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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    wlicn at breakfast, after oouiiiliiiuiug of headache, she suddenly became uu- conscious. She recovered her conscious- ness in about half an horn-, and went about her work ; but about four houi'S afterwai-ds she felt faint, sat down, and then fell to the right side. She was insensible for a few njinutes; and on recoveiing had lost the use of both right limbs, but could speak distinctly. In about tlu-ee hours aftei-waa-ds she had another attack, and remained un- conscious tOl midnight, when she pai- tially recovered. Till the last day of her life she re- mained almost always in a half-conscious state ; hemiplegic on the right side, and generally unable to speak. In the last day she became more and more coma- tose, and so died. In the examination after death, dis- eased miti-al valve, enlai-ged heai-t, and signs of bronchitis, were found. In the aortic valves and the arch of the aorta, and about the oiifices of its gi-eat branches, were numerous scattered de- posits of fatty matter; and similar de- posits were abimdant in the coronary arteries. The skull and dura mater were thick. On the upper smface of the left cerebral hemisphere, the substance of the brain, for about two inches in length, and one in breadth, near the longitudinal fissure, was flattened, soft, and spotted with deep red. The pai-ts immediately aroimd this poi-tion were of a light yellow tint, and much softer than the rest of the cerebral substance. Beneath the red-spotted pai-t, and to within a line of the roof of the lateral ventricle, was a brownish-red mass, consisting of clotted and pai-tially decolorized blood, intimately mixed with cerebral sub stance. The portion of brain ai'ound this was softened and yellowish, but the portion between the clots and tlie lateral ventricle appeai'ed healthy. So, also, did all the other pai-ts of the brain. Several portions of yellow fatty deposit existed in the walls of the branches of the arterial circle of Willis, and in the walls of the anterior and middle cere bral arteries; but the deposit did not any^vhere appear sufficient to impede the stream of blood. In microscopic examinations of por- tions of this brain, I found fatty dege- neration, in the forms dcscnbed above, affecting alike the vessels of tlic healthy, the broKcn, and the soi'tcnod portions of the brain; but the vessels of the healthy parts wei-e affected in a less degree tlian those of the others. Some vessels, not less than l-200th of an inch in diameter, appeared to have almost totally lost their natm'ol structm-es, though presenting but little fatty dege- neration. A similar loss of natm-al structure was observable wherever the degeneration existed. The disease affected principally the bloodvessels of about l-400th of an inch in diameter, but in some parts it existed also in even the smallest capillaries; such as, when collapsed, measin-ed not more than l-3000th of an inch. In many speci- mens it was easy to trace both an inner and an outer line at the sides of the deposits,—proving that they lay in the veiy substance of the coats of the vessels. In and about some of the affected bloodvessels were numerous lozenge- shaped, dai-k, blood-red crystals, some of which lay among the clusters of fatty particles in the walls, wliile others ap- peai'ed to be within the cavities of tlie bloodvessels.* Some, also, of the small bloodvessels presented well-mai'ked partial dilata- tions, like aneuiismal pouches, or Hke more extended varicose enlargements of theh' walls. In these, as in others, but in no gi-eater degi-ee, the fatty degene- ration existed. The cerebral substance appeared ge- nerally healthy, but in the softest parts granule-cells existed,—not, however, in gi-eat abimdance. Case TIT.—E. Kose, a sempsti-ess, 21 yeai's old, was admitted on the 8th of October into Harley's ward, imder Mr. Stanley, with an outward disloca- tion of the patella that had existed two months. The dislocation was with much difficulty reduced on the 16th of October, and, with equal difficulty, was'' prevented from reciming. The pres- sure of apparatus on the reduced pateUa caused shght slougliing of the integu- ments over it, and she was under treat- ment for tins, when, on the 29th of November, symptoms of affection of the * Respecting these singularcrystals, the reader may consult Virchow, who believes them to be formed of modified haimatin (Ueber pathol.Pig- mente; in his Archiv, B. i. p. 390, Tab. iii.) or Zwicky (Do corporum luteorum oriffme). KOI- liker also has some remarks on them in bis ZcitschriftfUr wissensch. Zoologie, B.i. p. 266.