Acute Inflammation of the Brain – Phrenitis. – The simple acute inflammation of ate substance of the b rain, a disease not very frequent, either begins with convulsions, or they soon occur, which, unless arrested, continue with little intermission till death take place. Or the disorder may set in with violent vomiting and intense febrile excitement. This form of the disease occurs principally in children apparently healthy, and of highly developed nervous (encephalic) organization; runs a very rapid course; and causes effusion into the ventricles – hydrocephalus internus.
Acute Inflammation of the Membranes of the Brain -Meningitis. – The acute inflammation of the membranes of the brain most frequently occurs in consequence of a blow or bruise, of some kind, upon the cranium, – traumatic meningitis, -which develops the disorder after the lapse of ten or fourteen days, when the original injury may even have been forgotten. The child complains of her head; there are convulsive motions in the eyes and eyelids; sudden and long-continued paroxysms of general convulsions; frequent attacks of vomiting; the headache is very violent; and there may be alternation of violent headache and violent sickness of the stomach. But perhaps the most remarkable characteristic indications of meningitis are found in the sharp, quick cries, which the pain occasions on its paroxysmal recurrence; aggravation from movement: these two latter symptoms are common to acute inflammations of the serous membranes, -as in the pleura and peritoneum. Aggravation from light and from noise is rather characteristic of phrenitis. The dropsical effusion, hydrocephalus externus, which soon results in severe cases of meningitis, produces symptoms indicative of pressure upon the brain, which are so similar to those following the effusion of phrenitis, that it is only in the early stages of the two affections that they can be distinguished; and they may even exist together. Inflammation of the dura mater, in particularly, may result from otitis; or even in cases of otorrhoea, -these latter cases are usually marked by distinct rigors or shivering fits; and they may be followed by phlebitis, from the veins of the diploe and even the sinuses of the brain itself becoming involved.
HYDROCEPHALUS is said to be the form in which cerebral disease usually appears in scrofulous subjects; and this is a disorder in the first instance rather of the membranes of the brain than of the brain itself. According to the results of examinations after death, -which however afford little aid in determining either the form of the disease during life, or the remedy suitable to it, – there are two classes of hydrocephalus; -the one resulting from simple inflammation, the other arising from deposit of tubercle in the membranes, – tubercular meningitis.
But we do not attempt to distinguish between the two; our present purpose will be answered by detailing the most remarkable of the precursory symptoms. The disposition of the child changes, it becomes variable, gloomy, listless and inactive, peevish, fretful and restless, with a vacant look and abstracted air; he is usually wakeful, or falls into a doze from which he starts with cries. If old enough to speak, he complains of pain in his head; or if younger the head is frequently rolled from side to side, or buried in the pillow; there is evening fever; vomiting, especially on rising from a recumbent position; constipation; delirium; sleep with the eyeballs turned upwards and inwards so as to hide the cornea under the edge of the upper eyelid; and as the disease advances constantly increasing drowsiness; there may be paralysis of one of the extremities, or of one side of the body; constant movement of the hands, or fidgety motion of the feet; soporous condition, with half-closed lids; the pupils of one or both eyes permanently dilated and insensible to light; -or the pupils may be very much contracted, almost closed; -constant strabismus, and irregular pulse. To these various symptoms, which in different degrees and in various combinations with others, present themselves at first, are joined in the last stages of the disorder those convulsive and paralytic symptoms which indicate pressure on the brain from copious effusion. In the acute forms of the disease, called water-stroke by some, the disorder attains in a few hours as great a progress as it does in as many days in the chronic form.
Aconite. Indicated where there is very active inflammation, with much heat, restlessness, and distress.
Apis. The child screams out very sharply in its sleep.
Arnica. When the disorder results from a concussion.
Arsenicum. Great depression of the vital powers; emaciation, and a very waxy, pale look. Thirst for water; only a little taken at a time, and that often.
Belladonna. Almost constant moaning; the child remains in a drowsy, sleepy state. Starting and jumping.
Bryonia. There is a motion, more or less constant, of the jaws, as if chewing something. Lips dry and parched. Constipation, &
c.
Calcarea c. Leucophlegmatic temperament; large open fontanelles; there is now, or formerly has been much perspiration about the head.
Camphor. Great coldness of the skin; and yet the child cannot bear to be covered.
Cina. The child picks its nose much as if from worms; has milky-white urine, and is cross and peevish.
Digitalis. Pulse very slow, or irregular; white evacuations, and bilious vomiting.
Helleborus. Scanty dark urine, with sediment like coffee- grounds.
Hyoscyamus. Delirium, with jerking of the limbs; watery diarrhoea; red face; wild staring look, and throbbing of the carotids.
Ignatia. Frequent sighing and sobbing. Compare Bryonia.
Ipecacuanha. The case is characterized by an almost constant nausea, from which the patient has hardly a moment’s relief. Ipecac.200 or 1000, is capable of entirely curing such cases.
Mercurius sol. Scorbutic gums; salivation; swelling of the glands; slimy or clay colored evacuations.
Opium. This remedy is of great value when cholera infantum threatens to terminate in this disease. Great drowsiness is the key-note symptom of this remedy.
Pulsatilla. Much slimy vomiting, and diarrhoea, worse at night. Stools ever varying in color.
Staphysagria. This remedy is indicated in some chronic cases, and may be is especial use if indicated in persons who have been mercurialized.
Stramonium. Called for when the child exhibits fear at the first sight of objects on awakening; strabismus, & c.
Sulphur. In cases where suppression of an eruption has preceded the disease; or the child does not get well on account of some constitutional dyscrasia, which may be evident from a careful examination of the case.
Zincum met. The child cannot keep its feet still. This remedy may be particularly indicated in dropsies following scarlet fever. May be studied in connection with Belladonna.
HYDROCEPHALOID. – This is a form on cerebral disease which was first described by Dr. Marshall Hall, -and by him named hydrocephaloid, -which is a secondary brain affection; and results from exhaustion of nervous vitality, and anaemia, of the brain; -as from debilitating diarrhoeas, and loss of blood.
*Dr. Schweikert, in Quarterly Hom. Journal. New Series, Vol.I. p.114. Boston, 1853.
The first stage, of irritation, is marked by restlessness, feverishness, sudden starting from noise, or being touched; bloated abdomen; diarrhoea of mucous or greenish, offensive masses.
The second stage is one of torpor; the face is pale, the cheeks cool, the eyelids half closed, the eyes unsteady, and unmoved by the approach of light; the respiration thick, irregular, sighing, the voice is husky, and sometimes cough. The whole state is one of evident prostration, – a sort of typhus condition of the brain; the head, face, hands and feet are cool, the pulse very small and rapid.
The remedies used successfully by Schweikert, were principally Phosphorus; Zinc; and Calcarea. Suitable nourishment to remove the exhaustion (starvation, loss of blood) should be carefully given. Compare West. Diseases of Children. p.130.
INFLAMED EYES – OPHTHALMIA.
New-born infants are very often subject to ophthalmia, or purulent inflammation of the eyes. The disorder is always serious; for, unless speedily cured, -which it is not always easy to effect, – the inflammation will result in opacity of the cornea, impaired vision, or even total blindness. And in neglected cases, especially those in which the necessary attention to cleanliness has not been enforced, ulceration of the cornea may take pale; and the contents of the eyeball be discharged, causing permanent deformity as well as hopeless blindness.
“The first indication of the disease is generally, the eyelids becoming glued together during the night, with swelling and redness externally. When the lid is raised, there occurs a gush of tears, and its conjunctiva is found to be uniformly red, and slightly thickened and covered often with a purulent, tenacious, transparent coating. As the disease proceeds, the lids become more constantly agglutinated; and an increased secretion from the surface of the inflamed conjunctiva takes place, of a thick, purulent matter, a portion of which exudes from between the lids, but the greater part is retained, causing a considerable bulging of the palpebrae-the integuments of which assume a dark red hue. – Condie.
