A text-book of medicine : for students and practitioners / by Adolf Strümpell.

  • Adolph Strümpell
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell. Source: Wellcome Collection.

    41/1106 (page 15)
    more than doubtful. Nor can the microscopic alterations in the brain, which have been reported, be regarded as important and authoi-itative. It is only in very rare cases that large cerebral haemorrhages or purulent meningitis have been found. As to this last, we should always be very cautious in making a diag- nosis, as symptoms which would seem to be most conclusively meningeal—such as stiffness of the neck, rigidity of the whole spinal column, and occipital head- ache—may appear in typhoid patients, and yet the autopsy show no trace of meningitis. One theory, which lias Liebermeister for its chief supporter, and which has won a tolerably wide-spread acceptance among physicians, is that the nervous symptoms are chiefly a direct result of the febrile temperature. It is impossible, however, for us to regard this view as universally true. The unprejudiced con- sideration of a large number of personal observations prevents it. Although it is undeniable that elevated temperature has a harmful influence on the nervous sys- tem, yet in numerous cases there is no relation between the height of the fever and the severity of the nervous derangements. There are cases in which the fever remains continuously high for days, while the palient feels perfectly comfortable and i>resents no symptoms of any important cerebi-al disturbance. The opposite class of cases is still more numerous, in which from the very start thei'e is always a low temperature, and, notwithstanding, the most severe nervous symptoms arise. Fräntzel has published very striking cases of this sort. Hence we nmst seek for some other special cause of the severe nervous symp- toms, and according to our present views this cause must be the intoxication re- sulting from the specific infection. We know that all bacteria produce, by their own tissue-metamorphosis and the chemical processes which they excite in their neighborhood, cei'tain cliemical matters which, especially in the case of the so-called pathogenic bacteria, seem to he similar to the alkaloids ( ptomaines and toxines'), and exercise a decided poisonous influence upon the body, and especially upon the nervous system. These ]iioducts are formed by the typhoid bacilli, enter the blood, and are the chief cause of the nervous phenomena. The difference in the violence of the latter in ditt'erent cases prol>al)]y depends mainly on a difference in the amount, and perhaps also in the quality, of the toxines produced by the typhoid bacilli, and probably also in the different susceptibility of individuals to the poison. The reason that the influence of these poisons is not much greater than it is, is that they are in part destroyed within the body and in part excreted with great rapidity, the channel of exit being mainly the kidneys. Thus is exi)lained the interesting fact discovered by Lepine, Bouchard, and others, that the urine of typhoid patients possesses poisonous properties not present in normal urine. That the appearance of the nervous symptoms is dependent not only on the material causes, but also on the susceptibility of the individual, is shown by the fact that certain patients are especially prone to exhibit marked nervous phe- nomena; for example, hard drinkers, nervous ' individuals, and also those who have suftered violent emotional disturbances shoi-tly before the onset of the disease. Actual insanity is not very infrequent during the course of typhoid, or in con- valescence. It generally takes the form of melancholia. We have repeatedly seen patients in such a state that they would lie almost motionless in bed, with eyes open, and perhaps assert that they were dead! In other cases there is mental excitement, sometimes combined with hallucinations, or there is confu- sion of ideas. In one case, in a girl who was evidently predis])osed to nervous dis- orders, we s^ typical hysterical insanity break out during the fever. Sometimes the mental excitement at the beginning of a relapse terminates in actual insanity.