SPEC. V. stance of the brain, and particularly into the white part, GEN. VIII. 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 Apoplexy. 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 proceed vessels. And there can be no question that in proportion 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 mollesccnt 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 former indeed asserts roundly that in the whole extent in the weakchiefly found of his practice he has never met with more than one in- ness of advanced age stance in which he was suspicious of it at or under the age of thirty, and as examination after death was not here allowed him, he does not regard even this case as of any moment. from the same cause. GEN. VIII. plexia. Apoplexy Nature of the conges tive fluid sometimes It is singular that the congestive fluid, instead of Carus Apo- proving a material elaborated by the animal frame itself, should sometimes consist of a foreign material recently received into the stomach. Dr. Cooke has given a case strikingly in proof of this, which I shall offer in his own words: "I am informed by Mr. Carlisle that, a few very singu- years ago, a man was brought dead into the Westminster lar, and has 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 two thirds water." It is curious, and scems to baffle all explanation, to see how readily substances foreign to the blood, when they once enter into its current, are often carried from one organ to another, undiluted and undisfrom organ solved, and deposited in an entire, or nearly an entire 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 mercury travels chiefly to the salivary glands, and perhaps several of the demulcents to the lungs. Parallel in stances of the transfer of exotic bodies or substances to organ. These dif ferent sources of a com pressed brain bespeak an opposite state of vascular action : and hence apoplexy has long been contemplat ed under two distinct neous from energy, and On examining the different sources of a compressed brain, as we have just enumerated them, it will be obvious that they bespeak a very different, and, indeed, opposite state of vascular action in different cases; and that while some of them necessarily imply a vehement and entonic power, others as necessarily imply an infirm and atonic condition. The external symptoms, from the first, speak to the same effect; and hence, from an early period of time,-as early at least as that of La Riviere or Riveriust-apoplexy has been contemplated under two distinct On Nervous Diseases, Vol. 1. p. 221. Schrader has a similar case, Observ. Anat. Med. Decad. iv. Amst. 1674. As also Wepffer, Observ. Medico-pract. p. 7. Scaph. 1722. + Praxis Medica. 8vo. Lugd. 1670. SPEC. V. a serous from defi forms or varieties, which have commonly been denominated GEN. VIII. sanguineous, and pituitous or serous; as though the for- Carus Apomer 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 dilute 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 objected to as not always expressive serous or of the actual state of the brain in atonic cases: terms strong The term pituitous or scrous, however, has been objected to as not always expressing the actual state of the brain in atonic apoplexy; since no serum has been found at times in cases where the symptoms of debility have peculiarly led those pathologists to expect it who have employed the distinctive term; while the cavities and interstitial parts of the brain, have, on the contrary, been someand hence times found as much loaded with blood, as in what they by some denominate sanguineous apoplexy. And hence, Forestus writers the and a few other writers have been disposed to exchange and weak the terms sanguineous and serous, for strong or perfect, apoplexy and weak or imperfect apoplexy. How far a modifica- have been tion of this disease, strictly serous, may be said to exist, stead, diswe shall examine presently; but that apoplexy is continually showing itself under the two forms of entonic, and atonic action, seems to be admitted by all. And, as the terms sanguineous and serous do not sufficiently express laying a this change of condition in every instance, the author, in proceeding to treat of these two varieties, will, for the fu- rieties with ture, distinguish them as follows: a Entonica. Entonic apoplexy. B Atonica. Atonic apoplexy. With a hard full pulse, flushed With a feeble pulse, and pale countenance. In ENTONIC APOPLEXY the fit is, for the most part, used in their luding to an tinctly alentonic and atonic action, and foundation for two va these names. GEN. VIII. SPEC. V. " C. Apoplexia entonica. Entonic sudden and without warning; though a dull pain in the head occasionally precedes the attack, accompanied with a sense of weight or heaviness, somnolency and vertigo. The inspirations are deeper than natural; the face and eyes are red and turgid, and blood bursts from the nostrils. On the incursion of the paroxysm, the patient falls to the ground, and lies as in a heavy sleep from which he cannot be roused. The breathing is strikingly oppressive: precursive though at first, perhaps, slow and regular, increasing in frequency, weakness, and irregularity with the progress of the fit, till at length it becomes, in many cases, intermitting and convulsive. apoplexy. Approach of the dis ease: occasional signs. Incursion. ways present in this disease. Accounted for. 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 mucus is secreted by their excretories, than is carried off almost alby the corresponding absorbents; in consequence of which form of the it accumulates, and impedes the free flux and reflux of the air in respiration. And hence, stertor, though not a symptom essential to apoplexy, as a species, may be ranked as a pathognomic character of the particular form before us. And to the same effect Dr. Cooke and the most celebrated pathogolists who have preceded him. "Boerhaave”, says illustrated. 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."* Further * On Nervous Diseases, Vol. 1. p. 171. GEN. VIII. SPEC. V. a C. Apoplexia enEntonic tonica. tinues even in the weakness of the The author has witnessed it in the same manner continuing to the last gasp of life: the reason of which is, that, although in consequence of the debility which has now, perhaps, succeeded to morbid strength of action, there is less mucus secreted in the larynx and fauces apoplexy. than on the commencement of the disease, the absorbents Stertor conof these organs, participating in the growing weakness, are only capable of carrying off the finer and more attenuate part of the fluid, and thus leave the more viscid 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. CO last gasp. Explained. Hence too an accumu lation of frothy sathe lips. Further description. Cornea liva about dull, pupil dilated. spastic or action. The skin is about the ordinary temperature, and vered with a copious perspiration, or a clammy sweat: the pulse is full and hard, the face flushed, the eyes blood-shot and prominent, and generally closed. The cornea is dull and glassy, and the pupil for the most part dilated. In a few cases, however, there is a tendency to either spastic or convulsive action, spreading sometimes over the limbs, but more generally confined to the muscles of the face: insomuch that, under the first, the teeth are firmly closed, Sometimes and deglutition is impeded. And where this state exists convulsive the pupil is contracted, as in a synizesis, sometimes, indeed, almost to a point. This last feature has been rarely dwelt upon by pathologists, whether of ancient or modern tracted, times: but it has not escaped the observant eye of my 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, Aretaus among the ancients, and Dr. Cheyne among the moderns excepted, who has noticed the contracted pupil in these Pupil some observed by particularly * On Nervous Diseases, Vol. 1. p. 174. |
