Observations on the disease lethargus : with cases and pathology / by Robert Clarke.

  • Clarke, Robert.
Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the disease lethargus : with cases and pathology / by Robert Clarke. Source: Wellcome Collection.

    5/6 (page 973)
    softened. In the ventricles n small quan¬ tity of iluid was present: the principal arteries at base were enlarged and turgid. Thorax: A good deal of serum was found between pleura on opening thorax: the inferior lobe of left lung was found to cohere to superior surface of diaphragm to the extent of a half crown piece, where a yellowish exudation was abundantly poured out, and which was discovered to exist in considerable quantity about root of lung. Surface of lung was rose-co¬ loured, from excessive congestion; on being cut into a reddish-like iluid oozed from every part. Right lung was also much engorged; pericardium collapsed; heart much loaded with fatty deposit, but of natural size. Abdomen: Stomach highly vascular between its great curvature and pylorus: intestines presented very consi¬ derable traces of inflammation in some points; spleen slightly enlarged; several lumbrici were present in small intestines; liver healthy; gall bladder filled with dnrk green bile ; peritoneum exceedingly vascular; cortical substance of kidneys highly injected. On sawing and chiselling out the ver¬ tical column to its termination, a consi¬ derable quantity of blood was found effused over cervical and dorsal aspects. Blood¬ vessels filled with blood were seen every¬ where minified in an exceedingly beautiful congeries of network over structure of cord. Case III.—John Silver, a liberated African of the Ackoo Tribe, *tat. 14, was sent to hospital on the 9th June, 1839, affected with' lcthargus, by which he was first attacked about three months previous to admission. When seen by me he lay upon his back in a state of stupor; pulse 90 and full: on application of light to pupil it remained uncontracted: on being roused he articulates with difficulty: he complained that he felt pain at lumbar sacral junction; expression of countenance stupid and vacant; the eye is bloodshot nnd listless; bowels open; tongue moist, clean at tip, but at base covered with green sordes; respiration natural; skin of natural temperature; slight rigidity of muscles of arm, accompanied by spas¬ modic motion of tiie lingers, with occa¬ sional slight jactitatory motion of the body;. feet cold; says he passed several lumbrici prior to admission ; states that he has not made water for mauy hours previous to admission. Applicetur Cucurbitula to portion of spine complained of. Head to bo shaved, and then apply thereto, so as to cover the scalp— p, Emplast. Lytt* G x4. Pulv. Jalap*, gr. x., Calomel, gr. v. M. Fiat Pulv. No. i. statiin snmend. Let his strength be »up. ported with thin soup, arrow r.*.t. and ngiddu, to which lie is oxtremrlt partial. Vespcre.—In the same profound com*. Pulse 104, and full; skill hot; nicdnntr has not operated. Flannel cloths to l>c immersed in boiling water and applied to feet nnd around ankles; but nltliough the application had the immediate effect of rousing him, the relief was not permanent. The skin was slightly vesicated by the high temperature. p, OI. Terebinth. Jj., Mucil. Gum Arabic. M. Fiat haustus. Statiui sumend. June 10th—During the night lie lay on his back, from which posture he did not move. Blister applied to head lias risen well; seven lumbrici, varying in length from four and three quarters to clcrcu inches, were evacuated: the faeces were of a dark green colour, being intermixed with a considerable quantity of mucus; in the course of twelve hours Jv. of uriiie of a very high colour was passed; pain in back gone; complains of pain about loft tfo- chanter major, where there is some slight swelling. P> Submur. Ilydrarg., 3i., Pulv. Opii., gr. iss. M. Divide in Pil. No. rj. One of the pills every hour. p, Tinct. Sapon., gi. Embrotation to thigh. Vespere.—Pulse 120, nnd full ; skin hot; %\v. of urine of a pale yellow colour passed in the course of eight hours : during the day he would occasionally awake nnd converse with boys of the same age in the ward. R Subcarb. Potass*, 3ij,; Mist. Cam. phor. §ij.; Antim. Tart. gr. ij.; Aq. Font.Jviij. M. Fiatmistura; cujus snmat cochleare magnum qnAquc tertik hork. The skin to be sponged with vinegar and water; pledgets, moistened with water, to lie constantly applied to head; bottles of warm water to feet, 11th. — Pulse 80 ; skin cool; tongue clean at tip, but loaded with a grey fur towards base; gums swollen and tender; countenance mild; articulates with diffi¬ culty, but returns appropriate answers to interpreter; appetite improved; docs nut complain of pain; respiration natural. On applying car to chest, the action of heart was violent, the impulse being ex¬ tended over a considerable portion. Pills to be discontinued. R Solut. Chlorid. Sod*, Jj.; Aqu* Font. Jxv. M. Fiat Solutio, with which the mouth is to be repented!) gargled. A largo blister to the calf of each leg. The application of cold water to tho head to be persevered in. Cold water also to be poured on the head from a tea kettle. Continue Mist. Diaplwr. 12th.—— Pulse 120; skin bedewed with a copious perspiration ; blisters have risen well. At the evening visit the countenance was natural, nnd more lively: during the day he ate some fish, which he appeared to relish. 13tli.— Makes no complaint; pulse natural and soft; tongue white and moist; extremities cold. Apply bottles of warm water to feet; cold application to head to be con¬ tinued; discontinue Mist. Diaphor. 14th. — Skin cool; pulse, although quick, is regular ; bowels costive. R OI. Terebinth. 5i*! Mucil. Gum Arabic, ^ss. M. Fiat haustus. 15th.— Bowels open ; evacuated several lumbrici: the discharge consisted of pure bile : the bedding lias a urinous smell, from the involuntary discharge of urine. 16th.—Urine and f*ees passed involun¬ tarily; wine ordered ad libitum, but lie continued to sink, and died at 2 o’clock a.m. of the 17th. Post-mortem examination Jive hours after death.—Emaciation considerable. Bead: The calvarium and dura mater being re¬ moved, the blood-vessels passing! between dura mater and brain were found enlarged to the size of a crow’s quill; retiform in¬ jection of the pia mater; a little serosity between membranes. On slicing tlie brain, many bloody points were discovered, closely congregated, both on medullary and cortical substances; investing mem¬ branes of ventricles highly vascular. Nothing particular in the cerebellum. Spinal marrow not examined. Thorax: The lungs were slightly congested, and of a rose colour. Deposited on inner and inferior aspect of left lung there was con¬ siderable effusion of yellowish lymph; heart enlarged, having its walls thickened; fibrinous clots were found in auricular and ventricular cavities; its parietes were loaded with fat. Abdomen: Stomach, at upper curvature, highly vascular; omen¬ tum loaded with fat, having its vessels highly injected with blood; liver, on being cut into, was found turgid with blood ; gall-bladder loaded with dark green bile similar to what had passed by stool; in¬ testinal canal contained the same coloured fluid, with here nud there hardened seybal*; four worms, from four to twelve . inches in length, were also found; spleen of middling consistence, between the state of health and degeneration; blood-vessels of kidneys completely gorged with blood; bladder contracted. Cabe 4.—Thomas Capcrhlll, a Creole boy, *t. 14, was admitted into Hospital on the evening of the Gtb July 1839, affected with the decided and far advanced symp¬ toms of lcthargus. I was informed by the person who brought him to hospital that he was an orphan, his parents having died about six years ago, leaving him to the tender mercies of an individual residing at the village of Wellington, by whom he had been employed to cultivate his farm on the banks of the Quia River, at a dis¬ tance from the residence of his assumed protector. From the same source I learnt that he had been attacked by the disease nbout five weeks prior to admission, and that no remedial means had been em¬ ployed to cheek its progress. When seen by me be lay upon his back' steeped in deep lethargic sleep ; expression of coun¬ tenance fatuous j skin rather hot; pulse small and irregular: tongue (which he had difficulty to protrude) covered at its base with grey sordes; bowels costive; respiration slightly crepitous ; impulse of heart heard over a large space; pupils contracted : articulation indistinct and hesitating; spasmodic rigidity of upper extremities; feet cold. Let the head be immediately shaved, and kept constantly wetted with cold lotion, pouring at intervals a stream of cold water over the head. Blisters to calves of legs. Apply boiling wa¬ ter by means of flannel cloths to feet and round ankles. This application roused him, but the benefit was not permanent. {t.01. Tiglii, gtt. i.; Calomel, gr. iv. M. Mor. sol. Fiat pil. No. i, Stat. sumend. Buttles of hot water to feet and legs. Let his strength be sup¬ ported with arrowroot given at short intervals. July 7th.— Blisters have risen well; bowels open, stools consisting of bard and dark coloured f*ces; reclines on his back; pulse small, weak, and intermitting; urine discharged involuntarily; the skin around feet and ankles is slightly vesicated, the result of application of hot flannel; extre¬ mities cold. Let the feet nnd ankles be dressed with R OI. Lini. Aqu* Calcis. aa. Jiij. M. Continue cold lotion to head. Apply warmth to extremities by means of bottles of hot water. Wine to be al¬ lowed at short intervals. During the night be expired. Post-mortem examination two hours and a half after death.—Head: Skull cap with much difficulty separated from dura mater; a very large portion adhered very firmly to calvarium, so as to be removed along with it. Engorgement of the vessels which ru-