Southern Medical and Surgical Journal - Georgia Regents University

1859.] Lecture on Cerebral Fever. 749We know howrather a morbid diathesis than a declared disease.much the character of a child changes under the influence of sickness,but few among ourselves have not learned, by experience,that such a change takes place in adults, even under the influenceof a light ailment! and the change takes place in children as muchmore readilv as their characters are more mobile.We can easily understand, then, this sadness of the child, thisunaccustomed repugnance to the sports of its age, this morosewhichis not habitual to it, without oalling to our aid anylocal encephalic lesion. We have for their explanation the existenceof a most grave, morbid state of the system—a tuberculousstate not yet manifesting itself by local affections, but profoundlyaffecting the entire economy. I should say, however, that, althoughthese precursory symptoms occur in the other diseases mentioned,thev are in no other cases so striking as in cerebral fever.Finallv. more decided symptoms of the disease manifest themselves.Most generally it is vomiting, and uncontrollable vomiting,which announces the commencement of cerebral fever. Inthe greater number of cases, the friends of the patient look uponthis svmptom as of slight importance : and as the child has eatenbut a few hours before, and perhaps even with good appetite, theyconsider it as only the effect of indigestion. During a day, orperhaps two. they remain of this opinion, but finding the vomitingpersist, are compelled to abandon it. And. in truth, it is veryrarely that vomiting is repeated in indigestion after the stomachhas once emptied itself. This persistence of the symptom is thena fact of great importance. When it occurs without febrileaction in a child which has been vaccinated, our attention shouldbe immediately directed to cerebral fever; occurring in one notvaccinated, accompanied with fever more or less severe and continuous,with profuse perspiration, diarrhoea, and pains in theloins, we should fear variola ; but, I repeat, in the absence ofthese conditions, the vomiting described announces the commencementof cerebral fever. It should be added that there isgenerally obstinate constipation.At the same time the patient complains considerably of headache;and although this is a symptom which strongly attracts theattention of the friends and the physician, it is a symptom whichcannot be considered as of any great value in this complaint, forthere are many other diseases which are attended by headache,more or less violent in proportion to the intensity of the fever.However, there is this peculiarity in the headache attending cerebralfever: it is rare that the initiatory fever, of which it is oneof the epiphenomena, is limited, as in the other diseases, to asingle accession ;generally the patient has two or three chills inthe twenty-four hours, and after each chill, some heat of skin andperspiration ; sometimes the chill returns each day at about the