Rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / by the late John Hilton ; edited by W.H.A. Jacobson.

  • John Hilton
Date:
1901
Catalogue details

Licence: In copyright

Credit: Rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / by the late John Hilton ; edited by W.H.A. Jacobson. Source: Wellcome Collection.

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    central parts of tlie base of the brain, instead of resting upon the bones of the skull at its base, rest upon this collection of cerebro-spinal fluid,* which forms for it a most beautiful, efficient, and perfectly adapted water-bed; the water-bed itself being sustained in its position by the force of the venous circulation—as I will prove to you presently — and also by the elasticity of the dura mater in the vertebral canal, j * M. Magendie (Recherches Physiol ogiques et Cliniques sur le Liquide Ceplialo-Rachidien ou Cerebro-spinal, 1842) describes the following collections of fluid at the base of the brain: the largest below the cerebellum; another in front of the pons and between the -crura and lodging the basilar artery, and one more anteriorly below the lamina cinerta which closes the third ventricle below and in front. Very similar collections (Cisterneu) are described and figured by Key and Retzius, loc. infr. cit.—[Ed.] f In the second edition this passage was left unaltered at Mr. Hilton’s wish. No change has of course been made in the later editions. The reader will see at once that the space between the two layers of the ■“ external arachnoid ” corresponds to the cavity of the arachnoid and that the interval between the two layers of the “ internal arachnoid ” is the sub-arachnoid space between the arachnoid and the pia mater. Mr. Hilton believed that the cerebro-spinal fluid is contained between two epithelial surfaces, i.e. that one such surface not only exists, as usually described, upon the arachnoid, but also upon the pia mater as well, and that thus the otherwise inevitable infiltration of the pia mater is prevented. With all due deference to Mr. Hilton, I cannot quite accept this view. In the first place, as far as I am able to make out microscopically and with the use of such reagents as silver nitrate, no layer of epithelial cells exists upon the pia mater. I am further in- •clined to believe that a slight infiltration of the superficial part of the pia mater does take place, as the cerebro-spinal fluid passes backwards and forwards over its surface. I am indebted to Mr. Davies-Colley for the knowledge of the fact that Henle applies to the sub-arachnoid tissue the epithet “ wassersiichtig,” cedematous. More than very slight infiltration is prevented, partly by the fact that the cerebro -spinal fluid is broken up into a number of little lakes and pools by the very delicate bands which are found in the sub-arachnoid space (the tissue forming these bands being also infiltrated by the fluid), and partly by the deeper layers being most closely united to the nerve substance by the innumerable vessels entering it. It is only a phasant act of justice to the memory of Mr. Hilton to state that the most recent and withal the most exact and elaborate researches into the anatomy of the nervous system tend to confirm, in part, at least, the accuracy of Mr. Hilton’s belief that the cerebro-spinal fluid is contained between two epithelial surfaces. Thus in the ‘ Studien der Anatomie des Nervensystems und des Bindegewebes,’ by the two Stockholm anatomists Axel Key and Gustaf Retzius, a layer of scattered
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