ON A CASE OF APOPLEXY.

72 There is generally some thirst, but no desire for food, int these cases. The patient, although apparently well, should be carefully watched for a few days after the accident, as theI

symptoms, which are temporarily removed,

are

very

apt

to,

and

perfectly insensible. This occurred in the back yard of a public-house, at half-past seven P.M., on the 7th of July, 1847. He was then decidedly I saw him shortly afterwards. apoplectic; the respiration laborious, and deeply stertorous;

Some unpleasant feelings about the head its noise could be heard at the distance of twelve or fourteen and chest, accompanied by much derangement of the general yards; the face was swollen and livid; the conjunctivse were health, have been observed to exist, not merely for a few days, highly injected; the pupils contracted to the size of a pin’shead; but even during life, if early and efficient relief has not been the pulse full, hard, and bounding, eighty per minute; no given. It seems to me desirable that the application of reme- movement of either extremity; the eyelids had lost their dies should be made in the order in which they are enume- reflex movement, and the face was insensible to stimuli; his breath smelt strongly of beer. rated above. The extreme contraction of the pupils led me to imagine 1st. Those which relate to the removal, if practicable, of the poison; and simultaneously as well as subsequently with these, that opium might have been taken, but his friends had no the stimulants, of which the oil of turpentine appears to me suspicion of the kind. Venesection was immediately practised infinitely the best, at least in the first instance, and until the in both arms; the blood did not flow rapidly; about thirty violence of the symptoms has become reduced, when this or thirty-five ounces were taken, which slightly lessened the may be superseded by an occasional dose of aromatic spirit of pulse, and scarcely improved the respiration, but as the skin ammonia, with a spoonful or two of camphor mixture, or a became cold, I considered it prudent to stop; he was carried home, and I saw him again in half an hour. glass of champagne or other wine. 2nd. The employment of bleeding, which I have hitherto The respiration was now even worse than before; nearly all thought it better to postpone until the system has become the auxiliary muscles of inspiration were brought into play, (but perceptibly brought under the action of the stimulants; and those of the face made a striking exception-the alse nasi were also because its earlier adoption might not improbably acce- never expanded; the mouth was passively open; if the head lerate the absorption of the poison before time had been given were unsupported, it fell forward on the chest, and closed the for the carrying into effect the primary indication. mouth; cold water dashed on the face did not excite inIn the case under consideration, a second bleeding was spiration.) The shoulders were raised with a convulsive found necessary a few hours only after the first; and had I shrug at each inspiratory effort; the intercostals were powerbeen apprised at the time, of even the slight symptoms that fully contracted at the same moment; the fibres of the two occurred on the second night, the bleeding, though to a still greater pectoral muscles quivered in a very remarkable manner, smaller extent, would have been repeated; this treatment as if each component fasciculus were excited to contract by a would most probably have prevented some slight " muscular separate discharge of electricity-in fact, this phenomenon pains," as the patient termed them, and uneasiness, which might be compared to the movements of the extensor tendons continued to be experienced several days afterwards. of the hand, when the fingers are moved in playing the piano. The reddish-brown, or copper-coloured snake, Coluberfitlvus There were no spontaneous movements of the upper or -Australicus, " Yoonga," (native name by the Sydney tribe;) lower extremities. I attempted to excite reflex movements Bulgora," (name by aborigines of Lake Macquarrie,) is very by tickling the soles of the feet, but failed. Although It is of a some- no convulsive movements were produced by dashing cold common in the neighbourhood of Sydney. what deep, rich copper colour along the back, passing into a water on the face, yet when thrown on the chest it induced an similar but lighter tint along the abdomen. The specimens I inspiratory effort. have seen have been, in general, between three and four feet I The stomach-pump was used, and a pint of dirty fluid, in length, and about two inches and a half in circumference. smelling strongly of beer, was thus removed: upon passing the The lower jaw is armed with two rows of extremely short, point of the tube over the larynx, an effort of coughing was prehensile teeth. The upper jaw, besides two complete rows produced. A teaspoonful of fluid poured down his throat of palatine teeth, is furnished, externally to these, with a induced coughing and symptoms of asphyxia ; I therefore tubular fang on either side, considerably longer and stouter placed four drops of croton oil on his tongue. As the pulse than any of the other teeth, and fixed on a slender process of was as strong as ever, I opened the jugular vein, and took the maxillary bone. A few small prehensile teeth form an twenty-five ounces more blood; this softened the pulse, and imperfect row, extending backwards in a direct line, at some lessened the lividity of the countenance, and relieved the fUstft.nce from these. dyspnoea; but the respiration was not natural-it was a gasping The two following experiments are selected out of a number for breath. Each inspiration made suddenly and convulsively; performed by a young friend of mine, Mr. Henry Smeathman, the expiration slow, and prolonged about twenty times per with a view to obtaining some approximative comparison of minute. He was ordered to bed ; sinapism3 to be applied to the the degree of virulence possessed in the venom of the above, and other snakes. neck and calves ; the head to be shaved, and cold nape Experiment I.-A part of the thigh of a chicken, about six water pads to be applied to the scalp ; with bottles o weeks old, was inserted between the jaws of a dead specimen He was again seen at ten P.1.I. His rewhen I left him ; it was (killed a few hours before) of the copper-coloured snake. This specimen was three feet one inch in length, and two Vomiting had been inches and a half in circumference throughout nearly its entire induced two or three times by the croton oil ; but the bowels at each effort length. The chicken was dead in four minutes. The punc- had not been emptied ; the bladder was tures from the bite of the snake were barely perceptible after of vomiting he ran great risk of suffocation. The case was death. evidently hopeless, and death could not be far distant ; in Experiment 2.-Inserted part of the thigh of a second fact, he lingered only till one in the morning, death occurring chicken, four weeks old, between the fangs of the samesnake. four hours and a half after the attack. It died in two minutes. This was very probably the result of Post-rnoTte1n exainitiation, t7tirty-seven hours afterwards.the difference of age in the two animals experimented upon; Decomposition had advanced frightfully. I never saw a more but in addition, the punctures in the latter instance were disgusting corpse. The whole face and scalp were dark olive acre clearly perceptible, and it is probable therefore that the green, frightfully swollen, and emphysematous. The brain inoculation with the poison had been more complete than in was not decomposed. The cerebral arachnoid was adherent the first experiment. in many places to its parietal layer, by old depositions of fibrin. Upon carefully removing the brain from its cavity in Sydney, New South Wales, March, 1847. the usual way, the pons Varolii appeared of nearly double the ordinary size, soft and pulpy, and blown out like a bladder; ON A CASE OF APOPLEXY. its basilar surface was covered over with a soft, slimy pulpSANGUINEOUS EFFUSION OCCURRING IN THE PONS VAROLII, BY in fact, softened brain. The crura cerebri appeared torn up and softened ; coagulated blood and softened brain filled the WHICH THE WHOLE OF THIS STRUCTURE WAS TORN UP, SOFTENED, AND DISORGANIZED, TOGETHER WITH NEARLY THE bladder formed by the altered pons Varolii. The commissural fibres of the pons appeared to be normal, but all the ascending WHOLE OF BOTH CRURA CEREBRI. fibres of the medulla oblongata, passing through the pons, BY W. B. HERAPATH, M.B., Bristol. were torn up and destroyed, with the exception of a small DANIEL C-,apainter by trade, aged forty-six, formerly bundle of the right posterior column. much addicted to drinking, was seized, while in the act of The spinal sheath was partially filled with softened brain. stooping, with what he called " the cramp" in the upper and The left lateral ventricle contained a few small clots of blood, lower extremities; he immediately fell down, and upon being and about half an ounce of bloody serum; this had apparently quickly raised by his companions, he appeared to be in a fit, entered by destruction of the hippocampus major. The return about sunset.

.

of the

warm

the more feet. water spirationtowas embarrassed than

as bad asbeforethe last bleeding.

empty;

73

IB

right lateral ventricle contained only a small quantity of serum. and that which is too contemptible a falsehood to require conThe third ventricle contained no clots, but the two lateral tradiction-too contemptible even to notice; and so the aborwalls of the thalami optici were stained with blood. The tion should have passed to the waste-paper basket, but that, in medulla oblongata and its ventricles were uninjured. No to our who may be tempted, by the fictitious justice readers, haemorrhage in any other part of the encephalon. This case presents many points of peculiar interest. The table of contents, to throw away even pence on this sorry quantity of effused blood, the importance and extent of the pamphlet, we feel called upon to exhibit the honesty of this part destroyed, render the length of time elapsing before death soi disant immaculate reviewer, who offers to " append his occurred, somewhat extraordinary. The symptoms shown observations to a summary of any book which an author may during life are all beautifully cleared up by the position of the send him;" presumes to call this a review; and to add his haemorrhage. The respiration was of course perfectly spinal name, as a caution that he is not to be bought. No; he is to or reflex the true brain was completely severed from the cord at the termination of the medulla oblongata. The be sold; or rather, those who may be silly enough to buy his origins of the fifth pair of nerves were destroyed-hence the trash. In the table of contents, eleven articles are dignified by non-appearance of reflex facial movements-the integrity of the arc was broken. The pneumogastric was still active the name of " Original Communications;" of these eleven, only when stimulated by irritation of its laryngeal, pulmonary, do not amount to half-a-dozc:! pages, are which, united, four, or gastric branches, as shown by coughing, vomiting, and the other seven are " To be continued;" yet of this complete; The when movements. intercostal stimunerves, respiratory lated, also induced inspiratory efforts, the motor impulse incompleteness, aud consequent worthlessness, not a word is being conveyed by the spinal accessory; branches of the said in the before-mentioned table. Moreover, the honourable cervical and brachial plexuses, external respiratory and editor, in his address, refers to " an accompanying page" for a phrenic nerves, together with the muscular branches of the specimen of his reviewing capability. In vain have we turned intercostal nerves, to the various muscles they supply. The we find neither a review nor an apology irregular contractions of the pectoral fibres are difficult to over all the pages; explain ; and the great contraction of the pupils are equally for its absence. In truth, what with promises of monograph without an apparent cause, especially as the third pair of numbers," " retrospect numbers," and 11 encyclopoedic pages," must we are lost in the mysteries of the " Record." nerves, by the destruction of the crura cerebri, &c., Of the have been separated from the spinal cord. It is possible the materials we find, first, an article by Dr. Radford, remaining irides were adherent to the capsule of the lens from syphilitic disease. A cicatrix of an old chancre existed on the right who, adopting as a text, " Be fruitful, and multiply, and side of the glans penis. replenish the earth," flies from the Jewish lawgiver to Baron I imagine the hsemorrhage to have occurred gradually in Platt and the jury of matrons, and weakens the force of this case, commencing in the pons Varolii, and thence passing a good and useful argument by a wondrous amount of diluon to the disorganization of the other structures. Was the tion. Next comes a Case of Aggravated Vomiting softening the cause or the effect of the hsemorrhage ? I am during(Incomplete.) related Pregnancy, by Dr. Churchill. There is "no inclined to believe the latter, as he was in good health at the time of the seizure, and such an important portion of the brain case"!but merely a summary of other people’s observations could not be disorganized without evident symptoms of its on the subject. (Incomplete.) Then we have a story by a progress. He had simply complained of a slight headach for Dr. Watson, who writes I.A.M.S.S. after his name, which is an a day or two previously. exceedingly curious coincidence, taken in connexion with our Bristol, January, 1848. opinion of his capabilities, after a perusal of his narration. It is this. A drunken prostitute, after excitement, comReviews. plained much of her head, and became insensible. The worthy doctor pursued the most energetic methods,ambiThe B7°itish Record of Obstetric Medicine <
of filthy