BMJ

Curious Train of Symptoms Connected with a Clot in the Middle Lobe of the CerebrumAuthor(s): Henry CooperSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 15, No. 11 (May 28, 1851), pp.295-296Published by: BMJStable URL: http://www.jstor.org/stable/25492971 .

Accessed: 18/06/2014 09:32

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org.

.

BMJ is collaborating with JSTOR to digitize, preserve and extend access to Provincial Medical and SurgicalJournal (1844-1852).

http://www.jstor.org

This content downloaded from 62.122.79.21 on Wed, 18 Jun 2014 09:32:54 AMAll use subject to JSTOR Terms and Conditions

DISEASE OF THE MIDDLE LOBE OF THE CEREBRUM. 295

house were superficially buried beneath the kitchen

floor?

The circumstances here detailed?the prevalence of

fever in dry countries equally as in wet?prove, I think, that whatever may be its source, decomposing vegetation is not that source, and show that, although decompo sition may be favourable to its development, it is so

in just the same manner as dirt, famine, or want of

ventilation.

Time may make us acquainted with the changes in

the atmosphere produced by electricity and other subtle

agents, and explain to us the laws of such changes, then we may see the reason of the periodicity of fatal seasons

at present concealed from us. Our knowledge is not

sufficiently advanced to enable us to discern these things now ; but it is much and useful, as I said at the

commencement, to find out what is not correct, for

displacing an erroneous opinion is a great step towards

attaining a true one.

I may add as a corroboration, that in Western Australia large and extensive swamps abound, and much

mangrove muddy country, yet no one ever heard of a virulent fever ; and Europeans are constantly in the habit of sleeping near such swamps, but they never have fever.

Heigham Retreat, Norwich, May 10,1851.

CURIOUS TRAIN OF SYMPTOMS CONNECTED WITH A CLOT IN THE MIDDLE LOBE OF THE CEREBRUM.

By HENRY COOPER, Esa., Lond., PHYSICIAN TO THE GENERAL INFIRMARY, H?LL.

To the Editor of the Provincial Medical and Surgical Journal.

Sir,?The following case has been one of great interest to the medical men in charge of it during its

long and painful progress ; if you think it will be so considered by your readers, it is very much at your service. The case is remarkable as shewing the variety and importance of diseased actions which may result

apparently from the same cause, such diseases, though varying in seat and intensity, still maintaining the same

general congestive character. The subject was a lady, 35 years of age, of spare j

habit, active, intelligent, and of exciteable temperament. | She had borne several children, and enjoyed good health, but for the last few years had undergone much

anxiety and fatigue in nursing. In the winter of 1848-9 she was knocked down by a carriage and sustained some injury of the head. In the autumn of 1848, she

had a severe attack of the malignant cholera then fatally prevalent. She rallied from the congestive stage of this disease and made a

satisfactory convalescence. An attack of epistaxis occurred in Jauuary, 1850. In the

spring of 1850 she was suddenly attacked with epileptic coma, while still subject to much harass of mind and

body. The seizures which I witnessed at a later period of the illness, commenced with convulsion, coming on

much as in ordinary epilepsy, generally with little or

no warning ; they continued three to five hours, and were so violent and long continued as to threaten to

destroy life either by asphyxia or exhaustion of vital

power. The means used exercised little control over

the paroxysm till its usual term of five hours had

expired, when the patient sunk into a deep and unrous

able torper. In twelve to twenty-four hours this state was succeeded by delirium of a wild character, not

unlike delirium tremens, accompanied with wakeful

nights ; after which a long deep sleep put an end to the

attack, and extreme prostration and partial amaurosis

of the right eye alone remained. The whole attack

would last four or five days. The paroxysms occurred

at variable periods of three or four weeks.

In November, 1850, this lady's life was further

placed in jeopardy by epistaxis, which had gone on to

a frightful extent before assistance arrived. Plugging of the posterior nares and the most careful restorative

measures brought her through this danger, and it was

hoped that an immunity had thus been ensured against the cerebral attacks.

In the early part of December we were surprised by another seizure equally violent and sudden with those

which had preceded, but in a totally different seat.

This was spasmodic asthma with intense dyspnoea, deep

congestion, and sudden oedema of the superior extremi

ties. From this desperate condition she again rallied, but there remained some dyspnoea, copious expectoration which became rusty, frequent spasmodic gasps in the

breathing, and a dull impermeable patch in the back of

left lung. During the whole of this time her intellect

remained clear, though she manifested irritability and

peculiarities of temper not natural to her.

We now come to the last phase of this long course of

suffering. While slowly recruiting from the congestive attack on the lungs, she had one evening a convulsive

paroxysm, of much less than usual severity, and in the

morning was found paralytic of the right side. From

this state she also slowly recovered, but the powers of

life were now worn out with the long struggle ; her

mind became fatuous, with occasional maniacal delirium, and she died seven days after the last attack, and eleven

months after the first epileptic seizure.

The post-mortem examination showed very great

congestion of the external vessels, of the scalp, and of

the scull and its membranes. The blood was fluid, and

ran from the incisions in a stream. The brain was firm

and healthy, and not unnaturally vascular ; nor did it

present any unusual appearance till the middle lobe was

sliced, when a solid, firm, palish, fibrinous clot, sur

rounded with a discoloured margin, was found imbedded

in the white matter under the thalamus of the left

side ; it was of an irregular oval shape, one inch long,

by somewhat less than half an inch broad, its long axis

looking upwards and forwards. There was little fluid

in the ventricles. The plexus was pale, but the arteries

at the base of the brain was somewhat thickened. The

lungs were somewhat oedematous. The heart was

This content downloaded from 62.122.79.21 on Wed, 18 Jun 2014 09:32:54 AMAll use subject to JSTOR Terms and Conditions

296 DR. BRINDLEY'S PROPOSED COLLEGIATE SCHOOL.

large, and the left ventricle was thickened distinctly, but

not excessively. In reviewing the incidents of this case, the question

naturally suggests itself, in what manner are the post mortem appearances connected with the singular series

of changes exhibited in the history of the disease. The

first epileptic seizure was probably directly consequent on the effusion of the clot, and this again may be fairly attributed to the impetus of the hypertrophied heart, and the changed mechanical properties of the vessels of

the brain, which so commonly accompany that disease.

The appearance of the clot favoured this view of its

date and history. In this case it is obvious that the

clot acted as a predisposing cause only in the subsequent abnormal movements of the nervous system, the prox imate cause being temporary congestion, either pro duced by the overactive heart, or by sympathy with

other organs in a disordered state.* The diseases

throughout assumed a marked congestive character.

The abdominal viscera, the brain, the lungs, and the

heart, becoming each in its turn the seat of this

congestion. I may add, that depleting measures were principally

resorted to, the violence of the attacks prohibiting

temporizing measures. Opium produced no effect.

Cupping, with or without the scarificator and purga

tives, were found the most effectual means.

I remain, Sir, Your obedient servant,

HENRY COOPER, M.D., Lond.

Hull, March 1, 1851.

^rnmtirwl Mt?xx? fc Ittrgiwl SnunutL

WEDNESDAY, MAY 28, 1851.

In our advertising columns will be found a

prospectus of a " Provincial Medical Collegiate

Institution, which is intended to be established

by Dr. Beindley, of Tarvin Hall School, near

Chester, as soon as he can make the necessary

arrangements, and, if thought desirable, under

the sanction of this Association. The object of

this proposed establishment is to afford that

preparatory education fox boys who are about

to enter the medical profession; which is now

rendered imperatively necessary by the require

ments of the University of London, of the

College of Surgeons, and of the Apothecaries'

Company, and still more by the increasing com

petition in the ranks of the profession itself.

* Dr. Bright, in his " Reports of Medical Cases/' gives a case of con

vulsions with apoplexy in which the clot was in the cineritious substance, (p. 280, Vol. i?) and several cases of epilepsy with coma, (p. 198,) which

he attributes to congestion in the cineritious matter; probably the latter condition may in this case have supervened at the time of the epileptic seizures.

Our readers are aware, that at tlie Northampton

meeting in 1844, it was proposed by Mr. Martin

to establish a school for the sons of medical men,

and a Committee was appointed for the further

ance of the object, which was unanimously con

sidered by the meeting a highly desirable one.

The Committee presented the following report in

the year 1845:?

"That, so far as the attention of the medical public has been directed to the subject, and opinions expressed on the plan proposed, the latter have for the most part been decidedly favourable.

" On one point only has any objection of importance been offered, and that is, as to the required uniformity of religious instruction in the first proposed school : but

the Committee are of opinion that a diversity on this

most important subject would be quite incompatible with the harmonious operation of any schlolastic esta

blishment of the kind contemplated. "

They feel assured also, and have no doubt of the

| concurrence of this meeting, that whatever legislative

measures may be adopted with respect to the medical

profession, an improved classical and general education

will be absolutely required of those youths who are

desirous of entering the profession. "The Committee are further of opinion, that the

plan, of which a mere outline only has been offered, is

perfectly practicable?is worthy of the support of the

profession ; and having that support, with united action

only, might assuredly be fully realized. "

But, notwithstanding its apparent desirableness,

and the favour with which the suggestion was first

received, subscriptions to the amoant of ^1610 only

j have been promised.

"They therefore request a more efficient patronage of the

plarj, now that, for a time at least, there will be

less occasion for discussion on the public affairs of the

profession. Time will thus be afforded for cool and

deliberate thought, on the subject of the preliminary education of the sons of medical men, whether they are destined for the profession of their fathers, or for

any other profession. " The Committee, for the present, rest in the con

fident hope for a more efficient support of their plan,

that they may be enabled, by a proper amount of sub

scriptions, to invite a meeting of the subscribers, for

the purpose of further proceedings. " Joseph Hodgson, Chairman.

' Thomas Martin, Secretary,''

The proposal was, indeed, taken up most

warmly by every one who was interested in the

education of the rising generation, and only

failed for want of funds, the subscriptions

I which were promised never amounting to more

than ?1625, whilst ?10,000 were considered

necessary to start a single school for 200 boys ;

and at the meeting held at Norwich in 1846, the

Committee sent in a report to the effect that the

object was unattainable, concluding in the fol

i lowing words :?

This content downloaded from 62.122.79.21 on Wed, 18 Jun 2014 09:32:54 AMAll use subject to JSTOR Terms and Conditions