Cases and Notes from Hospital and Private Practice
BMJ (Clinical Research Edition)
Physician to the East Suffolk and Ipswich Hospital. (Continued from page 732 of last volume.) CASE VI. SPINAL MENINGITIS; RECOVERY. T. C., aged 9, came under my care in conjunction with that of his usual medical attendant, June 7th, 1845. The previous history of this patient was extremely limited and unsatisfactory; all that could be elicitd from his friends was, that he had accidentally fallen into a cellar, nine months previously, from whicb, however, he perfectly recovered, and had since
... , and had since been at school and in good health. His present attack, which had commenced two or three weeks prior to my seeing him, appeared to indicate chiefly a deranged state of the digestive organs, with nervous irritability, accompanied by erratic pains in the trunk and ex. tremities. His countenance is now anxious, and indicative of great distress;-pulse 85; tongue clean; complete anorexia; bowels obstinately confined; evacuations fcetid and unhealthy; urine contains a copious deposit of lithate of ammonia. Complains of pain over the entire cardiac region, greatly increased by pressure; impulse of the heart abrupt; giving rise to a sound slightly resembling the crackling of parchment. (I was unable to detect this sound after the first examnination, the action of the heart baving become less irritable.) Ordered a blister over the heart; saline medicine; and three grains of mercury with chalk, every six hours. Jutne 9th. The pain has entirely left the heart, and is now located with equal severity in the tbroat, which -part he grasps with considerable firmness; there is pain also excited by pressure on the abdomen. On examining the spine, great pain was found to obtain on pressure over the lower cervical and upper dorsal rvertebrae. Eight leeches to be applied to the spine. To take two grains of calomel every four hours. 11th. Pain has left the throat, amd is again situated over the heart; pulse 90; respiration performed 'irregularly, and with frequent deeply drawp sighs; bowels remain obstinately confined; aperient medicine taken without effect; refuses food. Continue the calomel. One drachm of strong mer-,curial ointment to be rubbed into the axilla night and cnorning. 15th. Remains much in the same state; pulse 100, No. 1, January 7, 1846. small and irritable; pressure on the chest and abdomen excites considerable pain; gums not affected by the mercury. Calomel to be continued every two hours. 19th. Sighing continues; pulse 108; positively refuses to take food; has swallowed only a little cold water, and a small quantity of beer; bowels once relieved; evacutions dark and very fetid. Coutinuie the calomel every two hours. 21st. Has to day taken a very small quantity of broth ; in other respects the same. Continue the calomel and inunction. 25th. Has been much depressed, and thought to be dying; gums swollen; mercurial fetor evident; pulse 98; eyes closed; pupils dilated, scarcely sensible to light; continued jactitation of the fore-arm; bowels have not been relieved, neither has he taken food since the 21st. Blister to the nape of the neck; calomel night and morning; injection of strong beef-tea every four hours. 28tb. Mercurial action continues, with slight ptyalism; has been much convulsed; eyes closed; pupils less dilated; complains of great pain over the heart and epigastrinm; bowels once moved; evacuation dark, very fetid, and unhealthy; pulse 100, of moderate strength; no food taken by the mouth. Injections to be oontinued. July 3rd. Thve exhibition of the injections now produces so *nuch apparent pain and distress that they bave been discontinued; has taken a small quantity of lemonade; eyes half closed; tetanic rigidity of the muscles of the neck; head drawn back, and resting on the occiput; mouth open, which he has not the power of closing. Neck to be enveloped in lint, saturated with warm laudanum. 5th. Mouth now closed; muscles of the neck less rigid; is still at times much convulsed; emaciation extreme; great general sensitiveness of surface; suffers apparently acute pain in the neck; pulse 110; has tken a small quantity of milk; mercurial action continues. 7th. Bowels relieved; evacuations still dark and foetid; again refuses food. 14tlh. Has taken no food since the 7th; neither have the bowels been relieved; emaciated to the utmost possible extent. 17th. Has requested to have some cherries, of which he ate two pounds in the coune of the day. 19th. Better; boels have been three times relieved; has eaten a small piece of mutton.