Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1836
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Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    22/215 (page 228)
    Case 7.—Confluent smallpox—Complication of 2}ericarditis, announced merely by great dyspnoea. A young man, seventeen years old, entered the La Charite during the year 1818, on the third day of the eruption of a well-marked small pox. The pustules were everywhere very numerous. The symptoms were in other respects very mild up to the 7th day, the eruption proceeded very well, no complication inter- fering with it; but at the time the pustules began to be in a perfect state of sufipuration, the respiration suddenly became embarrassed, without there being either cough or bloody expectoration. The two following days the eruption became stationary ; several of the pustules became black ; others became filled with a reddish serum ; livid petechiae appeared in the intervals between them ; the patient fell rapidly into the last degree of prostration, though the tongue continued moist and whitish ; the dyspnoea went on increasing, and death took place the beginning of the 10th day. Post mortem. The only lesions found were a sero-purulent effusion into the pericardium, and a considerable injection of the mucous membrane of the stomach. Remarks.—This case, which is incomplete with respect to the description of several symptoms, and in particular those furnished by the heart and pulse, is not devoid of interest, by reason of the species of complication of which it affords an instance. We have here an example of what is called malignant small pox, the alarming symptoms and fatal termination of which may be explained by the com- plication of an internal inflammation. When this inflammation is a meningitis, a j)neumonia, a pleuritis, a gastro-enterite, the diagnosis is always sufficiently easy, and the judicious employment of the antiphlogistic treatment then presents many chances of success. But here, what symptom could reveal the nature of the internal lesion ? The bad aspect which the eruption assumed all at once, the petechiae which appeared, the sudden prostration of strength, and a remarkable dyspnoea, such were the morbid phenomena, the cause of which was to be ascertained. With the ancients these phenomena would have commenced the existence of what they called putrid or malignant small pox. No doubt, in fact, but that in consequence probably of the disturbance occasioned to the nervous system by the affection of the skin, there are observed during the course of certain cases of small pox, extraordinary and irregular symptoms, the cause of which pathological anatomy does not reveal. This happens not only in small pox but in ail the acute cutaneous exanthemata. Some months since vve examined the body of a woman, who, at the commencement of an eruption of measles, was seized with a slight delirium, and died unexpectedl}^ without any alarming symptom having announced this fatal symptom some hours before death. The examination of the body, which was conducted with the utmost care, presented all the organs in a sound state, except the bronchi, which were very much injected (as must take place in all cases of measles). In our patient, as in this woman, there was merely a disturbance, or perversion of the functions of the nervous system ; and could either the dyspnoea, or the change in the appearance of the eruption, be referred to the morbid modification of the innervation ? 'I'hat which seemed at least very certain, is, that the extreme prostration, into which the patient fell suddenly, succeeded the very satisfactory state of the strength too rapidly to be considered as real. Did it depend on any internal inflammation ? We were very much disposed to admit it, though we could not point out its seat. The dyspnoea seemed, however, to indicate some lesion of the organs of respiration or of circulation. The post mortem examination showed the cause of it to reside in an inflammation of the pericardium. A very striking example, no doubt, of the obscurity of the diagnosis