Cerebral congestion

“ In a word, increase of the cerebral circulation is the formula covering the majority of observations on this subject.
Does experimentation, strictly so called, teach us anything on this point? Numerous and well-known physiological researches, especially those of Mosso, show that all intellectual, and, most of all, emotional, work, produces cerebral congestion; that the brain-volume increases, and the volume of the peripheral organs diminishes. ”

“ In the meantime, with the advancing degeneration of the cerebral arteries, some sudden cerebral congestion, caused by leaning over, lifting, vomiting or hard coughing, may rupture a cerebral vessel, and all the symptoms of apoplexy are present. If small hemorrhages occur in the arterioles of the extremities, of course the prognosis is not serious. Sometimes some of the smaller vessels of the brain may become obstructed and cerebral degeneration occur. ”

“ The results obtained by physiological experimentation, to prove that sleep is accompanied by cerebral congestion, according to some, and according to others by cerebral anemia, are not more valuable than the results of clinical observation. Firstly, the animals upon which the experiments have been made have been wounded more or less severely, and thereby both excitement and pain have been caused ”

“ General prostration, partial palsy, coma, and convulsions were the leading symptoms after the accident was observed. In the four people found dead the most remarkable appearances were cerebral congestion, redness of the bronchial membrane, accumulation of bloody, frothy mucus in the air tubes, scarlet redness of the lungs, coagulation and darkness of the blood. In the person who was found alive, but did not recover, there was no cerebral congestion, gorging of the air tubes, or redness of the lungs. ”

“ To go more into detail, I could not do otherwise than narrate a series of cases which would differ from each other in most important points, and have nothing in common excepting pyrexia and brain symptoms. There is, generally, something wanting which makes us suspect that we have not to do with tubercular meningitis. Brain fever is as good a name as any whereby to designate these different anomalies; cerebral congestion, which is more commonly used, involves an explanation which is probably often wrong, and certainly never proved to be right. ”

“ How often symptoms are considered as cases of hypochondria or chronic gastritis, or the commencement of heart disease, which are really the results of generative abuse! A general exhaustion of the whole physical force, symptoms of cerebral congestion, or paralysis, attributed to some cerebrospinal lesion, are often due to the same causes. The same may be said of some of the severest forms of insanity. Many cases of consumption appearing in young men who suffer from no hereditary tendency to the disease enter into the same category. ”

“ Objectively considered what is observable is hypertrophy of the cellules and nerve-tubes, excessive cerebral plethora and vascularity due to the great efflux of blood and superabundant nutrition of the encephalon. Inflammation of the meningeal covering, and of the brain itself, is, sooner or later, a further result of the chronic congestion. ”

“ It is well established as regards other viscera, that during a condition of activity there is more blood in their tissues than while they are at rest. It is strange, therefore, that, relative to the brain, the contrary doctrine should have prevailed so long, and that even now, after the subject has been so well elucidated by exact observation, it should be the generally received opinion that during sleep the cerebral tissues are in a state approaching congestion. ”

“ The carotid artery is also dilated during cerebral work', and the carotidian pulse becomes dicrotic, but the radial pulse becomes smaller and less ample. The phenomena of congestion observed in the brain persist for a certain time after cerebral activity. ”

“ When the congestion is long-lasting, various further morbid changes may arise, pulmonary hyperaemia may eventuate in bronchitis, hyperaemia of the cerebral meninges may cause very severe headache, there may be syncopal attacks, tinnitus aurium, choroidal congestion, impaired vision, etc. ”

“ In more severe cases more radical measures must be adopted to combat the severe vaso-motor depression, with its consequent splanchnic congestion and cerebral anæmia. No method is more desirable than infusion. ”

“ CONGESTION AND ANAEMIA OF THE BRAIN.—In congestion of the brain, the blood-vessels distributed to the nerve tissue become engorged with blood. It may be either active or passive.
The cause of anaemia of the brain is an insufficient blood supply. This may be due to an abundant haemorrhage and cardiac weakness caused by shock or organic heart disease.
The causes of congestion of the brain are faulty methods of care and feeding. It sometimes occurs when horses are shipped in poorly ventilated cars, or kept in close stables. Climatic changes, or changing the stable and feed, may cause it. ”

“ It is, therefore, not difficult to understand how, when the circulation is in a state of permanent excitement, a very slight cause may suffice to overturn its equilibrium, and occasion a greater flow of blood to the brain than the organ is able to bear. Congestion of the brain, however, is not by any means limited to this season, but may occur at other times without any obvious exciting cause, and with no other explanation than is furnished by the well-known fact that all periods of development such as childhood, are periods during which the growing organs are most apt to become disordered. ”

“ The most usual cause of the disease, however, particularly in children, is an irritation which is sympathetically communicated to the brain, from a disturbance in the chylopoietic organs; and particularly from a functional disorder of the liver. The cerebral disorder, to which a derangement in the digestive functions thus gives rise, is only one of those numerous effects which arise out of sympathies, subsisting between these organs and different parts of the system. ”

“ Briefly, then, the brain is governed by the common law that controls blood-circulation in all the organs. By virtue of this law, when the organs are at rest and their action suspended, the circulation in them grows languid; and it increases, on the contrary, as soon as activity is resumed. The brain, I repeat, is no exception to this general law, as had been supposed, for it is now demonstrated that the state of sleep coincides not with congestion, but, on the contrary, with bloodlessness of the brain. ”

“ The sudden interference with the brain circulation produces unconsciousness, and destroys the checking influence of the higher centres on the reflexes in a manner analogous to any shock affecting the nerve centres. In the meantime, while there has been a sudden deprivation of arterial blood and a sinking of intracranial pressure so far as the great cerebral masses are concerned, there has been as sudden an influx of blood to the unaffected district of the vertebral arteries whose irrigation territory is now the seat of an arterial hyperæmia. ”

“ As the intra-cranial tension still further increases, the pressure gradually comes to affect the cerebral tissue itself, and so the extreme symptoms of compression are produced. The vagus and vaso-motor centres are irritated, and this causes slowing of the pulse, contraction of the small arteries, and increase of the arterial tension which tends to maintain an adequate circulation in the vital centres in the medulla. The Cheyne-Stokes respiration is due to rhythmical variations in the arterial tension: during the period of fall the centres become anæmic and the respiration fails ”

“ As stimulation of the brain causes dilatation of its vessels, and increases the flow of blood through them, mental action of itself not only attracts more blood to the brain, but provides to some extent for the removal of waste products. The movements induced by the cardiac pulsations are not so extensive as those caused by the respiratory movements or by muscular exertion, and therefore, when the brain is overworked, and the respiration and muscular movements are underworked, the cerebral nutrition will be diminished by the imperfect removal of waste from its substance. ”

“ The affection of the brain is sometimes so violent and sudden that the pulse is not only slow, but intermitting, and the respiration is suspirious. Frequent and deep sighing is not uncommon in severe cerebral cases, and it is highly characteristic of intense cerebral affection; but in such a violent attack as that of which we are now speaking, the suspirious breathing, even in the very commencement of the disease, is so great that it cannot be overlooked. ”

“ Considering the fact that cases with such marked and decisive symptoms as those last recorded have recovered, it is certainly the duty of the physician to prolong the life of his patient to the utmost, that absorption and condensation may go on as long as possible and collateral circulation be developed. Probably most physicians can recall cases of obscure cerebral disease going on to recovery contrary to all expectation, in which thrombosis furnishes an explanation quite as plausible as any other. ”

“ It is a fact of some importance to know, that cerebral hypertrophy may present symptoms indicative of effusion, and may even terminate fatally, yet without any other morbid appearance than extraordinary development of the brainular mass, and with only very little fluid in the ventricles. Instead of effusion, the convolutions of the brain appear flattened from previous pressure, exhibiting increased density of structure. ”

“ Such consideration is, however, without the sphere of the present paper, which deals with cerebral manifestations in relation to ordinary disease, and not with those ailments which belong to the province of the alienist physician. To one form of disorder of the cerebral cells alone may reference be made here, and that is as to the effects of mental over-strain. Brain-tissue can be developed by exercise, and worn out by overwork. When this latter condition has been induced, there exists that irritability which forms part of the early stage of the exhaustion of nerve-matter. ”

“ Prolonged and excessive nervous action is attended with too great a rush of blood to the nerve-centers, which can [pg 917] only be relieved by increasing the flow in the muscles. Congestion, or hyperæmia, in the spinal cord or brain, or both, is a condition ever present in neuralgia. The application of motion through the manipulator causes the blood to flow to the muscles, thus relieving nervous congestion and consequent neuralgia.
CURE OF PARALYSIS.
In no single disease has the transmission of motion through the Manipulator proved more thoroughly efficacious than in paralysis. ”

“ There are no vessels carrying blood to and from the various organs of the body which so frequently rupture as those in the brain. The causes that produce this result are the fatty degeneracy of the middle arterial coat of the cerebral vessels, whereby their elastic strength is much impaired, the great irregularity of blood distribution to the contents of the cranium, and the little support which the pulpy substance of the brain gives to the weakened vessels embedded in it. ”

“ Undisturbed by impulses from the external world, the brain seems then more sensitive to impressions that originate within the body. An overloaded stomach, an enfeebled heart, a turgid sexual apparatus, or an irritable nervous ganglion may become the source of irregular and uncompensated movements which may invade the cerebral cortex, and may there set in motion a whole battery of mechanisms whose influence upon consciousness would be quite unnoticed were the external senses in full operation. ”

“ Rarely there is scarcely any atrophy of the cortex. The central portion of the brain may be of leathery consistence, but usually shows marked sclerosis, which also may affect its different portions and the different ganglia very differently. The changes resulting from inflammatory, degenerative, and atrophic processes are general and profound.
An opinion is beginning to obtain that general paralysis is primarily a disease of the small cerebral blood-vessels, functional or vaso-motor ”

“ The more localizing features may be arranged in three groups: intellectual, motor, and sensory.
Intellectual symptoms. The condition of the patient is one of great restlessness, increasing sometimes to actual violence and mania. Attendants are usually required to restrain his movements, and, tossing about in bed, crying out in his pain, muttering and wandering in his delirium, he offers a typical clinical picture of cerebral irritation.
Motor symptoms. The motor symptoms vary according to the region mainly involved, cortex or base. ”

“ At the same time it is only logical to conclude that any morbid condition of the cerebral circulation or of the brain or membranes which leads to a corresponding amount of ventricular effusion, or atrophy or destruction of the nerve centres already designated, will produce the symptoms characteristic of this disease. Thus the different forms of meningitis, traumatic injuries to the cranium, chronic encephalitis, cerebral softening or degeneration, sclerosis, neoplasms of all kinds affecting the brain (cysts, cholesteatoma, psammoma, melanoma, etc.) , and parasites may occasion this disease. ”