HYPER.EMIA OF THE BRAIN AND ITS MEMBRANES. 191 



stroy any thing that comes in their way, cry, laugh, or sing. There is 

 also delirium of varying character ; usually the patients consider them- 

 selves as injured and betrayed, and rage against their enemies and 

 persecutors. The continued muscular exertion throws them into a 

 perspiration, the heart-beat and pulse are accelerated and stronger, 

 the face is usually reddened. This form is also very dangerous if it be 

 mistaken and improperly treated, for then an apoplectic attack, a true 

 apoplexy, or an excessive hyperaemia of the lung with acute cedema, 

 causes death. According to my observation, cases exactly like the 

 following, detailed by Andral, are by no means rare ; in the Mag- 

 deburg hospital, and in the Greifswalder clinic, I have seen several of 

 them within a few years : " For several days a middle-aged man kept 

 up a series of cries sufficient to disturb the whole hospital-ward. 

 These cries ceased suddenly, and on approaching his bed he was found 

 dead. He would not have died more suddenly if struck by lightning. 

 On opening the body, the only lesion found was a lively injection of 

 the cerebral substance." 



Lastly, we must mention those forms of cerebral hypera3mia where 

 symptoms of general depression and paralysis appear, and by their 

 sudden occurrence so resemble an apoplexy than an exact diagnosis is 

 often impossible. In some cases the attack is for a time preceded by 

 headache, disturbance of sensibility, dizziness, sleeplessness or psychi- 

 cal disturbances ; in others, it occurs without premonitory symptoms. 

 The patient suddenly becomes dizzy ; " every thing whirls around with 

 him ; " he staggers, all looks dark before him ; he loses consciousness 

 and sinks to the ground, either with or without slight spasm. Such 

 an attack, where all activity of the brain is lost, may cause death by 

 the paralysis extending from the brain to the centres of the organic 

 nervous system. More frequently the patients recover consciousness 

 after a time, with an indistinct remembrance of what has passed or 

 without any recollection of it. These apoplectiform attacks, occurring 

 in the course of hypergemia of the brain, correspond with the above- 

 mentioned epileptiform attacks, as regards the cerebral anaesthesia and 

 the paralysis of the psychical functions, and like them appear to 

 depend partly on obstructed escape of the venous blood, partly on 

 secondary cedema of the brain. As we have previously shown, both 

 states prevent the supply of oxygenated arterial blood, which is indis- 

 pensable for the excitability of the brain and the entire nervous sys- 

 tem. Traube, who refers the epileptiform attacks in Bright* s disease 

 also to oedema of the brain, has advanced the theory that an oedema, 

 limited to the greater hemispheres, induces simple loss of conscious- 

 ness ; when it affects both the hemispheres and medulla oblongata 

 there are loss of consciousness and convulsions. We shall not discuss 



