On the hypodermic administration of remedies in neuralgia and other affections : being a paper read before the St. George's Medical Society, on Decmeber 9th, 1858 / by Charles Hunter. Also a paper on the respiration therapeutically considered in certain cerebral conditions, read at the Western Medical Society, January 20th, 1860, and the St. George's Medical Society, February 2d, 1860.

Hunter, Charles, 1834 or 1835-1878.

Date:: 1860

Credit: On the hypodermic administration of remedies in neuralgia and other affections : being a paper read before the St. George's Medical Society, on Decmeber 9th, 1858 / by Charles Hunter. Also a paper on the respiration therapeutically considered in certain cerebral conditions, read at the Western Medical Society, January 20th, 1860, and the St. George's Medical Society, February 2d, 1860. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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There was no blood effused in the brain proper, but an immense clot of thick black blood in the medulla oblongata itself, breaking, up its texture; and at one part the wall of the fourth ventricle, which consequently contained some clotted blood, the presence of which had driven the normal fluid of the cavity tinged with blood into the other ventricles. This accounted for the rapid apnosal death, and for the body becoming colder and paler than the state of the heart was suffi- cient to explain; and for the very thick state of the blood, which would hardly flow from a large vein. The question is now to determine what the kind of apnoea waa which was induced in the two preceding cases, for the term apnoea (olim asphyxia) is usually employed to signify a state consequent on cessation of respiratory (muscular) action ; this point, the kind of apnoea, has not received, as yet, the attention it deserves; for it affects treatment. There is, in my opinion, a difference between cessation of lung action and respiratory, which is muscular, action. In neither of the cases just given was the death from cessation of respiratory action. In both, you will recollect, the respiratory efforts went on, and in the last case, although the medulla oblongata was nearly destroyed, even forced expiration now and then took place. The apnoea had a different cause; it was in both cases, from what appeared like complete relaxation of the pulmonary tissue (paralysis allowing exudation but no absorption), and so great was the mucous development in Case 2 (cerebral injury), that directly prenopnoea was adopted, a large quantity of frothy mucus rolled from the mouth with each expiration. But in the third case there was more than mucus, and that in less than an hour; there blood and mucus were poured out with the facility and rapidity that mucus alone was in the preceding case. I look on the pouring out of the blood with the mucus as indicative of the suddenness of, and the amount of the deprivation of nervous influence; just as in sudden cases of spinal paralysis, the urine, is one day clear, and the next full of blood and offensive. Extreme as these two cases were, life was prolonged in both by attention to the respiration. Surely this is encouragement for us not to neglect careful observation of the lungs in similar cases. Life may be the happy result. In this class of cases, it is not artificial respiration Avhich is indi- cated, but prenopnoea—iov the apnoea is from effusion, not from musculo-respiratory paralysis. The prenopnoea is trebly useful. lstly. Prophylactically to prevent (when employed early) the accumulation in the tubes. 2dly. To remove the fluid in the bronchia, if it has been allowed to collect; and in either case, 3dly. To prevent the secondary effect of narcotism, by carbonic acid being added to coma from compression, which must take place if the lungs are allowed to fill with fluid. In the slighter forms of apoplexy, the respiration is also affected, although none of the urgent symptoms which occurred in the cases described may manifest themselves.

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