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The William Osler Papers

[Case notes on apoplexy] pdf (713,704 Bytes) transcript of pdf
[Case notes on apoplexy]
From Osler's medical school notebook on Practice of Medicine.
Item is handwritten.
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4 (713,704 Bytes)
Date Supplied:
[Osler, William]
Original Repository: Osler Library of the History of Medicine, McGill University. Bibliotheca Osleriana
BO #7666
This item is in the public domain. It may be used without permission.
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Medical Education and Early Career, McGill University, 1870-1884
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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
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 . . .
[handwriting becomes increasingly illegible]
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