On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown.

  • Knaggs, Robert Lawford.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Dr. F. L. Mackenzie, who was called in to see the patient' somewhere about this time, has kindly supplied us with the follow- ing notes of his condition. On January 9, 1889, he saw the patient for the first time, and “ found him in an extremely weak and emaciated condition. He lay on his right side, his eyes half open, and without any other characteristic facial condition. He was coiled up, his head being flexed upon his chest, and both thighs acutely flexed on the abdomen. When shouted at, or shaken somewhat roughly, he responded with a howl and again became quiescent. There was no evidence of hemiplegia. The emaciation was so extreme that unilateral wasting could hardly have been detected. His pupils were equal, aud only slightly responded to light. The conjunctival reflex was very imperfect, and so was the knee tendon reflex.” “ Urine and faeces were- passed in bed. Bespiration was regular, and not indicative of cerebral disease. P. 120, small. Temperature 97.8.” “In the- course of a week the patient began to move in bed, and take more nourishment.”1 By the middle of April, his general condition was- greatly improved, and he was moderately intelligent, but “ as movement of the limbs* returned, evidence of hemiplegia showed itself—flattening of the left lip, slight contracture of the left hand, and flexion of the left leg ” (which last was corrected by exten- sion). The condition of spastic paralysis, which the arm pre- sented on admission, gradually developed, the flexion being first noted at the wrist, and then at the elbow. During the eight months the patient was in bed, he had no fits, but shortly after getting up he had one, in which he is stated to have squinted and worked the left side. These fits continued with increasing frequency till his admission. Dr. Mackenzie was again consulted on September 7, 1889, and describes “ attacks of sudden jerking, especially of the left leg ”—“ a sudden clonic spasm sometimes causing the patient to fall.” “ There was no loss of consciousness, no aura and no drowsiness after the attack.” At first, these attacks occurred two or three times a week, but they practically disappeared under treatment by the end of November. In March, 1891, Dr. Mackenzie saw the boy again for “ similar attacks affecting the upper extremity more markedly than formerly.” They occurred now as often as two or three times a day, and treatment had no effect upon them. With the increase in number of the fits, the loss of power on the left side became more marked, and for 18 months previous to 1 Mercury was given during this period, and its value seems to have been very marked.