Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
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Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

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    matter, and a considerable quantity of a hyaline matter, intermingled with their more solid constituents. Hypertrophy of the brain. Dr. Maufhner’s* researches on this subject are by far the most complete that have yet appeared. He prefaces his remarks by a series of observations on the growth of the brain and the increase of its weight at different periods of childhood. He shows that the weight of the organ is greatly modified by the amount of blood which is contained in its vessels, a fact which he uses in support of the opinion that a degree of vascu¬ lar congestion short of that which would occasion inflammation often gives rise to hypertrophy of the brain. He distinguishes an active and a passive hypertrophy of the brain, the latter of which is attended with expansion of the cranial bones, enlargement of the head, and all that train of symptoms usually regarded as characterizing the affection. In the active form of the dis¬ ease the bones do not yield, and the first indication of the affection is afforded by the sudden supervention of some form or other of acute cerebral'disease. He notices the difficulty of distinguishing between hypertrophy of the brain and chronic hydrocephalus, and lays down the following signs as affording means of discriminating between them.t In hypertrophy the posterior part of the skull is that which is observed first to become unnaturally prominent, and the projection of the forehead occurs subsequently, while the projection of the forehead is one of the first results of chrouic hydrocephalus. The fontanelles and sutures are never so wide open in hypertrophy of the brain as in chronic hydrocephalus. The latter affection is usually associated with a generally emaciated condition ; the former with a leucophlegmatic habit, and with in¬ creased deposits of fat. The constitutional symptoms of the two affections likewise differ ; convulsions, sopor, and restlessness attend the early stages of chronic hydrocephalus, while spasmodic affections of the respiration are among the earliest indications of hypertrophy of the brain, but seldom occur until an advanced stage of hydrocephalus. One case of the unsuccessful puncture of the head in a case of chronic hydrocephalus has occurred in the practice of Sir J. Fife.}; [Of 60 recorded cases in which puncture of the brain has been performed, 17, or 1 in 31, had a favorable termination, or, in other words, the recoveries have been to the deaths in the proportion of 28 per cent.] Convulsions. Dr. Mauthner’s^ chapter on this subject contains many obser¬ vations of considerable practical value. He points out the fact that convul¬ sions are a frequent result of febrile disturbance in early childhood, and shows how the tendency to venous congestion, which is so characteristic of early childhood, explains this occurrence. Somewhat similar are the remarks of Dr. JV1 orell|| on the same subject, [though in the form in which he has stated, or rather overstated the facts of the case, he has involved himself in error.] His aim is to show that infantile convulsions are the result of febrile excite¬ ment, and that the affection of the brain is in all cases a secondary occurrence. In fever there is increased arterial action on the one side with sluggish venous circulation on the other, connected with imperfect performance of respiration, and a tendency to congestion of the lungs. The imperfect respiration allows the lungs to become congested, and is unfavorable to the return of the blood from the abdomen and head, while the heart by its violent action continues to propel more blood to the brain. The yielding fontanelle relieves the com¬ pressed brain for a time, though insufficiently, so that the pressure finally affects the medulla oblongata; respiration is then further impaired, and con¬ vulsions result from the spasmodic effort of the voluntary muscles to maintain respiration. Venous blood now pours in rapidly from the extremities to the * Op. cit. cap. v. + Provincial Medical and Surgical Journal, Nov. 27, Dec. 24, 1844. || New York Journal of Medicine, May 1844. t Ibid. cap. vii, p. 249. § Op. cit. cap, x.