A text-book of mental diseases : with special reference to the pathological aspects of insanity / by W. Bevan Lewis.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of mental diseases : with special reference to the pathological aspects of insanity / by W. Bevan Lewis. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    more usual, however, to find both areas affected, and this to a pro- found degree. Certain cases of chronic alcoholism approach, as we have seen, in their clinical features, the history of general paralysis; and when we come to the morbid anatomy, we find the membranes of the brain often presenting similar appearances, both as regards naked- eye aspects and distribution of lesion. The vascular implication, however, is far different, and cannot be readily confused. In the one (alcoholism) the morbid change is centred in the atheromatous state of the inner coat; the numerous bulgings and fusiform dilatation being also highly characteristic of this chronic inflammatory implica- tion. The outer or adventitial investment does not show the enormous nuclear proliferation which is so notable a feature in general paralysis (PI. xvi., fig. 3); although in degenerated vessels it will be the seat of a profusion of sca/oenger-cells which entangle its walls in their processes. In' the other (general paralysis), as previously stated, the morbid change is concentrated in the adven- titial sheath, and is a far more acute irritative process in the loose external tunic of the vessel, which explains the more rapid implication of the nervous structures lying immediately around by direct extension. It is on this limitation of the more gross change for a time to the inner tunic of the blood-vessels in chronic alcoholism, that the slow (yet progressive) impairment of nutrition of the nerve- centres depends, which so frequently issues in steady enfeeblement of the mental faculties, akin to the advancing imbecility of senile atrophy, in which similar changes of the vessel’s wall occur. It is, on the other hand, in the early implication and rapid spread of morbid activity along the adventitial tunic of the vessels that the more acute changes are induced in the nerve-cells of the cortex in the general paralytic. When, however, superadded to the intravascular lesions, we find sclerous tissue permeating the peripheral zone of the cortex, we have an invasion of those most externally-disposed medullated fibres which are also involved in general paralysis (PI. xv.,fig. 1). It is in such cases, probably, that the mental symptoms assimilate to those characteristic of general paralysis. The sclerous shrinking of the new connective formation around the extensions from the under- lying ganglionic cells, results in a degeneration which is ultimately transferred to these cells themselves, inducing the already-described pigmentary and fatty degeneration preceding their absolute destruction and removal; but, this extensive atrophy of these large elements of the cortex is coincident only with the most advanced forms of alcoholic dementia; the earlier stage of vascular impairment, and the growth of young scavenger-cells in the peripheral zone, ere the cells are themselves involved, being apparently associated with the maniacal