The connection between tuberculosis and insanity / by T.S. Clouston.
- Thomas Clouston
- Date:
- 1863
Licence: Public Domain Mark
Credit: The connection between tuberculosis and insanity / by T.S. Clouston. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![it ])robable that even in these the original nucleus of tubercular matter had been deposited in the pia mater at the bottom of the sulci, and had extended towards the centre of the organ, encroaching on the white substance and corpus denticulare. In two other cases there were masses of tubercle extending inwards among the cerebral con- volutions, but they were in contact externally with the membranes. This is quite in accordance with the view of the origin of tubercle propounded by Vii-chow, and now so generally held by histologists of eminence. He believes, and indeed professes to have demonstrated, that tubercle is the result of an altered and increased development of the nucleated cells which exist in the ordinary connective tissue, or of the epithelium-cells. Now, although connective tissue has been demonstrated to exist among the nerve-fibres and nerve-cells of the brain and spinal cord, yet it is in such small quantity and of such a kind that its nuclei do not readily undergo the altered development into tubercle. In the pia mater and arachnoid, on the contrary, both connective tissue-corpuscles and epithelium-cells atound, and the tubercle is developed in them accordingly. In one of the cases the only parts tubercular were the choroid plexuses of the lateral ventricles. The most frequent site of the tubercular deposition was on the membranes over the hemispheres, or between the brain and cerebellum. In only one case was the tubercular meningitis at the base of the brain, and it was not confined to the anterior part, but ex- tended to the pons and medulla. In no case, therefore, was there any analogy to the ordinary tubercular meningitis of the child. I am not to be understood as saying that tubercle cannot be deve- loped in the cerebral substance. Such high authorities are in favour of that view that it would be presumption in me to do so. Guislain* expresses his decided conviction that it may be developed in the medullary brain-substance. Eokitansky holds the same view. Ancell says that tubercle of the brain rarely coincides with tubercle of the membranes ; but if he means by this that tubercular masses extend- ing into the cerebral substance are rarely associated with deposit in the membranes, his observation is very decidedly contradicted by the cases of which I have given a summary. Of fifty cases in which Dr. Chambers found tubercle in the nerve-centres, only eight were of the membranes. We cannot help thinking that he has included with tubercle of the membranes merely those cases in which they were covered with small, gray granulations, and has enumerated every example of soft, yellow tubercle, as in the brain, even though it was in contact externally with the membranes. In every one of the eight cases there was tubercle in the lungs. In three of the cases there was tubercle of the peritoneum and of nearly all the abdominal organs, and in two of them, tubercular](https://iiif.wellcomecollection.org/image/b21477085_0013.jp2/full/800%2C/0/default.jpg)
