A man, who in a state of health would faint from the abstraction of a pound of blood, will, when an inflammatory diathesis is present, part with two or three pounds, without any, or but trifling inconvenience.

CHAPTER VIII.

Inflammation of the Pia Mater.

THE following case, although in its symptoms and progress it bears a strong analogy to Hydrocephalus Internus, presents some peculiarities which it may be useful to record.

CASE VII.

Diana Lovell, aged 22 years, was admitted into the Infirmary, on the 18th March, 1815.

For fourteen days previous to her application she complained of constant and violent headach. In addition to this symptom she had a dry skin, frequent pulse, and a furred tongue; the fur nearly approached to the colour of lemon-peel. An uneasiness was occasioned by the admission of light to her eyes, and large and numerous blood vessels were seen ramifying upon the tunicæ conjunctivæ.

14th. She passed a restless night; pulse rather more frequent, skin hot, tongue foul, bowels confined; she could not move her head without suffering excessive pain.

15th. Delirium came on in the evening and continued throughout the night.

16th. In nearly the same state; muttered incessantly. 17th. Lay upon her right side; fixed her hands powerfully between her thighs, and moved in a peculiar manner, a manner extremely difficult to describe. I

know not how to convey an idea of it better than by stating, that she rocked herself upon her side. She screamed when her head was touched.

18th. Comatose, fæces and urine passed involuntarily; seesaw motion of the body continued.

19th. In the same state.

20th and 21st. Perfectly sensible; pulse very rapid and full; tongue foul; skin dry.

22nd. A strong epileptic fit terminated her sufferings.

Examination.

The sinuses of the dura mater were full of blood, but neither that membrane, the pia mater, nor the substance of the hemispheres exhibited any marks of disease. About half an ounce of serous fluid was found in the lateral ventricles.

At the basis of the cranium a large quantity of serum, slightly tinged with the red particles of blood, had been deposited. The arachnoid coat was destitute of transparency, and much thickened. The almost triangular compartment, formed by the converging optic nerves, was filled up with a jelly-like substance. The tuber annulare, crura cerebri et cerebelli, were almost veiled from the eye.

This obscurity was occasioned by the pia mater, which, (where it is passing over the tuber annulare, crura cerebelli, and parts adjacent.) was in a high state of inflammation. Its vessels were extremely numerous and had acquired an undue magnitude. The increase of vascularity extended upon each side of the medulla oblongata, and probably was continued for a considerable distance along the medulla spinalis. That projecting ridge formed at the superior part of the cerebellum by the union of its two lobes, had undergone some change in its appearance, but there was no perceptible alteration in its structure; it looked as though pus were de

posited beneath the pia mater. I have observed the same change in the brains of several epileptic patients.

The deposition of fluid at the basis of the cranium undoubtedly took place from the inflamed portion of the pia mater. Was the peculiar motion to which I alluded, occasioned by the tuber annulare and its continuations participating in the inflammatory process with which the pia mater investing them was attacked?

The effusion of the fluid into the ventricles is to be regarded as symptomatic of the disease at the basis of the brain.

The treatment employed in this case, consisted in the abstraction of blood from the arm and temporal artery, the administration of active purgatives, antimonials, &c. as circumstances indicated. Cold Lotions were applied to the head, and a blister to the nape of the neck.

CHAPTER IX.

Cerebri Abscessus.

THE following case will perhaps be found to possess a sufficient degree of interest to render it worthy of perusal. How is it that the slightest injury inflicted upon the brain will sometimes terminate fatally in a few hours; while at other times extensive lesion will exist for weeks, months, even years, without destroying life or materially disturbing the functions of the animal economy.

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CASE VIII.

Jane Bevan, aged 36, was admitted on the 12th of November, 1813. Three weeks previous to her admission she miscarried. Nothing remarkable occurred.

At the time she presented herself to the Physician

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her head was drawn towards the right side, she had however power to turn it partially towards the left; a considerable degree of stupor was observable, but upon being roused, she gave reasonable answers to such tions as were proposed to her. She complained of great pain in the head; the pupils were considerably dilated, more particularly that of the right eye, the globe of which was drawn towards the nose, inducing strabismus; the bowels were constipated, pulse natural; that is to say it was soft, regular, destitute of undue force, and about seventy in the minute. Purgative medicines were administered and a blister applied to the nape of the neck.

13th. More comatose, but still could be made to understand what was said to her; the pupils were more dilated. It was evident that there was considerable pressure upon the brain, but there was almost a total absence of that stertorous breathing which for the most part attends a state of apoplexy. Bowels slightly relieved, a plentiful secretion of urine, pulse distinct, slow and regular. The purgative medicines were directed to be continued, and a blister was applied to the calf of each leg.

14th. Still able to reply to questions proposed to her; pulse somewhat more full, the spasm affecting the muscles of the neck had subsided. In the afternoon twelve ounces of blood were drawn from the temporal artery; she died about an hour after the evacuation.

Examination.

Upon examination the following were the appearances which the brain exhibited.

The dura mater adhered so firmly and universally to the bones of the cranium that it could only be separated from them with extreme difficulty; the vessels of the pia mater were minutely injected; the cortical part of the cerebrum had a yellowish hue as though it were

tinged with bile. The structure of a portion of the middle of the right hemisphere of the cerebrum was completely destroyed; a considerable excavation of that part of it which is opposed to the squamous plate of the temporal bone had been effected by the absorbents. A loss of substance had likewise occurred in the anterior and posterior lobes, but the mischief was more superficial. The walls of the cavity seemed to be without organization, the slightest force being sufficient to break them down. They had a pulpy feel, and were of a reddish brown colour. It seemed to me that an abscess having the middle lobe of the cerebrum for its centre had extended itself upon the anterior and posterior lobes; in fact the whole lateral part of the right hemisphere of the brain was in a diseased state. There was no pus or other fluid in the cavity of the abscess. The right lobe of the cerebellum was perfectly healthy, but the texture of the left was completely altered; it was pulpy, of a dark red colour, and almost as destitute of regular organization as the parietes of the abscess.

The ventricles were distended with an immense quantity of water; the different parts contained within them had in consequence been rendered more than usually distinct. The foramen commune anterius was almost large enough to admit the point of the little finger and a large goose-quill would readily have passed through the foramen of Monro.

This patient had complained of occasional indisposition for a year and a half. She was affected with but little stertor throughout the disease. Only two hours before her death she could be made to answer questions, thrust out her tongue, and stretch forth her hand, for the purpose of having the pulse examined.