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limbs. Abdomen not particularly retracted, and walls flaccid.
third ribs rather toneless, and respiration high-pitched, but COMMENTARIES ON DISEASE
vocal resonance not increased. Elsewhere chest seems healthy.
At 9 a.m., temperature 102.2°; pulse 116 ; respirations 28. At
7 p.m., temperature 102:4°; pulse 152; respirations 24.
10th (sixth day).—More comatose, and quieter; screams less Physician to H.M. the King of the Belgians,
frequently ; lies with eyes half open and expression rather Physician to the East London Children's Hospital,
stupid than spiteful, but still is not completely insensible, for Assistant-Physician to the Victoria-park Hospital for Diseases of the Chest. complains if disturbed. Face paler. Pupils nearly equal, and
of moderate size; some internal squint of left eye. Bowels LECTUBE VI.-ACUTE TUBERCULOSIS (Continued)— TUBERCULAR
still confined ; passes water in the bed. The nurse states that MENINGITIS (ACUTE HYDROCEPHALUS).
he has been rather convulsed, his limbs and eyes "working."
Muscles generally flaccid, but still stiffness at back of neck, and (Continued from page 556, vol. 1.)
some rigidity about right knee-joint. 9 a.m.: Temperature The following case furnishes a very good example of an 102° ; pulse 130, regular, but weaker; respirations 26, irregular ordinary attack of acute hydrocephalus, and it is especially both in depth and frequency. 7 p.m.: Temperature 102° ; interesting from the fact that the patient was under observa- pulse 116 ; respirations 30. tion for some time previous to the beginning of the first definite 11th (seventh day).—Quiet ; has ceased screaming ; seems symptoms of the disease.
less stupefied; has spoken distinctly, and takes drink without William G., aged four years, was admitted into the East difficulty. Pupils act well with light; generally unequal. London Children's Hospital, under the care of my colleague Dr. Belly rather distended; bowels very confined. 9 a.m. : TemBruce, on December 4. He had been a healthy boy until a perature 103.2°; pulse 116, regular; respirations 30, sighing; month before admission. At that time he had an attack of 7 p.m.: Temperature 102.6o. measles, and on the disappearance of the eruption he did not 12th (eighth day).--Coma deeper ; face flushed and perthoroughly recover. The child seemed ailing; he coughed spiring. Ophthalmia of both eyes; pupils unequal. Irregular occasionally, and was a little feverish. He slept well, however, spasmodic movements of limbs, especially right arm and left and had a good appetite; his bowels were regular, and he did leg. 9a.m: Temperature 101.8°; pulse 112, regular ; respiranot notably lose flesh.
tions 40, very irregular. 7 p.m. : Temperature 103°. On admission he was found to be suffering from pulmonary 13th (ninth day).-Lying as if asleep; right cheek flushed. catarrh, and the percussion-note was thought to be a little Pupils equal, large, contract with light. When eyelids are high-pitched at the right apex, with some hollow quality of touched he opens both eyes and makes a moaning sound, but breathing there and at the left side, but nothing very definite was appears quite unconscious, although he is stated to have said discovered. For a few days the evening temperature was 100°, "no" in answer to a question from his mother. Sighs frequently. but on December 10 it became natural, and remained so until Bowels relieved last night by injection. Same stiffness about the 17th, when the child was sent as convalescent into the knee-joints. Large bubbling rhonchus heard about chest. country. On December 30, however, he was sent back to the 9 a.m.: Temperature 101.6°; pulse 116, irregular in force, hospital as not improving, and for the five following days he regular in rhythm ; respirations 40, excessively irregular. was noticed to be quiet and silent. He seemed unusually 7 p.m.: Temperature 102-4°. In afternoon had a fit in which drowsy, and his appetite began to fail. The bowels were not the right side of face alone was convulsed. confined, but acted two or three times in the day. During 14th (tenth day).-State much the same. Coma seems these five days his evening temperature was successively deeper. Rigidity of extensor muscles of leg. Moans occasion100•4°, 98-4', 98°, 99•6°, and 97:6°; and on this last evening ally. Ulceration of left cornea. 9 a.m. : Temperature 103.2°; (January 4) the pulse, which had been always over 100, pulse 128 ; respirations 44. 7 p.m.: Temperature 103.6°; was found to have fallen to 74 and to be irregular. On 15th (eleventh day).-Sinking. Face covered with large the next morning (January 5) he vomited, and his bowels drops of sweat. Abdomen more retracted than before. Rebecame confined. The temperature in the morning was 99•4°; spirations very irregular and laborious, 68; pulse excessively pulse 72, intermittent; respirations 36, irregular ; temperature rapid and weak; temperature 9 a.m. 104-4°, 3 p.m. 105.8°, in evening, 101.6°. These invasion symptoms marked the first 6 p.m. 106'. Patient died at 11 p.m. day of the established disease. The vomiting on this and the On examination of the body the pia mater was found much following day was very troublesome; he retched frequently, injected at the base of the brain, and contained numerous but with little effect. He was very drowsy, dozing and small grey granulations; corpus callosum much softened. waking up from time to time with a scream. There was no
Lateral ventricles contained a large quantity of fluid, and the squinting, and the pupils were equal.
convolutions were flattened. The lungs contained patches of January 6 (second day).–9 a.m.: Temperature 100-2°; collapse and a few caseous nodules, but no grey granulations pulse 62, very intermittent; respirations 18. 6 p.m.: Tem- were found in them or in any of the other organs. The perature 100°; pulse 78; respirations 26.
bronchial glands were enlarged and cheesy. 7th (third day).–Very stupid, but answers intelligently if The preceding description represents a typical case of acute roused. Occasionally gives a short angry cry, and then lies hydrocephalus, in which the brain symptoms are the first local quiet. Conjunctivæ injected, and transient internal squint of phenomena to occur in the general disease. It is then called both eyes. Pupils equal, and act naturally. Belly not much primary tubercular meningitis to distinguish it from cases retracted. 9 a.m.: Temperature 100·6°; pulse 80; respira- where the grey granulation is more generally diffused over the tions 22.6 p.m.: Temperature 101.2'.
body, and where the symptoms arising from the cranial cavity 8th (fourth day).-Dulness increases, but he still can be occur subsequently to others proceeding from the chest or the made to answer intelligently. He passes his water, however, abdomen. In this the secondary form of the disease, the in the bed. Bowels acted to-day (first time for forty-eight symptoms of the earlier stages are usually masked by the hours) after a purgative followed by an injection, and a large more prominent symptoms emanating from the organs preascaris lumbricoides came away with the stool. Face rather viously attacked. In such cases the first manifestation drawing flushed, but tâche cérébral not well marked. 9 a.m.: Tem- attention to the brain may be a violent convulsive fit, a perature 101°; pulse 84, still intermittent; respirations 28, paralytic lesion, or other sign indicative of the third stage of still irregular and sighing. 6 p.m.: Temperature 102° ; pulse the disease ; and it is not uncommon for acute tuberculosis 96 ; respirations 40.
with severe chest symptoms to be brought to a sudden close 9th (fifth day).--Lies with eyelids half closed, apparently by this complication. asleep; contracts brows, and every few minutes gives a pecu- John W., aged sixteen months, the illegitimate child of a liar squeal; expression of face spiteful; cheeks flushed, but consumptive mother, was said to have been healthy up to the not much redness produced by irritation of the skin; nares age of six months, when he was attacked with sickness and acting, but not with each breath ; squints slightly with left diarrhæa, which lasted eight weeks. After this, however, he eye, and left pupil is larger than right. When called by name seemed to recover, and remained pretty well until the beginning opens eyes, but does not appear to understand question. of May, when he began to cough, and his breathing seemed Respirations 16, with frequent pauses and occasional deep oppressed. After some time these symptoms improved, and sighs; pulse 160, regular in force and rhythm. Decided the child appeared, according to the mother's account, to be rigidity of muscles at back of neck, but none of muscles of going on well, when, on June 9, he had a fit which lasted a
VOL. II. 1874. No. 1253.