The brain itself is seldom or never in a healthy condition; the morbid
changes to be distinguished in it differ greatly in degree in different
cases, but still, in almost every case, some morbid change is to be
discerned. These changes consist of an altered state of its substance,
or of its cavities, or of both. The most usual change apparent in its
substance is a higher degree of vascularity than natural. This increased
vascularity is sometimes confined to the surface; sometimes it is more
manifest deep in its substance; and, while common to both, it may
exhibit different degrees of intensity in either. When on the surface,
this preternatural vascularity is denoted by a greater fullness of the
vessels, and, apparently by an increase in their number; when within the
substance, by a greater number of bloody points, which are rendered
visible by an incision with the scalpel. And in both situations it may
exist in all degrees, from a faint blush to a deep and vivid redness.
The substance itself is sometimes softer, sometimes firmer than natural.
The softening differs in degree and in extent. Sometimes the entire
cerebrum is manifestly and considerably softer than natural; at other
times, only particular portions of it are found in this softened state.
Now and then, but very rarely, abscess is discovered within its
substance. It is remarkable that the cerebellum is always considerably
softer than the cerebrum: whence these two portions of the organ are
often observed to be in opposite states, the cerebrum being frequently
preternaturally firm, and the cerebellum being almost always softer than
natural. The pituitary gland also is very constantly softened, and often
in a state of suppuration. When the cerebrum is preternaturally firm,
the firmness is usually general.
The morbid change observable in the cavities of the brain consists in
their containing an excess of secretion. This increase of secreted fluid
is usually accumulated in the lateral ventricles: the quantity varies
from a drachm to several ounces; when thus great, the lateral ventricles
themselves are enlarged, the third and fourth ventricles are likewise
distended with fluid, and the passages connecting them are
proportionally full.
Common as it is to find a preternatural quantity of fluid in the
ventricles, it is still more common to find it in excess between the
membranes; often between the dura mater and the arachnoid, almost always
between the arachnoid and the pia mater. It has been already stated,
that the fluid effused between the arachnoid is of a gelatinous
appearance and aspect; every where else it possesses the physical
properties of serum, being thin, transparent, and of a straw colour: now
and then it is thicker in consistence, opake, and even bloody, and
sometimes that beneath the membranes contains flakes of lymph, or is
mixed with pus.
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