Remarks on the diagnosis and treatment of diseases of the brain : delivered at a meeting of the Worcestershire and Herefordshire, Bath and Bristol, and Gloucestershire branches / by J. Hughlings Jackson.
- Jackson, John Hughlings, 1834-1911.
- Date:
- [1888]
Licence: Public Domain Mark
Credit: Remarks on the diagnosis and treatment of diseases of the brain : delivered at a meeting of the Worcestershire and Herefordshire, Bath and Bristol, and Gloucestershire branches / by J. Hughlings Jackson. 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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![brain are hemiplegia and aphasia, sometimes both together. There is no such disease as general softening of the brain. Some cases so-called are cases of cerebral atrophy, of general paresis, or are cases of cerebral tumour. Reasserting that softening of the brain is local, and that it is practically an affair of plugging of cerebral arteries, the next remark is that there are two processes of plug- ging—thrombotic and embolic. In the former, the vessel is crusted up, because the artery, mostly atheromatous, but some- times the subject of a syphilitic change, is roughened in its in- terior, or narrowed, or both; here the artery is in fault. In em- bolism the artery may be, and often is, quite healthy, innocent, and is corked up by something coming from a distance, in most cases, from the valves of the heart. No doubt there is sometimes partial occlusion by an embolon, complete closureof the artery be- ing effected by superinduced thrombosis. We sometimes hear of 44 extension of softening. I know of none, except possibly by plugging of other arterial branches, supplying parts near the already softened part; this is not, however, properly speaking, extension of, but additional softening. It is common enough to find general mental deterioration slowly following a local cerebral lesion, clot, or softening, which has produced hemiplegia. The patient suffers from defect of memory, and is incapable of sus- tained intellectual exertion. He is 44 more emotional (really there is here loss or defect of the highest [4l finest] with increased manifestation of the lower [4l coarser ] emotions). But I presume that the intellectual and emotional deterioration are owing, not to softening nor to extension of softening, but to widespread partial atrophy of convolutions. It is needless, for my present narrow purpose, to speak of the differential diagnosis between thrombosis and embolism as a cause of the local softening which produces hemiplegia. The commonest condition for the thrombotic process is arterial atheroma. I wish to speak of a rarer cause of thrombosis of the middle cerebral artery—of a third Type or variety of 44 syphilitic hemiplegia. We shall see another way in which syphilis produces nervous symptoms indirectly. I do not deny thatsypMlis may 44 attack proper nervous ele- ments, nerve cells^and fibres/of nervous organs directly, or be an important factor towards their degeneration. I say nothing here on that question. In cases of 44 syphilitic nervous affections of which we knoiv the morbid anatomy, the direct 44 attack is upon non-nervous ingredients of nervous organs. When there is a syphilitic neuroma, as it is often called, say the trunk of the third nerve is affected, the action of syphilis on nervous elements is indirect, but yet most nearly direct; an overgrowth of connective tissue there and then squeezes nerve fibres. The process by which syphilis produces the type or variety of 44 syphilitic hemiplegia I am about to remark on is far more indirect, although not so indi- rect as is the one whereby the type recently considered (post-epi- leptiform hemiplegia) is produced. There is first slowly estab- lished syphilitic disease of the middle cerebral artery or'of some branch of it: so far all may go indifferently well. But the dis- eased artery becoming narrowed, something happens which is not syphilitic. Thrombosis occurs, and thereupon ensues local soften- ing of the brain, causing hemiplegia of deliberate onset, without loss of consciousness, but, perhaps, if the main trunk-be plugged, with considerable stupor. I fear that it is not always realised that in this type of 44 syphilitic hemiplegia there is softening of the brain; that there is essentially the same change (I have not yet seen red softening in such cases) as that which occurs when](https://iiif.wellcomecollection.org/image/b22303273_0024.jp2/full/800%2C/0/default.jpg)
