a sort of languor; the head becomes very heavy and totters upon the shoulders; the mouth undergoes sudden distortion; the eyes become fixed and appear covered with a sort of cloud; the hands and some parts of the face are agitated with convulsive movements; the intellectual faculties become obscured, the patients are drowsy, and as if stupid or dull; the pulse becomes feeble, frequent, unequal, and death takes place in the space of several days. On opening the body one finds a considerable effusion of serous fluid in the ventricles of the brain." This is a good description, but it cannot be compared to the classic description given by Robert Whytt in 1768. Whytt's account consists of 48 pages in which he gives a short historical account of the disease, and states that no author had given any signs by which it could be distinguished. He evidently did not know of the work of Sauvages. Whytt's study was based on 20 cases. The symptoms come on four, five, or even six weeks before death. He divides the disease into three stages, according to the condition of the pulse. The first stage when there is a quick pulse, the second when the pulse is slow, and the last when the pulse again becomes rapid. For further details the reader is referred to the original or to the reprint of Whytt's work, which will be published later. Whytt's work gave a great impetus to the study of the condition, and his publication was followed by a large number of contributions. Among these may be mentioned that of Quin in 1790. He states in some few cases there has been reason to suspect the existence of a scrofulous taint. He noted, too, the red spots or blotches. He pointed out that the dropsy was not in the main feature of the disease but that it originated in a morbid accumulation of blood in the vessels of the brain which sometimes elevated to a certain degree of inflammation; this often produces, but not always, an effusion before death. Edward Ford thought that acute hydrocephalus was due to either an inflammation of the pia or scirrhus induration (tuberculosis) of the brain and cerebellum. In America, Benjamin Rush, in 1793, published an account of the disease. I have not been able to consult the original, and have to take Bricheteau's word that it was an able article. Many others wrote about the disease without adding anything essential to it. Fothergill, 1771, in England; Ludwig, 1774, in Germany; and Odier, 1779, in Geneva, may be mentioned. Bichat (1802), had he not died so soon, would have probably unraveled the mystery of the causation. Listen to his description of the lesions: "That the tissues belonging to the brain, by the arachnoid, to the lungs by the pleura, to the abdominal viscera by the peritoneum, it matters not which, may inflame all over in the same manner. Either the hydropsy comes on uniformly or it is subject to a species of eruption miliary-like and whitish, which has not been mentioned, I believe, and which nevertheless merits great consideration." After Ford, the majority of the writers regard the inflammation as the principal factor and the effusion as secondary. There was, however, a great difference of opinion as to the seat of the disease and the extent. Goelis, the Viennese, 1817, thought the arachnoid to be the seat of the trouble, while Coindet, 1817, placed it in the ventricles and called it internal hydrocephalus; Abercrombie placed the lesion in the brain; Brachet, in the lymphatics; Piorry, 1822, like Goelis, in the arachnoid; till finally Senn, of Geneva, in 1825, called it meningitis, and described the lesion in the pia mater. The cause of the disease was next to be sought. For a long time it had been associated in the mind with scrofula. Guibert, 1819, and Charpentier, had used the term granulations, and Senn had described a granular form of the disease. In 1827, Guersant used the term menengitis granuleuse, and he noted the frequency of tuberculosis in other organs. Curiously enough he did not seem to consider the granulations as tubercles, and this is the more remarkable, as Murdoch, one of the pupils, says that Guersant used to say that the hydrencephalics were the phthisics who died by the brain. Papavoine seems to have been the first to have associated the term tuberculosis, excepting Willis, and in 1830 he spoke of it as Arachnitis tuberculeuse. He distinguished two forms, granulations and placques. He noted that the tuberculosis preceded the effusion and also the coincidence of tuberculosis of the other organs. He also mentioned that the granulations could exist without occasioning inflammation. Five years later there were written three monographs, all of which demonstrated the points which Papavoine had insisted upon. These were: I. That the granulations were tubercles. 2. That they were indentical with the granulations of other serous membranes. 3. That they were only met with when there were other organs affected. 4. That acute hydrocephalus is tuberculosis. One of these monographs was the article by Gerhard in the American Journal of the Medical Sciences on the "Cerebral Affections of Children" (1834). This remarkable study was based on cases which he had seen in Paris and some in this country. It is a most clear and readable account and is deserving of study by the student of to-day. The two other monographs were a thesis by Rufz, who was a friend of Gerhard (in fact ten of the cases used by Gerhard were loaned him by Rufz), and a monograph by Fabre and Constant, which was never printed, but was presented as a prize essay. It won the prize and is said to be a remarkable study. In 1836, Piet wrote a very complete monograph on the subject. The question of differentiating other forms of meningitis may next be considered. Cerebro-spinal fever had been described in its epidemic form. Hopfengartner, of Stuttgart, in 1802, separated two forms of meningitis, but his observations do not seem to have excited any especial comment. Rilliet, in a journal article and also in the wonderful text-book on the diseases of children by him and Barthez (1843), published the first account of the differential diagnosis of the two forms of meningitis, the second of which they designated as meningite franche. The various points of difference were given in parallel columns and are clear and convincing. Notwithstanding this, the principal teachers and pediatricians of that time continued to teach only one form of meningitis. It was not until about the time of Kleb's discovery of a diplococcus in a case of meningitis (1875) that the profession generally adopted the idea that there were other forms of meningitis besides the tuberculous. The subsequent developments concerning the lumbar puncture and other points are of too recent date to require comment. NICHOLAS STENO.* [Read to the Medical Students of the St. Louis University.] By FRANK J. LUTZ, M.D., Professor of Surgery in the Medical Department of the St. Louis University, St. Louis, Mo. The throng of the curious which day after day crowds the basilica of St. Lawrence at Florence rarely pauses in the vault beneath the fourth chapel to the left to read this inscription: Nicolai Stenonis Episcopi Titiopolitani Quidquid mortale fuit, hic situm est. Roma Virtute probatum sacris infulis insignivit Fortem Evangelii assertorem agnovit Demum Diuturnis pro Christo laboribus aerumnisque confectum Suerinum desideravit Ecclesia deflevit Saltem in cineribus voluit. A. D. MDCLXXXVII. Only few of those who tarry before the simple slab or who admire the marble bust by Vincenzo Consoni, which was placed in the basilica by the International Congress of Geologists in 1883, know that in the quiet tomb of the Medici one of the greatest scientists of the seventeenth century has now rested for more than two hundred years. The visitor to the land of Hamlet, as he meanders through the Anatomie of the Copenhagen University, will be confronted by this picture of a Catholic bishop and wonder why a churchman has been placed among such strange company. *This sketch is based upon the life of "The Dane, Niel Stensen," by William Plenkers, S.J., Freiburg, 1884. |