Cases of Intestinal Obstruction; with Remarks
Authors: W. Cadge
Journal: BMJ (1868)

Surgeon to the Mineral Water Hospital, and to the Eastern Dispensary, Bath THE following case possesses some interest and value, on account of the complete history which was obtained.Some points in that history, too, may help to place the diagnosis of cerebral abscess on a surer foundation.G. T., a well-built muscular man, aged 6o, by occupation a carter, and in apparently sound and even vigorous health, fell off a load of thorns in the middle of November I866, and struck the back of his head.He was severely shaken, but was not made insensible.He did not vomit; and there was no outward injury inflicted on the body, beyond bruises.He stayed at home quietly for four days, and then went to work again; but, for many days after this, he always came home early, and, in a silent moody way, sat shivering all the evening over the fire.He often went to bed as early as seven o'clock, and said that he had a noise in his head like "singing".All through January, he stayed at home entirely, and was always silent and strange.The people around him had to speak two or three times before they could get an answer.This wvent on through February and nearly the whole of March.On March 28th, he felt so much better, that he went to a wood with two or three other men, in order to fell trees; and, while doing this, he had a " fit"-strictly epileptiform, for he was insensible and con.vulsed, and was brought home by his companions.Next morning, he was so far revived, that he resumed the work of the previous day, and did so until Monday, April ist, when he came home about noon, and did not go out again all the week.It was on Wednesday, April 3rd, that he was seen for the first time by the house-surgeon of the Eastern Dispensary, Mr. Exell.On Sunday evening, April 7th, he was re- markably lively and cheerful.The next day, he felled trees again in the old wood, but was again brought home in an epileptic convulsion, and never afterwanrd went nut of his er1d-chamber From this time till the middle of June, he received parochial relief and medical attendance.He was always in bed; and, at ten o'clock every moring, he was seized with a violent tremor, followed by a pun- gent heat and a profuse sweating; and, strange to relate, this hectic cycle was almost always most intense on Tuesdays.He now began to complain of an intense screwing pain at the vertex of the right half of the head, which continued for nearly three months with cruel rigour.A letter for the Eastern Dispensary was obtained for him in June, and I visited him rather frequently.No considerable variation in the symptoms occurred in July; but, in the first week of August, he suffered another, a third and last, epileptic fit.After this, he had no more pain; but he now lost his speech, and could utter nothing beyond groaning inarticulate noises.At about the same time, the power of swallowing also was lost.The pupils were always normal, and responded well to light.The protruded tongue invariably turned to the left side.Paralysis of the left arm and leg gin dually came on-the arm and leg which were clonically convulsed during the epileptic attacks; and the ever-spreading palsy soon merged