GEN. VII. Empresma SPEC. I. Inflamma the difference of its exciting cause, partly by the particular portion of the organ that is primarily or chiefly affected, and partly by circumstances which seem to Cephalitis. baffle all research. From this occasional difference of tion of the symptoms some nosologists have endeavoured to esta- brain. blish as many distinct affections, and have hence multiplied a single specific disease into a considerable number of distinct species, and even genera, and treated of it under a fearful host of distinct names: and hence the disease before us has been described, not only under the term cephalitis, but under those of phrenitis, paraphrenitis, phrenismus, sideratio, siriasis, sphacelismus, and typhomania, calentura, and a great many others, which have burthened the medical vocabulary, and perplexed the medical student. mence in or the sub stance of seat how The disease may commence in the meninges, or mem- Disease branes of the brain, or in the substance or parenchyma may comof this organ: and if it were to confine itself strictly to membranes the part first affected, instead of spreading from one part or the to another, there would perhaps be no great difficulty in the brain. determining, from the symptoms before us, its direct Original and actual seat; for while membranous and muscular distinguish inflammation, before the access of gangrene, is accom- able. panied with an acute and rousing pain, great heat, and a pulse considerably and permanently quickened, parenchymatous inflammation is rather distinguished by a heavy, and often a stupifying, pain, a slight increase of heat, and a pulse irregularly quickened, sometimes sinking even below its natural standard *. Now both these conditions are occasionally found in different cases of cephalitis; and we may hence infer that in the one instance the disease is seated chiefly, if not altogether, in the meninges, and in the other in some part of the substance of the brain itself, thus presenting to us the two following varieties:- • Hunter, On Blood, &c. pp. 288, 289. The varie ties apt to run into each other: Phrensy. B Profunda. Pain in the head acute; into- Deep-seated inflamma- The above clear and distinctive marks, however, by which the two varieties are separated from each other in exact cases are not often to be met with; as each, for and hence, reasons already given, is apt to assume something of the not sufficharacter of the other. And hence they have hitherto ciently noticed by escaped the attention of almost all our nosologists, even nosologists. of those who have subdivided inflammation of the brain into the greatest number of distinct genera or species of disease; whilst Vogel expressly declares that all the most acknowledged symptoms of inflammation of the brain are equivocal, not only as to a distinction of one morbid part from another, but as indicative of inflammation in any part; and Dr. Cullen asserts in a note subjoined to his generic definition (for he advances the disease to the rank of a genus, and a genus too without a species or a specific character), that there are no symptoms capable at all times of distinguishing, with certainty, inflammation of the brain from inflammation of its meninges. On which account he deviates from the more complicated arrangements of Sauvages, Linnéus, and Sagar, and includes several of their genera in his own definition, which runs in more general terms as follows: "pyrexy severe; pain of the head; redness of the face and eyes; intolerance of light and sound; watchfulness; fierce delirium or typhomania." Treated of too gene rally by Cullen. There is so much correctness in this remark of Dr. Inflamma of the pre sent subdi Cullen's, notwithstanding the error of his arrangement, GEN. VII. SPEC. I. that the present author yielded to it in the first edition Empresma of his Nosology, and introduced cephalitis, not indeed Cephalitis. as a naked genus without a specific character, but as a tion of the single species without enucleating its varieties; or, in brain. other words, without treating of deep-seated inflammation, constituting acute internal dropsy of the brain, separately from inflammation of the head generally. It Expediency may, perhaps, be doubted, whether acute dropsy of the brain ought to be regarded as an idiopathic inflamma- vision; tion at all, and consequently whether the present is the proper place for it: but the reasons which will immediately be advanced will, I trust, settle this point completely. And, as, upon a closer attention to the subject, notwithstanding Dr. Cullen's remark, I am induced to think that there are cases in which parenchymatous or deepseated inflammation may be distinguished from meningic, I have so far deviated from the first arrangement as to give these distinctions under the form of the above varieties. marks can I admit, nevertheless, with Dr. Cullen, that there are though the no symptoms capable at all times of distinguishing, with distinctive certainty, inflammation of the substance of the brain from not always inflammation of its meninges; and only contend that the be traced. distinction may be drawn in certain cases in which the disease is simple, and the characters strong and unmixed; and strikingly indicative of membranous or parenchymatous inflammation, according to the general rules just laid down upon this subject. what. It is possible, indeed, that meningic inflammation Arachnitis, may occasionally be still more limited, and exist chiefly or altogether in one of the membranes alone, as the arachnoid, whence some pathologists have set down ARACHNITIS as a sub-variety of the meningic form: but as such minute derivations can never be supported by pathognomic symptoms, nor lead to any practical utility, I cannot but prefer the example of Professor Frank, and indeed of most of the Italian pathologists, in rejecting GEN. VII. them, to that of Pinelle and other French writers in introducing or retaining them. SPEC. I. Empresma tion of the brain. discoverable more frequently in meningic than in Whence the first is universally described: I believe that a simple and unrestricted appearance of Inflamma- inflammation is more frequently to be traced in meningic than in profound or parenchymatous cephalitis; or, in These marks other words, that in primary inflammation of the substance of the brain, the meninges are more disposed to partake of the affection either by continuous action or sympathy, than the substance of the brain is in primary inflammadeep-seated tion of the meninges. And hence those nosologists that cephalitis. describe but a single species, or genus of this disease, as it has been often though incorrectly denominated, as Vogel, Cullen, and Parr, lean chiefly to the meningic variety, and define it by characters of great vehemence or acuteness, so as in reality to limit themselves to this variety alone. Yet as the symptoms do not always nor even most frequently mount up to this aggravation, in consequence of the disease more commonly originating, or being more commonly seated, in the substance of the brain itself than in its membranes, they have all been dissatisfied with their respective definitions; and instead of enlarging or modifying their terms to meet the distinctive phænomena as they vary according to the seat of the disease, have endeavoured to apologize for their own inaccuracy, by representing these phænomena as irreducible and anomalous. and given The first variety, therefore exists in the judgement as a general and even in the description of all writers, who, where they character of the discase. Reasons for admitting the second variety. have not entered into more minute subdivisions, have given it as the general character of the complaint. The existence of the second variety, or, in other words, the propriety of regarding what has hitherto been denominated acute or internal hydrocephalus as a variery of cephalitis, requires to be examined somewhat more at length. * Recherches sur l'Inflammation de l'Arachnoide, &c. Par P. Duchatelet, M,D,, &c. et I. Martinet, M.D. 8vo. Paris, 1821. GEN. VII. SPEC. I. Inflamma How far an apoplexy. The absurdity of the usual arrangement of internal hydrocephalus, and of contemplating it as belonging to Empresma the ordinary family of dropsies with which it has scarcely Cephalitis. a common symptom, has long been felt by pathologists, and is directly noticed both by Sauvages and Cullen. brain. But the question is, if we remove it from its usual situa- Absurdly tion, where are we to place it? if we do not regard it as belonging to regarded as a dropsy, in what light are we to contemplate it at all? dropsies. and how are we to regulate our treatment of it? The professor of Montpellier tells us that, according to its symptoms, it is to be ranked in the comatose, spasmodic, or some other tribe of diseases: distinctly importing that, in his own opinion, he could not refer it to any single division in his very extensive classification. Dr. Cullen's reply is, that it is an evident and idiopathic species of apoplexy, and ought to take its place under that genus; and he has hence distinguished it by the appellation apoplexia hydrocephalica, and in this manner assigned it "a local habitation and a name". In reference to this assignment he observes, however, that, in a nosological work, it is difficult to collate exactly diseases that in their progress assume a changeable form, and hence to allot a perfectly fitting place to hydrocephalic apoplexy. "Yet I prefer", says he, "placing this disease under the head of apoplexy, to placing it under that of hydrocephalus (dropsy of the head); first, as it differs extremely from the symptoms of sensible (external) dropsy of the head; and next, as in its proximate cause, and at length in its symptoms, it bears to apoplexy as near a relation as possible." Dr. Cullen evidently regarded the effusion or dropsy in the ventricles of the brain as a mere effect of the disease, rather than as the disease itself: yet the drowsiness, or heavy sleep, or whatever else there is a-kin to apoplexy, and which he contemplated as the proximate cause of the disease, and consequently as the disease itself, is a still more remote effect than even the effusion, for it is probably the mere result of such effusion. In truth, it is only necessary to run over Dr. Cullen's specific Mistake of the effect for the cause. |