Page:The American Cyclopædia (1879) Volume III.djvu/208

 202 BRAIN (DISEASES) may be incorrect. Blisters, active purgatives, and other debilitating and perturbatory mea- sures of treatment are not only not indicated, but tbey increase suffering and hasten the fatal termination. Inflammation either limited to or having its point of departure in the substance of the brain is known as cerebritis. As al- ready stated, the substance of the brain is more or less involved in meningitis. Independently of the latter, cerebritis is rare ; and if the cases be excluded in which inflammation of the sub- stance of the brain is secondary to tumors or to the presence of a clot, or is incident to in- juries, it is extremely infrequent. In fact, a primary or idiopathic cerebritis is one of the rarest of affections. Its infrequency has been rendered more evident within late years by the knowledge which has been acquired of ne- crobiosis, or softening from embolism and thrombosis, to which reference has been made under the head of anasmia of the brain. Oases of the latter kind of softening were formerly considered as cases of cerebritis. The presence of blood giving rise to "red softening" has been considered as evidence of inflammation ; but this is now held to be an error. Softening from defective nutrition may be red as well as white. The positive evidence of cerebritis is the presence in the cerebral substance of the in- flammatory products, fibrine or pus. Cerebritis, as a primary or idiopathic affection, is always circumscribed, or confined to a limited space. It occurs chiefly in the gray matter of the brain, that is, in the cortical portion of the corpus striaturn. If pus be present, it is called abscess of the brain. The symptoms and the duration in different cases entitle it to be con- sidered either an acute or a chronic affection. If acute, pain in the head is more or less prominent as a symptom, and there are present the symptoms denoting liyperamia or cerebral congestion. Spasms of certain muscles, either tonic or clonic, may occur, and sometimes there are general convulsions. Subsequently, when the inflamed portion becomes disorgan- ized, that is, when softening or the formation of an abscess ensues, paralysis generally occurs. The paralysis is developed gradually, and in different cases different muscles are affected. In most cases the muscles of the face are paralyzed in a greater or less degree, and hemi- plegia is common. The mental faculties be- come impaired, as denoted first by a morbid emotional susceptibility, and afterward by loss of memory and inability to carry on processes of ratiocination. At length mental imbecility or dementia is likely to occur. Chronic cere- britis, or abscess of the brain, presents the same symptoms which belong to the acute form after softening or suppuration has taken place. The points of distinction, as regards the symp- tomatology, between the acute and chronic affection, relate to the presence of symptoms denoting more distinctly an inflammatory con- dition in the former, and a longer duration of the disease in the latter. Chronic cerebritis or abscess is not easily discriminated during life from other affections which are to be no- ticed presently under the head of structural lesions. Cerebritis, both acute and chronic, is generally secondary to injuries of the skull, or to disease of the bones of the head. It is apt to follow caries of the petrous portion of the temporal bone, the latter being connected with inflammation of the internal ear. It may fairly be doubted if recovery ever takes place. Chronic cerebritis, however, leading to soften- ing or abscess, is not incompatible with a long duration of life, death at length occurring, perhaps, in consequence of some intercurrent disease. The indications for treatment relate to palliative measures, and those which enable the system to tolerate the affection as long as possible. V. STEUOTUEAL LESIONS. Lesions in- volving palpable changes in structure, affecting the brain more or less extensively, and with dif- ferent degrees of damage, are of various kinds. Important lesions have already been referred to, namely, softening from defective nutrition, and either inflammatory softening or suppura- tion. Another lesion, probably of inflamma- tory origin, is induration or sclerosis. Other lesions are the morbid growths or deposits which constitute the different tumors of the brain. These various structural changes have certain symptoms in common, and in medical practice it is by no means easy always to differentiate them. Induration of the brain, or sclerosis, may be confined to one situation which is more or less extensive, or it affects small circumscribed portions which are more or less numerous. The former is distinguished as diffused, and the latter as multiple cerebral sclerosis. The diffused form most frequently occurs in children, although it may occur at any period of life. It is a pathological con- dition which in certain cases affords an expla- nation of idiocy. It leads to paralysis, and consequently to an arrest of development of certain of the voluntary muscles. It may lead to contractions and deformities in conse- quence of the extensor muscles being more paralyzed than the flexors, or vice versa ; the muscles which are the least paralyzed contract- ing for want of the normal antagonism afforded by those in which the paralysis is greatest. In multiple cerebral sclerosis, hardened nodules, varying in size from a cherry stone to a small walnut, and more or less numerous, are scat- tered throughout the brain, generally being found in the white substance. They are pro- duced by a morbid growth of the connective tissue, that is, the tissue which unites the ner- vous fibres and cells together with the blood vessels. This tissue is now known by the name neuroglia. Its morbid growth is supposed to be a consequence of chronic inflammation. The hypertrophied neuroglia induces by pressure atrophy of the nervous structure, and conse- quently impairment of function in the scle- rosed portions. . The causes are obscure ; but circumstances connected with age have a