On the pathology and treatment of convulsive diseases / [by R. B. Todd].
- Robert Bentley Todd
- Date:
- 1849
Licence: Public Domain Mark
Credit: On the pathology and treatment of convulsive diseases / [by R. B. Todd]. 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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![80 died in the attack, when the cerebral con- gestion which exists is, in the words of the same distinguished physician, a feature, not of epilepsy, but of the state of asphyxia induced by it, and in which the patients have died ; still, in the more advanced stages of the disease, when the patients have expe- rienced many fits, morbid appearances are met with, and these affect the hemispheres of the brain chiefly. You have among the most common,opacities and thickening of the membranes, shrinking of the convolutions, enlargement of the sulci between them, in- creased subarachnoid fluid, alterations of colour and consistence of the grey and white matter of the hemispheric lobes. These alterations must be looked upon as the ac- cumulated effects produced by the various paroxysms. Each fit does some amount of damage to the brain; in tlie interval the brain recovers itself to a great degree, when a new fit comes on, and new mischief is done ; and so the repetition of the paroxysms leaves the brain altered as I liave described it. But, observe, the alterations are not of the cerebellum, nor of the medulla oblongata, nor of the corpora striata or optic thalami, —but of the hemispheric lobes. Bouchet and Cazaurielh, who have con- ducted an extensive series of researches into the clinical history of epilepsy, found these alterations of the hemispheric lobes so fre- quent in the chronic cases, that they attri- bute the disease to a chronic inflammation of the cerebral lobes, which determines epilepsy if it affect the white substance, insanity if it affect the grey. I refer to these researches, not because I believe that the conclusion founded on them by their authors is correct, but because they strikingly indicate that the seat of the or- ganic disturbance (which these authors admit to be caused by the fits) is in the he- mispheric lobes. It cannot, I think, under the weight of argument which may be adduced in refe- rence to the office of the hemispheric lobes, be doubted that an affection of these parts is capable of inducing all the phenomena of epilepsy, as far as regards consciousness and sensibility. But an important question remains ; can adis'.urbed state of the hemispheric lobes induce or excite convulsive movements ? The proper answer to this question appears to me to be this : under ordinary stimulation of the substance of the hemispheres, the fibres are incapable of exciting motion. It is not the office of these fibres to propagate the nervous force to muscles, but to other nervous centres. Their function is to esta- blish communications between the great sheet of vesicular or grey matter which covers the convolutions of the brain, and the cor- pora striata, optic thalami, and mesocephale, so that changes in any of these centres may be propagated from any one to any other, or to all the rest. Hence the sections and irritations by mechanical and galvanic means to which these fibres have been sub- jected in the hands of various experimen- talists, produce no disturbance of motion, so long as the irritation is strictly confined to them. So far, then, anatomy and experiment denote to us that of themselves these fibres of the hemispheric lobes cannot excite mo- tion, but that they may do so through their influence upon other ganglia of the brain ; and such phenomena, as I referred to at the commencement of the lecture, as a convul- sive affection of the whole of one side of the body, evidently brought on by the deposi- tion of tubercular matter on the surface of the cerebral hemisphere on the opposite side, and its consequent irritation, show that convulsive movements may be excited by a superficial lesion of the hemispheric lobes. Hence we must not deny to these lobes a certain power of exciting motion, either directly or indirectly, through their influence upon other ganglia of the brain. But it is important to remark that the influence of the hemispheres is most manifest for this purpose when the lesion is superficial ; that is, when it affects the grey matter. A de- position of tubercle, such as took place in the case I described at the commencement of the lecture, would produce little or no dis- turbance if it took place in the white sub- stance : it would interrupt the functions of some of the fibres ; but when deposited in the vesicular matter, among the particles of the generating plate of the nervous battery, the development of the nervous force be- comes seriously impaired. From all these facts, then, I infer that a disturbed state of the hemispheric lobes may undoubtedly give rise to so much of the phenomena of the epileptic paroxysm as re- fers to the affection of consciousness and sensibility, and that it may, in some degree at least, contribute to the development of the convulsions. We must not forget that, in forming a theory of the pathology of epilepsy, we have to explain not a continuous state of disturbed sensation and motion, but a malady, the grand feature of which is the periodical re- currence of the paroxysms, the patient being wholly or almost restored to his normal state in the intervals between the attacks. Now, it is not a little remarkable that there is no organ in the body which exhibits the same kind of ])eriodical activity and quiescence in the performance of its func- tions, as the hemispheric lobes. This pe- riodicity is manifest in the phenomena of sleep : throughout lifj the tendency exists.](https://iiif.wellcomecollection.org/image/b21470819_0032.jp2/full/800%2C/0/default.jpg)
