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stance of the brain, and particularly into the white part, Gen. VIII.
Spec. V. is a secretion sui generis, and so long as the secernents Carus Apoand absorbents of this organ maintain a healthy action, plexia. and precisely counterbalance each other, this material ap will be duly supplied, and in a healthy state, as it is wanted, and duly removed to make way for a fresh recruit as it becomes worn out. But if the organ from any cause become weakened in its vascular powers, that weakness will extend to one or both the sets of vessels we are now considering, and the result will necessarily be the existence of brainy matter of a depraved and untempered tenacity. The secernents may not pour it forth in a sufficient abundance to supply the waste, or they may pour it forth in a dilute and unelaborated crasis, whence the general tissue must be soft and pulpy: or if the material be duly attempered as furnished by the secernents, the absorbents may be too debilitated to imbibe more than the thinner and attenuate parts of the texture when worn out by use, and leave the grosser behind ; in which case the matter of the brain, at least in the regions thus affected, must necessarily be rendered morbidly tough or even horny.. And hence both extremes may proceed from the same Both may cause operating in a different way or upon different sets of pro vessels. And there can be no question that in proportion same cause. as the compages of the brain becomes looser and less resistible, effusions of serum and red-blood, ulceration. gangrene, and a total dissolution of the entire substance, must in many cases follow as a natural result, and in the order here stated. And hence in cancer of the brain the substance of the organ is always found in a soft or mollescent state. As a further proof that this peculiar change is for the most part a result of debility, it is admitted by both M. Rostan and M. Lallemand that it is by far most frequently met with in persons of advanced age; the Pulpy brain
he chiefly found former indeed asserts roundly that in the whole extent thi of his practice he has never met with more than one in- ness of adstance in which he was suspicious of it at or under the age vanced of thirty, and as examination after death was not here allowed him, he does not regard even this case as of any moment.
GEN. VIII. It is singular that the congestive fluid, instead of
should sometimes consist of a foreign material recently
received into the stomach. Dr. Cooke has given a case Nature of the conges- strikingly in proof of this, which I shall offer in his own tive fluid
words: “I am informed by Mr. Carlisle that, a few sometimes very singu- years ago, a man was brought dead into the Westminster
19. Hospital, who had just drank a quart of gin for a wager. been ardent spirits. The evidences of death being quite conclusive, he was Illustrated. immediately examined ; and within the lateral ventricles
of the brain was found a considerable quantity of a limpid fluid distinctly impregnated with gin, both to the sense of smell and taste, and even to the test of inflammability. " The liquid', says Mr. Carlisle, 'appeared to the senses
of the examining students as strong as one third gin to Parallel in- two thirds water.""* It is curious, and scems to baffle stances of
all explanation, to see how readily substances foreign to of exotic the blood, when they once enter into its current, are often substances carried from one organ to another, undiluted and undisfrom organ solved, and deposited in an entire, or nearly an entire to organ.
state, in a remote quarter. Absorbed pus affords us frequent examples of this, and morbid poisons, as they are called, still more frequent. It is hence that various medicines are enabled to act by a specific power; that mer
cury travels chiefly to the salivary glands, and perhaps These dif- several of the demulcents to the lungs.
On examining the different sources of a compressed
brain, as we have just enumerated them, it will be obbrain be
vious that they bespeak a very different, and, indeed, opspeak an posite state of vascular action in different cases ; and that opposite state of
while some of them necessarily imply a vehement and vascular entonic power, others as necessarily imply an infirm and action : and hence atonic condition. The external symptoms, from the first, apoplexy has speak to the same effect; and hence, from an early period Jong been contemplat- of time,-as early at least as that of La Riviere or Riveed under two riust-apoplexy has been contemplated under two distinct forms:
ferent sources of a compressed
* On Nervous Diseases, Vol. 1. p. 221. a sangui
Schrader has a similar case, neous From Observ. Anat. Med. Decad. Iv. Amst. 1674. As also Wepffer, Observ. Me excess of dico-pract. p. 7. Scaph. 1722. energy, and + Praxis Medica. 8vo. Lugd. 1670.
forms or varieties, which have commonly been denominated Gen. VIII. sanguineous, and pituitous or serous; as though the for
Spec. V. mer proceeded from an overflow of blood highly elaborated plexia. by a vigorous and robust constitution, and rushing for- Apoplexy. ward with great impetuosity; and the latter from thin from defidilute blood, or a leucophlegmatic habit, from the relaxed cient energy. mouths of whose vessels a serous effusion is perpetually flowing forth. Morgagni has endeavoured to show, but without success, that this distinction was in existence among the Greek writers. It is a distinction, however, that runs, not only through his own works, but through those of Boerhaave, Sennert, Mead, Sauvages, and Cullen, and is acknowledged by most practitioners of the present day.
The term pituitous or serous, however, has been ob- The term jected to as not always expressing the actual state of the pituitous obbrain in atonic apoplexy; since no serum has been found jected to as
not always at times in cases where the symptoms of debility have pe- expressive culiarly led those pathologists to expect it who have em- of the actual
state of the ployed the distinctive term ; while the cavities and intersti- brain in atotial parts of the brain, have, on the contrary, been some- nic cases : times found as much loaded with blood, as in what they an
by some denominate sanguineous apoplexy. And hence, Forestus writers the and a few other writers have been disposed to exchange to the terms sanguineous and serous, for strong or perfect, apoplexy and weak or imperfect apoplexy. How far a modification of this disease, strictly serous, may be said to exist, stead, diswe shall examine presently ; but that apoplexy is con
vis on tinctly al
luding to an tinually showing itself under the two forms of entonic, and entonic and atonic action, seems to be admitted by all. And, as the atonic
ld, as the action, and terms sanguineous and serous do not sufficiently express laying a this change of condition in every instance, the author, in
11 for two vaproceeding to treat of these two varieties, will, for the fu- rieties with ture, distinguish them as follows:
these names. a Entonica.
With a hard full pulse, flushed Entonic apoplexy. countenance, and stertorous
breathing. B Atonica.
With a feeble pulse, and pale
GEN. VIII. sudden and without warning ; though a dull pain in the
:: head occasionally precedes the attack, accompanied with a C. Apoplexia en- a sense of weight or heaviness, somnolency and vertigo. Entonic
The inspirations are deeper than natural; the face and apoplexy. eyes are red and turgid, and blood bursts from the nosApproach trils. On the incursion of the paroxysm, the patient falls of the dis
to the ground, and lies as in a heavy sleep from which he occasional cannot be roused. The breathing is strikingly oppressive: precursive though at first, perhaps, slow and regular, increasing in signs. Incursion.
frequency, weakness, and irregularity with the progress of the fit, till at length it becomes, in many cases, intermitting and convulsive.
It is in this form of the disease that we chiefly meet with, and are almost always sure to find, a snoring or stertorous breathing; nor is this difficult to be accounted for, since the vessels of the trachea, and particularly those
of the larynx and fauces, labouring under the same augStertorous mented action as those of the head, a larger portion of breathing almost al. mucus is secreted by their excretories, than is carried off ways pre by the corresponding absorbents; in consequence of which sent in this form of the it accumulates, and impedes the free flux and reflux of the disease. air in respiration. And hence, stertor, though not a symAccounted ptom essential to apoplexy, as a species, may be ranked as for.
a pathognomic character of the particular form before us.
And to the same effect Dr. Cooke and the most celebrated Further pathogolists who have preceded him. “Boerhaave”, says
he, “measures the strength of the disease by the degree of stertor; and Portal agrees with him in opinion on this subject; observing that respiration in apoplexy is greatly impeded and the motions of the breast are very apparent. We hear a noise of snoring or stertor," he says, “which is great in proportion as the apoplexy is strong. In all the cases of strong apoplexy which I have seen, the respiration in the beginning of the paroxysm was laborious, slow, and stertorous; and in those which proved fatal, this symptom as far as I can recollect, remained, even when the breathing had became weak and irregular."*
* On Nervous Diseases, Vol. I. p. 171.
The author has witnessed it in the same manner con- GEN. VIII.
Spec. V. tinuing to the last gasp of life: the reason of which is, a C. A that, although in consequence of the debility which has plexia en
tonica. now, perhaps, succeeded to morbid strength of action, Entonic there is less mucus secreted in the larynx and fauces apoplexy. than on the commencement of the disease, the absorbents Stertor con
tinues even of these organs, participating in the growing weakness, in the weakare only capable of carrying off the finer and more at- ness of the
last gasp. tenuate part of the fluid, and thus leave the more viscid Explained. in a state of accumulation. And it is for the same reason that from first to last there is often, also, an accumulation of frothy saliva or foam, which, as it becomes troublesome by its increase, is occasionally blown away from the lips with considerable force. The skin is about the ordinary temperature, and co- Hence too
an accumuvered with a copious perspiration, or a clammy sweat: the lation of pulse is full and hard, the face flushed, the eyes blood-shot frothy sa
liva about and prominent, and generally closed. The cornea is dull the lips. and glassy, and the pupil for the most part dilated. In a Further defew cases, however, there is a tendency to either spastic or scription. convulsive action, spreading sometimes over the limbs, but
Cornea more generally confined to the muscles of the face: inso- dilated. much that, under the first, the teeth are firmly closed, Sometimes
spastic or and deglutition is impeded. And where this state exists convulsive the pupil is contracted, as in a synizesis, sometimes, in- action. deed, almost to a point. This last feature has been rarely
ely times condwelt upon by pathologists, whether of ancient or modern tracted, times : but it has not escaped the observant eye of my bus accurate and learned friend Dr. Cooke: “ In some in- Cooke. stances”, says he, “I have seen the pupil contracted almost to a point, and a physician of eminence of my acquaintance has likewise observed this appearance of the eyes in apoplexy : yet although all writers on the subject mention the dilated pupils, I do not find any one, Aretæus among the ancients, and Dr. Cheyne among the moderns excepted, who has noticed the contracted pupil in these cases.” *
* On Nervous Diseases, Vol. 1. p. 174.