A treatise on the practice of medicine (Volume 2).

  • Eberle, John, 1787-1838.
Date:
1838
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the practice of medicine (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    sions of this kind occur into the substance of the lungs from violent engorgement of its blood-veseels. It appears highly probable, therefore, that strong vascular tur- gescence of the encephalic, mass, constitutes the primary pathological condition of apoplexy. This state often terminates almost immedi- ately in sanguineous extravasation, or at a later period in serous effusion; and both these consequences constitute, of course, additional causes of cerebral compression.* To this view of the pathology of apoplexy, it has been objected, that cases sometimes occur in which the brain on dissection exhibits no traces whatever of vascular congestion, nor any other obvious lesions. Petzold has related instances of this kind, which he ascribes to inanition of the cerebral vessels, and in which not the slightest unnatural appearances were discovered on dissection, except an empty and collapsed state of the vessels of the brain.t Such cases are, however, extremely uncommon; and do not, upon proper inquiry, militate against the doctrine advocated above. Upon this point Dr. Johnson observes, that there is nothing more certain than that the vascular turgescence in the brain may so far subside, in the interval between death and dissection, as to leave no trace of its previous existence. This, in fact, he continues, we consider to be the natural and true solution of the difficulty respecting the cause of apoplexy in those cases where the scalpel cannot detect deviations * M. Serres contends that both sanguineous and serous affections aTe always the effect, and not the cause of apoplexy. He denies that pressure, in any case is capable of producing either this disease or hemiplegia. He thinks, that what is usually termed serous apoplexy depends on disease of the meninges; apoplexy with paralysis, he says, is the immediate consequence of an altered state of the cerebral structure, attended generally with sanguineous extravasation as a secon- dary result. His reasons for denying the agency of pressure in the causation of this affection, are derived from the fact, that fatal apoplexy sometimes occurs without any effusion or extravasation, or even vascular turgescence appearing on dissection: and from some experiments which he made on animals, in which the cranium was opened, and a vessel wounded, and the blood carefully confined within the head by closing up the external opening. Although much blood was thus extravasated and lodged into the great interlobular scissure and upon the surface of the brain, no comatose or paralytic affections ensued. These views, so far as cerebral pressure is concerned in the production of the disease, are, however, directly contradicted by the results of some experiments made in rela- tion to this subject by Portal. This pathologist trepanned the cranium of a doo-. By different degrees of pressure made on the brain through the opening with the finger or a piece of wood, he could at pleasure produce convulsions, or coma, and apoplectic stertor; and Sir Astley Cooper obtained the same results from similar experiments made on a dog.(a) ■j- Dissert, de apoplexia ex inanitione vasorum cerebri, Goett. 1785. (a) Cook on Nervous Diseases.