.89, 122, 162 126 Dandruff.. 345, 367, 413 .262, 420 Epilepsy. .162, 417 ..38, 39, 127, 169, 257, 268, 376, 380 .5, 113, 170, 210, 390, 474 THE MEDICAL BRIEF, A MONTHLY JOURNAL OF PRACTICAL MEDICINE. J. J. LAWRENCE, A. M., M. D., EDITOR AND PROPRIETOR. · A Peculiar Case of Acute Idiopathic morning, a period of nearly twenty-four Meningitis. On Monday, October 3, 1887, at 1 P. M., I was hurriedly summoned to see M. L., a bright, intelligent boy of eight years, and found him presenting the following symptoms: High fever, pulse quick and hard, cheeks flushed, eyes brilliant, pupils contracted, grinding of the teeth, subsultus tendinum, expression wild, intelligence disordered, failing to recognize any one, refusing to answer questions or replying incoherently, and extreme restlessness. The parents informed me that on the morning of the day before (Sunday) he had been apparently in perfect health, had eaten a hearty breakfast, and gone to Sunday-school as usual. On his return he acted "yawny" and "stretchy," as if having a chill, although the day was pleasant, and, when questioned, complained of a slight headache. As he had been subject to occasional socalled "bilious attacks," with chill and fever, it was taken for granted to be something of the kind, and no uneasiness was felt. That opinion was further strengthened by his vomiting presently a large amount of bilious matter. He was therefore put to bed, covered up warmly, and a reasonable dose of quinine administered "to break up the chill." From that time on until Monday hours, he slept soundly, breathing somewhat heavily, but, to all appearances, naturally. Every hour or two he would rouse up, vomit bilious-looking matter, and immediately relapse into slumber. On Monday morning he appeared to be brighter and better, although somewhat listless, ate breakfast very sparingly, but was apparently free from fever. During the forenoon the fever reappeared, increased rapidly, and by noon the disordered intelligence and other symptoms caused the parents to suspect something more than a mere "bilious attack." Mr. L., one of those careful fathers who watch every ailment of their children, a habit intensified by some sad experiences in his family, came hurriedly after me, informing me that he was convinced that his little son was alarmingly ill and desiring my immediate attendance. The symptoms, previously described, pointed strongly to some trouble in the brain, but I hoped that perhaps the extreme height of the fever might furnish a sufficient explanation, and that upon its subsidence the alarming cerebral symptoms would disappear. As convulsions appeared imminent, I immediately ordered a hot bath, cold to the head, and prescribed one drop tinct. aconite and five grains brom. potass., hourly, until I saw him again. At 3 P. M., two hours later, he was resting more quietly, and the fever had decreased, although the head still remained very hot, eyes unnaturally bright, and cheeks flushed. At 6 P. M. the fever had still further de creased, the thermometer registering 102°, but all the other symptoms were exaggerated; pulse quicker and harder, eyes wild and brilliant, pupils variable, restlessness extreme, sensorium still more disordered, grinding of the teeth and subsultus more marked. There could be no room for doubt now, and I reluctantly admitted that my little patient was the subject of acute idiopathic meningitis, with the usual grave prognosis. From this time on, the alarming symptoms increased with amazing rapidity. Trismus was so marked, the teeth shutting with such tetanic force, that all attempts to give medicine by the mouth had to be virtually abandoned. Four grains of calomel were, however, successfully administered, wet cups freely applied to the nucha and down the spine, ice-bags to the head, sinapisms and bottles of hot water to the extremities. At 10 P. M. the patient seemed in extremis; the pulse at the wrist was 180, thready, irregular, and, at times, extinct; temperature 101°, respiration 46; dome of the head hot, but face pale and shrunken, pupils dilating and contracting irregularly, irresponsive to light, intelligence obliterated, trismus, symptoms of paralysis on left side, subsultus, extremities cold. Doctors Eddy and Brockman were called in consultation and after a careful examination confirmed the diagnosis. It was decided that no more active treatment than was being pursued was justifiable under the circumstances, and that no internal medication would ward off what seemed an inevitably fatal result. All agreed that a case pursuing such a rapid course, and lacking some of the diagnostic features, such as severe headache, was most unusual, but that there could be no doubt of the correctness of the diagnosis. At midnight the attending physicians withdrew, with instructions to continue the ice to the head and the heat and sinapisms to the extremities. The condition of the patient be came gradually worse, if such a thing were possible, and death was momentarily expected until 3 A. M., when the calomel acted freely and a trifling reaction was manifested. At 7 A. M., the pulse was 160, thready, but distinct, temperature 102; pupils dilated but more responsive to light, eyes brilliant, expression wild, slight evidences of intelligence, seemed to hear when spoken to somewhat loudly, could swallow with difficulty. Fifteen drops fluid extract of ergot and two drops fluid extract of calabar bean were ordered every two hours, together with one grain of calomel at the intermediate hour. By night the pulse had dropped to 140, temperature 102; subsultus and grinding of the teeth not so prominent, but delirium and restlessness increased. Ordered medicine discontinued during the night and prescribed chloral and bromide of potass. to procure sleep. From this time onward he gradually improved, the symptoms occasionally exhibiting stationary and even relapsing tendencies of a few hours duration, but a perceptible gain being manifest each twenty-four hours. By the sixth day I considered him out of danger. The treatment was steadily and faithfully maintained until all untoward symptoms had disappeared. The apartment was darkened and kept absolutely quiet. Bags of ice were constantly applied to the head night and day, and hot water bottles to the extremitles. Nourishment was given in as large quantities as the stomach would tolerate, at regular and frequent intervals. The ergot and calabar bean were administered steadily until the former seemed to produce nausea, when the iodide and bromide of potass. were substituted for a few doses, the ergot being resumed as soon as possible. Grain doses of calomel were also exhibited several times daily, not alone for its purgative and derivative effects, but for its supposed action upon inflammatory processes and products. Whenever the temperature increased, drop doses of aconite were ordered to be added to the other remedies until a reduction took place. Generally two or three doses accomplished that result. Restlessness, delirium and sleeplessness were controlled with chloral hydrat. Consciousness returned on the fourth |