First lines of the practice of physic (Volume 2).

  • William Cullen
Date:
1805
Catalogue details

Licence: Public Domain Mark

Credit: First lines of the practice of physic (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    1118.] It may indeed happen, that as the apoplectic and gouty predispositions do often concur in the same person ; so it may consequently happen, that the apoplexy coming upon gouty persons, may sometimes depend upon com- pression ; and dissections may, accordingly, discover that the circumstances of such a cause had preceded. But, in many cases of the apoplexy following a retrocedent or atonic gout, no such antecedent or concomitant circum- stances, as commonly occur in cases of compression, do distinctly or clearly appear ; while others present them- selves, which point out an affection of the nervous power alone. 1119.] With respect, however, to the circumstances which may appear upon the dissection of persons dead of apoplexy, there may be some fallacy in judging, from those circumstances, of the cause of the disease. What- ever takes off or diminishes the mobility of the nervous power, may very much retard the motion of the blood in the vessels of the brain ; and that perhaps to the degree of increasing exhalation, or even of occasioning rupture and effusion : so that, in such cases, the marks of compression may appear, upon dissection, though the disease had truly depended on causes destroying the mobility of the nervous power. This seems to be illustrated and confirmed from what occurs in many cases of epilepsy. In some of these, after a repetition of fits, recovered from in the usual man- ner, a fatuity is induced, which commonly depends upon a watery inundation of the brain: and in other cases of epilepsy, when fits have been often repeated without any permanent consequence, there happens at length a fatal paroxysm ; and upon dissection it appears, that an effusion of blood had happened. This, I think, is to be consider- ed as a cause of death, not as a cause of the disease : for in such cases, I suppose that the disease had diminished the action of the vessels of the brain, and thereby given occasion to a stagnation, which produced the appearances mentioned. And I apprehend the same reasoning will ap- ply to the cases of retrocedent gout, which, by destroy- ing the energy of the brain, may occasion such a stagnation as will produce rupture, effusion, and death ; and in such a case, the appearances upon dissection might lead us to think that the apoplexy had depended entirely upon compression. 1120.] The several causes mentioned in 1114, are often of such power as to occasion immediate death ; and there-
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