321 
PATHOLOGY. 
compact and unyielding ftruflure of the cranium, and the 
incompreflibility of thefubftanceof the brain, we (hall per¬ 
ceive, that a very (light increafe in the momentum of the 
blood mu ft exercife a powerful p re (1'ure on fome part or 
other; and it feems to us, that this part will be thee.rfmtte 
terminations of the arterial branches. Thefe terminations, 
having a ftrong tendency to diminifh theircaliberin a ratio 
increasing with the diminution of their Size, naturally 
exert this power in a much greater degree than the larger 
arteries, which pofiefs not only lefs of this power, but 
are fo much nearer the heart as to Suffer in a greater de¬ 
gree from its impulfes: consequently they will be emp¬ 
tied by the preil'ure of the larger arteries to a degree that 
will counterbalance all vis a tergo; fo that the circula¬ 
tion of the brain'will be kept up Solely by the middle- 
fized arteries and veins. That this is the cafe does not 
admit of direft proof; yet it is Supported by ftrong infe¬ 
rences, for it is allowed by all, that the brain cannot be 
diminiftied in its volume by preffure, except by the emp- 
tir.efs of its veflels. It is alfo allowed, that the pulfa- 
tions of the arteries going to the head manifeft vigour 
and fulnefs; and it is alfo pretty generally believed, that 
the blood comes back freely enough through the jugulars; 
and hence we have the llrongeft reafon to believe, that 
the capillary fyftem, and that only,-is emptied of its blood 
in apoplexy. 
This hypothefis explains the phenomena of apoplexy 
in a very clear manner. It explains the lofs of confeiouf- 
nefs that attends this difeafe ; a phenomenon always de¬ 
pending on want of due Supply to the arterial termina¬ 
tions of the cerebrum, as we fee in Syncope from bleed¬ 
ing. It explains how apoplexy is cured by venefeflion, 
which, by reftraining the aftion of the heart and the ple¬ 
thora, diminifties the preffure. It (hows how, when effu- 
fion of blood takes place, and paralyfis comes on, there 
is Some amelioration of the apopledfic Symptoms; i. e. 
becaufe the general preffure is removed, and one merely 
local remains; consequently affetfting only particular 
nerves and their dependant functions. That there are 
■exceptions tothelaft fa<St only (hows, that the effufion of 
blood may not always be followed by the dilatation of the 
capillaries; a faft not more Surprising than that emptied 
arteries do not always contract on their contents, as we 
have reafon to believe happens in phlogofis unreftrained 
by bleeding. 
The appearances on diffeftion are various. M. Serres 
dates, as vve before hinted, that in all Simple apoplexies 
(i. e. unaccompanied by paralyfis) the membranes of the 
brain are alone affedfted. The difeafe of membranes is 
Sometimes attended with effufion, which is Serous, San¬ 
guineous, or fero-fanguineous. Sometimes it confifts 
only of rednefs, diftention of the veflels, of the pia ma¬ 
ter, flirinking of the dura mater, and opacity, Sometimes 
accompanied wfith whitifh granulations, of the tunica 
arachnoides. Moft authors ftate, that the blood-veffels 
in the fubftance of the brain are always found much dif- 
tended. It is in the fubftance of the brain that Sangui¬ 
neous extravafation from rupture of the veflels is ufually 
met with ; the corpus ftriatum and the thalamus nervorum 
opticorum being the precife Situations of this lefion. 
When apoplexy terminates by paralyfis, and the latter 
in convaleicence, the changes which the difeafed ftruflure 
undergoes are very numerous. In the firft place, the 
apoplexy terminates in paralyfis, in confequence of the 
rupture of an artery or vein, which renders the preffure, 
before general, merely local; and consequently, when 
death does not Speedily follow, allows the cerebrum to 
reSume its funftions in fome part. The extravafated 
blood after a time becomes Surrounded with a cavernous 
pouch, Somewhat like an aneurifmal Sac, and which fre¬ 
quently opens by a rent into the ventricles, or on the Sur¬ 
face of the cerebrum. The parietes of this cavern is 
very Soft, tinged ftrongly by the blood, about aline or 
two in thicknefs, unequal, anfractuous, and evidently 
lacerated on its internal Surface, and prefenting flaky fila¬ 
ments when agitated in water. It is furrounded by a 
layer of cerebral fubftance, about three lines in thicknefs, 
of a pale yellow colour, and the confidence of thick cream, 
Scarcely mifcible with water: this layerbecomes gradually 
blended with, and loft in, the Surrounding healthy brain. 
From this cyft, abforption of the effufed blood gradually 
takes place; or at leaft the brain graduallyaccommodates it- 
felf to the imprefling body. “ After the abforption of the 
blood, (Says M. Rochoux,) the parietes of the cavern, or 
pouch, above deferibed, approximate, and in Some mea¬ 
sure cicatrize, by the intervention of a cellular and vaf- 
cular connexion, forming various areolae, between which 
is found a reddifh ichorous fluid, more or lefs abundant, 
and Sometimes glutinous. Thefe parietes are much 
denfer than the reft of the brain, about a line or two in 
thicknefs, and of a yellowifh-brown colour. I affirm 
that thefe caverns are conftantly found after apoplexy 
terminating in-paralyfis; and their number always cor- 
refpondswith the number of attacks.” This laft remark 
of Rochoux’s agrees with that long fince made by our 
illuftrious countryman Hunter. See Hunter on the 
Blood, p. 213. 
The treatment of apoplexy varies as it is accompanied 
with Symptoms of paralyfis or as thefe are wanting. In 
the firft attack of the difeafe, however, the treatment is 
the fame in each variety. The objedt is to deplete the 
cerebral veflels. For this purpofe the jugular vein 
fliould be opened, the patient fixed in an eredt pofture, 
and blood drawn until Some return of fenfation is mani- 
fefted. Frequently, however, this relief is expedted in 
vain. Seeing the difficulty, therefore, of removing apo¬ 
plexy, when once formed, it fliould be the care of the 
pradlitioner to notice its premonitory Symptoms with pe¬ 
culiar attention. The occurrence of vifual deception, 
the moft trifling aberration of the cerebral fundfions, if 
attended with Sanguineous fulnefs, or if occurring in 
patients predifpofed to apoplexy from age or formation, 
will warrant us in taking a large quantity of blood from 
the arm, and exhibiting a ftrong draftic purge. The lat¬ 
ter being repeated from time to time, and low diet en¬ 
joined, by thefe means an attack of this formidable ma¬ 
lady may in almoft all inltances be warded off. 
To return to the treatment of the difeafe when formed. 
Inftead of the jugular vein, Some pradlitioners have 
ftrongly recommended arteriotomy, and have feledled 
the temporal artery for this purpofe. It does not Seem 
of much confequence whether the temporal artery or the 
jugular vein be opened, provided a Sufficient quantity of 
blood be drawn, and that quickly. The fmallnefs of the 
temporal artery, however, often prevents a Sufficient flow 
of the blood; and no Such objedtion is in force againlt 
the jugular vein. When from one of thefe Sources a Suf¬ 
ficient quantity of blood has been drawn, our attention 
mull be diredled to the ftate of the alimentary canal. If 
a large meal has been taken within five or fix hours of 
the attack, or if the patient has been known to Suffer 
under dyfpepfia for fome time previous to the occurrence 
of apoplexy, a full dofe of ipecacuanha, with copious 
draughts of warm water, may be adminiftered. In the 
nervous apoplexy deferibed under Dyfpepfia, this mea¬ 
sure might precede or fuperfede blood-letting. Unfortu¬ 
nately, however, the diagnofis between nervous and San¬ 
guineous apoplexy is very obfeure. When the emetic 
has operated, aperient clyfters are to be given; and 
thefe may be followed by draftic purges. The peculiar 
kinds it is Scarcely worth while to Specify, as they are 
Sufficiently known. We may remark, however, that the 
oil of croton, from its intenfe and Sudden adtion, pro¬ 
mises much benefit in apoplexies. If under thefe cir- 
cumftances the difeafe in Some meafure goes off, refto- 
ring confcioufnefs and feeling to the patient, it will be 
right to prevent the recurrence of the fit by counter-ir¬ 
ritating diftant parts; as bliftering the legs, giving draft- 
