Mr. Davis discovered signs of inflammation, after death from this disease, to be universal. In eighteen or twenty dissections, he tells us, he found the pia mater always distended with blood[55]. Where signs of inflammation have not occurred, the blood-vessels had probably relieved themselves by the effusion of serum, or the morbid action of the blood-vessels had exceeded that grade of excitement, in which only inflammation can take place. I have seen one case of death from this disease, in which there was not more than a tea-spoonful of water in the ventricles of the brain. Dr. Quin mentions a similar case. Here death was induced by simple excess of excitement. The water which is found in the ventricles of the brain refuses to coagulate by heat, and is always pale in those diseases, in which the serum of the blood, in every other part of the body, is of a yellow colour.
In addition to these facts, in support of the internal dropsy of the brain being the effect of inflammation, I shall mention one more, communicated to me in a letter, dated July 17th, 1795, by my former pupil, Dr. Coxe, while he was prosecuting his studies in London. “It so happened (says my ingenious correspondent), that at the time of my receiving your letter, Dr. Clark was at the hospital. I read to him that part which relates to your success in the treatment of hydrocephalus internus. He was much pleased with it, and mentioned to me a fact which strongly corroborates your idea of its being a primary inflammation of the brain. This fact was, that upon opening, not long since, the head of a child that had died of this disease, he found between three and four ounces of water in the ventricles of the brain; also an inflammatory crust on the optic nerves, as thick as he had ever observed it on the intestines in a state of inflammation. The child lost its sight before it died. The crust accounted in a satisfactory manner for its blindness. Perhaps something similar may always be noticed in the dissections of such as die of this disease, in whom the eyes are much affected.”
Having adopted the theory of this disease, which I have delivered, I resolved upon such a change in my practice as should accord with it. The first remedy indicated by it was
I. Blood-letting. I shall briefly mention the effects of this remedy in a few of the first cases in which I prescribed it.
CASE I.
On the 15th of November, 1790, I was called to visit the daughter of William Webb, aged four years, who was indisposed with a cough, a pain in her bowels, a coma, great sensibility of her eyes to light, costiveness, and a suppression of urine, a slow and irregular, but tense pulse, dilated pupils, but no head-ach. I found, upon inquiry, that she had received a hurt on her head by a fall, about seven weeks before I saw her. From this information, as well as from her symptoms, I had no doubt of the disease being the internal dropsy of the brain. I advised the loss of five ounces of blood, which gave her some relief. The blood was sizy. The next day she took a dose of jalap and calomel, which operated twelve times. On the 18th she lost four ounces more of blood, which was more sizy than that drawn on the 15th. From this time she mended rapidly. Her coma left her on the 20th, and her appetite returned; on the 21st she made a large quantity of turbid dark coloured urine. On the 22d her pulse became again a little tense, for which she took a gentle puke. On the 23d she had a natural stool. On the 24th her pupils appeared to be contracted to their natural size, and on the 30th I had the pleasure of seeing her seated at a tea-table in good health. Her pulse notwithstanding, was a little more active and tense than natural.
CASE II.
On the 24th of the same month, I was called to visit the son of John Cypher, in South-street, aged four years, who had been hurt about a month before, by a wound on his forehead with a brick-bat, the mark of which still appeared. He had been ill for near two weeks with coma, head-ach, colic, vomiting, and frequent startings in his sleep. His evacuations by stool and urine were suppressed; he had discharged three worms, and had had two convulsion fits just before I saw him. The pupil of the right eye was larger than that of the left. His pulse was full, tense, and slow, and intermitted every fourth stroke. The symptoms plainly indicated an internal dropsy of the brain. I ordered him to lose four or five ounces of blood. But three ounces of blood were drawn, which produced a small change in his pulse. It rendered the intermission of a pulsation perceptible only after every tenth stroke. On the 25th he lost five ounces of blood, and took a purge of calomel and jalap. On the 26th he was better. On the 27th the vomiting was troublesome, and his pulse was still full and tense, but regular. I ordered him to lose four ounces of blood. On the 28th his puking and head-ach continued; his pulse was a little tense, but regular; and his right pupil less dilated. On the 29th his head-ach and puking ceased, and he played about the room. On the 4th of December he grew worse; his head-ach and puking returned, with a hard pulse, for which I ordered him to lose five ounces of blood. On the 5th he was better, but on the 6th his head-ach and puking returned. On the 7th I ordered his forehead to be bathed frequently with vinegar, in which ice had been dissolved. On the 8th he was much better. On the 9th his pulse became soft, and he complained but little of head-ach. After appearing to be well for near three weeks, except that he complained of a little head-ach, on the 29th his pulse became again full and tense, for which I ordered him to lose six ounces of blood, which for the first time discovered a buffy coat. After this last bleeding, he discharged a large quantity of water. From this time he recovered slowly, but his pulse was a little fuller than natural on the 19th of January following. He afterwards enjoyed good health.