A system of practical medicine . which is rare, is found most frequently The interval of consciousness is not, however, always present. (See Battle : lancet,1894, i. G74.) ?* Rarelv, however, a history of trauma is present. (See Koell, Correspond. Blatt. Aerzte, Basel, 1893, 783.) PA CHYMENINGITIS H^MORRHA GIGA. 373 in chronic and terminal insanities, and sometimes in cases where therehas been a history of alcoholism or sunstroke. At times it follows ex-hausting fevers, and infrequently it is found in autopsies in cases ofpernicious antemia. The atfection was for a long time consider
A system of practical medicine . which is rare, is found most frequently The interval of consciousness is not, however, always present. (See Battle : lancet,1894, i. G74.) ?* Rarelv, however, a history of trauma is present. (See Koell, Correspond. Blatt. Aerzte, Basel, 1893, 783.) PA CHYMENINGITIS H^MORRHA GIGA. 373 in chronic and terminal insanities, and sometimes in cases where therehas been a history of alcoholism or sunstroke. At times it follows ex-hausting fevers, and infrequently it is found in autopsies in cases ofpernicious antemia. The atfection was for a long time considered byVirchow and others as inflammatory in origin. However, Wiggles-worth, Hoyt, Whittaker, and the writer have pointed out that the lesionsfound can be attributed much more readily to hemorrhage. It is not im-probable that sometimes the hemorrhage is due to a degeneration of thevessels. It occurs especially in cases in which degenerative changes areapt to be marked—namely, the chronic insane—and in which, in all Fig. Section of membrane from a case of pachymeningitis hsemorrhagica ; beginning vascularization of the deposit at a and h. probability, the intracranial pressure is lessened, due to atrophic changesin the brain. At times, however, degenerative changes in the vesselsare not evident, and Ave are forced to the conclusion that the exudationof blood is neuro-angio-paralytic in character. In a remarkable casepublished by the writer^ there was no mental disease, no degenerativeaffection of the nervous system, and notwithstanding at the autopsy largehsematomata of the dura were found covering both hemispheres. In this Dercum : TJniw. Mtd. Mag., Oct., 1889. 374 DISEASES OF THE BLOODVESSELS OF THE BRAIN. instance the aifection was not limited to the internal dura, but aifectedthe external dura as well^ and with it the calvarium. The vessels ofthe external dura were exceedingly enlarged, and the calvarium Avassoft and spongy and was riddled with a large number of foram
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