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GEN. VII.

SPEC. I.

6 E. Cepha

litis profunda.

Deep-seated cephalitis. Internal, or

a fortnight, or even a week. Dr. Coindet has occasionally known the patient sink in two or three days *.

We have already observed that the substance of the brain has more generally evinced proofs of inflammation and other mischief than the membranes; though not unacute dropsy frequently the increased vascularity and turgescence have of the head. extended from the parenchyma to the surface. As the existence of effused fluid is not necessary to the disease, it varies considerably in quantity when it is found; as a mean measure however, it may be stated at five or six Most modern pathologists concur with Malpighi and Haller, in holding that it is incoagulable; but Pechlin, Lapeyronie, and a few authorities of the present day, have denied this. The disease is often connected with a scrofulous habit, and has sometimes formed a fatal metastasis to phthisis.

Amount of fluid effused.

Sometimes connected

with a scrofulous habit. Therapia.

Generally

accordant

ounces.

The mode of practice, in consequence of this discrepancy of opinion, has been extremely undecided: whilst many practitioners are so despondent as to fear that every plan is equally unavailing. It has fallen to the author's lot, however, to see several patients recover both in infancy and verging towards adult age, who had all the characteristics of the disease, and were unquestionably labouring under it.

Contemplating it as a variety of cephalitis, he has uniwith that for formly pursued the general plan recommended under the preceding variety, and to this practice he can only ascribe whatever degree of success he has been fortunate enough to meet with.

the prece

ding variety.

Blood should be drawn freely from the nape of the neck by cupping or leeches: the head should be shaven, and napkins dipped in ice-water, or vinegar and water, be applied to the posterior part of it, and be changed every hour or half hour. The bowels should be freely purged with calomel, or calomel and jalap : and the jalap should be toasted to render it less disposed to excite sickness; an easy diapnoë should, if possible, be excited

* Mémoire sur l'Hydrencéphale, &c. ut suprà. Geneva, 1818.

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GEN. VII.

E. Cepha

SPEC. I.

Deep-seated

funda.

Internal, or

acute dropsy of the head.

and maintained on the skin; the chamber should be large and well ventilated: and whenever it may be right to stimulate the head, epithems of neutralized ammonia litis proshould be preferred to blistering. The value of digitalis is doubtful; when used early it has seemed serviceable, cephalitis. but it should be avoided in the second stage of the disease, unless, indeed, it be employed as, by Dr. Golis, to smooth the passage to death, by diminishing the violence of the convulsions that usually precede it. In later life than infancy, where it has been necessary to draw blood repeatedly, I have occasionally prescribed opening the temporal artery with great success: for a small quantity, as six or eight ounces of blood, drawn in this way, will often answer the purpose of double or treble the tity abstracted from the arm. In a young lady of nineteen, labouring under very prominent symptoms of this disease, I found the violent and deep-seated pain in the head cease instantly; and the pulse sink from seventy to forty-four, as soon as a tea-cup full of blood only was taken away in this manner.

quan

Temporal times opened

artery some

with great

success.

and inter

Mercury employed both externally and internally, in Mercury a quantity sufficient to excite a ptyalism, has also been externally used in many instances with great success, both among nally in large doses. adults and infants, but particularly among the latter. Dr. Percival gives the history of a child of his own, aged three years and a quarter, in which a perfect cure was obtained by this, and nothing else. In forty-eight hours signs of amendment appeared, and in six days the child was well; during which time thirteen grains of calomel had been taken, and seven scruples of strong mercuril ointment had been rubbed into the legs *. Dr. Dobson of Liverpool employed quick-silver in the same double plan, and asserts that he found it equally useful, and most strikingly so in the following case. Four children of the same family had evinced this disorder in succession; three had fallen victims to it under a different treatment: one between three and four years old, was

* Edin. Med. Com. Vol. vi. p. 224.

SPEC. I.

& E. Cepha

litis pro-
funda.
Deep-seated
cephalitis.
Internal, or

GEN. VII. subjected to the mercurial plan of calomel and inunction. Inforty-eight hours a ptyalism was excited, the symptoms abated, and the child recovered*. Dr. Golis prefers the internal to the external use of mercury, as far more active and to be depended upon. He gives it in free doses, and observes, "that an infant of a year old and under will bear a much larger proportion without diarrhoea or griping, than those of four, five, six, or even eight years of age". And hence to the former he often prescribes eight or ten grains in the course of twentyfour hours. If diarrhoea or griping be produced, it should be remitted. With Golis ptyalism has proved a rare effect+.

acute dropsy of the head.

In adults the ordinary proportion is ten grains of calomel and a drachm of strong mercurial ointment every night. Under this treatment various cases of success are recorded in the Edinburgh Medical Journal.

GEN. VII.
SPEC. II.

Causes.

SPECIES II.

EMPRESMA OTITIS.

Ear-ache. Imposteme in the Head.

SEVERE PAIN IN THE EAR; TENDERNESS UPON PRESSURE;
DEAFNESS OR CONFUSION OF SOUNDS.

THIS is usually a distressing rather than a dangerous disease; but the fever is sometimes violent, and delirium and even death has been a consequence. It is often produced by cold, and is hence frequently a local catarrh : and is still more commonly, perhaps, occasioned by some exotic substance which has accidentally entered into the ear, as a small piece of ragged bone‡, a cherry-stone§, a worm, an insect, or the larve of an insect, as of an ant,

Edin. Med. Com. Vol. vi. p. 224.
Hagendorn, Cent. I. Obs. 64.

† Golis, ut suprà.

Fabric. Hildan. Cent. II. Obs. 4.

GEN. VII. SPEC. II. Empresma Otitis.

Ear-ache. Imposteme in the head, In these

cases inflam

mation in

ear: but

a spider, a fly, or a cricket; of all which we have a variety of curious histories in medical journals*. In these instances the disease is confined to the external ear: but from many of the ordinary sources of inflammation it often exists within the tympanal cavity; whence, too, the inflammatory action has extended to the brain, or affected it by sympathy+. In this case the membranes and lining of the inner organ are coated with coagulable the external lymph, pus, or both; while even the temporal bone of sometimes the affected side has become carious. An instance of this last kind is related by Dr. Powell in the Medical Transactions. The patient was a young gentleman of sixteen, who had been attacked with otitis once or twice before. The pain was intense, but the pulse never exceeded seventy-two: yet the disease proved fatal. The intellect was at no time disturbed ‡.

The disease therefore offers two distinct modifications, and is so far correctly arranged by M. Itard.

a Externa.

External Imposteme.

6 Interna.

Internal Imposteme.

External ear highly irritable,
lining membrane, when exa-
mined by a bright light, red
and tumid.
Hemicrania, sense of weight in
the head roughness about
the mouth of the Eustachian
tube: tonsils often enlarged.

A hissing or tingling sound accompanies both varieties, but is most painful in the latter. M. Itard§ believes both to proceed chiefly from cold, and to possess much of the nature of a catarrh: but in dividing them into two distinct

* Stalpart Van der Wiel. Maget. Journ. de Med. Tom. LXIV. Moehring, Obs. 21. Samml. Medicinischen Wahrnehmungen, B. vi. p. 37.

+ Case of Inflammation and Abscess of the Brain, attended with Disease of the Ear. By John O'Brien, M.D. Trans. King's and Queen's Coll. Dublin. Vol. I. p. 309. 8vo. 1824.

Vol. v. Art. xvi. p. 212.

§ Traité des Maladies de l'Oreille et de l'Audition. Par J. M. G. Itard, M.D. &c. 2 Tom. Paris, 1821

internal, and

extends to

the brain.

Empresma

Otitis.
Ear-ache.
Imposteme
in the head.

E. Otitis

externa. External

GEN. VII. sub-species, a catarrhal and purulent, he ramifies very SPEC. II. unnecessarily; for, let the exciting cause be what it may, the purulent is only a subsequent state to the preceding. The EXTERNAL OTITIS generally suppurates in a short time, and then more completely forms what is vulgarly called an IMPOSTEME OF IMPOSTHUME in the head, a term corrupted from aposteme; the discharge, which is usually yellowish, puriform, fetid, and somewhat bloody, Imposteme flows from the external auditory passage in a greater or less abundance, according to the extent of the inflammation. It commonly diminishes in about a fortnight or three weeks; when the fluid becomes thicker, and to the eye, and even the smell, caseous. It then ceases, and is succeeded by a copious ceruminous secretion, which passes off without any injury to the sense of hearing.

Otitis, or

in the head.

Sometimes becomes chronic,

otorrhoea.

This is the ordinary course: but it sometimes runs into a chronic state, and especially where there is a morbid diathesis from struma, syphilis, or variola; and under such circumstances it becomes often tedious and unmanageable, and is accompanied with a thickening of the tympanal membrane, and an obtuseness of hearing. In and is called some cases, however, the otorrhea or chronic state takes the lead. This is mostly the effect of cold, and is in fact an otitic catarrh. The discharge from the ear is at first perhaps, not attended to, and, from particular circumstances, occasionally ceases for a time; but only to show itself in any incidental excitement with renewed violence. The discharge differs in different individuals in its consistence, colour, and the peculiarity of its smell, though the last is always offensive; it is at first mucous, then purulent, and at length consists of a thin sanies; in which last case, connected with the specific fetor that issues from a carious bone, there can be little difficulty in determining that some of the small bones of the ear or even the temporal bone itself is affected; which, indeed, are at times thrown out in minute fragments. M. Lallemand, who has ably treated upon this subject, observes that "the morbid secretion is apt to alternate with attacks of rheumatism in other organs, catarrhous vesicæ, leucorrhoea,

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