Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa.

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    states which produce rapid loss of consciousness, or sudden paral- ysis. Not to mention epilepsy,—the phenomena of which we shall further on contrast with those of apoplexy, and shall observe to differ chiefly in the prominence of the convulsions; or meningitis, —in which fever, headache, and other signs of an acute cerebral disease precede insensibility; or a tumor,—which, save in the rarest instances, leads only very gradually to a comatose condition; or sun-stroke,—belonging to the same group as cerebral hemor- rhage, yet presenting points of contrast, which will shortly engage our attention,—we find, excluding concussion and compression as belonging more strictly to surgical diagnosis, these morbid states liable to be mistaken for apoplexy: Insensibility feom Drink, or from Narcotic Poisons; Uraemia ; Syncope ; Asphyxia ; Acute Softening; Sudden Extensive Paralysis ; Obstructions of the Cerebral Arteries; Protracted Sleep; Cerebral Hysteria ; Aphasia. Insensibility from Drink, or from Narcotic Poisons.—Both these conditions are sometimes very difficult to distinguish from the coma of apoplexy; and if we are not cognizant of the circum- stances preceding their development, we have only these points to guide us: in intoxication there is a strong smell of whisky, gin, or whatever liquor has produced it, emanating from the mouth (a point which would be conclusive were it not that apoplexy may come on in the drunken state), and the man, although unconscious, is not often entirely bereft of all power of motion,—he is certainly not paralyzed. Moreover, the pulse is not slow, it is frequent; the pupils are generally dilated; the eye is injected, shows no lateral deviation; and the symptoms become suddenly much ame- liorated after the inhalation of ammonia, or after the stomach has been emptied of its contents. In narcotic poisoning, especially if from opium, the pupils are very much contracted, and we are likely to encounter repeated vomiting, and a gradual intensification of the coma. The patient, however, unless death be close at hand,