A treatise on mental diseases : based upon the lecture course at the Johns Hopkins University, 1899, and designed for the use of practitioners and students of medicine / by Henry J. Berkley.

  • Henry Johns Berkley
Date:
1901
Catalogue details

Licence: In copyright

Credit: A treatise on mental diseases : based upon the lecture course at the Johns Hopkins University, 1899, and designed for the use of practitioners and students of medicine / by Henry J. Berkley. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    418/708 (page 364)
    the apoplexies and apoplectiform or epileptiform convulsions it is deeper, and the sufferer cannot even for a moment be awakened. Albuminuria with convulsions, especially where the urine shows granular tube-easts, and perhaps blood cells, \b 2>rima facie evidence of nrjemia, but albumin is also occasionally found after the convul- sions se(pient to an ordinary apoplexy, after epileptic seizures, and the apoplectiform and apoplectic attacks of the paretic and svplii- litic dement, as well as in kindred states. The condition of the pupils, too, is not pathognomonic. In some cases of uraemia they are contracted even to pin-head size, and immobile; in others they are widely dilated, and irresponsive to light; or, again, they may be of normal size. Inequality of the pupils usually indicates some localized irritative mischief in the brain, and is not often found in Briglitic coma. An examination of the fundus of the eye will, when there is retinitis in combination with an albuminuric urine, give the necessary diagnostic clinch. In uraemia, uncomplicated by local inflammation or a general infectious condition, such as may arise from a cystitis following retention of urine, there is persistent subnormal temperature. In apoplexies, continued epilejDtic con- vulsions, or coma arising from increased intracranial pressure from tumour, there is a normal temperature or pyrexia. Articulation cannot be made to serve as a guide in the differential diagnosis. When a person lies in ursemic coma, and can be roused sufiiciently to utter articulate sounds, the speech, it is true, is thick, guttural, and laboured ; but the same applies equally after gross lesion of the cerebrum; or aphasia may be present with both. The blood in uraemia invariably exhibits an excess of acid, often many times in excess of the normal quantity (von Jaksch). Delirium is a not infrequent symptom in the last stages of chronic nephritis. It may be either quiet or active, the former form predominating; as a result of the attendant sensory decep- tions inanimate objects are taken for animals, or a strange nurse is addressed as an intimate friend. Broken sentences, often single words, are repeated over and over again in a monotonous voice, as if the sounds catching the patient's obtunded sense of hearing were repeated automatically. The condition is, therefore, a variety of the so-called low muttering delirium. The forms of actual psychoses attendant upon uraemia vary, not only with the nature of the renal trouble but also with the individual susceptibility of the patients to the non-excreted toxines.