A manual of clinical medicine and physical diagnosis - Softcover

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1871 Excerpt: ...nor the power of voluntary motion, nor sensation; but the pulmonary branches of the par vagum continue to excite, through the medulla oblongata, the involuntary movements of the thorax. When this upper part of the cranio-spinal axis becomes involved in the disease, and its reflex power ceases, the breathing stops also, and the patient is presently dead. On being called to a case of deep coma there will often be experienced great difficulty in deciding whether this condition is due to apoplexy (see general remarks on brain disease), or to a large dose of opium, or to a poisonous quantity of alcohol. All physicians engaged in hospital practice have seen cases in which they have been placed in this dilemma--a most unhappy one, since the HEADACHE--VERTIGO. 179 life of the sufferer may depend upon the correctness of the diagnosis. The points which will assist the practitioner in forming an opinion are, the history of the patient, his general appearance, and such other circumstances as can be gleaned from his friends, or those persons who picked him up in the street; the smell of his breath, the odor of tobacco, of spirits, or of wine, being often easily detected; his condition in life; and the state of his mind for the previous few days. In cases of poisoning by opium, however, the pupils are almost invariably contracted, sometimes to the size of a pin's point; in deep intoxication they are often dilated, but sometimes contracted; and so in apoplexy. The diagnosis of intoxication is often difficult, for though the odor of the breath is one of the best means of throwing light on the case, Jret it must be remembered that a fit of apoplexy or epilepsy is very likely to occur in a plethoric predisposed person after a glass or two of spirits. Headache.--It is usual t...