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Rheumatism Case Xi

time, patient and delirium

RHEUMATISM CASE XI. " Symptoms of meningitis. Acute inflammation of the pericardium.A aged 26, the mother of two children, and .7D who had recently had a miscarriage, was admitted into La Charite early in the year 1820, in such a state of delirium that no information could be got regarding her antecedents. The delirium was remark able for the obstinate taciturnity by which it was accompanied. When asked a question, the patient looked fixedly at one without answering ; the face was pale; the lips, separated from each other, and agitated from time to time as by a convulsive trembling, allowed the tongue to he seen, moist and white. The pulse was frequent and small, but regular; the skin rather cold.

"During the next two days there was frequent bending backward of the head, sudden raising of the trunk at intervals, and substdfus tendinton. The patient spoke, and appeared to understand what was said to her, but was quite incoherent in what she said. The face was very pale; the pulse very frequent, and intermittent. On the fourth day after admission the delirium ceased : the patient com plained only of great weakness : the muscles of the face were agitated by almost continual convulsive movements ; and the upper extremities were affected from time to time with an almost tetanic rigidity. On

the fifth day the delirium returned, the features were distorted ; during the course of the clay the patient became comatose, and died in the evening." On post-mortem examination it was found that "there was no ap preciable change in the color or consistence of the brain, spinal cord, or their membrane. The digestive canal, opened throughout its whole extent, presented only a slight injection here and there. The other abdominal viscera were free from lesion. The lungs were slightly congested posteriorly. The substance of the heart presented no trace of morbid change : the vessels entering and issuing from it were also healthy. But the pericardium was covered with a lymphy deposit (pur des crmerairms ullytininettse8), which stretched at many points like a soft bridle from the visceral to the parietal surface. Effused into its cavity, too, were several ounces of a greenish and flocculent serum,"