Supplement to Some observations on the muscular contractions which occasionally happen after death from cholera: containing a note of a case of apoplexy, after which similar movements were remarked / [William Frederick Barlow].

  • Barlow, W. F. (William Frederick), 1817-1853
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Supplement to Some observations on the muscular contractions which occasionally happen after death from cholera: containing a note of a case of apoplexy, after which similar movements were remarked / [William Frederick Barlow]. Source: Wellcome Collection.

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    I ment of tlie principal pathological changes observed after death in the pre¬ ceding instance. There was no peculiarity in the ex¬ ternal appearance of the body, which was examined eighteen hours after death. The limbs were by no means unusu¬ ally rigid. The vessels of the brain were more congested than usual, and a flattening of the convolutions was observed. On opening the left lateral ventricle it was found completely filled with co- .agulated blood ; the septum was broken down, and some bloody fluid, with scarcely any coagula, was observed in the fellow cavity. Some blood, too, had made its way into the fourth ventricle. The hae¬ morrhage seemed to have proceeded from the corpus striatum, thalamus op¬ ticus, and almost the entire portion of brain which formed the floor of the left lateral ventricle. This portion was soft, irregular, shreddy, and the blood which covered it was mixed here and there with diffluent cerebral matter. Nume¬ rous bloody points remained diffused everywhere, after wrater had been gently but freely poured over it. There was no marked degree of softening in any place, if we except that part of the brain which lay just immediately beneath what appeared the direct seat of the apoplexy. The arteries at the base of the organ presented unmistakeable and pretty ge¬ neral signs of fatty degeneration. The heart, which was, I think, to some de¬ gree enlarged, showed a marked rigor mortis, such as formerly led to the use of the erroneous term “ concentric hy¬ pertrophy.” The aorta was thickly studded with atheromatous or fatty de¬ posit, and there was a considerable layer of fat upon the surface of the right ven¬ tricle. The kidneys, which lay im¬ bedded in most abundant fat, were atro¬ phied, and far advanced in granular degeneration. Some urine was in the bladder, which was highly albuminous. Thinking it most likely that the mus¬ cular fibres of the heart would be to some extent in a state of fatty degene¬ ration, though, looking to the rigid state of the organ, not far gone therein, I requested Dr. Quain to examine it mi croscopically; but, through accident, the heart did not reach him in a state sufficiently fresh to admit of that satis¬ factory scrutiny which was desirable. Dr. Quain observes, in a letter with which he favoured me,—“ There is abun¬ dant evidence of granular fatty matter in the muscular fibre. This appearance exists throughout several parts of the heart that I have examined; but the granules are very small. The degene¬ ration, therefore, though extensive, is not greatly advanced. It is possible that the presence of some of this mat¬ ter is due to decomposition; still I feel quite satisfied, from the general appear ance of the heart, that fat would have been found if the heart had been exa¬ mined when fresh.”* Examinations of cases of this kind cannot, of course, be satisfactory without the microscope be used. The pathology of fatty degeneration is only to a slight extent explorable by the unaided eye. I can hardly doubt that, had the small blood-vessels of the brain been examined, we should have discovered in such de¬ generation of them the precursor and cause of the apoplexy. I rest this ob¬ servation on a communication of Mr. Paget to the Abernethian Society, “ On Fatty Degeneration of the Small Blood¬ vessels of the Brain, and its relation to Apoplexy,”-)-—a contribution to patho¬ logy of the highest value. It would have been necessary to have apologised for making such special re¬ ference to the fatty degeneration of the heart which was observed, had not the subject of that common change the widest possible relation to the whole question of muscular irritability, when¬ ever, however manifested. The relation of such degeneration to the irritability of the heart is every now and then emphatically exemplified by the action of the organ suddenly failing, and as suddenly producing death. The proper stimulus is not withdrawn, but the damaged fibre fails to respond : the stimulus cannot act on it, as galva- * The just published volume of the Royal Me¬ dico-Chi rurgical Society contains a most ad¬ mirable contribution, by Dr. Quain, on Fatty Diseases of the Heart. f Since published in the Medical Gazette. Fatty degeneration 'will, it may be fairly antici¬ pated, be the means of explaining some forms of paralysis, both cerebral and spinal, some dis¬ eases of the special senses, and some affections of the mind, especially in aged people, whereof the immediate cause is at present hidden. In a case of nearly complete blindness (the subject of which was a patient of Mr. Holt’s) the optic nerves were found after death to have most exten¬ sively undergone this form of degeneration. They were first examined by Mr. Holthouse, and afterwards by Mr Dalrymple, who were both quite satisfied on this point. I had the opportu¬ nity of examining them.