ON THE PATHOLOGY AND DIAGNOSIS OF CEREBRAL DISEASES
Authors: R. H. Semple
Journal: BMJ (1853)

Ox a former occasion, I introduced to the notice of this societv some Clinical Illustrations of Diseases of the Nervous System; and I then stated my intention, at some future period, to offer some general remarks upon the pathology, diagnosis, and treatment of this class of affec- tions. 1 now proceed, as far as lies in my power, to redeem that promise, with the aid of such observations as I have subseilluently been enabled to make in this very obscure department of practical medicine.Bearing, in mind the limited period allotted to papers like the present, I have no intention to present an elaborate essay upon cerebral diseases; biut while grouping together wiv observations for the sake of clearness of description, I shall carefully avoid availing nmy.sclf of the works of well- known authors, and confine mv illustrations to those cases wlich havc fallen under my own care, and my reflections to those ideas which have occurred to my own mind.In order also to obviate unnecessary prolixity, I shall lightly pa-s over those sub.jectswhich are well understood, and on wvhieh little or no difference of opinion exists, and attach a due (legree of prominence to those points which have been butt litle investigated by authors, or on which the opinions of wvell informed praetitioners are diviided.With regard to the PATHOLOGY of cerebral diseases, it must be admitted that the greatest obscurity and difficulty still exist; and it is too freqluently a matter almost of im- possibility to connect the symptoms observed during life witlh the appearances revealed after dteath by the sealpel.But as the term "p pathology" inieludes both classes of phe- no!niena, it will tend to simplify the subjcct if I confine my remnarks, in the first place, only to the appearances ob- served after death, or, in other words, to the morbid ana- tuiosy of the textures.Before proceeding to the consideration of those altera- tions of structure which are seen in or upon the encephalon and its miiembranes, it is of extremc imiportance to notice the morbid anatomy of the calvarium, which is undoubtedly concerned in the production of many cases of cerebral disease.Independently of those iinstances of external in- jury whliel induce cerebral symptonms, andI of which I do not intelnd to treat, there are miiorbid changes in the bony structutres, occurring spontaneously, which involve serious disttrbances of the inervous system.Tlhe tfllowing cases will, I thini.k,prove the truth of this position:-CAiSE J.A woman in the Isliugtton Infirmiary suffered coldtinulially from epileptic seizures, and was under my ob- selvLtion for about ten years: the fits were frequent, occurrigat irregular intervals, and of a very violent character.In the intermissions between tllc fits, her health was toler- ablv good, wvith the exception of occasional headache ; her intellectual faculties were quite unimpaired.She always deriVed benefit froinu the local abstraction of blood, and she weas thlercfore on several occasions cupped between the shoulders.Blisters were appliedi, and kept opein in the same situation; purgatives were adminiistered, and a strict anti$hlogistic regimen was maintained.Iler diet was of the lightest character; no solid food or beer was allowed;.and she derived her suistenance enitirely from a very moder- ate allowance of milk, egg,s, bread, and thin broth or beeftea.rhis treatment was so far successful as to afford her considerable relief; but at length the fits became more and