[ ' Bought 01 1 Ip BLAKISTON, SON & CO '^- Mescal B0OKSKLLKB3 No lOia Waimit btieet, pnaABKLPHIA. yv^tVv- J--J:P:''-^-' :^')^ • '■■■■ ''>,\^"~-- ^:-/ .'X> ; -J >J "'.'.'y .^^ I>rain-pressure gauge. I record tlie arterial pressure by means of a mercurial manometer ; the respiratory record I obtain by means of a Paul Bert or Marey tambour applied to the lower part of the thorax, or by a T-tube placed in the trachea. Connec- tion in either case is made with a recording tambour. I register at the same time the pressure of the injecting fluid and the intracranial pressure. In some cases I measure the cerebral venous pressure in place of the intracranial pressure. In one class of experiments I have recorded intracranial pressure in the parietal region, in a second class in the cerebellar region, and in a third class over the upper end of the spinal cord. This last I efiect by trephining the flat lamina of the atlas, opening the subarachnoid space and screwing in either a brain-pressure gauge or a brass tube connected with a manometer. The seat of injection has also been varied in the same way. Normal saline was the fluid generally injected. In other cases, either water or serum. Sometimes the fluid was warmed to the tem- perature of the body, at other times injected at the temperature of the room. The nature or the temperature 166 THE CEREBRAL CIRCULATION. of the above fluids proved unimportant. The symptoms simply and solely arise from the pressure of injection. In the second method I employ, my manner of pro- ceeding is as follows. I connect the carotid artery to a brass injection-tube which is screwed into the cranium, and interpose a clamp. In the femoral artery I record the blood pressure. In all other respects the experi- mental method is the same. Blood is permitted to flow from the carotid into the cranium, either into the subdural space or between the bone and the dura. The pressure in the femoral artery gives me the tension of the injection. In some experiments I have wounded a small vessel in^ the pia mater. The trephine hole has then been closed and the results recorded. In my third method of investigation I proceed thus : A small india-rubber bag is attached to the end of a certain special piece of apparatus. This consists of an outer steel tube, which is screwed into a trephine hole, and an inner tube to which the bag is tied (Fig. 1, B). CEREBRAL COMPRESSION. 167 This inner tube screws into the steel tube by means of a male and female screw. By means of a syringe the bag is distended at will with M^ater, and the volume of the foreign body thus introduced is measured after each experiment by emptying the bag into a measure glass. The bag is distended either over the cerebellum or over the cerebrum. These three methods are shown in Fig. 33. An important distinction must be drawn between compression by a foreign body of limited volume and compression loy the continuous injection of fluid of a constant pressure. I will first consider the case of the continuous injection of fluid into the cranial cavity. If the fluid spread with ease to all parts of the cranial cavity, pressure throughout this cavity will then rise to the tension of the injection. The efiect on the cerebral and spinal circulation is to cause all the veins and capillaries to become compressed, as the pressure of injection and the intracranial pressure rise, until when the injection pressure is made equal to the arterial pressure they are finally obliterated. Those capillaries and veins which are placed less favourably and ofler greater resistance to blood-flow, must have a lower internal blood tension, and will therefore be obliterated by lower injection pressures. For the blood-flow will always follow the pathways of least resistance — that is to say, as the injection pressure rises, the circulation will be confined to the more open channels where the internal resistances are least. When the intracranial pressure reaches the arterial pressure, the cerebral circulation in these must also cease entirely. I have found, as all past 168 THE CEREBKAL CIRCULATION. observers have, that when the tension of the injec- tion fluid is raised gradually, fatal symptoms do not originate until the injection and consequently the intracranial pressure reach almost to the height of the arterial tension (Fig. 34). Fig. 34. I i \ i A. Carotid artery. ~B. Pressure of saline injection.* C. Brain-pressure gauge. D. Respiration. It will be remembered that, according to PoisseuUes' law, as capillaries are diminished in diameter so blood- flow decreases by the fourth power. It is therefore evident that the bulbar centres can functionate with a greatly diminished blood supply. In reference to this point Nabarro and I have determined that the * B and C are to be read in mm. Hg. The tracing is reduced one-third, CEREBRAL COMPRESSION. IfiO metabolism of the brain as measured ])y its ()iit})nt of carbonic acid is very low. If on iiijc^ction the (lui6, 12, p. 527. Regnard. Rech. sur la congestion cerebrale, thesis, Strasburg, 1868. BIBLIOGRAPHY. 205 Roy and Adami. Waist Belts and Stays, National Reviev), Nov. .1888; Brit. Med. Jov/rn., London, 2, p. 1321, 1888. Salatuk. Trav. du Lab. de M. Marey, 2, 1870, pp. 340-41)1 ; and 1877, pp. 251-272. ScuAPiEO. Jahrh. iiher Anat. u. Phys., 1881, ii. 00. CEREBRAL ANiEMIA. Bastgen. Puls-frequenz u. Hirndruck bei capillarer Embolie der Hirngefasse, Wiirzburg Dissert., 1879. Bell, Joun and Charles. Anatomy and Physiology of the Human Body, vol. ii. pp. 88-90. Chevers, Norman. London Med. Gaz., 1845, 36, p. 1140. Cooper, Astley. Guys Hasp. Rej)., London, vol. i. 1830, p. 457. CoRiN. Bull. d. I' Acad. roy. d. Sc. de Belg., Brux., 3 Ser. 14. CouTY. Arch, de Biol., Paris, 1870 ; Sac. Biol. Mem. (Compt. Rend.), Paris, 3, 1887, pp. 296-298. Duval. iSoc. Biol. Mem. {Gompt. Rend.), 1895. FiLEHNE AND KiONKA. ArcJi. f. d. gss. Physiol., 1896. Gad. Arch. f. Physiol., Du Bois-Reymond, 1880, p. 543. GowERS. Diseases of the Central Nervous System, 2nd edit., London. HoRSLEY AND SpENCER. Brit. Med. Journ., vol. i. 1889, p. 457. KussMAUL AND Tenner. Molesch. Untersuch., 1857, Bd. iii. 1. Markwald. Zeitschr.filr Biol., Miinchen, 1890, 20, p. 259. Panum. Zeitschr.f. klin. Med., v. Giinsberg, vii. Ramon y Cajal. Arch. f. Physiol., Du Bois-Reymond, 1895, p. 375. ScHiFF. Lehrbuch d. Physiol., 1858-59, p. 108. SoKOLOW AND LucHSiNGER. Arch. f. d. ges. Physiol., 23, 283, 1880. THE METABOLISM OF THE BRAIN. Bernard, Claude. Le9ons sur la chaleur animale, p. 32, 1876. Heldenhain, R. Arch./, d. ges. Physiol., iv. 1871, p. 558. Mosso, A. Proc. Roy. Soc. London, 1892 ; Die Temperatur des Gehims, Leipzig, 1894. Rolleston. Jov/rn. of Physiol., xi. 208, 1890. CEREBRAL COMPRESSION. Adamkiewicz. Die Lehre vom Hirndruck, Arc. ; Sitzungsb. d. k. Akad. d. Wissensch., Wien, 88, 3, pp. 11-98 and 231-355, June, 1883; Wien klin. Wochenschr., 1884, 8 and 9. 206 BIBLIOGRAPHY. Althan. Der Krieslauf in cler Schadel-Ruckgratshohle, Dorpat, 1871. Bergmann. Deutsche Chirurgie, Kopjverletzmfigen, vol. xxx. p. 274 seq. BoERHAAVE. Institutes, 1742, vol. ii. p. 307. Cybulski. Gentralhl. f. Physiol., Leipzig u. Wien, 1890, p. 834. Ucishu Mozgu, Krakow, 1891. Dean. Journ. of Pathology, London, i. 1892, p. 26. DuRET. Arch, de Physiol., Paris, 1874 ; Gaz. med. de Paris, 1877, Nos. 49, 50, 61 ; Etude exper. et cliniq. sur les Traumatismes Oerebraux, Paris, 1878. Falkenheim and Naunyn. Arch. f. Exper. Path. u. Pharm., Leipzig, 1887, xxii. p. 261. Flourens. Rech. exper. sur fonct. du syst. nerveux, 2"® edit., Paris, 1842 ; Gaz. med. de Paris, 1848, No. 30. France, Franqois. Journ. de I'Anat., de Robin, 1877, pp. 267-307 ; Trav. du Lab. de M. Marey, 1877, pp. 273-292. Freind. History of Physic, 1727. HoRSLEY AND Spencer. Trans. Roy. Soc. London, 1892. HuGUENiN. Allgemeine Patliologie der Krankheiten des Nerven- systems, Zurich, 1873. Hutchinson. Lectures on Compression of the Brain, Loud. Hosp. Rep., vol. iv. GoLTZ. Arch.f, d. ges. Physiol., 1876, p. 1 seq. Leidesdorf AND Stricker. Vierteljahrsschrift fur Psychiatrie, 1867, p. 68. Leyden. Virchow's Arch., Berlin, 1866, 37, p. 519. Naunyn and Schreiber, Arch.f. exper. Path. u. Pharm., Leipzig, 14,p. 1,1881. Niemeyer. Handbuch der spec. Pathol, u. Therap., Berlin, 1871, ii. p. 168. Pagenstecher. Exp. u. Stud. ii. Gehirndruck, Heidelberg, 1871. De la Peyronie. Mem. de VAcad. Roy. des Sci., 1741. Y. ScHULTEN. Arch.f Ophthal., Leipzig, xxx. 1884, p. 1^76 ; Arch. f klin. Ghir., Berlin, xxxii. 1885, INDEX OF NAMES. Abercrombie, 3 1 Ackermann, 37, 45 Adami, 101, 112 Adamkiewicz, 18 Althan,8, IGl Baglivius, 6 Bastgen, 121 Bayliss, 40, 42, 45, 48, 62, 66, 73, lo3 Bell, John, 1 17 Bergmann, 7, 8. 27, 71, 135, 158, IGU, 161, 162, 176, 189, 193 Berlin, 7, 8 Bernard, Claude, 153 Bochefontaine, 26 Boerhaave, 156 Brissaud, 81 Burrows, 32, 33 Cash, 59 Cavazzani, 38, 45 Chevers, Norman, 142, 143 Columbus, 142 Cooper, Astley, 118, 121, 141, 151 Corin, 124 Cotugno, 26 Couty, 120 Cramer, 10, 45, 50, 55, 73, 143 Cybulski, 39, 72, 80, 135, 161 Dean, 14, 37,53,56, 164,190 Dogiel, 46 Bonders, 6, 7, 8, 35 Dunstan, 59 Buret, 7, 18, 158, 159, 160, 162 Burham, 147 Buval, 149 Ehrmann, 120 Engel, 33 Esher, 119 Eve, 137 Falkenheim, 14, 15, 18, 27, 37, 56, 71, 72, 193 Fallopius, 6 Ferrari, 120 Filehne, 131, 132, 133 Flourens, 158 Franck, 7, 8, 81, 135, 162, 163 Freind, 157 Gad, 130 Gaertner, 10, 38, 46, 57, 58, 64- 68 Galen, 5, 156 Gaskell, 59, 124 Geigel, 68 Gerdy, 104 Goltz, 137, 162 Gowers, 144, 193. 194, 197 Grashey, 2, 68, 71 Gulland, 45, 75 Hales, Stephen, 101 Hall, Marshall, 80, 108 Haller, 6, 26, 157 Halliburton, 23 Heidenhain, 153 Hermann, 81, 119 Horsley, 61, 143, 163, 164, 183, 193 Hiirthle, 38, 46, 56, 59 Hyderabad Commission, 107, 109 Jackson, Hughlings, 146 Jolly, 7, 45, 46, 55, 119, 143 Kellie, 31 32, 33, 34, 67 Kennedy, 147 Key, 16, 17, 24, 71, 73 Kionka, 132 Koch, 71 Kolliker, 149 208 INDEX OF NAMES. Kussmaul, 33, 35, 118, 119, 1?1, 135, 142, 144, 160, 162 Laurie, 107 Leyden, 6, 7, 71, 158, 159, 160, 162 Levy, 60, 61, 62 Longet, 6 Lorry, 6 Lower, 117 Ludwig, 48, 153 Luschka, 18 MacWilliam, 110 Magendie, 16, 17, 120, 158 Malgaigne, 159 Markwald, 121 Mayow, 6 Mendel, 81 Michel, 17 Monro, Alexander, 31, 67 Morgagni, 117, 118 Mosso, 7, 125, 147, 3 52, 153, 154, 155 Mott, 141 Mure, De la, 6 Nabarro, 68, 151 Naunyn, 14, 15, 18, 27, 37, 56, 71, 72, 162, 193 Niemejer, 161 Nothnagel, 37, 45, 55 Oliver, George, 66, 105, 106, 148 Oudin, 7 Pacchionus, 6 Pagenstecher, 158, 159, 160, 162 Panum, 118 Pechlinus, 117 Peyronie, La, 157 Piorry, 78, 79, 80 Poisseuille, 120 Quincke, 17, 72 Eamon y Cajal, 146, 148, 149 Eegnard, 111 Reid, 32 Reiner, 23 Retzius, 16, 17, 24, 71, 73 Ridley, 6 Riegel, 45 RoUeston, 153 Roy, 39, 40, 46, 53, 55, 57, 58, 59, 62, 63, 64, 73, 101, 112 Salathe, 7, 37, 80, Bl, 104, 111 Sanderson, Burdon, 2 Schafer, 66 Schiff, 142 Schnitzler, 23 Schreiber, 18, 162 SchuUer, 37 Schulten, V., 36, 37, 46, 57, 143, 162 Schultz, 7, 45 Schwalbe, 17, 18 Severus, 157 Sequeira, 140 Shaw, Claye, 81, 93 Sherrington, 39, 40, 46, 53, 55, 57, 58, 59, 62, 63, 64, 73 Shore, 59, 124, 131 Speiss, 153 Spencer, 143,163, 164, 183, 193 Starling, 48 Stelling, 46 Swieten, Van 117 Symmington, 13, 49 Tenner, 33, 35, 118, 119, 121, 135, 142, 144, 160, 162 Valsalva, 117 Vieussens, 18 Vulpian, 120 ' Wagner, 11, 38, 46, 57, 58, 64, 68, 81 Wertheimer, 40, 57, 64, 67 Willis, 6, 38 Fruited by Ballantvne, Hanson & Co. London a,7id Edinburgh. r.v-w'S^ ^ %■■■ -^r^:. i'M'-^^^mM ■M^m^r '1. J,.; "-^^'-J^'^^.^yfV^-,' '•■■'i^vi|| COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE in, i: j'-: '^ OCT 1 9 19^ 3 m^^ V f: f-- M Rl i "f^: ''H 2 H iSi4S ( ^ ;.'... __..^ ^^ C28(1 140)MI00 ■..::jr'^,^^ ^K'h--.-. . .'^^^'^"^IJiH^I .:^\ ;f£i-' l^^^^^^^^l ■\misism - t ^3^^^^