BM 
 
 UN/VERSITY OF rA 
 ^ DAT 
 
 E DUE 
 
 WlAY 16 
 
 UUWW 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " • 
 
 
 
 ' 
 
 i 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 CAYLORO 1 
 
 
 
 PRINTED IN USA.
 
 cri- 
 
 U 
 
 Is 3fL.
 
 WL 300 L677h 1882 
 ""imMlM Ill'J'.f.iSl.f.'i'i^i?... 5A.N..qiEG0 E 
 
 3 1822 01030 2909 
 
 
 ::> 
 
 Ub77 \ 
 
 ^V\ 
 
 THE HUMAN BEAIN 
 
 HISTOLOGICAL AI^D COAESE METHODS OF 
 
 RESEARCH
 
 THE 
 
 HUMAN BRAIN 
 
 HISTOLOGICAL AND COARSE METHODS OF RESEARCH 
 
 A MANUAL FOR STUDENTS AND ASYLUM 
 MEDICAL OFFICERS 
 
 By W. BEYAN lewis, L.R.C.P. (Lond.) 
 
 DEPUTV MEnlCAL SUl'ERIXTEXnENT TO THE WEST BIDINO LUNATIC ASYLUM 
 
 LONDON 
 AND A. CHURCHILL, 
 
 NEW BURLINGTON STREET 
 1882
 
 PREFACE. 
 
 In these days of a voluminous scientific literatui'e the • 
 appearance of every new manual demands some justifica- 
 tion ; a genuine want can alone excuse additions to an 
 already extensive series of handbooks of scientific methods 
 of research. 
 
 The onus 2J)-obandi of this want rests, of course, with the 
 author,, and can in the present instance be readily met. 
 
 Prompted by the editors of Brain, as well as by a 
 personally-felt need for a concise summary of methods of 
 examination of the nervous centres, the author contributed 
 to the pages of that journal a series of articles on " Methods 
 of Preparing, Demonstrating, and Examining Cerebral 
 Structure in Health and Disease." 
 
 An appeal thus made to what was regarded as a gene- 
 rally prevailing want amongst asylum medical officers and 
 students, was met with signs of cordial approval, and the 
 frequently expressed wish for the re-appearance of these 
 articles in a separate and convenient form. 
 
 Such expressions of approval form the author's justi- 
 fication for this Manual of Methods. 
 
 West Riding Asylxtm, April, 1882.
 
 CONTENTS. 
 
 PART I. 
 
 Coarse Examination of the Brain and its Membranes. 
 
 CHAPTER I. 
 
 The Duka Mater and Venous Sinuses. 
 
 C I'AOE 
 
 General Anatomical Features— General Appearance at the Vault — 
 Examination of the larger Venous Sinuses — GenenU Appear- 
 ance at the Base . . . . . . - . • • . • • . • 3-S 
 
 CHAPTER 11. 
 
 The Aeachnoid and Pia Matek. 
 
 General Anatomical Features — Coarse Examination of the Mem- 
 branes.. .. .. .. .. .. .. .. ..iJ-H 
 
 CHAPTER 111. 
 
 The Aetekial System of the Beain. 
 
 Dissection — Arrangement of the Blood-supply in Circle of Wiliis— 
 Superficial Examination of the Arterial Tunics — Capacity of 
 the Arteries at the Base — Vessels of the Pia Mater — Nutrient 
 Vessels at the Base . . . . . . . . . . . . 15-25 
 
 CHAPTER IV. 
 
 Physical Properties of the Grey and "White Substance of 
 
 the Brain. 
 
 \ CONSISTENCE 27 
 
 Conditions modifying Normal Consistence — Estimation of Textural 
 Cohesion— Consistence of the Normal Brain — Reductions in
 
 Vlll CONTENTS. 
 
 PAUli 
 
 Consistence: 1. Putrefactive Changes; 2. Indications of 
 Softening; 3. White Softening of the Brain ; 4. Limited Foci 
 of Softening; 5. YeUow Softening of the Brain; 6. Eed or 
 Inflammatory Softening of the Brain ; 7. Simple OEdematous 
 Conditions of the Brain— Augmented Consistence: 1. Super- 
 ficial Scleroses; 2. Hypertrophy of Neuroglia; 3. Cicatricial 
 Formations; 4. Disseminated Sclerosis; 5. Descending 
 Sclerosis . . . . , . . . . . . . . . . . 45 
 
 § COLOUR 45 
 
 Pallor: 1. Partial Mottling and Laminated Pallor; 2. General 
 Diffused Pallor— Kedness : 1. Congested Zones ; 2. Patchy 
 Kedness of Cortex ; 3. Puncta Vasculosa — Kesultsof Increased 
 Intra-Cranial Pressure — Results of Increased Intra-Thoracic 
 Pressure 55 
 
 § VOLUME . . . . 55 
 
 Volumetric Methods for the Brain : 1. Dr. Hack Tuke's; 2. Other 
 Methods ; 3. By Stevenson's Apparatus— Estimation of 
 Cranial Capacity : 1. Dr. Hack Tuke's ; 2. Professor Flowers' ; 
 3. Paraffin Method ; 4. Broca's Eesiilts .. ,. ..60 
 
 § WEIGHT 60 
 
 Gravimetric Methods— Absolute Weight of Brain — Specific 
 Gravity by : 1. Bucknill's Method ; 2. Sankey's Method ; 
 3. Stevenson's Apparatus — Proportion of White and Grey 
 Substance (Danilewsky) .. .. .. .. ..68 
 
 CHAPTER V. 
 
 Removal akd Dissection of the Beain. 
 
 § EXTERNAL ASPECT OF THE BRAIN 69 
 
 § EXAMINATION OF INTERNAL STRUCTURE OF THE 
 BRAIN 71 
 
 CHAPTER VI. 
 
 StrPEEFICIAL TOPOGKAPHY. 
 
 § GENERAL REFERENCE TO THE PHOTOGRAPHS . . 77 
 
 § LIST OF SYNONYMS FROM ECKER , , 78
 
 CONTENTS. IX 
 
 PAKT II. 
 
 Minute Examination of the Brain. 
 
 PAGE 
 
 CHAPTER VII. 
 The Methods of Reseakch Conteasted 85 
 
 CHAPTER VIII. 
 
 MlCEOTOMES FOE IMBEDDING AND FeeEZING. 
 
 Microtomes for Imbedding : 1. Stirling's ; 2. Ranvier's ; 3. Ruther- 
 ford's; 4. Roy's; 5. Schiefferdecker's ; 6. For Large Sections 
 — Microtomes for Freezing: 1. The Ether Freezing Micro- 
 tome (Bevan Lewis) ; 2. The Ice and Salt Freezing Microtome 
 (Rutherford) ; 3. The Quekett Club Freezing Microtome 
 ("Williams) 89-99 
 
 r CHAPTER IX. 
 
 Peepaeation of Haedened Beaijt. 
 § HARDENING BY CHROME 102 
 
 1. MiiUer's Fluid and Potassiimi Bichromate ; 2. Potassium 
 Bichromate and Chromic Acid (Rutherford) ; 3. Iodized 
 Spirit and Potassium Bichromate (Betz) ; 4. MiiUer's Fluid 
 and Ammonium Bichromate (Hamilton) ; 5. Chromic Acid 
 (Lockhart Clarke) .. .. ..105 
 
 § HARDENING BY OSMIC ACID (EXNER'S PROCESS) . 105 
 
 § SUMMARY OF PROCESSES FOR HARDENING . . . 106 
 
 § IMBEDDING AND SECTION-CUTTING 107 
 
 The Imbedding Mass— Section- Cutting — The Section-Blade— Sub- 
 sequent Treatment of Sections — Sections through a Hemi- 
 sphere — List of Apparatus Required ., .. .. ..114 
 
 § STAINING AND MOUNTING 115 
 
 Hsematoxylin Staining: 1. The Dye; 2. The Staining Process; 
 3. Notes on the Reaction of the Dye — Cai-mine Staining : 
 
 1. The Dye; 2. The Staining Process; 3. Notes on the 
 Reaction of the Dye — Picro-cannine Staining : 1 . The Dye ; 
 
 2. The Staining Process ; 3. Notes on the Reaction of the Dye — 
 Aniline Blue-black Staining : 1. The Dye ; 2. The Staining 
 Process ; 3. Notes on the Reaction of the Dye — Osiuic Acid 
 Staining (Exner' s Process) — On the Use of Compound Pigments : 
 1. Ajiiline Picro-carminate ; 2. Picro-aniline Staining ; 
 
 3. Osmium and Picro-carmine ; 4. Hsematoxylin with Aniline ; 
 
 5. Eosin and Logwood ; 6. Picro-carmine and Iodine Green .. 131
 
 X CONTEXTS. 
 
 PAGE 
 
 § STAINING OF SPECIAL REGIONS OF THE BRAIN AND 
 
 SPINAL CORD 131 
 
 Staining the Cortex Cerebri — Staining the Cortex Cerebelli 
 — Staining the Central Medulla and Ganglia— Staining the 
 Pons, Medulla Oblongata, and Cord — List of Apparatus 
 Required ... . . . . . . . • • • • • . . 1 3o 
 
 CHAPTER X. 
 Pkepaeation of Nekvous Tissue in the Fuesh State. 
 
 § PREPARATION OF SECTIONS FROM FROZEN TISSUES . . 137 
 
 The Freezing Method— Staining Fresh Sections of Cortex — 
 Mounting for Permanent Preservation — Staining Fresh Sec- 
 tions of Central Medulla 143 
 
 § PREPARATION OF NERVOUS TISSUES BY DISSOCIATION 144 
 
 Gerlach's Method for the Spinal Cord — Rapid Method for the 
 Multipolar Cells of Cord — Rapid Method for the Ganglion Cells 
 of the Cortex Cerebri : 1. First Stage, The Film; 2. Second 
 Stage, Staining the FUm ; 3. Third Stage, Permanent Mount- 
 ing — Examination of the Neuroglia: 1. Boll's Method; 
 2. Ranvier's Method; 3. Mierzejowski's Method — Dissection of 
 MeduUated Strands in the Fresh Brain — Remarks ni^on 
 Dissociation of Nerve-CeUs .. .. .. .. ..1-49 
 
 PAET III. 
 
 List of Keagents and Mounting Media. 
 
 List of Hardening Reagents — Stock Solutions and Special Solu- 
 tions .. .. .. .. .. .. .. .. ..153 
 
 List of Staining Reagents — Stock Reagents and Special Solutions 155 
 List of Macerating and Dissociating Reagents ,, ., ..158 
 
 List of Media for the Mounting of Preparations . . . . . . 159 
 
 List of Cements . . . . . . . . . . . . . . . . 159
 
 LIST OF ILLUSTRATIONS. 
 
 Tm. PAGE 
 
 1. Diagram Illustrative of the Effects of Embolic Plugging (after 
 
 Rindfleisch) . . . . . . . . . . . . . . . . 36 
 
 2. Specific Gravity Test Apparatus . . . . . . . . . . 63 
 
 3. Stevenson's Displacement Apparatus . . . . . . . . 65 
 
 4. Convolutions of the Cerebnim as seen at the Vertex (after 
 
 Bischoff) 
 
 5. Convolutions of the Cerebrum, as seen at the Median Aspect 
 
 (after Bischoff) 
 
 6. Convolutions of the Cerebrum, as seen at the Base (after Bischoff) 
 
 7. Convolutions of the Cerebrum, Lateral Aspect (after Bischoff) . . 
 
 8 The Avithor's " Ether Freezing Microtome " (Original Model) . . 93 
 
 <J. The Author's " Ether Freezing Microtome " (New Foi-m) . . 94 
 
 10. Rutherford's Freezing Microtome .. .. .. .. .. 96 
 
 1 1 . Williams' Freezing Microtome , . . . . . . . . . 98
 
 THE HUMAN BEAIN. 
 
 HISTOLOGICAL AND COARSE METHODS OF RESEARCH. 
 
 INTEODUCTION. 
 
 Important and necessary as are the minute investigations 
 made by microscopic agency into the normal structure of the 
 brain or its pathological deviations, we must guard ourselves 
 from the very serious error of considering this method as 
 essential or exclusively necessary in these studies. This 
 error is a common one, and is too apparent to need mucli 
 comment upon my part ; for all who are engaged in the 
 prosecution of cerebral histology must have recognized the 
 prevailing tendency to disregard the naked-eye appear- 
 ances of the brain, or to consider them as of very secondary 
 import compared with a minute investigation aided by the 
 complex armamentarium of the microscopist. If any of 
 my readers are possessed of this notion I would ask them 
 at the outset to rid themselves immediately of so fallacious 
 an idea as one which, if fostered, must prove a serious 
 obstacle to the acquirement of that intimate acquaintance 
 with the true significance of the varied appearances presented 
 by normal and diseased tissues. The skilled obstetrician 
 recognizes as an invaluable acquirement that tactus eruditus 
 which a constant and intelligent employment of a special
 
 XIV INTRODUCTION, 
 
 sense can alone confer ; and no less should the histologist 
 endeavour to obtain a special visual tact, a highly refined and 
 educated visual power, which can alone enable him to recog- 
 nize by the unaided eye appearances which pass wholly 
 unnoticed by the casual observer. I cannot too strongly 
 insist upon this point, for he who would successfully study 
 the morbid anatomy of the brain must, as in the morbid 
 anatomy of other tissues, begin seriously to educate the eye 
 to the coarse appearances presented to the unaided vision. 
 The employment of a hand-lens of 2 to 4 inches focal 
 length will prove of service here, the naked-eye appearance 
 being contrasted with the magnified field, and the eye 
 thus educated up to recognizing characters which without 
 the aid of the lens were previously indefinite or unrecog- 
 nizable. Nothing beyond repeated and energetic efforts in 
 this direction will enlarge the area of the visual field and 
 present to the mind the manifold appearances which consti- 
 tute an unbroken whole, and wliich are absolutely necessary 
 to a refined interpretation of the picture presented to the 
 mind's eye. Repeatedly have I had occasion to observe that 
 the student, after a full curriculum of hospital training — 
 a training which should pre-eminently involve the high 
 culture of the sense of sight, hearing, and touch — fails wholly 
 to appreciate the most obvious abnormalities of the cerebro- 
 spinal tissues, and this because he has neglected to tutor the 
 eye so far as to learn what to look for, and how to look for it. 
 If you place before him the brain of a case of chronic mania, 
 without coarse lesion, and note his observations upon the 
 appearances of a section across the hemisphere, it will be 
 found that beyond a statement that the grey matter is pale, 
 anoemie, and wasted, that the white matter is altered in con- 
 sistence, and presents numerous coarse vessels, his untutored 
 eye teaches him no more ; and should he be examined even 
 for the grounds upon which these statements are made, a too 
 evident vagueness mil be apparent — his ideas on relative 
 depth of cortex or anoemic states of the brain and consistence 
 of its tissue are ^ugcd by no mental standard, and are
 
 INTRODUCTION. XV 
 
 remarkable only for their indefiniteness. The practised eye 
 of the histologist, however, sees far more : the relative depth 
 of cortex in various regions ; the relation borne by this depth 
 to normal standards ; the varied depths of the several laminoe 
 of the cortex, their distinctness of outline, general and local 
 vascularity, as well as the deviations in hue dej^endent upon 
 fatty or upon pigmentary changes. The oedematous, degene- 
 rated aspect of the medullary tracts, the presence of minute 
 sclerosed patches, and a host of other morbid appearances, 
 present to his mind a picture which the unpractised eye 
 wholly fails to appreciate. To those who are liable to err in 
 the direction pointed out, I now address myself in the hope 
 of rendering their studies of the naked-eye appearance of 
 healthy and diseased brain more inviting and instructive, by 
 means of a few simple directions as to what appearances are 
 to be sought and how they are to be looked for. 
 
 A few fiu-ther statements on the object and scope of these 
 articles may not prove amiss. 
 
 I address myself almost exclusively to the student who, up 
 to the present time, has devoted but little of his attention to 
 cerebral pathology or to the histology of the central nervous 
 system ; and more especially to asylum medical officers, 
 whose opportunities for research in this field are so numerous, 
 yet so sadly neglected. I shall endeavour here to place at 
 the disposal of the student the more important, essential, 
 and trustworthy information in this department which I find 
 scattered promiscuously throughout an extensive literature. 
 If amongst these gleanings my remarks should appear to the 
 advanced student burdened by too much detail, my excuse 
 must be that the primary object is to overcome the diffi- 
 culties presented by these studies to the novice, difficulties 
 which every expert observer has at the beginning to 
 encoimter.
 
 PAET I 
 COARSE EXAMINATION OF THE BEAIN 
 
 U«
 
 CHAPTEE I. 
 
 THE DURA MATER AND VENOUS SINUSES. 
 
 General Anatomical Features, — It is necessary here that 
 the student should recall to mind certain anatomical details 
 affecting the relationships of this membranous investment of 
 the brain which have an important pathological significance, 
 and in the first place note that : — 
 
 1. The dura mater is a fibro-sevous membrane ; the outer 
 sm-f ace being fibrous and rough, the inner being smooth and 
 polished by a layer of epithehal cells constituting a parietal 
 arachnoid. 
 
 2. Cut off a small portion and float it in water. The rough 
 pilose outer surface due to the numerous fibrous connections 
 and vessels which unite it to the inner table of the skull 
 becomes hereby very apparent in contrast to the smooth inner 
 surface. 
 
 3. Next note that the dura mater is composed of Uco didinct 
 layers, which, by their divergence, occasion the formation of 
 the different venous sinuses ; whilst the inner layer, by its 
 duplications, forms the various intra-cranial membranous 
 partitions, the falx cerebri and cerebelli, as well as the 
 tentorium. 
 
 4. Lastly, he must observe the close anatomical relation- 
 ships between the lateral sinuses and the mastoid cells, and 
 again between the superior petrosal sinuses and the internal 
 ear. Caries of the petrous portion of the temporal bone and 
 of its mastoid cells is so frequent an affection, that the con- 
 tiguity to them of tliese venous sinuses is most important as 
 
 1! 2
 
 4 COARSE EXAMINATION OF THE 15RA1N. 
 
 likely to occasion not only localized pachymeningitis or 
 inflammation of the opposed dura mater, but inflammation 
 and thrombosis of the venous siniises, leading probably to 
 metastatic deposits in the lung. 
 
 5, The position of the vense Graleni, which receive the 
 blood returning from the choroid plexuses and open into the 
 straight sinus, is such that tumours or abscesses of the mid- 
 lobe of the cerebellum would compress them. 
 
 Upon removal of the skull-cap the student should proceed 
 to investigate the condition of the dura mater after the follow- 
 ing systematic manner : — 
 
 1st. Note the general aspect of the membrane covering 
 the hemispheres. 
 
 2nd. Examine the several venous sinuses. 
 
 3rd. Observe the condition of the dura mater in those 
 regions at the base Avhere there exists a special 
 proclivity to disease. 
 
 General Appearance at the Vault. — A glance at the 
 superficial aspect of the dura mater may reveal the presence of 
 inflammatory products which are frequent here. If present, 
 note their character, whether they are simple inflammatory 
 exudates, capable of undergoing organization, or whether 
 they be the results of suppui'ative inflammation. In the 
 former case, observe how softened the membrane is, and how 
 readily separable from the bone ; in the latter case the 
 presence of pus will almost certainly lead to the detection of 
 a carious state of the internal table and diploe of the skull, 
 and a more or less sloughy aspect of the disintegrating mem- 
 brane. The organizable • blastema maybe found in various 
 stages of development, as loose areolar or thick tough fibrous 
 tissue, or it may have formed bony plates which eventually 
 unite with the cranial bones. Should dense fibrous bands be 
 formed, adhesions betwixt the dura mater and bone occur, 
 chiefly along the course of the sutures, or in localized islets 
 over frontal or parietal bones, or so extensively that it is
 
 THE DURA MATER AND VENOUS SINUSES. 
 
 imj)Ossible to remove the skull-cap without at the same time 
 including the dm-a mater, as their forcible separation would 
 entail injury to the brain. 
 
 If there be the above given indications on the sm'face of 
 recent or of old inflammation, note the density, thickness, 
 Sicollent appearcowe, and colour of the membrane at these parts. 
 Recent inflammations involve much swelling, interstitial 
 infiltration, softening and looseness of textiu'e, and a very 
 red colour ; whilst the effects of an old inflammation are seen 
 in a callous fibroid induration and thickening, often with 
 bony concretions formed in the interstices of its textm-e, 
 together with the adhesion to the inner table of the skull 
 just alluded to, - 
 
 The student must be prepared to make allowances for the 
 general increase in thickness and firmer adhesion of the dura 
 mater, which pertains to advanced age independent of in- 
 flammatory changes. Superficial inspection will also enable 
 him to detect attenuation of this membrane, such as results 
 from the pressure of a hypertrophied brain, from the effusion 
 of hydrocephalus or morbid growths. Local thinness of this 
 membrane also may be due to the pressure of pacchionian 
 bodies which perforate the dm-a mater frequently, and 
 imbed themselves in fossae on the internal surface of the 
 cranium. 
 
 Extravasation of blood, forcing the membrane apart from 
 the bone, may be frequently found, and its origin should be 
 carefully sought. 
 
 Examination of the larger Venous Sinuses. — A fold of 
 dura mater close to the longitudinal sinus at its exposed frontal 
 extremity must now be pinched up by a forceps, and the 
 scalpel passed through it and do^vn into the longitudinal 
 fissure of the brain, so as to divide the union betwixt the 
 falx cerebri and crista galli. Introduce a curved bistoury 
 into the anterior end of the longitudinal sinus, and carry the 
 blade backwards to its occipital extremity so as to expose the 
 sinus throughout its greater extent. The oblique orifices of
 
 6 COARSE EXAMINATION OF THE BRAIN. 
 
 the veins of the vertex which empty themselves into this 
 sinus mil now be exposed. 
 
 Note, 1st, The capacity of the sinus throughout. 
 
 Note, 2n(i, The nature of its contents. 
 
 Note, 3rd, The condition of its lining membrane. 
 
 The incision through the frontal end of the falx cerebri 
 should now be extended on either side through the dm\a 
 mater backwards, upon a level with the sawn edge of the 
 cranial bones. The anterior extremity of the falx being then 
 seized with a forceps, should be drawn forcibly backwards 
 from between the hemispheres, carefully dividing the great 
 superficial veins where they open into the sinus, when the 
 convolutionary aspect of the brain, covered by its soft mem- 
 branes, will be exposed to view. At this stage of dissection 
 the pia mater, arachnoid, and superficial aspect of the brain 
 will require attention, and the method to be adopted will be 
 detailed in the following chapter, to which the student must 
 be referred. Continuing, however, our examination of the 
 sinuses of the dura mater, it must be presumed that the brain 
 has been removed, and the following procedure will then be 
 necessary : — 
 
 Lay open the larger venous sinuses at the base, commenc- 
 ing at the torcular herophili behind, and carrying the blade 
 down eacli lateral sinus to the foramen jugulare. Open up 
 the straiglit sinus running into the torcular herophili in 
 the base of the falx cerebri. Deal in like manner with the 
 petrosal and cavernous sinuses. 
 
 A close inspection of these sinuses should be instituted 
 with the object of learning the natiu'e of their contents, and 
 the morbid or healthy condition of the textm-es of these 
 venous channels. The most frequent morbid conditions 
 foimd here are those of phlebitis and thrombosis, the thi^ombus 
 being usually the result of inflammation of the walls of the 
 sinus. 
 
 Thrombosis of the venous sinuses of the dura mater is so 
 frequent and so important an affection, that the possibility of
 
 THE DURA MATER AND VENOUS SINUSES. I 
 
 its occurrence should always suggest itself when examining 
 this membrane. 
 
 If a thrombus obstruct any one of these sinuses, note the 
 more or less organized condition of the clot and its adhesion 
 to the lining membrane of the sinus. 
 
 Examine closely its apparent site of origin and extensions, 
 the latter often reaching into the jugular veins. 
 
 Next take into consideration the constitution of the clot, 
 whether recent, organized and firm, or breaking up and pre- 
 senting the appearance of a crumbling mass, which, dming 
 life, would give rise to metastatic deposits in distant organs. 
 
 The condition of the lining membrane and tissues of the 
 sinus should next be noted. If inflamed, the inflammatory 
 action should be traced to its origin, usually in a carious 
 state of the cranial bones ; or by extension of simple inflam- 
 mation of the dura mater in the neighbourhood of the sinus ; 
 or less frequently, induced as a secondary resvdt of thrombosis. 
 The student should carefidly study the effect of plugging of 
 the different sinuses, and their proclivity to disease as a result 
 of their varied anatomical relationships. 
 
 1. Inflammation of the longitudinal sinus will be accom- 
 panied by occlusion of the venous trunks from the convexity 
 of the brain where they open into the sinus. 
 
 2. If the straight sinus be occluded as the result of adhesive 
 phlebitis, the student will remark that its effects in obstruct- 
 ing the return of blood from the choroid plexus will be 
 similar to what occiu-s when the venae Graleni are compressed 
 by a tumour of the mid-lobe of the cerebellum. Effusion 
 into the ventricles might be expected in these cases, and the 
 enlargement of the head from this cause has been recognized 
 clinically. 
 
 3. If the lateral sinus be inflamed, we miglit expect, as 
 a result, extension of phlebitis into the jugular veins, and 
 plugging of the smaller sinuses or veins opening into it. In 
 connection with this — note, that the small " emissary veins " 
 (Santorini), which perforate the bone at the anterior extremity 
 of the lateral sinus, and Avhich form a communication between
 
 8 COARSE EXAMINATION OF THE BRAIN. 
 
 tlie sinus and tlie veins on the outside of the skull at the back 
 of the head, may become plugged by a thrombus producing 
 a painful a3dema behind the ear, also recognized clinically by 
 Grriesinger.^ 
 
 4. The position of the petrosal and lateral sinuses naturally 
 exposes them to phlebitis and thrombosis. Lying on the 
 petrous portion of the temporal bone, they are always liable 
 to be implicated by extension of inflammation from the 
 internal ear and caries of the temporal bone. 
 
 5. Thrombosis of the cavernous sinus has been frequently 
 noted. In connection with this condition the student must 
 be prepared to note the pressure which will probably result 
 to the carotid artery, which runs through this sinus invested 
 by its lining membrane." He may also look for extension 
 of inflammation of the coats of this sinus to the facial veins 
 with which the ophthalmic vein communicates, noting the 
 obstruction to the return of blood from the cavity of the 
 orbit. 
 
 6. Amongst other results of thi'ombosis of the cerebral 
 veins and sinuses, will often be found punctiform hasmor- 
 rhages into the substance of the brain. 
 
 General Appearance at the Base. — Observe the con- 
 dition of the dura mater at the base, where there exists a 
 special proclivity to disease. The sites alluded to are : — 
 
 1. Petrous portion of temporal bone. 
 
 2. Ethmoidal plate. 
 
 3. Parts adjoining superior cervical vertebrae. 
 
 1 Quoted by Niemeyer in " Text-Book of Practical Medicine," vol. ii. 
 
 2 This condition has been recognized clinically by a loud bruit heard on 
 auscultation of the skull. Dowse, etc. Lancet.
 
 CHAPTER 11. 
 
 THE ARACHNOID AND PIA MATER. 
 
 General Anatomical Features. — In proceeding to in- 
 vestigate the healthy and morbid appearances of the arach- 
 noid, the follomng anatomical facts will prove serviceable to 
 the student. 
 
 1. The arachnoid is usually regarded as consisting of a 
 parietal and visceral layer like ordinary serous sacs, the 
 former, however, being merely a layer of nucleated poly- 
 gonal epithelium lining the inner surface of the dura 
 mater ; the latter forming the far more substantial invest- 
 ment of the convolutions of the brain separated from them 
 by the pia mater. This closed sac is lubricated by a 
 portion of the general cerebro-spinal fluid. 
 
 2. The visceral layer of arachnoid does not dip into the 
 sulci with the pia mater, but bridges them across, whilst in 
 other regions it is widely separated from the pia mater so as 
 to enclose between them extensive spaces. Thus, at the base, 
 a delicate veil of arachnoid stretches across the pons and 
 interpeduncular space as far as the optic chiasma ; a similar 
 film of arachnoid closes in the fouiih ventricle, stretching 
 across from the medidla to the cerebellum ; the arachnoid also 
 does not pass down to the bottom of the longitudinal fissure, 
 but spans across immediately beneath the falx cerebri ; hence 
 a space is left here between the two inner membranes of the 
 brain immediately above the corpus callosum. 
 
 3. The various spaces alluded to above all communicate 
 freely with one another, and with an extensive space around
 
 10 COARSE EXAMINATION OF THE BRAIN. 
 
 the whole length of the spinal cord betwixt the pia mater and 
 arachnoid sac. The whole system of spaces is termed the 
 subarachnoid space, and is filled by the greater bulk of the 
 cerebro-spinal fluid. 
 
 4. A space intervenes between the parietal layer of the 
 arachnoid and the dm-a mater. It has been fully investigated 
 and described by Axel Key and Ketzius/ and is called by 
 these anatomists the sub-dura-mater space (subdiu-alraum). 
 The student must therefore regard the membranous invest- 
 ments of the brain as consisting of a lirm and immovable 
 fibrous outer membrane, the dm'a mater forming also the 
 periosteal lining of the cranial cavity ; of an intermediate 
 serous sac or arachnoid whose visceral layer moves freely with 
 the movements of the hemisphere ; and lastly, of a vascular 
 membrane supporting the blood-supply of the brain — tlie pia 
 mater, which closely lines the cortex, dipping into the sulci, 
 and being prolonged into the ventricles. 
 
 Between the various investments are fom* great cavities : — 
 
 1. The subdui'alraum betwixt diu-a mater and the parietal 
 arachnoid. 
 
 2. The arachnoid cavity formed by the arachnoid sac. 
 
 '3. The sub-arachnoid cavity betwixt visceral arachnoid and 
 pia mater. 
 
 4. The epi-cerebral space betAvixt pia mater and cortex. 
 
 It must also be borne in mind that compensatory adjust- 
 ments for lessened or decreased intra-cranial pressure are 
 obtained by means of the cerebro-spinal fluid ; increase in the 
 pressure, as in the increased amount of blood, gro-sHh of 
 tumours, etc., being allowed for by escape of this fluid into 
 the spinal sub-arachnoid space. In relation to this important 
 subject it has been shown by Axel Key and Eetzius, that the 
 pressm-e of the cerebro-spinal fluid is always higher than that 
 of the venous blood, and its specific gravity lower ; hence its 
 
 ' "Studieu in der ADatomie des Ncrvensystems." Axel Key und Gustav 
 Retzius. Stockholm, 1875.
 
 THE ARACHNOID AND TIA MATER. 11 
 
 free mingling with the blood-currents by osmosis is much 
 facilitated.^ 
 
 Coarse Examination of the Membranes. — The healthy 
 and morbid appearance of the arachnoid should be subjected 
 to close and critical examination. 
 
 Upon reflecting the dura mater the contents of the arach- 
 noid sac will be revealed, and in relation to this point we 
 must note : — 
 
 1. Variations in the amount of cerebro-spinal fluid here. 
 
 2. Modified appearance of this fluid from admixtm-e with 
 morbid products. 
 
 3. Note especially extravasations of blood, and the age of 
 these haemorrhages as revealed by the condition of the clot. 
 It may be purely fluid blood, coagula, or a delicate film of 
 fibrinous nature ; or it may be in various stages of organiza- 
 tion. The various stages of the arachnoid cyst in relation to 
 pachymeningitis have all been most graphically described. 
 
 4. Note the superficial aspect of the visceral and parietal 
 arachnoid as regards — 
 
 a. Absence of clear, moist, glistening surface. 
 
 h. Presence of morbid deposits, such as films of lymph of 
 varied appearance and stage of organization ; as a 
 delicate, greyish, mucus-like exudation, or a mem- 
 brane possessing a certain amount of consistence, or 
 flakes which are yellow and pimform, and more 
 rarely fibroid patches ; or, again, the development 
 of bony plates in the parietal layer. 
 
 c. Adhesions between layers of arachnoid sac, such as 
 occm' naturally by the development of the pac- 
 chionian bodies. 
 
 5. Note the anomalies of texture due to interstitial change 
 and to deposits occurring here. The effect of frequent hyper- 
 
 ' Op. fit.
 
 12 COARSE EXAMINATION OF THE BRAIN. 
 
 reiiiia is seen in tlie opalescent, creamy white, or perfectly 
 opaque appearance presented, especially along tlie course of 
 the blood-vessels, and always seen after middle life to a 
 greater or less extent. Hypertrophy of the textures, giving 
 the membrane a tough and thick character, will result from 
 similar causes. The membranes may be, however, soft, 
 tumid, and swollen from cedema of its texture ; and where it 
 bridges the sulci a solid gelatiniform aspect is often given it 
 by the subjacent fluid. 
 
 6. The relative amount of cerebro-si:)inal fluid in the sub- 
 arachnoid space should next be taken into account. It should 
 be collected, together with that which escapes from the arach- 
 noid sac and ventricles, and carefully measiu'ed. The appear- 
 ance of the arachnoid, when buoyed up by any undue 
 amount of this fluid, should be noted before removal of the 
 brain from the skull. It will be found that in these cases the 
 arachnoid is widely separated from the pia mater by the sub- 
 jacent fluid. The limpid character of this fluid may be 
 tested by slitting up the arachnoid over a sulcus. 
 
 So far our remarks chiefly apply to the arachnoid, and we 
 will now turn our attention to the pia mater. The proximity 
 of these two membranes to one another of course predisposes 
 to their common implication in any morbid process, yet the 
 pia mater is not by any means unusually involved without 
 extension to the brain-substance, and still more frequently 
 without extension to the arachnoid. In healthy states these 
 membranes are very thin and delicate, and removed from 
 the brain-surface with difficulty. "We should, therefore, 
 note their proximity to each other over the summits of the 
 gyi'i, alterations in the thicliness of the pia mater and in its 
 toughness, infiltratimis of its texture, and the ease or difficulty 
 experienced in its removal from the cortex. 
 
 Thus it may be found widely separated from the arach- 
 noid, the latter being buoyed up by sub-arachnoid effusion. 
 In these cases the appearance of the fluid should be noted, 
 especially as regards the presence of inflammatory exudates, 
 as flakes of lymph, etc.
 
 THE ARACHNOID AND PIA MATER. 13 
 
 If thickened in textm-e the alteration of the pia mater 
 should be traced to its origin, whether this be simple serous 
 infiltration or oedema conjoined with inflammatory material. 
 Tortuosity and varicosity of the vessels will also be further 
 indications of repeated congestions of this membrane. Espe- 
 cial caution must be observed against drawing hasty conclu- 
 sions regarding congestion of the membranes from the mere 
 fulness of the blood-vessels and hypostasis.^ 
 
 The student will find ample opportunity for studying the 
 appearances presented by oedema and thickening of the soft 
 membranes of the brain in cases of senile atrophy, general 
 paralysis, and alcoholism. 
 
 The presence of inflammatory material modifying the 
 thickness and toughness of the membranes should lead to a 
 study of the nature of the exudate, whether it appears as a 
 tough exudate of plastic lymph more or less yellowish in 
 hue, or more serous, sero-purulent, opaque, and less organ- 
 izable material. 
 
 With the presence of these more or less plastic exudates 
 note the general infiltration of the membranes around with 
 greyish, opaque serum. Such changes afford excellent 
 opportunities for the study of the results of inflammatory 
 action in loose areolar tissue. In connection ^vdth inflamma- 
 tion of the pia mater — a condition which will frequently 
 engage the attention of the student — he should also follow up 
 his investigation of the nature of the exudate by examining 
 also : — 
 
 a. The direction taken by the morbid product, noting 
 
 that this occiu-s almost invariably along the vas- 
 
 cidar tracts, the coiu'se of the vessels being marked 
 
 out by opacities. 
 
 h. The extension to neighboming structm-es (brain, 
 
 arachnoid, dura mater, and skull). 
 c. The limitation of inflammation to s)naU areas (as 
 when originating secondarily from caries of the 
 
 ' On this point see Niemeyer. Art. " Hyi^ersemia of Brain and its Mem- 
 branes." "Text Book of Medicine," yoI. ii.
 
 14 COARSE EXAMINATION OF THE BRAIX. 
 
 cranial bones) ; or to the coiivexifij of the hemi- 
 spheres (chiei3y accompanied by plastic products) ; 
 or, lastly, characterized by the base of the brain 
 being originally and chiefly involved (usually 
 accompanied by aplastic and tubercular pro- 
 ducts.) 
 
 Note attentively the greater or less facility of stripping 
 the pia mater from the cortex. The membrane may be 
 oeclematous, thickened, gelatinous, and most readily removed ; 
 or, on the other hand, it may cling with greater tenacity or 
 adhere so firmly that portions of the cortex tear away with it, 
 leaving an eroded, worm-eaten aspect of the surface of the 
 gyri. 
 
 Attention should be directed to the strength of these adhe- 
 sions, their implication of the summits of the gyri only, their 
 localization over the convolutionary surface of ihe brain, and 
 the coarseness of the blood-vessels entering the cortex at 
 the sites of adhesion. 
 
 Whenever the student is engaged with a case of menin- 
 gitis, the morbid topography must be carefully studied. If 
 basic, the veil of arachnoid extending from the optic chiasm 
 to the pons must be examined and removed, noting imjolica- 
 tion of the numerous vascular and fibrous twigs extending 
 betwixt it and the subjacent pia : follow these results of 
 inflammatory action up along the vessels of the fissures of 
 Sylvius and the anterior cerebrals in the longitudinal fissure. 
 Examine the regions just named for tubercular granulations, 
 paying especial attention to the smaller blood-vessels, which 
 may have tubercular masses in their sheaths, occluding more 
 or less the calibre of the vessel. Should granulations appear 
 around the blood-vessels, let them be removed and floated in 
 water for more careful observation.
 
 CHAPTEE III. 
 
 ARTERIAL SYSTEM OF THE BRAIX. 
 
 Dissection. — After carefully noting the external appear- 
 ance of the membranes covering the hemispheres both at the 
 vertex and the base, the condition of the arterial system 
 should be inquired into. The brain being placed with its 
 base uppermost, the fine expanse of arachnoid which bridges 
 across the inter-peduncidar space is first removed, and the 
 great vessels forming the circle of Willis will then be ex- 
 posed to view. Now separate the temporo-sphenoidal lobe 
 from the adjacent frontal and parietal lobes by di\'iding 
 the bridge of arachnoid extending between them across the 
 Sylvian fissure. 
 
 On gently drawing back the temporo-sphenoidal lobe the 
 Sylvian branch of the middle cerebral artery will be observed 
 running deeply in the fissure towards the upper extremity of 
 the latter, giving off small branches in this coiu-se. The 
 radiating gyri of the island of Reil (central lobe) vnW in 
 most cases be only partially exposed, and it will be necessary 
 to separate the opercuhmi, or that portion of the third or 
 inferior frontal convolution which laps over the anterior 
 portion of this lobe. The five or seven gyri of the island 
 will now be seen radiating outwards like a fan and supporting 
 the various branches deri-\-ed from the middle cerebral in its 
 sulci. Split up the arachnoid which bridges across the longi- 
 tudinal fissure anteriorly from one frontal lobe to the other. 
 We shall thus have exposed the various branches of the circle 
 of Willis as far as they can be seen at the base. Note first 
 the arrangement of the blood- ve!<!<eh.
 
 16 COARSE EXAMINATION OF THE BRAIN. 
 
 The Circle of Willis. — A first glance at the arrange- 
 ment of the great arteries at the base of the brain entering 
 into the formation of the circle of "Willis cannot fail to 
 impress upon the student's mind this important fact : there 
 are here two great arterial systems more or less distinct and inde- 
 pendent. In front lies the carotid system, supplying by far 
 the greater bulk of the brain ; behind lies the vertebral system, 
 distributed to the posterior and inferior regions of the cere- 
 brum — an area small in comparison to the former. These 
 two great arterial systems are united by the two posterior 
 comnumicating arteries which connect each carotid with its 
 corresponding posterior cerebral artery. 
 
 Examine the posterior communicating arteries and note 
 the remarkable smallness of their calibre, a fact which suffices 
 to ensure us that the circulation in the carotid and vertebral 
 systems is in the main distinct; whilst the arrangement 
 allows of compensatory enlargement and a free communica- 
 tion betwixt both systems where emboli, thrombi, or diseased 
 textures obstruct the circulation of a main branch. 
 
 Next observe the junction between the two anterior cere- 
 brals deep in the longitudinal fissure by means of the cross 
 branch, the anterior communicating artery. Raise the branch 
 on the forceps and note its short length, small calibre, and 
 right-angled direction, facts which teach us that, although in 
 case of obstruction on the carotid side of the anterior cerebral, 
 this branch, by dilating, may afford a satisfactory re-establish- 
 ment of circulation over the area to which it is distributed, 
 yet for the greater part the circulation betwixt the two anterior 
 cerebrals is distinct. 
 
 A little further consideration will teach us that the circu- 
 lation of each hemisphere is by the above mechanism rendered 
 wholly distinct and independent ; that the circulation of the 
 mid-cerebral region of one side is wholly separated from that 
 of the opposite hemisphere ; whilst the anterior cerebral areas 
 are more closely associated through the medium of an anterior 
 communicating branch. 
 
 Lastly, through the medium of tlie posterior communi-
 
 ARTERIAL SYSTEM OF THE BRAIX. 17 
 
 eating artery (especially when we recall to mind the frequent 
 enlargement of this vessel met with) there will be a far more 
 ready communication betwixt the carotid and vertebral cir- 
 culation than there can be betwixt the vascular apparatus of 
 both hemispheres. We should pay especial attention, there- 
 fore, to the following observations : — 
 
 a. The almost comj)lete independence of hemispheric 
 
 circulation. 
 h. The very complete independence established betwixt 
 
 the circulation of one middle cerebral and that of 
 
 the other. 
 
 c. The interdependence established betwixt the two 
 
 anterior cerebral streams through the medium of 
 an enlarged communicating branch. 
 
 d. The possible admixture of the carotid and vertebral 
 
 circulation of the same side through the medium 
 of the posterior communicating — a condition very 
 frequently established. 
 
 The arrangement of the internal carotid ere it reaches the 
 circle of Willis is one of interest and significance. Within 
 its bony canal the tortuous sigmoid com'se taken by it is 
 undoubtedly one means whereby the brain is protected from 
 the results of the cardiac pulsations. The student will recall 
 a similar tortuous course taken by the vertebral artery ere 
 it enters the cranium. It has long been noticed that the 
 middle cerebral is more readily blocked by emboli than the 
 other branches, and that the area of its distribution shows 
 especial proclivity to haemorrhage. Anatomical reasons, and 
 the fact that this vessel lies " more directly in the way of 
 strain fi'om the heart explains its frequent plugging and 
 ruptui-e from disease " (Hughlings Jackson ^). Thus Prevost 
 and Cotard found that tobacco seeds injected into a dog's 
 carotid most often lodged in the middle cerebral. Again, the 
 fact that the left carotid arises directly from the summit of 
 the aortic arch, whilst the right, arising from the innominate, 
 
 > Lancet, September 4, 1875. 
 
 (; 
 
 ^'5
 
 18 COARSE EXAMINATION OF THE BRAIN. 
 
 is inclined at an angle to the aortic current, is sufficient to 
 explain the greater immunity from embolism experienced by 
 the right carotid in its distribution to the brain. The right 
 vertebral arises from the horizontal part of the subclavian, 
 and is therefore also less subject to embolism than the left 
 vertebral, which arises from the simimit of the ascending 
 portion of the left subclavian. 
 
 The Arterial Tunics. — Note the following points : — 
 
 1. Colour and opacity. 
 
 2. Relative toughness of coats. 
 
 3. Tortuosity or kinks in the course of the vessel. 
 
 4. Local bulgings or constrictions from diseases of texture. 
 
 1. The arteries may be perfectly white in cases of slow 
 and lingering death, and contain a decolourized clot extend- 
 ing into its minute ramifications. On the other hand, they 
 may be of a deep red hue from fluid blood, dark clots, and 
 blood staining of the lining membrane. The vessels, again, 
 may be thin and semi-transparent, or opaque from thicken- 
 ing of the arterial tunics and morbid deposits. 
 
 2. The toughness of the arterial tunics caji be tested later 
 on after their removal. Their resistance to strain is an im- 
 portant feature, and due attention should be paid to it by the 
 student. The apparent thinness of a vessel should never 
 be allowed to deceive him, as the thicker vessels are often 
 most degenerated and least resistant to traction or expansion. 
 Traction may be applied to the vessel held between two pairs 
 of forceps, when an approximate idea of the breaking strain 
 may be acquired, whilst the use of a conical gauge will 
 enable him to note the various degrees of resistance these 
 textures offer to expanding forces. 
 
 3. Tortuosity and kinks in the smaller branches should be 
 noted as suggestive of previous forcible distension from con- 
 gestion. This is often apparent in the larger arteries ; thus, 
 Quain has noticed frequent tortuosity of the internal carotid 
 before it enters the carotid canal outside the skull in apoj^lec- 
 tic subjects.
 
 ARTERIAL SYSTEM OF THE BRAIN. 19 
 
 4. Local biilgings may be clue to aneurismal dilatations, 
 to the different forms of arteritis— atheroma, tubercle, 
 syphilitic gummata, or to the impaction of a thi'ombus 
 or embolus. The arteries at the base mil be found often 
 exceedingly atheromatous, tortuous, knotty, and white ; the 
 amount of atheromatous material occluding even the larger 
 cerebral arteries, often converting the smaller branches into 
 irregular knotty cords. The student should never infer 
 from the aspect or feel of such a vessel that it is occluded, but 
 he should always make a section across the mass of diseased 
 tissue, when, if the vessel be permeable, the orifice is readily 
 detected. 
 
 Note particularly the branches which are occluded. If 
 the bulging be due to inflammatory swelling and exudation 
 into the outer tunics of the artery, it will be observed that 
 corresponding to the site of lesion the vessel is dilated — a 
 condition due to paralysis of the muscular coat of the vessel, 
 together with implication of the elastic outer timic. Make a 
 section across the inflamed tissue, and observe how readily 
 the elastic or outer coat may be stripped from the muscular 
 by means of a forceps ; also how friable and easily separable 
 are the muscular fibres of the media. The inner coat mil be 
 probably deeply stained by htematin, or may be eroded and 
 covered by an adherent clot immediately beneath the inflamed 
 patch. When a clot appears to obstruct the calibre of a 
 blood-vessel, the character of the clot should be taken into 
 consideration, its fibrinous constitution, stage of organization, 
 adhesion to vascular walls, its fomi, prolongations, and 
 appearance of its section. The sheath and outer tunic of the 
 arteries should be closely examined, especially in the neigh- 
 bom^hood of the Sylvian fissure and island of Reil, for tuber- 
 cular or syphilitic growths. Especial care must be taken to 
 exactly note the arterial tunics involved, so as to discrimi- 
 nate between ordinary endarteritis, residting in atheromatous 
 degeneration, and the syphilitic node or gumma involving the 
 outer coats, and the tubercular nodules involving the arterial 
 sheaths, all of which lesions may give rise to blocking, con-
 
 20 COARSE EXAMINATION OF THE BRAIN. 
 
 traction of the cavity, and thrombosis. Such lesions should 
 he examined microscopically. In all cases the above super- 
 ficial examination should be supplemented by removal of 
 short lengths of any diseased vessels, to be reserved for 
 freezing and section-cutting, according to the methods 
 detailed in the microscopic section. 
 
 The vessels spreading over the island of Reil and up the 
 Sylvian fissure should now be raised by passing a forceps 
 beneath them, and with a clean sweep of the scalpel they 
 should be all divided just where they turn over on to the 
 superficial aspect of the brain ; this should be repeated on the 
 opposite side. The two anterior cerebral arteries should now 
 be divided at the genu of the corpus callosum, and dissected 
 back to their origin from the carotids. The posterior cere- 
 brals will be found running backM^ards round the crura 
 cerebri under cover of a bridge of arachnoid. The posterior 
 cerebrals, together with the three cerebellar branches, may 
 be followed to a short distance and then divided. It will 
 now be found that the circle of Willis is retained merely by 
 the numerous minute nutritive branches, between the basilar 
 artery and pons, and those from the anterior, middle, and 
 posterior cerebrals, which pass through the anterior and pos- 
 terior perforated sj)aces. Grently draw these vessels out by 
 means of a forceps as far as possible, sever them close to the 
 surface of the brain, and then float off the vessels of the base 
 into a shallow dish or plate of water, arranging the branches 
 in their relative positions. 
 
 Capacity of the Arteries at the Base. — It may be 
 found advisable in certain cases to test the relative capacity 
 of the larger vessels at the base, and this may be obtained 
 approximately by means of a small graduated conical gauge. 
 
 In making these comparisons the student should bear in 
 mind that the united areas of the branches equal very nearly 
 the area of the trunk from which they originated, although 
 their united diameters far exceed that of the latter. It has 
 been shown by Paget's measurements that the equality
 
 ARTERIAL SYSTEM OF THE BRAIN. 
 
 21 
 
 between the area of the trunk and of its branches is not exactly 
 maintained, the area sometimes increasing in the vessels of 
 the upper extremities and head and neck, and diminishing 
 in the lower extremities. Now, according to the mathe- 
 matical law that the areas of circles are as the squares of 
 their diameters, it will be necessary to contrast in our 
 measurements the square of the diameter of the trunk with 
 the sum of the squares of that of the branches arising from 
 it. The student, therefore, should proceed in the following 
 manner : — 
 
 Let us suppose he wishes to estimate the relative capacity 
 of the vessels at the base and theii' primary branches ; let 
 him remove these vessels as already recommended, and float 
 them out in a shallow vessel containing water. With a 
 sharp pair of scissors cut across the vessel exactly at right 
 angles to its direction, pass the graduated cone into it, and 
 gently draw the vessel on until it is fully distended, but not 
 stretched, by the gauge ; read off the diameter as shown on 
 the gauge, and proceed in like manner mth the other vessels. 
 Arrange the diameter and the squares in appropriate columns, 
 opposite the names of the vessels, for future comparison. The 
 following tables represent the average measurements of the 
 various vessels at the base in forty-five cases of insanity I 
 have investigated : — 
 
 DiAMETEB. 
 
 Vertebral Artery — Right 
 Left 
 
 Basilar 
 
 Posterior Cerebral —Right 
 
 Left 
 
 Carotid — Right . . . 
 
 „ Left .... 
 
 Mid- Cerebral— Right . 
 
 Left . . 
 
 Anterior Cerebral — Right 
 
 Left 
 
 mm. 
 147 
 
 Square. 
 
 42 
 
 82 
 
 658 
 
 56 
 
 951 
 
 02 
 
 133 
 
 55 
 
 73 
 
 66 
 
 10 
 
 12 
 
 14 
 
 7 
 
 6 
 
 15 
 
 16 
 
 10 
 
 10 
 
 7 
 
 7 
 
 •J41 
 •039 
 •805 
 •213 
 •551 
 •789 
 •026 
 •063 
 
 •;.^5i 
 
 •55 
 •■145
 
 22 COARSE EXAMIXATIOX OF THE BRAIN. 
 
 Thus the sum of the square of the diameters of the 
 anterior aud middle cerebrals of the right side was to that 
 of the left side as 17-613 to 17-796. 
 
 The square of the diameter of right and left anterior and 
 middle cerebrals amounted in the aggregate to 35-409, both 
 posterior cerebrals reaching only 13-764. 
 
 Contrasting again the mid-cerebral supply of both sides 
 with that of both anterior cerebrals, we find it represented 
 by 20-414 against 14-995. 
 
 Reference to the table of measurements will show that the 
 posterior and anterior cerebral supply of both sides is almost 
 exactly similar : thus, on the right side, we find 7-213 con- 
 trasted with 7-55 ; and on the left side, 6-551 with 7-445. 
 
 Another interesting feature in connection with these 
 measurements is the great preponderance in areas of the two 
 vertebrals over the basilar, which they form by their union. 
 The two former have as the sum of the square of their 
 diameters 22*38, the basilar only averaging 14-805 ; and in 
 several cases I have found the basilar artery not more than 
 one-half the area of the united vertebrals. 
 
 It may assist the student to obtain a clearer idea of these 
 areas if he represents them graphically as straight lines upon 
 an enlarged scale. 
 
 Vessels of the Pia Mater. — First note the general 
 appearance and distribution of the vessels of the pia mater 
 as they lie in situ. Observe the relative position taken by 
 the veins and arteries, the former being large and sujierficial, 
 the latter much smaller and concealed chiefly within the folds 
 of pia mater, which dip into the sidci and are bridged across 
 by arachnoid. The upper aspect being arachnoid, should, in 
 health, present a smooth endothelial surface. Use a hand-lens 
 in examining these vessels. The student should observe any 
 fibrinous effusions, purulent exudates, or minute extravasa- 
 tions along the course of the blood-vessels, the presence of 
 atheroma, morbid growths — as gummata, tubercle, etc. If 
 tuberculosis be suspected, examine the arteries deep in the
 
 ARTERIAl, SYSTEM OF THE BRAIN. 23 
 
 sulci, and this with care, as tubercle along the course of the 
 vessels is found with far greater difficulty here than at the 
 base or up the Sylvian fissure. 
 
 Next strip off a large portion of arachnoid and pia mater 
 from the sm-face, and transfer it to a deep vessel containing 
 water, the arachnoid siu"face being uppermost. Observe the 
 velvety aspect of the lower surface, due to a fine pile of blood- 
 vessels, and the very rich fringe of vessels along the inter- 
 gyral folds, for the supply of the cortex deep within the sulci. 
 
 Seize Avath a forceps one of these richly fringed folds and 
 snip off a portion with a scissors, floating it on to a glass 
 slide, with its vessels disentangled and spread out. Eemove 
 also to another glass slide a portion of the membranes de- 
 tached from the summit of a convolution, and study them by 
 means of a hand-lens, both in reflected and transmitted light. 
 Educate the eye in this manner to the recognition of the 
 various healthy and morbid structures to be found here. 
 
 For microscopic purposes, both these slides last mentioned 
 should be reserved, whilst a small portion of brain covered 
 by its membrane, and including two adjacent convolutions, 
 should also be set aside. These will aiforcl subjects for a 
 hrnVs-eye view of the surface under low powers of the micro- 
 scope, such an examination being always insisted upon as 
 especially valuable. The portion of brain must then be 
 frozen and cut in such a direction that the sections so obtained 
 represent both gyri with the intervening sulcus bridged over 
 by arachnoid. We thus obtain very beautiful slides for fresh 
 examination, which afford us the opportunity of minute 
 examination of the cortex and the connections and relation- 
 ships between it and its membranes. 
 
 The large superficial veins at the vertex where they open 
 into the longitudinal sinus, are occasionally found plugged 
 by thrombi ; they shoidd therefore always be examined with 
 the object of ascertaining the nature of their contents, espe- 
 cially if there is evidence of inflammation of the dura mater 
 or its sinuses, or of pm-ulent meningitis. 
 
 The student should also take CA'ery opportunity of follow-
 
 24 COARSE EXAMINATION OF THE BRAIN. 
 
 ing up the arterial branches given off from the anterior, 
 middle, and posterior cerebrals, in their course along the sulci, 
 until he has familiarized himself with the exact supply of 
 various regions and convolutions of the brain. It is only 
 necessary to allude to the work of Duret and Charcot in this 
 direction to indicate the importance of a minute knowledge 
 of the arterial districts of the encephalon in order to fully 
 appreciate numerous lesions met with in the brain. 
 
 Nutrient Vessels at the Base. — We should devote 
 attention to the numerous vascular tufts which arise from the 
 large vessels at the base for the supply of the central ganglia 
 and pons Varolii. Those which supply the basal ganglia 
 are disposed into anterior and posterior groups — the former 
 arising from the anterior cerebral, anterior communicating, 
 and middle cerebral ; the latter taking origin from the bifur- 
 cation of the basilar, often from an enlarged posterior com- 
 municating, a further series arising from each posterior 
 cerebral artery as it mnds around the crura cerebri. 
 Roughly, it may be stated that the anterior group supplies 
 the corpus striatum and anterior extremity of the thalamus 
 opticus, whilst the posterior group is distributed chiefly to the 
 thalamus. 
 
 Note, first, their remarkably fine calibre, considering their 
 direct origin from main arterial trunks ; and secondly, observe 
 that they are given off from these trunks at a right angle — a 
 significant fact, as they can only be affected to a minimum 
 degree by the propulsive wave of blood caused by each 
 cardiac systole. They are filled, therefore, by a sustained 
 lateral pressm*e. 
 
 An examination of the nutrient supply to the pons will 
 impress us with the follomng facts : — 
 
 a. The nutrient twigs arising from the main artery are 
 remarkably small, as in the other cases. 
 
 h. They also arise at right angles from the basilar. 
 
 c. The basilar is but slightly over half the capacity of 
 both vertebrals, which supply it.
 
 ARTERIAL SYSTEM OF THE BRAIN. 25 
 
 The latter fact, which I have abeady demonstrated by 
 measurement in our remarks upon arterial capacity, when 
 taken in conj unction with the other two data, warrants us in 
 assuming that these nutrient branches are kept constantly 
 filled by high lateral pressure, and exhibit none of the 
 phenomena of the pulse. I need not insist upon the beauty 
 of this arrangement of means to end. 
 
 In removing the vessels at the base, be careful not to tear 
 these nutrient vessels short, but with gentle traction draw them 
 out and cut them across with fine curved scissors ; float the 
 circle of WilHs and its branches in a shallow dish of water, and 
 examine the various nutrient groups. Snip off some of the 
 anterior and posterior tufts, float them on to a slide, arrang- 
 ing the branches, and examine by the naked eye as well as 
 by microscopic aid. 
 
 Wherever arterial degeneration is suspected, never miss the 
 opportunity of thus closely inspecting the nutrient supply of 
 the corpora striata, optic thalami, and pons Varolii. The 
 naked eye will sufiice to reveal to us aneurismal dilatations 
 along these branches, atheromatous degeneration, thrombi or 
 embolic plugging, often explanatory of haemorrhages within 
 the structure of the basal ganglia or pons.
 
 CHAPTER IV. 
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 
 
 In the introductory chapter to his great work on Pathological 
 Anatomy, Rokitansky has said : — " Just as there is a general 
 and a special anatomy, physiology, pathology, so there must 
 in like manner he a general and a special pathological 
 anatomy. The former treats of anomalies of organization, 
 the latter of the special anomalies of individual textures and 
 organs.^ " It appears to me that in the examination of the 
 diseased brain this natural classification must be kept in view. 
 The student should be taught to appreciate the various general 
 anomalies of organization as they present themselves in the 
 brain ; and the methods to be adopted in estimating the 
 degree, extent, and significance of such physical deviations. 
 It is, of course, not our function to detail the various diseases 
 of texture to which the brain is subject, but rather to place 
 the student in possession of those indications of healthy and 
 diseased tissues which are presented by alterations in the 
 physical properties of grey and white matter. The elements 
 of a physical diagnosis, so to speak, are placed at his disposal, 
 and hints thrown out for his guidance, where it is thought 
 a wrong construction might be attached to the physical 
 signs. 
 
 It will be found convenient, however, to illustrate the more 
 profound anomalies in consistence, colour, specific weight, and 
 other physical qualities by reference to some of the i^pecial 
 diseases of texture to which the nervous centres are liable, and 
 
 ' "Pathological Anatomy," Sydenham Soc. vol. i.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 27 
 
 which may serve as typical eases wherein the student may 
 acquire a practical acquaintance mth the methods of pliysical 
 research. 
 
 The fundamental physical properties of the nervous tissues 
 with which it is necessary we should acquaint ourselves are 
 briefly as follows : — Consistence, colour, volume, and weight, 
 both absolute and specific. Each in turn will now claim our 
 close attention. 
 
 § CONSISTENCE. 
 
 The firmness, solidity, or consistence of a textm^e depends 
 upon the cohesive force exerted by the individual elements 
 of its mass, and to which is due, on the one hand, the varying 
 degrees of toughness, hardness, and resistance, or, on the other 
 hand, of softening and friability and liquefaction, to which 
 they are liable. The consistence of a compound tissue so 
 complex as the brain is necessarily subject to very great 
 variations, since its individual constituents vary amongst 
 themselves greatly in their physical properties. An organ 
 composed of nerve-tubuli, nerve-cells, of a connective frame- 
 work, and an elaborate system of arteries and veins, the whole 
 pervaded by nutrient fluid, must be subjected to great modi- 
 fications in consistence due to alterations in the relative pro- 
 portions of one or other of the constituents. Hence it is 
 that we get such variety in the structural firmness of brain- 
 tissue, not only in different animals and in the brain of man, 
 but in different regions of the same brain. It is this textiu^al 
 difference betwixt grey and white matter which explains 
 their varying degrees of consistence, the same explana- 
 tion pertains to the firmness of the occipital as contrasted 
 with the frontal lobe, and of the central grey ganglia as con- 
 trasted ^\ith the grey envelope or cortex of the cerebrum. 
 The grey cortex, consisting of a vast assemblage of nerve- 
 cells and their protoplasmic extensions, imbedded in a most 
 delicate web of connective tissue, with a complicated vascular 
 apparatus, has a far lower degree of consistence than the
 
 28 COARSE EXAMINATION OF THE BRAIN. 
 
 white matter which owes its solidity to large meduUated 
 nerve-fibres and an abundant and coarser connective matrix. 
 
 A moment's consideration will suffice to indicate that the 
 forces which in disease modify textural cohesion must come 
 from without or from within the structural elements ; in other 
 words, the tissue elements may be forced asunder by fluids 
 pervading the texture and by the intrusion of adventitious 
 bodies, or by nutritive changes in the elements themselves, 
 whereby a quantitative or qualitative transformation may be 
 induced. 
 
 Conditions modifying Normal Consistence. — 1. The 
 forcible infiltration of nervous texture by serous fluid, by 
 plastic exudates, or by blood, will in the first place tend to 
 destroy all textural cohesion, and consequently produce reduc- 
 tions in consistence ; whilst further changes in the effused 
 blastemata due to organization will result in increased firm- 
 ness or indiu-ation. 
 
 2. Chemical changes in the constitution of the individual 
 elements, according to their nature, may tend to produce 
 increase or reduction of consistence, e.g., fatty, amyloid, and 
 calcareous degenerations, the nutritive anomalies due to 
 inflammation, decomposition of the stnictural elements due 
 to putrefactive changes. 
 
 3. Apart from the above qualitative anomalies of nutrition, 
 we must not overlook the quantitative element which some- 
 times exists alone or in combination with the former. 
 
 Such are the forms of hypertrophy and atrophy due to an 
 increase in size and number of constituent elements on the one 
 side, and on the other, in the decrease in size, wasting, and 
 diminution in the number of the tissue elements. 
 
 The student must guard against the fallacy of regarding 
 density and consistence of a tissue as in any way mutually 
 convertible terms, for although in a large number of cases 
 increased density may co-exist with increased consistence of 
 the brain (sclerosis, hypertrophy, etc.), yet conditions occur 
 where with increase of density there is really a diminution
 
 PHYSICAI, PROPEKTIES OF GREY AND AVIIITE MATTER. 29 
 
 in consistence. Thus, in inflammatory conditions of the 
 brain-tissue where plastic exudates have forcibly reduced the 
 cohesion of the mass, the specific \iceiglit of the part is notably 
 increased. Hence the specific gravity of cerebral tissue will 
 afford us no exact and reliable guide as to degrees of con- 
 sistence ; and, in fact, we have no more exact gauge of 
 consistence of texture than the rough-and-ready methods 
 afforded by the sense of sight and touch. 
 
 Estimation of Textural Cohesion. — 1. By the eye we 
 note deviations from the natural compactness of an organ, or 
 the maintenance of its normal contour. Contrast the brain 
 of a senile dement or of a general paralytic with the compact 
 firm brain of epilepsy ; or the same organ in warm weather 
 and in a state of incipient decomposition with the recent brain 
 removed from the skull in cold frosty weather. 
 
 2. By the sense of touch note the relative resistance to 
 pressure and the compressible and lacerable character of the 
 tissues. Especially note this with respect to the central com- 
 missural tracts, basal ganglia, fornix, and septum lucidum. 
 
 3. By its resistance to a graduated force, such as the rough 
 gauge afforded by a stream of water falling from a variable 
 height (applicable only to cases of much reduced consistence). 
 Any case of white or inflammatory softening may thus be 
 tested. 
 
 4. By its resistance to section (applicable to the slighter 
 degrees of reduction and all degrees of increased consistence). 
 Contrast the resistance to section presented by the medulla, 
 pons, cerebellum, cerebral hemispheres, and ganglia at base. 
 
 Observe that we gain by these means not only a satisfac- 
 tory gauge of consistence, but that the methods vary in their 
 relative value in different cases. We should take every 
 opportimity of rendering oiu-selves perfectly familiar with 
 the general consistence of healthy brain prior to post-moi-tem 
 change. Let us remove a normal brain for careful study, 
 and note the following points : —
 
 30 COAKSE EXAMINATION OF THE BRAIN. 
 
 The Normal Brain. — Observe that upon removal from 
 the cranial cavity it preserves its normal contour, although it 
 has lost its natural support — the cranial bones. It is plump, 
 rounded, and compact, giving a general impression of firmness 
 and solidity, ere we gauge its consistence further by handling. 
 The hemispheres are closely approximated by means of the 
 strong commissural band — the corpus callosmn, showing no 
 tendency to fall apart from rupture of the commissui-e, such 
 as is so frequently seen in the degenerated and diseased brain. 
 Upon separating the cerebral hemispheres with the hand the 
 corpus callosum appears intact, and offers fair resistance to 
 the blade when dividing the hemispheres along this course. 
 The individual lobes maintain their characteristic forms, 
 their salient margins, and relative positions ; each con- 
 volution remains firm, plump, and in close contact with 
 its neighboui% whilst the arachnoid investment gives a 
 uniform, smooth, glossy aspect to the consolidated organ 
 beneath. 
 
 A section across the centrum ovale reveals a similar con- 
 dition — observe the general solidity of the parts ; how per- 
 fectly relative positions are maintained ; the absence of any 
 gaping of the sulci ; observe also that the white substance 
 cuts with a clean section, and shows no tendency to cling to 
 the blade. Next open up the lateral ventricles, and observe 
 the rounded firm aspect of the intraventricular portion of 
 the corpus striatum and thalamus. Examine the fornix and 
 septum lucidum — parts especially prone to softening in certain 
 affections of the brain. Pay special attention to the relative 
 consistence and size of the corpora quadi'igemina, the cerebral 
 peduncles, the pons and medulla. Now we must be prepared 
 to meet with all varieties of consistence betwixt the above- 
 described normal firmness of health and extreme alterations 
 produced as the result of disease. The consistence, as we 
 shall illustrate further on, may be so far reduced that the 
 cerebral substance may be perfectly diffluent, and may be 
 poured away like thin cream ; or, on the other hand, it may 
 possess the firmness, aspect, and character of the hard-boiled
 
 PHYSICAL PROPERTIES OF GREY AXD WHITE MATTER. 31 
 
 white of egg ; or even cause the knife to creak in cutting 
 through patches of almost fibro-cartilaginous induration. 
 
 Reductions in Consistence. — With the object of ren- 
 dering ourselves familiar with reductions in consistence, 
 let us consider briefly the appearance and significance of those 
 abnormal conditions of cerebral tissue which lead to softening, 
 dwelling only upon those which are most likely to present 
 themselves frequently to om- examination. The conditions 
 best illustrative of reduced consistence are the following : — 
 
 Putrefactive changes. 
 
 Softening as the result of disease. 
 
 a. White softening. 
 
 b. Yellow or gelatinous softening. 
 
 c. Red or inflammatory softening. 
 Simple oedematous conditions. 
 
 1. Putrefactive Changes. — ^Now these changes in the 
 brain occur sooner or later after death, according to the tem- 
 peratm-e andhiunidityof the surrounding atmosphere, modified, 
 of course, by the morbid conditions of its texture and con- 
 tained fluid. It is on this account that the report of an 
 examination of the brain should invariably be accompanied 
 by a statement of the number of Jwurs offer death at which 
 the examination was made, the average temperature of the 
 post-mortem- room, and the condition of the atmosphere ns to 
 humidity. Fremy, in an elaborate research in 1841 ("Ann. 
 Chim," 2, 463), arrived at the conclusion that the ordinary 
 form of softening of the brain was analogous in its production 
 to the putrefactive process occurring post-mortem ; an opinion 
 which has not been supported by later researches into the 
 chemistry of the brain. We shoidd learn to discriminate 
 between the softening due to this cause, and that due to 
 morbid alteration of texture. We are guided here by observ- 
 ing that the softening is general throughout the encephalon, 
 and attended by much blood-staining from diapedesis, by the 
 evolution of offensive gas, and the presence of the latter
 
 32 COARSE EXAMINATION OF THE BRAIN. 
 
 within the blood-vessels and beneath the membranes. We 
 must also take into account the absence of any morbid con- 
 dition tending to produce softening, and the conditions, 
 atmospheric and otherwise, to which the brain has been exposed 
 since death. It is essential, also, to keep in mind the fact 
 that various diseases predispose to early putrefactive changes, 
 whilst the mode of death may expedite or defer the same. 
 
 To retard putrefactive changes when the brain cannot be 
 immediately examined, it shoidd be placed in a cold room 
 with a damp cloth thrown over the hemisphere to prevent 
 desiccation of the outer cortical layers ; or better still, it may 
 be enclosed within an ice safe. The student can readily 
 extemporize for his own use such a safe, by placing the brain 
 in a jar or box which fits into a larger box, leaving a space of 
 an inch and a half around between the outer and inner box, 
 into which ice is packed. The outer vessels must be thickly and 
 completely enclosed in felt. Such a contrivance he will find 
 of great service in the summer months, when it is difficult to 
 keep anatomical subjects fresh for many hours together. 
 Portions of brain reserved for microscopic examination after 
 hardening should be transferred immediately to methylated 
 spirits or Mliller's fluid, or better still to methylated 
 spirits colom-ed of a dark sherry tint by tincture of iodine. 
 For the fresh methods of examination, we must trust to the 
 ice safe for the preservation of om- material, should any delay 
 occur, preservative fluids being scarcely admissible. As 
 regards the latter, however, the strong solution of acetate 
 of ammonium recommended by Sankey ^ is perhaps the best 
 which can be used (sp. gr. r040). 
 
 2. Indications of Softening. — A general reduction in 
 the consistence of the brain will usuoUy reveal itself at first 
 sight by a mere superficial glance. The whole brain assmnes 
 an unusually flattened squat appearance, and the hemispheres 
 diverge. The student will find the former due to extension 
 
 1 " New Process for Examining Brain Structure," West Riding Asylum 
 Reports, vol. v. p. 192.
 
 PHYSK AI. PROPERTIES OF OREY AND WHITE MATTER. 33 
 
 of softeuiDg to the central portions of the hemispheres which 
 support in the normal state the convolutionary sm*face folded 
 over them, whilst he observes the commissural band connect- 
 ing the hemispheres (corpus callosiun) tends to split asunder 
 in a longitudinal direction — i.e., across the course of the great 
 bulk of its softened fibres. Proceeding to handle the brain, 
 he finds the convolutions flabby to the touch and presenting 
 less resistance to pressm^e — the whole brain is less able to 
 resist the ordinary force of gravity, and is therefore strongly 
 contrasted with the plump, erect, and compact aspect of the 
 healthy organ. Let the student examine the brain of an 
 advanced general paralytic, and he will find this condition 
 well represented. Cut across the hemisphere of such a brain 
 so as to expose the centrum ovale, and it will be observed that 
 the brain-tissue clings to the blade with unusual tenacity 
 unless the latter be kept constantly wet by water or spirit. 
 As a result, the cerebral tissues, both grey and white, are 
 lacerated and tear away in slireds, leaving an unmistakable 
 softened, rottenecl aspect of the surface of the section. This 
 tearing away of brain-tissue is apt to give one a false idea of 
 the couiparatire coarseness of texfure ; thus, in the brain of a 
 general paralytic the adherent, thickened membrane and 
 softened cortex cannot be cut without leaving a coarse 
 irregular sm'face, unless the precaution be taken of using a 
 very sharp blade, and keeping its siu'face constantly wet. 
 Let us now examine more carefully the special form of soften- 
 ing kno^vn as white softening. 
 
 3. White Softening of the Brain. — AVe ma}^ meet 
 with this condition as one generally diffused through a hemi- 
 sphere or in patches limited to a convolution, the area of 
 softening being often no larger than a pea, although more 
 extensive tracts are usually involved. 
 
 In the fu'st place, suppose we have before us a brain in 
 which the greater part has thus sirffered. The affected 
 hemisphere presents to the touch a soft, boggy feel, sometimes 
 communicating an almost tremulous, fluctuating sensation to 
 
 D
 
 34 f'OARSE EXAMINATION OF THE BRAIN. 
 
 the fingers if the disintegration be extreme. The brain will 
 be with difficulty removed, the disintegrated tissue tending 
 to burst through the softened walls which confine it, and 
 more especially is this the case in the neighbourhood of the 
 anterior perforated space and commencement of the Syhian 
 fissm-e. All unnecessary manipulation of such a brain should 
 be avoided, as it is attended with danger to the textural 
 continuity of internal parts, which should also be examined 
 at as early a stage as possible. Observe the lateral divergence 
 of the hemispheres and their flattened aspect above. By 
 gently drawing the hemispheres apart and introducing a 
 blade into the longitudinal fissiu-e, a section may be made 
 outwards across the affected hemisphere, and thus removing 
 the vault we find the centrum semi-ovale occupied by a mass 
 of broken-do"v\Ti medulla — all normal cohesion being destroyed 
 by the presence of a large quantity of interstitial serous 
 effusion. The disintegrated substance will probably have 
 the appearance of soft watery or creamy pap, readily raised 
 upon the blade, or it may be absolutely diffluent, flowing 
 away as soon as the resistance ofPered by the confining grey 
 cortex is overcome. It may, however, retain a certain amount 
 of cohesion, yet break up readily and wash away on placing 
 it beneath a stream of water. The ganglia at the base may 
 be implicated, and the septum pellucidum, grey commissure, 
 fornix, and corpus callosum will generally be found softened 
 or even broken down, the ventricle containing more or less 
 serous fluid. Now such a brain as we have just been con- 
 sidering will be met with in acute hydrocephalus, in tlii-om- 
 bosis, or in embolic plugging of the main cerebral arteries. 
 With such a case before him the student should pay attention 
 to the following points : — 
 
 a. Degree of softening — 
 
 Does it resist a stream of water ? 
 
 Does it render a stream of water milky or break 
 
 down readily under it ? 
 Is it from the first diffluent ? 
 
 h. Extent of area involved.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 35 
 
 c. Q^dematous condition of the parts involved. 
 
 d. Turbidity or clearness and colour of effused fluid in the 
 ventricles. 
 
 In noting the degree of sofleniiuj learn to appreciate how 
 very short a period is requisite, after arrest of blood-supply, 
 for the production of extensive nutritive changes. 
 
 With what object do w^e endeavour accurately to map out 
 the extmt of the destroying lesion ? Oui' object is to detect 
 that portion of the vascular apparatus involved if the soften- 
 ing be due, as it most frequently is, to plugging of a large 
 branch. This, the more frequent source of extensive white 
 softening, requires, therefore, for its full comprehension, an 
 acquaintance with the vascular areas of the hrain. 
 
 On noting the appearance of the serous ep)ision in the 
 ventricles, so often accompanying white softening, the student 
 will be guided towards concluding as to the presence or not 
 of inflammatory action in the meninges or in the substance of 
 the brain itself. Thus, if the fluid be more or less turbid and 
 discolom^ed (as tlie result of a plastic exudate and macerated 
 cerebral substance), we may reasonably suspect an inflam- 
 matory condition, and expect to find, upon microscopic 
 examination, exudation corpuscles, compound cells of Gluge, 
 and other products of inflammation. Such are the conditions 
 found in acute hj'drocephalus, distinguishing it from a purely 
 non-inflammatory form of hydrocephalus, which occurs where 
 the fluid, though perhaps slightly tm'bicl from broken-down 
 cerebral tissue and shreds from the macerated lining mem- 
 brane of the ventricles, presents no inflammatory material 
 amongst the debris. 
 
 4. Limited Foci of Softening. — Acquaintance with 
 the peculiar arrangement of the cerebral blood-vessels soon 
 leads the student to infer that very minute tracts of softening- 
 may result as the effect of thrombosis or embolism, the area 
 involved being dependent upon the size of the clot and the 
 site of its arrest or formation. It is necessary that the 
 mechanism of white softening of cerebral tissue, as a result 
 
 n 2
 
 36 
 
 COARSE EXAMINATION OF THE BRAIN. 
 
 of thrombosis or embolism, be thoroughly imderstood. The 
 process may be best elucidated by the diagram below. 
 
 a a 
 
 Va 
 
 Fig. 1. — Diagram illustrative of the Effects of Embolic Plugging 
 
 (after Rindfleisch) . 
 an. Portion deprived of its blood-supply Ijy the embolus. A, Artery. V. Vein filled 
 with blood-clot. The airows indicate the collateral channels -which lead to a hyperfemic 
 zone around the occluded vessels. 
 
 Beyond the obstructed artery is the wedge-shaped area of 
 its distribution, now anfemic and consequently deprived of 
 its functional power. Below the embolus are seen swollen 
 l)ranches, which tend to establish a collateral circulation. If 
 this fails, we get as a result engorgement of the latter vessels, 
 and a congestive vascular zone surroimding the wedge-shaped 
 area. The tissue here becomes swollen and oedematous, and 
 minute haemorrhages are apt to occur, whilst the whole 
 central and peripheral texture becomes broken up by the 
 effusion, and a true necrosis occurs of the tissue forming the 
 area of distribution of the nutrient branch which has been 
 plugged. 
 
 All inflammatory foci have, as a result, the production of a 
 similar congestion and aidema of the surrounding texture, 
 accompanied by white softening ; and as new growths or 
 tumovu-s are frequently the site of such inflammatory states, 
 we may find them imbedded in a cavity containing broken- 
 do\\Ti tissue. 
 
 In addition, therefore, to the appearances which we have to 
 look for in white softening of the brain, let us also note — 
 
 Any obstruction to the vascular supply by thrombi, emboli.
 
 PHYSICAL PROPERTIES OF GREY AND AVHITE MATTER. 37 
 
 or adventitious products pressing upon tlie vessels from 
 without.^ 
 
 The establishment of a collateral circulation. 
 
 The presence of inflammatory foci, to which the white 
 softening is secondary. 
 
 5. Yellow Softening. — In the course of pathological 
 studies we frequently meet with appearances which, whilst 
 significant of cerebral softening, differ much from that just 
 described. We find frequently in the white substances of 
 the hemispheres, less frequently in the cerebellum, and 
 rarely on the convolutionary siu'face of the cerebrum, a focus 
 of softened tissue, varying in size, but scarcely ever larger 
 than a hen's egg, and characterized by its bright straw-yellow 
 coloixr and soft gelatinous consistence. Pressure causes a 
 yellowish fluid to exude, and when cut across it is found to 
 be somewhat sharply defined from the pale swollen and 
 ojdematous tissue around. We recognize in these softened 
 areas the lesion termed " yellow softening of the brain," 
 
 Fmiher examination reveals the fact that these spots may 
 be primary, or, on the other hand, secondarily induced around 
 adventitious products, such as tubercle, cancer, cysts, haemor- 
 rhages, or around a patch of inflamed tissue. If secondary 
 to adventitious growths, there is, as Rokitansky points out, 
 an intermediate zone of red softening betwixt the growth and 
 the yellow softened exterior. 
 
 It is important that these patches should not mislead the 
 student. He must from the outset regard them as identical 
 in natm-e ^vith the first form of softening described, the 
 difference in colour being due, according to some, to altered 
 blood-pigment, but according to Rokitansky, to a peculiar 
 chemico-pathological process. 
 
 The following facts are to be noted : — 
 
 a. The fluid is usually intensely acid. 
 
 h. There is little or no vascularity smTOunding the patch. 
 
 c. Every degree of tint may be foimd, from white 
 
 ' Plastic exudates, tubercle, .sypliilitic gummata.
 
 38 COARSE EXAMINATION OF THE BR AIM. 
 
 softening up to tlie bright yellow of typical yellow 
 
 softening. 
 d. Colour differs from the rusty or ochre-yellow tint 
 
 seen in old apoplectic cavities, etc. 
 c. Microscopic examination fails to reveal inflammatory 
 
 products. 
 
 6. Red or Inflammatory Softening. — Profound altera- 
 tions in consistence may thus attend inflammation of the 
 nervous structures, and we find little difficulty in recognizing 
 foci of inflammatory softening. "We occasionally meet with 
 portions of acutely inflamed tissue in the medidlary strands 
 of the cerebrum, varying in size from a hazel-niit to that of 
 an orange, or still larger ; yet by far the more frequent site 
 of such inflammatory foci will bo the grey cortex of the cere- 
 brum and the basal ganglia. 
 
 Examine a brain which presents a focus of inflammatory 
 softening in the medulla of one of its hemispheres. Note the 
 following facts : — The softenitig of texture is accompanied by 
 modifications of colour and general moisture. Thus the increase 
 in vascularity gives the affected part a streaky red aspect, 
 often profusely besprinkled by puncta vasculosa ; the oedema- 
 tous infiltration of texture is recognized, in its swollen and 
 ^noist aspect. Where the engorgement has reached a high 
 degree, note the numerous minute extravasations of blood, the 
 streaked or punctated capillary haemorrhages. 
 
 Now all the above characters may be developed in the 
 course of extreme congestion. What impresses upon the 
 affected part the stamp of inflammatory action is the presence 
 of exudates, which modify the above-described appearances 
 in two directions : — 
 
 a. The dark red becomes of a paler and more uniform 
 
 hue, whilst exudations of lymph still further modify 
 the aspect. 
 
 b. Alterations in consistence occur; rapid softening or 
 
 solutions of textural continuity varying with the 
 plasticity of the exudates.
 
 niYSRAL PROPERTIES OF GREY AND WHITE MATTER. 39 
 
 Observe, therefore, that the essential features of red inflam- 
 matory softening are profound alterations of consistence, 
 associated with the pouring out of inflammatory exudations. 
 
 In advanced stages of red inflammatory softening, the 
 student will, therefore, find the tissues broken down into a red- 
 dish pulp, or having a brownish or rusty aspect, washing away 
 freely when held beneath a stream of water. He will also 
 note the results of swelling from congestion and oedema, viz., 
 the flattening of the convolutions of the hemispheres from 
 pressm^e against the internal table of the skull, and a well- 
 marked prominence of the surface of a section of the inflamed 
 and oedematous textures. 
 
 Examine a patch of inflammatory softening in the coi-tex, 
 and note : — 
 
 Inflammatory foci situated in the cortex will implicate by 
 contiguity the superimjjosed membranes. Observe in these 
 cases that the grey matter is more deeply coloured, and is 
 still more swollen, moist, and softened than when the white 
 matter is involved. The far greater vascularity and the 
 naturally looser texture of the grey matter account for this 
 difference. Next direct attention to the state of the mem- 
 branes. The pia mater cannot be removed without peeling 
 off with it a layer of the softened cortex, whilst the meshes of 
 the membrane are found inflltrated with inflammatory pro- 
 ducts, and are both thickened and oedematous. As regards 
 these apparent adhesions of pia mater, observe that the brain 
 substance may tear away with the removal of the pia mater 
 from two causes : — 
 
 1st. Mere unnatural softening and loss of textural cohesion 
 of the grey matter, without any true adhesion to the mem- 
 branes, as in early inflammatory and congestive stages, etc. 
 
 2nd. Actual adhesion, inflammatory in origin, may be the 
 cause of this tearing of the cortex. 
 
 How are we to distinguish the laeerable cortex in the 
 former case from the genuine inflammatory adhesions of the 
 membranes ? Note, in the former case, the surface left by the 
 in-egular sln-eds torn off is soft, pappy, and uniformly smooth
 
 40. COARSE EXAMINATION OF THE BRAIN. 
 
 or liomogeneous ; in the latter case, tlie surface is studded 
 with numerous perforations — the apertures of perivascular 
 channels from which the blood-vessels have been withdi'awn. 
 These channels will be seen much dilated from the prior 
 engorgement of the blood-vessels, and the surface generally 
 has a peculiar worm-eaten appearance. 
 
 FALLACY TO BE AVOIDED.— We imxst not regard 
 all cases of encephalitis as necessarily attended by injection 
 and discoloration of tissue. The larger number of cases, in 
 fact, show little or no discoloration ; and even where softening 
 has advanced to an extreme degree, the naked eye fails to 
 appreciate in the uniformly dull white pulj^y material its 
 inflammatory origin. 
 
 What criterion have we here for determining the nature of 
 the lesion ? Resource must be had to the microscojie and 
 specific gravity bulbs. 
 
 The niicroscope shows us nuclei, nucleoli, pigment, and 
 compound granule-cells amongst broken-down cerebral tissue 
 infiltrated with leucocytes and effused lymph along the 
 course of the blood-vessels. 
 
 The specific gravity test (p. 63) will indicate an in- 
 variable increase in specific weight where infiammatorij 
 exudation has occurred, no matter whether the altered con- 
 sistence be great or scarcely appreciable. On the other 
 hand, non-inflammatory white softening shows an invariable 
 reduction in specific gravity. 
 
 By the freezing methods it will be possible to obtain fair 
 sections through inflammatory patches of greatly reduced 
 consistence, and much valuable information will be thus 
 obtained ; but in all cases of extreme softening all that can 
 bo hoped for is obtained by raising a little of the creamy 
 pulp upon the scalpel, and transferring it to a slide and 
 using a thin glass cover. Sections through the membranes 
 and cortex, in cases where these are involved, will jirove 
 highly instructive, and should never be neglected. They 
 should be studied in the fresh state, and the student become
 
 PHYSICAL PROPERTIES OF GREY A^^D WHITE MATTER. 41 
 
 thorouglily familiarized with the morbid appearances ere he 
 attempts to mount stained sections of such lesions for perma- 
 nent preservation. Coarse blood-vessels passing through the 
 inflamed patch shoidd be dra-\vn out and examined microscopi- 
 cally, noting abnormal conditions of their coats and sheath. 
 
 7. CEdematous Conditions of the Brain. — It will be 
 seen from the foregoing remarks that this morbid state of 
 the cerebral tissue accompanies all cases of softening of the 
 brain, whether inflammatory or non-inflammatory in origin ; 
 yet it is thought ad\dsable here to consider it independently 
 as a condition, often the only morbid one recognized by the 
 naked eye, in the brain of the chronic insane. As it is chiefly 
 compensatory in its origin, it will be considered together with 
 that compensatory effusion into the ventricles and beneath 
 the membranes of the brain which so frequently accompanies 
 it. If the cerebral tissue becomes much infiltrated with 
 serum, it is liable to break down the textiu-e of the brain. 
 As before stated, this may proceed to a state of white soften- 
 ing, in which the brain-tissue may become quite diffluent, 
 such as we observe in the neighbom'hood of the lateral ven- 
 tricles in acute hydrocephalus and around inflammatory foci. 
 The more frequent condition met with in the brain of the 
 insane is that of a general moist condition of the white 
 matter, which is soft, almost pasty, clings to the blade, and is 
 apt to tear away in shreds of a dirty white hue. Such is the 
 appearance in cases of senile wasting of the brain. The 
 white medullary strands immediately bordering upon the 
 lateral ventricles will usually be found most implicated, being 
 here in closer contact Avith the serum contained in these 
 cavities. The lesser degrees of oedema are recognized by a 
 pecuHar and notable brilliancy of the white substance when 
 cut across, and is one of the most frequent appearances in the 
 brain of the insane. The student must learn to recognize the 
 general moisture, swollen condition, alterations in consistence, 
 and alterations in appearance from a brilliant to a dull, dirty 
 white Jnie, associated with varying degrees of oedema.
 
 43 COARSE EXAMINATION OF THE BRAIN. 
 
 If the freezing microtome be liberally used, he cannot fail 
 to appreciate to the fullest extent the varying degrees of 
 oedema of the cerebral tissue ; and this not only because it 
 proves the most troublesome obstacle to a free manipulation 
 of delicate sections, but from the tendency of cedematous 
 brain to freeze into a hard icy solid, differing much from the 
 consistence of healthy brain when frozen. It is impossible to 
 cut through such frozen brains except by a modified process 
 to be alluded to further on. In the hardening processes, also, 
 these brains undergo, by dehydi"ation, enormous shrinking. 
 
 The serous effusions beneath the arachnoid and into the 
 ventricles, which have been alluded to as often associated 
 with cedematous conditions of the brain, may occur as the 
 result of — 
 
 1. Senile atrophy of the brain (compensatory). 
 
 2. Pressure by morbid products on the vessels, as in — 
 
 Tubercular meningitis. 
 Syphilitic disease of blood-vessels. 
 Tumours. 
 
 Growths, or abscesses of mid-lobe of cerebellum press- 
 ing on venae Graleni. 
 
 3. As a gradual accumidation from anaemia and other 
 existing morbid conditions, e.g.y chronic phthisis. 
 
 Where does the effusion of serum attending oedema of the 
 brain occur? 
 
 1. Into sac of the arachnoid, i.e., betwixt the cerebral 
 layer of the arachnoid and the polished inner surface of the 
 dura mater. On removal of the brain, we note this fact by 
 examining the amount accumulated in the occipital fossae 
 above and below the tentorium. 
 
 2. Beneath the cerebral arachnoid. Observe how the 
 latter is floated up by the subjacent fluid where this mem- 
 brane bridges across the sulci. 
 
 8. In the meshes of the pia mater. Note its swollen 
 gelatinous appearance from infiltration with serum. 
 
 4. Into the ventricles, more or less distending the lateral
 
 PHYSICAL PKOPERTIES OF GKEY AND WHITE MATTER. 43 
 
 ventricles. Stretcliing tense the thin arachnoid which extends 
 between the cerebellum and medulla over fourth ventricle. 
 
 Before concluding the subject of oedematous conditions of 
 brain and compensatory effusions of serum, we would recom- 
 mend the student to acquire infoi'mation upon the following 
 facts in all such cases : — 
 
 1. Condition of ependyma (lining membrane of ventricles). 
 
 a. As to healthy aspect, h. Grranular appearance 
 and feel. c. Macerated aspect. cL Fibro- 
 cartilaginous plates. 
 
 2. Turbidity and coloration of serous fluid. 
 
 3. S^^ecific gravity of serous fluid. 
 
 4. Reaction to litmus paper. 
 
 5. Specific gravity of the brain. 
 
 Augmented Consistence. — All cases of indm\ation of 
 the brain should induce us to examine the morbid change in 
 the texture as regards its degree, its diatrihution, and nature. 
 The cases most likely to present themselves to our notice 
 may be embraced under the following categories : — 
 
 1st, Greneral augmented firmness of the whole brain 
 
 from increase of its connective or neuroglia element. 
 2nd. Limited but extremely indurated patches or 
 
 nodules due to morbid growths, especially the 
 
 carcinomata. 
 3rd. Limited indurations of grey or white matter due 
 
 to transformation of inflammatory products. 
 4th. Sclerosis disseminated or distributed down the 
 
 motor strands. 
 
 The student will observe that the increase in consistence 
 may vary from a scarcely appreciable degree, and due 
 merely to a lessened quantity of water (Rokitansky) up to 
 a condition of leathery callous consistence. 
 
 A few words upon the varieties of sclerosis met with in 
 cerebro-spinal centres independent of that general increased
 
 44 COARSE EXAMINATION OF THE BRAIN. 
 
 firmness from increase of neuroglia observed in the brain 
 of many epileptics. 
 
 1. Superficial Scleroses. — We should also look for 
 instances of partial sclerosis of the grey cortex occasionally to 
 be seen in epileptics and imbeciles, and characterized by a 
 peculiar shallow puckering of the surface of the gyri, 
 which are somewhat indm\ated, and have a cauliflower 
 appearance. 
 
 2. Hypertrophy of Neuroglia. — Again we may meet 
 with instances of hypertrophy of the brain, as it is termed, 
 which has been found due to extreme increase of the 
 neuroglia around the medullary strands of the hemispheres. 
 Such a case would present us with increase in consistence, 
 elasticity, and volume. In all cases of general increased 
 consistence it is imperative that the greatest attention 
 should be paid to examination of the brain under the 
 following heads : — 
 
 a. Volumetric measurement. 
 
 h. Absolute weight of brain and its divisions. 
 
 €. Specific gravity of grey and white matter. 
 
 3. Cicatricial Formations. — The indui'ations resulting 
 from inflammatory action will frequently attract attention. 
 Such patches of callous tissue may surround foci of softening 
 of the cortex due to plugging, or the site of old hsemor- 
 rhages. Cyst-like cavities, with hard fibroid walls, may thus 
 be formed deep in the substance of the hemispheres. 
 Sections through such structures should be made for micro- 
 scopic examination, as they illustrate well the various stages 
 of transformation of inflammatory products into callous 
 cicatricial tissue. 
 
 4. Disseminated Sclerosis. — If, in slicing a brain, 
 greyish nodules are found scattered irregularly through the 
 white substance resembling the cineritious substance in colour.
 
 THYSICAL PROPERTIES OF GREY AXl) AVHITE MATTER. 45 
 
 but becoming of a rosy hue on exposure, and exuding a 
 colourless fluid, the student has probably to deal with a 
 case of disseminated sclerosis. Note in such a case the 
 increased consistence of the sclerosed patches, their yascu- 
 larity, irregular distribution through the medullary substance, 
 and the comparative immunity from this lesion enjoyed by 
 the cortex. Sections should be preserved for microscopic 
 examination. The extent of implication of the ganglia, 
 pons, medulla, and spinal cord should also be examined. 
 
 5. Descending Sclerosis. — If again a greyish indiu'ation 
 should be met with involving the white strands running 
 down from the motor region of the brain to the internal 
 capsule, or from the latter down into the crm-a, and on 
 into the lateral columns of the cord, we are dealing with 
 a secondary descending sclerosis (fasciculated sclerosis of 
 Charcot) . 
 
 § COLOUR. 
 
 The alternating ligliter and darker shadings of the cortical 
 layers vary much in the depth of their liue, rendering the 
 distinctness or differentiation of the individual layers more 
 or less apparent. The variations in hue from the normal 
 standard may be distributed in mottled patches or laminated 
 zones, or uniform ti/ spread thronrjhout the wJioJe cortical envelope. 
 We should consider the conditions usually associated mth 
 alterations in the coloiu- of the cortical layers, and first and 
 most frequent amongst such conditions must be placed altera- 
 tions in the hlood-supphj. The next most frequent condition 
 met with is disintegration of nervous tissiie : next to these in 
 their relative order of occurrence we find morbid deposits ; 
 and lastly, new grouihs in the cortex. 
 
 Let us first consider the morbid conditions associated -witli 
 unusual pallor.
 
 46 COARSE EXAMINATION OF THE BRAIN. 
 
 1. Partial Mottling and Laminated Pallor. — A very 
 slight acquaintance with the morbid appearances found in the 
 brain of the insane will suffice to attract attention to the 
 frequent presence of irregular, oval, or circular patches of 
 pallor, very limited in extent, and of a yellowish grey hue. 
 These patches may extend throughout the whole depth of 
 the grey matter or be limited to the superficial layers alone. 
 Now this condition appears almost invaiiably attributable to 
 antemie zones, in which special systems of arterioles are 
 involved. It may, however, be due to granular disintegra- 
 tion of nerve-cells and fatty accumulations in the peri- 
 vascular sheaths. 
 
 A similar patchy pallor will also be frequently met with in 
 the central ganglia, but here it will usually be found asso- 
 ciated with fatty degeneration of the nuclei in the walls of 
 the blood-vessels. 
 
 A portion of a convolution exhibiting this appearance 
 should be placed on the freezing microtome, with the blotchy 
 aspect uppermost. On freezing it will be observed that the 
 whole depth of cortex assumes a uniform pallor throughout, 
 and sections cut o& and floated in water /ail to exhibit t/ie 
 pale patches if the latter be due to ana3mic conditions simply ; 
 on the other hand, if due to structural disintegration, the 
 appearance vanishes during the frozen state, only to return 
 rapidly when the section is cut. The process of hardening 
 by chrome salts dissipates all patches of pallor due to anaemic 
 zones, for by both processes the blood-vessels are more or less 
 emptied of their contents, and a uniform tint residts. 
 
 Apart from the presence of fatty or granular debris, the 
 general pallor of the cortex may be due to great paucity of 
 nerve-cells, whilst the blood-supply being diminished the 
 resulting pallor will be associated with a poor differentiation 
 of layers. This apparent fusion of laj'ers and loss of the 
 sharp boundary lines seen in healthy brain is therefore a fact 
 of some significance ; it almost invariably points to general 
 malnutrition and disintegration of nerve-cells. Pallor, how- 
 ever, is not necessarily associated with disintegration of
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 47 
 
 nerve-cells, for tlie latter condition is frequently attended by 
 vascular injection. 
 
 2. General Diffused Pallor. — I cannot do tetter here 
 than describe the appearances fonnd in the case of a patient 
 exhausted by phthisis, in which the typical palJor and mal- 
 nutrition of the nervous centres is always so prominent a 
 feature. Such cases are unfortunately so frequent in oiu' 
 asylums that the student will have little difficrdty in pro- 
 curing such a brain for study. 
 
 Upon removal of the extremely thin, blanched skull cap, 
 and reflecting the dm-a mater, the subjacent membranes were 
 seen separated "widely from the surface of the brain, buoyed 
 up by fluid which in part was clear and translucent, in part 
 slightly turbid from films and flakes of lymph. The small 
 arterial branches were not visible, the larger primary branches 
 being alone apparent at the vertex. The venous sj^stem was 
 represented by engorged trunks, their minutest radicles being 
 well seen. The arachnoid where it crossed the sulci was more 
 or less cloudy, the milky opalescence being due to interstitial 
 change and lymph deposits. In the postero-parietal regions, 
 where the membranes were floated by the distending fluid off 
 from the siu-face of the gyri, the smaller veins could be traced 
 meandering through the fluid, and dipping down to enter the 
 cortex. Tracing the course taken by these vessels, the smallest 
 radicles were seen emerging from the cortex, uniting here 
 and there with larger twigs, which ramify through the serous 
 fluid and cross obliquely or directly over the summit of the 
 convolution, to terminate in the primary veins which are 
 formed by their convergence. These latter veins run up the 
 sulci on either side of the convolution, superficially exposed 
 and directed towards the median line or longitudinal fissm'e, 
 where they terminate in the longitudinal sinus. To render 
 their distribution more apparent, we have only to compress 
 the orifice of one of the larger superficial veins near tlie 
 median line, whilst Avith the handle of the scalpel placed on a 
 distal part of the same vein, we include numerous converging
 
 48 COARSE EXAMINATION OF THE BRAIN. 
 
 radicles betwixt the occluded points. Upon gradually draw- 
 ing the handle of the scalpel along the course of the vein 
 upwards, the blood is projected into these radicles, and innu- 
 merable branchlets before invisible strike across the field over 
 the convolution, or meander in tortuous arborescent forms 
 through the subjacent fluid. The student will learn from the 
 above examination the following relevant and useful facts : — 
 1st. The larger arteries being at the base, the smaller 
 branches are alone seen near the vertex, and 
 these usually deeply seated in the sulci. 
 2nd. All the larger blood-vessels usually exposed at the 
 
 vertex are veins. 
 3rd. The direction taken by the minute venous radicles 
 
 will be accurately learnt. 
 4th. A high degree of vascularitj^ simulating passive con- 
 gestion may be induced artificiaUy with ease by 
 slight force. 
 
 It is necessary to observe here that great caution should be 
 taken by the student against hastily arriving at any conclusion 
 as to the presence of congestion of the brain from a super- 
 ficial view of the veins at the vertex — upon this point the 
 tyro constantly errs. " We must make it a rule to consider 
 hypercemia of the cerebral membranes as proved only in those 
 cases where the finest vessels are also injected, and where the 
 overloading of the cerebral vessels is not at all in proportion 
 to the amount of blood in other organs." ^ So says Niemeyer, 
 reiterating a caution constantly given by pathologists, and as 
 frequently neglected. Proceeding with our study of the 
 anaemic brain, the membranes were next stripped and two 
 facts noted ; they were slightlj^ thicker and more tough than 
 in health, and ^Qj Avere removed with extreme ease. The 
 student must be familiar with the difiicult}^ experienced in 
 stripping the membranes from healthy brain, being recom- 
 mended often to remove them under water. This difficulty 
 is not alone due to the tenuity of the pia mater and arach- 
 
 1 Niemeyer' s " Practical Medicine," translated by Drs. Humphrey and 
 Hackley, vol. ii. p. loo.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 49 
 
 noid, but also to the fact that the former membrane is attached 
 to the siu-face by the prolongations of connective cells recog- 
 nized as Deiter's corpuscles. These are by no means nume- 
 rous in health, yet sufficiently so as to keep the pia mater in 
 firm contact with the cortex. These cells are chiefly found 
 in the neighbourhood of the vessels, where they enter the 
 cortex from the pia mater, and both together they form an 
 impediment to easy stripping. In cases of serous subarach- 
 noid effusion, such as the one under consideration, the mem- 
 branes have been floated up from the receding surface of the 
 atrophic cortex, and the connections with Deiter's corpuscles 
 have therefore been forced asunder. After noting fully the 
 consistence of the brain accordmg to the plan ah-eady given, 
 a section was made exposing the centrum semi-ovale, and the 
 following facts presented themselves : — 
 
 1st. The blanched aspect of the cortex and the absence of 
 any reddish striation of the upper layers, such as is seen when 
 the cortical vessels are fidl of blood. The hue of the cortex 
 was asht/ grey throughout, except in its most vascular zone, 
 where perhaps the slightest warmth of tint was recognizable, 
 but beyond this, nowhere did any blush suggest the presence 
 of its extremely elaborate vascular apparatus. 
 
 2nd. The layers were individually very poorly differen- 
 tiated. 
 
 3rd. The medulla was brilliant white, glistening, slightly 
 reduced in consistence, and showed few or no puncta vas- 
 culosa. 
 
 "We must bear in mind that the vessels of the meninges 
 may be tortuous and tm-gid with blood whilst the minute 
 vascular supply of the cortex is absolutely diminished, and 
 the layers appear blanched and anoemic. To a certain extent 
 this was the case in the brain we have under consideration. 
 How this occurs (passive or active hyperremia of the mem- 
 branes associated with anaemia of the cortex) will be explained 
 in our next section when speaking of hyperoemia of the brain. 
 For the present let us mark well the fact that the vascular 
 condition of the membranes is no index, as a rule, to the state 
 of the cerebral substance.
 
 50 COARSE EXAMINATION OF THE BRAIN. 
 
 The brilliant white glistening aspect of the medulla was 
 due, as will be shown fmiher on, to a slight degree of oedema 
 of the brain-substance. 
 
 Let us now place a small portion of a parietal convolution of 
 thin and anaemic brain upon our freezing microtome, and cut 
 a fine section through the cortex — float it on the glass slide 
 and drain off superfluous fluid. Take a hand lens and 
 examine first by reflected light. 
 
 The cortex is seen as apparently to consist of — 
 
 1st. An outer light translucent zone extending half way 
 
 down. 
 2nd. A. deep opaque white layer extending to the 
 
 medulla, which is still more opaque and white 
 
 in aspect. 
 
 Eaise the slide and examine by transmitted light. We 
 now see — 
 
 1st. The narrow translucent grey of the first or outer 
 
 layer of the cortex. 
 2nd. A broad less translucent grey zone of the second 
 
 and third layers. 
 3rd. A broad stripe of darker grey extending to the 
 medulla, but separated at one-third its depth 
 by a narrow bluish belt. 
 
 We see thus by the naked eye the constitution of the 
 cortex in this region of the brain, except that the narrow 
 second layer cannot be defined from the third layer by 
 unaided vision. Let us tiirn to the cortex prior to section 
 cutting and examine by means of a hand lens imder re- 
 flected light, and the appearances are as follows: — 
 
 1st. A grey belt corresponding to the first layer. 
 2nd. A broad white belt divided midway by a narrow 
 
 grey line. 
 3rd. A grey belt constituting the deepest layer. 
 
 We have, I think, gone sufficiently into the appearances 
 afforded by the ansemie brain for our present pui-pose. The
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 51 
 
 examination of the various layers above recommended will 
 prepare us not only for recognizing the relative positions of 
 layers which have later on to be minutely studied, but will 
 teach us to estimate roughly — 
 
 a. The differentiation of the layers by naked vision. 
 h. The relative depth of individual layers. 
 
 c. The atrophy or normal depth of the cortex. 
 
 d. The presence of morbid products. 
 
 Of the latter I need here only mention those cases of so- 
 called miliary sclerosis in which the nodules can be distinctly 
 seen in sections on examination by reflected ligJtt, dotting the 
 surface over mth minute opalescent spots. Let us now 
 recapitulate shortly the observations to be made when 
 examining by naked vision a cortex of unusual pallor : — 
 
 1st, The extent of pallor throughout the brain. 
 2nd. Its limitation in depth through the cortex. 
 3rd. Its disposition in patchy areas or otherwise. 
 4th. Its association with obscure laminar boundaries. 
 5th, Its association mth pigmentary tints. 
 6th. Its association with altered consistence and oedema. 
 7th. Its reappearance in sections from frozen brain. 
 8th. Examination of sections by transmitted and reflected 
 light. 
 
 Redness. — The depth of tint acquired by the grey layers 
 of the cortex depends not alone on the presence of pigmented 
 nerve-cells, but also on the far greater vascularity of the grey 
 as compared with the white matter, whilst the layers most 
 richly supplied with nerve-elements possess also the more 
 abundant capillary supply. The more vascular the layer is, 
 the deeper and warmer will be its tint. Now the capillaries 
 of the cortex are of remarkably fine calibre, and hence, when 
 the ultimate arterioles are injected, the appearance resulting 
 is that of a uniform rosij hlunh more or less dark, the surface 
 smooth and sicollen. This uniform coloration, if at all extreme, 
 is often attended by slight extravasations of blood, and the 
 
 E 2
 
 52 COARSE EXAMINATION OF THE BRAIN. 
 
 tissue around presents a different staining from blood-pigment. 
 Such are the conditions found in genuine congestion of the. 
 cerebral substance, and the analogous condition is readily 
 recognizable in the soft membranes. The student must make 
 himself thoroughly acquainted with the evidences of a 
 genuine active or passive congestion of the brain, and learn to . 
 distinguish it from actual inflammation, where, as ak-eady 
 pointed out, the consistence as well as colour are profoundly 
 implicated, and the specific gravity also affected. 
 
 1. Congested Zones. — One of the most frequent appear- 
 ances in the cortex of the acute forms of insanity, is a bright 
 arterial zone, which bounds the confines of the white and 
 grey matter of the convolutions, following out accurately the 
 direction of the innermost cortical layer. This congested 
 belt corresponds to the horizontally disposed nexus of 
 blood-vessels into which the larger straight cortical arteries 
 empty themselves after passing through the various cortical 
 layers. Any undue engorgement of the vessels of the pia 
 mater will necessarily affect these larger blood-vessels, and, 
 from their general arrangement, a mechanical element is 
 brought to bear, such that, as I shall endeavour to show 
 fiu-ther, is significant of a safety-valve action for the cortex 
 in cases of vascular engorgement, relieving the cortex some- 
 what by their distension from congestive conditions. It is 
 on this account, I believe, that this linear vascularity is so 
 often apparent without a corresponding blush in the cortical 
 layers, indicative of distension of the minute capillaries. 
 
 2. Limited Patchy Congestion of Cortex. — When, 
 however, the cortex is itself congested, the student will 
 frequently observe irregular bright red patches, suggestive, 
 like the anaemic patches already referred to, of the implication 
 of minute vascular areas, whilst leading down to them are 
 seen the distended straight cortical vessels, giving the upper 
 layers a reddish streaked aspect. The last act of arterial 
 contraction, in ^hich the smaller arterioles have failed to
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 53 
 
 empty themselves into the venous system, may in part explain 
 this appearance, and caution is necessary, lest we hastily 
 assume that this state is the result of morbid activity. The 
 student should, therefore, examine closely the injected part 
 by the microscope, and look for evidence of minute extrava- 
 sations, hsematine crystals, and staining as well as broken- 
 down texture, or other results of inflammatory action and of 
 congestion. This blotchy red aspect of the cortex reappears 
 very frequently in the medulla in similar cases, and is indica- 
 tive of engorgement of the minute capillaries of these regions. 
 
 3. Puncta Vasculosa. — It is customary, in judging of the 
 degree of engorgement of the vessels of the white matter, to 
 be guided by the paucity or abundance of the puncta vascu- 
 losa, caused by section of the engorged channels — in other 
 words, the number of drops of blood oozing from the 
 divided vessels are supposed to form some criterion of the 
 engorged condition of the vascular system here. It has been 
 shown by Niemeyer that this is no safe criterion, as 
 
 1st. The number of puncta vasculosa vary greatly with the 
 fluidity of the blood, which is an important element in their 
 causation. 
 
 2nd. They are often almost entirely absent when we have 
 had indisputable evidence of intense vascular engorgement 
 during life. 
 
 We must, therefore, be on our guard against attributing too 
 much importance to abundant bloody points on section of the 
 medulla, whilst we should never fail to note whether this 
 condition is or is not associated with distension of the minute 
 capillaries as indicated by fine diffuse patchy redness. 
 
 I need not here dwell upon the changes of coloiu' due to 
 inflammatory action, as these have been already disposed of 
 when illustrating anomalies of consistence ; but I must here 
 repeat the important caution that the student be not misled 
 by expecting to find engorgement and redness in all cases of 
 encephalitis. The larger number of such cases present no 
 undue red coloration.
 
 54 COARSE EXAMINATION OF THE BRAIN. 
 
 Results of Intra-cranial Pressure, — Due allowance 
 must be made for conditions of increased intra-cranial {hut 
 extra-vascular) pressure. Wlien the cranial cavity is en- 
 croached upon by a tumour, abscess, hsemorrhage, or serous 
 accumulation, compensation is made by the outflow of the 
 subarachnoid fluid into the spinal meninges. The limit of this 
 compensatory arrangement is soon reached, and then the only 
 available space is that gained at the expense of the general 
 vascular calibre. Encroachments upon the cranial cavity 
 therefore eventually empty the blood-vessels, causing partial 
 or more or less general anaemia prior to compression of the 
 brain-substance itself. It is therefore far from improbable 
 that, as Niemeyer teaches, engorgement of the blood-vessels 
 may reach such a degree, that after the limit of subarachnoid 
 compensation has been reached, effusion of serum occui-s into 
 the perivascidar spaces and brain-tissue, and suiflces to com- 
 press the minuter blood-vessels and capillaries. Hence we 
 may find in such cases an association of marked cerebral 
 anaemia with tortuous and engorged blood-vessels in the 
 meninges. 
 
 Results of Intra-thoracic Pressure. — Venous engorge- 
 ment of the brain is a fi'equent result of obstructed circula- 
 tion through the medium of pleuritic effusions, intra-thoracic 
 growths, fibroid ind oration, and other changes obstructing or 
 obliterating the vascular system of the lungs. Occasionally, 
 although rarely, there is found an extraordinary engorgement 
 and varicosity of the veins of the pia mater — the vessels 
 winding in all directions, and, as Eokitansky states,i even in 
 spirally -twisted coils and intestine-like ciiTiunvolutions. In 
 these cases the brain-substance will be found dark and 
 engorged, full of puncta vasculosa and even miliary apo- 
 plexies. In one very typical case occurring at West Riding 
 Asyliun the brain-surface was actually concealed over exten- 
 sive tracts by a vast development of varices and contorted 
 vessels, and when cut into, the grey and white substance was 
 
 ' " Patliological Anatomy," Sydenham Soc. vol. iv. pp. 372-3.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 55 
 
 not only deeply engorged, but presented very numerous 
 miliary haemorrhages, forming patches varying from a pea to a 
 florin in extent, and in all degrees from the purely punctif orm 
 to the diffuse uniform extravasation. A similar case was ex- 
 hibited some years back by Dr. Coupland at the Pathological 
 Society of London.^ In this case the mechanical hyperaemia 
 was due to acute bronchitis — in the Asylum case the imme- 
 diate cause was the supervention of capillary bronchitis upon 
 fibroid limgs in a patient who gave a history of intemperance. 
 Its association with diink has been recognized by Rokitansky. 
 The occm-rence then of such cases should direct the student's 
 attention to the effects of intra-thoracic pressure upon the 
 venous circulation of the brain. 
 
 § VOLUME. 
 
 Volumetric Methods for the Brain. — The cubic 
 measm^ement or volume of the encephalon can be very readily 
 ascertained, and considering the important information it 
 affords, it is a process too frequently neglected in our post- 
 mortem rooms. The volume of the brain is estimated by its 
 displacement of fluid. 
 
 1. Dr. Hack Tuke has detailed, in the January number 
 of the British and Foreign Medical Review for 1855, the 
 result of examination by this method of sixty-three brains, 
 together with the capacity of the crania.. The vessel used by 
 this observer was one of convenient size and shape, with a 
 capacious spout placed at an acute angle with the sides. 
 Water is poured into this vessel up to the level of the spout. 
 Fluid contained mthin the ventricles and subarachnoid space 
 is allowed first to escape by several long incisions, and then 
 the brain, including the medidla oblongata, is immersed, 
 the displaced water, as it escapes from the spout, being caught 
 and measured, affording an exact criterion of the actual bulk 
 of the brain. The student may, however, prefer the use of a 
 
 ' Reported in the Lancet for January 11, 1879.
 
 56 COARSE EXAMINATION OF THE BRAIN. 
 
 graduated vessel upon which lie can at once read off the dis- 
 placement of fluid, but the exact graduation of large vessels, 
 such as would be required, is open to several fallacies ; and 
 these possible sources of error are, of course, wholly avoided 
 by Dr. Hack Tuke's method. If such a vessel as that used 
 by Dr. Tuke be not at hand, a ready method is the one I 
 have used, as follows : — 
 
 2. Half fill with water an inverted bell-glass of sufficient 
 dimensions, and mark the level of the fluid. Now immerse 
 the brain in the fluid, and note the level of displacement, 
 after which the brain is removed ; and, if the original level 
 is not exactly maintained owing to imbibition by the brain, 
 pour in sufficient fluid to compensate for the loss. Water is 
 now poured in from a graduated measure up to the displace- 
 ment level, the amount required for this pui^pose giving us the 
 volume of the brain. The volume should be estimated in 
 cubic centimeters and cubic inches. 
 
 I employ for section-cutting a vessel which answers well 
 for the volumetric estimate of the brain. It consists simply 
 of a large glass vessel, such as is used for the preservation of 
 brain in museums, but fitted with a stopcock arrangement 
 in the side near the bottom of the vessel. It is filled with 
 sufficient water to cover the brain, the level being marked or 
 indicated by a weighted float. The brain is next immersed, 
 and whilst so immersed, the fluid of displacement is run 
 off by the stopcock, and measm-ed in a graduated vessel. 
 Again, in lieu of a graduated vessel, the student may emj^loy 
 a float, movable along a graduated weighted stem (gradu- 
 ated, of coiu-se, for the vessel used). Such a float should 
 terminate below in a brass button, which rests against the 
 bottom of the vessel, keeping the graduated stem in a 
 vertical position, whilst the float freely moves with the 
 rising or falling level of the fluid along the graduated stem. 
 
 3. When referring to the specific gravity of the brain 
 an apparatus will be described whereby volume as well as 
 weight of brain are readily measured.^ Such an apparatus 
 
 ^ Stevenson's Displacement Apparatus, vide p. 65.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 57 
 
 has the recommendation of being cheap and efficient. 
 Whatever arrangement be adopted we should not rest 
 content with the estimate of the volume of the encephalon 
 alone. Each hemisphere should be separately measured, as 
 also . the cerebellmn, pons, and medulla. It will be found 
 convenient to use smaller and more delicately-graduated 
 vessels for the latter. 
 
 Cranial Capacity. — This should be estimated Avith a 
 ■vdew to a comparison between the actual volume and weight 
 of the brain and the dimensions of the cranial cavity, as 
 well as for comparison with the capacity of average-sized 
 skulls. The relationship between cranial capacity and brain- 
 weight has been sho\\Ti by Dr. Barnard Davis, who has 
 adopted the general rule that a deduction of about fifteen 
 per cent, from the capacity of the cranium gives the 
 ^' capacity " of the brain, whereby its weight may be readily 
 calculated.^ The large bulk of cranio-metric observations 
 having been taken upon the cliied skull, we should, when 
 dealing with the fresh subject, make allowances for slight 
 divergence ; and, in order to approximate the conditions, 
 the dm-a mater should be wholly removed from the skull- 
 cap and the base. When, however, our intention is to 
 estimate the difference in any single case between cranial 
 capacity and brain-volimie, rather than for more general 
 comparative purposes, it will be necessary to open the skull 
 prior to opening the thorax, so as to avoid emptying the 
 venous sinuses, whilst at the same time the diu-a mater must 
 not be stripped away from the skull-cap nor the base be 
 uncovered. 
 
 1. With the object of estimating the amomit of cerebral 
 atrophy, a valuable series of observations were made by 
 Dr. Hack Tuke, and the process he adopted is described as 
 follows : — " The foramina at the base of the brain are 
 
 ^ *' On the Weight of the Brain in the different Races of Man." Thilos. 
 Trans., 1868, pp. 506 and 526.
 
 58 COARSE EXAMINATION OF THE BRAIN, 
 
 carefully plugged witli tenacious clay — that used by statu- 
 aries for modelling answers best ; a small triangular piece 
 of the frontal bone is removed with the saw ; the calvarimn 
 is readjusted to the base, the dm^a mater being left attached. 
 The space left by the attrition of the saw in removing the 
 calvarium is filled with clay ; and a narrow bandage with 
 clay spread upon it is made to surromid the cranium three 
 or four tunes, covering this space. If this manipulation 
 has been carefully done, the cavity of the cranium will now 
 be found as tight as a bottle. Sixty fluid ounces of water 
 having been measured, a sufficient quantity to fill the cranial 
 cavity is now poured into it by means of a funnel, through 
 the orifice in the frontal bone, taking care that the stream 
 does not wash away the luting of the foramina. The fluid 
 which remains, after having filled the cranial cavity, is 
 measm^ed, and being deducted from the sixty ounces gives 
 the amount emj)loyed. To this must be added half an ounce 
 for the space occupied by the luting." Having thus obtained 
 the cranial capacity, he deducts from it the brain volimie, 
 and obtains thus the exact measui^ement of shrinking or 
 atrophy. Millet seed and sand have been used for measur- 
 ing the capacity of the cranial ca^dty, and the latter in the 
 dried skull has answered admirably. It must, however, be 
 borne in mind that a fallacy may be introduced by the 
 employment for this purpose of materials liable to be 
 influenced by temperatm'e. Fluids are, of course, more 
 open to this objection, their expansion by heat being pro- 
 portionately more rapid than solids, and hence it would 
 appear that sand is preferable to water in these investiga- 
 tions. 
 
 2. Mustard seed was employed by Professor Flowers in 
 his extensive series of researches.^ 
 
 3. The method adopted by myself arose from my em- 
 ployment of solid paraffin in obtaining casts of the brain- 
 
 ' The capacity of the crania contained in the Himterian Museum of the 
 Royal College of Surgeons was obtained by Professor Flowers in this 
 manner.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 59 
 
 surface, and the interior of tlie skuU. It was soon apparent 
 that the finest and most delicate impressions and most perfect 
 casts coidd be obtained by the use of this substance, and that 
 it did not share in the great disadvantage which accrues 
 from the use of plaster of Paris, viz., that of great con- 
 traction during solidification. It is in this respect also far 
 superior to white wax, which, as is well known, contracts 
 much whilst solidif jing. I proceed as follows : — Fill up 
 the foramina at the base as pre\iously described. A tri- 
 angular or wedge-shaped piece is now sa^vn out of the 
 occipital bone after removal of the calvarimn, but retained 
 in situ. The base is then filled up by melted paraffin, the 
 skrdl-cap replaced and fastened by luting, just as in Dr. 
 Tuke's process, having previously trephined a piece out of 
 the frontal bone. Through the latter orifice more of the 
 paraffin is poiu"ed in imtil the cranial cavity is filled. When 
 cool and solid remove the calvarium, as well as the wedge- 
 shaped piece of bone from the occiput, and then gentle 
 pressure from behind tilts the solid mass out of the cranium, 
 Avhen it will be found to form an exquisite mould of the 
 interior. The moidd thus obtained is now to be measured 
 by displacement, whence we obtain the cranial capacity. 
 This method has afforded me great satisfaction, as it gives 
 data of great value at the expense of very little trouble : 
 it supplies us with a method of — 
 
 1st. Estimating cranial capacity. 
 2nd. Grives us an exact mould of the cranial cavity. 
 3rd. As a permanent record — numerous linear angular 
 measurements and volume measiu-ements may be obtained. 
 
 4. From some invaluable measurements by the late 
 lamented Broca,^ it was found that of 115 skulls of indivi- 
 duals living in the tweKth century, the average capacity was 
 1425 "98 cubic centimeters ; whilst of 125 skulls of the nine- 
 teenth century the average capacity was 1461'53 cubic centi- 
 meters. The following table of percentage will be found of 
 
 1 Quoted by Vogt, " Lectures on Man." Anthrop. Soc.
 
 60 
 
 COARSE EXAMINATION OF THE BRAIN. 
 
 use by those interested in the subject of cranial capacity. It 
 is given by Le Bon as illustrative of the relationship of race 
 to cranial capacity : — 
 
 Cranial Capacity in different Human Races. 
 
 CRANIAL 
 
 capacity. 
 
 Modern 
 
 Parisians. 
 
 Parisians of 
 12th Cent. 
 
 Ancient 
 Egyptians. 
 
 Negroes. 
 
 Australians. 
 
 Cubic Centimeters. 
 
 
 
 
 
 
 1,200 to 1,300 . 
 
 0-0 
 
 0-0 
 
 
 
 7-4 
 
 45-0 
 
 1,300 to 1,400 . 
 
 10-4 
 
 7-5 
 
 12-1 
 
 35-2 
 
 25-0 
 
 1,400 to 1,500 . 
 
 14-3 
 
 37-3 
 
 42-5 
 
 33-4 
 
 20-0 
 
 1,500 to 1,600 . 
 
 46-7 
 
 29-8 
 
 36-4 
 
 14-7 
 
 10-0 
 
 1,600 to 1,700 . 
 
 16-9 
 
 20-9 
 
 9-0 
 
 9-3 
 
 0-0 
 
 1,700 to 1,800 . 
 
 6-.5 
 
 4-0 
 
 0-0 
 
 0-0 
 
 0-0 
 
 1,800 to 1,900 . 
 
 5-2 
 
 0-0 
 
 0-0 
 
 0-0 
 
 0-0 
 
 § WEIGHT. 
 
 Gravimetric Methods. — The student must make him- 
 self familiar with the various circumstances which modify 
 brain-weights. Some of these conditions have been sum- 
 marised by Bastian.^ They appear to be chiefly as follows : — 
 
 1. Length and natm^e of illness. 
 
 2. Mode of death (vascidar engorgement favom'ing high 
 weight). 
 
 3. Certain neuroses, as epilepsy. 
 
 4. All conditions inducing sclerosis. 
 
 5. Atrophy. 
 
 6. Congenital micro- or megalo-cephaly. 
 
 The student must also take into consideration the relationship 
 between weight of brain and the age and sex of the individual 
 as well as the weight and height of body. 
 
 ^ ''The Bruin as an Organ of Mind," chap. xx.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 61 
 
 Absolute Weight of Brain. — Before weighing tlie 
 brain, all fluid from the subarachnoidal space and ventricles 
 must be di-ained off, and allowance made for the membranes, 
 which will scarcely exceed an oimce in weight. The plan 
 adopted at the "West Riding Asylum, however, is to first 
 strip the brain of its membranes, to liberate the fluids in the 
 ventricles, and weigh the whole encephalon. The membranes 
 can afterwards be weighed if thought necessary. In all 
 cases when the pia mater is firmly adherent to the cortex, it 
 is as well to weigh the brain prior to stripping, as large 
 shi'eds of the cortex are often removed in these cases. Pre- 
 caution must be taken, however, by incisions, to release any 
 accumulation of fiuid in the subarachnoid spaces and meshes 
 of the membrane, and, subsequent to weighing, allowance 
 must be made for the pia mater and arachnoid. After the 
 weight of the encephalon has been obtained, the cerebellum 
 and pons must be removed by di\iding the crura cerebri close 
 to the pons} A longitudinal incision is then carried through 
 the median line of the corpus callosum from before back- 
 wards, so as to separate the two hemispheres. The pedun- 
 cular connections of the pons and medulla with the cere- 
 bellum are then divided, and the former (pons) also separated 
 from the medulla at its natiu-al line of division. This is the 
 method adopted at West Riding Asjdum, but for several 
 years it was the custom here to separate the frontal lobes 
 from the remaining posterior part of the brain by an incision 
 carried through the fissure of Rolando, The weights of 
 these individual parts are then taken. 
 
 It will be foimd ad\dsable to use the metric system in aU 
 our estimates of capacity, volume, and weight, and all the 
 standard brain-weights afforded by the elaborate tables of 
 Tiedemann, Reid, Boyd, Wagner, and others shoidd be 
 expressed in grammes rather than ounces. Dr. Sharpey, 
 after an elaborate analysis of brain- weights given by Grlen- 
 
 ' A modification of the plan is recommended in tlie section on the dis- 
 section of the brain as preferable when the question of weight is of secondary 
 import (p. C9).
 
 62 COARSE EXAMINATION OF THE BRAIN. 
 
 dinning, Sims, Tiedemann, and Reid, supplies us with the 
 following valuable results : — ^ 
 
 
 
 ozs. 
 
 Maximum 
 
 weight of adult Male Brain 
 
 65 
 
 Average 
 
 » )) 5) 
 
 49^ 
 
 Minimum 
 
 ») )) )» 
 
 34 
 
 Maximum 
 
 „ „ Female Brain 
 
 56 
 
 Average 
 
 » » j> 
 
 44 
 
 Minimum 
 
 )) 5> »> 
 
 31 
 
 The heaviest human brain on record has been described by 
 Dr. Morris,^ and was carefully examined at University 
 College Hospital : the weight was 67 oz. 
 
 Compatible with ordinary intelligence, the lowest limit of 
 the human brain, as regards weight, is, according to Gratiolet, 
 900 grammes, and, according to Broca, 907 for the female, 
 and 1049 grammes for the male.^ 
 
 Specific Gravity. — Researches upon the specific gravity 
 of the encephalon are becoming more and more interesting 
 with our knowledge of cerebral localization and intimate brain- 
 structure. The late suggestive work of Danilewsky upon the 
 relative amount of grey and white matter in the brain depends 
 greatly upon the accuracy of the specific gravity for its cor- 
 rectness. The more important methods adopted are those of 
 Drs. Bucknill, Sankey, and Peacock. 
 
 1 "Elements of Anatomy," 7th Edition, vol. ii. p. 568. 
 
 2 Brit. 3Ied. Journ. Oct. 26, 1872, p. 465. 
 
 2 Quoted by Bastian, "The Brain as an Organ of Mind," 1880, p. 365. 
 In connection with the weight of the brain in the insane, the student 
 will find most valuable information in articles by Dr. Crochley Clapham, 
 contained in the 3rd and 6th vols, of the "West Riding Asylum Medical 
 Reports." His observations embrace 1,200 cases of insanity. Fiu-ther 
 information upon this subject may be obtained by reference to the 
 following : — Sims, Medico-Chirurt/. Trans, vol. xix. ; Glendinning, Medico- 
 Chirurg. Trans, vol. xxi. ; Tiedemann, " Das Hirn des Negers," Heidelberg, 
 1837 ; Reid, London and Edin. Month. Journ. Med. Science, April, 1843 ; 
 Thurman, Journ. Mental Science, 1866 ; Wagner, " Vor.studien," 1862, 2' Abh. 
 pp. 93-95 ; Peacock, Month. Journ. Med. Science, 1847, and Journ. of Tathol. 
 Soc. 1860; Boyd, Philos. Trans. 1860; Bastian, " The Brain as an Organ 
 of Mind," 1880 ; Clapham, loc. cit. and Journ. of the Anthropolog. Inst. 
 vol. vii. p. 90.
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 63 
 
 1. Buckniil's Method. — Dr. Biicknill was tlie first who 
 originated a satisfactory and ready method for estimating the 
 specific weight of brain. The foUomng is his detailed account 
 of the process : — " The specific gravity of the cerebrum and 
 cerebellum is ascertained by immersing a portion of each in a 
 jar of water wherein a sufiicient quantity of sulphate of mag- 
 nesia has been dissolved to raise the density of the fluid to the 
 point required, adding water or a strong 
 solution of the salt, until the cerebral 
 mass hangs suspended in the fluid 
 without any tendency to float or sink, 
 and then, by testing with the hydro- 
 meter, the specific gravity is thus f oimd 
 with great delicacy and facility, a 
 difference of half a degree in the density 
 of the fluid being indicated by the rise 
 or fall of the substance immersed. The 
 soluble salt is chosen, for its possessing 
 no astringent or condensing action upon 
 animal tissues."^ 
 
 2. Sankey's Method. — This pro- 
 cess is the one which has been used 
 most extensively by Dr. Crichton 
 Browne at West Riding Asylimi, and 
 it is the method which I have myself 
 invariably adopted. It appears to me 
 in every respect highly satisfactory and 
 simple. "We require a series of cylin- 
 drical glass jars, such as the one figured, 
 and a set of graduated hollow glass bulbs, which can 
 be readily obtained.- 
 
 These glass bulbs are accm-ately graduated, or r 
 
 Fig. 2. 
 Specific Geavxty 
 
 Test. 
 now 
 
 rather 
 marked with the specific gravity of the fluid in which they 
 
 1 Lancet, 1852, vol ii. p. 589. 
 
 2 Such a set of graduated bulbs may be obtained of Mr. Stevenson, 
 Philosophical Instrument Maker, No. 9, Forrest Road, Edinburgh.
 
 1031 
 
 1032 
 
 1033 
 
 1034 
 
 1032 
 
 1033 
 
 1034 
 
 1035 
 
 1033 
 
 1034 
 
 1035 
 
 1036 
 
 64 COARSE EXAMINATION OF THE BRAIN. 
 
 would liang suspended when immersed, neither tending to 
 float nor sink. The glass jars are partly filled with water, 
 and then a concentrated solution of Epsom salts added 
 to each, until its specific gravity is such that whilst one 
 bulb floats, a bulb two degrees higher sinks. Thus a series 
 of jars are filled as represented below : — 
 
 Bulbs floating .... 1030 
 Specific gravity of fliiid = 1031 
 Bulbs sunk 1032 
 
 The middle line represents the specific gravity of the fluid, 
 and therefore of the portion of brain which tends neither to 
 float nor sink, but to remain suspended wherever placed. It 
 will occur to the student that the jars may be so graduated, 
 that whilst one bulb floats, another, one degree higher, sinks, 
 and hence that half a degree specific gravity may be indicated 
 as follows : — 
 
 Bulb floats 1030 1031 
 
 Specific gravity of fluid and suspended body 1030'5 1031-5 
 Bulb sinks 1031 1032 
 
 This is a degree of nicety, however, to which the use of the 
 beads shotdd not be pressed, and if required, should demand 
 in preference the use of the 1000-gramme specific gravity 
 bottle. A series of jars should be graduated from 1028 to 
 1050, so as to enable us to deal withwhite or grey matter of 
 cerebrum, cerebellum, and central ganglia. Occasionally still 
 more dilute solutions mil be requisite. 
 
 A minute piece of white or grey matter is now raised by a 
 scalpel and placed upon the perforated spoon or scoop, which 
 is gently lowered into one of the jars of saline solutions, and 
 the fragment of brain tm-ned off the scoop and closely 
 observed. If it sinks, it is of course of higher specific gravity 
 than the fluid, and must be passed on to stronger solutions 
 until, reaching one of its o^ti density, the fragment remains 
 stationary where placed. If, on the other hand, it floats, it 
 must, of coiu-se, be moved to a solution of less specific weight, 
 until the same conditions are obtained. Should the specific
 
 PHYSICAL PROPERTIES OF GREY AND WHITE MATTER. 65 
 
 gravity beads be cbosen by the student for tliis purpose, it 
 would be well for him to attend to the following rules : — 
 
 a. After obtaining the specific gravity of any one portion 
 of brain, repeat the trial with fresh portions at least two or 
 three times, so as to ensure perfect accuracy. 
 
 b. Examine the brain as soon as possible after death, 
 wholly rejecting such as show the least evidence of com- 
 mencing decomposition. 
 
 c. Keep the jars covered with glass squares in a cool room, 
 so as to avoid dust and evaporation as far as possible. 
 
 d. Before commencing any series of observations, note the 
 position of the bulbs, any tendency of the lower bulbs to float 
 from evaporation of the solution being rectified by the addition 
 of water. 
 
 3. Stevenson's Displacement Apparatus. — A simple 
 and most reliable apparatus has been devised hy Mr. Stevon- 
 
 FiG. 3. — Stevenson's Displacement Api-aeatus. 
 
 son for estimating at the same time both the bulk and specific 
 gravit}' of large irregular bodies by the principle of displace- 
 
 F
 
 66 -OOARSE EXAMINATION OF THE BRAIN. 
 
 ment. Tlie apparatus consists of a jar, A, fitted -witli a 
 large drooping tubidatiu'G, B, with stopcock attached. A 
 metal gauge, D, having a thin horizontal straight edge inside 
 the jar, determines the exact water-level, and over it the 
 surplus water flows. The other jar, E, is graduated on the 
 sides into cubic inches, avoirdupois lbs. and ozs., and thousandth 
 parts of a gallon. The packing case, Gr, serves as a stand for 
 the jar. In taking the specific gravity of the brain, or any 
 body a little heavier than water, the jar must be filled with a 
 solution of salt or sulphate of magnesia up to the level of 
 the gauge, the stopcock being closed. The brain is then 
 immersed in the fluid, in which it ought to float, and the fluid 
 immediately rises in the jar; let it come to rest; open the 
 stopcock, and the quantity displaced Avill flow into the 
 graduated jar and represent the u-eight-indication of the brain 
 (since any floating body displaces exactly its own weight of 
 the fluid) . The stopcock is now shut, and the brain depressed 
 by the brass piece, F ; and when the water has again come 
 to rest, open the stopcock and receive the f m-ther displacement 
 in the jar E. The whole bulk of displaced fluid read off the 
 graduated jar indicates, of course, the volume of the brain. 
 To obtain the specific gravity, multiply the weight-indication 
 by the specific gravity of the fluid and divide by the vokmie- 
 indication. I need scarcely indicate to the student the 
 simplicity and value of this method, whereby the weighty the 
 volume, and the specific gravity of the brain may be simul- 
 taneously obtained.^ The apparatus, as figiu-ed, is somewhat 
 smaller than what would be required for brain. 
 
 In estimating the specific gravity of the encephalon, the 
 student will soon appreciate the fact that the specific weight 
 varies not only in the cerebrum, central ganglia, and cere- 
 bellum, but that variations occur over different regions of 
 the cerebrimi, suggesting the importance of a comparative 
 examination by this method of the various cerebral con- 
 volutions. By cautious manipulation he will also be able to 
 show that the specific gravity of the cortex varies with its 
 
 ^ This apparatus is sold by Mi\ Stevenson, 9, Forrest Road, Edinburgh.
 
 PHYSICAL PROPERTIES OF GREY AND AVHITE MATTER. 67 
 
 deptli. Dr. Sankey otserves that the specific gravity dimin- 
 ishes in the ratio of •001 for every twenty-four hoiu's after 
 death. This must, however, be greatly modified by the 
 temperatiu^e of the surrounding atmosphere, and other condi- 
 tions favouring putrefactive changes. The folloAving embrace 
 the more important residts obtained by different observers, and 
 they will serve as a useful guide to the student in his prosecu- 
 tion of similar observations ^ : — 
 
 Average specific 
 
 gravity 
 
 of 
 
 whole 
 
 Enccphalon 
 
 1036 
 
 (Ikicknill) 
 
 
 
 
 )» 
 
 Cerebrum 
 
 1030-'48 
 
 (Aitkin). 
 
 
 
 
 )» 
 
 Cerebellum 
 
 1038-'49 
 
 (Aitkin). 
 
 
 
 
 »> 
 
 Grey matter 
 
 1034 
 
 (Sankey). 
 
 
 
 
 j> 
 
 White matter 
 
 1141 
 
 (Sankey) . 
 
 
 
 
 )) 
 
 Central ganglia 
 
 1040-'47 
 
 (Aitkin). 
 
 Proportion of White and Grey Matter in the Brain. 
 
 — Tlie specific gravity of the grey and white matter, 
 together with that of the whole brain, has been applied to 
 solve the very important problem of the relative percentage 
 of grey and white matter in the human brain. Danilewsky 
 has lately published his results and method of procediu'e, an 
 account of which may be seen in the Ccntralblatt f. d. Med. 
 Wissenchaftci), No. 14, 1880. ^ The formula given by him is 
 as follows : — 
 
 X = — Y- ^ where x is the quantity of grey or of white 
 
 matter, p the specific, grcmty of the whole brain, a of the grey 
 and h of the white substance, and P is the weight of the 
 Avhole brain. He gives, as the results of one series of experi- 
 ments, a percentage for the grey matter of 37'7 to 39, against 
 a percentage of 60'3 up to 61 for the white substance. By 
 taking the average depth of grey matter it is, of course, an 
 
 ^ References to work done in the Specific Gravity of the Brain : — Bucknill, 
 Lancet, vol. ii. 1852, and the Med.-Chir. Rev. 18-55; also " Psj^chologica 1 
 Medicine," Bucknill and Tuke, 3rd edit. pp. 520 and 587; Sankey, Brit, 
 and For. Mcd.-Chir. Rev. 1853 ; Peacock, " Trans. Pathol. Soc. of London," 
 1861-2 ; Aitkin, " Science and Practice of Medicine," 1865, vol. i. p. 265. 
 
 ^ Vide Abstract by Dr. Geoghegan, Journ. Mental Science, p. 437, Oct. 
 1880. 
 
 T^ 9
 
 68 COARSE EXAMINATION OF THE BRAIN. 
 
 easy matter to obtain tlie surface measurement of the brain. 
 Wagner's researches upon the superficial area of the brain are 
 of interest here.^ The student, however, must be warned 
 against regarding results so obtained as other than merely 
 approximate^ as it is next to impossible to exclude the 
 numerous fallacies to which the estimation of average specific 
 gravity is liable. Thus the specific gravity of the grey 
 matter is known to vary with its depth, with its local distribu- 
 tion or area, with the amount of vascularity of the tissue, and 
 time after death. Beyond this the very cases in which the 
 pathologist would be interested in estimating the relative 
 proportions of grey and white matter are those which are 
 subject to such diffuse and local change in consistence that 
 an average specific gravity for either white or grey could not 
 be attained with any degree of exactness. For comparative 
 investigation of healthy brain, the process adopted by 
 Danilewsky promises to afford valuable results as long as 
 the greatest care is observed to exclude fallacies. 
 
 1 Quoted in Quain's " Anatomy," vol. ii.
 
 CHAPTER V. 
 
 REMOVAL AND DISSECTION OF THE BRAIN. 
 
 § EXTERNAL ASPECT OF THE BRAIN. 
 
 It may be usefiJ here to review the course to be piirsiied in 
 removing and preparing the various parts of the brain for 
 coarse examination, and the following method is recommended 
 as in every way the more reliable and satisfactory one. 
 
 In the fii'st place the head should be so supported as to 
 command a good light and a full and satisfactory view of 
 the brain i)i dtii. 
 
 In the next place never neglect the rule of o]iening the 
 skull and examining the brain ^j/vor to opening the thorax 
 and dividing the great vessels. 
 
 Cranial Membranes and External Aspect of Brain. 
 — The skull-cap having been removed sec. art. we proceed as 
 follows : — 
 
 ' 1. Examine upper surface of dura mater in its relation- 
 ships to the skull (pp. 3-5). 
 
 2. With a forceps raise a fold of dm-a mater anteriorly, 
 run the scalpel through it, and carry the blade along either 
 side on a level with the sawn edge of the cranium far back 
 towards the occiput, stopping short of the middle line. 
 
 3. Reflect these lateral halves of the membrane towards 
 the middle line, observing the condition of the large super- 
 ficial veins running into the longitudinal sinus. 
 
 4. Replace the dura mater, and with a curved bistomy
 
 70 COARSE EXAMINATION OF THE BRAIN. 
 
 open up the longitudinal sinus in • its whole length back 
 towards the torcular herophili, noting the condition of the 
 parts (p. 5). 
 
 5. Divide the connection between dura mater and crista 
 galli, and seizing the anterior end of the falx cerebri, 
 forcibly draw the membrane backwards, dividing the 
 junction of the superficial veins in this course, and thus 
 expose the surface of the hemispheres. 
 
 6. With a good light thrown on the subject, and, if 
 requisite, the aid of a hand lens, observe the appearances 
 presented at the vertex, noting the condition of the vessels, 
 membranes, and general conformation of the brain. It is 
 absolutely necessary to pay attention to this point, as the 
 appearances presented in situ are often greatly modified or 
 wholly lost upon removing the brain at a later stage. 
 
 7. Grently raise the tips of tlie frontal lobes from the 
 orbital plates, carefully removing the olfactory bidbs with 
 the brain, and then using a little gentle traction, the optic 
 nerves are exposed and divided close to their foramina. 
 With the same blunt-pointed curved bistomy divide suc- 
 cessively the infundibulum, carotid arteries, and third nerve. 
 A good view is thus afforded of the tentorium, which should 
 be divided along its attachment to the ridge of the temporal 
 bone, dividing at the same time the fom-th nerve. The base 
 of the brain is now exj^osed, and the fifth, sixth, and seventh 
 nerves readily divided, after which the blade is passed do-wn 
 into the vertebral canal on either side of the medulla, and, 
 cutting forwards, it severs the vertebral arteries, the eighth 
 and ninth pairs, and spinal accessory nerves. A sweep of 
 the scalpel across the front of the cord liberates the brain, 
 which can be now raised out of the cranial cavity with 
 ease. 
 
 8. The next procedm^e is to place the brain base upwards 
 in the skull-cap, the latter being conveniently steadied by 
 any simple contrivance. This enables us with less sacrifice 
 to the appearances at the vertex, to study the important 
 region of the base. In doing so, follow out the instructions
 
 REMOVAL AND DISSECTION OF THE BRAIN. 71 
 
 already given (p. 15), taking the parts in the following 
 order : — 
 
 a. Arrangement and appearance of the great vessels at 
 
 the base. 
 h. Condition of the membranes and subjacent gyri. 
 c. Condition of the various cranial nerves. 
 (/. Open up the fissure of Sylvius on either side, tracing 
 
 the large arterial branches upwards ; also examine 
 
 nutrient supply to the basal ganglia at anterior and 
 
 posterior perforated spots. 
 e. Strip the base of its membranes, noting adhesions, 
 
 etc. etc. 
 
 9. The cerebrum may now be turned out upon the dis- 
 secting tray, with vertex uppermost, and the membranes 
 carefully examined and stripped. Take note of the arrange- 
 ment of the gyri, the presence of superficial lesions, general 
 consistence, and coloiu'. 
 
 10. The clui'a mater and its sinuses at the base of the 
 skull may be now examined (p. 8), completing thus the 
 examination of the cranial membranes and the external 
 aspect of the brain. 
 
 § EXAMINATION OF INTERNAL STRUCTURE 
 
 OF THE BRAIN. 
 
 1. Introduce a large section knife into the longitudinal 
 fissure, and cut outwards across each hemisphere, about | inch 
 above the corpus callosmn, exposing the centrum ovale minus. 
 Repeat the same procedure on a level with the corpus 
 callosum, exposing the greater centrum ovale, and exhibiting 
 the continuation of the transverse strands of this great com- 
 missm-al tract with the medulla of the hemisphere. The 
 student will now proceed to note the relative and absolute 
 amount of grey and white matter, and incj^uire into the con- 
 sistence, colour, and other physical qualities of these parts in 
 the manner abeady detailed (Chap. IV.).
 
 72 coause examination of the brain. 
 
 2. By an incision carried from before backwards across the 
 fibres of the corpus callosimi, a short distance on each side of 
 the median line, the lateral ventricles are opened. To 
 expose the structures more fully, divide the corpus callosum 
 anteriorly, and whilst gently reflecting it cut backwards, 
 with a scissors, through the vertical septum (septum lucidum) , 
 which is attached to its under surface, and which, descend- 
 ing, divides the lateral ventricles into two cavities. After 
 reflecting the corpus callosum, and dividing it across behind, 
 note the condition of the following structures seriatim : — 
 
 a. The caudate nuclei or intra-ventricular portions of 
 
 the corpora striata. 
 
 b. Septum lucidum, enclosing betwixt its walls the fifth 
 
 ventricle. 
 
 c. Exposed anterior tubercle of the thalamus opticus. 
 
 d. Stria cornea, or exposed part of the taenia semi- 
 
 circularis, coursing between the thalamus and 
 corpus striatum. 
 
 €. Fringed margins of the velum interpositum or 
 
 choroid plexus of lateral ventricles. 
 /. Fornix, and behind its descending pillars, the fora- 
 men of Monro. 
 
 (/. Greneral condition of lining membrane or ependyma. 
 
 3. Divide the fornix anteriorly close to its descending 
 pillars, and after examining the subjacent velum inter- 
 positum, reflect both structures backwards, exposing the 
 thalami optici, separated by the intervening third ventricle, 
 and note the condition of the following parts : — 
 
 a. Grey matter forming the boundaries of the central 
 
 cavities. 
 
 b. Anterior, middle, and posterior commissure. 
 
 c. Pineal gland, and its ganglionic extensions, or 
 
 peduncles. 
 
 d. Corpora quadrigemina (nates and testes). 
 
 e. Follow out the fornix posteriorly into the descending 
 
 cornua of the ventricles.
 
 REMOVAL AND DISSECTION OF THE BRAIN. 73 
 
 4. On separating the occipital lobes from the cerebellum 
 the curved bistoury may, by a little careful dissection, be 
 made to cut through both crura cerebri obliquely upwards, 
 to meet above the corpora quadrigemina at an obtuse angle 
 in the third ventricle in front of the posterior commissure. 
 
 By so doing we separate from the cerebrum the cere- 
 bellum, pons, and medulla, together with the corpora quadri- 
 gemina and pineal gland intact. This method is certainly 
 preferable to dividing the cms at the level of the superior 
 cerebellar peduncle, which is so often done at the sacrifice of 
 the normal relationships of most important regions. 
 
 5. Separate the cerebral hemispheres by median section 
 through the slight remaining connections, and proceed as 
 follows : — 
 
 a. Slice one of the hemispheres in a direction parallel 
 
 to the sections already made when exposing the 
 centrum ovale. Let numerous sections in this 
 direction be made at different planes from above 
 downwards through the whole hemisphere, so as 
 to expose the structure of the thalamus and corpus 
 striatum down to the base. 
 
 b. Slice the remaining hemisphere in a direction at right 
 
 angles to its long axis, or, in other words, from 
 above downwards, beginning our sections near the 
 olfactory bulb, and proceeding as far back as the 
 occipital lobe. 
 
 These sections {a and b) will familiarize the student Avith 
 the relationships and coarse structure of the basal ganglia — ■ 
 points of considerable moment. Examine, therefore, by aid 
 of these sections, the medvdlary tracts forming the internal 
 and external capsules, the lenticular and caudate nucleus of the 
 corpus striatum, the thalamus opticus and its various regions 
 and environment. All these parts may be studied in suc- 
 cession, referring to good illustrations, such as appear in the 
 last edition of Uuain's "Anatomy." The intimate structm-e 
 and relationships of these regions will be dealt with fm-ther on.
 
 74 COARSE EXAMINATION OF THE BRAIN. 
 
 6. Remove the cerebellum from its attachments bj 
 dividing the three peduncles, and proceed to examine suc- 
 cessively — 
 
 a. Superficial aspect of membranes covering pons and 
 
 medulla, 
 h. Condition of blood-vessels and superficial origin of 
 
 the cranial nerves. 
 
 c. Condition of valve of Vieussens, aqueduct, and fourth 
 
 ventricle. 
 
 d. By transverse sections expose structure of nates and 
 
 testes, of the pons, its anterior, or motor, and pos- 
 terior or tegmental tract, of the medulla oblongata, 
 noting the relative dimensions and appearance of 
 the olivary bodies, the pyramidal and restiform 
 tracts. 
 
 7. Lastly, after examining the lobules and membranes of 
 the cerebellum, we divide it into an upper and lower half by 
 an incision carried through both hemispheres from behind 
 forwards, exposing the central medulla. 
 
 Vertical section — i.e., at right angles to the lamina of the 
 cerebellum — will display its foliated aiTangement, and betwixt 
 vermiform process and the middle of each hemisphere we 
 pass through the plicated corpus dentatum.
 
 CHAPTER VI. 
 
 SUPERFICIAL TOrOGRAPHY. 
 
 Since the prosecution of researches into the minute anatomy 
 of the brain will necessarily lead us into structui'al details of 
 infinite diversity (for the complete histology of the human 
 cortex cerebri is infinitely more complex than any of our 
 classical works on this subject would lead us to conceive), we 
 shall have to bestow a predominating share of our attention 
 upon cerebral localization. Hence at the outset it is essential 
 that we obtain clear and defiuite ideas of the various sub- 
 divisions of the brain, both as regards convolutionary 
 arrangement and central medullated fasciculi. A knowledge 
 of the convolutions and sulci must be immediately acquired, 
 and from this superficial topography we learn readily to 
 appreciate the relative positions of those smaller areas which, 
 from experimental data, have been proved to possess diversi- 
 fied functional endowments, as well as those cortical tracts 
 which histological inquiry has invested with structural 
 peculiarities. 
 
 It is not within the scope of this manual to give even 
 an outline of the internal medullated structure of the brain, 
 but it may prove of service here to indicate Professor 
 Turner's nomenclature of the convolutions which, from its 
 great simplicity and clearness, has found such general favour.^ 
 For minute details as to the course, relationships, and devia- 
 tions of these gyri, the student is referred to that very 
 
 1 "The Convolutions of the Human Cerebrum Topographically Con- 
 sidered," by William Turner, M.B. Lond., F.R.S.E. Ediu. Med. Jnuyn. 
 June, 1866,
 
 76 COARSE EXAMINATION OF THE BRAIN. 
 
 excellent translation of Ecker, " On the Convolutions of the 
 Human Brain," by J. C. Gralton. From this work, with 
 the editor's kind permission, I have tabulated the various 
 English and foreign synonyms, as likely to prove of value in 
 the fui'ther prosecution of our studies in this department. 
 The photographs from Bischoff's work on the Convolutions 
 are intended for immediate reference in the laboratory.
 
 GENERAL REFERENCE TO THE 
 PHOTOGRAPHS. 
 
 I. Frontal Lobe. II. Paeietai Lobe. III. Occipital Lobe. 
 IV. Tempoeo-sphenoidal Lobe. 
 
 4. 
 
 6. 
 
 7. 
 
 9. 
 11. 
 12. 
 13. 
 14. 
 10. 
 16. 
 
 n7. 
 
 Superior Frontal Gyrus 
 Middle Frontal G-yru3 , . 
 
 Inferior Frontal Gyrus 
 
 ) Separated by the Supero- frontal 
 j Sulcus. 
 
 Separated by the Infero -frontal 
 Sulcus. 
 
 Separated by 
 Rolando. 
 
 the Fissure of 
 
 Separated by the Intra-parietal 
 Fissure. 
 
 External Orbital Gyi'us. 
 
 Ascending Frontal Gyrus 
 
 Ascending Parietal Gyrus 
 
 Postero-parietal Lobule 
 
 Supra-marginal Lobule 
 
 Angular Gyrus . . 
 
 Third and Fourth Annectant Gyri. 
 
 First Annectant Gyrus. 
 
 Quadiilateral Lobule .. \„ ,,, ,, t, it. 
 
 n a • r» • -i 1 r Separated by the Internal Pa 
 
 Cuneus, or Superior Occipital \ ^, ^ •_;i„i a ,i„„„ 
 
 ^1 
 
 Separated 
 
 *j I Fissure. 
 
 Lobule . . 
 Lingual Gyrus 
 
 rieto- occipital Sulcus. 
 
 by the Calcarine 
 
 *18. Fusiform Gyrus 
 
 / 
 
 19. 
 20. 
 21. 
 22. 
 5. 
 
 23. 
 
 Superior Temporo- sphenoidal Gyrus 
 Middle Temporo -sphenoidal Gja-us 
 Inferior Temporo-sphenoidal Gyrus ) 
 Uncinate Gyrus . . . . j 
 
 Median Aspect of Superior Frontal \ 
 
 Gyrus . . . . . . . . f 
 
 Convolution of the Corpus Cal- ( 
 
 losum . . . , . . , . / 
 
 Separated 
 
 ty 
 
 the 
 
 Collateral 
 
 Fissure. 
 
 
 
 
 Separated 
 
 by 
 
 the 
 
 Parallel 
 
 Fissure. 
 
 
 
 
 Separated 
 
 by 
 
 the 
 
 Collateral 
 
 Fissure. 
 
 
 
 
 Separated 
 
 by the Calloso-mar- 
 
 ginal Fissure. 
 
 
 
 N.B.— At the Base No. 2, 3, 4, indicate respectively the Internal, 
 Posterior, and External Orbital Gyri. I need scarcely add that the darker 
 and lighter shading of the brain, as shown in the photographs, is well 
 calculated to bring into strong relief the moi'e distinctive areas and divisions 
 of the surface. The relative areas occupied by difierent lobes over each 
 aspect of the hemisphere are thus better displayed than by outline figures, 
 whilst the distinctive character of the gyri is not interfered with. 
 
 » Neither of these terms is included in Turner's nomenclature. They are adopted 
 by Ecker.
 
 LIST OF SYNONYMS FROM ECKER. 
 
 ADAPTED TO TURXER S NOMENCLATURE. 
 
 SuPERioB Feo^jtal Gyeus. 
 
 Erste oder obere Stirnwindung . . . . {Ecker.) 
 
 Etas'e frontal superieur ou troisiSme . . ) ,^ ^- , ^ \ 
 
 ° \ [ {Gratiolet.) 
 
 Pli de la zone externe . . . . . . . . ) 
 
 Supero-fi'ontal gyrus . . . . . . . . {Rnxlei/.) 
 
 Middle Feontal Gyeus. 
 
 Zweite oder mittlere Stirnwindung . , . , {Eclrr.) 
 
 Etage frontal nioy en .. .. .. .. {Gratiolet.) 
 
 Medio-frontal gyras . . . . . . . . [Huxlcij.) 
 
 Infeeior Feontal Gyeus. 
 
 Dritte oder untere Stirnwindung .. .. {Ecker.) 
 
 Pli frontal infferieur ou premier ou etage 
 
 surcilier .. .. .. .. ,. {Gratiolet.) 
 
 Infero-frontal gyrus . . , . , . . . {Huxley.) 
 
 Ascending Feontal Gyrus. 
 
 Vordere Centralwindung .. ., .. {Rusckke.) 
 
 Processi enteroidei verticali di mezzo (anterior 
 
 part) . . . , . . . . . . . . {Rolando.) 
 
 Circonvolution transverse parietale anterieur (Foville.) 
 
 Premier pli ascendant . . . . . . . . {Gratiolet.) 
 
 Antero- parietal gyrus . . . . . . , . {Huxley.) 
 
 SUPEEIOR TEMP0E0-SPHEN0ID.\i GyRUS. 
 
 Erste obere Schlilf enwindung . , . . ( Wayiier. ) 
 
 Antero-temporal . . . . . . . . {Ha.dcy.) 
 
 Pli temf)oral superieur ou.. .. ..\ 
 
 Pli marginal posterieur ) {Gratiolet.) 
 
 Gyrus temporalis superior sive infra marginalis {Huschke.) 
 
 Middle Temporo- sphenoidal Gyrus, 
 
 Zweite oder mittlere Schlafenwindung 
 Mittlere Schlafenwindung 
 
 ( Wagner.) 
 {Hi/achkr.)
 
 LIST OF SYNONYMS FROM ECKER. 
 
 79 
 
 Pli temporal moyen ou partie descendante du 
 
 pli courbe . . . . . . . . . . {Gratiolet.) 
 
 Medio-temporal gyrus .. .. ... {Huxhij.) 
 
 Inteeiok Tempoho- sphenoidal Gyeus. 
 
 Dritte oder imtere Schlaf enlappenwindung i 
 Gyrus temporalis tertius sive inferior . . ' 
 
 Lingual Lobule. 
 
 TJntere innere Hinterhauptwindungsgruppe 
 Lobulus LinguaUs — Zungenlappchen 
 Gyi-us occipito -temporalis mediaUs . . 
 
 Fusifoem: Lobule. 
 
 Untere aussere Hiuterhauptwindungszug . . 
 Gyrus occii^ito-temporalis lateralis . . 
 Spindellappchen . . 
 
 Lobulus fusiformis — Spindelformiges 
 Liippchen. 
 
 Ascending Pakietal Gyrus. 
 
 Ilintere Centralwindung 
 Processi enteroidei verticale di mezzo 
 (posterior segment) . . . . . . ■ 
 
 Cu'convolution tranverse medio-parietale . . 
 Deuxieme pli ascendant 
 Postoro -parietal gyrus 
 
 PosTERO- Parietal Lobule. 
 
 Oberes Scheitellappchen 
 
 Gyrus parietalis superior 
 
 Lobule du deuxieme pli ascendant . . 
 
 Erste Sclieitellappen-windung 
 
 Obere Sclieitelbeinlappen 
 
 Obere innere Scheitelgruppe . . 
 
 Supra- Marginal Lobule. 
 
 Dritte Scheitellappenwindung 
 
 Unterzug aus der hintern Centralwindung ) 
 
 ScheitelhiJckerlappclien . . . . . . ' 
 
 PU marginal superieur 
 
 Erste oder vordere Sclieitelbogenwindimg . . 
 
 Angular Gyrus {Huxleij). 
 
 Unteres Scheitellappchen (posterior part) . . 
 Zweite oder mittlere ScheiteUappenwindung 
 Auf steigende "Windung zum hintern aussem j 
 
 Scheitellappchen und 
 Hinteres iiusseres Scheitellappchen 
 
 \ 
 
 ( Wagner. ) 
 
 (Bisc/wf.) 
 [Htischke.) 
 {Panschand EcJcer.) 
 
 {Bischoff.) 
 
 {Fansch and Ecker.) 
 
 {Eclcer.) 
 
 {Hiischke.) 
 
 {Ecker.) 
 
 [Rolando.) 
 {Foville.) 
 [Gratiolet.) 
 [Huxleij.) 
 
 {Ecker.) 
 {Punsch.) 
 [Gratiolet.) 
 { Wagner.) 
 [Huschke .) 
 [Bischoff.) 
 
 [Wagner.) 
 {Huschke.) 
 
 {Gratiolet.) 
 {Bischoff.) 
 
 {Ecker.) 
 { Wagner.) 
 
 {IluscJike.)
 
 80 
 
 COARSE EXAMINATION OF THE BRAIN. 
 
 Zweite odei' mittlere Scheitelbogenwindung [BiscJioff.) 
 
 Pli courbe .. .. .. .. ,. {Gratiolet.) 
 
 Quadrate Lobule (Ricrley.) 
 
 Vorzwickel 
 Lobule quadrilatere 
 Prsecuneus 
 
 {BurdacJi.) 
 
 (Foville.) 
 
 {Burclaeh.) 
 
 Convolution of Corpus Callosum. 
 
 Gyrus Fornicatus — Bogenwulst 
 Gyrus cingiili Zwiuge or Cingula 
 Callosal gyrus . , 
 Circonvolution de I'ourlet 
 Processo enteroidio cristato . . 
 
 {Arnold.) 
 
 {Burdach.) 
 
 {Huxleij.) 
 
 {Foville.) 
 
 {Rolando.) 
 
 Uncinate Gyrus {Huxley — Turner). 
 
 Gyrus Hippocampi 
 Subiculum Cornu Ammonis 
 Circonvolution a crochet 
 Pli Unciforme . . 
 Temporal moyen interne 
 Lobule de riiippocampe 
 
 Dentate Gyrus. 
 
 Coi-ps godronne . , 
 
 CuNEUS {Burdach, Turner, etc.) 
 
 Zwickel . . 
 
 Erste oder Hinterhauptlappenwindung 
 
 Oberer Zwischensclieitelbeinlappen . . 
 
 Lobule occipital 
 
 Internal occipital lobule 
 
 First Annectant Gyrus. 
 
 Erste oder obere HinterhauptAvindung 
 
 Oberer Zug der liintern Ceutralwindung . . 
 
 Erste obere Hinteiiappenwindung . . 
 
 Obere innere Scheitelbogenwindung 
 
 Fir^t external annectant gyrus 
 
 Pli de passage superieur externe . . . . ) 
 
 Pli occipital superieur . . . . , . . . j 
 
 {Burdach.) 
 {Burdach.) 
 { Vicq d'Azi/r.) 
 
 {Gratiolet.) 
 
 {Gratiolet, etc.) 
 
 {Echer.) 
 {Wag)ier.) 
 {Huschke.) 
 {Gratiolet. ) 
 {ff/aiei/.) 
 
 {EcJ.-er.) 
 {Huschke.) 
 { Wagner.) 
 {Bischnff.) 
 {Huxletj.) 
 
 {Gratiolet.) 
 
 Second Annectant Gyrus. 
 
 Zweite oder mittlere Hinterliauptwindung. . 
 Zweite mittlere Ilinterlappenwindung 
 Pli occipital moyen . . . . . , , , ) 
 
 Deuxieme pli de passage externe . . . . j 
 
 Gyrus occipitalis medius 
 
 {EcJcer.) 
 ( IVac/ncr.) 
 
 {Gratiolet.) 
 {Pansch.)
 
 LIST OF SYNONYMS FROM ECKER. 
 
 81 
 
 Medio -occipital and second external an- 
 
 nectant .. .. .. .. .. {Huxley.) 
 
 Third and Fourth Annectant Gyei. 
 
 Dritte oder untere Hinterhauptwindimg . . {Echer.) 
 
 Dritte untere Hinterlappenwindung .. {Wagner.) 
 
 Pli occipital inferieur . . . . . .\ 
 
 Troisieme et Quatrieme pli de passage ^ {Gratiolet.) 
 exteme . . . . . • . . . . ' 
 
 Gyrus occipitalis inferior .. .. .. (Pause h.) 
 
 Lobes of the Ceeebeum. 
 
 Frontal 
 
 Parietal . . 
 Temporo-splienoidal . . 
 
 Occipital . . 
 Central Lobe 
 
 = Scheitellappen. 
 
 = Stiralappen. 
 
 = ScMafenlappen.i 
 
 Keilbeinlappen . ^ 
 
 Schlafen-KeQbeinlappen. ^ 
 = Hinterhauptlappen. 
 = Zwiscbenlappen. 
 
 Versteckterlappen. 
 
 Centrallappen. 
 
 Stammlappen. 
 
 Insel. 
 
 1 •= Temporal 
 
 Sphenoidal. 
 
 ■* - Temporo-sphenoidal.
 
 Fig. 4.— convolutions of the cerebrum, as seen 
 
 AT THE VERTEX (after Bischnf).
 
 Fig. 5.-CONVOLUTIONS OF THE CEREBRUM, AS SEEN 
 AT THE MEDIAN ASPECT (after Bischof).
 
 ^ 
 
 ^ \ 
 
 \ 
 
 ^r^ 
 
 ^ir- 
 
 -<. 
 
 kV 
 
 y 
 
 KlG. 0.— CONVOLUTIONS OF THE CEREBRUM. AS SEEN 
 AT THE BASE (nficf BUchof).
 
 KIG. 
 
 -CONVOLUTIONS OF THE CEREBRUM, LATERAL 
 ASPECT (after Bischof).
 
 PART II 
 MINUTE EXAMINATION OF THE BRAIN 
 
 G 2
 
 CHAPTEE VII. 
 
 THE METHODS OF RESEARCH, 
 
 Prior to considering in detail the methods adopted for the 
 minute examination of the brain, the student should be fully 
 impressed with the conditions which render many of the 
 processes applicable for other tissues quite inadmissible here. 
 The consistence of cerebral tissue is such that cutting fine 
 sections by the hand, either with an ordinary razor or the 
 Valentin blades, cannot be adopted with any hope of success, 
 since the finest sections thus obtainable are useless for micro- 
 scopic examination, which requires sections of extreme 
 tenuity. These extremely fine sections can only be obtained 
 by aid of the screw microtome from portions of hardened or 
 frozen brain. In order to modify the consistence of the 
 tissue so as to adapt it for this purpose, various methods of 
 hardening by chromic acid, chromic salts, alcohol, picric acid, 
 and osmic acid have been devised. The results which have 
 accrued from these methods have been most valuable, yet they 
 are uniformly open to the serious objection that this altered 
 consistence induced by the req.gent is obtained at the expense 
 of modified structure and altered relationships. Amongst the 
 most serious drawbacks to the use of corrugating reagents in 
 the examination of the brain are the following : — 
 
 A considerable expenditure of time (from three to eight 
 weeks being requu-ed for satisfactory hardening). 
 
 The process itself is extremely tedious, and often unsatis- 
 factory in its results, as evidenced by experienced 
 histologists.
 
 86 MINUTE EXAMINATION OF THE BRAIN. 
 
 It requires a considerable amount of practised manipula- 
 tion, and exposes the tyro to numerous disappoint- 
 ments and failures. 
 
 The shrinldng of tissue is a most objectionable feature in 
 the cortex, often a,mounting to one-half the original 
 bulk. 
 
 The normal wealth of structm-e is greatly modified; in 
 this respect it is infinitely surpassed by fresh methods. 
 
 The absolute and relative depth of the various layers of the 
 cortex is subjected to most objectionable modifica- 
 tions. 
 
 It affects the cortex of different animals to a different 
 extent, thus interfering with comparative investiga- 
 tions. Many pathological and normal aj)pearances 
 are wholly obliterated by the " hardening processes." 
 
 Of all tissues, that of the brain, from its extreme delicacy 
 and susceptibility to rapid post-mortem change, is the tissue 
 which, above all others, demands a rapid, ready, and fresh 
 method of preparation, the employment of indifferent media, 
 and the restriction of all corrugating reagents. No method 
 as yet adopted can surpass for elegance, expedition, and 
 certainty the freezing method ; and, above all, it is f/w 
 method which should be chiefly trusted to in all exact 
 anatomical and pathological research. Yet, whilst we claim 
 for the fresh freezing methods such self-evident advantages 
 over the older process, the long series of objections to the 
 latter tabulated above must not induce us to blind our eyes to 
 the fact that it also possesses its own advantages and cannot 
 be dispensed with. Most of our classical descriptions of 
 cerebral structure refer to brain which has been subjected to 
 these methods of preparation ; and few indeed, far too few, 
 are the delineations of the minute structiu-es of the cortex 
 and medulla in the perfectly fresh brain. Hence, as a 
 question of simple comparison between the results of different 
 observers and our own, the hardening methods must still be 
 adopted. There are numerous other very apparent reasons
 
 THE METHODS OF RESEARCH. 87 
 
 ■why we cannot afford to dispense with the older processes, 
 and the student is therefore recommended, whilst guarding 
 himself from its fallacies, checking or confirming its results 
 by the fresh methods, to make himself equally familiar 
 with the practical details of both methods, and to learn to 
 discriminate the special work to which each process is more 
 particidarly suited. 
 
 Two Distinct Methods of Freezing. — Just as we find 
 amongst the list of reagents used for hardening brain, some, 
 and especially osmic acid, far less open to the objectionable 
 qualities possessed by alcohol and chromic acid, inducing in 
 fact very slight alteration in the relationships and bulk of 
 the tissue, so do we find the different methods of freezing- 
 possess their o^vn distinct and relative merit. This fact, 
 which it is all-important to recognize when dealing with 
 structures like the brain, has been wholly misunderstood or 
 overlooked by all authorities who have written upon the 
 subject, and we constantly find histologists grouping the 
 freezing by ice and salt with the ether freezing method, as 
 though both were equally suitable for all tissues alike. 
 Now the fact is that the ordinary ice and salt freezing micro- 
 tome is entirely useless for brain-structures, except after a 
 modification of the latter by a process of hardening, and 
 hence no longer a fresh method. Upon the other hand, the 
 ether freezing microtome is applicable to all tissues having a 
 consistence not above that of the liver, but is pre-eminently 
 adapted for nervous tissue. I find it necessary to insist upon 
 this point, since it seems generally understood that the ice 
 and salt mixture is suitable for freezing brain. Prior to the 
 introduction of freezing by ether, practised liistologists con- 
 stantly complained of the impossibility of obtaining fine 
 sections of brain by freezing, the objections being that hard 
 spiculse formed within its structm^e, and tore it up on cutting 
 through it. Yery lately this fact has been again asserted by 
 a skilled manipidator,^ who has even introduced a method of 
 
 ^ Vide Hamilton in the Journ. Anatomy and Fhys. vol. xii. p. 259.
 
 88 MINUTE EXAMINATION OF THE BRAIN. 
 
 combined hardening and freezing to overcome this very 
 unsatisfactory action. Hitherto, therefore, it may be 
 asserted that the use of the ice and salt microtome has 
 failed for the purposes of the cerebral histologist ; and 
 although by further development it may be rendered sub- 
 servient to his purposes, for the present the freezing of 
 brain-substance must be uniformly pursued upon the ether 
 freezing microtome. The methods available for the exami- 
 nation of the minute structure of the brain are as follows: — 
 
 Hardening processes for sections to be cut on the imbedding 
 
 microtome. 
 Hardening processes for sections to be cut on the freezing 
 
 microtome. 
 Fresh process by means of the ether freezing microtome. 
 Fresh process by a modified teazing and staining. 
 Fresh process by ordinary teazing with dissociating 
 
 reagents. 
 
 We will preface our account of these methods by a brief 
 outline of the more useful microtomes used.
 
 CHAPTER VIIL 
 microtomes for imbedding and freezing. 
 
 Microtomes for Imbedding. 
 
 Amongst the various instruments devised for cutting sections 
 of hardened tissues are the microtomes of Henson, Rivet- 
 Leiser, Brandt, Roy, His, Ranvier, Stirling, and Rutherford. 
 The instrument more generally used in this country is that 
 devised hy Stirling, and its modification by Rutherford, 
 either of which instruments will prove satisfactory to the 
 student ; whilst that of Ranvier may be employed where it 
 is desirable to grasp the microtome in the hand, or immerse 
 it during section-cutting in water or spirit. 
 
 The principle adopted in Stirling's instrument has been 
 very generally followed. In the last three named, the body 
 of the instrmnent consists of a metal tube or hollow cylinder, 
 fixed to a table by some simple arrangement, or held in the 
 hand in an upright or vertical position. A fine micrometer- 
 screw works into the lower end, driving through the hollow 
 of the cylinder a closely-fitted piston-plug, which in its turn 
 propels the mass in which the tissvie to be cut is imbedded. 
 The essential portion of this form of microtome, therefore, 
 is the body or cylinder, and the powerful micrometer-screw. 
 The body, or cylinder, includes the following divisions: — 
 the hollow, or " well " of the cylinder ; its closely-fitted 
 plug, or "piston ;" the upper smooth and levelled extremity, 
 or " section-plate ;" the lower extremity forming a " female 
 screw " for the reception of the micrometer-screw. It is far 
 preferable that the cylinder should be clamped by projecting
 
 90 MINUTE EXAMINATION OF THE BRAIN. 
 
 arms and screw to a firm support as a table. In choosing a 
 microtome for cutting sections of an imbedded tissue tbe 
 student must be guided by the following considerations. 
 The instrument should be strong but compact, and not 
 weighty or cumbersome ; it should possess appliances for 
 fixing it firmly and immovably to a supporting ledge or 
 table. Its well should be at least one inch in diameter, and 
 the oval section is to be preferred to the circular well, since 
 this form of well wholly prevents rotation of the imbedded 
 mass. The section-plate should be absolutely level, perfectly 
 smooth, polished, and show no irregularities of sm^face or 
 indentations around the margin of the well, which otherwise 
 would ruin the edge of the blade. The micrometer-screw 
 should be of powerful leverage, work evenly, easily, and 
 without the slightest " loss of time," and have a pitch of at 
 least fifty threads to the inch. Allowing his judgment to be 
 guided by the above rules, the student cannot err greatly in 
 his selection of a microtome for ordinary work and the smaller 
 class of sections. A few words on the different varieties of 
 instruments used may prove of service to the student. 
 
 1. Stirling's Microtome is a compact, strong, and 
 admirably finished instrument, embracing all the qualities 
 essential for the section-cutting of hardened preparations. 
 For small sections no better adapted form has yet been 
 devised, and for his earliest attempts in cutting hardened 
 brain the student is recommended to secui-e this form of 
 microtome. This instrument is made to be clamped to a 
 table, so that both hands are free for section-cutting. 
 
 2. Ranvier's Microtome, — This is a smaller but very 
 useful instrument. It has, however, to be held in the hand, 
 a defect which is in part counterbalanced by the ease with 
 which it can be immersed in spirit, and sections cut whilst so 
 situated. It is well adapted for sections of spinal cord and 
 the large nerve-trunks. 
 
 3. Rutherford's Microtome. — This, which is a modified 
 form of Stirling's microtome, is a most valuable instrument,
 
 MICROTOMES FOR IMBEDDING. 
 
 91 
 
 as it is well adapted for section-cutting of imbedded or of 
 frozen tissues. It will be described fully in the section on 
 freezing microtomes. It has the disadvantage of being some- 
 what cmnbersome as compared with the smaller " Stirling," 
 whilst at the same time as a freezing instrument for nervous 
 tissues it is excelled by the ether freezing microtomes. The 
 latter remark does not apply to other animal tissues. 
 
 4. Roy's Microtome^ consists of an inner vertical brass 
 plate covered with a layer of cork, and sHding by vertical 
 movement within an outer brass frame-work. A glass rod 
 of horse-shoe form is fixed horizontally by its extremities 
 into the brass frame, upon which the blade glides during 
 section-cutting. The imbedding mixtm^e is first cast in a zinc 
 mould, the tissue being placed in it, and when hardened, the 
 mass is fixed upon the cork plate. The vertical movement of 
 the brass slide is obtained by propulsion from a fine-threaded 
 screw fixed below. A simple tubulature, adapted to the 
 instrument, allows spirit or water to be blown upon the mass 
 when requii-ed. It has been stated that tissues may be cut 
 fresh with this microtome after freezing by the direct appli- 
 cation of the ether spray. The student must be cautioned 
 against any such attempt; for all tissues alike, the dii"ect 
 application of ether is to be deprecated, and for brain and 
 spinal cord and all nervous structures such a method is 
 wholly inadmissible. Eoy's microtome has the disadvantage 
 of not being readily fixed to a table during manipulation. " 
 
 5, Schiefferdecker's Microtome is described here as 
 appUcable to hardened preparations, although it is essentially 
 constituted to dispense with the method of imbedding. The 
 object to be cut is fixed within a hollow brass cylinder by 
 means of a clamp upon its surface worked b.y two screws. 
 In lieu of a propelling screw below, as in other microtomes, 
 a circular plate forming the section-plate can be elevated or 
 lowered by the revolution of an outer concentric plate which 
 
 1 Described and figured in the Journal of Physiology, vol. ii. No. 1. 
 
 2 Tlie instrument is made hy Mr. Gardner, South Bridge, Edinburgh.
 
 92 MINUTE EXAMINATION OF THE BRAIN. 
 
 turns upon a screw. The student will find this microtome 
 figured and described in the Qiiarterhj Jownial of Micro- 
 scopical Science for January, 1877. 
 
 6. Microtome for Slicing through Whole Hemi- 
 sphere of Human Brain. — The instrument which I have 
 had made for this purpose at the West Riding Asylum consists 
 of a heavy brass cylinder, 3 inches deep and 8 inches in 
 diameter, closed in below, where, however, its cavity com- 
 municates centrally with that of a small secondary cylinder — 
 the screw-socket. In this socket, which is 4 inches deep, 
 works a powerful and finely-threaded screw, having a milled 
 head 3 inches in diameter. A flat, circular brass plate, 
 accm'ately fitted to the interior of the upper cylinder or well, 
 is raised or lowered by means of the screw, the movement 
 being communicated to the imbedding mass, which rests 
 upon it above. The section-plate is constituted by the 
 projecting rim of the cylinder above, and is mathematically 
 level and smoothly polished. The microtome rests upon the 
 iron collar of a powerf id tripod stand. A zinc tray, 2\ inches 
 deep and 26 by 17 inches, can be adapted to the microtome- 
 cylinder, so that sections may be cut under water with the 
 greatest ease. 
 
 Microtomes for Freezing. 
 
 1. The Ether Freezing Microtome (Bevan Lewis). 
 — This microtome was described in the Journal of Anatomy 
 and Physiology for April, 1877, but has been modified and 
 improved in several resjDects by the present maker. ^ It 
 consists essentially of «, the body ; h, the freezing chamber ; 
 c, the section-plate. 
 
 a. The Body. — This is really a modified " Stirling micro- 
 tome," and forms the lower half of the instrument. Through 
 its central aperture works a brass plug, driven by a strong 
 but fine micrometer-screw. In my own instrument, the pitch 
 
 ' The improved microtome may be obtained of Mr. Gardner, 45, South 
 Bridge, Edinbvu'gh, who, at a minimum of charge, has fully perfected the 
 woi'kmanship. Descriptions of the microtome may be also found in Brain, 
 October, 1878; and in Dr. Stirling's " Text -book of Practical Histology."
 
 MICROTOMES FOR FREEZING. 
 
 93 
 
 of the screw is fifty tlireads to the inch ; the screw has a diameter 
 of ---inch, with a milled head, Ih inches across. A coarse 
 screw secures the body of the instrument to a table. 
 
 b. The Freezing Chamber. — This consists of a zinc cylinder, 
 closed above and below, pierced on either side by a large 
 
 Fig. 8.— The Ethee Freezing Microtome. (Original Model.) 
 
 aperture, to allow of the admission of the nozzle of the spray- 
 producer, as well as to permit free evaporation of ether, 
 much of which, however, condenses on the bottom, and is 
 conveyed off by the bent tube into a bottle attached to it. I 
 have found it convenient to have the zinc cylinder quite 
 21 inches wide by Ih inches deep, and the aperture in the side 
 of the instrument f -inch in diameter. 
 
 The cap or plate closing the cylinder above, I term the 
 freezing plate, and upon it rests the tissue, whilst the ether 
 spray plays upon the plate from below. The freezing- 
 chamber is thus rapidly reduced in temperature, and to pre- 
 vent conduction by means of the section-plate, it is well to 
 have a free interval all around the freezing cylinder, securing 
 it from actual contact with the section-plate.
 
 94 
 
 MINUTE EXAMINATION OF THE BRAIN. 
 
 c. The Section-Plate. — This is made either of metal or of 
 plate-glass, drilled with a central aperture, through which the 
 freezing chamber glides. If of metal, it should, by prefer- 
 ence, be made of a smooth, polished zinc plate, about -f -inch 
 thick, supported by strong vertical arms upon the body of 
 
 Fia. 9. — TnE Ether Freezing Microtome. (New Form.) 
 
 tlie instrument. I would strongly advocate the use of the 
 plate-glass, since it renders the movements of the knife abso- 
 lutely free and easy ; whilst, on the other hand, the blade 
 never gets injured from scratches, which, sooner or later, 
 invariably appear upon a metal section-plate, and wliich turn 
 or indent the edge.
 
 MICROTOMES FOR FREEZING. 95 
 
 To recapitulate — the various divisions of our microtome are 
 as follows : — 
 
 a. The "body," comprising the "well," the "piston," 
 and the " micrometer-screw." 
 
 h. The " freezing chamber," fitted with sloping false- 
 bottom, an " exit-tube," and capped by the " freezing 
 plate." 
 
 c. The "section-plate," drilled for the passage of the 
 " freezing chamber." 
 
 The Freezing Medium. — The best anaesthetic ether 
 should be employed. I find it more economical than 
 methylated ether. The ordinary Richardson ether spray is 
 the more generally used instrument ; but a further improve- 
 ment has been introduced by the maker, in the form of a 
 lateral support for the ether-spray apparatus, communicating 
 with a bellows worked by the foot. In this form, the spray 
 adjustment is easy, and the hands are both free for section- 
 cutting and manipulation, and thus a most substantial and 
 valuable improvement has been obtained, with but a very 
 trifling addition to the cost of the microtome. 
 
 2. Rutherford's Freezing Microtome.^ — This instru- 
 ment consists of a brass section-plate, with a central aperture 
 leading into the interior of a vertical tube, in which a plug 
 is fitted to move upwards or downwards by means of a fine 
 screw. The cylinder is surrounded on all sides by a metal 
 box covered with gutta-percha, which holds the freezing 
 mixture of ice and salt. An exit tube allows of the escape 
 of water. The whole instrument can be securely clamped to 
 a table. The method of using this instrument for freezing 
 is as follows : — The plug is first unscrewed and oiled, so as 
 to prevent its fixture clming the process of freezing. The 
 tissue to be frozen and cut is first immersed in a thick 
 
 ' "A New Freezing Microtome:" Monthly Micros. Journnl, vol. x. 
 p. 185. "Outlines of Practical Histology : " by William Rnlherford, M.D. 
 2ncl edit. p. 164.
 
 96 
 
 MINUTE EXAMINATION OF THE BRAIN. 
 
 solution of gum for some hours, " in order that the gum may 
 permeate every part of the tissue, and prevent the formation 
 of a crystalline condition within the frozen tissue." If the 
 tissue has been previously immersed in alcohol, all traces of 
 the latter shoidd be first removed by soaking in water. 
 Equal parts oi finely-powdered ice and salt are now placed in 
 the freezing box and stirred around the well, whilst the latter 
 is filled with the solution of gum. As the gum freezes 
 around the periphery, the tissue is plunged into it, and held 
 
 Fig. 10. — Exttherford's Freezing Microtome. 
 
 until it is fixed by the advancing ice. Care should be taken 
 to keep the exit-tube of the box open, so as to allow of free 
 escape of water, and to close the freezing box by a weighted 
 strip of cork, to prevent the entrance of heat and to exclude 
 the salt of the freezing mixture. By this method the freez- 
 ing process may be accomplished in from ten to twenty 
 minutes. All delicate tissues require a sipecial prejmrofion to 
 adapt them for this process, otherwise the water which they 
 contain freezes into hard icy spicules, whicli tear the structure
 
 MICROTOMES FOR FllEEZTXG. 9T 
 
 when it is cut. Dr. Pritchard has therefore recommended a 
 prior immersion of the tissue in thick solution of gmn-arabie, 
 using the same solution as the imbedding material. 
 
 Quite recently, Dr. Hamilton whites as follows with regard 
 to freezing the nervous structures, and especially brain, by 
 means of the ice and salt microtome. " It was found that 
 the crystals of ice so broke up the delicate nervous tissue as 
 
 to render it totally useless for minute examination I 
 
 attempted two years ago to modify the method of freezing, 
 but without success, and accordingly gave it up as an almost 
 hopeless task." ^ 
 
 According to this statement, the writer's exi^erience tallies 
 wholly ^^'ith my own ; and f idly acquainted as he was with the 
 methods of steeping tissues in gum prior to freezing which 
 were adopted by Dr. Eutherford, it is clear that this method 
 of freezing was not applicable for fresh brain, although it 
 answers admirably in the case of firmer and less delicate 
 textm-es. Dr. Hamilton overcame the difficulty of freezing 
 brain with the ice and salt mixture, but at the expense of 
 sacrificing the fresh for the chrome hardening process, a 
 special procedure being requisite, which will be considered 
 further on. Now it is after such considerations that we 
 recognize the undoubted superiority of the ether freezing 
 microtome for nervous structures. It has been stated that the 
 ether freezing process has been entirely superseded by the 
 introduction of ice and salt, or other mixtures, which by con- 
 stant refrigeration keep the mass in a frozen state for houi's. 
 All practical manipulators, however, know that this is, as 
 regards nervous structures, a fallacy and a blunder, since the 
 very excellence of the ether freezing method depends upon 
 the fact that it can be checked at any stage and renewed 
 when required. This is the all-important consideration in 
 freezing brain, for beyond certain limits it is frozen into a 
 hard icy solid, which at once blunts or tm-ns the edge of the 
 blade ; but with the ether-spray this stage need never be 
 attained, and a consistence is obtained admirably adapted for 
 
 ' Jonrti. of Aiuif. and riiijs. vol. xii. p. 257. 
 
 H
 
 98 MINUTE EXAMINATION OF THE BRAIN. 
 
 section-cuttiug. The student should therefore bear in mind 
 that the constant cqyjjiication of a freezing mixture to fresh brain 
 cannot but result in failure for section-cutting ; and that bi/ use 
 of the ether process the prior jnrparation of brain by hardening, 
 or by immersion and saturation in mucilaginous fluids, may be 
 wholly dispensed irith. 
 
 3. Williams' Freezing Microtome.^ — In this instru- 
 ment a wooden tub containing a freezing mixture of ice and 
 
 Fig. 11.— Williams' Freezing Miceotome. 
 
 salt is covered by a glass lid, the frame of which is seciu-ed 
 by a clamp screw. An upright brass conducting-bar passes 
 from the interior of this box through a central apertm-e in 
 the lid, and to the extremity of this bar is screwed the 
 circular brass plate which supports the tissue to be frozen. 
 The arrangement of the knife is peculiar, since it is fixed in 
 
 1 This instrument is made by Messrs. Swift & Son, University Street, 
 London.
 
 MICROTOMES FOK FREEZING, 99 
 
 a triangular frame, and can be either raised or lowered by 
 the screws which are adapted to the frame. There are three 
 additional plates for supporting the frozen object, and a brass 
 cup for holding substances, which are fixed in cacao-butter 
 or paraffin. 
 
 The box is filled with equal parts of pulverized ice and 
 salt, care being taken to prevent the mixture touching and 
 so fixing the cover. After the cover is replaced and screwed 
 down, the substance to be cut is placed on the central brass 
 plate, surrounded by a little solution of gum, and the appa- 
 ratus is covered with baize to facilitate freezing. When 
 frozen, raise the blade, and after the fii'st cut across, proceed 
 as follows : — Each end of the razor must be presented to the 
 surface of the section, and exactly levelled by means of each of 
 the hack screws. If the large back screw be now tiu-ned, the 
 blade can be lowered to any required extent ; and since a 
 complete revolution of the screw gives us a section -p^-jy-inch 
 in thickness, and the screw-head is graduated into sixths — a 
 movement through sixty degrees gives us a section ^-^p-inch 
 thick. 
 
 The special featm'es of this microtome, in which it differs 
 materially from others already described, consist in an 
 arrangement whereby the blade and not the imbedded or 
 frozen tissue becomes the movable part of the instrument ; 
 and the edge of the knife is only brought into contact with 
 the substance to be cut. 
 
 h2
 
 CHAPTER IX. 
 
 PREPARATION OF HARDENED BRAIN. 
 
 In subjecting the brain to the agency of hardening reagents 
 certain important conditions should always be kept in mind, 
 as they are essential to success. The conditions are as 
 follows : — 
 
 a. The reagent should act equably upon all portions of 
 
 the tissue. 
 
 b. The requisite consistence must be acquired at the 
 
 expense of the minimum of alteration and shrinking 
 of tissue. 
 
 Now the fii'st of these conditions can only be obtained by 
 ensuring a thorough saturation of the tissue throughout, so 
 that the fluid permeates rapidly to the central or deepest 
 portions of the mass. It is evident that the surface of the 
 tissue being bathed in the reagent will be more actively 
 affected by the latter than the more distant parts within, 
 and thus arises the danger of a too rapid hardening of the 
 exterior, which forms a mechanical impediment to the per- 
 meation of the deeper structures by the surrounding fluid. 
 Always, therefore, take the precaution to ensure a free and 
 rapid permeation of the tissues by the fluid. 
 
 Again, if any portion of the surface is in close contact with 
 the side of the containing vessel, it necessarily is less affected 
 than the surface bathed in the fluid. The mass should there- 
 fore be so suspended that it is equably bathed all around in the 
 reagent.
 
 PREPARATION OF HARDENED BRAIN. 101 
 
 Another important consideration is that of temperature, for 
 under the most favourable cii'cumstances the central or deeper 
 structures must remain far less subject to the action of the 
 reagent than the exterior of the mass, and are, therefore, the 
 parts which most readily succumb to putrefactive changes. 
 The larger the mass, therefore, to be hardened, the moi'e 
 difficult is it to prevent central decay, whilst an elevated 
 temperatui'e induces the same result. The tissue to be 
 hardened should therefore be of moderate hulk as compared 
 with the fluid in which it is immersed, and the preparation 
 should be kept in a cool spot, or better still, in an ice safe. 
 
 The next condition we have named, and which it is equally 
 important to secure, is that a minimum of shrinking of tissue 
 should result from the action of the reagent, and it is a well- 
 known fact that all the reagents used for this purpose will, if 
 employed in too concentrated a form, ruin the preparation 
 by inducing extreme shrinking and brittleness of the mass ; 
 whilst again, some of these reagents are far more reliable than 
 others, and less open to these disadvantages. The more 
 commonly used hardening reagents are — osmic acid, Miiller's 
 fluid, solutions of the chrome salts, chromic acid, picric acid, 
 methylated spuits, and alcohol. Now this list represents their 
 relative value as hardening reagents for nervous tissues, osmic 
 acid and Miiller's fluid standing at the head of the series as 
 the most valuable and least injurious in their action, chromic 
 acid and alcohol occupying a far less prominent position in 
 the scale. In order therefore to secm^e the tissue from 
 injurious shrinking, employ in preference to the others the 
 reagents noted at the head of the list, and use the weakest solu- 
 tions compatible with safety to the tissue, commencing with the 
 weakest, and gradually augmenting the strength of the solu- 
 tion, or, later on, even replacing by the more astringent 
 reagents. Let us now detail throughout the process recom- 
 mended to the student for his first essay in chrome-harden- 
 ing, subsequent to which it will be useful to briefly dwell 
 upon the various modifications of the process adopted by 
 others.
 
 102 MINUTE EXAMINATION OF THE BRAIN, 
 
 § PROCESS OF HARDENING BY CHROME. 
 
 1. Miiller's Fluid and Potassium Bichromate. — 
 Excise a portion of the ascending frontal or parietal convolu- 
 tion of human brain, cutting across its length so as to remove 
 about an inch of the convolution along with its central and 
 deeper medulla. Lightly cover it all round with a little 
 cotton-wool, and immerse it in from two to three ounces of 
 methylated spirits contained in a four-ounce stoppered bottle. 
 
 Label the bottle with the name of the specimen and date, 
 placing it in a cool cellar or ice safe. 
 
 In twenty-four hours pour away the spirit, replacing it by 
 four ounces of Miiller's fluid, the preparation being sur- 
 rounded as before by cotton-wool to ensure it being bathed 
 upon all sides alike by the fluid. 
 
 Let the bottle stand in a cool spot, and in three days 
 replace the fluid by a fresh quantity. At the end of one 
 week the fluid should be again renewed, or, preferably, a. 
 weak solution of potassium bichromate substituted (2 per 
 cent.). At the end of the second week a solution of the latter 
 of double the strength may be added ; and if at the termina- 
 tion of the third week the mass is still pliable, and of the 
 consistence of ordinary rubber, it is as yet unfit for section- 
 cutting, and the reagent should be rej)laced by a solution of 
 chromic acid. 
 
 In these later stages the chromic acid expedites the process 
 without producing the extreme shrinking of tissue which 
 ensues if it be used at earlier stages. For the same reason 
 even absolute alcohol may at this stage be employed, but 
 although valuable in the preparation of the spinal cord, it 
 cannot be equally well recommended for the cortex of the 
 hemispheres. By the above process our preparation will have 
 attained the requisite consistence within a period of from four 
 to eight weeks. It will be observed that in the various steps 
 of this process the conditions previously emphasized as essential 
 to success are obtained. Thus the early immersion in methy-
 
 PREPARA.TION OF HARDENED BRAIN. 103 
 
 lated spirit abstracts all superfluous fluid from the brain aud 
 its vessels, and entering its substance by its afiinity for water, 
 aids in tbe rapid permeation of the mass by the chromic solu- 
 tion in the next stage. The more prolonged action of the 
 spirit would, however, prove highly detrimental. Again, the 
 cotton- wool ensures an equable distribution of fluid around, 
 whilst the comparative bulk of the mass and fluid in which it 
 is immersed, and the temperature to which it is exposed, 
 provide for equable hardening to its deepest structures, and 
 ensure it against decomposition. The gradual increase in the 
 potency of our reagents from Miiller's fluid to the strong 
 solutions of chrome is also an adjunct to the hardening of 
 the central portions, whilst we also expedite the process 
 of hardening. 
 
 2. Potassium Bichromate and Chromic Acid 
 
 (Eutherf ord) . — Place small portions of the cerebrum in 
 methylated spirit for twenty-four hours, observing the same 
 precautions as to relative bulk of the preparation and the 
 reagent, covering with cotton-wool, and leaving in a cool 
 place. Replace the spirit by a mixture of potassium bichro- 
 mate and chromic acid. The proportions may advantageously 
 be varied, according to the condition of the structure to be 
 hardened ; but the solution recommended by Rutherford, and 
 which answers well, contains 1 gramme of chromic acid and 
 2 graromes of potassium bichromate to 1,200 c.c. of water. 
 Change at the end of eighteen hours, and then once a week. 
 Should the tissue not be sufficiently tough for cutting at the 
 end of six weeks, place it in a ^ per cent, solution of chromic 
 acid for a fortnight, and then in rectified spirit. 
 
 3. Iodized Spirit and Potassium Bichromate (Betz). 
 — Large portions of cerebrum may also be placed for a few 
 hoiu-s in methylated spirit, tinted of a light sherry-brown by 
 tincture of iodine. Add fresh iodine solution as the colour 
 fades. In one or two days remove the pia mater, and return 
 the preparation to the solution, adding to the latter haK its 
 bulk of fresh iodized spirit. After the lapse of another period
 
 104 MINUTE EXAMINATION OF THE BRAIN. 
 
 of two days, replace tlie solution by iodized alcohol (alcohol 
 70° — 80°) tinted of a sherry-brown by a tincture of iodine. 
 In from two to three days it should be transferred to a 4 per 
 cent, solution of potassium bichromate until sufficiently 
 hardened for section-cutting. Shoidd a brown deposit form 
 over its surface during the process, let it be well washed, and 
 a fresh solution used. When hardened, these preparations 
 may be kept permanently in 0*5 per cent, solution of bichro- 
 mate. If the cerebellum is to be hardened, the segments are 
 at once placed in the iodized alcohol, adding fresh iodine 
 frequently as the colour of the solution j)ales. Remove, the 
 pia mater on the second or third day, and in a week transfer 
 to pm'e methylated spirit for twenty-fom^ hours, and finally 
 harden it in a '5 per cent, solution of potassium bichromate. 
 This process, recommended by Prof. Betz, is not suitable 
 for examination of the cortex, as the iodized spirit is injurious 
 to the after-processes of staining. It is, however, especially 
 suited for obtaining large sections through the hemisphere, 
 the whole cerebrum and cerebellum, when sliced evenly across 
 into segments |-inch thick, being most satisfactorily hardened 
 throughout. For the minute examination of the cortex 
 methods 1 and 2 are pre-eminently to be preferred. 
 
 4. Miiller's Fluid and Ammonium Bichromate 
 (Hamilton). — This method is especially applicable to large 
 segments of the brain, and is much to be preferred to the 
 process by chromic acid, 5. The brain is sliced completely 
 through into segments about one inch thick. Each segment 
 may now be placed in a large vessel, such as a brain-prepara- 
 tion jar, padded with cotton-wool, and containing a com- 
 paratively large bulk of the solution, which consists of three 
 parts of Midler's fluid to one part of methylated spirit. A 
 refrigerator or ice safe should invariably be employed to pre- 
 clude decomposition, and the pieces should be turned over 
 occasionally in the solution. In about three weeks they 
 may be transferred to a solution of ammonium bichromate 
 (•25 per cent.). At the end of the fom'th week replace by a
 
 PREPARATIOX OF HARDENED BRAIX. 105 
 
 1 per cent, solution of the same salt, and the following week 
 by a 2 per cent, solution, in which they remain until fit for 
 section-cutting. 
 
 5. Chromic Acid Solution (Lockhai-t Clarke). — The 
 convolutions of the cerebrum and cerebellum were by tliis 
 process hardened in a 0*25 per cent, solution of the crystallized 
 chromic acid — a stronger solution rendering them far too 
 brittle for section-cutting. As stated above, chromic acid is 
 not adapted for hardening so satisfactorily and uniformly as 
 the chrome salts. This method, emploj^ed by Lockhart 
 Clarke, has been superseded by more reliable methods, as 
 are also the processes recommended by Stilling, Kolliker, 
 Hanover, and Yan-der-Kolk, for the hardening of nervous 
 textm'es. 
 
 § HARDENING BY OSMIC ACID. 
 
 It has been already stated that osmic acid (OsO^) is one of 
 the most reliable agents for hardening the brain and other 
 nervous textures which we possess. Prof. Sigm. Exner, of 
 Vienna, has therefore devised a method whereby small por- 
 tions of the brain may be prepared for section-cutting by 
 means of this reagent.^ 
 
 Exner's Process. — A small portion of brain, not ex- 
 ceeding one cubic centimetre in size, is placed in ten times 
 its volume of a solution of osmic acid (1 per cent.). The 
 solution should be replaced by a fresh reagent of the same 
 strength after the lapse of two days — a proceeding which may 
 be advantageously repeated at the end of the fourth day. In 
 from five to ten days the piece is usually stained throughout, 
 for this reagent has the valuable property of hardening and 
 staining simultaneously. The hardened brain is then washed 
 in water, plunged for a second in alcohol to facilitate the 
 imbedding, and sections are cut in the iisual way in an 
 
 ' "Zur Kenntniss vom feineren Baue der Grosshimrinde." Aus dem 
 Ixxxiii. Bande der Sitzb. der k. Akad. dcr Wissensch. iii. Abth. 1881.
 
 lOG MINUTE EXAMINATION OF THE BRAIN. 
 
 ordinary microtome. The subsequent treatment of these 
 sections will he given later on, when methods of staining and 
 mounting are considered. It is only necessary here to remind 
 the student that osmic acid is really a most valuable agent in 
 the investigation of brain-structm^e, and he shordd avail him- 
 self of every opportunity of becoming familiar with its action. 
 
 § SUMMARY OF PROCESSES FOR 
 HARDENING. 
 
 The student having been thus placed in possession of the 
 more valuable methods for preparing the brain for the 
 imbedding microtome, it will be well to indicate the method 
 he should adopt in his earlier attempts, as each process has its 
 own individual merits. It is advisable that his first attempts 
 should be made with comparatively small portions of tissue 
 — about 3 c.c. in bulk — and that he should employ the 
 process of hardening by Miiller's fluid and potassium bichro- 
 mate. 
 
 1. This process, to which I assign the first place amongst 
 the chrome-hardening processes, is slow but very certain. The 
 results are, to my mind, more satisfactory than those of any 
 of the other methods, and I invariably adopt it myself as the 
 one for general use at the West Riding Asylum. The vessels 
 which the student will find most convenient to use for harden- 
 ing these smaller portions of tissues are the stoppered glass 
 bottles of 4-oz. capacity employed for dispensing purposes. 
 Each bottle should be labelled with the name of specimen and 
 date and nature of each successive change of reagent, whilst 
 the specimen should occasionally be removed, and its con- 
 sistence noted so as to familiarize the touch with the increas- 
 ing firmness of the tissue, and the degree of hardness 
 requisite. The method recommended by Rutherford (2) is 
 also very reliable for moderate-size specimens. The methods 
 advocated by Betz and Hamilton (3, 4) are peculiarly well 
 adapted for large segments of the brain, a whole hemisphere
 
 rilErARATlON OF HAKDEXED BKAIN. 107 
 
 being thus readily hardened throughout. When these large 
 masses of tissue have to be dealt with, special precautions are 
 requisite. Thus the hemisphere should be sliced horizontally 
 or vertically into segments not over f-inch in thickness. 
 Each segment should rest upon a bed of cotton-wool in the 
 vessel for its reception ; and if two segments are included, 
 another stratum of cotton-wool should be interposed betwixt 
 them. The vessels containing the specimen should be of 
 large size, varying in capacity with the bulk of the latter. 
 Thus a large preparation glass, such as is used for preserving 
 brain in spirit on museum shelves, mil be found well adapted 
 for hardening the whole hemisphere ; whilst pickle-bottles, 
 esjDccially those provided vdth. the " patent lever stopper," are 
 most suitable for the basal ganglia, cerebellimi, smaller por- 
 tions of the cerebrimi and the pons. Still smaller segments, 
 such as the student will have more frequently to deal with, 
 are best hardened in the 4-oz. stoppered bottle, a good 
 supply of which should be kept on hand. All the foregoing 
 processes are contrasted with that of Exner's (osmic acid) 
 in being most adapted for the demonstration of the nerve- 
 cells and plexuses of the grey matter of the brain and its 
 ganglia ; whilst the latter, failing in this respect, is, on the 
 other hand, infinitely better suited for exhibiting the struc- 
 ture of the cerebral medulla and its extensions into the cortex 
 of the brain. The student is therefore recommended to make 
 himself acquainted with the structures of the cortex by the 
 chrome methods, and subsequently to employ Exner's method 
 for demonstrating the medullated tracts of the cortex. 
 
 § IMBEDDING AND SECTION-CUTTING. 
 
 Having satisfied himself that the specimen is sufiiciently 
 hard for section-cutting, the student first cuts off a portion 
 which can be accommodated by the well of the microtome, 
 and prepares it for imbedding by a prior immersion for a 
 few minutes in rectified spirits. This removes the fluid 
 derived from the chrome solution from which it has been
 
 108 MINUTE EXAMINATION OF THE BRAIN. 
 
 taken. In the meantime the imbedding mass should he 
 melted at the lowest temperatm-e requisite. The micrometer- 
 screw should he lowered sufficiently to allow of a deep imbed- 
 ding of the tissue. The preparation is next removed from the 
 spirit, rapidly dried by a fold of blotting-paper, and momen- 
 tarily plunged into the warm imbedding mixtiu'e, which, upon 
 its removal, leaves a film over its surface, whilst all small 
 cavities or lacuna which it may contain are filled up. The 
 melted mass is now poured into the well of the microtome, 
 and the preparation immersed and held in the position re- 
 quired for section-cutting until fixed by the cooled and con- 
 solidated mass. If the imbedding mass is one subject to 
 much contraction on cooling, it is requisite, just as it is 
 becoming " set," to press down with the end of a spatula the 
 margin of the wax and the oil mass against the sides of the 
 well. 
 
 The Imbedding Mass. — In the process of imbedding, 
 the principle to be remembered is that the mass should be not 
 too resistant to the blade, whilst at the same time it affords 
 efficient support for the imbedded tissue. If the textm-e be 
 one readily permeated by the imbedding mixture, contraction 
 of the latter in cooling is apt to result in injmy to the prepa- 
 ration, more especially if this be one of the more dehcate 
 structures. Thus, in the delicate embryos of the fowl and 
 other similar organisms, special methods of imbedding will 
 be requisite. For the brain and spinal cord, however, the 
 process is comparatively simple, since the imbedding mass 
 neither permeates its structures nor injures it by contracting. 
 
 The following are the more important media employed for 
 imbedding prior to section-cutting : — 
 
 1 . White wax. Olive oil, equal parts. 
 
 2. White wax, 3 parts. Olive oil, 1 part. 
 
 3. Wliite wax. Cacao -butter. 
 
 4. Solid paraffin, 5 parts. Hog's lard, 1 part. 
 
 6. Solid paraffin, 5 parts. Paraffin oil, 1 pai-t. Hog's lard, 1 part. 
 
 6. Solid paraffin, 5 parts. Spermaceti, 2 parts. Hog's lard, 1 part. 
 
 7. Spermaceti, 4 parts. Cacao-butter, 1 part. 
 
 8. Spermaceti, 4 parts. Castor oil, 1 part.
 
 PREPARATION OF HARDENED BRAIN. 109 
 
 The first on this list is perhaps the more generally employed 
 medimn, but it possesses the disadvantage of contracting 
 strongly on cooling, so as to leave an interval betwixt the 
 wax plug and the sides of the well : this, of course, will 
 necessarily tend to loosen the mass, and allow rotatory or 
 " wobbhng " movements, which prevent accurate section- 
 cutting. These disadvantages may be overcome by one or 
 other of the following measures : — 
 
 Yary the proportion of the oil and wax in favour of the 
 former. When solidifying, press down the edge of 
 the mass with a spatula. Use a microtome plug wdth 
 groove or projections on upper surface. Drive the 
 mass out of the well, partly surround it with a narrow 
 strip of blotting-paper, and return it — forcibly pressing 
 it down into the well — the blotting-paper swells by 
 imbibition of the spirit in section-cutting, and so fixes 
 the plug firmly. 
 
 In the use of the third medium, viz., white wax and cacao- 
 butter, far less contraction ensues upon solidification, and a 
 firm supporting mass is obtained, the proportion of the in- 
 gredients varj'ing with the firmness required. I can also 
 speak favourably of the combination of paraffin with hog's 
 lard. In all these cases it is well to keep the mass in a 
 small tinned pot with lip, provided with cover and handle, so 
 that it can readily be held over a gas-jet or Bunsen burner, 
 and melted as required. Another imbedding agent used is 
 gum, which is solidified by the application of alcohol or 
 methylated spuits. This method, proposed by Briicke, 
 although valuable for many tissues, cannot be recommended 
 for brain. ^ 
 
 Imbedding is wholly dispensed with in the form of micro- 
 tome devised by Schieif erdecker, where the preparation having 
 been hardened by alcohol as far as practicable, is placed in 
 the well and clamped firmly by the arrangement already de- 
 scribed. In the small hand-microtome of Eanvier, again, the 
 
 1 " Handbook of the Physiological Lahoratoiy," p. 92.
 
 110 MINUTE EXAMINATIOX OF THE HRAIN. 
 
 ordinary melted media for imbedding are often exclianged 
 for elder-pith, whicli is packed around the tissue in the well 
 in a dry state, and then, upon immersion in spirit, the pith 
 swells and firmly fixes the preparation. None of these latter 
 methods are so suitable for hardened brain as imbedding in 
 the wax and paraffin mixtures. 
 
 Section-Cutting. — The preparation being satisfactorily 
 imbedded, and the mass perfectly cold and hard, our next 
 procedure is to cut the finest possible sections — they cannot 
 he cut too fine. Place on the table supporting the microtome, 
 and in front of the latter, two vessels, one a Griffin beaker- 
 glass of three inches diameter, and the other a cylindrical 
 glass jar, a brain-preparation jar, or better still, a flat-bottomed 
 porcelain evaporating basin. Nearly fill the beaker with 
 methylated spirit, and the latter with water. Seat yourself 
 in front of the microtome at a convenient level for the free 
 play of the hands, place a soft towel over the knees, to be 
 used for wiping off adherent wax from the imbedding mass. 
 Have close at hand, also, a razor-strop, a porcelain capsule of 
 small size, and some camel-hair brushes. 
 
 Dip the section-blade in the methylated spirit, and having 
 raised the imbedded mass slightly above the level of the sec- 
 tion-plate, slice off the superficial portion, exposing a clean 
 smooth siu'f ace of the tissue for cutting. Again dip the blade 
 into the spirit, and turning the micrometer-screw, say through 
 one-eighth of a revolution, place the flat of the blade upon the 
 section-plate in front of the mass, with the back towards 
 yourself and the handle in your right hand, grasped near the 
 heel of the blade. Now cut your first section by a clean 
 steady sweep from heel to point, and always aicay from your- 
 self. No saw-like movement should be performed, nor should 
 the blade be arrested occasionally in its course, the section 
 shaved continuously and evenly off the preparation. The 
 thin film of wax removed from the front of the tissue is 
 sometimes likely to get in the way of very fine sections, and 
 hence it is usually advisable, with a penknife to gently
 
 PEEPARATION OF HARDENED BRAIN. Ill 
 
 remove all the imbedding mass in front of the preparation 
 to about the depth of a couple of millimeters prior to section- 
 entting. Subsequent sections should be cut with a still more 
 restricted movement of the screw, until the operator has foimd 
 the minimum degree of movement at which a section can be 
 cut. This, of coiu-se, is a matter of tact, and the student 
 will find that he daily improves the quality of his sections 
 by practical manipulation. Two precautions must ever be 
 taken if successful sections are desii-ed. The first is, that as 
 the blade is raised out of the spirit, the latter should not be 
 drained off, but a good flow be retained over the surface of 
 the blade, so that the section is floated up as it is cut. In 
 the next place make it a rule to pass the blade across the 
 strop frequently, after cutting half-a-dozen sections, as it 
 requu-es to be kept at the flnest possible edge. As the 
 sections are cut they are floated off into the porcelain basin 
 of water, and are freed from adherent particles of the 
 imbedding mass by the rapid gyratory movements they here 
 tmdergo from the euiTents caused by the attraction of water 
 for the spirit they contain. After floating off each section 
 in the water, pass the blade softly over the towel to clear its 
 surface from adherent wax, prior to bathing it afresh in the 
 spiiit. How is the student to ascertain whether his sections 
 be sufficiently thin ? The exact thickness of the section is 
 ascertained if the pitch of the micrometer-screw is known, and 
 the degree of movement which he adopts noted. Thus, if the 
 screw have eighty threads to the inch, a movement through 
 one-eighth of a complete tm-n, i.e., 45°, will give a section 
 ■g-J-Q-inch in thickness, whilst a movement through an 
 arc of 30°, or one-twelfth the entire turn, gives a section 
 g-^-o-inch thick. He will, however, be not far fi'om wrong 
 by following this rule : reject all sections which do not float, 
 and of the latter preserve as valuable only those which appear 
 as a mere film on the surface of the fluid, requiring to be 
 looked at sideways to be distinctly seen. It is at this stage 
 of the proceeding, that of section-cutting, that we can best 
 judge of the merits of the imbedding mass, which, if found
 
 112 MINUTE EXAMINATION OF THE BRAIN. 
 
 unnecessarily resistant to the blade, should be modified by 
 the addition of more of the diluting adjuncts, viz., lard, oil, 
 or cacao-butter. 
 
 The Section Blade. — This is an item of supreme im- 
 portance to the histologist, and it is by no means true, as we 
 often find asserted, that any razor blade answers the pm^pose 
 equally well with the specially prepared knives. I have 
 found this statement made frequently by those who were by 
 no means fortunate in the thinness and delicacy of their 
 sections ; whilst all with whom I am acquainted, who can 
 rejoice in the good qualities of their sections, have always 
 paid great attention to the section-blade which they employ. 
 The qualities of a good blade for section-cutting upon the 
 microtome depend upon its make, form, edge, and tempering. 
 It shoidd be sufficiently long to ensure a free sweep over the 
 whole surface of the section-plate from heel to point, wide 
 enough from back to edge to support and float up the 
 largest-sized section which might have to be cut ; it should 
 be hollowed out on both sm-faces, but be most concave on the 
 sui'face uppermost in section-cutting ; the edge should be 
 extremely sharp, and perfect, whilst the angle formed by the 
 converging sto-faces here should not be so acute as to involve 
 bending of the blade when subjected to slight pressure ; the 
 quality and tempering of the steel should be of the best 
 character. The above points are all most essential require- 
 ments in a good section-blade ; but another important con- 
 sideration is that the plane of the back and edge of the knife 
 should exactly coincide when it rests upon a perfectly level 
 surface as the microtome section-plate — not the slightest 
 degree of tilting being admissible. 
 
 For the smaller microtomes I have invariably used razor- 
 blades, my three instruments measuring in length and width 
 of cutting- surface as follows : — 
 
 No. 1 . 4 inches x 1 incli (made by Weeclon) . 
 
 4i 
 
 1) 
 
 X 1 ,, 
 
 ( 
 
 II 
 
 Young) 
 
 5 
 
 )> 
 
 X U M 
 
 ( 
 
 j» 
 
 Yonng)
 
 PREPARATION OF HARDENED BRAIN. 113 
 
 The first is a most valuable knife. It is fitted into a short, 
 firm, and fixed handle. The latter, which is my favourite 
 blade, has a folding handle, and is sketched in outline with a 
 section of its concave surfaces in an early number of Brain} 
 Some of the earliest and most discouraging failures upon the 
 part of the tyro in section- cutting depend upon the condition 
 of the blade, and it is necessary that he should be fully 
 impressed with the fact that not only must he secui"e a couple 
 of section-knives with the above qualities, but that he should 
 jealously keep them in most perfect order. To ensure 
 the latter condition, let him observe the following precau- 
 tions : — 
 
 Use no undue pressm^e against the section-plate whilst cut- 
 ting, and keep the surface of the blade absolutely level with 
 the plate. Pass it frequently along the strop whilst cutting 
 sections. After each day's work examine its edge most 
 critically, and if the slightest irregularity or notching be 
 apparent, it must be reset before use. 
 
 Keep the blade dry and well polished by a soft handker- 
 chief, and if in a closed handle, have a chamois-leather case 
 made for it. - 
 
 Subsequent Treatment of Sections. — The sections 
 have now to be removed carefully by a camel-hair brush to 
 methylated spirit contained in the small porcelain capsule, in 
 which they may be allowed to soak for some time to remove 
 all traces of chrome, which otherwise interferes with the 
 subsequent staining they have to undergo. 
 
 Large Sections through Hemisphere. — The above 
 account refers especially to the smaller class of sections. 
 When it is requisite to obtain sections upon a much larger 
 scale, such as those thi'ough the hemisphere or the whole brain, 
 the process requires modification. The method of imbedding 
 is precisely similar in all its details, but when we come to 
 
 ^ V'nh- Brain, part iii. p. 3r>3. October, 1878.
 
 114 MINUTE EXAMINATION OF THE BRAIN. 
 
 cutting the section, special forms of knife are found requisite. 
 The blade which I use measures 16 inches long by 2 inches 
 wide, and is fixed in upright handles at each end. The zinc 
 basin in which the large microtome rests is filled with water, 
 and then sections are cut with a saw-like movement of the 
 blade, and not, as in the former cases, by one complete sweep 
 through the structures. It requires a steady hand and much 
 manipulative skill to obtain these larger sections both thin 
 and perfect, and the student will only perfect himself by 
 frequent and persevering efforts. These large sections can 
 be readily removed by means of sheets of paper upon Avhich 
 they are floated, and this support may be given to them 
 throughout the various subsequent stages of preparation. 
 When the desired number of sections have been obtained, 
 the imbedded plug may be removed, the remaining portion 
 of tissue placed in a 0*5 per cent, solution of bichromate of 
 potash, until required. The microtome should be carefully 
 dried and placed away in a drawer for safety, as the slightest 
 scratching of the polished section-plate will ruin a good blade 
 in a few minutes. 
 
 Apparati;s for Hardening Tissues and 
 Section-cutting. 
 
 Winchester bottles for hardening reagents. 
 
 Jars and 4-oz. phials for hardening tissues. 
 
 An ice safe. 
 
 Microtome for imbedding. 
 
 Microtome for freezing. 
 
 Griass " preparation- j ar " for receiving sections. 
 
 Imbedding mass. 
 
 Spirit lamp. 
 
 Porcelain capsule. 
 
 Griass beaker for methylated spirit. 
 
 Ether spray apparatus. 
 
 Section-knife.
 
 PREPARATION OF HARDENED BRAIN. 115 
 
 § STAINING AND MOUNTING SECTIONS OF 
 HARDENED BRAIN AND CORD. 
 
 The staining reagents advocated by different authorities 
 for sections of the nervous system prepared by hardening are 
 numerous, and the list has become so lengthened since the 
 earlier labours of Lockhart Clarke, Van-der-Kolk, and others, 
 that one great difficulty presented to the student is to make 
 a judicious selection of such as will yield him the best results 
 in the special direction pursued by his work. Amongst 
 those more generally used are carmine and its combinations, 
 picro-carmine, indigo-carmine, and borax- carmine ; the 
 aniline series, comprising aniline blue-black, auiline blue, 
 methyl-aniline, rosanilin or magenta ; hoematoxylin or log- 
 wood ; eosin ; picric acid ; osmic acid ; double chloride of gold 
 and potassium. Many years' experience has convinced me 
 that a large proportion of these reagents may be safely dis- 
 pensed with. The following really comprises all essential 
 staining solutions for nervous tissues : — 
 
 Haematoxylin. 
 
 Carmine in ammoniacal solution. 
 
 Picro-carmine. 
 
 Aniline blue-black. 
 
 Aniline blue. 
 
 Osmic acid. 
 
 The only solution comprising a double pigment in this 
 list is the picro-carmine, but double staining may be exten- 
 sively employed by the combined agency of the above and 
 two other dyes, the more useful being as follows : — 
 
 List of Pigments for Dourle Staixtxo. 
 
 Aniline picro-carminate. 
 
 Picro-anilin. 
 
 Osmium with picro-cannine. 
 
 Hoematoxylin with anilin. 
 
 Hsematoxylin with eosin. 
 
 Picro-carmine witli iodine green. 
 
 I 2
 
 116 MINUTE EXAMINATION OF THE BRAIN. 
 
 In making clioice of metallic impregnation and reduction 
 by osmium or gold, or of staining by the mineral or vegetable 
 pigments in the list given, the student must be influenced by 
 several considerations. 
 
 Does he require a uniform staining by a simple dye, or 
 does he wish for differentiation of elements by the use of 
 double pigments — the process of double staining ? Does he 
 wish to examine more specially the cortex or medulla of 
 the cerebrum, or the cortex of the cerebellum, or again, 
 the pons, medulla oblongata, or spinal cord ? 
 
 Does he desii-e to display certain particular constituents of 
 the cortex — e.g.^ the nerve-cells and their processes — to the 
 fullest possible extent, even at the sacrifice of other structures, 
 such as is often required in minute investigations into the 
 histological constitution of tissues ? 
 
 Whatever be his object, these questions must receive an 
 answer before the staining reagent can be selected which will 
 yield him the effect desired. I propose to give here the com- 
 position of each reagent, the methods of staining, the special 
 value of each dye for the various histological elements, and 
 to supplement these observations by an analysis of their 
 relative merit for different regions of the cerebro-spinal 
 system. 
 
 HiEMATOXYLIN STAINING. 
 
 1. The Dye. — This reagent has often fallen into great 
 disrepute, owing to the notable variability in the quality 
 of the solutions issued by different makers. The student is 
 strongly recommended to make his own solution, adopting 
 the formula given by Minot or that employed by Kleinen- 
 berg. For the brain and spinal cord I use the former, as 
 preferable to that of Kleinenberg, and I find it at all times 
 most trustworthy in its reaction, and in the uniformity' of 
 results obtained.
 
 prepakatio^ of hardened brain. 117 
 
 Minot's Formula. 
 
 Hsematoxylin (crystals) ... ... 3"5 parts. 
 
 Absolute alcohol ... ... ... 100"0 ,, 
 
 Alum ... ... ... ... ... I'O ,, 
 
 Water 300-0 „ 
 
 First dissolve the htematoxylin in the alcohol, and add to 
 it the alum, previously dissolved in the water. Keep in a 
 closely-stoppered glass bottle labelled " hsematoxylin dye 
 (Minot)." For use, a solution of alimi (0*5 per cent.) is 
 poured into a watch-glass or porcelain capsule, according to 
 the size and number of sections to be stained. A little of 
 the dye is then dropped in, until the solution assumes a light 
 violet tint, when it should be carefully filtered before the 
 sections are immersed. The degree of dilution will soon be 
 learnt after a little practice. 
 
 Kleinenberg's Formula. 
 
 a. Make a satm-ated solution of crystallized calcium chloride 
 
 in alcohol (70 per cent.), and add alum to saturation. 
 h. Make a satm-ated solution of alum in alcohol (70 per cent.), 
 
 and add Solution 1 to Solution 2 in the proportion of 
 
 1 to 8. 
 c. To the resultant mixture now add a fetv drops of a barely 
 
 alkaline saturated solution of hsematoxylin. 
 
 Excellent as this logwood solution is for embryonic tissues, 
 I cannot recommend it for the sections of hardened brain, 
 such as we are now engaged with, to the same extent that I 
 can Minot's solution. 
 
 2. The Staining Process.— Withdi'aw the sections to 
 be stained from the methylated spirits in Avhich they float 
 by means of a glass rod or camel-hair pencil, and immerse 
 them in the logwood dye contained in a watch-glass or porce- 
 lain capsule. The sections should be lightly stained, other- 
 wise they are spoilt by too diffuse a ooloming and by
 
 118 MINUTE EXAMINATION OF THE BRAIN. 
 
 acquiring a brittleness unfavourable to subsequent manipula- 
 tion. In his first attempts the student should examine a 
 section occasionally on the stage of the microscope, and so 
 learn to judge of the progress made by the staining. When 
 sufficiently stained, the dye should be poured off, the sec- 
 tions floated up in a porcelain capside half full of water, the 
 capside slightly inclined towards a gentle stream of water from 
 a tap which, falling upon the edge of the vessel, keeps up a 
 constant change of fluid and ensiu'es a most thorough washing 
 of the sections in the currents it produces. Care must be 
 taken that the delicate sections are not torn by this means, 
 which is really necessary to ensure removal of the deposit 
 which adheres to their surface. Next remove the sections to 
 a capside containing methylated spirit, and in one or two 
 hours all tendency to diffuse staining will have disaj^peared. 
 They are now placed for five or ten minutes in rectified 
 spirits or absolute alcohol for dehydration, transferred to the 
 centre of a glass slide, floated up by a drop or two of oil of 
 cloves, which, when it has permeated the tissue and rendered 
 it perfectly transparent, is drained off, and the section 
 mounted in Canada balsam. 
 
 To ensui'e successful staining with this reagent, the follow- 
 ing points must be carefully attended to : — 
 
 Stain only the very finest sections, 
 
 Ijet the sections be perfectly freed by spirit from any 
 acidity (chromic or picric acid, etc.), otherwise the staining 
 will be a failure. 
 
 Make your own solution of hcematoxylin. 
 
 Employ Minot's solution in preference to others, and 
 reserve Kleinenberg's for embryonic brain. 
 
 Never omit the proper dilution and filtering prior to use. 
 
 Guard against diffuse staining and brittleness from too 
 prolonged action of the dye. 
 
 Wash the sections very tJiovoiigJiIy subsequent to staining. 
 
 Remove any accidental diffuse coloration by long im- 
 mersion in spirit.
 
 PllEPAKATlON OF HARDENED BKAIN. 119 
 
 Dehydrate perfectly before clearing up with, clove oil. 
 Mount in a benzole solution of balsam. 
 
 3. Notes on the Reaction of the Dye. — Hsema- 
 
 toxylin is specially well suited for the display of the various 
 nuclei met with in brain and spinal cord, — e.g., the con- 
 nective nuclei of neuroglia, the peri-cellular and peri- 
 vascular nuclei, the nuclei and nucleoli of the nerve-cells. 
 The larger nerve-cells of the cortex are beautifidly shown in 
 successful preparations, and their primary and secondary 
 branches may be followed for some distance, but never to the 
 extent seen in aniline staining. On the other hand, both 
 neuroglia basis and nerve-structm-es undergo much shrinking 
 by the use of the dye, and from this cause the smaller cells 
 of the upper layers lose, to a great extent, their normal 
 features. The protoplasmic extensions and nerve-fibre net- 
 work of the cortex are indeed very poorly exhibited in 
 logwood, as compared with aniline preparations. The axial 
 cylinders of medullated fibres exposed in transverse section 
 are well exhibited by logwood, and hence the sections of 
 spinal cord and medulla, stained by the dye, show to 
 advantage. 
 
 Carmine Staining. 
 
 1. The Dye. — The most useful solution for hardened 
 brain sections is that recommended by Beale, diluted to the 
 required strength, the original solution being too strong for 
 our piu-pose. 
 
 Beale's Formula. 
 
 Carmine (in small fragments) 
 
 10 grains. 
 
 Strong solution of ammonia 
 
 1 drachm 
 
 Price's glycerine 
 
 2 ounces. 
 
 Alcohol 
 
 h „ 
 
 Distilled water 
 
 2 „ 
 
 Agitate the carmine with the liquor ammonige in a test tube 
 gently heated over a spirit lamp. When solution is complete,
 
 120 MINLTE EXAMINATION OF THE BRAIN. 
 
 carefully boil for a few minutes and expose tlie open test tube 
 for an hour to allow excess of ammonia to escape. Add the 
 water, filter, and after the addition of the spirit and glycerine, 
 expose to the air until the odour of ammonia given off from 
 it is very faint. Keep the clear fluid in a stoppered bottle, 
 and whenever carmine becomes precipitated, add a drop or 
 two of liquor ammonitB. 
 
 Formula for Borax Carmine. 
 
 Carmine ... ... ... ... 1 part. 
 
 Borax ... ... ... ... ... 4 ,, 
 
 Water ... ... ... ... ... 56 „ 
 
 Alcohol q.s. 
 
 Dissolve the borax in the water, and add the carmine. Filter 
 the solution, and add just sufficient alcohol to ensure free 
 permeation of the tissue by the dye. 
 
 Thiersch's Formula. 
 
 Solution A. Carmine ... ... 1 part. 
 
 Liquor ammonifc ... 1 ,, 
 
 Distilled water ... ... 3 , , 
 
 Dissolve and filter. 
 
 Solution B. Oxalic acid. ... ... 1 part. 
 
 Distilled water ... ... 22 „ 
 
 Mix one part of Solution A with eight parts of Solution B, 
 and add twelve parts of absolute alcohol. Modifications of 
 Grerlach's original carmine dye have also been introduced by 
 Frey and others, but the three above given are all that are 
 really requisite for staining nervous tissues. 
 
 2. The Staining Process. — Give the preference to 
 Beale's solution, although its density from the glycerine 
 renders the action slow. Dilute the strong solution with 
 seven times its bulk of water and filter. The sections should 
 be placed in a comparatively Jorge quantity of the dilute
 
 PREPAHATIOISI OF HARDENED BRAIN. 121 
 
 solution covered from dust and left to undergo very gradual 
 staining, a process wliicli may occupy eight hours, or even 
 longer. "When a section removed to the microscope stage 
 shows sufficient staining, the reagent may be poured off, 
 sujjerfluous carmine removed by gentle washing, and all the 
 sections immersed in a dilute solution of glacial acetic acid 
 (0"5 per cent.) for fifteen to twenty minutes. The acid 
 deprives the specimen of all diffuse staining, and fixes the 
 dye more especially in the germinal centres, whilst at the 
 same time the tint is brightened by its agency. Great care 
 should be taken that neither section nor staining solution is 
 very alkaline in reaction, otherwise the staining will prove too 
 deep and diffuse, and the structure itself injuriously affected. 
 A minimum amount of ammonia, however, must be present 
 in the dye just recognizable by its odour, and if this be not the 
 case, a drop or two of the liquor ammonite should be added 
 to Beale's strong dye prior to making the dilute solution. 
 These sections may now be washed and mounted in glycerine 
 or Farrant's solution, or they may be dehydrated in the usual 
 way by spirit, cleared up in oil of cloves, and mounted in 
 Canada balsam or dammar. 
 
 With a few of these carmine-stained sections the student 
 shoidd try the following modified process of mounting, 
 whereby valuable information may be obtained. Several 
 years ago I described a method of displaying a great wealth 
 of stmctiu'e on the cortex cerebri by altering the refractive 
 indices of the structm-al elements, and so producing very 
 remarkable differentiation of structui'e.^ I there stated what 
 follows : — " On placing an unstained section of cerebrimi or 
 cerebellum satiu*ated with spirit in the field of the micro- 
 scope, little or no structure is apparent, but if a drop of 
 essential oil be now allowed to run over it, there will be 
 observed at a certain stage of clearing up, and whilst the spirit 
 is evaporating, a sudden starting out in bold relief of the 
 cells, nerve-fibres, blood-vessels, etc., which again disappear or 
 partially fade on perfect clearing of the section. Now, this 
 
 ' Quarterly Journal of Micros. Sac. vol. xvi.
 
 122 MINUTE EXAMINATION OF THE BRAIN. 
 
 appearance may be fixed by suddenly dropping over its 
 sm-face a little balsam and permanently mounting. Upon 
 this fact depends the process now to be described. Sections 
 treated with Beale's carmine solution (1 to 7) and washed with 
 the acid, are placed, saturated with spii'it, upon a slide. 
 When the spirit has nearly all evaporated, a drop of oil of 
 anise is allowed to flow over the section (not to float it up), 
 and the clearing is watched on the stage of the microscope ; 
 then, just when the appearance referred to above is presented 
 to view, a drop of balsam is allowed to run over the section, 
 and a covering glass permanently fixed on. In lieu of oil 
 of anise, I frequently employed glycerine with the same 
 results, mounting the specimen in glycerine jelly. * * * 
 I ^vill state my belief that this method will yet prove of most 
 essential service in the estimation of the relative proportion 
 of cell-processes in any individual section, and the most 
 accurate tracing of any existing connections, for not by the 
 deepest aniline staining have I yet succeeded in demonstrating 
 the existence of so thick and numerous a series of j)rocesses 
 diverging from the pyramidal layers of the cerebral cortex 
 as by the method described above." It is satisfactory to find 
 these opinions confirmed by Prof. Stirling in his recent text- 
 book of " Practical Histology." Dr. Stirling says : — " The 
 processes of the cells (of the cerebrum) are best seen in pre- 
 parations which are only iMrtialhj cleared up imder the 
 influence of clove oil. This is a most important method of 
 investigation. I have often seen in this way delicate fibrils, 
 not unlike elastic fibres, and which are not distinct when 
 the section is completely cleared up."^ 
 
 3. Notes on the Reaction of the Dye. — Carmine is 
 especially suited as a dye for the large nerve-cells, their 
 contents, nuclei, and nucleoli. It exhibits well the connective 
 cells and the vascular apparatus. For the large ganglionic 
 cells and their immediate environment, nothing can perhaps 
 sm-pass a successful carmine preparation, whilst it does not 
 
 » "Text-book of Practical Histology," p. 101. Smith, Elder, & Co.
 
 PKEPARATIOX OF HARDENED BRAIN. 123 
 
 appear to produce any further slirinldng of protoplasm or 
 connective such as is produced by hsematoxylin. It is less 
 adapted for displaying the cell-processes, and wholly fails to 
 exhibit the details of structure in smaller nerve-cells, such as 
 those of the upper cortical layers. It has been regarded, 
 even by so eminent an authority as Charcot, as the only 
 reliable dye for exhibiting the morbid state regarded as 
 sclerosis of the different columns of the cord. This, how- 
 ever, is not the case, since aniline blue-black poi'traj's the 
 lesion even more distinctly. The more important objections 
 attached to this dye are the variable results given ; the little 
 definition often afforded of the tissue elements from the 
 tendency to diffuse staining ; the unpleasant glare of the 
 ca]*mine tint for continuous work, and its unsuitability for 
 examination by artificial light. 
 
 Picro-Carmine Staining. 
 
 1 . The Dye. — This valuable reagent, introduced by 
 Hanvier, is of very special use in the preparation of nervous 
 tissues. It is readily made as follows : — 
 
 Ranvier's Formula, 
 
 Best carmine ... ... ... 1 gramme. 
 
 Water ... ... 10 c.c. 
 
 Liquor ammonise ... ... ... 3 c.c. 
 
 liub the carmine up with water, add the solution of 
 ammonia to the fluid in a test tube, and aid the solution of 
 the carmine by gentle heat carefully a2:)plied. When dis- 
 solved and the solution perfectly cold, pour it into 200 c.c. 
 of a saturated aqueous solution of picric acid. Place the 
 solution in an open vessel and Tvith gentle warmth evajiorate 
 to ono-third of its bulk. Filter and keep in a stoppered 
 bottle labelled " Ranvier's picro-carminate dye." 
 
 Picro- carmine may be purchased in a solid form as a 
 granular and imperfectly crystalline substance — a 1 per
 
 124 MINUTE EXAMINATION OF THE BRAIN. 
 
 cent., solution is then used. From personal experience I 
 cannot commend its use, and I would strongly recommend 
 the preparation after the formula above given. 
 
 2. The Staining Process. — Immerse the sections in a 
 small quantity of the picro-carminate solution for a period of 
 from twenty to thirty minutes. Pour off the dye, draining away 
 all the superfluous fluid, and then, without urishing the sectiom, 
 float them up by glycerine in which they must be mounted. 
 It will often be found advisable to stain each section upon 
 the slide, dropping over sufficient of the reagent to cover it — 
 to clear it up with glycerine and mount it permanently upon 
 the same slide. Picric acid, being soluble in water, is readily 
 removed upon washing these sections ; hence, to preserve the 
 colour due to both pigments, we must carefully avoid washing 
 with water.^ 
 
 Upon the other hand, washing freely, dehydrating with 
 spirit, and mounting in the usual way in balsam, will yield 
 us excellent carmine preparations, and so far as my 
 experience goes, better specimens than those subjected to 
 the action of the simple ammoniacal or borax solutions. 
 
 3. Notes on the Reaction of the Dye. — Picro- 
 carmiiie has the special merit of showing less tendency to 
 diffuse staining than simple carmine dyes. The presence 
 of the two pigments appear notably to restrict their action 
 to the germinal centres, for which they each have affinity. 
 Elastic tissue and muscle will be stained yellow, whilst nuclei 
 and connective take the carmine tint. Minute nervous 
 plexuses are poorly shown, as they occur in the structure of 
 the cortex ; hence, the nerve-cell processes and their ramifi- 
 cations can rarely be followed to any distance. The structure 
 of the investing membranes and the vascular apparatus is 
 better defined by this reagent than any other we are acquainted 
 with. In fact, the merits and demerits of carmine staining, 
 pertain to the picro-carminate, although, for powers of 
 
 1 This difficulty is also overcome by washing in a saturated aqueous solu- 
 tion of picric acid, and dehydrating in an alcoholic solution of the same 
 acid.
 
 PREPARATION OF HARDENED BRAIN. 125 
 
 differentiation, it is superior to simple amraoniacal carmine, 
 and its roJe as a staining- reagent more extensive. For com- 
 bination with other dyes, such as aniline, logwood, and osmic 
 acid, it is peculiarly useful. As a general dye for nerve- 
 structures, it ranks next to aniline and aniline picro-carminate, 
 and is far superior to logwood. 
 
 Aniline Staining. 
 
 1. The Blue-black Dye.— This, which is by far the 
 most valuable of the aniline series of dyes for the brain and 
 spinal cord, is thus made : — 
 
 Aniline blue-black 1 gramme. 
 
 Distilled water 400 c.c. 
 
 Dissolve, filter, and keep in a stoppered bottle, labelled 
 " anihne black dye, aqueous solution, 0-25 per cent." It may, 
 however, be convenient to keep a stock solution of 1 per cent, 
 strength, as rapid staining is occasionally required, and to 
 dilute, as required, to 0-2-3 or O'o per cent., always filtering 
 these dilutions prior to use. The solution, as above given, 
 may be employed for staining fresh and hardened sections, 
 the aqueous solution being the best dye we possess for the 
 former. The alcoholic solution, as first recommended by Mr. 
 Sankey, was the following : — 
 
 Aniline blue-black ... 5 centigrammes. 
 
 Water ... ... ... 2 cubic centimeters. 
 
 Dissolve and pom- into it 99 c.c. of methylated spirit. 
 Filter the solution, and label "alcoholic solution of aniline 
 black, O'Oo per cent." 
 
 Professor Stirling advises the use of a solution double the 
 strength of the above, thus : — 
 
 Aniline blue-black ... 1 decigramme. 
 
 Water ... ... ... 4 cubic centimeters. 
 
 Dissolve, and add 100 c.c. of rectified spirit, and filter. 
 Label, " anihne blue black, alcoholic solution, O'l per cent." 
 I much prefer the aqueous solution for most pm-poses.
 
 126 MINUTE EXAMINATION OF TflE BRAIN. 
 
 2. The Staining Process. — Sections of liardened cortex, 
 pons, medulla, and spinal cord, may alike be left in the 
 aqueous solution (0*25 per cent.) for one hour. In this 
 time they will, generally, be found stained to a sufficient 
 extent, when they must be removed to a vessel containing 
 water, and well washed from superfluous dye. Next, dehydrate 
 by rectified spirit or absolute alcohol ; clear up by oil of 
 cloves, and mount in balsam or dammar. 
 
 Sections of Cerebellar Cortex shoidd be deeply stained 
 by aniline, gently washed in water, and immersed for 
 twenty to thirty minutes in a solution of chloral hydrate 
 (2 per cent.). Next transfer them to the following solu- 
 tion : — 
 
 Solution of chloral (2 per cent.). 
 
 Oil of cloves equal parts. 
 
 Alcohol ... ... ... q. s. to dissolve per- 
 
 fectly, and form a clear solution. Add the alcohol by 
 degrees, stirring the solution with a glass rod, and avoiding 
 excess of spirit. During use, carefully cover the watch- 
 glass containing this solution, so as to avoid evaporation. The 
 chloral removes diffuse staining, whilst the clove oil clears up 
 the section, and enables us, by examining one occasionally 
 under a low magnifying power, to decide when they have 
 reached a satisfactory stage. When this has been attained, 
 remove your section to a slide ; rapidly wash with a little 
 pm-e alcohol ; thoroughly clear with clove oil, and mount with 
 balsam. The alcoholic solution of aniline also stains sections 
 of cerebrum, pons, and medulla, and must be cleared and 
 mounted in the usual Avaj^ Grlj^cerine being a powerful 
 solvent of aniline, must not be made the medium for mounting 
 these sections. 
 
 3. Notes on the Reaction of the Dye. — Its action is 
 energetic, and its results are certain and constant. It is 
 readily controlled, so that any depth of staining may be 
 obtained with ease. The tint given varies from a bluisli-grey to
 
 PREPARATION OF HARDENED 15RAIN. 127 
 
 a deep bkie-'black, and is a pleasant one for the eye, causing 
 little or no fatigue. It enables us to obtain the clearest and 
 sharpest definition of elements in a tissue, without modifying 
 their structm-e by shrinking or other change. No otlier 
 staining reagent displays the nerve-cell processes to sucli a 
 remarkable extent as does this dye, the very finest ramifica- 
 tion being followed out with ease. It has a special affinity 
 for protoplasm, staining the nuclei of the nerve-cells most 
 deeply, then the nerve-cells themselves and their protoplasmic 
 extensions, and, to a less intense degree, the nuclei of 
 the neuroglia and perivascular walls. The finely-formed 
 nerve and connective mesh-work, forming the basis substance 
 of the cortex, is stained of a pale grey. This dye fails to 
 produce any action upon the medullated sheath of nerve- 
 fibres, affecting only the axis-cylinder. Transverse sections, 
 therefore, of nerve-fibres, such as are seen in cross sections of 
 the medulla, cord, and nerve-trunks, exhibit the axis-cylinder 
 stained of a bluish-black tint, the unstained white matter of 
 Schwann siuTOunding it ; whilst the intertubular connective, 
 lightly stained, differentiates the medullated tubes from each 
 other. The value of this clj^e for connective tissue is very 
 limited, its role being chiefly confined to the nerve-elements. 
 
 OsMic Acid Staining. 
 
 This method we owe to Professor Exner. It is peculiar 
 in the fact that the hardening and staining proceed 
 simultaneously, the same reagent being employed for both 
 purposes. The preparation of the hardened brain hy im- 
 mersion in osmic acid has ah-eady been alluded to, and we 
 have now simply to detail his further treatment of the 
 sections so obtained by the microtomo. The sections, owing 
 to the deep staining they undergo, must be extremely thJn 
 and should be placed in glycerine immediately, since pro- 
 longed immersion in alcohol injm-es them seriously. Transfer 
 a section to a glass slide and add a few drops of strong liquor 
 ammonia?. Absorb all superfluous moistiu'e around the section
 
 128 MINUTE EXAMINATION OF THE BRAIN, 
 
 with blotting jiaper, and after waiting a short time for the 
 ammonia to effect the section thoroughly, place the cover 
 glass on without injury to the preparation which has heen 
 softened by the reagent, and examine immediately on the 
 microscope stage. It is at this early period that the section 
 shows to greatest advantage. For permanent preservation 
 Exner surrounds the cover glass with the soluble silicate 
 called water glass. Formerly an ammoniacal carmine solu- 
 tion was used, but Exner found that the results obtained 
 could be attributed only to the reaction of ammonia, and so 
 he has dispensed with any carmine staining as the osmium 
 suffices for all pui-poses. 
 
 Notes on the Value of this Method. — The meduUated 
 fibres can be traced upwards into the highest realms of the 
 cortex, exhibiting a wealth of structure which no other 
 method displays. The meduUated sheath is deeply stained 
 and can be traced distinctly in the case of the smallest nerve- 
 fibres. The nerve-cells, although stained, do not form such 
 prominent objects as by other methods of staining ; this 
 process being especially adapted for tracing the ultimate 
 course of meduUated fibres through the difPerent layers of the 
 cortex and determining their final destination. Exner states 
 that the staining of the minute fibres occasionally disappears 
 in time, and the student should also be aware that the brain- 
 structm'e swells up so much under the agency of ammonia 
 that the section is increased by one-third its full diameter.^ 
 
 On the Use of Compound Pigments. 
 
 Under this head I would include some of the most valu- 
 able methods we possess for delineating the minute structures 
 of the nervous system. Picro-carmine, as consisting of two 
 pigments, would naturally fall under this category, but since 
 it is employed in the same way as the simple dyes, I have 
 
 ^ For results obtained by Prof. Exner with this method, sec Original 
 Memoir (op. cit.), or abstract of the same in Brain, part xv.
 
 PREPARATION OP HARDENED BRAIN. 129 
 
 found it more convenient to include it amongst them. The 
 methods of staining to which I now refer are those in which 
 the tissue is first submitted to one dye, and the result subse- 
 quently modified by the addition of a second pigment. In 
 these cases, either different histological elements assume the 
 tint of each pigment, or the former staining is greatly 
 improved in character by the second pigment combining and 
 modifying the tint acquired. In the former case only does 
 a genuine double staining occur ; in tlie latter we obtain a 
 single tint, but one of valuable quality. 
 
 1. Aniline Picro-carminate Staining. — Three pig- 
 ments are here used, viz., the aqueous solution of aniline 
 blue-black (0"25 per cent.), and Eanvier's compound dye, 
 picro-carmine. Sections, which should be very thin, may be 
 stained on a glass slide, by dropping over them from a pipette 
 sufficient picro-carmine to cover the section completely. 
 When deeply stained by this reagent the latter is di'ained off 
 and the section covered in a like manner by a quantity of the 
 aniline blue-black solution. It will be found that the action 
 of the aniline proceeds much more rapidly upon a section 
 stained by picro-carmine — ten minutes usually sufficing to 
 produce the desired effect. This result is acquired when 
 upon draining off the dye the section is found to have 
 changed from the bright carmine to a deep violet tint. Wash 
 the sections well in water, dehydrate by spirit, clear by clove 
 oil, and mount in balsam. In this way the most beautiful 
 effects are obtained, which are specially valuable and instruc- 
 tive. The tint is much less fatiguing to the eye than the 
 bright glare of carmine, whilst in the differentiation of 
 nervous tissue in the hardened brain this method of stain- 
 ing appears to me unrivalled. The deeper the tint desired 
 the longer immersion in aniline must be practised, but for 
 the more satisfactory and pleasing effects I have usuallj^ 
 found it suffice to stain for half an hour in picro-carmine 
 and fifteen minutes in aniline. 
 
 Notes on the Reaction of the Dye. — This compound 
 
 K
 
 130 MINUTE EXAMINATION OF THE BRAIN. 
 
 staining enliances tlie value of an ordinary picro-carminate 
 preparation in the fact that a better differentiation of structure 
 is obtained, and examination by artificial light rendered as 
 agreeable and valuable as by day-light. With all the 
 advantages of a picro-carmine staining we have conjoined 
 tlie sjiecial action exhibited by aniline for the cell-processes 
 and finer nervous meshwork, whilst at the same time the 
 general tint is deeper than by picro-carmine, and the contrast 
 betwixt the deeper and lighter stained parts more marked. 
 The nem'oglia is stained faintly; the connective nuclei are 
 prominent objects; the nerve-cells are well shown, the nucleus 
 taking a much deeper tint. The axis-cylinder, in transverse 
 sections of medullated fasciculi, is stained of a deep purple, 
 the intertubular connective and its nuclei being of much 
 lighter hue. The vascular channels and their nuclear elements, 
 which are not satisfactorily shown in simple aniline staining, 
 are exhibited to great advantage. I find this method of 
 staining very suitable for displaying the coarse structure of 
 the brain, and sections through a whole hemisphere treated 
 by this method are most instructive for naked-eye examina- 
 tion or by low-power objectives. 
 
 2. Picro-Aniline Staining. — A useful staining of 
 medulla and spinal cord may be obtained by emplojdng 
 Judson's " Cambridge blue " as the first pigment, washing 
 oif superfluous dye, and then by momentary immersion in a 
 saturated solution of picric acid the section acquires a bril- 
 liant green, which exhibits structural details remarkably well. 
 Since both pigments are soluble in alcohol, the sections should 
 be very rapidly dehydrated, cleared by clove oil, and mounted 
 in the usual manner. 
 
 3. Osmic Acid and Picro-carmine. — The section is 
 immersed in a solution of osmic acid (1 per cent.) carefully 
 covered over so as to confine this very volatile reagent as far 
 as possible to the tissues to be acted upon. "When the latter 
 has acquired a dark-brown tint the section should be removed, 
 well washed, and lightly stained with picro-carmine.
 
 PREPARATION Ol' HARDENED BRAIN. 131 
 
 Such sections should be mounted in glycerine or glycerine 
 jelly. Sections through the hemispheres of the brain in 
 small animals, or the pons and medulla may be conveniently 
 treated by the osmic acid contained in a watch-glass covered 
 by a small glass plate. The above is a most valuable method 
 of staining. 
 
 4. Haematoxylin with Aniline. — This, like the last, 
 gives a genuine double staining. Sections are first stained 
 by logwood according to the directions already given, and 
 immersed for a fcic seconds only in the aqueous solution of 
 aniline blue-black (O'o per cent). A solution of chloral 
 hydrate (2 per cent.) will remove any excess of aniline 
 staining. Wash the sections well, rapidly dehydrate by 
 alcohol, and mount sec. art. This process is chiefly adapted 
 for sections of cerebellmn, and its special value will be 
 referred to later on. The above are all the methods of 
 staining I have found to be of greatest value, but I append 
 here two methods of double staining for the cortex of the 
 cerebellum, advocated by Professor Stirling,^ of the merits 
 of which I have not had personal experience. 
 
 5. Eosin and Logwood. — Stain a section for a few 
 seconds in a very dilute watery solution of eosin (1 part to 
 1,500 of water) until it has a faint red colour, Grreat care 
 must be taken not to over-stain. Wash with water, stain the 
 section with logwood, and mount in dammar. 
 
 6. Picro-carmine and Iodine Green. — Stain a section 
 in picro-carmine. Wash it in water acidulated with dilute 
 acetic acid, and, after washing in pure water, stain again by 
 means of iodine green, and mount in dammar. 
 
 § STAINING OF SPECIAL REGIONS OF THE 
 BRAIN AND SPINAL CORD. 
 
 The Cortex Cerebri. — The cortex at the vertex in the 
 frontal regions should by preference be stained by the 
 
 ' "Practif-al Histolog'y," p. 100. 
 
 k2
 
 132 MINUTE EXAMINATION OF THE BRAIN. 
 
 aqueous solution of aniline blue-black which has so remark- 
 able an affinity for the nervous protoplasmic masses and their 
 extensions, and which in these regions are so numerous. 
 Next in value to aniline are the pioro-carminate and logwood 
 dyes. With care very beautifid sections may be obtained 
 from this part of the brain stained with picro-aniline, but a 
 good aniline blue-black surpasses all others in intrinsic merits 
 and for purely anatomical details. When it is desired to 
 examine critically the contents of the nerve-cells with regard 
 to morbid change the picro-carminate gives equally good 
 results with the aniline. No reagent, on the other hand, 
 exhibits so remarkably the proliferation of Deiter's corpuscles 
 in the cortex as does aniline. 
 
 In more posterior planes, and especially at the occipital 
 pole of the hemisphere, where layers of the granule-cell 
 formation predominate, the hematoxylin dye brings out the 
 distinctive features of these realms better than any other. 
 The nuclei of the crowded granide series are deeply stained 
 by this reagent, although the large nerve-cells in the inter- 
 mediate layers are but faintly seen. It is on this account 
 advisable to attempt double staining by logwood and 
 aniline when both granule cells and the larger nerve-cells 
 are well shoAvn. The same remarks apply to the cortex in 
 the olfactory region, where, in like manner, small granule 
 elements predominate. 
 
 The peculiar crowded cell-formation of the cornu ammonis 
 stained by aniline blue-black affords beautiful preparations. 
 
 The Cortex Cerebelli. — The granule layer of the 
 cerebellar cortex is readily stained by any of the pigments 
 more generally used, but not so the layers of Pm-kinje or their 
 cell-processes, which branch out so abundantly in the pure 
 grey layer. 
 
 Picro-carmine and logwood alike yield fine, yet imperfect, 
 preparations, since the mere outline of the Pm-kinje cell or 
 its nucleus is often all that is visible in this layer. Occa- 
 sionally, however, a few branches may be seen. To exhibit
 
 PREPARATION OF HARDENED BRAIN. 133 
 
 the great profusion of branches arising from these cells stain 
 with aniline black, or preferably employ the double staining 
 by logwood and aniline black. In these cases the granule 
 layer will be of a bright purplish blue, whilst the cells of 
 Purkinje will be distinctly mapped out, the nucleus of a 
 bluish black tint, and their branches displaying a perfect 
 forest of twigs. 
 
 The Central Medulla. — The student should make sec- 
 tions, both in a vertical and horizontal direction, through 
 the brain of the smaller mammalia, e.g., the cat, dog, or 
 rabbit, and stain these preparations with the double object of 
 utilizing them for coarse examination by the naked eye or 
 two-inch objective, to learn the relationships of the various 
 central structures at different planes, as also for the more 
 arduous duty of tracing out the course taken by the different 
 systems of meduUated fasciculi in the interior of the brain. 
 Such preliminary work he will find invaluable when he 
 attempts to unravel the intricate mechanism of the human 
 brain. 
 
 For the coarse examination of the larger sections through 
 the whole brain or one hemisphere, the aniline picro-car- 
 minate has always appeared to me the better method of 
 staining, but for the more minute microscopic tracing of 
 central fasciculi the double staining by osmium and picro- 
 carmine is the only reliable method. 
 
 It must be remembered that whenever we are dealing with 
 sections carried transversely to the axis of the medullated 
 fasciculi these latter will be well delineated by aniline blue- 
 black, picro-carmine, or logwood ; but where the plane of 
 section lies parallel with the long axis of these fasciculi, the 
 more reliable staining is that of the medullated sheath by 
 means of osmic acid. Hence it arises that in following out 
 the lengthened course of fibres through the brain by sections 
 along their planes, osmium is the most valuable adjunct, 
 whilst the structure of the medulla, studied in transverse 
 section, is best treated by other reagents. Although when
 
 134 MINUTE EXAMINATION OF THE BRAIN. 
 
 dealing witli the more extensive areas, as in sections tlirough 
 the hemispheres, it is advisable to obtain extremely thin 
 j)reparations, yet the vast majority of valuable sections for 
 the purpose of tracing the central medulla are most unsuit- 
 able for minute examination of the cortex, the details of 
 which will be very poorly delineated. The choicest sections 
 through the cortex, such, in fact, as are essential to a favour- 
 able investigation of its structure, must be of extreme 
 tenuity — a degree indeed not attainable in large sections 
 through the hemispheric mass. 
 
 Let the series of preparations illustrative of the minute 
 structure of the cortex in diiferent realms, therefore, be 
 wholly distinct from those illustrative of the central medidla 
 and basal ganglia, since the methods of preparation which 
 are most suitable for these diverse parts diifer so essentially. 
 On the other hand, Exner's process is available for both 
 regions. 
 
 The Pons, Medulla, and Spinal Cord. — The same 
 method of staining is applicable to all these parts. Logwood 
 has been used extensively for these regions, carmine still 
 more so ; whilst the anihne reagent, which I regard as of far 
 the greater value, has been comparatively neglected, at least 
 so I judge from the fact that whenever sections of cord or 
 medulla are exhibited, the carmine preparations infinitely 
 outnimiber the aniline. A tolerably thick section of medulla 
 or cord appears wonderfully thin when stained by carmine 
 and cleared up by oil of cloves ; it shows to very fair 
 advantage even to the higher powers of the microscope, and 
 any inequality of surface or scoring from the frayed edge 
 of the section-knife is obscured or entirely concealed from 
 view. This is not the case with the aniline preparations. 
 The depth of tint here not only warns us but too surely of 
 any undue thickness of our section, but shows up any faults 
 in the section due to scoring or tearing of structiu-e to a 
 remarkable and most unpleasant degree. Hence, I incline 
 to the belief that faults really attributable to the section-
 
 PKEl'AUATroN OF HARDENED BRAIN. 135 
 
 cutter and liis blade' have been credited to the dye, which 
 has, therefore, fallen into comparative disrepute. Of this, 
 however, we may be certain, that sections of medulla and 
 cord properly stained by aniline blue-black are the most 
 beautifvd preparations of these regions we can by our present 
 methods possess ; and that a really good aniline preparation 
 of these parts must of necessity be a reyy thin and perfect 
 section, — a statement which can scarcely be made of carmine 
 preparations. The student should therefore possess himself 
 of the thinnest possible sections of the different regions of 
 the medulla and sjjinal cord, prepared by the aqueous 
 solution of aniline blue-black, and with due care to the con- 
 dition of his section-knife, he may thus prepare a most 
 invaluable series of sections ; yet from the necessary fine- 
 ness of the sections, he will meet with greater difficulty in 
 obtaining perfect preparations than by the carmine staining. 
 Whilst thus giving the foremost place to aniline blue-black 
 for staining these regions, I would not wish to undervalue 
 the merits of picro-carmine. Next to aniline, it is pre- 
 eminently useful here. Do not, however, be deceived by its 
 peculiar power of concealing the demerits of your section, 
 and so be led to regard a section as thin because it appears 
 so when mounted. In this way, minute details may be 
 wholly overlooked which really thin sections would have 
 exhibited. With the high powers the actual thickness of 
 the section may be decided readily. 
 
 Apparatus required for Staining and Mounting. 
 
 Bottles of staining reagents 
 
 Porcelain capsules 
 
 Watch-glasses 
 
 Slides 
 
 Cover-glasses 
 
 Tray for fresh slides 
 
 Bottles of mounting media 
 
 Grlass rods 
 
 Pipettes 
 
 Camel-hair brush 
 
 Funnel and filtering paper 
 
 Mounted needles 
 
 Turn-table 
 
 Bottles of cement
 
 CHAPTER X. 
 
 PREPARATION OF NERVOUS TISSUE IN THE FRESH STATE. 
 
 Among the facilities offered for immediate examination of 
 brain and spinal coi-d in the recent state, two processes 
 present themselves for examination ; these are — 
 
 1. Methods of section-cutting and preparation of frozen 
 
 tissues. 
 
 2. Methods of dissociation and teasing out of fresh tissues. 
 
 We should perfectly familiarize ourselves with all these 
 methods. There are certain difficulties peculiar to the pre- 
 paration of fresh nervous tissues, and not met with in the 
 manipulation of hardened sections, with which it is well to 
 be acquainted. We shall recognize in the details of pre- 
 paration now to be given, the means adopted for overcoming 
 these obstacles. 
 
 Sections of frozen brain must be extremely thin for satis- 
 factory preparations, and these most delicate films absorb 
 water so rapidly that the constituents undergo rapid dissocia- 
 tion when floating in water. Again, after removal to a slide, 
 the upper surface is found highly repellant of watery 
 solutions, so that the application of osmic acid equably over 
 its surface is a matter of some difficulty when dealing with 
 so fine a film. Lastly, fine sections of spinal cord exhibit 
 such rapid endosmose of fluid, that unless each section be 
 removed immediately it is floated off the blade into glyce- 
 rine, the nervous elements swell up and burst through the 
 encircling girdle of membranes, becoming completely dis-
 
 PREPARATION OF NERVOUS TISSUE IN THE FRESH STATE, 137 
 
 sociated. The first difSculty as regards the cortex is met by 
 the osmio acid treatment, the second is overcome by a 
 little i^ractical manipulation, and the difficulty connected 
 with section of the cord is wholly avoided by glycerine 
 diluted with one-half or two-thirds its bulk of water. 
 
 It must be remembered that all alcoholic and highly astringent 
 reagents must be excluded from our list for staining purposes, 
 and therefore haematoxylin and several other dyes employed 
 for hardened brain are wholly inadmissible for fresh nervous 
 tissues. We are, therefore, chiefly restricted to aniline blue- 
 black, carmine, picro-carmine, and osmic acid. The osmium 
 and aniline are especially valuable agents. 
 
 § PREPARATION OF SECTIONS FROM 
 FROZEN TISSUES. 
 
 The Freezing Method. — Use the ether freezing micro- 
 tome and secure it to a firm support, as a table or ledge in 
 front of an open window, where a cool di-aught plays over 
 the section-plate. Place a large deep glass vessel half -filled 
 with clear water on the support in front of the microtome ; 
 have the ether-spray apparatus ready on the left hand, and 
 the section-blade on the right. Throw across the knees a 
 soft towel, with which the under surface of the section-blade 
 has to be gently wiped occasionally to remove superfluous 
 moisture. Next take up the section-blade, and holding it 
 horizontally, pour upon its upper surface a small quantity of 
 ether, allowing it to sweep from end to end, and agitate the 
 blade in water until the blade, on removal, remains perfectly 
 wet from end to end. Repeat the ether wash if the surface 
 still remains somewhat greasy, as in this state it is unsuited 
 for section-cutting. Lower the freezing chamber of the 
 microtome until its surface, or freezing plate, is four or six 
 millimeters below the upper surface of the section-plate. 
 Place upon the upper surface of the freezing chamber the 
 tissue to be frozen, which should be but a little over a quarter
 
 J 38 MINUTE EXAMINATION OF THE BRAIN. 
 
 of an inch thick. Introduce the nozzle of the ether-spray 
 instrument through the opening in the left-hand of the 
 freezing chamber, so that the spray be directed upwards 
 against the freezing plate immediately beneath the tissue. 
 A steady current will, in a few seconds, cause blanching of 
 the tissue next to the plate, to which it now firmly adheres, 
 and fi'eezing proceeds rapidly upwards, as evidenced by its 
 colour and firmness. It is not necessary to freeze above the 
 level of the section-plate. Remove the unfrozen tissue down 
 to a level with the section-plate by a sweep of the blade — 
 plunge the latter into water, lightly wipe its iinckr surface 
 upon the towel, and raising the section by the micrometer- 
 screw, cut the first section with a sweep away from you, and 
 from your left to yom* right hand. The section must be 
 floated off in the glass vessel, and not plunged beneath the 
 sm^face of the water. 
 
 One should aim at acquii'ing the greatest expedition at this 
 work, rapidly floating off each section, and wiping the blade 
 preparatory to the next. It is all-important that fresh 
 sections be removed from the water in which they float as 
 quickly as possible, whilst, at the same time, a number of 
 sections should be cut before the frozen mass begins to thaw and 
 loosen from the plate. Practised manipulators can with ease 
 cut a dozen fine sections ere the mass loosens from the plate, 
 but the tyro, Avhen simply practising the cutting of sections, 
 is slow in his manipidation, and finds the mass loosens before 
 he has secured three or four specimens. Two or three puffs 
 from the spray, however, will, at this stage, fix it to the plate 
 again, and thus he may with ease cut through the whole depth 
 of tissue with very little expenditm-e of ether. When he has 
 obtained sufficient manipulative skill at section-cutting, he 
 will find it advisable to pass the first half-dozen sections 
 through the second stage of the process before he cuts another 
 series, so as to avoid the injury resulting from prolonged 
 floating in water ; this last statement holds good for all 
 nervous tissues alike. There is, perhaps, no method of 
 obtaining fine sections of tissue so exj)editiously and with
 
 PREPARATION OF NER\"OUS TISSUE IN THE FRESH STATE. 139 
 
 such extreme simplicity of detail as that just described, and 
 certainlj none involving so little expenditure of time or labour ; 
 yet, as the beginner will always meet with some obstacles in 
 his first attempts, however simple the process, it will be as 
 well to indicate those which most frequently present them- 
 selves. His failiu'ss will invariably be due to one or other of 
 the following causes : — 
 
 1. The 1 0)12)6 rature of the room above 60° F. This also 
 involves unnecessary waste of ether. Freezing should only 
 be practised by ether spray when the temperatm'e of the 
 atmosphere falls below 60° F. 
 
 2. The brain mass frozen too high. Brain-tissue, when 
 fi'ozen hard, cannot be properly cut ; in fact, our sections are 
 invaiiably obtained from the tissue which is slowly thawing, 
 and which is always of most delicate consistence for cutting. 
 On this account it is not necessary to freeze up to the level of 
 the section-plate. 
 
 3. Too much uxiter on the blade. If this superfluous fluid 
 runs off on to the section and freezing-plate, it sets into a 
 solid icy mass, which injm-es the blade and greatly retards 
 section-cutting. 
 
 4. Water freezes over the. section-dilate. The uneven sur- 
 face thus produced prevents section-cutting. The difficulty 
 is removed by never neglecting to draw the under surface of 
 the blade over the towel before each section is taken. 
 
 5. Brain freezes too Jiard inrspcctive of the above conditions. 
 This only results when the tissue is extremely oedematous 
 from morbid states, and when the temperature of the siu'- 
 rounding atmosphere is so low that freezing is unusually 
 rapid. The difficulty is met by moistening the upper siu'face 
 of the blade with glycerine instead of water, and carefully 
 guarding it from extending to the freezing plate. 
 
 6. Sections tear or cling to the blade. This residts from 
 the greasy surface of the blade retaining no water to float up 
 the section. 
 
 7. Tissue cannot be frozen to plate or loosens too soon. The
 
 140 MIMUTE EXAMINATION OF THE BRAIN. 
 
 first occurs when glycerine or other medium which cannot be 
 frozen has been accidentally smeared over the plate — the 
 latter usually from want of rapid manipulation on the part of 
 the operator, or too warm an atmosphere for satisfactory 
 freezing. 
 
 8. Lastly, the icell or freezing chamber may he too sni'dl, 
 in which case freezing is not only retarded, but subsequent 
 thawing is hastened. For my own part I would strongly 
 recommend this portion of the instrument to be full 2 inches 
 in diameter by 1| inches deep. 
 
 We now proceed to the subsequent treatment of our 
 sections. 
 
 Staining Fresh Sections of Cortex. — In this stage our 
 sections pass through two processes — the osmic acid treat- 
 ment and aniline staining. Take a perfectly clean glass 
 slide, pass it beneath a section floating in water, and, fixing it 
 to the slide by a needle, remove it carefully, draining off all 
 superfluous fluid from the slide. Remove each section in a 
 similar way, and next, by means of a pipette, let two or three 
 drops of osmic acid solution (0"25 per cent.) fall on the slide 
 and float up the section ; with a pen-knife carefully spread 
 this fluid over the upper surface of the section, which, on 
 account of the repulsion afforded, gives a little trouble with 
 extremely thin films. This procedure is, of course, not 
 necessary where the section has been sunk in water, but the 
 more delicate sections float, and can be plunged beneath the 
 surface of the water only at the risk of ruining them. A 
 little practice soon enables us to carry the osmic acid over the 
 most delicate films without tearing them. Sections thus 
 treated should not remain over one minute in the osmic acid 
 of the strength named, but should at once be immersed in a 
 vessel of pure water and left here for five or ten minutes. By 
 this time all superfliious acid has been removed, . and the 
 osmium has " fixed " the nervous structures, so that they are 
 manipulated without danger and do not deteriorate in water. 
 The sections may now be stained collectively, or, as I prefer
 
 PREPARATION OF NERVOUS TISSUE IN THE FRESH STATE. 141 
 
 it, each section should be placed on a slide, and sufficient 
 aniline blue-black dye (0'25 per cent.) poured on to completely 
 cover the film. Place the slides under cover. It is well to 
 have a small tray with a shelf attached around its sides on 
 which the slides may rest, the tray being fitted with a cover. 
 The staining with the aqueous solution of the dye occupies 
 about one hour ; alcoholic solutions of the dye are of course 
 inadmissible. When staining is complete a pipette will 
 remove superfluous dye, or it may be drained off carefull}'', 
 and the sections again plunged into water and gently moved 
 about imtil well washed from unfixed dye. There are certain 
 circumstances which the student shoidd be aware of in adopt- 
 ing this process of staining, and these I will here briefly 
 allude to. 
 
 If the osmic acid solution be too strong or left on the 
 section too long, subsequent staining by aniline will prove 
 very unsatisfactory, and, moreover, the osmium staining 
 becomes apparent, and is dissolved out subsequently by the 
 benzole solution of balsam tinting the latter strongly and 
 spoiling the preparation. Since the osmic acid is used simply 
 to give the sections the necessary consistence for manipulation, 
 and not for the purpose of staining, it should be employed in 
 the weakest form consistent with this action, and the sections 
 exposed to its agency for the very shortest period necessary, 
 and very thoroughly washed prior to staining. If the osmic 
 acid be unequally spread over the section, those parts not 
 immersed will stain with less vigour by aniline. 
 
 Again, when all the above precautions have been taken, it 
 is sometimes found that sections exhibit a rough, irregularly- 
 stained surface, really due to the edge of the section-blade 
 being somewhat frayed, and so tearing the delicate structures 
 in cutting through them. 
 
 Mounting for Permanent Preparations. — Let each 
 section, when well washed, be received upon the centre of a 
 perfectly clean glass slide ; all fluid drained off, and the 
 specimens again placed upon the shelf of the covered tray, to
 
 142 MINUTE EXAMINATION OF THE «RAIN, 
 
 dry spontaneously. The process may be hastened, if neces- 
 sary, by enclosing them within a bell-glass along with a 
 capsiile containing strong sulphuric acid. When perfectly 
 dehydrated, let a drop or two of a benzole solution of balsam 
 fall on the section, and adjust the cover- glass. 
 
 Staining Fresh Sections of Central Medulla. — 
 
 As before stated, the same method of staining is not alike 
 suitable for both cortex and medulla. The aniline process, 
 just described, is in every way adapted for the cortex of the 
 cerebrum and cerebellum ; but when our object is to follow 
 the com-se of the central medullated fasciculi, and examine 
 the structiu'e of the basal ganglia, the use of osmic acid has 
 to be invoked. Before practising on the more extensive areas 
 of the human cerebrum, it would be well for the student to 
 slice the brain of one of the smaller animals — (the cat, dog, 
 rabbit, are very suitable) — upon the freezing microtome, 
 carrying sections through the hemispheres in vertical and 
 horizontal planes. Such sections should be extremely fine, 
 and on removal on a slide to the stage of the microscope, 
 shoidd exhibit, in an exquisite manner, the details of 
 medullated structures. The grey matter will, of course, be 
 translucent, and apparently structureless ; but the medullated 
 fasciculi will appear in striking relief of a pure white, the 
 minutest fibre readily followed by a comparatively low-power 
 objective. Our object, however, is to render these structures, 
 not only clearly-defined, but permanent preparations, and this 
 may be effected by the following procedure. The finest 
 sections are removed as rapidly as possible from the water in 
 which they float upon a slide, and floated up immediately by 
 osmic acid (1 per cent, solution)^ drawn also carefully over 
 the upper surface of the section. The slide is placed aside, 
 closely covered over, so as to confine the vapom- of this very 
 volatile reagent as much as possible to the section. In a 
 period, varying from five to ten minutes, the sections are 
 floated off into Avater, and freely washed. They acquire 
 rapidly the deep brown tint of osmium, and can be manipu-
 
 PREPARATION OF N;ERV0US TISSUE IN THE FRESH STATE. 143 
 
 lated without fear of tearing. The depth of tint required 
 can be best learnt by experience. 
 
 After well washing, the sections may either be mounted as 
 they are, or immersed for a few moments in picro-carmine ; 
 the latter is, perhaps, the best plan to adopt, as the grey 
 matter is thus shown stained, in striking contrast to the 
 medulla. 
 
 The mounting of these preparations is more tedious, as 
 they require to be j)reserved in glycerine or aqueous solutions, 
 and careful sealing-up is therefore requisite. Take up the 
 sections on the centre of a slide, after washing off the picro- 
 carmine dye, and allow a drop or two of strong glycerine to 
 float up the sections and remain exposed for five or ten 
 minutes. The section becomes clearer and freed from much 
 water by this means, and the glycerine is drained off. Just 
 sufficient strong glycerine is again di'opped on to the section 
 to cover it completely, and the cover is placed on. All traces 
 of superfluous glycerine must be carefully removed from the 
 margins of the cover-glass after it has been gently pressed 
 down, and on no account must any glycerine remain on the 
 slide just outside the cover- glass. A thin coating of the lead 
 cement is laid on around the square or circle of thin glass, 
 just overlapping by a couple of millimeters the edges of the 
 latter. This must be allowed to dry completely, when a 
 second coating is run on, and also allowed to dry. Over this, 
 a layer of gold size may be painted, and a finish afforded by 
 the Avhite zinc paint. This method of sealing-up, although 
 tedious, is most reliable and durable ; it well repays the 
 trouble taken. The same method may be employed where 
 preservative fluids, such as Farrant's, Groadby's, or sodium 
 chloride with camphor solution are - used. We should be 
 cautious in using these fluid preservatives, to lay the gold 
 size above and not beneath the red lead cement. A weak solu- 
 tion of chloride of sodimn, made with camphor- water, also 
 answers well for preserving the preparations stained by osmie 
 acid alone.
 
 144 MINUTE EXAMINATION OF THE BRAIN. 
 
 § PREPARATION OF NERVOUS TISSUES BY 
 
 DISSOCIATION. 
 
 Prior to the systematic section-cutting of frozen brain, 
 various methods of fresh preparation had been tried. Thus, 
 a thin section of cortex was often pressed out between the 
 cover-glass and slide, and its vascular system fairly well 
 displayed ; but the nerve-cells and their delicate ramifications 
 could not, of course, be detected by such a coarse method of 
 procedure. It was found necessary to prepare the section by 
 certain reagents whereby dissociation of elements might be 
 secured, whilst some form of staining reagent was likewise 
 essential. Amongst the earher attempts of this kind, was 
 that made by Grerlach,^ but the process is applicable only to 
 the large ganglionic cells of the spinal cord. I have myself 
 employed a process less tedious than that of Grerlach, having 
 the advantage of being rapid and immediate in application, 
 with results which, to me, appear equivalent to what is 
 obtained by the more lengthened process. I shall describe 
 both. 
 
 Gerlach's Method of Dissociation. — The finest pos- 
 sible sections are made longitudinally, through the perfectly 
 fresh spinal cord of the calf or ox, and are immediately placed 
 in a very weak solution of bichromate of ammonia (1 part to 
 5,000 or 10,000 parts of water). Let them remain here for 
 two or three days, at a cool temperature. Next, immerse 
 them for twenty-four hours in a dilute solution of ammoniacal 
 carmine. Wash the sections well with distilled water, and 
 tease out the nerve-cells with a needle, under a lens. Preserve 
 in glycerine, or evaporate to dryness on a slide ; moisten with 
 oil of cloves, and mount in Canada balsam. 
 
 Dissociation may thus be practised in the case of ganglionic 
 cells, wherever they are found, the macerating fluid being 
 either dilute bichromate of potash or ammonia, Miiller's fluid, 
 
 ' Strieker's " Human and Comparative Histology." Syd. Soc. Vol. ii. 
 p 345.
 
 PREPARATION OF NERVOUS TISSUE IN THE FRESH STATE. 145 
 
 or iodized serum, the process of maceration occupying from 
 one to three days. 
 
 Rapid Dissociation and Teasing. — Make a fine 
 section with a razor through the anterior cornu of the 
 cord in its lumbar enlargement. The section must be 
 made longitudinally, and either by hand or on the freezing 
 microtome. Place the section in the centre of a glass slide ; 
 saturate it by immersion in Miiller's fluid for a few minutes ; 
 place a glass cover over the section, and gradually compress 
 it by a mounted needle between the cover-glass and slide. 
 Before a fine film is obtained, the shde is carefully wiped on 
 its under sm-face, and examined by a low power under the 
 dissecting microscope. Even as opaque objects, the ganglion 
 cells Avill now attract our attention by their little masses of 
 pigment. With the slide still under a low objective, steadily 
 and gradually compress the part where the cells chieflj' con- 
 gregate, and, by a gentle rocking movement of the cover- 
 glass, we may thus spread them out over the field, or aggre- 
 gate towards the clearer areas, whilst any alteration they 
 might suffer from this compression, is sure to be very trivial, 
 owing to the elastic resistance of the neuroglia framework. 
 The cover-glass may now be partly pressed and partly tilted 
 off the film, and the mounted needle used to arrange the cells 
 according to our mind, whilst the other textures around may 
 be carefully removed. A few drops of Beale's strong 
 solution of carmine, or the aqueous solution of aniline blue- 
 black (0'25 per cent.), will very rapidly tint the germinal 
 centres of the required depth of hue, and should then be 
 removed by immersion in water, or by allowing a few drops 
 of water gently to flow over the preparation. The cells are 
 dried in situ, moistened with clove oil, and mounted in 
 balsam. 
 
 Dissociation and Staining of Ganglion-cells of 
 Cortex. — The two methods just detailed are available 
 only for the cells of the spinal cord. For the ganglion- 
 cells of the human cortex, I devised a method which
 
 14G MINUTE EXAMINATION OF THE 15KA1N. 
 
 was described in the Monthly Microscopical Journal for 
 1876, and which affords very satisfactory results. The 
 process may be considered under three stages: 1. Obtaining 
 the fihn ; 2. Staining ; 3. Permanent mounting of the prepa- 
 ration. 
 
 1. First Stage: The Film. — Strip the convolution of 
 its membranes, and excise a portion convenient for manipida- 
 tion. Hold it betwixt the thumb and second finger of the 
 left hand, so that the index finger may guide and support the 
 blade. Then, with the razor-blade satiu-ated with methylated 
 spirit, cut section after section vertically to the surface of the 
 cortex, and of the greatest delicacy possible by these means. 
 Very thin sections may thus be obtained with little trouble. 
 Each should be placed on a glass slide, and three or four 
 drops of Miiller's fluid allowed to fall upon them from a 
 pipette. Maceration in this fluid for a few seconds, prevents 
 the film adhering, dming the next procedure, to the cover- 
 glass or slide. The cover is next placed on, and so arranged 
 as to cover the film by only one-half its diameter. Place the 
 point of a mounted needle upon the centre of the cover-glass, 
 and by steady pressure flatten out the section into an 
 almost transparent film. Practice will soon enable the 
 operator to so arrange the cover-glass that the extreme edge 
 of the compressed section still occupies the space covered by 
 the glass circle. Now remove the superfluous reagent by 
 rapid rinsing in water, and place the slide in a flat porcelain 
 bath or tray, containing methylated spirit. In from thirty 
 to forty seconds, the cover can be removed without tearing 
 the film. For this purpose, remove the slide, steady the cover 
 by the pressure of a finger against one part of its edge, 
 and pass the point of a needle under the edge, near the 
 medullated portion of the section, and gradually elevate 
 it. "Wash the films from spirit by allowing a stream of water 
 to flow over them from a large camel-hair brush. 
 
 2. Second Stage : Staining. — The aniline blue-black 
 solution (1 per cent.), is the most suitable staining reagent.
 
 TREPARATION OF XERVOl'S TISSUE IX THE FRESH STATE. 147 
 
 It is dropped upon the film as it lies oil the slide, and when 
 sufficiently stained, the superfluous dye is poured off, and the 
 slide lowered gently into water, the film being washed by 
 agitating the fluid around it with a camel-hair brush. Car- 
 mine and picro-carmine may be also used for staining ; but 
 hithei'to the best results have been obtained with aniline black 
 dye. 
 
 3. Third Stage : Permanent Mounting. — The speci- 
 mens lying in the centre of their respective slides are now 
 transferred to a bell-glass, so as to exclude dust, and left to 
 dry spontaneously, or the process of desiccation is hastened by 
 including a capsule containing strong sulphm'ic acid. When 
 perfectly dry, let a drop of chloroform fall on the preparation, 
 and immmediately add the balsam (chloroform or benzole 
 solution), and adjust the cover glass. 
 
 Examination of Neuroglia. 
 
 The neuroglia may be well shown in the spinal cord by 
 the methods of dissociation above given. It has been especi- 
 ally studied in the fresh state by Boll, Eanvier, Mierzejewski, 
 and others, and the following methods are worthy of note : — 
 
 1. Boll's Method. — Thin sections of the brain-substance 
 were plunged into a solution of osmic acid, O'l per cent., and 
 after twenty-four hovu's immersion, were washed in distilled 
 water and kept in a concentrated solution of potassic acetate. 
 For microscopic examination, .these darkened sections were 
 dissociated or compressed strongly betwixt cover and slide. 
 
 2. Ranvier's Method. — Osmic acid (1 part in 300 parts 
 of water) was injected interstitiaUy into the fresh spinal cord. 
 The pai-ts infiltrated by the reagent were afterwards removed 
 by the section-knife, torn up, and teased in distilled water, 
 coloured by picro-cai-mine, and examined in glycerine. Tliis, 
 I may add, is a very excellent and valuable method. 
 
 L 2
 
 148 MINUTE EXAMINATION OF THE BRAIN. 
 
 3. Mierzejewski's Method. — ^A fragment of the white 
 substance of the brain, about one cubic centimeter in bulk, 
 was placed for twelve to twenty-four hours in a solution 
 of osmic acid (1 part in 300 parts of water). By this time 
 the preparation was impregnated by the reagent and its 
 exterior dark and callous. The hardened exterior was then 
 sliced off by the section-knife, when the parts immediately 
 beneath it were found pretty equably affected by the osmium. 
 Minute preparations were then obtained from this region, 
 after the manner of Eanvier, viz., by staining with picro- 
 carmine and examining in glycerine. Mierzejewski employed 
 this method satisfactorily in his studies of the neuroglia of 
 the brain in general paralysis.^ 
 
 Dissection of MeduUated Strands in the Fresh 
 Brain. — Much valuable information may be gleaned by the 
 student in the examinatian of the brain of the smaller 
 mammalia by dissection beneath a fixed lens or dissecting 
 microscope. The brain should be placed beneath the light 
 concentrated by a bull's-eye condenser. The scalpel, 
 mounted needle, and camel-hair pencil are all the aids he 
 requires. In fact, the needle and brush do nearly all the 
 work, the broken-down tissue and grey matter being washed 
 off by the brush filled -with a solution of chloride of 
 sodium (1 per cent.). It is astonishing to one who has not 
 tried this method how much can thus be done. It is well to 
 begin with the very small brains, such as that of the rat. 
 
 Remarks upon Dissociation of Nerve-Cells. — The 
 student must not regard the methods of dissociation just 
 given as being merely a rough and ready means of displaying 
 the coarse structure of nervous tissue. Where the microtome 
 is not at hand, or cannot be employed, these methods are very 
 valuable ; but, even when possessed of the permanent sections 
 obtained by the microtome, dissociation should supplement 
 our inquiries. The films thus obtained, as well as those off 
 
 1 ' ' Etudes sur les Lesions Cerebrales dans la Paralysie Generale.' ' Archives 
 de Fhysiologie, 1873.
 
 PREPARATION OF NERVOUS TISSUE IN THE FRESH STATE, 149 
 
 the freezing microtome, afford us miicli information upon 
 histo- chemical examination. The elements may thus be 
 treated by osmic acid, salts of gold, platinum, and silver, and 
 a variety of dyes. For examination of the reactions with 
 chemical reagents, I have found it useful to obtain the 
 faintest tint by aniline, just sufficient, indeed, to bring into 
 view the outline of the cells and their nuclei. For this pur- 
 pose a few drops of very weak aniline dye, left on for a few 
 minutes, and then washed off, may be fixed in the germinal 
 centres by a di-op of extremely dilute hydrochloric acid, 
 which is immediately cleared off by water, and the film 
 left in a satisfactory state for noting the effect of reagents.
 
 PAET III 
 LIST OF REAGENTS AND MOUNTING MEDIA
 
 LIST OF REAGENTS AND MOUNTING MEDIA. 
 
 The following list comprises fill the more useful reagents 
 which the student will require in the prosecution of the 
 minute examination of the brain. Those marked with an 
 asterisk (*) are the most important, and cannot be dispensed 
 with. 
 
 Hardening Reagents. 
 
 1.* Chromic acid (stock solution, 1 per cent.). 
 
 Chromic acid cry st. ... 10 grammes. 
 Water 1,000 c.c. 
 
 Dissolve. Dilute to O'lo pei- cent, for brain, and 0-25 
 per cent, for spinal cord. 
 
 2.* Bichromate of potassium (stock solution, 4 per cent.) . 
 
 Bichromate of potassiimi ... 40 grammes. 
 "Water (hot) .;. ... 1,000 c.c. 
 
 Dissolve. Used in dilutions from 0-25 per cent, upwards. 
 
 3. Bichromate of ammoniimi (stock solution, 4 per 
 cent.), made as the potassium solution above. 
 
 4.* Mailer's fluid. 
 
 Bichromate of potassium ... 25 grammes. 
 
 Sodium sulphate ... ... 10 „ 
 
 Water ... 1,000 c.c. 
 
 Dissolve. 
 
 5. 
 
 Picric acid solution. 
 Cold satiu-ated solution in water.
 
 154 LIST OF REAGENTS AND MOUNTING MEDIA. 
 
 6.* Osmic acid. 
 A solution of 1 per cent, should be kept in a blue glass 
 closely-stoppered bottle, to be diluted when required imme- 
 diately before use. 
 
 7.* Methylated spirit. 
 
 8.* Absolute alcohol. 
 
 Formula of tSi-Eci \.l Holutkjns. 
 
 9. llutherford's reagent. 
 
 Cliromic acid ... ... 1 gramme. 
 
 Bichromate of potassium ... 2 ,, 
 
 Water 1,200 c.c. 
 
 Dissolve. 
 
 10. Solutions for Betz's method. 
 
 {a) Iodized alcohol. 
 
 Alcohol (70 to 80 per cent.), tinted sherry- 
 brown by tinct. iodi. co. 
 {b) Iodized spirit. 
 
 Methylated spirit, tinted sherry - brown by 
 tinct. iodi. co. 
 ic) Bichromate solutions. 
 
 Solutions of potassium bichromate from 0*5 
 per cent, up to 5 per cent. 
 
 11. Solutions for Hamilton's method. 
 
 (r/) Midler's fluid 3 parts. 
 
 Methylated spiiit ... ... 1 „ 
 
 Mix. 
 [h] Solutions (aqueous) of ammonium bichromate, 
 
 0"25 per cent, to 2 per cent. 
 
 12. Kleinenberg's picric acid solution. 
 
 Cold saturated aqueous solution of 
 
 picric acid ... ... ... 800 c.c. 
 
 Concentrated sulphmic acid ... 6 c.c. 
 
 Mix, filter, and add to the filtrate, Avater 900 c.c.
 
 Ll.ST OF KEAGENTS AND MOUNTING MEJ)IA. 155 
 
 Staining Reagents. 
 
 The following may be regarded as a fairly complete list of 
 the reagents more generally employed ; the f ormnlie for special 
 solutions are also given below : — 
 
 1.* Carmine. ' Aniline dyes comprising — 
 
 2* Hsematoxylin (crystals). irv* a -t it it ^ 
 
 -r 1 . / 10.* Aniline blue-black. 
 
 LiOgwood extract. -. , , , 
 
 8.* Picric acid (crystals). ^' ,^ " .,. " , ^ 
 
 . ^ "^ I -'-■^- Iv-osanihn (magenta). 
 
 13. Fuchsine. 
 
 14. Metli34-aniline. 
 
 15. Iodine green. 
 
 16. Judson's dyes, espe- 
 
 cially *" Cambridge 
 blue." 
 
 17. Various combinations 
 
 5. Gold chloride. 
 (J. Double chloride of gold 
 and potassium. 
 
 7. Silver nitrate (0'5 per 
 
 cent.). 
 
 8. Silver lactate (Alferow's 
 
 formula) . , " p i i v 
 
 . * ^ • • ■. 1 i \ of the above. 
 
 d. Osmic acid (1 per cent.). ' 
 
 Formula for Special Solutions. 
 
 1.* Beale's carmine reagent. 
 
 Carmine (in small fragments) 10 grains. 
 Liquor ammonife ... • • ■ h drachm. 
 
 Glycerine (Price's) 2 ounces. 
 
 Alcohol ... •■• ••• ^ 5J 
 
 Distilled water ... ••• 2 ,, 
 
 Heat the carmine with the ammonia in a test-tube carefully, 
 boil for a few minutes, and expose for one hour. Add the 
 water ; filter. Add the spirit and glycerine, and expose until 
 the odour of ammonia is scarcely perceptible. 
 2. Thiersch's carmine reagent. 
 
 (a) Cannine ••• ••• ••• 1 \)ia:i. 
 
 Liquor ammonite ... • • • 1 ?> 
 
 Distilled water 1 » 
 
 Dissolve and filter. 
 
 {h) Oxalic acid 1 P'^i't- 
 
 Distilled water 22 „
 
 156 LIST OF REAGENTS AND MOUNTING MEDIA. 
 
 Mix one part of (a) witli eight parts of (b), and add 
 twelve parts of alcohol. 
 
 3. Borax carmine. 
 
 Carmine ... ... ... 1 part. 
 
 Borax .., ... ... ... 4 „ 
 
 AVater 56 „ 
 
 Alcohol ... ... ... q.s. 
 
 Dissolve the borax in the water, and add the carmine ; 
 filter, and add to the filtrate two volumes of absolute alcohol. 
 
 4.* Ranvier's picro-carmine. 
 
 (a) Carmine 
 
 Liquor ammonite . . . 
 Water 
 
 1 gramme. 
 3 c.c. 
 10 c.c. 
 
 liub the carmine up with water ; add the ammonia, and 
 dissolve with heat carefully applied, 
 
 (b) Saturated aqueous solution of picric acid, 200 c.c. 
 
 Add, when perfectly cold, (a) to (b), and evaporate with 
 gentle warmth to one-third its bulk. Filter, and keep in 
 stoppered bottle. 
 
 5.* Minot's hsematoxylin dye. 
 
 («) Heematoxylin crystals 
 Absolute alcohol 
 Alum 
 Water 
 
 Dissolve the hsematoxylin in alcohol, and add the alum, 
 dissolved in the water. 
 
 (b) Alum 1 part. 
 
 Water ... 200 
 
 3-5 
 
 parts 
 
 100 
 
 >> 
 
 1 
 
 5> 
 
 300 
 
 )> 
 
 J> 
 
 Dissolve. For use, pour a little of (b) into a watch-glass, 
 and add sufficient of (a) to colour it a light violet tint. 
 Filter prior to staining.
 
 LIST OF REAGENTS AND MOUNTIXCx MEDIA. 157 
 
 6.* Kleinenberg's hoematoxylin dye. 
 
 (a) Make a saturated solution of crystallized calcium 
 cliloride in alcohol (70 per cent.), and add alum 
 to saturation. 
 
 (b) Make a saturated solution of alum in alcohol (70 
 per cent.), and add solution {a) to {h), in the pro- 
 portion of 1 to 8. 
 
 (c) To this resultant mixture, now add a feiv drops of a 
 harely alkaline saturated solution of hsematoxylin. 
 
 7.* Aniline blue-hlack (aqueous solution). 
 
 Aniline blue-black ... 1 gramme. 
 Distilled water 400 c.c. 
 
 Dissolve, filter, and label " 0-25 per cent." Or, make a 
 1 per cent, solution ; dilute and filter when required. 
 
 8. Aniline blue-black (alcoholic solution). 
 
 Aniline blue-black ... 1 decigramme. 
 
 Water 4 c.c. 
 
 Dissolve and add recti- 
 fied spiiit ... 100 c.c. 
 Filter, and label " O'l per cent." 
 
 9. Aniline blue reagent. 
 
 Aniline blue J grain. 
 
 Distilled water 1 ounce. 
 
 Alcohol 25 drops. 
 
 10. Rutherford's rosanilin dye. 
 
 Rosanilin or magenta (crystals) 1 grain. 
 
 Absolute alcohol 100 minims. 
 
 Distilled water 5 ounces. 
 
 11. Dyes used in combination. 
 
 Aniline blue-black (Aq. sol., 0-25 per cent.) 
 + ricro-carmine.
 
 158 LIST OF REAGENTS AND MOUNTING MEDIA. 
 
 Judson's " Cambridge blue " | 
 + Picric acid. j 
 
 Osmic acid (1 per cent.) + Picro-carmine. 
 Hsematoxylin ... + Aniline blue-black 
 
 (0*5 per cent.). 
 Eosin (1 to 1,500) ... + Hsematoxylin. 
 Picro-carmine ... + Iodine green. 
 
 12. Alferow's lactate of silver : — 
 
 Lactate of silver ... ... 1 part. 
 
 Distilled water 800 „ 
 
 Concentrated solution of lactic 
 
 acid ... ... ... A few drops. 
 
 Note. — " The free acid renders precipitation less easy, and 
 the chloride and albuminate of silver are alone formed." 
 
 13. Gerlach's gold and potassium solution.^ 
 
 Double chloride of gold and 
 
 potassium ... ... 1 part. 
 
 Water, feeblv acidulated 
 
 with hydrochloric acid.. 10,000 ,, 
 
 Sections acquire a pale lilac colom' in this solution in from 
 ten to twelve hours. 
 
 Solutions for Macerating and Dissociating 
 
 Tissues. 
 
 1. Iodized serum. 
 
 Fresh amniotic fluid ... 100 c.c. 
 
 Tincture of iodine ... ... 1 c.c. 
 
 Carbolic acid ... ... 2 drops. 
 
 For small quantities, use the aqueous humour from the eye 
 of sheep or ox. Other useful fluids are — 
 
 2. Glycerine and water. 
 
 ' For staining sections of spinal cord by this method, see Art. " The Spinal 
 Cord," by Gerlach, in Strieker's " Human and Comparative Histoloo-y."
 
 LIST OF REAGENTS AND MOUXTIXG MEDIA. 150 
 
 3, Chloride of sodium solution (0*75 per cent.). 
 
 4, Ammonium and potassium bichromate (1 part to 
 
 10,000 of water). 
 
 5, Midler's fluid, freely diluted. 
 
 Mounting Media. 
 
 1.* Griycerine (Price's) ; 2.* Glycerine jelly (Rimming- 
 ton's) ; 3.* Canada balsam ; 4.* Dammar varnish ; 5. Far- 
 rant's solution. 
 
 3.* Benzole solution of balsam. 
 
 Canada balsam evaporated in a water-bath to a brittle, 
 resinous consistency, is dissolved in benzole until it is 
 sufficiently fluid to drop slowly from a glass rod. 
 
 4.* Dammar fluid. 
 
 Gum dammar, gum mastic, 
 
 of each ... ... ... h ounce. 
 
 Benzole ... ... ... 3 ,, 
 
 Dissolve the gum in the benzole and filter. 
 
 5.* Farrant's solution. 
 
 Glycerine, saturated solution of arsenious acid, gum- 
 arabic, equal parts of each. 
 
 Let the mixture stand for several weeks, frequently stirring; 
 and when no more of the gum-arabic is dissolved, filter the 
 solution. 
 
 Cements. 
 1.* Mr. Kitton's cement for glycerine mounting. 
 
 White lead, red lead, litharge in powder, equal paris. 
 
 Mix well. Keep a stock of the mixture ready ground in a 
 bottle. 
 
 For use — rub up a little of the powder with turpen- 
 tine, and add sufficient gold size to allow it to work readily 
 with a brush. The first coat should always be perfectly dry 
 before the application of a second.
 
 IGO LIST OF REAGENTS AND MOUNTING MEDIA. 
 
 2.* Zinc-white cement. 
 
 Griim dammar. . . ... ... 8 oimces. 
 
 Zinc oxide ... . . ... 1 ,, 
 
 Benzole ... ... ... 8 ,, 
 
 Dissolve the gum in the benzole, add the zinc, and strain 
 through muslin. 
 
 3. Marine glue. 
 4.* Gfold size. 
 5. Brunswick black. 
 6.* Balsam or dammar varnish. 
 In addition to the list of reagents above given, the student 
 sliould supply himself with a bottle of clove oil, glacial acetic 
 acid, and solution of chloral hydrate, 2 per cent.
 
 I ^^ D E X. 
 
 Absolute weight of brain, 61 
 Acid, chromic, 105, 153 
 
 osmic, 105 
 
 picric, 154 
 Alferow's sUver lactate, 158 
 Amnioniiun bichromate, 104, 154 
 AnUice blue -black, 157 
 
 picro-carminate, 129 
 
 staining, 125 
 Apparatus, displacement, 65 
 
 specific gravity, 63 
 
 for hardening tissues and section- 
 cutting, 114 
 
 for staining and mounting, 135 
 Arachnoid, examination of, 9 
 Arteries, capacity of, 20 
 
 dissection of, 15 
 
 nutrient, 24 
 
 tunics of, 18 
 
 B 
 
 Base of brain, 8 
 
 Beale's carmine fluid, 155 
 
 Betz's method of hardening, 103 
 
 hardening solutions of, 154 
 Bichromate solutions, 154 
 Blood-vessels, distribution of, 10 
 
 capacity of, 20 
 
 coats of, 18 
 
 nutrient, 24 
 Boll's method for neuroglia, 147 
 Borax carmine, 156 
 Broca's estimates of capacity, 59 
 Bucknill's specific gravity test, 63 
 
 Canada balsam 159 
 Capacity, arterial, 20 
 
 cranial, 57 
 Carmine staining fluids, 155 
 
 staining process, 120 
 Cements, list of, 159 
 Central medulla, 133 
 Chrome hardening, 102 
 Chromic acid, 105, 153 
 Cicatricial tissue, 44 
 Circle of Willis, 16 
 Colour of cortex, 45 
 Compound pigments, 128, 157 
 Consistence, estimation of, 29 
 
 reductions in, 31 
 
 augmented, 43 
 Convolutions of brain, 75 
 
 synonyms of, 78 
 Cortex cerebelli, staining, 132 
 
 cerebri, staining, 131 
 
 congestion of, 52 
 
 ganglion-cells of, 145 
 Cranial capacity, 57 
 
 D 
 
 Dammar mounting medium, 159 
 Danilewski's method for weight, 07 
 Dissection of brain, 69 
 Dissociation of nervous tissue, 144 
 cells in cortex, 145 
 rapid method of, 145 
 Gerlach's method of, 144 
 Dissociating reagents, 158 
 Dura mater, examination of, 3
 
 162 
 
 INDEX. 
 
 E 
 
 Ecker's s3monyms, 78 
 Embolic pluggiuyr of brain, 36 
 Eosin staining iluid, 131 
 Exner's osniic acid process, 105 
 
 EaiTant's solution, 159 
 
 Flowers' method for cranial capacity, 
 
 58 
 Freezing methods, 137 
 
 microtomes, ether, 92 — 95 
 Eutherford's, 90, 95 
 Williams', 98 
 Fresh brtiin, preparation of, 136 
 sections, staining, 140 
 
 G 
 
 Ganglia of brain, staining, 142 
 Ganylion-cells of cortex, 122, 145 
 Gerlach's gold and potassium solution, 
 158 
 method of dissociation, 144 
 Gravimetric methods, 60 
 
 H 
 
 Hajmatoxylin dye, 156 
 
 staining, process of, 116 
 Hamilton's methods of hardening, 104 
 
 hardening solutions, 154 
 Hardened brain, preparation of, 100 
 Hardening by chrome salts, 102 
 
 by osmium, 105 
 
 reagents, list of, 153 
 
 Imbedding mixtures, 108 
 
 process of, 107 
 Iodine green reagent, 131 
 Iodized serum, 158 
 
 K 
 
 Kitton's lead cement, 159 
 Kleinenberg's hgematoxylin dye, 117 
 picric acid solution, 154 
 
 List of apparatus for section-cutting, 
 114 
 for staining and mounting-, 135 
 solutions for hardening, 153 
 dissociating, 158 
 mounting, 159 
 staining, 155 
 Logwood staining reagent, 155 
 
 M 
 
 Macerating reagents, 158 
 Magenta dye, 157 
 Medulla oblongata, 134 
 Medulla, staining of central, 133 
 Membranes, examination of, 1 — 14 
 Methods of preparation, 86 
 Microtome, ether freezing, 92, 95 
 
 imbedding, 89 
 
 Ranvier's, 90 
 
 Eoy's, 91 
 
 Eutherford's, 90, 95 
 
 Schiefferdecker's, 91 
 
 Stirling's, 90 
 
 Williams', 98 
 Mierzejewski, method for neuroglia, 
 
 148 
 Minot's hfematoxylin dye, 116 
 Mounting fresh tissues, 143 
 
 hardened tissues, 115 
 
 media, 159 
 Miiller's fluid, 153 
 
 N 
 Neuroglia, examination of, 147 
 hypertrophy of, 44 
 
 
 Osmic acid, process of hardening by, 
 105 
 staining by, 130 
 
 Pallor of cortex, 46 
 
 Paraffin mass for imbedding, 108 
 
 cast of cranium, 58 
 Physical properties of cerebral sub- 
 stance, 26 
 Pia mater, examination of, 9 
 
 vessels of, 22
 
 INDEX. 
 
 163 
 
 Picric acid solutions, 153,154 
 Picro- aniline staining, 130 
 Picro-cannine reagent, 156 
 
 staining, 124 
 Pigments, compound, 12S 
 Pons, staining of, 134 
 Potassitun bichromate solutions, 1-3 3, 
 
 154 
 Preparation of fresh tissues, 136 
 
 of hardened tissues, 100 
 Pressiu'e, residts of intra-cranial, 54 
 
 intra-thoracic, 54 
 Puncta vasculosa, 53 
 Putrefactive changes, 31 
 
 Q 
 
 Quekett Club microtome, 98 
 
 R 
 
 Ranvier's method for neuroglia, 147 
 
 microtome, 90 
 
 picro-carmine dye, 156 
 Reaction of aniline blue-black, 126 
 
 carmine, 122 
 
 hfematoxylin , 119 
 
 osmic acid, 128 
 
 picro-carmine, 124 
 Reagents, list of, 153 
 Reference to photographs, 77 
 Roy's microtome, 91 
 Rutherford's hardening fluid, 154 
 
 microtome, 90, 95 
 
 rosanilin dye, 157 
 
 S 
 
 Sankey's aniline solution, 125 
 
 specific gravity test, 63 
 Schieff erdecker' s mici'otome, 91 
 Sclerosis of nervous centres, 44 
 Section-blade, 112 
 Section-cutting, 110, 137 
 
 Sections, prei)aration of hardened, 115 
 
 preparation of fresh, 140 
 Silver lactate, 158 
 Sinuses of skidl, 5 
 Softening, indications of, 32 
 
 ischsemic, 33 
 
 yeUow, 37 
 
 inflammatory, 38 
 
 oedematous, 41 
 Special regions, staining of, 131 
 Specific gravity of brain, 62 
 Staining reagents, list of, 155 
 
 methods, 115, 140 
 Stevenson's displacement apparatus, 
 
 65 
 Stii-ling's microtome, 90 
 Siunniary of hardening methods, 106 
 Synonyms of convolutions, 78 
 
 Thiersch's carmine dye, 155 
 Topography of brain, superficial, 75 
 Tuke, method of estimating cranial 
 capacity by Dr. Hack, 57 
 
 Vault of cerebrum, examination of, 4 
 Venous sinuses, 5 
 Volume of brain, 55 
 Volumetric methods, 55 
 
 W 
 
 Weight of brain, absolute, 61 
 
 dift'erential, 67 
 
 specific, 62 
 Williams' microtome, 98 
 
 Zinc cement, 160 
 
 Zones, congested cortical, 52 
 
 Pardon and Sons, Printers, Paternoster Row, London.
 
 Catalogue B] 
 
 Loftdon, II, Ne%v Burlington Street 
 October, 1887 
 
 SELECTION 
 
 FROM 
 
 J. k A. CHURCHILL'S GENERAL CATALOGUE 
 
 COMPRISING 
 
 ALL RECENT WORKS PUBLISHED BY THEM 
 
 ON THE 
 
 ftKT A^D SCIENCE OF MEDICINE 
 
 N.B. — As far as possible, this List is arranged in the order in 
 which medical study is usually pursued.
 
 J. & A. CHURCHILL publish for the following Institutions 
 
 and Public Bodies:— 
 
 ROYAL COLLEGE OF SURGEONS. 
 
 CATALOGUES OF THE MUSEUM. 
 Twenty-three separate Catalogues (List and Prices can be obtained of J. &. A. Churchill). 
 
 GUY'S HOSPITAL. 
 
 REPORTS BY THE MEDICAL AND SURGICAL STAFF. 
 
 Vol. XXVIIL, Third Series. 7s. 6d. 
 FORMULA. USED IN THE HOSPITAL IN ADDITION TO THOSE 
 IN THE B.P. IS. 6d. 
 
 LONDON HOSPITAL. 
 
 PHARMACOPCEIA OF THE HOSPITAL. 3s. 
 
 CLINICAL LECTURES AND REPORTS BY THE MEDICAL AND 
 SURGICAL STAFF. Vols. I. to IV. 7s. 6d. each. 
 
 ST. BARTHOLOMEW'S HOSPITAL. 
 
 CATALOGUE OF THE ANATOMICAL AND PATHOLOGICAL 
 
 MUSEUM. Vol. I.— Pathology. 15s. Vol. II.— Teratology, Anatomy 
 and Physiology, Botany, ys. 6d. 
 
 ST. GEORGE'S HOSPITAL. 
 
 REPORTS BY THE MEDICAL AND SURGICAL STAFF. 
 
 The last Volume (X.) was issued in 1880. Price 7s. 6d. 
 CATALOGUE OF THE PATHOLOGICAL MUSEUM. 15s. 
 SUPPLEMENTARY CATALOGUE {1882). 5s. 
 
 ST. THOMAS'S HOSPITAL. 
 
 REPORTS BY THE MEDICAL AND SURGICAL STAFF. 
 
 Annually. Vol. XV., New Series. 7s. 6d. 
 
 MIDDLESEX HOSPITAL. 
 
 CATALOGUE OF THE PATHOLOGICAL MUSEUM. 12s. 
 
 WESTMINSTER HOSPITAL. 
 
 REPORTS BY THE MEDICAL AND SURGICAL STAFF. 
 Annually. Vol. II. 6s. 
 
 ROYAL LONDON OPHTHALMIC HOSPITAL. 
 
 REPORTS BY THE MEDICAL AND SURGICAL STAFF. 
 Occasionally. Vol. XL, Part IV. 5s. 
 
 OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. 
 
 TRANSACTIONS. 
 
 Vol. VI. I2S. 6d. 
 
 MEDICO-PSYCHOLOGICAL ASSOCIATION. 
 
 JOURNAL OF MENTAL SCIENCE. 
 
 Quarterly, 3s. 6d. each, or 14s. per annum. 
 
 PHARMACEUTICAL SOCIETY OF GREAT BRITAIN. 
 
 PHARMACEUTICAL JOURNAL AND TRANSACTIONS. 
 Every Saturday. 4d. each, or 20s. per annum, post free. 
 
 BRITISH PHARMACEUTICAL CONFERENCE. 
 
 YEAR BOOK OF PHARMACY. 
 
 In December. los. 
 
 BRITISH DENTAL ASSOCIATION. 
 
 JOURNAL OF THE ASSOCIATION AND MONTHLY REVIEW 
 OF DENTAL SURGERY. 
 
 On the 15th of each Month. 6d. each, or 7s. per annum, post free.
 
 A SELECTION 
 
 FROM 
 
 J. & A. CHURCHILL'S GENERAL CATALOGUE, 
 
 COMPRISING 
 
 ALL RECENT WORKS PUBLISHED BY THEM ON THE 
 ART AND SCIENCE OF MEDICINE. 
 
 N.B. — J. 4* ^' ChurchilVs Descriptive List of Works on Chemistry, Materia Medica, 
 
 Pharmacy, Botany, Photography, Zoology, the Microscope, and other Branches 
 
 of Science, can be had on application. 
 
 Practical Anatomy : 
 
 A Manual of Dissections. By Christopher 
 Heath, Surgeon to University College 
 Hospital. Sixth Edition. Revised by 
 RiCKMAN J. GODLEE, M.S. Lond., 
 F.R.C. S., Demonstrator of Anatomy in 
 University College, and Assistant Surgeon 
 to the Hospital. Crown 8vo, with 24 
 Coloured Plates and 274 Engravings, 15s. 
 
 ■Wilson's Anatomist's Vade- 
 
 Mecum. Tenth Edition. By George 
 Buchanan, Professor of Clinical Surgery 
 in the University of Glasgow; and Henry 
 E. Clark, M.R.C.S., Lecturer on Ana- 
 tomy at the Glasgow Royal Infirmary 
 School of Medicine. Crown 8vo, with 
 450 Engravings (including 26 Coloured 
 Plates), i8s. 
 
 Braune's Atlas of Topographi- 
 cal Anatomy, after Plane Sections of 
 Frozen Bodies. Translated by Edward 
 Bellamy, Surgeon to, and Lecturer on 
 Anatomy, &c., at, Charing Cross Hos- 
 pital. Large Imp. 8vo, with 34 Photo- 
 lithographic Plates and 46 Woodcuts, 40s. 
 
 An Atlas of Human Anatomy. 
 
 By Rickman J. Godlee, M.S., 
 F.R.C.S., Assistant Surgeon and Senior 
 Demonstrator of Anatomy, University 
 College Hospital. With 48 Imp. 4to 
 Plates (1x2 figures), and a volume of Ex- 
 planatory Text, 8vo, £^ 14s. 6d. 
 
 Harvey's (Wm.) Manuscript 
 
 Lectures, Prelectiones Anatomise Uni- 
 versalis. Edited, with an Autotype repro- 
 duction of the Original, by a Committee 
 of the Royal College of Physicians of 
 London. Crown 4to, half bound in 
 Persian, 52s. 6d, 
 
 Anatomy of the Joints of Man. 
 
 By Henry Morris, Surgeon to, and 
 Lecturer on Anatomy and Practical Sur- 
 gery at, the Middlesex Hospital. 8vo, 
 with 44 Lithographic Plates (several being 
 coloured) and 13 Wood Engravings, 1 6s. 
 
 Manual of the Dissection of the 
 
 Human Body. By Luther Holden, 
 Consulting Surgeon to St. Bartholomew's 
 Hospital. Edited by John Langton, 
 F.R.C.S., Surgeon to, and Lecturer on 
 Anatomy at, St. Bartholomew's Hos- 
 pital. Fifth Edition. 8vo, with 208 
 Engravings. 20s. 
 
 By the same Author. 
 
 Human Osteology. 
 
 Seventh Edition, edited by Charles 
 Stewart, Conservator of the Museum 
 R.C.S.,andR.W.REiD,M.D.,F.R.C.S., 
 Lecturer on Anatomy at St. Thomas's 
 Hospital. 8vo, with 59 Lithographic 
 Plates and 75 Engravings. i6s. 
 Also. 
 
 Landmarks, Medical and Surgi- 
 cal. Fourth Edition. 8vo. [/« the Press. 
 
 The Student's Guide to Surgical 
 Anatomy. By Edward Bellamy, 
 F.R.C.S. and Member of the Board of 
 Examiners. Third Edition. Fcap. 8vo, 
 with 81 Engravings. 7s. 6d. 
 
 The Anatomical Remembran- 
 cer ; or, Complete Pocket Anatomist. 
 Eighth Edition. 32mo, 3s. 6d. 
 
 Diagrams of the Nerves of the 
 Human Body, exhibiting their Origin, 
 Divisions, and Connections, with their 
 Distribution to the Various Regions of 
 the Cutaneous Surface, and to all the 
 Muscles. By W. H. Flower, C.B., 
 F.R.S., F.R.C.S. Third Edition, with 
 6 Plates. Royal 410, 12s.
 
 J. ^- A. CHURCHILL'S RECENT WORKS. 
 
 General Pathology. 
 
 An Introduction to. By John Bland 
 Sutton, F.R.C.S., Sir E. Wilson 
 Lecturer on Pathology, R.C.S. ; Assistant 
 Surgeon to, and Lecturer on Anatomy at, 
 Middlesex Hospital. 8vo, "with 149 En- 
 gravings, 14s. 
 
 Atlas of Pathological Anatomy. 
 
 By Dr. Lancereaux. Translated by 
 W. S. Greenfield, M.D., Professor 
 of Pathology in the University of Edin- 
 burgh. Imp. 8vo, with 70 Coloured 
 Plates, ^5 5s. 
 
 A Manual of Pathological Ana- 
 tomy. By C. Handfield Jones, 
 M.B., F.R.S., and E. H. Sieveking, 
 M.D., F.R.C.P. Edited by J. F. 
 Payne, M.D., F.R.C.P., Lecturer 
 on General Pathology at St. Thomas's 
 Hospital. Second Edition. Crown 8vo, 
 with 195 Engravings, i6s. 
 
 Post-mortem Examinations : 
 
 A Description and Explanation of the 
 Method of Performing them, with especial 
 reference to Medico-Legal Practice. By 
 Prof. ViRCHOW. Translated by Dr. T. 
 P. Smith. Second Edition. Fcap. 8vo, 
 with 4 Plates, 3s. 6d. 
 
 The Human Brain : 
 
 Histological and Coarse Methods of Re- 
 search. A Manual for Students and 
 Asylum Medical Officers. ByW. Bevan 
 Lewis, L.R.C.P. Lond., Medical Super 
 intendent. West Riding Lunatic Asylum. 
 8vo, with Wood Engravings and Photo- 
 graphs, 8s. 
 
 Manual of Physiology : 
 
 For the use of Junior Students of Medi- 
 cine. By Gerald F. Yeo, M.D., 
 F.R.C.S., Professor of Physiology in 
 King's College, London, Second Edition. 
 Crown 8vo, with 318 Engravings, 14s. 
 
 Principles of Human Physi- 
 ology. By W. B. Carpenter, C.B., 
 M.D., F.R.S. Ninth Edition. By 
 Henry Power, M.B., F. R.C.S. 8vo, 
 with 3 Steel Plates and 377 Wood Engrav- 
 ings, 31S. 6d. 
 
 Elementary Practical Biology : 
 
 Vegetable. By Thomas W. Shore, 
 M.D., B.Sc. Lond., Lecturer on Com- 
 parative Anatomy at St. Bartholomew's 
 Hospital. 8vo, 6s. 
 
 Histology and Histo-Chemistry 
 of Man. By Heinrich Prey, Pro- 
 fessor of Medicine in Zurich. Translated 
 by Arthur E. J. Barker, Assistant 
 Surgeon to University College Hospital. 
 8vo, with 608 Engravings, 21s. 
 
 AText-Bookof Medical Physics, 
 
 for Students and Practitioners. By J. C. 
 Draper, M.D., LL.D., Professor of 
 Physics in the University of New York. 
 With 377 Engravings. 8vo, i8s. 
 
 Medical Jurisprudence : 
 
 Its Principles and Practice. By Alfred 
 S. Taylor, M.D., F.R.C.P., F.R.S. 
 Third Edition, by Thomas Stevenson, 
 M.D., F.R.C.P., Lecturer on Medical 
 Jurisprudence at Guy's Hospital. 2 vols. 
 8vo, with 1 88 Engravings, 31s. 6d. 
 
 By the same Authors. 
 
 A Manual of Medical Jurispru- 
 dence. Eleventh Edition. Crown 8vo, 
 with 56 Engravings, 14s. 
 
 Also. 
 Poisons, 
 
 In Relation to Medical Jurisprudence and 
 Medicine. Third Edition. Crown 8vo, 
 with 104 Engravings, i6s. 
 
 Lectures on Medical Jurispru- 
 dence. By Francis Ogston, M.D., 
 late Professor in the University of Abet' 
 deen. Edited by Francis Ogston, jun., 
 M.D. 8vo, with 12 Copper Plates, i8s. 
 
 The Student's Guide to Medical 
 Jurisprudence. By John Aber- 
 CROMBiE, M.D., F.R.C.P., Lecturer on 
 Forensic Medicine to Charing Cross 
 Hospital. Fcap. 8vo, 7s. 6d. 
 
 Influence of Sex in Disease. 
 
 By W. Roger Williams, F. R.C.S., 
 Surgical Registrar to the Middlesex Hos- 
 pital. 8vo, 3s. 6d. 
 Microscopical Examination of 
 Drinking "Water and of Air. By 
 J. D. Macdonald, M.D., F.R.S., Ex- 
 Professor of Naval Hygiene in the Army 
 Medical School. Second Edition. 8vo, 
 with 25 Plates, 7s. 6d. 
 
 Pay Hospitals and Paying 
 "Wards throughout the "World. 
 By Henry C. Burdett. 8vo, 7s. 
 
 By the same Author. 
 
 Cottage Hospitals — General, 
 
 Fever, and Convalescent : Their 
 Progress, Management, and Work. .Second 
 Edition, with many Plans and Illustra- 
 tions. Crown Svo, 14s. 
 
 Hospitals, Infirmaries, and Dis- 
 pensaries : Their Construction, Inte- 
 rior Arrangement, and Management; 
 with Descriptions of existing Institutions, 
 and 74 Illustrations. By F. Oppert, 
 M.D., M.R.C.P.L, Second Edition. 
 Royal Svo, I2s. 
 
 Hospital Construction and 
 
 Management. By F. J. Mouat, 
 M.D., Local Government Board Inspec- 
 tor, and H. Saxon Snell, Fell. Roy. 
 Inst. Brit. Architects. In 2 Parts, 4to, 
 15s. each; or, the whole work bound in 
 half calf, with large Map, 54 Lithographic 
 Plates, and 27 Woodcuts, 35s. 
 
 Public Health Reports. 
 
 By Sir John Simon, C.B., F.R.S. 
 Edited by Edward Seaton, M.D., 
 F.R.C.P. 2 vols. Svo, with Portrait, 36s.
 
 J. .S' A. CHURCHILL- S RECENT JVORA'S. 
 
 5 
 
 A Manual of Practical Hygiene. 
 
 By F. A. Parkes, M.D., F.R.S. Seventh 
 Edition, by F. DE Chaumont, M.D., 
 F.R.S., Professor of Military Hygiene in 
 the Army Medical School. 8vo, with 
 9 Plates and lOO Engravings, i8s. 
 
 A Handbook of Hygiene and 
 
 Sanitary Science, By Geo. Wilson, 
 M.A., M.D., F.R.S.E., Medical Officer 
 of Health for Mid-Warwickshire. Sixth 
 Edition. Crown 8vo, with Engravings, 
 los. 6d. 
 
 Bj' tJie same Author. 
 
 Healthy Life and Healthy 
 
 Dwellings : A (juide to Personal and 
 Domestic Hygiene. Fcap. 8vo, 5s. 
 
 Sanitary Examinations 
 
 Of Water, Air, and Food. A Vade- 
 Mecum for the Medical Officer of Health. 
 By Cornelius B. Fox, M.D., F.R.C.P. 
 Second Edition. Crown 8vo, with IIO 
 Engravings, 12s. 6d. 
 
 Dangers to Health : 
 
 A Pictorial Guide to Domestic Sanitary 
 Defects. By T. Pridgin Teale, M.A., 
 Surgeon to the Leeds General Infirmaiy. 
 Fourth Edition. Svo, with 70 Lithograph 
 Plates (mostly coloured), ids. 
 
 Manual of Anthropometry : 
 
 A Guide to the Measurement of the 
 Human Body, containing an Anthropo- 
 metrical Chart and Register, a Systematic 
 Table of Measurements, &c. By Charles 
 Roberts, F.R.C.S. 8vo, with numerous 
 Illustrations and Tables, 8s. 6d. 
 By the same Author. 
 
 Detection of Colour-Blindness 
 
 and Imperfect Eyesight. Svo, with 
 a Table of Coloured Wools, and Sheet of 
 Test-tyj^es, 5s. 
 Illustrations of the Influence of 
 the Mind upon the Body in 
 Health and Disease : Designed to 
 elucidate the Action of the hnagination. 
 By Daniel Hack Tuke, M.D., 
 F.R.C.P., LL.D. Second Edition. 
 2 vols, crown Svo, 15s. 
 
 By the same Author. 
 
 Sleep-Walking and Hypnotism. 
 
 Svo, 5s. 
 A Manual of Psychological 
 
 Medicine. With an Appendix of 
 Cases. By John C. Bucknill, M.D., 
 F.R.S., and D. Hack Tuke, M.D., 
 F.R.C.P. Fourth Edition. Svo, with 12 
 Plates (30 Figures) and Engravings, 25s. 
 
 Mental Affections of Childhood 
 
 and Youth (Lettsomian Lectures for 
 18S7, Sec). By J. Langdon Down, 
 M.D., F.R.C.P., Senior Physician to the 
 London Hospital. Svo, 6s. 
 
 Private Treatment of the Insane 
 
 as Single Patients. By Edward 
 East, M.R.C.S., L.S.A. Crown Svo, 
 2s. 6d. 
 
 Mental Diseases. 
 
 Clinical Lectures. By T. S. Clouston, 
 M.D., F.R.C.P. Edin., Lecturer on 
 Mental Diseases in the University of 
 Edinburgh. Second Edition. Crown 
 Svo, wuh 8 Plates (6 Coloured), 12s. 6d. 
 Manual of Midwifery. 
 
 By Alfred L. Galaiun, M.A., M.D., 
 F.R.C.P., Obstetric Physician to, and 
 Lecturer on Midwifery, &c. at, Guy's 
 Hospital. Crown Svo, with 227 En- 
 gravings, 15s. 
 
 The Student's Guide to the 
 Practice of Mid'wifery. By D. 
 Lloyd Roberts, M.D., F.R.C.P., Lec- 
 turer on Clinical Midwif^ery and Diseases 
 of Women at the Owens College ; Obstetric 
 Physician to the Manchester Royal In- 
 firmary. Third Edition. Fcap. Svo, with 
 2 Coloured Plates and 127 Wood Engrav- 
 ings, 7s. 6d. 
 
 Lectures on Obstetric Opera- 
 tions : Including the Treatment of 
 Haemorrhage, and forming a Guide to 
 the Management of Difficult Labour. 
 By Robert Barnes, M.D., F.R.C.P., 
 Consulting Obstetric Physician to St. 
 George's Hospital. Fourth Edition. Svo, 
 with 121 Engravings, 12s. 6d. 
 
 By the same Author. 
 
 A Clinical History of Medical 
 and Surgical Diseases of 
 'Women. Second Edition. Svo, with 
 iSi Engravings, 28s. 
 
 Clinical Lectures on Diseases 
 
 of 'Women : Delivered in St. Bartho- 
 lomew's Hospital, by J. Matthews 
 Duncan, M.D., LL.D., F.R.S. Third 
 Edition. Svo, 1 6s. 
 
 By the same Author. 
 Sterility in Woman. 
 
 Being the Gulstonian Lectures, delivered 
 in the Royal College of Physicians, in 
 Feb., 1S83. 8vo, 6s. 
 
 Notes on Diseases of W^omen : 
 
 Specially designed to assist the Student 
 in preparing for Examination. By J. J. 
 Reynolds, L.R.C.P., M.R.C.S. Third 
 Edition. Fcap. Svo, 2s. 6d. 
 By the same Author. 
 
 Notes on Midwifery : 
 
 Specially designed for Students preparing 
 for Examination. Second Edition. Fcap. 
 Svo, with I S Engravings, 4s. 
 
 Dysmenorrhoea, its Pathology 
 
 and Treatment. By Heywood Smith, 
 M.D. Crown Svo, with Engravings, 
 4s. 6d. 
 A Manual of Obstetrics. 
 
 By A. F. A. King, A.M., M.D., Pro- 
 fessor of Obstetrics, &c., in the Columbian 
 University, Washington, and the Univer- 
 sity of Vermont. Third Edition. Crown 
 Svo, with 102 Engravings, 8s.
 
 J. 4'- A. CHURCHILL S RECENT WORKS. 
 
 The Student's Guide to the 
 Diseases of 'Women. By Alfred 
 L. Galabin, M.D., F.R.C.P., Obstetric 
 Physician to Guy's Hospital. Fourth Edi- 
 tion. Fcap.Svo, with 94 Engravings, 7s.6cl. 
 
 West on the Diseases of 
 
 "Women. Fourth Edition, revised by 
 the Author, with numerous Additions by 
 J. Matthews Duncan, M.D., F.R.C.P., 
 F.R.S.E., Obstetric Physician to St. Bar- 
 tholomew's Hospital. 8vo, i6s. 
 
 Obstetric Aphorisms : 
 
 For the Use of Students commencing 
 Midwifery Practice. By Joseph G. 
 SwAYNE, M.D. Eighth Edition. Fcap. 
 8vo, with Engravings, 3s. 6d. 
 
 Handbook of Midwifery for Mid- 
 -wives : By J. E. Burton, L.R.C.P. 
 Lond., Surgeon to the Hospital for 
 Women, Liverpool. Second Edition. 
 With Engravings. Fcap. 8vo, 6s. 
 
 A Handbook of Uterine Thera- 
 peutics, and of Diseases of Women. 
 By E. J. Tilt, M.D., M.R.C.P. Fourth 
 Edition. Post 8vo, ids. 
 
 By the same A tit ho?: 
 
 The Change of Life 
 
 In Health and Disease : A Clinical 
 Treatise on the Diseases of the Nervous 
 System incidental to Women at the De- 
 clineofLife. Fourth Edition. 8vo, los. 6d. 
 
 Diseases of the Uterus, Ovaries, 
 and Fallopian Tubes : A Practical 
 Treatise by A. Courty, Professor of 
 Clinical Surgery, Montpellier. Translated 
 from Third Edition by his Pupil, Agnes 
 McLaren, M.D., M.K.Q.C.P.I., with 
 Preface by J. Matthews Duncan, M.D., 
 F. R. C. P. 8vo, with 424 Engravings, 24s. 
 
 The Female Pelvic Organs : 
 
 Their Surgery, Surgical Pathology, and 
 Surgical Anatomy. In a Series of Coloured 
 Plates taken from Nature ; with Com- 
 mentaries, Notes, and Cases. By Henry 
 Savage, M.D., F.R.C.S. , Consulting 
 Officer of the Samaritan Free Hospital. 
 Fifth Edition. Roy. 4to, with 17 Litho- 
 graphic Plates (15 coloured) and 52 Wood- 
 cuts, £1 15s. 
 
 A Practical Treatise on the 
 
 Diseases of "Women. By T. Gail- 
 lard Thomas, M.D., Professor of 
 Diseases of Women in the College of 
 Physicians and Surgeons, New York. 
 Fifth Edition. Roy. 8vo, with 266 En- 
 gravings, 25s. 
 
 Backward Displacements of the 
 Uterus and Prolapsus Uteri : 
 Treatment by the New Method of Short- 
 ening the Round Ligaments. By Wil- 
 liam Alexander, M.D., M.Ch.Q.U.L, 
 F. R. C. S. , Surgeon to the Liverpool Infir- 
 mary. Crown 8vo, with Engravings, 3s. 6d. 
 
 Gynaecological Operations : 
 
 (Handbook of). ByALBAN H. G. Doran, 
 F.R.C.S., Surgeon to the Samaritan Hos- 
 pital. Svo, with 167 Engravings, 15s. 
 
 Abdominal Surgery. 
 
 By J. Greig Smith, M.A., F.R.S.E., 
 Surgeon to the Bristol Royal Infirmary. 
 Svo, with 43 Engravings, 15s. 
 
 Ovarian and Uterine Tumours : 
 
 Their Pathology and Surgical Treatment. 
 By Sir T. Spencer Wells, Bart., 
 F.R.C.S., Consulting Surgeon to the 
 Samaritan Hospital. Svo, with En- 
 gravings, 2 Is. 
 
 By the same Author. 
 
 Abdominal Tumours: 
 
 Their Diagnosis and .Surgical Treatment. 
 Svo, with Engravings, 3s. 6d. 
 
 The Student's Guide to Diseases 
 
 of Children. ByjAs. F. Goodhart, 
 M.D., F.R.C.P., Physician to Guy's 
 Hospital, and to the Evelina Hospital for 
 Sick Children. Second Edition. Fcap. 
 Svo, I OS. 6d. 
 
 Diseases of Children. 
 
 For Practitioners and Students. By W. 
 H. Day, M.D., Physician to the Sama- 
 ritan Hospital. Second Edition. Crown 
 Svo, I2S. 6d. 
 
 A Practical Treatise on Disease 
 
 in Children. By Eustace Smith, 
 M.D., Physician to the King of the 
 Belgians, Physician to the East London 
 Hospital for Children. Svo, 22s. 
 By the same Aiitlior. 
 
 Clinical Studies of Disease in 
 
 Children. Second Edition. Post Svo, 
 7s. 6d. 
 
 Also. 
 
 The "Wasting Diseases of Infants 
 
 and Children. Fourth Edition. Post 
 Svo, Ss. 6d. 
 A Practical Manual of the 
 Diseases of Children. With a For- 
 mulary. By Edward Ellis, M.D. 
 Fifth Edition. Crown Svo, los. 
 
 A Manual for Hospital Nurses 
 
 and others engaged in Attending on the 
 Sick. By Edward J. Domville, 
 Surgeon to the Exeter Lying-in Charity. 
 Fifth Edition. Crown Svo, 2s. 6d. 
 A Manual of Nursing, Medical 
 and Surgical. By Charles J. Cul- 
 lingworth, M.D., PhysiciantoSt. Mary's 
 Hospital, Manchester. Second Edition. 
 Fcap. Svo, with Engravings, 3s. 6d. 
 By the same Author. 
 
 A Short Manual for Monthly 
 
 Nurses. Second Edition. Fcap. Svo, 
 is. 6d. 
 Diseases and their Commence- 
 ment. Lectures to Trained Nurses. 
 By Donald W. C. Hood, M.D., 
 M.R.C.P., Physician to the West London 
 Hospital. Crown Svo, 2s. 6d.
 
 J. i^ A. CHURCHILLS RECENT WORKS. 
 
 Notes on Fever Nursing. 
 
 By J. W. Allan, M.B., Physician, 
 Superintendent Glasgow Fever Hospital. 
 Crown 8vo, with Engravings, 2s. 6d. 
 By the same Author. 
 
 Outlines of Infectious Diseases : 
 
 For the use of Clinical Students. Fcap. 8vo. 
 
 Hospital Sisters and their Du- 
 ties. By Eva C. E. Luckes, Matron to 
 the London Hospital. Crown 8vo, 2s. 6d. 
 
 Infant Feeding and its Influ- 
 ence on Life ; By C. H. F. Routh, 
 M. D. , Physician to the Samaritan Hospital. 
 Fourth Edition. Fcap. 8vo. [Preparing: 
 
 Manual of Botany : 
 
 Including the Structure, Classification, 
 Properties, Uses, and Functions of Plants. 
 By Robert Bentley, Professor of Bo- 
 tany in King's College and to the Phar- 
 maceutical Society. Fifth Edition. 
 Crown 8vo, with 1,178 Engravings, 15s. 
 
 By the same Author. 
 
 The Student's Guide to Struc- 
 tural, Morphological, and Phy- 
 siological Botany. With 660 En- 
 gravings. Fcap. Svo, 7s. 6d. 
 
 Also. 
 The Student's Guide to Syste- 
 matic Botany, including the Classi- 
 fication of Plants and Descriptive Botany. 
 Fcap. 8vo, with 350 Engravings, 3s. 6d. 
 
 Medicinal Plants : 
 
 Being descriptions, with original figures, 
 of the Principal Plants employed in 
 Medicine, and an account of their Pro- 
 perties and Uses. By Prof. Bentley and 
 Dr. H. Trimen. In 4 vols., large Svo, 
 with 306 Coloured Plates, bound in Half 
 Morocco, Gilt Edges, ;i{^ii lis. 
 
 The National Dispensatory : 
 
 ContainingtheNatural History, Chemistry, 
 Pharmacy, Actions and Uses of Medicines. 
 By Alfred Stills, M.D., LL.D., and 
 John M. Maisch, Ph.D. Fourth Edi- 
 tion. Svo, with 311 Engravings, 36s. 
 
 Royle's Manual of Materia 
 Medica and Therapeutics. Sixth 
 Edition, including additions and altera- 
 tions in the B.P. 1885. By JOHN 
 Harley, M.D., Physician to St. 
 Thomas's Hospital. Crown Svo, with 
 139 Engravings, 15s. 
 
 Materia Medica and Therapeu- 
 tics : Vegetable Kingdom — Organic 
 Compounds — Animal Kingdom. By 
 Charles D. F. Phillips, M.D., F.R.S. 
 Edin., late Lecturer on Materia Medica 
 and Therapeutics at the Westminster 
 Hospital Medical School. Svo, 25s. 
 
 The Student's Guide to Materia 
 
 Medica and Therapeutics. By 
 John C. Thorowgood, M.D., F.R.C.P. 
 Second Edition. Fcap. Svo, 7s. 
 
 Materia Medica. 
 
 A Manual for the use of Students. By 
 Isambard Owen, M.D., F.R.C.P., Lec- 
 turer on Materia Medica, &c., to St. 
 George's Hospital. Second Edition. 
 Crown Svo, 6s. 6d. 
 
 The Pharmacopoeia of the Lon- 
 don Hospital. Compiled under the 
 direction of a Committee appointed by the 
 Hospital Medical Council. Fcap. Svo, 3s. 
 
 A Companion to the British 
 
 Pharmacopceia. By Peter Squire, 
 Revised by his Sons, P. W. and A. H. 
 Squire. 14th Edition. Svo, los. 6d. 
 By the same Authors. 
 
 The Pharmacopoeias of the Lon- 
 don Hospitals, arranged in Groups 
 for Easy Reference and Comparison. 
 Fifth Edition. iSmo, 6s. 
 
 The Prescriber's Pharmacopceia: 
 
 The Medicines arranged in Classes accord- 
 ing to their Action, with their Composi- 
 tion and Doses. By Nestor J. C. 
 Tirard, M.D., F.R.C.P., Professor of 
 Materia Medica and Therapeutics in 
 King's College, London. Sixth Edition. 
 32mo, bound in leather, 3s. 
 
 A Treatise on the Principles 
 and Practice of Medicine. Sixth 
 Edition. By Austin Flint, M.D., W.H. 
 Welch, M.D., and Austin Flint, jun., 
 M.D. Svo, with Engravings, 26s. 
 
 Climate and Fevers of India, 
 
 with a series of Cases (Croonian Lec- 
 tures, 1882). By Sir Joseph Fayrer, 
 K.C.S.I., M.D. Svo, with 17 Tem- 
 perature Charts, 12s. 
 Family Medicine for India. 
 
 A Manual. ByWiLLiAMj. Moore, M.D. , 
 CLE., Honorary Surgeon to the Viceroy 
 of India. Published under the Authority of 
 the Government of India. Fifth Edition. 
 Post Svo, with Engravings. \_In the Press. 
 By the same Author. 
 
 A Manual of the Diseases of 
 
 India : With a Compendium of Diseases 
 generally. Second Edition. Post Svo, los. 
 Also. 
 
 Health- Resorts for Tropical 
 
 Invalids, in India, at Home, and 
 Abroad. Post Svo, 5s. 
 
 Practical Therapeutics : 
 
 A Manual. By Edward J. Waring, 
 CLE., M.D., F.R.C.P., and Dudley 
 W. Buxton, M.D., B.S. Lond. Fourth 
 Edition. Crown Svo, 14s. 
 
 By the same Attthor. 
 
 Bazaar Medicines of India, 
 
 And Common Medical Plants : With Full 
 Index of Diseases, indicating their Treat- 
 ment by these and other Agents procur- 
 able throughout India, &c. Fourth 
 Edition. Fcap. Svo, 5s.
 
 J. i^- A. CHURCHILL'S RECENT WORKS. 
 
 A Commentary on the Diseases 
 of India. By Norman Chevers, 
 CLE., M.D., F.R.C.S., Deputy Sur- 
 geon-General H.M. Indian Army. 8vo, 
 24s. 
 
 The Principles and Practice of 
 Medicine. By C. Hilton Fagge, 
 M.D. Edited byP. H. Pye-Smith, M.D., 
 F. R.C.P. , Physician to, and Lecturer on 
 Medicine at, Guy's Hospital. 2 vols. 8vo, 
 1S60 pp. Cloth, 36s. ; Half Persian, 42s. 
 
 The Student's Guide to the 
 Practice of Medicine. By Mat- 
 thew Charteris, M.D., Professor of 
 Materia Medica in the University of 
 Glasgow. Fourth Edition. P'cap. 8vo, 
 with Engravings on Copper and Wood. 9s. 
 
 Hooper's Physicians' Vade- 
 
 Mecum. A Manual of the Principles 
 and Practice of Physic. Tenth Edition. 
 By W. A. Guy, F.R.C.P., F.R.S., and 
 J. Harley, M.D., F.R.C.P. With 118 
 Engravings. P'cap. 8vo, 12s. 6d. 
 
 The Student's Guide to Clinical 
 Medicine and Case-Taking. By 
 Francis Warner, M.D., F.R.C.P., 
 Physician to the London Hospital. 
 Second Edition. Fcap. 8vo, 5s. 
 
 How to Examine the Chest : 
 
 Being a Practical Guide for the use of 
 Students. By Samuel West, 1\LD., 
 F.R.C.P., Physician to the City of London 
 Hospital for Diseases of the Chest ; 
 Assistant Physician to St. Bartholomew's 
 Hospital. With 42 Engravings. Fcap. 
 8vo, 5s. 
 
 The Contagiousness of Pulmo- 
 nary Consumption, and its Anti- 
 septic Treatment. By J. Burney 
 Yeo, M.D., Physician to Iving's College 
 Hospital. Crown 8vo, 3s. 6d. 
 
 The Operative Treatment of In- 
 
 tra-thoracic Effusion. Fothergillian 
 Prize Essay. By Norman Porritt, 
 L.R.C.P. Lond., M.R.C.S. With En- 
 gravings. Crown 8vo, 6s. 
 
 Diseases of the Chest : 
 
 Contributions to their Clinical History, 
 Pathology, and Treatment. By A. T. 
 Houghton Waters, M.D., Physician 
 to the Liverpool Ixoyal Infirmary. 
 Second Edition. 8vo, with Plates, 15s. 
 
 Pulmonary Consumption : 
 
 A Practical Treatise on its Cure with 
 Medicinal, Dietetic, and Hygienic 
 Remedies. By James Weaver, M.D., 
 L.R.C.P. Crown Svo, 2s. 
 
 Croonian Lectures on Some 
 Points in the Pathology and 
 Treatment of Typhoid Fever. 
 By William Cayley, M.D., F.R.C.P., 
 Physician to the Middlesex and the London 
 Fever Hospitals. Crown Svo, 4s. 6d. 
 
 The Student's Guide to Medical 
 
 Diagnosis. By Samuel Fenwick, 
 M.D., F.R.C.P., Physician to the Lon- 
 don Hospital, and Bedford Fenwick, 
 M.D., M. R.C.P. Sixth Edition. Fcap. 
 Svo, with 114 Engravings, 7s. 
 
 By the same Author. 
 
 The Student's Outlines of Medi- 
 cal Treatment. Second Edition. 
 Fcap. Svo, 7s. 
 
 Also. 
 
 On Chronic Atrophy of the 
 
 Stomach, and on the Nervous Affections 
 of the Digestive Organs. Svo, Ss. 
 
 The Microscope in Medicine. 
 
 By Lionel S. Beale, M.B., F.R.S., 
 Physician to King's College Hospital. 
 Fourth Edition. Svo, with 86 Plates, 21s. 
 Also. 
 
 On Slight Ailments : 
 
 Their Nature and Treatment. Second 
 Edition. Svo, 5s. 
 
 Medical Lectures and Essays. 
 
 By George Johnson, M.D., F.R.C.P., 
 F. R. S., Consulting Physician to King's 
 College Hospital. Svo. 
 
 The Spectroscope in Medicine. 
 
 By Charles A. MacMunn, B.A., M.D. 
 Svo, with 3 Chromo-lithographic Plates of 
 Physiological and Pathological Spectra, 
 and 13 Engravings, 9s. 
 Notes on Asthma : 
 
 Its Forms and Treatment. By John C. 
 Thorowgood, M.D., Physician to the 
 Hospital for Diseases of the Chest. Third 
 Edition. Crown Svo, 4s. 6d. 
 
 What is Consumption ? 
 
 By G. W. Hambleton, L.K.Q.C.P.I. 
 Crown Svo, 2s. 6d. 
 
 Winter Cough 
 
 (Catarrh, Bronchitis, Emphysema, Asth- 
 ma). By Horace Dobell, M.D., 
 Consulting Physician to the Royal Hos- 
 pital for Diseases of the Chest. Third Edi- 
 tion. Svo, with Coloured Plates, los. 6d. 
 By the same Autlior. 
 
 Loss of Weight, Blood-Spitting, 
 
 and Lung Disease. Second Edition. 
 
 Svo, with Chromo-lithograph, los. 6d. 
 
 Also. 
 
 The Mont Dore Cure, and th^ 
 
 Proper Way to Use it. Svo, 7s. 6d. 
 Vaccinia and Variola : 
 
 A Study of their Life History. By JoilN 
 B. BuiST, M.D., F.R.S.E., Teacher of 
 Vaccination for the Local Government 
 Board. Crown Svo, with 24 Coloured 
 Plates, 7s. 6d. 
 
 Treatment of Some of the Forms 
 of Valvular Disease of the Heart. 
 By A. E. Sansom, M.D., F.R.C.P., 
 Physician to the London Hospital. 
 Second Edition. Fcap. Svo, with 26 
 Engravings, 4s. 6d.
 
 J. ^- A. CHURCHILL'S RECENT WORKS. 
 
 Diseases of the Heart and Aorta : 
 
 Clinical Lectures. By G. W. Balfour, 
 M.p., F.R.C.P., F.R.S. Eclin., late 
 Senior Physician and Lecturer on Clinical 
 Medicine, Royal Infirmary, Edinburgh. 
 Second Edition. 8vo, with Chromo-litho- 
 graph and Wood Engravings, I2s. 6d. 
 
 Medical Ophthalmoscopy : 
 
 A Manual and Atlas. By William R. 
 GOWERS, M.D., F.R.C.P., Professor 
 of Clinical Medicine in University College, 
 and Physician to the Hospital. Second 
 Edition, with Coloured Autotype and 
 Lithographic Plates and Woodcuts. 8vo, 
 i8s. 
 
 By the same Aitthor. 
 
 Pseudo-Hypertrophic Muscular 
 
 Paralysis : A Clinical Lecture. Svo, 
 with Engravings and Plate, 3s. 6d. 
 Also. 
 
 Diagnosis of Diseases of the 
 
 spinal Cord. Third Edition. Svo, 
 with Engravings, 4s. 6d. 
 Also. 
 
 Diagnosis of Diseases of the 
 
 Brain. Second Edition. Svo, with 
 Engravings, 7s. 6d. 
 Also. 
 
 A Manual of Diseases of the 
 
 Nervous System. Vol. I. Diseases 
 of the Spinal Cord and Nerves. Roy. Svo, 
 with 171 Engravings(manyfigures), I2s.6d. 
 
 Diseasesof the Nervous System. 
 
 Lectures delivered at Guy's Hospital. By 
 Samuel WiLKs, M.D., F.R.S. Second 
 Edition. Svo, iSs. 
 Diseases of the Nervous System: 
 
 Especially in Women. By S. Weir 
 Mitchell, ]\LD., Physician to the Phila- 
 delphia Infirmary for Diseases of the 
 Nervous System. Second Edition. Svo, 
 with 5 Plates, 8s. 
 
 Nerve Vibration and Excitation, 
 as Agents in the Treatment of 
 Functional Disorder and Organic 
 Disease. By J. Mortimer Granville, 
 M.D. Svo, 5s. 
 
 By the same Author. 
 
 Gout in its Clinical Aspects. 
 
 Crown Svo, 6s. 
 
 Regimen to be adopted in Cases 
 of Gout. By Wilhelm Ebstein, 
 M.D., Professor of Clinical Medicine in 
 Gottingen. Translated by John Scott, 
 M.A., M.B. Svo, 2s. 6d. 
 
 Diseases of the Nervous System. 
 Clinical Lectures. By Thomas Buzzard, 
 M.D., F.R.C.P., Physician to the National 
 Hospital for the Paralysed and Epileptic. 
 With Engravings, Svo. 15s. 
 By the same Aitthor. 
 
 Some Forms of Paralysis from 
 Peripheral Neuritis : of Gouty, 
 Alcoholic, Diphtheritic, and other origin. 
 Crown Svo, 5s. 
 
 Diseases of the Liver: 
 
 With and without Jaundice. By George 
 Harley, M.D., F.R.C.P., F.R.S. Svo, 
 with 2 Plates and 36 Engravings, 21s, 
 By the same Author. 
 
 Inflammations of the Liver, and 
 
 their Sequelae. Crown Svo, with 
 Engravings, 5s. 
 
 Gout, Rheumatism, 
 
 And the Allied Affections ; with Chapters 
 on Longevity and .Sleep. By Peter 
 Hood, M.D. Third Edition. Crown 
 Svo, 7s. 6d. 
 
 Diseases of the Stomach : 
 
 The Varieties of Dyspepsia, their 
 Diagnosis and Treatment. By S. O. 
 Habershon, M.D., F.R.C.P. Third 
 Edition. Crown Svo, 5s. 
 
 By the same AiUJior. 
 
 Pathology of the Pneumo- 
 
 gastric Nerve : Lumleian Lectures 
 for 1S76. Second Edition. Post Svo, 4s. 
 Also. 
 
 Diseases of the Abdomen, 
 
 Comprising those of the Stomach and other 
 parts of the Alimentary Canal, Oesopha- 
 gus, Ctecum, Intestines, and Peritoneum. 
 Third Edition. Svo, with 5 Plates, 21s. 
 Also. 
 
 Diseases of the Liver, 
 
 Their Pathology and Treatment. Lett- 
 somian Lectures. Second Edition. Post 
 Svo, 4s. 
 Acute Intestinal Strangulation, 
 
 And Chronic Intestinal Obstruction (Mode 
 of Death from). By Thomas Bryant, 
 F. R.C.S., Senior Surgeon to Guy's 
 Hospital. Svo, 3s. 
 
 A Treatise on the Diseases of 
 the Nervous System, By James 
 Ross, JNLD., F.R.C.P., Assistant Physi- 
 cian to the Manchester Royal Infirmary. 
 .Second Edition. 2 vols. Svo, with Litho- 
 graphs, Photographs, and 332 Woodcuts, 
 52s. 6d. 
 
 By the same Author. 
 
 Handbook of the Diseases of 
 
 the Nervous System. Roy. Svo, 
 with 184 Engravings, iSs. 
 Also. 
 Aphasia : 
 
 Being a Contribution to the Subject of 
 the Dissolution of .Speech from Cerebral 
 Disease. Svo, with Engravings, 4s. 6d. 
 
 Spasm in Chronic Nerve Disease. 
 
 (Cnilstonian Lectures.) By Seymour J. 
 Sharkey, M.A., M.B., F.R.C.P., 
 Assistant Physician to, and Joint Lec- 
 turer on Pathology at, St. Thomas's 
 Plospital. Svo, with Engravings, 5s. 
 
 On Megrim, Sick Headache, and 
 
 some Allied Disorders : A Contribu- 
 tion to the Pathology of Nerve Storms. By 
 E. LiVEiNC, M.D., F.R.C.P. Svo, 15s.
 
 lO 
 
 J. <§• A. CHURCHILL'S RECENT WORKS. 
 
 Food and Dietetics, 
 
 Physiologically and Therapeutically Con- 
 sidered. By F. W. Pavy, M.D., F.R.S., 
 Physician to Guy's Hospital. Second 
 Edition. 8vo, 15s. 
 
 By the same Author. 
 
 Croonian Lectures on Certain 
 Points connected -with Diabetes. 
 8vo, 4s. 6d. 
 
 Headaches : 
 
 Their Nature, Causes, and Treatment. 
 By W. H. Day, M.D., Physician to the 
 Samaritan Hospital. Fourth Edition. 
 Crown 8vo, with Engravings. [/« the Press. 
 
 Health Resorts at Home and 
 Abroad. By Matthew Charteris, 
 M.D., Physician to the Glasgow Royal 
 Infirmary. Second Edition. Crown Svo, 
 with Map, 5s. 6d. 
 
 The Principal Southern and 
 Swiss Health-Resorts : their Cli- 
 mate and Medical Aspect. By William 
 Marcet, M.D., F.R.C.P., F.R.S. With 
 Illustrations. Crown Svo, 7s. 6d. 
 
 Winter and Spring 
 
 On the Shores of the Mediterranean. By 
 Henry Bennet, M.D. Fifth Edition. 
 Post Svo, with numerous Plates, Maps, 
 and Engravings, 12s. 6d. 
 
 By the same Author. 
 
 Treatment of Pulmonary Con- 
 sumption by Hygiene, CHmate, and 
 Medicine. Third Edition. Svo, 7s. 6d. 
 
 Medical Guide to the Mineral 
 "Waters of France and its "Win- 
 tering Stations. With a Special 
 Map. ByA. ViNTRAS, M.D., Physician 
 to the French Embassy, and to the French 
 Hospital, London. Crown Svo, 8s. 
 
 The Ocean as a Health-Resort : 
 
 A Practical Handljook of the Sea, for the 
 use of Tourists and Health-Seekers. By 
 William S. Wilson, L.R.C.P. Second 
 Edition, vi^ith Chart of Ocean Routes, «S:c. 
 Crown Svo, 7s. 6d. 
 
 Ambulance Handbook for Volun- 
 teers and Others. By J. Ardavon 
 Raye, L.K. & Q.C.P.I., L.Ri.C.S.1., 
 late Surgeon to H.B.M. Transport No. 
 14, Zulu Campaign, and Surgeon E.I.R. 
 Rifles. Svo, with 16 Plates (50 figures), 
 3s. 6d. 
 
 Ambulance Lectures : 
 
 To which is added a Nursing Lecture. 
 By John M. H. Martin, Honorary 
 Surgeon to the Blackburn Infirmary. 
 Crown Svo, with 53 Engravings, 2s. 
 
 Commoner Diseases and Acci- 
 dents to Life and Limb : their 
 Preventionand Immediate Treat- 
 ment. By M. M. Basil, M.A., M.B., 
 CM. Crown Svo, 2s. 6d. 
 
 Handbook of Medical and Sur- 
 gical Electricity. By Herbert 
 TiBBiTS, M.D., F.R.C.P.E., Senior 
 Physician to the West London Hospital for 
 Paralysis and Epilepsy. Second Edition. 
 Svo, with 95 Engravings, 9s. 
 By the same Author. 
 
 How to Use a Galvanic Battery 
 in Medicine and Surgery. Third 
 
 Edition. Svo, with Engravings, 4s. 
 Also. 
 
 A Map of Ziemssen's Motor 
 Points of the Human Body : A 
 
 Guideto Localised Electrisation. Mounted 
 on Rollers, 35 x 21. With 20 Illustra- 
 tions, 5s. ^4iso. 
 
 Electrical and Anatomical De- 
 monstrations. A Handbook for 
 Trained Nurses and Masseuses. Crown 
 Svo, with 44 Illustrations, 5s. 
 
 Spina Bifida : 
 
 Its Treatment by a New Method. By 
 Jas. Morton, M.D., L.R.C.S.E., Pro- 
 fessor of Materia Medica in Anderson's 
 College, Glasgow. Svo, with Plates, 7s. 6d. 
 Surgical Emergencies : 
 
 Together with the Emergencies attendant 
 on Parturition and the Treatment of 
 Poisoning. ByW.PAULS\VAiN,F.R.C.S., 
 Surgeon to the South Devon and East Corn- 
 wall Hospital. Fourth Edition. Crown 
 Svo, with 120 Engravings, 5s. 
 
 Operative Surgery in the Cal- 
 cutta Medical College Hospital. 
 
 Statistics, Cases, and Comments. By 
 Kenneth McLeod, A.M., M.D., 
 F. R. C.S.E., Surgeon-Major, Indian 
 Medical Service, Professor of Surgery 
 in Calcutta Medical College. Svo, with 
 Illustrations, 12s. 6d. 
 
 Surgical Pathology and Morbid 
 
 Anatomy (Student's Guide). By An- 
 thony A. BowLBY, F.R.C.S., Surgical 
 Registrar and Demonstrator of Surgical 
 Pathology to St. Bartholomew's Hospital. 
 Fcap. Svo, with 135 Engravings, 9s. 
 
 A Course of Operative Surgery. 
 
 By Christopher Heath, Surgeon to 
 University College Hospital. Second 
 Edition. With 20 coloured Plates (180 
 figures) from Nature, by M. LfiVEiLLfi, 
 and several Woodcuts. Large Svo, 30s. 
 By the same Author. 
 
 The Student's Guide to Surgical 
 
 Diagnosis. Second Edition. Fcap. 
 Svo, 6s. 6d. Also. 
 
 Manual of Minor Surgery and 
 
 Bandaging. For the use of House- 
 Surgeons, Dressers, and Junior Practi- 
 tioners. Eighth Edition. Fcap. Svo, 
 with 142 Engravings, 6s. 
 Also. 
 
 Injuries and Diseases of the 
 Jaws. Third Edition. Svo, with Plate- 
 and 206 Wood Engravings, 14 s.
 
 J. 8f A. CHURCHILDS RECENT WORKS. 
 
 II 
 
 The Practice of Surgery : 
 
 A Manual. By Thomas Bryant, 
 Surgeon to Guy's Hospital. Fourth 
 Edition. 2 vols, crown 8vo, with 
 750 Engravings (many being coloured), 
 and including 6 chromo plates, 32s. 
 
 Surgery : its Theory and Prac- 
 tice (Student's Guide). By William J. 
 Walsham, F.R.C.S., Assistant Surgeon 
 to St. Bartholomew's Hospital. Fcap. 
 8vo, with 236 Engravings, los. 6d. 
 
 The Surgeon's Vade-Mecum : 
 
 A Manual of Modern Surgery. By R. 
 Druitt, F.R.C.S. Twelfth Edition. 
 By Stanley Boyd, M.B., F.R.C.S. 
 Assistant Surgeon and Pathologist to 
 Charing Cross Hospital. Crown 8vo, 
 with 373 Engravings i6s. 
 
 Regional Surgery : 
 
 Including Surgical Diagnosis. A Manual 
 for the use of Students. By F. A. 
 SouTHAM, M.A., M.B., F.R.C.S., As- 
 sistant Surgeon to the Manchester Royal 
 Infirmary. Part I. The Head and Neck. 
 Crown 8vo, 6s. 6d. — Part II. The 
 Upper Extremity and Thorax. Crown 
 8vo, 7s. 6d. Part III. The Abdomen 
 and Lower Extremity. Crown 8vo, 7s. 
 
 Illustrations of Clinical Surgery. 
 
 By Jonathan Hutchinson, F.R.S., 
 Senior Surgeon to the London Hospital. 
 In occasional fasciculi. I. to XIX., 
 6s. 6d. each. Fasciculi I. to X. bound, 
 with Appendix and Index, £■}, iQs. 
 
 By the same Author. 
 
 Pedigree of Disease : 
 
 Being Six Lectures on Temperament, 
 Idiosyncrasy, and Diathesis. 8vo, 5s. 
 
 Treatment of Wounds and Frac- 
 tures. Clinical Lectures. By Sampson 
 Gamgee, F.R.S.E., Surgeon to the 
 Queen's Hospital, Birmingham. Second 
 Edition. 8vo, with 40 Engravings, los. 
 
 Electricity and its Manner of 
 "Working in the Treatment of 
 Disease. By \Vm. E. Steavenson, 
 M.D., Physician and Electrician to St. 
 Bartholomew's Hospital. 8vo, 4s. 6d. 
 
 Lectures on Orthopaedic Sur- 
 gery. By Bernard E. Brodhurst, 
 F.R.C.S., Surgeon to the Royal Ortho- 
 pedic Hospital. Second Edition. 8vo, 
 with Engravings, 12s. 6d. 
 
 By the same Author. 
 
 On Anchylosis, and the Treat- 
 
 nnent for the Removal of De- 
 formity and the Restoration of 
 Mobility in Various Joints. 
 Fourth Edition. 8vo, with Engravings, 5s. 
 
 Also. 
 
 Curvatures and Diseases of the 
 
 Spine. Third Edition. 8vo, with 
 Engravings, 6s. 
 
 Diseases of Bones and Joints. 
 
 By Charles Macnamara, F.R.C.S.,. 
 Surgeon to, and Lecturer on Surgery at, 
 the Westminster Hospital. 8vo, with 
 Plates and Engravings, 12s. 
 
 Injuries of the Spine and Spinal 
 Cord, and NERVOUS SHOCK, 
 
 in their Surgical and Medico- Legal 
 Aspects. By Herbert W. Page, M.C. 
 Cantab., F.R.C.S., Surgeon to St. Mary's- 
 Hospital. Second Edition, post 8vo, lOs. 
 
 Face and Foot Deformities. 
 
 By Frederick Churchill, CM., Sur- 
 geon to the Victoria Hospital for Children. 
 8vo, with Plates and Illustrations, los. 6d. 
 
 Clubfoot : 
 
 Its Causes, Pathology, and Treatment. 
 By Wm. Adams, F.R.C.S., Surgeon ta 
 the Great Northern Hospital. Second 
 Edition. 8vo, with 106 Engravings and 
 6 Lithographic Plates, 15s. 
 
 By the same Author. 
 
 On Contraction of the Fingers, 
 
 and its Treatment by Subcutaneous Opera- 
 tion ; and on Obliteration of Depressed 
 Cicatrices, by the same Method. 8vo, 
 with 30 Engravings, 4s. 6d. 
 
 Also. 
 
 Lateral and other Forms of 
 Curvature of the Spine : Their 
 Pathology and Treatment. Second Edi- 
 tion. 8vo, with 5 Lithographic Plates and 
 72 Wood Engravings, ids. 6d. 
 
 Spinal Curvatures : 
 
 Treatment by Extension and Jacket ; with 
 Remarks on some Affections of the Hip, 
 Knee, and Ankle-joints. By PI. Mac- 
 naughton Jones, M.D., P\R.C.S. I, 
 and Edin. Post 8vo, with 63 Engravings, 
 4s. 6d. 
 
 On Diseases and Injuries of the 
 
 Eye : A Course of Systematic and 
 Clinical Lectures to Students and Medical 
 Practitioners. By J. R. Wolfe, M.D., 
 F.R.C.S.E., Lecttirer on Ophthalmic 
 Medicine and Surgery in Anderson's Col- 
 lege, Glasgow. With 10 Coloured Plates 
 and 157 Wood Engravings. 8vo, £1 Is. 
 
 Hints on Ophthalmic Out-Patient 
 Practice. By Charles Higgens, 
 Ophthalmic Surgeon to Guy's Hospital. 
 Third Edition. Fcap. 8vo, 3s. 
 
 Short Sight, Long Sight, and 
 Astigmatism. By George F. Helm, 
 M.A., M.D., F.R.C.S., formerly Demon- 
 strator of Anatomy in the Cambridge 
 Medical School. Crown 8vo, with 35 
 Engravings, 3s. 6d. 
 
 Manual of the Diseases of the 
 
 Eye. By Charles Macnamara, 
 F.R.C.S., Surgeon to Westminster Hos- 
 pital. Fourth Edition. Crown 8vo, with 
 4 Coloured Plates and 66 Engravings, 
 lOs. 6d.
 
 12 
 
 J. ^- A. CHURCHILL'S RECENT WORKS. 
 
 The Student's Guide to Diseases 
 of the Eye. ByEdwardNettleship, 
 F.R.C.S., Ophthalmic Surgeon to St. 
 Thomas's Hospital. Fourth Edition. 
 Fcap. 8vo, with 164 Engravings and a 
 Set of Coloured Papers illustrating Colour- 
 Blindness, 7s. 6d. 
 
 Normal and Pathological His- 
 tology of the Human Eye and 
 Eyelids. By C. Fred. Pollock, 
 M.D., F.R.C.S. and F.R.S.E., .Surgeon 
 for Diseases of the Eye to Anderson's 
 College Dispensary, Glasgow. Crown 
 8vo, with 100 Plates (230 drawings), 15s. 
 
 Atlas of Ophthalmoscopy. 
 
 Composed of 12 Chromo - lithographic 
 Plates (59 Figures drawn from nature) 
 and Explanatory Text. By Richard 
 LiEBRElCH, M.R.C.S. Translated by H. 
 Rosborough Swanzy, M.B. Third 
 edition, 4to, 40s. 
 
 Glaucoma : 
 
 Its Causes, Symptoms, Pathology, and 
 Treatment. By Priestley Smith, 
 M.R.C.S., Ophthalmic Surgeon to the 
 Queen's Hospital, Birmingham. 8vo, 
 with Lithographic Plates, ids. 6d. 
 
 Refraction of the Eye : 
 
 A Manual for Students. By GusTAVUS 
 Hartridge, F.R.C.S., Assistant Physi- 
 cian to the Royal Westminster Ophthalmic 
 Plospital. Second Edition. Crown 8vo, 
 with Lithographic Plate and 94 Woodcuts, 
 5s. 6d. 
 
 Squint : 
 
 (Clinical Investigations on). By C. 
 Schweigger, M.D., Professor of Oph- 
 thalmology in the University of Berlin. 
 Edited by Gustavus Hartridge, 
 F.R.C.S. 8vo, 5s. 
 
 The Electro-Magnet, 
 
 And its Employment in Ophthalmic Sur- 
 gery. By Simeon Snell, Ophthalmic 
 Surgeon to the .Sheffield General In- 
 firmary, &c. Crown 8vo, 3s. 6d. 
 
 Practitioner's Handbook of 
 Diseases of the Ear and Naso- 
 pharynx. By H. Macnaughton 
 Jones, M.D., late Professor of the Queen s 
 University in Ireland, Surgeon to the Cork 
 Ophthalmic and Aural Hospital. Third 
 Edition of "Aural .Surgery." Roy. 8vo, 
 with 128 Engravings, 6s. 
 
 By the same Author. 
 
 Atlas of Diseases of the Mem- 
 hrana Tympani, In Coloured 
 Plates, containing 62 Figures, with Text. 
 Crown 4to, 21s. 
 
 Endemic Goitre or Thyreocele : 
 
 Its Etiology, Clinical Characters, Patho- 
 logy, Distribution, Relations to Cretinism, 
 Myxoedema, &c., and Treatment. By 
 William Robinson, M.D. 8vo, 5s. 
 
 Diseases and Injuries of the 
 Ear. By Sir William B. Dalby, Aural 
 Surgeon to St. George's Hospital. Third 
 Edition. Crown 8vo, with Engravings, 
 7s. 6d. 
 
 By the Same Author, 
 Short Contributions to Aural 
 Surgery, betw^een 1875 and 1886. 
 
 8vo, with Engravings, 3s. 6d. 
 
 Diseases of the Throat and 
 
 Nose : A Manual. By Sir MoRELL 
 Mackenzie, M.D., Senior Physician 
 to the Hospital for Diseases of the Throat. 
 Vol. II. Diseases of the Nose and Naso- 
 pharynx ; with a .Section on Diseases of 
 the CEsophagus. Post 8vo, with 93 En- 
 gravings, I2S. 6d. 
 
 By the same Author. 
 Diphtheria : 
 
 Its Nature and Treatment, Varieties, and 
 Local Expressions. 8vo, 5s. 
 
 Sore Throat : 
 
 Its Nature, Varieties, and Treatment. 
 By Prosser James, M.D., Physician to 
 the Hospital for Diseases of the Throat. 
 Fifth Edition. Post 8vo, with Coloured 
 Plates and Engravings, 6s. 6d. 
 
 A Treatise on Vocal Physio- 
 logy and Hygiene. By Gordon 
 Holmes, M.D., Physician to the Muni- 
 cipal Throat and Ear Infirmary. Second 
 Edition, with Engravings. Crown 8vo, 
 6s. 6d. 
 
 A System of Dental Surgery. 
 
 By Sir John Tomes, F.R.S., and C. S. 
 Tomes, M.A., F.R.S. Third Edition. 
 Crown 8vo, with 292 Engravings, 15s. 
 
 Dental Anatomy, Human and 
 
 Comparative : A Manual. By Charles 
 vS. Tomes, M.A., F.R.S. Second Edition. 
 Crown 8vo, with 191 Engravings, I2s. 6d. 
 
 The Student's Guide to Dental 
 
 Anatomy and Surgery. By Henry 
 Sewill, M.R.C.S., L.D.S. Second 
 Edition. Fcap. 8vo, with 78 Engravings, 
 5s. 6d. 
 
 Notes on Dental Practice. By 
 
 Henry C. Quinby, L.D.S.R. C.S.I. 
 8vo, with 87 Engravings, 9s. 
 
 Mechanical Dentistry in Gold 
 
 and Vulcanite. By F. H. Balk- 
 will, L.D.S. R.C.S. 8vo, with 2 Litho- 
 graphic Plates and 57 Engravings, ids. 
 
 A Practical Treatise on Mecha- 
 nical Dentistry. By Joseph Rich- 
 ardson, M.D., D.D.S., late Emeritus 
 Professor of Prosthetic Dentistry in the 
 Indiana Medical College. Fourth 
 Edition. Roy. Svo, with 458 Engravings, 
 
 2IS.
 
 J. ^- A. CHURCHILDS RECENT WORKS. 
 
 13 
 
 Principles and Practice of Den- 
 tistry : including Anatomy, Physiology, 
 Pathology, Therapeutics, Dental Surgery, 
 and Mechanism. By C. A.Harris, M.D., 
 D.D.S, Edited by F. J. S. Gorgas, 
 A.M., M.D., D.D.S., Professor in the 
 Dental Department of Maryland Univer- 
 sity. Eleventh Edition. 8vo, with 750 
 Illustrations, 31s. 6d. 
 
 A Manual of Dental Mechanics. 
 
 By Oakley Coles, L.D.S.R.C.S. 
 Second Edition. Crown 8vo, with 140 
 Engravings, 7s. 6d. 
 
 Elements of Dental Materia 
 Medica and Therapeutics, with 
 Pharmacopoeia. By James Stocken, 
 L.D.S.R.C.S., Pereira Prizeman for 
 Materia Medica, and Thomas Gaddes, 
 L.D.S. Eng. and Edin. Third Edition. 
 Fcap. 8vo, 7s. 6d. 
 
 Dental Medicine : 
 
 A Manual of Dental Materia Medica and 
 Therapeutics. By F. J. S. Gorgas, A.M., 
 M.D., D.D.S., Editor of "Harris's 
 Principles and Practice of Dentistry," 
 Professor in the Dental Department of 
 Maryland University. 8vo, 14s. 
 
 Atlas of Skin Diseases. 
 
 By Tilbury Fox, M.D., F.R.C.P. 
 With 72 Coloured Plates. Royal 4to, half 
 morocco, £6 6s. 
 
 Diseases of the Skin : 
 
 With an Analysis of 8,000 Consecutive 
 Cases and a Formulary. By L. D. BuLK- 
 LEY, M.D., Physician for Skin Diseases at 
 the New York Hospital. Crown 8vo, 6s. 6d. 
 
 By the same Author. 
 
 Acne : its Etiology, Pathology, 
 
 and Treatment : Based upon a Study 
 of 1,500 Cases. Svo, with Engravings, 
 
 lOS. 
 
 On Certain Rare Diseases of the 
 
 Skin. By Jonathan Hutchinson, 
 F.R.S., Senior Surgeon to the London 
 Hospital, and to the Hospital for Diseases 
 of the Skin. Svo, los. 6d. 
 
 Diseases of the Skin : 
 
 A Practical Treatise for the Use of 
 Students and Practitioners. By J. N. 
 Hyde, A.M., M.D., Professor of Skin and 
 Venereal Diseases, Rush Medical College, 
 Chicago. Svo, with 66 Engravings, 17s. 
 
 Parasites : 
 
 A Treatise on the Entozoa of Man and 
 Animals, including some Account of the 
 Ectozoa. ByT.SrENCERCoKitOLD,M.D., 
 F.R.S. Svo, with 85 Engravings, 15s. 
 
 Manual of Animal Vaccination, 
 
 preceded by Considerations on Vaccina- 
 tion in general. By E. Warlomont, 
 M.D., Founder of the State Vaccine 
 Institute of Belgium. Translated and 
 edited by Arthur J. Harries, M.D. 
 Crown Svo, 4s. 6d. 
 
 Leprosy in British Guiana. 
 
 ByJOHND.HiLLis,F.R.C.S.,M.R.I.A., 
 ISIedical Superintendent of the Leper 
 Asylum, British Guiana. Imp. Svo, with 
 22 Lithographic Coloured Plates and 
 Wood Engravings, £\ lis. 6d. 
 
 Cancer of the Breast. 
 
 By Thomas W. Nunn, F.R.C.S., Con- 
 sulting Surgeon to the Middlesex Hos- 
 pital. 4to, with 21 Coloured Plates, £2. 2s. 
 On Cancer : 
 
 Its Allies, and other Tumours; their Medi- 
 cal and Surgical Treatment. By F. A. 
 Purcell, M.D., M.C., Surgeon to the 
 Cancer Hospital, Brompton. Svo, with 
 21 Engravings, los. 6d. 
 
 Sarcoma and Carcinoma : 
 
 Their Pathology, Diagnosis, and Treat- 
 ment. By Henry T. Butlin, F.R.C.S., 
 Assistant Surgeon to St. Bartholomew's 
 Hospital. Svo, with 4 Plates, Ss. 
 
 By the same Author. 
 
 Malignant Disease of the La- 
 rynx (Sarcoma and Carcinoma). 
 
 Svo, with 5 Engravings, 5s. 
 
 Also. 
 
 Operative Surgery of Malignant 
 
 Disease. 8vo, 14s. 
 Cancerous Affections of the Skin. 
 
 (Epithelioma and Rodent Ulcer.) By 
 George Thin, M.D. Post Svo, with 
 8 Engravings, 5s. 
 
 By the same Author. 
 
 Pathology and Treatment of 
 
 Ringworm. Svo, with 21 Engravings, 
 5s- 
 Cancer of the Mouth, Tongue, 
 
 and Alimentary Tract : their 
 Pathology, Symj^toms, Diagnosis, and 
 Treatment. By Frederic B. Jessett, 
 P'.R.C.S., Surgeon to the Cancer Hospi- 
 tal, Brompton. Svo, los. 
 
 Clinical Notes on Cancer, 
 
 Its Etiology and Treatment ; with special 
 reference to the Heredity-Fallacy, and to 
 the Neurofic Origin of most Cases of 
 Alveolar Carcinoma. By Herbert L. 
 Snow, M.D. Lond., SurgeontotheCancer 
 Hospital, Brompton. Crown Svo, 3s. 6d. 
 
 Lectures on the Surgical Dis- 
 orders of the Urinary Organs. By 
 Reginald Harrison, F.R.C.S., Surgeon 
 to the Liverpool Royal Infirmary. Third 
 Edition, with 1 17 Engravings. Svo, 12s. 6d. 
 
 Hydrocele : 
 
 Its several Varieties and their Treatment. 
 By Samuel Osborn, late Surgical 
 Registrar to St. Thomas's Hospital. 
 Fcap. Svo, with Engravings, 3s. 
 
 By the same Author. 
 
 Diseases of the Testis. 
 
 Fcap. Svo, with Engravings, 3s. 6d.
 
 14 
 
 J. 8c A. CHURCHILL'S RECENT WORKS. 
 
 Diseases of the Urinary Organs. 
 
 Clinical Lectures. By Sir Henry 
 Thompson, F.R.C.S., Emeritus Pro- 
 fessor of Clinical Surgery in University 
 College. Seventh (Students') Edition. 
 8vo, with 84 Engravings, 2s. 6d. 
 
 By the same Author. 
 
 Diseases of the Prostate : 
 
 Their Pathology and Treatment. Sixth 
 Edition. 8vo, with 39 Engravings, 6s. 
 
 Also. 
 
 Surgery of the Urinary Organs. 
 
 Some Important Points connected there- 
 with. Lectures delivered in the R.C..S. 
 8vo, with 44 Engravings. Students' 
 Edition, 2s. 6d. 
 
 Also. 
 
 Practical Lithotomy and Litho- 
 
 trity; or, An Inquiryinto the BestModes 
 of Removing Stone from the Bladder. 
 Third Edition. 8vo, with 87 Engravings, 
 
 IDS. 
 
 Also. 
 
 The Preventive Treatment of 
 
 Calculous Disease, and the Use of 
 Solvent Remedies. Second Edition. 
 Fcap. 8vo, 2s. 6d. 
 
 Also. 
 
 Tumours of the Bladder: 
 
 Their Nature, Symptoms, and Surgical 
 Treatment. 8vo, with numerous Illustra- 
 tions, 5s. 
 
 Also. 
 
 Stricture of the Urethra, and Uri- 
 
 naryFistulee: their Pathology and Treat- 
 ment. Fourth Edition. With 74 Engrav- 
 ings. 8vo, 6s. 
 
 Also. 
 
 The Suprapubic Operation of 
 Opening the Bladder for the 
 Stone and for Tumours. 8vo, 
 with 14 Engravings, 3s. 6d. 
 
 The Surgery of the Rectum. 
 
 By Henry Smith, Professor of Surgery 
 in King's College, Surgeon to the Hos- 
 pital. Fifth Edition. 8vo, 6s. 
 
 Modern Treatment of Stone in 
 the Bladder by Litholopaxy. By 
 P. J. Freyer, M.A., M.U., M.Ch., 
 Bengal Medical Service. 8vo, with En- 
 gravings, 5s. 
 
 Diseases of the Testis, Sperm- 
 atic Cord, and Scrotum. By 
 Thomas B. Curling, F.R.S., Consult- 
 ing Surgeon to the London Hospital. 
 Fourth Edition. 8vo, with Engravings, i6s. 
 
 Diseases of the Rectum and 
 
 Anus. By W. Harrison Critps, 
 F. R.C.S., Assistant Surgeon to St. Bar- 
 tholomew's Hospital, &c. 8vo, with 13 
 Lithographic Plates and numerous Wood 
 Engravings, 12s. 6d. 
 
 Urinary and Renal Derange- 
 ments and Calculous Disorders. 
 By Lionel S. Beale, F.R.C.P., 
 F.R.S., Physician to King's College 
 Plospital. 8vo, 5s. 
 
 Fistula, Haemorrhoids, Painful 
 Ulcer, Stricture, Prolapsus, and 
 other Diseases of the Rectum : 
 
 Their Diagnosis and Treatment. By 
 William. Allingham, Surgeon to St. 
 Mark's Hospital for Fistula. Fourth 
 Edition. 8vo, with Engravings, los. 6d. 
 
 Pathology of the Urine. 
 
 Including a Complete Guide to its Analy- 
 sis. By J. L. W. Thudichum, M.D., 
 F.R.C.P. Second Edition, rewritten and 
 enlarged. 8vo, with Engravings, 15s. 
 
 Student's Primer on the Urine. 
 
 By J. Travis Whittaker, M.D., CHni- 
 cal Demonstrator at the Royal Infirmary, 
 Glasgow. With 16 Plates etched on 
 Copper. Post 8vo, 4s. 6d. 
 
 Syphilis and Pseudo-Syphilis. 
 
 By Alfred Cooper, F.R.C.S., Surgeon 
 to the Lock Hospital, to St. Mark's and 
 the West London Hospitals. 8vo, los. 6d. 
 
 Diagnosis and Treatment of 
 
 Syphilis. By Tom Robinson, M.D., 
 Physician to St. John's Hospital for Dis- 
 eases of the Skin. Crown Svo, 3s. 6d. 
 
 By the same Author. 
 
 Eczema : its Etiology, Patho- 
 logy, and Treatnnent. Crown Svo, 
 3s. 6d. 
 
 Coulson on Diseases of the 
 Bladder and Prostate Gland. 
 
 Sixth Edition. By Walter J. Cotjlson, 
 Surgeon to the Lock Hospital and to St. 
 Peter's Hospital for Stone. 8vo, i6s. 
 
 The Medical Adviser in Life As- 
 surance. BySirE.H.SiEVEKiNG, M.D., 
 F.R.C.P. Second Edition. Crown Svo, 6s. 
 
 A Medical Vocabulary : 
 
 An Explanation of all Terms and Phrases 
 used in the various Departments of Medical 
 Science and Practice, their Derivation, 
 Meaning, Application, and Pronunciation. 
 By R. G. Mayne, M.D., LL.D. Fifth 
 Edition. Fcap. Svo, los. 6tl. 
 
 A Dictionary of Medical Science: 
 
 Containing a concise Exjjlanation of the 
 various Subjects and Terms of Medicine, 
 &C. By ROBLEY DUNGLISO.N, M.D., 
 LL.D. Royal Svo, 28s. 
 
 Medical Education 
 
 And Practice in all parts of the World. 
 By H. J. Hardwicke, M.D., M.R.C.P. 
 Svo, los.
 
 INDEX. 
 
 Abercrombie's Medical Jurisprudence, 4 
 Adams (W.) on Clubfoot, 11 
 
 on Contraction of the Fingers, 11 
 
 on Curvature of the Spine, 11 
 
 Alexander's Displacements of the Uterus, 6 
 Allan on Fever Nursing, 7 
 
 Outlines of Infectious Diseases, 7 
 
 Allingham on Diseases of the Rectum, 14 
 Anatomical Remembrancer, 3 
 
 Balfour's Diseases of the Heart and Aorta, 9 
 Balkwill's Mechanical Dentistry, 12 
 Barnes (R.) on Obstetric Operations, 5 
 
 on Diseases of Women, 5 
 
 Basil's Commoner Diseases and Accidents, 10 
 Beale's Microscope in Medicine, 8 
 
 Slight Ailments, 8 
 
 Urinary and Renal Derangements, 14 
 
 Bellamy's Surgical Anatomy, 3 
 
 Bennet (J. H.) on the Mediterranean, 10 
 
 on Pulmonary Consumption, 10 
 
 Bentley and Trimen's Medicinal Plants, 7 
 Bentley's Manual of Botany, 7 
 
 Structural Botany, 7 
 
 Systematic Botany, 7 
 
 Bowlby's Surgical Pathology and Morbid Anatomy, 10 
 
 Braune's Topographical Anatomy, 3 
 
 Brodhurst's Anchylosis, 11 
 
 ■ — — Curvatures, &c., of the Spine, 11 
 
 Orthopeedic Surgery, ii 
 
 Bryant's Acute Intestinal Strangulation, 9 
 
 Practice of Surgery, 11 
 
 Bucknill and Tuke's Psychological Medicine, 3 
 Buist's Vaccinia and Variola, 8 
 Bulkley's Acne, 13 
 
 Diseases of the Skin, 13 
 
 Burdett's Cottage Hospitals, 4 
 
 Pay Hospitals, 4 
 
 Burton's Midwifery for Midwives, 6 
 Butlin's Malignant Disease of the Larynx, 13 
 
 Operative Surgery of Malignant Disease, 13 
 
 Sarcoma and Carcinoma, 13 
 
 Buzzard's Diseases of the Nervous System 9 
 
 Peripheral Neuritis, 9 
 
 Carpenter's Human Physiology, 4 
 Cayley's Typhoid Fever, 8 
 
 Charteris on Health Resorts, 10 
 
 Practice of Medicine, 8 
 
 Chavers' Diseases of India, 8 
 Churchill's Face and Foot Deformities, 11 
 Clouston's Lectures on Mental Diseases, 5 
 Cobbold on Parasites, 13 
 
 Coles' Dental Mechanics, i^ 
 Cooper's Syphilis and Pseudo-Syphilis, 14 
 Coulson on Diseases of the Bladder, 14 
 Courty's Diseases of the Uterus, Ovaries, &c., 6 
 Cripps' Diseases of the Rectum and Anus, 14 
 CuUingworth's Manual of Nursing, 6 
 
 Short Manual for Monthly Nurses, 6 
 
 Curling's Diseases of the Testis, 14 
 Dalby's Diseases and Injuries of the Ear, 12 
 Day on Diseases of Children, 6 
 
 on Headaches, 10 
 
 Dobell's Lectures on Winter Cough, 8 
 
 Loss of Weight, &c., 8 
 
 Mont Dor^ Cure, 8 
 
 Domville's Manual for Nurses, 6 
 Doran's Gynaecological Operations, 6 
 Down's Mental Affections of Childhood, 5 
 Draper's Text Book of Medical Physics, 4 
 Druitt's Surgeon's Vade-Mecum, 11 
 Duncan on Diseases of Women, 5 
 
 on Sterility in Woman, 5 
 
 Dunglison's Medical Dictionary, 14 
 East's Private Treatment of the Insane, 5 
 Ebstein on Regimen in Gout, 9 
 
 Ellis's Diseases of Children, 6 
 Fagge's Principles and Practice of Medicine, 
 Fayrer's Climate and P'evers of India, 7 
 Fenwick's Chronic Atrophy of the Stomach, 8 
 
 Medical Diagnosis, 8 
 
 Outlines of Medical Treatment, 8 
 
 Flint's Principles and Practice of Medicine, 7 
 
 Flower's Diagrams of the Nerves, 3 
 
 Fox's (C. B.) Examinations of Water, Air, and Food, 5 
 
 Fox's (T.) Atlas of Skin Diseases, 13 
 
 Freyer's Litholopaxy, 14 
 
 Frey's Histology and Histo-Chemistry, 4 
 
 Galabin's Diseases of Women, 6 
 
 Manual of Midwifery, 5 
 
 Gamgee's Treatment of Wounds and Fractures, 11 
 
 Godlee's Atlas of Human Anatomy, 3 
 Goodhart's Diseases of Children, 6 
 Gorgas' Dental Medicine, 13 
 Gowers' -Diseases of the Brain, g 
 
 Diseases of the Spinal Cord, 9 
 
 Manual of Diseases of Nervous System, 9 
 
 Medical Ophthalmoscopy, 9 
 
 Pseudo-Hypertrophic Muscular Paralysis, 9 
 
 Granville on Gout, 9 
 
 on Nerve Vibration and Excitation, 9 
 
 Guy s Hospital Formulae, 2 
 
 Reports, 2 
 
 Habershon's Diseases of the Abdomen, 9 
 
 Liver, 9 
 
 , Stomach, 9 
 
 Pneumogastric Nerve, 9 
 
 Hambleton's What is Consumotion? 8 
 Hardwicke's Medical Education, 14 
 Harley on Diseases of the Liver, 9 
 
 Inflammations of the Liver, 9 
 
 Harris's Dentistry, 13 
 
 Harrison's Surgical Disorders of the Urinary Organs, 13 
 
 Hartridge's Refraction of the Eye, 12 
 
 Harvey's Manuscript Lectures, 3 
 
 Heath's Injuries and Diseases of the Jaws, 10 
 
 Minor Surgery and Bandaging, 10 
 
 Operative Surgery, 10 
 
 Practical Anatomy, 3 
 
 Surgical Diagnosis, 10 
 
 Helm on Short and Long Sight, &c., 11 
 Higgens' Ophthalmic Out-patient Practice, 11 
 Hillis' Leprosy in British Guiana, 13 
 Holden's Dissections, 3 
 Human Osteology, 3 
 
 Landmarks, 3 
 
 Holmes' (G.) Vocal Physiology and Hygiene, 12 
 Hood's (D. C. ) Diseases and their Commencement, 6 
 Hood (P.) on Gout, Rheumatism, &c., 9 
 Hooper's Physician's Vade-l\Iecum, 8 
 Hutchinson's Clinical Surgery, n 
 
 Pedigree of Disease, 11 
 
 '■— Rare Diseases of the Skin, 13 
 
 Hyde's Diseases of the Skin, 13 
 
 lames (P.) on Sore Throat, 12 
 
 Jessett's Cancer of the Mouth, &c., 13 
 
 Johnson's Medical Lectures and Essays, 8 
 
 Jones (C. H.) and Sieveking's Pathological Anatomy, 4 
 
 Jones' (H. McN.) Diseases of the Ear and Pharynx, 12 
 
 — — Atlas of Diseases of Membrana Tympani, 12 
 
 Spinal Curvatures. 11 
 
 Journal of British Dental Association, 2 
 
 ■ ■ Mental Science, 2 
 
 King's Manual of Obstetrics, 5 
 
 Lancereaux's Atlas of Pathological Anatomy, 4 
 
 Lewis (Bevan) on the Human Brain, 4 
 
 Liebreich's Atlas of Ophthalmoscopy, 12 
 
 Liveing's Megrim, Sick Headache, &c., 9 
 
 London Hospital Reports, 2 
 
 Lfickes' Hospital Sisters and their Duties, 7 
 
 Macdonald's (J. D.) Examination of Water and Air, 4 
 
 Mackenzie on Diphtheria, 12 
 
 on Diseases of the Throat and Nose, 12 
 
 McLeod's Operative Surgery, 10 
 MacMunn's Spectroscope in Medicine, 8 
 IMacnamara's Diseases of the Eye, 11 
 
 Bones and Joints, 11 
 
 Marcet's Southern and Swiss Health-Resorts, 10 
 
 Martin's Ambulance Lectures, 10 
 
 Mayne's Medical Vocabulary, 14 
 
 Middlesex Hospital Reports, 2 
 
 Mitchell's Diseases of the Nervous System, 9 
 
 Moore's Family Medicine for India, 7 
 
 Health-Resorts for Tropical Invalids, 7 
 
 — ^ Manual of the Diseases of India, 7 
 
 Morris' (H.) Anatomy of the Joints, 3 
 
 Morton's Spina Bifida, 10 
 
 Mouat and Snell on Hospitals, 4 
 
 Nettleship's Diseases of the Eye, 12 
 
 Nunn's Cancer of the Breast, 13 
 
 Ogston's Medical Jurisprudence, 4 
 
 Ophthalmic (Royal London) Hospital Reports, 2 
 
 Ophthalmological Society's Transactions, 2 
 
 Oppert's Hospitals, Infirmaries, Dispensaries, &c. , 4 
 
 Osborn on Diseases of the Testis, 13 
 
 on Hydrocele, 13 
 
 Owen's Materia Medica, 7 
 Page's Injuries of the Spine, 11 
 Parkes' Practical Hygiene, 5 
 Pavy on Diabetes, 10 
 
 Pavy on Food and Dietetics, 10 
 
 [Continued on the next pagt.
 
 Index — contimied. 
 
 Pharmaceutical Journal, 2 
 Pharmacopoeia of the London Hospital, 7 
 PhiUips' Materia Medica and Therapeutics, 7 
 Pollock's Histology of the Eye and Eyelids, 12 
 Porritt's Intra-Thoracic Effusion, 8 
 Purcell on Cancer, 13 
 Quinby's Notes on Dental Practice, 12 
 Raye's Ambulance Handbook, 10 
 Reynolds' (J. J.) Diseases of Women, 5 
 
 Notes on Midwifery, 5 
 
 Richardson's Mechanical Dentistry, 12 
 Roberts' (C.) Manual of Anthropometry, 5 
 
 Detection of Colour-BIindness, 5 
 
 Roberts' (D. Lloyd) Practice of Midwifery, 5 
 Robinson (Tom) on Eczema, 14 
 
 — — on Syphilis, 14 
 
 Robinson (W.l on Endemic Goitre or Thyreocele, 12 
 Ross's Aphasia, 9 
 
 Diseases of the Nervous System, 9 
 
 Handbook of ditto, 9 
 
 Routh's Infant Feeding, 7 
 
 Royal College of Surgeons Museum Catalogues, 2 
 
 Royle and Harley's Materia IMedica, 7 
 
 St. Bartholomew's Hospital Catalogue, 2 
 
 St. George's Hospital Reports, 2 
 
 St. Thomas's Hospital Reports, 2 
 
 Sansom's Valvular Disease of the Heart, 8 
 
 Savage on the Female Pelvic Organs, 5 
 
 .Schweigger on Squint, 12 
 
 Sewill's Dental Anatomy, 12 
 
 Sharkey's Spasm in Chronic Nerve Disease, 9 
 
 Shore's Elementary Practical Biologj', 4 
 
 Sieveking's Life Assurance, 14 
 
 Simon's Public Health Reports, 4 
 
 Smith's (E.) Clinical Studies, 6 
 
 ■ Diseases in Children, 6 
 
 Wasting Diseases of Infants and Children, 6 
 
 Smith's (J. Greig) Abdominal Surgery, 6 
 
 Smith's (Henry) Surgery of the Rectum, 14 
 
 Smith's (Heywood) Dysmenorrhoea, 5 
 
 Smith (Priestley) on Glaucoma, 12 
 
 Snell's Electro-Magnet in Ophthalmic Surgery, 12 
 
 Snow's Clinical Notes on Cancer, 13 
 
 Southam's Regional Surgery, 11 
 
 Squire's Companion to the Pharmacopoeia, 7 
 
 Pharmacopceias of London Hospitals, 7 
 
 Steavenson's Electricity. 11 
 
 Stills and Maisch's National Dispensatory, 7 
 
 Stocken's Dental Materia Medica and Therapeutics, 13 
 
 Sutton's General Pathology, 4 
 
 Swain's Surgical Emergencies, 10 
 
 Swayne's Obstetric Aphorisms, 6 
 
 Taylor's Medical Jurisprudence, 4 
 
 Taylor's Poisons in relation to Medical Jurisprudence, 4 
 
 Teale's Dangers to Health, 5 
 
 Thin's Cancerous Affections of the Skin, 13 
 
 — Pathology and Treatment of Ringworm, 
 
 Thomas's Diseases of Women, 6 
 Thompson's (Sir H.) Calculous Disease, 14 
 
 Diseases of the Prostate, 14 
 
 — Diseases of theUrinarj' Organs, 14 
 
 • Lithotomy and Lithotrity, 14 
 
 Stricture of the Urethra, 14 
 
 Suprapubic Operation, 14 
 
 Surgery of the Urinary Organs, 14 
 
 Tumours of the Bladder, 14 
 
 Thorowgood on Asthma, 8 
 
 on Materia Medica and Therapeutics, 7 
 
 Thudichum's Pathology of the Urine, 14 
 Tibbits' Medical and Surgical Electricity,- 10 
 
 Map of Motor Points, 10 
 
 How to use a Galvanic Battery, 10 
 
 Electrical and Anatomical Demonstrations, 10 
 
 Tilt's Change of Life, b 
 
 Uterine Therapeutics, 6 
 
 Tirard's Prescriber's Pharmacopoeia, 7 
 Tomes' (C. S.) Dental Anatomy, 12 
 Tomes' (J. and C. S.) Dental Surgery, 12 
 Tuke's Influence of the Mind upon the Body, 5 
 
 Sleep-Walking and Hypnotism, 5 
 
 Vintras on the Mineral Waters, &c., of France, 10 
 Virchow's Post-mortem Examinations, 4 
 Walsham's Surgery : its Theory and Practice, 11 
 Waring's Indian Bazaar Medicines, 7 
 
 Practical Therapeutics, 7 
 
 Warlomont's Animal Vaccination, 13 
 Warner's Guide to Medical Case-Taking, 8 
 Waters' (A. T. H.) Diseases of the Chest, 8 
 Weaver's Pulmonary Consumption, 8 
 Wells' (Spencer) Abdominal Tumours, 5 
 
 Ovarian and Uterine Tumours, 5 
 
 West and Duncan's Diseases of Women, 5 
 West's (S.) How to Examine the Chest, 8 
 Whittaker's Primer on the Urine, 14 
 Wilks' Diseases of the Nervous System, 8 
 Williams' (Roger) Influence ot Sex, 4 
 Wilson's (.Sir E.) Anatomists' Vade-!Mecum, 3 
 Wilson's (G.) Handbook of Hygiene, 5 
 
 Healthy Life and Dwellings, 5 
 
 Wilson's (W. S.) Ocean as a Health-Resort, 10 
 Wolfe's Diseases and Injuries of the Eye, 11 
 Year Book of Pharmacy, 2 
 Yeo's (G. F.) Manual of Physiology, 4 
 Yeo's (J. B.) Contagiousness of Pulmonary Consump.^ 
 tlon, 8 
 
 The following CATALOGUES issued by J. & A. Churchill will be forwarded 
 
 post free on application : — 
 
 A. J. l\'- a. ChiirchilPs General List of about 650 works on A7iatomy^ 
 Physiology^ Hygie7te, I\Jidzuifery^ Materia Medica, Medicine, Surgery, Chemistry, 
 Botany, Hfc, i^^-c, with a complete Index to their Subjects, for easy reference. 
 N.B.— jy^V List iiicludes B, C, & D. 
 
 B. Selection from J. Sf A. ChurchilPs General List, comprising all recent 
 Works published by them on the Art and Science of Medicine. 
 
 C. J. 8f A. ChurchilPs Catalogue of Text Boohs specially arranged for Students. 
 
 D. A selected and descriptive List of J. S,' A. ChurchilPs Works art 
 Chemistry, Materia Medica, Pharmacy, Botany, Photography, Zoology, f he- 
 Microscope, and other branches of Science. 
 
 E. The Half-yearly List of New Works and New Editions published by 
 J. 8f A. Churchill during the previous six months, together tvith particulars of 
 the Periodicals issued from their House. 
 
 [Sent in January and July of each year to every Medical Practitioner in the United 
 Kingdom whose name and address can be ascertained. A large number are 
 also sent to the United States of America, Continental Europe, India, and the- 
 Colonies.] 
 
 America. — J. ^ A. CluivcJiUl being in constant coninninication %vith 
 various publishing- Jwnses in Boston, Nezu York, and Philadelphia, are 
 able, notzvithstanding the absence of international copyright, to conduct 
 negotiations favo7ii'able to English A tithors. 
 
 LONDON: 11, NEW BURLINGTON STREET. 
 
 Pardon <t ."ians, Printers,} 
 
 [IFine Office Court, Fleet Street, E.C.
 
 University of California 
 
 SOUTHERN REGIONAL LIBRARY FACILITY 
 
 305 De Neve Drive - Parking Lot 17 • Box 951388 
 
 LOS ANGELES, CALIFORNIA 90095-1388 
 
 Return this material to the library from which it was borrowed.