Southern Medical and Surgical Journal - Georgia Regents University

1859.] Lecture on Cerebral Fever. 751the child opens widely the eyes ; they are brilliant, and at that momenta bright redness overspreads the face, comparable to theblush which modesty sends to the cheeks of a young woman.This redness disappears in a minute or two, the eyes close again,and the child returns to its former state. This reddening of tliecountenance is repeated from time to time during the day ; it isalso of value. Soon it occurs more frequently, and in a greatnumber of cases; when it takes place the child utters a few plaintivecries,—a characteristic phenomenon which Coindet has particularlypointed out ; this is the hydrocephalic cry, the cry ofcerebral fever ; it may be repeated every hour, every-half hour,or at much greater intervals. It is a cry of pain, and the patienthaving uttered two or three of these, falls again into the calmnessand into the sleep from which its sufferings had for a momentroused it. This peculiar appearance of the countenance and thehydrocephalic cry completes the description of the second period,with the exception of one sign of which it is necessary to speak.I allude to retraction of the abdominal parietes. The abdomen ishollowed out, and this fact is especially important in establishingthe differential diagnosis between the disease under considerationand typhoid lever, a disease in which the abdominal parietes arealways protuberant.One other symptom, however, must still be mentioned ; it hasstruck those who observed the little girl, who is the subject of thepresent lecture. I refer to irregularity of respiration. It was wellmarked in our patient, as I have said, but less so than in manyothers I have seen. How did she respire ? In counting therespirations, watch in hand, there was extreme difficulty in followingthem ; first, there was a feeble inspiration followed by a feebleexpiration, then a stronger inspiration and expiration, and againa feeble one, and finally a period of cessation. These four respiratorymovements were accomplished rapidly, and the chest remainedmotionless afterwards during three, four, five, and sixseconds. That is what occurred yesterday; that is what occurstoday ; to-morrow, in place of an interval of five or six seconds,there will be one of ten, twelve, or fifteen.In a child of two years, in the Hospital Necker, afflicted withthis disease, I was able to count by the watch, periods of cessationof respiration of thirty, thirty-five, forty, and even of fiftysevenseconds; and it is remarkable that this irregularity of respirationextends to the third period of the disease, when the slownessof the pulse has been succeeded by great frequency—thisinfrequent respiration occurs with a pulse beating, as in the caseof our little patient, as high as one hundred and sixty per minute.In no other disease can this singular anomaly be found ; this unequalrespiration does not occur in the idiopathic convulsions ofinfancy, nor in typhoid fever,—so that in cases where we hesitate