cerebral congestion

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641 faculty against giving bTisk purgatives in tetanus. The few patients I have had of this kind, all seemed essentially benefited by their use. As tetanus and rabies seem nearly allied, and as nothing has given any relief in hydro- phobia, would not the turpentine be worth experiment? Mr. Youatt, of London, is a very intelligent man, and I dare say would render any assistance in his power in testing the medicine. I have the honour to remain, Sir, your most obliged servant, J. PEACOCK. Darlington, Jan. 1837. J. PEACOCK. CEREBRAL CONGESTION. QUALITY OF THE BLOOD. THE following is the substance of a valu- able paper which has been presented to the Medical Society of Angers, by M. J. GUER- TIN, entitled "Observations upon some Points in the History of Cerebral Conges- tions," and published in the Archives Géné- rales de Médicine for October, 1836 :— In the discussion of this subject I will content myself by statirg facts which were observed with due attention, and which, generally speaking, confirm the symptoma- tology which has been given to the world by Professor Andral. Cerebral congestion consists in the pre- sence of a subordinate quantity of blood in the vessels of the encephalon, produced either by an increased afflux of that fluid, or an interruption of its return. Are the symp- toms of cerebral congestion attributable to the superabundance of blood alone ? Is not the excessive richness of nutritive materials of that fluid sometimes the cause? These are serious questions with authors who have observed, first, the absolute inutility of bloodletting, even though frequently re- peated, in some cases ; secondly, that this congestion frequently prevails amongst those persons who indulge in abundant and rich nourishment; and, finally, that symptoms of excess of cerebral blood are prolonged in in- dividuals who, upon post-mortem examina- tion being made, have not displayed more than a normal quantity of blood in the ves- sels of the encephalon. Persons who for a length of time have pre- sented a plethoric constitution, suddenly fall down, without warning, and die, not showing any peculiarity of organization which throws light on the subject, even when autopsies are most carefully performed. No fulness of the cerebral vessels is perceived ; the blood does not contain more than the normal quantity of fibrine. Is it ridiculous to sup- pose that in such cases the blood had-gradu ally arrived at that point of excessive rich ness which would no longer allow life to be maintained ? CASE.ŁPIerre Dodin, aged 47, a stone’ cutter, of middle size, and squat form, was received in the Hotel-Dieu at’Angers, on the e 6thof April, 1834. From his seventh or eighth year he had shown a remarkably plethoric habit. The neck was short, the face red, the pulse full and rebounding; the perspi- ration was free; his muscular movements were slow ; he had frequent headachs, par- ticularly in the forehead, and sometimes a stunning and a sensation of amazement. The patient was accustomed to excess of diet, and indulged in copious libations. He had been frequently bled or leeched; sometimes his eyesight was better than usual, and his ideas were less obtuse ; but this improved state did not continue longer than two days. The torpor and stiffness alwaya remained. He had never experienced a rapid determi- nation of blood to the head, nor had he been paralytic. These symptoms were remarked when he was received into the hospital. The respiratory functions, the circulatory system, and the digestion, were natural, only his ap- petite was inconsiderable, and he was easily satiated. He had no febrile symptom. Up to the 22d of April, 1834, he had been bled twice, to the extent of 14 ounces each time, and 25 leeches had been applied to the breech. At the- same time an infusion of balm was used, but there was no sensible amelioration of the symptoms.-On the even- ing of the 22d, after having walked for the greater part of the day, (as he was accus- tomed), he laid down, at about 7 o’clock, and it was reported that he appeared to sleep tranquilly for about two hours. After midnight he called the overseer of the Infir- mary, and complained of a most violent headach, flashings of light, and stupor. Soon afterwards he lost his voice, and also his mental faculties. It was also observed that his limbs became rigid. He died in ten minutes afterwards. Dissection.-The muscles were well de- fined ; their outline was distinct, and the tint of the skin was slightly blue.—Encepha- ton. The membranes of the cranium were sound. The superior longitudinal sinus con- tained consistent black blood, with some polypus concretions, about three inches in length. About an ounce of limpid serum was contained within the pia mater. The membranes were not unusually vascular. The volume, consistence, and general aspect of the encephalon, were normal, and when cut into fine slices, scarcely any red points were visible. Nearly an ounce of serum was contained in the ventricles. The cerebellum, the protuberance, and the spinal marrow, were in a natural state.-thorax. 2U

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641

faculty against giving bTisk purgatives intetanus. The few patients I have had ofthis kind, all seemed essentially benefitedby their use.As tetanus and rabies seem nearly allied,

and as nothing has given any relief in hydro-phobia, would not the turpentine be worthexperiment? Mr. Youatt, of London, is avery intelligent man, and I dare say wouldrender any assistance in his power in testingthe medicine. I have the honour to remain,Sir, your most obliged servant,

J. PEACOCK.Darlington, Jan. 1837.

J. PEACOCK.

CEREBRAL CONGESTION.

QUALITY OF THE BLOOD.

THE following is the substance of a valu-able paper which has been presented to theMedical Society of Angers, by M. J. GUER-TIN, entitled "Observations upon some

Points in the History of Cerebral Conges-tions," and published in the Archives Géné-

rales de Médicine for October, 1836 :—

In the discussion of this subject I willcontent myself by statirg facts which wereobserved with due attention, and which,generally speaking, confirm the symptoma-tology which has been given to the world byProfessor Andral.Cerebral congestion consists in the pre-

sence of a subordinate quantity of bloodin the vessels of the encephalon, producedeither by an increased afflux of that fluid, oran interruption of its return. Are the symp-toms of cerebral congestion attributable tothe superabundance of blood alone ? Is notthe excessive richness of nutritive materialsof that fluid sometimes the cause? Theseare serious questions with authors who haveobserved, first, the absolute inutility of

bloodletting, even though frequently re-

peated, in some cases ; secondly, that thiscongestion frequently prevails amongst thosepersons who indulge in abundant and richnourishment; and, finally, that symptoms of excess of cerebral blood are prolonged in in-dividuals who, upon post-mortem examina-tion being made, have not displayed morethan a normal quantity of blood in the ves-sels of the encephalon.Persons who for a length of time have pre-

sented a plethoric constitution, suddenly falldown, without warning, and die, not showingany peculiarity of organization which throwslight on the subject, even when autopsiesare most carefully performed. No fulnessof the cerebral vessels is perceived ; theblood does not contain more than the normal

quantity of fibrine. Is it ridiculous to sup-pose that in such cases the blood had-gradually arrived at that point of excessive richness which would no longer allow life to bemaintained ? .

CASE.ŁPIerre Dodin, aged 47, a stone’cutter, of middle size, and squat form, wasreceived in the Hotel-Dieu at’Angers, on the e6thof April, 1834. From his seventh or eighthyear he had shown a remarkably plethorichabit. The neck was short, the face red,the pulse full and rebounding; the perspi-ration was free; his muscular movementswere slow ; he had frequent headachs, par-ticularly in the forehead, and sometimes astunning and a sensation of amazement. Thepatient was accustomed to excess of diet,and indulged in copious libations. He hadbeen frequently bled or leeched; sometimeshis eyesight was better than usual, and hisideas were less obtuse ; but this improvedstate did not continue longer than two days.The torpor and stiffness alwaya remained.He had never experienced a rapid determi-nation of blood to the head, nor had he beenparalytic. These symptoms were remarkedwhen he was received into the hospital. Therespiratory functions, the circulatory system,and the digestion, were natural, only his ap-petite was inconsiderable, and he was easilysatiated. He had no febrile symptom.Up to the 22d of April, 1834, he had been

bled twice, to the extent of 14 ounces eachtime, and 25 leeches had been applied tothe breech. At the- same time an infusionof balm was used, but there was no sensibleamelioration of the symptoms.-On the even-ing of the 22d, after having walked for thegreater part of the day, (as he was accus-tomed), he laid down, at about 7 o’clock,and it was reported that he appeared to

sleep tranquilly for about two hours. Aftermidnight he called the overseer of the Infir-mary, and complained of a most violentheadach, flashings of light, and stupor. Soonafterwards he lost his voice, and also hismental faculties. It was also observed thathis limbs became rigid. He died in tenminutes afterwards.

Dissection.-The muscles were well de-fined ; their outline was distinct, and thetint of the skin was slightly blue.—Encepha-ton. The membranes of the cranium weresound. The superior longitudinal sinus con-tained consistent black blood, with somepolypus concretions, about three inches inlength. About an ounce of limpid serumwas contained within the pia mater. Themembranes were not unusually vascular.The volume, consistence, and generalaspect of the encephalon, were normal, andwhen cut into fine slices, scarcely any redpoints were visible. Nearly an ounce ofserum was contained in the ventricles. Thecerebellum, the protuberance, and the spinalmarrow, were in a natural state.-thorax.

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The lungs were sound, and crepitatingthroughout, and were slightly blue. Onethird of the posterior portion of the lungs,when cut into, was of a deep-red tint. Therewas no indication of pulmonary apoplexy,nor was there any softening of the substanceof the lungs. The trachea and larynx werein a normal state. The right ventricle of theheart showed a slight eccentric hypertrophy.Black blood, in consistent clots, with abun-dant fibrinous concretions, filled, exactly,the two ventricles of the heart, and the archof the aorta. The blood was somewhat ad-hesive, black, and clotted throughout in itstexture. Several small zones, of a deep-redcolour, were observed upon a certain partof the stomach. There was also a smallwhite zone at the cardia.M. Guertin appended reports of several

other cases to his communication, which itis not necessary to translate. We are awarethat certain descriptions of blood circulatevery readily in the vessels of the brain, andothers do not. We need scarcely point outto our readers, boy way of illustration, thedifficulty with which the black and anormalblood in cholera cases circulated in theencephalon.

" Many patients," says M. Guertin,94 displaying a striking resemblance in theiraspect and progress, presented symptomswhich have not been set forth in the eightforms of M. Andral. I do not know whether,in the fourth form, that illustrious Professormeant by irregularity,’ disorders of mobility,-not only.the convulsive motions and mus-cular rigidity, but also certain general mo-tions-a kind of play of the muscles-whichI will signalize:in the following observations,joined to a certain degree of consciousness.In this case it will become me to combinethese with this fourth form, but the fewwords which M. Andral bestows thereon,do not appear to me to comprehend, or in-clude, the symptoms noted in the subjoinedinstances. I have thought it advisable tocombine them in one particular groiip."We will give another case, out of several,

which have been published by M. Guertin,and which, in our opinion, illustrates, veryremarkably, the theory of that gentleman :-CASE.-A quarry-man, aged 25, of robust

constitution and vigorous muscular power,was conveyed to the H6tel-Dieu., on the 24thof June, at three P.1Bf, We may remark, thata month previously he had attended at thehospital for ordinary symptoms of cerebralplethora, and he said, at that time, that inother respects he was in ordinary health;but that at irregular periods, from two tofour times annually, he was seized, in a gra-dual manner, with headachs, attended by apropensity to sleep, and that, very frequently,one bloodletting dissipated those symptoms.He had been in this state of health for about

eight years. At two different times he had

also experienced a loss of sensibility, andhad suddenly been restored to his wontedstate of health. The persons who conveyedthe patient to the hospital reported, that twodays previously to the present attack, hehad complained of severe headach, and thathis countenance was flushed, when sud.denly, at the stone-quarry, at nine o’clock inthe morning of that day, viz., June 24, hefell down in a state of insensibility, andbecame immoveable ; the face was red, andthe limbs were stiff. He had no bleedingat the nose or mouth, but the respirationwas hurried. He was carried to his ownhouse in a state of unconsciousness, Anhour afterwards he opened his eyes, andlooked around him with an air of astonish.ment, and soon afterwards he began to movehis limbs in a gentle manner. He was bledcopiously. A quarter of an hour afterwardshe was seized with violent muscular motions,which suddenly subsided, and were againrenewed; and in that state of the system hearrived at the hospital. These alternationshad continued for two hours.Upon his arrival his face was. bloated,

and slightly violet in tint; the eyes wereshut, and the pupils dilated. He turnedhimself very frequently, in a lively manner,on his bed; he had stunnings, and violentbeatings of the carotids ; the respiration VIasa little hurried, being 30 per minute; therewas a slight hindrance of breathing, andrespiratory murmur; he puffed in his respi.ration, to a certain extent ; the pulse wasstrong and full, and 30 per minute; and hewas affected with a general sensation andprickling. His replies to questions pro.pounded to him were correct, but his arti.culation was hurried; he was agitated, anddid not know what position to assume. Attimes the respirations were deep, and alsoprolonged.Every twenty minutes, or thereabout, we

remarked an augmented turgidity of thefeatures, and an increase of animal heat;the agitation and restraint of respiration alsoincreased; he strove violently, a ild showed anaugmentation of muscular power; he rolledabout in his bed, and struck out right andleft. He experienced a succession of theseparoxysms, which only differed from eachother by a diversity of tremors, and whichwere not followed by rigidity of the mem-bers nor by convulsions. These paroxysmscommenced and terminated in a similarmanner.

Bloodletting to the extent of eighteenounces was performed ; and mustard cata-plasms were ordered, which it was foundneedful to secure in a proper manner. Atabout half-past eight o’clock he became ex.ceedingly weak, and coma succeeded theinordinate motions of the limbs, and soonafterwards the breathing became stertorous.He died at about four o’clock in the morn-ing,

643

Posf-mO1’fem Examination twelve hours afterdeath,-There was no exterior contractionof the body. The face was bloated and had

a slightly blue tint.BraHt.—On a careful examination of the

encephalon, a fulness was found in the

sinuses and in the vessels of the pia mater,which formed a well-grounded and uniformnetwork upon that membrane, without anyabnormal adhesions, or inflammation, or

traces of inflammation. This membrane wasin other respects sound, and contained about.two ounces of serum in its cavity. Thecerebral mass presented arosy aspect. Therewas no softening, nor any augmentation ofdensity in any portion of the cerebrum. Theyenticles were sound, and the volume of thebrain was normal. Upon slicing that organ,the medullary pulp was found to have auniformly rosy hue. Little drops of blood,most of them not larger than a pin’s head,were observed to take their origin fromthousands of apertures in the sliced portionsof the brain. The substance of the cere-

bellum appeared to be slightly softened

throughout the whole mass, and showedmore congestion than the cerebellum. The

spinal marrow was sound.Thorax.-The third part of the posterior

portion of the lungs showed a deep tint.

Several parts of the lungs were friable.

When cut into slices they crepitated through-out the greatest portion of their extent. Thecolour of the slices, upon the posterior sides,was deep-tinted, and the posterior portionsof the lungs scarcely floated in water. No iapoplectic focus was discovered in the

lungs. The heart was sound, voluminous,and normal with respect to its own propor-tions. The blood was black, and coagulated,in the right cavities. There was passivecongestion of the liver, and also of the in-testines, but the mucous coat was sound.

Remarks.-Although we cannot explainthe affinity which obtains between the con-gestion and the affections which follow, inthe reports which have been made, we can-not, nevertheless, refuse to accord to the

first a certain influence in the production ofthe second. Numerous observations uponthis point may perhaps lead to some newresult.

THE LANCET.

London, Saturday, January 28th, 1837.

BRITISH MEDICAL ASSOCIATION.

SELDOM could it happen that a proposal,

or, rather, that a series of proposals, for ef-fecting any important change in an existinginstitution of ancient origin, would be heardwithout exciting a contest in the minds ofthe very persons who have been aggrievedby the burdens which it is sought to re-

move. All may agree in acknowledgingthe presence and weight of the evil, whilstthe widest difference of opinion may prevailas to the probable success of any suggestedremedy. _

When the grievances are of so galling anature as to urge the mind to the formation

of hurried conclusions,ņ’when, under a

sense of wrong, passion usurps the prero-gative of the judgment, then, especiallyamongst the untutored and inexperienced of

any class or classes of men, that scheme

of redress which approaches nearest to a

system of retaliation or revenge, is the one

which is most eagerly embraced; The me-

dical practitioners of England have in viewa far higher object than that of persecutingtheir now crest-fallen and humbled perse-cutors. Retaliation and revenge enter not

into the elements of the scheme which theywould adopt for regenerating the characterof the profession, and for rendering thescience of medicine a subject of study withthe learned, and the practitioners of medicine

objects of respect and attachment with thewhole of the community. Still, in propos-ing a plan of Reform, a mode of removingthe monstrous grievances which have solong oppressed the general body of medical

practitioners in this country, it certainlycould not be expected that any scheme wouldbe devised which contained within it onlyone attribute, or arrangement, against whicha single feasible objection could be main-tained. Hear the astounding fact, ye mer-

cenary monopolists of our corrupt colleges!2U2