From Osler's medical school notebook on Practice of Medicine.
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Original Repository: Osler Library of the History of Medicine, McGill University. Bibliotheca Osleriana
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Medical Subject Headings (MeSH):
Medical Education and Early Career, McGill University, 1870-1884
Coma coming on suddenly. No longer needed to distinguish a single form of disease. It rather applies to a group of symptoms
which occur in Embolism Cerebrites[?], congestion of brain. Clot from disease of blood vessels, poisoning by uremia, etc.
it does not always occur where haemorrhage has taken place into the brain. Indeed it does not not as a rule unless clot occupies
pons, ventricle, or a large of mass on hemisphere[?] or arachnoid sac. Pathologists now prefer to describe extravasation into
and congestion of brain separately.
Nervous apoplexy -- Formerly, people found dead, having died suddenly of coma were said to have died of apoplexy. This is
rare now as we find most of the cases due to emboli, uremic poisoning, disease of heart or they may even die of suffocation.
Serious apoplexy -- in which excess of serum was found in pia mater and ventricles. Now doubted by best pathologists. Facts
wh justify the doubt, 1) no necessary relation between the effusion and the symptoms 2) exists in pia mater and ventricles
of old people and after many forms of death as intemperance
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apoplexy, exhausting disease. 3) It is often poured out during the death agony, 4) Often poured out rapidly. Held that the
serum did not cause the symptoms but the general congestion did. So that serious apoplexy is now not recognized [ . . . ]
doubts the fact of congestive apoplexy also.
Haemorrhage in Britain -- May be minute capillary extravasation size of pin's head, between this and the extravasations
we may have every grade and degree. Where is the blood extravasated? Most often into substance and then the membranes and
then substance of corpus striatum and [ . . . ] optici 3 1/3 times as often into them and substance around as all other parts
put together. Rare in cerebellum, pons, or medulla, seldom in formix or [ . . . ] the blood coagulates, colouring matter is
absorbed gradually until the clot becomes colourless. Clot gradually becomes [ . . . ] and is absorbed. At end of 3 weeks
with microscope you will discover crystals of [ . . . ] and oil globules. The brain substance [ . . . ] the clot is [ . .
. ] The walls are rough, jagged, and if you wash it you may discover rough and [ . . . ] vessles like those of chorion. These
become stained with colouring matter of the blood. In from 4-8 days reaction sets up around the clot, the connective tissue
begins to proliferate and a cyst forms atoned it by proliferation of connective issue of brain. Then you fear too strong a
reaction [ . . . ] centrites. In from 10-11 days distinct membrane may be formed, this membrane secretes a serous fluid tinged
with coloring matters of the blood. This will become straw colored and finally colourless. It may remain as a distinct cyst
or if small the walls will collapse and you have a cicatrix. Secondary changes also may occur . . .