A Study of Two Illustrative Cases of Epilepsy
Authors: J. Coats
Journal: BMJ (1876)

of Cambridge, a friend of the patient, who was present at the opera- tion, kindly remained with him, anid gave him twenty minims of laudanum with advantage.When I sawIhim in the afternoon, I gave him ten grains of chloral-hydrate, as I thought the diarrhoea was pro- bably, like the frequent desire to micturate, spasmodic.I also pre- scribed thirty grains of chloral at bedtime, and hot flannels sprinkled with laudanum to the abdomen.MIarch 27th.The diarrhoea returned in the evening, but was checked by an injection of starch and laudanum.This also relieved the pain in the abdomen, and the patient slept after it for two hours.At 2 A.M., he had the thirty grains of chloral, and slept after this till nearly 6 A. A. Diarrhoea then returned again, but was checked by fifteen minims of laudanum.When I saw him at 3.30, I found him much more comfortable.He had had a little pain in the abdomen, which had been relieved by linseed-meal poultices.The tongue was cleaner; pulse quiet, 78; temperature IOI deg.Fahr.He was not so thirsty, but slightly flushed.I ordered milk and lime-water, and a bismuth and morphia mixture for the diarrhea.iNlarch 28th.He had one relapse of diarrhoea last evening, which bismuth mixture soon relieved.He passed a comfortable night with- out chloral or opiates.From this time his progress towards recovery was uninterrupted.He was going about again on April 3rd, his temperature and pulse being normal.No increased liver-dulness could now be detected.Dr.BIurrell and I again carefully examined this gentleman on May 22nd, ancd we could detect nothing abnormal about the liver.The patient expressed himself as feeling quite well.On June gth, the patient wrote to me from Hastings, stating that he was still going on satisfactorily.CASE II.-H.WV., aged i6, an errand boy, living in Cambridge, vas admitted into Addenbrooke's Hospital, under my care, April 5th, I876.The lad had a healthy appearance, and gave the following account of his illness.He came of a healthy family.His own health wa^s quite good up to four years ago, when he was in the hospital for a period of sixteen weeks, under one of my colleagues.His symptom, at that time were slight constipation, nausea, abdominal pain, and the presence of a hard lump at the epigastrium.He got stronger durinlg his stay in the hospital, but did not lose the swelling, which seems to have been present ever since, but has given him no trouble with the exception of a little pain at rare intervals.Two weeks ago, he felt a settled pain and soreness in the centre of the epigastrium, and aching pain across the chest.A large tumour of the size of a4cetal head occupied the right hypo- chon1lriac and epigastric regions, and was apparently continuous with the liver.The surface of the tumour was somewhat nodulated.Tihe tumour was very prominent and globular below the right ribs ; the left half did not stand out so well, and was rather difficult to define ; on it could be felt several small flat elevations, one of whith was acutely tender.There was a loss of the elasticity of the ribs over the tumour.The tumour itself felt rather elastic, and moved up and down on breathing.No hydatid fremitus could be detected.The case was diagnosed by Dr. Humphry and myself as one of hydatid of the liver.Accordingly, on April gth, Dr. Humphry, at I I A.At., introduced a needle of the aspirator into the tumour at a spot one inch below the point of the ensiform cartilage and three-fourths of an inch to the right of the middle line.Twenty-two ounces of hydatid fluid containing echinococci were withdrawn.6 P.Mi.Immediately after the withdrawal of the fluid, the patient felt easier, and was soon quite comfortable.Pulse 94.Temperature, 99.2 den.Fahr.Ordered beef-tea and milk.April ioth.I-Ie complained of frontal headache and of being dizzy.He twice vomited a small quantity of thin, yellowish, bilious-looking fluid.He did not sleep much last night.Temperature, 99.8 deg.Fahr.Pulse 98.The bowels acted last night.F.rom this time, the patient went on satisfactorily in every respect.No urticaria followed the operation.On April 15th, it was noted that the patient felt quite well.Oni Alay 25th, the patient presented himself at the hospital for careful examination.The lad said he felt perfectlv well.There was no pain nor tendel-ness over the region where the tumour had been ; and careful percussion failed to reveal any enlargement of the liver.So far as one could judge, the cure was perfect.RENIARKS.