On fatty degeneration of the small blood-vessels of the brain, and its relation to apoplexy : communicated to the Abernethian Society of St. Bartholomew's Hospital / by James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
1850
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Licence: Public Domain Mark

Credit: On fatty degeneration of the small blood-vessels of the brain, and its relation to apoplexy : communicated to the Abernethian Society of St. Bartholomew's Hospital / by James Paget. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    brain ensued. Her general health had not been materially affooted, but for three or four days she liad complained of want of sleep, and headache. On the 29th she became, almost suddenly, hemiplegia, losing all sensation and power of vohmtary motion on her right side. She appeai-ed, too, very di-owsy, and half comatose. From this time she seemed occasionally to improve, but, on the whole, became gradually worse : she passed restless nights, often shriek- ing and deliiious, and was once or twice severely convulsed; her tongue was usually diy, and nearly black, and she had intense headache. A week after the attack of hemij^legia, sloughs formed in the skin of the right leg where the bed-clothes pressed on it: a few days later the skin and other tissues began to slough on the nates on both sides, on the sacrum, the right ann, the back of the head, and the right ear-. She died in exti'eme emaciation on the 3lBt of December.* In the examination after death, the tissue of the pia mater was found con- taining a large quantity of pellucid fluid. All the brain appeared quite healthy, exoe2Dt the left corpus striatum, of which nearly the whole was reduced to a soft pulpy substance, with mingled shades of pink, greyish, and pale yel- low, and with small spots of blood here and there scattered thi-ough it. On the mitral valve tliere was a thick patch of recently deposited lymph, and in the upper poi't of the left kidney was a large collection of pus in a cavity witla sloughing walls. Tufts of small blood-vessels di-aAvn from the diseased pai't of the brain showed the most stiiking degeneration. It was best mai'ked in vessels from l-150th to l-400th of an inch in dia- meter. These presented no change of shape, no dilatations: then- outlines were distinct and uniform, but of the several tissues of theu* coats scarcely a trace remained: they appeared as if formed of pellucid simple membrane, varied only by the fatty deposits, which existed in all the varieties of form already described. In blood- vessels less than l-400th of an inch in diameter, both the loss of proper struc- tures and the fatty degeneration were less, and both seemed to diminish witli * For many of the particulars of tbis case 1 have to thank Mr. H. O. Thorold, who was the patient's dresser. the size of the vessels: many of tlie capillaries appeared neaily healthy; others, liowever, were tliickly spiinkled with oU-particles. The softened cerebral substance con- tained abundant gi-anule-cells, with cell- shaped clusters of gi-anules, and diifused granular matter. Some corpuscles, also, were seen like those of Ipnj^h formed in inflammation; but these might be co- lom-less blood-corpuscles, such as existed abmidantly in the blood. Groups of dai-k blood-red crystals, of apparently prismatic form, were numerous in the softened substance of the brain. In the blood-vessels of otlier and healthy-looking pai-ts of the brain, scai'cely any appeai'ance of fatty degene- ration was observed. The gi-eat arteries of the brain appeai-ed quite healthy, and there were only very trivial de- posits of fatty matter in the aorta. In the foregoing cases, tlie fatty de- generation of the small blood-vessels of the brain existed in an exti'eme de- gree. In a less degi-ee I have observed it in the brain of a man, 51 yeai's old, who died with suppression of mine; in that of an epileptic woman, 45 years old; and in such other cases that I think it will be foimd a fi'equent condi- tion in the appai-ently healthy brains of persons past the middle period of adult life. In all such cases, when the dis- ease is far advanced in any of the blood- vessels, the loss of their proper sti'uc- tures, and the weakening of the remains of their walls by the copious deposits of fatty matter in them, must make them pecuhaily liable to ruptui-e. It cannot but be that tliis affection shoifld consti- tute a 2uedisposition to apoplexy, whe- ther occuning in its simplest fonn or in connection with cerebral softening; indeed, how readily vessels thus aflected may be toni, we may see in tlio fi-e- quenoy with which, in the microscopic examinations of them, specimens of considerable blood-vessels ai-e found torn across at or near the auormal de- posits. If what I have written should induce others to investigate this subject, I venture to suggest that they should especially examine the connection of this fonn of degeneration with the com- mon fatty or atheromatous degeneration of the lai-ger arteries, and with tlie morbid softenings and other eiTorg of