Brain fever

“ Brain fever is a boon to the novel writer, and like all cheap boons it has been wofully abused.
Brain fever, however, is not nearly as frequent in real life as it is in novels. It is fiction's way out of a climax. ”

“ Error serious and fatal many have fallen into, and, on this very account, still continue to fall into, with regard to the existence of cerebral disease in fever. Abundant evidence will be given in the pathology, that it is not uncommon for the most unequivocal and extensive changes of structure to take place in the brain and its membranes without severe pain having ever been felt. Pain, however, though it be not great, is almost always present. It is seldom that the pain extends over the whole head; the patient generally points to some particular part where it is peculiarly felt. ”

“ This fever is attended with great inirritability, as appears from the dilated pupils of the eyes, in which it corresponds with the dropsy of the brain. And the latter disease has its paroxysms of quick pulse, and in that respect corresponds with other fevers with inirritability.
The hydrocephalus internus is distinguished from apoplexy by its being attended with fever, and from nervous fever by the paroxysms being very irregular, with perfect intermissions many times in a day. In nervous fever the pain of the head generally affects the middle of the forehead ”

“ If we are shocked too severely, we become totally and permanently impaired, and suffer violent fits and fearful rages, insanity or imbecility.
Different shocks, and even forms of disease, result in certain action upon our chemical brain, which causes it to lose only part of its ability. Extreme high fever is only one form of illness which causes the brain to lose its stability and run rampant and unbridled. ”

“ THE OPINION OF DR JULES. ‘TIENS!’ said old Monsieur Croite, the family doctor and trusted friend of the Choisigny family, who had been hastily summoned from Dinard, and who stood looking down at his little patient, with Mr Maxwell and the Vicomte at his elbow. ‘At the first there has been a chill, a most severe one, and that has brought on a slight attack of rheumatic fever. Not bad, that is to say, but still it is there. And on the top of that, as it were, there are signs of irritability of the brain. That may arise from one thing, or it may arise from another. ”

“ This is a disease very much resembling the last mentioned, and is often called brain-fever or frenzy; it arises pretty much from the same cause; all excitants of the system, all things which tend to drive the blood to the head, will induce it. The symptoms are prostration of strength, blindness, frenzy, and often convulsions. The treatment must consist in copious bleedings and strong purgatives, which should be followed up by doses of sulphur to keep the bowels open. ”

“ This new name of the typhus or nervous fever establishes its analogy with several other diseases. We have the acute and the chronic rheumatism; the acute and chronic pneumony, commonly called the pleurisy and pulmonary consumption; the acute and chronic inflammation of the brain, known unfortunately by the unrelated names of phrenitis, madness, and [50] internal dropsy of the brain. Why should we hesitate, in like manner, in admitting acute and chronic fever, in all those cases where no local inflammation attends? ”

“ The mind suffered with the morbid states of the brain and nerves. A delirium was a common symptom. It alternated in some cases with the exacerbations and remissions of the fever. In [119] some, it continued without a remission, until a few hours before death. Many, however, passed through the whole course of the disease without the least derangement in their ideas, even where there were evident signs of a morbid congestion in the brain. Some were seized with maniacal symptoms. In these there was an apparent absence of fever. ”

“ Finally, there is a condition of temporary, evanescent brain-impairment, which is produced by acute disease, and especially by severe attacks of fever. The mental faculties are usually somewhat impaired by severe attacks of typhoid fever, and soldiers, after recovery from such, are not put on sentry duty for months, as they are pretty certain to forget the watchword and countersign. At other times, more marked impressions are made; certain acquirements are entirely lost, or the mind may even become a smoothed tablet. ”

“ We now revert to the year 1517, and shall consider the epidemics which accompanied the English sweating sickness. First of all, the Hauptkrankheit, that brain fever which so often recurred in the central parts of Europe, appeared extensively throughout Germany. Many died of this dangerous disease, and we are assured by contemporaries that other inter-current inflammatory fevers were also very fatal [137] . Such was the 224case in Germany, the heart of Europe. ”

“ The doctor was sent for, but when the spasms ceased, alarming symptoms set in, and he pronounced it a serious case of brain fever. It is impossible to tell the shame and remorse of the conscience stricken girls. ”

“ How great then must necessarily be the diversity of symptoms presented by the different forms of fever! How incalculable are the varieties that result from difference of intensity alone. One degree of affection of the brain, for example, will occasion violent headache, constant watchfulness, great restlessness, a peculiar expression of the eye, and intolerance of light; in another there will be no headache, or none of which the patient will complain; there will be sleep though it be disturbed and unrefreshing; there will be no peculiar expression of the eye, and no intolerance of light. ”

“ No information could be got from the lady herself, who was temporarily insane from an acute attack of brain fever. ”

“ In like manner those who maintain that inflammation of the brain is the sole cause of fever, assume as an established and admitted fact the universal and invariable existence of inflammation of the brain in this disease. ”

“ And in the milder forms which the fever of our own country presents, in the most intense cerebral affection with which we ever meet, there will always be present unequivocal indications of deranged function both in the heart and arteries, and in the organs of secretion and excretion: while in cases in which the brain may be tolerably clear ”

“ The affection of the brain is sometimes so violent and sudden that the pulse is not only slow, but intermitting, and the respiration is suspirious. Frequent and deep sighing is not uncommon in severe cerebral cases, and it is highly characteristic of intense cerebral affection; but in such a violent attack as that of which we are now speaking, the suspirious breathing, even in the very commencement of the disease, is so great that it cannot be overlooked. ”

“ I talked for an hour in this strain; and then my poor faculties, long struggling and sore pushed, gave way completely, and I fell into brain fever.
I chanced upon kind and good-hearted folk, who nursed me with care and watched me with interest; but my illness was a severe one, and it was only in the sixth week that I could be about again, a poor, weak, emaciated creature, with failing limbs and shattered nerves. ”

“ The immediate cause of fever is a poison, which operates primarily and specifically upon the brain and the spinal cord. The diseased state into which these organs are brought by the operation of this poison, deprives them of the power of communicating to the system that supply of stimulus (nervous and sensorial influence) which is requisite to maintain the functions of the economy in the state of health. The organs, the seats of the functions, deprived of their supply of nervous influence, become deranged, the derangement in each taking place in a fixed order, and in a determinate manner. ”

“ It is as much an original disease of the blood-vessels, as any other state of fever. It is to phrenitis, what pulmonary consumption is to pneumony. The derangement in the operations of the mind is the effect only of a chronic inflammation of the brain, existing without an abstraction of muscular excitement. ”

“ In beginning acute mania the condition of the blood affecting the brain or the pathological changes are probably as nearly identical with those in the acute stage of pneumonia, certain forms of typhoid fever, cerebro-spinal meningitis, and other diseases as the symptoms of the mania are now and then difficult to differentiate from those of the other diseases just mentioned. ”

“ Some of the principal symptoms are delirium and drowsiness, fullness of the blood vessels of the head, beating of the temporal arteries, redness and fullness of the face, the pupils dilated, (though in the very early stage they may be contracted.) If the membranes of the brain be the seat of the disease, the pain is more intense, and frequently the limbs are in a palsied state. The patient sometimes vomits immoderately, and the pulse is slow and irregular, but full. The breathing becomes stertorous. The fever is very considerable, and the head hot. ”

“ Giddiness is not uncommon, due partly to increase of labyrinthine pressure, and in some cases to a sympathetic irritation and congestion of the vessels of the basilar brain membrane. Fever is always to be looked for in acute middle-ear disease. ”

“ And conversely, if the brain be injured, consciousness is abolished or altered, even although every other organ in the body be ready to play its normal part. A blow on the head, a sudden subtraction of blood, the pressure of an apoplectic hemorrhage, may have the first effect; whilst a very few ounces of alcohol or grains of opium or hasheesh, or a whiff of chloroform or nitrous oxide gas, are sure to have the second. The delirium of fever, the altered self of insanity, are all due to foreign matters circulating through the brain, or to pathological changes in that organ's substance. ”

“ In the human subject, fever the result of mechanical interference with the nervous system rarely occurs, but it can readily be produced in the lower animals by stimulating certain parts of the great brain, e.g. the anterior portion of the corpus striatum. This leads to a rise of temperature with increased heat production. The high temperature seems to cause disintegration of cell protoplasm and increased excretion of nitrogen and of carbonic acid. Possibly some of the cases of high temperature recorded after injuries to the nervous system may be caused in this way ”

“ Complication of the brain.—At any time during the course of the disease congestion of the brain may occur; at an early period if the fever has been intense from the outset, but in ordinary cases more frequently after three or four days. The animal, which has been stupid and immobile, becomes suddenly restless, walks forward in the stall until it fastens its head in the corner. ”

“ Causeless frequently repeated vomiting [Pg 96] in a child not ill but ailing, is nine times out of ten a sign of mischief in the head. The degree of fever which attends this condition varies much, and its returns are irregular; but any one who knows how to feel the pulse will find it permanently quickened, and if the head is unclosed the pulsations of the brain may be seen and felt distinctly. The sleep is disturbed, the child often waking with a start, while there is occasional twitching of the muscles of its face, or of the tendons of its wrist. ”

“ A further support to the postulate that the brain-cells contribute to the production of fever by sending impulses to the muscles is found in the effect of muscular exertion, or of other forms of motor stimulation, in the presence of a fever-producing infection. Under such circumstances muscular exertion causes additional fever, and causes also added but identical changes in the brain-cells. Thyroid extract and iodin have the same effect as muscular exertion and infection in the production of fever and the production of brain-cell changes. ”

“ In this form of fever, the chilliness in many cases never amounts to shivering; in others, there is an attack of well-marked rigor, and in others, again, there is either no feeling of cold, or it is so slight that it escapes observation.
The symptoms now enumerated are all clearly referrible to derangement of the function of the spinal cord and brain. There is as yet no affection of any 82other organ obviously or, at least, much developed. The circulating system, it is true, is just beginning to be affected. The pulse is no longer perfectly natural. ”

“ It is evident that the thresholds of the brain have been sensitized. In this hypersensitization we find the following strong evidence as to the identity of the various mechanisms for the production of fever. ”

“ If any evidence of cerebral hyperæmia be observed, it is well to give chloral hydrate and the bromides. Hyoscyamus, belladonna, and cannabis indica are useful when the pupils are contracted and when spasmodic symptoms are present. Lukewarm baths, wet packs, and cool sponging are exceedingly [Pg 105] grateful, and often assist in the evolution of a suppressed eruption in the exanthematous fevers.
In the later stages of fever a condition of cerebral exhaustion is sometimes encountered. Irritable weakness caused by starvation of the brain is the prominent feature. The pulse is small and weak. ”

“ The moaning and groaning, The sighing and sobbing, Are quieted now, With that horrible throbbing At heart:—ah, that horrible, Horrible throbbing! The sickness—the nausea— The pitiless pain— Have ceased, with the fever That maddened my brain— With the fever called “Living” That burned in my brain. ”