On the influences of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain : a course of lectures, delivered at the Royal College of Surgeons of England in the years 1860, 1861, and 1862 / John Hilton.

  • Hilton, John, 1804-1878.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On the influences of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain : a course of lectures, delivered at the Royal College of Surgeons of England in the years 1860, 1861, and 1862 / John Hilton. 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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    intended to lubricate the two surfaces of the external arachnoid during the movements of the brain. These movements being, as you are well aware, two : one, under the influence of the arterial circulation, derived directly from the impulse of the heart; and the other depending upon the occurrence of any difficulty in the transmission of venous blood through the lungs from the right to the left side of the heart. This obstruction leads to congestion of all the smaller veins tributary to the large veins winch enter the chest—and therefore, amongst others, to the in- ternal jugulars, which return the blood from the brain and from the interior of the skull. The ill effects of undue friction under these two circumstances are prevented by the small quantity of fluid which exists between the sur- faces of the external arachnoid. The letter c points to what I should denominate the internal arachnoid. It is this internal arachnoid which contains the cerebro-spinal fluid, winch proceeds to the interior of the brain through the cerebro-spinal opening, and then lines all the ven- tricles of the brain, and their different intermediate passages —with the exception of the fifth ventricle. The existence of this cerebro-spinal aperture underneath the cerebellum, and between the cerebellum and the me- dulla oblongata, is not perhaps universally admitted; but I believe, beyond all doubt, that it is the normal arrange- ment of structure, that there should be such an aperture. Some years ago I took a great deal of trouble for the pur- pose of ascertaining this point in a very exact manner ; and in no one instance, except where there were abnormal collections of fmid in the interior of the brain, did I find this aperture wanting. In other words, in every brain which I examined, except in cases of disease, I found there was such an aperture, freely allowing fluid to pass inwards and outwards from the interior of the brain. I shall hereafter have the opportunity of laying before you some cases in which this aperture was closed, producing, in fact, internal hydrocephalus. This diagram (Fig. 3) does not pretend to explain the exact and minute distribution of the internal arachnoid membrane, but only the general arrangement which exists