Case CVIII.
Elizabeth Turner, æt. 26, servant. Admitted on the 15th day of fever: no account to be obtained of previous symptoms: at present extremely restless; much delirium; almost constant talking or moaning; no sleep; mind quite confused and wandering; when roused to answer a question she seems sensible for a moment, but immediately lapses into low muttering incoherence; if asked whether she has any pain in the head she points to the forehead; says she has no pain in chest or abdomen; no cough; abdomen not tender.
16th. No sleep; constant restlessness; almost unceasing incoherent talking; incapable of answering when spoken to; tongue cannot be protruded; stools in bed; pulse too feeble and indistinct to be counted. Died in the evening.
Head. Dura mater along the course of the longitudinal sinus very adherent to the arachnoid; arachnoid and pia mater white and opake; surface and substance of brain highly vascular; surface of cerebellum vascular; substance healthy; pituitary gland suppurating; more fluid than natural in the ventricles; an ounce at the base. Thorax. Mucous membrane of bronchi highly inflamed; bronchial tubes filled with mucus mixed with pus; [pleura costalis of right side vascular; slight effusion into right pleural cavity, and into parenchyma of right lung; lower lobe much inflamed; pleuræ of left side adherent; that covering left side of diaphragm much inflamed; substance of left lung partly inflamed, partly consolidated.] Abdomen. Mucous membrane of small intestines inflamed; in that of ilium numerous large, raised ulcers; [liver adherent by several unnatural connexions to diaphragm, spleen and transverse arch of colon, but its substance was healthy; appendix vermiformis likewise adherent to abdominal peritoneum;] head of pancreas enlarged; [internal inguinal glands much enlarged, and some of them impacted with calcareous matter;] other viscera healthy.
Case CIX.
Mr. W——, æt. 50. The progress of this case having been observed with great care from the commencement to the termination of the disease, and affording an excellent illustration of the insidious manner in which the mixed form of fever sometimes attacks, and of the silent but rapid progress it makes without exciting alarm, until, at last, symptoms the most formidable, and which, to those who are not acquainted with the nature of the malady, appear to be most sudden, supervene, it may be useful to give a detailed account of it.
This gentleman had been out of health six months previously to the present attack of fever: he had been observed to be gradually losing flesh, and fading; yet he laboured under no complaint that could be ascertained, excepting that his appetite failed; that he could digest well no kind of food; that he was badly nourished and, therefore, weaker in body and less vigorous in mind than usual.
About three weeks before the fever commenced, his stomach-complaints became worse, and for these he requested the advice of his friend Mr. Chaldecott. During this gentleman’s attendance, his patient was one day attacked with slight chilliness, an unusual degree of lassitude, together with pains in the limbs: but the chilliness never amounted to rigor; the general pains were not severe; there was no pain whatever in the head; yet the sudden debility which affected both mind and body was very striking. Still the mind was perfectly distinct; the sleep was sound; the expression of the countenance was natural; the tongue, however, became loaded with white fur; there was some thirst; the pulse varied from 84 to 96, while the temperature and the softness of the skin remained in a healthy state. In this manner he went on about eight or ten days, and, during the whole of this period, he was daily questioned by his medical attendant and examined with much anxiety relative to the condition of the organs in the head, chest and abdomen; but he was steady in affirming that he was free from all uneasiness in the head, and that he had no pain in the chest; nor could any pain be excited by the fullest pressure, either in the epigastrium or in any part of the abdomen. It was observable, however, that he had some cough without expectoration, and that his respiration was short and hurried. His appearance, too, indicated more disease than his sensations; he was obviously worse than he expressed, or than could be accounted for from the apparent affection of any organ, and this excited alarm both in his family and in his medical attendants; and it is always a truly alarming condition.
On the 11th day a remarkable change took place: for two or three hours he was chilly; to this succeeded heat of skin and flushing of the face; what was very alarming, the colour of the flash was purple, while that of the whole face was dusky; there was no cough, but the respiration was short and hurried; the mind was confused and dull, though a coherent answer might still be obtained to any question that was asked; the pulse now rose to 120, there was little or no sleep, but great restlessness during the night, in the course of which delirium appeared, and the next morning there came on muscular tremor. As the day advanced the flushing and heat disappeared; the mind became quite distinct, and the pulse fell to 96. Towards evening he again became restless, the pulse rose to 104, and about one o’clock, a.m. the increased heat, the flushing of the face, the purple colour of the cheek, the dusky appearance of the skin, the short and hurried respiration, and the convulsive action of the muscles all returned, and in a greater degree, while the pulse again rose to 120. From this state he never recovered in the least degree, but became more and more dull, and at length nearly insensible; his debility rapidly increased until it became extreme; he lay quite prostrate on the back, with his arms extended, as if lifeless; the muscular tremor increased; the respiration became extremely short and hurried; the tongue became dry, red, glazed, and sticky; the bowels torpid; the pulse 130; and with these symptoms he expired on the 13th day of fever.
Head. Dura mater healthy; arachnoid thickened and opake; much gelatinous effusion between it and the pia mater; substance of brain highly vascular and firm; lateral ventricles distended with fluid, much also at the base. Thorax. Mucous membrane of bronchi universally of a dark red colour and lined with a tenacious fluid, which was slightly sticky; bronchial tubes filled with frothy mucus; substance of lungs perfectly healthy. Abdomen. Mucous membrane of small intestines generally inflamed; lower part of ilium and commencement of colon filled with large and raised ulcers, some of which were just forming, while others had penetrated through a thick mass of adventitious deposit to the muscular coat of the intestine.