Monday, July 25, 2011
Brain, liquefaction of
The following is an excerpt from my unpublished manuscript “A Shorter History of Bodily Fluids”
Brain, liquefaction of: also known as encephalomalacia (from the Greek, μαλακία softening), necrencephalus (from Greek, νεκρο + κεϕαλή deadhead), ramollissement cérébral (from the French ramollissement cérébral), cerebromalacia (from the Greek, μαλακία a colloquial onanist, esp a vehicular onanist; cf blood, semen), cerebral softening (from the Old English soft meaning soft), or more commonly, softening of the brain (pronounced US /breɪn/). When the tissue affected is white matter it is called leukoencephalomalacia; polioencephalomalacia refers to necrosis of the gray matter. This condition may manifest as multiple necrotic fluid-filled cavities replacing healthy brain tissue. It is preferable to inspect this necrosis post-mortem especially if attempting to administer home remedies. If you are a sheep the following suite of symptoms will be diagnostically useful in identifying brain liquefaction: somnolence, short sightedness, ataxia (poor coordination), head pressing, tumblesaulting, walking in circles, walking bipedally, excessive bleating or bleating in prime numbers, and terminal coma. I treated a mouse once that after a fall complained to me that she could only walk in circles. It greatly affected her travel plans and she died penniless, vastly undereducated, and living very close to where she was born.
If after munching on yellow star thistle (Centaurea solstitialis) you become excessively sleepy or find yourself given to aimless wandering and go off your feed, you might be a horse. Unfortunately you also have a condition called nigropallidal encephalomalacia. Avoid prehending Russian Knapweed. If you are a chicken and have ataxia, paralysis, severe softening of the brain, and are brooding excessively on death you have “crazy chick disease”. Take vitamin E capsules with your feed and avoid gassy foodstuffs. Rhinoceroses should also remember to regularly get their vitamin E levels assessed; consider doing so even between regular checkups. If you are a Rhinoceros be vigilant for signs of depression; if you are feeling down, just pop in to your vet. If your condition has progressed to coma, its best to have him visit you.
Clinical notes of liquefaction of the brain
Fragment from the journal of Dr K, of Naumburg
“I had a patient today (to protect his anonymity I will refer to him as Master F Nietzsche) who presented with headaches. Friedrich is 18. He is a squat young man, moody and diffident; short sighted in one eye, long-sighted in the other. The locations of his headaches are worth remarking; one of them was on his glabella one of the supraorbital processes, another very thin headache runs along the coronal suture, one on the patellar grove, and there is a persistent one above his pronounced ischial callosities. N complains of cephalalgia throughout his body. He is also suffering from a great despondency which expressed itself in a fixed stare and excessive sighing. Apparently his father went blind and wasted away, dying young from liquefaction of the brain. He fears this same fate. I recommended a companion animal to him but he muttered that his dog was already dead, or was it that the log is painted red? I prescribed fresh air, a moustache, and morose meditation.” (translation mine)
The ramollissement of Mr P
I had occasion to work quite recently with William Madden, MD, Physician of the Torbay Infirmary and Dispensary on the following fascinating case of ramollissement of the grey matter of the medulla. Our patient, Mr P came under our care in the late summer of 1838. Mr P had engaged in heavy drinking with some rowdy boys, greedily joining in on their excessive imbibitions. After this he developed a burning pain on the instep of his left foot. He lost much of the feeling in the ailing foot and the lower part of the leg. When he walked it felt as though he were walking upon “heaps of warm bran.” After a chilly journey to Roslin a few miles from his home his face stiffened on the side closest to the carriage window. Dr Madden and I prescribed the following usually very efficacious cures: bleeding, blistering of the head and spine, and severe purgation – these continuing for several days, ceasing only when Mr P partially lost his vision. Naturally enough we tried galvanism though I am not inclined to inform you how much we shocked the ailing man as Dr Madden and I disagreed on precisely this point. Alas after six tries Mr P abandoned the cure. He also refused more bleeding. His family reported that he was becoming increasingly irritable and burdensome at home. His bowels remained open and his stools loose but not excessively so (cf. Stool, runny). As the days wore on the pain increased and the patient’s arms were in constant motion. We bled him, draining him to the point that his pulse dropped and then administered a purgative to his unwilling bowels. He slept poorly but his bowels were productive. We bled him, and bled him again. Finally the sensations came back to his feet after which Mr P died. The sectio cadaveris performed forty-two hours after death revealed that the ventricles were distended with fluid, with much of it spilling over into the spinal canal. Other parts of the brain were pulpy. The center of the spinal cord had become completely fluid.
A case of brain shrinkage and liquefaction
During the post-mortem examination of a Mr S I found that when I sawed open his head there was a very significant quantity of clear serum on the surface of the brain. I had treated this man alongside Dr Thomas Nunnelley. You probably know Nunnelley as the surgeon to the Leeds General Eye and Ear Infirmary. Mr S suffered from wakeful nights and complained of heat in his head. After he was seized by a fit in September 1841 Dr Nunnelley and I suspected acute liquefaction of the brain. The patient was cupped, leeched, blistered, and administered mercurous chloride, henbane with camphor, and strychnine. Naturally, he improved. Little changed in his condition with the exception of the growing offensiveness of his language, something he was not inclined towards when in good health. Additionally he took to yelling out “Oh dear! Oh dear!” or would occasional mutter to the servants “Is there Mary”, or “What do you say Charles”. I am reminded here of the case reported to me from my colleague Dr G of Genoa who related that as the Irish leader Daniel O’Connell lay dying of softening of the brain he repeatedly murmured “Jesus…Jesus…Jesus…”. The “Liberator” and Member of Parliament for Dublin died in 1847 a year after Mr S. To continue, Mr S’s bowels were constipated. After his fit he lingered for two years and died in his chair. As I said, when I examined him postmortem the surface of the brain was excessively wet. When I dissected the hemisphere I found the ventricles distended with serum and the lining of the ventricles were pultaceous. I have never seen such a small cerebellum. I did not have an opportunity to weigh this organ.
A note on sources
I am especially indebted to my former student, the late Professor E Z, whose magisterial General and Special Pathology, originally published in 1881, usefully synthesized our current clinical knowledge of the liquefaction of necrotic tissue. Z was Professor of Pathology in the University of Freiburg; before this he was Chair of Pathology and Morbid Anatomy in the University of Zurich and later at Tubingen. Beloved by his students, his specialty was in “tubercle” and in the cellular nature of the inflammation. Another discovery of Z’s: “All life”, he said, “comes soon or later to an end – to death.” [Emphasis Z’s]. This fact I suppose was well enough known before this time; science, however, often calls for the bold statement of the obvious. Yet another insight of Professor Z’s “When death occurs prematurely…it must be regarded as a pathological phenomenon.” At the time of Z’s death we were working up our autopsy notes on the case of a retired philologist from the University of Basel. This man had gained some notoriety as a philosopher-poet. Our philologist had lapsed into a demented silence after his 1889 collapse in Turin, and had eventually died on August 25th 1900 after a series of apopleptic fits. Though tertiary cerebral syphilis was suspected, Drs Binswanger and Ziehen, the philologist’s physicians, contrary to the desire of his sister, requested a post-mortem confirmation of the diagnosis. Alas, our dear Professor Z died in Freiburg at aged 56 before we completed the manuscript. The location of the autopsy notes is unknown at this time. I shall reconstruct them at a later stage as it has not escaped my notice that there has been some speculation among the greater public on this case. The philologist is buried next to his beloved father in Röcken.
I extend gratitude to my colleagues Drs Madden and Nunneley for sharing with me their notes and manuscripts (listed below) on these edifying cases of liquefaction of the brain; these amply jogged my memory which has become diminished of late.
Krell, David F and Bates, Donald L. (1999) The Good European Nietzsche's Work Sites in Word and Image University Of Chicago Press
Madden, William H. (1850) Illustrations of Diseases of the Nervous System London Journal of Medicine, Vol. 2, No. 13 (Jan., 1850), pp. 10-16
Miller, R. Eric, Richard C. Cambre, Alexander de Lahunta, Roger E. Brannian, Terry R. Spraker, Carol Johnson, William J. Boever Encephalomalacia in Three Black Rhinoceroses (Diceros bicornis). Journal of Zoo and Wildlife Medicine, Vol. 21, No. 2 (Jun., 1990), pp. 192-199
Nunneley, Thomas (1846) Case of Diminished Brain: Provincial Medical and Surgical Journal (1844-1852), Vol. 10, No. 26 pp.297-299.
O'Faoláin, Seán (1938) King of the beggars: a life of Daniel O'Connell, the Irish liberator, in a study of the rise of the modern Irish democracy (1775-1847). The Viking Press.
Thom, Alexander (1906) Ernst Ziegler, M.D., Professor Of Pathology, University Of Freiburg. The British Medical Journal, Vol. 1, No. 2352, pp. 236-237
Ziegler, E (1898) General Pathology. Translated by Aldred Scott Warthin. William Wood and Company
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