DR. COPLAND ON PALSY AND APOPLEXY. * LIE views, and to
some extent the matter of this volume, have already appeared at various times and on various occasions, as we intimated in acknowledging its receipt. Part of it was pub- lished many years since, in the author's Dictionary of Practical Medicine ; part in the Croonian Lectures, delivered before the
of Physicians in 1846 and 1847 ; other parts again are of still older date, having been promulgated as early as 182 i and some of the immediately succeeding years. The treatise before us combines the opinions formerly advanced in separate appearances, enlarged and strengthened by additional experience, and by the sift- ing to which controversy has exposed, or the confirmation to which adoption has subjected them, as well as by experiments upon the nature of the blood, instituted by the author himself and other in- quirers.
Exhaustive and complete is the character of the treatise. The broad divisions of the description of disease, its causes and com- plications, the precautions for prevention, the treatment for cure . or alleviation, and the regimen necessary to keep off a recurrence i of the attack, are common arrangements in medical treatises. Dr. Copland pursues these divisions to greater length and minuteness than is usual, especially in exhibiting the various forms and the nu- merous complications both of palsy and apoplexy. Fulness of ex- position, however, is the main feature. No possible circumstance that causes or characterizes the disease or its complications seems overlooked; the opinions of all ancient and modern writers of any authority upon cause and treatment, are tersely stated, in con- junction with. Dr. Copland's own; and the reader is helped to a con- clusion. The treatment is not always so fully directed, because the work is addressed more to the practitioner than the pupil, and the nature of the disease being once explained the management follows from the diagnosis. But the principles of treatment are always laid down, with the reasons; the preference for one kind of medicine over another, and even for one form over another, is also given ; and in many cases prescriptions are printed.
• On the Causes, Nature, and Treatment of Palsy and Apoplexy; of the Forms, Seats, Complications, and Morbid Relations of Paralytic and Apoplectic Diseases. By James Copland, M.D., 8m. Ike. Published by Longman and Co.
This fulness of matter causes a somewhat overladen style, and renders the work as a literary composition. less. broadly popular than.some other medical treatises. The learning too that is poured hateit, though by no means pedantic, is rather formal, and lacks that living spirit which some writers infuse into the knowledge of the past ; whereas Dr.. Copland gives only the naked opinion. As the professional treatise, for which it is designed, the bookia full, thorough, and safe. It is the fate of the discoverers of useful truths to be deprived
brtheir. 'success of the striking effect of their discoveries, which seem after a. while to become common property. It has fared even worse, with Dr. Copland ; for some of his views have been attri- bute/lite other writers, who subsequently advanced the same opi- then. Perhaps the level expositional style in which Dr. Cop- laid propounds his views, rather hides, not their importance, but their originality. &me of them. not only depend upon teebniesl appreliensime but upon. professional learning toEprecnite fully. - The broadest feature is not the connexion•of y and. apoplexy,. I or the complication of one or both with other • rders, or the re- condite views of the numerous causes of the diseases,. but the im- portant distinction between the two kinds of apoplexy. With people , in. general, apoplexy is deemed a determination of blood to the head, the rupture of a, vessel, an overflow (extravasation) of blood, or (if their knowledge goes so far) an overcharged condition of the ves- sels, which causes death, insensibility, or palsy, by pressing upon the brain. Too inn& blood is their notion of the cause ; copious breeding. the modus curandi, (unless they happen to have a preja- dice against bleeding); and when they hear that apoplexy is ap prehended in the ease of any person, they wonder the doctors do not keep it off by blood-letting. As far as too much blood in the region of the brain is in question, their view of the cause is mostly correct enough; bat deranged circulation, or a weakness in the coats of the vessels of the brain, or defieiesit vital power or adieu, may be a cause of apoplexy, as well as a general super- abundance of blood. When a middle-aged man of strongeonstitu-
aldermanie look and aldermanie i
habits, drops down nsensible afteran aldermanie meal, and his pulse actually thumps the forger; copious bleeding with subsequent depletion .by purgatives, blisters, capping, and what not, is indicated. It should be' said, however, that some authorities. hold that bleeding even in such ease only tends to shake the constitution, while it dces not contribute to ab- sorb the effusion -on the brain. But this is the opinion of a mi- nority, and it may be called a peculiar opinion ; the practitioners invest' opposed to active treatment admitting the necessity of relief by bleeding when the action of an organ is overpowered to the ex- tent of insensibility as regards the brain, and to extensive derange- ' Mont of funetien in severe.inflammation. But bleeding is a. very critical matter when apoplexy attacks a person in advancing life or old age, (and these are the most general epochs of this disease,) with a constitution' originally delicate, or which has been lowered b_y sedentary occupations, thought, trouble,. or excesses. NO doubt, there may be a disproportionate quantity of bloodin the brain, as well as effusion thereon ; but the attack, so to• speak, in the brain, arises from deranged circulation elsewhere, or from deficient -vital power or action. To bleed such a patient, might kill hint on the spot, or so reduce, him. that recovery would be. hopeless. even if he survived the doctor in the first stage of the disease. At the same time, there is a risk of inflammation super- vening about the injured part, and bleeding nicer proportioned to the case may be desirable when the patient has rallied, while tonics May become a necessary accompaniment. And these are ques- tions whose settlement involves the nicest/ discernment in' the medical man ; for no teaching can do more than indicate the prio- ciples1 the practice must depend upon long experience and indivi- dual perception in each individual case. Here is one, in which, too, the obvious signs of delieaey.from personal appearance would seem to have been absent.
“. In some instances, the apoplectic seizure commences and continues for a time in the weak form now being considered, and panes into a state of mode- rate reaction, with more or less marked cerebral disorder, or determination of blood to the herder especially after a recourse, necessary at the time, to restorative means. The following case, illustrative of this, occurred to me many rears ago, and T have observed similar instances since then. When Unveiling in the summer in one of the short stages,. I eat opposite an aged and corpulent man, who, very soon after our leaving town suddenly lost consciousness and power of motion. His countenance became first pale, then bloated and inexpressive, his breathing slow and. slightly stertorous, all his Muscles completely relaxed ; and he fell, in a few seconds, upon those sitting around him. We were only a few doors from a chemises shop; the coach Was-sitopped, and he was carried thither. He was now profound y apoplectic ; axe/pious• a flowed from his face and forehead, the veins of which wore distended,. and all hia senses were completely abolished_ There was no sign of hemiplegia, but there was general and complete loss of motion and sensation. His neckcloth having been removed, the pulsation of the carotids was found to be slow, and of natural strength and ft/bless. Whilst he was held in a sitting posture in a chair, cold water was squeezed gently over his Bead from a. sponge, and his head frequently sponged with it ; volatile salts were also held for a short time and at intervals to his nostrils. The power of-deglutition was at this time abolished, so that it was impossible to imme- diately administer a draught, chiefly consisting of a small quantity of spiritue annum/he aromaticus and camphor mixture, which was prescribed. In a very few minutes his consciousness returned, he took the draught, and in a short time afterwards he walked to a coach, in which I acton ied. him. home. He now complained only of a very slight confusion of • eas, with scarcely any heedaehe ; but his carotids beat more firmly. One moderate blood-let- ting and an active purgative were now directed: The next day he was y well, and has continued so. What would have been the result had been largely blooded previously to the reaction ?"
Dr. Copland agrees with Abercrombie and Crnveilhier; in con- sidering that there is no valid reason for the diatinetion, proposed between serous and sanguineous apoplexy; nor in the instance of
primary apoplexy does he consider the serous effusion the actual cause of death
"Many of the cases which terminate by serous effusion exhibit in their early stages all the symptoms usually assigned to sanguineous apoplexy, such as flushed countenance, strong-pulse, vigour of constitution, &c.; whilst, on the other hand, many of those accompanied by paleness of countenance and feebleness of the pulse are found to be purely sanguineous ; even the preexistence of dropsical effusion, or the leueo-phlegmatic diathesis, or great age, &e., furnish no certain data, although a strong presumption, Of the at- tack being that depending upon the effusion of serum. The shock given to vitality by the sanguineous effusion is generally not sufficiently estimated or correctly interpreted by many.
"The serous effusion in those cases in which_it constitutes even the chief lesion,, cannot be viewed in any other light than in that of a result of pre existing disturbance of the circulation, depending, as will be more lir alluded to in the sequel, either upon imperfect vital tonicity or action of the vessels, or upon obstructed circulation, especially in the veins and sinuses of the organ, or even upon both Another circumstance well deserving of notice, and evincing that the serous effusimiis of itself to be viewed as merely a part and indeed no very important part of the existing lesions, although the most demonstrable, is the fact also first insisted on by Dr. Physick and. Dr. Abercrombie, that the quantity of fluid effused bears no proportion to the degree of the apoplectic symptoms : for we find it in large quantity- when the symptoms hare been slight; in small quantity when they have been both strongly marked and long continued; and finally, we find most
i
extensive effusion in the head when there have been no apoplectic symptoms at all. The inference, therefore, clearly deducible from the most faithfully observed facts is, that the effusion is not the cause of the apoplectic seizure, but the consequence of that state of circulation on which the disease more immediately depends. Indeed, I am of opinion that a considerable portion of the. effusion takes place either immediately before death, or soon after life. is extinct ; and that several cases referred to serous effusion have not arisen. from this cause, the quantity of serum having evidently not been greater-than. we have reason. to believe naturally exists in the head, as necessary to regularity of the functions of the brain, under the varying states of circulation, and of atmospheric pressure on the surface of the,bly, from which the unyielding bones of the cranium protect the encephalen_
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