vii TUBERCULAR MENINGITIS 57 



to two grains, and is further increased if needful, but seldom 

 to cause tenderness of the gums ; as soon as the pain abates 

 the anodyne is diminished by degrees. The opium acts, in 

 his view; not only by controlling pain but by restraining the 

 action of the antimony on the stomach and conducting it, as 

 it were, to the remoter parts. The patient is not generally 

 confined within doors. Fothergill states that cases of genuine 

 sciatica seldom fail to yield to this treatment in the space of a 

 few weeks, and that the complaint rarely returns. 1 



HYDROCEPHALUS INTERNUS [TUBERCULAR MENINGITIS] 



A distemper, of which Fothergill saw about one or two 

 instances yearly, was then obscurely alluded to by medical 

 authors as Hydrocephalus internus. In 1768, whilst he was 

 proposing to himself to write an account of it, the Observations 

 on the Dropsy in the Brain by that acute observer of nervous 

 disorder, Whytt of Edinburgh, were posthumously published. 

 Fothergill brought forward his own paper in the same year, 

 a paper which Vicq d'Azyr calls " un des tableaux les plus 

 finis que Ton ait jamais traces en medecine." His clinical 

 picture is in several respects fuller than Whytt's, and, differing 

 from that author, he lays stress on the often sudden onset of 

 the disease in children or young adults, who appear, he says, 

 to be healthy and active, sometimes " the favourites or sole 

 hopes of their parents." 



He traces its course : the drooping in some cases for a few 

 days, access of fever, costiveness, pains about the nape and 

 limbs, headache from temple to temple, deep and tense, and 

 persistent vomiting ; the pulse at first slow, unequal in force 

 and time ; irregular suspirious respiration " sometimes 

 they only seem to breathe in sighs for some minutes together " 

 (compare Cheyne-Stokes respiration) ; the wakefulness and 

 startings, the pupils dilated and at length fixed, the photo- 

 phobia, the piercing scream, and the gradual lapse into 

 unconsciousness none of these features escape him. 



As regards treatment Fothergill confesses his impotence 

 to cure. He begins with calomel, rhubarb and scammony, 

 and perhaps tartar emetic. Anthelmintics are then given ; 

 but unless these relieve, the disorder goes on to a fatal end, in 

 despite of blisters and sinapisms. He urges the duty of 

 inspecting the body after death ; we must not despair, he 

 writes, of ascertaining the cause. He has himself found a 



1 Med. Obs. & Inq. iv. 69 ; Works, ii. 77. 



