The clinique medicale, or, Reports of medical cases / by G. Andral ; condensed and translated, with observations extracted from the writings of the most distinguished medical authors, by D. Spillan.

  • Spillan D. (Daniel), -1854.
Date:
1836
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Licence: Public Domain Mark

Credit: The clinique medicale, or, Reports of medical cases / by G. Andral ; condensed and translated, with observations extracted from the writings of the most distinguished medical authors, by D. Spillan. 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.

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    JRemarks.—One could not luive announced from the symptoms during life, that the membranes at the base of the brain were the exclusive seat of the disease, as nearly similar symptoms were observed to exist in cases where the meninges of the upper surface were engaged. MM. Parent du Chatelet, and Martinet have given coma as the distinguishing characteristic of meningitis of the base. But this symptom has been observed in cases where the meninges of the convexity were affected. The absence of headach could not be accounted for by the seat of the affection, as the same absence was observed where the membrane of the convexity was the seat of inflammation. Neither can the contraction of the pupils be converted into a sign, as in diseases precisely similar, both in their seat and apparent nature, the pupils have been observed sometimes considerably dilated, sometimes strongly contracted, and sometimes in the natural state; and occasionally contracted on one side and dilated on the other. Acute meningitis is very rarely observed to accelerate the death of phthisical patients. Some of them, to be sure, become delirious a little before death; but no lesion of the brain or its membranes has been detected to account for this symptom. Case 16.—Intense headache with vomiting at first—Tendency to sleep, and disin- clination to move—Gradual establishment of coma—Natural state of the pupils— Purulent infiltration of the pia mater of the base of the cerebmm and cerebellum. A labouring man, of middle age and strong constitution, on entering the hospital complained of nothing but violent headach, which commenced five or six days previous, and was for the first two days aceompanied with a painful vomiting. The temples were the seat of the pain; they seemed as if compressed in a vice; at intervals he felt acute lancinating pains either at the temples or the occiput, and occasionally the back or the neck became so painful that the patient could not move: he then presented all the symptoms of wry-neck—he felt easy only when perfectly at rest; appetite gone; and w.hat he ate, he said, gave him no strength ; since the invasion of the headach had been but once at stool. We saw him first on the 3rd of July, when he presented the following state:—Face pale and dejected ; look quite vacant; eyes very sensible to strong light; intelligence clear; pulse and skin natural. The headache the only important symptom in this case; ^bleeding to sixteen ounces; sinapisms ta legs; purgative lavement); the blood formed into a soft coagulum, with little serum, and no buff. 4th July. He complained aloud of the violent pain of head ; he fancied his skull beaten in as it were with a hammer. Still his forehead was cool, and his face paler than the day before; the pupils, intellect, circulation, natural. Thus the bleeding produced no diminution of the headach.—(a second bleeding). On the 5th thirty leeches were applied to the neck. On the 6th headach less ; but he answers questions with ditticulty; he lies on his back and remains motionless, and resembles a person ping to sleep, or whose eyelids are struggling against sleep. He still retains his intelligence, but appears to use it in spite of him; countenance very pale; features rawn, and as it were fatigued. (Two blisters to the legs.) On the 7th he ap- pears m a profound sleep, will not answer questions; when bid he puts out his thaflfelni' pinched he shows Uiat he still retains all his sensibility; pupils sensible to light; pulse sixty; heat apnearsnortn h Profound coma; he refuses to open his eyes, and Su'd fill sensibility still comnleto lose ^ extremities). On the 10th. Coma still; fmns of re l 1 li?rT 1/f’ °‘’>'‘’^‘ding this annihilation of the func- natural On the f ! ‘^’Pe^^ture of skin, and respiration, tils verv mult ale 1 ^^^Pi^'^tion appeared affected' some: just made seemed *^i ’ •^''nes so slow that the respiratory movement just made, seemed not likely to be succeeded by another. On the 13th. Respi-
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