Cerebral compression : its physiological basis and therapeutic indications : address delivered at the annual meeting of the Medical Society of Nova Scotia, Windsor, July, 1907 / by Edward Archibald.

  • Archibald, Edward William, 1872-1945.
Date:
[1907]
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Licence: In copyright

Credit: Cerebral compression : its physiological basis and therapeutic indications : address delivered at the annual meeting of the Medical Society of Nova Scotia, Windsor, July, 1907 / by Edward Archibald. 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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    9 rest of the parietal lobe has to do mainly with the sensory system in general ; the occipital lobe with higher vision; Broca’s convolulion and the temporo-sphenoidal with the various forms of aphasia; and the pre-frontal lobe with the functions of the higher intellectual and psychic life. These signs may or may not be present as part of cerebral compres- sion according to whether the latter bear upon a limited area or be more or less generally transmitted. Their finer interpretation belongs rather to the neurologist than to the general practitioner. On the other hand it is much more important for the general practitioner to be conversant with the symptoms of general or major cere- bral compression, that is the bulbar symptoms, inasmuch as in this case life itself may be in immediate dan- ger. I may here perhaps be allowed to recall briefly to your minds the three chief medullary centres situated in the floor of the fourth ventricle. Here we have the respiratory, the vagus or cardio-inhibitory, and the vaso- motor centres. Stimulation of the vagus centre slows the heart; stimu- lation of the respiratory centre de- ranges, or may temporarily paralyze respiratory movements ; finally, stimulation of the vaso-motor centre raises general blood pressure by con- stricting the peripheral arteries. These are the few and simp'e facts which are of fundamental import- ance. Now, let us turn for a moment to consider in a general way the clini- cal conditions which correspond to this division of compression into “local” and “general or bulbar.” As examples of local compression we have tumour, cyst, abscess, haemorr- hage from the middle meningeal ar- tery Remember, however, that anv one of these local compressions may, it it become great enough, transmit its pressure throughout the skull to I such a degree as to become general; that is, as to affect finally the vital centres in the medulla and call forth the “major” symptoms of compres- sion. It is likewise evident that if the local compression be situated primarily in or near the bulb, it will produce these major symptoms first of all. As examples of general compres- sion, usually without local signs, we have basal haemorrhage in fracture of ' the skull, acute hydrocephalus; acute ceiebral oedema following concus- ' sion, and meningitis. The compres- sion Avhich tf ese exert is general, be- cause as you see it 's usually fluid in j character and therefore is more uni- ' formily distributed over the cranial cavity and does not press upon any area in particular; or, if so, only over a “silent” area. To-day we leave aside the question of local pressure, which would take i:s too far afield, and confine ourselves to the consideration of the manner in which general compression affects the vital centres in the medulla. You are all familiar, to take an example, with the fact that a man with a fracture of the skull is apt to lie comatose with- out localising symptoms, but with a slow, high-tension pulse, and ster- torous irregular breathing. Ti-ese are the effects of pressure exerted general- ly it is true, but acting in particular on the bulbar centres already men- tioned. In what way, now, are these centres stimulated by the compres- sion of the effused blood, a compres- sion which is acting from a distance? Ii is not, we may say at the outset, by direc*’ pressure, mechanically speak- ing; it is rather by expressing the blood and by preventing good blood