelas, and became con- valescent. At our next meeting I propose to con- sider the treatment of the delirium of typhus fever, and the delirium of hysteria and of epilepsy.](https://iiif.wellcomecollection.org/image/b21955566_0062.jp2/full/800%2C/0/default.jpg)
