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Fractured neck, of the Os Brachii.

Next with regard to fractures of the neckof the os brachii, I have seen some caseswhere the fracture was near the joint; Idon’t know exactly what the nature of thecase was, but we believed it to be the frac-ture of the neck of the os brachii, whereconsiderable motion arose from turning theend round. There are very serious accidents

happening to such parts of the bone, butthere are no rules to be given with regardto the treatment of those accidents.

Fractured Os Brachii.

It might be affronting you to speak of thefracture of the os brachii-that’s very sim-ple indeed. But I say the grand rule is, tokeep the elbow joint under the shoulder;keep it steadily fixed in its proper situation,and put two splints to it.

LECTURES

ON THE

Diseases of the Nervous System.BY

DR. CLUTTERBUCK.

LECTURE II.

Diseases of the Brain.

Gentlemen,-Having in my last Lecturespoken in a general way of the structure,and circulation of blood in the brain, andalso of the effects resulting from its incom-pressibility, and its confinement in an un-

yielding case of bone, (the cranium,) whichit completely fills, I proceed now to statethat absorption is a process taking place inthe brain, as well as in every other part ofthe body. It is true, that no distinct appa-ratus, as far as we know, exists for the per-formance of this office, no absorbing vesselshaving as yet been seen. As, however, ab-sorption is necessary, in order to account forthe phenomena of growth, and for the ex-planation of what appears to be taking placein disease, we may safely proceed upon theadmission, that absorption exists in this

organ, as in every other.With respect to the sensibility of the brain,

we must distinguish between the organ it-self, and its membranes or coverings. It is

sufficiently proved by direct experiments,

that great part of the brain, at least, pos.sesses very little sensibility or feeling; forthe rudest injuries purposely inflicted on thebrain of animals, appeared to give no pain.And we have abundant proofs, that in manyof its diseases, and those of the most formid.able and destructive kind, it evinces verylittle sensibility ; a curious circumstance,considering that the brain is, as it were, thesource of feeling to all other parts. Thisinsensibility of the substance of the brain,is, however, not to be taken without somequalification : the deep-seated, throbbingpain felt at times in the very centre of thebrain, in some of its inflammatory disorders,sufficiently proves that it is not wholly des.titute of feeling, at least when labourinaunder disease. But the conclusion, never-theless is, that the degree and danger ofcerebral diseases, are not to be estimated

altogether by the pain the patient snffers.On the contrary, it may be rather said, iaa ageneral way, that the most dangerous affections of this organ, are often the least

painful : witness apoplexy, palsy, epilepsy,and many of the worst cases of fever, where,often, no complaint is made of pain in thehead, at the very time that the brain mani.fests the greatest possible disease, by thedisordered and interrupted state of its func.tions. Hence it is to the state of its func-tions, and not of its feelings, that we prin.cipally look, as indicating the existence anddegree of disease actually present.The membranes of the brain have little or

no sensibility in the healthy state, but mayacquire it under disease, as inflammation;and that in a high degree ; so as to makemembranous inflammation of the brain, whenacute, like that of other serous membranes,a very painful affection.

Of the Functions of the Brain.

We proceed next to speak of the functionsperformed by the brain, and which may bedivided into special or peculiar, and generalas regards the rest of the system. The

special functions exercised by the brain, andwhich belong to it exclusively, are three, viz.sensation, volition, and intellect, or mind orthought.

1. Sensation is the result of a change in-duced in the brain, in consequence of an

impression made upon some sentient part ofthe body ; the effect of the impression beiagtransmitted to the brain by the nerves, in away that we are totally ignorant of. The

cognizance which the mind takes of thissensation, is termed perception or consciousness.

There are a great variety of sfMsii’MM pro-ducible in the brain, according to the struc-ture, and other properties of the part, uponwhich the impression is made. A divisionof our sensations has been generally made

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into five different species, to each of whicha particular organ or structure is devoted :these are called the organs of the five senses,vision, hearing, smell, taste, and toitch. Butthere are sensations which can hardly be in-cluded in any of these ; as in the stomachmore particularly, as hunger, thirst, satiety,and nausea; and probably others in otherparts. In disease, we experience also va-rious new sensations, for which names arewanting. Sensation, likewise, is modified bythe nature of the impressing cause, and evenby the force with which it is applied : thuswe distinguish between pricking, and cut-ting, and tearing: and between different

degrees of heat and cold.2. Volition.—Sensations may be agreeable,

or otherwise ; and we are led accordingly todesire or to avoid the object making theimpression. But to attain the one or theother purpose, a movement of some partmust be made : and this movement takes

place by the contraction of moving fibres,called the volznztarv muscles.

This contraction is excited primarily by anoperation of mind, called volition or the will;which follows the sensation, and which, likethis, appears to originate in the brain, andits influence to be communicated along thenerves, to the moving part. This is provedby the division or compression of a nerve,any where in its course ; and also by theeffect of pressure, or other injury, of thebrain itself; by either of which, the influ-ence of the will on the muscles, is interceptedand prevented. Thus it appears, that thenerves are the medium through which the mindbecomes acquainted with the existence andqualities of things around us ; and, at thesame time, through which the influence ofthe mind is carried to the moving parts (thevoluntary muscles) by which we act upon ex-ternal things.

It seems at first extraordinary, that thesame nerves should serve to perform officesso distinct r.s these. The difficulty vanishes,however, when we consider, that a nerve is,in fact, a bundle of nervous fibrils, each en-veloped in a distinct covering, (neurileme,)and having no communication with theothers but by cellular membrane. Thus,while some of these fibrils serve for the

conveyance of impressions from withoutinwards, others may carry the deteranina-tions of the mind in the reverse direction tothe moving parts, the muscles.

3. Of Intellect.--ls sensations are various,we have the power of comparing them to-gether ; of judging of them ; of feeling de-sire or aversinn for the objects producingthem; re-calling the idea of them ; andthe like : all of which are modifications oj

i’a,)iiolit, or mental operations, of which thebrain, is the corporeal organ.

Thus it appears, that the brain is thepart where sensation really exists ; wherethe will, or determination to act by meansof the voluntary muscles, originates ; andwhere the various operations of the mind orintellect are carried on, as far as organiza-tion is concerned. These three functions,then, sensation, volition, and mind or thought,are the special functions peculiarly belongingto the brain, or sensorittm commune, as it isoften called. They are denominated, ac-cordingly, the sensorial functions.

Whether the other movements of the

body, that are not voluntary, such as thoseof the heart and vessels, the alimentarycanal, &c. are, likewise, wholly dependentupon the nervous system, has been disputed.It has been supposed by some, that the in-voluntary movements alluded to, are effectedby an inherent power lodged in the partsthemselves, (a vis insita, as it has been

termed,) and that they take place indepen-dently of the nervous power. This, however,is doubtful; while it is certain, that the in-voluntary movements are all more or lessunder the infiuence of the nervous system.This is a fact that it behoves you to bearwell in mind; for many diseases of thebrain are as strongly indicated by disturb-ance in other parts, as by the disturbanceof its own feelings or functions.Thus affections of the brain are often

strongly depicted in the countenance ; partlyby the expression of the eyes, dependingchiefly upon the state of contraction in theiris; partly upon the state of action in themuscles of the face, upon the contraction ofwhich the expression of countenance greatlydepends.The stomach is a part under the influence of

the brain and its functions, in a striking man-ner. Thus you will observe, that powerfulsensations of all kinds, whether agreeable orpainful, take away appetite, and impair di-gestion ; a’Id the same effects result fromintense thinking, mental emotions, and greatmuscular exertion. A blow on the head pro-duces vomiting, which thus becomes one ofthe signs of injured ;rain, upon which muchreliance is placed by surgeons ; many of thediseases, again, of the brain, are ushered inby vomiting, as apoplexy, and many cases ofidiopathic f·ever of all kinds. In that forrn ofcerebral inflammation that, from terminatingin serous accumulation, is called hydrocepha-lus, or dropsy of the brain, vomiting is oftenthe first and most prominent symptom ; ininfants, therefore, this symptom, when se-vere or continued, ought always to excitesuspicion of cerebral disorder arising. In

some chronic diseases of the brain, on the, other hand, as in many cases of hemiplega,the appetite for food is voracious (bulimia) ; ;, while in others, it is impaired, or lost (arzo-9-etia) ; or vitiated (pica).

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The intestinal canal, likewise, is evidently those muscles, giving rise to slow and inter.under the influence of the brain ; for in the rupted breathing, (sighing and sobbing,) so ,

greater number of the diseases of this organ, as at times almost to threaten suffocation.the intestines become torpid, as is evident In some brain-affections, as apoplexy, respi.in the state of costiveness that ensues ration becomes slow and laborious; in(obstipatio). On the other hand, it is highly others, it is quickened.probable that, in certain states of the brain, There is much reason to believe, likewise,the intestinal canal may acquire increased that a paroxysm of asthma, in some forinsofirritability, so as to give rise to diarrhœa; an this disease, consists in a spasmodic stateaffection produced in many individuals by of the diaphragm, and perhaps of the inter.emotions of mind. costal muscles also, the cause of whichThe same torpor that affects the intesti- exists in the brain; for I cannot see how

nal canal, in many brain affections, .often otherwise the paroxysm should take place so

extends itself to the liver, and probably other suddenly, and recede so quickly, as it some.secreting organs, the functions of which are, times does, without any intermediate changein consequence, impaired or suspended; by expectoration or otherwise, and withoutwhile it is equally probable that, as with re- any apparent disease in the respiratorygard to the intestines, the irritability of organs themselves. Asthma of this de.those organs may, on some occasions of dis- scription, is capable of being induced byease in the brain, be preternaturally in- mental emotion, which is a further proof ofcreased, with the effect of augmenting the its dependence upon the brain.secretions. And in this way, I think, the Thus you perceive, that the brain exerts asymptoms of cholera, namely, vomiting and paramount influence in the system, regu-purging of bilious matters, that attend many lating the feelings and movements of everycases of fever at their outset, but which part; and you will not wonder, therefore,cease as the fever advances, may be ex- at being

told, that when the brain is rio.plained : that is, they are only symptoms of lently and extensively diseased, the wholethe fever or brain-affection. body and all its functions, both bodily and

It is almost superfluous to mention, that mental, are liable to be disturbed. Hencethe heart, and doubtless the bloodvessels, as the not unnatural mistake of consideringparts of the same system, are under the in- certain brain-affections as universal diseases;nuence of the brain, and that in a very high though, in reality, founded in a disease of adegree. Thus the pulse is quickened, or single organ.retarded, or rendered irregular, in different Now as the brain performs such a varietystates and stages of disease in the brain, so of functions, special and general, and as it is anas often to furnish us with means of judging organ of very various construction, and con-of the condition of this organ. Certain sists of numerous and distinct parts, it is rM-affections of the brain induce a peculiar soiiable to believe, even a priori, that its differ.softness of the pulse, owing apparently to a ent parts are destined 10 different purposes;want of contractility in the individual fibres one part being devoted to sensation, anotherof the arterial coats; such a pulse is observed to voluntary motion, and another to mind or

in most cases of idiopathic, fever, and serves, intellect; and that different parts also are inin a great measure, to characterise the dis- connexion with different organs, throughoutease. In many bad cases of fever, such as the body.are termed putrid or malignant, this want of If all this were fully and satisfactorilycontractility extends itself to the extremities made out, we should be able to refer a greatof the vascular system, and is probably the number of diseases to their appropriate seatioccasion of those haemorrhages of black in the brain; each part of the structure, (byblood that take place in these cases in and its connexion with, and disturbance of, par-under the skin, as well as from the different ticular functions,) giving rise to a particularoutlets of the body. Such a state of pulse train of symptoms. So again, from theis always attended with softness or flaccidity symptoms taking place during life, we shouldof the solids altogether, and deficient coagu- be able to predict the appearances thatlation of the blood when drawn from a vein ; would be found after death ; or, at all events,and doubtless from a similar cause, want of the part of the brain afl’ected. But om

contractility. I might further add, as a knowledge of the brain, and of the uses ofproof of the great influence of the brain over its individual parts, is too limited to allowthe heart, the ready excitement and dis- of this being done to any great extent. Inturbance produced in this organ by a variety most cases, we can only refer to the organof mental emotions. generally, as the probable seat of disease.The great influence of the brain upon This, however, practically speaking, is of

respiratioa is also very striking, acting little moment ; as we have no remeclies, orthrough the medium of the respiratory mus- modes of treatment, applicable to one rathercles. Hence it is, that mental emotions often than to other parts of the brain.excite the greatest disorder in the action of

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Qf the state of the Brain during Sleep.

The sensorial or proper functions of thebrain, have this peculiarity, in comparisonwith others, that they are subject to be sus-pended periodically; and for the most partonce at the least in every 24 hours. This sus-pension is termed sleep, a state which is sub-ject to great irregularity, both as to the timeof its occurrence, and its duration. Sleepmay be more or less perfect. Instead of a

suspension of all the sensorial functions,one or more may remain in an active state ; -,as we see in regard to the mind, in dreaming.Sometimes the muscular power, and even theexternal senses, are awake ; as in cases ofsnmnambzzlism or sleep-walking.

This periodical suspension of the sensorialfunctions, it may be presumed, has an influ-ence on the diseases of the brain, and mayhe one cause at lea-<t of their periodicaltendency, a tendency which is more remark-able in brain-affections than in others. It

may serve also to account, in some degree,for the exacerbations of fever, and even fortheir intermitting character, as often ob-served, though it must be confessed therewould be diiliculty in accounting in this wayfor the different types, as the tertian and

quartan; and also for the different hours ofattack, which are observed often to take

place, and that with much regularity, atdifferent times of the dav.With respect to the physical condition of

the brain in sleep, as compared with thewaking state, many different notions havebeen entertained. It may be worth whileto mention a few ofthee.

Haller ascribes sleep to the absence, de-ficiency, or immobility of the animal spirits;or to compression of the nerves at their

origin in the brain ; and. in all cases, to themotion of the animal siii-its through the brainbeing impeded; this impeded motion, heconsiders to be frequently owing to san-

guineous congestion.Dr. Cullen refers sleep to callapse of the

brain ; by which he understands, a state ofdimiuiahed mobility of the nervous fluid: whileBrown and Darwin suppose it to dependupon the exhaustion of the principle of ex-citability, as the consequence of the exer-

tions taking place in the waking state, andwhich is re-accumulated by sleep.

Blumenbach again refers sleep to a di-minished afflux of blood to the brain.-Richerand’s opinion is not very differentfrom this ; he thinks the circumstances de-note a diminished circulation in the brain,from less blood being carried to it, and thatthe brain in consequence falls into a state ofcollapse. Bichat simply refers it to an ulti-rnate law of nature ; which is, in fact, noexplanation at all.

Some of the opinions now stated, are

purely hypothetical, and rest upon no ascer-tained fact. Such are the notions of collapseof the brain, and diminished mobility of thenervous fluid, or animal spirits. The theoryof exhurcsted excatabilitu, is negatived by thecircumstances; for sleep bears no propor-tion, or but little, to the degree of excite-ment or exertion that takes place during theday. Without mentioning further objec-tions, I shall offer what appears to me themost probable sclution of the problem ;though in some points it may be little morethan conjectural.

That the states of sleep and waking are tobe referred to the brain, and that exclusively,appears from different circumstances. Sleepis a cessation of the proper functions of this

organ, and which does not materially affectother parts. It is produced by causes, someof which act immediately upon the brain ;such as direct pressure, either external orinternal. These are sufficient to warrantus in considering the brain as the seat of

sleep, if one may so speak.2. There appears reason to believe, that

sleep is occasioned by impeded circulationin the brain, that is, in those parts of theorgan which are devoted to the sensorialfunctions. This, I think, will appear froma consideration of the causes that are foundto induce or favour the approach of sleep,as well as those which tend to prevent it.

In the first place, direct pressure uponthe brain, whether produced by external orinternal causes, suspends the sensorial func-tions, or, in other words, induces sleep ; andit is evident that this cause must have theeffect of compressing more or less the blood-vessels of the brain, so as to impede propor-tionally the circulation.

Secondly, the recumbent posture, and stillmore a depression of the head below thelevel of the body. This impedes the re-turn of blood from the head, and so farmust retard the circulation in the brain.

This leads me to recommend to your no-tice, a practice from which 1 have seen, Ithink, much advantage ; namely, that of

laying the head low in bed, and even con-siderably lower than the trunk of the body,in some affections of the brain where thesensorial functions are greatly excited. Iwas first led to this, by observing the pa-tient getting his head ofi’ the pillow, as ifhe suti’ered less in this posture.

These causes operate directly in inducingsleep : but there are others, which producetheir effect in an indirect way, though theyultimately produce the same result, of re-tarded circulation in the brain, No one

doubts, I believe, that a moderate exerciseof the sensor ialf iczzctinazs, whether it be mus-cular exertion, agreeable sensations, or men-tal employment, is attended at first with an

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increase of vascular action in the brain ; orthat the continuance of such exertion leads

naturally to the opposite, that is, dii-nished action ; just as exercise is followed

by fatigue. And I need not observe, that I,such a moderate exercise of the faculties,continued for a certain time, favours theapproach of sleep.

Thitdly, darkness and silence, which ge-nerally (though not always) conduce to

sleep, probably operate by the abstractionof stimulus from the eye and the ear, theexcitement of which organs tends, for a time,to ward off sleep, though the same excite-ment, when continued, ultimately pro-motes it.

Fourthly. How opium or other narcoticsubstances, operate in producing sleep, itis more difficult to determine. There is

great reason to suppose, however, that thesedrugs do, as their primary effect, increasethe arterial action of the brain in a highdegree ; at least, we have all the signs oftheir doing so, with regard to the externalvessels of the head ; while the throbbinghead-ache that succeeds the use of them,when the stupor is at an end and the patientrecovers his feeling, serves to show whathas been going on within. How an increaseof arterial action in the brain, taking placeto a certain degree, tends to retard the cir-culation through the organ, will be made toappear hereafter.Upon the whole, I think It probable, that

the immediate or proximate cause of sle’!p,or a suspension of the sensorial functions, isretarded circulation in such parts of the brainas are devoted to those functions. The gra-dual approach of sleep, and its imperfectstate at first ; and also the gradual returnto the waking state ; agree very well withthe supposition here announced.

We are prepared now, Gentlemen, to enterupon the consideration of the diseases of this

part of the frame, the brain. Many of these,of a chronic kind, have been called HgfMMS;though improperly, as they have no imme-diate concern with the nerves themselves.Those who employ the term nervous diseases,seldom affix any distinct meaning to the

expression : brain affections, is the one bywhich they may be properly designated.

Brain affections, then, are infinitely variousas to form, but, in nature, very simple andeasily understood ; as far at least as ourlimited knowledge of this part of the animaleconomy allows of. Almost all the cerebraldiseases we have any distinct knowledge of,either consist immediately in disordered ar-terial action in this organ, (ancl that for themost part of an inflammatory kind,) or areconsequences, more or less remote, of sucha state. This, I have no doubt, will appear

clear to you, when we come to speak of themmore in detail. If there be any that origi.nate in a different way, we have at least))) nodistinct knowledge of them, and in ordertuexplain them are obliged to resort to eou.,jecture and hypothesis ; as those do whotalk of collapse of the brain, of dimiraished mo.bility of the nervous fluid, and other imagi.nary states, that rest upon no real obserra.tion. It cannot be. doubted, that the func.tions of’ the brain are capable of being dis.turbed in a great variety of ways, by disur.dered action of its vessels, even though nolamounting to actual disease ; as may be seenby referring to the state we call intoxication,as produced by vinous or spirituous liquor"Now as this state tends to throw light uponsome of the diseases of the brain, such as

apoplexy and certain forms of fever, I shallendeavour to explain to you the nature ofintoxicatiora, as resulting from increasedarte.rial action in the brain. But this must ttdeferred till our next meeting.

FOREIGN DEPARTMENT.

PHYSIOLOGY.

Experiments relating to the Question, Whetherthe Blood can be the Seat lit’ Disease? Paperread at the Academy of Sciences, Feb. 21,1826. By SEGALAS D’ETCHEPARE*.

The different parts of the body, the fluids as

well as the solids, may undergo modificationsin the state of disease. This is a fact de-monstrated by observation, and acknow.

ledged by the profession. But the morhid

changes of the fluids, do they merit thaname of diseases In other words, can therbe the seat of primitive alterations, ao;1such, that disorder of the organs and dis-turbance of the functions cin be the const.

quences or symptoms ? This is a point stillcontested by several pathologists; experi-ment appears to prove, that those fluijswhich play the principal part in the animaleconomy, are subject to changes. The ex-

periments which have been tried are niiiiie,raus ; they have been tried with different

agents, and on animals of different classesand genera. I will only mention for the

present those I tried on dogs with alcohol,and the alcoholic extract of nux vomica.

1. If a certain quantity of alcohol at 86&deg;,half an ounce, for instance, were injcctei

* Archives Generales, Sept. 1826.