March 6th.-Pills purge; in other respects the same. Let a grain of opium be joined with the calomel night and morning. March 8th. Still passes evacuations in bed; takes food with more desire; pulse feeble; ulcers have been discovered between the toes of both feet. Continue. March 13th-Much vomiting of a greenish fluid, streaked with blood; belly regular; urines freely; but still, from obstinacy, the nurse says, will not make known her wants; sleeps ill; refuses food: apply a blister to the head. Continue the medicines, and repeat the wine as before March 15th.-Mortification has taken place in the toes; debility increasing; countenance somewhat collapsed; pulse very feeble; takes very little nourishment; dyspnea; evacuations passed as before. Continue the medicines, wine increased to half a pint daily. March 17th.-Mortification extending; much vomiting; ammonia gr. x. camphor gr. vj. opium gr. in a bolus, every three hours, with a mixture of decoction of cinchona, and the extract of rhatany root. March 18th.-Cannot take the medicine; countenance sunk; much fetor from the body. Continue the wine. March 21st.-Died this morning. SECTIO CADAVERIS. On exposure of the cranium, the blood-vessels appeared slightly turgid; the cranium was particularly thick; about two ounces of fluid were confined under the dura mater; no water in the ventricles; the brain appeared natural. The following case of the same disease, although not in the table, may not be thought unworthy of a place here: WILLIAM WOOD, æt. 11. came under the care of the reporter, in the hospital, June 11th 1805. Complains of much pain in his head; dimness of vision; but no dilatation of the pupils, or other morbid appearance of the eyes; pain in the stomach and bowels; nausea, and oftentimes vomiting of a greenish fluid; pulse full, quick, about 104; belly open; urines freely. His mother relates, that he has been subject to pain in his head from infancy; but vision was not observed to be affected until within these three months; has not taken any medicines. Two leeches to each temple, and a purgative immediately. June 13th. Pain in the head increased. Repeat the purgative, and take the pulv. ipecac. comp. gr. v. at bedtime. Leeches and blisters to each June 15th. Pain moderated. temple, and the purgative repeated. June June 17th.-A slight paroxysm of fever. An ounce of a saline mixture every four hours. June 19th.-But little amendment. Electrical sparks were recommended from the temples; the purgative and saline repeated. June 29th.-Somewhat better. Repeat the blisters, and continue the medicines. July 3d.-Pain in the head increased; fever diminished; belly regular; pulse quick and small. Omit the remedies, and take a decoction of cinchona. July 5th.-Much the same. Bark omitted. Dolichos pruriens gr. x. ol. rutæ gutt. j. in a bolus, twice a-day, and the purgative repeated two days after; the boluses nauseated; the dolichos to be exhibited alone; and the purgative as before. July 13th.-Much vomiting; pain in the head augmented; moans in his sleep; pupils dilated; vision defective; belly costive; passed about three quarts of urine in the last 24 hours. Omit the medicines. Pil. hydrar. gr. v. night and morning. July 15th.-Pulse sharp, 76; pain in the head increased. Shave the head, wash it with vinegar and water, and apply a blister to the crown; continue the pills. July 20th.-Blister healed; pain moderated; vision as before; belly regular. Repeat the blister; continue the pills. July 22d.-Much pain in the head; vomiting; restlessness; pulse 100; belly costive; skin hot and dry. A dose of opening mixture immediately; continue the pills; ung. hydrar. fort. 38. to be rubbed in night and morning. July 28th.-More easy; pulse 128; belly costive; repeat the aperient occasionally; and continue the remedies. August 3.-Much pain and beating in the head; pulse 130; belly very open; continue the remedies. Take tinct. digital. (Ph. Ed.) gutt x, three times a-day. August 13th.-Pain in the head is at times very violent; mouth and gums very sore; no ptyalism; belly open; the pulse, since last report, has varied from 100 to 94;-continued the pills, and gutt. xv. of the digitalis for a dose; ung, hydrar. fort. 3i. to be used night and morning. August 17th.-Pain in the head moderated; pulse 88; belly regular. Continue the remedies. August 22d.-Has ejected all his food; pains very violent, and seated in the back of the head; no ptyalism. Continue the pills and tincture; 3iß. of the ointment night and morning. August 24th.-But slight soreness of the mouth; two pills at night, and one in the morning. Continue the tincture and oint ment. August August 26th.-Pulse 104; belly regular; in other respects as before;-two pills night and morning, and 3ii. of the ointment both night and morning. Continue the digitalis. August 28th.-After the visit on the 26th, was suddenly seized with convulsions, which continued about fifteen minutes; the pupils were very much dilated, and at the conclusion he screamed very loud; when recovered, he asked the bystanders if he had been sleeping; pulse 80; head painful; no soreness of mouth. Continue. August 30th.-After the visit on the 28th, he was attacked with a fit similar to the last; much pain in the head; pupils more dilated; pulse 72, intermittent; belly regular; gums sore. Continue the remedies. August 31st.-More lively; some ptyalism. Let a blister be applied to the head, and the remedies continued. September 1st.-Has complained much of his head; shiverings, and convulsive twitching of the extremities; belly regular; pulse 94; ptyalism. Continue the remedies. September 5th.-Ptyalism increased; vertigo and much vomiting; convulsive motions continue; much pain in the head; the frontal bone appears more prominent; pulse, yesterday, 96; to-day, after vomiting, 150; belly regular. Omit the digitalis; continue the pills and ointment ;-let him have nourishing diet, and iv. of port wine daily. September 7th.-Fits return frequently; startings; tremor; screaming; ptyalism complete; belly regular; pulse cannot be reckoned from his restlessness; cannot take his medicine, or bear the ointment. Continue the wine ;-æther sulfur. gutt. xx. tinct. opii. gutt. x. to be taken immediately, and repeated in four hours. September 8th.-Fits return on the least motion; could take only one of his draughts; ptyalism diminished; pulse 80, moderately full. Continue the wine. September 9th.-Died this morning at six, without much expression of pain. SECTIO CADAVERIS. In sawing through the cranium, about three ounces of fluid escaped; the calvaria being removed, the dura mater appeared much collapsed on the right posterior lobe of the cerebrum; on opening the dura mater at that part, a ruptured sac was found in a cavity, formed in the substance of the cerebrum, which, when filled with water, contained about four ounces of fluid; it was separated from the dura mater by the cerebrum, one eighth of an inch in thickness. Each ventricle was distended with about an ounce ounce of fluid; the blood-vessels on the surface of the pia mater were very turgid; the sutures of the cranium were completely closed. On the first admission of this patient, the only symptoms that : might indicate apoplexia hydrocephalica, were pain in the head, and vomiting of a greenish fluid, but these are by no means diagnostic symptoms. It is very difficult, perhaps impossible, to give an infallible diagnostic at the commencement of the disease. Of this the learned and accurate Fothergill was fully aware, when he remarks," it may be sufficient to mention, that, whenever I am called to a patient, in the early stages of this distemper, I proceed in the same manner as if the disease was supposed to arise from worms, or some cause of irritation capable of being removed." And again, "By treating the complaint, however, in the manner above-mentioned, we lose no advantage, we are almost sure to succeed if the case be only worms; but if otherwise, we at least are treating it in the most rational method, increasing all the secretions, and thereby preventing any addition to the extravasated fluid to the utmost in our power +." One symptom usually attending this disease, "pain in the limbs," was absent in this case, nor was the patient constipated, a symptom considered a diagnostic. "Another circumstance is familiar, if not peculiar to this disease; I recollect not one instance, in which the patient was not costive, and in which likewise, it was not without singular difficulty that stools were procured +." The disease in this lad must have been making very gradual progress, previous to his admission, and insidiously advanced to July 13th, when its nature became evident. The difficulty of detecting this malady is noticed by Heberden, in the following sentence: "Neque tamen perpetuum est, ut hæc signa ex hydrope cerebri nascantur; etenim vidi ea omina in puero, cujus cerebrum non nisi consueta humoris copia humectatum erat, testi peritissimo anatomico, qui cadaver inciderat §." The prevalence of dyspepsia, hysteria, gastrodynia, and hypochondriasis, may be attributed to close confinement, bad air, improper food, the habitual use of tobacco, and the abuse of tea, or all these combined. The females are most subject to these diseases, and fall a ready prey to the itinerant quack, or are easily induced by the advice of some officious neighbour to smoke, or to Lettsom's Fothergill, Vol. II. p. 72. Id. p. 73. Id. p. 69. Edinburgh Medical and Surgical Journal, Vol. II. p. 55. to take rum and milk, or other spirits, although the inhabitants are not, by any means, addicted to the abuse of spirits; nor is there a town in England where the lower class are less accustomed to intoxication: consequently, the prevalence of dyspepsia cannot arise here from that habit, which, according to Willan, appears to be the case in London *. The great abuse of tea must be very injurious; it is drank by the lower class regularly twice, and very often three times a-day, and as hot as the stomach can bear it. Whether the noxious effects arise from the warmth of the fluid, or from the herb itself, is a matter at present undecided. Warm water is a powerful stimulus to the stomach, and is recommended with that view in diseases arising from a torpid state of that organ, particularly when the person has been addicted to the abuse of spirits, or to the use of powerful condiments. The smell of the herb in its dried state is said to be very injurious. "Cognovi tres homines qui in exploranda et olifacienda thea occupati, tremoribus atque aliis hypochondriasis malis afflicti sunt, quæ omnia theæ imputarunt; rectne, an secus, viderint alii qui amplioris nacti sunt occasiones perspiciendi quid in hac re verum sit + " In gastrodynia, the oxide of bismuth, as recommended in this country by Dr Marcet ‡, has been exhibited with manifest advantage, in combination with the compound powder of tragacanth, or the gum pill. In two cases, the medicine was intentionally omitted during the progress of the cure, when the pain returned with its former violence, and was again removed by its exhibition. It may be considered almost unnecessary to remark, that it is useful only where a feeble pulse indicates a want of tone in the stomach. The use of this medicine in five cases would not be sufficient proof of its efficacy, were it not confirmed by the cases Dr Bardsley had presented us, in which its curative power was distinctly evinced §. Mons. Leroux, one of the editors of the Journal de Médecine, after noticing Dr Marcet's paper on the oxide of bismuth in gastrodynia, adds, "Il a deja été parlé dans ce journal des effets du magistere ou oxide blanc de bismuth. Je l'ai depuis employé chez un assez grand nombre de malades, et le plus souvent avec succés; mais j'ai été obligé d'en porter le dose beaucoup plus haut qu'il n'est indiqué dans l'article qu'on vient de lire. J'en ai quelquefois donne chaque jour jusqu'à trente grains divisés en trois doses, et je n'en ai jamais vu resulter d'inconvenient. Ce medicament * Reports, p. 148. Heberden, Com. Morb. p. 201. Memoirs of the London Medical Society, Vol. V. |