Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson.

  • Watson, Thomas, Sir, 1792-1882.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    are very common and very important symptoms of disease. Incoherence of the trains of thought—palpahly false belief—extravagant perversions of the judgment. These affections are sometimes considered as primary diseases themselves; they very frequently accompany certain febrile diseases ; and they are not uncommon in diseases that are unattended with fever. There is more or less derangement of the internal senses from the very beginning of continued fever. The power of attention is impaired. That kind and degree of mental exertion which would afford gratification and amusement when we are well, become laborious and irksome when we are ill; and to compel, or to urge the attention, under such cir- cumstances, is injurious. This state is probably only the first degree of delirium, and therefore these slight approaches to derangement of the internal senses are by no means to be disregarded. It is curious that the delirium of fever is always most marked during the night; this seems to be owing to the circumstance that the erroneous notions and wandering thoughts of the patient are not corrected by impressions made upon his external senses. You will find, conformably with the same principle, that your patient sometimes ceases to be delirious upon your visiting him: the sight of a new face rouses him for a time, but he soon relapses. Voluntary motion is another function connected with the nervous system, and one which affords a great variety of important symptoms. Like the power of the senses, it may be excessive, or deficient, or perverted. Excess of voluntary motion is not common, nor very important. Maniacal patients sometimes exhibit an extra- ordinary degree of muscular strength; indeed, in the delirium of fever something of the same kind may be observed. But the opposite state, that in which the power of voluntary motion is deficient, muscular debility is exceedingly common. Debility is an original and essential part of fevers. It appears before there has been time for it to be produced by the exhaustion of disease. It is not always proportional to the other symptoms, and does not necessarily imply any great degree of danger. This sudden and early weakness has been a very striking symptom in our two recent visitations of influ- enza. Persons previously in apparent good health would be seized as they walked along the street, and be glad to sit down in a shop, or a carriage, and to get home and go to bed. Young and strong persons would be thus rapidly prostrated. In some instances debility does not appear till late in the disease, of which it then forms an important prognostic symptom, and an important guide for our treatment. It shows us that there is a tendency to death by asthenia, and we have to endeavour to keep the patient alive by supporting his strength as well as we can, this being the chief or the only indication. Debility is occasionally the principal symptom of the whole disease—as in hemiplegia, paraplegia, or in more partial palsy, palsy of one limb, even of a finger, or of a single muscle, as of the levator palpebrarum. This, though it may seem trivial in itself, is far from being so in reality ; it often forms a fragment only of a most serious disease. From such partial manifestations of palsy we presage a more general and alarming attack; as the loosening of a few stones in the wall announces the commencing earthquake. A slight degree of paralysis, affecting some of the muscles of the eye, will produce a squint, and consequent double vision; and this occurs not only in hydrocephalus, when it is a most significant phenomenon, but also as a prelude to more extensive palsy. General palsy is sometimes prefaced by a similar affection of the tongue, producing a faltering and indistinctness of speech. Spasm is an instance of disturbance and perversion of the power of voluntary motion. It consists in an irregular and violent contraction of muscular parts involuntary, even when the voluntary muscles are concerned. Cramp is a familiar example of it; and we have been taught, since the cholera came amnnn us, to regard cramp as sometimes a very formidable symptom : not formidable in itself, but formidable in respect to the condition that gives rise to it. Tonic spasm is the principal symptom, also, of that frightful disease—frightful in its phenomena and in its frequent fatality—tetanus. The convulsions of epilepsy and hysteria,