A lecture on the pathology and treatment of epilepsy / by George Johnson.

  • Johnson, George, 1818-1896.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: A lecture on the pathology and treatment of epilepsy / by George Johnson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    These experiments obviously cannot be repeated on the human sub- ject; but.Drs. Kussmaul and Tenner describe the effects of compressing the carotids in six men. In all, the face turned pale ; the pupils first contracted and then dilated; the respiration became slow, deep, and sighing; then there was giddiness, staggering, and unconsciousness, and the patients would have fallen had they not been supported. In two subjects, of weak intellect and moderately anaemic, in whom, notwith- standing the above symptoms, the compression was continued, a choking sensation, attended by vomiting and general convulsions, came on, which, however, did not attain an aggravated form; for, on withholding the compression, they disappeared in a few seconds. (Op. cit., p. 28.) Compressing the carotids does not, of course, entirely cut off the supply of arterial blood to the brain; but these experiments render it probable that sudden occlusion of all the arteries of the head will as certainly excite epileptic convulsions in man as in the lower animals. There is a class of cases in which a sudden arrest of the blood in its passage through the lungs causes convulsions and speedy death. I mean cases in which the circulation is arrested by the admission of atmospheric air into the veins; cases of embolism of the pulmonary artery; again, cases in which the flow of blood through the lungs is stopped by the injection of certain salts into the veins ; and, lastly, cases of acute apneea. When animals are killed by blowing air into the veins, the breathing becomes hurried, the animal falls down, and usually dies in convulsions; the contents of the bladder and rectum being frequently expelled at the time of death. Dr. John Reid states that, in a very few cases only, is death from this cause not preceded by convulsions. {Phy- siological, Anatomical, and Pathological Researches.) The immediate cause of death in these cases is the arrest of the frothy mixture of air and blood in its passage through the minute pulmonary arteries (the air rarely reaches the left side of the heart); and, as a result of this arrest, there is, of course, anamiia of the brain and of every other organ sup- plied by the systemic arteries. In man, it appears that death from the admission of atmospheric air into the veins has been less frequently preceded by convulsions. Probably the chief reason of the less frequent occurrence of convul- sions in the human subject is, that the amount of air accidentally ad- mitted is less, and death, consequently, is less rapid than when air is forcibly driven into the veins of an animal. It would probably be found, on a careful inquiry, that the occurrence of convulsions in these cases depends upon the circulation being suddenly and completely arrested. Convulsions are mentioned in only five out of fifteen cases collected