LECTURES ON DISEASES OF THE BRAIN AND NERVOUS SYSTEM,

M. Andral
1836 The Lancet  
GENTLEMEN,—Let us now pass to ramollissement affecting other parts of the brain than the cerebral hemispheres. The first which naturally present themselves for examination are, The Corpus Callosum, the Septum Lucidum, and tlee Fornix. We have already described the anatomical characters of the lesion when situated in those parts, and have now merely to occupy ourselves with the functional derangements to which it may give rise. We shall only add on the present occasion, that, when softened, we
more » ... when softened, we generally find the ramcllissement accompanied by another lesion, viz. effusion of a serous fluid into the cavities of the lateral ventricles ; this certainly occurs in a great majority of cases. Whenever ramollissement occupies the white central parts of the brain, it is very rare not to find at the same time a greater or less quantity of serous effusion in the ventricles. The ramollissement is, then, nothing more than a constituent element of the disease so generally known under the name of " acute hydrocephalus." However, we cannot now enter into an examination of this latter form of ramollissement; it is foreign to the question which now occupies us, and however interesting in itself, it would lead us too far from the principal subject of our study. We must, therefore, confine ourselves, for the present, to cases in which Ramollissement exists as a Single Lesion, unaccompanied by any effusion of fluid into the ! ventricular cavities, which cases are excessively rare, and will not, I fear, permit the deduction of any general principles. The ramollissement now spoken of is remarkable in this respect, that it is rarely'accompanied with a red coloration of the nervous pulp ; on the contrary, the softened cerebral substance is white, of a dull pale colour, and we seldom or never find any trace of injection in the vessels. ABERCROMBIE gives one case of this kind ; but we may establish it as a general rule, that red softening of the medullary central parts of the brain is a lesion excessively rare. It may attack all the three parts mentioned a while ° ago, or only one of them. Ramollissement of the corpus callosum is the most rare of the three. Softening of the septum lucidum alone is also a lesion very seldom observed in the dead body. In the considerations we have to lay before you on this part of our subject, we find ourselves compelled, contrary to custom, to depend alone on the history of particular facts, for the records of the science do not furnish a sufllcient number of examples of ramollissement affecting the white central parts, to enable us to -draw a general picture of this lesion. Were we to launch out into general reflections, and attempt to describe the form under an ensemble of symptoms, we should only run the chance of deceiving and leading you astray, for we again repeat, the records of medicine do not afford a sufficient number of facts for the deduction of general principles. We shall speak, in the first instance, of ramollissement when confined to any one part alone; we shall then consider it 'when affecting at one and the same time the corpus callosum, the septum lucidum, and the fornix. First, for ramollissement confined to the thin layer of medullary substance called septum lucidum. You will find one example of this kind in M. ROSTAN'S work; a second is related in the letters of M. LALLEMAND on diseases of the brain and nerves. Now what
doi:10.1016/s0140-6736(02)84773-0 fatcat:gmbago52gjgd5dwdlctntrhm2a