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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    gitis the jiciitc! mental disliirbancc is not so immediate. Acute meningitis runs its course usually in a week. Various intracranial diseases may resemble at different times the disease under consideration ; but as I propose to treat of these hereafter, it will be well to omit them here. F. ]£xhaustion—The excitement that has been lately aroused in Eng- land by the Penge case giives this part of the subject decided importance. It will be remembered that one Louis Staunton, with two accomplices, one of whom was his brother, and tlie other a woman with whom lie was living upon terms of criminal intimacy, starved to death his wife, and that they all narrowly escaped capital punishment or transportation. Tlie coroner's jury decided that the real cause of her death was starvation, while several dis- tinguished medical men contended that siie had died from tubercular menin- gitis, but did not deny that she had been neglected. The disputed points seemed to be, the rapid emaciation and great antemia of the tissues, as Avell as disappearance of subcutaneous fat. Her symptoms before death were drowsiness, passing into coma, stertor, rigidity of one arm, and inequality of pupils. These symptoms appeared but shortly before death, and were supposed by Dr. Greenfield,^ who made a most sensible and convincing communication to the Lancet, not to account for starvation alone, but to be probably due to tubercular meningitis. Opposed to him are several observers (among them Virchow, who re- viewed the English testimony), who held that the great emaciation, loss of weight of the internal organs, emptiness of the cavities of the heart, and certain forms of congestion were clearly indicative of starvation. Green- field proves, I think, that none of these appearances were sufiScient in themselves for us to say definitely that they were due to starvation ; tliat they may often be a result of exhausting disease; that the congestion wit- nessed was an ordinary post-mortem appearance; and finally that tubercle existed in the lungs and brain; while in the latter there were found pri- mary indications of softening as well as adhesion of the meninges. Gee calls attention to forms of wasting disease with profound emaciation which may closely simulate tubercular meningitis, but are connected with digestive derangements and malnutrition; and Sir Wm. Gull, in one of the English hospital reports, brought forward several cases of hysterical anorexia; and in the profound form of cerebral anajmia there can be symp- toms which may resemble some of those expressed in tubercular meningitis so greatly, as to possibly lead to an error in diagnosis. Treatment More can be done for the patient in the early stages tluin at any other time. Cod-liver oil, phosphorus (F. 37), a nitrogenous diet, and preparations of iodine are all of great service. The syrup of the iodide of iron (F. 42) is an excellent remedy in the earliest stage, if we recognize the significance of the somewhat irregular group of symptoms. The iodide of potassium has been by many used during later stages. ' London Lancet, Oct. 6, 1877.