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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![rough pathology of a case was epistaxis or retinal haemorrhage, events of very evil significance in cases of chronic Bright's disease. The results of the measures one adopts for diminishing arterial tension are not always pleasing to the patient; perhaps sometimes we have too much zeal. A certain degree of arterial tonus is necessary for everybody's well-being; the more blood is in the arteries, the less is in the capillaries, that is, the less is close to the tissues. To an increased degree of arterial tonus the cheering effects of a cold bath are due, a luxury few people after fifty ought to indulge in. I submit that a healthy degree of arterial tonus is kept up by a normal degree of waste nitrogenised products in the blood, the natural stimulant, I imagine, of the vasomotor centre, as venous blood is the natural stimulant of the respiratory centres.15 In Bright's disease and in gouty states there is an excess of these natural stimulants and very likely presence of some unnatural ones, whereby I suppose the vasomotor centre is over- stimulated; hence excess of arterial tonus, or, as we call it when morbid, high tension. I have heard an eminent medical man say that he felt best when a little gouty; I suppose he had then a slight extra degree of tonus, so that his brain had a better supply of blood; the cerebral arteries, having less muscular tissue than most other arteries, would be less constricted. But in a high degree of tonus, high tension, such a feeling of well-being is more pleasant than safe. I think there is sometliing in the statements we hear about patients who die of apoplexy, that they had felt unusually well just before the onset of their illness, that is, before a fatal cerebral haemorrhage, that is, before the bursting of a cere- bral artery. If we reduce our patient's arterial tension, perhaps sometimes too much, by low diet and purgatives, he feels weak and is very naturally dissatisfied until it is explained to him that he had better be safe than have a feeling of well-being from undue arterial tension. Many a man with chronic Bright's disease lives on the brink of cerebral hfemorrhage; the less he lives the longer will he live; but if he tries to get the most out of himself and is careless of his diet and of the state of his bowels he may be high up in a certain kind of health, so to call it, only for a sudden fall to a low level of disability or to death. I will now speak more generally on the essentially non-nervou3 nature of many diseases called nervous. For a realistic considera- tion of the pathology of any case of disease of the brain we have to consider whether or not the morbid change begins in nervous or is The hypothesis more generally is that there is in health Chemical Kegula- tion, so to call it, by natural stimulants in addition to, or rather as an aid to, physiological regulation by nerve centres and nerves, and that some particular morbid effects are the results of excess of those stimulants. I have (Brain, April, 1886) suggested that the convulsion in laryngismus stridulus is owing to supervenosity, to an excess of a natural stimulant of the respiratory centres. In the same way I think it likely that rigor is owing to an excess of the natural stimulant of the vasomotor centre, and very likely that some convulsions in kidney disease (not those which are unilateral) are owing to excessive stimula- tion, primarily of various regulating centres in the medulla oblongata, by waste products which the kidneys ought to, but cannot efficiently, eliminate. [Consider in this connection convulsions in animals after injection of the poison absinthe, and especially Dr. George Johnson's researches on convulsions in man consequent on poisoning by camphor. (Medical, Lectures a7id Essays, p. 311.)] Dr. Maclagan, in his work on Fever, makes the very interesting and, as I think, most important remark, that heat is the natural stimulus of the heat-inhibiting function and that accumulation of heat in the system naturally excites that function to increased activity and may at length exhaust it. In some cases of jaundice the pulse is less frequent than normal, possibly by action of bile acids. The mode of action of bile acids on the circulation is not known, and it would be premature, for several reasons, to conclude that there is in such cases an excess of a natural stimulant to the ends of the vagi.](https://iiif.wellcomecollection.org/image/b22303273_0029.jp2/full/800%2C/0/default.jpg)
