Nervous diseases : their description and treatment / by Allan McLane Hamilton.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Nervous diseases : their description and treatment / by Allan McLane Hamilton. 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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    31 CHRONIC PACHYMENINGITIS. A for more interestin;? class of cases are tliose wliicli have lasted for some time, liave invaded the underlyiirg membranes, ending in involve- ment of the cortex cerebri. The following is a fair example :— Symptoms John McM., age 30, of temperate habits. The patient ■was a young man of the laboring class, and was employed in a machine- shop at the time of the accident. Three years ago, while turning a piece of metal, it caught upon the end of his turning tool and flew out of the lathe (Avhich was driven by steam-power), striking his head, and cutting a scalp wound over the upper part of the right parietal bone. He fell un- conscious, and was caiTied to his home, remaining in the same state for about eight hours. After this he recovered slowly, -was delirious, and evi- dently had had convulsions. From this period to the time when I saw him his history was not very clear, but he had had convulsive paroxysms from time to time, and severe headache, which he complained of when he came for advice. This pain was limited to the right side of the head, and prin- ci])ally centered at the injured spot. His face was quite puffed and swollen, and his eyes were red and watery. Pressure upon the cicatrix caused intense pain. His right pupil was slightly enlarged, and he com- plained that his vision was imperfect. Sleep was disturbed by the pain which would often occur in paroxysms of a very intense character. He complained that his left arm felt stiff, and that his fingers were cold, but I was unable to find any loss of power. He continued in this state for a year or more, and when I next saw him his speech had become slow and hesitating, and his face wore rather a silly expression. He then com- plained of some feebleness of the left arm and leg. The headache had not abated, and the convulsions had been much more frequent. His friend who came with him stated that his mind had greatly clianged, that his be- havior was eccentric, and that he had had delusions of various kinds. I subsequently lost sight of him. In some features this case resembles one of softening. This form of chronic pachymeningitis is much more obscure when it is connected with syphilis. There is not only a great dispropor- tion between the severity of the symptoms and the extent of the morbid process, but symptoms of great variety may be evinced as expressions of pachymeningitis of syphilitic origin.^ Lagneau fils reports a case in which this inconsistency was shown. The only symptom was headache, which was most violent at night. Post-mortem examination revealed pachy- meningitis over the anterior lobes of the cerebrum, with bony plates and some sclerosis of the brain-substance. There Avas, in addition, extensive perforation of the ethmoid bone. Instances are related by Gama where the patients had died conscious, and their meninges were found to be de- cidedly affected. Keyes,^ in a most complete and exhaustive memoir, pre- ' Trans. N. Y. Path. See, vol. i. p. 1.3. ^ Observation 3, Lagneau, Maladies syphilitiqucs du Systfemo nerv^eux. Paris 18G0. Syphilis of the Nervous System. Now York, 1870.