Joseph Mortimer-Granville
1880 The Lancet  
947 scope shows atrophy of discs after neuritis. Smell, taste, and hearing not appreciably affected, and common sensibility seems good in all parts of the body. Speech drawling, or low and whining at times, but when playing with other children she talks quite freely. Moves both arms equally well; dropping of both wrists, especially of right. Grasp of hands fair and equal. Manages to sit up in bed with very slight assistance, but is not very firm when in that position, and seems unable to
more » ... her head. (The nurse says that in dressing or moving the patient about she falls more to the left than to the right side.) Able to move both legs when lying. Is unable to stand by herself; her legs collapse under her at once. No rigidity, except of ankle-joints, which require force to be fully flexed. Feet usually occupy position of talipes equino-varus, but can be put by pressure into natural position. No ankle clonus. No vomiting ; appetite good ; bowels regular; heart and lungs apparently healthy. Temperature normal. Oct. 22nd.-No vomiting ; no pain in thigh since admission ; occasional pains in back of neck. Nov. 19th.—Vomited once ; pain in neck and thigh (the left), relieved by rubbing. Not the slightest power of standing. If held moves legs as though for walking, but does so on her toes. Right leg seems weaker than the left. Very doubtful if she sees at all. Appetite very good. Seems rather more cheerful, but on the whole no distinct improvement since admission. (Had been taking from Sept. 6th on to Nov. 9th one drachm of cod-liver oil night and morning, and the following mixture :-Seven grains of iodide of potassium, half a drachm of solution of bichloride of mercury, ten minims of compound tincture of lavender, and half an ounce of infusion of calumba, three times a day. On the latter date, as her gums were a little red and tender, the solution of bichloride of mercury was omitted. The iodide of potassium was taken regularly till Dec. 10th, and then discontinued.) Jan. 17th, 1879.—Has not been sick since last note. Occasional pains in neck, especially when moved. No pain in thighs or elsewhere. Is totally blind. During the last six weeks head has been increasing in size (very gradually). Its circumference measures twenty-three inches. It is pearshaped with the large end posteriorly, the maximum breadth being in the hinder part of the parietal region. The sagittal and the coronal sutures have slightly opened, and the anterior fontanelle can be easily distinguished. Feb. 17th.—Very irritable of late ; drowsy ; frequently wishes to be moved. Complains of pains in the legs, especially the right. Frequent desire to micturate. Some incontinence of urine and faeces. She is utterly helpless, lies on back with hands turned up on her chest. Wrists drop equallv, and to marked extent. Uses hands feebly to nurse her doll, left more than right. Legs straight down, anklejoint fully extended; some inversion of feet. (On Feb. 10th circumference of head was twenty-three inches and a quarter.) March 20th.-No change except that for some time she has not complained of pain anywhere. Position as before. Appetite exceedingly good. Sleeps well. Answers slowly but correctly, usually in a whining tone, a marked interval between each word. Iodide of potassium mixture again resumed after a long interval, in which citrate of iron and salines had been taken. On March 29th circumference of head was twenty-three inches and a half. April 14th.—Vomited after breakfast this morning. No retching. Was as usual afterwards. 18th.—Pains in head all day. No sickness. Cried much and would not eat. Circumference of head still twentythree inches and a half. 20th.-Spoke to resident medical officer as usual in the morning, saying she was " very well." Pupils equal. Afterwards became very drowsy. At 3 P.M. convulsions commenced, at first very slight, but gradually increasing in severity.-;.30 P.M. : Face flushed; pupils unequal, the left being much contracted; oscillation of eyeballs, especially right; much dyspnoea ; breathes rapidly four or five times, then holds her breath, during which her left hand is con. vulsed ; at ocher times almost tetanic rigidity of both arms ; wrist flexed to right angle and fingers turned into palm oi hand; both legs stiff, ankles extended; feet almost in straight line with legs, soles slightly turned in; is restless and extremely distressed; answers when spoken to in the slow manner previously described; swallows well.-5.30 P.M. Unconscious; eyes wide open; convulsive movements gradu. ally becoming more extensive; both arms now affected; legs apparently not convulsed; pupils still unequal, rather more so than previously, left contracted almost to pin-point size; face slightly cyanosed; breathing stertorous, shorter and more rapid. -6.15 P.M.: Breathing slower and getting gradually shallower; spasm of limbs relaxed; no convulsions ; face pale; eyes wide open till death, at 7 P.M. CASE 2.-B. was about five-and-thirty years of age, but prematurely old. He had ample means for his personal requirements as a bachelor, and good expectations, but no settled or earnest purpose in life. He was educated without any view to personal activity, and, though a man of excellent parts, had never achieved permanent success in any enterprise, because, on his own confession, he lacked a motive to prosecute any undertaking beyond the point at which it chanced to become irksome or ceased to inspire interest. He was a lounger in life, less from idleness than from what he and his friends believed to be a "constitutional" " inability to engage in any serious occupation, unless impelled by impulse, or excited by some strong liking for the special enterprise ; he was emotional and enthusiastic, but of late had lost all zest for existence, and, after a career of somewhat refined dissipation, he had become moody, and fears were entertained for his sanity, so jaded was he mentally and physically, and so completely had he ceased to feel, or show himself capable of the ordinary exertions which even a life of pleasure in society demands. He had been recommended "change," and had spent two years in dragging a weary round of the too familiar centres of fashionable social activity, without benefit. Indeed, he reported himself rather the worse than the better for being incessantly on the move. It seemed to have added restlessness to his previous ennui, and unless something was done for his amendment his friends feared, and he himself at times appeared to apprehend, a disastrous ending. There was no indication of physical disease, and no complaining except of insufferable mindweariness and an oppressive powerlessness to find relief or satisfaction in anything. A fastidious appetite would seem to have been the last source of daily excitement, but even that was beginning to lose its influence as a mental stimulant. He had not even the energy to be an epicure.
doi:10.1016/s0140-6736(02)31696-9 fatcat:bcysbjznrvhpfkflac3ncprhte