On spinal apoplexy / [Alexander Peddie].

  • Peddie, Alexander, 1810-1907
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: On spinal apoplexy / [Alexander Peddie]. Source: Wellcome Collection.

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    the name of serous apoplexy has been applied. I have therefore limited the selection of cases, strictly to spontaneous hemorrhage of the medulla and its membranes. But in the table now presented I have included extravasation of the medulla oblongata; for although that part presides over a special function, namely, respiration, although in it decussation commences, and although it does not lie in the vertebral canal, it must be regarded as the cerebral portion of the cord, and consequently must have a place in the arrange¬ ment. Hemorrhage of the annular protuberance, however, is not so clas¬ sified, for although M. Ollivier has arranged such cases under the general title of Hoematomyelie on Apoplexie de la Moelle Epiniere, this portion of the cerebro-spinal system bears neither an ana¬ tomical nor physiological resemblance to the medulla spinalis. As some, however, may approve of Ollivier’s arrangement, I may mention in general, from a survey of the cases reported by himself, by Serres,1 Cruveilhier,2 Cheyne3 and others, that extravasation in this situation appears to be much more frequent than in the spinal cord, contrary too, from what might have been expected consider¬ ing the density of texture; that its seat is in the grey substance, sometimes circumscribed—from the size of a nut to that of a pouch¬ like bulging out of the whole protuberance, but in nearly an equal proportion of cases, producing rupture, and spreading into some part of the brain, or into the medulla oblongata—as it did in one instance; that its subjects are commonly old people, and males; that, with age, debility of constitution seems to be the most common predisposing causes; that the attack is sudden, and a fatal result nearly immediate, although in a few cases there is time for com¬ plaint. of giddiness and sickness, without the ability of speech; and that the progress of the lesion is distinguished by insensibility, with stertorous breathing of the pipe-blowing character, complete para¬ plegia (in one instance, however, the cross effect was observed) alternating or intermitting with epilepti-form convulsions, and death,4 as if from asphyxia, within a few hours from the period of seizure. The most marked diagnostic signs of apoplexy in this situation, therefore,appear to be asudden invasion with lossof speech, insensibility, paraplegia alternating with epileptic movements, and an overwhelming of the respiratory function, which, however, ap¬ pears to be principally occasioned by pressure on the medulla ob¬ longata. It is to be regretted that some of the sixteen cases of spontaneous 1 Annuaire Medico-Chirurg. des Hopiteaux, p. 351, &c. 2 Diet. Med. et Chirurg. prat, tome iii., art. “Apoplexie,” p. 239. 3 Cases of Apoplexy and Lethargy, p. 102, &c. 4 If the extravasation is to a small extent and without lacerating, but merely separating the fibres, life may be prolonged and absorption take place. Vide Cases of Series, also Ollivier, p. 160-166.
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